Comparison of Medical Adhesive Tapes in Patients at Risk of Facial Skin Trauma under Anesthesia

We report a case of endotracheal tube malfunction, in which the inner surface of the tube peeled off during anesthesia. The patient, a 7-year-old boy, was under general anesthesia for the treatment of multiple dental caries. The damaged tube could have caused respiratory failure, putting the patient's life at risk. We speculate that the use of nitrous oxide was one of the contributing factors to the inner wall detachment. Several additional lessons can be learned from this incident in order to prevent tube-related trouble during an operation.

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Delirium in Older Patients after Combined Epidural–General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial

Anesthesiology ◽

10.1097/aln.0000000000003834 ◽

2021 ◽

Author(s):

Ya-Wei Li ◽

Huai-Jin Li ◽

Hui-Juan Li ◽

Bin-Jiang Zhao ◽

Xiang-Yang Guo ◽

...

Keyword(s):

At Risk ◽

Relative Risk ◽

General Anesthesia ◽

Epidural Anesthesia ◽

Older Patients ◽

Postoperative Delirium ◽

Number Needed To Treat ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Patients At Risk

Background Delirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural–general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery. Methods Patients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural–general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days. Results Between November 2011 and May 2015, 1,802 patients were randomized to combined epidural–general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural–general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P < 0.001), and more epidural patients were given vasopressors (495 [58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P < 0.001). Conclusions Older patients randomized to combined epidural–general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Dysrhythmias under General Anesthesia and Their Management

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v5i3.1213 ◽

2019 ◽

Author(s):

Zahid Hussain Khan ◽

Ali Movafegh ◽

Hussain Kareem Abed Ali

Keyword(s):

At Risk ◽

General Anesthesia ◽

Cardiac Arrhythmias ◽

Drug Effects ◽

Cardiovascular Outcomes ◽

Patients At Risk ◽

Treatment Of Arrhythmias ◽

Careful History

Cardiac arrhythmias during anesthesia are common and almost benign, with the incidence ranging from 60 to 90%. Arrhythmias are one of several significant predictors for severe cardiovascular outcomes. It is essential, therefore, for the anesthetist to evaluate patients at risk preoperatively with a careful history and to have an appropriate knowledge concerning the etiology, electrophysiology, diagnosis, drug effects and treatment of arrhythmias.

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Spinal Instead of General Anesthesia for Two Pediatric Patients at Risk for Malignant Hyperthermia

Journal of Medical Cases ◽

10.14740/jmc2854w ◽

2017 ◽

Vol 8 (10) ◽

pp. 297-300

Author(s):

Ambrish B. Patel ◽

Emmett Whitaker ◽

Richard S. Cartabuke ◽

Gina Fedel ◽

Joseph D. Tobias

Keyword(s):

At Risk ◽

Malignant Hyperthermia ◽

General Anesthesia ◽

Pediatric Patients ◽

Patients At Risk

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Intraoperative electroencephalographic burst suppression may help to indentify patients at risk for long-term adverse outcome: Findings from a homozygous twins case

10.21203/rs.2.417/v2 ◽

2019 ◽

Author(s):

Federico Linassi ◽

Eleonora Maran ◽

Matthias Kreuzer ◽

Anna Paola Mazzarolo ◽

Edoardo Rosellini ◽

...

Keyword(s):

