Articles: general-anesthesia.
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Prior meta-analyses have established the potential of intravenous ketamine in safeguarding against neurocognitive impairment, but the efficacy of intravenous esketamine for the prevention of perioperative neurocognitive disorders (PND) remains uncertain. The primary aim of this meta-analysis was to conduct a comprehensive evaluation of the effects of esketamine on PND in adult surgical patients undergoing general anesthesia. ⋯ The use of intravenous esketamine as an adjuvant in general anesthesia may represent a potentially beneficial strategy for reducing susceptibility to PND, with potential benefits for preventing POD and POCD. Furthermore, it can decrease intraoperative opioid consumption and alleviate postoperative pain intensity without increasing the incidence of PONV.
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Anesthesia and analgesia · Dec 2024
Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.
Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications. ⋯ Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.
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Masseter spasm after induction of anaesthesia can be generally defined as a marked difficulty in manual mouth opening that interferes and impedes direct laryngoscopy and tracheal intubation without the presence of temporomandibular joint dysfunction. Several factors have been implicated in the literatures responsible for causing masseter spasm including use of non-depolarizing muscle relaxants, selective serotonin reuptake inhibitor and anxiety. ⋯ Anaesthesiologist should be aware of this complication when dealing with anxious patients on antidepressant therapy during induction of anaesthesia. Masseter spasm with locked jaw, can be a potential life-threatening situation particularly in scenarios of "cannot- ventilate-cannot intubate".
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Eur J Trauma Emerg Surg · Dec 2024
ReviewThe wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review.
Human hands have a complex anatomical structure. The thumb, being an integral part of the hand, has an essential function in gripping. In this sense, thumb fractures account for 4% of all hand fractures (it may occur in association with fractures of the trapezium). The majority of hand fractures should be treated non-surgically and surgeons must avoid unnecessary surgery. Historically, hand surgery has used a combination of local/regional/general anaesthesia and a tourniquet. This study aims to carry out a systematic review to determine whether the WALANT technique is an advantageous alternative to conventional anaesthesia for surgical procedures on thumb injuries, in terms of patient function and pain. ⋯ WALANT is a convenient and favourable option in several studies. It has been demonstrated the benefits in terms of return to function and pain.
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Anesthesia and analgesia · Dec 2024
Curriculum Development for the South African Essential Steps in Managing Obstetric Emergencies (ESMOE) Anesthesiology Training Module: A Delphi Study.
The United Nations Sustainable Development Goal 3 (SDG3) for 2030 aims at <70 maternal deaths per 100,000 live births. South Africa (SA) falls short of this goal and most deaths occur in district and regional hospitals. Due to low anesthesiologist (specialist anesthetist) numbers in the public sector, the anesthetic workforce in these hospitals consists mainly of nonspecialist (general practitioner) junior doctors with limited supervision. The Essential Steps in Managing Obstetric Emergencies (ESMOE) training program for interns was introduced in 2008 to reduce maternal deaths in SA. Training is not consistently offered at all intern-training institutions and it has not been recently revised. This study sought expert suggestions to guide a revision of the regulation, pedagogy, and content of the ESMOE anesthetic module. ⋯ Attendance of the ESMOE anesthesia module should be mandatory. Its pedagogy should be updated to a blended learning style to benefit the current digital native intern generation. The content should be updated to address the main causes of maternal mortality in SA in line with SDG3. A national obstetric anesthesia guideline should be considered, and lea-dership and collaboration are required to improve the alignment of undergraduate, internship, and junior doctor anesthesia training in SA. The content, process, and stakeholder engagement suggestions in this study can assist short-course-based anesthesia workforce training in similar global contexts.