Administration Of Anesthetic Agents Research Articles

Therapeutic Aspects of Lipofilling, Abdominoplasty in Combination with Body Liposuction and Bariatric Surgery

This review article is dedicated to the therapeutic aspects of various plastic surgery procedures. Nowadays, improving appearance and quality of life through plastic surgery is becoming increasingly popular. Managing patients after lipofilling and abdominoplasty combined with liposuction is an interdisciplinary challenge. Intraoperative risks in plastic surgery are associated with anesthesia and comorbidities. The immediate response of the cardiovascular and respiratory systems to the administration of anesthetic agents and the anesthesiologist's qualifications determines the immediate success of the operations. The duration of the surgery, volumetric disturbances, reduction of body surface area, and changes in metabolic and immunological status after mechanical impact on adipose tissue significantly alter the rate of compensatory-adaptive reactions of the body. In the long-term period after lipofilling, abdominoplasty, liposuction, and augmentation mammoplasty, systemic complications are often observed. These include insomnia, chronic kidney disease, protein-energy malnutrition, arthropathies, nonspecific interstitial lung lesions, unverified hepatitis, lupus-like syndrome, antibodies to transplanted fats and silicone materials, idiopathic limb edema, as well as autoinflammatory syndromes. The presented work also provides data on propofol infusion syndrome and the clinical-prognostic significance of vascular endothelial growth factor in plastic surgery. The authors’ team also presents their own clinical data on obesity and associated diseases. To maintain the aesthetic effect and prevent long-term complications after lipofilling, liposuction, augmentation mammoplasty, blepharoplasty, and rhinoplasty, it is recommended to follow a hypoallergenic and low-calorie diet for the next 3-6 months, avoid night work, excessive physical exertion, simultaneous intake of antibiotics and anti-inflammatory drugs, sun exposure, trips to mountainous areas, and long flights.

Comparison of effect of inhaled anaesthetic (Sevoflurane) versus intravenous (Propofol) anaesthetic on core and peripheral body temperature during general anaesthesia: A randomised control study

: The fall in core body temperature and peripheral body temperature following the administration of anaesthetic agent has been studied and demonstrated so far, along with the comparison of the same parameters following induction with propofol in contrast to that with sevoflurane. But no study so far, has compared the effects of TCI-propofol based anaesthesia with that of sevoflurane based anaesthesia for induction and maintenance, on core and peripheral body temperature and the gradient of temperature between the agents. The studies conducted so far, has shown more fall in core and peripheral body temperature from their respective baseline values when propofol was used for induction of anaesthesia in comparison to the use of sevoflurane. A total of 60 adults were randomized into two groups of 30 each; Group 1 were induced with TCI- propofol at 8mcg/ml plasma concentration and maintaind with TCI-propofol at 2-3mcg/ml plasma concentration and 66% nitrous oxide and 33% oxygen gas mixture. Group 2 were induced with intravenous thiopentone at 3-5mg/kg body weight and maintained with 1-1.5MAC sevoflurane, 66% nitrous oxide and 33% oxygen gas mixture. Core body temperature was measured inserting the temperature probe into nasophraynx and peripheral temperature was measured with the temperature probe inserted onto thenar eminence of either hand. We observed that both anaesthetic agents have caused similar fall in core temperature. However, peripheral temperature fell more with sevoflurane compared to TCI-propofol. In parallel with these observations, the increase in temperature gradient was higher in magnitude for sevoflurane based anaesthesia. The core temperature was comparable between the groups from their respective baseline values. But, the fall in peripheral temperature was more in sevoflurane group, so was the temperature gradient. Thus, TCI-propofol when used in appropriate plasma concentration for induction and maintenance of anaesthesia causes less hypothermia in contrast to sevoflurane.

Sequence of administration of anesthetic agents during rapid sequence induction for emergency intubation: a French survey on current practices.

Sequence of administration of anesthetic agents during rapid sequence induction for emergency intubation: a French survey on current practices.

