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Deep anesthesia

Manuel de la Matta
It is universally accepted that deep sedation involves more risks than light-to-moderate sedation. Deep sedation for endoscopic explorations is normally provided by anesthesiologists in Spain and in most countries of the European Unión. The present debate about deep sedation-anesthesia states goes beyond the topic of cardiovascular and respiratory adverse events, and targets the cognitive consequences and global increased mortality of uncontrolled sedation states, especially in specific fragile populations...
October 19, 2016: Revista Española de Enfermedades Digestivas
Yalcin Yontar, Atilla Coruh, Nadire Dinc, Olgun Kontas
Early tangential excision of the burn wound is essential for removal of necrotic tissue and promotion of burn wound healing process. However, the depth of the burn wound is not easily assessed during the tangential excision performed by hand-held dermatomes, and it may be possible to excise unburned vital dermis unnecessarily, which aids in primary epithelization of the burn wound by adnexal structures. We herein present early clinical results of steel wool-aided dermabrasion in patients with deep partial-thickness burns...
October 7, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Anthony G Hudetz, Jeannette A Vizuete, Siveshigan Pillay, George A Mashour
Consciousness has been linked to the repertoire of brain states at various spatiotemporal scales. Anesthesia is thought to modify consciousness by altering information integration in cortical and thalamocortical circuits. At a mesoscopic scale, neuronal populations in the cortex form synchronized ensembles whose characteristics are presumably state-dependent but this has not been rigorously tested. In this study, spontaneous neuronal activity was recorded with 64-contact microelectrode arrays in primary visual cortex of chronically instrumented, unrestrained rats under stepwise decreasing levels of desflurane anesthesia (8%, 6%, 4%, and 2% inhaled concentrations) and wakefulness (0% concentration)...
October 14, 2016: Neuroscience
Eugene T H Ek, Sophia K Paul, Robert N Hotchkiss
BACKGROUND: The role of elbow contracture release in the very young is unclear, with existing studies reporting conflicting results. This study evaluated the long-term results after open elbow contracture release in patients aged younger than 18 years. METHODS: Between 1994 and 2012, 32 patients underwent open elbow contracture release at a mean age of 13.8 years (range, 5-18 years), and their outcomes were reviewed. The primary cause was traumatic in 30 patients (4 radial head/neck fractures, 5 intra-articular distal humeral fractures, 11 extra-articular distal humeral fractures, 10 complex fracture-dislocations), and the mean time from the index injury to contracture release was 16...
October 14, 2016: Journal of Shoulder and Elbow Surgery
Brian M Ilfeld
A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim...
October 3, 2016: Anesthesia and Analgesia
Dafna Willner, Valeria Spennati, Shelly Stohl, Giulia Tosti, Simone Aloisio, Federico Bilotta
Spine surgery has been growing rapidly as a neurosurgical operation, with an increase of 220% over a 15-year period. Intraoperative blood transfusion is a major outcome determinant of spine procedures. Various approaches, including pharmacologic and nonpharmacologic therapies, have been tested to decrease both intraoperative and postoperative blood loss. The aim of this systematic review is to report clinical evidence on the relationship between intraoperative blood loss (primary outcome) and on transfusion requirements and postoperative complications (secondary outcomes) in patients undergoing spine surgery...
October 3, 2016: Anesthesia and Analgesia
Shruti Jain, Nazia Nazir, Rashid M Khan, Syed M Ahmed
INTRODUCTION: Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA™) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA™) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™ and ETT/OPA™ exchange technique. MATERIAL AND METHODS: This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia...
September 2016: Anesthesia, Essays and Researches
M Clerc, J Prothet, T Rimmelé
Composite tissue allotransplantation (CTA) is a complex procedure requiring a multidisciplinary collaboration between surgeons, anesthetists, and transplantation specialists. We will describe the perioperative management of a bilateral forearm allograft performed at our facility. A 40-year-old man who lost both forearms was registered on the transplant waiting list; a suitable graft was available 11months later. Anesthesia required planning for vascular access, hemodynamic monitoring, fluid therapy management and prevention of deep vein thrombosis...
