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Anesthesia and consciousness

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https://www.readbyqxmd.com/read/27911815/nicotinic-receptors-in-mouse-prefrontal-cortex-modulate-ultraslow-fluctuations-related-to-conscious-processing
#1
Fani Koukouli, Marie Rooy, Jean-Pierre Changeux, Uwe Maskos
The prefrontal cortex (PFC) plays an important role in cognitive processes, including access to consciousness. The PFC receives significant cholinergic innervation and nicotinic acetylcholine receptors (nAChRs) contribute greatly to the effects of acetylcholine signaling. Using in vivo two-photon imaging of both awake and anesthetized mice, we recorded spontaneous, ongoing neuronal activity in layer II/III in the PFC of WT mice and mice deleted for different nAChR subunits. As in humans, this activity is characterized by synchronous ultraslow fluctuations and neuronal synchronicity is disrupted by light general anesthesia...
December 2, 2016: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/27903341/-the-application-of-conscious-sedation-with-a-small-dose-of-dexmedetomidine-and-sufentanil-in-elderly-patients-undergoing-multiple-intestinal-polyps-resection
#2
C M Shi, Y D Zhou, M Xu, X D Wang, L M Meng, X J Liu, X Y Guo
Objective: To explore the effectiveness and feasibility of conscious sedation with a low dose of dexmedetomidine and sufentanil during multiple intestinal polyps resection in elderly patients. Methods: Sixty elderly patients who underwent multiple intestinal polyps resection in Peking University Third Hospital from Janurary to May 2016 were randomly divided into dexmedetomidine group (D group, n=30) and propofol group (P group, n=30). There were 28 males and 32 females with a mean age of (70.4±4.5) years old (range: 65-80 years old)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27898546/lateral-position-for-cesarean-delivery-because-of-severe-aortocaval-compression-in-a-patient-with-marfan-syndrome-a-case-report
#3
John C Coffman, Russell L Legg, Catherine F Coffman, Kenneth R Moran
Prompt recognition and management of hypotension resulting from aortocaval compression syndrome are essential to optimize the maternal and fetal outcomes. Management involves increasing leftward uterine displacement and sometimes full lateral positioning, although lateral position during cesarean delivery is typically considered to be impractical. We report an obstetric patient case of severe aortocaval compression syndrome resulting in hypotension and loss of consciousness that ultimately underwent cesarean delivery under general anesthesia in the lateral position...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27893492/safety-of-local-intracutaneous-lidocaine-anesthesia-used-by-dermatologic-surgeons-for-skin-cancer-excision-and-postcancer-reconstruction-quantification-of-standard-injection-volumes-and-adverse-event-rates
#4
Murad Alam, Matthew R Schaeffer, Amelia Geisler, Emily Poon, Scott W Fosko, Divya Srivastava
BACKGROUND: Intracutaneous lidocaine is used for anesthesia in dermatologic surgery for skin cancer excision and repair with exceedingly low incidence of reported adverse events. OBJECTIVE: To measure (1) the quantity of lidocaine typically used for facial skin cancer excision and reconstruction; and (2) the frequency and character of associated adverse events. METHODS: Survey study of dermatologic surgeons with longitudinal reporting. Reported practice during 10 business days: (1) mean volume of 1% lidocaine per skin cancer excision; (2) maximum per excision; (3) mean per reconstruction; and (4) maximum per reconstruction...
December 2016: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
https://www.readbyqxmd.com/read/27873010/regional-block-via-continuous-caudal-infusion-as-sole-anesthetic-for-inguinal-hernia-repair-in-conscious-neonates
#5
Claudia M Mueller, Tiffany J Sinclair, Megan Stevens, Micaela Esquivel, Noah Gordon
PURPOSE: The use of general anesthesia in young children has come under increasing scrutiny due to its potential long-term neurotoxic effects. Meanwhile, regional anesthesia for surgical procedures in neonates has many advantages, including preservation of respiratory status and faster return to feeding. We describe the successful use of 3% 2-chloroprocaine administered via continuous caudal infusion as the sole anesthetic agent during elective surgical procedures in infants. METHODS: A retrospective chart review of all patients who underwent elective surgical procedures under continuous caudal regional anesthetic at a single institution was performed...
November 21, 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27871542/severe-respiratory-depression-and-bradycardia-before-induction-of-anesthesia-and-onset-of-takotsubo-cardiomyopathy-after-cardiopulmonary-resuscitation
#6
Yuko Furuichi, Ayaka Hamada, Keiko Nakazato, Katsuya Kobayashi, Atsuhiro Sakamoto
A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27858407/preclinical-imaging-anesthesia-in-rodents
#7
Giancarlo Vesce, Fabiana Micieli, Ludovica Chiavaccini
Despite the outstanding progress achieved by preclinical imaging science, laboratory animal anesthesia remains quite stationary. Ninety percent of preclinical imaging studies are carried on small rodents (mice and rats) anesthetized by outdated injectable and/or inhalation agents. A need for imaging awake (conscious) animals is questionably registered mainly for brain research, for phMRI and for accomplishing pain and analgesia studies. A need for improving current rodent anesthesia protocols and for enforcing the 3Rs paradigm is sought...
