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Anesthesia And Safety(Regional)

Ian R Slade, Ron E Samet
Regional anesthesia for the acute trauma patient is increasing due to the growing appreciation of its benefits, development of newer techniques and equipment, and more robust training. Block procedures are expanding beyond perioperative interventions performed exclusively by anesthesiologists to paramedics on scene, emergency medicine physicians, and nurse-led services using these techniques early in trauma pain management. Special considerations and indications apply to trauma victims compared with the elective patient and must be appreciated to optimize safety and clinical outcomes...
September 2018: Anesthesiology Clinics
Christopher A J Webb, T Edward Kim
Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics...
September 2018: Anesthesiology Clinics
Benjamin J Walker, Justin B Long, Madhankumar Sathyamoorthy, Jennifer Birstler, Christine Wolf, Adrian T Bosenberg, Sean H Flack, Elliot J Krane, Navil F Sethna, Santhanam Suresh, Andreas H Taenzer, David M Polaner, Lynn Martin, Corrie Anderson, Rani Sunder, Trevor Adams, Lizabeth Martin, Martha Pankovich, Amod Sawardekar, Patrick Birmingham, Ryan Marcelino, R J Ramarmurthi, Peter Szmuk, Galit Kastner Ungar, Sara Lozano, Karen Boretsky, Ranu Jain, Maria Matuszczak, Timothy R Petersen, Jennifer Dillow, Robert Power, Kim Nguyen, Benjamin H Lee, Lisa Chan, Jorge Pineda, Jacob Hutchins, Kimberly Mendoza, Kristen Spisak, Aali Shah, Kathryn DelPizzo, Naomi Dong, Vidya Yalamanchili, Claudia Venable, Cassandra Armstead Williams, Reena Chaudahari, Susumu Ohkawa, Helga Usljebrka, Tarun Bhalla, Pedro Paulo Vanzillotta, Seza Apiliogullari, Andrew D Franklin, Akiko Ando, Sophie R Pestieau, Caroline Wright, Julia Rosenbloom, Tony Anderson
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children. METHODS: This is a prospective, observational study of routine clinical practice...
July 30, 2018: Anesthesiology
Yanzi Zhang, Bo Cui, Chunyu Gong, Yidan Tang, Jianxiong Zhou, Yi He, Jin Liu, Jing Yang
It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5-1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0...
July 26, 2018: Laboratory Animals
Ellen M Soffin, Melinda M Gibbons, Clifford Y Ko, Stephen L Kates, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Christopher L Wu
Successes using enhanced recovery after surgery (ERAS) protocols for total hip arthroplasty (THA) are increasingly being reported. As in other surgical subspecialties, ERAS for THA has been associated with superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost savings. Nonetheless, the adoption of ERAS to THA has not been universal. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery...
July 21, 2018: Anesthesia and Analgesia
Alexander Kulikov, Federico Bilotta, Beatrice Borsellino, Denis Sel'kov, Grigory Kobyakov, Andrey Lubnin
BACKGROUND: The asleep-awake-asleep (AAA) craniotomy is a technique that offers the opportunity of having a patient fully cooperative during the awake phase, and minimizes the possible discomfort, due to the asleep phase. The aim of this prospective observational case series, is to test the use of Xenon in the first asleep phase of an AAA craniotomy, in patients undergoing craniotomy for brain tumor resection. METHODS: The data have been collected from 40 awake craniotomy procedures, performed in patients with cerebral tumor, treated with the AAA technique...
July 20, 2018: Minerva Anestesiologica
Xiaocheng Liu, Guiming Huang, Ruipeng Zhong, Shifu Hu, Ruiming Deng
The aim of the present meta-analysis was to systematically examine the literature and to identify of the results of randomized controlled trials (RCTs) comparing the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for percutaneous nephrolithotomy (PCNL). An exhaustive electronic literature search of PubMed, Embase, and Web of science was performed until March 2018. Nine prospective RCTs concluding 858 patients comparing the use of RA to GA for PCNL were included. Combined results demonstrated that PCNL under RA could reduce operative time (mean difference [MD] -6...
