Surgical Music Therapy: A Narrative Review

This study is aimed to review the documents and clarify the relation between music therapy and surgical procedures. Surgical procedures are often accompanied by psychological feelings such as fear and anxiety, which can affect the anesthesia process and lead to increased sedation and undesirable physiological and metabolic changes. These changes can cause deleterious effects when exaggerated. According to neuroscience-based evidences, music can activate limbic and paralimbic brain structures, which play a role in changing the emotional state. In conclusion, music could help to alleviate unwanted feelings and control surgical stress

Anesthetic Management of a Patient with Achondroplasia Undergoing Adenotonsillectomy: A Case Report

Background: There are several situations that can create a challenge to every anesthesiologist; one of them is genetic disorders such as achondroplastic dwarfism. Achondroplastic dwarfism is the most common form of skeletal dysplasia, affecting about one in 20,000 newborns. It is an autosomal disorder caused by a mutation of the fibroblastic growth factor receptor-3 gene.Case Presentation: A 7‐year‐old boy diagnosed with achondroplasia was admitted for adenotonsillectomy. He had several classical symptoms and signs of upper airway and cardiac involvement. In this case report, we describe the anesthetic management of this patient, while reviewing the difficulties encountered by the anesthesia team perioperatively.Conclusions: Difficulties with airway management and physiology of this disease can create significant challenges to the anesthesiologist. So, we should keep in mind that achondroplasia can be a complicated situation and were should be prepared to manage it

Could molecular studies save Hydroxyethyl starch from total disappearance?

Up until now, hydroxyethyl starch (HES) solutions have mainly been indicated as "volume expanders". Recent unfavorable reports of these solutions such as probability of kidney injury or inducing coagulopathy have relatively ejected these solutions in many centers, particularly in European countries. Despite several confirming studies, multiple anecdotal letters or reviews has challenged total disappearance of these colloids from medicine practice. Also, some novel observations emphasized the distinguished ability of HES to preserve the microvascular integrity even at the presence of an inflammatory process. Despite extreme statements has been published demanding immediate suspension of these fluids from the market, it seems logical to revise the most recent studies which may declare new pathways to approach HES family of solutions.

Anesthetic management of patients with Klippel-Feil syndrome, a case series

Introduction: Klippel feil syndrome (KFS) is a rare entity which is characterized by failure of normal segmentation of cervical vertebrae resulting in short neck with restricted movement and cervical instability. This anomaly increases the risk of neurological damage during airway instrumentation like laryngoscopy and positioning for surgery.Case Rports: We report three patients, a 42 year old male patient with KFS who scheduled for craniocervical fusion under general anesthesia and a 6 year old girl candidate for cleft palate repair and a 26 year old woman candidate for craniocervical fusion.Conclusion: All the cases were successfully managed using fiberoptic bronchoscope in first two cases and gum elastic bougie (GEB) in the last case. All things together, Awake fiberoptic intubation could be the safest technique for airway management

Anesthetic Management of Cervical Disc Herniation in a Patient with Churg-Strauss Syndrome: A Case Report

Churg-Strauss syndrome (CSS) or allergic granulomatosis is a necrotizing vasculitis with different presentations. In this case highlights the anesthetic management of a known case of CSS who underwent posterior spinal fixation surgery. Our patient fulfilled the ACR diagnosis criteria because of  showing asthma, paranasal sinusitis, positive skin biopsy and eosinophilia.Before anesthesia induction, laryngeal nerves block by lidocaine was conducted. Fiber-optic bronchoscopy was preceded by inserting a No. 7.5 spiral cuffed endotracheal tube

Anesthetic considerations of Palmoplantar Keratoderma (PPK), a case report.