November 18, 2016: Quarterly Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/27818803/eminectomy-for-habitual-luxation-of-the-temporomandibular-joint-with-sedation-and-local-anesthesia-a-case-series
#8
Joe Iwanaga, Yoshiaki Nakamura, Jingo Kusukawa, R Shane Tubbs
Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the TMJ. The age of patients ranged from 18 to 93 years...
2016: Case Reports in Dentistry
https://www.readbyqxmd.com/read/27811133/even-small-decreases-in-blood-pressure-during-conscious-sedation-affect-clinical-outcome-after-stroke-thrombectomy-an-analysis-of-hemodynamic-thresholds
#9
M K Whalin, K M Halenda, D C Haussen, L C Rebello, M R Frankel, R Y Gershon, R G Nogueira
BACKGROUND AND PURPOSE: The adverse effects of general anesthesia in stroke thrombectomy have been attributed to intraprocedural hypotension, yet optimal hemodynamic targets remain elusive. Identifying hemodynamic thresholds from patients without exposure to general anesthesia may help separate the effect of hypotension from the effect of anesthesia in thrombectomy outcomes. Therefore, we investigated which hemodynamic parameters and targets best correlate with outcome in patients treated under sedation with monitored anesthesia care...
November 3, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27802272/isoflurane-and-sevoflurane-induce-severe-hepatic-insulin-resistance-in-a-canine-model
#10
Stella P Kim, Josiane L Broussard, Cathryn M Kolka
INTRODUCTION: Anesthesia induces insulin resistance, which may contribute to elevated blood glucose and adverse post-operative outcomes in critically ill patients, and impair glycemic control in surgical patients with diabetes. However, little is known about the mechanisms by which anesthesia impairs insulin sensitivity. Here we investigate the effects of anesthesia on insulin sensitivity in metabolic tissues. METHODS: Hyperinsulinemic-euglycemic clamps were performed in 32 lean (control diet; n = 16 conscious versus n = 16 anesthetized) and 24 fat-fed (6 weeks fat-feeding; n = 16 conscious versus n = 8 anesthetized) adult male mongrel dogs in conjunction with tracer methodology to differentiate hepatic versus peripheral insulin sensitivity...
2016: PloS One
https://www.readbyqxmd.com/read/27790322/role-of-transpedicular-percutaneous-vertebral-biopsy-for-diagnosis-of-pathology-in-vertebral-compression-fractures
#11
Saurabh Shrinivas Pagdal, Sunil Nadkarni, Sharad Moreshwar Hardikar, Madan Sharad Hardikar
STUDY DESIGN: Retrospective observational study. PURPOSE: To identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures. OVERVIEW OF LITERATURE: Vertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures...
October 2016: Asian Spine Journal
https://www.readbyqxmd.com/read/27790142/physical-properties-and-effect-in-a-battery-of-safety-pharmacology-models-for-three-structurally-distinct-enteric-polymers-employed-as-spray-dried-dispersion-carriers
#12
Ryan M Fryer, Mita Patel, Xiaomei Zhang, Katja S Baum-Kroker, Akalushi Muthukumarana, Brian Linehan, Yin-Chao Tseng
Establishing a wide therapeutic index (TI) for pre-clinical safety is important during lead optimization (LO) in research, prior to clinical development, although is often limited by a molecules physiochemical characteristics. Recent advances in the application of the innovative vibrating mesh spray-drying technology to prepare amorphous solid dispersions may offer an opportunity to achieve high plasma concentrations of poorly soluble NCEs to enable testing and establishment of a wide TI in safety pharmacology studies...
2016: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/27785516/effect-of-conscious-sedation-vs-general-anesthesia-on-early-neurological-improvement-among-patients-with-ischemic-stroke-undergoing-endovascular-thrombectomy-a-randomized-clinical-trial
#13
Silvia Schönenberger, Lorenz Uhlmann, Werner Hacke, Simon Schieber, Sibu Mundiyanapurath, Jan C Purrucker, Simon Nagel, Christina Klose, Johannes Pfaff, Martin Bendszus, Peter A Ringleb, Meinhard Kieser, Markus A Möhlenbruch, Julian Bösel
Importance: Optimal management of sedation and airway during thrombectomy for acute ischemic stroke is controversial due to lack of evidence from randomized trials. Objective: To assess whether conscious sedation is superior to general anesthesia for early neurological improvement among patients receiving stroke thrombectomy. Design, Setting, and Participants: SIESTA (Sedation vs Intubation for Endovascular Stroke Treatment), a single-center, randomized, parallel-group, open-label treatment trial with blinded outcome evaluation conducted at Heidelberg University Hospital in Germany (April 2014-February 2016) included 150 patients with acute ischemic stroke in the anterior circulation, higher National Institutes of Health Stroke Scale (NIHSS) score (>10), and isolated/combined occlusion at any level of the internal carotid or middle cerebral artery...
