Anesthesia In Adult Patients Research Articles

A study comparing brain wave patterns of fentanyl and ketamine in adult patients undergoing minimally invasive surgery.

This study aimed to investigate and compare the neurophysiological impacts of two widely used anesthetic agents, Fentanyl and Ketamine, on EEG power spectra during different stages of anesthesia in adult patients undergoing minimally invasive surgery. EEG data were collected from patients undergoing anesthesia with either Fentanyl or Ketamine. The data were analyzed for relative power spectrum and fast-to-slow wave power ratios, alongside Spectral Edge Frequency 95% (SEF95), at 3 key stages: pre-anesthesia, during stable anesthesia, and post-anesthesia. EEG Relative Power Spectrum: Initially, both groups exhibited similar EEG spectral profiles, establishing a uniform baseline (P > .05). Upon anesthesia induction, the Fentanyl group showed a substantial increase in delta band power (P < .05), suggesting deeper anesthesia, while the Ketamine group maintained higher alpha and beta band activity (P < .05), indicative of a lighter sedative effect. Fast and Slow Wave Power Ratios: The Fentanyl group exhibited a marked reduction in the fast-to-slow wave power ratio during anesthesia (P < .05), persisting post-anesthesia (P < .05) and indicating a lingering effect on brain activity. Conversely, the Ketamine group demonstrated a more stable ratio (P > .05), conducive to settings requiring rapid cognitive recovery. Spectral Edge Frequency 95% (SEF95): Analysis showed a significant decrease in SEF95 values for the Fentanyl group during anesthesia (P < .05), reflecting a shift towards lower frequency power. The Ketamine group experienced a less pronounced decrease (P > .05), maintaining a higher SEF95 value that suggested a lighter level of sedation. The study highlighted the distinct impacts of Fentanyl and Ketamine on EEG power spectra, with Fentanyl inducing deeper anesthesia as evidenced by shifts towards lower frequency activity and a significant decrease in SEF95 values. In contrast, Ketamine's preservation of higher frequency activity and more stable SEF95 values suggests a lighter, more dissociative anesthetic state. These findings emphasize the importance of EEG monitoring in anesthesia for tailoring anesthetic protocols to individual patient needs and optimizing postoperative outcomes.

Intranasal Premedication With Dexmedetomidine in an Adult Patient With Intellectual Disabilities: A Case Report

Recently, intranasal dexmedetomidine (DEX) has been reported to be effective as a preanesthetic medication, mostly in healthy pediatric patients. We attempted to administer intranasal DEX premedication in this case to an adult patient with intellectual disability who previously had difficulty tolerating premedication with oral midazolam. Using an intranasal atomization delivery device (MAD Nasal, Teleflex), we administered 1.5 µg/kg of DEX intranasally and were able to achieve adequate sedation, which facilitated a smooth mask induction of general anesthesia with sevoflurane. Premedication with intranasal DEX may be a useful method for enabling induction of general anesthesia in adult patients with intellectual disabilities.

High-flow nasal cannula oxygen reduced hypoxemia in patients undergoing gastroscopy under general anesthesia at ultra-high altitude: a randomized controlled trial.

