Anesthetic Agents Research Articles

NÚMERO DE CIRURGIAS ONCOLÓGICAS NO BRASIL NOS ÚLTIMOS 10 ANOS E O PAPEL DA ANESTESIA NA PREVENÇÃO DA RECORRÊNCIA TUMORAL DO CÂNCER DE MAMA

Cancer represents one of the major global public health challenges, being the second leading cause of death after cardiovascular diseases. In 2020, the World Health Organization (WHO) recorded approximately 20 million new cases and around 10 million cancer deaths worldwide. In Brazil, breast cancer is the most frequent among women, with an estimated 73,610 new cases annually for the period from 2023 to 2025, representing a significant impact on the healthcare system. Oncologic surgery is essential in cancer management, especially for solid tumors, and is often complemented by chemotherapy, radiotherapy, or hormone therapy. However, studies indicate that the perioperative environment, including anesthesia, may influence tumor progression and disease recurrence, particularly in the context of breast cancer. In recent years, evidence has emerged suggesting that anesthesia, especially the anesthetic agents used, may play an important role in modulating the perioperative immune environment, potentially influencing cancer progression and recurrence. Nevertheless, the evidence remains inconsistent, and further studies are needed to clarify the direct impact of anesthesia on breast cancer recurrence and other types of cancer. The aim of this study is to review the epidemiology of oncologic surgery in Brazil over the past 10 years and to discuss the role of anesthesia in this context, focusing on surgical procedures related to breast cancer and the discussion of anesthetics in relation to tumor recurrence.

Skin testing - A valued tool for assessing adverse reactions to anaesthetic agents in patients allergic to multiple drugs: A case report from a secondary-level hospital.

Patients with allergy to multiple drugs who have experienced anaphylaxis multiple times present a significant challenge in perioperative management. This report presents a 27-year-old female patient diagnosed with cholelithiasis scheduled for cholecystectomy. The patient has a history of adverse reaction to multiple drugs, including Amoxicillin/Clavulanic acid, Cefpodoxime, Levofloxacin and two additional drugs (one analgesic and the other multivitamin) each resulting in symptoms suggestive of anaphylaxis on separate occasions. However, the patient has demonstrated tolerance to Amikacin and Paracetamol on several occasions. Given the patient's drug hypersensitivity state, the patient's anaesthetist sought clearance for use of anaesthetic drugs and disinfectants prior to surgery. Comprehensive skin testing was conducted for the same, and all drugs tested negative. The outcomes of this testing guided the selection of anaesthesia agents, ensuring safe perioperative care. Subsequently, surgery was performed, using Succinylcholine, Propofol, Rocuronium, Atropine and Neostigmine for general anaesthesia and Chlorhexidine for disinfection, and the postoperative period was uneventful. This case highlights the significance of preoperative assessment and drug testing in patients with a history of drug allergies or anaphylaxis to multiple drugs, to prevent any perioperative complications.

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure

In the study, we comment on the article by Qu et al . Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Articaine Versus Mepivacaine in Inferior Alveolar Nerve Block for Patients With Irreversible Pulpitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Inferior alveolar nerve block (IANB) as an anesthetic strategy has shownconflicting results in terms of efficacy in the treatment of patients with irreversible pulpitis. Mepivacaine and articaine are anesthetic agents commonly used in the IANB technique for pulpal anesthesia. This review aimed to compare mepivacaine and articaine regarding pain and success rate. We conducted a search on the databases PubMed, Scopus, Web of Science (WOS), and Cochrane Central for randomized controlled trials (RCTs) assessing mepivacaine versus articaine until September 2024. The primary outcome of interest was success rate, while the secondary outcomes were pain intensity assessed by a 10-point visual analog scale (VAS) and incidence of severe pain. Data were pooled as odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) in a random-effect model using STATA. Five RCTs including 568 patients were included in the final analysis. While there was no significant difference between the two studied groups regarding the success rate (OR: 0.92, 95% CI: 0.69 to 1.21, p=0.54), articaine significantly reduced the pain intensity compared to mepivacaine (MD: 0.59, 95% CI: 0.31 to 0.86], p<0.001). Moreover, no significant difference was observed regarding the incidence of severe pain. Articaine reduced the intensity of pain post-procedure, with comparable results regarding success rate and incidence of severe painwith mepivacaine. Further large-volume RCTs are warranted to study the differences between the two options in the long term.

