Anesthetic Management Of Patient Research Articles

Anesthetic Management in Thoracic Trauma Patients

In daily practice, management of patients with blunt thoracic trauma is challenging for the anesthetist. Injuries of airways, lungs, diaphragm, heart and large vessels are the main difficulties.Respiratory and circulatory physiology in general is affected by general anesthesia, which may result in an increased number of perioperative complications. Therefore, anesthetic management of patients with thoracic trauma needs to address different clinical topics: management of difficult airways, intrinsic effects of anesthetics and mechanical ventilation on respiratory and cardiac function, the adequate replacement of blood loss as well as type and extent of the surgical intervention. Postoperatively, sufficient pain therapy avoids pulmonary complications and can improve outcome.Therefore, a high degree of (patho-)physiological understanding and manual skills are required in this scenario. Interdisciplinary cooperation during diagnostic, treatment and in the perioperative course is a prerequisite for a successful management.The present work describes the main characteristics of thoracic trauma and discusses important precautions and typical problems the anesthetist has to face in the clinical setting.

Difficult Postoperative Extubation in a Patient with Hypoproteinemia: A Case Report

Hypoalbuminemia is common in critically ill patients, chronic hypoproteinemia tend to cause some negative impacts on the body's internal environment. Hypoalbuminemia poses many challenges to the perioperative anesthesia management. This article describes a case of difficult postoperative extubation in a 62-year-old woman with hypoalbuminemia. She was diagnosed with intestinal tuberculosis, hypoproteinemia and edema for 3 years. During the anesthesia management process, we found some physiological changes in hypoproteinemia and the management of anesthesia during perioperative period is complex. So in this article, we provide some advice for the treatment and anaesthetic management of patients with hypoproteinemia.

Renal transplantation in a patient with alport syndrome and cardiac dysfunction: Role of levosimendan

Anesthetic management in patients with end-stage renal disease and cardiac dysfunction coming for renal transplant is very challenging since the maintenance of adequate cardiac output is essential for good graft function. Levosimendan is an inodilator that increases cardiac output without increasing cardiac workload. Hence, it is the drug of choice in patients with ischemic heart disease and congestive cardiac failure. We present successful perioperative management of a renal transplant recipient with left ventricular dysfunction using levosimendan for maintenance of stable hemodynamics. Levosimendan, an inodilator, can be safely used in patients with cardiac dysfunction coming for renal transplantation.

Posterior Segmental Enstrümantasyon ve Osteotomi Yapılan Ağır Ankilozan Spondilitli Olguda Anestezi Yönetimi

Ankolizan spondilit (AS); disk, eklemler ve ligamentlerin ossifikasyonu ile karakterize, sistemik kronik inflamatuar bir artropatidir. Primer tutulum sakroiliak eklem ve vertebralar olmakla birlikte, ekstraspinal eklemlerde de tutulum olabilmektedir. AS'li hastanın yönetiminde ilk basamakta en önemli sorun servikal vertebraları tutan ankiloze ve bambu omurga nedeni ile havayolu açıklığının sağlanması ve güvenli entübasyon olmakla birlikte, bu hastalarda olası kardiyovasküler ve pulmoner patolojiler, medullaya bası ve nöroaksiyel anestezinin teknik zorluğu ve kontrendikasyonu anestezi ve cerrahi ekibe ek problemler getirebilmektedir. Ek olarak, bu hastalara pozisyon verme sırasında oluşabilecek spontan kırık ve buna bağlı gelişebilecek nörolojik komplikasyonlar ya da 'prone' pozisyona bağlı beklenmeyen kanama başlı başına ciddi problemlerdir. Bu çalışmada, ileri derecede kifoz ile birlikte vertebraları total fikse olan ve vertebrada spontan kırık nedeni ile posterior segmental enstrümantasyon ve osteotomi yapılan AS'li bir wekwk olgunun anestezi yönetimi literatür eşliğinde tartışılmıştır.

Airway management with a rigid external distractor in place.

Airway management with a rigid external distractor in place.

