Anesthesia Group Research Articles

Use of Ultrasound in Pediatric Caudal Anesthesia: A Randomized Comparative Study

Objective: The aim of this comparative study was to evaluate the efficacy and safety of ultrasound-guided caudal anesthesia compared to blind caudal anesthesia for subumbilical surgery in pediatric patients. Methods: This prospective study included pediatric patients undergoing subumbilical surgery in the Department of Pediatric Surgery. Patients were divided into two groups: the ultrasound-guided caudal anesthesia group and the blind caudal anesthesia group. Primary outcomes assessed included the success rate of block placement, onset and duration of sensory and motor blockade, analgesic requirements, and perioperative complications. Results: A total of 40 patients were included in the study, with 20 patients in the ultrasound-guided group and 20 patients in the blind group. The success rate of block placement was significantly higher in the ultrasound-guided group compared to the blind group (p < 0.001). The ultrasound-guided group also demonstrated faster onset of sensory and motor blockade (p < 0.05) and longer duration of analgesia (p < 0.05) compared to the blind group. Postoperative analgesic requirements were significantly lower in the ultrasound-guided group (p < 0.001). No significant differences in perioperative complications were observed between the two groups. Conclusion: Ultrasound-guided caudal anesthesia was found to be more effective and reliable than blind caudal anesthesia for subumbilical surgery in pediatric patients. It provided a higher success rate of block placement, faster onset and longer duration of sensory and motor blockade, reduced postoperative analgesic requirements, and comparable safety profile. Ultrasound guidance should be considered as the preferred technique for caudal anesthesia in this patient population.

The immune response to systemically administered endotoxin in the murine intestinal microcirculation under pentobarbital versus isoflurane anesthesia.

Pentobarbital and isoflurane are commonly used veterinary anesthetics. Due to the dangers of overdose by repeat-bolus regimen of pentobarbital, isoflurane has been recommended. However, literature suggests isoflurane-induced inhibition of cytokine and adhesion molecule release, impacting leukocyte adhesion. This study aims to characterize the impacts of pentobarbital versus isoflurane on leukocyte interactions within the intestinal microcirculation with and without endotoxin challenge. Female BALB/c mice were subjected to pentobarbital or isoflurane (N = 20) and challenged with endotoxin or saline by intraperitoneal injection. The mice were kept under anesthesia for 2 hours. Fluorochromes, rhodamine-6 G and fluorescein isothiocyanate, were injected intravenously. To visualize leukocyte adhesion within the intestinal microcirculation, laparotomy and intravital microscopy was performed. Leukocyte rolling and adhesion was quantified offline in a blinded fashion. Within collecting venules, leukocyte rolling and adhesion showed no significant differences between pentobarbital and isoflurane anesthesia under basal conditions. Endotoxin challenge caused a similar response in both anesthetic groups. Within postcapillary venules, no statistical differences between the two anesthetics were found for adhering leukocytes under basal conditions or following endotoxin challenge either. However, leukocyte rolling after LPS-challenge was significantly decreased in postcapillary venules during isoflurane anesthesia compared to pentobarbital anesthesia. Isoflurane anesthesia showed only minor differences in the immune response to endotoxin within the intestinal microcirculation compared to pentobarbital anesthesia. Due to the superior safety profile of volatile anesthetics, immunological studies may choose isoflurane over pentobarbital as the veterinary anesthetic of choice.

Study of safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery for hard-grade cataracts.

The purpose was to study the safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery (MSICS) in patients with hard-grade cataracts. The design of the study was a prospective, observational, and randomized control study. A total of 196 eyes, including 98 eyes in the subconjunctival anesthesia group (group A) and 98 eyes in the sub-Tenon anesthesia group (Group B), undergoing MSICS were enrolled in the study. A single surgeon performed all the surgeries. Intraoperative and postoperative pain scores, patient comfort, surgeon's satisfaction, and intraoperative complications were examined. The mean age of patients in Group A was 66.64 ± 9.95 years and that of patients in Group B was 64.52 ± 9.46. No statistically significant difference was noted in the intraoperative (P = 0.54) and postoperative pain (P = 0.66) scores between the two groups. There was no pain (0 score) in 30% of patients in Group A and 35% of patients in Group B intraoperatively. The average surgical time (P = 0.66) and surgeon's comfort (P = 0.34) were not statistically significant. The mean corneal haze was 0.054 ± 0.12 in group A and 0.065 ± 0.22 in group B (P = 0.45). Two patients in group A required supplemental anesthesia. There were no surgical complications that could compromise visual outcomes. No patients in either group showed alterations in vital parameters or required intravenous sedation. Both techniques of anesthesia are safe and effective for performing MSICS in hard-grade cataracts. However, it is prudent to choose a technique according to the surgeon's requirements.

