Joyce Lilian Dunlop

Joyce went to Trinity College Dublin to study medicine in 1954, where she enjoyed the Dublin University Biological Society and where she met the love of her life, Jim, a Scotsman, at the Dublin sailing school. After house jobs, Joyce spent some time in Northern Ireland, training in anaesthetics for obstetrics and gynaecology. Before coronavirus took hold, she was looking forward to a family holiday in Croatia in the summer with her three children, their spouses, and all her grandchildren, before her sudden death.

Impact of COVID-19 on Sedation Requirements during Veno-Venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

COVID-19-associated ARDS (C-ARDS) is mentioned to express higher analgosedation needs, in comparison to ARDS of other etiologies. The objective of this monocentric retrospective cohort study was to compare the analgosedation needs between C-ARDS and non-COVID-19 ARDS (non-C-ARDS) on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Data were collected from the electronic medical records of all adult patients treated with C-ARDS in our Department of Intensive Care Medicine between March 2020 and April 2022. The control group included patients treated with non-C-ARDS between the years 2009 and 2020. A sedation sum score was created in order to describe the overall analgosedation needs. A total of 115 (31.5%) patients with C-ARDS and 250 (68.5%) with non-C-ARDS requiring VV-ECMO therapy were included in the study. The sedation sum score was significantly higher in the C-ARDS group (p < 0.001). COVID-19 was significantly associated with analgosedation in the univariable analysis. By contrast, the multivariable model did not show a significant association between COVID-19 and the sum score. The year of VV-ECMO support, BMI, SAPS II and prone positioning were significantly associated with sedation needs. The potential impact of COVID-19 remains unclear, and further studies are warranted in order to evaluate specific disease characteristics linked with analgesia and sedation.

Regional Anesthesia for Anesthesia Technologists

The anesthesia technicians/technologists (ATs) have expanded coordinated efforts with physicians in the perioperative environment. They are acting vigorously for the setup, operation, and maintenance of the necessary equipment that the anesthesia team of today and the future will use to care for the patient. Several tasks can be performed efficiently by ATs such as set up adjustment with complex procedures, escorting patients, solving trouble shooting, and assisting with patient's monitoring. This chapter is dedicated to serve the current and prospective ATs awareness with regional anesthesia procedures. It dissects the preparation, equipment set up, different types of regional blocks, and explain management of consequences during performing the procedures. Recommendations for regional anesthesia techniques during COVID-19 crisis are discussed to provide safety for both patients and healthcare providers. We hope this chapter provides the adequate information for our ATs in their daily collaborative work. © Springer Nature Switzerland AG 2022.

The Impact of the COVID-19 Pandemic on Emergency Surgical Operations in State Hospitals in Turkey: A Retrospective and Descriptive Study

Aim: Emergency surgery can be defined as surgical interventions and operations necessary to deal with an acute threat to life, organ, limb, or tissue. Our study examined the impact of the Coronavirus disease-2019 (COVID-19) pandemic on emergency surgical operations (ESOs) performed in state hospitals in Turkey. Materials and Methods: In this national, retrospective, and descriptive study, ESOs performed in 2nd and 3rd-level state hospitals in Turkey in 2021 were recorded for the study. ESOs performed in 2019 were taken as the control group, and the changes between the two groups were examined. Results: A total of 1,822,075 ESOs were included in the analysis. There was a 7.6% decrease in ESOs in 2021 compared to 2019. In both 2019 and 2021, cesarean section, surgical treatment of upper/lower extremity fractures and dislocations, and cholecystectomy were the most frequently performed ESOs. An increase in the number of ESOs in 2021 compared to 2019 was observed only in the urology department (7.1%) and orthopedics and traumatology department (2.7%). The surgical departments with the greatest decreases were neurosurgery (-28.1%), Otolaryngology-Head and Neck Surgery (-27.7%), and thoracic surgery (-20.9%) Conclusion: During the COVID-19 pandemic, the number of ESOs performed in the 2nd and 3rd-level state hospitals in Turkey decreased compared with the previous year.

