Anaesthetic Practice Research Articles

Unveiling preoperative clinical profiles in pediatric aortic coarctation: Insights into surgical interventions and institutional anesthesia practices

ABSTRACT Objectives: The study seeks to provide valuable insights into the outcomes of anesthesia and surgical practices employed in our institution, addressing the challenges posed by preoperative conditions such as heart failure, inotropic support requirements, and mechanical ventilation needs, particularly in the delicate population of newborns. Methods: Our investigation conducted a retrospective analysis encompassing all patients who underwent surgery for aortic coarctation at the Pediatric Cardiac Surgery Clinic of the 350-bed Children Hospital between 2012 and 2021. Results: The study encompassed a cohort of 97 patients spanning from newborns to adolescents, with 61 males and 36 females, revealing a 19.5% incidence of genetic anomalies. Intraoperatively, 4.1% of patients required vasodilators, and 13.4% had a triple inotropic requirement. Postoperatively, monitoring distribution included 59 patients in the cardiac surgery intensive care unit, 36 in the neonatal intensive care unit, and 2 in the pediatric intensive care unit. Early extubation within the first 24 hours was achieved in 57.7% of patients. Conclusion: This research contributes critical insights aimed at refining treatment strategies and enhancing overall outcomes, with particular attention to addressing challenges related to delayed extubation and postoperative vasodilator requirements.

Influence of pediatric ERCP positioning on procedural outcomes: A single-center study.

Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally done in the prone position. In pediatrics, patient anatomy and anesthesia practices are considerations that affect procedural success and anesthesia time. The aim of our study was to evaluate the safety, procedural success, and efficiency of pediatric ERCP in the prone versus supine positions. ERCPs from September 2016 to August 2023 were reviewed at our center. Demographic and procedure variables were collected. Multivariate linear regression was performed to determine the effect of patient position on total anesthesia time. Two hundred eighty-three patients (378 ERCPs) were included. There were significant differences in fellow involvement, proportion of native papillae, procedural indication, and total anesthesia time by ERCP position. Multivariate linear regression found that supine position was associated with 9.3-min decrease in anesthesia time and American Society of Anesthesiologists Class 1 or 2 was associated with 10.6-min decrease in anesthesia time. Factors that were associated with increased anesthesia time were additional procedure, increased procedure time, and native papilla. Finally, we found a learning curve for transitioning from prone to supine position was between 10 and 40 cases. After the learning curve, we found 11-min decrease in mean procedure time and 16-min decrease in total anesthesia time in the supine position. This is the first pediatric study to evaluate the role of patient positioning on ERCP outcomes and total anesthesia time. Given similar procedural outcomes, the impact of increased anesthesia time on neurodevelopment in children, and the cost to the patient, the supine position may be preferred to a prone position.

The Analysis Study of Effectiveness and Complication of Propofol for Anesthesia: A Comprehensive Systematic Review

Background: Propofol has become one of the most widely used anesthetic agents worldwide, known for its rapid onset and quick recovery profile. This systematic review aims to analyze propofol’s effectiveness and complications in anesthesia practice based on literature from the past decade. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2014 to 2024. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 2,172 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Propofol is a versatile and effective anesthetic, improving procedural efficiency, reducing PONV, and enhancing cancer surgery survival. However, challenges like hypotension and immune suppression require attention. Further research is needed to refine its use, dosing, and long-term effects.

ED Regional Anesthesia Practice and the Basics on Local Anesthesia Toxicity.

In the United States and the United Kingdom, where the author resides, many Emergency Departments utilize nerve blocks for fractures waiting to be seen by orthopedic surgery. As emergency nurses, be it advance practice nurse or staff nurse, it is our professional responsibility to be aware of emergencies that can result from these nerve blocks, namely local anesthetic toxicity (LAT). In the United Kingdom, there are protocols and guidelines for the treatment of this adverse event, which are shared in this article as a knowledge base for identifying and treating LAT. This paper also discusses the similarities in symptoms of LAT and anaphylaxis.

GLP-1 receptor agonists and delayed gastric emptying: implications for invasive cardiac interventions and surgery.

