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He HC, Yu BJ, Mai SY, Liu Y, Li MY, Yan XY, Huang XH. Effects of Three Different Heating Devices on Patients Undergoing Surgery: A Network Meta-Analysis. J Perianesth Nurs 2024:S1089-9472(23)01105-X. [PMID: 38795084 DOI: 10.1016/j.jopan.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 05/27/2024]
Abstract
PURPOSE Perioperative hypothermia is a common anesthesia-related complication that can result in negative outcomes. Intraoperative active heating can positively impact these outcomes. Therefore this study aimed to investigate the effectiveness of three common heating devices for controlling hypothermia, improving thermal comfort, and reducing anesthesia recovery time. DESIGN Systematic review and meta-analysis. METHODS Seven electronic literature databases were searched from the inception date of the databases to March 18, 2022. RevMan 5.4 and Stata 15.1 were used to perform meta-analyses on the obtained data, and the Cochrane Evaluation Manual was used for quality risk assessment of the included studies. FINDINGS A total of 18 studies involving 1,511 patients undergoing surgery using heating devices were included. In this meta-analysis, a ranking method known as the Surface Under the Cumulative Ranking Curve (SUCRA) was used. SUCRA provides a numerical measure of the effectiveness of treatments, with higher values indicating superior efficacy. Findings demonstrated that the concurrent use of three heating devices led to an elevation in core body temperatures (SUCRA = 69.2%) and enhanced delayed recovery (SUCRA = 88.6%) as compared to the application of a single device. Furthermore, for thermal comfort, the employment of heating blankets proved to be the most effective (SUCRA = 87.8%). CONCLUSIONS This study showed the core body temperatures and reductions in delayed recovery were greater when three heating devices were used together as compared to use one of them alone. Heating blankets was the most effective option for improving the thermal comfort of patients. Thus, clinicians should opt for appropriate heating equipment according to the type of surgery and the characteristics and needs of patients. The choice of appropriate heating equipment will ensure surgical safety, improve patient comfort, and reduce surgical risks.
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Affiliation(s)
- Hao C He
- Guangdong Pharmaceutical University, Guangdong, China; The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China
| | - Bi J Yu
- Guangdong Pharmaceutical University, Guangdong, China
| | - Shu Y Mai
- Guangdong Pharmaceutical University, Guangdong, China
| | - Ye Liu
- Guangdong Pharmaceutical University, Guangdong, China
| | - Meng Y Li
- Guangdong Pharmaceutical University, Guangdong, China
| | - Xiao Y Yan
- Guangdong Pharmaceutical University, Guangdong, China
| | - Xiao H Huang
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China.
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Jones H, Robson K, Maddox T, Alderson B. Incidence of and risk factors for poor recovery quality in dogs recovering from general anaesthesia-a prospective case control study. Vet Anaesth Analg 2024; 51:227-234. [PMID: 38350794 DOI: 10.1016/j.vaa.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate the incidence of and identify risk factors associated with poor quality of recovery in dogs recovering from general anaesthesia. STUDY DESIGN Case controlled study. METHODS All dogs undergoing general anaesthesia at the University of Liverpool Small Animal Teaching Hospital between January 2020 and January 2021 were eligible for recruitment. Signalment, anaesthetic case management and a recovery score were recorded. Univariable and multivariable logistic and ordinal logistic regression analysis were used to identify factors which impact incidence of poor quality of recovery. RESULTS A total of 247 dogs undergoing general anaesthesia were included. Overall, 72 [29.1%; 95% confidence interval (CI) 23.8%-35.1%] dogs experienced a poor quality recovery. Of these, 40 (55.5%) required sedation to manage behaviours associated with poor recovery. Multivariable logistic regression revealed American Society of Anesthesiologists (ASA) physical status classification of III or higher was associated with a decreased incidence of poor quality recovery [odds ratio (OR) = 0.34, 95% CI 0.12-0.93, p = 0.037] and the use of multiple inhalational anaesthetics during one procedure was associated with an increased incidence of poor quality of recovery (OR = 42.5, 95% CI 3.0-598.3, p = 0.005). CONCLUSIONS AND CLINICAL RELEVANCE Poor quality recovery is common in dogs recovering from general anaesthesia and sedation is often required for resolution. It is more likely to occur in healthy veterinary patients (ASA I and II). The use of multiple inhalational anaesthetic agents during one procedure should be discouraged as this may increase the likelihood of poor quality of recovery.
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Affiliation(s)
- Heather Jones
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK.
| | - Katherine Robson
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Thomas Maddox
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Briony Alderson
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
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Alghamdi L, Filfilan R, Alghamdi A, Alharbi R, Kayal H. Factors Associated With Prolonged-Stay Patients Within the Post-anesthesia Care Unit: A Cohort Retrospective Study. Cureus 2024; 16:e60092. [PMID: 38860092 PMCID: PMC11163871 DOI: 10.7759/cureus.60092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The post-anesthesia care unit (PACU) plays a crucial role in providing specialized care to postoperative patients. However, a subset of these patients experiences complications that result in a prolonged stay of 90 minutes or more in the PACU. This not only impacts the patient's quality of life but also disrupts hospital workflow, as it might cause postoperative pain, nausea, or vomiting. It is essential to identify the factors contributing to this prolonged length of stay (LOS) and explore strategies for its prevention and management. Methods: We conducted a retrospective cohort study of postoperative patients between 2020 and 2021. We included patients who had a prolonged stay, excluding cardiac patients, patients who had a planned prolonged stay, and patients waiting for an intensive care unit bed. We used a non-probability consecutive sampling technique. Data were obtained from the BestCare System, the hospital's information system, using a data collection sheet. RESULTS A total of 15,170 patients underwent surgical procedures during the study period, out of which only 181 (1.19%) experienced a prolonged PACU stay. Pain and altered mental status were strongly associated with a prolonged PACU stay (P = 0.035 and P = 0.0009, respectively). However, there was no significant association between overall comorbidities and prolonged LOS in the PACU, except for patients with asthma (P = 0.003). Different types and durations of surgeries did not significantly contribute to a prolonged PACU stay. CONCLUSIONS Our study found that among the various variables examined, asthma, pain, and altered mental status were significantly associated with a prolonged LOS in the PACU. These findings suggest that targeted interventions addressing these factors may help reduce the incidence of prolonged PACU stays and optimize patient outcomes.
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Affiliation(s)
- Leen Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Razan Filfilan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Arwa Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Roza Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Haifaa Kayal
- Anesthesiology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Li T, Jiang Q, Zhong W, Zhu T, Lu Z, Ding Y. One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study. J Orthop Surg Res 2024; 19:254. [PMID: 38649974 PMCID: PMC11034078 DOI: 10.1186/s13018-024-04743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The one-hole split endoscopy (OSE) was first proposed and clinically applied in China in 2019. The aim of this study was to compare the clinical efficacy of one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) for treating lumbar spinal stenosis (LSS). METHODS One hundred sixty patients with LSS who met the inclusion from November 2020 to August 2022 were analyzed and divided into OSE and UBE groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the two groups. After matching, surgical outcomes were recorded, and clinical data, including functional scores and imaging findings, were compared. Functional scores included the visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), the Japanese Orthopedic Association score (JOA), and the Oswestry Disability Index (ODI). Imaging data included dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST). RESULTS After PSM, 104 LSS patients were included in the study, and all covariates were well-balanced between the two groups. Among the matched patients, the OSE showed advantages over the UBE regarding operative time (62.42 ± 4.86 vs. 68.96 ± 4.56) and incision length (2.30 ± 0.14 vs. 2.70 ± 0.15) (P < 0.001). However, differences between the two groups in intraoperative blood loss, hospital length of stay, and complication rates were not statistically significant (P > 0.05). There was no statistically significant difference regarding VAS-BP, VAS-LP, JOA, and ODI between the two groups (P > 0.05). However, all clinical and functional scores significantly improved postoperatively (P < 0.05). Postoperative DCSA of both groups was significantly found to be improved (P < 0.05), ROM and ST remained within the normal range, and no cases of lumbar instability were recorded. According to the modified MacNab criteria, the excellent and good rates in the OSE and UBE groups were 94.23% and 90.38%, respectively, with no statistically significant difference (P = 0.713). CONCLUSION OSE is an alternative technique to UBE for the treatment of LSS, with similar satisfactory clinical outcomes, shorter operative time, and smaller incision length. Further studies are needed for long-term efficacy.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Qiang Jiang
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Wei Zhong
- School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Tengyue Zhu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Zhengcao Lu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
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Elsaeidy AS, Ahmad AHM, Kohaf NA, Aboutaleb A, Kumar D, Elsaeidy KS, Mohamed OS, Kaye AD, Shehata IM. Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis. Curr Pain Headache Rep 2024; 28:211-227. [PMID: 38214834 PMCID: PMC10940385 DOI: 10.1007/s11916-023-01208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE OF REVIEW The combination of ketamine with propofol and dexmedetomidine has gained popularity for sedation and general anesthesia in different populations. In our meta-nalysis, we helped the anesthesiologists to know the efficiency and the efficacy of both combinations in adult and pediatric patients. METHODS We searched PubMed, CENTRAL, Web of Science, and Scopus from inception to August 1, 2023. Our outcome parameters for efficacy were recovery time, pain score, and physician satisfaction while for safety were the related cardiorespiratory, neurological, and gastrointestinal adverse events. RECENT FINDINGS Twenty-two trials were included with a total of 1429 patients. We found a significantly longer recovery time in the ketadex group of 7.59 min (95% CI, 4.92, 10.26; I2 = 94%) and a significantly less pain score of - 0.72 (95% CI, - 1.10, - 0.34; I2 = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I2 = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I2 = 36%). Furthermore, we found a significant difference between the combinations with a higher incidence in the ketadex group with pooled odds ratio of 1.75 (95% CI, 1.06, 2.88; I2 = 15%). Ketadex was associated with lower pain scores, hypoxic events and airway obstruction, and emergence agitation. At the same time, ketofol had much more clinician satisfaction which might be attributed to the shorter recovery time and lower incidence of nausea and vomiting. Therefore, we suppose that ketadex is the better combination in periprocedural sedation for both adult and pediatric patients who are not at greater risk for postoperative nausea and vomiting.