Comparative Study of Effect of Dexmedetomidine and Fentanyl as Epidural Adjuvants in Abdominal Hysterectomies Using Combined Spinal Epidural Technique - A Randomised Prospective Study

Background: Regional anesthesia is defined as loss of sensation in a body produced by administration of anaesthetic agent to the nerves supplying that region. Regional anesthesia whether by spinal, epidural, peripheral nerve blocks offer a number of advantages. Bupivacaine has become standard agent for intrathecal anesthesia. A number of adjuvants can be added to prolong the duration of analgesia. In our study we are comparing fentanyl & dexamedetomidine as an epidural adjuvant to spinal bupivacaine in abdominal hysterectomies. Materials and Methods: A total of 60 patients scheduled for abdominal hysterectomy under CSE were enrolled for this prospective randomized study which was conducted in hospital from November 2019 to October 2020. This work has been granted ethical committee approval. Results: Two groups comprising of 30 patients each were taken randomly. Haemodynamic parameters of heart rate, blood pressure, spo2, were monitored and recorded every 5 min for first 20 minutes and then every 10 minutes till the end of surgery and thereafter postoperatively. The sensory block was assessed by bilateral pin prick method and motor blockade according to Modified Bromage Scale. Duration of anesthesia was taken as time period till VAS of 4 was recorded. Conclusion: In our study we concluded that dexmedetomidine is better adjuvant as compared to fentanyl in combined spinal epidural anaesthesia with intrathecal bupivacaine.

Status Epilepticus in Meningoencephalitis Patients with Hyponatremia Associated with Use of Hypotonic Maintenance Solutions in Children: Is It the Time Switching to Isotonic Maintenance Solutions?

Hyponatremia is one of the complication of inpatient care which is quite common in the pediatric population. This condition often occurs due to the administration of intravenous fluids that are hypotonic and is exacerbated by the condition of SIADH (Syndrome of Inappropriate Anti Diuretic Hormone) which occurs in patients with pain, anxiety, stress, administration of anesthetic agents, narcotics, operative procedures and administration of positive pressure ventilation and infections, especially pneumonia and meningitis. In addition, this condition is also exacerbated by the addition of glucose into the administration of pediatric maintenance fluids. when glucose is metabolized it will leave free water which will affect plasma osmolality. In 2018, the AAP released strong recommendations in administering isotonic fluids as maintenance fluids in pediatric patients in addition to the addition of glucose and potassium. but in clinical practice in hospitals, the use of hypotonic fluids that have been used for a long time is still difficult to abandon because practitioners feel they have not found enough cases of complications. This case report describes a meningoencephalitis patient with status epilepticus who experienced hyponatremia after being given hypotonic fluids according to local guidelines and improved after sodium correction

Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section

BackgroundNeonatal health at delivery as measured by apgar scores is an important outcome. This study was done to assess the impact of anesthesia on Apgar 1-minute and 5-minute scores of infants delivered through elective cesarean section in Zimbabwe.MethodsWe carried out a secondary analysis of data from the Efficacy of Tranexamic Acid in Preventing Postpartum Hemorrhage (ETAPPH) clinical trial in Zimbabwe. Outcomes measured were infant Apgar scores at 1 and 5 min, exposure was the administration of either a general (intravenous propofol/ketamine/sodium thiopental) or spinal (hyperbaric bupivacaine 0.5%) anesthesia for anesthesia during the elective cesarean section procedure. Marginal Structural Logistic Modelling (MSM) using an unstabilized Inverse Probability Treatment Weight (IPTW) estimator was used to assess the relationship between anesthetic administration method and infant Apgar scores.ResultsFour hundred and twenty-one (421) women who had an elective caesarean section in the ETAPPH study had their infants assessed for Apgar scores. Comparing general anesthesia to spinal anesthesia, spinal anesthesia was related to good Apgar scores at 1-minute (adjusted odds ratio [aOR] = 4.0, 95% Confidence Interval = 1.5–10.7, sensitivity analysis E-value = 3.41). Spinal anesthetic administration was also related to good Apgar scores at 5 min (adjusted odds ratio [aOR] = 6.2, 95% Confidence Interval = 1.6–23.1, sensitivity analysis E-value = 4.42).ConclusionsWhen providing anesthesia for patients undergoing elective cesarean section, care should be taken on the method of administration of anesthetic agents. General anesthesia tends to depress Apgar scores at 1 min, although most neonates recover and have better scores at 5 min. Spinal anesthesia should be the first choice whenever possible.Trial registrationThe clinical trial from which data of this study was abstracted was registered under clinical trials registration number NCT04733157.

