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1.
J Int Med Res ; 49(9): 3000605211043245, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34521241

RESUMO

OBJECTIVE: Pulmonary complication is common in older patients after surgery. We analyzed risk factors of lower respiratory tract infection after general anesthesia among older patients. METHODS: In this retrospective investigation, we included older patients who underwent surgery with general anesthesia. Logistic regression analyses were performed to determine risk factors of lower respiratory tract infection. RESULTS: A total 418 postoperative patients with general anesthesia were included; the incidence of lower respiratory tract infection was 9.33%. Ten cases were caused by gram-positive bacteria, 26 cases by gram-negative bacteria, and 2 cases by fungus. We found significant differences in age, smoking, diabetes, oral/nasal tracheal intubation, and surgery duration. Logistic regression analysis indicated that age ≥70 years (odds ratio [OR] 2.028, 95% confidence interval [CI] 1.115-3.646), smoking (OR 2.314, 95% CI 1.073-4.229), diabetes (OR 2.185, 95% CI 1.166-4.435), nasotracheal intubation (OR 3.528, 95% CI 1.104-5.074), and duration of surgery ≥180 minutes (OR 1.334, 95% CI 1.015-1.923) were independent risk factors of lower respiratory tract infections. CONCLUSIONS: Older patients undergoing general anesthesia after tracheal intubation have a high risk of lower respiratory tract infections. Clinical interventions should be provided to prevent pulmonary infections in patients with relevant risk factors.


Assuntos
Anestesia Geral , Infecções Respiratórias , Idoso , Anestesia Geral/efeitos adversos , Humanos , Intubação Intratraqueal , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Estudos Retrospectivos , Fatores de Risco
2.
Pan Afr Med J ; 38: 375, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367454

RESUMO

Introduction: incident reporting systems are widely utilised within healthcare to analyse adverse events and have been shown to reduce patient harm. With data to suggest high anaesthetic-related mortality in low and middle-income countries (LMICs), such systems could allow more accurate determination of rates and types of incidents and could improve patient safety. Methods: this prospective observational study carried out over six-weeks in March to April 2019 in an Ethiopian tertiary referral hospital, included direct observations in the operating room and recording of any anaesthesia-related adverse events occurring during the perioperative period. Results: fifty surgical cases were observed during weekday daytime hours. Sixteen anaesthesia-related adverse events were observed in 12 patients, including six elective cases and six emergencies, an adverse event rate of 32% (n=16), affecting 24% (n=12) of patients. Most incidents occurred in infants less than one-year-old and those between 11-20 years (31.3%; n=5 each) and those undergoing general anaesthesia (66.7%; n=8), particularly during the induction phase (50%; n=8), the most common event being prolonged desaturation (31.3%; n=5). Most events were considered to contribute a low level of harm (56.3%; n=9). There were no intra-operative mortalities. Conclusion: this study presents evidence of a higher rate of adverse events during anaesthesia at a tertiary referral hospital in Ethiopia, than reported in current literature from LMICs. There is potential for large volume data to be produced and learnt from with a reporting system in place in this setting. The most common event was desaturation detected by pulse oximetry, particularly in paediatric surgery.


Assuntos
Anestesia Geral/efeitos adversos , Anestesia/efeitos adversos , Adolescente , Adulto , Distribuição por Idade , Anestesia/métodos , Anestesia Geral/métodos , Criança , Pré-Escolar , Etiópia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Oximetria , Estudos Prospectivos , Gestão de Riscos , Centros de Atenção Terciária , Adulto Jovem
3.
Medicine (Baltimore) ; 100(32): e26773, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397880

RESUMO

ABSTRACT: Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR.Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery.We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146-1.904), body mass index ≥25 kg/m2 (OR 1.303, 95% CI 1.102-1.912), alcohol drinking (OR 2.041, 95% CI 1.336-3.085), smoking (OR 1.128, 95% CI 1.007-2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039-1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013-1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008-1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05).It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
4.
Am J Vet Res ; 82(9): 695-700, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34432514

