Anesthesia Department Research Articles

Knowledge, fear and acceptance rate of spinal anesthesia among pregnant women scheduled for cesarean section: a cross-sectional study from a tertiary care hospital in Karachi.

Worldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital. This cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis. A total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36-37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%). The present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia. Not applicable.

Assessment of Informatics Competency Among Nursing Faculty Members and Its Application in Educating Nursing Students at Abadan Nursing Faculty

Background: Nursing informatics in educational activities can serve as a strategy to bridge the gap between clinical practice and nursing education programs. Objectives: This study aimed to assess the informatics competency of nursing faculty members and its application in educating nursing students at Abadan Nursing Faculty. Methods: This descriptive-analytical research was conducted in 2023 at Abadan Nursing Faculty. The sample consisted of 73 faculty members from the nursing, operating room, and anesthesia departments, who were included in the study through census sampling. Data collection was performed using the standardized Nursing Informatics Competency Assessment Tool (NICAT) and an electronic teaching aids checklist. Data were analyzed using SPSS version 18, with independent t-tests, one-way analysis of variance (ANOVA), and Pearson’s correlation at a significance level of P < 0.05. Results: The mean score of faculty members’ nursing informatics competency at the Nursing Faculty was 110 out of a maximum of 150, placing it within the proficient range. The highest score for nursing informatics competency was related to the informatics literacy dimension (47.65), while the lowest was related to the information management skills dimension (19.54). Information management skills (r = 0.881, P < 0.001), computer literacy (r = 0.871, P < 0.001), and informatics literacy (r = 0.976, P < 0.001) were significantly correlated with nursing informatics competency. Faculty members reported the highest use of multimedia content development (mean score = 4.19) and the lowest use of robotic surgery (mean score = 1.71). Conclusions: Faculty members’ informatics competency was reported to be at a proficient level. However, due to advancements in technology and transformations in nursing care, it seems necessary to improve nursing faculty members’ abilities in all aspects, particularly in the information management skills dimension. It is recommended to hold faculty development programs regarding the integration of technology into the curriculum to elevate the quality of education.

Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries.

Objective: To compare the mean time for analgesic requirement of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Combined Military Hospital, Kharian. Period: 1st July 2022 to 1st January 2023. Methods: A total of 60 patients with 30 patients in each group undergoing elective c section were included in the study. Patients were counselled about VAS scoring system before procedure. Time (in minutes) for first rescue analgesia and requirement in 24 hours was noted. Results: Mean time required for first analgesia was 143.966±8.15 minutes in group A as compare to 86.400±7.08 minutes in group B (p=0.000). Conclusion: Our study has concluded that TAP block is a promising technique in alleviating postoperative pain in patients undergoing lower abdominal gynecological surgeries.

Comparison of Awake Craniotomy with Craniotomy Under General Anesthesia for Resection of Tumors in Eloquent Areas of Brain

Objective: To compare awake craniotomy with craniotomy under general anesthesia for early post-operative parameters in patients undergoing resection of tumors in eloquent areas of brain. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan Apr 2021 to May 2022. Methodology: All the patients who underwent resection surgeries for brain tumors in eloquent areas of brain were included in the study. They were divided into two Groups via lottery method. Group A underwent awake craniotomy while Group B underwent craniotomy under general anesthesia. Relevant intraoperative and early post-operative parameters were compared in both the Groups. Results: A total of 60 patients who underwent resection of eloquent area brain tumors in our hospital during the study period were included in the final analysis. Out of these 40(66.7%) underwent craniotomy under general anesthesia while 20(33.3%) underwent awake craniotomies. Mean age of the study participants was 45.61±7.889 years. Frontal lobe tumors were the most encountered brain tumors in our study participants. Patients who underwent awake craniotomy had statistically significantly lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits (p-value <0.005) as compared to those who underwent craniotomy under general anesthesia. Conclusion: Awake craniotomy emerged as superior option as compared to craniotomy under general anesthesia in terms of early post-operative parameters. Lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits were seen in patients undergoing awake craniotomy.

