General anesthesia and regional anesthesia are the anesthetic techniques of choice for caesarian delivery. Anesthetic technique of choice is determined by several factors such as the safety of the parturient (evaluation of the airway and risk of aspiration), technical problems, the wellbeing of the fetus, and the experience of the anesthesiologist. Superiomposed preeclampsia is defined as chronic hypertension in pregnant women with gestational age > 20 weeks. When neurological manifestations arises, this condition becomes an emergency and requires immediate pregnancy termination by caesarian section. We report a case of a 42-year-old woman, 38-39 weeks pregnant, with a history of hypertension and ADHF Profile B, in an intubated state has undergone a green code caesarean section with general anesthesia using propofol 200 mg, fentanyl 100 mcg, rocuronium 50 mg. The operation lasted 50 minutes, and the patient maintained stable hemodynamics, with 300 ml blood loss. The baby was a male, born with APGAR score of 8/9, weighted 2410g. The patient was observed in the intensive care unit post-operatively. Pregnancy with superimposed preeclampsia carries a high risk of morbidity and mortality, for both the parturient and the fetus. Caesarean section with general anesthesia is preferred in superimposed preeclampsia with neurologic complications because it can achieve rapid induction, optimal airway control, and lower risk of hypotension and cardiovascular instability.
{"title":"General Anesthesia for the Gravid Patient in the Emergency Operating Room at Sanglah General Hospital","authors":"Munif Achmad, Jelita Kadek Intan, Wijaya I Nyoman Santa, Parami Pontisomaya","doi":"10.23937/2377-4630/1410134","DOIUrl":"https://doi.org/10.23937/2377-4630/1410134","url":null,"abstract":"General anesthesia and regional anesthesia are the anesthetic techniques of choice for caesarian delivery. Anesthetic technique of choice is determined by several factors such as the safety of the parturient (evaluation of the airway and risk of aspiration), technical problems, the wellbeing of the fetus, and the experience of the anesthesiologist. Superiomposed preeclampsia is defined as chronic hypertension in pregnant women with gestational age > 20 weeks. When neurological manifestations arises, this condition becomes an emergency and requires immediate pregnancy termination by caesarian section. We report a case of a 42-year-old woman, 38-39 weeks pregnant, with a history of hypertension and ADHF Profile B, in an intubated state has undergone a green code caesarean section with general anesthesia using propofol 200 mg, fentanyl 100 mcg, rocuronium 50 mg. The operation lasted 50 minutes, and the patient maintained stable hemodynamics, with 300 ml blood loss. The baby was a male, born with APGAR score of 8/9, weighted 2410g. The patient was observed in the intensive care unit post-operatively. Pregnancy with superimposed preeclampsia carries a high risk of morbidity and mortality, for both the parturient and the fetus. Caesarean section with general anesthesia is preferred in superimposed preeclampsia with neurologic complications because it can achieve rapid induction, optimal airway control, and lower risk of hypotension and cardiovascular instability.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43443605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.23937/2377-4630/1410133
Lim Chaeseong, Pak Yujin, Park Hanmi, Lee Wonhyung, Yoon Seokhwa, Shin Yongsup
{"title":"Unexplained Intraoperative Hypertension and an Electrocautery Burn: A Case Report","authors":"Lim Chaeseong, Pak Yujin, Park Hanmi, Lee Wonhyung, Yoon Seokhwa, Shin Yongsup","doi":"10.23937/2377-4630/1410133","DOIUrl":"https://doi.org/10.23937/2377-4630/1410133","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41652033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.23937/2377-4630/1410131
Gabriele F Silveira, Isadora AC Fraga, Larissa RM Castro, José Lucas UM Gomes, M. A. Delgado
{"title":"Anesthetic Immunomodulation and the Tumor Recurrence: A Narrative Literature Review","authors":"Gabriele F Silveira, Isadora AC Fraga, Larissa RM Castro, José Lucas UM Gomes, M. A. Delgado","doi":"10.23937/2377-4630/1410131","DOIUrl":"https://doi.org/10.23937/2377-4630/1410131","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44264289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.23937/2377-4630/1410132
Petros K Yosief, G. G. Beraki, Susan R. Mayer, M. B. Mengistu, E. Tesfamariam
{"title":"Incidence and Risk factors of Postoperative Nausea and Vomiting after ENT Surgery","authors":"Petros K Yosief, G. G. Beraki, Susan R. Mayer, M. B. Mengistu, E. Tesfamariam","doi":"10.23937/2377-4630/1410132","DOIUrl":"https://doi.org/10.23937/2377-4630/1410132","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46338268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.23937/2377-4630/1410130
D. Karantoula, E. Stamatakis, Sofia Hadzilia, P. Antsaklis, D. Valsamidis
Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet rich-thrombi. TTP is specifically related to a severe deficiency of ADAMTS13, a cleaving protease for von Willebrand (vWF). TTP is occurring in between 1 and 13 cases per million people depending on geographic location, and 1 in 25,000 pregnancies. We present 40-yr-old parturient with TTP who underwent spinal anesthesia for cesarean delivery at 37 weeks of gestation. Treatment for our case included acetylsalicylic acid, methylprednisolone and administration of fresh frozen plasma (FFP). We emphasize the importance of a multidisciplinary team approach to succeed the best outcome for this patient. Literature is discussed.
