Choice Of Anesthetic Technique Research Articles

Thorough perioperative and anesthetic considerations for cerebellar syndrome induced by posterior fossa tumors

Posterior fossa tumors are relatively rare pathologies, predominantly observed in pediatric populations. Nevertheless, there have been documented cases in adults, where these tumors are often associated with a higher prevalence of vascular lesions compared to those found in children. Given the inherent high mortality risk associated with this condition, meticulous anesthetic management is paramount. A comprehensive evaluation of patient-specific factors, including existing comorbidities, hemodynamic stability, and neurological status, is essential. Moreover, perioperative considerations such as patient positioning, the choice of anesthetic technique, and the duration of the surgical procedure must be carefully planned to optimize outcomes. This article presents a case review of a young adult patient with no significant medical history who was diagnosed with a posterior fossa tumor. The discussion encompasses the anatomical considerations of this pathology, critical preoperative assessments, anesthetic strategies tailored to this surgical context, and an analysis of the patient’s postoperative course.

Management and Consideration of Anesthesia Procedures in Eclampsia: A Case Report

Introduction: Eclampsia is a serious pregnancy complication with high maternal and fetal mortality rates. The choice of anesthetic technique in eclamptic patients must consider various factors, including the condition of the mother and fetus, the risk of complications, and the experience of the anesthesia team. Case presentation: We report the case of a 21-year-old 39-week-old primigravida (G1P0A0) with severe eclampsia who experienced two tonic-clonic seizures. The patient was intubated in the emergency room and underwent an emergency caesarean section under general anesthesia. The patient was treated in the ICU for one day and extubated on the second day. Conclusion: The choice of anesthetic technique in eclamptic patients must be done individually by considering various factors. The anesthesia team must be experienced in treating eclamptic patients and have the readiness to deal with complications that may occur.

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Choice of anesthesia technique is associated with earlier hospital discharge and reduced costs after transcatheter transfemoral aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) has become a viable alternative to palliation in patients with severe aortic stenosis. We compared general anesthesia to conscious sedation for TAVI procedures with respect to post operative morbidity, hospital length of stay, and financial burden. We conducted a retrospective review of prospectively collected data in patients undergoing transfemoral TAVI procedures from 2012 to 2017. Patients were matched based on age and sex and classed into either general anesthesia or conscious sedation groups respectively. Conscious sedation was provided with a dexmedetomidine infusion, and patients in general anesthesia group received a standard induction, tracheal intubation, and maintenance with sevoflurane. The hospital case costs were compared between the two groups before and after adjustment for inflation. We matched 124 pairs for a total of 248 patients. Both groups were similar with respect to demographic data, past medical history, medications, and intraoperative characteristics. There was no difference in postoperative morbidity and mortality between the two groups. The median hospital length of stay was 5 [interquartile range (IQR): 3, 10] and 7 (IQR: 4, 12) days, P=0.01, and after adjustment for inflation, the total hospital case costs were $48,984 (IQR: $44,802, $61,438) Canadian (CAD) vs. $55,333 (IQR: $46,832, $68,702) CAD, P=0.01, in the conscious sedation and general anesthesia groups, respectively. Advancements in TAVI technologies, conscious sedation and a collaborative, multidisciplinary team approach reduces overall length of hospital stay and procedure costs.

Inhaled anesthesia associated with reduced mortality in patients with stage III breast cancer: A population-based study.

Patients diagnosed with stage III breast cancer often undergo surgery, radiation therapy, and chemotherapy as part of their treatment. The choice of anesthesia technique during surgery has been a subject of interest due to its potential association with immune changes and prognosis. In this study, we aimed to compare the mortality rates between stage III breast cancer patients undergoing surgery with propofol-based intravenous general anesthesia and those receiving inhaled anesthetics. Using data from Taiwan's National Health Insurance Research Database and Taiwan Cancer Registry, we identified a cohort of 10,896 stage III breast cancer patients. Among them, 1,506 received propofol-based intravenous anesthetic maintenance, while 9,390 received inhaled anesthetic maintenance. To ensure comparability between the two groups, we performed propensity-score matching. Our findings revealed a significantly lower mortality rate in patients who received inhaled anesthetics compared to those who received propofol-based intravenous anesthesia. Sensitivity analysis further confirmed the robustness of our results. This study suggests that inhaled anesthesia technique is associated with a lower mortality rate in clinical stage III breast cancer. Further research is needed to validate and expand upon these results.

