Administration Of Anesthesia Research Articles

THE ROLE AND CORRECTION OF SEXUAL DYSFUNCTION AS A COMPONENT OF THE QUALITY OF LIFE IN PATIENTS OPERATED ON FOR CEREBRAL ANEURYSM RUPTURE

Introduction. Hemorrhagic stroke due to the rupture of the intracranial aneurysm (IA) is a typical clinical manifestation of the disease and one of the main causes of disability, affecting the quality of life in operated patients.
 The aim. To determine the feasibility and safety of implementing protocols for diabetes mellitus (DM) treatment as part of rehabilitation interventions in patients who have undergone surgery for the rupture of intracranial aneurysm (IA) in the brain.
 Materials and methods. To determine the effectiveness and safety of implementing diabetes mellitus (DM) treatment protocols in individually developed rehabilitation interventions following surgery for the rupture of intracranial aneurysm (IA) in the brain, a retrospective cohort study was conducted in parallel groups.
 Results. Sexual dysfunctions (SD) resulting from the rupture of IA are multifactorial. The causes of SD can be categorized as primary, secondary, and tertiary. Primary causes include damage to brain structures by hemorrhagic stroke or vascular ischemic events affecting sexual functioning, pre-existing medical conditions, and side effects related to medication therapy during treatment. Secondary causes encompass persistent sensorimotor disturbances due to a prior stroke. Issues related to cognitive, behavioral, and psychosocial adaptation constitute tertiary causes of SD. The effective and prompt correction of sexual dysfunction in patients following the rupture of cerebral blood vessel aneurysms largely depended on the proper administration of anesthesia during surgical interventions and intensive therapy in the perioperative period. This includes preoperative preparation and patient analgesia, the administration of anesthesia, and adequate postoperative care.
 Conclusions. The application of SD correction in men as part of rehabilitation measures from the 6th to the 24th month after surgical treatment of intracranial aneurysm (IA) has a positive impact, reducing SD regression from 88.9% (n=56/63) to 34.9% (n=22/63).

Frequency and features of medical emergencies at a teaching dental hospital in Saudi Arabia: a 14-year retrospective observational study

BackgroundThis study aimed to determine the nature, frequency, and characteristics of medical emergencies occurring at the King Abdulaziz University Dental Hospital.Materials and methodsThe incident reports of medical emergencies recorded at the King Abdulaziz University Dental Hospital from January 2008 to December 2022 were retrospectively reviewed. The annual/overall incidence of medical emergency events was calculated per 100,000 patients. The following characteristics of the patients/events were evaluated: age, gender, operator, procedure, location, timing of treatment, administration of local anesthesia, past medical history, symptoms, diagnosis, outcome, and disposition. Multivariable logistic regression models were used to investigate the associations of these characteristics with two outcomes: syncope and transfer to the emergency room (ER).ResultsThe incidence of emergency events was 17.4 per 100,000 patients. Syncope and hypoglycemia were the most common emergencies. Most incidents recovered, with only 13% requiring transfer to the ER. Undergoing no procedure and American Society of Anesthesiologists (ASA) class 2,3 were associated with syncope. Undergoing a general dental procedure, ASA class 2,3, and a diagnosis other than hypoglycemia and syncope were associated with transfer to the ER.ConclusionsThe incidence of medical emergencies was low. Dental practitioners need to remain aware of the contributing factors, such as past medical history and anxiety, but medical emergencies can occur in healthy individuals as well. Preparation of the dental office, training of the personnel, and proper recording of the events are essential components of a well-established medical emergency protocol in dental institutions.

Intercomparison of Efficacy of Transcutaneous Electrical Nerve Stimulation and Precooling Vibration Device on Pain and Anxiety Management during Administration of Local Anesthesia Injection in 6-12-year-olds.

