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Research Article
Incidence of Anesthesia Awareness: A Study in the Southern Part of the Volta Region of Ghana
Issue:
Volume 13, Issue 1, June 2025
Pages:
1-12
Received:
12 December 2024
Accepted:
25 December 2024
Published:
21 January 2025
DOI:
10.11648/j.ijacm.20251301.11
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Abstract: Background: Intraoperative awareness during anaesthesia occurs when a patient can recall some or all the events during a surgical procedure. Unintended intraoperative awareness during anaesthesia and surgery can either be determined by formally interviewing patients post-operatively or by patients reporting themselves during review. Intraoperative awareness may occur during general anaesthesia, on the operating table when the patient has not been given enough of the general anaesthetic or analgesic to render the patient unconscious during general anaesthesia. Objective: This study investigates the prevalence, causes, and risk factors of intraoperative awareness under general anaesthesia in five district hospitals in Ghana’s Volta Region. Method: Using a quantitative case study design, data were collected from 480 patients and 17 anaesthetists through close-ended questionnaires. Results: Findings reveal that while anaesthetists demonstrated strong knowledge of awareness and adherence to safety protocols (17, 100%), challenges such as inadequate monitoring devices (10, 57.1%) and limited workforce participation in call duty (17, 100%) hinder optimal practice. Key risk factors identified included light anaesthesia (15, 90.5%), with extremes of age, obesity, and genetic resistance recording 12 responses (71.4%), with light anaesthesia being the most recognized. Patient responses highlighted a general expectation of complete unconsciousness (yes=353, 73.5%), low incidences of awareness (yes=109, 22.7%), and mixed experiences with dreaming (yes=219, 45.6%), reflecting varying perceptions of anaesthetic care. Conclusion: The study underscores the need for targeted policy reforms and emphasizes standardized safety protocols, improved patient communication, and continuous professional development. Also, exploring future research could broaden geographic scopes, longitudinal outcomes, and the implementation of advanced monitoring technologies. It recommends that prioritizing increased funding for anaesthesia services in resource-limited settings could enhance monitoring capabilities, ensure proper equipment maintenance, and address workforce shortages, improving overall patient safety.
Abstract: Background: Intraoperative awareness during anaesthesia occurs when a patient can recall some or all the events during a surgical procedure. Unintended intraoperative awareness during anaesthesia and surgery can either be determined by formally interviewing patients post-operatively or by patients reporting themselves during review. Intraoperative ...
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Review Article
Observation on the Clinical Effect of Hyperbaric Oxygen Therapy on Postoperative Recovery of Patients with Kashin-Beck Disease in Plateau Areas After Total Knee Arthroplasty (TKA)
Zhifu Zhao*
,
Li Liu
Issue:
Volume 13, Issue 1, June 2025
Pages:
13-19
Received:
20 December 2024
Accepted:
2 January 2025
Published:
22 January 2025
Abstract: Background: When the altitude is 0 meters above sea level, the oxygen concentration in the air is approximately 21%. As the altitude increases, the oxygen concentration gradually decreases. At an altitude of 3,000 meters, the oxygen concentration in the air is about 15%. The low oxygen concentration seriously affects the recovery after knee joint surgery and is more likely to lead to postoperative complications. This study aims to explore the efficacy of hyperbaric oxygen therapy on the early postoperative recovery of patients with Kashin-Beck disease in high-altitude areas after undergoing total knee arthroplasty (TKA). Methods: The clinical data of 58 patients with Kashin-Beck Disease who were hospitalized and underwent TKA in Ruoergai County People's Hospital at an average altitude of 3,500 meters were retrospectively analyzed. According to whether hyperbaric oxygen therapy was used after surgery, they were divided into two groups: the hyperbaric oxygen group (HO group, hyperbaric oxygen therapy was administered daily from the 1st to the 7th day after surgery) and the conventional group (GO group, only normal pressure oxygen inhalation was carried out without hyperbaric oxygen therapy after surgery). Finally, a total of 56 patients were included in the study, with 22 patients in the HO group and 34 patients in the GO group, and the evaluation was carried out based on the recovery status of all selected patients at the time of discharge after surgery. Results: There was no significant difference in the general clinical data between the two groups; the overall incidence of adverse reactions after surgery in the HO group was significantly lower than that in the GO group (P<0.01); the postoperative quality of recovery score (QoR-40) of the HO group was significantly higher than that of the GO group on the 3rd, 7th, and 14th days after surgery (P<0.01); although there was no significant difference in the pain (NRS) score, knee joint score, and surgical satisfaction between the two groups at 2 hours, 12 hours, 24 hours, 48 hours, and 72 hours after surgery, the length of hospital stay in the HO group was significantly shorter than that in the GO group, and this difference was statistically significant (P<0.05). Conclusion: Hyperbaric oxygen therapy for patients with Kashin-Beck Disease in plateau areas after TKA is beneficial to the early postoperative recovery process, can reduce the incidence of postoperative complications, and shorten the length of hospital stay, which has significant clinical application value.
