Anesthetic Protocol Research Articles

Anesthetic protocol for exploratory laparotomy in giant anteater (myrmecophaga tridactyla): case report

The movement of the giant anteater (Myrmecophaga tridactyla) in search of water and food causes a large number of accidents. The objective of this study is to describe the anesthetic protocol used in an exploratory laparotomy to control internal bleeding in a giant anteater. The animal was treated at the “Luiz Quintiliano de Oliveira” Veterinary Hospital of the Araçatuba School of Veterinary Medicine (UNESP) with a history of being run over. Midazolam was administered to restrain and position the animal during the physical and ultrasound examination, tramadol hydrochloride as premedication, and ketamine and midazolam for induction. Finally, anesthesia was maintained under inhalation anesthesia with isoflurane. Bradycardia during the transoperative period was corrected with a bolus of hypertonic solution (7.5% NaCl) and hydroxyethyl starch (Voluven®). The animal showed a satisfactory anesthetic recovery. Therefore, it is concluded that the anesthetic protocol is declared adequate for this procedure in giant anteaters.

Compliance of enhanced recovery after surgery (ERAS) protocol in emergency and elective colorectal cancer surgery with a perspective from a developing country.

To evaluate compliance with enhanced recovery after surgery protocol of patients undergoing colorectal carcinoma surgery, and to compare its effect on outcomes. The retrospective study was conducted at the Maroof International Hospital, Islamabad, Pakistan, and comprised data from July 15, 2016, to March 20, 2022, of patients of either gender undergoing elective or emergency colorectal carcinoma surgery. Data included age, gender, tumour site, type of surgery, surgical approach, compliance with each of the 25 components of the enhanced recovery after surgery protocol, length of hospital stay, surgery duration, 30-day readmission rate and perioperative mortality. Data was analysed using SPSS 23. Of the 96 patients with mean age 50.03±14.86 years (range: 20-79 years), 65(67.7%) were males, 70(72.91%) were aged at least 40 years, and 75(78.12%) underwent elective surgery. Most common tumour site was rectum and sigmoid 49(51%). Laparoscopic surgery was performed in 17(17.7%) patients. No compliance was seen with carbohydrate loading of patients or limiting use of opioids in standard anaesthesia protocol. No nutritional supplementation was started from postoperative day 1. Mean compliance with all the protocol components was 74.9%±37.652 for both elective and emergency cases. Mean duration of surgery was 192.50±75.33 minutes, while mean length of hospital stay was 5.52±1.57 days. Re-admission within 30 days was needed in 2(2.1%) cases. There was no perioperative mortality. Better compliance with enhanced recovery after surgery protocol resulted in better perioperative outcomes.

