Duration Of Anesthesia Research Articles

Regulating the activity of GABAergic neurons in the ventral pallidum alters the general anesthesia effect of propofol

The full mechanism of action of propofol, a commonly administered intravenous anesthetic drug in clinical practice, remains elusive. The focus of this study was the role of GABAergic neurons which are the main neuron group in the ventral pallidum (VP) closely associated with anesthetic effects in propofol anesthesia. The activity of VP GABAergic neurons following propofol anesthesia in Vgat-Cre mice was observed via detecting c-Fos immunoreactivity by immunofluorescence and western blotting. Subsequently, chemogenetic techniques were employed in Vgat-Cre mice to regulate the activity of VP GABAergic neurons. The role of VP GABAergic neurons in generating the effects of general anesthesia induced by intravenous propofol was further explored through behavioral tests of the righting reflex. The results revealed that c-Fos expression in VP GABAergic neurons in Vgat-Cre mice dramatically decreased after propofol injection. Further studies demonstrated that chemogenetic activation of VP GABAergic neurons during propofol anesthesia shortened the duration of anesthesia and promoted wakefulness. Conversely, the inhibition of VP GABAergic neurons extended the duration of anesthesia and facilitated the effects of anesthesia. The results obtained in this study suggested that regulating the activity of GABAergic neurons in the ventral pallidum altered the effect of propofol on general anesthesia.

Expediting the reversal of inferior alveolar nerve block anesthesia in children with photobiomodulation therapy.

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808nm, 250 mW, 23s continuous, 0.5cm², 11.5J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26min, while the sham laser group experienced 134.44 ± 21.8min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

Abdominal emergency laparoscopy: Addressing anesthetic concerns for abdominal emergency surgery

Introduction: CO2 insufflation during laparoscopic procedures leads to respiratory changes, making general anesthesia during laparoscopy considered high-risk anesthesia. In an emergency context, this risk is likely heightened. The objective of our study is to evaluate the role of anesthesia during laparoscopy in non-traumatic emergency abdominal surgery. Materials and Methods: Descriptive and prospective study conducted between February 2018 and October 2021, involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Of the 337 patients operated on, 190 were female (56.4%) and 147 were male (43.6%), with a mean age of 38 years ± 15 years (range 15-82 years). Comorbidities were noted in 109 patients (32.3%), with 39 patients (11.6%) having multiple concomitant comorbidities. Our patients were classified as ASA I in 74.8% (252 patients), ASA II in 22% (74 patients), and ASA III in 3.3% (11 patients). Perioperative morbidity and mortality related to anesthesia were nil. During the analytical study, we found no correlation between anesthesia duration and perioperative and postoperative morbidity and mortality (p value: 0.082) and no relationship between ASA stage and postoperative morbidity (p value = 0.392, chi-square test). Conclusion: Emergency abdominal surgery via laparoscopy is feasible and safe from an anesthetic standpoint.

Urinary syndecan-1 in dogs anesthetized with isoflurane or sevoflurane: A randomized, prospective study.

Syndecan-1 (SDC1) is an established marker of endothelial glycocalyx shedding. Most research on SDC1 has focused on plasma or serum concentrations, and little is known about urine concentrations. Measure urinary SDC1 concentrations in dogs undergoing anesthesia with either sevoflurane or isoflurane and assess the effects of anesthesia duration and IV crystalloids on urinary SDC1 concentrations. Thirty-one client-owned dogs undergoing anesthesia for magnetic resonance imaging (MRI) with or without surgery for suspected intervertebral disk disease (IVDD) were used. Dogs with suspected IVDD were randomized to undergo anesthesia with either sevoflurane or isoflurane. Urine was collected before and immediately after anesthesia for the analysis of SDC1. Urinary creatinine concentrations also were measured, and the ratio of urinary SDC1 to urinary creatinine (USCR) was used to account for dilution. Median (range) USCR was significantly higher after anesthesia compared with baseline for all groups combined (P < .05). No significant difference was found between the groups for age, sex, weight, and type of anesthesia. Multiple regression analysis of the effect of the independent variables inhalant type, age, weight, sex, anesthesia time, surgery, and quantity of IV fluids on the dependent variable SDC1 found that only the quantity of IV fluids significantly predicted a change (P < .001). The total volume of lactated Ringer's solution administered to anesthetized dogs may affect USCR. Further investigations are warranted to evaluate the relationship between IV fluids and SDC1.

Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis.

Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = -1.99 [95% CI -3.01 to -0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = -1.34 [95% CI -2.29 to -0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile.

Clinical effects of epidurally administered lidocaine with or without dexmedetomidine in sheep

The study was designed as a randomized, prospective, blinded, clinical trial to compare the clinical effects of epidural lidocaine hydrochloride 2% (L2%) alone and in combination with dexmedetomidine (DL2%) in sheep. A total of 19 adult sheep, 14 females & 5 males were assigned to one of the two lumbosacral epidural treatments: L2% (4 mg kg –1) and DL2% (2.5 µg kg –1 + 4 mg kg –1) in a randomized order. The total volume of the drug combination was kept constant. Onset, analgesia, motor blockade, sedation and behaviour were determined before treatment, after effect of treatment and at recovery. Duration of epidural anesthesia and motor blockade were recorded. Heart rate, blood pressure, respiratory rate, rectal temperature and capillary refill time were recorded prior to treatments and every 15 minutes following epidural anesthesia for 60 minutes. Epidural anesthesia was produced with both the treatments effectively and was easily performed in all the studied animals. Both the treatments provided complete analgesia however no significant difference (p = 0.35) was recorded in onset time to analgesia. Duration of epidural anesthesia was significantly greater (p < 0.0001) with DL2% (239.56 ± 19.48 min) than L2% (69.30 ± 3.03 min). Significant extension (p < 0.0001) of motor blockade was recorded with DL2% (251.89 ± 22.18 min) than with L2% (88.30 ± 2.36 min) alone. The median analgesic scores were significantly higher in DL2% in comparison to the L2% alone. Rescue analgesia had to be given in 20% of L2% and 33.3% of DL2%.

High-flow nasal cannula oxygen reduced hypoxemia in patients undergoing gastroscopy under general anesthesia at ultra-high altitude: a randomized controlled trial.

Hypoxemia can occur in people at ultra-high altitude (above 3500m) even at rest, and patients undergoing gastroscopy under general anesthesia have higher risk of hypoxemia. Supplementary oxygen via standard nasal cannula (SNC) is the standard of care for most patients who undergo gastroscopy under general anesthesia, which provides oxygen flow up to 15L/min. High-flow nasal cannula (HFNC) could deliver oxygen at a rate up to 60L/min, which is recommended by the American Society of Anesthesiologists Practice Guidelines. We speculated that the benefit with HFNC is more prominent in high-altitude areas, and aimed to compare the incidence of hypoxemia during gastroscopy under general anesthesia at ultra-high altitude with oxygen supply via either HFNC or SNC. The trial was registered at at Chinese Clinical Trial Registry (ChiCTR2100045513; date of registration on 18/04/2021). Adult patients undergoing gastroscopy with anesthesia (estimated duration of anesthesia at ≥ 15min) were randomized at a 1:1 ratio to receive HFNC oxygen or SNC oxygen. The primary outcome was hypoxemia (SpO2 < 90% for any duration). Secondary outcomes included severe hypoxemia (SpO2 < 75% for any duration or SpO2 < 90% but ≥ 75% for ≥ 60s) and hypotension, as defined by reduction of mean arterial blood pressure by ≥ 25% from the baseline. A total of 262 patients were enrolled: 129 in the HFNC group and 133 in the SNC group. All patients received the designated intervention. Student's t-test, Mann-Whitney U test and χ2 test were employed in the study. The rate of hypoxemia was 9.3% (12/129) in the HFNC group versus 36.8% (49/133) in the SNC group [risk ratio (95% confidence interval): 0.25(0.14-0.45); P < 0.001). The HFNC group also had lower rate of severe hypoxemia [0.0% (0/129) versus 11.3% (15/133); risk ratio (95% confidence interval): 0.03(0.00-0.55); P < 0.001, respectively]. The rate of hypotension did not differ between the 2 groups [22.5% (29/129) in HFNC group versus 21.1% (28/133) in SNC group; risk ratio (95% confidence interval): 1.07(0.67-1.69) ; P = 0.779]. HFNC oxygen reduced the incidence of hypoxemia during anesthesia in adult patients undergoing gastroscopy at ultra-high altitude.

