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1.
Artigo em Inglês | MEDLINE | ID: mdl-34204087

RESUMO

This study presents an anticipatory integrated education program for nausea, vomiting, and dizziness prevention (anti-NVD education program) for patients undergoing abdominal surgery under general anesthesia. The anti-NVD education program for nephrectomy patients consisted of the following: the causes of postoperative nausea, vomiting, and dizziness; effective deep breathing and how to use an inspirometer; postoperative nausea and vomiting; effective methods of patient-controlled analgesia; and the stepwise standing up method to prevent dizziness. A study was conducted among 79 adults (experimental group: n = 40, control group: n = 39). The degree of nausea and dizziness was measured using a numerical rating scale (NRS), and vomiting and the frequency of antiemetic use were measured in terms of the number of patients. The experimental group, which received the anti-NVD education, showed remarkably lower levels of nausea (p = 0.013) and dizziness (p < 0.001) than the control group. The frequency of antiemetic use 48 hours after surgery was significantly lower in the experimental group (p = 0.03). This study proved the efficacy of the anti-NVD education program for reducing postoperative nausea and dizziness. This program can be used as a noninvasive nursing intervention to prevent nausea, vomiting, and dizziness among patients undergoing abdominal surgery.


Assuntos
Antieméticos , Náusea e Vômito Pós-Operatórios , Adulto , Analgesia Controlada pelo Paciente , Anestesia Geral/efeitos adversos , Antieméticos/uso terapêutico , Tontura/etiologia , Tontura/prevenção & controle , Método Duplo-Cego , Humanos , Náusea e Vômito Pós-Operatórios/prevenção & controle
2.
Adv Gerontol ; 34(2): 264-271, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34245510

RESUMO

Airway patency during ENT surgery in general anesthesia is a serious problem. It is important to manage the degree of intraoperative bleeding to improve the visibility of the surgical site and reduce the risk of complications. Airway management may affect the severity of intraoperative bleeding. We have shown that the use of a laryngeal mask during endoscopic endonasal rhinosinus surgery during general anesthesia reduces the severity of the hemodynamic response, which is expressed in an increase in heart rate, mean arterial pressure and intraoperative bleeding, and also reduces the risk of surgery.


Assuntos
Geriatria , Máscaras Laríngeas , Anestesia Geral , Frequência Cardíaca , Hemodinâmica
3.
Trials ; 22(1): 458, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271982

RESUMO

BACKGROUND: The 'Melatonin for Anxiety prior to General anaesthesia In Children' (MAGIC) trial was designed to compare midazolam and melatonin as pre-medications for anxious children (aged five to fourteen), undergoing day-case surgical procedures under general anaesthesia. Low recruitment is a challenge for many trials, particularly paediatric trials and those in 'emergency' settings. A qualitative study as part of MAGIC aimed to gather stakeholder perspectives on barriers and enablers to recruitment. METHODS: Sixteen stakeholders from six sites participated in semi-structured interviews about their experiences of setting up the MAGIC trial and recruiting patients as part of the internal pilot. Data was analysed using framework analysis. RESULTS: Participants identified barriers and enablers to recruitment. Barriers and enablers related to the study, participants, the population of anxious children, practitioners, collaboration with other health professionals, ethics, specific settings and the context of surgical day units and the wider health system. Attempting to recruit anxious children from a surgical day unit is particularly challenging for several reasons. Issues include the practicalities of dealing with a child experiencing anxiety for parents/guardians; professional unwillingness to make things more difficult for families and clinicians and nurses valuing predictability within a busy and time-sensitive setting. CONCLUSIONS: Multi-site RCTs face recruitment barriers relating to study-wide and site-specific factors. There are multiple barriers to recruiting anxious children due to undergo day-case surgery. Barriers across domains can interrelate and reinforce each other, reflecting challenges relating to populations and settings. For example, in the case of anxious children, parents and other health professionals are concerned about exacerbating children's anxiety prior to surgery. They may look for ways to keep things predictable and avoid the uncertainty of an RCT. Pre-trial engagement work could help address concerns among collaborating health professionals. Using rapid ethnography during set-up or an internal pilot to focus on how the protocol will be or has been operationalised in practice may help identify issues. Allowing time to reflect on the findings of internal pilots and implement necessary changes could facilitate higher recruitment during the main phase of a trial. TRIAL REGISTRATION: NIHR Trial Registration Number: ISRCTN18296119 . Registered on October 01, 2019.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestésicos Gerais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Anestesia Geral/efeitos adversos , Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Criança , Humanos , Projetos Piloto
4.
Isr Med Assoc J ; 23(7): 408-411, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251121

RESUMO

BACKGROUND: Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries. OBJECTIVES: To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic. METHODS: We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications. RESULTS: We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001). CONCLUSIONS: We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.


