The utilization of intranasal local anesthetic agents has become a prevalent approach in nasal endoscopy procedures, aimed at enhancing patient comfort and optimizing procedural outcomes. This comprehensive literature review seeks to evaluate the benefits and risks associated with the use of intranasal anesthetics prior to nasal endoscopy. A total of twenty-eight studies published within the last three decades were meticulously examined and incorporated in this literature review. The majority of the reviewed studies overwhelmingly demonstrated no significant reduction in patient discomfort or pain during nasal endoscopy with the use of intranasal anesthetics. However, it is noteworthy that two of the included studies highlighted the potential benefits of masking agents to mitigate the bitter taste associated with anesthetic agents, leading to increased analgesic properties during the endoscopic procedure. Conversely, three of the reviewed studies indicated that intranasal anesthetic usage positively impacted the ease of the procedure for the endoscopist, resulting in improved visualization of the nasal cavity and higher-quality images. Interestingly, the choice of specific anesthetic agents, such as cocaine, tetracaine, lidocaine, or co-phenylcaine, did not appear to play a substantial role in the reported outcomes across the studies. In contrast, the method, timing, and decision-making process regarding the application of intranasal anesthetics emerged as crucial factors that influenced the observed outcomes and potential side effects. The variations in these factors yielded diverse results among the studies, emphasizing the significance of careful consideration and standardized protocols in the administration of intranasal anesthetics. Overall, while the reviewed studies generally did not demonstrate significant benefits in terms of reducing patient discomfort or pain, there were notable improvements in the ease of procedure for the endoscopist with intranasal anesthetic usage. Furthermore, the choice of anesthetic agent alone did not significantly impact the outcomes. However, the methodology, timing, and decision-making were shown to be important factors in achieving desirable results. Further research is warranted to explore optimal approaches for intranasal anesthetic administration, including the development of effective masking agents and standardized protocols. It is crucial for further research to assess the utilization of intranasal anesthetics to ensure patient comfort, procedural efficacy, and safety during nasal endoscopy procedures.

Anesthesia awareness is a rare, but severe complication of anesthesia with possible severe long-term effects that is more commonly reported after trauma and emergent surgery. Anesthesia awareness in trauma patients who require emergency surgery has not been researched on since Bogetz and Katz’s study in 1984. This landmark study reported a higher risk of anesthesia awareness due to multiple factors, including intolerance of anesthetic agents in these patients who often present with hemodynamic instability and low blood pressure. Given the reported risk of awareness in this population, clinicians continue to administer standard doses of anesthetic agents despite the associated hemodynamic effects and the concern for other anesthesia-related complications. Therefore, it is important to determine if the risk factors and incidence of awareness remains high despite recent advances in anesthetic techniques and monitoring. We hypothesized that awareness under general anesthesia in trauma patients is less common with the use of modern-day anesthetic agents and monitoring devices. To examine this hypothesis, the incidence of anesthesia awareness was retrospectively studied in all trauma patients requiring emergency surgery at Boston Medical Center (BMC) between January 2020 and February 2022. The patients were asked a 5-minute questionnaire which included questions from the modified Brice questionnaire to determine the incidence of perioperative awareness. It was found that the incidence of awareness during general anesthesia in trauma surgery patients at BMC from January 2020 through February 2022 was significantly lower (with an incidence of 0%) than the previously reported incidence of 11% by Bogetz and Katz, (p = 0.028, CI -0.22-0.00). Further research is warranted to confirm our findings and further explore the incidence and impact of awareness in this vulnerable population. Future prospective studies should examine a greater number of trauma patients, associated risk factors, and the role of processed EEG monitoring in preventing awareness during general anesthesia.

Thesis (M.S.)--University of Michigan, 2006. / Includes bibliographical references (leaves 116-122).

