Anesthesia Group Research Articles

Effect on the size of optic nerve sheath diameter in patients undergoing surgeries under spinal anaesthesia versus peripheral nerve blocks – A randomised controlled study

Background and Aims: Post-dural puncture headache is a complication of spinal anaesthesia, theorised to be triggered by a lowering in intracranial pressure due to the cerebrospinal fluid leak through the dural puncture. Our objective was to evaluate whether there is a decrease in optic nerve sheath diameter (ONSD) with a reduction in intracranial pressure after spinal anaesthesia. Methods: Patients were randomised by a computer-generated randomisation table to receive spinal anaesthesia (Group S) or peripheral nerve block (Group P) after assessing their eligibility for the anaesthesia procedure as per the protocol. The ONSD was measured in the preoperative period and again at 4 h and 24 h after the anaesthetic, both in the supine and sitting positions, along with haemodynamic parameters. Continuous variables such as age, height, weight, mean arterial pressures, and ONSD were expressed as mean [standard deviation (SD)] [95% confidence interval (CI)] and compared using the student’s t-test. Repeated measure ANOVA and Bonferroni were used to compare intra-group parameters. Results: The mean decrease in the ONSD from a baseline mean of 3.95 (SD: 0.17) (95%CI: 3.87, 4.02) to 3.89 (SD: 0.26) (95%CI: 3.78, 4.007) mm at 4 h and 3.94 (SD: 0.12) (95%CI: 3.89, 4.0) mm at 24 h after spinal anaesthesia was statistically significant. The changes in the ONSD measurements in Group P were not statistically significant. Headache was not reported at 24 h or in the follow-up at postoperative day 5. Conclusion: Measurement of ONSD is an easy, economical method for identifying decreased intracranial pressure after spinal anaesthesia. Further research could identify cut-off values to prognosticate PDPH in high-risk individuals.

Anesthesia depth monitoring during opioid free anesthesia – a prospective observational study

BackgroundPatients undergoing general anesthesia are more frequently monitored for depth of anesthesia using processed electroencephalography. Opioid-free anesthesia is nowadays an accepted modality for general anesthesia, however it is unclear how to interpret data from processed electroencephalography when using a mixture of non-opioid anesthetic drugs. Our objective was to describe density spectral array patterns and compare processed encephalographic data indices between opioid-free and routine opioid based anesthesia.MethodsThis prospective observational cohort study was conducted on 30 adult patients undergoing laparoscopic surgery in a non-tertiary regional hospital. The patients underwent general anesthesia with three different methods and were monitored for anesthesia depth using processed encephalography and density spectral array. Primary outcome is a group-derived mean difference in patient state index and spectral edge frequency. As a secondary outcome a descriptive comparison of the spectral power, derived from the density spectral array, was done between groups.ResultsThe opioid-free anesthesia group had significantly higher patient state index and spectral edge frequency compared to routine anesthesia. Density spectral array patterns were also different, most notably lacking the high power in alpha frequency spectrum seen in the other routine anesthesia methods.ConclusionsProcessed electroencephalography monitoring can be used in opioid-free anesthesia, however clinicians should expect higher values in monitoring indices. The density spectral array pattern using a common protocol for opioid-free anesthesia, with mainly sevoflurane combined with low doses of dexmedetomidine and esketamine, differs from well described opioid and GABA-ergic anesthesia methods. These findings should be further validated using other protocols for opioid-free anesthesia in order to safely monitor anesthesia depth.Trial registrationClinicaltrials.gov registration number NCT06227143, registration date; 26th of January 2024.

Single Dose Prophylactic versus Multiple Dose Antibiotics for Reducing Surgical Site Infection in Elective Laparoscopic Cholecystectomy

