Anesthetic Management Research Articles

Findings of Hypotension in Spinal Anesthesia Patients with Lumbar 3-4 And Lumbar 4-5

Background: Hypotension is a common complication associated with spinal anesthesia, often resulting from sympathetic nerve block. Factors such as the type of drug, patient positioning, injection site, dosage, and age influence the incidence of hypotension. Purpose: This study aimed to evaluate the incidence of hypotension in patients receiving spinal anesthesia at the lumbar 3-4 (L3-L4) and lumbar 4-5 (L4-L5) injection sites. Methods: A quantitative descriptive study with a cross-sectional approach was conducted, involving 190 respondents selected via purposive sampling. Univariate data analysis was performed. Findings: Findings indicated that patients receiving spinal anesthesia at the L3-L4 site experienced an average systolic blood pressure decrease of 24.69% and a diastolic decrease of 16.17%. In contrast, patients with L4-L5 injections showed a lesser reduction, with systolic pressure dropping by 15.51% and diastolic pressure by 12.31%. Additionally, the pulse rate decreased progressively within the first 20 minutes following induction. The average pulse rate at the 20th minute was 75.06 for patients with L3-L4 injections and 75.65 for those with L4-L5 injections. Conclusion: The study highlights that the incidence of hypotension varies based on the spinal injection site, with more significant decreases in blood pressure observed in patients receiving injections at L3-L4 compared to L4-L5. These findings have important implications for anesthesia management in clinical practice.

Anesthetic management of a rare case of mobile vocal cord polyp causing dynamic airway obstruction: A case report

We report the anesthetic management of a patient presenting with a mobile vocal cord lesion in combination with restricted mouth opening. Fiber-optic laryngoscopy revealed a highly mobile vocal cord lesion, moving in and out of the vocal cords with respiration. A very small tracheal lumen was visible posteriorly during expiration. ASA difficult airway algorithm was applied, and the patient was successfully intubated awake with a # 5 microlaryngeal tube loaded over a pediatric bronchoscope. We aim to highlight the importance of detailed preoperative evaluation, adopting difficult airway algorithms and utilization of devices, with which we have maximum expertise with some modification as the key to avoid airway-related adverse events in such patients.

Exploring Anesthesiology Management of Living Donor Liver Transplantation: Survey From the Society for the Advancement of Transplant Anesthesia and the Korean Society for Transplantation Anesthesiologists.

While living donor liver transplantation (LDLT) serves as the predominant method of adult liver transplant (LT) in the Republic of Korea (ROK), it represents a minority of LT in the United States (US). A survey was conducted to gain insight into these nations' anesthetic management. An electronic questionnaire was distributed to directors of LT anesthesiology overseeing LDLT programs in both countries between May 2021 and October 2021. The response rate was 93.0% (100% [37/37] in the US and 80% [16/20] in the ROK). Both countries mainly adhered to deceased donor LT recipient management practices, including the frequency of routine pulmonary artery catheter use, transesophageal echocardiography, and point-of-care coagulation monitoring. Differences were observed in early extubation of recipients (US vs. ROK: 39.7%vs. 14.7% of all cases), participation in donor selection meetings (88.9% [32/36] vs. 6.3% [1/16], p < 0.0001), application of the Enhanced Recovery After Surgery donor protocol (69.4% [25/36] vs. 12.5% [2/16], p < 0.0001), and cell saver usage for donors (94.4% [34/36] vs. 18.8% [3/16], p < 0.0001). More ROK programs implemented simultaneous donor/recipient anesthesia supervision by a single anesthesiologist. Several important differences were identified between the US and the ROK in adult LDLT anesthetic management.

A retrospective study of anesthesia management in patients operated for neuromuscular scoliosis

