Articles: general-anesthesia.
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Anesthesia and analgesia · May 2017
Review Meta AnalysisSystematic Quality Assessment of Published Antishivering Protocols.
Shivering is a common side effect of targeted temperature modulation and general anesthesia. Antishivering strategies often employ a stepwise approach involving both pharmacological and physical interventions. However, approaches to treat shivering are often empiric and vary widely across care environments. ⋯ Of these, the American Society of Anesthesiologists guidelines recommending forced-air warming and meperidine received the highest mAGREE II score (14 points), whereas the remaining 2 recommendations had low scores (<5 points). Current published antishivering protocols/guidelines lack methodological rigor, reliability, and strength, and even the highest scoring of the 18 protocols/guidelines fulfilled only 60% of quality items. To be consistent with evidence-based protocol/guideline development processes, future antishivering treatment algorithms should increase methodological rigor and transparency.
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Review Case Reports
Case Report of a Patient With Idiopathic Hypersomnia and a Family History of Malignant Hyperthermia Undergoing General Anesthesia: An Overview of the Anesthetic Considerations.
The pathophysiologic underpinnings of idiopathic hypersomnia and its interactions with anesthetic medications remain poorly understood. There is a scarcity of literature describing this patient population in the surgical setting. This case report outlines the anesthetic considerations and management plan for a 55-year-old female patient with a known history of idiopathic hypersomnia undergoing an elective shoulder arthroscopy in the ambulatory setting. ⋯ Anesthesia was maintained with total intravenous anesthesia via the use of propofol and remifentanil. The depth of anesthesia was monitored with entropy. There were no perioperative complications.
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The use of laryngeal mask airways with morbidly obese patients remains controversial. A recent legal case involving the use of a laryngeal mask airway with a morbidly obese patient who aspirated during the anesthetic found the anesthesia providers negligent. We sought evidence examining the use of laryngeal mask airways with obese patients undergoing surgery. ⋯ Subjects received general anesthesia with a laryngeal mask airway. Outcomes included the ability to successfully place a laryngeal mask airway, ease and time of insertion, ability to ventilate, hypoxemia, presence of laryngospasm/ bronchospasm, and/or evidence of aspiration. The trials had some methodologic concerns including the inability to blind anesthesia providers, not including exclusively morbidly obese subjects, not powered to detect all complications such as aspiration, and overall small sample sizes. The investigators reported few problems when using these devices with obese subjects. However, because of the limited amount and quality of the evidence and the catastrophic nature of potential complications, future research must be done before a recommendation can be made regarding the use of these devices with morbidly obese patients.
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The search for agents that bring about faster induction and quicker recovery in the operating room have yielded numerous anesthetics whose mechanisms of action and potential toxic side effects remain unknown, especially in the young and aging brain. ⋯ This review will focus primarily on the cytotoxic effects of anesthetics, and offer some practical resolutions that may attenuate their long-term harm. An urgent need for studies on animal models and an increased focus on highly controlled prospective epidemiological studies is also reinforced.