Does Positioning During Oral and Maxillofacial Surgery Operations Influence the Development of Upper Extremity Peripheral Neuropathy?

BackgroundControversy exists regarding the role of specific etiology and mitigating factors in perioperative upper extremity peripheral neuropathy (PUN) development during oral and maxillofacial surgery (OMS) procedures. PurposeThe purpose of this study was to measure the association between upper extremity positioning and developing PUN in oral and maxillofacial surgery operations. Study design, setting, sampleThe investigators implemented a retrospective cohort study. Patients referred to the Department of Oral and Maxillofacial Surgery at Jefferson Health who underwent orthognathic, telegnathic, or free flap surgery from April 2017 through December 2021 were identified. Exclusion criteria were age less than 13, revision surgery, ablative case without free flap reconstruction, incomplete medical record, pre-existing neuropathy, and upper extremity position other than tucked or abducted. Predictor variableThe predictor variable was upper extremity (UE) position during surgery, which had two levels-- tucked or abducted. Outcome variableThe outcome variable was self-reported development of PUN, defined as new sensory and/ or motor deficit in a non-operated extremity diagnosed within 48 hours of surgery. CovariatesDemographic covariates included age, gender, and race. Perioperative covariates included American Society of Anesthesiologists (ASA) physical status and body mass index (BMI). The operative covariate was general anesthesia (GA) duration. AnalysesDescriptive statistics were calculated. Shapiro-Wilk test was used to assess normality of the sample. Categorical variables were analyzed with Fisher’s exact test. Continuous variables were analyzed with Mann-Whitney U test. Significance was defined at P<0.05. ResultsOf the 432 patients identified, 342 met inclusion criteria. Median (IQR) ages for the abducted and tucked cohorts were 40 (31) and 34 (28) years, respectively (P<0.01). Males comprised 55.4% (n=41) and 54.1% (n=145) of abducted and tucked groups, respectively (P=0.9). PUN frequency was 6.8% (n=5) for abducted subjects and 3.7% (n=10) for tucked subjects (relative risk 1.8, 95%CI [0.7,5.1]; P=0.33). PUN was associated with gender (P=0.01), ASA status (P=0.03), BMI (P=0.01), and GA duration (P<0.01) on bivariate analysis. When adjusting for covariates, only GA duration (P<0.01) and BMI (P=0.03) were associated with PUN development Conclusion and relevanceThe findings suggest that PUN development during OMS procedures was not associated with upper extremity position.

Combining melatonin with dexmedetomidine improves anesthesia in rats.

Melatonin (ML) and dexmedetomidine (DM) are used separately as anesthetic premedication or as an anesthetic in humans and laboratory animals. In this study, we aimed to investigate the anesthetic properties of both drugs combined. The anesthetic effects of several combinations of ML (50 and 100 mg/kg) and DM (50 and 100 μg/kg) were evaluated in rats by observing behavioral manifestations and recording the duration and depth of anesthesia. Five anesthetic intervals were established according to the loss and recovery of reflexes. While each individual drug did not induce an appropriate anesthetic effect at the tested doses, ML50 + DM100, ML100 + DM50 and ML100 + DM100 combinations resulted in surgical anesthesia intervals of 60 to 360 min. Together, our results point that the use of ML allows to decrease the dose of DM, reducing the unwanted anesthetic effects of this α2-agonist.

Clinical and Hematological Effect of Constant Rate Infusion of Ketamine Alone and Ketamine-dexmedetomidine Combination on Isoflurane Anesthesia in Horses

