Anesthetic Management Research Articles

Anesthesia strategies for elderly patients with craniocerebral injury due to foreign-body penetration in the plateau region: a case report

BackgroundThe administration of anesthesia for elderly individuals who are critically ill, suffering from severe craniocerebral injuries, and living in plateau regions presents a rare, intricate, and high-risk challenge. This case study outlines the specific anesthesia management protocols necessary for plateau-dwelling patients with significant craniocerebral damage undergoing prolonged invasive procedures.Case reportA 76-year-old male patient had a 26-year history of foreign-body penetration of the skull and had experienced local purulent discharge and pain for the previous 20 days. The diagnoses included right hypoplasia, a foreign body in the skull with an infection, hypokalemia, hypoproteinemia, pulmonary fibrous foci, and bilateral pleural effusion. For almost 6 months, the patient suffered from recurring headaches, blurred vision, and sluggish bodily movement. The patient had a poor diet, poor sleep quality, normal urination, and no noticeable weight loss since the onset of the illness. The right anterior ear had a 2 cm skin abscess with yellow pus and a black metal foreign body tip. The left eyelid was red and swollen, and the left conjunctiva was hyperemic; the right eyelid showed no abnormalities, and both pupils were wide and round, with light and adjustment reflexes and no cyanosis on the lips. Skull development was normal. No dry or moist rales were audible in either lung. The heart rhythm was regular, and the heart rate was 50 bpm. Chest CT revealed left lung calcification foci, bilateral pleural effusion, and fiber foci in the lower lobes of both lungs.ConclusionFurthermore, the patient in question was of advanced age and had a complex medical history, including prolonged exposure to high altitudes and previous instances of severe craniocerebral trauma, among other uncommon pathophysiological characteristics. In particular, the patient also underwent surgical interventions at both high and low altitudes, adding to the complexity of their case. To ensure patient safety, close multidisciplinary collaboration, the development of a precise surgical plan, and the implementation of a suitable perioperative anesthetic management strategy are imperative.

Anesthetic Management and Considerations in a Rare Case of Parietal Bone Hemangioma

Anesthetic Management and Considerations in a Rare Case of Parietal Bone Hemangioma

Anaesthesia management of a patient with Bethlem Myopathy for elective tonsillectomy: a case report

BackgroundBethlem Myopathy is a collagen VI-related myopathy presenting as a rare hereditary muscular disorder with progressive muscular weakness and joint contractures. Despite its milder clinical course relative to other myopathies, anaesthetic management can be challenging. High arched palates and fixed flexion deformities may contribute to a difficult airway. A progressive decline in pulmonary function can present later into adulthood. This respiratory decline can carry secondary cardiovascular consequences due to the progressive nature of restrictive lung disease, including right sided heart disease and pulmonary hypertension. We describe a case of a male patient with Bethlem Myopathy undergoing anaesthesia, to contribute to the limited body of literature on this condition and enhance awareness and guidance amongst anaesthesiologists on approaching patients with this condition. This is the first case report within the literature of its kind.Case presentationThis case details a 33-year-old male with Bethlem Myopathy undergoing tonsillectomy. Diagnosed in childhood following developmental delays, the patient had no prior anaesthetic exposure and no family history of anaesthetic complications. Anaesthetic induction was achieved without complications, avoiding depolarizing muscle relaxants and careful airway management. Extreme care was taken in patient positioning to prevent complications. The surgery proceeded without incident and muscle paralysis was reversed with Suggammadex, resulting in no adverse post-operative respiratory complications. The patient was discharged on the first post-operative day without any respiratory or cardiovascular compromise.ConclusionsBethlem Myopathy, while often exhibiting a mild clinical course, can present anaesthetic challenges. Awareness of potential complications including a difficult airway, cardiovascular and respiratory implications as well as the need for specialised monitoring and positioning is crucial to ensure a safe peri-operative course.

