DOCSLIB.ORG

Section 8: Awareness During General Anaesthesia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Section 8: Awareness During General Anaesthesia Section 8: Awareness Risks associated with your anaesthetic Section 8: Awareness during general anaesthesia hen you have a general anaesthetic, you become unconscious. The Wanaesthetist decides how much anaesthetic you need to keep you unconscious during your operation. Awareness is when you become conscious during your operation and can remember things that happened. This is an uncommon event, but it can be very distressing. This article tells you more about how it can occasionally happen, what steps are taken to prevent it and what to do if you think it has happened to you. What is awareness? for you. For some operations these drugs Awareness is becoming conscious during are essential as they allow the surgeon some part of your operation. The majority access to parts of your body that he/ she could not reach without muscle of patients who are aware do not feel any relaxants. These drugs also allow lighter pain, but may have memories of events in levels of anaesthetic to be used, and this the operating theatre. reduces dangerous side effects. Muscle Dreaming around the time of an operation relaxants also prevent movement, and is very common (6 in 100) but this is your anaesthetist uses information coming not awareness.1 Some patients recall from monitors (heart rate, blood pressure, events from the recovery room after their anaesthetic gas levels etc) to judge whether operation and mistakenly believe them to you are unconscious or not. be memories from during the surgery. Awareness occurs if your anaesthetist misjudges the amount of anaesthetic How and why does it happen? needed to keep you unconscious. It You are not receiving enough anaesthetic can also happen if the equipment that to keep you unconscious. delivers the anaesthetic to your body Anaesthetics have side effects that is malfunctioning, or there may be a combination of these. increase as more anaesthetic is given. These include falling blood pressure and How likely is it? reduced breathing. Your anaesthetist is present throughout the whole operation. Careful studies, which include interviews He/she uses clinical judgement and with many thousands of patients, have 1,2 experience to ensure that you are been done. Most studies suggest receiving enough anaesthetic to keep you that between 1 and 2 people per 1,000 anaesthetics experience some kind of unconscious, but not so much that you awareness. Only a third of these people suffer serious side effects. feel pain, although the experience can still Anaesthetists sometimes use muscle be very distressing. However, a recent relaxing drugs as part of the anaesthetic. survey3 of over 80,000 patients, published These drugs stop your breathing and your in 2007 found that only 1 in 14,000 people anaesthetist will use a ventilator (breathing having a general anaesthetic experience machine) to do the breathing awareness. Most of the cases they found 1 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists Section 8: Awareness happened to people who had certain risk He/she will talk to you about your factors. If no risk factor is present, the risk memories and try to work out if you was 1 in 42,000 anaesthetics. Awareness have been aware or if your memories are is more likely, (but still rare) if you are dreams or relate to things that happened having open heart surgery, obstetric while your anaesthetist is allowing you to surgery (childbirth) or surgery after a wake up. If you have been aware when major accident. you should not have been aware, your anaesthetist will explain to you how this What does it feel like if it happens might have happened. You will be offered to me? counselling. Help is available on the Over half of aware patients recollect sounds internet.6 and conversations within the operating theatre.1,2,4 You may be unable to move and How can awareness be avoided have feelings of anxiety and panic.1,4 totally? Approximately a quarter of aware patients If you do not have a general anaesthetic, are aware of the insertion or presence of then you cannot have unintentional the endotracheal (breathing) tube in their awareness. Some operations can be throats.1,4,5 carried out using a local or regional Pain is experienced by about one third of anaesthetic to numb part of the body. You aware patients.1,2,4,5 will not need a general anaesthetic and you will be awake during the operation. Are there any long-term effects? You can find out more about these anaesthetics in the booklet ‘Anaesthesia Many people who have been aware Explained’ on the Royal College of during a general anaesthetic suffer long- Anaesthetists website (www.rcoa.ac.uk). term effects.2,4 These include anxiety, Your anaesthetist will be able to tell you if fear of anaesthesia, sleep disturbances, these anaesthetics are suitable for you. nightmares, flashbacks and in some cases post-traumatic stress disorder. You can choose to have sedation with a local or regional anaesthetic. Sedation If I think I have been aware, what is medicine that makes you drowsy and should I do? mentally relaxed, but not unconscious. Your anaesthetist should be informed You will probably remember events in the as soon as possible. You can ask your operating theatre. nurses, or, if you are already at home, your GP, to contact him/her. Your How is awareness prevented during anaesthetist will want to know about it, a general anaesthetic? and you will benefit from talking about