Controlled elevation of intraocular pressure in anesthetized mice

Our purpose was to develop a protocol for prolonged anesthesia in mice and evaluate optic nerve axon injury in response to 4 h of controlled elevation of intraocular pressure (CEI). During CEI, C57BL/6 male mice (3–5 months old) were anesthetized with 1.5% isoflurane with 100% oxygen for 4 h and placed on a warm platform, with expired gas and anesthetic actively evacuated. Lactated ringers (0.5 ml) with 5% dextrose was administered subcutaneously at the start and end of CEI. Physiological parameters (oxygen saturation = O2, heart rate = HR, systolic blood pressure = SBP, and temperature) were monitored throughout the 4-h CEI. One eye was cannulated with polyurethane tubing connected to a balanced salt solution reservoir and IOP elevated to 20 (N = 18), 30 (N = 13), 50 (N = 14), and 60 mmHg (N = 16). An additional group of 22 female mice was exposed to CEI of 60 mmHg. Fourteen days after CEI, optic nerves were assessed for axonal injury by masked observers that assigned a grade on a scale from 1 (normal) to 5 (>50% of axons degenerating). CEI optic nerve injury was compared to injury assessed in contralateral optic nerves (N = 84) and naïve optic nerves (N = 18) using a one-way ANOVA followed by Kruskal-Wallis test for multiple comparisons. The relationship between optic nerve injury, physiological parameters, and IOP were assessed by linear regression analyses. Physiologic parameters remained stable throughout CEI (O2 = 95 ± 9%; HR = 450 ± 39; SBP = 102 ± 15 mmHg, and temperature = 38 ± 0.7 °C) and were not statistically different between groups (all comparisons had P > 0.5). Mean optic nerve injury grades (±SD) for naïve optic nerves (1.01 ± 0.02) were not significantly different from fellow/contralateral optic nerves (1.03 ± 0.07, P > 0.99), or from CEI of 20 mmHg (1.04 ± 0.08, P > 0.99) or 30 mmHg (1.05 ± 0.06, P = 0.6). However, animals exposed to CEI of 50 mmHg (2.09 ± 1.43, P = 0.0005) and 60 mmHg (male: 2.86 ± 1.30, P < 0.0001, female: 1.63 ± 1.00, P = 0.0006) developed significant optic nerve injury relative to their fellow/contralateral optic nerves. Axonal injury grades following a CEI of 60 mmHg were not significantly different between male and female mice (P = 0.19). Optic nerve injury positively correlated (P < 0.0001) with IOP and not with physiological parameters, indicating that the optic nerve injury is IOP-related. In conclusion, prolonged anesthesia in mice requires careful attention to animal physiology. With this, a 4-h exposure to elevated IOP can produce significant optic nerve injury with IOPs equal to or greater than 50 mmHg. We provide detailed descriptions of methods and materials for producing prolonged elevations of IOP in mice while maintaining and monitoring their physiology, as well as a unique, cost-effective transducer system for monitoring pressure delivery.

A study comparing brain wave patterns of fentanyl and ketamine in adult patients undergoing minimally invasive surgery.

This study aimed to investigate and compare the neurophysiological impacts of two widely used anesthetic agents, Fentanyl and Ketamine, on EEG power spectra during different stages of anesthesia in adult patients undergoing minimally invasive surgery. EEG data were collected from patients undergoing anesthesia with either Fentanyl or Ketamine. The data were analyzed for relative power spectrum and fast-to-slow wave power ratios, alongside Spectral Edge Frequency 95% (SEF95), at 3 key stages: pre-anesthesia, during stable anesthesia, and post-anesthesia. EEG Relative Power Spectrum: Initially, both groups exhibited similar EEG spectral profiles, establishing a uniform baseline (P > .05). Upon anesthesia induction, the Fentanyl group showed a substantial increase in delta band power (P < .05), suggesting deeper anesthesia, while the Ketamine group maintained higher alpha and beta band activity (P < .05), indicative of a lighter sedative effect. Fast and Slow Wave Power Ratios: The Fentanyl group exhibited a marked reduction in the fast-to-slow wave power ratio during anesthesia (P < .05), persisting post-anesthesia (P < .05) and indicating a lingering effect on brain activity. Conversely, the Ketamine group demonstrated a more stable ratio (P > .05), conducive to settings requiring rapid cognitive recovery. Spectral Edge Frequency 95% (SEF95): Analysis showed a significant decrease in SEF95 values for the Fentanyl group during anesthesia (P < .05), reflecting a shift towards lower frequency power. The Ketamine group experienced a less pronounced decrease (P > .05), maintaining a higher SEF95 value that suggested a lighter level of sedation. The study highlighted the distinct impacts of Fentanyl and Ketamine on EEG power spectra, with Fentanyl inducing deeper anesthesia as evidenced by shifts towards lower frequency activity and a significant decrease in SEF95 values. In contrast, Ketamine's preservation of higher frequency activity and more stable SEF95 values suggests a lighter, more dissociative anesthetic state. These findings emphasize the importance of EEG monitoring in anesthesia for tailoring anesthetic protocols to individual patient needs and optimizing postoperative outcomes.

Dexmedetomidine leads to the amelioration of stress response to surgery.