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Affiliation(s)
| | | | - Neveen A Kohaf
- Clinical Pharmacy, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Aya Aboutaleb
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Danisha Kumar
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ola Saeed Mohamed
- Critical Care Medicine, Menofia University, Shibin El Kom, Menofia, Egypt
| | - Alan D Kaye
- Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, 1501 Kings Hwy, Shreveport, LA, 71103, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
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Chen W, Guoyang H, Yu H, Xu Y. Comparisons of fentanyl and sufentanil on recovery time after inguinal hernia repair in children: a randomized clinical trial. BMC Surg 2024; 24:55. [PMID: 38355485 PMCID: PMC10865580 DOI: 10.1186/s12893-024-02346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Inguinal hernia repair is a common pediatric procedure. We studied postoperative recovery times in children undergoing laparoscopic inguinal hernia repair with anesthesia induced by fentanyl versus sufentanil. METHODS We performed a pilot randomized clinical trial between February and December 2022. Eligible children were assigned into two age groups, 2-6 and 6-12 years old groups. Then, children in each age group were randomly assigned into either the fentanyl (2 µg/kg) or sufentanil (0.2 µg/kg) group for anesthesia induction. Baseline characteristics were collected. The primary outcome was the postoperative recovery time, which was recorded as the time period from extubation to a Steward recovery score reaching 6. Secondary outcomes included surgical duration, anesthetic duration, intubation duration, and intraoperative hemorrhage. RESULTS There were 300 children, with 75 children in each group. In the 2-6 years old group, children who received fentanyl had statistically significantly shorter postoperative recovery times than children who received sufentanil (0.9 ± 0.4 versus 1.5 ± 0.3 h, P < 0.001). However, in the 6-12 years old group, children who received fentanyl had statistically significantly longer postoperative recovery times than children who received sufentanil (1.2 ± 0.4 versus 0.8 ± 0.4 h, P < 0.001). Baseline characteristics and secondary outcomes were comparable between two groups. CONCLUSIONS Anesthesia induction with fentanyl or sufentanil resulted in different postoperative recovery times after laparoscopic inguinal hernia repair in children in different age groups. More studies are required to determine the appropriate induction anesthetic in children of different ages. TRIAL REGISTRATION The study protocol was retrospectively registered online at the Chinese Clinical Trial Registry (registration number ChiCTR2300072177, retrospectively registered on 06/06/2023).
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Affiliation(s)
- Wen Chen
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, 745 Wuluo Road, Hongshan District, Wuhan, 430070, China.
| | - Hongyun Guoyang
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, 745 Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Hui Yu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, 745 Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Yutong Xu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, 745 Wuluo Road, Hongshan District, Wuhan, 430070, China
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Radkowski P, Oniszczuk H, Fadrowska-Szleper M, Onichimowski D. Decoding the Neurological Sequelae of General Anesthesia: A Review. Med Sci Monit 2024; 30:e942740. [PMID: 38258288 PMCID: PMC10823754 DOI: 10.12659/msm.942740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/25/2023] [Indexed: 01/24/2024] Open
Abstract
General anesthesia is an integral part of modern surgical practice, but it is associated with a number of complications, including neurological ones. This article provides a thorough analysis of these complications, taking into account the most common ones like drug complications, through delirium, postoperative cognitive impairment (POCD), to the rarest ones like perioperative stroke (POS), spinal cord ischemia (SCI), and postoperative visual loss (POVL). Its main goal is to familiarize healthcare professionals, especially those involved in anesthesiology, with the intricacies of neurological complications. Given their specificity and frequency of occurrence, it is well known that the diagnosis and management of these complications can sometimes cause problems for physicians without advanced neurological knowledge. Also, in addition to complex diagnostics, the pathomechanism of non-pharmacological complications is often not fully understood due to their multifactoriality and sometimes paucity of research. For this reason, an increasing amount of work is being done in the medical community to better understand this group of conditions, enabling faster diagnosis and more effective treatment, as well as perioperative prevention. This paper aims to increase awareness and vigilance among physicians across the spectrum of surgical patient care, from premedication to postoperative follow-up. Drawing on the authors' experience and the extensive medical literature, this paper includes 39 selected articles from 1994 to 2023, seeking the latest insights in the constantly evolving field of neurology and anesthesiology. This article aims to review the neurological complications of general anesthesia.
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Affiliation(s)
- Paweł Radkowski
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Olsztyn, Poland
- Department of Anaesthesiology and Intensive Care, Hospital zum Heiligen Geist in Fritzlar, Fritzlar, Germany
| | - Hubert Oniszczuk
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Białystok, Białystok, Poland
| | - Magdalena Fadrowska-Szleper
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dariusz Onichimowski
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Olsztyn, Poland
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Marino J, Sikachi RR, Ramkumar PN, Baichoo N, Germano JA, Sison C, Lesser ML, Gould JS, Mont MA, Scuderi GR. Discharge From the Postanesthesia Care Unit With Motor Blockade After Spinal Anesthesia Safely Optimizes Fast Track Recovery in Primary Total Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:44-48.e1. [PMID: 37474080 DOI: 10.1016/j.arth.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Post anesthesia care units (PACU) await return of motor function in lower extremities, prior to discharge for patients undergoing spinal anesthesia. The purpose of this study was to assess the impact of a newly utilized recovery protocol that facilitated early discharges of patients undergoing total hip and knee arthroplasties (THA/TKA) to the floor before full motor recovery from spinal anesthesia is achieved. METHODS A total of 647 patients undergoing spinal anesthesia for primary THA (n = 190) and TKA (n = 457) were divided into 2 groups: (1) Early PACU discharge group: patients with partial or full motor blockade at discharge. (2) Control PACU discharge group: patients with full motor recovery at discharge. Readiness for discharge was assessed using a modified Aldrete Score system. The primary outcome was incidences of hypotension or rapid responses post-operatively. RESULTS There was no significant difference in the incidence of hypotension between the two groups (1.4 versus 1.39%, P = 1.0) and zero rapid responses were noted. Early discharge shortened mean PACU LOS time from 86.50 minutes to 70.27 minutes (P < .01). There was no difference in the incidence of nausea (0.55 versus 0%; P = .51) ordizziness (2.22 versus 0.35%; P = .09). CONCLUSION In this retrospective observational study, we found that early PACU discharge did not result in an increase in hemodynamic consequences on the surgical floor. Thus, discharge from PACU can be safely and more expeditiously performed without waiting for return of motor function in patients receiving spinal anesthesia for THA/TKA using a modified Aldrete Score recovery protocol.
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Affiliation(s)
- Joseph Marino
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Valley Stream, New York
| | - Rutuja R Sikachi
- Department of Anesthesiology, Mount Sinai West and Morningside Hospitals, New York, New York
| | - Prem N Ramkumar
- Department of Anesthesiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Cristina Sison
- Biostastics Unit, Feinstein Institute of Medical Research, Northwell Health, Manhasset, New York
| | - Martin L Lesser
- Biostastics Unit, Feinstein Institute of Medical Research, Northwell Health, Manhasset, New York
| | - J Scott Gould
- Department of Physician Assistant Studies, Hofstra University, Hempstead, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New York, New York
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Aggarwal S, Misquith JCR, Rao ST, Mahanta P. Comparison of three scoring criteria to assess recovery from general anesthesia in the postanesthesia care unit in the indian population. Ann Afr Med 2024; 23:82-86. [PMID: 38358176 PMCID: PMC10922174 DOI: 10.4103/aam.aam_165_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
Background Different discharge criteria are available for shifting patients out from postanesthesia care room following surgery. This study was done to compare the three-scoring system namely traditional time-based criteria, Fast track criteria and modified Aldrete score, in Indian population patients who recover after general anesthesia in postanesthesia care unit (PACU). Materials and Methods Three hundred and seventy-five patients scheduled for general anesthesia were included in this study. Induction of anesthesia was done with intravenous (IV) propofol and maintained with sevoflurane inhalation with oxygen and nitrous oxide. Reversal of residual neuromuscular blockade was done with IV neostigmine and glycopyrrolate. Patients were shifted to PACU following tracheal extubation and recovery was assessed using the traditional time-based criteria, fast track criteria, and modified Aldrete score. Results As per modified Aldrete score, mean time of shift out is 19 min with median of 15 min and standard deviation of 21.7 min. As per fast-track score, mean time of shift out is 187 min with median of 30 min and standard deviation of 243.7 min. As per the time-based criteria, mean time of shift out is 222 min with median of 240 min and standard deviation of 136.8 min. While using modified Aldrete score, majority of patients had a shorter stay in PACU and faster time to shift out as compared to fast-track criteria and traditional time-based criteria. Conclusion Modified Aldrete score when compared to fast-track scoring and time-based criteria shows early recovery and reduces the length of stay in PACU.
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Affiliation(s)
- Shagun Aggarwal
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Julie C R Misquith
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sumesh T. Rao
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Priyanka Mahanta
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Srinivasa NK, Mishra RK, Bhadrinarayan V, Kulanthaivelu K. Hippocampal volume and recovery profile following propofol sedation in children undergoing magnetic resonance imaging: An exploratory study. Saudi J Anaesth 2024; 18:12-16. [PMID: 38313727 PMCID: PMC10833008 DOI: 10.4103/sja.sja_108_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/26/2023] [Indexed: 02/06/2024] Open
Abstract
Background Reduction in the hippocampal volume may contribute to agitated and delayed emergence after anesthesia in epilepsy surgery. We hypothesized that hippocampal volume and the duration of various recovery parameters after a short duration of sedation may be correlated. The primary objective was to evaluate the correlation between hippocampal volumes with time to recovery after the stoppage of propofol infusion. Methods After obtaining Institute Ethical Clearance, we included all children of the age group 5-17 years, who needed sedation for brain magnetic resonance imaging (MRI) for at least 20-60 minutes for the evaluation of epilepsy. The hippocampal volume was estimated bilaterally in the pre-contrast volumetric magnetization-prepared rapid gradient-echo (MPRAGE) brain imaging by the radiologist using statistical parametric mapping. The correlation of hippocampal volume with recovery and time to discharge (assessed by the modified Aldrete score (MAS)) was obtained using Spearman's correlation coefficient (rho). A rho > ± 0.5 was considered a good correlation between the variables. Results Data on a total of 18 children (10 males and 8 females) who required sedation for an MRI were studied over a period of six months. The correlation coefficients of right and left corrected hippocampal volumes with time to spontaneous eye opening were -0.052 and -0.195, respectively. The correlation coefficients of right and left corrected hippocampal volumes with time to respond to oral commands were -0.017 and -0.219, respectively. Conclusion There was a weak negative correlation between hippocampal volumes and recovery parameters after a short duration of sedation with propofol in children.
