Articles: general-anesthesia.
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Review Comparative Study
Update on the Physiologic Effects of Ketamine in General Anesthesia and Spinal Blockade: A Review of the Literature.
Ketamine, a phencyclidine analog and dissociative anesthetic, has been used in anesthesia since the 1960s. Serial subanesthetic administration has been explored for treatment of depression and chronic pain; however, there has been a recent surge in its intraoperative and perioperative use among anesthesia providers. ⋯ Herein, we review the primary scientific literature and discuss recent studies that have implicated ketamine in inflammation and oxidative stress, inhibition of ion channels in dorsal horn neurons, and in disruption of frontoparietal communication. Also discussed are the potential clinical implications these effects may have for patients.
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Paediatric anaesthesia · Dec 2019
Meta AnalysisThe Effect of Ketamine on Emergence Agitation in Children: A Systematic Review and Meta-analysis.
Although there is some evidence that ketamine may reduce emergence delirium in children, it is generally low quality and inconsistent, and practice change is not recommended.
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High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. ⋯ HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.
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Curr Opin Anaesthesiol · Dec 2019
ReviewIndications, contraindications, and safety aspects of procedural sedation.
There is a steadily increasing demand for procedural sedation outside the operating room, frequently performed in comorbid high-risk adult patients. This review evaluates the feasibility and advantages of sedation vs. general anesthesia for some of these new procedures. ⋯ Anesthesiologists are facing continuously new indications for procedural sedation in sometimes sophisticated diagnostic or therapeutic procedures. Timely availability of anesthesia staff will mainly influence who is performing sedation, anesthesia or nonanesthesia personal. While the number of absolute contraindications for sedation decreased to almost zero, relative contraindications are becoming more relevant and should be tailored to the individual procedure and patient.
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Review
[Regional anesthesia in daily clinical practice: an economic analysis based on case vignettes].
The economic effect is a crucial aspect of every medical procedure. This article analyzes the economic implications of various methods in anesthesia based on three case vignettes. ⋯ Even considering that this cost analysis was calculated based on data from only one medical institution (General Hospital of Vienna, Medical University of Vienna), regional anesthesia appeared to be cost efficient compared with other anesthesia procedures. Main cost drivers in this example were personnel costs.