Glucagon-like peptide-1 (GLP-1) is a hormone involved in glucose homeostasis and satiety regulation. The review highlights the importance of understanding the interplay between GLP-1 and gastric motility. This paper explores the intricate connection between GLP-1 and delayed gastric emptying, specifically gastroparesis, and its implications in the context of pulmonary aspiration during anesthesia along with the potential effects of GLP-1 medications on absorption of other medications. The findings noted in this paper serve as a catalyst for continued exploration into the intricate dynamics of GLP-1 and its implications in the context of perioperative care, aiming to enhance patient safety and optimize anesthesia practices. The inquiry suggests that an in-depth examination of this relationship is crucial for refining perioperative management strategies. It underscores the need for further research to elucidate the mechanisms involved and to establish guidelines that address the potential risks associated with GLP-1 modulation, particularly in patients undergoing anesthesia for various cardiac surgeries and procedures. Specifically in the context of cardiac interventions understanding the potential for delayed absorption of critical cardiac medications due to the influence of GLP-1 on gastric emptying is particularly important as drug absorption can play a crucial role for ensuring successful outcomes.

The environmental effects of anesthetic agents and anesthesia practices

The environmental effects of anesthetic agents and anesthesia practices

Veterinary Anaesthesia Curricula Beliefs and Practices

Veterinary Anaesthesia Curricula Beliefs and Practices

THE IMPORTANCE OF REALISTIC SIMULATION LEARNING IN MANAGING RARE SITUATIONS IN ANESTHESIA: MALIGNANT HYPERTHERMIA

Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder triggered by certain anesthetic agents, requiring rapid recognition and intervention to prevent serious complications. Given its infrequency, healthcare professionals, especially anesthesia providers, may have limited exposure to managing this critical emergency. This study aims to evaluate the impact of simulation-based training on improving the knowledge, skills, and confidence of anesthesia residents in managing malignant hyperthermia. A pre-experimental study was conducted with 50 anesthesia residents at the Mohamed V Military Instruction Hospital. Participants engaged in a simulation session designed to mimic the clinical scenario of malignant hyperthermia during surgery. Knowledge assessments conducted before and after the simulation revealed a significant improvement in the residentsÂ’ understanding of MH, including its recognition, triggers, and management. Self-reported confidence in handling MH crises also increased notably. Furthermore, 90% of residents expressed overall satisfaction with the simulation-based training, highlighting its value for enhancing critical care readiness. The results underscore the effectiveness of high-fidelity simulation in preparing anesthesia residents for rare but life-threatening scenarios, thereby contributing to better patient safety and clinical outcomes in anesthesia practice.

A comprehensive analysis of in-hospital adverse events after scopolamine administration: insights from a retrospective cohort study using a large nationwide inpatient database

BackgroundScopolamine is a widely used antiemetic in anesthetic practice, particularly for postoperative and post-discharge nausea and vomiting. Despite its frequent usage and recognized efficacy, concerns have emerged regarding the potential for increased side effects, particularly in elderly patients. Further research is needed to assess safety and determine age thresholds for adverse events. This study hypothesizes associations between perioperative scopolamine use, worse clinical outcomes, increased pneumonia, delirium, urinary retention, and readmissions.MethodsA large, retrospective cohort study was performed using the TriNetX Analytics Network database on patients undergoing major surgical procedures between Jan 1, 2009, and March 21, 2018, to examine the impact of perioperative scopolamine use on in-hospital adverse events. Patients were divided into age groups and compared to a control group. The primary outcomes assessed were delirium, pneumonia, in-hospital death, new antipsychotic use, readmission, and new onset urinary retention within 7 days post-surgery. 1:1 propensity score matching was performed to reduce bias. Relative risk and risk differences with 95% confidence intervals were estimated.ResultsAfter 1:1 propensity score matching, we identified a total of 403,816 (201,908 pairs) perioperative scopolamine users and nonusers. The cohorts of 20–29, 30–39, 40–49, 50–59, 60–69, and 70 + contained 22,910 (11,455 pairs), 44,170 (22,085 pairs), 58,590 (29,295 pairs), 71,660 (35,830 pairs), 88,386 (44,193 pairs), and 118,100 (59,050 pairs) patients respectively. Across older age cohorts, after propensity score matching, perioperative scopolamine recipients had significantly increased relative risk and risk difference of delirium, pneumonia, in-hospital mortality, new antipsychotic use, readmission, and new-onset urinary retention.ConclusionsIn this cohort study, perioperative scopolamine usage was associated with a significantly increased risk of in-hospital adverse events, both within the 70 + age cohort and among the 20–29, 30–39, 40–49, 50–59, and 60–69 age cohorts after major surgery. These findings highlight the need for careful assessment of scopolamine’s risks and benefits, especially for patients aged 40 and older. Scopolamine may be most suited for post-discharge nausea and vomiting in ambulatory patients and clinicians should reassess its standard use for postoperative nausea and vomiting, favoring shorter-acting agents with fewer side effects.