COMPARISON OF TWO DIFFERENT DOSES OF ORAL GABAPENTIN FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY UNDER SPINAL ANAESTHESIA

Background: Pre-emptive analgesia is a technique of pain control where treatment is initiated before intervention and operational during the surgical procedure in order to reduce the physiological consequences of nociceptive transmission provoked by the procedure. Gabapentin has demonstrated analgesic effects in clinical trials as a preemptive analgesic in acute postoperative pain management with very few side effects. Owing to the protective effect of gabapentin on the nociceptive pathways, preemptive analgesia has the potential to be more effective and hence reduce postoperative pain and development of chronic pain. Objective: We therefore designed this study to compare two different doses of Oral Gabapentin (300mg and 600mg) given as pre-emptive analgesic for post-operative pain relief in lower limb surgeries under spinal anaesthesia. Method: After the approval from ethical committee this prospective randomized double blinded clinical study was conducted over a period of two years in department of anaesthesia in M.G.M.s medical college, Aurangabad. Randomly allocated two groups were given Oral Gabapentin 300mg and 600mg respectively, one hour prior to giving spinal anaesthesia for post operative analgesia in lower limb surgeries. Conclusion: There is no statistically significant difference between group G300 (gabapentin 300mg) and group G600 (gabapentin 600mg) regarding age, gender, duration of analgesia (i.e. demand for first rescue analgesic), total dose of analgesics in first twenty four hours after surgery, duration of sensory block (i.e. L1 regression), highest ramsay sedation score and VAS scores. No significant difference was seen in cases hemodynamic stability and incidence of side effects.

Evaluation of Bedside Lung Ultrasonography in Diagnosis of Acute Pulmonary Oedema

Background: Pulmonary oedema is one of the major causes of mortality and morbidity. Acute heart failure is the major cause of pulmonary oedema. NT-pro B-type natriuretic peptide has been found to be effective in distinguishing acute pulmonary oedema from other causes of dyspnea in the emergency care setting. But it is costly and time consuming. Bedside lung ultrasonography (LUS) is being considered as noninvasive, radiation-free and easy to perform tool to diagnosis pulmonary oedema. Objective: To determine the role of bedside LUS in diagnosis of patients with acute pulmonary oedema. Methods: This observational cross-sectional study was carried out in ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka from August 2018 to October 2019. Ethical approval was sought before conduction of the study. One hundred critically-ill patients with pulmonary oedema, detected by clinical examination & chest X-ray, due to heart failure were included in the study. Routine labs including NT-pro B-type natriuretic peptide level were sent. Bedside LUS was done with a portable ultrasound machine. Data was collected by using a semi-structured data sheet. Observation and Results: The median age was 42 years (IQR 18-66). Among them, 67.71% were male. 90.0% of patients diagnosed as acute pulmonary oedema by NT-pro B-type natriuretic peptide levels findings and 88.5% of patients were diagnosed as acute pulmonary oedema by bedside lung ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasonography findings alone statistically significant as 94.2%, 66.7%, 96.4% & 54.5% and 91.66% respectively in detection of pulmonary oedema. Conclusions: Bed side lung ultrasonography can be an effective adjunct tool for rapid and high diagnostic accuracy for diagnosis of acute pulmonary oedema along with NT pro BNP level in ICU. Bangladesh Crit Care J September 2024; 12 (2): 113-117

Conscientious Objection and the Anesthesiologist: An Ethical Dilemma.

Conscientious objection is a legally protected right of medical professionals to recuse themselves from patient care activities that conflict with their personal values. Anesthesiology is different from most specialties with respect to conscientious objection in that the focus is to facilitate safe, efficient, and successful performance of procedures by others, rather than to perform the treatment in question. This could give rise to a unique, somewhat indirect ethical tension between the application of conscientious objection and potential infringement upon patient autonomy and well-being. While some situations have clear grounds and precedent for conscientious objection (e.g., abortion, or futile procedures), newer procedures, such as gender-affirming surgery and xenotransplantation, may trigger conscientious objection for complex reasons. This review discusses ethical, legal, and practical aspects of conscientious objection; challenges to anesthesia groups, departments, and healthcare organizations when conscientious objection is invoked by anesthesiologists; and strategies to help mitigate the ethical dilemmas.

