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General Anesthesia


Presentation

  • In cardiac arrest survivors, postresuscitation myocardial stunning usually presents as either global left ventricular dysfunction or regional dyssynergy including the various forms of stress cardiomyopathy, in which rare variants may be difficult to diagnose[ncbi.nlm.nih.gov]
  • The subsequent organ damage that manifests in childhood and early adulthood presents a widely variable clinical picture of pain, hypertension, and cardiac, renal, nervous system, and lung dysfunction.[ncbi.nlm.nih.gov]
  • It is intended that the present case serve as a guide for fellow surgeons to identify and manage this syndrome. The present case was explained and a review of the literature was performed.[ncbi.nlm.nih.gov]
  • We report an 87-year-old woman who presented with unexpected systolic anterior motion (SAM) of the mitral valve after the induction of general anesthesia. She was receiving medication for hypertension and cerebral infarction.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: We present the case of a 32-year-old man with a 10-cm aneurysm in the ascending aorta. A total aortic arch replacement was planned.[ncbi.nlm.nih.gov]
Hypothermia
  • A myotonic crisis can be induced by numerous factors including hypothermia, shivering, and mechanical or electrical stimulation.[ncbi.nlm.nih.gov]
  • In turn this results in redistribution of body heat from core to periphery with subsequent rapid hypothermia during anaesthesia.[web.archive.org]
  • Severe hypothermia may result in coagulopathy, delayed awakening, or arrhythmia.[emedicine.medscape.com]
  • Temperature measurement to discern hypothermia or fever, and to allow early detection of malignant hyperthermia. Electroencephalography, entropy monitoring, or other systems may be used to verify the depth of anaesthesia.[en.wikipedia.org]
Short Stature
  • Noonan syndrome (NS) is an autosomal dominant disorder characterized by facial anomalies, short stature, chest deformity, congenital heart diseases, and other comorbidities.[ncbi.nlm.nih.gov]
Hoarseness
  • On the first postoperative day, she complained left sided tongue deviation, subtle hoarseness and swallowing difficulty.[ncbi.nlm.nih.gov]
  • Also, some people have a sore throat or hoarseness from the breathing tube inserted after the person is unconscious. Inserting the breathing tube can sometimes cause damage to a person's mouth or teeth, but this is uncommon.[northshore.org]
  • These include: Breathing problems Nausea and vomiting Sore throat or hoarseness (usually temporary) Allergic reaction to the anesthetic Irregular heartbeat (rare) Cardiac arrest (rare) Anesthesia safety Follow all instructions you are given for how long[fairview.org]
Chest Deformity
  • Noonan syndrome (NS) is an autosomal dominant disorder characterized by facial anomalies, short stature, chest deformity, congenital heart diseases, and other comorbidities.[ncbi.nlm.nih.gov]
Psychomotor Retardation
  • The typical clinical manifestations of PMD include psychomotor retardation, nystagmus, abnormal muscle tone, seizures, and cognitive impairment.[ncbi.nlm.nih.gov]
Amnesia
  • Under general anesthesia, the patient is unable to feel pain and may also have amnesia.[medicalnewstoday.com]
  • This involves achieving the desired elements of the 4 components of general anesthesia ala Woodbridge (1957): block of mental, reflex, sensory and motor function; or, the 3 A's of Anesthesia (with or without muscle relaxation): Amnesia (anxiolysis, ataraxia[web.archive.org]
  • Anesthesia causes amnesia. General anesthesia keeps you relaxed, blocks pain, and may also cause amnesia.[medicaldaily.com]
  • This medication may cause some amnesia. Even though you may be awake and talking it is possible that you will have no, or very little, memory of the actual operating room.[bouldervalleyanesthesiology.com]
  • General anesthesia also causes forgetfulness (amnesia) and relaxation of the muscles throughout your body.[northshore.org]
Agitation
  • It can also decrease postoperative pain and incidence of the emergence agitation. Due to the small number of studies, further clinical trials are needed to confirm these results.[ncbi.nlm.nih.gov]
  • The respiration recovery time and extubation time in Group P were significantly shorter than those in Group G (P 0.05); the incidence of agitation was significantly lower than that in Group G (P 0.05).[ncbi.nlm.nih.gov]
  • There is no consistent evidence to suggest a reduction in the phenomenon of emergence agitation. Evidence suggesting an improvement in behavioural outcomes at home is also inconsistent.[ncbi.nlm.nih.gov]
  • Ellerkmann, Postoperative Agitation im Kindesalter, Der Anaesthesist, 64, 5, (373), (2015). E. Ericsson, M. Brattwall and S.[doi.org]
  • To assess the level of sedation, the CAM-ICU utilizes the Richmond Agitation and Sedation Score which is a 10 point scale that provides discrete criteria for levels of sedation and agitation ( Ely et al 2003 ).[ncbi.nlm.nih.gov]
Stupor
  • The terms anaesthesia (Greek: without feeling) and narcosis (Greek: stupor, paralysis) were introduced soon after the discovery of etherization.[bja.oxfordjournals.org]
Altered Mental Status
  • General anesthesia or sedation can mask a hypoglycemia-altered mental status. Acute hypoglycemia might result in permanent brain injury.[ncbi.nlm.nih.gov]

