Choice Of Anesthesia Research Articles

Is target-controlled infusion better than manual controlled infusion during TIVA for elective neurosurgery? Results of a single-centre pilot study.

Maintaining optimal systemic circulatory parameters is essential to ensure adequate cerebral perfusion (CPP) during neurosurgery, especially when autoregulation is impaired. To compare two types of total intravenous anaesthesia i.e. target controlled infusion (TCI) and manually controlled infusion (MCI) with propofol and remifentanil in terms of their control of cardiovascular parameters during neurosurgical resection of intracranial pathology. Patients with supratentorial intracranial pathology were selected for the study. Patients in ASA grades III and IV and those with diseases of the circulatory system were excluded. Patients were randomly divided into two equal groups according to the method of general anaesthesia used i.e. TCI or MCI. During the neurosurgery, the values of mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS) and central venous pressure were monitored and recorded at the designated 14 relevant (i.e. critical from the anaesthetist's and neurosurgeon's points of view) measurement points. Fifty patients (25 TCI and 25 MCI) were enrolled in the study. The groups did not differ with respect to sex, age and BMI, operation time or volume of removed lesions. TCI-anaesthetised patients had better MAP stability at the respective time points. Due to the greater stability of MAP, which has a direct effect on CPP, TCI appears to be the method of choice in anaesthesia for intracranial surgery.

Medial versus lateral approach in ultrasound-guided costoclavicular brachial plexus block for upper limb surgery: a randomized control trial.

Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently employed: the medial and lateral approach. Our study aims to compare the two approaches in terms of performance time and patient-specific clinical outcomes. The primary outcome assessed was performance time. The secondary outcomes were imaging time, needling time, block onset time, total anaesthesia time, anaesthesia success, and performer difficulty score. Of 59 patients, 30 patients were randomized to Group M and 29 patients were randomized to Group L. We conducted statistical analysis using a modified intention-to-treat approach. The mean ± SD for performance time (in minutes) was 11.9 ± 3.8 in Group M and 9.4 ± 4.1 in Group L with a difference between means (95% CI) of 2.4 (0.3 to 4.5) ( P < 0.05). The median (interquartile range) needling time of Group M was 9.5 minutes (5-16) vs. 7 (4-19) in Group L ( P = 0.035). Among patients, 40%, 26.67%, 33.3% in Group M had grade 3, 2, 1 performer difficulty whereas 10.3%, 37.9%, 51.7% in Group L had grade 3, 2, 1 performer difficulty, respectively ( P = 0.032). The mean performance time was 9.95 minutes in patients with body mass index (BMI) 25 ( P = 0.0243). Our study revealed that the medial approach has no significant advantage over the lateral approach with regards to performance time, imaging time, needling time, and performer difficulty. Both performance time and performer difficulty increase with BMI and depth of the cords, with a larger difference in the medial approach.

Retrospective study on patient comfort and post-operative condition associated with intravenous sedation versus general anesthesia for third molar extraction in ambulatory surgery in a state hospital

Objectives: Third molar extraction requires local or general anesthesia. In public hospitals, general anaesthesia is frequently used to perform the most complex extractions and to accommodate patients' wishes. However, the choice of general anesthesia is at the discretion of the care center. Intravenous sedation is also an option. We suggest that comfort and post-operative condition are better in patients undergoing sedation rather than general anesthesia. This study aimed to evaluate the comfort and post-operative condition after third molar extraction in an 18–50-year-old ambulatory surgical population in a state hospital. Method and materials: In the stomatology and maxillofacial surgery department of Roanne Hospital, two anesthetic protocols are used for third-molar extraction. We retrospectively collected 47 patients who underwent third molar extraction between 1st July 2022 and 31st December 2022. Results were collected by questionnaires and data were retrospectively retrieved from medical records. Results: Twenty patients underwent a general anesthesia and twenty-seven underwent intravenous sedation. The study found no difference for the pain level (p &lt; 0.62) between the two anesthesia techniques. The comparison of the approaches indicated that intravenous sedation required a shorter duration of anesthesia (p &lt; 0.0001) and a shorter time in the recovery room (p &lt; 0.0001). Conclusion: This study indicates the feasibility and the effectiveness of intravenous sedation for patients undergoing third molar extraction in a state hospital. As other studies in the literature that have shown greater satisfaction and better recovery in patients undergoing intravenous sedation compared with general anesthesia.

