Anesthetic Dose Research Articles

The Frail Elderly Patient and the Need for a Video Store on Regional Anaesthesia Blocks

The Frail Elderly Patient and the Need for a Video Store on Regional Anaesthesia Blocks

Retracted: Effects of Different Doses of Dex Anesthesia on Inflammatory Factors and Hemodynamics in Patients Undergoing Neurosurgery and its Relationship with RSS Score.

[This retracts the article DOI: 10.1155/2022/6447407.].

A Clinical Study for Removal of Impacted Mandibular Third Molar under Local Anaesthesia, with and without Ketamine - A Split Mouth Comparative Study.

Disimpaction is one of the most common operations done by oral and maxillofacial surgeons around the world. Ketamine is a well-known general anaesthetic and short-acting intraoperative analgesic. The aim of this study was to measure the efficacy of anaesthesia using combined treatment with local anaesthetic plus a subanaesthetic dose of ketamine and local anaesthetic alone in bilaterally impacted mandibular third molar surgery. A total of 24 patients who consented were taken up for a split-mouth study. In the control group, surgical extraction of the impacted lower third molar was done using local anaesthesia (lignocaine 2% with 1:80,000 adrenaline) only, and in the study group, local anaesthesia with ketamine extraction was done using ketamine (0.2 mg/kg) along with local anaesthesia (LA). The time of onset and the duration of anaesthesia intraoperatively were recorded using a digital stopwatch. The depth of anaesthesia was noted on the 10th, 30th and 60th min. After extraction, the post-operative pain on the first, fourth, eighth and 12th hour was evaluated using a Visual Analogue Scale (VAS) score rating of 1-10. The pulse was also noted and compared for any differences in either of the groups. A statistically significant (P < 0.005) difference in result was obtained for the onset, duration, depth and pain score after surgical extraction in both the evaluated groups. The pain index score by the ketamine group was significantly low as compared to the local anaesthesia-only group. Intraoperative onset, duration and depth of anaesthesia obtained had a significant difference. Ketamine can be used as a viable option for surgical third molar extractions with reduced discomfort and post-operative pain.

Risk factors for insufficient ultrasound-guided supraclavicular brachial plexus block

PurposeUltrasound-guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements.MethodsIn total, 269 patients receiving ultrasound-guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut-off values with the highest predictive potential.ResultsOf 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139–171) mmHg vs. 145 (127–155) mmHg; P = 0.026].ConclusionElbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement.Level of EvidencePrognostic Level III

Combined Serratus Intercostal Fascial Block (SIFB) and Rectus Sheath Block (RSB) for Chest Wall Fracture

Purpose: Rib fractures are common in patients presenting chest trauma and are associated with significant morbidity and mortality. Traditional pain management options for rib fractures include thoracic epidural and/or paravertebral blocks. However, novel regional anesthesia techniques have been demonstrated to improve pain scores and aid patient recovery. We describe the application of a combined Serratus-Intercostal Fascial (SIFB) and Rectus Sheath (RS) nerve blocks to provide analgesia for a patient with lower anterior and lateral rib fractures. Clinical Features: To perform the combined block, an 18-gauge Tuohy needle was inserted deep to the rectus sheath muscle above the transversus muscle with obvious spread of local anesthetic superficial to the posterior rectus sheath where 10mls of 0.375% bupivacaine was injected. The needle continued laterally under the external oblique until it was positioned deep to the left serratus anterior muscle where an additional 15ml was injected. In both blocks, CPNB catheters were inserted beyond the end of the Tuohy needles. On postoperative day 2, the patient reported no pain in his anterior chest and abdomen with improved inspiratory capacity and was able to ambulate. After postoperative day 7 the patient no longer required his oral scheduled opioids and continued to report no chest pain. Conclusion: A combined SIFB and RS block using a single-incision was effective in providing analgesia while being less invasive and providing more control over potential infection sites. The technique also allows for lower dosage of anesthetics which can be relevant in other clinical settings.

