Perioperative challenges in a primary hyperparathyroid patient with osteitis fibrosa cystic and borderline QTc: a case-based review and practice analysis

2019 ◽  
Vol 2 ◽  
pp. 57-63
Author(s):  
Karim HMR. ◽  
Neema PK. ◽  
J. Iqbal
Keyword(s):  
Anesthetic Management ◽  
Renal Involvement ◽  
Perioperative Period ◽  
Time Frame ◽  
Osteitis Fibrosa ◽  
Drug Induced ◽  
Balanced Anesthesia ◽  
Challenging Situation ◽  
Primary Hyperparathyroid ◽  
Case Based

<b>Introduction:</b> Perioperative care of primary hyperparathyroidism patients is a significant challenge. The challenge increases when the preoperative optimization of the patient is suboptimal due to any reason. Concomitant complications like osteitis fibrosa cystic, renal involvement, and multiple electrolyte abnormalities predispose these patients towards multiple morbidities and even mortality during the perioperative period. It is known that the hypercalcemia causes shortened QT, and the inhalational and intravenous anesthesia drug-induced QT prolongation is likely to be buffered. On the other hand, prolonged QTc in primary hyperparathyroid patients in the presence of hypercalcemia is more uncommon, but an extremely challenging situation for anesthesiologists as these patients are more prone to torsadogenesity. <br><b>Materials and methods:</b> A case-based review is presented in this paper. To review the current practice and opinions, we searched PubMed and Google Scholar using the advanced search engine with the combination index words of primary hyper-parathyroidism, anesthesia, anaesthesia, anesthesia management, and anaesthesia management with a time frame of January 1, 2000, to August 30, 2018. <br><b>Results:</b> The results are enumerated in the text. Although anesthetic management of primary hyperparathyroid patients is available in the literature, anesthetic management of primary hyperparathyroid patients with prolonged or borderline QTc is not well described. In this paper, we present a case that was successfully managed using Desflurane based minimal flow anesthesia, which is probably also the first of such. <br><b>Conclusion:</b> Balanced anesthesia with Propofol induction and modern inhalational agents for maintenance and non-depolarizing neuromuscular blockade appears to be safe method of anesthesia.

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 Lack of drug-induced post-retrieval amnesia for auditory fear memories in rats

BMC Biology ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Laura Luyten ◽  
Anna Elisabeth Schnell ◽  
Natalie Schroyens ◽  
Tom Beckers
Keyword(s):  
Fear Conditioning ◽  
Critical Time ◽  
Fear Memory ◽  
Time Frame ◽  
Long Term Memory ◽  
Sprague Dawley ◽  
Drug Induced ◽  
Pharmacological Agents ◽  
Administration Routes ◽  
Permanent Storage

Abstract Background Long-term memory formation is generally assumed to involve the permanent storage of recently acquired memories, making them relatively insensitive to disruption, a process referred to as memory consolidation. However, when retrieved under specific circumstances, consolidated fear memories are thought to return to a labile state, thereby opening a window for modification (e.g., attenuation) of the memory. Several interventions during a critical time frame after this destabilization seem to be able to alter the retrieved memory, for example by pharmacologically interfering with the restabilization process, either by direct protein synthesis inhibition or indirectly, using drugs that can be safely administered in patients (e.g., propranolol). Here, we find that, contrary to expectations, systemic pharmacological manipulations in auditory fear-conditioned rats do not lead to drug-induced post-retrieval amnesia. Results In a series of well-powered auditory fear conditioning experiments (four with propranolol, 10 mg/kg, two with rapamycin, 20–40 mg/kg, one with anisomycin, 150 mg/kg and cycloheximide, 1.5 mg/kg), we found no evidence for reduced cued fear memory expression during a drug-free test in adult male Sprague-Dawley rats that had previously received a systemic drug injection upon retrieval of the tone fear memory. All experiments used standard fear conditioning and reactivation procedures with freezing as the behavioral read-out (conceptual or exact replications of published reports) and common pharmacological agents. Additional tests confirmed that the applied drug doses and administration routes were effective in inducing their conventional effects on expression of fear (propranolol, acutely), body weight (rapamycin, anisomycin, cycloheximide), and consolidation of extinction memories (cycloheximide). Conclusions In contrast with previously published studies, we did not find evidence for drug-induced post-retrieval amnesia, underlining that this effect, as well as its clinical applicability, may be considerably more constrained and less readily reproduced than what the current literature would suggest.

