Anesthetic and airway management in a pediatric patient with Morquio Syndrome:A case report

@#Morquio syndrome is a subtype of mucopolysaccharidoses, wherein the accumulation of glycosaminoglycans (GAGs) in various organ systems lead to alteration of anatomy and physiology. Most prominent features are extensive bony abnormalities, which normally require surgical correction. This paper reports the case of a 7-year-old child with Morquio syndrome who successfully underwent correction of genu valgum under general endotracheal anesthesia via asleep induction and videolaryngoscopy, with supplemental peripheral nerve block. The precautions and anesthetic care done to ensure a safe procedure are discussed, especially with anticipation of a possible difficult airway.

The use of peripheral nerve block and intra-articular steroid injection for pain management in an adolescent with Hutchinson-Gilford Progeria Syndrome: A case report

@#Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder causing accelerated aging and agerelated pathologies. Weighing benefits and risks on doing surgical versus conservative pain management require multidisciplinary planning and consideration in HGPS patients. This presents a case of a 15-year-old patient with HGPS with severe pain from bilateral hip dislocation managed with peripheral nerve block and steroid injection. This afforded her immediate pain relief allowing her to undergo physical rehabilitation comfortably.

Anesthetic management of a patient with Klippel-Feil Syndrome for Laparoscopic Pelvic Surgery: A case report

@#Klippel-Feil Syndrome (KFS) continues to pose significant challenges for anesthesiologists. Beyond the expected complexities of managing difficult airways in these patients, they often present with systemic anomalies that can elevate the risk of morbidity during surgeries conducted under anesthesia. Furthermore, laparoscopic procedures bring about additional physiologic changes that must be taken into consideration when planning the anesthetic care for these individuals. This report details the anesthetic management of a 29-year-old female diagnosed with Klippel-Feil Syndrome (KFS) and concomitant Müllerian duct aplasia-Renal agenesis-Cervicothoracic Somite dysplasia (MURCS) as well as Chiari Type 1 Malformation, who underwent a successful pelvic laparoscopic surgery. The airway was secured through awake fiberoptic-guided intubation while general anesthesia was maintained with a combination of sevoflurane inhalation and remifentanil infusion. Intraoperatively, the team prioritized neuroprotection, lung-protective ventilation strategies, and renal preservation measures. The anesthetic management of patients with KFS necessitates a comprehensive assessment of their anomalies. Incorporating these considerations into the anesthetic management will help mitigate the procedure's adverse effects and lead to favorable patient outcomes.

Anesthesia for a patient with base of tongue mass undergoing transoral robotic surgery: A case report

@#Transoral robotic surgery (TORS) is a minimally invasive surgical technique that has recently gained popularity. This involves the use of a robotic system to access and operate on hard-to-reach areas of the body, such as the base of tongue and pharynx. General anesthesia is the technique of choice in TORS as this procedure poses unique challenges due to the patient's airway anatomy, the need for precise surgical movements, and the potential for postoperative complications. Awake fiberoptic intubation (AFOI) is the gold standard for an anticipated difficult airway. This case report describes the anesthetic management for a patient undergoing TORS for a tongue base mass.

Children's preoperative stress according to the parental presence evaluated by salivary cortisol and mYPAS: quasi-randomized trial / Estresse pré-operatório em crianças de acordo com a presença dos pais avaliada por cortisol salivar e mYPAS: ensaio quase-randomizado / Estrés preoperatorio en niños según la presencia de los padres evaluado mediante cortisol salival y mYPAS: ensayo cuasi-aleatorio

ABSTRACT Objective: The main objective of this study was to compare stress and anxiety levels in children undergoing surgical procedures with or without parental presence at induction of anesthesia by measuring salivary cortisol levels and applying the mYPAS. Method: Quasi-randomized trial with children aged 5-12 year, with ASA physical status I, II, or III, undergoing elective surgery. According to parents' willingness, the pair were defined as accompanied or unaccompanied group. Chi-square, Fisher's exact tests, Student's t test, Mann-Whitney, Hodges-Lehman and Spearman's tests were used for statistical analyzes. Results: We included 46 children; 63% were preschool children mostly accompanied by their mothers (80%). The median mYPAS score was 37.5 (quartile range, 23.4-51.6) in unaccompanied children, and 55.0 (quartile range, 27.9-65.0) in accompanied children, with an estimated median difference of +11.8 (95% CI of 0 to 23.4; p = 0.044). There were no significant differences in the mean salivary cortisol levels. Conclusion: The level of anxiety was higher in accompanied children. There were no differences in salivary cortisol levels between both groups. Brazilian Registry of Clinical Trials (ReBEC):RBR-9wj4qvy.

