Different Types Of Anesthesia Research Articles

Anesthesia for Endovascular Therapy for Stroke.

In patients with acute ischemic stroke, the standard of care is to perform intra-arterial endovascular thrombectomy in addition to intravenous thrombolysis. In this study, we investigated the different anesthetic techniques chosen for this procedure and clinical outcomes. Patients undergoing endovascular procedures were divided into three groups. The first group consisted of patients who received general anesthesia, the second group underwent the procedure under conscious sedation and local anesthesia at the catheter insertion site, and lastly the third group included patients who received only local anesthesia at the catheter insertion site, without sedation. During the endovascular procedure, we did not notice significant differences in vital parameters, in particular the mean blood pressure (MAP) between patients treated with different types of anesthesia. Also, the duration of the revascularization did not show significant differences between the three groups. The main point is the absence of differences in terms of functional and clinical outcomes, using various scores as reference, such as the National Institutes of Health Stroke Scale (NIHSS) score at 7 days, NIHSS and Modified Rankin Scale (MRS) at time of discharge, and MRS after 3 months. These scores did not show significant differences in groups treated with different types of anesthesia. The rate of success of the revascularization procedure is almost overlapping between patients treated with conscious sedation and general anesthesia. In addition, we did not notice significant differences between groups in terms of functional and clinical outcomes. Considering the possible usefulness of applying conscious sedation, at OCSAE of Baggiovara, an internal protocol for conscious sedation was introduced to standardize the treatment in patients undergoing endovascular procedures.

Anesthetic Mechanisms: Synergistic Interactions With Lipid Rafts and Voltage-Gated Sodium Channels.

Despite successfully utilizing anesthetics for over 150 years, the mechanism of action remains relatively unknown. Recent studies have shown promising results, but due to the complex interactions between anesthetics and their targets, there remains a clear need for further mechanistic research. We know that lipophilicity is directly connected to anesthetic potency since lipid solubility relates to anesthetic partition into the membrane. However, clinically relevant concentrations of anesthetics do not significantly affect lipid bilayers but continue to influence various molecular targets. Lipid rafts are derived from liquid-ordered phases of the plasma membrane that contain increased concentrations of cholesterol and sphingomyelin and act as staging platforms for membrane proteins, including ion channels. Although anesthetics do not perturb membranes at clinically relevant concentrations, they have recently been shown to target lipid rafts. In this review, we summarize current research on how different types of anesthetics-local, inhalational, and intravenous-bind and affect both lipid rafts and voltage-gated sodium channels, one of their major targets, and how those effects synergize to cause anesthesia and analgesia. Local anesthetics block voltage-gated sodium channel pores while also disrupting lipid packing in ordered membranes. Inhalational anesthetics bind to the channel pore and the voltage-sensing domain while causing an increase in the number, size, and diameter of lipid rafts. Intravenous anesthetics bind to the channel primarily at the voltage-sensing domain and the selectivity filter, while causing lipid raft perturbation. These changes in lipid nanodomain structure possibly give proteins access to substrates that have translocated as a result of these structural alterations, resulting in lipid-driven anesthesia. Overall, anesthetics can impact channel activity either through direct interaction with the channel, indirectly through the lipid raft, or both. Together, these result in decreased sodium ion flux into the cell, disrupting action potentials and producing anesthetic effects. However, more research is needed to elucidate the indirect mechanisms associated with channel disruption through the lipid raft, as not much is known about anionic lipid products and their influence over voltage-gated sodium channels. Anesthetics' effect on S-palmitoylation, a promising mechanism for direct and indirect influence over voltage-gated sodium channels, is another auspicious avenue of research. Understanding the mechanisms of different types of anesthetics will allow anesthesiologists greater flexibility and more specificity when treating patients.

