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https://www.readbyqxmd.com/read/29772562/using-neuroimaging-to-uncover-awareness-in-brain-injured-and-anesthetized-patients
#1
Mackenzie Graham, Adrian M Owen, Charles Weijer, Lorina Naci
We cast a novel perspective on two distinct populations: patients who become accidentally intraoperatively aware after receiving general anesthesia and severely brain-injured patients who are diagnosed as being in a vegetative state. In both cases, patients are behaviorally non-responsive -and on this basis presumed to lack consciousness- yet, retain covert awareness. In both contexts, detecting consciousness is highly challenging, yet highly important for ensuring adequate patient care. Although great strides have been made in the development of depth-of-anesthesia monitors, these monitors have significant limitations...
June 1, 2018: Frontiers in Bioscience (Scholar Edition)
https://www.readbyqxmd.com/read/29766368/systemic-contact-dermatitis
#2
REVIEW
Marcella Aquino, Greg Rosner
Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications...
May 15, 2018: Clinical Reviews in Allergy & Immunology
https://www.readbyqxmd.com/read/29761788/block-based-robust-control-of-stepping-using-intraspinal-microstimulation
#3
Ehsan Rouhani, Abbas Erfanian
OBJECTIVE: The problem of motor control using intraspinal microstimulation (ISMS) can be approached at two levels of the motor system: individual muscles (motor pools) and motor primitives. The major challenges of direct ISMS at the level of individual muscle are the number of electrodes that are required to be implanted in order to recruit all muscles involving the motion and the muscle selectivity. One solution to cope with these problems is the control of movement generated by appropriate combination of the movement primitives...
May 15, 2018: Journal of Neural Engineering
https://www.readbyqxmd.com/read/29757793/technique-utilizing-a-modified-oral-ring-adair-elwyn-tube-to-provide-continuous-oxygen-and-sevoflurane-delivery-during-nasotracheal-intubation-in-an-infant-with-a-difficult-airway-a-case-report
#4
Janice Y Man, John E Fiadjoe, Grace Hsu
Managing the airway of an infant with Pierre Robin sequence (PRS) is particularly challenging for anesthesiologists. Patients with PRS have the triad of micrognathia, glossoptosis, and airway obstruction that potentially and frequently leads to difficulty with both ventilation and intubation. Thus continuous oxygenation and spontaneous ventilation during intubation are essential. We describe a new method to deliver continuous oxygen and volatile anesthetic during nasotracheal intubation in an infant with PRS...
May 15, 2018: A&A practice
https://www.readbyqxmd.com/read/29728269/mechanics-of-anesthetic-needle-penetration-into-human-sciatic-nerve
#5
Joseph E Pichamuthu, Spandan Maiti, Maria G Gan, Nicole M Verdecchia, Steven L Orebaugh, David A Vorp
Nerve blocks are frequently performed by anesthesiologists to control pain. For sciatic nerve blocks, the optimal placement of the needle tip between its paraneural sheath and epineurial covering is challenging, even under ultrasound guidance, and frequently results in nerve puncture. We performed needle penetration tests on cadaveric isolated paraneural sheath (IPS), isolated nerve (IN), and the nerve with overlying paraneural sheath (NPS), and quantified puncture force requirement and fracture toughness of these specimens to assess their role in determining the clinical risk of nerve puncture...
April 25, 2018: Journal of Biomechanics
https://www.readbyqxmd.com/read/29728240/adaptive-median-binary-patterns-for-fully-automatic-nerves-tracking-in-ultrasound-images
#6
Mohammad Alkhatib, Adel Hafiane, Omar Tahri, Pierre Vieyres, Alain Delbos
BACKGROUND AND OBJECTIVE: In the last decade, Ultrasound-Guided Regional Anesthesia (UGRA) gained importance in surgical procedures and pain management, due to its ability to perform target delivery of local anesthetics under direct sonographic visualization. However, practicing UGRA can be challenging, since it requires high skilled and experienced operator. Among the difficult task that the operator can face, is the tracking of the nerve structure in ultrasound images. Tracking task in US images is very challenging due to the noise and other artifacts...
July 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29704203/safety-and-efficacy-of-synchronous-robotic-surgery-for-colorectal-cancer-with-liver-metastases
#7
REVIEW
Rozana H Dwyer, Matthew J Scheidt, J Stephen Marshall, Steven S Tsoraides
Timing of resection and treatment of colorectal cancer (CRC) with liver metastases varies based on patient characteristics and center protocols. Concerns of increased morbidity and mortality (M&M) related to anesthetic time and blood loss have limited widespread adaptation of synchronous colorectal and liver resections. Furthermore, technical challenges have made minimally invasive synchronous resections less common. We present our series of synchronous robotic surgery for CRC with liver metastases. Retrospective review of prospectively collected data of patients with stage IV CRC with liver metastases treated at a tertiary center from February 2013 to June 2014...
