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1.
Harefuah ; 160(9): 586-593, 2021 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-34482671

RESUMO

INTRODUCTION: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, debilitating syndrome involving bladder pain and lower urinary tract symptoms (LUTS), with a substantial effect on patients' quality of life. IC/BPS poses a diagnostic challenge, and its available treatment options remain only moderately effective. Bladder-wall biopsies from IC/BPS patients commonly uncover mastocytosis. While mast-cells are suspected as pivotal in disease pathogenesis, the clinical significance of their presence remains unclear. Clinical guidelines differ on whether or not bladder biopsies should be a part of routine IC/BPS workup. AIMS: To determine whether detrusor mastocytosis can serve as a prognostic marker for treatment response and improvement duration. METHODS: We retrospectively collected patient data for IC/BPS patients who underwent bladder hydrodistension under anesthesia. We used statistical modelling to determine the effect of mastocystosis and other possible predictive factors - age, comorbidity, Hunner lesions - on the presence and duration of symptom improvement. RESULTS: A total of 35 patients (89% female, median age 63.5 [IQR 48.8-73.6] years) underwent hydrodistension, of whom 28 (89% female, median age 63.0 [44.8-73.1] years) had bladder biopsies; 11 (39%) of them had mastocystosis. Within a median follow-up of 8.8 [1.7-24.2] months, 11 (100%) of the patients with mastocytosis and 9 (53%) of the patients without it, experienced symptomatic improvement (p=0.007). Improvement duration was 8 months longer (p=0.006) in those with mastocystosis. Univariate logistic regression models were used to estimate odds ratios (OR). Mastocytosis (p=0.004) and Charlson Comorbidity score were the only variables with a statistically significant OR. Univariate survival models were fitted, and improvement duration was estimated to be longer in patients with mastocystosis (p=0.01). A multivariate Cox regression model found no variable to be statistically significant, though mastocystosis was borderline significant (p=0.055). CONCLUSIONS: Mastocystosis defines a discernible phenotype of IC/BPS, which exhibits higher rates and longer duration of hydrodistention treatment response. DISCUSSION: Notwithstanding limitations of sample size and retrospective study design, we were able to demonstrate that mastocystosis can serve as a prognostic factor for symptom improvement after hydrodistension in IC/BPS patients. Prospective studies are required to validate this finding and to investigate the mechanisms involved.


Assuntos
Anestesia , Cistite Intersticial , Mastocitose , Cistite Intersticial/diagnóstico , Cistite Intersticial/etiologia , Cistite Intersticial/terapia , Feminino , Humanos , Masculino , Mastocitose/diagnóstico , Mastocitose/terapia , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos
2.
J Adv Res ; 32: 27-36, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34484823

RESUMO

Introduction: In long-term induced general anesthesia cases such as those uniquely defined by the ongoing Covid-19 pandemic context, the clearance of hypnotic and analgesic drugs from the body follows anomalous diffusion with afferent drug trapping and escape rates in heterogeneous tissues. Evidence exists that drug molecules have a preference to accumulate in slow acting compartments such as muscle and fat mass volumes. Currently used patient dependent pharmacokinetic models do not take into account anomalous diffusion resulted from heterogeneous drug distribution in the body with time varying clearance rates. Objectives: This paper proposes a mathematical framework for drug trapping estimation in PK models for estimating optimal drug infusion rates to maintain long-term anesthesia in Covid-19 patients. We also propose a protocol for measuring and calibrating PK models, along with a methodology to minimize blood sample collection. Methods: We propose a framework enabling calibration of the models during the follow up of Covid-19 patients undergoing anesthesia during their treatment and recovery period in ICU. The proposed model can be easily updated with incoming information from clinical protocols on blood plasma drug concentration profiles. Already available pharmacokinetic and pharmacodynamic models can be then calibrated based on blood plasma concentration measurements. Results: The proposed calibration methodology allow to minimize risk for potential over-dosing as clearance rates are updated based on direct measurements from the patient. Conclusions: The proposed methodology will reduce the adverse effects related to over-dosing, which allow further increase of the success rate during the recovery period.