To compare and evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) and a vibrational precooling system in reducing pain and anxiety during the administration of local anesthesia in children aged 6-12 years old. A total of 60 children aged 6-12 years old participated in this randomized controlled trial and were randomly allocated to three groups: the conventional method group, the vibrational precooling system group, and the TENS group. The Modified Dental Anxiety Scale (MDAS), pulse rate, and oxygen saturation were recorded to assess the preoperative anxiety of the participating children. Sound, motor, and eyes (SEM) and face, legs, activity, cry, and consolability (FLACC) scores were recorded during the procedure, along with pulse rate and oxygen saturation, to measure pain during the procedure. This was followed by a self-administered visual analog scale (VAS) to assess the discomfort felt by the child. A statistically significant reduction in pain was observed with the usage of the vibration system and TENS, as measured by the FLACC scale, compared to the conventional method group. Similarly, statistically significant differences in SEM scores were noted between the vibrational precooling system group and the conventional method group, as well as between the TENS group and the conventional method group, with the highest scores observed in the conventional method group. The children reported the highest comfort levels with the usage of the vibration system, as indicated by the self-administered VAS. However, no statistically significant difference was observed within any group. The new vibrational precooling system as well as TENS can be effectively used to alleviate the pain experienced during the administration of local anesthesia. Singh K, Jhingan P, Mathur S, et al. Intercomparison of Efficacy of Transcutaneous Electrical Nerve Stimulation and Precooling Vibration Device on Pain and Anxiety Management during Administration of Local Anesthesia Injection in 6-12-year-olds. Int J Clin Pediatr Dent 2024;17(3):297-302.

Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.

Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

Impact of Temperature on the Quality of Local Anesthetic Effect during Subarachnoid Block

In contrast to general anesthesia, which affects the entire body, spinal anesthesia specifically targets a limited area, leading to a temporary loss of sensory and motor function. The duration of the effect varies on many factors depending on the specific anesthetic agent used, level of injections given and, baricity, dose, temperature and, many more factors. The temperature of the administered bupivacaine solution has been recognized as a potential modulator of its onset of action, influencing factors such as speed, depth, and duration of anesthesia. The temperature of the medication can influence the speed at which the local anesthetic takes effect. Warmer solutions may have a faster onset of action compared to colder ones. The duration of anesthesia may also be affected, with warmer solutions potentially providing a more prolonged effect. The temperature of the injected medication can influence the patient's comfort during the administration of spinal anesthesia. The present analysis indicates that there is a definite relationship between the temperature of the injected local anesthetic and the quality of the block achieved.

Is it possible to extract primary maxillary molars without palatal injection?: a controlled clinical trial

ObjectivesThe absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times.Materials and methodsA single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS).ResultsIn terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05).ConclusionsWhile the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction.Clinical relevanceExtraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.

Effect of preoperative oral medication of Diclofenac sodium, Ibuprofen and Etoricoxib on the effectiveness of maxillary infiltration anaesthesia in patients with irreversible pulpitis: A Randomized Clinical Study

Introduction Preoperative pain of endodontic origin, has its effect on the patient‘s attitude towards the endodontic treatment. Dental anxiety associated with the above may cause ineffective anaesthesia of the tissues of interest. To assess the efficacy of preoperative oral single-dose administration of three non-steroidal anti-inflammatory drugs namely, Diclofenac sodium 50 mg, Ibuprofen 200 mg and Etoricoxib 60 mg and on the effectiveness of infiltration anaesthesia in patients with irreversible pulpitis of maxillary first molars. Material and Methods Sixty (n=60) patients with a chief complaint of moderate to severe pain of endodontic origin participated in the study. Patients were asked to indicate their pain scores on a visual analog scale (VAS) and then they were divided into three groups of n=20. Then according to their groups, the patients received a single dose of Diclofenac sodium 50 mg, Ibuprofen 200 mg and Etoricoxib 60 mg one hour before administration of the infiltration anaesthesia with 2% lignocaine containing 1:80,000 epinephrine. The patients indicated their pain score on VAS after one hour of drug administration and again after completion of the access opening. Differences in the pain scores at these three intervals were noted. Data was collected and analyzed using SPSS v.20 software and subjected to descriptive statistics, one-sample t-test and one-way ANOVA test with the acceptance level of significance set at p&lt;0.05. Results Diclofenac sodium 50 mg, Ibuprofen 200 mg and Etoricoxib 60 mg had shown a gradual decrease in mean pain scores after the completion of access opening, which was statistically significant (p&lt;0.05). Etoricoxib 60 mg (p=0.01) showed lower mean pain scores compared to Diclofenac sodium 50 mg and Ibuprofen 200 mg. Conclusion Within the limitations of the present study, Etoricoxib significantly lower mean pain scores when compared with the other two groups. Key Words Drug efficacy, Non-steroidal anti-inflammatory drugs, Visual Analog

Comparison of different porcine models simulating myocardial cold ischemia of pediatric donor hearts.

