Anesthetic Risk Research Articles

Methods to increase the effectiveness of cytoreductive surgical interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis

The expediency of performing two-stage cytoreductive interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis is presented. Ninety-two patients with complicated disseminated tumors of the abdominal cavity and pelvis were examined into two groups. The main group consisted of 33 patients who received surgical treatment by two-stage cytoreductive surgery. The control group included 59 patients who underwent single-stage cytoreductive operations. In both groups, life-threatening complications were dominated by primary tumor necrosis (main group, n = 15; control group, n = 31) and impaired intestinal patency (main group, n = 12; control group, n = 16, respectively). The average Charlson comorbidity index was 7.85 1.37 and 7.53 1.5 points, respectively. Anesthetic risk of grades IIIIV according to the classification of the American Society of Anesthesiologists was detected in 23 (69.7%) and 45 (76.27%) patients of the main and control groups, respectively. Functional status of 23 points on the Eastern Cooperative Oncological Group was established in 23 (69.7%) and 46 (77.9%) patients of the main and control groups, respectively. The peritoneal carcinomatosis index was significantly higher in the main group (13.1 6 vs 9.9 4.8 points) than in the control group (p = 0.012). A comparative analysis of the results obtained in the treatment of the main and control groups demonstrated that the two-stage cytoreductive surgical interventions can reduce the frequency of postoperative complications, primarily ClavienDindo grades IIIIV from 40.7 to 18.2% (p = 0.049) and mortality from 16.9% to 9.1% (p = 0.468) and increase the frequency of achieving complete cytoreduction from 49.1% to 90.9% (p = 0.002) and the frequency of intraperitoneal hyperthermic chemoperfusion from 40.7 to 93.9% (p 0.001). Thus, two-stage cytoreductive surgical interventions are a safe and effective technique in the surgical treatment of complicated disseminated tumors of the abdominal cavity and pelvis.

RADIAL HEAD ARTHROPLASTY USING “WIDE AWAKE LOCAL ANAESTHESIA NO TOURNIQUET” TECHNIQUE: CLINICAL REPORT AND LITERATURE REVIEW

Radial head fractures are among the most common fractures around the elbow. Radial head arthroplasty is one of the surgical treatment options after complex radial head fractures. This surgery is usually done under general anaesthesia. However, there is a recent anaesthetic technique - wide awake local anaesthesia no tourniquet (WALANT) - that has proven useful in different surgical settings, such as in distal radius or olecranon fractures. It allows a good haemostatic control without the use of a tourniquet and allows the patient to actively collaborate during the surgical procedure. Furthermore, there are no side effects or complications caused by the general anaesthesia and there's an earlier patient discharge.The authors present the case of a seventy-six-year-old woman who presented to the emergency department after a fall from standing height with direct trauma to the left elbow. The radiological examination revealed a complete intra-articular comminuted fracture of the radial head (Mason III).Clinical management: The patient was submitted to surgery with radial head arthroplasty, using WALANT. The surgery was successfully completed without pain. There were no intra or immediate post-operative complications and the patient was discharged on the same day. Six weeks after surgery, the patient had almost full range of motion and was very pleased with the functional outcome, with no limitations on her activities of daily living.The use of WALANT has been expanded beyond the hand and wrist surgery. It is a safe and simple option for patients at high risk of general anaesthesia, allowing similar surgical outcomes without the intraoperative and postoperative complications of general anaesthesia and permitting an earlier hospital discharge. Furthermore, it allows the patient to actively collaborate during the surgery, providing the surgeons the opportunity to evaluate active mobility and stability, permitting final corrections before closing the incision.

Incidence of Chronic Postsurgical Pain after Upper Extremity Surgery and its Correlation with Preoperative Pain.

Patients scheduled for elective upper extremity surgery were included, and numeric rating scale (NRS) score for pain was obtained preoperatively and at 5 years postoperatively. According to the International Association for the Study of Pain definition, CPSP was defined as an increase in NRS compared with preoperatively. A total 168 patients were contacted at 5 years postoperatively. Incidence of CPSP was 22%, and 35% had an NRS score of 4 or more. The number of patients with an NRS score of 0 and with an NRS score of 4 or more preoperatively was higher in the no-CPSP group, with P values of 0.019 and 0.008, respectively. Of the patients with no preoperative pain, 34% developed CPSP. Regional anesthesia was associated with a lower CPSP incidence (P = 0.001) and was more frequently applied in surgery on bony structures and in patients with a preoperative NRS score of 4 or more. The incidence CPSP was 22%. Patients with no pain or an NRS score of 4 or more preoperatively were less likely to develop CPSP, but individual susceptibility to pain and success of the surgery may be of influence. One-third of the patients with no preoperative pain developed CPSP. More studies are needed to reveal the exact relation between brachial plexus anesthesia and CPSP.

