Effects Of Anesthesia Research Articles

The role of adjuvants in regional anesthesia: the postoperative analgesic effectiveness of dexamethasone vs. tramadol given as adjuvants to bupivacaine for ultrasound-guided supraclavicular block for upper extremity surgery—a prospective cohort study

BackgroundBrachial plexus block is used as a surgical anesthesia and analgesia for postoperative pain. Recently, the use of local anesthetics for regional nerve block has been enhanced by mixing them with a different class of drugs as adjuvants. These adjuvants of local anesthetics improved the quality and duration of nerve block and reduced the dose-dependent side effects of local anesthetics. However, the effectiveness of these adjuvants varies depending on the nature of the nerve block and the type of local anesthetics used. Therefore, we aimed to compare the postoperative analgesic effectiveness of dexamethasone vs. tramadol when used as adjuvants to bupivacaine for ultrasound-guided supraclavicular block in upper extremity surgery.MethodsUtilizing a prospective cohort study design, 126 consecutive patients who were undergoing upper extremity surgery with ultrasound-guided supraclavicular block were included. Patients were divided into three groups based on the preference of the responsible anesthetist to use adjuvants with bupivacaine for the block. The dexamethasone group (n = 42) were given 30 ml of 0.25% bupivacaine with 8 mg dexamethasone, the tramadol group (n = 42) were given 30 ml of 0.25% bupivacaine with 100 mg tramadol, and the non-adjuvant group (n = 42) were given 30 ml of 0.25% bupivacaine alone. The primary outcomes evaluated were postoperative pain severity using the numerical pain rating scale (NRS), the duration of analgesia, and the total postoperative analgesic consumption. Secondary outcomes included the incidence of postoperative complications.ResultA total of 126 patients were recruited and analyzed. There was no statistical difference in the demographic data among the groups. The postoperative NRS score was significantly reduced in the dexamethasone and tramadol group compared with the non-adjuvant group (p < 0.001). The NRS score in the dexamethasone group at 18 and 24 h was statistically much lower than in the tramadol and non-adjuvant group. The postoperative duration of analgesia was significantly prolonged in the dexamethasone (1,069 ± 316.99 min) group compared with the tramadol (617.02 ± 214.05 min) and non-adjuvant (434.17 ± 111.23 min) groups (p < 0.001). Patients in the non-adjuvant group had a significantly higher total analgesic consumption over 24 h. The dexamethasone group experienced significantly fewer incidences of nausea, with no differences in other complications among the groups.ConclusionThe addition of dexamethasone as an adjuvant to bupivacaine for ultrasound-guided supraclavicular block improves postoperative analgesia. We recommend the integration of dexamethasone as an adjuvant to local anesthetics during nerve blocks to enhance postoperative pain management after surgery.

Anesthetic sampling and the tissue regeneration potential of oysters: A study with Crassostrea hongkongensis

The use of an appropriate amount of anesthetic can prevent the sacrifice of oysters during experimental sampling or seedling rearing. In this study, we assessed the effects of air exposure and three concentrations of magnesium chloride (10, 40, and 70 g L–1) on the anesthetic efficiency for Crassostrea hongkongensis. We examined the recuperative capacity of the oysters post-tissue sampling. The results indicated that 36 h of air exposure could significantly enhance the anesthetic efficiency of C. hongkongensis while ensuring the oysters’ survival. A 40 g L–1 solution of magnesium chloride had the optimal anesthetic effect on C. hongkongensis across all oyster sizes. In addition, smaller oysters (119.10 g) had a higher relaxation rate than larger oysters (191.00 g). The oysters anesthetized with 40 g L–1 magnesium chloride also demonstrated the best recovery. No deaths were observed among the non-anesthetized oysters, anesthetized-recovered oysters, or non-recovered oysters during a seven-day post-farming period. In terms of live sampling, the control group (100 %), gonad group (100 %), mantle group (98.67 %), gill group (89.33 %), and adductor muscle group (97.33 %) all showed high survival rates after anesthesia. Observation of tissue growth post-sampling revealed the presence of focal green areas in tissues between days 7 and 14. By day 30, the adductor muscle and mantle tissues had fully healed, and the regrown tissue in the gills had approached its original length. A 40 g L–1 magnesium chloride solution had no significant effects on gametes in terms of fertilization rate, growth rate, and attachment rate. The present findings indicated that C. hongkongensis could be effectively anesthetized using a 40 g L–1 magnesium chloride solution following 36 h of aerial exposure. Post-anesthesia tissue and gamete sampling did not result in significant mortality, and the tissues had fully recovered within 30 days post-sampling. The anesthesia did not have any adverse effects on the progeny.

OXY-SCORE and Volatile Anesthetics: A New Perspective of Oxidative Stress in EndoVascular Aneurysm Repair-A Randomized Clinical Trial.

