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1.
Acta Med Okayama ; 76(2): 187-193, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35503447

RESUMO

Remifentanil is an ultra-short-acting opioid that sometimes causes opioid-induced hyperalgesia, which has led to controversy regarding the association between intraoperative remifentanil administration and postoperative pain. This study aimed to assess the effects of the intraoperative remifentanil dose on postoperative pain. Patients undergoing esophageal, gastric/hepatobiliary, or intestinal/colon surgery and using postoperative patient-controlled epidural analgesia were analyzed. The patients were divided into two groups based on the average intraoperative remifentanil dose (high-dose remifentanil [HR] group: ≥0.1 µg/kg/min; low-dose remifentanil [LR] group: <0.1 µg/kg/min). In all, 406 patients met the inclusion criteria. A significant difference in the average dose of remifentanil was seen between the groups during the anesthesia period (0.14±0.05 vs. 0.07±0.02 µg/kg/min). However, no significant difference was seen in pre- or intraoperative patient characteristics. Numerical rating scale (NRS) scores on postoperative day 1 were similar between the groups (HR: 1.7±2.0; LR: 1.7±2.0; p=0.74). The incidence of poor pain control (NRS > 3/10) was also similar between the groups (HR: 14%; LR: 16%; p=0.57). Older age (> 60 years) and type of surgery (esophageal surgery) were associated with worse postoperative NRS scores. No significant association was seen between the intraoperative remifentanil dose and postoperative NRS scores following thoracoabdominal surgery with postoperative epidural pain management.


Assuntos
Analgésicos Opioides , Anestesia , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Anestesia/efeitos adversos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Remifentanil/efeitos adversos
4.
Anesth Analg ; 134(5): e29, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35427277
5.
Biomed Pharmacother ; 149: 112897, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35378503

RESUMO

A great number of pediatric patients undergoing varied procedures make neonatal surgery plus anesthesia become a matter of great concern owing to underlying neurotoxicity in developing brain. The authors set out to assess long-term effects of surgery plus anesthesia in mouse model. Six-day-old C57BL/6 mice were randomized to receive either anesthesia with 3% sevoflurane, abdominal surgery under the same anesthesia, or the control condition. These mice were examined of learning and memory at juvenile age in Morris water maze test. The brain tissues of mice were harvested for Western blot analysis, including purinergic receptors P2X family, CaMKII and NF-κB. Another battery of mice were administered with inhibitors of P2RX2/3 (e.g., A317491) into hippocampal dentate gyrus before behavioral testing. We found that neonatal surgery plus anesthesia, but not sevoflurane anesthesia alone, impaired the learning and memory of juvenile mice, as evidenced by delayed escape latency and reduced platform-crossing times. Immunoblotting analysis showed that behavioral abnormalities were associated with increased levels of P2RX2, phosphorylated-CaMKIIß and activated NF-κB in mouse hippocampus. Injection of A317491 ameliorated the impaired learning and memory of juvenile mice undergoing neonatal surgery plus anesthesia, and it also mitigated the neonatal surgery-induced signaling enhancement of P2RX2/CaMKII/NF-κB. Together, these results indicate that neonatal surgery plus anesthesia may cause long-term cognitive dysfunction, with potential mechanism of increasing P2RX2 and downstream signaling of phosphorylated-CaMKII and NF-κB. Our findings will promote more studies to assess detrimental effects of surgery and accompanying inflammation, diverse anesthetics and even sleeping deprivation on mouse neurodevelopment and neurobehavioral performance.


Assuntos
Anestesia , Hipocampo , Aprendizagem em Labirinto , Transtornos da Memória , Anestesia/efeitos adversos , Animais , Animais Recém-Nascidos , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina , Hipocampo/efeitos dos fármacos , Hipocampo/fisiopatologia , Aprendizagem em Labirinto/efeitos dos fármacos , Aprendizagem em Labirinto/fisiologia , Transtornos da Memória/epidemiologia , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Receptores Purinérgicos P2X2 , Sevoflurano/farmacologia
6.
Otolaryngol Clin North Am ; 55(2): 421-430, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365315

RESUMO

Anesthesia for pituitary surgery is tailored to each individual patient and the type of tumor they have. Anesthetic considerations include difficult airways, hormonal and electrolyte abnormalities, cardiac abnormalities, the potential for catastrophic hemorrhage, and the importance of a smooth extubation. The anesthesiologist is able to assist the surgeons by keeping the patient motionless and lowering the blood pressure to minimize surgical bleeding. Postoperative nausea and vomiting are also of greater importance than usual, as the Valsalva movements associated with retching could cause bleeding and disruption of the surgical site.


