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1.
Anesth Analg ; 138(3): 491-494, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38364239
2.
Anesth Analg ; 138(3): 487, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38364237
3.
Anesth Analg ; 138(2): 236-237, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38215702
4.
Anesth Analg ; 138(2): 239-251, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38215704

RESUMO

The last 2 decades have brought important developments in anesthetic technology, including robotic anesthesia. Anesthesiologists titrate the administration of pharmacological agents to the patients' physiology and the needs of surgery, using a variety of sophisticated equipment (we use the term "pilots of the human biosphere"). In anesthesia, increased safety seems coupled with increased technology and innovation. This article gives an overview of the technological developments over the past decades, both in terms of pharmacological and mechanical robots, which have laid the groundwork for robotic anesthesia: target-controlled drug infusion systems, closed-loop administration of anesthesia and sedation, mechanical robots for intubation, and the latest development in the world of communication with the arrival of artificial intelligence (AI)-derived chatbots are presented.


Assuntos
Anestesia , Anestésicos , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Inteligência Artificial , Anestesia/efeitos adversos
5.
Anesth Analg ; 138(2): 295-307, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38215709

RESUMO

Anesthesia objectives have evolved into combining hypnosis, amnesia, analgesia, paralysis, and suppression of the sympathetic autonomic nervous system. Technological improvements have led to new monitoring strategies, aimed at translating a qualitative physiological state into quantitative metrics, but the optimal strategies for depth of anesthesia (DoA) and analgesia monitoring continue to stimulate debate. Historically, DoA monitoring used patient's movement as a surrogate of awareness. Pharmacokinetic models and metrics, including minimum alveolar concentration for inhaled anesthetics and target-controlled infusion models for intravenous anesthesia, provided further insights to clinicians, but electroencephalography and its derivatives (processed EEG; pEEG) offer the potential for personalization of anesthesia care. Current studies appear to affirm that pEEG monitoring decreases the quantity of anesthetics administered, diminishes postanesthesia care unit duration, and may reduce the occurrence of postoperative delirium (notwithstanding the difficulties of defining this condition). Major trials are underway to further elucidate the impact on postoperative cognitive dysfunction. In this manuscript, we discuss the Bispectral (BIS) index, Narcotrend monitor, Patient State Index, entropy-based monitoring, and Neurosense monitor, as well as middle latency evoked auditory potential, before exploring how these technologies could evolve in the upcoming years. In contrast to developments in pEEG monitors, nociception monitors remain by comparison underdeveloped and underutilized. Just as with anesthetic agents, excessive analgesia can lead to harmful side effects, whereas inadequate analgesia is associated with increased stress response, poorer hemodynamic conditions and coagulation, metabolic, and immune system dysregulation. Broadly, 3 distinct monitoring strategies have emerged: motor reflex, central nervous system, and autonomic nervous system monitoring. Generally, nociceptive monitors outperform basic clinical vital sign monitoring in reducing perioperative opioid use. This manuscript describes pupillometry, surgical pleth index, analgesia nociception index, and nociception level index, and suggest how future developments could impact their use. The final section of this review explores the profound implications of future monitoring technologies on anesthesiology practice and envisages 3 transformative scenarios: helping in creation of an optimal analgesic drug, the advent of bidirectional neuron-microelectronic interfaces, and the synergistic combination of hypnosis and virtual reality.


Assuntos
Anestesia , Anestésicos , Humanos , Nociceptividade/fisiologia , Monitorização Intraoperatória , Anestesia/efeitos adversos , Anestesia Intravenosa , Dor , Eletroencefalografia , Anestesia Geral
6.
Anesth Analg ; 138(2): 326-336, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38215711

RESUMO

Over the last few decades, the field of anesthesia has advanced far beyond its humble beginnings. Today's anesthetics are better and safer than ever, thanks to innovations in drugs, monitors, equipment, and patient safety.1-4 At the same time, we remain limited by our herd approach to medicine. Each of our patients is unique, but health care today is based on a one-size-fits-all approach, while our patients grow older and more medically complex every year. By 2050, we believe that precision medicine will play a central role across all medical specialties, including anesthesia. In addition, we expect that health care and consumer technology will continually evolve to improve and simplify the interactions between patients, providers, and the health care system. As demonstrated by 2 hypothetical patient experiences, these advancements will enable more efficient and safe care, earlier and more accurate diagnoses, and truly personalized treatment plans.


