Anesthetic Considerations Research Articles

Anesthetic Consideration for Modified Electroconvulsive Therapy in an Adolescent With Uncorrected Atrial Septal Defect: A Case Report

Anesthetic Consideration for Modified Electroconvulsive Therapy in an Adolescent With Uncorrected Atrial Septal Defect: A Case Report

Anaesthetic considerations in a rare case of Bardet Biedl syndrome patient scheduled for adenotonsillectomy

Anaesthetic considerations in a rare case of Bardet Biedl syndrome patient scheduled for adenotonsillectomy

Surgical and Anesthetic Considerations in the Management of Ossifying Fibroma of the Mandible with Congenital Factor VII Deficiency: A Case Report and Literature Review

Surgical and Anesthetic Considerations in the Management of Ossifying Fibroma of the Mandible with Congenital Factor VII Deficiency: A Case Report and Literature Review

Airway Management With Congenital Tracheal Stenosis: Surgical and Anesthetic Consideration.

To investigate demographic data and airway management techniques for patients with congenital tracheal stenosis (CTS) during the preoperative, intraoperative, and postoperative periods. A retrospective chart review. This study was a retrospective case series at a single tertiary care pediatric medical center. It encompassed all children diagnosed with CTS who underwent slide tracheoplasty from January 2001 through December 2018. Exclusion criteria were acquired stenosis, tracheomalacia, patients without a confirmed diagnosis of CTS, and those with missing data. Patient demographics and details of airway management were collected and analyzed. A total of 148 patients met the inclusion criteria. The most common etiology of CTS was congenital tracheal rings (90.5%). The median age at surgery was 9 months (interquartile range [IQR] 3.3-35.4), and the median stenosis length was 4.0 cm (IQR 3.5-5.4). The most frequent comorbidities were genetic diseases, prematurity, and preoperative intubation. The most common related cardiac comorbidities were pulmonary artery sling, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of Fallot. Most of the patients with CTS exhibited 50% to 80% stenosis. Most of the patients underwent thoracic approach slide tracheoplasty. Airway management was primarily accomplished using an oral or nasal endotracheal tube preoperatively, cardiopulmonary bypass during surgical repair, and an oral or nasal endotracheal tube during closure and the postoperative period. Slide tracheoplasty is an effective treatment for congenital tracheal stenosis. Coordinated airway management between the anesthesia and surgical teams is crucial. Appropriate planning yields the best patient outcomes. 4 Laryngoscope, 2024.

Considerations in dental local anaesthesia for the patient with cleft lip and palate

Patients who have had a history of surgical repair of cleft lip and palate can often develop scar tissue post-operatively that can make it more difficult for dentists to achieve sufficient local anaesthesia. In addition, the presence of a cleft can result in anatomical variation of nerve supply to the maxillary region, which can result in further complications for achieving sufficient anaesthesia. This article reviews the anatomical variations that can occur, and posits a technique to allow for more predictable and successful local anaesthesia in this cohort of patients. CPD/Clinical Relevance: GDPs may have difficulty in achieving sufficient local anaesthesia for patients with a cleft lip and palate.

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

Anesthetic Considerations for Endovascular Repair of the Thoracic Aorta.

Thoracic aorta pathologies, especially those of the ascending aorta and aortic arch, were traditionally approached via open surgical repair. This carries risk of ischemic end-organ damage and other complications. Endovascular repair of ascending aorta and aortic arch pathologies is becoming more successful and widespread, thereby posing numerous challenges to the anesthesiologist. This article reviews the anesthesia-pertinent pathophysiology, repair techniques, preoperative evaluation, intraoperative management, and postoperative care of patients presenting for endovascular repair of thoracic aorta pathologies.

Anesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation, A Retrospective Observational Cohort Study

Anesthetic and Perioperative Considerations for Convergent Procedure for Atrial Fibrillation, A Retrospective Observational Cohort Study

Evidence of renal tubular injury in canine patients after elective desexing.