Assuntos
Anestesia , Anestésicos , Anestesia/efeitos adversos , Humanos , Náusea e Vômito Pós-Operatórios
7.
Paediatr Anaesth ; 32(6): 697-705, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35266610

RESUMO

Neonatal surgery and concomitant anesthesia coincide with a timeframe of rapid brain development. The speed and complexity of early brain development superimposed on immature regulatory mechanisms that include incomplete cerebral autoregulation, insufficient free radical scavenging and an immature immune response puts the brain at risk. Brain injury may have long-term consequences for multiple functional domains including cognition, learning skills, and behavior. Neurodevelopmental follow-up studies have noted mild-to-moderate deficits in children who underwent major neonatal surgery and related anesthesia. The present review evaluates neonatal surgery against the background of neurobiological processes that unfold at a pace unparalleled by any other period of human brain development. First, a structured summary of early brain development is provided in order to establish theoretical groundwork. Next, literature on brain injury and neurodevelopmental outcome after neonatal surgery is discussed. Special attention is given to recent findings of structural brain damage reported after neonatal surgery. Notably, high-quality imaging data acquired before surgery are currently lacking. Third, mechanisms of injury are interrogated taking the perspective of early brain development into account. We propose a novel disease model that constitutes a triad of inflammation, vascular immaturity, and neurotoxicity of prolonged exposure to anesthetic drugs. With each of these components exacerbating the other, this amalgam incites the perfect storm, resulting in brain injury. When examining the brain, it seems intuitive to distinguish between neonates (i.e., <60 postconceptional weeks) and more mature infants, multiple and/or prolonged anesthesia exposure and single, short surgery. This review culminates in an outline of anesthetic considerations and future directions that we believe will help move the field forward.


Assuntos
Anestesia , Anestésicos , Lesões Encefálicas , Síndromes Neurotóxicas , Anestesia/efeitos adversos , Anestésicos/efeitos adversos , Encéfalo , Criança , Humanos , Lactente , Recém-Nascido
8.
AANA J ; 90(2): 148-154, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35343897

RESUMO

Anesthetic management of the patient with mitochondrial disease (MD) requires thoughtful preoperative planning and hypervigilant perioperative monitoring. MD affects 1 in 4,000 persons and is often an unfamiliar topic to the anesthesia provider. This review aims to inform the anesthetist on important considerations in perioperative management of MD. Patients with MD have impaired mitochondrial energy formation pathways affecting function of cardiac, central nervous, and musculoskeletal systems. All general anesthetics interfere with these mitochondrial bioenergetic pathways. MD patients exhibit hypersensitivity to volatile anesthetics. Propofol interferes with mitochondrial function via multiple pathways thus its use should be limited. MD is not at increased risk for malignant hyperthermia and should not be managed with prolonged propofol infusion. Succinylcholine is contraindicated due to hyperkalemia and myotonic risks. Nondepolarizing agents should be used with caution given unpredictable effects. No single anesthetic plan has been found to be safer than another in patients with MD. Intravenous and volatile anesthetics should be titrated incrementally while monitoring anesthetic depth clinically or via processed electroencephalogram (EEG). All MD patients should be optimized by minimizing fasting times, careful fluid selection to avoid lactate, and hypervigilant temperature management aimed at reducing the detrimental effects of catabolic stress during the perioperative period.


