Anaesthetic Assessment Research Articles

Pre-Anesthesia Assessment and Preparation

The aims of the study is to find out pre – anesthesia assessment and preparation. The result of the study shows that Pre-anesthesia is an important first step in a series of anesthesia procedures performed on patients who are planned to undergo surgery. The things that need to be done include history taking, physical examination, laboratory examination, and physical status classification. Preparations are made at the clinic or at home for outpatients, in the treatment room, in the Central Surgery Installation (IBS) room, and in the operating room. Pre-anesthesia physical status assessment is very important. Anesthesia is not differentiated based on the size of the surgery but consideration of the choice of anesthesia techniques that will be given to patients is very complex and comprehensive considering all types of anesthesia have risk factors for complications that can threaten the patient's life

Association Between Preoperative Obstructive Sleep Apnea and Preoperative Positive Airway Pressure With Postoperative Intensive Care Unit Delirium

Obstructive sleep apnea has been associated with postoperative delirium, which predisposes patients to major adverse outcomes. Positive airway pressure may be an effective intervention to reduce delirium in this population. To determine if preoperative obstructive sleep apnea is associated with postoperative incident delirium in the intensive care unit and if preoperative positive airway pressure adherence modifies the association. A retrospective single-center cohort study was conducted at a US tertiary hospital from November 1, 2012, to August 31, 2016, among 7792 patients admitted to an intensive care unit who underwent routine Confusion Assessment Method for the intensive care unit after major surgery. Patients were adults who had undergone a complete preoperative anesthesia assessment, received general anesthesia, underwent at least 1 delirium assessment, were not delirious preoperatively, and had a preoperative intensive care unit stay of less than 6 days. Statistical analysis was conducted from August 20, 2019, to January 11, 2020. Self-reported obstructive sleep apnea, billing diagnosis of obstructive sleep apnea, or STOP-BANG (Snoring, Tiredness, Observed Apnea, Blood Pressure, Body Mass Index, Age, Neck Circumference and Gender) questionnaire score greater than 4, as well as self-reported use of preoperative positive airway pressure. Delirium within 7 days of surgery. A total of 7792 patients (4562 men; mean [SD] age, 59.2 [15.3] years) met inclusion criteria. Diagnosed or likely obstructive sleep apnea occurred in 2044 patients (26%), and delirium occurred in 3637 patients (47%). The proportion of patients with incident delirium was lower among those with obstructive sleep apnea than those without (897 of 2044 [44%] vs 2740 of 5748 [48%]; unadjusted risk difference, -0.04; 99% credible interval [CrI], -0.07 to -0.00). Positive airway pressure adherence had minimal association with delirium (risk difference, -0.00; 99% CrI, -0.09 to 0.09). Doubly robust confounder adjustment eliminated the association between obstructive sleep apnea and delirium (risk difference, -0.01; 99% CrI, -0.04 to 0.03) and did not change that of preoperative positive airway pressure adherence (risk difference, -0.00, 99% CrI, -0.07 to 0.07). The results were consistent across multiple sensitivity analyses. After risk adjustment, this study found no association between obstructive sleep apnea and postoperative delirium in the context of usual care in the intensive care unit, with 99% CrIs excluding clinically meaningful associations. With limited precision, no association was found between positive airway pressure adherence and delirium. Selection bias and measurement error limit the validity and generalizability of these observational associations; however, they suggest that interventions targeting sleep apnea and positive airway pressure are unlikely to have a meaningful association with postoperative intensive care unit delirium.

Improvement in pre-operative risk assessment in adults undergoing noncardiac surgery by a process-oriented score: A prospective single-centre study.

