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1.
J Hand Surg Asian Pac Vol ; 26(1): 84-91, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559584

RESUMEN

Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients. This situation may poorly impact our capacity to care for critically injured patients. We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited. Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services. We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care. Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020. Patient characteristics, management details, and outcomes were analysed. Results: A total of 102 hand injuries were encountered. Five patients were COVID-19 positive. The mean age was 28.9 ± 14.8 years and eighty-two (80.4%) were males. Thirty-one injuries involved fractures/dislocations, of which 23 (74.2%) were managed non-operatively. Seventy-five (73.5%) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable. Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days. At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively. Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals. We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.


Asunto(s)
/epidemiología , Traumatismos de la Mano/epidemiología , Traumatismos de la Mano/terapia , Adolescente , Adulto , Anestesia General/estadística & datos numéricos , Anestésicos Locales/administración & dosificación , Bloqueo del Plexo Braquial/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , India/epidemiología , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Pandemias , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Centros Traumatológicos , Adulto Joven
2.
Medicine (Baltimore) ; 100(4): e24495, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530271

RESUMEN

RATIONALE: Sevoflurane-induced seizures are most often caused by high concentrations of sevoflurane during anesthesia induction. However, in this case, we found a rare case of seizure-like movements caused by residual sevoflurane inside the anesthesia machine. Therefore, we propose that the detection of residual anesthesia-inhaled drugs should be included in pre-anesthesia checkout procedures. PATIENT CONCERNS: An 11-year-old girl with a history of epilepsy was scheduled for emergency appendectomy under general anesthesia. The patient presented with seizure-like movements caused by residual sevoflurane inside the anesthesia machine after pre-oxygenation during rapid sequence induction. DIAGNOSES: Based on the clinical presentation and previous history of seizures, sevoflurane-induced seizures were diagnosed. INTERVENTIONS: A washout procedure was performed by turning the oxygen flow up to 10L/min to wash out the residual sevoflurane from the anesthesia machine. OUTCOMES: The seizures ceased spontaneously, and the vital signs of the patient were stable during the washout procedure. Rapid sequence anesthesia induction and total intravenous anesthesia maintenance were uneventful. Surgery was performed as planned, and there were no postoperative problems. The patient was discharged after 4 days without complications and was well on follow-up. LESSONS: The check-up procedure of residual anesthesia-inhaled drugs inside the anesthesia machine should be included in the checkout design guidelines, or else the washout procedure should be performed in the pre-anesthesia checkout procedures.


Asunto(s)
Anestésicos por Inhalación/efectos adversos , Convulsiones/inducido químicamente , Sevoflurano/efectos adversos , Anestesia General/efectos adversos , Anestesia General/instrumentación , Niño , Femenino , Humanos
3.
Medicina (Kaunas) ; 57(2)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33567770

RESUMEN

Background and objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to more than 200 countries. In light of this situation, the Japanese Government declared a state of emergency in seven regions of Japan on 7 April 2020 under the provisions of the law. The medical care delivery system has been under pressure. Although various surgical societies have published guidelines on which to base their surgical decisions, it is not clear how general anesthesia has been performed and will be performed in Japan. Materials and Methods: One of the services provided by the social network service Twitter is a voting function-Twitter Polls-through which anonymous surveys were conducted. We analyzed the results of a series of surveys 17 times over 22 weeks on Twitter on the status of operating restrictions using quadratic programming to solve the mathematical optimizing problem, and public data provided by the Japanese Government were used to estimate the current changes in the number of general anesthesia performed in Japan. Results: The minimum number of general anesthesia cases per week was estimated at 67.1% compared to 2015 on 27 April 2020. The timeseries trend was compatible with the results reported by the Japanese Society of Anesthesiologists (correlation coefficient r = 0.69, p < 0.001). Conclusions: The number of general anesthesia was reduced up to two-thirds during the pandemic of COVID-19 in Japan and was successfully quantitatively estimated using a quick questionnaire on Twitter.


