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1.
Georgian Med News ; (294): 141-145, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687967

RESUMO

General anesthesia may cause damage of the central nervous system and cognitive dysfunction in the postoperative period. A new intranasal form of Noopept (N-Phenylacetyl-L-prolylglycine ethyl ester) was developed by our team at the Department of the medical technology (Zaporizhzhia State Medical University, Ukraine). The objectives of this investigation were the study of neuroprotective action of Noopept and to prove using in the clinic for correction of amnestic and behavioral disorders after ketamine anesthesia. We discovered that the intranasal administration of noopept after ketamine anesthesia significantly decreases anxiety and excitability, raises the animal's activity, shows an intensive antiamnesic effects and increases animal's training ability. Noopept significantly exceeds piracetam and cerebrocurin according to neuroprotective effects.


Assuntos
Amnésia/tratamento farmacológico , Ketamina/efeitos adversos , Transtornos Mentais/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Amnésia/induzido quimicamente , Anestesia , Anestesia Geral , Animais , Dipeptídeos/uso terapêutico , Ketamina/administração & dosagem , Transtornos Mentais/induzido quimicamente , Resultado do Tratamento , Ucrânia
2.
Pan Afr Med J ; 33: 233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692841

RESUMO

Introduction: As the life expectancy and weight of patients are increasing, more old and obese patients are undergoing total knee arthroplasty (TKA). TKA may lead to several perioperative complications. These include anesthesia-related risks, exacerbation of comorbid medical issues and complications of surgical procedure. We have no studies reporting medical complications following TKA among our population. This study aimed to evaluate perioperative complications of TKA and to identify the related risk factors. Methods: It was a monocentric retrospective including 410 observations in the local TKA registry. Data of patients operated for primary unilateral TKA during the period from January 2014 to December 2017 were reviewed. All patients had standardized protocols of anesthesia and post operative care for three days following surgery. Multivariate logistic regression was used to identify the predicting factors for complications. Results: Incidence of perioperative complications was 37.1%. The most frequent were per operative hypotension (14.1%) and postoperative desaturation (21.7%, including pulmonary embolism in 2.4%). Multivariate logistic regression analysis identified: age ≥ 65 years (OR=1.9; p=0.006), respiratory diseases (OR=1.8; p=0.042) and general anesthesia (OR=2.8; p=0.009) as significant risk factors for any complications. Loss of autonomy (OR=4.8; p <0.001) and general anesthesia (OR=2.6; p=0.03) were significant risk factors for hypotension. Age ≥ 65 years (OR=2.6;p<0.001), female gender (OR=4.3;p=0.006) and respiratory diseases(OR=1.9;p=0.02) were associated with postoperative desaturation. Conclusion: This study highlighted hemodynamic and respiratory complications as the most common early complications in TKA. Age ≥ 65years, general anesthesia and respiratory diseases were significant risk factors.


Assuntos
Anestesia Geral/efeitos adversos , Artroplastia do Joelho/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/métodos , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Respiratórias/complicações , Estudos Retrospectivos , Fatores de Risco
3.
J Clin Pediatr Dent ; 43(6): 413-416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31657986

RESUMO

Objective: To present comparative data with the aim of assisting the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N2O-O2 alone or combined with midazolam 0.5 mg/kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Study design: Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Results: Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N2O-O2 alone had a 6.1-fold greater risk of failure compared to N2O-O2+midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). Conclusions: The GA mode yielded significantly greater success than the N2O-O2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N2O-O2. When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.


Assuntos
Anestesia Dentária , Restauração Dentária Permanente , Anestesia Geral , Terapia Comportamental , Criança , Coroas , Amálgama Dentário , Assistência Odontológica , Humanos
4.
AANA J ; 87(2): 16, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31587732
5.
Pediatr Dent ; 41(5): 397-403, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31648672