Brain Tissue Oxygen and BOLD fMRI Under Different Levels of Neuronal Activity.

Localized increases in neuronal activity are supported by the hemodynamic response, which delivers oxygen to the brain tissue to support synaptic functions, action potentials and other neuronal processes. However, it remains unknown if changes in baseline neuronal activity, which are expected to reflect neuronal metabolic demand, alter the relationship between the local hemodynamic and oxygen behaviour. In order to better characterize this system, we examine here the relationship between brain tissue oxygen (PO2) and hemodynamic responses (BOLD functional MRI) under different levels of neuronal activity. By comparing the stimulus-evoked responses during different levels of baseline neuronal activity, the awake state vs isoflurane anesthesia, we were able to measure how a known change in neuronal demand affected tissue PO2 as well as the hemodynamic response to stimulation. We observed a high correlation between stimulus-evoked PO2 and BOLD responses in the awake state. Moreover, we found that the evoked PO2 and BOLD responses were still present despite the elevated tissue oxygen baseline and decreased baseline of neuronal activity under low concentration isoflurane,and that the magnitudes of these responses decreased by similar proportions but the relationship between these signals was distorted. Our findings point to distortion of the BOLD-PO2 relationship due to anesthesia. The feedback mechanism to adjust the level of brain tissue oxygen, as well as the correlation between BOLD and PO2 responses, are impaired even by a small dose of anesthetics.

Height-adjusted dose of intrathecal bupivacaine on surgical anesthesia for the cesarean section

Background: In the spinal anesthetic technique, local anesthetic dose (concentration and volume) is the main determinant of its adequacy and success of block to be achieved. The lack of pain during surgical intervention rather than on dermatome sensory block level is considered to be an appropriate indicator of surgical anesthesia. Spinal anesthesia is the most common anesthetic technique to provide anesthesia for the elective or emergent cesarean section (CS). However, spinal block-induced maternal hypotension is the most common adverse effect during single-shot spinal anesthesia. In our study, we aim to study the height-adjusted dose of 0.5% Bupivacaine Heavy (BH) in achieving surgical anesthesia and its effect on maternal hypotension. Participants and Method: One hundred parturients scheduled for elective CS were enrolled and were compared to the parallel arms of parturients receiving conventional BH. Fifty parturients in each group were included. In the conventional group (B), participants received spinal block with 12 mg of 0.5% BH, and in the height adjusted-dose group (H), participants received a dose of 0.5% BH in 0.06 mg per centimetre height. A sensory block level of T6 dermatome or higher was consider adequate to start surgery. The adequate surgical anesthesia is considered to be achieved if cesarean delivery can be performed without supplementary analgesia. The need of supplementary analgesia, conversion to general anesthesia, or no block till 15 min of intrathecal BH is considered spinal failure. Results: 4% of the height-adjusted dose group have a low block level. Two cases complained of pain, and of them, one received supplementary analgesia and one was converted to general anesthesia. Systolic hypotension of a maternal blood pressure of less than 90 mm Hg was found in 19 (38%) and 10 (20%) in the conventional group and HAD group, respectively, which was highly significant statistically (p value 0.001%). Conclusion: Intrathecal hyperbaric bupivacaine in height adjusted 0.06 mg per cm height of patient can achieve surgical anesthesia with maintainance of systolic blood pressure. However, low dosing of intrathecal BH has higher cases of block failure in comparison to the conventional fixed dose regime of spinal anesthesia.

The effect of body condition on alfaxalone induction dosage requirement in dogs.

