Anesthesiological Management Research Articles

Anesthesiological Management of a Patient with Williams Syndrome Undergoing Spine Surgery.

Williams Syndrome (WS) is a complex neurodevelopmental disorder associated with a mutation on chromosome 7. Patients with WS usually display dysmorphic facial and musculoskeletal features, congenital heart diseases, metabolic disturbances and cognitive impairment. Structural cardiovascular abnormalities are present in the majority of the children and may provide a substrate for perioperative Sudden Cardiac Death, as presented by several reports, something that creates a great challenge to the anesthetic conduct. We present the case of a 12-year old girl who required anesthetic care for surgical correction of an acquired kyphoscoliosis. Potential anesthesiological implications of WS are subsequently reviewed.

MP2-10 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION AND NUMBER OF TRANSFUSED UNITS ON SURVIVAL FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder Cancer: Upper Tract TCC I1 Apr 2015MP2-10 THE IMPACT OF PERIOPERATIVE BLOOD TRANSFUSION AND NUMBER OF TRANSFUSED UNITS ON SURVIVAL FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Michael Rink, Armin Soave, Atiqullah Aziz, Fahmy Al-Sayed, Oliver Engel, Sven Peine, Luis A. Kluth, Felix K. Chun, Roland Dahlem, Arnulf Stenzl, Maximilian Burger, Margit Fisch, Hans-Martin Fritsche, and Georgios Gakis Michael RinkMichael Rink More articles by this author , Armin SoaveArmin Soave More articles by this author , Atiqullah AzizAtiqullah Aziz More articles by this author , Fahmy Al-SayedFahmy Al-Sayed More articles by this author , Oliver EngelOliver Engel More articles by this author , Sven PeineSven Peine More articles by this author , Luis A. KluthLuis A. Kluth More articles by this author , Felix K. ChunFelix K. Chun More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , Maximilian BurgerMaximilian Burger More articles by this author , Margit FischMargit Fisch More articles by this author , Hans-Martin FritscheHans-Martin Fritsche More articles by this author , and Georgios GakisGeorgios Gakis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.133AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative anemia is an independent predictor for unfavorable outcomes in upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Allogenic blood transfusion has been associated with increased risks of cancer recurrence and mortality in bladder cancer patients. To analyze the impact of perioperativ blood transfusions (PBT) on outcomes in UTUC patients treated with RNU. METHODS We collected data of 285 UTUC patients treated with RNU from 1990 – 2011 without neoadjuvant chemotherapy at three German academic institutions. Application of PBT was analyzed as dichotomous (administered vs. not administered) variable, the number of PBT units as continuous and categorized (0 vs. ≤2 vs. >2) variable. Cox regression models analyzed the impact on disease recurrence, cancer-specific and overall survival, respectively. RESULTS In total, 81 patients (28.4%) received a PBT; the median number of transfused PBTs was 2 (IQR: 2;4) in those receiving a PBT. Administration of PBT was associated with advanced tumor stages (p=0.004), higher grade (p=0.049), and preoperative anemia (p=0.001), respectively. At a mean follow-up of 52 months, administration of PBT (p=0.023) and an increasing number of PBT units (0 vs. >2; p=0.025) were significantly associated with overall survival, but not recurrence-free or cancer-specific survival in Kaplan-Meier analyses. In univariable Cox regression analyses administration of PBT (p=0.024), as well as an increased number of PBT units in continuous (p=0.009) and categorical (p=0.049) analyses, respectively, were associated with overall survival. In multivariable analysis that adjusted for age, ECOG performance score, tumor stage and grade, lymph node metastasis, LVI, tumorarchitecture and –necrosis, adjuvant chemotherapy and preoperative anemia, administration of PBT was significantly associated with overall survival (HR:1.6; 95%CI 1.055-2.428; p=0.027). The number of PBTs was no independent predictor for overall survival. CONCLUSIONS PBT is an independent risk factor for worse overall survival in UTUC patients treated with RNU. Continued efforts are warranted to optimize the patients' preoperative hemoglobin level, surgical accuracy and anesthesiological management of RNU to reduce the necessity of PBT. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e14 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rink More articles by this author Armin Soave More articles by this author Atiqullah Aziz More articles by this author Fahmy Al-Sayed More articles by this author Oliver Engel More articles by this author Sven Peine More articles by this author Luis A. Kluth More articles by this author Felix K. Chun More articles by this author Roland Dahlem More articles by this author Arnulf Stenzl More articles by this author Maximilian Burger More articles by this author Margit Fisch More articles by this author Hans-Martin Fritsche More articles by this author Georgios Gakis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pitfalls of anesthesiologic management in operative or interventional securing of aneurysm

Despite significant advances in operative, interventional and perioperative management aneurysmal subarachnoid hemorrhage is still associated with high rates of 30-day mortality in 35% and severe impairments in neurologic functional outcomes in up to 50% of the survivors. Apart from severity of initial brain injury prognosis depends on the extent of secondary brain injury triggered by re-rupture, vasospasm, hydrocephalus and/ or further operative, interventional or intensive-care associated complications. Due to the complexity of disease the paper exclusively deals with pitfalls of anesthesiologic management in operative and non-operative aneurysm repair.

