Articles: general-anesthesia.
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Case Reports
Misinterpretation and Limitations of pEEG Monitoring During Multimodal General Anesthesia: A Case Report.
The adequate titration of hypnotic agents can be achieved using processed electroencephalogram (pEEG) monitors. pEEG monitors with a spectrogram, such as bilateral bispectral index (BIS), are useful because they can show different signatures that suggest the effect of a given drug on brain activity. Multimodal general anesthesia is based on a combination of hypnotic and antinociceptive agents. We report a case of awareness in a patient monitored with bilateral BIS during multimodal general anesthesia. This case illustrates the limitations of the index and the value of the spectrogram in the assessment of hypnosis.
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Hypertension is an important risk factor for cognitive impairment. This study explored whether elderly patients with stage I hypertension (HPs) and normotensive patients (NPs) showed differences in the recovery of postoperative attention network function according to the attentional network test (ANT) performance. ⋯ HPs showed selective cognitive impairment at different time points following elective hip or knee arthroplasty. Compared with NPs, during the first postoperative week, HPs were more likely to experience delayed recovery of alerting and executive control network function, but not orienting network function.
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The Analgesia Nociception Index (ANI) is a new method of identifying nociception-analgesia balance. In this study, we investigate the correlation between the ANI and numeric rating scale (NRS) values immediately before and after extubation. The NRS values were recorded in the postanesthesia care unit, in a group of patients who underwent laparoscopic cholecystectomy, with the aim of evaluating the potential use of ANI values in the prediction of postoperative pain levels. ⋯ We failed to identify a correlation between ANI and NRS values before and after extubation. Previous studies suggested that the ANI provides more valuable information in anesthetized patients, whereas our findings show that it is ineffective in the prediction of potential postoperative pain.
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Observational Study
LMA Gastro™ airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients: a single-center observational study.
Nonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice. While the numbers of patients with severe comorbidities are rising constantly, gastrointestinal endoscopic interventions are moving closer to minimally invasive endoscopic surgery. The LMA Gastro™ is a new supraglottic airway device, developed specifically for upper gastrointestinal endoscopy and interventions. The aim of this study was to evaluate the feasibility of LMA Gastro™ in patients with ASA physical status ≥3 undergoing advanced endoscopic procedures. ⋯ We demonstrated the feasibility of the LMA Gastro™ during general anesthesia for advanced endoscopic procedures in high-risk patients.
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Anesthesia and analgesia · Feb 2020
Randomized Controlled Trial Comparative StudyProspective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients.
Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. ⋯ The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.