ABSTRACT
The evidence supporting the intraoperative use of processed electroencephalography (pEEG) monitoring to guide anesthetic delivery is growing rapidly. This article reviews the key features of electroencephalography (EEG) waveforms and their clinical implications in select patient populations and anesthetic techniques. The first patient topic reviewed is the vulnerable brain. This term has emerged as a description of patients who may exhibit increased sensitivity to anesthetics and/or may develop adverse neurocognitive effects following anesthesia. pEEG monitoring of patients who are known to have or are suspected of having vulnerable brains, with focused attention on the suppression ratio, alpha band power, and pEEG indices, may prove useful. Second, pEEG monitoring along with vigilant attention to anesthetic delivery may minimize the risk of intraoperative awareness when administering a total intravenous anesthesia in combination with a neuromuscular blockade. Third, we suggest that processed EEG monitoring may play a role in anesthetic and resuscitative management when adverse changes in blood pressure occur. Fourth, pEEG monitoring can be used to better identify anesthesia requirements and guide anesthetic titration in patients with known or suspected substance use.
ABSTRACT
The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel(TM) supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.
Subject(s)
Humans , Airway Management , Constriction, Pathologic , Hemorrhage , Intubation , Respiration, ArtificialABSTRACT
Atrial septal defect [ASD] is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography [TEE] is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine [DEX], which is a highly selective a-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation
ABSTRACT
Extremely low frequency electromagnetic field [ELF-EMF] is harmful to human body and causes various diseases like cancer. ELF-EMF is mainly produced by surgical or anesthetic equipment in operating room. However, it can be made by surrounding electricity without electric device. We measured it in an empty operating room of our hospital over two days and nights. The intensity of ELF-EMF was measured as two-second interval for two days in an empty operating room. One day was divided to three groups; night, morning, and afternoon. Each group continued for three hours due to capacity of ELF-EMF instrument. All of electrical devices were off including lamp, computer and air conditioner. Groups were compared using one-way ANOVA. P<0.05 was considered significant. Mean value of ELF-EMF during 1st and 2nd night was 1.9459 and 1.9486 respectively. It was lower than data of morning and afternoon [P<0.001]. All values [100%] were above 2 mG [micro-Gauss] in daytime. In night time, most of ELF-EMF [99.9%] was below 2 mG. The intensity of ELF-EMF is higher in an empty daytime operating room than at night time
Subject(s)
Operating Rooms , Anesthesiology/instrumentation , Occupational Exposure , Equipment Safety , Risk Assessment , Prospective Studies , Analysis of VarianceABSTRACT
Surgical excision was performed on a 30-years old woman with a painful mass on her left thigh. The pathologic findings on the mass indicated fibromatosis. After the operation, she complained of allodynia and spontaneous pain at the operation site and ipsilateral lower leg. We treated her based on postoperative femoral neuropathy, but symptom was aggravated. We found a large liposarcoma in her left iliopsoas muscle which compressed the lumbar plexus. In conclusion, the cause of pain was lumbar plexopathy related to a mass in the left iliopsoas muscle. Prompt diagnosis of acute neuropathic pain after an operation is important and management must be based on exact causes.
Subject(s)
Female , Humans , Femoral Neuropathy , Fibroma , Hyperalgesia , Leg , Liposarcoma , Lumbosacral Plexus , Muscles , Neuralgia , ThighABSTRACT
Endovascular stent graft placement is a minimally invasive technique that can be applied to treat many diseases of the descending thoracic aorta. For accurate stent graft placement, clear identification of aortic lesion is important and transesophageal echocardiography (TEE) is an ideal imaging tool for descending thoracic aortic aneurysms. Also TEE is able to detect a perigraft leak that cannot be confirmed by angiography. Unlike angiography, TEE image acquisition capability is not dependent on nephrotoxic contrast dye. The analysis of perioperative cardiac function provided by TEE may be helpful in the perioperative anesthetic management. Furthermore, the tip of the transesophageal echocardiographic probe can be used as a marker to guide stent graft positioning. We report a case of endovascular stent graft placement using TEE in a patient with descending thoracic aortic aneurysm under general anesthesia.
Subject(s)
Humans , Anesthesia, General , Angiography , Aorta, Thoracic , Aortic Aneurysm, Thoracic , Echocardiography, Transesophageal , Endoleak , Stents , TransplantsABSTRACT
A 33-year-old male patient with multiple sclerosis (MS) received an emergency laparotomy because of perforated appendicitis. He had been suffering from MS for 2 years and the symptoms of MS were paraplegia and urinary incontinence. Anesthesia was induced with propofol and remifentanil and maintained with nitrous oxide, sevoflurane and remifentanil. Rocuronium was used for tracheal intubation. Train of four ratio and bispectral index scale were also monitored for adequate muscle relaxation and anesthetic depth. The patient emerged from general anesthesia smoothly and was extubated without any complication. Postoperative exacerbation of MS symptoms did not appear. However, he was rehospitalized because deep vein thrombosis (DVT) occurred after discharge and he received heparinization immediately. Eventually, he was discharged after a full recovery from DVT. We report a safe anesthetic management of the patient with MS, with the use of sevoflurane and with no the aggravation of MS during postoperative period.