Balanced Anesthesia Research Articles

Effect of balanced anaesthesia with and without modified pectoralis nerve block on postoperative analgesia after breast surgeries: A randomised controlled trial.

Background and Aims:Modified pectoral nerve block (PEC) has been reported to have variable effects on perioperative pain in patients undergoing surgery for carcinoma breast. This randomised controlled trial was conducted to study the effect of modified PEC on postoperative pain relief in patients undergoing breast surgery.Methods:Fifty patients with carcinoma breast undergoing breast surgery were randomised to receive a modified PEC block consisting of 30 ml of ropivacaine 0.2% after induction of anaesthesia (PEC group) or no block (GA group) in this prospective randomised trial. Time to first rescue analgesia was recorded as primary outcome. Other secondary outcomes recorded were postoperative visual analogue scale (VAS) scores, number of rescue boluses and 24-h fentanyl consumption.Results:There was no significant difference in time to first rescue analgesia between the two groups, with mean difference (95% confidence interval) of 22.91 (−6.8 to 52.69) min. Amount of fentanyl required to keep pain VAS less than 3 was also comparable between the two groups, mean (standard deviation) of 42.0 μg (17.42) in GA group versus 43.24 μg (17.22) in PEC group; P = 0.830.20/25 patients required rescue analgesia in GA group as compared to 17/25 in PEC group (P = 0.334). The postoperative VAS scores were also comparable between the groups at all time intervals.Conclusion:Balanced anaesthesia supplemented with modified PEC block performed after general anaesthesia did not improve the postoperative pain in patients undergoing modified radical mastectomy.

Determination of the average intraocular pressure values, optimum anesthesia dose and phenotypic characteristics in Oscar fish (Astronotus ocellatus)

This research was carried out to determine the intraocular pressure values, optimum anesthesia dose and phenotypic characteristics in Oscar fish (Astronotus ocellatus). A total of 11 adult, male Oscar fish were used in the study. Optimum anesthesia dose, pre-and post-anesthesia intraocular pressure values and phenotypic measurements (total length, fork length, standard length, dorsal fin base length, head length, body length, eye diameter, body depth, pectoral length, pelvic fin bottom length, anal fin bottom length) were determined and reference values specific to this fish species were obtained by performing a statistical analysis. When exposed to 3 cc/L of the concentrations, fish achieved a deep state of anesthesia (induction time 1.31 min; recovery time 6.42 min). The most balanced anesthesia without risking vital functions was achieved using Clove oil with a dose of 2.5 cc/L. Compared to the other dimensions, total length, fork length and standard length were the most consistent body measurements with high positive correlations. No statistically significant difference (p > 0.05) was seen in both eyes between the intraocular pressure values before (5.36-5.86) and after (5.59-5.36) anesthesia. It is recommended that the ideal concentration of clove oil was 2.5 cc/L to reduce stress and injury damage during handling procedures. Additionally, intraocular pressure values, body measurements and Clove oil optimum anesthesia dose obtained in this study can be used as reference values for Oscar fish raised in aquarium conditions.

Comparison of Recovery Quality Following Medetomidine versus Xylazine Balanced Isoflurane Anaesthesia in Horses: A Retrospective Analysis.

Simple SummaryRecovery from general anaesthesia poses the most critical phase of equine anaesthesia and is the main cause for the relatively high anaesthetic mortality rate compared to other species. It is, therefore, essential to identify anaesthetic protocols that promote safe recoveries. This retrospective study compared the quality of 470 recoveries following general anaesthesia with the anaesthetic gas isoflurane combined with a constant rate infusion of two different alpha-2 adrenergic agonists (xylazine or medetomidine). On the basis of video recordings, recovery quality was scored by two observers unaware of animal details, procedure, or drugs used. Additionally, factors that may affect recovery (e.g., breed, age, procedure, duration of anaesthesia, and intraoperative complications) were taken into consideration. Horses needing higher doses of xylazine to sedate prior to anaesthesia, the intraoperative use of tetrastarch for cardiovascular support, and the use of salbutamol to improve inadequate blood oxygenation during general anaesthesia were related to poorer recovery scores. Whilst recoveries of horses treated with medetomidine took significantly longer compared to xylazine, the attempts to stand and the overall quality of recovery were similar for both groups, indicating that both anaesthetic protocols promote similarly safe recoveries.Medetomidine partial intravenous anaesthesia (PIVA) has not been compared to xylazine PIVA regarding quality of recovery. This clinical retrospective study compared recoveries following isoflurane anaesthesia balanced with medetomidine or xylazine. The following standard protocol was used: sedation with 7 µg·kg−1 medetomidine or 1.1 mg·kg−1 xylazine, anaesthesia induction with ketamine/diazepam, maintenance with isoflurane and 3.5 µg·kg−1·h−1 medetomidine or 0.7 mg·kg−1·h−1 xylazine, and sedation after anaesthesia with 2 µg·kg−1 medetomidine or 0.3 mg·kg−1 xylazine. Recovery was timed and, using video recordings, numerically scored by two blinded observers. Influence of demographics, procedure, peri-anaesthetic drugs, and intraoperative complications (hypotension, hypoxemia, and tachycardia) on recovery were analysed using regression analysis (p < 0.05). A total of 470 recoveries (medetomidine 279, xylazine 191) were finally included. Following medetomidine, recoveries were significantly longer (median (interquartile range): 57 (43–71) min) than xylazine (43 (32–59) min) (p < 0.001). However, the number of attempts to stand was similar (medetomidine and xylazine: 2 (1–3)). Poorer scores were seen with increased pre-anaesthetic dose of xylazine, intraoperative tetrastarch, or salbutamol. However, use of medetomidine or xylazine did not influence recovery score, concluding that, following medetomidine–isoflurane PIVA, recovery is longer, but of similar quality compared to xylazine.