Hypoxemia can occur in people at ultra-high altitude (above 3500m) even at rest, and patients undergoing gastroscopy under general anesthesia have higher risk of hypoxemia. Supplementary oxygen via standard nasal cannula (SNC) is the standard of care for most patients who undergo gastroscopy under general anesthesia, which provides oxygen flow up to 15L/min. High-flow nasal cannula (HFNC) could deliver oxygen at a rate up to 60L/min, which is recommended by the American Society of Anesthesiologists Practice Guidelines. We speculated that the benefit with HFNC is more prominent in high-altitude areas, and aimed to compare the incidence of hypoxemia during gastroscopy under general anesthesia at ultra-high altitude with oxygen supply via either HFNC or SNC. The trial was registered at at Chinese Clinical Trial Registry (ChiCTR2100045513; date of registration on 18/04/2021). Adult patients undergoing gastroscopy with anesthesia (estimated duration of anesthesia at ≥ 15min) were randomized at a 1:1 ratio to receive HFNC oxygen or SNC oxygen. The primary outcome was hypoxemia (SpO2 < 90% for any duration). Secondary outcomes included severe hypoxemia (SpO2 < 75% for any duration or SpO2 < 90% but ≥ 75% for ≥ 60s) and hypotension, as defined by reduction of mean arterial blood pressure by ≥ 25% from the baseline. A total of 262 patients were enrolled: 129 in the HFNC group and 133 in the SNC group. All patients received the designated intervention. Student's t-test, Mann-Whitney U test and χ2 test were employed in the study. The rate of hypoxemia was 9.3% (12/129) in the HFNC group versus 36.8% (49/133) in the SNC group [risk ratio (95% confidence interval): 0.25(0.14-0.45); P < 0.001). The HFNC group also had lower rate of severe hypoxemia [0.0% (0/129) versus 11.3% (15/133); risk ratio (95% confidence interval): 0.03(0.00-0.55); P < 0.001, respectively]. The rate of hypotension did not differ between the 2 groups [22.5% (29/129) in HFNC group versus 21.1% (28/133) in SNC group; risk ratio (95% confidence interval): 1.07(0.67-1.69) ; P = 0.779]. HFNC oxygen reduced the incidence of hypoxemia during anesthesia in adult patients undergoing gastroscopy at ultra-high altitude.

Estimating the usefulness of inferior vena cava collapsibility index and caval aorta index to predict hypotension after spinal anaesthesia in adult patients undergoing elective surgery in a tertiary care hospital

Abstract Background and Aims: Post-spinal anaesthesia hypotension (PSAH) can occur in 25–75% of patients. The preload or volume status of a patient is an important contributor to PSAH, and coloading with fluids is advocated to prevent PSAH. Instead of blind volume loading, prediction of volume status using inferior vena cava (IVC) collapsibility index (IVCCI) and caval aorta index (IVC:Ao index) may be used to guide fluid administration. Material and Methods: In our study, we used ultrasound in the immediate pre-operative period to calculate IVCCI and IVC:Ao index in patients scheduled for elective surgery in the supine position, under spinal anaesthesia. Spinal anaesthesia was given in the lateral position with 0.5% hyperbaric bupivacaine. Patients were placed supine thereafter, sensory blockade level was ascertained, and blood pressure (BP) was measured every 2 min for 30 min. Episodes of hypotension were treated with fluids or vasopressors as per the discretion of the treating anaesthesiologist. In the study, 73 patients were screened, out of which 69 were included. Results: Totally, 23 participants out of 69 developed PSAH. The receiver operating characteristic (ROC) curve was made and the area under the curve analysis was done on our collected data. We found that IVC:Ao index has better sensitivity (0.696 for IVC:Ao index ≤0.810) and specificity (0.717 for IVC:Ao index ≤0.810) than IVCCI (sensitivity 0.522 and specificity 0.630 for IVCCI ≥33.32%) to predict PSAH. Conclusion: IVC:Ao index is a better predictor of PSAH than IVCCI. Thus, it may be used to predict volume status and guide in coloading with fluids during spinal anaesthesia.

Effects of addition of fentanyl to lidocaine plus adrenaline during peribulbar anaesthesia for cataract surgery: A prospective study