At Risk ◽

General Anesthesia ◽

Test Performance ◽

Postoperative Cognitive Dysfunction ◽

Burst Suppression ◽

The Other ◽

Cognitive Test ◽

Increased Risk ◽

Patients At Risk ◽

Neurocognitive Decline

Abstract Background: Postoperative cognitive dysfunction (POCD) presents a risk factor after general anesthesia, especially for old or cognitively impaired patients. Hence, strategies to identify possible patients at risk could help to decrease the rate of POCD. In this case report we relate the occurrence of electroencephalographic burst suppression and low bispectral indices to the development of neurocognitive decline after 12 months in one homozygous twin, whereas the other twin exhibited neither burst suppression nor neurocognitive decline. Case presentation: Two 68-year-old homozygous twins underwent the same surgical procedure with the same anesthetic regimens in comparable concentrations. For cognitive assessment, we applied a battery of neurocognitive tests at baseline (one day before surgery), at hospital discharge (three days after surgery), and 12 months after the procedure. The twins performed similarly in preoperative and discharge testing, but one twin showed worse test performance after 12 months. During surgery, we tested for possible connected consciousness by applying the isolated forearm technique (IFT). For assessment of the level of anesthesia and visual inspection of the EEG, we used the bispectral index (BIS). Neither of the twins showed signs of connected consciousness during anesthesia and the emergence tone to the return of a positive IFT response were similar. We observed lower intraoperative BIS indices for one twin. Furthermore, this twin also had two episodes of Burst Supppression. Vital parameters, particularly mean blood pressure, were stable and comparable during the entire duration of anaesthesia. The twin who exhibited Burst Suppression and lower BIS indices showed distinctly worse cognitive test scores after 12 months compared to baseline and discharge testing, indicating serious neurocognitive decline. The other twin’s cognitive performance did not decrease. Conclusions: We present findings from a unique scenario of homozygous twins with comparable lifestyles undergoing the same surgical intervention. The twin with neurocognitive decline had lower BIS values and multiple episodes of BSupp. These findings suggest that EEG monitoring under general anesthesia could help to identify frail brains that may be at increased risk of developing cognitive impairments.

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Intraoperative electroencephalographic burst suppression may help to identify patients at risk for long-term adverse outcome: Findings from a homozygous twins case

10.21203/rs.2.417/v3 ◽

2019 ◽

Author(s):

Federico Linassi ◽

Eleonora Maran ◽

Matthias Kreuzer ◽

Anna Paola Mazzarolo ◽

Edoardo Rosellini ◽

...

Keyword(s):

At Risk ◽

General Anesthesia ◽

Test Performance ◽

Postoperative Cognitive Dysfunction ◽

Burst Suppression ◽

The Other ◽

Cognitive Test ◽

Increased Risk ◽

Patients At Risk ◽

Neurocognitive Decline

Abstract Background: Postoperative cognitive dysfunction (POCD) presents a risk factor after general anesthesia, especially for old or cognitively impaired patients. Hence, strategies to identify possible patients at risk could help to decrease the rate of POCD. In this case report we relate the occurrence of electroencephalographic burst suppression and low bispectral indices to the development of neurocognitive decline after 12 months in one homozygous twin, whereas the other twin exhibited neither burst suppression nor neurocognitive decline. Case presentation: Two 68-year-old homozygous twins underwent the same surgical procedure with the same anesthetic regimens in comparable concentrations. For cognitive assessment, we applied a battery of neurocognitive tests at baseline (one day before surgery), at hospital discharge (three days after surgery), and 12 months after the procedure. The twins performed similarly in preoperative and discharge testing, but one twin showed worse test performance after 12 months. During surgery, we tested for possible connected consciousness by applying the isolated forearm technique (IFT). For assessment of the level of anesthesia and visual inspection of the EEG, we used the bispectral index (BIS). Neither of the twins showed signs of connected consciousness during anesthesia and the emergence tone to the return of a positive IFT response were similar. We observed lower intraoperative BIS indices for one twin. Furthermore, this twin also had two episodes of Burst Supppression. Vital parameters, particularly mean blood pressure, were stable and comparable during the entire duration of anaesthesia. The twin who exhibited Burst Suppression and lower BIS indices showed distinctly worse cognitive test scores after 12 months compared to baseline and discharge testing, indicating serious neurocognitive decline. The other twin’s cognitive performance did not decrease. Conclusions: We present findings from a unique scenario of homozygous twins with comparable lifestyles undergoing the same surgical intervention. The twin with neurocognitive decline had lower BIS values and multiple episodes of BSupp. These findings suggest that EEG monitoring under general anesthesia could help to identify frail brains that may be at increased risk of developing cognitive impairments.

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