To determine the impact of intravenous Dexmedetomidine (Dex) administered perioperatively on stress response markers in patients undergoing ENT surgeries. This randomized interventional study was conducted at POFs Hospital and NUMS affiliated WMC, Wah Cantt, in collaboration with IIMC Rawalpindi, Pakistan, from October 2021 to April 2022. One hundred patients aged between 15-60 years, after satisfying the inclusion standards were randomly divided into two groups C and D. Group-C (n=50) received normal saline in addition to the standard anesthesia protocol. The intervention Group-D (n=50) was administered 1µg/kg dexmedetomidine hydrochloride intravenously over 10 minutes just before the induction followed 0.5μg/kg/hr as maintenance dose till the end of surgery. Serum inflammatory biomarkers (interleukins-6, TNF-α and cortisol) were measured in blood samples in both groups, taken at 0 (T0), 30 minutes(T1), and two hours (T2) time intervals and analyzed by using Enzyme-linked immunosorbent assay (ELISA). Data was statistically analyzed using SPSS 23. The patients receiving Dex showed marked decrease in serum levels of cortisol, TNF- α and interleukins-6, from 139.73 to10.18, 99.51 to 0.96 and 85.09 to 0.96 respectively. Comparison between C and D groups revealed significant differences (p≤0.05) in these serum biomarkers. In the present study, intravenous Dex suppressed the intraoperative rise in levels of cytokine secretion and enhanced smooth recovery with no incidence of nausea and vomiting. These effects could be attributed to the anti-inflammatory effects of dexmedetomidine.

Outpatient partial parotidectomies are feasible in a well-selected population: a French experience.

This study aimed to evaluate the feasibility, safety, and patient satisfaction of outpatient partial parotidectomies in a French university hospital, addressing the lack of national data on such procedures amidst a push for increased ambulatory surgeries. A prospective cohort study was conducted, involving patients undergoing partial parotidectomy for non-malignant tumors from March 2021 to May 2023. Inclusion was based on surgical, medical, and social criteria. A control group was also reviewed for comparison. The study followed a standardized surgical and anesthesia protocol, with patient satisfaction assessment. From an initial pool of 104, 64 patients passed surgical screening, and 45 remained after anesthesia and social considerations, marking a 70% inclusion rate for outpatient care. The success rate of outpatient procedures stood at 98%, with complication incidences mirroring those of inpatient counterparts. 91% of participants expressed high satisfaction, scoring their experiences 7/10 or above. Outpatient partial parotidectomies within the French health infrastructure are both viable and align with patient expectations, reinforcing the shift towards ambulatory surgery.

Use of a Schelin catheter for transurethral intraprostatic anesthesia (TUIA) prior to iTIND procedure.

Endorsing the principles of minimal invasiveness in benign-prostatic hyperplasia (BPH) surgery, we conducted the first evaluation of transurethral intraprostatic anesthesia (TUIA) using Schelin catheter® (SC) prior to iTIND positioning. Of 23 patients enrolled, 11 (48%) received TUIA via SC whereas the remaining underwent standard anesthesia protocol. Pain was assessed using visual analogue scale (VAS). No differences between cohorts were observed for pain during the device implantation and removal. Conversely, significantly lower median VAS scores were reported at 24- (1.0 vs. 3.0) and 48- (1.0 vs. 2.5) hour follow-up favoring TUIA. SC TUIA offers effective pain control during iTIND procedures, supporting its use in outpatient settings.

Ultrasound assessment of gastric content in elective surgery

Objective: To determine the prevalence of patients with ultrasound signs of a full stomach during surgery at the Sominé Dolo Hospital in Mopti. Methodology: Observational study investigated prospective, single-center over a period of one month include patients in surgery program aged 18 to 85 years. Our data was collected on individual survey sheets and analysed with the Epi info7 software. Result: Out of a total of 140 patients, 41 patients were included in our study, i.e. a frequency of 29.28%. The mean age of patients was 38 years +/-17. The average body mass index was 23+/- 4.65. Females predominated: 60.98% (n=25) compared to 39.02% (n=16) for males, with a sex ratio of 0.6/1. The ASA classification was rated at II in 51.22% of patients (n=21). The gastric antrum was visualized in 40 patients, i.e. an ultrasound sensitivity of 97.56%, of which seven (07) were difficult to see and not visualized in one patient. We found a relationship between high BMI and difficulty in visualizing gastric contents (P-value = 0.00001), but no relationship was found between BMI and Perlas score (P-Value = 0.75411). The Perlas score was rated at 0 in 85% (n=34), fluid content was found in 12.5% (n=5) of patients while one patient had solid content. Patients observed an estimated preoperative fasting duration of an average of 11 hours +/- 2.86. Conclusion: Despite the implementation of a preoperative fasting protocol, cases of full stomachs are still to be feared and the ultrasound at the bedside of patients is a simple, quick examination to best adjust the anesthesia protocol. Keywords: full stomach, gastric antrum, ultrasound, Perlas score, Mopti.

