Anesthetic Management Of Patient Research Articles

Anaesthetic management of patient with incidental left atrial myxoma posted for wound debridement in hand.

Anaesthetic management of patient with incidental left atrial myxoma posted for wound debridement in hand.

Anaesthetic Management of Patient with Left Atrial Myxoma, Coronary Artery Disease 3 Vessels Disease, and Parkinson’s Disease

Myxomas are the most common primary benign intracavitatory tumour with the incidence of 0.5 per million populations. Myxomas account for 0.3% of all cardiac surgeries performed. Clinically, they are characterized by a triad of embolisation, obstruction of blood flow, and constitutional symptoms (Goodwin’s triad). Meanwhile Parkinson's disease is a degenerative neurologic disorder caused by degeneration of nerve cells in the substantia nigra causing weakness motor coordination. Symptoms include tremor, bradykinesia, rigidity, and postural instability. Achieving a satisfactory hemodynamic performance is the primary objective in the management of cardiac surgery patient. Optimal cardiac function ensures adequate perfusion and oxygenation of other organ systems (in particular vital organs) and improves the chances for an uneventful recovery from surgery. A 61-year old female diagnosed with Coronary Artery Disease 3 Vessel Disease (CAD 3 VD), Parkinson’s disease, and left atrial myxoma was brought to the emergency department with dyspnea. The patient has undergone angiography and the echocardiography result was LVEF 59% with global normokinetic, LA myxoma causing non-significant mitral flow. LA myxoma excision under general anaesthesia on CPB was planned. Balanced general anaesthesia on cardiopulmonary bypass forms the basis of Anaesthetic management of Cardiac myxomas. However specific individual considerations will have to be made regarding drugs, doses, regional anaesthetic choices, anticoagulation and post-operative management. There is no simple anesthetic technique for patients with Parkinson’. Therefore, careful preoperative assessment, administration of drugs during and after anesthesia, as well as avoiding agents that are known to trigger Parkinson's symptoms is a major factor in reducing postoperative morbidity and mortality.

Anesthetic management of patients with class 3 obesity undergoing elective Cesarean delivery: a single-centre historical cohort study

PurposeThe preferred neuraxial anesthetic technique for patients with class 3 obesity undergoing elective Cesarean delivery is still under debate. We aimed to describe the anesthetic technique used in our tertiary institution across body mass index (BMI) groups and different surgical incisions.MethodIn this historical cohort study, we reviewed medical records of patients with a BMI ≥ 40 kg·m–2 undergoing elective Cesarean delivery between July 2014 and December 2020. We collected data on patient characteristics, anesthetic and surgical technique, and procedural times. For data analysis, we stratified patients by BMI into three different groups: 40.0–49.9 kg·m–2, 50.0–59.9 kg·m–2, and ≥ 60.0 kg·m–2.ResultsWe included 396 deliveries, distributed as follows: 258 with a BMI 40.0–49.9 kg·m–2, 112 with a BMI 50.0–59.9 kg·m–2, and 26 with a BMI ≥ 60.0 kg·m–2. For patients with a BMI 40.0–49.9 kg·m–2, the anesthetic technique of first choice was predominantly spinal anesthesia (71%), whereas for those with a BMI ≥ 60.0 kg·m–2, spinal anesthesia was never used as the anesthetic of first choice. With regard to the surgical incision, spinal anesthesia was almost exclusively used for patients undergoing Pfannenstiel incision and was rarely used for a higher supra- or infraumbilical transverse or midline incision. The overall incidence of general anesthesia was low (7/396, 1.8%). Anesthetic time, surgical time, and operating room time increased almost twofold in patients with a BMI ≥ 60.0 kg·m–2 compared with those with a BMI of 40.0–49.9 kg·m–2.ConclusionNeuraxial anesthesia was successfully used in approximately 98% of patients with class 3 obesity undergoing elective Cesarean delivery. The choice of regional anesthesia technique varied with increasing BMI and with the planned surgical incision. Procedural times increased with increasing BMI. This information should prove useful for comparing anesthetic choices and outcomes in this challenging population.

Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Aim: Central airway obstructions (CAO) are one of the main reasons for morbidity and mortality, often originate in the lungs, and are generally unresectable. Interventional airway procedure is a preferred method in these cases. This study aimed to analyze anesthesia management in patients undergoing interventional procedures for CAO. We aimed to highlight the problem and solutions that may be encountered in such cases.
 Material and Method: The data of 49 patients who had interventional airway procedure were analyzed retrospectively. Patients’ demographic data, type of interventional procedures, localization of the lesion, and duration of the procedure were analyzed. Vital parameters and arterial blood gases (ABG) levels had been recorded before anesthesia induction (T1), after rigid bronchoscope insertion (T2), 20th-minute of the procedure (T3), after extubation (T4), and in the postoperative care unit (T5).
 Results: The mean age was 57.90±11.99 years. The mean duration of the procedure was 34.75±15.62 minutes. The majority of the patients had American Society of Anesthesiologists (ASA) III-IV physical status. CAOs were mostly found in the main bronchus. Tumors debulking, biopsy, mechanical dilatation, argon plasma coagulation, and mechanical tumor resection were the most performed procedures. Stent insertion was performed in 3 (6.1%) patients. Two patients (4.1%) had bleeding, 3 (6.1%) patients had desaturation, and 1 (2.1%) patient had atrial fibrillation.
 Conclusion: Interventional airway procedures are frequently used for high risk patients with CAO and comorbidities. Detailed preoperative evaluation, periprocedural teamwork, and close hemodynamic and ABG follow-up are keys to success.

Epidural Anesthesia Management in Cesarean Section with Placenta Accreta

Background: In pregnant women, the spectrum of placenta accreta is considered a high risk syndrome. Placenta accreta is responsible for 7-10% of all maternal deaths worldwide. This study reports on a patient with placenta accreta who underwent a cesarean section using epidural anesthesia. Case: A 30-year-old woman (Gravida: 3, Abortus: 1, Partus: 1) with a gestational age of 8 months came to the hospital. with 8 months of gestation was diagnosed with antepartum hemorrhage et causa placenta previa totalis morbidly adherent placenta high risk with planned elective cesarean section with bilateral tubectomy to hysterectomy, Double J (DJ) stent, Ballooning using epidural anesthesia with physical American Society of Anesthesiologists (ASA) II status. Local anesthetic with 2% lidocaine 2 ml, 12 ml of 0.5% bupivacaine given in incremental doses of 4 ml every 5 minutes while monitoring the patient's hemodynamics. Intraoperative drugs consist of intravenous (IV) dexamethasone 5 mg IV, ondansetron 8 mg IV, tranexamic acid 1 gram, paracetamol 1 gram IV, bupivacaine 0.5% 3ml every 1 hour via an epidural catheter. Maintenance using O2 3 lpm. The operation lasted 450 minutes, with stable outcome both maternal and fetal. Conclusion: Anesthesia management in patients with bleeding during labor is very important. In this case, epidural anesthesia provide a good outcome in maternal and fetal after cesarean section in placenta accreta patient.

The Health Effects and Anesthetic Management for Patients Using E-Cigarettes and Heat-Not-Burn Tobacco Products: A Narrative Review

The implementation of policies aimed at promoting smoking cessation led to a decrease in the use of tobacco. There has been an increase in the use of systems such as electronic nicotine delivery systems and electronic non-nicotine delivery systems - also known as electronic cigarettes, and heat-not-burn tobacco products. The aim of this review is to describe the pathophysiological implications of these devices and their perioperative impact. A literature search was carried out by the authors to identify studies published in English on PubMed and MEDLINE between 2007 and 2021, and using the terms 'vaping', 'electronic nicotine delivery systems', 'heated tobacco products', 'IQOS' and 'anesthesia'. A total of 654 articles were found, and the most relevant ones were selected. There is currently insufficient information available regarding the perioperative implications of electronic cigarettes and heat not-burn tobacco products. These devices release potentially harmful substances - such as nicotine - that have a negative impact on the health of consumers. These substances affect the cardiovascular, respiratory and immune systems, and can interact with multiple drugs, which can affect the anesthetic management. The users of these devices are also at a higher risk of explosion injuries and cancer. A number of interventions that may improve the perioperative management of these patients are suggested. Awareness of the potential harmful effects of these devices, and their perioperative implications, is essential, as it enables the implementation of interventions to minimize the risks and improve patient outcomes.

