Anesthetic Dose Research Articles

Exploring the Gender-Specific Impact of Intraperitoneal Bupivacaine on Early Postoperative Pain in Sleeve Gastrectomy.

Background: Early postoperative pain is a significant problem in bariatric and metabolic surgery. Our study aimed to investigate the potential role of intraperitoneal bupivacaine hydrochloride in pain management in the early postoperative period after bariatric and metabolic surgery. Methods: This double-blind, prospective, randomized, controlled study included 68 individuals who underwent bariatric and metabolic surgery at the Department of Surgery, Istanbul Aydin University Hospital. The study group received 20 mL of 0.5% bupivacaine hydrochloride intraperitoneally at the operative site, and the control group received 20 mL of normal saline. Visual analog scale (VAS) scores of each patient were recorded at 2nd, 4th, and 6th hours postoperatively. Results: Our study found significant differences in VAS scores of patients between study group and control group at 2nd, 4th, and 6th hours postoperatively. Significant differences were found between male and female patients in the control group at 2nd, 4th, and 6th hours postoperatively. Interestingly, no significant difference was found between female patients in the study group and control group at 2nd, 4th, and 6th hours postoperatively. Conclusions: Our study suggests that intraperitoneal administration of bupivacaine hydrochloride is effective in reducing early postoperative pain in male patients. However, no significant difference was found between the study group and the control group in female patients. Our results indicate that there may be a gender-related difference in the response to bupivacaine administration. Further research is needed to confirm these findings and determine the optimal dosing and administration of local anesthetics for postoperative pain management.

Comparison of lidocaine and its combination with ketamine for distal intravenous regional anesthesia (DIVRA) in bovines

The hoof diseases of cattle can be managed surgically under intravenous regional anesthesia (IVRA). For routine induction of IVRA, a tourniquet is placed circumferentially at the metacarpus/metatarsus. In the present study, hoof diseases of cattle were corrected using a modified IVRA technique. The cattle with hoof ailments were randomly divided into two groups and a tourniquet was placed just distal to the dew claws instead of at the metacarpus/metatarsus in order to decrease the dose of anesthetic. In group I lidocaine (2mg/kg) and in group II a mixture of lidocaine and ketamine (2mg/kg+1.5mg/kg) was injected into the axial digital vein to induce distal intravenous regional anesthesia (DIVRA). The heart rate, respiration rate, systolic and diastolic pressure were unaffected in both groups. Oxygen saturation was significantly (P<0.05) lower between 5 and 60 minutes in group I and between 15and 40 minutes in group II animals. The sensory and motor block onset time was shorter, and the sensory and motor block recovery time was longer in group II animals as compared to group I animals. It was concluded that the DIVRA technique using lidocaine alone and lidocaine admixed with ketamine are suitable for hoof examination and surgery.

Transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration for diagnostic and staging purposes: a narrative review.

Transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is a feasible and well-tolerated modality that is increasingly used to diagnose intrathoracic lesions. This narrative review summarizes the current application of EUS-B-FNA for diagnosing lung cancer, thoracic sarcoidosis, and metastases from extrathoracic malignancies. A comprehensive and systematic online literature search via Medline/PubMed for the period January 2005 to December 2022 was conducted for articles published using the keywords "EUS-B-FNA", "endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA)", "endoscopic ultrasound fine-needle aspiration (EUS-FNA)", "lung cancer", "staging", and "sarcoidosis". Recent data prove the efficacy and safety of EUS-B-FNA for providing complete lung cancer staging, when combined with EBUS-TBNA, and in the evaluation of para-esophageal lesions. EUS-B-FNA allows access to inferior mediastinal lymph nodes and para-esophageal masses that are not accessible by EBUS-TBNA. Additional advantages of using EUS-B-FNA include significantly lower doses of anesthetics and sedatives, a shorter procedural time, fewer incidents of oxygen desaturation due to a poor respiratory reserve, significantly less cough, and higher operator satisfaction. Moreover, this procedure can be performed sequentially in the same setting with EBUS-TBNA by one operator. Other benefits include a lower cost, a single setting, and scope use. As EUS-B-FNA and EBUS-TBNA have complementary access to the mediastinum, the diagnostic yield of EUS-B-FNA combined with EBUS-TBNA is higher than that of endosonographic techniques alone in the diagnostic workup of intrathoracic lesions.

