Anesthesia In Adult Patients Research Articles

Comparison of two doses of succinylcholine to facilitate the Laryngeal mask airway insertion under propofol anaesthesia in adult patients undergoing elective minor surgical procedures

Background: Small dose of succinylcholine combined with propofol facilitates Laryngeal maskairway (LMA) insertion. This study was designed to compare the efficacy of two differentsmall doses of succinylcholine for LMA insertion.Aims and Objectives: The aim of our study is to compare the usefulness of two different doses of succinylcholine to facilitate the insertion of laryngeal mask airway under intravenous anaesthesia.Material and Methods: 70 patients of ASA I and II posted for elective day care procedure under general anaesthesia with Laryngeal mask airway (LMA) were randomly allocated into two groups of 35 each. 35 patients in group PS1 received Inj. propofol 2.0 mg/kg + succinylcholine 0.1 mg/kg (diluted to 2 ml). 35 patients in group PS2 received Inj. propofol 2.0 ml/kg + succinylcholine 0.2 mg/kg (diluted to 2 ml). During insertion of laryngeal mask airway jaw relaxation, gagging/coughing, head and limb movements, presence or absence of laryngospasm and duration of apnoea were noted.Results: Patients in PS2 had better conditions for LMA insertion, reduced the upper airway responses to the LMA insertion, and reduced the supplement doses of propofol compared to PS1.Conclusion: Succinylcholine in 0.2 mg/kg compared to 0.1kg provides optimal conditions for LMA insertion.Asian Journal of Medical Sciences Vol.8(4) 2017 21-26

Optimal pressure for facemask ventilation during induction of general anesthesia in adult patients: real-time ultrasonographic measurement of antral cross-sectional area

Objective To determine the optimal pressure for facemask ventilation during induction of general anesthesia by real-time ultrasonographic measurement of antral cross-sectional area(CSA)in adult patients. Methods Sixty American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 18-60 yr, with body mass index of 20-25 kg/m2, scheduled for elective operation under general anesthesia, were divided into 5 groups(n=12 each)using a random number table: P10 group, P13 group, P16 group, P19 group and P22 group.After induction of anesthesia, an oropharyngeal airway was inserted, and the patients were ventilated for a 2-min period in a pressure-controlled mode using the two-handed mask ventilation technique.The pressure for facemask ventilation was 10, 13, 16, 19 and 22 cmH2O in P10, P13, P16, P19 and P22 groups, respectively.The antral CSA was measured using real-time ultrasonography before and after facemask ventilation.Respiratory parameters were recorded. Results Compared with group P10, the number of patients in whom CSA<340 mm2 after facemask ventilation was significantly decreased in P16, P19 and P22 groups, and the number of patients in whom the tidal volume ≥ 6 ml/kg was increased in P13, P16, P19 and P22 groups(P< 0.01). The number of patients in whom optimal pressure for facemask ventilation was achieved was 2, 10, 6, 4 and 1 in P10, P13, P16, P19 and P22 groups, respectively, with the most cases in group P13(P < 0.01). Conclusion The optimal pressure is 13 cmH2O for facemask ventilation during induction of general anesthesia when determined by real-time ultrasonographic measurement of antral CSA, and it can ensure adequate oxygen supply and reduce gastric insufflation in adult patients. Key words: Masks; Ultrasonography; Respiration, artificial

Risk factors of emergence agitation after general anesthesia in adult patients

Risk factors of emergence agitation after general anesthesia in adult patients

A Comparative Study of Rocuronium and Succinylcholine for Rapid Sequence Induction of Anaesthesia

Rocuronium bromide introduced in 1994 was a non depolarizing muscle relaxant which became the first competitor to succinylcholine by producing excellent to good intubating conditions at 60 seconds. It had an intermediate duration of action with minimal hemodynamic changes and no histamine release. Also, it was devoid of the adverse effects seen with succinylcholine. The present study was undertaken to evaluate the efficacy of two different doses of Rocuronium bromide in comparison to Succinylcholine for use during rapid sequence induction of anaesthesia. Ninety patients posted for elective surgeries were divided into groups of 30 each randomly. Group S received Succinylcholine 1.5 mg/kg and Group R8 received Rocuronium bromide 0.8 mg/kg. Laryngoscopy and intubation was done at 60 seconds after assessing the relaxation of jaw, vocal cords status and response to intubation using a standard intubation scoring system by a double blinded assessor. Results were tabulated and analyzed using appropriate statistical methods. Excellent intubating conditions were seen in 100% of Group S and 88% in Group R8 respectively. Rocuronium 0.8 mg/kg also had a shorter duration of action compared to the usual high dose (0.9-1.2 mg/kg) given in rapid sequence induction of anaesthesia. Hemodynamic changes returned to pre-induction baseline values by the end of 5 minutes in both groups Hence we concluded that Rocuronium bromide was a safer and a good alternative to Succinylcholine for rapid sequence induction of anaesthesia in adult patients where Succinylcholine was contraindicated provided that there was no anticipated difficulty in intubation.

