Combined Anesthesia Research Articles

Achıevements in the Surgıcal Treatment of Aneurysms of the Infrarenal Regıon of the Abdomınal Aorta

The article’s topic is devoted to the surgical treatment of aneurysms of the infrarenal aorta, the achievements we have achieved in the perioperative period, and the prevention of possible complications that may arise in the postoperative period. For this purpose, clinical materials from 125 patients were analyzed. Operation “Resection of the aneurysm using a synthetic aortic prosthesis” in 34 patients; “thromboendarterectomy from the abdominal aorta, biiliac bifemoral synthetic aortic prosthesis” was performed on 91 patients. In patients, the operation was performed using combined epidural intubation anesthesia. The duration of the operation was 293.0±11.87 minutes. The Cell-Saver apparatus was used for autotransfusion. The average volume of blood loss was 3252.5±219.12 ml. Mortality in the postoperative period occurred in 3.2% of patients. Cause of death; “Thrombohemorrhagic syndrome” developed as a result of internal bleeding in 1 patient; 1 patient had “intestinal obstruction”, and 2 patients had “acute myocardial infarction, pulmonary-heart-renal failure”.

Pyridoxine Prevents Postoperative Nausea and Vomiting in Gynecological Laparoscopic Surgery: A Double-blind Randomized Controlled Trial.

Postoperative nausea and vomiting (PONV) are common complications after gynecological laparoscopic surgery. Pyridoxine has been recommended as a first-line drug to prevent and treat nausea and vomiting during pregnancy; however, its efficacy in preventing PONV remains unclear. Patients of 18 to 65 years old, who received elective gynecological laparoscopic surgery under general anesthesia, were randomized into either the pyridoxine or control group. The pyridoxine group received 0.2g vitamin B6 before anesthesia induction, and the control group received normal saline intravenously. Both groups received a similar regimen of combined intravenous and inhalation general anesthesia. All patients received dexamethasone(intravenous) after anesthesia induction and ondansetron(intravenous) before surgery completion. PONV occurrence was recorded according to the patients' self-reported data. Other clinical data were collected from hospital system, and concentrations of blood interleukin-6 and substance P were measured by ELISA. A total of 442 patients were screened and 240 patients were equally randomized to the pyridoxine or control group. The incidence of PONV was statistically significant lower in the pyridoxine group than in the control group (16.7% [20/120] vs. 35.8% [43/120]; relative risk (RR) = 0.47 [95% CI: 0.29, 0.74]; absolute risk reduction (ARR) = 0.20 [95% CI: 0.08, 0.30]; P = 0.001), and pyridoxine decreased the incidence of postoperative nausea (12.5% [15/120] vs. 35% [42/120]; RR = 0.36 [95% CI: 0.21, 0.61]; ARR = 0.23 [95% CI: 0.12, 0.33]; P < 0.001). There were no statistical differences in postoperative vomiting, time to the first PONV occurrence, pain, serum interleukin-6 and substance P, and white blood cell and neutrophil counts. In this single center randomized trial, pyridoxine plus dexamethasone and ondansetron reduced the incidence of PONV in patients undergoing elective gynecological laparoscopic surgery under general anesthesia. These findings need to be validated in multicenter studies in diverse populations to ensure generalizability.

Comparison of radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid in chronic perineal pain

Abstract Background and Aims: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6–18%. The etiology for CPP may be idiopathic, benign, or malignant. We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid for management of chronic perineal pain, with respect to pain relief, patients’ self-reported belief about the efficacy of treatment, and side effects or complications, if any. Material and Methods: Forty patients attending the Pain Management Centre of either sex in the age group of 20–70 years with history, physical examination, and pain patterns consistent with chronic perineal pain, who had been investigated to rule out malignancy and failed to respond to 6 weeks of conservative treatment with a combination of analgesics, anti-inflammatory drugs, neuromodulators, and physiotherapy, were enrolled in the study. The patients were randomly divided into two groups of 20 each using a computer-generated randomization number table. Group-I (n = 20): Patients were administered ganglion Impar block using a drug mixture comprising of 8 ml of 0.25% bupivacaine plus 80 mg of triamcinolone acetate under fluoroscopic guidance. Group II (n = 20): Patients received conventional radiofrequency thermocoagulation of ganglion Impar at 80 degree Celsius for 90 seconds under fluoroscopic guidance. Outcome assessment was done after minimally invasive pain and spine intervention (MIPSI) with evaluation of pain using the Numeric Rating Scale (0–10), patients’ self-reported belief about the efficacy of treatment using Patient Global Impression of Change (PGI-C), and side effects or complications, if any. Results: The majority of the patients in our study were in the age group of 40–50 years, and 80% of the patients were females and weighed 60–70 kg. The majority of the patients in our study had history of trauma, which led to coccygodynia. There was statistically and clinically significant improvement in pain score after ganglion Impar block in both the groups at all time intervals during the study period (P &lt; 0.05). Patients’ self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II as compared to group I at all time intervals throughout the study period (P &lt; 0.005). Four patients in group I required second ganglion Impar block during the 12 months study period. The most common side effect was temporary pain on injection. Conclusions: Both the techniques of MIPSI, that is, fluoroscope-guided ganglion Impar block using corticosteroid and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. With respect to improvement in pain relief and patients’ self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation is better as compared to fluoroscope-guided ganglion Impar block using corticosteroids and local anesthetics.