DEVELOPMENT OF PRACTICAL SKILLS IN FOREIGN STUDENTS DURING EDUCATION AT THE DEPARTMENT OF PROPEDEUTICS OF SURGICAL DENTISTRY

The goal of higher education is to produce highly qualified, competitive young professionals capable of innovation, self-improvement, and continuous development. The assimilation of theoretical material, the ability to analyze, search and process the received information are definitely important goals, however, the content of medical education cannot be reduced to only theoretical knowledge, but must ensure the mastery of practical skills. Considering the fact that the education of foreign students is carried out in a distance format due to the military situation in the country, mastering practical skills by these students has certain difficulties.&#x0D; Therefore, the analysis of the problems and prospects of the formation of practical skills among foreign students at the department of propaedeutics of surgical dentistry is currently one of the most urgent issues.&#x0D; The principle of mastering practical skills is laid down in the standards of higher dental education: educational and qualification characteristics, educational and professional program and is checked by standardized means of assessing theoretical knowledge and skills – "KROK-2. Dentistry", as well as during objective structured clinical examination in dentistry.&#x0D; Theoretical knowledge is checked during practical classes. They are carried out both by testing students and by oral interview, as well as practice of practical skills, which can be provided by working on phantoms, as well as participation in the examination and clinical analysis of patients in the clinical room.&#x0D; During face-to-face training, students visit the clinical room together with the teacher, participate in management patients, filling out medical documentation, assist, describe radiographs, and have the opportunity to choose anesthesia and tools for tooth extraction. The teacher demonstrates various manipulations, commenting and explaining each of them. After that, students practice practical skills on cranium, jaws, dummies, repeating after the teacher or with his help. Foreign students forced to study remotely do not have such opportunities, so we decided to create conditions close to real ones for them. The use of a laptop in the WiFi network allows you to use it in the clinical room and, in the same way as domestic students, demonstrate patient management: survey, inspection, basic methods of examination, choice of anesthesia and tools. However, the small area of the operating field, especially during intraoral interventions, does not provide a sufficient view when using a laptop and does not allow the teacher to show this or that surgical intervention in detail. To solve this problem, we use a phone that we synchronize with a laptop. The phone serves as a camera, which allows you to take a detailed picture of the operating field and broadcast the image to the screen for students. Thus, conditions become close to real ones. Students see all stages of surgical intervention with the teacher's explanation, have the opportunity to participate in the discussion during the patient's appointment. Demonstration of manipulation by the teacher is the first step to mastering practical skills. Unfortunately, remotely, students cannot practice and demonstrate skills, but an excellent command of theoretical material and an understanding of the necessary actions will help students in their assimilation in the future. Further, during classes to consolidate the material, a step-by-step discussion of operative interventions is carried out, which allows to interest and involve all present students in the discussion and to check the level of students' knowledge.&#x0D; Unfortunately, teachers are only able to visualize and comment in detail on the performing of certain manipulations. However, even a partial solution of this component in the form of justification and demonstration of the algorithm creates a stable argument for further study of surgical stomatology, and achievement of the ultimate goals of training a dentist.

DESCRIPTION OF PATIENTS WITH ODONTECTOMY IN RSUD SULTAN FATAH DEMAK

Introduction: Odontectomy is the surgical removal of teeth. The choice of anesthesia is also one of the considerations in the odontectomy surgical technique. Information regarding gender, age and comorbidities in patients can also be considered in the selection of anesthetics for odontectomy procedures. Purpose: to provide information regarding impacted teeth and to determine the frequency distribution of odontectomy patient profiles at the Oral Surgery Polyclinic of Sultan Fatah General Hospital, Demak Regency. Methods: descriptive study by collecting secondary data using a retrospective approach from medical records from visits to the Oral Surgery Polyclinic, Sultan Fatah Demak Regional General Hospital from 8-12 May 2023. Results and Discussions: a total of 36 patients were obtained on 8-12 May 2023, with 32 patients who met the inclusion criteria. The majority of patients were male with a percentage of 55.6%. Based on the age of the most patients in the age range of 21-30 years (15 patients), while the least age group is the age group &lt;20 years (4 patients). Based on the type of teeth, the most odontectomy performed was tooth 48 with a total of 14 teeth. Conclusion: The distribution of the frequency of odontectomy patients at Sultan Fatah General Hospital is most commonly found in the male sex, age group 21-30 years, the type of tooth that was odontectomy was tooth 48.