Assuntos
Anestesia por Condução , Anestesia Geral , Anestesia Obstétrica , Cesárea , Recusa do Paciente ao Tratamento , Adulto , Anestesia por Condução/métodos , Anestesia por Condução/psicologia , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/métodos , Anestesia Geral/estatística & dados numéricos , Anestesia Obstétrica/métodos , Anestesia Obstétrica/psicologia , Árabes/psicologia , Árabes/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cesárea/métodos , Cesárea/estatística & dados numéricos , Salas de Parto/organização & administração , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Inovação Organizacional , Gravidez , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , Estudos Retrospectivos , Recusa do Paciente ao Tratamento/etnologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos
5.
J Contemp Dent Pract ; 22(4): 388-393, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34267008

RESUMO

AIM: This study aims to describe dental treatment provided to healthy and medically compromised patients treated under general anesthesia (GA) over a four-year period. MATERIALS AND METHODS: A total of 97 patients who received dental treatment under GA at the Saint Joseph University, Lebanon, from 2016 to 2019 were included in the study. The study population was analyzed according to the patient's age, medical status, and type of treatment done accordingly. RESULTS: The mean age of the patients was 9.15 ± 8.84 years. About 58.8% were aged below 6 years (primary dentition) and 48.5% had medical problems. Dental procedures performed were mostly extractions (4.00 ± 4.15 per patient) followed by resin composite restorations (3.66 ± 3.02 per patient). The mean number of pulpotomies per patient (p <0.001) and stainless steel crowns (p <0.001) were significantly higher in primary dentition, whereas in permanent dentition, the mean number of endodontic treatments per patient (p = 0.016) was significantly larger. Also, there was a significant difference between the type of treatment done on healthy and medically compromised patients (p <0.001). CONCLUSION: Better emphasis on oral health education and preventive strategies for children and special need patients is essential. CLINICAL SIGNIFICANCE: Dental GA is a reliable treatment for young uncooperative children and medically compromised patients. A multidisciplinary treatment plan must be conducted to ensure optimal oral healthcare and avoid unnecessary extractions.


Assuntos
Anestesia Dentária , Cárie Dentária , Adolescente , Idoso , Anestesia Geral , Criança , Pré-Escolar , Assistência Odontológica , Cárie Dentária/epidemiologia , Humanos , Lactente , Líbano , Estudos Retrospectivos , Dente Decíduo
6.
Medicine (Baltimore) ; 100(25): e26468, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160453

RESUMO

RATIONALE: The COVID-19 pandemic is spreading around the world and the leading cause of death is rapidly progressive respiratory failure because of lung damage and consolidation. Lung transplantation is the last line of treatment for chronic end-stage lung diseases. There were several cases of lung transplantation reported in patients with COVID-19 pneumonia. However, anesthetic management of lung transplantation in this subpopulation is rare. We report the anesthetic and perioperative management of lung transplantation in a patient with COVID-19 pneumonia. PATIENT CONCERNS: A 70-year-old man with a 7-day history of fever was diagnosed with COVID-19 pneumonia. His throat swab was positive for COVID-19, but negative for other common viruses. Chest radiography showed multiple inflammatory foci in both lungs. By day 5, he presented respiratory distress. Computed tomography (CT) scan showed progressive deterioration of both lungs. Starting on day 7, SARS-CoV-2 RNA in bronchoalveolar lavage samples were continuously negative. However, his lung condition deteriorated. By day 17, a veno-venous extracorporeal membrane oxygenation (ECMO) was initiated. After 10 days of ECMO support, the patient's lung condition did not improve. CT scan revealed bilateral parenchymal consolidation with pulmonary fibrosis and hydrothorax. DIAGNOSIS: Irreversible lung function loss induced by COVID-19 pneumonia. INTERVENTIONS: Bilateral transplantation was performed because the patient's lung condition did not improve and CT scan revealed parenchymal consolidation with pulmonary fibrosis after 10 days of ECMO support. Thirty-six hours after the surgery, ECMO was discontinued. A percutaneous transluminal coronary angioplasty and a stent implantation were performed because of acute coronary syndrome and myocardial ischemia 4 days postoperatively. OUTCOMES: The patient remained hospitalized because of requirements for intermittent assisted ventilation via tracheostomy. LESSONS: This case further supports the consideration that lung transplantation can potentially be the successful therapy for these patients who have developed irreversible lung function lose due to COVID-19 pneumonia. However, most critical patients with COVID-19 are older individuals with various comorbidities, which present new anesthetic challenges.