The Analgesic Effects of the Thoracic Paravertebral Block on Post-percutaneous Nephrolithotripsy: A Retrospective Study.

Percutaneous nephrolithotripsy (PCNL) is a minimally invasive procedure for treating large and complex kidney stones, often resulting in significant post-operative pain and increased opioid use. This study aims to compare pain scores between patients undergoing PCNL who did and did not receive a preoperative single-shot thoracic paravertebral block (PVB) at the post-anesthesia care unit (PACU) as the primary outcome. Secondary outcomes were patient-controlled analgesia (PCA) usage on post-operative day 1 (POD 1), total opioid consumption on PACU and POD 1, and post-operative nausea and vomiting (PONV). A retrospective cohort study was conducted on the medical records of 341 patients who underwent PCNL from July 2014 to April 2016 in a single major academic center. PVB was administered at thoracic levels T7-9 using a volume of 20 cc of bupivacaine, ranging from 0.25% to 0.5%, to achieve the desired analgesic effect. After excluding 34 patients, the study included 123 in the no block (NB) group and 149 in the regional anesthesia (RA) group. There were no differences in demographics, including age, sex, weight and height, BMI, and indication for PCNL. The results revealed that the RA group experienced a statistically significant reduction in PCA usage in both crude and adjusted models (adjusted logistic regression analysis: OR = 0.19, 95% CI = 0.05-0.60; p = 0.008). However, there were no significant changes in total opioid consumption, pain scores, or incidents of PONV. The retrospective analysis did not reveal any discernible advantage in pain management associated with the use of PVB for post-PCNL analgesia, except for reducing the percentage of PCA narcotics used. Future investigations with larger sample sizes and meticulous control for surgical indications and complexity are imperative to accurately assess the efficacy of this block in the context of post-PCNL surgery.

Effect of propofol and isoflurane on NK Cells: A pilot study on perioperative breast cancer patients from Eastern India

Introduction: In onco-anesthesiology, the selection between intravenous and volatile anesthetics for maintaining NK cell response during cancer surgery has been an ambiguous area. In the absence of any such comparative Indian report, this pilot study aimed to investigate the effect of intravenous anesthetic, Propofol, and volatile anesthetic, Isoflurane on the NK cell-mediated immune-inflammatory response of perioperative breast cancer patients. Materials and Methods: Treatment naive breast cancer patients (N, 50) selected for surgery were randomly subjected to either Isoflurane (N, 25) or Propofol (N, 25) anesthetic group. The peripheral blood samples were collected 1 day before surgery (Pre), 1 h after incision (Intra) and 48 h after surgery (Post). The blood samples were subjected to immunophenotyping, activation, degranulation, and cytokine analysis. Results: The frequency of NK cell populations did not differ between the Isoflurane and Propofol groups irrespective of cancer stage II/III. NK cell degranulation marker CD107a and activation marker CD335 expression were significantly reduced in the postoperative period compared to the preoperative group in the Isoflurane group but Propofol did not inflict such alterations. Both Isoflurane/Propofol elicited similar trends in the cytokine profiles of interleukin (IL)-6, IL-15, interferon (IFN)-g and transforming growth factor (TGF)-β levels. Isoflurane significantly increased IL-8 during the intraoperative period and matrix metalloproteinase (MMP)-9 during the postoperative period whereas no such changes were observed with Propofol. Conclusion: This pilot study indicated that Propofol partially proved better over Isoflurane in maintaining the activation (CD335) and degranulation of NK cells (CD107a) and alleviating inflammation (IL-8 and MMP-9) during the perioperative period in the breast cancer patients.

