Method Of Anesthesia Research Articles

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.

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.

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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.

This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent GA or SA during vaginal pelvic floor surgeries. A retrospective cohort study. 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. 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). Limitaions: This is a rerospective study, thus the choice of anesthesia may be biased. 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. GENERAL ANESTHESIA; SPINAL ANESTHESIA, ANALGESIA, PELVIC FLOOR SURGERY, PELVIC ORGAN PROLAPSE, STRESS URINARY INCONTINENCE, ERAS. Vaginal pelvic floor surgeries under spinal anesthesia is associated with less postoperative pain and intravenous analgesia requirement.

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

Objective 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). Methods 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. Results 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 &lt; .05), and IA was 3 times higher than TIVA to have overall and early, but not late, PONV (P &lt; .05). Conclusion 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.

The relationship between postoperative cognitive dysfunction and cerebral small vessel disease: A comprehensive review.

Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients, and cerebral small vessel disease (CSVD) has been suggested as a potential risk factor. This review examines the relationship between POCD and CSVD from epidemiological, pathophysiological, and clinical perspectives, while also considering the role of Alzheimer's disease (AD) pathology. We conducted a comprehensive literature search of major databases, supplemented by reference list checking, to ensure a thorough review of studies published between 2000 and 2023 on the relationship between POCD and CSVD. Epidemiological studies have shown that POCD and CSVD are associated in terms of common risk factors, including advanced age, vascular comorbidities, impaired baseline cognitive function, and certain population characteristics. Animal studies have revealed that CSVD and POCD share similar neuropathological changes, including abnormal cerebral hypoperfusion, inflammatory responses, and blood-brain barrier disruption. Furthermore, recent research suggests a complex interplay between CSVD, AD pathology, and POCD, with potential synergistic effects on cognitive decline. Neuroimaging studies have further demonstrated that preoperative CSVD burden and postoperative CSVD progression are associated with the development of POCD, and the presence of both CSVD and AD markers may increase the risk of cognitive decline. The association between CSVD and POCD has important implications for the perioperative management of elderly patients, including preoperative assessment, choice of anesthesia and surgical methods, intraoperative management, postoperative care, and long-term follow-up. A better understanding of the relationship between CSVD and POCD will guide evidence-based strategies to prevent and manage this debilitating complication in the aging population.

Whether monitored anesthesia care is the optimal anesthetic strategy for transcatheter aortic valve implantation surgery? a meta-analysis and systematic review

ObjectivesTo explore whether monitored anesthesia care is more beneficial to the outcome of transcatheter aortic valve implantation.MethodsThe research methodology involved comprehensive searches across major databases, including the Cochrane Library, PubMed, Scopus, and Web of Science, covering the period from January 1, 2010, to March 1, 2024. The aim was to identify trials comparing different anesthetic methods for transcatheter aortic valve implantation. The primary outcomes assessed were mortality and length of hospital stay, while secondary outcomes included common complications such as bleeding, stroke, paravalvular leakage, renal failure, and others. Data synthesis was conducted using risk ratios or standardized mean differences, along with 95% confidence intervals. The study protocol was prospectively registered with PROSPERO (CRD42024507749).ResultsA total of 35 trials and 45,616 patients were included in this study. The results showed that monitored anesthesia care significantly reduced the patient's risk of death, shortened the patient's length of hospital stay, and also reduced the risk of common complications such as paravalvular leakage (RR, 0.80; 95% CI: 0.72 to 0.88; p < 0.00001; I2 = 0) and stroke (RR, 0.80; 95% CI: 0.65 to 0.99; p = 0.04; I2 = 0).ConclusionMonitored anesthesia care has an absolute advantage in patient survival and effectively shortens the length of hospitalization. In addition, it also reduces the risk of complications such as paravalvular leakage and stroke. Monitoring care under anesthesia plays a vital role during TAVI surgery, not only helping to ensure the smooth progress of the surgery and patient safety, but also promoting the patient's recovery and recovery.