Caudal Dexmedetomidine versus Fentanyl with Bupivacaine in Decreasing Post-Operative Pain in Pediatric Inguinoscrotal Surgery : A Comparative Study

Introduction: Despite various advancements in postoperative analgesia in children, about half of post-surgical children still experience pain. Opioids like fentanyl are used as an adjunct leading to a lower dose of caudal local anesthetics but have many side effects. Administration of caudal dexmedetomidine with local anesthetics was shown to prolong postoperative analgesia and sedation in children. This study was conducted to compare the effects of caudally administered fentanyl and dexmedetomidine in children undergoing inguinoscrotal surgery. Methods: This was a comparative clinical study in which 152 patients were included. Patients were divided into two groups to receive a caudal block, each having 76 cases. Group A and Group B received single-dose caudal analgesia using fentanyl (1mcg/kg) and dexmedetomidine (1mcg/kg) with 0.25% bupivacaine(0.75ml/kg), respectively. The analgesic effect of the caudal block was evaluated using the FLACC score and sedation using the RSS score. The statistical significance was evaluated using independent t test using confidence interval of 95% (p value<0.05). Results: The study showed no statistical significance in the demographic and operative variables between the two groups. The duration of analgesia (p value<0.001) and both the FLACC (p value=0.001) and RSS score (p value=0.004) only at 30 min postoperative values were statistically significant between the groups. The only side effect that showed statistical significance was vomiting (p value=0.03) seen in fentanyl group. Conclusion: Dexmedetomidine can thus be used safely in children along with bupivacaine in routine inguinoscrotal surgery with additional benefits of prolonged analgesia and decreased side effects.

Comparison of clinical effectiveness of propofol auto co-induction and midazolam propofol co-induction using the priming principle among patients undergoing surgeries

Introduction and Aim: Anaesthesia is a balance between adequate usage of anaesthetic drugs and the state of arousal of the patient. Inadequate dose of anaesthesia leads to increased incidence of awareness, while administration of generous drugs leads to complications such as hemodynamic instability and delayed recovery. The objective of the present study was to investigate the clinical effectiveness of propofol auto co-induction (PP) and midazolam propofol co-induction (PM) using the priming principle among patients undergoing surgeries. Materials and Methods: A prospective, randomized and comparative study, recruited 80 patients who were admitted for elective surgeries was carried out after the approval from institutional ethics committee approval and the trial was registered with the clinical trial registry-India (CTRI). Patients were randomly divided into 2 groups: PP group, where patients received 0.4mg/kg of propofol and PM group, where patients received 0.05mg/kg of midazolam. This was followed by propofol induction (2 mg/kg)-10mg every 15 seconds until a BIS value of 45 was attained in both groups. The collected data was assessed for the normality using the Shapiro-Wilk test. A p-value greater than 0.05 (>0.05) was considered to check the normality. The Student’s t-test and Mann-Whitney U test was used to analyse parametric data and non-parametric data before and after the intervention, respectively. Results: The results depicted a significantly reduced requirement of propofol (induction dose) in the PM group. Conclusion: Pre-dosing with Midazolam significantly decreases the induction dose (propofol) requirement without affecting hemodynamic stability.

Assessing Continuous Epidural Infusion and Programmed Intermittent Epidural Bolus for Their Effectiveness in Providing Labor Analgesia: A Mono-Centric Retrospective Comparative Study.