Asunto(s)
Anestesia General/estadística & datos numéricos , Anestesiología/estadística & datos numéricos , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Medios de Comunicación Sociales/estadística & datos numéricos , Humanos , Japón , Cómputos Matemáticos , Proyectos de Investigación , Sociedades Médicas/estadística & datos numéricos , Encuestas y Cuestionarios
5.
Zhongguo Zhen Jiu ; 41(1): 59-64, 2021 Jan 12.
Artículo en Chino | MEDLINE | ID: mdl-33559444

RESUMEN

OBJECTIVE: To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery. METHODS: Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T0), skin incision (T1), extubation (T2) and 2 h after operation (T3); the dosage of anesthetics and extubation time were recorded; the plasma levels of ß-endorphin (ß-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) were measured at the following time points: T0, T3, 12 h after operation (T4), 24 h after operation (T5) and 48 h after operation (T6). Visual analogue scale (VAS) was used to evaluate the analgesic effect. RESULTS: The MAP at T1 and T2 in the group A was lower than that in group B and control group (P<0.05), and HR at T1 and T2 was lower than that in control group (P<0.05). The MAP and HR at T1 and T2 in the group B were lower than those in the control group (P<0.05). The dosage of remifentanil in the group A and group B was lower than that in the control group (P<0.05), and extubation time was earlier than that in the control group (P<0.05). The content of ß-EP at T4, T5 and T6 in the group B was higher than that in the group A and control group (P<0.05); the contents of 5-HT and PGE2 at T3, T4 and T5 in the group A and group B were lower than those in the control group (P<0.05). The VAS scores at T3, T4 and T5 in the group A and group were lower than those in the control group (P<0.05). CONCLUSION: The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.


Asunto(s)
Electroacupuntura , Bloqueo Nervioso , Cirugía Torácica , Anestesia General , Espacio Epidural , Humanos
6.
J Postgrad Med ; 67(1): 39-42, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33533746

RESUMEN

An elderly hypertensive lady presented with fever, respiratory symptoms, and mild abdominal discomfort and was diagnosed to have COVID-19 pneumonia. Respiratory symptoms improved with steroids, awake proning, high flow nasal cannula oxygen therapy and antibiotics. After 4 days, she developed non-occlusive superior mesenteric artery thrombosis, which initially responded to anticoagulants but was complicated on tenth day by intestinal obstruction necessitating emergency surgery. Challenges encountered perioperatively were multi systemic involvement, pneumonia, ventilation- perfusion mismatch, sepsis along with technical difficulties like fogging of goggles, stuck expiratory valve on anesthesia machine, inaudibility through stethoscope and discomfort due to personal protective equipment. Perioperative focus should be on infection prevention, maintenance of hemodynamics, and optimization of oxygenation with preoperative high flow nasal cannula oxygen therapy. Ultrasound lung helps in correct placement of endotracheal tube. We recommend daily machine check, taping of N95 mask to face and ambient operation theatre temperatures of 20-22°C to reduce technical problems.


Asunto(s)
Anestesia General/métodos , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/cirugía , Laparotomía , /diagnóstico , Urgencias Médicas , Femenino , Humanos , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/virología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/virología , Persona de Mediana Edad
7.
Medicine (Baltimore) ; 100(6): e24595, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578560

RESUMEN

ABSTRACT: Gastroesophageal reflux (GER) in radiofrequency catheter ablation (RFCA) occurs due to vagal plexus damage during pulmonary vein isolation. We hypothesized that the frequency of GER in the oropharynx will be less compared to other areas (low-esophagus, mid-esophagus). We confirmed the frequency of GER before and after RFCA in 3 areas.We studied 30 patients who were scheduled for RFCA under general anesthesia. Anesthesia was performed using supraglottic devices (SGD) with a suction port. Two esophageal temperature probes capable of suction and measuring temperature were inserted through the suction port. The pH of the 3 areas was measured before and after the RFCA at 3 areas (mid-esophagus, low-esophagus, and oropharynx).GER was observed in 13 of 30 patients (43%). In one patient, it was observed in the oropharynx, in 4 patients it was observed in the mid-esophagus, and in 13 patients, it was observed in the low-esophagus. For patients with GER at the oropharynx and mid-esophagus, it was also observed at the low-esophagus. The difference in the pH before and after the RFCA was not significant at the oropharynx and mid-esophagus (P = .726 and P = .424, respectively), but it was significantly different at the low-esophagus (P < .001). The total ablation time was longer in the GER group compared to the non-GER group (P = .021).GER after RFCA occurred in 43% of patients, only 1 patient in the oropharynx. And aspiration pneumonia after SGD extubation did not occur. Therefore, the use of SGDs in RFCA does not completely eliminate the possibility of aspiration, so care should be taken.


Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Reflujo Gastroesofágico/etiología , Anciano , Anestesia General , Monitorización del pH Esofágico , Femenino , Reflujo Gastroesofágico/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , República de Corea/epidemiología
8.
Medicine (Baltimore) ; 100(5): e23992, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592855

RESUMEN

BACKGROUND: There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia. METHODS: This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials that investigated the effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia. RESULTS: Among the 314 patients in the 6 studies, 147 received intravenous dexamethasone (dexamethasone group), and 167 received intravenous saline or other antiemetics (control group). The primary outcome, the time to recovery after sugammadex administration (the time to recovery of the train-of-four ratio to 0.9 after sugammadex administration; s) was comparable between the 2 groups, the weighted mean difference (95% confidence interval [CI]) being -2.93 (-36.19, 30.33) (I2 = 94%). The time to extubation after sugammadex administration (s) and incidence of postoperative nausea and vomiting was not different between the 2 groups, the weighted mean difference (95% CI) being 23.31 (-2.26, 48.88) (I2 = 86%) and the pooled risk ratio (95% CI) being 0.25 (0.03, 2.11), respectively. The time to recovery after sugammadex administration might be different according to the study design or study region. CONCLUSION: This meta-analysis showed that use of dexamethasone in the perioperative period neither delayed nor facilitated the reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients undergoing elective surgery with general anesthesia. However, given that the results showed high heterogeneity, further randomized controlled trials are needed to confirm these findings.


Asunto(s)
Anestesia General/métodos , Dexametasona/farmacología , Interacciones Farmacológicas , Bloqueo Neuromuscular/métodos , Rocuronio/farmacología , Sugammadex/farmacología , Procedimientos Quirúrgicos Electivos/métodos , Glucocorticoides/farmacología , Humanos , Fármacos Neuromusculares no Despolarizantes/farmacología , Atención Perioperativa/métodos
9.
Medicine (Baltimore) ; 100(7): e24786, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607831

RESUMEN

INTRODUCTION: Routine anesthesia modality for modified radical mastectomy (MRM) includes general anesthesia (GA), epidural blockade-combined GA and nerve blockade-combined GA. However, GA has been associated with postoperative adverse effects such as vertigo, postoperative nausea and vomiting and requirement for postoperative analgesia, which hinders recovery and prognosis. Moreover, combined blockade of thoracic paravertebral nerves or intercostal nerves and adjuvant basic sedation for massive lumpectomy provided perfect anesthesia and reduced opioid consumption, whereas the excision coverage did not attain the target of MRM. Regional anesthesia strategies involving supplementation of analgesics in ultrasound-guided multiple nerve blocks have garnered interests of clinicians. Nevertheless, the precise effects of intercostal nerves, brachial plexus and supraclavicular nerves in MRM in patients with breast cancer remain obscure. METHODS: Eighty female patients with breast cancer scheduled for MRM were recruited in the present trial between May, 2019 and Dec., 2019 in our hospital. The patients ranged from 30 to 65 years of age and 18∼30 kg/m2 in body-mass index, with the American Society of Anesthesiologists I or II. The patients were randomized to ultrasound-guided multiple nerve blocks group and GA group. The patients in multiple nerve blocks group underwent ultrasound guided multiple intercostal nerve blocks, interscalene brachial plexus and supraclavicular nerve blocks, (local anesthesia with 0.3% ropivacaine: 5 ml for each intercostal nerve block, 8 ml for brachial plexus block, 7 mL for supraclavicular nerve block) and basic sedation and intraoperative mask oxygen inhalation. The variations of hemodynamic parameters such as mean arterial pressure, heart rate (HR) and pulse oxygen saturation were monitored. The visual analog scale scores were recorded at postoperative 0 hour, 3 hour, 6 hour, 12 hour and 24 hour in resting state. The postoperative adverse effects, including vertigo, postoperative nausea, and vomiting, pruritus, and urinary retention and so on, as well as the analgesic consumption were recorded. CONCLUSIONS: The ultrasound guided multiple intercostal nerve blocks, brachial plexus and supraclavicular nerve blocks could provide favorable anesthesia and analgesia, with noninferiority to GA and the reduced incidence of adverse effects and consumption of postoperative analgesics.


