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Techniques: General
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Baha Al-Shaikh, Sanjay Agrawal, Sindy Lee, Daniel Lake, Nessa Dooley, simon Stacey, Maureen Bezzina, Gregory Waight
TIVA is a technique where intravenous drugs are used to induce and maintain general anaesthesia, avoiding the use of inhalational anaesthetics. A continuous intravenous infusion is used commonly in the form of a target controlled infusion (TCI) pump.
Bilateral Lobar Lung Transplantation with Extra-corporal Life Support (ECLS) in a Jehovah’s Witness
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Bastian Grande, Isabelle Opitz, Ilhan Inci
Therefore, careful interdisciplinary teamwork aiming at minimal blood loss was mandatory. Before the induction of general anesthesia, an arterial catheter was placed. Anesthesia was induced using fentanyl, and propofol as target-controlled infusion and rocuronium. Propofol and remifentanil were used to maintain anesthesia, rocuronium was administered for neuromuscular blockade, and bispectral index (BIS) was used to control the depth of anesthesia. After a four-luminal central venous catheter and a pulmonal arterial catheter were placed, autologous harvest was performed through a 14 G peripheral venous cannula by removing two bags of whole blood (a total of 380 cc, each). The blood remained in a closed-circuit connected to the patient, and this blood withdrawal was primarily not replaced because the patient remained hemodynamically totally stable throughout the scavenging process. The patient underwent a clamshell access and central cannulation for venoarterial ECLS, which was performed under standardized heparin protocol. For arterial cannulation, we used the ascending aorta, and for venous cannulation, the right atrium. After administering heparin, an application error was detected; 15,000 IU heparin had been given instead of 1,500 IU. The activated clotting time (ACT) increased from 141 to 270 seconds and decreased thereafter to 200 seconds throughout the procedure. During the transplantation, 1,500 cc crystalloid and 500 cc gelatin solutions were infused. Perioperative blood loss was 660 cc estimated with the hemoglobin dilution method. Cell saver blood as well as patient’s own scavenged blood was reinfused at the end of the bilateral left lower lobe lung transplantation (Figures 48.1 and 48.2). The patient could be weaned from ECLS in the OR. Total ECLS time was 198 minutes. Subsequently, she was transferred to ICU in a stable hemodynamic condition, without bleeding complications.
The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea
Published in Annals of Medicine, 2022
Alonço Viana, Débora Estevão, Chen Zhao
Recommended monitoring during DISE includes oxygen saturation (SaO2), electrocardiogram (ECG), and blood pressure (BP). A video-endoscopy system with a flexible nasoendoscope 4 mm in diameter or smaller can be used. Other suggested supplies and equipment include: (i) a standard infusion pump, preferably with target-controlled infusion (TCI). TCI is more effective and safer, allowing better adjustment of the infusion speed [16]; and (ii) a monitoring system for electroencephalogram (EEG)-derived indices - Bi-Spectral Index (BIS) or Cerebral State Index (CSI) [5]. BIS can assist in controlling the level of consciousness and the depth of sedation to mimic natural sleep, with recommended rates of 50–60 [17,18]. Cardiorespiratory polygraphy is suggested for identifying obstructive respiratory events due to hypopneas [19].
High intra-abdominal pressure during hyperthermic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery (CRS) for peritoneal surface malignancies
Published in International Journal of Hyperthermia, 2022
Louis Choon Kit Wong, Jolene Si Min Wong, Chin Jin Seo, Khee Chee Soo, Chin-Ann Johnny Ong, Claramae Shulyn Chia
Intra-operative anesthetic management and continuous parameters monitoring were performed by the dedicated anesthetist. General anesthesia was typically induced using propofol, rocuronium and a target-controlled infusion of remifentanil, then maintained using a volatile anesthetic such as desflurane with remifentanil and as-needed atracurium. Parameters of interest in the current study include heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), respiratory rate (RR), end tidal CO2 (ETCO2), as well as temperature. For analysis, data was collected at 7 time points—the first and second time points at the start and end of CRS, 4 subsequent time points in 15 min increment during HIPEC, and the final time point 15 min post-HIPEC. Blood gas analysis and serum chemistry were obtained via arterial blood samples before and after HIPEC administration, and included that of hemoglobin, sodium, potassium, calcium, glucose, pH, pO2, pCO2, as well as bicarbonate.
Blinding and expectancy confounds in psychedelic randomized controlled trials
Published in Expert Review of Clinical Pharmacology, 2021
Suresh D. Muthukumaraswamy, Anna Forsyth, Thomas Lumley
One important issue related to psychedelic drug trials is that while trials can be double-masked ‘by design’, retrospective examination of the maintenance of masking is rarely reported and when it is it often reveals that masking was not maintained. For example, take our recent crossover-RCT assessing antidepressant responses to ketamine (0.43 mg/kg) which included the active placebo remifentanil (1.7 ng/ml) [55]. For reference, a target-controlled infusion of 1.7 ng/ml is a fairly sedative dose – with much higher levels causing increasing frequency of apnea in participants. At the end of the trial, 27 participants were asked which study day they thought was which prior to being unmasked. Participants guessed correctly 88% of the time (24/27) and scored their confidence with an average of 7.67/10 (SD = 2.12). The other 12% guessed incorrectly with an average 9/10 confidence (SD = 1). The most common reason given by participants for a correct guess was psychoactive symptoms, followed by stronger symptoms overall, and then the magnitude of the antidepressant response to ketamine. The reason for incorrect guesses appeared to be driven by mistaken expectations of how the drugs would feel [55]. Similarly, the masked outcome assessor guessed correctly 88.5% of the time and scored their confidence with an average 6.42/10 (SD = 2.54). These data suggest that for our trial, breaking of masking was widespread.