Method Of Anesthesia Research Articles

Effectiveness of vapocoolant spray compared toeutectic lidocaine/prilocaine cream to enhance tolerance during intravenous catheterisation: a randomised controlled trial.

To determine if tolerance of intravenous catheterisation differs following the application of vapocoolant spray compared to lidocaine/prilocaine cream in dogs and cats. A randomised controlled trial of client-owned dogs and cats requiring intravenous catheterisation was performed. They were randomly allocated to either have lidocaine/prilocaine cream applied to their skin 1 hour prior to intravenous catheterisation or a swab saturated with vapocoolant spray applied immediately prior to intravenous catheterisation. The procedure was video-recorded and a single blinded observer reviewed the recordings and assigned reaction scores (0 to 3) at 4 time points (initial restraint, limb handling, swab application and skin puncture). Between October 2020 and March 2022, a total of 101 animals (83 dogs and 18 cats) were enrolled, with 56 patients randomised to receive vapocoolant spray and 45 to receive lidocaine/prilocaine cream. There was no significant difference in the age, sex status, number of cross and pure breeds, and mentation detected between the groups. There was no significant difference in reaction scores between the treatments when comparing all patients at any time point except for a significantly increased swab application reaction score in patients receiving vapocoolant spray. Vapocoolant spray was significantly less effective in reducing adverse reaction to skin puncture than lidocaine/prilocaine cream in the small number of cats evaluated. When considering all patients together, no single method of anaesthesia appeared superior for improving tolerance of intravenous catheter placement. However, vapocoolant spray may be less effective than lidocaine/prilocaine cream in reducing adverse response to skin puncture during catheterisation in cats.

Heavy gravity combined with light gravity local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in maternal women: a prospective cohort study

BackgroundSubarachnoid anesthesia is the primary anesthetic method for elective cesarean section surgery, characterized by rapidly taking effect and reliable analgesia. However, subarachnoid anesthesia is prone to cause a high block level, resulting in a high incidence of maternal hypotension. How to reduce the incidence of maternal hypotension under subarachnoid anesthesia is a practical problem that needs to be solved urgently in clinical practice.MethodsThis prospective cohort study was performed at Nantong Maternal and Child Health Care Hospital in China between January and July 2023. This study compared the incidence of hypotension in pregnant women undergoing subarachnoid anesthesia during elective cesarean section in four groups, including group A (control group) with 10 mg of 10% glucose solution; Group B with 5 mg 10% glucose solution group; Group C with 4 mg 10% glucose solution group; Group D with 2 mg 10% glucose solution group. Each group was given a dose of 10 mg Ropivacaine with a concentration of 0.5% and a volume of 2 ml. The primary outcome was the incidence of maternal hypotension. The secondary outcomes were the plane of anesthesia, abdominal wall muscle relaxation degree and the incidence of adverse events.ResultsData from 74 (18, A group; 26, B group; 15, C group; 15, D group) participants were analyzed. Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women (P = 0.152). The plane of anesthesia gradually shifted from T4 to T10 as the specific gravity of ropivacaine decreased (P < 0.01). Satisfaction about abdominal wall muscle relaxation degree gradually decreased with the decrease of the specific gravity of ropivacaine (P = 0.04). And the incidence of adverse events gradually increased with the decrease of the specific gravity of ropivacaine (P = 0.027).ConclusionsHyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women.

Retrospective evaluation of the effects of different anesthesia methods on emergence agitation in patients undergoing vitreoretinal surgery.

The agitation that can occur in patients undergoing vitreoretinal surgery on awakening from general anesthesia is a serious post-operative problem. In our study, we aimed to compare the effects of different anesthesia methods on emergence agitation in patients undergoing vitreoretinal surgery. Patients undergoing vitreoretinal surgery were divided into two groups: Total intravenous anesthesia (Group T) and inhalation anesthesia (Group D) according to the maintenance of anesthesia applied by consulting the records. Patients' heart rate, mean blood pressure, extubation quality scores, and Richmond Agitation and Sedation Scale values were examined. For the study, data were available from 100 patients undergoing vitrectomy surgery. It was observed that in the total intravenous anesthesia group the quality of extubation and the patients' additional analgesic requirements were better, and the patients' agitation levels at min 0 were lower. In our study, it was observed that the choice of total intravenous anesthesia as an anesthetic method in patients undergoing vitreoretinal surgery reduced agitation upon awakening compared to those receiving inhalational anesthesia.