Assuntos
Anestesia Geral/métodos , COVID-19/complicações , Transplante de Pulmão/métodos , Pulmão/patologia , Síndrome do Desconforto Respiratório/terapia , Idoso , COVID-19/diagnóstico , COVID-19/terapia , COVID-19/virologia , Oxigenação por Membrana Extracorpórea , Fibrose , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Monitorização Intraoperatória/métodos , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
J Stroke Cerebrovasc Dis ; 30(8): 105926, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34171637

RESUMO

OBJECTIVE: Rebleeding of aneurysmal subarachnoid hemorrhage (aSAH) is one of the significant risk factors for poor clinical outcome. The rebleeding risk is the highest during the acute phase with an approximate rebleeding rate of 9-17% within the first 24 h. Theoretically, general anesthesia can stabilize a patient's vital signs; however, its effectiveness as initial management for preventing post-aSAH rebleeding remains unclear. The purpose of this study was to determine the feasibility and safety of ultra-early general anesthesia induction for reducing the rebleeding rates among patients with aSAH. MATERIALS AND METHODS: We retrospectively evaluated patients with aSAH who were admitted to our department between January 2013 and December 2019. All the patients underwent ultra-early general anesthesia induction as initial management regardless of their severity. We evaluated the rebleeding rate before definitive treatment, factors influencing rebleeding, and general anesthesia complications. RESULTS: We included 191 patients with two-third of them having a poor clinical grade (World Federation of Neurological Society [WFNS] grade IV or V). The median duration from admission to general anesthesia induction was 22 min. Rebleeding before definitive treatment occurred in nine patients (4.7%). There were significant differences in the Glasgow Coma Scale score (p = 0.047), WFNS grade (p = 0.02), and dissecting aneurysm (p <0.001) between the rebleeding and non-rebleeding patients. There were no cases of unsuccessful tracheal intubation or rebleeding during general anesthesia induction. CONCLUSION: Ultra-early general anesthesia induction could be performed safely in patients with aSAH, regardless of the WFNS grade; moreover, it resulted in lower rebleeding rate than that reported in previous epidemiological reports.


Assuntos
Anestesia Geral , Prevenção Secundária , Hemorragia Subaracnóidea/prevenção & controle , Tempo para o Tratamento , Adulto , Idoso , Anestesia Geral/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Neuroscience ; 468: 110-122, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34126184

RESUMO

Alterations in thalamic GABAergic signaling are implicated in mediating the rise in 12-30 Hz electroencephalogram (EEG) activity that signals anesthetic-induced loss-of-consciousness with GABAA receptor-targeting general anesthetics. A number of modeling studies have identified that anesthetic-induced alterations in thalamocortico-corticothalamic signaling in the same network that generates sleep spindles would be sufficient to elicit this key EEG signature of anesthetic hypnosis with general anesthetic agents. Accordingly, we hypothesize that targeted stimulation of this thalamic GABAergic circuitry into a sleep-spindle mode of activity would promote the general anesthetic effects of etomidate. We recorded EEG activity and loss-of-righting reflex in transgenic mice expressing channel rhodopsin-2 on GABAergic neurons (ChR2-VGAT, n = 8) and control, wild-type mice (C57BL/6J, n = 8). On two consecutive days mice were randomly assigned to receive spindle-rhythm stimulation via an optical probe targeting the left reticular thalamic nucleus or no stimulation. After an initial 30-minute recording, mice were administered etomidate (12 mg/kg, intraperitoneal) and recorded for 90 min with or without optical stimulation. Etomidate elicited an increase in 12-30 Hz EEG power in wild-type and ChR2-VGAT mice for 20 min following administration (p < 0.001). Optical spindle-rhythm stimulation prolonged the increase in 12-30 Hz activity in ChR2-VGAT mice only (p = 0.023). Spindle-rhythm stimulation also increased the incidence and duration of sleep spindle-like oscillations in ChR2-VGAT mice only (all p ≤ 0.001). Despite the maintained anesthetic-like changes in EEG activity, optical spindle-rhythm stimulation was not associated with changes in the time to and duration of the loss-of-righting reflex, a behavioral endpoint of etomidate-induced general anesthesia in rodents.


