Articles: anesthesia.
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Enhanced recovery after surgery (ERAS) protocols incorporating multimodal analgesia (MMA) have become increasingly popular for breast cancer surgery. Our study evaluated an ERAS approach that combined nonintubated general anesthesia with thoracic paravertebral block (TPVB) as part of the MMA and compared it to traditional general anesthesia (GA). Postoperative outcomes were assessed using numerical rating scale (NRS) pain scores, total analgesic consumption, and nausea and vomiting (PONV). ⋯ Nonintubated general anesthesia with TIVA and MMA using TPVB is a viable and safe alternative for breast cancer surgery. It results in reduced pain scores and analgesic needs compared with conventional GA, with PONV outcomes comparable to those managed with standard intravenous medications.
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Anaesth Intensive Care · Feb 2025
Survey of administration of intravenous ketamine for perioperative pain management in Australia and New Zealand.
Ketamine is an N-methyl-d-aspartate receptor antagonist approved for use in anaesthesia, with analgesic properties. Despite publication of numerous trials and expert guidelines on its use for pain management, administration of ketamine as part of multimodal perioperative analgesia remains 'off-label'. We conducted an online, prospective survey of ANZCA Fellows, exploring current prescribing practices of intravenous ketamine for perioperative analgesia. ⋯ Postoperative ketamine infusion was most commonly prescribed as third-line or rescue analgesia. The majority of respondents thought it either 'likely' or 'very likely' ketamine would reduce postoperative chronic pain after thoracic surgery, but not in other surgical categories. Our findings suggest that off-label perioperative administration of ketamine at analgesic dose ranges is routine or common practice in major surgery for a majority of specialist anaesthetists in Australia and New Zealand.
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Telehealth is a popular way for health care providers to connect with patients and is utilized by anesthesiologists across the world for preoperative evaluations. The purpose of this review is to outline the latest literature about telehealth use within obstetric anesthesia. ⋯ Obstetric anesthesiologists play a pivotal role in the perioperative planning for high-risk pregnant women, and telehealth can serve as a tool to make this easier and more efficient with high patient and provider satisfaction.
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Anaesth Intensive Care · Feb 2025
Unrecognised drug error and subsequent airway management utilising ultrasound-guided cricothyroidotomy and Rapid-O2® oxygen insufflation.
Tubeless microlaryngoscopy optimises surgical access but typically relies on total intravenous anaesthesia, commonly using propofol and remifentanil infusions. We present a difficult airway case where an unrecognised drug error during programming of an infusion pump resulted in unexpected apnoea. ⋯ Furthermore, cricothyroid membrane identification failed with digital palpation but was successful with ultrasonography. While the latter is currently not considered the standard of care for preparing for front-of-neck access in a time-critical 'can't intubate, can't oxygenate' scenario, in our case it proved helpful.
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Test the hypothesis that the center of ventilation, a measure of ventro-dorsal atelectasis, is posterior during supraglottic ventilation indicating better dependent-lung ventilation. Secondarily, we tested the hypothesis that supraglottic ventilation improves oxygenation and carbon dioxide elimination. ⋯ The center of ventilation distribution, a measure of atelectasis, was similar with supraglottic and subglottic jet ventilation. Subglottic jet ventilation improved the dorsal-dependent lung region and provided superior arterial oxygenation. Both techniques effectively eliminated carbon dioxide, with the supraglottic approach demonstrating slightly superior efficacy.