General Anesthesia as a Multimodal Individualized Clinical Concept

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

Deadline for manuscript submissions: closed (1 July 2021) | Viewed by 24375

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Special Issue Editors

1. Anaesthesia and Intensive Care Department, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
2. Clinic of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu", Timisoara, Romania
3. Medical Education and Clinical Research Department, Romanian Society of Anesthesia and Intensive Care, Bucharest, Romania
Interests: critical care; anaesthesia; biochemistry; molecular pathways
Special Issues, Collections and Topics in MDPI journals
1. Anaesthesia and Intensive Care Department, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
2. Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Timisoara, Romania
3. Medical Education and Clinical Research Department, Romanian Society of Anesthesia and Intensive Care, Bucharest, Romania
Interests: anaesthesia; intensive care; antibiotics; biochemistry
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

General anesthesia has been evolving and improving step-by-step in recent years. One of the main segments that has been in the public eye lately is represented by the multimodal monitoring techniques that ultimately lead to an increased safety of the medical act. Therefore, modern techniques for monitoring the depth of anesthesia have been introduced, together with monitoring the nociception–antinociception balance, the neuromuscular transmission, and monitoring the autonomic nervous system (heart rate, blood pressure, temperature, etc.). Another important aspect of general anesthesia is represented by the probability of awareness, but also by the economic aspects and environmental aspects related to the exhausted gases.

Through this Special Issue, we wish to gather international papers on the core topic of modern multimodal monitoring techniques during general anesthesia, with a focus on a patient-oriented anesthesia based on the individual needs of each patient reflected in the degree of hypnosis, the nociception–antinociception balance, and neuromuscular transmission. Moreover, we wish to address certain important segments regarding methods of reducing anesthetic drug doses by tailoring the administration to the individual needs of patients.

Dr. Alexandru Florin Rogobete
Prof. Dr. Dorel Sandesc
Guest Editors

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Keywords

  • general anesthesia
  • entropy
  • multimodal monitoring
  • depth of anesthesia
  • nociception–antinociception balance
  • post-operative cognitive dysfunction
  • sevoflurane consumption
  • personalized medicine
  • titrated anesthesia
  • neuromuscular transmission
  • analgesia
  • recovery
  • opioids consumption

Published Papers (7 papers)

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Editorial

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3 pages, 240 KiB  
Editorial
General Anesthesia as a Multimodal Individualized Clinical Concept
Medicina 2022, 58(7), 956; https://doi.org/10.3390/medicina58070956 - 19 Jul 2022
Viewed by 1888
Abstract
In the last decades, several new and modern techniques have been developed for the continuous monitoring of vitals for patients undergoing surgery under general anesthesia. These complex methods are meant to come as an adjunct to classical monitoring protocols used in general anesthesia [...] Read more.
In the last decades, several new and modern techniques have been developed for the continuous monitoring of vitals for patients undergoing surgery under general anesthesia. These complex methods are meant to come as an adjunct to classical monitoring protocols used in general anesthesia to increase patient safety. The main objectives of multimodal monitoring are avoiding the over- or underdosing of anesthetic drugs, adapting the concentration for the substances in use, reducing post-anesthetic complications, and increasing patient comfort. Recent studies have shown a series of benefits with significant clinical impact such as a reduced incidence of nausea and vomiting, shorter reversal times, a reduction in opioid consumption, shorter hospital stays, and an increase in patient satisfaction. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)