“Treading on Thin Ice: Anesthesia Management of a Neonate with Pierre Robin Sequence for Feeding Gastrostomy and Diagnostic Bronchoscopy” – A Case Report

Pierre Robin sequence (PRS) is a rare congenital anomaly characterized by the triad of micrognathia, glossoptosis, and airway obstruction, with an incidence of approximately 1 in 8500 live births. Managing neonates with PRS, particularly during anesthesia, poses significant challenges due to airway obstruction, which may be compounded by associated congenital anomalies and medical complications. This case report describes the anesthetic management of a 28-day-old female neonate with PRS and a pre-existing hypoxic-ischemic injury. The neonate presented with symptoms of recurrent regurgitation and noisy breathing, with a history of pneumonia and delayed onset sepsis, which resolved with medical management. The neonate had an orogastric tube in situ for feeding and was scheduled for a diagnostic bronchoscopy and feeding gastrostomy. On clinical examination, the neonate displayed the classical features of PRS, including micrognathia, glossoptosis, airway obstruction, and an incomplete post-palatal cleft. Imaging revealed a small patent foramen ovale with a left-to-right shunt, mild pulmonary arterial hypertension, and residual opacification in the left lower lobe, indicative of prior respiratory infection. These factors, combined with the known airway complications associated with PRS, necessitated careful anesthetic planning to ensure the safety and stability of the patient during diagnostic and therapeutic procedures. A combined general and regional anesthesia approach was selected. The neonate was induced using sevoflurane and air, and a pediatric flexible fiberoptic bronchoscope was inserted through a No. 1 i-gel as a conduit. Notably, neuromuscular blockers and opioids were avoided to maintain vocal cord mobility and minimize airway compromise. Bronchoscopy identified an adduction deformity of the posterior vocal cords. Subsequently, a gastrostomy was performed under spinal anesthesia without hemodynamic instability. In addition, a left-sided rectus sheath block was executed. Regional anesthesia minimized the reliance on systemic opioids, reduced the risks associated with general anesthesia, and facilitated a rapid recovery. Postoperatively, the neonate was transferred to the Neonatal Intensive Care Unit and demonstrated stable airway patency, normal limb movements, and adequate pain control. This case emphasizes the advantages of regional anesthesia in managing neonates with PRS. It offers a safer, opioid-sparing alternative to general anesthesia and mitigates the risks of airway compromise. We propose effective pain management techniques along with enhanced overall patient safety, thereby contributing to improved anesthetic outcomes in neonates with complex airway challenges.

Effect of electroacupuncture pretreatment on the quality of recovery in the patients undergoing laparoscopic gastrointestinal surgery