Background: Local anaesthesia is most commonly used for cataract surgery in adult patients. Different combinations of local anesthetic agents and adjuvants have been used to provide adequate anaesthesia and analgesia. This study assessed the effect of adding 25 µg fentanyl to lidocaine with adrenaline mixture on the onset and duration of anaesthesia in adult patients undergoing cataract surgery under peribulbar anaesthesia. Methods: This was a double blind, randomized controlled study. Adult patients aged 40 years and above with American Society of Anesthesiologists Physical Status Classes 1 and 2 undergoing cataract surgery under peribulbar block (PB) were studied. Sixty-six patients were randomized into two equal groups. Group A had 25 µg fentanyl (0.5 mL) added to 6 mL of 2% lidocaine with adrenaline while Group B had sterile water 0.5 mL added to 6 mL of 2% lidocaine with adrenaline for PB. Onset and duration of lid akinesia, globe akinesia, globe anaesthesia, Numerical Rating Scale (NRS) pain score, time to analgesia request as well as patient and surgeon satisfaction were assessed. Results: The differences in the onset of lid akinesia, globe akinesia, and globe anaesthesia between the two groups were statistically significant (P ≤ 0.001, respectively). The mean duration of globe akinesia and globe anaesthesia was longer in Group A as compared to Group B (P = 0.008 and P = 0.009, respectively). Statistically significant differences in median NRS scores were found at the 4th, 5th, and 6th h (P = 0.001, respectively). The mean duration to analgesia request was 238.1 ± 65.5 min in Group A compared to 207.2 ± 49.1 min in Group B (P = 0.034). Conclusion: The addition of 25 µg fentanyl to 2% lidocaine plus adrenaline mixture improved the quality of peribulbar anaesthesia and is recommended in Nigerian adults scheduled for cataract surgery under peribulbar anaesthesia to improve their surgical experience.

Comparison of Two Different Volumes of Epidural Normal Saline for Enhancing the Effects of Spinal Anesthesia in Adult Patients Undergoing Elective Lower Limb Surgeries: A Prospective Randomized Study

Background: The combined spinal-epidural (CSE) anesthesia technique gives a reliable subarachnoid block as well as the flexible epidural block. One of the modified technique of CSE is epidural volume expansion (EVE) in which normal saline or local anesthetic (LA) is instilled though epidural catheter leading to increase in level of sensory blockade. Aim of the study was to compare two different volumes of normal saline for enhancing the effects of spinal anaesthesia in adult patients undergoing elective lower limb surgeries.&#x0D; Methods: 90 patients were randomly divided into two group. Group A - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 10ml of 0.9% normal saline for EVE using CSE technique. Group B - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 15ml of 0.9% normal saline for EVE using CSE technique.&#x0D; Results: The demographic data were comparable in both groups. Significant difference was seen in total duration of sensory blockade between group A (192.11±9.80) and group B (Mean ± SD 215.33±17.57minutes) (p&lt;0.0001). Total duration of motor blockade was longer in group B (Mean± SD: 181.91± 16.42) as compared to group A (Mean ± SD: 162.48 ± 9.35 minutes) (p&lt;0.0001).&#x0D; Conclusion: We conclude that epidural volume expansion (EVE) with 15 ml epidural normal saline was associated with faster onset, higher level and early achieve maximum level of sensory blockade, longer two segment regression time, early onset and longer duration of motor blockade as compared to EVE with 10 ml epidural normal saline.

Comparing Ambu AuraGain™ Disposable Laryngeal Mask with i-gel™ as a conduit for fibreoptic guided tracheal intubation for elective surgery under general anaesthesia in adult patients

BackgroundSupraglottic airway devices (SADs) have emerged as an alternative for airway management, serving as conduits for tracheal intubation with fibreoptic bronchoscopy (FOB). In this study, we aim to compare the efficacy of two SADs for FOB guided tracheal intubation in adult patients undergoing elective surgery. Methods120 patients were randomly assigned to two groups Group A (i-gel™) or Group B (Ambu AuraGain™ Disposable Laryngeal Mask). The ease of insertion, time for successful placement, number of attempts, need for manipulation, time for FOB intubation and laryngeal view were recorded. ResultsThe first pass success rate of intubation through either SAD was 100% (p = 1). Group A had a significantly higher ease of insertion score of 1 than Group B (63.33% vs 38.33%, p = 0.003). The time required for successful placement of the device was significantly longer in Group B than in Group A (17.44 ± 5.46 s vs13.62 ± 4.67 s, p = 0.001). The mean ± SD of time for FOB guided intubation(seconds) in group A was 66.59 ± 21.42 which was significantly higher as compared to group B (55.93 ± 19.79) (p value = 0.005). Conclusion: Our study compared i-gel™ and Ambu AuraGain™ for FOB-guided tracheal intubation and found both SADs equally effective with similar laryngeal views. Despite i-gel's superior ease of insertion, shorter time for insertion and fewer airway manipulations for insertion, Ambu AuraGain™ exhibited a shorter intubation time. Incidences of intraoperative and postoperative complications were comparable. Clinicians should choose the SAD based on preference and familiarity.