General anesthesia for treating scoliosis with congenital myasthenia syndrome: a case report

BackgroundCongenital myasthenia syndrome is a heterogeneous disease with impaired neuromuscular transmission.Case presentationThis report describes a 13-year-old child with congenital myasthenia syndrome who underwent surgery for scoliosis under general anesthesia. We used a small dose of rocuronium, neuromuscular transmission monitoring, and non-invasive positive pressure ventilation for postoperative respiratory management. There were no respiratory complications during the perioperative period.ConclusionAs there are only a few reports on the anesthetic management of patients with congenital myasthenia syndrome, we applied the principles of managing autoimmune myasthenia gravis. The postoperative management described herein can prevent respiratory complications in patients with congenital myasthenia syndrome.

Anesthetic Management for Patient with Poems Syndrome

We provided anesthesia for a 65-year-old female undergoing right lumpectomy. Preoperative examination revealed significant ascites and heart failure. Additional examination confirmed increased level of M protein, plasma vascular and endothelial growth factor (VEGF), as well as polyneuropathy. The patient was diagnosed with POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin abnormalities) syndrome, in which prolonged duration of action of neuromuscular blocking agents has been reported. Anesthesia was maintained with sevoflurane and remifentanil. We monitored the effects of rocuronium bromide using TOF-WatchTM. In this case, we did not find any prolonged effect of neuromuscular blocking agents and we successfully performed perioperative anesthetic management.

Utility of thromboelastogram in cardiac surgery in Jacobsen syndrome associated with platelet dysfunction: a case report

BackgroundJacobsen syndrome is a rare genetic disorder with multiple congenital anomalies and platelet abnormalities caused by chromosome 11 deletion.Case presentationA 7-month-old boy with thrombocytopenia underwent ventricular septal defect closure. At the beginning of surgery, the platelet count was 168 × 103/μL, and heparinized kaolin with heparinase reaction time (HKH-R), which represents clot formation time, was prolonged at 30.4 min. Platelet transfusion was continued, and at the end of surgery, the platelet count and HKH-R values improved to 215 × 103/μL and 15 min, respectively.ConclusionsAs anesthetic management of patients with abnormal platelet function, the viscoelasticity test might be useful in evaluating hemostatic capacity.

Anesthetic Management of Patient with Mediastinal Tumor Posted for Thoracotomy and Tumor Excision

Introduction: Mediastinal tumor are uncommon entity they present a major anesthetic challenges due to major airway and vascular compression. Case Report: A 60yr, old diagnosed with posterior mediastinum tumour at C7 level. Airway assessment revealed mallampatti class IV. Blood investigations were within normal limit. Pulmonary function test revealed mild obstructive disease. CT shows lesion in posterior mediastinum extending to right IJV with complete thrombosis displacing trachea and thyroid. Triple lumen CVP line was secured. Difficult intubation trolley with tracheostomy set was kept ready. Routine monitoring, left radial artery cannulation done. Patient was Preoxygenated, Premedicated and Induced. 37F Left Double lumen tube was inserted and tube position confirmed with paediatric fiberoptic bronchoscope. Patient was hemodynamically stable in the intraoperative period. Patient was reversed and extubated uneventfully. Conclusion: Mediastinal tumor resection surgery is a very complicated and requires a team effect anesthesiologists, surgeon and intensivist. A thorough pre-operative assessment of the patient should be done before the conduct of anesthesia to avoid the complications due to posterior mediastinal mass. Keywords: Thoracotomy, One-Lung Ventilation, Mediastinal Tumor. Key Messages: Anesthetic management of patient with mediastinal tumor posted for thoracotomy and tumor excision requires a double lumen ET tube for lung isolation and decrease in lung atelectasis. In this case a 60 year old male presented with mild symptoms and we highlight the usage of one lung ventilation in patient with posterior mediastinal tumor.