An aortic aneurysm (AA) is a life-threatening condition. Oxidative stress may be a common pathway linking multiple mechanisms of an AA, including vascular inflammation and metalloproteinase activity. Endovascular aneurysm repair (EVAR) is the preferred surgical approach for AA treatment. During surgery, inflammation and ischemia-reperfusion injury occur, and reactive oxygen species (ROS) play a key role in their modulation. Increased perioperative oxidative stress is associated with higher postoperative complications. The use of volatile anesthetics during surgery has been shown to reduce oxidative stress. Individual biomarkers only partially reflect the oxidative status of the patients. A global indicator of oxidative stress (OXY-SCORE) has been validated in various pathologies. This study aimed to compare the effects of the main volatile anesthetics, sevoflurane and desflurane, on oxidative status during EVAR. Eighty consecutive patients undergoing EVAR were randomized into two groups: sevoflurane and desflurane. Plasma biomarkers of oxidative damage (protein carbonylation and malondialdehyde) and antioxidant defense (total thiols, glutathione, nitrates, superoxide dismutase, and catalase activity) were measured before surgery and 24 h after EVAR. The analysis of individual biomarkers showed no significant differences between the groups. However, the OXY-SCORE was positive in the desflurane group (indicating a shift towards antioxidants) and negative in the sevoflurane group (favoring oxidants) (p < 0.044). Compared to sevoflurane, desflurane had a positive effect on oxidative stress during EVAR. The OXY-SCORE could provide a more comprehensive perspective on oxidative stress in this patient population.

Desflurane Versus Sevoflurane and Postoperative Cardiac Biomarkers in Older Adults Undergoing Low- to Moderate-Risk Noncardiac Surgery-Secondary Analysis of a Prospective, Observer-Blinded, Randomized Clinical Trial.

Background/Objectives: Previous preclinical studies have shown that desflurane might have the most significant cardioprotective effect of all volatile anesthetics. However, data regarding the cardioprotective effects of desflurane versus sevoflurane are lacking. Therefore, we evaluated the effect of the maintenance of anesthesia using desflurane versus sevoflurane on the postoperative maximum concentrations of cardiac biomarkers in older adults undergoing low- to moderate-risk noncardiac surgery. Methods: In this secondary analysis of a prospective randomized trial, we included all 190 older adults undergoing low- to moderate-risk noncardiac surgery. Patients were randomized to receive desflurane or sevoflurane for the maintenance of anesthesia. We administered desflurane or sevoflurane, aiming at a BIS value of 50 ± 5. The cardiac-specific biomarkers included troponin T, NT-proBNP, and copeptin, which were measured preoperatively, within one hour after surgery, and on the second postoperative day. Results: There were no significant differences between the desflurane and sevoflurane groups in the postoperative maximum concentrations of troponin T (11 ng.L-1 [8; 16] versus 13 ng.L-1 [9; 18]; p = 0.595), NT-proBNP (196 pg.mL-1 [90; 686] versus 253 pg.mL-1 [134; 499]; p = 0.288), or copeptin (19 pmol.L-1 [7; 58] versus 12 pmol.L-1 [6; 41]; p = 0.096). We also observed no significant differences in the troponin T, NT-proBNP, or copeptin concentrations between the desflurane and sevoflurane groups at any measured timepoint (all p > 0.05). Conclusions: In contrast to preclinical studies, we did not observe a significant difference in the postoperative maximum concentrations of cardiac biomarkers. It seems likely that desflurane does not exert significant clinical meaningful cardioprotective effects in older adults. Thus, our results do not support the use of desflurane in patients undergoing low- to moderate-risk noncardiac surgery.

Effect of General Anesthesia vs Regional Anesthesia on Sleep Disturbance in Elderly Patients After Discharge from the Hospital for 3 Months.

This study aims to investigate the impact of anesthetic methods on the occurrence of postoperative sleep disorders in elderly patients following their discharge from the hospital for 3 months. This retrospective observational cohort study included elderly patients aged >60 years who had undergone general and regional anesthesia from 1 June 2023 to 31 December 2023. These patients were then assessed for sleep by telephone callback using the Athens Insomnia Scale after discharge from the hospital three months later. The duration of pain and sleep disturbance experienced by patients following discharge was also recorded. Following propensity score matching, 308 individuals were included in the study (154 in the GA group and 154 in the RA group). Compared with general anesthesia (11.7%), regional anesthesia (5.2%) reduced the prevalence of sleep disorders in elderly patients after discharge from the hospital. However, the duration of sleep disturbance and pain exhibited no statistically significant difference between the two groups (p=0.818; p=0.211). Regional anesthesia was associated with a reduction in the incidence of sleep disorders in elderly patients after discharge from the hospital for 3 months.