RESUMO

OBJECTIVE: To investigate whether premedication with hydromorphone alone or combined with acepromazine or dexmedetomidine affects the incidence of gastroesophageal reflux (GER) and regurgitation in dogs undergoing general anesthesia for elective orthopedic surgery. ANIMALS: 39 healthy client-owned dogs undergoing general anesthesia for elective orthopedic surgery between November 2016 and November 2018. PROCEDURES: For this prospective, randomized, controlled, blinded clinical trial, dogs were randomly assigned to be premedicated with hydromorphone (0.1 mg/kg, IM) alone (group H [control group]) or with either acepromazine (0.05 mg/kg, IM; group AH) or dexmedetomidine (6 µg/kg, IM; group DH) before undergoing general anesthesia induced with propofol and maintained with isoflurane. A pH sensor-tipped probe was used to identify episodes of GER (esophageal pH < 4 or > 7.5 for ≥ 30 seconds). Results for GER, regurgitation, vomiting, propofol dose, and durations of food withholding and anesthesia were compiled and compared across groups. RESULTS: There were 13 dogs in each group, and no meaningful differences were detected in age, body weight, sex, breed, or durations of anesthesia or food withholding across groups. Overall, 16 of the 39 (41%) dogs developed GER: 9 in group H, 6 in group AH, and 1 in group DH. The incidence of GER was significantly lower for group DH versus group H. Six of the 39 (15%) dogs regurgitated: 4 in group H and 2 in group AH. CONCLUSIONS AND CLINICAL RELEVANCE: The combined use of dexmedetomidine and hydromorphone as premedication may be a better choice to reduce GER in healthy dogs undergoing orthopedic surgery than would the use of hydromorphone with or without acepromazine. Additional research is warranted.


Assuntos
Dexmedetomidina , Doenças do Cão , Refluxo Gastroesofágico , Acepromazina , Anestesia Geral/efeitos adversos , Anestesia Geral/veterinária , Animais , Doenças do Cão/prevenção & controle , Cães , Refluxo Gastroesofágico/veterinária , Hidromorfona , Pré-Medicação/veterinária , Estudos Prospectivos , Vômito/veterinária
5.
Curr Opin Anaesthesiol ; 34(5): 563-568, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34291750

RESUMO

PURPOSE OF REVIEW: Deep brain stimulation (DBS) is a rapidly expanding surgical modality for the treatment of patients with movement disorders. Its ability to be adjusted, titrated, and optimized over time has given it a significant advantage over traditional more invasive surgical procedures. Therefore, the success and popularity of this procedure have led to the discovery of new indications and therapeutic targets as well as advances in surgical techniques. The aim of this review is to highlight the important updates in DBS surgery and to exam the anesthesiologist's role in providing optimal clinical management. RECENT FINDINGS: New therapeutic indications have a significant implication on perioperative anesthesia management. In addition, new technologies like frameless stereotaxy and intraoperative magnetic resonance imaging to guide electrode placement have altered the need for intraoperative neurophysiological monitoring and hence increased the use of general anesthesia. With an expanding number of patients undergoing DBS implantation, patients with preexisting DBS increasingly require anesthesia for unrelated surgery and the anesthesiologist must be aware of the considerations for perioperative management of these devices and potential complications. SUMMARY: DBS will continue to grow and evolve requiring adaptation and modification to the anesthetic management of these patients.


Assuntos
Anestésicos , Estimulação Encefálica Profunda , Anestesia Geral/efeitos adversos , Humanos , Imageamento por Ressonância Magnética , Procedimentos Neurocirúrgicos
6.
Eur J Vasc Endovasc Surg ; 62(3): 476-484, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34303598

