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1.
Anaesthesist ; 69(4): 225-235, 2020 04.
Artigo em Alemão | MEDLINE | ID: mdl-32189015

RESUMO

The current outbreak of coronavirus disease (COVID-19) has reached Germany. The majority of people infected present with mild disease, but there are severe cases that need intensive care. Unlike other acute infectious diseases progressing to sepsis, the severe courses of COVID19 seemingly show prolonged progression from onset of first symptoms to life-threatening deterioration of (primarily) lung function. Diagnosis relies on PCR using specimens from the respiratory tract. Severe ARDS reflects the hallmark of a critical course of the disease. Preventing nosocomial infections (primarily by correct use of personal protective equipment) and maintenance of hospitals' operational capability are of utmost importance. Departments of Anaesthesia, Intensive Care and emergency medicine will envisage major challenges.


Assuntos
Anestesia Geral/métodos , Anestesiologistas , Infecções por Coronavirus , Cuidados Críticos/normas , Infecção Hospitalar , Controle de Infecções , Pandemias , Pneumonia Viral , Anestesia Geral/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Alemanha , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Salas Cirúrgicas , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
2.
Einstein (Sao Paulo) ; 17(4): eAE4791, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553359

RESUMO

Data collection for clinical research can be difficult, and electronic health record systems can facilitate this process. The aim of this study was to describe and evaluate the secondary use of electronic health records in data collection for an observational clinical study. We used Cerner Millennium®, an electronic health record software, following these steps: (1) data crossing between the study's case report forms and the electronic health record; (2) development of a manual collection method for data not recorded in Cerner Millennium®; (3) development of a study interface for automatic data collection in the electronic health records; (4) employee training; (5) data quality assessment; and (6) filling out the electronic case report form at the end of the study. Three case report forms were consolidated into the electronic case report form at the end of the study. Researchers performed daily qualitative and quantitative analyses of the data. Data were collected from 94 patients. In the first case report form, 76.5% of variables were obtained electronically, in the second, 95.5%, and in the third, 100%. The daily quality assessment of the whole process showed complete and correct data, widespread employee compliance and minimal interference in their practice. The secondary use of electronic health records is safe and effective, reduces manual labor, and provides data reliability. Anesthetic care and data collection may be done by the same professional.


Assuntos
Registros Eletrônicos de Saúde/normas , Controle de Formulários e Registros/métodos , Sistemas Computadorizados de Registros Médicos/normas , Anestesia Geral/normas , Confiabilidade dos Dados , Formulários como Assunto , Humanos , Complicações Pós-Operatórias , Estudos Prospectivos , Reprodutibilidade dos Testes , Respiração Artificial/normas , Procedimentos Cirúrgicos Robóticos/normas , Fatores de Tempo
3.
Curr Opin Anaesthesiol ; 32(5): 683-689, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389804

RESUMO

PURPOSE OF REVIEW: In several guidelines, regional anesthesia and analgesia have been suggested as safer alternatives for general anesthesia and systemic analgesia for their safety profile in patients suffering from obstructive sleep apnea (OSA). However, the underlying scientific basis is still evolving. The present review is intended to provide an up-to-date account on the question whether the use of regional anesthesia improves outcomes in patients with OSA. RECENT FINDINGS: A number of studies found favorable effects of regional anesthesia used in patients with OSA, including reduced incidence of major perioperative complications such as the need for mechanical ventilation, reintubation and pulmonary/cardiac complications. No negative effects of regional anesthesia specific to patients with OSA were found. Regional anesthesia was most effective when used as a sole technique, but also carried benefits when added to general anesthesia. The majority of available literature focuses on orthopedic surgery and neuraxial anesthesia. SUMMARY: Regional anesthesia can be recommended as a good strategy to treat patients with OSA whenever feasible, as it reduces the incidence of potentially catastrophic perioperative complications. However, the breadth of both surgical and regional anesthetic techniques analyzed is limited; further research should focus on extending the knowledge base beyond neuraxial anesthesia and orthopedics.