RESUMO

Purpose: The purposes of this study of children with autism spectrum disorder (ASD), who had successfully accepted a dental examination seated in a dental chair following desensitization interventions, were to: (1) determine if ability to accept an examination was maintained two years following initial success; (2) quantify new dental skills acquired; and (3) analyze the use of advanced behavior guidance techniques. Methods: This retrospective two-year case series included 138 ASD children. Data were obtained from dental records. Descriptive statistics were calculated, and Fisher's exact test was used for comparisons of interest. Results: Most children (92 percent) maintained the ability to receive minimum threshold examinations once the initial exam had been achieved. New basic dental skills attained by most children included receiving toothbrush prophylaxis (83 percent) and accepting fluoride varnish (77 percent). Few children required oral sedation or protective stabilization, but 22 percent received general anesthesia. Conclusions: Most children with autism spectrum disorder who learned to accept an examination maintained that skill over time, and many accepted toothbrush prophylaxis and fluoride varnish. Sensory-invasive skills, such as radiographs and rubber cup prophylaxis, were acquired with lower frequency. Therefore, when treating ASD patients, it is important to consider that some will require advanced behavior guidance techniques. (Pediatr Dent 2019;41(5):397-403).


Assuntos
Transtorno do Espectro Autista , Anestesia Geral , Criança , Assistência Odontológica , Humanos , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 98(41): e17387, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593088

RESUMO

BACKGROUND: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied. METHODS: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively. RESULTS: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups. CONCLUSIONS: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.


Assuntos
Anestesia Geral/métodos , Broncoconstritores/administração & dosagem , Ventilação Monopulmonar/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose Pulmonar/cirurgia , Idoso , Feminino , Hemodinâmica , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Pressão Parcial
8.
Medicine (Baltimore) ; 98(41): e17405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593093

RESUMO

RATIONALE: Midazolam is known as a safe drug and is widely used as a sedative and an anesthetic adjuvant. Therefore, there is a lack of awareness that midazolam can cause anaphylaxis. Midazolam anaphylaxis is rare, and only a few cases have been reported, but such a risk is always present. In this study, we report a case of midazolam anaphylaxis by an intravenous injection, in the prone position, during general anesthesia. PATIENT CONCERNS: A 62-year-old woman was intravenously administered 1 mg midazolam during general anesthesia, and sudden severe hypotension, bronchospasm, decreased oxygen saturation, erythema, and diarrhea occurred. DIAGNOSIS: Midazolam anaphylaxis was presumptively diagnosed by clinical symptoms and was confirmed by an intradermal test after 9 weeks. INTERVENTIONS: The patient was treated with 100% oxygen, large volume of fluid, epinephrine, phenylephrine, ephedrine, dexamethasone and prednisolone, ranitidine, and flumazenil. OUTCOMES: Severe hypotension and decreased oxygen saturation were resolved within 20 minutes of the onset of anaphylaxis, and the patient was discharged after 3 days without any sequelae. LESSONS: Midazolam anaphylaxis is very rare, but it can happen always. Therefore, the possibility of anaphylaxis due to midazolam should be considered and always be prepared for treatment.


Assuntos
Anafilaxia/induzido quimicamente , Anestesia Geral/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Midazolam/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade
9.
Br J Anaesth ; 123(6): 808-817, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31587833

RESUMO

BACKGROUND: Preclinical studies suggest that exposure to general anaesthesia (GA) could cause neurodegeneration consistent with Alzheimer's disease (AD) pathology. Brain magnetic resonance imaging (MRI) is useful to study structural brain changes. We tested the hypothesis that exposure to surgery with GA (surgery/GA) is associated with greater cortical thinning and increased frequency of white matter lesions. METHODS: This is a cross-sectional analysis of 70-91-yr-old participants enrolled in the Mayo Clinic Study of Aging who had baseline MRI. The thickness of selected cortical regions, the volume of white matter hyperintensities, and the frequency of cortical infarctions were compared in participants who were and were not exposed to surgery/GA within 20 yr before the first MRI obtained after enrolment. RESULTS: Of 1410 participants with MRI scans, 932 were exposed to surgery/GA before scanning. In adjusted analyses, cortical thickness in regions vulnerable to AD was significantly less in those exposed to surgery/GA in the prior 20 yr (difference -0.023 mm, [95% confidence interval (CI) -0.041 to -0.005], P=0.014). Those with surgery in the prior 20 yr were more likely to have 'abnormal thickness' compared with those without surgery (odds ratio=1.45, [95% CI 1.10-1.90], P=0.009). Exposure was not associated with white matter hyperintensities or the presence of brain infarcts. CONCLUSIONS: This study suggests that exposure of older adults to surgical anaesthesia is associated with thinning in cortical regions implicated in AD. The pathogenesis and mechanisms driving these neurodegenerative changes, and the potential clinical significance of these findings, require further study.