Intra Venous Butorphanol versus Intravenous Nalbuphine for (Intra Operative) Balanced Anaesthesia and Post Operative Analgesic Effect in Patients Undergoing Laparoscopic Surgery

Laparoscopic surgery has replaced many of the open surgeries because of its advantages. Both the groups of drugs have hemodynamic stability, analgesia, sedation and decrease the requirement of other anesthetic drugs. So we have chosen Butorphanol and Nalbuphine to study the analgesia and hemodynamic changes in both groups. In our study mean heart rate was lower in Butorphanol group compare to Nalbuphine group. Similarly fifty patients of ASA I&amp;II scheduled for elective laparoscopic surgery, were randomized in to butorphanol group and nalbuphine group. It was observed that there was significant rise in systolic blood pressure &amp; Diastolic Blood pressure after intubation in fentanyl group compare to Butorphanol. This study finds that suppression of sympathetic response to laryngoscopy and intubation was better with Butorphanol than Fentanyl. This study analysis indicates that both Butorphanol and Nalbuphine help in maintaining a steady haemodynamic state all throughout the procedure.

244. Impact of inhalational anesthetic agents on the baseline monitorability of motor evoked potentials (MEPs) during spine surgery: A review of 22,755 cervical and lumbar procedures

<h3>BACKGROUND CONTEXT</h3> During spine surgery, motor evoked potentials (MEPs) are often utilized to monitor both spinal cord function and spinal nerve root or plexus function. While there are reports evaluating the impact of anesthesia on the reliability of MEPs to monitor spinal cord function, less is known about the impact of anesthetics on the ability of MEPs to monitor spinal nerve root and plexus function. <h3>PURPOSE</h3> To compare the baseline monitorability and amplitude of MEPs during cervical and lumbar procedures between two cohorts based on the maintenance anesthetic regimen: a total intravenous anesthesia (TIVA) vs a regimen balanced with volatile inhalational and intravenous agents. <h3>STUDY DESIGN/SETTING</h3> Baseline MEP data from a total of 16,559 extradural cervical and 6,196 lumbar spine procedures utilizing multimodality intraoperative neuromonitoring (IONM) including MEPs between January 2017 and March 2020 were obtained from a multi-institutional database. Two cohorts were delineated based on the anesthetic regimen: a TIVA cohort and a balanced anesthesia cohort. <h3>PATIENT SAMPLE</h3> Age 18 and older. <h3>OUTCOME MEASURES</h3> Percent monitorability and amplitudes of baseline MEPs. <h3>METHODS</h3> The baseline monitorability of each muscle MEP was evaluated by the IONM team in real time and recorded in the patient's electronic medical record. The relation between anesthetic regimen and baseline monitorability was estimated using mixed effects logistic regression, with distinct models for cervical and lumbar procedures. Subsets of cervical and lumbar procedures from each anesthesia cohort in which all MEPs were deemed monitorable were randomly selected and the average peak-to-trough amplitude of each muscle MEP was retrospectively measured. Mixed-effects linear regression models were estimated (one each for cervical and lumbar procedures) to assess possible differences in average amplitude associated with anesthesia regimen. <h3>RESULTS</h3> At the time of surgery, baseline MEPs were reported as monitorable from all targeted muscles in 86.8% and 83.0% of cervical and lumbar procedures, respectively, for the TIVA cohort, but were reported as monitorable in just 59.3% and 61.0% of cervical and lumbar procedures, respectively, in the Balanced cohort, yielding disparities of 27.5% and 22.0%, respectively. The model-adjusted monitorability disparity between cohorts for a given muscle MEP ranged from 0.2% -16.6% but was smallest for distal intrinsic hand and foot muscle MEPs (0.2%-1.1%) and was largest for proximal muscle MEPs (deltoid: 10.8%, biceps brachii: 8.8%, triceps: 13.0%, quadriceps: 16.6%, gastrocnemius: 7.8%, and tibialis anterior: 3.7%) where the monitorability was significantly decreased in the Balanced cohort relative to the TIVA cohort (P < 0.0001). Relative to the TIVA cohort, the model-adjusted amplitude of an MEP in the Balanced cohort was smaller for all muscles measured, ranging from 27.5%-78.0% smaller. Relative to the TIVA cohort, the model-adjusted amplitude of an MEP was significantly decreased (P <0.01) in the Balanced cohort for the most proximal muscles (percent smaller: deltoid: 74.3%, biceps: 78.0%, triceps: 54.9.0%, quadriceps: 54.8%). <h3>CONCLUSIONS</h3> TIVA is the preferred anesthetic regimen for optimizing MEP monitoring during spine surgery. Inhalational agents significantly decrease MEP monitorability and amplitudes for most muscles, and this effect is especially pronounced for proximal limb muscles such as the deltoid, biceps, triceps, and quadriceps. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration.

