General Anaesthetic Practice Research Articles

Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery.

To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.

Does Practitioner Experience Affect Intraocular Pressure After Endotracheal Intubation?

Intraocular pressure (IOP) may decrease or increase during general anesthesia, depending on various factors. This study aimed to investigate theeffects of the level of provider training period on post-intubation IOP values and hemodynamic response. This study was a cross-sectional observational study. Before inclusion in the study, informed consent was obtained from all participants. The study was approved by the localethical committee. The study included 120 adult patients, both sexes, aged between 18 and 65, with physical statuses according to the American Society of Anesthesiologists (ASA) I or II, Mallampati score I. The research included 120 anesthesiologist resident doctors who received their training in our clinic. In this study, anesthesiology resident doctors were divided into three separate seniority groups (group 1, less than one-year residents in anesthesiology who had performed fewer than 10 intubations; group 2, one- to three-year residents; and group 3, more than three-year residents). After receiving a standard intravenous induction, direct laryngoscopy and endotracheal intubation techniques were performed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and IOP were measured and recorded before pre-induction (T1), the first minute after induction (T2), and the first minute after laryngoscopy and intubation (T3). There was nostatistically significant difference (p > 0.05) between groups in the values of IOP, SBP, DBP, and HR measured at T1, T2, and T3. Measurements at T1, T2, and T3 were similar in all three groups. Comparisons within the groups revealed that IOP values at all measurement times (T1, T2, and T3)were different from each other in less than three-year resident groups. This difference was statistically significant (p < 0.001). The measurement values at T2 were the lowest and T3 were the highest in less than three-year resident groups. There was a significant increase in IOP after endotracheal intubation (T3) compared to baseline levels (T1) in less than three-year resident groups. IOP values at T2 were also significantly lower than the values at T1 and T3(p < 0.001) in the more than three-year resident group (group 3). However, when we compared IOP measurements at T1 and T3 among themselves in the more than three-year resident group, no significant difference was found (p > 0.05). This study showed that endotracheal intubation in general anesthesia practice is performed most effectively by resident doctors with more than three years of anesthesiology training, without changing the IOP value.

Low Dose Combined Spinal-Epidural (CSE) Anaesthesia with Blocks for Management of A High-Risk Geriatric Patient with Dilated Cardiomyopathy Posted for TURBT

Introduction: Transurethral resection of bladder tumors (TURBT) is the first-line method and mainstay for endoscopic diagnosis, staging, and treatment of urinary bladder tumours. Hypotonic fluid absorption, electrolyte imbalance from irrigation, haemorrhage, and obturator jerk episodes are just a few of the procedure’s intrinsic risks. Cardiovascular issues were more likely to arise in elderly patients undergoing this surgery. A high risk of pulmonary oedema, arrhythmia, and bleeding problems exists in individuals with coronary artery disease (CAD), dilated cardiomyopathy (DCMP), multiple comorbidities, and anticoagulant medication. Case Presentation: Here, we provide a challenging situation of A 74-year-old man was scheduled to have TURBT (Transurethral Resection of Bladder Tissue) for a bladder mass with hematuria and many comorbidities, including Hypertension (HTN), Chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), post percutaneous transluminal coronary angioplasty (PTCA), cerebrovascular accident (CVA), dilated cardiomyopathy (DCMP), ejection fraction (EF) 25%, and Severe MR necessitating obturator nerve block (ONB), spinal anaesthesia (SA), and epidural anaesthesia (EA) for perioperative and postoperative anaesthetic as well as analgesia, which was effectively handled without any difficulties. Conclusion: Elderly patient with ischemic cardiomyopathy are at higher risk of major cardiovascular events perioperatively. Low dose spinal anaesthesia combined with epidural anaesthesia provides better hemodynamic stability, prevents myocardial depression, provide perioperative analgesia and early ambulation. Keywords: Obturator nerve block, Spinal anaesthesia, General anaesthesia practice, Transurethral Resection of Bladder Tissue (TURBT), Cerebrovascular accident (CVA), Chronic obstructive pulmonary disease (COPD)

Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study.

