Application Of General Anesthesia Research Articles

General anesthesia in patients with hepatic encephalopathy and acute variceal bleeding undergoing endoscopic treatment: A retrospective study.

The management of cirrhotic patient with encephalopathy and acute variceal bleeding (AVB) remains a clinical challenge with a high mortality. Early endoscopic therapies are frequently applied in patients with AVB. However, the application of general anesthesia in endoscopic surgery for patients with hepatic encephalopathy (HE) is pretty challenging. The present study aimed to evaluate the possible effect of general anesthesia with tracheal intubation on patient complicated with encephalopathy and AVB during endoscopic procedure. Thirty-six cirrhotic patients with encephalopathy and AVB were retrospectively studied, 14 patients underwent endoscopic treatment under general anesthesia with tracheal intubation, and 22 patients received pharmacological treatment, or and endoscopic therapy without general anesthesia served as the control group. Routine clinical and laboratory data were collected. The total mortality rate was 13.9% (5/36), 2 (14.3%) in the anesthesia group, 3 (13.6%) in the control group. The child-Pugh class of death cases were all grade C, 3 (60%) of them were in the stage IV of HE. The stage of HE was all improved in the 2 groups, 12 (85.8 %) patients were totally recovered from consciousness disturbance in the anesthesia group and 16 (72.7 %) in the control group respectively, the difference between the 2 groups was not significant (P>0.05). Except the death cases, there were still 3 patients in the control group had impaired consciousness at discharge. Child-Pugh score, Child-Pugh class and the stage of HE in the anesthesia group were significantly improved at discharge compared with those before operation. General anesthesia does not aggravate the severity of encephalopathy, and endoscopic treatment under general anesthesia with tracheal intubation is effective for HE patients complicated with AVB.

EXAMINATION OF THE FACTORS AFFECTING THE COGNITIVE LEVELS AND RECOVERY STATUS OF GERIATRIC PATIENTS UNDERGOING SURGICAL INTERVENTION

Introduction: The aim of this study was to examine the factors affecting the cognitive levels and recovery status of geriatric patients who undergo surgical intervention. Materials and Method: This was a descriptive cross-sectional study that was conducted between December 30, 2021-August 30, 2022 with 250 geriatric patients who underwent major surgical intervention in the cardiovascular, orthopedics, and general surgery departments of a hospital in Turkey. The descriptive data form, postoperative recovery index, and mini-mental state examination were used as data collection forms. The data of the study were collected with geriatric patients who were in the 48–72-hour postoperative period. The data were analyzed using the Statistical Package for Social Sciences 24.0. Results: The mean age, mini-mental test score and recovery index score of the patients are 69.70±4.81, 24.71±3.07, 2.29±0.33 respectively. It was found that the risk of cognitive impairment increased with increasing age. It was determined that the day of hospitalization before the operation, the application of general anesthesia, the duration of anesthesia, the first mobilization time, the malnutrition, the intensive care stay in the postoperative period made recovery difficult. A negative statistically significant relationship was found between the mini-mental state examination score and postoperative recovery index scores. Conclusion: Approximately half of the patients were at risk of cognitive impairment, which negatively affected the postoperative recovery process. A comprehensive preoperative evaluation of geriatric patients, provision of optimal nutrition, and early mobilization during the postoperative period will positively affect the recovery process. In-service training on the care of geriatric patients is recommended for healthcare professionals. Keywords: Aged; Surgery; Postoperative Period; Dementia.

Application of General Anesthesia with Laryngeal Mask Airway Preserving Autonomous Breathing in Thoracoscopic Surgery

Application of General Anesthesia with Laryngeal Mask Airway Preserving Autonomous Breathing in Thoracoscopic Surgery

Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross\u2010sectional study

ObjectivesBehaviour management strategies involving pharmacological or non-pharmacological interventions during dental procedures should be considered to attain safe and successful treatment outcomes. This study compared the frequencies of use and the completeness of treatment with these interventions.MethodsA total of 1725 dental records of patients up to 18 years old, who were treated in the King Abdulaziz Medical City in Jeddah City from October 2018 to June 2019, were used in this retrospective, cross-sectional study. Inferential analysis, Chi-square test, Kruskal–Wallis test, and regression model were used in the data analysis.ResultsAbout two-thirds of the patients were treated with attendant non-pharmacological interventions, while one-third, with pharmacological interventions. The application of General Anesthesia (GA) was the most frequently used intervention. Restorative procedures and extractions were done in higher frequencies with pharmacological interventions. Treatments with space maintainers and orthodontic appliances were carried out in higher frequencies with non-pharmacological strategies. The choice of intervention was significantly influenced by the systemic conditions of the patients. Patients treated with non-pharmacological intervention comprised the dominant type of patients, because they required treatments with less pain. Those treated with GA needed restorative treatments and extractions, or treatments that involve pain, but these treatments had higher frequencies of being completed.ConclusionsThe treatments with pharmacological intervention through GA have higher frequencies of being completed, compared to those with non-pharmacological interventions. Factors, such as age, potential to complete the treatment, and the type of dental treatment applied, influence the choice of treatment intervention.

