Dissertations / Theses on the topic 'Anesthesia method'

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.<br>Introduction: Patients who develop delirium while hospitalized are increasingly recognized as at risk for the development of long term cognitive impairment. We became interested in the contribution of delirium to the development of post-operative cognitive dysfunction (POCD) when we found that patients at Mayo Clinic in Arizona, compared to patients at the Mayo facilities in Rochester, MN, were 17 times more likely to receive the drug physostigmine (Antilirium®) for the treatment of delirium in the Post Anesthesia Care Unit (PACU). However, before we could examine the relationship between delirium and POCD we needed to validate a tool we could use to quickly assess the presence of delirium in patients emerging from anesthesia in the PACU. Hypothesis: The Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) can be used in the PACU to identify patients with delirium. Methods: Patients 65 years of age or greater who were going to have a standardized general anesthetic for a surgical procedure were identified on the day of surgery and consent to participate in the study was obtained. The CAM-ICU was used preoperatively to determine study eligibility (patients who scored less than 7 [scale of 1-10], indicating delirium, on the test were not followed further) and postoperatively, one hour after the patient was admitted to the PACU, to assess for delirium. The CAM-ICU was administered after we asked the patient’s nurse whether or not he or she had determined that the patient was delirious. Results: 168 patients, mean age 75 ± 7 (SD) with the majority of participants having urologic or orthopedic procedures were assessed pre- and post-operatively with the CAM-ICU, and post-operatively by a nursing assessment for delirium. The CAM-ICU took little time to administer and was easy for patients to understand and use. The nurse at the bedside identified 5 of 168 patients as delirious (prevalence of 2.98%). The CAM-ICU was positive for delirium in 11 of 168 (6.55%). The CAM-ICU had a sensitivity of 60% (3/5) and a specificity of 95% (155/163). Conclusion: In this investigation, the CAM-ICU was easy to use and had a high specificity for identifying post-operative delirium.

Att behöva opereras kan vara en stor händelse i många människors liv. Det kan både vara positiva och negativ orsaker till operationen. Oavsett operationstyp eller syfte för operationen så skall patienten behandlas och vårdas på ett värdigt och professionellt sätt. Författarna till studien anser att den perioperativa vårdprocessen ger patienten möjlighet att vårdas på ett bra sätt. Syftet med studien är att belysa patienters upplevelse av den perioperativa vårdprocessen. Metoden som användes var en litteraturstudie baserad på kvalitativa, vetenskapliga studier. Litteratursökningen gjordes både manuellt och i databaserna Cinahl, Medline, och Pubmed. Analysen av artiklarna är gjord efter Evans (2002) innehållsanalysmodell och resultatet presenteras i fyra övergripande teman med tillhörande subteman.Resultatet beskriver att de flesta patienter har positiva upplevelser av vårdandet när en och samma sjuksköterska följer dem genom den pre, intra och postoperativavården. Disskussionen belyser för och nackdelar med den perioperativa processen, samt sjuksköterskans roll utifrån organisation och arbetssätt. Konklusionen ger en sammanfattande bild av innehåll och fynd i studien.<br>Program: Specialistsjuksköterskeutbildning med inriktning mot anestesisjukvård

Каудальная анестезія - вид епідуральної анестезії, відноситься до центральних нейроаксиальної блокадам і здійснюється шляхом введення розчину місцевого анестетика в крижовий канал через крижово-куприкову зв'язку. В зв'язку з тим, що каудальна анестезія не виконується в чистому вигляді, а комбінуються з поверхневою анестезією, визначення часу настання та ефективності каудально- епідурального блока являється важливим для лікарів анестезіологів.

Oral health problems have been a major public health concern profoundly affecting people’s general health and quality of life. Given that oral health data is composed of several measurable dimensions including clinical measurements, socio-behavioral factors, genetic predispositions, self-reported assessments, and quality of life measures, strategies for analyzing multidimensional data are neither computationally straightforward nor efficient. Researchers face major challenges to identify tools that circumvent the processes of manually probing the data. The purpose of this dissertation is to provide applications of the proposed methodology on oral health-related data that go beyond identifying risk factors from a single dimension, and to describe large-scale datasets in a natural intuitive manner. The three specific applications focus on the utilization of 1) classification regression tree (CART) to understand the multidimensional factors associated with untreated decay in childhood, 2) network analyses and network plots to describe connectedness of concurrent co-morbid conditions for pediatric patients with autism receiving dental treatments under general anesthesia, and 3) random forests in addition to conventional adjusted main effects analyses to identify potential environmental risk factors and interactive effects for periodontitis. Compared to findings from the previous literature, the use of these innovative applications demonstrates overlapping findings as well as novel discoveries to the oral health knowledge. The results of this research not only illustrate that these data mining techniques can be used to improve the delivery of information into knowledge, but also provide new avenues for future decision making and planning for oral health-care management.

Copy of author's previously published work inserted. Includes bibliographical references (leaves 273-283). Aims to identify if the current practice of post-operative vital sign collection detects complications in the first 24 hours after the patient has returned to the general ward setting using a combination of methods within a triangulated approach to data collection.

Bakgrund: Barn i sjukvården som ska genomgå anestesi och kirurg känner betydande oro och ångest vilket medför ett lidande hos barnet. Detta kan resultera i postoperativa komplikationer och förlängda vårdtider. I sjuksköterskans ansvarsroll ingår det att hjälpa barnet lindra sin oro och ångest. Syfte: Att beskriva och utvärdera de preoperativa metoder sjuksköterskan kan använda sig av för att minska barns oro och ångest inför anestesi och kirurgi. Metod: Design: Litteraturstudie. Artikelsökning genomfördes i databaserna Pubmed och Cinahl. Efter analys och kvalitetsgranskning valdes 20 artiklar ut till resultatet. Inklusionskriterier: Kvantitativa studier genomförda på barn, 0-18 år.  Studierna ska ha publicerats 2005 eller senare samt ha etiskt godkännande alternativt resonemang. Exklusionskriterier: Då interventionen var riktad mot föräldrar eller om barnen inte skulle genomgå anestesi. Resultat: Resultatet visade fyra olika teman med metoder som kan användas för att minska barns preoperativa oro och ångest. Dessa var clowninteraktion, sjukhusmiljö, distraktion och preoperativ information. Clowninteraktion och distraktion visar tydligast evidens för minskad oro och ångest hos barn. Att låta barnet bekanta sig med sjukhusmiljö samt medicinsk utrustning har även en positiv inverkan. Slutsats: I sjuksköterskans profession ingår ansvaret att arbeta mot minskad oro och ångest hos barn. Oro och ångest hos barn ger inte enbart ett ökat lidande utan även förlängda vårdtider med ekonomiska konsekvenser. Sjuksköterskan har olika metoder att använda sig av där distraktionsteknik samt clowninteraktion är de som idag har störst evidensstyrka.<br>Background: Children within healthcare who are undergoing anesthesia and surgery experience severe anxiety which results in suffering and can also lead to post-operative complications and extended hospitalization. As a registered nurse you are responsible to help the child reduce their anxiety. Aim: To describe and evaluate the pre-operative methods a registered nurse can use to reduce children’s anxiety related to anesthesia and surgery. Method: Literature review. Design: An article search was conducted in Pubmed and Cinahl, 20 articles were chosen for the result. Inclusion criteria: Quantitative studies conducted on children 0-18 years. Exclusion criteria: The aims of the study were directed against the parents or children not undergoing anesthesia. Results: The results showed four different themes that can be used in the reduction of children´s pre-operative anxiety. These were interaction with clowns, hospital environment, distraction, and pre-operative information. Interaction with clowns and distraction are the two methods that show the highest evidence of reducing anxiety. Allowing children to get familiar with the hospital environment and the medical equipment had a positive effect but more studies are needed in this area for greater evidence. Conclusion: The registered nurse is responsible for reducing anxiety in children who are undergoing anesthesia and surgery. A child with anxiety not only suffers more but is also at risk for prolonged hospitalization with economic consequences.  Although the registered nurse has several methods to choose from, distraction techniques and clown interaction produce the greatest results in decreasing anxiety.

