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Hypnosis support in anaesthesia is rarely used in German anaesthesia departments - a nationwide survey among leading physicians of anaesthesia departments

The aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their a...

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The relationship between Geriatric Nutritional Risk Index (GNRI) and in-hospital mortality in critically ill patients with Acute Kidney Injury (AKI)

The role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain.

Effect of different anesthesia depths on perioperative heart rate variability and hemodynamics in middle-aged and elderly patients undergoing general anesthesia

To analyze the effects of different anesthesia depths on perioperative heart rate variability and hemodynamics in middle-aged and elderly patients undergoing general anesthesia, and to provide a basis for clin...

Gender and Race/Ethnicity dynamics in anesthesiology mentorship: results of a European survey

Mentorship is crucial to career advancement, medical education, and psychosocial support, especially for women and minorities. Although anesthesia mentoring programs have shown promise, there are no survey dat...

Perioperative pain management interventions in opioid user patients: an overview of reviews

Every year, many opioid users undergo surgery, experiencing increased postoperative complications, inadequate pain control, and opioid-related adverse effects. This overview aims to summarise and critically as...

“Ping-pong” in the heart: a case report and literature review

Ball thrombus is rare and life-threatening. The correct diagnosis and timely management are key to improving patient prognosis. Here, we present a case report and literature review of ball thrombus.

Quantification of muscle recovery in post-ICU patients admitted for acute pancreatitis: a longitudinal single-center study

Critically ill patients with severe pancreatitis exhibit substantial muscle wasting, which limits in-hospital and post-hospital outcomes. Survivors of critical illness undergo extensive recovery processes. Pre...

Does IV fentanyl, frequently used in emergency departments, change QT C value? A prospective observational study

Fentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QT C values of the patients or being monitored. However, the effect of fentanyl on Q...

Artificial intelligence-assisted interventions for perioperative anesthetic management: a systematic review and meta-analysis

Integration of artificial intelligence (AI) into medical practice has increased recently. Numerous AI models have been developed in the field of anesthesiology; however, their use in clinical settings remains ...

The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis

Open liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate...

Modified thoracoabdominal nerve block via perichondral approach: an alternative for perioperative pain management in laparoscopic cholecystectomy in a middle-income country

Laparoscopic cholecystectomy is known for its minimally invasive nature, but postoperative pain management remains challenging. Despite the enhanced recovery after surgery (ERAS) protocol, regional analgesic t...

Correction: Usefulness of lactate to albumin ratio for predicting in-hospital mortality in atrial fibrillation patients admitted to the intensive care unit: a retrospective analysis from MIMIC-IV database

The original article was published in BMC Anesthesiology 2024 24 :108

The annoyance of singultus: a case report of a rare adverse effect after epidural steroid injection

Cervical epidural steroid injections (ESIs) can provide effective pain management for patients suffering from chronic neck pain due to various pathological changes of the cervical spine. There are several rare...

External validation of the CARDOT score for predicting respiratory complications after thoracic surgery

The CARDOT scores have been developed for prediction of respiratory complications after thoracic surgery. This study aimed to externally validate the CARDOT score and assess the predictive value of preoperativ...

Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane

The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital’s anaesthesia department is actively reducing desflurane use and transitioning tow...

Effects of intraoperative different fluid therapy protocols on postoperative renal functions

Planning intraoperative fluid therapy in patients undergoing major abdominal surgery is important. It was aimed to define the difference between fluid therapy protocols for renal function, bleeding and postope...

Predictive value of perioperative NT-proBNP levels for acute kidney injury in patients with compromised renal function undergoing cardiac surgery: a case control study

Acute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-pr...

Early oral hydration on demand in postanesthesia care unit effectively relieves postoperative thirst in patients after gynecological laparoscopy: a prospective randomized controlled trial

Postoperative thirst is one of the most intense, common and easily ignored subjective discomforts in patients after gynecological surgery. This study aimed to investigate whether early oral hydration on demand...

The relationship between anti-seizures medications and metabolic acidosis in craniotomy operations: is topiramate or zonisamide the cause of metabolic acidosis?

The most commonly prescribed anti-seizures medications (ASMs) for the treatment of epilepsy are currently topiramate, zonisamide, lacosamide, carbamazepine and levetiracetam. The objective of this study was to...

90% effective volume of 0.1% ropivacaine combined with 0.4 µg/ml sufentanil for epidural labour analgesia with push pump at a rate of 400 mL/hr and a bolus interval of 30 min: a double-blind sequential dose-finding study

It was reported that either shorter programmed intermittent epidural bolus (PIEB) intervals or high-speed bolus can produce more extensive epidural spread. We hypothesized that a combination of shortened time ...

Ability of parasternal intercostal muscle thickening fraction to predict reintubation in surgical patients with sepsis

We aimed to evaluate the ability of the parasternal intercostal (PIC) thickening fraction during spontaneous breathing trial (SBT) to predict the need for reintubation within 48 h after extubation in surgical ...

Effect of esketamine on serum neurotransmitters in patients with postpartum depression: a randomized controlled trial

The development of postpartum depression has been linked to fluctuations in the levels of neurotransmitters in the human body, such as 5-hydroxytryptamine (5-HT), dopamine (DA), noradrenaline (Norepinephrine, ...

The influence of sex on the dosage of remimazolam co-administered with remifentanil for loss of consciousness in adult patients: an up-and-down sequential allocation trial

This study aimed to determine the 50% effective dose of remimazolam co-administered with remifentanil for loss of consciousness in men and women as well as to investigate whether there are between-sex differen...

Airway management of a patient with coffin-lowry syndrome: a case report

Coffin-Lowry Syndrome (CLS) is a rare X-linked genetic disorder characterized by growth delays, facial dysmorphisms, and intellectual disabilities. Currently, there are limited published case reports regarding...

Effects of different doses of alfentanil on cardiovascular response to rapid sequence intubation in elderly patients: a parallel-controlled randomized trial

Rapid sequence intubation (RSI) have been shown to be effective in preventing reflux aspiration in patients with a full stomach during anaesthesia induction and endotracheal intubation. However, there is curre...

Effect of intra-operative Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation: a randomized controlled trial

Over the last two decades, a large body of literature has focused on studying the prevalence and outcome of the postoperative delirium and sleep disturbance. The aim of this work was to evaluate the effect of ...

Use of intermediate cervical plexus block in carotid endarterectomy –an alternative to deep cervical plexus block: a case series

Carotid endarterectomy is performed for patients with symptomatic carotid artery occlusions. Surgery can be performed under general and regional anesthesia. Traditionally, surgery is performed under deep cervi...

Exploring thirst incidence and risk factors in patients undergoing general anesthesia after extubation based on ERAS principles: a cross sectional study

This study aims to comprehend the levels of dry mouth and thirst in patients after general anesthesia, and to identify the factors influencing them.

Reply to comment on: Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study

The original article was published in BMC Anesthesiology 2024 24 :267

Accessing the efficacy and peri-operative adverse effects of three different hyperbaric bupivacaine 0.5% dosages for spinal anesthesia induction in lower limb orthopedic surgeries: a randomized clinical trial

Spinal anesthesia (SA) is a conventional method for proper nerve block in abdominopelvic and lower extremity surgeries. Compared to general anesthesia, SA has reduced perioperative complications significantly....

Intermittent hemodialysis as a rewarming strategy for severe hypothermia in patients without renal failure: a case report

This case report highlights the effective use of intermittent hemodialysis (IHD) in warming a 71-year-old female patient with severe hypothermia who presented with a rectal temperature of 25 °C and signs of he...

Efficacy and safety of hydromorphone for cancer pain: a systematic review and meta-analysis

Cancer pain significantly impacts individuals’ quality of life, with opioids being employed as the primary means for pain relief. Nevertheless, concerns persist regarding the adverse reactions and effectivenes...

Positive end-expiratory pressure and postoperative pulmonary complications in laparoscopic bariatric surgery: systematic review and meta-analysis

This study compares the effect of positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in patients with obesity undergoing laparoscopic bariatric surgery (LBS) under general ...

Effect of positive airway pressure on obese patients undergoing surgery: a systematic review and meta-analysis

This systematic review and meta-analysis (SRMA) evaluates the efficacy and safety of Positive Airway Pressure (PAP) therapy in perioperative care for obese surgical patients. We reviewed 24 studies, encompassi...

Differential response to preoperative exercise training in patients candidates to cardiac valve replacement

There is lack of evidence regarding safety, effectiveness and applicability of prehabilitation on cardiac surgery population, particularly in patients candidates to cardiac valve replacement. The aim of the st...

Repeated complete atrioventricular block during remifentanil administration in a pediatric patient with brain tumor and acute hydrocephalus: a case report

Remifentanil, an ultra-short-acting µ-opioid receptor agonist, is commonly used for anesthetic management due to excellent adjustability. Remifentanil is known to cause sinus bradycardia, however, because it h...

Perioperative dexmedetomidine-induced delirium in a patient with schizophrenia: a case report

Dexmedetomidine is a selective α2 receptor agonist with sedative, analgesic, anxiolytic, and anti-sympathetic effects. Dexmedetomidine is widely used for various surgical procedures performed under general ana...

Evaluation of oxygen administration in cesarean section under spinal anesthesia via lung ultrasound and the oxygen reserve index

Respiratory functions may be impaired in cesarean section (C/S) delivery performed under spinal anesthesia (SA) and oxygen supplementation may be required. Therefore, we conducted a randomized controlled study...

Brain natriuretic peptide as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis

Early identification of patients with sepsis at high risk of death remains a challenge, and whether brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) has a prognostic eff...

Cardiopulmonary crisis caused by bronchial blocker malposition in a patient with aberrant tracheal anatomy: a case report

Double-lumen tubes (DLTs) and bronchial blockers (BBs) can be used to establish one-lung ventilation (OLV) for thoracic surgery. BBs are a good alternative when DLTs are not suitable or patients have difficult...

The analgesic effects of combined bilateral parasternal block and serratus anterior plane block for coronary artery bypass grafting surgery

Severe pain occurs after cardiac surgery in the sternum and chest tubes sites. Although analgesia targeting the sternum is often prioritized, the analgesia of the drain site is sometimes overlooked. This study...

Evaluating tissue hypoxia and the response to fluid administration in septic shock patients: a metabolic cluster analysis

The selection of adequate indicators of tissue hypoxia for guiding the resuscitation process of septic patients is a highly relevant issue. Current guidelines advocate for the use of lactate as sole metabolic ...

Risk factors for postoperative urinary retention in patients underwent surgery for benign anorectal diseases: a nested case–control study

Postoperative urinary retention (POUR) is a common complication of anorectal surgery. This study was to determine the incidence of POUR in anorectal surgery for benign anorectal diseases, identify its risk fac...

Impact of the American Society of Anesthesiologists (ASA) classification on hip fracture surgery outcomes: insights from a retrospective analysis

The American Society of Anesthesiologists (ASA) classification is the most used system to assess patient health status before surgery, ranging from I to V levels. This study aims to explore the impact of diffe...

Drug administration errors among anaesthesia providers in South Africa: a cross-sectional descriptive study

Drug administration errors (DAEs) in anaesthesia are common, the aetiology multifactorial and though mostly inconsequential, some lead to substantial harm. The extend of DAEs remain poorly quantified and effec...

Ultrasound-guided superior laryngeal nerve block: a randomized comparison between parasagittal and transverse approach

Different approach ultrasound-guided superior laryngeal nerve block was used to aid awake intubation, but little is known which approach was superior. We aimed to compare the parasagittal and transverse approa...

Outcomes of delayed tracheostomy among intubated patients during the coronavirus disease pandemic

Respiratory distress and failure is a complication of the coronavirus disease (COVID-19) and tracheostomy may be necessary in cases of prolonged intubation in order to reduce mechanical ventilation duration. H...

Comment on: “Operator gender differences in major mechanical complications after central line insertions: a subgroup analysis of a prospective multicentre cohort study”

We read with great interest the recent study by Naddi et al. in BMC Anesthesiology, which explores operator gender differences in major mechanical complications following central venous catheterization. The st...

The original article was published in BMC Anesthesiology 2024 24 :68

The Matters Arising to this article has been published in BMC Anesthesiology 2024 24 :286

The awareness of enhanced recovery after surgery (ERAS) cesarean delivery guidelines among anesthesiology and reanimation assistants in Turkey; a questionnaire study

To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim...

Anesthetic key points in a patient with a terminal ileum neuroendocrine tumor and a rare carcinoid left heart disease presented for non-cardiac surgery: case report

Carcinoid tumors are rare neuroendocrine malignancies presenting in an increasing number in our center. The incidence of carcinoid tumors is approximatively between 2.5 and 5 cases per 100,000 people of whom a...

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This case report describes a diagnosis of iatrogenic Cushing syndrome as a result of sub-Tenon triamcinolone injection in a patient receiving treatment for HIV who presented with decreased visual acuity in both eyes.

This cross-sectional study examines the longitudinal trends in endotracheal intubation and supraglottic airway utilization for airway management in a national emergency medical services cohort.

This systematic review and meta-analysis evaluates the clinical outcomes associated with daily sedation interruption vs continuous intravenous sedation in children receiving mechanical ventilation support.

This essay describes the author’s experience as a medical trainee with narcolepsy with cataplexy, highlighting the toll of self-sacrifice and the need for a cultural shift in medicine to better support trainees with disabilities.

• Slow-Release Ketamine Tablets Improved Hard-to-Treat Depression JAMA News July 19, 2024 Depressive Disorders Psychiatry and Behavioral Health Full Text | pdf link PDF

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In this Medical News interview, Sachin Kheterpal, the University of Michigan Medical School’s associate dean for research information technology, joins JAMA Editor in Chief Kirsten Bibbins-Domingo to discuss AI’s number-crunching potential for improving patient care.

This randomized clinical trial tests the efficacy and the optimal tilt angle of the semirecumbent position during anesthesia emergence in reducing postoperative hypoxemia among patients undergoing laparoscopic upper abdominal surgery.

This secondary analysis of a randomized clinical trial assesses whether baseline clinical features may be associated with differential improvement with ketamine vs electroconvulsive therapy in adults with nonpsychotic treatment-resistant major depression.

This randomized clinical trial examines whether electroencephalogram -guided anesthesia decreases the incidence of delirium after cardiac surgery among adults 60 years or older.

• Anesthesia Dose and Delirium—A Picture Coming Into Focus JAMA Opinion June 10, 2024 Neurology Surgery Full Text | pdf link PDF
• New Rules Require Explicit Consent for Students to Perform Sensitive Exams JAMA News April 26, 2024 Medical Education and Training Shared Decision Making and Communication Ethics Health Care Economics, Insurance, Payment Reproductive Health Full Text | pdf link PDF

This randomized clinical trial assesses whether preoperative cognitive training reduces the incidence of delirium among patients in China undergoing coronary artery bypass grafting surgery.

This randomized clinical trial examines the effect of transcranial direct current stimulation (tDCS) on perioperative anxiety in patients undergoing colorectal cancer (CRC) resection in China.

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This cohort study of adult patients with chronic pain assesses the association of physician empathy with patient outcomes, including patient-reported pain, function, and health-related quality of life.

This Viewpoint discusses the use of nerve blocks for pain during pelvic cancer treatment.

This cluster randomized clinical trial assesses the extent to which video laryngoscopy compared with direct laryngoscopy might facilitate intubation in patients undergoing surgical procedures during routine clinical practice.

This cohort study examines regional and institutional variation in overall opioid exposure and methadone treatment in high-risk infants at US children’s hospitals.

• Opioids in Hospitalized Infants—Managing Pain and Sedation While Avoiding Overuse JAMA Network Open Opinion March 12, 2024 Pediatrics Neonatology Pain Medicine Substance Use and Addiction Medicine Opioids Full Text | pdf link PDF open access

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Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019

• Published: 22 August 2021
• Volume 126 , pages 8749–8759, ( 2021 )

Cite this article

• S. G. Grace   ORCID: orcid.org/0000-0001-7583-717X 1 ,
• F. S. S. Wiepking   ORCID: orcid.org/0000-0002-3509-7549 1 &
• A. A. J. van Zundert   ORCID: orcid.org/0000-0002-1836-6831 1  

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Publication of research in anaesthesia is increasingly competitive. Understanding what topics of research are more likely to be published and where, is clearly valuable for authors seeking to optimise reach and impact of their work. This study aimed to identify the relative proportion of anaesthesia articles by topic for five anaesthesia journals over a 10-year period from 2010 to 2019, including any differences between journals and regions. We chose five anaesthesia journals based on current impact factor. All journal issues published between 2010–2019 were checked for total number of articles with only original research articles being further categorised by topic, country of research, funding status and citation count. Of 5782 original research articles analysed, the most frequent article topics published were translational studies (16%) and clinical practice (16%). Obstetric anaesthesia was the least frequent published (4%). Translational studies were the most frequently funded (84%) while articles on paediatric anaesthesia were least frequently funded (29%). The average number of citations per funded article was 37 versus 28 for non-funded articles. Translational studies were the most frequently published topic of research conducted in North America (25%) and Asia (25%), but of only average frequency in Europe (9%). Studies in obstetric and paediatric anaesthesia are less well-represented in anaesthesia literature and researchers may experience greater difficulty publishing these topics and obtaining funding accordingly. Authors should be aware of the diverse publishing tendencies of the different journals in anaesthesia in order to save time and effort when submitting research for publication.

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Abbreviations.

British Journal of Anaesthesia

European Journal of Anaesthesiology

Regional Anesthesia and Pain Medicine

High-income country

Low/middle-income country

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Acknowledgements

Many thanks to Rachel Ling and Aakanksha Sahu for their assistance with the original data collection.

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S. G. Grace, F. S. S. Wiepking & A. A. J. van Zundert

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Grace, S.G., Wiepking, F.S.S. & van Zundert, A.A.J. Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019. Scientometrics 126 , 8749–8759 (2021). https://doi.org/10.1007/s11192-021-04129-0

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The Top 25 Up-To-Date Dissertation Topics In Anaesthesiology

• A comparative study into the effectiveness of using variable dosage of intravenous fluid used during a transurethral resection of the prostrate to prevent hyponatremia.
• A study into the results of the performance of Nurse anaesthetists in National Board Certification Exams.
• The development of a model of Anaesthesiology Care (during and post operative) that can be provided by Physicians and Nurses.
• Research into the effect of the use of PCA (patient controlled analgesia) with young patients (under 15) who have undergone hip replacement.
• The impact of using an early tracheotomy (in comparison to a late one) on patients who have suffered a severe head injury.
• The effect of using a lighter state of anaesthetic (with a spinal block) as opposed to a full general anaesthetic on the recovery and immediate mobility after hip replacement.
• Quality of care and patient satisfaction after anaesthesia has been delivered within an office-based surgery.
• Research in the effect of bio-feedback prior to surgery and its correlation to the reported post-opt recovery.
• The effectiveness of a rectally administered pre-medication in comparison to an orally administered pre-medication in young children.
• The positive effect of music-therapy as a tool to reduce sedation and cortisol levels in patients undergoing lower limb arthroscopic procedure under spinal anaesthesia.
• An evaluation into the use and effectiveness of a bacteriostatic heat and moisture exchanger in comparison to a non- bacteriostatic exchanger.
• A study in to the factors that influence parental anxiety and satisfaction if they are allowed to be present during administration of anaesthesia to their child.
• Study into the effectiveness of the percutaneous nerve stimulation for the performance and education of the peripheral nerve block administration.
• A comparative study on the prevention of pain by the use of propofol injection of Novocaine; pethidine; dexamethasone and placebo.
• A study based on the 2002 paper “Maternal hypo-tension and epidural anaesthesia for Caesarean section”.
• Research into the possible current need for anaesthesia during and MRI scan and the possibility of designing and monitoring its protocols.
• A study to determine the selection criteria and academic progression for doctors who express an interest in becoming anaesthetists.
• A Comparative study in to the use of epidural anaesthesia for caesarean patients with pregnancy induced hypertension.
• An evaluation of the use of epidural tramadol and its effects on the duration of the need for postoperative analgesia in urological surgical patients.
• A study into the prevention of postoperative nausea and vomiting in patients undergoing a laproscopic cholecystectomy (a randomised, double-blind placebo-controlled study).
• A comparative study into the effects of the use of pre-operative low dose ketamine infusion on postoperative males and females.
• A comparative study into the efficiency of graisetron as opposed to droperidsol as a preventative of postoperative nausea and vomiting.
• Research into the advantages of using tramadol as a wound filtration in children comparison to bupivacaine.
• An evaluation into the use of sedation monitors that are used during conscious sedation procedures during a colonoscopy.
• The effectiveness of bi-spectral monitoring as a tool for predicting the recovery time following a procedure that was performed under conscious sedation.
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Anesthesia Thesis Topics For MD/DNB

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Below is the list of 100 free Anesthesia thesis topics for MD/DNB. You can select any good Anesthesia thesis topics for MD/DNB from here. For more thesis topics you can avail the service of premium Anesthesia thesis topics. The premium Anesthesia thesis topics include list of 2000+ premium and updated Anesthesia thesis topics as well as recent Anesthesia topics which has been published in various national and international Anesthesia journals. 

Though Anesthesia thesis topics can be searched online and for this purpose various Anesthesia journals can be browsed but its a time consuming process. We have collected all important Anesthesia thesis topics by painstakingly browsing through past and present issues of Anesthesiology journals. Not only the Anesthesia journals but also we have compiled the list of all top Anesthesia thesis topics by physically going through the libraries of various medical colleges.

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• Effects of intravenous dexmedetomidine in patients receiving 0 5% hyperbaric bupivacaine spinal asaesthesia.
• A comparative study of patient controlled epidural analgesia vs continous epidural infusion in labour analgesia using ropivacaine with fentanyl.
• To study correlation of extravascular lung water and compliance of lung in mechanicaly ventilated patients in ICU of a tertiary care centre.
• Combination of ropivacaine and dexmedetomidine for supraclavicular brachial plexus block using ultrasound and nerve stimulator guided technique: An intervention study to determine the effective volume.
• Comparison of efficacy of sedation with dexmedetomidine plus ketamine and propofol plus fentanyl in adult patients undergoing out-patient colonoscopy.
• To study the correlation between cerebral,rSO2 and outcomes in severe head injury cases.
• Comparision of dexmedetomidine and ketamine vs propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterisation lab.
• To compare the analgesic efficacy of continuous femoral nerve block (CFNB) with local anaesthetic through a catheter versus patient controlled analgesia with intravenous morphine after total knee arthroplasty.
• Correlation between centrally versus peripherally transduced venous pressure in patients undergoing craniotomy.
• To study the incidence and risk factors of post-operative sore throat in patients undergoing elective surgeries under general anaesthesia with endotracheal tube.
• A comparative study of scoring systems used to predict difficult airway.
• An assessment of satisfaction of family members of patients admitted in the ICU.
• Comparative study of IV dexmedetomidine vs IV midazolam for sedation during tympanoplasty and modified plasty and modified radical mastoidectomy.
• Comparison between epidural tramadol and fentanyl for post operative analgesia.
• The efficacy of dexmedetomidine as an adjuvant in brachial plexus block by supraclavicular approach with 0.25% bupivacaine.
• Effect of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with 05% hyperbaric bupivacaine.
• Effects of IV dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries.
• Comparison of haemodynamic changes of proseal LMA and endotracheal tube for laparoscopic surgeries.
• Comparative study of intrathecal isobaric 0.5% bupivacaine and isobaric 0.75% ropivacaine for lower abdominal and lower limb surgeries.
• Comparison of recovery characteristics of desflurane, sevoflurane and propofol in patients undergoing laparoscopic cholecystectomy.
• Effect of preoperative intramuscular morphine injection for post operative analgesia in patients undergoing joint replacement surgery.
• Evaluation of efficacy of tranversus abdominis plane block for post operative analgesia in patients undergoing total abdominal hysterectomy.
• A comparative study between ropivacaine with fentanyl versus bupivacaine with fentanyl for post operative epidural analgesia in patients undergoing elective lower abdominal and lower limb surgeries.
• To compare the effect of preloading with 6% (HES) hexaethyl starch versus intravenous ephedrine for the prevention of hypotension following spinal anesthesia for parturients undergoing caesarean section.
• Comparative study of dexmedetomidine and lignocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation.
• Effect of addition of intrathecal fentanyl to hyperbaric bupivacaine (0.5%) for casearean section.
• Comparative study of the intubating conditions and cardiovascular effects following succinylcholine and rocuronium in adult elective surgical patients.
• Attenuation of the circulatory responses to endotracheal intubation with preinduction intravenous labetalol.
• Comparative evaluation of bupivacaine and bupivacaine with dexmedetomidine in subarachnoid block.
• Comparative evaluation of thiopentone sodium and propofol for electro convulsive therapy.
• Comparative study of 0.5% lignocaine with dexmedetomidine and 0.5% lignocaine in intravenous regional anaesthesia.
• Comparison of efficacy of levobupivacaine and clonidine with bupivacaine and clonidine in spinal anaesthesia for lower segment caesarean section.
• A comparative study of intrathecal dexmedetomidine and fentanyl as an adjuvant to bupivacaine.
• Comparision of bupivacaine,bupivacaine plus clonidine, bupivacaine plus dexmeditomedine intrathecally in lower abdominal surgeries.
• The effects of ephedrine infusion for the prevention of hypotension during spinal anaesthesia for elective lower segment caesarean section.
• The comparative study of epidural anaesthesia between isobaric ropivacaine 0.5% and isobaric bupivacaine 0.5% for lower abdominal surgeries in tertiary care institute.
• A comparative study on effect of adding dexmedetomidine and dexamethasone to local anaesthetics in brachial plexus block.
• A randomised study on the efficacy of ketamine and pethidine in the treatment of postoperative shivering in patients undergoing general anaesthesia.
• A double blinded randomized control trial to compare hyperbaric ropivacaine (18 mg) with hyperbaric bupivacaine (18 mg) for spinal anaesthesia in lower limb orthopedic surgeries.
• Comparative evaluation of addition of dexamethasone to two different local anaesthetics in supraclavicular brachial plexus block
• Comparative study of propofol versus ketamine as inducing agent on hemodynamic and seizure activity in modified electroconvulsive therapy.
• Prevention of sevoflurane related emergence agitation in children undergoing general anaesthesia : a comparison study between dexmedetomidine and propofol.
• A comparative study of hernial block versus subarachanoid block for elective inguinal hernia repair.
• Effect of dexmedetomidine in supraclavicular brachial plexus block as an adjuvent : A comparative study.
• Mechanical complications during insertion of central venous catheter in subclavian vein and internal jugular vein – A comparitive study.
• Comparison of ambu laryngeal mask airway with soft seal laryngeal mask airway during routine surgical procedure.
• Study of efficacy of dexmethasone as preemptive analgesic in patients undergoing total abdominal hysterectomy under spinal anaesthesia.
• A clinical assessment of macintosh,miller blades and king visionTM video laryngoscope for laryngeal exposure and difficulty in endotracheal intubation.
• Comparison of two doses of dexmedetomidine combined with ketamine for anesthesia in dilatation and curettage.
• Evaluation of effect of low dose of intravenous dexmedetomidine supplementation on sensory and motor blockade produced by intrathecal hyperbaric bupivacaine.
• Comparison of the effects of lateral and sitting position during induction of spinal anaesthesia with plain levobupivacaine in cesarean section.
• Comparitive study of bupivacaine with dexmedetomidine and bupivacaine alone in supraclavicular brachial plexus block.
• A comparative study of propofol and thiopentone with local anaesthetic spray as inducing agents for I gel insertion.
• A comparative study of perioperative effects of preemptive dose of dexamethasone versus clonidine in lower abdominal surgeries under spinal anaesthesia.
• Intravenous dexmedetomidine vs. intravenous clonidine to prolong bupivacaine spinal anesthesia.
• Comparative study of the effect of IV ketamine and IV tramadol for control of shivering in cases of caesarean section under spinal anaesthesia.
• Comparison of inj. Lignocaine (preservative free) 1.5mg/kg IV with oral pregabalin 150 mg for attenuation of haemodyanamic response to laryngoscopy and tracheal intubation.
• Comparative study of supraclavicular block using bupivacaine with perineural dexamethasone, bupivacaine with I.V. dexamethasone and bupivacaine only.
• Comparative study of intrathecal bupivacaine with fentanyl and intrathecal bupivacaine with clonidine for quality of anaesthesia and duration of post operative pain relief in patients undergoing lower abdominal and lower limb surgeries.
• A comparison of efficacy of pre-emptive analgesia with three small doses of N-Methyl-D- aspartate antagonist ketamine for improving post operative analgesia after laparoscopic surgeries,
• A study of perioperative airway and respiratory complications in children undergoing cleft lip and palate repair.
• Identification of risk factors for hypotension after spinal anaesthesia in patients undergoing casarean section.
• Use of McCoy and truview laryngoscope blades for intubation in patients with anticipated difficult airway with respect to ease of intubation and haemodynamic response.
• Audit of perioperative complication of patients unergoing turp surgeries :: an anaesthetist’s perspective.
• An audit of blood and blood products transfusion practices in elective spine surgery.
• The type of anaesthesia and outcome in preeclamptic patients undergoing caesarean section an observational study.
• Comparison of palonosetron, ondansetron, and metoclopramide in controlling post operative nausea and vomiting in obstetrical and gynaecological surgeries.
• Comparison between intranasal dexmedetomidine and intranasal midazolam for preanaesthetic sedation in children.
• Comparison between 0.125% bupivacaine and 0.125% ropivacaine for epidural analgesia during labour.
• Dexamethasone as an adjuvant to local anaesthetic in supra clavicular block a comparitive study.
• Observational study of hemodynamic effects of etomidate and propofol used as induction agents in patients planned for off pump cabg
• An observational study to compare the haemodynamic parameters following spinal anaesthesia with hyperbaric bupivacaine in hypertensive and normotensive patients.
• Correlation of leak around uncuffed endotracheal tube and postoperative morbidity in children: an observational study.
• A cross-sectional observational analysis of preoperative blood glucose levels in patients presenting for surgery.
• Monitoring of depth of anaesthesia using entropy monitor during cardiopulmonary bypass-a prospective study.
• An evaluation of procedural sedation techniques in duchenne muscular dystrophy patients undergoing stem cell therapy.
• Anaesthesia risk stratifaction: comparison between silverman-holt aggregate preoperative evaluation (SHAPE) and american society of anaesthesiologists physical status (ASA PS) evaluation systems.
• Efficacy of spinal anaesthesia for laparoscopic ventral hernia repair
• Comparative study of nalbuphine vs. pentazocine for postoperative analgesia.
• Comparative study of intrathecal isobaric levobupivacaine versus hyperbaric bupivacaine in lower abdominal surgery.
• Comparative study of 0.5% (heavy) intrathecal bupivacaine alone with 0.5% (heavy) intrathecal bupivacaine midazolam combination in patients undergoing elective inguinal hernia repair.
• Comparative evaluation of induction with propofol and sevoflurane for insertion of laryngeal mask airway in children.
• Hemodynamic behaviour,ECG changes and postoperative outcome of hypertensive and normotensive patients under spinal anaesthesia.
• The comparision of single bolus dose of dexmedetomidine with bolus plus infusion of dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine.
• Evaluation of airway and predicting difficult endo- tracheal intubation in diabetic patients -A comparison with non diabetic patients.
• Observational study for dose-response characteristics of intrathecal hyperbaric bupivacaine(0.5%) by using sequential combined spinal epidural anesthesia (SCSEA) in patients aged over sixty year for orthopedic surgeries.
• A comparison of thyromental height with the ratio of patient’s height to thyromental distance and the upper lip bite test in predicting difficult laryngoscopy.
• A comparetive study of arterial PH and chloride levels following 6% HES 130/0.4 saline solution or 6% HES 130/0.4 balanced solution used during cardiac surgery involving cardiopulmonary bypass.
• A prospective study to compare efficacy of interlaminar vs caudal epidural steroids in chronic lower back pain.
• A prospective comparative study of ondansetron against tramadol pretreatment to reduce pain on injection of propofol.
• A comparative study between clinical efficacies of levobupivacain plain and levobupivacaine with fentanyl for urological surgeries under subarachnoid block.
• A comparison of the efficacy of fentanyl and clonidine for attenuation of pressor response to endotracheal intubation.
• Pre treatment with intravenous granisetron to alleviate pain on propofol injection: A double blind randomised controlled study using normal saline as control.
• Randomised prospective study of comparison of USG guided subcostal transversus abdominis plane block techinque (sta block) versus conventional port site infiltration techinque used in laparoscopic cholecystectomy for post operative analgesia.
• Correlation of bispectral index with depth of sedation: A comparison between dexmedetomidine versus propofol in patients undergoing infraumabilical surgery under subarachnoid block.
• Ultrasonographic measurement of optic nerve sheath diameter to detect raised intracranial pressure in head injury patients in ICU and its correlation with CT scan findings.
• Comparison between palonosetron and granisetron in prevention of postoperative nausea and vomiting (PONV) in elective laparoscopic surgeries under general anaesthesia.
• A comparison of upper Lip Bite Test with modified mallampati classification in predicting difficulty in endotracheal intubation.
• Effect of dexmedetomidine hydrochloride as an adjuvant to lignocaine hydrochlorid for intravenous regional anaesthesia.
• Postoperative nausea and vomiting -prophylaxis with palonosetron hydrochloride.
• Comparison of dexmedetomidine and midazolam for sedation in post -operative surgical patients.
• Study of hemodynamic changes during laparoscopic surgery using non-invasive cardiac output monitor (NICOM) Low flow anaesthesia : a prospective observational study.

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Core Topics in Airway Management

Hinkelbein, Jochen MD, DESA, EDIC, FAsMA; Yücetepe, Sirin MD

Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany, [email protected]

Airway management is the core topic in anesthesiology. It is an important and challenging aspect of many clinician’s work and is, however, a source of complications and litigation. Airway management—if failing—often results in significant harm to the patient, desaturation, resuscitation, and sometimes a fatal outcome. Although airway management has become safer in recent decades, the incidence of complications is still around 3% to 5%, with <1% resulting in fatalities. 1 The risk of brain damage and death is supposed to be 1:110,000 to 1:200,000 during airway management.

Core Topics in Airway Management is edited by Cook, who is a Consultant in Anaesthesia and Intensive Care Medicine at the Royal United Hospital in Bath, United Kingdom, and is also the Director of National Audit Projects and College Advisor on Airway at the Royal College of Anaesthetists. Kristensen is a Consultant in Anaesthesia and Intensive Care Medicine and the Head of Airway Anaesthesia Research and Development at Rigshospitalet, Copenhagen University Hospital, Denmark, and is also the President of the European Airway Management Society (EAMS). Both editors are highly recognized as specialists in the field. Additionally, 60 highly important and well-known authors contributed, with a total of 38 chapters.

The book series “Core Topics” from Cambridge University Press consists of several books on specific aspects in medicine. Core Topics in Airway Management is part of this series and focuses on airway management as well as many related topics.

The third edition of this book is a clear, practical, and highly illustrated guide to all necessary aspects of airway management. This book has been updated throughout as compared to the second edition to cover all changes to best practice and clinical management. It provides extensive coverage of the key skills and knowledge required to manage airways in a wide variety of patients and clinical settings. The hardcover book is printed in a high-quality layout, with color figures and pictures underlining the text. It is well structured, providing headings and several subheadings in every chapter.

Core Topics in Airway Management starts in section 1 (Background and Techniques) with anatomy, physiology, and epidemiology aspects of airway management and provides insight into planning, preanesthetic management, and airway assessment. In addition, specific procedures like using Bougie, Video Laryngoscopy or Supraglottic Airways are presented. Section 2 covers the clinical setting and subspecialties, followed by section 3 with organizational aspects for airway management.

This book provides an excellent introduction to problems arising during airway management and solutions for daily routine. Besides the daily routine of patient assessment, tracheal intubation, or the use of supraglottic airways, more sophisticated procedures are also explained. Understanding is enhanced by the inclusion of several pictures. Airway management has high priority for specific patient groups, such as the morbidly obese, pediatric, or trauma patients, all of whom are covered in the book.

Reading the book is nicely entertaining and facilitates interest in the topic. The clear structure with sections and chapters allows reading the book from beginning to end. However, it can also be used to look up the state-of-the-art management for specific topics. Concerning the content and details presented, it is of high value both for the clinical anesthesiologist and for focused learning (eg, examinations).

IDEAS FOR THE NEXT EDITION

Besides all clinical aspects in the book, a future edition may be supplemented by some additional topics related to airway management. Although the book addresses clinicians in the operating room (OR), intensive care unit (ICU), or emergency department (ED), some additional remarks on the prehospital setting would be interesting. In addition, extracorporeal membrane oxygenation (ECMO)—as the ultimate technique to reestablish oxygenation after failed airway management—could be discussed. Besides, there are many other fields where airway management is of highest importance as, for example, in-flight emergencies or airway management for space missions. 2 Covering these topics in a future edition would expand the knowledge of anesthesiologists.

CONCLUSIONS

There are hundreds of books on airway management available on the market. Therefore, the question arises as to why to buy or read this specific book. From our point of view, it is clearly up to date and provides an excellent mixture of routine clinical aspects and the underlying scientific background. Furthermore, reading is pleasurable and available for a reasonable price for a high-quality book. This content is essential for anyone who manages the airway, including trainees and specialists in anesthesia, emergency medicine, intensive care medicine, and prehospital medicine, as well as nurses and other health care professionals. Thus, the price-to-value ratio is excellent. Core Topics in Airway Management is a must for every anesthesiologist’s bookshelf. We provide a clear “YES” to buy it!

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A List Of Unexplored Dissertation Topics In Anaesthesia

Anaesthesia is a medical term which means “loss of sensation”. The medications and their related catalysts are called anaesthetics. These anaesthetics are very useful and crucial in performing the medical tests and the surgical operations in order to induce sleep. It is necessary to put the patient to sleep because this prevents the person from feeling any kind of discomfort and pain and it also enables the surgeons to perform a very wide range of medical procedures that regularly need to be performed for various reasons.

Here we have a number of dissertation topics for your inspiration and needs. These topics are perfect and very suitable for your purpose of starting a good thesis based on a strong but unexplored research in field of anaesthesia. One can do their homework on any of these terms of interest. These dissertation topics are also a good choice for writing an essay for your medical speeches and exhibitions.

Here is a list of some interesting dissertation topics in the field of anaesthesia that have not been appropriately explored yet are:

• The comparatively exhaustive relation between fentanyl, hyperbaric lignocaine and intrathecal hyperbaric lignocaine during spinal blockade.
• Pain relief via intramuscular route post operation with comparison of inhibitors NSAID and COX-2
• The effect of intrathecal tramadol for surgery of hernia on the behavior of subarachnoid blocks.
• The overall influence and effect of intrathecal midazolam on the block of subarachnoid for the caesarean section.
• Comparatively vigorous study of pre operated bilateral infraorbital block of nerve along with the peri incisional infiltration for the need of post-operative pain relief in the cleft lip surgery in the matters of pediatric cases.
• Comparison of intra venous esmolol and oral clonidine for attenuation of the stress response to intubation and laryngoscopy in the middle ear surgery procedures.
• Effects of low dose dexmedetomidine upper infusion on the perioperative hemodynamic response and the post-operative analgesia requirements in the patients that are undergoing laparoscopic cholecystectomy.
• Dexmedetomidine acting as an adjuvant to the intrathecal hyperbaric bupivacaine for the spinal block characteristics and the post-operative analgesia for the lower limb orthopedic surgeries.
• Air way management in the field of pediatric anaesthesia (the Pro seal laryngeal mask airway v/s the endtracheal intubation).
• The efficiency and effectiveness of dexamethasone while getting added as an adjuvant to the combination of local anaesthetics in the brachial plexus block for the post-operative analgesia.
• The placental morphology and mechanism in the pregnancy induced hyper tension along with its clinical significance.

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Hot Topics in Safety for Pediatric Anesthesia

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

1. Introduction

Anesthesiology has made great strides in patient safety over the past several decades, with mortality decreasing from 1:2500 to 1:13,000 [ 1 , 2 , 3 ]. Pediatric anesthesiology is inherently higher risk than adult anesthesiology due to the difference in physiology in children. The sub-specialty specializes in dealing with these differences. We aimed to describe the highest yield safety topics for pediatric anesthesia.

Pediatric perioperative safety events fall into major categories including airway, cardiovascular, and medication error events. Research analyzing the location of the anesthetic (operating room or OR versus non-operating room anesthesia or NORA) in determining perioperative risks, as well as care transition and handovers associated with transferring patients to and from the operating room from other areas in the hospital has been conducted. The Neonatal Intensive Care Unit (NICU) population is at particularly increased risk due to rapidly changing physiology and smaller margin of error. With the increased incidence of obesity, the field is encountering unique challenges in this population as well. Major research efforts to improve safety include the concern for neurotoxicity in small children. Several safety resources have been developed such as pediatric perioperative crisis and airway checklists through various pediatric anesthesiology organizations including the Society for Pediatric Anesthesia (SPA) and Wake Up Safe (WUS). In addition, WUS provides event data for analysis and dissemination and methods for quality improvement and enhanced patient safety.

2. Historical and Current Pediatric Perioperative Adverse Events

2.1. historical pediatric perioperative event reporting.

Historically, major studies that investigated pediatric perioperative adverse events include the following. Snyder et al. reported 23 cardiac arrests out of 57,600 anesthetics at Children’s Hospital Los Angeles from 1932 to 1952. The incidence increased from 1:2504 in the first 15 years to 1:1128 in last five years in conjunction with the change in practice from open drop delivery of ether to administration of volatile anesthesia via anesthesia machines. The hypotheses of these findings included dead space ventilation and resistance of the tubing leading to hypoxia and/or hypercarbia in small children [ 4 ].

Rackow et al. presented cardiac arrest data due to anesthesia from 1947 to 1958 at a frequency of 1:719 for patients under one year and 1:2326 for ages one through 12 versus 1:2580 in patients 13 years or older due to anesthesia and unknown causes [ 5 ]. Most common causes included anesthetic overdose, anoxia, inadequate ventilation/oxygenation, and aspiration. Eighty percent of these anesthetics were administered by residents with 2 ½ months of pediatric anesthesia experience. Almost all the remaining anesthetics were administered by attending anesthesiologists, with very few by nurses. In children who experienced a cardiac arrest, 16% had a full recovery, 16% had a partial recovery, and 68% died. By comparison, adults experienced 50% complete recovery after cardiac arrest.

In France, Tiret et al. gathered data on 40,240 pediatric (<15 years) anesthetics from 440 institutions from 1978–1982. They found 27 major complications (including death) and that the risk of complications was significantly higher in infants (4.3 per 1000) than in children (0.5 per 1000). The overall mortality rate was one in 40,000. Respiratory failure was the most common cause of complications in infants and tended to occur during the maintenance phase. In children, cardiovascular failure was as frequent as respiratory failure and occurred equally during induction, maintenance and recovery. Complications included airway management ( N = 5), complications of intubation ( N = 4), aspiration ( N = 4), postoperative respiratory depression ( N = 2), equipment failure ( N = 1), halothane overdose ( N = 2), anaphylactoid shock ( N = 3), acute pulmonary edema ( N = 2), severe arrhythmia ( N = 2) and cardiac arrest with no obvious cause ( N = 2). The incidence of complications increased with increasing American Society of Anesthesiologists (ASA) physical status, prior history of anesthesia, emergent procedures and preoperative fasting of less than eight hours [ 6 ].

2.2. General Pediatric Perioperative Adverse Events in the Modern Era

Several more recent studies analyzed the incidence and associations of pediatric perioperative adverse advents. Schleelein et al. at Children’s Hospital of Philadelphia analyzed non-cardiac cases for adverse events requiring a rapid response from April 2010 to September 2012. There were 213 events for a prevalence of 0.0046 (1:234) [ 7 ]. Respiratory events, primarily laryngospasm, were most common followed by cardiovascular events. Median age was lower in the event cohort than in controls (2.86 years vs. 6.20 years). Odds ratios for ASA physical status, multiple services involved in procedure, NORA vs. operating room location, and attending anesthesiologist experience were all significant.

MacLennan and Smith analyzed critical events in the UK national reporting system from 2006 to 2008. Out of 606 incidents, six deaths were reported and 48 events resulted in severe harm [ 8 ]. The most common issues were related to medication errors (35.6%) with duplicate dosing in the OR and ward being the most notable. Airway and ventilation issues made up 18.8% of events, cardiovascular incidents 5.9%, and equipment issues (failure or unavailability) were involved in 15.7% of events. Communication and organizational issues were cited in 8.6% of reports.

The Anaesthesia Practice In Children Observational Trial (APRICOT) study was a prospective observational multicenter cohort study of severe critical events in pediatric anesthesia from 261 hospitals in Europe. From April 2014 to January 2015, 31,127 anesthetic procedures in 30,874 children were analyzed. The incidence of severe perioperative critical events was 5.2%. The incidence of respiratory events was 3.1% and cardiovascular events was 1.9%. The thirty-day in-hospital mortality rate was 10:10,000 and was independent of anesthesia type. Major risk factors included age under one year, complex medical history, and physical condition. A beneficial effect was noted with years of experience of the most senior anesthesia team member for respiratory and cardiovascular events rather than the type of institution or providers [ 9 ].

Boston Children’s Hospital analyzed 193 emergent (STAT) calls for help by the perioperative team between August 2011 and September 2015. They found that higher ASA status, history of respiratory illness, cardiac inciting event, occurrence during induction phase, post anesthesia care unit location, and calls initiated by an attending physician or fellow were more likely to be associated with a complicated STAT call. A subset of 108 calls indicated that age <1 year old and a history of prematurity were independent predictors of higher incidence of STAT calls [ 10 ].

3. Pediatric Anesthesia Safety Topics

3.1. airway events.

Perioperative respiratory adverse events are a cause of major morbidity and mortality, contributing to 30% of perioperative cardiac arrests, and can lead to increased length of stay, worsened outcomes, and higher hospital costs [ 11 , 12 ]. Risk factors include age less than 6 years, a recent (<4 weeks) or currently active upper respiratory tract infection (URI), pulmonary comorbidity (asthma, prematurity, cystic fibrosis, etc.), current significant infectious disease, snoring, type of airway device used intraoperatively, experience of the anesthesiologist, and type of surgery [ 13 ].

A systematic review by Porter et al. of respiratory and hemodynamic perioperative adverse events in intravenous (IV) vs. inhalational induction in pediatric patients resulted in two studies that found no difference and two studies that found a higher risk of respiratory events with inhalation induction [ 14 ]. Hasani et al. showed no difference in coughing or laryngospasm with induction type [ 15 ]. Guard et al. showed no difference in coughing with sevoflurane vs. propofol, and neither group had bronchospasm or hypoxia. Laryngospasm did occur twice in the sevoflurane group and not at all in the propofol group, so a relative risk could not be calculated [ 16 ]. Chen et al. found a lower risk of coughing during emergence in the propofol group [ 17 ]. Ramgolam et al. found a higher risk of respiratory events in the inhalation group during induction and higher risk of perioperative respiratory adverse events as compared to the IV induction group [ 18 ]. More events occurred in children with multiple risk factors for respiratory adverse events (reactive airway disease or passive smoke exposure); however, this did not reach statistical significance [ 14 ]. Reasons for decreased respiratory events with an IV induction may be that muscle relaxation is given sooner, propofol may influence position of vocal cords (abduction), or propofol may suppress laryngeal reflex response. By comparison, sevoflurane maintains the airway in an excitement stage longer, potentially predisposing to laryngospasm.

WUS is a patient safety organization that collects data on perioperative anesthesia adverse events from multiple member institutions. Pfaff et al. analyzed WUS data on perioperative aspiration events in children from 29 institutions from 2010–2017. Out of 2,440,810 anesthetics, there were 135 pulmonary aspiration events (0.006%) with 110 cases (82%) resulting in escalation of care, 51 (38%) resulting in harm, and 2 (1.5%) resulting in death. Emergency surgery (14 of the cases) and higher ASA (≥3) status were more likely to experience aspiration. Reported causes of aspiration included gastrointestinal comorbid conditions (19%), post coughing event or laryngospasm (14%), nil per os (NPO) violation (11%), blood or secretions in the airway during or following the procedure (6%), and oral premedication reaction (3%) [ 19 ].

URIs are the most common perioperative comorbidity in children, and approximately 30% of children presenting for surgery have a URI [ 20 , 21 ]. Despite increased risk of respiratory events, most are without long-term sequelae, but there have been at least two peri-operative deaths in patients with URI [ 22 , 23 ]. The decision on whether to proceed with surgery in a child with an active URI is a long-standing debate. Subramanyam developed and validated a risk prediction tool in pediatric ambulatory anesthesia [ 24 ]. Lee et al. reported on perioperative respiratory adverse event risk in children with URIs and validated the current signs and symptoms, onset of symptoms, lung disease, device to be used for airway management and surgery type (COLDS) score as a potential algorithm to decide on whether to proceed or delay elective surgery. In the COLDS acronym, C stands for current signs and symptoms; O stands for onset of symptoms; L stands for lung disease; D stands for the device to be used for airway management; and S stands for surgery type (airway vs. non-airway) [ 13 , 25 ]. Another group performed a systematic review and meta-analysis on laryngeal mask airways (LMA) vs. other airway devices used in children with a URI. Five randomized clinical trials (RCTs) were included and found no statistical difference between LMA and endotracheal tube (ETT) regarding breath holding or apnea, laryngospasm, and arterial desaturation; however, the LMA did reduce cough compared with an ETT [ 26 ].

3.2. Cardiovascular Events

Another analysis of WUS data found 531 perioperative cardiac arrests out of 1,006,685 anesthetics from January 2010 to December 2015. Cardiac arrest was associated with age <6 months, ASA status III-IV, and emergency status. Increased mortality after cardiac arrest was noted with emergency status and off-hours (nights and weekends) procedures [ 27 ]. The APRICOT study reported 10 episodes of cardiac arrest in nine out of 30,874 patients (0.03%). Hypoxemia was cited as the cause in four cases, low cardiac output in four cases and hypotension in two cases [ 9 ].

An additional area of interest in pediatric anesthesia is the risk associated with children with congenital heart disease (CHD) who present for non-cardiac procedures. Taylor and Habre looked at National Surgical Quality Improvement Program (NSQIP) data and found that patients with single ventricle physiology, severe/supra-systemic pulmonary hypertension, complex lesions, and cardiomyopathy with reduced ventricular function were at increased risk of adverse events [ 28 ]. Lee et al. analyzed 3010 patients with CHD who presented for non-cardiac procedures over a five-year period. They found an 11.5% incidence of cardiovascular events and 4.7% incidence of respiratory events. Perioperative cardiovascular events were associated with an ASA status of 3 or higher, emergency cases, major and severe CHD, single ventricle physiology, and ventricular dysfunction. Orthopedic surgery, general surgery, neurosurgery, and pulmonary procedures were the most commonly associated with cardiac events. Respiratory events were associated with an ASA status of 4 or higher, and otolaryngology, gastrointestinal, general surgery, and maxillofacial procedures. They found that the incidence of cardiac events was higher than respiratory events, and though cardiovascular events were associated with cardiovascular status, respiratory events were not [ 29 ]. Institutions should consider the need for and availability of specialty trained pediatric cardiac anesthesiologists for complex congenital heart disease patients.

3.3. Medication Errors

WUS data from 2010 to September 2016 from 32 institutions was analyzed for medication related events. The query included 2,316,635 anesthetics with 2087 adverse events reported. There were 276 medication errors reported, and this was the third leading cause of adverse events following respiratory and cardiovascular events. The medication errors most commonly involved opioids and sedatives/hypnotics. Thirty errors occurred during preparation, 67 during prescribing and 179 during administration. The most common error was administration of the wrong dose ( N = 84), followed by administration of the wrong syringe ( N = 49). Twenty-one percent ( N = 57) of medication errors involved infusions as opposed to one-time bolus administrations. Errors were committed by all types of anesthesia providers, but most commonly by attendings. Over 80% of reported errors impacted the patient and more than half of those caused harm. Five percent ( N = 15) of events required life-sustaining intervention. Ninety-seven percent of the errors were deemed likely or certainly preventable [ 30 ].

3.4. Handovers/Communication Errors

An additional analysis of WUS data reviewed complications associated with the anesthesia transport of pediatric patients. Of 2971 events, 148 events (5%) were related to transport and were primarily respiratory in nature. Almost 40% of events occurred in infants six months of age or younger. Almost 60% of the events were deemed at least somewhat preventable and over 36% were associated with harm. There were 86 reported cardiac arrests, 50 of which had respiratory causes, and 74% of those were related to anesthesia or perioperative team factors. Respiratory events occurred at all stages of care with 21.4% during preoperative transport and 75.5% postoperatively. Of unplanned extubations during transport, 93% occurred in patients six months old or younger. There were 10 medication events and two of those resulted in cardiac arrest. Root causes were attributed to provider and patient factors and, occasionally, verbal miscommunication was referenced [ 31 ].

3.5. Non-Operating Room Anesthesia (NORA)/Sedation

Uffman et al. reviewed WUS data from 2010 to 2015 to analyze severe outcomes of pediatric perioperative events occurring in operating rooms compared to off-site anesthetizing locations. There were 1594 events, of which 362 were associated with NORA locations. Adverse events in cardiac catheterization suites had higher odds of severe outcome compared to the operating room, but this difference was not found in other off-site locations [ 32 ]. However, other groups have reported a lower incidence of critical events at off-site locations compared to the operating room [ 9 , 10 ].

Lee et al. reviewed media reports of deaths associated with pediatric dental sedation and general anesthesia. Most deaths occurred among two- to five-year-olds (21/44) in an office setting (21/44) with a general/pediatric dentist (25/44) as the sole anesthesia provider. In the 25 deaths associated with a dentist providing the anesthetic, 17 were linked to a sedation anesthetic. Eleven cases were reviewed by an external body, and deficient practice patterns from these reports fell into the following categories: medication/dosing error (inappropriate doses of a sedative, a local anesthetic or a paralytic agent contributing to or resulting in cardiac arrest), inadequate monitoring (untrained staff who did not recognize respiratory failure in the post anesthesia care unit (PACU), and absence of vital sign monitoring, equipment or documentation), inadequate resuscitation (failure to recognize cardiac arrest, inadequate or no resuscitation efforts, limited resuscitation efforts due to untrained staff or inadequate equipment), and inadequate preoperative preparation (inadequate discussion of anesthetic risks and lack of medical evaluation). Eight adverse judgments concerned care in an office, while only one adverse judgment was associated with hospital/surgery center care [ 33 ].

Other pediatric subspecialists provide procedural sedation outside of the operating room. Kamat et al. prospectively collected data from 2007 to 2018 to analyze patient characteristics, medications, types of providers, adverse events, and interventions. A total of 432,842 encounters were included and divided into three 4-year epochs. Their findings included a decreasing trend in infants less than three months of age receiving sedation, a large increase in pediatric hospitalists providing procedural sedation, and a decrease in sedation provided by providers not trained in emergency medicine, critical care, or anesthesiology. In regard to medications used, they noted an increasing trend in the use of dexmedetomidine and a decreasing trend in the use of chloral hydrate and pentobarbital. Serious adverse events showed a non-significant increase overall [ 34 ].

3.6. Obesity

The global prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010 and is expected to reach 9.1% or approximately 60 million children in 2020. In North America, 30% of school-age children are overweight or obese and 15% are obese [ 35 ]. Perioperative respiratory adverse events occur more commonly in obese children with significant associations between obesity and hypoxemia, upper airway obstruction, and difficult bag–mask ventilation [ 36 ]. Train et al. found that anesthesia and operative times were significantly longer for obese patients undergoing most types of surgical procedures [ 37 ]. The prevalence of obstructive sleep apnea (OSA) has increased with the increasing prevalence of obesity. Kako et al. reported increased PACU length of stay in 30% of cases and supplemental oxygen use was higher in patients with documented or likely OSA [ 38 ].

There are several preoperative considerations that must be assessed. The ASA practice guidelines recommend that questions regarding OSA (snoring, apnea, frequent arousals, morning headaches, and daytime sleepiness) be included in the preoperative interview for all obese patients over the age of one year. Obese patients with significant episodes of desaturation (<70% saturation) are at risk of ventricular dysfunction and are predictive of pulmonary hypertension in patients with OSA. Pre-operative echocardiography and electrocardiogram may be indicated. Special attention must be paid during the airway evaluation due to possible difficult mask ventilation and intubation [ 39 ].

Drug dosing in obese pediatric patients has several considerations. The volume of distribution, which determines loading dose and onset of action, may be altered in severely obese children. Drug clearance, which determines a drug’s maintenance dose, may be altered in obese patients, but this is not conclusive. Considerations for specific anesthetics in obese pediatric patients can be seen in Table 1 .

Considerations for anesthetic agents in pediatric patients with obesity.

In addition, several postoperative considerations must be recognized. Unplanned hospital admissions and length of stay in the PACU are higher in obese children. Although there are no specific guidelines on postoperative monitoring in obese patients, the ASA Task Force on Perioperative Management of Patients with OSA has recommended that patients should establish that they are able to maintain their baseline oxygen saturation during an unstimulated environment (preferably while asleep) [ 39 ]. Close monitoring is recommended with opioid use postoperatively and use of non-opioid analgesics, pain adjuncts, and regional techniques should be strongly considered.

3.7. Neonatal Intensive Care Unit Patients

Neonatal patients are at particular risk in the perioperative period given their size, fragility and physiology yet are vastly understudied in the perioperative arena. Rates of adverse events may be up to eight times higher for NICU patients compared to hospitalized adults [ 44 ]. According to 2012 National Surgical Quality Improvement Program Pediatric (NSQIP-P) data, neonates represent only 6% of all patients, yet account for 60% of 30-day post-operative morbidity and 16% of 30-day post-operative mortality [ 45 ]. Long et al. characterized adverse events in neonatal intensive care unit patients who recovered in the PACU from June 2014 to May 2018. Of 707 operative cases, 81 events were recorded and 64 of those were considered major events, all of which were respiratory in nature. The risk of any postoperative event was 11.5%, major respiratory event requiring intervention was 9.1%, and reintubation was 0.8%. Birth weight <1.58 kg and post gestational age at surgery <41 weeks were strongly associated with increased risk of major postoperative respiratory event. A patient with both those features had a sevenfold increase in the odds of a major respiratory event in the PACU [ 46 ].

France et al. conducted a prospective observational study of neonatal surgical patients to compare the incidence, severity, preventability and contributing factors of non-routine events (NREs) associated with perioperative handovers. An NRE is described as any deviation from optimal care based on the clinical situation. They found that 101 out of 130 cases (78%) had a clinician-reported NRE. They also evaluated direct handovers (handovers between the OR and NICU teams when the patient was retrieved from and/or returned directly to the NICU) and indirect handovers (between NICU nurse and pre-operative or PACU nurse). They found no difference in NRE rate between direct and indirect handovers. NRE severity and incidence of major morbidity as defined by NSQIP-P data were both significantly higher in the direct handover group, but is likely due to direct handovers involving more critically ill patients. They determined that nearly half of NREs resulted from preventable factors. Additional work continues in this area [ 47 ].

3.8. Neurotoxicity

Potential anesthetic neurotoxicity has been a topic of discussion in the realm of pediatric anesthesia for multiple years. The U.S. Food and Drug Administration (FDA) issued a safety announcement in 2016 stating that children under the age of three who undergo anesthesia for more than three hours or are exposed to repeated anesthetics could be at increased risk of learning, memory, or behavioral problems in the future. Because of this, Strategies for Mitigating Anesthesia-Related Neuro-Toxicity in Tots (SmartTots), a public–private partnership formed to identify, support, and fund pediatric anesthesia research focused on potential neurotoxicity. Through this partnership, studies such as the General Anesthesia Spinal (GAS) and the Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) were undertaken. The GAS study compared general and spinal anesthesia in infants for urologic surgery and found that children under age two who were exposed to less than one hour of general anesthesia had no increased risk of adverse neurodevelopmental outcomes compared to infants who received a spinal anesthetic [ 48 ]. The PANDA study found that a single anesthetic exposure before age three did not increase the risk of neurocognitive dysfunction [ 49 ]. The Mayo Anesthesia Safety in Kids (MASK) Study did not find associations between anesthesia exposure before age three and general intelligence. Secondary outcomes indicated that multiple exposures may change some neuropsychological domains associated with learning and behavioral difficulties [ 50 ]. Based on the findings and the FDA’s warning, current recommendations are to not delay surgery and anesthesia for life-threatening conditions including but not limited to congenital heart defects, esophageal atresia, bowel obstruction, gastroschisis, omphalocele, diaphragmatic hernia, congenital lung lesions, pyloric stenosis, craniofacial reconstruction, and complex urological reconstruction. For elective procedures, parents should discuss the timing of surgeries that could be delayed without jeopardizing their child’s health. Since no anesthetic or sedative medication has been shown to be safer than any other, no specific alteration of anesthesia practice has been recommended [ 51 ].