Case study: chemical contaimnent in parrots (Amazona SP - Lesson, 1830) from de Quinzinho de Barros Zoological Park, municipality of Sorocaba, São Paulo

The containment and anesthesia of wild animals is extremely important for veterinarians who intend to or already practice in this field. However, before administering anesthesia, it is essential to understand the pharmacology of anesthetics and the biological aspects related to the anatomical, physiological, and behavioral peculiarities of the species to be restrained. The aim of this research was to evaluate parameters such as heart rate (HR), respiratory rate (RR), temperature (T°), muscle relaxation, reflexes (palpebral, ocular, and pedal), and respiratory pattern in four anesthetic protocols: ketamine 5% at a dose of 30mg/kg combined with xylazine 2%-2mg/kg; ketamine 5% at doses of 15mg/kg and 20mg/kg with diazepam 1% at a dose of 1mg/kg; diazepam 0.5% at a dose of 5mg/kg 15 minutes before isoflurane administration; and the use of isoflurane alone in parrots (Amazona sp) kept at the Quinzinho de Barros Municipal Park, Sorocaba, São Paulo. Eleven animals were used: three with the ketamine combined with xylazine protocol, three with ketamine plus diazepam, three with diazepam before isoflurane, and two with the isolated use of isoflurane. The results of this research showed that with the use of ketamine combined with xylazine at this dosage, only superficial sedation was achieved. With the supplementary dose of ketamine and xylazine, the animal reached a moderate anesthetic plane, but respiratory depression occurred. The use of diazepam combined with ketamine 5% at a dose of 15mg/kg is only recommended for minor procedures. Recovery was slightly less prolonged and with less cardiorespiratory depression compared to the use of ketamine combined with xylazine. Diazepam 0.5%-5mg/kg before isoflurane did not allow for the intubation of the animal; it served to reduce the stress of restraint, requiring a lower concentration of isoflurane for induction. Apnea was observed with the increase of isoflurane concentration, even with the use of diazepam before isoflurane. With the isolated use of isoflurane, the animal reached a moderate to deep anesthetic plane, which would allow for more invasive procedures.

Evaluation of Anaesthetic Efficacy of Xylazine-Ketamine-Guaifenesin Combination for Relieving Dystocia in Buffaloes

Background: Dystocia in dairy animals remains major concern causing huge economical losses of farmers. Over the past years, field veterinarian relieves dystocia via maneuvering, fetotomy, modified Schaffers and cesarean methods under local or regional anaesthesia which is always stressful and painful procedure leading to excessive tissue damage. Considering the involved stress and further conception during relieving dystocia under local or regional anaesthesia is always questionable. Hence, the present study was aimed to relieve dystocia in buffalo without stress by improving gentle handling of uterus during cesarean or obstetrical method under the anaesthetic combination of xylazine-ketamine-guaifenesin under field condition. Methods: The present study was undertaken in twelve clinical cases of buffaloes with history of dystocia irrespective of age and breed and they were sedated with xylazine and subjected to obstetrical or cesarean procedure under ketamine and guaifenesin anaesthetic protocol. Result: Twelve buffaloes with average age between 3-8 years and body weight 389.66±19.56 kg reported to hospital and amongst them eight were primiparous. Among maternal dystocia, uterine torsion was most common followed by incomplete cervical dilation whereas in foetal dystocia, malpositioned foetus and emphysematous foetus was reported. Tachycardia and hypothermia were consistent findings in all animals. The alkaline phosphatase, SGPT and SGOT has been increased significantly due to muscular damage. Mean duration of general anaesthesia required for obstetrical and cesarean procedure was 35.00±0.25 min and 132.00±0.18 min, respectively. The present study was concluded that, use of ketamine-Guaifenesin combination premedicated with xylazine hydrochloride produced excellent muscle relaxation during obstetrical and cesarean procedure in buffaloes characterized by loss of abdominal muscle tone, stable respiration and minimal cardiopulmonary changes.