Background and Objectives: Local anesthetics administered via epidural catheters have evolved from intermittent top-ups to simultaneous administration of continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) using the same device. The latest programmed intermittent epidural bolus (PIEB) model is believed to create a wider and more even distribution of analgesia inside the epidural space. The switch from CEI + PCEA to PIEB + PCEA in our department began in 2018; however, we received conflicting feedback regarding workload from the quality assurance team. This study aimed to investigate the benefits and drawbacks of this conversion, including the differences in acute pain service (APS) staff workload, maternal satisfaction, side effects, and complications before and after the changeover. Materials and Methods: Items from the APS records included total delivery time, average local anesthetic dosage, and the formerly mentioned items. The incidence of side effects, the association between the duration of delivery and total dosage, and hourly medication usage in the time subgroups of the CEI and PIEB groups were compared. The staff workload incurred from rescue bolus injection, catheter adjustment, and dosage adjustment was also analyzed. Results: The final analysis included 214 and 272 cases of CEI + PCEA and PIEB + PCEA for labor analgesia, respectively. The total amount of medication and average hourly dosage were significantly lower in the PIEB + PCEA group. The incidences of dosage change, manual bolus, extra visits per patient, and lidocaine use for rescue bolus were greater in the PIEB + PCEA group, indicating an increased staff workload. However, the two groups did not differ in CS rates, labor time, maternal satisfaction, and side effects. Conclusions: This study revealed that while PIEB + PCEA maintained the advantage of decreasing total drug doses, it inadvertently increased the staff burden. Increased workload might be a consideration in clinical settings when choosing between different methods of PCEA.

Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing.

The primary aim was to assess the pain during intraseptal anesthesia (ISA) administration, as well as during and after scaling and root planing (SRP). The secondary aims pertained to comparing the pain in different jaw regions and evaluating the factors affecting pain during ISA administration, during and after SRP. ISA was obtained with three different doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) in 360 patients. The pain levels were measured using the visual analogue scales (VAS) for pain intensity during ISA administration (VASa), during SRP (VASi), and after SRP (VASp). These findings were then correlated with periodontal parameters. Regression analysis was performed for pain during ISA, during and after SRP. Anesthesia administration was painful in 80.8% of cases. VASa negatively correlated with pocket depth (PPD). VASi showed no dose-dependency, except in mandibular premolars. VASi negatively correlated with the clinical attachment level (CAL). VASp positively correlated with PPD and CAL. Positive bleeding on probing reduced the chance of pain during ISA administration. Longer anesthesia duration and wider anesthetic field (orally) increased the prospects of painless SRP. No dose-dependent differences were found regarding patient discomfort and pain intensity of ISA delivery of 4%Ar + Ep for SRP. The pain during ISA administration was mild and well tolerated regardless of the anesthetic dose. A lower intensity of pain during SRP can be expected in patients with greater CAL. Post-treatment pain can be anticipated after SRP in the regions with greater PPD and CAL. NCT04392804 (May 9th, 2020).

Continuous thoracic epidural versus continuous paravertebral analgesia in patients undergoing open renal surgery: Evaluation of pulmonary function; randomized double-blinded clinical trial

