Anesthetic Protocol Research Articles

Comparison of three anaesthetic protocols in captive baboons (Papio hamadryas): preliminary results

Comparison of three anaesthetic protocols in captive baboons (Papio hamadryas): preliminary results

Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real-world data.

This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan-Do-Study-Act cycles. From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure-specific perioperative Plan-Do-Study-Act cycles, three procedure-specific postoperative prescription Plan-Do-Study-Act cycles, and four general ambulatory surgical center enhanced recovery Plan-Do-Study-Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30-day reoperation rate. A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30-day reoperation rates were unchanged. The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay.

Management and monitoring of anesthesia during the perioperative period in a Tertiary Hospital in Bangladesh

Background: Anesthesia management is crucial for ensuring patient safety and optimal surgical outcomes during the perioperative period. In Bangladesh, the challenges faced in managing and monitoring anesthesia in tertiary care hospitals necessitate a comprehensive evaluation of current practices. This study aims to assess the anesthetic management protocols and monitoring strategies employed in a tertiary hospital in Bangladesh. Methods: This observational study was conducted in Islami Bank Medical College Hospital, Rajshahi, Bangladesh from July to December 2023. Data were collected from patients undergoing various surgical procedures requiring anesthesia. The anesthetic techniques used, intraoperative monitoring parameters, and any complications encountered were recorded. The study included a review of anesthesia charts, patient records, and interviews with anesthesia providers. Statistical analysis was performed to identify trends and correlations. Results: A total of 200 patients were included in the study. The most commonly used anesthetic technique was general anesthesia (65%), followed by regional anesthesia (30%) and local anesthesia (5%). Intraoperative monitoring parameters included heart rate, blood pressure, oxygen saturation, and end-tidal carbon dioxide levels, which were consistently documented in 95% of cases. Complications occurred in 10% of patients, primarily involving respiratory issues and cardiovascular instability. Proper adherence to monitoring protocols significantly reduced the incidence of complications. Conclusion: Effective management and monitoring of anesthesia during the perioperative period are vital for patient safety in a tertiary hospital setting. The study highlights the importance of standardized protocols and continuous monitoring to minimize complications. Recommendations for improving anesthetic practices include regular training for anesthesia providers and enhancing monitoring infrastructure to ensure optimal patient care.

Evaluation of Dexmedetomidine with Tiletamine-Zolazepam for Snow Leopard (Panthera uncia) Immobilization.

This study describes two different doses of dexmedetomidine combined with tiletamine-zolazepam (TZ) for anesthesia in snow leopards (Panthera uncia). A total of 11 adult snow leopards were anesthetized in Xining City, Qinghai Province, China from November 2019 to June 2023. We recorded the onset time, anesthesia duration, head-up time, and walking time. Vital signs were recorded every 5 min during anesthesia. Arterial blood gas analysis was performed approximately 20 min after the onset of anesthesia by collecting blood from the femoral artery. All results were presented as mean±SD. There were no significant differences in onset time, anesthesia duration, head-up time, and walking time between the two anesthesia protocols. Heart rate, respiratory rate, body temperature, and blood pressure had a gradual decreasing trend, and blood oxygen saturation gradually increased. Our results suggest that using dexmedetomidine at doses of 21.25±1.38 μg/kg to 30.95±1.13 μg/kg combined with TZ at 2.07±0.08 mg/kg to 2.13±0.15 mg/kg can provide safe and effective anesthesia for snow leopards.

The analgesic benefit of rectus sheath block in robotic gynecologic surgery: A retrospective study.

With the growing adoption of robotic techniques in gynecologic surgery, the advantages of minimally invasive procedures over traditional open surgery, such as reduced postoperative pain and quicker recovery, are clear. Yet, establishing an effective multimodal analgesic regimen remains a challenge. This retrospective study from a tertiary care center aimed to assess the analgesic efficacy of the rectus sheath block (RSB) on postoperative pain and opioid consumption after robotic gynecologic surgery. Between June 2022 and March 2023, 20 patients who underwent robotic gynecologic surgery were evaluated. Key parameters included postoperative visual analog scale scores, opioid consumption, and postoperative nausea/vomiting instances. Anesthesia protocols were standardized, with postsurgical pain management involving RSB and a patient-controlled analgesia device filled with morphine. Patients showed an average morphine intake of 8.2 ± 5.09 mg over the initial 24 hours postsurgery. During mobilization, average pain scores were consistently low, with no correlation identified between opioid consumption and age or body mass index. 40% of patients reported postoperative nausea on the first day, and no complications linked to the RSB were observed. The study underlines the potential of integrating RSB in a multimodal analgesic regimen after robotic gynecologic surgery. Its application may lead to reduced opioid consumption and more efficient postoperative pain management. Further randomized controlled trials are recommended to validate these findings.

