Presentación de un caso y revisión de literatura: anestesia total intravenosa en cirugía de estesioneuroblastoma / Presentation of a case and literature review: total intravenous anesthesia in estesioneuroblastoma surgery

Resumen: El estesioneuroblastoma es una neoplasia de las células del neuroepitelio olfatorio. Tiene una baja incidencia de 0.4 por cada millón de habitantes. Se caracteriza por síntomas como sinusitis, epistaxis, cefalea, discapacidad visual, obstrucción nasal, hiposmia y rinorrea. En este reporte se presenta el caso de un paciente masculino de 29 años con estesioneuroblastoma estadio Kadish C, quien fue programado para resección quirúrgica bajo anestesia total intravenosa con resultados satisfactorios durante el procedimiento quirúrgico.

Abstract: Esthesioneuroblastoma is a neoplasm of the olfactory neuroepithelium cells, it has a low incidence of 0.4 per million inhabitants. It is characterized by symptoms such as sinusitis, epistaxis, headache, visual impairment, nasal obstruction, hyposmia, and rhinorrhea. We present the case of a 29-year-old male patient with Kadish C stage esthesioneuroblastoma, who was scheduled for surgical resection under total intravenous anesthesia with satisfactory results during the surgical procedure.

Comparison of total intravenous anesthesia with alfentanil and remifentanil undergoing endoscopic sinus surgery / 临床麻醉学杂志

Objective To compare the effect of postoperative between total intravenous anesthesia(TIVA)use of alfentanil and remifentanil undergoing endoscopic sinus surgery.Methods A total of 130 and thirty patients scheduled for endoscopic sinus surgery,62 males and 68 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly divided into two groups:alfentanil group(group A)and remifentanil group(group R).Midazolam 0.02 mg/kg,propofol target-controlled infusion(TCI)3 μg/ml,alfentanil 20 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group A,and target-controlled infusion of propofol combined with alfentanil was used to maintain anesthesia.Midazo-lam 0.02 mg/kg,propofol TCI 3 μg/ml,remifentanil 1 μg/kg,and rocuronium 0.6 mg/kg were injected intravenously in group R,and target-controlled infusion of propofol combined with remifentanil was used to maintain anesthesia.The number of intraoperative hemodynamic adverse reactions such as hypertension,tachycardia,hypotension,bradycardia during operation,and pain degree at 30 minutes,60 minutes,24 hours after operation,extubation time,and rescue analgesia and adverse reactions such as nausea and vomi-ting,skin pruritus,respiratory depression within 24 hours after operation were recorded.Results Compared with group R,the incidence of intraoperative hypotension in group A was significantly lower(P＜0.05),the incidence of painless in group A 30 and 60 minutes after operation was significantly higher(P＜0.05),the incidence of mild and moderate pain was significantly decreased(P＜0.05),and the recovery time was significantly prolonged(P＜0.05).There was no significant difference in rescue analgesia within 24 hours after operation.There were no significant differences in the incidence of postoperative nausea and vomiting,postoperative skin pruritus,and respiratory depression between the two groups.Conclusion In endoscopic sinus surgery,the effect of total intravenous anesthesia with alfentanil on postoperative analgesia is better than that of remifentanil,and the incidence of perioperative and postoperative adverse reactions in alfentanil is lower than that of remifentanil,while the recovery time of alfentanil is slightly longer than that of remifentanil.

Effects of different anesthesia methods on anesthesia quality, postoperative recovery, cognitive status and visual analogue scale score in patients undergoing laparoscopic hysterectomy / 中国医师进修杂志

Objective:To explore the effects of different anesthesia methods on anesthesia quality, postoperative recovery, cognitive status and pain in patients undergoing laparoscopic hysterectomy.Methods:A prospective study was conducted among 98 patients who underwent laparoscopic hysterectomy in Donghai County People′s Hospital of Jiangsu Province from July 2020 to December 2022. According to different anesthesia methods, the subjects were divided into group A (48 cases, intravenous-inhalation combined anesthesia) and group B (50 cases, intravenous general anesthesia and epidural anesthesia). The recovery quality, cognitive status and VAS scores before operation (T 0), at 12 h after operation (T 1), 24 h after operation (T 2) and 48 h after operation (T 3) were compared between the groups. The total incidence rates of adverse reactions in the two groups were recorded. Results:The extubation time, respiratory recovery time and awakening time in group B were shorter than those in group A: (5.69 ± 0.75) min vs. (10.02 ± 1.26) min, (4.52 ± 0.65) min vs. (6.59 ± 1.04) min, (8.65 ± 1.12) min vs. (13.52 ± 1.45) min ( P<0.05). The two groups had similar mini-mental state examination (MMSE) scores and VAS scores at T 0 ( P>0.05). MMSE scores of the two groups were lower at T 1-T 3 than T 0. Group B had higher scores than group A at T 1-T 3: (23.14 ± 1.85) scores vs. (20.36 ± 2.15) scores, (25.18 ± 2.47) scores vs. (22.31 ± 2.35) scores, (27.05 ± 1.18) scores vs. (26.31 ± 1.01) scores, P<0.05. VAS scores of the two groups were higher at T 1-T 3 than T 0. Group B had lower scores than group A: (5.17 ± 0.54) scores vs. (6.21 ± 0.75) scores, (4.42 ± 0.51) scores vs. (5.63 ± 0.62) scores, (2.58 ± 0.34) scores vs. (3.14 ± 0.42) scores, P<0.05. The total incidence rates of adverse reactions in the two groups had no statistical difference ( χ2 = 0.17, P>0.05). Conclusions:Compared with intravenous-inhalation combined anesthesia, general anesthesia combined with epidural anesthesia has better anesthesia quality in patients undergoing laparoscopic hysterectomy, which can improve postoperative cognitive function and relieve pain. The two anesthesia methods are both safe.