RESUMO

OBJECTIVE: Primary and secondary lower extremity amputation, performed for patients with lower extremity arterial disease, is associated with increased post-operative morbidity. The aim of the study was to assess the impact of regional anaesthesia vs. general anaesthesia on post-operative pulmonary complications. METHODS: A retrospective analysis of 45 492 patients undergoing lower extremity amputation between 2005 and 2018 was conducted using data from the American College of Surgeons National Safety Quality Improvement Program database. Multivariable logistic regression was carried out to assess differences in primary outcome of post-operative pulmonary complications (pneumonia or respiratory failure requiring re-intubation) within 48 hours and 30 days after surgery between patients receiving regional (RA) or general anaesthesia (GA). Secondary outcomes included post-operative blood transfusion, septic shock, re-operation, and post-operative death within 30 days. RESULTS: Of 45 492 patients, 40 026 (88.0%) received GA and 5 466 (12.0%) RA. Patients who received GA had higher odds of developing pulmonary complications at 48 hours (2.1% vs. 1.4%; adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI] 1.09 - 1.78; p = .007) and within 30 days (6.3% vs. 5.9%; aOR 1.15, 95% CI 1.09 - 1.78; p = .039). The odds of blood transfusions (aOR 1.11, 95% CI 1.02 - 1.21; p = .017), septic shock (aOR 1.29, 95% CI 1.03 - 1.60; p = .025) and re-operation (OR 1.26, 95% CI 1.03 - 1.53; p = .023) were also higher for patients who received GA vs. patients who received RA. No difference in mortality rate was observed between patients who received GA and those who received RA (5.7% vs. 7.1%; odds ratio 0.95, 95% CI 0.84 - 1.07). CONCLUSION: A statistically significant reduction in pulmonary complications was observed in patients who received RA for lower extremity amputation compared with GA.


Assuntos
Amputação/efeitos adversos , Anestesia por Condução , Anestesia Geral/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Amputação/mortalidade , Anestesia por Condução/efeitos adversos , Anestesia por Condução/mortalidade , Anestesia Geral/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
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
8.
J Coll Physicians Surg Pak ; 31(8): 885-890, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34320702

RESUMO

OBJECTIVE: To evaluate the impact of general anesthesia (GA) combined with epidural anesthesia (GAEA) on postoperative cognitive dysfunction (POCD) and inflammatory markers in patients with esophageal cancer (EC).   Study Design: A randomised controlled trial. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan Province, China, from August 2019 to April 2020. METHODOLOGY: SPSS was used to randomly divide 142 cases into two groups, namely: the GA (n=71) and GAEA (n=71) categories. 128 candidates were used in this study. Cognitive function and the levels of interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis markers α (TNF-α) in serum were evaluated at baseline, 1, 3 and 7 days after operation by Montreal Cognitive Assessment (MoCA) and enzyme-linked immunosorbent assay (ELISA), respectively. Pearson correlation analysis was used to assess the interrelationships between MoCA score and inflammatory markers levels. RESULTS: Compared to the GA group (n=64), the GAEA category (n=64) showed significantly higher MoCA score on 1 day and 3 days postoperatively (all p <0.05). IL-6, IL-8 and TNF-α in the GA group were significantly increased on 1, 3 and 7 days after surgery (all p <0.05). Pearson correlation analysis indicated that the three inflammatory markers were inversely correlated with cognitive function score (all p <0.05). The postoperative adverse events between the two groups were comparable (all p >0.05). CONCLUSION: Combining general and epidural anesthesia may reduce the incidence of POCD in patients undergoing esophagectomy by suppressing inflammatory response. Key Words: General anesthesia, Epidural anesthesia, Esophageal cancer, Postoperative cognitive dysfunction, Inflammatory markers.


Assuntos
Anestesia Epidural , Disfunção Cognitiva , Neoplasias Esofágicas , Anestesia Epidural/efeitos adversos , Anestesia Geral/efeitos adversos , China , Disfunção Cognitiva/etiologia , Neoplasias Esofágicas/cirurgia , Humanos , Complicações Pós-Operatórias
9.
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
10.
Artigo em Inglês | MEDLINE | ID: mdl-34299991

RESUMO

BACKGROUND: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. METHODS: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. RESULTS: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. CONCLUSIONS: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.