Alfaxalone is commonly used in veterinary anesthesia for the induction of general anesthesia (GA) in dogs. However, it has been associated with dose-dependent cardiovascular depression. Therefore, the administration of liposoluble, intravenous (IV)-administered injectable induction agents, such as alfaxalone, is recommended to be based on the dog's lean body mass (LBM). To determine the influence of body condition score (BCS) on IV alfaxalone dose requirements to achieve endotracheal intubation in dogs. Prospective clinical study. A group of 34 dogs undergoing GA for diagnostic and/or surgical procedures, body weight (BW) > 4 kg, BCS > 2, age 1-14 years, American Society of Anesthesiologists (ASAs) classification I-III. Dogs were allocated to two different groups according to their BCS: non-overweight group (NOW) BCS: 3-5 and over-weight group (OW) BCS: 6-9. All dogs were premedicated IV with methadone 0.2 mg kg-1, and anesthesia was induced by a slow IV infusion of alfaxalone at 1 mg kg-1 minute-1, delivered with a syringe driver, until loss of jaw tone and no/minimal gagging reflex sufficient to allow endotracheal intubation was achieved. The total dose of alfaxalone and the occurrence of post-induction apnoea were recorded.The Shapiro-Wilk test was performed to test for normality. A Chi-square test was performed to compare the incidence of post-induction apnoea between groups, and the Mann-Whitney U test was performed to compare the induction dose of alfaxalone between groups. A p-value < 0.05 was considered statistically significant. The mean dose ± standard deviation of alfaxalone in NOW was 2.18 ± 0.59 mg kg-1, and in OW, it was 1.63 ± 0.26 mg kg-1 (p = 0.002). The sedation score did not differ between groups. Postinduction apnoea (PIA) occurred in 6 of 17 animals in NOW and 15 of 17 in OW (p = 0.002). The dose of IV alfaxalone per kg of total body mass required to achieve endotracheal intubation was lower in overweight dogs, suggesting that LBM should be considered when calculating IV anesthetic doses. The incidence of post-induction apnoea was higher in overweight/obese dogs with alfaxalone administered at a rate of 1 mg kg-1 minute-1.

Laparoscopic Cholecystectomy Lower Thoracic Spinal Anesthesia. A retrospective Study with 505 Patients

Background: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a retrospective study with patients undergoing laparoscopic cholecystectomy under thoracic spinal anesthesia. Methods: A total of 505 laparoscopic cholecystectomy patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T8 to T11, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with two doses of 0.5% bupivacaine hyperbaric plus 25 µg of fentanyl, until reaching the sensitive level of T3. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications. Results: All 505 patients developed spinal. Neither the dose of hyperbaric solution of 0.5% bupivacaine nor the addition of fentanyl affected the onset of sensory block. The duration of sensory block was greater than the motor block with hyperbaric solution. Bradycardia occurred in 16 (3.1%) patients, and was not correlated with the level of thoracic puncture. Hypotension occurred in 82 (16.2%), with no significant association with the dose of local anesthetic. None of the 505 patients had the maximum degree of lower limb motor block, with significant difference in terms of dose. Paresthesia was observed in 28 (5.5%) without significant difference between needles. All paresthesias were transient and without residual sequelae. Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery, without neurological sequelae.

Study of Two Different Volumes of 0.75% Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility

Background &#x0D; Use of ultrasound guidance during supraclavicular brachial plexus block allows the usage of a lower anesthetics dose and minimizing unwanted effects of the anesthesia.&#x0D; Objective To compare the success of sensory blockade and the incidence of hemidiaphragmatic dysfunction in patients receiving two different volume of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block.&#x0D; Method A prospective randomized double-blinded comparative study was conducted. Group A patients (n=30) received 20 ml and Group B (n=30) received 25 ml of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Hemodynamic parameters, oxygen saturation, diaphragmatic excursion, onset of sensory blockade and time for completion of blockade were measured. Independent t-test, Chi-square test and Mann-Whitney U test were used to analyze the data at p value of less than 0.05 using Statistical Package for Social sciences (version 11.5).&#x0D; Result At 30 minutes, 29 (96.67%) patients in group B and 27 (90.0%) patients in group A had no sensation in median, radial, ulnar, musculocutaneous and medial cutaneous nerves territories; however, it was not significant statistically (p value &gt; 0.05). At 30 minutes in Group A, 25 (83.33%) patients had no diaphragmatic hemiparesis and five (16.67%) patients had partial diaphragmatic hemiparesis. However, three (10%) patients had no diaphragmatic hemiparesis in Group B, 25 (83.33%) patients had partial and two (6.67%) patients had complete diaphragmatic hemiparesis and it was statistically significant (p &lt; 0.05). Age and sex had no effect on diaphragmatic hemiparesis in both groups (p value &gt; 0.05).&#x0D; Conclusion The patients receiving lower volume of Ropivacaine had less incidence of hemidiaphragmatic dysfunction with similar sensory blockade as compared to the patients receiving higher volume of Ropivacaine.

