Articles: general-anesthesia.
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We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome. ⋯ The number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.
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Randomized Controlled Trial
Effects of video-assisted preanesthetic patient education on preanesthetic interview time; A prospective, single-blinded, randomized controlled trial.
A preanesthetic evaluation interview with an anesthesiologist is essential for patient safety, however, it is not performed adequately owing to the excessive workload of doctors. This study aimed to determine whether video-assisted preanesthetic patient education can reduce patient interview time and solve the problem of excessive labor at a relatively low cost. ⋯ Watching the informational video about anesthesia before preanesthetic evaluation could reduce the interview time by an average of 24 seconds, with no difference in patients' or doctors' satisfaction or anxiety compared to patients who did not watch it. Video-assisted preanesthetic patient education indicates that the load on anesthesiologists can be reduced.
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Anesthesia and analgesia · Jun 2024
Intraoperative Hypotension in Patients Having Major Noncardiac Surgery Under General Anesthesia: A Systematic Review of Blood Pressure Optimization Strategies.
Intraoperative hypotension is associated with increased risks of postoperative complications. Consequently, a variety of blood pressure optimization strategies have been tested to prevent or promptly treat intraoperative hypotension. We performed a systematic review to summarize randomized controlled trials that evaluated the efficacy of blood pressure optimization interventions in either mitigating exposure to intraoperative hypotension or reducing risks of postoperative complications. ⋯ Several different blood pressure optimization interventions show promise in reducing exposure to intraoperative hypotension. Nonetheless, the impact of these interventions on clinical outcomes remains unclear. Future trials should assess promising interventions in samples sufficiently large to identify clinically plausible treatment effects on important outcomes.
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Anesthesia and analgesia · Jun 2024
Distinct Neural Mechanisms Between Anesthesia Induction and Emergence: A Narrative Review.
Anesthesia induction and emergence are critical periods for perioperative safety in the clinic. Traditionally, the emergence from general anesthesia has been recognized as a simple inverse process of induction resulting from the elimination of general anesthetics from the central nervous system. ⋯ Moreover, additional brain regions have also been implicated in distinct neural mechanisms for anesthesia induction and emergence, which extends the concept that anesthetic induction and emergence are not antiparallel processes. Here, we reviewed the current literature and summarized the evidence regarding the differential mechanism of neural modulation in anesthesia induction and emergence, which will facilitate the understanding of the underlying neural mechanism for emergence from general anesthesia.
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Anesthetic agents used during deep brain stimulation (DBS) surgery might interfere with microelectrode recording (MER) and local field potential (LFP) and thus affect the accuracy of surgical target localization. This review aimed to identify the effects of different anesthetic agents on neuronal activity of the subthalamic nucleus (STN) during the MER procedure. ⋯ The effects of the tested anesthetics on the STN in MER and LFP of Parkinson's disease varied; however, identifying the STN and achieving a good clinical outcome are possible under controlled anesthetic conditions. For patient comfort, anesthesia should be considered in STN-DBS.