Safe Anesthesia Research Articles

Enhance the management of perioperative crisis events, improve the safety and quality of pediatric anesthesia

Perioperative crisis events refer to unexpected seriously life-threatening when the patient is during or after surgery, and require rapid identification, evaluation, and management by clinical teams to minimize harm. The pediatric anesthesia management during perioperative period is special and challenging for anesthesiologists, requiring professional technical and non-technical skills. The article mainly elaborates on the incidence and risk factors of pediatric anesthesia crisis events during perioperative period and introduces the concept of anesthesia crisis resource management and strategies. The anesthesiologist team needs to adopt a crisis resource management strategy, taking a typical crisis event of malignant hyperthermia as an example, including identification of crisis signs immediately, termination of trigger drugs rapidly, intravenous injection of the special drug dantrolene, physical cooling, and symptomatic support treatment, seeking assistance from other teams actively, recording and feeding back. This study aims to improve the cognitive decision-making ability and teamwork ability of anesthesiologists and their teams, effectively preventing and responding to potential crisis events effectively, and ensuring the safety of pediatric patients during perioperative period.

Using Virtual Reality to teach ultrasound-guided needling skills for regional anaesthesia: A randomised controlled trial

Study objectiveWe previously designed and validated a virtual reality-based simulator to help train novices in ultrasound-guided needling skills necessary for safe and competent ultrasound-guided regional anaesthesia. This study was designed to compare the performance and error rates of novices trained by a human faculty aided with the assistance of this virtual reality simulator (virtual reality-assisted training), versus novices trained wholly by humans (conventional training). Design, setting, and participantsIn this single centre, randomised controlled study, we used a standardised teaching protocol, rigorous blinding, iterative training of assessors, and validated global rating scale and composite error score checklists to assess skills learning of novice participants. Main resultsWe recruited 45 novices and scored 270 assessments of performance and error rates. Inter-rater correlation coefficient of reliability of scoring between assessors for the global rating scale was 0.84 (95%CI 0.68–0.92) and for the composite error score checklist was 0.87 (95%CI 0.73–0.93). After adjustment for age, sex, Depression, Anxiety and Stress-21, and baseline score, there was no statistical difference for virtual reality-assisted training compared to conventional training in final global rating score (average treatment effect −3.30 (95%CI-13.07–6.48), p = 0.51) or in the final composite error score (average treatment effect 1.14 (95%CI -0.60–2.88), p = 0.20). Realism in the virtual reality simulator was similar to real-life when measured by the Presence Questionnaire, all components p > 0.79; and task workload assessed by the NASA-Task Load Index was not statistically different between groups, average treatment effect 5.02 (95%CI -3.51–13.54), p = 0.25. Results were achieved in the virtual reality-assisted group with half the human faculty involvement. ConclusionNovices trained using a hybrid, virtual reality-assisted teaching program showed no superiority to novices trained using a conventional teaching program, but with less burden on teaching resources.

Anaesthetic practices and attitudes to patient safety in a sample of Australian veterinary practices

ObjectiveTo survey anaesthetic practices and attitudes towards veterinary patient safety in Australia. Study designThis was a cross-sectional sample population from Australian veterinary practices, including first opinion small animal, mixed animal and referral small animal practices. The survey included practices’ anaesthetic management, monitoring equipment and topics regarding patient safety. ResultsResponses were obtained from 310/1700 (18%) veterinary practices, with 208 respondents from small animal practices (67%), 71 mixed animal practices (23%) and 31 referral small animal centres (10%). Overall, 61% of respondents reported always having a dedicated staff member monitoring the anaesthetic, who was most commonly a certified veterinary nurse (89%). In 22% of the practices, some of the staff monitoring an anaesthetic did not have any qualification. Completion of anaesthetic plans for each animal prior to an anaesthetic was reported by 24.5% of respondents and labelling of syringes was completed in 80% of practices. Pulse oximetry (98%) and temperature (88%) were the most common clinical variables monitored. The use of capnography (46%) or an electrocardiogram (48%) was also reported by the respondents. Emergency drugs, airway and ventilation equipment are available in 96%, 88% and 59% of practices, respectively. A defibrillator was available in 11% of practices with only 54% respondents being confident in using it. Of the respondents 60% were aware of anaesthesia safety interventions and clinical guidelines regarding patient safety during anaesthesia. Conclusions and clinical relevanceDespite practices showing a relative improvement over the years in the standard of anaesthesia care, most of them are still not meeting international guidelines. Areas where changes could lead to improved safety practices could include: a trained person dedicated to monitor anaesthesia, pain scoring evaluation in patients recovering from anaesthesia, an increased use of standardised handover checklists, record keeping and an increase in open discussion of adverse events by the veterinary team.