Asunto(s)
Neoplasias de la Mama/cirugía , Sedación Consciente/métodos , Mastectomía Radical Modificada/métodos , Bloqueo Nervioso/métodos , Anestesia General/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional/métodos
10.
BMC Anesthesiol ; 21(1): 28, 2021 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494705

RESUMEN

BACKGROUND: Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. METHODS: Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. RESULTS: Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286-0.612) and its OR value was 10.09 (95%CI: 4.19-24.28), sensitivity was 0.469 (95%CI: 0.325-0.617), specificity was 0.929 (95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847 (95%CI: 0.825-0.865). CONCLUSION: Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. TRIAL REGISTRATION: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry ( ChiCTR1900026775 ).


Asunto(s)
Manejo de la Vía Aérea/métodos , Anestesia General/métodos , Intubación Intratraqueal/métodos , Laringoscopía/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Estudios Prospectivos , Sistema Respiratorio/anatomía & histología , Sensibilidad y Especificidad
11.
Medicine (Baltimore) ; 100(1): e24216, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429815

RESUMEN

INTRODUCTION: Hyperparathyroid crisis is a rare and potentially life-threatening complication of severe calcium intoxication. Parathyroidectomy is the only curative method for hyperparathyroid crisis. Several case reports and case series have been published on the medical and surgical treatments for hyperparathyroid crisis, however, few reports have focused on the associated perioperative anesthetic management. PATIENT CONCERNS: A 48-year-old Chinese woman presented with a 2-week history of nausea and vomiting and complained of mental status alteration including confusion and agitation in the 24 hours prior to her admission. She denied any history of past illness. Laboratory tests showed severe hypercalcemia crisis with a serum calcium level of 5.21 mmol/L and a serum intact parathyroid hormone level of > 5000 pg/mL. DIAGNOSIS: The diagnosis was hyperparathyroid crisis, acute kidney injury, acute liver injury, rhabdomyolysis, infection, and shock. INTERVENTIONS: She underwent initial management with aggressive intravenous fluid resuscitation, loop diuretic treatment, vitamin D supplement, intravenous bisphosphonates, and calcitonin therapy. However, her condition worsened, and she was transferred to the operating theater for a parathyroidectomy under general anesthesia. She was under general anesthesia and monitored with electrocardiogram, pulse oxygen saturation, continuous arterial blood pressure, central venous pressure and nasopharyngeal temperature. Cardiac output and stroke volume variation were monitored from the FloTrac system. After liberal fluid rehydration, circulatory support, cooling treatment and calcium supplement after tumor removal, her unstable vital signs gradually improved. OUTCOMES: After meticulous anesthetic management by the anesthesiologist and complete tumor resection by the surgeon, she survived this fatal disease. The patients was discharged on postoperative day 37 without any sequelae. LESSONS: Patients with hyperparathyroid crisis should undergo a thorough preoperative evaluation. Difficult airway, fluid depletion, multiple organ dysfunction, hypercoagulability, and concomitant diseases are the primary challenges in anesthetic management. After tumor removal, the serum calcium level should be monitored closely and calcium should be supplemented in a timely manner to prevent serious complications.


Asunto(s)
Anestesia General , Hipercalcemia/sangre , Hiperparatiroidismo/diagnóstico , Paratiroidectomía , Diagnóstico Diferencial , Femenino , Humanos , Hiperparatiroidismo/sangre , Hiperparatiroidismo/complicaciones , Hiperparatiroidismo/cirugía , Persona de Mediana Edad , Náusea/etiología
12.
Zhonghua Yi Xue Za Zhi ; 101(1): 52-56, 2021 Jan 05.
Artículo en Chino | MEDLINE | ID: mdl-33423445

