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Indian Journal of Ophthalmology Jul 2023: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon...
BACKGROUND
: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon carry out each step of the surgery precisely and beautifully. The art of giving a good local anesthesia is to be learnt and practiced not only by anesthetists, but also by the practicing ophthalmologists.
PURPOSE
: This video gives an overview of anatomy in terms of the nerve supply of the orbit, the surface marking, and the techniques of giving regional and nerve blocks.
SYNOPSIS
: In this video, we describe the anatomy, the surface marking, the technique of regional anesthesia including peribulbar, retrobulbar, and subtenon blocks and of nerve blocks, specifically of facial, frontal nerve and its branches, infraorbital, nasociliary, infratrochlear, and dorsal nasal nerves, with their application in ocular plastic surgery.
HIGHLIGHTS
: This video highlights the essence of providing appropriate and good anesthesia so that the surgeon works in an optimal field with maximum comfort to the patients. Video link https://youtu.be/h8EgTMQAsyE.
Topics: Humans; Anesthetics, Local; Anesthesia, Local; Nerve Block; Ophthalmologic Surgical Procedures; Orbit
PubMed: 37417157
DOI: 10.4103/IJO.IJO_1366_23 -
British Journal of Anaesthesia Sep 2022There are two established techniques of delivering general anaesthesia: propofol-based total intravenous anaesthesia (TIVA) and volatile agent-based inhaled anaesthesia....
There are two established techniques of delivering general anaesthesia: propofol-based total intravenous anaesthesia (TIVA) and volatile agent-based inhaled anaesthesia. Both techniques are offered as standard of care and have an established safety track record lasting more than 30 years. However, it is not currently known whether the choice of anaesthetic technique results in a fundamentally different patient experience or affects early, intermediate-term, and longer-term postoperative outcomes. This editorial comments on a recently published study that suggests that inhaled volatile anaesthesia might be associated with fewer postoperative surgical complications than propofol-based TIVA for patients undergoing colorectal cancer surgery. We consider the strengths and limitations of the study, place these findings in the context of the broader evidence, and discuss how the current controversies regarding anaesthetic technique can be resolved, thereby helping to bring precision medicine into the modern practice of perioperative care.
Topics: Anesthesia, General; Anesthesia, Intravenous; Anesthetics; Anesthetics, Inhalation; Anesthetics, Intravenous; Humans; Postoperative Complications; Propofol
PubMed: 35835606
DOI: 10.1016/j.bja.2022.06.008 -
British Journal of Anaesthesia Jan 2023At this centenary of the British Journal of Anaesthesia (BJA) in 2023, six of its 12 editors/editors-in-chief detail developments over the decades that have led to the...
At this centenary of the British Journal of Anaesthesia (BJA) in 2023, six of its 12 editors/editors-in-chief detail developments over the decades that have led to the BJA becoming a high-impact international scientific journal. As a charity, the BJA supports academic research and training in anaesthesia, critical care, and pain medicine including funding of research grants and postgraduate education. Building on this foundation, the BJA continues to innovate as it aims to become fully electronic, expand into open access publishing, and increase the diversity of its editorial board.
Topics: Humans; Anesthesiology; Anesthesia; Critical Care
PubMed: 36376100
DOI: 10.1016/j.bja.2022.10.013 -
British Journal of Hospital Medicine... Oct 2022Peripheral regional blockade is a type of regional anaesthesia involving depositing local anaesthetics around a specific nerve or bundle of nerves that help transmit... (Review)
Review
Peripheral regional blockade is a type of regional anaesthesia involving depositing local anaesthetics around a specific nerve or bundle of nerves that help transmit nociceptive signals to higher centres, such as the thalamus and somatosensory cortex. It is not only a widely used technique that provides surgical anaesthesia, but also acts as an essential part of the armamentarium against postoperative pain and pain following major skeletal trauma. This article discusses the structure and function of peripheral nerves, the classification and pathophysiology of peripheral nerve injury and, finally, how practising anaesthetists are committed to maximising success and minimising harm when performing peripheral nerve blockade in the operating theatre.