The possibility of using perfluorocarbon compounds for virus-associated pneumonia treatment

The issues of practicality in using perfluorocarbon gas transport emulsions (or pure perfluorocarbons) in severe virus-associated pneumonia treatment were considered, including those caused by coronavirus infection. Perfluorocarbons are fully fluorinated carbon compounds, on the basis of which artificial blood substitutes have been developed - gas transport perfluorocarbon emulsions for medical purposes. Perfluorocarbon emulsions were widely used in the treatment of patients in critical conditions of various genesis at the end of the last-the beginning of this century, accompanied by hypoxia, disorders of rheological properties and microcirculation of blood, perfusion of organs and tissues, intoxication, and inflammation. Large-scale clinical trials have shown a domestic plasma substitute advantage based on perfluorocarbons (perfluoroan) over foreign analogues. It is quite obvious that the inclusion of perfluorocarbon emulsions in the treatment regimens of severe virus-associated pneumonia can significantly improve this category's treatment results after analyzing the accumulated experience. A potentially useful area of therapy for acute respiratory distress syndrome is partial fluid ventilation with the use of perfluorocarbons as respiratory fluids as shown in the result of many studies on animal models and existing clinical experience. There is no gas-liquid boundary in the alveoli, as a result of which, there is an improvement in gas exchange in the lungs and a decrease in pressure in the respiratory tract when using this technique, due to the unique physicochemical properties of liquid perfluorocarbons. A promising strategy for improving liquid ventilation effectiveness using perfluorocarbon compounds is a combination with other therapeutic methods, particularly with moderate hypothermia. Antibiotics, anesthetics, vasoactive substances, or exogenous surfactant can be delivered to the lungs during liquid ventilation with perfluorocarbons, including to the affected areas, which will enhance the drugs accumulation in the lung tissues and minimize their systemic effects. However, the indications and the optimal technique for conducting liquid ventilation of the lungs in patients with acute respiratory distress syndrome have not been determined currently. Further research is needed to clarify the indications, select devices, and determine the optimal dosage regimens for perfluorocarbons, as well as search for new technical solutions for this technique.

Challenges faced by anesthesiologists during the cesarean section of COVID-19 patients - an observational study

Background: The health-care system has encountered exceptional circumstances, experiencing unique challenges, and manifesting as acute challenges in health-care services due to the spread of COVID-19. Aims and Objectives: The present study aimed to report the difficulties faced by the anesthetists while performing a cesarean section under the subarachnoid block (SAB) in COVID-19 patients at a dedicated COVID Level 3 hospital. Materials and Methods: Twenty healthy anesthetists (six consultants and 14 postgraduate) aged 20-40 years performed 60 elective or emergency cesarean sections of known COVID-19-positive gravida patients aged 20-35 years with no comorbidity and no spine abnormality under the SAB. Anesthetist;s responses to the challenges faced while performing procedures wearing the Level 3 personal protective equipment were recorded using a pre-structure self-administered questionnaire. To quantify the intensity of these problems, all the physical and psychological difficulties were graded as mild, moderate, and severe. Results: In the present study, 75% experienced moderate-to-severe sweating, and 60% experienced moderate-to-severe headaches. A total of 45% experienced moderate-to-severe breathlessness. Though there was little difficulty in communication among doctors and staff, almost 75% of anesthetists faced it. The fear of contracting the disease and spreading it to the family members was expressed by 75-80% of anesthetists. Conclusion: The present scenario has increased physical stress and other psychological problems among health workers. Therefore, hospital support with regular psychological counseling sessions is needed for healthcare workers to cope with the current situation.

Year 2022 in review - Respiratory failure and lung support therapy.