The current status of general anesthesia practice for cesarean delivery in Japan remains unknown. Therefore, using a nationwide claims database, we aimed to investigate general anesthesia use for cesarean delivery over a period of 15 years, and to analyze the general anesthesia practice in Japan. Patients who claimed the Japanese general anesthesia claim code (L008) for cesarean delivery between 1 January 2005, and 31 March 2020, were analyzed. Primary endpoint was the prevalence of general anesthesia use. We used two definitions of general anesthesia: L008 code only (insurance definition) and combination of the L008 code with muscle relaxant use (clinical definition). The general anesthesia claim cohort (L008) included 10,972 cesarean deliveries at 1111 institutions from 2005 to 2020. Muscle relaxants were used in 27.3% of L008 claims cases. The rate of general anesthesia use for cesarean delivery ranged from 3.9% in clinical definition to 14.4% in insurance definition of all cesarean deliveries. We observed a temporal trend of gradual decrease in general anesthesia use, regardless of its definition (p for trend < 0.001). We recommend the clinical definition of general anesthesia as the combination of L008 code and muscle relaxant use in a claims-based approach.

Anesthesia management in a pregnant patient with neurofibromatosis

Neurofibromatosis (NF) is a genetic and multisystemic disease with autosomal dominant transition. It can affect anesthesia applications by affecting more than one system. In the presence of neurofibromas in the airway, it can cause airway obstruction and difficulties in respiratory delivery during general anesthesia. The presence of tumors affecting the central nervous system makes spinal anesthesia risky. Anesthesiologists should act with awareness of each multisystemic complication when evaluating and managing patients. This case report aims to present our general anesthesia practice in an elective cesarean operation in a pregnant patient with neurofibromatosis type 1.

Postoperative Residual Curarization in Difficult Environment for the Practice of General Anesthesia: Inventory of the Yaounde/Essos Hospital Center

Postoperative Residual Curarization in Difficult Environment for the Practice of General Anesthesia: Inventory of the Yaounde/Essos Hospital Center

Effect of Head Rotation on Efficiency of Face Mask Ventilation among Apnoeic Patients: A Cross-sectional Study

Introduction: Respiratory function is crucial in the practice of anaesthesia. An in depth understanding of respiratory physiology is a must because it aids in the proper execution of daily general anaesthesia practice. Head and body postures have long been known to affect the patency of the upper airway. Head extension and a lateral recumbent position help to clear the upper airway. Head rotation is known to expand the upper airway’s cross-sectional area. Aim: To determine the effect of head rotation on efficiency of face mask ventilation among apnoeic patients, by measuring expiratory tidal volume. Materials and Methods: This cross-sectional study was conducted in the Department of Anaesthesiology at Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from May 2021 to November 2021. Total 40 patients belonging to the age group of 20 to 40 years, American Society of Anaesthesiologists’ (ASA) class I and II, undergoing surgeries requiring general anaesthesia with endotracheal intubation, were selected as study subjects. They were administered inj. fentanyl at a dose of 1 to 2 μg/kg, inj.propofol at a dose of 1 to 2 mg/kg, and inj.vecuronium bromide (0.08 to 0.1 mg/kg). Patients were mask ventilated with pressurecontrolled ventilation, for a total of 3 minutes, during which they were ventilated in a neutral head position for 90 seconds and then rotated for another 90 seconds. Following induction, the expiratory tidal volume was measured every 30 seconds in both postures Software used was Statistical Package for Social Sciences for windows (SPSS Inc., Chicago, IL, USA), version 17.0. A p-value &lt;0.05 was considered statistically significant. Results: The mean age of patients was 48±8.3 years. The 45° head rotation was beneficial to all patients, the mean expiratory tidal volume was 423±62.5 mL in the rotated head position compared to 397±52.5 mL in the neutral head position (p-value=0.045). It was also observed that some individuals profited more than others. Patients with airway obstruction, for example, had a greater VTE at 45° head rotation than in a neutral head position. Conclusion: The most notable conclusion is that in apnoeic adult patients, a 45° head rotation showed a significant enhancement in VTE when compared to a neutral position ofthe head.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

Nalbuphine versus dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation: A randomised double blind comparative study

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation.After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), &amp; Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p&amp;#60;0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after intubation. Both group N and group D showed no significant increase in mean HR at any time point compared to baseline values. There was no significant increase in mean SBP at any time interval in both the groups when compared to baseline. There was a significant increase (p&amp;#60;0.001) in mean DBP and MAP at the time of intubation in group N whereas no significant increase in mean DBP, and MAP was observed in group D at any time point.Dexmedetomidine was found to be more effective in attenuating haemodynamic response to laryngoscopy and intubation as compared to nalbuphine.

