Absence of Bronchodilation during Desflurane Anesthesia

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.)

Download Full-text

Risk factors for postoperative spinal infection: A retrospective analysis of 5065 cases

Surgical Neurology International ◽

10.25259/sni-284-2019 ◽

2019 ◽

Vol 10 ◽

pp. 121

Author(s):

Matt El-Kadi ◽

Erin Donovan ◽

Laurel Kerr ◽

Coby Cunningham ◽

Victor Osio ◽

...

Keyword(s):

Diabetes Mellitus ◽

Infection Rate ◽

Immunosuppressive Drugs ◽

Smoking History ◽

History Of ◽

American Society ◽

American Society Of Anesthesiologists ◽

Record Review ◽

Subsequent Introduction ◽

Retrospective Medical Record Review

Background: Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism. Methods: Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk. Results: The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time. Conclusions: Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.

Download Full-text

Anesthesia Prevents Auditory Perceptual Learning

Anesthesiology ◽

10.1097/01.anes.0000363310.19041.90 ◽

2009 ◽

Vol 111 (5) ◽

pp. 1010-1015 ◽

Cited By ~ 1

Author(s):

Kristoffer C. Aberg ◽

Eric Albrecht ◽

Elisa M. Tartaglia ◽

Alain Farron ◽

Patrice Soom ◽

...

Keyword(s):

General Anesthesia ◽

Perceptual Learning ◽

Bispectral Index ◽

Elective Surgery ◽

Frequency Discrimination ◽

Auditory Stimulation ◽

Pure Tones ◽

American Society ◽

Index Level ◽

American Society Of Anesthesiologists

Background An auditory perceptual learning paradigm was used to investigate whether implicit memories are formed during general anesthesia. Methods Eighty-seven patients who had an American Society of Anesthesiologists physical status of I-III and were scheduled to undergo an elective surgery with general anesthesia were randomly assigned to one of two groups. One group received auditory stimulation during surgery, whereas the other did not. The auditory stimulation consisted of pure tones presented via headphones. The Bispectral Index level was maintained between 40 and 50 during surgery. To assess learning, patients performed an auditory frequency discrimination task after surgery, and comparisons were made between the groups. General anesthesia was induced with thiopental and maintained with a mixture of fentanyl and sevoflurane. Results There was no difference in the amount of learning between the two groups (mean +/- SD improvement: stimulated patients 9.2 +/- 11.3 Hz, controls 9.4 +/- 14.1 Hz). There was also no difference in initial thresholds (mean +/- SD initial thresholds: stimulated patients 31.1 +/- 33.4 Hz, controls 28.4 +/- 34.2 Hz). These results suggest that perceptual learning was not induced during anesthesia. No correlation between the bispectral index and the initial level of performance was found (Pearson r = -0.09, P = 0.59). Conclusion Perceptual learning was not induced by repetitive auditory stimulation during anesthesia. This result may indicate that perceptual learning requires top-down processing, which is suppressed by the anesthetic.

Download Full-text

Awareness during Anesthesia

Anesthesiology ◽

10.1097/00000542-199904000-00019 ◽

1999 ◽

Vol 90 (4) ◽

pp. 1053-1061 ◽

Cited By ~ 204

Author(s):

Karen B. Domino ◽

Karen L. Posner ◽

Robert A. Caplan ◽

Frederick W. Cheney

Keyword(s):

General Anesthesia ◽

Elective Surgery ◽

Anesthetic Techniques ◽

Post Traumatic Stress ◽

Intraoperative Awareness ◽

Malpractice Claims ◽

Depth Analysis ◽

American Society ◽

Closed Claims ◽

American Society Of Anesthesiologists

Background Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. Methods The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. Results Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P < 0.001). Claims for recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). Conclusions Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia were more likely in women and with nitrous-narcotic-relaxant techniques.

Download Full-text

Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

Medical Sciences ◽

10.3390/medsci9020021 ◽

2021 ◽

Vol 9 (2) ◽

pp. 21

Author(s):

Cyrus Motamed ◽

Migena Demiri ◽

Nora Colegrave

Keyword(s):

Neuromuscular Blockade ◽

Lower Limit ◽

Elective Surgery ◽

Orotracheal Intubation ◽

Neuromuscular Blocking ◽

Physical Status Classification ◽

Train Of Four ◽

Surgery First ◽

American Society ◽

American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

Download Full-text

Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

10.21203/rs.3.rs-29085/v1 ◽

2020 ◽

Author(s):

Atef Mohamed Sayed Mahmoud ◽

Joseph Makram Botros ◽

Safaa Gaber Ragab

Keyword(s):

