Anesthetic Management Research Articles

Anaesthetic management of a child with syringomyelia undergoing foramen magnum decompression: A case report

Anaesthetic management of a child with syringomyelia undergoing foramen magnum decompression: A case report

Perioperative Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) and Gastric Point Of Care Ultrasound (POCUS)

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are frequently used for diabetes and weight loss management. The GLP-1 RA drugs delay gastric emptying and are a concern for increased risk of aspiration in the perioperative period. Current recommendations to hold these medications before surgery are consensus based. Gastric point of care ultrasound (POCUS) can provide information regarding nature and volume of gastric contents in these patients during the perioperative period. In this case series, we present three patients where gastric POCUS helped formulate a safer, alternative anesthetic plan. Anesthetic management varied depending on the situation, urgency and needs of the procedure. We recommend gastric POCUS in this group of patients to provide objective assessment of gastric contents.

Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-analysis.

This study evaluates the efficacy and safety of various anesthetic and sedative regimens for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios. 42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR<0.01), dexmedetomidine plus fentanyl (RR<0.01), propofol plus nalbuphine (RR=0.01), Mg sulfate plus propofol (RR=0.01), and propofol plus fentanyl (RR=0.02), showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR=0.01), propofol plus oxycodone (RR=0.09), and dexmedetomidine plus fentanyl (RR=0.2) exhibited lower rates of adverse events compared to propofol. This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.

Anesthetic Management of Cesarean Delivery for a Parturient With Dextro-Transposition of the Great Arteries Post-Senning Procedure: A Case Report

The Senning procedure is a palliation technique for addressing dextro-transposition of the great arteries; deoxygenated blood is redirected to the left ventricle, making the right ventricle the systemic ventricle. The physiologic increase in cardiac output during pregnancy may place additional stress on the right ventricle and given the existence of atrial scar tissue, trigger arrythmias. Because the technique was gradually abandoned starting in the 1970s, few remaining patients of child-bearing age remain. We emphasize here the importance of interdisciplinary team planning for delivery. Preparation for possible arrhythmia and potential decompensation in right ventricular function are essential.

Anesthetic Management of Laparoscopic Surgery on a Pediatric Patient: Case Report

Inguinal hernia is an opening on myofascial oblique muscle and transversal muscle or the failure of Nuck canal or processus vaginalis during the gestation week which allows herniation of intra-abdominal or extraperitoneal organ. A 5-year-old child was diagnosed with a left lateral inguinal hernia. The results of the inguinal ultrasound showed movement and movement of the intestines in the left inguinal area through a defect measuring approximately 2.96 centimeters. The patient was planned to undergo laparoscopic high ligation hernia. Laparoscopic technique in adult commonly applied with special consideration. However, the practice in pediatric patient could be more challenging for anesthesiologist. Although laparoscopic surgery is less invasive it could cause more stress due to the pressure of the intra-abdominal pneumoperitoneum by CO2 that is done during the procedure, which then causes hypercapnea due to the absorption of CO2, the decrease of tidal volume, and the decrease of end-tidal volume. Considering pediatric’s different physiology compared to adult and the risks of laparoscopic surgery, special anesthesia management should be conducted.

Precision Medicine in Anesthesia: Pharmacogenomics and Personalized Care

Precision medicine in anesthesia represents a transformative approach aimed at optimizing anesthetic care by tailoring interventions to individual patient characteristics, particularly their genetic profile. Pharmacogenomics, a cornerstone of precision medicine, explores the genetic factors influencing drug metabolism, efficacy, and adverse reactions. This article delves into the integration of pharmacogenomics in anesthesia, discussing its impact on drug selection, dosage adjustments, and patient outcomes. It also highlights the potential for reducing perioperative complications, enhancing patient safety, and improving recovery through personalized anesthetic care. Challenges such as the need for robust genetic databases, ethical considerations, and the cost-effectiveness of implementing precision medicine in clinical practice are also discussed. The future of anesthesia lies in harnessing pharmacogenomics to provide individualized care, ultimately advancing patient-centric anesthetic management.

