865 results match your criteria anaesthesia titration

A One-Day Prospective National Observational Study on Sedation-Analgesia of Patients with Brain Injury in French Intensive Care Units: The SEDA-BIP-ICU (Sedation-Analgesia in Brain Injury Patient in ICU) Study.

Neurocrit Care 2021 Jul 30. Epub 2021 Jul 30.

Anesthesia and Intensive Care, Bretonneau University Hospital, Tours, France.

Background: Sedation/analgesia is a daily challenge faced by intensivists managing patients with brain injury (BI) in intensive care units (ICUs). The optimization of sedation in patients with BI presents particular challenges. A choice must be made between the potential benefit of a rapid clinical evaluation and the potential exacerbation of intracranial hypertension in patients with impaired cerebral compliance. Read More

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Age, minimum alveolar concentration and choice of depth of sedation monitor: examining the paradox of age when using the Narcotrend monitor: A secondary analysis of an observational study.

Eur J Anaesthesiol 2021 Jul 26. Epub 2021 Jul 26.

From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern (DH, CS, MH, FS, HAK) and Department of General Internal Medicine, Canton Hospital Frauenfeld, Frauenfeld, Switzerland (CS).

Background: With an ageing global population, it is important to individualise titration of anaesthetics according to age and by measuring their effect on the brain. A recent study reported that during general surgery, the given concentration of volatile anaesthetics, expressed as a fraction of the minimum alveolar concentration (MAC fraction), decreases by around only 3% per age-decade, which is less than the 6% expected from age-adjusted MAC. Paradoxically, despite the excessive dosing, Bispectral index (BIS) values also increased. Read More

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Protein Binding and Population Pharmacokinetics of Dexmedetomidine after Prolonged Infusions in Adult Critically Ill Patients.

Clin Ther 2021 Jul 22. Epub 2021 Jul 22.

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.

Purpose: Dexmedetomidine (DEX) is a highly selective α-adrenoceptor agonist with high protein binding of 94%. Critical illness may affect protein binding and the pharmacokinetic (PK) parameters of many drugs, including DEX. In critically ill patients receiving prolonged infusions of DEX, there is little information documenting the relationship between key pathophysiologic factors and DEX protein binding or PK parameters. Read More

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Inflammatory Biomarkers Are Associated With a Decline in Functional Status at Discharge in Children With Acute Respiratory Failure: An Exploratory Analysis.

Crit Care Explor 2021 Jul 13;3(7):e0467. Epub 2021 Jul 13.

Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

To evaluate the link between early acute respiratory failure and functional morbidity in survivors using the plasma biomarkers interleukin-8, interleukin-1 receptor antagonist, thrombomodulin, and plasminogen activator inhibitor-1. We hypothesized that children with acute respiratory failure with higher levels of inflammation would have worse functional outcomes at discharge, as measured by Pediatric Overall Performance Category.

Design: Secondary analysis of the Genetic Variation and Biomarkers in Children with Acute Lung Injury (R01HL095410) study. Read More

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Effect of electroencephalogram-guided anaesthesia administration on 1 yr mortality: 1 yr follow-up of a randomised clinical trial.

Br J Anaesth 2021 Jul 6. Epub 2021 Jul 6.

Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.

Background: Intraoperative EEG suppression duration has been associated with postoperative delirium and mortality. In a clinical trial testing anaesthesia titration to avoid EEG suppression, the intervention did not decrease the incidence of postoperative delirium, but was associated with reduced 30 day mortality. The present study evaluated whether the EEG-guided anaesthesia intervention continued to be associated with reduced 1 yr mortality. Read More

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Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation.

BMC Anesthesiol 2021 Jun 29;21(1):183. Epub 2021 Jun 29.

Department of Anesthesiology, Perioperative and Pain Medicine- Icahn School of Medicine at Mount Sinai, New York, USA.

Background: Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion.

Methods: In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Read More

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Adequacy of Anesthesia Guidance for Colonoscopy Procedures.

Pharmaceuticals (Basel) 2021 May 14;14(5). Epub 2021 May 14.

Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-555 Katowice, Poland.

In patients undergoing colonoscopy procedures (CPs), inadequate dosing of hypnotic drugs (HD) and opioid analgesics (OA) during intravenous sedoanalgesia (ISA) may lead to intraprocedural awareness with recall (IAwR), intraprocedural (IPP) and postprocedural pain (PPP), as well as postoperative nausea and vomiting (PONV). The aim of this study was to evaluate whether the titration of HD and OA based on the observance of changing values of state entropy (SE) and surgical pleth index (SPI) (adequacy of anesthesia-AoA), state entropy alone, or standard practice may reduce the number of adverse events. One hundred and fifty-eight patients were included in the final analysis. Read More

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Clinical Practice: Should we Radically Alter our Sedation of Critical Care Patients, Especially Given the COVID-19 Pandemics?