Pre-operative risk assessment is important to quantify the patient's risks of morbidity and mortality, but its quality differs. We created a process-oriented score (PRO-score) for risk evaluation of adults as a three-stage warning score checklist with concrete guidance. It contains the contents of current guidelines and the assessment of vital signs. We investigated whether the PRO-score is suitable to detect 'red flag' warning signs not only in American Society of Anesthesiologists (ASA) physical status (PS) 3 or 4 patients but also in ASA-PS 1 or 2 patients. Resulting medical, therapeutic or structural consequences were recorded. Prospective single-centre study. The study was performed in a German university hospital between November 2015 and December 2018. We included 54 455 adult patients undergoing a pre-operative risk assessment for general or regional anaesthesia and elective noncardiac surgery. In all, 388 patients presented 'red flag' warning signs in the PRO-score during risk assessment; 85 (21.9%) were labelled ASA-PS 1 or 2, 244 (62.9%) ASA-PS 3 and 59 (15.2%) ASA-PS 4. Additional examinations were performed in 179 patients and technical tests in 175 patients (ASA-PS 1 or 2: 53 and 63 patients, respectively). After re-evaluation of the peri-operative risk in an interdisciplinary conference, surgery was cancelled in 44 patients (ASA-PS 1 and 2, 17 patients) or performed under local anaesthesia in 15 patients (ASA-PS 1 and 2, 2 patients). A downgrading to PRO-score 2 was reached in 168 patients after therapeutic interventions (ASA-PS 1 and 2, 54 patients). Undergoing surgery despite 'red flag' events resulted in major complications in 34 patients, and 16 patients died (ASA-PS 1 or 2: 7 and 3 patients, respectively). The PRO-score detected warning signs in 'healthy' ASA-PS 1 or 2 and in ASA-PS 3 or 4 patients. Furthermore, it influenced the management of these patients, and thus improved the process quality of risk assessment. The physical examination should include the assessment of vital signs.

Service Requirements of Liver Transplant Anesthesia Teams: Society for the Advancement of Transplant Anesthesia Recommendations.

There are disparities in liver transplant anesthesia team (LTAT) care across the United States. However, no policies address essential resources for liver transplant anesthesia services similar to other specialists. In response, the Society for the Advancement of Transplant Anesthesia appointed a task force to develop national recommendations. The Conditions of Transplant Center Participation were adapted to anesthesia team care and used to develop Delphi statements. A Delphi panel was put together by enlisting 21 experts from the fields of liver transplant anesthesiology and surgery, hepatology, critical care, and transplant nursing. Each panelist rated their agreement with and the importance of 17 statements. Strong support for the necessity and importance of 13 final items were as follows: resources, including preprocedure anesthesia assessment, advanced monitoring, immediate availability of consultants, and the presence of a documented expert in liver transplant anesthesia credentialed at the site of practice; call coverage, including schedules to assure uninterrupted coverage and methods to communicate availability; and characteristics of the team, including membership criteria, credentials at the site of practice, and identification of who supervises patient care. Unstructured comments identified competing time obligations for anesthesia and transplant services as the principle reason that the remaining recommendations to attend integrative patient selection and quality review committees were reduced to a suggestion rather than being a requirement. This has important consequences because deficits in team integration cause higher failure rates in service quality, timeliness, and efficiency. Solutions are needed that remove the time-related financial constraints of competing service requirements for anesthesiologists. In conclusion, using a modified Delphi technique, 13 recommendations for the structure of LTATs were agreed upon by a multidisciplinary group of experts.

Machine learning based method for the evaluation of the Analgesia Nociception Index in the assessment of general anesthesia

Measuring the level of analgesia to adapt the opioids infusion during anesthesia to the real needs of the patient is still a challenge. This is a consequence of the absence of a specific measure capable of quantifying the nociception level of the patients. Unlike existing proposals, this paper aims to evaluate the suitability of the Analgesia Nociception Index (ANI) as a guidance variable to replicate the decisions made by the experts when a modification of the opioid infusion rate is required. To this end, different machine learning classifiers were trained with several sets of clinical features. Data for training were captured from 17 patients undergoing cholecystectomy surgery. Satisfactory results were obtained when including information about minimum values of ANI for predicting a change of dose. Specifically, a higher efficiency of the Support Vector Machine (SVM) classifier was observed compared with the situation in which the ANI index was not included: accuracy: 86.21% (83.62%–87.93%), precision: 86.11% (83.78%–88.57%), recall: 91.18% (88.24%–91.18%), specificity: 79.17% (75%–83.33%), AUC: 0.89 (0.87–0.90) and kappa index: 0.71 (0.66–0.75). The results of this research evidenced that including information about the minimum values of ANI together with the hemodynamic information outperformed the decisions made regarding only non-specific traditional signs such as heart rate and blood pressure. In addition, the analysis of the results showed that including the ANI monitor in the decision making process may anticipate a dose change to prevent hemodynamic events. Finally, the SVM was able to perform accurate predictions when making different decisions commonly observed in the clinical practice.