Background: Anaesthetic management of horses for a successful surgery is of utmost importance but a risky procedure than other companion animals. Peri-aneasthetic morbidity and mortality in horses could be alarming if proper combinations of drugs were not used. Balanced anaesthetic combinations are being explored by various authors to find safer combinations.Therefore current study was planned to evaluate the effect of CRI of ketamine alone and ketamine-dexmedetomidine combination for isoflurane anesthesia in horses. Methods: Twenty four clinical cases of horses were randomly divided into three groups S, D and DK, having eight animals in each. Xylazine (1 mg/kg) and butorphanol (0.05 mg/kg) were given intravenously for premedication and ketamine (2 mg/kg) and midazolam (0.2 mg/kg) were used for induction of anesthesia. Normal saline (1000 ml/hour), ketamine alone (2 mg/kg/hr), ketamine (2 mg/kg/hr) and dexmedetomidine (2 µg/kg/hr) combination were given as CRI in groups S, K and KD, respectively. Thiopentone sodium (200 mg bolus, 5%) was given as fast intravenous to facilitate endotracheal intubation in some of the cases. Anesthesia was maintained with isoflurane in oxygen and anesthetic efficacy was evaluated based on clinical and haematological parameters. Result: Overall quality of sedation, muscle relaxation, response to surgical stimuli, quality of intubation, anesthetic depth and quality of recovery was significantly (p less than 0.05) better in group KD. Down-time (min) and duration of anesthesia were non significantly less in group KD. CRI of ketamine and dexmedetomidine combination was having significant (p less than 0.05) thiopentone sodium and isoflurane sparing effect. Heart rateand RR, did not show any significant variation among groups but rectal temperature was significantly low in KD group than groups S and K. CRI of ketamine-Dexmedetomidine combination produced a better quality of anesthesia and significant thiopentone sodium and isoflurane sparing effect thus was found suitable for anesthesia of horses.

A Rabbit Clinical Trial of Xylazine-Ketamine vs. Fentanyl-Ketamine for General Anesthesia

The Aim of Study: The current investigation was designed to compare the anesthetic and physiological effects of ketamine with different pre-anesthetics protocol. Methods: A total of twelve healthy male rabbits were chosen for the clinical anesthetic trial. Animals were presented to the faculty of veterinary medicine at Kerbala University for skin wound procedures and separated into two equal groups 6 rabbits each (group A and group B). Rabbits in group A were administered an intramuscular injection of xylazine (10mg/kg BW) followed by ketamine (50 mg/kg I.M) after 10 minutes. while those in group B were injected with fentanyl (0.04 mg/kg BW, I.M) first plus ketamine (50 mg/kg I.M) after 10 minutes. The physiological and anesthetic parameters to assess the complications that associated with anesthetic, were recorded and analyzed. Results: The level of induction and recovery varied significantly (P&lt;0.05) among the groups. Compared to group B, group A had a considerably (P&lt;0.05) shorter induction time. Furthermore, group A's mean time for losing pedal reflex revealed a substantial (P&lt;0.05) decrease. Between-group differences in the responses to the pain test and muscular relaxation were statistically significant (P&lt;0.05). Group A experienced a substantially longer (P&lt;0.05) induction period, surgical anesthetic duration, and recovery period than group B. No rabbits died as a result of the anesthetic or the recuperation. Conclusion: Compared to Fentanyl-ketamine (FK) combination anesthesia, administration of Xylazine with ketamine (XK) apparently does not influence the physiological parameters. Additionally, this method provides a very successful anesthetic procedure for a flawless induction, suitable muscle relaxation, extended anesthesia, and a painless recovery.

Prevalence of Corneal Lesions in Dogs After Non-Ocular Surgery: Impact of Preoperative Topical Lubrication and Duration of Anaesthesia

Corneal lesions are the most common ophthalmologic complication that occurs during general anesthesia (GA) for non-ocular surgery (Di Pietro et al., 2021). The aim of this study was to identify the prevalence of corneal lesions in dogs that were administered preoperative ocular lubrication and those that did not and how the duration of anesthesia influences the occurrence of them. A fluorescein test was performed before and after anesthesia in 18 dogs undergoing non-ophthalmic procedures. Subjects were randomly divided into two groups of 9 subjects each, group A which received preoperative ocular lubrication and group B that did not. Subsequently, the subjects were divided into three groups according to the duration of anesthesia in order to highlight the correlation between its duration and the occurrence of corneal lesions: group 1 (under 90 minutes) with 4 subjects, group 2 (between 90 and 180 minutes) with 9 subjects and group 3 (over 180 minutes) with 5 subjects. Only 11% (1 subject) of group A showed postoperative corneal lesion, while no subjects in the group B showed a positive fluorescein test result. 20% of subjects (1 subject) from group 3 had postoperative corneal lesions and a positive fluorescein test result, while no subjects from group 1 and 2 showed a postoperative positive fluorescein test result. The results of the study could not highlight the protective role of preoperative ocular lubrication. Further studies on a larger number of subjects and homogeneous groups are needed for more relevant results.