Objective: Scoliosis frequently develops as a complication of neuromuscular diseases, often progressing and necessitating surgical intervention. Although complications can arise in spinal fusion surgery for all types of scoliosis, they are more frequent during and after the procedure in cases of neuromuscular scoliosis. This retrospective study aims to explore the preoperative characteristics, anesthesia protocols, as well as intra- and postoperative complications and associated conditions in patients who underwent surgery for neuromuscular scoliosis at our hospital.Material and Methods: After receiving approval from the ethics committee of our hospital, this study conducted a retrospective review of patient files from individuals who underwent surgery for neuromuscular scoliosis at Ankara Training and Research Hospital between 2008 and 2012. A total of 26 patient files were analyzed. Patient parameters including age (years), gender (female (F), male (M)), weight (kg), presence of neuromuscular disease, concomitant cardiovascular and respiratory conditions, as well as other systemic anomalies and diseases, spirometry findings (FEV1, FVC, FEV1/FVC), nutritional status (total protein, albumin), pre-operative hemoglobin (Hg) and hematocrit (Htc) levels, Cobb angle index, angle direction, type of surgical approach (anterior or posterior), muscle relaxants utilized, additional dosage requirements, operation duration, intraoperative bleeding volume (ml), transfusion volume (ml), and intraoperative complications were documented. Results: As the Cobb angle increased, several factors were affected: the duration of the operation was extended (p &lt; 0.05), there was an increase in blood loss (p = 0.012), and more blood transfusions were required (p = 0.32). Furthermore, there was a correlation between increasing age and the amount of blood transfused (p = 0.035). Conclusion: It has been concluded that a comprehensive preoperative assessment is crucial, as it can offer valuable insights into anesthesia management both before and after surgery for scoliosis. Therefore, conducting a detailed preoperative evaluation is essential for patients undergoing these procedures

Anaesthetic Management of Laparoscopic Cholecystectomy and Splenectomy in Hereditary Spherocytosis: A Case Report

Anaesthetic Management of Laparoscopic Cholecystectomy and Splenectomy in Hereditary Spherocytosis: A Case Report

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery.

Intraoperative fluid management is an important aspect of anesthesia management in gastrointestinal surgery. Intraoperative goal-directed fluid therapy (GDFT) is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time. To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery. This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital. The experimental group (GDFT group) and the control group, each comprising 30 patients, received intraoperative GDFT and traditional fluid management strategies, respectively. The effect of GDFT was evaluated by comparing postoperative recovery, complication rates, hospitalization time, and other indicators between the two patient groups. Intraoperative blood loss in the experimental and control groups was 296.64 ± 46.71 mL and 470.05 ± 73.26 mL (P < 0.001), and urine volume was 415.13 ± 96.72 mL and 239.15 ± 94.69 mL (P < 0.001), respectively. The postoperative recovery time was 5.44 ± 1.1 days for the experimental group compared to 7.59 ± 1.45 days (P < 0.001) for the control group. Hospitalization time for the experimental group was 10.87 ± 2.36 days vs 13.65 ± 3 days for the control group (P < 0.001). The visual analogue scale scores of the experimental and control groups at 24 h and 48 h post-surgery were 3.38 ± 0.79 and 4.51 ± 0.86, and 2.05 ± 0.57 and 3.51 ± 0.97 (P < 0.001), respectively. The cardiac output of the experimental and control groups was 5.99 ± 1.04 L/min and 4.88 ± 1.17 L/min, respectively, while the pulse pressure variability for these two groups was 10.87 ± 2.36% and 17.5 ± 3.21%, respectively. The application of GDFT in gastrointestinal surgery can significantly improve postoperative recovery, reduce the incidence of complications, and shorten hospital stays.

Anesthetic management of acute embolic stroke following Non-ST-Elevation Myocardial Infarction: a case report

Anesthetic management of acute embolic stroke following Non-ST-Elevation Myocardial Infarction: a case report

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.

Anaesthetic concerns in a patient with aortic aneurysm for non-cardiac surgery: A case report.

Abdominal aortic aneurysm poses a significant risk of rupture, with mortality rates of 80% to 90% if untreated. Management focuses on identifying and repairing the aneurysm before rupture, considering factors like size, type and symptoms. We report successful anaesthetic management in a case of intertrochanteric fracture of femur of an elderly patient who was to undergo elective surgery for abdominal aortic aneurysm. Few cases detail abdominal aortic aneurysm management during non-cardiac surgery, emphasising careful anaesthesia titration. This case report underscores the importance of precise intraoperative anaesthesia management in emergency non-cardiac surgery for abdominal aortic aneurysm patients.

Anesthetic Management of Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: An Overview.

Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents-such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine-depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period.

