Anesthetic Technique Research Articles

A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7-9-year-old children: A randomized split-mouth cross-over trial.

Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7-9-year-old children. A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.

Perioperative care in acute liver failure: An anaesthesiologist perspective in the operating theatre.

Acute liver failure (ALF) is a life-threatening condition characterized by rapid liver function deterioration, necessitating a multidisciplinary approach for optimal perioperative care. This comprehensive review focuses on the critical role of the anaesthesiologist throughout the preoperative, intraoperative, and postoperative phases, addressing the unique challenges posed by ALF. The article begins with an exploration of ALF, underlining the urgency of timely referral to specialized hepatology centres. Liver transplantation emerges as a life-saving intervention, and the complex decision-making process is discussed, emphasizing the need for a multidisciplinary team to assess transplantation candidacy based on established prognostic criteria. In the preoperative phase, the review stresses the importance of early engagement with tertiary liver centres for timely referrals and identifies patients suitable for transplantation. Safe transport protocols are detailed, highlighting the meticulous planning required for the secure transfer of ALF patients between healthcare facilities. The intraoperative management section delves into the anaesthesiologist's key concerns, including neurological status, sepsis, acute kidney injury, body mass index, and preoperative fasting. Hemodynamic stability, fluid management, and coagulation balance during surgery are emphasized, with insights into anaesthesia techniques, vascular access, monitoring, and hemodynamic management tailored to the challenges posed by ALF patients. The postoperative care is thoroughly examined covering neurological, hemodynamic, metabolic, renal, and nutritional aspects. Management of ALF involves multidisciplinary team, including nephrology for continuous renal replacement therapy, transfusion medicine for plasma exchange, critical care for overall patient care, nutritionists for ensuring adequate nutrition, and hepatologists as the primary guides. In conclusion, the review recognizes the anaesthesiologist as a linchpin in the perioperative care of ALF patients. The integration of safe transport protocols and multidisciplinary approach is deemed crucial for navigating complexities of ALF, contributing to improved patient outcomes. This article serves as an invaluable resource for gastroenterologist and intensivists, enhancing their understanding of the anaesthesiologist's indispensable role in the holistic care of ALF patients in an ever-evolving healthcare landscape.

Pecto-intercostal Fascial Plane Block: A Novel Technique for Analgesia in Patients with Sternal Dehiscence.

Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.

The Gluteus Deep Investing Fascia Compartment Block: A Novel Technique for Posterior Femoral Cutaneous Nerve Block.

The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the "Gluteus-Deep Investing Fascia compartment Block (GDIF block)"for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the 'Gluteus Deep Investing Fascia Compartment'. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named"CLEFT Block." This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique. Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine. The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia. The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.

Obstetrical anesthesia for a patient with multiple sclerosis: case report and literature review

Introduction. Multiple sclerosis is an autoimmune disease characterized by chronic inflammation with progressive demyelination and axonal dysfunction. The disease affects about 1 million young adults, 2/3 of which are women of childbearing age, with all patients develop irreversible neurological dysfunction. There is observed a stagnation of the disease during pregnancy, with the return of exacerbations in the postpartum period. Contemporary specialty textbooks neither confirm nor deny the safety of neuraxial anesthesia in patients with central nervous system diseases. Clinical case. We present the clinical case of a 25-year-old nullipara pregnant (36 weeks and 6 days gestation age), known with relapsing-remitting multiple sclerosis and epilepsy. The woman has relapsing multiple sclerosis symptoms during last 6 days, reason why is urgently consulted by the anesthesiologist for cesarean delivery. Management and outcome. The article describes the technique of epidural anesthesia for the obstetrical patient with multiple sclerosis and the course of the perianesthetic evolution, including 1-year follow-up after cesarean section. Discussions. With the aim of avoiding potential influences on the evolution and progression of the disease, clinical judgment and the choice of anesthetic technique (general vs. neuraxial) depends on several factors: vaginal delivery or caesarean section, the presence of contextual clinical modifiers (native or drug-induced coagulopathy, infection), the urgency of the intervention, and the patient’s cooperation. In case of parturients with multiple sclerosis, all the risks should be rigorously evaluated: on one hand - the additional risk of general anesthesia (risk of aspiration, potential loss of airway control, critical desaturations) and on the other hand - the risk of hypothetical local anesthetic toxicity in the case of neuraxial techniques. Conclusion. Neuraxial epidural anesthesia is a safe technique in obstetric patients with multiple sclerosis.