Desflurane consumption with automated vapour control systems in two different anaesthesia machines. A randomized controlled study.

In general anaesthesia practice a fresh gas flow (FGF) of ≥0.5L/min is usually applied. Automated gas delivery devices are developed to reduce volatile anaesthetic consumption by limiting gas flow. This study aimed to compare desflurane consumption between automated gas control devices compared to conventional low flow anaesthesia in the Flow-I and Aisys anaesthesia machines, and to compare desflurane consumption between the two automated gas delivery devices. We hypothesised that desflurane consumption would be lower with automated gas delivery compared to conventional low flow anaesthesia, and that desflurane consumption could differ between the different gas delivery devices. We allocated 160 patients undergoing robot-assisted laparoscopic surgery into four groups, Flow-I with automated gas control, Flow-i with conventional low-flow(1 L/min), Aisys with end tidal gas control and Aisys with conventional low flow. Patients were maintained at minimum alveolar concentration (MAC) 0.7-0.8. Desflurane consumption was recorded after 9, 30 and 60minutes of anaesthesia. After 60minutes, compared to conventional low flow anaesthesia, automated gas delivery systems reduced desflurane consumption from 25.8 to 15.2mL for the Aisys machine (P<.001) and from 22.1 to 16.8mL for the Flow-I (P<.001). Time to MAC 0.7 and stable FGF was shorter with Aisys endtidal control compared to Flow-I automated gas control. Under clinical conditions, we found a reduction in desflurane consumption when using automated gas delivery devices compared to conventional low flow anaesthesia. Both devices were reliable in use.

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study.

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%).

Procedural sedation in ambulatory anaesthesia: what's new?

Although sedation traditionally has been regarded as an easy, straight forward and simple variety of general anaesthesia; the trends are to make sedation more sophisticated and dedicated. Also to have a critical look at old dogmas, as they are usually derived from the practice of general anaesthesia. Safety always has to be first priority, especially as the practice grows out of traditional theatres and frequently are being practiced by nonanaesthetic personnel. Safety comes from learning of rare cases with severe problems as well as better guidelines and rules of accreditation. Further, there is a growing quest for evidence on pragmatic, high-quality, cost-effective practice; in terms of logistics, monitoring, choice of drugs and quality assurance. The traditional drugs, such as propofol, midazolam and remifentanil, are still defending their dominant position but are being challenged by ketamine and etomidate. Remimazolam and dexmedetomidine are new promising drugs in this area, whereas metoxyflurane may have a revival in some situations. Further, there is growing evidence into specific protocols, practice for special procedures and for patients with special challenges. Procedural sedation deserves to have high degree of attention for further developments, both from a scientific and pragmatic point of view, as the practice is very diversified and growing.

Multimodal General Anesthesia: Theory and Practice.

Balanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. While opioids are the most effective antinociceptive agents, they have undesirable side effects. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Under these approaches, called “multimodal general anesthesia,” the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries.

Train-of-four guard-controlled sugammadex reversal in patients with multiple sclerosis.

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating autoimmune disease of the central nervous system. It is known that the disease, which is manifested by a wide variety of symptoms, may exacerbate after anesthesia and show different responses to muscle relaxants in the normal population. It is planned to measure train-of-four (TOF) values of MS patients to be operated under general anesthesia before sugammadex application. With the approval of the local ethics committee of the University of Health Sciences Bagcilar Training and Research Hospital and with written consents of participants, we anesthetized ten patients (from April 2014 to March 2017) with MS and ten American Society of Anesthesiologists I-III patients without MS. Neuromuscular conduction was assessed by the acceleromyometric method using a TOF-Guard apparatus (Organon, Holland). The patients were extubated after recovery of TOF higher than 0.9. The primary efficacy variable was the time from the start of administration of sugammadex to recovery of the TOF ratio to 0.9. The demographic characteristics of both groups, the type and duration of surgery and anesthesia applied, and the temperature of the operation room were similar. Similar characteristics of both groups were of concern for postoperative residual paralysis, and therefore we did not notice any difference between time to TOF> 90/s for both groups. Sugammadex and TOF patients will increase patient safety in general anesthesia practice.