The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Surgical interventions in hip fracture have been associated with multiple adverse events, including perioperative hypotension and mortality, making the choice of the anesthetic method for this procedure crucial. There is still no consensus on whether regional (RA) or general (GA) anesthesia should be used to maintain hemodynamic stability and more favorable outcomes. Therefore, this meta-analysis examines the differences between RA and GA groups in the incidence of mortality, intraoperative hypotension, and other intra- and postoperative complications. The comparison is essential given the rising global prevalence of hip fractures and the need to optimize anesthesia strategies for improved patient outcomes, particularly in an aging population. We followed PRISMA guidelines (PROSPERO #CRD42022320413). We conducted the search for studies published in English before March 2022 in PubMed, Google Scholar, and the Cochrane Library. We included RCTs that compared general and regional anesthesia in adult patients having hip fracture surgical interventions. The primary outcome was perioperative mortality. The secondary outcomes were peri- or postoperative complications and duration of hospital stay. We conducted a meta-analysis in RevMan (version 5.4). We examined the quality of the methodology with the Cochrane risk of bias 2 tool, while the quality of evidence was determined with GRADE. Fifteen studies with 4110 patients were included. Our findings revealed no significant difference between general and regional anesthesia in risk of perioperative mortality (RR = 1.42 [0.96, 2.10], p-value = 0.08), intraoperative complications, or duration of hospital length of stay. Our results suggest that regional anesthesia and general anesthesia have comparable safety and can be used as alternatives based on specific patient requirements.

Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis

BackgroundPrevious studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery.MethodsWe performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus.ResultsTwenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13–1.29; P < 0.001, n = 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96–1.05; P = 0.95, n = 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82–1.06; P = 0.28, n = 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74–1.20; P = 0.61, n = 2861) had no significant difference.ConclusionRegional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.

Carotid artery corrected flow time and respiratory variation of blood flow peak velocity for prediction of hypotension after induction of general anesthesia in adult patients undergoing emergency laparotomy for peritonitis: A prospective, observational study.

Doppler waveform analysis of carotid artery has been found to predict fluid responsiveness in patients undergoing elective surgeries. We evaluated the role of carotid artery corrected flow time (FTc) and respiratory variation of blood flow peak velocity (ðVpeak) in predicting post induction hypotension in patients undergoing emergency laparotomy for peritonitis. Adult patients (n = 60) with perforation peritonitis undergoing emergency laparotomy under general anesthesia (GA) were recruited in this prospective, observational study. Carotid ultrasonography was performed pre-induction, to determine FTc and ðVpeak. Post-induction hemodynamic parameters were recorded for 5 minutes. Spearman's rank correlation coefficient was used to determine the relationship between hypotension and carotid artery measurements. Post-induction hypotension occurred in 48.3% of patients. The carotid artery FTc was significantly lower (P = 0.008) in patients who developed post-induction hypotension, but ðVpeak was statistically similar (P = 0.62) in both groups. Spearman's rank correlation coefficient revealed a statistically significant correlation between FTc and systolic blood pressure (SBP) change at one-minute post induction (r2 = -0.29, P = 0.03); however statistical significance were not achieved at 2 minutes and 3 minutes (P = 0.05 at both time points). Carotid artery FTc had an area under the receiver operating characteristic (AUROC) curve (95% CI) of 0.70 (0.57-0.84) to predict post-induction hypotension and best cutoff value of 344.8 ms with a sensitivity and specificity of 61% and 79%, respectively. Carotid artery ðVpeak had an AUROC curve (95% CI) of 0.54 (0.39-0.69) to predict post-induction hypotension and best cutoff value of 7.9% with a sensitivity and specificity of 62% and 55%, respectively. Carotid artery FTc and ðVpeak are not reasonable predictors of hypotension in patients undergoing emergency laparotomy for perforation peritonitis.

Early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study.

