Safe Administration Of Anesthesia Research Articles

Universal Anesthesia Machine: Clinical Application in an Austere, Resource-Limited Environment.

In austere environments, the safe administration of anesthesia becomes challenging because of unreliable electrical sources, limited amounts of compressed gas, and insufficient machine maintenance capabilities. Such austere environments exist in battlefield medicine, in low- and middle-income countries (LMICs), and in areas struck by natural disasters. Whether in military operations or civilian settings, the Universal Anesthesia Machine (UAM) (Gradian Health Systems, New York, New York) is a draw-over device capable of providing safe and effective general anesthesia when external oxygen supplies or reliable electrical sources are limited. This brief report discusses a proof-of-concept observational study demonstrating the clinical utility of the UAM in a resource-limited area. This observational study of 20 patients in Haiti who underwent general anesthesia using the UAM highlights the device's capability to deliver anesthesia intraoperatively in a resource-limited LMIC clinical setting. Preoxygenation was achieved with the UAM's draw-over oxygen supply. Patients received acetaminophen for analgesia, dexmedetomidine for preinduction anesthesia, and succinylcholine for paralysis. After induction, the UAM provided a mixture of oxygen and isoflurane for maintenance of anesthesia. Manual ventilation was performed using draw-over bellows until spontaneous ventilation recurred, when clinically appropriate, artificial airways were removed. Intraoperative medication was administered at the anesthesiologist's discretion. The institutional review board at the U.S. anesthesiologists' affiliated institution and the Haitian hospital approved this study; patients were consented in their native language. Two anesthesiologists used the UAM to deliver general anesthesia to 20 patients in a Haitian hospital without access to an external oxygen supply, reliable power grid, or opioids. The patients' average age was ~40years, and 90% of them were male. Most of the cases were herniorrhaphy (50%) and hydrocelectomy (25%) surgeries. The median American Society of Anesthesiologists (ASA) score was 2; 45% of the patients had an ASA score of 1, and none had an ASA score >3. Of the 20 cases, 55% of patients received an endotracheal tube, and 40% received a laryngeal mask airway; for one patient, only a masked airway was used. Every patient was discharged on the day of the surgery. No complications occurred in the perioperative or 1-month follow-up period. The UAM can be used where a lack of resources and training exist because of its simple design, built-in oxygen concentrator, and capacity to revert from continuous-flow to draw-over anesthesia in the event of a power failure or if external oxygen supplies are unavailable. We believe the UAM addresses some of the shortcomings of modern anesthesia machines and has the potential to improve the delivery of safe general anesthesia in combat and austere scenarios. Further studies could consider different types of surgeries than those reported here and involve more complex patients. Studies involving alternative anesthetic agents and non-anesthesiologist personnel are also needed. Overall, this brief report detailing the use of the UAM following a natural disaster in a LMIC is proof of concept that the machine can provide reliable anesthesia for surgical procedures in austere and resource-limited environments, including disaster areas and modern combat zones.

The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery.

The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery.

Anaesthetic considerations for surgery in newborns

Almost 30 years ago, the American Academy of Pediatrics Committee on Fetus and Newborn coauthored a policy statement strongly advocating for the use of anaesthesia in all neonates stating ‘local...

Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section

ABSTRACT The pregnant patient with sickle hemoglobinopathy (SH) and mitral stenosis (MS) presenting for emergency lower (uterine) segment cesarean section (LSCS) represents a challenge to the anesthesiologist. In such a case, the choice of anesthesia is dependent on the patient’s clinical condition, urgency of surgery, and the reports of laboratory investigations. An understanding of physiological changes in pregnancy and the pathological impact of MS and SH on pregnancy will help the administration of safe anesthesia for mother and baby. We have discussed the management of a pregnant patient with SH and MS for emergency LSCS. How to cite this article Devalkar P, Salgaonkar S, Dhale VV. Anesthesia Management of a Patient with Sickle Hemoglobinopathy and Mitral Stenosis for Emergency Lower (Uterine) Segment Cesarean Section. Res Inno in Anesth 2017;2(1):18-20.

The environmental impact of the Glostavent® anesthetic machine.