Our team previously identified a stem cell-derived cardioprotective additive that can be added to standard cardioplegia to extend myocardial viability during prolonged myocardial cold ischemic time (CIT) in rodent models. The purpose of this study was to utilize a porcine model to compare in-vivo versus ex-vivo porcine simulation of CIT that accompanies cardiac transplantation in humans, in order to determine an optimal method for translation of our studies to larger animals. Eight 39-55kg Yorkshire X pigs were randomly assigned to either in-vivo or ex-vivo simulation. After administration of general anesthesia and endotracheal intubation, baseline measurement of left ventricular performance was obtained via transesophageal echocardiography (TEE). After midline sternotomy and heparin administration, the aorta was cross-clamped and twoliters of HTK-Custodiol were introduced via the aortic root. The in-vivo method utilized cold ischemic heart storage in the chest cavity while supporting the experimental animal with cardiopulmonary bypass (CPB). The ex-vivo method involved standard cardiac procurement, cold ischemic storage outside of the body, and subsequent cardiac reperfusion utilizing cardiac reanimation in a Langendorff heart perfusion mode. After CIT, measurements of post-ischemic left ventricular performance were obtained via echocardiography. Results are presented as: Mean ± Standard Deviation (Median, Minimum-Maximum). Weight (kilograms) was similar in the in-vivo group and the ex-vivo group: 44 ± 1.8 (44, 42-46) versus 44 ± 5.1 (43.5, 39-51), respectively. Cold ischemic time (minutes) was longer in the ex-vivo group: 360 ± 0 (360, 360-360) versus 141 ± 26.7 (149, 102-163). Temperature (degrees Celsius) was colder in the ex-vivo group: 8 ± 0 (8, 8-8) versus 16.5 ± 4.2 (16, 12-16).In the in-vivo group, baseline ejection fraction and ejection fraction after CIT were: 48.25% ± 14.95% (48.5%, 33%-63%) and 41.25% ± 22.32% (41.5%, 20%-62%), respectively. In the ex-vivo group, baseline ejection fraction and ejection fraction after CIT were: 56.4% ± 5.9% (57%, 50%-67%) and 60.4% ± 7.7% (61.5%, 51.9%-67%), respectively. The ex-vivo technique is suitable to evaluate cardioplegia additives that may substantially extend myocardial tolerance to cold ischemia.

Global Issues in Obstetric Anesthesia: Perspectives From South Africa, Japan, China, Latin America, and North America

(Int J Obstet Anesth. 2023:54:103648) Anesthesia provision varies worldwide, and obstetric anesthesia in particular is highly variable. The first country discussed in this article is South Africa, which is classified as a low-income to middle-income country. South Africa has high patient mortality related to cesarean delivery. The epidural rates for labor in South Africa are &lt;5%, which is considered extremely low. Approximately one-third of maternal deaths investigated occurred following the administration of spinal anesthesia. In South Africa, it is 3 times more likely for maternal mortality to occur following cesarean delivery than vaginal birth. The mortality rates following a cesarean delivery in South Africa are also 50 times higher than in other regions of the world. Training has been implemented to reduce these statistics, although the level of preparedness following this training has been questioned.

Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study.

Motor-sparing analgesia after total knee arthroplasty (TKA) is crucial. The primary endpoint was the postoperative visual analogue scale (VAS) score after triple injection peri-sartorius (TIPS) block after TKA. Secondary endpoints were postoperative morphine consumption, 24-h postoperative ambulation distances and the degrees of active knee extension. After general anaesthesia or spinal anaesthesia administration and before surgical incision, 80 patients undergoing TKA were randomised into group TIPS (received ultrasound-guided TIPS block where 40 ml 0.25% bupivacaine and 4 mg dexamethasone were injected: 10 ml at the distal femoral triangle, 10 ml above the sartorius and 20 ml at the distal adductor canal) and group FNB (femoral nerve block; received ultrasound-guided FNB with 20 ml 0.25% bupivacaine mixed with 4 mg dexamethasone). Postoperative pain score was noted and compared. Dynamic VAS scores were lower in the TIPS group than in FNB, while the resting VAS scores were not significantly different. Mean (standard deviation [SD]) postoperative morphine consumption was 5.82 (2.47) mg in the TIPS group (95% confidence interval [CI] 5.03,6.61) versus 9.87 (2.99) mg in the FNB group (95% CI 8.91,10.83). Ambulation distances and active postoperative knee extension in the TIPS group showed greater significance than in the FNB group (TIPS: 18.0 [7.37] m, 95% CI 15.64,20.35] vs. FNB: 8.95 [5.93] m, 95% CI 7.05,10.84) and (TIPS: 52.12 [16.39], 95% CI 46.88,57.33 vs. FNB: 26.05 [11.10], 95% CI 22.501,29.59). Nausea was more evident in FNB patients. TIPS block provides superior analgesia than FNB with motor sparing of the quadriceps after TKA.

