Anesthesia Research Articles

Analgesia and Anesthesia Practice Patterns for Gynecologic Brachytherapy Procedures and Potential Impact on Women's Procedural Experience: A National Survey

PurposeTo determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures. Methods and MaterialsA 27-item survey created with expertise from five brachytherapists was distributed electronically to 90 U.S. Radiation Oncology academic programs and publicized on social media and at two national meetings during June-October 2023. ResultsForty-one responses were received (46%). Fifty-four percent identified as female, 66% Caucasian and 85% non-Hispanic/Latino ethnicity. Forty nine percent utilize a BT suite +/- CT simulator alone, 39% the operating room +/- BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic exam room. Thirty four percent utilize general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone, and 28% combination. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, while 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to alleviate BT related emotional distress. ConclusionsMany U.S. brachytherapists report using GA, CS or epidural AS, yet 10% are using only OA and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe PTSD symptoms can occur after BT, but few offer any intervention. AS resources and clinician preference should be targeted for expansion of higher quality care.

Development of a QuEChERS combined with LC-MS/MS method for determining 24 sedatives and anesthetics in animal-derived foods

This study aims to establish a rapid, accurate, safe, inexpensive, and effective method that combines QuEChERS pre-treatment with liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the simultaneous determination of 20 benzodiazepine sedatives (SDTs) and 4 eugenol anaesthetics (AETs) in chicken, canned fish, meat floss, and powdered milk such that technical support can be provided for monitoring residues of 24 SDTs and AETs in the food matrix and for protecting human life and health. Results demonstrated that all 24 SDTs and AETs exhibited good linearity in their corresponding concentration ranges with correlation coefficients (r) of > 0.999. The limit of detection (LOD) and limit of quantification (LOQ) were in the ranges of 0.01–0.22 and 0.03–0.67 µg∙kg−1, respectively, and the recoveries were in the range of 70.04–110.26% (n = 7) with precision in the range of 0.75–9.99% (n = 7) for 24 SDTs and AETs at different concentrations (4, 20, and 100 µg∙kg−1). This method was successfully applied to real samples and provides a convenient tool for detecting residues of SDTs and AETs in animal-derived foods.

Prevalence and Factors Associated with Anastomotic Leakage Among Patients Undergoing Bowel Resection and Anastomosis.

Purpose: This study aimed at giving evidence on prevalence and factors associated with anastomotic leakage among patients undergoing bowel resection and anastomosis at Bugando Medical Centre (BMC) and Sekou Toure Regional Referral Hospital (SRRH).
 Methodology: A descriptive cross-sectional analytical study was used involving patients undergoing bowel resection and anastomosis at Bugando Medical Centre and Sekotoure regional referral hospital over a four-month period from March 2017 to June 2017 inclusive.
 Findings: Eight out of 144 patients (5.6%) developed anastomotic leakage. The common indication for surgery was sigmoid volvulus, the common performed anastomosis was ileo-ileo end to end, and double layer continuous anastomotic suture was the common method of anastomosis Anemia (0.012), presence of premorbid illnesses (p=0.003), American association for anesthesia (ASA) greater than II (p=0.001), intraoperative contamination/sepsis (p< 0.001), low ranked operator (p=0.046), prolonged duration of operation (p=0.001), and delayed passage of stool and flatus (p=0.001) were found to be variables associated with anastomotic leakage among study participants. Anastomotic leakage in our setting occurs in approximately 5.6% of patients operated. Several factors such as high American society for Anesthesiologist above III, premorbid condition such as uncontrolled Diabetes Mellitus, intraoperative contamination/sepsis, low ranked operator, prolonged duration of operation above 3 hours and prolonged ileus were among factors that the present study found to be associated with high risk of anastomotic leakage.

Comparison of intravenous ibuprofen and paracetamol for peri-operative analgesia in paediatric day care tonsillectomy.