The global research trends in perioperative cognitive function protection for preventing postoperative delirium: A bibliometric analysis.

This study aims to analyze the global trends and current status of perioperative cognitive function protection for preventing postoperative delirium(PCFP-POD), as well as to predict research hotspots. We conducted a literature search on the Web of Science Core Collection (WoSCC) and selected articles published between January 1, 2014, and December 31, 2023, related to PCFP-POD. The retrieved data were subjected to bibliometric analysis and visualization using CiteSpace 6.2.R4, VOSviewer 1.6.20 software, and the Bibliometrics website. A total of 355 articles published between 2014 and 2023 were retrieved from the online databases. The number of publications on perioperative cognitive function protection for preventing postoperative delirium sharply increased from 2018 onwards. Key themes included drug and non-drug interventions, postoperative cognitive dysfunction in cardiac and hip surgery, and the effects of anesthetic drugs. High-frequency keywords included postoperative delirium, intervention, postoperative cognitive impairment, and cognitive training. The number of research articles on PCFP-POD increased significantly from 2014 to 2023. Future research trends may focus on cognitive function protection related to surgical categories, anesthesia methods, electroencephalogram monitoring, and nursing care.

Comparing C3, 4, and 5 nerve root block and interscalene with intermediate cervical plexus block in diaphragmatic motion for clavicle surgery

Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients.Trial registration number: ChiCTR2300078283 04/12/2023.

Does cytochrome 2D6 genotype affect the analgesic efficacy of codeine after ambulatory surgery? Prospective trial in 987 adults.

Paracetamol-codeine combination tablet is widely used in pain management after day surgery. For safety reasons, its use has decreased in recent years. Codeine is a prodrug metabolised in the liver by the cytochrome P450 2D6 (CYP2D6) enzyme to morphine that produces the analgesic effect of codeine. CYP2D6 is highly polymorphic, and based on genotypes, individuals can be divided into four categories: poor-, intermediate-, normal- and ultrarapid metabolisers. Differences in morphine and its metabolite concentrations have been described between different CYP2D6 genotypes following codeine administration. The aim of the study was to investigate the possible effect of CYP2D6 genotype on codeine efficacy and adverse effects in a large cohort of adult patients undergoing ambulatory surgery. A total of 987 patients scheduled for ambulatory surgery were included in the analyses. Operation types or anaesthesia methods were not limited in the study protocol. All study patients received a fixed dose of paracetamol (1000 mg) and codeine (60 mg) orally for premedication. A blood sample was drawn to identify the genotype of CYP2D6. At home, the first-line analgesic was paracetamol-codeine combination of 1-2 tablets at 1-3 times per day. Data on the efficacy and side effects of codeine were collected on the day of surgery and the following two postoperative days. Of the studied patients, 37 (3.7%) were poor CYP2D6 metabolisers, 264 (27%) were intermediate, 623 (63%) were normal and 63 (6.4%) were ultrarapid metabolisers. Activity scores ranged from 0 to 4. CYP2D6 genotype was not associated in a statistically significant manner with postoperative pain, opioid consumption or the adverse effects of codeine, except for constipation at home. Poor CYP2D6 metabolisers reported significantly less severe constipation compared with normal metabolisers (p = .009, OR 0.40, 95% Cl 0.20-0.80). CYP2D6 genotype appears to be of minor importance for the analgesic efficacy of oral paracetamol-codeine combination therapy after ambulatory surgery in adult patients undergoing similar types of surgery as in the present study but it may affect the risk of constipation.

Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial

BackgroundThe effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA)...