Novel Classification System of Adenoids Based on Appearance and Its Relationship with Drug Therapy

Introduction: Adenoidectomy is a common procedure in children who have adenoid hypertrophy (AH), but anesthesia risks should be considered. We proposed a novel classification system for adenoids based on their appearance. Additionally, we explored whether the novel classification of adenoids correlates with the response to therapy and thus might be helpful for further treatment recommendations. Methods: We used fiberoptic nasal endoscopy to determine the degree and appearance of AH. Obstructive Sleep Apnea Questionnaire (OSA-18) was used to assess the quality of life of children with AH. The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and Western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids. Results: 70.67% (106/150) of AH patients presented with allergic rhinitis (AR), and of them, 68% (72/106) of adenoids were the edematous type. The expressions of CGR-α, CGR-β, and eosinophil count were higher in the edematous compared with the common and fibrous types. The expression of the leukotriene receptor was similar in all types. Upon montelukast combined with nasal glucocorticoid therapy, improvement of OSA-18 scores and AH grade was significantly compared to montelukast monotherapy for edematous type. There was not any statistically significant difference between the scores upon montelukast combined with nasal glucocorticoid and montelukast monotherapy for common and fibrous type. We observed a positive correlation between eosinophil count in the blood and in the adenoid tissue. Conclusion: AR was the risk factor for the development of edematous AH. All subtypes of AH responded to montelukast, while there was an additional effect of nasal glucocorticoid in the edematous type. A combination therapy of nasal glucocorticoid with leukotriene receptor antagonist can be recommended for AH patients with AR, patients with edematous adenoids, and/or patients with increased eosinophils in blood routine.

Ultrasound Guided Cervical Plexus Block for Parathyroidectomy-Out First Experiences

Ultrasound guided Cervical Plexus Block (CPB) is a technique that has been applied in parathyroid surgery. Main advantages of ultrasound technique include a direct view of nerves; local anaesthetic (LA) spreading during injection; reduced volume of LA; blood vessels and other structures injury is significantly reduced. It is especially useful in patients with serious comorbidities, in which possible peri-operative consequences and risks of general anaesthesia can be avoided. Based on our first results of the presented cases, we can say that superficial CPB is a safe and simple procedure in order to provide perioperative analgesia in parathyroid surgery.

Successful endoscopic treatment of giant multiple choledocholithiasis using oral transpapillary cholangioscopy and intraductal contact lithotripsy

The paper presents a clinical case of successful staged endoscopic treatment for giant multiple choledocholithiasis . Conventional surgery was contraindicated in the patient due to significant comorbidities and high anaesthetic risk . Contact lithotripsy was the basic minimally invasive treatment method . It was combined with balloon dilatation of the endoscopic papillosphincterotomy area and mechanical intraductal lithotripsy . Contact lithotripsy in oral transpapillary cholangioscopy , in combination with other modern methods for endoscopic treatment of choledocholithiasis , has a good technical and clinical effect even with giant calculi .

To Compare Isobaric Thoracic Spinal Anesthesia Versus General Anesthesia in Laparascopy Cholecystectomy

Background: The laparoscopic cholecystectomy procedure is typically carried out under general anesthesia, but regional techniques, such as low thoracic isobaric spinal anesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anesthesia. Segmental spinal anesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. Material and Methods: Total 60 adult patient with ASA1 & I I, 18-60 years, with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric) - given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9-T10/T10-T11 into sub arachnoid space. Group GA – given general anesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methylsulfate and glycopyrrolate at the end of surgery. Results: Isobaric spinal anesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itchng which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. Conclusions: In conclusion, this study provide evidence that segmental spinal anesthesia can be used in place of general anesthesia in healthy individuals also.

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures.

The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality. This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality. We included 25,938 patients (2888 were 75-79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery >48 hours was independently associated with length of stay (correlation coefficient 3.99 [95%CI: 2.35-5.64; p<0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95%CI: 0.09-0.70; p=0.009] and ASA score III [OR 0.43, 95%CI: 0.19-0.96; p=0.039]). Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.

