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Hemodynamically Unstable/ Shocked Patient in OR. Challenge For
Journal of Anesthesia & Critical Care: Open Access Opinion Open Access Hemodynamically unstable/ shocked patient in OR challenge for teamwork efficacy when time is critical Volume 7 Issue 4 - 2017 Dimosthenis Petsas,1 Yasir Othman AT,1 Marton Hannus,1 Eljona Cumashi2 Opinion 1Anaesthetics Department, HMG Hospital, UAE 2OB/GYNAE Department, HMG Hospital, UAE In the present article we present a case report with comments/ suggestions about team dynamics. The emergency case report is only Correspondence: Dimosthenis Petsas, Anaesthetics used to highlight the importance of teamwork dynamics and many Department, HMG Hospital Dubai, Dubai Healthcare City, Building 57, UAE, PO BOX 505005, Tel 00306972008383, clinical details are not mentioned. Treating a hemodynamically Email unstable/shocked patient can be a challenging procedure and requires perfect teamwork to have the best possible outcome. Reviewing Received: March 10, 2017 | Published: March 15, 2017 the present case report we should always keep in mind that the organization is a private hospital with all the differences in resources compared to a large public hospital. A 33-year old female patient presented to ER department with signs of circulatory shock (low blood pressure, tachycardia, drowsiness and clumsy sweaty skin). Her vital signs were BP=75/35 mmHg, HR ranging from 120-135 bpm, temperature was 35.9 Celsius, pale skin and drowsiness. Initial resuscitation in ER included administration of Table 2 Intraoperative hemoglobin and coagulation 2 liters IV ringers lactate and oxygen through face mask at 5-6 lt/ min. There was temporary improvement of vital signs. Bloods were sent Investigation Value for complete blood count, coagulation, biochemistry. -
Effects of Prophylactic Ketamine and Pethidine to Control Postanesthetic Shivering: a Comparative Study
Biomedical Research and Therapy, 5(12):2898-2903 Original Research Effects of prophylactic ketamine and pethidine to control postanesthetic shivering: A comparative study Masoum Khoshfetrat1, Ali Rosom Jalali2, Gholamreza Komeili3, Aliakbar Keykha4;∗ ABSTRACT Background: Shivering is an undesirable complication following general anesthesia and spinal anesthesia, whose early control can reduce postoperative metabolic and respiratory complications. Therefore, this study aims to compare the effects of prophylactic injection of ketamine and pethi- dine on postoperative shivering.Methods: This double-blind clinical trial was performed on 105 patients with short-term orthopedic and ENT surgery. The patients were randomly divided into three groups; 20 minutes before the end of the surgery, 0.4 mg/kg of pethidine was injected to the first group, 0.5 mg/kg of ketamine was injected to the second group, and normal saline was injected to the third group. After the surgery, the tympanic membrane temperature was measured at 0, 10, 20, and 30 minutes. The shivering was also measured by a four-point grading from zero (no shiv- ering) to four (severe shivering). Data were analyzed by one-way ANOVA, Kruskal Wallis, Chi-square 1Doctor of Medicine (MD), Fellow of and Pearson correlation. Results: The mean age of patients was 35.811.45 years in the ketamine Critical Care Medicine (FCCM), group, 34.811.64 years in the normal saline group, and 33.1110.5 years in the pethidine group. Department of Anesthesiology and The one-way ANOVA showed no significant difference in the mean age between the three groups Critical Care, Khatam-Al-Anbiya (P=0.645). -
Psychotropic Drug Use and Alcohol Consumption Among Older Adults in Germany: Results of the German Health Interview and Examination Survey for Adults 2008–2011
Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-012182 on 8 October 2016. Downloaded from Psychotropic drug use and alcohol consumption among older adults in Germany: results of the German Health Interview and Examination Survey for Adults 2008–2011 Yong Du, Ingrid-Katharina Wolf, Hildtraud Knopf To cite: Du Y, Wolf I-K, ABSTRACT Strengths and limitations of this study Knopf H. Psychotropic drug Objectives: The use and combined use of use and alcohol consumption psychotropic drugs and alcohol among older adults is a ▪ among older adults in A large sample of concurrent data on medication growing public health concern and should be constantly Germany: results of the use, sociodemographic and health characteristics German Health Interview and monitored. Relevant studies are scarce in Germany. allows analyses of psychotropic drug and Examination Survey Using data of the most recent national health survey, we alcohol use on a population representative level. for Adults 2008–2011. BMJ analyse prevalence and correlates of psychotropic drug ▪ The short observation period (7 days) minimises Open 2016;6:e012182. and alcohol use among this population. recall bias concerning medication use, and doi:10.1136/bmjopen-2016- Methods: Study participants were people aged 60– quality control is ensured by checking original 012182 79 years (N=2508) of the German Health Interview and packages. Examination Survey for Adults 2008–2011. Medicines ▪ Alcohol consumption was measured by fre- ▸ Prepublication history for used during the last 7 days were documented. quency and quantity. this paper is available online. Psychotropic drugs were defined as medicines acting ▪ The use of psychotropic drugs is likely to be To view these files please on the nervous system (ATC code N00) excluding underestimated as people who are institutiona- visit the journal online anaesthetics (N01), analgesics/antipyretics (N02B), but lised and those with severe disease and psychi- (http://dx.doi.org/10.1136/ including opiate codeines used as antitussives (R05D). -
Anesthesia: the Good, the Bad, and the Elderly
ANESTHESIA: THE GOOD, THE BAD, AND THE ELDERLY Item Type Electronic Thesis; text Authors Hansen, Madeline Citation Hansen, Madeline. (2020). ANESTHESIA: THE GOOD, THE BAD, AND THE ELDERLY (Bachelor's thesis, University of Arizona, Tucson, USA). Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 25/09/2021 08:05:26 Item License http://rightsstatements.org/vocab/InC/1.0/ Link to Item http://hdl.handle.net/10150/651023 ANESTHESIA: THE GOOD, THE BAD, AND THE ELDERLY By MADELINE JOLLEEN HANSEN ____________________ A Thesis Submitted to The Honors College In Partial Fulfillment of the Bachelors degree With Honors in Physiology THE UNIVERSITY OF ARIZONA M A Y 2 0 2 0 Approved by: ____________________________ Dr. Zoe Cohen Department of Physiology Table of Contents Page number(s) Abstract……………………………………………………………………………………………………..2 General History of Anesthesia.………………………………………………………………………….3-14 Prehistoric-200AD…………………………………………………………….………………....3-5 200AD- 1846 (historical surgery)…………………….………………………………………….5-8 1847-1992……………………...…………………….……………………………………...….9-14 Physiology of General Anesthesia………………………………………………………...…………...14-16 Understanding of anesthesia mechanism…………………………………………………………14 System impacts………………………………………………………………………………..15-16 Description -
001-017-Anesthesia.Pdf
Current Fluid Therapy Topics and Recommendations During Anesthetic Procedures Andrew Claude, DVM, DACVAA Mississippi State University Mississippi State, MS • Intravenous fluid administration is recommended during general anesthesia, even during short procedures. • The traditional IV fluid rate of 10 mls/kg/hr during general anesthesia is under review. • Knowledge of a variety of IV fluids, and their applications, is essential when choosing anesthetic protocols for different medical procedures. Anesthetic drug effects on the cardiovascular system • Almost all anesthetic drugs have the potential to adversely affect the cardiovascular system. • General anesthetic vapors (isoflurane, sevoflurane) cause a dose-dependent, peripheral vasodilation. • Alpha-2 agonists initially cause peripheral hypertension with reflex bradycardia leading to a dose-dependent decreased patient cardiac index. As the drug effects wane, centrally mediated bradycardia and hypotension are common side effects. • Phenothiazine (acepromazine) tranquilizers are central dopamine and peripheral alpha receptor antagonists. This family of drugs produces dose-dependent sedation and peripheral vasodilation (hypotension). • Dissociative NMDA antagonists (ketamine, tiletamine) increase sympathetic tone soon after