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Case Report
Anesthesia Management in a Low Weight Patient with Parkinson's Disease: A Case Report
Hong Tu*
Issue:
Volume 12, Issue 2, December 2024
Pages:
70-72
Received:
21 June 2024
Accepted:
8 July 2024
Published:
23 July 2024
Abstract: Background: Parkinson's disease (PD) is a progressive neurological disease related to the destruction of dopaminergic neurons in the substantia nigra, basket spot and other brain regions, which is mainly characterized by motor neurological disorders and non-motor neurological disorders. Middle-aged and elderly people are more common, with more women than men. Polypharmacy in PD patients may lead to potential interactions with anesthetic drugs, so perioperative management is very important. Case presentetion: An 80-year-old female with a medical history of PD weighing 28kg, planed to undergo elective peritoneoscopically assisted transvaginal uterine abdominal wall suspension under general anesthesia. Antiparkinsonian medications continued until just before the induction of anesthesia. Preoperative examinations were completed and they showed no obvious abnormality. Vital signs, train-of-four (TOF) and bispectral index (BIS) were monitored to guide the administration of anesthesia. Appropriate sedatives, analgesics, muscle relaxants and antiemetics were selected after fully assessed the patient's condition and drug interactions during the perioperative period. The patient successfully completed the surgery and discharged from hospital. Conclusions: General anesthesia (GA) is the main anesthesia method for patients with Parkinson's disease undergoing surgery. When patients with PD undergo surgery, the anesthesiologists should fully and carefully evaluate the patient's status and preoperative combination of medications. Perioperative drugs that aggravate Parkinson's disease should be avoided in order to facilitate a smooth recovery after surgery.
Abstract: Background: Parkinson's disease (PD) is a progressive neurological disease related to the destruction of dopaminergic neurons in the substantia nigra, basket spot and other brain regions, which is mainly characterized by motor neurological disorders and non-motor neurological disorders. Middle-aged and elderly people are more common, with more wome...
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Research Article
Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery
Rodrigo Sebastian Parada Heit*
Issue:
Volume 12, Issue 2, December 2024
Pages:
73-80
Received:
25 February 2024
Accepted:
15 April 2024
Published:
29 July 2024
Abstract: Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. Methods: Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. Results: 35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). Conclusions:. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.
Abstract: Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large numbe...
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Case Report
A Case of Optimizing Anesthetic Management for an Elderly Patient with Severe Left Ventricular Dysfunction Through a Multi-disciplinary Treatment Approach
Dai-liang Zhao*,
Yan Li
Issue:
Volume 12, Issue 2, December 2024
Pages:
81-84
Received:
6 May 2024
Accepted:
9 July 2024
Published:
31 July 2024
Abstract: This case report presents a multi-disciplinary treatment (MDT) approach to optimize anesthetic management for an elderly patient with a giant inguinal hernia and severe left ventricular dysfunction. The patient, a 68-year-old male, had a 30-year history of a large inguinal hernia and was diagnosed with left ventricular hypertrophy and cardiac insufficiency, with an ejection fraction of 24%. Given the patient's complex comorbidities and the risks associated with anesthesia, a MDT was formed to develop a personalized treatment plan. The team included gastrointestinal surgeons, anesthesiologists, cardiovascular specialists, and intensive care physicians who collaborated to mitigate perioperative risks. The MDT strategy involved continuing preoperative cardiovascular medications, selecting anesthesia techniques to minimize impact, and maintaining strict fluid management during surgery. The patient underwent a successful tension-free repair of the inguinal hernia with the aid of an ultrasound-guided nerve block and local infiltration anesthesia. Throughout the procedure, vital signs remained stable, and the patient experienced no discomfort or complications related to anesthesia. The patient recovered well and was discharged after five days. The effectiveness of MDT in overseeing the care of elderly patients with high-risk conditions throughout the perioperative anesthesia phase is underscored. It underscores the importance of a collaborative approach to ensure patient safety and optimal outcomes in complex surgical cases. The MDT framework helps to prevent treatment deviations and delays, reducing patient anxiety and improving the overall quality of care.
Abstract: This case report presents a multi-disciplinary treatment (MDT) approach to optimize anesthetic management for an elderly patient with a giant inguinal hernia and severe left ventricular dysfunction. The patient, a 68-year-old male, had a 30-year history of a large inguinal hernia and was diagnosed with left ventricular hypertrophy and cardiac insuf...