Nästan alla patienter blev hypoterma före, under och efter operation. För att undvika detta vidtog sjuksköterskan olika omvårdnadsåtgärder för att minska risken för oönskad hypotermi. Det var viktigt för vårdpersonal att få kunskap om vilka omvårdnadsåtgärder som är optimala för att minska komplikationer, samt få förståelse för hur hypotermi påverkar patienten under hela vårdförloppet. Kunskapen behövs för att lindra lidandet och öka tryggheten i samband med operation. Syftet var att söka evidens för bästa beprövade omvårdnadsåtgärd för att förebygga hypotermi hos patienter samt beskriva hypotermins påverkan på patienter under dagoperativt vårdförlopp. En litteraturstudie genomfördes där kvantitativa och kvalitativa artiklar analyserades med hjälp av innehållsanalys enligt Fribergs modell (Friberg 2012). Resultatet visade att det var viktigt att börja värma patienten före operation och att starta med en högre begynnelsetemperatur. Vid steriltvättning rekommenderades varm desinfektion. Även vid artroskopier var det en fördel att använda uppvärmd vätska. Vid korta ingrepp fungerade både värmekällan Hot dog (elektriskt täcke/madrass) och Bair Hugger (varmluftstäcke). Bair Hugger var i dagsläget den enskilt mest effektiva metoden för att snabbt höja temperaturen, mest miljömässiga samt ekonomiskt hållbara metoden vid längre operationer, givet att den var inställd på hög värme (43°C). Dock räckte det inte med en metod för att få en normaltempererad patient, utan flera olika metoder behövde kombineras samtidigt. En riktlinje för sjuksköterskor var att fortsätta med hög temperatur på värmekällan även då patientens kroppstemperatur hade uppnått normal temperatur. Först när patienten började svettas var det lämpligt att sänka temperaturen. Det var viktigt att mäta temperaturen för att fånga upp alla som var hypoterma, då inte alla patienter uppvisade symtom såsom shivering. Öka vårdpersonalens medvetenhet om vikten av att värma patienter på operation och använda alla metoder som finns tillgängliga för att minska hypotermi och öka välbefinnandet.

Cette thèse présente trois contributions pour améliorer la reconnaissance d’imaginations motrices utilisées par de nombreuses interfaces cerveau-ordinateur (BCI) comme moyen d'interaction. Tout d'abord, nous proposons d'estimer la qualité des images motrices en détectant des valeurs aberrantes et de les supprimer avant apprentissage. Ensuite, nous étudions la sélection des caractéristiques pour sept imaginations de mouvements. Enfin, nous présentons une architecture d'apprentissage profond reprenant les principes du réseaux EEGnet applicable directement sur des signaux électro-encéphalographiques simplement filtrés et adapté au nombre d’électrodes. Nous montrons en particulier ses bénéfices pour l'amélioration de la détection des réveils peropératoires et d'autres applications<br>This thesis presents three contributions to improve the recognition of motor imaginary movements used by numerous brain-computer interfaces (BCI) as types of interaction. First of all, we propose to estimate the quality of motor images by detecting outliers and removing them before training. Next, we study the feature selection for seven different motor imaginary movements. Finally, we present a deep learning architecture based on the principles of EEGNet network applied directly on raw electroencephalographic signals and adapted to the number of electrodes. We show in particular its benefits for improving the detection of intraoperative awareness and other applications

Modificações na fisiologia do organismo da mulher ocorrem durante a gravidez em conseqüência às alterações hormonais, anatômicas e metabólicas. No sistema circulatório a modificação mais significativa é o aumento do débito cardíaco a partir do primeiro trimestre da gestação. Mulheres portadoras de cardiopatias podem apresentar graves complicações durante o período gestacional devido à inapropriada adaptação à sobrecarga hemodinâmica, mesmo em pacientes consideradas em capacidade funcional favorável, no início da gestação. A literatura carece de estudos dos efeitos dos anestésicos locais com ou sem vasoconstritor utilizados nos procedimentos odontológicos, sobre os parâmetros cardiovasculares de mulheres gestantes portadoras de valvopatias e seus conceptos. A escassez científica fez deste tema nosso objetivo de estudo: avaliar e analisar parâmetros da cardiotocografia, como freqüência cardíaca, motilidade fetal e contrações uterinas e de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática quando submetida à anestesia local com lidocaína, com e sem vasoconstritor, durante procedimento odontológico restaurador. Para tanto, a monitorização ambulatorial da pressão arterial (MAPA) e a eletrocardiografia ambulatorial (Holter) materna, ambas obtidas durante 24 horas e a cardiotografia (CTG) de 31 portadoras de cardiopatia reumática entre a 28ª e 37ª semana de gestação, nos períodos: (1) basal - 60 minutos antes do procedimento para MAPA e Holter e 20 minutos para CTG; (2) procedimento - 56+15,5minutos (média+desvio padrão); (3) pós-procedimento - 20 minutos; e (4) média das 24 horas para freqüência cardíaca e extra-sístoles e média da vigília e do sono para pressão arterial, permitiu a análise da variação desses parâmetros, utilizando-se lidocaína 2% sem vasoconstritor e lidocaína 2% com epinefrina 1:100.000, compondo-as em dois grupos. Demonstrou-se redução significativa nos valores de freqüência cardíaca materna durante o procedimento somente quando comparado aos demais períodos (p<0,001). Quando comparados os dois grupos, não houve diferença (p>0,05). Houve ocorrência de arritmia cardíaca em 9 (29,0%) pacientes, sendo 7 (41,8%) do grupo que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos os períodos ou os grupos (p>0,05). O mesmo ocorreu (p>0,05) nas análises comparativas dos parâmetros fetais obtidos por meio da CTG - número de contrações, nível e variabilidade da linha de base, número de acelerações da freqüência cardíaca fetal e padrão de reatividade fetal. Concluiu-se que o uso da lidocaína 2% associado à adrenalina mostrou-se seguro em procedimento odontológico durante a gestação de mulheres com cardiopatia valvar reumática.<br>During pregnancy, the organic systems of a woman are subjected to physiological modifications consequential to hormonal, anatomic and metabolical alterations. The most significant modification in the circulatory system is an increased cardiac output from the first three months of gestation. Women with heart disease may present with severe complications during the gestational period, because of inappropriate adaptation of her body to this hemodynamic overload, even those patients who are thought to have an appropriate functional capacity during early pregnancy. There are scant studies in the literature on the effects of local anesthetics, with and without vasoconstrictor, used in dental procedures on the cardiovascular variables of pregnant women with valvar disease, as well as on their concepti. Driven by this shortage, we decided to have this subject studied, by assessing and analyzing cardiotachographic parameters, such as heart rate, fetal motility and uterine contractions, in addition to blood pressure and electrocardiographic variables, in pregnant women with rheumatic valvar disease who undergo local anesthesia with lidocaine, with and without vasoconstrictor, during restorative dental procedure. For this, 31 rheumatic heart disease patients who were in their 28th to 37th week of gestation, had 24-hour ambulatory monitoring of their blood pressure (BP) and Holter electrocardiography (Holter-ECG), and cardiotocography (CTG), performed during: (1) baseline - 60 minutes before the procedure for BP and Holter- ECG monitoring, and 20 minutes before the procedure for CTG; (2) procedure - 56±15.5 minutes (mean±SD); (3) post-procedure - 20 minutes; and (4) mean 24-hour heart rate and extrasystoles measurement, and mean wake and sleeping periods BP monitoring. Variation of the above variables was analyzed in two groups, one with infusion of a 2% solution of lidocaine with vasoconstrictor, and the other with infusion of a 2% solution of lidocaine with epinephrine 1:100.000. The maternal heart rate values obtained during the procedure showed a significant reduction only in comparison with the other time periods (P<0.001). The comparison of the two groups did not reveal any significant difference (P>0.05). Cardiac arrhythmia was detected in 9 (29.0%) patients, 7 of them (41.8%) from the group who received anesthetics with epinephrine. Maternal blood pressure did not show any significant difference neither between time periods, nor between groups (P>0.05). The same occurred in the comparative analysis of the fetal parameters obtained during CTG -number of contractions, level and variability from baseline, number of fetal heart rate accelerations and fetal reactivity pattern. Our conclusion was that the use of 2% solution of lidocaine in association with epinephrine proved safe during dental procedure in pregnant women with rheumatic valvar cardiopathy.

