https://www.clinsurggroup.us/journals/global-journal-of-anesthesiology A Peertechz Open Access Journal en-us 03 Apr, 2026 https://www.clinsurggroup.us/articles/GJA-13-162.php Introduction: Spinal anaesthesia is widely used around the globe for surgeries involving lower abdomen, pelvis, and lower limbs. Bupivacaine and its S-enantiomer Levobupivacaine are among the most commonly used drugs for subarachnoid block. 11 Feb, 2026 https://www.clinsurggroup.us/articles/GJA-13-161.php Diffuse cellulitis affecting the bilateral submandibular, sublingual, and submental spaces characterizes Ludwig’s angina, a quickly developing, potentially fatal soft tissue infection. It is a medical emergency due to its sudden onset and rapid spread. In this report, we describe a case of a widespread odontogenic infection that spread to the cervical region with an elevated floor of the mouth and compromised airway. The affected spaces were drained. Case report: A 9-year-old female child with Ludwig’s angina was taken up for emergency incision and drainage. The airway management was anticipated to be difficult. Initial tracheal intubation was difficult, and an attempt at tracheostomy was made, which led to drainage of pus, but the trachea could not be identified due to inflammation. Following the drainage of pus, oral intubation was done with a smaller tube (4.5), and the airway was secured. Conclusion: In a case of Ludwig’s angina, difficult mask ventilation due to swelling of the soft tissues, difficult laryngoscopy due to swelling and inflammation of the floor of the mouth, and difficult intubation should be anticipated by the anaesthesiologists. Hence, there should be minimal airway manipulation with a trial of intubation by an experienced anaesthesiologist and tracheostomy is considered the mainstay of airway management. In the paediatric age group, tracheostomy could be associated with tracheal stenosis; hence, endotracheal intubation is usually preferred over tracheostomy as the first line of airway management. 08 Nov, 2025 https://www.clinsurggroup.us/articles/GJA-12-160.php Aim and background: Homocystinuria is a rare metabolic disorder with characteristic involvement of connective and vascular tissue associated with increased bleeding risk. This article reports a rare and clinically significant case of difficult ventilation caused by upper airway bleeding in a case of homocystinuria during dental rehabilitation surgery, emphasising the challenges faced in airway management and the tailored anaesthetic care given. Case report: A 9-year-old female with homocystinuria was taken up for dental rehabilitation surgery. Patient sustained profuse upper airway bleeding after attempted nasal intubation and sudden blockage of both bronchi, which led to difficulty in securing the airway and further ventilation difficulties, which were managed with oral intubation, bronchial suctioning, and tailored care to clear the airways and improve the ventilation. Conclusion: In a case of homocystinuria with increased bleeding tendency due to coexisting Aspirin administration, the anesthesiologist should understand the pathogenesis, complications, and tailor the anaesthetic care with minimal airway manipulation and trauma, and manage all difficult ventilation that may arise as a complication of the same. 01 Feb, 2025 https://www.clinsurggroup.us/articles/GJA-12-159.php Introduction: Choosing an anesthetic that presents the least danger to the patient’s life continues to be the top priority for the Anesthesia and Critical Care Department personnel when it comes to techniques, medications, tactics, and recommendations for choosing the optimal anesthesia. The most popular and efficient kind of anesthetic for those who repair hernias is spinal anesthesia. Subjects and methods: an accurate and up-to-date study of the patients. Based on the types of spinal and general anesthesia, we divided the 100 patients who had herniotomy into two groups: 50 patients received spinal anesthesia, while the remaining 50 patients received general anesthetic. The patient’s age, weight, pulse rate, and blood pressure change were all analyzed. The study divided patients between the ages of 20 and 90 into two groups: General Anesthesia (GA) and Spinal Anesthesia (SA) in order to do thorough follow-ups; before, during, and after operations. Results: We demonstrate that it is also more stable in SA, which is around 56%, compared to GA, which is roughly 40%. However, blood pressure is higher in GA, which was 32%, and in SA, which was 24%, and lower in GA, which was 28%, and in SA, it was 20%. As demonstrated in this study, the heart rate is more stable in SA (56%) compared to GA (32%), and it increases in SA (34%), while it increases in GA (60%). The impact of (SA) is more consistent, and the heart rate dropped by 10% in (SA) and around 8% in (GA). Conclusion: We found that spinal