June 2016: Hand Surgery and Rehabilitation
Robert Z Tashjian, Daniel T Lilly, Aaron M Isaacson, Cory E Georgopoulos, Stephen P Bettwieser, Robert T Burks, Patrick E Greis, Angela P Presson, Erin K Granger, Yue Zhang
Reported rates of venous thromboembolism (VTE) after shoulder arthroplasty (SA) range from 0.2% to 13%. Few studies have evaluated the incidence of VTE in a large patient population from a single institution. We conducted a study to determine the incidence of VTE (deep venous thrombosis [DVT] and pulmonary embolism [PE]) in a large series of SAs. Cases of SAs performed at our institution between January 1999 and May 2012 were retrospectively reviewed for development of symptomatic VTE within the first 90 days after surgery...
September 2016: American Journal of Orthopedics
Anna Castrioto, Odeya Marmor, Marc Deffains, Dafna Willner, Eduard Linetsky, Hagai Bergman, Zvi Israel, Renana Eitan, David Arkadir
Classical rate models of basal ganglia circuitry associate discharge rate of the globus pallidus external and internal segments (GPe, GPi respectively) solely with dopaminergic state and predict an inverse ratio between the discharge rates of the two pallidal segments. In contrast, the effects of other rate modulators such as general anesthesia (GA) on this ratio have been ignored. To respond to this need, we recorded the neuronal activity in the GPe and GPi in awake and anesthetized human patients with dystonia (57 and 53 trajectories respectively) and in awake patients with Parkinson's disease (PD, 16 trajectories) undergoing deep brain stimulation procedures...
September 26, 2016: European Journal of Neuroscience
Jared B Smith, Zhifeng Liang, Glenn D R Watson, Kevin D Alloway, Nanyin Zhang
The claustrum is a brain region whose function remains unknown, though many investigators suggest it plays a role in conscious attention. Resting-state functional magnetic resonance imaging (RS-fMRI) has revealed how anesthesia alters many functional connections in the brain, but the functional role of the claustrum with respect to the awake versus anesthetized states remains unknown. Therefore, we employed a combination of seed-based RS-fMRI and neuroanatomical tracing to reveal how the anatomical connections of the claustrum are related to its functional connectivity during quiet wakefulness and the isoflurane-induced anesthetic state...
October 6, 2016: Brain Structure & Function
Abigail C Mancuso, Kelsey Lee, Ran Zhang, Elizabeth A Hoover, Colleen Stockdale, Abbey J Hardy-Fairbanks
OBJECTIVES: Safety of outpatient dilation and evacuations with intravenous (iv) sedation without intubation has been demonstrated, but there is a paucity of data on deep iv sedation on an inpatient second trimester surgical termination population. The purpose of this study is to evaluate complications of deep sedation with propofol without the use of intubation during second trimester surgical terminations in an inpatient teaching institution. STUDY DESIGN: A retrospective chart review of all obstetrical and anesthetic data from inpatient dilation and evacuations between gestational ages 15 0/7 and 24 0/7 during the years 2002 to 2015...
October 3, 2016: Contraception
Li Shuying, Li Ping, Lin Xuemei
BACKGROUND: Postoperative shivering (POS) is a common complication that occurs after regional and general anesthesia. Thus far, numerous studies have reported on the effectiveness of tramadol in preventing or treating POS. Here, we performed a meta-analysis to assess the efficacy of tramadol in the prevention of POS. METHODS: We systematically searched PubMed, Embase and the Cochrane Library to identify studies of the efficacy of tramadol in the prevention of POS...
October 5, 2016: Minerva Anestesiologica
G Daş, A Vernunft, S Görs, E Kanitz, J M Weitzel, K-P Brüssow, C C Metges
Physiological research with swine often includes sedation or general anesthesia (GA), which may influence the basal physiological responses of experimental animals and may have the potential to confound or interfere with the effects of experimental factors of interest. Using 6 adult female pigs, we investigated whether selected plasma metabolites and hormones are influenced by GA induced with ketamine (K) and 2 neuroleptic sedatives, namely azaperone (A) and xylazine (X). Fasted pigs rotationally received either no drug, a single intravenous administration of A or X, or A or X combined with ketamine (AK or XK, respectively), and plasma concentrations of glucose, lactate, non-esterified fatty acids (NEFA), triglycerides (TG), glucagon, insulin, and cortisol were determined for a 5-h period following administration...