Application value of intravenous anesthesia combined with ultrasound-guided nerve block in patients with intestinal cancer / 中国医学装备

Objective:To investigate the application value of intravenous anesthesia combined with ultrasound-guided nerve block in patients with intestinal cancer.Methods:A total of 200 patients who prepared to undergo laparoscopic radical resection of intestinal cancer under general anesthesia in Beijing Yanhua Hospital between January 2017 and January 2022 were selected as the study subjects.They were divide into study group and control group according to inter-group matching principle,with 100 cases in each group.Control group adopted single intravenous anesthesia,and study group adopted intravenous anesthesia combined with ultrasound-guided nerve block.The heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO2)before anesthesia(T0),after anesthesia(T1),when skin incision(T2)and when completed surgery(T3),and the visual analogue scale(VAS)values,the time of the first exhausting,the time of postoperative hospital stay,the occurrence of adverse reaction at the 6th h(T4)and 12th h(T5)after surgery between two groups were compared.The drive pressure(DP)values at five time points included 5min(t1)after endotracheal intubation,5min(t2)after establishing pneumoperitoneum,5min(t3)and 60min(t4)after implementing the position with lower head and higher foot,and 5min(t5)after restoring horizontal position of pneumoperitoneum exhaust were recorded.And then,the concentrations of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),angiotensin(AngⅡ)and cortisol(Cor)before and 24h after surgery were respectively measured.Results:The results of one-way ANOVA indicated that there were no statistically significant differences in HR,MAP and SpO2 between the two groups at T0,T1,T2 and T3(P>0.05),respectively.The dosage of Propofol within unit time of study group was significantly lower than that of control group(t=8.305,P<0.05),and the time of the first exhausting and the time of hospital stay of study group were significantly shorter than those of control group(t=7.978,t=9.141,P<0.05),respectively.The VAS scores of study group were significantly lower than that of control group at T4 and T5(t=10.033,t=9.071,P<0.05),and the incidence of adverse reaction of study group was significantly lower than that of control group(x2=13.78,P<0.05),respectively.The results of one-way ANOVA showed that there were statistically significant differences in DP values between the two groups at different times(F=595.765,F=448.108,P<0.05),and the DP values of two groups at t2,t3,t4 and t5 were significantly higher than that at t1(10.59±1.52)(F=595.765,P<0.05).The DP values at t2,t3 and t4 of study group were significantly higher than those of control group(t2=17.69±2.12,t3=20.16±2.06,t4=20.06±2.0)(t=9.650,t=14.339,t=0.738,P<0.05),respectively.The differences of the serum AngⅡ,Cor,TNF-α and IL-6 levels between two groups were not statistically significant before surgery(P>0.05).The serum AngⅡ,Cor,TNF-α and IL-6 levels of the two groups of patients after surgery were significantly higher than them before surgery.At 24 hours after surgery,the serum AngⅡ,Cor and TNF-α and IL-6 levels of study group of patients were significantly lower than them of control group(t=2.601,t=3.790,t=5.779,t=6.154,P<0.05),respectively.Conclusion:The application of intravenous anesthesia combined with ultrasound-guided nerve block in patients who undergo laparoscopic radical resection of intestinal cancer can effectively maintain intraoperative hemodynamic stability,and reduce the amount of anesthetic,and shorten the times of the first exhausting and hospital stay,and reduce postoperative pain,stress and inflammation reaction,and improve respiratory function.

A difficult airway approach in a merosin-deficient congenital muscular dystrophy patient: a case report

Abstract Merosin-deficient muscular dystrophy is caused by an autosomal recessive mutation on laminin-α2 gene characterized by severe progressive muscle weakness associated with neuromuscular scoliosis and restrictive lung disease. In this case report, we describe an alternative airway approach performed in a child with anticipated difficult airway and merosin-deficient muscular dystrophy. Significant anesthetic implications may increase the perioperative risk, requiring accurate knowledge to anticipate an adequate management and provide patient-safety strategies.

Resultados de la anestesia total intra venosa (TIVA) con perfusión controlada por objetivo (TCI) en pacientes sometidos a trasplante renal / Outcomes of Total Intravenous Anesthesia (TIVA) with Goal Controlled Perfusion (TCI) in Kidney Transplant Patients

Introducción: La anestesia total intravenosa (TIVA) con perfusión controlada por objetivo (TCI) es una técnica de anestesia general que usa una combinación de fármacos administrados exclusivamente por vía intravenosa sin usar fármacos por vía inhalatoria. Objetivos: Determinar los resultados del uso de TIVA TCI en los pacientes sometidos a trasplante renal, donantes y receptores, entre noviembre de 2014 y julio de 2018, en el Hospital de Clínicas. Pacientes y métodos: Estudio observacional, analítico transversal, con muestreo no probabilístico a criterio. La serie se agrupó en donantes y receptores. Los datos se expresan en medias y proporciones, se analizó el Odds Rattio y el R2. Se consideró una p< 0,05 como significativa. Resultados: se incluyeron a 198 intervenciones anestésicas, 131 (66,2%) fueron receptores. El rango de edad fue de entre 5 y 66 años (35,8±13 años) y 114 (57%) fueron masculinos. En el post operatorio inmediato, el tiempo en despertar, la PAS, PAD, PAM, frecuencia cardiaca y saturación de oxígeno no tuvieron diferencias significativas, en la comparación de los grupos (donante y receptor). Se observó cefalea en 3 (1,5%) del grupo de donantes y ninguna en los receptores. La diuresis fue tardía en 18 (9,1%) pacientes (p= 0,084 R2=29). Conclusión: La TIVA TCI demostró ser una técnica muy efectiva en el trasplante renal, con pronta recuperación y despertar inmediato tras la extubación, con lucidez absoluta en todos los pacientes.

