Anesthesia-related Complications Research Articles

Incidence of Complications in Obese Patients Undergoing Elective Spine Surgery Under General Anesthesia: A Retrospective Study

Abstract Background The prevalence of obesity has been increasing worldwide. Simultaneously, the number of obese patients undergoing anesthesia and the risk of anesthesia-related complications are increasing. Our study aimed to identify the incidence of intraoperative anesthetic complications in obese patients undergoing elective spine surgery. Methods Electronic medical records of patients with a body mass index (BMI) ≥ 30 kg/m2 who underwent elective spine surgery at the Neurological Institute of Thailand between January 2018 and December 2020 were retrospectively reviewed. The primary outcome was the incidence of five anesthetic adverse events: difficult intubation, oxygen desaturation, hypotension, major adverse cardiac and cerebrovascular events (MACCE), and pressure skin lesions. Logistic regression was used for statistical analysis. Results A total of 165 obese patients' medical records were analyzed. Their mean age was 56.8 ± 11.9 years, and median BMI (interquartile range) was 32.04 kg/m2 (31.11–34.69 kg/m2). Fifty-one patients (30.9%) experienced adverse events. Six patients (3.6%) with class 3 obesity had anesthetic complications. The most common adverse event was intraoperative hypotension (26.7%), followed by pressure skin lesions (4.2%), intraoperative oxygen desaturation (1.2%), and MACCE (0.6%). No difficult intubations or deaths occurred. Conclusion The incidence of overall intraoperative anesthetic complications in obese patients undergoing spine surgery was 30.9%, and class 3 obesity was an independent risk factor for these complications. Consequently, well-trained, vigilant, and experienced anesthesiologists should manage anesthesia in these patients.

Effects of Three Different Heating Devices on Patients Undergoing Surgery: A Network Meta-Analysis

PurposePerioperative hypothermia is a common anesthesia-related complication that can result in negative outcomes. Intraoperative active heating can affect patients. Therefore this study aimed to investigate the effectiveness of three common heating devices for controlling hypothermia, improving thermal comfort, and reducing anesthesia recovery time. DesignSystematic review and meta-analysis MethodsSeven electronic literature databases were searched from the inception date of the databases to March 18, 2022. RevMan 5.4 and Stata 15.1 were used to perform meta-analyses on the obtained data, and the Cochrane Evaluation Manual was used for quality risk assessment of the included studies. ResultsA total of 18 studies involving 1511 patients undergoing surgery using heating devices were included. In this meta-analysis, a ranking method known as the Surface Under the Cumulative Ranking Curve (SUCRA) was utilized. SUCRA provides a numerical measure of the effectiveness of treatments, with higher values indicating superior efficacy. The findings from this meta-analysis demonstrated that the concurrent use of three heating devices led to an elevation in core body temperatures (SUCRA = 69.2%) and enhanced delayed recovery (SUCRA = 88.6%), as compared to the application of a single device. Furthermore, for thermal comfort, the employment of heating blankets proved to be the most effective (SUCRA = 87.8%). ConclusionThis study showed the core body temperatures and improved delayed recovery were greater when three heating devices compared to use one of them alone, and the use of heating blankets was the most effective option for improving the thermal comfort of patients. Thus, clinicians should opt for appropriate heating equipment according to the type of surgery and the characteristics and needs of patients. The choice of appropriate heating equipment will ensure surgical safety, improve patient comfort, and reduce surgical risks.

The Scheduling Mode of Anesthesia Nurses Affects Postanesthesia Care Unit Efficiency: A Single-Center Retrospective Study From China