Workup

  • Postoperative workup did not reveal any organic pathology. Unbeknown to the treating physicians, the patient had a comorbid untreated psychiatric history.[ncbi.nlm.nih.gov]
Burst Suppression
  • Demographic data, indication for surgery, clinical history, history of prior seizures, duration of surgery and duration of burst suppression were recorded. Cases where seizures were observed were analyzed in detail.[ncbi.nlm.nih.gov]
Hypercapnia
  • Severe hypercapnia is a rare but harmful complication of general anesthesia. We report the case of a newborn who developed severe hypercapnia with unknown reasons during general anesthesia but recovered well.[ncbi.nlm.nih.gov]
  • Performing meta-analyses on hypertension, hypercapnia and hypoxemia was not possible.[ncbi.nlm.nih.gov]
  • 50 kg/m(2)) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia[ncbi.nlm.nih.gov]
  • . • Cardiac arrhythmias: serious if hypercapnia develops due to hypoventilation and an increase in the plasma concentration of catecholamines) • Hypotensive effect (phenylephrine recommended) • Hepatotoxic: is oxidatively metabolized in the liver to tissue[slideshare.net]
Glucose Increased
  • RESULTS: Resting energy expenditure (B1: 1230 228; B2: 1317 282; C: 1012 153 kcal/h; B2 vs C, P CONCLUSIONS: The administration of amino acids and glucose increased measured energy expenditure, alleviated nitrogen balance, and may decrease the length[ncbi.nlm.nih.gov]
Right Bundle Branch Block
  • Abstract Brugada Syndrome is a genetic cardiac disease characterized by electrocardiogram changes consisting of an incomplete right bundle branch block, and ST-segment elevations in right precordial leads V1-V3.[ncbi.nlm.nih.gov]

Treatment

  • Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian.[ncbi.nlm.nih.gov]
  • […] trial, Sedation versus Intubation for Endovascular Stroke Treatment (SIESTA).[ncbi.nlm.nih.gov]
  • His treatment procedure was performed by a dental surgeon, a hematologist, and an anesthesiologist.[ncbi.nlm.nih.gov]
  • Here we describe dental treatment under general anesthesia performed for a 28-year-old man with NS. He had characteristic features of NS along with mild pulmonary valve stenosis.[ncbi.nlm.nih.gov]