Abstract OT3-21-01: A pilot study of robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction using da Vinci SP ® single-port system

Abstract Introduction- Robotic mastectomy is a novel breast surgery approach accessed from a concealable anterior axillary incision showing better cosmetic outcomes with a scarless front view. The oncological safety awaits further follow-up from clinical trials or registered studies to mature. Compared to older da Vinci systems with multiple arms, the new SP system is single-armed, equipped with flexible instruments and a camera that may avoid instrument collision and dead spots in the surgical field. This trial (NCT05448963) is not only the leading SP mastectomy trial in Asia but also the first one that incorporates autologous flap reconstruction. Methods- -Objectives: To determine the performance, technical algorithm, safety data, and patient-reported outcomes in single-port-accessed nipple-sparing mastectomy using da Vinci SP® system. -Study design: This study is a pilot clinical study conducted in a single-arm, non-randomized design with a goal to recruit 30 participants. The da Vinci SP ® surgical robot is applied in the nipple-sparing mastectomy and axillary lymph node dissection (if indicated) of each enrolled patient in Chang Gung Memorial Hospital Linkou Medical Center. The post-mastectomy reconstructive method may use autologous flaps or implants depending on the type of build, technical feasibility, and flap site availability of the patient. The eligibility criteria include: I. Meet at least one of the following indications of NSM for breast cancer: 1. Preoperative clinical tumor sizes less than 5 cm, with an adequate tumor-skin distance of at least 3mm and above, and without nipple-areolar involvement in at least 1cm around the nipple by image 2. Breast cancer up to stage IIIa (T3, N1-2) as the initial clinical stage showing adequate response to neoadjuvant therapy and meeting criteria 1. 3. Germline pathogenic/likely pathogenic BRCA1 or 2 mutation carriers (actionable mutations including pathogenic and likely pathogenic mutations) with a breast cancer diagnosis or requiring unilateral or bilateral prophylactic mastectomy as a risk reduction procedure II. Age equal to or above 20 years III. ECOG (Eastern Cooperative Oncology Group) performance score 0-1 IV. ASA anesthesia risk class 1~2, and with adequate organ functions Endpoint measures: -Primary endpoint: Ability to complete nipple-sparing mastectomy with da Vinci SP system in the per-protocol population. -Secondary endpoints: Safety measured by adverse events through 30-day post-operative follow up -Exploratory endpoints: Surgical time, blood loss, hospital stay, breast specimen weight, cancer resection margin, nipple-preservation rate morbidity and mortality rate within 30 days of operation, and reoperation within 30 days post-surgery -Statistical analysis: Point estimation with a 95% confidence interval will be used to analyze the mean or proportion of key performance parameters. No interim analysis will be performed due to the limited number intended to recruit. -Trial status: Active recruitment Conclusion: The single-port robotic system features single port access with multi-jointed instruments which is particularly designed for narrow surgical spaces such as mastectomy. The feasibility of applying da Vinci SP systems to robotic nipple-sparing mastectomy and robiotic axillary lymph node dissection will be demonstrated in this study. Citation Format: Wen-Ling Kuo, Chia-Huei Chu, Jung-ju Huang. A pilot study of robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction using da Vinci SP ® single-port system [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-21-01.

Bilateral Congenital Nasolacrimal Duct Obstruction in Williams-Beuren Syndrome.

A 23-year-old patient with Williams-Beuren syndrome presented with ocular irritation and bilateral persistent tearing. Despite probing as an infant which showed bilateral nasolacrimal duct obstruction, dacryocystorhinostomy had been avoided due to the patient's syndromic supravalvular stenosis and related anesthesia risk. As the known diminished production of elastin in Williams-Beuren syndrome causes an array of associated vascular diseases, this case report hypothesizes that the lacrimal duct becomes obstructed through a similar mechanism. This case presents the unique findings of bilateral congenital nasolacrimal duct stenosis in a Williams-Beuren syndrome patient.