PurposeAnesthesia nurses play an important post-surgical role during anesthesia recovery period, which is characterized by a high incidence of complications related to anesthesia and surgery. Strengthening staff allocation and skill management in LOS (PACU) is therefore particularly important. We aim to investigate the effect of two schedule modes for anesthesia nurses on PACU efficiency. DesignA retrospective observational cohort study. MethodWe conducted a retrospective study in a large tertiary academic medical center. In 2018, the PACU operated with traditional scheduling and the nurse-to-patient ratio was 1.2:1. The PACU implemented intensive scheduling and this ratio was adjusted to 1:1 in 2019 by adjusting the anesthesia nurse allocation scheme. We compared the number of admitted patients, length of PACU stay, the incidence of anesthesia-related complications, and nurse satisfaction with the two modes. FindingsThe total number of admitted patients was 10,531 in 2018 and 10,914 in 2019. PACU admitted 401 more patients in 2019 than in 2018, even with 2 fewer nurses per day. Nevertheless, the median length of PACU stay in 2019 was statistically significantly shorter than in 2018 [29 (22–40) vs. 28 (21–39), P＜0.001], while the incidence of anesthesia-related complications including postoperative pain, nausea and vomiting, hypertension, and shivering were comparable in the two years (P > 0.091). The intensive scheduling implemented in 2019 received more satisfaction from nurses than the traditional scheduling applied in 2018 (P < 0.01). ConclusionThe scheduling of anesthesia nurses affects PACU efficiency. The intensive scheduling mode implemented in 2019 resulted in a comparable number of admitted patients, a better quality of care, and higher nurse satisfaction than those under the traditional scheduling mode.

A Comparison of Perioperative Complications and Outcomes in Patients Undergoing Cerebral Aneurysm Clipping Performed Ultra-Early (≤ 24 hours) versus Late (&gt; 24 hours): A 7-Year Retrospective Study of 302 Patients

Abstract Objectives The intracerebral aneurysm with subarachnoid hemorrhage (SAH) has a high morbidity and mortality rate. This study aimed to compare the incidences of perioperative complications in ultra-early surgery (within 24 hours) with those in late surgery (&gt; 24 hours). Methods Retrospective data were reviewed for 302 patients who underwent craniotomies with aneurysm clipping between January 2014 and December 2020. Perioperative data were obtained from the medical records and reviewed by the investigators. The complications were compared between ultra-early and late operations. We were interested in major complications such as delayed ischemic neurologic deficit (DIND), intraoperative aneurysm rupture (IAR), and anesthesia-related complications. The short-term (in hospital) and long-term (1 year) outcomes in patients with or without DIND and IAR were compared. The collected data was statistically analyzed. Results Three hundred and two patients were analyzed, and 264 patients had completed follow-up. The ultra-early cases (150 patients) had a higher American Society of Anesthesiologists physical status, a lower Glasgow Coma Scale, and higher Hunt and Hess scales. The surgeons operated on more cases of the anterior cerebral artery as ultra-early operations. The incidence rates of DIND, IAR, severe hemodynamic instability, and cardiac arrest were 5.6, 8.3, 6.3, and 0.3%, respectively, which were not different between groups. However, the reintubation rate was higher in the ultra-early surgery cases (0 vs. 3.3%, p = 0.023). The DIND and IAR patients had poorer short-term (in hospital) outcomes. Conclusions There were no differences in major complications between ultra-early and late craniotomy with aneurysm clipping. However, the reintubation rate was strikingly higher in the ultra-early group. Patients with major complications had early, unfavorable outcomes.

Marijuana Use Increases Risk of Hematoma Formation in Patients Undergoing Abdominal Body Contouring Surgery