Achieving discharge within 24 h of robotic unicompartmental knee arthroplasty may be possible with appropriate patient selection and a multi-disciplinary team approach

AimsThere has been significant interest in day-case and rapid discharge pathways for unicompartmental knee replacements (UKR). Robotic-assisted surgery has the potential to improve surgical accuracy in UKR. However, to date there are no published studies reporting results of rapid-discharge pathways in patients receiving UKR using the NAVIO◊ robotic system. MethodsA retrospective analysis identified 19 patients who were safely discharged within 24 h following UKR using the NAVIO◊ robotic system between June 2017 and October 2019. All patients went through a standardised UKR pathway protocol. Pre-operatively patients underwent education sessions and anaesthetic assessment, with selected patients undergoing occupational/physiotherapy assessment prior to surgery. All patients received a general anaesthetic with local anaesthetic infiltration prior to closure; nerve blocks were not used routinely. A multi-modal analgesic regime was utilised. Patients were discharged home once they were safe to mobilise on ward, had normal vital signs and pain was adequately controlled. Patients were discharged with outpatient physiotherapy referral and consultant follow up at 6 weeks. ResultsAll patients were discharged within 24 h; there were no post-operative complications and no readmissions to hospital. The mean length of stay was 19.5 h (SD = 6.8), with patients seen twice on average by physiotherapy post-operatively. Active range of motion at 6 weeks was 105.8°, with all patients mobilising independently. The median 6-month post-operative Oxford Knee Score was 44 out of 48. ConclusionThis initial feasibility study suggests that patients may be safely discharged within 24 h of UKR using the NAVIO robotic system. Appropriate patient selection will ensure successful discharge. Further prospective studies are needed.

Assessment of anesthesia on physiological stability and BOLD signal reliability during visual or acoustic stimulation in the cat

BackgroundNeuroimaging methods including fMRI provide powerful tools to observe whole-brain functional networks. This is particularly powerful in animal models, allowing these networks to be probed using complementary methods. However, most animals must be anesthetized for neuroimaging, giving rise to complications resulting from anesthetic effects on the animal’s physiological and neurological functions. For example, an established protocol for feline neuroimaging involves co-administration of ketamine and isoflurane – the latter of which is known to suppress cortical function. New methodHere, we compare this established protocol to alfaxalone, a single-agent anesthetic for functional neuroimaging. We first compare the two in a controlled environment to assess relative safety and to measure physiological stability over an extended time window. We then compare patterns of auditory and visually-evoked activity measured at 7 T to assess mean signal strength and between-subjects signal variability. Results in comparison with existing methodsWe show that alfaxalone results in more stable respiratory rates over the 120 min testing period, with evidence of smaller between-measurements variability within this time window, when compared to ketamine plus isoflurane. Moreover, we demonstrate that both agents evoke similar mean BOLD signals across animals, but that alfaxalone elicits more consistent BOLD activity in response to sound stimuli across all ROIs observed. ConclusionsAlfaxalone is observed to be more physiologically stable, evoking a more consistent BOLD signal across animals than the co-administration of ketamine and isoflurane. Thus, an alfaxalone-based protocol may represent a better approach for neuroimaging in animal models requiring anesthesia.

Robust approach to depth of anaesthesia assessment based on hybrid transform and statistical features

To develop an accurate and efficient depth of anaesthesia (DoA) assessment technique that could help anaesthesiologists to trace the patient's anaesthetic state during surgery, a new automated DoA approach was proposed. It applied wavelet-Fourier analysis (WFA) to extract the statistical characteristics from an anaesthetic electroencephalogram (EEG) signal and to design a new DoA index. In this proposed method, firstly, the wavelet transform was applied to a denoised EEG signal, and a fast Fourier transform was then applied to the wavelet detail coefficient D3. Ten statistical features were extracted and analysed, and from these, five features were selected for designing a new index for the DoA assessment. Finally, a new DoA (WFA DoA ) was developed and compared with the most popular bispectral index (BIS) monitor. The results from the testing set showed that there were very high correlations between the WFA DoA and the BIS index during the awake, light and deep anaesthetic stages. In the case of poor signal quality, the BIS index and the WFA DoA were also tested, and the obtained results demonstrated that the WFA DoA could indicate the DoA values, while the BIS failed to show valid outputs for those situations.

