Optimal Anesthesia by RENNY

Stress is commonly viewed negatively, associated with chronic pressures such as work or health crises. However, not all stress is harmful. Eustress, or “good stress,” promotes recovery by enhancing cellular resilience, while distress, or “bad stress,” predisposes to inflammation and organ dysfunction. The concept of hormesis — where low-dose stressors trigger adaptive benefits — offers a useful fr...

Case Context A 65-year-old patient’s front tooth was accidentally knocked out during intubation. The risk of dental injury was not discussed during the preoperative consent process. As the anesthesiologist, there is an ethical obligation to address the incident promptly and professionally. Immediate Management The dislodged tooth should be carefully retrieved and stored in normal saline or milk to...

Clinical Snapshot A 62-year-old male, on postoperative day one following an open hemicolectomy, presents with Child-Pugh B cirrhosis, severe anemia (hemoglobin 6.5 g/dL), hypoalbuminemia (albumin 2.8 g/dL), ascites, and hepatic encephalopathy. A nasogastric (Ryle’s) tube is in place. He is receiving CPAP with pressure support of 10 cmH₂O, PEEP of 7 cmH₂O, and FiO₂ of 40%. While the monitor display...

Chronological vs Physiological Age in Anesthesiology In anesthesiology, distinguishing between chronological and physiological age is essential for providing personalized care. Chronological age refers simply to the number of years a person has lived since birth. Physiological age, on the other hand, reflects the body’s overall health at molecular, cellular, and systemic levels, and it indicates h...

Gender Variations in Anesthesia Gender variations in anesthesia reflect a complex interplay between physiology, hormonal profiles, anatomy, and pharmacodynamics. These differences significantly influence how patients respond to anesthetic agents, how pain is perceived, and how cardiovascular and respiratory systems behave during surgery. A growing body of evidence highlights the importance of sex-...

Introduction The menstrual cycle exerts a profound influence on women’s physiological and psychological states through its hormonal fluctuations. The cycle, divided into menstrual, follicular, ovulatory, and luteal phases, affects pain perception, analgesic response, emotional well-being, and the pharmacodynamics of anesthetic drugs. For anesthesiologists, an awareness of cycle-dependent changes i...

Case Summary A 59-year-old male sustained a nasal bone fracture when an axe accidentally struck the nasal bridge. He was scheduled to undergo nasal bone reduction and fixation under general anesthesia. The anesthetic plan was designed with a multimodal approach, integrating agents with well-defined molecular pharmacology and ensuring meticulous airway protection. Yilmaz and colleagues emphasize th...

Case Summary A 45-year-old female with a history of autosomal dominant polycystic kidney disease, status post bilateral nephrectomy, presented with an obstructed left lumbar incisional hernia and required emergency laparoscopic repair. She was dialysis-dependent with end-stage renal disease (ESRD), receiving thrice-weekly hemodialysis and had undergone emergency dialysis earlier on the day of surg...

Case Summary A 29-year-old male presented with a right foot degloving injury, right subclavian artery thrombosis, brachial plexus avulsion, and a right hip fracture. He underwent orthopedic fixation, subclavian artery thrombectomy, and brachial plexus exploration. Perioperative lactate monitoring revealed a preoperative lactate of 1.4 mmol/L, which rose to 3.5 mmol/L after revascularization. On po...

Case Summary A 77-year-old male with a history of coronary artery disease (CAD) presented for transurethral resection of the prostate (TURP) for a markedly enlarged prostate gland measuring 128 cc. The surgical duration was 45 minutes. Pre-induction serum sodium was 142 mmol/L. Rationale for General Anesthesia General anesthesia was chosen to maintain hemodynamic stability in a patient with CAD, a...

Case Summary A 42-year-old right-handed male sustained a crush injury to his right hand when bricks fell, resulting in a near-total amputation of the right middle finger with vascular compromise. The time from injury to surgical assessment was less than three hours. Emergency debridement and revascularization were planned. Because of the urgency of intervention, general anesthesia (GA) was chosen...

Case Summary Patient:  49-year-old male History: The patient underwent a renal transplant in 2011 for IgA nephropathy. Since 2018, he has had graft failure and is maintained on thrice-weekly dialysis via a left internal jugular catheter. He has an ejection fraction of 35% with global hypokinesia and grade II diastolic dysfunction. He also has severe secondary hyperparathyroidism with a parathyroid...

Patient Overview A 69-year-old female, height 149 cm and weight 54 kg (BMI ≈ 24.3 kg/m²), with a prior right total knee replacement, presented for a left total knee replacement. Comorbidities included hypertension treated with Telvas-AM (telmisartan + amlodipine) and type 2 diabetes mellitus treated with sitagliptin + metformin and gliclazide. Preoperative echocardiography showed normal left ventr...