To evaluate the use of ketamine-medetomidine-midazolam total intravenous infusion as part of a balanced anaesthetic technique for surgical castration in horses. Five healthy Standardbred cross colts were premedicated with IV acepromazine (0.01–0.02 mg/kg), medetomidine (7 µg/kg) and methadone (0.1 mg/kg) and anaesthesia induced with IV ketamine (2.2 mg/kg) and midazolam (0.06 mg/kg). Horses were anaesthetised for 40 min with an IV infusion of ketamine (3 mg/kg/h), medetomidine (5 µg/kg/h) and midazolam (0.1 mg/kg/h) while routine surgical castration was performed. Cardiorespiratory variables, arterial blood gases, and anaesthetic depth were assessed at 5 to 10 min intervals. Post-anaesthesia recovery times were recorded, and the quality of the recovery period was assessed. The anaesthetic period and surgical conditions were acceptable with good muscle relaxation and no additional anaesthetic required. The median (range) time from cessation of the infusion to endotracheal tube extubation, head lift and sternal recumbency were 17.2 (7–35) min, 25 (18.9–53) min and 28.1 (23–54) min, respectively. The quality of anaesthetic recovery was good, with horses standing 31.9 (28–61) min after the infusion was ceased. During anaesthesia, physiological variables, presented as a range of median values for each time point were: heart rate 37–44 beats/min, mean arterial pressure 107–119 mmHg, respiratory rate 6–13 breaths/min, arterial partial pressure of oxygen 88–126 mmHg, arterial partial pressure of carbon dioxide 52–57 mmHg and pH 7.36–7.39. In conclusion, the co-administration of midazolam, ketamine and medetomidine as in IV infusion, when used as part of a balanced anaesthetic technique, was suitable for short term anaesthesia in horses undergoing castration.

A PROSPECTIVE RANDOMISED STUDY TO ASSESS WHETHER PROPHYLACTIC ATROPINE ADMINISTRATION ATTENUATES THE NEGATIVE HAEMODYNAMIC EFFECTS OF INDUCTION OF ANAESTHESIA WITH PROPOFOL AND FENTANYL

INTRODUCTION: To provide optimal surgical conditions safely and to avoid particular complications, balanced general anaesthesia by administering a combination of propofol and fentanyl as analgesics. This type of balanced anaesthesia often induces unwanted bradycardia and hypotension, raising concerns regarding haemodynamic stability and tissue oxygenation. It is possible that atropine could replace the common clinical practice of administering vasoactive medication such as phenylephrine or norepinephrine to maintain mean arterial pressure (MAP) levels. AIM OF THE STUDY: To study the effect of atropine in suppressing the negative haemodynamic effects of induction agents- propofol and fentanyl in patients receiving general anaesthesia. MATERIALS AND METHODS: This is a prospective randomised interventional study carried out in Department of Anaesthesiology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were allocated into two groups (25 patients each) by randomization. After preoxygenation Group A: Patient receives Atropine. Patient in Group S: Receives Saline. BMI, Height, weight, Heart rate, Noninvasive blood pressure, Mean arterial pressure were recorded for every minute for 15 minutes. RESULTS: The demographic parameters like age, height, weight and BMI were similar in both groups. Comparing the SBP of both group, at base and 1 minute the difference of SBP was small. After that, the SBP was increasing trend in Atropine subjects and SBP was decreasing trend in saline subjects (P&lt;0.001). Comparing the DBP between the two groups, Base and 1 minutes, the DBP of both groups were not differed signicantly (P&gt;0.05),after that the DBP of Atropine group DBP was increasing trend and the DBP of saline group was decreasing trend (P&lt;0.001). The HR of the both groups were increasing and decreasing accordingly (P&lt;0.001). Comparing the MAP of both groups at base through 15 minutes,MAP of both group at 1minute was not differed signicantly (P&gt;0.05),after that the MAP of Atropine subjects were increasing and Saline subjects were decreasing trend P&lt;0.001). Percentage of fall of parameters (SBP, DBP, HR, and MAP) was more signicant at 5 and 15 mins compared to 10 mins in both th group. This may be due to the intubation response after the 5 minute of induction. All values were signicant with P&lt;0.001. CONCLUSION: Administration of atropine before Propofol and Fentanyl induction during general anaesthesia can signicantly attenuate the fall in Systolic Blood Pressure, Diastolic Blood Pressure, Heart Rate and Mean Arterial Pressure.

Impact of inhalational anesthetic agents on the baseline monitorability of motor evoked potentials during spine surgery: a review of 22,755 cervical and lumbar procedures

BACKGROUND CONTEXTDuring spine surgery, motor evoked potentials (MEPs) are often utilized to monitor both spinal cord function and spinal nerve root or plexus function. While there are reports evaluating the impact of anesthesia on the ability of MEPs to monitor spinal cord function, less is known about the impact of anesthesia on the ability of MEPs to monitor spinal nerve root and plexus function. PURPOSETo compare the baseline monitorability and amplitude of MEPs during cervical and lumbar procedures between two cohorts based on the maintenance anesthetic regimen: a total intravenous anesthesia (TIVA) versus a regimen balanced with volatile inhalational and intravenous agents. STUDY DESIGNBaseline MEP data from a total of 16,559 cervical and 6,196 lumbar extradural spine procedures utilizing multimodality intraoperative neuromonitoring (IONM) including MEPs between January 2017 and March 2020 were obtained from a multi-institutional database. Two cohorts for each region of spine surgery were delineated based on the anesthetic regimen: a TIVA cohort and a Balanced anesthesia cohort. PATIENT SAMPLEAge 18 and older. Fellowship support for 65,000 for year 2021. OUTCOME MEASURESPercent monitorability and amplitudes of baseline MEPs. METHODSThe baseline monitorability of each muscle MEP was evaluated by the IONM team in real-time and recorded in the patient's electronic medical record. The relation between anesthetic regimen and baseline monitorability was estimated using mixed effects logistic regression, with distinct models for cervical and lumbar procedures. Subsets of cervical and lumbar procedures from each anesthesia cohort in which all MEPs were deemed monitorable were randomly selected and the average peak-to-trough amplitude of each muscle MEP was retrospectively measured. Mixed-effects linear regression models were estimated (one each for cervical and lumbar procedures) to assess possible differences in average amplitude associated with anesthesia regimen. RESULTSAt the time of surgery, baseline MEPs were reported monitorable from all targeted muscles in 86.8% and 83.0% of cervical and lumbar procedures, respectively, for the TIVA cohort, but were reported monitorable in just 59.3% and 61.0% of cervical and lumbar procedures, respectively, in the Balanced cohort, yielding disparities of 27.5% and 22.0%, respectively. The model-adjusted monitorability disparity between cohorts for a given muscle MEP ranged from 0.2% to 16.6% but was smallest for distal intrinsic hand and foot muscle MEPs (0.2%–1.1%) and was largest for proximal muscle MEPs (deltoid: 10.8%, biceps brachii: 8.8%, triceps: 13.0%, quadriceps: 16.6%, gastrocnemius: 7.8%, and tibialis anterior: 3.7%) where the monitorability was significantly decreased in the Balanced cohort relative to the TIVA cohort (p<.0001). Relative to the TIVA cohort, the model-adjusted amplitude of an MEP in the Balanced cohort was smaller for all muscles measured, ranging from 27.5% to 78.0% smaller. Relative to the TIVA cohort, the model-adjusted amplitude of an MEP was significantly decreased (p<.01) in the Balanced cohort for the most proximal muscles (Percent smaller: deltoid: 74.3%, biceps: 78.0%, triceps: 54.9%, quadriceps: 54.8%). CONCLUSIONSTIVA is the preferred anesthetic regimen for optimizing MEP monitoring during spine surgery. Inhalational agents significantly decrease MEP monitorability and amplitudes for most muscles, and this effect is especially pronounced for proximal limb muscles such as the deltoid, biceps, triceps, and quadriceps.