Assuntos
Anestesia , Anestésicos Gerais , Hipertermia Maligna , Doenças Mitocondriais , Anestesia/efeitos adversos , Humanos , Doenças Mitocondriais/induzido quimicamente , Doenças Mitocondriais/complicações , Doenças Mitocondriais/cirurgia , Succinilcolina/efeitos adversos
10.
Vet Anaesth Analg ; 49(3): 233-242, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35314123

RESUMO

OBJECTIVE: The provision of general anesthesia is common in veterinary hospitals and procedures include some level of risk, up to and including mortality. A quality initiative was introduced with a focus on reducing canine and feline anesthesia mortality. This paper describes the development and implementation of risk-based medical quality standards (MQS) and resultant impacts on anesthesia mortality. STUDY DESIGN: This was a qualitative observational study. MQS focused on the provision of anesthesia were researched, developed and implemented. Anesthesia mortality rates, captured via an automated process based on the electronic medical record, were recorded before and after implementation. Compliance to standards was determined via hospital auditing. ANIMALS: Client-owned dogs and cats presenting to Banfield Pet Hospital (a national network of primary care hospitals) for elective and nonelective general anesthesia procedures. Over the course of the study, 2,038,318 dogs and 350,410 cats had a general anesthesia event. METHODS: Literature reviews and analysis of veterinary patient medical records identified risk factors associated with anesthesia mortality. Risk factors informed the development of MQS. Evidence-based standards focused on the provision of general anesthesia were written, reviewed, evaluated and edited. Implementation occurred over 6 months via a robust communication plan. Anesthesia mortality rates were continuously monitored before, during and after the introduction of standards. Compliance with all quality standards was assessed via hospital-based auditing performed on an annual basis. RESULTS: Prior to quality standards implementation, anesthesia mortality rates for dogs and cats combined was 7.4 deaths/10,000 procedures. At 6 months after implementation, the mortality rate was 6.24 deaths/10,000 procedures, representing a 16% decrease. Compliance with standards improved over time with continued focus and education. CONCLUSIONS AND CLINICAL RELEVANCE: Development, implementation and continued focus on MQS can improve anesthetic safety and reduce anesthesia mortality in primary care veterinary hospitals.


Assuntos
Anestesia , Anestesiologia , Doenças do Gato , Doenças do Cão , Anestesia/efeitos adversos , Anestesia/veterinária , Animais , Doenças do Gato/etiologia , Gatos , Doenças do Cão/etiologia , Cães , Atenção Primária à Saúde
13.
A A Pract ; 16(3): e01569, 2022 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-35299226

RESUMO

Propofol "frenzy" is considered a severe propofol-induced neuroexcitatory reaction involving nonepileptic spells of extremity thrashing, marked agitation, irregular eye movements, and impaired consciousness. Patients with propofol neuroexcitation present unique challenges for anesthesia providers due to underrecognition, lack of diagnostic tests, and differentiating from other comparable disorders that require medications that can exacerbate symptoms. We present a case of a healthy young patient whose postoperative course was complicated by propofol frenzy and functional limb paralysis following hip surgery with a spinal anesthetic and propofol sedation. This case highlights anesthesia considerations for propofol frenzy and discusses dexmedetomidine as a promising modality for prompt management.


Assuntos
Anestesia , Propofol , Anestesia/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Humanos , Propofol/efeitos adversos
15.
Artigo em Inglês | MEDLINE | ID: mdl-35134016

RESUMO

Bilateral tibiofemoral knee dislocations are a relatively rare injury, and there is a scarcity of literature on its appropriate evaluation and treatment. Even less knee dislocations with concomitant popliteal artery injury have been described. Postoperative graft occlusion accounts for approximately half of the overall complication rate, occurring in up to 18% of the patients undergoing femoropopliteal bypass grafting. Furthermore, anticoagulation and antiplatelet therapy after graft placement is a point of contention. Here, we describe a case of a knee dislocation with associated popliteal artery transection treated initially with successful knee-spanning external fixation and arterial grafting, respectively. At 6 weeks after injury, the patient underwent external fixation removal and closed manipulation of the knee for arthrofibrosis. After manipulation, yet still under anesthesia, distal pulses were acutely diminished and subsequent CTA demonstrated femoropopliteal graft thrombosis. This case demonstrates successful recognition, thrombectomy, and restoration of arterial blood flow, which has since been maintained. Written consent by the patient involved in this case report was obtained.