The importance of a veterinary anaesthetist and pain treatment according to dog and cat owners

In Switzerland, compared to the United Kingdom or the United States of America, fewer veterinary anaesthetists are employed in private practice, which raises the question about the reason. The present survey aimed at investigating the awareness of pet owners concerning the specialization of veterinary anaesthesia and the value they attribute to such a specialist. Also, estimation of pain in dogs and cats and the importance of its treatment from the point of view of the pet owners was analysed. Furthermore, the necessity of veterinary anaesthetists in private practice and the influencing factors were investigated. The survey was created on LimeSurvey, an online tool for questionnaires and sent to dog and cat owners of the small animal clinic of the University Hospital of Zurich. 317 fully completed questionnaires were evaluated. In general, pet owners appreciated the specialization of veterinary anaesthesiology. Great importance was attributed to the supervision of anaesthesia and analgesic therapy by a specialist. A preliminary talk with an anaesthetist would be appreciated. Owners would be willing to cover additional costs for a specialized anaesthetist, if recommended by the private veterinarian, and to bring their animal to the University Hospital, in case of an increased anaesthetic risk.

Hyaluronic acid as a means to correct entropion in animals

Entropion, or inversion of the edge of the eyelid, is a frequent multifactorial disease in which the ciliated edge of the eyelid is wrapped inside, which leads to permanent corneal trauma and eye irritation. Currently, subcutaneous fillers based on hyaluronic acid are used to correct entropion due to the fact that it does not have organ- and speciesspecificity and, therefore, carries a minimal risk of allergic reactions. The advantage of subcutaneous fillers based on HA is that the injection can be reversed with the development of complications with the help of drugs based on hyaluronidase. The assessment was carried out by the amount of periocular moistening, alopecia and/or hyperemia of the eyelids with manual rotation of the eyelids outward during the examination. All patients underwent a complete ophthalmological examination with a slit lamp and indirect ophthalmoscopy, a Schirmer test and intraocular pressure. The injection methods used included linear threading, a series of single-point injections, or a combination of them. The criteria for evaluating the effectiveness of the use of hyaluronic acid as a means for correcting entropion in animals were local reactions to skin filler, inflammatory processes in the eye area associated with a relapse of entropion, as well as the duration of the period before repeated administration of the drug. The technique of subcutaneous injection of the GC filler is a simple, reliable, effective, safe, prolonged procedure that requires a minimum amount of time, which allows you to immediately alleviate the patient's condition from mild to moderate severity as a result of entropion in cats and dogs. This procedure is especially preferable for age-related patients and patients with high anesthetic risk.

Incisional Release and Fat Grafting for the Surgical Management of Perioral Fibrosis in Scleroderma: A Technical Report and Institutional Review.

Scleroderma (systemic sclerosis [SSc]) is a rare autoimmune, connective tissue disorder. Perioral fibrosis is a local cutaneous complication, negatively impacting functional capabilities and aesthetic satisfaction. Fat grafting has been postulated to aid in the management of SSc fibrosis thanks to stem cell enrichment. This technique's success has been demonstrated using different graft origin sites and different injection targets. We aim to demonstrate our SSc patients' success using abdominal fat and perioral target. We queried our records for patients with preexisting SSc who underwent incisional release and fat grafting for perioral fibrosis from 2018 to 2021. For perioral release, a semisharp cannula was tunneled under the vermilion border into the vermilion and along the skin. For grafting, cannulas were used to infiltrate the fat with a retrograde filling technique in a radial-fanning manner. Their autoimmune diagnosis, anesthetic risk assessment, systemic disease complications, and degree of presenting symptoms were reviewed along with their postoperative outcomes. From 2018 to 2021, 16 patients diagnosed with SSc were treated with incisional release and fat grafting for the management of perioral fibrosis. Of the SSc patients, 8 presented with limited SSc, and 8 presented with diffuse SSc. The mean patient age was 54.31 years. All SSc patients presented with functional symptoms with the most common concern (n = 9) being "decreased mouth opening." Other common complaints were "difficulty eating" (n = 3) or "difficulty drinking" (n = 2). Some patients (n = 11) also presented with cosmetic concerns with "perioral rhytids" being the most common (n = 6). The mean number of systemic complications, at the time of presentation, was 3.06. The mean anesthetic risk assessment was 2.44. The average amount of fat grafted intraoperatively was 14.89 mL. Two patients with SSc required regrafting. For one patient, this was part of the original treatment plan and for the other due to fat resorption. Patients who followed up reported improved functionality and were pleased aesthetically. Patients with perioral fibrosis due to SSc can benefit from autologous fat grafting. Incisional release in combination with fat grafting can enhance procedure outcomes. This technique provides beneficial functional and aesthetic outcomes. Patients with both diffuse and limited disease are appropriate candidates for this procedure.