Thoracic epidural anesthesia for severe myasthenia gravis patient undergoing laparoscopic cholesistectomy

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease characterized by different degrees of weakness and fatigue of skeletal muscles after physical exercise. It has an incidence of 2-10/100000 per year. The optimal anesthetic management of these patients is still controversial. A 69 year-old male patient with MG was scheduled for laparoscopic cholesistectomy due to gallbladder stone. Epidural puncture was performed by a 18G Tuohy needle inserted between 7th and 8th thoracic vertebrae. After the placement of epidural catheter, a combination of 40 mg bupivacaine, 100 mg prilocaine and 100 µg fentanil were applied slowly. Pneumoperitonium was applied with approximetly 12 mmHg CO2 for laparoscopic view. At the 10th minute of the surgery, a sudden deep bradicardia was observed. Following administration of one mg of atropine, heart rate of the patient turned to normal ranges within 30 seconds. In the postoperative period no respiratory or cardiac complications were detected and the patient was discharged from hospital after three days. Anesthetic management of MG patients should be individualized due to increased risk of intraoperative and postoperative complications. Their increased sensitivity to nondepolarizing muscle relaxants can lead to prolonged postoperative mechanical ventilation need. In adult patients, regional anaesthesia alone can be a good and safe method for myasthenic patients by eleminating the need for muscle relaxants and opioids in abdominal surgeries. In this case we prefer to insert a thoracic epidural catheter to control the level of blockage intraoperatively. Continuous epidural infusion allowed us to maintain postoperative analgesia without intravenous opioid agents.

総肺静脈還流異常症，大血管転位症の麻酔管理

総肺静脈還流異常症と大血管転位症はともに新生児期に根治的手術が必要となりうる先天性心疾患である．新生児の心臓は構造的，機能的に未熟であるため術後心不全に陥りやすい．加えて総肺静脈還流異常症，大血管転位症の患者は疾患特有の血行動態により左心不全や肺高血圧のリスクが高く注意が必要である．両疾患の新生児期の根治的手術を成功に導くためには，前負荷，後負荷，心筋収縮力，心拍数を適切に調節し限られた心機能を無理なく発揮できる環境を作ることが重要である．

Patient-centered care: perfusion and anesthetic management in patients undergoing repreat heart valve replacement

Patient-centered care: perfusion and anesthetic management in patients undergoing repreat heart valve replacement

Anesthetic Management of Congenital Insensitivity to Pain with Anhidrosis in a Child: A Case Report

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary sensory autonomic neuropathy. Anesthetic management of those patients is challenging for anesthesiologist because of the potential risks for them including regurgitation and aspiration, sympathetic nervous dysfunction, mandibular osteomyelitis as well as hyperthermic events. Case report: We present total intravenous anesthesia (TIVA) with spontaneous respiration via facemask was applied in a 2 y old child with CIPA who underwent closed reduction and plaster external fixation of a bilateral dislocation of the hip. The patient vital signs remained stable, and did not show any signs of distress by anesthetics during the surgery. And no complication occurred. Conclusion: TIVA with spontaneous respiration via facemask is an effective and safe anesthetic management for patients with CIPA.

Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update.

Deep brain stimulation (DBS) can be an effective treatment option for patients with essential tremor and Parkinson's disease. This review provides an overview on the functioning of neurostimulators and recent advances in this technology and presents an updated guide on the anesthetic management of patients with an implanted neurostimulator undergoing surgery or medical intervention. A search was conducted on MEDLINE®, EMBASE™, and Cochrane Database of Systematic Reviews databases to identify studies published in English from 1974 to December 2015. Our search also included relevant and available incident reports from the manufacturers, Health Canada, the United States Food and Drug Administration, and the European Medicines Agency. Thirty of 232 articles identified were found to be relevant to this review. Deep brain stimulation systems now offer a range of options, including pulse generators with dual-channel capabilities, rechargeable batteries, and current-control modes. Preoperatively, the anesthesiologist should ascertain the indications for DBS therapy, identify the type of device implanted, and consult a DBS specialist for specific precautions and device management. The major perioperative concern is the potential for interactions with the medical device resulting in patient morbidity. Neurostimulators should be turned off intraoperatively to minimize electromagnetic interference, and precautions should be taken when using electrosurgical equipment. Following surgery, the device should be turned on and checked by a DBS specialist. The anesthesiologist plays an important role to ensure a safe operating environment for patients with an implanted DBS device. Pertinent issues include identifying the type of device, involving a DBS-trained physician, turning off the device intraoperatively, implementing precautions when using electrosurgical equipment, and checking the device postoperatively.