This study was undertaken to investigate the efficacy, tolerability, and outcome of different timing of anesthesia in adult patients with status epilepticus (SE). Patients with anesthesia for SE from 2015 to 2021 at two Swiss academic medical centers were categorized as anesthetized as recommended third-line treatment, earlier (as first- or second-line treatment), and delayed (later as third-line treatment). Associations between timing of anesthesia and in-hospital outcomes were estimated by logistic regression. Of 762 patients, 246 received anesthesia; 21% were anesthetized as recommended, 55% earlier, and 24% delayed. Propofol was preferably used for earlier (86% vs. 55.5% for recommended/delayed anesthesia) and midazolam for later anesthesia (17.2% vs. 15.9% for earlier anesthesia). Earlier anesthesia was statistically significantly associated with fewer infections (17% vs. 32.7%), shorter median SE duration (.5 vs. 1.5 days), and more returns to premorbid neurologic function (52.9% vs. 35.5%). Multivariable analyses revealed decreasing odds for return to premorbid function with every additional nonanesthetic antiseizure medication given prior to anesthesia (odds ratio [OR] = .71, 95% confidence interval [CI] = .53-.94) independent of confounders. Subgroup analyses revealed decreased odds for return to premorbid function with increasing delay of anesthesia independent of the Status Epilepticus Severity Score (STESS; STESS = 1-2: OR = .45, 95% CI = .27-.74; STESS > 2: OR = .53, 95% CI = .34-.85), especially in patients without potentially fatal etiology (OR = .5, 95% CI = .35-.73) and in patients experiencing motor symptoms (OR = .67, 95% CI = .48-.93). In this SE cohort, anesthetics were administered as recommended third-line therapy in only every fifth patient and earlier in every second. Increasing delay of anesthesia was associated with decreased odds for return to premorbid function, especially in patients with motor symptoms and no potentially fatal etiology.

Effects of sugammadex versus neostigmine on postoperative nausea and vomiting after general anesthesia in adult patients:a single-center retrospective study

We aimed to compare the effect of sugammadex to that of neostigmine with respect to the occurrence of postoperative nausea and vomiting (PONV) during the first 24 h following general anesthesia. This retrospective cohort study included patients who underwent elective surgery under general anesthesia in 2020 at an academic medical center in Seoul, South Korea. The exposure groups were determined according to whether the patient received sugammadex or neostigmine as a reversal agent. The primary outcome was PONV occurrence during the first 24 h postoperatively (overall). The association between the type of reversal agent and primary outcome was investigated using logistic regression while adjusting for confounding variables using stabilized inverse probability of treatment weighting (sIPTW). Of the 10,912 patients included in this study, 5,918 (54.2%) received sugammadex. Sugammadex was associated with a significantly lower incidence of overall PONV (15.8% vs. 17.7%; odds ratio, 0.87; 95% confidence interval [CI], 0.79–0.97; P = 0.010) after sIPTW. In conclusion, compared with neostigmine/glycopyrrolate, sugammadex use has a lower risk of PONV during the first 24 h following general anesthesia.

Norepinephrine versus phenylephrine for treating hypotension during general anaesthesia in adult patients undergoing major noncardiac surgery: a multicentre, open-label, cluster-randomised, crossover, feasibility, and pilot trial

BackgroundIntraoperative hypotension is associated with postoperative complications. The use of vasopressors is often required to correct hypotension but the best vasopressor is unknown. MethodsA multicentre, cluster-randomised, crossover, feasibility and pilot trial was conducted across five hospitals in California. Phenylephrine (PE) vs norepinephrine (NE) infusion as the first-line vasopressor in patients under general anaesthesia alternated monthly at each hospital for 6 months. The primary endpoint was first-line vasopressor administration compliance of 80% or higher. Secondary endpoints were acute kidney injury (AKI), 30-day mortality, myocardial injury after noncardiac surgery (MINS), hospital length of stay, and rehospitalisation within 30 days. ResultsA total of 3626 patients were enrolled over 6 months; 1809 patients were randomised in the NE group, 1817 in the PE group. Overall, 88.2% received the assigned first-line vasopressor. No drug infiltrations requiring treatment were reported in either group. Patients were median 63 yr old, 50% female, and 58% white. Randomisation in the NE group vs PE group did not reduce readmission within 30 days (adjusted odds ratio=0.92; 95% confidence interval, 0.6–1.39), 30-day mortality (1.01; 0.48–2.09), AKI (1.1; 0.92–1.31), or MINS (1.63; 0.84–3.16). ConclusionsA large and diverse population undergoing major surgery under general anaesthesia was successfully enrolled and randomised to receive NE or PE infusion. This pilot and feasibility trial was not powered for adverse postoperative outcomes and a follow-up multicentre effectiveness trial is planned. Clinical trial registrationNCT04789330 (ClinicalTrials.gov).