Assuntos
Anestesia por Condução/métodos , Manejo da Dor/métodos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Apneia Obstrutiva do Sono/complicações , Analgesia/métodos , Analgesia/normas , Anestesia por Condução/normas , Anestesia Geral/efeitos adversos , Anestesia Geral/normas , Anestesiologia/normas , Humanos , Incidência , Manejo da Dor/efeitos adversos , Manejo da Dor/normas , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Resultado do Tratamento
4.
Anesth Analg ; 129(3): 794-803, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425222

RESUMO

BACKGROUND: Noise in the operating room may cause distractions during critical periods and impair reliable communication between staff. Even momentary inefficiency while administering anesthesia can lead to errors and serious consequences for the patient. Distractions to an anesthesia provider during critical periods such as induction and emergence are a patient safety issue. Because of concerns regarding unacceptable noise levels and distractions during induction of general anesthesia, our institution developed a quality improvement initiative, the "Distraction-Free Induction Zone." The specific aim of this project was to decrease the percentage of cases with a distraction, described as music, unnecessary conversations, or loud noises, occurring during induction of general anesthesia in pediatric otolaryngology operating rooms from 61% to 15%. METHODS: To complete this quality improvement initiative, a multidisciplinary team used improvement science methods, including The Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We used tools such as the Key Driver Diagram, Pareto Charts, Process Flow Chart, and Plan-Do-Study-Act worksheets. Data were manually collected and entered weekly in an Excel spreadsheet. Statistical process control methods, including a run chart and a P-control chart, were used for data analysis. Our measure was a composite measure in which observation of 1 of the 3 distractions during induction of general anesthesia categorized the case as a case with a distraction. RESULTS: We tested and implemented several interventions via Plan-Do-Study-Act cycles in which 3 main interventions collectively were associated with an observed decrease in distractions during induction of general anesthesia. These included educating the perioperative staff present in the operating room to help them understand that distractions to anesthesia providers represent a patient safety issue, the operating room circulating nurse taking responsibility to pause any music on arrival to the operating room, and the anesthesiologist reminding the staff in the operating room of induction time and/or asking for quiet during induction if a distraction occurs. The percentage of cases with a distraction during induction of general anesthesia in our pediatric otolaryngology operating rooms decreased from 61% to 15% by April 15, 2017 and to 10% by June 5, 2017. CONCLUSIONS: Using improvement science methods, we observed a decrease in distractions during induction of general anesthesia, improved a process, and encouraged change in culture at a large academic children's hospital to enhance the quality and safety of the anesthetic care we provide our patients.


Assuntos
Centros Médicos Acadêmicos/normas , Anestesia Geral/normas , Pessoal de Saúde/normas , Hospitais Pediátricos/normas , Cuidados Pré-Operatórios/normas , Melhoria de Qualidade/normas , Centros Médicos Acadêmicos/métodos , Anestesia Geral/métodos , Anestésicos/administração & dosagem , Humanos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários
5.
BMC Urol ; 19(1): 61, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277626

RESUMO

BACKGROUND: One of the greatest challenges presented with RIRS is the potential for movement of the stone within the operative field associated with diaphragm and chest respiratory excursions due to mechanical ventilation. To overcome this challenge, we propose in this pilot study a new general anesthesia technique combining high frequency jet ventilation (HFJV) with small volume mechanical ventilation (SVMV). Data regarding safety, feasibility and surgeons' impression was assessed. METHODS: Patients undergoing RIRS for kidney stones from November 2017 to May 2018 were prospectively recruited to participate in the study. In each case after the beginning of general anesthesia (GA) with mechanical ventilation (MV) surgeons were asked to assess the mobility of the operative field and conditions for laser lithotripsy according to the developed questionnaire scale. The questionnaire consisted of 5 degrees of assessment of kidney mobility and each question was scored from 1 to 5, 1 being very mobile (extremely poor conditions for dusting) and 5 completely immobile (Ideal conditions for dusting). After the assessment GA was modified with combined respiratory support (CRS), reducing tidal volume and respiratory rate (small volume mechanical ventilation, SVMV) and applying in the same time transcatheter high frequency jet ventilation (HFJV) inside the closed circuit. After beginning of CRS, surgeons were once again asked to assess the mobility of the operative field and the conditions for laser lithotripsy. Main ventilation parameters were recorded and compared in both regimens. RESULTS: A total of 38 patients were included in the study. The mean age was 49 (range 45-53) with a mean stone size of 10 mm (range 10-14) and Hounsfield unit of 1060 (range 930-1190). All patients underwent successful RIRS and no intraoperative complications occurred throughout the duration of the study. A statistically significant difference between ventilation parameters prior to and after CRS institution was detected in all cases, however their clinical impact was negligible. Despite this, assessment via the questionnaire scale point values varied significantly before and after the application of CRS and were 2.3 (2.1; 2.6) and 3.8 (3.7; 4.0) respectively (p < 0.001). CONCLUSIONS: The novel combined respiratory approach consisting of HFJV and SVMV appears to provide better conditions for stone dusting through reduced respiratory kidney motion and is not associated with adverse health effects or complications. TRIAL REGISTRATION: NCT03999255 , date of registration: 25th June 2019 (retrospectively registered).