RESUMO Objetivo: O principal objetivo deste estudo foi comparar os níveis de estresse e ansiedade em crianças submetidas a procedimentos cirúrgicos com ou sem presença dos pais na indução da anestesia, medindo os níveis de cortisol salivar e aplicando o mYPAS. Método: Ensaio quaserandomizado com crianças de 5 a 12 anos, com estado físico ASA I, II ou III, submetidas a cirurgia eletiva. De acordo com a disposição dos pais, o par foi definido como grupo acompanhado ou não acompanhado. Foram utilizados testes de qui-quadrado, exato de Fisher, t de Student, Mann-Whitney, Hodges-Lehman e Spearman para as análises estatísticas. Resultados: Foram incluídas 46 crianças; 63% delas em idade préescolar, principalmente acompanhadas por suas mães (80%). A pontuação mYPAS mediana foi de 37,5 (intervalo interquartil, 23,4-51,6) em crianças não acompanhadas e de 55,0 (intervalo interquartil, 27,9-65,0) em crianças acompanhadas, com uma diferença mediana estimada de +11,8 (IC de 95% de 0 a 23,4; p = 0,044). Não houve diferenças significativas nos níveis médios de cortisol salivar. Conclusão: O nível de ansiedade foi maior em crianças acompanhadas. Não houve diferenças nos níveis de cortisol salivar entre os dois grupos. Registro Brasileiro de Ensaios Clínicos (ReBEC):RBR-9wj4qvy.

RESUMEN Objetivo: El objetivo principal de este estudio fue comparar los niveles de estrés y ansiedad en niños sometidos a procedimientos quirúrgicos con o sin presencia de los padres en la inducción de la anestesia mediante la medición de los niveles de cortisol salival y la aplicación del mYPAS. Método: Ensayo cuasi-aleatorio con niños de 5 a 12 años, con estado físico ASA I, II o III, sometidos a cirugía electiva. Según la disposición de los padres, se definieron como grupo acompañado o no acompañado. Se utilizaron pruebas de chi-cuadrado, exacta de Fisher, t de Student, Mann-Whitney, Hodges-Lehman y Spearman para los análisis estadísticos. Resultados: Se incluyeron 46 niños; el 63% eran niños en edad preescolar, en su mayoría acompañados por sus madres (80%). La puntuación mYPAS mediana fue de 37,5 (rango intercuartílico, 23,4-51,6) en niños no acompañados y de 55,0 (rango intercuartílico, 27,9-65,0) en niños acompañados, con una diferencia mediana estimada de +11,8 (IC del 95% de 0 a 23,4; p = 0,044). No hubo diferencias significativas en los niveles medios de cortisol salival. Conclusión: El nivel de ansiedad fue mayor en los niños acompañados. No hubo diferencias en los niveles de cortisol salival entre ambos grupos. Registro Brasileño de Ensayos Clínicos (ReBEC):RBR-9wj4qvy.

Descorna bilateral em bovino: aspectos anestésicos e cirúrgicos relato de caso / Bilateral dehorning in cattle: anesthetics and surgical aspects / Descorne bilateral en bovinos: aspectos anestésicos y quirúrgicos reporte de caso