At the start of the day, your anaesthetist it and understanding how it might have will check all equipment to ensure it is happened. functioning properly. Misconnections and Studies have shown that some people do disconnections of the breathing tubes can not realise that they have been aware until cause awareness. All anaesthetists are several days later. You can still report the trained to spot these problems, hopefully fact that you think you have been aware, before awareness occurs. even days later. Before the start of your anaesthetic you The anaesthetist who conducted the will be connected to a monitor that tells anaesthetic will talk to you. He/she will ask the anaesthetist how you are responding you to explain exactly what you remember. during the operation. Another monitor 2 Risks associated with your anaesthetic v Information for Patients: The Royal College of Anaesthetists Section 8: Awareness will usually be used which shows the types of sleeping tablets and morphine- amount of anaesthetic in your body. like drugs. It is very important that you This monitoring equipment helps the inform the anaesthetist of all your regular anaesthetist judge whether you are having medications. the right amount of anaesthetic. Some types of general anaesthetic Monitors, which try to detect awareness are more likely to be associated with by analysing brain activity, have been awareness than others. There is not developed. These have been studied in usually any choice in which kind of a number of trials of varying size and anaesthetic you have – it depends on what quality.7,8 The results of the different operation you are having and on your trials do not agree. At the present time general health. Most cases of awareness these monitors are not in routine use in leading to serious psychological upset British hospitals nor are they generally occur in people who have received muscle 9 recommended for routine use in America. relaxants. Only one study in the last 50 years has shown awareness in people If I have had an episode of who were breathing for themselves.2 awareness, is it more likely None of these people suffered serious to happen during my next psychological upset as a result. anaesthetic? In some types of surgery the side Yes, you are at a slightly increased risk effects of anaesthetic drugs may be during your next anaesthetic. It is very particularly dangerous to you (or, if you important you tell your anaesthetist about are pregnant, to your unborn child). The your previous episode of awareness. He/ risk of awareness is increased because she will try to ensure that you receive your anaesthetist may need to use less adequate doses of anaesthetic throughout anaesthetic. For example: surgery. If available, he/she may make use of additional monitors that help to 4 cardiac surgery (the risk may be decrease the likelihood of awareness. 1 in 100) Many hospitals in this country do not yet 4 emergency surgery for major trauma provide this kind of equipment. (1 in 20) 4 emergency Caesarean section under a Are there any circumstances in general anaesthetic (4 in 1,000).5 which awareness is more or less likely? Is there anything I can do to prevent it from happening? If you are very ill, awareness is more common.1 Very ill patients have a low Ask your anaesthetist if it is possible to blood pressure and anaesthetics can avoid having a general anaesthetic and decrease the blood pressure further have your operation performed with a which may cause harm (e.g. heart attack local anaesthetic. You can have sedation or stroke). The anaesthetist may use as well to help you feel drowsy and a lighter general anaesthetic to reduce mentally relaxed. the risks to you. However, the risk of Tell the anaesthetist about all your regular you being aware of what is going on is medications or drugs, especially those increased. mentioned above, and about your alcohol If you take certain medications you will intake. Also tell him/her if you think you require more anaesthetic. These include may have been aware during any previous alcohol (prolonged, heavy use), some anaesthetic.
Load more

Recommended publications
  • General Anesthesia and Altered States of Arousal: a Systems Neuroscience Analysis
    General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation Brown, Emery N., Patrick L. Purdon, and Christa J. Van Dort. “General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis.” Annual Review of Neuroscience 34, no. 1 (July 21, 2011): 601–628. As Published http://dx.doi.org/10.1146/annurev-neuro-060909-153200 Publisher Annual Reviews Version Author's final manuscript Citable link http://hdl.handle.net/1721.1/86331 Terms of Use Creative Commons Attribution-Noncommercial-Share Alike Detailed Terms http://creativecommons.org/licenses/by-nc-sa/4.0/ NIH Public Access Author Manuscript Annu Rev Neurosci. Author manuscript; available in PMC 2012 July 06. NIH-PA Author ManuscriptPublished NIH-PA Author Manuscript in final edited NIH-PA Author Manuscript form as: Annu Rev Neurosci. 2011 ; 34: 601–628. doi:10.1146/annurev-neuro-060909-153200. General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis Emery N. Brown1,2,3, Patrick L. Purdon1,2, and Christa J. Van Dort1,2 Emery N. Brown: [email protected]; Patrick L. Purdon: [email protected]; Christa J. Van Dort: [email protected] 1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114 2Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 3Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 Abstract Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures.