HYGIENE DES DISPOSITIFS MEDICAUX REUTILISABLES DANS LA GESTION DES VOIES AERIENNES EN ANESTHESIE AU CHUD/ BORGOU-ALIBORI

Introduction :Nosocomial infection is a priority concern for hospitals. The aim of this study was to investigate the hygiene of reusable medical devices (DMR) used in anesthesia at CHUD-B/A. Methods :The study was observational, cross-sectional, descriptive and analytical. It surveyed nursing staff in the anesthesia department of CHUD Borgou/Alibori. Sampling was non-random, with a census of all staff. Data analysis was performed using IBM SPSS Statistics 21 software. Observations in the study were presented in proportions for qualitative variables and quantitative data using central tendency parameters such as mean with standard deviation, median as appropriate, mode and extremums. Results :A total of 14 caregivers were surveyed. Intermediate risks were related to semi-critical materials, according to 64.3% of subjects. Knowledge of DMR processing steps was affirmed by 92.2% of staff. Decontamination followed by cleaning and rinsing was confirmed by 84.6% of respondents. It was observed that equipment was immersed in a small jar containing a small volume of non-renewed decontamination solution, that there was no decontamination protocol, that hand hygiene was observed in 25 cases, and that gloves were worn in 30 cases. Conclusion:The absence of a DMR management protocol is apparent. Device hygiene needs to be improved. The development of a protocol for DMR treatment and the promotion of single-use equipment are necessary.

Regional anaesthetic techniques in 14 Slovenian obstetric units between 2013 and 2021: where are we and where are we going?

Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (> 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in > 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of >10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departments.

Prescription pattern of usage of analgesics in pain relief in cancer patients at a tertiary care teaching hospital - An observational prospective study

Objective The World Health Organization has developed guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents to provide evidence-based guidance to healthcare providers on the adequate relief of pain associated with cancer. This prospective study was done to evaluate the prescription pattern of analgesics for the treatment of cancer pain. Material and Methods This prospective observational study was conducted in cancer patients attending the pain clinic of the Anesthesia and Radiotherapy Outpatient Department. Approval was obtained from the Institutional Human Ethics Committee. Inclusion criteria were age ≥18 years of either gender, willing to provide written informed consent, and patients undergoing radiotherapy, chemotherapy, or palliative treatment. Exclusion criteria were patients having psychiatric illness, not willing to provide written informed consent, patients having renal and or hepatic dysfunction, patients with comorbidities with chronic pain, and patients who underwent surgical intervention. Results A total of 100 participants were recruited during the study period of July 2022–April 2024 whose data were assessed. Participants were prescribed different classes of analgesic drugs, which included 30% participants on opioid analgesics, 30% on non-opioid analgesics, and 40% on combination therapy. Among opioid analgesics, morphine was the most commonly prescribed. Among non-opioid, paracetamol was the most commonly prescribed. Among combination therapy, tramadol was the most commonly prescribed. Pregabalin was most commonly used as an adjuvant analgesic. Conclusion This study also emphasizes on need for adequate treatment of cancer pain and vigilant monitoring of patients on opioids to prevent drug abuse, drug dependence, and adverse drug reactions.

The Role of Regional Anesthesia in Reducing Postoperative Pain in Pediatric Patients

Introduction: Ensuring adequate analgesia is crucial for minimizing morbidity and healthcare costs, ultimately enhancing the success of ambulatory surgery outcomes. The purpose of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Aim of the study: The aim of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Methods: This prospective observational study included 60 pediatric patients who underwent various surgical procedures with regional anesthesia at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, Bangladesh, from January 1, 2022, to December 31, 2023. Patients aged < 15 years were included, with baseline pain scores recorded preoperatively and postoperative pain levels assessed at 1, 3, 6, 12, and 24 hours. Data on regional anesthesia techniques and pain scores were analyzed using SPSS version 22.0. Result: The study revealed that the largest group of pediatric patients were aged 7–14 years, with regional anesthesia techniques like upper and lower limb blocks being the most common. Postoperatively, 33.33% of Neonates and Infants reported a pain score of 0 within the first 3 hours, while nausea and postdural puncture headache (PDPH) were observed in 25.00% and 13.33% of patients, respectively. Most patients had a hospital stay of 4–6 days, though 21.67% required more than 10 days. Conclusion: Regional anesthesia effectively reduced postoperative pain in pediatric patients, demonstrating significant pain management benefits, minimal complications, and a positive impact on recovery and hospital stay duration.