Our experience in providing anesthesia during surgical interventions for necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is one of the most common serious acquired diseases of the gastrointestinal tract, both in full-term and premature infants, and is associated with a high risk of complications and high mortality. Anesthetic management for necrotizing enterocolitis in newborns during surgery is a complex task and is still relevant, since the future fate of the patient depends on adequacy of the anesthesia used. Purpose of the study: Optimization of anesthesia during surgery in newborns for necrotizing enterocolitis. Material and research methods: The study was conducted in surgical clinics of the Azerbaijan Medical University. The paper presents the results of treatment of 96 patients based on the assessment of clinical indicators of preoperative preparation, anesthesiological care, and the study of central hemodynamics in newborns operated on for necrotizing enterocolitis. Newborns were divided into 2 groups depending on the method of anesthesia used: group I with general anesthesia and group II with general anesthesia using caudal anesthesia. Results: The results of this study showed that effective interruption of nociceptive impulses from the surgical site through caudal blockade and sufficient sedation can prevent pronounced activation of the body's neurohumoral reactions to surgical stress under conditions of balanced regional anesthesia, and it was also revealed that the modern muscle relaxant rocuronium bromide allows the concept of multicomponent anesthesia to be implemented, causing complete relaxation of the striated muscles during surgery, which helps to effectively block pathological reactions in response to surgical stress.

Xenon as an anesthetic of choice for full mouth debridement in a child with drug-resistant epilepsy: A clinical case

Background: Outpatient dental care in children with epilepsy (particularly drug-resistant epilepsy) is challenging for anesthesiologists in terms of selecting appropriate anesthesia methods and agents, as well as for dentists in terms of improving treatment efficacy and quality while minimizing intervention time. General anesthetics may trigger seizures in patients with epilepsy, including those with drug-resistant epilepsy. As a result, selecting the appropriate anesthetic is critical during preparation stages and anesthetic management in these patients. Case description: A clinical case of full mouth debridement in a 3-year-old child with drug-resistant epilepsy is presented to demonstrate the efficacy of xenon as an inhalational anesthetic in patients with drug-resistant epilepsy. Combination inhalation anesthesia with xenon was used. There were no signs of seizures during surgery and within two days after anesthesia. Conclusion: Xenon may be a viable inhalational anesthetic for patients with drug-resistant epilepsy.

Dual-route administration of balanced anesthesia using medetomidine, midazolam, and butorphanol provides both suitable anesthetic depth and reduced tissue injury in rabbits.

Medetomidine, midazolam, and butorphanol (MMB) anesthesia is the preferred choice for rodents but requires excess volume of intramuscular injection in rabbits, which can lead to muscular damage. This study aimed to evaluate a dual-route MMB administration via the intravenous and subcutaneous routes in rabbits. MMB was administered to male Kbs:JW rabbits with an intravenous injection of 0.2 mL/kg followed by a subcutaneous injection of 0.8 mL/kg, totaling 0.2 mg/kg medetomidine, 2.0 mg/kg midazolam, and 2.0 mg/kg butorphanol. We compared the anesthetic effects of this dual-route method with those of intramuscular administration. The dual-route method resulted in a shorter induction time and similar anesthetic duration compared with those of the intramuscular route. While it induced a temporary decrease in body temperature within 30 min post-injection, other vital signs, such as respiration rate, heart rate, and O2 saturation, remained similar. Notably, unlike intramuscular administration, dual-route administration did not increase tissue injury marker levels. This dual-route MMB administration provided sufficient anesthetic depth during surgery, eliminating pain reflexes. Double-dose administration extended anesthetic duration but resulted in rare fatalities, indicating room for protocol improvement. In conclusion, the novel anesthetic method is preferable for injectable anesthesia in rabbits, providing rapid induction and sufficient anesthetic duration, while potentially minimizing muscle injury. This technique may be beneficial for both laboratory and companion animals and significantly enhance animal welfare in anesthesia by reducing the pain associated with injectable anesthesia.