anesthesia was better than general anesthesia at preserving blood pressure stability and a minimum or normal heart rate. 28 Dec, 2024 https://www.clinsurggroup.us/articles/GJA-11-158.php Propofol, an IV hypnotic with a modulating action on γ-aminobutyric acid receptors, is widely used for anesthesia and sedation during interventional procedures and in intensive care units. Favorable characteristics of propofol are the lack of accumulation and the relatively short recovery time. 16 Aug, 2024 https://www.clinsurggroup.us/articles/GJA-11-157.php Background: Extubation is considered a critical event in general anesthesia. A smooth endotracheal intubation or an uneventful intra-operative period can still lead to a difficult extubation. This is a case report of an eventful and unanticipated difficult elective extubation in a post coronary artery bypass grafting patient. Observations: A knot was found on the pilot balloon tubing during extubation of the patient which made deflation of the endotracheal tube cuff almost impossible. After several minutes of troubleshooting, we were able to extubate the patient with stable hemodynamics without any evidence of sore throat. Significance: Rare cases and difficulties like these, challenge a healthcare provider to think beyond common knowledge and this serves as an example for other anaesthesiologists that how minute malfunctions in our common devices/instruments can lead to disastrous outcomes and hence vigilance is important. 10 Jul, 2024 https://www.clinsurggroup.us/articles/GJA-11-156.php Evaluation of coronary artery blood flow using transesophageal echocardiography is a very useful noninvasive and rapid test, although there are some problems such as technical differences between examiners and angle dependency of blood flow evaluation. In coronary artery bypass surgery, it is useful to determine the degree of preoperative coronary artery stenosis and to evaluate grafts, and in Bentall surgery, it is useful to confirm that no medically induced coronary artery stenosis caused by coronary artery reconstruction has occurred. Further studies will be conducted to improve the accuracy and usefulness of this method. 30 Dec, 2023 https://www.clinsurggroup.us/articles/GJA-10-155.php Pregnancy, in itself, is a high-risk condition and any procedures performed during any gestation period can prove detrimental for the mother as well as the fetus, hence it becomes a challenge for the anesthetist to choose a mode of anesthesia that can prevent major complications. We witnessed a similar case in our hospital wherein a 30-year-old pregnant patient at 34 weeks gestation with carcinoma breast was posted for mastectomy. Considering all the risks, we managed this case by thoracic epidural successfully. The surgery was uneventful. 28 May, 2022 https://www.clinsurggroup.us/articles/GJA-9-154.php Anesthesiologists are on the frontline in the war against the global COVID-19 pandemic, providing airway, ventilatory, and hemodynamic support to acute patients suffering from severe and critical COVID-19 infection. 24 Nov, 2021 https://www.clinsurggroup.us/articles/GJA-8-153.php Background/Aims: Upper airway stimulation with endoscopes and pH-impedance probes during deep propofol sedation confers unknown risk for associated respiratory adverse airway events. This report quantifies frequencies of such events and airway rescue interventions associated with Esophagogastroduodenoscopies (EGD) and multi-channel intraluminal acid detection impedance probe (MIIP) placements. Methods: This was a prospective observational study regarding occurrence of adverse respiratory events in 42 children undergoing propofol sedated EGDs and MIIP placements: Group 1. (n=21 EGDs), Group2 (n=21 EGDs before MIIP), Group 3. (n=21 during MIIP). Results: All procedures were successfully completed using deep propofol sedation. Respiratory events were transient and associated with no morbidity or mortality. Nearly half of each group experienced a respiratory event. “Partial airway obstruction” during 42 EGDs occurred in 28.6% and responded to simple airway interventions. “Complete airway obstruction” occurred during 1/42 EGDs and 2/21 MIIPs. Throughout MIIP placement, endoscopic visualization of the glottis was maintained and unnecessary stimulation of the glottis was avoided; nonetheless, complete airway obstruction occurred in 2/21. Advanced airway rescue maneuvers were not required in either instance. Conclusions: Respiratory adverse events commonly occurred during EGDs and MIIP placements. All events were successfully rescued by simple airway interventions. 