Effects of combined anesthesia on pulmonary oxygenation function, hemodynamics, and respiratory compliance in elderly patients undergoing pulmonary lobectomy for lung cancer.

Traditional general anesthesia in elderly lung cancer patients undergoing pulmonary lobectomy may lead to hemodynamic fluctuations and postoperative complications. To optimize anesthesia efficacy, this study explores the application of combined anesthesia (general anesthesia combined with thoracic paravertebral block) in such surgeries. We evaluated the improvement of pulmonary oxygenation function, hemodynamic stability, and respiratory compliance in elderly lung cancer patients undergoing pulmonary lobectomy with combined anesthesia. This retrospective study analyzed 100 elderly lung cancer patients who underwent pulmonary lobectomy at our hospital from February 2020 to December 2023. Patients were divided into 2 groups: the control group received general anesthesia, while the treatment group received combined anesthesia (general anesthesia plus thoracic paravertebral block). By comparing intraoperative hemodynamic parameters, postoperative pulmonary oxygenation function, respiratory compliance, cognitive function, sleep quality, and postoperative complication rates between the 2 groups, we assessed the application efficacy of combined anesthesia. Compared to the control group, the treatment group exhibited better hemodynamic stability intraoperatively, significantly improved postoperative pulmonary oxygenation function and respiratory compliance. Additionally, patients in the treatment group showed faster recovery of cognitive function, better sleep quality, and a relatively lower incidence of postoperative complications. Combined anesthesia demonstrates unique advantages in pulmonary lobectomy for elderly lung cancer patients, optimizing intraoperative hemodynamic stability, promoting postoperative pulmonary function recovery, accelerating cognitive function recovery, improving sleep quality, and potentially reducing the risk of postoperative complications. This finding provides a new effective strategy for anesthesia management in elderly lung cancer patients.

Whole lung lavage: considerations from the anesthesiology perspective.

Whole lung lavage (WLL) remains the standard treatment for pulmonary alveolar proteinosis (PAP). The procedure involves meticulous preparation, including a multidisciplinary team and appropriate facilities, to ensure patient safety and procedural success. Effective anesthesia management is essential to allow for successful completion of the procedure and prevent complications. Effective anesthesia management, including total intravenous anesthesia (TIVA) and careful intraoperative monitoring, is essential to prevent complications such as hypoxemia and fluid overload. Proper airway control with a double-lumen tube, careful positioning, and continuous monitoring during the lavage phase are key to minimizing risks. Challenges such as fluid spillage and ventilation-perfusion mismatch must be managed proactively with techniques such as fiberoptic bronchoscopy and recruitment maneuvers. In cases of severe hypoxemia, advanced options like extra-corporeal membrane oxygenation (ECMO) or sequential lavage may be required. WLL is a pivotal treatment for PAP, offering significant relief and improvement for many patients despite the challenges in standardizing the procedure due to the rare nature of the condition. Involvement of a multidisciplinary team involving pulmonologist, anesthesiologist, critical care personnel, operating room personnel and in some cases and centers, cardiothoracic surgeon and perfusionist is critical to the success of the procedure.

The Role of Anesthetic Management in Lung Cancer Recurrence and Metastasis: A Comprehensive Review

The Role of Anesthetic Management in Lung Cancer Recurrence and Metastasis: A Comprehensive Review

An Unusual Case of Alarming Lactic Acidosis: Brain Metabolic Cross-Talk

AbstractA 39-year-old male with a BMI of 30.8 kg/m2 and a normal medical history underwent excision of a left orbito-cavernal hemangioma (4 × 2 × 2 cm) under general anesthesia. Balanced anesthesia and fluid management guided by pulse pressure variation (kept below 12%) were employed. Despite stable hemodynamics and normal blood sugar levels, arterial blood gas (ABG) analysis revealed a progressive rise in lactate levels, reaching 10.6 mmol/L, accompanied by acidemia. Systemic hypoperfusion was ruled out by maintaining mean arterial pressure between 70-80 mm Hg, ensuring a capillary refill time of less than 3 seconds, and confirming a central venous oxygen saturation of 72%. With a total blood loss of 800 mL, one unit of packed red blood cells was transfused due to concerns about decreased microcirculation and tissue hypoxia. After 10 hours of surgery, sodium bicarbonate (NaHCO3) was administered to mitigate metabolic acidosis and its potential impact on intracranial pressure. Postoperatively, lactate levels remained elevated (8-9 mmol/L), but with continued NaHCO3 infusion, lactate reduced to 6.4 mmol/L, allowing extubation. The patient's lactate normalized by the evening, and recovery was uneventful. This case highlights the significant metabolic disturbances, particularly lactic acidosis, that can arise during brain tumor surgery due to prolonged operative times, large tumor size, higher BMI, and stress-induced metabolic derangements. Awareness and prompt management of these disturbances are crucial for successful patient outcomes.

