Perioperative Anesthetic Management Research Articles

Prevalence, impact and associated factors of abnormal preoperative investigation result in patients undergoing surgery in Dilla University referral hospital: cross-sectional study

Background: As one domain of preoperative assessment, preoperative investigations are often ordered to evaluate patient’s medical condition for risk stratification and assessing patient status to undergoing surgery. Despite the fact that laboratory testing can assist in ensuring the best possible preoperative condition, routine screening examinations have a number of drawbacks. Although there are evidence-based recommendations for which investigations should be done, the tradition of routine preoperative testing is still prevalent and clinical practice with abnormal results detected varies. Method: Institution-based cross-sectional study design was conducted from 1 November to January at Dilla University Referral Hospital. Data was collected from complete pre-anaesthesia check-up sheets, investigations already done. It was collected at the individual level by using, closed-ended self-guided questionnaire. The collected data was entered, cleaned, edited and checked using SPSS version 26 for data processing and analysis. Logistic regression was performed to examine the impacts of abnormal preoperative investigation results and summarised by using tables and figures. An Adjusted odds ratio with 95% CI was computed to determine the level of significance. Result: Data of 208 patients (65.9 female) with mean±standard deviation age 30.83±15.340 years and 22.59±2.99 BMI were analysed. Patients were mostly American Society of Anaesthesiologists I and II underwent National Institute of Clinical and Health Excellence Grade 2 surgeries and surgical shape class 3. Totally, 178 (44.5%) test results were abnormal. CBC is the most detected abnormal result. Only 15 (3.75%) abnormalities had an impact in terms of delay, further investigations, and surgical technique. Comorbidity (AOR 7.982, 95% CI, P=0.041), medication history (AOR 1.463, 95% CI, P=0.013), ASA physical status II (AOR 3.287, 95% CI, P=0.029) and history of smoking (AOR 1.577, 95% CI, P=0.049) were factors which was significantly associated with abnormal preoperative investigation result. Conclusion: Only 0.6% of all tests had a significant impact in terms of changing perioperative anaesthetic management. The significant impact of abnormal investigation result noticed was delayed surgery

Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery-A review of 148 cases.

Patients with hypoplastic left heart syndrome undergo the comprehensive stage 2 procedure as the second stage in the hybrid approach toward Fontan circulation. The complexity of comprehensive stage 2 procedure is considered a potential limitation, and limited information is available on its anesthetic management. This study aims to address this gap. A single-center retrospective cohort study analyzed 148 HLHS patients who underwent comprehensive stage 2 procedure, divided into Group A (stable condition, n = 116) and Group B (requiring preoperative intravenous inotropic therapy, n = 32). Demographic data, intraoperative hemodynamics, anesthetic management, and postoperative outcomes were collected. Etomidate (40%) was the most common induction agent, followed by esketamine (24%), midazolam (16%), and propofol (13%). Inhaled induction was rarely necessary (2%), occurring only in Group A patients. No statistical differences were found between groups for induction drug choice. Post-cardiopulmonary bypass management included moderate hypoventilation, inhaled nitric oxide (100%), and hemodynamic support with milrinone (97%) and norepinephrine (77%). Group B patients more frequently required additional levosimendan (20%) and epinephrine (18%). Extracorporeal membrane oxygenation was necessary in 8 patients (5%) with no between-group differences. Switching from fentanyl to remifentanil reduced postoperative ventilation time overall. However, Group B experienced significantly longer ventilation (6.3 vs. 3.5 h) and ICU stay (22 vs. 14 days). In-hospital mortality was 5% overall (Group A: 4%, Group B: 9%). Long-term survival analysis revealed a significant advantage for Group A. The use of short-acting opioids and adjusted ventilation modes enables optimal pulmonary blood flow and rapid transition to spontaneous breathing. Differentiated hemodynamic support with milrinone, norepinephrine, supplemented by levosimendan and epinephrine in high-risk patients, can mitigate the effects on the preoperatively volume-loaded right ventricle. However, differences in long-term survival probability were observed between groups. Local ethics committee, Medical Faculty, Justus-Liebig-University-Giessen (Trial Code Number: 216/14).