RESUMEN

Objective: To investigate the incidence of hypothermia and its risk factors in patients after general anesthesia in the post anesthesia recovery unit (PACU). Methods: A total of 10 341 patients after general anesthesia in the PACU of Peking University People's Hospital from January to December 2019 were retrospectively reviewed. According to whether hypothermia occurred in the PACU, the patients were divided into hypothermia group and non-hypothermia group. After propensity score matching based on age and gender, 336 cases in hypothermia group and 336 cases in non-hypothermia group were finally included. The clinical characteristics of the two groups were compared, and the potential risk factors of hypothermia in the PACU were analyzed by multivariate logistic regression model. Results: The incidence of hypothermia in PACU was 3.3% (339/10 341). The age of hypothermia group was (54.1±17.1) years, with 156 males and 180 females; the age of non-hypothermia group was (53.1±16.0) years, with 156 males and 180 females. There was no statistically significant difference in age, gender, American Society of Anesthesiologists (ASA) classification and operation type between the two groups (all P>0.05). Compared with the non-hypothermia group, the body mass index (BMI) [(22.8±3.5) kg/m2 vs (24.7±4.2) kg/m2] and baseline body temperature [(36.3±0.5)℃ vs (36.5±0.5)℃] were lower, and anesthesia time [(4.4±1.6) h vs (3.2±1.5) h] and operation time [(3.1±1.4) h vs (2.1±1.3) h] were longer in hypothermia group. The amount of intraoperative bleeding, blood transfusion and intravenous fluid was larger in hypothermia group (all P<0.001). Multivariate logistic regression analysis showed that larger amount of blood loss (L) (OR=5.361, 95%CI: 2.863-10.037, P<0.001), prone position operation (OR=3.653, 95%CI: 2.104-6.342, P<0.001), longer anesthesia time (h) (OR=1.421, 95%CI: 1.227-1.646, P<0.001), and general anesthesia combined with regional nerve block (OR=1.708, 95%CI: 1.026-2.843, P=0.039) were independent risk factors of hypothermia in the PACU, and higher BMI (OR=0.849, 95%CI: 0.801-0.900, P<0.001) was an independent protective factor. Conclusions: The incidence of hypothermia in patients after general anesthesia in the PACU remains relatively high. Therefore, more attention should be paid to identify high-risk patients, and active preventive measures should be taken for the risk factors of hypothermia.


Asunto(s)
Hipotermia , Periodo de Recuperación de la Anestesia , Anestesia General , Temperatura Corporal , Femenino , Humanos , Hipotermia/epidemiología , Masculino , Estudios Retrospectivos , Factores de Riesgo
13.
Arthroscopy ; 37(1): 147-148, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33384078

RESUMEN

Hip arthroscopy continues to be one of the fastest-growing orthopaedic procedures nationally, and pain control following these procedures can be challenging. As regional anesthesia techniques for this population have shown to have limited benefits, pain management for hip arthroscopy focused on multimodal analgesia and preventive analgesia, interventions that reduce postoperative hyperalgesia. The use of neuraxial anesthesia such as spinal and epidural anesthesia, established preventive analgesic anesthetic techniques, has demonstrated to improve postoperative pain in orthopaedic surgery when compared with general anesthesia. This promising finding highlights that despite potential disadvantages of neuraxial anesthesia, such as a small risk for complications or delayed resolution of the neuraxial block that could delay discharge, neuraxial anesthesia could be a suitable anesthetic technique for ambulatory orthopaedic surgery.


Asunto(s)
Analgésicos Opioides , Anestesia Epidural , Anestesia General , Artroscopía , Humanos , Dolor Postoperatorio/prevención & control , Alta del Paciente
14.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431460

RESUMEN

Oculodentodigital dysplasia (ODDD) is a rare congenital disorder characterised by developmental abnormalities of the eye, dentition and digits of the hands and feet, with neurological symptoms reported in 30% of individuals. Dental anomalies associated with ODDD include enamel hypoplasia and subsequent caries, microdontia, missing teeth, amelogenesis imperfecta, pulp stones and delayed tooth development. Here, we describe the comprehensive dental management of a 3-year-old girl who presented with rapid deterioration of the primary dentition due to generalised enamel hypomineralisation. Conservative, comprehensive restorative management was performed under general anaesthesia. Within 6 months, further breakdown of the remaining unrestored enamel was noted. This case documents the challenges of conservative management in dental anomalies that are not well documented due to the extreme rarity of the disorder.


Asunto(s)
Anomalías Craneofaciales/complicaciones , Atención Dental para Niños/métodos , Hipoplasia del Esmalte Dental/terapia , Anomalías del Ojo/complicaciones , Deformidades Congénitas del Pie/complicaciones , Sindactilia/complicaciones , Anomalías Dentarias/complicaciones , Anestesia General , Preescolar , Anomalías Craneofaciales/diagnóstico , Anomalías Craneofaciales/genética , Anomalías Craneofaciales/terapia , Coronas , Atención Dental para Niños/efectos adversos , Atención Dental para Niños/instrumentación , Esmalte Dental/diagnóstico por imagen , Hipoplasia del Esmalte Dental/diagnóstico , Hipoplasia del Esmalte Dental/genética , Anomalías del Ojo/diagnóstico , Anomalías del Ojo/genética , Anomalías del Ojo/terapia , Femenino , Deformidades Congénitas del Pie/diagnóstico , Deformidades Congénitas del Pie/genética , Deformidades Congénitas del Pie/terapia , Humanos , Dolor Asociado a Procedimientos Médicos/etiología , Dolor Asociado a Procedimientos Médicos/prevención & control , Linaje , Selladores de Fosas y Fisuras , Radiografía Dental , Sindactilia/diagnóstico , Sindactilia/genética , Sindactilia/terapia , Anomalías Dentarias/diagnóstico , Anomalías Dentarias/genética , Anomalías Dentarias/terapia , Diente Primario/diagnóstico por imagen
15.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(1): 128-134, 2021 Jan 30.
Artículo en Chino | MEDLINE | ID: mdl-33509765