Introduction: Total intravenous anesthesia (TIVA) with goal-controlled perfusion (TCI) is a general anesthesia technique that uses a combination of drugs administered exclusively intravenously without using inhalational drugs. Objectives: To determine the results of the use of TIVA TCI in kidney transplant patients, donors and recipients, between November 2014 and July 2018, at the Hospital de Clínicas. Patients and methods: Observational, cross-sectional analytical study, with non-probabilistic sampling at the discretion. The series was grouped into donors and recipients. The data is expressed in means and proportions, the Odds Rattio and the R2 were analyzed. A p<0.05 was considered significant. Results: 198 anesthetic interventions were included, 131 (66.2%) were recipients. The age range was between 5 and 66 years (35.8±13 years) and 114 (57%) were male. In the immediate postoperative period, time to awakening, SBP, DBP, MAP, heart rate and oxygen saturation did not show significant differences when comparing the groups (donor and recipient). Headache was observed in 3 (1.5%) of the donor group and none in the recipients. Diuresis was late in 18 (9.1%) patients (p= 0.084 R2=29). Conclusion: TIVA TCI proved to be a very effective technique in kidney transplantation, with prompt recovery and immediate awakening after extubation, with absolute clarity in all patients.

Dos concentraciones de ketofol en anestesia total intravenosa para cirugía mínimamente invasiva / Tow concentrations of ketofol in total intravenous anesthesia for minimally invasive surgery

Introducción: En los últimos años se ha iniciado un interés especial por la combinación de ketamina/propofol para pacientes intervenidos por procedimientos mínimamente invasivos. Objetivo: Evaluar la efectividad y seguridad de la anestesia intravenosa total con ketofol en concentración 1:4 contra la concentración 1:2 en pacientes intervenidos por cirugía mínimamente invasiva. Métodos: Estudio analítico, cuasiexperimental, prospectivo y longitudinal, en el Hospital Universitario General Calixto García entre diciembre de 2019 a diciembre de 2020, en 30 pacientes divididos en dos grupos de 15 pacientes: grupo estudio (GE): Ketofol 1:4 y grupo control (GC): Ketofol 1:2. Se analizaron: tensión arterial media y frecuencia cardiaca intra operatoria, grado de hipnosis, grado de nocicepción, necesidad de rescate para hipnosis y analgesia, tiempo de recuperación anestésica, analgesia posoperatoria y efectos adversos. Resultados: Entre los grupos fueron similares la edad, el sexo, el peso, estado físico y tipo de intervención quirúrgica. La frecuencia cardiaca no mostró diferencias entre los grupos. En relación a la tensión arterial mediapos-incisión, fue mayor en el grupo control con diferencias significativas (p=0,03). La necesidad de rescate intraoperatorio para la hipnosis y analgesia fue significativamente mayor en el grupo control. Con respecto a la recuperación anestésica, analgesia posoperatoria y efectos adversos no hubo diferencias significativas. Conclusiones: La combinación ketofol resultó segura y efectiva para proveer una adecuada anestesia en procedimientos quirúrgicos mínimamente invasivos con tiempos quirúrgicos menores a 30 min. La concentración de 1:4 brindó mejor estabilidad hemodinámica, adecuada hipnosis y analgesia intraoperatoria, con menor incidencia de efectos adversos(AU)

Introduction: In recent years, a special interest has appeared in the ketamine/propofol combination for patients intervened by minimally invasive procedures. Objective: To evaluate the effectiveness and safety of total intravenous anesthesia with ketofol at 1:4 concentration versus 1:2 concentration in patients undergoing minimally invasive surgery. Methods: An analytical, quasiexperimental, prospective and longitudinal study was carried out at General Calixto García University Hospital, between December 2019 and December 2020, with thirty patients divided into two groups of fifteen patients each: study group (SG; ketofol 1:4) and control group (CG; ketofol 1:2). The following aspects were analyzed: mean blood pressure and intraoperative cardiac frequency, degree of hypnosis, degree of nociception, necessity of rescue for hypnosis and analgesia, anesthetic recovery time, postoperative analgesia and adverse effects. Results: Age, sex, weight, physical condition and type of surgery were similar between groups. Heart rate showed no differences between groups. Mean blood pressure after incision was higher in the control group, with significant differences (P=0.03). The necessity of intraoperative rescue for hypnosis and analgesia was significantly higher in the control group. Regarding anesthetic recovery, postoperative analgesia and adverse effects, there were no significant differences. Conclusion: The ketofol combination was safe and effective for providing adequate anesthesia in minimally invasive surgical procedures with surgical times of less than thirty minutes. The 1:4 concentration provided better hemodynamic stability, adequate hypnosis and intraoperative analgesia, with lower incidence of adverse effects(AU)

