Opioid-free Anesthesia: Time to Regain Our Balance

Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.

Download Full-text

Assessment of risk factors for postoperative cognitive dysfunction after coronary artery bypass surgery: a single-center retrospective cohort study

Bioscience Reports ◽

10.1042/bsr20190719 ◽

2021 ◽

Vol 41 (2) ◽

Author(s):

Yongtao Sun ◽

Hai Feng ◽

Ting Zou ◽

Ming Hou ◽

Yanwu Jin ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Carotid Artery ◽

Coronary Artery Bypass ◽

Cognitive Dysfunction ◽

Carotid Artery Stenosis ◽

Artery Bypass ◽

Postoperative Cognitive Dysfunction ◽

Aortic Plaque ◽

Anesthesia Time

Abstract Aim: To find out risk factors for postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG), and to provide basis for clinical prevention of POCD. A total of 88 patients who underwent CABG were surveyed with Telephone Questionnaire (TICS-M) for their cognitive impairment after 3, 7, 21, 90, 180 days post-surgery. The occurrence of POCD was diagnosed by Neuropsychological Battery which included Vocabular Learning Test (VLT), Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and Symbol Digit Modalities Test (SDMT). The preoperative, intraoperative and postoperative risk factors were assessed by the χ2 or t test. Multivariate analysis was used to study the correlation between the risk factors and the occurrence of POCD. Age, aortic plaque, carotid artery stenosis, cerebrovascular disease, anesthesia time, the rate of decline in intraoperative hemoglobin concentration (ΔHb) and systemic inflammatory response syndrome (SIRS) score on postoperative day 2 had statistically significant (P<0.05) influence on the occurrence of POCD. Aortic plaque, carotid artery stenosis, anesthesia time and SIRS score (odds ratio (OR) value > 1, P<0.05) are the risk factors for POCD. The incidence of day-21 and -180 POCD was approximately 26.1 and 22.7%, respectively.

Download Full-text

First in Man Pilot Feasibility Study in Extracranial Carotid Robotic-Assisted Endovascular Intervention

Neurosurgery ◽

10.1093/neuros/nyaa461 ◽

2020 ◽

Cited By ~ 1

Author(s):

Virendra R Desai ◽

Jonathan J Lee ◽

Trevis Sample ◽

Neal S Kleiman ◽

Alan Lumsden ◽

...

Keyword(s):

Endovascular Intervention ◽

Inclusion Criteria ◽

Robotic Technology ◽

Robotic Assisted ◽

Diagnostic Angiography ◽

Fluoroscopic Time ◽

Carotid Circulation ◽

Anesthesia Time ◽

Pilot Feasibility Study ◽

Clinical Deficits

Abstract BACKGROUND Robotic-assistance in endovascular intervention represents a nascent yet promising innovation. OBJECTIVE To present the first human experience utilizing robotic-assisted angiography in the extracranial carotid circulation. METHODS Between March 2019 and September 2019, patients with extracranial carotid circulation pathology presenting to Houston Methodist Hospital were enrolled. RESULTS A total of 6 patients met inclusion criteria: 5 underwent diagnostic angiography only with robotic-assisted catheter manipulation, while 1 underwent both diagnostic followed by delayed therapeutic intervention. Mean age was 51 +/− 17.5 yr. Mean anesthesia time was 158.7 +/− 37.9 min, mean fluoroscopic time was 22.0 +/− 7.3 min, and mean radiation dose was 815.0 +/− 517.0 mGy. There were no technical complications and no clinical deficits postprocedure. None of the cases required conversion to manual neurovascular intervention (NVI). CONCLUSION Incorporating robotic technology in NVI can enhance procedural technique and diminish occupational hazards. Its application in the coronary and peripheral vascular settings has established safety and efficacy, but in the neurovascular setting, this has yet to be demonstrated. This study presents the first in human feasibility experience of robotic-assisted NVI in the extracranial carotid circulation.

Download Full-text

Metastability of Neuronal Dynamics during General Anesthesia: Time for a Change in Our Assumptions?

Frontiers in Neural Circuits ◽

10.3389/fncir.2017.00058 ◽

2017 ◽

Vol 11 ◽

Cited By ~ 15

Author(s):

Andrew E. Hudson

Keyword(s):

General Anesthesia ◽

Neuronal Dynamics ◽

Anesthesia Time

Download Full-text

C.07 Door to decompression should be the benchmark in trauma craniotomies

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.73 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S12-S13

Author(s):

J Marcoux ◽

D Bracco

Keyword(s):

Emergency Department ◽

System Performance ◽

Trauma System ◽

Surgical Time ◽

Delivery Of Care ◽

Surgical Positioning ◽

Anesthesia Time ◽

The Brain ◽

Decompression Time

Background: Quality control indicators for mass lesion in TBI use the delay between emergency department (ED) and OR arrival to measure quality of care. It does not provide the timing of brain decompression. The goals of this study are to observe step by step where delays occur from hospital admission until effective decompression of the brain. Methods: A prospective observational data collection of timing from ED admission to decompression was conducted for all emergency trauma craniotomies over a period of 15 months. Results: Sixty-five patients were included. Doing a CT at the outside institution instead of transferring the patient prior to CT resulted in a 112min delay in care. Neurosurgery team notification prior to patient’s arrival to ED shortened delivery of care by 51min. The time elapsed between OR arrival and brain decompression was 50min: anesthesia time 3min, surgical positioning/preparation 29min and surgical time 17min. Burrhole decompression followed by craniotomy (9min) shortened the decompression time by 17min compared to standard 4 holes craniotomy approach (26min). Conclusions: Benchmark for trauma system performance in emergency craniotomies should be door to decompression time. Bypassing CT in local hospitals, pre-alerting neurosurgeons, and burrhole decompression followed by standard craniotomy significantly decrease door to decompression time.

