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Anesthesia and Sedation for Out-of-Operating-Room Procedures

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (31 March 2025) | Viewed by 7557

Special Issue Editor


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Guest Editor
Professor and Medical Director of Jefferson Surgical Center Endoscopy, Department of Anesthesiology and Critical Care Medicine, Sidney Kimmel Medical College, Jefferson Health, Philadelphia, PA 19107, USA
Interests: out-of-operating-room anesthesia; procedural sedation; GI endoscopy and bronchoscopy
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Special Issue Information

Dear Colleagues,

The field of out-of-operating-room anesthesia is unique as it encroaches into many areas that are traditionally considered non-surgical. This emerging field is mainly composed of interventional procedures, and many such procedures benefit from sedation, the spectrum of which ranges from moderate sedation to general anesthesia. Such specialties and procedures include and are not limited to gastrointestinal endoscopy, bronchoscopy, interventional neuroradiology, cardiac electrophysiological procedures, and electroconvulsive therapy. Although the field is sizable, there are no journals dedicated to publishing related research.

This Special Issue will try and provide a platform for many researchers and authors across the medical specialties to narrate their experiences, publish their findings, and provide commentaries. We invite original articles, reviews, and meta-analyses. 

As someone who has researched and published in the field extensively, it is my honor to be the Guest Editor of this Special Issue.

Prof. Dr. Basavana Gouda Bharamana Goudra
Guest Editor

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Keywords

  • gastrointestinal endoscopy
  • bronchoscopy
  • electrophysiological procedures
  • electroconvulsive therapy
  • out-of-operating-room anesthesia

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Published Papers (4 papers)

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Research

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13 pages, 932 KiB  
Article
An Increase in Mean Aortic Valve Gradients the Day After Transcatheter Aortic Valve Implantation: The Effects of Evolving Anesthesia Techniques
by Benjamin Fogelson, Raj Baljepally, Billy Morvant, Terrance C. Nowell, Robert Eric Heidel, Steve Ferlita, Stefan Weston, Aladen Amro, Zachary Spires, Kirsten Ferraro and Parth Patel
J. Clin. Med. 2025, 14(10), 3272; https://doi.org/10.3390/jcm14103272 - 8 May 2025
Viewed by 612
Abstract
Background and Objectives: After transcatheter aortic valve implantation (TAVI), transvalvular gradients increase immediately following the procedure up to 24 h afterward. While factors such as anesthesia type and fluid status have been suggested as potential contributors, the underlying cause remains unclear. With [...] Read more.
Background and Objectives: After transcatheter aortic valve implantation (TAVI), transvalvular gradients increase immediately following the procedure up to 24 h afterward. While factors such as anesthesia type and fluid status have been suggested as potential contributors, the underlying cause remains unclear. With advancements in TAVI techniques, there has been a shift in anesthesia protocols from general anesthesia (GA) to monitored anesthesia care (MAC). This study aimed to assess the impact of GA and MAC on the increase in transvalvular gradients observed 24 h post-TAVI. Methods: A retrospective, single-center analysis was conducted on patients who underwent TAVI at our institution between 2011 and 2023 (n = 744, males = 421). The patients were divided into two groups: those who received GA (n = 201) and those who received MAC (n = 543). The GA group received either inhaled anesthetics, with or without propofol infusions, or propofol infusions at a rate of ≥100 mcg/kg/min. The MAC group received bolus doses and continuous infusions of dexmedetomidine. Transvalvular gradients were compared between immediate and 24 h post-procedure echocardiograms. Results: The average age of patients in the GA group (78 years [IQR 71–83]) was similar to that of the MAC group (77 years [IQR 71–83]). The GA group had a higher prevalence of comorbidities at baseline. Both groups exhibited stable, normotensive blood pressure levels during the procedure, though the GA group required more vasopressors and intravenous fluid. The GA group showed a 24 h post-TAVI mean transvalvular gradient change of +5.1 mmHg [IQR 3–8.1], while the MAC group had a 24 h mean transvalvular gradient change of +5.8 mmHg [IQR 3.2–9], with no significant difference between the groups (p = 0.139). Conclusions: Despite the greater cardiovascular depressive effects and increased need for vasopressors and fluid resuscitation in the GA group, there was no significant difference in the increase in transvalvular gradients between the GA and MAC groups at 24 h post-TAVI. Further research is needed to fully understand the reasons behind the increase in gradients observed after TAVI. Full article
(This article belongs to the Special Issue Anesthesia and Sedation for Out-of-Operating-Room Procedures)
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14 pages, 1518 KiB  
Article
Dexmedetomidine Continuous Infusion vs. Remifentanil Target-Controlled Infusion for Conscious Sedation in Otosclerosis Surgery—A Prospective, Single-Center, Randomized Controlled Trial
by Caius Mihai Breazu, Alma Aurelia Maniu, Ioan Florin Marchis, Matei Florin Negrut, Răzvan Alexandru Ciocan, Florin Vasile Mihăileanu and Violeta Necula
J. Clin. Med. 2025, 14(9), 2869; https://doi.org/10.3390/jcm14092869 - 22 Apr 2025
Viewed by 596
Abstract
Background/Objectives: Otosclerosis causes progressive hearing loss through abnormal bone remodeling within the otic capsule and predominantly affects young individuals. Surgical intervention can markedly enhance a patient’s quality of life and socio-economic status. Anesthetic management may involve either general anesthesia or monitored anesthesia care, [...] Read more.
Background/Objectives: Otosclerosis causes progressive hearing loss through abnormal bone remodeling within the otic capsule and predominantly affects young individuals. Surgical intervention can markedly enhance a patient’s quality of life and socio-economic status. Anesthetic management may involve either general anesthesia or monitored anesthesia care, with the latter enabling real-time assessment of hearing improvement while providing optimal surgical conditions and patient satisfaction. This study examines the efficacy and safety of continuous dexmedetomidine infusion and target-controlled remifentanil infusion for conscious sedation combined with local anesthesia in otosclerosis surgery. Methods: Seventy-four adult patients undergoing otosclerosis surgery were randomly assigned to either the dexmedetomidine group or the remifentanil group. Primary outcomes included patient satisfaction at 24 h post-surgery and surgeon satisfaction with operative conditions. Secondary outcomes comprised hemodynamic effects, the necessity for adjuncts to the proposed sedation protocols, and intra- and postoperative complications. Results: There was no statistically significant difference between the dexmedetomidine and remifentanil groups regarding patient satisfaction (p = 0.943) and surgeon satisfaction (p = 0.069). A strong correlation was observed between surgeons’ assessments and patients’ satisfaction Composite Scores (η2 = 0.185, p = 0.003). Dexmedetomidine was more effective in significantly reducing arterial pressure and heart rate without undesirable clinical effects. Conclusions: No significant difference was found between the groups concerning patient and surgeon satisfaction. Dexmedetomidine infusion led to considerable reductions in arterial pressure and heart rate compared to remifentanil. Full article
(This article belongs to the Special Issue Anesthesia and Sedation for Out-of-Operating-Room Procedures)
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Review