    [Show full text]
  • A Look at Closed Claims
    Looking at the past to improve A Look at the future: • Ethical considerations preclude direct, Closed Claims prospective experimentation to quantify Where and how can we improve? risks and predict outcomes associated with differences in anesthesia practice. • Prospective nonexperimental studies are prohibitively expensive for rare events, Mary Wojnakowski, CRNA, PhD such as anesthesia incidents. Associate Professor Midwestern University • Retrospective studies are therefore the Nurse Anesthesia Program norm, including examination of closed malpractice claims. Definitions: • Malpractice claim: demand for financial compensation for an injury resulting from medical care. • Closed malpractice claim: claim is dropped or ASA Closed Claims Project settled by the parties or adjudicated by the courts. • Closed Claim Analysis: closed claim file is reviewed by a practicing provider and consists of relevant hospital & medical records, narrative statement from involved healthcare personnel, expert & peer reviews, summaries of depositions, outcome reports, and cost of settlement. • Standardized form for data collection • Initiated in 1984 • Initial findings: unexpected group of claims • Currently contains approx 8000 claims (14 out of 900) that involved sudden dating back to 1962 from 35 cardiac arrest in relatively healthy patients participating insurance carriers. who had received spinal anesthesia. • Excludes claims for dental damage • Sudden appearance of bradycardia & hypotension, which rapidly progressed • Propose: improve patient safety and
    [Show full text]
  • National Institute for Clinical Excellence Guidance on Measuring Depth of Anaesthesia: Limitations of EEG-Based Technology
    Volume 110, Number 3, March 2013 British Journal of Anaesthesia 110 (3): 325–8 (2013) doi:10.1093/bja/aet006 EDITORIAL I Downloaded from https://academic.oup.com/bja/article/110/3/325/250090 by guest on 30 September 2021 National Institute for Clinical Excellence guidance on measuring depth of anaesthesia: limitations of EEG-based technology J. J. Pandit1* and T. M. Cook2 1 Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK 2 Royal United Hospital, Bath, UK * E-mail: [email protected] Accidental awareness during anaesthesia, especially with The available evidence on the impact of the technologies on pain and subsequent recall of the event, is a terrifying pros- reducing the likelihood of intraoperative awareness is limited. Overall, [EEG-base monitors are] not associated with a statistic- pect. A high proportion of those who experience it are ally significant reduction in intra-operative awareness in reported to go on to develop symptoms similar to post- patients classified as at higher risk ... traumatic stress disorder.1 The reported incidence of recall after general anaesthesia, as ascertained by later question- What is the anaesthetist reader (or patient) to make of these ing using the Brice questionnaire, is high, 1–2 per 1000 contemporaneous and conflicting conclusions? cases (although the majority of these do not involve painful The bodies providing these two sources of advice had very experiences, are very brief recollections, or both).2 –8 There- different remits, which may explain the opposing conclu- fore, a monitor to help the anaesthetists identify those sions. The Technology Assessment Report was a review (in- patients who are awake during surgery would be extremely cluding a meta-analysis which incorporated results of a 11 useful.
    [Show full text]
  • NAP5 Chapter 12
    CHAPTER 121 AAGAReports during of AAGA induction after ofsedation anaesthesia and transfer into theatre James H MacG Palmer Michael RJ Sury Jaideep J Pandit HEADLINE 12.1. Approximately one in five of all reports of AAGA that NAP5 received followed intended sedation rather than general anaesthesia. The rate of reports of ‘AAGA’ following sedation appears to be as high as after general anaesthesia. The experiences of those reporting AAGA after sedation and the psychological sequelae were similar in nature, though perhaps less in severity than reports of AAGA after anaesthesia. Reports of AAGA after sedation represent a failure of communication between anaesthetist and patient and should be readily reduced, or even eliminated by improved communication, management of expectations and consent processes. BACKGROUND 12.2 NAP5 focuses on patient reports of AAGA. These 12.4 Reports of AAGA after sedation imply two reports may arise when a patient has not actually things: first that the patient does not have a received general anaesthesia. It is well recognised full understanding of the intended level of that reports of AAGA may occur after sedation consciousness, and second that the level of (Samuelsson et al., 2007; Mashour, 2009; Kent, consciousness experienced was likely undesirable. 2013). In the study by Samuelsson et al., 5% of 12.5 Esaki et al. (2009) studied 117 patients undergoing patients reporting AAGA had received intended regional anaesthesia or ‘managed anaesthesia sedation. In Kent’s study of self-reports to the ASA care’, and performed a structured interview awareness registry, 27 of 83 (33%) patients who assessing expected and experienced levels of reported AAGA had received intended sedation: consciousness.