Abstract: Background: When the altitude is 0 meters above sea level, the oxygen concentration in the air is approximately 21%. As the altitude increases, the oxygen concentration gradually decreases. At an altitude of 3,000 meters, the oxygen concentration in the air is about 15%. The low oxygen concentration seriously affects the recovery after knee joint s...
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Research Article
Effect of White Noise Combined with Chloral Hydrate Sedation on Improving the Success Rate of MRI Examination in Neonatal
Issue:
Volume 13, Issue 1, June 2025
Pages:
20-23
Received:
5 February 2025
Accepted:
18 February 2025
Published:
27 February 2025
Abstract: Objective: Observe the sedative effect of white noise combined with hydrolytic aldarin in the newborn MRI examination. Methods: Selected 70 newborns of MRI inspections received by Zhuhai City People's Hospital from November 2021 to November 2023, using random digital tables to divide them into the observation group and control group, each group of 35 cases. The control group used 10% chloral hydrate solution to perform retention enema 30 minutes before MRI examination according to the dosing standard of 0.5 ml/kg. The observation group used laxative drugs for retention enema 15 minutes before chloral hydrate administration, and white noise intervention was given for sleep deprivation on the basis of the control group. Compare the two sets of MRI to check successful power, as well as Brussels sedation score and vital signs at different time points before and after intervention. Observe the occurrence of adverse reactions in the two groups. Results: Brussels sedation score in both groups showed a downward trend with the progress of time, and the change range in the observation group was greater (P<0.05). The blood oxygen saturation in both groups showed an upward trend with the progress of intervention time, while the systolic blood pressure, heart rate and respiratory rate showed a downward trend (P<0.05). The heart rate and respiratory rate in the observation group decreased significantly compared with those in the control group (P<0.05). There were no adverse reactions such as bradycardia, hypotension and decreased oxygen saturation in both groups. Conclusion: White noise combined with chloral hydrate has obvious sedative and analgesic effects in neonatal MRI examination, which is safe and worth popularizing.
Abstract: Objective: Observe the sedative effect of white noise combined with hydrolytic aldarin in the newborn MRI examination. Methods: Selected 70 newborns of MRI inspections received by Zhuhai City People's Hospital from November 2021 to November 2023, using random digital tables to divide them into the observation group and control group, each group of ...
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Review Article
Vasopressors Aggravate Passive Pulmonary Hypertension Due to Left Heart Disease, from Basic Pathophysiology to Clinical Management
Xiao Xiao,
Yan Xu,
Chunling Jiang*
Issue:
Volume 13, Issue 1, June 2025
Pages:
24-29
Received:
2 March 2025
Accepted:
14 March 2025
Published:
28 March 2025
DOI:
10.11648/j.ijacm.20251301.14
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Abstract: Pulmonary hypertension due to left heart disease (PH-LHD) is the most common form of pulmonary hypertension (PH), accounting for 65–80% of cases, and is associated with significant morbidity and mortality. PH-LHD is traditionally considered a passive condition, primarily driven by elevated left heart pressure, which increases pulmonary venous pressure. However, vasopressors, such as phenylephrine, frequently used in critical care to enhance vascular tone, can induce another form of passive PH. This vasopressor-induced PH shares hemodynamic similarities with PH-LHD, characterized by increased pulmonary blood volume and left atrial pressure, and exerts additive effects on pre-existing PH-LHD, exacerbating pulmonary congestion and worsening clinical outcomes. The interaction between vasopressors and PH-LHD is often overlooked, yet it poses significant risks, particularly in patients with heart failure. This review explores the pathophysiology of passive PH-LHD, the mechanisms of vasopressor-induced PH, and their additive effects. We also highlight the challenges in diagnosing passive PH, which is frequently misclassified as pulmonary arterial hypertension (PAH), leading to inappropriate treatment and potential harm. Current therapeutic strategies, such as diuretics and blood volume management, are discussed as potential approaches to mitigate these effects. Improved understanding of these mechanisms is crucial for optimizing treatment and reducing morbidity and mortality. Future research is needed to develop targeted therapies and improve outcomes for patients with PH-LHD and vasopressor-induced PH.