Anesthesia and Brugada syndrome: a 12-year case series

Study objectiveThe aim of this 12-year case series was to review the drugs used during anesthetic management of patients with diagnosis of or risk criteria for Brugada syndrome (BrS), and to document any possible association between these drugs and arrhythmogenic activity or unexplained hemodynamic instability. DesignA retrospective clinical observational study. SettingTertiary hospital. PatientsThirty-one patients met our inclusion criteria: 20 belonging to group D (diagnosed BrS) and 11 to group R (risk of BrS). They underwent a total of 43 anesthetic interventions (28 in group D and 15 in group R). InterventionsRecords from patients with or at risk of BrS who underwent anesthetic intervention at our hospital between May 2003 and May 2015 were retrospectively reviewed. Drugs used were compared with those recommended to be avoided or preferably avoided, published by specialists in the field at brugadadrugs.org. MeasurementsHemodynamic and cardiac complications during anesthesia were assessed for hypothetical association with these drugs. Main resultsFrom the list of drugs available in medical literature recommended to avoid in BrS patients the following were used in our series: propofol (n = 8 in group D, n = 8 in group R), local anesthetics (n = 15 in group D, n = 8 in group R), tramadol (n = 1 in group D), and metoclopramide (n = 1 in group D). Hemodynamic complications occurred in 5 procedures, but no direct association was found between these events and the use of the drugs listed above. ConclusionsMajor adverse events related to the deleterious effects of drugs recommended to be avoided were not detected in our series of patients with or at risk of BrS. Although authors cannot refute the theoretical risk of major adverse advents when using known or potential BrS triggers, the true clinical risk of these drugs is unknown, and recommendations to avoid their use should be better supported.

Successful airway management using a MultiViewScope handle with a stylet scope in a patient with Schwartz–Jampel syndrome

Schwartz–Jampel syndrome (SJS) is a rare disorder characterized by micrognathia, kyphoscoliosis, and myotonia. The greatest challenge in the anesthetic management of patients with SJS is performing tracheal intubation. The MultiViewScope (MVS) is a video laryngoscope system in which the video monitor handle can be attached to a stylet scope, laryngoscope blade, or fiberscope. We report a 21-month-old boy with SJS who required general anesthesia. Direct laryngoscopy was impossible because of his limited mouth opening; however, his trachea was easily intubated using an MVS handle with a stylet scope. The MVS is useful for managing difficult airways associated with SJS.Electronic supplementary materialThe online version of this article (doi:10.1186/s40981-016-0062-5) contains supplementary material, which is available to authorized users.

Anesthesia Management in Patients With Choanal Atresia.

In this study, the anaesthetic management of newborn and infant patients who underwent surgery for choanal atresia between 2009 and 2016 is discussed in the light of recently published literature. The diagnoses, demographic data, anaesthetic risk and duration, additional anomalies, airway management, and complications that arose in 41 patients with choanal atresia who were operated on between 2009 and 2016 were evaluated retrospectively by examining their medical and anaesthesia records. The patients were divided into 2 groups: Group I-bilateral choanal atresia and Group II-unilateral choanal atresia. Of the 41 patients included in the study, 24 (58.53%) were in the bilateral group, and 17 (41.46%) were in the unilateral group. Fifteen (34.1%) of the patients were male, and 26 (59.1%) of the patients were female. The mean age of the 24 patients in Group I was 25.86 days (3-72), and the mean age of the 17 patients in Group II was 171.08 days (81-365). Additional congenital anomalies were present in 13 of the patients in the bilateral choanal atresia group and 3 of the patients in the unilateral choanal atresia group.Seven patients from Groups I and 2 patients from Group II were determined to have difficult airways. The laryngoscopic images from these patients were classified as grades 3 and 4 according to the Cormack-Lehane classification system. When the durations of anesthesia in the groups were compared, the duration of anesthesia in Group I was found to be significantly longer (Table 3). Anesthesia-related complications were observed in 9 patients (37.5%) from the bilateral choanal atresia group and in 4 patients (2.3%) from the unilateral atresia group. Steroids were used as prophylactics in these patients. Congenital anomalies and their associated risks, as well as intubation and ventilation problems and the complications that might arise, must be considered in addition to anesthetic management when repairing choanal atresia in newborn and infant patients.

Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians-gynecologists was used for comparison with anesthesiologists. Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians-gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.