Anesthetic Methods for Hip Fracture.

To review the benefits, risks, and contraindications of traditional and new anesthesia approaches for hip fracture surgery and describe what is known about the impact of these approaches on postoperative outcomes. This review describes general and spinal anesthesia, peripheral nerve block techniques used for pain management, and novel, local anesthesia approaches which may provide significant benefit compared with traditional approaches by minimizing high-risk induction time and decreasing respiratory suppression and short- and long-term cognitive effects. Hip fracture surgery places a large physiologic stress on an already frail patient, and anesthesia choice plays an important role in managing risk of perioperative morbidity. New local anesthesia techniques may decrease morbidity and mortality, particularly in higher-risk patients.

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

Introduction: Regional anesthetic techniques and local anesthesia have proven to be more effective than general anesthesia in the practice of ambulatory anesthesia. Spinal anesthesia is the technique of choice for ambulatory anesthesia in cervical cancer brachytherapy patients. Low-dose local anesthetics can speed up the ambulation time. This study aims to compare the ambulation time of low-dose spinal anesthesia with conventional doses. Fast ambulation time can speed up recovery time for patients, thereby reducing the patient's length of stay.&#x0D; Methods: This study was a double-blind, randomized controlled trial conducted in August – September 2022 at the Radiotherapy Installation of Dr. Mohammad Hoesin General Hospital (RSMH) Palembang. All cervical cancer patients undergoing brachytherapy in adults with ASA I-II physical status were included in the study sample. Samples will be randomized into two groups, namely a combination of hyperbaric bupivacaine 5 mg and fentanyl 25 mcg and a group of bupivacaine 2.5 mg and fentanyl 25 mcg. Patients with allergies, impaired motor function, spinal failure, block level not achieved, shock, apnea, respiratory depression, and experiencing pain during the procedure were excluded from the study.&#x0D; Results: Ambulation time in the hyperbaric bupivacaine 5 mg and 25 mcg fentanyl group was longer than the hyperbaric bupivacaine 2.5 mg and 25 mcg fentanyl (155.22 + 10.68 minutes versus 98.69 + 7.13 minutes) with a significance level of p&lt;0.001. Spinal anesthetic drugs work in a dose-dependent manner. Increasing the dose will increase the duration of action of the spinal anesthetic. The only side effects found were hypotension and pruritus.&#x0D; Conclusion: Spinal anesthesia with hyperbaric bupivacaine 2.5 mg and fentanyl 25 mcg can accelerate the ambulation time of cervical cancer patients undergoing brachytherapy.

Anesthesia choice and its potential impact on endoluminal functional lumen imaging probe measurements in esophageal motility disorders

The widespread use of peroral endoscopic myotomy (POEM) has revolutionized the management of esophageal motility disorders (EMDs). The introduction of an endoluminal functional lumen imaging probe (EndoFLIP, Medtronic, Dublin, Ireland) can serve as a complementary diagnostic tool to assess the mechanical properties (ie, pressure, diameter, distensibility, topography) of the esophagus. During EndoFLIP measurements, different anesthesia techniques may induce variable degrees of neuromuscular blockade, potentially affecting esophageal motility and altering the results of EndoFLIP metrics. The aim of this study was to compare the impact of using total intravenous anesthesia (TIVA) versus general anesthesia with inhalational anesthetics (GAIA) on diagnostic EndoFLIP measurements. This retrospective study included all adult patients (≥18 years) undergoing EndoFlip during the POEM procedure at our institution between February 2017 and February 2022. Differences in pressure, diameter, and distensibility index were obtained by using propofol-based TIVA versus sevoflurane-based GAIA with a 30 mL and a 60 mL balloon. The differences were divided into terciles and compared between diagnoses by using univariate comparisons and logistic regression models. A total of 49 patients were included (39% type I achalasia, 43% type II or III achalasia, and 18% jackhammer esophagus [JE]). Compared with spastic disorders (types II and III achalasia and JE), type I had lower values of pressure differences at 60 mL in univariate (3.75 vs 15.20, P= .001) and multivariate (adjusted odds ratio, .89; 95% confidence interval, .82-.978) analyses. Compared with type I, types II and III achalasia had higher rates of pressure differences at 60 mL in the univariate (9.85 vs 3.75, P= .04) analysis and nearly reached significance in the multivariate analysis (1.09; 95% confidence interval, 1-1.20). Compared with type I achalasia, JE exhibited higher values in pressure differences at 60 mL (27.7 vs 3.75, P< .001). Esophageal pressure, as measured by EndoFLIP, was significantly reduced when patients were sedated with sevoflurane-based GAIA. The use of sevoflurane-based GAIA for diagnostic EndoFLIP may potentially lead to the misclassification of spastic disorders as type I achalasia. Propofol-based TIVA should therefore be considered over sevoflurane-based GAIA for sedation during the diagnostic test.

Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 11, techniques and complications of local anesthesia for cataract surgery in the United Kingdom.

To describe variation in local anesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom. Reporting centers to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD). Retrospective cross-sectional register-based study. Data from the RCOphth NOD were used. Eligible for analysis were 1 195 882 cataract operations performed using local anesthesia between April 1, 2010, and March 31, 2020, in 80 centers. Overall, topical anesthesia alone was used in 152 321 operations (12.7%), combined topical and intracameral in 522 849 (43.7%), sub-Tenon in 461 175 (38.6%), and peribulbar/retrobulbar in 59 537 (5.0%). In National Health Service (NHS) institutions, 48.3% of operations were topical with/without intracameral vs 88.7% in independent sector treatment centers (ISTCs). 45.9% were sub-Tenon in NHS vs 9.6% in ISTCs. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTCs. Anesthetic complication rates decreased from 2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTCs). Overall anesthetic complication rates were 0.3%, 0.3%, 3.5%, and 3.1% for topical alone, combined topical/intracameral, sub-Tenon, and peribulbar/retrobulbar, respectively. Complication rates were higher for sharp-needle anesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; P = .024). Considerable variation was observed between centers on anesthetic choices and anesthetic complication rates. Combined topical and intracameral is the most common choice of anesthesia for cataract surgery in the United Kingdom and is associated with lower anesthetic-related complication rates than sub-Tenon and peribulbar/retrobulbar anesthesia. Variation in the anesthetic choice exists between centers and between NHS and ISTC sectors.

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights.

Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. Level III.

Use of Topical Phenol in Awake Young Children for Tympanostomy Tube Placement.

Importance: Phenol kits cleared by the Food and Drug Administration (FDA) are indicated as a topical anesthetic for the tympanic membrane (TM) in adults. However, there is no existing literature that reports outcomes to support the safety and use of phenol on the TM of awake children. Objective: Determine if topical phenol is safe and at low risk for complications and therefore be used effectively in awake children to facilitate office otologic procedures as in adults. Design, Setting, and Participants: Children under 21 years of age whose parents agreed to participate in an awake office setting for tympanostomy tube (TT) placement. All children had TT placement after phenol placement on the TM prior to insertion. Main Outcomes and Measures: TM perforation or other signs of TM complications through a minimum of 6-month clinical follow-up, along with assessment of the tolerability of the procedure by the child. Results: A total of 228 children with an age range of 6 months to 15.9 years and 435 TMs completed TT placement using phenol as a local anesthetic while awake in the office. There were no complications reported in the 204 children at the first follow-up visit post TM placement within 3 to 10 weeks. Of the 93 children followed up at least 6 months, there were no TM complications reported. Conclusions: This is the first study to report the outcomes on the use of phenol in an office setting in children. In this large experience, phenol appears to be tolerable and safe for use in young children in the office and is a potential safe choice of topical anesthesia for surgeons if they choose to perform office procedures such as myringotomies or TT placement on children.

