Recommendations for anesthetic management for intraoperative neuromodulation cases

2021 ◽  
Author(s):  
Alyssa C Zhu ◽  
Jennifer Tram ◽  
Ruth Waterman ◽  
Mark Wallace ◽  
Krishnan Chakravarthy
Keyword(s):  
Peripheral Nerve ◽  
Anesthetic Management ◽  
Postoperative Management ◽  
Dorsal Column ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Management Guidelines ◽  
Single Center Experience ◽  
Guidelines And Recommendations ◽  
Pump Implantation

This paper performs a review of current literature as well as uses our single-center experience to discuss pre-operative, intra-operative and, briefly, postoperative management for dorsal column stimulators (DCSs), dorsal root ganglion (DRG) stimulators, peripheral nerve stimulators (PNSs) and intrathecal pumps. Generally, pre-operative antibiotics are recommended with discontinuation within 24 h postoperatively. For dorsal column and DRG stimulation, monitored anesthesia care or general anesthesia with intra-operative neuromonitoring is recommended; for peripheral nerve stimulation and intrathecal pump implementation, monitored anesthesia care is preferred. There is little information on appropriate anesthetic management during these forms of neuromodulation. More research is necessary to articulate specific pre-operative, intra-operative and postoperative management guidelines and recommendations for dorsal column stimulator, DRG stimulation, PNS and intrathecal pump implantation.

scholarly journals Anesthetic considerations for awake craniotomy

2020 ◽  
Vol 15 (3) ◽  
pp. 269-274
Author(s):  
Seung Hyun Kim ◽  
Seung Ho Choi
Keyword(s):  
Brain Mapping ◽  
Gold Standard ◽  
Anesthetic Management ◽  
Standard Of Care ◽  
Awake Craniotomy ◽  
Anesthesia Care ◽  
Surgical Team ◽  
Monitored Anesthesia Care ◽  
Eloquent Areas ◽  
Anesthetic Considerations

Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.

scholarly journals Safety and feasibility of the Woven EndoBridge device deployment with monitored anesthesia care

2020 ◽  
Vol 26 (6) ◽  
pp. 767-771
Author(s):  
Daizo Ishii ◽  
Luyuan Li ◽  
Mario Zanaty ◽  
Jorge A Roa ◽  
Lauren Allan ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Anesthetic Management ◽  
Length Of Hospital Stay ◽  
Maximum Diameter ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Device Deployment ◽  
Woven Endobridge ◽  
Web Device ◽  
The Web

Objective The Woven EndoBridge (WEB) device can be used for complex intracranial aneurysms (IAs), mostly under general anesthesia (GA). However, it remains controversial if anesthetic management could affect procedural outcomes after endovascular treatments using the WEB for IAs. The purpose of this study is to investigate the safety and feasibility of the WEB deployment for patients under monitored anesthesia care (MAC). Methods We reviewed 27 IAs in 25 patients who were treated by using the WEB device from February to December in 2019. Our first-line anesthetic management of patients during the procedures was the MAC. GA was performed based on patient’s clinical status or preference. Subjects’ demographic data, aneurysms’ characteristics, procedure-related complications, grade of stasis after the WEB deployment, duration of procedure, and length of hospital stay were compared between subjects who underwent GA versus those who underwent MAC. Results Successful deployment of the WEB device was obtained in all patients. In total, 10 and 17 IAs were treated with GA and MAC, respectively. There was no significant difference in demographics (age: p = 0.12, sex: p = 0.54), aneurysms’ characteristics (ruptured: p = 1.00, neck width: p = 0.96, aspect ratio: p = 0.98, maximum diameter: p = 0.69), complications ( p = 1.00), postprocedural grade of stasis ( p = 1.00), duration of the procedure ( p = 0.23), and the length of hospital stay ( p = 0.81) between GA and MAC. Conclusions MAC can be used for the WEB device deployment safely and effectively.

scholarly journals Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia

2016 ◽  
Vol 43 (6) ◽  
pp. 496-502 ◽  
Author(s):  
Yi Deng ◽  
Payam S. Naeini ◽  
Mehdi Razavi ◽  
Charles D. Collard ◽  
Daniel A. Tolpin ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Perioperative Complications ◽  
Anesthetic Management ◽  
Structural Heart Disease ◽  
Scar Tissue ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Cardiopulmonary Support

Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.

scholarly journals Monitored Anesthesia Care for Subcutaneous Cardioverter-Defibrillator Implantation: A Single-Center Experience

2016 ◽  
Vol 30 (5) ◽  
pp. 1228-1233 ◽  
Author(s):  
Michael K. Essandoh ◽  
Andrew J. Otey ◽  
Mahmoud Abdel-Rasoul ◽  
Erica J. Stein ◽  
Katja R. Turner ◽  
...  
Keyword(s):  
Anesthesia Care ◽  
Single Center ◽  
Monitored Anesthesia Care ◽  
Cardioverter Defibrillator ◽  
Single Center Experience

scholarly journals Endoscopy- and Monitored Anesthesia Care-Assisted High-Resolution Impedance Manometry Improves Clinical Management

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Kaci E. Christian ◽  
John D. Morris ◽  
Guofeng Xie
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Ineffective Esophageal Motility ◽  
Targeted Interventions ◽  
Single Center Experience ◽  
Esophageal Spasm ◽  
Number Of Patients ◽  
Per Oral

Background. High-resolution impedance manometry (HRiM) is the test of choice to diagnose esophageal motility disorders and is particularly useful for identifying achalasia subtypes, which often guide therapy. HRiM is typically performed without sedation in the office setting. However, a substantial number of patients fail this approach. We report our single-center experience on endoscopy-assisted HRiM under monitored anesthesia care (MAC) in adults to demonstrate the feasibility and effectiveness of this approach. Methods. Patients who had failed prior HRiM attempts received propofol under MAC. Patients then underwent an upper endoscopy, followed immediately by passage of a Diversateck HRiM motility catheter through the nares and under direct visualization into the stomach, often using the tip of the endoscope to guide the catheter. We then awakened the patients and asked them to perform 10 saline swallows. Results. We successfully completed HRiM studies in 14 consecutive patients. Six patients had achalasia; two had esophagogastric junction outflow obstruction; two had absent contractility; one had distal esophageal spasm; one had ineffective esophageal motility; and one had a normal study. The majority of these patients were treated successfully with targeted interventions, including per oral endoscopic myotomy, gastrostomy, botox injection, medical therapy, and dietary modifications.

Anästhesie bei ophthalmologischen Operationen – eine Standortbestimmung

2016 ◽  
Vol 73 (2) ◽  
pp. 61-66 ◽  
Author(s):  
Jens Moll ◽  
Mark Kaufmann
Keyword(s):  
Anesthesia Care ◽  
Monitored Anesthesia Care

Zusammenfassung. Ein Grossteil der opthalmologischen Eingriffe kann heute in Lokoregionalanästhesie mit «Monitored Anesthesia Care» (MAC) durchgeführt werden. Allgemeinanästhesieverfahren sind hauptsächlich im pädiatrischen Segment, bei spezifischer Comorbidität und bei langdauernden Eingriffen mit völlig ruhiggestelltem OP-Gebiet notwendig. Kataraktoperationen bei mehrheitlich geriatrischen Patienten gehören aufgrund Ihrer Häufigkeit zur sogenannten «Hochvolumen-Chirurgie»: In Anbetracht des niedrigen perioperativen Risikos bei dieser Patientengruppe sind angepasste, optimierte Prozesse sinnvoll. Eine fokussierte Prämedikation und Information dieser Patienten gewährleistet eine gute perioperative Compliance. Präoperative Untersuchungen sollen bei dieser Patientengruppe nur in Abhängigkeit von relevanter Comorbidität durchgeführt werden. Neben der klassischen Anästhesiesprechstunde stehen heute für gesundheitlich kompensierte Patienten auch neue Verfahren wie eine internetbasierte Prämedikationsvisite zur Verfügung. Das intraoperative Anästhesieverfahren hängt von den Erfordernissen des Chirurgen und den Erwartungen und Kooperationsmöglichkeiten des Patienten ab.

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