Assuntos
Anestesia , Anestésicos , Humanos , Anestesia/efeitos adversos , Atenção à Saúde , Segurança do Paciente
7.
Anesth Analg ; 138(2): 273-283, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38215707

RESUMO

The monitoring of vital signs in patients undergoing anesthesia began with the very first case of anesthesia and has evolved alongside the development of anesthesiology ever since. Patient monitoring started out as a manually performed, intermittent, and qualitative assessment of the patient's general well-being in the operating room. In its evolution, patient monitoring development has responded to the clinical need, for example, when critical incident studies in the 1980s found that many anesthesia adverse events could be prevented by improved monitoring, especially respiratory monitoring. It also facilitated and perhaps even enabled increasingly complex surgeries in increasingly higher-risk patients. For example, it would be very challenging to perform and provide anesthesia care during some of the very complex cardiovascular surgeries that are almost routine today without being able to simultaneously and reliably monitor multiple pressures in a variety of places in the circulatory system. Of course, anesthesia patient monitoring itself is enabled by technological developments in the world outside of the operating room. Throughout its history, anesthesia patient monitoring has taken advantage of advancements in material science (when nonthrombogenic polymers allowed the design of intravascular catheters, for example), in electronics and transducers, in computers, in displays, in information technology, and so forth. Slower product life cycles in medical devices mean that by carefully observing technologies such as consumer electronics, including user interfaces, it is possible to peek ahead and estimate with confidence the foundational technologies that will be used by patient monitors in the near future. Just as the discipline of anesthesiology has, the patient monitoring that accompanies it has come a long way from its beginnings in the mid-19th century. Extrapolating from careful observations of the prevailing trends that have shaped anesthesia patient monitoring historically, patient monitoring in the future will use noncontact technologies, will predict the trajectory of a patient's vital signs, will add regional vital signs to the current systemic ones, and will facilitate directed and supervised anesthesia care over the broader scope that anesthesia will be responsible for.


Assuntos
Anestesia , Anestesiologia , Humanos , Anestesia/efeitos adversos , Monitorização Fisiológica , Sinais Vitais , Computadores
8.
BMC Anesthesiol ; 24(1): 21, 2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-38216874

RESUMO

PURPOSE: Hypoxia is one of the most frequent adverse events under deep sedation in the semiprone position. We hypothesized that supraglottic jet oxygenation and ventilation (SJOV) via Wei nasal jet tube (WNJ) can reduce the incidence of hypoxia in patients under deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A total of 171 patients were divided into three groups: N group, supplementary oxygen via a nasopharyngeal airway (4-6 L/min); W group, supplementary oxygen via WNJ (4-6 L/min); WS group, SJOV via WNJ. The primary outcome was the incidence of adverse events, including sedation-related adverse events [SRAEs, hypoxemia (SpO2 = 75-89% lasted less than 60 s); severe hypoxemia (SpO2 < 75% at any time or SpO2 < 90% lasted more than 60 s] and subclinical respiratory depression (SpO2 = 90-95%). Other intraoperative and post-operative adverse events were also recorded as secondary outcomes. RESULTS: Compared with the N group, the incidence of hypoxemia and subclinical respiratory depression in the WS group was significantly lower (21% vs. 4%, P = 0.005; 27% vs. 6%, P = 0.002). Compared with Group W, the incidence of hypoxemia and subclinical respiratory depression in Group WS was also significantly less frequent (20% vs. 4%, P = 0.009; 21% vs. 6%, P = 0.014). No severe hypoxia occurred in the group WS, while four and one instances were observed in the group N and group W respectively. There were no significant differences in other adverse events among the three groups. CONCLUSION: SJOV can effectively improve oxygenation during ERCP in deeply sedated semiprone patients.