Abstract Goals/Purpose The physiological effect of marijuana is thought to include platelet inhibition and poor wound healing, however, there is mixed clinical evidence in the plastic surgery literature regarding this topic. As marijuana usage continues to increase, this study sought to identify the effect of marijuana on postoperative complication rates in patients undergoing abdominal body contouring surgery (ABCS) while controlling for tobacco consumption and other comorbidities. Methods/Technique A retrospective cohort study was conducted in patients who underwent panniculectomy or abdominoplasty at our institution between 2016 and 2021. Patients were separated into groups of active (at time of surgery), former, and no marijuana use. Demographic characteristics, smoking history, laboratory results, comorbidities, operative details, and postoperative complications including hematoma, deep vein thrombosis (DVT) and pulmonary embolism (PE), and wound healing complications were analyzed. Parametric, nonparametric, and multivariable regression modeling was used for analysis. Results/Complications 815 patients who underwent panniculectomy or abdominoplasty were included in the study. 61 patients (7.5%) reported active marijuana use at time of their surgery, and 31 patients (3.8%) reported former marijuana use (defined as last use &amp;gt;2 months prior). Patients who reported any marijuana use were significantly younger (40.5 years vs 45.9 years; p&amp;lt;0.0001) and more likely to identify as Black (OR=2.34; p=0.005). Any marijuana use was significantly associated with reported tobacco use (OR=4.80; p&amp;lt;0.001; 95% CI 1.69-12.69) After adjusting for age, BMI, tobacco use, platelet count, and comorbidity index, active marijuana use was associated with significantly higher risk of hematoma formation (OR=2.55; P= 0.03; 95% CI 1.12-6.55) as well as any complication combined (OR=1.73; p=0.02, 95% CI 1.15-3.56). Other complications, including venous thromboembolism, infection, seroma, umbilical necrosis, wound dehiscence, or anesthetic-related complications were not significantly associated with reported marijuana use. Conclusion When controlling for multiple confounders, marijuana use appears to be independently associated with increased risk of hematoma development in patients undergoing abdominal body contouring surgery with either abdominoplasty or panniculectomy. Further research is warranted to investigate the exact relationships and mechanisms of action behind this finding.

Climate Change, Emerging Vector-Borne Illnesses, and Anesthetic Considerations.

As a result of the widespread prevalence of anesthetic usage, anesthesia-related complications are well studied, ranging from benign postoperative nausea and vomiting to potentially fatal complications, such as paralysis, malignant hyperthermia, and death. However, one intersection that still needs further analysis is the relationship between vector-borne illnesses (VBIs) and anesthetic complications. With the advent of climate change and global warming, what were previously endemic vectors have spread far beyond their typical regions, resulting in the spread of VBI. As the incidence of VBIs rapidly increases in the United States, operations for diagnostic testing, and thus the identification and treatments of these VBIs, have significantly diminished. A literature review was conducted to analyze case reports of patients with VBIs and anesthetic concerns with sources from PubMed and Google Scholar databases, and a wide range of complications were found.

Why Craniofacial Surgeons/Researchers Need to be Aware of Native American Myopathy?

Congenital myopathy type 13 (CMYO13), also known as Native American myopathy, is a rare muscle disease characterized by early-onset hypotonia, muscle weakness, delayed motor milestones, and susceptibility to malignant hyperthermia. The phenotypic spectrum of congenital myopathy type 13 is expanding, with milder forms reported in non-native American patients. The first description of the disease dates to 1987 when Bailey and Bloch described an infant belonging to a Native American tribe with cleft palate, micrognathia, arthrogryposis, and general-anesthesia-induced malignant hyperthermia reaction; the cause of the latter remains poorly defined in this rare disease. The pan-ethnic distribution, as well as its predisposition to malignant hyperthermia, makes the identification of CMYO13 essential to avoid life-threatening, anesthesia-related complications. In this article, we are going to review the clinical phenotype of this disease and the pathophysiology of this rare disease with a focus on two unique features of the disease, namely cleft palate and malignant hyperthermia. We also highlight the importance of recognizing this disease's expanding phenotypic spectrum-including its susceptibility to malignant hyperthermia-and providing appropriate care to affected individuals and families.

Factors influencing decision-making for the anesthetic technique in molar pregnancy patients for suction curettage: A retrospective study