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P>0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P<0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Quadratus lumborum block in laparoscopic inguinal hernia repair: A single center study.

Objective: To evaluate the efficacy of QL block in patients undergoing laparoscopic TEP inguinal hernia repair. Study Design: Randomized Clinical Trial. Setting: Kalsoom International Hospital, Islamabad. Period: Dec 2022 to June 2023. Methods: In this, all patients between the ages of 18 and 70 who were scheduled for laparoscopic TEP inguinal hernia repair to repair a one-sided inguinal hernia and did not have any complications related to the hernia. In one group, the patients received general anesthesia and in the other group, the patients were given sedation along with a technique called QL block. Age, gender, pain score on VAS at 1 hours, 6 hour and 12 hours after procedure was noted. Comparison of pain according to the VAS by type of anesthesia was done between the two groups and independent sample t-test was applied to see the statistical significant. Results: The patients' mean age was 43 + 9.09 years. Around 70% of the patients were males, while 30% were females, indicating a male predominance. The study's outcome was the mean pain score after 1 hour, 6 hours, and 12 hours. The two techniques of anesthesia utilized in the two groups were compared in terms of pain. The mean VAS at 1 hour after the initiation of anesthesia was not significantly different between the two groups, but it was statistically significant at 6 and 12 hours (p value of 0.001). Conclusion: QL block is a safe and effective alternative for patients undergoing TEP inguinal repair because to the observed reduction in early postoperative pain, shorter hospitalization, and cheaper anesthetic and hospital costs. Although our research showed that pain was significantly reduced for up to 12 hours after the operation, more information is needed before we can confidently endorse it for widespread use.

Comparison of the effect of 2 mL versus 3 mL sub-Tenon xylocaine injection on akinesia and analgesia in cataract patients at the University of Ilorin Teaching Hospital, Nigeria.

Sub-Tenon anesthesia is a form of local anesthetic techniques used in ophthalmic procedures, especially in cataract surgery. Few studies in our environment have reported the effects of sub-Tenon anesthesia on akinesia and analgesia as well as optimum volumes of anesthetic agents that are required for effective analgesia and akinesia. The objective of this study is to determine and compare the level of analgesia and akinesia and the effect of ocular compressions after sub-Tenon injection of 2 mL versus 3 mL of xylocaine among patients booked for cataract surgery in the University of Ilorin Teaching Hospital (UITH). A cross-sectional comparative study among cataract patients booked for surgery in the Department of Ophthalmology at UITH was carried out from March 2017 to August 2017. A total of 200 cataract patients that met the inclusion criteria were recruited into the study over 6 months. Lists of cataract patients booked for surgery formed the sampling frame. Questionnaires were administered to obtain information on sociodemographic, ocular symptoms, and other histories. Visual acuity was checked, and ocular examination was done with a pen-torch, ophthalmoscope, and slit-lamp examination with 78D. Tonometry and optic nerve assessments were done to exclude any patient with preexisting glaucoma or suspicious disc. About 200 patients were randomly allocated into one of two volume groups (Group 1 had 2 mL sub-Tenon xylocaine injection whereas Group 2 had 3 mL); level of analgesia and akinesia was checked 12 min and 15 min, respectively. The age range was 20-107 years; mean age for Group 1 was 63.8 ± 12.64, whereas the mean age of Group 2 was 64.14 ± 14.14. There was a slight female preponderance given a M:f of 1:1.4 and more than half of the patients presented with right eye (RE) cataract. Levels of analgesia 12 min after sub-Tenon injections in both groups were similar. However, two patients were found to have severe pain in Group 1, and no patients had severe pain in Group 2. The level of akinesia which was assessed 15 min after injection in both groups was found to be significantly better in Group 2. There was a slight female preponderance with about two-third of the total patients being female and the percentage of females who had no pain was more than the male, more than 50% of the patients had RE cataracts. Sub-Tenon anesthesia whether with 2 mL or 3 mL led to a statistically significant rise in intraorbital pressure (IOP); however, with ocular compression, the IOP was found to decrease below the preinjection pressure in both groups. Levels of analgesia were similar in the two groups, whereas akinesia was statistically better in the group that had 3 mL injection.