Transoral Robotic Surgery for Patients with Obstructive Sleep Apnoea: A Systematic Literature Review of Current Practices.

Transoral robotic surgery (TORS) for tongue base reduction (TBR) and/or epiglottic surgery is an effective treatment option for selected patients with moderate to severe obstructive sleep apnoea (OSA). This systematic review aims to provide an up-to-date overview of current practices and challenges associated with TORS for OSA. PubMed and Embase databases were searched up to December 2022 following PRISMA guidelines. Primary outcome measures were surgical technique, intraoperative measures, postoperative management and complications. A total of 32 articles, including 2546 patients, met the inclusion criteria. TORS was most commonly performed as part of a multilevel surgical approach. Nasotracheal intubation was the preferred method for general anaesthesia. The surgical technique for TORS tongue base and epiglottis did not differ significantly among institutions, although some variations exist. Postoperative management varied, with most authors aiming for immediate postoperative extubation, routine postoperative ward admission and early oral intake initiation. Common postoperative complications were dysphagia and bleeding, with no reported mortality. TORS is established as a safe and feasible surgical option for selected OSA patients, addressing tongue base and/or epiglottic obstruction. However, further studies are required to determine patients' selection criteria, preferred volume of excised tongue tissue and to assess the necessity for postoperative intensive care unit monitoring.

Local anaesthesia vs. brachial plexus block in trapeziometacarpal joint arthroplasty

IntroductionAn established anaesthetic procedure used during total trapeziometacarpal joint (TMCJ) arthroplasty is the brachial plexus block (BPB). It was hypothesized that local anaesthesia (LA) provides advantages in overall cost, enables intraoperative assessment of the prosthesis, and minimises the anaesthetic risk. In this study, LA to BPB was compared and outcomes, safety, and overall patient satisfaction were analyzed.Materials and methodsIn this single-center cohort study, 32 patients (34 operated thumbs) who underwent total TMCJ arthroplasty between February 2018 and July 2021 were included. Two groups were formed depending on the anaesthetic method used. One group was operated under LA, and the other under BPB. Functionality scores were assessed preoperatively and three month postoperatively. Additionally, pain was assessed on the 1st and 12th postoperative day. Data on intraoperative pain and anxiety, overall satisfaction, pain medication use, and willingness to undergo the procedure again were gathered through a retrospective telephone survey.ResultsNo significant differences between LA and BPB were found in terms of functional outcomes, pain reduction, and willingness to repeat the procedure. The analysis further showed significant differences in intraoperative anxiety (higher in the LA group; LA 1.69, SD: 2.65; BPB 0.28, SD: 0.58; measured using a numeric rating scale 0–10; p = 0.045), operation length (higher in BPB group; LA 39 min, SD: 7.46; BPB 45 min, SD: 7.02; p = 0.018) and overall setup time (higher in BPB group; LA 76 min, SD: 15.85; BPB 102 min, SD: 19.66; p < 0.001). No conversion from LA to another anaesthetic method was necessary.ConclusionThe use of LA in total TMCJ arthroplasty is a practical and reliable alternative to the well-established BPB. LA reduces the cost of the procedure, necessity of an anaesthesiology team and the duration of the patients´ hospital stay. Patients should be actively involved in selecting the anaesthetic method to optimize the operative procedure and overall outcome.

Total extra peritoneal Repair of Inguinal Hernia under General Anesthesia Versus Spinal Anesthesia