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Affiliation(s)
| | - Rajeeb Kumar Mishra
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Varadarajan Bhadrinarayan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Liu X, Zhang Y, Cai X, Kan H, Yu A. Delayed discharge from post-anesthesia care unit: A 20-case retrospective series. Medicine (Baltimore) 2023; 102:e35447. [PMID: 37904367 PMCID: PMC10615528 DOI: 10.1097/md.0000000000035447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/06/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To summarize the characteristics of patients with delayed discharge from the post-anesthesia care unit and to analyze the factors and outcomes of delayed discharge. METHODS Twenty cases of delayed discharge from the PACU (PACU stay >2 hours after surgery) of the main operating room in Liaocheng People's Hospital, a class A tertiary comprehensive hospital, between January 1, 2021, and December 31, 2022, among 28,084 patients who were transferred to the PACU from the operating rooms after surgery, were retrospectively analyzed. The collected data included patient characteristics, American society of anesthesiologists grade, information related to surgery and anesthesia, and outcomes. The factors for delay were assigned to 1 of 6 groups: delayed recovery from anesthesia, surgical complications, cardiovascular instability, hypoxia, inadequate analgesia, and waiting for the operating room. RESULTS The incidence of delayed discharge from PACU was 0.7‰. Among 20 patients, more than half of the patients were over 65 years of age, American society of anesthesiologists grade II~III, body mass index <30 kg/m2, and urological surgery (7, 35%), liver surgery (4, 20%), thoracic surgery (4, 20%) accounted for a relatively high proportion. Nineteen (95%) patients received general anesthesia with or without peripheral nerve block. The main factors included delayed recovery from anesthesia (6, 30%), surgical complications (5, 25%), cardiovascular complications (4, 20%), hypoxia (3,15%). After discharge from the PACU, 1 (5%) died in the intensive care unit, and the other 19 (95%) patients were safely discharged from the hospital. CONCLUSION The incidence of delayed discharge from the PACU was low, and it was more likely to occur in the elderly, during major operations, and under general anesthesia. Delayed recovery from anesthesia was the most common factor. Most patients were safely discharged from the hospital.
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Affiliation(s)
- Xiaohui Liu
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Yimin Zhang
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Xingzhi Cai
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Huili Kan
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Ailan Yu
- Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
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12
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Alghamdi AS, Almuzayyen H, Chowdhury T. The elderly in the post-anesthesia care unit. Saudi J Anaesth 2023; 17:540-549. [PMID: 37779571 PMCID: PMC10540998 DOI: 10.4103/sja.sja_528_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/18/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023] Open
Abstract
It is increasingly conceivable that elderly patients will be treated in perioperative settings as the world's population shifts toward an older age distribution. They are more prone to a variety of unfavorable outcomes as a consequence of the physiological changes that accompany aging and the coexistence of multiple medical conditions. Postoperative complications in elderly patients are linked to a large increase in morbidity and mortality and the burden placed on the healthcare system. Our goal is to determine how elderly patients' recovery after anesthesia differs from that of younger patients. In addition, we will discuss the main postoperative complications experienced by elderly patients and the measures that are utilized to limit the risk of these complications developing.
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Affiliation(s)
| | - Hisham Almuzayyen
- Department of Anesthesiology, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Tumul Chowdhury
- Associate Professor, Staff Anesthesiologist, Toronto Western Hospital, Clinical Investigator, UHN, University of Toronto, Canada
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13
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Vincent KF, Solt K. Modulating anesthetic emergence with pathway-selective dopamine signaling. Curr Opin Anaesthesiol 2023; 36:468-475. [PMID: 37552017 PMCID: PMC10528732 DOI: 10.1097/aco.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW To summarize the recent preclinical findings investigating dopaminergic circuits for their involvement in reversing anesthetic-induced unconsciousness. RECENT FINDINGS The release of dopamine from the ventral tegmental area onto dopamine D1 receptor-expressing neurons in the nucleus accumbens promotes emergence following general anesthesia. Two relevant targets of dopamine D1 receptor-expressing neurons in the nucleus accumbens include the lateral hypothalamus and ventral pallidum. Activating mesocortical dopaminergic projections from the ventral tegmental area to the prelimbic cortex has also been shown to hasten emergence from general anesthesia. In contrast, the nigrostriatal dopamine pathway is not involved in regulating anesthetic emergence. The role of the tuberoinfundibular endocrine dopamine pathway remains to be tested; however, recent studies have identified an important function of neuroendocrine signaling on modulating general anesthesia. SUMMARY Potential avenues for accelerating anesthetic emergence may be found through targeting specific arousal-promoting pathways in the brain. Accumulating evidence from rodent studies manipulating cell type- and circuit-specific signaling pathways have identified dopamine as a potent modulator of general anesthesia. Specifically, dopamine signaling along the mesolimbic and mesocortical pathways plays a fundamental role in regulating consciousness.
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Affiliation(s)
- Kathleen F. Vincent
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Ken Solt
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Bayable SD, Amberbir WD, Fetene MB. Delayed awakening and its associated factor following general anesthesia service, 2022: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:4321-4328. [PMID: 37663712 PMCID: PMC10473332 DOI: 10.1097/ms9.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/15/2023] [Indexed: 09/05/2023] Open
Abstract
Background The time to emerge from anesthesia is affected by patient factors, anesthetic factors, the duration of surgery, and preoperative and intraoperative pain management. Objective This study aimed to determine the prevalence and contributing factors of delayed awakening following general anesthesia. Method A cross-sectional study was conducted from January to June 2022. After getting ethical approval with the permission number S/C/R 37/01/2022, willing patients participate with written informed consent. Chart reviews in the preoperative and postoperative recovery rooms were used to collect data. Frequency and percentage with cross-tabulation were used to provide the descriptive statistics. To determine the predictive variables that were associated with the outcome variable, bivariable, and multivariable logistic regression models were fitted. The statistical significance was evaluated using P-values of 0.05 for multivariable regression. Results In the current study, a normal emergency occurred in 91.7% of surgical patients receiving general anesthesia, while delayed awakening, emergence with hypoactive, and emergence with delirium occurred in 2.6, 3.9, and 1.8% of cases, respectively. Patients older than 64 years [adjusted odds ratio (AOR): 1.33, 95% CI: 0.83-7.191], being diploma anesthesia providers (AOR: 2.38, 95% CI: 2.05-7.15), opioids (AOR: 2.3, 95% CI: 2.20-5.76), surgery lasting longer than 2 h (AOR: 1.91, 95% CI: 1.83-6.14), estimated blood loss of more than 1500 ml (AOR: 1.20, 95% CI: 0.62-11.30), crystalloid administration of more than 3000 ml (AOR: 3.12, 95% CI: 2.19-7.32), intraoperative hypotension (AOR: 3.37, 95% CI: 2.93-9.41) and extreme body weight, were significantly linked to delayed awakening after general anesthesia. Conclusion Although delayed emergence is an uncommon condition with a number of contributing causes, it is preventable, and once it has occurred, it presents a challenge for anesthetists.
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Affiliation(s)
- Samuel D. Bayable
- Department of Anesthesia, College of Medicine and Health Science, Debre Markos University, Amhara
| | - Wubet D. Amberbir
- Department of Anesthesia, Menelik II Health Science College, Addis Abeba
| | - Melaku B. Fetene
- Department of Anesthesia, College of Medicine and Health Science, Debre Berhan University, Debre Birhan, Ethiopia
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15
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Liu T, Zhang X, Li A, Liu T, Yang X, Zhang H, Lei Y, Yang Q, Dong H. Effects of intra-operative administration of subanesthetic s-ketamine on emergence from sevoflurane anesthesia: a randomized double-blind placebo-controlled study. BMC Anesthesiol 2023; 23:221. [PMID: 37353750 PMCID: PMC10288804 DOI: 10.1186/s12871-023-02170-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Ketamine is administered in the perioperative period for its benefits in analgesia, anti-agitation and anti-depression when administered at a small dose. However, it is not clear whether the intra-operative administration of ketamine would affect emergence under sevoflurane anesthesia. To investigate this effect, we designed this trial. METHODS In this randomized, double-blind, placebo-controlled study, we enrolled 44 female patients aged 18-60 who were scheduled to elective laparoscopic gynecological surgeries. All patients were randomly assigned to saline or s-ketamine group. In s-ketamine group, patients received 0.125 mg/kg s-ketamine 30 min after the start of surgery. In saline group, patients were administered the same volume of saline. Sevoflurane and remifentanil were used to maintain general anesthesia. The primary outcome was emergence time. We also assessed postoperative agitation, cognitive function, and delirium. In addition, we collected and analyzed prefrontal electroencephalogram (EEG) during and after general anesthesia. RESULTS There were no significant differences in emergence time between s-ketamine group and saline group (10.80 ± 3.77 min vs. 10.00 ± 2.78 min, P = 0.457). Neither postoperative agitation (4 [3, 4] vs. 4 [3, 4], P = 0.835) nor cognitive function (25.84 ± 2.69 vs. 25.55 ± 2.19, P = 0.412) differed between groups. No postoperative delirium was observed in either group. Subanesthetic s-ketamine resulted in active EEG with decreased power of slow (-0.35 ± 1.13 dB vs. -1.63 ± 1.03 dB, P = 0.003), delta (-0.22 ± 1.11 dB vs. -1.32 ± 1.09 dB, P = 0.011) and alpha (-0.31 ± 0.71 dB vs. -1.71 ± 1.34 dB, P = 0.0003) waves and increased power of beta-gamma bands (-0.30 ± 0.89 dB vs. 4.20 ± 2.08 dB, P < 0.0001) during sevoflurane anesthesia, as well as an increased alpha peak frequency (-0.16 ± 0.48 Hz vs. 0.31 ± 0.73 Hz, P = 0.026). EEG patterns did not differ during the recovery period after emergence between groups. CONCLUSION Ketamine administered during sevoflurane anesthesia had no apparent influence on emergence time in young and middle-aged female patients undergoing laparoscopic surgery. Subanesthetic s-ketamine induced an active prefrontal EEG pattern during sevoflurane anesthesia but did not raise neurological side effects after surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2100046479 (date: 16/05/2021).
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Affiliation(s)
- Tiantian Liu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Xinxin Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Ao Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Tingting Liu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Xue Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Huanhuan Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Yanling Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China
| | - Qianzi Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China.
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China.
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16
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Shrestha A, Bhattarai A, Tamrakar KK, Chand M, Yonjan Tamang S, Adhikari S, Neupane HC. Utility of the Parkland Grading Scale to determine intraoperative challenges during laparoscopic cholecystectomy: a validation study on 206 patients at an academic medical center in Nepal. Patient Saf Surg 2023; 17:12. [PMID: 37226189 DOI: 10.1186/s13037-023-00364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Most of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. This study aims to utilize the Parkland Grading Scale system to assess the intraoperative challenges during laparoscopic cholecystectomy. METHOD This was a prospective, cross-sectional study done at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal. All the patients underwent laparoscopic cholecystectomy from April 2020 to March 2021. Based on the initial intra-operative finding, Parkland Grading Scale was noted and at the end of the surgery, the level of difficulty was given by the operating surgeon. All the pre-operative, intra-operative, and post-operative findings were compared with the scale. RESULTS Out of 206 patients, there were 176 (85.4%) females, and 30 (14.6%) males. The median age was 41 years (Range 19-75). The median body mass index was 23.67 kg/m2. There were 35(17%) patients with a history of previous surgery. The rate of conversion to open surgery was 5.8%. According to Parkland Grading Scale, 67(32.5%), 75(36.4%), 42(20.4%), 15(7.3%), and 7(3.4%) were graded as grade 1, 2, 3, 4, and 5 respectively. There was a difference in the Parkland grading scale in patients with a history of acute cholecystitis, gallbladder wall thickness, pericholecystic collection, stone size, and body mass index (p < 0.05). The total operative time, level of difficulty in surgery, rate of help needed from colleagues or replacement as the main surgeon, bile spillage, drain placement, gallbladder decompression, and conversion rate all increased with an increase in scale (p < 0.05). There was a significant increase in the development of post-operative fever, and post-operative hospital stay as the scale increased (p < 0.05). The Tukey-Kramer test for all pair-wise comparisons revealed that each grade was significantly different from each other (p < 0.05) on the difficulty of surgery except for grade 4 from 5. CONCLUSION Parkland Grading Scale system is a reliable intra-operative grading system to assess the difficulty in laparoscopic cholecystectomy and helps the surgeon to change the strategy of surgery. An increase in scale is associated with an increased difficulty level of the surgery.