Research

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10 pages, 775 KiB  
Article
The Impact of Monitoring Depth of Anesthesia and Nociception on Postoperative Cognitive Function in Adult Multiple Trauma Patients
Medicina 2021, 57(5), 408; https://doi.org/10.3390/medicina57050408 - 23 Apr 2021
Cited by 8 | Viewed by 2564
Abstract
Background and Objectives: Patients with traumatic injuries have often been excluded from studies that have attempted to pinpoint modifiable factors to predict the transient disturbance of the cognitive function in the postoperative settings. Anesthetists must be aware of the high risk of [...] Read more.
Background and Objectives: Patients with traumatic injuries have often been excluded from studies that have attempted to pinpoint modifiable factors to predict the transient disturbance of the cognitive function in the postoperative settings. Anesthetists must be aware of the high risk of developing postoperative delirium and cognitive dysfunction (POCD) in patients undergoing emergency surgery. Monitoring the depth of anesthesia in order to tailor anesthetic delivery may reduce this risk. The primary aim of this study was to improve the prevention strategies for the immediate POCD by assessing anesthetic depth and nociception during emergency surgery. Material and Methods: Of 107 trauma ASA physical status II–IV patients aged over 18 years undergoing emergency noncardiac surgery, 95 patients were included in a prospective randomized study. Exclusion criteria were neurotrauma, chronic use of psychoactive substances or alcohol, impaired preoperative cognitive function, pre-existing psychopathological symptoms, or expected surgery time less than 2 h. Entropy and Surgical Pleth Index (SPI) values were constantly recorded for one group during anesthesia. POCD was assessed 24 h, 48 h, and 72 h after surgery using the Neelon and Champagne (NEECHAM) Confusion Scale. Results: Although in the intervention group, fewer patients experienced POCD episodes in comparison to the control group, the results were not statistically significant (p < 0.08). The study showed a statistically significant inverse correlation between fentanyl and the NEECHAM Confusion Scale at 24 h (r = −0.32, p = 0.0005) and 48 h (r = −0.46, p = 0.0002), sevoflurane and the NEECHAM Confusion Scale at 24 h (r = −0.38, p = 0.0014) and 48 h (r = −0.52, p = 0.0002), and noradrenaline and POCD events in the first 48 h (r = −0.46, p = 0.0013 for the first 24 h, respectively, and r = −0.46, p = 0.0002 for the next 24 h). Conclusions: Entropy and SPI monitoring during anesthesia may play an important role in diminishing the risk of developing immediate POCD after emergency surgery. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)
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9 pages, 296 KiB  
Article
Infodemia: Another Enemy for Romanian Frontline Healthcare Workers to Fight during the COVID-19 Outbreak
Medicina 2020, 56(12), 679; https://doi.org/10.3390/medicina56120679 - 09 Dec 2020
Cited by 27 | Viewed by 4548
Abstract
Background and Objectives: The population has been overwhelmed with false information related to the Coronavirus disease (COVID-19) crisis, spreading rapidly through social media and other channels. We aimed to investigate if frontline healthcare workers affected by infodemia show different psychological consequences than frontline [...] Read more.
Background and Objectives: The population has been overwhelmed with false information related to the Coronavirus disease (COVID-19) crisis, spreading rapidly through social media and other channels. We aimed to investigate if frontline healthcare workers affected by infodemia show different psychological consequences than frontline clinicians who do not declare to be affected by false news related to the COVID-19 pandemic. Materials and Methods: One hundred twenty-six frontline healthcare workers from the Intensive Care Unit (ICU) and Emergency Departments in Romania completed a survey to assess stress, depression, anxiety, and sleep disorders, between March and April 2020. We split the sample of frontline healthcare workers into two groups based on the self-evaluated criteria: if they were or were not affected by infodemia in their activity. Results: Considering limitations such as the cross-sectional design, the lack of causality relationship, and the sample size, the results show that, the frontline medical workers who declared to be affected by false news were significantly more stressed, felt more anxiety, and suffered more from insomnia than healthcare workers who are not affected by false information related to pandemic time. Conclusions: The infodemia has significant psychological consequences such as stress, anxiety, and insomnia on already overwhelmed doctors and nurses in the outbreak of the COVID-19 crisis. These findings suggest that medical misinformation’s psychological implications must be considered when different interventions regarding frontline healthcare workers during the COVID-19 pandemic are implemented. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)
9 pages, 305 KiB  
Article
Evaluation of Different Positive End-Expiratory Pressures Using Supreme™ Airway Laryngeal Mask during Minor Surgical Procedures in Children
Medicina 2020, 56(10), 551; https://doi.org/10.3390/medicina56100551 - 21 Oct 2020
Cited by 4 | Viewed by 2248
Abstract
Background and objectives: The laryngeal mask is the method of choice for airway management in children during minor surgical procedures. There is a paucity of data regarding optimal management of mechanical ventilation in these patients. The Supreme™ airway laryngeal mask offers the option [...] Read more.
Background and objectives: The laryngeal mask is the method of choice for airway management in children during minor surgical procedures. There is a paucity of data regarding optimal management of mechanical ventilation in these patients. The Supreme™ airway laryngeal mask offers the option to insert a gastric tube to empty the stomach contents of air and/or gastric juice. The aim of this investigation was to evaluate the impact of positive end-expiratory positive pressure (PEEP) levels on ventilation parameters and gastric air insufflation during general anesthesia in children using pressure-controlled ventilation with laryngeal mask. Materials and Methods: An observational trial was carried out in 67 children aged between 1 and 11 years. PEEP levels of 0, 3 and 5 mbar were tested for 5 min in each patient during surgery and compared with ventilation parameters (dynamic compliance (mL/cmH2O), etCO2 (mmHg), peak pressure (mbar), tidal volume (mL), respiratory rate (per minute), FiO2 and gastric air (mL)) were measured at each PEEP. Air was aspirated from the stomach at the start of the sequence of measurements and at the end. Results: Significant differences were observed for the ventilation parameters: dynamic compliance (PEEP 5 vs. PEEP 3: p < 0.0001, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001), peak pressure (PEEP 5 vs. PEEP 3: p < 0.0001, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001) and tidal volume (PEEP 5 vs. PEEP 3: p = 0.0048, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001). All parameters increased significantly with higher PEEP, with the exception of etCO2 (significant decrease) and respiratory rate (no significant difference). We also showed different values for air quantity in the comparisons between the different PEEP levels (PEEP 5: 2.8 ± 3.9 mL, PEEP 3: 1.8 ± 3.0 mL; PEEP 0: 1.6 ± 2.3 mL) with significant differences between PEEP 5 and PEEP 3 (p = 0.0269) and PEEP 5 and PEEP 0 (p = 0.0209). Conclusions: Our data suggest that ventilation with a PEEP of 5 mbar might be more lung protective in children using the Supreme™ airway laryngeal mask, although gastric air insufflation increased with higher PEEP. We recommend the use of a laryngeal mask with the option of inserting a gastric tube to evacuate potential gastric air. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)

