Anesthetic Management Of Patient Research Articles

A right para-tracheal mass extending into the anterior mediastinum: An anesthetic management conundrum

The anesthetic management of patients with a mediastinal mass represent a challenge due to the potential for difficult ventilation and intubation, as well as the risk of cardiovascular collapse upon induction of general anesthesia. Different strategies and alternatives have been described. We present the case of a 70-year-old man with a right para-tracheal mass extending into the anterior mediastinum with 90% mid-tracheal lumen obstruction who was successfully managed with venous-venous extra-corporeal membrane oxygenation (ECMO) during mass debulking and tracheal stent placement.

Effect of large volume paracentesis performed just prior to transjugular intrahepatic portosystemic shunt on the anesthetic management during the procedure.

Background and Aims:Patients often undergo paracentesis prior to a transjugular intrahepatic portosystemic shunt (TIPS) procedure to improve respiratory mechanics. However, the effect of large volume paracentesis (LVP) on intraoperative hemodynamics and anesthetic management when it is performed immediately before the TIPS procedure is not well documented.Material and Methods:This is a retrospective study in patients undergoing the TIPS procedure between 2004 and 2017. Patients were divided into two groups based on the volume of preoperative paracentesis, namely, small volume paracentesis (SVP), defined as paracentesis volume less than 5 L and LVP, defined as paracentesis volume of at least 5 L. Patients' demographics and perioperative information were collected through chart review. The Wilcoxon signed-rank test, student's t-test, and Fisher's exact test were used when appropriate. Uni- and multivariate linear regression analyses were used to determine the predictive value of paracentesis volume in relation to intraoperative hemodynamics and management of hypotension.Results:Of 49 patients, 19 (39%) received LVP and the remainder received SVP. Baseline demographics were comparable between groups as were intraoperative hypotension and volume of infused crystalloid and colloid. However, vasopressor use (P = 0.02) and packed red blood cell transfusion (P = 0.01) were significantly higher in the large volume group. Paracentesis volume was an independent predictor of the phenylephrine dose (P = 0.0004), and of crystalloid (P = 0.05) and colloid (P = 0.009) volume administered after adjusting for age, sex, body mass index, alcohol use, hemoglobin, and model for end-stage liver disease score.Conclusion:The anesthetic management of patients who undergo LVP just prior to a TIPS procedure may require larger doses of vasopressors and colloids to prevent intraoperative hemodynamic instability during the TIPS placement but may be as well tolerated as SVP.

A physician survey of perioperative neuraxial anesthesia management in patients on a direct oral anticoagulant

BackgroundThe perioperative management of patients taking a direct oral anticoagulant (DOAC) who require a high‐bleed‐risk surgery and/or neuraxial anesthesia is uncertain. We surveyed clinician practices relating to DOAC interruption and related perioperative management in patients having high‐bleed‐risk surgery with neuraxial anesthesia, and assess the suitability of a randomized trial of different perioperative DOAC management strategies. MethodsWe surveyed members of the American Society of Regional Anesthesia and Pain Medicine, the Canadian Anesthesia Society and Thrombosis Canada. We developed four clinical scenarios involving DOAC‐treated patients who required anticoagulant interruption for elective high‐bleed‐risk surgery. In three scenarios, patients were to receive neuraxial anesthesia, and in one scenario they were to receive general anesthesia. We also asked about the merit of a randomized trial to compare a 2‐day versus longer (3‐ to 5‐day) duration of DOAC interruption. ResultsThere were 399 survey respondents of whom 356 (89%) were anesthetists and 43 (11%) were medical specialists. The responses indicate uncertainty about the DOAC interruption interval for high‐bleed‐risk surgery and/or neuraxial anesthesia; anesthetists favor 3‐ to 5‐day interruption whereas medical specialists favor 2‐day interruption. Anesthetists were unwilling to proceed with neuraxial anesthesia in patients with a 2‐day DOAC interruption interval, preferring to cancel the surgery or switch to general anesthesia. There is general agreement on the need for a randomized trial in this field to compare a 2‐day and a 3‐ to 5‐day DOAC interruption management strategy. ConclusionsThere is variability in practices relating to the perioperative management of DOAC‐treated patients who require a high‐bleed‐risk surgery with neuraxial anesthesia; this variability relates to the duration of DOAC interruption in such patients.