Assuntos
Anestesia Geral/métodos , Cálculos Renais/cirurgia , Litotripsia/métodos , Respiração Artificial/métodos , Anestesia Geral/normas , Feminino , Humanos , Cálculos Renais/diagnóstico , Litotripsia/normas , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração Artificial/normas
7.
Curr Opin Anaesthesiol ; 32(4): 523-530, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31045592

RESUMO

PURPOSE OF REVIEW: Anesthetic assistance is often required during endovascular therapy (EVT) of large vessel occlusion in patients with acute ischemic stroke. It is currently debated whether EVT should be performed under general anesthesia or conscious sedation. This review will summarize the recent literature with emphasis on the influence of anesthesia method on neurological outcome. RECENT FINDINGS: Recent randomized trials have reported no difference in outcome after EVT performed under either conscious sedation or general anesthesia. This is in contrast to a substantial number of retrospective studies, which found that EVT performed under general anesthesia was associated with a worse neurologic outcome compared with conscious sedation. Anesthetic drugs affect vessel tone and the level of blood pressure may influence outcome. The most favorable choice of anesthetic agents and ventilatory strategy is still debated. SUMMARY: The optimal anesthetic practice for EVT remains to be identified. Currently, conscious sedation is often an easy first-line strategy, but general anesthesia can be considered an equal and safe alternative to conscious sedation when there is a carefully administered anesthetic that maintains strict hemodynamic control. Attention to ventilation is advocated. The presence of a specialized neuroanesthesiologist or otherwise dedicated anesthesia personnel is highly recommended.


Assuntos
Anestesia Geral/normas , Infarto Encefálico/cirurgia , Sedação Consciente/normas , Procedimentos Endovasculares/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Anestesia Geral/efeitos adversos , Anestésicos Locais/administração & dosagem , Sedação Consciente/efeitos adversos , Europa (Continente) , Humanos , Estudos Observacionais como Assunto , Dor Pós-Operatória/etiologia , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
BMC Anesthesiol ; 19(1): 44, 2019 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-30927922

RESUMO

BACKGROUND: The intubating laryngeal mask Fastrach™ is considered a gold standard for blind intubation as well as for fibreoptic guided intubation via a laryngeal mask. Recently, a single use version of the mask has been introduced. We compared the Fastrach single use with the new, low-priced single use intubating laryngeal mask Ambu Aura-i™. We hypothesised that the LMA Ambu Aura-i and the LMA Fastrach are comparable with respect to success rates for mask placement and blind tracheal intubation through the LMA device. METHODS: A prospective, randomised clinical trial. University Hospital Schleswig-Holstein, Campus Kiel, from April 2011 to April 2012. Eighty patients undergoing general anaesthesia with planned tracheal intubation were randomised and enrolled in the study. Blind intubation was performed with either laryngeal mask using two different tracheal tubes (Rüsch Super Safety Silk™ and LMA ETT™). A crossover-design was performed after an unsuccessful procedure. Primary outcome measure was the overall success rate of blind intubation. Secondary outcome measures were the time to the first adequate ventilation, a subjective handling score, and a fibreoptic control of placement, as well as the success rate of mask placement, time for mask removal after successful intubation, differences in airway leak pressure, and the incidence of postoperative sore throat and hoarseness. RESULTS: The success rate of tracheal intubation with the Fastrach for the first and second attempt was significantly better compared with the Ambu Aura-i. Tracheal intubation was also significantly faster (14.1 s. ±4.4 versus 21.3 s. ±9.0; p < 0.01), and the time interval for mask removal after successful intubation was significantly shorter using the Fastrach device (24.0 s. ±8.2 versus 29.4 s. ±7.5; p < 0.001). There were no significant differences between groups regarding the incidence of postoperative sore throat and hoarseness. CONCLUSION: Both laryngeal mask devices are suitable for ventilation and oxygenation. Blind intubation remains the domain of the LMA Fastrach, the Ambu Aura-i is not suitable for blind intubation. TRIAL REGISTRATION: Clinicaltrials.gov Identification Number NCT03109678 , retrospectively registered on April 12, 2017.


