Articles: anesthetics.
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Over the past two decades there has been an increase in reports of attention deficit-hyperactivity disorder and perhaps autism spectrum disorder that appear to coincide with a substantial number of general anaesthesia interventions during early stages of human brain development. Is there a link between anaesthesia exposure and neurocognitive effects considering the growing body of evidence in numerous animal species, including humans, that suggests long-lasting socio-affective behavioural impairments after early exposure to general anaesthesia? Could routinely used general anaesthetics contribute as environmental toxins? Here we present the case that this notion is worthy of further consideration.
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Transforaminal endoscopic discectomy has been found to have equivalent outcomes to traditional discectomy techniques. Controversy exists concerning whether this should be performed under general anesthetic with neuromonitoring or can be safely performed on awake patients without neuromonitoring. This study aimed to evaluate the safety and effectiveness of awake transforaminal endoscopic discectomy in an ambulatory setting. ⋯ Level IV.
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The objective of this study is to evaluate the impact of the introduction of an education program familiarizing staff with the effective and appropriate use of Laceraine application to children's lacerations requiring repair at The Prince Charles Hospital Children's Emergency Department (TPCH-CED), Brisbane. ⋯ There was a significant change in practice with greater use of topical anesthetic (Laceraine) for the management of laceration repair of children, as expected, after the focused education program on its correct use. As emergency departments continue to be overwhelmed with increasing attendances and long patient wait times, a simple small intervention, such as that described, has potential to improve flow through the children's emergency department. Future research should focus on a randomized control trial to determine the contribution of the use of a topical agent, as opposed to injectable local anesthetic and/or full procedural sedation to determine the contribution to the impact of this simple change of practice on patient flow and satisfaction.
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Journal of anesthesia · Aug 2023
Clinical TrialChronological changes in plasma levobupivacaine concentrations after bilateral modified thoracoabdominal nerve block through perichondrial approach.
The local anesthetic (LA) systemic toxicity of trunk blocks is a major concern. Recently, modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) has attracted attention; however, plasma LA level is unknown. We tested whether the peak plasma LA concentration following M-TAPA, using 25 mL of 0.25% levobupivacaine mixed with epinephrine on each side, would be below the toxic level (2.6 μg/mL). ⋯ Our results indicated that the plasma LA concentration following M-TAPA using total of 50 mL of 0.25% levobupivacaine with epinephrine remains below the toxic level. Further research is required due to the small sample size of this study. Trial registry number: UMIN000045406.