Comparison between ultrasound guided erector spinae plane block and paravertebral block on acute and chronic post mastectomy pain after modified radical mastectomy: randomized controlled trial

BackgroundInadequate acute postoperative pain management is linked to the effect on the stress response and development of chronic pain. A unique regional anaesthetic method that is becoming more important for postoperative pain management is erector spinea plane block (ESP). Since its initial description, physicians have questioned weather this novel easy method can take the place of paravertebral block (PVB). Our goal was to evaluate, in contrast to control group, the effects of ESP & PVB on acute and chronic post-mastectomy pain.MethodsOne hundred and five female patients undergoing modified radical mastectomy participated in this study, randomly allocated into three equal groups: erector spinae plane block (ESP), thoracic paravertebral (TPV), and control groups. Both blocks were ultrasound-guided with 20 ml 0.25% bupivacaine according to patients’ group, control group was administered standard general anaesthesia without intervention. Total morphine consumption in the first 24 h postoperative was the primary outcome. The secondary outcomes were time to the first analgesia, (Visual Analogue Scale)VAS score, serum level of cortisol and prolactin, sedation score, side effects, and LANSS scores in the first, third, and sixth postoperative months were among the variables compared between groups.ResultsTotal morphine consumption in the first 24 h was significantly higher in control than ESP and TPV groups (10.74 ± 1.37, 8.17 ± 1.69, 5.70 ± 1.95 respectively p < 0.001). Time to first analgesic request was the shortest in control versus ESP and TPV groups as (4.37 ± 3.06, 8.13 ± 1.75, 10.64 ± 1.83 h respectively p ˂0.001). ESP and TPV had significantly lower cortisol and prolactin levels compared to control (p < 0.001). The highest LANSS scores were in the control group in the first, third, and sixth months compared with ESP and TPV, with no significant difference between ESP and TPV.ConclusionESP and TPV blocks provided superior early postoperative analgesia and reduced stress response compared to the control group in female patients undergoing modified radical mastectomy. PVB is better than ESB in acute postoperative pain management (the total morphine consumption VAS score and time of first analgesic request). Both techniques showed better long-term outcomes compared to the control group regarding LANSS score in the 6-month follow-up.Trial registrationhttps://www.ClinicalTrials.gov trial registry (identifier NCT04498234 on 04/08/2020).

Analysis of influencing factors and construction of nomogram prediction model of postoperative kinesiophobia in patients undergoing total knee arthroplasty.

To explore the influencing factors of kinesiophobia and to establish a nomogram prediction model. A retrospective observational study was conducted in 354 patients who underwent TKA in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from December 2019 to December 2022. Sociodemographic characteristics, anesthesia methods, Tampa Scale for Kinesiophobia (TSK), numeric rating scale (NRS), hospital for special surgery (HSS), activities of daily living (ADL), and self-rating anxiety scale (SAS) were reviewed and analyzed. Logistic regression analysis was used to identify the influencing factors of kinesiophobia, and a nomogram model was established based on the identified influencing factors and verified by consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Incidence of kinesiophobia in patients who received TEAS combined with western medicine (dexmedetomidine and remifentanil) was significantly lower than that in patients who received western medicine alone. The logistic regression analysis showed that family monthly income level, HSS, ADL, and combined TEAS and western medicine approach were independent protective factors for kinesiophobia (all P<0.05). The degree of pain and anxiety were independent risk factors for kinesiophobia (both P<0.05). A nomogram model was constructed with C-index of 0.721 (0.658, 0.784), and the area under curve (AUC) was 0.748 (95 %CI: 0.685-0.807). The calibration curve also showed good consistency between actual observations and nomogram model predictions. Family monthly income level, anesthesia methods, NRS, HSS, ADL, and SAS scores are influencing factors of kinesiophobia, and the nomogram model can be useful for predicting postoperative kinesiophobia.

Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study

(Anesth Analg. 2024;138(6):1275–1284.) Maternal and neonatal mortality rates are significantly high in Africa. The African Surgical Outcomes Study (ASOS) revealed that maternal mortality (MM) following cesarean delivery is 50 times higher in Africa compared with high-income countries, primarily due to obstetric hemorrhage and anesthesia complications. General anesthesia (GA) was particularly risky, with 1 in 66 GAs resulting in maternal death and a higher MM rate compared with spinal anesthesia (SA) (1.5% vs. 0.3%). A substudy was conducted within ASOS to estimate the association between preoperative risk factors and anesthesia methods. Secondary aims included examining the relationship between anesthesia type and maternal intraoperative hypotension, severe anesthesia complications, and neonatal mortality. This secondary analysis of the ASOS obstetric cohort involved patients aged 18 and older across 183 hospitals in 22 African countries. Data collected included gravidity, parity, gestational age, and complications like preeclampsia and eclampsia. The study followed the STROBE guidelines and received ethical approvals from relevant committees.

