Pregnancy and Hereditary Neuropathy With Liability to Pressure Palsies: A Case Report and Narrative Review of the Literature.

Pregnancy in patients with hereditary neuropathy with liability to pressure palsy (HNPP) can present unique challenges. This is due to the potential exacerbation of neurological symptoms and the need for careful management during the antepartum, intrapartum, and postpartum periods. In this case report, we will discuss the successful management of a young pregnant female with a history of HNPP delivered by cesarean section. We will also review the existing literature on the management of pregnant patients with HNPP, focusing on the multidisciplinary input and strategies to minimize the risk of complications during labor and delivery. Reporting cases of pregnancy in HNPP is important for increasing awareness among clinicians and optimizing patient care.

Postoperative sore throat: prophylaxis and treatment.

Postoperative sore throat (POST) is one of the most reported complications after general anesthesia with an incidence of as high as 60% which may impact patient satisfaction and increase the cost of treatment. The aim of this review is to summarize the currently accepted approaches and new trends intended to reduce the risk and increase the treatment efficacy of POST. Difficult intubation, traumatic intubation, and several other factors contribute to the development of POST. Endotracheal intubation using a stylet-loaded tube exerts excessive pressure on the anterior tracheal wall predisposing to mucosal trauma and contributing to development of POST. Pharmacological interventions are aimed at prevention, amelioration of symptoms, and treatment of POST. Medications suggested for this purpose include corticosteroids, topical sprays and creams, non-steroidal anti-inflammatory drugs (NSAID), and N-methyl-D-aspartate (NMDA) receptor antagonists. The use of video-laryngoscopes (VL) for endotracheal intubation improves the glottic view and increases the success rates with less force required to ensure adequate laryngoscopic view. Nevertheless, despite advances in laryngoscopic devices, the incidence of POST remains high. A novel intubation technique with endotracheal tube (ETT) rotation 180 degrees (ETT 180°) has been suggested to overcome stylet related injury and, possibly, decrease the POST. To date, no clinical trials have been conducted to test the efficacy of ETT 180° in reducing the incidence of POST. Undoubtedly, the suggested method deserves further investigation to determine its role in patient care.

Complicaciones relacionadas al manejo anestésico de pacientes pediátricos con osteogénesis imperfecta sometidos a procedimientos ortopédicos / Complications related to the anesthetic management of pediatric patients with osteogenesis imperfecta undergoing orthopedic procedures

Resumen: Introducción: la osteogénesis imperfecta es un trastorno sistémico del tejido conectivo, se caracteriza por una densidad ósea menor y variabilidad de la fragilidad ósea. Material y métodos: se realizó un estudio retrospectivo, observacional, descriptivo de casos consecutivos, cuyo objetivo principal fue determinar las complicaciones relacionadas al procedimiento anestésico en pacientes pediátricos con diagnóstico de osteogénesis imperfecta sometidos a procedimientos ortopédicos en el Hospital Infantil de México «Federico Gómez¼ mediante la revisión de expedientes clínicos. Se incluyeron pacientes con diagnóstico de osteogénesis imperfecta, menores de 18 años, sometidos a cirugía ortopédica electiva. Se utilizaron medidas de tendencia central y dispersión así como pruebas de hipótesis diversas. Resultados: se incluyeron 86 registros anestésicos. La mayoría del tipo III de osteogénesis imperfecta. La anestesia general balanceada fue la técnica más frecuente con intubación orotraqueal. De las complicaciones reportadas hubo intubación difícil en dos casos (2.3%). En seis casos (6.9%) se consideró ventilación difícil. Otra de las complicaciones reportadas fue el sangrado, encontrando un sangrado mayor al previsto en 33 casos (38.4%). Conclusiones: la anestesia requerida en los pacientes con osteogénesis imperfecta se llevó a cabo con un mínimo de complicaciones.

