Anesthesia Induction Time Research Articles

Effect of interactive, multimedia-based home-initiated education on preoperative anxiety inchildren and their parents: a single-center randomized controlled trial

BackgroundAnesthesiologists need to appreciate the impact of preoperative anxiety in children. The present study aimed to explore whether interactive multimedia-based home-initiated interventions could effectively relieve preoperative anxiety in pediatric patients.MethodsIn this prospective study, we compared preoperative anxiety between two groups of children aged 4–9 years. Children in the control group received a question-and-answer (Q&A) introduction, and children in the intervention group received multimedia-based home-initiated preoperative education using comic booklets, videos, and coloring game books. Differences in anxiety between the two groups were evaluated by the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) at four time points: in the ophthalmology outpatient clinic before intervention as the baseline (T0); in the preoperative waiting area (T1); at the time of separating from their parents and moving to the operating room (T2); and at the time of anesthesia induction (T3). Parental anxiety was assessed by the Self-rating Anxiety Scale (SAS) and Visual Analog Scale (VAS) at T0 and T2. Other related information was collected by questionnaire.ResultsEighty-four children who underwent pediatric strabismus in our center between November 2020 and July 2021 were included in this study. An intention-to-treat (ITT) analysis was performed on data from 78 enrolled children. Children in the intervention group exhibited lower m-YPAS-SF scores at T1, T2, and T3 than those in the control group (all p < 0.001). By using a mixed-effect model with repeated measurement (MMRM) after adjusting the m-YPAS score at T0 as a covariate, the interventional effect in terms of themYPAS-SF score was also significant over time (p < 0.001). The percentage of children with perfect induction compliance (ICC = 0) in the intervention group was significantly higher than that in the control group [18.4% vs. 7.5%], and poor induction compliance (ICC>4) was lower (2.6% vs. 17.5%, p = 0.048). The mean parental VAS score at T2 in the intervention group was significantly lower than that in the control group (p = 0.021).ConclusionsInteractive multimedia-based home-initiated intervention could reduce preoperative anxiety in children and improve the quality of anesthesia induction based on ICC scores, which may in turn impose a positive impact on parental anxiety.

C57BL/6J and C57BL/6N mice exhibit different neuro-behaviors and sensitivity to midazolam- and propofol-induced anesthesia

Phenotypes of inbred mice are strain-dependent, indicating the important influence of genetic background in biomedical research. C57BL/6 is one of the most commonly used inbred mouse strains, and its two closely related substrains, C57BL/6J and C57BL/6N, have been separated for only about 70 years. These two substrains have accumulated genetic variations and exhibit different phenotypes, but it remains unclear whether they respond to anesthetics differently. In this study, commercially acquired wildtype C57BL/6J or C57BL/6N mice from two different sources were analyzed and compared for their response to a spectrum of anesthetics (midazolam, propofol, esketamine or isoflurane anesthesia) and their performance in a series of behavioral tests associated with neurological functions including open field test (OFT), elevated plus maze (EPM), Y maze, prepulse inhibition (PPI), tail strain test (TST) and forced swimming test (FST). Loss of the righting reflex (LORR) is used to measure the anesthetic effects. Our results suggested that the anesthesia induction time induced by either of the four anesthetics were comparable for the C57BL/6J and C57BL/6N mice. However, C57BL/6J or C57BL/6N mice do exhibit different sensitivity to midazolam and propofol. The anesthesia duration of midazolam of C57BL/6J mice was about 60% shorter than that of the C57BL/6N mice, while the LORR duration induced by propofol in C57BL/6J mice was 51% longer than that of the C57BL/6N. In comparison, the two substrains were anesthetized by esketamine or isoflurane similarly. In the behavioral analysis, the C57BL/6J mice exhibited a lower level of anxiety- and depression-like behaviors in OFT, EPM, FST and TST than the C57BL/6N mice. Locomotor activity and sensorimotor gating of these two substrains remained comparable. Our results stress the point that when selecting inbred mice for allele mutation or behavioral testing, the influence of even subtle differences in genetic background should be fully considered.