ABSTRACT Background This study aimed to assess pulmonary functions after either continuous thoracic paravertebral block (cTPVB) or thoracic epidural block (cTEB) in open renal surgeries. Methodsː The double-blinded, randomized clinical trial included 40 patients scheduled for open renal surgeries at Urology Hospital-Assiut University, equally assigned into group E (n = 20) and group P (n = 20), both at the level of 7th-8th thoracic vertebra. Initially, 7.5–12 mL of bupivacaine 0.25% was started before the induction of general anesthesia, followed by bupivacaine 0.125% continuously at a rate of 5–15 ml/h. Forced vital capacity (FVC) measured every 6 hours postoperatively within the first 24 hours was the primary outcome. Secondary outcomes were peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV1), diaphragmatic excursion (DE), postoperative analgesia, total opioid consumption, total local anesthetic dose, hemodynamics and complications. Resultsː FVC, FEV1 and DE were better preserved in cTPVB where the lowest postoperative readings as a fraction of preoperative control were 0.7 ± 0.11 vs 0.65 ± 0.11 L, 0.74 ± 0.11 vs 0.64 ± 0.10 L and 0.73 ± 0.1 vs 0.58 ± 0.1 cm, respectively. The lowest postoperative PEFR was reported in cTEB (p-value = 0.128). Analysis of numeric rating pain scale, total opioid consumption and time of first rescue analgesic request revealed a statistical nonsignificant difference. The total infused dose of local anesthetic was significantly higher in cTPVB group. Incidence of sympatholytic complications was higher in cTEB. Conclusion cTEB and cTPVB had convergent effect on respiratory function and diaphragmatic motility and equivalent analgesic efficacy after open renal surgeries. Although cTPVB was technically easier and less time-consuming than cTEB, higher dose of local anaesthetic was required in cTPVB.

Haemodynamic and Haemato-Biochemical Changes with Ketamine, Propofol and Ketofol as Constant Rate Infusion Anesthesia for Elective Ovariectomy in Dogs

Background: Combination of glycopyrrolate, butorphanol, xylazine as premedication and induction with propofol and maintenance with ketamine, propofol and propofol mixtures (Ketofol 1:1) as constant rate infusion (CRI) would have the ability to maintain better hemodynamic and reduce the dose of general anesthesia for maintenance. This technique once gets standardized; it may transfer to field veterinarians for elective ovariectomy under a routine animal birth control programme (ABC) for safe handling of canines. Therefore, the present study was designed to evaluate haemodynamic and haemato-biochemical changes with Ketamine, Propofol and Ketofol as CRI anesthesia in dogs. Methods: The study was conducted on 18 female dogs during 2019-2021 and these animals were randomly divided into three experimental groups, each group (I, II and III) containing six animals. All animals were pre-medicated with glycopyrrolate @ 0.01 mg/kg b.wt I/M followed by inj. butorphanol 0.2 mg/kg b.wt and xylazine 1mg/kg b.wt I/M after 5 minutes by using different syringes. After 10 minutes of xylazine, animals were induced (till effect) with propofol and immediately just after induction animals were maintained with constant rate infusion of ketamine, propofol and ketofol 1:1 along with normal saline @ 10 ml/kg/hr. Result: Cardiovascular parameters showed that the value of systolic arterial pressure increased significantly (P less than 0.05) after pre-medication in all three groups in comparisons to respective base values. Value of diastolic arterial pressure increased significantly (P less than 0.05) after pre-medication in groups I and II, whereas non-significantly (p greater than 0.05) in group III in comparisons to respective base values. Hemoglobin and PCV values decreased non-significantly after pre-medication and remained non-significantly lower at various intervals in comparison to respective base values during observation periods except at recovery in group II. Changes in TLC did not show a definite pattern and values of TEC in all groups changed non-significantly (p greater than 0.05) at various time intervals in comparison to respective base values during the observation period.

Processed EEG for personalized dosing of anesthetics during general anesthesia

Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations.

Transversus abdominis plane block versus local anesthetic infiltration for anesthetic effect in peritoneal dialysis catheter insertion: A systematic review and meta-analysis.