14 Jul, 2021 https://www.clinsurggroup.us/articles/GJA-8-152.php Background: Laryngeal Mask Airway (LMA) is usually inserted without muscle relaxants, which requires good jaw relaxation. Previous studies have focused on creating the optimal condition for LMA insertion with different anesthetic adjuncts. This study is to determine whether the time interval between induction and insertion influences placement conditions. Insertion of LMA at the best time interval may decrease the complications associated with LMA placement. Methods: This is a prospective randomized study with a total of 198 ASA I or II patients assigned to three groups: Group 0”, Group 60” and Group 90”, with number representing the seconds from loss of eye lash reflex (ELR) to LMA insertion. All patients were pretreated with intravenous midazolam 2 mg and fentanyl 1 mcg/kg at a given time. Induction was achieved with 2.5 mg/kg propofol. Ambu® AuraOnceTM LMA was placed by a blinded anesthesiologist who also assessed the condition for LMA insertion based on a score system. The primary outcome is to find the optimal condition for LMA insertion in each group. The conditions were defined as optimal or non-optimal based on the total score of 6 or > 6, respectively. Results: The percentage of the optimal condition was significantly different amongst the three groups (p = 0.031). The optimal condition was 68% in Group 60”, that was significantly higher than 45% in Group 0” (p = 0.008), but not than 58% in Group 90” (p=0.207). Conclusions: Induction of general anesthesia with 2.5 mg/kg of propofol, with pre-administration of midazolam and fentanyl, provided the highest percentage of optimal condition of LMA insertion at 60 seconds after loss of ELR. 12 May, 2020 https://www.clinsurggroup.us/articles/GJA-7-151.php During disasters, anesthesiologists may play a main role. It is known that anesthesiologist is extremely effective and capable in the management emergency cases during disaster times. 12 May, 2020 https://www.clinsurggroup.us/articles/GJA-7-150.php Living donor and cadaveric donor renal transplantation have received a significant interest. During the procedure, both volatile agents and total intravenous anesthesia are used. However, the effects of volatile agents used during anesthesia on primary graft dysfunction is controversial. Besides evidence-based scientific data is not enough to conclude the ideal inhalation agent in renal transplantation. This review aimed to determine the effects of volatile agents preventing or improving the Ischemia Reperfusion (IR) injury during general anesthesia in patients undergoing renal transplantation. The possible mechanisms that affect the outcome of the patients after transplantation will be discussed. 16 Mar, 2020 https://www.clinsurggroup.us/articles/GJA-7-149.php Objective: Patients undergoing major limb amputations are often elderly, debilitated patients with comorbidities that increase their operative risks and postoperative morbidity and mortality rates. We, as anesthesiologists, aimed to underline the factors that are important in decision-making for the well-being of these patients in the preoperative period. 08 May, 2019 https://www.clinsurggroup.us/articles/GJA-6-148.php The prevalence of congenital heart disease is about 8 to 10 case per 1000 live births and is a major cause of increased mortality and morbidity in pediatric patients undergoing noncardiac surgery. Therefore safe anesthesia and adequate recovery should be provided. It is important to determine the patient’s risk score in the preoperative period. However, the risk assessment tools have a limited prediction for increased mortality and morbidity of non-cardiac surgery. The most important point in determining the anesthesia method is to be aware of the latest situation both anatomically and physically about the circulation of patient and to create the specific planning. In these patients, the aim of maintenance of anesthesia is to increase arterial oxygen saturation by increasing pulmonary blood flow. Thus the use of appropriate anesthesia and monitoring methods through multidisciplinary decision-making and planning, as well as the identification of high-risk patients based on risk classification, may reduce mortality and morbidity in the pediatric patients with congenital heart disease. 15 Apr, 2019 https://www.clinsurggroup.us/articles/GJA-6-147.php Postoperative pain control is an important factor affecting patient recovery, return to normal bowel movement, ambulation and daily activity. Intravenous patient-controlled analgesia (IV-PCA) which allows the patient to administer his own pain relief is considered as an efficient tool to control postoperative pain. Safety of IV-PCA relies on the concept of negative feedback control system so that the patient will become too sedated to physically push the button to receive more opioid before reaching a critical point of severe respiratory depression [1]. 