Thoracic CT incidental pulmonary bullae in dogs: Characterization, interobserver variability, and general anesthesia risks.

Ruptures of pulmonary blebs and bullae are the most common cause of spontaneous pneumothorax in dogs. Incidental bullae/blebs have been documented in otherwise healthy people, however information for veterinary patients is currently lacking. Objectives of this retrospective, observer agreement, analytical study were to characterize incidental bullae in thoracic CT studies of dogs, assess interobserver variability for characterizing the bullae, and assess anesthesia risks. Inclusion criteria were dogs presenting for non-pneumothorax related reasons that had a thoracic CT at a single specialty and emergency hospital from 2012 to 2021 and had a bulla listed in the CT report. Medical records for dogs meeting inclusion criteria were reviewed to collect data on signalment, weight, total number of general anesthesia procedures 2 years prior and 2 years following the CT scan, and adverse anesthesia events. In addition, the CT images were reviewed by three American College of Veterinary Radiology-certified veterinary radiologists to collect data on the location, size, number of bullae and thickness of the bulla wall. A total of 1119 dogs met initial inclusion criteria and 74 dogs were included in analyses. There was no sex predilection for incidental pulmonary bullae. Bullae were more commonly found in older (median age 11.3 years), large breed dogs (median weight 20.7kg). A solitary bulla of less than 1cm was the most common finding with no apparent predilection for a particular lung lobe. There was strong correlation among the three radiologists for bulla location, size, and number, but weak correlations for bulla wall thickness. No adverse anesthesia events were found following CT anesthesia or following repetitive anesthesia procedures.

Surgical Management of Congenital Lung Malformations

Congenital lung malformations (CLMs) are commonly diagnosed prenatal lesions with varied natural history. Prenatal diagnosis and monitoring help to guide fetal interventions, delivery planning, and need for urgent perinatal surgical interventions. All prenatally diagnosed CLMs should be evaluated postnatally, typically with cross-sectional imaging, because many lesions persist despite the appearance of complete 'regression' in utero. Management of CLMs in asymptomatic infants weighs the surgical and anesthetic risk of prophylactic resection against the risk of expectant management, including the possibility of infection, malignant degeneration, and more complicated surgical resection later with loss of compensatory lung growth.

Initial results of use and prospects of hospital-substituting technologies in gynecology

Background. The first day-care hospital (DCH) in the Russian Federation with 30 beds was established in the departments of general surgery, urology, and gynecology of the Botkin Hospital in 2016 in Moscow.&#x0D; Aim. To analyze the six-year experience of the gynecological DCH based on the Botkin Hospital.&#x0D; Materials and methods. The six-year experience (20162021) of the gynecological DCH based on the Botkin Hospital was analyzed.&#x0D; Results. The number of patients treated in the DCH increased progressively from 2016 to 2019. Due to the gain in the experience of DCH, patients with a broader spectrum of diseases can receive care in DCH settings, the number of hospitalized patients with a higher anesthetic risk has increased, and the proportion of patients over 65 years of age has also increased.&#x0D; Conclusion. Analysis of the activities of the DCH based on the Botkin Hospital showed that the pilot project can be considered successful due to good clinical and economic indicators. This activity format can be widely implemented, and it is optimal to establish such hospitals in multidisciplinary clinics.

Vacuum-assisted excision biopsy for definitive diagnosis of breast lesions of uncertain malignant potential (B3 lesions) on core biopsy - A single centre Western Australian experience.

In Australia, the usual approach to breast lesions where core biopsy returns an uncertain result ("B3" breast lesion) is to perform surgical diagnostic open biopsy (DOB). This is associated with patient time off work, costs of hospital admission, risks of general anaesthesia and surgical complications. The majority of B3 lesions return benign results following surgery. Vacuum assisted excision biopsy (VAEB) is a less invasive, lower cost alternative, and is standard of care for selected B3 lesions in the United Kingdom. Similar use of VAEB in Australia, could save many women unnecessary surgery. The aim of this study was to document our experience during the introduction of VAEB as an alternative to DOB for diagnosis of selected B3 lesions. The multidisciplinary team developed an agreed VAEB pathway for selected B3 lesions. Technically accessible papillary lesions, mucocele-like lesions and radial scars without atypia measuring ≤ 15mm were selected. Over a 7 month period, 18 women with 20 B3 lesions were offered VAEB. 16 women (18 lesions) chose VAEB over DOB. Papillomas were the commonest lesion type. All lesions were successfully sampled: 17/18 were benign. One lesion (6%) was upgraded to malignancy (ductal carcinoma insitu on VAEB, invasive ductal carcinoma at surgery). No major complications occurred. Patient satisfaction was high: 15/16 respondents would again choose VAEB over surgery. VAEB is a patient-preferred, safe, well-tolerated, lower-cost alternative to DOB for definitive diagnosis of selected B3 breast lesions.