Promoting a Patient Safety Culture in Anesthesia Practice

Promoting a Patient Safety Culture in Anesthesia Practice

Connecting the Dots Between Inpatient Quality of Obstetric Recovery and Postpartum Depression: Are We Ready for a Cultural Shift?

(J Clin Anesth. 2024;96:111372 I. https://doi.org/10.1016/j.jclinane.2023.111372 I) Enhanced recovery protocols have recently been developed to improve recovery after childbirth, focusing on minimizing maternal morbidity and pain following cesarean delivery. However, there is limited literature on the effort it takes to return to a healthy and normal standard in the postpartum period. The measurement of recovery quality is a new area of focus in the research and practice of obstetric anesthesia. Aspects such as postpartum discomfort, nausea, lightheadedness, shaking, ease, movement, capacity to care for the baby, self-care, and sense of empowerment all influence the quality of recovery during hospitalization. Pervez and colleagues developed a new survey called Obstetric Quality of Recovery (ObsQoR-10), which is a patient-reported outcome measure (PROM) used to evaluate recovery after vaginal and cesarean deliveries in hospital settings. Although numerous studies have assessed global PROMs for postpartum healing and screening tools for postpartum depression (PPD), there is still a lack of ideal measures for assessing outpatient recovery quality.

Quality Metrics for Cesarean Delivery: More Than Just General Anesthesia Rates

(J Clin Anesth. 2024;94:111398. https://doi.org/10.1016/j.jclinane.2024.111398) General anesthesia should be avoided for cesarean deliveries when possible but used when necessary, and sometimes it may be the preferred option. The shift in obstetric anesthesia practices to minimize general anesthesia for cesarean deliveries for maternal safety began in 1997. Hawkins and colleagues reported a 17-fold increase in mortality for patients undergoing general anesthesia for cesarean delivery compared with those receiving regional anesthesia. From 2011 to 2013, maternal mortality in the United States was 17 per 100,000 births, and the proportion of anesthesia-related maternal deaths decreased from 1.6% (1990 to 1997) to 0.2% (2011 to 2013). This reduction is partly attributed to decreased general anesthesia rates for cesarean deliveries.

Comparative evaluation of first-attempt intubation success rate using direct laryngoscope with Macintosh blade and video laryngoscope during rapid sequence induction in patients undergoing emergency surgery: A prospective randomised controlled trial.

Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries. We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery. In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction. The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack-Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123). This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

Management of the Expected Difficult Airway with Planned One-Lung Ventilation: A Retrospective Analysis of 44 Cases.