Download Full-text

Residual Neuromuscular Blockade in Critical Care

Critical Care Nurse ◽

10.4037/ccn2012107 ◽

2012 ◽

Vol 32 (3) ◽

pp. e1-e10 ◽

Cited By ~ 4

Author(s):

Jason Wilson ◽

Angela S. Collins ◽

Brea O. Rowan

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Critical Care ◽

Intensive Care ◽

Neuromuscular Blockade ◽

Upper Airway ◽

Surgical Interventions ◽

Residual Neuromuscular Blockade ◽

Factors Affecting ◽

Anesthesia Time

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

Download Full-text

Is quicker better? A NSQIP analysis of anesthesia time and complications following tracheostomy placement

The American Journal of Surgery ◽

10.1016/j.amjsurg.2018.07.059 ◽

2018 ◽

Vol 216 (4) ◽

pp. 805-808 ◽

Cited By ~ 1

Author(s):

Monica C. Azmy ◽

Amy P. Bansal ◽

Candice Yip ◽

Evelyne Kalyoussef

Keyword(s):

Anesthesia Time

Download Full-text

Comparison of Fentanyl, Remifentanil, Sufentanil and Alfentanil in Combination with Propofol for General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Current Clinical Pharmacology ◽

10.2174/1567201816666190313160438 ◽

2019 ◽

Vol 14 (2) ◽

pp. 116-124 ◽

Cited By ~ 2

Author(s):

Kannan Sridharan ◽

Gowri Sivaramakrishnan

Keyword(s):

Systematic Review ◽

General Anesthesia ◽

Outcome Measures ◽

Randomized Clinical Trials ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Opioid Analgesics ◽

Effect Estimate ◽

Eye Opening ◽

Anesthesia Time

Background: Opioid analgesics are commonly used along with propofol during general anesthesia. Due to the dearth of data on the quality of anesthesia achieved with this combination, the present meta-analysis was carried out. Methods: Electronic databases were searched for appropriate studies using a suitable search strategy. Randomized clinical trials comparing the combination of remifentanil/sufentanil/alfentanil with propofol with fentanyl and propofol, were included. The outcome measures were as follows: total propofol dose to achieve the desired general anesthesia; time of onset and duration of general anesthesia; depth of general anesthesia; and recovery time (time for eye-opening and time taken for extubation). Risk of bias was assessed and Forest plots were generated for eligible outcomes. The weighted mean difference [95% confidence intervals] was used as the effect estimate. Results: Fourteen studies were included in the systematic review and 13 were included in the metaanalysis. Statistically significant differences were observed for remifentanil in comparison to fentanyl when combined with propofol: Propofol dose (in mg) -76.18 [-94.72, -57.64]; time of onset of anesthesia (min) -0.44 [-0.74, -0.15]; time taken for eye-opening (min) -3.95 [-4.8, -3.1]; and time for extubation (min) -3.53 [-4.37, -2.7]. No significant differences were observed for either sufentanil or alfentanil about the dose of propofol required and due to scanty data, pooling of the data could not be attempted for other outcome measures for either sufentanil or alfentanil. Conclusion: To conclude, we found that remifentanil has a statistically significant anesthetic profile than fentanyl when combined with propofol. Scanty evidence for both alfentanil and sufentanil precludes any such confirmation.

Download Full-text

A mouthpiece face mask for the exercising dog

Journal of Applied Physiology ◽

10.1152/jappl.1988.64.5.2240 ◽

1988 ◽

Vol 64 (5) ◽

pp. 2240-2244 ◽

Cited By ~ 12

Author(s):

J. Ampil ◽

J. I. Carlin ◽

R. L. Johnson

Keyword(s):

Cardiac Output ◽

Lung Volume ◽

Dead Space ◽

Face Mask ◽

Diffusing Capacity ◽

Lung Volumes ◽

Fabrication Procedure ◽

Time Required ◽

Anesthesia Time ◽

Rebreathing Method

To develop a rebreathing method for lung volumes, cardiac output with acetylene, and CO diffusing capacity in awake exercising dogs, we have modified and adapted the low-dead-space mask of Montefusco et al. (Angiology 34: 340–354, 1983). We have simplified the fabrication procedure, allowing the physiologist to make the device from parts that can be prefabricated before each dog is custom fitted with the mouthpiece. This decreases the anesthesia time required to custom fit the mouthpiece to each dog. We have also reduced the weight of the mask, making it more tolerable during exercise. We have validated that the mask is leak-free by having the dog rebreathe an inert insoluble gas, He, until equilibration is achieved between the bag and lung. Preliminary measurements of lung volume, cardiac output with acetylene, and CO diffusing capacity have been made during exercise.

Download Full-text