Anesthesia Methods for Abdominal Aortic Aneurysm Repair
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Questions and Answers

What is the primary outcome of combined neuraxial and general anesthesia in elective open abdominal aortic aneurysm repair?

  • Reduction in 90-day mortality (correct)
  • Increased risk of neuraxial-related complications
  • Prolonged hospital stay
  • Reduction in 30-day morbidity

    • What is the recommended approach for patients undergoing elective open AAA repair?

  • General anesthesia alone in all cases
  • Combined general and neuraxial anesthesia in the absence of contraindications (correct)
  • Combined general and neuraxial anesthesia in all cases
  • Neuraxial anesthesia alone in high-risk patients

    • What is the main limitation of the study design in this population-based observational research?

  • Small sample size
  • High risk of bias in the data collection
  • Lack of randomization (correct)
  • Insufficient follow-up period

    • What is the primary benefit of considering physiologic, anatomical, medication, dose, and technical variables in future studies?

    <p>Improving the accuracy of the study results</p> Signup and view all the answers

    What is the primary benefit of using intrathecal morphine in totally endoscopic coronary artery bypass surgery?

    <p>Significant postoperative analgesia and decreased use of opioids for 48 hours</p> Signup and view all the answers

    What is the dosage of intrathecal morphine used in the study for patients undergoing totally endoscopic CABG?

    <p>5 mcg/kg</p> Signup and view all the answers

    What is the duration of postoperative analgesia achieved with intrathecal morphine in the study?

    <p>48 hours</p> Signup and view all the answers

    What is the potential benefit of using intrathecal morphine in minimally invasive cardiac surgeries?

    <p>Improved analgesia in a wide variety of surgeries</p> Signup and view all the answers

    What is the most effective method for preventing hypotension due to spinal anesthesia in lower abdominal and lower limb vascular surgery?

    <p>Prophylactic intravenous ephedrine infusion</p> Signup and view all the answers

    What is the primary benefit of using prophylactic intravenous ephedrine infusion in lower abdominal and lower limb vascular surgery?

    <p>Prevention of hypotension due to spinal anesthesia</p> Signup and view all the answers

    In comparison to fluid preload, what is the advantage of prophylactic intravenous ephedrine infusion in preventing hypotension due to spinal anesthesia?

    <p>Greater efficacy</p> Signup and view all the answers

    What is the main outcome of using dexmedetomidine in addition to local regional anesthesia in carotid endarterectomy?

    <p>Similar rates of immediate and short-term complications and postoperative pain scores</p> Signup and view all the answers

    What is the main advantage of using dexmedetomidine in addition to local regional anesthesia in carotid endarterectomy?

    <p>It is a safe and acceptable alternative to conventional GETA or LRA alone</p> Signup and view all the answers

    What is the primary benefit of MEP monitoring during TAA/TAAA open repair surgery?

    <p>To detect intraoperative spinal cord ischemia and postoperative paraplegia</p> Signup and view all the answers

    What is the therapeutic effect of dexmedetomidine on aortic dissection?

    <p>Reduces inflammatory response</p> Signup and view all the answers

    What is the primary goal of using dexmedetomidine in aortic dissection?

    <p>To decrease inflammatory response</p> Signup and view all the answers

    What is the primary benefit of using Non-intubated Deep Paralysis (NIDP) in vocal cord polypectomy?

    <p>Significantly reducing the duration of anesthesia and postoperative recovery</p> Signup and view all the answers

    What is the impact of NIDP on postoperative recovery in vocal cord polypectomy?

    <p>It reduces the duration of postoperative recovery</p> Signup and view all the answers

    How does dexmedetomidine compare to propofol in terms of postoperative sedation effects?

    <p>Dexmedetomidine has superior sedation effects compared to propofol</p> Signup and view all the answers

    What is the primary benefit of using dexmedetomidine for postoperative sedation in patients following UPPP, in terms of respiratory depression?