Rom J Anaesth Intensive Care 2020 Dec 4;27(2):43-76. Epub 2021 Jan 4.

Hôpital d'Instruction des Armées Desgenettes, Lyon, France.

The high number of patients infected with the SARS-CoV-2 virus requiring care for ARDS puts sedation in the critical care unit (CCU) to the edge. Depth of sedation has evolved over the last 40 years (no-sedation, deep sedation, daily emergence, minimal sedation, etc.). Read More

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December 2020

Oxygen Reserve Index Guided Oxygen Titration in One Lung Ventilation With Low Fresh Gas Flow.

Turk J Med Sci 2021 May 30. Epub 2021 May 30.

Background/aim: The decrease in Oxygen Reserve Index (ORI) provides a prediction for the development of hypoxemia and hyperoxia. Our aim is to determine the effect of ORI-guided oxygen titration on hyperoxemia-mediated morbidity.

Materials And Methods: Consecutive 120 ASA I-III patients, 18-70 years of age, without severe obstruction or restriction, undergoing one lung ventilation (OLV), were included. Read More

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The influence of age on EEG-based anaesthesia indices.

J Clin Anesth 2021 Oct 8;73:110325. Epub 2021 May 8.

Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany. Electronic address:

Study Objective: In the upcoming years there will be a growing number of elderly patients requiring general anaesthesia. As age is an independent risk factor for postoperative delirium (POD) the incidence of POD will increase concordantly. One approach to reduce the risk of POD would be to avoid excessively high doses of anaesthetics by using neuromonitoring to guide anaesthesia titration. Read More

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October 2021

Effects of two stepwise lung recruitment strategies on respiratory function and haemodynamics in anaesthetised pigs: A randomised crossover study.

Eur J Anaesthesiol 2021 06;38(6):634-643

From the Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (JW, RH, MS, TK, JH, LV, AB, MGdeA, TB), Department of Pathophysiology and Transplantation, University of Milan, Milan (LV), San Martino Hospital, IRCCS for Oncology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy (AB, PP), Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (MJS), Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy (PP) and Outcomes Research Consortium, Cleveland, Ohio, USA (MGdeA).

Background: Lung recruitment manoeuvres and positive end-expiratory pressure (PEEP) can improve lung function during general anaesthesia. Different recruitment manoeuvre strategies have been described in large international trials: in the protective ventilation using high vs. low PEEP (PROVHILO) strategy, tidal volume (VT) was increased during volume-controlled ventilation; in the individualised peri-operative open-lung approach vs. Read More

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Continuous Spinal Anaesthesia for Intertrochanteric Femur Fracture in a Patient with Skeletal Dysplasia.

Case Rep Anesthesiol 2021 9;2021:6644894. Epub 2021 Apr 9.

National Academy of Medical Sciences, National Trauma Centre, Kathmandu, Nepal.

The practice of continuous spinal anaesthesia is not common. Though underutilised, it offers significant advantage when compared to the single-shot technique nonetheless. Time and again, it has proven its worth in patients with advanced cardiac illness, spinal deformities, and obesity. Read More

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Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial.

Anesthesiology 2021 Aug;135(2):258-272

Background: Individualized hemodynamic management during surgery relies on accurate titration of vasopressors and fluids. In this context, computer systems have been developed to assist anesthesia providers in delivering these interventions. This study tested the hypothesis that computer-assisted individualized hemodynamic management could reduce intraoperative hypotension in patients undergoing intermediate- to high-risk surgery. Read More

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Comparative evaluation of propofol and combination of propofol-dexmedetomidine in adjunct with topical airway anesthesia for rigid bronchoscopy: A randomized double-blinded prospective study.

Ann Card Anaesth 2021 Jan-Mar;24(1):49-55

Department of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India.

Context: Rigid bronchoscopy (RB) procedures require continuous vigilance and monitoring. Such procedures warrant proper ventilation strategy and titration of potent short-acting anesthetics.

Aims: To compare propofol with the propofol-dexmedetomidine in conjunction with topical airway anesthesia in two groups during spontaneous assisted ventilation on peri-procedural hemodynamic stability. Read More

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Regional citrate anti-coagulation dose titration: impact on dose of continuous renal replacement therapy.

