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Minerva Anestesiologica Mar 2020
Topics: Anesthesiologists; Anesthesiology; Anesthetics; Electroencephalography; Humans; Monitoring, Intraoperative
PubMed: 32191408
DOI: 10.23736/S0375-9393.20.14297-4 -
Anesthesiology Feb 2020
Topics: Anesthesia; Anesthesiology; Anesthetics
PubMed: 31939836
DOI: 10.1097/ALN.0000000000003088 -
Brazilian Journal of Anesthesiology... 2021The first anesthetic machines appeared following their public demonstration by Morton in 1846. These initial devices were simple inhalers based on the evaporation of the... (Review)
Review
The first anesthetic machines appeared following their public demonstration by Morton in 1846. These initial devices were simple inhalers based on the evaporation of the anesthetic agent. Their main problem was the loss of effectiveness with cooling. More complex inhalers were subsequently developed, in which the main difference was the possibility to provide more than one agent. Moreover, the concentration of the inhaled anesthetic was regulated for greater efficiency. At the beginning of the twentieth century, gas machines emerged, allowing the application of an anesthetic flow independent of the patient's inspiratory effort. These machines incorporated technological advances such as flow meters, carbon dioxide absorption systems and fine adjustment vaporizers. In this period, in the field of thoracic surgery, intraoperative artificial ventilation began to be employed, which helped overcome the problem of pneumothorax associated with open pleura by applying positive pressure. From the 1930s, the gas machines were fitted with a ventilator, and by the 1950s this had become a basic component of the anesthesia system. Later still, in the 1980s, alarm and monitoring systems were incorporated, giving rise to the current generation of workstations.
Topics: Anesthesiology; Anesthetics; Humans; Nebulizers and Vaporizers; Respiration, Artificial; Ventilators, Mechanical
PubMed: 33894858
DOI: 10.1016/j.bjane.2021.02.017 -
British Journal of Anaesthesia Dec 2015Screen-based simulation can improve patient care by giving novices and experienced clinicians insight into drug behaviour. Gas Man(®) is a screen-based simulation... (Review)
Review
Screen-based simulation can improve patient care by giving novices and experienced clinicians insight into drug behaviour. Gas Man(®) is a screen-based simulation program that depicts pictorially and graphically the anaesthetic gas and vapour tension from the vaporizer to the site of action, namely the brain and spinal cord. The gases and vapours depicted are desflurane, enflurane, ether, halothane, isoflurane, nitrogen, nitrous oxide, sevoflurane, and xenon. Multiple agents can be administered simultaneously or individually and the results shown on an overlay graph. Practice exercises provide in-depth knowledge of the subject matter. Experienced clinicians can simulate anaesthesia occurrences and practices for application to their clinical practice, and publish the results to benefit others to improve patient care. Published studies using this screen-based simulation have led to a number of findings, as follows: changing from isoflurane to desflurane toward the end of anaesthesia does not accelerate recovery in humans; vital capacity induction can produce loss of consciousness in 45 s; simulated context-sensitive decrement times explain recovery profiles; hyperventilation does not dramatically speed emergence; high fresh gas flow is wasteful; fresh gas flow and not the vaporizer setting should be reduced during intubation; re-anaesthetization can occur with severe hypoventilation after extubation; and in re-anaesthetization, the anaesthetic redistributes from skeletal muscle. Researchers using screen-based simulations can study fewer subjects to reach valid conclusions that impact clinical care.
Topics: Anesthesia, Inhalation; Anesthesiology; Anesthetics, Inhalation; Computer Graphics; Computer Simulation; Education, Medical, Graduate; Humans; Quality Improvement
PubMed: 26658205
DOI: 10.1093/bja/aev370 -
British Journal of Anaesthesia Dec 2017Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug... (Review)
Review
Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects. Recently, questions around neonatal neurotoxicity, delirium and postoperative cognitive dysfunction have stimulated research to characterise these phenomena and explain them in mechanistic terms. Emergent basic science from these enquiries together with exploration of possible effects of anaesthetic drug choice on patient outcomes from cancer surgery may yield new targets for drug discovery.