The optimal choice of regional anesthesia in total knee arthroplasty: a prospective, double-blind, randomized, placebo-controlled study

The optimal choice of regional anesthesia in total knee arthroplasty: a prospective, double-blind, randomized, placebo-controlled study

Environmental sustainability from anesthesia providers’ perspective: a qualitative study

BackgroundThe world faces a significant global health threat – climate change, which makes creating more environmentally sustainable healthcare systems necessary. As a resource-intensive specialty, anesthesiology contributes to a substantial fraction of healthcare’s environmental impact. This alarming situation invites us to reconsider the ecological health determinants and calls us to action.MethodsWe conducted a single-center qualitative study involving an online survey to explore the environmental sustainability from anesthesia providers’ perspectives in a center implementing internal environmentally-sustainable anesthesia guidelines. We asked care providers how they perceive the importance of environmental issues in their work; the adverse effects they see on ecological sustainability in anesthesia practice; what measures they take to make anesthesia more environmentally friendly; what barriers they face in trying to do so; and why they are unable to adopt ecologically friendly practices in some instances. Using a thematic analysis approach, we identified dominating themes in participants’ responses.ResultsA total of 62 anesthesia providers completed the online survey. 89% of the participants stated that environmental sustainability is essential in their work, and 95% reported that they implement measures to make their practice greener. A conscious choice of anesthetics was identified as the most common step the respondents take to reduce the environmental impact of anesthesia. Waste production and improper waste management was the most frequently mentioned anesthesia-associated threat to the environment. Lacking knowledge/teaching in sustainability themes was recognized as a crucial barrier to achieving ecology goals.ConclusionsSustainable anesthesia initiatives have the potential to both encourage engagement among anesthesia providers and raise awareness of this global issue. These findings inspire opportunities for action in sustainable anesthesia and broaden the capacity to decrease the climate impact of health care.

Clinical Characteristics of Spinal versus General Anaesthesia in Older Patients Undergoing Hip Fracture Repair Surgery in Jordan: A Multicentre Study.

The primary aim of this study was to examine the clinical characteristics and outcomes of older patients who underwent hip fracture repair surgery. The secondary aims were to assess the predictors of the choice of spinal or general anaesthesia and to explore the risk factors for all-cause mortality. This three-tertiary centres study was conducted at a tertiary care centre in Jordan. Clinical data include previous fracture history; medication details; comorbidities; surgical approach; and postoperative pain management. Overall, 1084 patients who underwent hip fracture repair were included in this study. The mean age of patients was 78 years, and 55.2% were women. Twenty-four were treated with bisphosphonates before the fracture, whereas 30 were in steroid therapy. Overall, 61.8% of patients underwent spinal anaesthesia, whereas 38.2% underwent general anaesthesia. Spinal anaesthesia group had a lower prevalence of cardiovascular accidents (16.3% vs. 22.3%, p = 0.014) and Alzheimer's (3.4% vs. 1.4%, p = 0.049) than the general anaesthesia group. In the spinal anaesthesia group, postoperative opioid administration (p = 0.025) and postoperative blood transfusion (p = 0.011) occurred more frequently than general anaesthesia group. In hospital, 30-day and all-cause mortality were comparable between both groups. Diabetes mellitus (HR = 2.6; 95%CI = 1.5-4.4; p = 0.001); cemented hip hemiarthroplasty (HR = 2.4; 95%CI = 1.1-5.1; p = 0.025); deep venous thrombosis/pulmonary embolism (HR = 5.0; 95%CI = 1.2-12.9; p = 0.001); and readmission within 1 month from surgery (HR = 3.6; 95%CI = 2.0-6.3; p < 0.001) were all significant predictors of mortality. This study provides insights into the outcomes and factors associated with different anaesthesia types in hip fracture repair surgery. The anaesthesia type does not affect all-cause mortality in patients undergoing hip fracture repair.

Opioid-Free Anesthesia (OFA) as a Safe Anesthetic Choice for Epilepsy Patient

Background: The opioid-free anesthesia (OFA) approach, although not widely employed in anesthesia, offers distinct benefits for some populations, such as epilepsy patients, due to the propensity of opioids to trigger seizures. Hence, the objective of this study was to conduct an opioid-free anesthesia (OFA) procedure on the left lateral rhinotomy in a patient with concurrent epilepsy.&#x0D; Case presentation: Our patient is a 59-year-old woman suffering from epilepsy with a left nasal cavity tumor, scheduled for a left midfacial degloving rhinotomy. Given the patient's epilepsy comorbid, we have opted for an opioid-free anesthesia (OFA) procedure. OFA procedures are not yet widely employed in anesthesia; however, they offer advantages for specific patient populations, including epilepsy patients, as opioids have the potential to induce seizures.&#x0D; Conclusion: The various OFA protocols being conducted worldwide require refinement, and the potential interactions of each component should be explored further.