Anestesia total intravenosa libre de opioides guiada por qCON y qNOX en paciente obesa / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: En los últimos años la anestesia libre de opioides ha constituido una alternativa más a las técnicas tradicionales de anestesia general. Con la exclusión de este grupo de fármacos se evitan los múltiples efectos adversos y complicaciones asociados al mismo. A pesar de que la anestesia libre de opioides tiene sus indicaciones y que ha demostrado sus beneficios en cierto grupo de pacientes, existen aún controversias en relación con su utilidad en el paciente obeso. Características como la obesidad hacen que los modelos multimodales empleados para programar la anestesia libre de opioides sean cada vez más complejos. Objetivos: Describir un caso clínico realizado con la técnica de anestesia libre de opioides que constituye la primera experiencia en Ecuador. Presentación del caso: Se presenta el caso de una paciente obesa intervenida de colecistectomía laparoscópica mediante infusión de propofol, ketamina, lidocaína, sulfato de magnesio, y dexmedetomidina. La titulación de estos fármacos se realizó mediante cálculo de concentraciones plasmáticas a través de modelos farmacocinéticos y guiada por monitorización de profundidad anestésica y analgésica, con lo cual se logró optimizar el consumo de fármacos, disminuir las complicaciones y una evolución clínica favorable. Hasta donde se conoce a nivel local y de país (Ecuador) es la primera experiencia que se reporta con esta técnica. Conclusiones: La anestesia libre de opioides puede resultar una elección en el paciente obeso ya que asegura una adecuada recuperación sin efectos adversos asociados(AU)

Introduction: In recent years, opioid-free anesthesia has become another alternative in front of traditional general anesthesia techniques. The exclusion of this group of drugs avoids the numerous adverse effects and complications associated with its usage. Although opioid-free anesthesia has its indications and has showed its benefits in a certain group of patients, there is still controversy regarding its usefulness in the obese patient. Characteristics such as obesity make the multimodal models used to program opioid-free anesthesia increasingly complex. Objectives: To describe a clinical case involving the opioid-free anesthesia technique, which is the first experience in Ecuador. Case presentation: The case is presented of a female obese patient who underwent laparoscopic cholecystectomy by infusion of propofol, ketamine, lidocaine, magnesium sulfate and dexmedetomidine. Titration of these drugs was carried out by calculating plasma concentrations through pharmacokinetic models and guided by monitoring of anesthetic and analgesic depth, thus optimizing drug consumption, reducing complications and achieving a favorable clinical evolution. As far as known locally and in the country (Ecuador), this is the first reported experience with this technique. Conclusions: Opioid-free anesthesia may be a choice in the obese patient, since it ensures adequate recovery without associated adverse effects(AU)

Anestesia total intravenosa en pacientes con síndrome oclusivo intestinal / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: La anestesia total intravenosa es una técnica de anestesia general en la que se administran los fármacos exclusivamente por vía endovenosa, en ausencia de agentes inhalatorios. Objetivo: Describir los resultados que se observaron en el empleo de la anestesia total intravenosa en los pacientes con diagnóstico de síndrome oclusivo para tratamiento quirúrgico. Métodos: Se desarrolló una investigación observacional descriptiva, longitudinal en el Hospital General Docente "Abel Santamaría Cuadrado", de enero de 2014 a enero de 2017. De un universo de 417 pacientes, se seleccionó una muestra de 205 casos que cumplieron con los criterios de inclusión y exclusión. Las variables fueron presión arterial media, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación y respuesta analgésica. Resultados: El 95,61 por ciento de los casos se mantuvieron normotensos y el 96,10 por ciento con frecuencia cardíaca normal. Se constataron signos clínicos de superficialidad anestésica en el 1,46 por ciento de los individuos. La mayoría de los casos se recuperaron entre 10 y 20 min para un 92,19 por ciento. Se observó un nivel de sedación insuficiente en 189 pacientes (92,19 por ciento). No se evidenciaron complicaciones posoperatorias en el 96,58 por ciento. La respuesta analgésica fue adecuada en el 95,12 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía por oclusión intestinal demostró resultados satisfactorios como método anestésico(AU)

Introduction: Total intravenous anesthesia is a general anesthesia technique in which drugs are administered exclusively intravenously, in the absence of inhalation agents. Objective: To describe the outcomes observed in the use of total intravenous anesthesia in patients diagnosed with occlusive syndrome for surgical treatment. Methods: A descriptive, longitudinal and observational research was carried out in Abel Santamaría Cuadrado General Teaching Hospital of Pinar del Río, Cuba, from January 2014 to January 2017. From a universe of 417 patients, a sample of 205 cases that met the inclusion and exclusion criteria was selected. The variables were mean arterial pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, and analgesic response. Results: 95.61 percent of the cases remained normotensive and 96.10 percent kept a normal heart rate. Clinical signs of sedation were found in 1.46 percent of the individuals. Most of the cases recovered between 10 and 20 minutes, accounting for 92.19 percent. Insufficient sedation was observed in 189 patients (92.19 percent). No postoperative complications were observed in 96.58 %. Analgesic response was adequate in 95.12 percent of cases. Conclusions: The application of total intravenous anesthesia for intestinal occlusion surgery showed satisfactory outcomes as an anesthetic method(AU)

Anestesia total intravenosa en la cirugía oncológica de mama / Total intravenous anesthesia in oncologist breast surgery

Introducción: El cáncer es la principal causa de muerte. Cada año se diagnostican millones de mujeres con cáncer de mama que necesitan tratamiento quirúrgico, para lo cual la anestesia total intravenosa parece ser una excelente opción. Objetivo: Describir los resultados de la aplicación de la anestesia total intravenosa en las pacientes a las que se les efectuó cirugía oncológica de mama. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal, prospectivo, en el Servicio de Anestesiología del Hospital General Docente "Abel Santamaría Cuadrado" en el período comprendido entre enero de 2013 y enero de 2015. Se estudió una población accesible de 111 pacientes seleccionados mediante criterios de inclusión y exclusión. Para el análisis estadístico se utilizaron distribuciones de frecuencias, cálculo de medidas de tendencia central y de dispersión. Algunas de las variables fueron tensión arterial, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación, respuesta analgésica. Resultados: Se logró gran estabilidad hemodinámica en más del 95 por ciento de las pacientes. Se detectó superficialidad anestésica en 1,80 por ciento de los casos. El 92,80 por ciento de los casos se recuperaron entre 10 y 20 min. Se presentó sedación adecuada en 106 pacientes. Las principales complicaciones fueron las náuseas y los vómitos en 9,01 por ciento. Existió una adecuada respuesta analgésica en 93,69 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía oncológica de mama arrojó resultados muy satisfactorios como método anestésico(AU)