Anaesthesia in SARS-CoV-2 infected children - single-centre experience. Acase-control study.

Although manifestation of SARS-CoV-2 infection in children is gene-rally mild or asymptomatic, anaesthetic implications of the infection in children are still a matter of concern. Single reports suggest that patients with SARS-CoV-2 infection are at higher risk of anaesthetic complications. We performed a retrospective, case control study analysing the risk of general anaesthesia in SARS-CoV-2 infected children admitted to a tertiary paediatric university hospital for the purpose of urgent procedures requiring anaesthesia between April 1st and September 30 th , 2021. The control group consisted of SARS-CoV-2 negative children consecutively anaesthetised for the same reasons during the first month of observation. Our hypothesis was: general anaesthesia can be safely performed in SARS-CoV-2 infected children. Study endpoints: primary - anaesthetic respiratory complications (bronchospasm, laryngospasm, intraoperative desaturation below 94%, desaturation below 94% after awakening, unplanned postoperative mechanical ventilation); secondary - hospital length of stay, thrombotic, cardiac, haemorrhagic events, ICU admission, deaths during hospitalisation. The examined group consisted of 58 SARS-CoV-2 infected children, the matched control group of 198 patients. The rate of complications in both groups was very low, with no significant difference between the groups. The only differences observed were a higher frequency of desaturations in the awakening period and longer time of hospitalisation in SARS-CoV-2 infected patients. Multivariate logistic regression analysis showed that physical status of the patient and duration of the procedure were the main factors influencing the risk of complications. In our experience anaesthesia of SARS-CoV-2 infected children can be safely performed.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Effect of Intravenous Etomidate versus Propofol on Seizure duration and Haemodynamic Response during Modified Electroconvulsive Therapy: A Randomised Clinical Trial

Introduction: Seizure duration in Electro convulsive Therapy (ECT) is a clinically important factor in managing psychiatric patients subjected to the procedure. Various induction agents are being used with varying efficacy on seizure duration and haemodynamic response like thiopentone, propofol, ketamine and etomidate. As repeated ECT sessions pose significant risk of general anaesthesia and its complications, in this study the efficacy of etomidate and propofol was compared. Aim: To assess the seizure duration and compare haemodynamic variables using etomidate and propofol. Materials and Methods: A randomised clinical trial was done in the Department of Anaesthesiology, at tertiary care hospital between July 2021 to June 2022 on 40 patients of age group 18 to 60 years of either sex, belonging to American Society of Anaesthesiologists (ASA) Grade-I and II scheduled for ECT. Patients were allocated into two groups. Preinduction baseline values of Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded using pulse oximeter and Non Invasive Blood Pressure (NIBP). Patients were induced with either, inj. etomidate 0.2 mg/ kg (Group E) or inj. propofol 1 mg/kg (Group P). HR, SBP, DBP and MAP were recorded soon after induction, after application of stimulus and at one minute interval after electric 156 shock for five minutes and then at five minutes interval. Statistical analysis was done by using the unpaired Student’s t-test for quantitative data. The p-value &lt;0.05 was considered significant. Results: Demographic data were similar in both the groups. The mean seizure duration in Group E (51.25±9.01 seconds) was greater than in Group P (38.30±9.92 seconds) and was statistically significant. There was significant increase in the HR in both groups and the HR did not reach the baseline even after 10 minutes. There was a rise in the mean SBP by approximately 7 mm Hg in the Group P compared to 4 mm Hg in the Group E. The mean DBP rise in the propofol group was 6 mm Hg as compared to 5 mm Hg in the Group E. The MAP in both the groups increased by 7 mm Hg. The parameters reached the baseline earlier with Group P compared to Group E. Conclusion: The study concludes etomidate has a distinct advantage over propofol in producing seizures of adequate duration during ECT whereas propofol blunts the sympathetic response to ECT more effectively than etomidate.