Discharge within 24 h, transvaginal natural orifice transluminal endoscopic surgery- more suitable for ambulatory surgery in gynecology procedures: a retrospective study

BackgroundNatural orifice transluminal endoscopic surgery (NOTES) is an achievement in the field of minimally invasive surgery. However, the vantage point of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologicalprocedures remains unclear. The main purpose of this study was to compare vNOTES with laparo-endoscopic single-site surgery, and to determine which procedure is more suitable for ambulatory surgery in gynecologic procedures.MethodsThis retrospective observational study was conducted at the Department of Gynecology, Chengdu Women’s and Children’s Central Hospital. The 207 enrolled patients had accepted vNOTES and laparo-endoscopic single-site surgery in gynecology procedures from February 2021 to March 2022. Surgically relevant information regarding patients who underwent ambulatory surgery was collected, and 64 females underwent vNOTES.ResultsMultiple outcomes were analyzed in 207 patients. The Wilcoxon Rank-Sum test showed that there were statistically significant differences between the vNOTES and laparo-endoscopic single-site surgery groups in terms of postoperative pain score (0 vs. 1 scores, p = 0.026), duration of anesthesia (90 vs. 101 min, p = 0.025), surgery time (65 vs. 80 min, p = 0.015), estimated blood loss (20 vs. 40 mL, p < 0.001), and intestinal exhaustion time (12.20 vs. 17.14 h, p < 0.001). Treatment with vNOTES resulted in convenience, both with respect to time savings and hemorrhage volume in surgery and with respect to the quality of the prognosis.ConclusionThese comprehensive data reveal the capacity of vNOTES to increase surgical efficiency. vNOTES in gynecological procedures may demonstrate sufficient feasibility and provide a new medical strategy compared with laparo-endoscopic single-site surgery for ambulatory surgery in gynecological procedures.

Physio-Anatomical complications in short and long surgical procedures with General Anesthesia. A comparative cross-sectional study

Background: The complication intensity of short- and long-term anesthesia during different surgeries depends upon the age, medical history and general lifestyle of a patient. Aims and objectives: The aims and objectives of present study were to evaluate the risks associated with general anesthesia during various surgical procedures. Methodology: Current comparative cross-sectional study was conducted in ICU, general surgery and gynecology units of Ghurki Trust and Teaching Hospital from July 2023 to February 2024. Total 100 patients of appendectomy and hysterectomy were selected as study subjects and divided into two groups. In Group-A (short surgery group) 65patients with appendectomy and in Group-B (Long surgery group) 35 women patients with hysterectomy were included. All of the clinical and demographic data were recorded on MS Excel and SPSS version 2024 were used to process, analyze, and distribute the data as needed and graph pad prism was used to plot graphical data representation. Results: The study identified a significant association between anesthesia duration and increased postoperative complications, notably in patients aged 51-55 years. Enhanced risks included postoperative pain, nausea, and respiratory distress, emphasizing the need for tailored anesthesia strategies based on surgical length and patient demographics. Conclusion: General anesthesia is largely safe but linked to some complications, necessitating innovative improvements and further research with larger sample sizes for enhanced safety.

Perinatal outcomes among pregnant patients with peripartum coronavirus disease 2019 infection