Comparison of Hemodynamic Effect of Propofol and Ketofol during Induction of Anaesthesia in General Surgery Patients

Objective: To determine the comparison of homodynamic effect of propofol and ketofol duringinduction in general surgery patients.Study design: Randomized control trialSetting: Department of Anesthesia, Surgical ICU and Pain management, Civil Hospital Karachi.Duration: Seven months from June 2019 to January 2020.Methods: Patients scheduled for elective general surgery procedures, aged 20 to 60 years, bothmale and female patients were included. Patients were randomly allocated into two groups.Group A received a combination of ketofol while Group B received propofol as the inductionagent. After recording of the base line values of mean arterial pressure patient was induced usingpropofol or ketofol. Mean arterial pressure readings were noted at 30 seconds after druginjection, as well as at 1 minute, 5 minutes, and 10 minutes after intubation, to capture theimmediate hemodynamic effects of the drugs and to observe any potential changes over timefollowing intubation.Results: The average age of the patients was 37.38±13.78 years. Out of 64 patients, 30(46.9%)were male and 34(53.1%) were female. Homodynamic effect was significantly high in thosepatients who received ketofol than those who received propofol (100% vs. 59.4% p=0.0005).The findings observed also with significant differences in hemodynamic effects between the twogroups, even after controlling for age, gender, and ASA classification (p-<0.05).Conclusion: Combination of Ketofol with ketofol was observed to be the betterhemodynamically as compared to Propofol. Additionally, the use of ketofol reduces the cost ofinduction and decreasing the economic burden on the patient.

Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities

AbstractThe sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for midbrain cavernoma excision in a sitting position. Evoked potential monitoring was performed as the tumor was in proximity to cortico-spinal tracts. We used a combination of inhalational and intravenous anesthetics for the maintenance of anesthesia. Intraoperatively significant events included two episodes of venous air embolism, and loss of motor evoked potentials during the resection of the tumor. These complications were promptly recognized and managed. In the early postoperative period, the patient had motor power 3/5 in flexors of the right upper limb, which improved to normal by Day 5. Thus, good communication among anesthesiologists, neurologists, and surgeons helped identify altered evoked potential signals early, aiding the modification of dissection accordingly.

Association of Dexmedetomidine and Intraoperative Thermal Insulation with Postoperative Outcomes in Colorectal Cancer Resection

Objective To investigate the effects of dexmedetomidine combined with intraoperative thermal insulation on postoperative cognitive function, cellular immune status and inflammatory markers in patients undergoing radical resection for colorectal cancer. Methods Fifty patients who underwent radical resection of colorectal cancer in our hospital from March 2020 to September 2021 were selected and divided into observation group (26 cases with dexmedetomidine combined with intraoperative thermal insulation intervention) and control group (24 cases with conventional anesthesia management). The evaluation measures included the mini-mental state scale (MMSE) score, CD4+ T cell, CD8+ T cell ratio and CD4+/CD8+ ratio, the level of inflammatory markers (IL-6, TNF-α, CRP), and the incidence of postoperative complications. Results The MMSE score of the observation group was significantly higher than that of the control group on the 3rd day after operation (P < 0.001). After treatment, the proportion of CD4+ T cells, the proportion of CD8+ T cells and the ratio of CD4+/CD8+ in observation group were higher than those in control group (P < 0.01), while the inflammatory markers IL-6, TNF-α and CRP were lower than those in control group (P < 0.01). The incidence of postoperative cognitive dysfunction (POCD) in the observation group (7.69%) was significantly lower than that in the control group (33.33%) (P = 0.010), and the postoperative infection rate was also significantly decreased (P = 0.042). Conclusion Dexmedetomidine combined with intraoperative insulation can significantly improve postoperative cognitive function, maintain immune balance, reduce inflammatory response, reduce the incidence of POCD and other postoperative complications in patients with radical resection of colorectal cancer.

Anesthetic management for cesarean section in two parturient with ascending aortic aneurysm: a case-based discussion

BackgroundThe anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for aortic dissection or aneurysm rupture.Case presentationWe present some aspects of the anesthetic management of two parturients with ascending aortic aneurysm for cesarean sections; amongst, the use of remifentanil with its effects on patient and newborn. We emphasize the importance of a cardio-obstetric team in the context of preoperative planning of such patients. Also, we reviewed some literature on the anesthetic management with its effect on peri-operative hemodynamic stability.ConclusionMaintaining hemodynamic stability is paramount in the prevention of the rupture or dissection of ascending aortic aneurysm during labor of parturient.

Individualized Anesthetic Management of a Patient With Pheochromocytoma and Concurrent Breast Cancer: A Case Report

Individualized Anesthetic Management of a Patient With Pheochromocytoma and Concurrent Breast Cancer: A Case Report

Impact of anesthesia-related genes on prognosis and tumor microenvironment in hepatocellular carcinoma: A comprehensive analysis.

