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Author(s):  
Mijung Yun ◽  
Gunn Hee Kim ◽  
Sung-chul Ko ◽  
Yun Jae Han ◽  
Wooshik Kim

Background: Myasthenia gravis (MG) is an autoimmune disease, and early thymectomy is recommended. Since the introduction of video-assisted thoracoscopic surgery, the safety and effectiveness of carbon dioxide insufflation in the thoracic cavity (capnothorax) has been controversial. This study aimed to compare the safety and effectiveness of ventilation methods in bilateral video-assisted thoracoscopic extended thymectomy (BVET) with capnothorax.Methods: We retrospectively investigated the medical records of patients with MG who underwent BVET between August 2016 and January 2018. Patients were divided into two groups: group D (n = 26) for one-lung ventilation and group S (n = 28) for two-lung ventilation. We set nine anesthesia time points (T0–T8) and collected respiratory and hemodynamic variables, including arterial O2 index (PaO2/FiO2).Results: SpO2 at T1–T3 and T8 was significantly lower in group D than in group S. The FiO2 in group S was lower than that in group D at all time points. The number of PaO2/FiO2 ≤ 300 and PaO2/FiO2 ≤ 200 events was significantly higher in group D than in group S. Hemodynamic variables were not significantly different between the two groups at any time point. The duration of surgery and anesthesia was shorter in group S than in group D. Conclusions: This retrospective study suggests that anesthesia using two-lung ventilation during BVET with capnothorax is a safe and effective method to improve lung oxygenation and reduce anesthesia time.


Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 733-740
Author(s):  
Jae-Koo Lee ◽  
Jong Hwa Park ◽  
Seung-Jae Hyun ◽  
Daniel Hodel ◽  
Oliver N. Hausmann

This paper is an overview of various features of regional anesthesia (RA) and aims to introduce spine surgeons unfamiliar with RA. RA is commonly used for procedures that involve the lower extremities, perineum, pelvic girdle, or lower abdomen. However, general anesthesia (GA) is preferred and most commonly used for lumbar spine surgery. Spinal anesthesia (SA) and epidural anesthesia (EA) are the most commonly used RA methods, and a combined method of SA and EA (CSE). Compared to GA, RA offers numerous benefits including reduced intraoperative blood loss, arterial and venous thrombosis, pulmonary embolism, perioperative cardiac ischemic incidents, renal failure, hypoxic episodes in the postanesthetic care unit, postoperative morbidity and mortality, and decreased incidence of cognitive dysfunction. In spine surgery, RA is associated with lower pain scores, postoperative nausea and vomiting, positioning injuries, shorter anesthesia time, and higher patient satisfaction. Currently, RA is mostly used in short lumbar spine surgeries. However, recent findings illustrate the possibility of applying RA in spinal tumors and spinal fusion. Various researches reveal that SA is an effective alternative to GA with lower minor complications incidence. Comprehensive insight on RA will promote spine surgery under RA, thereby broadening the horizon of spine surgery under RA.


2021 ◽  
pp. 000313482110545
Author(s):  
John M. Pickering ◽  
Wesley H. Giles

Background Intraoperative parathyroid hormone (iPTH) testing is often used to confirm successful removal of hypersecreting parathyroid glands during parathyroidectomy. Unfortunately, the iPTH test can be a time-consuming and highly variable process that occurs while the patient is under anesthesia. We set out to improve iPTH lab efficiency and variability. Methods We performed a retrospective review of 85 patients who underwent parathyroidectomy at our institution from October 2017 to October 2019. Each step of the iPTH lab reporting process was recorded and analyzed. Three simulations were performed of the entire process. We then established interventions to modify inefficiencies in the process and studied 21 patients who underwent parathyroidectomy at our institution from November 2019 to March 2020. Results Twenty-five minutes of time inherent to the process were identified. Four critical steps were identified as modifiable steps in the process: 1. Operating room (OR) blood draw ---> lab receipt. 2. Lab receipt ---> placement on centrifuge. 3. Removal from centrifuge ---> placement on PTH machine. 4. PTH machine result ---> OR verbal report. We improved iPTH lab efficiency by 19%, decreasing the average lab result from 45 to 36 minutes ( P = .001). We improved iPTH lab variability by 62%, decreasing the standard deviation from 21 to 8 minutes ( P = .001). Discussion Utilizing a team-based approach to identify and expedite critical steps in the iPTH lab process can make a significant improvement in iPTH lab efficiency, improving patient care by decreasing total anesthesia time.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yen-Chang Lin ◽  
Wei-Chieh Chen ◽  
Chun-Yu Chen ◽  
Shyh-Ming Kuo

Abstract Background The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures. Methods We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment. Results A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery. Conclusions The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.


2021 ◽  
Vol 12 ◽  
Author(s):  
Wei-Cheng Tseng ◽  
Meei-Shyuan Lee ◽  
Ying-Chih Lin ◽  
Hou-Chuan Lai ◽  
Mu-Hsien Yu ◽  
...  