“Effectiveness of Topical Vs Retrobulbar Anesthesia in Cataract Surgery”

Introduction: Local anesthesia has become preferable to general anesthesia for cataract surgery due to improvements in techniques and instrumentation. The advantages of local anesthesia are well known and include more rapid ambulation, the ability to perform the procedure as an outpatient, avoidance of complications of general anesthesia, and quicker surgery. This study aimed to evaluate and compare the efficacy of topical and retrobulbar anesthesia for cataract surgeries. Methods: This was a retrospective observational study and was conducted in the Department of Anaesthesia, analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2022 to August, 2023. In our study, we included 60 patients who were undergoing cataract surgery. Patients were divided into two groups – Group A (Patients who received topical anesthesia) and Group B (Patients who received retrobulbar anesthesia. Result: The mean age of study patients was 73.4 ± 8.9 and 74.2 ± 7.4 in Groups A and B respectively. The mean Pain score was 0.87 ± 1.41 and 0.74 ± 1.70 in Groups A and B respectively. The most common preoperative risk factor was exfoliation syndrome (40% in group A and 30% in group B). Twenty-eight patients (93%) in the topical anesthesia group and 60% in the retrobulbar anesthesia group reported no pain at all. Conclusion: In conclusion, topical anesthetic, as opposed to retrobulbar anesthesia, offers the surgeon good surgical conditions and comfortable operating circumstances for the patient, even in challenging instances with related ocular comorbidities.

Anesthesia-related Complications in General Surgery: Strategies for Prevention and Management

Background: Anesthesia-related complications in general surgery remain a significant concern despite advances in anesthetic techniques. These complications can lead to increased morbidity and mortality if not effectively managed. This study aimed to evaluate the incidence, prevention, and management of anesthesia-related complications in a tertiary care hospital in Bangladesh. Methods: A prospective observational study was conducted on 60 patients who underwent general surgery at the Department of Anesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, from 2022 to 2023. Demographic data, anesthesia-related complications, preventive measures, and management strategies were recorded and analyzed. Results: Cardiovascular complications were the most common, with hypotension in 11.7% and arrhythmias in 6.7% of patients. Respiratory complications, including hypoxemia and bronchospasm, occurred in 13.3% and 5% of cases, respectively. Neurological complications, such as postoperative delirium, were observed in 10% of patients. Preventive strategies, including fluid preloading, bronchodilators, and antiemetic prophylaxis, were effective in reducing the incidence of complications. All cases of hypotension, hypoxemia, postoperative nausea and vomiting (PONV), and arrhythmias were successfully managed with standard interventions, achieving a 100% success rate. Conclusion: This study demonstrates that anesthesia-related complications can be effectively managed through vigilant perioperative care and established management protocols. Cardiovascular and respiratory complications were the most common, and prompt interventions such as fluid resuscitation, oxygen therapy, and pharmacological treatment ensured favorable outcomes. Future studies with larger sample sizes and multicenter settings are recommended to further validate these findings and optimize anesthesia practices in diverse healthcare environments.

Impact of Ultrasound-Guided Regional Anesthesia on Pain Management in Orthopedic Trauma Surgery