A prospective clinical audit on quality of anaesthesia and accidental awareness in patients undergoing elective surgery under general anaesthesia

Background: In order to assess and improve quality of patient care in perioperative period, knowledge of patient perspective is most important. A Prospective Clinical Audit was done on Quality of Anaesthesia and Accidental Awareness in patients undergoing elective surgery under General Anaesthesia. Aims a) The primary aim is to assess the quality of peri-operative anaesthesia care and patient satisfaction using a validated patient reported outcome measure. b) To establish an estimate of accidental awareness during general anaesthesia. Settings and Designs: This was a cross-sectional, prospective audit on elective post-operative patients who underwent surgery under routine balanced general anaesthesia at a tertiary health care centre. Total 94 post-operative cases, who underwent surgery within last three months, were included in the audit. Material and Methods: Audit protocol was presented to competent Institutional Ethics committee and approval taken. The patients included in the audit had received routine balanced general anaesthesia for their surgery along with prophylactic analgesic, antiemetic and antacid intra-operatively. Anaesthetists randomly visited to the patients 24 hours after surgery and distributed structured questionnaires to the participants. Basic demographic information was collected from medical record and patients. We used Bauer Patient Satisfaction Questionnaires to obtain data regarding anaesthesia related discomfort and Modified Brice Questionnaire was used to assess Accidental Awareness during Anaesthesia. Statistical Analysis: SPSS software for Windows version 21.0 was used for data analysis. Categorical data was presented as frequency and proportion whereas continuous data was presented as mean and Standard Deviation. Results: Mean age of study subjects was- 51.81(16.82). Most of the cases belonged to ASA Grade III&IV (82.9%). When evaluating the questions on anaesthesia-related discomfort, the most frequent complaint of

EFFECTIVENESS OF ULTRASOUND-GUIDED MODIFIED PECTORAL NERVE BLOCK (PECS II) FOR POST-OPERATIVE PAIN RELIEF AFTER MODIFIED RADICAL MASTECTOMY (MRM)

Objective: To find the effectiveness of ultrasound guided modified pectoral nerve block (PECS II) versus conventional analgesics for post-operative pain relief in women undergoing modified radical mastectomy.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of Anaesthesia, Pak Emirates Military Hospital Rawalpindi Pakistan, from May 2018 to Oct 2019.&#x0D; Methodology: A total of 74 adult female patients scheduled for elective unilateral modified radical mastectomy under general anaesthesia were randomized into two groups, pectoral nerve block II (P) group (n=37) and control (C) group (n=37). An ultrasound-guided pectoral nerve block II block was performed using 30 ml of 0.25% Bupivacaine in pectoral nerve block II group after induction of general anaesthesia. In control group (C), patients received only general anaesthesia. Primary outcome measure was opioid consumption in first 24 hours, and the secondary outcome was pain at the breast and axillary region measured using the numerical rating scale (NRS) in first 24 hours at fixed intervals after surgery. Patient satisfaction was evaluated upon discharge using a 4-point scale.&#x0D; Results: Nalbuphine consumption was significantly reduced in pectoral nerve block group as compared to control group. Patients in pectoral nerve block II group experienced much less pain because their numerical rating scale was lower than the control group in postoperative period. Patient satisfaction was found to be high in pectoral nerve block II group.&#x0D; Conclusion: The pectoral nerve block II block is a simple block which provides excellent analgesia for modified radical mastectomy. It can be used for balanced anaesthesia.......

Efficacy of a combination of regional methods of anesthesia with general anesthesia in corneal transplantation

Background. Despite the significant development of modern anesthesiology, the pain relief of surgical patients is still unsatisfactory. Inadequate pain management causes psychological discomfort and complications. The combination of general anesthesia with various options for local anesthesia allows one to get closer to solving the problem of pain. The aim of the study was to compare the effect of multicomponent balanced anesthesia (intravenous + inhalation) and multicomponent balanced anesthesia, supplemented by pterygopalatine fossa blockade on the safety and efficacy of anesthesia for corneal transplantation. Materials and methods. The study included 73 patients, divided into two groups. Group С received multicomponent balanced anesthesia, group B — pterygopalatine fossa blockade additionally. The main criteria for evaluating the results of the study were: stability of hemodynamics and gas exchange during surgery, the severity of intraoperative pain syndrome by recording the analgesia nociception index, the severity of postoperative pain syndrome and the incidence of postoperative nausea and vomiting. Results. Both schemes of anesthetic management made it possible to avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group С, pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the operation, while in group B the analgesia nociception index did not decrease below 50. Statistically significant differences were obtained during 8 out of 10 minutes of the stage. Analysis of the pain relief quality in the postoperative period has shown that the level of pain according to the visual analogue scale upon awakening was equal to 0 in both groups, at the next three stages of the study (two and six hours after surgery and on the morning of the next day) the level pain in group C was significantly higher than in group B. Conclusions. The addition of regional blockade to multicomponent general anesthesia allows for adequate control of postoperative pain without compromising the safety profile.

Hemodynamic changes after spinal anesthesia in children below the age of four years

Introduction: Introduction: Spinal anesthesia has become the anesthesia of choice for most of the surgeries of the abdominal-pelvic region. Cited with benefits such as lesser risks of apnea, minimal cardiopulmonary alteration, and abnormalities associated with neurocognitive development, it incorporates all components of balanced anesthesia, especially in pediatric surgeries. Encouraging results on the safety, efficacy, and feasibility of spinal anesthesia has increased its utility. The objective of our study was to assess the hemodynamic change occurring in children below four years undergoing lower abdominal and pelvic surgeries following spinal anesthesia.&#x0D; Method: This is a cross-sectional study conducted over 2 years and includes children undergoing surgery of the lower abdomen in Kathmandu Model Hospital. The information was data regarding patients' demography, hemodynamic status prior, during, and after the procedure of spinal anesthesia, measuring systolic blood pressure (SBP), diastolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), sensory and motor block characteristics (modified Bromage scale) and complications.&#x0D; Result: The intraoperative and postoperative hemodynamics did not show major differences. The mean peak sensory level was T4 (C7-T10) during the block. Recovery of sensory and motor blocks was complete in all patients. Modified Bromage scale was 1 in 57(98.27%), 2 h post-surgery. The average duration of the block was 75 min (30-180). 1(1.72%) patient developed apnea during the surgery.&#x0D; Conclusion: Spinal anesthesia in small children showed minimal variation in intraoperative and postoperative hemodynamics and is a safer mode of anesthesia with sparing of respiratory alterations seen with general anesthesia.

Comparative Evaluation of the Isoflurane-sparing Effects of Butorphanol and Pentazocine in Buffaloes Undergoing Diaphragmatic Herniorrhaphy

Background: Isoflurane is commonly used as an inhalant anaesthesia in animals. Foreign body syndrome ultimately results into diaphragmatic hernia which is common in buffaloes. Diaphragmatic herniorrhaphy is generally performed under isoflurane anaesthesia. But there are adverse effects of isoflurane like respiratory depression, hypotension, reduced cardiac output and its metabolites cause atmospheric pollution. So, the present study was planned with the hypothesis that inclusion of opioid analgesic in the balanced anaesthesia might have isoflurane sparing effect. Methods: The present study was conducted in 15 female buffaloes which were suffering from diaphragmatic hernia which was diagnosed by radiography and later confirmed on rumenotomy. Animals were randomly divided in three groups - group I (Atropine (0.04 mg/kg) - xylazine (0.05 mg/kg) - propofol (till effect) - isoflurane; AXPI), group II (Atropine - xylazine - butorphanol (0.03 mg/kg) - propofol - isoflurane; AXBPI) and group III (Atropine - xylazine - pentazocine (0.75 mg/kg) - propofol - isoflurane; AXPPI) having five animals in each. Group I was taken as control as no analgesic was used in anaesthetic combination for animals of this group. The total isoflurane vapour delivered (mL) for the total duration of anaesthesia was calculated and the values so obtained were equated to 400 kg body weight and 40 minute duration for each animal for statistical comparison.Result: The Mean volume of isoflurane (ml) utilized for group I (65.58±8.8) was significantly higher than in Group II (38.54±5.7) and Group III (41.01±4.8). There were no significant changes in the haematological and biochemical profile of these buffaloes among three groups.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Use of Preoperative Single Dose Ivabradine for Perioperative Hemodynamic Stabilization During Non-Cardiac Elective Surgery Under General Anaesthesia: A Pilot Study.

BackgroundPeri-anesthetic hemodynamic fluctuations during non-cardiac surgeries are sometimes of serious consequences and associated with increased morbidity and mortality, especially in undiagnosed vulnerable patients. Currently used drugs like β-blocker, α2 agonist or sedative analgesic have their own limitations like combined negative ionotropic and chronotropic action, and unwanted bradycardia associated with hypotension, respectively. In this context, ivabradine has been used extensively in cases of cardiac failure, myocardial ischemia and cardiomyopathies for its funny channel associated dependable heart rate reducing property. Hence, for the first time, in search of a better agent for perioperative hemodynamic stabilization, the present study evaluated the role of ivabradine in patients undergoing non-cardiac surgeries.MethodsThis was a prospective, observer blind, randomized, interventional pilot study, conducted among 50 patients belonging undergoing elective abdominal laparoscopic surgeries, under general anesthesia. The study group patients received ivabradine tablet 7.5 mg, 2 h before scheduled time of surgery with a sip of water. All the patients received standardized balanced general anesthesia as practiced in our institute with all standard monitoring with additional minimum alveolar concentration (MAC) monitoring to ensure an adequate depth of anesthesia, and neuromuscular monitoring to ensure adequate and standard muscle relaxation. Hemodynamic stability of the groups was tested by comparing them at time points like induction, incision and operation, and extubation. Mean values of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were compared between groups, and also for variation with lapse of time, using RMANOVA analysis, using baseline parameters as covariate so as to standardize them.ResultsOn multivariate analysis using Wilk’s lambda multivariate test, there was a statistically significant difference (F = 3.587, P = 0.036) in HR between the groups with time, while no significant difference of SBP, DBP and MAP between the groups with time.ConclusionsThe study revealed a significant attenuation of HR response to stressful events like laryngoscopy, intubation and surgical incision with ivabradine. Also, a good intraoperative protection against cardiovascular ischemic and arrhythmic episodes in perioperative period was achieved with this drug ivabradine.