Assuntos
Hipotermia , Anestesia Geral/efeitos adversos , Temperatura Corporal , Criança , Humanos , Hipotermia/prevenção & controle , Fatores de Risco
11.
Anesth Analg ; 133(2): 491-499, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081034

RESUMO

BACKGROUND: Cricoid pressure has been used as a component of the rapid sequence induction and intubation technique. However, concerns have been raised regarding the effectiveness and safety of cricoid pressure. Paratracheal pressure, a potential alternative to cricoid pressure to prevent regurgitation of gastric contents or aspiration, has been studied to be more effective to cricoid pressure in preventing gastric insufflation during positive pressure ventilation. However, to adopt paratracheal compression into our practice, adverse effects including its effect on the glottic view during direct laryngoscopy should be studied. We conducted a randomized, double-blind, noninferiority trial comparing paratracheal and cricoid pressures for any adverse effects on the view during direct laryngoscopy, together with other secondary outcome measures. METHODS: In total, 140 adult patients undergoing general anesthesia randomly received paratracheal pressure (paratracheal group) or cricoid pressure (cricoid group) during anesthesia induction. The primary end point was the incidence of deteriorated laryngoscopic view, evaluated by modified Cormack-Lehane grade with a predefined noninferiority margin of 15%. Secondary end points included percentage of glottic opening score, ease of mask ventilation, change in ventilation volume and peak inspiratory pressure during mechanical mask ventilation, ease of tracheal intubation, and resistance encountered while advancing the tube into the glottis. The position of the esophagus was assessed by ultrasound in both groups to determine whether pressure applied to the respective area would be likely to result in esophageal compression. All secondary outcomes were tested for superiority, except percentage of glottic opening score, which was tested for noninferiority. RESULTS: Paratracheal pressure was noninferior to cricoid pressure regarding the incidence of deterioration of modified Cormack-Lehane grade (0% vs 2.9%; absolute risk difference, -2.9%; 95% confidence interval, -9.9 to 2.6, P <.0001). Mask ventilation, measured on an ordinal scale, was found to be easier (ie, more likely to have a lower score) with paratracheal pressure than with cricoid pressure (OR, 0.41; 95% confidence interval, 0.21-0.79; P = .008). The increase in peak inspiratory pressure was significantly less in the paratracheal group than in the cricoid group during mechanical mask ventilation (median [min, max], 0 [-1, 1] vs 0 [-1, 23]; P = .001). The differences in other secondary outcomes were nonsignificant between the groups. The anatomical position of the esophagus was more suitable for compression in the paratracheal region, compared to the cricoid cartilage region. CONCLUSIONS: Paratracheal pressure was noninferior to cricoid pressure with respect to the effect on glottic view during direct laryngoscopy.


Assuntos
Anestesia Geral , Cartilagem Cricoide , Glote , Intubação Intratraqueal , Laringoscopia , Respiração Artificial , Traqueia , Adulto , Idoso , Anestesia Geral/efeitos adversos , Cartilagem Cricoide/diagnóstico por imagem , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Esôfago/diagnóstico por imagem , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Laringoscopia/efeitos adversos , Laringoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Seul , Traqueia/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia
12.
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
13.
Anesth Analg ; 133(2): 406-412, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34106905

RESUMO

BACKGROUND: It remains unknown what constitutes physiologically relevant intraoperative bradycardia. Intraoperative bradycardia is usually defined using absolute heart rate thresholds, ignoring preoperative baseline heart rates. In contrast, we considered defining intraoperative bradycardia relative to preoperative ambulatory nighttime heart rate. Specifically, we hypothesized that the individual mean intraoperative heart rate is lower than the mean preoperative ambulatory nighttime heart rate. We, therefore, sought to investigate the relationship between the intraoperative and preoperative ambulatory nighttime heart rates in adults having noncardiac surgery with general anesthesia. Additionally, we sought to investigate the incidence of intraoperative bradycardia using relative versus absolute heart rate thresholds. METHODS: We conducted a secondary analysis of a database from a prospective study including preoperative ambulatory and intraoperative heart rates in 363 patients having noncardiac surgery with general anesthesia. RESULTS: The mean intraoperative heart rate was lower than the mean nighttime heart rate (mean difference, -9 bpm; 95% confidence interval [CI], -10 to -8 bpm; P < .001). The mean intraoperative heart rate was lower than the mean nighttime heart rate in 319 of 363 patients (88%; 95% CI, 84%-91%). The incidence of intraoperative bradycardia was 42% (95% CI, 38%-47%) when it was defined as intraoperative heart rate >30% lower than mean nighttime heart rate and 43% (95% CI, 38%-49%) when it was defined as intraoperative heart rate <45 bpm. CONCLUSIONS: The mean intraoperative heart rate is lower than the mean nighttime heart rate in about 9 of 10 patients. Intraoperative bradycardia might thus be physiologically and clinically important. Future research needs to investigate whether there is an association between intraoperative bradycardia and postoperative outcomes.