Voglibose and saxagliptin ameliorate the post-surgical stress and cognitive dysfunction in chronic anaesthesia exposed diabetic MCAo induced ischemic rats

Chronic surgical anaesthesia and uncontrolled hyperglycemia are bidirectional risk factors for the development of psychiatric, cerebrovascular, and cardiovascular diseases. The current study was designed to elucidate the neuroprotective effects of anti-diabetic agents in pre and post-surgical anaesthesia exposure on diabetic ischemic rats. The diabetes type-2 was induced and rats having more than 250gm/dl blood glucose levels were considered for study. Administration of anaesthetic agents (ketamine 100mg/kg IP, xylazine 10mg/kg IP) were done pre and post MCAo surgery for 7 days. The treatment with anti-diabetic agents (voglibose, saxagliptin, repaglinide, dapagliflozin) was carried out after 7 days of Post MCAo surgery for one week. After treatment, assessment of neurobehavioral function was carried out using Morris Water Maze. After that, brains were excised and bloods were collected from all groups subjected for assessment of neuromodulator levels, oxidative stress parameters, serum biochemical biomarkers. The treatment with voglibose and saxagliptin not only improved neuromodulator levels statistically significant (p<0.001) and cognitive profile but also significantly improved (p<0.01) overall stroke serum biomarkers (Serum Glucose, GGT, CRP, CK-MB, LDH). The results of the present study, suggested that chronic exposure of anaesthesia worsens the cognition and increases risk of stroke biomarkers in diabetic conditions. We can conclude that voglibose, saxagliptin, and dapagliflozin can significantly improve the postoperative mortality, morbidity, and cognitive dysfunction caused by post-surgical stress and chronic anaesthesia-induced cognitive dysfunction.

Comparison of the effects of caffeine, aminophylline, and saline on the recovery from total intravenous anesthesia in laparoscopic surgeries: A randomized controlled trial.

The return of consciousness (ROC) after general anesthesia (GA) is by stopping the administration of anesthetic agents. At present, no drug is given to reverse the loss of consciousness produced by general anesthetic agents. This study is conducted to find whether caffeine and aminophylline hasten the ROC. This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 and 60 years. The patients were divided into three equal groups (Group C: caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by a computer-generated random number table. GA was induced with propofol, fentanyl, and maintained with propofol infusion. On completion of the surgery, the neuromuscular blocking agent was reversed and then the infusion of propofol was stopped. The study drug was administered intravenously when the BIS 60 was achieved. Time to achieve BIS 90, return of first gag reflex, eye-opening on verbal command, and extubation after study drug administration were noted. Hemodynamic parameters and SpO2 were also monitored. The time for BIS 60 to 90 was 10 (4.25) min in the caffeine group, 13 (4.25) min in the aminophylline group, and 26 (9.0) min in the saline group. The time to return of gag reflex and time to extubation were shorter in the caffeine and aminophylline group compared to the saline group. The time to eye-opening on verbal command was shorter in the aminophylline group compared to the saline group. Hemodynamic parameters after infusion of the study drug were comparable in all three groups. Caffeine hastens the recovery from total intravenous anesthesia with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline.