Sufentanil target controlled infusion (TCI) versus remifentanil TCI for monitored anaesthesia care for patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy: protocol for a prospective, randomised, controlled study

IntroductionThe use of monitored anaesthesia care (MAC) is necessary and ubiquitous for fiberoptic bronchoscopy. Anaesthetic management of patients with severe tracheal stenosis has always been a challenge. The efficacy and...

Anaesthetic management of an abdominal aortic aneurysmorrhaphy in Klippel-Trenaunay-Weber syndrome: a case report

BackgroundKlippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital malformation. Although there have been few reports on anaesthetic management of patients with KTWS, there is a lack of data on anaesthetic management for abdominal aortic aneurysm (AAA) surgeries in these patients.Case presentationA 74-year-old man (height, 160 cm and body weight, 51.5 kg) with KTWS was scheduled for AAA replacement. Abdominal computed tomography (CT) showed prominent tortuosity below the abdominal aorta with an infrarenal abdominal aortic aneurysm, right common iliac artery aneurysm, and right external iliac artery aneurysm. Moreover, a remarkably noted arteriovenous fistula had developed between the aneurysm and peripheral artery. General anaesthesia was induced. Furthermore, a central venous catheter and an 8.5 French sheath in the left internal jugular vein were inserted. During the operation, bleeding from a collateral vessel in the cross-clamped aorta led the surgeon to decide to perform aneurysmorrhaphy. Intraoperatively, blood loss was 1500 ml, and 20 units of red blood cell concentrate were used.ConclusionsRegarding AAA procedures in patients with KTWS, aortic cross-clamping may not sufficiently intercept blood flow due to collateral vessels. In these patients, the anaesthesiologist must be prepared to transfuse blood more rapidly and frequently than during normal AAA procedures.

Peripartum anesthetic management in patients with left ventricular noncompaction: a case series and review of the literature

BackgroundThis retrospective review focuses on peripartum anesthetic management and outcome of a series of five pregnant women with left ventricular noncompaction (LVNC). MethodsThe Mayo Clinic Advanced Cohort Explorer medical database was utilized to identify women diagnosed with LVNC who had been admitted for delivery at the Mayo Clinic in Rochester, Minnesota, between January 2001 and September 2021. Echocardiograms were independently reviewed by two board-certified echocardiographers, and those determined by both to meet the Jenni criteria and/or having compatible findings on magnetic resonance imaging (MRI) were included. Electronic medical records were reviewed for information pertaining to cardiac function, labor, delivery, and postpartum management. ResultsWe identified 44 patients whose medical record included the term “noncompaction” or “hypertrabeculation” and who had delivered at our institution during the study period. Upon detailed review of the medical records, 36 did not meet criteria for LVNC, and three additional patients did not receive the diagnosis until after delivery, leaving five patients with confirmed LVNC who had undergone six deliveries during the study interval. All five patients had a history of arrhythmias or had developed arrhythmias during pregnancy. One patient underwent emergency cesarean delivery due to sustained ventricular tachycardia requiring three intra-operative cardioversions. ConclusionsThis case series adds new evidence to that already available about pregnancies among women with LVNC. Favorable obstetrical outcomes were achievable when multidisciplinary teams were prepared to manage the maternal and fetal consequences of intrapartum cardiac arrhythmias and hemodynamic instability.

Anesthesia and Outcome of 33 Surgeries in 24 Multiple Endocrine Neoplasia Type 2A (MEN2A) Patients: A National Rare Disease Center's Experience.