COMPARISON OF TREATMENT OF INTRAABDOMINAL POST-OPERATIVE ABSCESSES WITH THE LAPAROTOMIC AND MINI-INVASIVE INVASIVE ACCESS

Summary. The aim of the work was to compare the results of surgical treatment of patients for postoperative abdominal abscesses using different tactics.
 Materials and methods. The study included data from 63 patients with postoperative abdominal abscesses. Laparotomy access and use of percutaneous puncture / drainage were compared. Kaplan-Meier survival analysis was used to compare hospitalization duration.
 Results. Laparotomic access was performed according to classical methods. After the application of general anesthesia and treatment of the surgical field was performed opening the anterior abdominal wall. The abscess was opened and the contents were aspirated, after treatment of the cavity site with aqueous solutions of antiseptics, the wound was closed and the drainage system was established. Further stages of treatment of intra-abdominal abscess after routine surgery were: aspiration of abscess in the postoperative period through established drainage; diagnostic control of abscess resolution; effective antimicrobial and detoxification therapy. Percutaneous puncture / abscess drainage was performed under ultrasound control using special puncture needles of size F8 - F12. The needle or drainage stlet-catheter was inserted into the abscess cavity, followed by aspiration of the abscess contents and leaving the drainage system. Kaplan-Maier has reduced hospitalizations in patients who have used mini-invasive technologies.
 Conclusions. Treatment of postoperative abdominal abscesses involves a surgical approach. Patients with postoperative abscesses who underwent laparotomy access were likely to have an increased total hospitalization duration of 5 days compared with the use of mini-invasive technologies.

PSIII-10 Body temperature changes in piglets anesthetized for castration during the recovery phase

Abstract In several countries, an application of general anesthesia for pain prevention during castration is discussed. A disadvantage is the prolonged recovery phase, accompanied by severe body temperature drops in piglets. Aim of this study was to investigate effects on body temperature during recovery after anesthesia. Piglets were anesthetized, castrated and placed in boxes (0.24m2) for 4h. Before, 2 and 4h after the application (0.3ml ketamine+azaperone/kg BW), rectal temperatures (RT) and skin temperatures behind the ear (ST) were measured. In a first trial, impacts of infrared lamp (250W, 50-55cm height) and number of animals per box (3 vs 6) were analyzed (n = 30). In a complementary trial, infrared lamps’ height (60 vs 70cm) and piglet age were varied (n = 27) and temperatures measured half-hourly. Differences were estimated in linear models (SAS® 9.4). Mean RT before anesthesia was 39.1±0.4°C with ranges of less than 1.9°C. After 2h, mean RT in lamp-warmed piglets increased to 40.8°C (P < 0.01), whereas in absence of lamps RT dropped to 37.3 (P < 0.001), with significant differences between groups (P < 0.001). To prevent life-threatening cooling, piglets with RT as minimal as 33.5°C were warmed immediately, so that their mean RT after 4h was not different from initial temperatures. Animal number per box caused no differences. Variation between individual RT was up to 8.2°C at 2h (first trial). Means in the second trial did not differ, but variation pattern of individual temperatures was highest after 1h (6.1°C), indicating that individual differences regarding anesthetics or external factors might occur. When lamps hung lower ST were higher after 3h (P < 0.05) and 4h (P < 0.01). RT and ST were dependent on age after 0.5h (P < 0,05, respectively) and tendentious at 1h and 2h, indicating that older piglets can rely on more distinct temperature regulation abilities and use endogenous energy resources to regain homeostasis.