scholarly journals ORi™: a new indicator of oxygenation

2021 ◽  
Author(s):  
Yusuke Ishida ◽  
Toshio Okada ◽  
Takayuki Kobayashi ◽  
Hiroyuki Uchino
Keyword(s):  
Respiratory Function ◽  
Early Stage ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Arterial Oxygen ◽  
Reserve Capacity ◽  
Monitoring Method ◽  
Unit Scale ◽  
Noninvasive Monitor ◽  
Near Future

AbstractIn the perioperative period, hypoxemia and hyperoxia are crucial factors that require attention, because they greatly affect patient prognoses. The pulse oximeter has been the only noninvasive monitor that can be used as a reference of oxygenation in current anesthetic management; however, in recent years, a new monitoring method that uses the oxygen reserve index (ORi™) has been developed by Masimo Corp. ORi is an index that reflects the state of moderate hyperoxia (partial pressure of arterial oxygen [PaO2] between 100 and 200 mmHg) using a non-unit scale between 0.00 and 1.00. ORi monitoring performed together with percutaneous oxygen saturation (SpO2) measurements may become an important technique in the field of anesthetic management, for measuring oxygenation reserve capacity. By measuring ORi, it is possible to predict hypoxemia and to detect hyperoxia at an early stage. In this review, we summarize the method of ORi, cautions for its use, and suitable cases for its use. In the near future, the monitoring of oxygen concentrations using ORi may become increasingly common for the management of respiratory function before, after, and during surgery.

scholarly journals Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kota Saito ◽  
Sho Ohno ◽  
Makishi Maeda ◽  
Naoyuki Hirata ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Maze Procedure ◽  
Intraoperative Awareness ◽  
Case Presentation ◽  
Venous Oxygen Saturation ◽  
Index Value

Abstract Background Remimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients. However, the efficacy and safety of remimazolam in cardiac surgery with cardiopulmonary bypass (CPB) have not been reported. We present a case of successful anesthetic management using remimazolam in cardiac surgery with CPB. Case presentation A 76-year-old female was scheduled for mitral valve repair, tricuspid annuloplasty, maze procedure, and left atrial appendage closure. We used remimazolam in induction (6.0 mg/kg/h) and maintenance (0.6–1.0 mg/kg/h) of general anesthesia, and the bispectral index value was maintained in the range of 36 to 48 including the period of CPB. Hemodynamics, mixed venous oxygen saturation, and bilateral regional cerebral oxygen saturation were maintained within acceptable ranges. There was no intraoperative awareness/recall or serious complications associated with remimazolam throughout the perioperative period. Conclusions Remimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.

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.

A Clinical Observational Study on the Application of Enhanced Recovery After Laparoscopic Pancreaticoduodenectomy

2021 ◽  
Author(s):  
Rui Liao ◽  
Ping Che ◽  
Jun-Cai Li ◽  
Jie Chen ◽  
Xiong Yan
Keyword(s):  
Enhanced Recovery ◽  
Operation Time ◽  
Perioperative Period ◽  
Medical Costs ◽  
Time Frame ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Readmission Rates ◽  
Retrospective Clinical Study ◽  
Previously Treated ◽  
The Impact

Abstract Background: The safety and feasibility of enhanced recovery after surgery (ERAS) for laparoscopic pancreaticoduodenectomy (LPD) are unclear. The aim of this retrospective clinical study was to evaluate the impact of ERAS protocols for LPD.Methods: Between March 2016 and December 2018, a total of 34 consecutive patients with ERAS for LPD were prospectively enrolled and compared with 68 consecutive patients previously treated for non-ERAS after LPD during an equal time frame. The intraoperative and postoperative data were collected and comparatively analyzed. Results: The mean length of postoperative hospital stay (15.8±3.4 and 23.1±5.1 days, P<0.001) and total medical costs (¥14.3±4.8 x104 and ¥15.8±4.9 x104, P=0.017) were reduced significantly in ER group than those in non-ER group. The operation time (462.7±117.0 vs 450.9±109.8 min, P=0.627) and intraoperative blood loss (523.5±270.0 vs 537.5±241.8 mL, P=0.800) were similar in the two groups. The complications of patients with ERAS protocols were not increased (P>0.05). No difference in mortality and readmission rates was found.Conclusions: The ERAS is safe and effective in the perioperative period of LPD. It could effectively reduce the length of postoperative stay and medical costs, and does not increase the incidence of postoperative complications.