The perioperative frailty index derived from the Chinese hospital information system: a validation study

BackgroundThere are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11).MethodsA prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty.Results335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0%) were females, and the Median(P25, P75)age at surgery was 69 (65,74) years. The prevalence of frailty in the study population was 16.4% (assessed by FI-32). After adjusting for concomitant variables including demographic characteristics (such as gender, BMI, smoking, drinking, average monthly income and educational level) and surgical factors (such as surgical approach, surgical site, anesthesia method, operation time, intraoperative bleeding, and intraoperative fluid intake), there was a statistically significant association between frailty and the development of postoperative complication after surgery (OR = 3.051, 95% CI:1.460–6.378, P = 0.003). There were also significant differences in mortality within 30 days of surgery, the length of hospital stay (LOS) and the hospitalization costs. FI-32, FRAIL and mFI-11 showed a moderate predictive ability for postoperative complications, the Area Under Curves (AUCs) were 0.582, 0.566 and 0.531, respectively. With adjusting concomitant variables associated with postoperative complications, the AUCs of FI-32, FRAIL and mFI-11 in the adjusted prediction models were 0.824, 0.827 and 0.820 respectively.ConclusionsThe FI-32 has a predictive effect on postoperative adverse outcomes in elderly Chinese patients. Compared to FRAIL and mFI-11, the FI-32 had the same ability to predict postoperative complications, and FI-32 can be extracted directly from HIS, which greatly saves the time for clinical medical staff to evaluate perioperative frailty.

Emergency Open Appendectomy Under Continuous Lumbar Epidural Anesthesia in a Patient with Massive Ameloblastoma

Background: Open appendectomy is still performed in the Philippines. The choice of anesthetic technique should tailor the patient's profile and the disease’s extent. This case presents a unique scenario involving a patient with a known case of ameloblastoma, complicating her anesthetic management Method: A 29-year-old female presented with migratory abdominal pain associated with symptoms of acute appendicitis. She was scheduled for an emergency open appendectomy under continuous lumbar epidural anesthesia, selected for its advantage in providing reliable surgical anesthesia in a probable prolonged surgery. Result: Epidural anesthesia provided adequate sensorimotor blockade during the three-hour surgery. Patient had an uneventful postoperative course and was discharged two days after the operation. This case presents the need for tailored anesthetic approaches in managing patients with unique medical histories undergoing common surgical procedures. These findings contribute to the limited studies on open appendectomy under continuous lumbar epidural anesthesia in a patient with massive ameloblastoma.

Letter to the editor regarding "Carotid endarterectomy outcomes according to anesthesia method: General anesthesia or regional anesthesia"

Letter to the editor regarding "Carotid endarterectomy outcomes according to anesthesia method: General anesthesia or regional anesthesia"

Impact of remimazolam on postoperative inflammatory markers and complications in thoracoscopic pulmonary lobectomy patients: A retrospective analysis.