The influence of anaesthesia on cancer growth.

Oncological patients make up a large proportion of all surgical patients. Through its influence on the patient's inflammatory and immune system, the choice of anaesthetic technique has an indirect impact on the health of the individual patient and on public health. Both the specific and the non-specific immune system have a major influence on the recurrence of carcinomas. The pathophysiological basis for growth and metastasis after surgery is the physiological response to stress. Inflammation is the organism's universal response to stress. Anaesthetics and adjuvants influence perioperative inflammation in different ways and have an indirect effect on tumour growth and metastasis. In vitro studies have shown how individual anaesthetics influence the growth and spread of cancer, but clinical studies have not confirmed these results. Nevertheless, it is advisable to use an anaesthetic that has shown lesser effect on the growth of cancer cells in vitro. In this review, we focus on the area of the effects of anaesthesia on tumour growth. The field is still relatively unexplored, there are only few clinical prospective studies and their results are controversial. Based on the review of new research findings we report on recommendations about anaesthetics and anaesthetic techniques that might be preferable for oncological surgical procedures.

QUALITY AND EFFICACY OF GENERAL ANESTHESIA VERSUS SEGMENTAL THORACIC SPINAL ANESTHESIA IN MODIFIED RADICAL MASTECTOMY SURGERY: A SINGLE-CENTER OBSERVATIONAL STUDY

Objective: Surgical resection remains the most important treatment modality for breast cancers. Recent research suggests that the choice of anesthesia technique might also have a role in the recurrence of the disease. We compared quality and efficacy of the conventional general anesthesia technique with segmental thoracic spinal (STS) anesthesia technique used in modified radical mastectomy. Methods: 60 American Society of Anesthesiologists II/III patients were divided into two groups Group C (Control group) and Group S (Study group). Group C patients were induced with standard anesthesia regimen while Group S patients were given STS at T4–T5 inter space with 1.5 mL of 0.5% hyperbaric levobupivacaine along with 15 µg of fentanyl with conscious sedation. Hemodynamics, pain score, time for first rescue analgesia, experience of anesthesiologist, surgeon, and patients were recorded. Results: Time for induction in group S is significantly longer (Group C 17.4±3.8 vs. 36.2±7.2 min, in Group S). The duration of surgery (56±13.6 min vs. 76.4±15.9 min) was also significantly longer, while reversal period was shorter in Group S (9.2±6.2 and 6.3±5.7 min). Modified Aldrete’s recovery score achieved quickly in Group C (16.8±4.9 vs. 29.7±9.8 min), but postoperative analgesia was better in Group S as first rescue analgesic sode required after 6.2±1.9 h in Gr. S while in Gr. C time duration was 4.9±1.3 h. Length of stay in hospital was more in Group S, (Group C 45.4±4.8 vs. Group S 56.3±8.5 [h]) while ease and comfort of surgeon anesthesiologist and patient satisfaction score were more in Group C. Conclusion: STS anesthesia is feasible for breast carcinoma surgeries but it is easier for surgeon and anesthesiologist to manage patient under general anesthesia. STS anesthesia has advantage in terms of early post-operative analgesia and will definitely be helpful in cases where patient is not fit for general anesthesia.

Do Certain Anaesthetic Drugs Affect Postoperative Cancer Recurrence Rates? Implications for Drug Discovery

Recurrence of cancer after primary tumour resection is a leading cause of cancer-related mortality. Preclinical research indicates that surgery induces a stress response that inhibits cell-mediated immunity as a possible basis for risk of recurrence. Other preclinical evidence suggests that, conversely, propofol and local anaesthetics diminish the effects of the surgical stress response and so could directly inhibit cancer progression, and this is supported by several retrospective cohort studies and meta-analyses. However, the first large-scale randomised clinical trial (RCT), comparing recurrence after mastectomy in patients anaesthetised with either propofol/local anaesthetic or sevoflurane/opioids, concluded that recurrence was not significantly improved in the propofol/local anaesthetic group (p = 0.84). Other cancers may prove more responsive and results from a number of ongoing RCTs, encompassing several cancer types, are currently awaited. These trials should establish whether choice of anaesthetic technique is an important determinant of cancer recurrence risk.