    [Show full text]
  • Review Articles Intraoperative Awareness
    REVIEW ARTICLES INTRAOPERATIVE AWARENESS: MAJOR FACTOR OR NON-EXISTENT? VARINEE LEKPRASERT*, ELIZABETH A.M. FROST** AND SOMSRI PAUSAWASDI*** Introduction Intraoperative awareness has been brought to our attention and even sensationalized often by the media over the past few years, as a major problem during anesthesia. The true incidence and the actual incidence have been questioned. Others have even questioned if the complication has been reported in order to garner sympathy at the least and financial gain at the most. Certainly the incidence of intraoperative awareness under general anesthesia is rare (0.1-0.2%)1-4 but given that some 21 million anesthetics are administered annually in the United States alone, this figure translates to an occurrence of 20,000 to 40,000 cases. Worldwide the number of cases would easily reach into the millions, especially in countries that lack the resources to administer the newer inhalational anesthetics through state-of- the art anesthetic machines. To those who have experienced anesthesia awareness, it is considered a distressing complication which can cause significant psychological sequelae including post-traumatic stress disorder (PTSD)5. The syndrome and its sequelae have been discussed on television talk shows, and have been the topic of many articles and panels at national and international meetings. From Dept. of Anesthesiology, Ramathibodi Hospital, Mahidol Univ., Bangkok, Thailand. * MD, Assist. Prof. *** MD, Prof. From Dept. of Anesthesiology, Mount Sinai Medical Center, N.Y., USA. ** MD, Prof. Correspondence: Dr. Elizabeth AM Frost, Professor of Anesthesiology, Mount Sinai Medical Center, New York, N.Y, USA. E-mail: [email protected]. 1201 M.E.J.
    [Show full text]
  • CORRESPONDENCE Pressure-Support Ventilation in The
    Ⅵ CORRESPONDENCE Anesthesiology 2007; 107:670 Copyright © 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Pressure-support Ventilation in the Operating Room To the Editor:—I read with interest the study by Jaber et al.1 and the rhythm, and depth of breathing can be observed. Titration of anes- accompanying editorial by Tantawy and Ehrenwerth2 regarding pres- thetic agents, most notably opioids, is also facilitated. The abnormal sure-support ventilation (PSV). The Jaber study is noteworthy for ventilation/perfusion ratios that can occur during controlled ventila- documenting that the performance of PSV using modern anesthesia tion may be less likely to occur when supported spontaneous ventila- ventilators approaches the performance of an intensive care unit ven- tion is used rather than controlled mechanical ventilation. There is tilator. The editorial correctly indicates that the testing was not per- even evidence to suggest that PSV set to provide continuous positive formed under conditions of varying lung compliance and airway resis- airway pressure or bilevel positive airway pressure can be used in Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/107/4/678/364912/0000542-200710000-00037.pdf by guest on 03 October 2021 tance that influence the ventilation result obtained when using PSV. awake patients to prevent atelectasis during the preoxygenation pro- Nevertheless, PSV is most likely to find application in the operating cess.5 Finally, spontaneous ventilation offers the safety advantage of room for patients who can be allowed to breathe spontaneously knowing that the patient will likely continue to breathe even if an rather than for patients who present a significant ventilation chal- artificial airway should become dislodged.