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Affiliation(s)
- Anup Shrestha
- Department of Surgery, Chitwan Medical College and Teaching Hospital, Chitwan, Nepal.
- Department of Surgery, Indira Gandhi Memorial Hospital, Male, Maldives.
| | - Abhishek Bhattarai
- Department of Surgery, Chitwan Medical College and Teaching Hospital, Chitwan, Nepal
| | - Kishor Kumar Tamrakar
- Department of Surgery, Chitwan Medical College and Teaching Hospital, Chitwan, Nepal
| | - Manoj Chand
- Department of Surgery, Chitwan Medical College and Teaching Hospital, Chitwan, Nepal
| | | | - Sampada Adhikari
- School of Medicine, Chitwan Medical College and Teaching Hospital, Chitwan, Nepal
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17
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Deverett B. Anesthesia for non-traditional consciousness. Front Hum Neurosci 2023; 17:1146242. [PMID: 37228852 PMCID: PMC10203240 DOI: 10.3389/fnhum.2023.1146242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
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18
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Zhang Q, Xu F, Xuan D, Huang L, Shi M, Yue Z, Luo D, Duan M. Risk factors for delayed recovery in postanesthesia care unit after surgery: a large and retrospective cohort study. Int J Surg 2023; 109:1281-1290. [PMID: 37074025 PMCID: PMC10389494 DOI: 10.1097/js9.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/12/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Delayed recovery in the postanesthesia care unit (PACU) after surgery, as a severe occurrence, influences enhanced recovery after surgery. The data from the observational clinical study is a paucity. MATERIALS AND METHODS This large, retrospective, and observational cohort study initially included 44 767 patients. The primary outcome was risk factors for delayed recovery in PACU. A generalized linear model and nomogram were employed to identify risk factors. Discrimination and calibration were used to evaluate the performance of the nomogram via internal and external validation. RESULTS Of 38 796 patients, 21 302 (54.91%) were women. The delayed recovery aggregate rate was 1.38% [95% CI, (1.27, 1.50%)]. In a generalized linear model, risk factors for delayed recovery were old age [RR, 1.04, 95% CI, (1.03,1.05), P <0.001], neurosurgery [RR, 2.75, 95% CI, (1.60, 4.72), P <0.001], using antibiotics during surgery [RR, 1.30, 95% CI, (1.02, 1.66), P =0.036], long anesthesia duration [RR, 1.0025, 95% CI, (1.0013, 1.0038), P <0.001], ASA grade of III [RR, 1.98, 95% CI, (1.38, 2.83), P <0.001], and postoperative analgesia [RR, 1.41, 95% CI, (1.10, 1.80), P =0.006]. In the nomogram, old age and neurosurgery had high scores in the model and contributed significantly to the increased probability of delayed recovery. The area under the curve value of the nomogram was 0.77. The discrimination and calibration of the nomogram estimated by internal and external validation were generally satisfactory. CONCLUSION This study demonstrates that delayed recovery in PACU after surgery was associated with old age, neurosurgery, long anesthesia duration, an ASA grade of III, using antibiotics during surgery, and postoperative analgesia. These findings provide predictors of delayed recovery in PACU, especially neurosurgeries and old age.
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Affiliation(s)
- Qingtong Zhang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongsheng Xuan
- Department of Anesthesiology, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an People’s Hospital, Lu’an
| | - Li Huang
- Department of Anesthesiology, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an People’s Hospital, Lu’an
| | - Min Shi
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Zichuan Yue
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Dongxue Luo
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
| | - Manlin Duan
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University
- State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province
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Xu Z, Hu SW, Zhou Y, Guo Q, Wang D, Gao YH, Zhao WN, Tang HM, Yang JX, Yu X, Ding HL, Cao JL. Corticotropin-releasing factor neurones in the paraventricular nucleus of the hypothalamus modulate isoflurane anaesthesia and its responses to acute stress in mice. Br J Anaesth 2023; 130:446-458. [PMID: 36737387 DOI: 10.1016/j.bja.2022.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 11/23/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Corticotropin-releasing factor (CRF) neurones in the paraventricular nucleus (PVN) of the hypothalamus (PVNCRF neurones) can promote wakefulness and are activated under anaesthesia. However, whether these neurones contribute to anaesthetic effects is unknown. METHODS With a combination of chemogenetic and molecular approaches, we examined the roles of PVNCRF neurones in isoflurane anaesthesia in mice and further explored the underlying cellular and molecular mechanisms. RESULTS PVN neurones exhibited increased Fos expression during isoflurane anaesthesia (mean [standard deviation], 218 [69.3] vs 21.3 [7.3]; P<0.001), and ∼75% were PVNCRF neurones. Chemogenetic inhibition of PVNCRF neurones facilitated emergence from isoflurane anaesthesia (11.7 [1.1] vs 13.9 [1.2] min; P=0.001), whereas chemogenetic activation of these neurones delayed emergence from isoflurane anaesthesia (16.9 [1.2] vs 13.9 [1.3] min; P=0.002). Isoflurane exposure increased CRF protein expression in PVN (4.0 [0.1] vs 2.2 [0.3], respectively; P<0.001). Knockdown of CRF in PVNCRF neurones mimicked the effects of chemogenetic inhibition of PVNCRF neurones in facilitating emergence (9.6 [1.1] vs 13.0 [1.4] min; P=0.003) and also abolished the effects of chemogenetic activation of PVNCRF neurones on delaying emergence from isoflurane anaesthesia (10.3 [1.3] vs 16.0 [2.6] min; P<0.001). Acute, but not chronic, stress delayed emergence from isoflurane anaesthesia (15.5 [1.5] vs 13.0 [1.4] min; P=0.004). This effect was reversed by chemogenetic inhibition of PVNCRF neurones (11.7 [1.6] vs 14.7 [1.4] min; P=0.001) or knockdown of CRF in PVNCRF neurones (12.3 [1.5] vs 15.3 [1.6] min; P=0.002). CONCLUSIONS CRF neurones in the PVN of the hypothalamus neurones modulate isoflurane anaesthesia and acute stress effects on anaesthesia through CRF signalling.
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Affiliation(s)
- Zheng Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Su-Wan Hu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Yu Zhou
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Qingchen Guo
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Di Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Yi-Hong Gao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Wei-Nan Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Hui-Mei Tang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Jun-Xia Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Xiaolu Yu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Hai-Lei Ding
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China.
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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20
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Transient ischemic attack after indirect revascularization surgery for pediatric patients with moyamoya disease: A retrospective study of intraoperative blood pressure. Anaesth Crit Care Pain Med 2023; 42:101168. [PMID: 36309164 DOI: 10.1016/j.accpm.2022.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to investigate the association between intraoperative blood pressure and postoperative transient ischemic attacks (TIAs) in pediatric patients with moyamoya disease after indirect revascularization surgery. METHODS We retrospectively reviewed the medical records of patients with moyamoya disease younger than 15 years who underwent indirect revascularizations under general anesthesia from 2013 to 2019. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. Univariate and multivariable mixed-effect logistic regressions were used to identify predictors of postoperative TIA and symptom progression. RESULTS Among 444 hemispheres in 296 pediatric patients, 70 cases (16%) experienced postoperative TIAs within 2 weeks after surgery, and 34 cases (7.7%) developed postoperative symptom progression. Baseline mean blood pressure (MBP) (adjusted odds ratio, 1.261; 95% confidence interval, 1.037-1.528; P < 0.001), Average mean arterial pressure (MAP) (adjusted odds ratio, 1.137; 95% confidence interval, 1.052-1.228; P = 0.006), and Ipsilateral magnetic resonance angiography (MRA) score (adjusted odds ratio, 1.464; 95% confidence interval, 0.886-2.419; P = 0.012) were statistically significant risk factors for postoperative TIA. Average real variability of MAP (ARV-MAP), which were measures of intraoperative MAP variability (adjusted odds ratio, 4.731; 95% confidence interval, 1.419-15.257; P = 0.003) and maximum MAP declination (MaxD-MAP) (adjusted odds ratio, 1.271; 95% confidence interval, 1.013-1.520; P = 0.010) were statistically significant risk factors for postoperative symptom progression. CONCLUSION Higher pre-induction baseline blood pressure and ipsilateral MRA score were independent risk factors predicting postoperative TIA in pediatric patients with moyamoya disease after indirect revascularization. The high variability and drastic decline in intraoperative MAP showed predictive value in postoperative symptom progression.
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Zhou Y, Peng J, Zhu W, Ke Y, Shan L. Clinical study of multifunctional laryngeal mask in airway interventional therapy. Medicine (Baltimore) 2022; 101:e31388. [PMID: 36397451 PMCID: PMC9666165 DOI: 10.1097/md.0000000000031388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study is conducted to evaluate the efficacy and safety of using multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy. METHODS A total of 200 patients receiving airway interventional therapy were enrolled in this retrospective study and were divided into 2 groups (group M and group P) by doctors in our hospital to compare the effect of different laryngeal masks. Group M used common laryngeal masks and an anesthesia machine for positive pressure ventilation while group P took multifunctional intubation laryngeal masks and used a jet ventilator for normal frequency jet ventilation. The patients' mean arterial pressure, heart rate, arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2), and the operation time, recovery score and the patients' and doctors' satisfaction levels were compared between the 2 groups. RESULTS Both groups were hemodynamically stable, and their PaO2 levels were significantly higher before the operation than that during and after the operation (P < .05). Compared with group M, the PaCO2 level of group P was more stable both during and after the operation, and this difference was statistically significant (P < .05). There was no statistically significant difference in terms of the 2 group's operating time, recovery score, and patients' satisfaction levels (P > .05). However, the satisfaction levels of doctors in group P were higher than that in group M, and this difference was statistically significant (P < .05). CONCLUSION As statistics show, the intraoperative hemodynamics and PaO2 and PaCO2 levels were stable, and patients, surgeons and anesthesia operators were satisfied. Therefore, it is feasible to apply multifunctional intubation laryngeal masks with normal frequency jet ventilation in airway interventional therapy and it is a safe and ideal way to ensure ventilation.