administration. When dissociative NMDA antagonists are used as induction agents in patients with sympathetic exhaustion or decreased cardiac reserve (morbidly ill patients), these drugs could further depress myocardial contractility. • Propofol can depress both myocardial contractility and vascular tone resulting in marked hypotension. Propofol’s negative effects on the cardiovascular system can be especially problematic in ill patients. • Potent mu agonist opioids can enhance vagally induced bradycardia. Why is IV fluid therapy important during general anesthesia? • Cardiac output (CO) equals heart rate (HR) X stroke volume (SV); IV fluids help maintain adequate fluid volume, preload, and sufficient cardiac output. -
Muscular Hyperactivity After General Anaesthesia
MUSCULAR HYPERACTIVITY AFTER GENERAL ANAESTHESIA MAGDIG. SOLIMA~,M.B., n.crl.,* and Dr_ara~lm M. M. CmLmS, wx.B., c~.~.* MvsctrzA~ HYPEr~,CrlWTY during recovery from general anaesthesia variously termed "spasticity, .... shivering," and "shakes," has been described by several authors and has been particularly related to halothane. 1~ Several mechanisms have been suggested in explanation including heat loss, t respiratory alkalosis, a early recovery of spinal reflex activity) at~d sympathetic overactivity.7 The re- ported incidence varies from 5 per cent to 70 per centa.s and this suggests that perhaps different phenomena are being described. Having noticed that some patients seemed to show true shivering whilst others showed intense muscular spasticity during emergence from general anaesthesia, this study was designed to try to elucidate whether there were, indeed, two dis- tinct phenomena, what was their incidence, and whether they were specifically i~lated to halothane anaesthesia. Spasticity was defined as sustained muscular hypertonieity most easily ob- served in jaw, neck and pectoral muscles, flexors of the upper limbs, and ex- tensors and adductors of the lower limbs. Shivering, on the other hand, was a rhythmic contraction of muscle groups with irregular intermittent periods of relaxation. METHODS The recovery of 215 unselected patients who had been anaesthetised for a wide variety of surgical procedures, both elective and emergent, was studied. Pre- medication was given one hour pre-operatively in the usual dosage, using ani- leridine and promethazine in the large majority. Induction was with thiolmntone. The largest group (I25) received halothane as the main agent, 50 received methuxyflurane, 20 cyelopropane, and 29 nitrous oxide, meperidine relaxant. -
ANESTHESIA a Comprehensive Review
ANESTHESIA A Comprehensive Review FIFTH EDITION Brian A. Hall, MD Assistant Professor of Anesthesiology College of Medicine, Mayo Clinic Rochester, Minnesota Robert C. Chantigian, MD Associate Professor of Anesthesiology College of Medicine, Mayo Clinic Rochester, Minnesota 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 ANESTHESIA: A COMPREHENSIVE REVIEW, FIFTH EDITION ISBN: 978-0-323-28662-6 Copyright © 2015, 2010, 2003, 1997, 1992 by Mayo Foundation for Medical Education and Research, Published by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions poli- cies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a profes- sional responsibility. -
Annual Medical Student Abstract Journal
Medicine of the Highest Order 2015 Annual Medical Student Abstract Journal Sponsored by: Center for Advocacy, Community Health, Education and Diversity Offices for Medical Education Medical Student Research Faculty Advisory Committee Community Outreach Faculty Advisory Committee International Medicine Faculty Advisory Committee Medical Humanities Faculty Advisory Committee Basic Science, Clinical & Translational Research Aaserude, Eric & Hong, Steven Preceptor: Beau Abar, Ph.D. University of Rochester School of Medicine and Dentistry Department of Emergency Medicine Access to care and depression among emergency department patients Introduction: Major depressive disorder is a serious, common public health concern that is characterized by a series of symptoms including depressed mood and diminished interest or pleasure in most activities of the day (DSM-V). The prevalence of depression during a lifetime is 16.2% and the 12-month prevalence is 6.6%. 