Abstract: Introduction: osteogenesis imperfecta is a systemic disorder of connective tissue, characterized by decreased bone density and variability of bone fragility. Material and methods: a retrospective, observational, descriptive study of consecutive cases was carried out, whose main objective was to determine the complications related to the anesthetic procedure in pediatric patients with a diagnosis of osteogenesis imperfecta undergoing orthopedic procedures at the «Federico Gómez¼ Children's Hospital of Mexico, through the review of clinical records. Patients diagnosed with osteogenesis imperfecta, under 18 years of age, undergoing elective orthopedic surgery, were included. Measures of central tendency and dispersion were used, as well as tests of various hypotheses. Results: 86 anesthetic records were included. Most of the type III of osteogenesis imperfecta. Balanced general anesthesia was the most frequent technique with orotracheal intubation. Of the reported complications, difficult intubation was found in two cases (2.3%). In six cases (6.9%) ventilation was considered difficult. Another of the complications reported was bleeding, finding bleeding greater than expected in 33 cases (38.4%). Conclusions: the anesthesia required in patients with osteogenesis imperfecta was carried out with a minimum of complications.

Analgesia in Pregnancy.

Pain management during labor and delivery is complex and must balance efficacy and toxicity to both the pregnant person and the fetus. There are numerous ways to achieve safe and effective analgesia and anesthesia during labor and delivery, including neuraxial and nonneuraxial techniques. This review describes important anesthetic considerations that should be made when formulating a pain management plan and an overview of common anesthesia-related complications encountered in the obstetric population.

Timely diagnostics and safe procedures in children with anterior mediastinal masses (AMMs): a qualitative review of the AMM protocol at BC Children's Hospital in Vancouver BC.

The presence of an anterior mediastinal mass should prompt rapid triage, workup and treatment to effectively manage and prevent emergent complications. Implementation of an AMM protocol can ensure the response is standardized and coordinated. Importantly, such a protocol can encourage prompt multi-disciplinary communication to mitigate risks associated with procedures required for timely diagnosis. The aim of this review is to evaluate the BC Children's Hospital's Pediatric New/Suspected Anterior Mediastinal Mass (AMM) Protocol. Retrospective chart review was conducted for 18 patients admitted from February 2016 to May 2020 with AMM for whom the protocol was enacted. Primary parameters assessed presence of high-risk feature at time of presentation, time from admission and/or protocol activation to specific time points, including imaging, first diagnostic procedure, and diagnosis. Data regarding perioperative management, including anesthetic considerations and peri-operative complications, was also collected. Mean time from protocol activation to first diagnostic procedure and diagnosis were 1.88 days (range 0-7) and 2.24 days (range 0-7), respectively. The majority of procedures were conducted under sedation (n = 77, 64%), followed by general anesthetic (GA; n = 34, 28%) and local anesthetic (n = 10, 8%). Despite 15 cases having more than one high risk feature, pre-operative steroids were only administered for four of the total 158 procedures (3%) and extracorporeal life support (ECLS) and otolaryngology (ENT) were only required for immediate availability for seven procedures (4%). Furthermore, only 10 procedures (8%) had associated complications and none of these complications resulted in patient death. Our data demonstrate that implementation of a streamlined multi-disciplinary protocol can expedite time to diagnosis without impacting patient safety.

ACE-Inhibitor or ARB-Induced Refractory Hypotension Treated With Vasopressin in Patients Undergoing General Anesthesia for Dentistry: Two Case Reports.

Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.

Dental Strain on Maxillary Incisors During Tracheal Intubation With Double-Lumen Tubes and Different Laryngoscopy Techniques - A Blinded Mannequin Study.