    <p>It reduces the risk of respiratory depression during extubation</p> Signup and view all the answers

    Compared to midazolam, what is the primary advantage of dexmedetomidine in patients undergoing partial and total laryngectomy?

    <p>Lower incidence of adverse events</p> Signup and view all the answers

    What is the effect of dexmedetomidine on hemodynamic changes during emergence from anesthesia in patients undergoing partial and total laryngectomy?

    <p>Attenuates hemodynamic changes</p> Signup and view all the answers

    What is the primary outcome of using single-dose dexamethasone in children undergoing adenotonsillectomy?

    <p>Significant reduction in postoperative pain and PONV</p> Signup and view all the answers

    What is the primary benefit of using intraoperative dexamethasone in children undergoing adenotonsillectomy?

    <p>Achievement of adequate postoperative analgesia and antiemesis without side effects</p> Signup and view all the answers

    What is the primary role of dexamethasone in the context of adenotonsillectomy?

    <p>Pain management</p> Signup and view all the answers

    What is essential when considering antibiotic therapy in tonsillectomy patients?

    <p>A comprehensive analysis of potential benefits and risks</p> Signup and view all the answers

    Which type of neck dissection has the lowest estimated prevalence of shoulder syndrome/spinal accessory nerve injury?

    <p>Selective neck dissection</p> Signup and view all the answers

    What is the recommended approach to reduce the prevalence of nerve injuries compared with radical neck dissection?

    <p>Performing modified radical neck dissection or selective neck dissection when oncologically feasible</p> Signup and view all the answers

    What is the primary benefit of administering remimazolam in children undergoing tonsillectomy and adenoidectomy under sevoflurane anesthesia?

    <p>Decreasing the likelihood of emergence delirium</p> Signup and view all the answers

    What is the dosage of remimazolam administered at the end of surgery to prevent emergence delirium in children?

    <p>0.2 mg/kg</p> Signup and view all the answers

    What is the primary outcome of this study on neuromuscular blockade during neck dissection?

    <p>No association with iatrogenic cranial nerve injury</p> Signup and view all the answers

    What is the conclusion of the study regarding the use of neuromuscular blockade during neck dissection?

    <p>It has no association with iatrogenic cranial nerve injury.</p> Signup and view all the answers

    What is the primary benefit associated with EVAR compared to other surgical procedures?

    <p>Lower short-term mortality rates</p> Signup and view all the answers

    Why is preoperative assessment and optimization crucial for patients undergoing EVAR?

    <p>Due to the high incidence of major comorbidities</p> Signup and view all the answers

    What is the primary distinction that should be made when performing EVAR?

    <p>Between simple and complex EVAR procedures</p> Signup and view all the answers

    Why is teamwork and communication essential during EVAR?

    <p>To facilitate emergency EVAR</p> Signup and view all the answers

    Compared to balanced anesthesia, what is the effect of opioid-free total intravenous anesthesia on postoperative nausea and vomiting?

    <p>It reduces the relative risk of PONV</p> Signup and view all the answers

    What is the mechanism by which opioid-free total intravenous anesthesia reduces postoperative nausea and vomiting?

    <p>It decreases the activity of the emetic center in the brain</p> Signup and view all the answers

    What is the primary advantage of using opioid-free total intravenous anesthesia in bariatric surgery beyond triple prophylaxis?

    <p>It reduces the severity of postoperative nausea and vomiting</p> Signup and view all the answers

    What is the primary concern when using combined spinal epidural anesthesia for laparoscopic appendectomy?

    <p>Cardiorespiratory complications</p> Signup and view all the answers

    What is the primary advantage of using combined spinal epidural anesthesia for laparoscopic surgeries?

    <p>Effective anesthetic technique with minimal complications</p> Signup and view all the answers

    In which patients is careful evaluation of combined spinal epidural anesthesia particularly important?

    <p>Patients with compromised cardiorespiratory conditions</p> Signup and view all the answers

    What is the primary characteristic of spinal anesthesia with Hyperbaric Bupivacaine and Fentanyl for elective laparoscopic appendectomy?

