Anesthesia Management For A Patient Having Transoral Approach For Anterior Cervical Osteophyte Resection.

Anterior cervical osteophytes (ACOs) are a common condition in the elderly, leading to dysphagia, odynophagia, aspiration, neck pain, dysphonia, and dyspnea. Transoral surgical resection is an approach to managing cervical (C1 and C2) ACOs where the endoscopic endonasal approach is contraindicated. Advantages of the transoral approach include it providing direct access to the cervical spine, limits injury to surrounding neurovascular structures, and eliminates scarring. Anesthesia considerations for transoral surgical resection of ACOs will be covered in the following case report. A review of the literature examines the prevalence of and anesthesia considerations for the transoral approach to anterior cervical osteophyte resection.

Peripheral Nerve Blockade for Patients With Raynaud Phenomenon and Other Causes of Digital Ischemia: A Case Report and Practice Implications.

Raynaud phenomenon can be an idiopathic benign disease, or it can be associated with vascular insufficiency due to arterial disease caused by other processes. Medical management of Raynaud phenomenon can be difficult, and digital ischemia, gangrene, and ulcers may occur secondary to vascular insufficiency. This case report describes the anesthetic management of a patient with a diagnosis of Raynaud phenomenon who presented to the perioperative area for débridement and distal amputation of the right third finger, which had become necrotic and gangrenous. An ultrasound-guided supraclavicular nerve block was performed preoperatively with 15 mL of 1.5% mepivacaine and 15 mL of 0.5% bupivacaine. The block was performed without complication, and the patient tolerated the procedure. A review of literature related to the use of peripheral nerve blockade for the treatment of digital ischemia is discussed. Ultrasound-guided technique is considered the gold standard for the performance of peripheral nerve blocks because this technique provides better efficacy and safety. These same ultrasonographic skills can expand anesthesia providers' practice beyond nerve blockade for anesthesia and analgesia with the addition of treatment and management of digital ischemia.

Anesthetic and Analgesic Influence on Cancer Recurrence and Metastasis.

Cancer is one of the leading causes of death in the United States. Total resection of tumors can be curative; however, investigators have speculated that inflammatory, metabolic, neuroendocrine, and immunologic changes that occur perioperatively may be promoted or induced by anesthetics. The influence of anesthetic choice on cancer recurrence and metastasis has yet to be definitively linked. Retrospective, animal model, and in vitro studies investigating volatile anesthetics, local anesthetics, and intravenous analgesics have resulted in contradicting findings. Results ranged from no association between type of anesthetic used and cancer recurrence, to immune-protective effects inhibiting tumor cell growth, or immune-suppressive effects promoting tumor cell growth or metastasis. It has yet to be confirmed whether volatile anesthetics, intravenous anesthetics, and analgesics are causal factors for cancer metastasis or recurrence. There are increasing data suggesting the immunosuppressant effects of anesthesia can be circumvented by avoiding opioids and volatile anesthetics. Further evaluation is required to determine the implications of regional anesthesia and propofolbased total intravenous anesthesia on cancer recurrence. Several ongoing randomized controlled trials are studying this link. Changes to clinical practice cannot definitively be recommended until the results of these studies can be examined.

Effects of ubiquinol with fluid resuscitation following haemorrhagic shock on rat lungs, diaphragm, heart and kidneys.

Haemorrhagic shock (HS) and fluid resuscitation can lead to increased reactive oxygen species (ROS), contributing to ischaemia-reperfusion injury and organ damage. Ubiquinol is a potent antioxidant that decreases ROS. This study examined the effects of ubiquinol administered with fluid resuscitation following controlled HS. Adult male Sprague-Dawley rats were randomly assigned to treatment [ubiquinol, 1 mg (100 g body weight)(-1)] or control groups. Rats were subjected to 60 min of HS by removing 40% of the total blood volume to a mean arterial pressure ∼45-55 mmHg. The animals were resuscitated with blood and lactated Ringer solution, with or without ubiquinol, and monitored for 120 min. At the end of the experiments, the rats were killed and the lungs, diaphragm, heart and kidneys harvested. Leucocytes were analysed for mitochondrial superoxide at baseline, end of shock and 120 min following fluid resuscitation using MitoSOX Red. Diaphragms were examined for hydrogen peroxide using dihydrofluorescein diacetate and confocal microscopy. The apoptosis in lungs, diaphragm, heart and kidneys was measured using fluorescence microscopy with acridine orange and ethidium bromide. Leucocyte mitochondrial superoxide levels were significantly lower in rats that received ubiquinol than in the control animals. Production of hydrogen peroxide and apoptosis were significantly reduced in the organs of rats treated with ubiquinol. These findings suggest that ubiquinol, administered with fluid resuscitation after HS, attenuates ROS production and apoptosis. Thus, ubiquinol is a potent antioxidant that may be used as a potential treatment to reduce organ injury following haemorrhagic events.

Apoptosis: understanding programmed cell death for the CRNA.

Apoptosis, or programmed cell death, is a physiologic mechanism employed by most multicellular organisms to maintain homeostasis of body tissues. In balance with the production of new cells by mitosis, apoptosis provides for the orderly destruction and removal of cells that are no longer needed by the organism. Apoptosis occurs by complex pathways involving multiple biochemical signals and processes. Dysfunctional apoptotic mechanisms are the pathologic basis for many human diseases, including common disorders of the heart, lungs, brain, and endocrine systems. Researchers have demonstrated in animal models that neurodegenerative changes after the administration of anesthetic drugs are related to apoptosis. Anesthesia drugs have been found to induce apoptosis, perhaps through the production of reactive oxygen species. Propofol is a drug used in anesthesia that has unique antioxidant qualities that may be beneficial. The purpose of this article is to review, for nurse anesthesia providers, current information about the process of apoptosis, the role of apoptosis in comorbid diseases, and the implications of the effects of anesthesia drugs on normal apoptotic mechanisms that need to be evaluated as potential sources of risk or benefit to surgical patients.