PurposeEvaluate maternal and neonatal outcomes in peripartum coronavirus disease 2019 (COVID-19) positive women.MethodsA retrospective cohort study was conducted, comparing outcomes between women with and without peripartum COVID-19. All singleton deliveries from June 2020 to January 2022 were included. Univariate analysis was followed by multivariate analysis.ResultsOf 26,827 singleton deliveries, 563 women had peripartum COVID-19, associated with preterm deliveries both near-term and remote from term [adjusted odds ratio (aOR) 1.6 and 2.0, respectively, p = 0.007 and 0.003]. Women with peripartum COVID-19 had a significantly higher rate of disseminated intravascular coagulation (DIC) (aOR 23.0, p < 0.001). Conversely, peripartum COVID-19 peripartum COVID-19 was negatively associated with premature rupture of membranes and prolonged maternal length of stay (aOR 0.7 and 0.5, respectively, p = 0.006 and <0.001).In cesarean delivery (CDs), patients with COVID-19 had higher rate of urgent CDs (75.5 vs. 56.1%, p < 0.001), higher rate of regional anesthesia (74.5 vs. 64.9%, p = 0.049), and longer anesthesia duration (86.1 vs. 53.4 min, p < 0.001). CD rate due to non-reassuring fetal heart rate (NRFHR) was significantly higher in women with COVID-19 (29.6 vs. 17.4%, p = 0.002). Conversely, CDs rate due to history of previous single CD was significantly higher in patients without COVID-19 diagnosis (13.6 vs. 4.1%, p = 0.006).Concerning neonatal outcomes, an association has been observed between COVID-19 and low one-minute APGAR score <5, as well as neonatal COVID-19 infection (aOR 61.8 and 1.7 respectively, p < 0.001 and p = 0.037).ConclusionsPeripartum COVID-19 is associated with preterm deliveries, urgent CDs and DIC, potentially aligning with the infection’s pathophysiology and coagulation alterations.

Utility of Dexmedetomidine in Paediatric Cardiac Surgery: a Systematic Review and Meta-analysis

Dexmedetomidine is a selector α 2-agonist that provides sedation with sparing respiratory depression, anxiolysis, and analgesic adjunct with opioids and benzodiazepines sparing effects, prolongs the duration of regional anesthesia and allows early tracheal extubation after pediatric cardiac surgery.[1,2,3 ] Recently, dexmedetomidine has been established as a cardioprotective agent in adult cardiac surgical patients. Some trials show significantly lower myocardial injury markers like interleukin-6 (IL-6) levels, cardiac troponin I (cTnI), and creatinine kinase-myocardial band (CK-MB), after cardiac surgery in the dexmedetomidine group.[ ] The majority of published studies have suggested that dexmedetomidine is a seemingly efficacious agent protecting against cardiac injury during CPB.[6] Its administration lowers mechanical ventilation period, ICU stay, and length of hospital stay after pediatric cardiac surgery. In addition, it is effective against postoperative shivering, refractory JET rhythm and Tet spells, and acute kidney injury (AKI) in cyanotic pediatric patients undergoing corrective surgery. However, studies on its application in pediatric heart surgery using cardiopulmonary bypass (CPB) remain limited. This systematic review aimed to provide information on the utility of dexmedetomidine in patients undergoing pediatric cardiac surgery using CPB: hemodynamic stability, cardioprotective, renal protection, neuroprotective effects, control of refractory JET, and Tet spells, and the early and late outcome.

Perioperative Hypothermia in Elderly Patients During Pelvic Floor Reconstruction Surgery: An Observational Study.

The potential predictors of pelvic floor reconstruction surgery hypothermia remain unclear. This prospective cohort study was aimed at identifying these predictors and evaluating the outcomes associated with perioperative hypothermia. Elderly patients undergoing pelvic floor reconstruction surgery were consecutively enrolled from April 2023 to September 2023. Perioperative temperature was measured at preoperative (T1), every 15min after the start of anesthesia (T2), and 15min postoperative (T3) using a temperature probe. Perioperative hypothermia was defined as a core temperature below 36°C at any point during the procedure. Multivariate logistic regression analysis was conducted to determine factors associated with perioperative hypothermia. A total of 229 patients were included in the study, with 50.7% experiencing hypothermia. Multivariate analysis revealed that the surgical method involving pelvic floor combined with laparoscopy, preoperative temperature < 36.5°C, anesthesia duration ≥ 120min, and the high levels of anxiety were significantly associated with perioperative hypothermia. The predictive value of the multivariate model was 0.767 (95% CI, 0.706 to 0.828). This observational prospective study identified several predictive factors for perioperative hypothermia in elderly patients during pelvic floor reconstruction surgery. Strategies aimed at preventing perioperative hypothermia should target these factors. Further studies are required to assess the effectiveness of these strategies, specifically in elderly patients undergoing pelvic floor reconstruction surgery.

Individualized Care Delivery for Children With Autism and Related Disabilities Undergoing Overnight Video Electroencephalography (EEG): One Hospital's Experience With a Coordinated Team Approach.