Anesthetic Management in Parturients With Fontan Physiology

Anesthetic Management in Parturients With Fontan Physiology

1: Comparison of the effect of caffeine and aminophylline on recovery from total intravenous anaesthesia with propofol and fentanyl in laparoscopic hysterectomy: A randomised controlled trial

Background and Aims:During extubation, the loss of consciousness (LOC) after general anaesthesia (GA) is reversed by stopping the administration of anaesthetic agents. It is a passive process and it is affected by many factors like age, sex, weight, temperature, duration of surgery, and type of anaesthetic agent used. This study is conducted to find whether caffeine and aminophylline hasten the emergence and reversal of LOC caused by propofol.To evaluate recovery time [time to Bispectral(BIS) index 90] from total intravenous anaesthesia (TIVA) in patients receiving caffeine and aminophylline in comparison to saline/placebo.Methods:This study was conducted on 75 American Society of Anesthesiologists (ASA) I and II female patients undergoing laparoscopic hysterectomy, aged between 18 to 60 years. The patients were divided into three equal groups (Group C: Caffeine citrate, Group A: aminophylline, and Group S: saline) of 25 each by random number computer table. The allocation was concealed by the sealed envelope method which was opened after giving GA. GA was induced with propofol, fentanyl, and rocuronium followed by endotracheal intubation and was maintained with propofol infusion. On completion of surgery, infusion of propofol was stopped. The study drug was administered intravenously when a BIS of 60 was achieved. Time to achieve BIS 90, time to the return of regular breathing with adequate tidal volume, to the return of first gag reflex, time to eye-opening on verbal command, handgrip on verbal command, and time to extubation after study drug administration were noted.Haemodynamic and respiratory parameters were also monitored. The Modified Aldrete score was recorded in all patients.Results:The time for BIS 60 to 90 was 10.6±3.9 min in the caffeine group, 12.6± 2.9 min in the aminophylline group, and 24.8 ± 4.8 min in the saline group. Thus, time to recovery was decreased by 57% and 49% in caffeine and aminophylline groups respectively and is statistically significant. The time to return of adequate tidal volume was least in the aminophylline group while it was highest in the control group. The difference was statistically significant when the aminophylline group was compared to the control group while it was insignificant for others. Time to return of gag reflex and time to extubation were statistically significant between aminophylline and saline group, and between caffeine and saline group. Haemodynamic parameters after infusion of the study drug were comparable in all three groups. Modified Aldrete score was higher in both caffeine and aminophylline group than in the control group and the difference was statistically significantTimeGroup S Median (IQR) (min)Group C Median (IQR) (min)Group A Median (IQR) (min) P Return of adequate tidal volume5.0 (3.25)4.0 (2.10)3.8 (2.75)P=0.035Return of gag reflex6.0 (2.85)3.6 (2.6)4.0 (3.5)P=0.005Return of eye opening6 (2.85)5.0 (3.85)4.6 (3.88)P=0.044Return of hand grip6.0 (3.35)4.0 (3.25)5.0 (4.5)P=0.05Extubation time7.0 (2.75)5.5 (3.0)5.0 (3.8)P=0.006Conclusion:Caffeine hastens the recovery from TIVA with propofol and fentanyl in laparoscopic hysterectomy as effectively as aminophylline. The recovery is significantly earlier with either of the drugs compared to when none of the drugs is given

Deep learning-based segmentation of the thorax in mouse micro-CT scans

For image-guided small animal irradiations, the whole workflow of imaging, organ contouring, irradiation planning, and delivery is typically performed in a single session requiring continuous administration of anaesthetic agents. Automating contouring leads to a faster workflow, which limits exposure to anaesthesia and thereby, reducing its impact on experimental results and on animal wellbeing. Here, we trained the 2D and 3D U-Net architectures of no-new-Net (nnU-Net) for autocontouring of the thorax in mouse micro-CT images. We trained the models only on native CTs and evaluated their performance using an independent testing dataset (i.e., native CTs not included in the training and validation). Unlike previous studies, we also tested the model performance on an external dataset (i.e., contrast-enhanced CTs) to see how well they predict on CTs completely different from what they were trained on. We also assessed the interobserver variability using the generalized conformity index (hbox {CI}_{mathrm{gen}}) among three observers, providing a stronger human baseline for evaluating automated contours than previous studies. Lastly, we showed the benefit on the contouring time compared to manual contouring. The results show that 3D models of nnU-Net achieve superior segmentation accuracy and are more robust to unseen data than 2D models. For all target organs, the mean surface distance (MSD) and the Hausdorff distance (95p HD) of the best performing model for this task (nnU-Net 3d_fullres) are within 0.16 mm and 0.60 mm, respectively. These values are below the minimum required contouring accuracy of 1 mm for small animal irradiations, and improve significantly upon state-of-the-art 2D U-Net-based AIMOS method. Moreover, the conformity indices of the 3d_fullres model also compare favourably to the interobserver variability for all target organs, whereas the 2D models perform poorly in this regard. Importantly, the 3d_fullres model offers 98% reduction in contouring time.