The effect of saline versus air for cuff inflation on the incidence of high intra-cuff pressure in paediatric MicroCuff® tracheal tubes: a randomised controlled trial.

The use of cuffed tracheal tubes in paediatric anaesthesia is now common. The use of nitrous oxide in anaesthesia risks excessive tracheal tube cuff pressures, as nitrous oxide can diffuse into the cuff during the course of surgery. The aim of this single-centre, prospective, randomised controlled trial was to compare the effect of saline versus air for the inflation of tracheal tube cuffs on the incidence of excessive intra-operative cuff pressure in children undergoing balanced anaesthesia with nitrous oxide. Children (age ≤16y) were randomly allocated to receive either saline (saline group) or air (air group) to inflate the cuff of their tracheal tube. The pressure in the tracheal tube cuff was measured during surgery and brought down to the initial inflation level if it breached a safe limit (25 cmH2 O). Post-extubation adverse respiratory events were noted. Data from 48 patients (24 in each group), aged 4months to 16y, were analysed. The requirement for reduction in intra-cuff pressure occurred in 1/24 patients in the saline group, compared with 16/24 patients in the air group (p<0.001). The incidence of extubation-related adverse events was similar in the saline and air groups (15/24 vs. 13/24, respectively; p=0.770). The use of saline to inflate the cuff of paediatric cuffed tubes reduces the incidence of high intra-cuff pressures during anaesthesia. This may provide a pragmatic extra safety barrier to help reduce the incidence of excessive tracheal cuff pressure when nitrous oxide is used during paediatric anaesthesia.

Quality of Recovery of Patients Who Underwent Curative Pancreatectomy: Comparison of Total Intravenous Anesthesia Versus Inhalation Anesthesia Using the QOR-40 Questionnaire.

There has been increasing attention on the subjective recovery of patients undergoing cancer surgery. Total intravenous anesthesia (TIVA) and inhaled anesthesia with volatile anesthetics (INHA) are safe and common anesthetic techniques. Currently, TIVA and INHA have only been compared for less invasive and less complex surgeries. This prospective randomized trial aimed to compare the quality of recovery between TIVA and INHA in patients undergoing pancreatoduodenectomy (PD) or distal pancreatectomy (DP) using the Quality of Recovery (QOR)-40 questionnaire. We enrolled 132 patients who were randomly assigned to either the desflurane (DES) (INHA, balanced anesthesia with DES and remifentanil infusion) or TIVA (effect-site target-controlled infusion of propofol and remifentanil) groups and completed the QOR-40 questionnaire postoperatively. The mean global QOR-40 score on postoperative day 3 was significantly higher in the TIVA group than in the DES group. In the PD group, the total QOR-40 score was significantly higher in the TIVA group than in the DES group. Moreover, the TIVA group had significantly higher scores in the physical comfort and psychological support QOR-40 dimensions than the DES group. TIVA provides better quality of recovery scores on POD 3 for patients undergoing curative pancreatectomy. NCT03447691.

Clinical Randomized Comparison of Medetomidine and Xylazine for Isoflurane Balanced Anesthesia in Horses.

