Anaesthetic Problems Research Articles

Guidelines for Scrutiny of Death Associated With Surgery and Anesthesia.

The death of a patient in the operating room frequently causes great distress to the patient's family, and the surgical team members who performed the procedure typically feel uneasy about it afterward. Anesthetic death is characterized as a death that happens 24 hours after anesthesia is administered and is caused by anesthetic-related factors. However, death can come much later because of its complications. This review thoroughly explains mortality resulting from surgery and anesthesia, including autopsy reports, investigative data, analytical techniques, and conclusions. Following surgery and anesthesia-related death,in case of death after surgery, an autopsy determines the cause of death and if the procedure had any impact on it. Individuals who pass away during or after surgery may do so for a wide range of reasons, such as a generally natural condition, an early or late surgical complication, an anesthetic problem, or an error during the operation or anesthesia. The pathologist should take the results of the examination into account while looking into an anesthetic death. In the majority of anesthesia-related deaths, autopsies reveal little diagnostic informationwith the absence of an underlying cause of death. The analyses help determine and estimate the dosage of medication given, as well as the amount of anesthetic agent overdose provided before death. The best consensus opinion to provide the investigative authorities and courts of law for the cause of death investigation may come from a discussion amongst forensic pathologists, surgeons, and anesthetists. In conclusion, the family and friends of the deceased are greatly affected by an unexpected or unexplained death, and the organizations entrusted with determining the cause of death bear a great deal of responsibility. Science and technology are becoming more and more important in death investigations. Following precise and well-founded procedures is one of the science's defining characteristics.

Exhaled Anesthetic Xenon Regeneration by Gas Separation Using a Metal-Organic Framework with Sorbent-Sorbate Induced-Fit.

Noble gas xenon (Xe) is an excellent anesthetic gas, but its rarity, high cost and constrained production prohibits wide use in medicine. Here, we have developed a closed-circuit anesthetic Xe recovery and reusage process with highly effective CO2-specific adsorbent CUPMOF-5 that is promising to solve the anesthetic Xe supply problem. CUPMOF-5 possesses spacious cage cavities interconnected in four directions by confinement throat apertures of ~3.4 Å, which makes it an ideal molecular sieving of CO2 from Xe, O2, N2 with the benchmark selectivity and high uptake capacity of CO2. In situ single-crystal X-ray diffraction (SCXRD) and computational simulation solidly revealed the vital sieving role of the confined throat and the sorbent-sorbate induced-fit strengthening binding interaction to CO2. CUPMOF-5 can remove 5 % CO2 even from actual moist exhaled anesthetic gases, and achieves the highest Xe recovery rate (99.8 %) so far, as verified by breakthrough experiments. This endows CUPMOF-5 great potential for the on-line CO2 removal and Xe recovery from anesthetic closed-circuits.

Exhaled Anesthetic Xenon Regeneration by Gas Separation Using a Metal–Organic Framework with Sorbent‐Sorbate Induced‐Fit

AbstractNoble gas xenon (Xe) is an excellent anesthetic gas, but its rarity, high cost and constrained production prohibits wide use in medicine. Here, we have developed a closed‐circuit anesthetic Xe recovery and reusage process with highly effective CO2‐specific adsorbent CUPMOF‐5 that is promising to solve the anesthetic Xe supply problem. CUPMOF‐5 possesses spacious cage cavities interconnected in four directions by confinement throat apertures of ~3.4 Å, which makes it an ideal molecular sieving of CO2 from Xe, O2, N2 with the benchmark selectivity and high uptake capacity of CO2. In situ single‐crystal X‐ray diffraction (SCXRD) and computational simulation solidly revealed the vital sieving role of the confined throat and the sorbent‐sorbate induced‐fit strengthening binding interaction to CO2. CUPMOF‐5 can remove 5 % CO2 even from actual moist exhaled anesthetic gases, and achieves the highest Xe recovery rate (99.8 %) so far, as verified by breakthrough experiments. This endows CUPMOF‐5 great potential for the on‐line CO2 removal and Xe recovery from anesthetic closed‐circuits.