Evaluation of Ketamine Hydrochloride in Combination with Midazolam, Dexmedetomidine and Butorphanol as Balanced Anaesthesia in Cats

Background: As cats undergo stress at the time of presentation before surgery and therefore sedation is required often. It is very difficult to choose a balanced anaesthetic protocol during the surgical intervention in the case of a cat. Therefore, the present study was undertaken to evaluate the effect of ketamine hydrochloride in combination with midazolam, dexmedetomidine and butorphanol as balanced anaesthesia on clinico-physiological, haematological, serum biochemical profile in the surgical management of cats undergoing neutering. Methods: The study was performed on 18 clinical cases of cats which were brought to the Teaching Veterinary Clinical Complex, College of Veterinary Sciences and Animal Husbandry (CVSc and AH), Central Agricultural University (CAU), Selesih, Aizawl, Mizoram for elective surgery such as neutering. Cats were randomly divided into 3 equal groups, i.e. Gr. A, Gr. B and Gr. C. Animals were premedicated with glycopyrrolate @ 0.01 mg/kg, i/m. After 10 minutes of premedication, in Gr. A ketamine hydrochloride @15 mg/kg and midazolam @ 0.5 mg/kg, in Gr. B ketamine hydrochloride @10 mg/ kg and dexmedetomidine@ 5 mcg /kg and in Gr. C ketamine hydrochloride @ 5 mg/kg, dexmedetomidine@ 5 mcg/kg and butorphanol @ 0.2 mg/kg was administered intramuscularly. Clinico-physiological and haemato-biochemical profiles were evaluated at 0 minute (baseline), then at 15, 30 and 60 minutes after administration of anaesthetic agents to evaluate their anaesthetic effect. Result: In the case of time for induction, the quality of induction, assessment of peri-operative analgesia, depth of anaesthesia and quality of recovery there was no significant difference among all three groups. In Gr. B, animals showed significantly higher duration of recumbency (DOE) and recovery. The assessment of peri-operative analgesic effect among the groups revealed that analgesia during the perioperative period appeared best in Gr. C protocol. In regards to depth of anaesthesia, ketamine hydrochloride in combination with dexmedetomidine and butorphanol group showed a better result. Rectal temperature decreased significantly (P greater than 0.05) up to 60th minutes in Gr. A, but it remained within the physiological range. Heart rate raised significantly (p less than 0.05) from the baseline (0 minutes) onwards and decreased significantly (p less than 0.05) till the end (60 minutes) of the study in Gr. C. The respiration rate was significantly (p less than 0.01) different in between time intervals for all three groups. No significant difference was observed on haemato-biochemical observation except glucose level which significantly increased after induction of anaesthesia. In conclusion, treatment with ketamine hydrochloride in combination with dexmedetomidine and butorphanol led to acceptable sedation and mild changes in clinico-physiological, haematological, serum biochemical profile in comparison to the other two groups.

An Evaluation of Timing of Discharge Instruction and the Impact on Patient Satisfaction

PurposeSurgical patients face unique challenges with discharge instructions and retention. The volume of information provided to patients, frequently combined with sedatives and opioids, leads to failure to retain this crucial information needed for home care. The purpose of this project was to implement a preoperative teaching intervention to provide written and verbal discharge instructions in the preoperative area before the administration of anesthetic agents to improve patient retention of information, and improve percentile ranking on the Outpatient Ambulatory Surgery- Consumer Assessment of Health Care Providers and Systems (OAS-CAHPS) survey. DesignCross-sectional descriptive MethodsAn additional educational intervention was implemented to provide discharge instructions in the preoperative area. Data was collected from the Press-Ganey database on patient responses to questions 13, 14, 15, 17, 19, and 21 and the global discharge domain scores of the OAS-CAHPS survey over a period of 12 weeks. This data was compared to the patient responses to the same questions over the same date range in the year time prior. FindingsStatistical analysis demonstrated significant change in the percentile rank scores for the intervention period (P = .0024). Average percentile rank change on discharge domain questions was an increase by 50 points. Patient and staff feedback further demonstrated value to the intervention. ConclusionsProviding discharge instructions in the preoperative area in addition to providing instructions immediately before discharge can improve the percentile rankings associated with OAS-CAHPS questions related to discharge.

