Progress In Anesthesia Research Articles

Recent advances in anaesthesia for abdominal solid organ transplantation.

Organ transplantation has undergone remarkable revolution in the last two decades and offers a scope for survival amongst patients with end-stage organ failure. Along with availability of advanced surgical equipment and haemodynamic monitors, minimally invasive surgical techniques have emerged as options for surgery both amongst the donors and recipients. Newer trends in haemodynamic monitoring and expertise in ultrasound guided fascial plane blocks have changed the management in both donors and recipients. The availability of factor concentrates and point-of-care tests for coagulation have allowed optimal and restrictive fluid management of patients. Newer immunosuppressive agents are useful in minimising rejection following transplantation. Concepts on enhanced recovery after surgery have allowed early extubation, feeding and shorter hospital stay. This review gives an overview of the recent progress in anaesthesia for organ transplantation.

Optimal dose of dexmedetomidine retrobulbar anesthesia during phacoemulsification cataract surgery

Background:The cataract surgery anesthesia should be to make the procedure as safe and as satisfactory as possible for all concerned. The recent progress in anesthesia and surgery now allow cataract extraction to be done with minimal physiological changes to the patient. We aimed in the study to compare between two different doses of dexmedetomidine combined with lidocaine and bupivacaine during retrobulbar anesthesia for cataract extraction by phacoemulsification.Materials and Methods:This study was done on forty patients with cataract. The patients were enrolled in two groups: Group (A):Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.25 μg/kg of dexmedetomidine and Group (B): Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.5 μg/kg of dexmedetomidine.Results:The globe anesthesia duration, globe, and lid akinesia were significantly longer in the Group B than in the Group A (P < 0.05). Intraocular pressure decreased through the first 15 min after anesthesia in the two groups, and the changes were not significant between the two groups but highly significant in every group when compared to its baseline reading. As regards the conscious level in the two groups, there was a significant difference (P < 0.001). Group A is higher regarding score 2 and 3, and Group B higher in score 4.Conclusions:We concluded that dexmedetomidine 0.25 μg/kg, when added to retrobulbar block for cataract surgery, will significantly increase the duration of retrobulbar block and improve both the surgeon and the patient satisfaction.

Current status of surgical and anesthetic interventions in fetal life

The current advancements in fetal medicine are a celebration of human ingenuity and triumph. A realm that is both poignant and captivating, the possibilities born out of progress in anesthesia and minimal access surgical techniques in the fetal microcosm are huge. A number of strategic approaches, including fetoscopic interventions, minimally invasive surgeries, and ex utero intrapartum—the so-called EXIT—procedures have facilitated correction of a number of life-threatening fetal conditions and anomalies. However, the challenges and risks in performing in utero fetal anesthesia and surgical maneuvers are so considerable that still only a few tertiary healthcare facilities across the globe carry out these procedures.

Endocrinopathies: The current and changing perspectives in anesthesia practice.

The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer.

New progress in anesthesia for hematological disease patients

Blood system consists of blood and hematopoietic organs. There are various kinds of hematological diseases. In recent decades, as the rapid development of immunology, pathology, cytology and molecular genetics expanded methods and techniques in the research of hematology, we have vastly increased our understanding of these diseases. Since the treatments we used are becoming more effective, the patients have a higher life expectancy. Hematological diseases often result in functional or organic lesion of other organs, so the number of hematological disease patients with or without complications requiring surgeries has increased greatly. These diseases may bring trouble to the anesthetic management and choice, sometimes even threaten the patients' lfie. The perioperative management is especially important for the hematological disease patients requiring anesthesia. Key words: Hematological disease; Anesthesia; Progress

Traitement des cancers infiltrants non métastatiques de la vessie chez les patients âgés

Total cystectomy is the reference treatment for infiltrating nonmetastatic bladder cancers. With the progress in anesthesia and postoperative intensive care, this treatment can be applied to a population of elderly subjects provided there is a strict oncological and geriatric evaluation of the patient. Recent series reporting total cystectomies in subjects over 75 years of age report comparable morbidity and mortality rates to the general population. Strategies to preserve the vesical reservoir can be indicated in selected cases. Their objectives are to guarantee local control and follow-up identical to radical cystectomy, while preserving a functional bladder and good quality of life. The strategies including transurethral resection with radiochemotherapy are analyzed. Thus, with multidisciplinary consensus and adapted management, elderly patients with significant comorbidities should not be automatically excluded from access to effective treatment of these cancers.