The transversus abdominis plane (TAP) block is commonly used in surgical practice for postoperative analgesia in abdominal surgery. However, numerous studies have demonstrated that TAP block is also suitable for intraoperative anesthesia of peritoneal dialysis catheter (PDC) insertion, although its efficacy and safety are still controversial. Local anesthetic infiltration (LAI) is currently the most general anesthesia strategy for PDC insertion. Consequently, we conducted this systematic review and meta-analysis to identify which anesthesia strategy is better between TAP block and LAI. A systematic and comprehensive search was conducted on 5 databases, retrieving published and registered randomized controlled trials as of March 10, 2022, comparing the anesthesia effects of TAP block and LAI. The primary outcomes are the visual analogue scale (VAS) pain score of patients at various time points in the surgery. The secondary outcomes are the VAS pain score at rest at 2 and 24 hours postoperatively, intraoperative rescue anesthesia, general anesthesia switching rate, and PD-related complications. There were 9 trials with 432 patients identified. TAP block was more effective than LAI at reducing intraoperative and postoperative VAS pain scores in patients. Compared to LAI, TAP block significantly reduces the dosage of anesthetics used to rescue anesthesia during surgery, the general anesthesia switching rate, and the incidence of postoperative PD-related complications in patients. Our systematic review and meta-analysis proved that TAP block could be used as the primary anesthetic technique for PDC insertion, with superior anesthetic effects to LAI.

Subanaesthetic doses of ketamine reduce but do not eliminate predictive coding responses: implications for mechanisms of sensory disconnection

BackgroundSensory disconnection is a key feature of sleep and anaesthesia. We have proposed that predictive coding offers a framework for understanding the mechanisms of disconnection. Low doses of ketamine that do not induce disconnection should thus diminish predictive coding, but not abolish it. MethodsKetamine was administered to 14 participants up to a blood concentration of 0.3 μg ml−1 Participants were played a series of tones comprising a roving oddball sequence while electroencephalography evoked response potentials were recorded. We fit a Bayesian observer model to the tone sequence, correlating neural activity with the prediction errors generated by the model using linear mixed effects models and cluster-based statistics. ResultsKetamine modulated prediction errors associated with the transition of one tone to the next (transitional probability), but not how often tones changed (environmental volatility), of the system. Transitional probability was reduced when blood concentrations of ketamine were increased to 0.2–0.3 μg ml−1 (96–208 ms, P=0.003); however, correlates of prediction error were still evident in the electroencephalogram (124–168 ms, P=0.003). Prediction errors related to environmental volatility were associated with electroencephalographic activity before ketamine (224–284 ms, P=0.028) and during 0.2–0.3 μg ml−1 ketamine (108–248 ms, P=0.003). At this subanaesthetic dose, ketamine did not exert a dose-dependent modulation of prediction error. ConclusionsSubanaesthetic dosing of ketamine reduced correlates of predictive coding but did not eliminate them. Future studies should evaluate whether states of sensory disconnection, including anaesthetic doses of ketamine, are associated with a complete absence of predictive coding responses. Clinical trial registrationNCT03284307.

Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial

Background: An adequate dose of spinal anesthetic is very crucial in elderly surgical patients. The routine method to calculate the dose in a particular patient is usually based upon the weight of the patient, but the effect cannot always be predictable. We evaluated the efficacy and safety of the height-based dose of spinal anesthetic versus the conventional dose on intraoperative hemodynamics and spinal block characteristics in geriatric patients scheduled for lower limb surgeries.
 Methodology: This single-blinded, parallel-group, randomized, clinical trial enrolled 56 patients, aged 60 y or above who were scheduled for lower limb orthopedic surgeries under spinal anesthesia. The patients were randomly divided into two groups. In the height-based group, 0.06 mg of 0.5% hyperbaric bupivacaine/cm height of the patient was administered intrathecally. The control group received a fixed dose of 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. All patients received 25 µg of fentanyl (0.1 mg / 2 ml) intrathecally. The incidence of hypotension was the primary outcome. The incidence of bradycardia, highest sensory level, onset and duration of sensory and motor block, incidence of shivering, the total dose of bupivacaine, total amount of fluid infused, vasopressors needed, and blood loss were the secondary outcomes.
 Results: The incidence of hypotension was significantly reduced in patients receiving height-based spinal dose compared to those in which standard dose was administered (57.1% vs. 82.1%, P = 0.042). The duration of sensory blocks was significantly shorter in height-based group compared to the control group (116 ± 32.77 vs. 90.59 ± 19.66 min; P = 0.001) as was the duration of the motor block (153.18 ± 42 and 117 ± 25.37 min; P < 0.001).
 Conclusion: In geriatric patients undergoing orthopedic lower limb surgery, the height-based dose of spinal anesthesia was effective and safe in reducing the incidence of hypotension with fast recovery from sensory and motor block.
 Abbreviations: ASA- American Society of Anesthesiologists; COPD- Chronic Obstructive Pulmonary Disease; CSF- Cerebrospinal Fluid; DVT- Deep Venous Thrombosis; IQR- Interquartile range- n: Numbers; SD- Standard Deviation; SA- Spinal Anesthesia
 Key words: Bromage scale; Elderly; Height; Hypotension; Orthopedics; Anesthesia, Spinal
 Citation: Alkonaiesy TM, Amin SM, Abdallah NM, Sherif Ismail Muhammad SI, Hassan H. Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial. Anaesth. pain intensive care 2023;27(4):565−572; DOI: 10.35975/apic.v27i4.2160
 Received: February 20, 2023; Reviewed: May 16, 2023; Accepted: June 16, 2023