Background: Total extra peritoneal inguinal hernia repair is established approach to inguinal hernia repair usually performed under general anesthesia. Aim of the study was to compare Total extra peritoneal inguinal hernia repair outcome when operated under spinal anesthesia and general anesthesia. Methods: A prospective cross-sectional study was conducted at Bir hospital on patients undergoing Total extra peritoneal inguinal hernia repair under either spinal anesthesia or general anesthesia for inguinal hernia from September 2022 to August 2023. Operative time, postoperative hospitalization time, postoperative pain, postoperative adverse effects, level of satisfaction and recurrence rate at one year was compared.Results: Fifty-eight patients were included, divided into two groups TEP-GA and TEP-SA, 29 in each arm. All procedures were completed by allocated method of anesthesia. Though pain score was low in TEP-SA in initial four hours, 2.79±1.08 (GA) and 1.99±0.97 (SA) and 2.28±1.09 (GA) and 1.80±0.80 (SA) at one and four hours post-operative respectively, no statistical difference was noted between two groups regarding surgery time, pain score complications, hospital stay, recovery or recurrence.Conclusions: Spinal anesthesia is at par with general anesthesia instead of better than generalanaesthesia for total extra peritoneal inguinal hernia repair, if not better. It may be appropriate anesthetic modality in patients considered high risk for general anaesthesia.Keywords: general anesthesia; inguinal hernia; spinal anesthesia; total extra peritoneal inguinal hernia repair.

Effects of intravenous anesthesia and inhalation anesthesia on postoperative inflammatory markers in patients with esophageal cancer: a retrospective study

BackgroundInflammatory markers have been confirmed to be associated with the prognosis of cancer patients. In this study, we compared the impacts of intravenous anesthesia and inhalation anesthesia on the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII) after esophageal cancer surgery.MethodsWe retrospectively reviewed the electronic medical records of patients who underwent esophagectomy from January 1, 2014 to December 31, 2016. Patients respectively received total intravenous anesthesia (TIVA) or inhalational anesthesia (INHA). Inverse probability of treatment weighting (IPTW) was employed to minimize differences. The Mann-Whitney U test or Kruskal Wallis test was utilized to compare the effect of the two groups on postoperative NLR, PLR and SII.ResultsA total of 519 patients who had undergone esophageal cancer resection were recruited in this study, among whom 339 patients were eligible (TIVA group, n = 201, INHA group, n = 138). After IPTW, there was no statistically significant difference in NLR, PLR, and SII on the first postoperative day(P = 0.1951), (P = 0.5611), (P = 0.9684) and on the third postoperative day(P = 0.5961), (P = 0.1804), (P = 0.9653) between the two groups.ConclusionsIn conclusion, there was no significant difference in NLR, PLR and SII between intravenous anesthesia or inhalational anesthesia. TIVA is not superior to INHA in reducing the perioperative inflammatory response of esophageal cancer.SynopsisInflammatory markers play an important role in the recurrence, metastasis and survival of tumor patients after surgery. In this study, we will compare the effects of different anesthesia methods on inflammatory markers.

Spinal anesthesia vs general anesthesia in the endoscopic management of proximal ureteral stones: A critical evaluation focusing on the total anesthesia time.

This study was aimed to compare spinal and general anesthesia methods in endoscopic management of proximal ureteral stones with a particular emphasis on total anesthesia time. A total of 246 adult patients undergoing ureteroscopic management for proximal ureteral stones between January 2021 and March 2023 were enrolled. Two different types of anesthesia namely spinal (Group 1, n=109) and general (Group 2, n=137) anesthesia were applied during these procedures. The mean total anesthesia time of Group 1 was statistically significantly shorter than that of Group 2 (61.4±28.7 and 93.7±29.2 min, respectively, p=0.013). While 92.7% of patients in Group 1 were stone free after the interventions, this value was 92 % in Group 2 (p=0.828). There was no statistically significant difference between the two groups regarding peri- (p=0.126) or postoperative (p=0.284) complications. Our results demonstrated well that both spinal and general anesthesia methods could be applied in a successful and safe manner in the endoscopic management of proximal ureteral stones. However, a shorter total anesthesia time under spinal anesthesia could be anticipated during endoscopic management of proximal ureteral stones.