Introduction: Cancer is the leading cause of death worldwide. Every year millions of women are diagnosed with breast cancer and they need surgical treatment, for which total intravenous anesthesia seems to be an excellent option. Objective: Describe the results of the application of total intravenous anesthesia in patients undergoing oncological breast surgery. Methods: An observational, descriptive, longitudinal, prospective study was conducted in the Anesthesiology Service of "Abel Santamaría Cuadrado" Hospital in the period between January 2013 and January 2015. An accessible population of 111 patients selected using inclusion and exclusion criteria was studied. For the statistical analysis, frequency distributions, calculation of measures of central tendency and dispersion were used. Some of the variables were blood pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, analgesic response. Results: High hemodynamic stability was achieved in more than 95 percent of the patients. Anesthetic superficiality was detected in 1.80 percent of cases. 92.80 percent of the cases recovered after 10 to 20 minutes. Adequate sedation was present in 106 patients. The main complications were nausea and vomiting in 9.01 percent There was an adequate analgesic response in 93.69 percent of the cases. Conclusions: The application of total intravenous anesthesia for oncological breast surgery yielded very satisfactory results as an anesthetic method(AU)

Effects of intravenous combined epidural anesthesia on perioperative hemodynamic indexes, cardiac function and immune function during laparoscopic surgery in elderly gastric cancer patients complicated with coronary heart disease / 肿瘤研究与临床

Objective:To explore the effects of intravenous combined epidural anesthesia on perioperative hemodynamic indexes, cardiac function and immune function during laparoscopic surgery in elderly gastric cancer patients complicated with coronary heart disease.Methods:A total of 94 elderly gastric cancer patients with coronary heart disease who were admitted to Shanxi Province Cancer Hospital from January 2017 to June 2021 were selected. They were divided into the total intravenous anesthesia group (control group) and intravenous combined epidural anesthesia group (observation group) by random envelope lottery, with 47 cases in each group. Hemodynamic indexes, cardiac function, immune function, pain and sedation scores were compared between the two groups.Results:When pneumoperitoneum was established (T 1) and the left gastric artery was immediately free during operation (T 2), systolic blood pressure in the observation group was (136.6±9.9) mmHg (1 mmHg = 0.133 kPa) and (133.9±9.4) mmHg, and diastolic blood pressure was (74.6±4.6) mmHg and (80.7±6.0) mmHg; heart rate was (79.8±4.0) times/min and (80.9±2.7) times/min, respectively. The systolic blood pressure of the control group was (159.3±7.6) mmHg and (162.5±8.5) mmHg, and the diastolic blood pressure was (91.2±5.2) mmHg and (88.3±4.7) mmHg, respectively. The heart rate was (106.2±3.3) times/min and (101.9±4.0) times/min, respectively; compared with the control group at the same time point, the observation group had lower blood pressure and slower heart rate ( t values were 4.25, 2.53, 6.40, 6.81, 1.85, and 1.35, all P < 0.05). The blood concentrations of cardiac troponin and creatine kinase isoenzyme in the control group were (0.143±0.052) ng/ml and (5.65±0.77) mg/L at 12 h (T 4) after surgery, which were higher than those in the observation group [(0.098±0.015) ng/ml and (3.08±1.06) mg/L] ( t values were 4.32 and 10.19, both P < 0.05). The intraoperative utilization rate of vasoactive drugs and the incidence of electrocardiogram abnormalities in the observation group were 19.1% (9/47) and 25.5% (12/47), which were lower than those in the control group [48.9% (23/47) and 55.3% (26/47)] ( χ2 values were 8.49 and 8.66, both P < 0.05). Compared with 1 day before operation (T 5), the proportion of CD4 + T cells increased and the proportion of CD8 + T cells decreased in control group at 3 days after operation (T 6) (both P < 0.05). The pain score and sedation score of the observation group at 12 h (T 4) and 1 day after surgery (T 7) were better than those of the control group (all P < 0.05). Conclusions:Laparoscopic radical gastrectomy with intravenous combined epidural anesthesia in elderly gastric cancer patients with coronary heart disease can achieve better anesthesia effect, and can provide better protection for the patient's cardiac function and immune function.

Factores pronósticos de complicaciones en pacientes con cardiopatía isquémica sometidos a anestesia total intravenosa en cirugía electiva / Total intravenous anethesia in ischemic coronary patients: Prognosis factors

A prospective longitudinal cohort study was conducted in patients with ischemic heart disease undergoing total intravenous anesthesia in elective surgery at the "Carlos Manuel de Céspedes Bayamo Provincial Hospital, from the Cauto region during the period from January 1, 2015 to March 30, 2017; with the aim of identifying the risk factors hypothetically related to the prognosis of the appearance of anesthetic complications. The exposed cohort consisted of 47 patients who developed complications in the study period and met the inclusion criteria. To assess the association between the variables, the Mantel Chi-square test was used. The magnitude of the associations was estimated by calculating the relative risks (RR) of complications. The consumption of to- bacco as a toxic habit, the non-use of beta-blockers and statins were the surgical risk factors depending on the patient associated with the prognosis of the appearance of anesthetic complications; not so age. Comorbidity in patients with ischemic heart disease of diabetes mellitus, heart failure and arrhythmias, were associated with the appearance of anesthetic complications. The ASA III-IV classification and high-risk surgical procedures were the surgical risk factors based on the surgery related to the prognosis of anesthetic complications.