29 Mar, 2019 https://www.clinsurggroup.us/articles/GJA-6-146.php Background: To compare the Adequacy of combined lumbosacral plexus block over subarachnoid block and epidural in terms of motor blockade and sensory blockade, surgeon and patient satisfaction and time for first rescue analgesia for unilateral elective hip surgeries. Materials and methods:A single centred randomized, single blinded study, conducted between May2017 to October 2018, on 60 patients undergoing elective unilateral hip surgeries with 20 patients in each group (group I -combined lumbar and sacral plexus block, Group II - Epidural & Group III- Subarachnoid block). Patients belonging to American society of anaesthesiologists, physical status 1 & 2, aged between 18 – 60 years were enrolled for the study and distributed randomly into one of the three groups. Adequacy of block in terms of motor and sensory blockade, patient and surgeon satisfaction and time for first analgesia were noted. 29 Mar, 2019 https://www.clinsurggroup.us/articles/GJA-6-145.php Background: Laparoscopic surgeries are most commonly performed surgeries. However, they are associated with increased incidences of postoperative nausea and vomiting. Aim: We aimed to compare the effectiveness of dexamethasone, haloperidol, granisetron in prevention of postoperative nausea and vomiting following laparoscopic surgeries. Methods: We conducted a randomized, double-blinded study including 90 patients both males and females undergoing laparoscopic surgeries in a tertiary hospital over 18 months. The subjects were randomized into three groups. Group I Dexamethasone 8mg, Group II Granisetron 2mg, Group III Haloperidol 1mg (n=30 each group). The study drugs were administered intravenously immediately after intubation. Patients were observed every 4th hourly till 24 hours for incidence of nausea, vomiting, pain and sedation. 05 Jan, 2019 https://www.clinsurggroup.us/articles/GJA-6-144.php The incidence of caesarean section (C/S) is increasing up to 40% even in many developed countries [1]. General and regional anesthesia techniques are used for providing anesthesia in C/S. Epidural anesthesia ensures better control of sensory level as compared to spinal anesthesia and provides better postoperative analgesia. However, it is easier and faster to perform spinal anesthesia. It may produce more intense motor block, and as the amount of local anesthetic is lower, there is less risk for systemic toxicity [2]. On the other hand, post puncture headache is a common complication following spinal anesthesia. 09 Nov, 2018 https://www.clinsurggroup.us/articles/GJA-5-143.php Management of perioperative anti-coagulation is a general clinical dilemma, and generally accompanied by the signifi cant adverse effects. A personalized approach is necessary to minimize the risks of anesthesia and surgery in patients with comorbidities. 30 Oct, 2018 https://www.clinsurggroup.us/articles/GJA-5-142.php Bleeding is a potentially preventable reason of the death among patients during major surgery. 26 Oct, 2018 https://www.clinsurggroup.us/articles/GJA-5-141.php Aim: To assess the involvement of health workers in Cross River State, Nigeria with CPR during witnessed sudden cardiac arrest and the resources available to them for intervention. Settings and Design: The study was carried out in Cross River State, Southern Nigeria which has an international boundary with Cameroon in the East. It is a descriptive, Cross sectional study among health workers. 18 Jan, 2018 https://www.clinsurggroup.us/articles/GJA-5-140.php Aims: The volatile general anesthetic sevofl urane is commonly used across all ages in the clinic. Sevofl urane-induced neurotoxic effects on the developing dopaminergic system are still unclear. The aim of this study was to evaluate the integrity of the D2/D3 receptor in developing rat brain utilizing molecular imaging techniques. 10 Nov, 2017 https://www.clinsurggroup.us/articles/GJA-4-139.php Ketamine is a dissociative anesthetic that is frequently used for the induction and maintenance of general anesthesia in children. It has been reported that blockade of NMDA receptors by ketamine may cause neurotoxicity in neonatal rats when given over a 12 hour period during the brain growth spurt. 27 Oct, 2017 https://www.clinsurggroup.us/articles/GJA-4-138.php Lung isolation management has long been a complicated issue in the neonatal patient due to the patient’s size which limits the ability to use many of the devices used in the adult patient. The Arndt bronchial blocker is now available in sizes that allow lung isolation to be feasible in the pediatric patient. 28 Aug, 2017 https://www.clinsurggroup.us/articles/GJA-4-137.php Subclavian artery stenosis (SAS) is a relatively rare condition, even more so for its bilateral existence. In a study [1], the prevalence of SAS was 1.9% in the free-living ohorts and 7.1% in the clinical cohorts. SAS was signifi cantly associated with smoking and higher levels of systolic blood pressure. 