Comparative analysis of Apgar scores in newborns: the impact of anesthesia methods during cesarean delivery

Analgesia during caesarean section has a protective property regarding the condition of mother and child. Anesthesia methods should minimize harm to the newborn. The main problem after general anesthesia is respiratory distress syndrome.The objective: to evaluate the impact of the use of different types of anesthesia (general anesthesia or spinal anesthesia) during cesarean section on the health of newborns.Materials and methods. 120 full-term pregnant women who underwent planned cesarean section were included in the study. The study participants are divided into groups: I group – 70 pregnant women who underwent a cesarean section under general anesthesia; Group II – 50 patients with spinal anesthesia during cesarean section.The duration of labor and the time of induction of anesthesia were carefully recorded. To assess the health of the newborn the Apgar score was used 1, 5 and 10 minutes after delivery.Results. The study found that the method of delivery affects the neonatal Apgar score. Shorter time from anesthesia to birth (within 5 min) and delivery through the uterus (more than 120 s) led to a decrease in Apgar scores by 1 min.At the same time, it was established that the assessment of newborns at birth according to the Apgar scale at the level of 4–6 points after 5 and 10 minutes was lower during childbirth with general anesthesia compared to the assessment of newborns who were born with the use of spinal anesthesia, and at the assessment of 7–10 points – greater after 5 min and 10 min in newborns who were born in childbirth with spinal anesthesia than in babies who were born in childbirth under usual general anesthesia.Conclusions. The results of the study demonstrate that the methods of anesthesia during cesarean section improve the health of the mother and the child. Health care providers can improve prenatal care and outcomes with this knowledge. Spinal anesthesia improves the condition of the newborn, as determined by the Apgar score at three intervals.

PHARMACOGENETICS OF ANESTHESIOLOGICAL SUPPORT

Pharmacogenetics studies the relationship between a person’s individual genetic characteristics and the human body’sresponse to the action of various drugs, particularly the occurrence of undesirable side eff ects. Thanks to the development of the latest technologies and methods, this branch of medical genetics and clinical pharmacology is developing very actively. Data are being accumulated, special databases are being created with the aim of creating individual genetic passports in the future, which will allow the selection of personalized treatment schemes.Anesthesiology is a special area of pharmacogenetic research because, more than any other medical specialty, it ischaracterized by polypharmacy-the simultaneous or sequential administration of many drugs. The same dose of a drug may be inadequate for some patients and may be life-threatening or cause unwanted side eff ects for others. Today, information about genetic factors is being used by clinicians to prescribe drugs to tailor drug therapy to a patient’s genome. In anesthesiology, the principles of pharmacogenetics have been explained for neuromuscular blocking agents, opioid metabolism, different types of anesthetics, and postoperative nausea and vomiting. On the other hand, a large number of anesthetics have a narrow therapeutic index.This review summarizes the most recent data from the scientifi c literature on the pharmacogenetics of diff erent types ofanesthetics. Inhalational anesthetics are halogenated derivatives of methyl ethyl ether, the exact mechanism of action of which is not yet fully understood. One of the rare but very serious side eff ects of all halogenated anesthetics is malignant hyperthermia, a genetically determined autosomal dominant disorder that manifests as a hypermetabolic response to drug administration. The dosage of intravenous anesthetics should also be carefully determined, taking into account the patient’s age, cardiovascular, hepatic, and renal status, concomitant drug therapy, and genetic factors. Ontogeny and genetic variability of drug-metabolizing enzymes are interrelated because genetic variability in drug-metabolizing enzyme expression cannot be assessed until the required protein is suffi ciently expressed. Pharmacogenetic variants may contribute to unpredictable drug exposure at the same weight- based drug dose.There are a number of potentially clinically applicable pharmacogenetic data in newborns, but more research is needed toconfi rm these fi ndings and understand how to incorporate them into clinical care.The selection of drugs and dosing regimens based on a patient’s pharmacogenomic profi le may be an important part of thefuture of medicine. Personalized treatment based on the specifi c variants in the genome will ultimately reduce the incidence of side eff ects and length of hospital stay for patients and save healthcare costs. Although pharmacogenomics and its application in clinical practice are still in their infancy, different variants and their implications for many clinical areas, including anesthesiology, are emerging every day.

Descemet Membrane Endothelial Keratoplasty (DMEK) Anesthesia Analysis.