Laparoskopik Kolesistektomi Sonrası Bulantı ve Kusmanın Önlenmesinde Deksametazon ve Gabapentinin Etkinliği ve Karşılaştırılması

Objective: Postoperative nausea and vomiting (PONV) is a common postoperative complication. The aim of this study was to investigate the efficacy of gabapentin and dexamethasone as new treatment strategies in the treatment of PONV. Methods: This retrospective study included a total of 136 ASA I-II patients aged 18-70 years who underwent elective cholecystectomy. Group D (n=66) received 4 mg intravenously dexamethasone after anesthesia induction and Group G (n=70) received 600 mg gabapentin oral treatment. Standard DII and V5 lead ECG, automatic non-invasive blood pressure and peripheral oxygen saturation monitoring was applied to all patients in the general operating room, anesthesia maintenance was provided with total intravenous anesthesia after orotracheal intubation and at the end of surgery, patients were transferred to the postoperative care unit. Nausea and vomiting symptoms, pain scores and the time and dose of additional antiemetic/analgesic requirements in the first 24 hours were monitored. Results: There were no statistically significant demographic differences between the groups and the results showed that both dexamethasone and gabapentin were effective in preventing PONV. The need for rescue antiemetic therapy was similar in both groups (p=0.2). Significantly less postoperative analgesic was required in the gabapentin group than in the dexamethasone group. Conclusion: Antiemetic drug prophylaxis should be administered to patients at high risk of PONV and treatment with different groups of antiemetic drugs should be considered. Dexamethasone and gabapentin can be considered effective drugs for the prevention of PONV. Keywords: Postoperative nausea and vomiting, dexamethasone, gabapentin, laparoscopic surgery, laparoscopic cholecystectomy

Effect of intravenous anesthetic drugs on fertilization rate in oocyte retrieval.

The purpose of this study was to investigate the effects of intravenous anesthetic drugs on fertilization rate in subjects receiving oocyte retrieval by assisted reproduction technology (ART). A retrospective cohort study was designed. The clinical information of subjects who received oocyte retrieval procedure was collected. The subjects were divided into two groups based on the type of anesthesia used: the no-anesthesia group and the intravenous anesthesia group. Propensity score matching (PSM) was performed and multiple linear regression analyses were conducted. Fertilization rate was compared between the two groups before and after PSM. A total of 765 subjects were divided into two groups: the no-anesthesia group (n = 482) and the intravenous anesthesia group (n = 283). According to propensity scores, 258 pairs of subjects were well matched, and the baseline data between the two groups were not significantly different (P > 0.05). Fertilization rate was 77% in the intravenous anesthesia group, and 76% in the no-anesthesia group, without significant between-group difference (P = 0.685). Before matching, Poisson regression analysis showed no effect of intravenous anesthetic drugs on fertilization rate (RR = 0.859, 95%CI: 0.59 to 1.25, P = 0.422). After matching, no difference was found either (RR = 0.935, 95%CI: 0.67 to 1.29, P = 0.618). Intravenous anesthetic drugs may exert no effects on fertilization rate in subjects receiving ART.

Comparative analysis of combined spinal–epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction

ObjectiveWe aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively.Materials and methodsThe study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal–epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded.ResultsDuring the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team’s satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05).ConclusionPCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.

Comparison of automated and manual control methods in minimal flow anesthesia.

New-generation anesthesia machines administer inhalation anesthetics and automatically control the fresh gas flow (FGF) rate. This study compared the administration of minimal flow anesthesia (MFA) using the automatically controlled anesthesia (ACA) module of the Mindray A9 (Shenzhen, China) anesthesia machine versus manual control by an anesthesiologist. We randomly divided 76 patients undergoing gynecological surgery into an ACA group (Group ACA) and a manually controlled anesthesia group (Group MCA). In Group MCA, induction was performed with a mixture of 40-60% O2 and air with a 4L/min FGF until the minimum alveolar concentration (MAC) reached 1. Next, MFA was initiated with 0.5L/min FGF. The target fraction of inspired oxygen (FiO2) value was 35-40%. In Group ACA, the MAC was defined as 1, and the FiO2 was adjusted to 35%. Depth of anesthesia, anesthetic agent (AA) consumption, time to achieve target end-tidal AA concentration, awakening times, and number of ventilator adjustments were analyzed. The two groups showed no statistically significant differences in depth of anesthesia or AA consumption (Group ACA: 19.1 ± 4.9ml; Group MCA: 17.2 ± 4.5; p-value = 0.076). The ACA mode achieved the MAC target of 1 significantly faster (Group ACA: 218 ± 51s; Group MCA: 314 ± 169s). The number of vaporizer adjustments was 15 in the ACA group and 217 in the MCA group. The ACA mode was more advantageous than the MCA mode, reaching target AA concentrations faster and requiring fewer adjustments to achieve a constant depth of anesthesia.

