Effects Of Anesthesia Research Articles

Continuous monitoring of somatosensory evoked potentials following spinothalamic tract stimulation in brainstem and spinal cord surgery: case report and literature review

The primary objective of neurosurgical intervention for central nervous system tumors is a balance between optimal tumor resection and minimal postoperative neurological impairment. Intraoperative neurophysiological monitoring is essential in safeguarding somatosensory tracts during surgery. Virtually the only tool for continuous monitoring of sensory pathways is registration of peripheral somatosensory evoked potentials (SSEPs). However, this method has some limitations. To increase the quality of intraoperative SSEP monitoring in surgical treatment of brainstem and spinal cord tumors. To ensure continuous monitoring of sensory pathway function in brainstem and spinal cord surgery, we modified the method for monitoring of SSEPs. Unlike standard technique, we placed two-contact electrode for stimulation either in the area of the bottom of the fourth ventricle or on posterior surface of the spinal cord along the midline. This allows us to stimulate pontine tegmentum or posterior columns of spinal cord. We demonstrated the feasibility of this method in 2 cases. The advantage of this method is possible brainstem or spinal cord stimulation reducing the chain of somatosensory tract that is valuable to neutralize the effect of anesthesia on significance of neurophysiological data.

Interactions Between Anesthesia and Sleep: Optimizing Perioperative Care to Improve Sleep Quality and Surgical Recovery Outcomes.

Sleep is a fundamental physiological process that supports immunity, cognition, memory, and metabolism, making it essential for overall health and well-being. Poor-quality sleep is associated with the onset of many diseases, including cardiovascular and mental health disorders. When using anesthesia, it is essential to have a thorough understanding of the metabolic dysfunction and immunosuppression linked to sleep loss to ensure appropriate perioperative management. Commonly used agents like propofol, sevoflurane, and ketamine affect consciousness, pain levels, and autonomic responses. Inhaled anesthetics (e.g., sevoflurane and isoflurane) and intravenous anesthetics (propofol) act on gamma-aminobutyric acid (GABA) receptors and influence stages of sleep and circadian rhythms. Ketamine may uniquely preserve some aspects of restorative sleep, while most anesthetics affect rapid eye movement (REM) and slow wave sleep (SWS), altering cognitive and physical recovery. Modifying anesthetic regimes depending on the patient's sleep history and risk factors can maximize sleep health and postoperative patient outcomes. The physiological effects of anesthesia on the central nervous system persist beyond the perioperative period by influencing sleep quality, circadian regulation, and postoperative outcomes. Effective pain management is a significant component in addressing sleep quality. Opioids, while effective for pain relief, disrupt sleep architecture by reducing REM and SWS, increasing awakening frequency, and potentially causing respiratory depression. Multimodal pain therapy, including non-opioid analgesics, can reduce dependence, improve sleep quality, and lower adverse effects. Anesthetic agents can influence the body's internal clock, leading to mood changes, fatigue, and cognitive deficits. This review exploits the relationship between sleep and anesthesia, detailing the effect of anesthetic agents on the quality, architecture, and recovery of sleep patterns post-surgery. It also explores how these agents influence sleep stages, such as REM and non-REM sleep, and their implications for patient outcomes. Incorporating sleep optimization techniques can enhance recovery timelines and patient well-being. Researching anesthetic techniques that support postoperative sleep health is essential for further improving patient outcomes.

Righting response and electrocardiographic evaluation of juvenile tambaqui (Colossoma macropomum) (Cuvier, 1818) exposed to immersion baths with different concentrations of bushy lippia essential oil (Lippia alba).

In recent years, the use of natural products as alternatives to synthetic anesthetic agents has gained notoriety in aquaculture. Among the essential oils studied, Lippia alba has attracted attention due to its diverse pharmacological properties, including sedative and anesthetic effects. This study aims to evaluate the anesthetic activity of Lippia alba essential oil (LAEO) to propose a therapeutic window for its use in tambaqui (C. macropomum). In this research, juvenile tambaqui (10.9 ± 5.9g, n = 90) were submitted to anesthetic baths with LAEO at concentrations of 80-140 μL.L-1 for behavioral assessment and electrophysiological recordings. The findings showed that all concentrations were effective in inducing the loss of posture reflex and its subsequent reversible return. However, electrocardiographic recordings at concentrations of 120 and 140 μL.L-1 revealed alterations in the graph elements, indicating more intense bradycardia and atrioventricular block during anesthetic induction. Nevertheless, during the anesthetic recovery period, cardiac normality was restored at all tested concentrations, although more slowly at the highest concentration (140 μL.L-1). Thus, we conclude that this oil is safe for providing short-term anesthesia at concentrations between 80 and 100 μL.L-1 in C. macropomum specimens.