Anesthetic techniques for suction curettage in molar pregnancy patients described in the literature can be classed into general anesthesia and regional anesthesia techniques. The aim of the present study was to report the factors influencing the decision-making for the choice of anesthetic technique in molar pregnancy patients who underwent suction curettage at Siriraj Hospital. The reported intraoperative and postoperative complications were also analyzed.A retrospective chart review was conducted among pregnant women diagnosed with molar pregnancy who had underwent suction curettage under anesthesia at Siriraj Hospital between January 2007 to September 2021. Overall, 244 patients were diagnosed with molar pregnancy, with 110 of these included for analysis in this study after consideration of the inclusion and exclusion criteria. Quantitative data of the included patients were analyzed by either unpaired t-test or Mann–Whitney U test, while qualitative data were analyzed by the chi-square test. Logistic regression was used to establish the factors influencing the decision-making for the anesthetic technique.General anesthesia was the most preferred anesthetic technique (77.4%) in the molar pregnancy patients who had underwent suction curettage, followed by regional anesthesia (11.3%) and intravenous sedation (11.3%). General anesthesia was likely to be used in patients with an enlarged uterine size ≥ 16 weeks with an adjusted odds ratio of 11.64 (95% CI 1.08–125.72, p &amp;#60; 0.05). Patients with a larger uterine size were associated with higher beta-hCG levels, resulting in more severe medical complications, such as hyperthyroidism and hyperemesis gravidarum (p &amp;#60; 0.05). Intraoperative complications, such as uterine atony (17.7%), massive hemorrhage (7.3%), and pulmonary edema (4.2%), were confined within patients receiving general anesthesia, but there was no statistical significance. None of the patients had anesthesia-related complications. The reported postoperative serious complications, such as pulmonary edema (4.2%), which required postoperative intubation and transferal to the intensive care unit, were all in the general anesthesia group. Patients with higher co-morbidities were advised by anesthesiologists to receive general anesthesia. However, an enlarged uterine size ≥ 16 weeks was the only factor that had an influence on the decisions of the anesthesiologists to provide general anesthesia.

Effect of target-controlled infusion of remifentanil in combination with propofol on anesthesia and endotracheal intubation response in patients undergoing surgical aneurysm clipping

Purpose: To investigate the effect of target-controlled infusion of remifentanil in combination with propofol on anesthesia and endotracheal intubation response in patients undergoing surgical aneurysm clipping. &#x0D; Methods: The clinical data of 106 patients undergoing surgical aneurysm clipping at the Central Hospital of Wuhan, Wuhan City, China from September 2020 to December 2022 were retrospectively analyzed. Subjects in control group were given fentanyl intravenous infusion anesthesia while study group was treated with target-controlled infusion anesthesia of remifentanil combined with propofol. Hemodynamics and blood-gas indices were evaluated before anesthesia (T1), immediately after endotracheal intubation (T2) and at extubation (T3). The incidence of anesthesia-related complications was determined. &#x0D; Results: In study group, the agitation score was decreased compared to that of control group, while the Ramsay sedation score was increased (p &lt; 0.05). The incidence of cough during endotracheal catheter indwelling and extubation was 7. 27 % in study group, which was less than 21. 57 % in control group (p &lt; 0.05). The cough score of study group was also reduced (p &lt; 0.05). There were no significant differences in the SpO2 and PetCO2 values between the two groups at different times (p &gt; 0.05). Furthermore, the mean arterial pressure at T2 and T3 was upregulated and heart rate (HR) was downregulated in study group (p &lt; 0.05). Recovery time of spontaneous respiration, time of eye-opening and extubation in study group were decreased compared to control group (p &lt; 0.05). &#x0D; Conclusion: Target-controlled infusion of remifentanil in combination with propofol improves anesthetic effect in patients undergoing surgical aneurysm clipping, reduces tracheal intubation reaction, maintains hemodynamic stability and improves recovery quality of patients. Future study will be required to evaluate the efficacy and optimal effective concentration in a diverse population.

Nanotherapeutics for Alleviating Anesthesia-Associated Complications.

Current management of anesthesia-associated complications falls short in terms of both efficacy and safety. Nanomaterials with versatile properties and unique nano-bio interactions hold substantial promise as therapeutics for addressing these complications. This review conducts a thorough examination of the existing nanotherapeutics and highlights the strategies for developing prospective nanomedicines to mitigate anesthetics-related toxicity. Initially, general, regional, and local anesthesia along with the commonly used anesthetics and related prevalent side effects are introduced. Furthermore, employing nanotechnology to prevent and alleviate the complications of anesthetics is systematically demonstrated from three aspects, that is, developing 1) safe nano-formulization for anesthetics; 2) nano-antidotes to sequester overdosed anesthetics and alter their pharmacokinetics; 3) nanomedicines with pharmacodynamic activities to treat anesthetics toxicity. Finally, the prospects and challenges facing the clinical translation of nanotherapeutics for anesthesia-related complications are discussed. This work provides a comprehensive roadmap for developing effective nanotherapeutics to prevent and mitigate anesthesia-associated toxicity, which can potentially revolutionize the management of anesthesia complications.