Difficult airway management is essential in anesthesia practice. Particular challenges are posed to patients who require intraoperative one-lung ventilation. Specific guidelines for these scenarios have been lacking. The recent update of German guidelines incorporates recommendations for securing the airway in anticipated difficult airway scenarios in patients requiring one-lung ventilation. However, scientific data on this specific topic is rare. A retrospective analysis was conducted on adult patients undergoing thoracic surgery with one-lung ventilation from 2016 to 2021. During these years, the standard of practice has been in line with the now published guidelines. Patients with anticipated difficult airways were identified, and airway management strategies were analyzed. Among 3,197 anesthetic procedures, 44 cases involved anticipated difficult airways, primarily due to prior head and neck tumor treatment. Nasal bronchoscopic awake intubation followed by oral reintubation under videolaryngoscopic inspection and the use of bronchial blockers was the standard procedure. No severe complications were recorded, and one-lung ventilation was maintained successfully in all cases. The study highlights the challenges of managing difficult airways during thoracic surgery. Recommendations align with recent guidelines, emphasizing the importance of tailored approaches. The use of single-lumen tubes with bronchial blockers appears favorable over double-lumen tubes, offering comparable ventilation quality with reduced risks. Despite limitations, the study underscores the safety and efficacy of tailored airway management strategies during one-lung ventilation in patients with anticipated difficult airways. The presented approach offers patient safety and practicability. Further multicenter studies are warranted to validate these findings and refine clinical approaches.

Safe Anesthesia Practices for Minimally Invasive, Image-guided Procedures: CT, MRI, and Ultrasound

Background: The demand for minimally invasive, image-guided procedures, such as CT, MRI, and ultrasound, is increasing. Understanding the role of anesthesia in enhancing patient safety, comfort, and procedural success is essential. Methods: This study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, over two years, involving 150 patients. Anesthesia techniques were categorized as general anesthesia, sedation, and local anesthesia. Patient outcomes, complications, and satisfaction scores were recorded and analyzed. Results: In this study, general anesthesia was administered to 65 patients (43.3% of cases), sedation was used for 56 patients (37.3%), and local anesthesia was applied to 29 patients (19.3%). The overall procedural success rate was high, at 141 successful completions (94%), with minor complications occurring in 7 patients (4.7%) and major complications in 2 patients (1.3%). Patient satisfaction scores indicated that 96 participants (64%) reported being very satisfied with their anesthesia experience, while 45 patients (30%) indicated they were satisfied. These findings highlight the effectiveness and safety of the selected anesthesia practices in minimally invasive, image-guided procedures, demonstrating a strong correlation between appropriate anesthesia techniques and positive patient outcomes. The data underscore the importance of tailored anesthesia protocols to enhance procedural success and patient satisfaction in this clinical setting. Conclusion: The study demonstrates that tailored anesthesia practices can achieve high success rates and patient satisfaction in minimally invasive, image-guided procedures. Despite the low incidence of complications, ongoing research is needed to refine anesthesia protocols and explore advanced, image-guided techniques to further enhance patient safety and comfort.

Protocol development and feasibility of the PEACH in Asia study: A pilot study on PEri-anesthetic morbidity in CHildren in Asia.

Comprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings. The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study. This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study. The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2-16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource-limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e-CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing). The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e-CRF technical difficulties, and ensuring consistent institutional support.

A Retrospective Analysis of Non-Operating Room Anesthesia Practices at University Hospital

Abstract: Objective: The use of non-operating room anesthesia (NORA) is increasing due to its advantages in procedure success and patient management. This study aims to retrospectively evaluate the NORA practices at Hatay Mustafa Kemal University hospital over a two-year period. Materials and Methods: After obtaining ethical approval, the records of patients who underwent sedation-analgesia outside the operating room for diagnostic and therapeutic purposes between 2018 and 2020 were retrospectively analyzed. Recorded data included age, gender, weight, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, types of procedures, anesthesia and recovery times, medications used, and complications. Results: A total of 1199 patients were included in the study, with 63.3% (759) adults and 36.7% (440) pediatric patients. The patient group comprised 69.1% (829) female and 30.9% (370) male, with a mean age of 35.62 ± 28.69 years (0-98). Of the patients, 46.1% (547) were in the ASA 2 risk group. The most common procedure was Magnetic Resonance Imaging (MRI) 45.1% (541). The most frequently used anesthetic regimen was a combination of midazolam, propofol, and ketamine 70.1% (840). Hypotension was the most common complication 3.7% (44), followed by bradycardia 3.2% (38). Hypertension was the most frequently (12.0%) observed comorbidity. Conclusion: The frequency of non-operating room anesthesia (NORA) procedures is steadily increasing due to growing patient and surgeon satisfaction. Comprehensive preanesthetic evaluations, ensuring appropriate physical conditions and patient-specific drug selection are crucial for appropriate and rapid interventions for possible complications. Keywords: Non-operating room anesthesia practices, Pre-anesthetic evaluation, Sedation, Anesthetic agents, Complications

A Paradigm for Shared Decision-Making in Pediatric Anesthesia Practice for Children with Autism for the Generalist Clinician.