The role of anesthesiology in modern cardiac surgery: overview of key techniques and issues

Anesthesiology plays a key role in modern cardiac surgery, ensuring the safe conduct of surgical interventions on the heart and blood vessels. The paper provides an overview of the main techniques and problems in the field of anesthesiology in cardiac surgery. The first section is devoted to the basic methods of anesthesiological provision of cardiac surgery. He describes the various types of anesthesia used in cardiac surgery, including general anesthesia, epidural and spinal anesthesia, as well as combined methods. The advantages and disadvantages of each of them are considered, as well as the specifics of their application, depending on the type of operation and the patient’s condition. The second section examines the key problems faced by anesthesiologists in cardiac surgery. This includes managing hemodynamic parameters during surgery, monitoring heart and respiratory function, ensuring adequate analgesia, and preventing possible complications such as myocardial ischemia, arrhythmias, hypothermia, and thromboembolic events. Special attention is paid to solving problems related to patients with concomitant diseases such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease, etc. The article discusses the features of the use of cardiothoracic anesthesia in cardiac surgery, as well as emerging problems and prospects in this area. An overview of the use of anesthesia in the field of cardiac surgery is presented, both current challenges and problems in this area are highlighted. The current state of anesthesia in cardiac surgery is analyzed and a number of problems faced by anesthesiologists during cardiac surgery, including problems of cardiothoracic anesthesia, are highlighted. This includes difficulties with controlling the depth of anesthesia, ensuring safety while maintaining artificial circulation, managing fluid balance, and monitoring cardiac function during surgery. The article reveals the relevance and importance of the work of anesthesiologists in cardiac surgery and the problems they face, as well as reveals the prospects for the development of anesthesia in cardiac surgery. This work will help anesthesiologists and cardiac surgeons better understand the specifics of anesthesiological care in cardiac surgery and effectively solve emerging problems, ensuring maximum safety and comfort for patients.

An evaluation of wet and dry needling techniques for treating myofascial pain in trapezius muscle – A meta-analysis

Abstract Introduction: Myofascial pain is a common sign of temporomandibular joint disorders and a significant cause of dysfunction in the general population. Although there are many ways to treat it, because of their ease of use and effectiveness in reducing pain, needling therapies, particularly those inside the masticatory muscles, have seen a recent surge in attention. Aim: The aim of the study was to evaluate the comparison between wet and dry needling therapies in myofascial pain management. Materials and Methods: The following study was built using the PICOS and Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols. A comprehensive search of the literature utilizing the PubMed search engines with the keywords acupuncture, dry needling, wet needling, botulinum toxin, local anesthesia, and masticatory muscle problems was done. A total of 412 items were found after searching the databases. Finally, the analysis contained 21 publications that met the parameters. Results: A statistically significant (P < 0.001) impact on pain reduction was seen by this meta-analysis when comparing wet versus dry needling (mean difference = 0.80, 95% confidence interval = −0.52–2.12, n¼ 7 trials). Discussion: The effectiveness of wet and dry needling in treating symptoms of neck discomfort with musculoskeletal origins related to TrPs was compared in this meta-analysis. We found strong evidence that lidocaine, a local anesthetic, used in wet needling reduced pain more effectively than dry needling. Conclusion: Evidence from this meta-analysis suggests that in individuals with trigger points (TrPs) associated with symptoms of neck discomfort, lidocaine TrP injection works better than dry needling to reduce pain.

Implementation of a robotic surgical practice in inflammatory bowel disease.