Ultra-low-impact laparoscopy: a new concept for a minimally invasive surgery.

Minimally invasive surgery is considered the gold standard for the treatment of gynecological diseases. Our study aims to assess the effectiveness of the new concept of ultra-low-impact laparoscopy as a combination of low-impact laparoscopy, consisting in the use of miniaturized instruments through 3-5mm ports and low-pressure pneumoperitoneum, with regional anesthesia to evaluate the perioperative outcomes. A cross-sectional study was performed from May 2023 to December 2023, to enroll 26 women affected by benign gynecological disease and threated by mini-invasive surgical approach. The surgical procedures were performed following the low-impact laparoscopy protocol and the regional anesthesia protocol. The postoperative pain, nausea, and vomiting and the antiemetic/analgesic intake were evaluated. Postoperative surgical and anesthesiological variables were analyzed. Operative time was within 90 min (41.1 ± 17.1 mean ± standard deviation (SD)) and no conversion to laparotomy or general anesthesia was required. According to VAS score, the postoperative pain during the whole observation time was less than 3 (mean). Faster resumption of bowel motility (6.5 ± 2.1 mean ± SD) and women's mobilization (3.1 ± 0.7 mean ± SD) were observed as well as low incidence of post-operative nausea and vomit. Early discharge and patient's approval were recorded. Intraoperatively pain score was assessedon Likert scale during all stages. Ultra-low-impact laparoscopy showed to provide a satisfying recovery experience for patients in terms of short hospital stays, cosmetic result, and pain relief, without compromising surgical outcomes. The encouraging results lead us to recruit a greater number of patients to validate our technique as a future well-established produce.

Fasting horses perioperatively decreases manure production and increases time to manure output postoperatively: a controlled randomized trial.

To compare 3 perioperative feeding regimens and their effect on anesthetic complications, manure output, and colic proportion in healthy horses. 45 horses presenting for elective orthopedic procedures were randomly assigned to 1 of 3 groups: not fasted (NF; continuous access to hay perioperatively), fasted muzzled (FM; 10-hour preoperative fast with slow refeeding postoperatively and muzzle placement), or fasted not muzzled (FNM; same as FM without muzzle placement). Anesthetic protocol was standardized. Outcomes compared between groups included anesthesia time, arterial oxygenation, duration of hypotension, perioperative manure output, time to first passage of manure postoperatively, pain scores, and colic proportion. Comparisons were made with a mixed model and Fisher exact test with statistical significance considered at P ≤ .05. No differences were seen in pain scores, oxygenation, hypotension, or colic between groups. Groups FM and FNM had a significantly greater mean reduction in postoperative manure weight (-81% and -70%; P = .003) and number of manure piles (-63% and -55%; P = .005) compared to group NF (-39% and -22%; P < .001; weight and piles, respectively). Mean ± SD minutes to passage of manure postoperatively was significantly shorter in group NF (238 ± 13 minutes) than groups FM (502 ± 174 minutes; P < .001) and FNM (444 ± 171 minutes; P = .003). Horses with continuous access to hay prior to and following recovery from anesthesia passed more manure and passed manure sooner after surgery than their fasted counterparts without detrimental effect on anesthetic parameters and postoperative complications. Continuous access to hay perioperatively supports manure production in healthy horses without increase in anesthetic complications.

Enhanced Recovery after Surgery Protocol for Anaesthesia: Caveats in Oncosurgical Patients

Enhanced Recovery after Surgery Protocol for Anaesthesia: Caveats in Oncosurgical Patients

A Comparison of the Effects of Different Positive End-Expiratory Pressure Levels on Respiratory Parameters During Prone Positioning Under General Anaesthesia: A Randomized Controlled Trial.