To investigate the effect of electroacupuncture pretreatment on the quality of recovery in the patients undergoing laparoscopic gastrointestinal surgery. Sixty patients for elective laparoscopic resection of gastrointestinal tumors under general anesthesia were randomly assigned to either an observation group or a control group, with 30 patients in each group. In the control group, the routine inhalation-intravenous combined general anesthesia was adopted. On the basis of the control group, in the observation group, 30 min before anesthesia induction, electroacupuncture was applied to bilateral Neiguan (PC 6) and Neimadian (Extra) for 30 min, using disperse-dense wave and at 2 Hz/100 Hz. The recovery time of spontaneous breathing, awakening time, extubation time, and the post-anesthesia care unit (PACU) stay time were compared between the two groups. Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2) were recorded at multiple time points: before electroacupuncture (T0), before extubation (T1), immediately after extubation (T2), 5 minutes (T3) and 10 minutes (T4) after extubation, and upon discharge from PACU (T5). The visual analogue scale (VAS) score for pain and Ramsay sedation score at T3, T4 and T5 were observed; and the incidence of agitation, nausea and vomiting at T5 was evaluated in the two groups. At T0 and T5, the serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and cortisol were determined in the two groups. In the observation group, the recovery time of spontaneous breathing, awakening time, extubation time, and PACU stay time were shorter (P<0.001), MAP and HR at T2 were lower (P<0.01, P<0.05), the VAS scores for pain at T3, T4, and T5 dropped (P<0.001, P<0.01), and the Ramsay sedation score at T3 reduced (P<0.05) compared with those in the control group. The incidence of nausea and vomiting was lower in the observation group when compared with that in the control group (P<0.05). In comparison with the indexes at T0, the serum levels of TNF-α, IL-6, and cortisol increased at T5 in both groups (P<0.01); and these indexes at T5 in the observation group were lower than those in the control group (P<0.01, P<0.05). Electroacupuncture pretreatment can enhance the quality of recovery in the patients undergoing laparoscopic gastrointestinal tumor surgery, shorten the time for spontaneous breathing recovery, awakening, extubation and PACU stay, and attenuate postoperative pain and stress response.

Comparison of the effect of general anesthesia and combined epidural anesthesia on the anesthetic management of gynecological oncological surgery.

To evaluate the potential advantages of combined general and epidural anesthesia for major gynecological oncological surgeries. The data of 690 gynecological cancer were retrospectively examined, and 223 patients who met the inclusion criteria were included in the study. The patients were divided into two groups: Group G (123 patients who received general anesthesia only) and Group C (100 patients who received combined epidural and general anesthesia. The perioperative follow-up data were comparatively analyzed. Operation times in Group G were significantly lower than those in Group C (p=0.018). The blood product replacement rate was higher in Group G (p<0.05). Additionally, intraoperative bleeding rates were lower in Group C (p<0.05). Postoperatively, the analgesic requirement time of Group C was significantly later than that of Group G (p=0.0001). The first mobilization time of Group C was substantially earlier (p=0.0001). Thrombosis and cardiac complications were considerably less frequent in group C, although allergic complications were more common (p<0.05). The length of hospital stay was shorter in Group C (p<0.05). Combined epidural and general anesthesia in gynecological oncological surgeries may improve postoperative outcomes, including reduced analgesic requirements, earlier patient mobilization, shorter hospitalization, and decreased rates of complications, particularly cardiovascular and thrombotic events.

Impact of Intraoperative Opioid Use and a Combined Anesthesia Regimen in Patients Undergoing Radical Prostatectomy for Prostate Cancer in a Single-Center Cohort.

Introduction: Higher intraoperative opioid doses may be associated with worse long-term oncological outcomes after radical prostatectomy (RP) for prostate cancer. We aimed to evaluate the impact of higher doses of intraoperative opioids and type of anesthesia on biochemical recurrence (BCR) and mortality after RP in a high-volume tertiary center. Methods: All patients underwent RP at our center between 2015 and 2021. The role of major intraoperative opioid agents, such as sufentanil remifentanil, and morphine milligram equivalents (MMEs), as well as the type of anesthesia [total intravenous anesthesia (TIVA), versus a combination of TIVA and epidural anesthesia, versus solely epidural anesthesia], was assessed in predicting BCR and survival after RP. Results: A total of 1137 patients who had a median age of 66 years (interquartile range: 61-72) were included. Overall, 1062 (93%) patients received TIVA, 37 (3%) received TIVA and epidural anesthesia, and 41 (4%) only epidural anesthesia. At a median follow-up of 431 days (interquartile range: 381-639) from RP, 257 (24%) patients developed a BCR. Accordingly, at a median follow-up of 500 days (interquartile range: 450-750), 33 (2.9%) patients died. The type of anesthesia, as well as the dosage or type of the selected intraoperative opioid agents, did not affect either BCR or long-term overall survival. Conclusions: These findings suggest that intraoperative opioid application during RP has no negative oncological impact in the short and long term in patients with localized prostate cancer. Accordingly, combined TIVA and epidural anesthesia, as well as solely epidural anesthesia were associated with similar short- and long-term outcomes compared to TIVA.