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Affiliation(s)
- Yuan Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Jianliang Peng
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Wujian Zhu
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Yazhen Ke
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
| | - Ligang Shan
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P.R. China
- *Correspondence: Ligang Shan, Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian Province 361021, P.R. China (e-mail: )
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22
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Liu Y, Huang H. Clinical report of delayed recovery after general anaesthesia in elderly patients with cervical spine surgery: A case report. J Int Med Res 2022; 50:3000605221134462. [PMID: 36300317 PMCID: PMC9619878 DOI: 10.1177/03000605221134462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This report describes a case of a 70-year-old male that underwent decompression laminectomy and internal fixation under general anaesthesia. After extubation, the patient gradually developed no response to instructions and the disturbance of consciousness persisted with unequal pupils in size, but clinical neurological findings and a brain computed tomography scan showed no organic abnormalities. A careful medical history undertaken by anaesthesiologists revealed that the patient had a history of trauma to his left eye, resulting in blindness in this eye, but the surgeons, anaesthesiologists and nurses did not find these problems before the operation. The diagnosis in this case was prolonged unconsciousness due to delayed recovery from anaesthesia. Careful titration of the dose based on individual response in order to reduce adverse effects of general anaesthetics is especially important in elderly patients. Multiple checks of the patient information, surgical safety checklist and medical history by anaesthesiologists, surgeons and nurses can minimize the chance of an adverse outcome.
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Affiliation(s)
- Yang Liu
- Department of Anaesthesia, Huzhou Central Hospital, Affiliated
Central Hospital Huzhou University, Huzhou, Zhejiang Province, China
| | - Huilian Huang
- Key Laboratory of Molecular Medicine, Huzhou Central Hospital,
Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang Province,
China,Huilian Huang, Key Laboratory of Molecular
Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou
University, 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang Province, China.
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Kim SH, Kim KM, Lim YH, Yoo BH, Cho J, Jun IJ. Psychogenic coma after general anesthesia with remimazolam and remifentanil -a case report. Korean J Anesthesiol 2022; 75:449-452. [PMID: 35535428 PMCID: PMC9539421 DOI: 10.4097/kja.22242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed emergence from general anesthesia is associated with life-threatening conditions with pharmacological, neurological, metabolic, and rarely, psychiatric causes. This case report was presented to report psychogenic coma after recovery from anesthesia with remimazolam and remifentanil. CASE An elderly woman was unresponsive after recovery from anesthesia with remimazolam and remifentanil. Physical examination, laboratory testing, and radiographic imaging did not reveal any obvious organic causes. Pharmacological or metabolic abnormalities were not found. Absence of those causes strongly suggests that prolonged unconsciousness is related to psychiatric origin. The patient spontaneously regained consciousness after 48 h without any neurological complications. CONCLUSIONS Anesthesiologists should be aware of the possibility of psychogenic coma for patients with unexplained delay in emergence from anesthesia after the exclusion of other causes.
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Affiliation(s)
- Song Hyun Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kye Min Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Yun-Hee Lim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byung Hoon Yoo
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Joonho Cho
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - In-Jung Jun
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Tavares D, da Silva Matos SLB, Duran LM, Castro SA, Taylor EW, Filogonio R, Fernandes MN, Leite CA. Baroreflex responses of decerebrate rattlesnakes (Crotalus durissus) are comparable to awake animals. Comp Biochem Physiol A Mol Integr Physiol 2022; 273:111286. [DOI: 10.1016/j.cbpa.2022.111286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
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Zhang X, Wang H, Li L, Deng X, Bo L. Neurofilament Light Chain: A Candidate Biomarker of Perioperative Stroke. Front Aging Neurosci 2022; 14:921809. [PMID: 35875791 PMCID: PMC9300966 DOI: 10.3389/fnagi.2022.921809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Perioperative stroke is defined as a brain infarction of ischemic or hemorrhagic etiology that occurs during surgery or within 30 days after surgery. However, identifying perioperative stroke is challenging. Thus, the discovery and validation of neurological biomarkers for perioperative stroke are urgently needed. Neurofilament forms part of the neuronal cytoskeleton and is exclusively expressed in neurons. After disease-related neuroaxonal damage occurs, neurofilament light chain protein is released into the cerebrospinal fluid and blood. Blood neurofilament light chain has recently been shown to serve as a potential marker of interest during the perioperative period. Therefore, the aim of the present review was to give an overview of the current understanding and knowledge of neurofilament light chain as a potential biomarker of perioperative stroke.
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Affiliation(s)
- Xiaoting Zhang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huixian Wang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li Li
- Department of Anesthesiology, Affiliated Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Deng
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Lulong Bo,
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Saadeh YS, Smith E, Bilowus JM, Linzey JR, Chopra Z, Park P. Intrathecal Medication From Pain Pump Caused Prolonged Alteration in Mental Status Following Decompression of Severe Spinal Stenosis. Cureus 2022; 14:e24180. [PMID: 35592186 PMCID: PMC9110096 DOI: 10.7759/cureus.24180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/05/2022] Open
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Ma Z, Zheng JC, Li T, Xie Z, Kang L. Janus Kinase Mediates Faster Recovery From Sevoflurane Anesthesia Than Isoflurane Anesthesia in the Migratory Locusts. Front Physiol 2022; 13:806746. [PMID: 35431999 PMCID: PMC9006988 DOI: 10.3389/fphys.2022.806746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/24/2022] [Indexed: 12/03/2022] Open
Abstract
Inhalation anesthetics isoflurane and sevoflurane have been widely used in clinical practice for anesthesia. However, the molecular mechanisms underlying the faster recovery from sevoflurane anesthesia than isoflurane anesthesia remain largely undetermined. Herein, we use RNA-seq, RNA interference, quantitative real-time PCR and western blotting to explore the mechanisms of recovery from isoflurane and sevoflurane anesthesia in the migratory locusts. Although the migratory locusts show similar anesthetic responses to these two chemicals in corresponding half-maximal effective concentrations (EC50s), the recovery from sevoflurane anesthesia is significantly faster than that for isoflurane anesthesia after 30 min of anesthetic exposure. Transcriptome analysis shows that those transcripts involved in cytoskeletal components, Janus kinase (JAK) pathway and cuticle protein are differentially expressed in locust brains in response to isoflurane and sevoflurane. RNAi knockdown confirms that Actin, Myosin-like protein 84B (Mlp84B), JAK and cuticle protein NCP56 do not affect anesthetic response of the locusts to these two chemical anesthetics. Moreover, actin, Mlp84B and NCP56 do not affect differential recovery from isoflurane and sevoflurane anesthesia, whereas RNAi knockdown of JAK and its partner STAT5B does not affect anesthetic recovery from isoflurane but elongates recovery duration from sevoflurane anesthesia. Thus, JAK may mediate faster recovery from sevoflurane anesthesia than from isoflurane anesthesia in the migratory locust. This finding provides novel insights into the molecular mechanism underlying faster recovery from sevoflurane anesthesia than isoflurane anesthesia.
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Affiliation(s)
- Zongyuan Ma
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Jialin C. Zheng
- Center for Translational Neurodegeneration and Regenerative Therapy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhongcong Xie
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Zhongcong Xie,
| | - Le Kang
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
- Le Kang,
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Feng L, Liu Y, Tang H, Ling Z, Xu L, Yuan W, Feng Z. Delayed Recovery After Deep Brain Stimulation Surgery for Parkinson's Disease Under General Anesthesia-Cases Report. Front Surg 2022; 9:811337. [PMID: 35300247 PMCID: PMC8921249 DOI: 10.3389/fsurg.2022.811337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Parkinson's disease (PD) is a neurodegenerative syndrome, and deep-brain stimulation (DBS) is an effective therapy for carefully screened patients with PD. However, delayed recovery after anesthesia, which occurs after taking prolonged general anesthesia for such patients, has been reported less frequently in literature. This report explores the possible causes of postoperative awakening delay in patients undergoing DBS surgery due to general anesthesia and provides a reference for anesthesia management of similar operations in the future. Case Presentation Three patients with PD elective underwent DBS surgery. The first patients demonstrated walking disability, gait deficits, unstable posture, limb stiffness, and imbalance. The second demonstrated left limb static tremor, stiffness, and bradykinesia. The third demonstrated bradykinesia, rigidity, walking deficits, and decreased facial expression. These included two males and one female with a mean patient age of 60.7 ± 6.7year, weight of 63.7 ± 11 kg, the height of 163.3 ± 7.6 cm, and preoperative American Society of Anesthesiology rating of 2.3 ± 0.6. The preoperative Glasgow Coma Scale mean score was 15. All patients completed the operation under general anesthesia (the mean anesthesia time was 5.3 ± 1.1 h). The mean operation time was 252 ± 60 min. The mean bleeding volume was 50 ml, and the urine volume was 867 ± 569 ml. However, all the patients showed unconsciousness after 95 ± 22 min after stopping the anesthetic, and the respiratory function was in good condition, but they could not cooperate with anesthesiologists and had no response to the anesthesiologist's instructions. The mean hospital stay was 17 ± 7 days. All patients were discharged uneventfully. The average number of days patients followed up postoperatively was 171 ± 28.5 days. Motor and speech were improved significantly postoperatively in three patients compared with preoperatively. Taking anti-Parkinson medication was markedly reduced. There were no complications during postoperative follow-up. Conclusions To prevent delayed recovery occurring after DBS surgery in Parkinson's disease, it is recommended to take scalp nerve block + general anesthesia to complete the procedure while avoiding general anesthesia.
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Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Yaohong Liu
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Hao Tang
- Department of Neurosurgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
| | - Zhipei Ling
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
- Zhipei Ling
| | - Longhe Xu
- Department of Anesthesiology, The Third Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Longhe Xu
| | - Weixiu Yuan
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, China
- Weixiu Yuan
| | - Zeguo Feng
- Department of Pain, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Zeguo Feng
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Guo J, Xu K, Yin JW, Zhang H, Yin JT, Li Y. Dopamine transporter in the ventral tegmental area modulates recovery from propofol anesthesia in rats. J Chem Neuroanat 2022; 121:102083. [PMID: 35181484 DOI: 10.1016/j.jchemneu.2022.102083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/12/2022] [Accepted: 02/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE(S) To investigate the role of the dopamine transporter (DAT) in the ventral tegmental area (VTA) in the recovery from propofol anesthesia in rats. MATERIALS AND METHODS A total of 150 Sprague-Dawley (SD) rats were randomly split into a normal control group (NC), saline group (S), propofol anesthesia group (P), adeno-associated viral-NC-mCherry (AAV-NC) group, and AAV-DAT-RNAi (DAT-RNAi) group (n = 30 per group). In rats in the AAV intervention group, AAV was injected into the VTA nucleus via a stereotaxer. The rats in each group were continuously pumped with propofol through the tail vein at a dose of 70mg/kg/h, and the control group was infused with the same dose of saline at the same speed for 30min. Immunofluorescence staining was used to observe the expression of c-fos protein in the prefrontal cortex (PFC). The induction and recovery time of propofol anesthesia were recorded based on the time of disappearance of the righting reflex (LORR) and recovery (RORR). The anesthesia depth score was performed on all rats 10min after starting the administration and 10min after withdrawal, which represented the depth of anesthesia during anesthesia and the degree of recovery during anesthesia recovery, respectively. electroencephalogram (EEG) was recorded during propofol anesthesia and recovery. RESULTS Compared to the NC group, the RORR of the DAT-RNAi group was shortened, and the anesthesia depth score was higher (P < 0.05). In the DAT-RNAi group, during the period of propofol anesthesia, the β wave frequencies increased, the θ wave frequencies decreased, and the expression of c-fos protein in PFC increased and during the recovery from propofol anesthesia, the α wave and β wave frequencies were increased (P < 0.05). CONCLUSION Knockdown of the DAT in the VTA region can enhance the activity of PFC neurons and promote the recovery of rats from propofol anesthesia.