Anaesthetic Effects of Propofol, Ketamine and their Combination (Ketofol) as Total Intravenous Anaesthesia (TIVA) in Pigs

Background: Endotracheal intubation for inhalation anaesthesia in pigs is not considered a good anaesthetic method as it is technically difficult because of oral anatomy and the presence of excess tissues in the oropharyngeal region. Moreover, the major limitation of inhalation anaesthesia is that it requires the use of a cumbersome and costly anaesthetic machine, including a suitable breathing system and vaporizer and is the exposure of operating-room personnel to the pollution in the ambient air. Therefore, the present study was undertaken to evaluate the effect of propofol, ketamine and their combination ‘Ketofol’ as a TIVA in pigs. Methods: The study was conducted in eighteen piglets of either sex. The piglets were randomly divided into three groups with six animals in each group. All the three groups were premedicated with Atropine sulphate @ 0.04mg/kg body weight and Xylazine Hydrochloride @ 1mg/kg body weight I.M. and Medazolam @ 0.5mg/kg body weight I.M. with minimum forcible restraint as pre-anaesthetic. In group-I, propofol @ 5mg/kg body weight, in group-II, ketamine @ 5mg/kg body weight and in group-III, ketofol @ 4mg/kg body weight was administered intravenously for induction after 15 minutes of pre-anaesthetic administration. Surgical anaesthesia was maintained for 90 minutes in all three groups viz. group-I, group-II and group-III with propofol @ 2.5mg/kg, ketamine @ 2.5mg/kg and ketofol @ 2mg/kg body weight respectively by intermittent bolus injection (IBI) technique. Clinical and cardiopulmonary profiles were evaluated before administration of the anaesthetic agent (0 minutes) then at 15, 30, 60 and 90 minutes during and after administration of anaesthetic agents to evaluate their anaesthetic effect. Result: The study revealed that induction time (IT), duration of analgesia (DOA), duration of recumbency (DOR) and recovery time (RT) interval showed better result in the combination of ketamine and propofol group as compared to propofol and ketamine-induced individual group. The temperature and respiration rate was significantly decreased in all the groups at 30 minutes during TIVA whereas heart rate was significantly increased in all the groups at 15 minutes. The combination of ketamine and propofol group showed a consistent diastolic pressure and systolic pressure during the entire period of anaesthesia. The SPO2 in the ketamine-induced group showed a significant decrease (P less than 0.01) as compared to the propofol and ketofol group. It was concluded that the anaesthetic drug combinations resulted in smooth and uneventful induction with mild cardiopulmonary depressions and rapid recovery.

Ketamine and xylazine effects in murine model of acute pancreatitis

Ketamine and xylazine (Ket/Xyl) are anesthetic agents that target neural pathways and are commonly used in combination in mouse studies. Since neural pathways can modulate acute pancreatitis severity we asked if Ket/Xyl affect disease severity. C57BL/6 mice were treated with six hourly injections of cerulein to induce mild acute pancreatitis. Mice were also treated with and without ketamine, xylazine, and Ket/Xyl prior to pancreatitis induction in vivo and in vitro. Ket/Xyl pre-treatment in vivo increased select parameters of pancreatitis severity such as trypsin activity and edema; these effects were predominantly mediated by xylazine. Ket/Xyl also changed markers of autophagy. These in vivo effects of Ket/Xyl were not attenuated by atropine. The drugs had no little to no effect on pancreatitis responses in isolated pancreatic cells or lobules. These findings suggest that Ket/Xyl administration can have substantial effect on acute pancreatitis outcomes through non-muscarinic neural pathways. Given wide-spread use of this anesthetic combination in experimental animal models, future studies of inflammation and injury using Ket/Xyl should be interpreted with caution.

Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review.

Intracranial aneurysms (IA) occur in 3-5% of the general population and may require surgical or endovascular obliteration if the patient is symptomatic or has an increased risk of rupture. These procedures carry an inherent risk of neurological complications, and the outcome can be influenced by the physiological and pharmacological effects of the administered anesthetics. Despite the critical role of anesthetic agents, however, there are no current studies to systematically assess the intraoperative anesthetic risks, benefits, and outcome effects in this population. In this systematic review of the literature, we carefully examine the existing evidence on the risks and benefits of common anesthetic agents during IA obliteration, their physiological and clinical characteristics, and effects on neurological outcome. The initial search strategy captured a total of 287 published studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 28 studies were included in the final report. Our data showed that both volatile and intravenous anesthetics are commonly employed, without evidence that either is superior. Although no specific anesthetic regimens are promoted, their unique neurological, cardiovascular, and physiological properties may be critical to the outcome in vulnerable patients. In particular, patients at risk for perioperative ischemia may benefit from timely administration of anesthetic agents with neuroprotective properties and optimization of their physiological parameters. Further studies are warranted to examine if these anesthetic regimens can reduce the risk of neurological injury and improve the overall outcome in these patients.

Effects of Propofol, Ketamine and their Combination (ketofol) as Total Intravenous Anesthesia (TIVA) on Haematological, Serum Biochemical and Hormonal Profile in the Surgical Management of Canine Patients

Background: The non-availability of the sophisticated anaesthetic machine and the necessary equipment to administer inhalant anaesthetic in the field hospitals make their use practically unfeasible for the field veterinarians. Therefore, the present study was undertaken to evaluate the effect of propofol, ketamine and their combination ‘Ketofol’ as a TIVA on certain haematological, serum biochemical and hormonal profiles in atropine and xylazine premedicated dogs. Methods: The study was conducted in eighteen clinical cases of dogs of either sex. The animals were randomly divided into three groups with six animals in each group. All the three groups were premedicated with Atropine sulphate @ 0.04mg/kg body weight and xylazine HCl @ 0.5mg/kg body weight intramuscularly. In group-I, propofol @ 5mg/kg body weight, in group-II, ketamine @ 5mg/kg body weight and in group-III, ketofol @ 4mg/kg body weight was administered intravenously for induction after 15 minutes of pre-anesthetic administration. Surgical anaesthesia was maintained for 90 minutes in all three groups viz. group-I, group-II and group-III with propofol @ 2.5mg/kg. b.w., ketamine @ 2.5mg/kg b.wt. and ketofol @ 2mg/kg b.wt. respectively by intermittent bolus injection (IBI) technique. Haematological, serum biochemical and hormonal profile were evaluated before administration of the anaesthetic agent (0 minutes) then at 15, 30, 60 and 90 minutes during and after administration of anaesthetic agents. Result: The study revealed that Hb, PCV and TEC were significantly decreased in all the groups at 60 mints and 30 mints respectively. The biochemical evaluation revealed that blood glucose level was significantly increased in all the groups until the end of the experiment. BUN and creatinine value was a significant increase in group-I and group-II than group-III at different time intervals up to the end of the experiment. In all the groups’ alanine aminotransferase (ALT) values significantly increased up to 60th minutes during TIVA whereas AST value was significantly increased in group-II at 30th and 60th minute of the experiment in compare to group-I and group-III. A higher level of cortisol values was recorded in group-I animals for the entire period of observation. There were no changes observed in the case of T3. Transient variables of haemato-biochemical have been reported following propofol, ketamine and their combination (ketofol) as total intravenous anaesthesia (TIVA). Thus, it has been concluded that diligent monitorization and electrolyte support are essential during the period of anaesthesia.

