Anesthesia For Procedures Research Articles

MORTALIDADE NO PERÍODO GESTACIONAL POR COMPLICAÇÕES ANESTÉSICAS: NÚMEROS NACIONAIS DOS ÚLTIMOS 10 ANOS

Brazil stands out globally for the number of cesarean sections performed annually, with figures far exceeding the recommendations of the WHO – World Health Organization. Cesarean delivery requires appropriate anesthetic blockade, with various techniques possible, the most common being spinal anesthesia and, less frequently, general anesthesia techniques. Both regional and general anesthesia techniques have advanced significantly in recent years but are not free from complications, which are associated with both maternal history and the anesthetic procedure itself. Maternal morbidity and mortality during the gestational period is a public health issue, which is also linked to the appropriate choice of delivery method and necessary anesthesia procedure. Therefore, the aim of this study is to examine the national number of maternal deaths related to anesthetic procedures over the past 10 years – from 2014 to 2023 – and to compare national data with international data, based on the most recent scientific literature.

Sensors: future tools for detecting young patient's stress during a dental invasive versus a non-invasive dental treatment-a pilot study.

A reliable tool to visualise children's early stress signs to prevent dental fear development is needed. The aim was to evaluate the commercially available, CE marked, Shimmer3 GSR + unit's ability to indicate for stress as a reaction of fear or pain for a non-invasive dental treatment (NI) and an invasive dental treatment (I). Patients 14-16years old were invited to undergo an oral check-up (NI) or an orthodontic premolar extraction (I), respectively. Digital data, measured via electrodes and optical pulse probe, placed on the wrist and fingers, monitored by the Shimmer3 GSR + unit, was transferred via Bluetooth to the HP-laptop. The observed digital parameters were: heart rate based on photoplethysmography (PPG), galvanic skin response (GSR), and 3-axis gyroscope and accelerometer signals for hand movements. Protocols for patient self-report scales were used: coloured analogue scale for pain intensity, facial analogue scale for the mood, and a dental fear scale. Descriptive statistics was performed. The NI-group: 20 patients, (14.6 ± 0.5years), underwent 20 oral check-ups. The I-group: 14 patients, (15.3 ± 0.5years), underwent 28 premolar extractions. All patients tolerated the Shimmer3 GSR + unit well. The GSR signal increased significantly, at start and during the oral injection, in the I-group. The GSR amplitudes persisted throughout and post the dental injection. No general uniform pattern or high GSR amplitudes were produced regarding NI-group. Considering the limitations of this study, the following conclusions can be made: the invasive treatment resulted in a specific unison GSR pattern, while the non-invasive procedure showed individually scattered GSR reactions. The commercially available CE-marked Shimmer3 GSR + device indicated the patient's stress response triggered by the invasive anaesthetic procedure.

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.

A Prospective Randomised Comparative Study of Baska Mask and I-Gel for Airway Management in Elective Surgeries: Focus on Airway Sealing Pressure, Insertion Time, and Haemodynamic Response

Introduction: General anesthetic procedure requires a safe and open airway. Endotracheal intubation is the gold standard for airway management; it is being replaced by supraglottic airway devices because they are easy to introduce, better tolerated and results in a lesser haemodynamic response. As both the Baska mask and I-gel have a non-inflatable self-sealing mechanism, these two devices were compared in our study in terms of time taken for insertion, airway sealing pressure, the number of attempts, hemodynamic changes, and complications. Methods: A Prospective comparative study was conducted on 90 patients (45 in each group), aged 18-60 years, undergoing elective surgeries under general anesthesia at Tertiary care Hospital, Madurai. Patients were randomized into two groups using the computer generated statistical software STATA version14 (Texas, USA): Group B: Airway was secured by insertion of Baska mask. Group I: Airway was secured by insertion of I Gel. Following assessments were done to evaluate the SAD: Time taken to insert the device, airway sealing pressure, rate of successful insertion, number of attempts, Haemodynamic parameters, laryngopharyngeal morbidity. Data were analyzed using Student t-tests and chi-square tests, with p < 0.05 considered significant. Results: The mean airway sealing pressure of the Baska mask (26.1+6.1 cmH2O) was significantly higher than that of the I-gel (23.1± 5.9 cmH2O) with a P value of 0.019 which was statistically significant. In our study the time taken to insert the device, for Baska mask it was 18.9+4.1 seconds and for the I gel it was 17.2±5.1 seconds with a P value of 0.089 which was statistically insignificant. In our study there was no statistical difference between Baska mask and I-gel groups in regards to hemodynamic changes (Heart rate and Mean arterial pressure). This may be due to the same stress response produced by the both devices. Conclusion: Baska mask is superior to I-gel in positive pressure ventilation under general anaesthesia for short surgical procedures with statistically significant higher airway sealing pressure though it has comparable time of insertion, haemodynamic changes and laryngopharyngeal morbidity.