July 20, 2018: Urologia Internationalis
Mohammed S ElSheemy, Waleed Ghoneima, Akram A Elmarakbi, Ahmed M Al-Kandari, Hamdy Ibrahim, Sunil Shrestha, Sanjay Khadgi
OBJECTIVE: To compare safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) vs staged-Mini-PNL. PATIENTS AND METHODS: Adult patients with bilateral renal stones indicated for PNL were managed with BSS-Mini-PNL (45 patients, 90 renal units) and prospectively compared versus staged-Mini-PNL (55 patients, 110 renal units) between July 2014 and December 2017. Mini-PNL was done through 18Fr tract in prone position under regional anesthesia and fluoroscopy using pneumatic lithotripsy...
July 19, 2018: Urology
Evgeny Goloborodko, Ann Christina Foldenauer, Nassim Ayoub, Matthias Knobe, Stephan Christian Möhlhenrich, Kristian Kniha, Frank Hölzle, Ali Modabber
Patients with sleeping disorders, such as obstructive sleep apnea, (OSA) have a higher risk for postoperative complications after maxillofacial surgery under general anesthesia. The aim of this study was to detect specific complications after oral and maxillofacial surgery. Sixty-nine cases of patients with middle or severe sleep apnea who underwent an operation under general anesthesia in the oral and maxillofacial region were retrospectively analyzed. This group was compared with an age and diagnosis matched group without sleep apnea receiving the same operative treatment...
June 12, 2018: Journal of Cranio-maxillo-facial Surgery
Michael J Barrington, Yoshiaki Uda
PURPOSE OF REVIEW: Ultrasound guidance has become the accepted standard of practice for peripheral regional anesthesia. Despite evidence supporting the efficacy of ultrasound-guided regional anesthesia, its impact on patient safety has been less clear. RECENT FINDINGS: Evidence has been consistent that ultrasound guidance reduces the incidence of vascular injury, local anesthetic systemic toxicity, pneumothorax and phrenic nerve block. Within the limited global scope of the epidemiology and etiologic complexity of perioperative (including block-related) peripheral nerve injury, there has not been consistent evidence that ultrasound guidance is associated with a reduced incidence of nerve injury...
July 12, 2018: Current Opinion in Anaesthesiology
Kang Zhou, Zhuoli Zhang, Matteo Figini, Junjie Shangguan, Yining Wang, Haifeng Shi, Yumei Li, Zhengyu Jin, Jie Pan
The efficacy and safety of combining open-configuration magnetic resonance imaging (MRI) and an optical surgical navigation system (OSNS) for guidance of percutaneous liver cryoablation were evaluated in a pig model. This approach was successfully executed in eight test pigs under general anesthesia. Another two pigs spared from ablation served as controls. MRI studies, blood testing, and pathologic examinations were performed at various time points. MRI-determined minimal and maximal cryolesion diameters were 19...
2018: American Journal of Translational Research
Sangeeta Kumaraswami, Suryanarayana Pothula, Mario Anthony Inchiosa, Keshar Paul Kubal, Micah Alexander Burns
Introduction: Neuraxial labor analgesia has become an integral part of modern obstetric anesthetic practice. Presence of a familiar person during its placement may be beneficial to the patient. A survey was sent to anesthesiologists practicing obstetric anesthesia in the USA to determine their views. Methods: The survey queried the following: existence of a written policy; would they allow a visitor; visitor's view, sitting or standing; reasons to allow or not allow a visitor; and influence by other staff on the decision...
2018: Anesthesiology Research and Practice
Eric S Schwenk, Eugene R Viscusi, Asokumar Buvanendran, Robert W Hurley, Ajay D Wasan, Samer Narouze, Anuj Bhatia, Fred N Davis, William M Hooten, Steven P Cohen
BACKGROUND: Ketamine infusions have been used for decades to treat acute pain, but a recent surge in usage has made the infusions a mainstay of treatment in emergency departments, in the perioperative period in individuals with refractory pain, and in opioid-tolerant patients. The widespread variability in patient selection, treatment parameters, and monitoring indicates a need for the creation of consensus guidelines. METHODS: The development of acute pain ketamine guidelines grew as a corollary from the genesis of chronic pain ketamine guidelines...