Endoskopik Endonazal Transsfenoidal Hipofiz Cerrahisinde Farklı End Tidal CO2 Değerlerinin Hemodinami ve Cerrahiye Etkileri

Objective : We aimed to examine the effect of different intervals of end tidal CO2 ( etCO2 ) values on hemodynamics and surgery in endoscopic endonasal transsphenoidal pituitary surgery. Material and Methods: Two groups were evaluated retrospectively according to the maximum etCO2 values at the time of sellar resection. Group 1: 21 patients, etCO 2 =25-37 mmHg and Group 2: 21 patients, etCO 2=38-50 mmHg. The demographic characteristics, mean arterial pressure (MAP), heart rate (HR), etCO2 , pCO2 at the time of anesthesia induction, sellar excision moment and pre-extubation periods , total amount of bleeding, ease of surgery (good-moderate-bad) obtained from computer records, anesthesia receipts and surgical reports. Results: There was no difference between the two groups in terms of demographic data, complications or bleeding. A relationship was found between arterial pCO2 at the time of sellar excision. Surgical satisfaction was evaluated as "good" in 9 patients in Group 1 and 12 patients in Group 2. Conclusion: High etCO 2 values (38-50 mmHg) facilitated surgical excision of the mass and did not affect hemodynamics. Surgery has increased satisfaction. Keeping EtCO2 slightly higher than normal may be a good choice in these cases. Well-designed prospective studies are needed.

Orexinergic innervations at GABAergic neurons of the lateral habenula mediates the anesthetic potency of sevoflurane.

The circuitry mechanism associated with anesthesia-induced unconsciousness is still largely unknown. It has been reported that orexinergic neurons of the lateral hypothalamus (LHA) facilitate the emergence from anesthesia through their neuronal projections to the arousal-promoting brain areas. However, the lateral habenula (LHb), as one of the orexin downstream targets, is known for its anesthesia-promoting effect. Therefore, the current study aimed to explore whether and how the orexinergic projections from the LHA to the LHb have a regulatory effect on unconsciousness induced by general anesthesia. We applied optogenetic, chemogenetic, or pharmacological approaches to regulate the orexinergicLHA-LHb pathway. Fiber photometry was used to assess neuronal activity. Loss or recovery of the righting reflex was used to evaluate the induction or emergence time of general anesthesia. The burst-suppression ratio and electroencephalography spectra were used to measure the anesthetic depth. We found that activation of the orexinergicLHA-LHb pathway promoted emergence and reduced anesthetic depth during sevoflurane anesthesia. Surprisingly, the arousal-promoting effect of the orexinergicLHA-LHb pathway was mediated by excitation of glutamate decarboxylase (GAD2)-expressing neurons, but not glutamatergic neurons in the LHb. The orexinergicLHA-LHb pathway facilitates emergence from sevoflurane anesthesia, and this effect was mediated by OxR2 in GAD2-expressing GABA neurons.

A meta‐analytic review of monoterpene for fish anaesthesia

AbstractThe use of anaesthetic agents has been increasing to address the welfare needs of different fish species in scientific and aquaculture practices. MS‐222 is the most used synthetic anaesthetic but some limitations and side effects have been reported. Natural substances have been used as potential substitutes with clove oil playing an important role due to its eugenol content. Yet, other monoterpenes have shown anaesthetic properties in different fish species. As such, a quantitative assessment has been conducted to explicitly relate and summarise the use of monoterpenes with described anaesthetic properties in fish. A combined PubMed, Web of Science, Scopus, PubMed Central and Europe PMC electronic database search was performed, from January 2002 to August 2022, following the PRISMA guidelines. Out of 1555 articles retrieved from the literature search, 30 English reports met the criteria for inclusion in the meta‐analysis through a generic inverse‐variance method (random‐effects model) and according to the fish age. The findings show a total of 10 different monoterpenes with high homogeneity and effectiveness in inducing anaesthesia and recovery according to the fish anaesthetic criteria. Further subgroup analysis showed these effects were independent of fish age. Meta‐regression of the included studies revealed an inverse linear association between anaesthesia induction and recovery time and water bath temperature while no further correlation was found with other confounding factors (body weight, water pH and dissolved oxygen levels). Although further studies will be required, this meta‐analysis provides robust evidence that different monoterpenes serve as an attractive and effective alternative for fish anaesthesia although water bath temperature also played an important role in anaesthesia outcome.

Elective Tracheotomy in Patients Receiving Mandibular Reconstructions: Reduced Postoperative Ventilation Time and Lower Incidence of Hospital-Acquired Pneumonia.

