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Anaesthesia: Approaches and Limitations
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
The primary objective of delivering anaesthesia for surgical procedures elsewhere in the body is to allow the surgeon(s) to carry out the desired procedure in a safe and stable hemodynamic environment without causing pain or discomfort to the patient. The usual forms of anaesthesia used in general surgery include general anaesthesia, regional anaesthesia, and local anaesthesia. While local infiltrative anaesthesia can be administered by the surgeon, for general anaesthesia and regional anaesthesia, the expertise of specially trained physicians is mandatory. Administering anaesthesia during major vitreoretinal surgery, in addition to achieving analgesia, must also ensure akinesia of the extraocular muscles and relaxation of the eyelid muscles. The majority of vitreoretinal procedures can be undertaken using regional anaesthesia, so it is important for the vitreoretinal surgeon to be able to deliver it. Even in situations wherein the patient has other morbidities that increase the risk of a serious systemic intraoperative adverse reaction, such as coronary artery disease or bronchial asthma, ocular anaesthesia of choice remains regional anaesthesia, with continuous monitoring of the systemic parameters by the anaesthetic team. Indications for general anaesthesia during vitreoretinal surgery include the paediatric age group, hearing impaired, mentally challenged, and during repair of severe open globe injury.
Preanesthetic Evaluation
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Communication with the owner or representative is advisable after the evaluation and before anesthesia. Risks of anesthesia include possibility of myopathy, neuropathy, spinal myelomalacia and limb fracture. Suggest insisting on a quiet environment without patient stimulation during recovery from anesthesia.
The Spirits of Pain and Suffering
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
Anesthesia is broadly considered to be the provision of pain relief, unconsciousness and motionlessness during surgery. Most surgical anesthetics are general anesthetics, but anesthetic techniques are much more extensive than that. They include regional (nerve block) anesthesia, the provision of pain relief through the use of local anesthetic blocking major nerves to the arms or legs, as well as spinal or epidural anesthesia, blocking spinal nerves, typically for obstetrical pain relief or extremity surgery. Pain treatment specialists perform specific nerve blocks for the treatment of cancer pain, trauma, inflammatory diseases, headache and other disorders that can be treated with such blocks. They will also employ multi-modal analgesic medications because of their expert understanding of the various kinds of nerves and neurotransmitters involved in different modalities of pain – the lancinating pain of trauma, the sharp, twinging of peripheral neuropathies such as diabetic neuropathy, and the burning of complex regional pain syndromes. Critical Care Medicine, a melting pot of medical specialties such as anesthesiology, surgery, pulmonary medicine and pediatrics, began in the back of the Recovery Room (now called the Post Anesthesia Care Unit, or PACU) with anesthesiologists, as specialists in cardiopulmonary support and mechanical ventilation.
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis
Published in Expert Review of Respiratory Medicine, 2023
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
The bronchoscopy procedures were performed by interventional pulmonologists with flexible or rigid bronchoscopes or a combination of both methods, depending on the location and type of the airway stenosis. The rigid bronchoscope was used to place silicone stents, for debulking extensive tumor and granulation tissues, and for removing large foreign bodies that were essential. Otherwise, a flexible bronchoscope was used. The anesthesia methods included local anesthesia and general anesthesia. Local anesthesia was achieved with topical tetracaine and lidocaine. General anesthesia was achieved with intravenous propofol and remifentanil, and high frequency ventilation was used during the procedure. The operation techniques and devices that were used were chosen depending on the patients’ conditions and the interventional pulmonologists’ discretions. A combination of different techniques was used when needed.
A hypnotic turbo-induction technique for wisdom tooth extraction
Published in American Journal of Clinical Hypnosis, 2023
Albrecht Schmierer, Leonardo De Col, Thomas Stöcker, Thomas G. Wolf
Additionally, the patient from Gheorghiu and Orleanu (1982) described his state after the induction like he was separated from his body. He knew that the treatment was going to be painful, but he did not feel that he could or would have intervened; in a treatment without hypnosis, he feels that he would have resisted the intervention. So, with these rapid induction techniques the patients seem to be disconnected from their bodies and because of this they don’t really feel the pain, but most of the time they are totally aware of what is happening around them. Vaguely like the feeling experienced, when a treatment is performed with local anesthesia, where as well, the pain in the respective area is turned off, but everything else can be noticed, especially the pressure from the instruments used by the dentist. However, with local anesthesia just the feeling of pain is eliminated and not the whole body is disconnected.
Surgicel® fibrillar as an innovative analgesic reservoir for post-laparoscopic cholecystectomy pain management: Randomized double-blind trial
Published in Egyptian Journal of Anaesthesia, 2022
Esam Hamed, Ragaa Herdan, Ahmed M. Taha, Abdullah AlHaddad, Mohamed F. Mostafa
The study enrolled 90 patients who were investigated and statistically evaluated. The flow diagram of CONSORT for this study is shown in Figure 1. The demographic characteristics of these patients were comparable and were demonstrated in Table 1, with no statistically significant differences between the three study groups regarding age, gender, and body mass index (p-value <0.05). The mean duration of anesthesia was 70.37 ± 13.3, 73.17 ± 13.9, and 70.20 ± 12.1 min in the groups I, II and III, respectively, with no statistically significant difference (p-value = 0.618). For the duration of surgery, there was also no statistically significant difference between the study groups (p-value = 0.719). The mean duration of surgical procedure was 62.00 ± 13.2 min in group-I, 64.40 ± 12.7 minutes in group-II, and 62.27 ± 11.6 minutes in the group-III. All groups were analogous with no statistically significant differences (p-value <0.05) for the intraoperative hemodynamic parameters at the induction of general anesthesia (baseline) until the end of the surgery including the heart rate, mean blood pressure, SpO2, and EtCO2.