scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

scholarly journals A “Rash” Decision in Anesthetic Management: Benzyl Alcohol Allergy in the Perioperative Period

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Michael Tripp ◽  
Matthew Ribeiro ◽  
Susanna Kmiecik ◽  
Ramon Go
Keyword(s):  
Contact Dermatitis ◽  
General Anesthesia ◽  
Benzyl Alcohol ◽  
Patch Testing ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Maculopapular Rash ◽  
Hypersensitivity Reactions ◽  
Anesthetic Agents ◽  
Total Body

Here, we present the case of a 54-year-old female presenting for outpatient ankle hardware removal who experienced severe total body pruritus along with a maculopapular rash persisting four days after the procedure. Patch testing demonstrated a sensitivity to benzyl alcohol, a preservative in propofol and several other anesthetics. The patient returned for left ankle arthroscopy a year later, and during that procedure, the anesthetic team avoided medications containing benzyl alcohol. This resulted in no pruritus or rash. Hypersensitivity reactions, ranging from contact dermatitis to anaphylaxis, are critical events in the perioperative period. Induction of general anesthesia has been implicated as the inciting event for perioperative hypersensitivity reactions. Benzyl alcohol is among a few excipients found in common anesthetic agents known to cause hypersensitivity reactions in susceptible patients. While reports of adult death are rare, infantile death due to benzyl alcohol has been described.

Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

2020 ◽  
pp. 151-158
Author(s):  
Rafael Antonio Caldart Bedin ◽  
Maisa Schultz ◽  
Antonio Bedin
Keyword(s):  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Laboratory Animals ◽  
Average Weight ◽  
Anesthetic Induction ◽  
Anesthetic Agents ◽  
Reasonable Degree ◽  
Bioethical Debate ◽  
Precordial Stethoscope

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

scholarly journals Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery

2017 ◽  
Vol 64 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Naotaka Kishimoto ◽  
Ikue Kinoshita ◽  
Yoshihiro Momota
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Anesthetic Management ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Anesthesia Induction ◽  
Sagittal Split Ramus Osteotomy ◽  
Junctional Rhythm ◽  
Appropriate Treatment ◽  
Slow Heart Rate

We report a case of junctional rhythm that occurred both preoperatively and later during a portion of general anesthesia. A 19-year-old woman was scheduled to undergo bilateral sagittal split ramus osteotomy after being diagnosed with a jaw deformity. Preoperative electrocardiography (ECG) revealed a junctional rhythm with a slow heart rate (HR). At 90 minutes after anesthesia induction, local anesthesia with 10 mL of 1% lidocaine and 1:100,000 adrenaline was administered. A junctional rhythm appeared 15 minutes after the local anesthesia. We believe that the atrioventricular nodal pacemaker cells accelerated because of the increased sympathetic activity due to the adrenaline. On the preoperative ECG, the junctional rhythm with slow HR appeared as an escaped beat caused by slowing of the primary pacemaker. Therefore, we think that the preoperative junctional rhythm and the junctional rhythm that appeared during general anesthesia were due to different causes. Understanding the cause of a junctional rhythm could lead to more appropriate treatment. We therefore believe that identifying the cause of the junctional rhythm is important in anesthetic management.

scholarly journals Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology

2021 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
Elmira A. Satvaldieva ◽  
Otabek Ya. Fayziev ◽  
Anvar S. Yusupov
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Postoperative Recovery ◽  
Surgical Pathology ◽  
Abdominal Organ ◽  
Epidural Blockade ◽  
Abdominal Operations

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

TMS in the perioperative period

2012 ◽  
Author(s):  
Laverne D. Gugino ◽  
Rafael Romero ◽  
Marcella Rameriz ◽  
Marc E. Richardson ◽  
Linda S. Aglio
Keyword(s):  
Spinal Cord ◽  
Potential Role ◽  
Perioperative Period ◽  
Neurosurgical Procedures ◽  
General Anesthetic ◽  
Motor Pathways ◽  
Anesthetic Agents ◽  
Myogenic Responses ◽  
Selective Monitoring

Two stimulation approaches developed for selectively exciting descending motor pathways are, transcranial electrical (TES) and transcranial magnetic (TMS) stimulation. This article highlights the comparison between electrical and magnetic transcranial stimulation. Magnetic stimulation is relatively painless; therefore it is the more preferred technique. The article reviews the use of TMS for monitoring the functional integrity of the descending motor systems during surgery and discusses the potential role of TMS in the preoperative period for conscious patients planning to undergo neurosurgical procedures involving the cerebral cortex. Selective monitoring of spinal cord motor function involves acquisition of TMS-induced epidural and/or myogenic responses. As patients are generally given anesthesia before spinal cord surgeries, this article discusses the effect of general anesthetic agents on the myogenic responses.

scholarly journals Myotonic Dystrophy and Anesthetic Challenges: A Case Report and Review