The effects of dexmedetomidine on thiol/disulphide homeostasis in coronary artery bypass surgery: a randomized controlled trial

BackgroundThiol-disulfide homeostasis (TDH) plays a pivotal role in various physiological mechanisms, including antioxidant defence, detoxification, apoptosis, regulation of enzyme activities and cellular signal transduction. TDH can be used as a biomarker to detect oxidative stress (OS) levels and ischemia status in the tissues. Coronary artery bypass grafting (CABG) surgery is a procedure associated with high oxidative stress. Dexmedetomidine, an alpha-2 agonist anaesthetic agent, has antioxidant effects. In this study, the effects of dexmedetomidine on oxidative stress in CABG surgery were investigated.MethodsPatients who underwent on-pump CABG surgery were divided into two groups: those receiving dexmedetomidine (Group D) and those not receiving dexmedetomidine (Group C). From anesthesia induction to the end of surgery, patients in Group D received intravenous infusions of 0.05–0.2 mcg/kg/min remifentanil and 0.2–0.7 mcg/kg/h dexmedetomidine. Patients in Group C received intravenous infusion of 0.05–0.2 mcg/kg/min remifentanil. Blood samples were collected from the patients 30 min before induction of anesthesia (T1), 30 min after removal of the aortic cross-clamp (T2), and at the end of the surgery (T3). Thiol-disulfide homeostasis (TDH) was assessed using a novel method. A novel automated method enables the determination of native thiols, total thiols and disulfides levels in plasma, allowing the calculation of their respective ratios.ResultsIn patients receiving dexmedetomidine, lower postoperative levels of disulfide, disulfide/native thiol, and disulfide/total thiol, along with higher native thiol/total thiol, were observed compared to the control group. (p < 0.05) Postoperative native thiol and total thiol levels were similar for both groups. (p > 0.05)ConclusionsIn our study, through dynamic thiol-disulfide measurements, we found that levels of oxidative stress (OS) were lower in patients who received dexmedetomidine. We believe that the positive effects of dexmedetomidine on OS could be beneficial in CABG surgery. Furthermore, we anticipate that with further studies conducted in larger patient cohorts, the clinical utilization of dexmedetomidine will become more widespread.Trial registration numberNCT05895331 / 06.07.2023.

Cannabinoids and General Anesthetics: Revisiting Molecular Mechanisms of Their Pharmacological Interactions.

Cannabis has been used for recreation and medical purposes for more than a millennium across the world; however, its use's consequences remain poorly understood. Although a growing number of surgical patients are regular cannabis consumers, little is known regarding the pharmacological interactions between cannabis and general anesthetics; consequently, there is not a solid consensus among anesthesiologists on the perioperative management of these patients. The existing evidence about the molecular mechanisms underlying pharmacological interactions between cannabinoids and anesthetic agents, both in animal models and in humans, shows divergent results. While some animal studies have demonstrated that phytocannabinoids (tetrahydrocannabinol [THC], cannabidiol [CBD], and cannabinol [CBN]) potentiate the anesthetic effects of inhalation and intravenous anesthetics, while others have found effects comparable with what has been described in humans so far. Clinical studies and case reports have consistently shown increased requirements of GABAergic anesthetic drugs (isoflurane, sevoflurane, propofol, midazolam) to achieve adequate levels of clinical anesthesia. Several potential molecular mechanisms have been proposed to explain the effects of these interactions. However, it is interesting to mention that in humans, it has been observed that the ingestion of THC enhances the hypnotic effect of ketamine. Animal studies have reported that cannabinoids enhance the analgesic effect of opioids due to a synergistic interaction of the endogenous cannabinoid system (ECS) with the endogenous opioid system (EOS) at the spinal cord level and in the central nervous system. However, human data reveals that cannabis users show higher scores of postoperative pain intensity as well as increased requirements of opioid medication for analgesia. This review aims to improve understanding of the molecular mechanisms and pharmacological interactions between cannabis and anesthetic drugs and the clinical outcomes that occur when these substances are used together.