To determine the effectiveness of intravenous ibuprofen and acetaminophen as perioperative analgesics in paediatric patients undergoing day- care tonsillectomy with general anaesthesia. The quasi-experimental stud y was conduc ted at the Ana esthe sia D epartment of Pa k Emirates M ilitary Hospital, Rawalpindi , Pak ist an, from July 20 21 to June 2022, and comp rised paediatric pa t ients aged 5-12 yea r s undergoing day- care tonsil lec tomy with gen era l anaesthesia. The sub jec ts were divid ed into two equa l groups. Patients in Group I received intravenous ibuprofen 7mg/kg and patients in Group P received intravenous paracetamol 10mg/kg im media t ely after induction of anaesthesi a. All patients recei ved standard general anaesthesia with endotracheal intubation. The primary outcome measured was revised faces pain score immediately after recovery and at the time of discharge 6 hours later. Adverse events were also noted. Data was analysed using SPSS 26. Of the 100 patients, there were 50(50%) in Group I; 21(42%) boys and 29(58%) girls with mean age 7.82±1.903 years. The remaining 50(50%) subjects were in Group P; 25(50%) boys and 25(50%) girls with mean age 7.68±1.812 years. At baseline, 44(88%) patients in Group I and 42(84%) in Group P reported no pain, while 6(12%) and 8(16%) patients in the two groups, respectively, reported pain (p=0.56). At discharge, 35(70%) patients in Group I and 18(36%) in Group P reported no pain (p<0.001). Adverse events were not significantly different between the groups (p>0.05). I ntravenous ibuprofen was found to b e a superior pain-killer than intravenous paracetamol for perioperative care of paediatric patients in day- care tonsillectomy.

Anesthesia and surgery induce changes in endogenous brain protective protein (RNF146) and delirium-like behavior in aged rats.

Postoperative delirium (POD) is a common complication after anesthesia and surgery, especially in the elderly. RNF146 has neuroprotective effects in cerebral ischemia, hypoxia, and chronic neurological diseases. However, whether RNF146 expression is related to the occurrence and development of POD remains unclear. Therefore, in this study, we aimed to determine whether RNF146 is involved in the occurrence of POD. (Sprague-Dawley) male rats (18 months old) were splenectomized under sevoflurane anesthesia. The cognitive function of rats at 1, 3, and 7 d after anesthesia and surgery was evaluated. Changes in the expression of neuroinflammatory cytokines, IL-6 and IL-10, and RNF146 were measured in the hippocampus in both control group (con) and anesthesia (AS) group. We examined cognitive outcomes and expression of inflammatory factors and RNF146 in con and AS mice using cluster analysis. The cognitive ability and mobility of rats after anesthesia and surgery at day 1, 3, and 7 decreased, especially at day 3. Similarly, the expression of neuroinflammatory factors and RNF146 increased after anesthesia and surgery at day 1, 3, and 7, and the increase was highest at day 3. The clustering and correlation analysis of RNF146 expression in the hippocampi of elderly rats revealed a correlation between POD and neuroinflammation resulting from anesthesia and surgery. Anesthesia and surgery can lead to POD and neuroinflammation. The expression of RNF146 correlates with delirium and neuroinflammation caused by anesthesia and surgery.

Effects of sevoflurane on left ventricular function by speckle-tracking echocardiography in coronary bypass patients: A randomized trial.

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography, and to assess the effect of sevoflurane on cardiac function. Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia (AS) group and a propofol-based total intravenous anesthesia (AA) group. The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T 1 (after harvesting all grafts and before coronary anastomosis) and T 2 (30 min after completing all coronary anastomoses) ( P < 0.05). Moreover, strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group, compared with the AA group at both T 1 and T 2 ( P < 0.01). The flow of the left internal mammary artery-left anterior descending artery graft was superior, and the postoperative concentration of troponin T decreased rapidly in the AS group, compared with the AA group ( P < 0.05). Compared with total intravenous anesthesia, sevoflurane resulted in a significantly higher global longitudinal strain, stroke volume, and cardiac output. Sevoflurane also led to an amelioration in the condition of the arterial graft. Furthermore, sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value. The findings need to be replicated in larger studies.

Music in the Operating Room: Comparing the Opinions of Surgeons, Anesthesiologists, and Nurses.