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Chanchal Mangla ◽  
Kimmy Bais ◽  
Joel Yarmush
Keyword(s):  
General Anesthesia ◽  
Myotonic Dystrophy ◽  
Electric Stimulation ◽  
Case Reports ◽  
Laparoscopic Hysterectomy ◽  
General Anesthetic ◽  
Anesthetic Agents ◽  
History Of ◽  
Extreme Sensitivity ◽  
Volatile Agents

Providing anesthesia to patients with myotonic dystrophy (DM) can be very challenging due to the multisystemic effects of the disease and extreme sensitivity of these patients to sedatives, opioids, and anesthetic agents. Other factors such as hypothermia, shivering, or mechanical or electric stimulation during surgery can precipitate myotonia which is difficult to abolish and can lead to further complications. Generally, local or regional anesthesia is preferred to avoid the complications associated with general anesthesia in this group. However there are several case reports of successful use of general anesthesia (with or without volatile agents and with or without opioids). These general anesthetic cases led to postoperative admission to the regular floor or ICU. We present a case of a woman with a history of DM who underwent robotic assisted laparoscopic hysterectomy under general anesthesia and was discharged home on the same day.

scholarly journals Network Actions of Pentobarbital in the Rat Mesopontine Tegmentum on Sensory Inflow Through the Spinothalamic Tract

2009 ◽  
Vol 102 (2) ◽  
pp. 700-713 ◽  
Author(s):  
Dhananjay R. Namjoshi ◽  
Shelly A. McErlane ◽  
Niwat Taepavarapruk ◽  
Peter J. Soja
Keyword(s):  
General Anesthesia ◽  
Extracellular Recording ◽  
Current View ◽  
General Anesthetic ◽  
Spinothalamic Tract ◽  
Anesthetic Agents ◽  
Sensory Transmission ◽  
Switch Mechanism ◽  
Spontaneous Firing Rate ◽  
Mesopontine Tegmentum

The recent discovery of a barbiturate-sensitive “general anesthesia switch” mechanism localized in the rat brain stem mesopontine tegmental anesthesia area (MPTA) has challenged the current view of the nonspecific actions of general anesthetic agents in the CNS. In this study we provide electrophysiological evidence that the antinociception, which accompanies the behavioral state resembling general anesthesia following pentobarbital (PB) microinjections into the MPTA of awake rats, could be accompanied by the attenuation of sensory transmission through the spinothalamic tract (STT). Following bilateral microinjections of PB into the MPTA spontaneous firing rate (SFR), antidromic firing index (FI), and sciatic (Sc) as well as sural (Su) nerve-evoked responses (ER) of identified lumbar STT neurons in the isoflurane-anesthetized rat were quantified using extracellular recording techniques. Microinjections of PB into the MPTA significantly suppressed the SFR (47%), magnitudes of Sc- (26%) and Su-ER (36%), and FI (41%) of STT neurons. Microinjections of PB-free vehicle control did not alter any of the above-cited electrophysiological parameters. The results from this study suggest that antinociception, which occurs during the anesthesia-like state following PB microinjections into the MPTA, may be due, in part, to (in)direct inhibition of STT neurons via switching mechanism(s) located in the MPTA. This study provides a provenance for investigating electrophysiologically the actions on STT neurons of other current agents used clinically to maintain the state of general anesthesia.

scholarly journals Thyroid surgery when general anesthesia is not feasible

2016 ◽  
Vol 44 (1) ◽  
pp. 38-40
Author(s):  
Manilal Aich ◽  
Md Asadur Rahman ◽  
Sharfuddin Mahmud ◽  
Siddikur Rahman ◽  
Md Mizanur Rahman ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Postoperative Recovery ◽  
Anesthetic Techniques ◽  
General Anesthetic ◽  
Early Assessment ◽  
Duration Of Action ◽  
Anesthetic Agents ◽  
Sedation And Analgesia ◽  
Effective Sedation

Historically, thyroid and parathyroid surgery was done initially under local anesthesia. With the advent of safer general anesthetic techniques, the need for local anesthesia fell dramatically. Recently the use of local anesthesia combined with monitored anesthesia care (MAC) has been reintroduced as an alternative to general anesthesia for some particular thyroidectomy. Newer intravenous anesthetic agents allow for the establishment of effective sedation and analgesia with adjusted level and duration of action. This allows for monitoring of the effectiveness of the anesthesia during the surgical procedure that meet the patient's comfortable needs and the surgeon's technical needs. This approach allows for rapid recovery of alertness and early assessment of the patient's initial postoperative recovery. Additionally, it optimizes the potential for outpatient .Bangladesh Med J. 2015 Jan; 44 (1): 38-40

scholarly journals General Anesthesia in Red-footed Tortoise (Chelonoides carbonaria) for Gastric Foreign Body Removal