Assessing the Safety and Efficacy of Spinal Anesthesia in Preterm and Term Neonates: A Multicenter Experience

Background: Worldwide, the incidence of premature birth is increasing with its attending congenital anomalies, so complex surgical interventions to manage these congenital anomalies or complications are usually performed at early days of life. Neonates are vulnerable to apnea, and congenital cardiopulmonary problems and they have higher morbidity and mortality compared to older children and adults etc. In the preterm neonate, the risk of bronchopulmonary dysplasia and apnoea make their management complex and this is further compounded by their smaller size. Objective of study: The aim of the study was to determine the safety and efficacy of spinal anesthesia among neonates. Methodology: The study is a prospective study conducted in three tertiary health Institutions in northeast Nigeria. It includes all neonates scheduled for surgery amenable under SA. Sociodemographic variables, Haemodynamic variables, duration of surgery, and complications observed were all recorded. Results: Spinal anaesthesia SA was done in 230 patients, 90% of the patients were term, and only 10% were preterm. The majority were male with a mean weight of 3002 ± 660 grams and a mean age of 14.51±7.28 days. SA was successful in 93% of the patients in the first attempt. Heart rate, mean arterial pressure and oxygen saturation remained stable all through the duration of surgery. About 6% of the patients were converted to General Anaesthesia GA on account of prolonged surgery. The highest level of sympathetic block was recorded at the level of T4 while the lowest was at T6. Herniotomy was the most common surgery performed. The surgery lasted an average of 72 ± 28 minutes. No complication was recorded. Conclusion: Spinal anaesthesia provides a safe and reliable option for neonates who may require surgery early in life to improve their chances of survival. It serves as an alternative to GA with enhanced haemodynamic stability in this fragile population.

Pharmacokinetics in regional anesthesia.

Pharmacokinetics of local anesthetics are one of the main determinants of success and safety of regional anesthesia and comprise local and systemic distribution phases. This review aims to summarize the latest research findings on this topic in the context of various regional blocks performed for different surgeries and patient populations. Research into local kinetics and systemic absorption of local anesthetics has chiefly been focused on novel fascial plane blocks, especially the erector spinae plane block, as these are increasingly adopted for regional anesthesia and pain management. As their clinical efficacy is very dependent on injection of large volumes of local anesthetic, doses over typically recommended limits are often administered. Fascial plane blocks are the regional anesthesia techniques in need of the most pharmacokinetic characterization, not only to better understand their complex mechanisms of action but also to avoid harm from excessive doses of local anesthetics. Further mapping of risk factors for systemic toxicity from administration in different block sites is crucial. Extremes of age and pregnancy are vulnerable patient populations but in whom regional anesthesia, including novel techniques, has been performed with few complications.

Safety and Efficacy of Conscious Sedation Versus General Anesthesia for Distal Vessel Thrombectomy

BACKGROUND AND OBJECTIVES: Anesthesia modality for endovascular thrombectomy (EVT) for distal and medium vessel occlusions remains an open question. General anesthesia (GA) may offer advantages over conscious sedation (CS) because of reduced patient movement facilitating catheter navigation, but concerns persist about potential delays and hypotension affecting collateral circulation. METHODS: In our prospectively maintained stroke registry from December 2014 to July 2023, we identified patients with distal and medium vessel occlusions defined as M2, M3, or M4 occlusion; A1 or A2 occlusion; and P1 or P2 occlusion, who underwent EVT for acute ischemic stroke. We compared patients who received CS with those who received GA. Primary outcomes were early neurological improvement (ENI), successful reperfusion, first-pass effect, and good outcome at 90 days. Secondary outcomes included intracerebral hemorrhage, subarachnoid hemorrhage, and 90-day mortality. RESULTS: Of 279 patients, 69 (24.7%) received GA, whereas 193 (69.2%) received CS. CS was associated with higher odds of ENI compared with GA (odds ratio [OR] 2.59, 95% CI [1.04-6.98], P < .05). CS was also associated with higher rates of successful reperfusion (OR 2.33, 95% CI [1.11-4.93], P < .05). CS nonsignificantly trended toward lower rates of mortality (OR 0.51, 95% CI [0.2-1.3], P = .16). No differences in good outcome at 90 days, intracerebral hemorrhage, subarachnoid hemorrhage, or first-pass effect were seen. CONCLUSION: The use of CS during EVT seems to be safe and feasible with regard to successful recanalization, hemorrhagic complications, clinical outcome, and mortality. In addition, it may be associated with a higher rate of ENI. Further randomized studies in this specific EVT subpopulation are warranted.