21 Aug, 2017 https://www.clinsurggroup.us/articles/GJA-4-136.php Post-Dural Puncture Headache is a common complication for patients with dural puncture and if untreated, it can result in complications such as subdural hematoma and seizures. The aim of this case report is to present a case of headache after corrective spinal surgery for idiopathic scoliosis resolved with a BGON block. 08 Jul, 2017 https://www.clinsurggroup.us/articles/GJA-4-135.php Background & Aims: An experience feedback committee (EFC) is a management method for patientsafety designed for a medical team. The aim of this study was to analyse the functioning of an EFC in an anaesthesia department and to explore its contribution to patient safety. 04 Jul, 2017 https://www.clinsurggroup.us/articles/GJA-4-134.php Purpose: Knee arthroscopy is one of the most frequent procedures in orthopedic surgery. It has a large range of indications. Post-operative pain is one complication and it is managed with analgesics sometimes with weak opioids. It has been proven that auriculotherapy is effi cient in decreasing post-operative pain for many orthopedic surgeries, in particular knee and hip arthroplasty. We studied the interest of uriculotherapy for post-operative pain after knee arthroscopy. 04 Jul, 2017 https://www.clinsurggroup.us/articles/GJA-4-133.php This case report revealed that Raynaud’s phenomenon happened during anesthesia recovery period and caused panic. We performed general anesthesia for a patient who underwent laparoscopic nephrectomy and denied any signifi cant medical history. 21 Apr, 2017 https://www.clinsurggroup.us/articles/GJA-4-132.php Study Objective: Our hypothesis is that systemic lidocaine can signifi cantly reduce chronic pain associated with fi bromyalgia. A secondary goal of the study is to determine if other patient demographics can affect the response to IV lidocaine. 03 Apr, 2017 https://www.clinsurggroup.us/articles/GJA-4-131.php Modern day general anesthesia has a convincing safety record in any age group presenting with or without severe co-morbidities, hence allowing surgeons to introduce a broad range of patients to surgical procedures. 21 Mar, 2017 https://www.clinsurggroup.us/articles/GJA-4-130.php Aim: The purpose of this randomized double-blinded study is to compare the safety and effi cacy of two different concentrations of ketofol on the intraoperative hemodynamics, respiration, bispectral index values and post-anesthesia recovery profi les in morbid obese patients undergoing upper GI endoscopy. 25 Jan, 2017 https://www.clinsurggroup.us/articles/GJA-4-129.php The perioperative management of children undergoing corrective spinal surgery is challenging. The major challenges include the extensive nature of surgery, associated comorbidities and the need for neurophysiological monitoring to diagnose any form of intra-operative neurological insult. The pre-operative functional status and the intra-operative events could dictate the requirement for post-operative mechanical ventilation. 23 Jan, 2017 https://www.clinsurggroup.us/articles/GJA-4-128.php Fascial plane blocks have become quite popular in the present practice of regional anaesthesia. Transverses abdominal plane (TAP) block, quadratus lumborum (QL), serratus anterior plane (SAP) block, pectoralis block (PECS 1/ 2), rectus sheath and adductor canal block are quite easy to perform with ultrasonographic (USG) guidance. 30 Dec, 2016 https://www.clinsurggroup.us/articles/GJA-3-127.php In recent years, research has shown the involvement of free radicals in the development of the pain that accompanies many pathological conditions. In the treatment of acute and chronic pain, the most effective therapies are natural and synthetic opioid alkaloids. Their metabolism in itself may contribute to the formation of free radicals and thus affect body system load and the perception of pain. 29 Dec, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-126.php I experienced the case of an elderly patient with dementia who had recurrent respiratory failure due to the abuse of a transdermal fentanyl patch. Opioids have been recently used in patients with moderate-to-severe chronic non-cancer pain and in those with cancer pain in palliative care [1]. 17 Oct, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-125.php The bisphosphonate related osteonecrosis of the jaws (BRONJ) is defined as a drug-adverse reaction that involves the maxillary bones. 12 Jul, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-124.php Aims: As old paracervical block using Kobak needle (Atom Medical, Tokyo, Japan) abondoned developing fetal bradycardia, new safe vaginal submucosal anesthesia was tried to safely remove labor pain. 27 Apr, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-123.php Recently, there has been increased interest and concern regarding the safety of anesthetics on the long-term impairment of the central nervous system (CNS). The field of anesthesia-related toxicology, therefore, has engaged multiple scientific disciplines in attempt to identify the basic characteristics of the anesthetic agents that produce harmful acute and/or chronic effects on the nervous system. Currently, the clinical relevance of anesthetic neurotoxicity is an urgent matter of public health. 