A Paradigm for Shared Decision-Making in Pediatric Anesthesia Practice for Children with Autism for the Generalist Clinician.

A deep dive into neonatal well-being and anesthesia in cesarean sections: From procedure to outcome.

This observational study analyzed data from 502 participants undergoing cesarean section (CS) procedures at an obstetrics and gynecology department, aiming to explore anesthesia practices, neonatal outcomes, and demographic characteristics within the cohort. Participants, aged 17 to 59 years with a mean age of 32.23 years, were enrolled based on the clinical necessity for cesarean delivery during the study period. Informed consent was obtained from each participant or their guardians before data collection, which included detailed demographic information, medical histories, specifics of the cesarean section procedure, and APGAR scores of neonates immediately postbirth (at 0 and 5 minutes). Primary outcomes focused on APGAR scores, critical indicators of neonatal health, while secondary outcomes included the distribution of patient ages, reasons for cesarean sections, and the administration of Bupivacaine during anesthesia. Data were rigorously analyzed using descriptive and inferential statistics to summarize participant demographics, anesthesia practices, and neonatal outcomes. Statistical methods included measures of central tendency and dispersion, correlation analyzes to explore associations between variables, and regression models to identify predictors of neonatal APGAR scores. The study identified a range of indications for cesarean sections, with common reasons including fetal distress and maternal health complications. Findings indicated an average APGAR score of 7.02 at 0 minutes and 7.84 at 5 minutes, reflecting generally favorable immediate neonatal outcomes. Anesthesia protocols predominantly involved Bupivacaine, with doses ranging from 1.8 to 2.2 mL, administered based on clinical requirements. In conclusion, this study underscores the importance of comprehensive data collection and rigorous statistical analysis in evaluating cesarean section procedures. Future research could further explore long-term neonatal outcomes and refine anesthesia protocols to optimize maternal and neonatal health during cesarean deliveries.

A Randomized Controlled Trial to Compare the Analgesic Efficacy of Ultrasound-Guided Fascia Iliaca Compartment Block and Femoral Nerve Block in Patients with Neck of Femur Fracture

ABSTRACT Background and Aims: Regional nerve blocks under ultrasound guidance have heralded the era toward safer anesthetic practices. They provide adequate analgesia during positioning for subarachnoid block in patients posted for hip. We aimed to compare the analgesic efficacy of fascia iliaca compartment block and femoral nerve block for pain during sitting position for subarachnoid block, duration of post-op analgesia, and document any complications. Material and Methods: A randomized double-blind study was conducted in 60 patients undergoing isolated neck of femur fracture surgery under subarachnoid block. They were randomized by a computer-generated randomization table into two groups – group A received a fascia iliaca compartment block and group B received a femoral nerve block. Numeric rating score (NRS) was noted before block, during positioning, and postoperatively for 24 hours. An independent sample t-test and a paired t-test were used for intergroup and intra-group comparisons. Results: The mean NRS before block in group A (7.57 ± 0.50) and group B (7.40 ± 0.49) (P-value = 0.203) was not significant. NRS during positioning in group A (2.10 ± 0.88) was significantly lower than group B (3.33 ± 0.71) (P-value = 0.001*). The mean NRS from the sixth till 20th hour postoperatively was significantly higher in group B compared to group A (P-value <0.05 for all). The mean time to first rescue analgesia was significantly longer in group A (23.57 ± 2.22 hours) compared to group B (11.97 ± 1.73 hours) (P-value = 0.001*). No complications were noted during the study. Conclusion: Fascia iliaca compartment block gives significantly better pain relief during positioning for subarachnoid block and prolonged postoperative analgesia as compared to femoral nerve block.