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2.
BMJ Open ; 12(2): e052893, 2022 02 07.
Article in English | MEDLINE | ID: covidwho-1673433

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has renewed interest in the use of inhaled anaesthetics for sedation of ventilated critically ill patients. Preliminary data show that inhaled anaesthetics reduce lung inflammation, time to extubation and intensive care unit length of stay compared with intravenous sedatives. However, the impact of inhaled anaesthetics on cognitive and psychiatric outcomes is not well described in this setting. Randomised controlled trials are underway to establish if inhaled anaesthetics affect these and other patient and health system outcomes. Our aim is to summarise the known effects of inhaled sedatives on cognitive and psychiatric outcomes. METHODS AND ANALYSIS: In this systematic review, we will use MEDLINE, EMBASE, and PsycINFO to identify studies from 1970 to 2021 that assessed cognitive and psychiatric outcomes in critically ill adult patients sedated with inhaled anaesthetics. We will include case series, observational and cohort studies and randomised controlled trials. We will exclude case studies due to the heterogeneity of reporting in these studies. For randomised controlled trials comparing inhaled to intravenous sedation, we will report cognitive and psychiatric outcomes for both study arms. Studies will be selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data will be extracted using a standardised data extraction tool by two independent reviewers. Studies will be assessed for bias using the Cochrane risk of bias tool for randomised controlled trials, or the Newcastle-Ottawa Scale for cohort and case-control studies. Findings will be reported according to outcome and descriptive statistics will be used to illustrate findings in a narrative fashion. ETHICS AND DISSEMINATION: The systematic review uses published data and therefore does not require ethics approval. Results will be disseminated via publication in peer-reviewed journals and presentation at conferences related to the field. PROSPERO REGISTRATION NUMBER: CRD42021236455.


Subject(s)
Anesthetics , COVID-19 , Adult , Cognition , Critical Illness , Humans , Pandemics , SARS-CoV-2 , Systematic Reviews as Topic
3.
BMJ Case Rep ; 14(11)2021 Nov 29.
Article in English | MEDLINE | ID: covidwho-1546478

ABSTRACT

Primary amyloidosis is a rare systemic disorder often associated with multiple organ dysfunction. The most common form, light chain amyloidosis, has an estimated age-adjusted incidence of 5.1-12.8 cases per million person-years. Spine involvement is extremely uncommon. We present the case of a young Asian man with newly diagnosed amyloidosis involving the lumbar spine among multiple organs with a pathological vertebral fracture that required urgent spine surgery. We believe this is the first reported case to discuss the perianaesthetic challenges in the management of lumbar spine amyloidosis.


Subject(s)
Amyloidosis , Anesthetics , Immunoglobulin Light-chain Amyloidosis , Amyloidosis/surgery , Child , Child, Preschool , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Lumbosacral Region , Male
5.
Nurs Stand ; 36(9): 77-81, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1369911

ABSTRACT

Ketamine is a synthetic drug with unique properties which started to be used therapeutically in humans in the 1970s and is now widely used in all fields of nursing. Ketamine acts on the central nervous system, primarily through inhibiting N-methyl-D-aspartate receptors. However, the precise understanding of its mechanisms of action remains elusive in many respects. Ketamine is frequently used as an anaesthetic in medical and surgical procedures and as an analgesic in children and adults. It is increasingly used in mental health settings to treat depression. It has potential to be used more often in areas such as palliative care and mental health care. This article reviews the physiological and pharmacological properties of ketamine, explores its main therapeutic uses, and considers the associated implications for nursing practice.


