Neuraxial Anesthesia and Analgesia for Pediatric Surgery

2018 ◽  
Author(s):  
Heather Ballard ◽  
Ravi Shah ◽  
Santhanam Suresh
Keyword(s):  
General Anesthesia ◽  
Postoperative Analgesia ◽  
Pediatric Surgery ◽  
Volatile Anesthetics ◽  
Neuraxial Anesthesia ◽  
Single Shot ◽  
Long Term Effects ◽  
History Of ◽  
History Of Use ◽  
Upper Abdomen

Neuraxial anesthesia has a long history of use in pediatric surgery. It can be used as a sole anesthetic or as an adjunct to sedation or general anesthesia. Neonatal spinals and single-shot caudal anesthesia are effective for lower abdominal, urological, and lower extremity orthopedic surgeries. When a thoracic, lumbar, or caudal epidural catheter is utilized, postoperative analgesia can also be provided to surgeries involving the chest and upper abdomen. There is renewed interest in neuraxial anesthesia due to concerns of the effect of volatile anesthetics on the developing brain. Though research studies on the long-term effects of volatile anesthetics are still inconclusive, neuraxial anesthesia has been shown to provide effective surgical anesthesia and postoperative analgesia. When used in combination with general anesthesia, it has the benefit of reducing the amount of sedatives required. The use of ultrasound may increase success and margin of safety.

scholarly journals Anesthetic Management of a Patient With a History of Rhabdomyolysis for Dental Treatment

2017 ◽  
Vol 64 (4) ◽  
pp. 251-252
Author(s):  
Hitomi Terasaki ◽  
Shinichi Ito
Keyword(s):  
Nitrous Oxide ◽  
General Anesthesia ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Fluid Management ◽  
Volatile Anesthetics ◽  
Electrolyte Balance ◽  
Rocuronium Bromide ◽  
History Of ◽  
Thiamylal Sodium

When general anesthesia is administered for patients considered at high risk for rhabdomyolysis, appropriate precautions are warranted. The use of suitable anesthetics, with attention to intravenous fluid management, electrolyte balance, respiration, and metabolism, should be addressed. We performed general anesthesia for dental treatment and biopsy for fibrous hyperplasia of the buccal mucosa in a patient with a history of rhabdomyolysis. We utilized thiamylal sodium, midazolam, rocuronium bromide, nitrous oxide, fentanyl, and remifentanil without using volatile anesthetics and propofol for this case. No complications of rhabdomyolysis were noted.

Absence of Bronchodilation during Desflurane Anesthesia

2000 ◽  
Vol 93 (2) ◽  
pp. 404-408 ◽  
Author(s):  
Mitchell J. Goff ◽  
Shahbaz R. Arain ◽  
David J. Ficke ◽  
Toni D. Uhrich ◽  
Thomas J. Ebert
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Volatile Anesthetics ◽  
Smoking History ◽  
Respiratory Resistance ◽  
Volatile Anesthesia ◽  
History Of ◽  
Respiratory System Resistance ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Bronchospasm is a potential complication in anyone undergoing general anesthesia. Because volatile anesthetics relax bronchial smooth muscle, the effects of two newer volatile anesthetics, desflurane and sevoflurane, on respiratory resistance were evaluated. The authors hypothesized that desflurane would have greater bronchodilating effects because of its ability to increase sympathetic nervous system activity. Methods Informed consent was obtained from patients undergoing elective surgery with general anesthesia. We recorded airway flow and pressure after thiopental induction and tracheal intubation (baseline) and for 10 min after beginning volatile anesthesia ( approximately 1 minimum alveolar concentration inspired). Respiratory system resistance was determined using the isovolume technique. Results Fifty subjects were randomized to receive sevoflurane (n = 20), desflurane (n = 20), or thiopental infusion (n = 10, 0.25 mg. kg-1. h-1). There were no differences between groups for age, height, weight, smoking history, and American Society of Anesthesiologists physical class. On average, sevoflurane reduced respiratory resistance 15% below baseline, whereas both desflurane (+5%) and thiopental (+10%) did not decrease respiratory resistance. The respiratory resistance changes did not differ in patients with and without a history of smoking during sevoflurane or thiopental. In contrast, administration of desflurane to smokers resulted in the greatest increase in respiratory resistance. Conclusions Sevoflurane causes moderate bronchodilation that is not observed with desflurane or sodium thiopental. The bronchoconstriction produced by desflurane was primarily noted in patients who currently smoked. (Key words: Bronchospasm; respiratory resistance; volatile anesthetics.)