The Task‐Sharing Path to Safe and Accessible Anaesthesia Care in India: The Role of Professional Associations in Health Policy Reform

ABSTRACTThe worldwide anaesthesia workforce shortage is a concern and ‘shared responsibility’ for all the national or state anaesthetic societies and Ministries of Health. The Lancet Commission on Global Surgery estimated the need for 143 million additional surgeries each year globally. These would be included in the World Health Organization's (WHO) 44 essential surgeries to be performed at district hospitals. However, insufficient availability of safe anaesthesia is a key barrier. The World Federation of Societies of Anaesthesiologists (WFSA) recommends at least five specialist physician‐anaesthesia providers per 100,000 population. India requires at least 60,000 additional physician‐anaesthesiologists over the next 10 years. This paper discusses the two‐decade journey of a policy initiative by the Ministry of Health and Family Welfare (MoHFW) in India to create a new category of a physician with Life Saving Anaesthetic Skills (LSAS). This addressed the shortage of anaesthetists specifically for the dire emergency obstetric situations at the First Referral hospitals. The annual training capacity for physicians for LSAS training was 40–100 in 5 of the poorest states of India, with the maximum shortages of anaesthetists. On following up a sample of 838 LSAS physicians, only about two‐thirds were able to practice their life‐saving skills. The MoHFW innovated further by pairing a physician trained in Emergency Obstetric Care with an LSAS‐physician (buddy‐pairing) as a functioning team. For comparison, we discuss the midwife model supported by the professional association of obstetricians in India. The flexible, ‘team‐based’ task‐sharing approach optimizes anaesthesia care within available resources. Leadership and vision from the professional societies of anaesthesiology are key to policy reform in India. National engagement can be facilitated through support for district‐level non‐specialist physician provider with life‐saving anaesthesia skills training, engagement in research and formulation of the national surgical and anaesthesia plans to achieve universal healthcare in India.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.

Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique. The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications. The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively). CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Does higher performance in a national licensing examination predict better quality of care? A longitudinal observational study of Ethiopian anesthetists.

Ethiopia made a national licensing examination (NLE) for associate clinician anesthetists a requirement for entry into the practice workforce. However, there is limited empirical evidence on whether the NLE scores of associate clinicians predict the quality of health care they provide in low-income countries. This study aimed to assess the association between anesthetists' NLE scores and three selected quality of patient care indicators. A multicenter longitudinal observational study was conducted between January 8 and February 7, 2023, to collect quality of care (QoC) data on surgical patients attended by anesthetists (n = 56) who had taken the Ethiopian anesthetist NLE since 2019. The three QoC indicators were standards for safe anesthesia practice, critical incidents, and patient satisfaction. The medical records of 991 patients were reviewed to determine the standards for safe anesthesia practice and critical incidents. A total of 400 patients responded to the patient satisfaction survey. Multivariable regressions were employed to determine whether the anesthetist NLE score predicted QoC indicators. The mean percentage of safe anesthesia practice standards met was 69.14%, and the mean satisfaction score was 85.22%. There were 1,120 critical incidents among 911 patients, with three out of five experiencing at least one. After controlling for patient, anesthetist, facility, and clinical care-related confounding variables, the NLE score predicted the occurrence of critical incidents. For every 1% point increase in the total NLE score, the odds of developing one or more critical incidents decreased by 18% (aOR = 0.82; 95% CI = 0.70 = 0.96; p = 0.016). No statistically significant associations existed between the other two QoC indicators and NLE scores. The NLE score had an inverse relationship with the occurrence of critical incidents, supporting the validity of the examination in assessing graduates' ability to provide safe and effective care. The lack of an association with the other two QoC indicators requires further investigation. Our findings may help improve education quality and the impact of NLEs in Ethiopia and beyond.