{"title":"Anesthetic Management in a Parturient with Thrombotic Thrombocytopenic Purpura for Cesarean Section: A Case Report and Literature Review","authors":"D. Karantoula, E. Stamatakis, Sofia Hadzilia, P. Antsaklis, D. Valsamidis","doi":"10.23937/2377-4630/1410130","DOIUrl":"https://doi.org/10.23937/2377-4630/1410130","url":null,"abstract":"Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia linked to disseminated microvascular platelet rich-thrombi. TTP is specifically related to a severe deficiency of ADAMTS13, a cleaving protease for von Willebrand (vWF). TTP is occurring in between 1 and 13 cases per million people depending on geographic location, and 1 in 25,000 pregnancies. We present 40-yr-old parturient with TTP who underwent spinal anesthesia for cesarean delivery at 37 weeks of gestation. Treatment for our case included acetylsalicylic acid, methylprednisolone and administration of fresh frozen plasma (FFP). We emphasize the importance of a multidisciplinary team approach to succeed the best outcome for this patient. Literature is discussed.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44571376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.23937/2377-4630/1410129
Martínez Diego Escarramán, Gutiérrez Manuel Alberto Guerrero, Aguilar José Antonio Meade, Rojas Miguel Ángel Martínez, Nieto Orlando Rubén Pérez, Sánchez Bertha M Córdova, Lopez Eder Ivan Zamarrón, Diaz Jesús Salvador Sánchez
{"title":"Acute Kidney Injury in the Perioperative Period: Beyond the Obvious","authors":"Martínez Diego Escarramán, Gutiérrez Manuel Alberto Guerrero, Aguilar José Antonio Meade, Rojas Miguel Ángel Martínez, Nieto Orlando Rubén Pérez, Sánchez Bertha M Córdova, Lopez Eder Ivan Zamarrón, Diaz Jesús Salvador Sánchez","doi":"10.23937/2377-4630/1410129","DOIUrl":"https://doi.org/10.23937/2377-4630/1410129","url":null,"abstract":"","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48944963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-05DOI: 10.23937/2377-4630/1410126
L. Lydia, Lim Yiqi Ofelia, Chan Lijuan Jasmine, A. Joseph
Background: Spontaneous intracranial hypotension (SIH) is uncommon and postulated to occur due to spontaneous cerebrospinal fluid (CSF) leak. Subdural hemorrhage is a rare but serious complication of intracranial hypotension. With a paucity of high-level evidence to guide treatment, its management remains challenging. Case presentation: We report a case of spontaneous intracranial hypotension which was successfully treated with an epidural blood patch. The patient is a 59-year-old man with poorly controlled diabetes and hyperlipidemia who presented with left trochlear nerve palsy and bilateral acute subdural haemorrhage (SDH) secondary to SIH. He underwent bilateral burr hole drainage of acute SDH under general anaesthesia. Post-extubation, an epidural blood patch was performed which resulted in resolution of his symptoms. Conclusion: We highlight an interesting case of SIH presenting atypically with cranial nerve IV palsy and its successful management with epidural blood patch.