Comparison of safety and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in topical, peribulbar, or general anesthesia. Retrospective, post hoc matched study of 346 patients who received DMEK surgery with different types of anesthesia (n = 54 topical, n = 137 peribulbar, n = 155 general anesthesia). Outcome criteria were intraoperative complications, endothelial cell count (ECC), central corneal thickness (CCT) and graft rejection rate, rebubbling rate, and visual acuity (VA). Mean follow-up time was 9.4 ± 2.8 months. The group with topical anesthesia showed intraoperative difficulties such as vitreous pressure (p = 0.01) and difficult graft unfolding (p = 0.4), possibly leading to a higher rebubbling rate (p = 0.03) and therefore graft failure (p = 0.39). However, rebubbling and graft failure occurred more often when the graft preparation was more difficult (p = 0.2, p = 0.13, respectively), which was independent of anesthesia. All three groups achieved comparable functional results regarding VA, ECC, and CCT after 6 months. DMEK under topical anesthesia is feasible and shows comparable final visual outcomes but should be limited to selected cooperative patients and performed by experienced surgeons due to the potential for increased intraoperative challenges.

Prediction of the healing efficiency of episiotomy wounds using hydrogel dressings with lidocaine

The objective: to study the factors affecting the healing process of an episiotomy wound and the effectiveness of using hydrogel dressings with lidocaine for its healing.Materials and methods. The prospective randomized study includes the analysis of anamnestic data from the medical cards of 123 primiparous women with episiotomy wounds who gave birth in the Kyiv City Maternity Hospital No. 5 during 2021–2022. The women were divided into two groups: a comparison group – 63 patients who received standard treatment, and a research group – 60 patients who additionally used hydrogel dressings with lidocaine on the wound.The healing of episiotomy wounds was evaluated according to the REEDA scale. Factors that may influence episiotomy wound healing were studied in patients of both groups: anthropometric indicators (age, height, body mass index), interventions during childbirth, and indicators of obstetric and gynecological history (term of gestation, volume of blood loss during childbirth, body weight of the newborn, etc.). Statistical analysis was performed using the Fisher, Mann–Whitney, Student and chi-square tests of the statistical package EZR v. 1.54.Results. Age (p=0.689) and body mass index (p=0.974) of patients in both groups did not show statistically significant differences. The duration of the second period of labor on average was 72 min (57.6–86.4) in the comparison group versus 43.2 min (28.8–57.6) in the research group with a statistically significant difference (p<0.001). No statistically significant differences were found between the two groups regarding the term of delivery, the volume of blood loss, the weight of the newborn, the risk of pregnancy loss, the frequency of labor induction, the weakness of labor activity, manual revision of the uterine cavity, and vacuum extraction of the fetus. The frequency of use of different types of anesthesia during childbirth also did not differ (p=0.396).REEDA scale assessment revealed a reduced risk of high sum scores in the research group (odds ratio (OR) = 0.16, 95% confidence interval (CI): 0.07–0.38), that supports the efficacy of hydrogel dressings with lidocaine. Analysis of the duration of the second labor period and gestational term also revealed an association with the risk of a high sum of points on the REEDA scale (OR = 1.22, 95% CI: 1.02–1.45 per 0.01 days; OR = 1.65, 95% CI: 1.16–2.35 per week of pregnancy).A multivariate model which included research group, body mass index, duration of the second labor period, gestational term confirmed a reduced risk according to the REEDA scale in this group (OR = 0.19, 95% CI: 0.08–0.47). The four-factor model had a high accuracy (AUC = 0.81, 95% CI: 0.73–0.88), indicating a strong relationship between the selected factors and the risk of complications after episiotomy.Conclusions. The use of hydrogel dressings with lidocaine and taking into account some aspects of childbirth, namely, the duration of childbirth and gestational period, can contribute to the improvement of the course of healing of episiotomy wounds. Such a comprehensive approach supports the effectiveness and significance of using hydrogel dressings with lidocaine in the practice of modern obstetrics to improve the results of treatment of patients with an episiotomy wound.In the future, studies on the effectiveness of using hydrogel dressings for the treatment of episiotomy wounds are necessary.