Optimizing anesthesia management based on early identification of electroencephalogram burst suppression risk in non-cardiac surgery patients: a visualized dynamic nomogram

Background Burst suppression (BS) is a specific electroencephalogram (EEG) pattern that may contribute to postoperative delirium and negative outcomes. Few prediction models of BS are available and some factors such as frailty and intraoperative hypotension (IOH) which have been reported to promote the occurrence of BS were not included. Therefore, we look forward to creating a straightforward, precise, and clinically useful prediction model by incorporating new factors, such as frailty and IOH. Materials and methods We retrospectively collected 540 patients and analyzed the data from 418 patients. Univariate analysis and backward stepwise logistic regression were used to select risk factors to develop a dynamic nomogram model, and then we developed a web calculator to visualize the process of prediction. The performance of the nomogram was evaluated in terms of discrimination, calibration, and clinical utility. Results According to the receiver operating characteristic (ROC) analysis, the nomogram showed good discriminative ability (AUC = 0.933) and the Hosmer–Lemeshow goodness-of-fit test demonstrated the nomogram had good calibration (p = 0.0718). Age, Clinical Frailty Scale (CFS) score, midazolam dose, propofol induction dose, total area under the hypotensive threshold of mean arterial pressure (MAP_AUT), and cerebrovascular diseases were the independent risk predictors of BS and used to construct nomogram. The web-based dynamic nomogram calculator was accessible by clicking on the URL: https://eegbsnomogram.shinyapps.io/dynnomapp/ or scanning a converted Quick Response (QR) code. Conclusions Incorporating two distinctive new risk factors, frailty and IOH, we firstly developed a visualized nomogram for accurately predicting BS in non-cardiac surgery patients. The model is expected to guide clinical decision-making and optimize anesthesia management.

Блокада нервов нижней конечности: показания и преимущества

An inadequate approach to the choice of anesthetic care during surgery and in the postoperative period leads to numerous complications, chronic pain, decreased quality of life, as well as to the formation of a negative patient attitude and dissatisfaction with anesthetic care. Currently, there is a constant search for optimal methods of anesthetic management, especially in high-risk patients. Objective. To summarize and present current information on lower limb nerve blockade. Materials and methods. During the research work, an analysis of dissertations on this topic for 2014–2023 was carried out, and Internet resources Elibrary, Cyberleninka, PubMed for the last 9 years were used, since there are not enough literary sources on this topic from 2018 to 2023. Results. An analysis of Russian and foreign literature for 2014–2023 was given, devoted to such a type of anesthetic management as lower limb nerve blockade. Indications, anatomical features, methods, complications in femoral, obturator and sciatic nerve blockades are described. Conclusion. Due to the use of ultrasound navigation, neuromuscular stimulation, catheter technologies, it has become possible to perform peripheral blockades with a minimal risk of complications, as well as to carry out extended peripheral blockades, which allows to speed up the postoperative recovery of patients. Due to the lack of influence of peripheral blockades on hemodynamics, a smaller number of severe complications inherent in central blockades, anesthesiologists increasingly prefer peripheral blockades when choosing a method of anesthetic support for operations on the lower extremities. This type of anesthesia is offered as an alternative to neuraxial blockades, especially in elderly patients with a high class of physical condition.

Exploring Heart Rate Variability Biofeedback as a Nonpharmacological Intervention for Enhancing Perioperative Care: A Narrative Review.

Heart rate variability biofeedback (HRVBF) is a non-invasive therapeutic technique that aims to regulate variability in heart rate. This intervention has promise in mitigating perioperative stress, a critical factor for surgical patient outcomes. This comprehensive review aimed to explore the current evidence on the perioperative role of HRV biofeedback in improving patient outcomes, reducing perioperative stress, enhancing recovery, and optimizing anaesthesia management. A review of the PubMed and Google Scholar databases was conducted to identify articles focused on HRVBF in relation to the perioperative period. Studies were selected using appropriate keywords in English (MeSH). Ample potential applications of HRVBF in clinical anaesthesia have been identified and proven feasible. It is a non-invasive and an easy method an anaesthesiologists has at its disposal with potential utility in reducing perioperative stress, as a tool of optimization of comorbidities, analgesia supplementation and in predicting catastrophic complications. Although HRVBF has the potential to enhance anaesthesia management and improve patient outcomes, several limitations and challenges must be addressed to maximize its clinical utility. Overcoming these obstacles through research and technological advancements will be crucial for realizing the full benefits of HRVBF in perioperative care.