Intravenous infusion of dexmedetomidine during the surgery to prevent postoperative delirium and postoperative cognitive dysfunction undergoing non-cardiac surgery: a meta-analysis of randomized controlled trials.

Dexmedetomidine plays a pivotal role in mitigating postoperative delirium and cognitive dysfunction while enhancing the overall quality of life among surgical patients. Nevertheless, the influence of dexmedetomidine on such complications in various anaesthesia techniques remains inadequately explored. As such, in the present study, a meta-analysis was conducted to comprehensively evaluate its effects on postoperative delirium and cognitive dysfunction. A number of databases were searched for randomised controlled trials comparing intravenous dexmedetomidine to other interventions in preventing postoperative delirium and cognitive dysfunction in non-cardiac and non-neurosurgical patients. These databases included PubMed, Embase, and Cochrane Library. Statistical analysis and graphing were performed using Review Manager, STATA, the second version of the Cochrane risk-of-bias tool for randomised controlled trials, and GRADE profiler. This meta-analysis comprised a total of 24 randomised controlled trials, including 20 trials assessing postoperative delirium and 6 trials assessing postoperative cognitive dysfunction. Across these 24 studies, a statistically significant positive association was observed between intravenous administration of dexmedetomidine and a reduced incidence of postoperative delirium (RR: 0.55; 95% CI 0.47 to 0.64,p < 0.00001, I2 = 2%) and postoperative cognitive dysfunction (RR: 0.60; 95% CI 0.38 to 0.96,p = 0.03, I2 = 60%). Subgroup analysis did not reveal a significant difference in the incidence of postoperative delirium between the general anaesthesia and non-general anaesthesia groups, but a significant difference was observed in the incidence of postoperative cognitive dysfunction. Nonetheless, when the data were pooled, it was evident that the utilisation of dexmedetomidine was associated with an increased incidence of hypotension (RR: 1.42; 95% CI 1.08 to 1.86,p = 0.01, I2 = 0%) and bradycardia (RR: 1.66; 95% CI 1.23 to 2.26,p = 0.001, I2 = 0%) compared with other interventions. However, there was no significantly higher occurrence of hypertension in the DEX groups (RR = 1.35, 95% CI 0.81-2.24, p = 0.25,I2 = 0%). Compared with other interventions, intravenous dexmedetomidine infusion during non-cardiac and non-neurosurgical procedures may significantly reduce the risk of postoperative delirium and cognitive dysfunction. The results of subgroup analysis reveal a consistent preventive effect on postoperative delirium in both general and non-general anaesthesia groups. Meanwhile, continuous infusion during general anaesthesia was more effective in reducing the risk of cognitive dysfunction. Despite such findings, hypotension and bradycardia were more frequent in patients who received dexmedetomidine during surgery.

Pain during primary molar local anaesthesia with SleeperOne5 computerized device versus conventional syringe: A randomized, split-mouth, crossover, controlled trial.

Because of controversial results from clinical studies comparing different dental local anesthesia methods in children, the primary objective of this randomized, split-mouth, crossover, controlled trial was to compare pain intensity during local anaesthesia (LA) performed with a computer-controlled LA delivery system (C-CLADS) versus a conventional syringe (CONV). Secondary objectives included comparisons during dental treatment. Participants (4-8 years) with tooth pair requiring similar treatment were recruited from five French hospitals. The right primary molar, which was treated at the first visit, was randomly allocated to one of the anaesthesia groups (either intraosseous with C-CLADS or infiltration with CONV), whereas the contralateral molar (treated at the second visit) was assigned to the other group. Pain intensity and behaviour outcomes, assessed with the Faces Pain and Venham revised scales, respectively, were compared between groups using Proc mixed. Stratified analyses were performed on dentition and location. Among 107 participants, the analysis revealed reduced pain perception during LA in the C-CLADS group compared with the CONV group (-0.72, 95% CI: -1.43, -0.006), but not during dental treatment. Stratified analyses showed that this effect was observed only in primary dentition (p = .006) and mandibular molars (p = .005). Behavioural issues were fewer in the C-CLADS group than in the CONV group (p = .05) only during injection. C-CLADS emerged as the preferable system in primary dentition.