Background: Surgical Site Infection (SSI) is a less commonly encountered condition in Laparoscopic Cholecystectomy (LC). Whether prophylactic use of antibiotics in elective LC can reduce the incidence of SSI remains inconclusive. Prophylactic multiple dose antibiotic therapy after surgery is a common practice in our country to combat SSI. The study aimed to compare the incidence of SSIs after elective LC with single dose antibiotic and conventional multi doses prophylaxis antibiotic regimen. Materials and methods: This prospective randomized study was conducted during the period September 2019 to August 2020. A total of 100 patients who were admitted for elective LC in the Department of Surgery, Chittagong Medical College Hospital were included in this study. Patients were randomly allocated into two equal groups based on antibiotic prophylaxis: Single Dose Group (SDG) and Multiple Dose Group (MDG). SD group was given Cefuroxime axetil (750 mg) intravenously at the time of induction of anaesthesia and MD group was given Cefuroxime axetil (750 mg) intravenously at the time of induction of anaesthesia, followed by Cefuroxime (500 mg) orally twice daily for 7 days. Patients were followed up till 30th post-operative day to assess postoperative outcome in terms of SSI and other complications. Results: Both the groups were similar in terms of their demographic characteristics. The mean duration of postoperative hospital stay was 1.44±0.57 and 1.5±0.61 days in SDG and MDG, respectively. Grade I (Normal healing with mild bruising or erythema according to Southampton Wound Grading System) was found 3(6.0%) and 5(10.0%) in SDG and MDG, respectively (p=0.461). Conclusion: As there is no statistical difference between use of single dose antibiotic before and use routine multi doses antibiotic before and after elective LC, it could be concluded that preoperative single dose antibiotic is comparable to conventional multi doses prophylaxis antibiotic regimen in elective LC. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 34-37

Clinical practice guidelines for perioperative fluid therapy in Chinese adult patients (2025 edition)

Perioperative fluid therapy is a pivotal component of surgical patient management, as appropriate fluid administration can significantly enhance postoperative recovery. To standardize perioperative fluid therapy for adult patients in China, the Geriatric Anesthesia and Perioperative Management Group of the Chinese Society of Anesthesiology has developed the "Clinical Practice Guidelines for Perioperative Fluid Therapy in Chinese Adult Patients". Based on current clinical status in China, this guideline addressed 11 key areas based on clinical evidence, more than 30% of which is from China researchers, including principles for the selection of common fluid types, preoperative fasting and hydration following enhanced recovery after surgery (ERAS) protocols, intraoperative fluid requirements for adult patients, perioperative volume assessment, perioperative evaluation of volume overload/insufficiency, goal-directed fluid therapy, restrictive fluid therapy, perioperative fluid therapy strategies for high-risk patients, fluid resuscitation for massive blood loss, the relationship between perioperative fluid therapy and postoperative complications, and the relationship between perioperative fluid therapy and ERAS. The guideline included 51 evidence-based recommendations aimed at optimizing perioperative fluid management and improving patient outcomes after surgery.

Locoregional anesthesia in patients with Brugada syndrome. A retrospective database analysis.

The use of local anesthetics (LA) in individuals with Brugada syndrome (BrS) remains a subject of debate due to the lack of large-scale studies confirming their potential risks. This study primarily aimed to evaluate the incidence of new malignant arrhythmias or defibrillation events in patients diagnosed with BrS during the perioperative period, following the administration of local anesthetics, and within 30 days postoperatively. The secondary objective was to analyze the occurrence of adverse effects during hospitalization, as well as 30-day readmission and mortality rates. A retrospective cohort study was performed on patients with BrS who underwent locoregional anesthesia between January 1, 1996, and September 30, 2020. Anesthetic records and electronic medical records were thoroughly reviewed for up to 30 days following each administration of local anesthetics. A total of 47 procedures involving patients with BrS who underwent locoregional anesthesia were analyzed. The patients were categorized into three groups: 27 in the peripheral nerve block (PNB) group, 13 in the epidural anesthesia group, and 9 in the spinal anesthesia group. One patient in the PNB group experienced intraoperative ventricular fibrillation following the administration of ajmaline. No other adverse events were observed. In this retrospective study, our findings do not indicate an increased arrhythmogenic risk or a higher incidence of adverse events associated with the administration of local anesthetics in patients with BrS. However, the available data are insufficient to confirm the safety of local anesthetic use in this population. Enhanced vigilance is recommended when administering local anesthetics to individuals with BrS. Prospective studies are necessary to further evaluate and establish the safety profile of local anesthetics in this patient group.

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.

Recurrence-free survival after hepatectomy using propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: a randomised controlled study.

While evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra-operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra-operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma. Adult patients scheduled for elective hepatectomy for hepatocellular carcinoma were assigned randomly (1:1) to either propofol-based total intravenous anaesthesia or sevoflurane-based inhalational anaesthesia. For recurrence-free survival, overall survival, intrahepatic recurrence-free survival and extrahepatic recurrence-free survival, the survival curves of the two groups were estimated using the Kaplan-Meier method and compared with the log-rank test. The primary outcome was one-year recurrence-free survival. Among the 536 patients enrolled, primary analysis comprised 228 and 226 patients in the total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia groups, respectively. The probability of recurrence-free survival at one year was 79.1% (47 events) and 77.7% (50 events) in the total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia groups, respectively (adjusted hazard ratio 1.04, 95%CI 0.72-1.52). The probability of intrahepatic and extrahepatic recurrence-free survival, as well as overall survival at one year, was not significantly different between total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: 81.3% (42 events) vs. 81.7% (41 events); 91.5% (19 events) vs. 88.8% (25 events); 99.1% (2 events) vs. 100.0% (no event), respectively. Subgroup analyses revealed that in patients undergoing open hepatectomy, total intravenous anaesthesia was associated with a significantly lower hazard of tumour recurrence or death (hazard ratio 0.49, 95%CI 0.25-0.95, p = 0.034), while in patients undergoing laparoscopic surgery, no significant difference was observed (hazard ratio 1.14, 95%CI 0.73-1.80, p = 0.558). Intra-operative anaesthesia technique did not affect postoperative recurrence and overall survival in patients with hepatocellular carcinoma undergoing hepatectomy.

Metabolic Differences in Neuroimaging with [18F]FDG in Rats Under Isoflurane and Hypnorm-Dormicum.

Anesthesia can significantly impact positron emission tomography (PET) neuroimaging in preclinical studies. Therefore, understanding these effects is crucial for accurate interpretation of the results. In this experiment, we investigate the effect of [18F]-labeled glucose analog fluorodeoxyglucose ([18F]FDG) uptake in the brains of rats anesthetized with two commonly used anesthetics for rodents: isoflurane, an inhalation anesthetic, and Hypnorm-Dormicum, a combination injection anesthetic. Female adult Sprague Dawley rats were randomly assigned to one of two anesthesia groups: isoflurane or Hypnorm-Dormicum. The rats were submitted to dynamic [18F]FDG PET scan. The whole brain [18F]FDG standard uptake value (SUV) and the brain voxel-based analysis were performed. The dynamic [18F]FDG data revealed that the brain SUV was 38% lower in the isoflurane group after 40 min of image (2.085 ± 0.3563 vs. 3.369 ± 0.5577, p = 0.0008). In voxel-based analysis between groups, the maps collaborate with SUV data, revealing a reduction in [18F]FDG uptake in the isoflurane group, primarily in the cortical regions, with additional small increases observed in the midbrain and cerebellum. The observed differences in [18F]FDG uptake in the brain may be attributed to variations in metabolic activity. These results underscore the necessity for careful consideration of anesthetic choice and its impact on neuroimaging outcomes in future research.

Regional Analgesia in Pediatric Cardiothoracic Surgery: A Bayesian Network Meta-Analysis.

Various regional analgesia techniques are used to reduce postoperative pain in pediatric patients undergoing cardiothoracic surgeries. This study aimed to determine the relative efficacy of regional analgesic interventions. PubMed, EMBASE, Web of Science, and Cochrane databases were searched to identify all randomized controlled studies evaluating the effects of regional block after cardiothoracic surgery. The primary endpoint was opioid consumption within 24 hours postoperatively, Pain scores, the time to first rescue analgesic, and the incidence of postoperative nausea and vomiting were also collected. A Bayesian NMA was performed to compare the outcomes of interest. A total of 24 studies involving 1602 patients and 13 regional blocks were included. All techniques reduced opioid consumption within 24 hours postoperatively. The largest decrease was in the thoracic retrolaminar block group, with a WMD of -0.97 (95% CrI -1.1, -0.84) mg/kg morphine equivalent. In terms of pain scores, there was no significant difference between any block and the control at any time point except for the thoracic retrolaminar block group at 0 hours postoperatively. In addition, all regional blocks prolonged the time to first rescue analgesic, which was the longest in the pectoral nerve block group. The incidence of postoperative nausea and vomiting was the lowest in the epidural anesthesia group, followed by the transversus thoracis muscle plane block group. Regional anesthesia revealed significant opioid-sparing effects following pediatric cardiothoracic surgery. However, indirect comparisons are limited because of the heterogeneity of previous studies, and direct comparisons are needed to establish the relative efficacies of different blocks.

The Practice of Percutaneous EVAR under Local Anesthesia.