Estudamos 62 pacientes, que com teste ergométrico positivo, manifestaram angina estável e estavam sob controle farmacológico. Todos apresentavam cinecoronariografia mostrando obstrução >70% em pelo menos uma das principais artérias coronárias. Objetivamos avaliar parâmetros eletrocardiográficos e de pressão arterial, durante procedimento odontológico restaurador sob anestesia local com e sem vasoconstritor em presença de doença arterial coronária. As idades variaram de 39 a 80, média de 58,7±8,8 anos, sendo 51 (82,3%) homens. Trinta pacientes foram randomizados para receber anestesia local com solução de lidocaína a 2% com adrenalina 1:100.000 e os demais para lidocaína a 2% sem vasoconstritor. Todos os pacientes foram submetidos à monitorização ambulatorial da pressão arterial (MAPA) e eletrocardiografia dinâmica por 24 horas, iniciados 2 horas antes do procedimento odontológico. Consideramos 3 períodos de registro: (1) basal - os 60 minutos que antecederam ao procedimento odontológico; (2) procedimento - desde o início da anestesia até o final do procedimento odontológico restaurador; (3) subseqüente completar das 24 horas. A análise de variância com medidas repetidas mostrou que houve elevação significativa da pressão arterial sistólica e diastólica do período basal para o procedimento nos dois grupos estudados (aproximadamente 14mmHg e 5 a 7mmHg) respectivamente, quando analisados separadamente e quando confrontados não apresentaram diferença de comportamento entre si. A freqüência cardíaca não se alterou nos dois grupos estudados. Depressão do segmento ST >1mm ocorreu em 10 (17,9%) pacientes; todos os eventos ocorreram no mínimo 2 horas após o término do procedimento odontológico. Extra - sístoles supra-ventriculares e/ou extra-sístoles ventriculares em número maior do que 10/hora estiveram presentes em 17 (30,4%) pacientes durante as 24 horas e durante o período do procedimento em 7 (12,5%), sendo 4 (13,8%) do grupo que recebeu anestesia sem adrenalina e 3 (11,1%) do grupo que recebeu anestesia com adrenalina e o teste Exato de Fisher não mostrou diferença entre os grupos. Concluímos que não houve diferença em relação ao comportamento de pressão arterial, freqüência cardíaca, evidência de isquemia e arritmias entre os grupos. O uso associado de vasoconstritor mostrou-se, portanto, seguro dentro dos limites do estudo.<br>We enrolled 62 patients with positive exercise stress test who presented with stable angina and were receiving drug therapy. All had a coronary angiography screening showing >70% obstruction in at least one of the main coronary arteries. The study aimed to compare electrocardiographic and blood pressure parameters during restorative dentistry procedure under local anesthesia, both with and without vasoconstrictor, in the presence of coronary artery disease. Ages ranged from 39 to 80, (mean ± SD) 58.7±8.8 years, 51 (82.3%) of them were male. Thirty patients were randomly assigned to receive 2% lidocaine local anesthesia with 1:100,000 epinephrine, the others receiving 2% lidocaine without vasoconstrictor. All the patients underwent ambulatory blood pressure and 24-hour Holter monitoring, beginning two hours ahead of the dental procedure. Recording were made during (1) baseline - 60-minute period before dental procedure began; (2) procedure - from beginning of anesthesia until the end of the procedure; and (3) subsequent 24-hour period. Analysis of variance with repeat measures showed significant diastolic and systolic blood pressure increases from baseline to the period of the procedure, in the two study groups (approximately 14 mm Hg, and 5 to 7 mm Hg, respectively); both in a separate analysis and in a comparative analysis no significant difference between them could be confirmed. Heart rate did not change in neither of the two groups. ST-segment >1 mm depression was detected in 10 (17.9%) patients; all these events occurred at least two hours after the end of the dentistry procedure. Premature supraventricular systoles and/or premature ventricular systoles in a greater number than 10/hour were seen in 17 (30.4%) patients in the 24-hours period after the procedure; during the procedure they occurred in 7 (12.5%) patients, of whom 4 (13.8%) were in the group without, and 3 (11.1%) in the group with vasoconstrictor. The Fisher\'s exact test revealed no difference between the groups. We concluded that there was no difference of blood pressure, heart rate, evidence of ischemia or arrhythmia episodes between the groups. Thus, the associated use of vasoconstrictor proved to be safe within the limits of this study

Este é um estudo clínico, prospectivo, aleatório, e duplamente encoberto realizado em 40 crianças submetidas a cirurgia infra-umbilical de pequeno porte, sob anestesia epidural sacra realizada com a mistura enantiomérica de bupivacaína (S75R25) comparada com a bupivacaína racêmica (SR50) isoladas ou em associação com a clonidina. O objetivo foi avaliar a duração do bloqueio motor e sensitivo, o consumo de sevoflurano e as variações da pressão arterial sistólica (PAS) e freqüência cardíaca (FC). O bloqueio motor foi avaliado pela escala de Bromage, durante o período de oito horas de observação no pós-operatório. A analgesia foi avaliada pelos escores obtidos com escala objetiva para análise da dor e a duração da analgesia foi considerada como o tempo entre a administração do anestésico local no espaço epidural sacro e a primeira dose de analgésico administrado. Os resultados obtidos foram submetidos à análise estatística onde p< 0,05 foi considerado significante. Os resultados mostraram que houve aumento significativo do bloqueio motor somente na primeira hora quando a bupivacaína SR50 foi associada a clonidina, mas não ocorreu o mesmo com a bupivacaína S75R25. Em relação a analgesia não houve diferença significante entre a bupivacaína SR50 e a bupivacaína S75R25 associadas ou não à clonidina. Não houve diferença significativa no consumo de sevoflurano entre os grupos estudados quando a clonidina foi associada aos anestésicos. Os valores da PAS e FC no pós-operatório, nos grupos onde a clonidina foi associada com ambos anestésicos locais, foram inferiores em todos os momentos de avaliação, porém sem significância estatística<br>This is a prospective, randomized double-blind clinical trial performed in 40 children using an enantiomeric mixture of bupivacaine (S75R25) compared to racemic bupivacaine SR50 plain or associated with clonidine, to caudal blockade. The aim of this study was to investigate the motor and sensitive block, sevoflurane requirement, blood pressure (PAS) and heart rate (FC) in children scheduled to sub-umbelical surgeries. The motor block was evaluated by Bromage scale for eight hours during the postoperative period. The analgesia was evaluated postoperatively for eight hours by an objective pain scale and the analgesia duration was taken as the time between the local anesthetic administration into epidural space and the first analgesic rescue. The results obtained were submitted to statistical analysis test where p< 0,05 was considered significant. There was a significant increase in the motor block at first hour on postoperative period when bupivacaine SR50 was associated to clonidine, but it did not occurr with the enantiomeric mixture of bupivacaine S75R25. There was no difference between bupivacaine SR50 and bupivacaine S75R25 associated or not to clonidine regarding to analgesia duration. There was no difference in the requirement of sevoflurane between groups in spite of the clonidine admixture to the local anesthetics. There was an absolut decrease in the PAS and FC values on the postoperative evaluation, but it was not statistically significant