Anaesthetic Management of Parturient with Severe Mitral Stenosis Planned for Elective Caesarean Section for Safe Confinement

Perioperative management of pregnant women with cardiac disease is challenging. The physiological cardiac changes that occur during late pregnancy leads to haemodynamic stress to the patient with the cardiac disease during and immediately after parturition. Pregnant women with severe valvular disease do not tolerate haemodynamic changes associated with pregnancy. The choice of anaesthesia technique either general anaesthesia or regional anaesthesia is depending on the haemodynamic goals, cardiac status of the patient, and mode of delivery. A 23-year-old female patient was planned for elective caesarean section for safe confinement. She was an operated case of Balloon Mitral Valvuloplasty (BMV). General anaesthesia was preferred due to the severity of mitral stenosis. Incorporation of epidural analgesia with general anaesthesia provided intraoperatively haemodynamic stability during laryngoscopy, intubation, and extubation. Also, postoperatively analgesia could be achieved due to epidural top-ups. Ultimately, a good perioperative outcome has been achieved due to haemodynamic stability which reduces perioperative morbidity and mortality of the patient.

Lumbar Epidural Anesthesia in a High-Risk Patient with Advanced Lung Cancer, Multi-Organ Metastasis and Hydropneumothorax

Epidural anesthesia (EA) can be applied in the perioperative period (PP) in addition to general anesthesia (GA) or as a stand-alone anesthesia technique. EA provides better hemodynamic stability in high-risk patients, reduced neurohormonal surgical stress response, and preserved airway reflexes with spontaneous breathing. In addition, EA prevents pulmonary dysfunction through decreasing multifactorial mediators, improves pulmonary functions by reducing the decrease in functional residual capacity, and protects spontaneous respiratory and airway reflexes. Herein, we wanted to emphasize the importance of the perioperative approach, the choice of anesthesia technique, and the effects of this choice on the postoperative period in a high-risk patient with incidental stage four lung adenocarcinoma, right parietal brain, lumbar vertebral, liver, and adrenal metastasis, as well as hydropneumothorax. With a successful epidural catheterization and anesthesia, the patient was follow-up without any problems. As in our patient, we should adopt a multimodal approach in the perioperative period, perform a detailed examination before the operation, and evaluate all risks and benefits comparatively when choosing the most appropriate anesthesia technique. Thus, it should be kept in mind that the chosen technique will significantly affect perioperative complications, morbidity and mortality, drug use, length of hospital stay, and cost.

A comparative study between ultrasonography guided classical interscalene block plus superficial cervical plexus block versus low approach interscalene block plus superficial cervical plexus block in lateral one-third of clavicle and proximal humerus surgery

Background: Classical interscalene approach of brachial plexus block with superficial cervical plexus block has become the anesthetic technique of choice in the upper arm, shoulder, and clavicle surgery but there is high risk of complications and sparing of C8-T1 nerve roots. Here, we used low approach of interscalene block (ISB) with superficial cervical plexus block for lateral one-third of clavicle and proximal humerus surgeries. Previously, none of the study compare ultrasonography (USG) guided low ISB (LISB) to the conventional approach for lateral one-third of clavicle and proximal humerus surgeries. Aims and Objectives: The aim of the study was to compare onset, duration, density of sensory-motor block, and severity of complication between ISB and LISB with superficial cervical plexus block. Materials and Methods: Patients with fracture of lateral end of clavicle and proximal humerus of 18–60 years of 324, American Society of Anesthesiologists I and II patients, were randomly assigned into two groups ISBS and LISB with superficial cervical plexus block (LISBS) to find out the difference in density of sensory-motor blockade associated with any complications between two groups. Results: The degree of the ulnar block after 5 and 15 min was found to be 2.8±2.6 and 1.1±1.8 in LISBS, respectively, for ISBS 3.0±1.5 and 1.8±2.0, respectively, based on a ten-point scale. After 15 min, motor block occurred in the median nerve in 151 patients out of 162 (92.8%), and in all of the other three nerves in all 162 patients. Horner syndrome and hoarseness were less frequent in LISB with superficial cervical plexus block patients than in ISB with superficial cervical plexus block patients (P=0.0009 and 0.003, respectively) which was statistically significant. Conclusion: The present study confirmed the achievement of an appropriate sensory and motor block in the lateral one-third of clavicle with proximal humerus surgery, including the ulnar nerve with no complications than ISB.