Anesthetic management and anesthesia-related complications in dogs with a dilated cardiomyopathy phenotype: a retrospective study of 30 dogs (2010-2024).

To describe perioperative anesthetic management in canines with a dilated cardiomyopathy (DCM) phenotype and to compare the frequency of general anesthesia-related complications with a control group of dogs without heart disease. 30 dogs with DCM phenotype (cases) and 30 dogs without heart disease (controls). Dogs presented to a teaching hospital between 2010 and 2024 that were diagnosed with a DCM phenotype via echocardiography were included in this study. Controls were dogs that presented during the same time period and were matched with cases based on their age, breed, and type of procedure; however, no standardization of treatment between the groups was performed. Medical records were reviewed to evaluate the occurrence of anesthetic complications. Of dogs with a DCM phenotype, 2 had overt DCM, 22 had occult DCM, and 6 had equivocal DCM. Dogs with DCM exhibited a lower likelihood of being premedicated with dexmedetomidine or induced with propofol. Conversely, DCM dogs were more likely to be induced with etomidate or midazolam compared to their counterparts without DCM. Dogs with DCM demonstrated an increased likelihood of experiencing cardiac arrhythmias during anesthesia, received comparatively lower volumes of IV fluids, and were more likely to be administered dobutamine during anesthesia. No significant differences were identified in terms of postanesthesia complications or survival rates to discharge. Dogs with a DCM phenotype, primarily characterized by asymptomatic presentation, demonstrated comparable perioperative outcomes under general anesthesia when compared to matched controls, though the lack of standardization in anesthetic management limits definitive conclusions.

Perioperative anaesthetic management of an elderly high-risk male with cardiac ochronosis undergoing aortic valve replacement with coronary artery bypass graft: A case report.

Alkaptonuria is a rare autosomal recessive congenital disorder of metabolism that affects 1 in 250,000 live births. It manifests as ochronosis and degenerative arthritis due to the accumulation of homogentistic acid in cartilage and heart valves along with precipitation of renal, salivary, pancreatic and gall bladder calculi. It is noted to cause cardiac valve stenosis and regurgitation secondary to calcification leading to cardiac failure in 10% of patients. Through this report, we present a successful perioperative anaesthetic management of a 74-year-old man with cardiac ochronosis, who underwent an aortic valve replacement with coronary artery bypass graft surgery at our centre.

Perioperative Anesthetic Management in Repair Diaphragmatic Hernia with Atrial Septal Defect and Pulmonary Hypertension

Introduction: Patients who had suffered disease of atrial septal defect (ASD) coming by pulmonary hypertension (PH) often present a clinical dilemma. Both of these disorders are congenital anomalies that often appear in pediatrics. Anaesthetic management in diaphragmatic hernia repair with this comorbidity requires precision and accuracy to avoid morbidity and mortality during surgery. The right management and care of anesthetic procedures is needed for patients who will be operated on with these two disorders. Objective: To describe the anesthetic management of a diaphragmatic hernia repair patient with comorbid ASD and pulmonary hypertension. Case report: The patient, a 1.5-month-old female baby born, has presented with shortness of breath complaints since the birth. Those were born spontaneously at the midwife's office and did not cry immediately, and a history of blueing and decreased consciousness was admitted for 20 days. Based on the examination, the diagnosis of diaphragmatic hernia from echocardiography found ASD and PH with a left ventricular ejection fraction of 64%. The patient was planned for diaphragmatic hernia repair under general anesthesia. Induction of anesthesia was performed with 5 mcg of fentanyl and inhalation anesthetic 3.5 vol% sevoflurane. After the endotracheal tube (ETT) was attached, the patient was desaturated to 50%, then the hyperventilated oxygenation was performed and positioned with knee chest position, and then milrinone at a dose of 1 mcg/min was given, saturation rose to 100%. During intraoperative ventilation control with manual bagging and maintenance anesthesia with inhalation ansethetic sevoflurane of 3.2 vol%. After surgery, the patient was admitted and observed in the pediatric intensive care unit for 2 days before extubation. Conclusion: Appropriate perioperative management in ASD patients with PH can reduce perioperative morbidity and mortality.