The Effect of Depth of Anesthesia on Postoperative Pain in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

BackgroundPatients with obesity are more sensitive to pain and more likely to have acute postoperative pain (APP). Studies have shown that the depth of anesthesia may affect the incidence of APP. The purpose of the study was to look into the connection between APP and depth of anesthesia in patients with obesity undergoing laparoscopic sleeve gastrectomy.MethodsThis is a prospective, double-blinded randomized clinical trial, 90 patients undergoing laparoscopic sleeve gastrectomy were randomly divided into two groups: the light anesthesia group (Bispectral Index of 50, BIS 50) and the deep anesthesia group (BIS 35). The degree of pain was evaluated by the visual analogue scale (VAS) at 0, 12, 24, 48, and 72 h after surgery. The use of analgesics, grade of postoperative nausea and vomiting (PONV), and the Quality of Recovery-15 (QoR-15) score were recorded.ResultsThe VAS scores at rest or coughing at 0, 12, and 24 h after surgery in the BIS 35 group were lower than those in the BIS 50 group (P < 0.05). Fewer patients in the deep anesthesia group needed analgesia during the recovery period, and patient satisfaction was higher on the 3rd day after surgery (P < 0.015, P < 0.032, respectively).ConclusionsFor patients with obesity, maintaining a deeper depth of anesthesia during surgery is beneficial to reduce APP causes less need for additional analgesic drugs, and improves patient satisfaction.Graphical

The impact of ultrasound-guided erector spinae plane block on hemodynamic stability and postoperative pain in patients undergoing modified radical mastectomy for breast cancer.

Breast cancer, a prevalent global malignancy in women, necessitates a comprehensive treatment approach, with surgery playing a crucial role. Severe acute pain is common post-radical breast cancer surgery, emphasizing the significance of hemodynamic stability and postoperative pain control for optimal outcomes. This study evaluates the impact of ultrasound-guided erector spinae plane block (ESPB) on these parameters in ASA scores 1-2 patients undergoing modified radical breast cancer surgery with general anesthesia. Forty-eight patients were divided into two groups: a general anesthesia group, with erector spinae plane block (GA+ESPB), and a control group receiving only general anesthesia (GA). Hemodynamic parameters were continuously monitored, and postoperative pain was assessed using the visual analog scale (VAS) at various time points. Ultrasound-guided ESPB effectively maintained hemodynamic stability and reduced postoperative pain in breast cancer surgery patients. Statistically significant differences were observed in heart rate, systolic and diastolic blood pressure, and mean arterial pressure between the GA and GA+ESPB groups at multiple time points (p < 0.05). VAS scores showed a significant interaction time*group (p < 0.001), with consistent differences between the groups at all time points (p ≤ 0.001). Ultrasound-guided ESPB application proved effective in preserving hemodynamic stability and managing postoperative pain in modified radical breast cancer surgery. The technique demonstrates promise in minimizing complications related to hemodynamic variations and postoperative pain, contributing to a comprehensive approach to breast cancer surgical treatment.

Comparative assessment of hemodynamic parameters during anesthesia in orthopedic and traumatological operations on the lower extremities in children

Objective. To conduct a comparative analysis of hemodynamic parameters during orthopedic and traumatological operations on the lower extremities in children performed under conditions of multicomponent balanced general and combined anesthesia. Materials and methods. A single-center prospective study. The present study included 60 children aged 6 to 17 years who underwent planned orthopedic and trauma surgery interventions on the lower extremities. Patients were divided into two groups depending on the method of anesthesia: Group 1 (n = 25) - multicomponent balanced general anesthesia, Group 2 (n = 35) - combined anesthesia (multicomponent balanced general anesthesia in combination with regional blocks of the sciatic and femoral nerves). To solve these problems, a comparative analysis of heart rate, systolic, diastolic and mean arterial blood pressure was carried out at seven stages of the study: 1st stage - initial, child on the operating table; 2nd stage - induction of anesthesia; 3rd stage - placement of the laryngeal mask; 4th stage - start of the operation; 5th stage - traumatic stage of the operation; 6th stage - completion of the operation; 7th stage - after removal of the laryngeal mask. Results. In all cases, the surgical interventions were successful. The study found that in the group of children who underwent multicomponent general anesthesia at the 4th (start of surgery), 5th (traumatic stage of surgery) and 6th (end of surgery) stages, heart rate (HR) was higher compared to the group of combined anesthesia. Systolic and mean arterial blood pressure during the traumatic phase of surgery were also higher in children undergoing multicomponent general anesthesia. The values of diastolic blood pressure did not differ between groups throughout the study with the exception of the 3rd stage (laryngeal mask placement) where lower values were observed in patients of the Group 1. Diastolic blood pressure values did not differ between groups throughout the study, with the exception of 3th stage (laryngeal mask placement), where lower values were noted in Group 1 patients. Conclusion. Combined methods of anesthesia based on the combination of multicomponent general anesthesia and conductive peripheral nerve blocks provide the greatest hemodynamic stability during orthopedic and traumatologic surgeries on the lower extremities in children.