Assuntos
Anestesia , Oclusão de Enxerto Vascular , Anestesia/efeitos adversos , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Grau de Desobstrução Vascular
16.
J Cardiothorac Vasc Anesth ; 36(6): 1606-1616, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35181233

RESUMO

OBJECTIVES: To determine the incidence of clinically significant serious adverse events in a contemporary population of pediatric patients with pulmonary hypertension who require anesthesia and identify factors associated with adverse outcomes. DESIGN: A retrospective, cross-sectional study. SETTING: A single-center quaternary-care freestanding children's hospital in the northeastern United States. PARTICIPANTS: Pediatric patients with pulmonary hypertension based on hemodynamic criteria on cardiac catheterization during a 3-year period from 2015 to 2018. INTERVENTIONS: Anesthesia care for cardiac catheterization, noncardiac surgery, and diagnostic imaging. MEASUREMENTS AND MAIN RESULTS: Two hundred forty-nine children underwent 862 procedures, 592 for cardiac catheterization and 278 for noncardiac surgery and diagnostic imaging. The median age was 1.6 years, and the weight was 9.5 lbs. On index catheterization, median pulmonary artery pressure was 36 mmHg, and the pulmonary vascular resistance was 5.1 indexed Wood units. Ten percent of anesthetics were performed with a natural airway, and 80% used volatile anesthetics. Serious adverse events occurred in 26% of procedures (confidence interval [CI], 22%-30%). The rate of periprocedural cardiac arrest was 8 per 1,000 anesthetic administrations. In multivariate analysis, younger age (adjusted odds ratio [aOR], 1.4 per year; CI, 1.1-1.9; p = 0.01), location in the catheterization laboratory (aOR, 5.1; CI, 1.7-16; p = 0.004), and longer procedure duration (aOR, 1.3 per 30 minutes; CI, 1.1-1.4; p = 0.001) were associated with serious adverse events. Patients with a tracheostomy in place were less likely to experience an adverse event (aOR, 0.1; CI, 0.04-0.5; p = 0.001). The primary anesthetic technique was not associated with adverse events. Interventional cardiac catheterization was associated with an increased incidence of adverse events compared with diagnostic catheterization (42% v 21%; OR, 2.23; CI, 1.5-3.3; p < 0.001). CONCLUSIONS: Serious adverse events were common in this cohort. Careful planning to minimize anesthesia time in young children with pulmonary hypertension should be undertaken, and these factors considered in designing risk mitigation strategies.


Assuntos
Anestesia , Hipertensão Pulmonar , Anestesia/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Criança , Pré-Escolar , Estudos Transversais , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Lactente , Estudos Retrospectivos
17.
Anaesth Crit Care Pain Med ; 41(2): 101036, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35181529

RESUMO

INTRODUCTION: Neonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study. MATERIAL AND METHODS: Data from the French centres that participated to the NECTARINE study were analysed. The primary goal of the study was the description of patients' characteristics, procedures and perioperative management and their comparison with the results of the European NECTARINE study. Secondary outcomes were the description of major perioperative complications and death. RESULTS: Overall, 926 procedures collected in 15 centres (all teaching hospitals) were analysed. Comparison between the French and European NECTARINE cohorts found few differences related to patients' characteristics and procedures. The rate of interventions for critical events (respiratory, haemodynamic, and metabolic) was similar between the two cohorts. Near-infrared spectroscopy monitoring was used in 12% of procedures. Nearly none of the thresholds for these interventions met the published standards. By day 30, complications (respiratory, haemodynamic, metabolic, renal, and liver failure) and death were observed in 14.4% [95% CI 11.6-16.4]% and 1.8% [95% CI 1.1-2.9] of cases, respectively. DISCUSSION: Although the health status of the patients in the French cohort was less severe, procedures, management and postoperative complications and mortality rates were similar to the European cohort. However, thresholds for interventions were often inadequate in both cohorts. Efforts should be undertaken to improve the knowledge and use of new monitoring devices in this population.