(040) Local Anesthesia Only for Penile and Scrotal Procedures: A Prospective Analysis of Patient Tolerability as an Alternative to Sedation

Abstract Introduction Traditionally, urological procedures utilize general or spinal anesthesia (GA) in an operating room (OR) to achieve adequate periprocedural pain relief. However, this approach presents various obstacles, including high OR related expenses, difficulties in accessing healthcare in rural areas, higher risk of anesthetic related complications and long wait times for patients due to limited OR space. This is particularly evident in penile and scrotal procedures, which often receive non-urgent treatment and result in wait times exceeding six months in Canada. The use of local anesthesia (LA) only is an appealing approach that has been gaining more traction in recent literature – however, no study to date has evaluated patient-reported tolerability to procedures conducted in this manner. Objective To investigate the surgical outcomes and patient-reported tolerability of penile and scrotal urologic procedures performed solely under LA. Additionally, information regarding complications is collected to provide data regarding the safety of this method, offering a viable alternative without the need for sedation. Methods This prospective study is registered as a clinical trial NCT05617261. Adult patients undergoing penile or scrotal surgery under LA only have been enrolled since August 2022, and is ongoing until August 2023. Procedures of interest include hydrocelectomies, spermatocelectomies, epididymectomies, testicular biopsies, circumcisions and frenulectomies. For scrotal procedures LA is administered along the median raphe along with a spermatic cord block, and for penile procedures a subcutaneous ring and dorsal penile block is utilized. Demographics, surgeon- and patient-reported visual analogue pain scores (VAS), and surgical variables are collected. Patient tolerability to the procedure and future anesthetic choice for a hypothetical repeat procedure are assessed at a follow-up appointment as our primary outcome. Complication data is also collected including recurrence (if applicable), emergency room visits, excess pain, hematoma &amp; infection. Statistical tests include analyses to determine associations between demographic or surgical variables and patient-reported outcomes. Results Thus far, 215 patients are enrolled with complete follow-up data and statistical analysis on 72 patients. The mean age ± SD is 42.2 ± 16.4 years and there has been a 100% success rate with no perioperative complications or conversions to sedation or general anesthetic. Table 1 highlights the current patient demographic differences between those who do or do not recommend LA. Table 2 describes VAS at each point in time. On follow-up, 93.1% of patients indicated they would opt for LA for a hypothetical repeat procedure, with Figure 1 illustrating this by procedure type. Of the minority opting for GA, only 2 patients did so due to excess pain – highlighting that patient tolerability is not a limiting factor; instead, a desire to have no memory of the procedure is prevalent in this small cohort. Conclusions LA only is a promising technique for various scrotal and penile urologic procedures with high levels of patient tolerability. As we continue our analysis, we anticipate minimal complication rates similar to existing literature and data highlighting cost savings to our public health care system with a substantial reduction in patient wait times and surgical and recovery times – allowing for increased surgical efficiency and accessibility. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Comparison of the Effect of Landmark-Based Midline and Paramedian Approaches on Spinal Anesthesia-Related Complications in Adult Patients: A Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: Spinal anesthesia is widely used in various types of surgery. However, several complications can occur afterward. This study aimed to identify differences in the incidence of anesthesia-related complications according to the approach methods (midline versus paramedian) for landmark-based spinal anesthesia. Materials and Methods: We searched electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, for eligible randomized controlled trials. The primary outcome was post-dural puncture headache (PDPH) incidence, and secondary outcomes were low back pain (LBP) incidence and success rate in the first trial of spinal anesthesia. We estimated the odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. Results: In total, 2280 patients from 13 randomized controlled trials were included in the final analysis. The incidence rates of PDPH were 5.9% and 10.4% in the paramedian and midline approach groups, respectively. The pooled effect size revealed that the incidence of PDPH (OR: 0.43, 95% CI [0.22-0.83]; p = 0.01; I2 = 53%) and LBP (OR: 0.27, 95% CI [0.16-0.44]; p < 0.001; I2 = 16%) decreased, and the success rate in the first attempt was higher (OR: 2.30, 95% CI [1.36-3.87]; p = 0.002; I2 = 35%) with the paramedian than with the midline approach. Conclusions: Paramedian spinal anesthesia reduced PDPH and LBP and increased the success rate of the first attempt.