OBJECTIVES: To quantify dental forces during double-lumen tube intubations with different laryngoscopy techniques. DESIGN: Experimental biomechanical mannequin study. SETTING: Two German university hospitals. PARTICIPANTS: One hundred four anesthesiologists with varying levels of experience. INTERVENTIONS: Participants performed a sequence of intubations on a mannequin equipped with hidden forces sensors in the maxillary incisors. Different laryngoscopy techniques were evaluated under normal and difficult airway conditions. Direct laryngoscopy was compared with different videolaryngoscopy techniques: the C-MAC with a Macintosh blade, the GlideScope, and the KingVision with hyperangulated blades. MEASUREMENTS AND MAIN RESULTS: A total of 624 intubations were evaluated. In normal airway conditions, the median (interquartile range [range]) peak forces were significantly lower when the GlideScope (15.7 (11.3-22.0 [2.1-110.5]) N) was used compared with direct laryngoscopy (21.0 (14.1-28.5[4.7-168.6]) N) (p = 0.007). In difficult airways, resulting forces were reduced using hyperangulated videolaryngoscopes (GlideScope: -13.7 N [p < 0.001]; KingVision: -11.9 N [p < 0.001]) compared with direct laryngoscopy, respectively. The time to intubation was prolonged with the use of the KingVision (25.5 (17.1-41.9[9.2-275.0])s [p < 0.001]) in comparison to direct laryngoscopy (20.8 (15.9-27.4[8.7-198.6]) s). The C-MAC demonstrated the shortest time to intubation. CONCLUSIONS: Although hyperangulated videolaryngoscopes improve dental strain, clinicians also should consider the time to intubation, which is shortest with nonhyperangulated videoblades, when choosing a laryngoscopy technique on an individual patient basis.

Complications of bronchial thermoplasty using laryngeal mask: case series / Complicaciones de la termoplastia bronquial usando máscara laríngea: serie de casos

Abstract Severe asthma affects more than 250 million people and represents high healthcare costs. Bronchial thermoplasty is a relatively new technique in interventional pulmonology for managing this condition. The procedure is done under general anesthesia and the patients are mostly ASA II and III; therefore, the anesthesia plan must be safe. The purpose of the article is to describe the anesthetic technique used (general anesthesia and laryngeal mask) and the immediate and early complications of the procedure. Four patients were included, each undergoing three sessions. The complications during and immediately after the procedure, as well as the early complications (up to seven days post-procedure) that could have required hospital management were discussed. In three of the sessions at least one acute bronchospasm event presented, but only one patient required hospital admission for more than 24 hours. Experience suggests that thermoplasty may be safely conducted under general anesthesia and laryngeal mask.

Resumen El asma grave afecta a más de 250 millones de personas y genera altos costos en el sistema de salud. La termoplastia bronquial es una técnica relativamente novedosa de la neumología intervencionista para el manejo de esta condición. Este procedimiento se realiza bajo anestesia general, y los pacientes son en su mayoría ASA II y III, por lo que el plan anestésico debe ser seguro. El objetivo del artículo es describir la técnica anestésica utilizada (anestesia general y máscara laríngea) y las complicaciones inmediatas y tempranas del procedimiento. Se incluyeron cuatro pacientes, cada uno de los cuales fue sometido a tres sesiones. Se describieron las complicaciones durante e inmediatamente después del procedimiento y las complicaciones tempranas (hasta siete días posprocedimiento), que hubieran requerido manejo hospitalario. En tres de las sesiones se presentó al menos un evento agudo de broncoespasmo y solo un paciente requirió hospitalización mayor a 24 horas. La experiencia sugiere que la termoplastia puede ser llevada a cabo de manera segura bajo anestesia general y mascara laríngea.

Anesthetic complications in children with mucopolysaccharidosis / Complicaciones anestésicas en niños con mucopolisacaridosis

Abstract: Introduction: A high percentage of mucopolysaccharidosis patients require surgery at some point. Common features like respiratory limitations and cardiovascular disease pose a high anesthetic risk. We describe the prevalence of anesthetic complications in our institution. Material and methods: Patients' medical history and reported surgery data from 18 eligible records were reviewed from a total of 29 mucopolysaccharidosis diagnosed children registered between the years 1999 to 2019 at a hospital in Mexico. Results: Median age was 11 years. 12 patients were type I, two type II, three type IV, and one type VI. Intravenous premedication was administered in 69.5% and induction was intravenous in 91.3% of the surgical procedures. Orotracheal intubation was the first attempted anesthetic method in 47.8% and a laryngeal mask in another 47.8%. Bronchospasm was the most frequent complication in 17.4% followed by difficult intubation in 13.1%. Conclusions: Bronchospasm was the most prevalent complication. A higher Cormack-Lehane grade was primarily related. The most prevalent concomitant risk factors were short neck and restrictive chest rendering airway management difficult in comparison to the general population.