The use of ECMO methods has experienced a significant boom in recent years, mainly due to the SARS-CoV-2 pandemic. Many workplaces that had little or no experience with ECMO currently possess the relevant technology and can use this method in real clinical practice. The prone position (PP) has changed from the original position of rescue intervention to the leading position among the methods that should be considered standard in patients with a severe form of acute respiratory failure. Thus, the combination of pronation and ECMO support has received considerable attention in recent years. This text, although a year in the 2022 review, briefly discusses available evidence-based medicine publications over the past few years devoted to this topic. The use of PP in clinical conditions other than mechanical ventilation (MV), e.g. in conscious patients on non-invasive ventilatory support, is described in the next section of this text. Another topic is the correct setting of MV while using PP and the effect of PP in pregnant patients with COVID-19. Inhalational anesthetics and their use for sedation of patients on UPV are currently among the frequently discussed topics within the optimization of intensive care. Conversely, ventilator-induced dysfunction of the main respiratory muscles, especially the diaphragm, has been a serious topic in critical care for a long time. Next, critically ill patients are at risk of hyperoxemia both as part of MV and ECMO support. The negative impact of this condition is the final topic of the article.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

An Approach to Acute SARS-CoV-2 Management with Complementary Neuraltherapeutic Medicine: A Case Report.

Background: It has been proposed that the immunomodulatory capacity of neuraltherapeutic medicine (NTM) functions by means of stimuli to the nervous system, which influences the self-regulatory and plastic capacity of the nervous system, especially through the autonomic balance between the sympathetic and parasympathetic nervous systems. Several studies report the usefulness of NTM in inflammatory pathologies. Case presentation: A case report through a retrospective review of the medical history of an 82-year-old male patient with a diagnosis of acute SARS-CoV-2 who received a therapeutic intervention of NTM at the beginning of his hospitalization and presented satisfactory clinical evolution, with a follow-up for 18 months without post-COVID sequelae. A patient diagnosed with acute pneumonia for SARS-CoV-2, and mild ARDS, with markers of severity given by the history of COPD, advanced age, and elevation of LDH, ferritin, and CRP. On the third day of hospitalization, he presented an episode of pulmonary thromboembolism. He presented significant clinical improvement with in-hospital management for 9 days and underwent out-patient control with no post-COVID sequelae. Conclusions: NTM could be useful for the management of acute inflammatory diseases, including viral diseases such as SARS-CoV-2, in a mild or severe state of inflammation, when added to allopathic medicine, and it can improve clinical evolution and long-term sequelae. More studies are needed to validate this information.

Inhaled Sedation with Volatile Anesthetics for Mechanically Ventilated Patients in Intensive Care Units: A Narrative Review.

Inhaled sedation was recently approved in Europe as an alternative to intravenous sedative drugs for intensive care unit (ICU) sedation. The aim of this narrative review was to summarize the available data from the literature published between 2005 and 2023 in terms of the efficacy, safety, and potential clinical benefits of inhaled sedation for ICU mechanically ventilated patients. The results indicated that inhaled sedation reduces the time to extubation and weaning from mechanical ventilation and reduces opioid and muscle relaxant consumption, thereby possibly enhancing recovery. Several researchers have reported its potential cardio-protective, anti-inflammatory or bronchodilator properties, alongside its minimal metabolism by the liver and kidney. The reflection devices used with inhaled sedation may increase the instrumental dead space volume and could lead to hypercapnia if the ventilator settings are not optimal and the end tidal carbon dioxide is not monitored. The risk of air pollution can be prevented by the adequate scavenging of the expired gases. Minimizing atmospheric pollution can be achieved through the judicious use of the inhalation sedation for selected groups of ICU patients, where the benefits are maximized compared to intravenous sedation. Very rarely, inhaled sedation can induce malignant hyperthermia, which prompts urgent diagnosis and treatment by the ICU staff. Overall, there is growing evidence to support the benefits of inhaled sedation as an alternative for intravenous sedation in ICU mechanically ventilated patients. The indication and management of any side effects should be clearly set and protocolized by each ICU. More randomized controlled trials (RCTs) are still required to investigate whether inhaled sedation should be prioritized over the current practice of intravenous sedation.

Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19.

BACKGROUND: Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented.1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses.2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 µg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. RESULTS: A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, P = .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, P < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, P = .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 µg/h or 1,200 µg/d (2.2 ampules/d, P < .001), and that of midazolam dose was 5.7 mg/h. CONCLUSIONS: Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.