24 Mar, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-122.php The use of brain stimulation either without drugs at all or with ones that are currently obsolete for the promotion of general anesthesia [1]. Furthermore, different intensities and time durations of stimulation were reported, making it difficult to compare between studies. 18 Mar, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-121.php This case report describes an unusual presentation and anesthesia management of a rare genetic association. The MURCS association, a variant of Mayer-Rokitansky-Küster-Hauser syndrome is a rare (1/4500-1/50,000) congenital syndrome, of unknown etiology, consisting of mullerian duct (MU) aplasia, renal (R) aplasia, and cervicothoracic somite (CS) dysplasia. 02 Jan, 2016 https://www.clinsurggroup.us/Anesthesiology/GJA-3-120.php Introduction: There are many different analgesic methods used for children undergoing inguino-scrotal surgery. Research suggests that caudal analgesia reduces the need for postoperative pain relief in these children compared with regional techniques but may increase the risk of motor block and urinary retention. This can be problematic given that these procedures are commonly performed as day cases. 10 Dec, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-119.php A parturient with placenta previa and accreta combined with fetal congenital high airway obstruction was scheduled for cesarean section. Ex utero intrapartum (EXIT) treatment on fetus after classical cesarean section was planned. General anesthesia was induced after routine and invasive haemodynamic monitoring started. Profuse bleeding was started as soon as the baby was delivered. EXIT procedure was cancelled and cord was clamped and cut. ENT surgeon performed tracheostomy on baby and airway was secured but baby died after half an hour. Emergency cesarean hysterectomy was done after all measures to control the bleeding were failed. 15 Oct, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-118.php In dental practice, intravenous general anesthesia is useful for patients who are difficult to treat when not sedated such as those with neurological disorders 15 Oct, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-117.php Open surgery and fetoscopic surgery are of the safest procedures, whilst the ex-utero intrapartum treatment (EXIT) procedure has lost its significance as a result of the severe complications experienced both by the mother and the fetus. While uteroplacental circulation maintains, the EXIT is performed before delivery. The fetus is to be delivered at the conclusion of the case. A neonatal resuscitation area and two operating rooms are needed. Significant uterine relaxation is required for open midge station surgery. The risk for rapid bleeding and hemodynamic instability are the common accompanying parts of this procedure. It still continues to be a process done in certain centers not only in United States but also in Europe [11. Sviggum HP, Kodali BS (2013) Maternal anesthesia for fetal surgery. Clin Perinatol 40: 413-427.]. 15 Oct, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-116.php Oxygen consumption increases with increased alveolar ventilation and respiratory alkalosis occurs. Thus, PaCO2 becomes 28-32 mmHg in pregnant women, and this amount is compensated with renal bicarbonate absorption. Preoxygenation can be made slower by inhalation of 100% oxygen for 2-5 minutes. Denitrogenation of the lungs occurs after three minutes [11. Baraka AS, Taha SK, Aouad MT, El-Khatib MF, Kawkabani NI (1999) Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology 91: 612-616.]. Another method can be applied quickly with 4-8 deep breaths of 100% oxygen [22. Benumof JL (1999) Preoxygenation: best method for both efficacy and efficiency. Anesthesiology 91: 603-605.]. However, for pregnant women who will have a cesarean section under general anesthesia, an oxygen fraction of 1 has been shown to increase fetal oxygenation more compared with the 0.3 or 0.5 FiO2 [33. Khaw KS, Ngan Kee WD, Chu CY, Ng FF, Tam WH, et al. (2010) Effects of different inspired oxygen fractions on lipid peroxidation during general anaesthesia for elective Caesarean section. Br J Anaesth 105: 355-360. ]. As this may lead to free oxygen radicals and apsorbtion atalectesia, 80 % oxygen is recommended. 