November 15, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27767401/-awake-clipping-of-cerebral-aneurysms-report-of-initial-series
#14
Saleem I Abdulrauf, Peter Vuong, Ritesh Patel, Raghu Sampath, Ahmed M Ashour, Lauren M Germany, Jonathon Lebovitz, Colt Brunson, Yuvraj Nijjar, J Kyle Dryden, Maheen Q Khan, Mihaela G Stefan, Evan Wiley, Ryan T Cleary, Connor Reis, Jodi Walsh, Paula Buchanan
OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping...
October 21, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27765304/transcarotid-transcatheter-aortic%C3%A2-valve%C3%A2-replacement-general-or-local-anesthesia
#15
Nicolas Debry, Cédric Delhaye, Alexandre Azmoun, Ramzi Ramadan, Sahbi Fradi, Philippe Brenot, Arnaud Sudre, Mouhamed Djahoum Moussa, Didier Tchetche, Said Ghostine, Darren Mylotte, Thomas Modine
OBJECTIVES: The study sought to assess the safety and efficacy of a minimally invasive strategy (MIS) (local anesthesia and conscious sedation) compared to general anesthesia (GA) among the largest published cohort of patients undergoing transcarotid transcatheter aortic valve replacement (TAVR). BACKGROUND: Transcarotid TAVR has been shown to be feasible and safe. There is, however, no information pertaining to the mode anesthesia in these procedures. METHODS: Between 2009 and 2014, 174 patients underwent transcarotid TAVR at 2 French centers...
October 24, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27751957/repertoire-of-mesoscopic-cortical-activity-is-not-reduced-during-anesthesia
#16
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)...
December 17, 2016: Neuroscience
https://www.readbyqxmd.com/read/27751762/short-term-angiotensin-subtype-1-receptor-blockade-does-not-alter-the-circulatory-responses-to-sympathetic-nervous-system-modulation-in-healthy-volunteers-before-and-during-sevoflurane-anesthesia-results-of-a-pilot-study
#17
Shahbaz R Arain, Julie K Freed, Jutta Novalija, Paul S Pagel, Thomas J Ebert
OBJECTIVE: The mechanism of perioperative hypotension in patients taking an angiotensin-receptor blocker up to the time of surgery remains unclear. This study tested the hypothesis that short-term angiotensin-receptor blocker treatment attenuated the sympathetic and vascular responses to autonomic stimuli in volunteers undergoing anesthesia. DESIGN: Randomized, crossover, blinded, pilot design. SETTING: Zablocki Veterans Affairs Medical Center, Milwaukee, WI...
December 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27747238/inhalation-conscious-sedation-with-nitrous-oxide-and-oxygen-as-alternative-to-general-anesthesia-in-precooperative-fearful-and-disabled-pediatric-dental-patients-a-large-survey-on-688-working-sessions
#18
Angela Galeotti, Annelyse Garret Bernardin, Vincenzo D'Antò, Gianmaria Fabrizio Ferrazzano, Tina Gentile, Valeria Viarani, Giorgio Cassabgi, Tiziana Cantile
Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27746156/cost-analysis-of-iliac-stenting-performed-in-the-operating-room-and-the-catheterization-lab-a-case-control-study
#19
Sooyeon Kim, Sage P Kramer, Adam J Dugan, David J Minion, John C Gurley, Daniel L Davenport, Victor A Ferraris, Sibu P Saha
BACKGROUND: Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations. METHODS: Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures...
October 12, 2016: International Journal of Surgery
https://www.readbyqxmd.com/read/27734209/fatal-complications-following-microvascular-decompression-could-it-be-avoided-and-salvaged
#20
Lei Xia, Ming-Xing Liu, Jun Zhong, Ning-Ning Dou, Bin Li, Hui Sun, Shi-Ting Li
Although the microvascular decompression (MVD) surgery has become an effective remedy for cranial nerve rhizopathies, it is still challengeable and may result in a fatal sequel sometimes. Therefore, the operative skill needs to be further highlighted with emphasis on the safety and a preplan for management of postoperative fatal complications should be established. We retrospectively analyzed 6974 cases of MVD. Postoperatively, 46 patients (0.66 %) presented decline in consciousness with a positive finger-nose test (or failure to be tested) after wake up from the anesthesia, whom were focused on in this study...
October 12, 2016: Neurosurgical Review
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