scholarly journals Jojoba Oil: An Updated Comprehensive Review on Chemistry, Pharmaceutical Uses, and Toxicity

Polymers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 1711
Author(s):  
Heba A. Gad ◽  
Autumn Roberts ◽  
Samirah H. Hamzi ◽  
Haidy A. Gad ◽  
Ilham Touiss ◽  
...  
Keyword(s):  
Industrial Applications ◽  
Literature Survey ◽  
Jojoba Oil ◽  
Pharmacological Activities ◽  
Wide Range ◽  
Liver Functions ◽  
History Of ◽  
History Of Use ◽  
Pharmaceutical Uses ◽  
Obesity And Cancer

Jojoba is a widely used medicinal plant that is cultivated worldwide. Its seeds and oil have a long history of use in folklore to treat various ailments, such as skin and scalp disorders, superficial wounds, sore throat, obesity, and cancer; for improvement of liver functions, enhancement of immunity, and promotion of hair growth. Extensive studies on Jojoba oil showed a wide range of pharmacological applications, including antioxidant, anti-acne and antipsoriasis, anti-inflammatory, antifungal, antipyretic, analgesic, antimicrobial, and anti-hyperglycemia activities. In addition, Jojoba oil is widely used in the pharmaceutical industry, especially in cosmetics for topical, transdermal, and parenteral preparations. Jojoba oil also holds value in the industry as an anti-rodent, insecticides, lubricant, surfactant, and a source for the production of bioenergy. Jojoba oil is considered among the top-ranked oils due to its wax, which constitutes about 98% (mainly wax esters, few free fatty acids, alcohols, and hydrocarbons). In addition, sterols and vitamins with few triglyceride esters, flavonoids, phenolic and cyanogenic compounds are also present. The present review represents an updated literature survey about the chemical composition of jojoba oil, its physical properties, pharmacological activities, pharmaceutical and industrial applications, and toxicity.

scholarly journals Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

2021 ◽  
pp. 014556132110331
Author(s):  
Yong Won Lee ◽  
Bum Sik Kim ◽  
Jihyun Chung
Keyword(s):  
General Anesthesia ◽  
Incidence Rate ◽  
Urinary Retention ◽  
Nasal Surgery ◽  
Prostate Hyperplasia ◽  
Postoperative Urinary Retention ◽  
Asa Classification ◽  
History Of ◽  
Male Patients ◽  
Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

scholarly journals Excessive dynamic airway collapse during general anesthesia: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shunichi Murakami ◽  
Shunsuke Tsuruta ◽  
Kazuyoshi Ishida ◽  
Atsuo Yamashita ◽  
Mishiya Matsumoto
Keyword(s):  
General Anesthesia ◽  
Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Computed Tomography Scan ◽  
Case Presentation ◽  
Airway Lumen ◽  
Asthma Attack ◽  
Airway Collapse ◽  
History Of ◽  
Tomography Scan

Abstract Background Excessive dynamic airway collapse (EDAC) is an uncommon cause of high airway pressure during mechanical ventilation. However, EDAC is not widely recognized by anesthesiologists, and therefore, it is often misdiagnosed as asthma. Case presentation A 70-year-old woman with a history of asthma received anesthesia with sevoflurane for a laparotomic cholecystectomy. Under general anesthesia, she developed wheezing, high inspiratory pressure, and a shark-fin waveform on capnography, which was interpreted as an asthma attack. However, treatment with a bronchodilator was ineffective. Bronchoscopy revealed the collapse of the trachea and main bronchi upon expiration. We reviewed the preoperative computed tomography scan and saw bulging of the posterior membrane into the airway lumen, leading to a diagnosis of EDAC. Conclusions Although both EDAC and bronchospasm present as similar symptoms, the treatments are different. Bronchoscopy proved useful for distinguishing between these two entities. Positive end-expiratory pressure should be applied and bronchodilators avoided in EDAC.