A comparative study between Thoracic Epidural Anesthesia in non-intubated video-assisted thoracoscopes and the conventional general anesthesia with one lung ventilation

ABSTRACT Background Video-assisted thoracoscopic surgery (VATS) refers to the minimally invasive thoracic surgeries performed by video cameras to avoid the invasive conventional open thoracotomy. The majority necessitate one-lung ventilation. Regional anesthesia is involved to avoid the risks of general anesthesia(GA) and one-lung ventilation and promote efficient recovery of these vulnerable populations. Objective To assess the feasibility of non-intubated VATS with Thoracic Epidural Anesthesia (TEA) compared to the conventional GA in terms of hemodynamic and ventilatory parameters, postoperative pain control, opiate consumption, ambulation, and length of hospital stay. Patients and Methods This study is a prospective randomized clinical study conducted in Ain Shams University Hospitals over 2 years, with a sample size of 40 patients in 2 groups. The GA group, after induction of anesthesia, double-lumen endotracheal tube was inserted to facilitate one-lung ventilation. The TEA group, an epidural catheter was inserted between T3 and T4 orT4 and T5 intervertebral space, local anesthetic dose titrated aiming to achieve sensory and motor block between C7-T7 levels. Results The findings revealed no statistically significant difference between groups throughout the perioperative period (p >0.05) regarding ventilatory and circulatory parameters besides opiate consumption. Conversely, in terms of postoperative ambulation and length of hospital stay (LOS), p-value=0.013 and 0.001 respectively for each favoring the TEA group. Similar results were denoted for postoperative pain control, there was statistically significant difference between groups in VAS score at 3 hours (P =0.004). Conclusion The feasibility of nonintubated VATS with TEA was tested with respect to safety and efficiency compared to the conventional GA. The results of both groups are comparable in terms of hemodynamics and ventilatory parameters. Despite similar overall opiate consumption in both groups, the TEA group demonstrated promising results regarding the enhanced recovery parameters in terms of better early postoperative pain control, earlier ambulation, and decreased length of hospital stay.

Does the Choice of Anaesthesia Affect Cancer? A Molecular Crosstalk between Theory and Practice

In recent years, there has been an increasing scientific interest in the interaction between anaesthesia and cancer development. Retrospective studies show that the choice of anaesthetics may influence cancer outcome and cancer recurrence; however, these studies show contradictory results. Recently, some large randomized clinical trials have been completed, yet they show no significant effect of anaesthetics on cancer outcomes. In this scoping review, we compiled a body of in vivo and in vitro studies with the goal of evaluating the biological effects of anaesthetics on cancer cells in comparison to clinical effects as described in recent studies. It was found that sevoflurane, propofol, opioids and lidocaine are likely to display direct biological effects on cancer cells; however, significant effects are only found in studies with exposure to high concentrations of anaesthetics and/or during longer exposure times. When compared to clinical data, these differences in exposure and dose-effect relation, as well as tissue selectivity, population selection and unclear anaesthetic dosing protocols might explain the lack of outcome.

Comparison of Continuous and Programmed Intermittent Bolus Infusion of 0.2% Ropivacaine after Ultrasound-Guided Continuous Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery.

