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Anesthetic Management of Laproscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Most anesthesiologists prefer general anesthesia with short-acting opioids and inhalational anaesthetic agents over sole regional anesthesia during laparoscopic colorectal surgery. Muscle relaxation with nondepolarizing agent allows controlled ventilation compensating for the various changes in oxygenation and ventilation. Concomitant neuraxial blockade with an epidural may be used with general anesthesia. Intraoperative epidural local anesthetic administration permits a decrease in the amounts of inhalational anesthetics, opioids, and muscle relaxants used. It may be beneficial to insert an epidural catheter if conversion to open surgery is likely.
Anticoagulation in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Rachel A. Newman, Ather Mehboob, Judith H. Chung
For an induction, patients who have been on therapeutic anticoagulation are started on an unfractionated heparin drip. Close monitoring of the therapeutic level is monitored with aPTT. When a patient desires neuraxial anesthesia, preliminary ASRA guidelines recommend 4−6 hours between administration of a therapeutic dose and neuraxial blockade [27,48]. Prior to placement, aPTT should have normalized. If it has not, aPTT is rechecked in 1 hour, and repeated until the value has normalized before placing the catheter for neuraxial anesthesia.
Abdominal surgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Brian J Pollard, Gareth Kitchen
Neuraxial blockade reduces the surgical stress response and may contribute to overall reduction in complications associated with major colorectal surgery in particular postoperative ileus. This benefit has also been shown in patients undergoing laparoscopic surgery.
Interventional pain management in patients with cancer-related pain
Published in Postgraduate Medicine, 2020
Pain is one of the most feared symptoms of cancer and poorly controlled pain is often debilitating and affects the quality of life at all stages of the disease. A meta-analysis of several studies concluded that 38.0% of all cancer patients reported moderate to severe pain (numerical rating scale score ≥5) with the prevalence rates of 55.0% during treatment, 39.3% after curative treatment, and up to 66.4% in the terminally ill patients [1]. The World Health Organization (WHO) analgesic ladder advocates the use of simple analgesia and opioids with adjuncts orally and this can effectively manage most of the pain in cancer patients [2]. However, 10% of patients do not achieve adequate analgesia with oral medications or suffer unacceptable side effects [3]; these patients could benefit from peripheral nerve and plexus blocks, central neuraxial blockade, sympathetic blocks, neurolytic blocks, intrathecal drug delivery systems, neuromodulation, and neurosurgical procedures and should have access to these services in a timely manner.
Perioperative care of geriatric patients
Published in Hospital Practice, 2020
Aditya P. Devalapalli, Deanne T. Kashiwagi
A retrospective study of older patients who underwent hip fracture repair in Japan evaluated outcomes based on general versus regional anesthesia. When subjects were matched based on propensity scores to reduce confounding factors of age, gender, claim type, fracture type, and comorbidities, regional anesthesia was associated with shorter perioperative length of stay compared to general anesthesia (28.0 versus 29.7 days, P < 0.001); there were no significant differences in 30- and 90-day mortality, however [40]. Regional anesthesia should be considered for patients undergoing hip fracture repair, but this technique may not necessarily be generalizable to other procedures or clinical scenarios. A systematic review of the Cochrane database found that neuraxial blockade was linked to lower 30-day mortality compared to general anesthesia based on 20 studies of over 3000 patients (risk ratio 0.71, CI 0.53–0.94); there was also a lower risk of pneumonia in patients who received neuraxial blockade compared to general anesthesia (risk ratio 0.45, CI 0.26–0.79); there were no significant differences in risk of MI found, however [41]. Nonetheless, older surgical patients may benefit from regional anesthesia with regards to hip fracture repair, elective hip or knee arthroplasty, and lower limb revascularization, given reduced mortality and reduced sedation frequency in these distinct patient populations [41]. The decision to offer regional anesthesia should be made in a multidisciplinary fashion and after careful discussion of the risks and benefits.
Intraoperative hypotension and its organ-related consequences in hypertensive subjects undergoing abdominal surgery: a cohort study
Published in Blood Pressure, 2021
Szymon Czajka, Zbigniew Putowski, Łukasz J. Krzych
Induction of anaesthesia (intubation, cannulation) with insufficient pain control leads to increased sympathetic activation, which increases BP and heart rate. However, the opposite is more often the case. Anaesthetic agents and central neuraxial blockade lead to the loss of baroreceptor reflex control and a decrease in systemic vascular resistance. Excessive depth of anaesthesia and hypovolemia may worsen the situation. [21]. Previous studies showed a relationship between the occurrence of intraoperative cardiovascular complications in patients and preoperative diagnosis of arterial hypertension. Those complications included not only intraoperative hypertension and arrhythmias but also the episodes of hypotension [31].