Specific aspects of anesthesiological management of laser surgery in otorhinolaryngology

Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associated with this technique necessitate strict compliance with safety regulations and precautions. The safe anesthesiological and surgical management of such procedures requires explicit knowledge of the risks inherent to laser use, as well as close communication between surgeon and anesthesiologist throughout all operative and perioperative procedures. Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery.

Besonderheiten des anästhesiologischen Managements bei laserchirurgischen Eingriffen in der Hals-Nasen-Ohren-Heilkunde

Transoral laser surgery has become a standard procedure in the treatment of benign and malignant neoplasms of the upper aerodigestive tract. As the laser cuts and coagulates simultaneously, intraoperative bleeding is reduced, thus improving visualization of the operative field. However, the specific risks for patients and personnel that are associated with this technique necessitate strict compliance with safety regulations and precautions. The safe anesthesiological and surgical management of such procedures requires explicit knowledge of the risks inherent to laser use, as well as close communication between surgeon and anesthesiologist throughout all operative and perioperative procedures. Although potentially fatal complications are rare, surgeon and anesthesiologist need to be aware of the dangers at all times and have exact knowledge of emergency measures. The use of suitable laser-resistant endotracheal tubes, total intravenous anesthesia and an optimized breathing gas mixture can contribute to minimize the occurrence of complications in otorhinolaryngology laser surgery.

Role of preoperative tracheobronchoscopy in newborns with esophageal atresia: A review.

Preoperative tracheobronchoscopy (TBS) in the diagnostic assessment of newborns affected by esophageal atresia (EA) was described in 1981. Nevertheless, the value of the procedure is actually much debated; only a few studies have clearly explored the advantages of TBS and this procedure is not yet routinely included in the diagnostic and therapeutic assessment in many international pediatric surgery settings. Routine preoperative TBS is a safe procedure that enables the accurate examination of the tracheobronchial tree, the visualization of tracheoesophageal fistula and the diagnosis of tracheomalacia or associated respiratory anomalies. When a distal fistula is found, its occlusion with a Fogarty balloon catheter improves mechanical ventilation and facilitates surgical repair. This review provides a detailed overview on the use of TBS in newborns with EA, focusing on technical aspects, anesthesiological management, indications and limits. The benefits and risks of the procedure are also compared with alternative diagnostic tools, such as an esophageal contrast study, computed tomography scan and ultrasound.

Anesthesiology management for the transcatheter aortic valve implantation

Methods All procedures were performed in period between March 2011 and May 2013.In that period, 26 procedures performed in patients with severe aortic stenosis: of total, sixteen patents received Medtronic/CORE valve. Ten patients received Edwards/Sapien Aortic Bioprosthesis, of which, one implanted by transaortic way. The average age was 78.43 years. In premedication, all received midazolam 5 mg and clopidogrel 150 mg. All procedures were performed in general anesthesia using sevoflurane, small doses of i.v. fentanyl and rocuronium at the start of the procedure. Anesthesia maintained with sevoflurane up to the end of procedure. Rapid ventricular pacing achieved with transvenous temporary pacemaker. For evaluation of aortic valve, aortic root, left ventricular outflow tract pre and after procedure, in all patients transesophageal echocardiography (TEE) was used.

EComment. Total surgical aortic arch replacement

We would like to congratulate Czerny et al. for their very well written article and favourable results [1]. The authors conclude that open total aortic arch replacement shows very satisfying results, mainly due to improvements in perfusion technology, better surgical technique, and careful anesthesiology management. In our exerience, out of 52 consecutive patients that required open total aortic arch replacement, either for dissection or aneurysmal disease, the 30-day mortality was 4.3% and the peri-operative neurological injury was 7.1%. We use deep hypothermic circulatory arrest in all patients with retrograde cerebral perfusion through the superior vena cava. We routinely cannulate the femoral artery when necessary, instead of the axillary artery. Almost one quarter of our patients underwent a re-operation, with the majority having a prior ascending aortic aneurysm repair. We use an elephant trunk technique in cases of aneurysmal dilatation of the thoracic aorta. It is our strong belief that the key to a successful outcome in open aortic arch replacement is surgical perfection and speed of the operation, in order to minimize the body ischaemia during the circulatory arrest. This means that it is a type of surgery that should be performed only by experienced surgeons in large referral centers. Conflict of interest: none declared

Anesthesiologic management of patients with chronic pulmonary arterial hypertension (PAH) undergoing surgical implantation of infusion pumps for continuous i.v. delivery of Treprostinil

Anesthesiologic management of patients with chronic pulmonary arterial hypertension (PAH) undergoing surgical implantation of infusion pumps for continuous i.v. delivery of Treprostinil

McArdle's disease (glycogen storage disease typeV) and anesthesia – a case report and review of the literature

McArdles disease (glycogen storage disease type v) is a rare condition in which energy-metabolism in the muscle is hampered. A case report is presented and the possible risk for perioperative complications including malignant hyperthermia is discussed. A checklist for the anesthesiological management of patients with McArdles disease is provided. A short overview of anesthesiological challenges and perioperative complications of other glycogen storage diseases is given.