Background and objective In general anesthesia, for certain surgical procedures in the prone position, patients often face increased airway pressures, reduced pulmonary and thoracic compliance, and restricted chest expansion, all of which can affect venous return and cardiac output, impacting overall hemodynamic stability. Positive end-expiratory pressure (PEEP) is used to address these issues by improving lung recruitment and ventilation while reducing stress on lung units. However, different PEEP levels also present risks such as increased parenchymal strain, higher pulmonary vascular resistance, and impaired venous return. Proper positioning and frequent monitoring are key to ensuring adequate oxygenation and minimizing complicationsarising from prolonged periods in the prone position. This study aimed to evaluate the effects of different PEEP levels (0 cmH2O, 5 cmH2O, and 10 cmH2O) in the prone position to determine the optimal setting for balancing improved oxygenation and lung recruitment against potential adverse effects. The goal is to refine individualized PEEP strategies beyond what is typically outlined in standard PEEP tables. We endeavored to examine the impact of different PEEP levels during pressure-controlled ventilation (PCV) on arterial oxygenation, respiratory parameters, and intraoperative blood loss in patients undergoing spine surgery in a prone position under general anesthesia. Methodology This randomized, single-blinded, controlled study enrolled 90 patients scheduled for elective spine fixation surgeries. Patients were randomized into three groups: Group A (PEEP 0), Group B (PEEP 5), and Group C (PEEP 10). Standardized anesthesia protocols were administered to all groups, with ventilation set to pressure-controlled mode at desired levels. PEEP levels were adjusted according to group allocation. Arterial blood gases were measured before induction, 30 minutes after prone positioning, and 30 minutes post-extubation. Arterial line insertion was performed, and dynamic compliance, mean arterial pressure (MAP), heart rate (HR), and intraoperative blood loss were recorded at regular intervals. Data were analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY). Results Arterial oxygenation was significantly higher in Groups B (PEEP 5) and C (PEEP 10) compared to Group A (PEEP 0) at both 30 minutes post-intubation and post-extubation. Specifically, at 30 minutes post-intubation, arterial oxygenation was 142.26 ±24.7 in Group B and 154.9 ±29.88 in Group C, compared to 128.18 ±13.3 in Group A (p=0.002). Similarly, post-extubation arterial oxygenation levels were 105.1 ±8.28 for Group B and 115.46 ±15.2 for Group C, while Group A had levels of 97.07 ±9.90 (p<0.001). MAP decreased significantly in Groups B and C compared to Group A. Dynamic compliance was also improved in Groups B and C. Furthermore, intraoperative blood loss was notably lower in Group C (329.66 ±93.93) and Group B (421.16 ±104.52) compared to Group A (466.66 ±153.76), and these differences were statistically significant. Conclusions Higher levels of PEEP (10 and 5 cmH2O) during prone positioning in spine surgery improve arterial oxygenation, dynamic compliance, and hemodynamic stability while reducing intraoperative blood loss. These findings emphasize the importance of optimizing ventilatory support to enhance patient outcomes during prone-position surgeries.

Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure.

Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy. Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b. Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant. Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.

Prilocaine vs bupivacaine in spinal anesthesia for urologic endoscopy: clinical trials &amp; historical overview

Introduction. In the evolving landscape of anesthetic practices for short-duration urologic procedures, the quest for an anesthetic agent that balances efficacy with minimal side effects remains a significant clinical challenge.The objective was to compare the efficacy and safety of 2% hyperbaric prilocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia.Materials and methods. A comparative analysis was performed in terms of onset and duration of sensory and motor block, incidence of side effects (hypotension and bradycardia), and overall patient outcomes in urologic endoscopy. The research sample was divided into two groups, each consisting of 20 patients. In one case, spinal anesthesia was performed using 2% hyperbaric prilocaine (40 mg) + fentanyl 25 mcg, in the other – 0.5% hyperbaric bupivacaine (10 mg) + fentanyl 25 mcg.Results. Prilocaine offers a faster onset of sensory and motor block and a shorter duration of sensory block compared to bupivacaine. Prilocaine also showed a quicker recovery of full motor function and had a significantly lower incidence of side effects such as hypotension and bradycardia.Conclusion. These results suggest that 2% hyperbaric prilocaine could be an alternative to 0.5% hyperbaric bupivacaine in spinal anesthesia for urologic endoscopy, especially in procedures requiring quick recovery. The promising results of prilocaine in such short-duration surgeries can also prompt a reevaluation of anesthesia protocols across various surgical interventions and lead to enhanced patient outcomes, emphasizing safety, comfort, and efficacy of surgical care.

