3,331 research outputs found
Anaesthetic management of a patent ductus arteriosus (PDA) occlusion using an Amplatz canine duct occluder (ACDO) in a dog
Patent ductus arteriosus (PDA) is one of the most common diagnosed congenital disease in dogs that usually causes heart failure and death unless corrected at a young age. A 2.5-year-old female intact Coton de Tuléar was referred and diagnosed with a left to right shunt PDA. Closure of the PDA was performed via a minimally invasive approach by means of an Amplatz canine duct occluder device. In this case report, we describe a successful anaesthetic protocol that included premedication using a combination of acepromazine and methadone, induction with propofol and midazolam and maintenance with isoflurane in oxygen, as well as a lidocaine constant rate constant rate infusion for intraoperative analgesic and cardiovascular support. This protocol provided excellent intraoperative cardiopulmonary stability and a smooth and rapid recovery
Anesthesia for cystotomy in a dog with pancreatitis and a portosystemic shunt
A 21-month-old Cocker spaniel with a portosystemic shunt, a moderate thrombocytopenia and a history of pancreatitis, was anesthetized for a cystotomy to remove bladder polyps and stones. The portosystemic shunt had been treated conservatively with lactulose, ampicillin and a special diet. After premedication with methadone 0.2 mg/kg, by intramuscular (IM) injection, anesthesia was induced with propofol 4 mg/kg intravenously (IV) and maintained with isoflurane in oxygen. Additionally, 2 mL lidocaine 2% and 0.1 mg/kg morphine were injected in the lumbosacral epidural space and 0:1 mg/kg meloxicam was administered intravenously. Except for a moderate decrease in arterial pressure after the epidural injection and the need for intermittent positive pressure ventilation during surgery, anesthesia and recovery were uneventful. Postoperative analgesia was provided with methadone (0.2 mg/kg every 4 hours initially, then 0.1 mg/kg every 6 hours IM) and oral meloxicam (0.1 mg/kg the first day, 0.05 mg/kg during 4 days)
Dynamic and volumetric variables reliably predict fluid responsiveness in a porcine model with pleural effusion
Background: The ability of stroke volume variation (SVV), pulse pressure variation (PPV) and global end-diastolic volume (GEDV) for prediction of fluid responsiveness in presence of pleural effusion is unknown. The aim of the present study was to challenge the ability of SVV, PPV and GEDV to predict fluid responsiveness in a porcine model with pleural effusions.
Methods: Pigs were studied at baseline and after fluid loading with 8 ml kg−1 6% hydroxyethyl starch. After withdrawal of 8 ml kg−1 blood and induction of pleural effusion up to 50 ml kg−1 on either side, measurements at baseline and after fluid loading were repeated. Cardiac output, stroke volume, central venous pressure (CVP) and pulmonary occlusion pressure (PAOP) were obtained by pulmonary thermodilution, whereas GEDV was determined by transpulmonary thermodilution. SVV and PPV were monitored continuously by pulse contour analysis.
Results: Pleural effusion was associated with significant changes in lung compliance, peak airway pressure and stroke volume in both responders and non-responders. At baseline, SVV, PPV and GEDV reliably predicted fluid responsiveness (area under the curve 0.85 (p<0.001), 0.88 (p<0.001), 0.77 (p = 0.007). After induction of pleural effusion the ability of SVV, PPV and GEDV to predict fluid responsiveness was well preserved and also PAOP was predictive. Threshold values for SVV and PPV increased in presence of pleural effusion.
Conclusions: In this porcine model, bilateral pleural effusion did not affect the ability of SVV, PPV and GEDV to predict fluid responsiveness
Direct Current Auditory Evoked Potentials During Wakefulness, Anesthesia, and Emergence from Anesthesia
Direct current auditory evoked potentials (DC-AEPs)
are a sensitive indicator of depth of anesthesia in ani-mals. However, they have never been investigated in
humans. To assess the potential usefulness of DC-AEPs
as an indicator of anesthesia in humans, we performed
an explorative study in which DC-AEPs were recorded
during propofol and methohexital anesthesia in hu-mans.