THORACIC SEGMENTAL SPINAL ANAESTHESIA IN UPPER ABDOMINAL SURGERIES AND SIMPLE MASTECTOMY-A CASE SERIES

Objective: To observe safety and efficacy of Segmental thoracic spinal anesthesia (STSA) in upper abdominal and breast surgeries. Methods: 14 cases were selected, out of which 6 laparoscopic cholecystectomy (LC), 4 open cholecystectomy (OC), 3 emergency exploratory laparotomy and 1 simple mastectomy. Under full aseptic precaution, segmental thoracic spinal anesthesia was administered through midline approach in T8-9 space for upper abdominal surgeries and T5-6 space in a simple mastectomy. Using 25G Quincke spinal needle 1.5 ml [7.5 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl was given in abdominal surgeries and 1.2 ml [6 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl in simple mastectomy. Results: Age group of patients ranged from 25 to 65 y, Male: Female ratio of 4:10, Body Mass Index (BMI) range of 22 to 24.9 with physiological status of ASA I to ASA III. Hemodynamically, hypotension was observed in every patient after 5-10 min of STSA well managed with fluid and vasopressors with no bradycardia. Average width of sensory block was T3 to L1-2 in upper abdominal surgeries and T1 to T8 in a simple mastectomy. Motor block was Modified Bromage Scale (MBS) of 0 to 1 during and postoperatively. Regarding analgesia, Visual Analogue Scale (VAS) score was 0 intraoperatively and 0-1 postoperatively. Sedation score was 2 both intraoperatively and postoperatively with no significant complications and good patient and surgeon satisfaction. Conclusion: Segmental thoracic spinal anaesthesia is a safe and effective procedure with good patient and surgeon satisfaction.

What are standard monitoring devices for anesthesia in future?

Monitoring the patient's physiological functions is critical in clinical anesthesia. The latest version of the Japanese Society of Anesthesiologists' Guidelines for Safe Anesthesia Monitoring, revised in 2019, covers various factors, including electroencephalogram monitoring, oxygenation, ventilation, circulation, and muscle relaxation. However, with recent advances in monitoring technologies, the information provided has become more detailed, requiring practitioners to update their knowledge. At a symposium organized by the Journal of Anesthesia in 2023, experts across five fields discussed their respective topics: anesthesiologists need to interpret not only the values displayed on processed electroencephalogram monitors but also raw electroencephalogram data in the foreseeable future. In addition to the traditional concern of preventing hypoxemia, monitoring for potential hyperoxemia and the effects of mechanical ventilation itself will become increasingly important. The importance of using AI analytics to predict hypotension, assess nociception, and evaluate microcirculation may increase. With the recent increase in the availability of neuromuscular monitoring devices in Japan, it is important for anesthesiologists to become thoroughly familiar with the features of each device to ensure its effective use. There is a growing desire to develop and introduce a well-organized, integrated "single screen" monitor.

Use of Ultrasound in Pediatric Caudal Anesthesia: A Randomized Comparative Study

Objective: The aim of this comparative study was to evaluate the efficacy and safety of ultrasound-guided caudal anesthesia compared to blind caudal anesthesia for subumbilical surgery in pediatric patients. Methods: This prospective study included pediatric patients undergoing subumbilical surgery in the Department of Pediatric Surgery. Patients were divided into two groups: the ultrasound-guided caudal anesthesia group and the blind caudal anesthesia group. Primary outcomes assessed included the success rate of block placement, onset and duration of sensory and motor blockade, analgesic requirements, and perioperative complications. Results: A total of 40 patients were included in the study, with 20 patients in the ultrasound-guided group and 20 patients in the blind group. The success rate of block placement was significantly higher in the ultrasound-guided group compared to the blind group (p &lt; 0.001). The ultrasound-guided group also demonstrated faster onset of sensory and motor blockade (p &lt; 0.05) and longer duration of analgesia (p &lt; 0.05) compared to the blind group. Postoperative analgesic requirements were significantly lower in the ultrasound-guided group (p &lt; 0.001). No significant differences in perioperative complications were observed between the two groups. Conclusion: Ultrasound-guided caudal anesthesia was found to be more effective and reliable than blind caudal anesthesia for subumbilical surgery in pediatric patients. It provided a higher success rate of block placement, faster onset and longer duration of sensory and motor blockade, reduced postoperative analgesic requirements, and comparable safety profile. Ultrasound guidance should be considered as the preferred technique for caudal anesthesia in this patient population.