Descorna cirúrgica em bovinos é uma prática bastante realizada na medicina veterinária, com indicação principalmente para evitar acidentes com fraturas, trabalhadores e outros animais. O objetivo do presente relato seria ressaltar o uso de analgésicos e sedativos em bovinos submetidos a este procedimento cirúrgico, compartilhar técnica cirúrgica utilizada, informações de monitoramento de sinais vitais no trans cirúrgico e recomendações pré, trans e pós-cirúrgicas, assim como possíveis complicações. Foi atendido um bovino da raça Jersey, fêmea, 1 ano de idade, pesando cerca de 222kg, submetido a descorna bilateral devido ao comportamento agressivo. Contido em tronco de contenção e tranquilizado com acepromazina, recebeu meloxicam e associação de sulfa com trimetropim. Após tricotomia e antissepsia foi realizado bloqueio perineural do ramo cornual do nervo zigomático temporal e bloqueio infiltrativo ao contorno de cada corno com lidocaína sem vasoconstritor. Com os cornos insensíveis, se deu início ao procedimento de descorna cirúrgica pela associação das técnicas de serra de gigli com o alicate do tipo Dick Kaber. Concluímos ser de extrema importância a execução da técnica cirúrgica por médico veterinário apto, realizando o procedimento de forma asséptica e com analgesia visando o bem estar do animal. No caso em questão, a associação das técnicas de serra de gigli com o alicate do tipo Dick Kaber foi parcialmente satisfatória, o animal apresentou boa margem de fechamento da sutura e sem deiscência dos pontos, porém houve dificuldades de retirada de margens ósseas pontiagudas após uso do alicate. A tranquilização associada ao bloqueio local foi efetiva para tal procedimento.(AU)

Surgical dehorning in cattle is widely performed practice in veterinary medicine, primarily indicated to prevent accidents involving workers, fights between animals, and skull fractures. This procedure involves the removal of the horns of the horns of cattle and should be performed using ethical methods by a qualified veterinarian. The objective of this case report is to highlight the use of analgesics and sedatives in cattle undergoing this surgical procedure, share the surgical technique employed, information on vital sign monitoring during the procedure, and pre-, intra-, and post-surgical recommendations, as well as potential complications. A Jersey cattle, female, 1 year old, weighing approximately 222kg, underwent bilateral dehorning due to aggressive behavior. Restrained in a cattle chute and tranquilized with acepromazine, she received meloxicam and a combination of sulfadiazine with trimethoprim. After trichotomy and antiseptic preparation, perineural blockade of cornual branch of the zygomatic temporal nerve was performed, follows by infiltrative blockade around each horn with lidocaine without vasoconstrictor. With the horns desensitized, the surgical dehorning procedure began using a combination of Gigli saw and Dick Kaber-type wire snare. In conclusion, it is of utmost importance for the surgical technique to be performed by a qualified veterinarian, ensuring aseptic procedure and correct analgesia for the well-being of the cattle. In this case, the combination of Gigli saw and Dick Kaber-type wire snare was partially satisfactory; the animal had a good suture closure margin and did not present suture dehiscence, but there were difficulties in we moving pointed bony margins after using the wire snare. Tranquilization combined with local blockade was effective for this procedure.(AU)

El descornado quirúrgico del ganado bovino es una práctica muy utilizada en medicina veterinaria, indicada principalmente para prevenir accidentes que involucren fracturas, trabajadores y otros animales. El objetivo de este informe sería resaltar el uso de analgésicos y sedantes en bovinos sometidos a este procedimiento quirúrgico, compartir la técnica quirúrgica utilizada, información sobre el monitoreo de signos vitales durante la cirugía y recomendaciones pre, trans y posquirúrgicas, así como posibles complicaciones. Se trata de una hembra bovina Jersey, de 1 año de edad, con un peso aproximado de 222 kg, siendo sometida a descornado bilateral por comportamiento agresivo. Se recibieron contenidos en un baúl de contención y tranquilizados con acepromacina, meloxicam y una combinación de sulfas y trimetopim. Mediante tricotomía y antisepsia se realizó bloqueo perineural de la rama cornual del nervio temporal cigomático y bloqueo infiltrativo en todo el contorno de cada miembro con lidocaína sin vasoconstrictor. Con cuerpos insensibles se inició el procedimiento de descornado quirúrgico, combinando técnicas de aserrado con alicates Dick Kaber. Concluimos que es de suma importancia realizar la técnica quirúrgica por un veterinario calificado, realizando el procedimiento de manera aséptica y con analgesia administrada para el bienestar del animal. En el caso que nos ocupa, la asociación de técnicas de la sierra con la pinza tipo Dick Kaber fue parcialmente satisfactoria, el animal presentó un buen margen de cierre de sutura y ninguna dehiscencia de los puntos, sin embargo, hubo dificultades para eliminar los márgenes óseos afilados después de usar alicates La tranquilidad asociada al bloqueo local fue eficaz para este procedimiento.(AU)