Topics: Humans; Nerve Block; Anesthesia, Conduction; Anesthetics, Local; Pain, Postoperative; Anesthesia, Local; Peripheral Nerves
PubMed: 36322433
DOI: 10.12968/hmed.2022.0304 -
Best Practice & Research. Clinical... Jun 2023Spinal anaesthesia is an established and frequently used anaesthetic technique in adults. However, this versatile regional anaesthetic technique is less frequently used... (Review)
Review
Spinal anaesthesia is an established and frequently used anaesthetic technique in adults. However, this versatile regional anaesthetic technique is less frequently used in paediatric anaesthesia even though it can be used for minor (e.g. inguinal hernia repair) and major (e.g. cardiac surgery) surgical procedures. The aim of this narrative review was to summarize the current literature with regard to technical aspects, surgical context, choice of drugs, potential complications, as well as the effects of the neuroendocrine surgical stress response and potential long-term effects of anaesthesia during infancy. In summary, spinal anaesthesia represents a valid alternative in the paediatric anaesthesia setting also.
Topics: Adult; Humans; Child; Anesthesia, Spinal; Anesthesia, Local; Anesthetics; Hernia, Inguinal
PubMed: 37321762
DOI: 10.1016/j.bpa.2023.01.002 -
Current Oncology (Toronto, Ont.) May 2023With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the... (Review)
Review
BACKGROUND
With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the question of whether anaesthetic and analgesia techniques during primary cancer resection surgery might influence long term oncological outcomes assumes high priority.
METHODS
We searched the available literature linking anaesthetic-analgesic techniques and strategies during tumour resection surgery to oncological outcomes and synthesised this narrative review, predominantly using studies published since 2019. Current evidence is presented around opioids, regional anaesthesia, propofol total intravenous anaesthesia (TIVA) and volatile anaesthesia, dexamethasone, dexmedetomidine, non-steroidal anti-inflammatory medications and beta-blockers.
CONCLUSIONS
The research base in onco-anaesthesia is expanding. There continue to be few sufficiently powered RCTs, which are necessary to confirm a causal link between any perioperative intervention and long-term oncologic outcome. In the absence of any convincing Level 1 recommending a change in practice, long-term oncologic benefit should not be part of the decision on choice of anaesthetic technique for tumour resection surgery.
Topics: Humans; Anesthetics; Anesthesia, Conduction; Propofol; Anesthesia, General; Neoplasms
PubMed: 37366886
DOI: 10.3390/curroncol30060403 -
British Journal of Anaesthesia Nov 2021Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have... (Review)
Review
Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have increased significantly in the last 20 yr and are projected to account for half of all anaesthetics delivered in the next decade. In contrast to most other medication administration contexts, NORA is performed in high-volume fast-paced environments not optimised for anaesthesia care. These predisposing factors combined with increasing case volume, less provider experience, and higher-acuity patients increase the potential for preventable adverse events. Our narrative review examines morbidity and mortality in NORA settings compared with the OR and the systems factors impacting safety in NORA. A review of the literature from January 1, 1994 to March 5, 2021 was conducted using PubMed, CINAHL, Scopus, and ProQuest. After completing abstract screening and full-text review, 30 articles were selected for inclusion. These articles suggested higher rates of morbidity and mortality in NORA cases compared with OR cases. This included a higher proportion of death claims and complications attributable to inadequate oxygenation, and a higher likelihood that adverse events are preventable. Despite relatively few attempts to quantify safety concerns, it was possible to find a range of systems safety concerns repeated across multiple studies, including insufficient lighting, noise, cramped workspace, and restricted access to patients. Old and unfamiliar equipment, lack of team familiarity, and limited preoperative evaluation are also commonly noted challenges. Applying a systems view of safety, it is possible to suggest a range of methods to improve NORA safety and performance.