Effectiveness of intrathecal dexmedetomidine as an adjuvant to bupivacaine spinal anesthesia in adult patients undergoing elective surgery: a systematic review protocol.

The current review aims to identify the effects of intrathecal dexmedetomidine as an adjuvant to bupivacaine spinal anesthesia compared to the sole use of bupivacaine spinal anesthesia alone in adult patients undergoing elective surgical procedures.

Efficacy of a separate informed consent for anesthesia services: A prospective study from the Caribbean.

Background and Aims:This study aimed to determine whether a separate written consent form improved the efficacy of the informed consent process for anesthesia in adult patients undergoing elective surgery at a tertiary care teaching hospital.Material and Methods:We randomized patients into two groups prospectively. The first group (Group A) signed the hospital's standard Consent for Operation form only while the second group (Group B) signed a separate Consent for Anesthesia form additionally. Patients were interviewed postoperatively with an eight-item questionnaire with responses in a 5-point Likert scale. A composite adequacy of consent index was generated from the responses and analyzed.Results:Two hundred patients (100 in each group) were studied. All patients indicated that the anesthesiologist(s) had their permission to proceed with their anesthesia care. The mean adequacy of consent index score in Group B was higher than that of Group A (30.6 ± 4.6 [standard deviation (SD)] vs. 27.9 ± 5.2 [SD]) (P < 0.001). The separate written consent had a positive impact on the patients’ understanding of the nature and purpose of the intended anesthesia procedures (P = 0.04), satisfaction with the adequacy of information provided about common side effects (P < 0.001) and rare but serious complications (P = 0.008).Conclusions:A separate written consent for anesthesia improved the efficacy of the informed consent process with respect to better information about the nature and purpose of anesthesia, common side effects, and rare but serious complications.

Assessment of cuff presure during general anesthesia in adult patients

BackgroundThe insufflation pressure of tracheal tubes is usually determined by the finger-pressure technique has low precision. The minimum leak technique is an alternative to determine whether the cuff is occluding the trachea with safe pressures (20-30cm of H2O). Our group previously described that 43% of intubated patients had excessive cuff pressures (> 30cm of H2O) when the finger-pressure technique was used. ObjectiveTo compare the finger-pressure and minimum leak techniques to achieve safe intracuff pressures in patients undergoing endotracheal intubation. Data was analyzed with t-student and lineal regression. MethodsAdult surgical patients requiring intubation were randomized in two groups in which cuff insufflation was checked by either the finger-pressure or minimum leak technique. After insufflation, the intracuff pressure was measured using an aneroid manometer. Data analysis was performed to evaluate variables that may affect performance. ResultOur study included 286 patients (216 female) with a mean age of 44.6 SE±14.9 years. The mean insufflation pressures differed significantly between groups (finger-pressure, 36.9 SE±1.9cm H2O; minimum leak, 25.3 SE±1.4cm H2O; P<0.0001). Each group had 35% of patients with pressures within safe limits. Using finger-pressure, 46% of patient had excessive pressures (>30cm H2O). Using minimum leak technique, 42% of patients had insufficient pressures (<20cm H2O). We found a consistent association between the intracuff pressure and the body mass index (r2=0.223, P<0.0001). ConclusionsFinger-pressure insufflation technique gave mean pressures 11cm H2O higher than the minimum leak technique but no replace to aneroid manometer.