Assuntos
Anestesia , COVID-19 , Hipnóticos e Sedativos , Modelos Biológicos , SARS-CoV-2 , Idoso , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacocinética , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Pandemias
4.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(3): 290-297, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34402265

RESUMO

To investigate the effect of multiple propofol anesthesia and operative trauma on neuroinflammation and cognitive function in development rats and its mechanism. A total of 104 13-day-old neonatal Sprague-Dawley rats were randomly divided into 4 groups with 26 rats in each group: control group was treated with saline q.d for propofol group was treated with propofol q.d for surgery group received abdominal surgery under local anesthesia and then treated with saline q.d for surgery with propofol group received propofol anesthesia plus abdominal surgery under local anesthesia with ropivacaine at d1, then treated with propofol q.d for At d2 of experiment, 13 rats from each group were sacrificed and brain tissue samples were taken, the concentration of TNF-α in hippocampus was detected with ELISA, the expression of caspase-3 and c-fos in hippocampal tissue was determined with immunohistochemical method, the number of apoptotic neurons in hippocampus was examined with TUNEL assay. Morris water maze test was used to examine the cognitive function of the rest rats at the age of 60 d, and the TNF-α concentration, caspase-3, c-fos expressions and the number of apoptotic neurons in hippocampus were also detected. Compared with control group, TNF-α concentration, caspase-3, c-fos expression and the neuroapoptosis in hippocampus increased significantly in other three groups (all <0.05). Compared with surgery group, propofol group and surgery with propofol group showed increased TNF-α level, caspase-3 and c-fos expressions and apoptotic cell numbers (all <0.05), but there was no significant difference between last two groups (all >0.05). Morris water maze test showed that there were no significant differences in swimming speed, escape latency, target quadrant residence time and crossing times among groups (all >0.05). TNF-α level, expressions of caspase-3 and c-fos and apoptotic cell numbers in hippocampus had no significant differences among the 4 adult rats groups (all >0.05). Abdominal surgery and multiple propofol treatment can induce neuroinflammation and neuroapoptosis in hippocampus of neonatal rats, however, which may not cause adverse effects on neurodevelopment and cognitive function when they grown up.


Assuntos
Anestesia , Propofol , Animais , Cognição , Hipocampo , Propofol/efeitos adversos , Ratos , Ratos Sprague-Dawley
5.
Comput Intell Neurosci ; 2021: 8430565, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422035

RESUMO

One of the important tasks in the operating room is monitoring the depth of anesthesia (DoA) during surgery, and noninvasive techniques are very popular. Hence, we propose a new scheme for DoA monitoring considering the time-frequency analysis of electroencephalography (EEG) signals and GLCM features extracted from them. To this end, at first, the time-frequency map (TFM) of each channel of each EEG is computed by smoothed pseudo-Wigner-Ville distribution (SPWVD), where the EEG signal used in this paper is recorded in 15 channels. After that, we consider the gray-level co-occurrence matrix (GLCM) to obtain the content of TFM, and after that, four features such as homogeneity, correlation, energy, and contrast are obtained for each GLCM. Finally, after the selection of efficient features using the minimum redundancy maximum relevance (MRMR) method, the K-nearest neighbor (KNN) classifier is utilized to determine the DoA. Here, we consider the three states, namely, deep hypnotic, surgical anesthesia, and sedation and awake states according to bispectral index (BIS), and each EEG epoch is classified to these states. We also employ data augmentation to enhance the training phase and increase accuracy. We obtain the accuracy and confusion matrix of the proposed method. We also analyze the effects of a number of gray levels of GLCM, distance measure in KNN classifier, and parameters of data augmentation on the performance of the proposed method. Results indicate the efficiency of the proposed method to determine the DoA during surgery.


Assuntos
Algoritmos , Anestesia , Eletroencefalografia
6.
Swiss Med Wkly ; 151(33-34)2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34448557

RESUMO

AIMS OF THE STUDY: The Swiss healthcare system is highly ranked, given its unrestricted access to specialised care and short waiting lists for surgery. However, the need for anaesthetic and surgical care is escalating owing to the increasing size and ageing of the Swiss population. In addition, to address the persistent and recurrent SARS-CoV-2 pandemic crisis, the speciality of anaesthesia is under tremendous pressure to maintain an effective workforce in order to address population needs. The current number, characteristics and future evolution of the physician anaesthesia workforce in Switzerland are currently unknown. The purpose of this study was to assess the size and professional and sociodemographic characteristics of the current anaesthesia workforce in Switzerland and to forecast its development up to 2034. METHODS: We performed a cross-sectional study using a 150-item questionnaire prepared by the National Anaesthesia Workforce Study Group (NAWOS). We included all physicians (trainees and certified) practising anaesthesia in Switzerland. We collected demographic and professional information, such as the current position, hospital characteristics, workload, number of shifts and future life plans. We built a computer-based Markov model with Monte Carlo simulations to project both supply and demand for physician anaesthesia provider positions. RESULTS: Of the 2661 distributed questionnaires, 1985 (74.2%) were completed and returned. We found that the average age of anaesthesiologists practising in Switzerland was 45.2 years, with 44.3% of them being women and 76.9% holding a Swiss specialist title. Only 59.6% of respondents worked full time. The forecasting model showed a steady increase in the number of anaesthesiologists retiring by 2034, with 27% of full-time equivalent jobs being lost in the next 8 years. Even if existing full-time equivalent training positions are all filled, a gradual deficit of anaesthesiologists is to be expected after 2022, and the deficit should culminate in 2034 with a deficit ratio of 0.87. CONCLUSIONS: Due to the upcoming high retirement rate of anaesthesiologists, Switzerland is likely to face a shortage of anaesthesiologists in the near future. To compensate for the shortage, the country will likely increase its reliance on medical staff trained abroad. Southern and eastern cantons of Switzerland are particularly at risk, given that they already heavily rely on foreign anaesthesia workforce. This reliance should be considered a national priority because anaesthesiologists are heavily involved in both the treatment of patients with respiratory complications of SARS-CoV2 infection and the care of surgical patients, the number of which is expected to rise steadily in upcoming years.