Elective tracheotomy (ET) secures the airway and prevents adverse airway-related events as unplanned secondary tracheotomy (UT), prolonged ventilation (PPV) or nosocomial infection. The primary objective of this study was to identify factors predisposing for airway complications after reconstructive lower ja surgery. We reviewed records of patients undergoing mandibulectomy and microvascular bone reconstruction (N = 123). Epidemiological factors, modus of tracheotomy regarding ET and UT, postoperative ventilation time and occurrence of hospital-acquired pneumonia HAP were recorded. Predictors for PPV and HAP, ET and UT were identified. A total of 82 (66.7%) patients underwent tracheotomy of which 12 (14.6%) were performed as UT. A total of 52 (42.3%) patients presented PPV, while 19 (15.4%) developed HAP. Increased operation time (OR 1.004, p = 0.005) and a difficult airway (OR 2.869, p = 0.02) were predictors, while ET reduced incidence of PPV (OR 0.054, p = 0.006). A difficult airway (OR 4.711, p = 0.03) and postoperative delirium (OR 6.761, p = 0.01) increased UT performance. HAP increased with anesthesia induction time (OR 1.268, p = 0.001) and length in ICU (OR 1.039, p = 0.009) while decreasing in ET group (HR 0.32, p = 0.02). OR for ET increased with mounting CCI (OR 1.462, p = 0.002) and preoperative radiotherapy (OR 2.8, p = 0.018). ET should be strongly considered in patients with increased CCI, preoperative radiotherapy and prolonged operation time. ET shortened postoperative ventilation time and reduced HAP.

Glutamatergic neurons of piriform cortex delay induction of inhalational general anesthesia

Since their clinical application in the 1840s, the greatest mystery surrounding general anesthesia (GA) is how different kinds of general anesthetics cause reversible unconsciousness, and the precise neural mechanisms underlying the processes. Over past years, although many studies revealed the roles of cortex, thalamus, brainstem, especially the sleep-wake circuits in GA-induced loss of consciousness (LOC),the full picture of the neural circuit mechanism of GA is still largely unknown. Recent studies have focused on the importance of other brain regions. Here, we report that the activity of glutamatergic (Glu) neurons in the piriform cortex (PC), a critical brain region for odor encoding, began to increase during the LOC of GA and gradually recovered after recovery of consciousness. Chemical lesions of the anterior PC (APC) neurons accelerated the induction time of isoflurane anesthesia. Chemogenetic and optogenetic activation of APCGlu neurons prolonged isoflurane and sevoflurane anesthesia induction, whereas APCGlu neuron inhibition displayed the opposite effects. Moreover, the modification of APCGlu neurons did not affect the induction or emergence time of propofol GA. In addition, odor processing may be partially involved in the induction of isoflurane and sevoflurane GA regulated by APCGlu neurons. In conclusion, our findings reveal a critical role of APCGlu neurons in inhalational GA induction.

A comparison between propofol and sevoflurane for easy insertion of laryngeal mask airway among adults in minor elective surgeries: An observational study

Background: The laryngeal mask airway (LMA) has reached ample popularity for the management of airway during surgery. Propofol, used as induction agent, causes change in blood pressure and heart rate (HR) while insertion of LMA. Sevoflurane, whereas, has the potential to be a good induction agent as propofol. We have compared propofol and sevoflurane for easy insertion of LMA among adults in minor surgeries. Aim and Objectives: The primary objective of the study was to compare the ease of insertion of LMA and its characteristics related to insertion among adults in minor elective surgeries using intravenous propofol or inhalational sevoflurane. While time taken to set induction and actual event of LMA insertion along with number of attempts, jaw relaxation time, LMA insertion time, apnea time, monitoring hemodynamic changes, and occurrence of complications were taken as secondary objectives. Materials and Methods: It was a prospective and observational study done in Department of Anesthesiology and Operation Theaters of Fortis Hospital, Kolkata, after getting ethical approval. Total 100 patients were recruited by consecutive sampling and divided into two groups - P (propofol) and S (sevoflurane) group. Anesthesia induction time, jaw relaxation time, LMA insertion time, etc. were noted. LMA insertion conditions were assessed by a 3-point scale using six variables, total score was calculated for each group. Hemodynamic parameters and induction complications were also recorded. Results: There was no significant difference in demographic parameters, American Society of Anesthesiologists class, Modified Mallampati Grading, and LMA size, between the groups. LMA insertion time was comparable between the two groups. Regarding complications, there was no incidence of coughing while minor gagging (4%) and laryngospasm (6%) were noted only with sevoflurane. Final summation of scores showed excellent insertion characteristics with propofol (94%) and sevoflurane (84%), respectively, with no significant difference. Conclusion: Inhalational sevoflurane may be regarded as a viable alternative to inj. propofol for insertion of laryngeal mask among adults in minor elective surgeries.