252 Chronic Subdural Hematoma Drainage Under Local Versus General Anesthesia: Systematic Review and Meta-analysis

INTRODUCTION: Chronic subdural hematoma (CSDH) is one of the most encountered conditions seen in neurosurgery. Although mainstay treatment of cSDH has been burr hole drainage, no consensus yet exists on optimal anesthetic technique for surgical treatment between general (GA) and local (LA) anesthesia. METHODS: A search was conducted in MEDLINE (1946 to November 11, 2022), Embase (1974 to November 11, 2022), and PubMed (up to November 11, 2022). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically screen studies. RESULTS: Our literature search identified 521 studies, out of which 20 were included. There were a total of 1750 patients in the LA group and 699 patients in the GA group. Our meta-analysis found that the LA group had significant shorter operative time (mean difference -29.28 minutes, p <0.0001), length of admission (Mean difference -1.58 days, 95% CI = -2.40 to -0.76 days, p = 0.0002), and postoperative complications rate (odds ratio 0.38, 95% CI = 0.25 to 0.59, p < 0.0001) compared to GA. There was no significant difference between the two groups in revision rate (odds ratio 2.71, 95% CI 0.89 to 8.25, p = 0.08) and mortality rate (odds ratio 1.23, 95% CI 0.63 to 2.43, p = 0.55). CONCLUSIONS: In this meta-analysis, LA shows benefits in shorter operative time, shorter admission length, and fewer postoperative complications. This makes local anesthesia a less invasive alternative to general anesthesia especially in elderly patients.

Comparison of Postoperative Analgesia Between Intrathecal Nalbuphine and Intrathecal Fentanyl in Infraumbilical Surgeries: A Double-Blind Randomized Controlled Trial.

Spinal anesthesia is a widely used regional anesthesia technique for surgeries below the umbilicus, butpostoperative analgesia is of major concern due to the relatively short duration of the local anesthetic. Various drugs were used as an additive to local anesthetic to prolong the duration of postoperative analgesia. This study aims to compare the efficacy ofnalbuphine and fentanyl as an intrathecal additive along with local anesthetic. A total of 166 patients aged between 18 and 65 years belonging to the American Society of Anesthesiologists(ASA) I and II undergoing elective infraumbilical surgeries were included in the prospective double-blind randomized controlled trial. The patients were allocated into two groups of 83 each. Group N was given 2.5 mL of 0.5% bupivacaine + 1 mg of nalbuphine (0.5 mL), and group F received 2.5 mL of 0.5% bupivacaine + 25 mcg fentanyl (0.5 mL). Both groups were compared for postoperative analgesia, onset and duration ofboth sensory and motor blockade, intraoperative hemodynamics, and side effects. All demographic data, hemodynamic parameters, and side effects were not statistically significant among the two groups. However, other parameters, such as the mean duration of analgesia, which was 267.27 ±172.099 minutes in group N and 161.35 ±14.957 minutes in group F; meantime for the onset of sensory blockade, whichwas 3.94 ±1.769 minutes in group N and 5.94 ±0.929 minutesin group F; onset of complete motor blockade, which was 7.10 ±1.858 minutes in group N and 11.61 ±1.218 minutes in group F; duration of motor blockade, which was 182.57 ±13.011 minutes in group N and 112.53 ±7.389 minutes in group F;and mean time taken for two-segment regression, which was 118.20 ±12.61 minutes in group N and 113.72 ±8.84 minutes in group F, were all comparable between the two groups. Nalbuphine was found to be more efficacious for prolongation of postoperative analgesia with better hemodynamic stability.