Objectives: Endovascular aortic repair (EVAR) should be performed using a less invasive procedure based on the patient's clinical condition, as many patients who undergo this procedure are elderly and have poor surgical tolerance. We report our experience and results of percutaneous EVAR under local anesthesia in order to practice minimally invasive EVAR at our hospital. Methods: In August 2019, we started percutaneous EVAR using Perclose ProGlide under local anesthesia. We compared the backgrounds and surgical outcomes of patients who underwent EVAR at our hospital before and after the introduction of percutaneous EVAR under local anesthesia. Results: We included 148 patients in this study. The age at surgery and prevalence of severe renal dysfunction were significantly higher in percutaneous EVAR under local anesthesia group. The operative time and postoperative hospital stay were significantly shorter in the percutaneous EVAR group under local anesthesia. Conclusions: The introduction of percutaneous EVAR under local anesthesia enabled minimally invasive EVAR to be performed safely even in high-risk patients. (This is a translation of J Jpn Coll Angiol 2022; 62: 1-5.).

Local anesthesia with and without conscious sedation versus general anesthesia for oral surgical procedures in pediatric patients: a retrospective cross-sectional study

Objectives: To compare the effectiveness of general anesthesia versus local anesthesia with or without conscious sedation for minor oral surgery procedures in pediatric patients. Methods: We performed a retrospective chart review of 192 pediatric patients who underwent 227 minor oral surgery procedures between 2017 and 2019 at the Oral and Maxillofacial Surgery Department at Hospital Clínico Universitario in Valencia, Spain. Results: Of the 192 patients studied, 57.27% were male and 42.73% female (mean age, 9.83 years). General anesthesia was used in 51.54% of procedures, and LA with or without conscious sedation in 48.46%. Pain, occurring in 2.56% of general anesthesia procedures and 2.73% of local anesthesia procedures, was the most common complication, followed by infection (1.71% of general anesthesia procedures). Procedural success was 94.87% in the general anesthesia group and 91.82% in the local anesthesia group. No significant differences were observed in success or complication rates between the groups. Conclusions: Compared with local anesthesia with or without conscious sedation, general anesthesia does not result in lower procedural success rates or a higher risk of complications other than mild pain in pediatric dental patients.

Exploring the impact of perioperative analgesia on postoperative chronic analgesic prescriptions in patients with lung cancer undergoing minimally invasive thoracic surgery: A retrospective observational study.

Lung cancer surgery is associated with a high incidence of chronic postsurgical pain (CPSP), which necessitates long-term analgesic prescriptions. However, while essential for managing pain, these have shown various adverse effects. Current guidelines recommend using peripheral nerve blocks over epidural anaesthesia for perioperative analgesia in minimally invasive thoracic surgery (MITS). However, the impact of perioperative analgesia on chronic analgesic prescriptions remains unclear. Therefore, this study investigated chronic analgesic prescription patterns following MITS in patients with lung cancer who received either perioperative epidural anaesthesia or nerve block. We conducted a retrospective cohort study using data from the Japanese Diagnosis Procedure Combination database. Data were extracted from patients with primary lung cancer who underwent MITS between April 2018 and March 2022. Patients were divided into two groups based on the perioperative analgesia they received: the epidural anaesthesia group and the nerve block group. We compared the proportion of analgesic prescriptions 3-6 months postoperatively between both groups using multivariable logistic regression analysis. Inverse probability of treatment weighting was used to balance the covariates between the two groups. Among the 38,719 eligible patients, 4513 (11.6%) were prescribed postoperative analgesics. We found no significant difference in the proportion of analgesic prescriptions between the epidural anaesthesia and nerve block groups (odds ratio, 1.00; 95% confidence interval, 0.99-1.01). This nationwide retrospective study suggests that the choice between perioperative epidural anaesthesia or nerve block in patients with lung cancer undergoing MITS does not influence the proportion of postoperative chronic analgesic prescriptions.

Involvement of the parabrachial nucleus in emergence from general anesthesia.

The parabrachial nucleus (PBN), located in the dorsolateral pons, is involved in many important biological functions, such as sensory signaling, feeding, defensive behaviors, fear, anxiety, and sleep-wake cycles. General anesthesia shares the classical feature of reversible loss of consciousness with natural sleep, and accumulating evidence has indicated that general anesthesia and sleep-wake behaviors share some common underlying neural mechanism. In recent years, emerging studies have investigated the involvement of PBN in emergence from general anesthesia, but divergence exists in terms of different types of general anesthetics or different durations of treatment with the same group of general anesthetics. Here, we reviewed the current literature and summarized the evidence about the contribution of PBN to general anesthesia.