Music is part of operating room (OR) culture; however, some personnel may perceive music as a distraction. A single institution survey of surgeons (SURG), anesthesia (ANES), and nursing (NURS) regarding attitudes on music in the OR. There were 222 responses (67% response rate) agreeing that music in the OR should be allowed (91%), is calming (75%), and helps with focus (63%). Most did not feel music was distracting (63%) or unsafe (80%). SURG were more likely to state that surgeons should decide (46.7%) if music should be played, whereas ANES and NURS (81%) were more likely to feel decisions should be made collaboratively (P < .001). Most OR personnel feel positively towards music. Surgeons were more likely to believe the decision to play music should be the surgeon's choice. The majority of OR staff agreed with collaborative decision-making, aligning with creating a safe OR culture.

Simultaneous determination of the residues of anesthetics and sedatives in fish using LC-QLIT-MS/MS combined with DSPE

Liquid chromatography coupled with quadrupole linear ion trap tandem mass spectrometry (LC-QLIT-MS/MS) technology operated in electrospray ionization (ESI) was developed for tracing anesthetic (AETs) and sedatives (SDTs) in fish. Sampling procedure was achieved by using acetonitrile extraction followed by dispersive solid phase extraction (DSPE) clean-up. Under the optimized laboratory conditions, reliable qualitative confirmation was obtained through the multiple reaction monitoring-information dependent acquisition-enhanced product ion (MRM-IDA-EPI) mode. Results indicated a favorable linear in the concentration range of 1–100 μg∙kg−1 (0.1–10 μg∙kg−1 for MS-222), with regression coefficient not less than 0.9997. The detection limit ranges from 0.03 to 0.4 μg∙kg−1 (S/N = 3). The validated method was applied to determine AETs and SDTs in fish with satidfied recoveries of 86.3 %–111.7 % and the relative standard deviations (RSD) of 1.9 %–8.9 % (n = 6). Practical samples analysis indicated that the proposed method is simple, rapid, sensitive and accurate for identification of AETs and SDTs.

Питання анестезіологічного забезпечення в інтервенційній кардіології

З кожним роком прогрес тільки набирає обертів, і все більше серцево-судинних захворювань лікуються із застосуванням міні-інвазивних методів. Це зумовлює стрімкий розвиток медичних технологій, упровадження нових методик лікування й діагностики у сфері кардіохірургії та інтервенційної кардіології. Незважаючи на те що в Україні удосконалилася підготовка лікарів — інтервенційних кардіологів, створений Український реєстр з інтервенційної кардіології, питання анестезіологічного забезпечення інтервенційних процедур залишається дискусійним та недостатньо вивченим. У статті наводиться огляд проблеми анестезіологічного забезпечення в інтервенційній кардіології.

Malignant (Anaplastic) Amelanotic/Hypomelanotic Melanoma in a Kurdish Gelding

We report an 11-year-old Kurdish gelding with an anaplastic malignant melanoma arising from his right lateral of the neck, which developed over 6 weeks. A ~10 cm in diameter, firm, and non-ulcerated nodular subcutaneous mass located at the middle and proximal of the left side of the neck was detected in a physical examination. No evidence of local extent or metastasis was detected. Complete surgical excision was performed under general anesthesia. Gross morphology and histopathological examination of the mass confirmed an anaplastic malignant melanoma, in which the major part of the mass has little or no pigmentation. The gelding was euthanized due to tumor regrowth. The heterogeneity in pigmentation of equine melanocytic tumors can make diagnosis difficult in punch biopsy specimens. Anaplastic malignant melanoma is most often a very aggressive neoplasm and surgical excision was not effective in this case.

Lameness and Radial Nerve Neuropathy Caused By Chondroma Tumor in a Male Dog

A 5-year-old mongrel male dog with severe left forelimb lameness was referred to the veterinary clinic of Urmia University. On initial physical examination, vital signs were normal. However, a firm swelling with a history of one year progressive increasing in size was observed on the caudolateral aspect of the left shoulder. Pedal reflex was negative. On radiographic examination, a large mass with abnormal radiodensity was seen in the caudal humerus. Hypodermic needle aspiration specimen were unremarkable except large number of normal blood cells. Under general anesthesia, the tumoral mass was surgically removed via a caudolateral approach to the humerus. Pathological assessments corroborated the lobular pattern with the presence of tumor cells similar to normal chondrocytes in an amorphous, basophilic matrix that confirmed the chondroma tumor. In the postoperative follow-up, normal nerve function was returned and lameness was disappeared. Chondroma tumors should be considered in the differential diagnosis of dogs with persistent lameness and neuropathies.