General anesthesia vs. conscious sedation and local anesthesia for endovascular treatment in patients with posterior circulation acute ischemic stroke: An updated systematic review and meta-analysis

IntroductionThe best anesthetic choice for patients with acute posterior circulation stroke during endovascular treatment (EVT) remains uncertain. MethodWe searched five databases to identify studies that met the inclusion criteria. Our primary outcome measure was functional independence (FI). Secondary outcomes were 3-month mortality, any intracranial hemorrhage (ICH), symptomatic ICH (sICH), successful reperfusion, and procedure- and ventilator-associated complications. ResultsA total of 10 studies were included in our meta-analysis. No significant differences were detected between the general anesthesia (GA) and conscious sedation and local anesthesia (CS/LA) groups in 3-month FI (nine studies; OR=0.69; 95% CI 0.45–1.06; P=0.083; I2=66%;), 3-month mortality (nine studies; OR=1.41; 95% CI 0.94–2.11; P=0.096; I2=61.2%;), any ICH (three studies; OR=0.75; 95% CI 0.44–1.25; P=0.269; I2=0%;), or sICH (six studies; OR=0.64; 95% CI 0.40–1.04; P=0.073; I2=0%;). No significant differences were observed for successful reperfusion (10 studies; OR=1.17; 95% CI 0.91–1.49; P=0.219; I2=0%;), procedure-related complications (four studies; OR=1.14; 95% CI 0.70–1.87; P=0.603; I2=7.9%;), or respiratory complications (four studies; OR=1.19; 95% CI 0.61–2.32; P=0.616; I2=64.9%;) between the two groups. ConclusionsOur study showed no differences in 3-month FI, 3-month mortality, and successful reperfusion between patients treated with GA and those treated with CS/LA. Additionally, no increased risk of hemorrhagic transformation or pulmonary infection was observed in the CS/LA group. These results indicate that CS/LA may be an EVT option for acute posterior circulation stroke patients.

Opioid-Free Anesthesia (OFA) as a Safe Anesthetic Choice for Epilepsy Patient

Introduction: The opioid-free anesthesia (OFA) approach, although not widely employed in anesthesia, offers distinct benefits for some populations, such as epilepsy patients, due to the propensity of opioids to trigger seizures. Hence, the objective of this study was to conduct an opioid-free anesthesia (OFA) procedure on the left lateral rhinotomy in a patient with concurrent epilepsy.Case presentation: Our patient is a 59-year-old woman suffering from epilepsy with a left nasal cavity tumor, scheduled for a left midfacial degloving rhinotomy. Given the patient's epilepsy comorbid, we have opted for an opioid-free anesthesia (OFA) procedure. OFA procedures are not yet widely employed in anesthesia; however, they offer advantages for specific patient populations, including epilepsy patients, as opioids have the potential to induce seizures.&#x0D; Conclusion: The various OFA protocols being conducted worldwide require refinement, and the potential interactions of each component should be explored further.

Impact of anesthesia choice in cutaneous melanoma surgery.

Invasive cutaneous melanoma is the most lethal skin cancer, but fortunately, the vast majority can be surgically treated with wide local excision, and sometimes additionally with sentinel or index lymph node biopsy for prognostication. Melanomas are particularly immunogenic malignancies, and preclinical studies have demonstrated that use of volatile anesthetics and opioids, unlike local agents, can suppress the immune system during the perioperative period. Immunosuppression has implications for creating a potentially favorable microenvironment for the survival and propagation of residual melanoma cells or micro-metastases, which could lead to disease relapse, both in the local tumor bed and distally. Results from observational clinical studies are mixed, but the literature would suggest that patients are at risk of decreased melanoma-specific survival after undergoing general anesthesia compared to regional anesthesia and spinal blocks. With the safety of close observation now established rather than automatic completion or total lymph node dissection for patients with either a positive sentinel lymph node biopsy or significant clinical response to neoadjuvant immunotherapy after index node sampling, the indications for definitive surgery with local or regional anesthesia have increased tremendously in recent years. Therefore, cutaneous melanoma patients might benefit from avoidance of general anesthesia and other perioperative drugs that suppress cell-mediated immunity if the option to circumvent systemic anesthesia agents is feasible.