The potential anti-tumor effect of anesthetics on cancer by regulating autophagy.

Autophagy is a conserved, cellular self-degradation system that is essential for maintaining intracellular homeostasis. Increasing evidence suggests that autophagy plays an important dual regulatory role in the development of many human diseases, such as cancer. Recent studies have shown that the autophagy process in tumor cells can be regulated by various stimuli from both intracellular and extracellular environments, including the effects of anesthesia. Anesthetics have been shown to not only have clinical anesthetic and sedative effects but also play important roles in the progression of tumors. The effects of different types of anesthetics on tumors differ. In this review, we summarize the basic information on autophagy, the regulatory function of autophagy in cancer, currently used autophagy-targeted tumor therapy, and the effects of different types of anesthetics on tumor progression. We focus on the molecular mechanisms by which anesthetics exert tumor-inhibiting effects by activating or inhibiting autophagy. Herein, we also explore the potential application of the anesthetic/autophagy system in clinical tumor treatment. These findings provide a theoretical basis for the use of anesthetics during the perioperative period to suppress tumor development and provide insights for autophagy-targeted cancer treatment and drug development.

Chitosan-Deficient Cryptococcus as Whole-Cell Vaccines.

Creating a safe and effective vaccine against infection by the fungal pathogen Cryptococcus neoformans is an appealing option that complements the discovery of new small molecule antifungals. Recent animal studies have yielded promising results for a variety of vaccines that include live-attenuated and heat-killed whole-cell vaccines, as well as subunit vaccines formulated around recombinant proteins. Some of the recombinantly engineered cryptococcal mutants in the chitosan biosynthesis pathway are avirulent and very effective at conferring protective immunity. Mice vaccinated with these avirulent chitosan-deficient strains are protected from a lethal pulmonary infection with C. neoformans strain KN99. Heat-killed derivatives of the vaccination strains are likewise effective in a murine model of infection. The efficacy of these whole-cell vaccines, however, is dependent on a number of factors, including the inoculation dose, route of vaccination, frequency of vaccination, and the specific mouse strain used in the study. Here, we present detailed methods for identifying and optimizing various factors influencing vaccine potency and efficacy in various inbred mouse strains using a chitosan-deficient cda1Δcda2Δcda3Δ strain as a whole-cell vaccine candidate. This chapter describes the protocols for immunizing three different laboratory mouse strains with vaccination regimens that use intranasal, orotracheal, and subcutaneous vaccination routes after the animals were sedated using two different types of anesthesia.

Global Trends in Research of Perioperative Analgesia Over Past 10 Years: A Bibliometric Analysis.

The postoperative acute pain caused by surgery has been a major problem plaguing anesthesiologists, and even some acute pain progresses to chronic pain syndrome, terribly reducing the quality of life of patients. To this end, increasing attention has been paid to the management of perioperative analgesia. At present, with the increase of research on perioperative analgesia, the understanding and solution of this clinical problem have been further developed. Bibliometrics can estimate research hot-spots and trends of related fields in a certain period of time. However, a systematic bibliometric analysis has not been conducted to explore current research hotspots and future development trends, which is thus the purpose of this study. Articles and reviews published from 2012 to 2021 were retrieved from the Web of Science Core Collection (WoSCC) database, and the bibliometric analysis of the keywords and references of articles was performed using VOSviewer1.6.18. Besides, the number of articles related to perioperative analgesia in term of countries, affiliations, authors, and journals were analyzed. Finally, 3157 articles meeting the screening requirements were retrieved, and it was hereby found that the research on perioperative analgesia had received more attention and interest in the past 10 years, with the United States making more contributions, where there were eight of the top ten affiliations by the number of publications. Kaye AD was the most active researcher in this field. Most related articles were published in Anesthesia and Analgesia, accounting for 2.76% of all literature. Enhanced recovery after surgery, different types of anesthesia and multi-mode analgesic drug intervention were the main trends and hotspots. Perioperative analgesia has attracted considerable academic interest. In the past decade, the effects of enhanced recovery after surgery, different types of anesthesia and multi-mode analgesic drug intervention on perioperative analgesia have become the research hotspots, which are also likely to be the focus of future study.