The effect of regional anesthesia of the nerves of the pelvic limb on hemodynamic parameters during operations on the anterior cruciate ligament in dogs

The article presents data on the study of the effect of regional anesthesia of the nerves of the pelvic limb during operations on the anterior cruciate ligament in dogs on hemodynamic parameters: heart rate and average blood pressure. The study was performed throughout the entire surgical intervention. Indicators of the state of circulatory function were recorded before anesthesia, after induction and after 5, 10, 20, 30, 40, 50, 60 minutes after the injection of a local anesthetic, then 10 and 20 minutes after waking up. Depending on the method of anesthesia used, the experimental animals were divided into 4 groups. In the course of the study, it was found that the heart rate in dogs significantly increased, and the average blood pressure decreased when performing surgery on the anterior cruciate ligament under epidural anesthesia and multimodal analgesia in comparison with the group where dogs underwent anesthesia of the lateral cutaneous nerve of the thigh. Such dynamics of indicators can lead to inhibition of circulatory function, which increases the risk and probability of resuscitation during reconstructive knee joint operations.

Topical intranasal anesthesia impairs trigeminal function and airflow perception.

Impairment of airflow perception by the intranasal trigeminal system may explain chronic nasal obstruction (CNO),especially in cases where no major deformity or mucosal inflammation can explain reduced airflow. We aim to characterize the effect of topical intranasal anesthesia on intranasal trigeminal sensitivity and consequently the sensation of nasal obstruction. We performed a crossover study of 16 healthy subjects, randomised for either treatment (topical intranasal anesthesia with 10% Xylocaine) or placebo (saline solution). We used the Trigeminal Lateralization Task (TLT) with eucalyptol to assess trigeminal sensitivity. We measured nasal patency objectively with Peak Nasal Inspiratory Flow (PNIF), and subjectively with a Visual Analog Scale (VAS), the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Topical intranasal anesthesia significantly reduced intranasal trigeminal sensitivity. Further, after topical intranasal anesthesia,reduced trigeminal sensitivity was associated with the subjectively reduced nasal patency, as highlighted by ENS6Q and NOSE scores. Topical intranasal anesthesia reduces intranasal trigeminal function resulting in subjectively reduced nasal patency. In future studies, the relation of reduced intranasal trigeminal function and subjective nasal obstruction needs to be addressed to open an avenue for potential interventions for an important portion of ENT patients.

Pulse oximeter perfusion index as a new predictor of hypotension following subarachnoid block in lower segment Cesarean section: A prospective randomized study

Background: Hypotension is a common adverse effect of spinal anesthesia, especially during pregnancy, due to the blockade of pre-ganglionic sympathetic fibers, resulting in reduced peripheral vascular resistance. This study explores the perfusion index (PI) as a potential predictor for hypotension during spinal anesthesia in lower segment Cesarean sections (LSCS). Aims and Objectives: The aim of the study was to study the correlation between baseline PI and the incidence of hypotension following subarachnoid block in LSCS. Materials and Methods: This prospective observational study included 90 parturients, divided into two groups based on baseline PI: Group 1 (PI≤3.5) and Group 2 (PI>3.5). Spinal anesthesia was administered with 10 mg of 0.5% hyperbaric bupivacaine at the L3-L4 interspace. The study evaluated the correlation between baseline PI and the degree of hypotension, as well as PI’s predictive capacity for hypotension during Cesarean delivery. Results: Hypotension occurred in 35.55% of Group 1 and 75.55% of Group 2 (P<0.001). A significant correlation was found between baseline PI>3.5 and both the incidence of hypotension and the total mephentermine dose required (P<0.001). The sensitivity and specificity of PI>3.5 for predicting hypotension were 68% and 72.5%, respectively. The area under the receiver operating characteristic curve for PI as a predictor of hypotension was 0.914. Conclusion: A higher baseline PI is associated with a higher incidence and severity of hypotension following spinal anesthesia. Baseline PI is a reliable predictor of spinal anesthesia-induced hypotension during Cesarean delivery and could be used for early identification and management of at-risk patients.