    [Show full text]
  • Everything You Need to Know
    Anesthesia 101 Everything you need to know Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 2.8 1.5 ANCC CONTACT HOURS CONTACT HOURS By Laura Palmer, DNP, CRNA, MNEd Successful patient outcomes from an operative procedure require vigilance, diligence, and teamwork among the various providers involved with the surgical procedure. An understanding of the responsibilities and appreciation for the complexities of each healthcare provider’s role in the operative process is essential to a harmonious relationship among the perioperative Steam to improve the working environment and provide safe patient care. The information provided in this article is based on commonly observed practices in the anesthesia community with the caveat that the choices can vary considerably and are influenced by patient presentation and surgical requirements. Provision of anesthesia services Several regulatory agencies at state and federal levels, along with reimburse- ment requirements, control who can provide anesthesia services. Providers are generally limited to physicians, certified registered nurse anesthetists (CRNAs), and anesthesia assistants (AAs) in a limited number of states. The practice patterns commonly seen are: anesthesiologists or CRNAs indepen- dently providing direct anesthesia care, CRNAs and anesthesiologists work- ing together in the anesthesia care team model, or physicians medically directing AAs. CRNAs receive direct reimbursement from the Centers for Medicare and Medicaid Services, but AAs must always work with anesthesiologists in the medical direction model.1 Although the provider administering anesthesia can vary by practice setting and geographic location, the process and goals are comparable. Types of anesthesia When anesthesia services are necessary, there are several options to provide the patient with pain relief, reduce anxiety, and meet the requirements of the surgical procedure.
    [Show full text]
  • Anesthesia Awareness
    PatientReprinted Safety from the PA-PSRS Patient SafetyAdvisory Advisory—Vol. 2, No. 3 (Sept. 2005) Produced by ECRI & ISMP under contract to the Pennsylvania Patient Safety Authority Anesthesia Awareness wareness has been associated with the admini- • The anesthesia canister was locked in place A stration of general anesthesia since its inception. but not seated properly, presumably prevent- More than 150 years ago, when William Morton ad- ing the anesthetic gas from flowing to the pa- ministered ether as the first anesthetic, his patient tient. reported being aware during the surgical procedure.1 Not until the early 1960s did anesthesia awareness • A discrepancy between the vaporizer setting became a significant subject of inquiry, with reports and the amount of anesthesia the patient ac- estimating the incidence and the psychological conse- tually received. quences of awareness during general anesthesia.2 • A procedure was started before the anes- thetic was administered. Types of Awareness Awareness is usually defined simply as the patient • The anesthesiologist thought the procedure remembering an event that occurs during anesthe- was completed and woke the patient prema- sia.3 A variation of anesthesia awareness is awake turely. paralysis, in which the patient inadvertently receives a paralytic agent but is still awake because an anes- Incidence thetic agent is not given or the level of anesthesia is Historically, anesthesia awareness has been under- not adequate.4 recognized and under-treated. As a result, the inci- dence of intraoperative awareness and recall has Another way of categorizing anesthesia awareness is been poorly documented in the past. More recent from the perspective of memory.
    [Show full text]
  • Intra-Operative Awareness with Recall Under General Anesthesia
    DePaul University Via Sapientiae College of Science and Health Theses and Dissertations College of Science and Health Summer 8-20-2017 Intra-operative Awareness with Recall under General Anesthesia Kelly Lannert DePaul University, [email protected] Dulcie J. Schippa DePaul University, [email protected] Follow this and additional works at: https://via.library.depaul.edu/csh_etd Part of the Nursing Commons Recommended Citation Lannert, Kelly and Schippa, Dulcie J., "Intra-operative Awareness with Recall under General Anesthesia" (2017). College of Science and Health Theses and Dissertations. 215. https://via.library.depaul.edu/csh_etd/215 This Dissertation is brought to you for free and open access by the College of Science and Health at Via Sapientiae. It has been accepted for inclusion in College of Science and Health Theses and Dissertations by an authorized administrator of Via Sapientiae. For more information, please contact [email protected]. RUNNING HEAD: AWARENESS WITH RECALL 1 Intra-operative Awareness with Recall under General Anesthesia Kelly Lannert RN, BSN, CCRN, NAT and Dulcie Schippa RN, BSN, CCRN, NAT DePaul University RUNNING HEAD: AWARENESS WITH RECALL 2 TABLE OF CONTENTS Abstract ..................................................................................................................................3 Introduction ............................................................................................................................4 Background .......................................................................................................................4
    [Show full text]