GABAergic neurons in the dorsomedial hypothalamus regulate states of consciousness in sevoflurane anesthesia

The neural inhibitory gamma-aminobutyric acid (GABA) system in the regulation of anesthetic consciousness is heterogeneous, and the medial hypothalamus (MH), consisting of ventromedial hypothalamus (VMH) and dorsomedial hypothalamus (DMH), plays an important role in sleep and circadian rhythm. However, the role of MH GABAergic neurons (MHGABA) in anesthesia remains unclear. In this study, we used righting reflex, electroencephalogram (EEG), and arousal behavioral score to evaluate the sevoflurane anesthesia. Activation of MHGABA or DMHGABA neurons prolonged the anesthesia induction time, shortened the anesthesia emergence time, and induced EEG arousal and body movement during anesthesia; meanwhile, VMHGABA neurons activated only induced EEG changes during 1.5% sevoflurane anesthesia. Furthermore, inhibition of DMHGABA neurons significantly deepened sevoflurane anesthesia. Therefore, DMHGABA neurons exert a strong emergence-promoting effect on induction, maintenance, and arousal during sevoflurane general anesthesia, which helps to reveal the mechanism of anesthesia.

Use of oral contrast for CT scanning and time to diagnosis and treatment of acute appendicitis.

The aim of this study was to investigate whether there is a delay in treatment for patients having pre-operative CT imaging with both intravenous and oral contrast (CTIVO) compared to intravenous contrast alone (CTIV). A retrospective review of patients who underwent emergency appendicectomy at a single hospital during a two-year period (1/1/2019-31/12/2020) was performed. Demographic details, imaging timing/modality; biochemical markers; American Society of Anaesthesiologists (ASA) physical status classification, anaesthetic induction time; operative report findings; histopathology, peri-operative complications, admission/discharge times were recorded. The Sunshine Appendicitis Grading System (SAGS) score was used for severity of appendicitis. Pre-operative CT was performed in 294 patients; CTIVO: 159 (54%), CTIV: 135 (46%). Both groups were comparable for age, sex, ASA status and inflammatory markers. The median time from CT request to scanning was longer with CTIVO (CTIVO: 170 min, CTIV: 65 min, P< 0.0001). The median time from CT request to induction of anaesthesia was also longer with CTIVO (CTIVO: 780 minutes, CTIV: 406 min, P< 0.0001). A delay to theatre was not significantly associated with severity of appendicitis (SAGS score). The diagnostic accuracy was not reduced in the CTIV group compared to the CTIVO group. CTIVO scans significantly delay CT diagnosis and surgical treatment of appendicitis compared to CTIV. Omitting oral contrast does not result in a reduction in diagnostic accuracy for appendicitis.

The Effects of Origanum vulgare L. Essential Oils on Anaesthesia and Haemato-Biochemical Parameters in Mozambique Tilapia (Oreochromis mossambicus) Post-Juveniles

This study investigated the effects of oregano (Origanum vulgare) essential oil (OEO) anaesthesia and stress-related physiological parameters in tilapia mossambicus (Oreochromis mossambicus) post-juveniles. Fish were subjected to different concentrations of OEO (25, 50, 100, and 150 μL L−1) to assess the effects of the anaesthesia and recovery time. A second experiment subjected fish to other handling treatments, including a control (no OEO exposure), ethanol solution, 25 μL L−1 (low effective anaesthesia concentration of OEO), and 100 μL L−1 high effective anaesthesia concentration of OEO) for 10 min to assess the haemato-biochemical indices and survival rate at 0 h and after 24 h. Moreover, all the tested OEO concentrations induced anaesthesia in the studied fish, where the anaesthesia induction time decreased with increased OEO concentrations. Meanwhile, the inverse was reported for recovery time. Based on the ideal anaesthetic criteria, 50 μL L−1 and 100 μL L−1 were the suitable concentrations that could be recommended for quick anaesthesia. However, according to the haemato-biochemical parameters and survival results, 25 μL L−1 was safe to anaesthetise tilapia mossambicus for 10 min and could be recommended for time-consuming fish-handling procedures. Future studies should investigate multiple factors that influence anaesthesia in fish for better optimisation of OEO in tilapia mossambicus.