Robotics adoption has increased in colorectal surgery. While there are well-established advantages and standardised techniques for cancer patients, the use of robotic surgery in inflammatory bowel disease (IBD) has not been studied yet. To evaluate the feasibility and safety of robotic surgery for IBD patients. Prospectively data in IBD patients having robotic resection at Guy's and St Thomas' hospital. All resections performed by a single colorectal surgeon specialised in IBD, utilising DaVinci platform. July 2021 to January 2023, 59 robotic IBD cases performed, 14 ulcerative colitis (UC) and 45 Crohn's disease (CD). Average age; CD patients 35, UC 33years. Average Body mass index (BMI); 23 for CD and 26.9 for UC patients. In total, we performed 31 ileo-caecal resections (ICR) with primary anastomosis (18 Kono-S anastomosis, 6 mechanical anastomosis and 7 ileo-colostomy), of those 4 had multivisceral resections (large bowel, bladder, ovary). Furthermore, 14 subtotal colectomy (1 emergency), 8 proctectomy, 3 panproctocolectomy and 3 ileoanal J pouch. 18 of the 45 patients (45.0%) with Crohn's disease had ongoing fistulating disease to other parts of the GI tract (small or large bowel). ICR were performed using different three ports position, depending on the anatomy established prior to surgery with magnetic resonance images (MRI). One patient had conversion to open due to anaesthetic problems and one patient required re-operation to refashion stoma. 98.0% cases completed robotically. Median Length of hospital stay (LOS) was 7days for CD and 7 for UC cases, including LOS in patients on pre-operative parenteral nutrition. Robotic colorectal techniques can be safely used for patients with IBD, even with fistulating disease. Future research and collaborations are necessary to standardize technique within institutions.

The problem of anesthesia of regional society (on the example of the Republic of Mordovia)

Target: the aim is to identify the factors contributing to the involvement of the population of the Republic of Mordovia in drug use.Materials and methods. The study was conducted among residents of the Republic of Mordovia aged 14 to 60 years. Here we used a multi-stage sampling with quota selection of respondents at the last stage. A two-stage cluster analysis was applied to determine the factors of population involvement in drug use.Results. The study showed that the population is aware of the seriousness of the problem of drug addiction in the country. However, other questions require priority resolution at the respondent’s place of residence.The article compares the indicators of the spread of non-medical drug use according to official medical statistics and the results of sociological research. There is a discrepancy between the values of the prevalence of non-medical drug use according to the data of the Ministry of Health of the Republic of Mordovia and the data of sociological studies. According to the study, the proportion of the population of Mordovia who consume drugs is 0,7%. The main factors of involvement in drug use were the social environment, the influence of the Internet, and the availability of narcotic drugs.Conclusion. According to the analysis, two clusters are identified. The first one forms the majority (90%) of the inhabitants of Mordovia. It includes those who have not received offers to try drugs, do not use the Internet to get information about drugs and who do not have drug users in their social environment. The second cluster (10%) included respondents who received an offer to try drugs, who were familiar with drug users and resorted to the Internet for drug information. The socio-demographic characteristics of the second cluster differ from the general sample, men prevail here, and the population in the age ranges from 21 to 25 years, 26–30 years and 31–35 years.

Aspects and Problems of Local Anesthesia in Older Patients: State of the Question

Dental care is one of the types of medical care most demanded by various age groups of patients. In the process of human aging, pathological and dystrophic changes develop in all organs and tissues, including the tissues of the maxillofacial region, which increases the need for patients to contact various specialists. Older and oldest-old often have several chronic somatic diseases and age-related mental characteristics, for the treatment of which several groups of drugs are used simultaneously. In geriatric dentistry, anesthesia should be applied taking into account polypharmacy, somatic and cognitive health. When deciding on a dosing regimen and assessing the risks of local anesthesia, it is important to consider not only the length of each visit to the dentist but also the total number of visits required to achieve dental health.