Because anesthetic machines have become more complex and more expensive, they have become less suitable for use in the many isolated hospitals in the poorest countries in the world. In these situations, they are frequently unable to function at all because of interruptions in the supply of oxygen or electricity and the absence of skilled technicians for maintenance and servicing. Despite these disadvantages, these machines are still delivered in large numbers, thereby expending precious resources without any benefit to patients. The Glostavent was introduced primarily to enable an anesthetic service to be delivered in these difficult circumstances. It is smaller and less complex than standard anesthetic machines and much less expensive to produce. It combines a drawover anesthetic system with an oxygen concentrator and a gas-driven ventilator. It greatly reduces the need for the purchase and transport of cylinders of compressed gases, reduces the impact on the environment, and enables considerable savings. Cylinder oxygen is expensive to produce and difficult to transport over long distances on poor roads. Consequently, the supply may run out. However, when using the Glostavent, oxygen is normally produced at a fraction of the cost of cylinders by the oxygen concentrator, which is an integral part of the Glostavent. This enables great savings in the purchase and transport cost of oxygen cylinders. If the electricity fails and the oxygen concentrator ceases to function, oxygen from a reserve cylinder automatically provides the pressure to drive the ventilator and oxygen for the breathing circuit. Consequently, economy is achieved because the ventilator has been designed to minimize the amount of driving gas required to one-seventh of the patient's tidal volume. Additional economies are achieved by completely eliminating spillage of oxygen from the breathing system and by recycling the driving gas into the breathing system to increase the Fraction of Inspired Oxygen (FIO2) at no extra cost. Savings also are accrued when using the drawover breathing system as the need for nitrous oxide, compressed air, and soda lime are eliminated. The Glostavent enables the administration of safe anesthesia to be continued when standard machines are unable to function and can do so with minimal harm to the environment.

Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance

Urolithiasis in pregnancy represents a major diagnostic and therapeutic challenge to the obstetrician, urologist, radiologist and anesthetist. It is a cause of major concern, considering the potential adverse effects of radiation exposure and of any invasive surgical procedure and anesthesia on the mother and fetus. Fortunately, with conservative management, 70-80% of symptomatic calculi pass spontaneously with no sequel. However, fever, infection, uncontrolled pain and progressive hydronephrosis are indications for surgical intervention when retrograde placements of a ureteral stent or a percutaneous nephrostomy tube are the most traditional options. The recent technological advances in stone fragmentation devices and the administration of safe anesthesia have forced clinicians to embark on more definitive stone management techniques in pregnancy. Ureteroscopy is considered the first definitive treatment of obstructive ureteral calculi during all trimesters of pregnancy, but also has limitations. Although generally avoided during pregnancy, percutaneous nephrolithotomy can be a good treatment choice in selected patients.

Availability of Anesthesia Equipment in Chinese Hospitals

Availability of physiologic monitoring equipment to ensure the safe administration of anesthesia is an expected standard in many parts of the world. Many hospitals in China may not have an adequate quantity and variety of anesthesia delivery and patient monitoring equipment to assure safe administration of anesthesia patient care. We present some typical cases of hospitals of different sizes and located in regions with different economic levels; our data demonstrate that there is a lack of available anesthesia administration and patient monitoring equipment in small hospitals and hospitals in economically underdeveloped regions.

Endoscopic sedation training in gastroenterology fellowship

Sedation in endoscopy has recently been much debated, yet it is not usually a topic formally addressed during fellowship. Recommendations recently published in a consensus statement will inevitably steer changes in sedation practices. In this month's Fellows' Corner, Dr. Tyler Berzin, a gastroenterology fellow at Beth Israel Deaconess Medical Center, experienced in the study of endoscopic sedation, summarizes the key elements stirring the propofol controversy and offers advice on training in the safe administration of anesthesia.

Ureteroscopic holmium laser lithotripsy in patients with renal impairment

In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria. Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1-7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure. All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%. A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.

Assessing the Past and Shaping the Future of Anesthesiology

Assessing the Past and Shaping the Future of Anesthesiology

Clinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Edition

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Earle R. Young; Clinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Edition. Anesth Prog 1 March 2005; 52 (1): 45. doi: https://doi.org/10.2344/0003-3006(2005)52[45:CAPOTM]2.0.CO;2 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest Search

A new frontier: magnetic resonance imaging-operating room.