To investigate the frequency of perioperative acute kidney injury (AKI) in American Society of Anesthesiologists (SA) Grade I canine patients undergoing elective desexing using urine microscopy techniques and assess if pre- and intraoperative factors affect risk of developing AKI. Prospective observational clinical study conducted between September 2020 and October 2020. University teaching hospital. Thirty-two female and four male dogs between 5 months and 5 years of age classified as ASA I undergoing elective desexing surgery. Urinalysis was performed preoperatively and 20-24 h postoperatively to identify markers of renal tubular injury (RTI), particularly the presence of granular and renal tubular epithelial cell (RTEC) casts on sediment analysis. Dogs underwent a full physical examination and a preoperative assessment including measurement of urine specific gravity (USG), packed cell volume (PCV), total plasma protein and serum creatinine (sCr) was conducted as a part of the desexing programme. Anaesthetic records were examined for any evidence of intraoperative hypotension, defined as a mean arterial pressure (MAP) of <60 mmHg for any duration of time. MAP was measured using an indirect oscillometric technique. For analysis, animals were subdivided into affected and nonaffected groups, with affected animals those that hadpostoperative increases in granular and RTEC casts. Categorical and comparative analyses were then performed between groups to identify associations of increased casts with pre-, intra- and postoperative variables. A frequency of RTI of 5.6% was identified. This was accompanied by a significant association between increases in casts with total duration (p = 0.027) and number (p = 0.016) of hypotensive episodes. RTI is an anaesthetic consideration in ASA I veterinary patients undergoing elective desexing surgery. The identification of an association between the total duration and number of hypotensive episodes and the frequency of RTI highlights the importance of early detection of hypotension along with prompt and effective intervention in veterinary patients.

Anesthetics in pathological cerebrovascular conditions.

The increasing prevalence of pathological cerebrovascular conditions, including stroke, hypertensive encephalopathy, and chronic disorders, underscores the importance of anesthetic considerations for affected patients. Preserving cerebral oxygenation and blood flow during anesthesia is paramount to prevent neurological deterioration. Furthermore, protecting vulnerable neurons from damage is crucial for optimal outcomes. Recent research suggests that anesthetic agents may provide a potentially therapeutic approach for managing pathological cerebrovascular conditions. Anesthetics target neural mechanisms underlying cerebrovascular dysfunction, thereby modulating neuroinflammation, protecting neurons against ischemic injury, and improving cerebral hemodynamics. However, optimal strategies regarding mechanisms, dosage, and indications remain uncertain. This review aims to clarify the physiological effects, mechanisms of action, and reported neuroprotective benefits of anesthetics in patients with various pathological cerebrovascular conditions. Investigating anesthetic effects in cerebrovascular disease holds promise for developing novel therapeutic strategies.

Anesthetic Management and Considerations During Surgical Dissection of a Schwannoma Causing Severe Cervical Spinal Canal Stenosis and Vertebral Artery Compression

Anesthetic Management and Considerations During Surgical Dissection of a Schwannoma Causing Severe Cervical Spinal Canal Stenosis and Vertebral Artery Compression

Anesthetic Considerations and Management of Corpus Callosal Glioma with Bifid Uvula: A Rare Case Report

Anesthetic Considerations and Management of Corpus Callosal Glioma with Bifid Uvula: A Rare Case Report

Comments on "Expert Opinion on Anesthetic Considerations For Patients Receiving a Classic Monoamine Oxidase Inhibitor".

Comments on "Expert Opinion on Anesthetic Considerations For Patients Receiving a Classic Monoamine Oxidase Inhibitor".

Anesthetic management of a patient with mandibular hypoplasia, deafness, progeroid features, lipodystrophy syndrome: a case report

BackgroundMandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a rare autosomal dominant disorder that presents unique challenges for anesthetic management due to its multisystemic manifestations. This report outlines the anesthetic considerations for MDPL patients based on our case experience.Case presentationA 15-year-old male with MDPL syndrome underwent testicular extraction under general anesthesia. Insertion of a peripheral venous catheter was challenging due to scleroderma-like skin. Although the facial features of MDPL syndrome suggested a difficult airway, intubation with a McGrath™ Mac video laryngoscope was successful. Despite MDPL syndrome’s association with hypertriglyceridemia due to lipodystrophy, this patient’s triglyceride levels were normal. Thiamylal and sevoflurane were used without issues such as delayed emergence from anesthesia.ConclusionsMDPL syndrome requires careful preoperative assessment and tailored anesthetic management due to potential airway challenges arising from its distinctive facial features and the possibility of altered anesthetic pharmacokinetics associated with lipodystrophy.

Anesthesia for Posterior Tracheopexy in Pediatric Patients.