Comparison of laryngeal mask airway Supreme and laryngeal mask airway Pro-Seal for controlled ventilation during general anaesthesia in adult patients

Laryngeal mask airway (LMA) Supreme is a newly introduced single-use supraglottic device, which shares common features of both the LMA Pro-Seal and the intubating LMA (ILMA). Clinical studies have compared the safety and efficacy of the LMA Supreme over the 'gold standard' LMA Pro-Seal in different patient populations. However, the clinical relevance of the potential advantage which one device may offer over the other remains unclear. To quantify the potential advantage that the LMA Supreme may offer over the LMA Pro-Seal on oropharyngeal leak pressures in adult patients. A systematic review and meta-analysis of randomised controlled trials. Three authors independently searched PubMed, PubMed Central, Scopus, Central Register of Clinical Trials of the Cochrane Collaboration, Google Scholar and Directory of open access journals. Randomised trials comparing the LMA Supreme and the LMA Pro-Seal in adults in supine position, reporting on safety outcomes and published in English. Seven randomised controlled trials met the eligibility criteria and were included in the meta-analysis. Pooled data from 666 patients showed that the LMA Supreme provided lower oropharyngeal leak pressures than the LMA Pro-Seal [mean difference -2.48 cmH2O, 95% confidence interval (CI) -4.45 to -0.52]. First insertion success rate was higher for the LMA Supreme than for the LMA Pro-Seal when a muscle relaxant was not used [relative risk 1.17, 95% CI 1.03 to 1.35; number needed to treat (NNT) 6, 95% CI 4 to 12]. Time taken to insert the LMA was similar for the two devices. Complications associated with the use of either of the devices are infrequent and similar. Although the single-use LMA Supreme provides lower oropharyngeal leak pressures in comparison with the LMA Pro-Seal for controlled ventilation in supine adult patients, the clinical relevance of this small difference may be debatable and should be weighed against the potential risks of transmission of communicable diseases with the LMA Pro-Seal.

Intravenous Lipid Emulsion Improves Recovery Time and Quality from Isoflurane Anaesthesia: A Double‐Blind Clinical Trial

Recovery time and quality after general anaesthesia is important for patient safety. This study aimed to determine whether intravenous lipid emulsion could improve recovery profiles from isoflurane anaesthesia in adult patients undergoing laparoscopic cholecystectomy. Sixty-six patients were enrolled. After anaesthesia induction, inspired isoflurane concentration was adjusted to maintain stable vital signs and the suitable conditions for operation. At the end of the operation, the isoflurane was discontinued, and either 2 ml/kg 30% lipid emulsions or 0.9% saline solution was administered intravenously. The time to eye opening, extubation and exit from the operation room was recorded, and the quality of recovery from anaesthesia was assessed. Sixty patients completed the study. The median time to eye opening and exit from the operation room was significantly shorter in the lipid emulsion group than in the saline group [15.5 (interquartile range 9.0) versus 20.0 (10.0) min., p = 0.01; 19.5 (8.3) versus 23.6 (6.3) min., p = 0.04, respectively], whereas the median time to extubation did not show any noticeable difference. The quality of recovery was better in the lipid emulsion group than that of the saline solution group with respect to drowsiness visual analogue scale score (p < 0.01), Observer's Assessment of Alertness/Sedation score (p < 0.01), Mini-Mental State Examination score (p = 0.04) and Modified Aldrete Post Anaesthesia Recovery score (p = 0.03). No serious adverse events were observed during the study period. In conclusion, intravenous lipid emulsion may effectively improve the recovery time and quality from isoflurane anaesthesia for laparoscopic cholecystectomy.

Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis

Both propofol and volatile anesthetics are commonly used for maintenance of anesthesia in patients undergoing neurosurgical procedures. The effects of these two classes of drugs on cerebral hemodynamics have been compared in many clinical trials The objectives of this review were to evaluate the cerebral hemodynamic effects, operative conditions, recovery profiles, postoperative complications, and neurological outcomes of propofol-based vs volatile-based anesthesia for craniotomy. MEDLINE®, EMBASE™, Cochrane, and other relevant databases were searched for randomized controlled trials that compared propofol-maintained anesthesia with volatile-maintained anesthesia in adult patients undergoing elective craniotomy. The primary outcome measure was the intraoperative brain relaxation score. Secondary outcome measures included intraoperative cerebral hemodynamics (intracranial pressure [ICP], cerebral perfusion pressure [CPP]), cardiovascular changes, recovery profiles, postoperative complications, and clinical outcomes (neurological morbidity, mortality, quality of life). A meta-analysis was conducted using a random effects model to compare the outcomes of the two anesthetic techniques. Fourteen studies (1,819 patients) met inclusion criteria and were analyzed. Brain relaxation scores were similar between the two groups after dural opening; however, ICP was lower (weighted mean difference of -5.2 mmHg; 95% confidence interval -6.81 to -3.6) and CPP was higher (weighted mean difference of 16.3 mmHg; 95% confidence interval 12.2 to 20.46) in patients receiving propofol-maintained anesthesia. Postoperative complications and recovery profiles were similar between the two groups, except for postoperative nausea and vomiting being less frequent with propofol-maintained anesthesia. There were inadequate data to perform a meta-analysis on clinical outcome. Propofol-maintained and volatile-maintained anesthesia were associated with similar brain relaxation scores, although mean ICP values were lower and CPP values higher with propofol-maintained anesthesia. There are inadequate data to compare clinically significant outcomes such as neurological morbidity or mortality.