Кардиомиопатии у беременных: особенности анестезиологического обеспечения в родах

В статье рассматриваются особенности проведения анестезиологического пособия у беременных с кардиомиопатиями. Приведены патофизиологические изменения, происходящие при гипертрофической, дилатационной и рестриктивной кардиомиопатии на фоне беременности. Анестезиологическая тактика при кардиомиопатии у беременных, нуждающихся в родоразрешении, существенным образом определяется степенью компенсации кровообращения. Одним из главных требований к анестезиологическому пособию при родоразрешении в данной ситуации является максимально возможная стабильность параметров гемодинамики. Эпидуральная анестезия является методом выбора при родоразрешении беременных с кардиомиопатией.

Bidirectional endoscopy in the assessment of iron deficiency in the elderly.

Iron deficiency is a common pathology in elderly patients. It is most often due to lesions in the digestive tract, which raises the issue of benefit/risk balance and yield from investigation. Current UK guidelines recommend that bidirectional endoscopy (oesophago-gastro-duodenoscopy and colonoscopy) is performed synchronously, with no upper age limit. In studies conducted in people over 75 years of age, the diagnostic yield varies between 63 and 68%, which is similar to that in younger people, with approximately 40% revealing upper lesions and 40% lower lesions. Approximately 10% of elderly patients show upper and lower digestive lesions at the same time. Complications as a result of oesophago-gastro-duodenoscopy are rare and mainly related to anaesthesia. The main complication of colonoscopy is perforation and there is a slightly higher risk of perforation in older patients. This risk is less significant for computed tomographic colonography. Contraindications of endoscopies are very rare. When endoscopy is negative, this raises the question of whether further investigations should be pursued.

Day case tonsillectomy: A 9 year experience in Delta State Nigeria

Tonsillectomy has generally been regarded as an in-patient procedure. Presently though, due to rising costs and space constraints, it has increasingly became popular as a day case procedure world-wide. However, careful selection of patients is advised so as to avoid undue risks and possible resulting mortalities. To find out the suitability or otherwise of day case tonsillectomies in a resource poor country, taking note of possible complications arising from the surgeries and also pre-operative management modalities adopted to prevent these. Case notes of 52 Patients who underwent day case tonsillectomies and Adenotonsillectomies over a nine year period were reviewed. Indication for Surgery was recurrent tonsillitis for 11 (25.6) children and Adenotonsillar Hypertrophy for 32 (74.4%) children. The indication for surgery of all the adults was recurrent tonsillitis. Data extracted included age, sex, indication for surgery, procedure used for both Anesthesia and Surgery and complications arising from Surgery. 52 Patients met the criteria for day case surgeries. 43 (82.7) were Children and 9 (17.3%) were Adults. 49 patients (94.3) recovered well except 3 (5.7%) patients who had had complications and had to be admitted overnight afterwards. 1(1.9%) patient represented in the Hospital following earlier discharge for overnight admission. Day case Tonsillectomies/Adenotonsillectomies are relatively safe procedures especially when patients are carefully selected and pre-operative measures to encourage heamostasis instituted. Key words: Day case, costs, tonsillectomies, complications, haemostasis.

Effects of preoperative melatonin on postoperative pain following cesarean section: A randomized clinical trial