August 2016: Journal of Animal Science
David W Polly, Stacey J Ackerman, Karen Schneider, Jeff B Pawelek, Behrooz A Akbarnia
PURPOSE: Traditional growing rod (TGR) for early-onset scoliosis (EOS) is effective but requires repeated invasive surgical lengthenings under general anesthesia. Magnetically controlled growing rod (MCGR) is lengthened noninvasively using a hand-held magnetic external remote controller in a physician office; however, the MCGR implant is expensive, and the cumulative cost savings have not been well studied. We compared direct medical costs of MCGR and TGR for EOS from the US integrated health care delivery system perspective...
2016: ClinicoEconomics and Outcomes Research: CEOR
Lauren A Beaupre, B Sharifi, D W C Johnston
BACKGROUND: This 10-year follow-up compares health-related quality of life (HRQL) and reoperations in 100 subjects who were randomized to receive posterior cruciate ligament substituting (PS) or posterior cruciate ligament retaining (CR) total knee arthroplasty. We previously reported 2-year results. METHODS: Subjects were enrolled preoperatively and randomized at surgery. Subjects completed HRQL questionnaires at all evaluation points. Subjects were re-evaluated at 2 and 10 years with reoperations determined through regional medical record review and patient report...
September 8, 2016: Journal of Arthroplasty
Marcus Hards, Arisa Harada, Isobel Neville, Sheelagh Harwell, Mahwash Babar, Abdulsatar Ravalia, Giles Davies
STUDY OBJECTIVES: To determine the effectiveness of serratus plane block performed under direct vision on postoperative pain after mastectomy. DESIGN: We performed a retrospective study of elective breast surgery patients undergoing mastectomy over 6 months. We collected data on the outcomes for the pain score and use of analgesia in recovery, the use of analgesia and antiemetics overnight, and the pain score and mobilization status of the patient 1 day after the operation...
November 2016: Journal of Clinical Anesthesia
Ying Wang, Jianxun Lei, Mihir Gupta, Fei Peng, Sarah Lam, Ritu Jha, Ellis Raduenz, Al J Beitz, Kalpna Gupta
Integrative approaches such as electroacupuncture, devoid of drug effects are gaining prominence for treating pain. Understanding the mechanisms of electroacupuncture induced analgesia would benefit chronic pain conditions such as sickle cell disease (SCD), for which patients may require opioid analgesics throughout life. Mouse models are instructive in developing a mechanistic understanding of pain, but the anesthesia/restraint required to administer electroacupuncture may alter the underlying mechanisms. To overcome these limitations, we developed a method to perform electroacupuncture in conscious, freely moving, unrestrained mice...
September 30, 2016: Scientific Reports
Zahra Hajimashhadi, Nahid Aboutaleb, Farinaz Nasirinezhad
Apelin is an endogenous ligand for apelin receptor (APJ) with analgesic effect on visceral, analgesic and proanalgesic influences on acute pains in animal models. The purpose of this study was to determine the possible analgesic effects of [Pyr(1)] apelin-13 on chronic pain after spinal cord injury (SCI) in rats. Animals were randomly divided into three major groups as intact, sham and SCI. The SCI group randomly allocated to four subgroups as no treatment, vehicle-treatment (normal saline: 10μl, intrathecally) and two subgroups with intrathecal injection (i...
September 2, 2016: Neuropeptides
Tsinsue Chen, Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, Francisco A Ponce
OBJECTIVE As the number of deep brain stimulation (DBS) procedures performed under general anesthesia ("asleep" DBS) increases, it is more important to assess the rates of adverse events, inpatient lengths of stay (LOS), and 30-day readmission rates in patients undergoing these procedures compared with those in patients undergoing traditional "awake" DBS without general anesthesia. METHODS All patients in an institutional database who had undergone awake or asleep DBS procedures performed by a single surgeon between August 2011 and August 2014 were reviewed...
September 23, 2016: Journal of Neurosurgery
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