Intrathecal Morphine and Ropivacaine for Quality of Recovery After Laparoscopic Colorectal Surgery: A Randomized Controlled Trial.

Intrathecal morphine is increasingly used for pain management in laparoscopic colorectal surgery. While ropivacaine shows advantages of reduced cardiotoxicity and faster motor recovery compared to bupivacaine, the impact of intrathecal morphine-ropivacaine combination on postoperative recovery quality remains unclear. This study aimed to evaluate this combination's effect on recovery outcomes after laparoscopic colorectal surgery. In this randomized, double-blind, placebo-controlled trial, 78 patients undergoing laparoscopic colorectal surgery received either preservative-free intrathecal morphine 250μg with ropivacaine 15 mg (Intrathecal group) or a sham subcutaneous saline injection (Control group). The primary outcome was the Quality of Recovery-15 (QoR-15) score 24hours after surgery. Secondary outcomes included pain scores, opioid consumption, and adverse effects. The intrathecal group showed significantly higher QoR-15 scores 24hours postoperatively compared to the control group (median [IQR]: 121 [109-128] vs 111 [102-116], p < 0.001), with improvements in pain management (p < 0.001), physical comfort (p = 0.001), and physical independence (p = 0.002). The intrathecal group had lower pain scores at rest (area under the curve 0-48h: 66 [59-90] vs 107 [89-126], p < 0.001) and during coughing (152 [137-172] vs 191 [166-213], p < 0.001), particularly from 0.5 to 24hours. They also required less postoperative morphine (0-48h: 10 [6-20] vs 26 [22-36] mg, p < 0.001). While hypotension (43.6% vs 17.9%, p = 0.014) and pruritus (35.9% vs 2.6%, p < 0.001) were more frequent in the intrathecal group, but no respiratory depression occurred in either group. Intrathecal morphine-ropivacaine administration improves 24-hour postoperative recovery quality and provides superior pain relief after laparoscopic colorectal surgery, despite increased but manageable side effects. Further research should focus on dose optimization and comparative studies of different intrathecal local anesthetic combinations. The Chinese Clinical Trial Registry, ChiCTR2100052337.

Тошнота и рвота после сочетанной анестезии с применением ксенона в амбулаторной стоматологии у детей: ретроспективное наблюдательное исследование

INTRODUCTION: According to the literature, the incidence of PONV is 2 times higher in children compared to adults. In the studies conducted, there are conflicting data on the pro-emetogenic and anti-emetogenic properties of xenon. OBJECTIVES: To study the effect of xenon on the incidence of PONV in the early post-anesthesia period using it in combined anesthesia when performing oral sanitation in children. MATERIALS AND METHODS: Retrospective, observational study included 113 children of both sexes (42 girls, 71 boys). All children underwent combined inhalation anesthesia using xenon in conjunction with local anesthesia by articaine. RESULTS: According to the results of the study, the incidence of PONV was 4.4 %, whereas the estimated PONV was 30 % in 68 % of children from the presented sample of patients before anesthesia. CONCLUSIONS: In outpatient dental practice, when performing combined anesthesia with the use of xenon, the incidence of PONV is within 4 %. The choice of inhalation anesthetic xenon in children in terms of the incidence of postoperative nausea and vomiting is justified and can be recommended in outpatient practice.

Association between thoracic epidural anesthesia and driving pressure in adult patients undergoing elective major upper abdominal surgery: a randomized controlled trial