Low-dose epidural anesthesia decreases the use of intraoperative systemic analgesics in goats undergoing lower urinary tract surgery.

To test whether the use of low-dose epidural anesthesia (EA) in goats undergoing lower urinary tract surgery reduces the requirements of perioperative analgesics, contributes to intraoperative hypotension, and improves postoperative comfort during the first 24 hours after surgery. Retrospective analysis of 38 goats between January 2019 and July 2022. Goats were divided into 2 groups (EA or no EA). Demographic characteristics, surgical procedure, time of anesthesia, and anesthetic agents used were compared between treatment groups. Outcome variables potentially related to the use of EA included dose of inhalational anesthetics, incidence of hypotension (mean arterial pressure < 60 mm Hg), intraoperative and postoperative administration of morphine, and time to first meal after surgery. EA (n = 21) consisted of bupivacaine or ropivacaine 0.1% to 0.2% with an opioid. There were no differences between groups except for age (EA group was younger). Less inhalational anesthetic (P = .03) and less intraoperative morphine (P = .008) were used in the EA group. The incidence of hypotension was 52% for EA and 58% for no EA (P = .691). Administration of postoperative morphine was not different between groups (EA, 67%, and no EA, 53%; P = .686). Time to first meal was 7.5 hours (3 to 18 hours) for EA and 11 hours (2 to 24 hours) for no EA (P = .057). Low-dose EA reduced the use of intraoperative anesthetics/analgesics in goats undergoing lower urinary tract surgery without an increased incidence of hypotension. Postoperative morphine administration was not reduced.

A comparative study of efficacy of ropivacaine (0.75%) with adjuvants – dexmedetomidine and fentanyl in supraclavicular brachial plexus block