Does Functional Status Predict Worse 30-D Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms? A Propensity-Score Matched Study From ACS-NSQIP Targeted Database From 2012 to 2022

IntroductionIn patients undergoing endovascular aneurysm repair (EVAR), existing studies have identified an association between dependent functional status (DFS) and poorer outcomes after EVAR. However, noted limitations, especially the lack of differentiation between ruptured and nonruptured abdominal aortic aneurysm (AAA), potentially affect the extrapolation of these findings to specific patient groups. Thus, this study aimed to evaluate the association between functional status and 30-d outcomes after EVAR in ruptured and nonruptured AAA patients separately. MethodsPatients who underwent infrarenal EVAR were identified in the American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012-2022. Patients with DFS and those with independent functional status (IFS) were stratified into the two study cohorts. In nonruptured AAA, a 1:1 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distal extent of the aneurysm, anesthesia, and concomitant procedures between patients with DFS and IFS. The sample size for ruptured patients with AAA was too small for meaningful statistical analysis so only qualitative description was provided. Thirty-d postoperative mortality and morbidities of EVAR were assessed. ResultsFor nonruptured cases, there were 380 (2.55%) DFS and 14,545 (97.45%) patients with IFS, where 453 patients with IFS were matched to the DFS cohort. For ruptured AAA, there were 17 (6.39%) DFS and 249 (93.61%) IFS. After matching, nonruptured DFS and patients with IFS had similar 30-d mortality rates (2.37% vs 2.11%, P = 1.00). However, patients with DFS had a higher risk of bleeding requiring transfusion (18.42% vs 11.84%, P = 0.01) and longer length of stay (median 3.00 [Q1 1.00, Q3 6.00] vs median 2.00 [Q1 1.00, Q3 4.00] d, P < 0.01). All other outcomes, including major adverse cardiovascular events, cardiac complications, stroke, pulmonary complications, renal complications, sepsis, venous thromboembolism, wound complications, lower extremity ischemia, ischemic colitis, postoperative ruptured aneurysm, unplanned reoperation, 30-d readmission, were not different between patients with DFS and IFS. Qualitatively, ruptured patients with DFS had higher crude rates of 30-d mortality and morbidities compared to patients with IFS. ConclusionsContrary to previous literature, patients with DFS with nonruptured AAA undergoing EVAR were found to have largely comparable outcomes to patients with IFS, although extra attention should be paid to postoperative bleeding.

Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre cohort study (the EVALYMPH study).

Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs). We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence. The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up. Multivariate analyses were performed to determine the risk factors for PIs and for postoperative lymphopaenia. Patients were included from January 2016 to September 2017 in 25 French centres. Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion. PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy). Of 1207 patients included, 273 (22.6%) developed at least one infection within 30 days after surgery, with a median [IQR] time to onset of 8 [5 to 11] days. An increased risk of PI was significantly associated with an ASA score of IV: hazard ratio (HR) 4.27 (95% confidence interval (CI), 1.87 to 9.72), surgery > 200 min (HR 1.58 (1.15 to 2.17) and lymphopaenia on postoperative day 1 (POD1) (HR 1.56 (1.08 to 2.25). This risk was associated with changes in postoperative LC over time (P = 0.001) but not with preoperative LC (P = 0.536).POD1 lymphopenia was related to patient characteristics and duration of surgery but not to potentially modifiable other surgical or anaesthetics factors. POD1 lymphopaenia was associated with PIs in patients undergoing thoracic or gastrointestinal cancer surgery. To individualise care, patient characteristics and surgery duration should be taken into account. ClinicalTrials.gov Identifier: NCT02799251.

Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade After Approval: General Versus Local Anesthesia for BotulinumtoxinA Detrusor Injection

Background: The onabotulinumtoxinA detrusor injection (OnabotA DI) was approved a decade ago for the treatment of patients with idiopathic overactive bladder (iOAB) or neurogenic detrusor overactivity (nDO) dysfunction who had not been treated successfully otherwise. The procedure is usually performed under local anesthesia (LA), and various approaches have been investigated to make the procedure as painless as possible. We examined the level of anxiety and pain experienced by patients who wanted to have the procedure performed under LA or general anesthesia (GA). Material and Methods: Patients scheduled for OnabotA DI were able to choose the anesthesia procedure (LA or GA). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to grade anxiety before anesthesia or before the procedure itself. Intra- and postoperative pain was determined using the Visual Analogue Scale (VAS). Various established questionnaires (including the Urinary Distress Inventory UDI-6), as well as a postoperative satisfaction questionnaire, were used to evaluate the success of the therapy. Results: In total, 104 patients (93 F, 11 M; age 64.0 (22–89) years; 80× iOAB, 24× nDO) were evaluated. OnabotA-DI was performed with LA in 72 patients and GA in 32. Stratified by first versus repeat injection in the LA group, there was a significant decrease in the Anxiety Score in the first vs. repeat injection group (p = 0.038). The LA group showed higher concerns in the anesthesia questions of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) than the GA group (OR: 0.29, 95%CI: 0.02–1.74). The VAS Pain Score during the procedure was significantly lower in the GA group compared to the LA group (LA: 3.3 ± 2.2, GA group 1.5 ± 1.5; p &lt; 0.001). There were no differences in the success of therapy. Despite the fear and pain, patients preferred LA to GA. Conclusions: This study shows that the anxiety and pain burden of patients undergoing OnabotA-DI under LA is significant in comparison to GA during the first injection, but insignificant for following injections. Overall, LA is favored over GA.

Oxygen in the newborn pneriod: Could the oxygen reserve index offer a new perspective?

Oxygen therapy has been one of the main challenges in neonatal intensive care units (NICU). The guidelines currently in use try to balance the burden of hypoxia and hyperoxia such as retinopathy of prematurity, bronchopulmonary dysplasia, and death. The goal of this paper is to review neonatal oxygenation and the impact of hyperoxia and hypoxia in neonatal outcomes as well as review the available literature concerning the use of Oxygen Reserve Index (ORiTM) in clinical practice and its potential in Neonatology, particularly in NICU. Pulse oximetry has been used to monitor oxygenation in newborns with the advantage of being a noninvasive and continuous parameter, however it has limitations in detecting hyperoxemic states due to the flattening of the hemoglobin dissociation curve. The ORiTM is a new parameter that has been used to detect moderate hyperoxia and, when used in addiction to spO2, could be helpful in both hypoxia and hyperoxia. Studies using this tool are mainly in the adult population, during anesthetic procedures with only a small number of studies being performed in pediatric context. Oxygen targets remain a major problem for neonatal population and regardless of the efforts made to establish a safe oxygenation range, a more individualized approach seems to be the more appropriate pathway. ORiTM monitoring could help defining how much oxygen is too much for each newborn. Despite its promising potential, ORiTM is still a recent technology that requires more studies to determine its true potential in clinical practice.