10 Sep, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-115.php Objective: Opioid-induced constipation (OIC) is the most prevalent patient complaint associated with longer-term opioid use and interferes with analgesic efficacy, functionality, quality-of-life, and patient compliance. To compare effects of prolonged release (PR) oxycodone and PR naloxone (OXN), vs. PR oxycodone (OXY) vs. PR morphine (MOR) on bowel function under real-life conditions in chronic low back pain (LBP) patients with vs. those without pre-existent constipation. 03 Sep, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-114.php One aspect of oral pathology and maxillofacial not to be overlooked in the anesthesiological approach to the patient are complications due to local anesthesia in maxillary bone. 01 Sep, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-113.php Therapeutic hypothermia has been advocated for neuroprotection in cardiac arrest-induced encephalopathy, neonatal hypoxic-ischemic encephalopathy, traumatic brain injury, stroke, hepatic encephalopathy, and spinal cord injury, and as an adjunct to certain surgical procedures. In this review, we address physiological mechanism of hypothermia to mitigate neurological injury, the trials that have been performed for each of these indications, the strength of the evidence to support treatment with mild/moderate hypothermia. 03 Aug, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-112.php Takotsubo Cardiomyopathy (TC) is a reversible, stress-induced, non-ischemic cardiomyopathy associated with temporary weakness of the myocardium and midventricular or apical ballooning [11. Emanuele Cecchi, Guido Parodi, Cristina Giglioli, Silvia Passantino, Brunella Bandinelli, et al. (2013) Stress-Induced Hyperviscosity in the Pathophysiology of Takotsubo Cardiomyopathy. The Am J Cardiol: 1523–1529.,22. Sharkey SW, Lips DL, Pink VR, Maron BJ (2013) Daughter-Mother Tako-Tsubo Cardiomyopathy. The Am J Cardiol 137–138.]. Angina, ST abnormalities, elevated troponins, ventricular asynergy, CHF, and decreased EF are all components of TC. The unique finding is that they occur on the absence of CAD [33. Bielecka-Dabrowa A, Mikhailidis DP, Hannam S, Rysz J, Michalska M, et al. Takotsubo cardiomyopathy -The current state of knowledge. Int J Cardiol:120–125.]. In this case series with IRB approval we report three cases of post-operative cardiac symptoms that all resulted in a diagnosis of TC. 06 May, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-111.php Objectives: The aim of this study was to assess the effect of perineural injection of meloxicam on the recovery of vocal cord paresis due to recurrent nerve injury after thyroid surgery. A secondary objective was listed the neural inflammation as possible risk factor for delayed recovery of vocal cord paresis. 24 Apr, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-110.php Oxygen is known to be one of the strongest electron acceptors and has one of its main functions in the electron transport chain producing ATP and heat, so important for energy expenditure and thermoregulation. However, some important mechanisms of oxygen functions are not completely delineated, yet. Sensing oxygen is purposeful and serves various specific functions. One mode of action is to initiate afferent neuronal activity which requires increased cytosolic Ca2+ concentrations. Another action is linked to the Hypoxia Inducible Factor, HIF-1, which in the normoxic state is produced in a prolyl-hydroxylase regulated reaction. 15 Apr, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-109.php Fibreoptic bronchoscopy (FB) and laryngeal mask airway (LMA) have been used successfully in children since the early 1980s [11. Wood RE, Postma D (1988) Endoscopy of the airway in infants and young children. J Pediatr 112: 1-6.,22. Brain AI (1983) The laryngeal mask-a new concept in airway management. Br J Anaesth 55: 801-805.]. The paediatric fibreoptic bronchoscopy visa laryngeal mask airway (LMA) in general anesthesia was established in 1990s [33. Smyth AR, Bowhay AR, Heaf LJ, Smyth RL (1996) The laryngeal mask airway in fibreoptic bronchoscopy. Arch Dis Child 75: 344-345.,44. Wood RE (1996) Pediatric bronchoscopy. Chest Surg Clin N Am 6: 237-251.]. Although previous studies have shown some experience on FB in infant, conclusive effects on bronchoscopy intervention are unknown. We report the use of laryngeal mask airway (LMA) to guide electric bronchoscopy interventions (EBI) while maintaining an adequate depth of anesthesia and effective ventilation in small infant who was diagnosed of having severe airway stenosis from computed tomography (CT) scan. 18 Mar, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-108.php Background and Aim: Thoracic, abdominal and thoraco-abdominal aortic pathologies have highest mortality and morbidity causing pathologies in cardiovascular surgery. Co-existing diseases and age significantly increase risk of anesthesia and mortality rate in treatment of these patients. Endovascular techniques are used increasingly due to minimally invasive approach, decreased anesthesia risk during implementation, reduced length of hospital stay, and low mortality and mobidity rates. The aim of this investigation was to report our anesthetic experiences in endovascular techniques performed at our center. 