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1.
Can Vet J ; 61(10): 1092-1100, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33012826

RESUMO

As a result of the various restrictions associated with the current COVID-19 pandemic, the practice of veterinary telehealth is likely to grow substantially. One area in which high quality care can be maintained while respecting physical distancing is teleconsulting, which describes the relationship between an attending and off-site consulting veterinarian. This guide uses a dentistry case to illustrate the provision of real-time anesthesia consulting, with a focus on the technological considerations central to facilitating live, 2-way video-communication. Case selection, teamwork, and patient safety are also discussed.


Assuntos
Anestesia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Telemedicina , Anestesia/efeitos adversos , Anestesia/veterinária , Animais , Betacoronavirus
2.
Vestn Oftalmol ; 136(5. Vyp. 2): 197-203, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063964

RESUMO

PURPOSE: To analyze diagnostic and treatment outcomes in patients with strabismus and oculomotor disorders induced by injection anesthesia for cataract surgery. MATERIAL AND METHODS: The study included 11 patients (7 women and 4 men) aged 61 to 85 years (the mean age of 66±7.1 years) who complained of diplopia in the early post-op period after cataract phacoemulsification and elastic IOL implantation under retrobulbar anesthesia. Prior to further surgical treatment, all of the patients underwent functional multispiral computer tomography of the orbits. Prismatic spectacle correction was also used independently or in addition to surgical treatment. RESULTS: Eight out of eleven patients underwent one- or two-step surgical treatment (3 and 5 cases, respectively). In 2 patients, hypotropia did not exceed 10 prism diopters, and thus, diplopia could be compensated with prismatic spectacle correction alone. In 5 cases, binocular vision was achieved throughout the whole field of gaze. In 3 cases, surgical treatment enabled elimination of heterotropia in the primary gaze and compensation of diplopia within a radius of 40º from the center of gaze and within the entire horizontal range of eye-movement in the downward gaze. The limitation of ocular mobility decreased from 2.36 to 0.55 points leading to an associated decrease in the area of binocular diplopia - from 98% to 29%. In one case, spectacle occlusion was used. CONCLUSION: The inferior rectus restriction is the morphological substrate of anatomical and functional changes induced by retrobulbar anesthesia. As treatment options for restrictive vertical strabismus and binocular diplopia, both surgical (extraocular muscle surgery) and optical (prismatic correction, occlusion) methods should be considered.


Assuntos
Anestesia , Extração de Catarata , Catarata , Estrabismo , Idoso , Idoso de 80 Anos ou mais , Diplopia/diagnóstico , Diplopia/etiologia , Diplopia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estrabismo/etiologia , Estrabismo/cirurgia
3.
Medicine (Baltimore) ; 99(41): e22625, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031322

RESUMO

RATIONALE: Giant ovarian tumors are very rare. Patients with large ovarian tumors appear similar to pregnant women and morbidly obese patients. The management of such patients is associated with significant mortality. Therefore, additional clinical research is essential to understanding the perioperative complications of this disease. PATIENT CONCERNS: We report the perioperative management of a patient with a giant ovarian tumor that contained 23 L of fluid who underwent tumor resection. Given the infrequency of these giant ovarian tumors, a detailed anesthetic plan and postoperative respiratory support strategy were tailored to address the patient's hemodynamic and respiratory risks, as well as to minimize potential complications, including supine hypotensive syndrome, re-expansion pulmonary edema, and postoperative intestinal ileus. To prevent supine hypotensive syndrome, the patient used a mild left-sided position (10∼20°) after admission until the tumor was removed. In order to prevent re-expansion pulmonary edema (RPE), the intraoperative ventilator mode was set to pressure-controlled ventilation (PCV), with the addition of 8 cmH2O positive end-expiratory pressure (PEEP). The airway pressure was lower while maintaining a certain tidal volume. In the ICU, in the ventilator mode, we use pressure support ventilation as well as PEEP and adjust it according to the patient's spontaneous breathing situation and blood gas analysis to prepare for further detach from the respirator and extubation. And we prevent the occurrence of postoperative intestinal ileus by placing the abdominal binder after the operation. DIAGNOSIS: Mucinous cystadenoma of the left ovary. INTERVENTIONS: The patient underwent exploratory laparotomy with debulking of the left ovarian mass, transabdominal hysterectomy with bilateral salpingo-oophorectomy, complete omentectomy with appendectomy, and pelvic lymphadenectomy. OUTCOMES: After surgery, the patient experienced intestinal distention. Up to now, the patient has recovered well. LESSONS: A multidisciplinary approach is essential. Knowing the possibility of complications and choices for management can lead to favorable outcomes in such rare cases. This case reminds us that postoperative complications such as postoperative intestinal ileus may be fatal.