The story of transjugular intrahepatic portosystemic shunt (TIPSS) at the Royal Free Hospital, 2021–2022: indications and outcomes of 84 procedures

Transjugular intrahepatic portosystemic shunt (TIPSS) is an effective treatment for decompression of portal hypertension and is most commonly indicated in patients with chronic liver disease (CLD) or portal vein thrombosis (PVT). It is a technically challenging intervention. CLD patients are often frail with comorbidities conferring increased procedural risk. We tell the story of one year of procedures at the Royal Free Hospital (RFH), one of the major centres for TIPSS in Europe.A retrospective electronic casenote review was carried out for all patients who underwent TIPSS procedure at the RFH between April 2021 and April 2022. The outcomes of interest were success rate, complications and survival including those who went on to transplantation. A successful procedure was defined as a correctly placed stent with no procedural complications and symptom resolution. Eighty-four (84) patients underwent TIPSS during the 12-month period. Of these, 3 were abandoned: 2 because portal hypertension was absent on direct measurement and 1 due to anatomical infeasibility. Of the 81 completed, the most common indication was diuretic-intolerant ascites (n=32), followed by variceal bleeding (n=27), PVT (n=14), and other indications (n=8). The clinical success rates post-TIPSS for each indication are as follows. For diuretic intolerant ascites, 53.1% (17/32) of patients no longer require large volume paracentesis (LVP), 28.1% (9/21) require LVP at a reduced frequency, 6.3% (2/32) have been transplanted and 1 patient continues to have LVP at the same rate. For variceal bleeding, 85.2% (23/27) of patients have had no further episodes of bleeding. For PVT, 85.7% (12/14) of TIPSS remain patent with no patient requiring surgical intervention. No procedural complications were reported. Overall survival post-TIPSS is 87.7% (71/81) with procedure-related mortality accounting for no deaths. 8 patients who received TIPSS went on to be listed for liver transplant, of those 3 successfully received a graft, 4 remain listed and 1 has died while listed.A high number of TIPSS procedures were performed. The majority were successful with favourable clinical outcomes. Major challenges faced by the service during this time included staff shortages, bed capacity, transfer logistics and the wider impacts of the COVID-19 pandemic. This service depends on the collective expertise and close working of multiple specialties including hepatology, interventional radiology, intensive care and anaesthetics along with logistical and operational support. In an environment where all of these healthcare professionals work together to support the provision of TIPSS, patients can benefit from positive outcomes.

Aquaculture: an introductory text

This 4th edition covers issues associated with sustainable aquaculture development, culture systems, hatchery methods, nutrition and feeding of aquaculture species, reproductive strategies, harvesting, and many other topics. While its main focus is on the culture of fish, molluscs and crustaceans for food, the book also covers other forms of aquaculture, such as the production of seaweeds, recreational fish and ornamental species, as well as live foods, such as algae and rotifers that are used to feed larval shrimp and marine fish. Thoroughly updated and revised, this essential textbook now includes increased coverage of open-ocean cage culture and sea lice issues with salmon culture, coverage of the significant progress made in nutrition, including the move away from fishmeal as protein and fish oil as lipids in feed, information on biofloc technology uses, predictive impacts of climate change, probiotics, and the impact of COVID-19 on the aquaculture community, and updated aquaculture production statistics and lists of approved anaesthetics. Aquaculture remains one of the most rapidly growing agricultural disciplines, and this book remains an essential resource for all students of aquaculture and related disciplines.

Sevoflurane administration from extracorporeal membrane oxygenation via the AnaConDa device for a patient with COVID-19: A breakthrough solution for the shortage of intravenous anesthetics.

One of the major issues encountered during the coronavirus disease 2019 (COVID-19) pandemic has been the shortage of intravenous anesthetics. Moreover, patients undergoing extracorporeal membrane oxygenation (ECMO) need large quantities of intravenous anesthetics for sedation. We report the case of a 52-year-old man who was admitted to our hospital due to acute respiratory distress syndrome by COVID-19 and treated with ECMO. As controlling sedation with intravenous anesthetics was challenging, we attempted to administer inhaled anesthetics via the gas flow of ECMO. We decreased the quantity of intravenous anesthetics and opioids. This method might help overcome the shortage of intravenous anesthetics.