1 In particular, several studies have shown that among patients in the Emergency Department (ED), the prevalence of depression is even higher than in the general population.2-3 One study showed that the prevalence of a positive depression screen is approximately 33%, and using a 33% positive predictive value, an estimated 10.5% would met the diagnostic criteria for major depressive disorder.2 Because of the high concentration of patients with depression, the ED may serve as an important forum for the identification of depression and the intervention in the disease process.4 Concomitant to identification of potential concerns regarding depression is the issue of patient access to appropriate care. Many patients lack the ability to affordably receive efficacious treatment due to insurance-related barriers.5 Furthermore, other individuals may be unaware of their level of access for primary and behavioral health services, and this lack of awareness will lead to patients in need not receiving the care appropriate to their concerns. -
Anticoagulation, Hemostasis, and Transfusions
FRONT OF BOOK ↑ [+] Cover [+] Authors - Foreword - Preface TABLE OF CONTENTS ↑ [+] 1 - General and Perioperative Care of the Surgical Patient [+] 2 - Common Postoperative Problems [+] 3 - Nutrition for the Surgical Patient [+] 4 - Fluid, Electrolytes, and Acid-Base Disorders [+] 5 - Anticoagulation, Hemostasis, and Transfusions [+] 6 - Anesthesia [+] 7 - Critical Care [+] 8 - Burns [+] 9 - Wound Care [+] 10 - Head, Neck, and Spinal Trauma [+] 11 - Chest Trauma [+] 12 - Abdominal Trauma [+] 13 - Extremity Trauma [+] 14 - Common Surgical Procedures [+] 15 - Acute Abdomen [+] 16 - Esophagus [+] 17 - Stomach [+] 18 - The Surgical Management of Obesity [+] 19 - Small Intestine [+] 20 - Surgical Diseases of the Liver [+] 21 - Surgical Diseases of the Biliary Tree [+] 22 - Surgical Diseases of the Pancreas [+] 23 - Spleen [+] 24 - Colon and Rectum [+] 25 - Anorectal Disease [+] 26 - Cerebrovascular Disease [+] 27 - Thoracoabdominal Vascular Disease [+] 28 - Peripheral Arterial Disease [+] 29 - Venous and Lymphatic Disease [+] 30 - Hemodialysis Access [+] 31 - Transplantation [+] 32 - Pediatric Surgery [+] 33 - Cardiac Surgery [+] 34 - Lung and Mediastinal Diseases [+] 35 - Breast [+] 36 - Skin and Soft-Tissue Tumors [+] 37 - Fundamentals of Laparoscopic, Robotic and Endoscopic Surgery [+] 38 - Hernias [+] 39 - Diseases of the Adrenal and Pituitary Gland and Hereditary Endocrine Syndromes [+] 40 - Thyroid and Parathyroid Glands [+] 41 - Otolaryngology for the General Surgeon [+] 42 - Plastic and Hand Surgery [+] 43 - Urology for the General Surgeon [+] 44 - Obstetrics and Gynecology for the General Surgeon [+] 45 - Biostatistics for the General Surgeon [+] 46 - Patient Safety and Quality Improvement in Surgery BACK OF BOOK ↑ [+] Answer Key [+] Index > Table of Contents > Authors Editors Mary E. Klingensmith MD1 1Department of Surgery Washington University School of Medicine St. Louis, Missouri Chandu Vemuri MD1 1Department of Surgery Washington University School of Medicine St. Louis, Missouri Oluwadamilola M. -
ECT – Anesthesia
Managing specific problems within anesthesia Alexander Sartorius Head of ECT Research and Supervison Head, Research Group Translational Imaging Department of Psychiatry and Psychotherapy Central Institute of Mental Health (CIMH) Medical Faculty Mannheim University of Heidelberg ECT – anesthesia: 1. Ketofol – two stones to catch one bird ? 2. Oxygen – the good gas ! 3. What’s that on the printout / monitor ? Part 1: Ketofol Adapted from: Folkerts HW. Electroconvulsive therapy. Indications, procedure and treatment results Nervenarzt. 2011 Jan;82(1):93-102 Swartz CM Electroconvulsive and neuromodulation therapies. 2009 Cambridge Univ, Cambridge New York Melbourne ECT – anesthesia: - thiopental 3-5 mg/kg - methohexital 50-120 mg - propofol 1-2 mg/kg German guidelines for tx of status epilepticus 1 => lorazepam up to 10mg i.v. 2 => phenytoin up to 30 mg/kg KG i.v. 3 => phenobarbital 20 mg/kg KG i.v. 4 => thiopental 4-7 mg/kg KG i.v. vs. propofol 1-2 mg/kg KG i.v. vs. midazolam or valproate Dosing of ECT anesthetics - experience of the anesthesiologist - experience from previous ECT sessions - time needed for full recovery - patient remembers muscle relaxation - systematic / non-systematic movements of the “cuffed” limb - objective criteria for “dosing” and “timing” do not exist … Br J Psychiatry. 