    <p>It is adequate and safe for healthy patients</p> Signup and view all the answers

    What is the primary advantage of using combined spinal epidural anesthesia for laparoscopic surgeries?

    <p>It allows for successful performance of laparoscopic surgeries without significant complications</p> Signup and view all the answers

    What is the primary advantage of the ultrasound-guided lateral approach quadratus lumborum (QL) block after laparoscopic appendectomy?

    <p>Equivalent analgesia to transversus abdominis plane (TAP) block</p> Signup and view all the answers

    What is the primary benefit of using both the TAP block and the lateral QL block in multimodal analgesia for pain control after laparoscopic appendectomy?

    <p>Effective pain management</p> Signup and view all the answers

    How do the lateral QL block and the TAP block compare in terms of postoperative opioid consumption in patients undergoing laparoscopic appendectomy?

    <p>Both blocks result in equivalent opioid consumption</p> Signup and view all the answers

    What is the primary benefit of using goal-directed fluid therapy based on Pleth Variability Index in laparoscopic bariatric surgery?

    <p>Preventing intraoperative excessive fluid loading</p> Signup and view all the answers

    What is the primary advantage of using dynamic indicators like Pleth Variability Index in fluid therapy during laparoscopic bariatric surgery?

    <p>It decreases intraoperative volume of infused fluids</p> Signup and view all the answers

    What is the potential limitation of the study on the use of Pleth Variability Index in fluid therapy during laparoscopic bariatric surgery?

    <p>Further research is warranted to assess its adequacy</p> Signup and view all the answers

    What is the primary factor that contributes to the development of post-operative pulmonary complications after thoracotomy?

    <p>Patient's pre-operative medical status</p> Signup and view all the answers

    Which of the following pulmonary complications is unique to patients undergoing thoracic surgery?

    <p>Pulmonary emboli</p> Signup and view all the answers

    What is the primary consequence of respiratory failure in patients who have undergone thoracotomy?

    <p>Morbidity and mortality</p> Signup and view all the answers

    What is the primary benefit of anticipation and recognition of post-operative pulmonary complications following thoracotomy?

    <p>Preventing major complications</p> Signup and view all the answers

    What is the primary factor that determines the severity of post-operative pulmonary complications following thoracotomy?

    <p>Invasiveness of the surgical procedure</p> Signup and view all the answers

    What is the effect of S-ketamine on the intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic surgery?

    <p>It is associated with lower intraoperative SPI 30 minutes after the start and at the end of surgery</p> Signup and view all the answers

    What is the effect of S-ketamine on NRS scores in patients undergoing video-assisted thoracoscopic surgery?

    <p>It reduces the NRS scores 6 and 12 hours after surgery</p> Signup and view all the answers

    What is the significance of using the SPI in patients undergoing video-assisted thoracoscopic surgery?

    <p>It allows for individualized and rational administration of opioids during surgery</p> Signup and view all the answers

    What is the primary benefit of thymectomy in patients with nonthymomatous myasthenia gravis?

    <p>Improving clinical outcomes over a 3-year period</p> Signup and view all the answers

    What is the effect of thymectomy on the requirement for prednisone and azathioprine therapy in patients with nonthymomatous myasthenia gravis?

    <p>Decreases the requirement for both therapies</p> Signup and view all the answers

    What is the duration of clinical benefit associated with thymectomy in patients with nonthymomatous myasthenia gravis?

    <p>3 years</p> Signup and view all the answers

    What is the primary function of the surgical pleth index (SPI) during general anesthesia?

    <p>To detect the balance between nociceptor activation and analgesia</p> Signup and view all the answers

    What can the SPI values recorded before patient arousal help clinicians predict?

    <p>The degree of postoperative pain and analgesic requirements</p> Signup and view all the answers

    What is required for continuous, noninvasive monitoring with the SPI?