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Affiliation(s)
- Jia Guo
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Ke Xu
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Jiang-Wen Yin
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Han Zhang
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Jie-Ting Yin
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China
| | - Yan Li
- Department of Anesthesiology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi 832000, China.
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Aguilar‐Catalan A, Fresno Bermejo L, Murison PJ. Continuous mandibular nerve block as sole analgesia for postoperative pain management after a hemi‐mandibulectomy in a French bulldog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Adrià Aguilar‐Catalan
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona Bellaterra Barcelona Spain
| | - Laura Fresno Bermejo
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona Bellaterra Barcelona Spain
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Demelash G, Berhe YW, Gebregzi AH, Chekol WB. Prevalence and Factors Associated with Postoperative Pain After Cesarean Section at a Comprehensive Specialized Hospital in Northwest Ethiopia: Prospective Observational Study. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s347920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Al-Rasheedi KA, Alqasoumi AA, Emara AM. Effect of inhaled anaesthetics gases on cytokines and oxidative stress alterations for the staff health status in hospitals. Int Arch Occup Environ Health 2021; 94:1953-1962. [PMID: 33959815 PMCID: PMC8490262 DOI: 10.1007/s00420-021-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the effects of waste anaesthetic gases on cytokines and oxidative stress of hospital health team members following exposure to waste anaesthetic gases (WAGs). SUBJECTS AND METHODS In total, 180 participants took part in this study; 60 of these were healthy male controls and the 120 participants in the intervention group were staff who work in the operating room. This latter group comprises six occupational subgroups (1) surgeons, (2) surgical assistants, (3) anaesthesiologists (4) anaesthesiology assistants, (5) nurses and (6) janitors. The following parameters were assessed: catalase (CAT), glutathione peroxidase (GSHpx) and superoxide dismutase (SOD) activities, plasma fluoride, serum interferon gamma (IFN-γ), serum interleukin 2 (IL2), serum interleukin 4 (IL4) and plasma thiobarbituric acid reactive substances (TBARS). RESULTS Anaesthesiologists and their assistants exhibited the highest levels of plasma fluoride, serum IFN-γ and IL 2, exceeding the levels in detected in all the other occupational subgroups. Furthermore, the serum levels of IL4 were significantly raised in anaesthesiologists and the difference between this group and other groups was statistically significant. However, compared with the other subgroups, surgeons exhibited elevated plasma TBARS and reduced CAT, GSHpx and SOD; these variances were also statistically significant. CONCLUSION AND RECOMMENDATIONS The findings of this study indicate that operating room staff exposed to WAGs are vulnerable to experiencing immunotoxicity as the WAGs are considered to initiate oxidative stress and increase the levels of cytokines in serum. Thus, an education programme is warranted to inform staff working in environments where they may be subjected to WAGs on the effects that the gases can have upon their health and how to minimise their exposure to WAGs. An ongoing effort is also needed to ensure anaesthesia safety standards are maintained at all times. The findings of this study may provide a springboard for future research into occupational exposure to WAGs and their wider effect upon health.
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Affiliation(s)
- Khaled A Al-Rasheedi
- Khyber General Hospital, Ministry of Health, Khyber, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Abdulmajeed A Alqasoumi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Ashraf M Emara
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraidah, Qassim, Saudi Arabia.
- Department of Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Lai YM, Boer C, Eijgelaar RS, van den Brom CE, de Witt Hamer P, Schober P. Predictors for time to awake in patients undergoing awake craniotomies. J Neurosurg 2021:1-7. [PMID: 34678766 DOI: 10.3171/2021.6.jns21320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Awake craniotomies are often characterized by alternating asleep-awake-asleep periods. Preceding the awake phase, patients are weaned from anesthesia and mechanical ventilation. Although clinicians aim to minimize the time to awake for patient safety and operating room efficiency, in some patients, the time to awake exceeds 20 minutes. The goal of this study was to determine the average time to awake and the factors associated with prolonged time to awake (> 20 minutes) in patients undergoing awake craniotomy. METHODS Records of patients who underwent awake craniotomy between 2003 and 2020 were evaluated. Time to awake was defined as the time between discontinuation of propofol and remifentanil infusion and the time of extubation. Patient and perioperative characteristics were explored as predictors for time to awake using logistic regression analyses. RESULTS Data of 307 patients were analyzed. The median (IQR) time to awake was 13 (10-20) minutes and exceeded 20 minutes in 17% (95% CI 13%-21%) of the patients. In both univariate and multivariable analyses, increased age, nonsmoker status, and American Society of Anesthesiologists (ASA) class III versus II were associated with a time to awake exceeding 20 minutes. BMI, as well as the use of alcohol, drugs, dexamethasone, or antiepileptic agents, was not significantly associated with the time to awake. CONCLUSIONS While most patients undergoing awake craniotomy are awake within a reasonable time frame after discontinuation of propofol and remifentanil infusion, time to awake exceeded 20 minutes in 17% of the patients. Increasing age, nonsmoker status, and higher ASA classification were found to be associated with a prolonged time to awake.
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Affiliation(s)
| | | | - Roelant S Eijgelaar
- 3Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | | | - Philip de Witt Hamer
- 2Neurosurgery, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam; and
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Ono S, Ishimaru M, Ida Y, Yamana H, Ono Y, Hoshi K, Yasunaga H. Validity of diagnoses and procedures in Japanese dental claims data. BMC Health Serv Res 2021; 21:1116. [PMID: 34663302 PMCID: PMC8525021 DOI: 10.1186/s12913-021-07135-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dental claims data have been used for epidemiological studies without establishing the validity of the recorded diagnoses or procedures. The present study aimed to examine the accuracy of diagnoses, procedures, operation time, and the number of teeth recorded in dental claims data. METHODS We reviewed the charts of 200 patients who visited and 100 patients who were hospitalized in the Department of General Dentistry, Orthodontics, and Oral and Maxillofacial Surgery in an academic hospital between August 2012 and December 2017. The sensitivity and specificity of the dental claims data for five diseases and 15 procedures were evaluated. We assessed the difference in the number of teeth and duration of general anesthesia between claims data and chart reviews. RESULTS Sensitivity was more than 86% for six out of seven diagnoses except for pericoronitis (67%). Specificity ranged from 72% (periodontal disease) to 100% (oral cancer for inpatient). The sensitivity of procedures ranged from 10% (scaling for inpatient) to 100%, and the specificity ranged from 6% (food intake on the day of the surgery) to 100%. The mean (standard deviation [SD]) number of teeth in the chart review was 22.6 (6.8), and in the dental claims was 21.6 (8.6). The mean (SD) operation time was 171.2 (120.3) minutes, while the duration of general anesthesia was 270.9 (171.3) minutes. CONCLUSIONS The present study is the first study to validate dental claims data, and indicates the extent of usefulness of each diagnosis and procedure for future dental research using administrative data.
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Affiliation(s)
- Sachiko Ono
- Department of Eat-loss Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Miho Ishimaru
- Department of Health Service Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Ida
- Healthcare Executive Program, The University of Tokyo, 4F Administration Bldg., UTokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hayato Yamana
- Department of Health Service Research, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuto Hoshi
- Department of Eat-loss Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Sensory and Motor System Medicine, The University of Tokyo, The University of Tokyo Hospital Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Songvejkasem M, Auychai P, Chankanka O, Songsiripradubboon S. Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth. Clin Exp Dent Res 2021; 7:978-986. [PMID: 34272835 PMCID: PMC8638319 DOI: 10.1002/cre2.473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the survival rates of pulpectomized primary teeth treated under general anesthesia (GA) or local anesthesia (LA), and to determine which factors affected tooth survival following pulpectomy. Materials and methods This retrospective study collected data from dental records. Patients under 5 years of age received dental treatment under GA or LA during 2007–2016, with at least one anterior or posterior tooth receiving a pulpectomy, were recruited. Pulpectomy was considered a failure if the tooth required extraction or retreatment due to pulp treatment failure. Survival analysis was used to assess the outcome. The cumulative survival probability was analyzed with the Kaplan–Meier estimator. Cox regression analysis was used to evaluate the associations between tooth survival and possible prognosis factors; sex, age, dental arch (upper/lower), tooth type (anterior/posterior), molar type (first/second molar), molar location (upper/lower molar), root filling material type, restoration type, preoperative radiographic findings and presence of pathologic root resorption. Results Two hundred and twenty‐seven primary teeth were included. At the 5‐year follow‐up, the survival rates of the pulpectomized teeth treated under GA and LA were 81.4% and 87.4%, respectively, which were not significantly different (p ≥ 0.05). A radiolucency on the preoperative radiograph was the only factor associated with tooth extraction or retreatment following pulpectomy, with a hazard ratio of 3.88 (95% CI = 1.29–11.65). Conclusions Pulpectomized primary teeth treated under GA and LA demonstrated high survival rates. Preoperative radiolucency is a possible associated factor that decreases tooth survival following pulpectomy. Why this paper is importantPulpectomy treatment under GA and LA provided high 5‐year cumulative survival rates, which were not significantly different. Pulpectomy treatment in teeth with a preoperative radiolucency were 3.9‐fold as likely to fail as teeth without pathology. Based on our findings, practitioners could apply these findings and discuss with caregivers about the treatment options, outcomes, and prognosis of pulpectomized teeth.