1995 Jan;166(1):118-9. Anaesthetic technique in the practice of ECT. Collins IP, Scott IF. Bispectral Index Monitoring (BIS) - has been developed to prevent intraoperative awareness - uses combined EEG/EMG to derive a measure for “cortical integrity” inter alia by analyzing coherences between different frequency bands - More precisely: bispectrum is a 3rd order Fourier transformation that includes amplitude, phase AND coherence information. -
A Comparison Between the I-Gel® and Air-Q® Supraglottic Airway Devices
Hindawi BioMed Research International Volume 2018, Article ID 5202957, 7 pages https://doi.org/10.1155/2018/5202957 Research Article A Comparison between the i-gelD and air-QD Supraglottic Airway Devices Used for the Patients Undergoing General Anesthesia with Muscle Relaxation Nilofar Massoudi ,1 Mohammad Fathi,1 Navid Nooraei ,2 and Alireza Salehi1 Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Anesthesiology Research Center, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence should be addressed to Navid Nooraei; [email protected] Received 14 February 2018; Revised 30 April 2018; Accepted 17 May 2018; Published 18 November 2018 Academic Editor: Yukio Hayashi Copyright © 2018 Nilofar Massoudi et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Te aim of the present study was to compare two supraglottic airway (SGA) devices (i.e., the i-gel5 ©IntersurgicalLtd and air-Q5 (Reusable) Cookgas company) in terms of the insertion time, amount of leak during ventilation with maximum positive pressure, and postoperative complications in patients referring to Modarres Hospital in Tehran. Method. Te present double-blind clinical trial was performed on 60 patients undergoing elective surgeries that required general anesthesia with muscle relaxation. Patients were randomly assigned to either i-gel5 (n =30)orAir-Q5 (n =30)groups.Results. Te mean age, body mass index, duration of surgery, duration of anesthesia, and gender ratio were not signifcantly diferent between the two groups. -
Do Complexity Measures of Frontal EEG Distinguish Loss of Consciousness in Geriatric Patients Under Anesthesia?
UCLA UCLA Previously Published Works Title Do Complexity Measures of Frontal EEG Distinguish Loss of Consciousness in Geriatric Patients Under Anesthesia? Permalink https://escholarship.org/uc/item/63j9k57t Authors Eagleman, Sarah L Vaughn, Don A Drover, David R et al. Publication Date 2018 DOI 10.3389/fnins.2018.00645 Peer reviewed eScholarship.org Powered by the California Digital Library University of California fnins-12-00645 September 18, 2018 Time: 16:50 # 1 ORIGINAL RESEARCH published: 20 September 2018 doi: 10.3389/fnins.2018.00645 Do Complexity Measures of Frontal EEG Distinguish Loss of Consciousness in Geriatric Patients Under Anesthesia? Sarah L. Eagleman1*†, Don A. Vaughn2,3*†, David R. Drover1, Caitlin M. Drover4, Mark S. Cohen2,5, Nicholas T. Ouellette6 and M. Bruce MacIver1 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States, 2 UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States, 3 Department of Psychology, University of Santa Clara, Santa Clara, CA, United States, 4 University of Washington, Seattle, WA, United States, 5 UCLA Departments of Psychiatry, Neurology, Radiology, Psychology, Biomedical Physics and Bioengineering, California Nanosystems Institute, Los Angeles, CA, United States, 6 Department of Civil and Environmental Engineering, Stanford Edited by: University, Stanford, CA, United States Kay Jann, University of Southern California, United States While geriatric patients have a high likelihood of requiring anesthesia, they carry an Reviewed by: increased risk for adverse cognitive outcomes from its use. Previous work suggests this Keiichiro Nishida, could be mitigated by better intraoperative monitoring using indexes defined by several Kansai Medical University, Japan Thomas Koenig, processed electroencephalogram (EEG) measures.