Anaesthetic Management of Patients with Dilated Cardiomyopathy Undergoing Non-Cardiac Surgery

The anaesthetic management of a patient with dilated cardiomyopathy (DCM) undergoing non-cardiac surgery has always posed a challenge for Anaesthesiologist either due to pre-existing or a risk of precipitating congestive heart failure. Hereby, we report a case of an elderly patient with Dilated cardiomyopathy and Ejection Fraction less that 35%, MET criteria more than 5 for mid- Ureteric calculus removal surgery under Epidural Anaesthesia.

Anesthetic Management of a Patient With Spasmodic Torticollis Treated With a Deep Brain Stimulator Implant Operated for Inguinal Hernia

Spasmodic torticollis (ST) is the most frequent and familiar type of focal dystonia. Nowadays, deep brain stimulation (DBS) seems to be an effective treatment for ST and is considered a first-line therapy. Anesthesia in such patients requires special considerations, because of the characteristics of the disease as well as the respective treatment. We present the anesthetic management of a patient with ST treated with DBS. A 53-year-old man with idiopathic cervical dystonia treated with a deep brain stimulator device underwent an inguinal hernia correction under general anesthesia. A detailed preanesthesia evaluation was performed to assess any issues associated with the disease especially concerning the airway. A total intravenous anesthesia technique was planned. The device was turned off immediately after induction and turned on before emergency. The patient did not report any discomfort and the stimulator did not present any malfunction or interference with other devices. Anesthetic management of patients with ST treated with deep brain stimulator should focus on a careful preanesthesia evaluation regarding primarily the airway examination, a detailed planning of the anesthetic technique to be applied, and a correct handling of the DBS implanted as it can interfere with other monitoring and therapeutic devices, sometimes with severe consequences. J Med Cases. 2016;7(9):376-378 doi: http://dx.doi.org/10.14740/jmc2588w

Anesthetic management in bronchial asthma

In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial asthma needs to address different clinical topics: the physical appearance of pulmonary disease, type and extent of surgical intervention as well as effects of therapeutic drugs, anesthetics and mechanical ventilation on respiratory function. The present work describes important precautions in preoperative scheduling of the asthmatic patient. In the operative course, airway manipulation and a number of anesthetics are able to trigger intraoperative bronchial spasm with possibly fatal outcome. It is essential to avoid these substances to prevent asthma attack. If asthmatic status occurs, appropriate procedures according to therapeutic standards have to be applied to the patient. Postoperatively, sufficient pain therapy avoids pulmonary complications and improves outcome.

Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade.

Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block.

Anesthetic Management of a Patient With Spasmodic Torticollis Treated With a Deep Brain Stimulator Implant Operated for Inguinal Hernia

Spasmodic torticollis (ST) is the most frequent and familiar type of focal dystonia. Nowadays, deep brain stimulation (DBS) seems to be an effective treatment for ST and is considered a first-line therapy. Anesthesia in such patients requires special considerations, because of the characteristics of the disease as well as the respective treatment. We present the anesthetic management of a patient with ST treated with DBS. A 53-year-old man with idiopathic cervical dystonia treated with a deep brain stimulator device underwent an inguinal hernia correction under general anesthesia. A detailed preanesthesia evaluation was performed to assess any issues associated with the disease especially concerning the airway. A total intravenous anesthesia technique was planned. The device was turned off immediately after induction and turned on before emergency. The patient did not report any discomfort and the stimulator did not present any malfunction or interference with other devices. Anesthetic management of patients with ST treated with deep brain stimulator should focus on a careful preanesthesia evaluation regarding primarily the airway examination, a detailed planning of the anesthetic technique to be applied, and a correct handling of the DBS implanted as it can interfere with other monitoring and therapeutic devices, sometimes with severe consequences. J Med Cases. 2016;7(9):376-378 doi: http://dx.doi.org/10.14740/jmc2588w

Anesthetic management of ischemic heart disease with ejection fraction of 35% in a patient of fracture neck femur

Anesthetic management of cardiac patients coming for noncardiac surgery has always been challenging. Goal of anesthesia management is to keep myocardial oxygen supply greater than demand to avoid ischemia. In this case report, anesthetic implications included assessment of cardiovascular status of the patient preoperatively with selection of epidural anesthesia (EA) and analgesia technique. Incremental doses of local anesthetic were given to maintain myocardial oxygen demand. To the best of our knowledge, there have been only few case reports on EA for ischemic heart disease patient coming for noncardiac surgery. Hence, we report a successful anesthetic management of a patient with ischemic heart disease posted for fracture neck of femur under EA and analgesia.