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Awareness under anesthesia

Richard H Epstein, Joni M Maga, Michael E Mahla, Eric S Schwenk, Marc J Bloom
BACKGROUND: Processed electroencephalogram (EEG) monitors help assess the hypnotic state during general anesthesia or sedation. Maintaining the bispectral index (BIS) or state entropy (SE) between 40 and 60 has been recommended to mitigate anesthesia awareness. Nonetheless, SEs > 70 were frequently observed at end-tidal sevoflurane concentrations unlikely to allow awareness. We sought to determine the prevalence of elevated discordant measurements during BIS and SE monitoring. METHODS: Electronic data collected over 11 months at two academic hospitals were retrospectively reviewed...
March 9, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Sean Hickey, Jeremy Goverman, Jonathan Friedstat, Robert Sheridan, John Schulz
INTRODUCTION: There are an estimated 2.75 million electronic cigarette (EC) users in the United States. ECs have become the most commonly used nicotine-containing product in young adults ages 18-24 years. Thermal, blast, and missile injuries from EC explosions has grown rapidly in recent years. Burn surgeons must remain up to date regarding management and treatment of burn injuries related to EC device ignition. METHODS: An IRB approved retrospective review of all patients admitted to the Massachusetts General Hospital Burn Center from January 2015 to April 2017 was performed...
March 1, 2018: Burns: Journal of the International Society for Burn Injuries
Hesameddin Modir, Esmail Moshiri, Bijan Yazdi, Abolfazl Mohammadbeigi, Amirreza Modir
Adverse events following surgical operations are common complications due to removal of tracheal tube in contrast to the tracheal intubation. Awareness about the new methods and strategies for tracheal tube extubation is necessary for a safe and successful extubation. Therefore, we aimed to assess the safety and efficacy of laryngeal mask airway (LMA), streamlined liner of the pharyngeal airway (SLIPA) and I-gel in extubation time of tracheal tube. A one-single randomized clinical trial was conducted in 105 eligible patients in three groups including LMA, SLIPA and I-gel...
October 2017: Medical Gas Research
Dong Wang, Xiao-Mei Sun, Jin Wu
RATIONALE: Cavernous sinus-carotid fistula (CCF) is a rare complication of craniofacial injuries in patients receiving oral and maxillofacial surgical care. PATIENT CONCERNS: A retrospective review of 15 patients with CCF records was conducted. In addition, we present a rare case of a 32-year-old Chinese woman with CCF receiving oral and maxillofacial surgical care. DIAGNOSES: Digital subtraction angiography (DSA) confirmed a diagnosis of CCF...
December 2017: Medicine (Baltimore)
(no author information available yet)
INTRODUCTION: Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery...
February 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Koichi Sairyo, Takashi Chikawa, Akihiro Nagamachi
Transforaminal (TF) percutaneous endoscopic surgery for the lumbar spine under the local anesthesia was initiated in 2003 in Japan. Since it requires only an 8-mm skin incision and damage of the paravertebral muscles would be minimum, it would be the least invasive spinal surgery at present. At the beginning, the technique was used for discectomy; thus, the procedure was called PELD (percutaneous endoscopic lumbar discectomy). TF approach can be done under the local anesthesia, there are great benefits. During the surgery patients would be in awake and aware condition; thus, severe nerve root damage can be avoided...
December 13, 2017: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Antonella Cotoia, Lucia Mirabella, Renata Beck, Pompeo Matrella, Valentina Assenzo, Thierry Chazot, Gilda Cinnella, Ngai Liu, Michele Dambrosio
BACKGROUND: Emergence delirium (ED) is an acute change in cognition after general anesthesia (GA) occurring in operative room, recovery room or in postanesthesia care. The automated propofolremifentanil titration by Bispectral index (BIS) (AutoTIVA) avoids period of deep (BIS<40) anesthesia and could potentially decrease the ED. The aim of this study was to evaluate ED in surgical patients under AutoTIVA, manual titration of propofol-remifentanil (ManualTIVA) or volatile BIS-guided GA...
December 13, 2017: Minerva Anestesiologica
Mi Wang, Wael Saasouh, Thomas Botsford, Allen Keebler, Andrew Zura, Michael S Benninger, Rafi Avitsian
BACKGROUND: Parkinson disease (PD), a neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra of the midbrain, is commonly thought of as a motion disorder, but it can have significant effect on the respiratory system. Respiratory failure is the most common cause of death in these patients, but it can also affect laryngeal function causing dysphonia, dysphagia, and dysarthric speech. Acute upper airway obstruction is a rare finding in PD, especially in the perioperative settings...
March 2018: World Neurosurgery
Aaron Kwang Yang Lee, Aaron Yik Hang Kong, Chee Fai Kong
OBJECTIVE: This pilot study aimed to evaluate the performance of target-controlled infusion (TCI) of propofol using the Schnider pharmacokinetic model in patients undergoing cardiac surgery requiring cardiopulmonary bypass. DESIGN: This was a prospective pharmacokinetic study. SETTING: A tertiary care hospital. PARTICIPANTS: This study is comprised of 10 patients, aged between 46 and 81, who underwent elective cardiac surgery requiring the use of cardiopulmonary bypass...
October 4, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Sunil M Nadkarni, Pavankumar Kohli, Bhupesh Patel, Satishchandra Gore, Bhagyashree S Kulkarni
Background: STITCHLESS percutaneous endoscopic cervical discectomy s[PECD] is safe, precise, targeted, and a complete endoscopic procedure to treat soft cervical disc herniation with unilateral radiculopathy. It allows direct visualization of herniated fragment and its removal, inspection of decompressed nerve root in an awake and aware patient. It reduces the risk related to general anesthesia and to the neurological structures. However, all the patients treated with PECD can be candidates for anterior cervical discectomy and fusion (ACDF)...