Postoperative stroke in acute type A aortic dissection: incidence, outcomes, and perioperative risk factors

BackgroundDespite advances in surgical techniques, the incidence of stroke following acute type A aortic dissection (ATAAD) repair remains markedly high, with substantial immediate and long-term adverse outcomes such as elevated mortality, extended hospital stays, and persistent neurological impairments. The complexity of managing ATAAD extends beyond the operation itself, highlighting a crucial gap in research concerning modifiable preoperative patient conditions and perioperative anesthetic management strategies.ObjectivesThis investigation aimed to elucidate the incidence, consequences, and perioperative determinants of stroke following surgical intervention for acute type A aortic dissection (ATAAD).MethodsIn a multicenter retrospective analysis, 516 ATAAD surgery patients were evaluated. The data included demographic information, clinical profiles, surgical modalities, and outcomes. The primary endpoint was postoperative stroke incidence, with hospital mortality and other complications serving as secondary endpoints.ResultsPostoperative stroke occurred in 13.6% of patients (70 out of 516) and was associated with significant extension of the ICU (median 10 vs. 5 days, P < 0.001) and hospital stay (median 18 vs. 12 days, P < 0.001). The following key independent stroke risk factors were identified: modified Frailty Index (mFI) ≥ 4 (odds ratio [OR]: 4.18, 95% confidence interval [CI]: 1.24–14.1, P = 0.021), common carotid artery malperfusion (OR: 3.76, 95% CI: 1.23–11.44, P = 0.02), pre-cardiopulmonary bypass (CPB) hypotension (mean arterial pressure ≤ 50 mmHg; OR: 2.17, 95% CI: 1.06–4.44, P = 0.035), ≥ 20% intraoperative decrease in cerebral regional oxygen saturation (rSO2) (OR: 1.93, 95% CI: 1.02–3.64, P = 0.042), and post-CPB vasoactive-inotropic score (VIS) ≥ 10 (OR: 2.24, 95% CI: 1.21–4.14, P = 0.01).ConclusionsPostoperative stroke significantly increases ICU and hospital durations in ATAAD surgery patients. These findings highlight the critical need to identify and mitigate major risks, such as high mFI, common carotid artery malperfusion, pre-CPB hypotension, significant cerebral rSO2 reductions, and elevated post-CPB VIS, to improve outcomes and reduce stroke prevalence.Trial RegistrationThai Clinical Trials Registry (TCTR20230615002). Date registered on June 15, 2023. Retrospectively registered.

Thoracotomy: An Overview of Perioperative Anaesthetic Management

Background: The anesthesiologist's role during open thoracotomy includes using a double lumen tube (DLT) for lung isolation, maintaining oxygenation with one-lung ventilation (OLV), and providing postoperative analgesia. This study aims to describe patient demographics, comorbidities, perioperative anesthetic management, complications, and the effectiveness of epidural catheter analgesia. Methods: In this prospective, observational study, patients who underwent open thoracotomy for decortications were evaluated. Thoracotomy was done under general anaesthesia, OLV with DLT, and epidural analgesia. Postoperatively, all the patients were shifted to the intensive care unit. Collected data included patient demographics, associated co-morbidities, severity of lung diseases, complications, and postoperative recovery. Postoperative analgesia was assessed by the visual analogue scale (0-10). Result: Of 20 patients, 16 were male, and 4 were female, with a mean age of 35 years (range 15-60) and a mean weight of 52 kg (range 36-66). History of hypertension (N=5), hypertension with diabetes (N=3), obstructive lung disease (N=6), restrictive lung disease (N=11), and both combined (N=3) were noted on pre-anesthetic check-ups. Intraoperative complications were hypotension (N=3), desaturation (N=3), respiratory acidosis (N =7), and metabolic acidosis (N=3). Postoperative analgesia was managed with an epidural catheter (N=18) &amp; systemic analgesia (N=2). All patients had uneventful postoperative courses except one patient who had pulmonary edema and did not survive. Conclusion: Patients undergoing open thoracotomy had an increased risk for adverse perioperative outcomes. The incidences of perioperative morbidity are high in patients with associated comorbidities. Proper OLV strategy helps to correct intraoperative desaturation. Epidural analgesia plays a key role in postoperative recovery.