Hepatocellular carcinoma (HCC), renowned for its bleak prognosis and high recurrence rates, necessitates innovative strategies for prognosis assessment and therapeutic intervention. In this pursuit, we systematically investigated the influence of anesthesia-related genes (ANARGs) on HCC outcomes. Leveraging data from The Cancer Genome Atlas (TCGA), our study scrutinized RNA sequencing data and clinical profiles from 374 HCC patients alongside 50 non-tumor liver samples to unravel ANARG expression patterns and their clinical relevance. Employing consensus clustering, we segregated HCC samples into two distinct subtypes based on ANARG profiles, unveiling significant survival disparities between them. Further differential expression analysis pinpointed pivotal genes and pathways distinguishing these subtypes, notably implicating lipid metabolism and the MTOR signaling pathway in HCC pathogenesis. A prognostic model, comprising five key ANARGs (DAGLA, CYP26B, HAVCR, G6PD and AKR1B), exhibited robust predictive capability for patient outcomes, validated across independent patient cohorts. Furthermore, immune infiltration analysis uncovered a nuanced interplay between ANARG expression and the tumor immune microenvironment, spotlighting variations in immune cell infiltration and function across the identified HCC subtypes. This comprehensive analysis underscores not only the prognostic significance of ANARGs in HCC but also their potential to modulate the tumor microenvironment, providing novel insights for tailoring anesthetic management and therapeutic strategies in HCC care. Our findings advocate for a more integrative approach to HCC management, amalgamating molecular profiling with traditional clinical parameters to refine patient stratification and personalize treatment strategies.

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (&gt;65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

6275602 Anesthetic management of a pregnant patient with congenital long QT syndrome type 2 undergoing ovarian dermoid cyst excision: A Case Report

6275602 Anesthetic management of a pregnant patient with congenital long QT syndrome type 2 undergoing ovarian dermoid cyst excision: A Case Report

6302019 The search for unwarranted variation in the availability of anaesthetic management for persons following the diagnosis of intrauterine fetal death

6302019 The search for unwarranted variation in the availability of anaesthetic management for persons following the diagnosis of intrauterine fetal death

6281706 Anaesthetic management of women with booking body-mass index > 40 kg ·m−2 for Caesarean. A retrospective analysis from the north-west of England

6281706 Anaesthetic management of women with booking body-mass index > 40 kg ·m−2 for Caesarean. A retrospective analysis from the north-west of England

Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium

Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium

6290914 14 year review of the anaesthetic management of the parturient with spina bifida

6290914 14 year review of the anaesthetic management of the parturient with spina bifida

Anesthetic Management for Atrial Septal Defect Closure in a Patient with Bidirectional Shunt and Pulmonary Hypertension

&lt;p&gt;&lt;strong&gt;Background &lt;/strong&gt;: ASD bidirectional shunt occurs when flow moves between left and right depending on the higher pressure, either systemic vascular resistance (SVR) or pulmonary vascular resistance (PVR). The anesthetic management aimed to maintain the left-to-right shunt and control factors that could increase PVR while retaining SVR within normal or slightly elevated ranges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Illustration &lt;/strong&gt;: We reported a 39-year-old female patient with ASD, bidirectional shunt, and pulmonary hypertension (PH) who underwent defect closure. Due to the mean pulmonary pressure exceeded 50% of mean systemic pressure, an intentional ASD creation was performed. It is not a routine procedure; however, it serves as a “way out” if there is severe left ventricular dysfunction. Attention and intervention were promptly administered for any identified post-surgical issues, including PH crisis or right ventricular dysfunction. The management of PH was conducted during perioperative period and the patient was successfully extubated at 17 hours post-surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion &lt;/strong&gt;: Perioperative management of bidirectional shun ASD with PH requires a SVR and PVR. Factors that can increase PVR must be avoided/controlled and on the other hand SVR must be maintained.&lt;/p&gt;

Revolutionizing trauma care: advancing coagulation management and damage control anesthesia.