Morphometric Study on the Mandibular Foramen.

Aims and objectives This study aimed to analyze the mandibular foramen (MF) by identifying its average vertical and horizontal diameters, determining its localization, and assessing the prevalence of accessory mandibular foramina. Methodology The study was conducted at the Institute of Anatomy, Madras Medical College, Chennai, India over one month in August 2024. A total of 77 human dry mandibles were examined, excluding those that were damaged to the extent that measurements could not be taken. The dimensions of the MF were measured in two directions: superoinferior and anteroposterior. Localization measurements were taken from the MF to key anatomical landmarks, including the coronoid notch, the inferior border of the ramus, the pterygomandibular raphe (third molar tooth), and the posterior border of the ramus. Measurements were recorded using digital vernier calipers and documented in Google Sheets (Google Inc., Mountain View, CA). The study also recorded the presence or absence of accessory MF. Results The superoinferior diameter of the MF was found to be 4.20 ± 0.94 mm (right (R)) and 4.28 ± 1.21 mm (left (L)). The anteroposterior diameter was found to be 3.55 ± 0.90 mm (R) and 3.60 ± 0.80 mm (L). The distance between the MF and the coronoid notch was found to be 17.60 ± 2.95 mm (R) and 17.93 ± 3.16 mm (L). The distance between the MF and the inferior border was found to be 24.61 ± 4.32 mm (R) and 24.20 ± 4.28 mm (L). The distance between the MF and the pterygomandibular raphe was found to be 20.93 ± 1.98 mm (R) and 20.63 ± 2.00 mm (L). The distance between the MF and the posterior border was found to be 11.31 ± 1.67 mm (R) and 11.70 ± 2.28 mm (L). This present study identified 20 instances of an accessory MF, with 10 occurring on each side. Additionally, 10 mandibles displayed accessory mandibular foramina on both sides. Conclusions The comprehensive analysis of the MF and its anatomical landmarks in this study offers valuable insights that enhance our understanding of mandibular anatomy, with direct implications for clinical practice. The identification of the pterygomandibular raphe as a measurable landmark from within the buccal cavity introduces a practical guide for dental practitioners and maxillofacial surgeons, potentially improving the accuracy of surgical and anesthetic procedures. Furthermore, the detailed measurements of MF width provide a foundation for refining anesthetic techniques, thereby enhancing patient outcomes. The observed prevalence of accessory MF underscores the importance of considering anatomical variability in clinical practice, highlighting the need for continuous anatomical research to advance clinical methodologies and ultimately improve patient care and surgical success.

Potential nephroprotective effect of dapagliflozin against renal ischemia reperfusion injury in rats via activation of autophagy pathway and inhibition of inflammation, oxidative stress and apoptosis

Renal ischemia/reperfusion injury is a common cause of acute kidney injury (AKI), causing tissue damage, inflammation and oxidative stress. Autophagy, responsible for breakdown and recycling of cytoplasmic components. In hypoxic and ischemic renal damage, autophagy may serve as a survival strategy for the cells. Dapagliflozin has been shown to have protective effects against ischemia. Objective: The study investigates the potential nephro-protective effects of dapagliflozin on renal ischemia reperfusion injury, evaluating its antioxidant, anti-inflammatory, anti-apoptotic effects and activation of autophagy via biochemical parameters and histopathological changes in adult male rats. Material and method: In this study, twenty eight male rats weighing between 200-300g, were divided into 4 groups sham, RIRI, DMSO, Dapagliflozin pretreated groups. All groups subjected to 30 min. of ischemia then 24 h of reperfusion except sham undergo the same anesthesia and surgical procedures except for bilateral renal ischemia. Dapagliflozin 1mg/kg and DMSO was given 2 hours before the induction of ischemia. Results: The study found that blood urea and serum creatinine levels increased in RIRI and DMSO groups when compared with sham group. Renal tissue levels of IL-6, Kim-1, caspase-3, LC-3 and Akt were also elevated in RIRI while GSH levels decreased in the RIRI. Dapagliflozin group showed significant increases in GSH, LC-3 and Akt levels when compared to sham group. Dapagliflozin reduced serum urea and creatinine levels, and renal tissue levels of IL-6, Kim-1, and caspase-3 also reduced. Conclusion: Dapagliflozin significantly reduced renal damage in rat model due to its antioxidant, anti-inflammatory, anti-apoptotic, and activation autophagy.