DC-AEPs were recorded via 22 scalp electrodes
in 19 volunteers randomly assigned to receive either
propofol or methohexital. DC-AEPs were evoked by
binaurally presented 2-s, 60-dB, 800-Hz tones; meas-urements
were taken during awake baseline, anesthesia,
and emergence. Statistical analysis included analy-sis
of variance and discriminant analysis of data
acquired during these three conditions. About 500 ms
after stimulus presentation, DC-AEPs could be ob-served.
These potentials were present only during base-line
and emergencenot during anesthesia. Statistically
significant differences were found between
baseline and anesthesia and between anesthesia and
emergence. In conclusion, similar effects, as reported in
animal studies of anesthetics on the DC-AEPs, could be
observed in anesthetized humans. These results dem-onstrate
that DC-AEPs are potentially useful in the assessment
of cortical function during anesthesia and
might qualify the method for monitoring anesthesia in
humans
To Tube or Not to Tube? The Role of Intubation during Stroke Thrombectomy.
In the 10 years since the FDA first cleared the use of endovascular devices for the treatment of acute stroke, definitive evidence that such therapy improves outcomes remains lacking. The decision to intubate patients undergoing stroke thrombectomy impacts multiple variables that may influence outcomes after stroke. Three main areas where intubation may deleteriously affect acute stroke management include the introduction of delays in revascularization, fluctuations in peri-procedural blood pressure, and hypocapnia, resulting in cerebral vasoconstriction. In this mini-review, we discuss the evidence supporting these limitations of intubation during stroke thrombectomy and encourage neurohospitalists, neurocritical care specialists, and neurointerventionalists to carefully consider the decision to intubate during thrombectomy and provide strategies to avoid potential complications associated with its use in acute stroke
Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients : a single-center, randomized, controlled trial
Background
Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia.
Methods
Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV).
Results
MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (− 41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: − 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341).
Conclusions
Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol
Comparison of the Effects of Target-Controlled Propofol Infusion and General Anesthesia with Isoflurane on Postoperative Cognitive Functions in Controlled Hypotensive Anesthesia
Background/aim: We evaluated anesthesia depth, cerebral oxygenation and postoperative cognitive functions with NIRS and BIS monitoring and Mini-Mental State Examination (MMSE) score.Materials and methods: We studied 60 patients in Al –zahra teaching hospital over 18 years of age, with a preoperative MMSE test score of 23 and above. Hemodynamic parameters, BIS and bilateral NIRS values were recorded. The mean arterial pressure (MAP) value was kept between 55-65 mmHg. MMSE test was repeated 1 hour before and 24 hours postoperatively.Results: The extubation time was shorter. Aldrete recovery score and NIRS values were was higher and blood pressure and heart rate values were lower in the desflurane group. There was a moderate positive correlation between blood pressure values and NIRS in a certain part of the operation in the isoflurane group. In the propofol group, 5 patients had a more than 20% decrease in rSO2. In MMSE test score, there was no decrease in both groups in the preoperative and postoperative period.Conclusion: We think that, the isoflurane group be preferred as a priority with less remifentanil expenditure, lower blood pressure values, higher rSO2 values, no 20% decrease in rSO2 values, faster extubation, and statistically significant early recovery.Bispectral index, isoflurane, Controlled hypotension, Near-infrared spectroscopy, Postoperative cognitive dysfunction, Propofol, Mini mental scoreion DOI: 10.7176/JHMN/95-04 Publication date: November 30th 2021
ASSESSMENT OF TOTAL INTRAVENOUS ANESTHESIA BY PROPOFOL AND INHALATIONAL ANESTHESIA WITH ISOFLURANE FOR CONTROLLED HYPOTENSION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY
Objective: The study’s key objective is to compare the propofol-based total intravenous anesthesia (TIVA) with isoflurane-based inhalational anesthesia for controlled hypotension during functional endoscopic sinus surgery (FESS).
