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Deep anesthesia

Tsinsue Chen, Zaman Mirzadeh, Kristina M Chapple, Margaret Lambert, Holly A Shill, Guillermo Moguel-Cobos, Alexander I Tröster, Rohit Dhall, Francisco A Ponce
OBJECTIVE Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called "asleep" DBS, and historical cohorts undergoing "awake" DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution...
March 16, 2018: Journal of Neurosurgery
Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Antonio Tancredi, Paolo Graziano, Lucia Dimitri, Elvira Impagnatiello, Marco Taurchini
A sclerosing perineurioma presents as a single asymptomatic papule or nodule located on the hands of adult patients; approximately 60 cases have been reported in medical literature since 1997. Histologically, it originates from the perineural cells of the peripheral nerves and presents epithelial membrane antigen (EMA) positivity and S100 protein negativity. Here, we present the case of a 58-year-old male admitted to our surgery unit complaining of left supraclavicular swelling of 1-cm in size, having no significant past medical history...
February 2018: Eurasian Journal of Medicine
Sadaaki Horiguchi, Hisako Ono, Hiroyuki Shirato, Toshimitsu Kawakami, Shiho Yabuki, Naomi Morita, Nozomu Shirasugi
In our varicose vein center, on a trial basis, among the patients with asymptomatic calf deep vein thrombosis (CDVT) we carefully selected the patients for varicose vein surgery using the requirements as follows; 1) the patients had varicose veins with incompetent saphenous veins, 2) sequential examination including DUS confirmed stability and clinical insignificance of asymptomatic CDVT, 3) the patients do not have any risk factors for DVT such as a coagulation profile disorder (antithrombin deficiency, protein C deficiency, protein S deficiency, or antiphospholipid syndrome) or malignancies, 4) surgery is possible under local anesthesia alone, and 5) the patients can understand the concept of asymptomatic CDVT and undergo the surgery on their own will and informed consent...
December 25, 2017: Annals of Vascular Diseases
Andrew Adams, Carilynne Yarascavitch, Carlos Quiñonez, Amir Azarpazhooh
OBJECTIVE: This study aims to assess barriers to the use of deep sedation/general anesthesia (DS/GA) identified by dentists in Ontario. METHODS: An email invitation to a web-based survey was distributed to all licensed dentists and specialists who have provided an email address to the provincial regulator (n = 5507). Descriptive and regression analyses were performed to explore practice and demographic factors associated with the use of DS/GA. RESULTS: The response rate was 18...
July 2017: Journal—Canadian Dental Association, Journal de L'Association Dentaire Canadienne
Khaled Dajani, Mohammed Almualim, Akshay Menon, Jacqueline Volpi-Abadie, Kierstin Lund
OBJECTIVES: Management of pediatric patients with neurological diagnoses can be challenging for anesthesiologists. We sought to determine whether preexisting neurologic disease could serve as an intrinsic risk factor for prolonged emergence. METHODS: Following institutional review board approval, we conducted a database search from 2012 to 2015. Included were patients aged 0 to 18 years undergoing ambulatory procedures, and carrying neurological diagnoses that profoundly affected their development...
March 2018: Southern Medical Journal
Ayako Kukida, Yasushi Takasaki, Mio Nakata, Tasuku Nishihara, Sakiko Kitamura, Sonoko Fujii, Yuji Watanabe, Toshihiro Yorozuya
RATIONALE: Although an inferior vena cave (IVC) filter is placed to prevent fatal pulmonary embolism (PE), several complications associated with an IVC filter have been reported. We describe a case with symptomatic PE, of which the origin was an occlusive IVC thrombus that developed from the placement of an IVC filer after a laparoscopy-assisted total gastrectomy (LATG). PATIENT CONCERNS: A 71-year-old man underwent LATG under general anesthesia alone. He had an IVC filter implanted 13 years ago...
January 2018: Medicine (Baltimore)
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
Martijn Boon, Christian Martini, Albert Dahan
Muscle relaxation is a routine part of anesthesia and has important advantages. However, the lingering effects of muscle relaxants in the postoperative period have historically been associated with postoperative adverse events. Neuromuscular reversal, together with neuromuscular monitoring, is a recognized strategy to reduce the rate of postoperative residual relaxation but has only marginally improved outcome in the past few decades. Sugammadex, a novel reversal agent with unique encapsulating properties, has changed the landscape of neuromuscular reversal and opened up new opportunities to improve patient care...
2018: F1000Research
Ramin Jamshidi
Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when considering etiology and management, distinguishing between infants, children, and adolescents. For all ages, malignancy is rarely a consideration, but a thorough examination of infants and children typically requires deep sedation or general anesthesia. Very little primary literature or evidence exists to guide care; so there are many opportunities for careful study to enhance our understanding beyond personal experience and historical practice patterns...
March 2018: Clinics in Colon and Rectal Surgery
Ruixue Hou, Hong Wang, Lianhua Chen, Yimin Qiu, Shitong Li
Objectives: Clinical observation, as well as randomized controlled trials, indicated an increasing rate of postoperative cognitive dysfunction (POCD) with increasing depth of general anesthesia. However, the findings are subject to bias due to varying degree of analgesia. In this trial, we compared the rate of POCD between patients receiving light versus high anesthesia while holding analgesia comparable using nerve block. Methods: Elderly patients (≧60 years) receiving elective total knee replacement were randomized to receive the surgery under general anesthesia at BIS 40-50 (LOBIS group) or BIS 55-65 (HIBIS group)...