Our Experience in Transcatheter Aortic Valve Implantation (TAVI) from the Anesthesiologist's Perspective: A Single-Center Retrospective Study

Objectives This study is aimed to review the perioperative complications, morbidity, and mortality rates of patients undergoing TAVI at our tertiary care hospital. Material and Methods The data for this retrospective study including 34 patients was collected from medical records of the patients. Statistical analyses were performed using SPSS 26 programme. The results were considered statistically significant at p&lt;0.05. Results The study cohort, predominantly the elderly population (mean age 77.3 years), underwent TAVI under local anesthesia and sedation. Anesthetic induction involved fentanyl, ketamine and midazolam, with adjustments using propofol as needed. Hypotension emerged as the most common anesthesia-related complication. Importantly, the procedure was completed with conscious sedation in all cases that are not complicated by surgery, with no instances of respiratory complications. The most frequent procedure-related complication was atrioventricular bundle branch block. Postoperative outcomes demonstrated a significant reduction in aortic valve parameters, validating the efficacy of the procedure. Notably, the 30- and 90-day mortality rates were 0%, indicating favorable short-term survival. The study highlighted the importance of maintaining hemodynamic stability through vasopressors, with noradrenaline being the preferred choice. While the overall length of hospital stay averaged six days, the study emphasized the evolving landscape of TAVI, with shorter hospitalizations attributed to increasing procedural experience and refined anesthetic approaches. The need for permanent pacemaker was observed in 20% of cases. Conclusion This comprehensive analysis contributes valuable insights into the evolving field of TAVI, emphasizing the role of experienced anesthesiologists in optimizing patient outcomes. The study underscores the importance of refining anesthesia protocols, staying abreast of emerging guidelines and developing solution algorithms for emergency scenarios, ultimately enhancing the safety and efficacy of TAVI procedures in a rapidly expanding patient population.

A Prospective Randomized Controlled Double Blinded Interventional Study to Compare Post Operative Analgesia Using Sequential Intrathecal Injection of Fentanyl at Different Rates with Hyperbaric Bupivacaine in Lower Segment Caesarean Sections

Background: This study compared rapid and slow intrathecal fentanyl injection followed by a slow injection of bupivacaine to estimate the duration of postoperative analgesia in lower-segment caesarean sections (LSCS). Methods: The study was performed on 60 parturient aged 18-35 years undergoing LSCS and was divided equally into two groups. Group A (Normal Sequential) received slow sequential intrathecal injections of fentanyl and hyperbaric bupivacaine and Group B (Rapid Sequential) received a rapid intrathecal injection of fentanyl followed by a slow injection of hyperbaric bupivacaine. We compared the duration of postoperative analgesia, time of onset of sensory and motor block attained, the highest level of sensory block attained, duration of motor block, Visual Analogue Scale (VAS) scores, spinal anaesthesia-related complications and haemodynamic parameters between both the groups. Results: The duration of postoperative analgesia was longer (P &lt; 0.001) in group B (3.22 ± 0.66 hrs) as compared to group A (2.53 ± 0.41 hrs.) The onset of sensory block was faster (P &lt; 0.001) in group B (1.01 ± 0.29 min) as compared to group A (1.32 ± 0.08 min). More patients in group B achieved higher levels of sensory blockade as compared to group A (5 patients in group A and 12 patients ofgroup B achieved a sensory block up to the T2 dermatome). VAS scores and the requirement of rescue analgesia were significantly lower (10 in group B and 19 in group A). Conclusion: Rapid sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided better anaesthesia and postoperative analgesia than the normal group.