{"title":"Epidural Blood Patch for Spontaneous Intracranial Hypotension","authors":"L. Lydia, Lim Yiqi Ofelia, Chan Lijuan Jasmine, A. Joseph","doi":"10.23937/2377-4630/1410126","DOIUrl":"https://doi.org/10.23937/2377-4630/1410126","url":null,"abstract":"Background: Spontaneous intracranial hypotension (SIH) is uncommon and postulated to occur due to spontaneous cerebrospinal fluid (CSF) leak. Subdural hemorrhage is a rare but serious complication of intracranial hypotension. With a paucity of high-level evidence to guide treatment, its management remains challenging. Case presentation: We report a case of spontaneous intracranial hypotension which was successfully treated with an epidural blood patch. The patient is a 59-year-old man with poorly controlled diabetes and hyperlipidemia who presented with left trochlear nerve palsy and bilateral acute subdural haemorrhage (SDH) secondary to SIH. He underwent bilateral burr hole drainage of acute SDH under general anaesthesia. Post-extubation, an epidural blood patch was performed which resulted in resolution of his symptoms. Conclusion: We highlight an interesting case of SIH presenting atypically with cranial nerve IV palsy and its successful management with epidural blood patch.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42903889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-31DOI: 10.23937/2377-4630/1410118
Sezen Ozlem, Çevik E. Banu, Saracoglu Kemal Tolga
Background/aims: The aim of this study was to investigate the effects of the preemptive administration of a single dose of intravenous (IV) ibuprofen on the intraoperative hemodynamic parameters, recovery characteristics, and postoperative pain management in patients undergoing laparoscopic cholecystectomy. The time to first analgesic requirement during postoperative period was the main goal of this study. Material and methods: Following ethical committee approval, sixty patients scheduled for laparoscopic cholecystectomy with American Society of Anesthesiologists (ASA) physical status I-II and aged 30-65 years of either genders were included in this prospective, randomized, placebo-controlled double blinded study. Patients were randomly divided into two groups. The study group (group I) received 400 mg ibuprofen in 100 ml IV saline 15 min before anesthesia induction, whereas the placebo group (group C) received IV 100 ml saline only. The study drug and the saline were administered by an anesthesia nurse blinded to the study. The same general anesthesia protocol was applied in both groups. Hemodynamic parameters (non-invasive systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), bispectral index (BIS) values and SpO2 values were recorded before induction (baseline) and after induction, peroperative 10, 20, 30, minutes., before extubation. The time to achieve a modified Aldrete score of ≥ 9 was recorded as the recovery time. During postoperative period, the time to first analgesic requirement and the total amount of analgesics within 24 hours was recorded. Patients were asked to give a number between from 1 to 5 for the satisfaction assessment for the anesthesia management. Results: There was no difference between the groups in terms of hemodynamic findings before anesthesia induction and in the peroperative period. The time until Aldrete score of 9 was statistically significantly shorter in Group I (Group I 3.8 ± 1.4 min, and Group C 6.3 ± 1.9 min, p < 0.001). Sevoflurane consumption was lower in the group given preemptive single dose IV ibuprofen, but the time to first postoperative analgesic requirement was longer (p < 0.001). Total analgesic consumption was highest in Group C (p < 0.001). Conclusion: Preemptive single dose i.v. ibuprofen (400 mg) can be used in laparoscopic cholecystectomy with the advantages of reducing the consumption of peroperative sevoflurane, providing better VAS scores, shortening the time to the first postoperative analgesic requirement and reducing analgesic consumption.