Despite the clinical effectiveness of the programmed intermittent bolus (PIB) method for epidural analgesia, evidence for this method in continuous interscalene brachial plexus block (CIBPB) is unclear. This study aimed to investigate the pain relief effect after arthroscopic shoulder surgery according to the administration method by comparing the PIB and continuous infusion methods among the administration methods of local anesthetics. Sixty-four patients aged >19 years scheduled for elective arthroscopic shoulder surgery were enrolled and divided into two groups. Ultrasound-guided CIBPB was performed to control postoperative pain. The infusion pump was programmed so that 0.2% ropivacaine was continuously injected at 1.1 mL/h in group A, whereas in group B, 0.1 mL/h was continuously injected and 4 mL was periodically injected at 4 h intervals. In both groups, a further infusion of 4 mL of 0.2% ropivacaine was administered if the patient requested additional analgesia, and the lockout time was set at 30 min. Postoperative pain quality was assessed using a visual analog scale (VAS), and the incidence of patients requiring additional analgesics, motor blockade using a modified Bromage scale (MBS), and consumed doses of local anesthetic were assessed. The VAS and incidence of rescue analgesics were performed when the patient could communicate voluntarily after admission to the post-anesthetic care unit, and at 24 and 48 h after surgery showed no significant difference between the two groups. The MBS at 24 h after surgery was significantly higher in group B (p = 0.038). In the comparison of consumed doses of local anesthetic, group B had a significantly higher bolus injection dose (p = 0.047) and frequency of bolus use in the 24 h after surgery (p = 0.034). The PIB method in CIBPB after arthroscopic shoulder surgery provided a similar analgesic effect, with a higher bolus injection dose of local anesthetic and increased motor blockade than the continuous infusion method.

Alfaxalone anaesthesia increases brain derived neurotrophic factor levels and preserves postoperative cognition by activating pregnane-X receptors: an in vitro study and a double blind randomised controlled trial

BackgroundAlfaxalone is a fast acting intravenous anaesthetic with high therapeutic index. It is an analogue of the naturally-occurring neurosteroid allopregnanolone responsible for maintenance of cognition and neuroprotection by activation of brain pregnane X receptors and consequent increased production of mature brain-derived neurotrophic factor (m-BDNF). Two studies are reported here: an in vitro study investigated whether alfaxalone activates human pregnane X receptors (h-PXR) as effectively as allopregnanolone; and a clinical study that measured postoperative changes in serum m-BDNF and cognition in patients after alfaxalone anaesthesia compared with propofol and sevoflurane.MethodsIn vitro Activation of h-PXR by allopregnanolone and alfaxalone solutions (206 - 50,000 nM) was measured using human embryonic kidney cells expressing h-PXR hybridised and linked to the firefly luciferase gene. Light emission by luciferase stimulated by each ligand binding with h-PXR was measured.Clinical A double blind prospective randomised study of patients undergoing hip arthroplasty anaesthetised with alfaxalone TIVA (n = 8) or propofol TIVA (n = 3) or propofol plus sevoflurane inhalational anaesthesia (n = 4). The doses of anaesthetics were titrated to the same depth of anaesthesia (BIS 40-60). Subjects’ cognitive performance was assessed using the Grooved Pegboard Test, Digit Symbol Substitution Test (DSST) and Mini Mental State examination (MMSE) for 7 days postoperatively. Serum m-BDNF concentrations were measured for 7 postoperative days.ResultsIn vitro Allopregnanolone and alfaxalone both activated h-PXR, alfaxalone being more efficacious than allopregnanolone: 50,000 nM, p = 0.0019; 16,700 nM, p = 0.0472; 5600 nM, p = 0.0031.Clinical Alfaxalone treated subjects scored better than propofol and sevoflurane anaesthetised patients in the cognition tests: (MMSE p = 0.0251; Grooved Pegboard test dominant hand pre v post anaesthesia scores p = 0.8438 for alfaxalone and p = 0.0156 for propofol and propofol/sevoflurane combined). The higher cognition scores were accompanied by higher serum m-BDNF levels in the alfaxalone anaesthetised patients (p < 0.0001).ConclusionsThese results suggest that sedation and anaesthesia induced by the synthetic neuroactive steroid alfaxalone may be accompanied by effects normally caused by physiological actions of allopregnanolone at PXR, namely, increased secretion of m-BDNF and consequent neuroprotection and preservation of cognition.Trial registrationThe clinical trial was registered on 17/01/2018 with the Australian New Zealand Clinical Trials Registry: registration number ACTRN12618000064202 [Universal Trial Number U1111-1198-0412].