In Response

We read with interest the comments by Grocott1 and Chin and Barrington2 on our study.3 Though the efficacy of erector spinae plane (ESP) block has been reported in many publications, we believe that our study is one of the earliest prospective randomized controlled trials (RCTs) that documented the potential benefits of this regional anesthetic technique. The author commented on the difference between the registered end points in the Pan African Clinical Trials Registry (PACTR) and those reported in our study. At the time of registering the trial, we planned to evaluate the visual analog scale (VAS) of pain as our primary outcome. However, after registration, we thought it would be better to report VAS at 2 hours postoperative as the primary outcome, because it would be a surrogate of block success because we did not perform sensory assessment of dermatomal block to maintain the double-blinded nature of the trial. Yet, we assessed VAS along the first 24 hours postoperatively and reported them as secondary outcomes. The time to the first rescue analgesic request was not registered as a secondary outcome in the PACTR. The registered outcomes, as well as the published secondary outcomes, included the consumption of intraoperative fentanyl and the 24-hour rescue analgesic consumption. We thank the author for pointing out the fact that most of the RCTs, including ours, lack the reporting of any patient-centered outcomes. We agree with him that the reporting of the standardized end points suggested by The Standardised Endpoints in Perioperative Medicine (StEP) initiative4 would facilitate future clinical trials assessing patient comfort and pain after surgery. However, Myles et al4 in their systematic review suggested that those end points are still to be evaluated and updated. They also suggested that other factors, other than those reported end points, might eventually be found to be valid and patient-centered. Though our RCTs did not report those patient-centered outcomes, which is an obvious limitation, we assessed postoperative VAS scale of pain for the first 24 hours postoperatively because we mainly focused on analgesic effects of the ESP block, and that was the main outcome of our study. We also reported the incidence of nausea and vomiting as a complication. We recommend further implementation of those end points in future RCTs evaluating any regional anesthetic technique and assessment of other potential patient-centered outcomes. Though our publication had some limitations, and based on our results, we believe that ESP is a promising regional anesthetic technique. Mohamed M. Abu Elyazed, MDShaimaa F. Mostafa, MDMohamed S. Abdelghany, MDGehan M. Eid, MDDepartment of Anesthesia and Surgical ICUFaculty of MedicineTanta UniversityTanta, Egypt[email protected]

Delay in anesthesia assessment time – A cause of postponement in orthopedic trauma surgery

Background: Postponement of surgery increases the length of hospitalization and medical expenses, the mortality rate, and the prevalence of major medical complications. There is a limited study about the role of anesthesia assessment in developing these complications. Thus, the aim of the present study was to examine the anesthesia assessment time for traumatic patients aged over 50 years and also to investigate the role of anesthesia service in surgery postponement. Materials and Methods: This descriptive retrospective study was performed on 110 patients with traumatic injuries referred to Imam Khomeini Hospital Complex (Tehran, Iran) from March to September 2017. The information was extracted retrospectively from the hospital information system. The standard definitions in the International Classification of Diseases 10 code S00-T88 were used to identify traumatic injuries and fractures. Results: The results of the present study showed that the mean of anesthesia assessment time was significantly different in terms of the type of trauma, and femoral fractures had a higher anesthesia assessment time (P = 0.009). Furthermore, the anesthesia assessment time in patients who underwent echocardiography was significantly higher than those with no echocardiography (P

Current Neurologic Assessment and Neuroprotective Strategies in Cardiac Anesthesia: A Survey to the Membership of the Society of Cardiovascular Anesthesiologists.