2021 ◽  
Vol 49 ◽  
Author(s):  
Ellen Cristina Siepmann ◽  
Jéssica Fernanda Sinotti ◽  
Carolina Fucks de Souza ◽  
Hidemi Kelly Nishimura ◽  
Larissa Yurika Tanabe ◽  
...  
Keyword(s):  
Foreign Body ◽  
General Anesthesia ◽  
Muscle Relaxation ◽  
Positive Pressure ◽  
Induction Agent ◽  
Anesthesia Induction ◽  
Nociceptive Response ◽  
Foreign Body Removal ◽  
Normal Ranges ◽  
Long Duration

Background: The anatomical, physiological, and pharmacological characteristics of reptiles make anesthesia in chelonians particularly challenging. Specific literature regarding safe anesthetic protocols that provide immobilization, antinociception, amnesia, and unconsciousness are scarce. Thus, this paper aims to report the case of a red-footed tortoise submitted to long-duration general anesthesia to celiotomy for foreign body removal.  Case: An adult red-footed tortoise (Chelonoides carbonaria), 5.9 kg, was admitted due to hyporexia after ingesting a metallic fishhook. Serial radiographs confirmed the diagnosis and location of the foreign body in the stomach. The animal was premedicated with 0.03 mg/kg dexmedetomidine, 6 mg/kg ketamine, and 0.4 mg/kg butorphanol intramuscularly. After 90 min we inserted a 22G jugular catheter and proceeded to anesthesia induction with 5 mg/kg propofol. We intubated the animal with a 2.5 mm uncuffed endotracheal and started fluid therapy at a rate of 5 mL/kg/h. Surgical anesthesia was maintained with isoflurane in 0.21 oxygen, in a non-rebreathing circuit (baraka), under spontaneous breathing. Expired isoflurane was maintained between 3 and 4.5%. Due to reduced respiratory rate and hypercapnia, we opted for implementing manually-assisted positive pressure ventilation. Morphine (0.5 mg/kg) was administered at 10 and 87 min after the beginning of the surgery for further analgesia when the isoflurane requirement increased significantly. We did not detect any alterations in heart and body temperature. Surgical anesthesia lasted 6 h. During anesthesia recovery, voluntary head retraction and coordinated movement of the limbs occurred at 240 and 540 min after the extubation, respectively. In 2 days, the patient returned to voluntary feeding, being very active and responsive to stimulus. The post-surgical hematologic evaluation was unremarkable. Discussion: Pre-anesthetic medication aimed to promote sedation and preemptive analgesia. Due to its minimal cardiorespiratory depression, we chose the combination of ketamine, dexmedetomidine, and butorphanol. Dexmedetomidine reduced the ketamine dose and caused sufficient muscle relaxation and immobilization to perform the jugular catheter placement. Butorphanol is an agonist-antagonist opioid; that is why we decided to add it to the protocol for antinociception. However, due to signs of nociceptive response (increased isoflurane requirements and heart rate), and considering the evidence of a predominance of μ receptors in reptiles, we administered low-dose morphine twice during the procedure. Propofol was chosen as an induction agent at a dose sufficient to allow endotracheal intubation. Since reptilians often show apnea in the presence of 100% oxygen, we used a 0.21 oxygen fraction. Despite this, the patient showed respiratory depression. Due to right to left cardiac shunt, sudden changes in the direction of the blood can lead to very rapid changes in the serum concentrations of isoflurane, which leads to frequent oscillations in the anesthetic depth and consequently the need for vaporizer adjustments, which may justify the high expired isoflurane fraction during the procedure. Despite that, physiological parameters were maintained within normal ranges for the species, with slight variations during the surgical procedure. We conclude that the proposed anesthetic protocol is safe for long-duration anesthesia in chelonians, ensuring cardiovascular and respiratory stability. Thus, this report may help veterinarians to perform safe anesthesia in tortoises submitted to invasive surgical procedures.  Keywords: testudines, dexmedetomidine, ketamine, butorphanol. Descritores: testudines, dexmedetomidina, cetamina, butorfanol.

scholarly journals Targeted Temperature Management of Severe Lactic Acidosis in a Patient with MELAS Syndrome after Cardiac Arrest

2021 ◽  
Vol 39 (3) ◽  
pp. 185-187
Author(s):  
Hyun Ji Kim ◽  
Byeongcheon Lee ◽  
Seong Kyu Yang ◽  
So Yeon Yun ◽  
Museong Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Lactic Acidosis ◽  
Mitochondrial Disease ◽  
Targeted Temperature Management ◽  
Mitochondrial Encephalomyopathy ◽  
Temperature Management ◽  
Melas Syndrome ◽  
Severe Lactic Acidosis

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is known as a maternally inherited mitochondrial disease with a m.3243A>G mutation in the MT-TL1 gene. Here, we report a case of targeted temperature management in a MELAS patient who had a cardiac arrest and severe lactic acidosis after recurrent seizures.

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