scholarly journals The Botanical, Chemical and Ethnobotanical Diversity of Southern African Lamiaceae

Molecules ◽  
2021 ◽  
Vol 26 (12) ◽  
pp. 3712
Author(s):  
Ryan D. Rattray ◽  
Ben-Erik Van Wyk
Keyword(s):  
Southern Africa ◽  
Folk Medicine ◽  
Taxonomic Diversity ◽  
Volatile Oils ◽  
Edible Plant ◽  
Flora Of Southern Africa ◽  
Traditional Uses ◽  
History Of ◽  
Pharmaceutical Industries ◽  
History Of Use

The Lamiaceae is undoubtedly an important plant family, having a rich history of use that spans the globe with many species being used in folk medicine and modern industries alike. Their ability to produce aromatic volatile oils has made them valuable sources of materials in the cosmetic, culinary, and pharmaceutical industries. A thorough account of the taxonomic diversity, chemistry and ethnobotany is lacking for southern African Lamiaceae, which feature some of the region’s most notable medicinal and edible plant species. We provide a comprehensive insight into the Lamiaceae flora of southern Africa, comprising 297 species in 42 genera, 105 of which are endemic to the subcontinent. We further explore the medicinal and traditional uses, where all genera with documented uses are covered for the region. A broad review of the chemistry of southern African Lamiaceae is presented, noting that only 101 species (34%) have been investigated chemically (either their volatile oils or phytochemical characterization of secondary metabolites), thus presenting many and varied opportunities for further studies. The main aim of our study was therefore to present an up-to-date account of the botany, chemistry and traditional uses of the family in southern Africa, and to identify obvious knowledge gaps.

scholarly journals Nanomedicine Reformulation of Chloroquine and Hydroxychloroquine

Molecules ◽  
2020 ◽  
Vol 26 (1) ◽  
pp. 175
Author(s):  
David M. Stevens ◽  
Rachael M. Crist ◽  
Stephan T. Stern
Keyword(s):  
Safety Evaluation ◽  
Therapeutic Index ◽  
Short Term ◽  
Tissue Concentrations ◽  
History Of ◽  
History Of Use ◽  
Novel Applications ◽  
Therapeutic Doses ◽  
Extensive Clinical Experience ◽  
Higher Doses

The chloroquine family of antimalarials has a long history of use, spanning many decades. Despite this extensive clinical experience, novel applications, including use in autoimmune disorders, infectious disease, and cancer, have only recently been identified. While short term use of chloroquine or hydroxychloroquine is safe at traditional therapeutic doses in patients without predisposing conditions, administration of higher doses and for longer durations are associated with toxicity, including retinotoxicity. Additional liabilities of these medications include pharmacokinetic profiles that require extended dosing to achieve therapeutic tissue concentrations. To improve chloroquine therapy, researchers have turned toward nanomedicine reformulation of chloroquine and hydroxychloroquine to increase exposure of target tissues relative to off-target tissues, thereby improving the therapeutic index. This review highlights these reformulation efforts to date, identifying issues in experimental designs leading to ambiguity regarding the nanoformulation improvements and lack of thorough pharmacokinetics and safety evaluation. Gaps in our current understanding of these formulations, as well as recommendations for future formulation efforts, are presented.

scholarly journals Clinical Study of Postoperative Bleeding after Tonsillectomy in 497 Cases

2021 ◽  
Vol 4 (01) ◽  
pp. e17-e20
Author(s):  
Takeshi Tanaka ◽  
Kenji Ishii ◽  
Kyoko Matsumoto ◽  
Koushirou Miura ◽  
Ayako Kihara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Clinical Study ◽  
General Anesthesia ◽  
Retrospective Analysis ◽  
Body Mass ◽  
Smoking Habit ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
History Of

