Techniques of total intravenous anaesthesia with ketamine and continuous epidural block are compared with the conventional method of using halothane, nitrous oxide and relaxant. Both ketamine and epidural techniques were associated with minimal cardiovascular disturbances, low blood loss and better quality of anaesthesia and recovery scores. The usual psychomimetic effect associated with ketamine administration was observed in only one patient. Further experience of total intravenous ketamine anaesthesia with adjunctive use of fentanyl to attenuate cardiovascular effects and midazolam for the pyschomimetic effect can further refine the technique. Cerebral function monitoring, if possible, will allow correlation of depth of anaesthesia with drug dosage and can ensure appropriate anaesthetic depth and recovery.
Adult ; Anesthesia - standards ; Anesthesia, Intravenous ; Humans ; Ketamine - administration & ; dosage ; Papua New Guinea

The function theory of an anesthesia vaporizer was studied and the geometry configuration was measured in this study. The internal gas flow and mixing process in the anesthesia vaporizer were simulated using CFD method. Applying tracking in turbulent flow to stochastic particle, for the droplet of anesthesia drug, the moving track of droplet was traced. Based on the results, the internal gas flow variation, the concentration distribution of anesthesia drug volatilization process and mixing process with gas were ascertained. Numerical simulation results showed that, the diluted gas velocity reduction of internal flow in the anesthesia vaporizer was higher. Because of the anesthesia vaporizer geometry, the mixing process between anesthesia drug vapor and diluting gas was not homogeneous. This also influenced the stability and accuracy of anesthesia drug concentration. The optimization precept of anesthesia vaporizer is ascertained.
Anesthesia, Inhalation ; instrumentation ; Computer Simulation ; Humans ; Imaging, Three-Dimensional ; Nebulizers and Vaporizers ; standards ; Numerical Analysis, Computer-Assisted

In acupuncture practice of animals, preanesthetics sometimes are needed. The purpose of this study was to select the ideal chemical restraint at acupuncture for gastric motility. Nine healthy mixed breed dogs weighed 10-21 kg and aged 1-3 years old were used in this study. Two EMG surface electrodes were placed between the seromuscular and the mucosal layer of pylorus. Twenty minutes after feeding normal gastric motility was recorded for 60 minutes using physiograph (Narco-Biosystem). Then preanesthetic treated-gastric motility was observed for 30 minutes. Preanesthetics used were xylazine, diazepam, and acepromazine. Acupuncture needles were inserted to BL-21 (Wei-Yu) acupoint, and then changes of gastric motility were recorded for 60 minutes. The gastric motility following xylazine administration (1 mg/kg, IV) was markedly decreased. BL-21 (Wei-Yu) acupoints stimulation did not alter xylazine-induced depression of gastric motility. The diazepam (1 mg/kg IV) treated-gastric motility was increased mildly 20 minutes after drug administration. BL-21 (Wei-Yu) acupoint stimulation after diazepam administration enhanced gastric motility significantly. The gastric motility following acepromazine (0.3 mg/kg, IM) administration was not changed compared with normal gastric motility. Application of traditional acupuncture at BL-21 (Wei-Yu) significantly increased the gastric motility. Based on these results, acepromazine and diazepam could be acceptable chemical restraints for acupuncture therapy of gastric motility, but xylazine couldn't be.
Acepromazine ; Acupuncture/*standards ; *Acupuncture Points ; Adjuvants, Anesthesia ; Adrenergic alpha-Agonists ; Animals ; Antipsychotic Agents ; Atropine ; Diazepam ; Dogs/*physiology ; Dopamine Antagonists ; Electromyography/veterinary ; Gastrointestinal Motility/drug effects/*physiology ; Hypnotics and Sedatives ; Metoclopramide ; Parasympatholytics ; Preanesthetic Medication/standards/*veterinary ; Xylazine