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

No description available.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

The topic of this dissertation, modeling and identification of nonlinear oscillation, represents an area of mathematical systems theory that has received little attention in the past. Primarily, the types of oscillation of interest are those found in biological systems where theoretical foundations for mathematical models are insufficient. These oscillations are also observed in other systems including electrical, mechanical, and chemical. The contributions of this dissertation are a generalized class of autonomous differential equations that are found to exhibit stable limit cycles, and an investigation of a method of system identification that can be used to estimate the model parameters. Here the observed signal is modeled as the response of a nonlinear system that can be described by differential equations. Modeling the signal in this way shifts the emphasis from signal characteristics, such as spectral content, to system characteristics, such as parameter values and system structure. This shift in emphasis may provide a better method for monitoring complex systems that exhibit periodic behavior such as patients under anesthesia. A class of autonomous differential equations, called the generalized oscillator models, are presented as one nᵗʰ-order differential equations with nonlinear coefficients. The coefficients are chosen to change sign depending on the magnitude of the phase variables. The coefficients are negative near the origin and positive away from the origin. Motivated by the generalized Routh-Hurwitz criterion, this coefficient sign changing produces the desired oscillation. Properties of the generalized oscillator model are investigated using the describing function method of analysis and numerical simulation. Several descriptive examples are presented. Based on the generalized oscillator model as a set of candidate models, the system identification problem is formed as a mathematical programming problem. The method of quasilinearization is investigated as method of solving the identification problem. Two examples are presented that demonstrate the method. It is shown that in general, the method of quasilinearization as a solution to the system identification problem will not converge regardless of the initial starting point. This result indicates that although the quasilinearization method is useful for solving two-point boundary value problems, it is not useful (in its present form) for solving the system identification problem.

ANESTHESIA RECORDKEEPING: ACCURACY OF RECALL WITH COMPUTERIZED AND MANUAL ENTRY RECORDKEEPING By Thomas Corey Davis, PhD A dissertation submitted in partial fulfillment of the requirements for the degree of PhD in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Dr. Chuck Biddle Director of Research, Department of Nurse Anesthesia And Dr. Jeffery A. Green Assistant Chief of Anesthesiology, Department of Anesthesia Introduction: Anesthesia information management systems are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and permanent electronic record. At risk is a potential loss of “connectedness” to the patient with the use of computerized recordkeeping, perhaps jeopardizing vigilance. Methods: This research analyzed differences in the accuracy of Certified Registered Nurse Anesthetists' (CRNAs) recall of specific patient variables during the course of an actual anesthetic case. CRNAs using computerized recordkeeping systems were compared to CRNAs using manual entry recordkeeping. Accuracy of recalled values of 10 patient variables was measured - highest and lowest heart rate, systolic blood pressure, inspiratory pressure, and end-tidal carbon dioxide levels, lowest oxygen saturation and total fluid volume. In addition, a filmed educational vignette was presented to evaluate any effect on accuracy of recall following this presentation. Four tertiary care facilities participated in this research. A Solomon four-group research design was selected to control for the effect of pretesting on results of the filmed educational treatment. Results: 214 subjects participated in this study; 106 in the computerized recordkeeping group, and 108 in the manual entry recordkeeping group. Demographic covariates were analyzed to ensure homogeneity between groups and facilities. No significant statistical differences were identified between the accuracy of recall among the groups. There was no statistically significant effect of the educational film vignette on accuracy of recall. Conclusions: There was no difference in the accuracy of practitioners’ recall of patient variables when using computerized or manual entry recordkeeping systems, suggesting little impact on vigilance. The educational film presented did not have an effect on accuracy of recall following the discussion of benefits and limitations of methods of recordkeeping.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesia Johannesburg, April 2013 / BACKGROUND: Once lauded as one of the most valuable interventions across all fields of contemporary medicine, perioperative beta blockade (PBB) is a practice that has come under intense scrutiny. Publication of the PeriOperative ISchemic Evaluation (POISE) study forced a modification of recommendations for PBB in consensus guidelines. Practice in South Africa has not been previously reported. OBJECTIVES: The primary objective of this study was to describe current intended practice, with respect to PBB, in patients undergoing major vascular surgery at South African specialist training facilities. Secondary objectives were describing participant satisfaction with current strategy, reporting suggested modifications to clinician responsibilities in the future, and identifying potential barriers to the intervention. METHOD: One anaesthesiologist and one vascular surgeon from each of the seven recognised training facilities for vascular surgery in South Africa were included in a partially selective observational survey. Data was generated by the use of a semi-structured questionnaire specifically developed to address the objectives of the study. RESULTS: The POISE study results and updated international consensus guidelines had not prompted a change in approach at most facilities. There was inconsistency in methods of risk stratification, treatment implementation, titration practices, and the timing of withdrawal of medication. Anaesthesiologist and vascular surgeon opinion on current intended practice correlated poorly. Opinions correlated least well at facilities where both clinicians claimed responsibility for PBB, implying that communication may be a problem. Similarities, where they did occur, were in keeping with recommendations that are widely supported in the literature. Less than half of the participants were satisfied with current practice. The involvement of the anaesthesiologists in the perioperative management of vascular surgery patients was less than reported in other countries. The participants supported a major role for anaesthesiologists in the future, and a move towards multidisciplinary involvement in policy development and patient management. The need for appropriate monitoring was identified as one of many important barriers. CONCLUSIONS: This study describes current intended practice at South African training facilities for vascular surgery. The variable practice across the country; the poor correlation of participant responses; widespread dissatisfaction with current strategy; suggested changes to clinician responsibilities; and the identification of multiple barriers to the implementation of strategy, highlight the need for review at all facilities. Further research is needed, since the optimal strategy for reducing risk in patients undergoing vascular surgery remains elusive.