    <p>A pulse oximeter attached to the finger</p> Signup and view all the answers

    What is the primary mechanism by which ketamine reduces postoperative opiate consumption in opiate-dependent patients?

    <p>Reduction in central sensitization via NMDA receptor antagonism</p> Signup and view all the answers

    In which patients is ketamine most efficacious in reducing postoperative opiate consumption?

    <p>Patients who consume higher amounts of preoperative opiate medications</p> Signup and view all the answers

    What is the benefit of using ketamine in opiate-dependent patients with chronic back pain undergoing painful surgery?

    <p>Reduced postoperative opiate consumption and pain intensity</p> Signup and view all the answers

    What is the impact of ketamine on opiate tolerance in opiate-dependent patients with chronic back pain?

    <p>Ketamine reduces opiate tolerance</p> Signup and view all the answers

    What is the benefit of using nonintubated spontaneous ventilation (NI-VATS) in mediastinal tumor surgery?

    <p>Facilitating a more rapid recovery</p> Signup and view all the answers

    What is the primary treatment for mediastinal tumors?

    <p>Surgical intervention</p> Signup and view all the answers

    What is the advantage of video-assisted thoracoscopic surgery (VATS) over median sternotomy?

    <p>It has less intraoperative bleeding and fewer postoperative complications</p> Signup and view all the answers

    What is the outcome of perioperative data comparisons between NI-VATS and I-VATS?

    <p>Anesthesia and operation time, operation bleeding, and hospital stay were significantly better in the NI-VATS group</p> Signup and view all the answers

    What is the nature of most mediastinal tumors?

    <p>Benign</p> Signup and view all the answers

    What is the type of neuromuscular blockers that myasthenic patients are typically resistant to?

    <p>Depolarizing</p> Signup and view all the answers

    What is the effect of ester-based anesthetics on cholinesterase in patients taking anticholinesterase medications?

    <p>Increase the blood levels of the anesthetics</p> Signup and view all the answers

    What is the advantage of using non-intubated anesthesia in thymectomy over traditional double-lumen intubation?

    <p>Reduced intubation-associated adverse effects</p> Signup and view all the answers

    What is the mechanism of action of nondepolarizing neuromuscular blockers in patients with myasthenia gravis?

    <p>Antagonist action</p> Signup and view all the answers

    What is the reason for increased requirements of depolarizing neuromuscular blockers in patients with myasthenia gravis?

    <p>Loss of receptors</p> Signup and view all the answers

    What is the primary reason for patients with myasthenia gravis to be resistant to depolarizing neuromuscular blocking agents?

    <p>Due to the decreased amount of ACh available</p> Signup and view all the answers

    What is the ideal extubation method for patients with myasthenia gravis who underwent general anesthesia using paralytic agents?

    <p>Awake extubation with confirmation of good ventilatory function</p> Signup and view all the answers

    What is the primary benefit of using sugammadex in patients with myasthenia gravis?

    <p>Complete reversal of neuromuscular blockade</p> Signup and view all the answers

    What is the primary consideration for parturients with myasthenia gravis during anesthesia?

    <p>Increased risk of respiratory compromise</p> Signup and view all the answers

    What is the primary benefit of epidural anesthesia in parturients with myasthenia gravis?

    <p>Reduced risk of respiratory complications</p> Signup and view all the answers

    What is the primary consequence of neonatal myasthenia gravis?

    <p>Respiratory dysfunction and feeding difficulties</p> Signup and view all the answers

    What is the primary importance of a collaborative model in managing patients with myasthenia gravis?

    <p>Ensuring timely and accurate communication</p> Signup and view all the answers

    What is the primary goal of preoperative optimization in patients with myasthenia gravis?

    <p>Optimizing disease status and current health</p> Signup and view all the answers

    What is the primary characteristic of patients with Myasthenia Gravis?

    <p>Increased weakness at the end of the day, or after exercise or exertion</p> Signup and view all the answers

    What is a significant concern in patients with Myasthenia Gravis as the disease progresses?