Assuntos
Anestesia , Insuficiência Respiratória , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Hipóxia/etiologia , Hipóxia/prevenção & controle , Hipóxia/epidemiologia , Oxigênio , Insuficiência Respiratória/complicações , Anestesia/efeitos adversos
9.
Synapse ; 78(1): e22286, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38287474

RESUMO

In this study, we aimed to validate the hypothesis that the interplay between sevoflurane, oxidative stress and ferroptosis is crucial for the pathogenesis of sevoflurane-induced cognitive impairment in aged individuals. The mice with sevoflurane-induced cognitive impairment were used to explore the effects of sevoflurane on oxidative stress, iron homeostasis, and cognitive function in aged mice. Iron content and oxidative stress markers were analyzed in hippocampal tissue homogenates using specific assays. Additionally, the levels of iron death-related markers (Fth1 and Gpx4) were assessed by real-time PCR and Western blotting. Morris Water Maze and novel object recognition (NOR) tests were conducted to evaluate cognitive function. Sevoflurane exposure in aged mice resulted in a significant increase in iron overloading in the hippocampus, followed by a subsequent stabilization. Oxidative stress levels were elevated in the hippocampal tissue of sevoflurane-exposed mice, and a significant correlation was observed between iron death and oxidative stress. Liproxstatin-1, a ferroptosis inhibitor, effectively ameliorated the decline in memory and learning abilities induced by sevoflurane anesthesia. Liproxstatin-1 treatment reduced iron overload and oxidative stress in the hippocampal tissue of aged mice. The expression of Fth1 and Gpx4, iron death-related markers, was downregulated following Liproxstatin-1 intervention. Our findings suggest that sevoflurane anesthesia disrupts iron homeostasis, leading to increased oxidative stress and cognitive impairment in aged mice. These results highlight the potential of targeting iron-mediated processes to mitigate sevoflurane-induced cognitive impairment in the aging population.


Assuntos
Anestesia , Disfunção Cognitiva , Ferroptose , Quinoxalinas , Compostos de Espiro , Animais , Camundongos , Sevoflurano/efeitos adversos , Sevoflurano/metabolismo , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/tratamento farmacológico , Estresse Oxidativo , Anestesia/efeitos adversos , Cognição , Ferro/efeitos adversos , Ferro/metabolismo , Hipocampo/metabolismo
10.
Eur J Neurosci ; 59(2): 208-219, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38105520

RESUMO

Postoperative cognitive dysfunction (POCD) is a prevalent central nervous system complication predominantly observed in elderly patients. Sevoflurane, a general anaesthetic agent, has been implicated in the development of POCD, yet the underlying regulatory mechanisms potentially involving Sestrin1 (SESN1), a stress-responsive protein that plays a critical role in cellular homeostasis and protection against stress-induced damage, including oxidative stress and DNA damage, remain elusive. This study endeavoured to elucidate the impact of SESN1 on sevoflurane-induced cognitive impairment in rats. Employing a model in which SESN1 was transfected into SD male rats and cognitive dysfunction was induced by sevoflurane. The Morris Water Maze test was used for behavioural evaluation, Enzyme-Linked Immunosorbent Assay, Western blotting and immunofluorescence were applied to assess the influence of SESN1 on the inflammatory response and mitophagy in the rat hippocampus. The study further aimed to uncover the putative mechanism by which SESN1, through SIRT1, might modulate cognitive function. Concurrently, levels of malondialdehyde, superoxide dismutase and mitochondrially produced ATP within the rat hippocampus were quantified. Experimental outcomes suggested that SESN1 overexpression significantly mitigated the deleterious effects of sevoflurane anaesthesia, ameliorated neuroinflammation and inflammasome activation, modified mitochondrial function and facilitated mitophagy. Additionally, SESN1, via the activation of SIRT1, may suppress inflammasome activation and mitochondrial dysfunction. Collectively, these findings underscore SESN1's integral role in counteracting sevoflurane-induced cognitive impairment, impeding inflammasome activation, enhancing mitochondrial function and fostering mitophagy, which appear to be intricately linked to SESN1-mediated SIRT1 activation. SESN1 is a novel therapeutic target for POCD, potentially advancing neuroprotective strategies in clinical settings.