Perfusion index versus non-invasive hemodynamic parameters during insertion of i-gel, classic laryngeal mask airway and endotracheal tube

Background:Perfusion index (PI) is a non-invasive numerical value of peripheral perfusion obtained from a pulse oximeter. In this study, we evaluated the efficacy of PI for detecting haemodynamic stress responses to insertion of i-gel, laryngeal mask airway (LMA) and endotracheal tube and compare, its reliability with the conventional haemodynamic criteria in adults during general anaesthesia.Methods:Sixty patients scheduled for elective general surgery under general anaesthesia were randomised to three groups. (i-gel, LMA and ET groups (n=20/group). Heart rate (HR) (positive if ≥10 bpm), systolic blood pressure (SBP), diastolic blood pressure (DBP) (positive if ≥15 mm Hg) and PI (positive if ≤10%) were monitored for 5 min after insertion. Main outcome measures: SBP, DBP, HR and PI were measured before induction of anaesthesia and before and after insertion of the airway device.Results:Insertion of airway devices produced significant increases in HR, SBP and DBP in LMA and ET groups. Moreover, PI was decreased significantly by 40%, 100% and 100% in the three groups. Using the PI criterion, the sensitivity was 100% (CI 82.4-100.0%). Regarding the SBP and DBP criterions, the sensitivity was 44.4% (CI 24.6-66.3%), 55.6% (CI 33.7-75.4%) respectively. Also, significant change in the mean PI over time (from pre-insertion value to the 1st min, 3rd min, until the 4th min after insertion without regard the device type), (P<0.001).Conclusion:PI is a reliable and easier alternative to conventional haemodynamic criteria for detection of stress response to insertion of i-gel, LMA and ET during propofol fentanyl isoflurane anaesthesia in adult patients.

The Baska Mask® -A new concept in Self-sealing membrane cuff extraglottic airway devices, using a sump and two gastric drains: A critical evaluation

Background: In this study, we evaluated the performance of the Baska Mask® , a new extraglottic airway device (EAD) for use in anesthesia in adult patients undergoing a variety of surgical interventions. Materials and Methods: The self-recoiling membrane distally open cuff silicone mask consists of an anatomically curved airway tube with: (1) a bite block over the full length of the airway; (2) a self-sealing membranous variable-pressure cuff which adjusts to the contours of the mouth and pharynx; (3) a large sump cavity with two aspiratable gastric drain tubes; together with a number of special features such as (4) a tab for manually curving the mask to ease insertion; and (5) a suction elbow integral to one port with a second port acting as a free air flow access. The cuff of the Baska Mask® is not an inflatable balloon, but a membrane which inflates on every breath during intermittent positive pressure ventilation (IPPV) to achieve a superior seal when opposed to the larynx. An increase in IPPV pressure increases the oropharyngeal seal. With existing extraglottic airway devices, an increase in IPPV merely increases the leak. Results: Fifty patients with American Society of Anesthesiologists (ASA) physical status I-III were enrolled. We evaluated the first attempt and overall insertion success rates, insertion time, ease of insertion and removal of the device, oropharyngeal leak pressure, and anatomical position at fiberoptic view. The first attempt success rate was high (88%) and overall insertion success rates was considered easy to very easy by the operators in 92% of patients. Removal of the device was considered easy in all cases. The oropharyngeal leak pressure was above 30 cm H 2 O in all patients and the maximum of 40 cm H 2 O was achieved in 82% of the patients. In two patients, no adequate capnogram was obtained, so a smaller size mask was inserted with correction to adequate function. At fiberoptic evaluation of the anatomical position of the masks, the vocal cords could be seen, except in six patients (12%), where only the epiglottis could be visualized. Conclusion: The new EAD Baska Mask® has many novel features which should improve safety when used in both spontaneously breathing and IPPV anesthesia.