Tracheobronchomalacia refers to an abnormally excessive collapse of the trachea and/or bronchi during exhalation. In the pediatric population, tracheobronchomalacia is increasingly recognized as a cause of morbidity and mortality. Historically, options for medical management and surgical intervention were limited, and patient outcomes were poor. Over the last decade, select US pediatric institutions have devoted significant resources to the establishment of dedicated surgery and anesthesia teams and the development of novel techniques for the successful identification, assessment, and surgical correction of tracheobronchomalacia in a highly complex subset of the pediatric population. The close communication, collaboration, and evolution of anesthesia techniques to meet the unique requirements of new surgical procedures have greatly improved patient safety and optimized outcomes. More than 800 cases have been performed across 2 US pediatric institutions using these techniques. This article reviews the posterior tracheopexy procedure, a newer but increasingly common surgery designed to address tracheobronchomalacia, and provides an overview of related anesthesia considerations and unique challenges. In addition, this article describes novel anesthesia techniques developed specifically to facilitate optimal diagnosis of tracheobronchomalacia and intraoperative management of posterior tracheopexy and similar airway surgeries. These include methods to safely enable 3-phase rigid dynamic bronchoscopy for accurate tracheobronchomalacia diagnosis, recurrent laryngeal nerve monitoring during cervical and thoracic surgical dissection, continuous intraoperative bronchoscopy to enable real-time images during airway reconstruction, and intraoperative assessment of airway repair adequacy to ensure successful correction of tracheobronchomalacia.

Perioperative considerations in anesthesia for minimally invasive repair of pectus excavatum, Nuss procedure

Pectus excavatum (PE) is a common anterior chest wall deformity that affects the heart and lungs depending on the severity of compression. The Nuss procedure, a minimally invasive repair of pectus excavatum, has evolved over the years with thoracoscopic assistance and minimal incision. Despite improved surgical techniques, pain and nausea are often the most common factors determining hospital length of stay. This review will explore the preoperative, intraoperative, and postoperative anesthetic considerations necessary for improving patient outcomes, reducing surgical stress, and shortening hospital stays for patients undergoing the Nuss procedure.

Perioperative considerations in anesthesia for pediatric bariatric procedures

Obesity is a global epidemic affecting a broad range of individuals, regardless of economic and social strata. In 2022, the World Health Organization (WHO) reported that 16 % of adults and 160 million children were living with this condition. The economic impact is significant, with a recent Milken report estimating the annual cost of obesity in the US at 1.4 trillion dollars, accounting for almost 7 % of the United States gross domestic product. It is widely recognized that the most severe forms of pediatric obesity (120 % of the 95th percentile for age and sex) represent an epidemic within an epidemic, given their potential for diminished long-term health and shortened lifespan. The treatment paradigm for obesity covers a range of approaches, with the American Academy of Pediatrics (AAP) recommending behavior and lifestyle modification as initial components of care. Since 2004, bariatric surgery has increasingly been utilized as an additional option for treating adolescent obesity, as long-term findings have shown sustained reductions in BMI and improvements in comorbid conditions. For anesthesiologists, these patients present specific challenges that require review.

Anesthetic considerations for fetal interventions

Fetal therapy is a well-established but rapidly evolving field discipline. Fetal interventions require a multidisciplinary team approach that emphasizes collaboration and communication. The success of a fetal therapy program relies on the availability of a comprehensive obstetric and neonatal care team, support services, and advanced imaging. Technological advancements in prenatal fetal imaging and genetic diagnosis have improved our understanding of various fetal anomalies. Surgical techniques and anesthetic management have also advanced, leading to better outcomes. Fetal anesthesia presents unique challenges as it involves managing both the mother and the fetus. Anesthetic management focuses on ensuring maternal safety and comfort, maintaining adequate uteroplacental perfusion, optimizing surgical conditions, and minimizing risks for both the mother and the fetus. This article reviews current anesthesia practices for fetal surgery, highlighting recent advances and future directions.

Cardiac and Renal Transplantation in Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Symptoms: Anesthetic Challenges and Considerations

Cardiac and Renal Transplantation in Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Symptoms: Anesthetic Challenges and Considerations

Anesthesia Management of Hip Fracture Surgery in Geriatric Patients: A Review.

Hip fractures are increasingly prominent concerns in healthcare, especially in light of a growing elderly population. These fractures contribute to mortality and morbidity in the elderly. Many hip fractures require emergent surgical intervention and may have consequences of serious postoperative complications. Multidisciplinary approaches of management have been utilized to optimize care and improve patient outcomes. Due to the myriad of multi-organ system comorbidities that are increasingly prevalent in the geriatric population, anesthetic management proves to be difficult to standardize. Enhanced Recovery After Surgery (ERAS) protocols have shown benefits for optimizing patient outcomes by focusing on premedication, nutritional support, and pain management; however, specific anesthetic management techniques are not discussed. This literature review aims to discuss ways to optimize hip fracture management in geriatric patients through effective preoperative evaluation, anesthetic considerations, and postoperative optimization and care. A review of currently available guidelines may help determine the optimal management for hip fractures in geriatric patients and improve immediate and lasting postoperative outcomes.