BackgroundThoracic epidural anesthesia (TEA) is associated with a knowledge gap regarding its mechanisms in lung protection and reduction of postoperative pulmonary complications (PPCs). Driving pressure (ΔP), an alternative indicator of alveolar strain, is closely linked to reduced PPCs with lower ΔP values. We aim to investigate whether TEA contributes to lung protection by lowering ΔP during mechanical ventilation.MethodsIn this prospective, randomized, patient and evaluator-blinded parallel study, adult patients scheduled for elective major upper abdominal surgery were assigned to either the TEA group with combined thoracic epidural anesthesia and general anesthesia (TEA-GA) (n = 30) or the control group with only general anesthesia (GA) (n = 30).MeasurementsThe primary outcome was the minimum ΔP determined based on positive end-expiratory pressure (PEEP) after intubation. Secondary outcomes included the incidence of PPCs within seven days, the minimum ΔP at various time points, blood gas analysis, intensive care unit (ICU) admission rates, length of hospital stay, and 30-day mortality rate.ResultsThe TEA group had a significantly lower minimum ΔP titrated based on PEEP compared to the control group (11.23 ± 2.19 cmH2O vs. 12.67 ± 2.70 cmH2O; P = 0.028). Multivariate linear regression analysis showed that intraoperative TEA application (compared with its absence; unstandardized beta coefficient (B) = -1.289; P = 0.008) significantly correlated with ΔP. The incidence of PPCs did not differ significantly between the two groups (8 of 30 [26.7%] vs. 12 of 30 [40%]; P = 0.273), but the incidence of atelectasis in the TEA group was significantly lower than in the control group (5 of 30 [16.7%] vs. 12 of 30 [40.7%]; P = 0.012). Multivariate logistic regression analysis indicated that ΔP was the only variable significantly associated with PPCs (Adjusted Odds Ratio [OR] = 2.190; 95% Confidence Interval [CI]: 1.300 to 3.689; P = 0.003).ConclusionCompared to GA, TEA-GA can reduce intraoperative ΔP in patients undergoing major upper abdominal surgery, especially those undergoing laparoscopic surgery. However, compared to GA combined with ΔP-guided ventilation, TEA-GA combined with ΔP-guided ventilation does not reduce the risk of PPCs. There was no significant difference in the total use of various vasoactive drugs between the two groups.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (registration number ChiCTR2300068778 date of registration February 28, 2023).

Echocardiographic Effects of Tiletamine-zolazepam and Ketamine-diazepam in Dogs Undergoing Ovariohysterectomy

Background: Echocardiography is ultrasound of heart. In order to promote reduction in mortality rates due to anaesthesia, it is essential to understand the potential depressant effects of anaesthetic drugs on the cardiovascular system, so that anaesthetic procedures are conducted in the best possible way. Cardiac monitoring during surgery offers rapid and safe information about the alterations that may appear during the surgical procedure that can affect cardiac functions. Methods: The present study was undertaken to evaluate the echocardiographic effects of Tiletamine-zolazepam and Ketamine-diazepam anaesthetic combination in twelve healthy female dogs for ovariohysterectomy. These twelve dogs were randomly allotted to two equal groups irrespective of age, breed and body weight. Dogs were anaesthetized with Tiletamine-zolazepam (7.5 mg/kg, IV) in group 1 and Ketamine (5.0 mg/kg, IV)-Diazepam (0.5 mg/kg, IV) in group II. Atropine sulphate (0.04 mg/kg IM) followed by butorphanol (0.2 mg/kg IM) after 10 minutes was used as preanaesthetic drugs. Echocardiographic indices were recorded at different time intervals during the study period. Result: Non-significant changes were found in both systolic and diastolic functions. Thus, present findings suggested that Tiletamine-Zolazepam and Ketamine-Diazepam anaesthetic combinations provided good cardiovascular stability in dogs undergoing ovariohysterectomy.

Nationwide Trends in Anesthetic and Analgesic Protocols for Spay-Neuter Clinics: A Survey of Practices and Preferences in the United States

Introduction: The advancement of spay-neuter procedures has been vital to the reduction of euthanized dogs and cats. Even though many spay-neuter clinics and shelters have adopted anesthesia protocols that align with best practices, there is currently little published data reporting trends among these clinics in the United States. The aim of this study was to document the most commonly used spay-neuter anesthetic/analgesic protocols. Methods: In 2017, a voluntary, anonymous web-based survey was distributed to shelters/clinics through the high quality, high volume spay-neuter (HQHVSN) veterinarians’ listserv and the ASV listserv. Results: One hundred and six facilities participated in the survey spanning 36 states in the United States. The most commonly used canine anesthesia premedication was acepromazine paired with an opioid, with acepromazine/hydromorphone and acepromazine/butorphanol representing 26% (24/91), and 23% (23/91) of the responses, respectively. Ketamine/midazolam was the most commonly used canine induction anesthetic representing 39% (35/91) of the responses. The most commonly used feline protocol was a total intramuscular anesthetic combination such as dexmedetomidine/ketamine/butorphanol (DKT) or Telazol/butorphanol/dexmedetomidine (TTDex) accounting for 39% (35/91) and 33% (30/91) of the responses, respectively. The majority of respondents administered an injectable non-steroidal anti-inflammatory drug (NSAID) to their canine and feline patients at 63% (67/106) and 59% (63/106)), respectively. Only 26% (25/98) of respondents used to-go-home (TGH) medications and only 40% (41/102) of respondents used local anesthetics. Overall protocol satisfaction was 86% (59/66). Conclusion: This survey identified that across a wide range of spay-neuter clinics there exists significant trends with regards to anesthetic and analgesic protocols.