BackgroundMultiple endocrine neoplasia type 2A (MEN2A) is a rare syndrome that presents as medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. Experience is lacking in the anesthetic management of patients with this syndrome, particularly in those who present with pheochromocytoma receiving nonpheochromocytoma resection. We aimed to share our experience with the anesthetic management of MEN2A patients.MethodWe retrospectively enrolled 24 MEN2A patients who had received different types of surgery at Peking Union Medical College Hospital from January 1, 2015, to December 31, 2021. All the medical records were reviewed and analyzed.ResultIn total, 33 surgeries were performed in 24 MEN2A patients, with 20 surgeries comprising pheochromocytoma resection in 17 patients. Most of these patients who had received pheochromocytoma resection had typical hemodynamic changes during surgery and anesthesia. Regarding the other 13 nonpheochromocytoma resections in 13 patients, 10 were performed in patients without pheochromocytoma, and 3 surgeries were performed with either functional primary (1, bilateral tumor whose patient refused adrenalectomy) or metastatic pheochromocytoma (2, unresectable and malign tumors developed years after bilateral adrenalectomy). Regarding the latter 3 patients, 1 showed hypertension and tachycardia during anesthesia induction, 1 showed tachycardia during surgery and the other showed stability during surgery. Patients who had received pheochromocytoma resection (n=17) required longer postoperative hospital stays than those who had received nonpheochromocytoma resection without pheochromocytoma (n=10) (5.8 ± 1.8 vs. 4.3 ± 1.6; P = 0.031).ConclusionsWhenever MEN2A patients are diagnosed with pheochromocytoma, surgical resection of the pheochromocytoma remains the primary choice for MEN2A treatment. Nonpheochromocytoma surgeries performed with existing pheochromocytoma could be risky and require full caution and preparation.

Anaesthetic Management of Patient with Hypertrophy Obstructive Cardiomyopathy Posted for Elective Caesarean

Introduction: Dynamic valvular insufficiency and LVOT blockage are also possible outcomes of hypertrophic obstructive cardiomyopathy (HOCM). Furthermore, attempting to replace an inadequate mitral valve surgically can result in iatrogenic LVOT blockage. In the general population, it affects one out of every 500 adults, with a male to female ratio of 2:1. Among the general population, the prevalence is around 0.2 percent, and the incidence in pregnant women is around 0.1–0.5 percent. Case Report: 21 year old female patient presented with 9 months of amenorrhea posted for elective lower segment caesarean section. Her previous documents revealed that she was a diagnosed case of hypertrophic obstructive cardiomyopathy during her last pregnancy 1 year ago. History of previous surgery that is induced abortion at two and half months of gestation age a year back operated under spinal anaesthesia. ECG showed ST elevation present in V2 , V3, V4 , V5 leads and features of left ventricular hypertrophy (LVH) , Her echocardiography report revealed features of hypertrophic obstructive cardiomyopathy with severe LVOT obstruction. Left ventricular ejection fraction (LVEF) was 20-25%. Conclusion: HOCM is normally well tolerated during pregnancy, although those who have had previous symptoms or arrhythmias may experience an exacerbation of symptoms. The majority of these people, on the other hand, can be effectively controlled medically. This case report showed that patients with HOCM can be safely managed under general anaesthesia with muscle relaxants and inhalational volatile anaesthetics, as well as an erector spinae block for analgesia

Perioperative and anesthetic management of patients with rheumatoid arthritis.

Our understanding and management of rheumatoid arthritis (RA) have greatly improved, but perioperative and anesthetic management remain challenging. RA is not limited to joints; systemic evaluation is thus required when planning perioperative management. Especially, careful airway evaluation is needed; management of airway-related arthritis is challenging. A multidisciplinary approach is essential to prevent complications without exacerbating RA disease activity. Guidelines published in 2017 are available for perioperative management of anti-rheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. However, the guidelines focus only on anti-rheumatic medications, and do not consider all aspects of perioperative management (including anesthesia). Here, we discuss the perioperative and anesthetic management of patients with RA.

Perioperative anaesthetic management in cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC): a retrospective analysis in a single tertiary care cancer centre.

ObjectivesCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with increased morbidity and mortality. We retrospectively analysed the perioperative anesthetic management in patients undergoing HIPEC surgery.MethodsAfter ethics approval, we reviewed the records of patients who underwent CRS/HIPEC from 2015 until 2020. We noted the peritoneal carcinomatosis index (PCI), blood loss, anastomoses done, total amount of fluid given, delta temperature and duration of surgery. These were correlated with the need for postoperative ventilation, length of ICU stay, Clavien–Dindo score and 30 day mortality.ResultsOf the 180 patients reviewed, the majority were women (85%) with a mean age of 48 years who had ovarian tumors (n=114). The total amount of fluid given was associated with an increased length of ICU stay (p=0.008). Prolonged surgery resulted in increased length of ICU stay (p<0.001), need for postoperative ventilation (p=0.006) and a poor Clavien–Dindo score (p=0.039). A high PCI score correlated with increased ICU stay, 30 day mortality (p<0.001), and the need for postoperative ventilation (0.005).ConclusionsPCI, duration of surgery and blood loss were major predictors of postoperative morbidity. Additionally, the amount of fluid given and delta temperature affected patient outcome and should be individualized to the patient’s needs.