{"title":"The Effect of Single-Dose Preemptive Intravenous Ibuprofen on the Intraoperative Hemodynamic Parameters, Recovery Characteristics, and Acute Pain after Laparoscopic Cholecystectomy: A Randomized Double-Blind, Placebo-Controlled Clinical Trial","authors":"Sezen Ozlem, Çevik E. Banu, Saracoglu Kemal Tolga","doi":"10.23937/2377-4630/1410118","DOIUrl":"https://doi.org/10.23937/2377-4630/1410118","url":null,"abstract":"Background/aims: The aim of this study was to investigate the effects of the preemptive administration of a single dose of intravenous (IV) ibuprofen on the intraoperative hemodynamic parameters, recovery characteristics, and postoperative pain management in patients undergoing laparoscopic cholecystectomy. The time to first analgesic requirement during postoperative period was the main goal of this study. Material and methods: Following ethical committee approval, sixty patients scheduled for laparoscopic cholecystectomy with American Society of Anesthesiologists (ASA) physical status I-II and aged 30-65 years of either genders were included in this prospective, randomized, placebo-controlled double blinded study. Patients were randomly divided into two groups. The study group (group I) received 400 mg ibuprofen in 100 ml IV saline 15 min before anesthesia induction, whereas the placebo group (group C) received IV 100 ml saline only. The study drug and the saline were administered by an anesthesia nurse blinded to the study. The same general anesthesia protocol was applied in both groups. Hemodynamic parameters (non-invasive systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), bispectral index (BIS) values and SpO2 values were recorded before induction (baseline) and after induction, peroperative 10, 20, 30, minutes., before extubation. The time to achieve a modified Aldrete score of ≥ 9 was recorded as the recovery time. During postoperative period, the time to first analgesic requirement and the total amount of analgesics within 24 hours was recorded. Patients were asked to give a number between from 1 to 5 for the satisfaction assessment for the anesthesia management. Results: There was no difference between the groups in terms of hemodynamic findings before anesthesia induction and in the peroperative period. The time until Aldrete score of 9 was statistically significantly shorter in Group I (Group I 3.8 ± 1.4 min, and Group C 6.3 ± 1.9 min, p < 0.001). Sevoflurane consumption was lower in the group given preemptive single dose IV ibuprofen, but the time to first postoperative analgesic requirement was longer (p < 0.001). Total analgesic consumption was highest in Group C (p < 0.001). Conclusion: Preemptive single dose i.v. ibuprofen (400 mg) can be used in laparoscopic cholecystectomy with the advantages of reducing the consumption of peroperative sevoflurane, providing better VAS scores, shortening the time to the first postoperative analgesic requirement and reducing analgesic consumption.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48568609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-20DOI: 10.23937/2377-4630/1410104
Basto Tatiana, S. MachadoHumberto
Introduction: Balanced anaesthesia relies on the administration of opioids in the perioperative period as antinociceptive agents. There is no clear evidence that intraoperative opioids result in reduction of postoperative pain scores. Opioid-free anaesthesia (OFA), combination of various opioids-sparing techniques leading to no administration of intraoperative systemic, neuraxial or intracavitary opioids, arises from the attempt to develop anti-hyperalgesic techniques to improve postoperative pain control. Therefore, the aim of this review is to understand to which extend is opioid free beneficial in the perioperative period, more specifically the analgesic impact of this technique. Methods: The electronic databases Medline and PubMed were searched until November 2019. We included meta-analyses, randomized controlled trials and prospective studies investigating pain outcomes comparing any type of intra-operative opioid general anaesthesia with opioid-free general anaesthesia. The primary outcome was first measure of pain score at rest and at 24 postoperative hours. Secondary outcomes included rescue analgesia, intravenous (i.v.) morphine consumption equivalents at 24h postoperatively, rates of postoperative nausea and vomiting (PONV) within the first 24 postoperative hours, rates of rescue antiemetic drugs, length of stay in post-anaesthesia care unit (PACU) and total hospital length of stay. Eleven studies were identified, three of which are meta-analysis. Results: Mean pain scores at rest in the first measure as well as at 24 postoperative hours were lower in the opioid free anaesthesia (OFA) group than in opioid based anaesthesia (OBA). Use of rescue postoperative analgesia and i.v. morphine consumption equivalents were lower in the OFA group. A statistically significant trend toward a decrease in PONV and use of antiemetic drugs among patients who did not received opioids was observed. Length of stay PACU was longer in the opioid free group, but only three of six trials reported a statistically significant difference. Finally, total length of stay in the hospital was investigated by two trials and was similar between groups. Conclusion: OFA, when compared with OBA, does not present inferior results regarding pain scores or opioid consumption in the postoperative period. It is also associated with reduced postoperative nausea and vomiting. The OFA technique presents as future challenges an objective documentation of both its short-term and long-term benefits and inconveniencies. Further research with robust methodological trials with large sample sizes are required to better determine the efficacy and safety of opioid-free anaesthetic strategy.