Assuntos
Anestesia Geral/métodos , Anestesia Geral/normas , Competência Clínica/normas , Máscaras Laríngeas/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
9.
Curr Opin Anaesthesiol ; 32(4): 511-516, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30994477

RESUMO

PURPOSE OF REVIEW: Peroral endoscopic myotomy (POEM) was developed in Japan as a less invasive treatment for esophageal achalasia requiring general anesthesia under positive pressure ventilation. In 2018, the Japan Gastroenterological Endoscopy Society published the first guidelines describing the standard care for POEM. Based on these guidelines, we discuss the typical approach to anesthesia during POEM for the management of esophageal achalasia in Japan. RECENT FINDINGS: Prior cleansing of the esophagus is essential to prevent both aspiration during induction of anesthesia and contamination of the mediastinum and thoracic/abdominal cavity by esophageal remnants after endoscopic resection of the esophageal mucosa. Although rare, adverse events related to intraoperative carbon dioxide insufflation occur. These are treated through percutaneous needle decompression and insertion of a chest drainage tube for pneumoperitoneum and pneumothorax, respectively. Caution should be exercised regarding the development of subcutaneous emphysema and its involvement in airway obstruction. SUMMARY: Prevention of aspiration pneumonia and adverse events related to the insufflation of carbon dioxide is essential in the management of esophageal achalasia through POEM. Close cooperation between gastrointestinal endoscopic surgeons and anesthesiologists is indispensable in POEM.


Assuntos
Anestesia Geral/normas , Acalasia Esofágica/cirurgia , Miotomia/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Anestesiologistas/normas , Dióxido de Carbono/administração & dosagem , Dióxido de Carbono/efeitos adversos , Japão , Boca , Miotomia/métodos , Miotomia/normas , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/normas , Dor Pós-Operatória/etiologia , Equipe de Assistência ao Paciente/normas , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/prevenção & controle , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/normas , Guias de Prática Clínica como Assunto , Padrão de Cuidado , Cirurgiões/normas
10.
J Neurointerv Surg ; 11(11): 1070-1072, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30926686

RESUMO

BACKGROUND: The "General or Local Anesthesia in Intra-Arterial Therapy" (GOLIATH) trial compared infarct growth and outcome in patients undergoing endovascular therapy (EVT) under either general anesthesia (GA) or conscious sedation (CS). The results were the same for the primary outcome (infarct growth) but successful reperfusion was higher in the GA arm. OBJECTIVE: To further examine differences in the quality and safety of EVT with the two anesthetic regimens in a post hoc analysis of GOLIATH. METHODS: In GOLIATH, 128 subjects with anterior circulation large vessel occlusion stroke within 6 hours of onset were randomized to either GA or CS (1:1 allocation). We compared the quality of reperfusion, treatment delay, use of catheters, and contrast and radiation dosage between the trial arms. RESULTS: Sixty-five subjects were randomized to GA. Baseline demographic and clinical variables were similar between the treatment arms. We found no difference in procedure time, contrast dose, or radiation dose between the two arms. Tandem occlusions were associated with a longer procedure time, but there was no difference between the two arms. There was no difference in reperfusion rates between the direct aspiration technique and a stent retriever (86% vs 79%, respectively, p=0.54), but aspiration was associated with a shorter procedure time (28 min vs 42 min for a stent retriever), p=0.03. CONCLUSION: Safety and quality of EVT under either GA and CS are comparable. TRIAL REGISTRATION: Unique identifier: NCT02317237;Post-results.