Anaesthetic Management for a Dilated Cardiomyopathy Patient, Scheduled for Lumbar Spine Surgery

Background: Dilated cardiomyopathy (DCM) is characterized by dilatation and impaired contraction of left or both ventricles. Diagnostic criteria are left ventricular ejection fraction less than 40% or fractional shortening less than 25%. Perioperative anesthetic management of these patients are very challenging for anesthesiologists and intensive care team. Case presentation: A 55-year-old female, presented with complaints of severe low-back ache with bilateral lower limb involvement without involvement of bladder and bowel. Severe cord compression at the L4-5 level and severe lumbar canal stenosis were detected by magnetic resonance imaging. Echocardiography showed that the left ventricle (LV) had global hypokinesia, with an ejection fraction of 25% to 30%. The planed surgical procedures were L4 lumbar laminectomy and L4-5 microdiscectomy. Conclusion: Continuous monitoring and control of hemodynamic parameters as well as central venous pressure guided fluid therapy is the cornerstone in improving outcome in patients with dilated cardiomyopathy for non-cardiac surgery.

Major Pelvic Ortho-oncological Surgeries: Our Experience

Background and Aims: Anaesthesia for pelvic tumour surgeries is challenging because of major blood loss, extensive tissue damage, hypothermia due to the longer duration of surgery, unusual and frequent change in positions, ongoing postoperative blood loss and post-operative pain management. This retrospective study aimed to assess the perioperative anaesthetic management for patients undergoing major pelvic tumour surgeries in our institute. Methods: We collected data from 20 patients from the patient files, anaesthesia records and electronic medical records about demographics, type and duration of surgery, pre-operative morbidities, preoperative chemotherapy/radiotherapy, intraoperative anaesthesia management with respect to fluids, blood loss, blood products transfused and postoperative pain management and complications. Data were summarised using percentages for categorical data and medians for continuous data. Results: Sixteen patients were given epidural and general anaesthesia, while four were given only general anaesthesia. The median duration of surgery was 7 h (interquartile range [IQR] 5–10 h). Multiple surgeons were involved in four cases. The median blood loss was 1500 ml (IQR 550–2750 mL); nine patients needed massive blood transfusions. Navigation-guided surgical cuts were made in eight patients. Three required postoperative mechanical ventilation. The pain was managed by epidural infusions and intravenous patient-controlled fentanyl infusions. The postoperative complication was seen in two patients in the form of wound infection and a post-operative bleed. Conclusion: The major pelvic orthopaedic oncological surgeries require meticulous attention to patient-centric perioperative care. A dedicated team approach with a definitive surgical plan, anticipating complications and their timely intervention, pain management and postoperative rehabilitation can lead to improved outcomes.

The Effect of Intra-abdominal Pressure on Heart Rate Variability and Hemodynamics During Laparoscopic Cholecystectomy: A Prospective Observational Study.