Anesthesia in patients with chronic liver disease: An updated review.

Anesthesia in chronic liver disease patients can be challenging because of the medications given or interventions performed and their effects on liver physiology. Also, the effects of liver disease on coagulation and metabolism should be considered carefully. This review focuses on anesthesia in patients with different chronic liver disease stages. A literature search was performed for Scopus and PubMed databases for articles discussing different types of anesthesia in patients with chronic liver disease, their safety, usage, and risks. The choice of anesthesia is of crucial importance. Regional anesthesia, especially neuroaxial anesthesia, may benefit some patients with liver disease, but coagulopathy should be considered. Regional anesthesia provides optimum intraoperative relaxation and analgesia that extends to the postoperative period while avoiding the side effects of intravenous anesthetics and opioids. Pharmacodynamics and pharmacokinetics of anesthetic medications must guard against complications related to overdose or decreased metabolism. The choice of anesthesia in chronic liver disease patients is crucial and could be tailored according to the degree of liver compensation and the magnitude of the surgical procedure.

Effects of volatile anesthetics on circadian rhythm in mice: a comparative study of sevoflurane, desflurane, and isoflurane.

Volatile anesthetics affect the circadian rhythm of mammals, although the effects of different types of anesthetics are unclear. Here, we anesthetized mice using several volatile anesthetics at two different times during the day. Our objective was to compare the effects of these anesthetics on circadian rhythm. Male adult C57BL/6J mice were divided into eight groups (n = 8 each) based on the anesthetic (sevoflurane, desflurane, isoflurane, or no anesthesia) and anesthesia time (Zeitgeber time [ZT] 6-12 or ZT18-24). Mice were anesthetized for 6h using a 0.5 minimum alveolar concentration (MAC) dose under constant dark conditions. The difference between the start of the active phase before and after anesthesia was measured as a phase shift. Clock genes were measured by polymerase chain reaction in suprachiasmatic nucleus (SCN) samples removed from mouse brain after anesthesia (n = 8-9 each). Phase shift after anesthesia at ZT6-12 using sevoflurane (- 0.49h) was smaller compared with desflurane (- 1.1h) and isoflurane (- 1.4h) (p < 0.05). Clock mRNA (ZT6-12, p < 0.05) and Per2 mRNA (ZT18-24, p < 0.05) expression were different between the groups after anesthesia. 0.5 MAC sevoflurane anesthesia administered during the late inactive to early active phase has less impact on the phase shift of circadian rhythm than desflurane and isoflurane. This may be due to differences in the effects of volatile anesthetics on the expression of clock genes in the SCN, the master clock of the circadian rhythm.

Differences in intracortical responses following non-noxious and noxious stimulation in anaesthetized rats

Cortical responses have been proposed as a source for the extraction of unique and non-subjective sensory information. The present study aimed to investigate if it is possible to distinguish between non-noxious and noxious cortical responses with two different types of anesthesia. Sixteen rats were randomly allocated to receive either Hypnorm/Dormicum (HD) or isoflurane (ISO) anesthesia. Each animal had a custom-made microelectrode array implanted in the primary somatosensory cortex to record the local field potentials and a cuff electrode implanted around the sciatic nerve to deliver electrical stimulations. Three stimulation intensities were applied: 1x movement threshold (MT) (i.e., non-noxious activation), 5x MT (low intensity noxious activation), and 10x MT (high intensity noxious activation). The evoked potentials were assessed by extracting three features: 1) the negative peak (NP), 2) the positive peak (PP), and 3) the peak-to-peak (PtP) amplitudes. Our results showed that it was possible to distinguish between three levels of stimulation intensities based on the NP, PP, and PtP features for the HD group, whereas it was only possible to make the same differentiation with the use of PP and PtP when applying ISO. This work is believed to contribute to a basic understanding of how the cortical responses change in the hyperacute phase of pain and which cortical features may be suitable as objective measures of nociception.