Neurologic injury and cognitive disorder after cardiac surgery are associated with morbidity and mortality. Variability in the application of neuroprotective strategies likely exists during cardiac surgery. The Society of Cardiovascular Anesthesiologists (SCA) conducted a survey among its members on common perioperative neuroprotective strategies: assessment of aortic atheromatous burden, management of intraoperative blood pressure, and use of cerebral oximetry. A 15-item survey was developed by 3 members of the SCA Continuous Practice Improvement - Cerebral Protection Working Group. The questionnaire was then circulated among all working group members, adapted, and tested for face validity. On March 26, 2018, the survey was sent to members of the SCA via e-mail using the Research Electronic Data Capture system. Responses were recorded until April 16, 2018. Of the 3645 surveys e-mailed, 526 members responded (14.4%). Most responders worked in academic institutions (58.3%), followed by private practices (38.7%). Epiaortic ultrasound for the assessment of aortic atheromatous burden was most commonly utilized at the surgeon's request (46.5%). Cerebral oximetry was most commonly used in patients with increased perioperative risk of cerebral injury (41.4%). Epiaortic ultrasound (1.9%) and cerebral oximetry (5.2%) were rarely part of a standardized monitoring approach. A majority of respondents (52.0%) reported no standardized management strategies for neuroprotection during cardiac surgery at their institution. A total of 55.3% stated that no standardized institutional guidelines were in place for managing a patient's blood pressure intraoperatively or during cardiopulmonary bypass. When asked about patients at risk for postoperative cerebral injury, 41.3% targeted a blood pressure goal >65 mmHg during cardiopulmonary bypass. The majority of responders (60.4%) who had access to institutional rates of postoperative stroke/cerebral injury had standard neuroprotective strategies in place. Our data indicate that approximately half of the respondents to this SCA survey do not use standardized guidelines/standard operating procedures for perioperative cerebral protection. The lack of standardized neuroprotective strategies during cardiac surgery may impact postoperative neurologic outcomes. Further investigations are warranted and should assess the association of standardized neuroprotective approaches and postoperative neurological outcomes.

Interpretation of clinical practice guideline for anorectal day surgery 2019 edition

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.

The Influence of Gender on Outcomes Following Elective Repair of Asymptomatic Large Abdominal Aortic Aneurysms

Introduction: Vascular Services Quality Improvement Program (VSQIP) was introduced in the United Kingdom in order to reduce mortality from elective repair of AAA. Prior to introduction of VSQIP women had lower survival rates from AAA repair (1). This study examines the influence of gender on perioperative outcome and post operative survival following elective repair of AAAs in the 10 years after implementation of the (VSQIP) in a regional vascular surgery center in the United Kingdom. Methods: Patients who underwent elective repair of AAA in a specialist vascular center between 1st January 2008 and 31st March 2018 were included. All patients were assessed using the nationally agreed Vascular Services Quality Improvement Programme care pathway for AAAs. The VSQIP pathway involved anesthetic assessment prior to intervention which included cardiopulmonary exercise testing as well as contrast enhanced CT scan of aorta. This was followed by multidisciplinary assessment to plan each patient's treatment. Each CT scan was examined to assess the morphology of AAA. Patients were stratified by age, gender, AAA morphology and preoperative anaerobic threshold. Postoperative survival was assessed using Kaplan-Meier analysis. Multivariate logistic regression analysis was used to determine predictors of perioperative mortality. Results: A total of 702 patients underwent elective repair of AAA of whom 632 were men and 70 were women. The mean age of study cohort was 73.5 years (std. dev: 7.3) and mean AAA diameter was 62 mm (std. dev.: 9.9). Two hundred and forty four patients underwent open repair, 402 underwent standard infra renal EVAR and 56 underwent complex EVAR with perioperative and 30 day mortality of 1.13%. Anaerobic threshold< 8 (HR: 95%CI: 2.01 (1.09-3.32)), complex aneurysm morphology [HR (95%CI): 4.55 (1.51-7.33)] were independent risk factor for perioperative mortality, whilst female gender [(HR (95%CI): 0.98 (092-1.68)] was not. There was no difference in post-operative survival between men and women who underwent elective repair of AAA (Log rank: 1.82 P=NS) Conclusion: Following the implementation of VSQIP female gender is no longer a significant risk factor for perioperative mortality or postoperative reduced survival following elective repair of large asymptomatic AAA. Disclosure: Nothing to disclose

Clinical Assessment of Anesthesia Caused by Combinational Protocol of Acepromazine-Fentanyl-Ketamine in Dogs

Clinical Assessment of Anesthesia Caused by Combinational Protocol of Acepromazine-Fentanyl-Ketamine in Dogs

Simulation-based assessment in anesthesia: an international multicentre validation study.