Assuntos
Cistadenoma Mucinoso/cirurgia , Neoplasias Ovarianas/cirurgia , Assistência Perioperatória , Idoso , Anestesia , Cistadenoma Mucinoso/patologia , Feminino , Humanos , Neoplasias Ovarianas/patologia , Ovário/patologia
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2508-2511, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018516

RESUMO

Hypnosis control is an essential process commonly used during medical surgeries and operations. In clinical practice, this process is achieved by an anesthesiologist who estimates the required dose for a patient and monitors the hypnotic status of the patient. For closed-loop sedation control systems to be approved for clinical practice, they have to demonstrate efficiency and robustness under parameter uncertainties and potential device faults. In this paper, new modeling and analysis of the closed-loop anesthesia administration are proposed using priced timed automata. The modeling involved the physiological system, the closed-loop controllers, and the fault scenario. The physiological model is based on a general model that accounts for parameter variability and residual errors from a broad group of data-sets. Two control techniques are analyzed: the proportional-integral-derivative controller and a variant of the sliding mode controller. The results have shown that the performance of both controllers was impacted by the sensor fault with the later one outperforming the former.Clinical relevance- The proposed in-silico methodology is used to estimate the performance degradation in closedloop anesthesia administration as a result of temporal faults. Moreover, it allows for evaluating different control techniques and help design reliable automatic control.


Assuntos
Anestesia , Simulação por Computador , Humanos , Hipnóticos e Sedativos , Análise de Sistemas
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2610-2613, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018541

RESUMO

The zebrafish model has been demonstrated as an ideal vertebrate model system for a diverse range of biological studies. Along with conventional approaches, monitoring and analysis of zebrafish electrocardiogram (ECG) have been utilized for cardio-physiological screening and elucidation. ECG monitoring has been carried out with fish treated with anesthetic drugs, rendering the short period of time in recording the signals (<5 min). In this work, a prolonged sedation system for continuous ECG monitoring of multiple zebrafish was proposed and developed. We built a circulation system to provide prolonged mild anesthesia which allows more consistent and intrinsic ECG measurement. The use of prolonged anesthesia helped reduce the concentration of the anesthetic drug (MS222 or Tricaine) from 200 mg/L to 100 mg/L and even lower; thus, maintaining the integrity of intrinsic ECG. Moreover, heartrate variation during recording was investigated, showing minute changes (±3.2 beats per minute - BPM). The development of this prolonged ECG monitoring system would open the possibility of long-term monitoring for studies such as drug screening and forward genetic screening.


Assuntos
Anestesia , Anestesiologia , Animais , Eletrocardiografia , Frequência Cardíaca , Peixe-Zebra
6.
Artigo em Russo | MEDLINE | ID: mdl-33081448

RESUMO

OBJECTIVE: To increase the efficacy of acute poisoning with severe psychodisleptics. MATERIAL AND METHODS: Fifty-two patients with acute psychoactive substance poisoning were studied. Patients of the main group (n=27) received cytoflavin infusion in combination with inhaled sedation with sevoflurane in addition to conventional therapy. The comparison group consisted of 25 patients who received conventional therapy. RESULTS AND CONCLUSION: Augmentation of conventional therapy with cytoflavin in combination with inhaled sedation with sevoflurane, affecting various links in the pathogenesis of acute severe poisoning with psychodisleptics, made it possible to cope in a shorter time.