Results and complications of spinal anesthesia in percutaneous nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large kidney calculi, staghorn calculi, and calculi that are multiple or resistant to shock wave lithotripsy. In many centers, PCNL is performed under general anesthesia. However, complications under spinal anesthesia can be less frequent. We evaluated the impact of spinal anesthesia on intra-operative and postoperative outcome in patients undergoing PCNL. The intra-operative and postoperative anesthetic and surgical outcomes were evaluated in 160 consecutive patients who underwent PCNL under spinal anesthesia in the prone position. The mean age of the patients was 40.0 +/-14.3 years, and the mean operative time was 95.0 +/- 37.8 minutes. The mean calculus size was 34.2 +/- 9.8 mm. Ten patients had staghorn calculi (mean size, 4.2 +/- 1.1 cm; mean operative time, 140 +/- 40 minutes). Return of sensory and motor activity took 140.0 +/- 19.7 minutes and 121.0 +/- 23.8 minutes, respectively. During the first part of anesthesia, 18 patients developed hypotension, which was controlled by ephedrine, 10 mg, intravenously. Ten patients (6.3%) needed blood transfusion and 6 complained of mild to moderate headache, dizziness, and mild low back pain for 2 to 4 days after the operation, which improved with analgesics and bed rest. Seventy percent of the patients had complete clearance of calculus or no significant residual calculi larger than 5 mm on follow-up ultrasonography. Spinal anesthesia is safe and effective for performing PCNL and is a good alternative for general anesthesia in adult patients.

Anesthesia in adult patients with congenital heart disease

Recent advances in prenatal diagnosis, interventional cardiology, pediatric cardiac surgery, anesthesia, and critical care have resulted in an increasing number of adult patients with congenital heart disease (CHD). Most of these patients will require noncardiac surgery thus presenting a new challenge for anesthesiologists. The purpose of this article is to summarize preoperative and intraoperative implications for the anesthesiologist in the noncardiac surgery setting. These patients present with an increased risk of perioperative mortality. One of the most specific recommendations from the American College of Cardiology conference published in 2001 was that adult patients with moderate-to-severe CHD undergoing noncardiac surgery should be referred to an adult CHD center with the consultation of an expert anesthesiologist. However, though most experts agree that grown-up CHD poses an increasing risk for noncardiac surgery, no major study focusing on this topic has yet been performed. The number of adult patients with CHD is now superior to the number of children. This is a new challenge for anesthesiologist in the noncardiac surgery settings.

Comparative study of recovery after sevoflurane versus halothane anaesthesia in adult patients

Background: Induction and maintenance characteristics of sevoflurane and halothane have been studied, but little work has been done to compare the postoperative recovery of these two agents. Methods: Sixty adult, ASA I and II patients were allocated randomly into Group A and Group B of 30 each. Group A received sevoflurane and Group B received halothane for maintenance. At the end of surgery early recovery, intermediate recovery and discharge criteria were assessed. Results: Early recovery assessed with the mean time to extubation was 6.7 ± 2.29 min in Group A and 9.07 ± 1.64 min in Group B; eye opening was 7.28 ± 2.3 min in Group A and 10.6 ± 1.77 min in Group B; response to verbal command was 8.52 ± 2.83 min in Group A and 12.33 ± 2.17 min in Group B, while orientation was 10.43 ± 3.15 min in Group A and 14.77 ± 2.66 min in Group B. These differences were statistically significant (p<0.001).The mean time to reach post anaesthesia care unit discharge criteria was shorter for Group A (21.1 ± 4.69 min) as compared to Group B (27.43 ± 6.51 min) and this difference was statistically significant (p<0.001) Conclusion: Early recovery time and time taken to achieve discharge criteria were faster with sevoflurane.

