Articles: general-anesthesia.
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The current coronavirus disease 2019 (Covid-19) pandemia is a highly dynamic situation characterized by therapeutic and logistic uncertainties. Depending on the effectiveness of social distancing, a shortage of intensive care respirators must be expected. Concomitantly, many physicians and nursing staff are unaware of the capabilities of alternative types of ventilators, hence being unsure if they can be used in intensive care patients. ⋯ Modern transport ventilators are mainly for bridging purposes as they can only be used with 100% oxygen in contaminated surroundings. Unconventional methods, such as "ventilator-splitting", which have recently received increasing attention on social media, cannot be recommended. This review intends to provide an overview of the conceptual and technical differences of different types of mechanical ventilators.
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Curr Allergy Asthma Rep · Apr 2020
Review Case ReportsPediatric Patients with Previous Anaphylactic Reactions to General Anesthesia: a Review of Literature, Case Report, and Anesthetic Considerations.
It is rare to see pediatric patients with previous perioperative anaphylaxis receiving future anesthesia, but it is critical to understand how to choose assessments, interpret the results, and develop a future anesthetic plan. ⋯ Analysis of the results revealed that patients, at any age, regardless of sex and nationality, and the number of surgeries, have the risk of perioperative anaphylaxis while the risk of allergy increases as patients present multiple surgical events or have a previous history of atopy. 94.7% of pediatric patients with allergy testing after perioperative anaphylaxis tolerated subsequent general anesthesia without complications. Specific IgE tests, basophil activation tests, and skin tests are not available and suitable for all culprits. The early skin test could be considered a supplement for later testing. Drug challenge test is the golden standard but can only be used as the last resort. If general anesthesia is inevitable, avoidance of the culprit and use of alternative agents can help the patients prevent another potential recurrence. Full use of inhalation anesthesia without unnecessary neuromuscular blockade agents and avoidance of latex is recommended when the surgery is urgent or skin tests for children cannot be performed in time. This review summarizes characteristics of perioperative pediatric anaphylaxis, main tests for various drugs, and their sensitivities and specificities as well as recommendations as to how to implement safe anesthesia in the future.
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J Coll Physicians Surg Pak · Apr 2020
Meta AnalysisEffect of General and Non-general Anesthesia on Postoperative Cognitive Dysfunction.
ABATRACT Controversy exists in the effect of general anesthesia and non-general anesthesia on postoperative cognitive dysfunction (POCD). The authors aimed to perform this systematic review to comprehensively assess the effect of general anesthesia or non-general anesthesia on POCD. Relative studies from the online literature database were retrieved. ⋯ In conclusion, when compared with the non-general anesthesia, general anesthesia increases the incidence of POCD in patients within three days after surgery, but makes no difference after seven days. It suggests that early intervention should be conducted on patients undergoing general anesthesia. Key Words: General anesthesia, Postoperative cognitive dysfunction, Meta-analysis.
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Acta Anaesthesiol Scand · Apr 2020
Review Meta AnalysisTracheal intubation in patients at risk for cervical spinal cord injury: a systematic review.
Tracheal intubation in patients at risk for secondary spinal cord injury is potentially difficult and risky. ⋯ Videolaryngoscopy and fiberoptic-assisted techniques might be associated with higher first-attempt failure rate over controls. However, low to very low certainty of evidence does not allow firm conclusions on the best tracheal intubation in patients at risk for cervical spinal cord injury.
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Emergence coughing can harm the patient following completion of surgery, but it is unclear which medication is most effective at reducing this event. We conducted a systematic review and network meta-analysis of RCTs to determine the medications' relative efficacies on decreasing moderate to severe emergence coughing after general anaesthesia. Medications studied were lidocaine (i.v., intracuff, topical, or tracheal application), dexmedetomidine, remifentanil, and fentanyl. ⋯ PROSPERO registration number: CRD42018102870.