Articles: anesthetics.
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Paediatric anaesthesia · Apr 2024
Review Meta AnalysisIncidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: An updated systematic review and meta-analysis.
Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta-analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta-analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta-analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children. ⋯ The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation.
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J Neurosurg Anesthesiol · Apr 2024
Randomized Controlled TrialModified thoracolumbar Interfascial Plane Block Versus Erector Spinae Plane Block in Patients Undergoing Spine Surgeries: A Randomized Controlled Trial.
Lumbar spine surgery is associated with significant postoperative pain. Interfascial plane blocks, such as erector spinae plane (ESP) and thoracolumbar interfascial plane (TLIP) blocks, can play a significant role in multimodal analgesic regimens. ⋯ Compared with the mTLIP block, the ESP block was associated with lower pain scores and a small decrease in perioperative fentanyl consumption in patients undergoing lumbar spine surgeries. Both blocks could form a part of a multimodal analgesic regimen in spine surgery patients.
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J Neurosurg Anesthesiol · Apr 2024
ReviewRegional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence.
Neurosurgical procedures are often associated with significant postoperative pain that is both underrecognized and undertreated. Given the potentially undesirable side effects associated with general anesthesia and with various pharmacological analgesic regimens, regional anesthetic techniques have gained in popularity as alternatives for providing both anesthesia and analgesia for the neurosurgical patient. The aim of this narrative review is to present an overview of the regional techniques that have been incorporated and continue to be incorporated into modern neuroanesthesia practice, presenting in a comprehensive way the evidence, where available, in support of such practice for the neurosurgical patient.
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Curr Opin Anaesthesiol · Apr 2024
ReviewIntraoperative EEG-based monitors: are we looking under the lamppost?
While electroencephalogram (EEG)-based depth of anesthesia monitors have been in use clinically for decades, there is still a major debate concerning their efficacy for detecting awareness under anesthesia (AUA). Further utilization of these monitors has also been discussed vividly, for example, reduction of postoperative delirium (POD).It seems that with regard to reducing AUA and POD, these monitors might be applicable, under specific anesthetic protocols. But in other settings, such monitoring might be less contributive and may have a 'built-it glass ceiling'.Recent advances in other venues of electrophysiological monitoring might have a strong theoretical rationale, and early supporting results, to offer a breakthrough out of this metaphorical glass ceiling. The purpose of this review is to present this possibility. ⋯ Attention-related monitoring might have a strong theoretical basis for the prevention of AUA, POD, and potentially other distressing postoperative outcomes, such as stroke and postoperative neurocognitive disorder. There seems to be already some initial supporting evidence in this regard.
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Journal of anesthesia · Apr 2024
ReviewNeurosteroids and their potential as a safer class of general anesthetics.
Neurosteroids (NS) are a class of steroids that are synthesized within the central nervous system (CNS). Various NS can either enhance or inhibit CNS excitability and they play important biological roles in brain development, brain function and as mediators of mood. One class of NS, 3α-hydroxy-pregnane steroids such as allopregnanolone (AlloP) or pregnanolone (Preg), inhibits neuronal excitability; these endogenous NS and their analogues have been therapeutically applied as anti-depressants, anti-epileptics and general anesthetics. ⋯ Recent advances in understanding NS mechanisms of action and improved formulations have rekindled interest in development of NS as sedatives and anesthetics. In this review, the synthesis of NS, and their mechanism of action will be reviewed with specific emphasis on their binding sites and actions on γ-aminobutyric acid type A (GABAA) receptors. The potential advantages of NS analogues as sedative and anesthetic agents will be discussed.