Cambios en el índice de stress y presión inspiratoria pico posterior a neumoperitoneo en colecistectomía laparoscópica / Changes in Stress Index and Peak Inspiratory Pressure after Pneumoperitoneum in Laparoscopic Cholecystectomy

Introducción: es bien sabido que el neumoperitoneo en cirugía laparoscópica afecta tanto al sistema cardiovascular como al sistema respiratorio, pero no se entiende por completo el grado en el que debemos modificar los parámetros ventilatorios para mini-mizar las complicaciones debido a la insuflación del neumoperitoneo. Estos cambios in-cluyen disminución de la distensibilidad y mayores presiones inspiratorias pico.

Abstract Background: it is well known that pneumoperitoneum in laparoscopic surgery affects both cardiovascular and respiratory system, but it is not fully understood yet the degree in which we have to make changes in the ventilatory settings to minimize the complica-tions due to insufflation of peritoneum, changes including impaired compliance and hig-her peak inspiratory.

Manejo de la hipoxia durante ventilación unipulmonar en un paciente con absceso mediastinal y mediastinitis para toracotomía abierta. Reporte de caso / Hypoxia Management during One-Lung Ventilation in a Patient with Mediastinal Abscess and Mediastinitis for Open Thoracotomy. Case Report

Introducción: la mayoría de los pacientes que se someten a cirugía torácica pueden ser clasificados en el grupo de alto riesgo para hipoxia, especialmente cuando se decide por una ventilación unipulmonar, debido al desequilibrio V/Q; por lo tanto, se han desa-rrollado nuevas estrategias ventilatorias y maniobras de rescate para hipoxia. Curso clínico: presentamos una paciente de 85 años de edad sin comorbilidades programada para toracotomía abierta y manejada con ventilación unipulmonar. Durante el mane-jo anestésico, se presenta hipoxia secundaria a desequilibrio V/Q y choque hipovolémi-co hemorrágico, con respuesta positiva a las maniobras de rescate para hipoxia. Con-clusión: es importante prevenir en la medida de lo posible la hipoxia en la ventilación unipulmonar, siguiendo las nuevas estrategias ventilatorias. Sin embargo, cuando se presenta una crisis, no debemos retrasar las maniobras de rescate de forma moderna. (AU)

Introduction: most of the patients undergoing thoracic surgery fit in the high risk group for hypoxia, especially when deciding to use one-lung ventilation due to the V/Q mis-match; therefore, new ventilation strategies and hypoxia rescue manoeuvres have been developed. Clinical course: we present an 85-year old female with no major co-morbidities scheduled for open thoracotomy and managed with one-lung ventilation. During the course of the anaesthetic management, hypoxia presents secondary to V/Q mismatch and haemorrhagic hypovolemic shock, with a positive response to hypoxia rescue manoeuvres. Conclusion: it is important to prevent as much as we can the hy-poxia in a one-lung ventilation following the new ventilation strategies. Although when facing a crisis, proper hypoxia management with a modern approach should not be de-layed. (AU)

Patient satisfaction in ambulatory anesthesia assessed by the Heidelberg Peri-anaesthetic Questionnaire: a cross-sectional study

Abstract Background: Service quality in anesthesiology has been frequently measured by morbidity and mortality. This measure increasingly considers patient satisfaction, which is the result of care from the client's perspective. Therefore, anesthesiologists must be able to build relationships with patients, provide understandable information and involve them in decisions about their anesthesia. This study aimed to evaluate the peri-anesthetic care provided by the anesthesia service in an ambulatory surgery unit using the Heidelberg Peri-anaesthetic Questionnaire. Methods: This cross-sectional study used the Heidelberg Peri-anaesthetic Questionnaire to evaluate 1211 patients undergoing ambulatory surgery. We selected questions that showed a greater degree of dissatisfaction and correlated them with patient characterization data (age, sex, education, and ASA physical status), anesthesia data (type, time, and prior experience), and surgical specialty. Results: Questions in which patients tended to show dissatisfaction involved fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain. Conclusion: The Heidelberg Peri-anaesthetic Questionnaire proved to be a useful tool in identifying points of dissatisfaction, mainly fear of anesthesia and surgery, feeling cold, the urgent need to urinate, pain at the surgical site, and the team's level of concern and speed of response in relieving the patient's pain in the population studied. These were correlated with patient, anesthesia, and surgical variables. This allows the establishment of priorities at the different points of care, with the ultimate goal of improving patient satisfaction regarding anesthesia care.

