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Regional general anesthesia

Ariel Kiyomi Daoud, Tessa Mandler, Alexia Georgia Gagliardi, Harin Bhavin Parikh, Patrick M Carry, Anusara Carolyn Ice, Jay Albright
Background: Despite advancements in minimally invasive arthroscopic surgical techniques, post-operative pain management following ACL reconstruction remains a concern. This study compares the effectiveness of two common intraoperative pain management strategies - a femoral nerve catheter (FC) versus a combined femoral nerve catheter and single injection sciatic nerve block (FSB) - in pediatric patients undergoing ACL reconstruction. Methods: The medical records of patients age 8 to 18 who underwent ACL reconstruction at our institution were reviewed retrospectively...
2018: Iowa Orthopaedic Journal
Elisabeth Dewhirst, Hina Walia, Walter P Samora, Allan C Beebe, Jan E Klamar, Joseph D Tobias
Introduction: Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO2 ) using near-infrared spectroscopy (NIRS). Changes in rSO2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO2 during intraoperative changes in mechanical ventilation...
2018: Medical Devices: Evidence and Research
Stephen Tabiri, Edwin M T Yenli, Frank E Gyamfi, Ali Jalali, Richard E Nelson, Raymond R Price, Micah G Katz
BACKGROUND: Despite the recognition that inguinal hernia (IH) repair is cost-effective, repair rates in low- and middle-income countries remain low. Estimated use of mesh in low- and middle-income countries also remains low despite publications about low-cost, noncommercial mesh. The purpose of our study was to assess the current state of IH repair in the northern and transitional zone of Ghana. MATERIALS AND METHODS: A retrospective review of surgical case logs of IH repairs from 2013 to 2017 in 41 hospitals was performed...
October 2018: Journal of Surgical Research
Aysha Hasan, Autumn D Nanassy, Gregory Disilvio, Teerin Meckmongkol, L Grier Arthur, Pravin A Taneja
The sickle cell patient population continues to provide challenges in pain control. Current therapies include narcotic usage with adjuvant therapies such as anti-inflammatories and nonpharmacological interventions. Poor pain management in the sickle cell patient population, especially postoperatively, can lead to hypoventilation, escalating opioid requirements, poor recovery, and longer hospital stays. This case report addresses a novel addition of ultrasound-guided paravertebral and rectus sheath blocks postinduction of general anesthesia and before surgical incision to assist with the intravenous postoperative pain management regimen after laparoscopic cholecystectomy in a 10-year-old boy with sickle cell disease...
August 7, 2018: A&A practice
James R Riehl, Ben J Palanca, ShiNung Ching
Characterizing anesthesia-induced alterations to brain network dynamics provides a powerful framework to understand the neural mechanisms of unconsciousness. To this end, increased attention has been directed at how anesthetic drugs alter the functional connectivity between brain regions as defined through neuroimaging. However, the effects of anesthesia on temporal dynamics at functional network scales is less well understood. Here, we examine such dynamics in view of the free-energy principle, which postulates that brain dynamics tend to promote lower energy (more organized) states...
2018: Network neuroscience
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
Szymon Bialka, Maja Copik, Katarzyna Rybczyk, Aleksander Owczarek, Ewa Jedrusik, Damian Czyzewski, Marek Filipowski, Eva Rivas, Kurt Ruetzler, Lukasz Szarpak, Hanna Misiolek
BACKGROUND: Electrical impedance tomography (EIT) is a tool to monitor regional ventilation distribution in patient's lungs under general anesthesia. The objective of this study was to assess the regional ventilation distribution using different driving pressures (DP) during high frequency jet ventilation (HFJV). METHODS: Prospective, observational, cross-over study. Patients undergoing rigid bronchoscopy were ventilated HFJV with DP 1.5 and 2.5 atm. Hemodynamic and ventilation parameters, as well as ventilation in different regions of the lungs in percentage of total ventilation, assessed by EIT, were recorded...
July 31, 2018: BMC Anesthesiology
Neil De Souza, Saurabh Kamat, Paul Chalakkal, Rakshit V Khandeparker
The use of 3D printing in the medical field has been well documented, with significant developments in fabrication of tissues, organs, customized prosthetics, implants, and anatomical models as well as pharmaceutical research. Its use in dentistry, however has been limited mainly to maxillofacial surgery and reconstruction, orthognathic surgery and trauma. Compound odontomes are usually prevalent in the anterior maxilla, however, their occurrence in the anterior mandibular region is rare. This case report highlights the effective usage of 3D printing as an aid in the surgical removal of a compound odontome and impacted incisors in the mandibular anterior region...
July 2018: Journal of Clinical and Experimental Dentistry
Karthik Narendra Kumar, Ravikumar Nagashetty Kalyane, Naveen G Singh, P S Nagaraja, Madhu Krishna, Balaji Babu, R Varadaraju, N Sathish, N Manjunatha
Background: Good postoperative analgesia in cardiac surgical patients helps in early recovery and ambulation. An alternative to parenteral, paravertebral, and thoracic epidural analgesia can be pectoralis nerve (Pecs) block, which is novel, less invasive regional analgesic technique. Aims: We hypothesized that Pecs block would provide superior postoperative analgesia for patients undergoing cardiac surgery through midline sternotomy compared to parenteral analgesia...