Investigation of Abdominoplasty Without General Anesthesia: A Scoping Review

Introduction: Abdominoplasty is a common aesthetic surgical procedure primarily performed under general anesthesia (GA). However, GA is aerosol-generating and involves extended immobilization associated with systemic complications like venous thromboembolisms (VTEs). There is increasing interest in performing abdominoplasties without GA because of potential lower complication rates and shorter postoperative recovery time. This review sought to summarize all available literature on the safety and outcomes of abdominoplasty performed without GA. Methods: A scoping review was conducted with no date limits in October 2023 encompassing Medline, Embase, Web of Science, and CINAHL. The type of anesthesia was separated into 3 categories: conscious or intravenous (IV) sedation, regional anesthetic blocks (RAB: spinal and epidural), and local anesthesia (direct local infiltration and field blocks). Results: A total of 28 studies were included. Safety data was reported for abdominoplasty alone ( n = 6), with liposuction ( n = 14), or both ( n = 1). The employed anesthesia methods were IV and local ( n = 13), RAB and local ( n = 3), IV and RAB ( n = 2), IV and RAB and local ( n = 2), and IV only ( n = 1). A total of 48 379 patients were identified, with 30 cases of VTEs reported. Two studies reported GA conversion rates between 4.8% and 6.0%. A total of 11 studies assessed abdominoplasty outcomes, highlighting high patient satisfaction and low postoperative pain. The majority of analyzed studies had a “high” or “critical” risk of bias. Conclusion: Our review provides preliminary evidence that performing abdominoplasty without GA is safe and feasible. Additional high-quality studies are necessary to further validate our findings and to develop a standardized approach.

Transesophageal motor-evoked potentials, a novel method induced by transesophageal spinal cord stimulation, are less sensitive to anesthetics than transcranial motor-evoked potentials.

Intraoperative neurologic monitoring can be useful, but transcranial motor evoked potentials (TcMEPs) are sensitive to anesthetic agents. We compared the effects of anesthetics on the newly developed transesophageal motor evoked potentials (TeMEPs) with those on TcMEPs. Eleven pigs (25.6 ± 0.8 kg) were anesthetized by desflurane inhalation, remifentanil was maintained at 0.5 µg/kg/min until the end of the experiment. End-tidal desflurane concentration was then maintained at 7, 4, 10, and 13%, and TcMEPs and TeMEPs were measured at each concentration. Desflurane was then discontinued and propofol was infused at 10, 20, 40, and 60 mg/kg/h, and TcMEPs and TeMEPs were measured at each infusion dose. An electroencephalogram monitor was used to measure the hypnotic level. Both desflurane and propofol anesthesia decreased bispectral index in a dose-dependent manner (P < 0.0001), replicating shallow (or adequate) to deep hypnotic levels in both anesthetic methods. The amplitude of TeMEPs was clearly larger than that of TcMEPs and was significantly larger at all anesthetic depths and all limb sites (P < 0.0001). Amplitudes of the lower extremities were lower than those of the upper extremities (P < 0.0001) for both TcMEPs and TeMEPs, but the amplitudes of TeMEPs were sufficiently large under desflurane as under propofol. The trend of concentration-dependent decrease in the amplitudes of TeMEPs under both anesthetics was not as apparent as in that of TcMEPs. TeMEPs are more tolerant to anesthesia than TcMEPs and may be a promising MEP monitoring technique for the lower corticospinal tract.

Comparing the Safety and Efficacy of Remimazolam-based Total Intravenous Anesthesia versus Volatile Agent-based Anesthesia: A Meta-Analysis of Randomized Controlled Trials.

Remimazolam is a novel short-acting benzodiazepine that has recently been used for general anesthesia. This study compared the safety and efficacy of remimazolam-based total intravenous anesthesia (TIVA) and volatile agent-based anesthesia in adults undergoing general anesthesia. We searched electronic databases including PubMed, EMBASE, CENTRAL, and Scopus for relevant studies. The primary outcome was the proportion of patients who experienced hypotension during surgery. Secondary outcomes included incidence of bradycardia, extubation time, duration in the post-anesthesia care unit (PACU) hospital stay, and incidence of postoperative nausea and/or vomiting (PONV). We estimated the relative risk (RR) and mean difference (MD) with 95% CIs using a random-effects model. A total of 969 patients from 12 randomized controlled trials were included. The incidence of hypotension was 14% and 34% in the remimazolam and volatile agent groups, respectively. Remimazolam significantly lowered the incidence of hypotension (RR: 0.43, 95 CI [0.29, 0.63], P = 0.0000, I2 = 26%). The remimazolam group had a PONV incidence of 13%, compared to 28% in the volatile agent group, indicating a significant difference (RR: 0.51, 95% CI [0.37, 0.72], P = 0.0001, I2 = 15%). No significant differences were observed in the other outcomes. Remimazolam-based TIVA demonstrated favorable hemodynamic effects, with a lower incidence of hypotension and similar bradycardia rates, compared to volatile agent-based anesthesia. Furthermore, the reduction in PONV supports the use of remimazolam-based TIVA as a valuable method for general anesthesia.