MATERNAL SATISFACTION TOWARDS SPINAL ANAESTHESIA FOR CAESAREAN SECTION

ABSTRACT Background There has been an increase in the use of spinal anaesthesia for Caesarean section (CS) in Nigeria in the past decades. There is, therefore, a need to evaluate the level of satisfaction among patients that had spinal anaesthesia, as an index of the quality of reproductive health care. Methodology A prospective observational study of 380 consenting parturients in ASA classes I, II, and III, who underwent CS under spinal anaesthesia between January and December 2019. Satisfaction score was assessed using a three-point Likert scale. Data were analysed using [IBM SPSS software version-22]. The level of statistical significance was set at p-value <0.05. Results A total of 380 consenting patients underwent spinal anaesthesia within the study period with 219 (57.6%) aged ≥30 years. Most were emergency CS 267 (70.3%). Most patients 294 (77.4%) expressed satisfaction for being involved in decision-making about the choice of anaesthesia technique. The majority of the patients 333 (87.6%) were satisfied with pain relief during the operation. The complications experienced by the patients intraoperatively included dizziness, 50 (13.2%), shivering, 139 (36.6%), and intraoperative nausea and vomiting, 48 (12.6%). Overall, 295 (77.6%) of the patients expressed willingness to have spinal anaesthesia again in the future, out of the 295, 293 (99.4%) were satisfied with the current spinal anaesthesia. P = 0.000 Conclusion Maternal satisfaction to spinal anaesthesia in this study was high. This could be attributed to patient’s participation in decision-making, prompt treatment of complications, and overall good anaesthetic care.

Anesthesia during pregnancy

Surgery during pregnancy post additional concerns an represent a major stress factor for both anesthesiologist and gynecologists. Approximately 0.5-2% of all pregnant women undergo a least one nonobstetric surgery during their pregnancy, and the number is growing in recent years. Until present days, no anesthetic drug has been shown to be clearly dangerous to human fetus. Thus, a pregnant woman should never be delayed from surgery regardless of teratogenic effects at any gestational age. The choice of anesthetic technique, drugs and surgical procedure should be guided by mother safety and continuation of adequate uteroplacental perfusion. Regarding Cesarean Section, it is now the most common surgery performed in the United States, with over 1 million women delivered by cesarean every year. Due to medical and legal implication, anesthesia must be safe in order to improve maternal and fetal outcome. Ultimately, success of each case is granted by multidisciplinary team approach and adherence to the latest clinical practice guidelines.

Anaesthetic management of a covid 19 positive parturient with newly diagnosed cardiomyopathy presenting with supraventricular tachycardia

Covid 19 has been a globally concerning pandemic affecting more than 20 million population worldwide including pregnant women. Cardiomyopathy is a rare affliction occurring in the last trimester of pregnancy or early postpartum manifesting as acute heart failure/ development of sudden arrhythmias/ thromboembolic complications. Anaesthetic management of such patients for caesarean section can be quite challenging, the main goals being maintenance of preload and afterload while avoiding myocardial depression at the same time whatever be the choice of anaesthetic technique. Here we report the successful management of a Covid-19 positive parturient under regional anaesthesia who was recently diagnosed with cardiomyopathy presenting with supraventricular tachycardia.

Comparative Analysis of Memory and Alertness in the Perioperative Period of Operative Delivery in Pregnant Women With Preeclampsia and Without it With Different Kinds of Anesthesia

Relevance. The article investigates the choice of anesthesia technique during a caesarean section, which would minimally affect such components of cognitive functions as memory and alertness.The aim of the study is to increase the safety of anesthetic care in women of reproductive age by choosing the method of anesthesia.Material and methods. Two groups of maternity patients were examined: with a normal pregnancy and preeclampsia. They were tested according to a specially designed examination, which included: MoCA test, Benton’s test, Wechsler’s test, self-assessment questionnaire, hospital scale of anxiety and depression before and after surgical delivery.Results. According to the test results, it was found that memory and alertness in pregnant women were initially reduced (compared to the norm), especially with concomitant preeclampsia. When comparing the test results before and after abdominal delivery, it was found that the deterioration of memory and alertness parameters occurs less after the use of neuraxial methods (spinal and epidural anesthesia) compared to patients who underwent general combined anesthesia.