July 2018: Annals of Cardiac Anaesthesia
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
A Rizk, M Hamed
Fractures of the rostral mandible in horses are the most common type of jaw fractures. The present study was performed for stabilization of rostral mandibular fracture with cerclage wire. In a retrospective case series, six client-owned horses with unilateral mandibular fractures were admitted to our clinic and suffered from a major gingival wound at rostral part of mandible. Rostral mandibular fracture was diagnosed through clinical examination and radiography. Fractured region was repaired by cerclage wire under the effect of general anesthesia and wires were maintained for 6-12 weeks...
2018: Iranian Journal of Veterinary Research
M Campos, J Azevedo, L Mendes, H Rebelo
Breast cancer surgery is usually performed under general anesthesia or, more recently, combined with conventional regional techniques. Pectoral nerves (PECs) block appears as an analgesic alternative in these procedures, but few studies refer to it as a single anesthetic technique1-3 . In this case report, we describe a 56-year-old female patient, BMI 31kg/m2 , ASA IV, admitted for elective tumorectomy of the left upper quadrant of the breast and sentinel node investigation. Given the multiple comorbidities and the high anesthetic and surgical risk, the anaesthetic plan consisted in ultrasound guided PECs II block as a single anesthetic technique...
July 20, 2018: Revista Española de Anestesiología y Reanimación
Jason Tri, Roshini Asirvatham, Christopher V DeSimone, Ammar M Killu, Alan M Sugrue, Scott H Suddendorf, Dorothy J Ladewig, Suraj Kapa, Paul A Friedman, Christopher J McLeod, Samuel J Asirvatham
INTRODUCTION: The His-Purkinje system has been shown to harbor triggers for ventricular fibrillation (VF) initiation. However, the substrate responsible for VF maintenance remains elusive. We hypothesized that standard, electrode-based, point-to-point mapping would yield meaningful insight into site-specific patterns and organization which may shed light on the critical substrate for maintenance of VF. METHODS: VF was induced under general anesthesia by direct current (DC) application to the right ventricle in 7 acute canines...
July 20, 2018: Indian Pacing and Electrophysiology Journal
Kiran Radder, Ashwin Shah, Chaitanya Kothari, Girish Giraddi, Dinesh Sharma, Ranganath Nayak
Background: With definitive indications, extraoral techniques of achieving regional nerve blocks are a boon to oral and maxillofacial surgical practice. Though less commonly practiced, since general anesthesia is more favored, certain medical conditions favor the use of regional nerve blocks over general anesthesia. To block the maxillary nerve extraorally, sigmoid notch approach and frontozygomatic approach have been previously described in the literature, but a clinical trial comparing these techniques is sparse...
September 2018: Journal of Maxillofacial and Oral Surgery
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
Elaine Yang, Daniele Granata, Roderic G Eckenhoff, Vincenzo Carnevale, Manuel Covarrubias
Propofol is widely used in the clinic for the induction and maintenance of general anesthesia. As with most general anesthetics, however, our understanding of its mechanism of action remains incomplete. Local and general anesthetics largely inhibit voltage-gated Na+ channels (Navs) by inducing an apparent stabilization of the inactivated state, associated in some instances with pore block. To determine the biophysical and molecular basis of propofol action in Navs, we investigated NaChBac and NavMs, two prokaryotic Navs with distinct voltage dependencies and gating kinetics, by whole-cell patch clamp electrophysiology in the absence and presence of propofol at clinically relevant concentrations (2-10 µM)...
July 17, 2018: Journal of General Physiology
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
Eiko Onishi, Mamoru Murakami, Ryo Nishino, Ruri Ohba, Masanori Yamauchi
Thoracic epidural anesthesia (TEA) and paravertebral block (PVB) have been performed for perioperative regional anesthesia in the trunk. However, TEA and PVB are associated with a risk of serious complications, such as pneumothorax, hypotension, or nerve damage. Retrolaminar paravertebral block (RLB) was introduced as a new alternative to PVB. This new approach might lower the risk of serious complications, but its use has not been well established yet. Therefore, we conducted a double-masked, placebo-controlled, randomized clinical trial to evaluate the efficacy of a double-level RLB for postoperative analgesia after breast cancer surgery...
July 2018: Tohoku Journal of Experimental Medicine
Jacob E Sunshine, Andrew T Humbert, Benjamin Booth, Steven M Bowman, Eileen M Bulger, Sam R Sharar
BACKGROUND: Virtually all anesthesiologists care for patients who sustain traumatic injuries; however, the frequency with which operative anesthesia care is provided to this specific patient population is unclear. We sought to better understand the degree to which anesthesia providers participate in operative trauma care and how this differs by trauma center designation (levels I-V), using data from a comprehensive, regional database-the Washington State Trauma Registry (WSTR). We also sought to specifically assess operative anesthesia care frequency vis a vis the American College of Surgeons guidelines for continuous anesthesiology coverage for Level II trauma center accreditation...
July 11, 2018: Anesthesia and Analgesia
Vuslat Muslu Erdem, Turgut Donmez, Sinan Uzman, Sina Ferahman, Engin Hatipoglu, Oguzhan Sunamak
Introduction: Laparoscopic appendectomy (LA) has been generally performed under general anesthesia. Laparoscopic appendectomy is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. Aim: To compare spinal/epidural anesthesia (SEA) and general anesthesia (GA) during LA with respect to perioperative and postoperative adverse events and postoperative pain. Material and methods: Fifty patients, aged 18-65, who underwent LA, were randomly allocated to two groups: the GA (n = 25) and SEA (n = 25) groups...
June 2018: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
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