Comparative Effects of Spinal Anesthesia and Combined Spinal with Peripheral Nerve Blocks on Postoperative Outcomes in Anterior Cruciate Ligament Repair.

Objectives: This study aimed to compare the effectiveness of spinal anesthesia (SA) alone versus combined spinal anesthesia with adductor canal block (ACB) and sciatic nerve block (SNB) (SA + ACB + SNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. We hypothesized that SA + ACB + SNB would provide better analgesia, greater patient satisfaction, and shorter postanesthesia recovery times than SA alone. Methods: A prospective randomized controlled trial was conducted with 60 patients aged 15-49 years scheduled for elective arthroscopic ACL reconstruction. Participants were randomly assigned to receive either SA or SA + ACB + SNB. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4, 12, and 24 h post-operation. General health was evaluated using the 12-item Short Form Survey (SF-12) at 1 month postoperatively. Range of motion and analgesic consumption were also recorded. Results: The median VAS score at 4 h post-operation was significantly lower in the SA + ACB + SNB group compared to the SA group (0 [IQR: 0-1] vs. 2 [IQR: 1-3], p = 0.0137). No significant differences in VAS scores were found at 12 h (p = 0.9282) and 24 h (p = 0.5809). PCS-12 and MCS-12 scores did not differ significantly between groups. The SA group had a lower postoperative range of motion (ROM) compared to the SA + ACB + SNB group, with a mean active ROM of 40.67 degrees (±23.52) versus 72.17 degrees (±24.69), respectively (p < 0.0001). Analgesic consumption was similar, with 53.33% of participants in each group using postoperative analgesics (p = 1.0). The mean surgery duration was 74.6 min. The gender distribution was 83% male and 17% female, with an average age of 27.7 years. Conclusions: Adding ACB and SNB to spinal anesthesia improved immediate postoperative pain relief and preserved range of motion in patients undergoing ACL reconstruction, suggesting potential clinical benefits in pain management and functional recovery.

Effects of combined anesthesia on pulmonary oxygenation function, hemodynamics, and respiratory compliance in elderly patients undergoing pulmonary lobectomy for lung cancer.

Traditional general anesthesia in elderly lung cancer patients undergoing pulmonary lobectomy may lead to hemodynamic fluctuations and postoperative complications. To optimize anesthesia efficacy, this study explores the application of combined anesthesia (general anesthesia combined with thoracic paravertebral block) in such surgeries. We evaluated the improvement of pulmonary oxygenation function, hemodynamic stability, and respiratory compliance in elderly lung cancer patients undergoing pulmonary lobectomy with combined anesthesia. This retrospective study analyzed 100 elderly lung cancer patients who underwent pulmonary lobectomy at our hospital from February 2020 to December 2023. Patients were divided into 2 groups: the control group received general anesthesia, while the treatment group received combined anesthesia (general anesthesia plus thoracic paravertebral block). By comparing intraoperative hemodynamic parameters, postoperative pulmonary oxygenation function, respiratory compliance, cognitive function, sleep quality, and postoperative complication rates between the 2 groups, we assessed the application efficacy of combined anesthesia. Compared to the control group, the treatment group exhibited better hemodynamic stability intraoperatively, significantly improved postoperative pulmonary oxygenation function and respiratory compliance. Additionally, patients in the treatment group showed faster recovery of cognitive function, better sleep quality, and a relatively lower incidence of postoperative complications. Combined anesthesia demonstrates unique advantages in pulmonary lobectomy for elderly lung cancer patients, optimizing intraoperative hemodynamic stability, promoting postoperative pulmonary function recovery, accelerating cognitive function recovery, improving sleep quality, and potentially reducing the risk of postoperative complications. This finding provides a new effective strategy for anesthesia management in elderly lung cancer patients.