The Efficacy of Caudal Anesthesia in Pediatric Surgery

Background: Despite a long history of safety, spinal anesthesia (SA) is still seldom used outside of specialist pediatric institutions and is sometimes debated as a primary anesthetic approach for children. To lessen the risk of postoperative apnea, it is often used on previously preterm newborns who have not yet reached viability (60 weeks post- conception) (GA). There is, however, a wealth of evidence indicating its safety and effectiveness for appropriate operations in adolescents. Objective: The primary purpose of this investigation is to assess the efficacy of Caudal anesthesia pediatric surgery. Method: Tertiary care hospital was the setting for this prospective investigation. 200 children, ages 4 to 10, were included in the research because they were all given different types of anesthesia for infraumbilical or lower extremities surgery during the study's 1-year time frame. The research participants had a thorough preoperative assessment. During the study 50 patients of each were given different anesthesia including Endotracheal intubation, LMA, Caudal block and local anesthesia. Results: Majority was belonged to 4-6 years age group, 70% and 60% were male. Plus, majority of the patients were undergone circumcision, 35% and Herniorrhaphy, 28%. Followed by 20% undergone appendectomy and 5% undergone hypospadias repair. Besides, anesthesia induction and recovery on the operating room table, was lowest in the local anesthesia group (P = 0.015), whereas the results were comparable in the other groups. However, patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit (P &lt; 0.001). In fact, patients who got Caudal block had less complication where only 1% had Convulsions, Bloody puncture and vomiting. Conclusion: Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

Pattern and outcome of Anaesthesia techniques in patients presenting with pre-eclampsia/eclampsia for caesarean section in a Teaching Hospital

Objectives: To review the pattern of anaesthesia techniques among pregnant women with pre-eclampsia or eclampsia who had caesarean section in our health facility and their management outcomeMethods: A retrospective analysis was undertaken for all the obstetric patients with pre-eclampsia or eclampsia who had caesarean sections under different types of anaesthesia in a tertiary hospital between January 1st 2014 and December 31st 2018.Results: A total of one hundred and eighty-two patients who presented with pre-eclampsia and eclampsia had emergency caesarean sections. Of these, 134 (74%) were diagnosed pre-eclampsia and 48 (26%) had eclampsia. The mean age was 29.71±6.40years. Subarachnoid block was performed in 165 (90.66 %), 15 (8.24 %) had general anaesthesia relaxant technique, and the remaining two (1.10 %) had local anaesthetic infiltration ± total intravenous anaesthesia. Peri-operative anaesthetic complications encountered included post-anaesthetic shivering 19 (10.44%), hypotension 16 (8.79 %) and nausea 1 (0.55 %). Incidence of death on table was six percent (11 patients). Among those that died, the anaesthesia technique was general anaesthesia in eight cases (73%) while three patients (27%) had subarachnoid blocks.Conclusion: Spinal anaesthesia was the most commonly used anaesthesia technique in this centre for patients with pre-eclampsia and conscious eclamptic patients, and it proved to be a relatively safe technique with few mortality.

The impact of different types of anaesthesia on the course of tonsillectomy surgery

Recurrent tonsillitis is considered to be one of the most common ENT diseases. Tonsillectomy as a method of recurrent tonsillitis' treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how quickly he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anaesthetic management.&#x0D; Our study aimed to optimise the approach to choosing between endotracheal anaesthesia and local anaesthesia. Clinical studies were made among 158 patients with recurrent tonsillitis who underwent a bilateral tonsillectomy. The patients were divided into two groups.&#x0D; The first group consisted of 97 patients undergoing tonsillectomy using local anaesthesia. The control group included 61 patients undergoing tonsillectomy using endotracheal anaesthesia. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period.&#x0D; Conclusions: tonsillectomy surgery using local anaesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and fewer incidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anaesthesia.