    <p>Respiratory muscles</p> Signup and view all the answers

    Why must caution be exercised when giving benzodiazepines and opiates to patients with Myasthenia Gravis?

    <p>They are more sensitive to the depressive respiratory effects of these medications</p> Signup and view all the answers

    What is the impact of Myasthenia Gravis on the body?

    <p>It has a significant effect on the body, particularly in the perioperative setting</p> Signup and view all the answers

    What is a characteristic of deep tendon reflexes in patients with Myasthenia Gravis?

    <p>They are normal</p> Signup and view all the answers

    What is the role of the interprofessional team in managing patients with Myasthenia Gravis?

    <p>They play a critical role in managing patients with this condition</p> Signup and view all the answers

    What is a challenge anesthesia providers face when managing patients with Myasthenia Gravis?

    <p>The unique challenges posed by the disease and its treatment</p> Signup and view all the answers

    What is the primary benefit of using propofol or sevoflurane anesthesia without muscle relaxants in myasthenia gravis patients?

    <p>Providing safe and effective conditions for thoracoscopic thymectomy</p> Signup and view all the answers

    How do propofol and sevoflurane compare in terms of intraoperative muscular relaxation in myasthenia gravis patients?

    <p>Sevoflurane provides higher levels of muscular relaxation</p> Signup and view all the answers

    What is the effect of propofol and sevoflurane anesthesia on postoperative neuromuscular function in myasthenia gravis patients?

    <p>It has no effect on postoperative neuromuscular function</p> Signup and view all the answers

    What is the main advantage of using propofol or sevoflurane anesthesia without muscle relaxants in myasthenia gravis patients?

    <p>Offering safe and effective conditions for thoracoscopic thymectomy</p> Signup and view all the answers

    What is the primary purpose of the study comparing nonintubated spontaneous ventilation and intubated mechanical ventilation anesthesia in VATS?

    <p>To assess the safety and feasibility of nonintubated spontaneous ventilation anesthesia in VATS</p> Signup and view all the answers

    What is the primary advantage of using NI-SV anesthesia in VATS?

    <p>No clear advantage was found in the study</p> Signup and view all the answers

    What is the primary benefit of using serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery?

    <p>Reducing postoperative opioid consumption and incidence of postoperative nausea and vomiting</p> Signup and view all the answers

    What is the limitation of the study on the effectiveness of serratus anterior plane block in patients undergoing VATS?

    <p>Lack of well-designed, large-scale RCTs</p> Signup and view all the answers

    What is the effect of serratus anterior plane block on postoperative pain management in patients undergoing VATS?

    <p>Reduces postoperative pain scores</p> Signup and view all the answers

    What is the implication of using serratus anterior plane block in patients undergoing VATS?

    <p>It is a promising, excellent adjunct to conventional general anesthesia</p> Signup and view all the answers

    What is the primary outcome of using serratus anterior plane block in patients undergoing VATS?

    <p>Reducing postoperative pain scores and opioid consumption</p> Signup and view all the answers

    Study Notes

    Antibiotics in Tonsillectomy

    • The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks.
    • Perioperative use of antibiotics is justified only in selected cases, i.e., in individuals with comorbidities.

    Nerve Injuries Following Neck Dissections

    • The estimated prevalence of the shoulder syndrome/spinal accessory nerve injury following radical neck dissection was 94.8%, modified radical neck dissection 33.0%, and selective neck dissection 27.9%.
    • Marginal mandibular-nerve injury following neck dissection is sparse.
    • Patients should be informed about the risk of particular injuries to their spinal accessory nerve due to their specific subtype of neck dissection.

    Remimazolam and Emergence Delirium

    • In children undergoing tonsillectomy and adenoidectomy, administration of remimazolam 0.2 mg/kg at the end of the surgery resulted in a significantly lower likelihood of emergence delirium after sevoflurane anesthesia.