Assuntos
Anestesia , Anestésicos Inalatórios , Éteres Metílicos , Humanos , Sevoflurano
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 361-364, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018003

RESUMO

Closed-loop controlled drug dosing has the potential of revolutionizing clinical anesthesia. However, inter-patient variability in drug sensitivity poses a central challenge to the synthesis of safe controllers. Identifying a full individual pharmacokinetic-pharmacodynamic (PKPD) model for this synthesis is clinically infeasible due to limited excitation of PKPD dynamics and presence of unmodeled disturbances. This work presents a novel method to mitigate inter-patient variability. It is based on: 1) partitioning an a priori known model set into subsets; 2) synthesizing an optimal robust controller for each subset; 3) classifying patients into one of the subsets online based on demographic or induction phase data; 4) applying the associated closed-loop controller. The method is investigated in a simulation study, utilizing a set of 47 clinically obtained patient models. Results are presented and discussed.Clinical relevance-The proposed method is easy to implement in clinical practice, and has potential to reduce the impact from surgical stimulation disturbances, and to result in safer closed-loop anesthesia with less risk of under- and over dosing.


Assuntos
Anestesia , Propofol , Humanos
8.
BMC Anesthesiol ; 20(1): 262, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33050885

RESUMO

BACKGROUND: The Coronavirus infectious disease 2019 (COVID-19) brings anesthesiologists and intensive care physicians to the mainstay of clinical workload and healthcare managements' focus. There are approximately 900 anesthesiologists in Israel, working in non-private hospitals. This nationwide cross-sectional study evaluated the readiness and involvement of anesthesia departments in Israel in management of the COVID-19 pandemic. The impact on anesthesiologists' health, workload, and clinical practices were also evaluated. METHODS: An online questionnaire was distributed to all of anesthesia department chairs in Israel on April 14th. Each response was identifiable on the hospital level only. Informed consent was waived since no patient data were collected. RESULTS: Response rate was 100%. A decrease of at least 40% in operating-room activity was reported by two-thirds of the departments. Anesthesiologists are leading the treatment of COVID-19 patients in 19/28 (68%) Israeli hospitals. Israel Society of Anesthesiologists' recommendations regarding intubation of COVID-19 patients were strictly followed (intubations performed by the most experienced available physician, by rapid-sequence induction utilizing video-laryngoscopy, while minimizing the number of people in the room - about 90% compliance for each). Anesthesiologists in most departments use standard personal protective equipment when caring for COVID-19 patients, including N95 masks, face shields, and water-proof gowns. Only one anesthesiologist across Israel was diagnosed with COVID-19 (unknown source of transmission). All department chairs reported emerging opportunities that advance the anesthesia profession: implementation of new technologies and improvement in caregivers' clinical capabilities (68% each), purchase of new equipment (96%), and increase in research activity (36%). CONCLUSIONS: This nationwide cross-sectional study had a complete response rate and therefore well-represents the anesthesia practice in Israel. We found that Israeli anesthesia departments are generally highly involved in the health system efforts to cope with the COVID-19 pandemic. Anesthesia and airway management are performed in a remarkably comparable manner and with proper protection of caregivers. Ambulatory anesthesia activity has dramatically decreased, but many departments find opportunities for improvement even in these challenging times.


Assuntos
Serviço Hospitalar de Anestesia/organização & administração , Anestesiologistas/organização & administração , Anestesiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Manuseio das Vias Aéreas/métodos , Anestesia/métodos , Estudos Transversais , Humanos , Intubação Intratraqueal/métodos , Israel/epidemiologia , Salas Cirúrgicas/organização & administração , Pandemias , Inquéritos e Questionários
10.
Rev Med Liege ; 75(9): 598-603, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32909412

RESUMO

Penetration syndrome is common and dangerous. In front of any suspicion of inhalation of foreign bodies, an endoscopy is necessary and the anesthesia that accompanies this gesture is a real challenge given the complexity of the management and exposure of the airways. The anaesthesiologist is confronted with unsafe, partially obstructed airways and will have to share his workspace with surgeon colleagues while ensuring efficient ventilation and oxygenation. This is a real teamwork requiring close and permanent collaboration with the surgical team. Jet ventilation is a technique that is particularly useful and adapted to this type of operation. It offers undeniable advantages, such as continuity of the gesture, better visualization of the laryngeal structures and a clear operating field. Its use is constantly increasing. It is nevertheless a technique that requires regular training and is reserved for experienced anaesthesiologists in this field. This article covers the main principles of anaesthetic management of the penetration syndrome, highlighting the advantages of jet ventilation.