July 2018: Regional Anesthesia and Pain Medicine
Hesham Elsharkawy, Theresa Barnes, Rovnat Babazade, Maria Huarte, Wael Ali Sakr Esa, Brian M Ilfeld
BACKGROUND: Various methods for peripheral nerve and epidural catheter location assessment exist, with varying degrees of ease of use, utility, and accuracy. Pulsed wave Doppler (PWD) evaluates the presence of fluid flow and is possible modality to assess the location of a percutaneously inserted perineural catheter. METHODS: A retrospective chart review was conducted in which PWD ultrasonography was used to confirm the position of nerve catheters for regional anesthesia...
May 11, 2018: Minerva Anestesiologica
Michael K Essandoh, George E Mark, Johan D Aasbo, Charles A Joyner, Saumya Sharma, Beningo F Decena, Eric D Bolin, Raul Weiss, Martin C Burke, Timothy R McClernon, Emile G Daoud, Michael R Gold
BACKGROUND AND OBJECTIVE: Worldwide adoption of the subcutaneous implantable cardioverter-defibrillator (S-ICD) for preventing sudden cardiac death continues to increase, as longer-term evidence demonstrating the safety and efficacy of the S-ICD expands. As a relatively new technology, comprehensive anesthesia guidance for the management of patients undergoing S-ICD placement is lacking. This article presents advantages and disadvantages of different periprocedural sedation and anesthesia options for S-ICD implants including general anesthesia, monitored anesthesia care, regional anesthesia, and nonanesthesia personnel administered sedation and analgesia...
May 13, 2018: Pacing and Clinical Electrophysiology: PACE
Mehmet Baki Senturk, Ozan Doğan
INTRODUCTION AND HYPOTHESIS: Sacrospinous ligament fixation(SSLF) is a commonly used surgical procedure in pelvic organ prolapse due to high treatment success rates. Many intraoperative and postoperative anesthesia-related obstacles may be encountered by the elderly population. Local anesthesia alone or with intravenous sedation may provide simple, cheap, and safe anesthesia. For elderly patients at high risk for general anesthesia according to the American Society of Anesthesiologists(ASA), it is better to operate through the vaginal route under local anesthesia...
May 7, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Seung-Hyun Kim, Hyun Jin Shin
PURPOSE: To determine whether an infratrochlear nerve block (ITB) can reduce the oculocardiac reflex (OCR) during strabismus surgery on the medial rectus muscle (MR). METHODS: This prospective, randomized single-masked study included 60 patients with intermittent exotropia scheduled for unilateral MR resection/lateral rectus recession under general anesthesia. Patients were randomly allocated to receive a regional nerve block of the infratrochlear nerve (ITB group) prior to surgery or standard treatment without a nerve block (control group)...
May 5, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
Meng Huang, Brian Dalm, Richard K Simpson
The off-label usage of amino-amide anesthetics in intrathecal drug delivery systems (IDDS) for the treatment of chronic non-malignant and malignant pain is supported in the polyanalgesic consensus guidelines as a second-line adjunctive therapy. Although strong evidence for its clinical efficacy is lacking, its clinical safety profile has been well established within established dosing parameters. Despite the rarity of neurological adverse reactions to intrathecal bupivacaine, whether given as regional anesthesia or intrathecal therapy, neurologic morbidity associated with its administration is well documented...
February 27, 2018: Curēus
Jinwook Hwang, Jae Seung Shin, Joo Hyung Son, Too Jae Min
Background: Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. Methods: Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study...
March 2018: Journal of Thoracic Disease
Amir Poya Zanjani, Azam Ghorbani, Babak Eslami, Babak Mirzashahi
General anesthesia (GA) is associated with serious concerns in advanced cases of Charcot-Marie-Tooth (CMT). Despite several benefits of applying regional anesthesia (RA), recommendation for RA is controversial in CMT due to insufficient supporting documents and trials. We report combined epidural/general anesthesia for a 12-year-old boy with CMT disease undergoing major spine corrective surgery. This manuscript is presented not only to evaluate the costs and benefits of RA, but also to highlight the safety of neuraxial anesthesia and emphasis on the broad potential role of RA to reduce risks of GA in CMT patients...
October 2017: Anesthesiology and Pain Medicine
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