Cesarean Section in a COVID-19 Positive Patient with Takayasu Arteritis: A Case Report

Takayasu arteritis is an idiopathic, granulomatous aorto-arteritis that usually affcts young or middle-aged women. The anesthetic management of patients with Takayasu arteritis undergoing cesarean section with COVID-19 is challenging. Patients may have concomitant hypertension, tissue hypoperfusion with the potential for major perioperative cardiovascular complications. The challenges increase considerably in resource-limited settings. We report the case of a 27-year-old primigravida at 39 weeks of gestation with concomitant Takayasu arteritis, chronic hypertension, hypothyroidism, and COVID-19, who underwent an elective cesarean section at our hospital. She incidentally tested positive for SARS-CoV-2 after admission to the hospital. The cesarean section was successfully performed under subarachnoid block. We are not aware of any previous publication describing the anesthetic management in patients with Takayasu arteritis and COVID-19 undergoing cesarean section.

Anaesthetic management in neurological disorders: is combined spinal-epidural a suitable option? Case report

Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.

Возможности прогноза и предупреждения ранних послеоперационных осложнений

Objective. The article provides information on how to improve the forecast of the early postoperative period by additional individualization of anesthetic management of patients during emergency surgical interventions on the gallbladder using artificial neural network technologies. Materials and methods. The course of combined anesthesia and the features of the postoperative period were analyzed in 92 patients with an endoscopic cholecystectomy performed for urgent indications. The prediction of the variant of the postoperative stage of hospitalization was realized using the analysis of the significance of 20 different-modal variables selected for the description of patients using fuzzy logic technologies. The possibility of changing the forecast to a more favorable one was achieved on the basis of the developed algorithm for evaluating the results of training neural networks on the Neuro Pro 0.2 neuroimitator. Results. According to the generally accepted criteria, all patients had endoscopic cholecystectomy and anesthesia wit out complications. At the postoperative stage, 2 groups of persons were identified - with the expected short hospitalization (72 cases - 6.7±2.1 days) and with the clinic, which led to its reliable prolongation (20 cases - 12.2±3.5 days). It has been shown that the use of a neural network approach makes it possible with a confidence of more than 80% to assume cases with a high probability of postoperative disorders and in half of such patients to improve the prognosis within the framework of neural network technology and the developed algorithm for selecting the severity of the selected 5 variable factors related to the method of conducting anesthesia. Conclusion. Neural network technology makes it possible to predict cases with individual “unpredictable” responses to surgical trauma. Assessing the significance of the factors used and varying their severity create the basis for the individualization of anesthetic management of patients, prevention of postoperative reactions and a reduction in the period of hospitalization.

Anestesia en enfermedades raras.

Se presenta información acerca de la web Orphananesthesia (www.orphananesthesia.eu), una base de datos del tratamiento anestésico de pacientes con enfermedades raras. Se hace énfasis en los aspectos que conlleva de seguridad para los pacientes y de información actualizada y compendiada, así como revisada por expertos, de fácil accesibilidad. La web estará disponible en breve en español, además de en inglés.

Anesthetic Management of Patients with Sickle Cell Disease Posted for Bipolar Prosthesis

In case of surgical procedures in sickle cell disease (SCD), patients are associated with high risk ofperioperative complications like vaso-occlusive crisis, chest syndrome, post-operative infections, congestiveheart failure, cerebrovascular accident and acute kidney injury. Preoperative assessment and stabilizationlike control of sepsis, blood transfusion, correction of hypoxia, hypothermia, dehydration and acidosis isneeded to reduce peri-operative complications. Blood transfusion (Simple, manual exchange and automatedexchange) remains an important therapeutic intervention in patients with SCD. The case study below showsthe perioperative management of patients posted for bipolar prosthesis due to AVN (avascular necrosis).Adequate analgesia, incentive spirometry, early mobilisation and oxygen supplementation is the mainstayof post-operative management.

Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion

Anesthetic management of patients with dilated cardiomyopathy (DCM) can be challenging for anesthesiologists because it is associated with high perioperative mortality rate.
 This case report describes successful management and important anesthetic considerations in a 15-year-old boy, a known case of burn-associated dilated cardiomyopathy, who underwent bilateral ectropion correction surgery.
 In such patients, it is imperative to have meticulous preoperative planning, wise selection of medications, and tailored anesthetic technique in order to achieve a favourable outcome.
 Key words: Anesthesia; Burns; Cardiomyopathy, Dilated; Ketamine; Propofol; Dopamine
 Citation: Sheikh N, Salik M, Faraz A, Aldahish MM. Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion. Anaesth. pain intensive care 2020;24(5):
 Received: 22 August 2020, Reviewed: 23 August 2020, Accepted: 28 August 2020

Anesthesia Management in Patients with Covid-19

The coronavirus disease 2019 (COVID-19) pandemic that started in China in 2019 has led to millions of infection cases worldwide As the number of people with COVID-19 has increased, the number of patients with health problems that require surgery during the pandemic also increased, and at the same time, anesthesia is needed for these patients In patients infected with acute respiratory syndrome coronavirus 2, some features related to the clinical course of the disease should be known and considerations for the protection of healthcare workers and other patients due to increased contagiousness must be adopted This review of the literature presents approaches in cases of patients diagnosed with COVID-19 and issues to be considered during anesthesia management

The use of intraoperative bedside lung ultrasound in optimizing positive end expiratory pressure in obese patients undergoing laparoscopic bariatric surgeries.

Anesthetic management of patients with obesity undergoing laparoscopic abdominal surgeries requires careful plan for intraoperative mechanical ventilation aiming to avoid lung atelectasis and/or overdistention. There are conflicting data on the optimum positive end expiratory pressure (PEEP) during these surgeries. We hypothesized that lung ultrasound could be used for PEEP titration during laparoscopic surgery. The purpose of this study is to evaluate the effectiveness of intraoperative individualized lung ultrasound-guided PEEP in obese patients undergoing laparoscopic bariatric surgery on intraoperative partial arterial oxygen tension (PaO2) and early postoperative pulmonary complications. A randomized controlled trial included 40 adult patients with body mass index (BMI) > 35 kg/m2 undergoing laparoscopic bariatric surgery. Patients were randomized into: control group (n= 20) who received PEEP 4 cm.H2 O and ultrasound-guided group (n = 20) who received individualized lung ultrasound stepwise PEEP. All patients received volume-controlled ventilation with a tidal volume of 6 mL/kg of ideal weight and a fraction of inspired oxygen of .5. The primary outcome was the difference in partial arterial oxygen tension (PaO2) between the control group and the ultrasound-guided group. The secondary outcomes included the incidence of early postoperative pulmonary atelectasis, respiratory failure, bronchospasm, hypoxia or pneumothorax. General surgery operating theatre at Cairo University hospitals. Ultrasound-guided group showed higher PO2 after PEEP optimization and postoperatively compared with control group (P = .005, and P = .01 respectively). Also, ultrasound-guided group showed no postoperative complications compared with control group that had 5 cases who developed postoperative pulmonary complications in the form of hypoxia and basal collapse in the first 24 hour postoperatively chest x ray (0% versus 25%, P = .047). In patients with obesity undergoing laparoscopic bariatric surgery, the use of lungultrasound individualized stepwise PEEP approach improved oxygenation, compliance and reduced the incidence of postoperative pulmonary atelectasis and hypoxia without causing hemodynamicinstability.

Moyamoya disease in children and its anesthetic implications: A review.

Moyamoya disease is a rare, progressive cerebral vasculopathy which most commonly presents in the first and fourth decades of life. The mainstay of treatment is surgical revascularization; without treatment, most patients experience ischemic or hemorrhagic strokes. This report reviews moyamoya disease, its associated conditions, surgical treatment techniques, and anesthetic management of patients with moyamoya disease.