POSTOPERATIVE PAIN AND MULTIMODAL ANESTHESIA IN ABDOMINAL PLASTIC AND BARIATRIC SURGERY

Any rational anesthesia strategy should focus on intraoperative and postoperative pain control. Adverse effects of opioids on the course of the early postoperative period are known. The aim of our study is to determine the correlations of acute postoperative pain with different types of anesthesia. Methods 203 patients who underwent abdominal plastic and bariatric surgery were under our observation; 113 (55.67%) of them are women and 90 (44.33%) are men; Among them, 154 patients underwent abdominoplasty, and 49 underwent bariatric surgery. Standard anesthesia with opioids was administered to 49 (24.14%) patients - group I, multimodal + partial use of opioids - group II: 76 (37.44%), multimodal anesthesia - 78 (38.42%) - group III. Results During anesthesia with opioids, compared to the second and third groups, the pain in the operative area, as well as in the head, throat, waist and ears is significantly higher. During multimodal anesthesia, pain is reliably less in all cases, and pain in the throat was not noted. Correlation analysis showed that opioid anesthesia was significantly correlated with postoperative pain,: Pain in the operated area - r=0.504**, p&lt;0.001; Head pain - r=0.395**, p&lt;0.001; Throat pain - r=0.301**, p&lt;0.001Waist painr=0.320**, &lt;0.001, Muscles pain - r=0.422**, p&lt;0.001 whereas multimodal anesthesia was significantly negatively correlated with all types of postoperative pain. In the second phase, in the opioid anesthesia group, compared to the second group, there is significantly more pain in the lower back and muscles, and in the third group, there was no pain at all. The frequency of patients who did not require medical treatment during the intrahospital stage is not significantly different from each other, and the pain requiring non-opioid treatment is significantly less after multimodal anesthesia - Group I - 28(57.14%), Group II - 25(32.89%), Group III - 2(2.56)(p&lt;0.0001). Pain requires opioid medication - Group I - 20(40.82)Group II – 19(25.00%), (p&lt;0.0001). No patient in this group required opioid treatment. In the ambulatory stage, no patient in the multimodal anesthesia group needed medical treatment, and significantly fewer patients in group II needed non-opioid treatment. Conclusion Multimodal anesthesia reduces perioperative pain and the need for perioperative opioid use. Keywords: Postoperative pain, Multimodal anesthesia, perioperative opioid use.

Efficacy of Different Methods of General Anaesthesia in Pigs and their Influence on Haematological Parameters

Abstract This study focused on how haematology parameters differ with different types of anaesthesia that is given to piglets. In this study 18 piglets were used divided into three groups. In each of these experimental groups a different combination of anaesthetics was used. The first group received the combination of azaperone, diazepam, and ketamine. In the second group, we used the combination of azaperone, xylazine, and ketamine. In the third group, the anaesthesia was induced by azaperone, diazepam, butorphanol and ketamine. Blood samples were taken from the piglets three times throughout the procedure and the relevant haematological parameters were determined. With respect to haematological values, the combination used in group 1 appeared as the best for the anaesthesia of pig-lets. The haematological values, such as MCV (mean corpuscular volume), were similar in all groups with the exception of the third group where the MCV and the MCH (mean corpuscular haemoglobin) were significantly lower 24-hour post anaesthesia compared to the other two groups. Lymphocytes in the first two groups showed a steady decrease, while in the third group their levels increased. The opposite trend was observed for the segmented neutrophils that showed a steady increase over the 24-hour period in the 1st and 2nd group while in group 3 their levels decreased. Abolishment of pedal and nasal reflexes to external stimuli applied every 15 min post ketamine administration was observed. The piglets in the 1st group showed no reflexes to external stimuli, while the worst responses were observed in the 2nd group where many of the piglets started to show reflexes very early within the experimental time.