Abstract: Pulmonary hypertension due to left heart disease (PH-LHD) is the most common form of pulmonary hypertension (PH), accounting for 65–80% of cases, and is associated with significant morbidity and mortality. PH-LHD is traditionally considered a passive condition, primarily driven by elevated left heart pressure, which increases pulmonary venous press...
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Research Article
Efficacy and Safety of Different Esketamine Doses Combined with Propofol in Gastrointestinal Endoscopy
Issue:
Volume 13, Issue 1, June 2025
Pages:
30-36
Received:
23 March 2025
Accepted:
31 March 2025
Published:
22 April 2025
Abstract: This prospective randomized double-blind trial compared the efficacy and safety of 0.3 mg/kg versus 0.5 mg/kg esketamine combined with propofol in 120 young and middle-aged patients (ASA I–II, 20–45 years) undergoing combined gastroscopy and colonoscopy. Participants were randomized to 0.3 mg/kg (Esk0.3, n = 60) or 0.5 mg/kg esketamine (Esk0.5, n = 60). The Esk0.5 group required significantly less propofol (126.1 ± 38.5 mg vs. 154.5 ± 25.8 mg, P < 0.001) and shorter induction time (51.5 ± 8.3 s vs. 58.6 ± 9.1 s, P < 0.001) compared to Esk0.3. However, postoperative recovery time (17.6 ± 4.8 min vs. 13.2 ± 5.8 min, P < 0.001) and operating room exit time (28.7 ± 7.6 min vs. 21.5 ± 4.1 min, P < 0.001) were prolonged in the Esk0.5 group. No differences were observed in procedure duration or patient satisfaction. The Esk0.5 group exhibited higher heart rates at gastroscope withdrawal (83.55 ± 5.34 vs. 80.46 ± 7.45 bpm, P = 0.01), alongside increased adverse events including secretions (13.3% vs. 3.3%, P = 0.037) and diplopia (13.3% vs. 3.3%, P = 0.037). Both groups showed high rates of involuntary twitching (28.3% vs. 35.0%). Esketamine 0.5 mg/kg reduces propofol requirements and accelerates induction but prolongs recovery and increases specific adverse events, necessitating individualized dosing and postoperative monitoring to optimize safety.
Abstract: This prospective randomized double-blind trial compared the efficacy and safety of 0.3 mg/kg versus 0.5 mg/kg esketamine combined with propofol in 120 young and middle-aged patients (ASA I–II, 20–45 years) undergoing combined gastroscopy and colonoscopy. Participants were randomized to 0.3 mg/kg (Esk0.3, n = 60) or 0.5 mg/kg esketamine (Esk0.5, n =...