Assuntos
Anestesia , COVID-19 , Médicos , Estudos Transversais , Feminino , Humanos , RNA Viral , SARS-CoV-2 , Suíça , Recursos Humanos
7.
BMJ Open ; 11(8): e046798, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400450

RESUMO

OBJECTIVE: To systematically assess the efficacy and safety of dexmedetomidine as an anaesthesia adjuvant for cleft lip and palate (CLP) repair in children. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang (up to October 2020). Studies in languages other than English and Chinese were excluded. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) evaluating the impact of dexmedetomidine on emergence agitation (EA), the need for postoperative rescue analgesics, postoperative nausea and vomiting (PONV), and other adverse events in paediatric patients during CLP repair. DATA EXTRACTION AND SYNTHESIS: The quality of evidence was assessed by using the Cochrane Review Methods and the Grading of Recommendations Assessment, Development and Evaluation approach. Data were screened, extracted and assessed by two independent authors. Outcomes were reported as a risk ratio (RR) with a 95% CI. A random-effect model was used when heterogeneity was detected. RESULTS: Thirteen studies including 1040 children met the inclusion criteria. The incidence of EA was significantly decreased in the dexmedetomidine group (RR, 0.19; 95% CI 0.10 to 0.36; p<0.00001; I2=56%) as compared with the control group. Paediatric patients receiving dexmedetomidine had lower postoperative analgesic requirements (RR, 0.27; 95% CI 0.10 to 0.73; p=0.01; I2=84%) and a lower incidence of respiratory adverse events (RR, 0.49; 95% CI 0.31 to 0.78; p=0.003; I2=0%). There were no significant differences in the risk of PONV and cardiovascular adverse events. CONCLUSIONS: There was a lack of high-quality studies in this field. Perioperative administration of dexmedetomidine reduced the need for postoperative rescue analgesics and the incidence of EA in children without side effects undergoing CLP repair. However, further verification with larger samples and higher-quality RCTs is needed.


Assuntos
Anestesia , Fenda Labial , Dexmedetomidina , Criança , Fenda Labial/cirurgia , Dexmedetomidina/uso terapêutico , Humanos , Palato , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle
10.
Medicine (Baltimore) ; 100(29): e26683, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398038

RESUMO

RATIONALE: Nerve integrity monitoring (NIM) tubes are commonly used in thyroid surgery to prevent recurrent laryngeal nerve injury. To achieve the optimal electromyographic signal for NIM as intraoperative neural monitoring (IONM), the neuromuscular blocking agent (NMBA) dose should be low. The use of a low-dose NMBA increases the anesthetic and analgesic agent dose required to attenuate the laryngeal reflex during intubation. In addition, since the NMBA onset time is delayed, depending on the situation, anesthesia may become excessively deep or shallow before intubation. PATIENTS CONCERN: A 51-year-old woman scheduled for thyroid lobectomy received 0.3 mg/kg of rocuronium. Three minutes later, when the NIM tube was inserted through the vocal cord, the patient's heart rate (HR) was undetectable for 2 seconds. DIAGNOSIS: We suspected that the use of a high-dose anesthetic agent and remifentanil or the laryngocardiac reflex induced the sinus pause. INTERVENTIONS: To maintain the anesthetic depth, we administered 6 vol% of desflurane. Because the patient's systolic blood pressure was 70 mmHg and HR was 30 beats/min, we discontinued the remifentanil infusion and administered 8 mg of ephedrine. OUTCOMES: The patient's vital signs recovered to normal levels. Subsequently, there were no episodes of bradycardia or arrhythmia. CONCLUSION: Sinus pause or severe bradycardia may occur due to the laryngocardiac reflex or the administration of a high-dose anesthetic and analgesic agent during tracheal intubation in patients who received a low-dose NMBA for IONM induction using an NIM tube. Anesthesiologists should be aware of these risks and take precautions to maintain adequate anesthesia, be prepared to administer vasoactive drugs to increase the blood pressure and HR if needed, and, if possible, intravenously administer lidocaine to attenuate the laryngeal reflex during intubation.


