Anesthetic Principles

2020 ◽  
Author(s):  
Britlyn D. Orgill ◽  
Douglas L. Helm
Keyword(s):  
General Anesthesia ◽  
Local Anesthetic ◽  
Enhanced Recovery ◽  
Physical Status ◽  
Preoperative Risk ◽  
Nerve Blocks ◽  
Surgical Emergencies ◽  
Post Operative Pain ◽  
Joint Decisions ◽  
Selection Of

Advances in anesthesia have expanded the field of plastic surgery by allowing more procedures to be done, while also increasing the safety of the patient. Anesthesia is a spectrum ranging from local anesthetic injected by the surgeon, to regional and neuraxial blocks or general anesthesia with an anesthesia team. Anesthesiologists work with the surgeon to assess a patient’s preoperative risk and make joint decisions to determine if additional medical optimization is needed prior to surgery. New peripheral blocks allow alternatives to general anesthesia or serve as adjuncts to improve post-operative pain. Selection of drugs used to induce and maintain anesthesia are changing with the advent of Enhanced Recovery After Surgery Protocols and emphasis on decreasing opioids. Teamwork and excellent communication are imperative to navigate anesthetic and surgical emergencies.  This review contains 3 figures, 4 tables, and 29 references. Keywords: sedation, general anesthesia, regional anesthesia, peripheral nerve blocks, local anesthetic toxicity syndrome, ASA physical status, preoperative fasting guidelines, opioids, multi-modal analgesia, ERAS, crisis checklists

scholarly journals Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ariel Clare Johnson ◽  
Salih Colakoglu ◽  
Angela Reddy ◽  
Clara Marie Kerwin ◽  
Roland A Flores ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Enhanced Recovery ◽  
Anesthetic Technique ◽  
Single Shot ◽  
Nerve Blocks ◽  
Reconstruction Surgery ◽  
Opioid Medications

Context: High rates of mortality and chemical dependence occur following the overuse of narcotic medications, and the prescription of these medications has become a central discussion in health care. Efforts to curtail opioid prescribing include Enhanced Recovery After Surgery (ERAS) guidelines, which describe local anesthesia techniques to decrease or eliminate the need for opioids when used in a comprehensive protocol. Here, we review effective perioperative blocks for the decreased use of opioid medications post-breast reconstruction surgery. Evidence Acquisition: A comprehensive review was conducted using keywords narcotics, opioid, surgery, breast reconstruction, pain pump, nerve block, regional anesthesia, and analgesia. Papers that described a local anesthetic option for breast reconstruction for decreasing postoperative narcotic consumption, written in English, were included. Results: A total of 52 papers were included in this review. Local anesthetic options included single-shot nerve blocks, nerve block catheters, and local and regional anesthesia. Most papers reported equal or even superior pain control with decreased nausea and vomiting, length of hospital stay, and other outcomes. Conclusions: Though opioid medications are currently the gold standard medication for pain management following surgery, strategies to decrease the dose or number of opioids prescribed may lead to better patient outcomes. The use of a local anesthetic technique has been shown to reduce narcotic use and improve patients’ pain scores after breast reconstruction surgery.

scholarly journals Subparaneural injection in popliteal sciatic nerve blocks evaluated by MRI

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 346-353
Author(s):  
Benedikt Büttner ◽  
Alexander Schwarz ◽  
Caspar Mewes ◽  
Katalin Kristof ◽  
José Hinz ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Resonance Imaging ◽  
Nerve Blocks ◽  
Cross Sectional ◽  
Neurological Sequelae ◽  
Patient Reported ◽  
Study Population ◽  
Intraneural Injection

AbstractIntraneural injection of a local anesthetic can damage the nerve, yet it occurs frequently during distal sciatic block with no neurological sequelae. This has led to a controversy about the optimal needle tip placement that results from the particular anatomy of the sciatic nerve with its paraneural sheath.The study population included patients undergoing lower extremity surgery under popliteal sciatic nerve block. Ultrasound-guidance was used to position the needle tip subparaneurally and to monitor the injection of the local anesthetic. Sonography and magnetic resonance imaging were used to assess the extent of the subparaneural injection.Twenty-two patients participated. The median sciatic cross-sectional area increased from 57.8 mm2 pre-block to 110.8 mm2 immediately post-block. An intraneural injection according to the current definition was seen in 21 patients. Two patients had sonographic evidence of an intrafascicular injection, which was confirmed by MRI in one patient (the other patient refused further examinations). No patient reported any neurological symptoms.A subparaneural injection in the popliteal segment of the distal sciatic nerve is actually rarely intraneural, i.e. intrafascicular. This may explain the discrepancy between the conventional sonographic evidence of an intraneural injection and the lack of neurological sequelae.

scholarly journals Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Si Chen ◽  
Yuelun Zhang ◽  
Lu Che ◽  
Le Shen ◽  
Yuguang Huang
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Case Control Study ◽  
Case Control ◽  
Airway Compromise ◽  
Physical Status ◽  
Fluid Load ◽  
High Fluid ◽  
Head Neck ◽  
Control Study