Comparing anesthesia modes in major burns: Total intravenous anesthesia versus general anesthesia - A cross-sectional study in a Central Indian government hospital

Background: Burn injuries remain a significant public health concern, causing complex trauma. Early excision and skin grafting are standard in burn management to reduce infection and scarring. The choice of anesthesia is critical for optimal pain control and hemodynamic stability. Aims and Objectives: This study aims to compare total intravenous anesthesia (TIVA) and general anesthesia (GA) in patients of major burns. Materials and Methods: The study was conducted in the Department of Anaesthesia, M.G.M. Medical College and M.Y. Hospital, Indore, over a period of 12 months. One hundred and twenty patients with 10–12% total burn area were included and randomized into two groups of 60 patients each. Group T patients received TIVA and Group G patients received GA. Results: Both the groups were comparable with respect to age, gender, and baseline vitals. The mean heart rate, systolic and diastolic blood pressure, and mean MAP were significantly higher in Group G at 0, 30, and 60 min. In Group T, all patients achieved an Aldrete score of 9 or more within 10 min. Pain was more prevalent in Group G patients, and the comparison was found to be statistically significant. The mean time to first rescue analgesia in Group T was later than Group G, and the difference was found to be statistically significant. Conclusion: From the results, we may conclude that TIVA provides superior hemodynamic stability, shorter post-anesthesia unit recovery time, and improved analgesia compared to GA. However, there are lacunae in the literature, hence we recommend that larger studies comparing these two anesthesia modes be conducted before generalizing the present findings to the general population.

Abstract 058: General anesthesia versus conscious sedation during endovascular thrombectomy for distal vessel occlusions

Introduction Choice of anesthesia for endovascular thrombectomy in large vessel occlusion of the anterior circulation has been well studied, although practice patterns may still be variable. Anesthesia choice for distal vessel occlusions (DVO) presents unique challenges, however. General anesthesia (GA) may offer advantages over conscious sedation (CS) due to reduced patient movement facilitating catheter navigation, but concerns persist about potential delays and hypotension impacting collateral circulation. In our study, we aim to explore this question further. Methods In our prospectively maintained stroke registry from December 2014 to July 2023, we identified patients with DMVO defined as M2, M3, M4 occlusion, ACA occlusion, and PCA occlusion, who underwent MT for AIS. We compared patients who received CS to those who GA. Our primary outcome measures were length of procedure defined as time from entering angiography suite until final recanalization, access time to recanalization, CS to GA conversion rate, number of passes to reach TICI2b or better and first pass effect. Our secondary outcomes were length of stay, and modified Rankin Scale (mRS) at 5 days, 30 days, and 90 days. Results Total of 290 patients with DVO were identified, the median age was 73 (IQR 19). Of these, 86 patients (29.7%) underwent GA, and 200 (69.0%) received CS. CS to GA conversion was required in 36 patients (12.4%). Females accounted for 47.5% of the CS group and 38.4% of the GA group. No significant differences were found between the two groups in the racial and gender composition (p&gt;0.1). The mean admission NIHSS was significantly higher in the GA group (16.86) compared to the CS group (12.44) as was the rate of IV thrombolysis in the CS (36.2%) group compared to GA (31.4%) group (p&lt;0.01). The type of anesthesia used was not influenced by the laterality of the stroke in the middle cerebral artery territory (left vs right) (χ²=0.39, p=0.53). After adjusting for age, sex, IV thrombolysis, and admission NIHSS, CS usage did not result in an increase in procedural time (β=1.3, p=0.83). Furthermore, CS had no significant effect on the total number of passes (β=‐0.15, p=0.53), nor did it influence the likelihood of achieving first‐pass recanalization (β=0.28, p=0.48). No associations were found between CS use and the modified Rankin Scale (mRS) at 5 days (β=0.17, p=0.65), 30 days (β=0.22, p=0.75), or 90 days (β=0.15, p=0.67). Likewise, the length of stay in the hospital (β=1.71, p=0.77) was not significantly affected by the use of CS. Conclusion In our analysis of DMVO, the use of CS during thrombectomy appeared to be safe and feasible and comparable to GA with regards to procedural length, number of passes, and rate of first pass recanalization. Similarly, the type of anesthesia did not have an impact on clinical outcome. Further studies are needed to build on these findings and inform optimal management strategies.