Nahrungskarenz im Kreißsaal - Ein traditioneller Qualitätsstandard auf dem Prüfstand

Numerous scientific case reports and observational studies, including that of Curtis Mendelson with its great historical relevance, have reported the problem of aspiration pneumonitis during labour. Because of this, strict fasting prior to delivery to reduce pulmonary aspiration has been doctrine since the 1940s. However, maternal mortality from anaesthesia, particularly from aspiration, has dropped dramatically over recent decades. This is due both to far-reaching improved quality of care as well as technical progress in anaesthesia, which increasingly challenge the scientific basis for fasting in obstetric anaesthesia. Strict fasting has never been proven to reduce morbidity or mortality in labouring women. Because of the physiological and anatomical changes of pregnancy, gastric emptying is theoretically prolonged, and therefore the risk of aspiration is assumed to be increased. However, the available data with patients receiving clear fluids run contrary to this assumption, or at least dispute its clinical relevance. Recent studies report positive influence of reduced fasting time on both maternal comfort and maternal/fetal metabolism without increased risk. This has already led to meaningful discussion regarding a corresponding change in official recommendations.

Indications et résultats actuels de l’entéroplastie de substitution après cystectomie radicale

Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. Today, most patients can undergo substitution enteroplasty following cystectomy. Recto-colic urinary diversions and cutaneous ureterostomy are now uncommon. An ileal conduit (Bricker) may be proposed to patients with urethral involvement, as well as to elderly patients and to women who are at a high risk of severe urine leakage following enteroplasty. Thanks to progress in anesthesia, surgical techniques and intensive care, cystectomy with substitution enteroplasty is now a routine procedure. For localized bladder cancer (pT2N0M0 stage), this intervention is associated with a 10-year survival rate of about 80%. The mean length of stay in the intensive care unit varies between 1 and 7 days, and the mean total hospital stay ranges from 10 to 13 days. Early complications, which occur in less than 30% of cases, are mainly medical; the most common are cardiovascular complications, pulmonary embolism, disorientation and urinary tract and pulmonary infections. Late complications are less common and are mainly surgical; they include uretero-ileal stenoses (-10% of cases), uretero-ileal stenosis (4%), and intestinal obstruction (4%). Urinary and sexual disorders are frequent after radical cystectomy and substitution enteroplasty. Early postoperative incontinence occurs in more than 50% of cases but often responds to physiotherapy. In contrast, most male patients remain impotent. Simple transurethral resection of the prostate with cystectomy may be used instead of radical cystoprostatectomy in order to reduce the risks of incontinence and impotence, but this approach is controversial, as some authors have reported an increased risk of recurrence and metastasis.

Chirurgie esthétique et histoire

The history of aesthetic surgery is linked to that of the 20th century. The first operations allowed by the progress of anesthesia and asepsis are the correction of “proeminent ears” by Ely then rhinoplasty with endonasal incision by Roe. Considered by some as a precursor and a quack by others, C.C. Miller was the first surgeon to specialize and write books on the subject. Before world war I, aesthetic surgery was seldom practiced and publications were few. The war was at the origin of several units of maxillo-facial surgery created for the huge number of casualties with face trauma due to trench warfare. Many of those who will become great names in plastic surgery operated in these units: Blair, Davis, Léon Dufourmentel, Virenque, Morestin and Gillies. After the war, American surgeons were regrouped in scientific societies. Plastic surgery was privileged and aesthetic surgery was lifted for “quacks”. In France, several surgeons such as Suzanne Noël, Passot, Bourguet, Dartigues showed an important creativity and described several techniques that inspired recent ones. The Dujarier case discredited French aesthetic surgery but did not stop the creation of the first French Society of Plastic Surgery in 1930. World war II led to new orientations. In England, the East Grinstead center with Gillies and Mc Indoe during and after the war was at the origin of many vocations. After the war, many national and international societies of plastic surgery started to appear. The French Society of Plastic Surgery was born in 1952.

Surgical management of infiltrating bladder cancer in elderly patients.

To review the surgical therapeutic options in elderly patients with infiltrating bladder cancer. A review of the literature relevant to cystectomy and transurethral resection for infiltrating bladder cancer in elderly patients was conducted using Medline Services. Thanks to progress in anaesthesia, intensive care and surgery, cystectomy now forms part of the classical treatments for bladder cancer in elderly patients, with acceptable mortality and morbidity rates. The recent series of cystectomies performed in patients over 75 years old report a mortality rate associated with the procedure of less than 4.5%. The global mortality rate in the same population ranges from 10 to 50%. These rates are now similar to those reported in the general population. The mean survival after cystectomy in patients over 75 years old is more than 2 years. Global survival at 5 years is between 37 and 68%. It is acknowledged by most authors that resection alone is associated with higher relapse and progression rates than cystectomy. Cystectomy appears to be reasonable in elderly people who have a life expectancy of more than 2 years, provided that a rigorous pre-operative assessment and anaesthetic management are performed. Transurethral resection alone should be proposed only to patients with poor health status and/or very advanced age.