Empirical determination of the degree of analgesic activity of some new 3-aminothieno[2,3-b]pyridines and 1,4-dihydropyridines based on a complex criterion

Introduction: It is revelant to solve the problem of anesthesia based on the research of new highly effective and safe medicines. Among modern studies, the preparation of heterocyclic compounds starting from cyanothioacetamide with analgesic and anti-inflammatory activities is of considerable interest. Materials and Methods: болевой синдром Results: It is shown that all the studied 1,4-dihydropyridines and condensed thieno[2,3-b]pyridines and reveal analgesic activity of varying degrees of severity, based on the values of the criterion Anat. Discussion: It was found that the most pronounced analgesic activity was shown by three studied samples: compounds AZ-023, AZ-331 and AZ-383. The complex criterion of analgesic activity of Anat for animals receiving a sample AZ-023 was 50.1, exceeding the indicator in the comparison group by 42 times. The values of this criterion in animals that had received samples AZ-331 and AZ-383 were the highest, namely 64.3 and 68.4, which is 53 and 57 times higher than that of sodium metamizole, respectively. Conclusion: The obtained results and the advantage of the studied samples over the reference drug determine the expediency of further preclinical studies and a detailed study of their acute and chronic toxicity, as well as hepato-, nephro-, hemato- and gastrotoxicity. Graphical Abstract

MANAGEMENT OF PRE-ECLAMPSIA: ISSUES FOR ANAESTHETISTS

The role of anaesthetist for anaesthetic management for preeclamsia is very crucial. Anaesthetist's responsibility starts before the surgery at the moment of stabilizing patient's hemodynamic status and guiding to an obstetrician about administration of antihypertensives and seizure prophylaxis. The anaesthetic problems in these may be due to the effects on the cardiovascular, respiratory, neurologic, renal, haematologic, hepatic and uteroplacental systems. Labetolol, hydralazine, diazoxide and nifedipine is considered as the most common used drugs. Magnesium sulphate is the most effective agent for seizure prophylaxis. Platelet transfusion threshold is determined as 50000/mm3 in acutely bleeding patient. Cerebral haemorrhage remains the commonest cause of death in this group and hence rapid and effective treatment of hypertension to prevent haemorrhagic stroke is needed in these patients. As aetiology is largely unknown, preventative measures and screening tools are lacking and management is directed at the control of clinical manifestations. Delivery remains the only denitive treatment.

How maternal obesity affects pregnancy? - literature review

Introduction: Obesity is a well-known risk factor for many health problems. Recently, the increasing number of obese pregnant patients deserves our special attention, because maternal obesity is associated with numerous complications during the antepartum, intrapartum, and immediate postpartum stages of pregnancy. Purpose of the study: The aim of this study is to collect and summarize the latest views on maternal obesity in pregnancy and highlights the complications associated with it. Material and methods: Literature review was performed in English different databases, using keywords: morbid obesity, super-obesity, maternal obesity, pregnancy, complications. Results and conclusions: In our systematic review we would like to present the most important threats of obesity among pregnant women such as: cardiovascular, respiratory, endocrinology and gestational weight gain problems; pregnancy loss; fetal anomalies; anesthetic and delivery problems; breastfeeding disorders; problems with contraception and long-distant effects in a child's adult life. Therapeutic success of such a pregnancy should consist of the cooperation of many specialists. This phenomenon of maternal obesity will certainly spread in the future and for this reason - awareness of this problem is very important for both patients and physicians taking care of them.

A Review on the Anesthetic Management of Patients with Neuromuscular Diseases.