An Adequate Infusion Rate of Remimazolam for Induction of General Anesthesia in Adult Patients: A Prospective Up-and-Down Dose-Finding Study

Remimazolam is a recently developed anesthetic agent for general anesthesia and sedation. Currently, the optimal infusion rate for the induction of general anesthesia within two minutes remains unclear. We estimated the 50% and 90% effective doses (ED50 and ED90) of remimazolam required for loss of responsiveness within two minutes in adult patients using the up-and-down method. The starting infusion rate of remimazolam was 0.1 mg/kg/min and was increased or decreased by 0.02 mg/kg/min intervals in the following patient according to the success or failure of the previous patient. Success was defined as a loss of responsiveness within two minutes. Patient enrollment continued until six crossover pairs were observed. The ED50 and ED90 were estimated by centered isotonic regression and the pooled adjacent violators algorithm with bootstrapping, respectively. Twenty patients were included in the analysis. The ED50 and ED90 of remimazolam for loss of responsiveness within two minutes were 0.07 mg/kg/min (90% CI: 0.05, 0.09 mg/kg/min) and 0.10 mg/kg/min (90% CI: 0.10, 0.15 mg/kg/min), respectively. Vital signs were stable with an infusion rate of 0.10 mg/kg/min, and no patients required inotrope/vasopressor. Intravenous infusion of remimazolam at a rate of 0.10 mg/kg/min can be an effective approach to inducing general anesthesia in adult patients.

Efficacy and safety of ciprofol versus propofol for the induction of anesthesia in adult patients: a multicenter phase 2a clinical trial

BackgroundCiprofol is a novel 2, 6-disubstituted phenolic derivative anesthetic that binds to the gamma-aminobutyric acid-A receptor.AimTo determine the equally potent dose of ciprofol compared with propofol as an induction agent for general anesthesia in patients undergoing selective surgery, and to assess its safety.MethodA total of 109 patients undergoing selective non-emergency, non-cardiothoracic or non-neurosurgical surgery requiring tracheal intubation for general anesthesia were enrolled. Ten patients per group were assigned to ciprofol-0.3, 0.4 and 0.5 mg/kg, and propofol-2.0 or 2.5 mg/kg groups, respectively to receive an intravenous bolus dose. An additional 20 patients were enrolled in the ciprofol-0.3, 0.5 or propofol-2.0 mg/kg groups. The primary outcome was the success rate of induction defined as a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) ≤ 1 after the initial bolus dose. The secondary outcomes included the time to reach MOAA/S ≤ 1, the time to loss of the eyelash reflex, the incidences and severity of adverse events (AEs).ResultsThe success rates were 100% for all 5 groups. The mean time to MOAA/S ≤ 1 and the time to loss of the eyelash reflex were not different among the 5 groups, regardless of whether a top-up dose was needed. There were no significant differences in the incidences and severity of AEs in the dose ranges investigated of ciprofol vs. propofol.ConclusionThe efficacy and safety of a single bolus dose of ciprofol-0.5 mg/kg for the general anesthesia induction in selective surgery patients was comparable to that of propofol-2.0 mg/kg.Trial registrationClinicaltrials.gov, NCT03698617, retrospectively registered.

The use ofpreoperative inferior vena cava ultrasound to predict anaesthesia-induced hypotension: asystematic review.