In silico Evaluation of Anacyclus pyrethrum Composition for Inhibition of Spike RBD-ACE-2 Interaction to Treat COVID-19

Background: The spike glycoprotein of SARS-CoV-2, via its S1-subunit, binds with host angiotensin-converting enzyme 2 (ACE-2) receptors, and its S2-subunit mediates the fusion of the virus to the host cell. The entry of SARS-CoV-2 inside the host cell can be prevented by inhibition of the receptor binding domain (RBD) of S1-subunit of the spike. Anacyclus pyrethrum, a native herb of Algeria, Spain and Morocco has antidepressant, analgesic, antimicrobial, anesthetic, antioxidant, anti-inflammatory, aphrodisiac, antidiabetic and immunostimulant effects. Still, its antiviral effect has not been established yet. Methodology: The present study deals with ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity), molecular docking and molecular dynamic simulation based investigation to evaluate the potential of Anacyclus pyrethrum constituents for effective spike RBD inhibition. Results: ADMET analysis revealed that 10 out of 12 significant constituents belongs to toxicity class 4 to 6 proving least toxicity of the plant extract with high LD50 values. Molecular docking analysis of 10 considered compounds revealed that morphinan-6-one, 4,5.alpha.-epoxy-3-hydroxy-17-methyl, a derivative of morphine (well-known analgesic and anti-inflammatory compound) gave the maximum negative binding energy of -6.9Kcal/mol in best-docked conformation with spike RBD having 2 hydrogen bonds. Molecular dynamic simulation disclosed effective RMSD, RMSF, and Rg values over the simulation trajectory with significant hydrogen bonding proving stable interaction of the compound with that of the spike RBD. Conclusion: Hence, all these outcomes revealed the outstanding potential of the Anacyclus pyrethrum extract to inhibit the spike RBD of SARS-CoV-2. Therefore, further in-vitro investigation can develop natural and effective treatments against COVID-19 disease.

Sleep deprivation alters hepatic UGT1A9 and propofol metabolism in mice.

Sleep deprivation (SD) causes circadian misalignment, and circadian clock disruption is associated with metabolic diseases such as obesity, insulin resistance, and diabetes. However, the underlying mechanism for SD-induced circadian clock disruption as well as metabolic enzyme changes is still lacking. Here, we developed SD sensitizes mice with disrupted circadian rhythms to demonstrate the regulation role and mechanism of SD in UDP-glucuronosyltransferases (UGTs) expression and the metabolism of corresponding substrates. We found that UGT Family 1 Member A9 (UGT1A9) expression was significantly decreased in the liver of SD mice, which led to an elevation exposure and prolonged anesthesia effect of propofol, which was attributed to the decreased metabolism. Meanwhile, SD down-regulated basic helix-loop-helix ARNT like 1 (BMAL1) and its target clock genes period circadian clock (Per), cryptochrome circadian regulator (Cry), and nuclear receptor subfamily 1 group D member 1 (Rev-erb) expression in mice. Furthermore, the positive regulation of UGTIA9 mRNA and protein levels by Bmal1 was confirmed in hepatocyte-specific Bmal1-knockout mice (Bmal1-hkO) and Bmal1-overexpressed AML-12 cells. At last, through a combination of promoter analysis, luciferase reporter assay, and chromatin immunoprecipitation (ChIP) assay, it was conducted that Bmal1 regulates Ugtla9 expression by directly binding the -864bp E-box in Ugtla9 promotor or indirectly acting on the Rev-erbα- differentiated embryo chondrocyte 2 (Dec2) axis. In conclusion, our findings suggested that SD can lead to altered drug disposition and effects in vivo, and Bmal1 plays a crucial role in the crosstalk between SD-induced circadian clock disruption and drug metabolism. It initiates a new direction for the understanding of drug efficacy and toxicity changes in SD conditions and provides a scientific basis for improving the rationality of drug use.