Anesthetic management of patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide. It has a prevalence of 14% among Koreans aged above 40 years and a prevalence of 31% among those aged above 65 years. However, only 6% of the COPD patients receive treatment. Most of the patients do not seek medical attention, as they think that dyspnea, cough, and productive sputum, which are the common symptoms of COPD, are normal aging phenomena. Smoking is a major risk factor for COPD, but environmental hazards and genetic susceptibility are also involved. With aging, lung injuries due to these risk factors accumulate, leading to increased prevalence of COPD. The major concerns regarding perioperative management of COPD patients include preoperative evaluation of cardiopulmonary risks, optimization of lung function, and evaluation of COPD-related physiological functions that are easily aggravated during anesthesia. These include respiratory muscle dysfunction, dynamic hyperinflation and auto-positive end-expiratory pressure, hypoxia-hypercarbia, and pulmonary hypertension-associated heart failure. Therefore, anesthesia for COPD patients should focus on preoperative evaluation, risk reduction measures, and prevention of postoperative pulmonary complications.

Intensive care and anesthetic management of patients with Brugada syndrome and COVID-19 infection.

Coronavirus disease 2019 (COVID‐19) spreads across the world, and the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic viral infection. Rapid diagnosis, isolation, and intensive clinical management are very important for all patients with COVID‐19, especially for those with cardiac diseases as Brugada syndrome (BrS). BrS is an arrhythmogenic disease reported to be one among the leading causes of sudden cardiac death. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason management during ICU permanence or anesthesia must provide some precautions, avoiding factors that are known to have the potential to worsen the probability to induce arrhythmias. For ICU practitioners, management of acute respiratory failure, hemodynamics, and cardiovascular complications certainly are the key for the best treatment of these patients but to date specific data on supportive ICU care for these patients are lacking, and current recommendations are based on existing evidence from other viral infections and general intensive care management. We want to focus on some general rules, resulted from cases series and clinical practice, to be followed during the ICU management of patients with BrS and concomitant COVID‐19 infection.

The anaesthetic management of patients with thoracic ascending aortic aneurysms: A review.

Thoracic aortic aneurysms present significant challenges to clinicians, especially due to their complex nature and an evolving understanding of the safest and most effective ways to manage this condition in the perioperative setting. Thoracic aortic aneurysms have a prevalence rate of 1.3-8.9% in men and 1.0-2.2% in women, and they are estimated to affect more than five per 100,000 person-years. This is notable because the complications of thoracic aortic aneurysms can be catastrophic. The current understanding of the optimal intraoperative management of thoracic aortic aneurysms is changing, as more evidence becomes available regarding lung protective ventilation and its role in enhancing patient safety and wellbeing. This review strives to provide a brief historical understanding of thoracic aortic aneurysms and highlight some of the key discoveries and advances in the management of this condition. This review then describes an overview of the general anaesthetic principles associated with thoracic aortic aneurysms, including ventilatory modalities and how these impact a patient's physiology and intraoperative haemodynamics. A brief discussion on one-lung ventilation is then provided, drawing from current literature in the field, to describe the most up-to-date management of thoracic aortic aneurysms.

General Anesthesia for a Patient with <italic>GNE</italic> Myopathy: a case report

<p>GNE, or bifunctional UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase, myopathy presents with symptoms of foot drop, followed by lower and upper extremity muscle weaknesses and sparing of the quadriceps. Myopathies usually increase the risks of complications related to general anesthesia. The anesthetic management of patients with GNEmyopathy has not been previously reported. Herein, we report a case of GNEmyopathy in a 37-year-old woman and discuss anesthetic considerations for elective laparoscopic hysterectomy and bilateral salpingectomy, focusing on the postoperative airway management. We avoided administering neuromuscular-blocking agents and instead used a laryngeal mask airway.<p>The anesthetic management combining the use of a laryngeal mask airway and desflurane without neuromuscular-blocking agents provided sufficient abdominal and diaphragmatic muscle relaxations for sustaining the pneumoperitoneum for laparoscopic surgery.

Anesthetic management of laparoscopy-assisted total proctocolectomy in a cardiac sarcoidosis patient with a cardiac resynchronization therapy-defibrillator: a case report

BackgroundCardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D.Case presentationA 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0%, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTracTM system. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition.ConclusionsA detailed understanding of this patient’s condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient.

Giant Umbilical Hernia in a Patient with Hurler’s Syndrome: Case Report and Management Principles

The surgical and anesthetic management of patients with giant umbilical hernia associated with Hurler’s disease is a challenge due to the many problems. We present a recent case of giant umbilical hernia with skin necrosis accompanying Hurler’s syndrome.

Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis

Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation.

Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome COVID-19 Infection

Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors’ team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.