Developments in technology have led to the merger of two distinct environments, that of magnetic resonance imaging and that of the operating room. The major advantage of this merger for neurosurgical procedures is the ability to perform real-time imaging to help guide surgery. This review discusses the role of the anesthesiologist in the planning and administration of safe anesthesia in this new and challenging environment.

Tracheal Resection and Reconstruction

Purpose To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed.

THE VALUE OF MONITORS IN CARDIAC SURGERY

Abstract Instruments used as monitors during cardiac surgery are believed by most workers in this field to be of considerable value. Among these instruments are the electrocardiogram, electroencephalogram, pH meter, pressure transducers for arterial and venous pressure and continuously registering thermometer. The electrocardiogram provides useful information concerning the cardiac rate and rhythm especially in presenting evidence of an irritable myocardium in the appearance of ectopic ventricular beats. It must not, however, be regarded as a monitor of efficient cardiac action, as a tracing of normal appearance may be present during episodes of low cardiac output and severe hypotension. When the technic of induced cardiac arrest is used, the electrocardiogram is useful in showing when a normal heart rhythm has reappeared. The electroencephalogram indicates roughly whether or not the internal respiration of the brain is adequate. Gross changes in the pattern indicate that something is wrong in this mechanism: low blood pressure, poorly oxygenated blood, excess carbon dioxide in the blood, hypothermia or overdosage of anesthetic agent. Changes in the pattern alert the anesthesiologist to the fact that some defect is present which demands immediate diagnosis and correction. The pH meter calls attention to the presence of acidosis of respiratory or metabolic origin, so that measures for correction may be begun early (increased ventilation or intravenous administration of sodium bicarbonate). Pressure transducers are helpful in demonstrating hypotension or hypertension before, during and after the use of the artificial heartlung device. Body temperature is important in the safe administration of anesthesia. Especially in children, it is often beneficial to carry the patient with a moderately reduced temperature, or at least to prevent the occurrence of hyperthermia. It should be clearly understood that all these devices are to be considered only as adjuncts in the administration of safe anesthesia. The information they provide must be interpreted by a skilled and careful anesthesiologist to be of full value. A competent anesthesiologist who does not use any or all of these monitors may administer a safer anesthesia than one who depends heavily upon instruments.

The value of monitors in cardiac surgery ∗

Instruments used as monitors during cardiac surgery are believed by most workers in this field to be of considerable value. Among these instruments are the electrocardiogram, electroencephalogram, pH meter, pressure transducers for arterial and venous pressure and continuously registering thermometer. The electrocardiogram provides useful information concerning the cardiac rate and rhythm especially in presenting evidence of an irritable myocardium in the appearance of ectopic ventricular beats. It must not, however, be regarded as a monitor of efficient cardiac action, as a tracing of normal appearance may be present during episodes of low cardiac output and severe hypotension. When the technic of induced cardiac arrest is used, the electrocardiogram is useful in showing when a normal heart rhythm has reappeared. The electroencephalogram indicates roughly whether or not the internal respiration of the brain is adequate. Gross changes in the pattern indicate that something is wrong in this mechanism: low blood pressure, poorly oxygenated blood, excess carbon dioxide in the blood, hypothermia or overdosage of anesthetic agent. Changes in the pattern alert the anesthesiologist to the fact that some defect is present which demands immediate diagnosis and correction. The pH meter calls attention to the presence of acidosis of respiratory or metabolic origin, so that measures for correction may be begun early (increased ventilation or intravenous administration of sodium bicarbonate). Pressure transducers are helpful in demonstrating hypotension or hypertension before, during and after the use of the artificial heartlung device. Body temperature is important in the safe administration of anesthesia. Especially in children, it is often beneficial to carry the patient with a moderately reduced temperature, or at least to prevent the occurrence of hyperthermia. It should be clearly understood that all these devices are to be considered only as adjuncts in the administration of safe anesthesia. The information they provide must be interpreted by a skilled and careful anesthesiologist to be of full value. A competent anesthesiologist who does not use any or all of these monitors may administer a safer anesthesia than one who depends heavily upon instruments.