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Report
Cerebral Infarction by Paradoxical Gas Embolism Detected Non-Stop Extracorporeal Circulation Tricuspid Annuloplasty Surgery with Real-Time TEE: A Case Report
Issue:
Volume 12, Issue 2, December 2024
Pages:
85-88
Received:
5 July 2024
Accepted:
23 July 2024
Published:
31 July 2024
Abstract: Background: There is a risk of significant complications due to paradoxical gas embolism during tricuspid annuloplasty under non-stop extracorporeal circulation without aortic block. Intraoperative real-time transesophageal echocardiography (TEE) is the most sensitive indicator for the detection of gas embolism. Case: This case present a patent ductus arteriosus (PDA) patient with pulmonary hypertension and severe tricuspid regurgitation scheduled for PDA closure and tricuspid annuloplasty. Intraoperative real-time TEE also showed a large number of small bubbles appearing in the left atrium near the orifice of the pulmonary vein. This case demonstrates that the amount of bubbles from the right heart may have exceeded the gas exchange capacity of the lung and entered the left atrium through the pulmonary vein. The patient delayed awakening after surgery and developed convulsive symptoms, decreased muscle strength of the left extremity, and head MRI suggested the possibility of acute cerebral embolism. Lessons: As a relatively simple tricuspid annuloplasty under non-stop extracorporeal circulation without aortic block, surgical may have catastrophic arterial embolism complications.
Abstract: Background: There is a risk of significant complications due to paradoxical gas embolism during tricuspid annuloplasty under non-stop extracorporeal circulation without aortic block. Intraoperative real-time transesophageal echocardiography (TEE) is the most sensitive indicator for the detection of gas embolism. Case: This case present a patent duc...
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Case Report
On Arrival Blocks: Resuscitation of an Obese Patient Following Vehicular Accident in a Resource Poor Setting
Olayinka Olumide Ajiboye*,
Julian Ojebo
Issue:
Volume 12, Issue 2, December 2024
Pages:
89-92
Received:
29 April 2024
Accepted:
16 July 2024
Published:
20 August 2024
Abstract: Road traffic accidents has been reported to be on the increase, leaving patients with diverse orthopaedic injuries as well as traumatic brain injury. The accidents and emergencies unit continues to struggle during resuscitation and offer inadequate analgesia to these patients who also may be in shock or not fully resuscitated, owing to fear of worsening the haemodynamics, or the respiratory suppression from opioids, most trauma physicians refrain from using strong opioids. Intravenous access in the polytraumatized patients is usually challenging, even more so in obese patients, putting them to greater morbidity or mortality according to some published articles. This case report expresses the importance of prompt management, multi-disciplinary care of an obese polytraumatized patient, which led to shorter hospital stay and reduction in morbidity and mortality. A multi-disciplinary approach with quick involvement of the Anaesthetists made a big difference in establishing venous access promptly to commence resuscitation, preventing onset of morbidity such as acute kidney injury due to hypovolaemia. On arrival blocks, a technique developed by anesthesiologist Ravindra and plastic and hand surgeon Raja is a situation where the skilled Anaesthetist blocks different regions in order to offer patient excellent analgesia without compromising the haemodynamic or respiratory drive is important to note and emphasize.
Abstract: Road traffic accidents has been reported to be on the increase, leaving patients with diverse orthopaedic injuries as well as traumatic brain injury. The accidents and emergencies unit continues to struggle during resuscitation and offer inadequate analgesia to these patients who also may be in shock or not fully resuscitated, owing to fear of wors...
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Research Article
Airway Issues in Management of Severe Cut-Throat Injuries
Issue:
Volume 12, Issue 2, December 2024
Pages:
93-97
Received:
10 July 2024
Accepted:
29 July 2024
Published:
30 August 2024
Abstract: Introduction: Open or incised anterior neck injuries inflicted by sharp implements may be described as Cut-throat injuries (CTIs). The managing team is immediately confronted with airway management options, therefore, a close collaboration between the surgeon and the anesthetist is required to adopt a strategy that will guarantee a safe airway and ensure a successful outcome. In this article, we discuss the factors that led us to perform tracheostomy before repair while avoiding a rule of tracheostomy for all. Method: A prospective study was conducted at Federal Medical Centre, Gusau, between January 2019 -August 2023. Nine (9) patients presented with zone II cut-throat injuries and the choice of airway management was discussed between the surgeon and the anesthetist focused on symptoms of air obstruction and findings within the larynx that could lead to airway obstruction once repair was done. Result: There were nine patients (9) with the age range of 18-60 years. Tracheostomy rate was 55.6% (n=5). There is a positive correlation (+1) between tracheostomy and laryngeal edema. A subset of patients, 22.2% (n=2) was selected for repair without a tracheostomy. Conclusion: The choice of perfect airway management should result from constructive collaboration between the surgeon and the anesthetist. Tracheostomy should be considered in patients with asymptomatic laryngeal edema.
Abstract: Introduction: Open or incised anterior neck injuries inflicted by sharp implements may be described as Cut-throat injuries (CTIs). The managing team is immediately confronted with airway management options, therefore, a close collaboration between the surgeon and the anesthetist is required to adopt a strategy that will guarantee a safe airway and ...