Background: Brachial plexus block is preferred to general anesthesia (GA) as it reduces many complications of GA, provides good intra and postoperative analgesia, adequate muscle relaxation. Addition of adjuvants along with LA is used to prolong block with improved quality of anesthesia and decrease dose of LA. This study was done to see the efficacy of Ropivacaine with dexmedetomidine and fentanyl in terms of duration of action and pain relief. Aims and Objectives: Dexmedetomidine and Fentanyl along with Ropivacaine in patients undergoing upper limb surgeries, the onset and duration of sensory and motor blockade as well as post op analgesia is compared. Materials and Methods: Prospective Randomized Comparative study with three groups randomly divided received total volume of 30 mL of drug in peripheral nerve stimulator guided supraclavicular blocks in patients undergoing upper limb surgeries. Group Dexmedetomidine received 28 cc of 0.75% Ropivacaine and Dexmedetomidine (1 mcg/kg), Group Fentanyl patients received 28 cc of 0.75% Ropivacaine and fentanyl (1 mcg/kg), whereas, group plain Ropivacaine patients received 28 cc of 0.75% Ropivacaine and 2 mL of normal saline. Haemodynamics, sensory and motor block (MB) were evaluated by VAS and modified Bromage scale. Results: The onset of sensory block and MB in the dexmedetomidine group, fentanyl group, and ropivacaine groups was 3.57±0.50 min and 4.47±0.51 min, 5.50±0.51 min and 7.53±0.51 min, and 8.07±0.79 min and 10.07±0.79 min respectively which were statistically significant. The duration of MB in the dexmedetomidine group, fentanyl group, and ropivacaine group were 6.57±0.50 h, 4.47±0.51 h, and 2.50±0.51 h respectively which was statistically significant (P=0.0000). The duration at which first postoperative analgesia was required in the dexmedetomidine group, fentanyl group, and ropivacaine group were 8.57±0.50 h, 6.57±0.50 h, and 5.30±0.47 h respectively. Conclusion: Dexmedetomidine is better as an adjuvant to Ropivacaine for brachial plexus block in terms of onset and duration.

A Case Report: Combined Sciatic Nerve and Lumbar Plexus Nerve Block in A Patient with Acute Decompensated Heart Failure Undergoing Lower Extremity Surgical Debridement

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peripheral nerve block for lower extremity surgeries requires a minimum of two block injections. Although the combination of the lumbar plexus block and the sciatica block is a procedure that requires large doses of local anesthetic, which may induce cardiotoxicity, a recent study suggests that change in the hemodynamic system is not clinically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Description:&lt;/strong&gt; We report a case of a 53-year-old male presenting with a worsened shortness of breath two days before hospital admission. He also experienced a sudden high fever and pain on his right thigh. The patient had a history of Heart Failure (EF 28%) and Congestive liver disease and was diagnosed with right femur cellulitis with right phlegmon. Surgical debridement was planned to treat sepsis. Right lumbar plexus block and right sciatica block were performed as surgical anesthesia. The surgery duration was one hour, and the patient was transferred to the PACU. The patient was treated in ICU before being admitted to the general ward and was discharged on day three post-surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The combination of Sciatic nerve and lumbar plexus nerve block is an effective anesthesia and analgesia technique for lower limb surgery in individuals with a severe heart condition. &lt;/p&gt;

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification.

During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine. To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy. A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups. More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety. Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

FEATURES OF THE CASPASE-3 EXPRESSION IN THE HIPPOCAMPUS AT THE MODELLING OF THE EXPERIMENTAL ACUTE EPILEPTIC FIT

Epilepsy is one of the most common neurological pathologies, but the biological substrate of the disease is still poorly understood. A few studies have shown that in experimental animals after an epileptic fit there is an increase in the level of some caspases, but the available data are not enough to fully understand the nature of the caspase cascade in epilepsy, and especially its terminal phase. Of particular interest is the analysis of morphological changes in the structures of the hippocampus on the background of an acute epileptic fit in the correlation between neuronal loss and the terminal phase of apoptosis or the quantitative assessment of caspase-3 activity. The aim of the study was the immunohistochemical evaluation of caspase-3 expression in the hippocampus in an experimental model of epilepsy in laboratory mice. The animals were divided into two groups, the animals of the first group (n=28) were intraperitoneally injected with pentilenetetrazole once at a dose of 45 μg/kg to simulate an acute epileptic fit, which was assessed by the modified Racine scale, the second group of animals was the control (n=20). Animals were taken out of the experiment after 3 hours and consecutively on days 1, 3, and 5 from the start of the drug administration for a dynamic study of changes in the hippocampus. Animals were withdrawn from the experiment by introducing high doses of anaesthetic. Animal brain fragments were examined by Nissl staining and caspase-3 expression was quantified by immunohistochemistry in the subregions CA1, CA3 and the dentate gyrus of the hippocampus. 24 hours after the modelling of an acute epileptic fit, the preparations showed signs of hippocampal sclerosis (gliosis, loss of neurons) and an increase in the number of neurons expressing caspase-3 by 2.68 times compared to the number of neurons in the preparations of animals in the control group. As a result of the experiment, it was revealed that the loss of neurons in the hippocampus of the CA3 subregion is associated with an increase in the expression of caspase-3 24 hours after the simulation of an acute generalized seizure using an injection of pentilenetetrazole.