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15 pages, 1426 KiB  
Review
Recent Advances in Perioperative Analgesia in Thoracic Surgery: A Narrative Review
by John Mitchell, Céline Couvreur and Patrice Forget
J. Clin. Med. 2025, 14(1), 38; https://doi.org/10.3390/jcm14010038 - 25 Dec 2024
Cited by 2 | Viewed by 2018
Abstract
Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, and complications necessitate exploring alternative methods. This narrative review [...] Read more.
Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, and complications necessitate exploring alternative methods. This narrative review examined recent advances in perioperative analgesic strategies in thoracic surgery, focusing on regional anesthetic techniques like paravertebral blocks (PVBs), erector spinae plane blocks (ESPBs), intercostal blocks, and serratus anterior blocks. Each approach was evaluated for efficacy, safety, and impact on patient outcomes. PVB can provide effective unilateral analgesia with fewer systemic complications compared to epidurals. ESPB provides analgesia through a superficial, ultrasound-guided approach, minimizing risks and offering an alternative for various thoracic procedures. Intercostal blocks are effective but are limited by the need for multiple injections, increasing the complication risks. Serratus anterior blocks, targeting intercostal and thoracic nerves, show promise in managing lateral thoracic wall pain with a low complication rate. Advancements in surgical techniques including minimally invasive approaches further optimize pain control and recovery. A multimodal analgesic approach combining regional anesthesia and systemic therapies enhances outcomes by addressing somatic and visceral pain components. Despite the efficacy of epidural analgesia, alternative regional techniques offer comparable pain relief with fewer complications, suggesting their growing role in thoracic surgery. Collaborative efforts between surgical, anesthetic, and emergency teams are crucial for tailoring pain management strategies to individual patients, improving recovery and reducing long-term morbidity. Future research should continue exploring these methods to refine their application and broaden their accessibility. Full article
(This article belongs to the Special Issue Anesthesia and Sedation for Out-of-Operating-Room Procedures)
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24 pages, 11211 KiB  
Review
Anesthesia for Bronchoscopy—An Update
by Basavana Goudra, Lalitha Sundararaman, Prarthna Chandar and Michael Green
J. Clin. Med. 2024, 13(21), 6471; https://doi.org/10.3390/jcm13216471 - 29 Oct 2024
Cited by 2 | Viewed by 3891
Abstract
The field of interventional pulmonology has grown immensely and is increasingly recognized as a subspecialty. The new procedures introduced in the last decade pose unique challenges, and anesthesiologists need to readapt to their specific demands. In this review, we extensively discuss the pathophysiology, [...] Read more.
The field of interventional pulmonology has grown immensely and is increasingly recognized as a subspecialty. The new procedures introduced in the last decade pose unique challenges, and anesthesiologists need to readapt to their specific demands. In this review, we extensively discuss the pathophysiology, technical aspects, preprocedural preparation, anesthetic management, and postprocedural challenges of many new procedures such as navigational bronchoscopy, endobronchial valve deployment, and bronchial thermoplasty. Majority of these procedures are performed under general anesthesia with an endotracheal tube. Total intravenous anesthesia with rocuronium as a muscle relaxant seems to be the standard US practice. The easy availability and proven safety and efficacy of sugammadex as a reversal agent of rocuronium has decreased the need for high-dose remifentanil as an agent to avoid muscle relaxants. Additional research is available with regard to the utility of nebulized lidocaine and is discussed. Finally, two newer drugs administered for conscious sedation (typically without the need of an anesthesiologist) are likely to gain popularity in the future. Remimazolam is a new short-acting benzodiazepine with a relatively faster offset of clinical effects. Dexmedetomidine, a selective adrenergic agonist, is increasingly employed in bronchoscopy as a sedative during bronchoscopic procedures. Full article
(This article belongs to the Special Issue Anesthesia and Sedation for Out-of-Operating-Room Procedures)
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