Specific features of anesthesia management in a patient with a transplanted heart

Background. The number of heart transplant patients makes 1 per 100,000 in the Russian Federation, 1.2 per 100,000 population in the Tambov Region. The medical community is poorly informed about the specific features of managing such patients during non-cardiac surgical interventions. The article presents a case report of the management of a patient with a transplanted heart undergoing surgery for acute appendicitis. Preoperative preparation, anesthesia management, surgery, and postoperative care and rehabilitation were provided taking into account the presence of a transplanted heart in the patient, according to the Guidelines developed by the experts of the V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs where the heart transplant had been performed to the patient, and standard clinical recommendations.Case Report. An 18-year-old patient diagnosed with acute phlegmonous appendicitis with a heart transplanted in 2021 for dilated cardiomyopathy underwent laparoscopic appendectomy 3 years after heart transplantation. Anesthesia was provided taking into account the presence of a denervated donor heart, a high risk of myocardial ischemia and heart ailure (low cardiac output syndrome), and the need for a timely correction of hypovolemia and hypotension. Anesthesia management was a general combined multicomponent anesthesia.Conclusion. This clinical case has shown the possibility of providing medical care to a patient with a transplanted heart at a modern level in an urban multidisciplinary hospital. Non-cardiac surgery was performed in accordance with recommendations of specialists of V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs and clinical recommendations in order to achieve optimal results and the fastest possible rehabilitation in the postoperative period.

Minimal invasive extracorporeal circulation: A bibliometric network analysis of the global scientific output.

Minimal Invasive Extracorporeal Circulation (MiECC) has recently emerged as a more 'physiologic' alternative to conventional extracorporeal circulation. However, its adoption is still limited due to lack of robust scientific evidence and ongoing debate about its potential benefits. This bibliometric analysis aims to analyze the scientific articles on MiECC and identify current research domains and existing gaps to be addressed in future studies. Pertinent articles were retrieved from the Web of Science (WOS) database. The search string included 'minimal invasive extracorporeal circulation' and its synonyms. The VOSviewer (version 1.6.17) software was used to conduct comprehensive analyses. Semantic and research networks, bibliographic coupling and journal analysis were performed. Of the 1777 articles identified in WOS, 292 were retrieved. The trend in publications increased from 1991 to date. Most articles focused on transfusion requirements, acute kidney injury, inflammatory markers and cytokines, inflammation and delirium, though the impact of intraoperative optimal fluid and hemodynamic management as far as the occurrence of postoperative complications were poorly addressed. The semantic network analysis found inter-connections between the terms "cardiopulmonary bypass", "inflammatory response", and "cardiac surgery". Perfusion contributed the highest number of published documents. The most extensive research partnerships were between Germany, Greece, Italy, and England. Notwithstanding the scientific community's growing interest in MiECC, crucial topics (i.e., the best anesthetic management and intraoperative need for inotropes, vasopressors and fluids) still require more comprehensive exploration. This investigation may prove to be a useful tool for clinicians, scientists, and students concerning global publication output and for the use of MiECC in cardiac surgery.

Unveiling the Landscape of Acute Kidney Injury in Surgical Patients: A Systematic Review of Risk Factors and Clinical Biomarkers

Acute Kidney Injury (AKI) is a critical complication with significant implications for surgical patients, leading to increased morbidity, mortality, and healthcare costs. Identifying the risk factors and clinical biomarkers associated with AKI in the surgical context is essential for timely intervention and personalized management. To address this knowledge gap, we conducted a systematic review to comprehensively analyze existing literature on AKI in surgical patients. In this paper, we provided a systemically review analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique for AKI risk factors and clinical biomarkers. The advanced searching into two powerful databases which is Scopus, Pubmed and Mendeley. Based on searching, find finally main data n=30 and will be analyzed using the synthesis approach. Through a meticulous search and appraisal of studies in reputable scientific databases, we identified a diverse range of research articles, clinical trials, and cohort studies that met our rigorous inclusion criteria. Synthesizing the findings from these studies, we explored the multifactorial nature of AKI, encompassing patient-related factors, surgical variables, and exposure to potential nephrotoxic agents. Our review revealed that AKI in surgical patients is influenced by a complex interplay of risk factors, including patient demographics, comorbidities, surgical procedures, anaesthetic management, and exposure to nephrotoxic drugs. The systematic analysis identified the most common drug classes associated with drug-induced AKI, such as diuretics, ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), and antibiotics