Assuntos
Obstrução das Vias Respiratórias , Anestesia , Manuseio das Vias Aéreas , Humanos , Respiração Artificial , Síndrome
13.
Lancet ; 396(10252): 666-667, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891207

Assuntos
Anestesia
14.
Clin Imaging ; 67: 246-249, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871429

RESUMO

PURPOSE: The aims of our study were to compare cardiac magnetic resonance (CMR) scan time (time elapsed between first and last acquired sequence) and room time (time elapsed between patients' entrance and exit of the MRI room) between sedated and non-sedated children and to assess the contributing factors. METHODS: It is a cohort study performed at a CMR facility in a tertiary-care center. We compared scan time and room time between sedated and non-sedated children and assessed the influence of gender, age, weight, height, body surface area, number of sequences, and patients' diagnosis/previous procedures. RESULTS: We included 140 children (74 sedated and 66 non-sedated), age 7.6 years (3-12) and body surface area 0.83 m2 (0.57-1.25). The most common diagnosis/previous procedures were repaired tetralogy of Fallot, cardiomyopathies and single ventricle. Number of sequences: 18 (16-22). Scan time: 42 min (35-54.2); room time: 53 min (46-63). There was difference in room time between sedated and non-sedated children (57.6 ± 13.6 vs 52.2 ± 15 min, p < 0.05), but not in scan time (47.2 ± 14.1 vs 43.9 ± 16 min, p 0.2). The only factor associated with scan time was the number of sequences (r 0.75, p < 0.001). The only factor associated with room time was single ventricle as indication (r 0.26, p 0.007). CONCLUSIONS: Sedated children spent 5 more minutes in the CMR room than non-sedated children. Single ventricle was associated with increased room time. Number of sequences correlated with scan time. Sedation did not influence these times.


Assuntos
Anestesia , Cardiomiopatias/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Coração , Humanos , Imagem por Ressonância Magnética , Masculino
15.
Australas Psychiatry ; 28(5): 527-529, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32924540

RESUMO

OBJECTIVE: The recent and ongoing COVID-19 pandemic outbreak has placed a huge burden on healthcare systems worldwide. This emergent situation applies invariably to mental health services, and policy makers have issued new directives to adequately deal with this crisis. The COVID-19 outbreak poses special challenges to the administration of electroconvulsive therapy (ECT) since the anaesthetic induction is an aerosol-generating process. The report provides a narrative account of modifications to the ECT practice at a tertiary care psychiatric hospital to mitigate the risk of COVID-19 transmission. CONCLUSION: We emphasise two main modifications: use of personal protective equipment (PPE) during the ECT and modifications in the anaesthetic procedure to mitigate potential transmission.


Assuntos
Anestesia/métodos , Infecções por Coronavirus/prevenção & controle , Eletroconvulsoterapia/métodos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Betacoronavirus , Humanos
16.
J Anesth Hist ; 6(3): 101-109, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32921480

RESUMO

This paper is the first in a series of publications. These investigate, whether important elements of the historiography of anesthesia require a critical reappraisal. A systematic, combined presentation, contextualization and assessment of recent European research is provided. This includes the author's own findings. These emanate from two extensive projects. They combine very recent findings with results of earlier research, conducted by the author and numerous collaborators over the last 18 years. The findings represent an ever increasing and ever more robust body of evidence. They add an important new element to our international historiography. As an introduction, several definitions will be given for criteria, which designate "modern" anesthesia and its technology. On one of these criteria, the history of professionalization and specialization, a short overview will be given. This will be followed by an overview of general contexts, key features and early achievements of anesthesia-related technology. All results will be compared with a currently dominating narrative: This alleges "dominance" of US-American and British pioneers and developments. Apparent biases and inconsistencies are identified. These suggest that our current, international historiography of anesthesia may require a critical reassessment. Three subsequent articles will focus on specific aspects of anesthesia technique and technology. Their results likewise suggest a history of internationalism and trans-disciplinary reciprocity, rather than of national dominances. Further investigations will aim to ascertain the nature and extent of potential interactions, which may nowadays be underrecognized.


