Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 5 Articles
Background/Objective: POCUS is an invaluable tool for anatomical variation assessment, guidance of invasive interventions, and diagnosis of critical conditions that may change the anesthesiologist’s plan of care. This technology increases success rate, decreases time to surgery, and maximizes outcomes. The objective of this pilot program evaluation was to identify the anesthesiologists’ systems and processes for utilizing POCUS in clinical decision-making for patients during the perioperative phases of care for improved outcomes. Materials/Methods: A Multivariate Analysis of Variance (MANOVA) was conducted to identify differences across groups (scan type). The independent variable was the type of POCUS examination. The dependent variables included the patient’s: (1) Perioperative Status; (2) Cardiothoracic Anesthesiologist’s Review of Patient History and Formulating the Clinical Question; (3) Overall Risk Potential; (4) Aspiration Potential; (5) Issues Related to Cardiovascular Hemodynamics; (6) Issues Related to Volume Status; (7) Clinical Question Answered by POCUS; (8) Change in Plan of Care; (9) Interventions; and (10) Pharmacological Interventions. Results: MANOVA findings (Wilks’ λ) identified a statistically significant interaction between POCUS scan type and the cardiothoracic anesthesiologist’s clinical decision-making (p < 0.0001). The following four criteria were statistically significant: (1) patients (64%) were examined with POCUS preoperatively (p < 0.05); (2) patients (95%) identified as having some type of overall risk potential (p < 0.05); (3) patients (36%) specifically identified as an aspiration risk (p < 0.0001); and (4) patients (41%) identified with issues related to cardiovascular hemodynamics (p < 0.001). Conclusions: POCUS is a proven imaging modality that is easy, portable, sensitive, and specific for identifying various anatomical landmarks. POCUS utilization in the perioperative setting has potential to have a profound impact on successful surgical completion....
Anesthetic gases represent a small but significant portion of the environmental impact of health care in many countries. These compounds include several fluorocarbons commonly referred to as “fluranes”. The fluranes are greenhouse gases (GHG) with global warming potentials in the hundreds to thousands and are also PFAS compounds (per- and polyfluorinated alkyl substances) according to at least one definition. Nitrous oxide (N2O) is sometimes used as an adjunct in anesthesia, or for sedation, but has a significant stratospheric ozone depletion potential as well as GHG effects. Reducing emissions of these compounds into the environment is, therefore, a growing priority in the health care sector. Elimination or substitution of the highest impact fluranes with alternatives has been pursued with some success but limitations remain. Several emission control strategies have been developed for fluranes including adsorption onto solids, which has shown commercial promise. Catalytic decomposition methods have been pursued for N2O emission control, although mixtures of fluranes and N2O are potentially problematic for this technology. All such emission control technologies require the effective scavenging and containment of the anesthetics during use, but the limited available information suggests that fugitive emissions into the operating room may be a significant route for unmitigated losses of approximately 50% of the used fluranes into the environment. A better understanding and quantification of such fugitive emissions is needed to help minimize these releases. Further cost–benefit and techno-economic analyses are also needed to identify strategies and best practices for the future....
Background and Objectives: To prove the feasibility of continuous spinal extraperitoneal robot-assisted laparoscopic radical prostatectomy (cseRALP) in order to expand the pool of eligible patients. Materials and Methods: According to IDEAL guidelines, a consecutive cohort of patients who underwent cseRALP was enrolled. Pre-, intra-, and post-operative data were collected, with particular focus on safety and oncological outcomes. Results: A total of three patients underwent this technique, with no intra- or post-operative medical complications. Only a grade 1 Clavien–Dindo complication was reported, small urinary leakage treated with an indwelling catheter. Oncological and functional results at month 3 were satisfactory, with no recurrence and no stress incontinence. Conclusions: cseRALP seems to be feasible and safe; further trials are mandatory....
Cauda equina nerve roots may become damaged during neuraxial anesthesia, and postpuncture headache may appear in the case of cerebrospinal fluid leakage if needle tips are deformed due to bone contact when several attempts are needed. Our aim was to verify the correlation between skin–transverse process distance (st) and skin–dural sac distance (d) for calculation of optimal angles in a free visual guide and as a reference for the maximal depth to be traversed by the needle. Randomly selected ex vivo samples (n = 10) were flexed to reproduce the position of the lumbosacral spine during spinal anesthesia. Spinal needles were inserted perpendicular to the skin either blindly or following the inferred paramedian angle corresponding to ultrasound-measured (d). After computed tomography and three-dimensional reconstruction, both (st) and (d) were measured, and the Pearson correlation index was calculated. A free 3D-PDF tool was used to illustrate the potential affectation of nerve cuffs by needles located lateral to the dural sac. Correlation between (d) and (st) was 0.84–0.93 at L4L5-L3L4 intervertebral levels, and most needle tips were located within the spinal canal, but some traversed the zone where nerve cuffs emerge. In conclusion, ultrasound may determine if a perpendicular needle insertion is viable at midline. If not, the optimal paramedian angle and maximal depth may be determined by measuring (st)....
Background Postoperative negative pressure pulmonary edema (NPPE) can occur in any patient undergoing general anesthesia. There are several risk factors for it, especially postoperative laryngospasm. The disease is usually benign and quickly reversible. In our case the severity and need for advanced critical care therapy was unusual. Case We report a severe case of postoperative negative pressure pulmonary edema in a 62-year-old male patient undergoing elective right-sided retroperitoneoscopic adrenalectomy. The patient developed a severe case of acute respiratory distress syndrome (ARDS) after postoperative laryngospasm, possibly in conjunction with a suspected anaphylactic reaction. The patient was consequently treated with a combination of invasive airway pressure release ventilation (APRV) and a prone positioning regimen. After drastic improvement in respiratory function, the patient was discharged from the intensive care unit after 10 days and from the hospital after 14 days. Conclusion NPPE is a rare but relevant complication of anesthesia and laryngospasm. The disease can basically occur in any patient undergoing general anesthesia and therefore should be considered....
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