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Research Article
Effect of Esketamine Combined with Sufentanil-Based Patient-Controlled Intravenous Analgesia on Postoperative Pain in Elderly Total Hip Arthroplasty Patients: A Three-Arm Randomized Trial
Issue:
Volume 13, Issue 1, June 2025
Pages:
37-45
Received:
3 April 2025
Accepted:
14 April 2025
Published:
9 May 2025
Abstract: Background: Total hip arthroplasty (THA) is a common procedure for end-stage hip disorders, yet postoperative pain management remains challenging due to opioid-related complications, particularly in elderly patients vulnerable to respiratory depression and delirium. Multimodal analgesia strategies are increasingly prioritized to mitigate these risks. Esketamine, an NMDA receptor antagonist with opioid-sparing and anti-neuroinflammatory properties, shows promise in enhancing analgesia while reducing adverse effects. Preliminary studies suggest its efficacy in lowering postoperative pain and delirium risk, though optimal dosing in elderly THA populations remains unclear. This study aimed to evaluate the analgesic efficacy and safety of different dosages of esketamine combined with sufen-tanil for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing total hip arthroplasty. Methods: In this randomized, prospective, double-blind trial, 120 elderly patients were randomly divided into three groups: the control group (Group S, n = 40) received sufentanil 2 μg/kg; the experimental group SE1 (n = 40) received sufentanil 1.5 μg/kg combined with esketamine 1 mg/kg; and the experimental group SE2 (n = 40) received sufentanil 1 μg/kg combined with esketamine 2 mg/kg. Primary outcomes included resting and movement-associated Visual Analogue Scale (VAS) scores at 4, 8, 12, 24, and 48 h postoperatively. Secondary outcomes encompassed Ramsay Sedation Scale (RSS) scores, Quality of Recovery-15 (QoR-15) scores at 48 h, time to first walk, the number of patients requiring remedial analgesia, and adverse events (nausea/vomiting, hallucinations, pruritus, delirium, dizziness). Results: The SE1 and SE2 groups demonstrated significantly superior analgesic efficacy compared to the S group across all outcomes. Resting and movement-associated VAS scores were significantly lower in both esketamine-combined groups at all postoperative time points (4, 8, 12, 24, and 48 h; P < 0.05). Sedation levels (Ramsay scores) were dose-dependently enhanced with esketamine. Group SE2 exhibited higher sedation scores than Group S at 24 h (P < 0.01) and 48 h (P < 0.05). The QoR-15 scores at 48 h were significantly higher in Groups SE1 and SE2 compared to Group S (P < 0.001). Time to first walk was shorter in Groups SE1 and SE2 than in Group S (P < 0.001). No significant differences were observed in the requirement for rescue analgesia between groups. Adverse events showed a significant reduction in postoperative delirium (POD) incidence (P < 0.01) and nausea/vomiting (P < 0.05) in Groups SE1 and SE2 compared to Group S, with no significant differences in dizziness, hallucinations, or pruritus. Conclusion: This randomized controlled trial demonstrated that esketamine combined with reduced-dose sufentanil significantly improved postoperative analgesia and recovery outcomes in elderly patients undergoing THA.
Abstract: Background: Total hip arthroplasty (THA) is a common procedure for end-stage hip disorders, yet postoperative pain management remains challenging due to opioid-related complications, particularly in elderly patients vulnerable to respiratory depression and delirium. Multimodal analgesia strategies are increasingly prioritized to mitigate these risk...
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Case Report
Anesthetic Management of Extreme Obesity: A Case Study
Issue:
Volume 13, Issue 1, June 2025
Pages:
46-57
Received:
26 March 2025
Accepted:
16 April 2025
Published:
22 May 2025
Abstract: Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the anesthetic management of a 30-year-old male with a BMI of 101.1, weighing 707 lb (320.7 kg), measuring 5'9" (1.75 m) and ASD undergoing dental surgery. Preoperative challenges included obesity-related airway risks and communication barriers due to ASD. Despite preoperative preparation, the patient was uncooperative, requiring anesthesia induction on a transport cart. General anesthesia was administered using a rapid-sequence intubation technique with succinylcholine, and airway management was facilitated with ramp positioning. Intraoperative care included sevoflurane, along with adjunctive infusions of propofol, dexmedetomidine, and boluses of fentanyl. Postoperative recovery was uneventful, with stable vitals and effective pain management. Patients with both obesity and ASD present unique anesthetic challenges, including increased airway management risks and behavioral sensitivities. Effective strategies include individualized preoperative preparation, the use of anxiolytics like midazolam, and vigilant intraoperative monitoring. Postoperative care requires careful pain assessment, as individuals with ASD may express discomfort atypically. This case highlights the importance of interdisciplinary collaboration and adherence to obesity-specific perioperative guidelines to optimize outcomes. Further research is needed to establish tailored guidelines for managing individuals with extreme obesity and ASD undergoing surgical procedures.
Abstract: Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the...
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