Introdução: A formação de atelectasia durante a indução anestésica pode ser um dos fatores responsáveis pela ocorrência de complicações pulmonares pós-operatórias (CPP). A aplicação de pressão positiva expiratória ao final da expiração (PEEP), uso criterioso de altas frações inspiradas de oxigênio e a utilização de manobras de recrutamento alveolar no período intra-operatório são recursos utilizados para a prevenção de atelectasia em procedimentos anestésicos. O objetivo deste estudo foi avaliar o modelo de ventilação mecânica adotado em procedimentos anestésicos de longa duração e suas correlações com as complicações pulmonares pós-operatórias. Métodos: Foram avaliadas em estudo observacional as cirurgias com mais de cinco horas de duração. No início do procedimento anestésico, na sala de cirurgia e após o seu término, na unidade de terapia intensiva, os parâmetros ventilatórios utilizados foram anotados e correlacionados com os achados das radiografias torácicas e saturação periférica de oxigênio (SpO2) em ar ambiente. Resultados: Cento e vinte e um pacientes foram observados. O tempo total de anestesia 499,4 ± 159,8 minutos. O volume corrente (VC) determinado no período intraoperatório foi 8,09 ± 2,15 mL/kg e a PEEP utilizada de 3,05 ± 2,31 cmH2O. Houve diferença para a mediana da SpO2 em ar ambiente (96% [95-97] vs 95% [92-96], p <0,001) comparando os períodos pré e pós-operatório. A freqüência de pacientes que apresentaram atelectasia nas radiografias de tórax do período pós-operatório (38,8%) foi significantemente maior que a do período pré-operatório (0%), x2=32,259. Não foi encontrado correlação entre os achados e o tempo de anestesia (p=0,708); a PEEP intra-operatória (p=0,296); tempo de permanência com suporte ventilatório mecânico no pósoperatório (p = 0,146) e tabagismo (p = 0,563). Conclusões: No período intra-operatório o PEEP utilizado em procedimentos de longa duração é baixo. Ocorre queda na SpO2 e aumento na incidência de atelectasia no período pós-operatório em comparação com o pré-operatório. São necessários outros estudos para melhor avaliação dos fatores responsáveis<br>Introduction: The formation of the atelectasis during the induction of the anesthesia can be one of the factors involved in the occurrence of postoperative pulmonary complications (PPCs). The application of the positive end-expiratory pressure (PEEP), low inpiratory concentrations of oxygen and the alveolar recruitment maneuvers perform in the intraoperative period are approaches used in the prevention of atelectasis in the anesthesia procedures. The objective of this study was to evaluate, in prospective observational study, the pattern of mechanical ventilatory assistence during longer anesthesia procedures and its correlations with the PPCs. Methods: The surgeries procedures longer than five hours have been evaluated in observational study. At the beginning of the anesthesia procedure, in the operatory room and after its terminus, in the intensive care unit, the mechanical ventilation parameters were determined and correlated with the findings in the chest x-rays and peripheral oxygen saturation (SpO2) in room air. Results: One hundred twenty one patients have been observed. The total time of anesthesia was 499,4 ± 159,8 minutes. The tidal volume (VT) in the intraoperative period was 8,09 ± 2,15 mL/kg and the PEEP used was 3,05 ± 2,31 cmH2O. There was a difference for the median of the SpO2 in room air (96% [95-97] vs 95% [92-96], p <0,001) comparing the pre and postoperative periods. The frequency of patients who had presented atelectasis in the chest x-rays of the postoperative period (38,8%) was significantly higher than the preoperative period (0%), x2=32,259. No correlation was found among these findings and the anesthesia time (p=0,708); the intraoperative PEEP used (p=0,296); time with mechanical ventilatory support in the postoperative period (p = 0,146) and smoking habits (p = 0,563). Conclusions: In the intraoperative period, the PEEP is low in longer procedures. The SpO2 decreases and the incidence of the atelectasis increases in the postoperative period, when compared with the preoperative one. Other researches are required for better evaluation of the factors related for the development of the PPCs

Li, Xiang.<br>Thesis (Ph.D.)--Chinese University of Hong Kong, 2009.<br>Includes bibliographical references (leaves 161-184).<br>Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Abstract and appendix also in Chinese.

Dose-related adverse cardiopulmonary events associated with conventional intravenous sedation accounted for most of the complications during colonoscopy. This thesis described clinical trials to look for a safer sedative method (patient-controlled sedation, PCS) and possible ways to reduce the need of sedative medications during colonoscopy.<br>One hundred elderly patients (over 65 years old) were randomised to receive either PCS (a combination of propofol and alfentanil) or conventional intravenous sedation (a combination of diazemuls and pethidine) during colonoscopy. The patients in the PCS group experienced significant less adverse cardiopulmonary events. Other parameters, however, were similar in both groups. The use of PCS for colonoscopy thus appeared safer when compared to conventional intravenous sedation. In a subsequent large scale prospective study (N=500), twenty-two percent of the patients were unwilling to use PCS for colonoscopy; and that the younger patient (&lt;50 years old), female gender, a higher mean dose of sedatives consumed, a lower satisfaction score expressed, and the presence of delayed side effects were independent factors identified to predict the unwillingness of using PCS for colonoscopy.<br>The use of adjunct sedation such as audiovisual distraction was proposed as a way to reduce sedative requirements during colonoscopy. By using PCS as a quantitative outcome measure, audio distraction (in the form of music) was found to be able to decrease sedative requirements by 28%. The use of visual distraction alone, however, failed to decrease the sedative requirements; but nonetheless improved the acceptance of colonoscopy. Finally, a randomised comparison on the use of conventional endoscopes with that of the newly available variable stiffness endoscope used for colonoscopy was performed; and found that the latter was associated with less procedure-related pain and hence the consumption of sedative medications.<br>To conclude, PCS for colonoscopy was safe, feasible and acceptable. The use of adjunct sedation (audio distraction) and the newly available variable stiffness endoscope might decrease the need of sedative medications during the procedure.<br>Lee Wai Hung, Danny.<br>"September 2005."<br>Adviser: S. C. S. Chung.<br>Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3694.<br>Thesis (M.D.)--Chinese University of Hong Kong, 2005.<br>Includes bibliographical references (p. 256-280).<br>Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>School code: 1307.

