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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.
potential causative agents and maintain anaesthesia. • Important culprits: antibiotics, neuromuscular blocking agents, patent blue. • Consider chlorhexidine as cause (impregnated catheters, lubricants, cleansing agents). • Consider i.v. colloids as a possible cause. • Change to inhalational anaesthetic agent (if not already). ? Give 100% oxygen and ensure adequate ventilation: • Maintain the airway and, if necessary, secure it with tracheal tube. ? Elevate patient’s legs if there is hypotension (...) by the clinician in the light of the clinical data presented and the diagnostic and treatment options 3-11 High central neuraxial block v.1 • Can occur with deliberate or accidental injection of local anaesthetic drugs into the subarachnoid space. • Symptoms are – in sequence – hypotension and bradycardia – difficulty breathing – paralysis of the arms – impaired consciousness – apnoea and unconsciousness. • Progression through this sequence can be slow or fast. Box A: INDUCING ANAESTHESIA • Consider reduced
Regional or General Anesthesia in the Surgical Treatment of Distal Radial Fractures: A Randomized Clinical Trial Most patients undergoing surgery for the treatment of a distal radial fracture are treated in a day-surgery setting and are given either general anesthesia (GA) or regional anesthesia (RA). The main purpose of this study was to investigate the impact of the anesthesia method on patients' postoperative opioid consumption during the first 3 days following surgery.This was a single (...) , maximum pain, postoperative nausea and vomiting, perioperative time consumption (surgical, preoperative, and postoperative anesthesia care time), functional outcomes, and Patient-Rated Wrist Evaluation (PRWE) and EuroQol-5 Dimensions-3 Levels (EQ-5D-3L) scores up to 6 months.The total median OEC during the first 3 postoperative days was 85 mg (range, 0 to 218 mg) in the GA group and 60 mg (range, 3 to 150 mg) in the RA group (p = 0.1). The groups differed significantly in OEC and VAS for pain scores
Effect of Intravenous Dexamethasone on the Regression of Isobaric Bupivacaine Spinal Anesthesia: A Randomized Controlled Trial The effect of intravenous dexamethasone on the regression of sensory and motor block after isobaric bupivacaine spinal anesthesia is unknown. We conducted a prospective, double-blind, randomized controlled trial on 60 patients who received intravenously either placebo (group P) or 8-mg dexamethasone (group D) during the intrathecal injection of 12-mg isobaric (...) bupivacaine 0.5%. Primary outcome was the time from bupivacaine injection to regression of 2 dermatomes in relation to the highest dermatome blocked by the spinal local anesthetic. Time to 2-dermatome regression was 85 minutes (74-96 minutes) in group P versus 87 minutes (76-98 minutes) in group D (P = .79).
Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy Purpose: Combined regional and general anesthesia are often used for the management of breast cancer surgery. Thoracic spinal block, thoracic epidural block, thoracic paravertebral block, and multiple intercostal nerve blocks are the regional anesthesia techniques which have been used in breast surgery, but some anesthesiologists are not comfortable because (...) of the complication and side effects. In 2012, Blanco et al introduced pectoralis nerve (Pecs) II block or modified Pecs block as a novel approach to breast surgery. This study aims to determine the effectiveness of combined ultrasound-guided Pecs II block and general anesthesia for reducing intra- and postoperative pain from modified radical mastectomy. Patients and methods: Fifty patients undergoing modified radical mastectomy with general anesthesia were divided into two groups randomly (n=25), to either Pecs
Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia Ambulatory arthroscopic anterior cruciate ligament reconstruction is associated with moderate pain, even when nonopioid oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are used. Regional analgesia can supplement nonopioid oral analgesics and reduce postoperative opioid requirements, but the choice (...) , clinicians might use adductor canal block or femoral nerve block (weak recommendation, weak level of evidence). These recommendations have been endorsed by the Society of Ambulatory Anesthesia and approved by its board of directors.