Prevalence and associated factors of preoperative abnormal electrocardiography among older surgical patients in southern Ethiopia: Multicenter cross-sectional study

BackgroundThe prevalence of abnormal electrocardiography (ECG) increases with aging, and these abnormalities may have an impact on anesthesia management. Although a normal ECG does not guarantee a healthy heart, an abnormal ECG can quickly identify a patient who is at high risk of cardiac complications.ObjectiveThe aim of this study was to determine the prevalence and associated factors of preoperative abnormal electrocardiography among older surgical patients at selected teaching hospitals in southern Ethiopia, from February 15 to June 15, 2022.MethodologyA multicenter cross-sectional study was conducted at three randomly selected teaching hospitals in southern Ethiopia on 246 elderly surgical patients recruited consecutively. Data were entered into Epidata version 4.6, then exported and analyzed in STATA version 16. A binary logistic regression model was used to examine factors associated with abnormal ECG, and variables with a P-value < 0.2 were entered into the multivariate analysis to identify independent factors. Both crude and adjusted odds ratios were reported, and a P-value < 0.05 was considered statistically significant. The data were presented using frequencies, tables, charts, and figures.ResultIn the current study, 120 (48.78%) of older surgical patients had abnormal preoperative ECGs. In terms of severity, 55.3% were classified as minor, while 44.16% were major ECG abnormalities. The most common ECG abnormalities were left axis deviation (LAD), left ventricular hypertrophy (LVH), and ST segment changes. The presence of comorbidity (AOR = 3.44, P = 0.001), age ≥ 70 years (AOR = 2.5, P = 0.011), history of angina (AOR = 5.9, P = 0.011), history of smoking (AOR = 5.07, P = 0.024) and urban residency (AOR = 1.89, P = 0.039) were the strongest risk factors for an abnormal ECG.Conclusion and recommendationOur study shows that older patients are more likely to have an abnormal ECG before surgery, regardless of symptoms or risk factors. Therefore, it is suggested that all older patients undergo preoperative ECG screening. Further prospective cohort studies are needed to investigate the impact and outcome of patients with preoperative abnormal ECG.

From Hemorrhagic Shock to Postoperative Complications: Anesthesia, Intensive Care, and Surgical Management of a Young Male With Pulmonary Aspergillosis

From Hemorrhagic Shock to Postoperative Complications: Anesthesia, Intensive Care, and Surgical Management of a Young Male With Pulmonary Aspergillosis

Anesthetic Management in Obstructive Sleep Apnea: A Narrative Review

Obstructive Sleep Apnea (OSA) introduces substantial difficulties in the management of anesthesia, largely due to its implications for airway management, sensitivity to sedative agents, and an elevated risk of complications during the perioperative period. This narrative review seeks to offer an in-depth exploration of the contemporary approaches to anesthesia management in patients diagnosed with OSA. It covers the entire continuum of care, including preoperative, intraoperative, and postoperative phases. The review underscores the critical importance of an accurate and thorough diagnosis of OSA, which is essential for formulating effective anesthetic strategies. Risk stratification is emphasized as a key element in identifying the specific challenges posed by each patient’s condition and tailoring the anesthesia plan accordingly. By examining current practices and recommendations, the review aims to provide insights into how individualized anesthetic plans can be designed to reduce the risk of perioperative complications and enhance patient safety