Assuntos
Anestesia , Anestesia/efeitos adversos , Estudos de Coortes , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
18.
J Pediatr Orthop ; 42(5): e544-e549, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35220337

RESUMO

BACKGROUND: Postoperative urinary retention (POUR) is a surgical complication more prevalent in children with neurodisability and associated with an increase length of hospitalization. Risk factors include pre-existing bladder dysfunction, type and duration of surgery, anesthesia medications, postoperative opioid pain management, and patient demographics. The purpose of this investigation was (1) to determine the frequency of POUR following hip/lower limb orthopaedic procedures in which epidural analgesia was used for pain management; (2) to explore factors influencing postoperative bladder management. METHODS: A retrospective analysis of clinical data was performed in an orthopaedic specialty care health care system. A health outcomes network was queried for patients with a diagnoses of cerebral palsy (ICD-9/10 codes) who had one of 57 unique CPT procedure codes corresponding to hip osteotomies or tenotomies from 2011 to 2019. All surgical observations included in analysis required a discrete data element and the confirmation of a secondary proxy. The database was also queried for postoperative medications received and patient demographics of interest. RESULTS: A total of 704 surgical procedures met inclusion criteria resulting in a patient population with a mean age of 11 years, 58% male, 53% Caucasian, and 55% classified as quadriplegia [51% Gross Motor Function Classification System (GMFCS) levels IV/V]. Three hundred and thirty-five procedures (48%) involved epidural anesthesia. Sixty-five patients required intermittent catheterization (9.2%) postoperatively following foley catheter removal, of which 23 (3.3%) required recatheterization. The rate of recatheterization was similar regardless of anesthesia mode; 1.8% for general and 1.4% for epidural and was associated with a greater number of pain medications. Epidural anesthesia resulted in significantly longer periods of catheterization. For the total group the time to urinary catheter removal differed significantly among cerebral palsy subtypes, GMFCS Level, race, and ethnicity. Factors identified as significant predictors of the length of catheterization were epidural analgesia, number of pain medications, and osteotomy. CONCLUSIONS: The number of postoperative pain medications utilized was more predictive of POUR than the mode of analgesia delivery; however, epidural analgesia and the type of surgical procedure did significantly impact the length of catheterization. LEVEL OF EVIDENCE: Level III.


Assuntos
Analgesia Epidural , Anestesia , Paralisia Cerebral , Procedimentos Ortopédicos , Retenção Urinária , Analgesia Epidural/métodos , Anestesia/efeitos adversos , Paralisia Cerebral/complicações , Paralisia Cerebral/cirurgia , Criança , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Bexiga Urinária/cirurgia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Retenção Urinária/cirurgia
19.
Curr Opin Anaesthesiol ; 35(2): 242-247, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35125394

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to look at the current evidence on the consequences of intraoperative hypotension and discuss improvements that can be implemented for its prevention. RECENT FINDINGS: Literature continues to supply convincing evidence that even brief periods of intraoperative hypotension are associated with increased perioperative morbidity and mortality. Recent randomized controlled trial showed intraoperative early use of vasopressor and maintaining blood pressure within tight ranges improves outcomes. SUMMARY: There should be a shift in paradigm in focusing on the prevention of intraoperative hypotension instead treatment. The suggested goals to help maintaining hemodynamic stability during anesthesia include ensure adequate blood pressure and flow; hypotension prevention; and ensure adequate anesthetic depth without overdose.


Assuntos
Anestesia , Anestésicos , Hipotensão , Anestesia/efeitos adversos , Pressão Sanguínea , Humanos , Hipotensão/etiologia , Hipotensão/prevenção & controle , Vasoconstritores/uso terapêutico
20.
BMC Anesthesiol ; 22(1): 46, 2022 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-35164679

RESUMO

BACKGROUND: There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected. METHODS: An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020. RESULTS: A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2-negative and -positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p < 0.01 and p = 0.1, respectively). DISCUSSION: When comparing SARS-COV-2-positive and -negative patients, no significant difference was found regarding the rate of postoperative complications, while baseline characteristics strongly impact these outcomes. This finding suggests that patients should be scheduled for anesthetic procedures based on their overall risk of postoperative complication, and not just based on their SARS-CoV-2 status.


Assuntos
Anestesia , COVID-19/complicações , Idoso , Anestesia/efeitos adversos , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Doenças Respiratórias/complicações , Doenças Respiratórias/epidemiologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
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