The impact of surgery with general anesthesia on cognitive function and putamen volume: a cross-sectional study among older adults

BackgroundPrevious studies have shown that surgery under general anesthesia may diminish cognitive function; however, the proposed mechanisms need further elucidation. The purpose of the current study was twofold: (1) to compare overall and domain-specific differences in cognitive function between the surgery under general anesthesia group and the control group, and (2) to investigate the possible mechanisms of surgery under general anesthesia affecting cognitive function, using T1-structural magnetic resonance imaging.MethodsA total of 194 older adults were included in this study. Patients were divided into a surgery under general anesthesia group (n = 92) and a control group (n = 104). The two groups were matched for age, sex, and educational level. All participants underwent clinical evaluation, neuropsychological testing, blood biochemistry analysis, and T1 phase structural magnetic resonance imaging.ResultsWe found that older adults with a history of surgery under general anesthesia had lower Montreal Cognitive Assessment (MoCA) scores and smaller right putamen volumes (p < 0.05). Linear regression analysis (mediation model) indicated that surgery under general anesthesia affected MoCA scores by diminishing the volume of the right putamen (B = 1.360, p = 0.030).ConclusionWe found evidence that older adults who underwent surgery under general anesthesia had poorer cognitive function, which may have been caused by an apoptotic or otherwise toxic effect of anesthetic drugs on the volume of the right putamen.

Wide Awake Surgery Is Safe and Feasible in Pediatric Orthopaedic Surgery.

Wide awake local anesthesia no tourniquet (WALANT) techniques are increasingly utilized for hand surgeries in adults, given the clinical benefits to patients, reduced environmental waste during surgery, and lower costs to the health care system. This technique is not widely employed for pediatric hand surgeries given concerns for parental and patient anxiety, noncompliance during surgery, and tolerance of administration of local anesthesia. Select patients undergoing amenable procedures can potentially benefit from this method and enjoy the lower morbidities and costs that adult patients enjoy. It was hypothesized that WALANT technique would be safe, efficient, and feasible in a pediatric cohort. A retrospective chart review of all 223 upper extremity surgeries performed by a single surgeon at a pediatric hospital and its surgery center was performed. Patients aged 7 to 20 years scheduled for local anesthesia without monitored anesthesia care were included. These patients were not instructed to fast before their procedure. Patient demographics, surgical and recovery room times, pain scores, and complications were recorded. Eighty-six patients underwent surgery under local anesthesia and were compared with 76 patients undergoing similar surgeries under general anesthesia. Both soft tissue and bony surgeries were included. The WALANT group had both significantly shorter average length of surgery and time spent in recovery compared with the general anesthesia group, translating into significant cost savings. Lower pain scores and fewer narcotic prescriptions were noted. There were no conversions to any type of monitored anesthesia care, nor cancellations due to inability to tolerate administration of local. No difference in infection rates or other complications were noted between groups. WALANT is safe, efficient, and feasible in a pediatric hospital for a variety of surgeries. Expanding this technique for use in select children allows patients, their families, and the health care system to enjoy the clinical, financial, and environmental benefits of WALANT surgery. Level III-retrospective comparative study.

Anesthetics change the oral microbial composition of children and increase the abundance of the genus Haemophilus.