Assuntos
Estado de Consciência , Tálamo , Anestesia Geral , Animais , Eletroencefalografia , Camundongos , Camundongos Endogâmicos C57BL , Sono , Inconsciência/induzido quimicamente
10.
J Laryngol Otol ; 135(7): 620-624, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34078484

RESUMO

BACKGROUND: In adults, otitis media with effusion causes considerable morbidity and has poorly established outcomes. A small number of nasopharyngeal carcinoma patients present with isolated ear-related symptoms. The investigation of choice for these patients is a point of debate. METHODS: A retrospective cohort study was conducted using a local database of adult patients who underwent examination under anaesthesia of the post-nasal space with grommet insertion for otitis media with effusion between January 2014 and January 2016. RESULTS: Ninety-eight patients met the inclusion criteria. Follow-up duration ranged from 39 to 63 months. Complications of grommets were present in 36 out of 98 patients (36.73 per cent). The findings of examination under anaesthesia of the post-nasal space were documented as abnormal in three patients. No patient was diagnosed with nasopharyngeal carcinoma. CONCLUSION: Grommets in adults with otitis media with effusion as the sole presenting feature carry a high complication rate, especially in those with previously inserted grommets. Examination under anaesthesia of the post-nasal space offers a low yield. A magnetic resonance imaging scan of the post-nasal space may be a more sensitive alternative.


Assuntos
Ventilação da Orelha Média , Carcinoma Nasofaríngeo/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Otite Média com Derrame/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Estudos de Coortes , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nasofaringe , Exame Físico , Estudos Retrospectivos , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-34067551

RESUMO

Potential risk factors for postoperative vomiting (POV) are important for daily anesthesia practice. To identify the risk factors associated with POV we retrospectively reviewed 553 adult patients who underwent scheduled simple laparoscopic cholecystectomy under sevoflurane-based general anesthesia between January and December 2018. Patients who experienced POV were predominantly women, had lower body weight, and higher ASA (American Society of Anesthesiologists) physical status. The POV group showed female sex predominance, lower body weight, and higher ASA physical status, with a significant difference when compared with the non-POV group. In univariate analysis, female sex and Apfel scores of 2, 3, and 4 were associated with a higher POV incidence. Age > 70 years, higher body weight, and ASA physical status III were associated with a lower POV incidence. In multivariate logistic regression, sex, age, Apfel score, and intraoperative crystalloid infusion rate were POV predictive factors. Receiver operating characteristic analysis showed a negative association between the intraoperative crystalloid infusion rate and POV occurrence with an area under the curve of 0.73 (p = 0.001). The cutoff intraoperative crystalloid infusion rate was 2 mL/kg/h with 82% sensitivity and 49% specificity (≥2 mL/kg/h was associated with a lower POV incidence vs. <2 mL/kg/h (OR, 95% CI; 0.52 [0.33-0.83])). To decrease POV in these patients, identifying high-risk factors and an intraoperative crystalloid administration of ≥2 mL/kg/h should be considered in patients undergoing LC under sevoflurane-based general anesthesia.


Assuntos
Colecistectomia Laparoscópica , Náusea e Vômito Pós-Operatórios , Adulto , Idoso , Anestesia Geral/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Humanos , Incidência , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 100(23): e25859, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114984