Laparoscopic appendicectomy under spinal anesthesia, a cost effective and efficient approach

Introduction: Appendicitis is common surgical emergency in developing countries. One out of every 2000 people has an appendicectomy sometime during their lifetime. It can be done by open method or by laparoscopic method. Open method leads to long hospital stay and more chances of infection. On the other hand laparoscopy has advantage of shorter hospital stay, less pain and better cosmetic results. Objective: Laparoscopic appendicectomy can be done under general anaesthesia or spinal anaesthesia. General anaesthesia is costly and has its own complication. Use of spinal anesthesia is increasing day by day for laparoscopic procedure because of cost effectiveness and less complication rate, appendicectomy is common procedure which is perform laparoscopically in our set up. Objective of this study was to evaluate feasibility of laparoscopic appendicectomy under spinal anaesthesia. Method: This prospective observational study was conducted in Bundelkhand Medical College Hospital from August 2015 to March 2017. We have chosen 50 patients of laparoscopic appendicectomy (LA) for our study. All patients were explained about appendicectomy and spinal anaesthesia in detail. We prefer spinal anaesthesia (SA) over general anaesthesia (GA) despite of common practice of general anaesthesia for all laparoscopy. All were given injection midazolam, pentazocin and ketamine (MPK) after spinal anaesthesia but before pneumoperitonium. Result: None of them were required to convert to general anaethsesia with endotracheal intubation or open surgery. All tolerated the procedure well. Conclusion: So it can be concluded that it is cost effective and efficient approach

Uso de la anestesia total intravenosa en Colombia: encuesta nacional dirigida a anestesiólogos activos en Colombia

IntroductionThe use of total intravenous anaesthesia (TIVA) has been growing worldwide over the past 20years due to the creation of new drugs and the development of new target-controlled infusion pumps, many of which have already been approved in the United States by the FDA (Food and Drugs Administration), in Europe and in Colombia. However, the use of TIVA has not been expanded yet as part of routine practice. ObjectiveTo determine the frequency of TIVA use in our country and to identify existing barriers for its implementation. Materials and MethodsSurvey designed to determine the use of TIVA in general anaesthesia practice in Colombia. A representative random sample of the universe of anaesthetists registered in the database of the Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.) was calculated. Reminders were sent by e-mail and some of the selected respondents were contacted by phone. ResultsOverall, 141 (32.4%) responses were obtained. The frequency of TIVA use was reported as Always, 7 (5.0%), Almost Always, 52 (36.9%), Hardly Ever, 57 (40.4%) and Never, 25 (17.7%). The technology used for TIVA administration included macro drip devices (n=30; 21.3%), volumetric pumps (n=76; 53.9%), TCI pumps (n=45; 31,9%), and computer programs (n=9; 6.4%). The limitations identified for the use of TIVA included low availability of anaesthesia depth monitoring (n=68; 48.2%) and infusion pumps (n=52; 36.9%), lack of experience (n=41; 29.1%), little availability of workshops (n=26; 18.4%), low availability of medications (n=23; 16.3%), fear of intra-operative recall (n=22; 15.6%), limited knowledge of pharmacology (n=18; 12.8%), increased anaesthesia time (n=13; 9.2%), and perceived difficulty for performing the technique (n=13; 9.2%). ConclusionsThe use of TIVA has been limited by the low availability of technology, lack of experience or knowledge among anaesthetists, and a preference for the balanced anaesthesia technique. Many anaesthesiologists prefer balanced techniques for general anaesthesia. Some devices used for TIVA administration raise concerns about patient safety.