Evaluating the effect of an artificial intelligence system on the anesthesia quality control during gastrointestinal endoscopy with sedation: a randomized controlled trial

BackgroundSedative gastrointestinal endoscopy is extensively used worldwide. An appropriate degree of sedation leads to more acceptability and satisfaction. Artificial intelligence has rapidly developed in the field of digestive endoscopy in recent years and we have constructed a mature computer-aided diagnosis (CAD) system. This system can identify the remaining parts to be examined in real-time endoscopic procedures, which may help anesthetists use anesthetics properly to keep patients in an appropriate degree of sedation.AimsThis study aimed to evaluate the effects of the CAD system on anesthesia quality control during gastrointestinal endoscopy.MethodsWe recruited 154 consecutive patients at Renmin Hospital of Wuhan University, including 76 patients in the CAD group and 78 in the control group. Anesthetists in the CAD group were able to see the CAD system’s indications, while anesthetists in the control group could not. The primary outcomes included emergence time (from examination completion to spontaneous eye opening when doctors called the patients’ names), recovery time (from examination completion to achievement of the primary recovery endpoints) and patient satisfaction scores. The secondary outcomes included anesthesia induction time (from sedative administration to successful sedation), procedure time (from scope insertion to scope withdrawal), total dose of propofol, vital signs, etc. This trial was registered in the Primary Registries of the WHO Registry Network, with registration number ChiCTR2100042621.ResultsEmergence time in the CAD group was significantly shorter than that in the control group (p < 0.01). The recovery time was also significantly shorter in the CAD group (p < 0.01). Patients in the CAD group were significantly more satisfied with their sedation than those in control group (p < 0.01). Vital signs were stable during the examinations in both groups. Propofol doses during the examinations were comparable between the two groups.ConclusionThis CAD system possesses great potential for anesthesia quality control. It can improve patient satisfaction during endoscopic examinations with sedation.Trial registrationChiCTR2100042621.

Rapid cyclic fluctuations in blood pressure during two surgeries associated with pheochromocytoma: a case report

BackgroundWe measured catecholamine levels during periodic blood pressure fluctuations in patients with pheochromocytoma.Case presentationA 43-year-old man presented with periodic blood pressure fluctuations during surgery for a renal pelvic tumor. His blood levels of catecholamines (ng/mL) changed dramatically over a short time during blood pressure fluctuations: adrenaline 0.36 to 3.22, noradrenaline 0.47 to 1.98, and dopamine 0.02. After the diagnosis of pheochromocytoma, oral treatment with doxazosin 2 mg/day was administered, and left adrenalectomy was performed 4 months after the initial surgery. Periodic circulation fluctuations occurred after tracheal intubation at the time of anesthesia induction, but the degree of fluctuation was smaller than that of the first surgery.ConclusionsThe data suggest that the periodic blood pressure fluctuations in pheochromocytoma patients are caused by changes in blood catecholamine levels. Our data suggests that alpha blockers may also be effective against the cyclic fluctuations that occur in patients with pheochromocytoma.

Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery: a prospective, randomized, double-blind controlled clinical trial

