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Latest & greatest articles for anaesthesia
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Clinical Anaesthesia is used to induce a temporary medical state of controlled unconsciousness, inducing a loss of sensation or awareness. There are three main types of Anaesthesia:
Local and Regional
Anaesthesia is primarily used during surgical procedures to block pain. While unconscious, blood flow and heart rate is monitored.
Research and development in the use of Anaesthesia has helped anesthesiologists in the progression of patient safety before and after surgery and medical procedures. The developments and research of Anaesthesia through the years has massively influences medicine and surgery today.
Case studies and clinical trials help aid researchers in the development of aftercare during postoperative recovery. Research is a vital part in the field of Anaesthesia, it allows anesthesiologists to improve the delivery of patient safety while unconscious.
Learn more on the emerging technology in Anaesthesia and the advancements in Anaesthesia practise by searching Trip.
Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia Cancer-related mortality, a leading cause of death worldwide, is often the result of metastatic disease recurrence. Anesthetic techniques have varying effects on innate and cellular immunity, activation of adrenergic-inflammatory pathways, and activation of cancer-promoting cellular signaling pathways; these effects may translate into an influence of anesthetic technique on long-term cancer (...) outcomes. To further analyze the effects of propofol (intravenous) and volatile (inhalational gas) anesthesia on cancer recurrence and survival, we undertook a systematic review with meta-analysis.Databases were searched up to 14 November 2018. Comparative studies examining the effect of inhalational volatile anesthesia and propofol-based total intravenous anesthesia (TIVA) on cancer outcomes were included. The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Reported
Exploring the Role of Regional Anesthesia in the Treatment of the Burn-injured Patient: A Narrative Review of Current Literature The review article was designed to assess the effectiveness of regional anesthesia (RA), specifically peripheral nerve blocks, in the treatment of burn pain; with noting of clinical indications and contraindications for peripheral nerve block application, along with discussion of evidence-based analgesic strategies for providing improved, comprehensive burn pain (...) outcomes and reduce the adverse effects associated with general anesthetic. RA presents a safe and effective intervention for acute pain resulting from burn-acquired injury. This review of current literature supports the use of RA as a treatment to manage pain associated with burn-related care procedures as an addition to multimodal pain treatment. To date there is limited evidence showing the use of RA in the burns' patient population. In addition, there appear to be no particular risks to using
Nociception-guided versus Standard Care during Remifentanil-Propofol Anesthesia: A Randomized Controlled Trial The multidimensional index of nociception, the nociception level, outperforms blood pressure and heart rate in detection of nociceptive events during anesthesia. We hypothesized that nociception level-guided analgesia reduces opioid consumption and suboptimal anesthesia events such as low blood pressure and use of vasoactive medication.In this single-blinded randomized study, 80 (...) American Society of Anesthesiologists class I-III adult patients of either sex, scheduled for major abdominal procedures under remifentanil/propofol anesthesia by target-controlled infusion, were included. During the procedure nociception level, noninvasive blood pressure, and heart rate were monitored. Patients were randomized to receive standard clinical care or nociception level-guided analgesia. In the nociception level-guided group, remifentanil concentration was reduced when index values were
Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery. Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (...) (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary
Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits (...) herniorrhaphy, without previous exposure to general anaesthesia or risk factors for neurological injury. Patients were randomly assigned (1:1) by use of a web-based randomisation service to receive either awake-regional anaesthetic or sevoflurane-based general anaesthetic. Anaesthetists were aware of group allocation, but individuals administering the neurodevelopmental assessments were not. Parents were informed of their infants group allocation upon request, but were told to mask this information from
2019LancetControlled trial quality: predicted high
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures
Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial Diaphragmatic paralysis following supraclavicular brachial plexus block (SCBPB) is ascribed to phrenic nerve palsy. This study investigated the effect of 2 volumes of 0.375% ropivacaine on efficacy of block as a surgical anesthetic and as an analgesic and examined diaphragm compound (...) muscle action potentials (CMAPs) and pulmonary function before and after SCBPB.Eighty patients scheduled for removal of hardware for internal fixation after healing of an upper limb fracture distal to the shoulder were randomized to receive ultrasound-guided SCBPC for surgical anesthesia with 20 mL (Group A) or 30 mL (Group B) 0.375% ropivacaine. The latency and amplitude of diaphragm CMAPs and forced vital capacity (FVC), FVC% predicted, and forced expiratory volume in 1 s (FEV1) were measured