Effects of Anesthesia and Surgery on the Morphologic and Functional Development of the Premature Neonatal Brain: A Systematic Review and Meta-Analysis

Background: The percentage of preterm infants requiring surgery before 44 weeks of postmenstrual age (PMA) varies between 19% and 36%. The potential impact of general anesthesia on the vulnerable developing brain of preterm infants remains unknown. Methods: A systematic review and meta-analysis on the impact of general anesthesia on brain integrity and neurodevelopmental outcomes in preterm infants undergoing surgery before 44 weeks PMA was conducted. Studies were identified via a PubMed, EMBASE (Ovid), and Cochrane CENTRAL search conducted from inception until 8 March 2023, following PRISMA guidelines. Brain abnormality was assessed using MRI-based brain volume and abnormality scores. Neurodevelopment was evaluated through Bayley Infant and Toddler Development (BSID) or Wechsler Preschool and Primary Scale of Intelligence (WPPSI) tests. Quality was assessed via the Cochrane ROBINS-I tool and GRADE. Results: Our systematic search identified 2883 records, leading to the inclusion of 12 observational studies. Very low-quality evidence suggests that preterm infants exposed to anesthesia were more likely to show postoperative brain abnormalities on MRI (OR 2.01, 95%CI 1.24–3.25, p = 0.005). They had lower neurodevelopmental scores on the BSID II and III (psychomotor developmental index: mean difference (MD) −10.98; 95%CI −12.04 to −9.91; p < 0.001 and cognitive composite score: (MD) −10.11; 95%CI −11.06 to −9.16; p < 0.001 at two years of age compared to preterm infants not exposed to anesthesia. Conclusion: Exposure to surgery and anesthesia before term age is associated with brain abnormalities and neurodevelopmental delay at two years, but conclusions are limited by low evidence quality, uncontrolled confounders, and the methodological biases of the included studies; thus further robust studies are required (PROSPERO:CRD42021255907).

Effects of dexmedetomidine-ropivacaine assisted combined spinal-epidural anesthesia on neutrophil-lymphocyte ratio and postoperative delirium in elderly patients with intertrochanteric femoral fracture

Effects of dexmedetomidine-ropivacaine assisted combined spinal-epidural anesthesia on neutrophil-lymphocyte ratio and postoperative delirium in elderly patients with intertrochanteric femoral fracture

Sevoflurane Preconditioning Rescues PKMζ Gene Expression from Broad Hypoxia-Induced mRNA Downregulation Correlating with Improved Neuronal Recovery

Hypoxia due to stroke is a major cause of neuronal damage, leading to loss of cognition and other brain functions. Sevoflurane preconditioning improves recovery after hypoxia. Hypoxia interferes with protein expression at the translational level; however, its effect on mRNA levels for neuronal protein kinase and anti-apoptotic genes is unclear. To investigate the link between sevoflurane preconditioning and gene expression, hippocampal slices were treated with 4% sevoflurane for 15 min, a 5 min washout, 10 min of hypoxia, and 60 min of recovery. We used quantitative PCR to measure mRNA levels in the CA1 region of rat hippocampi. The mRNA levels for specific critical proteins were examined, as follows: Protein kinases, PKCγ (0.22), PKCε (0.38), and PKMζ (0.55) mRNAs, and anti-apoptotic, bcl-2 (0.44) and bcl-xl (0.41), were reduced 60 min after hypoxia relative to their expression in tissue not subjected to hypoxia (set to 1.0). Sevoflurane preconditioning prevented the reduction in PKMζ (0.88 vs. 1.0) mRNA levels after hypoxia. Pro-apoptotic BAD mRNA was not significantly changed after hypoxia, even with sevoflurane preconditioning (hypoxia 0.81, sevo hypoxia 0.84 vs. normoxia 1.0). However, BAD mRNA was increased by sevoflurane in non-hypoxic conditions (1.48 vs. 1.0), which may partially explain the deleterious effects of volatile anesthetics under certain conditions. The DNA repair enzyme poly ADP-ribose polymerase 1 (PARP-1) was increased by sevoflurane in tissue not subjected to hypoxia (1.23). PARP-1 mRNA was reduced in untreated tissue after hypoxia (0.21 vs. 1.0); sevoflurane did not improve PARP-1 after hypoxia (0.27). Interestingly, the mRNA level of the cognitive kinase PKMζ, a kinase essential for learning and memory, was the only one protected against hypoxic downregulation by sevoflurane preconditioning. These findings correlate with previous studies that found that sevoflurane-induced improvement of neuronal survival after hypoxia was dependent on PKMζ. Maintaining mRNA levels for critical proteins may provide an important mechanism for preserving neuronal function after stroke.