Greater occipital nerve block efficacy in COVID‑19 associated headache: a preliminary study

COVID‑19 is an infection caused by the new coronavirus SARS‑CoV‑2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID‑19 patients. Between March and May 2020, 27 patients (with laboratory‑confirmed 2019‑nCoV infection by next‑generation sequencing confirmation of real‑time PCR) that had moderate or severe headache associated with COVID‑19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre‑treatment and post‑treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID‑19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of "COVID‑19 associated headache treated with GON blockade". More long term and well‑designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.

Inhaled Sedation for Invasively Ventilated COVID-19 Patients: A Systematic Review.

BACKGROUND: Volatile anesthetics were used as sedative agents in COVID-19 (Coronavirus Disease 2019) invasively ventilated patients for their potentially beneficial pharmacological effects and due to the temporary shortages of intravenous agents during the pandemic crisis. METHODS: Online databases (PubMed, EMBASE, The Cochrane Central Register of Controlled Trial) and the "clinicaltrials.gov" website were searched for studies reporting the use of isoflurane, sevoflurane or desflurane. RESULTS: We identified three manuscripts describing the beneficial effects of isoflurane on 41 COVID-19 patients with acute respiratory distress syndrome (ARDS) in Germany (n = 2) and in the USA (n = 1), in terms of reduction in the use of opioids and other sedatives. We also found a case report of two patients with transient nephrogenic diabetes insipidus, which started after 6 and 8 days of sevoflurane sedation. We identified two randomized controlled trials (RCTs; 92 patients overall), two observational studies (238 patients) on the use of volatile anesthetics in COVID-19 patients that were completed but not yet published, and one RCT interrupted for a low recruitment ratio (19 patients) and thus not published. We also identified five ongoing RCTs on the use of inhaled sedation in ARDS, which are also likely to be recruiting COVID-19 patients and which have currently enrolled a total of >1643 patients. CONCLUSION: Isoflurane was the most frequently used volatile agent in COVID-19 patients and allowed a reduction in the use of other sedative and analgesic drugs. Randomized evidence is building up and will be useful to confirm or challenge these findings.

A Systematic Review of Epileptiform Changes During Sevoflurane Anesthesia In Infants and Children

OBJECTIVES/GOALS: Early clinical case reports have described incidental epileptiform changes during electrophysiological monitoring. The objective of this study was to perform a systematic review of all existing investigations of epileptiform activity during sevoflurane use in pediatric anesthesia. The heterogenous EEG data will be analyzed in a meta analysis METHODS/STUDY POPULATION: A targeted, PICO-based clinical question was crafted and registered a priori on PROSPERO on 3/19/21. Under the guidance of a librarian from the Albert Einstein College of Medicine, a boolean search string was generated to search articles and gray literature for terms such as pediatric, sevoflurane and electroencephalogram in PubMed, OVID, Cochrane, Google Scholar, etc. We utilized the software platform tool COVIDENCE to manage our review. 495 references were imported for initial screening. 56 English-language, full-text studies were included for further review. The final 13 references were included in data extraction and Newcastle-Ottawa bias assessment. The characteristics of the studies and their primary outcomes were collected in tabular form. Strategies for data synthesis were discussed weekly. RESULTS/ANTICIPATED RESULTS: Epileptiform changes reported in the literature during pediatric sevoflurane anesthesia ranged from 0 - 95%. EEG data were acquired using a variety of recording systems with variable number of leads and heterogeneous outcomes reported. The periods of anesthesia monitoring were also heterogeneous. Characteristics of the studies are presented in Table 1. 495 references were imported for screening with 13 final references for data extraction. EEG abnormalities were reported in 204/649 (31.4%) subjects ranging in age from neonate to 18 years;the majority of studies utilized less than 16 channels of (10/13, 76.9%) (Table 1). There was variability in sevoflurane dosing, premedication (e.g., midzolam, hydroxyzine), and periods of anesthesia monitored. DISCUSSION/SIGNIFICANCE: There was heterogeneity noted across reviewed literature including study design, phases of anesthesia, ventilation methods, number of EEG leads recorded and adjuvant anesthetics administered. Nevertheless, this review rigorously classified epileptiform activity during Sevoflurane thereby influencing modern anesthesia.