Assuntos
Anestesia Geral/métodos , Isquemia Encefálica/terapia , Sedação Consciente/métodos , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/normas , Isquemia Encefálica/diagnóstico por imagem , Sedação Consciente/normas , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/normas , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Resultado do Tratamento
11.
A A Pract ; 12(5): 176-179, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30550435

RESUMO

Multiple-system atrophy, a rare adult-onset neurodegenerative disease, is associated with autonomic dysfunction, features of parkinsonism, and cerebellar ataxia. This article discusses multiple-system atrophy pathophysiology, clinical presentation, and perioperative issues pertinent to anesthesia.


Assuntos
Anestesia por Condução/normas , Anestesia Geral/normas , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/cirurgia , Guias de Prática Clínica como Assunto/normas , Anestesia/métodos , Anestesia/normas , Anestesia por Condução/métodos , Anestesia Geral/métodos , Humanos
12.
Curr Opin Anaesthesiol ; 32(1): 116-119, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30543554

RESUMO

PURPOSE OF REVIEW: There is an urge to improve care for patients with hip fracture. The present review will compare the efficacy of spinal versus general anesthesia for patients requiring hip fracture surgery. RECENT FINDINGS: The present review gives an overview with particular emphasis on literature published during the past 24 months. SUMMARY: So far, no clear evidence form randomized trials exists to identify the best anesthesia technique for hip fracture surgery. However, several large-scale pragmatic trials are ongoing and will provide future guidance.


Assuntos
Anestesia Geral/efeitos adversos , Raquianestesia/efeitos adversos , Delírio do Despertar/epidemiologia , Fixação de Fratura/efeitos adversos , Fraturas do Quadril/cirurgia , Fatores Etários , Idoso , Anestesia Geral/normas , Raquianestesia/normas , Anestésicos/efeitos adversos , Tomada de Decisão Clínica , Delírio do Despertar/etiologia , Delírio do Despertar/prevenção & controle , Humanos , Equipe de Assistência ao Paciente/normas , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Medicina (Kaunas) ; 54(5)2018 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-30360531

RESUMO

Background and objectives: Despite its wide use in thoracic procedures, to date, few studies have assessed the effectiveness of paravertebral block (PVB) in laparoscopic cholecystectomy (LC) in an adult population. In these studies, PVB was performed bilaterally using nerve stimulator guidance. To the best of our knowledge, the effectiveness of unilateral preoperative and postoperative ultrasound-guided PVB has not been evaluated in patients undergoing elective LC. The aim of this study was to evaluate the efficacy of single-dose unilateral paravertebral block (PVB) in patients undergoing laparoscopic cholecystectomy (LC) under general anesthesia. Materials and Methods: Patients undergoing LC were randomly separated into control, preoperative block, and postoperative block groups. PVB was performed unilaterally using bupivacaine under ultrasound guidance. Postoperative pain within the first 24 h, side effects, intraoperative opioid and postoperative analgesic requirements were noted. Evaluation was made of a total of 90 patients (25 males, 65 females) with a mean age of 45.78 ± 14.0 years (range, 19⁻74 years). Results: Opioid and additional analgesic needs and nausea/vomiting rates were significantly reduced in the preoperative block group compared to the other groups (p < 0.05). Visual Analog Scale (VAS) scores were significantly lower in the preoperative and postoperative block groups compared to the control group (p < 0.05 for all). When the VAS scores were compared between the preoperative and postoperative block groups, a significant difference in favor of the preoperative group was observed in terms of the zero minute-, 1st and 2nd h assessments (p < 0.05 for all). Conclusions: Ultrasound-guided PVB is a useful and safe approach for pain management during and after LC. Preoperative block can also reduce the rate of requirement for intraoperative opioid and postoperative analgesia.