GINGIVECTOMY AS A CROWN LENGTHENING PROCEDURE FOR ALTERED PASSIVE ERUPTION TREATMENT

ABSTRACTBackground: Altered passive eruption is a condition that can make clinical crown of teeth seems shorten. The excessive gum or dentogingival junction level that overlap to enamel become causal factor for altered passive eruption. Crown lengthening is one of treatment that can treat altered passive eruption. One of crown lengthening procedure is gingivectomy. Purpose: To correct excessive gingiva and achieve ideal teeth appearance by using gingivectomy as crown lengthening procedure. Case: A 21‑years‑old, systemically healthy, non‑smoking female, referred from orthodontist to treat patient’s overlap gingiva. From the patient’s point of view, her upper front teeth were unpleasant to see. There were no abnormalities in extraoral. Intraoral, there were upper front clinical crown of teeth that seem shorter. Case management: The treatment started from administration of anesthetic agent, application of pocket marker forceps, gingival cutting and trimming process, then periodontal pack application. Treatment results were quite good. The appearance of upper front teeth became ideal in width and length ratio. Conclusion: Gingivectomy is one of crown lengthening method that can solve excessive gingiva in altered passive eruption.Keywords: Altered passive eruption; Crown lengthening; Dentogingival junction; Gingivectomy

Changes in Blood Pressure and Pulse Rate of Patients without Systemic Diseases Following the Injection of 2% Lidocaine Plus Epinephrine 1:80000 in an Inferior Alveolar Nerve Block - A Prospective Study.

Introduction:An inferior alveolar nerve block is dental anesthesia produced by the local injection of lidocaine plus epinephrine; however, its administration could cause cardiovascular side effects. We aimed to assess the changes in blood pressure and pulse rate following the injection of 2% lidocaine with epinephrine 1:80000 for an inferior alveolar nerve block.Materials and Methods:Seventy-one patients without any systemic disease were enrolled in this study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate were measured using an automatic digital blood pressure monitor in four stages as follows: at the rest time (Stage 1), prior to injection (Stage 2), immediately after injection (Stage 3), and 10 min after the administration of anesthetic agents (Stage 4). All injections and measurements were carried out by a single operator to minimize the variability.Results:SBP and DBP in all stages were within the normal range (lower than 130 and 80 mmHg, respectively), and none of the patients showed evidence of arterial hypertension. Although the pulse rate increased significantly at Stages 2, 3, and 4 compared with Stage 1 (P < 0.05), no evidence of bradycardia or tachycardia was seen.Discussion:Local anesthesia with 2% lidocaine plus epinephrine 1:80000 for an inferior alveolar nerve block would be safe for patients without any systemic diseases.

Assessing Patients' Knowledge on Anesthesia Services at Tamale Teaching Hospital.

Anesthesia is one of the most significant developments of modern medicine that allows treatment involving unbearable pain to be performed while the person is relaxed, asleep, and with no memory of the procedure. However, patients around the world have little or limited knowledge regarding anesthesia. It is in view of that, this study was undertaken to assess patients’ knowledge on anesthesia services at a preanesthetic clinic and recovery wards of a teaching hospital in Northern Ghana. Descriptive quantitative survey was used to identify patients’ knowledge about anesthesia services with the purpose to observe, describe, and document the situation as it naturally occurs. Data obtained from 100 participants were double entered into Microsoft Excel spreadsheet and validated for data errors. Data were then coded and exported to SPSS version 20.0 for Windows for analysis. Descriptive statistics such as frequencies and percentages were used to describe data. The results showed that 53% of participants were aware of anesthesia services as opposed to 47%. However, 30% of the respondents could not identify the type of anesthesia services, while 68% did not know the route of administration of anesthetic agents. Most importantly, 51% had no idea of what an anesthetist is, while 33% knew nothing about the role anesthetists play in the health delivery system. As a result, 26% thought an anesthetist is the theatre nurse, while 25% were of the view that the doctor doubles as the anesthetist. Anesthetists must therefore make conscious efforts to disseminate information before and after surgeries and follow-up clients who underwent anesthesia to provide for continuity of care. This may include preparation of leaflets, brochures, videos, and handouts to improve patients’ knowledge and attitude and to disseminate it to all departments in the hospital where anesthesia services are provided.