RESUMO

RATIONALE: Several hereditary myopathies that can predispose to malignant hyperthermia (MH) are reported. However, the risk of MH in myotonic dystrophy type I (DM1) has been suggested equal to general population, although the evidence is limited to only a few case reports. PATIENT CONCERNS: We encountered a rare case of MH during anesthesia induction with sevoflurane in a male adolescent with previously undiagnosed DM1. DIAGNOSES: After the event, genetic testing revealed the presence of a previously unknown heterozygous missense mutation in ryanodine receptor 1 (RYR1) associated with MH (c.6898T > C; p.ser2300Pro). Concomitantly, the patient was diagnosed with DM1 with abnormal cytosine-thymine-guanine triplet expansion in the DMPK gene. INTERVENTIONS: Dantrolene was administered to treat the hypermetabolic manifestations in 20 minutes after the identification of MH. OUTCOMES: The patient was successfully treated and discharged without any complications. Laboratory abnormalities were recovered to baseline at postoperative 4 days. LESSONS: The authors suggest that possible MH susceptibility in DM1 patients may be refocused. Genetic testing can be a screening tool for MH susceptibility in these population, prior to receiving general anesthesia.


Assuntos
Anestesia Geral , Hipertermia Maligna , Relaxantes Musculares Centrais/administração & dosagem , Distrofia Miotônica , Miotonina Proteína Quinase/genética , Adolescente , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Dantroleno/administração & dosagem , Predisposição Genética para Doença , Testes Genéticos , Humanos , Masculino , Hipertermia Maligna/diagnóstico , Hipertermia Maligna/etiologia , Hipertermia Maligna/terapia , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/genética , Distrofia Miotônica/fisiopatologia , Administração dos Cuidados ao Paciente/métodos , Torcicolo/diagnóstico , Torcicolo/cirurgia , Resultado do Tratamento , Expansão das Repetições de Trinucleotídeos
15.
Zhongguo Zhen Jiu ; 41(6): 598-602, 2021 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-34085474

RESUMO

OBJECTIVE: To observe the protective effect of electroacupuncture (EA) at Neiguan (PC 6) on pulmonary function during one-lung ventilation (OLV) in patients with lobectomy, and explore its action mechanism. METHODS: Sixty patients with lobectomy were randomly divided into an observation group and a control group, 30 cases in each one. The patients in the control group were treated with general anesthesia, and OLV was given when surgery began; when the surgery finished, air was removed from the thoracic cavity and two-lung ventilation was performed. On the basis of the treatment in the control group, the patients in the observation group were treated with EA (disperse-dense wave, 2 Hz/100 Hz of frequency) at Neiguan (PC 6) 30 min before anesthesia induction until the end of the surgery. The pulmonary function indexes [arterial partial pressure of oxygen (PaO2), oxygenation index (OI), compliance of lung (CL), respiratory index (RI)] and serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were observed before surgery (T0), 30 min into OLV (T1), 60 min into OLV (T2) and after operation (T3). The total incidence of complications, pressing times of postoperative patient-controlled analgesia pump in 48 h after surgery and hospital stay were compared between the two groups. RESULTS: Compared with T0, the PaO2, OI, CL and serum SOD at T1, T2 and T3 in the two groups were decreased (P<0.05), and those in the observation group were higher than those in the control group (P<0.05). The RI and serum levels of MDA, IL-6, TNF-α at T1, T2 and T3 in the two groups were increased, and those in the observation group were lower than those in the control group (P<0.05). The total incidence of complications in the observation group was lower than that in the control group [3.3% (1/30) vs 23.3% (7/30), P<0.05]. The pressing times of postoperative patient-controlled analgesia pump in 48 h after surgery and hospital stay in the observation group were less than those in the control group (P<0.05). CONCLUSION: EA at Neiguan (PC 6) has protective effects on lung injury induced by OLV after lobectomy, and its mechanism may be related to the improvement of oxidative stress and inflammatory response.


Assuntos
Eletroacupuntura , Lesão Pulmonar , Ventilação Monopulmonar , Anestesia Geral , Humanos , Pulmão
16.
Compend Contin Educ Dent ; 42(3): 134-138, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34010574

RESUMO

Protective stabilization (PS) is a method of medical restraint used for behavior management for children and adults with special needs for dental care. With the increase in availability and options for behavior management techniques, PS has become less popular and more controversial. This scoping review analyzes the use of PS for dental care for adults with special needs within the literature. METHODS: A review of publications between 1990 and 2020 was conducted in Ovid Medline, Embase, and Dentistry and Oral Sciences Source using the search terms as follows: "protective stabilization," "dentistry," "restraint," "patient positioning," and "immobilization," with Boolean operators "AND" and "OR." Articles were screened by title and abstract and included by full read review with consensus from the research team. RESULTS: A total of 298 articles were reviewed and 29 were included as part of the scoping review. The articles include original research, policy guidelines, and clinical commentary reviews. CONCLUSION: There is variable evidence regarding the use of PS as a method of behavioral management for adults with special needs. It is less popular for use due to improvements in alternative methods such as pharmacologic intervention and general anesthesia. PS still has applicable use among this population and is dependent on patient and parental consent, patient selection and safety, and clinician training.