碩士<br>臺灣大學<br>臨床醫學研究所<br>98<br>Key words: Heart rate variability, spinal anesthesia, general anesthesia, detrended fluctuation analysis, sample entropy, linear analysis Background Time and frequency domain analyses of heart rate variability (HRV) are the most commonly used noninvasive methods to evaluate autonomic regulation of heart rate in healthy subjects as well as in patients with cardiovascular disorders. Because nonlinear phenomena are involved in the genesis of human heart rate fluctuations, new analysis techniques have been developed to probe features in heart rate behavior that are not detectable by traditional analysis methods. Analysis of fractal scaling exponents by detrended fluctuation analysis (DFA) is one such method that describes the fractal-like correlation properties of R-R interval data. Sample entropy (SampEn) is another nonlinear method that quantifies the amount of complexity in the time-series data. Breakdown of short-term fractal-like behaviour of heart rate indicates an increased risk for adverse cardiovascular events and mortality, but the pathophysiological background for altered fractal heart rate dynamics is not known. Despite a large body of data concerning the changes in spectral characteristics of HRV during anesthesia, there is little information on the effects of theses physiological interventions on non-linear characteristics of heart rate behavior. This study was designed to assess the changes in the nonlinear features of HRV caused by the spinal anesthesia and general anesthesia. The main purpose was to gain insight into the physiological background for fractal and complexity characteristics of heart rate dynamics. Short-term fractal scaling exponent (α1)along with spectral components of HRV were analyzed during the following anesthesia interventions in patients : (1) spinal anesthesia group : 1)normal dose (Group HM, n=19), 2)low dose (Group LM, n=20), 3) low dose combine fentanyl (Group LMf, n=20); (2) general anesthesia group: 1)total intravenous propofol infusion (Group P, n=15),2) inhalation induction with desflurane (Group D, n=18) Method After institutional ethical approval and getting informed consent, we recorded the electrocardiogram of 100 ASA class I (American Society of Anesthesiologist physical status class I) patients proposed to receive elective surgery. Patients were excluded if they suffered from severe ischemic heart disease, congestive heart failure, diabetes mellitus, or other disorders known to affect autonomic function. None of the patient was taking medications that affect cardiovascular function. Each patient fasted at least 8h prior to testing. Vigorous exercise, alcohol and coffee were also forbidden for 48 h before the operation. On arrival to the operating room, the patients lay in a supine position in a quiet room at least 5 min prior to data collection. In Group HM and LM, 12mg and 6mg of 0.5% hyperbaric bupivacain were injected respectively. In Group LMf, 6mg of 0.5% hyperbaric bupivacaine was supplemented with 20μg of intrathecal fentanyl. All patients received 100% oxygen via face mask for 2 to 3 min prior to induction of general anesthesia. In Group P, patients received propofol infusion at a rate of 300ug/kg/min . In Group D, anesthesia was induced with 3-6-9-12% desflurane increasing gradually in 2L/min O2 and 2L/min N20. Arterial oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2) were monitored, and normoventilation was maintained with gentle IPPV via mask if required. Depth of anesthesia was monitor by AAI (A-Line ARX Index) continuously until the value reached 35. Therefore, the HRV measurements were performed at AAI values of 60 to 35 and less than 35. The electrocardiogram data was transferred into the hard disk in a personal computer and offline analysis was performed. Results Short-term fractal scaling exponent (α1) decreased during spinal anesthesia in three groups ( Group HM:from 1.24±0.15 to 0.78±0.11;Group LM:from 1.32±0.25 to 0.98±0.21;Group LMf:from 1.28±0.17 to 0.8±0.21，P&amp;lt;0.0001).α1 increased during both general anesthesia group at AAI value of 60 to 35. Thenα1 decreased during the AAI value less than 35 (Group P: from 1.14±0.2 to 0.94±0.35,P&amp;lt;0.05; Group D:from 1.1±0.26 to 0.7±0.31,P&amp;lt;0.0001). Conventional HRV indices did not show the dynamic changes in Group P.Group HM, LM, LMf and Group D decreased the normalized low frequency spectral power and LF/HF ratio and increased normalized high frequency spectral power (p&amp;lt;0.05). SampEn value decreased in Group LM, LMf and Group D. In addition, the receiver operating characteristic (ROC) was used to estimate the sensitivity and specificity of classification of subjects in awake and after anesthesia states using different parameters. The results show that the DFAα1 is a better indicator for distinguishing baseline from anesthesia state. Conclusion Spinal and deep general anesthesia result the breakdown of short-term fractal-like behaviour of heart rate. Incremental depth of anesthesia until AAI less than 35 results in bidirectional changes in correlation properties of R-R interval dynamics. The results suggest that decrease sympathetic outflow at the same time activation of vagal outflow explains the breakdown of fractal-like behaviour of human heart rate dynamics. Change in α1 can be detected also in light anesthesia levels, when the conventional measures of HRV can not be applied. In addition, α1 is a better indicator for distinguishing baseline from spinal anesthesia state.

Indiana University-Purdue University Indianapolis (IUPUI)<br>The pain-controlling effects of a recently introduced electronic dental anesthesia device (CEDETA) were compared with those of local anesthesia in this study. Procedures performed involved full-coverage stainless steel crowns on maxillary primary molars, some of which required indirect pulp therapy and pulpotomies. A total of 55 children, aged 6 years to 10 1/2 years, were randomly selected to have treatment done with CEDETA or local anesthetic. Eight of these patients were treated with both CEDETA and local anesthetic at different appointments. At various times during each procedure, the patient and operator rated the patient's level of discomfort using a 6-point Visual Analog Scale. For each of the five evaluation steps, no significant differences existed in discomfort ratings between the CEDETA and local anesthetic methods for the group of eight patients or for the entire group. Operator ratings of patient discomfort did not vary significantly between the two methods of anesthesia for each of the evaluation steps, except at the step of maximum output or after injection, when the CEDETA group as a whole had significantly lower operator-rated pain. In general, patients tended to rate their perceptions of pain higher than those of the operator. Although the operator and patients in this study found CEDETA to be as effective as local anesthetic for controlling dental operative pain, a number of factors must be considered when deciding to use this type of electronic dental anesthesia. A substantial monetary investment is required to purchase the CEDETA device and the disposable electrodes and batteries to power the unit. There is an increased operating expense for each procedure done when using CEDETA, because of the additional time needed for the operator, staff, and patients to become familiar with the use of the device. Additional setup and break-down time is also needed when using CEDETA as opposed to local anesthetic.

碩士<br>靜宜大學<br>應用化學系<br>100<br>A rapid detection of the local anesthetic ropivacaine was measured by electrochemical impedance method. According to Material Studio 4.3 software to simulate the adsorption energy between the polypyrrole -graphene oxide and anesthetic, it revealed that the adsorption energy is near van der Waals force (Adsorption energy is about 1.751 kcal/mole). Polypyrrole (Ppy) and polypyrrole (Ppy)-graphene oxide (GO) composites were prepared by electrochemical polymerization on the gold electrode as the working electrode. Various concentrations from 1 to 20 ppm of ropivacaine were prepared in D.I. water and 0.9% NaCl as the sample solution. Prepared Ppy and Ppy-GO were used as working electrodes in anesthetic for a sinusoidal excitation in the frequency range of 102 Hz to 106 Hz had been measured. It exhibits the best Linear Regress when the frequency in 100 kHz. The electrochemical properties of the Ppy and Ppy-GO composites electrode were investigated by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS), and the morphology and molecular structure were characterized by transmission electron microscopy (TEM), scanning electron microscope (SEM), Raman and infrared spectroscopy (IR).