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Affiliation(s)
- Methaphon Songvejkasem
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Prim Auychai
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Oitip Chankanka
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Songkhla, Thailand
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Choi J, Kim S. Delayed awakening time from general anesthesia for dental treatment of patients with disabilities. J Dent Anesth Pain Med 2021; 21:219-226. [PMID: 34136643 PMCID: PMC8187020 DOI: 10.17245/jdapm.2021.21.3.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 11/15/2022] Open
Abstract
Background Patients with disabilities often require general anesthesia for dental treatment because of their cooperative or physical problems. Since most patients with disabilities take central nervous system drugs, the management of recovery status is important because of drug interactions with anesthetics. Methods The anesthesia records of patients under general anesthesia for dental treatment were reviewed, and data were collected. Healthy patients under general anesthesia for dental phobia or severe gagging reflex were designated as the control group. Patients with disabilities were divided into two groups: those not taking any medication and those taking antiepileptic medications. The awakening time was evaluated in 354 patients who underwent dental treatment under general anesthesia (92 healthy patients, 183 patients with disabilities, and 79 patients with disabilities taking an antiepileptic drug). Based on the data recorded in anesthesia records, the awakening time was calculated, and statistical processes were used to determine the factors affecting awakening time. Results Significant differences in awakening time were found among the three groups. The awakening time from anesthesia in patients with disabilities (13.09 ± 5.83 min) (P < 0.0001) and patients taking antiepileptic drugs (18.18 ± 7.81 min) (P < 0.0001) were significantly longer than in healthy patients (10.29 ± 4.87 min). Conclusion The awakening time from general anesthesia is affected by the disability status and use of antiepileptic drugs.
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Affiliation(s)
- Junglim Choi
- Department of Advanced General Dentistry, School of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Seungoh Kim
- Department of Dental Anesthesiology, School of dentistry, Dankook University, Chenonan, Republic of Korea
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Abstract
PURPOSE OF REVIEW An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients. RECENT FINDINGS Perioperative management of pheochromocytoma and paraganglioma has been facilitated by improved medical management and the adoption of minimally invasive surgical techniques. An improved understanding of the sequelae of carcinoid syndrome has resulted in safer perioperative management. Perioperative glycemic management requires a fundamental understanding of perioperative fluid resuscitation and adverse events associated with the new generation oral hyperglycemic agents to prevent avoidable complications. SUMMARY Endocrine disorders will commonly present in the perioperative time period and the anesthesiologist plays a critical role in achieving good operative outcomes.
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Choi J, Doh RM. Dental treatment under general anesthesia for patients with severe disabilities. J Dent Anesth Pain Med 2021; 21:87-98. [PMID: 33880402 PMCID: PMC8039166 DOI: 10.17245/jdapm.2021.21.2.87] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 11/15/2022] Open
Abstract
Patients with disabilities have difficulties tolerating in-office dental treatment due to limitations relating to cooperation and/or physical problems. Therefore, they often require general anesthesia or sedation to facilitate safe treatment. When deciding on dental treatment under general anesthesia, the plan should be carefully determined because compared to general patients, patients with disabilities are more likely to experience anesthetic complications because of their underlying medical conditions and potential drug interactions. Clinicians prefer simpler and more aggressive dental treatment procedures, such as extraction, since patients with impairment have difficulty maintaining oral hygiene, resulting in a high incidence of recurrent caries or restorative failures. This study aimed to review the available literature and discuss what dentists and anesthesiologists should consider when providing dental treatment to patients with severe disability under general anesthesia.
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Affiliation(s)
- Junglim Choi
- Department of Advanced General Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Re-Mee Doh
- Department of Advanced General Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
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Lam K, Sangha N. Unresponsive postoperative patient. Pract Neurol 2021; 21:559-560. [PMID: 33737386 DOI: 10.1136/practneurol-2020-002812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Keng Lam
- Department of Neurology, Kaiser Permanente LAMC, Los Angeles, California, USA
| | - Navdeep Sangha
- Department of Neurology, Kaiser Permanente LAMC, Los Angeles, California, USA
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Zhan J, Wu ZX, Duan ZX, Yang GY, Du ZY, Bao XH, Li H. Heart rate variability-derived features based on deep neural network for distinguishing different anaesthesia states. BMC Anesthesiol 2021; 21:66. [PMID: 33653263 PMCID: PMC7923817 DOI: 10.1186/s12871-021-01285-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Estimating the depth of anaesthesia (DoA) is critical in modern anaesthetic practice. Multiple DoA monitors based on electroencephalograms (EEGs) have been widely used for DoA monitoring; however, these monitors may be inaccurate under certain conditions. In this work, we hypothesize that heart rate variability (HRV)-derived features based on a deep neural network can distinguish different anaesthesia states, providing a secondary tool for DoA assessment. Methods A novel method of distinguishing different anaesthesia states was developed based on four HRV-derived features in the time and frequency domain combined with a deep neural network. Four features were extracted from an electrocardiogram, including the HRV high-frequency power, low-frequency power, high-to-low-frequency power ratio, and sample entropy. Next, these features were used as inputs for the deep neural network, which utilized the expert assessment of consciousness level as the reference output. Finally, the deep neural network was compared with the logistic regression, support vector machine, and decision tree models. The datasets of 23 anaesthesia patients were used to assess the proposed method. Results The accuracies of the four models, in distinguishing the anaesthesia states, were 86.2% (logistic regression), 87.5% (support vector machine), 87.2% (decision tree), and 90.1% (deep neural network). The accuracy of deep neural network was higher than those of the logistic regression (p < 0.05), support vector machine (p < 0.05), and decision tree (p < 0.05) approaches. Our method outperformed the logistic regression, support vector machine, and decision tree methods. Conclusions The incorporation of four HRV-derived features in the time and frequency domain and a deep neural network could accurately distinguish between different anaesthesia states; however, this study is a pilot feasibility study. The proposed method—with other evaluation methods, such as EEG—is expected to assist anaesthesiologists in the accurate evaluation of the DoA. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01285-x.
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Affiliation(s)
- Jian Zhan
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.,Department of Anaesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhuo-Xi Wu
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Zhen-Xin Duan
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Gui-Ying Yang
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Zhi-Yong Du
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Xiao-Hang Bao
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Hong Li
- Department of Anaesthesiology, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
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Opioid use may be associated with postoperative complications in myotonic dystrophy type 1 with high-grade muscular impairment. Sci Rep 2021; 11:8. [PMID: 33431966 PMCID: PMC7801477 DOI: 10.1038/s41598-020-76217-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/22/2020] [Indexed: 12/25/2022] Open
Abstract
Individuals with myotonic dystrophy type 1 (DM1) reportedly have a higher risk of postoperative complications than those without DM1; however, factors related to perioperative complications in DM1 patients remain unclear. We aimed to identify the risk factors that may be associated with postoperative complications in DM1 patients. We reviewed medical records of 256 patients with DM1 from 1998 to 2018, among whom 42 (16.4%) had previously undergone 51 surgeries under general and regional anaesthesia. Among the 42 patients, 11 (21.5%) had 13 postoperative complications including respiratory complications, sustained hypotension, wound infection and dehiscence, artery thrombosis and occlusion, and delayed recovery from anaesthesia. There were significant inter-group differences between the non-complicated and complicated groups considering the following parameters: high-grade (≥ 3) muscular impairment rating scale (MIRS), extubation time, postoperative opioid use, and hospital length of stay. Furthermore, univariate analysis revealed that an MIRS score ≥ 3 (odds ratio [OR] 9.346, confidence interval [CI] 1.761–49.595, p = 0.009) and postoperative opioid use (OR 8.000, CI 1.772–36.127, p = 0.007) were the only statistically significant factors. Therefore, clinicians should be cautious in administering opioids, particularly in patients with a high-grade MIRS score during the perioperative period.
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Sung TY, Lee DK, Bang J, Choi J, Shin S, Kim TY. Remifentanil-based propofol-supplemented vs. balanced sevoflurane-sufentanil anesthesia regimens on bispectral index recovery after cardiac surgery: a randomized controlled study. Anesth Pain Med (Seoul) 2020; 15:424-433. [PMID: 33329845 PMCID: PMC7724124 DOI: 10.17085/apm.20022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background The present study was to compare the potential impact of remifentanil-based propofol-supplemented anesthesia regimen vs. conventional sevoflurane-sufentanil balanced anesthesia on postoperative recovery of consciousness indicated by bispectral index (BIS) values in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery were randomly allocated to get the remifentanil-based propofol-supplemented anesthesia employing target-controlled infusion (TCI) of remifentanil and propofol (Group-PR, n = 15) or a balanced-anesthesia employing sevoflurane-inhalation and TCI-sufentanil (Group-C, n = 19). In Group-PR, plasma concentration (Cp) of TCI-remifentanil was fixed at 20 ng/ml, and the effect-site concentration of TCI-propofol was adjusted within 0.8–2.0 μg/ml to maintain BIS value of 40–60. In Group-C, sevoflurane dosage was adjusted within 1–1.5 minimum alveolar concentration to maintain BIS of 40–60, and Cp of TCI-sufentanil was fixed at 0.4 ng/ml. The inter-group difference in the time for achieving postoperative BIS > 80 (T-BIS80) in the intensive care unit was determined as the primary outcome. The inter-group difference in the extubation time was determined as the secondary outcome. Results T-BIS80, was shorter in Group-PR than Group-C (121.4 ± 64.9 min vs. 182.9 ± 85.1 min, respectively; the difference of means –61.5 min; 95% CI –115.7 to –7.4 min; effect size 0.812; P = 0.027). The extubation time was shorter in Group-PR than in Group-C (434.7 ± 131.3 min vs. 946.6 ± 393.3 min, respectively, P < 0.001). Conclusions Compared with the conventional sevoflurane-sufentanil balanced anesthesia, the remifentanil-based propofol-supplemented anesthesia showed significantly faster postoperative conscious recovery in patients undergoing cardiac surgery.
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Affiliation(s)
- Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Korea
| | - Dong-Kyu Lee
- Department of Anesthesiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jiyon Bang
- epartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jimin Choi
- Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Saemi Shin
- College of Life Science and Biotechnology, Korea University, Seoul, Korea
| | - Tae-Yop Kim
- Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Ramlan AAW, Pardede DKB, Marsaban AHMS, Hidayat J, Peddyandhari FS. Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane. J Anaesthesiol Clin Pharmacol 2020; 36:177-181. [PMID: 33013031 PMCID: PMC7480301 DOI: 10.4103/joacp.joacp_257_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/25/2019] [Accepted: 11/10/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Emergence agitation (EA) is a common transient behavioral disturbance after inhalational anesthesia and may cause harm to the patient. This study evaluated the efficacy of 0.5 mg/kg of propofol administered at the end of anesthesia to reduce the incidence of EA in children undergoing general inhalational anesthesia. Material and Methods This double-blind randomized clinical trial was done in children aged 1-5 years undergoing general anesthesia with sevoflurane. One hundred and eight subjects were included using consecutive sampling method and randomized into two equal groups. Propofol in the dose of 0.5 mg/kg was administered at the end of anesthesia to children in the propofol group, while those in the control group did not receive any intervention at the end of anesthesia. Incidence of EA, transfer time, postoperative hypotension, desaturation, and nausea-vomiting were observed. Aono and Pediatric Anesthesia Emergence Delirium scale were used to assess EA. Results Incidence of EA was 25.9% in the propofol group compared to 51.9% in the control group (RR = 0.500; 95% CI 0.298-0.840; P = 0.006). Mean transfer time in propofol group was longer (9.5 ± 3.9 min) than control group (7.8 ± 3.6 min) (mean difference 1.71 min; 95% CI 0.28-3.14; P = 0.020). Hypotension was found in one patient (1.9%) in propofol group, while in control group there was none. Nausea-vomiting was found in five patients (9.3%) in propofol group and eight patients (14.8%) in control. There was no desaturation in both the groups. Conclusion Administration of 0.5 mg/kg of propofol at the end of anesthesia effectively reduces the incidence of EA in children undergoing general inhalational anesthesia with sevoflurane.