Se realizó un estudio longitudinal prospectivo de cohorte en pacientes con cardiopatía isquémica sometidos anestesia total intravenosa en cirugía electiva en el Hospital provincial "Carlos Manuel de Céspedes de Bayamo, procedentes de la región del Cauto durante el período comprendido desde el 1r de enero del 2015 hasta 30 de marzo de 2017. El objetivo era identificar los factores de riesgo hipotéticamente relacionados con el pronóstico de aparición de complicaciones anestésicas. La cohorte expuesta estuvo constituida por 47 pacientes que desarrollaron complicaciones en el período de estudio y cumplieron con los criterios de inclusión. Para valorar la asociación entre las variables, se empleó el test de Ji al Cuadrado de Mantel. La magnitud de las asociaciones se estimó mediante el cálculo de los riesgos relativos (RR) de complicaciones. El consumo de tabaco como hábito tóxico, el no uso de beta-bloqueadores y estatinas se constituyeron en los factores de riesgo quirúrgico en función del enfermo, asociados con el pronóstico de aparición de complicaciones anestésicas; no así la edad. La comorbilidad en los pacientes con cardiopatía isquémica de diabetes mellitus, insuficiencia cardíaca y las arritmias, se asociaron a la aparición de complicaciones anestésicas. La clasificación ASA III-IV y los procedimientos quirúrgicos de alto riesgo fueron los factores de riesgo quirúrgico en función de la cirugía relacionados con el pronóstico de aparición de complicaciones anestésicas.

Oxigenación apnéica para extracción de cuerpo extraño en vía aérea / Apneic oxygenation for extracting a foreign body in the airway

La oxigenación apnéica consiste en la administración de flujos altos de oxígeno a través de algún dispositivo supraglótico mientras el paciente se mantiene en apnea. Se explica por qué el alveolo desnitrogenizado con una composición en su mayor parte de oxígeno, permite la difusión alveolo capilar y genera una presión subatmosférica capaz de arrastrar el flujo de oxigeno existente en el árbol traqueobronquial hasta el mismo alveolo, siempre y cuando no hubiera obstrucción mecánica de la vía aérea. El tiempo aumenta considerablemente hasta que la saturación de oxígeno disminuya, lo que se conoce como tiempo de apnea segura. Se presenta la experiencia de emplear esta técnica en un escolar de 5 años sin antecedentes patológicos, que ingirió un cuerpo extraño (semilla de girasol), la cual se localizaba en vía aérea bronquio principal derecho. Este se extrajo por fibrobroncoscopía bajo anestesia total intravenosa, priorizando la ventilación espontánea hasta localizarlo, y luego, debido a la dificultad que presentó su extracción, se empleó relajación muscular y apnea para optimizar las condiciones de la extracción. Durante este periodo, se empleó la técnica de oxigenación apnéica, la cual se mantuvo durante 12 min. La saturación pulsátil de oxigeno fue mayor al 92 por ciento, tiempo suficiente para culminar la extracción con éxito y sin complicaciones(AU)

Apneic oxygenation consists in the administration of high flows of oxygen through a supraglottic device while the patient remains in apnea. It is explained because the alveolus with low nitrogen concertation/accumulation, with a composition mostly of oxygen, allows capillary alveolus to diffuse, as well as it generates a subatmospheric pressure capable of dragging the oxygen flow existing in the tracheobronchial tree to the alveolus itself, as long as there is no mechanical airway obstruction. The time increases considerably until oxygen saturation decreases, which is known as the safe apnea time. The experience of using this technique is presented is it was used with a five-year-old boy with no pathological history and who swallowed a foreign body (sunflower seed), which was located in the airway, specifically the right main bronchus. The foreign body was extracted by fiberoptic bronchoscopy under total intravenous anesthesia, prioritizing spontaneous ventilation until it was located; and then, due to the difficulty for its extraction, muscle relaxation and apnea were used to optimize the extraction conditions. During this period, the apneic oxygenation technique was used and maintained for twelve minutes. Pulsatile oxygen saturation was greater than 92 percent, enough time to complete the extraction successfully and without complications(AU)

Infusiones controladas por objetivo y sistemas de circuito cerrado. Límites en expansión / Target-controlled infusions and closed-loop systems: expansion limits

Introducción: La administración manual en bolo ha evolucionado desde la infusión volumétrica basada en regímenes farmacológicos estandarizados, hasta los sistemas de infusión controlada por objetivo y los más sofisticados sistemas de circuito cerrado. Objetivo: Describir los principios tecnológicos y aplicaciones clínicas extendidas de la infusión controlada por objetivo y los sistemas de circuito cerrado. Métodos: Se realizó una revisión no sistemática de la literatura, en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID y el buscador académico Google Scholar, en el mes de septiembre del año 2020. Desarrollo: La disponibilidad y portabilidad de dispositivos electrónicos con capacidad de procesamiento avanzado a precios relativamente accesibles, el perfeccionamiento del aprendizaje automático e inteligencia artificial aplicado a las decisiones médicas, y las iteraciones tecnológicas complejas incorporadas en los sistemas de circuito abierto y cerrado, desarrollados originalmente en el campo de la Anestesiología, han posibilitado su expansión a otras especialidades y entornos clínicos tan disímiles como el tratamiento de la diabetes mellitus, administración de fármacos antineoplásicos, ventilación mecánica, control de las variables hemodinámicas y la terapia antimicrobiana en pacientes críticos. Conclusiones: La infusión controlada por objetivo y los sistemas de circuito cerrado se han convertido en tecnologías maduras, seguras y viables, aplicadas clínicamente en múltiples naciones y escenarios, con un desempeño superior a los sistemas manuales tradicionales(AU)