Review

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16 pages, 9195 KiB  
Review
Ultrasound-Guided Regional Anesthesia–Current Strategies for Enhanced Recovery after Cardiac Surgery
Medicina 2021, 57(4), 312; https://doi.org/10.3390/medicina57040312 - 25 Mar 2021
Cited by 17 | Viewed by 5115
Abstract
With the advent of fast-track pathways after cardiac surgery, there has been a renewed interest in regional anesthesia due to its opioid-sparing effect. This paradigm shift, looking to improve resource allocation efficiency and hasten postoperative extubation and mobilization, has been pursued by nearly [...] Read more.
With the advent of fast-track pathways after cardiac surgery, there has been a renewed interest in regional anesthesia due to its opioid-sparing effect. This paradigm shift, looking to improve resource allocation efficiency and hasten postoperative extubation and mobilization, has been pursued by nearly every specialty area in surgery. Safety concerns regarding the use of classical neuraxial techniques in anticoagulated patients have tempered the application of regional anesthesia in cardiac surgery. Recently described ultrasound-guided thoracic wall blocks have emerged as valuable alternatives to epidurals and landmark-driven paravertebral and intercostal blocks. These novel procedures enable safe, effective, opioid-free pain control. Although experience within this field is still at an early stage, available evidence indicates that their use is poised to grow and may become integral to enhanced recovery pathways for cardiac surgery patients. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)
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18 pages, 951 KiB  
Review
Multiparametric Monitoring of Hypnosis and Nociception-Antinociception Balance during General Anesthesia—A New Era in Patient Safety Standards and Healthcare Management
Medicina 2021, 57(2), 132; https://doi.org/10.3390/medicina57020132 - 02 Feb 2021
Cited by 6 | Viewed by 3532
Abstract
The development of general anesthesia techniques and anesthetic substances has opened new horizons for the expansion and improvement of surgical techniques. Nevertheless, more complex surgical procedures have brought a higher complexity and longer duration for general anesthesia, which has led to a series [...] Read more.
The development of general anesthesia techniques and anesthetic substances has opened new horizons for the expansion and improvement of surgical techniques. Nevertheless, more complex surgical procedures have brought a higher complexity and longer duration for general anesthesia, which has led to a series of adverse events such as hemodynamic instability, under- or overdosage of anesthetic drugs, and an increased number of post-anesthetic events. In order to adapt the anesthesia according to the particularities of each patient, the multimodal monitoring of these patients is highly recommended. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, the reduction of awakening times, and the reduction of postoperative complications. Another important aspect is the impact on the status of inflammation and the redox balance. By minimizing inflammatory and oxidative impact, a faster recovery can be achieved that increases patient safety. The purpose of this literature review is to present the most modern multimodal monitoring techniques to discuss the particularities of each technique. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)
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9 pages, 521 KiB  
Review
Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods
Medicina 2020, 56(10), 528; https://doi.org/10.3390/medicina56100528 - 12 Oct 2020
Cited by 1 | Viewed by 2421
Abstract
Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute [...] Read more.
Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute or chronic inflammatory conditions), iron-restricted erythropoiesis can develop. This systemic review was conducted to draw attention to the delicate problem of perioperative anemia, and to provide solutions to optimize the management of anemic surgical patients. Systemic reviews and meta-analyses, clinical studies and trials, case reports and international guidelines were studied, from a database of 50 articles. Bone marrow biopsy, serum ferritin levels, transferrin saturation, the mean corpuscular volume, and mean corpuscular hemoglobin concentration were used in the diagnosis of iron deficiency. There are various intravenous iron formulations, with different pharmacological profiles used for restoring iron. In surgical patients, anemia is an independent risk factor for morbidity and mortality. Therefore, anemia correction should be rapid, with parenteral iron formulations—the oral ones—being inefficient. Various studies showed the safety and efficacy of parenteral iron formulations in correcting hemoglobin levels and decreasing the blood transfusion rate, the overall mortality, the postoperative infections incidence, hospitalization days, and the general costs. Full article
(This article belongs to the Special Issue General Anesthesia as a Multimodal Individualized Clinical Concept)
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