Background: Effective pain management is critical in orthopedic trauma surgery to enhance recovery, reduce opioid consumption, and minimize complications. Ultrasound-Guided Regional Anesthesia (UGRA) has emerged as a promising technique for improving postoperative outcomes. This study aimed to evaluate the impact of UGRA on pain control, opioid consumption, postoperative complications, and patient satisfaction compared to standard pain management. Methods: This prospective, comparative study was conducted with 60 patients undergoing orthopedic trauma surgery, divided into two groups: Group A (UGRA, n = 30) and Group B (Control, n = 30) at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Data on pain scores (VAS), opioid consumption, time to first ambulation, postoperative complications, patient satisfaction, and length of hospital stay were collected and analyzed. Statistical comparisons were made using appropriate tests. Results: UGRA significantly reduced pain scores at 1, 6, and 24 hours post-surgery (p < 0.001), with lower opioid consumption (10 ± 5 mg vs. 25 ± 8 mg, p < 0.001). Time to first ambulation was shorter in Group A (24 ± 4 hours vs. 30 ± 5 hours, p < 0.001). UGRA was associated with fewer complications, including nausea/vomiting (6.7% vs. 26.7%, p = 0.034) and respiratory depression (0% vs. 10%). Patient satisfaction was higher in the UGRA group (4.8 ± 0.4 vs. 3.5 ± 0.6, p < 0.001), with a shorter hospital stay (4 ± 1 days vs. 6 ± 2 days, p < 0.001). Conclusion: UGRA provides superior pain control, reduces opioid consumption and complications, and enhances patient satisfaction in orthopedic trauma surgery, contributing to faster recovery and shorter hospital stays.

Comparison of Dexmedetomidine and Midazolam for Preoperative Sedation in Patient Under Going Surgeries Under Spinal Anaesthesia

Preoperative anxiety is a frequent condition. Generally, it starts two days before the operation and reaches its peak just prior to induction of anesthesia. Anxiety, stress, and fear that arise just before the operation and anesthesia may lead to psychological trauma and increase the levels of stress hormones, resulting in undesirable metabolic responses before anesthesia. In our study primary objective was to compare the effectiveness of dexmedetomidine and midazolam with control group in preoperative sedation prior to surgical procedures. Considering the sample size and methodology of the seed article a sample size of 207 was obtained This prospective, hospital based, comparative study was conducted in Department of Anesthesia, Mahatma Gandhi Medical College & Hospital, Jaipur over a period from March 2023 to august 2024. Group C was control, Group D was dexmedetomidine, and Group M was the midazolam group. Patients of Group C were given 100 ml of physiological saline over 10 min. patients of Group D were given 0.25 µg/kg dexmedetomidine in 100 ml physiological saline over 10 min. Group M were given 0.03 mg/kg midazolam in 100 ml physiological saline over 10 min. Group D (dexmedetomidine group) has significantly lower bromage score, Anxiety, and VAS scores, demonstrating better overall recovery, reduced anxiety, and less pain as compare to other two group. Also group D patient show better stabilization of vital parameter.

The evolution and formalization of anesthesia assistant roles across Canada.

The purpose of this Special Article is to document the evolution of the anesthesia assistant (AA) profession in Canada and summarize AA practice at Canadian institutions as it exists today, five decades after Quebec and 15years after most other provinces formalized AA practice. Through the Management Committee of the Association of Canadian University Departments of Anesthesia (ACUDA), we conducted a purposeful sampling of all ACUDA chairs or their delegates. We requested the following data: history of AAs becoming a reality in their particular province or region; potential recruitment pools; training programs and curricula; pathway to credentialing; funding, pay, retention, recruitment, and status of union representation; and metrics. Data were provided by 19 institutions in 8 provinces: Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Given the different health care governance structures across the provinces, AA roles vary in terms of its associated technical, clinical, and educational responsibilities. The role of AAs in supporting anesthesia care through equipment maintenance and assistance with airway management, resuscitation, and administration of regional anesthesia seems to be well established, as is their role in providing brief intraoperative relief for anesthesiologists during a stable period of anesthesia. Anesthesia assistant duties continue to evolve, becoming more aligned with the specific institution and less dependent on the supervising anesthesiologist. Apart from the initial metrics collected during the Ontario ACT implementation pilot projects, we are not aware of any formal metrics, current or ongoing, being collected across Canada, related to either patient safety events or perioperative efficiency. This compilation of pan-Canadian AA data shows diverse models of practice and highlights the value to patients and the health care system as a whole of incorporating these allied professionals into the anesthesia care team (ACT). The present findings allow us to offer suggestions for consideration during discussions of retention, recruitment, program expansion, and cross-country collection of metrics and other data. We conclude by making six recommendations: 1. recognize that implementation of ACTs is a key element in solving the challenge of an increasing surgical backlog; 2. develop, or facilitate the development of, metrics and increase data-sharing nationally to enable health care authorities to better understand the importance of AAs in patient safety and perioperative efficiency; 3. develop and implement funding strategies to lower the barriers to AA training such as hospital-sponsored positions, ongoing salary support, and return-of-service arrangements; 4. ensure that salaries appropriately reflect the increased level of training and added levels of responsibility of certified AAs; 5. develop long-term strategies to ensure stable funding, recruitment and retention, and a better match between the number of AA training positions and the need for newly certified AAs; and 6. engage all stakeholders to acknowledge that AAs, as knowledgeable and specifically trained assistants, not only fulfill their defined clinical role but also contribute significantly to patient safety and clinical efficiency by assuming nondirect patient care tasks.