RESUMEN

OBJECTIVE: To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring. METHODS: Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded. RESULTS: No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)(P < 0.05) but recovered at 7 am on the second day after the surgery (T11);salivary melatonin levels at T4, T8, and T11 exceeded 3 pg/mL on the third day.No significant difference was found in illumination intensity or body temperature across the time points when melatonin level was measured.The children showed no significant changes in FLACC score, Riker score or QOR- 15 score after the operation, but the OSA-18 score was significantly lowered after the operation (P < 0.05).None of the 20 children had such adverse events as respiratory depression, sinus bradycardia, sinus tachycardia, hypertension, hypotension, nausea or vomiting during hospitalization. CONCLUSIONS: In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.


Asunto(s)
Melatonina , Anestesia General/efectos adversos , Secreciones Corporales , Niño , Preescolar , Ritmo Circadiano , Humanos , Ronquido
16.
Br J Anaesth ; 126(2): 445-457, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33461725

RESUMEN

Electroencephalographic (EEG) activity is used to monitor the neurophysiology of the brain, which is a target organ of general anaesthesia. Besides its use in evaluating hypnotic states, neurophysiologic reactions to noxious stimulation can also be observed in the EEG. Recognising and understanding these responses could help optimise intraoperative analgesic management. This review describes three types of changes in the EEG induced by noxious stimulation when the patient is under general anaesthesia: (1) beta arousal, (2) (paradoxical) delta arousal, and (3) alpha dropout. Beta arousal is an increase in EEG power in the beta-frequency band (12-25 Hz) in response to noxious stimulation, especially at lower doses of anaesthesia drugs in the absence of opioids. It is usually indicative of a cortical depolarisation and increased cortical activity. At higher concentrations of anaesthetic drug, and with insufficient opioids, delta arousal (increased power in the delta band [0.5-4 Hz]) and alpha dropout (decreased alpha power [8-12 Hz]) are associated with noxious stimuli. The mechanisms of delta arousal are not well understood, but the midbrain reticular formation seems to play a role. Alpha dropout may indicate a return of thalamocortical communication, from an idling mode to an operational mode. Each of these EEG changes reflect an incomplete modulation of pain signals and can be mitigated by administration of opioid or the use of regional anaesthesia techniques. Future studies should evaluate whether titrating analgesic drugs in response to these EEG signals reduces postoperative pain and influences other postoperative outcomes, including the potential development of chronic pain.


Asunto(s)
Analgésicos/administración & dosificación , Anestesia General , Anestésicos Generales/administración & dosificación , Ondas Encefálicas/efectos de los fármacos , Encéfalo/efectos de los fármacos , Electroencefalografía , Monitorización Neurofisiológica Intraoperatoria , Nocicepción/efectos de los fármacos , Umbral del Dolor/efectos de los fármacos , Dolor Postoperatorio/prevención & control , Encéfalo/fisiopatología , Relación Dosis-Respuesta a Droga , Humanos , Dolor Postoperatorio/fisiopatología , Estimulación Física , Valor Predictivo de las Pruebas , Factores de Tiempo , Resultado del Tratamiento
18.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509897

RESUMEN

Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.


Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Anestesia/métodos , Linfoma de Células B Grandes Difuso/complicaciones , Neoplasias Nasofaríngeas/cirugía , Traqueostomía/métodos , Enfermedad Aguda , Obstrucción de las Vías Aéreas/cirugía , Anestesia General , Anestesia Local , Anestesistas , Diagnóstico Diferencial , Femenino , Humanos , Laringoscopía/métodos , Pulmón/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/cirugía , Persona de Mediana Edad , Neoplasias Nasofaríngeas/complicaciones , Neoplasias Nasofaríngeas/diagnóstico por imagen , Nasofaringe/diagnóstico por imagen , Nasofaringe/cirugía , Radiografía/métodos
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