Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2023
ReviewA Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children.
The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. ⋯ This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child's anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.
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Anesthesia and analgesia · Jul 2023
Etomidate-Induced Myoclonus in Sprague-Dawley Rats Involves Neocortical Glutamate Accumulation and N-Methyl-d-Aspartate Receptor Activity.
Etomidate-induced myoclonus, a seizure-like movement, is of interest to anesthetists. However, its origin in the brain and its underlying mechanism remain unclear. ⋯ Etomidate-induced myoclonus or neuroexcitability is concentration dependent. Etomidate-induced myoclonus originates in the neocortex. The underlying mechanism involves neocortical glutamate accumulation and NMDAR modulation and myoclonus correlates with NMDAR-induced downregulation of KCC2 protein expression.
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Anesthesia and analgesia · Jul 2023
Ultrasound Assessment of Gastric Volume in Parturients After High-Flow Nasal Oxygen Therapy.
High-flow nasal oxygen (HFNO) therapy is widely used in critical care obstetrics to improve oxygenation. Much of the benefit of HFNO is linked to the creation of modest levels of positive airway pressure. Pregnant women are generally considered to be at high risk of regurgitation and aspiration. It is unknown whether HFNO may cause gas insufflation into the stomach and further increase this risk. Therefore, this study aimed to systematically evaluate the possible safety effects of HFNO on gastric volume in healthy fasted parturients. ⋯ Treatment with HFNO for 20 minutes at flow rates up to 50 L·min -1 did not increase gastric volume in term pregnant women breathing spontaneously when evaluated by gastric ultrasonography.
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Anesthesia and analgesia · Jul 2023
Observational StudyEnergy Expenditure Under General Anesthesia: An Observational Study Using Indirect Calorimetry in Patients Having Noncardiac Surgery.
Perioperative hemodynamic management aims to optimize organ perfusion pressure and blood flow-assuming this ensures that oxygen delivery meets cellular metabolic needs. Cellular metabolic needs are reflected by energy expenditure. A better understanding of energy expenditure under general anesthesia could help tailor perioperative hemodynamic management to actual demands. We thus sought to assess energy expenditure under general anesthesia. Our primary hypothesis was that energy expenditure under general anesthesia is lower than preoperative awake resting energy expenditure. ⋯ Median energy expenditure under general anesthesia is about one-quarter lower than preoperative awake resting energy expenditure in patients having noncardiac surgery.