Topics: Anesthesiology; Anesthetics, Inhalation; Anesthetics, Intravenous; Desflurane; Humans; Hypnotics and Sedatives; Thiopental
PubMed: 29161390
DOI: 10.1093/bja/aex328 -
Anaesthesiology Intensive Therapy 2014Conjoined twins have been a source of fascination to the public and the medical profession for centuries. Their birth was initially viewed as an ominous sign of... (Review)
Review
Conjoined twins have been a source of fascination to the public and the medical profession for centuries. Their birth was initially viewed as an ominous sign of impending disaster. Since Middle Ages into the 19th century they were regarded as monstrosities and were exhibited at circuses and sideshows. The frequency of conjoined twins is approximately 1 in 50,000 gestation, but many of them die in utero, are terminated or stillborn. The true incidence is estimated to be 1 in 200,000 live births. This article gives an overview of Siamese twins and of the prenatal diagnosis in assessing the prognosis, anaesthetic and post-natal surgical management and outcome. Anaesthesia for conjoined twins surgery, whether prior to or for separation, is an enormous challenge to the anaesthesiologist. The site and complexity of the conjunction affect management of the airway, an intravenous access, the extent of blood and number of surgical specialties involved. Preoperative assessment and planning with interdisciplinary communication and cooperation is vital to the success of the operations. Meticulous attention to detail, monitoring and vigilance are mandatory.
Topics: Anesthesia; Anesthesiology; Anesthetics; Cooperative Behavior; Female; Humans; Incidence; Interdisciplinary Communication; Pregnancy; Prenatal Diagnosis; Prognosis; Twins, Conjoined
PubMed: 24858973
DOI: 10.5603/AIT.2014.0023 -
Minerva Anestesiologica Jan 2019
Topics: Anesthesia; Anesthesiology; Anesthetics, Inhalation; Xenon
PubMed: 30394076
DOI: 10.23736/S0375-9393.18.13303-7 -
Anaesthesia Sep 2022Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation...
Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation represents an important opportunity for much needed leadership from the health community, addressing a threat that will directly and seriously impact the health and well-being of current and future generations. Inhalational anaesthetics are a significant contributor to healthcare-related greenhouse gas emissions and minimising their climate impact represents a meaningful and achievable intervention. A challenge exists in translating well-established knowledge about inhalational anaesthetic pollution into practical action. CODA is a medical education and health promotion charity that aims to deliver climate action-oriented recommendations, supported by useful resources and success stories. The CODA-hosted platform is designed to maximise engagement of the global healthcare community and draws upon diverse experiences to develop global solutions and accelerate action. The action guidance for addressing pollution from inhalational anaesthetics is the subject of this article. These are practical, evidence-based actions that can be undertaken to reduce the impact of pollution from inhalational anaesthetics, without compromising patient care and include: removal of desflurane from drug formularies; decommissioning central nitrous oxide piping; avoidance of nitrous oxide use; minimising fresh gas flows during anaesthesia; and prioritising total intravenous anaesthesia and regional anaesthesia when clinically safe to do so. Guidance on how to educate, implement, measure and review progress on these mitigation actions is provided, along with means to share successes and contribute to the essential, global transition towards environmentally sustainable anaesthesia.
Topics: Anesthesia, Inhalation; Anesthesiology; Anesthetics, Inhalation; Humans; Nitrous Oxide
PubMed: 35729804
DOI: 10.1111/anae.15785 -
Anaesthesia Jan 2000
Topics: Anesthesiology; Anesthetics; Equipment Design; Equipment Safety; History, 20th Century; Humans; United Kingdom
PubMed: 10594424
DOI: 10.1046/j.1365-2044.2000.01283.x -
BioMed Research International 2021Perioperative bleeding is one of the major comorbidities associated with surgery. While anesthesia is a critical component to perform surgery, a number of clinical... (Review)
Review
Perioperative bleeding is one of the major comorbidities associated with surgery. While anesthesia is a critical component to perform surgery, a number of clinical studies supported the contribution of anesthetic drugs to perioperative bleeding. Here, we reviewed the literature on this topic including the underlying mechanism and discussed the future direction on coagulation research in anesthesia.
Topics: Anesthesia; Anesthesiology; Anesthetics; Blood Coagulation; Desflurane; Hemorrhage; Hemostasis; Humans; Isoflurane; Perioperative Care; Propofol; Risk Factors; Sevoflurane; Xenon
PubMed: 34036098
DOI: 10.1155/2021/5510634