Simulated clinical events provide a means to evaluate a practitioner's performance in a standardized manner for all candidates that are tested. We sought to provide evidence for the validity of simulation-based assessment tools in simulated pediatric anesthesia emergencies. Nine centres in two countries recruited subjects to participate in simulated operating room events. Participants ranged in anesthesia experience from junior residents to staff anesthesiologists. Performances were video recorded for review and scored by specially trained, blinded, expert raters. The rating tools consisted of scenario-specific checklists and a global rating scale that allowed the rater to make a judgement about the subject's performance, and by extension, preparedness for independent practice. The reliability of the tools was classified as "substantial" (intraclass correlation coefficients ranged from 0.84 to 0.96 for the checklists and from 0.85 to 0.94 for the global rating scale). Three-hundred and ninety-one simulation encounters were analysed. Senior trainees and staff significantly out-performed junior trainees (P = 0.04 and P < 0.001 respectively). The effect size of grade (junior vs senior trainee vs staff) on performance was classified as "medium" (partial η2 = 0.06). Performance deficits were observed across all grades of anesthesiologist, particularly in two of the scenarios. This study supports the validity of our simulation-based anesthesiologist assessment tools in several domains of validity. We also describe some residual challenges regarding the validity of our tools, some notes of caution in terms of the intended consequences of their use, and identify opportunities for further research.

Why be sustainable? The Australian and New Zealand College of Anaesthetists Professional Document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice and its accompanying background paper.

Healthcare’s environmental sustainability is increasingly an area of research and advocacy focus. The Australian and New Zealand College of Anaesthetists (ANZCA) has produced a professional document, PS64, Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice, and a background paper, PS64 BP. The purpose of the statement is to affirm ANZCA’s commitment to environmental sustainability and support anaesthetists in promoting environmentally sustainable work practices. This article presents the main features of PS64 and its background paper, and the associated supporting evidence. The healthcare sector is highly interconnected with activities that emit pollution to air, water and soils, considerably adding to humanity’s collective ecological footprint. As anaesthetists, we are uniquely high-carbon doctors due to our work anaesthetising with greenhouse gases (particularly desflurane and nitrous oxide) and our exposure and contribution to large amounts of resource and energy use and waste generation in operating theatres. Discussion is made of the improving research base of anaesthetic life-cycle assessments—that is, cradle-to-grave studies of how much energy, water and so on a product or process requires throughout its entire life. Thereafter, reducing, reusing and recycling as well as water use are examined. Ongoing research efforts within environmentally sustainable anaesthesia are highlighted. Environmentally sustainable anaesthesia requires scholarship, health advocacy, leadership, communication and collaboration. The focus is placed on practical initiatives within PS64 and the background paper that can be achieved by all anaesthetists striving towards more sustainable healthcare practices that reduce waste, reap financial benefits and improve health.

A comparative study between levobupivacaine 0.5% plus lignocaine 2% or bupivacaine 0.5% plus lignocaine 2% for peribulbar block in cataract surgery