Determining the appropriate concentration of an anesthetic mixture in three different fish species with the PROMETHEE decision model

Anesthesia is applied to protect fish welfare for reducing employee workload in aquaculture. The efficacy of the anesthetic agent varies depending on the fish species. In this study, the effect of a commercial anesthetic (VetiVital AquaSED) manufactured mainly with herbal extracts (includes eugenol, linalool, linalyl acetat etc.) on three different fish species (rainbow trout, common carp, and Danube sturgeon) was investigated. In addition, the best available concentration of the anesthetic mixture for each species was determined using the PROMETHEE decision model. Danube sturgeon showed more resistance to anesthetics than the other two species. It was determined that the increase in concentration caused histological deterioration in fish. On the other hand, hematological parameters were affected by the anesthetic mixture, and this effect returned to normal levels after 8 h. According to the multi-criteria decision model, the best available concentrations determined by considering 10 different criteria are 400, 480, and 675 mg L−1 for rainbow trout, common carp and Danube sturgeon, respectively. Future studies should focus on developing the most appropriate anesthesia mixture in terms of physiological and anesthesia effectiveness for the target fish species.

PBM for dental analgesia and reversal from injected local anesthetic agents: a systematic review

PBM for dental analgesia and reversal from injected local anesthetic agents: a systematic review

Paradoxical Agitation and Masseter Spasm During Propofol Procedural Sedation: A Case Report

Introduction: Propofol is an anesthetic agent commonly used in emergency department (ED) procedural sedation. It is often preferred in orthopedic procedures because of its muscle-relaxing properties. Rarely, however, it can induce agitation and muscle hypertonicity. Case Report: A 58-year-old man presented to the ED with a left ankle fracture-dislocation. Propofol was used to facilitate procedural sedation, but the patient became mildly agitated. Ketamine was used to achieve full induction, after which propofol was used again to facilitate muscle relaxation. Near the end of the procedure, the patient had opisthotonos and masseter spasm requiring bag-valve-mask ventilation and subsequent intubation. This reaction was ultimately attributed to adverse effects of the propofol. Conclusion: While propofol is generally well tolerated, it can potentially cause agitation, hypertonicity, and other side effects such as muscle spasms and seizure-like activity. Acknowledging and preparing for these risks can potentially improve patient outcomes.

Pulmonary Atelectasis After Sedation With Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children

Little is known about the impact of different anesthetic agents used for routine magnetic resonance imaging (MRI) sedation on pulmonary function in children. To compare the incidence of pulmonary atelectasis after MRI sedation with propofol vs propofol-ketamine. This double-masked randomized clinical trial screened 117 consecutive pediatric patients aged 3 to 12 years with American Society of Anesthesiologists physical status I to II undergoing elective MRI under deep sedation from November 2, 2022, to April 28, 2023, at a tertiary referral center. Four patients met the exclusion criteria, and 5 patients refused to participate. The participants and outcome assessors were masked to the group allocation. During the MRI, the propofol group received 0.2 mL/kg of 1% propofol and 2 mL of 0.9% saline followed by a continuous infusion of propofol (200 μg/kg/min) and 0.9% saline (0.04 mL/kg/min). The propofol-ketamine group received 0.2 mL/kg of 0.5% propofol and 1 mg/kg of ketamine followed by a continuous infusion of propofol (100 μg/kg/min) and ketamine (20 μg/kg/min). The incidence of atelectasis assessed by lung ultrasonography examination. A total of 107 children (median [IQR] age, 5 [4-6] years; 62 male [57.9%]), with 54 in the propofol group and 53 in the propofol-ketamine group, were analyzed in this study. Notably, 48 (88.9%) and 31 (58.5%) patients had atelectasis in the propofol and propofol-ketamine groups, respectively (relative risk, 0.7; 95% CI, 0.5-0.8; P < .001). The incidence of desaturation and interruption of the MRI due to airway intervention or spontaneous movement did not significantly differ between the groups. The propofol-ketamine group showed a faster emergence time than the propofol group (15 [9-23] vs 25 [22-27] minutes in the propofol-ketamine vs propofol group; median difference in time, 9.0 minutes; 95% CI, 6.0-12.0 minutes; P < .001). No patient was withdrawn from the trial due to adverse effects. In this randomized clinical trial, the propofol-ketamine combination reduced sedation-induced atelectasis while allowing for faster emergence compared with propofol alone. cris.nih.go.kr Identifier: KCT0007699.

