Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2023
A Pilot Investigation Evaluating Relative Changes in Fronto-Occipital Alpha and Beta Spectral Power as Measurement of Anesthesia Hypnotic Depth.
Other than clinical observation of a patient's vegetative response to nociception, monitoring the hypnotic component of general anesthesia (GA) and unconsciousness relies on electroencephalography (EEG)-based indices. These indices exclusively based on frontal EEG activity neglect an important observation. One of the main hallmarks of transitions from wakefulness to GA is a shift in alpha oscillations (7.5-12.5 Hz activity) from occipital brain regions toward anterior brain regions ("alpha anteriorization"). Monitoring the degree of this alpha anteriorization may help to guide induction and maintenance of hypnotic depth and prevent intraoperative awareness. However, the occipital region of the brain is completely disregarded and occipital alpha as characteristic of wakefulness and its posterior-to-anterior shift during induction are missed. Here, we propose an application of Narcotrend's reduced power alpha beta (RPAB) index, originally developed to monitor differences in hemispheric perfusion, for determining the ratio of alpha and beta activity in the anterior-posterior axis. ⋯ FO-RPAB appears to qualify as a marker of unconsciousness, reflecting physiological fronto-occipital activity differences during GA. In contrast to frontal SEF-95, it is not disturbed by additional administration of ketamine for analgesia.
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Anesthesia and analgesia · Sep 2023
Association Between Hospital Postoperative Troponin Use and Patient Outcomes After Vascular Surgery.
Acute myocardial injury after noncardiac surgery, which is most often symptomatically silent, is associated with increased mortality and morbidity. However, it is not known if routine postoperative troponin testing will affect patient outcomes. ⋯ Patients undergoing vascular surgery at hospitals with higher postoperative troponin testing intensity experienced fewer adverse outcomes than patients who had surgery at hospitals with lower testing intensity.
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Anesthesia and analgesia · Sep 2023
Skill Translation Following the Vital Anesthesia Simulation Training Facilitator Course: A Qualitative Study.
Simulation-based education (SBE) is common in resource-rich locations, but barriers exist to widespread implementation in low-resource settings (LRSs). Vital Anesthesia Simulation Training (VAST) was developed to offer low-cost, immersive simulation to teach core clinical practices and nontechnical skills to perioperative health care teams. To promote sustainability, courses in new locations are preceded by the VAST Facilitator Course (VAST FC) to train local faculty. The purpose of this study was to explore the experiences of VAST FC graduates in translating postcourse knowledge and skills into their workplaces. ⋯ Participants found parallels between SBE debriefing conversations, clinical event debriefing, and feedback conversations and were able to apply knowledge and skills in a variety of settings post course. This study supports the relevance of simulation facilitator training for SBE in LRSs.
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Anesthesia and analgesia · Sep 2023
Perioperative Considerations for Patients Exposed to Psychostimulants.
Concerns regarding the perioperative management of acute psychostimulant intoxication have been recognized for decades, but novel and diverse substances in this class continue to be developed. Despite the similarities in mechanisms of action among psychostimulants, each subclass within this broad category has unique receptor specificity and different mechanisms that play a role in patient clinical presentation. ⋯ The epidemiology, pharmacology, and perioperative implications of psychostimulant use are presented for amphetamines and similar acting nonamphetamines, cocaine, and, finally, the mixed-action drugs known as entactogens that share stimulant and psychedelic properties. This information is then used as the foundation for safe and effective perioperative management of patients exposed to psychostimulants.
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Anesthesia and analgesia · Sep 2023
Substance Use Disorders: Basic Overview for the Anesthesiologist.
Substance use disorders (SUDs) represent a current major public health concern in the United States and around the world. Social and economic stressors secondary to the coronavirus disease 2019 (COVID-19) pandemic have likely led to an increase in SUDs around the world. ⋯ By such, through increased awareness and education, physicians and other health care providers have a unique opportunity to positively impact the lives and improve the perioperative outcomes of patients with SUDs. Understanding commonly used terms, potentially effective perioperative screening tools, diagnostic criteria, basics of treatment, and the perioperative implications of SUDs is essential to providing adequate care to patients experiencing this illness.