Remazolam is widely used for procedural sedation in intensive care units. It has been shown to have anti-inflammatory and organ-protecting properties. However, the changes in inflammatory markers and analgesic effects of remazolam after thoracoscopic pulmonary lobectomy remain unclear. This study aims to assess the effects of the novel drug remimazolam on inflammatory factor levels and postoperative complications in thoracoscopic pulmonary lobectomy patients, providing a scientific basis for clinical use. This retrospective study analyzed 200 thoracoscopic pulmonary lobectomy patients, who were divided into a control group and a remimazolam group based on their anesthesia method. Patients in ramazolam group were anesthetized with ramazolam, while patients in control group were anesthetized with propofol. All patients were performed by the same physician team and anesthesia team. Inflammatory factors (including interleukin-6 [IL-6], C-reactive protein [CRP], including interleukin-8) were measured preoperatively and postoperatively, and postoperative complication rates were compared between the 2 groups. The levels of IL-6 and CRP were significantly higher in the remimazolam group at 7 days postoperatively compared to the control group. No significant differences were observed in preoperative inflammatory factors or postoperative including interleukin-8 levels between the 2 groups. Additionally, there were no significant differences in the overall incidence of postoperative complications or in specific complications such as pulmonary infection, atelectasis, subcutaneous emphysema, pneumothorax, surgical site infection, and arrhythmia. Patients receiving remimazolam had higher postoperative IL-6 and CRP levels compared to the control group, without an increase in postoperative complications. In clinical use, attention should be paid to the control of inflammatory indicators in patients using remazolam. However, due to potential confounding factors and the retrospective design, we cannot establish a causal relationship between remimazolam and elevated inflammatory markers. These findings suggest a possible association that requires cautious interpretation. Further research is needed to assess the clinical relevance and explore the underlying mechanisms.

Caspase-9 and p53 Protein Levels in Cancer Patients after Different Anesthesia Techniques

The aim of this study was to investigate the changes in caspase-9 and p53 levels as biomarkers of pro- and anti-apoptotic pathways in the early postoperative period in patients who underwent lung surgery for malignant tumors under different types of multimodal or inhalation-intravenous anesthesia.Material and Methods. A single-center prospective study of 22 patients aged 45-64 years was conducted at the Omsk Clinical Oncology Early Treatment and Prevention Center from January to April 2020. The participants were divided into two groups. Group 1 patients received multimodal anesthesia, which included sympathetic nerve block and prolonged epidural analgesia in the postoperative period. Group 2 patients received inhalational and intravenous anesthesia followed by systemic morphine analgesia. Serum caspase-9 and p53 protein levels were measured at four time points: before anesthesia, one, twelve, and twenty-four hours after surgery. Statistical hypotheses were tested using nonparametric (rank) analysis methods. Friedman's ANOVA was used to compare multiple time points, while the Wilcoxon test was used to compare variables between two time points in dependent samples. The Mann-Whitney test was used to assess differences between groups in independent samples. P-values &lt; 0.05 were considered statistically significant. Results are expressed as median ± half interquartile range (Me ± (LQ-UQ)/2).Results. At time point 2, caspase-9 levels were significantly higher in group 2 patients than in group 1 (P = 0.045). There were no significant differences between the groups at any other time points.Conclusion. The lack of a significant difference in serum levels of caspase-9 and p53 protein at most time points between the groups demonstrates the efficacy of the anesthesia and analgesia methods used. Meanwhile, a significantly higher level of caspase-9 one hour after surgery demonstrates a greater susceptibility of patients without sympathetic blockade to activation of the apoptotic cell death program.

Multidisciplinary care in nonmalignant central airway obstruction.

The management of histologically benign central airway obstruction (CAO) is complex. Published studies have focused on the diagnostic approaches and therapeutic options provided by specific specialties, but there has been no focus on multidisciplinary management of this disease. Our objective is to review the current diagnostic and therapeutic modalities available for managing nonmalignant CAO from a multidisciplinary perspective involving otolaryngology, thoracic surgery and interventional bronchoscopists. For benign airway strictures, management is via medical and endoscopic therapy with surgical resection reserved for complex and recurrent stenoses. There is evidence and growing interest in intralesional corticosteroid injection in treating inflammation and potentially preventing recurrence. Airway specialists from distinct disciplines use different laser types, dilating balloons and anesthesia methods to manage benign CAO. Recent studies have demonstrated substantial improvements in patient breathlessness and quality of life following therapeutic airway interventions, highlighting the evolving landscape in this cross-disciplinary field. Nonmalignant CAO, arising from various mechanical, inflammatory, and infectious etiologies, poses significant morbidity and mortality risks. Current treatments include endoscopic resection, dilation, stent placement, and surgical resection which are selected based on lesion's complexity, extent, operability and patient's symptoms and goals. A multimodal and multidisciplinary approach to patient care could offer the best outcomes.