Thoracic paravertebral block (TPVB) consists of an injection of local anaesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. Clinically TPVB can be accomplished either as a single-injection or as a multiple-injection. It can also be used as a continuous paravertebral infusion through an indwelling catheter for continuous pain relief. However compared to an epidural block, TPVB is less well understood and not commonly used for anaesthesia and or analgesia in anaesthetic practice. I hypothesized that TPVB is effective for producing unilateral segmental thoracic anaesthesia and managing pain of unilateral origin from the thorax.<br>The objective of this thesis was to develop the technique of TPVB so that it becomes a useful technique for anaesthesia and pain management. So to test my hypothesis a series of clinical studies were performed on 416 patients (396 adults and 20 young infants), presenting for anaesthesia and or acute pain management, to evaluate various aspects of TPVB, namely; clinical application, anatomy of the thoracic paravertebral space, technique and safety, and pharmacology of local anaesthetic after TPVB. Also included are 9 published case reports and letters-to-editor (Appendix 1-9) based on my research that have provided new insights into the mechanism and applications of TPVB. The following section summarizes my research...<br>Karmakar, Manoj Kumar.<br>Thesis (M.D.)--Chinese University of Hong Kong, 2012.<br>Includes bibliographical references (leaves 270-285).<br>Appendix includes Chinese.<br>ABSTRACT --- p.v<br>PREFACE --- p.xxvii<br>STATEMENT OF WORK --- p.xxviii<br>ACKNOWLEDGEMENTS --- p.xxix<br>PUBLICATIONS AND PRESENTATIONS --- p.xxxii<br>LIST OF ABBREVIATIONS --- p.xxxviii<br>LIST OF TABLES --- p.xli<br>LIST OF FIGURES --- p.xliii<br>Chapter Part 1. --- Introduction --- p.1<br>Chapter Chapter 1. --- Objective and Plan of Research --- p.2<br>Chapter Chapter 2. --- Thoracic Paravertebral Block A Review of the Literature. --- p.7<br>Chapter 2.1. --- Introduction --- p.7<br>Chapter 2.2. --- History --- p.7<br>Chapter 2.3. --- Anatomy: --- p.9<br>Chapter 2.4. --- Techniques --- p.17<br>Chapter 2.4.1. --- Anatomical Landmark Based Techniques --- p.20<br>Chapter 2.4.1.1. --- Loss-of-resistance Technique --- p.20<br>Chapter 2.4.1.2. --- Advancing the Block Needle by a pre-determined Distance --- p.23<br>Chapter 2.4.1.3. --- Other Landmark Based Techniques --- p.24<br>Chapter 2.4.2. --- Fluoroscopic Guidance or Injection of Radiopaque Contrast medium --- p.24<br>Chapter 2.4.3. --- Peripheral Nerve Stimulation --- p.25<br>Chapter 2.4.4. --- Pressure Measurement Technique --- p.26<br>Chapter 2.5. --- Thoracic Paravertebral Catheter Placement --- p.27<br>Chapter 2.6. --- Ultrasound Guided Thoracic Paravertebral Block --- p.32<br>Chapter 2.6.1. --- Two Dimensional (2D) Sonoanatomy of the Thoracic Paravertebral Region --- p.32<br>Chapter 2.6.1.1. --- Basic Considerations --- p.32<br>Chapter 2.6.1.2. --- Transverse Scan of the Thoracic Paravertebral Region --- p.33<br>Chapter 2.6.1.3. --- Sagittal Scan of the Thoracic Paravertebral Region --- p.42<br>Chapter 2.6.2. --- Three Dimensional (3D) Sonoanatomy of the Thoracic Paravertebral Region --- p.46<br>Chapter 2.6.3. --- Ultrasound Guided Thoracic Paravertebral Block - Techniques --- p.49<br>Chapter 2.6.3.1. --- Transverse scan with short axis needle insertion (Technique 1) --- p.54<br>Chapter 2.6.3.2. --- Paramedian Sagittal scan with in-plane needle insertion (Technique 2) --- p.56<br>Chapter 2.6.3.3. --- Transverse scan with in-plane needle insertion or the Intercostal approach to the TPVS (Technique 3) --- p.58<br>Chapter 2.7. --- Mechanism and Spread of Anaesthesia --- p.58<br>Chapter 2.8. --- Indications --- p.65<br>Chapter 2.9. --- Contraindications --- p.65<br>Chapter 2.10. --- Drugs Used and Dosage --- p.68<br>Chapter 2.11. --- Pharmacokinetic Considerations --- p.70<br>Chapter 2.12. --- Failure Rate and Complications --- p.72<br>Chapter 2.13. --- Clinical Applications of Thoracic Paravertebral Block --- p.76<br>Chapter 2.13.1. --- Pain Relief after Thoracic Surgery --- p.76<br>Chapter 2.13.2. --- Pain Relief after Multiple Fractured Ribs --- p.78<br>Chapter 2.13.3. --- Anaesthesia and Analgesia for Breast Surgery --- p.80<br>Chapter 2.13.4. --- Thoracic Paravertebral Block and Chronic Pain after Breast Cancer Surgery --- p.84<br>Chapter 2.13.5. --- Thoracic Paravertebral Block and Cancer Recurrence after Breast Cancer Surgery --- p.85<br>Chapter 2.13.6. --- Anaesthesia and Analgesia for Inguinal Herniorrhaphy --- p.87<br>Chapter 2.13.7. --- Pain Relief after Cholecystectomy and Renal Surgery --- p.90<br>Chapter 2.13.8. --- Anaesthesia and Analgesia for Liver and Biliary Tract Surgery --- p.91<br>Chapter 2.13.9. --- Analgesia after Cardiac Surgery --- p.92<br>Chapter 2.13.10. --- Thoracic Paravertebral Block and Chronic Pain Management --- p.94<br>Chapter 2.13.11. --- Bilateral Thoracic Paravertebral Block --- p.94<br>Chapter 2.13.12. --- Miscellaneous Applications --- p.95<br>Chapter Part 2. --- Studies Evaluating the Efficacy of Thoracic Paravertebral Block in Adults. --- p.96<br>Chapter Chapter 3. --- Prospective Randomized Evaluation of the Effects of Combining a Single-injection Thoracic Paravertebral Block with General Anesthesia in Patients Undergoing Modified Radical Mastectomy. --- p.97<br>Chapter Chapter 4. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia A Prospective, Randomized, Double Blind, Controlled Trial. --- p.120<br>Chapter Chapter 5. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Pain Management in Patients with Multiple Fractured Ribs. --- p.137<br>Chapter Chapter 6. --- Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-related Quality of Life after Modified Radical Mastectomy. --- p.154<br>Chapter Chapter 7. --- Right Thoracic Paravertebral Anaesthesia for Percutaneous Radiofrequency Ablation of Liver Tumours. --- p.186<br>Chapter Part 3. --- Studies Evaluating The Efficacy Of Thoracic Paravertebral Block In Children. --- p.198<br>Chapter Chapter 8. --- Continuous Extrapleural Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia in Young Infants. --- p.199<br>Chapter Part 4. --- Studies Evaluating The Anatomy Relevant For Thoracic Paravertebral Block. --- p.213<br>Chapter Chapter 9. --- Thoracic Paravertebral Sonography - A Quantitative Evaluation of the Paramedian Sagittal Window for Visualizing the Anatomy Relevant for Thoracic Paravertebral Block. --- p.214<br>Chapter Chapter 10. --- Volumetric 3D Ultrasound Imaging of the Anatomy Relevant for Thoracic Paravertebral Block. --- p.228<br>Chapter Part 5. --- Pharmacokinetics of Ropivacaine after Thoracic Paravertebral Block. --- p.242<br>Chapter Chapter 11. --- Arterial and Venous Pharmacokinetics of Ropivacaine With and Without Epinephrine after Thoracic Paravertebral Block. --- p.243<br>Chapter Part 6. --- Summary and Conclusions --- p.266<br>Chapter Chapter 12. --- Summary and Conclusions --- p.266<br>Chapter Part 7. --- Bibliography --- p.270<br>Chapter Part 8. --- Appendix --- p.296<br>Chapter A. --- Published Case Reports and Letters-to-editor. --- p.297<br>Chapter Appendix: 1.0. --- Variability of a Thoracic Paravertebral Block. Are we ignoring the endothoracic fascia? (Published Commentary) --- p.297<br>Chapter Appendix: 2.0. --- Ipsilateral Thoraco-lumbar Anaesthesia and Paravertebral Spread after Low Thoracic Paravertebral Injection. (Published Case Report) --- p.301<br>Chapter Appendix: 3.0. --- The Use of a Nerve Stimulator for Thoracic Paravertebral Block Reply. (Published Letter-to-editor) --- p.310<br>Chapter Appendix: 4.0. --- Bilateral Continuous Paravertebral Block Used for Postoperative analgesia in an Infant having Bilateral Thoracotomy. (Published Case Report) --- p.312<br>Chapter Appendix: 5.0. --- Thoracic Paravertebral Block: Radiological evidence of Contralateral Spread Anterior to the Vertebral Bodies. (Published Case Report) --- p.317<br>Chapter Appendix: 6.0. --- Lymphatic Drainage of the Thoracic Paravertebral Space A Reply. (Published Letter-to-editor) --- p.325<br>Chapter Appendix: 7.0. --- Thoracic Paravertebral Block for Management of Pain Associated with Multiple Fractured Ribs in Patients with Concomitant lumbar Spinal Trauma. (Published Case Report) --- p.328<br>Chapter Appendix: 8.0. --- Right Thoracic Paravertebral Analgesia for Hepatectomy. (Published Case Report) --- p.340<br>Chapter Appendix: 9.0. --- Resolution of ST-segment Depression after High Thoracic Paravertebral Block during General Anesthesia. (Published Case Report) --- p.348<br>Chapter B. --- Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36) - Appendix 10. --- p.353<br>Chapter C. --- Hospital Anxiety and Depression Scale - Appendix 11. --- p.362<br>Chapter D. --- Postoperative Telephone Follow Up Questionnaire: Appendix 12. --- p.364