Neuromuscular diseases (NMDs) are regarded as a clinically and genetically heterogeneous group of diseases characterized by weakening muscle strength and dystrophic changes in the muscle. Due to the nature of these diseases, it can be challenging for anesthesiologists to provide appropriate pain medications, symptom management, and other necessary techniques that are implemented to anesthetize the patient properly. This study was based on the available literature and the authors' experience. The current study aimed to review the available anesthesia for patients suffering from NMDs. The search process resulted in the detection of relevant articles using valid keywords on electronic databases, including Embase, PubMed, Scopus, Web of Science, and Cochrane Library. Subsequently, 19 articles published between 2009 to 2022 were identified as eligible for this review. When anesthetizing a patient with NMD, special attention should be paid to preoperative evaluation, medical-history taking, risk of difficult intubation or cardiac incidents, respiratory insufficiency, and frequent pulmonary infections. It is also necessary to keep in mind that these patients are at risk of prolonged paralysis, hyperkalemia, rigidity, malignant hyperthermia, cardiac arrest, rhabdomyolysis, or even death. Problems of anesthesia in patients with NMDs arise from the nature of the condition itself and the interaction of anesthetics and muscle relaxants with anticholinesterase drugs used in therapy. Each patient's individual risk should be assessed before anesthesia. Therefore, it is important (and even necessary before major surgery) to perform a thorough preoperative examination to not only determine perioperative risk but also to ensure optimal perioperative follow-up.

A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing.

The aim of this review is to discuss recent developments in paediatric anaesthesia, which have evolved in an undulating fashion. The role and efficacy of pharmacological premedication is reevaluated. The anxiolytic and sedative properties of midazolam and α 2 -agonists have now been defined more precisely. Both classes of drugs have their unique profile, and there is no reason to condemn one or the other. Midazolam is an excellent anxiolytic, whereas dexmedetomidine is superior in the postoperative period and for sedation during diagnostic imaging.A total intravenous technique with propofol is often considered to be the standard for the prevention of emergence agitation; but alternatives do exist, such as a co-medication with dexmedetomidine or opioids. In clinical reality, a multimodal approach may often be advisable.The theoretical basis for propofol dosing has recently been adapted. In contrast to previous beliefs, the context-sensitive half-life of propofol seems to be quite short beyond the first year of life. Midazolam and dexmedetomidine are not interchangeable; each compound has its pros and cons. As an anxiolytic drug, midazolam indisputably deserves its place, whereas dexmedetomidine is a better sedative and particularly beneficial in the postoperative period. New data will allow more precise age-adapted dosing of propofol.

WHAT IS THE RELATIONSHIP BETWEEN A GYNECOLOGIST/OBSTETRICIAN AND THE AIRWAY?

Physiological changes in pregnancy as part of biohumoral and morphological changes (hyperemia, edema, hypersecretion) influence the possible problems in obstetric anesthesia. These changes by themselves, and particularly aggravated by acute or chronic gestational or non-gestational comorbidity, increase the risk of aspiration of gastric contents, failed intubation, esophageal intubation, inadequate ventilation, and respiratory failure. The types of premedication, anesthesia and techniques of anesthesia are evident from medical historiography. Almost obligatory promethazine and atropine was given intravenously either in the delivery room or on the operating table immediately before the induction of anesthesia in a dose of 0.5 mg in partuients of average body weight. Atropine has been a favorite premedicant for decades, given its pharmacological properties, especially its antisialogenic effect and absence of a depressant effect on the fetoplacental unit, but today it is rarely used. Nasal decongestants before surgery are not recommended but in cases of severe rhinitis, atropine, promethazine, or topical decongestants may be used.

Anaesthesia for caesarean section in a parturient with sjogren syndrome and scoping review

Sjogren syndrome is a slowly progressive autoimmune disease with lymphocytic infiltration of exocrine glands, peri-epithelial and extra-epithelial tissues. In light of better diagnostic modalities and improved treatment options, patients with Sjogren syndrome are now commonly encountered by anaesthetist for various surgeries. Here, we would like to describe an anaesthetic management of a parturient with bad obstetric history who was diagnosed with Sjogren syndrome and was planned for caesarean delivery. This article also reviewed anaesthetic problems faced due to inherent disease pathology and concurrent alterations in treatment modalities.