Introduction This study aimed to evaluate hemodynamic changes using heart rate variability (HRV) measurements in diabetic and nondiabetic patients who will undergo laparoscopic cholecystectomy and to provide our preoperative measurements to guide us for better perioperative anesthesia management. Materials and methods The study included 143 patients aged 40 years and older who would undergo elective laparoscopic surgery, did not have any comorbidities other than diabetes mellitus (DM) type II, and were in theAmerican Society of Anesthesiologists(ASA) class I-III risk group. Patients were divided into two groups: the control group (n = 77) and the DM group (n = 66). The preoperativeglycated hemoglobin (HbA1C) level was measured. Peripheral oxygen saturation (SpO2) and hemodynamic parameters such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and HRV parameters were measured preoperatively, perioperatively, and postoperatively. Intra-abdominal pressure (IAP) was administered at 10-12 mmHg. Results Even though SAP, DAP, MAP, and HR decreased with induction, they increased with insufflation, and an overall decrease was seen at the postoperative 24th hour for all parameters. When the groups were evaluated, no difference was observed except that the DAP was significantly lower in the DM group (p = 0.029) at insufflation and the HR was higher in the DM group at induction, and the difference was significant (p = 0.001). Preoperative HRV parameters were significantly lower in the DM group. According to the HRV parameters, although a decrease was observed after induction and insufflation, conversely, an increase was observed postoperatively. When the postoperative and preoperative values were compared, the standard deviation of the NN (R-R) intervals (SDNN), SDNN index, high frequency (HF), low frequency (LF), and LF/HF parameters were found to be significantly lower in the DM group than in the control group. Conclusion Diabetic patients are more sensitive to increased intra-abdominal pressure (IAP) in laparoscopic surgery, and the effects on cardiac autonomic functions can be determined by HRV measurements without clinically reflecting on hemodynamic data. Additionally, in diabetic patients with preoperative LF and/or HF values less than 100, we believe that careful follow-up in terms of autonomic neuropathy complications and anesthesia management should be done more meticulously in these patients.

A survey of practice in the anesthetic management of adolescent idiopathic scoliosis spine fusion by the North American Pediatric Spine Anesthesiologists Collaborative.

Adolescent Idiopathic Scoliosis (AIS) affects 2%-4% of the general pediatric population. While surgical correction remains one of the most common orthopedic procedures performed in pediatrics, limited consensus exists on the perioperative anesthetic management. To examine the current state of anesthetic management of typical AIS spine fusions at institutions which have a dedicated pediatric orthopedic spine surgeon. A web-based survey was sent to all members of the North American Pediatric Spine Anesthesiologists (NAPSA) Collaborative. This group included 34 anesthesiologists at 19 different institutions, each of whom has a Harms Study Group surgeon performing spine fusions at their hospital. Thirty-one of 34 (91.2%) anesthesiologists completed the survey, with a missing response rate from 0% to 16.1% depending on the question. Most anesthesia practices (77.4%; 95% confidence interval [CI], 67.7-93.4) do not have patients come for a preoperative visit prior to the day of surgery. Intravenous induction was the preferred method (74.2%; 95% CI 61.3-89.9), with the majority utilizing two peripheral IVs (93.5%; 95% CI 90.3-100) and an arterial line (100%; 95% CI 88.8-100). Paralytic administration for intubation and/or exposure was divided (51.6% rocuronium/vecuronium, 45.2% no paralytic, and 3.2% succinylcholine) amongst respondents. While tranexamic acid was consistently utilized for reducing blood loss, dosing regimens varied. When faced with neuromonitoring signal issues, 67.7% employ a formal protocol. Most anesthesiologists (93.5%; 95% CI 78.6-99.2) extubate immediately postoperatively with patients admitted to an inpatient floor bed (77.4%; 95% CI 67.7-93.3). Most anesthesiologists (87.1%; 95% CI 80.6-99.9) report the use of some form of an anesthesia-based protocol for AIS fusions, but our survey results show there is considerable variation in all aspects of perioperative care. Areas of agreement on management comprise the typical vascular access required, utilization of tranexamic acid, immediate extubation, and disposition to a floor bed. By recognizing the diversity of anesthetic care, we can develop areas of research and improve the perioperative management of AIS.

Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors.

Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood. This study aims to find the incidence of cardiac findings in patients with severe scoliosis ≥90° without cardiac history. A single-institution retrospective chart review was performed. Inclusion criteria were scoliosis patients with curves ≥90 degrees and a screening echocardiogram performed within 6 months of spine surgery. Patients with a previous cardiac history, diagnosis associated with cardiac comorbidities (eg, connective tissue disease), or major coronal curves <90 degrees were excluded. Echocardiogram reports and perioperative clinical notes from involved services (including orthopaedics, cardiology, and anesthesia) were reviewed. Any postoperative use of vasopressors and reasons for their use were recorded. Overall, 50 patients met the inclusion criteria. The mean age at surgery was 14.0 ± 4.9 years old (range: 2 to 33). The mean major curve was 108 ± 19 degrees (range: 90 to 160 degrees). A normal echocardiogram was seen in 38 (76%), whereas 6 patients (12%) had mild dilation of the aortic sinus or root, 4 (8%) had mild valvular regurgitation, 1 patient had a small atrial septal defect, and 1 had a trace pericardial effusion. No patient had any changes made to their perioperative plan and one patient was advised to see a cardiologist postoperatively. Postoperatively, 8 patients (16%) received vasopressors to raise blood pressure to meet preset goal MAP, but only one of these 8 had a positive echocardiogram (mild valvular insufficiency), which was not seen as a contributing factor to the use of pressors. This study suggests that screening echocardiograms for patients without a cardiac history or related symptoms does not contribute to the evaluation of perioperative risk or anesthetic management. Creating clear, evidence-based guidelines for the utilization of perioperative testing, like echocardiograms, can reduce the social, time, and financial burdens on families. Such guidelines are vital for appropriate risk assessment and proper utilization of health care resources. Level III.

Anesthesia for lung transplantation in children under 12 years of age: a single center experience of China

PurposeThis study aims to provide a comprehensive overview of anesthesia management strategies employed in pediatric lung transplantation.MethodsA retrospective analysis was conducted on data from 14 pediatric patients who underwent lung transplantation at the Wuxi Center between September 2019 and November 2022. Patient demographics, surgical particulars, airway management, utilization of extracorporeal support, fluid administration, blood gas and electrolyte profiles, and postoperative outcomes were systematically documented and subsequently summarized.ResultsOf the 14 patients, 7 received extracorporeal membrane oxygenation (ECMO) and 1 received cardiopulmonary bypass (CPB). The average operation time was 303 ± 53 min, with the median extubation time of 26 h. The entirety of pediatric lung transplant procedures was executed successfully, resulting in the discharge of thirteen patients postoperatively. Regrettably, one patient died due to infectious shock on the fourth postoperative day.ConclusionThe achievement of successful pediatric lung transplantation necessitates effective perioperative anesthesia management, with a focal emphasis on circulatory control. Real-time measurements serve as the cornerstone for decision-making. Proactive administration of vasoactive agents is integral to sustaining hemodynamic stability. The judicious assessment of ECMO necessity is paramount, favoring central ECMO during the surgical intervention.

Perioperative analgesic management in patients with bladder exstrophy: A clinical study