    Neuromuscular Blockade and Neck Dissection

    • Use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury.

    Anesthetic Considerations for Endovascular Abdominal Aortic Aneurysm Repair

    • EVAR was associated with lower short-term mortality but this benefit did not persist at the intermediate and long-term follow-ups.
    • Patients undergoing EVAR have a higher incidence of major comorbidities and should undergo thorough preoperative assessment and optimization prior to the procedure.

    Opioid-Free Total Intravenous Anesthesia and Postoperative Nausea and Vomiting

    • Opioid-free TIVA is associated with a large reduction in relative risk of PONV compared with balanced anesthesia.
    • Opioid-free TIVA was able to reduce PONV and the severity of PONV compared with inhalation anesthesia combined with opioids.

    Combined Spinal Epidural Anesthesia for Laparoscopic Appendectomy

    • Combined spinal epidural anesthesia is adequate and safe for elective laparoscopic appendectomy in healthy patients.
    • Careful evaluation of the method is needed particularly in patients with compromised cardiorespiratory conditions.

    Short-Term Outcomes of Combined Neuraxial and General Anesthesia

    • Combined general and neuraxial anesthesia is associated with reductions in 90-day mortality and morbidity.
    • This study highlights the role of combined general and neuraxial anesthesia as a safe and acceptable alternative to conventional GETA or LRA alone in CEA with similar rates of immediate and short-term complications and postoperative pain scores.### Surgical Pleth Index (SPI) Monitoring
    • SPI is a monitoring tool that uses photoplethysmographic signals of finger arterioles to detect the balance between nociceptor activation and analgesia during general anesthesia.
    • SPI-guided analgesia allows for appropriate doses of intraoperative analgesia with fewer adverse hemodynamic events, improving patient recovery and reducing postoperative pain and rates of adverse events.
    • SPI values recorded before patient arousal can help predict the degree of postoperative pain and analgesic requirements.

    managing Patients with Myasthenia Gravis (MG)

    • MG is a neuromuscular disorder affecting muscarinic, nicotinic acetylcholine receptors, characterized by weakness and fatigability of the skeletal muscles.
    • Patients with MG are often more sensitive to the depressive respiratory effects of benzodiazepines and opiates, and require special care during the perioperative period.
    • Preoperative evaluation of MG patients should be based on disease severity according to Osserman's classification and treatment regimen, with extra attention paid to voluntary and respiratory muscles.

    Anesthesia Management for MG Patients

    • Neuromuscular blocking agents act by interrupting neuromuscular transmission at the level of nicotinic acetylcholine receptors at the motor end plate.
    • Myasthenic patients are typically sensitive to nondepolarizing neuromuscular blockers, and resistant to depolarizing neuromuscular blockers (succinylcholine).
    • Regional- and local anesthesia should be carried out using reduced doses of amide (rather than ester) as local anesthetics in order to avoid increased blood levels.

    Non-Intubated Video-Assisted Thoracic Surgery (NI-VATS) Thymectomy

    • NI-VATS thymectomy is a promising novel approach with numerous apparent benefits, but further data evaluation and a larger scale of patient outcome analysis are needed to determine exact indications and feasibility of the technique.
    • Nonintubated spontaneous ventilation (NI-SV) anesthesia was feasible for VATS in the selected patients, with a greater incidence of intraoperative airway intervention events than intubated mechanical ventilation (I-MV) anesthesia.

    Postoperative Pain Management

    • The serratus anterior plane block (SAPB) shows an excellent performance in postoperative pain management in patients undergoing VATS, reducing pain scores, postoperative opioid consumption, and incidence of PONV.

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    Description

    This quiz assesses your understanding of the effects of combined neuraxial and general anesthesia versus general anesthesia alone for elective open abdominal aortic aneurysm repair. It evaluates the outcomes of these anesthesia methods on mortality and morbidity rates. Test your knowledge of anesthesia techniques and their applications in surgical procedures.

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