Subject(s)
Analgesics , Anesthetics , Ketamine , Analgesics/pharmacology , Analgesics/therapeutic use , Anesthetics/pharmacology , Anesthetics/therapeutic use , Anti-Inflammatory Agents/pharmacology , Anti-Inflammatory Agents/therapeutic use , Antidepressive Agents/pharmacology , Antidepressive Agents/therapeutic use , Humans , Ketamine/pharmacology , Ketamine/therapeutic use
6.
A A Pract ; 15(5): e01458, 2021 May 07.
Article in English | MEDLINE | ID: covidwho-1329124

ABSTRACT

A significant number of patients with coronavirus disease 2019 develop strokes with large vessel obstructions that may require endovascular treatment for revascularization. Our series focuses on periprocedural issues and the anesthetic management of these patients. We analyzed medical records of 5 patients with positive reverse transcription polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 during their hospitalization who underwent endovascular treatment at our hospital between March and mid-June 2020. We found that our patients were different from the typical patients with ischemic stroke in that they had signs of hypercoagulability, hypoxia, and a lack of hypertension at presentation.


Subject(s)
Anesthetics , Brain Ischemia , COVID-19 , Endovascular Procedures , Stroke , Humans , SARS-CoV-2
8.
Curr Opin Anaesthesiol ; 34(4): 464-469, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1313887

ABSTRACT

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. RECENT FINDINGS: National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SUMMARY: NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.


Subject(s)
Anesthesia , Anesthesiology , Anesthetics , COVID-19 , Anesthesia/adverse effects , Humans , SARS-CoV-2
9.
J Formos Med Assoc ; 121(1 Pt 2): 439-441, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1307040

ABSTRACT

Bronchoscopic interventions (BIs) and airway management for bronchoscopy are exceptionally high-risk procedures not only for anesthesiologists, pulmonologists, but also for nursing staff because they expose nurses to COVID-19-containing droplets. However, perioperative changes can be made to the anesthetic management for nonintubated BIs to minimize the spread of COVID-19.


Subject(s)
Anesthetics , COVID-19 , Humans , Pandemics , SARS-CoV-2
10.
J Neurosurg Anesthesiol ; 33(2): 107-136, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1254869

ABSTRACT

This review summarizes the literature published in 2020 that is relevant to the perioperative care of neurosurgical patients and patients with neurological diseases as well as critically ill patients with neurological diseases. Broad topics include general perioperative neuroscientific considerations, stroke, traumatic brain injury, monitoring, anesthetic neurotoxicity, and perioperative disorders of cognitive function.


Subject(s)
Anesthesiology , Anesthetics , Neurosurgery , Anesthetics/adverse effects , Humans , Neurosurgical Procedures , Perioperative Care
11.
Curr Opin Anaesthesiol ; 34(4): 464-469, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1254866

ABSTRACT

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. RECENT FINDINGS: National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SUMMARY: NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.


Subject(s)
Anesthesia , Anesthesiology , Anesthetics , COVID-19 , Anesthesia/adverse effects , Humans , SARS-CoV-2
12.
Curr Opin Anaesthesiol ; 34(4): 476-481, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1254865

ABSTRACT

PURPOSE OF REVIEW: This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke. RECENT FINDINGS: Recent randomized controlled trials have shown no differences in clinical outcomes between monitored anesthesia care with sedation compared with general anesthesia for endovascular stroke therapy. The COVID-19 pandemic has complicated decision-making in the neurointerventional setting. Advances in imaging techniques have extended the window of treatment for endovascular therapy. SUMMARY: Optimal time to intervention, hemodynamic stability, novel imaging techniques, and careful consideration of anesthetic plan can impact patient outcomes in reperfusion stroke therapy.


Subject(s)
Anesthetics , Brain Ischemia , COVID-19 , Endovascular Procedures , Ischemic Stroke , Stroke , Brain Ischemia/therapy , Conscious Sedation , Endovascular Procedures/adverse effects , Humans , Pandemics , Radiology, Interventional , SARS-CoV-2 , Stroke/therapy , Treatment Outcome
15.
PLoS One ; 16(3): e0248997, 2021.
Article in English | MEDLINE | ID: covidwho-1143298