scholarly journals Extreme Tracheal Compression due to Substernal Goiter: Surgical and Anesthetic Management

2012 ◽  
Vol 4 (2) ◽  
pp. 71-73 ◽  
Author(s):  
Benzon Dy ◽  
Kevin Wise ◽  
David Farley ◽  
Brian McGlinch
Keyword(s):  
Operative Treatment ◽  
Multidisciplinary Approach ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Airway Compromise ◽  
Successful Management ◽  
Tracheal Compression ◽  
Substernal Goiter ◽  
Biochemical Abnormalities

ABSTRACT Substernal goiters can have a range of presentations and pathology from a complete lack of symptoms to minimal biochemical abnormalities to potentially lethal physical derangements due to tracheal compression. We review a case of a substernal goiter with severe tracheal compression and airway compromise and describe the presentation, diagnosis, operative treatment, perianesthetic management and outcome of this patient. Substernal goiters can have a myriad of symptoms and etiologies. Once the diagnosis is secured, a multidisciplinary approach is key to successful management in the perioperative period. How to cite this article Dy B, Wise K, Farley D, McGlinch B. Extreme Tracheal Compression due to Substernal Goiter: Surgical and Anesthetic Management. World J Endocr Surg 2012;4(2):71-73.

Acute Liver Failure

2017 ◽  
Author(s):  
Cynthia Wang ◽  
Michelle Y. Braunfeld
Keyword(s):  
Supportive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Intraoperative Monitoring ◽  
Multiorgan Failure ◽  
Anesthetic Management ◽  
Specific Treatment ◽  
Patient Specific ◽  
Drug Induced

Acute liver failure produces widespread physiologic derangements including encephalopathy, coagulopathy, peripheral vasodilation, a systemic inflammatory response, and multiorgan failure. Morbidity is significant, and mortality is 50%. The classification of liver failure and the various etiologies, including viral hepatitis, drug-induced, toxins, and autoimmunity are reviewed here. The multisystem effects of acute liver failure influence all aspects of perioperative care and adequate supportive care during this time is crucial to providing the best possible outcome for the patient. Specific treatment objectives and recommendations are discussed, and the anesthetic management with regard to drug choices, hemodynamic goals, and intraoperative monitoring is reviewed.

scholarly journals Antimicrobial-induced cognitive side effects

2016 ◽  
Vol 6 (4) ◽  
pp. 207-214 ◽  
Author(s):  
Amanda Warstler ◽  
Jennifer Bean
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Time Frame ◽  
Drug Induced ◽  
Pubmed Search ◽  
Neuropsychiatric Side Effects ◽  
Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

scholarly journals A positioning strategy for a tourist destination, based on analysis of customers’ perceptions and satisfactions

2019 ◽  
Vol 26 (2) ◽  
pp. 131-151 ◽  
Author(s):  
Natasha Saqib
Keyword(s):  
Time Frame ◽  
Niche Markets ◽  
Case Study Methodology ◽  
Content Type ◽  
Tourism Product ◽  
Positioning Strategy ◽  
Study Methodology ◽  
One Year ◽  
Case Based

Purpose The purpose of this paper is to measure the perception and satisfactions of consumers of the tourism product of Kashmir region and identify potential niche markets that could be used in the development of the destination’s positioning strategy. Design/methodology/approach The author used a case study methodology. Self-completion questionnaires were distributed to tourists visiting Kashmir region at the peak of the 2018 tourism season. The scales used were adapted from two authoritative sources. Data from 479 completed questionnaires were analysed quantitatively by a variety of statistical techniques, including factor analysis. Findings Four possible niche markets are identified that can inform the development of the destination’s positioning strategy: nature based, adventure, cultural and culinary. The overall conclusions and discussion of the findings should provide a case-based framework for the practical planning and implementation of positioning strategies in the tourism context. Research limitations/implications The time frame of the study was five summer months in one year, and only actual visitors completed the questionnaire. The study did not assess their evaluation of the quality of the services provided and consumed. Originality/value The overall conclusions and discussion of the findings should provide a case-based framework for the practical planning and implementation of positioning strategies in the tourism context.

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