Comparative Evaluation of the Anesthetic Efficacy of Needle-Free Anesthesia and Conventional Anesthesia in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

Introduction Pain is the primary reason for which most of the patients seek endodontic treatment. Local anesthesia is considered to be the most important step in the procedure to reduce the pain. However, the majority of the patients do not cooperate due to the fear of syringe anesthesia. The aim of this clinical trial was to compare the anesthetic efficacy of needle-free anesthesia and conventional anesthesia in patients with symptomatic irreversible pulpitis undergoing root canal therapy. Materials and methods A total of 54 patients were enrolled in the study, and the treatment was administered by a single operator. The initial assessment of vitality included cold testing, heat testing, and electric pulp testing. Preoperative pain was assessed using the Visual Analog Scale (VAS) before the administration of anesthesia. Local anesthesia was administered according to the group assigned: Group 1 (conventional anesthesia) and Group 2 (needle-free anesthesia). The pain was assessed during the administration of anesthesia. Following the administration of anesthesia, the vitality of the tooth was evaluated using cold testing, heat testing, and electric pulp testing. Subsequently, the tooth was isolated with a rubber dam, and the access cavity was prepared. The pain was assessed during access cavity preparation and during the first file insertion. Working length was determined using an apex locator (Root ZX Mini, J Morita, Saitama, Japan) and was confirmed using intraoral periapical radiographs. Later on, further treatment was carried out. Results A total of 54 participants were included in this clinical trial. There was no significant difference in mean age distribution between the two groups (p=0.852). Considering the frequency distribution of gender, there was no significant difference; however, Group 1 had more female participants (59.3%) compared to Group 2 (33.3%). There was a significant reduction in the mean pain score in Group 2 compared to Group 1 during the delivery of anesthetic agents (p=0.000). Conclusion Needle-free anesthesia proves to be equally effective as the conventional syringe system in patients experiencing symptomatic irreversible pulpitis undergoing root canal treatment. However, it is noteworthy that patients exhibited greater comfort levels with needle-free anesthesia systems specifically during the administration of the anesthetic solution.

Clinico-Physiological and Haemodynamic Alterations Following Propofol Induction and Premedication with Butorphanol, Dexmedetomidine or Acepromazine in Dogs

The present study was conducted during February-October 2021 at Department of Veterinary Surgery and Radiology, College of Veterinary Science &amp; A.H. Anjora, Durg (C.G.), India to evaluate the alternations on clinico-physiological and haemodynamic parameters following propofol induction in dogs premedicated with butorphanol or dexmedetomidine or acepromazine. Eighteen adult dogs of either sex were randomly divided into three groups (BP, DP and AP) with six animals in each. Ten minutes prior to the anaesthetic administration, all the dogs were administered glycopyrrolate @ 0.02 mg kg-1 I/M. The animals of group BP, DP and AP were premedicated intramuscularly with butorphanol @ 0.3 mg kg-1 b.wt., dexmedetomidine @ 10 µg kg-1 b.wt. and acepromazine @ 0.4 mg kg-1 b.wt. respectively. General anaesthesia was induced with propofol @ 7 mg kg-1 b.wt. intravenously. Clinical parameters were recorded following induction with propofol. Physiological and haemodynamic parameters were recorded before (0), 5 min. after sedation, induction and at 10, 20, 40, 60 and 120 min. post propofol anaesthesia. The onset of sedation and anaesthesia was quicker in group DP followed by AP and BP. Duration of anaesthesia and complete recovery were significantly (p&lt;0.05) longer in group DP as compared to group BP and AP. The physiological and haemodynamic parameters showed transient changes which were compensated and remained within normal range during the study period without producing any deleterious effect. Thus, propofol can be safely used as induction agent in dogs premedicated with either dexmedetomidine or butorphanol or acepromazine and does not produce any adverse effect on cardiopulmonary system. However, dexmedetomidine-propofol combination provided longer duration of anaesthesia in dogs as compared to other groups.