Introduction: Manual bolus administration has evolved from volumetric infusion based on standardized pharmacological regimens to target-controlled infusion systems and the most sophisticated closed-loop systems. Objective: To describe the technological principles and extended clinical applications of target-controlled infusion and closed-loop systems. Methods: A nonsystematic review of the literature was carried out, during September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID and the academic search engine Google Scholar. Development: The availability and portability of electronic devices with advanced processing capacity at relatively affordable prices, the refinement of machine learning and artificial intelligence applied to medical decisions, as well as the complex technological iterations incorporated into open and closed-loop systems, originally developed in the field of anesthesiology, have enabled their expansion to other specialties and clinical settings so diverse as treatment of diabetes mellitus, administration of antineoplastic drugs, mechanical ventilation, control of hemodynamic variables and antimicrobial therapy in critical patients. Conclusions: Target-controlled infusion and closed-loop systems have become mature, safe and viable technologies, applied clinically in multiple nations and settings, with superior performance compared to traditional manual systems(AU)

Impacto de la anestesia intravenosa en cirugía robótica para paciente de alto riesgo sometido a cirugía oncológica de larga duración en el Centro Médico Naval / Impact of intravenous anesthesia in robotic surgery for high-risk patient undergoing long-term oncologic surgery at the Naval Medical Center

Resumen: La práctica de cirugía robótica es un proceso complejo que implica desarrollo y tecnología no sólo en el campo de la cirugía, sino también en el campo de la anestesiología. Implica un proceso multifactorial, ya que ha generado un cambio drástico multidisciplinario basado en tecnología de punta que pretende ofrecer mejores condiciones durante el manejo perioperatorio en cirugía robótica. La anestesia total intravenosa cumple objetivos específicos en relación a la posición del paciente, relajación cerebral, neuroprotección, hemodinamia, pérdida y recuperación de la conciencia, parálisis neuromuscular, parámetros ventilatorios, etc. Ofrece seguridad y calidad al paciente durante el procedimiento con una mínima interferencia con el monitoreo electrofisiológico y permite modular la profundidad anestésica desde una neurosedación hasta una anestesia general, de acuerdo a las diferentes etapas de la cirugía. Un factor atribuible a la anestesia moderna para el éxito de la cirugía robótica es usar diferentes agentes anestésicos que promuevan inducción, mantenimiento y emersión anestésica más rápida y suave, a fin de reducir el tiempo de recuperación del estado de conciencia, funciones básicas y psicomotoras como la anestesia general multimodal.

Abstract: The practice of robotic surgery is a complex process, involving development and technology; not only in the surgery field but also in the anesthesiology field. It implies a multifactorial process since it has generated a drastic multidisciplinary change based on state-of-the-art technology; which aims to offer better conditions during perioperative management in robotic surgery. Intravenous Total Anesthesia accomplishes specific objectives in relation to patient position, brain relaxation, neuroprotection, hemodynamics, loss and recovery of consciousness, neuromuscular paralysis, ventilatory parameters, providing safety and quality during the procedure; with minimal intervention during electrophysiological monitoring and enabling anesthetic depth to be modulated from neurosedation to general anesthesia, according to the different stages of the surgery. A factor attributable to modern anesthesia for robotic surgery success is to employ different anesthetic agents promoting induction, maintenance of general anesthesia, smother and faster anesthetic emersion, for the purpose of reducing recovery time of the state of consciousness), basic and psychomotor functions; as is the general multimodal anesthesia.

Challenges in the performance of awake craniotomies in the Philippine General Hospital: A case series

@#Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.

Maximum dose of continuous infusion of mivacurium for thyroid surgery under total intravenous anesthesia: a sequential trial of monitoring neurological function in 30 patients / 南方医科大学学报

OBJECTIVE@#To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring (IONM) and observe the adverse reactions during thyroid surgery under total intravenous anesthesia (TIVA).@*METHODS@#Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97 μg · kg@*RESULTS@#The EC@*CONCLUSIONS@#In patients undergoing thyroid surgery under TIVA, the EC

Sedación endovenosa versus lidocaína intraarticular en pacientes con luxación glenohumeral aguda / Endovenous sedation versus intra-articular lidocaine in patients with acute glenohumeral dislocation

INTRODUCCIÓN. La sedación endovenosa y la aplicación de lidocaína intraarticular se han convertido en las técnicas anestésicas preferidas en el área de emergencia para la reducción de la luxación glenohumeral, sin embargo, no están exentas de complicaciones. OBJETIVO. Determinar las diferencias y complicaciones entre el uso de sedación endovenosa y lidocaína intraauricular en la reducción de luxación glenohumeral. MATERIALES Y MÉTODOS. Estudio de evaluación, descriptivo, correlacional, retrospectivo, no experimental. Población de 125 Historias Clínicas, se tomó una muestra 82, que fueron atendidos en el Servicio de Emergencia del Hospital General Riobamba, periodo enero 2015 a diciembre 2019. Criterios inclusión: mayores de 15 años de edad con diagnóstico de luxación glenohumeral aguda, que firmaron el Consentimiento Informado. Se dividieron en dos grupos: grupo I: reducciones con lidocaína intraarticular, grupo II: sedación endovenosa. Los datos se obtuvieron del sistema informático MIS-AS400. El análisis de datos se realizó en el programa estadístico IBM SPSS versión 23. RESULTADOS. Se logró la reducción del 96,7% (29; 30) con el grupo I y un 94,2% (49; 52) con el grupo II. Las complicaciones con el grupo II fueron: depresión respiratoria 5,8% (3; 52), mareo 5,8% (3; 52), cefalea 1,9% (1; 52). No se encontraron complicaciones en el grupo I. DISCUSIÓN. Fue indispensable conseguir el alivio del dolor mediante el uso de técnicas anestésicas/analgésicas como: sedación en combinación con opioides y lidocaína intraarticular. CONCLUSIÓN. Se determinó menor número de complicaciones con la aplicación de lidocaína intraarticular y menor tiempo de estancia en emergencia.