Immunological effects of post-operative epidural analgesia versus oral opioids in VATS.

Anaesthetic choices in cancer surgery, including the use of epidural analgesia, may affect immune function during the perioperative period and might play an important role in subsequent cancer spread and recurrence. This was a prospective, randomised, controlled, double-blinded, single-centre study allocating patients scheduled for video-assisted thoracoscopic surgery (VATS) lobectomy to post-operative pain management using either thoracic epidural analgesia or oral morphine. We compared pre-, per-, and post-operative plasma levels of interleukin (IL)-6, IL-10, IL-12, and interferon (IFN)-γ using regression analysis, and conducted a two-year survival follow-up. A total of 66 patients were randomised. Fifty-six received the allocated treatment and were analysed. None of the investigated cytokines exhibited significant between-group differences in plasma concentrations when adjusted for the chosen covariates (p ≥ 0.204). A two-year follow-up showed no difference in survival between the two groups (p = 0.5). Our study found no differences in the impact on the innate, non-specific immune system related to epidural analgesia for pain management in VATS. The Danish Cancer Society (R150-A10139). Oberstinde Kirsten Jensa la Cours Mindelegat (JSP-25076). University of Southern Denmark, Region of Southern Denmark and Department of Anaesthesia and Intensive Care, Odense University Hospital. NCT02359175 (ClinicalTrials.gov).

Supraclavicular Brachial Plexus Block with and without Dexamethasone as Local Anaesthetics

Background: Brachial plexus block is good alternative to general anesthesia for upper limb surgery. This avoids the unwanted effect of anesthetic drugs used during general anesthesia and the stress of upper airway instrumentation. Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. This study was carried out to compare onset and duration of sensory and motor blockade and duration of postoperative analgesia on addition of dexamethasone to local anestheic and local anesthetic alone in supraclavicular brachial plexus block. Methods: In this prospective randomized, controlled, double blinded study which was conducted at Department of Anesthesia, 250 Beded Hospital, Lalmonirhat, Rangpur, Bangladesh from January to June 2023. We included 70 ASA I & II patients who were aged between 18 years & 60 years, underwent elective upper limb surgeries. They were divided into two equal groups. Group 1 (cases) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + dexamethasone 8mg (2ml). Group 2 (controls) who received 15 milliliter of 2% lignocaine with adrenaline and 15 milliliter of 0.5% bupivacaine + 0.9% normal saline (2ml). We observed the Onset of sensory and motor blockade, duration of sensory and motor blockade and postoperative analgesia between the two groups. Results: In this study of patients according to their age and weight. 37.26±15.55 years were mean age in group 1 and in group 2 it was 36.56±16.86 with p value being 0.8678. 58.466± 3.9642 kg was the mean weight in group 1 and in group 2 it was 60.4±4.95 kg with p value of 0.1002. So both the groups were comparable in terms of age and weight. In this study out of 70 patients, group1 consisted of 68.6% males whereas there were 60% in group 2 and group 1consisted of 31.4% of females and 40% in group2, hence males’ outnumbered females in both the groups. The mean duration of surgery in group 1 was 50±19.95 minutes and in group 2 were 46.6±15.55 minutes with p value of 0.4646. There was no statistical difference between both the groups. The onset of sensory blockade was within 7.3 min in group 1. In group 2 the onset of sensory blockade was 13.66 minutes. The onset of motor blockade was within 3.93 min in group 1. In group 2 the onset of motor blockade was 18.66 min. The duration of intra operative analgesia was 654.33 minutes in group 1. In group 2 the duration of intra operative analgesia was 292.6 minutes. The duration of post-operative analgesia was 815±13.57 minutes in group 1. The duration of post-operative analgesia in group 2 was 393.8±42.88 minutes. There were no complications in both the groups in intra operative period and post-operative period. Conclusion: Dexamethasone, when added to 15 millilitre of 0.5% bupivacaine and 15 millilitre of 2% lignocaine plus adrenaline, very effectively enhances the onset of sensory and motor blockade. It dramatically prolongs the duration of sensory and motor blockade and duration of analgesia. There were no untoward side effects with the use of dexamethasone as an additive in the brachial plexus block.

