Articles: general-anesthesia.
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Anesthesia and analgesia · Dec 2022
Decreased Electroencephalographic Alpha Power During Anesthesia Induction Is Associated With EEG Discontinuity in Human Infants.
Electroencephalogram (EEG) discontinuity can occur at high concentrations of anesthetic drugs, reflecting suppression of electrocortical activity. This EEG pattern has been reported in children and reflects a deep state of anesthesia. Isoelectric events on the EEG, a more extreme degree of voltage suppression, have been shown to be associated with worse long-term neurologic outcomes in neonates undergoing cardiac surgery. However, the clinical significance of EEG discontinuities during pediatric anesthesia for noncardiac surgery is not yet known and merits further research. In this study, we assessed the incidence of EEG discontinuity during anesthesia induction in neurologically normal infants and the clinical factors associated with its development. We hypothesized that EEG discontinuity would be associated with sevoflurane-induced alpha (8-12 Hz) power during the period of anesthesia induction in infants. ⋯ We demonstrate that EEG discontinuity is common during anesthesia induction and is related to the level of sevoflurane-induced posterior alpha power, a putative marker of cortical-thalamic circuit development in the first year of life. This association persisted even after adjusting for age and propofol coadministration. The fact that this difference was only observed during anesthesia and not in the baseline EEG suggests that otherwise hidden brain circuit properties are unmasked by general anesthesia. These neurophysiologic markers observed during anesthesia may be useful in identifying patients who may have a greater chance of developing discontinuity.
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Paediatric anaesthesia · Dec 2022
Comparison of General Endotracheal Anesthesia vs. Sedation without Endotracheal Intubation during Initial PEG Insertion for Infants: A Retrospective Cohort Study.
Critical airway incidents are a major cause of morbidity and mortality during anesthesia. Delayed management of airway obstruction quickly leads to severe complications due to the reduced apnea tolerance in infants and neonates. The decision of whether to intubate the trachea during anesthesia is therefore of great importance, particularly as an increasing number of procedures are performed outside of the operating room. ⋯ Study results suggest that providers selected general anesthesia over monitored anesthesia care for infants and neonates with low body weights, cardiac comorbidities, and neurologic comorbidities. Increased rates of airway intervention, and increased length of stay may be at least partially related to more severe patient comorbidity, as indicated by higher American Society of Anesthesiologists classifications. However, due to the exploratory nature of these analyses, further confirmatory studies are needed to evaluate the impact of airway selection during PEG on postoperative patient outcomes.
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Minerva anestesiologica · Dec 2022
Randomized Controlled TrialVentilatory performance of BASKA mask as an alternative to endotracheal intubation in short-term gynecologic laparoscopic procedures: a prospective randomized clinical trial.
Using laryngeal mask airways (LMAs) in laparoscopic surgery is still controversial because of the risk of insufficient ventilation and gastric overinflation. We investigated the use of BASKA LMA as an alternative to endotracheal intubation in low-risk females undergoing short-term gynecologic laparoscopic surgeries in Trendelenburg position under general anesthesia and positive pressure ventilation. ⋯ BASKA mask can be considered as a safe alternative to ETT with comparable ventilatory performance in low-risk females undergoing short-term gynecologic laparoscopic surgeries.