BackgroundOpioids analgesics commonly used in abortion procedures are associated with respiratory and circulatory depression. Esketamine is a N-methyl-D-aspartate receptor (NMDA) antagonist and a common analgesic. The drug has several advantages including rapid onset and offset and it causes minimal cardiorespiratory depression. However, studies have not explored the effects of esketamine in patients undergoing painless abortion surgery. Therefore, the present study sought to evaluate the effect of different doses of esketamine compared with the effect of fentanyl on incidence of perioperative hypotension in patients undergoing painless abortion surgery and to explore the optimal esketamine dose for this population.MethodsA total of 178 female patients undergoing painless abortion surgery were enrolled to the current study. The patients were aged 18–45 years, had a body mass index (BMI) of 18–28 kg m− 2 and a class I or II physical status as determined using the American Society of Anesthesiologists (ASA) system. Patients were randomly assigned to four groups as follows: group F (n = 45) in which patients underwent intravenous (IV) administration of 1 μg kg− 1 fentanyl followed by IV administration of 2 mg kg− 1 propofol, and group EL, group EM and group EH (n = 45, 44, 44) with patients receiving IV administration of 0.2 mg kg− 1, 0.25 mg kg− 1, 0.3 mg kg− 1 esketamine, respectively, followed by IV administration of 2 mg kg− 1 propofol. The primary outcome of the study was the incidence of hypotension whereas secondary outcomes included incidence of adverse events, perioperative changes of vital signs, anesthesia induction time, recovery time and dischargeable time, propofol addition, as well as patient, surgeon and anesthesiologist satisfaction levels.ResultsThe findings showed that the incidence of hypotension was significantly lower in subjects in group EL, group EM and group EH (0, 0, 0%) relative to the incidence in patients in group F (20%) (χ2 = 19.648; P = 0.000). In this study, the incidence of hypoxia of subjects in group EL, group EM and group EH (0, 2.3, 2.3%) was significantly lower compared with that of patients in group F (11.1%) (χ2 = 8.622; P = 0.035). The findings indicated that the incidence of somatic motor reactions was significantly lower in participants in group EM and group EH (9.1, 4.5%) relative to that of patients in group F and group EL (26.7, 15.6%) (χ2 = 10.254; P = 0.016). The results showed that the incidence of nausea and vomiting and potential psychiatric symptoms were significantly higher in patients in group EH (15.9, 11.4%) compared with that of participants in group F (2.2, 0%), group EL (4.4, 0%) and group EM (2.3, 2.3%) (χ2 = 7.493; P = 0.038 and χ2 = 8.248; P = 0.003). In this study, the mean arterial pressure (MAP) and heart rate (HR) of subjects in group EL, group EM and group EH were more stable compared with that of patients in group F. Frequency of the additional propofol dose was markedly less in group EM and EH (26.7%, 17,8%) compared with that in group F and EL (9.1, 4.5%) (χ2 = 10.254; P = 0.016). The findings indicated that the dischargeable time was significantly shorter for patients in group EM compared with that of subjects in group F, group EL and group EH.ConclusionsThe findings of the present study showed that single-dose esketamine (0.25 mg kg− 1) effectively decreased incidence of hypotension and total adverse events and reduced the frequency of additional propofol dose required for patients undergoing painless abortion with preservation of physician-patient satisfaction.

SP7.10 Improving Our Preop Fasting Practice

Abstract Aims Preoperative fasting has always been a tussle between patient and surgery staff. Keeping patient nil by mouth unnecessarily not only increases the anxiety, thirst, hunger, postoperative insulin resistance but can also lead to serious hypoglycemic events in diabetic patients. The objective of our study to standardize the habits of pre-operative fasting according to AABGI guidelines and make sure to curtail the fasting period to the required minimum to 2 hours for liquids. Method This retrospective study included all inpatients who had any vascular surgery done under general anaesthesia from Sep 2020 to Nov 2020 in Birmingham Heartland Hospital. As per departmental practices every patient is fasted from 0300. Anaesthesia induction time was noted for every patient from theatre logbook to calculate the fasting interval. After data analysis meetings were done with the ward sister, anaesthetic &amp; vascular surgery consultants to draw an action plan. Results Data collected from a total of 50 patients showed that average fasting period was 11 hrs 2 mins with longest fasting interval was 14 hrs 55 mins. Blanket allowance of clear fluids till 7 am, late dinner and communication of theatre list priority to the ward resulted in achieving an average fasting period of 2 hrs 53 minutes. Conclusions Identification of this simple but crucial problem is the first step towards compliance with the standard. These unassuming butchallenging implementations can significantly affect patient satisfaction and help achieve recommended fasting intervals. Pre-op fasting can easily be optimized by good communication between staff. As further evidence arises, structured peri-operative care can progress.

