Long-Term Registration of Cutaneous Microcirculation during General Anesthesia

Abstract BACKGROUND Subcortical mapping of the corticospinal tract has been extensively used during craniotomies under general anesthesia to achieve maximal resection while avoiding postoperative motor deficits. To our knowledge, similar methods to map the thalamocortical tract (TCT) have not yet been developed. OBJECTIVE To describe a neurophysiologic technique for TCT identification in 2 patients who underwent resection of frontoparietal lesions. METHODS The central sulcus (CS) was identified using the somatosensory evoked potentials (SSEP) phase reversal technique. Furthermore, monitoring of the cortical postcentral N20 and precentral P22 potentials was performed during resection. Subcortical electrical stimulation in the resection cavity was done using the multipulse train (case #1) and Penfield (case #2) techniques. RESULTS Subcortical stimulation within the postcentral gyrus (case #1) and in depth of the CS (case #2), resulted in a sudden drop in amplitudes in N20 (case #1) and P22 (case #2), respectively. In both patients, the potentials promptly recovered once the stimulation was stopped. These results led to redirection of the surgical plane with avoidance of damage of thalamocortical input to the primary somatosensory (case #1) and motor regions (case #2). At the end of the resection, there were no significant changes in the median SSEP. Both patients had no new long-term postoperative sensory or motor deficit. CONCLUSION This method allows identification of TCT in craniotomies under general anesthesia. Such input is essential not only for preservation of sensory function but also for feedback modulation of motor activity.

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Impact of Combination Epidural and General Anesthesia on the Long-Term Survival of Gastric Cancer Patients: A Retrospective Study

Medical Science Monitor ◽

10.12659/msm.899543 ◽

2016 ◽

Vol 22 ◽

pp. 2379-2385 ◽

Cited By ~ 10

Author(s):

Jiangling Wang ◽

Wenjing Guo ◽

Qicheng Wu ◽

Runze Zhang ◽

Jun Fang

Keyword(s):

Gastric Cancer ◽

Retrospective Study ◽

General Anesthesia ◽

Cancer Patients ◽

Term Survival ◽

Long Term Survival ◽

Gastric Cancer Patients

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Rolling technique for treatment of left displacement of the large colon in horses: 11 cases (2004-2009)

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/s0102-09352013000200004 ◽

2013 ◽

Vol 65 (2) ◽

pp. 329-334 ◽

Cited By ~ 1

Author(s):

P.A. Canola ◽

J.C. Lacerda Neto ◽

J.C. Canola

Keyword(s):

General Anesthesia ◽

Clinical Case ◽

Clinical Manifestations ◽

The Other ◽

Safe Procedure ◽

Emergency Procedures ◽

Case Selection ◽

Percutaneous Ultrasonography ◽

Rectal Palpation

The left displacement of the large colon, a condition that commonly occurs in horses, has two clinical manifestations. Different treatments including medical treatment, rolling the horse under general anesthesia or surgical correction have been recommended. The diagnosis can often be made by rectal examination and confirmed by percutaneous ultrasonography. During the period between 2004 and 2009, 11 horses were treated for left displacement of the large colon by rolling the horses under general anesthesia, using a slightly different technique than the ones previously described. The clinical case selection was based on rectal palpation confirmed with ultrasonogram. Nine animals were successfully treated and two had to be submitted to surgery after three attempts of rolling. No short or long term complications were observed after the procedure. Only one animal had a recurrence of the clinical manifestation 10 months after the first treatment and was successfully rolled once again. Despite a bit different from the other rolling procedures, this also proved to be an effective procedure. Rolling a horse even when attempted more than once showed to be a safe procedure, however, we reinforce the need for special attention following the procedure in order to establish proper emergency procedures in case complications occur.

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An Investigation of the Long and Short Term Behavioral Effects of General Anesthesia on Pediatric Dental Patients With Autism

Frontiers in Oral Health ◽

10.3389/froh.2021.679946 ◽

2021 ◽

Vol 2 ◽

Author(s):

Janine Tran ◽

Jung-Wei Chen ◽

Larry Trapp ◽

Laura McCormack

Keyword(s):