Evaluation of general anesthesia protocols for a highly controlled cardiac ischemia-reperfusion model in mice.

The aim of our study was to test different anesthetic mixtures in order to identify the most suitable one for a surgical cardiac ischemia-reperfusion model in mice. 1) Sixty four mice were submitted to one of the 6 combinations of ketamine or alfaxalone associated to xylazine, medetomidine or midazolam. Depth and quality of anesthesia were evaluated via 5 reflex scores. 2) Impact of analgesic (buprenorphine or butorphanol), anesthesia reversal (with atipamezole) and surgery (cardiac ischemia-reperfusion surgery) have been tested in the selected protocols. 3) infarction size has been measured with TTC (Triphenyl Tetrazolium Chloride) method in mice anesthetized with best protocols. Protocol involving medetomidine induced the longest surgical anesthesia: (median = 120, {interquartile range = 100-125}) min with ketamine and 53 {25-100} min with alfaxalone. Butorphanol substitution with buprenorphine did not alter time-related anesthesia parameters. Atipamezole reversal considerably reduced both recovery and immobilization time (respectively 22 {18-30} min and 98 {88-99} min vs. 55 {40-70} min and 143 {131-149} min, in groups with no reversal, p = 0.001) with no impact on infarction size measurement. In this study, the combination alfaxalone/medetomidine/buprenorphine (80/0,3/0,075 mg.kg-1, s.c.) associated with reversal by atipamezole was a reliable anesthetic protocol for murine surgery, particularly for the study of ischemia-reperfusion.

Transversus Abdominis plane block to manage post operative pain in canine mastectomy

The aim of this study was to assess effectiveness of transversus abdominis plane block as part of a multimodal anaesthetic protocol in controlling perioperative nociception/ pain in dogs that underwent mammary tumour excision. The study included twelve dogs belonging to different breeds and ages. The dogs were classified according to the American Society of Anaesthetists (ASA) classification of physical status, based on their pre-anaesthetic evaluations and were divided into two groups: I and II, each with six dogs. Dogs in both groups received dexmedetomidine for premedication and diazepam-propofol for induction. Group I dogs were subjected to Transversus abdominis plane (TAP) block and Group II dogs were given butorphanol. Pain score was assessed using the Glasgow Composite Measure Pain Scale (GCMPS-SF) at one hour post-operatively. The pain score was significantly lower in Group I. None of the dogs in Group I required rescue analgesia. TAP block proved beneficial in mitigating nociception and postoperative pain in dogs undergoing mammary tumour excision. Keywords: Mammary tumour resection, TAP block, post-operative pain

The Relationship Between Early Exposure to General Anesthesia and Neurobehavioral Deficits.

In contemporary medical practice, general anesthesia plays an essential role in pediatric surgical procedures. While modern anesthetic protocols have demonstrated safety and efficacy across various pathological conditions, concerns persist regarding the potential neurotoxic effects associated with early exposure to general anesthesia. Current research primarily examines the neurocognitive developmental impacts, with limited focus on neurobehavioral developmental disorders. This review presents a comprehensive analysis of clinical trial results related to five critical neurobehavioral developmental disorders: fine motor disability, attention-deficit-hyperactivity disorder (ADHD), impulse control disorders (ICDs), autism spectrum disorder (ASD), and developmental coordination disorder (DCD). Furthermore, the review synthesizes insights from basic research on the potential toxicological mechanisms of general anesthetic agents that could influence clinical neurobehavioral changes. These findings provide valuable guidance for the prudent and safe utilization of anesthetic agents in pediatric patients.

Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report.

Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (p = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (p = 0.002; p < 0.05) with no influence on the dose of IROA (p = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects.

Comparison of sedation and general anesthesia protocols for 18F-FDG-PET/CT studies in dogs and cats: Musculoskeletal uptake and radiation dose to workers.

In veterinary medicine, PET/CT scans are generally performed with the patient under general anesthesia. The aim of this prospective crossover study was to compare the musculoskeletal uptake of 18F-FDG and radiation doses to workers during PET/CT studies of healthy dogs and cats between sedation and general anesthesia. Volume and maximal standard uptake values (SUVmax) values of abnormal 18F-FDG uptake in the skeletal musculature, presence of misregistration artifact, and radiation doses to workers for each PET/CT study were recorded. Sedation was associated with increased volume of 18F-FDG uptake in the musculature of the thoracic limbs (p=.01), cervical (p=.02), and thoracic (p=.03) spine. Increased volume and SUVmax of the musculature assessed altogether were associated with the lighter degree of sedation (p=.04 for both). A significant decrease in the odds of misregistration artifact was observed for anesthetized animals in comparison with sedated (OR: 0.0, 95% CI: 0.0-0.0, p=.01). Radiation doses to workers were significantly higher for sedation compared with general anesthesia (p=.01) and for the anesthesia technician compared with the nuclear medicine technologist (p=.01). Use of sedation for PET/CT studies in dogs and cats is feasible. However, it is associated with increased physiologic musculoskeletal uptake of 18F-FDG in the thoracic limbs, cervical, and thoracic spine, with increased frequency of misregistration artifact, and with increased radiation doses to workers. These limitations can be overcome by recognition of the uptake pattern and monitoring/rotation of the involved staff at institutions where a high caseload is expected.

Effects of Intraoperative Opioid Use and a Combined Anesthesia Protocol in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder—A Single-Center Experience

Background: An increased intraoperative opioid dose seems to lead to worse outcomes in several types of cancer. We assessed the effect of intraoperatively administered opioids as well as the type of anesthesia on survival, recurrence rates and major perioperative outcomes in patients who underwent radical cystectomy (RC) for urothelial carcinoma of the urinary bladder. Methods: We included patients who underwent open RC at our center between 2015 and 2022. The role of the type and dosage of intraoperative opioid agents, such as remifentanil, sufentanil and morphine milligram equivalents (MME), as well as the type of anesthesia (intravenous only versus intravenous/epidural), was assessed regarding perioperative and long-term outcomes after RC. Results: A total of 508 patients with a median age of 73 years (IQR: 64–78) were included. Overall, 92 (18%) patients received intravenous anesthesia, whereas 416 (82%) received combined anesthesia. At a median follow-up of 270 days (IQR: 98–808), 108 (21%) deaths and 106 (21%) recurrences occurred. Combined anesthesia was associated with better survival (HR:0.63, 95% CI: 0.4–0.97, p = 0.037) and lower intensive care unit admission rates (OR: 0.49, 95% CI: 0.31–0.77, p = 0.002) in the univariate analysis (unadjusted). The type and dosage of intraoperative opioid agents did not affect long-term survival and recurrence rates, as well as major perioperative outcomes. Nevertheless, the findings of our study were limited by its single-center, retrospective design. Conclusion: The use of intraoperative opioids was not associated with worse outcomes in our cohort, while the use of additional epidural anesthesia seems to be beneficial in terms of overall survival and intensive care unit admissions. Nevertheless, further research is mandatory to validate the safety of opioids in patients undergoing RC.

Sperm collection in the domestic cat: a comparison of two techniques

Semen collection in cats in the clinic setting can be difficult. However, semen analysis is vital when evaluating breeding soundness of a male. Electroejaculation (EEJ) is currently the most reliable semen collection method but requires specialized equipment and training of the operator. Chemical ejaculation followed by urethral catheterization (UC) is a technique that allows semen collection without special equipment: a catheter is placed into the urethra of a sedated tom and semen is collected passively into the catheter. Earlier studies used the sedative medetomidine at high doses for this procedure. However, medetomidine has been replaced with dexmedetomidine in some countries. This study sought to compare the results of EEJ and UC for semen collection in the domestic cat using dexmedetomidine, a potent α2-adrenoceptor agonist (α2A), as a substitute for medetomidine at the equivalent dose to that used in earlier studies. Twelve domestic cats were collected thrice at weekly intervals. All cats received intramuscular ketamine (5 mg/kg) and intramuscular dexmedetomidine (30 μg/kg) for initial cleanout via EEJ, then randomly underwent either EEJ or UC one week apart. The EEJ was performed under the same anesthetic protocol as the initial cleanout. The UC was performed using intramuscular dexmedetomidine at a dose of 60 μg/kg. Success of collection, total sperm number, sperm morphology, and motility characteristics were analyzed. Sperm was collected successfully from all 12 cats via EEJ and from 11/12 via UC. There were no significant differences in the percentage of total motile, progressively motile, or morphologically normal sperm between ejaculate types when averaged across all cats or individual cats. Although UC yielded a lower volume and higher concentration ejaculate, it consistently produced a lower total sperm number than ejaculates retrieved via EEJ (17.91 x 106 total sperm for UC versus 46.51 x 106 total sperm for EEJ). These results indicated that dexmedetomidine is a very effective sedative and performed satisfactorily in both procedures at the doses used in this study. It was also safe with no adverse effects on healthy toms. EEJ remained the most reliable in terms of assessing semen quality and retrieving semen with adequate number of sperm for breeding purposes. However, UC with dexmedetomidine at this dose demonstrated a 92% success rate, presenting itself as a remarkably consistent alternative.

A comparative randomized study on effect of bispectral index versus end-tidal anesthetic gas concentration-guided protocol on time to tracheal extubation for isoflurane based general anesthesia

A comparative randomized study on effect of bispectral index versus end-tidal anesthetic gas concentration-guided protocol on time to tracheal extubation for isoflurane based general anesthesia

Effect of Chlordiazepoxide or Haloperidol Oral Premedication during Midazolam-Ketamine Anaesthesia on Physiological and Blood Gas Parameters in Adult Male Bonnet Macaques (Macaca radiata)

Capturing wild animals with minimal stress is crucial to reduce morbidity and mortality. Oral premedicants can ease handling and subsequent anaesthetic administration. This study evaluated anaesthetic protocols and physiological changes during vasectomy in 12 adult male Bonnet Macaques. Group I received 10 mg/kg chlordiazepoxide, and Group II received 1 mg/kg haloperidol orally four hours before midazolam-ketamine anaesthesia. Sedation quality, induction, maintenance, and recovery were assessed. Physiological and blood gas changes were monitored at 0, 5, 10, 15, and 20 minutes. Both groups exhibited sedation post-premedication. Induction, maintenance, and anaesthesia depth were similar. Group I had better analgesia, while Group II had superior muscle relaxation. Blood gas analysis indicated mild stress and respiratory acidosis in both groups, with Group II showing more significant hypoxemia and respiratory acidosis. Haloperidol-premedicated animals were easier to handle but exhibited increased stress parameters compared to chlordiazepoxide-premedicated animals. Recovery was better in Group I. Both protocols effectively induced sedation and anaesthesia in Bonnet Macaques.

The Effectiveness Of Hyperbaric Bupivacaine Administration On Hemodynamic Changes In Sectio Caesarea Patients

Background: Sectio Caesarea (SC) is a critical surgical intervention used to manage abnormal labor, addressing potential health risks for both mother and infant. Spinal anesthesia, frequently administered using hyperbaric bupivacaine, plays a crucial role in the procedure. Purpose: This study aimed to evaluate the impact of hyperbaric bupivacaine on hemodynamic parameters in SC patients at Kardinah Hospital, Tegal City. Methods: A pre-experimental design with a One-Group Pretest-Posttest approach was employed. The study utilized purposive sampling to include 67 SC patients, aged 18-40 years with a BMI &gt;18.5. Hyperbaric bupivacaine was administered as part of the anesthesia protocol. Hemodynamic parameters, including systolic and diastolic blood pressure, pulse rate, mean arterial pressure (MAP), SpO2, and respiratory rate (RR), were measured before and after administration of the anesthetic. Results: Analysis revealed a statistically significant effect of hyperbaric bupivacaine on systolic and diastolic blood pressure, pulse rate, and MAP (p = 0.00). In contrast, no significant effects were observed on SpO2 (p = 0.34) or RR (p = 0.15). Conclusions: The administration of hyperbaric bupivacaine in SC patients resulted in significant hemodynamic changes, particularly affecting blood pressure, pulse rate, and MAP. However, it did not significantly alter SpO2 or RR. These findings underscore the importance of monitoring hemodynamic parameters during spinal anesthesia to ensure patient safety and optimal management during cesarean sections