Use of total intravenous anaesthesia in Colombia: A national survey among active anaesthetists in Colombia

IntroductionThe use of total intravenous anaesthesia (TIVA) has been growing worldwide over the past 20 years due to the creation of new drugs and the development of new target-controlled infusion pumps, many of which have already been approved in the United States by the FDA (Food and Drugs Administration), in Europe and in Colombia. However, the use of TIVA has not been expanded yet as part of routine practice. ObjectiveTo determine the frequency of TIVA use in our country and to identify existing barriers for its implementation. Materials and methodsSurvey designed to determine the use of TIVA in general anaesthesia practice in Colombia. A representative random sample of the universe of anaesthetists registered in the database of the Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.) was calculated. Reminders were sent by e-mail and some of the selected respondents were contacted by phone. ResultsOverall, 141 (32.4%) responses were obtained. The frequency of TIVA use was reported as Always, 7 (5.0%), Almost Always, 52 (36.9%), Hardly Ever, 57 (40.4%) and Never, 25 (17.7%). The techology used for TIVA administration included macro drip devices (n=30, 21.3%), volumetric pumps (n=76, 53.9%), TCI pumps (n=45, 31.9%), and computer programmes (n=9, 6.4%). The limitations identified for the use of TIVA included low availability of anaesthesia depth monitoring (n=68, 48.2%) and infusion pumps (n=52, 36.9%), lack of experience (n=41, 29.1%), little availability of workshops (n=26, 18.4%), low availability of medications (n=23, 16.3%), fear of intra-operative recall (n=22, 15.6%), limited knowledge of pharmacology (n=18, 12.8%), increased anaesthesia time (n=13, 9.2%), and perceived difficulty for performing the technique (n=13, 9.2%). ConclusionsThe use of TIVA has been limited by the low availability of technology, lack of experience or knowledge among anaesthetists, and a preference for the balanced anaesthesia technique. Many anaesthesiologists prefer balanced techniques for general anaesthesia. Some devices used for TIVA administration raise concerns about patient safety.

The future of general anaesthesia in obstetrics

### Key points Until the 1950s, anaesthesia for Caesarean section was performed using an open breathing system with gauze and ether or chloroform. By the mid-1950s, the use of tubocurarine to facilitate tracheal intubation had become common practice. Succinylcholine then became popular because its rapid onset of action avoided some of the dangers associated with the delay in intubating the trachea when tubocurarine was used alone.1 In 1959, thiopental was used for induction of general anaesthesia in obstetrics as part of a technique based only on thiopental, succinylcholine, nitrous oxide, and oxygen (i.e. without the addition of a volatile agent). Cricoid pressure was introduced in 1961, and in 1970, the traditional rapid sequence induction (RSI) was described and halothane was used for maintenance of anaesthesia, alongside nitrous oxide. Apart from the introduction of new volatile agents, there has been almost no change in the practice of general anaesthesia in obstetrics since this time.2 It is well established that central neuraxial block is the gold standard technique for obstetric anaesthesia and understandably this has been the focus of research into improvements in quality and safety. However, in 2014, two major reports were published that call into question certain aspects of modern practice of general anaesthesia in obstetrics: the Fifth National Audit Project (NAP5) which investigated accidental awareness during general anaesthesia (AAGA),3 and the Report on Confidential Enquiries into Maternal Deaths (MBRRACE-UK report).4 General anaesthesia …

Preeclampsia in 2017: Obstetric and Anaesthesia Management.

In many centres, anaesthesia now incorporates perioperative medicine. Preeclampsia is a perioperative medical challenge requiring a multi-disciplinary team. New definitions stress the rapid progression of the disease and highlight the importance of early detection. Anaesthesiologists should understand the pathophysiology of the disease and develop the ultrasound skills required to assist in the assessment of disease severity. This facilitates the choice of anaesthesia method and perioperative management in complicated cases. Regional anaesthesia remains central, but there are important developments in the practice of general anaesthesia, if indicated. Appropriate haemodynamic monitoring should be established. Anaesthesiologists should also lead the resuscitation team in the management of cardiorespiratory failure and coagulopathy.

Ifdas Meeting is Coming Up

Ifdas Meeting is Coming Up