Background and Purpose: Children with developmental disabilities have increased risk of epilepsy and need for overnight video electroencephalographic (EEG) monitoring. However, video EEGs have historically been considered difficult to complete for this population. An autism support service at a pediatric tertiary care hospital implemented a coordinated team approach to help children with developmental disability tolerate overnight video EEGs. The project included completion of a caregiver-report preprocedure questionnaire that then was shared with the multidisciplinary team and used to create individualized care plans. The current study aims to describe rates of video EEG completion and need for lead placement under general anesthesia among children with autism and related disabilities who received these supports. Methods: Rates of video EEG completion and general anesthesia use were analyzed for children referred to the support service between April 2019 and November 2021. Results: A total of 182 children with developmental disability (mean age = 10.3 years, 54.9% diagnosed with autism) met inclusion criteria. 92.9% (n = 169) of children successfully completed EEG (leads on ≥12 hours). Only 19.2% (n = 35) required general anesthesia for video EEG lead placement. The majority (80.2%) of parents (n = 146) completed the preprocedure questionnaire. Video EEG outcomes did not differ based on completion of the questionnaire. Parent-reported challenges with communication and cooperation were associated with shorter video EEG duration and greater use of general anesthesia. Conclusions: These findings suggest that most children with developmental disability can complete video EEG with sufficient support. Preprocedure planning can identify children who would benefit from additional accommodations. Further research is necessary to clarify which supports are most helpful.

Regional anesthesia is associated with prolonged operative time and unplanned inpatient admission in distal radius fractures

Background: Regional anesthesia is commonly used as an alternative to general anesthesia in the surgical treatment of distal radius fractures. The purpose of this study is to evaluate the effect general versus regional anesthesia has on post-operative outcomes and perioperative time in the open treatment of distal radius fractures. Methods: The National Surgical Quality Improvement Program database was queried to identify adult who underwent open reduction and internal fixation of distal radius fractures between 2005 and 2018. Patients were classified as receiving either general anesthesia or regional anesthesia. Mean perioperative times and length of stay were compared between groups. Univariate analysis and multivariate logistic regression were used to assess the risk of prolonged operative time and of 30-day post-operative complications, based on anesthesia type. Results: A total of 13,059 patients were identified, with 11,761 (90.1%) receiving GA and 1,298 (9.9%) receiving RA. RA was associated with a significantly longer duration of anesthesia (124.5 vs. 115.7 min) and total operative time (77.0 vs. 72.6 min) but shorter wake-up times (11.8 vs. 13.0 min). Using multivariate analysis, RA was independently associated with an increased risk of prolonged operative time (OR 1.448; CI 1.234-1.699; P&lt;0.001) and unplanned inpatient admission (OR 1.225, CI 1.019-1.545, P=0.033). The risk of all other acute postoperative complications was similar between groups. Conclusion: Regional anesthesia is independently associated with prolonged operative time and unplanned inpatient admission but not with acute postoperative complications in the open treatment of distal radius fractures. Level of Evidence: III

The efficacy of articaine in pain management during endodontic procedures in pediatric patients

ObjectiveThis trial aimed to study the efficacy of articaine in pain management during endodontic procedures in pediatric patients.MethodsNinety-eight children who received endodontic painless treatment were collected and randomly divided into the control group and observation group, with 49 cases in each group. The control group received infiltration anesthesia with lidocaine, and the observation group received infiltration anesthesia with articaine. Anesthesia effect, anesthesia onset time, sensory recovery time, duration of anesthesia, pain intensity, blood pressure, heart rate, and adverse reactions were compared.ResultsThe effective rate of anesthesia in the observation group was higher than that in the control group. The anesthesia onset time and sensory recovery time were shorter, the duration of anesthesia was longer, and the VAS score and facial expression score were lower in the observation group than in the control group. The heart rate of the observation group was lower, and diastolic blood pressure was higher than those of the control group. The total incidence of adverse reactions in the observation group was lower than that in the control group.ConclusionIn the treatment of dental pulp diseases in children, the use of articaine can achieve better anesthesia effect and rapid onset of anesthesia and has less impact on the patient’s blood pressure and heart rate, but it also can relieve pain and has good safety after the use of medication. It is worthy of clinical application.