Preoperative ultrasound assessment of inferior vena cava (IVC) diameter and the collapsi-bility index might identify patients with intravascular volume depletion. The purpose of this review was to gather the existing evidence to find out whether preoperative IVC ultrasound (IVCUS) derived parameters can reliably predict hypotension after spinal or general anaesthesia. PubMed was searched to identify research articles that addressed the role of IVC ultrasound in predicting hypotension after spinal and general anaesthesia in adult patients. We included 4 randomized control trials and 17 observational studies in our final review. Among these, 15 studies involved spinal anaesthesia and 6 studies involved general anaesthesia. Heterogeneity with respect to the patient populations under evaluation, definitions used for hypotension after anaesthesia, IVCUS assessment methods, and cut-off values for IVCUS-derived parameters to predict hypotension precluded pooled meta-analysis. The maximum and minimum reported sensitivity of the IVC collapsibility index (IVCCI) for predicting post-spinal hypotension was 84.6% and 58.8% respectively, while the maximum and minimum specificities were 93.1% and 23.5% respectively. For the prediction of hypotension after general anaesthesia induction, the reported ranges of sensitivity and specificity of IVCCI were 86.67% to 45.5% and 94.29% to 77.27%, respectively. Current literature on the predictive role of IVCUS for hypotension after anaesthesia is heterogeneous both in methodology and in results. Standardization of the definition of hypotension under anaesthesia, method of IVCUS assessment, and the cut-offs for IVC diameter and the collapsibility index for prediction of hypotension after anaesthesia are necessary for drawing clinically relevant conclusions.

Spectral edge frequency during general anaesthesia: A narrative literature review.

Previous studies have attempted to determine the depth of anaesthesia with different anaesthetic agents using electroencephalogram (EEG) measurements with variable success. Measuring depth of anaesthesia is confounded by the complexity of the EEG and the fact that different agents create different pattens. A narrative review was undertaken to examine the available research evidence on the effect and reliability of spectral edge frequency (SEF) for assessing the depth of anaesthesia in adult patients under general anaesthesia. A systematic search of the PubMed®, Scopus®, CINAHL and Cochrane databases identified six randomized controlled trials and five observational studies. The findings of these studies suggest that SEF varies according to the anaesthetic drugs used. Remifentanil and age are two factors that can affect SEF, while other opioids and benzodiazepine (administered separately) seem to have no effect. No patients experienced intraoperative awareness. However, this does not indicate that SEF can provide full protection against it and the number of articles in which intraoperative awareness was studied was too small to afford any certainty. None of the studies demonstrated a reliable SEF interval associated with adequate general anaesthesia. SEF must be adapted to the anaesthetic drug used, the patient’s age and state while under general anaesthesia.

Intravenous versus intrathecal dexmedetomidine as an additive to hyperbaric bupivacaine in spinal anesthesia for hip arthroplasty. A randomized controlled trial

ABSTRACT Background This study aimed to assess the safety and efficacy of intravenous (IV) versus intrathecal (IT) dexmedetomidine as an additive to hyperbaric bupivacaine in spinal anesthesia in adult patients undergoing hip arthroplasty. Methods This randomized, controlled, triple-blinded trial enrolled 90 patients aged 18–65 years, American Society of Anesthesiologists physical status I–II who were scheduled for hip arthroplasty under spinal anesthesia. The study subjects were randomly assigned into three groups. The control group (group C) received IT hyperbaric bupivacaine (0.5%, 12.5 mg) plus 1 ml of normal saline. The IT group received IT hyperbaric bupivacaine (0.5%, 12.5 mg) plus 5 µg of dexmedetomidine diluted in 1 ml of normal saline. The IV group received hyperbaric bupivacaine (0.5%, 12.5 mg) plus 0.5 µg/kg of dexmedetomidine diluted in 20 ml of normal saline administered slowly IV. A modified Bromage scale was used to assess motor blocks. We used the Numerical Pain rating scale (NRS) for pain assessment. We used morphine for postoperative analgesia. Results Groups IT and IV had significantly lower total morphine consumption and higher time to the first analgesic request than group C. Durations to two-segment regression and motor block regression to Bromage 1 were significantly higher in groups IT and IV than in group C. Motor block regression to Bromage 1 showed a significant difference between the IT and IV groups with a more delayed motor recovery in the IT group. Conclusion Both IV and IT dexmedetomidine extend the effect of the sensorimotor impact of subarachnoid anesthesia, but IT dexmedetomidine was superior to IV dexmedetomidine in adult patients undergoing hip arthroplasty.