Assuntos
Anestesia , Arritmias Cardíacas/diagnóstico , Complicações Intraoperatórias/diagnóstico , Intubação Intratraqueal/efeitos adversos , Bloqueadores Neuromusculares/efeitos adversos , Tireoidectomia , Arritmias Cardíacas/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade
12.
BMC Pediatr ; 21(1): 336, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372814

RESUMO

BACKGROUND: Preoperative anxiety is a common problem in the paediatric population, and several studies have reported that it is related to adverse events such as emergence delirium and postoperative psychological and behavioural changes. In recent years, increasing attention has been paid to paediatric preoperative anxiety in China. A variety of strategies, including sedatives, parental presence, and audio-visual interventions, have been used to relieve paediatric preoperative anxiety, but there is no well-recognised procedure for paediatric preoperative sedation. Therefore, this study aimed to investigate current paediatric preoperative sedation practices in tertiary children's hospitals in China. METHODS: All tertiary maternity and children's hospitals registered with the National Health Commission of the People's Republic of China were invited to participate in an electronic survey, which included information on the preoperative sedation caseload, sites where preoperative sedation was performed, preoperative sedation methods used in different age groups, choice of sedatives, contraindications for premedication, staff structure for sedative administration and monitoring, and patient-monitoring practices. RESULTS: All 81 hospitals participating in our study completed the survey, and 38 hospitals (46.9 %) provided their preoperative sedation protocols. Twenty-four hospitals performed fewer than 5,000 preoperative sedation cases annually, and 9 hospitals performed more than 10,000 cases annually. Preoperative sedation was performed in preoperative preparation areas, preoperative holding areas, and operation rooms in 47.4 %, 26.3 %, and 13.2 % of hospitals, respectively. Sedatives were the most used interventions for paediatric preoperative sedation in all age groups, and the most widely used sedatives were propofol (intravenous) and dexmedetomidine (intranasal). The most common contraindications were American Society of Anesthesiologists class ≥ 3, emergency operation, and airway infection within 2 weeks. Sedatives were administered mainly by anaesthesiologists (63.2 %), and children were monitored mainly by anaesthesiologists (44.7 %) and nurses (39.5 %) after administration. Pulse oximetry was the most widely used monitoring device. CONCLUSIONS: Fewer than half of the tertiary maternity and children's hospitals in China provide paediatric preoperative sedation service, and the service practices vary widely. Further improvements are required to ensure the quality of paediatric preoperative sedation services and establish standard operating procedures.


Assuntos
Anestesia , Hipnóticos e Sedativos , Criança , Feminino , Hospitais Pediátricos , Humanos , Gravidez , Inquéritos e Questionários , Centros de Atenção Terciária
13.
AANA J ; 89(4): 291-298, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34342566

RESUMO

Patients with breast cancer often require several procedures requiring anesthesia, such as central venous catheter placements, mastectomies, lymph node dissections, and reconstructive surgeries. Recent research findings have suggested there may be a reduced risk of cancer recurrence and chronic pain with specific anesthetic techniques. Regional techniques, total intravenous anesthetics, and select adjuncts have been reviewed to identify their role in breast cancer recurrence and chronic pain. A review of the pathophysiology as it pertains to volatile anesthetics, propofol as a total intravenous anesthetic, paravertebral nerve blocks, dexmedetomidine, and ketorolac, as well as the role each of these plays in the prevention of chronic pain and cancer recurrence is provided. Current research and recommendations for practice are presented in the context of providing anesthesia to mitigate chronic pain and cancer recurrence in patients with breast cancer.