BackgroundData regarding the analgesic effects of melatonin after the surgery is scare. So far, only one study has investigated the analgesic effect of melatonin during cesarean section. Objective: The present study was performed to investigate the effect of preoperative oral melatonin on pain intensity after cesarean section during spinal anesthesia. MethodsIn a double-blind randomized controlled clinical trial study, 204 patients undergoing elective cesarean section with class 1 and 2 anesthesia (ASA) were enrolled. Patients were randomly divided into 3 groups of 68 patients. Patients in group A were given 5 mg melatonin tablets, patients in group B were given 10 mg melatonin tablets, and group C was given placebo. All patients underwent spinal anesthesia with the same anesthesia protocol. Pain intensity, nausea, vomiting, pruritus and headache were assessed and recorded 2, 6, 12 and 24 h after surgery. The time of first dose of analgesia, the amount of opioid consumed within 24 h, and the time to resume physical activity was also recorded. Statistical analysis of data was performed using SPSS 20 software. ResultsRepeated measurements of pain intensity during the study showed that in all 3 groups pain intensity was significantly reduced during the study, p < 0.001, respectively. The intensity of pain was significantly different in groups B and C, groups B and A and groups A and C, P < 0.001, respectively. The pain reduction was greatest in group B, followed by group A and group C, respectively. The time interval between the end of surgery and the patient's need for analgesia was significant in group B compared to group A (P = 0.035) and C (P < 0.001) and also in group A compared to group C (P = 0.011). The mean dose of opioid was significantly least in group B, p < 0.001. The mean time to resume physical activity was also shortest in group B, p < 0.001 Headache and nausea/vomiting were observed in 7 patients (10.7%) group A and 7 patients (10.7%) in group C. None of the patients in group B developed complications. ConclusionThe results of the present study showed that the use of 10 mg of melatonin before cesarean section with spinal anesthesia is not only safe, but also reduces the severity of patients' pain, increases the duration of postoperative analgesia, reduces the need for analgesics after surgery and resumption of physical activity.

Anesthesia for Hepatico-Pancreatic-Biliary Surgery and Transplantation.

Anesthesia for Hepatico-Pancreatic-Biliary Surgery and Transplantation.

Anesthesia for hepatico-pancreatic-biliary surgery and transplantation.

Anesthesia for hepatico-pancreatic-biliary surgery and transplantation.

Important Principles of Anesthesia

Reviews of Educational Material| July 2021 Important Principles of Anesthesia By David A. Corbett, M.B.B.S., F.A.N.Z.C.A., D A Corbett, 2020. Pages: 74. ISBN-13: 978-0-9924144-3-6. Price: Kindle edition $6.08. Dominic Rodwell, M.B.B.S.; Dominic Rodwell, M.B.B.S. https://orcid.org/0000-0001-9932-3077 Search for other works by this author on: This Site PubMed Google Scholar Victoria Howell, M.B.Ch.B., M.P.H., F.R.C.A. Victoria Howell, M.B.Ch.B., M.P.H., F.R.C.A. Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information The Queen Elizabeth Hospital King’s Lynn National Health Service Foundation Trust, Norfolk, United Kingdom (V.H.). vhowell@doctors.org.uk (Accepted for publication March 23, 2021. Published online first on April 27, 2021.) Anesthesiology July 2021, Vol. 135, 193. https://doi.org/10.1097/ALN.0000000000003796 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Dominic Rodwell, Victoria Howell; Important Principles of Anesthesia. Anesthesiology 2021; 135:193 doi: https://doi.org/10.1097/ALN.0000000000003796 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: analogy, languages, pupil light reflex, blood gas, chlorides, endotracheal intubation, ethics, evidence-based practice, intubation, knowledge acquisition You do not currently have access to this content.

Randomized controlled trial of functional outcome of periarthritis of shoulder (Adhesive Capsulitis) in a group of 60 patients using intraarticular triamcinolone vs. intraarticular platelet rich plasma

Background: Periarthritis shoulder is the most common cause of shoulder pain and stiffness encountered in day to day practice. Though the condition is self-limiting it may not be practical to wait for spontaneous resolution as it is associated with significant morbidity hampering routine activities. The various treatment options available include simple physiotherapy, intra articular injections, manipulation under general anaesthesia and surgical intervention. This study was undertaken to compare the efficacy and safety of two intraarticular injections that is triamcinolone acetonide and platelet rich plasma (PRP). Materials and Methods: Patients with periarthritis shoulder were randomly allocated into two groups. Group A receiving intraarticular triamcinolone acetonide injection and Group B receiving intra articular platelet rich plasma. Patients were followed up every four weeks for 24 weeks. And outcome was assessed using SPADI score before treatment and at every visit. Results were assessed using Epi Data version 2.2.2.186. Results: PRP treatment resulted in statistically significant improvement over triamcinolone acetate therapy in both SPADI and VAS scale. Conclusion: Intraarticular PRP is more effective and safe in treatment of periarthritis shoulder. Keywords: Periarthritis shoulder, Triamcinolone acetonide, Platelet rich plasma.

The Fire among Us: Burnout in Anesthesia

The Fire among Us: Burnout in Anesthesia