Comparison of Side Effects of General Anesthesia and Spinal Anesthesia in Postoperative Patients

Introduction: Anesthesia is an action to relieve pain during surgery and various other procedures that cause pain in the body, there are several anesthesia actions including general and spinal anesthesia but the anesthesia action causes some side effects. Objective: This study aims to determine the comparison of side effects of spinal anesthesia and general anesthesia in postoperative patients. Method: The research design used in this study is a comparative study with the type of descriptive research. Population The population in this study was patients under spinal anesthesia and general anesthesia. Result and Discussion: Based on the results of statistical analysis of the Chi-square test, it shows that there is a significant comparison in both types of anesthesia used for surgery, namely general narcose anesthesia and spinal anesthesia on postoperative side effects with a value of (p-value = 0.026). Conclusion: The conclusion of two different types of anesthesia shows significant differences due to differences in the way of administration of anesthetic drugs and the doses given so that they get different side effects. Advice in using the type of anesthesia must be considered the type of surgery to be performed as little as possible must reduce the side effects obtained by the patient.

Clinical features, management, and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13-year experience of a tertiary eye center.

To study the risk factors, clinical features, management, and outcomes of intraoperative expulsive choroidal hemorrhage (ECH) during cataract surgery. Aravind Eye Hospital, Madurai, Tamil Nadu, India. Retrospective hospital-based study. Of the 1 167 250 patients who underwent cataract surgery between 2008 and 2020, patients diagnosed with intraoperative ECH were included. Demography, ocular and systemic risk factors, visual acuity, type of ocular anesthesia, intraoperative and postoperative records, management, and surgical outcomes were analyzed. 52 eyes (0.004%) of 1 167 250 patients had ECH. Of the 52 cases, 43 cases (incidence rate 0.006%) were reported in the years 2008 to 2015 and 9 cases (incidence rate 0.002%) in the years 2016 to 2020. The change in the ocular anesthesia from peribulbar and retrobulbar anesthesia (2008 to 2015) to sub-Tenon anesthesia (2016 to 2020) was associated with a reduced rate of ECH ( P = .002). 28 eyes (53.8%) experienced limited ECH and 24 eyes (46.2%) full-blown ECH. The visual outcome was better in eyes with limited ECH compared with full-blown suprachoroidal hemorrhage in all follow-up visits. The median vision (interquartile range) before the cataract surgery and at postoperative day 1 were 1.30 (0.78 to 2.60) and 2.45 (1 to 2.75), respectively. The median final vision (interquartile range) after the secondary surgical intervention was 2.2 (0.60 to 2.60). This series included 52 eyes with ECH, recognized associations of ECH with different types of anesthesia and with different cataract surgical procedures, and described management of ECH. Postoperative visual outcome was poor.

Assessment of Patients' Satisfaction with Anesthesia Services and its Associated Factors at A Teaching Hospital in South India: A Cross-Sectional Study

Background: Patient satisfaction is one of the main quality indicators of anesthesia services. Various factors can determine patient satisfaction, such as anesthetist-patient interaction, perioperative anesthetic management, and postoperative follow-up. The aim of this study was to assess patient satisfaction with anesthesia services and its associated factors.&#x0D; Methods: An Institutional based cross-sectional study was conducted from July 2019 to October 2019 at a teaching hospital in South India. Patients who have undergone surgery by either general or regional anaesthesia were included. For postoperative interview, a structured questionnaire was administered. The satisfaction score was considered to be an outcome variable. Age, gender, ASA status, and type of anesthesia were considered to be explanatory variables.&#x0D; Results: A total of 462 patients were included in the study. The mean age of the study population was 41.84 (±13.48 SD) years. Males were found to have statistically higher mean satisfaction scores as compared to females. The mean satisfaction score among the patients with combined anesthesia (general anesthesia in addition to regional anesthesia) was significantly higher as compared to patients with GA, CNB, and PNB (p&lt;0.05). There was a significant difference in the degree of satisfaction with induction, intraoperative pain relief, and pain relief in the postoperative period among patients with different types of anesthesia (p&lt;0.05). 39.2% of patients were dissatisfied with the self-introduction of anesthetists, and 17.7% were dissatisfied with anesthetist revisit in postoperative period.&#x0D; Conclusion: Poor self-introduction of anesthetists, absence of postoperative revisit by the anesthetist, and lack of proper planning for postoperative pain relief contributed a major part to the dissatisfaction.