INTRODUCTION. Endovenous sedation and the application of intra-articular lidocaine have become the preferred anesthetic techniques in the emergency area for the reduction of glenohumeral dislocation, however, they are not free of complications. OBJECTIVE. To determine the differences and complications between the use of intravenous sedation and intra-atrial lidocaine in the reduction of glenohumeral dislocation. MATERIALS AND METHODS. Evaluation, descriptive, correlational, retrospective, non-experimental study. Population of 125 Clinical Histories, a sample of 82 was taken, who were treated in the Emergency Service of the Riobamba General Hospital, period from January 2015 to December 2019. Inclusion criteria: over 15 years of age with a diagnosis of acute glenohumeral dislocation, who signed Informed Consent. They were divided into two groups: group I: reductions with intra-articular lidocaine, group II: intravenous sedation. The data was obtained from the MIS-AS400 computer system. Data analysis was performed using the IBM SPSS version 23 statistical program. RESULTS. A reduction of 96,7% (29; 30) was achieved with group I and 94,2% (49; 52) with group II. Complications with group II were: respiratory depression 5,8% (3; 52), dizziness 5,8% (3; 52), headache 1,9% (1; 52). No complications were found in group I. DISCUSSION. It was essential to achieve pain relief through the use of anesthetic / analgesic techniques such as: sedation in combination with opioids and intra-articular lidocaine. CONCLUSION. A lower number of complications was determined with the application of intra-articular lidocaine and a shorter stay in the emergency room.

Comparison of post-operative nausea and vomiting with intravenous versus inhalational anesthesia in laparotomic abdominal surgery: a randomized clinical trial / Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós-operatórios em laparotomia: estudo clínico randomizado

Abstract Background: Postoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients' characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV. Methods: A single-blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided into two groups of Total Intravenous Anesthesia (TIVA) and inhalational anesthesia. The incidence and the severity of PONV were examined at 0, 2, 6, 12 and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated. Results: 50.9% of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the inhalational group and 3.8% of the TIVA group (p = 0.15). 24.5% of patients in the inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043). Conclusion: The incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug and the severity of nausea in patients were significantly lower in the TIVA group.

Resumo Justificativa: Náusea e Vômito no Pós-Operatório (NVPO) é uma complicação multifatorial com etiologia não esclarecida. A técnica anestésica, as características dos pacientes e o tipo de cirurgia são considerados fatores que afetam a NVPO. O presente estudo foi desenhado para comparar o efeito da anestesia inalatória com anestesia intravenosa na incidência e gravidade de NVPO na cirurgia abdominal. Método: Foi realizado estudo clínico mono-cego prospectivo randomizado com 105 pacientes com idades de 18 − 65 anos. Os pacientes foram divididos em dois grupos, Anestesia Total Intravenosa (TIVA) e anestesia inalatória. A incidência e gravidade de NVPO foram avaliadas em cinco momentos: 0, 2, 6, 12 e 24 horas pós-cirurgia. O uso de antiemético de resgate também foi avaliado. Resultados: NVPO ocorreu em 50,9% dos pacientes no grupo inalatória e 17,3% dos pacientes no grupo TIVA (p< 0,001). A incidência de vômitos relatados foi 11,3% no grupo Inalatória e 3,8% no grupo TIVA (p = 0,15). Necessitaram de medicação antiemética 24,5% dos pacientes no grupo Inalatória e 9,6% dos pacientes no grupo TIVA (p = 0.043). Conclusão: A incidência de náusea e vômito no pós-operatório, a necessidade de administração de droga antiemética de resgate e a gravidade da náusea foram significantemente mais baixas no grupo TIVA.

Anestesia total intravenosa libre de opioides en un paciente con síndrome de Joubert: caso clínico / Opioid free total intravenous anesthesia in Joubert syndrome: Case report

Joubert syndrome (JS) is a rare autosomal recessive disorder characterized by abnormal eye movements, respiratory pattern abnormalities, anatomical airway alterations, mental retardation and hypoplasia/aplasia of the cerebellar vermis confirmed by magnetic resonance imaging. This case report describes the successful management of a patient with JS operated of cholesteatoma under 100% opioid-free total intravenous general anaesthesia. We also provide a brief review of JS, its anaesthetic implications and opioid-free anaesthesia (OFA) technique.

El síndrome de Joubert (SJ) es una enfermedad autosómica recesiva poco frecuente caracterizada por trastornos oculares, respiratorios, alteraciones anatómicas de la vía aérea, retraso mental e hipoplasia/aplasia del vermis cerebeloso constatada mediante resonancia magnética. Presentamos un caso exitoso de paciente con SJ operado de colesteatoma bajo anestesia general endovenosa total 100% libre de opioides. Asimismo, realizamos una breve revisión del SJ, sus implicaciones anestésicas y de la técnica de anestesia libre de opioides.