Case Report Age:  13 years Sex:  Female Diagnosis:  Severe thoracic scoliosis (Cobb angle 80°) and severe lumbar scoliosis (Cobb angle 90°) Procedure:  Posterior spinal fusion Baseline Findings The patient had a respiratory rate of 18 per minute, oxygen saturation of 99 percent on room air, and an end-tidal carbon dioxide of 32 mmHg. She demonstrated good activity tolerance and was able to perform...

Anesthesia for LD Flap Excision and PMMC Reconstruction A 49-year-old female with left breast carcinoma, previously treated with chemotherapy and palliative radiotherapy, presented with lung and skeletal metastases. She had undergone a left modified radical mastectomy with latissimus dorsi (LD) flap closure and skin grafting. Due to flap necrosis, she was now scheduled for flap excision and pector...

CASE TITLE Age/Sex:  49-year-old male Weight:  90 kg Injury:  Right upper limb degloving crush injury, more than 7 hours old History:  No comorbidities, no medications, no prior surgeries Airway Assessment:  Thick, short neck, Mallampati grade III Vitals on OR Arrival:  HR 81/min, BP 91/56 mmHg, SpO₂ 95%. No laboratory values available at presentation. Planned Surgery:  External fixation and debri...

Intraoperative Hypertension Following Tourniquet Inflation in a Rheumatoid Arthritis Patient Clinical Context A 62-year-old female with rheumatoid arthritis (RA), weighing 65 kg and off disease-modifying medications for one year, underwent the following procedures for avascular necrosis of the talus with ankle subluxation, subtalar involvement, and cavus deformity: Tibiotalocalcaneal nailing Tibia...

Introduction Imagine a patient waking up from a lengthy spine surgery, only to reveal an unexpected complication: one side of their face swollen, the underlying muscle silently damaged. This was the reality for a 50-year-old obese male (BMI 35) who underwent an 8-hour neurofibroma resection in the prone position. Diagnosed with masseter muscle necrosis, this case underscores a rare but serious ris...

Radial Head Replacement – Anesthetic Considerations Patient Background Age/Sex:  42-year-old female History:  Sustained trauma from a road traffic accident Comorbidities:  None reported Condition:  Complex radial head fracture requiring excision or fixation Preoperative Anesthesia Evaluation History Mechanism of injury: Time and type of accident Presence of associated injuries such as head trauma,...

CASE SUMMARY A 37-year-old female presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea. Diagnostic imaging with CT cisternography revealed a 7 × 2.5 mm bony defect in the cribriform plate, consistent with an anterior skull base leak. There was no history of recent trauma, although the patient reported a road traffic accident 17 years prior. On preoperative assessment, dark red nail poli...

Clinical Scenario A 6-year-old male with recent-onset squint (strabismus) was scheduled for an MRI brain with contrast under anesthesia. Although the procedure may appear routine, the sudden appearance of a squint raises concern for  raised intracranial pressure (ICP)  or an intracranial mass lesion. This makes the anesthetic plan especially important, as it must prioritize both neurological stabi...

1798–1800: Humphry Davy and Nitrous Oxide 1798:  Thomas Beddoes establishes the  Pneumatic Institution  in Bristol, England, to explore the use of various gases in treating pulmonary tuberculosis. A young chemist,  Humphry Davy  (aged 20), is appointed to superintend the laboratory. 1798–1800:  Davy engages in extensive self-experimentation with  nitrous oxide , observing its capacity to diminish...

Coronary Circulation: Clinical and Anesthetic Relevance The heart can be imagined as a city where coronary arteries serve as highways delivering essential supplies—oxygen and nutrients—to every neighborhood, representing myocardial regions. Three main routes sustain this city: The  Right Coronary Artery (RCA) The  Left Main Coronary Artery (LMCA) , which branches into: the  Left Anterior Descendin...

The History of Anesthesia Through the Lens of Physics Introduction The history of anesthesia is fundamentally the history of physics applied to patient care. Each century brought discoveries that shaped how we deliver gases, ventilate lungs, and monitor the brain. From Robert Boyle watching air bubbles shrink in a glass tube, to modern monitors translating EEG signals into numbers, physics has gui...

Rezūm is a short, minimally invasive procedure for BPH that avoids major risks of TURP (fluid overload, TUR syndrome, bleeding). In elderly, anticoagulated patients with AF and comorbidities, neuraxial anesthesia may be contraindicated;  short general anesthesia with spontaneous ventilation  is a safe alternative. Careful titration of propofol and sevoflurane with adjuncts (fentanyl, dexmedetomidi...