Hemodynamics during epidural anesthesia in combination with transcranial electroanesthesia in pulmonary surgery

Pulmonary surgery performed under epidural anesthesia (EA) combined with transcranial electrical anesthesia (TEA) was characterized by minimum adverse hemodynamic reactions, typical of EA alone, and reduced overall dose of the local anesthetic with minimum volume of the infusion therapy and adequate anesthetic protection. The absence of marked hemodynamic reactions in this type of combined anesthesia made it possible to use it during pulmonary surgery in the most severely ill patients whose cardiovascular system is already compromised by the primary pulmonary disease.     

Perioperative management of the bariatric surgery patient: focus on cardiac and anesthesia considerations

Obesity is a major public health problem in developed nations worldwide. Currently, the only treatment for severe obesity (BMI > or = 35 kg/m2 with comorbidity) that provides long-term weight loss is bariatric surgery. Restrictive, malabsorptive, and combination procedures have been developed. Each type of procedure has its merits and unique set of risks and complications. Weight loss after bariatric surgery is accompanied by predictable improvement or resolution of obesity-related comorbidities and improved quality of life and life expectancy. Candidates for bariatric surgery are often at high risk for complications because of obesity-related comorbidities. Therefore, careful patient selection for bariatric surgery, together with well-designed strategies for preventing and managing complications, are keys to success. Close monitoring for nutritional deficiencies and short- and long-term complications is required to completely assess outcomes of these procedures.     

Using EEG to monitor anesthesia drug effects during surgery

The use of processed electroencephalography (EEG) using a simple frontal lead system has been made available for assessing the impact of anesthetic medications during surgery. This review discusses the basic principles behind these devices. The foundations of anesthesia monitoring rest on the observations of Guedel with ether that the depth of anesthesia relates to the cortical, brainstem and spinal effects of the anesthetic agents. Anesthesiologists strive to have a patient who is immobile, is unconscious, is hemodynamically stable and who has no intraoperative awareness␣or recall. These anesthetic management principles apply today, despite the absence of ether from the available anesthetic medications. The use of the EEG as a supplement to the usual monitoring techniques rests on the observation that anesthetic medications all alter the synaptic function which produces the EEG. Frontal EEG can be viewed as a surrogate for the drug effects on the entire central nervous system (CNS). Using mathematical processing techniques, commercial EEG devices create an index usually between 0 and 100 to characterize this drug effect. Critical aspects of memory formation occur in the frontal lobes making EEG monitoring in this area a possible method to assess risk of recall. Integration of processed EEG monitoring into anesthetic management is evolving and its ability to characterize all of the anesthetic effects on the CNS (in particular awareness and recall) and improve decision making is under study.Leslie C. Jameson, Tod B. Sloan. Using EEG to monitor anesthesia drug effects during surgery.     

非体外循环下冠状动脉搭桥术的麻醉管理

目的分析非体外循环下冠状动脉搭桥术OPCABG血流动力学的变化,探讨OPCABG的麻醉管理。方法择期行OPCABG的冠心病患者120例,年龄48～76岁,射血分数平均（0．53±0．32）,术前放置漂浮导管,监测血液动力学变化,分别在开胸前（T0）、吻合前降支（T1）、吻合回旋支（T2）、吻合对角支（L）、吻合右冠状动脉（T4）、心脏恢复原位置后（L）分别记录MAP、HR、CVP、PCWP、CI、CO、Sv02、SVRI、PVRI、LVSWI、RVSWI。结果吻合前降支时CI、LVSWI下降,PVRI增高,SvO2正常。吻合回旋支、对角支、右冠状动脉时,CI、CO、LVSWI、RVSWI、SvO2明显下降（P〈0．01）,而HR、CVP、PCWP、PVRI增高（P〈0．05）。结论术者翻动心脏可导致明显血流动力学变化,动作要轻,采取必要的心血管功能支持,避免发生严重低血压和心率失常。     

General anesthesia vs combined anesthesia during internal carotid artery surgery

Methods 50 patients underwent surgery on internal carotid artery. The first group of patients were performed combined anesthesia with Propofol , Phentanil and superficial cervical plexus block (SCPB). Second group were administrated Phentanil and Propofol. Monitoring: blood pressure, BIS, dose of anesthetic agents. Results of study indicated that combined method of anesthesia with SCPB provided better brain perfusion because of high level of MBP (mean blood pressure) at the time of occlusion of ICA and more stable hemodynamic indices. In addition second group of patient had longer period of recovery due to higher dose of Phentanil than the first group. CONCLUSION: Combined anesthesia with propofol, phentanil and CPB provides better analgesia and require less dose of opiodes anesthetics.     