Resumen: Introducción: Un alto porcentaje de pacientes con mucopolisacaridosis requieren cirugía en algún momento. Algunas características comunes como alteraciones respiratorias y enfermedades cardiovasculares constituyen un alto riesgo anestésico. Describimos la prevalencia de las complicaciones anestésicas en nuestra institución. Material y métodos: Fueron revisados los antecedentes y los datos quirúrgicos de 18 pacientes elegibles, extraídos de un total de 29 expedientes de niños con mucopolisacaridosis registrados entre los años 1999 y 2019 en un hospital de México. Resultados: La mediana de edad fue de 11 años. Doce pacientes fueron de tipo I, dos tipo II, tres tipo IV y uno tipo VI. La premedicación intravenosa se administró en 69.5% y la inducción fue intravenosa en 91.3% de los procedimientos quirúrgicos. El primer método anestésico intentado fue la intubación orotraqueal en 47.8% y la máscara laríngea en 47.8%. El broncoespasmo fue la complicación más frecuente en 17.4%, seguida de una intubación difícil en 13.1%. Conclusiones: El broncoespasmo fue la complicación más observada relacionada, primordialmente, con un grado Cormack-Lehane más alto. Los factores de riesgo concomitantes más frecuentes fueron el cuello corto y las restricciones torácicas, lo que dificulta en mayor grado el manejo de las vías respiratorias en comparación con la población general.

Caracterización clínica, epidemiológica y anatomopatológica de los tumores cerebrales supratentoriales y su morbilidad posanestésica / Clinical, Epidemiological and Anatomopathological Characterization of Supratentorial Brain Tumor and its Post-Anesthetic Morbidity

Introducción: Los tumores cerebrales no son frecuentes, pero tienen efectos devastadores. Objetivo: Caracterizar según criterios clínicos y anatomopatológicos a los pacientes con tumor cerebral supratentorial. Métodos: Se realizó un estudio observacional y descriptivo de casos clínicos en el período de enero 2017 - enero 2019, en el Hospital Provincial Saturnino Lora de Santiago de Cuba. El universo estuvo constituido por la totalidad de los 117 pacientes a los que se les realizó una tomografía computarizada de cráneo y con diagnóstico histológico postoperatorio de neoplasia primaria del sistema nervioso central (supratentorial) y metástasis cerebral, a los que se les realizó neurocirugía transcraneal. Resultados: Predominó el sexo masculino y las edades entre 40 a 59 años, clínicamente la mayoría de los casos presentó cefalea como signo de hipertensión endocraneana 76,1 por ciento. El 87,2 por ciento presentó la tumoración en los hemisferios cerebrales. El glioblastoma multiforme fue el tipo histológico prevaleciente con 45,3 por ciento. La hipopotasemia fue la complicación post anestésica más frecuente (21,4 por ciento). Conclusiones: Los tumores cerebrales supratentoriales en la edad adulta constituyen un problema de salud, principalmente en los hombres después de los 45 años de edad; la cefalea, las convulsiones y los vómitos son los síntomas cardinales. Durante la excéresis de los tumores supratentoriales los pacientes presentaron diversas complicaciones anestésicas(AU)