Prevalence of co-morbidities and referral patterns in routine preoperative evaluation: A retrospective observational analysis in a tertiary care government hospital

The initial interaction between patients and anaesthesiologists during pre-anaesthesia check-ups (PAC) is a crucial opportunity to diagnose and pre-optimize co-morbidities that might go unnoticed. This proactive approach contributes to safe anaesthesia administration, uneventful intra-operative experiences, and smooth post-operative recovery. Our study assesses the prevalence of diverse co-morbidities within a tertiary care centre's PAC. After analysing data from 3 months involving 905 patients, 624 individuals exhibited co-morbidities, with 217 cases being newly identified within the PAC clinic. Among female patients, anaemia emerged as the most prevalent anomaly (219 cases), while hypertension dominated among male patients (171 cases). Overall, anaemia constituted the most common co-morbidity (362 cases). A comprehensive clinical assessment during the Pre-Anaesthetic Clinic empowers formulation strategies for pre-optimization and treatment of co-morbidities. Timely intervention is pivotal, not only to prevent surgery delays but also to avert potentially catastrophic outcomes arising from untreated conditions. This approach translates into expedited patient recovery, minimizing anaesthesia-related complications. The Pre-Anaesthetic Clinic plays a pivotal role in diagnosing and intervening in patient co-morbidities. Beyond diagnosis, it is a crucial early intervention and treatment platform, significantly enhancing the overall surgical recovery process.

Enhanced recovery and same-day discharge after brain tumor surgery under general anesthesia: initial experience with Hospital-at-Home-based postoperative follow-up.

The objective of this study was to describe the outcomes of outpatient oncological neurosurgery (OON) in a European clinical setting and to compare them with the conventional inpatient protocol. Patients who had undergone OON (either tumor removal or biopsy) at the authors' center since 2019 were analyzed. A matched cohort of patients was selected from patients undergoing tumor surgery in the same period. Collected data included patient demographics, postoperative progress, specific location of the target lesion, and the procedure performed. There were 18 patients in the case group and 59 patients in the control group. The outpatient surgeries had a same-day discharge rate of 89%, and all ambulatory patients successfully completed the Enhanced Recovery After Surgery program within 6.24 hours of the procedure. All ambulatory patients underwent Hospital-at-Home postoperative follow-up for an average of 4.12 days. Radiological complications were present in 11% of the case group and 8% of the control group. Postoperative neurological deficit occurred in 6% of the same-day discharge group and 3% of the control group. Among the patients in the control group, 3% suffered from postoperative seizures, whereas no seizures were observed in the case group. These differences were not statistically significant. General anesthesia-related complications were not observed in any of the patients. The authors' findings demonstrate that Enhanced Recovery After Surgery protocols and same-day discharge craniotomy for tumor resection and image-guided biopsy under general anesthesia, when patients are carefully selected, can be safely performed with excellent outcomes in a European clinical setting. The OON program proved to be a viable alternative to conventional hospitalization, showing comparable safety records and offering advantages in terms of patient recovery.

Anesthetic management for surgery in a nemaline myopathy patient with difficult airway: A CARE-compliant case report.

Nemaline myopathy (NM) is a congenital disease characterized by nonprogressive or slowly progressing muscle weakness and may increase the risk of anesthesia in case of respiratory muscle or cardiac involvement. Care should be taken to prevent respiratory failure after surgery. A 35-year-old man with NM, who had difficult airway, restrictive ventilatory pattern, and pulmonary hypertension, required general anesthesia for surgery because of limited mouth opening. The patient was diagnosed with NM (ACTA1 mutation) and coronoid hyperplasia. Awake fiberoptic nasal intubation was performed following preparations for analgesia. General anesthesia was maintained using inhalational anesthetics and opioids without using neuromuscular blocking agents. General anesthesia remained well maintained during surgery, with no movement or spontaneous breathing of the patient and he recovered from anesthesia uneventfully without complications. This report highlights the safe performance of anesthesia induction and recovery in a case where anesthesia management is necessary for surgery in a patient of NM at a high risk of anesthesia-related complications.