Bridging the mismatch: observing the introduction of new anesthesia technology for a low-resource environment.

The objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments with limited clinical perioperative resources, on the choice of general anesthesia technique and safe anesthesia practice in a tertiary-care hospital in Sierra Leone. We introduced an anesthesia machine (UAM) into Connaught Hospital, Freetown, Sierra Leone. We conducted a prospective observational study of anesthesia practice and an examination of perioperative clinical parameters among surgical patients at the hospital to determine the usability of the device, its impact on anesthesia capacity, and changes in general anesthesia technique. We observed a shift from the use of ketamine total intravenous anesthesia to inhalational anesthesia. This shift was most demonstrable in anesthesia care for appendectomies and surgical wound management. In 10 of 17 power outages that occurred during inhalational general anesthesia, anesthesia delivery was uninterrupted because inhalational anesthesia was being delivered with the UAM. Anesthesia technologies tailored to overcome austere environmental conditions can support the delivery of safe anesthesia care while maintaining fidelity to recommended international anesthesia practice standards.

Anaesthesia in exotics part 2: birds

Anaesthesia in exotic species is often viewed as high risk and many nurses may be apprehensive to perform it. However, with careful preparation and monitoring techniques, safe anaesthesia of exotics is possible. This article looks at the principles of anaesthesia in birds, including pre-anaesthetic preparation, anatomical differences, induction, maintenance and recovery.

Study of safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery for hard-grade cataracts.

The purpose was to study the safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery (MSICS) in patients with hard-grade cataracts. The design of the study was a prospective, observational, and randomized control study. A total of 196 eyes, including 98 eyes in the subconjunctival anesthesia group (group A) and 98 eyes in the sub-Tenon anesthesia group (Group B), undergoing MSICS were enrolled in the study. A single surgeon performed all the surgeries. Intraoperative and postoperative pain scores, patient comfort, surgeon's satisfaction, and intraoperative complications were examined. The mean age of patients in Group A was 66.64 ± 9.95 years and that of patients in Group B was 64.52 ± 9.46. No statistically significant difference was noted in the intraoperative (P = 0.54) and postoperative pain (P = 0.66) scores between the two groups. There was no pain (0 score) in 30% of patients in Group A and 35% of patients in Group B intraoperatively. The average surgical time (P = 0.66) and surgeon's comfort (P = 0.34) were not statistically significant. The mean corneal haze was 0.054 ± 0.12 in group A and 0.065 ± 0.22 in group B (P = 0.45). Two patients in group A required supplemental anesthesia. There were no surgical complications that could compromise visual outcomes. No patients in either group showed alterations in vital parameters or required intravenous sedation. Both techniques of anesthesia are safe and effective for performing MSICS in hard-grade cataracts. However, it is prudent to choose a technique according to the surgeon's requirements.

Non-physician anaesthesia providers’ perspectives on task sharing practices in Zambia and Somaliland: a qualitative study

IntroductionThe 68th World Health Assembly, in 2015, called for surgical and anaesthesia services strengthening. Acknowledging the healthcare staff shortages, they referred to task sharing, among others, as a more effective...

Should an Incidental Meckel Diverticulum Be Resected? A Systematic Review.