Clinical value of general anesthesia combined with epidural anesthesia in laparoscopic radical resection of rectal cancer

Objective To explore the application of general anesthesia combined with epidural anesthesia in laparoscopic radical resection of rectal cancer. Methods From February 2015 to July 2016, 95 rectal cancer patients undergoing laparoscopic radical resection in the Fifth People's Hospital of Datong were randomly divided into general anesthesia(GA) group(48 cases) and GA combined with epidural anesthesia(CEGA) group(47 cases) according to the digital table.The effect of anesthesia, hemodynamic index, recovery time, extubation time, general anesthesia dosage, adverse reaction were assessed. Results In the CEGA group, 89.36% reached the level Ⅰ~Ⅱ anesthesia, GA group was 72.92%, the difference between the two groups was statistically significant (U=5.034, P<0.05). The anesthesia dosage of the GA group was higher than that of the CEGA group[(780.26±152.01)mg vs.(499.31±153.01)mg, the difference between the two groups was statistically significant(t=4.561, P<0.05). The recovery time, operation time in the CEGA group were (10.26±2.81)min, (139.26±34.16)min, respectively, which in the group GA were (23.46±3.64)min, (109.23±35.03)min, respectively, the difference between the two groups was statistically significant (t=6.235, 9.490, all P<0.05). The incidence rate of adverse reaction of the CEGA group was 10.64%, which of the GA group was 27.08%, the difference between the two groups was statistically significant (χ2=10.342, P<0.05). At pneumoperitoneum and extubation, HR, MVP in the GA group were (105.26±15.07)times/min, (109.18±16.27)times/min, (13.26±2.65)kPa, (14.91±2.57)kPa, respectively, which were significantly higher than those in the CEGA group (t=6.575, 6.154, 5.842, 6.544, all P<0.05). The Steward awakening scores of each base point before and after extubation in the CEGA group were significantly higher than those in the GA group (t=6.354, 3.268, 3.869, 3.992, 3.564, 4.065, 4.031, 4.689, all P<0.05). Conclusion CEGA has good anesthetic effect, less dosage in general anesthesia, little influence on hemodynamics and easy to wake up.It is an ideal anesthesia method for laparoscopic radical resection of rectal cancer. Key words: Anesthesia, general; Anesthesia, epidural; Laparoscopy; Colorectal surgery

Лапароскопічна холецистектомія із застосуванням субарахноїдальної анестезії на спонтанному диханні

Мета. Проаналізувати результати застосування субарахноїдальної анестезії на спонтанному диханні під час виконання лапароскопічної холецистектомії (ЛХЕ) для удосконалення методу регіонарної анестезії при операціях на органах черевної порожнини.&#x0D; Матеріали і методи. У 549 пацієнтів, віднесених до I-III класу за класифікацією American Society of Anesthesiology (ASA), віком від 25 до 82 років, середній вік становив (48,9 ± 13,1) року, виконали ЛХЕ із пневмоперитонеумом, який створювали нагнітанням в черевну порожнину вуглекислого газу (CO2), із застосуванням субарахноїдальної анестезії на спонтанному диханні. З приводу гострого холециститу (ГХ) оперовані 319 (58,1%) пацієнтів, хронічного калькульозного холециститу (ХКХ) - 230 (41,9%). Із 319 хворих із ГХ у 278 (87,4%) були деструктивні форми. Інтраопераційні параметри, інтенсивність післяопераційного болю та міру відновлення в цілому, а також задоволеність пацієнтів під час спостереження проспективно зафіксовані у дослідженні з метою оцінки можливості та безпечності процедури.&#x0D; Результати. Всі операції завершені лапароскопічно, у жодному спостереженні не виникло необхідності переходити з субарахноїдальної анестезії на загальну. Інтенсивність болю протягом 4 год після операції становила 1,6 ± 1,1 (діапазон 0 - 5), через 8 год - 1,2 ± 0,9 (діапазон 0 - 6), через 24 год – 1,02 ± 0,7 (діапазон 0-5). Всі пацієнти виписані через 1 - 7 днів.&#x0D; Висновки. ЛХЕ з пневмоперитонеумом CO2 може бути успішно та безпечно виконана із застосуванням субарахноїдальної анестезії на спонтанному диханні. Крім того, спинальна анестезія пов’язана з мінімальним післяопераційним болем і принаймні однаковою мірою відновлення, як у разі використання загального знеболювання.