Management of airway obstruction following lidocaine nebulization in a case of tracheal stenosis: case report

Abstract Stenting for lower tracheal stenosis is a tricky situation and for the safe conduct of anesthesia, it is imperative to maintain spontaneous respiration. Airway topicalization is routinely recommended for anticipated difficult airway. We report a case of upper airway obstruction following lidocaine nebulization in a patient to be taken for tracheal stenting for lower tracheal stenosis. We would like to highlight that close monitoring of the patient is advisable during airway topicalization to detect any airway obstruction at the earliest and how fiberoptic intubation can play a pivotal role to secure the airway in an emergency scenario.

Retromolar canal diagnosed by cone-beam computed tomography and its influence in inferior alveolar nerve block / Canal retromolar diagnosticado por tomografía computarizada de haz cónico y su influencia en el bloqueo del nervio alveolar inferior

The aim of this study was to observed the anesthetic efficacy of the alveolar nerve block on nine patients that CBCT diagnosed unilateral retromolar canal on a double-blind, split-mouth approach. The assessments of patient response to thermal (pulp vitality test) and pressure (compression of soft tissue) stimuli were carried out before and 5 minutes after the inferior alveolar nerve block procedure, using both visual analog scale (VAS) and Mc Gill pain questionnaires (McG). The mean percentage of patient response decreased after alveolar nerve block, according to both VAS and McG, and was statistically similar among hemi mandibles with and without retromolar canal (Wilcoxon>0.05); however, those without retromolar canal presented greater reduction in patient response in 6 out of 9 cases. Therefore, the retromolar canal is not a determinant factor of inferior alveolar nerve block failure.

El objetivo de este estudio fue observar la eficacia anestésica del bloqueo del nervio alveolar en nueve pacientes que CBCT diagnosticó canal retromolar unilateral en un abordaje de boca dividida doble ciego. Las evaluaciones de la respuesta del paciente a los estímulos térmicos (prueba de vitalidad pulpar) y de presión (compresión de los tejidos blandos) se realizaron antes y 5 minutos después del procedimiento de bloqueo del nervio alveolar inferior, utilizando tanto la escala analógica visual (VAS) como los cuestionarios de dolor de Mc Gill ( McG). El porcentaje medio de respuesta de los pacientes disminuyó tras el bloqueo del nervio alveolar, según EVA y McG, y fue estadísticamente similar entre hemimandíbulas con y sin canal retromolar (Wilcoxon>0,05); sin embargo, aquellos sin canal retromolar presentaron mayor reducción en la respuesta del paciente en 6 de 9 casos. Por lo tanto, el canal retromolar no es un factor determinante del fracaso del bloqueo del nervio alveolar inferior.

Minimal fresh gas flow sevoflurane anesthesia and postoperative acute kidney injury in on-pump cardiac surgery: a randomized comparative trial

Abstract Background Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia. Methods Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p= 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI. Conclusions When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.

Aplicaciones actuales de la ultrasonografía en anestesia / Current applications of ultrasonography in anesthesia

La ecografía es una herramienta segura, portátil, económica y de fácil acceso. Los médicos anestesiólogos pueden beneficiarse con esta herramienta diagnóstica rápida y precisa en su práctica habitual. Existen múltiples áreas potenciales donde la ecografía desempeña un papel importante, para la orientación de intervenciones a ciegas e invasivas, el diagnóstico de condiciones críticas y la evaluación de posibles variaciones anatómicas que pueden conducir a la modificación del plan anestésico. Esta revisión narrativa describe las principales aplicaciones de la ecografía en anestesia, las técnicas ecoguiadas y las tendencias actuales del manejo anestésico perioperatorio del paciente quirúrgico. Se realizó una búsqueda en las bases de datos PubMed y Cochrane, se incluyeron artículos originales, estudios aleatorizados y de revisión, en español y en inglés, publicados entre 2017-2021. El uso de ecografía ha entrado en el campo de la medicina del dolor, anestesia regional y del intervencionismo analgésico durante la última década, e incluso es el estándar de la práctica, por tanto, la capacitación y un adecuado aprendizaje en la ecografía deben ser parte del plan de estudios de cualquier programa de anestesiología