April 27, 2018: Journal of Robotic Surgery
https://www.readbyqxmd.com/read/29697466/perioperative-considerations-for-airway-management-and-drug-dosing-in-obese-children
#8
Jerrold Lerman, Karin Becke
PURPOSE OF REVIEW: Childhood obesity, a phenomenon that is increasing globally, holds substantial relevance for pediatric anesthesia. In particular, understanding the nuances of airway management and drug dosing in obese children can be daunting. RECENT FINDINGS: Respiratory adverse events and challenges in managing the airway may be anticipated. In addition, drug-dosing strategies for the obese child are complex and poorly understood although recent advances have clarified the optimal dosing for anesthetics in these children...
June 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29694305/the-use-of-local-anesthesia-to-perform-lower-limb-revascularization-in-the-fragile-patient-with-critical-limb-ischemia
#9
N Kontopodis, A Papaioannou, E Tavlas, G Papadopoulos, S Lioudaki, K Tzirakis, C V Ioannou
Patients with critical limb ischemia are usually compromised, frequently making administration of general or regional anesthesia problematic. We treated 3 fragile patients presenting contraindications to undertake traditional anesthetic techniques for lower limb revascularization, in whom local anesthesia with conscious sedation was used to complete the operation. An axillo-bifemoral, a unilateral axillo-femoral and a femoro-femoral bypass were performed. Procedure was uneventful in all three cases despite the coexistence of specific surgical challenges (distal anastomosis at the profunda in two cases, redo surgery and scarred groin in the third)...
March 2018: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/29688922/the-use-of-high-frequency-percussive-ventilation-for-whole-lung-lavage-a-case-report
#10
Sudhakar Kinthala, Mark Liang, Felix Khusid, Sebron Harrison
Whole-lung lavage (WLL) remains the gold standard in the treatment of pulmonary alveolar proteinosis. However, anesthetic management during WLL can be challenging because of the risk of intraoperative hypoxemia and various cardiorespiratory complications of 1-lung ventilation. Here, we describe a novel strategy involving the application of high-frequency percussive ventilation using a volumetric diffusive respirator (VDR-4) during WLL in a 47-year-old woman with pulmonary alveolar proteinosis. Our observations suggest that high-frequency percussive ventilation is a potentially effective ventilation strategy during WLL that may reduce the risk of hypoxemia and facilitate lavage...
April 23, 2018: A&A practice
https://www.readbyqxmd.com/read/29687529/lymphatic-imaging-and-intervention-in-a-pediatric-population-anesthetic-considerations
#11
David R Jobes, Lauren A Brown, Yoav Dori, Maxim Itkin, Susan C Nicolson
The recent adoption of an improved lymphatic access technique coupled with Dynamic Contrast-enhanced Magnetic Resonance Lymphangiography has introduced the ability to diagnose and treat severe lymphatic disorders unresponsive to other therapies. All pediatric patients presenting for lymphatic procedures require general anesthesia presenting challenges in managing highly morbid and comorbid conditions both from logistical as well as medical aspects. General anesthesia is used because of the procedural requirement for immobility to accurately place needles and catheters, treat pain secondary to contrast and glue injections, and to accommodate additional procedures...
April 23, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29673531/using-positron-emission-tomography-in-revealing-the-mystery-of-general-anesthesia-study-design-challenges-and-opportunities
#12
Harry Scheinin, Emilee C Alkire, Annalotta Scheinin, Michael T Alkire, Oskari Kantonen, Jaakko Långsjö
Functional neuroimaging with positron emission tomography (PET) is one of the cornerstones for studying the central nervous system effects of general anesthetics and anesthesia mechanisms. General anesthesia offers a unique and safe way to directly manipulate consciousness, and can thus be used as a powerful research tool to study the neurobiology of human consciousness. In this chapter, we will address the possibilities of PET imaging in revealing the mysteries of general anesthesia and anesthetic induced unconsciousness and summarize some of the recent advancements in the field...