Efficiency of Ocimum basilicum and Eucalyptus globulus essential oils on anesthesia and histopathology of rainbow trout, Oncorhynchus mykiss

AbstractIn this study, anesthetic effects of Ocimum basilicum and Eucalyptus globulus essential oils were investigated on rainbow trout, Oncorhynchus mykiss. Fish (average 10 g) were exposed to 20, 50, 70, 100, 150, 200, 300, 400, 500, and 600 mg L−1 essential oils, anesthesia induction, and recovery times were recorded separately for each fish. Acute toxicities of essential oils (10 min LC50 concentration) on rainbow trout were determined at 70–400 mg L−1. In addition, histopathological effects of the essential oils in fish tissues were determined after deep anesthesia. As a result of this study, O. basilicum at 300 mg L−1 dose and E. globulus essential oils at 400 mg L−1 dose showed ideal anesthetic effects on rainbow trout. Anesthesia induction (stage 4) and recovery times at this concentration for E. globulus were found as 186 and 117.5 s, respectively. Anesthesia induction (stage 4) and recovery times were 220.5 and 61 s for this concentration in O. basilicum essential oil, respectively. The toxic effects of essential oils for rainbow trout were not found. No pathological finding in gill, liver, and kidney was observed at the histopathological examination. Consequently, this study demonstrated that O. basilicum and E. globulus essential oils can be used as an effective and safe anesthetic in rainbow trout.

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

The incidence rate of lower limb fractures is high and has increased over the recent years, which affects the physical and mental health and the daily activities of patients. Lower limb fractures are often treated surgically. Therefore, an effective anesthesia regimen is crucial for a smooth and stable operation. To investigate the efficacy of posterior lumbar plexus block anesthesia during surgery for elderly patients with lower extremity fractures. In total, patients were divided into study and control groups. Anesthesia was administered by posterior lumbar plexus nerve block in the study group and epidural anesthesia in the control group. Hemodynamic parameters, anesthesia condition, pain level (VAS), and adverse effects were measured in both groups before anesthesia (T0), at anesthesia induction (T1), 30 min into the operation (T2), and at the end of the operation (T3). At T0, there were no significant differences in MAP and HR between the study and control groups. However, MAP and HR in the study group were significantly lower than those in the control group at T1, T2, and T3. The BIS value of the study group at each time point after anesthesia was significantly lower than that of the control group. The onset and induction time of anesthesia in the study group were also significantly shorter than those in the control group. Preoperative VAS scores did not differ between the study and control groups. However, the VAS scores of the study group at each time point were significantly lower than those of the control group. There was no significant difference in the incidence of adverse reactions between the two groups. Our results suggest that anesthesia with posterior lumbar plexus block surgery for lower extremity fractures in elderly patients can maintain hemodynamic stability and reduce block onset time, anesthesia induction time, and pain.

COMPARISON OF THREE CONCENTRATIONS OF AQUA-SEDTM FOR IMMERSION EUTHANASIA OF BUTTERFLY SPLITFIN (AMECA SPLENDENS).

The efficacies of three concentrations of 2-phenoxyethanol from Aqua-sedTM were examined to determine the suitability for euthanasia of butterfly splitfin (Ameca splendens). Thirty fish were randomly assigned to be immersed in one of three Aqua-SedTM concentrations: 0.5, 2, and 6 ml/L. Opercular rates and caudal fin stroke rates were quantified, and time to the cessation of physiological measures including heartbeat, caudal fin strokes, reaction to external stimuli, righting reflex, swimming, and operculation were recorded. To test for the effects of concentration of Aqua-sedTM on all times to cessation of physiological measures, a linear mixed model was performed followed by pairwise comparisons with a Bonferroni correction. A proportions test compared the number of fish that lost their heartbeat across Aqua-sedTM concentrations. Varying anesthetic induction times were observed for all three Aqua-sedTM concentrations; time to cessation of physiological measures was fastest with 6 ml/L, followed by 2 then 0.5 ml/L, but only concentrations of 2 and 6 ml/L induced anesthesia in less than the recommended 180 s. Aqua-sedTM concentration had a significant effect on time to cessation of physiological measures (P < 0.01), but not on time to cessation of a heartbeat (P > 0.05). Pairwise comparisons indicate time to cessation of caudal fin strokes, reaction to external stimuli, righting reflex, and swimming significantly decreased as concentration increased (P < 0.01). After 60 min of immersion in Aqua-sedTM the number of fish without a heartbeat differed significantly across concentrations (P < 0.01); 20% of fish immersed in 0.5 ml/L, 90% of fish immersed in 2 ml/L, and 90% of fish immersed in 6 ml/L had no heartbeat. A minimum dose of 2 ml/L of Aqua-sedTM, and an immersion time of 60 min for euthanasia of butterfly splitfin is recommended, with a secondary euthanasia measure to confirm death when the heartbeat remains.