Oral microbiome homeostasis is important for children's health, and microbial community is affected by anesthetics. The application of anesthetics in children's oral therapy has become a relatively mature method. This study aims to investigate the effect of different anesthesia techniques on children's oral microbiota. Sixty children who visited the Department of Stomatology of the Jiangxi Provincial Children's Hospital were recruited. Subjects who did not receive anesthesia during the surgery were divided into non-anesthesia (Noa) group. Other children who accepted anesthesia during the surgery were grouped into lidocaine group, sevoflurane group, and intravenous injection-inhalation (intra-inhalation) group. Subsequently, their saliva samples were collected for 16S rDNA sequencing. A total of 1,316 operational taxonomic units (OTUs) were identified in overall samples, and 75,275 reads per sample were obtained on average. There were 137 genera were shared among the Noa, lidocaine, sevoflurane, and intra-inhalation groups. The genera Neisseria, Prevotella-7, Streptococcus, and Veillonella had a higher abundance in the four groups. Compared to the Noa group, anesthetics increased the abundance of the genus Haemophilus in the anesthesia groups. Alpha and beta diversity analyses revealed significant differences in the comparisons of Noa vs. sevoflurane and Noa vs. intra-inhalation. In contrast, the difference between the lidocaine and the Noa groups was slight. Linear discriminant analysis effect size (LEfSe) analyses identified 52, 16, and 37 differential microbes in the Noa vs. sevoflurane, Noa vs. lidocaine, and Noa vs. intra-inhalation comparisons, respectively. Notably, Haemophilus genus was significantly enriched in the sevoflurane group compared to the Noa group. When comparing the Noa group with the other three anesthesia groups, between-group pathway differences were found in amino acid metabolism, energy metabolism, biofilm formation, cofactor and vitamin metabolism, and antibiotic synthesis. This study elucidated oral microbiome characteristics in children under different anesthesia technology and found an enrichment of Haemophilus genus in the sevoflurane group compared to the Noa group. Our findings provide new insights into the effect of anesthetic on oral microbiota of children.

The impact of anesthesia methods and rapid on-site evaluation on the diagnosis of lung cancer using endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective study.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a critical method for diagnosing lung cancer. While EBUS-TBNA is commonly performed under conscious sedation, the potential benefits of conducting the procedure under general anesthesia and incorporating rapid on-site evaluation (ROSE) to enhance diagnostic yield remain uncertain. This study aims to investigate the impact of anesthesia methods and ROSE on the diagnostic efficacy of EBUS-TBNA for lung cancer. This study collected data from patients who underwent EBUS-TBNA for suspected lung cancer in the Department of Respiratory and Critical Care Medicine at The Affiliated Hospital of Southwest Medical University from August 2018 to December 2023. Patients were categorized into three groups based on the anesthesia method used and whether ROSE was performed: the non-general anesthesia group (NGA group), the general anesthesia group (GA group), and the general anesthesia with ROSE group (RGA group). The study analyzed baseline characteristics, puncture details, diagnostic outcomes, and complications across the groups. The number of puncture needles used in the RGA group was significantly lower than in the other two groups (P<0.001). Most patients received a definitive diagnosis, with malignant tumor diagnostic rates of 80.95%, 85.71%, and 93.44% in the NGA, GA, and RGA groups, respectively (P=0.12). The overall disease diagnostic rates were 76.06%, 79.22%, and 86.11%, respectively (P=0.30). No severe complications occurred in any of the groups. The proportion of patients willing to undergo repeat EBUS-TBNA was significantly lower in the NGA group compared to the other two groups (P=0.002). Compared to local anesthesia combined with intravenous analgesia and sedation or general anesthesia alone, general anesthesia combined with ROSE reduces the number of puncture needles required during EBUS-TBNA but does not further improve diagnostic efficacy.

The genotoxicity effects and oxidative stress of common volatile and injectable anesthesia drugs on peripheral blood during irradiation of BALB/c mice

IntroductionIonizing radiation (IR) is well-known for its genotoxic and cytotoxic effects. Additionally, anesthesia has been shown to cause various side effects, including genotoxicity. This study aims to evaluate the DNA damage and oxidative stress resulting from exposure to both anesthesia and IR. MethodsSeventy BALB/c male mice were divided into 14 identical groups and anesthetized using three different inhalation anesthetics (isoflurane, sevoflurane, and halothane) and three different injectable anesthetics (propofol, ketamine, and thiopental). We also evaluated combinations of these anesthetic drugs with 1 Gy IR. DNA damage in white blood cells was assessed using the alkaline comet assay at 0, 2, and 24 h after treatment. Additionally, oxidative stress in blood samples was measured 6 h post-treatment. ResultsThe percentage of DNA in the tail and fragmented nuclei after 2 and 24 h was significantly higher in the groups given volatile anesthetics compared to the propofol and thiopental groups (P<0.05). Furthermore, oxidative stress levels were also significantly higher in the volatile anesthetic groups (P<0.05). When combined with IR, the volatile anesthetics and ketamine resulted in increased genotoxicity and significantly higher oxidative stress compared to the group exposed only to IR (P<0.05). In contrast, propofol and thiopental did not lead to a significant increase in genotoxicity or oxidative stress compared to the control group (P>0.07). ConclusionCombining volatile anesthetic drugs and ketamine with 1 Gy irradiation resulted in higher levels of toxic effects and oxidative stress, although this combination did not produce a synergistic effect. Additionally, the combination of propofol and thiopental with IR did not show a significant difference compared to the irradiated-only group in both the alkaline comet and oxidative stress assays.