Background and Aim: Local anesthetic techniques are increasingly popular for ophthalmic surgery. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. The present Study was performed with an aim to compare between levobupivacaine 0.5% or bupivacaine 0.5% both in a mixture with lignocaine 2% for peribulbar block in cataract surgery.Methodology: In this prospective double blind study, all the patients were randomly divided in two groups, Group B patients received inj bupivacaine 0.5% (5 ml) + lignocaine 2% (5 ml) + hyaluronidase (5 IU/ml), and Group L patients received inj levobupivacaine 0.5% (5 ml) + lignocaine 2% (5 ml) + hyaluronidase (5 IU/ml) for peribulbar block by akinetic technique to provide anesthesia for cataract surgery. The study was conducted for the period of one year. After routine pre anesthetic assessment, a peripheral intravenous (i.v.) line was inserted in 6 hours fasted patient and standard monitoring was conducted and recorded, including heart rate (HR), noninvasive arterial blood pressure (BP), electrocardiogram (5 leads), and peripheral oxygen saturation (SpO2). Motor block was evaluated by assessment of akinesia in four quadrants using general akinesia scoring system. Results: There were no significant difference between groups with respect to the akinesia score (p = 0.24) at 2, 5 and 10 min, the number of supplementary injections (p = 0.83) and initial and total required volume of local anesthetics (p = 0.78 and p = 0.79). There was no significant difference between the groups regarding surgeon and patient satisfaction (p &gt; 0.52). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (p &gt; 0.05). The need for additional intra-operative topical anesthetic was similar between the groups (p = 0.64).Conclusion: Peribulbar block with a mixture of levobupivacaine 0.5% and lignocaine 2% or bupivacaine 0.5% and lignocaine 2% provides similar block quality and efficacy.Citation: Shah J, Bhatt KA. A comparative study between levobupivacaine 0.5% plus lignocaine 2% or bupivacaine 0.5% plus lignocaine 2% for peribulbar block in cataract surgery. Anaesth pain &amp; intensive care 2019;23(2):192-197

TO DETERMINE THE RECURRENCE RATE OF STRICTURE URETHRA FOLLOWING OPTICAL URETHROTOMY IN DEPARTMENT OF UROLOGY AT PEOPLE’S MEDICAL COLLEGE HOSPITAL NAWABSHAH, A 2 YEARS’ EXPERIENCE.

Objectives: To determine the recurrence rate of Stricture Urethra following Optical Urethrotomy in department of Urology at people’s medical college hospital Nawabshah, a 2 years’ experience. Study Design: Prospective observational. Setting: Department of Urology at People’s Medical College Hospital Nawabshah. Period: January 2016 to January 2018. Methodology: Patients who fulfill inclusion criteria were admitted through Urology OPD. An informed consent was taken. All baseline investigations / Antegrade and Retrograde Urethrogram, Qmax in uroflowmetery, post void residual ultrasound scan were performed in all cases. The patients were asked to attend the OT after anesthetic assessment, under spinal anesthesia. They were advised to have follow-up visits with uroflowmetery and PVR. All the collected data was filled on Performa. Data was analyzed through SPSS Version 20.0. Results: A total of 95 patients (100 %) underwent first session of DVIU, out of 95 patients 37 patients (38.95 %) showed improvement in subjective, while remaining 58 patients (61.05%) showed deterioration. so they underwent second session of DVIU. After second session of DVIU 15 patients (25.86%) out of remaining 58 patients showed improvement, while 43 patients (74.14%) remained in agony, So I counseled them all (remaining 43 patients) for third sitting of DVIU or open urethroplasty. Out of 43 remaining patients only 23 patients willingly underwent third session of DVIU and remaining 20 patients refused and they directly underwent open end to end urethroplasty. The 23 patients, who underwent DVIU, have failed and finally they also underwent urethroplasty. Conclusion: The recurrence rate after DVIU has based on multiple factors that should be properly addressed during treatment planning to avoid unnecessary re treatment, to decrease the rate of more invasive open surgical procedure.

Saddle Block as an Option of the Anesthesia Technique for Prostate Puncture Biopsy

Objective: to identify the most effective and safest anesthesia technique for prostate puncture biopsy by means of the comparative analysis of the parameters of hemodynamics, postoperative motor block, and anesthesia, as well as the patient's subjective assessment of the quality of anesthesia. Material and methods: 30 male patients were divided into 2 clinical groups depending on the anesthesia technique. In the 1st group (15 patients), puncture biopsies (BP) were done under saddle spinal anesthesia, in the 2nd group (15 patients) - with the application of traditional spinal anesthesia (SA). The comparative analysis of hemodynamic indices, motor block, the efficiency of anesthesia and the patient satisfaction with the quality of anesthesia was performed. Results. No statistically significant difference between the hemodynamic indices, intraoperative anesthesia and subjective assessment of the quality of anesthesia by the patients was revealed, but at the same time the comparison of the postoperative motor block between the study groups found some statistically significant differences.

Core Topics in Preoperative Anaesthetic Assessment and Management

Core Topics in Preoperative Anaesthetic Assessment and Management