Evaluation of Lateral Head Rotation on Eficacy of Face Mask Ventilation during Induction of Anesthesia in Children

Background: The head's position during mask ventilation on the time of anesthesia induction in children may improve the lung ventilation.&#x0D; Aim: Current study was designed to verify whether lateral head rotation improves face mask ventilation efficiency during anesthesia induction in children.&#x0D; Methods: Fifty-six patients aged 1-4 years, candidate for elective surgery, were randomly divided into two equal groups. During induction of general anesthesia, face mask lung ventilation of patients continued with pressure-controlled mode, at a peak pressure level of 10 cmH2O for children 13-24 months and 14cmH20 for children 24-48 month. In patients in the N group, the head position during ventilation was initially in the neutral position for one minute, then the head was axially rotated 45-degree to the right position for one minute and pulmonary ventilation continued in this position, then the head was rotated again to the neutral position and ventilation continued for one minute. In group R patients, mode and time of ventilation was the same, but the order of head placement was first in the lateral rotated to the right, then neutral and then lateral rotated to the right. The primary outcome was the measurement of expiratory tidal volume in each position.&#x0D; Results: Generally, the mean measured expiratory tidal volume did not change in the neutral position compared to laterally rotated head position, 256.6 vs. 233.5 ml: difference -23.1 [95% confidence interval: 10.8 to 39.4 ml]. Also, the change of head position from lateral to neutral position did not show a significant change in the mean expiratory tidal volume, 232.28 vs.247.86 ml: difference -15 .82 (p= 0.4).&#x0D; Conclusion: The rotation of the head to the lateral position during induction of anesthesia in apnoeic children 1-4 years old could not improve the efficiency of mask ventilation relative to the neutral head position.

Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis

BackgroundNon-intubated video-assisted thoracoscopic surgery (NIVATS) is increasingly performed in different types of thoracic procedures. Based on the anesthetic perspective, the outcomes of this method are limited. General anesthesia with intubation and controlled ventilation for video-assisted thoracoscopic surgery (IVATS) is a standard technique. The current study aimed to compare the pulmonary gas exchange between NIVATS and IVATS, with a focus on desaturation event.MethodsThis was a retrospective study conducted at Vajira Hospital. Data were collected from the hospital medical record database between January 9, 2019, and May 15, 2020. A propensity score-matched analysis was used to adjust the confounders by indications and contraindication between NIVATS and IVATS. The perioperative outcomes of VATS and NIVATS were compared by the regression analysis method.ResultsIn total, 180 patients were included in the analysis. There were 98 and 82 patients in the NIVATS and IVATS groups, respectively. After a propensity score matching, the number of patients with similar characteristics decreased to 52 per group. None of the patients in both groups experienced desaturation. The lowest oxygen saturation of the NIVATS and IVATS groups did not significantly differ (96.5% vs. 99%, respectively; p = 0.185). The NIVATS group had a significantly higher ETCO2 peak than the IVATS group (43 vs. 36 mmHg, respectively; p < 0.001). According to the regression analysis, the NIVATS group had a significantly shorter anesthetic induction time (Mean difference (MD) = -5.135 min (95% CI = (- 8.878)- (-1.391)) and lower volume of blood loss (MD = -75.565 ml (95%CI = (- 131.08)—(- 20.65) but a higher intraoperative ETCO2 than the IVATS group (MD = 4.561 mmHg (95%CI = 1.852—7.269). Four patients in the NIVATS group required conversion to intubation due to difficulties encountered when using the surgical technique (7.7%, p = 0.041). Seven patients in the IVATS group, but none in the NIVATS group, presented with sore throat (13.5% vs. 0%, respectively; p = 0.006). Moreover, none of the patients in both groups experienced postoperative pneumonia, underwent reoperation, or died.ConclusionsThe anesthetic and surgical outcomes of NIVATS were comparable to those of IVATS.