The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study

ObjectiveElectrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation. DesignSingle-centered, prospective, unblinded, randomized, parallel-group clinical trial. SettingSurgical suite of a university-affiliated teaching hospital. PatientsThirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia. MeasurementsEIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T0), 15 min after OLV(T1), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T2). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images. ResultsMean arterial pressure (p < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (p = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) from T0 to T1 in both groups. The PaO2/FiO2 in the TEB group was significantly lower after epidural administration of the local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T2 (p < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (p = 0.499). ConclusionsBased on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.Trial registration: ClinicalTrials.gov, NCT04730089. Registration on January 25th, 2021.

Survey of Practice Patterns in the Use of Superior Laryngeal Nerve Blocks.

Superior laryngeal nerve (SLN) injection is performed for a variety of upper aerodigestive tract-related indications. Existing literature examines the efficacy of SLN injection for specific indications. However, there is a paucity of insight into overall practice patterns and a lack of standardization, particularly with regards to medication and dosing, treatment time frame, and circumstances. The goal of this study is to elucidate the practice patterns of SLN injection and allow for broader understanding of its utilization. This is a descriptive study of results from an electronic survey disseminated via email to US-based and international otolaryngologists and laryngologists. 80 responses were collected. 53.8% responders endorsed utilizing SLN injection in their practice, including 39/43 laryngologists (90.7%). Responders perform SLN injection for an array of indications, using a variety of anesthetic and steroid combinations and dosages. The most used steroid is triamcinolone (81.4%). The most used anesthetic is lidocaine (53.5%). 43% of respondents endorse willingness to perform bilateral injections simultaneously. Follow-up after initial injection is highly inconsistent, as are time intervals between injections and number of injections performed. With regards to side effects and complications discussed prior to the procedure, 95% counseled patients on pain/discomfort while roughly half of responders discussed bleeding/hematoma, aspiration risk, vasovagal response, and/or globus sensation, respectively. This is the first known study investigating the practice patterns of SLN injection. The substantial variability of responses reflects a lack of standardization of this procedure despite its widespread use. Further study is needed to optimize protocols. Levels 5 and 6 Laryngoscope, 2024.

Influence of Anesthesiology Protocol on the Quality of Intraoperative Nerve Monitoring During Thyroid Surgery, One-Year Single Center Experience.

Anesthesia plays a very important role in the successful management of intraoperative neuromonitoring (IONM). The aim of our study was to investigate the impact of anesthesia induction and maintenance on the quality of signals during surgeries on the thyroid and parathyroid glands using neuromonitoring. The study included 72 patients who underwent surgery with IONM for one year. All the patients were intubated using a Glidescope videolaryngoscope with a hyperangulated blade. Two different approaches were used to facilitate intubation: succinylcholine-1 mg/kg and rocuronium bromide-0.3 mg/kg. For anesthesia maintenance, total intravenous anesthesia (TIVA) or combined anesthesia was used. Patients' body movements during operations, as well as electromyography signals from the vagus and recurrent laryngeal nerves before resection, were recorded as V1 and R1. Intraoperative unwanted movements were recorded in 25% of patients. Undesired movements were more frequently recorded in the TIVA group compared to the combined anesthesia group (p < 0.001) as well as in patients who received succinylcholine compared to patients who received rocuronium bromide (p = 0.028). Type of anesthesia maintenance as well as type of muscle relaxant did not affect the quality of recorded nerve signals. (p = 0.169 and p = 0.894, respectively). The type of muscle relaxant used significantly affects the occurrence of undesirable movements during thyroid surgery with IONM, while the type of anesthesia maintenance did not influence either the quality of the obtained signal or the occurrence of undesirable movements.

Trends in changing the structure of anesthesia at the advanced stages of medical care in modern armed conflict

The objective was to analyze the structure of anesthesia provided to the wounded at the advanced stages of medical care in the active phase of hostilities.Materials and methods. A retrospective analysis of the medical data of anesthesia was performed. The data on the structure of anesthesia in military medical organizations of 1–3 levels in the zone of a special military operation for the period from 01.2023 to 07.2024 were analyzed.Results. In the structure of combat trauma, with the need for surgical intervention, gunshot wounds amounted to 85.2%, there was a predominance of combined (71.5%) and multiple (19.8%) wounds.The low proportion of combined general anesthesia and the lack of use of inhalation anesthesia at some stages is explained by the special conditions of care. Regional anesthesia (RA), including as part of combined anesthesia, in the structure of anesthesia at the stages of emergency specialized surgical care amounted to 34.5%, and at the stages of qualified surgical care – 25.4%. The lowest rates of RA use were at the stages of level 1, as well as at the stages of level 2 with a 100% flow of primary wounded.Conclusion. RA occupies a significant share in the structure of anesthesia at the military stages of medical evacuation; an increase in the frequency of its use is possible due to the introduction of ultrasonic navigation.