Assuntos
Bradicardia/epidemiologia , Ritmo Circadiano , Eletrocardiografia , Frequência Cardíaca , Monitorização Hemodinâmica , Monitorização Intraoperatória , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Anestesia Geral/efeitos adversos , Bradicardia/diagnóstico , Bradicardia/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
14.
Anesth Prog ; 68(2): 114-116, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34185860

RESUMO

The incidence of childhood-onset Basedow's (Graves') disease is approximately 5% of all cases. Herein, we report a teenage female patient diagnosed with childhood-onset Graves' disease immediately following general anesthesia. Her signs and symptoms included tachycardia immediately prior to general anesthesia, delirium upon emerging from anesthesia, persistent postoperative tachycardia and anxiety, and prolonged nausea and vomiting.


Assuntos
Doença de Graves , Cirurgia Bucal , Adolescente , Anestesia Geral/efeitos adversos , Feminino , Humanos
15.
Anesth Prog ; 68(2): 119-127, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34185861

RESUMO

Part 2 of "Anesthetic Management of the Pregnant Patient" reviews fetal development and maternal physiologic changes of interest to the dental practitioner. Part 2 of this review focuses on pharmacologic considerations, particularly the potential impact on the developing fetus. Along with a brief overview involving pharmacokinetics and pharmacodynamics of selected drugs, the following discussion focuses on currently accepted therapies and commonly used agents for pain control, sedation, and general anesthesia in the pregnant patient planned for or undergoing dental treatment.


Assuntos
Anestésicos , Odontólogos , Anestesia Geral/efeitos adversos , Anestésicos/efeitos adversos , Feminino , Feto , Humanos , Gravidez , Papel Profissional
16.
Int J Clin Pract ; 75(9): e14439, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34092002

RESUMO

PURPOSE: The aim of this study was to explore the overall efficacy and safety of ultrasound-guided quadratus lumborum block combined with general anaesthesia in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: The study included 76 patients who underwent PCNL at our hospital between October 2018 and October 2019. The patients were randomly divided into the study group (ultrasound-guided quadratus lumborum block combined with general anaesthesia, 38 cases) and the control group (general anaesthesia, 38 cases). The intra-operative estimated blood loss, operative time and intra-operative anaesthetic usage were recorded. Moreover, the effective pressing times of the posterior cerebral artery (PCA) and the dosage of sufentanil in patient-controlled intravenous analgesia (PCIA) were observed within 48 hours after operation. RESULTS: The dosage of propofol and remifentanil, the time of intestinal exhaust recovery time and the hospital study in the study group were lower than those in the control group. The HR and MAP of the two groups, with a trend towards gradual decrease at T0 and T1, were lower than those at T0. At 2, 6, 8 and 24 hours after operation, the visual analogue scale/score (VAS) of the study group was lower than that of the control group. The analgesic rescue rate, the dosage of sufentanil and the effective PCA compression times in the study group were lower than those in the control group. The total incidence of adverse reactions in postanaesthesia care unit in the study group was significantly lower than that in the control group (8/38 vs 18/38). CONCLUSION: The combination of ultrasound-guided quadratus lumborum block and general anaesthesia effectively exerts beneficial outcomes in terms of validly reducing the dose of tranquilisers and anaesthetic analgesics during PCNL, which is able to treat patients with anaesthetic mode of low opioids.


Assuntos
Nefrolitotomia Percutânea , Bloqueio Nervoso , Anestesia Geral/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Ultrassonografia de Intervenção
17.
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
18.
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
20.
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
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