Inhalational anaesthetic agent consumption within a multidisciplinary veterinary teaching hospital: An environmental audit

Inhalational anaesthetic agent consumption within a multidisciplinary veterinary teaching hospital: An environmental audit

Pericapsular Nerve Group (PENG) Block in Pediatric Patients Undergoing Hip and Pelvic Surgical Procedures: An Educational Focused Review.

Hip disorders in infants and children may result from congenital, infectious, developmental, inflammatory, neoplastic, and traumatic etiologies. Postoperative pain management associated with hip pathologies can be challenging especially due to complex innervation of the hip and surrounding structures. Given the adverse effect profile of systemic opioids, regional anesthesia offers an excellent alternative with more beneficial adverse effect profile. Various peripheral regional anesthetic techniques have been reported with variable results regarding analgesia and differing adverse effect profiles. The pericapsular nerve group (PENG) block is a novel motor-sparing regional anesthetic technique where the local anesthetic agent is deposited in the musculofascial plane between the psoas tendon and the pubic ramus. The main target is the genicular branches of the femoral, obturator, and accessory obturator nerve, which innervate the hip capsule. The anatomy involved with PENG block is reviewed and previous reports of PENG block in pediatric-aged patients, including single shot or continuous catheter techniques, are reviewed.

Efficacy and safety of ciprofol for general anesthesia induction in female patients with frailty: a prospective randomized controlled trial

BackgroundCiprofol, a recently developed anesthetic agent, is not inferior to propofol in terms of efficacy and safety. However, most previous clinical experience with ciprofol was based on a robust population. This study aimed to investigate the efficacy and safety of ciprofol for anesthesia induction in female patients with frailty.MethodsThis prospective randomized controlled trial included patients with frailty undergoing elective general anesthesia for gynecological surgery. Frailty was assessed using the modified frailty index. The patients were randomly administered propofol (2 mg/kg) or ciprofol (0.5 mg/kg) during anesthesia induction. The depth of anaesthesia was continually monitored by the bispectral index. The primary outcome was the lowest systolic blood pressure (SBP) during anesthesia induction. Secondary outcomes included the incidence of general anesthesia induction failure and adverse events.ResultsAmong the 69 enrolled patients with frailty, 67 were included in the final analysis. The success rate of anesthesia induction was 100% in both groups. The lowest SBP was significantly higher in the ciprofol group than in the propofol group (103 [96–110] vs. 90 [85–98] mmHg, respectively; P < 0.001), suggesting that the former caused less inhibition of hemodynamics during anesthesia induction in patients with frailty. The incidence of injection pain was lower in the ciprofol group than in the propofol group (3 [8.8%] vs. 11 patients [33.3%], respectively; P = 0.014).ConclusionsThe results of this study suggest that the efficacy of ciprofol for inducing general anesthesia in patients with frailty is comparable to that of propofol, with more stable hemodynamics.Trial registrationThe trial was registered, before patient enrollment, in the Chinese Clinical Trial Registry (www.chictr.org.cn) (Clinical trial number: ChiCTR2300075271; https://www.chictr.org.cn/showproj.html?proj=205160, principal investigator’s name: Zifeng Xu, date of registration: 31/08/2023).

The Utility of Electroencephalograhy in Guiding General Anesthesia in Children.