Introduction: To assess drug plasma levels, preanesthetic sedation, cardiopulmonary effects during anesthesia and recovery in horses anesthetized with isoflurane combined with medetomidine or xylazine.Study design: Prospective blinded randomized clinical study.Animals: Sixty horses undergoing elective surgery.Methods: Thirty minutes after administration of antibiotics, flunixine meglumine or phenylbutazone and acepromazine horses received medetomidine 7 μg kg−1 (group MED) or xylazine 1.1 mg kg−1 (group XYL) slowly intravenously (IV) and sedation was assessed 3 min later. Anesthesia was induced with ketamine/diazepam and maintained with isoflurane in oxygen/air and medetomidine 3.5 μg kg−1 h−1 or xylazine 0.69 mg kg−1 h−1. Ringer's acetate 10 mL kg−1 h−1 and dobutamine were administered to maintain normotension. All horses were mechanically ventilated to maintain end-tidal carbon dioxide pressures at 45 ± 5 mmHg (5.3–6.7 kPa). Heart rate (HR), invasive arterial blood pressures, inspired and expired gas compositions, pH, arterial blood gases, electrolytes, lactate and glucose were measured. For recovery all horses received intramuscular morphine 0.1 mg kg−1 and medetomidine 2 μg kg−1 or xylazine 0.3 mg kg−1 IV. Recovery was timed and scored using three different scoring systems. Plasma samples to measure medetomidine and xylazine concentrations were collected at predetermined timepoints. Repeatedly measured parameters were analyzed using a two-way repeated-measures analysis of variance for differences between groups and over time; p < 0.05 was considered statistically significant.Results: Mean arterial blood pressures (MAP) stayed within normal ranges but were higher (p = 0.011) in group XYL despite significant lower dobutamine doses (p = 0.0003). Other measured parameters were within clinically acceptable ranges. Plasma levels were at steady state during anesthesia (MED 2.194 ± 0.073; XYL 708 ± 18.791 ng mL−1). During recovery lateral recumbency (MED 42.7 ± 2.51; XYL 34.3 ± 2.63 min; p = 0.027) and time to standing (MED 62.0 ± 2.86; XYL 48.8 ± 3.01 min; p = 0.002) were significantly shorter in group XYL compared to group MED. Recovery scores did not differ significantly between groups.Conclusion and Clinical Relevance: In horses anesthetized with isoflurane and medetomidine or xylazine, xylazine maintained higher MAP, reduced the dobutamine consumption and recovery time, whilst overall recovery quality was unaffected.

Comparison of Balanced General and Total Intravenous Anaesthesia for Gasser Ganglion Percutaneous Balloon Microcompression for Trigeminal Neuralgia

Objective: To compare the effectiveness between balanced general anaesthesia and total intravenous anaesthesia for the hemodynamic control of patients undergoing percutaneous balloon microcompression of the Gasser’s ganglion in trigeminal neuralgia. Patients and methods: A retrospective trial was conducted in thirty patients with the diagnosis of essential trigeminal neuralgia, aged 37 to 82 years old, ASA I and II. The participants were randomly allocated in two groups: Group A, to receive balanced general anaesthesia (BGA) with isoflurane/fentanyl, or Group B, to receive total intravenous anesthesia (TIVA) with propofol/remifentanil. The systolic, diastolic and mean arterial blood pressure, heart rate and oximetry were measured at basal state, entrance to Meckel’s cavum and during the balloon compression. Statistical analysis with the Student T test for continuous quantitative variables and x2 (Chi square) for qualitative variables was performed. Results: The systolic blood pressure was significantly higher in group A at the moment of greatest stimulation. The technique propofol/remifentanil (group B) obtained better hemodynamic control and its management was easier. The incidence of bradycardia was similar in both groups and kept inverse relation with use of previous atropine. Conclusions: Total intravenous anesthesia (TIVA) is an attractive alternative to balanced general anesthesia due to the better hemodynamic response and the quick recovery that this technique offers. Moreover, Atropine use before the procedure is a measure that could benefit patients

The experience of using dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery

Various techniques are applied to reduce the severity of postoperative pain and discomfort in patients. The purpose of this research work was to evaluate the effectiveness and safety of Dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. The study included 80 patients who underwent corneal transplantation on the basis of Dnepropetrovsk Regional Clinical Ophthalmologic Hospital. Patients were divided into 2 groups: control (group K) – 30 men and main (group D) – 50 ones. Multicomponent balanced anesthesia was applied in both groups. Sibazone was administered as the sedative medicine in the group K, Dexmedetomedin was administered in the group D. The main criteria for evaluating the research results were hallmarked: hemodynamic stability during surgery, the amount of administered opiates, the severity of intraoperative pain syndrome by evaluating the ANI index (ANI – analgesia nociception index), the severity of postoperative pain syndrome and the frequency of postoperative nausea and vomiting (PONV). Both schemes of anesthesia allowed avoiding pronounced fluctuations in hemodynamic parameters and gas exchange at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group K pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the surgery, while in group D the ANI index did not fall below 50. Statistically significant differences were obtained on minute 1, 2, 5, 6, and 7 of the surgery. The number of episodes of insufficient anesthesia during the most traumatic stage of the surgery in group K was statistically significantly higher than in group D. Analyzing the quality of pain relief in the postoperative period it was determined, that the level of pain on the Visual Analog Scale (VAS) after awakening in both groups was equal to 0. At the next three stages of the study (2 hours, 6 hours after surgery, and the next morning), the level of pain in group K was significantly higher than in group D. In addition, it was determined that the need for narcotic analgesics and the number of episodes of postoperative nausea and vomiting in group K was statistically significantly higher than in group D. These given data allow us to conclude that Dexmedetomedin is the effective adjuvant of the anesthesia for corneal transplantation.