The effect of upper transabdominal plane block on diaphragm thickness in adult patients after laparoscopic cholecystectomy operation.

In this prospective and observational study, our objective was to examine the impact of subcostal transversus abdominis plane (SubTAP) block, along with intravenous analgesia techniques, on diaphragm thickness and post-operative pain following laparoscopic cholecystectomy. This study examined laparoscopic cholecystectomy patients aged 18-60 years with an American Society of Anesthesiologist score of 1-2. This study divided patients into Group 1 for SubTAP block and Group 2 for intravenous analgesia. This study had 67 patients, at least 30 from each group. Thus, diaphragm thicknesses and Visual Analogue Scale (VAS) values were compared between regional anaesthesia and intravenous analgesia groups. Pre-operative data showed no statistically significant changes between the groups, although post-extubation inspiratory thickness was closer to baseline in Group 1 patients who received regional block. The groups had different outcomes after extubation and at the post-operative 30th min (P = 0.028 and P = 0.001, respectively). There was also a significant difference in post-operative oxygen saturation and VAS scores (P = 0.001). Our receiver operating characteristic analysis determined that the threshold values for VAS parameters of 2 or 3 were 0.28 cm in inspiration, 0.18 cm in expiration and 1.29 as i/e ratio. Significant discomfort was defined as diaphragm parameter values below these limits. We found that the earlier return of diaphragmatic functions to baseline was associated with diaphragm thickness. According to the measurements made in the post-operative care unit, the regional block group effectively prevented the loss of diaphragm function.

Use of concomitant anesthesia (endotracheal anesthesia and femoral nerve block) in cardiac surgery: a prospective, cross-sectional study

BACKGROUND: Regional anesthesia reduces pain impulse transmission, which reduces hormonal and metabolic responses to operational stress. No studies have reported on the use of combined anesthesia, such as endotracheal anesthesia and femoral nerve block, in cardiac surgery. OBJECTIVE: To determine the efficacy of combined anesthesia by analyzing the cortisol, glucose, and lactate levels in cardiac surgery. MATERIALS AND METODS: Prospective cross-sectional study was conducted. The study included 60 cardiac surgery patients. The patients were divided into two groups: group 1, with endotracheal anesthesia and femoral nerve blockade, and group 2, with endotracheal anesthesia (control group). All patients underwent aortocoronary bypass grafting under artificial circulation conditions. Cortisol, glucose, and lactate levels at the five stages of the perioperative period were investigated. RESULTS: Data analysis showed that the cortisol level of patients with combined anesthesia was significantly 1.2 times lower (p=0.042) than that in the control group in step 2. Glucose levels were significantly lower in the combined anesthesia group by 1.28 times (p=0.0017) than in the control group in step 4 and significantly lower by 1.2 times (p=0.0016) in step 5. Additionally, lactate level was significantly lower in the combined anesthesia group than in the control group in step 4 by a factor of 1.3 (p=0.03) and in step 5 by a factor of 1.35 times (p=0.005). CONCLUSION: The determination of cortisol, glucose, and lactate levels can be used as a component of endocrine-metabolic anesthesiological monitoring when performing cardiac surgery under artificial circulation conditions. Stable parameters of endocrine-metabolic monitoring were established using both anesthesia methods. The use of femoral nerve block in combined anesthesia reduces stress response to surgery.