{"title":"Effect of Opioid-Free Anaesthesia on Perioperative Period: A Review","authors":"Basto Tatiana, S. MachadoHumberto","doi":"10.23937/2377-4630/1410104","DOIUrl":"https://doi.org/10.23937/2377-4630/1410104","url":null,"abstract":"Introduction: Balanced anaesthesia relies on the administration of opioids in the perioperative period as antinociceptive agents. There is no clear evidence that intraoperative opioids result in reduction of postoperative pain scores. Opioid-free anaesthesia (OFA), combination of various opioids-sparing techniques leading to no administration of intraoperative systemic, neuraxial or intracavitary opioids, arises from the attempt to develop anti-hyperalgesic techniques to improve postoperative pain control. Therefore, the aim of this review is to understand to which extend is opioid free beneficial in the perioperative period, more specifically the analgesic impact of this technique. Methods: The electronic databases Medline and PubMed were searched until November 2019. We included meta-analyses, randomized controlled trials and prospective studies investigating pain outcomes comparing any type of intra-operative opioid general anaesthesia with opioid-free general anaesthesia. The primary outcome was first measure of pain score at rest and at 24 postoperative hours. Secondary outcomes included rescue analgesia, intravenous (i.v.) morphine consumption equivalents at 24h postoperatively, rates of postoperative nausea and vomiting (PONV) within the first 24 postoperative hours, rates of rescue antiemetic drugs, length of stay in post-anaesthesia care unit (PACU) and total hospital length of stay. Eleven studies were identified, three of which are meta-analysis. Results: Mean pain scores at rest in the first measure as well as at 24 postoperative hours were lower in the opioid free anaesthesia (OFA) group than in opioid based anaesthesia (OBA). Use of rescue postoperative analgesia and i.v. morphine consumption equivalents were lower in the OFA group. A statistically significant trend toward a decrease in PONV and use of antiemetic drugs among patients who did not received opioids was observed. Length of stay PACU was longer in the opioid free group, but only three of six trials reported a statistically significant difference. Finally, total length of stay in the hospital was investigated by two trials and was similar between groups. Conclusion: OFA, when compared with OBA, does not present inferior results regarding pain scores or opioid consumption in the postoperative period. It is also associated with reduced postoperative nausea and vomiting. The OFA technique presents as future challenges an objective documentation of both its short-term and long-term benefits and inconveniencies. Further research with robust methodological trials with large sample sizes are required to better determine the efficacy and safety of opioid-free anaesthetic strategy.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44939779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-04DOI: 10.23937/2377-4630/1410101
Xinyue Liu, J. Jing, Guo-Qing Zhao
As the recent update of General Anaesthesia compared to Spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term cognitive functions. However pre-clinical results cannot translate to clinical practice directly. Three well designed large population-based human studies strongly indicated that a single brief exposure to general anesthesia (GAs) is not associated with any long-term neurodevelopment deficits in children’s brain. Multiple exposure might cause decrease in processing speed and motor skills of children. However, the association between GAs and neurodevelopment in children is still inconclusive. More clinical studies with larger scale observations, randomized trials with longer duration exposure of GAs and follow-ups, more sensitive outcome measurements, and strict confounder controls are needed in the future to provide more conclusive and informative data. New research area has been developed to contribute in finding solutions for clinical practice as attenuating the neurotoxic effect of ASAs. Xenon and Dexmedetomidine are already used in clinical setting as neuroprotection and anaesthetic sparing-effect, but more research is still needed.
{"title":"General Anesthesia Affecting on Developing Brain: Evidence from Animal to Clinical Research","authors":"Xinyue Liu, J. Jing, Guo-Qing Zhao","doi":"10.23937/2377-4630/1410101","DOIUrl":"https://doi.org/10.23937/2377-4630/1410101","url":null,"abstract":"As the recent update of General Anaesthesia compared to Spinal anaesthesia (GAS) studies has been published in 2019, together with other clinical evidence, the human studies provided an overwhelming mixed evidence of an association between anaesthesia exposure in early childhood and later neurodevelopment changes in children. Pre-clinical studies in animals provided strong evidence on how anaesthetic and sedative agents (ASAs) causing neurotoxicity in developing brain and deficits in long-term cognitive functions. However pre-clinical results cannot translate to clinical practice directly. Three well designed large population-based human studies strongly indicated that a single brief exposure to general anesthesia (GAs) is not associated with any long-term neurodevelopment deficits in children’s brain. Multiple exposure might cause decrease in processing speed and motor skills of children. However, the association between GAs and neurodevelopment in children is still inconclusive. More clinical studies with larger scale observations, randomized trials with longer duration exposure of GAs and follow-ups, more sensitive outcome measurements, and strict confounder controls are needed in the future to provide more conclusive and informative data. New research area has been developed to contribute in finding solutions for clinical practice as attenuating the neurotoxic effect of ASAs. Xenon and Dexmedetomidine are already used in clinical setting as neuroprotection and anaesthetic sparing-effect, but more research is still needed.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42105005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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