A depressão do sistema cardiocirculatório é um fator associado ao uso dos agentes halogenados na anestesia inalatória eqüina. Como conseqüência direta é observada a queda na perfusão tecidual, causadora de complicações como a miopatia pós-anestésica, o íleo paralítico ou a insuficiência renal. O objetivo do presente estudo foi avaliar os efeitos hemodinâmicos de dois fármacos simpatomiméticos, efedrina e fenilefrina, em eqüinos anestesiados com isoflurano que apresentaram episódio de hipotensão durante o procedimento anestésico. Foram utilizados 10 eqüinos sadios, em decúbito lateral, distribuídos aleatoriamente em dois grupos de cinco animais cada. O grupo I recebeu a infusão de efedrina (0.02mg/kg/min), e o grupo II de fenilefrina (0,002mg/kg/min), sendo que o avaliador não conhecia a natureza dos fármacos. Foram analisados os parâmetros hemodinâmicos, de oxigenação e de ventilação. Os dados foram submetidos à comparação estatística que constou de análise de variância seguida dos testes de Tukey Kramer e T de Student. Quando comparou-se os diferentes momentos do mesmo grupo, foi observada melhora ou manutenção dos parâmetros hemodinâmicos avaliados após o uso dos agentes simpatomiméticos, nos dois grupos. Porém, quando os momentos correspondentes dos grupos foram confrontados, o índice cardíaco, o conteúdo de oxigênio venoso misto, o índice de transporte do oxigênio, a pressão de oxigênio venoso misto e a saturação de oxigênio venoso misto foram superiores no grupo I. Foi concluído que os dois agentes proporcionaram os efeitos hemodinâmicos desejáveis, entretanto, a efedrina apresentou melhor resposta cardiovascular e de oxigenação que a fenilefrina. Assim, pode-se pressupor que a infusão com efedrina provavelmente proporciona melhor perfusão sangüínea, sendo portanto mais indicada para o tratamento da hipotensão nos eqüinos submetidos à anestesia geral. / Depression of the cardiovascular system is a feature of the use of halogenated anesthetics in equine anesthesia. A decrease in tissue perfusion is the main result and can be the cause of complications such as post-anesthetic myopathy, ileus and renal insufficiency. The aim of then present study was to evaluate the hemodynamic effects of two sympathomimetic agents, ephedrine and phenylephrine in horses anesthetized with isoflurane, which presented hypotension during the anesthetic procedure. Ten healthy horses, in lateral recumbence, were randomly distributed in two groups of five animals each. Group I received an infusion of ephedrine (0.02mg/kg/min) and group II an infusion of phenylephrine (0.002mg/kg/min) and the surveyor did not know the agent administered. Hemodynamic, oxygenation and ventilation parameters were evaluated and the results submitted to statistical analysis performed by means of analysis of variance followed by the Tukey-Kramer and Student-T test. When the different moments of the same group were compared, an increment or maintenance of the hemodynamic parameters evaluated after the infusion of both agents was noticed. However, when the correspondent moments of each group were compared, the cardiac index, the mixed venous oxygen content, oxygen transport index and both mixed venous oxygen saturation and partial pressure were superior in group I. It was concluded that the two agents promoted the desired hemodynamic effects, although ephedrine caused the best cardiovascular and oxygenation responses. For this reason, we can presume that ephedrine infusion probably promotes superior tissue perfusion, and therefore is more indicated for the treatment of hypotension in horses submitted to general anesthesia.