Assuntos
Anestesia Geral/efeitos adversos , Encéfalo/efeitos dos fármacos , Encéfalo/diagnóstico por imagem , Avaliação Geriátrica/métodos , Imagem por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino
11.
Zhen Ci Yan Jiu ; 44(10): 747-51, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31657165

RESUMO

OBJECTIVE: To observe the prewarming effect of transcutaneous acupoint electrical stimulation (TAES) preconditioning of Dazhui (GV14) and Mingmen (GV4) in patients undergoing elective video-assisted thoracoscopic lobectomy, so as to determine whether TAES can improve intraoperative hypothermia. METHODS: A total of 80 patients undergoing elective video-assisted thoracoscopic lobectomy were randomly divided into TAES group (40 cases) and control group (40 cases). Before surgery, all the patients were transferred to the fixed area of an anesthetic preparation room by using a surgery cart carrying the same temperature sheets and quilts before surgery. TAES (2 Hz/100 Hz, 20-30 mA) was applied to Dazhui (GV14) and Mingmen (GV4) for 30 min for patients of the TAES group and the same sheet electrodes of EA stimulator were only attached to GV14 and GV 4 without electrical current transmission for patients in the control group. Then, these patients in the two groups were transferred to the operation room and treated by total intravenous anesthesia, and their anesthetic depth was monitored with bispectral index (BIS, between 45-60) and end-tidal carbon dioxide tension (PETCO2, between 30-45 mmHg). The auricular tympanic temperature was monitored, and when the temperature was below 35.5 ℃, forced-air blanket was used to warm the patient as the remedial measure. The same temperature of operation room, surgical drape, infusion solution and pleural lavage fluid were controlled. The patients' body temperature in the preparation room and operation room during surgery, incidence of hypothemia, blood pressure (BP), heart rate (HR), duration of anesthesia, duration of operation, blood loss volume, urine output, total infusion volume, recovery (awaking) time, and chills during recovery were recorded. RESULTS: The body temperature of patients in the TAES group was significantly higher than that in the control group at the time of entering the operation room (P<0.05). The incidence of chills during recovery was obviously lower in the TAES group (3/40,7.5%) than in the control group (7/40, 17.5%, P<0.05), and the recovery time was significantly shorter in the TAES group than in the control group (P<0.05). There were no significant differences between the two groups in the incidence of intraoperative hypothermia, the duration of anesthesia and operation, blood loss volume, urine output, total infusion volume, BP and HR (P>0.05). CONCLUSION: TAES preconditioning of GV14 and GV4 can produce prewarming effect before anesthesia, shorten the awaking time and reduce the incidence of chills in the recovery period in patients undergoing elective video-assisted thoracoscopic lobectomy.


Assuntos
Anestésicos , Estimulação Elétrica Nervosa Transcutânea , Pontos de Acupuntura , Anestesia Geral , Estimulação Elétrica , Humanos
12.
Am Surg ; 85(10): 1099-1103, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657302

RESUMO

Foley catheters (FCs) are often used during inguinal hernia operations; however, the impact of intraoperative FC use on postoperative urinary retention (POUR) is not well understood. We reviewed unplanned returns to the urgent care or ED for 27,012 inguinal hernia operations across 15 Southern California Kaiser Permanente medical centers over 6.5 years. In total, 239 (0.88%) patients returned to urgent care/ED with POUR [235 (98%) men versus 4 (2%) women]. Overall, POUR increased with age (P < 0.00001). POUR was higher in open repairs using general anesthesia versus local with monitored anesthesia care (0.7% vs 0.3%, P < 0.0001). Of 5,017 laparoscopic operations, 28 per cent had FC use. Although POUR was greater for laparoscopic versus open operations (2.21 vs 0.58%, P < 0.00001), there was no difference in POUR for intraoperative FC versus no FC use in the laparoscopic approach (2.36% vs 2.15%, P = 0.33). For all laparoscopic operations, there was no difference in urinary tract infection within 7 or 30 days when comparing intraoperative FC versus no FC use (P = 0.28). POUR can be minimized by avoiding general anesthesia for open inguinal hernia repairs, but intraoperative FC use does not affect POUR or urinary tract infection rates for laparoscopic inguinal hernia repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cateteres Urinários/efeitos adversos , Retenção Urinária/etiologia , Distribuição por Idade , Fatores Etários , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/estatística & dados numéricos , California/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cateteres Urinários/estatística & dados numéricos , Retenção Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
13.
Sheng Li Xue Bao ; 71(5): 749-759, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31646329