  • Awareness During Anesthesia—Role of Benzodiazepines As a Premedicant Ananda Bhat1, Balajibabu Perumala Ramanna2, Ashwini Thimmarayappa3
    ORIGINAL RESEARCH ARTICLE Awareness during Anesthesia—Role of Benzodiazepines as a Premedicant Ananda Bhat1, Balajibabu Perumala Ramanna2, Ashwini Thimmarayappa3 ABSTRACT Background: Awareness during anesthesia is a frightening experience. Benzodiazepines like lorazepam have been used to decrease awareness and also to cause amnesia. However, there is insufficient evidence established regarding their efficacy and effectiveness. This study was carried out to evaluate the efficacy of benzodiazepines in minimizing the awareness during general anesthesia. Methods: This randomized controlled trial was undertaken on 100 patients who underwent various elective surgical procedures. Each group consisted of 50 participants who were randomly allocated based on the computer-generated random numbers. The experimental group received midazolam as a premedicant in addition to atropine, while the control group received only atropine. Results: In this study, the overall incidence of awareness was 16%. The incidence was higher in the control group (24%) compared to that in the experimental group (8%). In the control group, awareness was characterized by hearing conversation/music in 58.3% of the participants, followed by remembrance of intraoperative events in 41.6% of the participants. In the experimental group, awareness was pertained to dreaming in all the four participants (100%). Conclusion: There was a significant higher incidence of awareness under anesthesia in the patients who had received only atropine as premedication. Hence, it is recommended to include benzodiazepine like midazolam, a water-soluble agent, routinely as a premedicant to decrease the incidence of awareness. Keywords: Anesthesia, Awareness, Benzodiazepines, Premedication. The Journal of Medical Sciences (2019): 10.5005/jp-journals-10045-00102 INTRODUCTION 1–3Department of Anesthesiology, Sri Jayadeva Institute of Cardio- Anesthesia has helped mankind by abolishing one of its worst vascular Sciences and Research, Bengaluru, Karnataka, India enemies—pain.
    [Show full text]
  • Anesthesia for Bronchoscopy
    Send Orders of Reprints at [email protected] 6314 Current Pharmaceutical Design, 2012, 18, 6314-6324 Anesthesia for Bronchoscopy Basem B. Abdelmalak*, Thomas R. Gildea‡ and D. John Doyle† *Associate Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Director, Anesthesia for Bronchoscopic Surgery, Departments of General Anesthesiology and OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; ‡Staff, Department of Pulmonary, Allergy and Critical Care Medicine & Transplant Center, Head, Section of Bronchoscopy, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio; †Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case, Western Reserve University; Staff, Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio Abstract: Bronchoscopic procedures are at times intricate and the patients often very ill. These factors and an airway shared with the pulmonologist present a clear challenge to anesthesiologists. The key to success lies in the understanding of both the underlying pathol- ogy and procedure being performed combined with frequent two-way communication between the anesthesiologist and the pulmonolo- gist. Above all, vigilance and preparedness are paramount. Topics discussed in this review include anesthesia for advanced diagnostic procedures as well as for interventional/ therapeutic proce- dures. The latter includes bronchoscopic tracheal balloon dilation, tracheobronchial
    [Show full text]
  • What Types of Sedation Are Used in Pediatric Dentistry?
    Karimi. Clin Oral Sci Dent (2021), 4:1 P a g e | 1 CLINICAL ORAL SCIENCE AND DENTISTRY [ISSN 2688-7428] Opinion Article Open Access What Types of Sedation are used in Pediatric Dentistry? Mohammad Karimi1* 1 Department of Pediatric, University of Shiraz School of Dentistry, Sepideh Dental Clinic, Iran. Received date: March 04, 2021, Accepted date: July 27, 2021, Published date: August 09, 2021 Copyright: ©2021 Karimi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. *Corresponding Author: Karimi, University of Shiraz School of Dentistry, Sepideh Dental Clinic, Iran. Abstract Some children are not able to cooperate in dentistry for reasons such as low age, physical and mental disabilities, or severe and uncontrolled anxiety. Therefore, performing dental treatments in the office may be a risk factor for them. Besides, one of the important goals in children's dentistry is to maintain mental health while in evolution; and also create a positive memory of dentistry. In the event of an unpleasant childhood memory, the whole future of a person's dentistry may be affected. Consequently, for these children, dental treatments are recommended under anesthesia or sedation. Nowadays, there are several drugs available to help patients' comfort and relaxation during dental works. Oral sedation, nitrogen oxide, intravenous relaxation, and ultimately general anesthetic are major types of Anesthetics that are used in pediatric dentistry. Factors such as the age of the child, the severity and extent of dental caries, the dentist's expectation of the outcome of the treatment, the risk of treatment, and the satisfaction of the parents would affect the decision of the dentist to select the appropriate type of anesthesia.
    [Show full text]