The Effect of Fluid Preloading on the Incidence of Hypotension During Spinal Anesthesia

Background: Small doses of local anaesthetic are injected into the CSF fluid in the subarachnoid region to produce spinal anaesthesia (SA). Aim: This paper was contributed to study the effect of fluid preloading on the incidence of hypotension during spinal anaesthesia. Patients and methods: This cross-sectional study recruited 45 patients in different hospitals in Iraq for a study that ranged from the 15th of June in the year 2021 to the 24th of August in the year 2022. This paper dealt with the study of the effect of fluid preload on the incidence of hypotension during spinal anaesthesia, as it included in the clinical characteristics’ tests related to mothers or women who underwent caesarean delivery under spinal anaesthesia. This study divided the collected data into two groups, one of which was the patient group, which included patients who underwent spinal anaesthesia, which this group is considered as the co-loading group, which included 23 patients out of the total number of patients' data collected, while it was represented by the preload group, which included women who underwent spinal anaesthesia, which included 22 patients out of the total number of patients. This paper was conducting and analysing the collected data by SPSS. Discussion: The difference was that when their systolic blood pressure fell to 90 mm Hg, they began using a vasopressor heavily. The current finding found the Apgar score of the co-load who patients group (8.91) was found higher that preload who control group (8.95%) within 5 min in compare 1 min. In the present analysis, there was also a statistically significant variation between the co-load (81.4%) and pre-load (45.3%) groups in terms of the incidence of hypotension. The incidence of hypotension was statistically significantly different between the preload (80%) as well as co-load (51%) groups, according to research through (Oh AY et al., 2014). Both trials revealed that the co-load group's blood pressure dramatically decreased. Conclusion: This study found that (45.3%) were within the preload group as a control group and (81.4%) in the co-load group as patients group had hypotension. Preloading was, therefore, more effective than co-loading in preventing spinal anesthesia-induced hypotension of cesarean section moms. It may not be essential to postpone surgery to provide a preload of liquids.

Modulatory dynamics mark the transition between anesthetic states of unconsciousness

Unconsciousness maintained by GABAergic anesthetics, such as propofol and sevoflurane, is characterized by slow-delta oscillations (0.3 to 4 Hz) and alpha oscillations (8 to 14 Hz) that are readily visible in the electroencephalogram. At higher doses, these slow-delta-alpha (SDA) oscillations transition into burst suppression. This is a marker of a state of profound brain inactivation during which isoelectric (flatline) periods alternate with periods of the SDA patterns present at lower doses. While the SDA and burst suppression patterns have been analyzed separately, the transition from one to the other has not. Using state-space methods, we characterize the dynamic evolution of brain activity from SDA to burst suppression and back during unconsciousness maintained with propofol or sevoflurane in volunteer subjects and surgical patients. We uncover two dynamical processes that continuously modulate the SDA oscillations: alpha-wave amplitude and slow-wave frequency modulation. We present an alpha modulation index and a slow modulation index which characterize how these processes track the transition from SDA oscillations to burst suppression and back to SDA oscillations as a function of increasing and decreasing anesthetic doses, respectively. Our biophysical model reveals that these dynamics track the combined evolution of the neurophysiological and metabolic effects of a GABAergic anesthetic on brain circuits. Our characterization of the modulatory dynamics mediated by GABAergic anesthetics offers insights into the mechanisms of these agents and strategies for monitoring and precisely controlling the level of unconsciousness in patients under general anesthesia.