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<br>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.

碩士<br>靜宜大學<br>應用化學研究所<br>98<br>A fast response and recovery time on electrochemical impedance method developed to detect concentrations of the local anesthetic levobupivacaine hydrochloride was implemented, and concentrations of 1 ppm could be detected .Composites of polypyrrole (Ppy) and polypyrrole- single walled carbon nanotubes (Ppy-SWCNTs) were synthesized coated over gold electrodes for sensing studies. The morphology of the composites was characterized by FTIR ,Cyclic Voltammetry ,Scanning Electron Microscope and Transmission Electron Microscope. Various concentrations of Levobupivacaine from 1 to 500 ppm were prepared in DI water and medical injection 0.9 % NaCl solution as the test samples. A 10-kHz frequency was used for the calibration curve, and the short response and recovery time was tested as 5 s and 3 s. The Ppy/SWCNT material showed better linearity than Ppy material and with R2 as 0.9971. Using molecular dynamic simulation studies exothermic adsorption energies and bond lengths have been calculated and explained the fast response time and lower impedance of Ppy/SWCNT than Ppy.

The opioid epidemic is a public health crisis in the United States that impacts the lives of millions of people. There is a need for interventions aimed at minimizing opioid usage in clinical settings. The perioperative care period – consisting of the time before, during, and after surgery – is a time where interventions can be made in surgical and anesthesia practice to reduce the number of opioids used. Surgery and anesthesia are two areas where patients have traditionally been introduced to prescription opioids for the first time. Enhanced Recovery After Surgery pathways have been designed to integrate and improve surgical care for patients resulting in decreased length of stay in the hospital for surgical patients. Enhanced Recovery After Surgery pathways have also explored reducing opioid use during surgical care. Multimodal Analgesia and Opioid Free Anesthesia are two methods that have been researched and shown to be successful in limiting the perioperative use of opioids. Multimodal Analgesia and Opioid Free Anesthesia both reduce total perioperative opioid use and manage pain as effectively as opioids.

碩士<br>中臺科技大學<br>醫療暨健康產業管理系碩士班<br>105<br>Objective: With the prolongation of childbearing age and the advancement of medical knowledge and technology, the incidence of high risk pregnant mothers has increased, making maternal anesthesia more complicated and difficult to deal with. The aim of this study was to investigate the status and relevance of different anesthesia patterns in maternal and newborns after caesarean section. Methods: This study was used to analyze the maternal and neonatal medical records of all caesarean sections from January 2014 to December 2016, with the consent of the Human Test Committee. The maternal was divided into high risk pregnancy and general pregnancy. The descriptive analysis and reasoning analysis of Window for SPSS22.0 statistical software were carried out, and Pearson correlation and linear regression were used. Results: In the case of maternal, spinal anesthesia was significantly different from that of general anesthesia (p = .000), bleeding (p = .000) and infusion (p = .000); spinal anesthesia General anesthesia in the amount of bleeding (p = .000), infusion volume (p = .020) significant difference. For neonates, neonatal births of the first minute Apgar score score with birth fifth minute Apgar score score in spinal anesthesia than spinal anesthesia with general anesthesia (p = .000) with (p = .000), general anesthesia than spinal anesthesia modified general anesthesia (p = .022) and (p = .000) were significant differences. Conclusion: maternal in order to nurture the fetus, resulting in many physiological changes, these changes make pregnant women's physiology with the general person is not the same, but general anesthesia for caesarean section of maternal and fetal have a significant impact, so maternal spinal cord anesthesia way of caesarean section To achieve the relative safety of maternal and fetal.

碩士<br>國立臺灣大學<br>物理研究所<br>96<br>Two topics are covered by this thesis: the maximum likelihood method and molecular dynamics simulations of general anesthetics, halothane. For the first topic, I introduce the maximum likelihood method and its application in analyzing time series data, and then test it with simulated data. For the second topic, I introduce molecular dynamics (MD) simulations and the method of energy representation to general anesthetic research. Using the MD simulations and the method of energy representation, I have calculated the free-energy change of inserting a halothane molecule into different depths of a hydrated dimyristoylphosphatidylcholine (DMPC) bilayer at pressures of 1atm, 200atm and 400atm. It is found that halothane preferentially resides in the region between the headgroup and the lipid tails, between 10Å and 15Å from the centre of the membrane. It is also found that pressure has no detectable effect on the free-energy change of inserting a halothane from bulk water to DMPC, and does not change the regional preference of halothane, either.