AbstractWe conducted a retrospective analysis of 497 patients who underwent tonsillectomy at Kamio Memorial Hospital from September 2015 to August 2018. A total of 35 cases (7.0%) developed postoperative bleeding and three cases (0.6%) needed a second operation under general anesthesia to stop the bleeding. Postoperative bleeding most frequently occurred between 24 hours and 6 days after the operation. The incidence of postoperative bleeding was significantly higher in males and in patients aged 20 to 39 years old. The operation time, body mass index, smoking habit, and history of hypertension were not identified as clinical risk factors for bleeding after tonsillectomy in this study.

scholarly journals Aquaculture Production of the Brown Seaweeds Laminaria digitata and Macrocystis pyrifera: Applications in Food and Pharmaceuticals

Molecules ◽  
2021 ◽  
Vol 26 (5) ◽  
pp. 1306
Author(s):  
Diane Purcell-Meyerink ◽  
Michael A. Packer ◽  
Thomas T. Wheeler ◽  
Maria Hayes
Keyword(s):  
Dietary Supplements ◽  
Functional Foods ◽  
Folk Medicine ◽  
Macrocystis Pyrifera ◽  
Fish Feed ◽  
Laminaria Digitata ◽  
Brown Seaweeds ◽  
Commercial Potential ◽  
History Of ◽  
History Of Use

Seaweeds have a long history of use as food, as flavouring agents, and find use in traditional folk medicine. Seaweed products range from food, feed, and dietary supplements to pharmaceuticals, and from bioenergy intermediates to materials. At present, 98% of the seaweed required by the seaweed industry is provided by five genera and only ten species. The two brown kelp seaweeds Laminaria digitata, a native Irish species, and Macrocystis pyrifera, a native New Zealand species, are not included in these eleven species, although they have been used as dietary supplements and as animal and fish feed. The properties associated with the polysaccharides and proteins from these two species have resulted in increased interest in them, enabling their use as functional foods. Improvements and optimisations in aquaculture methods and bioproduct extractions are essential to realise the commercial potential of these seaweeds. Recent advances in optimising these processes are outlined in this review, as well as potential future applications of L. digitata and, to a greater extent, M. pyrifera which, to date, has been predominately only wild-harvested. These include bio-refinery processing to produce ingredients for nutricosmetics, functional foods, cosmeceuticals, and bioplastics. Areas that currently limit the commercial potential of these two species are highlighted.

scholarly journals Temperature Monitoring and Perioperative Thermoregulation

2008 ◽  
Vol 109 (2) ◽  
pp. 318-338 ◽  
Author(s):  
Daniel I. Sessler ◽  
David S. Warner ◽  
Mark A. Warner
Keyword(s):  
Body Temperature ◽  
General Anesthesia ◽  
Core Temperature ◽  
Core Body Temperature ◽  
Neuraxial Anesthesia ◽  
General Anesthetics ◽  
The Core ◽  
Core Body ◽  
Dose Dependent ◽  
Body Heat

Most clinically available thermometers accurately report the temperature of whatever tissue is being measured. The difficulty is that no reliably core-temperature-measuring sites are completely noninvasive and easy to use-especially in patients not undergoing general anesthesia. Nonetheless, temperature can be reliably measured in most patients. Body temperature should be measured in patients undergoing general anesthesia exceeding 30 min in duration and in patients undergoing major operations during neuraxial anesthesia. Core body temperature is normally tightly regulated. All general anesthetics produce a profound dose-dependent reduction in the core temperature, triggering cold defenses, including arteriovenous shunt vasoconstriction and shivering. Anesthetic-induced impairment of normal thermoregulatory control, with the resulting core-to-peripheral redistribution of body heat, is the primary cause of hypothermia in most patients. Neuraxial anesthesia also impairs thermoregulatory control, although to a lesser extent than does general anesthesia. Prolonged epidural analgesia is associated with hyperthermia whose cause remains unknown.

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