Methods: This study was a prospective randomized and controlled single-blinded clinical study. The study involved 40 patients posted for elective FESS surgery, selected randomly from the ENT department. Anesthesia was induced with Inj. Midazolam 2 mg, Inj. Fentanyl 2 μg/kg, Inj. Propofol 2 mg/kg, Inj. Vecuronium 0.1 mg/kg was ventilated using oxygen, air, and Isoflurane (FiO2 of 0.5) in patients with isofurane. Injections of 2 mg of midazolam, 2 μg/kg of fentanyl,2 mg/kg propofol, and 0.1 mg/kg vecuronium, as well as oxygen and air for ventilation, were used to induce anesthesia (FIO2 of 0.5) in TIVA group patients. Fromme boezaart scale was used as an evaluation scale for surgical site bleeding.
Results: The average blood loss in the isoflurane group was 134.25±4.65 ml and in the propofol group was 66.95±4.28 ml. The quality of the surgical field in the propofol group is (3.13±0.9), and in the isoflurane group is (3.13±0.8). The results are significant.
Conclusion: Total intravenous anesthesia using propofol provides notable advantages over the traditionally used inhalational anesthetic technique using isoflurane in surgical field conditions and intraoperative blood loss
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Neuroprotective Properties of Xenon.
Xenon is a rare noble gas that was introduced into clinical practice more than 70 years ago. Xenon's clinical properties are predicated by its ability to fit into preformed cavities of macromolecules thereby altering their biological functions. One such action targets the NMDA-subtype of the glutamate receptors thereby inhibiting its excitatory action. As the glutamate receptors are pivotal for both anesthesia and acute neurological injury, its clinical use has included both general anesthesia as well as neuroprotection. In this manuscript, the efficacy and safety of xenon in clinical trials that address both the anesthetic and neuroprotective applications are discussed. Because of the clinical safety of this chemically inert monatomic gas, the lack of an alternative for neuroprotection, and encouraging phase 2 trial data, a multinational pivotal randomized clinical trial (XePOHCAS) has been launched to assess the utility of xenon for patients that have been successfully resuscitated following an out of hospital cardiac arrest but still remain comatose, indicating ongoing neurological ischemic-perfusion injury. If successful, the trial will herald a new era of treatments for previously intractable conditions such as traumatic brain injury, ischemic and hemorrhagic strokes, and anesthetic-induced developmental neurotoxicity
Relación entre la farmacocinética y los cambios hemodinámicos durante la inducción y posicionamiento en pacientes quirúgicos anestesiados con propofol
Tesis por compendio de publicaciones[EN]For long years, it was thought that anaesthetic management did not influence
patient’s outcome. Surgical morbidity and long-term mortality were attributed to
patient’s comorbidity, malignance of the disease, risk infection and type of surgery.
Nowadays, there is an increasing evidence that intraoperative anaesthetic
management can influence long-term patient outcomes. In the last two decades,
surgical mortality rates have been falling and, in part, this is due to a huge
improvement in anaesthesia related factors and safety. For an anaesthesiologist,
perioperative care is no longer the simple fact of administrating the anaesthetic drug
and maintaining the patient “asleep”. Direct-guided fluid therapy, maintaining
intraoperative normothermia, minimizing blood transfusion and avoiding low mean
arterial pressure and deep hypnotic level are additional procedures the
anaesthesiologist is responsible for and that will probably improve patient’s outcome
and decrease surgical mortality.
Hypotension after induction of anaesthesia is quite common and more prevalent
during the late post-induction period and before skin incision (5-10 minutes after),
generally thought to be clinically irrelevant. Nowadays, there is some evidence that
small haemodynamic changes, such as hypotension, even for small periods, are
associated with poor patient outcomes, because they have the potential to cause
an ischemia–reperfusion injury which may be manifested as dysfunction of any vital
organ, like acute kidney and myocardial injury. Intra-operative management of
hypotension is usually guided by conventional monitoring (systolic blood pressure and
MAP) but these parameters could mask low levels of blood flow and oxygen delivery,
even for short periods, leading to major surgical complications and longer hospital
stays
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