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Latest & greatest articles for anesthesia
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Clinical anesthesia is used to induce a temporary medical state of controlled unconsciousness, inducing a loss of sensation or awareness. There are three main types of anesthesia:
Local and Regional
Anesthesia is primarily used during surgical procedures to block pain. While unconscious, blood flow and heart rate is monitored.
Research and development in the use of anesthesia has helped anesthesiologists in the progression of patient safety before and after surgery and medical procedures. The developments and research of anesthesia through the years has massively influences medicine and surgery today.
Case studies and clinical trials help aid researchers in the development of aftercare during postoperative recovery. Research is a vital part in the field of anesthesia, it allows anesthesiologists to improve the delivery of patient safety while unconscious.
Learn more on the emerging technology in anesthesia and the advancements in anesthesia practise by searching Trip.
Kicking on while it’s still kicking off - getting surgery and anaesthesia restarted after COVID-19 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/anae.15128 This article is protected by copyright. All rights reserved Editorial Kicking on while it’s still (...) kicking off – getting surgery and anaesthesia restarted after COVID-19 T.M. Cook 1 and W. Harrop-Griffiths 2 1 Consultant, Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, and Honorary Professor of Anaesthesia, University of Bristol, Bristol. 2 Professor, Imperial College, London and Consultant, Department of Anaesthesia, Imperial College Healthcare NHS Trust, London Corresponding author: T Cook Email for correspondence: timcook007
/standards- and-guidelines/continuum-of-depth-of-sedation-definition-of-general-anesthesia-and- levels-of-sedationanalgesia. Published 2019. Accessed April 10 2020. 2. Patel S, Vargo JJ, Khandwala F, et al. Deep Sedation Occurs Frequently During Elective Endoscopy with Meperidine and Midazolam. American Journal of Gastroenterology. 2005;100(12):2689-2695. 3. Forster A, Gardaz JP, Suter PM, Gemperle M. Respiratory depression by midazolam and diazepam. Anesthesiology. 1980;53(6):494-497. 4. Koniaris LG (...) and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology. 2018;128(3):437-479. 7. Early DS, Lightdale JR, Vargo JJ, 2nd, et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2018;87(2):327-337. 8. Qadeer MA, Lopez AR, Dumot JA, Vargo JJ. Hypoxemia during moderate sedation for gastrointestinal endoscopy: causes and associations. Digestion. 2011;84(1
A, Mouton R, et al. Stress, burnout, depression and work satisfaction among UK anaesthetic trainees: a qualitative analysis of in-depth participant interviews in the Satisfaction and Wellbeing in Anaesthetic Training study. Anaesthesia 2019; 74: 1240–51. 2. Looseley A, Wainwright E, Cook TM, et al. Stress, burnout, depression and work satisfaction among UK anaesthetic trainees; a quantitative analysis of the Satisfaction and Wellbeing in Anaesthetic Training study. Anaesthesia; 74: 1231–9. 3. McClelland (...) L, Holland J, Lomas J-P , Redfern N, Plunkett E. A national survey of the effects of fatigue on trainees in anaesthesia in the UK. Anaesthesia 2017; 72: 1069–77. 4. McClelland L, Plunkett E, McCrossan R, et al. A national survey of out-of-hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland. Anaesthesia 2019; 74: 1509–23. 5. Denisco RA, Drummond JN, Gravenstein JS. The effect of fatigue on the performance of a simulated anaesthetic
Advice for pregnant members of the anaesthesia and intensive care workforce during the COVID-19 pandemic 1 Occupational health advice for employers and pregnant women during the COVID-19 pandemic Version 3: Published Tuesday 21 April 2020 COVID-19 virus infection and pregnancy2 Updates Please note that version 1 of this occupational health guidance was published as a chapter in the RCOG’s general Coronavirus (COVID-19) Infection in Pregnancy guidance. The occupational health guidance will now