Traditional pediatric anesthetic dosing using pharmacokinetic estimates based on age and weight is often imprecise, frequently leading to oversedation. Intraoperative electroencephalography (EEG) allows visualization of the brain's response to anesthetic agents in real time, facilitating precise titration of anesthetic drug doses optimized for the individual child. The goal of EEG-guided anesthesia management is to maintain an optimal state of hypnosis during various stages of the procedure while minimizing hemodynamic instability and other adverse effects of anesthesia. This is especially important in children with less predictable anesthetic requirements, such as children with atypical neurodevelopment, altered levels of consciousness before anesthesia, or those receiving total intravenous anesthesia, neuromuscular blockers, or a combination of anesthetic agents with different mechanisms of actions. Children with limited cardiorespiratory reserves and those undergoing high-risk procedures such as cardiopulmonary bypass also benefit from EEG guidance as they have a narrower therapeutic window for optimal anesthetic dosing. Various processed EEG (pEEG) monitors are available for intraoperative monitoring in children. These monitors display a pEEG index based on the manufacturer's algorithm, purportedly indicating the patient's hypnotic state. Due to differences in developmental neurophysiology and EEG dynamics in children, pEEG indices may not always reliably indicate the hypnotic state, especially in neonates and infants. Learning to interpret nonproprietary EEG parameters including the raw EEG, spectral-edge frequency 95% (SEF95), and density spectral array can prevent overreliance on pEEG indices. This review provides an overview of the advantages of EEG guidance during clinical anesthesia, including potential reduction in anesthetic dosage, prevention of EEG suppression, and reduction in peri-operative adverse events. We describe the use of nonproprietary EEG parameters in guiding anesthesia in children for various clinical end points including laryngoscopy, surgical incision, and maintenance of anesthesia, as well as sedation. We illustrate these principles with various case examples commonly encountered during pediatric anesthesia. Lastly, we discuss strategies to expand intraoperative EEG monitoring in children through education and training programs, as well as advocate for further research to assess clinical outcomes associated with EEG guidance to support its routine use in clinical care.

Updating probability of pathogenicity for RYR1 and CACNA1S exon variants in individuals without malignant hyperthermia after exposure to triggering anesthetics

Objectives We aimed to classify genetic variants in RYR1 and CACNA1S associated with malignant hyperthermia using biobank genotyping data in patients exposed to triggering anesthetics without malignant hyperthermia phenotype. Methods We identified individuals who underwent surgery and were exposed to triggering anesthetics without malignant hyperthermia phenotype and who had RYR1 or CACNA1S genotyping data available in our biobank. We classified all variants in the cohort using a Bayesian framework of the American College of Medical Genetics and Genomics and the Association of Molecular Pathologists guidelines for variant classification and updated the posterior probabilities from this model with the new information from our biobank cohort. Results We identified 253 patients with 95 RYR1 variants and 12 CACNA1S variants. After applying a Bayesian framework, we classified 17 variants as benign (B), 31 as likely benign (LB), 57 as uncertain (VUS), and 2 as likely pathogenic (LP). When we incorporated evidence about unique exposures to malignant hyperthermia triggering anesthetic agents, 48 of 107 (45%) variants were downgraded (9 to B, 37 to LB, and 2 to VUS). Notably, 41 (72%) of 57 VUSs were downgraded to B or LB. When repeat anesthetics in the same individual were counted as one exposure, 42 of 107 (39%) of variants were downgraded (5 to B, 35 to LB, and 2 to VUS). Specifically, 37 (65%) of 57 VUSs were downgraded to LB. Conclusion Deidentified biorepositories linked with anesthetic data offer a new method of integrating clinical evidence into the assessment of variant probability of pathogenicity.

A Comparison of Different Doses Efficacy of Isobaric Ropivacaine 0.5% in Spinal Anesthesia in Cesarean Section

Background: Cesarean delivery is a standard surgical procedure in women. Thus, a practical, affordable, and low-risk anesthetic technique is essential for mother and infant safety. Spinal anesthesia is a popular and efficient technique for anesthesia during cesarean delivery. However, other local anesthesia drugs with negligible side effects should be considered. The most selective medication for this purpose is bupivacaine (marcaine), which creates optimal anesthesia at doses of 10 to 12 mg. Objectives: The most available medicine for spinal anesthesia during cesarean delivery is a 0.5% marine solution. However, ropivacaine for spinal anesthesia can occasionally be accessed as a long-acting amide local anesthetic agent used as an alternative to marcaine during the cesarean delivery. The ropivacaine's advantage over marcaine is its less neurotoxicity and cardiotoxicity, as well as the more stable hemodynamical condition of the patients. So far, no proper therapeutic dose of 0.5% isobaric ropivacaine has been proposed to be used during the cesarean delivery. Any increase in the dose may ensure the block performance, but, by contrast, some side effects may arise, including hypotension, bradycardia, vomiting, and nausea. Herewith, the likelihood of maximum block and most minor side effects was attempted to be assessed at the tiniest doses of this anesthetic agent. Methods: This randomized clinical trial was conducted on C-section candidates. Patients were categorized into three groups receiving 22.5, 25, and 20 mg of the 0.5% isobaric ropivacaine solution. Systolic and diastolic blood pressure, heartbeats, the level of sensational and sympathetic nerve block, duration to reach the maximum motor block, the rate of vasopressors and atropine consumption, rate of vomiting and nausea, the rate of using supplementary drugs, block breakdown, and the patient's satisfaction with the anesthesia were measured and recorded. The collected data were analyzed using IBM SPSS Statistics. Results: No significant difference was found between demographic characteristics. Likewise, there was no significant difference in systolic and diastolic blood pressure, heartbeats, the level of sensational and sympathetic nerve block, duration to reach the maximum motor block, the rate of vasopressors and atropine consumption, rate of vomiting and nausea, and the rate of using supplementary drugs between the three groups. The most significant block breakdown and use of supplementary drugs were found in the first group (20 mg), with a significant difference between the three groups. Conclusions: The three doses used did not result in meaningful differences between the three groups. However, the differences were significant for the block breakdown, with the higher block breakdown and supplementary drug use observed when using 20 mg of the 0.5 ropivacaine solution.