General Anesthesia ◽

Polycystic Ovary ◽

Controlled Trial ◽

Controlled Study ◽

Double Blind ◽

Randomized Controlled ◽

Airway Response ◽

American Society ◽

American Society Of Anesthesiologists ◽

Better Than

Abstract Background the outcome of ketofol on the hemodynamics and the airway response during induction of general anesthesia has been studied before. Its effect on smoothness of extubation has not been studied before. So, we aimed to assess the effect of ketofol on the smoothness of extubation and compare it with propofol only for induction of general anesthesia. Methods This double-blind, randomized, and controlled study was conducted on one hundred and six American Society of Anesthesiologists Physical status ''ASA PS'' class I and II female patients aged 18–40 years old and scheduled for laparoscopic drilling for polycystic ovary disease under general anesthesia. The patients were assigned into one of two groups (53) patients each; group KP = ketofol and group P = propofol. Results There was good sedation score during suction and extubation in the ketofol group. Airway response and smoothness of extubation were better in the ketofol group better than the propofol group. Conclusion Ketofol as an induction anesthetic agent was effective in attenuating the airway response during extubation more than profofol only. Trial registration: This trial was retrospectively registered at the Clinical Trial.gov with the Identification Number: NCT04365686.

Download Full-text

Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

SAGE Open Medicine ◽

10.1177/2050312118756804 ◽

2018 ◽

Vol 6 ◽

pp. 205031211875680 ◽

Cited By ~ 2

Author(s):

Takashi Suzuki ◽

Ryota Inokuchi ◽

Kazuo Hanaoka ◽

Machi Suka ◽

Hiroyuki Yanagisawa

Keyword(s):

Retrospective Study ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Anesthesia Care ◽

Low Back ◽

Monitored Anesthesia Care ◽

History Of ◽

American Society ◽

American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

Download Full-text

Intraoperative anaphylaxis

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v5i2.24013 ◽

2018 ◽

Vol 5 (2) ◽

pp. 62-65

Author(s):

Sujita Manandhar

Keyword(s):

Standard Protocol ◽

Recurrent Tonsillitis ◽

Upper Eyelid ◽

Anesthetic Agents ◽

Anesthetic Drugs ◽

Eyelid Swelling ◽

History Of ◽

Facial Area ◽

American Society ◽

American Society Of Anesthesiologists

A 24 years lady was scheduled for tonsillectomy for recurrent tonsillitis had anaphylaxis and asystole before extubation, she was revived successfully.She had no known history of allergy and exposure to anesthetic agents and was classified as an American Society of Anesthesiologists, ASA I. In the operating theatre, her baseline vitals were unremarkable and remained hemodynamically stable on receiving antibiotic and anesthetic drugs. The anesthetic course remained uneventful throughout the surgery. Upon removal of surgical drapes, upper eyelid swelling was noted, that rapidly progressed to facial area within minutes, and she developed cardiac arrest which was managed with standard protocol and resuscitated successfully.

Download Full-text

Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

Acta Médica Portuguesa ◽

10.20344/amp.10592 ◽

2019 ◽

Vol 32 (1) ◽

pp. 53

Author(s):

Luís Guilherme Casimiro ◽

Sara Marisa Pereira ◽

Sofia Cardoso Pires ◽

Joana Mourão

Keyword(s):

Informed Consent ◽

Elective Surgery ◽

University Hospital ◽

Anesthetic Technique ◽

Patient Relationship ◽

Active Process ◽

Legal Principles ◽

American Society ◽

American Society Of Anesthesiologists ◽

Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

Download Full-text

Obstetric Anesthesia Work Force Survey, 1981 versus 1992

Anesthesiology ◽

10.1097/00000542-199707000-00018 ◽

1997 ◽

Vol 87 (1) ◽

pp. 135-143 ◽

Cited By ~ 154

Author(s):

Joy L. Hawkins ◽

Charles P. Gibbs ◽

Miriam Orleans ◽

Gallice Martin-Salvaj ◽

Brenda Beaty

Keyword(s):

Cesarean Section ◽

Epidural Analgesia ◽

General Anesthesia ◽

Obstetric Anesthesia ◽

The United States ◽

Nurse Anesthetists ◽

Regional Analgesia ◽

American Hospital ◽

American Society ◽

American Society Of Anesthesiologists

Background In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. Methods Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. Results Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. Conclusions Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.

Download Full-text

The Combitube in Elective Surgery

Anesthesiology ◽

10.1097/00000542-200101000-00016 ◽

2001 ◽

Vol 94 (1) ◽

pp. 79-82 ◽

Cited By ~ 49

Author(s):

Luis A. Gaitini ◽

Sonia J. Vaida ◽

Somri Mostafa ◽

Boris Yanovski ◽

Milian Croitoru ◽

...

Keyword(s):

Elective Surgery ◽

Airway Device ◽

Spontaneous Ventilation ◽

Mechanically Ventilated ◽

Entire Duration ◽

Duration Of Surgery ◽

American Society ◽

End Tidal ◽

American Society Of Anesthesiologists ◽

Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

Download Full-text