Assuntos
Anestesia/história , Anestesiologia/história , Anestésicos/história , Anestesiologia/instrumentação , Historiografia , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Internacionalidade/história
17.
J Anesth Hist ; 6(3): 110-126, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32921481

RESUMO

This paper is the continuation (Part 2) of an extensive, critical reappraisal of the international historiography on modern anesthesia and its technology. The first paper of this series provided general definitions, backgrounds and an update on recent research on one aspect of this topic: the history of professionalization / specialization (Part 1).1This paper goes on to provide a first, international comparison of entire anesthesia devices and on the history of nitrous-oxide-based anesthesia (c. 1900-1930s). Results: A comparative chronology of internationally recognized milestones of entire anesthesia machines does not suggest significant differences between the nations of continental Europe on one side, or the USA and Britain on the other. The international historiography on one of the key techniques for which these devices were designed (nitrous-oxide-based anesthesia), is likewise demonstrably biased. These findings are further evidence that a frequently held hypothesis, which suggests national dominances in these fields, is incorrect. Contributing factors and wider contexts of this phenomenon can be further confirmed: These are an under-recognition of non-Anglo-American (particularly continental-European) and of primarily surgical contributions; contemporary international conflicts and inter-professional demarcation disputes. In addition, it can be shown that these phenomena had already started around the same time (c. 1900s-1930s). There also is evidence to suggest that they were at times reciprocal and quite deliberate. The author illustrates and argues that the currently prevalent historiography on modern anesthesia requires a thorough reassessment. This should be based on a perspective of internationalism and transdisciplinary reciprocity and should recognize much broader historical contexts.


Assuntos
Anestesia/história , Anestesiologia/história , Anestésicos Inalatórios/história , Óxido Nitroso/história , Anestesiologia/instrumentação , Equipamentos e Provisões/história , História do Século XIX , História do Século XX , Humanos , Internacionalidade/história
18.
Curr Opin Anaesthesiol ; 33(5): 639-645, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32796169

RESUMO

PURPOSE OF REVIEW: To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. RECENT FINDINGS: Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be most vulnerable to secondary injury. SUMMARY: Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.


Assuntos
Anestesia/efeitos adversos , Concussão Encefálica/diagnóstico , Anestesia/métodos , Encéfalo , Humanos , Período Perioperatório
19.
Curr Opin Anaesthesiol ; 33(5): 633-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32826629

RESUMO

PURPOSE OF REVIEW: Ketamine has been used for decades for a variety of indications. Beyond the historical benefits and effects of ketamine, newer developments have occurred worthy of an update. This review will discuss common uses and indications for ketamine in the perioperative setting, as well as highlight newer indications in recent years. RECENT FINDINGS: Multiple studies have examined the use of ketamine in a variety of environments, as ketamine has become more popular in emergency rooms and ICUs. Ketamine may be particularly beneficial in management of burn patients, who often require multiple procedures over the course of their treatment. Ketamine's role in the ongoing opioid crisis has been of particular interest, with multiple studies evaluating its potential role in managing both acute and chronic pain conditions. Ongoing studies examining the role of ketamine in treatment of depressions show promise as well. SUMMARY: Ketamine is regaining popularity in the field of anesthesia and beyond. New studies provide insight on the many indications and use that anesthesia providers may encounter during their perioperative care of patients. Ongoing research is needed to further elucidate ketamine's effects on the management of psychiatric conditions and potential indications for ketamine metabolites.


Assuntos
Analgesia , Analgésicos/farmacologia , Anestesia , Anestésicos Dissociativos/farmacologia , Queimaduras/tratamento farmacológico , Depressão/tratamento farmacológico , Ketamina/farmacologia , Dor/tratamento farmacológico , Humanos , Manejo da Dor , Período Perioperatório
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