The Spirits of Pain and Suffering
Robert S. Holzman in 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.
Anesthesia of Laboratory Rats
Yanlin Wang-Fischer in Manual of Stroke Models in Rats, 2008
Anesthesia is applied to eliminate the perception of pain; therefore, it is essential, by definition, that painful stimuli elicit no response. Indicators to assess the depth of anesthesia in rats include the following: Reflex tests such as pinching the tail or the interdigital skin (pedal reflex) or abdominal skin with a hemostat are common. Other common reflexes for assessment of central nervous system (CNS) function include eye closure response (the palpebral reflex, which is relatively insensitive to anesthesia), head shake following pinna stimulation, and jaw closure.Changes in skin color in the rat are best seen at the ear, nose, and feet (albino rat) and in the mucosa of the mouth. If the animals become cyanotic or extremely pale, a low oxygen level in the blood is indicated, mostly caused by poor circulation.Rate and depth of respiration (particularly useful with inhalation anesthesia) are assessed.The color and arterial beat of the common carotid artery supply useful information during the surgical procedure.
Anaesthesia: Approaches and Limitations
Pradeep Venkatesh in 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.
Accurate Neurosurgery for the Establishment of the Electric Kindling Model of Epilepsy in Mice
Published in Journal of Investigative Surgery, 2022
Verónica Custodio, Jorge Acosta, Carmen Rubio, Leonardo Hernández, Javier Brito, Elisa Taddei
During the anesthesia procedure, vital signs must be kept within basal limits (respiratory rate: 80–230 breaths per minute, heart rate: 310–840 beats per minute, body temperature 36.5–38 °C) and monitored to continuously assess the mouse condition. Normally, anesthesia induces a temporal and reversible inhibition of the level of consciousness, pain, sensation and movement. General anesthesia that is used in stereotaxic neurosurgery can be administrated by inhalation, intraperitoneal or intravenous injection [21–23]. It is necessary to consider the welfare of the mice during the surgery and always ensure the implementation of the principle of the three R’s: reducing the number of animals used, replacing animals with other methods and refining techniques to lessen suffering [24,25]. Considering some advantages of the inhalant anesthesia such as, the deepness of the anesthetic effect (strength), the faster recovery of the mice and the known and suggested use of it in certain breeds of mice, in this study we used an inhalant anesthetic (mixture of isoflurane and oxygen). It is crucial to know the impregnation and maintenance dosage to which the mouse will be exposed to, since the effect of the anesthetic depends on it. The anesthetic gas reaches the lungs and the concentration depends on the blood pressure during changes in ventilation/perfusion. The mechanism of action of this gas mixture is through the inhibition of the neurotransmitter acid γ-aminobutyric (GABA) [26].
The bleeding risk and safety of repeated bronchoscopies with tissue sampling in patients with pulmonary lesions
Published in Expert Review of Respiratory Medicine, 2022
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
The anesthesia types 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 determination of anesthesia type was based on the wills of patients. The ECG, SpO2 and respiratory rate were monitoring during the bronchoscopy procedures. The bronchoscopy procedures were carried out using the following bronchoscopes: BF-260, BF-P260, and BF-UC260F (Olympus, Tokyo, Japan). Radial ultrasound probes (UM-S20-20 R and UM-S20-17 S; Olympus, Tokyo, Japan) with a guide sheath were used if necessary. The bronchoscope entered through nasal if no contraindication. After the lesions were observed and localized, biopsy forceps were used to collect five or more pieces of tissue from the lesions if possible. After bronchoscopy-guided tissue sampling, the patients were observed for 2 hours to record the occurrence of discomfort and complications. Further examination and treatment were conducted depending on the patient’s conditions if complications occurred.
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.
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