Adverse events during general anesthesia at the university hospital center (CHU) “Hôpital du Mali”

Objective: To evaluate the incidence of adverse events during general anesthesia and to describe their progression. Methodology: Cross sectional study with retrospective collection over 6 months at the Mali Hospital University Hospital. It included all patients who underwent elective or urgent surgeries under general anesthesia (GA) with tracheal intubation. Vital parameters and details of incidents and accidents were collected and analyzed. Results: During the study period, 723 anesthesia procedures were performed, of which 339 were GA, a prevalence of 46.9%. Among these patients, 149 (43.9%) experienced at least one AE. The mean age was 28 ± 19.9 years old [3 days old; 85 years old], with a sex ratio ~1. AEs occurred during elective anesthesia in 68.4%. The primary surgical specialties were thoracic/cardiovascular surgery (40.4%) and neurosurgery (37.8%). Patients were classified as American Society of Anesthesiologists-2 (ASA 2) in 49.5%. Pharmacological premedication was administered in 84.7%. The intravenous hypnotics used included propofol (85.5%), thiopental (8%), and ketamine (6.5%). Inhalation agents used were isoflurane (99.4%) and halothane (0.6%). Vecuronium (95.5%) was the most commonly used muscle relaxant, while suxamethonium (4.5%) was used for intubation. AEs predominantly occurred during induction and maintenance of anesthesia, with hypotension (84.6%), desaturation, hypertension, and cardiac arrest being the most common. Delayed awakening was observed in 5.6%, including one instance of unrecovered cardiac arrest (0.6%). The overall mortality rate due to AEs was 0.6%. Conclusion: Adverse events are common during GA, particularly during induction and entretien phases, and are associated with a mortality rate of 0.6%. Keywords: Adverse events, GA, Incidence, Mali.

Correlation of Neuroinflammation and Therapeutic Targets in Perioperative Neurocognitive Disorders.

Perioperative Neurocognitive (PND) disorders represent a prevalent complication among geriatric patients, manifested in diverse forms of cognitive impairment following anesthesia and surgical procedures. Even though the exact origin of PND disorders is still unknown, neuroinflammation has been identified as a significant contributing factor, particularly in older patients. Hence, this review aims to provide a deeper insight into the underlying mechanism and associated potent therapeutic targets for the efficient management of perioperative neurocognitive disorders. Many factors, such as PRRs, chemokine receptors, immunoglobulin superfamily receptors, and purinergic receptors, are involved in the development and occurrence of perioperative neurocognitive disorders to varying degrees and may be valuable biomarkers for their effective management. Here, we present a comprehensive overview of the involvement of neuroinflammation in PND disorders, including their onset and possible therapeutic targets. This review would benefit future researchers in elucidating a better therapeutic approach for the management of perioperative neurocognitive disorders. We have also briefly outlined the clinical trials associated with Postoperative neurocognitive disorders in the last section of the review. Altogether, this review would help the researchers investigate better therapeutics for the management of PND disorders.

The Use of Point-of-Care Ultrasound (POCUS) in Anesthesiology: A Narrative Review.