Share Permalink Copy Page navigation Randomized Controlled Trial Anesth Analg Actions . 2020 Mar;130(3):787-795. doi: 10.1213/ANE.0000000000004600. Ultrasound-Assisted Versus Landmark-Guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy: A Randomized Controlled Trial , , , , , , Affiliations Expand Affiliation 1 From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. PMID (...) : 31880632 DOI: Item in Clipboard Randomized Controlled Trial Ultrasound-Assisted Versus Landmark-Guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy: A Randomized Controlled Trial Sun-Kyung Park et al. Anesth Analg . 2020 Mar . Show details Anesth Analg Actions . 2020 Mar;130(3):787-795. doi: 10.1213/ANE.0000000000004600. Authors , , , , , , Affiliation 1 From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College
and anesthetic agent but utilizes CO2 absorbent and generates heat and humidity. THE EXPERIENCE TO DATE IS CLEAR THAT WHEN AN ANESTHESIA MACHINE IS USED AS AN ICU VENTILATOR, LOW FRESH GAS FLOW LEADS TO EXCESSIVE HUMIDITY IN THE CIRCUIT, CLOGGING OF FILTERS, AND THE NEED TO CHANGE CO2 ABSORBENT FREQUENTLY. a. Initially, set fresh gas flow to equal minute ventilation - about 6-8 Liters per minute in adult patients b. Monitor the circuit for excess humidity and increase fresh gas flow if humidity is a problem (...) with an oxygen driven bellows, an intermittent low oxygen pressure alarm occuring on inspiration indicates inadequate oxygen supply pressure. This can occur when there is high demand on the central oxygen pipeline system during times of high use by multiple ventilators and flowmeters in the same area. 14. PROVIDING POTENT ANESTHETIC AGENTS (UPDATED APRIL 2, 2020) Anesthesia machines have the capability of providing inhaled anesthetics for sedation during long-term care. While this might be an attractive
Effect of bilateral scalp nerve blocks on postoperative pain and discharge times in patients undergoing supratentorial craniotomy and general anesthesia: a randomized-controlled trial Post-craniotomy pain is a common clinical issue and its optimal management remains incompletely studied. Utilization of a regional scalp block has the potential advantage of reducing perioperative pain and opioid consumption, thereby facilitating optimal postoperative neurologic assessment. The purpose (...) of this study was to assess the efficacy of regional scalp block on post-craniotomy pain and opioid consumption.We performed a prospective randomized-controlled trial in adults scheduled to undergo elective supratentorial craniotomy under general anesthesia to assess the efficacy of postoperative bilateral scalp block with 0.5% bupivacaine with 1:200,000 epinephrine compared with placebo on postoperative pain and opioid consumption. The primary outcome was the visual analogue scale (VAS) for pain at 24 hr
Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90 (...) of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis.Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI
Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol.Forty
Anesthetic Management Using Multiple Closed-loop Systems and Delayed Neurocognitive Recovery: A Randomized Controlled Trial Cognitive changes after anesthesia and surgery represent a significant public health concern. We tested the hypothesis that, in patients 60 yr or older scheduled for noncardiac surgery, automated management of anesthetic depth, cardiac blood flow, and protective lung ventilation using three independent controllers would outperform manual control of these variables (...) . Additionally, as a result of the improved management, patients in the automated group would experience less postoperative neurocognitive impairment compared to patients having standard, manually adjusted anesthesia.In this single-center, patient-and-evaluator-blinded, two-arm, parallel, randomized controlled, superiority study, 90 patients having noncardiac surgery under general anesthesia were randomly assigned to one of two groups. In the control group, anesthesia management was performed manually while
Dexmedetomidine for Improved Quality of Emergence From General Anesthesia: A Dose-Finding Study Dexmedetomidine provides smooth and hemodynamically stable emergence at the expense of hypotension, delayed recovery, and sedation. We investigated the optimal dose of dexmedetomidine for prevention of cough, agitation, hypertension, tachycardia, and shivering, with minimal side effects.In this prospective, randomized, double-blind trial, 216 adult patients were randomly assigned to dexmedetomidine 1 (...) treatment groups versus group C.D 1 at the end of surgery provides the best quality of emergence from general anesthesia including the control of cough, agitation, hypertension, tachycardia, and shivering. D 0.5 also controls emergence phenomena but is less effective in controlling cough. The 3 doses do not delay extubation. However, they cause dose-dependent hypotension.