Evaluating Patient Tolerability for Urological Procedures Under Conscious Sedation: A Prospective Study

PurposeAdministration of general or spinal anesthesia is associated with anesthetic-related complications, long wait times and high costs. Using intravenous conscious sedation and/or local anesthesia is an emerging alternative for a myriad of urologic procedures. Our objective was to prospectively evaluate patient-reported and surgical outcomes of urologic procedures with conscious sedation with or without local anesthesia. MethodsPatients were enrolled from June to Aug 2021 at a tertiary care hospital. All procedures were completed using fentanyl, midazolam or both with patient and procedural data recorded upon completion. Patients were telephoned 4-6 weeks post-procedure with a standardized patient tolerability questionnaire. A multivariable adjusted logistic regression analysis was performed to evaluate whether a patient would opt for conscious sedation again as opposed to general anesthesia. ResultsA total of 196 procedures were performed by 6 attending urologists with an overall success rate of 98.5% and 0% intraoperative complication rate. At 4-6 weeks follow-up, 85.6% of patients reported they would opt for conscious sedation as opposed to general anesthesia. Predictors of opting for conscious sedation in the future was older age (OR: 1.049; p = 0.017) and surgeon perceived level of patient tolerability (OR: 2.124; p < 0.001, scored 1-10). ConclusionPhysician directed, nursing administered IV conscious sedation is a viable alternative for various urologic procedures and has minimal risk of perioperative complications.

Polidocanol sclerotherapy for the treatment of aneurysmal bone cyst, with or without pathological fractures: A prospective, comparative study

IntroductionPolidocanol sclerotherapy in the treatment of aneurysmal bone cysts (ABCs) with or without pathological fractures has been a topic of debate. While some studies recommend intralesional curettage as the preferred treatment, others suggest intralesional sclerosants as an effective alternative. Material and methodsThis study evaluates the use of polidocanol-based percutaneous sclerosant therapy in 28 patients with ABCs, of which 8 patients had pathological fracture. The patients received injections every four weeks based on clinical and radiological evaluation of the cyst, and the study assessed the results and complications of the treatment. ResultsIn group A (without pathological fractures), 14 out of 17 (82.4 %) lesions healed without any significant residual lesion. Three out of 17 (17.6 %) patients required further surgical intervention and were treated by curettage and bone grafting, definitively. Minor local inflammatory reaction was observed in 3 patients, which resolved without intervention within 3–4 days. In group B, all the 8 patients (100 %) with pathological fracture in their lesions healed as Grade 1 healing, without any significant residual lesion. One patient developed an episode of anesthesia related complication (delayed recovery) which resolved within an hour, without any residual effect. At final follow up, no recurrence was seen in any patient. ConclusionThe study concludes that polidocanol sclerotherapy is an effective treatment option for patients with ABCs, with or without pathological fractures, and has the potential to become the new treatment of choice for pathological fractures due to its low invasiveness, low morbidity, and affordability. However, further research is needed to confirm the efficacy of polidocanol sclerotherapy in larger patient populations and to compare its effectiveness with other treatment options.

Anesthesia in patients with electrical burn: A retrospective study

Aim: We aimed to share our anesthesia experiences with patients hospitalized for electrical burns and underwent surgical intervention under anesthesia in the burn clinic of our hospital.Method: Data gained from our hospital's patient files and medical information system were retrospectively evaluated. The study included patients diagnosed with electrical burns hospitalized in our burn clinic in 2018-2022.Results: The study involved files of a total of 694 patients. Fifty (7.2%) patients were treated for electrical burns. The required data from 3 of the patients could not be accessed, therefore the study was completed including 47 patients. We found that 22 patients did not need surgical treatment. Twenty-five were given anesthesia for different surgical procedures: 20 of those received general anesthesia, while five underwent neuraxiel anesthesia/regional anesthesia. There were no anesthesia-related complications in any patients in the perioperative period.Conclusions: Anesthesia applications should be carefully planned against possible complications in patients with electrical burns.