PAIN AND HEMODYNAMIC STATUS ASSESSMENT IN CHILDREN UNDERGOING ORTHOPAEDIC TRAUMA SURGERIES AMID PERIOPERATIVE MULTIMODAL ANALGESIA

Stable hemodynamic parameters are used as one of the criteria for adequacy of analgesia during the surgery. In order to provide reliable antinociceptive protection, it is necessary to reduce the flow of nociceptive stimuli from the peripheral to central receptors.&#x0D; Hence, pain and hemodynamic assessment is crucial for adequate perioperative analgesia and the choice of anesthetic technique in children undergoing orthopaedic trauma surgeries. &#x0D; Purpose. This study aims to assess pain intensity and changes of hemodynamic parameters in orthopaedic trauma pediatric patients under perioperative multimodal analgesia.&#x0D; Materials and methods. A total of 61 patients with orthopaedic trauma were included in this study. Mean age was 9.3±4.5 years (range: 8-17). Open reduction was performed in 43 cases (70.5%), and 18 children (29.5%) underwent closed reduction. Mean duration of the surgery was 102.1±20.4 min. All patients have the premedication (atropine sulfate, diazepam, acetaminophen, intravenously) done 30-40 min. before the surgery in the surgical ward. Surgical procedures were performed under general anesthesia. Postoperative pain intensity was assessed by Individualized Numeric Rating Scale – NRS. Perioperative monitoring included peripheral pulse oximetry (SpO2), non-invasive blood pressure measurement (SBP, DBP, MAP), vital signs and blood glucose level control. Postoperative analgesia was maintained by IV acetaminophen, if necessary – by administration of divided dose of morphine. Results and conclusions. Mean pain intensity was 2.32±0.28 (6 hrs postop.), 12.06±0.16 (12 hrs postop.),&#x0D; 2.78±0.24 (24 hrs postop.), 2.04±0.6 (48 hrs postop.) based on NRS, respectively (p&lt;0.05). 26% patients required single dose administration of morphine during the first 24 hrs after the surgery.&#x0D; Significant decrease in blood glucose 12 hrs (4.3 mmol/l) and 24 hrs (4.6 mmol/l) after the surgery in comparison to the preoperative level (6.2 mmol/l) suggests of the severe stress resolution in the majority of the patients and adequate pain management. Preoperative stress is mainly caused by underlying disease and the surgical procedure itself.&#x0D; Heart rate (HR) monitoring shows that the vast majority of the patients (n=55, 86.5%) had mean pulse less than 110 bpm after IV Acetaminophen administration (20 mg/kg). &#x0D; Minimal mean HR throughout the study was 87.3±5.3 bpm, maximal mean HR was 120±5.3 bpm. Mean SBP throughout the study was 100.2±5.3 mm Hg and mean DBP – 66.4±1.8 mm Hg, respectively. Oxygen saturation was within normal limits in all children. Hemodynamic parameters were within physiological surgical stressrelated limits, which suggests of the fluctuant course of postoperative pain syndrome.&#x0D; A traditional approach to perioperative pain management in children is associated with a moderate pain syndrome according to the results obtained with pain scales, hyperkinetic type of hemodynamics 6.24 hrs after the surgery, and the fluctuant course of postoperative pain.

Ultrasound-Guided Caudal Epidural Block for Bilateral Testicular Ectopy and Circumcision in Child above 6 Years with Joubert Syndrome

Background: Abnormal respiratory control has been clearly documented in infants and children with Joubert Syndrome (JS) by polygraphic recordings, characterized by episodes of apnea, tachypnea, and/or hyperpnea and the risk of recurrence of these episodes increase probably in perioperative period. In those cases, the choice of anesthesia technique and postoperative pain protocol, constitute a challenge for anesthesiologists. Case: We describe a case of successful ultrasound-guided Caudal Epidural Block (CEB) for children above 6 years with Joubert Syndrome undergoing bilateral testicular ectopy and circumcision avoiding opioid-use. Conclusions: Despite the difficulty to achieve CEB in child above 6 years, the ultrasound-guided can increase the success providing effective analgesia in-patient with a high-risk of respiratory failure as child with JS.