Comparison of the Efficacy of Two Different Local Anesthesia Techniques for Mesotherapy in Temporal Region Alopecia.

Introduction Mesotherapy is a wide range of minimally invasive injections. In mesotherapy, a mixture of various tonics is injected into the skin. These include plant extracts, various medications, vitamins, enzymes, hormones, growth factors, and other factors that will help treat alopecia. Most commonly, a mixture of platelet-rich plasma (PRP) and vitamins is used. In mesotherapy treatment for hair regrowth in the temporal region, zygomaticotemporal nerve blocks, supratrochlear nerve blocks, and supraorbital nerve blocks are given. The zygomaticotemporal nerve, supraorbital nerve, and supratrochlear nerve are the branches of the trigeminal nerve. They provide sensation on the lateral side of the forehead, which is the temple region. Methods A sample size of 100 people was taken for the study who were undergoing mesotherapy in the bilateral temporal region for alopecia. Each group had 50 subjects: group I was given supratrochlear, supraorbital, and zygomaticotemporal nerve blocks as local anesthesia techniques, and group II was given supratrochlear and supraorbital nerve blocks. PRP was injected using an insulin syringe. Pain was assessed using a visual analog scale (VAS). Results During the procedure, a mean VASof 1 and 3 wasobserved in groups I and II, respectively, during the procedure (p-value0.023). A mean VASof 3 and 5 was observed in groups I and II, respectively, after three hours (p-value 0.000). This shows a significant difference in the pain experienced by the subjects between the groups. Conclusion This study proves that the zygomaticotemporal nerve, used along with supratrochlear and supraorbital nerve blocks, is better at producing analgesia and reducing pain.

Anesthesia Considerations in Patients Undergoing Spine Surgery with Evoked Potential Monitoring

Intra-operative neuromonitoring (IONM) facilitates monitoring of the functional integrity of neural structures under general anesthesia. It aids in early detection of injury and minimizes postoperative neurologic deficit. IONM may be used during spine surgery, where either the blood supply to the spinal cord could be compromised or the surgical procedures where there is manipulation of the spinal cord. Somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) are used to monitor the sensory and motor tracts in the spinal cord, respectively. Preoperatively, a team of surgeons, anesthetists, and neurophysiologists must discuss about modalities of IONM to be used, expected changes, and alarm criteria. Anesthesia drugs need to be appropriately selected to facilitate IONM, as they affect the SSEP and MEP response obtained. Both total intravenous anesthesia and balanced anesthesia technique may be used, with appropriate titration of drugs. False-positive changes in evoked potentials (EPs) must be prevented by a steady anesthesia state and physiologic parameters. It is preferable to have a checklist to follow whenever changes in EP response are observed to rule out surgical, anesthetic, and monitoring-related causes for change in response. Risk–benefit must be assessed before the selection of a patient for EP monitoring as it may be rarely associated with complications such as burns, seizures, and bite injuries to lips, tongue, and endotracheal tube. Teamwork with meticulous planning, preparation, and multidisciplinary communication is essential for the safe conduct of spine surgeries with SSEP and MEP monitoring. In this review, we discuss various considerations for anesthesia management in patients with intraoperative EP monitoring.

Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk?

Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.

Comparison of Automatically Controlled Injection System with a Traditional. Syringe for Multiple Infiltrations in Children Aged 6-12 Years: A Randomized Controlled Trial.