2018: Methods in Enzymology
https://www.readbyqxmd.com/read/29666797/development-and-implementation-of-a-perianesthetic-safety-checklist-in-a-veterinary-university-small-animal-teaching-hospital
#13
Gwennaëlle Menoud, Shannon Axiak Flammer, Claudia Spadavecchia, Mathieu Raillard
Introduction: The use of a surgical safety checklist is recommended by the World Health Organization and is associated with advantages: improved communication and reduced complications and mortality. Adapting checklists to the environment in which they are used improves their efficiency, but their implementation can be challenging. The aim of this study was to develop and implement a perianesthetic safety checklist for a small animal hospital. Materials and methods: A panel of eight anesthesia diplomates and seven residents and doctoral students were gathered...
2018: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/29666709/anesthetic-considerations-for-an-adult-patient-with-freeman-sheldon-syndrome-undergoing-open-heart-surgery
#14
S Viehmeyer, P Gabriel, K Bauer, S Bauer, R Sodian, J N Hilberath
Freeman-Sheldon syndrome (FSS) or "whistling face" syndrome is a rare congenital disorder complicated by characteristic facial deformities and muscular contractures. We report on a 64-year-old male patient presenting for surgical replacement of his aortic valve and review the available literature on anesthetic considerations and perioperative management principles. FSS frequently poses a significant challenge to airway management and gaining vascular access. Moreover, these patients are reportedly at risk for developing malignant hyperthermia (MH) or neuroleptic malignant syndrome...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29655774/twenty-years-experience-with-anaphylaxis-like-reactions-to-local-anesthetics-genuine-allergy-is-rare
#15
Axel Trautmann, Matthias Goebeler, Johanna Stoevesandt
BACKGROUND: Anaphylaxis-like reactions occur within minutes after application of local anesthetics (LA), most commonly during dental interventions. Impressive symptoms including respiratory distress or loss of consciousness frequently give rise to a suspicion of allergy and may prompt patients and treating physicians to refuse future LA injections. OBJECTIVE: Non-allergic mechanisms are responsible for the majority of LA-induced immediate-type reactions. In view of the preponderance of non-allergic reactions, the question arises whether genuine LA allergy may be missed during routine testing procedures...
April 12, 2018: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/29652286/anesthetic-challenges-of-a-patient-with-the-communicating-bulla-coming-for-nonthoracic-surgery
#16
Bernice Theodare, Vinolia Victory Nissy, Raj Sahajanandan, Ramamani Mariappan
Management of a patient with a giant bulla coming for a nonthoracic surgery is rare, and its anesthetic management is very challenging. It is imperative to isolate only the subsegmental bronchus, in which the bulla communicates to avoid respiratory morbidities such as pneumothorax, emphysema or atelectasis of the surrounding lung parenchyma, and postoperative respiratory failure. Herewith, we want to report the anesthetic challenges of a patient with giant bulla communicating into one of the subsegmental right upper lobe bronchus for splenectomy...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29652270/pulmonary-hypertension-and-cardiac-anesthesia-anesthesiologist-s-perspective
#17
REVIEW
Manjula Sudeep Sarkar, Pushkar M Desai
Perioperative management of pulmonary hypertension remains one of the most challenging scenarios during cardiac surgery. It is associated with high morbidity and mortality due to right ventricular failure, arrhythmias, myocardial ischemia, and intractable hypoxia. Therefore, this review article is intended toward the anesthetic considerations in the perioperative period, with particular emphasis on the selection of technique and choice of anesthesia with maintenance, anesthetic drugs, and the recent intraoperative recommendations for prevention and treatment of pulmonary hypertensive crisis...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29651134/endothelial-cell-phenotypes-are-maintained-during-angiogenesis-in-cultured-microvascular-networks
#18
Jessica M Motherwell, Christopher R Anderson, Walter L Murfee
A challenge in tissue engineering biomimetic models for studying angiogenesis is building the physiological complexity of real microvascular networks. Our laboratory recently introduced the rat mesentery culture model as an ex vivo experimental platform for investigating multicellular dynamics involved in angiogenesis within intact microvascular networks. The objective of this study was to compare endothelial cell phenotypes along capillary sprouts in cultured ex vivo rat mesentery microvascular networks to in vivo endothelial cell phenotypes...
April 12, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29643644/a-case-of-gorhams-syndrome-an-anesthetic-challenge
#19
Supriya Lynette Dsouza, Adarsh Kulkarni, Hashim Sageer, Naveen Pajai, Nirav Kotak
No abstract text is available yet for this article.
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29643641/pierre-robin-sequence-with-cervicothoracic-kyphoscoliosis-an-anesthetic-challenge
#20
V Abraham, S Grewal, G Bhatia, N Kaur, W Raghav, P Jain, N Gupta, M Singh, C George
No abstract text is available yet for this article.
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
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