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Review Article
Comparative Study of General Anesthesia and Regional Anesthesia in Obstetrics
Naureen Perween*
Issue:
Volume 12, Issue 2, December 2024
Pages:
98-108
Received:
8 September 2024
Accepted:
26 September 2024
Published:
31 October 2024
Abstract: Anaesthesia plays a major role in medical emergencies. In obstetric emergencies, general anaesthesia is preferred where rapid anesthesia is needed. Regional anaesthesia includes techniques like epidural, spinal, or combined spinal-epidural anesthesia and they produce loss of sensation without altering consciousness. The combined spinal-epidural improves epidural anesthesia quality during labor. Maternal mortality is a great concern worldwide. According to the World Health Organization, in the year 2020, 95% of maternal deaths occurred in low and lower-middle-income countries. Maternal mortality concern aims to reduce mortality rates. To reduce complication mentioned above, a primary literature survey of 34+ articles/papers has been performed to compare the implications of obstetrical anaesthesia, different anesthesia types and anaesthetic management. A comparative study based on the effective parameters like anesthetic management, Apgar score, maternal/neonatal outcome, maternal complication, maternal mortality, obstetric emergencies, and anesthetic preference has performed to assess the effect of general anaesthesia on maternal and neonatal outcomes, patient's safety, factors that affect anaesthetic management, identification and management of post-spinal hypotension in cesarean section, rapid assessment and management of obstetric and risk of failed intubation. The main contribution of the work is to summarize the outcomes to come up with significant observations which reveal that regional anaesthesia is a comparatively safe and common method of anaesthesia in non-emergent cases. The study also observed that the amalgamation of general anaesthesia with ‘rapid-Sequence induction and intubation’, and aspiration prophylaxis is the safest method of emergency management in cesarean section. The paper concludes that in non-emergent obstetric cases, regional anaesthesia is preferred over general anaesthesia, whereas the general anaesthesia is best option for emergent cases.
Abstract: Anaesthesia plays a major role in medical emergencies. In obstetric emergencies, general anaesthesia is preferred where rapid anesthesia is needed. Regional anaesthesia includes techniques like epidural, spinal, or combined spinal-epidural anesthesia and they produce loss of sensation without altering consciousness. The combined spinal-epidural imp...
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Research Article
Comparison of Intraoperative Fentanyl Usage and Waste After Transition from 100-μg Vials to 50-μg Preloaded Syringes: A Single-Center Retrospective Study
Huang Huang,
Emily Lai,
Shreyas Bhavsar,
Brian Miller,
Jovelle Chung,
Bradly Phillips,
Lei Feng,
Jose Miguel Soliz*,
Jessica Brown
Issue:
Volume 12, Issue 2, December 2024
Pages:
109-115
Received:
13 October 2024
Accepted:
30 October 2024
Published:
22 November 2024
Abstract: Background: The rapidly acting opioid fentanyl, commonly used in the perioperative setting, has traditionally been packaged in 100 or 250-μg vials. In September 2021, our institution implemented a change from fentanyl 100-μg vials to 50-μg preloaded syringes in our operating rooms. The objective of this study was aimed at assessing the association of the fentanyl product change on reducing medication waste and the amount of fentanyl administered during surgery. Methods: This single-center, retrospective study entailed a review of anesthesia records from September 2020 to September 2022 of adult patients who underwent general anesthesia and received fentanyl for surgery at The University of Texas MD Anderson Cancer Center. The data set was divided into a control period (CP) using 100-μg vials and a post transition period (PT) using 50-μg preloaded syringes. The primary outcome measures were the average amounts of fentanyl used and wasted per case. Secondary outcome measures consisted of intraoperative analgesic use as well as postoperative pain scores. Results: Among the 33,405 cases included in this study, the mean amount of fentanyl used per surgical case was higher in the CP group than in the PT group (133μg vs. 102μg; p<0.001). Additionally, fentanyl waste occurred in a higher percentage of cases in the CP group than in the PT group (13.9% vs. 2.9%; p<0.001). We did not observe a significant difference in post-anesthesia care unit pain scores between the CP and PT groups. Conclusion: Transitioning to preloaded fentanyl syringes decreased medication waste and overuse of opioids intraoperatively. Simultaneously, the transition did not adversely affect patient analgesia in the post-anesthesia care unit.
Abstract: Background: The rapidly acting opioid fentanyl, commonly used in the perioperative setting, has traditionally been packaged in 100 or 250-μg vials. In September 2021, our institution implemented a change from fentanyl 100-μg vials to 50-μg preloaded syringes in our operating rooms. The objective of this study was aimed at assessing the association ...
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