Evaluation of the Effectiveness of Eugenol and MS-222 as Anesthetics in Zebrafish in Repeated Exposures and Post-Anesthesia Behaviour.

The increasing use of the zebrafish (Danio rerio) in scientific experiments has made it necessary to implement anesthesia protocols guaranteeing minimum pain and suffering for these animals and ensuring the reliability of the results obtained from their research. Therefore, we aimed to compare the effectiveness of two anesthetics, eugenol and MS-222, in consecutive administrations and evaluate the zebrafish behaviour after repeated anesthesia. Thus, several zebrafish were anaesthetized with eugenol, MS-222, and buffered MS-222 three times repeatedly with a 24-h interval between each exposure. The induction and recovery periods were also timed. Their swimming frequency was determined after each exposure to assess their behaviour after the anesthesia. Anesthesia induction was quicker with eugenol compared to MS-222. However, eugenol presented longer recovery times, which were prolonged after each exposure. Also, the swimming frequency was reduced after each anesthesia with eugenol. The buffered version of MS-222 was more efficacious than the non-buffered one. Both versions of MS-222 did not affect the swimming frequency. Based on these findings, we recommend the utilization of MS-222 buffered rather than eugenol when repeated, brief-duration anesthesia is necessitated for a study.

Fidelity of Enhanced Recovery Protocol Implementation With Assessment of Hospital-Specific Materials

IntroductionVariability in implementation of enhanced recovery protocols (ERPs) often reduces the effects of an intervention on clinical outcomes. This study aimed to evaluate hospital-level implementation fidelity to a pediatric gastrointestinal surgery ERP by assessing site-specific implementation materials. MethodsThis document analysis study operationalized implementation fidelity as adherence to the creation of specified materials at each study site. During the 12-mo implementation phase within the stepped-wedge cluster randomized control trial, ENhanced Recovery In CHildren Undergoing Surgery, study sites were provided with materials (e.g., order sets), access to peer-counseling, and given key ERP elements spanning multiple phases of care. Sixteen of the 18 total study sites submitted implementation materials, including 14 anesthesia protocols, 11 order sets, and 16 sets of patient/family education materials. These materials were assessed and graded for fidelity using prespecified criteria. Hospital-level fidelity scores could range from 0 to a maximum score of 18, and were categorized as either high or low, based on whether the score was above or below/equal to the median. Descriptive statistics and Wilcoxon rank sum test were used for analysis. ResultsThe overall hospital-level median fidelity score for inclusion of ERP elements in the implementation materials was 10.5. The median score was 12.8 at nine high-fidelity sites and was 5.6 at nine low-fidelity sites (P < 0.01). Higher adherence was noted for avoiding prolonged fasting (n = 16/18 hospitals; 89%) and preventing nausea and vomiting (n = 16/18 hospitals; 89%) in anesthesia protocols and/or order sets. Lower adherence was noted for incorporation of minimally invasive surgical techniques (n = 2/18 hospitals, 11%) and of preoperative optimization of medical comorbidities (n = 0/18 hospitals, 0%) in implementation materials. ConclusionsDespite substantial resources to promote ERP elements, there was wide variation in fidelity for incorporating ERPs into implementation materials among hospital sites. Development of high-fidelity implementation materials for complex ERPs for gastrointestinal surgery in children may require longer than 12 months. Additional implementation strategies, resources, and modification of implementation-focused materials may be needed.