Background: Previous studies have shown that anesthetic techniques can affect outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective epithelial ovarian cancer surgery.Methods: This was a retrospective cohort study of patients who received elective open surgery for epithelial ovarian cancer between January 2009 and December 2014. Patients were grouped according to the administration of propofol or desflurane anesthesia. Kaplan–Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were used to compare hazard ratios for death after propensity matching. Subgroup analyses were performed for age, body mass index, preoperative carbohydrate antigen-125 level, International Federation of Gynecology and Obstetrics staging, and operation and anesthesia time.Results: In total, 165 patients (76 deaths, 46.1%) who received desflurane anesthesia and 119 (30 deaths, 25.2%) who received propofol anesthesia were eligible for analysis. After propensity matching, 104 patients were included in each group. In the matched analysis, patients who received propofol anesthesia had better survival with a hazard ratio of 0.52 (95% confidence interval, 0.33–0.81; p = 0.005). Subgroup analyses also showed significantly better survival with old age, high body mass index, elevated carbohydrate antigen-125 level, advanced International Federation of Gynecology and Obstetrics stage, and prolonged operation and anesthesia time in the matched propofol group. In addition, patients administered with propofol anesthesia had less postoperative recurrence and metastasis than those administered with desflurane anesthesia in the matched analysis.Conclusion: Propofol anesthesia was associated with better survival in patients who underwent elective epithelial ovarian cancer open surgery. Prospective studies are warranted to evaluate the effects of propofol anesthesia on oncological outcomes in patients with epithelial ovarian cancer.


Author(s):  
Orr Shauly ◽  
Gregory L Stone ◽  
Rebeca Shin ◽  
W Grant Stevens ◽  
Daniel J Gould

Abstract Background Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, SMAS manipulation, by way of plication, overlap or SMASectomy are common and have been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique. Objectives To assess the benefits and risks of the SMASectomy technique. Methods The records of all patients who underwent a facelift procedure between December 2004 and March 2019, were reviewed for this study. All procedures were performed at an AAAASF-accredited outpatient facility in Marina Del Rey, CA. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications. Results Average operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes was observed amongst those patients that underwent SMASectomy. This was significantly lower (p < 0.000001) than those that did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients that underwent SMASectomy. No DVT events were observed in this patient population. Conclusions In the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results.


2021 ◽  
Vol 134 (4) ◽  
pp. 509-514
Author(s):  
Evan D. Kharasch ◽  
J. David Clark
Keyword(s):  

2021 ◽  
Vol 41 (2) ◽  
Author(s):  
Yongtao Sun ◽  
Hai Feng ◽  
Ting Zou ◽  
Ming Hou ◽  
Yanwu Jin ◽  
...  

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.


2021 ◽  
Author(s):  
Mijung Yun ◽  
Gunn Hee Kim ◽  
Sung-chul Ko ◽  
Wooshik Kim

Abstract Background Myasthenia gravis (MG) is an autoimmune disease and early thymectomy has been recommended. After the introduction of VATS, the safety and effectiveness of carbon dioxide (CO2) insufflation in thoracic cavity (capnothorax) has been continuously controversial. This study aimed to compare the safety and effectiveness of ventilation methods in bilateral video-assisted thoracoscopic extended thymectomy (BVET) with capnothorax.Methods We retrospectively investigated the medical records of MG patients who underwent BVET between August 2016 and January 2018.Patients were divided into two groups: group D (n=26) for one-lung ventilation and group S (n=28) for two lung-ventilation. We set nine anesthesia time points (T0–T8) and collected respiratory and hemodynamic variables including arterial O2 index (PaO2/FiO2).Results The EtCO2 at T0, T1–T4, and T7 were insignificantly higher in group D than those in group S. The SpO2 at T1–T3 and T8 were significantly lower in group D than those in group S. The FiO2 in group S was lower than that in group D at all-time points. The number of PaO2/FiO2 ≤ 300 and PaO2/FiO2 ≤ 200 were significantly higher in group D than those in group S. Hemodynamic variables were not insignificantly different between the two groups at all-time points. The duration of surgery and anesthesia was shorter in group S than that in group D. Conclusions This retrospective study suggests that anesthesia using two-lung ventilation during BVET with capnothorax was a safe and effective method to improve lung oxygenation and reduce the operation and anesthesia time.


2021 ◽  
Vol 11 (1) ◽  
pp. 282-287
Author(s):  
Yunlong Lei ◽  
Zhenzhen Ma ◽  
Huiqing Li

Objective: In this paper, a lattice algorithm is used to explore the effect of MRI on anesthesia when used in neurosurgery. Methods: Sixty patients with glioma were randomly divided into two groups. Thirty patients underwent intracranial glioma resection (iMRI group) under the guidance of intraoperative magnetic resonance imaging (iMRI) and functional neuronavigational, and 30 patients underwent functional neuronavigational. Guide the traditional resection of traditional craniotomy gliomas (group N), and record the general situation, anesthesia time, operation preparation time, operation time, intraoperative blood loss, infusion volume, blood transfusion rate, preoperative and postoperative hemoglobin concentrations, Postoperative body temperature, dosage of muscle relaxant, perioperative accidents related to iMRI and anesthesia. Results: Compared with the N group, the general conditions, anesthesia time, intraoperative blood loss, infusion volume, blood transfusion rate, hemoglobin concentration, and postoperative body temperature of the patients in the iMRI group were not significantly different (P > 0.05), but the time for preparation and operation. It was significantly prolonged, and the amount of muscle relaxant was significantly increased (P < 0.05). There were no accidents related to iMRI and anesthesia in both groups. Conclusion: The use of iMRI in neurosurgical surgery improves the accuracy of surgery and makes tumor resection more complete, but the operation time is significantly longer, and other perioperative characteristics are not different from traditional neurosurgery. iMRI is used for anesthesia in neurosurgery. In addition to following the general principles of neurosurgery anesthesia, attention should also be paid to the regulation of anesthesia for long-term surgery.


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