Background: Bladder exstrophy is a complex, rare congenital malformation with an incidence of 3.3 cases in every 100000 live births and is slightly more common in males. Primary surgical repair requires many hours of surgery with fluid and blood loss. Because of wide fluctuations in hemodynamics, a longer duration of surgery, smaller age, risk of hypothermia and post-operative intensive care may be required. We evaluated the use of continuous caudal epidural infusion of bupivacaine and fentanyl under general anesthesia for urinary bladder exstrophy-epispadias surgery in children. Aims and Objectives: Aim of the study was to evaluate the postoperative analgesia in patients undergoing surgery for bladder exstrophy. The primary objective was to assess the postoperative pain using FLACC scale and sedation score after successful caudal administration. Secondary objective was to assess the hemodynamic changes after caudal administration. Materials and Methods: A total of 13 patients aged between 9months and 13 years of either sex, weighing between 5kg to 30kg, belonging to ASA grade II to IV, underwent surgery for epispadias–exstrophy complex. Initial bolus 0.75ml/kg of 0.25% bupivacaine with fentanyl 1ug/kg was given through epidural. Postoperative analgesia was maintained by continuous infusion of 0.0625% bupivacaine @0.1ml/kg/hr in young children and 0.125% bupivacaine with fentanyl 1ug/ml in older children for 4-5 days with the help of ON-Q pump or infusion pump. Baseline hemodynamic parameters including MAP, heart rate and SpO2 was recorded at various time intervals. Postoperative pain was assessed using face, legs, activity, cry and consolability (FLACC) pain scale and sedation score was assessed by using ramsay sedation score. Results: There was a statistically significant decrease in mean pulse rate in the study group from baseline to thirty minutes after reversal (p&lt;0.001). Similar observation was made for mean arterial pressure which also showed statistically significant decrease from baseline to thirty minutes after reversal (p&lt;0.001). No change was observed in SpO2 from baseline to any other follow-up interval. Conclusion: Perioperative anesthetic and analgesic management of the bladder exstrophy patient can improve the success rate. Epidural bupivacaine with or without fentanyl infusions for short duration can provide safe analgesia.

Anaesthesia Management of Child with Congenital Cystic Adenomatoid Malformation Posted for Lobectomy

Congenital cystic adenomatoid malformation (CCAM) is a benign lung lesion that appears before birth as a cyst or mass in the chest. It is made up of abnormal lung tissue that does not function properly, but continues to grow. These lesions compress the adjacent normal lung tissues. CCAMs occur sporadically, and there is no genetic predisposition. They are usually unilobed and unilateral, with arterial supply and venous drainage from the pulmonary circulation. The postnatal management of symptomatic CCAM varies on whether the patient has respiratory distress or is asymptomatic. Symptomatic patients require a lobectomy or pneumonectomy. Perioperative anaesthetic management is challenging because it involves thoracotomy in a young patient that may lead to hemodynamic compromise and inadequate ventilation.

Risk factors in perioperative anesthesia management in multiple thyroid nodule surgery

Introduction: Thyroid nodules are the most common endocrine disorders (endocrine neoplasms). Conducting regular physical examinations in risk factors of thyroid nodules is essential. This case report aims to describe how multiple thyroid nodules could be why muscle relaxant administration was repeated in this patient in a short time. Case Presentation: A 39 years old female, with clinical complaints of a lump in her neck. Right colli anterior region, fine needle aspiration biopsy (FNAB) gives a result the impression of cytomorphological picture is suspicious for papillary thyroid carcinoma. And the thyroid ultrasound examination results found the Impression of Single solid nodule with calcification on the right thyroid, multiple cystic nodules on the left thyroid, and bilateral multiple non-specific colli lymphadenopathy. The patient underwent total thyroidectomy, using General Anesthesia, with the muscle relaxant used, namely rocuronium, which was then carried out with a maintenance dose 3 times intraoperatively because the patient's spontaneous breathing returned while the operation was still in progress, after which the patient was transferred to the recovery room for post-operative monitoring. Conclusion: Multiple thyroid nodules could be the reason why muscle relaxant (rocuronium) administration was repeated in this patient in a short time.

Attenuation of intestinal ischemia-reperfusion-injury by anesthetics: a potentially protective effect of anesthetic management in experimental studies.