Children's conduct is significantly impacted by pain during dental procedures. Children's pain and discomfort can be reduced using computer-controlled local anesthetic delivery, which applies a steady, gradual flow of the anesthetic solution into the tissues. Using a self-report anxiety scale, the study aimed to assess and compare children's perceptions of discomfort following a new auto-controlled injection method to a traditional local anesthetic procedure. A total of 25 children, ages 6-12 requiring the use of local anesthesia for treatment on both sides of the arch were selected. It was a split-mouth design, in which each participating child received both types of infiltrations in two separate, consecutive visits, using a metallic syringe in one session, and using the I-Ject device in the other. Before administering anesthesia, all the children's anxiety scales were recorded using the Modified Child Dental Anxiety Faces Scale simplified to assess the anxiety level of a child. In the first appointment, Conventional anesthetic technique was and in the second appointment anesthesia was delivered using a computer-controlled device. Faces pain scaleRevised, a selfreport measure of pain was recorded immediately after completion of both types of local anesthesia (LA) administration. Patients reported greater comfort with the I-Ject computer-controlled device than with conventional anesthesia. Together with the practitioner, the computer system produced a pleasant and cozy environment for the youngster.

Anesthesia Management on 29 Weeks Pregnant Women with Intracranial SOL, Invasive Carcinoma Mammae and Bronchopneumoniaes

Background: Pregnancy gives whole different challenge for anesthesiologist because of we handle two lives at once. Brain tumor in pregnancy correlated with maternal mortality, prematurity and intra uterine growth restriction (IUGR). It makes delivery time, what kind of anesthesia technique we used choosen by the situation.Case: We report a case of anesthesia technique using general anesthesia (GA) to accommodate sectio cesarean transperitoneal profunda (SCTP) in a 29 weeks pregnancy age, G1P0A0 female patient, ASA IIIE with intracranial SOL suspect cerebri abscess multiple dd/ tuberculoma, invasive mammae carcinoma, and bronchopneumoniae.Disscussion: Space occupied lesion (SOL) is a lesion in intracranial space especially give effect to brain. In our patient with SOL from cerebri abscess multiple dd/ tuberculoma. It caused intracranial pressure increase and also spastic hemiparese dextra. Pregnancy termination was done depends on 29 weeks pregnancy with SOL in this patient. We used GA for cesarean section (CS). Anesthesia technique will be considered successful if new born baby activity, pulse, grimace, appearance, and respiration (APGAR) is good.Conclusion: Female G1P0A0, 32 years old, 29 weeks pregnancy age, single intrauterine fetus with intracranial SOL suspect cerebri abscess multiple dd/ tuberculoma, invasive mammae carcinoma, and bronchopneumoniae was consulted by Obstetrician to Anestesiologist to do CS with GA. During anesthesia and surgery, there was no complication. In this case, termination was done for baby and mother’s well being.

Pre-operative Anemia as a Risk Factor of Morbidity and Mortality in Valvular Surgeries

Pre-operative anemia can be a hindrance to speedy recovery and will increase blood transfusion intraoperative and post operatively. Objective: To find a correlation between preoperative anemia and the subsequent morbidity and mortality rates in patients undergoing valvular surgeries. Methods: A retrospective observational study, involving 493 valvular surgeries’ patients. All patients had the same anesthetic and surgical techniques. According to the WHO, anemia is a hemoglobin level < 13 g/dl for men and <12 g/dl for women. Clinical variables were compared using chi-square and independent t-test. Results: The patients received cardiac surgery for valvular heart disorders and had an average age of 42.2±14.1 years, with 60.9% being male. Most patients exhibited NYHA III (48.9%) and CCS III (36.5%) functional class symptoms. Highest comorbidity was hypertension (35.1%), followed by diabetes (14.4%) and dyslipidemia (6.5%). 43.2% were anemic and older than non-anemic individuals (P=0.02). Anemic people had a significantly greater incidence of HTN (P 0.02) and DM (P < 0.001). Both groups exhibited identical perfusion and cross-clamp periods (P=0.4 vs. P=0.3). Though not statistically significant (P=0.08), non-anemic patients needed more intraoperative blood or blood product transfusions. Patients with anemia have worse outcomes, including increased rates of in-hospital mortality (P=0.03), extended artificial breathing (P=0.04), and postoperative blood/product transfusion (P<0.001). 44.8% of anemic individuals needed RCC, 41.9% FFP, and 41.4% platelets. Conclusions: anemia is associated with the poorest post-operative results. There is conflicting information about the impact of preoperative anemia, particularly iron deficiency anemia, on valvular surgery.