General Anesthesia ◽

Sleep Disturbances ◽

Activity Level ◽

Behavioral Effects ◽

Healthy Children ◽

Post Discharge ◽

Dental Surgery ◽

Dental Patients ◽

Post Surgery

Purpose: The purpose of this study was to compare the incidence of short and long term adverse behavioral effects of general anesthesia (GA) in healthy vs. moderate to severe autistic (ASD) children.Methods: Forty healthy and 37 ASD children, aged 3–17 years, undergoing GA for dental surgery participated in this study. Their anesthesia records were reviewed, and their parents answered telephone surveys to assess activity level, sleep disturbances, gastrointestinal disturbances, central nervous system effects, and respiratory depression. Three follow-up surveys were taken 8 h, 24 h, and 3 months post-surgery.Results: Four hundred fifty-five incidences of adverse behavioral effects occurred within 8 h post-surgery. Significantly more ASD patients had difficulty walking (P = 0.016) and nausea (P = 0.030), while more healthy children snored in the car ride home (P = 0.036) and talked about the dental surgery (P = 0.027). Three months post-discharge, sixASD patients acted in a way that concerned caregivers compared to 0 healthy patients, (P = 0.008). Incidence of adverse behavioral effects significantly decreased from 8 to 24 h overall.Conclusions: Most behavioral effects occur within 8 h post-surgery. There are potential long term adverse behavioral effects in ASD children from GA, but the chance is low and generally not long lasting.

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Clinical, Surgical Characteristics and Long-Term Outcomes of Lumbar Hernia.

10.21203/rs.3.rs-107783/v1 ◽

2020 ◽

Author(s):

Chaoyong Shen ◽

Guixiang Zhang ◽

Sen Zhang ◽

Yuan Yin ◽

Bo Zhang ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Lumbar Hernia ◽

Consecutive Series ◽

Long Term Outcomes ◽

Anesthesia Group ◽

History Of ◽

Group A ◽

Group B

Abstract Background/AimLumbar hernia is extremely rare which resulting from a defect in the abdominal wall. Due to its rarity, there is no established optimal treatment available for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients in our hospital. MethodsPatients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. ResultsA consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46.4%) and 15 females (53.6%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6±14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39.3%), 15 (53.6%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89.3%) and 3 (10.7%) patients. General anesthesia was applied in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5±1.3 days vs. 7.1±3.2 days, p=0.001), as well as total hospitalization expenses between the two groups (8309.3±1467.1 CNY vs. 19117.3±8116.1 CNY, p<0.001). ConclusionsLumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia, and it may be more suitable than general anesthesia in some selected cases.

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Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia

ScienceOpen Research ◽

10.14293/s2199-1006.1.sor-med.atxb4f.v1 ◽

2014 ◽

Author(s):

Hani Annabi ◽

Charles Fleischer ◽

Robert Taylor ◽

Steven Gruendling ◽

joe pergolizzi ◽

...

Keyword(s):

General Anesthesia ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Anesthetic Technique ◽

Hybrid Technique ◽

Comorbid Conditions ◽

Neurological Assessment ◽

Left Neck ◽

Artery Disease

There is no clear consensus as to the appropriate anesthetic technique for patients undergoing a carotid endarterectomy. Such patients may have comorbid conditions, such as coronary artery disease, hyperlipidemia, and others. The two main anesthetic approaches are general anesthesia, including an endotracheal tube, with neurological monitoring and regional anesthesia that allows for an awake patient to be assessed neurologically. The objective of our study was to evaluate a novel anesthetic technique that combined general anesthesia with a laryngeal mask airway (LMA) plus regional anesthesia in the form of bupivacaine injected into the surgical site. Anesthesia was maintained with desflurane 4%, so the patient emerged rapidly for neurological assessment at the conclusion of surgery. We report on a case of a 55-year-old patient who underwent a successful carotid endarterectomy using this hybrid technique of general anesthesia with LMA plus regional anesthesia. This technique was safe and effective and the patient experienced no complications other than a hematoma on the left neck that was likely the result of long-term use of aspirin and Plavix. While further study is warranted, this hybrid technique of general anesthesia with LMA plus regional anesthesia holds promise for carotid endarterectomy patients.

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Intraoperative Awareness

Anesthesiology: A Problem-Based Learning Approach ◽

10.1093/med/9780190850692.003.0050 ◽

2018 ◽

pp. 443-446

Author(s):

Jennifer Knuth ◽

Lindsay Gennari ◽

John Cagino

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Trauma Surgery ◽

Rare Event ◽

General Anesthetic ◽

Intraoperative Awareness ◽

Patient Reports ◽

Increased Risk ◽

Patient’S Outcome

Awareness following general anesthesia is a rare event; however, it may have significant impact on patient satisfaction and long-term morbidity. Detecting intraoperative awareness during a general anesthetic is difficult due to the fact that the signs and symptoms are often absent in documented cases of awareness. Often, intraoperative awareness goes unnoticed until a patient reports the experience. Anesthesiologists should be cognizant of the risk factors associated with an increased risk of intraoperative awareness. Cesarean section performed under general anesthesia, cardiac surgery, and trauma surgery all carry an increased risk. Anesthesiologists should consider patient specific risk factors involving a higher than expected anesthetic requirement in developing their anesthetic plan. In the event of intraoperative awareness, the anesthesiologist’s actions and interactions with the patient are critical in improving the patient’s’ outcome and minimizing long-term psychological stress. Anesthesiologists should acknowledge the event and create a supportive relationship with the patient.

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