Introduction: Brain tumors are not frequent, but they have devastating effects. Objective: To characterize patients with supratentorial brain tumor, according to clinical and pathological criteria. Methods: An observational and descriptive study of clinical cases was carried out, in the period from January 2017 to January 2019, at Saturnino Lora Provincial Hospital in Santiago de Cuba. The universe consisted of the 117 patients who underwent computed tomography of the skull and with a postoperative histological diagnosis of primary neoplasia of the central nervous system (supratentorial) and brain metastases, who underwent transcranial neurosurgery. Results: The male sex predominated, together with the ages 40-59 years old. Clinically, most of the cases (76.1 percent) presented headache as a sign of intracranial hypertension. 87.2 percent presented the tumor in the cerebral hemispheres. Glioblastoma multiforme was the prevalent histological type, accounting for 45.3 percent. Hypokalemia was the most frequent post-anesthetic complication, accounting for 21.4 percent. Conclusions: Supratentorial brain tumors in adulthood constitute a health concern, mainly in men after 45 years of age; headache, seizures and vomiting are the cardinal symptoms. During excision of supratentorial tumors, the patients presented various anesthetic complications(AU)

Monitored Anesthesia Care versus General Anesthesia for Intrauterine Fetal Interventions: Analysis of Conversions and Complications for 480 Cases.

INTRODUCTION: Fetal intervention/surgery constitutes a relatively new field of maternal-fetal medicine in which monitored anesthesia care (MAC) or general anesthesia (GA) are utilized as anesthetic techniques when feasible. In this study, we sought to calculate the usage of MAC and GA in various fetal procedures as well as investigate any anesthetic complications and conversions from MAC to GA. METHODS: All intrauterine fetal intervention cases performed at the Texas Children's Hospital Pavilion for Women from 2012 to 2016 were retrospectively analyzed and categorized by mode of anesthesia. Anesthetic complications, conversions to GA, preoperative patient physical status, average number of intraoperative medications required, and average duration of procedure were compared between the MAC and GA groups. RESULTS: A total of 480 fetal interventions were performed with 432 under MAC (90%) and 37 under GA (7.7%). There were 11 conversions from MAC to GA (2.3%). These conversions were due to poor visualization with ultrasound and change of surgical approach to laparoscopic-assisted technique (n = 5), inability to lay flat due to back pain (n = 3), persistent vomiting (n = 2), and unresponsiveness after a spinal block (n = 1). One anesthetic complication occurred due to a medication administration error and did not require conversion to GA. The average preoperative American Society of Anesthesiologists (ASA) physical status classification was 1.97 for the MAC group and 1.87 for the GA group (p = 0.23). Duration of the interventions averaged 129 min under MAC and 138 min under GA (p = 0.23). An average of 7.8 different medications were administered during MAC cases compared to 13.1 during GA cases (p < 0.0001). DISCUSSION: This analysis suggests that MAC is the most commonly used anesthetic option for fetal interventions with a low complication rate and minimal conversion rates to GA. It is therefore preferable to use MAC when feasible due to the low complication rate and decreased drug exposure.

Cambios fisiológicos y consideraciones anestésicas en cirugía robótica no cardíaca / Physiological changes and anaesthetic considerations in non-cardiac robotic surgery

Resumen: La cirugía robótica ofrece numerosas ventajas sobre la cirugía laparoscópica convencional y la cirugía abierta. El anestesiólogo debe conocer los cambios que suceden en el paciente al ser sometido a cirugía robótica en el campo de la ginecología, urología, cirugía general, torácica y transoral. Los cambios fisiológicos son múltiples e involucran todos los sistemas: cardiovascular, respiratorio, neurológico, digestivo, renal; por lo que es de suma importancia el conocimiento de éstos para evitar complicaciones durante el período perioperatorio. De igual manera, es importante conocer el protocolo de seguridad para el retiro de los brazos del robot al verse con la necesidad de convertir la cirugía a laparoscópica o abierta. Se resumen las principales consideraciones anestésicas así como los cuidados específicos que el anestesiólogo debe tener durante cirugía robótica no cardíaca.

Abstract: Robotic surgery offers numerous advantages over conventional laparoscopic or open surgery. The anesthesiologist must have full knowledge of the physiological changes that happen when the patient undergoes robotic surgery; it being gynecological, urological, general surgery, thoracic or trans-oral surgery. There are multiple changes during robotic surgery involving the cardiovascular, respiratory, neurologic, digestive and renal systems. It is of utter importance the full knowledge of these changes in order to avoid complications during and after surgery. Also, it is important to fully know the emergency protocol for undocking if need be, to convert to laparoscopic or open surgery. We have summarized the main anesthetic considerations as well as the key points of care anesthesiologists must have during non-cardiac robotic surgery.