Continuous Spinal Anaesthesia for Below Knee Amputation in High Risk Case: A Case Report

Introduction: Lower limb ischemia, peripheral arterial disease, and diabetes mellitus are considered the major cause for limb amputations in more than 50% of cases. These patients have increased risk of perioperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Continuous spinal anaesthesia (CSA) provides better cardiovascular stability, less local anaesthetic requirement, better control of anaesthesia level and lower risk of local anaesthetic toxicity were reported in the CSA technique compared with a single-dose spinal anaesthesia technique. We reported a high-risk patient who underwent below knee amputation surgery under CSA. Case Report: This is a 50-year-old male, American Society of Anaesthesiologists (ASA) III, dilated cardiomyopathy admitted for below knee amputation surgery. Preop vitals are stable. Blood investigations are normal. Chest radiography showed cardiomegaly, and echocardiography revealed sinus tachycardia with poor R wave progression and low ejection fraction (EF) of 20%. Continuous spinal anaesthesia was planned for the procedure, during the surgery total amount of fluid given was 40 mL of crystalloids at the rate of 20ml/hr. Intraop vitals stable. The patient was transferred to post op ward following the removal of spinal catheter. No anaesthetic complications noted. Conclusion: We reported the successful anaesthetic management of a patient with coronary artery disease and low ejection fraction undergoing below knee amputation surgery. CSA technique with low dose hyperbaric bupivacaine provided safe and effective ananaesthesia with minimal haemodynamic changes for this case.

Anesthetic Management for Abdominal Aortic Aneurysm Rupture

Background: Aortic aneurysm is the thirteenth leading cause of death in the united states. Around 15.000 people died each year because of aortic aneurysm rupture. The mortality rate for this case are still high at around 90%. Patient diagnosed with acute aortic rupture will need an urgent surgery.Case: A 36-year-old man came with complaints of pain in the waist to back area since 1 week before entering the hospital and worsening 2 days before entering the hospital. Pain is felt intermittent. The pain is sharp and severe when the patient strains. On physical examination found high blood pressure (160/104 mmHg), chest X-ray showed widening of the mediastinum suspected descending aortic aneurysm, CT angiography showed a fusiform type descending aortic aneurysm pars thoracoles, ruptured abdominal aortic aneurysm of juxtarenal fusiform type to the terminal abdominal aorta and hemoperitoneum. The patient underwent repair of an abdominal aortic aneurysm under general anesthesia. After surgery the patient was admitted to the ICU for clinical and hemodynamic monitoring, but the patient's condition in the ICU worsened. The patient experienced acute kidney failure and liver failure, then the patient died on the 10th day after surgery.Discussion: Surgery for ruptured abdominal aortic aneurysm is associated with high mortality. Even patients who survive the initial procedure are at high risk of complications (such as renal, cardiac, respiratory, haematological, or gastrointestinal failure). The main goal of anesthesia is to maintain anesthesia with cardiovascular stability and normothermia for as long as possible. Minimum standards of monitoring for surgery include electrocardiogram, CVP, arterial line, temperature, and urine output. This operation uses a cell saver machine which functions to collect lost blood, clean the blood and return it to the patient.Conclusion: Surgery for patients with acute aortic rupture requires complicated and complex anesthetic techniques. This operation requires collaboration and good communication between the surgeon and the anesthesiologist.