Epidural anaesthesia helps return of bowel function after abdominal surgery Epidural anaesthesia helps return of bowel function after abdominal surgery Discover Portal Discover Portal Epidural anaesthesia helps return of bowel function after abdominal surgery Published on 27 September 2016 doi: High quality evidence suggests that an epidural anaesthetic (with or without an opioid) promotes the return of gut function after abdominal surgery. This is when compared to an opioid based regimen (...) and may reduce the need for opioids. This updated Cochrane review compared the effects of giving an epidural anaesthetic with giving opioids after abdominal surgery. Opioids could either be injected directly into the bloodstream or given through an epidural. What did this study do? The review pooled the results of 94 randomised controlled trials including 5,846 adults undergoing any form of abdominal surgery under general anaesthesia. Treatment groups received an epidural containing local anaesthetic
group versus 32% inhalation anaesthetic plus antiemetic group (risk ratio 0.99, 95% CI 0.77 to 1.27; 4 trials, 558 children). A similar amount of time was spent in the post-anaesthesia unit (mean difference ‑8.93 minutes, 95% CI ‑22.0 to 4.18). No other adverse events were reported in the trials. What does current guidance say on this issue? The Association of Paediatric Anaesthetists of Great Britain & Ireland (2016) suggest intravenous anaesthesia is considered in children at high risk of sickness (...) with anti-sickness medication in children has the same risk of vomiting as intravenous anaesthesia, although giving anti-sickness medication with an intravenous anaesthetic, or using more than one anti-sickness medication in either group, may further reduce the risk of vomiting. Squint surgery has one of the highest rates of post-operative vomiting – on average 59% without any preventive treatment. It remains unclear if similar results would be found for other types of surgery. Although the studies
reduce the frequency and severity of injection pain. The intravenous anaesthetic propofol is used at the start of almost all general anaesthetics in the UK but it does often cause unpleasant pain when it is injected. This review of trials looked for trials of any drug in the group of commonly-used anti-sickness drugs called 5HT3 receptor antagonists. Ondansetron, one of these drugs, is often used during anaesthesia to reduce nausea and vomiting after waking, but is usually given after the anaesthetic (...) Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first Discover Portal Discover Portal Pain on injection of a widely used anaesthetic may be reduced if a common anti-sickness drug is given first Published on 7 June 2016 doi: This review found that giving an anti-sickness drug, like ondansetron, before propofol, an anaesthetic, helped
local anaesthetic 12.6% (36/286) had failed fistulas compared to 4.1% (12/286) for those having a regional anaesthetic (odds ratio 0.28, 95% confidence interval 0.14 to 0.57). Complications of anaesthesia did not occur in one study, and were not reported in two studies. What does current guidance say on this issue? No relevant guidance is available on which anaesthetic to use when creating an arteriovenous fistula. What are the implications? These results show that different anaesthetic choices (...) and dose of drugs varied between studies. What did it find? Having a regional anaesthetic reduced the risk of the fistula failing by 72%. In those who had local anaesthetic 12.6% (36/286) had failed fistulas compared to 4.1% (12/286) for those having a regional anaesthetic (odds ratio 0.28, 95% confidence interval 0.14 to 0.57). Complications of anaesthesia did not occur in one study, and were not reported in two studies. What does current guidance say on this issue? No relevant guidance is available
an artificial joint. Nearly 200,000 hip or knee replacements were performed in 2013/2014 in England. These operations can be performed under general or neuraxial anaesthesia but there is little conclusive evidence as to which technique is safer, more effective or less expensive. General anaesthesia renders the patient unconscious. Pain is managed with drugs such as morphine during and after the surgery. Neuraxial anaesthesia (spinal or epidural anaesthesia) involves administering a local anaesthetic around (...) the individual may have. What are the implications? Neuraxial anaesthesia and general anaesthesia are each safe for total knee and/or hip operations. Neuraxial anaesthesia may reduce the time the patient needs to stay in hospital, which may reduce costs. This review did not examine self-limiting but common side effects of general anaesthesia, such as sore throat, drowsiness or breathing difficulties, which may be a consideration when patients are choosing an anaesthetic. Other outcomes that were
Onset Time of Local Anesthesia After Single Injection in Toe Nerve Blocks: A Randomized Double-Blind Trial. The study was conducted to investigate the onset time and safety profile of four different local anesthetic solutions.Randomized controlled clinical trial study.One hundred twelve healthy volunteers were assigned to receive digital block on their second toe. Individuals were randomly assigned to one of the following groups: lidocaine 2%, lidocaine 2% with epinephrine, bupivacaine 0.5 (...) %, or bupivacaine 0.5% with epinephrine. Onset time was measured until detecting the absence of pinprick sensation. Oxygen saturation was measured in the infiltrated toe up to 60 minutes.The subjects in the groups of anesthetics with epinephrine had a significantly lower mean onset time. There were no significant differences regarding oxygen saturation between the groups and no adverse effects were recorded.The use of anesthetics with epinephrine can be an effective form of local anesthetic for digital blocks