Meckel Diverticulum [MD), a common congenital anomaly of the gastrointestinal tract, poses a dilemma when incidentally encountered during surgery. Despite historical descriptions and known complications of symptomatic MD, the decision to resect an incidental MD (IMD) lacks clear guidelines. This study aims to assess whether resecting IMDs is justified by synthesizing evidence from studies published between 2000 and 2023. Factors influencing this decision, such as demographic risks, surgical advancements and complications, are systematically examined. Following the PRISMA 2020 guidelines, this review incorporates 42 eligible studies with data on outcomes of asymptomatic MD management. Studies, both favoring and opposing resection, were analyzed. Considering complications, malignancy potential, and operative safety, the risk-benefit analysis presents a nuanced picture. Some authors propose conditional resection based on specific criteria, emphasizing patient-specific factors. Of 2934 cases analyzed for short- and long-term complications, the morbidity rate was 5.69%. Of 571 cases where mortality data were available, all 5 fatalities were attributed to the primary disease rather than IMD resection. The sporadic, unpredictable presentation of IMD and the variability of both the primary disease and the patient make formulation of definitive guidelines challenging. The non-uniformity of complications reporting underscores the need for standardized categorization. While the balance of evidence leans towards resection of IMDs, this study acknowledges the individualized nature of this decision. Increased safety in surgery and anesthesia, along with better understanding and management of complications favor a judicious preference for resection, while taking into account patient characteristics and the primary disease.

Compatibility of eugenol anesthesia with classroom physiology experiments on nerve and muscle of frogs

Frogs serve as valuable model organisms for studying physiological responses of nerve, skeletal muscle and the heart in undergraduate biology labs. Heretofore, induced hypothermia has been the preferred technique for pain and stress reduction prior to euthanasia by pithing. However, AVMA guidelines discourage hypothermia for restraint or euthanasia of amphibians and advocate anesthetic overdose as preferable to pithing alone. Unfortunately, the primary anesthetic used in fish and other aquatic invertebrates, MS-222, blocks normal nerve and muscle function in leopard frogs and renders them useless for classroom physiology experiments, as demonstrated by Medler (2019). Eugenol is a safe and affordable anesthetic that is effective in amphibians. We sought to test the hypothesis that eugenol anesthesia is compatible with classroom nerve and muscle experiments on frogs. Bullfrogs and leopard frogs were immersed in a bath of eugenol suspended in tap water at 275 to 350 mg/L. At various time points, a four step reflex test was performed including tests of righting response, superficial pain reflex, deep pain reflex, and corneal blink reflex. Once all reflexes were absent, the frog was euthanized by pithing and the gastrocnemius muscle was prepared for force recordings. The sciatic nerve was stimulated with a bipolar stimulating electrode while gastrocnemius force was measured using an isometric force transducer. The threshold voltage eliciting a muscle contraction and the peak isometric twitch force were recorded at 15 minute intervals for 2 hours. Control frogs were sedated by immersion in ice water for 20 to 30 minutes, pithed when reflexes were substantially weakened, and then subjected to the same stimulation protocol and force measurements. At these doses, eugenol reliably induces loss of reflexes in 20 to 35 minutes and neuromuscular preparations maintain the ability to respond to electrical stimulation. Preliminary results suggest that eugenol may produce a modest elevation of threshold voltage and a modest reduction in maximum twitch force compared to control frogs euthanized without chemical anesthesia. Eugenol may be an effective anesthetic to prepare bullfrogs and leopard frogs for classroom experiments on nerve and muscle. Funding was provided by the Bill and Linda Frost Fund. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Regional anesthesia in neonates with cleft lip and palate: Retrospective study

BackgroundOrofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. Patients/methodsOverall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. ResultsData from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. ConclusionsRegional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. Clinicaltrials.gov identifierNCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.

Neuraxial Block in A Post-Hemorrhagic Stroke Pregnant Patient

The selection of anesthetic methods for labor and delivery in individuals with elevated intracranial pressure relies on careful consideration of the risks and benefits. While neuraxial analgesia and anesthesia are favored for healthy individuals, they might not be suitable for individuals with intracranial lesions or a heightened risk of bleeding. Neuraxial block in post-stroke patients raises a concerning question about its safety due to the risk of herniation. The risk of perioperative major vascular events and mortality between general anesthesia and regional anesthesia in post-stroke patients is comparable. However, the neuraxial block shows benefits regarding airway manipulation and lower risk of thromboembolism. A successful and safe neuraxial anesthesia in a pregnant patient with a history of hemorrhagic stroke was presented in this case report.