Just Published Anesthesia Research

Comparison of multidetector computed tomography-virtual bronchoscopy and conventional bronchoscopy in children with suspected foreign body aspiration.

Comparison of multidetector computed tomography-virtual bronchoscopy and conventional bronchoscopy in children with suspected foreign body aspiration.

Emerg Radiol. 2008 Nov 19;

Authors: Ozkurt H, Bahadir E, Ucgul A, Altuna C, Basak M, Cevizci NM, Dokucu AI

The aim of this study is to compare the diagnostic capability of multidetector computerized tomography (MDCT) and virtual bronchoscopy (VB) versus conventional bronchoscopy (CB) for the evaluation of children with suspected foreign body aspiration. Forty-two children (25 boys, 17 girls) with a mean age of 30, 5 months (4 months-10 years) with a suspicion of foreign body aspiration were included in this study. As the first step, the chest radiographs were obtained. Following it, MDCT was performed, and VB images were obtained. Niether IV contrast media nor sedation was used during the CT scanning. All patients underwent CB evaluation under general anesthesia by rigid bronchoscope within 24 h. Obstructive lesions were found in 35 of 42 patients as the result of MDCT-VB. External compression was detected in one of these patients. CB demonstrated foreign body in 30 patients. Mucoid plug in three patients and intrabronchial granuloma in two patients were detected which were misinterpreted as foreign bodies on MDCT-VB. The foreign body was detected by only CB but not with the MDCT-VB in one patient. Accepting the CB as the gold standard in diagnosis of the foreign body aspiration, MDCT-VB revealed the percentage values of sensitivity, 96%; specificity, 58%; positive predictive value, 85%; and negative predictive value, 87%. The location of the foreign body was the left main bronchus in 14 patients, the right main bronchus in ten patients, the right bronchus intermedius in five patients, and carina in one patient. MDCT and VB are practical and noninvasive modalities that can be used for the detection of suspected foreign body aspiration in children. Unnecessary application of conventional bronchoscopy would be avoided unless the foreign body is detected with MDCT-VB in the suspected cases.

PMID: 19018578 [PubMed - as supplied by publisher]

Early experience with unsedated ultrathin 4.9mm transnasal gastroscopy: A pilot study.

Early experience with unsedated ultrathin 4.9mm transnasal gastroscopy: A pilot study.

Can J Gastroenterol. 2008 Nov;22(11):917-922

Authors: Cheung J, Bailey R, Veldhuyzen van Zanten S, McLean R, Fedorak RN, Morse J, Millan M, Guzowski T, Goodman KJ,

BACKGROUND: Unsedated transnasal gastroscopy is a technique with unverified clinical advantages. OBJECTIVE: To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy. METHODS: Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times. RESULTS: Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (+/- SD) overall discomfort level during the procedure was 4.0+/-1.9 compared with a physician-estimated level of 3.2+/-1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5+/-9.3 min. The time from anesthesia to insertion was 7.0+/-5.3 min and from room exit to discharge 6.2+/-2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs. CONCLUSION: Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.

PMID: 19018337 [PubMed - as supplied by publisher]

Medical Thoracoscopy.

Medical Thoracoscopy.

Respiration. 2008;76(4):363-372

Authors: Rodríguez-Panadero F

As opposed to 'video-assisted thoracoscopic surgery' which requires general anesthesia, double-lumen tracheal intubation and single lung ventilation, medical thoracoscopy (or 'pleuroscopy') is frequently performed in the respiratory endoscopy suite using local anesthesia. It can be done by well-trained physicians, either pulmonologists or thoracic surgeons, and its main indication is related to diagnosis and treatment of pleural effusions. Also, pneumothorax can be managed in most cases using medical thoracoscopy. This article focuses in particular on technical aspects of medical thoracoscopy, including the selection and preparation of the patient, the choice of equipment, specific details of the procedure itself, and other technical details aimed at preventing complications.