Perioperative Management of Chronic Kidney Disease Patients with Bowel Perforation

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Anesthesia management applied during surgery in patients with chronic kidney disease (CKD) is different from ordinary anesthetic management. It is known that currently, there are not many case reports discussing anesthetic management in patients with CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Illustration&lt;/strong&gt;: A 70-year-old patient with abdominal colic et causa abdominal perforation complained of abdominal pain accompanied by heavy bowel movements and flatus throughout the abdominal area. The patient was anesthetized by regional anesthesia with local agent bupivacaine and treated with laparotomy. Bupivacaine is the first local anesthetic drug with an acceptable onset of action, long duration of action, and a tendency for the sensory block to be greater than its motor block.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: This case report explains the novelty of anesthetic management of CKD patients undergoing exploratory laparotomy surgery using the reported patient cases. Operations in patients with CKD are preferable to regional anesthesia.&lt;/p&gt;

Regional anesthesia in patients with Charcot-Marie-Tooth disease: a historical cohort study of 53 patients.

Anesthetic management for patients with Charcot-Marie-Tooth disease (CMT) is controversial. Description of the use of regional anesthesia (RA) in patients with CMT is limited. Regional anesthesia has traditionally been avoided because of risk of nerve injury. We retrospectively reviewed patients with CMT who received RA at our institution. We performed a historical cohort study of all patients with CMT who received RA from 30 April 2010 to 30 April 2020 within our institution. Charts were reviewed for information on demographics, RA procedures, perioperative variables, evidence of neurologic complications, post-RA neurology consults, and perioperative electromyography (EMG) results. Electromyographs were reviewed by a neurologist who was blinded to the surgical and RA details. Fifty-three patients received a total of 132 regional anesthetics during the study period. Twenty-five patients received RA on more than one occasion. Fifty-five EMGs and 14 postoperative neurology consults were performed. Two patients had neurology consults with peripheral nerve block (PNB) distribution complaints years later. Neither attributed the complaints to the PNB. The other neurology consults were for unrelated complaints. No EMG results suggested injury related to PNB. This study found no evidence of documented neurologic complications or an increased risk of nerve injury related to RA in CMT patients.

Anaesthetic management of patient with severe aortic stenosis posted for Myomectomy: A case report

Aortic stenosis is a stenotic valvular heart disease with a fixed cardiac output state. The patients with such illness can come for non-cardiac surgeries. They pose significant challenges to the attending anesthesiologist. Here, we report a 45-year-old 65 kg female with significant aortic stenosis posted for myomectomy. She was a known case of significant aortic stenosis with an orifice of 1 sq.cm. She was symptomatic with NYHA class three symptoms. The patient had a difficult airway with Mallampatti class IV with stiff temporomandibular joints. The pulse rate was 70 / minute and regular with a blood pressure of 110/70mmHg. After explaining the pros and cons of General and regional anaesthesia, the patient accepted for a regional technique. A bilateral TAP block was administered with 20 ml of 0.25 % bupivacaine on each side. She was administered intrathecal fentanyl 50 µg with 0.5 ml of 0.5 % hyperbaric bupivacaine. Surgical anaesthesia was obtained and myomectomy was completed within 45 minutes. The blood loss was approximately 500 ml which was replaced. After an uneventful early postoperative period of six hours, she became hypotensive with a heart rate of 122/minute. An emergency ultrasound scan revealed a collection. A passive leg rising test was positive. She was again administered two more units of compatible blood. The rest of the postoperative period was uneventful and discharged on the seventh day. This case is reported for its extreme rarity and successful management.