The Effects of Almond Oil, Walnut Oil and Corn Oil on Histopathology of the Heart, Aorta and Testes in L-NAME-induced Hypertensive Rats

Abstract Introduction: Chronic hypertension is a serious physiological condition that develops histopathological abnormalities such as remodelling, hypertrophy in heart muscle and vasoconstriction of blood vessels. The aim of the study was to determine the impact of almond, walnut and corn oils on remodelling and hypertrophy of the heart, aorta and testicles in high blood pressure (BP)-bearing rats. Materials and Methods: Twenty-five adult male albino rats (Rattus norvegicus) weighing 200–250 g were used. Rats were divided into 5 groups, with 5 rats in each group, as the following: Group first: normal control: standard rat chow and tap water ad libitum; Group 2: hypertension induced by L-NAME (model): This group received L-NAME (40 mg/kg/day) orally; Group 3: model + walnut oil, received almond oil (3 ml/kg) for 3 weeks; Group 4: model + almond oil, received walnut oil (3 ml/kg) for 3 weeks and Group 5: mode + corn oil, received corn oil (3 ml/kg) for 3 weeks. The experiment took 28 days, BP was recorded each week and then the animals were sacrificed under the effects of ketamin-xylazine anaesthesia by cervical dislocation. Histopathological slices were taken from the whole heart, aorta and testes using the standard method. The mean BP for each group was presented in the table, and t-test was used for statistical analysis. Histopathological results for each group are shown in the figures. Results: In contrast to almond oil, walnut oil and corn oil have significantly reduced BP (157.9 ± 4.490 mmHg) to (140.1 ± 3.068 mmHg) but not to the control level (130.7 ± 2.605). Walnut and corn oil could prevent tunica media thickness in the aortic, remodelling and hypertrophy in cardiac muscle and protect the architecture of spermatogenesis tissue in seminiferous tubules of testicle. Almond-treated groups showed no improvement in histopathological changes when compared with the model in aorta, cardiac muscle and testicle. Conclusion: Unlike almond oil, corn and walnut oil can reduce high BP induced by L-NAME and alleviate the histopathological changes that occur as the result of hypertension, such as aortic wall thickness and myocadiac hypertrophy.

Somatostatin-expressing neurons in the medial prefrontal cortex promote sevoflurane anesthesia in mice.

The medial prefrontal cortex plays a crucial role in regulating consciousness. However, the specific functions of its excitatory and inhibitory networks during anesthesia remain uncertain. Here we explored the hypothesis that somatostatin interneurons in the medial prefrontal cortex enhance the effects of sevoflurane anesthesia by increasing GABA transmission to pyramidal neurons. EEG was utilized to reflect the depth of anesthesia. Immunostaining and fiber photometry were employed to assess neuronal activities and GABA delivery. The regulation of neuronal activity was achieved by chemogenetics and optogenetics. The expression of c-Fos was increased in somatostatin neurons of the medial prefrontal cortex during sevoflurane anesthesia (air versus sevoflurane: 26.4 ± 6.5 % versus 48 ± 6.2 %, P=0.0007, n=5 mice). Chemogenetic inhibition or activation of somatostatin neurons in the medial prefrontal cortex reduced (from 84 ± 24 s to 51 ± 18 s, P=0.008, n=7 mice) or prolonged (from 97 ± 31 s to 140 ± 30 s, P=0.006, n=7 mice) the sevoflurane anesthesia recovery time. Increased GABA input to pyramidal neurons in the medial prefrontal cortex precedes sevoflurane-induced loss of consciousness (ΔF/F: from 0.46 ± 0.57 % to 2.25 ± 1.42 %, P=0.031, n=10 mice). Activation of somatostatin neurons in the medial prefrontal cortex, leading to a significant reduction in calcium signals within local pyramidal neurons (ΔF/F: from -0.14 ± 0.52 % to -10.08 ± 4.44 %, P=0.002, n=10 mice), and GABA input on pyramidal neurons increased (ΔF/F: from -0.001 ± 0.001 % to 0.28 ± 0.03 %, P=0.002, n=7 mice) in a time-locked manner. Chemogenetic inhibition of pyramidal neurons prolonged the recovery from sevoflurane anesthesia in mice (from 101 ± 46 s to 136 ± 54 s, P=0.017, n=19 mice). Cortical somatostatin neurons may inhibit local pyramidal neurons by enhancing GABA transmission, which increases the effectiveness of sevoflurane anesthesia.