Assuntos
Anestesia , Disfunção Cognitiva , Humanos , Masculino , Ratos , Animais , Idoso , Sevoflurano/farmacologia , Sirtuína 1/metabolismo , Mitofagia , Inflamassomos/efeitos adversos , Inflamassomos/metabolismo , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/tratamento farmacológico , Anestesia/efeitos adversos , Hipocampo/metabolismo , Sestrinas/metabolismo
11.
J Pediatr Orthop ; 44(1): e84-e90, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37937395

RESUMO

BACKGROUND: Management of postoperative knee arthrofibrosis can be challenging and the preferred time for intervention remains controversial. The purpose of this study is to evaluate the safety and efficacy of early (<3 mo postoperatively) manipulation under anesthesia (MUA) for the treatment of knee arthrofibrosis in adolescent patients. We hypothesized that early MUA could restore normal knee motion with a low complication rate and without the need for more invasive intervention. METHODS: In a retrospective review, 57 patients who underwent MUA for postoperative knee arthrofibrosis were identified. The time between the index surgery and MUA as well as changes in range of motion (ROM) before and after MUA were analyzed. Descriptive statistics with median and interquartile range were used to analyze this non-parametric study cohort. Repeated measures ANOVA was performed to assess improvement in ROM over time. A P value <0.05 denoted statistical significance. RESULTS: The median age of the cohort at time of MUA was 14.5 years [interquartile range (IQR) 12.9 to 17.6)]. 54.4% were male. Median time to MUA was 64 days (IQR 52 to 79) after index surgery. ROM before MUA was 90.0 degrees (IQR 75 to 100), which improved to 130 degrees (120 to 135) after MUA. At final median follow-up of 8.9 months (IQR 5.1 to 16.1), mean ROM was 133 degrees (130 to 140). There were no iatrogenic fractures or physeal separations associated with MUA. 12.3% (n=7/57) failed MUA either due to the need for subsequent repeat MUA (n=2), need for lysis of adhesions (n=3) or need for surgery after MUA (n=2). Those who failed early MUA and required subsequent procedures had ROM >120 degrees at final follow-up. CONCLUSIONS: Postoperative knee arthrofibrosis can be safely and effectively treated with early (<3 mo postoperative) MUA. There were no iatrogenic fractures or physeal separations during MUA. Patients who had recurrence of motion deficits after early MUA and required further intervention, regained satisfactory knee motion at final follow-up. Although further research is warranted to better characterize risk factors for knee arthrofibrosis in adolescent patients, early recognition and MUA is a safe and effective treatment for arthrofibrosis to help patients regain full ROM without invasive intervention. LEVEL OF EVIDENCE: Therapeutic Study - Level IV.


Assuntos
Anestesia , Artropatias , Humanos , Masculino , Adolescente , Feminino , Articulação do Joelho/cirurgia , Anestesia/efeitos adversos , Artropatias/etiologia , Artropatias/cirurgia , Resultado do Tratamento , Fatores de Risco , Estudos Retrospectivos , Amplitude de Movimento Articular
12.
Anaesthesia ; 79(1): 43-53, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37944508

RESUMO

Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, we studied a prospective national cohort of unselected patients. Anaesthetists recorded anonymous details of all cases undertaken over 4 days at their site through an online survey. Of 416 hospital sites invited to participate, 352 (85%) completed the survey. Among 24,172 cases, 1922 discrete potentially serious complications were reported during 1337 (6%) cases. Obstetric cases had a high reported major haemorrhage rate and were excluded from further analysis. Of 20,996 non-obstetric cases, 1705 complications were reported during 1150 (5%) cases. Circulatory events accounted for most complications (616, 36%), followed by airway (418, 25%), metabolic (264, 15%), breathing (259, 15%), and neurological (41, 2%) events. A single complication was reported in 851 (4%) cases, two complications in 166 (1%) cases and three or more complications in 133 (1%) cases. In non-obstetric elective surgery, all complications were 'uncommon' (10-100 per 10,000 cases). Emergency (urgent and immediate priority) surgery accounted for 3454 (16%) of non-obstetric cases but 714 (42%) of complications with severe hypotension, major haemorrhage, severe arrhythmias, septic shock, significant acidosis and electrolyte disturbances all being 'common' (100-1000 per 10,000 cases). Based on univariate analysis, complications were associated with: younger age; higher ASA physical status; male sex; increased frailty; urgency and extent of surgery; day of the week; and time of day. These data represent the rates of potentially serious complications during routine anaesthesia care and may be valuable for risk assessment and patient consent.