Morbidité et mortalité en anesthésie pour arthroplastie totale de la hanche sur terrain de drépanocytose dans un pays à faible revenu : cas du centre hospitalier Monkole

Background: Anaesthesia for hip arthroplasty in patients with sickle cell disease is considered a high-risk procedure. This study investigated morbidity and mortality in a low-income country using Monkole Hospital as an example.Methods. A cross-sectional study of electrophoretically confirmed sickle cell patients anaesthetised at Monkole for hip arthroplasty during the period October 2018 to April 2024. Peri-anaesthetic data up to hospital discharge were collected prospectively and analysed with SPSS 26.0 for p<0.05. Anaesthetic management at Monkole is multidisciplinary. Transfusion exchange, Hb S assay, and systematic cardiorespiratory investigations are not performed. Simple transfusion was carried out with the aim of achieving a haemoglobin level of 7 and 9 g/dl.Results. Eighty-six patients were enrolled. The mean age was 26.02 years, 88.54% were aged 18 and over, and 66.3% were women. BMI was <18.5 kg/mm2 in 48.8%; 84.9% were polytransfused; only 9.3% were on hydroxyurea and only one had received exchange transfusion; 2.3% were icteric and 97.7% were classified ASA III. The mean Hb level was 8.3g/dl, and less than 7g/dL in 15.1% of cases. Antibiotic prophylaxis was administered in all patients with cefazolin ± gentamycin. Spinal anaesthesia (bupivacaine + morphine) was used alone (95.3%), combined with general anaesthesia (3.48%), and the prosthesis was cemented in 95.35% of cases. Intraoperative complications were: arterial hypotension (18.6%), discomfort (4.6%), the effect of cementing (4.6%), poor quality of spinal block (1.6%), haemorrhage (2.3%). Transfusion was required for 79.1% of patients intraoperatively and 3.2% postoperatively. Postoperative complications accounted for 11.6%: anaemia (5.8%), vaso-occlusive crisis (2.3%), urinary retention (2.3%), and vomiting (1.6%). No deaths or acute chest syndrome were recorded. All patients spent one day in intensive care and the average hospital stay was 5 days. Alcohol consumption and procedures lasting longer than two hours were associated with intraoperative complications. Leanness, previous anaesthesia, platelet count below 1500000/mm3, prolonged activated partial thromboplastin time, and the presence of intraoperative complications were associated with postoperative complications.Conclusion. There was no and morbidity was represented by minor complications. It seems possible to anaesthetise patients with sickle cell disease for hip arthroplasty without measuring haemoglobin S or exchanging transfusions, with a lower risk of morbidity and mortality.

Epidural anesthesia as a sole anesthetic for a parturient with cardiac disease and low ejection fraction – a case report in resource limited setup

Introduction and importance: The effective care of pregnant women with cardiac conditions relies on collaboration among the obstetrician, cardiologist, and anesthesiologist throughout the peripartum period. Limited research exists regarding the safety of specific anesthetic approaches for patients with congestive heart failure (CHF), particularly in the context of pregnancy. Case presentation: This was a 28-year-old woman who was pregnant with her third child (gravida III, para II) and has not had a menstrual period for the past 8 months. She had been receiving antenatal care at a local health center. Currently, she was experiencing symptoms including coughing, difficulty breathing, epigastric pain, and chest pain, which had been present for 1 week. Upon examination, she was diagnosed with New York Heart Association class IV CHF with pulmonary edema, and preeclampsia with severe features, and she was in the third trimester of pregnancy. Clinical discussion: Pre-existing medical conditions can adversely affect pregnancy outcomes for women and their offspring, especially in resource-poor settings in Africa. The goals of anesthetic management are avoidance of myocardial depression, maintaining normovolemia, avoiding an overdose of drugs during induction as the circulation time is slow, and avoiding sudden hypotension when regional anesthesia is the choice. Conclusion: We believe that successful management of anesthesia for this critical case depends on a thorough understanding of the pathophysiology of the disease condition, the selection of anesthetic techniques, and the decision-making of our team. We showed epidural anesthesia could be safely used to manage high-risk cardiac patients, however, further interventional study is needed to prove safety.