Despite advances in emergency transfer systems and trauma medicine, the incidence of preventable deaths due to massive hemorrhage remains high. Recent immunological research has elucidated key mechanisms underlying trauma-induced coagulopathy in the early stages of trauma, including sympathoadrenal stimulation, shedding of the glycocalyx, and endotheliopathy. Consequently, the condition progresses to fibrinogen depletion, hyperfibrinolysis, and platelet dysfunction. Coexisting factors such as uncorrected acidosis, hypothermia, excessive crystalloid administration, and a history of anticoagulant use exacerbate coagulopathy. This study introduces damage-control anesthetic management based on recent insights into damage-control resuscitation, emphasizing the importance of rapid transport, timely bleeding control, early administration of antifibrinolytics and fibrinogen concentrates, and maintenance of calcium levels and body temperature. Additionally, this study discusses brain-protective strategies for trauma patients with brain injuries and the utilization of cartridge-based viscoelastic assays for goal-directed coagulation management in trauma settings. This comprehensive approach may provide potential insights for anesthetic management in the fast-paced field of trauma medicine.

Anesthesia Management of COVID-19 associated Rhino-Orbito-Cerebral Mucormycosis: A Prospective Observational Study

Abstract Background: Fungal infections (mucormycosis) have been reported as co-infection as well as opportunistic infection during and after COVID-19 (Coronavirus disease), involving the paranasal air sinuses with a high risk of morbidity and mortality. Considering the ongoing situation of COVID-19 associated with mucormycosis, we presented our experience of 110 patients being, or having previously been COVID -19 positive. Methods: This study included 110 patients in which surgical resection was done for Rhino-orbito-cerebral mucormycosis (ROCM) under general anesthesia and observed for 30 days postoperatively. Results: This study included 79 male patients with the majority of 51-60 years of age group (31.81%). Most common comorbidities observed in study were diabetes mellitus (77.27 %) followed by hypertension (39.09 %) &amp; ischemic Heart Disease (9.09 %). Majority patients had received steroids (80 %) as a part of covid-19 treatment. All patients were receiving Amphotericin B at the time of surgery. On operative table extubation was possible in 80 % of the cases while others required average ICU stay (9.83 ± 7.33 days). Inotropic support was required in 20 % of patients. Majority patients were discharged successfully (85.45 %), while 10.91 % had mortality. On 30 days follow-up frontal Sinus Abscess (6.36 %) &amp; maggots in maxilla and sphenoid (0.91 %) were noted. Conclusion: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. Perioperative anesthesia care plays an important role towards management and outcome of ROC mucormycosis. Difficult intubation is anticipated due to fungal debris and supraglottic edema in the oropharynx of the patient.

A Case Report on Anesthesia Management of a Giant Thymoma Excision with a Lateral Thoracotomy Approach

A Case Report on Anesthesia Management of a Giant Thymoma Excision with a Lateral Thoracotomy Approach

Cerrahi Debridman Gerektiren Mukormikozis Vakalarına Anestezik Yaklaşım

Objective: Mucormycosis is a rare, progressive, and life-threatening fungal infection that occurs in immunocompromised patients. In the present study, we aimed to evaluate the perioperative challenges in the anesthetic management of mucormycosis patients. Methods: Patients over 18 years of age who underwent surgery for mucormycosis within a 3-year period between January 1, 2020 and December 31, 2022 were included in the study. Perioperative records were retrospectively evaluated. Results: During this period, 25 of 47 cases of mucormycosis were surgically treated. Data from these 25 cases were analyzed. Twelve (48%) patients had a diagnosis of rhinocerebral, 7 (28%) rhino-orbital, 5 (20%) rhino-orbito-cerebral and 1 (4%) rhino-pulmonary mucormycosis. All patients had comorbidities. The most common comorbidities were diabetes mellitus in 20 (80%), followed by hypertension in 12 (48%), acute kidney injury in 7 (28%) and coronary artery disease in 5 (20%) patients. Six (24%) patients had a history of COVID-19 infection and were treated with steroids. Intubation was difficult in 2 (8%) patients. Two (8%) patients had intraoperative hemodynamic instability requiring inotropes. There were 17 (68%) patients, 6 (24%) of whom were intubated, who were transferred to the intensive care unit (ICU). The median length of stay in the ICU was 22.7 days and the total length of stay was 42 days. Eleven (44%) patients required mechanical ventilation. Mortality occurred in 12 (48%) patients. Conclusion: Anesthetic management of surgical debridement for mucormycosis is challenging. Challenges include difficult intubation and renal dysfunction. Postoperative follow-up in the ICU is important due to rapid progression and comorbidities. Keywords: Mucormycosis, COVID-19, anesthesia