in its use and are competent to do so. A self-in?ating bag should be immediately available in any location where anaesthesia is given. A two-bag test should be performed after the breathing system, vaporisers and ventilator have been individually checked. A record should be kept with the anaesthetic machine that these checks have been carried out. The ‘?rst user’ check, after servicing, is especially important and should be recorded. Recommendations 1. The checklist is intended to be used (...) settings where the checklist and guidance may be used are: • Military/defence/disaster relief anaesthesia • Anaesthesia in low and middle-income countries • In the future it is hoped the equipment can be used in the NHS or other modern anaesthetic settings to enable training to take place prior to anaesthesia secondment* *departments of anaesthesia wishing to approve the use of draw-over apparatus on NHS patients should give careful consideration to the governance issues related to their use in place
# * retain supplies of these drugs for use in critical care at times of increased demand during the COVID-19 crisis (each drug marked only once). # drugs which may be subject to demand pressure (each drug marked only once). Practice points ? Low flow anaesthesia will minimise medical gas use where it can be used safely. ? The use of processed EEG monitors supports efficient use of both intravenous and inhalational anaesthetic drugs. We are producing further more detailed guidance for specific drugs (...) Covid-19: Guidance on potential changes to anaesthetic drug usage and administration during pandemic emergency pressures 1 2 April, 2020 ------------------------------------------------------------------------------------------------------------------------------- Guidance on potential changes to anaesthetic drug usage and administration during pandemic emergency pressures The COVID-19 pandemic has affected services in many ways. The increased number of patients needing critical care
Anaesthetic guidance relating to Tier 3 Alert of supplies of Atracurium, Cisatracurium and Rocuronium Anaesthetic guidance relating to Tier 3 Alert of supplies of Atracurium, Cisatracurium & Rocuronium — ICM Anaesthesia COVID-19 Open Menu Close Menu (SDA) was published on 16 April regarding the use of atracurium, cisatracurium and rocuronium. This advises that once supplies of atracurium and cisatracurium are exhausted locally over the coming days, Trusts will need to switch to the alternative (...) (NMBAs), and to identify alternative practice where possible. The alert also has implications for anaesthetic practice, as rocuronium is a first line drug for paralysis in rapid sequence induction, which is the preferred technique for general anaesthesia in patients with known and suspected COVID-19 and is used frequently in patients at low risk of COVID-19 who have not been tested. Actions Use regional or neuraxial techniques wherever practicable. Consider using suxamethonium for neuromuscular
COVID-19 potential anaesthetic drug list Various drugs commonly used in anaesthesia and critical care are under supply pressure due to the increased demand driven by the COVID-19 pandemic. The Association of Anaesthetists and the Royal College of Anaesthetists have produced guidance which summarises potential miti-gations to be used in the management of such demand. This resource aims to provide a brief overview of drugs that you may not use in your regular practice. Further advice on drug (...) short-ages can be found here. COVID-19 POTENTIAL ANAESTHETIC DRUG LIST THIOPENTAL THIOPENTAL ETOMIDATE ETOMIDATE ISOFLURANE ISOFLURANE HYPERBARIC 2% PRILOCAINE HYPERBARIC 2% PRILOCAINE • Dose: 3-5mg/kg adult • Vasodilatation and hypotension • !!! Distal limb ischaemia with intra- arterial injection !!! • Poorly obtunds laryngeal reflexes • Contraindicated in porphyria • Dose: 0.2-0.3mg/kg • Relative cardiovascular stability • Suppresses adrenocortical function • Involuntary movements • Pain
and other work involving anaesthetic and critical care doctors. 4. Work collegiately with surgical and medical colleagues. Ensure as much interventional work as possible is undertaken as day case. 5. Collaborative working to maintain safety and efficiency: Anaesthesia and critical care must work together to support best care for the critically ill. This includes facilitating safe efficient intubation, transfers, support with procedures (eg line insertion) and providing additional critical care services (...) /anaesthesia into critical care roles. Assurance: • Create local systems (eg rotas and registers) to ensure all staff have completed relevant training. Resources: • Check Intensive Care Society and joint anaesthesia/ICM coronavirus website. In order of priority, time should be made to ensure staff can complete and are able to maintain competence in the following areas: Priority 1: Personal and patient safety for all staff members • Anaesthetists; doctors/HCP with airway skills; anaesthetic nurses