Spinal Anesthesia for Open Appendectomy in a Patient With Cystic Fibrosis and Coagulation Abnormalities: A Case of Tailored Anesthetic Management

Spinal Anesthesia for Open Appendectomy in a Patient With Cystic Fibrosis and Coagulation Abnormalities: A Case of Tailored Anesthetic Management

Anesthetic management for aspiration thrombectomy using the Penumbra Indigo System® in pediatric patients with congenital heart disease

ObjectivesDescribe clinical characteristics and outcomes including transfusion requirements of pediatric patients with congenital heart disease undergoing aspiration thrombectomy DesignRetrospective chart review SettingQuaternary academic children's hospital ParticipantsPatients < 18yrs with congenital heart disease undergoing aspiration thrombectomy from November 2017-February 2022. Measurements and main results13 patients underwent mechanical thrombectomy with the Penumbra Indigo System®. Median age was 3.8 years and median weight was 15.2kg. Seven patients had palliated single ventricle and 6 had biventricular circulation. Nine patients were receiving ICU care pre-procedure and 12 required ICU care post-procedure. Indications for thrombectomy included systemic venous thrombus (n=7), pulmonary arterial thrombus (n=3), systemic arterial thrombus (n=2), and systemic to pulmonary shunt occlusion (n=1). Median estimated blood loss was 7.7ml/kg (interquartile range 1.4ml/kg-15.8ml/kg, range 0.5ml/kg-51.5ml/kg). Seven patients required intraoperative transfusion of pRBCs (n=4), FFP (n=2), platelets (n=3), and/or cryoprecipitate (n=1). In those requiring transfusion, median transfusion volume was 22ml/kg (interquartile range 15.5ml/kg-76.5ml/kg, range 9.3ml/kg-132.8ml/kg). Thrombectomy was successful in 8 of 13 patients, although 3 experienced recurrent thrombosis. ConclusionsMechanical aspiration thrombectomy is increasingly used to treat critically ill pediatric patients and presents unique anesthetic considerations particularly related to the need for volume and blood product resuscitation

Anesthesia Management of Cesarean Section in Women with Peripartum Cardiomyopathy: A Case Series

Anesthesia Management of Cesarean Section in Women with Peripartum Cardiomyopathy: A Case Series

Uyanık Kraniyotomide Anestezi Yönetimi

Performing craniotomy on patients while they are “awake” requires a very specific anesthesia management. It is the anesthetist’s responsibility to apply sedation and analgesia when necessary to ensure optimal comfort of the patient during the surgery, and to continue electrophysiological monitoring and patient cooperation. In addition to specific anesthesia management, good teamwork, where communication is very important, is an absolute necessity for the awake craniotomy procedure. The aim of this review is to discuss in detail the different anesthesia techniques that can be applied during awake craniotomy and the intraoperative complications that may develop. Keywords: Awake craniotomy, anesthetic management, complications

Anesthesia Management of Patients with Esophageal Atresia/Traceoesophageal Fistula undergoing Thoracostomy and Esophagostomy Procedures

Esophageal atresia is a congenital disorder characterized by a disruption in the continuity of the esophageal lumen. Esophageal atresia may be accompanied by tracheoesophageal fistula, which is a lumen connection between the proximal and or distal part of the esophagus and the airway (trachea). Type C atresia is the most prevalent, which is approximately 88.5% to 90% of cases, where there is proximal esophageal atresia with distal tracheoesophageal fistula. In this case, a 9-day-old infant was admitted to Arifin Ahmad Hospital for thoracostomy and esophagostomy surgery due to continuous mucus discharge. The patient underwent awake intubation and was positioned intraoperatively, with a tilt to the right when an orogastric tube was placed. During surgery, the patient maintained stable hemodynamic and was subsequently admitted to the NICU using a ventilator. Infants with esophageal atresia often show symptoms of hypersalivation and shortness of breath caused by aspiration pneumonia. When the nasogastric tube cannot pass through the esophagus, atresia can be suspected. Radiology studies play an important role in diagnosing esophageal atresia, confirming esophageal atresia with or without fistula and diagnosing other anomalies associated with VACTERL.