RESUMO

With the evolution of medical techniques and technology, an increasing number of infants, neonates, and fetuses are exposed to general anesthesia for clinical diagnostic and therapeutic process. The neurotoxic effects of general anesthetics on developing brain have been a subject of concern and considerable research interest. Population-based study confirmed that single short-term general anesthetic exposure does not affect nervous system function, but multiple exposures to general anesthesia could damage cognitive function. Animal studies further discovered the underlying mechanisms. Nervous system is most susceptible to general anesthetics during the brain growth spurt. The time-point is more critical than the duration of exposure to general anesthetics. General anesthetics can induce intracellular calcium overload, disturb energy metabolism, promote cell apoptosis and lead to cell loss. General anesthetics can damage synaptic structure, transmission and plasticity, and impair brain function. High throughput omics technologies have been used to screen the differentially expressed genes induced by general anesthetics, which provide further understanding of the mechanism of general anesthetics affecting cognitive function. This review provides an update on the pathophysiologic mechanisms underlying the anesthesia-neurotoxicity, which will be helpful to provide instructions for the clinical use of general anesthesia in children.


Assuntos
Anestésicos Gerais/efeitos adversos , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Cognição , Anestesia Geral/efeitos adversos , Animais , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia
14.
Artigo em Alemão | MEDLINE | ID: mdl-31639857

RESUMO

Rapid sequence induction and intubation (RSII) is the appropriate method of inducing general anaesthesia in patients who are at a risk of aspiration. The classical RSII is limited to a few treatment recommendations which are rarely based on evidence-based findings. New techniques (e.g., video laryngoscopy) as well as new means of diagnostics (e.g., sonography) require reevaluation of traditional techniques. In this article non-pharmacological treatment strategies of RSII are described. Furthermore, old and new methods to minimise the risk of aspiration are discussed. This includes gastric tube and gastric sonography as well as modalities for anaesthesia induction, e.g. patient positioning, face mask ventilation, relaxometry, cricoid and left-paratracheal pressure. In-hospital, RSII treatment standards must be familiar to all team members and treatment processes have to be well established and practiced regularly. The aim of this article is to present systematics that can be used as a decision-making basis for local operating procedures.


Assuntos
Intubação Intratraqueal , Laringoscópios , Posicionamento do Paciente , Anestesia Geral , Humanos , Intubação Intratraqueal/efeitos adversos
15.
Artigo em Alemão | MEDLINE | ID: mdl-31639858

RESUMO

The rapid sequence induction (RSI) is a not evidence-based technique designed to minimize the chance of pulmonary aspiration in high-risk patients requiring general anesthesia. Primary aim of this anesthetic technique is, therefore, a fast airway protection with an endotracheal tube to reduce the chance of passive or active regurgitation. This article discusses the anesthetic management of patients with an increased risk of aspiration, and, particularly, refers to the medications required for RSI.


Assuntos
Anestesia Geral , Anestésicos , Anestésicos/administração & dosagem , Anestésicos/farmacologia , Humanos , Intubação Intratraqueal
16.
Artigo em Alemão | MEDLINE | ID: mdl-31639859

RESUMO

Aspiration during anesthesia induction is no triviality, but can lead to serious complications and mortality. The classic technique of rapid sequence induction (RSI) is a fundamental form of anesthesia induction in non-fasting patients to prevent pulmonary aspiration of gastric contents.Pregnant women and children pose a special challenge due to their hypoxia risk; the classical RSI concept "induction - apnea - (cricoid pressure -) intubation" can lead to hypoxia and therefore must be modified in favor of a controlled technique with preservation of oxygenation in this patient group. A controlled procedure with continuous oxygenation as far as possible should be used.The preparation of an RSI involves the careful selection of medicines, equipment and monitoring. An important quality criterion of RSI is the atraumatic airway management in deep anesthesia with profound muscle relaxation without resistance (coughing, choking, pressing) of the patient.