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Affiliation(s)
- Andi Ade Wijaya Ramlan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dimas K Bonardo Pardede
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arif H M S Marsaban
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Jefferson Hidayat
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fildza Sasri Peddyandhari
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Siam EM, Abo Aliaa DM, Elmedany S, Abdelaa ME. Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1821501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ezzzt M. Siam
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Doaa M. Abo Aliaa
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Sally Elmedany
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohamed E. Abdelaa
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Douville NJ, Kheterpal S, Engoren M, Mathis M, Mashour GA, Hornsby WE, Willer CJ, Douville CB. Genetic mutations associated with susceptibility to perioperative complications in a longitudinal biorepository with integrated genomic and electronic health records. Br J Anaesth 2020; 125:986-994. [PMID: 32891412 DOI: 10.1016/j.bja.2020.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/06/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Existing genetic information can be leveraged to identify patients with susceptibilities to conditions that might impact their perioperative care, but clinicians generally have limited exposure and are not trained to contextualise this information. We identified patients with genetic susceptibilities to anaesthetic complications using a perioperative biorepository and characterised the concordance with existing diagnoses. METHODS Adult patients undergoing surgery within Michigan Medicine from 2012 to 2017 were consented for genotyping. Genotypes were integrated with the electronic health record (EHR). We retrospectively characterised frequencies of variants associated with butyrylcholinesterase deficiency, factor V Leiden, and malignant hyperthermia, three pharmacogenetic factors with perioperative implications. We calculated the percentage homozygous and heterozygous for each that had been diagnosed previously and searched for EHR findings consistent with a predisposition. RESULTS Analysis of genetic data revealed that 25 out of 40 769 (0.1%) patients were homozygous and 1918 (4.7%) were heterozygous for mutations associated with butyrylcholinesterase deficiency. Of the homozygous individuals, 14 (56%) carried a pre-existing diagnosis. For factor V Leiden, 29 (0.1%) were homozygous and 2153 (5.3%) heterozygous. Of the homozygous individuals, three (10%) were diagnosed by EHR-derived phenotype and six (21%) by clinician review. Malignant hyperthermia was assessed in a subset of patients. We detected two patients with associated mutations. Neither carried clinical diagnoses. CONCLUSIONS We identified patients with genetic susceptibility to perioperative complications using an open source script designed for clinician use. We validated this application in a retrospective analysis for three conditions with well-characterised inheritance, and showed that not all genetic susceptibilities were documented in the EHR.
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Affiliation(s)
- Nicholas J Douville
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Sachin Kheterpal
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Milo Engoren
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael Mathis
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - George A Mashour
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Whitney E Hornsby
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Cristen J Willer
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Christopher B Douville
- Ludwig Center for Cancer Genetics and Therapeutics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ozsahin I. Identifying a Personalized Anesthetic with Fuzzy PROMETHEE. Healthc Inform Res 2020; 26:201-211. [PMID: 32819038 PMCID: PMC7438688 DOI: 10.4258/hir.2020.26.3.201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objective During an anesthetic evaluation, the individual's medical history and overall fitness for the whole medical procedure should be carefully examined. The objective of this study was to apply a multi-criteria decision-making technique to determine the proper anesthetic agent for specific patients. Methods The fuzzy PROMETHEE (Preference Ranking Organization Method for Enrichment of Evaluations) method was applied to determine the most appropriate agent. Minimum alveolar concentration, blood:gas and oil:gas partition coefficients, onset of action, recovery time, duration, induction and maintenance doses, and washout time were used as the criteria for the analysis. After defining the values of each criteria, the criteria weights and the preference function were set, and finally the results for two different examples, one for general ranking and one for a specific individual were obtained. RESULTS The results show that nitrous oxide and xenon are among the preferred inhaled anesthetics in the ranking of the inhaled anesthetics, whereas midazolam was identified as the preferred injected agent. When the weights are selected according to a specific patient's condition, namely a 70-year-old woman to undergo an emergent laparoscopic appendectomy with comorbidities, including severe chronic obstructive pulmonary disease as a consequence of a life-long smoking habit, morbid obesity, and type II diabetes, the results changed significantly. In this case, desflurane and etomidate come first in the ranking of inhaled and injected anesthetics, respectively, while nitrous oxide is the least preferred anesthetic agent. Conclusion Expert opinion is always needed. Assigning weights to criteria and grading alternatives are the major challenges in multi-criteria decision-making studies. Fuzzy PROMETHEE is proposed to solve a multi-criteria decision-making problem in selecting a general anesthetic.
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Affiliation(s)
- Ilker Ozsahin
- Department of Biomedical Engineering, Faculty of Engineering, Near East University, Nicosia/TRNC, Mersin, Turkey.,DESAM Institute, Near East University, Nicosia/TRNC, Mersin, Turkey
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Reazaul Karim HM. Minimum alveolar concentration based anesthesia in high altitude and anesthetic overdose: result needs cautious acceptance. Med Gas Res 2020; 9:107. [PMID: 31249261 PMCID: PMC6607865 DOI: 10.4103/2045-9912.260654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
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Barata-Antunes S, Teixeira FG, Mendes-Pinheiro B, Domingues AV, Vilaça-Faria H, Marote A, Silva D, Sousa RA, Salgado AJ. Impact of Aging on the 6-OHDA-Induced Rat Model of Parkinson's Disease. Int J Mol Sci 2020; 21:ijms21103459. [PMID: 32422916 PMCID: PMC7279033 DOI: 10.3390/ijms21103459] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 01/14/2023] Open
Abstract
Parkinson's disease (PD) is the second most common age-related neurodegenerative disorder. The neurodegeneration leading to incapacitating motor abnormalities mainly occurs in the nigrostriatal pathway due to the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). Several animal models have been developed not only to better understand the mechanisms underlying neurodegeneration but also to test the potential of emerging disease-modifying therapies. However, despite aging being the main risk factor for developing idiopathic PD, most of the studies do not use aged animals. Therefore, this study aimed at assessing the effect of aging in the unilateral 6-hydroxydopamine (6-OHDA)-induced animal model of PD. For this, female young adult and aged rats received a unilateral injection of 6-OHDA into the medial forebrain bundle. Subsequently, the impact of aging on 6-OHDA-induced effects on animal welfare, motor performance, and nigrostriatal integrity were assessed. The results showed that aging had a negative impact on animal welfare after surgery. Furthermore, 6-OHDA-induced impairments on skilled motor function were significantly higher in aged rats when compared with their younger counterparts. Nigrostriatal histological analysis further revealed an increased 6-OHDA-induced dopaminergic cell loss in the SNpc of aged animals when compared to young animals. Overall, our results demonstrate a higher susceptibility of aged animals to 6-OHDA toxic insult.
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Affiliation(s)
- Sandra Barata-Antunes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Fábio G. Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Bárbara Mendes-Pinheiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Ana V. Domingues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Helena Vilaça-Faria
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Ana Marote
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Deolinda Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
| | - Rui A. Sousa
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, 4805-017 Guimarães, Portugal;
| | - António J. Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (S.B.-A.); (F.G.T.); (B.M.-P.); (A.V.D.); (H.V.-F.); (A.M.); (D.S.)
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057/4805-017 Braga/Guimarães, Portugal
- Correspondence: ; Tel.: +351-253-60-4947; Fax: +351-253-60-4809
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Maheshwari K, Ahuja S, Mascha EJ, Cummings KC, Chahar P, Elsharkawy H, Kurz A, Turan A, Sessler DI. Effect of Sevoflurane Versus Isoflurane on Emergence Time and Postanesthesia Care Unit Length of Stay. Anesth Analg 2020; 130:360-366. [DOI: 10.1213/ane.0000000000004093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster. Anesthesiology 2020; 131:555-568. [PMID: 31356232 DOI: 10.1097/aln.0000000000002850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mutations in the presynaptic protein syntaxin1A modulate general anesthetic effects in vitro and in vivo. Coexpression of a truncated syntaxin1A protein confers resistance to volatile and intravenous anesthetics, suggesting a target mechanism distinct from postsynaptic inhibitory receptor processes. Hypothesizing that recovery from anesthesia may involve a presynaptic component, the authors tested whether syntaxin1A mutations facilitated recovery from isoflurane anesthesia in Drosophila melanogaster. METHODS A truncated syntaxin1A construct was expressed in Drosophila neurons. The authors compared effects on isoflurane induction versus recovery in syntaxin1A mutant animals by probing behavioral responses to mechanical stimuli. The authors also measured synaptic responses from the larval neuromuscular junction using sharp intracellular recordings, and performed Western blots to determine whether the truncated syntaxin1A is associated with presynaptic core complexes. RESULTS Drosophila expressing a truncated syntaxin1A (syx, n = 40) were resistant to isoflurane induction for a behavioral responsiveness endpoint (ED50 0.30 ± 0.01% isoflurane, P < 0.001) compared with control (0.240 ± 0.002% isoflurane, n = 40). Recovery from isoflurane anesthesia was also faster, with syx-expressing flies showing greater levels of responsiveness earlier in recovery (reaction proportion 0.66 ± 0.48, P < 0.001, n = 68) than controls (0.22 ± 0.42, n = 68 and 0.33 ± 0.48, n = 66). Measuring excitatory junction potentials of larvae coexpressing the truncated syntaxin1A protein showed a greater recovery of synaptic function, compared with controls (17.39 ± 3.19 mV and 10.29 ± 4.88 mV, P = 0.014, n = 8 for both). The resistance-promoting truncated syntaxin1A was not associated with presynaptic core complexes, in the presence or absence of isoflurane anesthesia. CONCLUSIONS The same neomorphic syntaxin1A mutation that confers isoflurane resistance in cell culture and nematodes also produces isoflurane resistance in Drosophila. Resistance in Drosophila is, however, most evident at the level of recovery from anesthesia, suggesting that the syntaxin1A target affects anesthesia maintenance and recovery processes rather than induction. The absence of truncated syntaxin1A from the presynaptic complex suggests that the resistance-promoting effect of this molecule occurs before core complex formation.
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