PMID: 19018161 [PubMed - as supplied by publisher]

Ascorbic Acid Does Not Influence Consciousness Recovery After Anesthesia.

Ascorbic Acid Does Not Influence Consciousness Recovery After Anesthesia.

Biol Res Nurs. 2008 Nov 17;

Authors: Talley HC, Wicks M, Carter M, Roper B

Several studies have examined the influence of general anesthesia on changes in consciousness and unconscious cognitive processes. However, much remains to be learned about potential moderators of general anesthetic agents, such as antioxidants including ascorbic acid, and their influence on the recovery of consciousness following general anesthesia. General anesthesia potentially affects plasma ascorbic acid levels and may impair consciousness during the postoperative period; however, published literature regarding these relationships is equivocal. Ascorbic acid is important for brain function and may be related to the return of postoperative consciousness through action on the synaptic receptors in the brain. This study was designed as a pretest-posttest repeated measures investigation. Ascorbic acid levels were measured at four time periods in patients (N = 50) undergoing surgery and general anesthesia. Following surgery, patients were administered a paper-and-pencil measure of concentration that served as an index of post-anesthesia consciousness. The results suggest that changes occur in plasma ascorbic acid levels at different time points during the anesthesia regimen in nonemergent surgical patients. No statistically significant relationships were found between plasma ascorbic acid levels and improved post-anesthesia consciousness, suggesting that ascorbic acid does not influence recovery of consciousness following general anesthesia.

PMID: 19017666 [PubMed - as supplied by publisher]

Anesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report.

Anesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report.

Cases J. 2008 Nov 18;1(1):327

Authors: Coskun D, Mahli A, Yilmaz Z, Cizmeci P

ABSTRACT: INTRODUCTION: The choice of anesthesic technique for Caesarean section of a pregnant woman with cerebral arteriovenous malformation (AVM) is made to maintain a stable cardiovascular system, but due to the rarity of this condition, no definitive guidelines exist. CASE PRESENTATION: We report the case of anesthetic management of Caesarean section of a pregnant woman with cerebral AVM (grade V). After the diagnosis, the radiologists decided to perform angiography and endovascular operation for treatment after the termination of pregnancy. The patient refused to undergo this procedure and with the beginning of the contractions of uterus, she was admitted to hospital urgently at the 40th week of gestational age and Caesarean section under general anesthesia was performed successfully. CONCLUSION: We concluded that in case of emergency, general anesthesia can be used satisfactorily for Caesarean section of a pregnant woman with cerebral AVM. Ensuring optimal maternal and fetal well-being, we are of the opinion that it is also possible to control the arterial blood pressure of patients with general anesthesia.

PMID: 19017413 [PubMed - as supplied by publisher]

[Anesthesiological management of patients with an acute abdomen.]

[Anesthesiological management of patients with an acute abdomen.]

Anasthesiol Intensivmed Notfallmed Schmerzther. 2008 Nov;43(11/12):734-744

Authors: Sakka SG, Wappler F

Patients with an acute abdomen present with marked deterioration in physiological and pathophysiological conditions, which make general anesthesia to a challenging but also potentially dangerous procedure. A broad and fundamental knowledge of the pathophysiologically involved mechanisms of cardiovascular functions during anesthesia and appropriate anesthesiological approach are crucial for a successful peri-operative management. The anesthesiologist's goal is to perform adequate anesthesia while maintaining cardiovascular stability. Monitoring and management of acid-base-status as well as cardiovascular functions are required to maintain sufficient tissue oxygenation during anesthesia. The postoperative anesthesiological management may also crucially influence the further course and therefore should be considered in the anesthesiological planning. Finally, adequate pain management in all these patients is an important and not to underestimate part in the treatment. This article gives an overview on the major aspects in the different fields in the anesthesiological management of patients with an acute abdomen.

PMID: 19016384 [PubMed - as supplied by publisher]