Prevention of hypotension during elective cesarean section with a combination of colloid co-load and a continuous infusion of a vasoconstrictive agent: A comparative randomized study

Background: Spinal anesthesia is considered the anesthetic technique of choice in cesarean section but it can be frequently complicated by hypotension, with occasionally serious consequences for both the mother and fetus. One of the standard techniques used in the prevention of maternal hypotension is the administration of a continuous phenylephrine infusion. However, phenylephrine can lead to baroreceptor-mediated reflex bradycardia with untoward consequences for the maternal cardiac output. Nowadays, noradrenaline has been proposed as an alternative agent in this context, since due to its additional weak dose-dependent β-action, it can be associated with an inferior incidence of maternal bradycardia and thus of propensity to decrease the cardiac output. Colloid co-hydration has also been proven to be an effective technique in the prevention of maternal hypotension. This double-blinded, prospective randomized study aimed to investigate whether the addition of a fixed rate phenylephrine infusion or noradrenaline infusion to a colloid co-hydration regimen results in better maternal hemodynamic status or in a more favorable metabolic profile in the newborn as compared to the administration of colloids alone without any vasoconstrictor during elective cesarean section under combined spinal-epidural anesthesia. Materials and methods: One hundred-twenty parturients were randomized to either phenylephrine 50 μg/min (group P) or noradrenaline 4 μg/min (group N) or placebo (group C). All infusions had been prepared in identical syringes and the infusion rate was 30 mL/h in order to ensure the “blindness” of the study. As soon as the spinal injection started, all groups were administered 10 mL/kg of hydroxyethyl starch (HES) solution simultaneously with the onset of vasoconstrictor infusion. The primary end-point of the study was the incidence of maternal hypotension (SAP <80% of baseline). Additionally, maternal hemodynamics at specific time-points were recorded using non-invasive technology (Edwards Lifesciences ClearSight System) as well as the incidence of reactive hypertension, bradycardia, the requirement for bolus vasoconstrictor administration and the fetal acid-base status, the umbilical venous and arterial blood gases and the newborn Apgar score. Results: The incidence of maternal hypotension was higher in group C than in group P and also higher in group C than in group N (p = 0.024 and 0.073, respectively). The need of bolus administration of vasoconstrictor was higher in group C than in group P and also higher in group C than in group N (p = 0.001 and 0.003, respectively). The incidence of bradycardia was higher in group P than in group N (p = 0.018). The incidence of reactive hypertension was higher in group P than in group N and also higher in group P than in group C (p = 0.029 and 0.005, respectively). The need of modification of the infusion rate was higher in group P than in group N and also higher in group P than in group C (p < 0.001 και p = 0.002, respectively). The fetal pH of the umbilical vein was higher in groups N and P than in group C (p < 0.001), the fetal pO2 of the umbilical vein was higher in group N than in group C (p = 0.023) and fetal blood glucose concentration was higher in group N than in group C (p = 0.025) as well as in group N than group P with no statistical significance. Higher systematic vascular resistance index (SVRI) and higher SAP were observed at specific time-points in group P versus the other two groups. Finally, post-delivery Apgar scores were similar in all groups. Conclusions: The combination of a fixed-rate infusion of noradrenaline with the co-administration of colloid seems to be the most effective in the obstetric management of the parturient during cesarean section under regional anesthesia since it ensures maternal hemodynamic stability and a favorable metabolic profile in the newborn. This regimen seems to be superior to either a combination of colloid co-administration with a fixed rate of phenylephrine or to the administration of colloid alone without any vasoconstrictor agent. The higher concentration of fetal blood glucose in group N might be due to a catecholamine-induced glucose metabolism activation and due to a β-receptor-mediated decrease of insulin release.

Anaesthetic Management of Non Traumatic Diaphragmatic Hernia as a Co-existing Disease: Combined Spinal Epidural to Rescue

Diaphragmatic hernia is a congenital or acquired defect in diaphragm, resulting in herniation of abdominal viscera into thoracic cavity. Acquired diaphragmatic hernia are seen mostly in patients with blunt or penetrating abdominal injuries. Nontraumatic acquired diaphragmatic hernias have been reported in literature but are extremely rare. Anaesthetic management of a patient presenting with nontraumatic diaphragmatic hernia as a co-existing disease offer unique challenges and considerations. This report was about the successful anaesthetic management of a 66-years-old male. He had Osteoarthritis (OA) of left knee with long standing massive right diaphragmatic hernia as a co-existing disease. He was scheduled for left Total Knee Replacement (TKR). Combined Spinal Epidural (CSE) with low dose Subarachnoid Block (SAB) was the anaesthetic technique of choice. Femoral sciatic block is an alternate technique of anaesthesia for such patients.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.