Articles: anesthesia.
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Anesthesia and analgesia · Oct 2024
The Utility of Electroencephalograhy in Guiding General Anesthesia in Children.
Traditional pediatric anesthetic dosing using pharmacokinetic estimates based on age and weight is often imprecise, frequently leading to oversedation. Intraoperative electroencephalography (EEG) allows visualization of the brain's response to anesthetic agents in real time, facilitating precise titration of anesthetic drug doses optimized for the individual child. The goal of EEG-guided anesthesia management is to maintain an optimal state of hypnosis during various stages of the procedure while minimizing hemodynamic instability and other adverse effects of anesthesia. ⋯ We describe the use of nonproprietary EEG parameters in guiding anesthesia in children for various clinical end points including laryngoscopy, surgical incision, and maintenance of anesthesia, as well as sedation. We illustrate these principles with various case examples commonly encountered during pediatric anesthesia. Lastly, we discuss strategies to expand intraoperative EEG monitoring in children through education and training programs, as well as advocate for further research to assess clinical outcomes associated with EEG guidance to support its routine use in clinical care.
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This article reviews point-of-care ultrasound (POCUS) in the perioperative period. Ultrasound-guided techniques for regional anaesthesia and vascular access have been well-established in anaesthesia for many years. ⋯ There is a growing body of evidence highlighting the benefits of POCUS throughout the perioperative period. Widespread use may help to improve patient care in anaesthesia.
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To ensure comprehensive dental treatment under general anesthesia(GA) is a viable option, postoperative complications must be minimized. This study investigates the incidence and determinants of acute psychological complications following comprehensive dental treatment under general anesthesia in uncooperative children. ⋯ Psychological complications persisted for a longer period compared to physical complications. The number of extracted teeth under GA had a significant influence on children's fear.
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A 39 year-old female with a history of Roux-en-Y gastric bypass underwent emergent partial colectomy. Her postoperative analgesic management of a transversus abdominus plane block administered with a combination of bupivacaine and liposomal bupivacaine was ineffective. A bupivacaine thoracic epidural was then placed, which provided significant pain relief. This use of a bupivacaine thoracic epidural infusion following liposomal bupivacaine regional anesthesia demonstrated a case of effective analgesia without the development of local anesthetic systemic toxicity symptoms in a remote hospital setting, where certain laboratory analyses were not readily available.
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Anesthesia and analgesia · Oct 2024
A Comparison of Remimazolam versus Propofol on Blood Pressure Changes During Therapeutic Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial.
Intraoperative hypotension is the most common adverse event in endoscopic retrograde cholangiopancreatography (ERCP) and is usually attributed to the vasodilatory effect of the anesthetic. The aim of this randomized controlled trial was to evaluate the impact of remimazolam versus propofol on blood pressure changes during the therapeutic ERCP procedure. ⋯ Remimazolam may be considered as an alternative to propofol for general anesthesia during therapeutic ERCP procedures, with the potential advantage of stable hemodynamics.