Indian journal of anaesthesia
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Minimum alveolar concentration (MAC) of inhalational agent denotes the requirement of it to maintain adequate plane of general anaesthesia. The precision to the maintenance of anaesthesia can be further guided by use of entropy to titrate the depth of anaesthesia. Regional anaesthesia and the concomitant deafferentation will decrease the need of general anaesthetics. We conducted a randomised double-blind trial to quantify the effect of addition of regional anaesthesia to sevoflurane based general anaesthesia technique guided by entropy to achieve satisfactory depth of anaesthesia. ⋯ Lower concentrations of volatile anaesthetic are required when entropy-guided general anaesthesia is combined with regional blockade.
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Case Reports
Haemodynamic and analgesic control in a perioperative opioid-free approach to bariatric surgery - A case report.
New approaches to bariatric surgery aim to achieve stress-free anaesthesia with sympathetic stability to protect organs and provide sufficient tissue perfusion, analgesia and rapid emergence. Opioid-free and multimodal approaches to anaesthesia provide intra- and post-operative sedation and analgesia, particularly advantageous in morbidly obese patients, but their feasibility and efficacy are still disputed. We describe the case of a female patient proposed for laparoscopic bariatric surgery, conducted under an opioid-free anaesthesia protocol, the haemodynamic, ventilatory and analgesic control, and intra- and post-operative monitoring and complications.
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Intraoperative hypotension (IOH) i.e., low arterial blood pressure (AP) during surgery is common in patients having non-cardiac surgery under general anaesthesia. It has a multifactorial aetiology, and is associated with major postoperative complications including acute kidney injury, myocardial injury and death. Therefore, IOH may be a modifiable risk factor for postoperative complications. ⋯ However, the optimal therapeutic approach to IOH remains elusive. There is evidence from one small randomised controlled trial that individualising AP targets may reduce the risk of postoperative organ dysfunction compared with standard care. More research is needed to define individual AP harm thresholds, to develop therapeutic strategies to treat and avoid IOH, and to integrate new technologies for continuous AP monitoring.