Abstract Background This study aimed to identify the risk factors and evaluate the prognosis of unplanned reintubation caused by acute airway compromise (AAC) after general anesthesia. Methods This case-control study included surgical patients who underwent unplanned reintubation in the operating room and postanesthesia care unit after general anesthesia between January 1, 2014, and December 31, 2018. Cases due to AAC were matched 1:4 with randomly selected controls. Results A total of 123,068 patients were included, and reintubation due to AAC was performed in 36 patients (approximate incidence 0.03%). Univariable analysis revealed that male sex, age > 65, ASA physical status 3, sepsis, heart disease history, cerebral infarction history, Cormack Lehane grade, surgery type, fresh frozen plasma infusion, increased intubation duration, white blood cell count, and creatinine clearance rate were related to AAC-caused unplanned reintubation. Multivariable analysis revealed that age > 65 (OR = 7.50, 95% CI 2.47–22.81, P < 0.001), ASA physical status 3 (OR = 6.51, 95% CI 1.18–35.92, P = 0.032), head-neck surgery (OR = 4.94, 95% CI 1.33–18.36, P = 0.017) or thoracic surgery (OR = 12.56, 95% CI 2.93–53.90, P < 0.001) and a high fluid load (OR = 3.04, 95% CI 1.16–7.99, P = 0.024) were associated with AAC-caused unplanned reintubation. AAC-caused unplanned reintubation patients had longer postoperative hospital (OR = 5.26, 95% CI 1.57–8.95, P < 0.001) and intensive care unit days (OR = 3.94, 95% CI 1.69–6.18, P < 0.001). Conclusions Age > 65, ASA physical status 3, head-neck or thoracic surgery and high fluid load were found to be associated with AAC-caused unplanned reintubation.

scholarly journals The Effects of Local Anesthetic Concentration and Dose on Continuous Infraclavicular Nerve Blocks: A Multicenter, Randomized, Observer-Masked, Controlled Study

2009 ◽  
Vol 108 (1) ◽  
pp. 345-350 ◽  
Author(s):  
Brian M. Ilfeld ◽  
Linda T. Le ◽  
Joanne Ramjohn ◽  
Vanessa J. Loland ◽  
Anupama N. Wadhwa ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Controlled Study ◽  
Nerve Blocks ◽  
Anesthetic Concentration

Comparing General Anesthesia with Preemptive IV Atropine vs General Anesthesia with Single Injection Peribulbar Block with Levobupivacaine 0.5% or Lidocaine 2% for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery: Randomized Control Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hani Ali Ezzat ◽  
Galal Adel ElKady ◽  
Melad Ragaey Zekry ◽  
Dalia Ahmed Ibrahim ◽  
Abeer Sameer Salem
Keyword(s):  
General Anesthesia ◽  
General Anaesthesia ◽  
Pain Control ◽  
Strabismus Surgery ◽  
Minor Role ◽  
Oculocardiac Reflex ◽  
Post Operative Pain ◽  
Peribulbar Block ◽  
Successful Group ◽  
Clinically Significant

Abstract Background Strabismus is one of the common health problems among the children. The incidence of the oculocardiac reflex decreases with age and tends to be more pronounced in young, healthy patients, which is clinically significant for pediatric as it is observed with greatest incidence in young healthy neonates and infants undergoing strabismus surgery. Objective to prevent and attenuate the oculocardiac reflex in children age group from (2yrs to 14 yrs) undergoing surgical correction for strabismus. Patients and Methods Three groups were allocated Group C received general anaesthesia combined with pre emptive atropine, Group L received general anaesthesia combined with Peribulbar block with Lidocaine 2 % and Group LB which received general anaesthesia combined with peribulbar block with Levobupivacaine 0.5%. Results In Our study we found that group L which received peribulbar lidocaine 2 % was the most successful group regarding blocking the occurrence of the OCR and with acceptable post operative pain control results. Conclusion In Our study the use of peribulbar block with lidocaine 2 % in combinations with General anaesthesia is very effective against the incidence of OCR in children undergoing strabismus surgery and superior to the Iv pre emptive Atropine with higher surgeon satisfaction while the use of peribulbar levobupivacaine 0.5% combined with general anaesthesia has a great role in post operative pain control with superior patient satisfaction, on the other hand the atropine is a very important emergency drug but our study found that it has a very minor role in both preventing the OCR and post operative pain control in addition to subjecting the patients to the tachycardia and other complications like dryness of the mouth and blushing so its not recommended by our study.

Ropivacaine magnetic nanoparticles: An efficient local anesthetic nerve conduction blocker

2021 ◽  
Vol 11 (11) ◽  
pp. 1819-1825
Author(s):  
Junying Su ◽  
Xiaohu Chen ◽  
Huizhang Liu ◽  
Yuhui Luo
Keyword(s):  
Magnetic Nanoparticles ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Temperature Response ◽  
Nociceptive Pain ◽  
Nerve Blocks ◽  
Anesthetic Effect ◽  
Field Of Vision ◽  
Clinical Anesthesia ◽  
The Stability

Ropivacaine (Rop) is one of the commonly used local nerve blocks in clinical anesthesia and postoperative analgesia and it inhibits the stimulation of peripheral nociceptive pain. However, Rop alone is not effective enough to exert a controllable anesthetic effect in patients with peripheral nociceptive pain. Therefore, there is an urgent need to improve the targeting of the local anesthetic effect of Rop and reduce its potential chronic or acute toxicity. In this study, a novel Rop nanocomposite hydrogel drug, N-isopropylacrylamide-methacrylic acid/ropivacaine magnetic nanoparticles (NIP-MAA/Rop MNPs), was constructed on magnetic iron oxide. The unique pH and temperature response of NIP-MAA can effectively retain magnetic properties, improve the stability and targeting controllability of magnetic nanoparticles, and avoid excessive drug diffusion. Therefore, the NIP-MAA/Rop MNPs is expected to open a new field of vision for the research of clinical anesthesia and postoperative analgesia.

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