Hypnosis support in anaesthesia is rarely used in German anaesthesia departments - a nationwide survey among leading physicians of anaesthesia departments

BackgroundThe aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their application lie and how great the interest in this type of therapy is. Another research question was to find out whether there are specialist areas in which these methods are used more frequently than in other specialist areas.MethodsA descriptive survey was conducted by means of a questionnaire in all hospitals with anaesthesia departments in Germany. 1124 questionnaires were sent out by post. The survey period was five months from 27/02/2023 to 31/07/2023. The clinic directors of all anaesthesiology departments in German hospitals were surveyed.Results476 departments (42%) responded by pre-paid envelope. Of these, only 39 (8%) use hypnosis and relaxation techniques perioperatively. These are mostly progressive muscle relaxation, hypnotic trance according to Erickson, calming words and suggestions or the use of virtual reality (e.g. using VR-glasses).ConclusionsHypnosis techniques have been shown in many studies to be effective in increasing patient comfort (less anxiety and stress) and reducing both the need for medication and perioperative pain. The therapy is rarely used in Germany, although once established it can be easily integrated into perioperative procedures. Many departments have shown great interest in the topic. In the interests of patients, a structural change should be considered to promote the use of hypnotic procedures.

Since the COVID-19 pandemic, approximately 90% of elective anesthetics have been ambulatory: A retrospective analysis of statewide data in Florida from 2010 through 2022

BackgroundWhen the vast majority (e.g., ≈90%) of a specialty's elective (scheduled) care is ambulatory (i.e., length of stay 0 or 1 night), the administrative, clinical, and economic policy implications are profound. We examined the progressive shift of elective anesthetics in Florida from inpatient to ambulatory, from the first quarter of 2010 through the fourth quarter of 2022. We were particularly interested in the most recent data following the lifting of COVID-19 restrictions on elective surgery in the state. MethodsThis retrospective cohort study included major therapeutic and major diagnostic procedures with >0 American Society of Anesthesiologists base units in the state of Florida inpatient and ambulatory surgery databases. The last 8 quarters of these operating room anesthetic data corresponded to the end of restrictions on elective surgery in Florida due to the COVID-19 pandemic. Our goal was to determine whether the overall mean percentage of cases with 0- or 1-day lengths of stay has reached 90% since the lifting of pandemic restrictions. Numbers of cases over periods of at least four weeks tend to follow normal distributions. Therefore, we analyzed the N = 8 quarters of cases from 2021 to 2022 using Student's t-test. The study was performed when there were N = 8 quarters available from the Florida healthcare databases. ResultsThere were overall 22,584,752 surgical cases studied. The percentages of elective anesthetics with length of stay ≤1-day increased progressively from 2010 through 2020. Among the eight successive quarters since the end of pandemic-related elective surgery restrictions, the percentage of elective cases with length of stay 0- or 1 day was stable, averaging 90% (95% two-sided confidence interval 89.4% to 90.3%). ConclusionSince the COVID-19 pandemic, the mean quarterly percentage of elective surgery cases with anesthesia in Florida that were ambulatory has been reliably ≈90%. Implications include value in expecting overnight post-anesthesia care unit stay in ambulatory surgery centers and scheduling and sequencing cases based on post-anesthesia care unit capacity. Furthermore, because the vast majority (i.e., ≈90%) of cases would be excluded (i.e., not involve hospital admission for at least 2 midnights), there is a minimal role that risk-adjusted hospital length of stay and mortality can have in evaluating anesthesia department overall quality and economic effectiveness.