A retrospective study of anesthesia management in patients operated for neuromuscular scoliosis

Objective: Scoliosis frequently develops as a complication of neuromuscular diseases, often progressing and necessitating surgical intervention. Although complications can arise in spinal fusion surgery for all types of scoliosis, they are more frequent during and after the procedure in cases of neuromuscular scoliosis. This retrospective study aims to explore the preoperative characteristics, anesthesia protocols, as well as intra- and postoperative complications and associated conditions in patients who underwent surgery for neuromuscular scoliosis at our hospital.Material and Methods: After receiving approval from the ethics committee of our hospital, this study conducted a retrospective review of patient files from individuals who underwent surgery for neuromuscular scoliosis at Ankara Training and Research Hospital between 2008 and 2012. A total of 26 patient files were analyzed. Patient parameters including age (years), gender (female (F), male (M)), weight (kg), presence of neuromuscular disease, concomitant cardiovascular and respiratory conditions, as well as other systemic anomalies and diseases, spirometry findings (FEV1, FVC, FEV1/FVC), nutritional status (total protein, albumin), pre-operative hemoglobin (Hg) and hematocrit (Htc) levels, Cobb angle index, angle direction, type of surgical approach (anterior or posterior), muscle relaxants utilized, additional dosage requirements, operation duration, intraoperative bleeding volume (ml), transfusion volume (ml), and intraoperative complications were documented. Results: As the Cobb angle increased, several factors were affected: the duration of the operation was extended (p &lt; 0.05), there was an increase in blood loss (p = 0.012), and more blood transfusions were required (p = 0.32). Furthermore, there was a correlation between increasing age and the amount of blood transfused (p = 0.035). Conclusion: It has been concluded that a comprehensive preoperative assessment is crucial, as it can offer valuable insights into anesthesia management both before and after surgery for scoliosis. Therefore, conducting a detailed preoperative evaluation is essential for patients undergoing these procedures

Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia.

Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity. To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery. This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups. The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (P < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (P > 0.05). The number of CD3+, CD4+, and CD4+/CD8+ cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8+ cells was lower in the observation group than in the control group (P < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (P > 0.05). The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Efficacy of Erector Spinae Plane Block on Postoperative Analgesia for Patients Undergoing Metabolic Bariatric Surgery: A Randomized Controlled Trial.

Metabolic bariatric surgery (MBS) advocates multimodal analgesia, discouraging opioid use to minimize side effects, such as nausea and vomiting, during postoperative pain management for quicker recovery. Combining erector spinae plane block (ESPB) with multimodal analgesia aims to reduce opioid consumption, improving postoperative recovery. This study aimed to compare morphine consumption between patients with severe obesity undergoing laparoscopic MBS with and without ESPB. This study enrolled 91 patients with severe obesity who underwent laparoscopic MBS involving either sleeve gastrectomy or Roux-en-Y gastric bypass. Of these, 63 patients were included in this study. The participants were randomly allocated to either the intervention group, which received an ESPB before the standard anesthesia protocol, or the control group, which did not receive pre-anesthesia block. The primary outcome measured was 24-h morphine consumption via a patient-controlled analgesia machine. Secondary outcomes included patients' satisfaction, postoperative numerical rating score, changes over time, and quality of recovery (QoR) using the Thai QoR-35 score. We found no statistically significant difference in morphine consumption between the intervention group and the control group. Furthermore, our analysis revealed no significant between-group differences in patient satisfaction, postoperative numeric rating score, or QoR across all five aspects evaluated using the Thai QoR-35 score. ESPB did not reduce morphine consumption or QoR following laparoscopic MBS. Further studies are required to confirm and identify the reasons for the ineffectiveness of ESPB.

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.