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Background. Regional anesthesia has become widely used in routine anesthesiology practice, it is considered a safer method of anesthesia in older patients and those with concomitant pathology. Nevertheless, both general and regional anesthesia have side effects on the cardiovascular system. The cardiotoxic effect of anesthesia in one way or another is present with any variant of anesthesia. One of the most transparent signs is rhythm alterations on the ECG. These changes can occur not only intraoperatively, but also in the early postoperative period, have an asymptomatic clinical course. But the presence of these signs can have a negative impact on the patient’s prognosis. That is why we performed daily Holter monitoring for patients undergoing trauma surgery. The purpose of the study was to compare regional and general anesthesia as a risk factor for perioperative rhythm disturbances. Materials and methods. It was a 2-group observational study that included 120 trauma patients undergoing surgery using general (group GA) or regional anesthesia (group RA). Postoperative Holter monitoring lasted 24 hours. Further analysis of the recording included the assessment of the presence of ischemic changes or extrasystoles. Results. The incidence of ST-depression episodes within 24 perioperative hours was 10 % in the GA group compared to 3 % in the RA group. In the GA group, the percentage of extrasystole was significantly higher compared to the RA group: 1.5 ± 2.1 % versus 0.7 ± 1.3 % (p = 0.0145). An increase in Qtd was significantly higher in the GA group 15 minutes after the start of anesthesia (51.31 ± 23.09) compared to the RA group (40.70 ± 19.97; p = 0.008). At the same time, QT dispersion was statistically significantly higher in the RA group 1 hour after the start of anesthesia compared to the GA group — 38.22 ± 12.30 versus 50.1 ± 19.5 (p = 0.04). The QT interval was significantly longer in the GA group 15 minutes after the start of anesthesia: 440.00 ± 33.09 versus 400.70 ± 23.18 in the RA group (p = 0.04). One hour after the start of anesthesia, QTt was longer in the RA group: 390.22 ± 23.60 versus 410.1 ± 30.1 in the GA group (p = 0.05). Conclusions. Regional anesthesia has less hemodynamic effects and is the method of choice in patients with cardiovascular comorbidity. However, given the risk of cardiotoxicity due to the resorptive effect of the local anesthetic, in older patients and with existing risk factors, it is crucial to account for the arrhythmogenic effects of local anesthetics and adjust the dosage accordingly.

Pain Level and Analgesic Requirements in Patients Who Underwent Vaginal Pelvic Floor Surgery following General or Spinal Anesthesia

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent general anesthesia (GA) or spinal anesthesia (SA) during vaginal pelvic floor surgeries. Design: This was a retrospective cohort study. Participants/Materials, Setting, Methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, p = 0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p = 0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient’s age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR = 0.33, p = 0.008) and mid-urethral sling placement (aOR = 0.37, p = 0.004). Limitations: This is a retrospective study, thus the choice of anesthesia may be biased. Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.

Effect of type of delivery and anesthesia method to ABR results on newborn hearing screening.