Factores de riesgo asociados a complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia / Risk factors associated with anesthetic complications in chronic renal patients undergoing emergency surgery

INTRODUCTION: Chronic kidney disease is a clinical entity secondary to the common final pathway of multiple etiologies with risk factors common to other chronic diseases. OBJECTIVE: To identify the risk factors related to the appearance of anesthetic complications in chronic renal patients undergoing emergency surgery. METHOD: A prospective cohort study was performed in patients with chronic kidney disease undergoing emergency surgery. The exposed cohort consisted of 15 patients with chronic kidney disease who developed complications during the study period. RESULTS: Age over 40 years, patients with ischemic heart disease and hypertensive patients presented a higher risk of anesthetic complications. Obesity and bronchial asthma were no risk factors. It was demonstrated that when the time elapsed between hemodialysis and the operation was less than 2 hours, the risk of anesthetic complications increased, the stage of the disease and the associated drugs were not related to the appearance of complications. Patients who received general anesthesia had three times more risk of complications than those under regional anesthesia. CONCLUSIONS: Age, arterial hypertension, ischemic heart disease, heart failure and the use of general anesthesia are risk factors associated with complications.

INTRODUCCIÓN: La enfermedad renal crónica es una entidad clínica secundaria a la vía final común de múltiples etiologías con factores de riesgo comunes a otras enfermedades crónicas. OBJETIVO: Identificar los factores de riesgo relacionados con la aparición de complicaciones anestésicas en enfermos renales crónicos intervenidos de urgencia. MÉTODO: Se realizó un estudio de cohorte prospectivo en pacientes con enfermedad renal crónica intervenidos por cirugía general de urgencia. La cohorte expuesta estuvo constituida por 15 pacientes con enfermedad renal crónica que desarrollaron complicaciones en el período en estudio. RESULTADOS: La edad mayor o igual a 40 años, los pacientes con cardiopatía isquémica y los hipertensos presentaron mayor riesgo de complicaciones anestésicas, no así la obesidad al igual que el asma bronquial. Se demostró que cuando el tiempo transcurrido entre la hemodiálisis y la operación fue inferior a 2 horas se incrementó el riesgo de complicaciones anestésicas, el estadio de la enfermedad y los medicamentos asociados no estuvieron relacionados con la aparición de complicaciones. Los pacientes a los que se administró anestesia general tuvieron tres veces más riesgo de complicaciones que aquellos que fueron intervenidos con anestesia regional. CONCLUSIONES: La edad, la hipertensión arterial, la cardiopatía isquémica, la insuficiencia cardiaca y el empleo de anestesia general son factores de riesgo asociados a complicaciones, en los pacientes portadores de IRC, sometidos a cirugía de urgencia.

Anesthetic complications in diabetic dogs subjected to phacoemulsification / Complicações anestésicas em cães diabéticos submetidos a facoemulsificação

The aim of this paper was to compare the incidence of anesthetic complications in diabetic and nondiabetic dogs subjected to phacoemulsification. In total, 30 male and female dogs of different breeds were used. The dogs were distributed into two groups: diabetic (DG) (n=15) and control (CG) (n=15). The animals were premedicated with acepromazine (0.03mg/kg) and meperidine (4mg/kg), intramuscularly. After 20 minutes, anesthesia was induced with propofol (2 to 5mg/kg) and maintained with isoflurane. The animals were monitored and the heart rate, respiratory rate, peripheral oxyhemoglobin saturation, end tidal carbon dioxide tension, inspired and expired isoflurane fraction, and invasive arterial pressure were recorded at 10 minute intervals during the surgical procedure. Arterial hemogasometry was performed after anesthetic induction (T0) and at the end of the surgical procedure. Diabetic patients (DG 10±2 years) were older than non-diabetic group (CG 6±2 years). The expired isoflurane fraction after induction was 30% higher in the control group (CG 1.3±0.3%, DG 1.0±0.2%) (p<0.01). The most common anesthetic complication was hypotension. In total, 80% of the diabetic animals (n=12) exhibited mean arterial pressure (MAP) lower than 60mmHg (54±9.6mmHg) after anesthetic induction, and 83% of the hypotensive dogs (n=10) required vasoactive drugs to treat hypotension. Regarding hemodynamic changes, diabetic patients subjected to general anesthesia were more likely to exhibit hypotension which may be due to the response of older animals to the drugs used; however, this change deserves further investigation.(AU)