Hypotension after unilateral versus bilateral spinal anaesthesia: A Systematic review with meta-analysis.

Spinal anaesthesia is frequently used in surgical procedures involving the lower abdomen and extremities, however, the occurrence of hypotension remains a common and clinically important adverse effect. Unilateral spinal anaesthesia seems to be a promising approach to minimise this complication but the effectiveness of this remains controversial. A meta-analysis was undertaken to evaluate the superiority of unilateral spinal anaesthesia over bilateral spinal anaesthesia with regard to the incidence of hypotension and other complications. Systematic reviews and meta-analysis of randomised controlled trials (RCTs). PUBMED, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched from their inception to 5 March 2024. Randomised controlled trials (RCTs) comparing unilateral spinal anaesthesia with bilateral spinal anaesthesia were eligible for inclusion. Observational studies, case reports, case series, and studies not conducted in humans were excluded. The incidence of hypotension, vasopressor requirement, and other complications were compared. Heterogeneity was assessed by subgroup analyses and sensitivity analysis. Twenty-one trials involving 1358 patients undergoing unilateral lower extremity surgery or lower abdominal surgery were included in the meta-analysis. Hyperbaric solutions were used in most trials. The Mantel-Haenszel random-effect model was used for the analysis of binary endpoints, reported as relative risk (RR) with a 95% confidence interval (CI). The incidence of hypotension was significantly lower in the unilateral spinal anaesthesia group compared with the bilateral spinal anaesthesia (RR 0.38, 95% CI 0.27 to 0.55; P < 0.001; I2 = 38%). Subgroup analysis shows that the occurrence of hypotension was significantly lower in the unilateral subgroup, regardless of dosage, surgical site, adjuvants to the local anaesthetics, and different definitions of hypotension. Unilateral spinal anaesthesia is associated with a significant reduction in the occurrence of hypotension, despite variations in the definition of hypotension, adjuvants, and site of surgery. These results favour the use of lateral spinal anaesthesia in patients undergoing unilateral lower abdominal or lower limb surgery. However, the GRADE assessment of the quality of evidence was 'low' due to the high risk of bias and heterogeneity. All the results should be treated with caution.

Neurodevelopmental Outcomes after Multiple General Anesthetic Exposures before 5 Years of Age: A Cohort Study.

The general anaesthesia or awake-regional anaesthesia in infancy (GAS) trial demonstrated evidence that most neurodevelopmental outcomes at 2 and 5 yr of age in infants who received a single general anesthetic for elective inguinal herniorrhaphy were clinically equivalent when compared to infants who did not receive general anesthesia. More than 20% of the children in the trial had at least one subsequent anesthetic exposure after their initial surgery. Using the GAS database, this study aimed to address whether multiple (two or more) general anesthetic exposures compared to one or no general anesthetic exposure in early childhood were associated with worse neurodevelopmental outcomes at 5 yr. Children with multiple general anesthetic exposures and children with one or no general anesthetic exposure were identified from the GAS database. The primary outcome was the full-scale intelligence quotient on the Wechsler Preschool and Primary Scale of Intelligence (third edition) at 5 yr of age. Secondary outcomes included neurocognitive tests addressing all major developmental domains and caregiver-reported questionnaires assessing emotional and behavioral problems. Complete assessment was available from a total of 90 children in the multiple general anesthetic group and 141 children in the no or one general anesthetic group. Compared with children with a single or no general anesthetic exposure, multiply exposed children scored on average almost 6 points lower (mean, -5.8; 95% CI, -10.2 to -1.4; P = 0.011) in the Wechsler Preschool and Primary Scale of Intelligence full-scale intelligence quotient. They also demonstrated lower verbal and performance IQ scores and more emotional, behavioral, and executive function difficulties. However, significant residual confounding cannot be excluded from the results due to the observational nature of this study. Multiple general anesthetic exposures before 5 yr of age were associated with reduced performance in general intelligence score and some domains of neurodevelopmental assessments. The clinical significance of this study's results must be cautiously interpreted in light of several sources of limitations including small sample size and unadjusted residual confounding. This study illustrates the limitations of trial data sets that may not be fit for the purpose for the secondary analysis.