andtheCounciloftheNeuroAnaesthesiaandCriticalCareSocietyofGreatBritainandIreland(NACCSGBI).Ithasbeen endorsed by the Safe Anaesthesia Liaison Group, the Royal College of Anaesthetists, the Association of Paediatric Anaesthetists of Great Britain and Ireland, the Society of British Neurosurgical Surgeons, the Royal College of RadiologistsandtheSocietyofAnaesthetistsinRadiology. Dateofnextreview:2023 Whatotherguidelinesandstatements areavailableonthistopic? The?rstAssociationofAnaesthetistsguidelineonprovision of anaesthetic services in magnetic resonance (MR) units (...) are essential. The increasing need for anaesthesia within the MR environmentmeansthatmoreanaesthetistswillbeinvolved in providing this service. When new procedures are planned, it is essential that the anaesthetic department is involvedinanydevelopmentoftheservice. The aim of this document is to update the guidelines published by the Association of Anaesthetists in 2002 and 2010[1,2],andtoofferpracticalsupportfortheprovisionof safeanaesthesiawithintheMRscanner. Hazards Magnetic resonance imaging is based
organisational factors such as overbooked or reorganised surgical lists) and highlight these at the WHO premeet/team brief 5. During induction of anaesthesia, practitioners should adhere to suitable dosing of intravenous agent, check anaesthetic effect before paralysis or instrumentation of the airway and maintain anaesthetic administration, including during transfer of patients (which is facilitated by a simple ABCDE checklist) 6. If AAGA is suspected during maintenance (e.g., by patient movement), prompt (...) to consent . This section incorporates that new evidence, and extends the results of NAP5 to focus specifically on the AAGA-related aspects of consent. There are two guiding principles: (a) to provide information on risk, its mitigation and use of appropriate monitoring, and allay anxieties about AAGA; (b) to offer a choice of anaesthetic technique, where possible.5 Association of Anaesthetists Association of Anaesthetists 5 Pre-hospital information (pre-assessment clinic) General anaesthesia
Exploring the Role of Regional Anesthesia in the Treatment of the Burn-injured Patient: A Narrative Review of Current Literature The review article was designed to assess the effectiveness of regional anesthesia (RA), specifically peripheral nerve blocks, in the treatment of burn pain; with noting of clinical indications and contraindications for peripheral nerve block application, along with discussion of evidence-based analgesic strategies for providing improved, comprehensive burn pain (...) outcomes and reduce the adverse effects associated with general anesthetic. RA presents a safe and effective intervention for acute pain resulting from burn-acquired injury. This review of current literature supports the use of RA as a treatment to manage pain associated with burn-related care procedures as an addition to multimodal pain treatment. To date there is limited evidence showing the use of RA in the burns' patient population. In addition, there appear to be no particular risks to using
Nociception-guided versus Standard Care during Remifentanil-Propofol Anesthesia: A Randomized Controlled Trial The multidimensional index of nociception, the nociception level, outperforms blood pressure and heart rate in detection of nociceptive events during anesthesia. We hypothesized that nociception level-guided analgesia reduces opioid consumption and suboptimal anesthesia events such as low blood pressure and use of vasoactive medication.In this single-blinded randomized study, 80 (...) American Society of Anesthesiologists class I-III adult patients of either sex, scheduled for major abdominal procedures under remifentanil/propofol anesthesia by target-controlled infusion, were included. During the procedure nociception level, noninvasive blood pressure, and heart rate were monitored. Patients were randomized to receive standard clinical care or nociception level-guided analgesia. In the nociception level-guided group, remifentanil concentration was reduced when index values were
Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (...) (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary
Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits (...) herniorrhaphy, without previous exposure to general anaesthesia or risk factors for neurological injury. Patients were randomly assigned (1:1) by use of a web-based randomisation service to receive either awake-regional anaesthetic or sevoflurane-based general anaesthetic. Anaesthetists were aware of group allocation, but individuals administering the neurodevelopmental assessments were not. Parents were informed of their infants group allocation upon request, but were told to mask this information from
2019LancetControlled trial quality: predicted high
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures
Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial Diaphragmatic paralysis following supraclavicular brachial plexus block (SCBPB) is ascribed to phrenic nerve palsy. This study investigated the effect of 2 volumes of 0.375% ropivacaine on efficacy of block as a surgical anesthetic and as an analgesic and examined diaphragm compound (...) muscle action potentials (CMAPs) and pulmonary function before and after SCBPB.Eighty patients scheduled for removal of hardware for internal fixation after healing of an upper limb fracture distal to the shoulder were randomized to receive ultrasound-guided SCBPC for surgical anesthesia with 20 mL (Group A) or 30 mL (Group B) 0.375% ropivacaine. The latency and amplitude of diaphragm CMAPs and forced vital capacity (FVC), FVC% predicted, and forced expiratory volume in 1 s (FEV1) were measured