Unraveling anesthetic challenges of a patient with dilated cardiomyopathy posted for lower limb amputation surgery -A case report

This case report details the anesthetic management of a 64-year-old male with dilated cardiomyopathy (DCM) and a significantly reduced ejection fraction, undergoing lower limb amputation for peripheral arterial disease. Managing anesthesia in such patients poses considerable challenges due to the complexities associated with congestive heart failure. The successful administration of general anesthesia in this case can be attributed to a rigorous preoperative assessment and a meticulously devised anesthetic plan. The systematic approach included careful monitoring, fluid management, and the use of specific anesthetic agents that minimize cardiovascular stress, thereby ensuring an uneventful anesthetic course. This report emphasizes the importance of strategic planning and expert execution in the anesthesia management of patients with severe cardiomyopathy undergoing major surgical procedures.

The role of microglia in neurocognitive deficits induced by general anaesthetic agents during neurodevelopment

AbstractBackground and AimsMicroglia are the innate immune cells of central nervous system which play critical roles in brain homeostasis. Recently, the effects of general anesthetic agents (GAAs) on microglia and their potential neurotoxicity in neurodevelopment have attracted the attention of anesthesiologists and neuroscientists.MethodsHere, we review the physiology of microglia in neurodevelopment, the potential mechanisms of GAAs on microglia and the consequent changes in microglial function.OutcomesMicroglia‐mediated neuroinflammation is a key mechanism of neurocognitive deficits during neurodevelopment. In addition, microglia could be primed by active inflammatory processes and have innate immune memory, both of which make them a potential candidate responsible of long‐term neural deficits.ConclusionThis review aims in summarizing the in vivo and in vitro studies associating microglia with general anesthesia and describing how GAAs induce neurocognitive deficits via microglia to further explore the effects of GAAs on neurodevelopment.

Preoperative echocardiography and anesthetic drugs as predictors of post-induction hypotension during general anesthesia: a prospective observational study

Post-induction hypotension (PIH) during general anesthesia is a serious concern due to its high incidence and association with adverse postoperative outcomes and prognosis. We prospectively enrolled consecutive 1,603 patients scheduled for non-cardiac and cardiac surgery under general anesthesia. The primary outcome was defined as the lowest mean blood pressure from induction of general anesthesia to the start of surgery: post-induction blood pressure (PIB). Multivariable regression analysis was used to investigate the relationships between PIB and preoperative echocardiographic measurements, types and doses of anesthetic agents, and preoperative comorbidities and oral medication. Left ventricle regional wall motion abnormality (RWMA) and lower estimated glomerular filtration rate significantly associated lower PIB. Factors significantly associated with higher PIB were high BMI, beta blockers, high pre-induction mean blood pressure, and starting induction in the afternoon. Sevoflurane and prophylactic norepinephrine use were associated with higher PIB as anesthetic interventions. Significant interactions were found between sevoflurane and RWMA (P for interaction: 0.01). This is the first study to demonstrate the feasibility of intervening in the selection of anesthetic agents based on echocardiographic findings and to recommend the use of sevoflurane and prophylactic norepinephrine for the prevention of PIH, especially in patients with RWMA.