Effectiveness and safety of thoracic segmental spinal anesthesia for breast surgery: A systematic review and meta-analysis

General anesthesia is the standard approach for thoracic and abdominal procedures; however, it has notable limitations, particularly in high-risk patients. Regional anesthesia techniques, such as thoracic segmental spinal anesthesia, have gained popularity due to their potential to reduce these associated risks. The aim of this study was to assess the effectiveness and safety of thoracic segmental spinal anesthesia in breast cancer surgery using systematic review and meta-analysis. This study adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, conducting a comprehensive literature search across ScienceDirect, Cochrane Library, and PubMed databases up to July 4, 2024. The inclusion criteria focused on studies that provided specific information on the effectiveness (postoperative pain reduction) and safety (incidence of adverse events and complications) of thoracic segmental spinal anesthesia, as well as satisfaction among patients and surgeons. Out of 4,060 articles, six studies were included for qualitative assessment, with four further analyzed quantitatively. Meta-analysis findings indicated that thoracic segmental spinal anesthesia provided significantly better pain control at 12 hours postoperatively (SMD: -1.25; 95%CI: -1.54 to -0.96; p<0.0001), although no significant difference was noted at 0 hours (SMD: -1.07; 95%CI: -2.33 to 0.18; p=0.09). Thoracic segmental spinal anesthesia was associated with a lower incidence of postoperative vomiting (RR: 0.46; 95%CI: 0.22–0.95; p=0.04), but it presented a higher risk of hypotension (RR: 2.57; 95%CI: 1.41–4.71; p=0.002). Importantly, no anesthesia-related mortalities were reported. The technique resulted in higher satisfaction levels among both patients (SMD: 0.63; 95%CI: 0.33–0.92; p<0.0001) and surgeons (SMD: 0.81; 95%CI: 0.51–1.11; p<0.0001) compared to general anesthesia. The study highlights that thoracic segmental spinal anesthesia is a safe and effective alternative to general anesthesia for breast cancer surgery, offering superior postoperative pain control, enhanced patient and surgeon satisfaction, and a reduced incidence of postoperative vomiting.

Laboratory animals anesthesia recommendations for biomedical research purposes

Anesthesia is widely used in experimental biomedical research to anesthetize and immobilize laboratory animals during surgical interventions and experimental procedures. In contrast to clinical and veterinary anesthesiology, an important aspect of anesthesia in laboratory animals is to minimize the effect of anesthetics on the results of the study. On November 19, 2022, the IV Scientific and Practical Conference “Experimental Surgery, Anesthesiology and Reanimatology of Laboratory Animals” was held in Moscow, where the community of specialists in the field of laboratory animal science, experimental surgery, pathophysiology, veterinary medicine, clinical and veterinary anesthesiology discussed various aspects of anesthesia in laboratory animals. This review is based on the conference proceedings and is devoted to general issues of animal anesthesia, its technological aspects (methods, equipment and consumables), consideration of advantages and disadvantages of the most commonly used inhalation and injection anesthetics.The advantages and schemes of modern combined anesthesia are substantiated, in particular, the need for adequate intraoperative analgesia and the possibility of regional anesthesia. The use of obsolete and non-recommended drugs is also discussed. The review and recommendations have a practical orientation and are intended for biomedical researchers who use laboratory animals in basic, translational and regulated preclinical studies.

Impact of infusion conditions and anesthesia on CSF tracer dynamics in mouse brain.

