Point-of-Care Ultrasonography: A

Until a few years ago to determine the depth of anesthesia, the anesthetists exploited only a series of physical signs of the patient. In 1994, Sigland Chamoun described a novel measure of the level of consciousness during general anesthesia: the Bispectral (BIS) analysis. It was the beginning of a revolution in anesthesia monitoring, indeed during the last 15-20 years a number of EEG-based technologies have become commercially available. Unfortunately, none of these technologies has definitively solved the problem of the anesthesia awareness, thus assessment of depth of anesthesia is still a serious problem. Through these considerations this work focuses on new perspectives in brain monitoring.

Complex does not mean complicated. Despite some controversies in its definition, complex systems features include coupled rule-independent subsystems which emerge a counterintuitive or difficult to understand phenomena.

Purpose: Intravitreal injection (IVI) pain is controlled by various methods; none is demonstrably superior. This prospective trial compared pain in patients undergoing IVI with topical anesthesia with or without 2% lidocaine gel.

Methods: Patients over 40 years scheduled for atleast two IVIs in one eye were included. Initial anesthesia was 0.5% proparacaine/hydroxyl propyl methyl cellulose or 0.5% proparacaine/2% lidocaine gel. Patients answered questionnaires about discomfort during blepharostat positioning and IVI pain from 0-10. Thirty days later, patients received the other anesthesia for the second IVI. Corneal and conjunctival staining with lissamine green and fluoresce in was evaluated on the first post operative day using the Oxford scale.

Results: Forty patients were included, comprising 18 men and 22 women (mean age, 68.15±10.38 years). There was no significant difference in age (p=0.880) or sex (p=0.635); significance was shown between diagnostic frequencies (p < 0.001). Mean pain scores during blepharostat placement were 0.75±0.98 and 0.50±0.75 in the placebo and lidocaine groups, respectively (p=0.040); during IVI, they were 1.35±1.09 and 0.95±0.96, respectively (p=0.017). The placebo and lidocaine groups differed significantly in satisfaction; 45% and 70% were very satisfied, respectively (p=0.031). There was no significant difference between groups in regard to keratitis mean score (p=0.897) and lissamine green staining (p=0.397).

Conclusion: Lidocaine gel has important benefits over standard topical anesthetics and relieves IVI pain.

The detection rate of neonatal ovarian cysts increased since routine antenatal ultrasound has been implemented. These cysts are generally asymptomatic during prenatal and antenatal period, they often regress spontaneously, and it was reported that big ones which have diameter larger than 4-5 cm have the risk of ovarian necrosis due to torsion, urinary tract compression, vena cava compression and cyst rupture.

Treatment with laparoscopic surgery have advantages such as better cosmetic outcomes, less fluid and heat loss, fast recovery and less postoperative pain.

Newborns have some specific features of anesthetic management because of their specific physiological features. We aimed to present of anesthetic experiences in newborns with giant ovarian cysts who were treated with laparoscopic surgery.

Anticoagulation for cardiopulmonary bypass is maintained with heparin. The primary mechanism of action of this drug is the activation of antithrombin III, which prevents thrombin transformation from prothrombin. Thus, it reduces the formation of clot. However, in some cases, despite a standard heparin dose, the intended active coagulation time cannot be obtained which is known as heparin resistance. Heparin resistance occurs in up to 22% of patients undergoing cardiac surgery requiring cardiopulmonary bypass and it is associated with decreased levels of antithrombin. Heparin resistance, although seen rare, can occur in varying severity in clinic. Treatment options for heparin resistance include administration of antithrombin or fresh frozen plasma. In this case presentation, we have reported the strategy for a planned pulmonary artery reconstruction operation under cardiopulmonary pypass in a patient that we could not maintain the adequate ACT levels despite a cumulative dose of 12 mg/kg heparin and 20 ml/kg fresh frosen plasma transfusion.

A 51-year-old man with obstructive jaundice who underwent an endoscopic retrograde cholangiopancreatography (ERCP).

A 6 month old patient with multiple congenital anomalies and adrenal neuroblastoma with hepatic metastasis underwent subclavian port placement under general anesthesia. During routine placement of the device into the vessel the patient developed acute hypotension progressing to bradycardic arrest due to cardiac tamponade. Hemodynamic compromise resolved immediately after pericardiocentesis and placement of a pericardial drain. This rare complication of central access placement should be considered with hemodynamic changes during these procedures.

Pain management in patients who have undergone hip surgery is a difficult and challenging aspect of post operative care. The Fascia Iliaca Compartment Block (FICB), placed either prior to, or after hip surgery, as a means to control post-operative pain, has been well defined in the evidence to be a very successful approach in controlling post-operative pain. The use of this block reduces opioid requirements and incidents of delirium in elderly patients. The evidence compares FICB to alternative approaches such as neuraxial anesthesia and General Anesthesia (GA). Among the benefits for the anesthetist performing the FICB is the relative technical ease of placing the block, and cost the established efficacy. A review of the current evidence regarding the use of FICB demonstrates that the FICB is highly effective in controlling post-operative pain following hip surgeries.

According to the National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center, the overall prevalence of chronic kidney disease is approximately 14 percent in the general population of the United States [1] This prevalence has remained relatively stable since 2004 [1] with approximately 468,000 Americans on dialysis as of 2015. [2] With diabetes and hypertension being the most common primary causes of End-Stage Renal Disease (ESRD), patients undergoing procedures for arteriovenous access tend to present with multiple co morbidities. For this specific patient population, these comorbidities may have specific anesthetic implications. This article focuses on the anesthetic considerations throughout the entire perioperatively period with special emphasis on the role of regional anesthesia.

Background: For patients undergoing spinal fusion, anesthesiologists are required to provide adequate intraoperative anesthesia that is conducive to swift emergence, patient comfort and reproducible participation in the neurological examination. The use of intraoperative low-dose ketamine infusion as part of the anesthetic regimen for spinal fusion surgery has waxed and waned in popularity. We analyzed a study to compare the effectiveness of low-dose ketamine in spinal fusion surgery in patients with idiopathic scoliosis.

Methods: A retrospective study was conducted to analyze 49 patients who underwent spinal fusion using one of the two TIVA protocols: propofol with Remifentanil (Protocol A), and propofol with Remifentanil in addition to low-dose ketamine infusion (Protocol B).

Results: Low-dose ketamine infusion did not improve post-operative pain scores, but patients were less sedated, and more neurologically intact when they arrived in the PACU.

Conclusion: We adapted our practice to include intraoperative infusion of low-dose of ketamine attempting to reduce intraoperative anesthetic requirements and to improve the recovery state. Our results demonstrate the benefit of low-dose intraoperative ketamine in prompt postoperative recovery in pediatric spinal fusion surgery.