Assuntos
Anestesia Geral , Atenção à Saúde , Adulto , Criança , Humanos
17.
Brain Behav ; 11(6): e02161, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33960706

RESUMO

INTRODUCTION: Endovascular therapy is the standard of care for severe acute ischemic stroke caused by large-vessel occlusion in the anterior circulation, but there is a debate on the optimal anesthetic approach during this therapy. Meta-analyses of observational studies suggest that general anesthesia increases disability and death compared with conscious sedation However, their results are conflicting. This meta-analysis study was performed to assess the relationship between the effects of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke. METHODS: Through a systematic literature search up to August 2020, 18 studies included 4,802 subjects at baseline with endovascular therapy for acute ischemic stroke and reported a total of 1,711 subjects using general anesthesia and 1,961 subjects using conscious sedation were found. They recorded relationships between the effects of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke. Odds ratio (OR) or Mean differences (MD) with 95% confidence intervals (CIs) were calculated between the effect of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke using the dichotomous or contentious methods with a random or fixed-effect model. RESULTS: No significant difference were found between general anesthesia and conscious sedation during the endovascular therapy for acute ischemic stroke in functional independence at 90 days (OR, 0.78; 95% CI, 0.44-1.40, p = 40); successful recanalization at 24 hr (OR, 1.23; 95% CI, 0.62-2.41, p = 55); mortality at 90 days (OR, 1.36; 95% CI, 0.83-2.24, p = .22); interventional complication (OR, 1.24; 95% CI, 0.76-2.02, p = .40); symptomatic intracranial hemorrhage (OR, 0.64; 95% CI, 0.41-0.99, p = .05); aspiration pneumonia (OR, 0.96; 95% CI, 0.58-1.58, p = .87); and National Institute of Health Stroke Scale score after 24 hr (MD, 0.38; 95% CI, -1.15-1.91, p = .62); with relative relationship favoring general anesthesia only in decreasing the symptomatic intracranial hemorrhage. CONCLUSIONS: General anesthesia has no independent relationship compared to conscious sedation during the endovascular therapy for acute ischemic stroke with a relative relationship favoring general anesthesia only in decreasing the symptomatic intracranial hemorrhage. This relationship encouraged us to recommend either anesthetic strategy during the endovascular therapy for acute ischemic stroke with no possible fear of higher complication.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Anestesia Geral , Isquemia Encefálica/terapia , Sedação Consciente , Procedimentos Endovasculares/efeitos adversos , Humanos , Acidente Vascular Cerebral/terapia , Trombectomia , Resultado do Tratamento
18.
Ann Palliat Med ; 10(6): 6919-6925, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33977757

RESUMO

Alzheimer's disease (AD) is one of the main causes of dementia in the senium and presenium, which is clinically characterized by memory loss, decreased intelligence and loss of fine motor skills. The cerebellum is a key part of distributed neural circuits, not only involved in motor functions, but also in autonomic nervous, limbic and cognitive behaviors. Motor cerebellar lesions may cause movement disorders, and cognitive and limbic cerebellar lesions in the posterior lobe may cause intellectual and emotional sensory disorders. Cerebellar dysfunction or sleep disturbances may aggravate neurodegenerative and neuropsychiatric disorders, and they are is important factors in promoting AD. Several studies have shown that general anesthesia is the loss of consciousness induced by general anesthetics, which may be neurotoxic and could cause various long-term behavioral disorders. However, clinical experience regarding the association between AD and the effect of general anesthesia on the cerebellum and sleep quality still remains limited. In our narrative review, we reviewed the effect of general anesthesia on AD-related proteins. In addition, we also provide a comprehensive review of the effects of cerebellar dysfunction and postoperative sleep disturbances after general anesthesia on AD. Large-scale, multicenter trials are still needed to provide early identification and intervention to improve the postoperative recovery of patients.