Tracer imaging has been instrumental in mapping the brain's solute transport pathways facilitated by cerebrospinal fluid (CSF) flow. However, the impact of tracer infusion parameters on CSF flow remains incompletely understood. This study evaluated the influence of infusion location, rate, and anesthetic regimens on tracer transport using dynamic contrast-enhanced MRI with Gd-DTPA as a CSF tracer. Infusion rate effects were assessed by administering Gd-DTPA into the cisterna magna (ICM) at two rates under isoflurane anesthesia. Anesthetic effects were evaluated by comparing transport patterns between isoflurane and ketamine/xylazine (K/X) anesthesia at the slower rate. Gd-DTPA transport was also examined after lateral ventricle (ICV) infusion, the primary site of CSF production. The results demonstrate that, besides anesthesia, both the location and rate of infusion substantially affected solute transport within the brain. ICV infusion led to rapid, extensive transport into deep brain regions, while slower ICM infusion resulted in more pronounced transport to dorsal brain regions. Cross-correlation and hierarchical clustering analyses of region-specific Gd-DTPA signal time courses revealed that ICM infusion facilitated transport along periarterial spaces, while ICV infusion favored transport across the ventricular-parenchymal interface. These findings underscore the importance of experimental conditions in influencing tracer kinetics and spatial distribution in the brain.

Delayed and long-term effects of epidural anesthesia in childbirth: A literature review

Delayed and long-term effects of epidural anesthesia in childbirth: A literature review

Clinical cases of the use of ESPB as a component of combined anesthesia in patients with liver resection operations

This scientific work is devoted to the topical and applied issue of modern anesthesiology – intensive care – rational anesthesia of laparoscopic liver resections. The transformation of surgical access from «open» to minimally invasive – laparoscopic and robot–assisted – encourages anesthesiologists to search for new methods of prolonged postoperative analgesia. The tendency of modern anesthesiology to limit the use of opioids and the popularization of ultrasound technologies expand the scope of application of myofascial blockades in various fields of surgery. The techniques are safe and effective and can be implemented in various groups of patients, in particular in those who has contraindications to neuroaxial block. Currently, the most commonly used method of anesthetic provision is combined anesthesia –general anesthesia and epidural analgesia. It should be remembered about the features of surgical interventions on the liver and the associated risk of developing massive blood loss syndrome, which increases the frequency of post-operative, primarily hemorrhagic complications, after the use of neuroaxial techniques of prolonged analgesia. The sympatholytic effect of local anesthetics with prolonged epidural infusion is well known, in some cases provoking hemodynamic instability, and, as a result, the need for monitoring the patient in the intensive care unit, as well as increasing the length of hospital stay in general. This circumstance contradicts the trend of modern surgery towards rapid and accelerated recovery after surgery. The above together is economically unprofitable and does not meet the requirements of modern protocols. An in-depth analysis of clinical practice led the authors to the idea of using myofascial blocks (in particular, erector spinae plane block), which have positive qualities of neuroaxial techniques, but are characterized by a better safety profile.

Effect of remimazolam on intraoperative hemodynamic stability in patients undergoing cerebrovascular bypass surgery: a prospective randomized controlled trial.

Maintenance of stable blood pressure (BP) during cerebrovascular bypass surgery is crucial to prevent cerebral ischemia. We compared the effect of remimazolam anesthesia with that of propofol-induced and desflurane-maintained anesthesia on intraoperative hemodynamic stability and the need for vasoactive agents in patients undergoing cerebrovascular bypass surgery. Sixty-five patients were randomized into remimazolam (n = 31, remimazolam-based intravenous anesthesia) and control groups (n = 34, propofol-induced and desflurane-maintained anesthesia). The primary outcome was the occurrence of intraoperative hypotension. The secondary outcomes included hypotension duration, lowest mean BP (MBP), generalized average real variability (ARV) of MBP, and consumption of phenylephrine, norepinephrine, or remifentanil. Occurrence rate and duration of hypotension were significantly lower in the remimazolam group (38.7% vs. 73.5%, P = 0.005; 0 [0, 10] vs. 7.5 [1.25, 25] min, P = 0.008). Remimazolam also showed better outcomes for lowest MBP (78 [73, 84] vs. 69.5 [66.25, 75.8] mmHg, P < 0.001) and generalized ARV of MBP (1.42 ± 0.49 vs. 1.66 ± 0.52 mmHg/min, P = 0.036). The remimazolam group required less phenylephrine (20 [0, 65] vs. 100 [60, 130] μg, P < 0.001), less norepinephrine (162 [0, 365.5] vs. 1335 [998.5, 1637.5] μg, P < 0.001), and more remifentanil (1750 [1454.5, 2184.5] vs. 531 [431, 746.5] μg, P < 0.001) than the control group. Remimazolam anesthesia may provide better hemodynamic stability during cerebrovascular bypass surgery than propofol-induced and desflurane-maintained anesthesia.

Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method.