Circumferential digit marking to prevent inadvertent wrong site surgery or anesthetic administration

Circumferential digit marking to prevent inadvertent wrong site surgery or anesthetic administration

Considering Anatomic Features When Retrieving a Separated Needle: A Case Report Using CT Navigation Within the Infratemporal Fossa

Needle separation is an unfortunate complication encountered during local anesthetic administration in dentistry. Attributing factors have been thought to be related to needle gauge, pre-injection needle bending, needle deflection, redirection, and depth of penetration. Various methods have been described for FB identification and retrieval. We present a case of a separated hypodermic needle in the infratemporal fossa after a posterior superior alveolar (PSA) nerve block. We describe the use of computed tomography (CT) navigation system with an expanded armamentarium of guided instrumentation. Utilization of our method can efficiently aid in the localization and removal of foreign bodies in the maxillofacial region.

Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia.

Administration of local anesthesia via injection is the main reason for inducing anxiety in children and if not intervened it aggravates the anxiety in subsequent appointments. There are many approaches, including pharmacological and non-pharmacological methods that can be used to reduce children’s perception of pain and anxiety. A frequently used non-pharmacological behaviour management method to reduce anxiety and procedure pain is distraction. The rationale of distraction is to shift the attention to avert the brain from receiving unwanted stimulus which induce anxiousness. Many approaches including music, television, portable video games, virtual reality (VR) helmet, and virtual reality audio-visual eyewear, have been implemented so far. Kaleidoscope and virtual reality goggles may help as distraction techniques in reducing the levels of anxiety caused during administration of local anesthesia. By the aid of which the operator may be able to make the dental experience child friendly and ultimately provide quality dental care to anxious children. Non pharmacological measures of reducing pain are cost effective and best means that can be used while performing dental procedures. This is a research protocol for a study aimed to evaluate and compare the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children.

Comparison of effects of telmisartan versus valsartan on post-induction hypotension during noncardiac surgery: a prospective observational study.

Telmisartan is considered more potent than valsartan. Hemodynamic response during anesthesia induction may be influenced by anti-hypertension (HTN) medication. The present study compared the effect of anti-HTN medications on post-induction hypotension during noncardiac surgeries. This observational study standardized the anesthetic regimen across patients, with hypotension defined as mean blood pressure (BP) of less than 65 mmHg. The hemodynamic changes within 5 min before and after endotracheal intubation, and within 10 min before and after surgical incision were measured. Transthoracic echocardiographic evaluation of the left ventricle (LV) during anesthesia induction was performed. The primary endpoint was the decline in mean BP after anesthetic administration in telmisartan and valsartan groups. Multivariate logistic regression analysis was used to identify predictors of post-induction hypotension. Data from 157 patients undergoing noncardiac surgery were analyzed. No significant differences were found in mean BP decline between the two groups during anesthesia induction. Hemodynamic changes and LV ejection fraction (EF) during anesthesia induction were similar between the groups. Age and preoperative initial mean BP in operation room (OR) were associated with post-induction hypotension in both groups. The angiotensin receptor blocker (ARB) type did not influence post-induction hypotension during anesthesia induction. Age and preoperative initial mean BP in OR were associated with post-induction hypotension in patients taking ARBs.

Machine Learning-Guided Anesthesiology: A Review of Recent Advances and Clinical Applications

: Anesthesia is the process of inducing and experiencing various conditions, such as painlessness, immobility, and amnesia, to facilitate surgeries and other medical procedures. During the administration of anesthesia, anesthesiologists face critical decision-making moments, considering the significance of the procedure and potential complications resulting from anesthesia-related choices. In recent years, artificial intelligence (AI) has emerged as a supportive tool for anesthesia decisions, given its potential to assist with control and management tasks. This study aims to conduct a comprehensive review of articles on the intersection of AI and anesthesia. A review was conducted by searching PubMed for peer-reviewed articles published between 2020 and early 2022, using keywords related to anesthesia and AI. The articles were categorized into nine distinct groups: “Depth of anesthesia", “Control of anesthesia delivery", “Control of mechanical ventilation and weaning", “Event prediction", “Ultrasound guidance", “Pain management", “Operating room logistic", “Monitoring", and “Neuro-critical care". Four reviewers meticulously examined the selected articles to extract relevant information. The studies within each category were reviewed by considering items such as the purpose and type of anesthesia, AI algorithms, dataset, data accessibility, and evaluation criteria. To enhance clarity, each category was analyzed with a higher resolution than previous review articles, providing readers with key points, limitations, and potential areas for future research to facilitate a better understanding of each concept. The advancements in AI techniques hold promise in significantly enhancing anesthesia practices and improving the overall experience for anesthesiologists.

