Review

Authors: R L H Yim, K M M Leung, C C M Poon...

Patients with Parkinson's disease are at higher risk of peri-operative medical and surgical complications. Multidisciplinary management, early recognition of potential complications, specialised care of medications and intra-operative protection of the vulnerable brain are all important aspects of the peri-operative management of patients with Parkinson's disease. Advances in continuous dopaminergic treatment, development of a peri-operative Parkinson's disease pathway and application of telemedicine are starting to play a role in improving peri-operative care. Management of patients with advanced Parkinson's disease is also evolving, with potential for incorporation of integrated care and changes in the anaesthetic management for deep brain stimulation surgery. There are new methods for localisation of target nuclei and increasing insight on the effects of anaesthetic drugs on microelectrode recordings and clinical outcomes. Parkinson's disease is a progressive disease, but management is improving with better peri-operative care for patients.

Topics: Anesthesia; Disease Management; Dopamine Agents; Humans; Monitoring, Intraoperative; Parkinson Disease; Perioperative Care

PubMed: 35001381
DOI: 10.1111/anae.15617

Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia.

Authors: A F Nimmo, A R Absalom, O Bagshaw...

Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia. Although total intravenous anaesthesia has advantages for some patients, the commonest technique used for maintenance of anaesthesia in the UK and Ireland remains the administration of an inhaled volatile anaesthetic. However, the use of an inhalational technique is sometimes not possible, and in some situations, inhalational anaesthesia is contraindicated. Therefore, all anaesthetists should be able to deliver total intravenous anaesthesia competently and safely. For the purposes of simplicity, these guidelines will use the term total intravenous anaesthesia but also encompass techniques involving a combination of intravenous infusion and inhalational anaesthesia. This document is intended as a guideline for safe practice when total intravenous anaesthesia is being used, and not as a review of the pros and cons of total intravenous anaesthesia vs. inhalational anaesthesia in situations where both techniques are possible.

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetists; Electroencephalography; Humans; Intensive Care Units; Magnetic Resonance Imaging; Practice Guidelines as Topic; Societies, Medical

PubMed: 30378102
DOI: 10.1111/anae.14428

Review

Authors: R Patel, J Kua, N Sharawi...

Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neuraxial anaesthesia; and the effect of mode of anaesthesia. We searched studies reporting inadequate neuraxial anaesthesia that used ≥ ED95 doses (effective dose in 95% of the population) of neuraxial local anaesthetic agents. Our primary outcome was the prevalence of inadequate neuraxial anaesthesia, defined as the need to convert to general anaesthesia; the need to repeat or abandon a planned primary neuraxial technique following incision; unplanned administration of intra-operative analgesia (excluding sedatives); or unplanned epidural drug supplementation. Fifty-four randomised controlled trials were included (3497 patients). The overall prevalence of requirement for supplemental analgesia or anaesthesia was 14.6% (95%CI 13.3-15.9%); 510 out of 3497 patients. The prevalence of general anaesthesia conversion was 2 out of 3497 patients (0.06% (95%CI 0.0-0.2%)). Spinal/combined spinal-epidural anaesthesia was associated with a lower overall prevalence of inadequate neuraxial anaesthesia than epidural anaesthesia (10.2% (95%CI 9.0-11.4%), 278 out of 2732 patients vs. 30.3% (95%CI 26.5-34.5%), 232 out of 765 patients). Further studies are needed to identify risk factors, optimise detection and management strategies and to determine long-term effects of inadequate neuraxial anaesthesia.

Topics: Anesthesia, Epidural; Anesthesia, General; Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Female; Humans; Pregnancy

PubMed: 35064923
DOI: 10.1111/anae.15657

Review

Authors: A J Fox, D J Rowbotham

Topics: Anesthesia; Anesthesia, Epidural; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics, Local; Humans; Laryngeal Masks; Laryngoscopes; Nausea; Vomiting

PubMed: 10463900
DOI: 10.1136/bmj.319.7209.557

Comparative Study Review

Authors: Gro Østgaard, Atle Ulvik

BACKGROUND

Paediatric anaesthesia comprises newborn, infants and children, necessitating a variety of techniques and approaches.

MATERIAL AND METHODS

This review is based on textbooks in paediatric anaesthesia, papers from major anaesthetic journals and many years of clinical experience.

RESULTS

Only a few Norwegian university hospitals have full-time paediatric anaesthesiologists. Anaesthesia in infants is associated with a higher frequency of morbidity and mortality than in adults; laryngospasm and emergency delirium are more common. Calculation of the amount of intravenous fluid and medication doses must be based on weight. Techniques such as mask inhalation for induction and caudal regional anaesthesia are used more frequently in children. Disease and congenital malformations can lead to anaesthetic problems. It is therefore important for the anaesthesiologist to have all available information preoperatively.

INTERPRETATION

Paediatric anaesthesia presents special challenges. Safe practice requires experience and knowledge of age-related anatomy, physiology and pathology.

Topics: Anesthesia; Anesthesiology; Child; Clinical Competence; Elective Surgical Procedures; Emergencies; Humans; Infant; Infant, Newborn; Norway; Patient Care Planning; Postoperative Complications; Preoperative Care; Risk Factors; Surgical Procedures, Operative

PubMed: 20379339
DOI: 10.4045/tidsskr.08.0529

Review

Authors: J A W Wildsmith

Topics: Anesthesia, Conduction; Anesthetics, Local; Humans

PubMed: 14705684
DOI: 10.1046/j.1365-2044.2003.03561.x

Authors: Daniel I Sessler

Intraoperative mortality is now rare. In contrast, 30-day postoperative mortality remains common, with most deaths occurring during the initial hospitalisation. The legacy of anaesthesiology will be determined by our success in dealing with postoperative mortality, which is currently the major problem in perioperative medicine. Carpe diem!

Topics: Anesthesia; Humans; Intraoperative Complications; Postoperative Complications

PubMed: 34949440
DOI: 10.1016/j.bja.2021.11.029

Review

Authors: T M Cook

The combined spinal-epidural technique has been used increasingly over the last decade. Combined spinal-epidural may achieve rapid onset, profound regional blockade with the facility to modify or prolong the block. A variety of techniques and devices have been proposed. The technique cannot be considered simply as an isolated spinal block followed by an isolated epidural block as combining the techniques may alter each block. This review concentrates on technical and procedural aspects of combined spinal-epidural. Needle-through-needle, separate-needle and combined-needle techniques are described and modifications discussed. Failure rates and causes are reviewed. The problems of performing a spinal block before epidural blockade (potential for unrecognised placement of an epidural catheter, inability to detect paraesthesia during epidural placement, difficulty in testing the epidural, delay in positioning the patient) are described and evaluated. Problems of performing spinal block after epidural blockade (risk of catheter or spinal needle damage) are considered. Mechanisms of modification of spinal blockade by subsequent epidural drug administration are discussed. The review considers choice of technique, needle type, patient positioning and paramedian vs. midline approach. Finally, complications associated with combined spinal-epidural are reviewed.

Topics: Anesthesia, Epidural; Anesthesia, Spinal; Anesthetics, Combined; Humans; Needles; Punctures

PubMed: 10594432
DOI: 10.1046/j.1365-2044.2000.01157.x

Authors: B McGuire, D N Lucas

Topics: Anesthesia, General; Anesthesia, Obstetrical; Female; Humans; Pregnancy

PubMed: 32144754
DOI: 10.1111/anae.14987

Authors: K J Chin, E R Mariano, K El-Boghdadly...

Topics: Anesthesia, Conduction; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Nerve Block

PubMed: 33426654
DOI: 10.1111/anae.15321