Clin Exp Nephrol 2021 Apr 22. Epub 2021 Apr 22.

Department of Renal Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.

Background: Regional citrate anti-coagulation (RCA) is the recommended anti-coagulation for continuous renal replacement therapy (CRRT). Citrated replacement fluids provide convenience but may compromise effluent delivery when adjusted to maintain circuit ionised calcium levels (circuit-iCa). This study aims to evaluate the effect of RCA titration on the delivered CRRT effluent dose. Read More

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Less is more: We are administering too much protamine in cardiac surgery.

Ann Card Anaesth 2021 Apr-Jun;24(2):178-182

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.

Context: Protamine is routinely administered to neutralize the anticlotting effects of heparin, traditionally at a dose of 1 mg for every 100 IU of heparin-a 1:1 ratio protamine sparing effects-but this is based more on experience and practice than literature evidence. The use of Hemostasis Management System (HMS) allows an individualized heparin and protamine titration. This usually results in a decreased protamine dose, thus limiting its side effects, including paradox anticoagulation. Read More

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A comparative study of desflurane versus sevoflurane in obese patients: Effect on recovery profile.

J Anaesthesiol Clin Pharmacol 2020 Oct-Dec;36(4):541-545. Epub 2021 Jan 18.

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Anesthesia in obese patients is difficult due to associated comorbidities and altered physiology. Desflurane and sevoflurane have a low fat-blood solubility coefficient and are better suited in these patients to achieve a rapid emergence. We studied BIS guided drug titration to compare the postoperative recovery characteristics and cognitive function of desflurane versus sevoflurane in obese patients undergoing laparoscopic abdominal surgeries. Read More

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January 2021

Effect of anesthesia on electrocorticography for localization of epileptic focus: Literature review and future directions.

Epilepsy Behav 2021 05 2;118:107902. Epub 2021 Apr 2.

Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale New Haven Hospital, New Haven, CT, United States; Human Brain Mapping Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.

Intraoperative electrocorticography (ECoG) is a useful technique to guide resections in epilepsy surgery and is mostly performed under general anesthesia. In this systematic literature review, we seek to investigate the effect of anesthetic agents on the quality and reliability of ECoG for localization of the epileptic focus. We conducted a systematic search using PubMed and EMBASE until January 2019, aiming to review the effects of anesthesia on ECoG yield. Read More

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Preventive Analgesia, Hemodynamic Stability, and Pain in Vitreoretinal Surgery.

Medicina (Kaunas) 2021 Mar 12;57(3). Epub 2021 Mar 12.

Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology in Katowice, 41-800 Zabrze, Poland.

Although vitreoretinal surgery (VRS) is most commonly performed under regional anaesthesia (RA), in patients who might be unable to cooperate during prolonged procedures, general anaesthesia (GA) with intraprocedural use of opioid analgesics (OA) might be worth considering. It seems that the surgical pleth index (SPI) can be used to optimise the intraprocedural titration of OA, which improves haemodynamic stability. Preventive analgesia (PA) is combined with GA to minimise intraprocedural OA administration. Read More

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Analysis of Heart-Rate Variability during Angioedema Attacks in Patients with Hereditary C1-Inhibitor Deficiency.

Int J Environ Res Public Health 2021 03 12;18(6). Epub 2021 Mar 12.

Department of Medicine, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy.

C1-inhibitor hereditary angioedema (C1-INH-HAE) is a rare disease characterized by self-limiting edema associated with localized vasodilation due to increased levels of circulating bradykinin. C1-INH-HAE directly influences patients' everyday lives, as attacks are unpredictable in frequency, severity, and the involved anatomical site. The autonomic nervous system could be involved in remission. Read More

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Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope.

Pediatr Neurosurg 2021 23;56(2):171-178. Epub 2021 Mar 23.

Department of Neurosurgery, Apollo Proton Cancer Center, Chennai, India.

Introduction: Unlike adult gliomas, the utility of combined application of awake anesthesia and intraoperative neurophysiological monitoring (IONM) for maximal safe resection in eloquent region gliomas (ERG) has not been established for pediatric population while it remains unexplored in preadolescents (below 11 years old).

Case Presentation: We report 2 cases of awake craniotomy with IONM in an 8 and 9 year old for safe maximal resection of ERG. In both the cases, repeated preoperative visits of the operating room was performed to familiarize and educate the children about intraoperative communication, comfortable positioning, and neurological assessment. Read More

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Intranasal midazolam for the sedation of geriatric patients with care-resistant behaviour during essential dental treatment: An observational study.