O objetivo do presente estudo foi comparar a incidência de complicações anestésicas em cães diabéticos e não diabéticos submetidos a cirurgia de facoemulsificação. Foram utilizados 30 cães, machos ou fêmeas de diversas raças. Os cães foram distribuídos em dois grupos: diabético (GD) (n=15) e controle (GC) (n=15). Os animais foram pré-tratados com acepromazina (0,03mg/kg) e meperidina (4mg/kg), pela via intramuscular. Após 20 minutos, a indução foi realizada com propofol (2 a 5mg/kg) e a manutenção da anestesia com isofluorano. Os animais foram monitorados e as variáveis de frequência cardíaca, frequência respiratória, saturação oxihemoglobina periférica, concentração dióxido de carbono no final da expiração, fração inspirada e expirada de isofluorano e pressão arterial invasiva, foram registradas em intervalos de 10 minutos durante o procedimento cirúrgico. A hemogasometria arterial foi realizada após a indução (T0) e ao final do procedimento cirúrgico (T40). A idade dos animais do grupo diabético (10±2 anos) foi superior em relação aos animais do grupo controle (6±2 anos) (p<0,0001). A concentração expirada de isofluorano após a indução foi 30% superior nos animais do grupo controle (GC 1,3±0,3%, GD 1,0±0,2%) (p<0,01). A complicação anestésica mais comum foi a hipotensão arterial, 80% dos animais diabéticos (n=12) apresentaram pressão arterial média inferior a 60mmHg (54±9.6 mmHg) após indução anestésica; 83% dos cães hipotensos (n=10) necessitaram de fármacos vasoativos para tratamento da hipotensão. Com relação às alterações hemodinâmicas, os pacientes diabéticos submetidos à anestesia geral foram mais propensos à hipotensão arterial que pode ser decorrente da resposta dos animais mais velhos aos fármacos empregados; entretanto essa alteração merece maior investigação.(AU)

Assessing the outcomes, risks, and costs of local versus general anesthesia: A review with implications for cutaneous surgery.

BACKGROUND: There is a paucity of data providing direct comparison of outcomes, complications, and costs between general and local anesthesia in cutaneous surgery. OBJECTIVE: Analyze the literature from dermatologic and other specialties to compare outcomes, risks, and costs of general and local anesthesia. METHODS: A retrospective analysis of case comparison studies from other specialties comparing outcomes, risks, and/or costs in local versus general anesthesia was performed. A review of the literature from dermatology and other specialties was included. RESULTS: A total of 51 studies were selected; 41 of them directly examined outcomes in procedures performed under local and general anesthesia, and none found a significant difference in outcomes. A total of 41 studies measured adverse effects. Of these, 15 studies (36.6%) report significantly better outcomes between the 2 techniques. Only 2 studies (4.9%) report significantly improved outcomes with use of general anesthesia; 15 of 36 studies (41.7%) report fewer adverse events in local anesthesia. Of the 13 studies that examined costs, all (100%) found significantly decreased costs with use of local anesthesia. LIMITATIONS: These data cannot be seamlessly applied to all cases of cutaneous surgery. CONCLUSION: Local anesthesia techniques provide outcomes equal to or better than general anesthesia and with significantly lower costs.

Local Anesthetic Systemic Toxicity.