Assuntos
Anestesia/normas , Neoplasias da Mama/cirurgia , Dor Crônica/prevenção & controle , Mastectomia/normas , Recidiva Local de Neoplasia/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Guias de Prática Clínica como Assunto , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estados Unidos
14.
AANA J ; 89(4): 319-324, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34342569

RESUMO

Anesthesia providers are regularly responsible for assessing, diagnosing, and determining pharmacologic treatment of a problem. This critical workflow often includes medication preparation. Decision making in anesthesia frequently requires rapid intervention, and caring for the pediatric population poses additional challenges, such as needing to quickly calculate the weight-based dosing of medications. The objective of this review article was to identify and describe themes related to pediatric medication errors associated with anesthesia. Additional goals of the review consisted of identifying and comparing various error reduction strategies with a primary goal of communicating the most effective methods to reduce medication errors in the pediatric population. Screening criteria were set, and 17 published scholarly articles meeting inclusion criteria were evaluated using a systematic process. Common themes found leading to medication errors were incorrect dosing, incorrect medication, syringe swap, wrong patient, and wrong dosing interval. The most valuable and sustainable error reduction strategies found were standardized labeling, prefilled syringes, and 2-person medication checks. It is believed that this review will expound on the factors that can be controlled or minimized to decrease the incidence of anesthesia-related pediatric medication errors and facilitate implementation of risk mitigation strategies immediately into clinical practice.


Assuntos
Anestesia/normas , Relação Dose-Resposta a Droga , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Pediatria/normas , Período Perioperatório/normas , Guias de Prática Clínica como Assunto , Adolescente , Anestesia/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Período Perioperatório/estatística & dados numéricos , Estados Unidos
15.
Curr Opin Anaesthesiol ; 34(5): 582-589, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34435601

RESUMO

PURPOSE OF REVIEW: Given the number of drugs available in the anaesthetist's armamentarium, drug interactions need to be managed. This is particularly true of psychoactive medications which primarily act on the central nervous system, targeting neurotransmitter pathways often affected by anaesthetic agents. This review gives an overview of the potential interactions of commonly used psychoactive medications with anaesthetic agents and hence their perioperative considerations. As anaesthetists will already be very familiar with the benzodiazepines, they will not be discussed here. Electroconvulsive therapy will also not be discussed. RECENT FINDINGS: A wide range of psychoactive medications can interact with drugs commonly used in perioperative care including anaesthetic agents. There is limited clinical research into their effects and hence these interactions are based on known pharmacological actions. SUMMARY: A cautious, pragmatic approach is recommended when managing patients on psychoactive medications requiring anaesthesia as part of their medical care.


Assuntos
Anestesia , Anestésicos , Doença de Parkinson , Anestesia/efeitos adversos , Anestésicos/efeitos adversos , Benzodiazepinas , Depressão , Humanos , Doença de Parkinson/tratamento farmacológico
16.
Curr Opin Anaesthesiol ; 34(5): 590-596, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34435602

RESUMO

PURPOSE OF REVIEW: We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery. RECENT FINDINGS: In recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist. SUMMARY: Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.


Assuntos
Anestesia , Monitorização Neurofisiológica Intraoperatória , Anestesia/efeitos adversos , Humanos , Neurocirurgiões , Procedimentos Neurocirúrgicos , Medula Espinal
17.
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
18.
Medicine (Baltimore) ; 100(30): e26780, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397727

RESUMO

BACKGROUND: Until now, target-controlled infusion of remifentanil with midazolam in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for percutaneous transluminal balloon angioplasty under monitored anesthesia care. METHODS: A prospective, randomized controlled trial including patients who received a percutaneous transluminal balloon angioplasty between March 2019 and March 2021 was conducted. Group 1 and Group 2 were, respectively, administered an initial effect-site concentration of remifentanil of 1.0 and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL with intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4, mean arterial pressure and heart rate at baseline levels ±â€Š30%, and patient comfort (remaining moveless). The primary outcome was to determine the appropriate effect-site concentration of remifentanil for the procedure in terms of patient comfort (remaining moveless), hemodynamic conditions, and adverse events. Secondary endpoints included the total dosage of anesthetics and total times of target-controlled infusion pump adjustments. RESULTS: A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between 2 groups, except Group 1 having higher peripheral oxygen saturation, while local anesthetic injection compared with Group 2. In addition, Group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 6, P = .034), less remifentanil consumption (189.65 ±â€Š69.7 vs 243.8 ±â€Š76.1 µg, P = .001), but more intraoperative movements affecting the procedure (14 vs 4; P = .016), total times of target-controlled infusion pump adjustment [2 (1-4) vs 1 (1-2), P < .001] compared with Group 2. CONCLUSION: In percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided appropriate hemodynamic conditions, sufficient sedation and analgesia, and acceptable apnea with desaturation.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Angioplastia , Midazolam/administração & dosagem , Remifentanil/administração & dosagem , Idoso , Anestesia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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