Topics: Anesthesia; Anesthetics; Equipment Design; Humans; Oxygen
PubMed: 34452733
DOI: 10.1016/j.bja.2021.07.007 -
British Journal of Anaesthesia May 2023The erector spinae plane block (ESPB) is one of seven 'Plan A' blocks proposed by Regional Anaesthesia UK, covering the key areas of commonly encountered surgeries and...
The erector spinae plane block (ESPB) is one of seven 'Plan A' blocks proposed by Regional Anaesthesia UK, covering the key areas of commonly encountered surgeries and acute pain. Unlike the other six blocks, the ESPB can be performed at all levels of the spine and provides analgesia to most regions of the body, leading to the argument that the ESPB is the ultimate Plan A block. Current studies show a high level of evidence supporting use in thoracoabdominal surgery but a lack of benefit in upper and lower limb surgery compared with local infiltration and other Plan A blocks. Thus, there is insufficient evidence to support the claim that the erector spinae plane block is the ultimate Plan A block.
Topics: Humans; Pain, Postoperative; Nerve Block; Pain Management; Analgesia; Anesthesia, Conduction
PubMed: 36775671
DOI: 10.1016/j.bja.2023.01.012 -
Paediatric Anaesthesia Dec 2022Anesthetic and surgical techniques for the liver transplantation have progressed considerably over the past sixty years; however, this procedure is still fraught with... (Review)
Review
Anesthetic and surgical techniques for the liver transplantation have progressed considerably over the past sixty years; however, this procedure is still fraught with substantial morbidity. To increase the safety culture associated with the liver transplantation, we detail nine error traps associated with anesthesia for pediatric liver transplantation. These potential pitfalls are divided into the operative phases: pre-operative preparation (Failure to have a dedicated anesthesia team for pediatric liver transplantation); pre-anhepatic (Failure to prepare for massive blood loss, Failure to monitor for coagulation abnormalities); anhepatic including reperfusion (Failure to prepare for clamping of the inferior vena cava, Failure to recognize metabolic changes, Failure to maintain homeostasis for reperfusion, Failure to prepare for Post-reperfusion syndrome); and post-anhepatic (Failure to optimize liver perfusion, Failure to maintain hemostatic balance). By offering practical advice on the preparation and treatment of these error traps, we aim to better prepare anesthesiologists to take care of pediatric patients undergoing the liver transplantation.
Topics: Humans; Child; Liver Transplantation; Anesthesia
PubMed: 36178188
DOI: 10.1111/pan.14565 -
BMJ Open Nov 2019The effect of mode of anaesthesia in emergency surgery is uncertain. This scoping review will identify and summarise the evidence for local, regional or general... (Review)
Review
INTRODUCTION
The effect of mode of anaesthesia in emergency surgery is uncertain. This scoping review will identify and summarise the evidence for local, regional or general anaesthetic in adult patients undergoing emergency surgical procedures.
METHODS AND ANALYSIS
Scoping review methodology will be followed. The search will be run in EMBASE and Medline. Further articles will be identified from searching references in relevant studies. A descriptive analysis will be performed considering the following main outcomes; mortality, length of stay, intensive care unit (ICU) admission, postoperative pain and morbidity. Data on complications including acute coronary syndrome, stroke, thromboembolic events, delirium, acute kidney injury, respiratory tract infection, surgical site infection and study-specific additional outcomes will also be collected.
ETHICS AND DISSEMINATION
No ethics approval is required. The results will be used to inform a funding application for a clinical trial comparing local/regional anaesthetic with general anaesthetic. The study will be disseminated via peer-reviewed manuscript and conferences.
TRIAL REGISTRATION NUMBER
Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. There are currently no registries that accept scoping reviews.
Topics: Anesthesia; Clinical Protocols; Critical Care; Emergencies; Hospital Mortality; Humans; Length of Stay; Outcome Assessment, Health Care; Postoperative Complications; Surgical Procedures, Operative
PubMed: 31719079
DOI: 10.1136/bmjopen-2019-030817