Assuntos
Raquianestesia/métodos , Bupivacaína/uso terapêutico , Colecistectomia Laparoscópica , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacologia , Anestesia Geral/normas , Anestesia Local , Raquianestesia/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Bupivacaína/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/prevenção & controle , Bloqueio Nervoso/efeitos adversos , Resultado do Tratamento , Ultrassonografia , Vômito/induzido quimicamente , Vômito/prevenção & controle , Adulto Jovem
14.
Acta Biomed ; 89(3): 337-342, 2018 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-30333456

RESUMO

BACKGROUND: A suitable, effective and free of complications anesthetic protocol is very important in experimental studies on animal models since it could bias the outcome of a trial. To date there is no universally accepted protocol for induction, maintenance and recovery from anesthesia. The endotracheal intubation with the use of inhalation anesthesia is used very especially in the from of large size laboratory animals, because it is a secure and easy control mode. However, it is not common for small laboratory animals because of the high technical skills required. AIM: The aim of this paper is a review of the main methods of induction of anesthesia in laboratory animals. MATERIALS AND METHODS: We performed an electronic search of MEDLINE (PubMed interface), ISI Web of Science and Scopus using the keywords "anesthesia" and "animal (s)" or "protocol (s)" or "surgery", without the data or the language restriction. We consider only the most common laboratory animals (rats, mice, rabbits, pigs). We identify all the scientific articles that refer to the use of anesthetics for studies on laboratory animals in all areas: experimental surgery, CT, MRI, PET. All documents identified the search criteria are subject to review only by identifying relevant studies. CONCLUSIONS: There is a strong need for application of existing guidelines for research on experimental animals; specific guidelines for anesthesia and euthanasia should be considered and reported in future studies to ensure comparability and quality of animal experiments.


Assuntos
Anestesia Geral/métodos , Animais de Laboratório , Anestesia Geral/normas , Anestésicos/administração & dosagem , Animais , Eutanásia Animal/métodos , Guias como Assunto , Complicações Intraoperatórias/prevenção & controle , Intubação Intratraqueal/métodos , Mamíferos , Monitorização Intraoperatória/métodos , Medicação Pré-Anestésica , Tamanho da Amostra , Especificidade da Espécie
18.
Br J Anaesth ; 121(3): 662-671, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30115265

RESUMO

BACKGROUND: Maintaining situation awareness of monitored patients can be challenging because care providers must continually read and integrate multiple waveforms and numerical vital sign values into a mental model of the patient's situation. We developed and evaluated a technology designed to improve perception of vital sign information by presenting patient status as an animated patient avatar. METHODS: After step-wise improvement of the avatar, anaesthesia professionals from two hospitals participated in a comparative study of conventional monitoring. Participants observed identical monitoring scenarios via the two technologies for brief time intervals and afterwards recalled patient status. RESULTS: Overall, 150 anaesthesia professionals participated in the validation process and 32 participated in the comparative study, completing 128 scenarios, which allowed for 64 direct comparisons. The avatar's inter-rater reliability was high, with Fleiss' kappa of 0.98 (95% confidence interval 0.96-0.99, P<0.001). With the avatar, participants recalled almost twice as many vital signs correctly as with conventional monitoring (9 vs 5, P<0.001). Perceived confidence was improved (2=certain vs 1=uncertain, P<0.001) and perceived workload lowered (task load index 60 vs 76, P<0.001). Participants obtained these results only after watching an educational video explaining the avatar and suggesting quick learnability and potential for real-life usability. CONCLUSIONS: This study provides empirical evidence that an animated avatar offers the opportunity to transmit vital sign information significantly more quickly than conventional monitoring and with improved confidence and reduced cognitive effort. This could help care providers gain situation awareness more efficiently.


Assuntos
Anestesia Geral/métodos , Conscientização , Gráficos por Computador , Monitorização Intraoperatória/métodos , Sinais Vitais/fisiologia , Adulto , Anestesia Geral/normas , Competência Clínica , Diagnóstico por Computador/métodos , Feminino , Humanos , Masculino , Monitorização Intraoperatória/normas , Variações Dependentes do Observador , Interface Usuário-Computador , Carga de Trabalho/estatística & dados numéricos
19.
Anaesthesist ; 67(9): 654-663, 2018 09.
Artigo em Alemão | MEDLINE | ID: mdl-29959500