A cross-sectional survey on knowledge and attitudes of Greek dentists regarding molar incisor hypomineralisation diagnosis and treatment

BackgroundMolar Incisor Hypomineralisation (MIH) remains a challenge for clinicians underlining the gap in the literature regarding the condition. The study aimed to record knowledge and attitudes of Greek dentists regarding diagnosis and treatment of MIH and correlate findings with non-dental characteristics.MethodsIt is a cross-sectional study based on a questionnaire consisting of 37 multiple-choice questions. Data regarding diagnosis, aetiopathogenesis, and clinical management of MIH were collected from active members of three Greek Dental Associations. Chi-square and student’s t-test were used to correlate responses with practitioners’ characteristics and odds ratios calculated to evaluate differences on treatment of MIH-affected teeth (p < 0.05).ResultsFrom the 360 participants (response rate = 94%), 185 were general dental practitioners (GDPs) and 175 dental specialists (59 paediatric dentists (PDs), 38 orthodontists and 78 of other specialties).MIH was commonly encountered as a clinical problem, with GDPs reporting genetics and fluoride intake as common aetiological factors at significantly higher percentages as compared to PDs (p < 0.05). Permanent molars and incisors (44%) were the teeth most commonly affected, with yellow/brown demarcated opacities (68%) the most common clinical feature with PDs reporting them in a significantly higher percentage (p < 0.05). Dentists with specialisation, dentists that treat > 10 children per week and children with MIH-affected teeth had a 2–5.5 times greater probability to report difficulty achieving sufficient anaesthesia and hypersensitivity problems (p < 0.001). Agreement between GDPs’ and dental specialists’ views was found on less invasive treatment of anterior lesions. Non-PDs reported bulk-fill restorations and onlays as the ideal treatment of severely-affected posterior teeth, as compared to PDs that preferred preformed metal crowns (p < 0.05). Multivariate logistic regression analysis revealed that the age of the clinician, years of experience and number of children treated per week were the factors significantly associated with the decision for the treatment of only severely-affected posterior MIH teeth.ConclusionsMost participants had encountered MIH-affected teeth in their clinical practice and were able to recognize main aetiological factors and clinical findings related to the condition. Nevertheless, their knowledge regarding treatment is limited.

P-044 LEARNING AND DATA FROM OUR TEP LEARNING CURVE

Abstract Aim Laparoendoscopic techniques for inguinal repair (TEP) offers advantages such as less postoperatory pain, less local complication rates and early comeback to work activities. We describe the TEP learning curve in our unit and we present a preliminary analysis of our results. Material and Methods We present the retrospective analysis of patients who underwent TEP inguinal hernioplasty between 2018 and 2021 in a Wall Surgery Unit of Navarra Hospital. We perform a descriptive analysis of the collected data. Results 182 patients were analysed, including 91.6% male with an average age of 57.1 years. 11patients required conversion from TEP to another technique (mainly TAPP and open preperitoneal surgery) due to surgical or anesthetic problems, with a conversion rate of 6%. 4 patients (2%) presented early recurrence and 6 patients (3%) late recurrence. 16 patients (8.8%) had moderate pain (VAS &amp;lt; 5) while 7 patients (3.8%) had severe pain (VAS ≥5). All the patients who presented postoperative pain were reviewed and none presented postoperative neuralgia. No patient showed surgical site infection neither epididymitis. 4 patients (2%) presented seroma and 23 (12.6%) hematoma. Conclusions Laparoendoscopic techniques, especially TEP, has more demanding learning curve than open repairs. Support and tutoring are imperative in the first cases. An adequate selection of cases at the beginning is important. Mastering open preperitoneal hernioplasty surgery leads to better and faster results in TEP approach.