Monitoring the depth of anesthesia (DOA) is essential for improving the quality of anesthesia and ensuring the patient's safety and rehabilitation. Monitoring DOA can increase the quality of anesthesia and the safety of operation, thus decreasing the complications caused by anesthesia. With the development of electronic and information technology, the researches for detecting DOA have made great progress. In this paper, the techniques for monitoring DOA are reviewed.
Anesthesia, General ; standards ; Electroencephalography ; Evoked Potentials, Auditory, Brain Stem ; Heart Rate ; Humans ; Monitoring, Intraoperative ; methods ; trends ; Monitoring, Physiologic ; methods ; trends ; Signal Processing, Computer-Assisted

OBJECTIVE: To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. METHODS: This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. RESULTS: Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm ²) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm ²). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. CONCLUSION Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.
Female ; Humans ; Male ; Anesthesia ; Anesthesiologists/statistics & numerical data* ; Disinfection/standards* ; Hand Hygiene/statistics & numerical data* ; Staphylococcal Infections ; Operating Rooms/statistics & numerical data* ; Staphylococcus aureus/isolation & purification*

INTRODUCTIONTo avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients' knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting.

METHODSPatients scheduled for 'day surgery' or 'same day admission surgery' under general or regional anaesthesia were surveyed over a four-week period. The patients were asked to answer an eighteen-point questionnaire on demographics, preoperative fasting and attitudes toward fasting.

RESULTSA total of 130 patients were surveyed. 128 patients fasted before surgery, 111 patients knew that they needed to fast for at least six hours before surgery, and 121 patients believed that preoperative fasting was important, with 103 believing that preoperative fasting was necessary to avoid perioperative complications. However, patient understanding was poor, with only 44.6% of patients knowing the reason for fasting, and 10.8% of patients thinking that preoperative fasting did not include abstinence from beverages and sweets. When patients who did and did not know the reason for fasting were compared, we did not find any significant differences in age, gender or educational status.

CONCLUSIONDespite the patients' poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anesthesia ; adverse effects ; Anesthesia, General ; adverse effects ; Anesthesiology ; standards ; Child ; Child, Preschool ; Fasting ; Female ; Humans ; Infant ; Male ; Middle Aged ; Patient Compliance ; Patient Education as Topic ; Pneumonia, Aspiration ; prevention & control ; Preoperative Care ; standards ; Singapore ; Surveys and Questionnaires ; Tertiary Care Centers ; Young Adult

Enhanced recovery after surgery (ERAS) has been rapidly developing by combining several techniques with evidence-based adjustments, including preoperative education, preoperative carbohydrate loading, epidural or regional anesthesia, early initiation of enteral nutrition, ambulation and multi-modal pain management. The core part of ERAS is to reduce and reverse surgical stress and therefore greatly improve clinical outcome. Under the guidance of ERAS, perioperative management of robotic gastric cancer operation should follow the basic principles of ERAS and clinical pathway to maximize the advantages of the robotic surgery. ERAS protocol is safe and feasible for patients undergoing robotic radical gastrectomy and it can reduce surgical stress, shorten hospital stay, improve quality of life and does not increase complications, whose mechanism may be associated with the reduction of inflammation and insulin resistance, the decrease of resting energy exposure, and the protection of mitochondria function. It is worth emphasizing that it is very important to fully understand the changes of pathophysiology during perioperative period, to strictly implement the ERAS pathway based on optimized evidence-based medicine, to cooperate closely with the multidisciplinary team, to observe and manage the postoperative complications dynamically by systemic classification. The improvement of ERAS program on the outcome of patients should be summarized regularly and the new interventional strategies should be evaluated further according to the international standard.
Anesthesia, Epidural ; Anesthesia, Local ; Convalescence ; Critical Pathways ; Enteral Nutrition ; Gastrectomy ; instrumentation ; methods ; rehabilitation ; Humans ; Length of Stay ; Pain Management ; Patient Education as Topic ; Postoperative Care ; methods ; standards ; Postoperative Complications ; prevention & control ; Preoperative Care ; Quality of Life ; Recovery of Function ; Robotic Surgical Procedures ; rehabilitation ; Stomach Neoplasms ; surgery