Redistribution of critical drugs in shortage during the first wave of COVID-19 in France: from operating theaters to intensive care units.

BACKGROUND: Tension in the supply of highly consumed drugs for patients with COVID-19 (propofol, midazolam, curares) led the French government to set up a centralized supply of hospitals with distribution based on the number of resuscitation beds in March 2020. The French Societies of Clinical Pharmacy and of Anesthesia and Critical Care aimed to evaluate the changes in total needs and the distribution between anesthesia and critical care activities (CCU), to prepare resumed surgical activity. METHODS: National declarative survey among pharmacists, via an online form (SurveyMonkey®), was conducted in April and May 2020. The analysis focused on quantities dispensed during the whole year 2019, and March and April of year 2019 and 2020 for the drugs subject to quota, and on their distribution in CCU and operating theaters. RESULTS: For the 358 establishments (47% public, 53% private), dispensations in CCU in March 2020 compared to March 2019 increased, respectively: propofol (+81%), midazolam (+125%), cisatracurium (+311%), atracurium (+138%), rocuronium (+119%); and decreased for anaesthesia: propofol (-27%), midazolam (-10%), cisatracurium (-19%), atracurium (-27%), rocuronium (+16%). CONCLUSIONS: Variation of dispensations between CCU and others was directly related to the increase of COVID patients in CCU and the decrease in surgical activity. Each establishment could receive up to five or six different presentations and concentrations, leading to a major risk of medication error. This collaborative national survey provided accurate data on the drugs' usual consumption. This work emphasized the need for a strong collaboration between pharmacists and anesthesiologists and intensive care physicians. It was further used by the Health Ministry to adjust the drug distribution.

Ultrasonographic approach for a foot ganglion after sewing masks in the COVID-19 pandemic: Blessing in disguise

Background: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. Objective and Methods: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. Results: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. Conclusion: In short, we highlight the importance of ultrasound examination in the management of work (overuse)- related disorders in occupational medicine practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Local Anesthetics and Recurrence after Cancer Surgery-What's New? A Narrative Review.

The perioperative use of regional anesthesia and local anesthetics is part of almost every anesthesiologist's daily clinical practice. Retrospective analyses and results from experimental studies pointed towards a potential beneficial effect of the local anesthetics regarding outcome-i.e., overall and/or recurrence-free survival-in patients undergoing cancer surgery. The perioperative period, where the anesthesiologist is responsible for the patients, might be crucial for the further course of the disease, as circulating tumor cells (shed from the primary tumor into the patient's bloodstream) might form new micro-metastases independent of complete tumor removal. Due to their strong anti-inflammatory properties, local anesthetics might have a certain impact on these circulating tumor cells, either via direct or indirect measures, for example via blunting the inflammatory stress response as induced by the surgical stimulus. This narrative review highlights the foundation of these principles, features recent experimental and clinical data and provides an outlook regarding current and potential future research activities.

Recommendations on analgosedation and neuromuscular blockade strategies. (Pautas nacionales para la atenci..n de pacientes adultos con COVID-19.) [Spanish]

The implementation of pharmacological and non-pharmacological measures for adequate analgesia, sedation and treatment of delirium in the ICU is a fundamental objective in critical patient care. In this sense, the recommendations set out below try to contemplate the different possible scenarios depending on the availability of supplies and the clinical situation of each patient. SARS-CoV-2 infection causes different degrees of respiratory failure that require different ventilatory support strategies. In general, suitable for non-invasive modalities of respiratory support or less complex invasive ventilation. This situation includes the different modalities of invasive and controlled mechanical ventilation. The analgosedation (AS) to be used in each case will be adapted to the respiratory situation and the strategy used. Pain monitoring, sedation and neuromuscular blockade are key to reducing the effects secondary and save drugs. The association of various drugs and the addition of others, such as neuroleptics, contributes to reducing tolerance and can allow savings in those at risk of shortages.