ABSTRACT

BACKGROUND: In Switzerland, details of current anaesthesia practice are unknown. However, they are urgently needed to manage anaesthesia drug supply in times of drug shortages due to the pandemic. METHODS: We surveyed all Swiss anaesthesia institutions in April 2020 to determine their annual anaesthesia activity. Together with a detailed analysis on anaesthetic drug use of a large, representative Swiss anaesthesia index institution, calculations and projections for the annual need of anaesthetics in Switzerland were made. Only those drugs have been analysed that are either being used very frequently or that have been classified critical with regard to their supply by the pharmacy of the index institution or the Swiss Federal Office of Public Health. RESULTS: The response rate to our questionnaire was 98%. Out of the present 188 Swiss anaesthesia institutions, 185 responded. In Switzerland, the annual number of anaesthesias was 1'071'054 (12'445 per 100'000 inhabitants) with a mean anaesthesia time of 2.03 hours. Teaching hospitals (n = 54) performed more than half (n = 572'231) and non-teaching hospitals (n = 103) provided almost half of all anaesthesias (n = 412'531). Thereby, private hospitals conducted a total of 290'690 anaesthesias. Finally, office-based anaesthesia institutions with mainly outpatients (n = 31) administered 86'292 anaesthesias. Regarding type of anaesthesia provided, two thirds were general anaesthesias (42% total intravenous, 17% inhalation, 8% combined), 20% regional and 12% monitored anaesthesia care. Projecting for example the annual need for propofol in anaesthesia, Switzerland requires 48'573 L of propofol 1% which corresponds to 5'644 L propofol 1% per 100'000 inhabitants every year. CONCLUSIONS: To actively manage anaesthesia drug supply in the context of the current pandemic, it is mandatory to have a detailed understanding of the number and types of anaesthesias provided. On this basis, the Swiss annual consumption of anaesthetics could be projected and the replenishment organized.


Subject(s)
Anesthesia/statistics & numerical data , Anesthetics/supply & distribution , COVID-19/pathology , COVID-19/epidemiology , COVID-19/virology , Humans , Pandemics , Retrospective Studies , SARS-CoV-2/isolation & purification , Switzerland/epidemiology
17.
Rev Esp Anestesiol Reanim (Engl Ed) ; 68(7): 408-413, 2021.
Article in English | MEDLINE | ID: covidwho-1087239

ABSTRACT

INTRODUCTION: Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery. CASE REPORT: A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed. CONCLUSION: This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era.


Subject(s)
Anesthetics , Breast Neoplasms , COVID-19 , Nerve Block , Ultrasonography, Interventional , Breast Neoplasms/surgery , Female , Humans , Mastectomy , Mastectomy, Simple , Middle Aged , SARS-CoV-2 , Stroke Volume , Ventricular Function, Left
19.
Clin Ther ; 43(3): e57-e70, 2021 03.
Article in English | MEDLINE | ID: covidwho-1064962

ABSTRACT

PURPOSE: The aim of the present article was to briefly summarize current knowledge about the immunomodulatory effects of general anesthetics and the possible clinical effects of this immunomodulation in patients with COVID-19. METHODS: The PubMed, Scopus, and Google Scholar databases were comprehensively searched for relevant studies. FINDINGS: The novel coronavirus causes a wide spectrum of clinical manifestations, with a large absolute number of patients experiencing severe pneumonia and rapid progression to acute respiratory distress syndrome and multiple organ failure. In these patients, the equilibrium of the inflammatory response is a major determinant of survival. The impact of anesthetics on immune-system modulation may vary and includes both pro-inflammatory and anti-inflammatory effects. IMPLICATIONS: Inhibition of the development of severe inflammation and/or the enhancement of inflammation resolution by anesthetics may limit organ damage and improve outcomes in patients with COVID-19.


Subject(s)
Anesthetics/administration & dosage , COVID-19/complications , Immune System/drug effects , COVID-19/immunology , Critical Illness , Humans , Inflammation/virology , Pneumonia/virology , Respiratory Distress Syndrome/virology
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