RESUMO

BACKGROUND: The goal of rapid sequence induction (RSI) in cases of emergency situations is to secure the airway as quickly as possible to prevent pulmonary aspiration of gastric contents; however, the technique itself is not standardized. For example, the choice of drugs, application of cricoid pressure and the patient position remain controversial. A survey of emergency medical services (EMS) physicians throughout Germany was carried out to assess the different RSI techniques used and with respect to complying with the national guidelines for emergency airway management anesthesia and local standard operating procedures (SOP). MATERIAL AND METHODS: Between 1 April 2017 and 31 May 2017, EMS medical directors in Germany were contacted and asked to distribute a 28-question online questionnaire to local EMS physicians. Of the questions 26 were multiple choice and 2 with plain text. After 6 weeks an e­mail reminder was sent. In addition, the survey was distributed via social media to EMS physicians. RESULTS: In total the survey was opened 2314 times and 1074 completed responses were received (completion rate 46%). Most of the participants were male (78%) and anesthesiologists (70%) and only one quarter had a local SOP for RSI. The most frequently used muscle relaxant was succinylcholine (62%) and over half of the participants reported using cricoid pressure (57%). There was a distinction between the specialist disciplines in the selection of drugs. Propofol was used most by anesthesiologists, while the others still used etomidate on a larger scale. Nearly 100% could fall back on supraglottic devices (one third laryngeal mask, two thirds laryngeal tube) but only 32.8% with the recommended esophageal drainage. A video laryngoscope was available to 51% of all EMS physicians surveyed. CONCLUSION: The results of the survey demonstrate heterogeneity in RSI techniques used by EMS physicians in Germany. Medical equipment and safe care practices, such as labeling of syringes varied considerably between different service areas. The recommendations of the S1 national guidelines on emergency airway management and anesthesia should be adhered to together with the implementation of local SOPs.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Geral/métodos , Manuseio das Vias Aéreas/normas , Anestesia Geral/normas , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Humanos , Intubação Intratraqueal , Masculino , Inquéritos e Questionários
20.
BMC Anesthesiol ; 18(1): 66, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29902969

RESUMO

BACKGROUND: It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. METHODS: Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40-60) or to a weight-related (2 mg.kg- 1) manual administration of propofol for induction of general anesthesia. The primary endpoint was the incidence of hypotension following the administration of propofol. Secondary endpoints included the degree of hypotension and correlations between BIS and drop in mean arterial pressure (MAP). Incidences were analyzed with Fisher's Exact-test. RESULTS: Of the 240 patients enrolled into this study, 235 predominantly non-geriatric (median 48 years, 25th - 75th percentile 35-61 years) patients without severe concomitant disease (88% American Society of Anesthesiology physical status 1-2) undergoing ear, nose and throat surgery, ophthalmic surgery, and dermatologic surgery were analyzed. Patients who were manually administered propofol guided by BIS (n = 120) compared to those who were given propofol by weight (n = 115) did not differ concerning the incidence of hypotension (44% vs. 45%; p = 0.87). Study groups were also similar regarding the maximal drop in MAP compared to baseline (33% vs. 30%) and the proportion of hypotensive events related to all measurements (17% vs. 19%). Final propofol induction doses in BIS group and NON-BIS group were similar (1.93 mg/kg vs. 2 mg/kg). There was no linear correlation between BIS and the drop in MAP at all times (r < 0.2 for all) except for a weak one at 6 min (r = 0.221). CONCLUSION: Results of our study suggest that a BIS-guided compared to a weight-adjusted manual administration of propofol for induction of general anesthesia in non-geriatric patients will not lower the incidence and degree of arterial hypotension. TRIAL REGISTRATION: German Registry of Clinical Trials ( DRKS00010544 ), retrospectively registered on August 4, 2016.


Assuntos
Anestesia Geral/métodos , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/administração & dosagem , Monitores de Consciência , Propofol/administração & dosagem , Adulto , Anestesia Geral/efeitos adversos , Anestesia Geral/normas , Anestesia Intravenosa/efeitos adversos , Anestesia Intravenosa/normas , Anestésicos Intravenosos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Monitores de Consciência/normas , Feminino , Humanos , Hipotensão/induzido quimicamente , Hipotensão/fisiopatologia , Hipotensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Propofol/efeitos adversos , Estudos Prospectivos
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