Intestinal ischemia-reperfusion injury (IRI) is a potentially severe clinical syndrome after major surgical procedures. In addition to causing intestinal mucosa injury, intestinal IRI further damages distant organs, causing the severity of the condition in patients. So far, effective therapy for intestinal IRI is still absent, and the survival rate of the patients is low. Previous experimental studies have shown that some anesthetics can alleviate intestinal IRI and protect organs while exerting their pharmacological effects, indicating that reasonable perioperative anesthesia management may provide potential benefits for patients to avoid intestinal IRI. These meaningful findings drive scholars to investigate the mechanism of anesthetics in treating intestinal IRI in-depth to discuss the possible new clinical uses. In the present mini-review, we will introduce the protective effects of different anesthetics in intestinal IRI to help us enrich our knowledge in this area.

Perioperative management of kidney transplantation in China: A national survey in 2021.

Perioperative anaesthesia management has an important significance for kidney transplantation; however, the related consensus remains limited. An electronic survey with 44 questions was developed and sent to the chief anaesthesiologist at 115 non-military medical centres performing kidney transplantation in China through WeChat. A response rate of 81.7% was achieved from 94 of 115 non-military medical centres, where 94.4% of kidney transplants (10404 /11026) were completed in 2021. The result showed an overview of perioperative practice for kidney transplantations in China, identify the heterogeneity, and provide evidence for improving perioperative management of kidney transplantation. Some controversial therapy, such as hydroxyethyl starch, are still widely used, while some recommended methods are not widely available. More efforts on fluid management, hemodynamical monitoring, perioperative anaesthetics, and postoperative pain control are needed to improve the outcomes. Evidence-based guidelines for standardizing clinical practice are needed.

Laser Interstitial Thermal Therapy (LITT) for Neurosurgical Procedures: Facts You Need to Know About the Anesthetic Management of LITT Procedures.

The field of medicine is constantly advancing to improve patient care. As physicians, we must improve our knowledge by listening, reading, and practicing evidence-based medicine. Laser treatment has evolved over the years in many surgical specialties. Laser interstitial thermal therapy (LITT), also known as stereotactic laser ablation (SLA), was developed in neurosurgical procedures to treat recurrent or metastatic brain tumors, radiation necrosis, and epilepsy lesions. LITT procedures are advantageous in providing better patient outcomes, decreased hospital length of stay, and reduced total hospital cost. These procedures are performed as a multi-disciplinary approach; this article discusses the different types of LITT systems, indications, contraindications, types of anesthesia, perioperative anesthetic management,safety precautions, complications, recovery during and after LITT procedures, and the future of LITT procedures.

Clinical characteristics and anaesthetic management of severe scoliosis patients with spinal muscular atrophy: case series

Introduction and importance: There is no expert consensus or guidance on perioperative anaesthesia management for spinal surgery of spinal muscular atrophy (SMA) patients with severe scoliosis (Cobb≧90°). We provide a comprehensive summary of the perioperative characteristics observed in patients with SMA and propose an optimized perioperative management strategy for anaesthesia. Methods: This study is a retrospective single-centre research. Twenty-six SMA patients with severe scoliosis underwent posterior spinal fusion surgery from September 2019 to September 2022 were enroled. The main outcomes were to show the patients’ characteristics in anaesthesia, intra- and post-operative periods. Outcomes: Nineteen patients underwent awake transnasal/transairway intubation. The median anaesthesia time of 25 patients treated under total intravenous anaesthesia was 425 min. After operation, the Cobb angle and correction rate in the coronal plane were median 54.0° and 54.4%. The length of mechanical ventilation with endotracheal intubation in ICU was median 17.5 h in 8 patients. The ICU length of stay of postoperative hospital was median 19 days. Postoperative pneumonia developed in nine patients, atelectasis in two patients, and pleural effusion in six patients. All patients did not need special oxygen therapy after discharge. Conclusion: Multidisciplinary consultation, lung-protective ventilation strategy, appropriate anaesthetic drugs and reasonable blood transfusion scheme and postoperative monitoring were important in anaesthesia, intraoperative and postoperative periods in the patients of severe scoliosis with spinal muscular atrophy.