Sedación para procedimientos quirúrgicos realizados con anestesia regional en pacientes adultos. Resultados de una encuesta entre anestesiólogos españoles

To analyze the frequency and methods of sedation used in the context of regional anesthesia in adults by means of a national survey. We carried out a survey of participants at the courses of an anesthesiology training organization (Fundación Europea de Enseñanza en Anestesiología), held in Spain in 2006. The survey questionnaires asked about indications for sedation used during surgery under regional anesthesia as well as the form of administration, follow-up, and complications. A total of 375 questionnaires were sent out and 185 responses were received (49.3%). Sedation is always used to accompany regional anesthesia by 69.2% of the respondents; 13.5% of them discuss the technique to be used with the patient and come to an agreement. The same type of sedation, regardless of the regional block performed, is used by 49.2% of respondents, and 64.3% use a scale to evaluate the level of sedation. The most favored sedation technique is continuous infusion, followed by target controlled infusion and boluses on demand. The most commonly used technique is sedation with bolus injections. Sixty percent use a single agent and 38.9% use combinations. The most commonly reported adverse effects are variability of patient response (53.5%) and respiratory complications (27%). In cases of ineffective regional blockade, 49.2% of those surveyed switch to general anesthesia. Sedation is very often used to complement regional anesthesia in adult patients. Even though continuous infusion is considered to be the most appropriate form of administration, the most commonly used form is injection of boluses. Sedation with a single drug is used more frequently than drug combinations. Variability of individual response is the complication most commonly reported by the respondents.

Repairing Urethrocutaneous Fıstula in Adults: Is a Catheter Necessary?

To demonstrate that urethrocutaneous fistulas can be repaired under local anesthesia in adult patients without catheters. From 1998 to 2006, 96 patients with urethrocutaneous fistulas underwent repair under local anesthesia. The patients were divided into two groups in terms of whether they did or did not have a catheter placed. The catheterized group included 45 patients and the uncatheterized group included 51 patients. The uncatheterized patients were discharged on the operation day, and the catheterized patients were discharged 1 to 4 days postoperatively. Patients were reevaluated on the 7th postoperative day and after 3 months in terms of wound infection, urethral stricture, and fistula recurrence. All patients tolerated the fistula repair well under local anesthesia. The success rate of fistula repair was 93.3% and 94.1% in the catheterized and uncatheterized groups, respectively. Wound infection was seen in 6 patients in the first group but was not noted in the uncatheterized group. Fistulas recurred in 3 patients in each group (6.6% and 5.8%) after 3 months postoperatively. Catheterless fistula repair with local anesthesia in adults is an effective, safe, and inexpensive procedure.

Comparison of the time to extubation after use of remifentanil or sufentanil in combination with propofol as anesthesia in adults undergoing nonemergency intracranial surgery: A prospective, randomized, double-blind trial

Background: Anesthetics with a short context-sensitive half-time (ie, the time required for the effect-site concentration of an IV drug to decrease by 50% at steady state), such as the opioids remifentanil and sufentanil, are suitable for anesthesia when early neurologic assessment is desired to detect postoperative complications. Objective: This study compared the efficacy and safety profile of remifentanil and sufentanil in combination with propofol for anesthesia in adult patients undergoing nonemergency intracranial surgery. Methods: This was a prospective, randomized, double-blind study in adults aged 18 to 75 years who were scheduled to undergo a supratentorial neurosurgical procedure with a maximum anticipated duration of 480 minutes. Eligible patients had no incapacitating severe systemic disease (American Society of Anesthesiologists physical status class 1–3), and only those in whom immediate postoperative extubation was planned were included. Anesthesia was induced with propofol and either remifentanil 1 μg/kg or sufentanil 0.25 μg/kg. Propofol was continued using a target-controlled infusion (TCI) system. Maintenance infusion rates for remifentanil and sufentanil were 0.25 and 0.0025 μg · kg −1 · min −1, respectively. The opioid and propofol infusions were adjusted based on hemodynamic parameters (mean arterial blood pressure, heart rate). The primary end point was the time to extubation. Secondary end points were hemodynamic stability (defined as the number of anesthetic adjustments required to maintain intraoperative hemodynamic parameters within 20% of preinduction values), postoperative IV morphine requirement, postoperative nausea/vomiting (PONV), and intraoperative anesthetic costs. Results: Sixty adults (29 remifentanil, 31 sufentanil) were included in the study. The 2 groups were similar with respect to sex, weight, indication for surgery, and duration of anesthesia. The sufentanil group was significantly older than the remifentanil group (55.3 vs 45.7 years, respectively; P = 0.001). The median extubation time was similar in the remifentanil and sufentanil groups (10 minutes [interquartile range, 5–19 minutes] and 16 minutes [interquartile range, 10–30 minutes], respectively). Remifentanil was associated with the need for significantly fewer adjustments to maintain hemodynamic stability compared with sufentanil (0.8 vs 2.1; P = 0.037), greater use of postoperative morphine (44.8% vs 22.6% of patients, P = 0.01; mean IV morphine dose per patient: 4 vs 1.3 mg, P = 0.016), and higher intraoperative opioid costs per patient € vs € P < 0.001). The incidence of PONV did not differ significantly between groups. The total cost of intraoperative anesthetics per patient was similar in the 2 groups € and € as was the cost of propofol € vs € Conclusion: In these adults undergoing nonemergency intracranial surgery, there was no significant difference in extubation time between those receiving remifentanil and sufentanil infusions adjusted based on hemodynamic parameters in combination with propofol administered by TCI.

