Minerva anestesiologica
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Awareness during anesthesia has been the subject of much research and commentary in recent years. In this article, we review the recent publications in the area of anesthesia awareness and attempt to answer the question: Is awareness a problem without solutions? The incidence of awareness has been reported in benchmark studies to be about 0.1%, but two recent studies in Spain and China have reported incidences of awareness of 1% and 0.4%, respectively. ⋯ The best current evidence from one randomized trial suggests that bispectral index monitoring identifies the presence and reduces the incidence of awareness in high-risk patients. More trials are needed and two large ongoing trials are exploring the value of monitoring end-tidal gas concentrations and maintaining adequate age-adjusted values during surgery as an alternative method to prevent awareness.
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Minerva anestesiologica · Aug 2010
Case ReportsUltrasound-guided interscalene catheters performed under general anesthesia in a patient with Huntington's disease.
The placement of interscalene nerve blocks in adults under general anesthesia remains controversial. There have been reports of patients who suffered permanent losses of cervical spinal cord function during this practice; however, these cases employed long needles and paresthesia or nerve stimulator techniques with high stimulation currents. As a result, practitioners currently use short needles for interscalene block and value feedback from patients who are awake. ⋯ Ultrasound permits direct visualization of the needle, nerves, and local anesthetic spread and may decrease the risk of catastrophic complications. As in children, in whom awake placement is extremely difficult or even impossible, certain adult patient populations may only be offered the advantages of a peripheral nerve catheter if it is placed after the induction of general anesthesia. We report the case of a patient with Huntington's disease who was only able to undergo a total shoulder arthroplasty following ultrasound-guided placement of a continuous interscalene block under general anesthesia.
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Minerva anestesiologica · Aug 2010
Tracheal intubation using the mobile C-MAC video laryngoscope or direct laryngoscopy for patients with a simulated difficult airway.
Several studies have shown that video laryngoscopy enhances the laryngeal view in patients with apparently normal and anticipated difficult airways. The utility of the novel, portable, battery-powered C-MAC video laryngoscope is unproven, but its design makes it potentially useful for emergency situations. We hypothesized that, in patients with a simulated difficult airway created by means of a rigid cervical immobilization collar, the rate of glottic views considered "failed" under direct laryngoscopy could be significantly reduced with the C-MAC video laryngoscope. ⋯ The C-MAC video laryngoscope effectively enhanced the laryngeal view in patients with limited inter-incisor distance and eliminated cervical spine clearance. However, endotracheal tube placement failed in 5/43 patients despite a mostly good laryngeal view.
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Minerva anestesiologica · Aug 2010
Editorial CommentVideolaryngoscopy: is it only a change of view?
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Living donor transplantation has helped to partially relieve the refractory shortage of deceased donor grafts. However, living related donation exposes healthy donors to a certain risk of morbidity and even mortality. Anesthetic management of elective live donation surgery with a relatively young and healthy patient is apparently simple; nonetheless, it requires both knowledge and diligence from the anesthesiologist. ⋯ Even when careful attention is paid to maintaining intraoperative cardiorespiratory and metabolic homeostasis, preventing blood loss, preserving renal function, and assuring adequate postoperative analgesia, among other things, these procedures are not completely devoid of some major risks related to anesthesia and surgery. Maximal effort should be applied to minimize the perioperative risks for the donor, every minimal impending complication should be promptly recognized, and a timely treatment implemented. Some anesthetic considerations regarding the most frequently performed living organ transplantations are briefly reported in this article.