Comparing the Efficacy of Various Anaesthesia Protocols for Caesarean Section in Dogs

Introduction. Caesarean section is attributed with frequent deaths among newborn puppies – up to 30%, depending on the chosen anaesthetic care and the presence of aggravating factors. The right choice of drugs and anaesthetic techniques can significantly affect the clinical outcomes. Because a standardised anaesthesia protocol for the caesarean section in dogs is missing in Russia, the research in this area is very relevant. The aim of the work is to compare three variants of the anaesthesia protocols across the basic clinical outcomes of a caesarean section delivery in a dog (including intra- and postoperative results, mortality rate) and to determine the most efficient and safe one for a bitch and puppies.Materials and Methods. The research was conducted at the premises of Rostov-on-Don veterinary clinic in the period from December 2021 to December 2023. There were selected 63 pregnant bitches who met the inclusion and exclusion criteria at that period of time. The animals were divided into three groups: in the first group the anaesthetic care included induction with propofol, intraoperative inhalation anaesthesia with sevoflurane and epidural lidocaine anaesthesia; in the second group the induction and maintenance of anaesthesia was performed with propofol, alongside the local anaesthesia with lidocaine was administered; the third group was administered propofol and inhalation anaesthesia with sevoflurane, excluding epidural anaesthesia. Monitoring was carried out according to the intraoperative indicators, post-anaesthesia recovery time, postoperative indicators of fear and pain, Apgar scores in puppies, the number of survivors and deaths in the short-term (30 minutes) and medium-term (during the day) periods.Results. The best intra- and postoperative indicators as well as the highest percentage of surviving puppies and the smallest number of stillbirths were revealed in patients of the first group. Medium results were recorded in the third group. The lowest intraoperative indicators in the function of cardiovascular and respiratory systems and the worst results as of hypoxia in newborn puppies were recorded in the second group of studied animals.Discussion and Conclusion. When determining the most efficient anaesthetic care for caesarean section in dogs, it should be borne in mind that propofol has a depressing effect on the respiratory and cardiovascular systems of patients, therefore its use is highly undesirable for the anaesthesia maintenance. Unlike propofol, sevoflurane does not penetrate the placenta barrier, is not metabolised and enables quick awakening of a bitch from anaesthesia. Moreover, in cases, when sevoflurane was used, the Apgar scores in the born puppies were the highest. Epidural anaesthesia with lidocaine reduces the postoperative pain of a bitch after caesarean section and has a positive effect on lactation. The use of epidural anaesthesia may be complicated with hypotension, however, the preventive use of crystalloid solutions, can mitigate this effect. Thus, the protocol with triple anaesthesia is optimal and preferable for caesarean section in dogs: induction with propofol, epidural anaesthesia with lidocaine and inhalation with sevoflurane to maintain anaesthesia.

Transvajinal ultrason eşliğinde oosit toplama işleminde anestezi yönetimi: Mini derleme

Oosit toplama işlemlerinde anestezi/analjezi yönetimi, in vitro fertilizasyon tedavisinde hasta konforunun, güvenliğinin ve prosedürel başarının sağlanmasında çok önemli bir rol oynamaktadır. Bu mini derleme, transvajinal ultrason eşliğinde oosit toplanması planlanan hastalarda bilinçli sedasyon, rejyonal anestezi veya genel anestezi yoluyla bireysel hasta ihtiyaçlarına göre yeterli analjezi ve konfor sağlamak için işlem öncesi/işlem sırasındaki hususları, anestezi tekniklerinin ve anestezik ilaçların seçimini ele almaktadır. Klinisyenler anestezi tekniklerini seçerken hastanın komorbiditelerini, ilaç kullanımlarını ve prosedürel gereklilikleri göz önünde bulundurmalıdır.