Assuntos
Doença de Alzheimer , Doenças Cerebelares , Transtornos do Sono-Vigília , Anestesia Geral/efeitos adversos , Doenças Cerebelares/etiologia , Humanos , Sono , Transtornos do Sono-Vigília/etiologia
19.
J Clin Anesth ; 73: 110325, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33975095

RESUMO

STUDY OBJECTIVE: In the upcoming years there will be a growing number of elderly patients requiring general anaesthesia. As age is an independent risk factor for postoperative delirium (POD) the incidence of POD will increase concordantly. One approach to reduce the risk of POD would be to avoid excessively high doses of anaesthetics by using neuromonitoring to guide anaesthesia titration. Therefore, we evaluated the influence of patient's age on various electroencephalogram (EEG)-based anaesthesia indices. DESIGN AND PATIENTS: We conducted an analysis of previously published data by replaying single electrode EEG episodes of maintenance of general anaesthesia from 180 patients (18-90 years; ASA I-IV) into the five different commercially available monitoring systems and evaluated their indices. We included the State/Response Entropy, Narcotrend, qCON/qNOX, bispectral index (BIS), and Treaton MGA-06. For a non-commercial comparison, we extracted the spectral edge frequency (SEF) from the BIS. To evaluate the influence of the age we generated linear regression models. We also assessed the correlation between the various indices. MAIN RESULTS: During anaesthetic maintenance the values of the SEF, State/Response Entropy, qCON/qNOX and BIS all significantly increased (0.05 Hz/0.19-0.26 index points per year) with the patient's age (p < 0.001); whereas the Narcotrend did not change significantly with age (0.06 index points per year; p = 0.28). The index values of the Treaton device significantly decreased with age (-0.09 index points per year; p < 0.001). These findings were independent of the administered dose of anaesthetics. CONCLUSIONS: Almost all current neuromonitoring devices are influenced by age, with the potential to result in inappropriately high dosage of anaesthetics. Therefore, anaesthesiologists should be aware of this phenomenon, and the next generation of monitors should correct for these changes.


Assuntos
Anestesiologia , Anestésicos , Delírio , Idoso , Anestesia Geral/efeitos adversos , Eletroencefalografia , Humanos
20.
Medicine (Baltimore) ; 100(18): e25717, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950954

RESUMO

BACKGROUND: Intravenous dexmedetomidine (DEX) has been used to prevent emergence agitation (EA) in children. The aim of this meta-analysis was to evaluate whether DEX decreases EA incidence without augmenting oculocardiac reflex (OCR) in pediatric patients undergoing strabismus surgery. METHODS: We searched PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and the Cochrane Library to collect the randomized controlled trials (RCTs) investigating the effects of intraoperative DEX in children undergoing strabismus surgery from inception to October 2019. Postoperative Pediatric Agitation and Emergence Delirium (PAED) score, postoperative EA, extubation or laryngeal mask airway (LMA) removal time, postanesthetic care unit (PACU) stay time, OCR, and postoperative vomiting (POV) were evaluated. RESULTS: 11 RCTs including 801 patients were included in this study. Compared with control group, intravenous DEX significantly reduced postoperative PAED score (WMD, 3.05; 95% CI: -3.82 to -2.27, P = .017) and incidences of postoperative EA 69% (RR, 0.31; 95% CI: 0.17 to 0.55, P < .00) and POV (RR, 0.28; 95% CI: 0.13 to 0.61, P = .001). Furthermore, the use of DEX significantly delayed extubation or LMA removal time (WMD, 2.11; 95% CI: 0.25 to 3.97, P < .001). No significant difference was found in the incidence of ORC and PACU stay time. CONCLUSION: Intravenous DEX reduced the incidences of EA without increasing OCR in pediatric patients undergoing strabismus surgery. Meanwhile, DEX infusion decreased the incidence of POV in children.


Assuntos
Anestesia Geral/efeitos adversos , Dexmedetomidina/administração & dosagem , Delírio do Despertar/prevenção & controle , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Reflexo Oculocardíaco/efeitos dos fármacos , Dexmedetomidina/efeitos adversos , Delírio do Despertar/epidemiologia , Delírio do Despertar/etiologia , Humanos , Incidência , Injeções Intravenosas , Período Perioperatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Estrabismo/cirurgia , Resultado do Tratamento
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