Palmoplantar keratoderma(PPK) refers to a group of heterogeneous disorders defined by thickening of skin on the palms and soles. Due to diversity of symptoms and involved organs, the term PPK does not describe each individual patient precisely. The syndrome is quite rare and unknown to the anesthesiologists, while serious associations such as difficult airway or cardiac disease are significant challenges during perioperative management. The literature lacks enough data on anesthetic considerations in these patients, implicating case reports as the only available sources. We revised the accessible information through description of our patient

A comparative study of influence of isoflurane and propofol on IL1, IL6, TNF serum levels after craniotomy for supratentorial brain tumors

Background: The purpose of this randomized, single-center study was to prospectively investigate the impact of anesthetic techniques for craniotomy on the release of cytokines (interleukin (IL)-1, IL-6, tumor necrosis factor factor-alpha (TNF-α)) and to determine whether intravenous anesthesia compared to inhalational anesthesia attenuates the inflammatory response.Methods and Materials: The study enrolled 60 patients undergoing craniotomy, allocated into two equal groups to receive either Isoflurane (n=30) and Propofol (n=30). Non-invasive hemodynamic monitoring was used. Serum levels of IL-1, IL-6 and TNF-α were evaluated before and at the end of surgery and anesthesia.Results: Although there was a significant rise in serum level of inflammatory cytokine but compared with patients anaesthetized with Isoflurane, patients who received Propofol had significant lower levels of IL-1, IL-6 and TNF-a after surgery (p<0.05).Conclusion: Patients who received Propofol had lower levels of IL-1, IL-6 and TNF-α after surgery. Our findings should incite future studies to prove a potential medically important anti-inflammatory role of Propofol in neuroanesthesia

Antioxidative Effects of Isoflurane and Propofol on Serum Levels of Catalase, Glutathione and Superoxide Dismutase in Craniotomy for Supratentorial Tumor

Background: Surgical stresses can reduce the activity level of antioxidant enzymes. The brain is one of the vital organs of the body and yet vulnerable to oxidative damage. Considering the antioxidative effects of anesthetics, this study aimed to compare the effect of isoflurane and propofol on the serum levels of catalase, glutathione peroxidase and superoxide dismutase in patients who experienced craniotomy due to supratentorial tumor.Methods and materials: This randomized clinical trial was performed on 40 patients with supratentorial tumor craniotomy in Loghman Hakim hospital in Tehran (capital city of Iran), who were randomly assigned to receive propofol and isoflurane. Data were collected using a questionnaire including age, sex, serum glutathione peroxidase level, serum superoxide dismutase level, serum catalase levels, duration of surgery, and fentanyl. Data were analyzed using SPSS-21 software, Chi-Square, Paired T-test, ANOVA, independent t-test, Kruskal-Wallis and Wilcoxon tests.Results: Increasing in serum catalase level after surgery was significant in propofol group (p=0.002), but not significant in isoflurane group. Reduction of serum glutathione peroxidase level after surgery was significant in the isoflurane group (p=0.003), but not significant in propofol group. Reduction of serum level of superoxide dismutase after surgery was not significant in both groups. Serum levels of catalase, glutathione and superoxide dismutase were not significantly correlated with age, sex, fentanyl and duration of surgery.Conclusion: The study showed that serum catalase levels increased in the propofol group after surgery. However, serum glutathione peroxidase levels decreased in the isoflurane group after surgery. Changes in serum level of superoxide dismutase after surgery were not related to the type of anesthetic drug.Keywords: Isoflurane, Propofol, Catalase, Glutathione peroxidaase, Superoxide dismutase, Craniotom

Osteogenesis Imperfecta: Genetic Overview and the Role of Anesthesiologists

Osteogenesis Imperfecta (OI) is a genetic disorder with skeletal, vascular and soft tissue involvement with different clinical presentations. Since these patients need different surgical procedure in their lifetime, anesthesiologists are involved with their perioperative care and should be familiar with pathogenesis and anesthetic considerations of OI. Here we represent a case of OI which was candidate for Video Assisted Thoracic Surgery (VATS) and review the literature