Assuntos
Anestesia , Anestésicos , Feminino , Gravidez , Humanos , Masculino , Incidência , Estudos Prospectivos , Anestesia/efeitos adversos , Hemorragia , Reino Unido/epidemiologia
14.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 58(11-12): 626-638, 2023 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-38056442

RESUMO

Based on the existing literature, the application of designated, processed EEG-monitors to measure anesthetic depth and the associated clinical implications are explained. EEG-monitors quantify the hypnotic portion of anesthesia, but not the nociceptive properties of anesthetics. Depth of anesthesia monitoring is common practice in many German hospitals and helps to visualize the interindividual variability of anesthetics, especially of propofol. Although deep anesthesia is associated with increased long-term mortality, this relation seems not to be causally related. Nevertheless, depth of anesthesia monitors help to identify patients being especially susceptible to anesthetics. Moreover, they have shown to reduce the incidence of intraoperative awareness and postoperative delirium. The application of processed EEG-monitors to reduce the incidence of postoperative delirium is currently recommended by the European Society of Anaesthesiology and Intensive Care.


Assuntos
Anestesia , Anestésicos , Delírio do Despertar , Propofol , Humanos , Delírio do Despertar/epidemiologia , Anestesia/efeitos adversos , Eletroencefalografia/efeitos adversos , Anestesia Geral/efeitos adversos
15.
Medicine (Baltimore) ; 102(50): e36523, 2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-38115349

RESUMO

To analyze clinical characteristics and anesthesia-related factors influencing central fever during cranial neurosurgery. 31 central fever cases (observation) and 120 controls (no fever) underwent detailed investigation. Anaesthesia-related variables were analyzed using logistic regression. Observation group exhibited significantly elevated indicators-CSF white blood cells, protein, CRP, severe EEG abnormalities, abnormal imaging, positive meningeal signs, seizures, consciousness disorders, and status epilepticus (P < .05). Anesthesia plans showed no influence (P > .05). pH, PaCO2, PaO2, SaO2, MAP, ICP, CPP, and SjiO2 didn't impact central fever (P > .05). However, high HR, low Da-jvO2, and low CEO2 were independent risk factors (P < .05). Central fever, marked by CNS abnormalities, manifests with distinctive clinical features. Anesthesia plans have limited impact, while elevated HR, low Da-jvO2, and low CEO2 independently contribute to central fever. Understanding these factors is crucial for perioperative care optimization.


Assuntos
Anestesia , Doenças do Sistema Nervoso Central , Humanos , Anestesia/efeitos adversos , Febre/etiologia , Fatores de Risco
16.
BMJ Open ; 13(12): e076803, 2023 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-38135325

RESUMO

INTRODUCTION: Older surgical patients are more likely to be living with frailty and multimorbidity and experience postoperative complications. The management of these conditions in the perioperative pathway is evolving. In order to support objective decision-making for patients, services and national guidance, accurate, contemporary data are needed to describe the impact and associations between frailty, multimorbidity and healthcare processes with patient and service-level outcomes. METHODS AND ANALYSIS: The study is comprised of an observational cohort study of approximately 7500 patients; an organisational survey of perioperative services and a clinician survey of the unplanned, medical workload generated from older surgical patients. The cohort will consist of patients who are 60 years and older, undergoing a surgical procedure during a 5-day recruitment period in participating UK hospitals. Participants will be assessed for baseline frailty and multimorbidity; postoperative morbidity including delirium; and quality of life. Data linkage will provide additional details about individuals, their admission and mortality.The study's primary outcome is length of stay, other outcome measures include incidence of postoperative morbidity and delirium; readmission, mortality and quality of life. The cohort's incidence of frailty, multimorbidity and delirium will be estimated using 95% CIs. Their relationships with outcome measures will be examined using unadjusted and adjusted multilevel regression analyses. Choice of covariates in the adjusted models will be prespecified, based on directed acyclic graphs.A parallel study is planned to take place in Australia in 2022. ETHICS AND DISSEMINATION: The study has received approval from the Scotland A Research Ethics Committee and Wales Research Ethics Committee 7.This work hopes to influence the development of services and guidelines. We will publish our findings in peer-reviewed journals and provide summary documents to our participants, sites, healthcare policy-makers and the public. TRIAL REGISTRATION NUMBER: ISRCTN67043129.