Feasibility of tension-free repair of inguinal hernia in senile patients under ultrasound-guided local nerve block

The clinical characteristics of open hernia repair under local nerve block guided by ultrasound and epidural anesthesia under daytime surgery mode were compared and analyzed, and the safety, rationality and effectiveness of tension-free repair of inguinal hernia in elderly patients under local nerve block guided by ultrasound were discussed. The clinical data of 200 patients who underwent inguinal hernia day surgery in Liaocheng People's Hospital Affiliated to Shandong First Medical University from January 2022 to October 2022 were retrospectively analyzed, including 150 patients who underwent local anesthesia block surgery and 50 patients who underwent epidural surgery. The visual analog score of the ultrasound local anesthesia group was lower than that of the epidural surgery group at 4 h after operation. The time of getting out of bed and postoperative exhaust were shorter than those of epidural operation group. The recovery rate of unrestricted activity 2 weeks after surgery was higher than that in epidural surgery group (P < 0.05). The incidence of postoperative acute urinary retention between the two groups was lower in local ultrasound anesthesia group, and the difference was statistically significant (P < 0.05). The median follow-up time was 4(1–6) months, and the follow-up rate was 100%. Postoperative complications were seroma, wound infection, chronic pain and recurrence, and there was no statistical significance between the two groups (P > 0.05). No serious complications occurred in both groups. Compared with open epidural surgery, ultrasound-guided local nerve block tension-free day surgery in the elderly has the advantages of less pain, faster recovery, and is safe and feasible.

Factors influencing decision-making for the anesthetic technique in molar pregnancy patients for suction curettage: A retrospective study

Anesthetic techniques for suction curettage in molar pregnancy patients described in the literature can be classed into general anesthesia and regional anesthesia techniques. The aim of the present study was to report the factors influencing the decision-making for the choice of anesthetic technique in molar pregnancy patients who underwent suction curettage at Siriraj Hospital. The reported intraoperative and postoperative complications were also analyzed.A retrospective chart review was conducted among pregnant women diagnosed with molar pregnancy who had underwent suction curettage under anesthesia at Siriraj Hospital between January 2007 to September 2021. Overall, 244 patients were diagnosed with molar pregnancy, with 110 of these included for analysis in this study after consideration of the inclusion and exclusion criteria. Quantitative data of the included patients were analyzed by either unpaired t-test or Mann–Whitney U test, while qualitative data were analyzed by the chi-square test. Logistic regression was used to establish the factors influencing the decision-making for the anesthetic technique.General anesthesia was the most preferred anesthetic technique (77.4%) in the molar pregnancy patients who had underwent suction curettage, followed by regional anesthesia (11.3%) and intravenous sedation (11.3%). General anesthesia was likely to be used in patients with an enlarged uterine size ≥ 16 weeks with an adjusted odds ratio of 11.64 (95% CI 1.08–125.72, p &amp;#60; 0.05). Patients with a larger uterine size were associated with higher beta-hCG levels, resulting in more severe medical complications, such as hyperthyroidism and hyperemesis gravidarum (p &amp;#60; 0.05). Intraoperative complications, such as uterine atony (17.7%), massive hemorrhage (7.3%), and pulmonary edema (4.2%), were confined within patients receiving general anesthesia, but there was no statistical significance. None of the patients had anesthesia-related complications. The reported postoperative serious complications, such as pulmonary edema (4.2%), which required postoperative intubation and transferal to the intensive care unit, were all in the general anesthesia group. Patients with higher co-morbidities were advised by anesthesiologists to receive general anesthesia. However, an enlarged uterine size ≥ 16 weeks was the only factor that had an influence on the decisions of the anesthesiologists to provide general anesthesia.

Development and Validation of the SCAN-Score to Indicate General Anesthesia for Dental Care in Children.

Background: General anesthesia is an approach used to address behavior issues in pediatric dentistry. This indication often relies on the practitioner's discretion rather than objective criteria. We developed SCAN-score to assist pediatric dentists in the case of doubt to indicate general anesthesia for uncooperative children. The study aims were to assess the validity of the SCAN-score, which aims to indicate general anesthesia or chairside management for dental care. Methods: A retrospective study was performed on children aged between 2 and 10 years who received dental care. The SCAN-score combined three item scales (age, need of care, behavior) and three additional factors: communication barriers, permanent teeth caries, and local anesthesia contraindications. Mean scores were estimated. An ROC curve was constructed with sensitivities and specificities obtained. Results: The study included 284 children, with 154 treated through chairside methods and 130 treated under general anesthesia. The mean score was 5.6 ± 2.8 in the chairside management group and 12.9 ± 1.9 in the general anesthesia group. The sensitivity of the score (cutoff at 10) was 0.99, and the specificity was 0.94. The estimate of the ROC is 0.994. Conclusions: The SCAN-score appears to be an excellent tool to support the practitioner's decision to refer to general anesthesia care.

Association between Anesthesia Group Size and Merit-Based Incentive Payment System Scores.

Association between Anesthesia Group Size and Merit-Based Incentive Payment System Scores.