OBEZ HASTALAR İÇİN GÜNÜBİRLİK ANESTEZİ UYGULAMALARI

Standard operating room conditions may not be provided in areas where ambulatory anesthesia is applied. For this reason, the infrastructure of the center should be taken into account when evaluating obese patients. Obesity is not an independent risk factor. Accompanying comorbidities are decisive in the development of perioperative complications. Obese patients should be evaluated for cardiac, pulmonary, endocrine, and OSAS. Particular attention should be paid when evaluating morbidly obese (BMI&gt; 40 kg / m2) patients. Comorbidities, not BMI alone, should be decisive in terms of suitability for outpatient surgery. Super morbid obese patients with BMI &gt; 50 kg / m2 can be taken to selected ambulatory surgery if there is no accompanying comorbidity. No relationship was found between BMI and difficult airway. However, it was stated that difficult mask ventilation and intubation were found in patients with a high mallampati score and neck circumference &gt;50 cm. Therefore, it may be helpful to look at the neck circumference of obese patients preoperatively. The drugs to be used should be adjusted according to the ideal body weight and used by titration. It is recommended to use wakefulness (BIS) monitoring methods when adjusting the anesthetic dose for obese patients. Non-opioid analgesia methods should be preferred. Opioids should be preferred as rescue analgesics. If possible, regional anesthesia and analgesia methods should be applied. Anatomical difficulties should be considered in regional anesthesia and analgesia applications. Hospitalization should be considered in surgeries longer than three hours. In surgeries longer than 6 hours, patients should be hospitalized.

Effect of Two Different Volumes of Ropivacaine and Lignocaine at Two Different Sites in Ultrasound-Guided Supraclavicular Brachial Plexus Block on Diaphragm Motility

Ultrasound (USG) guided supraclavicular brachial plexus block (BPB) helps in precise delivery of local anesthetic injection, reduced volume or dose of drug providing excellent surgical anesthesia with fewer complications. Objective of the study was to compare effect of two different volumes of Ropivacaine and Lignocaine at two different sites of USG-guided supraclavicular BPB on diaphragmatic motility, quality of block and tourniquet pain. A prospective randomized double-blinded comparative study was conducted among adult patient with below elbow elective surgery. In group A patients (n=17), 20ml of anesthetic solution was injected in the corner pocket and 10ml in the nerve cluster guided with USG. In group B patients (n=17), 15ml of the anesthetic solution was injected in the corner pocket and 5ml in the nerve cluster guided with USG. Hemodynamic parameters, diaphragmatic excursion, onset of anesthetic effects were measured at frequent intervals. The data were analyzed using Statistical Package for Social Sciences at P-value less than 0.05. Hemodynamic profile of the patients were similar in both groups (P-value&gt;0.05). Statistically significant hemi-diaphragmatic dysfunction (partial and complete paralysis) after 15 and 30minutes of blockade was more common in group A than Group B (P&lt;0.05). At 30 minutes after the injection of the anesthesia, all patient in both the groups had complete sensory and motor block in all nerve territory. Tourniquet time was lower in group A (80.35±9.59 minutes vs 84.12±7.75 minutes); however, it was statistically not significant (P-value&gt;0.05). The present study showed that the patients who received lesser half of the required volume of local anesthetics had less incidence of hemidiaphragmatic dysfunction with similar successful rate of blockage (100%) and similar quality of the block as compared to the patients who received greater half of the required volume of local anesthetics.