Point-of-care ultrasound (POCUS) has become an essential tool in modern anesthesiology, offering real-time imaging that aids in diagnosis, treatment, and procedural guidance. Its applications have expanded significantly, from routine assessments to complex perioperative management, enhancing patient care across various domains. This study aimed to review and summarize the current literature on the applications of POCUS in anesthesiology, focusing on its utility in airway management, cardiac assessment, lung ultrasound (LUS), and abdominopelvic evaluations. Additionally, it discusses the challenges and strategies for overcoming barriers to its widespread adoption. A narrative literature review was conducted, encompassing studies on using POCUS in anesthesiology. Key databases were searched for relevant articles ("Point-of-care ultrasound,""Focused cardiac ultrasound,""Lung ultrasound"),and studies were selected based on their relevance to the main topics of interest: airway management, cardiac ultrasound, LUS, and abdominopelvic and gastric ultrasound. Both observational studies and randomized controlled trials were included. POCUS improves the safety and accuracy of regional anesthesia and airway procedures, enhancing patient outcomes by providing real-time visualization. Focused cardiac ultrasound is valuable in preoperative, intraoperative, and postoperative care, allowing for tailored anesthesia plans and timely interventions based on cardiac function. The US is an effective diagnostic tool for assessing pulmonary conditions, with specific signs and artifacts aiding in identifying pathologies such as pneumothorax, pleural effusions, and pulmonary congestion. Despite its benefits, POCUS faces barriers such as limited access to training, the need for standardized protocols, and the high equipment cost, especially in low-resource settings. While its integration into clinical practice continues to grow, overcoming challenges related to training, standardization, and equipment access is essential to realize its full potential. Continued efforts in education and research are needed to support the widespread adoption of POCUS in anesthesiology.

Preoperative Congestive Heart Failure Is Associated with Higher 30-Day Myocardial Infarction and Pneumonia after Endovascular Repair of Abdominal Aortic Aneurysm

Introduction: Preoperative congestive heart failure (CHF) is associated with higher postoperative mortality and complications in noncardiac surgery. However, postoperative outcomes for patients with preoperative CHF undergoing endovascular aneurysm repair (EVAR) have not been thoroughly established. This study evaluated the effect of preoperative CHF on 30-day outcomes following nonemergent intact EVAR using a large-scale national registry. Methods: Patients who had infrarenal EVAR were identified in the ACS-NSQIP database from 2012 to 2022. A 1:5 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without preoperative CHF. Thirty-day postoperative outcomes were examined. Results: 467 (2.84%) CHF patients underwent intact EVAR. Meanwhile, 15,996 non-CHF patients underwent EVAR, where 2,248 of them were matched to all CHF patients. Patients with and without preoperative CHF had comparable 30-day mortality (3.02% vs. 2.62%, p = 0.64). However, CHF patients had higher myocardial infarction (3.02% vs. 1.47%, p = 0.03), pneumonia (3.23% vs. 1.73%, p = 0.04), 30-day readmission (p = 0.01), and longer length of stay (p < 0.01). Conclusion: While patients with and without preoperative CHF had comparable 30-day mortality rates, those with CHF faced higher risks of cardiopulmonary complications. Effective management of preoperative CHF may help prevent postoperative complications in these patients.

The seroprevalence of SARS-CoV-2-specific antibodies in Australian children: A cross-sectional study.

Following reduction of public health and social measures concurrent with SARS-CoV-2 Omicron emergence in late 2021 in Australia, COVID-19 case notification rates rose rapidly. As rates of direct viral testing and reporting dropped, true infection rates were most likely to be underestimated. To better understand infection rates and immunity in this population, we aimed to estimate SARS-CoV-2 seroprevalence in Australians aged 0-19 years. We conducted a national cross sectional serosurvey from June 1, 2022, to August 31, 2022, in children aged 0-19 years undergoing an anesthetic procedure at eight tertiary pediatric hospitals. Participant questionnaires were administered, and blood samples tested using the Roche Elecsys Anti-SARS-CoV-2 total spike and nucleocapsid antibody assays. Spike and nucleocapsid seroprevalence adjusted for geographic and socioeconomic imbalances in the participant sample compared to the Australian population was estimated using multilevel regression and poststratification within a Bayesian framework. Blood was collected from 2,046 participants (median age: 6.6 years). The overall adjusted seroprevalence of spike-antibody was 92.1% (95% credible interval (CrI) 91.0-93.3%) and nucleocapsid-antibody was 67.0% (95% CrI 64.6-69.3). In unvaccinated children spike and nucleocapsid antibody seroprevalences were 84.2% (95% CrI 81.9-86.5) and 67.1% (95%CrI 64.0-69.8), respectively. Seroprevalence was similar across geographic remoteness index and socioeconomic quintiles. Nucleocapsid antibody seroprevalence increased with age while the point seroprevalence of the spike antibody seroprevalence decreased in the first year of life and then increased to 97.8 (95% Crl 96.1-99.2) by 12-15 years of age. Most Australian children and adolescents aged 0-19 years, across all jurisdictions were infected with SARS-CoV-2 by August 2022, suggesting rapid and uniform spread across the population in a very short time period. High seropositivity in unvaccinated children informed COVID-19 vaccine recommendations in Australia.