February 2018: Brain and Behavior
Iacopo Cappellini, Fabio Picciafuochi, Daniele Ostento, Ginevra Danti, Angelo Raffaele De Gaudio, Chiara Adembri
BACKGROUND: The extensive use of neuromuscular blocking agents (NMBAs) during surgical procedures still leads to potential residual paralyzing effects in the postoperative period. Indeed, neuromuscular monitoring in an intra-operative setting is strongly advocated. Acetylcholinesterase inhibitors can reverse muscle block, but their short half-life may lead to residual curarization in the ward, especially when intermediate or long-acting NMBAs have been administered. Sugammadex is the first selective reversal drug for steroidal NMBAs; it has been shown to give full and rapid recovery of muscle strength, thus minimizing the occurrence of residual curarization...
February 21, 2018: Trials
Hong Yang, Xi-Bin Li, Jie Tan, Hao Li, Yin-Chu Shao, Feng Shuang
OBJECTIVE: To investigate the influential factors of total blood loss during unilateral artificial total hip arthroplasty (THA). METHODS: From January 2014 to July 2016, 131 patients undergwent primary unilateral total hip arthroplasty, including 55 males and 76 females, ranging in age from 40 to 89 years old, with an average of 64.5 years old. The data of patients with unilateral total hip arthroplasty were collected, and the data of hemodynamics, coagulation function, hemoglobin and hematocrit values were recorded according to the observation data...
November 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Yutaka Oda, Michie Fujita, Chika Motohisa, Shinichi Nakata, Motoko Shimada, Ryushi Komatsu
Background: Ovarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis. Case presentation: A 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section...
2018: JA Clin Rep
Antonis S Manolis, Spyridon Koulouris, Efthymia Rouska, John Pyrros
OBJECTIVE: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of transesophageal (TEE) or intracardiac echocardiography, incurring longer duration and higher cost. We have used a simplified, economical, fluoroscopy-only guided approach with local anesthesia, and herein report our data. METHODS: The study includes 112 procedures in 110 patients with PFO (n=75) or ASD (n=35), with use of an Amplatzer occluder, heparin and prophylactic antibiotics...
January 2018: Indian Heart Journal
Rodrigo Dos Santos Pereira, Jonathan Ribeiro da Silva, João Paulo Bonardi, Eduardo Hochuli-Vieira
The removal of displaced dental elements from deep anatomical spaces is a condition that requires the knowledge of the region and skills to perform the procedure. The lateral pharyngeal space contains important structures such as the internal carotid artery and close proximity with the cranium basis. The aim of this paper is to report a clinical case of a lower third molar displaced to the lateral pharyngeal space after a mandibular angle fracture and its treatment by surgical intervention. The tooth was removed under general anesthesia by direct approach and the fracture was reduced and fixed with a plate and screws...
February 18, 2018: Oral and Maxillofacial Surgery
Christopher J Pannucci, Kory I Fleming
OBJECTIVE: Perioperative venous thromboembolism (VTE) risk can be quantified with the 2005 Caprini score. The Caprini score has previously been validated by review of the electronic medical record (EMR) in >3000 plastic surgery patients. However, the accuracy of Caprini-based risk stratification using the EMR, as opposed to face-to-face contact with the patient, remains unknown. METHODS: Plastic and reconstructive surgery patients who had surgery under general anesthesia, required postoperative admission, and were started on enoxaparin prophylaxis were identified...
February 13, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Lara Luzón Solanas, Leticia Ollero Domenche, Eva María Sierra Moros, José Val Pérez, María Teresa Soria San Teodoro, Teresa Giménez Júlvez, Rafael Uribarrena Amezaga
INTRODUCTION: propofol administered by an endoscopist with a trained nurse has evolved as an alternative to anesthesia monitoring and is increasingly common in the routine clinical practice, even in advanced endoscopy. OBJECTIVE: to evaluate the safety of deep sedation with endoscopist-controlled propofol in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). MATERIAL AND METHODS: this was a prospective study in patients undergoing ERCP under deep sedation with propofol...
February 9, 2018: Revista Española de Enfermedades Digestivas
Gregor Lichtner, Ryszard Auksztulewicz, Evgeniya Kirilina, Helena Velten, Dionysios Mavrodis, Michael Scheel, Felix Blankenburg, Falk von Dincklage
Drug-induced unconsciousness is an essential component of general anesthesia, commonly attributed to attenuation of higher-order processing of external stimuli and a resulting loss of information integration capabilities of the brain. In this study, we investigated how the hypnotic drug propofol at doses comparable to those in clinical practice influences the processing of somatosensory stimuli in the spinal cord and in primary and higher-order cortices. Using nociceptive reflexes, somatosensory evoked potentials and functional magnet resonance imaging (fMRI), we found that propofol abolishes the processing of innocuous and moderate noxious stimuli at low to medium concentration levels, but that intense noxious stimuli evoked spinal and cerebral responses even during deep propofol anesthesia that caused profound electroencephalogram (EEG) burst suppression...
February 5, 2018: NeuroImage
Kellam D Bayley, R A Read
OBJECTIVE: To test a sub-Tenon's anesthesia technique in dogs as an alternative to systemic neuromuscular blockade to aid in canine cataract surgery under general anesthesia. PROCEDURES: A prospective controlled clinical study was performed involving 12 dogs undergoing bilateral cataract surgery under general anesthesia. One eye was randomly assigned to have phacoemulsification and prosthetic lens implantation performed with sub-Tenon's anesthesia (STA), and the control eye had surgery performed with systemic neuromuscular blockade (NMB)...
February 6, 2018: Veterinary Ophthalmology
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