Experience of using multimodal opioid-saving anesthesia in children: single-center prospective randomized study

BACKGROUND: In the protocols of rapid recovery after surgery, it is recommended to avoid long-term administration and/ or high doses of opioids in order to reduce the severity of their adverse reactions in the postoperative period. In this regard, opioid-sparing anesthesia (OSA) may become a promising approach to the treatment of cancer patients. AIM. To evaluate the effectiveness of multimodal OSA in the scheme "dexmedetomidine+ketamine (in subanesthetic doses)+lidocaine (intravenous infusion)" in pediatric oncosurgery. MATERIALS AND METHODS: A single-center prospective randomized study involved 40 children aged 12 to 18 years. Patients were divided into 2 groups depending on the method of anesthesia: in group I (n=20), combined endotracheal anesthesia with opioids was performed, in group II (n=20) — multimodal OCA based on intravenous infusion of lidocaine, dexmedetomidine and subanesthetic doses of ketamine. The patients underwent extended operations in the head and neck area in the volume of thyroidectomy with fascial-sheath lymph dissection and excision of the central tissue of the neck from 2 sides. RESULTS: With stable intraoperative hemodynamic parameters, the median total intraoperative need for analgesics in group II was: for lidocaine— 351 (289.6; 418.5) mg (which is 1.75mg/kg per hour), for dexmedetomidine— 88.2 (38.5; 119.7) µg, for ketamine — 21.6 (17.4; 27.3mg. In group I, the median total intraoperative need for fentanyl was 273.7 (406; 240.9)µg. In addition, in group I, the median amount required for postoperative analgesia of the synthetic opioid analgesic tramadol was 419 (365.6; 479)mg (which is 7.8mg/kg; p=0.01). In group II, the median amount of lidocaine required for postoperative analgesia (1 mg/kg per hour) turned out to be 1377.3 (735.7; 1894)mg, while additional tramadol administration at a dose of 57.3 (28.5; 107.7)mg was required in only 7(35%) patients. CONCLUSION: Multimodal OSA based on dexmedetomidine, lidocaine, ketamine and sevoflurane is an effective and safe method of anesthesia in children from 12 to 18 years old, which is not inferior to opioid analgesics in the treatment of perioperative pain during surgical interventions on the thyroid and parathyroid glands in cancer patients, and also reduces the number of adverse reactions characteristic of opioids.

Chronic postoperative pain syndrome and its neuropathic component in long-term period of coronary artery bypass grafting

Background: Along with increased safety and quality of the early postoperative period, 6.9% of patients who undergo sternotomy experience chronic pain at the surgical site. The significance of this issue is underestimated, with a third of these patients developing a neuropathic component of chronic pain syndrome. Aim: To assess the severity of acute and chronic postoperative pain following sternotomy and to identify predictors of the neuropathic component of chronic pain syndrome. Materials and methods: Out of 115patients who underwent elective coronary artery bypass grafting (CABG) randomized according to method of anesthesia, two study groups were formed based on the results of a telephone survey: a general anesthesia group (GA, n=28) and a combined anesthesia group (CA, n=34). As part of the posthoc analysis, a logistic regression model was built to predict chronic neuropathic pain syndrome based on gender, age, anesthesia method, and factors assessing the severity of the perioperative period and myocardial impairment. Results: Chronic postoperative pain syndrome was identified in 25.8% of patients, with a neuropathic component confirmed in 19.4% of cases. Pain severity at rest in the GA and CA groups was 2.0 (1.0) and 3.0 (3.0) points on a numeric rating scale one hour after extubation, and 2.0 (2.0) and 2.0 (2.0) points by the end of the first postoperative day (p=0.193 and 0.610, respectively). The logistic regression model achieved an AUROC of 0,82 (95% CI 0,68–0,96) with c2(10)=10.62, p=0.39. Conclusions: Neuropathic pain was diagnosed in 19.4% of patients following CABG. The use of regional anesthesia and the severity of acute pain did not impact the development of neuropathic pain syndrome in the long-term period after surgery. The proposed model for predicting the neuropathic component of chronic pain syndrome after CABG requires further improvement.