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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.
Does general anesthesia affect neurodevelopment in infants and children? General anesthesia has been unequivocally linked to abnormal development of the central nervous system, leading to neurocognitive impairments in laboratory models. In vitro and in vivo studies have consistently shown that exposure to GABA agonists (eg, volatile anesthetics, midazolam, and propofol) or NMDA antagonists (eg, ketamine, isoflurane, and nitrous oxide) produces dose dependent and developmental age dependent (...) effects on various neuronal transmission systems. Exposure to these drugs increases neuronal cell death in juvenile animals including rats, mice, and non-human primates. The possibility of anesthetic induced neurotoxicity occurring in children has led to concerns about the safety of pediatric anesthesia. A spectrum of behavioral changes has been documented after general anesthetic exposure in young children, including emergence delirium, which may be evidence of toxicity. Most clinical studies
disorders, and neoplasms.Among patients at increased risk of complications after major surgery, light general anaesthesia was not associated with lower 1-year mortality than deep general anaesthesia. Our trial defines a broad range of anaesthetic depth over which anaesthesia may be safely delivered when titrating volatile anaesthetic concentrations using a processed electroencephalographic monitor.Health Research Council of New Zealand; National Health and Medical Research Council, Australia; Research (...) Anaesthetic depth and complications after major surgery: an international, randomised controlled trial. An association between increasing anaesthetic depth and decreased postoperative survival has been shown in observational studies; however, evidence from randomised controlled trials is lacking. Our aim was to compare all-cause 1-year mortality in older patients having major surgery and randomly assigned to light or deep general anaesthesia.In an international trial, we recruited patients from
adequate initial blockade (risk ratio (RR) 0.32, 95% confidence interval (CI) 0.05 to 1.97; 7 studies, 341 women; low-quality evidence). We are uncertain whether having CSE or spinal makes any difference in the number of women requiring supplemental intra-operative analgesia at any time after CSE or spinal anaesthetic insertion (average RR 1.25, 95% CI 0.19 to 8.43; 7 studies, 390 women; very low-quality evidence), or the number of women requiring intra-operative conversion to general anaesthesia (RR (...) Combined spinal-epidural versus spinal anaesthesia for caesarean section. Single-shot spinal anaesthesia (SSS) and combined spinal-epidural (CSE) anaesthesia are both commonly used for caesarean section anaesthesia. Spinals offer technical simplicity and rapid onset of nerve blockade which can be associated with hypotension. CSE anaesthesia allows for more gradual onset and also prolongation of the anaesthesia through use of a catheter.To compare the effectiveness and adverse effects of CSE
Lidocaine 2% with Epinephrine versus Lidocaine 1% with Epinephrine for Patients Requiring Local Anesthesia: Clinical Effectiveness and Guidelines Lidocaine 2% with Epinephrine versus Lidocaine 1% with Epinephrine for Patients Requiring Local Anesthesia: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Lidocaine 2% with Epinephrine versus Lidocaine 1% with Epinephrine for Patients Requiring Local Anesthesia: Clinical Effectiveness and Guidelines Lidocaine 2 (...) % with Epinephrine versus Lidocaine 1% with Epinephrine for Patients Requiring Local Anesthesia: Clinical Effectiveness and Guidelines Last updated: May 3, 2019 Project Number: RA1030-000 Product Line: Research Type: Drug Report Type: Reference List Result type: Report Question What is the comparative clinical effectiveness of lidocaine 2% with epinephrine versus lidocaine 1% with epinephrine for patients requiring local anesthesia? What are the evidence-based guidelines regarding the use of lidocaine (1% or 2
Anaesthesia Agents The contribution of inhalational anaesthetic agents to climate change on the global scale is small, however anaesthetists are uniquely placed in that the choices we make at work can have an impact on our carbon footprint many times greater than that of our other day-to-day activities. The effect of each agent is dependent on its absorption of infrared radiation that would otherwise leave the Earth’s lower atmosphere, the amount used, and its atmospheric lifetime. As they are used (...) , Paulsen W, et al. Greening the Operating Room and Perioperative Arena: Environmental Sustainability for Anesthesia Practice. [Internet]. American Society of Anesthesiologists; [Updated 2017 Jan; cited 2019 Mar 4]. Available from: https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on- equipment-and-facilities/environmental-sustainability. 8. Pungsornruk K, Forbes MP, Hellier C, Bryant M. A renewed call for environmentally responsible anaesthesia. Anaesth Intensive care
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