Computerized anaesthesia information management systems: are we on the threshold of widespread use?

Despite a recognition that they are essential for the future progress of anaesthesia, computerized anaesthesia information management systems are not in widespread use. In this article, relevant recent publications are summarized with a view to identifying the reasons for the current situation. Several developments which might promote the wider use of such systems in the near future are also presented.

Le phéochromocytome : particularités pédiatriques

Pheochromocytoma is a rare tumor in children which explains, together with its miscellaneous symptomatology, why the diagnosis may be delayed. The localization of the tumor(s) rests mainly on MIBG scintigraphy, and CT scan and/or magnetic resonance imaging. Thanks to a systematic preoperative treatment of hypertension and major progress in anesthesia, the operative mortality of pheochromocytomas in children is nowadays very low. Nevertheless two major problems remain: 1) the difficulty of diagnosing and treating the malignant forms, 2) the high frequency of recurrences, sometimes many years after the removal of the primary tumor. A regular long term supervision is therefore necessary after the surgical treatment.

Harold Griffith Memorial Lecture. The Griffith legacy.

1992 was the anniversary of Crawford Long's use of ether in 1842, and Griffith and Johnson's introduction of Intocostrin into anaesthetic practice in 1942. Harold Randall Griffith was born in Montreal in 1894 and died in 1985. He interrupted his medical studies to serve in the first world war and was awarded the Military Medal for gallantry at the battle of Vimy Ridge. Griffith qualified from McGill University in 1922. After spending a year studying homoeopathic medicine, he joined his father's general practice and became the anaesthetist to the Homoeopathic Hospital in Montreal. He succeeded his father as Medical Director of the hospital (now renamed the Queen Elizabeth Hospital) in 1936 and retired in 1966. Griffith was a superb clinical anaesthetist. He was an early advocate of detailed anaesthetic records, and was responsible for the introduction of both ethylene and cyclopropane into Canadian practice, later teaching himself to intubate under these two agents. Griffith was one of the first to be concerned with standards of patient care. He introduced postoperative recovery and intensive care units into Canadian practice and played a major role in postgraduate teaching. He was unstinting in his support of organisations designed to further the progress of anaesthesia and was the first President of the Canadian Anaesthetist's Society. He was one of those responsible for inaugurating the World Federation of Societies of Anaesthesiology and was President of the First World Congress of Anaesthesiology in 1955. It is remarkable that the introduction of curare into anaesthetic practice was delayed until 1942, since curare had been used in anaesthesia some 30 years previously. However, it was probably Griffith's confidence in his own clinical abilities which enabled him to seize the opportunity when it was offered.

Amplification of the sounds of respiration of anesthetized patients.

In administering general anesthetics three important indicators communicate to the anesthesiologist the minute-to-minute changes that occur in the unconscious patient. Pulse, blood pressure, and respiration are the primary factors, although size of the pupils, position of the eyeball, color of the blood and nail beds, skin temperature, diaphoresis, and muscular relaxation are also important in this physiological appraisal. The character of the respiration, its rate and depth, and the patency of the air passage are probably the most important of the signals on which the anesthesiologist depends for his analysis of the progress of anesthesia. It was felt that an amplification of these important signals would be of considerable aid to anesthesiologists and to nurses and physicians caring for comatose or semicomatose patients, inasmuch as it would warn of vomiting before it occurred; it would obviate the intermittent compression of the corrugated breathing tubes against the ear to detect a

Anesthesia in pediatric urology.

During the past two decades, significant advances have been made in pediatric urology. While many difficulties have been resolved, the problem of a satisfactory and optimum anesthetic management still remains a challenge to some. Thus, published reports on uropediatric anesthesia are meager, limited to a few pediatric centers, and controversial in many respects. 1 In an attempt to clarify this problem, an analysis was made of the pertinent literature and the clinical experiences in the anesthetic management for pediatric urology. A survey of the progress in anesthesia is of paramount importance to the urologist interested in pediatrics. It reveals several fundamental facts inadequately stressed and not fully appreciated clinically. To begin with, there is no ideal anesthetic agent and/or technique per se. All have their advantages, disadvantages, limitations, contraindications, and complications. Accordingly, for safe and optimum anesthesia, the anesthetic management for each operative procedure must be individualized. Secondly, there is

THE PROGRESS OF ANAESTHESIA

THE PROGRESS OF ANAESTHESIA