Identification of Serum Biomarkers Associated With Emergence Agitation After General Anesthesia in Adult Patients: A Metabolomics Analysis.

BackgroundEmergence agitation (EA) is a conscious disturbance after general anesthesia in adult patients that can lead to severe respiratory or circulatory complications and serious physical injury to patients and caregivers. However, the pathophysiological mechanisms underlying EA remain unclear. The present study aimed to identify serum metabolites with significant alterations in EA patients after general anesthesia and enable inferences on their associations with EA.MethodsEA patients were identified by Richmond Agitation-Sedation Scale (RASS) ≥ + 2 among a cohort of adult patients who received elective surgery under general anesthesia in Peking University Third Hospital between 01 June 2020 and 30 December 2020. We further selected sex-, age-, and surgery type-matched non-EA control patients at a 1:1.5 ratio. Postoperative serum samples were collected from both groups of patients. An untargeted metabolic method was used to identify differences in serum metabolomic profiles between the EA patients and the non-EA patients.ResultsA total of 19 EA patients and 32 matched non-EA patients were included in the study. After screening and mapping with a database, 12 metabolites showed significant postoperative alterations in EA patients compared with non-EA patients, and were mainly involved in lipid, fatty acid and amino acid metabolism pathways. Receiver operating characteristic curve analyses indicated that vanillic acid, candoxatril, tiglylglycine, 5-methoxysalicylic acid, decanoylcarnitine, and 24-epibrassinolide may be involved in EA pathogenesis after general anesthesia.ConclusionIn this study, we found differences in the serum levels of vanillic acid, candoxatril, tiglylglycine, 5-methoxysalicylic acid, decanoylcarnitine, and 24-epibrassinolide involved in fatty acid metabolism, lipid metabolism, and amino acid metabolism pathways in EA patients compared with non-EA patients, which may demonstrate an EA pathogenesis-associated molecular pattern and contribute toward better understanding of EA occurrence.

Transurethral Holmium Laser Cystolithotripsy Under Local Anaesthesia in Adult Patients: A Prospective Observational Study at a Tertiary Care Centre in North-east India

Introduction: Urinary bladder stones comprise 5% of all urinary stones. Various modalities for the treatment of symptomatic bladder stones are available. They are open cystolithotomy, extra corporeal shock wave lithotripsy, cystolitholapaxy, suprapubic or transurethral cystolithotripsy using various energy sources. Presently transurethral Holmium laser cystolithotripsy is considered as the treatment of choice for symptomatic bladder stones. Aim: To report the experience of holmium laser cystolithotripsy for the treatment of symptomatic urinary bladder stones under local anaesthesia in adult patients. Materials and Methods: This prospective observational study was conducted on 86 patients at Department of Urology, NorthEastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India, between June 2016 and August 2019. It included consecutive adult patients with symptomatic bladder stones of size upto 4 cm who underwent transurethral holmium laser cystolithotripsy under local anaesthesia during the study period. Laser energy was delivered through a 9.5F semi rigid ureteroscope using 365 µm or 550 µm end-firing fibre. Pain during the procedure was assessed using Visual Analogue Scale (VAS). Descriptive statistics was used for analysis of the results. Results: During the study period, 86 patients (84 men, 2 women) underwent transurethral Holmium laser cystolithotripsy under local anaesthesia. Complete fragmentation of the stones was achieved in all patients. The mean stone size was 15.04 mm and the mean operating time was 23.81 minutes. The procedure was well tolerated by the patients and the mean pain score was 3.26. It was associated with minor complications only. There was no major complication or mortality during the study. Conclusion: Transurethral holmium laser cystolithotripsy under local anaesthesia is a safe procedure. It is well tolerated by adult patients and it can be used for the treatment of bladder stones of size upto 4 cm.