Articles: general-anesthesia.
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Anesthesia and analgesia · Aug 2024
Methylphenidate Reversal of Dexmedetomidine-Induced Versus Ketamine-Induced Sedation in Rats.
Dexmedetomidine and ketamine have long elimination half-lives in humans and have no clinically approved reversal agents. Methylphenidate enhances dopaminergic and noradrenergic neurotransmission by inhibiting reuptake transporters for these arousal-promoting neurotransmitters. Previous studies in rats demonstrated that intravenous methylphenidate induces emergence from isoflurane and propofol general anesthesia. These 2 anesthetics are thought to act primarily through enhancement of inhibitory Gamma-aminobutyric acid type A (GABAA) receptors. In this study, we tested the behavioral and neurophysiological effects of methylphenidate in rats after low and high doses of dexmedetomidine (an alpha-2 adrenergic receptor agonist) and ketamine (an N-methyl-D-aspartate [NMDA] receptor antagonist) that induce sedation and unconsciousness, respectively. ⋯ Methylphenidate reversed behavioral and neurophysiological correlates of sedation, but not unconsciousness, induced by dexmedetomidine. In contrast, methylphenidate did not affect sedation, unconsciousness, nor EEG signatures in rats after ketamine. These findings suggest that methylphenidate may be efficacious to reverse dexmedetomidine sedation in humans.
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General laryngeal mask anesthesia with the preservation of spontaneous breathing has accelerated the advancement of the enhanced recovery after surgery concept in thoracoscopic surgery. However, the need for increased doses of anesthetic drugs to reduce laryngeal mask airway (LMA) stimulation poses challenges due to the increased risk of hypotension, respiratory depression, susceptibility to hypoxemia, and carbon dioxide retention, particularly in the lateral position. ⋯ We used pharyngeal mucosal surface anesthesia and thoracic paravertebral nerve block in combination with remimazolam sedation to provide precise analgesia, moderate sedation, and successful LMA general anesthesia with preservation of spontaneous respiration in patients undergoing thoracoscopic pulmonary wedge resection.
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Randomized Controlled Trial Comparative Study
Impact of spinal versus general anaesthesia on perioperative obstructive sleep apnoea severity in patients undergoing hip arthroplasty: a post hoc analysis of two randomised controlled trials.
Recommendations suggest favouring regional over general anaesthesia to reduce impact on postoperative sleep apnoea severity, but there is currently no evidence to support this. We compared the impact of general vs spinal anaesthesia on postoperative sleep apnoea severity and assessed the evolution of sleep apnoea severity up to the third postoperative night. ⋯ NCT02717780 and NCT02566226.
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Review Meta Analysis
Geriatric nutritional risk index predicts postoperative delirium in elderly: A meta-analysis.
To review current evidence on using the geriatric nutritional risk index (GNRI) in predicting postoperative delirium (POD) in elderly patients. ⋯ Therefore, moderate and high GNRI increased the risk of POD in elderly patients.