Articles: anesthetics.
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Paediatric anaesthesia · Jun 2023
ReviewAnxiety in Children: A review on how to address it in the perioperative setting post pandemic.
In this paper, we review the psychological burden of SARS-CoV-2 on children and how health care workers can play a role in mitigating its mental health impact during anesthetic procedures. We evaluate the societal changes that have affected children over 2 years of the pandemic and the subsequent soaring rates of anxiety and depression reported. ⋯ Providers can utilize techniques based on developmental milestones, Certified Child Life Specialists, parental presence during induction, and medications to reduce anxiety. As health care workers, we need to recognize and address these concerns as untreated mental health issues can leave long-term consequences for children.
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Curr Opin Anaesthesiol · Jun 2023
ReviewThe anesthetic approach to a patient with placenta accreta spectrum.
Placenta accreta poses significant risk of morbidity and mortality to a laboring patient. Here we review available treatment options, highlight trends in bleeding prevention and diagnosis that have been shown to improve patient outcome, and provide best practice suggestions. We also discuss the decision-making process for choice of anesthesia, as it is not based on a gold-standard paradigm. ⋯ Optimal management of PAS begins with early and definitive diagnosis. A multidisciplinary approach along with preparation of special equipment and the use of a check-list maximize the chance for success. Anesthesia could be done with all types of regional or under general, considering case-by-case factors but most importantly choosing according to the institution's best facility and skill.
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J. Cardiothorac. Vasc. Anesth. · Jun 2023
ReviewAnesthetic Management of Patients With Kartagener Syndrome: A Systematic Review of 99 Cases.
KARTAGENER SYNDROME (KS) is characterized by the triad of chronic sinusitis, bronchiectasis, and situs inversus. The mirrored anatomy and respiratory infections in patients with KS patients pose great challenges for anesthetic management. The aim of this review is to summarize published cases with the hope of helping anesthesiologists perform anesthesia in patients with KS more safely. ⋯ For nonthoracic surgery, an endotracheal tube was the most commonly used airway device. For thoracic surgery, a double-lumen tube was the most commonly used airway device. The intraoperative process was uneventful in most patients, and most patients recovered smoothly in the postoperative course.
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Maintenance of ion homeostasis is essential for normal brain function. Inhalational anesthetics are known to act on various receptors, but their effects on ion homeostatic systems, such as sodium/potassium-adenosine triphosphatase (Na+/K+-ATPase), remain largely unexplored. Based on reports demonstrating global network activity and wakefulness modulation by interstitial ions, the hypothesis was that deep isoflurane anesthesia affects ion homeostasis and the key mechanism for clearing extracellular potassium, Na+/K+-ATPase. ⋯ The results demonstrate cortical ion homeostasis perturbation and specific Na+/K+-ATPase impairment during deep isoflurane anesthesia. Slowed potassium clearance and extracellular accumulation might modulate cortical excitability during burst suppression generation, while prolonged Na+/K+-ATPase impairment could contribute to neuronal dysfunction after deep anesthesia.
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Anesthesia and analgesia · Jun 2023
Neuraxial Use Among Total Knee and Hip Arthroplasty Patients With Multiple Sclerosis or Myasthenia Gravis.
Surgical patients with preexisting neurological diseases create greater challenges to perioperative management, and choice of anesthetic is often complicated. We investigated neuraxial anesthesia use in total knee and hip arthroplasty (TKA/THA) recipients with multiple sclerosis or myasthenia gravis compared to the general population. ⋯ Neuraxial anesthesia use was lower in surgical patients with multiple sclerosis compared to the general population but no different in those with myasthenia gravis. Neuraxial use was associated with lower odds of prolonged length of stay.