FP8.2 - Sustainability Within the Abscess Pathway

Abstract Background Global warming and the current climate crisis remain a threat to global health. It is estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to general anaesthetic (GA) gases, which contributes to ongoing ozone depletion. Aims To review current practices in managing abscesses and improve sustainability within the abscess pathway in our trust. Methods Retrospective data on all patients who underwent incision and drainages (I&amp;D) between January – July 2022 were collected and analysed. A new abscess pathway was introduced in June 2023 and departmental teaching provided to junior doctors on incision and drainage of abscesses under local anaesthetic (LA). Data on patients who underwent I&amp;D between June – September 2023 were collected and analysed to assess the impact of the new abscess pathway. Results In the first-cycle audit, 162 patients underwent I&amp;D, of which 119 (92%) were done under GA. Of these, 71 (60%) were suitable for LA I&amp;Ds, 91% were admitted for their procedures. The estimated carbon footprint was 4525kg CO2e/year. In the second-cycle audit, 68 patients underwent I&amp;D, of which 37 (76%) were done under GA. Of these, 31 (46%) were suitable for LA I&amp;Ds, 41% were admitted for their procedures. The estimated carbon footprint was 3735kg CO2e/year. Conclusions Following implementation of the new abscess pathway, we reduced the number of patients having general anaesthetic procedures and inpatient admission. This not only improves the sustainability of our practice, but makes treatment and recovery quicker for patients, and has a lower financial burden.

Comparative analysis of postoperative complications and outcomes in outpatient versus inpatient orthognathic surgery: a retrospective cohort study

The purpose of this study was to assess and compare the complication rates of single-jaw orthognathic surgery between outpatients and inpatients, and to examine their impact on the outcome of care setting.A retrospective cohort study was performed of patients who underwent single-jaw orthognathic procedures. Outpatients between 2008 and 2023 were selected as the study group, while inpatients between 1997 and 2023 were enrolled as the control group. The predictor variable was the patient care setting. The primary outcome variable was the occurrence of overall complications. Secondary outcomes included surgery-, anesthesia-, and patient-related complications. Other study variables included age, sex, surgery, and anesthesia procedures. Descriptive, bivariate, and multiple logistic regression statistics were computed and the significance level was set at p ≤ 0.05.The sample included 307 patients with a mean age of 23.1 years ± 9.5 years, of whom 55% were female. The outpatient and inpatient groups consisted of 123 (40.1%) and 184 (59.9%) patients, respectively. Of the 123 outpatients, 104 (85.5%) were discharged on the day of surgery. Age (p = 0.012) and ketamine administration (p = 0.022) were significantly associated with complications among outpatients. Outpatient setting and age were significantly associated with overall complications (OR 2.48; 95% confidence interval [CI] 1.34–4.66, p = 0.003 and OR 0.94, 95% CI 0.88–0.98, p = 0.021, respectively) and anesthesia-related complications (OR 4.43, 95% CI 2.03–10.5, p = 0.0003 and OR 0.92, 95% CI 0.83–0.98, p = 0.041, respectively).The study demonstrated that outpatient orthognathic surgery had a high success rate but also identified a higher rate of anesthesia-related complications among outpatients, particularly in younger patients and in those receiving ketamine.

Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers.

As higher acuity procedures continue to move from hospital-based operating rooms (HORs) to free-standing ambulatory surgery centers (ASCs), concerns for patient safety remain high. We conducted a contemporary, descriptive analysis of anesthesia-related liability closed claims to understand risks to patient safety in the free-standing ASC setting, compared to HORs. Free-standing ASC and HOR closed claims between 2015 and 2022 from The Doctors Company that involved an anesthesia provider responsible for the claim were included. We compared the coded data of 212 free-standing ASC claims with 268 HOR claims in terms of severity of injury, major injuries, allegations, comorbidities, contributing factors, and financial value of the claim. Free-standing ASC claims accounted for almost half of all anesthesia-related cases (44%, 212 of 480). Claims with high severity of injury were less frequent in free-standing ASCs (22%) compared to HORs (34%; P = .004). The most common types of injuries in both free-standing ASCs and HORs were dental injury (17% vs 17%) and nerve damage (14% vs 11%). No difference in frequency was noted for types of injuries between claims from free-standing ASCs versus HORs--except that burns appeared more frequently in free-standing ASC claims than in HORs (6% vs 2%; P = .015). Claims with alleged improper management of anesthesia occurred less frequently among free-standing ASC claims than HOR claims (17% vs 29%; P = .01), as well as positioning-related injury (3% vs 8%; P = .025). No difference was seen in frequency of claims regarding alleged improper performance of anesthesia procedures between free-standing ASCs and HORs (25% vs 19%; P = .072). Technical performance of procedures (ie, intubation and nerve block) was the most common contributing factor among free-standing ASC (74%) and HOR (74%) claims. Free-standing ASC claims also had a higher frequency of communication issues between provider and patient/family versus HOR claims (20% vs 10%; P = .004). Most claims were not associated with major comorbidities; however, cardiovascular disease was less prevalent in free-standing ASC claims versus HOR claims (3% vs 11%; P = .002). The mean ± standard deviation total of expenses and payments was lower among free-standing ASC claims ($167,000 ± $295,000) than HOR claims ($332,000 ± $775,000; P = .002). This analysis of medical malpractice claims may indicate higher-than-expected patient and procedural complexity in free-standing ASCs, presenting patient safety concerns and opportunities for improvement. Ambulatory anesthesia practices should consider improving safety culture and communication with families while ensuring that providers have up-to-date training and resources to safely perform routine anesthesia procedures.

Tau biosensor on aptamer-modified interdigitated electrode for monitoring neurological effect caused by anesthesia

General anesthesia is significantly gaining prominence and becoming unavoidable in modern medicine. Since neuroprotein fluctuations are common during anesthetic procedures, it is essential to monitor protein levels to identify neuro-related issues. Tau protein fluctuations are often found in the anesthetic process, and higher levels of tau are highly related to various neuro-related issues. Researchers are focusing on monitoring tau levels during and after anesthesia. This research has developed a high-sensitive tau biosensor on a gold nanomaterial-modified interdigitated electrode, measured at 0–2 V on a dual-probe station. Aptamer and antibody were used as capture and detection molecules, and a biotin-streptavidin strategy was employed to attach a higher number of aptamers on the electrode. These immobilized aptamers recognize the tau protein and form a sandwich with antibodies, lowering the detection of tau protein to 1 fM on a linear regression from 0.001 to 100 pM (y = 2.0651x - 1.3813, R2 = 0.987). Further, tau-spiked cerebrospinal fluid increases the current flow without any interferences, confirming the selective detection of tau protein.

Incidence and type of voluntary reported perianesthetic medication errors in community veterinary clinics in Calgary, Canada.

To collect medication error (ME) data during the perianesthetic period from small animal clinics. 6 small animal general practice veterinary clinics. Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing. A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education. These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.