Onset Time of Local Anesthesia After Single Injection in Toe Nerve Blocks: A Randomized Double-Blind Trial. The study was conducted to investigate the onset time and safety profile of four different local anesthetic solutions.Randomized controlled clinical trial study.One hundred twelve healthy volunteers were assigned to receive digital block on their second toe. Individuals were randomly assigned to one of the following groups: lidocaine 2%, lidocaine 2% with epinephrine, bupivacaine 0.5 (...) %, or bupivacaine 0.5% with epinephrine. Onset time was measured until detecting the absence of pinprick sensation. Oxygen saturation was measured in the infiltrated toe up to 60 minutes.The subjects in the groups of anesthetics with epinephrine had a significantly lower mean onset time. There were no significant differences regarding oxygen saturation between the groups and no adverse effects were recorded.The use of anesthetics with epinephrine can be an effective form of local anesthetic for digital blocks
Preoperative Blindfold Training Prevents Pediatric Psychological Behavior Disorders During the Anesthesia Recovery Period: A Randomized Controlled Trial. To identify the effectiveness and feasibility of blindfold training on preventing pediatric psychological behavior disorders during the anesthesia recovery period.This study investigated the effect of blindfold training through the assessment of anxiety, delirium, and pain in children during the anesthesia recovery period.This study (...) was a prospective, randomized, controlled trial. Pediatric patients were randomized into either a control (routine practice) or blindfold training group (routine practice + blindfold training). Anxiety, delirium, and pain levels of children were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium scale, and the Face, Legs, Activity, Cry, Consolability scale.The blindfold training group had significantly lower scores for emergence delirium, anxiety, and pain during
Effect of Benson Relaxation on the Intensity of Spinal Anesthesia-Induced Pain After Elective General and Urologic Surgery. The present study aimed to evaluate the effect of Benson's muscle relaxation on postoperative spinal anesthesia-induced pain.Randomized clinical trial.Sixty-four patients were randomly assigned to intervention and control groups. Benson's muscle relaxation was performed on the intervention group for 10 to 20 minutes based on the patients' tolerance. Before and after (...) the intervention, the two groups were assessed using the visual analog scale and compared. SPSS version 23 was used to analyze data.The mean pain score in the control group before and after the intervention was 5.34 and 5.62, respectively (P < .003), and in the intervention group, 5.28 and 4.03, respectively (P < .001).Benson's relaxation technique effectively influenced the intensity of postoperative spinal anesthesia-induced pain. Therefore, it can be used by nurses as a safe, simple, and inexpensive
Bupivacaine vs. Pethidine in Spinal Anesthesia of Old Patients: Haemodynamic Changes and Complications. Organ changes during the aging are one of the signifi cant events in old patients. rthopedic surgeries are common operations in these patients that accompany with hemodynamic changes as blood pressure decrease, heart rate, and respiratory rate change. On the other hand, pain management of the ancient patients due to negative consequences as tachycardia, blood pressure increase, and myocardial (...) posture by Quincke spinal needle 24 gauge, 12.5 mg of bupivacaine 0.5% (2.5 mL) injected in the subarachnoid space between L2-L3 or L3-L4. In the second group, in a same posture by applying the same spinal needle 24 gauge, 1 mg/kg of preservative-free pethidine injected in the subarachnoid space between L2-L3 or L3-L4. The patients evaluated for duration of anesthesia and analgesia, hemodynamic changes and complications such as headache, pruritus, shivering, urinary retention, and respiratory
no. SC040697). Association of Anaesthetists | The Anaesthesia Team 3 Contents 1. Recommendations 4 2. Introduction 4 3. Organisation and management 5 4. Pre-operative assessment 6 5. The operating department 7 6. The role of ‘anaesthetic assistant’ 8 7. Recovery in the post-anaesthetic care unit (PACU) 10 8. Postoperative pain management 10 9. References 11 To be reviewed by 2023 This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivs 4.0 International License CC BY-NC-ND4 (...) Association of Anaesthetists | The Anaesthesia Team Association of Anaesthetists | The Anaesthesia Team 5 1. Recommendations • Anaesthetic care within the peri-operative pathway can only be provided by an anaesthesia team led by consultant anaesthetists. All members of the team should be trained to nationally agreed standards. • Effective pre-operative assessment of patients for anaesthesia and surgery is vital. It improves safety, reduces cancellations, promotes efficient bed usage and can allay patients