The aim of this study is to examine the effect of type of delivery and anesthesia method on the screening ABR test results of newborns within the scope of the Newborn Hearing Screening Program (NHCP) and to investigate the relationship between the test results and the relevant variables. 441 newborns were included in the study. Of these newborns, 221 constituted the control group (normal (vaginal) delivery), and 220 constituted the study group (cesarean section, delivery). In the study, all newborns whose hearing was evaluated within the scope of the Newborn Screening Program were screened twice. Screening ABR test results applied were compared considering the type of delivery (normal (vaginal) or cesarean section) and anesthesia method (spinal or general). The effects of variables such as the duration of the baby's separation (dissection) from the mother's womb, the duration of exposure to the anesthetic agent and the total duration of the surgical procedure were examined. As a result of the study, a statistically significant relationship was found between delivery type (normal (vaginal) or cesarean section) and anesthesia method (spinal or general) and first screening ABR test results (p<0.001). While there was a statistically significant difference (p<0.001) in terms of separation time from the mother's womb (p<0.001) and exposure to an anesthetic agent among the first test screening ABR results of newborns born under general anesthesia, there was no statistically significant difference (p<0.001) in terms of total surgical procedure time (p=0.106) no difference was detected. There was no statistically significant difference between ABR test results and these three variables in newborns born under spinal anesthesia (p>0.05). The type of delivery newborns and the anesthesia method used at delivery may affect the results of screening ABR applied within the scope of a newborn hearing screening protocol. For this reason, it is very important to perform screening tests at the most appropriate and correct time.

Postoperative Nausea and Vomiting After Minor Oral Surgery: A Retrospective Cohort Study.

This study aimed to determine whether PONV rates differed over time and to identify potential differences in PONV risk factors for oral surgery patients undergoing general inhalational anesthesia (IA) or propofol-based total intravenous anesthesia (TIVA). This retrospective cohort study included patients between 16 and 85 years of age and who received intubated general anesthesia with either IA or TIVA for minor oral surgery between January 2021 and July 2022. Primary outcomes were PONV overall (onset at 0-24 hours), early (onset at 0-2 hours), and late (onset at 2-24 hours). Known PONV risk factors as identified from existing literature were included for analysis. Data were obtained from 188 patients. A total of 41 (21.8%) patients developed overall PONV, 35 patients (18.6%) had early PONV, and 14 patients (7.4%) had late PONV. Any PONV that occurred across 2 periods was categorized in each period. IA compared with TIVA had higher overall PONV (29.6% vs 13.3%; P = .008) and early PONV (25.5% vs 11.1%; P = .034). Female sex and increased Apfel scores were associated with increased overall, early, and late PONV. Per multivariate analysis, females were 2.5 to 6 times higher than males to have overall, early, and late PONV (P < .05), and IA was 3 times higher than TIVA to have overall and early, but not late, PONV (P < .05). Our results suggested that the method of anesthesia may impact the incidence of overall and early PONV and that female sex and increase Apfel scores correlated with increased PONV through all times.

Intraocular Pressure and Safety of Vitrectomy with Vitreous Gas Replacement using Low-concentration Nitrous Oxide Gas Anesthesia.

This study aims to evaluate the efficacy and safety of vitrectomy with vitreous gas replacement using low-concentration nitrous oxide (N2O) gas anesthesia, focusing on intraocular pressure (IOP) changes, pain, anxiety, and safety outcomes. This retrospective study analyzed 133 patients undergoing fluid-air exchange without use of such as SF6 or C3F8, at Saneikai Tsukazaki Hospital, Japan, from April 2019 to March 2022. Participants were divided into two groups: those receiving low-concentration nitrous oxide gas anesthesia (N2O group) and those receiving local anesthesia with room air inhalation (Air group). IOP, pain, anxiety levels, and intraoperative complications were assessed. No significant differences were found in IOP changes postoperatively between the N2O and Air groups. The N2O group reported significantly lower pain scores and had lower intraoperative systolic blood pressure and heart rate changes compared with the Air group. No significant intraoperative or postoperative complications were observed in either group. Vitrectomy with fluid-air exchange using low-concentration nitrous oxide gas anesthesia is safe, does not increase IOP, and may offer benefits in reducing intraoperative pain and stabilizing vital signs compared with traditional local anesthesia methods. This approach could be considered a viable option for vitreous surgery requiring fluid-air exchange.