General anesthesia during surgery of breast cancer]

In 1982-1989 intravenous anesthesia was performed to 1160 patients operated on for breast cancer. Intravenous analgesia has a number of advantages over endotracheal anesthesia. The analgesic techniques have been compared. Absence of complications in the operative and postoperative periods, prompt recovery of the patients' physical and psychic activity following intravenous anesthesia make it a method of choice for surgical treatment of cancer patients who require no myorelaxation.     

Cornerstones of patient blood management in surgery

Pre‐operative anaemia and perioperative red blood cell transfusion carry significant consequence when it comes to surgical outcomes. The establishment of patient‐centred clinical pathways has been designed to harness and endorse good transfusion practice, termed the three pillars of patient blood management (PBM). These focus on the timely and appropriate management of anaemia, prevention of blood loss and restrictive transfusion where appropriate. This article reviews the current evidence and ongoing research in the field of PBM in surgery. Strategies to implement PBM have shown significant benefits in appropriate transfusion practice, reduced costs and improved length of hospital stay. Recently published national quality standards have recognised the features of the PBM blueprint such as the consideration of alternatives to red blood cell transfusion, the active measures to reduce perioperative blood loss and the appropriate management of post‐operative anaemia. Adopting PBM in surgical patients should be paramount to reduce the risks posed by perioperative anaemia and blood transfusions. The principles of PBM help structure the interventions and decisions relating to anaemia and blood transfusion, but, more importantly, represent a paradigm shift towards a more considered approach to blood transfusion, acknowledging its risks, preventatives and alternatives.     

Regional anesthesia: management considerations in the trauma patient

From peripheral nerve blocks to central neuraxis blocks, regional anesthesia offers a wide range of options for the comprehensive management of trauma victims. Experience during wars and with mass casualties has proven the safety and efficiency of regional techniques. In this article, authors review the merit of these techniques to advance the quality of patient care. They also suggest the need to improve the selection of techniques, ranging from the prehospital phase to long-term rehabilitation.     

General anesthesia: management considerations in the trauma patient

Endotracheal intubation and mechanical ventilation are vital components of the resuscitation of the most seriously injured patients and those suffering from multisystem trauma. Therefore, general anesthesia administered both intravenously and endotracheally becomes the anesthetic of choice for most of this patient population. Endotracheal intubation and anesthetic induction techniques are designed to protect the patient's cervical spinal cord from injury and his or her airway from aspiration of gastric contents. Anesthetic drugs are chosen to minimize cardiovascular depression, to maximize oxygen delivery to the tissues, and to decrease intracranial pressure. Monitoring techniques include the basic noninvasive monitoring set forth in the American Society of Anesthesiologist's standards, as well as invasive cardiac monitoring via arterial catheters and pulmonary artery catheters. Attention to detail in the recovery room will continue the success of a well-conducted general anesthetic for the trauma patient.     

Special anesthesia considerations for the elderly plastic surgery patient.

Elderly patients may be at greater risk for perioperative complications and mortality due to an increased prevalence of age-related concomitant diseases, often more than one at a time, and a basic decline in organ functioning over time. Risks associated with age in the plastic surgery population may be minimized by a better understanding of the physiologic changes as well as the preoperative and postoperative considerations in caring for this special group of patients. The purpose of this article is to review the changes that occur with aging and the nursing care implications necessary to minimize the associated risks with anesthesia and plastic surgery.     

重度肺动脉高压患者全身麻醉下行肺叶切除术的护理

总结了1例重度肺动脉高压患者在全身麻醉下行肺叶切除术的护理经验.对患者进行严密的围术期护理,留王肺动脉导管监测肺血流动力学,应用伊洛前列素等肺血管扩张剂预防肺动脉高压危象的发生,对已发生的肺动脉高压危象进行积极处理,患者恢复,顺利出院.     

Pain management in oncological patients: a Turkish perspective

There are some practical and conceptual differences between the university hospitals and state hospitals in Turkey. Both the lack of knowledge among health care workers and some cultural values influence management of pain in cancer patients. Hopefully, in accordance with the development in many fields, nursing has also taken its part in the overall improvement in our country. The subject of pain control is included in the training programs of nursing schools that are giving education at the university level. Moreover, the Turkish Oncology Nurses Association is planning in-service education dealing with pain control of cancer patients.     

Optimising patient management before and after surgery

Enhanced recovery involves the implementation of several evidence-based interventions concurrently in pathways of care for surgery, rather than individually, to ensure they have a greater impact on patient outcomes. This article explains the enhanced recovery pathway and discusses some of its benefits.