Local anesthetics are commonly used in the perioperative environment to facilitate surgical procedures or to provide postoperative pain management for patients. The use of local anesthetics, however, introduces the risk of complications resulting from local anesthetic systemic toxicity and the risks of increased morbidity and mortality for the surgical patient. Systemic toxicity from the injection or overdose of local anesthetics is a rare but potentially fatal complication that occurs in less than 1 in 1,000 patients. This article provides the perioperative nurse with information about local anesthetics, the signs and symptoms of local anesthetic systemic toxicity, and the information needed to manage a patient experiencing this complication.

Paratracheal cyst rupture: a differential diagnosis for tracheal rupture / Ruptura de cisto paratraqueal: um diagnóstico diferencial para ruptura traqueal

Abstract Tracheobronchial rupture is a rare but potentially life-threatening complication commonly caused by neck and chest trauma. Iatrogenic tracheobronchial rupture can be caused by intubation, tracheostomy, bronchoscopy but also linked to pre-existing primary diseases. Paratracheal air cysts, infrequently described in literature, seem to be associated with obstructive lung disease and weaknesses in right posterior lateral wall of the trachea. We report a case of a paratracheal air cyst rupture in a previous healthy patient.

Resumo A ruptura traqueobrônquica (RTB) é uma complicação rara, mas potencialmente fatal, comumente causada por trauma de pescoço e tórax. A RTB iatrogênica pode ser causada por intubação, traqueostomia, broncoscopia, mas também pode estar relacionada a doenças primárias preexistentes. Os cistos aéreos paratraqueais, raramente descritos na literatura, parecem estar associados à doença pulmonar obstrutiva e fraqueza da parede posterolateral direita da traqueia. Relatamos o caso de uma ruptura de cisto aéreo paratraqueal em paciente previamente saudável.

Increasing Access to Auricular Acupuncture for Postoperative Nausea and Vomiting.

PURPOSE: Postoperative nausea and vomiting (PONV) affects more than 30% of surgical patients. Auricular acupuncture (AA) has been shown to decrease the incidence of PONV in select populations. DESIGN: An evidence-based quality improvement project made AA available to all adult surgical patients, and the results were recorded in a database. A retrospective between-groups analysis of 210 database entries was conducted, of those 25 receiving AA. FINDINGS: More risk factors for PONV were present in the AA group (P < .001). Both groups experienced a less-than-expected rate of PONV. Similar rates were shown between groups for PONV, postanesthesia care unit length of stay, and opioid consumption. Patient satisfaction was 96% with AA. The AA group was treated with less antiemetic medication (P < .001), yet PONV rates remained similar. CONCLUSIONS: A multimodal approach treating patients at risk for PONV is recommended. Administration of multiple antiemetics may result in unnecessary cost or unfavorable side effects when effective and less costly alternatives exist. AA is a viable treatment for PONV, considering cost and patient satisfaction.

Paratracheal cyst rupture: a differential diagnosis for tracheal rupture.

Tracheobronchial rupture is a rare but potentially life-threatening complication commonly caused by neck and chest trauma. Iatrogenic tracheobronchial rupture can be caused by intubation, tracheostomy, bronchoscopy but also linked to pre-existing primary diseases. Paratracheal air cysts, infrequently described in literature, seem to be associated with obstructive lung disease and weaknesses in right posterior lateral wall of the trachea. We report a case of a paratracheal air cyst rupture in a previous healthy patient.

[Paratracheal cyst rupture: a differential diagnosis for tracheal rupture]. / Ruptura de cisto paratraqueal: um diagnóstico diferencial para ruptura traqueal.

Tracheobronchial rupture is a rare but potentially life-threatening complication commonly caused by neck and chest trauma. Iatrogenic tracheobronchial rupture can be caused by intubation, tracheostomy, bronchoscopy but also linked to pre-existing primary diseases. Paratracheal air cysts, infrequently described in literature, seem to be associated with obstructive lung disease and weaknesses in right posterior lateral wall of the trachea. We report a case of a paratracheal air cyst rupture in a previous healthy patient.