Self-Warming Lidocaine/Tetracaine Patch Effectively and Safely Induces Local Anesthesia during Minor Dermatologic Procedures

Dermatologic procedures often cause some degree of pain. A self-warming patch containing lidocaine and tetracaine (L/T) was developed to provide topical local anesthesia prior to painful procedures. To evaluate the safety and efficacy of a self-warming L/T patch to provide anesthesia in adult patients undergoing minor dermatologic procedures. An active or placebo study drug was placed on adults 30 minutes prior to minor dermatologic surgical procedures in a prospectively randomized, double-blinded manner. Subcutaneous lidocaine injection was available during the procedure as a rescue medication if requested by the subject. Immediately following the procedure, the subjects, the investigator, and an independent observer rated pain intensity and adverse events were recorded. Patient-reported pain intensity was significantly lower in the L/T patch group (p<.001). Investigators and an independent observer rated the pain in the L/T patch group to be less than in the placebo patch group (p = .004 and p<.001, respectively). Forty-nine percent of patients in the placebo group required rescue subcutaneous lidocaine compared with 22% in the L/T patch study group (p = .008). One patient in the L/T patch group reported a transient moderate burning sensation. The self-warming L/T patch was effective in providing clinically useful local anesthesia for minor dermatologic procedures in adult patients.

Local Anesthesia With Monitored Anesthesia Care vs General Anesthesia in Thyroidectomy

Early in the 20th century, thyroid surgery was performed using local anesthetic techniques. When general anesthesia became safer, surgeons started performing thyroidectomy exclusively under general anesthesia. However, recent descriptions of thyroidectomy under local anesthesia claim similar results to thyroidectomy under general anesthesia. Surgery conducted under local anesthesia can result in early discharge, ie, a hospital stay of less than 8 hours. Thyroidectomy can be performed under local anesthesia with monitored anesthesia care (MAC) with results similar to general anesthesia in an outpatient or inpatient surgery setting. A prospective randomized study comparing local anesthesia with MAC vs general anesthesia in adult patients undergoing thyroidectomy in a potential outpatient setting, defined as same-day discharge. Patients were excluded if they were not able to receive local or general anesthesia. In addition, we performed an outcome evaluation of the use of local anesthesia with MAC for thyroidectomy and the use of outpatient surgery for thyroidectomy. We compared 58 consecutive thyroidectomies performed prior to the study with 58 consecutive thyroidectomies performed after the study. A 486-bed university-affiliated hospital. Fifty-eight patients undergoing thyroidectomy received random assignment: 29 to local anesthesia with MAC and 29 to general anesthesia under study protocol. Fifty-one surgical procedures (88%) were completed as outpatient surgery. No significant differences were found between the 2 study groups in demographics, postoperative adverse symptoms, complications, hospital admission, or patient satisfaction. Patients in the general anesthesia group spent, on average, more time postoperatively than patients in the group that received local anesthesia with MAC in the outpatient surgery center until same-day discharge (P = .02). When compared before the study, we found a significant increase after the randomized study in the use of local anesthesia with MAC (P<.001) and outpatient thyroidectomies (P<.001). Thyroidectomy can be performed in the studied patient population under either general anesthesia or local anesthesia with MAC, expecting similar operative results, clinical results, and patient satisfaction. In addition, local anesthesia with MAC can reduce the postoperative time spent in an outpatient surgery setting with potential health care cost savings.