Dexmedetomidine premedication increases preoperative sedation and inhibits stress induced by tracheal intubation in adult: a prospective randomized double-blind clinical study

ObjectiveThe aim of this prospective randomized double-blind study is to evaluate whether oral dexmedetomidine (DEX) premedication could increase sedation in order to reduce preoperative anxiety and inhibit stress response during general anesthesia tracheal intubation.MaterialsA total of 100 ASA I and II adult patients undergoing elective neurosurgery were randomly divided into the control group (C group, n = 50) and the oral DEX premedication (DEX group, n = 50). Patients were administrated 4 μg/kg dexmedetomidine orally pre-anesthesia 120 min. Hemodynamic variables were monitored and recorded from premedication to 10 min after tracheal intubation. The primary outcome, the sedation level of all participants, was evaluated by Richmond Agitation Sedation Scale (RASS), and Numerical Rating Scale was to measure their intensity of thirst and satisfaction of patients’ family members. During general anesthesia induction, the total dosage of induction anesthetics and complications relative to anesthesia induction were recorded. After tracheal intubation, blood sample was drain from radial atrial line to measure levels of adrenocorticotropic hormone (ACTH) and cortisol.ResultsRASS scores at 60 min after premedication and on arrival in the operating room were significantly reduced in the DEX group (P < 0.001). Oral DEX premedication not only increased the intensity of thirst but also the satisfaction of their family members (P < 0.001). The cortisol level after tracheal intubation was deduced by oral DEX premedication (P < 0.05). Oral DEX premedication reduced heart rate (HR) and mean arterial pressure (MAP) on arrival in the operating room, and HR when tracheal intubation (P < 0.05). During the whole process of anesthesia induction, although the lowest MAP in two groups were not significantly different, the lowest HR was significantly lower in the DEX group (P < 0.05). Oral DEX premedication might reduce HR from premedication to 10 min after tracheal intubation. However MAP was reduced just from premedication to on arrival in the operating room. Total induction dosages of propofol, midazolam, sulfentanil and rocuronium were similar in two groups (P > 0.05), as well as the complications relative to anesthesia induction and cases of rescue dopamine therapy were similar (P > 0.05).ConclusionOral DEX 4 μg/kg premedication was an efficient intervention to increase preoperative sedation and reduce stress reaction induced by general anesthesia tracheal intubation, but also it was with the stable hemodynamic during the process of general anesthesia tracheal intubation, and improved the satisfaction of patients’ family members. In this study, the sparing-anesthetic effect of 4 μg/kg DEX oral premedication was not significant, and this would be needed to study in future.Trial registrationThis trail was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn, Jie Gao) on 15/04/2021, registration number was ChiCTR2100045458.

Higher anesthetic dose requirement for sedation in children with autism spectrum disorder compared to neuro-atypical controls- a prospective observational study

IntroductionChildren with Autism Spectrum Disorders (ASD) are known to require general anesthesia or sedation for undergoing procedures like Magnetic Resonance Imaging (MRI). The dose required for sedation may vary depending on multiple factors. The aim of this study was to compare the sedative requirements of children with ASD with those who do not have ASD for undergoing MRI. MethodsThirty-four children with ASD and 31 neuro-atypical controls (children with other neurological disorders undergoing MRI) were recruited into the study. Children were premedicated with injection midazolam 0.1 mg/kg. This was followed by dexmedetomidine 2 mcg/kg over 2 min, followed by 2 mcg/kg/hour infusion inside the MRI gantry. If the above anesthetic was insufficient to make the child immobile, a bolus dose of thiopentone 3 mg/kg was supplemented and this was compared between the two groups. The children were monitored with ECG, and oxygen saturation. Since, these children were on sedative medications, each patient was given a sedation score depending on the number of sedative medications, the child was receiving. ResultsTwenty one of 34 children in the ASD group required thiopentone for sedation while 5 of 31 in the control group required thiopentone supplementation (p < 0.001). The thiopentone requirement continued to be significantly different between the two groups at each level of sedation score (0, 1, 2 +) (p < 0.004). ConclusionChildren with ASD required higher anesthetic dose for sedation compared to neuro-atypical controls for MRI. This study has shown that dexmedetomidine can be safely used for children with autism and additional sedatives are often required for imaging.