November 2017: Indian Journal of Orthopaedics
Barry L Friedberg
Friedberg's Triad is (1) measure the brain; (2) preempt the pain; (3) emetic drugs abstain. Persistent anesthesia problems include over- and under-medication, postoperative pain management, and postoperative nausea and vomiting. Inspired by Vinnik's diazepam-ketamine paradigm, Friedberg's propofol ketamine paradigm was first published in 1993. The 1997 addition of the bispectral (BIS) index brain monitor made the propofol ketamine paradigm numerically reproducible. The 1998 addition of the frontalis electromyogram (EMG) as a secondary trend to the BIS transformed the time-delayed BIS monitor into a real-time, extremely useful device...
October 2017: Plastic and Reconstructive Surgery. Global Open
Contardo Vergani, Marco Venturi, Sara Badiali, Barbara Chella, Enrico Mozzi
BACKGROUND: The observation of a relatively high number of pulmonary aspirations (PA) among gastric band (GB) carriers undergoing a second surgery, prompted us to modify our strategy for GB patients candidate to further operation under general anesthesia. MATERIAL OF STUDY AND RESULTS: In January 2013, following the occurrence of PA at the induction of general anesthesia in 1 GB carrier undergoing a further operation, we reviewed our Data Base between January 2005 and 2013, to explore the rate of pulmonary aspiration in patients GB carriers undergoing a second surgery...
November 7, 2017: Annali Italiani di Chirurgia
Marco Cascella, Roberta Fusco, Domenico Caliendo, Vincenza Granata, Domenico Carbone, Maria Rosaria Muzio, Giuseppe Laurelli, Stefano Greggi, Francesca Falcone, Cira Antonietta Forte, Arturo Cuomo
Background: Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep...
October 3, 2017: Oncotarget
Pei-Jen Kuo, Chia-Ling Lee, Jen-Huang Wang, Shiu-Ying Hsieh, Shian-Che Huang, Chen-Fuh Lam
BACKGROUND: Increased incidence of intraoperative awareness was reported in critically ill patients during major operations, particularly under total intravenous (TIVA) or endotracheal general anesthesia (ETGA). However, the incidence and effect of anesthesia techniques on awareness in generally healthy, non-critically ill patients during operations have yet to receive significant attention. METHODS AND RESULTS: This retrospective matched case-control study was conducted between January 2009 to December 2014...
2017: PloS One
Jinhun Chung, Minyoung Jeong
INTRODUCTION: We report a 39-year-old male patient with a fracture of the right acetabulum undergoing open reduction and internal fixation with a plate under general anesthesia. At closure, the surgeons injected 0.75% ropivacaine into the subcutaneous tissue of the incision wound for postoperative analgesia. Soon after injection, subcutaneous emphysema at the injection site and a sudden decrease in end-tidal CO2 tension with crude oscillatory ripples during the alveolar plateau phase were observed...
October 2017: Medicine (Baltimore)
Federico Landriel, Matteo Baccanelli, Santiago Hem, Eduardo Vecchi, Mariana Bendersky, Claudio Yampolsky
BACKGROUND: Spinal radiculomedullary artery aneurysms are extremely rare. Treatment should be tailored to clinical presentation, distal aneurysm flow, and lesion anatomical features. When a surgical occlusion is planned, it is necessary to evaluate whether intraoperative monitoring (IOM) should be considered as an indispensable tool to prevent potential spinal cord ischemia. METHODS: We present a patient with symptoms and signs of spinal subarachnoid hemorrhage resulting from the rupture of a T4 anterior radiculomedullary aneurysm who underwent open surgical treatment under motor evoked potential (MEP) monitoring...
2017: Surgical Neurology International
Kazuta Yamashita, Kosaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Masatoshi Morimoto, Takashi Chikawa, Akihiro Nagamachi, Koichi Sairyo
Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis...
2017: Journal of Medical Investigation: JMI
Se Hwan Hwang, Ho Seok Lee, Young Hoon Joo, Jae Hyun Seo, Jun Myung Kang
OBJECTIVES: The goal of this meta-analysis was to perform a systematic review of the literature on the effect of dexmedetomidine on perioperative morbidity following nasal surgery and on the adverse effects of dexmedetomidine. DATA SOURCES: MEDLINE, Scopus, and Cochrane Database of Systematic Reviews. REVIEW METHODS: Two authors independently searched scientific and medical databases from their inception of article collection to March 2017...
September 25, 2017: Laryngoscope
Ching-En Chen, Zen-Zhon Liao, Yen-Heng Lee, Cheng-Chieh Liu, Chi-Kao Tang, Yi-Rong Chen
BACKGROUND: Subgaleal hematoma (SGH), an abnormal accumulation of blood under the galeal aponeurosis of the scalp, is more commonly observed in newborns and children. According to previous cases, the etiology of SGH includes mild head trauma, vacuum-assisted vaginal delivery, contusion, and hair braiding or pulling. CASE REPORT: A 39-year-old healthy worker came to our emergency department (ED) due to scalp lacerations from an accident that caused severe twisting of his hair...
November 2017: Journal of Emergency Medicine
Ezgi Erkiliç, Elvin Kesimci, Aysun Yüngül, Ferit Alaybeyoğlu, Mustafa Aksoy
Some surgical procedures performed under moderate and sometimes extreme positions expose patients to nonphysiological changes. Especially, the manipulations of a patient in prone and lateral decubitus position might increase complications. Anesthesia mumps has been reported as one of these complications. It has been found to be rare but known entity associated with patients of all age groups and all surgical positions. We herein describe an early noticed acute case of unilateral anesthesia mumps that developed after endotracheal intubation in prone position in a 54-year-old female...
July 2017: Anesthesia, Essays and Researches
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