Gerodontology 2021 Mar 21. Epub 2021 Mar 21.

Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Objectives: To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care-resistant behaviour (CRB).

Background: Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non-invasive sedation method, but there is currently no information on its use in geriatric patients. Read More

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Efficacy of target controlled infusion of remifentanil with spontaneous ventilation for procedural sedation and analgesia (Remi TCI PSA): A double center prospective observational study.

J Opioid Manag 2021 Jan-Feb;17(1):69-78

Department of Anaesthesia, Gustave Roussy Cancer Centre, Villejuif, France.

Objective: Remifentanil, a rapid onset rapid offset synthetic opioid and potent analgesic, is often used for procedural conscious sedation in spontaneous ventilation, especially when delivered in target controlled infusion (TCI), which allows precise titration. We assessed efficacy, tolerance, and adverse events related with the use of remifentanil TCI during various procedures.

Design: Prospective, observational. Read More

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Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

Crit Care 2021 03 16;25(1):106. Epub 2021 Mar 16.

Manchester University NHS Foundation Trust, Manchester, UK.

Background: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice.

Methods: Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Read More

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Intrathecal pain management with ziconotide: Time for consensus?

Brain Behav 2021 03;11 Suppl 1:e02055

Functional Neurosurgery and Neurosurgical Pain Therapy, University Hospital Schleswig-Holstein, Lübeck, Germany.

This article summarizes recommendations made by six pain specialists who discussed the rationale for ziconotide intrathecal analgesia (ITA) and the requirement for evidence-based guidance on its use, from a European perspective. Riemser Pharma GmbH (Greifswald, Germany), which holds the European marketing authorization for ziconotide, hosted the meeting. The group agreed that ITA is under-used in Europe, adding that ziconotide ITA has potential to be a first-line alternative to morphine; both are already first-line options in the USA. Read More

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Minimal invasive extracorporeal circulation preserves coagulation integrity.

Perfusion 2021 Feb 26:267659121998544. Epub 2021 Feb 26.

Cardiothoracic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.

Introduction: Coagulopathy after cardiac surgery is a serious multifactorial complication that results in postoperative bleeding requiring transfusion of red blood cells and procoagulant products. Use of cardiopulmonary bypass represents the major contributing factor affecting coagulation. We sought to prospectively investigate the effect of contemporary minimal invasive extracorporeal circulation (MiECC) on coagulation parameters using point-of-care (POC) rotational thromboelastometry and the relation to postoperative bleeding. Read More

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February 2021

Breaking the Barrier: Challenges of Methadone Use - An Introductory Observation.

Indian J Palliat Care 2020 Oct-Dec;26(4):495-499. Epub 2020 Nov 19.

Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA IRCH, AIIMS, New Delhi, India.

Background: Palliative care physicians in India have achieved access to methadone for pain relief in cancer patients. Despite being an effective drug in terms of analgesia, there are a number of reasons why this opioid medication is not as much as popular as morphine. We identified and tried to overcome a few such barriers in treating cancer pain with methadone. Read More

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November 2020

Determination of the initial minimum effective dose of 0.5% bupivacaine with 20 μg of fentanyl for an operative fixation of fractured neck of femur: a prospective, observational trial.

Minerva Anestesiol 2021 Jul 16;87(7):766-773. Epub 2021 Feb 16.

Cork University Hospital, Cork, Ireland.

Background: Fractured neck of femur (FNF) is a common cause of morbidity and mortality in elderly. Spinal catheter allows fractionation of local anesthetic dose which combined with intrathecal opioid leads to a dose reduction and better hemodynamic stability. The primary objective of this paper was to investigate the initial minimum local anesthetic dose (iMLAD) of 0. Read More

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The Impact of Preintubation Noninvasive Ventilation on Outcomes in Pediatric Acute Respiratory Distress Syndrome.

Crit Care Med 2021 05;49(5):816-827

Department of Pediatrics, Sacred Hearts Children's Hospital, Spokane, WA.

Objectives: There is evidence that noninvasive ventilation decreases the need for invasive mechanical ventilation. However, children with pediatric acute respiratory distress syndrome who fail noninvasive ventilation may have worse outcomes than those who are intubated without exposure to noninvasive ventilation. Our objective was to evaluate the impact of preintubation noninvasive ventilation on children with pediatric acute respiratory distress syndrome. Read More

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