01 Mar, 2015 https://www.clinsurggroup.us/Anesthesiology/GJA-2-107.php Cerebrospinous fluid (CSF)-cutaneous fistula is a rare complication of neuraxial blockade. We present a case of a healthy patient who developed cerebrospinal fluid-cutaneous fistula after an uneventful epidural catheter insertion for perioperative analgesia. The patient was managed conservatively and the fistula resolved without further issues.The literature is reviewed for similar reports and diagnosis and management of this rare complication are discussed. 24 Nov, 2014 https://www.clinsurggroup.us/Anesthesiology/GJA-1-105.php Difficult airway is defined as the clinical situation in which a trained anesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both [1]. There is very little data on failed intubation in newborns and infants [2]. Surgical cricothyroidotomy is not recommended in pediatric patients due to the small size of the cricothyroid membrane [3]. Although surgical cricothyroidotomy is an option, it is a difficult procedure to perform in young children, infants and newborns. Transtracheal or transcricothyroid needle approach may be the only option for young children, infants and newborns that cannot be intubated and ventilated [2]. 24 Nov, 2014 https://www.clinsurggroup.us/Anesthesiology/GJA-2-106.php Difficult or failed tracheal intubation is an important cause of mortality and morbidity. Approximately 30% of anesthesia-related deaths are caused by the complications of difficult airway management. Also, 85% of respiratory complications result in brain damage or death [1]. Awake tracheal intubation is the most appropriate method for protection of airway reflexes in patients, who are expected or known to have difficult intubation. However, the use of video laryngoscope in awake patients in a way similar to the use of classic direct laryngoscope, which requires hanging of epiglottis or the use of fiber optic bronchoscope through nose, disturbs patients and complicates the procedure by causing gag reflex and mucosal bleeding. 15 Oct, 2014 https://www.clinsurggroup.us/Anesthesiology/GJA-1-104.php Objective: Breakthrough cancer pain (BTcP) affects 19-95% of cancer patients (dependent on the definition and methods used and the populations studied) and is associated with detrimental physical, psychological and social complications in affected individuals as well as with significant economic burden on society and the healthcare system. This study evaluated the analgesic efficacy and safety of intranasal fentanyl spray (INFS) for the treatment of BTcP in a clinical setting with a special focus on its impact on health care resource utilization. 06 Sep, 2014 https://www.clinsurggroup.us/Anesthesiology/GJA-1-103.php Rocuronium pharmacokinetics and pharmacodynamics can be influenced by several factors like gender and obesity. We propose a brief report of a patient (59 years old, weight 135 kg, BMI 52.7) who showed three episodes of severe hypotension not responsive to continuous noradrenaline infusion therapy after rocuronium administration (dose 0.6 mg/kg; total dose: 50 mg) not based on her IBW (ideal body weight). 13 Aug, 2014 https://www.clinsurggroup.us/Anesthesiology/GJA-1-102.php Physicians employed in operating and emergency rooms have utilized opioid antagonist for almost half a century for the treatment of opioid overdose. The prototype antagonist remains naloxone hydrochloride, which actually received FDA approval back in 1971. Why after so many years on the market is this medication now being formulated in the form of an easy to use “auto-injector” that was designed for non-medical professionals to be able to utilize at a moment's notice? Could this wonder product, being hailed as the best possible safety tool available for life threatening opioid emergencies actual make heroes out of lay people? [1]. 23 Jul, 2014 https://www.clinsurggroup.us/Anesthesiology/GJA-1-101.php In 1985, the first laparoscopic cholecystectomy was performed, and the introduction of laparoscopic cholecystectomy proved to be a new era in the management of cholelithiasis. In his only start, only patients who were good surgical risks, with non acute disease and no prior abdominal surgeries were selected for the procedure. However, as experience was gained, the pool of patients expanded to encompass those who were otherwise candidates for conventional cholecystectomy. To perform the surgery laparoscopically, there is a need to create a space between the abdominal wall and the viscera. If cholecystectomy was performed under anesthesia in high-risk patients, there is no explanation for the procedure to become routine in healthy patients.