AN OVERNIGHT SENSATION: HOW THE ACUTE INTRODUCTION OF A SHORT-STAY PATHWAY CAN BENEFIT A PREVIOUSLY COMPROMISED NHS ARTHROPLASTY SERVICE

We report the impact of implementing a new short-stay hip and knee arthroplasty pathway in a National Health Service (NHS) hospital. This was enacted due to existing concerns with a long length of stay (LOS) and reduced elective operating capacity each winter due to emergency bed pressures. The overnight introduction of this pathway was aimed to reduce LOS, alleviate bed pressures, minimise readmission rates and generate financial savings, all combining to facilitate full elective activity during the winter.We conducted a prospective study at a regional tertiary arthroplasty centre. The new pathway was introduced across the service overnight. It includes rigorous preoperative optimisation, specific anaesthetic protocols and uniform changes in surgical practice to allow a focus on early mobilization and discharge on the day of surgery where possible.Data collection spanned 17 months, including the initial six months post implementation of the short-stay pathway. LOS data was collected for the full period and data was compared pre- and post-implementation of the new pathway. Patient satisfaction and 30-day readmission data were also collected.There was an immediate and significant decrease in median LOS from 4 days pre-implementation to 1 day post-implementation. Patient satisfaction was high, and the 30-day readmission rate was unchanged (5.95%), with no readmissions directly related to decreased inpatient stay. Financial analyses revealed substantial cost savings due to reduced LOS and the elimination of routine post-operative blood tests, estimated at over £1.6m per year. Elective activity over winter was significantly higher (79%) than in the same time period in the previous year.An acute introduction of a carefully planned and coordinated short-stay hip and knee pathway is safe, cost-effective and popular with patients, but also contributes to increased efficiency in the delivery of elective healthcare in the context of increasing demand and financial constraints in the NHS.

Impacts of different anesthetic protocols on the speed and quality of postoperative resuscitation in patients undergoing painless gastroscopy

Objective: To estimate the impacts of different anesthetic protocols on the speed and quality of postoperative resuscitation in patients undergoing painless gastroscopy. Methods: This was a prospectively designed randomized control study that included 150 patients who underwent painless gastroscopy in Hainan Cancer Hospital affiliated to Hainan Medical College between April and December of 2023. All the patients, classified as American Society of Aneshesiologists (ASA) Grade Ⅰ or Ⅱ, were randomly divided into three groups with different anesthetic protocols, including propofol group (group P), remimazolam group (group R) and remimazolam with flumazenil group (group RF). There were eventually 50 patients in each group. The three groups of patients were compared for their resuscitation time and the time that they stayed in the resuscitation room (addressed as"room time"below). At 10 min and 20 min after resuscitation, each patient was tested for recognition ability (orientation score), walking ability and fine motor skill (including reaction speed, quick-click ability and visual memory), respectively, with possible adverse reactions recorded spontaneously, such as hypotension, dizziness, nausea and vomitus. Results: There were 29 males and 21 females in group P with an average age of (34±6) years, 27 males and 23 females in group R with an average age of (36±8) years, and 26 males and 24 females in group RF with an average age of (33±7) years, respectively. All examinations for each patient were successfully completed with no interruptions. The resuscitation time and room time of group RF were (47±15) s and (26±5) min,respectively, which were both shorter than those in either group R [(489±92) s and (35±6) min] or group P [(196±61) s and (31±7) min] (all P<0.05). The orientation score of patients in group RF at 10 min after resuscitation was (79.0±10.5), which was significantly higher than that in group R (70.0±11.7) (P<0.05). The patients' walking ability score of group RF at 10 min and 20 min after resuscitation were [(23.6±10.8), (48.0±4.5)], which were better than those in group R[(15.4±11.1), (47.6±4.8)] (both P<0.05). The patients' reaction speed and quick-click scores of group RF were [(851.0±150.9), (547.0±114.0) ms] and [(758.0±73.2), (629.0±128.9) ms], which were better than those in either group R [(1 151.0±206.0), (732.0±135.1) ms], [(893.0±110.9), (765.8±125.8) ms] or group P [(985.0±225.3), (613.0±123.2) ms], [(831.0±87.7), (691.0±115.8) ms] (all P<0.05). The incidence rate of hypotension in group P was 18% (9/50), higher than that in either Group R [4% (2/50)] or group RF [2% (1/50)] (all P<0.05). The incidence rates of dizziness, nausea and vomitus were comparable among all the three groups with no statistical differences (all P>0.05). Conclusion: In patients undergoing anesthesia with remazolam, the use of flumazenil can not only shorten the resuscitation time and the time that the patients need to stay in the resuscitation room, but also speed up the recovery of the patients' recognition, walking and fine motor skill abilities.