Ultrasound is a safe, portable, inexpensive, and easily accessible tool. Anesthesiologists can benefit from this fast and accurate diagnostic tool in their routine practice. There are multiple potential areas where ultrasound plays an important role in the guidance of blind and invasive interventions, diagnosis of critical conditions, and assessment of possible anatomical variations that may lead to modification of the anesthetic plan. This narrative review describes the main applications of ultrasound in anesthesia, ultrasound-guided techniques, and current trends in the perioperative anesthetic management of the surgical patient. A search was conducted in PubMed and Cochrane databases. Original articles, randomized and review studies in Spanish and English published between 2017-2021 were included. The use of ultrasound has entered the field of pain medicine, regional anesthesia, and interventional analgesia during the last decade and is even the standard of practice. Therefore, training and adequate learning in ultrasound should be part of the curriculum of any anesthesiology program

Efficacy of intravenous lidocaine in controlling emergence agitation in children for surgery under sevoflurane anesthesia: a meta-analysis

BACKGROUND@#Emergence delirium is a state of mental confusion and agitation after wakening from anesthesia that may result in traumatic injuries to the child. Limited drugs have been studied or used to prevent this occurrence.@*OBJECTIVE@#To determine the efficacy and safety of intravenous lidocaine in controlling emergence agitation (EA) in children undergoing surgeries done under general anesthesia compared to placebo or other intravenous anesthetics.@*METHODOLOGY@#This study is a meta-analysis, where published articles were obtained using PubMed, Cochrane Library, Clinical Trials, and Google Scholar up to August 2022. The primary outcome measure includes incidence of emergence delirium while secondary outcomes are postoperative pain and adverse effects comparing lidocaine and other intravenous drugs. The latter includes nausea and vomiting, untoward airway events and local anesthetic toxicity (LAST). Review Manager 5.4 was used for statistical analysis.@*RESULTS@#There were a total of 6 articles included for quantitative and qualitative analysis. The overall incidence of emergence agitation (RR=1.03, 95% CI [0.50, 2.13], P=0.94) and adverse events were higher in the Lidocaine group, although the differences were not significant. Subgroup analysis by comparator showed significant increased risk of developing EA with Lidocaine compared to other intravenous drugs (RR=2.06, 95% CI [1.32, 2.32], P=0.002). The risk for developing postoperative pain is decreased with Lidocaine compared to placebo and other drugs.@*CONCLUSION@#Intravenous lidocaine given to children undergoing general anesthesia with sevoflurane increased their risk for emergence delirium, compared to both placebo and other intravenous anesthetics.

Anesthesia management for patient with bipolar disorder complicated with hypothyroidism during oral surgery: a case report / 华西口腔医学杂志

Bipolar disorder is a major mental illness that is difficult to treat and has a high degree of recurrence. This article reports general anesthesia for oral surgery in a patient with bipolar disorder complicated with hypothyroidism. It also discusses the rational application of antipsychotic drugs and anesthetics with reference to the literature to improve the understanding of the disease and help patients with mental disorders complete the surgical treatment quietly and smoothly.

Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore

INTRODUCTION@#Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population.@*METHODS@#We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium.@*RESULTS@#A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium.@*CONCLUSION@#In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.

Standard Process for Palliative Sedation in Peking Union Medical College Hospital / 中国医学科学院学报

End-stage patients experience unbearable pain because of refractory symptoms.Palliative sedation is a form of palliative care which relieves patients' agony by lowering their consciousness.Standard palliative sedation can help patients die with dignity.It is distinct from euthanasia and does not alter the survival of patients.Sufficient palliative care is the premise of palliative sedation.Repeated and detailed clinical evaluation,as well as multidisciplinary involvement,is necessary for the standardized implementation of palliative sedation.Here,we proposed the standard process and specifications of palliative sedation in Peking Union Medical College Hospital.Furthermore,we reported a case of palliative sedation for an advanced cancer patient with refractory delirium and living pain to demonstrate its application in clinical practice.