An Interview with A.H. “Buddy” Giesecke Jr, MD

A. H. “Buddy” Giesecke Jr, MD, is an important figure in the history of the Department of Anesthesiology and Pain Management at the University Southwestern Medical Center and at Parkland Memorial Hospital in Dallas (Figure 1). He studied anesthesiology and later practiced there, where he worked closely with other renowned anesthesiologists, including M.T. “Pepper” Jenkins. Dr. Giesecke’s articles on endotracheal intubation in obstetrics and the interaction between succinylcholine and magnesium produced change in the practice of anesthesia. In his later years, he became interested in the history of anesthesia and was very active in the Anesthesia History Association. His passion for the specialty was evident in the way he spoke about anesthesia. Hear his words, and perhaps even his voice, in the interview below. school, I did my internship at William Beaumont Army Hospital in El Paso. I went into the army because the pay was better, and we were extremely poor. I went through medical school on $200 a month.

Peripartale Aortendissektion

A 29-year-old primagravida developed severe chest pains during labor. An emergency caesarean section was performed as the symptoms persisted. Imaging diagnosis immediately after delivery revealed an acute proximal (type A) aortic dissection. The patient was transferred to the nearest cardiothoracic surgery centre and successful emergency surgical aortic repair was performed. The perioperative course of a type A aortic dissection during pregnancy and labor is complicated by time pressure, diagnostic restrictions until delivery and potentially fatal uterine bleeding during cardiopulmonary bypass and hypothermic cardiac arrest. This case report describes the diagnosis and the surgical, anesthesiological and gynecological management of this life-threatening peripartum complication.

Anesthesiological management in ELBW infants: like ductal ligation, does necrotizing enterocolitis similarly lie between ‘simple anesthesia’ and ‘extreme art’?

Anesthesiological management in <scp>ELBW</scp> infants: like ductal ligation, does necrotizing enterocolitis similarly lie between ‘simple anesthesia’ and ‘extreme art’?

Early respiratory complications after liver transplantation

The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications' early clinical manifestations after OLT and influence on patient outcome.

Consideraciones preoperatorias y manejo neuroanestesiológico intraoperatorio

The anesthesiological management of patients undergoing neurosurgery of the posterior fossa has a series of characteristics that should be known by anesthesiologists. Intraoperative management is guided by a series of factors that include the physiopathological changes secondary to the patient's position during surgery, the importance of appropriate patient positioning to facilitate the surgical approach, the lower tolerance to changes in the elastance of the infratentorial region, the limited therapeutic options in episodes of intraoperative edema-swelling, and the presence of complications such as a venous air embolism. This first contribution to the guidelines discusses the main evidence available in the literature on the pre- and intraoperative approach to these patients.

Tipps &amp; Tricks – Anästhesie bei laparoskopischen Eingriffen mit Kapnoperitoneum

Among clinical benefits like reduction in blood loss, faster postoperative recovery of gastrointestinal and lung function, lower rate of perioperative complications and less postoperative pain level, cost reduction by shortening of hospital stay plays a pivotal role for high incidence of laparoscopic surgery.Elevated intraabdominal pressure due to creation of pneumoperitoneum induces various pathophysiologic changes. Most of these changes are clinical inapparent in case of appropriate anesthesiologic management. This paper aims to sensibilize the anaesthesiologist for pathophysiologic changes, particularly with regard to hemodynamic and pulmonary complications, differential diagnosis and therapies.

Akuter Sättigungsabfall nach Peritonektomie und hyperthermer intraperitonealer Chemotherapie

Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) may have a significant impact on physiological functions and is therefore a special challenge for anesthetists. In the presented case after opening the parietal pleura during subphrenical peritonectomy the HIPEC solution accidentally leaked into the right hemithorax with subsequent pleural effusion of more than 2,000ml. After extubation the patient presented with acute oxygen desaturation and orthopnea. Following pleural sonography and chest X-ray in the operating theatre and recovery area, a thorax drainage was inserted into the pleural space and ventilation support was provided by non-invasive continuous positive air pressure (CPAP) ventilation. With reference to recent publications the anesthesiological management of patients undergoing HIPEC is presented.

Peculiarities anesthesiological management in patients with complete atrioventricular septal defect

Peculiarities anesthesiological management in patients with complete atrioventricular septal defect

Perioperative care of the elderly oncology patient: A report from the SIOG task force on the perioperative care of older patients with cancer

Abstract The increasing number of older cancer patients seen in daily practice demands reflection on how to optimize their care during the perioperative period. Optimally tailored surgical management, at present the most successful cancer treatment, firmly rests on an accurate and careful anesthesiological management. The unique peculiarities of anesthesia in older cancer patients prompted the International Society of Geriatric Oncology (SIOG) to put together a panel of international experts with the aim of reviewing the literature and drafting a consensus document. This article summarizes their views.

Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia). Due to possible induction of hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine) should be administered with the greatest care. A method of treating elevations in pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone) in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike.