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Medicina
Special Issues
Updates on Perioperative Anesthetic Management
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Updates on Perioperative Anesthetic Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: closed (15 January 2023) | Viewed by 15993

Special Issue Editor

Dr. Henry Liu

E-Mail Website
Guest Editor
Department of Anesthesiology & Critical Care, Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Suite 680 Dulles, Philadelphia, PA 19104, USA
Interests: blood management; hemodynamic monitoring; perioperative management
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

This Special Issue intends to provide comprehensive research updates on all aspects of perioperative care and will include original investigations and case reports, among others.

The topics covered include ERAS, novel anesthetic techniques, novel anesthetic agents, advances in hemodynamic monitoring, opioid-sparing perioperative practice, multimodal postoperative analgesia, controversies in fluid therapy, new techniques/equipment in airway management, DINE procedure and its anesthetic management, postoperative neurocognitive decline and perioperative anticoagulation management.

In this Special Issue, we will consider articles from a wide spectrum of related areas, ranging from technical studies, review articles, meta-analyses, research articles (including observation and randomized) and case reports. 

Dr. Henry Liu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • opioid-sparing
  • ERAS
  • hemodynamic monitoring
  • fluid therapy
  • multimodal analgesia
  • novel anesthetic techniques
  • novel anesthetic agents
  • multimodal analgesia
  • controversies in fluid therapy
  • new techniques/equipment in airway management
  • DINE procedure and its anesthetic management
  • perioperative anticoagulation
  • postoperative neurocognitive decline

Published Papers (7 papers)

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Research

Jump to: Review, Other

9 pages, 896 KiB  
Article
The Effect of Remimazolam Compared to Sevoflurane on Postoperative Shivering in Patients Undergoing Laparoscopic Gynecologic Surgery under General Anesthesia: A Prospective Randomized Controlled Trial
by Cheol Lee, Cheolhyeong Lee, Hayoung Lee, Jeongki Park, Junsung Lim and Hyungtae Kim
Medicina 2023, 59(3), 578; https://doi.org/10.3390/medicina59030578 - 15 Mar 2023
Cited by 3 | Viewed by 1734
Abstract
Background and objectives: Anesthesia maintenance agents affect the incidence of postoperative shivering (PS) after general anesthesia. This study compared the effects of remimazolam with sevoflurane on PS in patients undergoing laparoscopic gynecologic surgery under general anesthesia. Materials and methods: Seventy-four patients [...] Read more.
Background and objectives: Anesthesia maintenance agents affect the incidence of postoperative shivering (PS) after general anesthesia. This study compared the effects of remimazolam with sevoflurane on PS in patients undergoing laparoscopic gynecologic surgery under general anesthesia. Materials and methods: Seventy-four patients were allocated into one of two groups. In anesthesia maintenance, group S received sevoflurane and remifentanil, and group R received remimazolam and remifentanil. Results: The incidence and severity of postoperative shivering, mean arterial pressure (MAP), heart rate (HR), core body temperature, and the association of PS with hypothermia, MAP, or HR in the post-anesthesia care unit (PACU) were measured. Group R had significantly lower rates of perioperative hypothermia (58.8 vs. 27.8%, p = 0.009) and postoperative shivering (41.2 vs. 19.4%, p = 0.047). The severity of PS was also lower in group R than in group S (p = 0.034). Core body temperature was significantly higher in group R than in group S from 10 min after induction (p = 0.047) to the PACU (p = 0.009). MAP and HR were significantly higher in group R than in group S from 20 min after induction (p = 0.047) to the PACU (p = 0.009). In group S, the correlation between the severity of PS and the incidence of hypothermia (φc = 0.414, p = 0.121) was moderate but not significant. In group R, the correlation between PS severity and hypothermia (φc = 0.418, p = 0.043) was moderate and significant. Conclusions: Remimazolam showed better results than sevoflurane in anesthesia maintenance regarding hypothermia and PS. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
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13 pages, 1698 KiB  
Article
AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study
by Anca Drăgan and Ioanel Sinescu
Medicina 2023, 59(2), 386; https://doi.org/10.3390/medicina59020386 - 16 Feb 2023
Cited by 1 | Viewed by 1495
Abstract
Background and Objectives: The recommended therapeutic management in renal cell carcinoma (RCC) with supradiaphragmatic inferior vena cava/right atrial thrombus (IVC/RA) is surgery. Extracorporeal circulation is required. Acute kidney injury (AKI), a frequent complication after nephrectomy and cardiac surgery is associated with long-term [...] Read more.
Background and Objectives: The recommended therapeutic management in renal cell carcinoma (RCC) with supradiaphragmatic inferior vena cava/right atrial thrombus (IVC/RA) is surgery. Extracorporeal circulation is required. Acute kidney injury (AKI), a frequent complication after nephrectomy and cardiac surgery is associated with long-term kidney disease. This study aims to identify the risk factors involved in the occurrence of the severe postoperative AKI (AKI3) and to analyse various preoperative validated risk scores from cardiac and noncardiac surgery in predicting this endpoint. Materials and Methods: The medical data of all patients with RCC with supradiaphragmatic IVC/RA thrombus who underwent radical nephrectomy with high thrombectomy, using extracorporeal circulation, between 2004–2018 in the Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, were retrospectively analysed. The patients who died intraoperatively were excluded from the study. The predefined study endpoint was the postoperative AKI3. Preoperative, intraoperative and postoperative data were collected according to the stratification of study population in two subgroups: AKI3-present and AKI3- absent patients. EuroSCORE, EuroSCORE II, Logistic EuroSCORE, NSQIP any-complications and NSQIP serious-complications were analysed. Results: We reviewed 30 patients who underwent this complex surgery between 2004–2018 in our institute. Two patients died intraoperatively. Nine patients (32.14%) presented postoperative AKI3. Age (OR 1.151, CI 95%: 1.009–1.312), preoperative creatinine clearance (OR 1.066, CI 95%: 1.010–1.123) and intraoperative arterial hypotension (OR 13.125, CI 95%: 1.924–89.515) were risk factors for AKI3 (univariable analysis). Intraoperative arterial hypotension emerged as the only independent risk factor in multivariable analysis (OR 11.66, CI 95%: 1.400–97.190). Logistic EuroSCORE (ROC analysis: AUC = 0.813, p = 0.008, CI 95%: 0.633–0.993) best predicted the endpoint. Conclusions: An integrated team effort is essential to avoid intraoperative arterial hypotension, the only independent risk factor of AKI3 in this highly complex surgery. Some risk scores can predict this complication. Further studies are needed. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
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9 pages, 722 KiB  
Article
Comparison of the McGRATHTM Video Laryngoscope and Macintosh Laryngoscope for Orotracheal Intubation in a Simulated Difficult Airway Scenario: An Open-Label, Randomized Clinical Trial
by Jong-Yeop Kim, Seonghyeok Park, Minho Oh, Jong-Bun Choi, Hyun-Ji John, Soo-Kyung Lee and Yi-Hwa Choi
Medicina 2023, 59(2), 282; https://doi.org/10.3390/medicina59020282 - 31 Jan 2023
Cited by 1 | Viewed by 1713
Abstract
Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients’ morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was [...] Read more.
Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients’ morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was to evaluate the efficacy of the McGRATH video laryngoscope for orotracheal intubation compared with that of conventional Macintosh laryngoscopes in simulated difficult airway scenarios. Materials and Methods: In this randomized controlled trial, patients who were scheduled for surgery under general anesthesia requiring orotracheal intubation were assigned to the Macintosh laryngoscope (n = 50) or McGRATH video laryngoscope (n = 45) groups. In this study, to create a simulated difficult airway condition, the subjects performed manual in-line stabilization and applied a soft cervical collar. The primary outcome was the rate of successful intubation within 30 s. The time required for an intubation, glottis grade, intubation difficulty scale (IDS score), the subjective ease of intubation, and optimal external laryngeal manipulation (OLEM) were evaluated. In addition, complications caused by each blade were investigated. Results: The intubation success rate within 30 s was not significantly different between the two groups (44 (88.0%) vs. 36 (80.0%), p = 0.286). The glottic grade was better in the McGRATH group than in the Macintosh group (p = 0.029), but neither the intubation time (26.3 ± 8.2 s vs. 24.2 ± 5.0 s, p = 0.134) nor the rates of oral bleeding (2 (4.0%) vs. 0 (0.0%)) and tooth injury (0 (0.0%) vs. 1 (2.2%)) were significantly different between the two groups. Conclusions: The use of the McGRATH video laryngoscope did not improve the intubation success rate or shorten the intubation time. However, the McGRATH video laryngoscope provided a better glottis view than the conventional Macintosh laryngoscope in patients with a simulated difficult airway. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
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10 pages, 914 KiB  
Article
Retrospective Comparison of Anesthetic Methods for Percutaneous Balloon Kyphoplasty Surgery: General Anesthesia and Erector Spinae Plane Block
by Ufuk Demir and Öztürk Taşkın
Medicina 2023, 59(2), 240; https://doi.org/10.3390/medicina59020240 - 27 Jan 2023
Cited by 1 | Viewed by 1397
Abstract
Background and Objectives: This study aims to investigate whether erector spinae plane (ESP) block can be an alternative to general anesthesia as a primary anesthesia method in percutaneous balloon kyphoplasty surgery. In addition, postoperative intensive care needs were compared in terms of [...] Read more.
Background and Objectives: This study aims to investigate whether erector spinae plane (ESP) block can be an alternative to general anesthesia as a primary anesthesia method in percutaneous balloon kyphoplasty surgery. In addition, postoperative intensive care needs were compared in terms of length of intensive care unit stay and length of hospital stay. Materials and Methods: Medical records of patients who underwent percutaneous balloon kyphoplasty operation at Kastamonu Training and Research Hospital between January 2020 and November 2022 were reviewed retrospectively. Among 70 patients who underwent percutaneous balloon kyphoplasty, 58 patients with ASA (American Association of Anesthesiologists) classification III or IV, who underwent general anesthesia as the anesthesia method or ESP block, were included in the study. The patients were divided into two groups according to the anesthesia method applied. Group GA: general anesthesia group (n = 19) and Group ESP: ESP block group (n = 39). Group data for age, gender, ASA classification, number of surgical levels, surgical urgency, duration of surgery, postoperative complications, need for intensive care, length of stay in the intensive care unit, and hospital stay were compared. Results: There was no statistically significant difference between Group GA and Group ESP in terms of age, gender, ASA classification, surgical urgency, number of surgical levels, duration of surgery, and postoperative complication data of the patients included in the study. Seven (36.6%) patients in Group GA and six (15.4%) patients in Group ESP needed intensive care, and there was no statistically significant difference between the groups (p = 0.06). However, the need for intensive care was higher in Group GA. A statistically significant difference was found in Group GA and Group ESP, which was higher in Group GA for the length of stay in the intensive care unit (p = 0.02) and length of hospitalization (p = 0.04). Conclusions: ESP block may be an alternative method to general anesthesia as the primary anesthetic option for single or multilevel percutaneous balloon kyphoplasty surgery. With the ESP block, the length of stay in the intensive care unit and the length of stay in the hospital can be reduced, especially in high-risk patients. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
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14 pages, 2658 KiB  
Article
Sevoflurane Exposure of Clinical Doses in Pregnant Rats Induces Vcan Changes without Significant Neural Apoptosis in the Offspring
by Yi Jin, Xiaoxue Hu, Fanhua Meng, Qing Luo, Henry Liu and Zeyong Yang
Medicina 2023, 59(2), 190; https://doi.org/10.3390/medicina59020190 - 17 Jan 2023
Viewed by 1581
Abstract
Background and Objectives: Sevoflurane is a commonly used inhalational anaesthetic in clinics. Prolonged exposure to sevoflurane can induce significant changes in lipid metabolism and neuronal damage in the developing brain. However, the effect of exposure of pregnant rats to clinical doses of sevoflurane [...] Read more.
Background and Objectives: Sevoflurane is a commonly used inhalational anaesthetic in clinics. Prolonged exposure to sevoflurane can induce significant changes in lipid metabolism and neuronal damage in the developing brain. However, the effect of exposure of pregnant rats to clinical doses of sevoflurane remains unclear. Materials and Methods: Twenty-eight pregnant rats were randomly and equally divided into sevoflurane exposure (S) group, control (C) and a blank group at gestational day (G) 18; Rats in S group received 2% sevoflurane with 98% oxygen for 6 h in an anesthetizing chamber, while C group received 100% oxygen at an identical flow rate for 6 h in an identical chamber. Partial least squares discriminant analysis (PLS-DA), ultra performance liquid chromatography/time-of-flight mass spectrometry(UPLC/TOF-MS) and MetaboAnalyst were used to analysis acquire metabolomics profiles, and immunohistochemical changes of neuronalapoptosis in hippocampus and cortex of neonatal rats were also analyzed. Results: This study aimed to explore lipidomics and transcriptomics changes related to 2% sevoflurane exposure for 6 h in the developing brains of newborn offspring rats. Ultra-performance liquid chromatography/time-of-flight mass spectrometry (UPLC/TOF–MS) and RNA sequencing (RNA-seq) analyses were used to acquire metabolomics and transcriptomics profiles. We used RNA-seq to analyse the expression of the coding and non-coding transcripts in neural cells of the cerebral cortex. No significant differences in arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), or arterial blood gas were found between the groups. The relative standard deviation (RSD) of retention times was <1.53%, and the RSDs of peak areas ranged from 2.13% to 8.51%. Base peak chromatogram (BPC) profiles showed no differences between the groups. We evaluated the partial least square-discriminant analysis (PLS-DA) model. In negative ion mode, R2X was over 70%, R2Y was over 93%, and Q2 (cum) was over 80%. Cell apoptosis was not remarkably enhanced by TUNEL and haematoxylin and eosin (HE) staining in the sevoflurane-exposed group compared to the control group (p > 0.05). Glycerophospholipid (GP) and sphingolipid metabolism disturbances might adversely influence neurodevelopment in offspring. The expression of mRNAs (Vcan gene, related to neuronal development, function and repair) of the sevoflurane group was significantly increased in the differential genes by qRT-PCR verification. Conclusions: GP and sphingolipid metabolism homeostasis may be potential therapeutic approaches against inhalational anaesthetic-induced neurodegenerative disorders. Meanwhile, sevoflurane-induced Vcan changes indicated some lipidomic and transcriptomic changes, even if neural cell apoptosis was not significantly changed in the usual clinical dose of sevoflurane exposure. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
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Review

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11 pages, 320 KiB  
Review
Hemoglobin-Based Oxygen Carriers: Where Are We Now in 2023?
by Lin Chen, Zeyong Yang and Henry Liu
Medicina 2023, 59(2), 396; https://doi.org/10.3390/medicina59020396 - 17 Feb 2023
Cited by 8 | Viewed by 4354
Abstract
The pursuit for blood a substitute has spanned over a century, but a majority of the efforts have been disappointing. As of today, there is no widely accepted product used as an alternative to human blood in clinical settings with severe anemic condition(s). [...] Read more.
The pursuit for blood a substitute has spanned over a century, but a majority of the efforts have been disappointing. As of today, there is no widely accepted product used as an alternative to human blood in clinical settings with severe anemic condition(s). Blood substitutes are currently also termed oxygen therapeutics. There are two major categories of oxygen therapeutics, hemoglobin-based and perfluorocarbon-based products. In this article, we reviewed the most developed but failed products and products still in active clinical research in the category of hemoglobin-based oxygen carriers. Among all of the discussed hemoglobin-based oxygen therapeutics, HemAssist, PolyHeme, Hemolink, Hemospan, and Hemoximer were discontinued. Hemopure is in clinical use in South Africa and Russia. Oxyglobin, the sister product of Hemopure, has been approved for veterinary use in the European Union and the United States. HemO2life has recently been approved for organ preservation in organ transplantation in the European Union. OxyVita and Sanguinate are still undergoing active clinical studies. The field of oxygen therapeutics seems to be entering a phase of rapid growth in the coming 10–20 years. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)

Other

Jump to: Research, Review

11 pages, 441 KiB  
Systematic Review
Music Therapy: A Noninvasive Treatment to Reduce Anxiety and Pain of Colorectal Cancer Patients—A Systemic Literature Review
by Evan Huang and Jeffrey Huang
Medicina 2023, 59(3), 482; https://doi.org/10.3390/medicina59030482 - 01 Mar 2023
Cited by 2 | Viewed by 3259
Abstract
Background and Objectives: Music interventions have been used for patients with cancer to meet their psychological, physical, social, and spiritual needs. This review identified the efficacy of music therapy among adult patients with colorectal cancer (CRC). Materials and Methods: We searched the PubMed/MEDLINE, [...] Read more.
Background and Objectives: Music interventions have been used for patients with cancer to meet their psychological, physical, social, and spiritual needs. This review identified the efficacy of music therapy among adult patients with colorectal cancer (CRC). Materials and Methods: We searched the PubMed/MEDLINE, CINAHL, and Cochrane Library databases. Only randomized controlled studies reported in English of patients with CRC were included. Two reviewers independently extracted data on patients and intervention measurements. The main outcomes included pain, anxiety, quality of life, mood, nausea, vomiting, vital signs. Results: A total of 147 articles were identified from the search. A total of 10 studies were included in the review. Nine out of the ten studies (90%) showed statistically and clinically significant improvements across the outcome variables. Only one study (10%) found no significant positive effect from music therapy in any of the measured outcomes. Among the seven studies measuring pain as an outcome, four studies (57%) demonstrated that music therapy reduced pain. Three studies (75%) showed that MT reduced anxiety. Conclusions: This systemic review indicates that music therapy might help reduce pain and anxiety for cancer patients, including those with colorectal cancer, who are receiving treatment in palliative care, inpatient care and outpatient care settings. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
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