3.9. Pediatric Anesthesia Patient Safety Resources

The SPA “advances the safety and quality of anesthesia care, perioperative care, and pain management in children by educating clinicians, supporting research, and fostering collaboration among clinicians, patient families, and professional organizations worldwide”. SPA also supports several committees including the Quality and Safety Committee whose goals include promoting an environment of process improvement, identifying key quality issues in pediatric anesthesia, and planning and implementing changes and projects. Further description is provided in the parallel manuscript to this, also by our group: “Pediatric Anesthesia Specialty Societies and Multi-Institutional Collaborations” [ 52 ]. One such project was the development of the Pedi Crisis checklist and mobile app [ 53 ]. The checklist was designed to support clinicians during pediatric perioperative life-threatening events. They have the latest evidence-based and expert opinion-based information in a just-in-time format and have been translated into multiple languages. The checklist has been used for both provider learning and just-in-time patient care, particularly among rural practitioners [ 54 ]. A COVID Pediatric Airway Checklist has also been developed.

SPA also sponsors WUS, a multi-institutional pediatric anesthesia quality improvement initiative and a designated Patient Safety Organization. Through its 37 participating institutions, data on thousands of pediatric anesthetics is collected each year and members have used this registry of serious adverse events to publish numerous papers and disseminate best practices. WUS also provides education in education science, holds twice-yearly meetings and monthly conference calls for members. One focus of WUS is quality improvement (QI). In fact, QI was used to design and implement WUS in 2008 [ 55 ]. Tjia et al. further describe the background and development of WUS [ 56 ].

4. Conclusions

Pediatric anesthesiology has made great strides in patient perioperative safety over the past several decades. With the recognition and development of subspecialty organizations such as SPA and its associated committees, associations, and special interest groups such as the SPA Quality and Safety Committee and WUS, the field of pediatric anesthesiology has become more focused on patient safety research to improve anesthetic care for pediatric patients by investigating adverse events. This includes investigating airway/respiratory events, cardiovascular events, medication errors, handover communications, NORA anesthesia and sedation, obesity, NICU patients, and potential neurotoxicity risk. This has encouraged improved perioperative adverse event reporting and analysis as well as an increase in QI initiatives. One recent QI initiative aims to decrease distractions on anesthesia providers during critical periods of anesthesia, and saw a 45% decrease with implementation of QI methods [ 57 ]. With increased event reporting and analysis, we can better investigate incidences, causes, and risks of complications and perioperative adverse events. Other areas for future research include resuscitation protocols, peri-operative nursing training, use of standardized protocols, enhanced recovery after surgery (ERAS), use of electronic medical record alerts, and many others. Continued and improved event reporting will continue to move pediatric anesthesiology forward in improving the safety of care for pediatric patients.

Author Contributions

Writing, review and editing—A.N.L., S.K.R., C.J.C., H.K.L., C.B.W. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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Anesthesia for the elderly: selected topics

Affiliation.

• 1 Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA.
• PMID: 16735817
• DOI: 10.1097/01.aco.0000192807.63785.59

Purpose of review: With the graying of the Western population, there is a continuous increase in the proportion of elderly patients undergoing surgical procedures. Geriatric anesthesia is emerging from a 'subspecialty' to the mainstream of today's anesthesia and perioperative care. Much has been written on anesthesia for the elderly, but this review will concentrate on selected topics related to elderly care that represent current unresolved and pertinent issues for the care of the elderly surgical patient.

Recent findings: Postoperative cognitive dysfunction, cardiac diastolic dysfunction and prophylactic perioperative beta-blockade in the process of major noncardiac surgery are three main topics that have recently attracted great interest in clinical practice and research, and have therefore been chosen as the selected topics for this current review.

Summary: Although age is a clear risk factor for postoperative cognitive dysfunction, the association of general anesthesia with cognitive dysfunction is less clear, as is the effect of anesthesia per se or surgery on long-term cognitive dysfunction. Cardiac diastolic dysfunction is a relatively new and evolving concept in anesthesia and perioperative medicine, yet clearly diastolic dysfunction even with a normal ejection fraction may have a significant effect on the perioperative outcome and management of elderly patients. Small, but powerful studies have shown significant outcome benefit with prophylactic perioperative beta-blockade in high-risk patients undergoing major noncardiac surgery. Data from other studies, however, are still conflicting and the final verdict awaits larger scale outcome studies.

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• Perioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery. Feringa HH, Bax JJ, Poldermans D. Feringa HH, et al. Curr Opin Anaesthesiol. 2007 Jun;20(3):254-60. doi: 10.1097/ACO.0b013e3280c60c50. Curr Opin Anaesthesiol. 2007. PMID: 17479031 Review.
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Core Topics in Neuroanesthesia and Neurointensive Care.

University of Arkansas for Medical Sciences, Little Rock, Arkansas. [email protected]

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Indranil Chakraborty; Core Topics in Neuroanesthesia and Neurointensive Care.. Anesthesiology 2013; 118:232–233 doi: https://doi.org/10.1097/ALN.0b013e318278cb21

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I have a confession to make … Neuroanesthesiology is my first love! There you go, I said it!

So I really had my “neurotransmitters” in overdrive mode when I got the opportunity to review Core Topics in Neuroanesthesia and Neurointensive Care  , by Dr. Matta and his team. Unlike many other specialized fields of modern medicine, neuroanesthesia and neurointensive care have never enjoyed the luxury of having a plethora of quality texts, barring a few. So when the call came, my response was obvious!

The first thing that struck me when I held the book in my hand was its convenient size. That perfectly serves the declared purpose of this book, which is meant for conveniently accessible quick reference. I can easily see the reader tucking it in his/her carry bag to work for quick and definitive reference. I believe that is a big part of the demographic that the authors hope to target through this text.

Also interesting is an almost complete lack of vibrant and overzealous use of color in the design and text material of this book, which I must quickly add is not necessarily a bad thing. To be fair, for the more visually inclined there is a section of color plates in the middle of the book containing excellent-quality and relevant color photographs, imaging scans, line diagrams, among others. This design scheme, consisting mainly of black and white and different shades of gray, is not completely bereft of its admirers. In fact, as a reader, I personally get distracted by too much color in serious medical texts, which seems to be the norm these days. The simple design scheme of this book also keeps the production costs low, which is critical for books like these as they are not meant for mass consumption but are aimed at a niche readership.

Basic concepts in applied physiology and pharmacology, anesthesia, and critical care are increasingly being recognized as a part of the continuum of quality patient care and outcome. As is nicely described by the authors in the Preface of the book, “Practice in related subspecialty areas of anesthesia and critical care often relies on a common knowledge base and skill sets. Neuroanesthesia and neurocritical care represent areas of subspecialty practice where such interdependence is arguably most relevant.” To that goal, the text in the book is conveniently divided into four sections of applied clinical physiology and pharmacology, monitoring and imaging, neuroanesthesia, and neurointensive care, with a total of 36 chapters. This represents a perfect continuum of knowledge progression and keeps the reader’s thought process streamlined and the topics relevant and focused. The authors have also done a commendable job of including most of the relevant topics while restricting the text to fewer than 500 pages.

There is a certain novelty to simplicity and this book is a perfect example of that. The easy-to-read and -understand narrative of this book will strike a chord even in the most uninitiated. The authors, who are well-respected experts in this field, have been able to incorporate the latest information on fundamental physiologic concepts, advanced monitoring technologies, and clinical research and outcome analysis data into the text in such a way that the reader is neither intimidated nor distracted. A lot of emphasis is on the latest developments in neuromonitoring over the last decade, with extensive discussions on topics such as cerebral microdialysis, computer-aided multimodal monitoring and outcome analysis, near-infrared spectroscopy, and others. Along with the traditional topics in neuroanesthesia, there are also chapters dedicated to neuromuscular disorders, central nervous system infections and inflammation, and death and organ donation, as well as ethical and legal issues.

The chapters are well written and contain up-to-date information. The authors provide a list of suggested further readings at the end of each chapter. One could argue that there could be a scope for more specific references in the text. But, considering the stated objectives and the target readership of the book, that is just a minor point. In my humble opinion, in handling such complex and intimidating subjects as neuroanesthesia and neurointensive care, Dr. Matta and his team have been able to strike a delicate balance between a comfortable easy-to-grasp narrative and depth and richness of content.

And, Neuroanesthesia, you will always be my first love!

, University of Arkansas for Medical Sciences, Little Rock, Arkansas. [email protected]

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