Assuntos
Obstrução das Vias Respiratórias , Anestesia Geral , Jejum , Intubação Intratraqueal , Manuseio das Vias Aéreas , Criança , Feminino , Humanos , Gravidez , Pressão
17.
JAMA ; 322(13): 1283-1293, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573636

RESUMO

Importance: General anesthesia during thrombectomy for acute ischemic stroke has been associated with poor neurological outcome in nonrandomized studies. Three single-center randomized trials reported no significantly different or improved outcomes for patients who received general anesthesia compared with procedural sedation. Objective: To detect differences in functional outcome at 3 months between patients who received general anesthesia vs procedural sedation during thrombectomy for anterior circulation acute ischemic stroke. Data Source: MEDLINE search for English-language articles published from January 1, 1980, to July 31, 2019. Study Selection: Randomized clinical trials of adults with a National Institutes of Health Stroke Scale score of at least 10 and anterior circulation acute ischemic stroke assigned to receive general anesthesia or procedural sedation during thrombectomy. Data Extraction and Synthesis: Individual patient data were obtained from 3 single-center, randomized, parallel-group, open-label treatment trials with blinded end point evaluation that met inclusion criteria and were analyzed using fixed-effects meta-analysis. Main Outcomes and Measures: Degree of disability, measured via the modified Rankin Scale (mRS) score (range 0-6; lower scores indicate less disability), analyzed with the common odds ratio (cOR) to detect the ordinal shift in the distribution of disability over the range of mRS scores. Results: A total of 368 patients (mean [SD] age, 71.5 [12.9] years; 163 [44.3%] women; median [interquartile range] National Institutes of Health Stroke Scale score, 17 [14-21]) were included in the analysis, including 183 (49.7%) who received general anesthesia and 185 (50.3%) who received procedural sedation. The mean 3-month mRS score was 2.8 (95% CI, 2.5-3.1) in the general anesthesia group vs 3.2 (95% CI, 3.0-3.5) in the procedural sedation group (difference, 0.43 [95% CI, 0.03-0.83]; cOR, 1.58 [95% CI, 1.09-2.29]; P = .02). Among prespecified adverse events, only hypotension (decline in systolic blood pressure of more than 20% from baseline) (80.8% vs 53.1%; OR, 4.26 [95% CI, 2.55-7.09]; P < .001) and blood pressure variability (systolic blood pressure >180 mm Hg or <120 mm Hg) (79.7 vs 62.3%; OR, 2.42 [95% CI, 1.49-3.93]; P < .001) were significantly more common in the general anesthesia group. Conclusions and Relevance: Among patients with acute ischemic stroke involving the anterior circulation undergoing thrombectomy, the use of protocol-based general anesthesia, compared with procedural sedation, was significantly associated with less disability at 3 months. These findings should be interpreted tentatively, given that the individual trials examined were single-center trials and disability was the primary outcome in only 1 trial.


Assuntos
Anestesia Geral/efeitos adversos , Sedação Consciente/efeitos adversos , Pessoas com Deficiência/estatística & dados numéricos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Idoso , Isquemia Encefálica/cirurgia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(42): e17450, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626100

RESUMO

BACKGROUND: Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1ß, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients. METHODS: We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1ß, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups. DISCUSSION: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome. TRIAL IS REGISTERED AT CLINICALTRIALS.GOV:: NCT03823482.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Citocinas/efeitos dos fármacos , Aneurisma Intracraniano/cirurgia , Lidocaína/administração & dosagem , Adolescente , Adulto , Idoso , Anestesia por Condução/métodos , Anestesia Geral/métodos , Craniotomia/métodos , Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Feminino , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/líquido cefalorraquidiano , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Faringe , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Couro Cabeludo , Resultado do Tratamento , Adulto Jovem
19.
Medicine (Baltimore) ; 98(42): e17650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626151

RESUMO

INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS: Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS: Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES: After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION: The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.


Assuntos
Anestesia Geral/métodos , Oxigenação por Membrana Extracorpórea/métodos , Bócio Subesternal/cirurgia , Posicionamento do Paciente , Tireoidectomia/métodos , Estenose Traqueal/cirurgia , Idoso , Broncoscopia/métodos , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Humanos , Intubação Intratraqueal/métodos , Masculino , Radiografia Torácica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Estenose Traqueal/complicações
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