Anti-manic and Antipsychotic Effects of Withania somnifera Extract in Rodent Model of Bipolar Disorder

Aim: The present study was to investigate the effects of WSE improve cognitive, behavioral and mood disorders in animal models of bipolar disorder. Materials: Animals were divided into six groups each group contain 6 wistar rats of either sex ,Behavioral and memory test were carried out followed by estimation of oxidative stress and neurotransmitters in rat brain using continuous sub anesthetic dose of Amph (1.5 mg/kg, i.p) with Withania somnifera extract (300 mg/kg, i.p) and Lithium chloride (100mg/kg, i.p.) administered daily for 21 days. Results: % Alternation was decreased in rat treated with WSE as compared to control indicating that it also improved spatial memory and learning. various oxidative parameters were estimated, oxidative stress was observed the levels of SOD and GSH reduced and increased in TBARS level compared to control groups, but reduced ion in oxidative stress upon administration of Withania somnifera extract and Lithium chloride indicates ameliorating effects of Withania somnifera extract in oxidative stress. Conclusion: We concluded that WSE showed improvement in learning and memory as animals treated with WSE spent more time in open arms as comapared to Amphetamine with Withania somnifera and Lithium chloridetreated rats. Overall, the findings of this work show that neurotransmitters get imbalance and change the mood and chemistry of the brain. Hence Withania somnifera extract improve neurotransmitter imbalance which is directly linked with mood, behavior, anxiety and manic episodes in an animal model of bipolar disorder

Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis

BackgroundDexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few side effects. We report our experience with dexmedetomidine use during orthopaedic surgery under locoregional anaesthesia to ensure adequate sedation and optimal postoperative pain control.MethodsIn this retrospective analysis, we included 128 patients who underwent orthopaedic surgery between January 2019 and December 2021. All patients received the same local anaesthetic dose of 20 ml of ropivacaine 0.375% + mepivacaine 0.5% for axillary and supraclavicular block and 35 ml of ropivacaine 0.375% + mepivacaine 0.5% for triple nerve block (femoral, obturator and sciatic nerve). The cohort was divided into two groups based on sedation drugs used during surgery (dexmedetomidine, or group D, vs midazolam, or group M). All patients received postoperative 24-h analgesia consisting of 60 mg of ketorolac, 200 mg of tramadol and 4 mg of ondansetron. The primary outcome measured how many patients in the two groups required an analgesic rescue dose of pethidine and the time to first pethidine administration. To reduce confounding, we included patients in two groups with non-statistically different demo-anamnestic parameters and who received the same dose of intraoperative local anaesthetic and postoperative analgesia.ResultsThe number of patients in group D who did not require a rescue dose of analgesia was significantly greater than in group M (49 vs 11, p < 0.001). Time-to-first postoperative opioid administration did not show a fundamental difference between the two groups under examination (523.75 ± 131.55 min vs 564 ± 117.84 min). Total opioid consumption was higher in the M group than in the D group (3529.8 ± 30.36 μg vs 1864.8 ± 31.59 μg, p 0.075), with a mean opioid consumption significantly higher in the M group than in the D group (26.26 ± 42.8 μg vs 69.21 ± 46.1 μg, p < 0.001): D group received 62.06% less opioid than M group.ConclusionsThe continuous infusion of dexmedetomidine during orthopaedic surgery performed under locoregional anaesthesia has been shown to increase the analgesic effect of local anaesthetics and reduce the consumption of major opioids in the postoperative period. Dexmedetomidine offers a unique ability to supply sedation and analgesia without respiratory depression, having a wide safety margin and an excellent sedative capacity. It does not increase the rate of postoperative complications.