Anaesthesiological management of pre-eclampsia and eclampsia

A new national treatment guideline from Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM) outlines the anaesthetic management of pre-eclampsia and eclampsia. Key principles involve blood pressure control, seizure treatment and prophylaxis, and restricted fluid therapy. Treatment algorithms, flow charts and checklists are provided. Anaesthetic recommendations for vaginal delivery and caesarean section are provided. Close monitoring, especially for patients with severe disease, organ dysfunction, or failure, is crucial, requiring a multidisciplinary approach, as argued in this review.

Anesthesia and Airway Management in a Child with Frank Ter Haar Syndrome Suspected Difficult Airway Undergoing Cardiac Surgery: A Case Report

Introduction: Frank ter Haar syndrome (FTHS) is a rare and complex multisystem congenital genetic disorder that leads to craniofacial, cardiac, and skeletal abnormalities. We report the anesthesia and airway management of a child with FTHS who was referred for repair of atrial septal defect (ASD) and ventricular septal defect (VSD). Case Presentation: The patient exhibited craniofacial and skeletal abnormalities, including craniosynostosis, micrognathia, a prominent forehead, hypertelorism, and anteverted nostrils. These features raised the possibility of a difficult airway. Conclusions: For patients with potential difficult airways undergoing elective surgery, the procedure should be postponed until all necessary equipment for managing a difficult airway is available.

Preoperative Geriatric Characteristics Associated with Changes in Postoperative Cognitive Function and Quality of Life: a Prospective, Observational Analytic Multicenter Study.

Changes in cognitive function are associated with increased depression and decreased quality of life (QOL). This study aimed to determine the relationship between the characteristics of geriatric patients and anesthetic management with changes in postoperative cognitive function and QOL of geriatric patients undergoing elective surgery. This prospective observational analytic multicenter study included patients aged ≥60 years who underwent elective surgery in hospitals in Indonesia. We used the whole sampling method and performed follow-up 30 days after surgery. Data were analyzed using bivariate chi-square and multivariate regression tests with a confidence interval of 95% and α=5%. Among the 933 geriatric patients included in this study (55.0% female), most (59.8%) received general anesthesia. Factors including age (p<0.001, B=-0.374, odds ratio [OR]=0.688), body mass index (BMI) (p<0.05, B=0.129, OR=1.138), and physical status based on American Society of Anesthesiologists (ASA) classification (p<.001, B=-0.458, OR=0.633) were significantly associated with postoperative cognitive function. BMI (p<.001, B=-0.218, OR=1.244), absence of comorbidities (p<0.05, B=-0.312, OR=0.732), regional anesthesia (p<0.05, B=0.606, OR=1.883), and changes in cognitive function (p<0.05, B=0.288, OR=1.334) were significantly correlated with changes in postoperative QOL. Age, BMI, and ASA physical status were significantly associated with postoperative cognitive function in geriatric patients, whereas BMI, comorbidities, regional anesthesia, and changes in postoperative cognitive function were associated with QOL. These preoperative factors can predict postoperative cognitive function and QOL and may be useful during preoperative planning.

The evolving role of the modern perfusionist: Insights from processed electro-encephalography.

Introduction: Since its origin in the 1920s, electroencephalography (EEG) has become a viable option for anesthesia and perfusion teams to monitor anesthetic delivery, optimizing drug dosage and enhancing patient safety. Patients undergoing cardiopulmonary bypass (CPB) are at particular high risk for excessive or inadequate anesthetic doses. During CPB, traditional physiological indicators such as heart rate and blood pressure can be significantly altered. These abnormalities are compounded by rapid changes in anesthetic concentration from hemodilution, circuit absorption, and altered pharmacokinetics. Method: This narrative highlights the use of processed EEG with spectral analysis for anesthetic management during CPB. Conclusion: We emphasize that neuromonitoring using processed EEG during CPB can assess adequacy of anesthesia delivery and monitor for pathologic conditions that can compromise brain function such as inadequate cerebral blood flow, emboli, and seizures. This information is highly valuable for the clinical team including the perfusionist, who regularly diagnose and manage these pathological conditions.