Surgery for Simple Anal Fistula under Local Anesthesia

Background: Infections of the anal glands, which drain into the anal crypts, account for more than 95% of all cases of anorectal abscess. Although fistula-in-ano is usually harmless, it can nonetheless cause severe pain and significantly impact patients' day-to-day lives. Even though most anorectal procedures are performed when the patient is under general or regional anesthesia, there is mounting proof that these procedures can be done safely and effectively in an outpatient setting using only local anesthesia. All procedures in the current investigation were performed with local anesthesia, specifically, 2% lidocaine and 0.5 % bupivacaine. Place and Duration of study: Departments of General Surgery, HMC Peshawar and Nishtar Hospital, Multan for the duration of six months from June 2021 to November 2021. Method: Including the time needed to inject the anesthetic, the typical surgical procedure lasted around 26 minutes. No patient reported more than a 7 on a visual analogue scale for pain on the day of surgery, or the first postoperative day. In most cases, patients spend around two days in the hospital. Results: Including the time needed to inject the anesthetic, the typical surgical procedure lasted around 26 minutes. No patient reported more than a 7 on a visual analogue scale for pain on the day of surgery, the day of surgery, or the first postoperative day. In most cases, patients spend around two days in the hospital. Conclusion: With early ambulation, good tolerability, and fewer anaesthetic problems, local fistula in- ano repair anesthesia is a safe and effective option. In-Ano Fistula, VAS, and Local Anesthetics are some of the terms that will be discussed.

Perioperative Management of Tonsillectomy in Pediatrics with Tetralogy of Fallot

Introduction. Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that includes ventricular septal defect, aortic overriding, infundibular stenosis, and Right Ventricle Hypertrophy (RVH). Perioperative management includes preoperative management, intraoperative anesthesia, and post-operative and potential problem management.&#x0D; Case presentation. We report a -8-year-old-girl with congenital heart disease TOF planned for tonsillectomy and adenoidectomy. The patient weighs 18 kilograms, has a blood pressure of 96/55 mmHg, pulse rate of 104 times per minute, respiratory rate 24 times per minute, and oxygen saturation of 74-79% supine position with room air. We find ejection systolic murmur at SIC 4/6 left parasternal and clubbing fingers-on physical examination. Laboratory preoperation shown Hb value 22.9; Hct : 70; AL : 11.2; AT : 281; AE : 8.58. We pre-medicate with ondansetron, dexamethasone, and sedation in the transit room with ketamine and midazolam. Induction by fentanyl and rocuronium to facilitate endotracheal intubation. Postoperatively, the patient was transferred to the PICU with an ET in a tube. She is monitored for a post-operative complications such as active bleeding to hyper cyanotic and performed extubation less than 24 hours after surgery.&#x0D; Conclusion. Anesthetic goals in this patient are to maintain or slightly increase the Systemic Vascular Resistance, minimize Pulmonary Vascular Resistance dan provide mild cardiac depression.

Opioid free anesthesia for facial cosmetic surgery with Friedberg’s Triad

: Elective facial cosmetic surgery specifically excludes medically indicated procedures like cleft palate repair and burn reconstruction. Cosmetic procedures have been performed with opioid free anesthesia (OFA) guided by the principles of Friedberg’s Triad, namely (I) measure the brain; (II) preempt the pain; (III) emetic drugs abstain. Persistent anesthesia problems like postoperative pain and postoperative nausea and vomiting (PONV) are virtually eliminated with OFA. Processed EEG level of sedation provides reproducible numerical values. Cortical measurement with the bispectral (BISTM) index monitor and secondary, real-time electromyogram (EMG) trending differentiates purposeful versus non-purposeful sedation movement. EMG spikes define incipient arousal. Non-purposeful movement is defined when propofol is titrated to BIS <75 and no EMG spike. Providing adequate analgesia with intravenous (IV) sedation demands re-injection with non-purposeful movement despite evidence of vasoconstriction from the initial injection. After two re-injections after the initial should additional ketamine be administered to eliminate non-purposeful movement. The contest of wills between ‘too light’ and ‘needs more local’ has an objective resolution. Patient satisfaction along with cost-effective care are values that suggest Friedberg’s Triad guided OFA is an acceptable alternative approach.