I found that 2.6ml of 0.5% levobupivacaine had similar clinical characteristics as the same volume of 0.5% bupivacaine in spinal anaesthesia. Both were effective for spinal anaesthesia in urological surgery, when a sensory block up to at least T10 dermatome was required. In comparing the use of levobupivacaine alone and levobupivacaine with fentanyl, there were no significant differences in haemodynamic changes and quality of sensory and motor block, when 2.6ml of levobupivacaine alone or 2.3ml of levobupivacaine with fentanyl 15mcg (0.3ml) were used in spinal anaesthesia. Both were effective for spinal anaesthesia in urological surgery. In comparing the use of ropivacaine 10mg and bupivacaine 10mg, both with fentanyl 15mcg in spinal anaesthesia for urological surgery, all the patients achieved adequate level of sensory block up to T10 dermatome or higher. The two drugs were similar in the onset time of motor block, the characteristics of sensory block and haemodynamic changes; however, the duration of motor block was shorter with ropivacaine. I concluded that both studied solutions, ropivacaine-fentanyl and bupivacaine-fentanyl, were effective for spinal anaesthesia in urological surgery and the duration of motor block was shorter with the ropivacaine-fentanyl solution. The dose-response relationship of ropivacaine in spinal anaesthesia for lower limb surgery requiring a sensory block up to at least the T12 dermatome was defined. Anaesthesia was successful in 0, 0, 42, 83 and 100% when ropivacaine at doses of 2, 4, 7, 10 and 14mg respectively were given. The derived values for ED50 and ED95 were 7.6mg and 11.4mg respectively. The cephalic level of sensory block and the degree of motor block increased with larger doses of ropivacaine. Finally, the median effective dose (ED50) of bupivacaine, levobupivacaine and ropivacaine in spinal anaesthesia for lower limb surgery were defined as 5.50mg (95% CI: 4.90--6.10mg), 5.68mg (95% CI: 4.92--6.44mg), and 8.41mg (95% CI: 7.15--9.67mg) respectively. The relative potency ratios were 0.97 (95% CI: 0.81--1.17) for levobupivacaine/bupivacaine, 0.65 (95% CI: 0.54--0.80) for ropivacaine/bupivacaine and 0.68 (95% CI: 0.55--0.84) for ropivacainellevobupivacaine.<br>In this series of studies, I have shown that levobupivacaine and ropivacaine are effective local anaesthetic agents for spinal anaesthesia in lower limb and urological surgery. This proved my hypothesis. Both are suitable alternatives to bupivacaine for spinal anaesthesia. Furthermore, these studies showed that ropivacaine is less potent than levobupivacaine and bupivacaine and the potency is similar between levobupivacaine and bupivacaine at median effective dose.<br>Levobupivacaine and ropivacaine are two relatively new local anaesthetics which were developed in view of their potential for less cardiotoxicity in comparison with bupivacaine, the most common local anaesthetic used in spinal anaesthesia for many years. Both are produced in pure S(-) enantiomer form in contrast to bupivacaine which is a racemic mixture. They have been shown to be effective in peripheral nerve blocks, and epidural analgesia and anaesthesia; nevertheless, experience of their use in spinal anaesthesia is limited. The objective of this thesis was to evaluate their use in spinal anaesthesia for surgery in non-obstetric patients. My hypothesis was that levobupivacaine and ropivacaine are effective local anaesthetic agents for spinal anaesthesia in lower limb and urological surgery. In order to test this hypothesis, I conducted five clinical studies on 269 patients who had urological surgery or lower limb surgery under spinal or combined spinal-epidural anaesthesia. First, I investigated the efficacy and clinical characteristics of levobupivacaine and the mixture of levobupivacaine with fentanyl in spinal anaesthesia. Next, I compared the use of ropivacaine-fentanyl with bupivacaine-fentanyl in spinal anaesthesia. Finally, I defined the dose-response relationship of ropivacaine in spinal anaesthesia using traditional dose-response methodology and defined the relative potency among levobupivacaine, ropivacaine and bupivacaine by comparing the defined ED50 in spinal anaesthesia using up-down sequential allocation method.<br>Lee, Ying Yin.<br>Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: .<br>Thesis (M.D.)--Chinese University of Hong Kong, 2011.<br>Includes bibliographical references (leaves 133-150).<br>Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.<br>Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

La ventilation mécanique est une thérapie fréquente au bloc opératoire et aux soins intensifs. Lorsque mésadaptée, celle-ci est responsable de la survenue de lésions pulmonaires (ventilator- induced lung injury ou VILI) qui ont été associées à un mauvais devenir clinique. Le principal mécanisme supputé du VILI est la déformation pulmonaire excessive. Peu de techniques validées et simple d’utilisation permettent la mesure de la déformation pulmonaire au chevet. Nous proposons l’élastographie ultrasonore comme nouvel outil permettant de mesurer la déformation pleurale régionale. Une étude randomisée en chassé-croisé à simple aveugle a été réalisée chez 10 patients intubés et ventilés dans le cadre d’une chirurgie élective sous anesthésie générale. Quatre volumes courants ont été étudiés en ordre aléatoire : 6, 8, 10 et 12 cc.kg-1 de poids prédit. Pour chaque volume, la plèvre sera imagée à 4 emplacements anatomiques. L’élastographie ultrasonore sera utilisée pour calculer les différentes composantes de translation, de déformation et de cisaillement. Ces différents paramètres d’élastographie ont été étudiés pour identifier ceux possédant les meilleurs effets dose-réponse à l’aide de modèles linéaires mixtes. La qualité de l’ajustement des modèles a été vérifiée à l’aide du coefficient de détermination. Les reproductibilités intra-observateur, inter-observateur et test-retest ont été calculées à l’aide des coefficients de corrélation intra-classe (ICC). L’analyse a été possible dans 90,7% des séquences échographiques. La déformation latérale absolu, le cisaillement latéral absolu et la déformation de Von Mises ont varié significativement avec le volume courant et présentaient les meilleurs effets dose-réponse ainsi que la meilleure qualité d’ajustement. Les estimés ponctuels de la reproductibilité intra-observateur étaient excellents pour les trois paramètres (ICC 0,94, 0,94, 0,93, respectivement). Les estimés ponctuels des reproductibilités inter-observateur (ICC 0,84, 0,83, 0,77, respectivement) et test-retest (ICC 0,85, 0,82, 0,76, respectivement) étaient bons. L’élastographie ultrasonore semble faisable et reproductible dans ce contexte clinique. Elle pourrait éventuellement servir à personnaliser la ventilation mécanique de patients.<br>Mechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which in turn is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography. We conducted a single blind randomized crossover pilot study in 10 patients requiring general anesthesia. After induction, patients were received tidal volumes of 6, 8, 10 and 12 mL.kg-1 in random order, while pleural ultrasound cineloops were acquired at 4 standardized locations. Ultrasound radiofrequency speckle tracking allowed computing various pleural translation, strain and shear components. These were screened to identify those with the best dose-response with tidal volumes using linear mixed effect models. Goodness-of-fit was assessed by the coefficient of determination. Intraobserver, interobserver and test-retest reliability were calculated using intraclass correlation coefficients. Analysis was possible in 90.7% of ultrasound cineloops. Lateral absolute shear, lateral absolute strain and Von Mises strain varied significantly with tidal volume and offered the best dose-responses and data modelling fits. Point estimates for intraobserver reliability measures were excellent for all 3 parameters (0.94, 0.94 and 0.93, respectively). Point estimates for interobserver (0.84, 0.83 and 0.77, respectively) and test-retest (0.85, 0.82 and 0.76, respectively) reliability measures were good. Thus, strain imaging is feasible and reproducible, and may eventually guide mechanical ventilation strategies in larger cohorts of patients.