Articles: general-anesthesia.
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Minerva anestesiologica · Mar 2023
Randomized Controlled TrialIntravenous lidocaine attenuates distention of the optical nerve sheath, a correlate of intracranial pressure, during endotracheal intubation.
By preventing hypoxia and hypercapnia, advanced airway management can save lives among patients with traumatic brain injury. During endotracheal intubation (ETI), tracheal stimulation causes an increase in intracranial pressure (ICP), which may impair brain perfusion. It has been suggested that intravenous lidocaine might attenuate this ICP response. We hypothesized that adding lidocaine to the standard induction medication for general anesthesia might reduce the ICP response to ETI. Here, we measured the optical nerve sheath diameter (ONSD) as a correlate of ICP and evaluated the effect of intravenous lidocaine on ONSD during and after ETI in patients undergoing anesthesia. ⋯ We found that the ONSD was distended during and after ETI in anesthetized patients, and intravenous lidocaine attenuated this effect.
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Anesthesia and analgesia · Mar 2023
Patient and Operative Factors Predict Risk of Discretionary Prolonged Postoperative Mechanical Ventilation in a Broad Surgical Cohort.
Patients undergoing surgery with general anesthesia and endotracheal intubation are ideally extubated upon case completion, as prolonged postoperative mechanical ventilation (PPMV) has been associated with poor outcomes. However, some patients require PPMV for surgical reasons, such as airway compromise, while others remain intubated at the discretion of the anesthesia provider. Incidence and risk factors for discretionary PPMV (DPPMV) have been described in individual surgical subspecialties and intensive care unit (ICU) populations, but are relatively understudied in a broad surgical cohort. The present study seeks to fill this gap and identify the perioperative risk factors that predict DPPMV. ⋯ DPPMV was uncommon in this broad surgical cohort but could be accurately predicted using readily available patient-specific and operative factors. These results may be useful for preoperative risk stratification, postoperative resource allocation, and clinical trial planning.
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Preclinical studies have indicated that anaesthesia is an independent risk factor for dementia, but the clinical associations between dementia and different types of general anaesthesia or regional anaesthesia remain unclear. We conducted a population-based cohort study using propensity-score matching to compare dementia incidence in patients included in the Taiwanese National Health Insurance Research Database who received various anaesthetic types for hip fracture surgery. ⋯ The incidence rate ratios of dementia amongst older adults undergoing hip fracture surgery were higher for those receiving general anaesthesia than for those receiving regional anaesthesia, with inhalational anaesthesia associated with a higher incidence rate ratio for dementia than total intravenous anaesthesia (TIVA).
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Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. ⋯ Conclusions: The perioperative management of the cognitive function of cirrhotic patients is challenging for anesthesia providers, with specific and targeted therapies for POCD still sparse. Therefore, the implementation of preventive strategies appears to remain the optimal attitude. Further research is needed for a better understanding of POCD, especially in cirrhotic patients.