Articles: anesthetics.
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Anesthesia and analgesia · Feb 2025
Observational StudyClinical Decision-Making and Process Complications During Anticipated Difficult Airway Management for Elective Surgery.
Difficult airway management (DAM) is a challenging aspect of anesthetic care. Although nearly all DAM episodes result in successful intubation, complications are common and clinical decision-making may be complex. In adults with anticipated DAM scheduled for nonemergent surgery, we prospectively observed clinical decisions made during DAM such as awake/sedated versus anesthetized, choice of initial and subsequent devices, case cancellation/postponement, conversions between awake and anesthetized approaches, and process complications such as multiple intubation/supraglottic airway (SGA) insertion attempts, difficult bag-mask ventilation (BMV), hypoxemia, and cardiovascular destabilization. ⋯ Airway management was successful in all patients and the incidence of process complications was higher than in routine airway management. Despite a high risk of DAM, 87% of patients were intubated anesthetized and conversions between awake and anesthetized approaches were rare. That patients intubated awake had more difficult airway indicators implies that clinicians reserve awake intubation for particularly difficult airways. The high incidence of multiple attempts, hypoxemia, and cardiovascular destabilization in patients intubated awake suggests that awake airway management remains challenging. We found no clear pattern in device choices after a first failed attempt. Patients with a first failed anesthetized intubation attempt and difficult BMV were at particularly high risk for hypoxemia.
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Life cycle assessment is increasingly used in the healthcare sector to facilitate more environmentally informed supply and medication use. A thorough life cycle assessment comparing the carbon impacts of 10 different single-use anaesthetic drug trays yielded surprising findings. Although life cycle assessment can guide decision-making, results must be interpreted clinically and in light of all available options, including eliminating unnecessary consumption altogether. Effective life cycle assessment in healthcare that is clinically applicable requires expertise from both environmental scientists and clinicians.
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This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space - the medial retro-SCTL space block. ⋯ A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax.
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Recent evidence indicates that general anesthesia and sleep-wake behavior share some overlapping neural substrates. γ-Aminobutyric acid-mediated (GABAergic) neurons in the central amygdala have a high firing rate during wakefulness and play a role in regulating arousal-related behaviors. The objective of this study was to investigate whether central amygdala GABAergic neurons participate in the regulation of isoflurane general anesthesia and uncover the underlying neural circuitry. ⋯ The results suggest that central amygdala GABAergic neurons play a role in general anesthesia regulation, which facilitates behavioral and cortical emergence from isoflurane anesthesia through the GABAergic central amygdala-basal forebrain pathway.
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Journal of anesthesia · Feb 2025
Impact of low-dose sevoflurane with propofol-based anesthesia on motor-evoked potentials in infants: a single-arm crossover pilot study.
The influence of anesthetic interactions on motor-evoked potentials in infants has rarely been reported. In infants, adding a small dose of sevoflurane to propofol-based total intravenous anesthesia is reasonable for reducing propofol administration. We collected preliminary data regarding the effect of low-dose sevoflurane in propofol-based total intravenous anesthesia on motor-evoked potentials in infants. ⋯ Adding even 0.1-0.15 age-adjusted minimum alveolar concentration sevoflurane to propofol-based total intravenous anesthesia attenuated the motor-evoked potential amplitudes in the lower extremities. A further prospective interventional study with an appropriate sample size is required to investigate the study hypothesis.