Application of general anesthesia as part of dental care for children with special needs

Application of general anesthesia as part of dental care for children with special needs

Application of general anesthesia with sevoflurane inhalation anesthesia combined with sacral block in children with indirect inguinal hernia in single hole laparoscopic operation

Objective To observe the clinical application effect of general anesthesia with sevoflurane inhalation anesthesia combined with sacral block in children with indirect inguinal hernia in single hole laparoscopic operation,and early postoperative recovery and analgesic effect.Methods 60 cases of children with indirect inguinal hernia operation,were randomly divided into the observation group and the control group (n=30).The observation group was given mask inhalation of sevoflurane anesthesia induction after insertion of endotracheal tube,the caudal block combined with sevoflurane inhalation anesthesia maintain,control group was treated with sevoflurane inhalation combined with intravenous anesthesia maintenance.The two groups were observed in heart rate,blood pressure and pulse oximetry,recovery time and room crying in pain score and 30 mins score.Results The incision of skin in two groups showed good effect of anesthesia,vital signs were stable during the time of analepsia; observation group (5.8 ± 3.6) min and control group (15.6 ± 8.5) min,showing statistical significant difference (P ＜ 0.001),with a better analgesic =effect in the room.Conclusion Sevoflurane inhalation anesthesia combined with sacral block is conducive to children's anesthesia management and postoperative rapid recovery in children with indirect inguinal hernia of single hole laparoscopic operation,and can provide good effect of postoperative analgesia. Key words: Inguinal hernia; Single hole laparoscopic operation; Sacral block anesthesia; Sevoflurane; Anesthesia

A Successful Aplication of the Caudal Block Anesthesia in Patient with Ankylosing Spondylitis Who Has Severe Kyphoscoliosis

Ankylosing spondylitis (AS), is a chronic, progressive, otoimmune collagen tissue disease characterized by spine, sacroiliac, joint and neighboring tissue inflammation. AS is important for anaesthesiologists due to the problems that can occur during the application of general anesthesia and regional anesthesia. In this paper, we aim to present the caudal block method that we applied to a patient who is planned to have a hemorrhoidectomy operation. We planned to perform a hemorrhoidectomy operation with caudal block method to a 71 year-old patient who was diagnosed as AS 20 years ago. Preoperative evaluation of patients showed that ASA 2, mallompati 2 and neck joint mobility was limited. The caudal block anesthesia is applied to the patient at prone position with 12 cc, 0.5% isobaric bupivacaine. No complications were observed in patients in intraoperative or post-operative period. In conclusion, caudal block method is a convenient approach in anogenital region operations for patients with ankylosing spondylitis.

Failure of epidural analgesia converted to epidural anesthesia for cesarean delivery in a patient with bronchial atresia in labor

Bronchial atresia is a rare anomaly characterized generally by obstruction in the bronchial system, mucus accumulation, emphysematous changes and bulla formation in the peripheral lung. Regional anesthesia is the choice for cesarean delivery in a parturient patient with this anomaly. We report a patient with a diagnosis of bronchial atresia in whom the conversion of epidural analgesia to epidural anesthesia for cesarean delivery failed during labor, needing the application of general anesthesia for a successful delivery.

631 Critical Supravalvular Aortic Stenosis in a Family with a New Elastin Gene Mutation

Background and aims: An elastin gene mutation causes manifold vascular stenosis in patients with Williams-Beuren Syndrome, but also in a nonsyndromatic congenital form. These patients have a higher risk of sudden death, particularly when undergoing diagnostic or surgical procedures. Methods: We performed Molecular genetic investigation of the elastin - Gen in one family. The cardiac and vascular malformations in these patients were determined and 2 lethal clinical courses are described. Results: Screening over 3 generations revealed 8 affected individuals with a new Elastin - gen mutation. The cardiac and vascular malformations range from mild asymptomatic supravalvular aortic stenosis and isolated dysplastic atrioventricular valves to diffuse arterial hypoplasia. Two infants presented arteries affected at multiple locations, including the left coronary artery. Both died of sudden heart death and myocardial ischemia, one while under general anesthesia for cardiac catheterization, the other perioperatively. Conclusions: In patients with arterial narrowing, elastin - Gen mutation should be considered. These patients have special pathophysiological aspects. Any application of general anesthesia should undergo careful scrutiny and only be performed by well-experienced anesthesiologists anticipating such problems.

EFFECTIVE BEHAVIOR THERAPY IN A MEDICAL CRISIS: A CASE REPORT

This is report of the successful use of behavioral treatment in a medical crisis. The intubation process inadvertently punctured a patient's throat during the application of general anesthesia while having a routine arthroscopy. This resulted in a rapidly spreading infection, spiking temperature and dehydration. To locate the puncture, a barium swallow x-ray was necessary, but the patient's weakened condition made standing impossible. A friend and experienced therapist accompanying the patient helped him stand for the several minutes necessary to complete the barium swallow by countering the hypotensive state with angry imagery to stimulate an adrenalin surge. Several principles of effective therapeutic practice were demonstrated by this case, including the importance of the alliance, of technical eclecticism, of engaging the patient in the treatment process, and therapist experience.