Preoperative Blindfold Training Prevents Pediatric Psychological Behavior Disorders During the Anesthesia Recovery Period: A Randomized Controlled Trial. To identify the effectiveness and feasibility of blindfold training on preventing pediatric psychological behavior disorders during the anesthesia recovery period.This study investigated the effect of blindfold training through the assessment of anxiety, delirium, and pain in children during the anesthesia recovery period.This study (...) was a prospective, randomized, controlled trial. Pediatric patients were randomized into either a control (routine practice) or blindfold training group (routine practice + blindfold training). Anxiety, delirium, and pain levels of children were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium scale, and the Face, Legs, Activity, Cry, Consolability scale.The blindfold training group had significantly lower scores for emergence delirium, anxiety, and pain during
Effect of Benson Relaxation on the Intensity of Spinal Anesthesia-Induced Pain After Elective General and Urologic Surgery. The present study aimed to evaluate the effect of Benson's muscle relaxation on postoperative spinal anesthesia-induced pain.Randomized clinical trial.Sixty-four patients were randomly assigned to intervention and control groups. Benson's muscle relaxation was performed on the intervention group for 10 to 20 minutes based on the patients' tolerance. Before and after (...) the intervention, the two groups were assessed using the visual analog scale and compared. SPSS version 23 was used to analyze data.The mean pain score in the control group before and after the intervention was 5.34 and 5.62, respectively (P < .003), and in the intervention group, 5.28 and 4.03, respectively (P < .001).Benson's relaxation technique effectively influenced the intensity of postoperative spinal anesthesia-induced pain. Therefore, it can be used by nurses as a safe, simple, and inexpensive
Bupivacaine vs. Pethidine in Spinal Anesthesia of Old Patients: Haemodynamic Changes and Complications. Organ changes during the aging are one of the signifi cant events in old patients. rthopedic surgeries are common operations in these patients that accompany with hemodynamic changes as blood pressure decrease, heart rate, and respiratory rate change. On the other hand, pain management of the ancient patients due to negative consequences as tachycardia, blood pressure increase, and myocardial (...) posture by Quincke spinal needle 24 gauge, 12.5 mg of bupivacaine 0.5% (2.5 mL) injected in the subarachnoid space between L2-L3 or L3-L4. In the second group, in a same posture by applying the same spinal needle 24 gauge, 1 mg/kg of preservative-free pethidine injected in the subarachnoid space between L2-L3 or L3-L4. The patients evaluated for duration of anesthesia and analgesia, hemodynamic changes and complications such as headache, pruritus, shivering, urinary retention, and respiratory
no. SC040697). Association of Anaesthetists | The Anaesthesia Team 3 Contents 1. Recommendations 4 2. Introduction 4 3. Organisation and management 5 4. Pre-operative assessment 6 5. The operating department 7 6. The role of ‘anaesthetic assistant’ 8 7. Recovery in the post-anaesthetic care unit (PACU) 10 8. Postoperative pain management 10 9. References 11 To be reviewed by 2023 This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivs 4.0 International License CC BY-NC-ND4 (...) Association of Anaesthetists | The Anaesthesia Team Association of Anaesthetists | The Anaesthesia Team 5 1. Recommendations • Anaesthetic care within the peri-operative pathway can only be provided by an anaesthesia team led by consultant anaesthetists. All members of the team should be trained to nationally agreed standards. • Effective pre-operative assessment of patients for anaesthesia and surgery is vital. It improves safety, reduces cancellations, promotes efficient bed usage and can allay patients
Transversus abdominis plane block under laparoscopic guide versus port-site local anaesthetic infiltration in laparoscopic excision of endometriosis: a double-blind randomised placebo-controlled trial To compare the efficiency of laparoscopically guided transversus abdominis plane block (LTAP) versus port-site local anaesthetic infiltration (LAI) in reducing postoperative pain following laparoscopic excision of endometriosis.A prospective, double-blind randomised controlled trial.A tertiary
Liposomal Bupivacaine Versus Standard Periarticular Injection in Total Knee Arthroplasty With Regional Anesthesia: A Prospective Randomized Controlled Trial Liposomal bupivacaine (Exparel) is a long-acting local anesthetic preparation with demonstrated efficacy over placebo in reducing postoperative pain and opioid requirement. Limited comparative efficacy and cost-effectiveness data exist for its use in total knee arthroplasty (TKA) when used in a multimodal, opioid-sparing analgesic (...) and anesthetic approach. We hypothesized that liposomal bupivacaine offers no clinical advantage over our standard of care but carries significant economic impact.This is a prospective, randomized, single-blinded, controlled trial comparing liposomal bupivacaine periarticular injection (PAI) to our current approach including conventional bupivacaine PAI, in the setting of regional anesthesia. All adult unilateral TKA patients of the collaborating surgeon were eligible to participate in the study. Patients