Prognosis

  • Abstract Postoperative acute kidney injury is associated with high mortality and poor prognosis.[ncbi.nlm.nih.gov]
  • The separation phenomenon of decrease in PETCO2 and increase in PaCO2 might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis.[ncbi.nlm.nih.gov]
  • Outlook (Prognosis) General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. References Cohen NH. Perioperative management.[mountsinai.org]
  • Fetal prognosis after anesthesia during gestation. Analg. 42;521-6 Shnider, SM, Webster, GM. 1965. Maternal and fetal hazards of surgery during pregnancy. Am. J. Obstet. Gynecol. 92;891-900. Sylvester, GC, et al. 1994.[mothertobaby.org]

Etiology

  • The specific etiology of this condition is widely speculated.[ncbi.nlm.nih.gov]
  • She was evaluated for alternative etiologies of her optic neuropathy, with negative results. She was found to have mild hypercholesterolemia, which was not known prior to surgery.[ncbi.nlm.nih.gov]
  • The etiologic diagnosis of perioperative anaphylaxis relies on a triad including clinical, biologic, and allergologic evidence.[doi.org]
  • Furthermore, it allows the identification of an etiologic relation between the outcome and multiple risk factors.[anesthesiology.pubs.asahq.org]

Epidemiology

  • BACKGROUND: Epidemiological data demonstrate that the worldwide prevalence of chronic obstructive pulmonary disease is increasing. These patients have an increased risk of mortality and morbidity and have constant limitations in airflow.[ncbi.nlm.nih.gov]
  • This systematic review and meta-analysis will be performed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA[ncbi.nlm.nih.gov]
  • (Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia); Rodney W. Hunt, Ph.D.[anesthesiology.pubs.asahq.org]
  • In fact, they have created their own section called Epidemiology and Safety. The other direction the Foundation went was to publish a quarterly Anesthesia Patient Safety Foundation Newsletter which has been immensely successful.[web.archive.org]
  • The Epidemiology of Valvular Heart Disease: a Growing Public Health Problem. Heart Fail Clin. 2006;2(4):379–93. pmid:17448426 View Article PubMed/NCBI Google Scholar 2. Hannan EL, Samadashvili Z, Stamato NJ, Lahey SJ, Wechsler A, Jordan D, et al.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • Our aim was to discuss the causes of sudden cardiac arrest during the perioperative period in apparently healthy patients and the pathophysiology of anomalous origin of the coronary arteries as a cause of sudden cardiac arrest.[ncbi.nlm.nih.gov]
  • Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under[ncbi.nlm.nih.gov]
  • Pathophysiologic Elements Anaphylaxis occurring during the perioperative period is a clinical syndrome involving multiple organ systems.[doi.org]
  • The underlying pathophysiology of delirium in general, and PD specifically, remains elusive.[anesthesiology.pubs.asahq.org]
  • Mehdi Ghasemi, Cristy Phillips, Ludwig Trillo, Zurine De Miguel, Devsmita Das and Ahmad Salehi, The role of NMDA receptors in the pathophysiology and treatment of mood disorders, Neuroscience & Biobehavioral Reviews, 47, (336), (2014).[doi.org]

Prevention

  • The purpose of early intervention in these cases is to facilitate oral feeding and prevent temporomandibular joint ankylosis.[ncbi.nlm.nih.gov]
  • Effective management of ammonia levels in this patient using preoperative hydration and dexmedetomidine as an adjunct to general anesthesia may have helped to prevent delayed emergence.[ncbi.nlm.nih.gov]
  • The aim of this study was to assess the ability of hydroxyethyl starch (HES) 130/0.4 to prevent hypotension and decreased CO during the induction of general anesthesia.[ncbi.nlm.nih.gov]
  • Early evaluation is vital to preventing the consequences of severe early childhood caries.[ncbi.nlm.nih.gov]
  • For preventing life-threatening bradycardia and asystole by vagal reflex, we suggest the use of atropine prior to the operations in patients undergoing abdominal or ophthalmic surgery, where vagal reflex may occur.[ncbi.nlm.nih.gov]

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