Assuntos
Anestesia , Delírio , Fragilidade , Humanos , Idoso , Fragilidade/epidemiologia , Fragilidade/complicações , Multimorbidade , Qualidade de Vida , Projetos de Pesquisa , Anestesia/efeitos adversos , Delírio/epidemiologia , Delírio/etiologia , Estudos Observacionais como Assunto
17.
Mo Med ; 120(6): 459-463, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38144931

RESUMO

You begin to hear distant rock music playing, people conversing about their weekend. Then the scalpel is requested-incision. Pain sends you reeling and you attempt to muster a scream. No one seems to hear you and you are unable to lift a finger. The scenario is so rare that numerous movies have been made about awareness under anesthesia. Awareness under anesthesia is a rare event, however, it is a complication that no one ever desires to occur. We will explore how frequent awareness is during surgery, what risk factors are involved, and what tools anesthesia providers utilize to ensure everyone undergoing surgery is adequately anesthetized.


Assuntos
Anestesia , Consciência no Peroperatório , Humanos , Anestesia/efeitos adversos
18.
Tuberk Toraks ; 71(4): 428-432, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38152013

RESUMO

Sevoflurane is a commonly used inhalational anesthetic agent for inducing and maintaining general anesthesia. However, it has been associated with a rare but serious pulmonary condition known as diffuse alveolar hemorrhage (DAH). DAH is characterized by decreased hemoglobin levels, diffuse pulmonary infiltration, and respiratory failure with hypoxemia. We present a case of DAH in a healthy young adult who experienced this condition following general anesthesia with inhaled sevoflurane during an uncomplicated orthopedic procedure. Notably, there were no other risk factors or known causes that could account for the development of DAH in this patient.


Assuntos
Anestesia , Pneumopatias , Adulto Jovem , Humanos , Sevoflurano/efeitos adversos , Alvéolos Pulmonares , Hemorragia/induzido quimicamente , Pneumopatias/complicações , Anestesia/efeitos adversos
19.
BMC Anesthesiol ; 23(1): 368, 2023 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-37950163

RESUMO

BACKGROUND: Postoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery. METHODS: We analysed data obtained for a prospective observational study in patients aged ≥ 65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of ≥ 25% relative to baseline in ≥ 2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score. RESULTS: Of the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8-27.9)], p < 0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001-1.005)], p = 0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[± 3.13]). CONCLUSION: In this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients' scores on cognitive tests improved postoperatively.


Assuntos
Anestesia , Disfunção Cognitiva , Humanos , Complicações Pós-Operatórias/etiologia , Anestesia/efeitos adversos , Transtornos Neurocognitivos/etiologia , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Testes Neuropsicológicos
20.
Anaesthesiologie ; 72(12): 907-918, 2023 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-37947803

RESUMO

Due to refined and new diagnostic possibilities and improved medical care, in the future anesthesiologists will be more frequently confronted with patients suffering from rare diseases. As the physicians providing perioperative care often have little or no experience with the diseases of such patients, the access to high-quality specific literature is essential. In this respect they must be able to assess and classify the quality of the information which is predominantly available online, especially as when evidence-based knowledge is available, it is only available to a very limited extent. Patients with rare diseases mostly present with recurring problem constellations. A systematic assignment to the most important problem areas (airway, circulation, metabolism, etc.) as well as a structured and interdisciplinary approach are decisive for a successful perioperative treatment of these patients. Due to low prevalence, lack of personal experience and lack of evidence-based data, anesthesia in patients with SE is an absolute challenge, especially in time-critical situations.


Assuntos
Anestesia , Anestesiologia , Humanos , Doenças Raras/diagnóstico , Anestesia/efeitos adversos , Assistência Perioperatória , Anestesiologistas
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