Efficacy of Different Techniques of the Inferior Alveolar Nerve Block for Mandibular Anesthesia: A Comparative Prospective Study.

Background The inferior alveolar nerve block (IANB) is a commonly employed technique in oral surgery for achieving profound anesthesia in the mandibular teeth and associated structures. Several techniques have been developed to enhance the success rate and patient comfort during the IANB. The aim of this study was to compare and evaluate the efficacy of different IANB techniques for mandibular anesthesia. Materials and methods The participants included in the study were adultsrequiringsurgical extraction of an impacted mandibular third molar teeth. A total of 100 participants were randomly assigned to five different groups representing various techniques of IANB, i.e., conventional Halsted technique, Vazirani-Akinosi technique, Gow-Gates technique, Fischer 1-2-3, and extraoral Kurt-Thoma technique, with 20 participants in each group. The participants were evaluated for the onset of anesthesia using subjective and objective methods, pain perception during the administration of local anesthesia using a 10-point visual analogue scale (VAS), and the incidence of trismus postoperatively. Data were analyzed using IBM SPSS Statistics for windows, version 23.0 (released 2015; IBM Corp Armonk, United States) with p-values less than 0.05 considered as statistically significant. Descriptive statistics, Kruskal-Wallis, and post-hoc tests were included in the data analysis for intergroup comparisons. Results The primary outcomes evaluated were the onset of anesthesia, the patient's perception of pain during the administration of local anesthesia, and the secondary outcome included in the incidence of trismus. In this study, it was found that the Kurt-Thoma technique had the fastest onset of anesthesia (2.25 minutes), higher incidence of trismus (25%), and higher pain perception (6.5 score on VAS). The conventional Halstead technique (3.55 minutes), Fischer 1-2-3 technique (3.5 minutes), and Vazirani-Akinosi technique (3.1 minutes) had an almost similar mean duration of anesthesia. The onset of anesthesia was delayed in the Gow-Gates technique (5.1 minutes). Patient perception of pain during administration of local anesthesia was higher in the Kurt-Thoma (6.5) and Gow-Gates techniques (4.95), and it was least in the Fischer 1-2-3 technique (0.75) in the VAS scores. The incidence of trismus was highest with the Kurt-Thoma technique (25%), then the Gow-Gates technique (20%), followed by the conventional Halstead technique (5%). Conclusion In this study, it was found that the conventional Halsted technique was the best among the different techniques of IANB and remains the gold standard.

Dexmedetomidine Versus Ketamine Pretreatment to Alleviate Propofol Injection Pain: A Randomized and Blinded Study

Background: Both ketamine and dexmedetomidine have proven effective in relieving the pain resulting from propofol injection. However, studies comparing them directly are limited. The primary outcome was to compare the incidence of propofol injection pain after dexmedetomidine pretreatment with ketamine pretreatment. Secondary outcome was to study the changes of haemodynamic parameters that arise after the administration of the pretreatment drug till anaesthesia was induced with propofol.&#x0D; Methods: In this randomized, triple blinded, parallel arm single centre study, we compared pre-treatment with dexmedetomidine 0.5mcg/kg (Group A) and ketamine 0.5mg/kg (Group B). Our primary objective was to compare the incidence of propofol injection pain. The McCririck and Hunter scale was used to evaluate the pain. Secondarily, we compared the changes of haemodynamic parameters that arose after the administration of the pre-treatment drug till induction of anaesthesia with propofol.&#x0D; Results: Among 168 patients evaluated for eligibility, 140 were included for final analysis with 70 patients in each group. The incidence of propofol injection pain in Group A was 74.3% (52/70) and that in Group B was 42.9% (30/70) (p value &lt;0.001). No pain was reported by 25.7% (18/70) and 57.1% (40/70) patients in Group A and B respectively. Mild and moderate to severe pain was experienced by 58.6% and 15.7% patients in Group A, where as it was 40% and 2.9% patients in Group B respectively.&#x0D; Conclusion: Ketamine leads to a greater reduction in both the frequency and intensity of pain resulting from propofol injection when compared to dexmedetomidine.

Preventing Local Anesthetic Systemic Toxicity After Administration of Long-Acting Local Anesthetics.

Preventing Local Anesthetic Systemic Toxicity After Administration of Long-Acting Local Anesthetics.