Comparison of Peribulbar and Topical Anesthesia in Phacoemulsification Cataract Surgery in Terms of Pain

Purpose: To compare effectiveness of Peribulbar and topical anesthesia in phacoemulsification in terms of severity of pain. Study Design: Quasi experimental study. Place and Duration of Study: This cross sectional study was conducted at Eye Department, Liaquat National Hospital, Karachi, from August 2017 to January 2020. Methods: This study included 1154 patients of 40-75 years of age who underwent phacoemulsification. Complete ocular examination was performed. Patients were allocated into two groups by convenient sampling. Cataract surgery was performed under Peribulbar anesthesia in 577 patients and other 577 patients were operated using topical anesthesia. Pain was assessed by Visual Analogue Scale Score. Frequency and percentage and mean± standard deviation was computed for qualitative and quantitative variables respectively using SPSS version 21. Chi square test was used for stratification of gender, duration of symptom and age, p≤0.05 was considered significant. Results: Average age of the patients was 57.43±6.70 years. There were 576(49.9%) males and 578(50.1%) females. There were 34 (5.9%) patients in Peribulbar group and 382 (66.2%) patients in topical group who had no pain (p=0.0005).Frequency of mild, moderate and sever pain was less in patients given topical anesthesia. The rate of pain was significantly higher in older and female patients with shorter duration of symptoms (p 0.0005). Conclusion: Phacoemulsification can be accomplished efficiently and effectively using topical anesthesia. Compared to retro bulbar and Peribulbar anesthesia, it offers several advantages and a high degree of pain satisfaction for the patient.

Magnesium Sulphate Versus Fentanyl as Adjuncts to Epidural Anaesthesia for Lower Limb Orthopaedic Surgeries: A Comparative Study

Abstract Introduction: Pain relief for lower limb orthopaedic surgeries is achievable with epidural anaesthesia. This study compared the analgesic effects of epidural anaesthesia with magnesium sulphate or fentanyl adjuvant in patients scheduled for elective lower limb orthopaedic surgeries. Patients and Methods: A double-blind randomisation study was carried out on 96 patients categorised into three groups; M, F, and C. All participants received 18 mL of 0.5% bupivacaine plus 1.5 mL of 75 mg magnesium sulphate in Group M or 50 mg of fentanyl in Group F or normal saline in Group C via the lumbar epidural route. Variables including the onset time of sensory and motor blockade, duration of anaesthesia, and time for postoperative Numerical Rating Scale (NRS) score of 3 were summarised using mean, median, standard deviation, and percentages as appropriate. A P value of &lt;0.05 was considered statistically significant. Results: Mean onset time for the sensory blockade at T8 was 23.7 ± 5.3, 20.5 ± 3.4, and 17.9 ± 5.6 min for groups C, F, and M, respectively (P = 0.001). The onset time for the motor blockade (Bromage score 3) was 29.8 ± 4.0, 26.6 ± 3.5, and 24.5 ± 5.3 min in groups C, F, and M, respectively (P = 0.001). The duration of epidural anaesthesia was 121.6 ± 31.5, 145.9 ± 29.6, and 167.0 ± 27.0 min in groups C, F, and M, respectively (P = 0.001). The time to attain an NRS pain score of 3 was 133.2 ± 27.7, 151.8 ± 32.4, and 172.0 ± 30.9 min in groups C, F, and M, respectively (P = 0.001). Conclusion: Magnesium sulphate is better as an epidural adjuvant compared to fentanyl in patients undergoing lower limb orthopaedic surgeries.

Comparison of inhalational and intravenous anesthesia induction on electroencephalogram and cerebral perfusion in children with congenital heart disease: A secondary analysis of a randomized controlled trial

ObjectiveThe effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction. DesignA randomized controlled trial. SettingOperation room in two tertiary hospitals. ParticipantsA cohort of 116 pediatrics patients undergoing cardiac surgery. Measurements and main resultsThe patients were randomly assigned to either the intravenous group (n=58) or the inhalational group (n=58). The inhalational group received anesthesia induction with 4-6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, while the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison to the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (P<0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (P<0.05 for all). ConclusionThe administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared to the use of intravenous medications for anesthesia induction.

The effects of general anaesthesia on body temperature of dogs subjected to ovariohysterectomy or orchiectomy performed by veterinary students in a teaching hospital

Hypothermia during anaesthesia is a significant concern in veterinary practice, as it can lead to various complications, making it essential to understand the factors that contribute to temperature regulation in animals undergoing surgical procedures. This retrospective study aimed to evaluate the change in body temperature over the course of anaesthesia in dogs undergoing elective ovariohysterectomy and orchiectomy, and determine the effect of gender, dose of premedication, weight, age and duration of anaesthesia of the change of body temperature over time. One-hundred and ten dogs (n=110) that underwent elective ovariohysterectomy (n=75) and orchiectomy (n=35) surgery performed by veterinary students at the University of Adelaide were enrolled in this study. Dogs’ anaesthesia records were evaluated for change in body temperature over the course of anaesthesia, and correlated with gender, two premedication doses of acepromazine (mg/kg), body weight (kg), age (months) and anaesthesia times (minutes). The analyses were performed at TPm (temperature at premedication), T0 (induction), T15, T30, T60, T90, T120 and TRec (recovery) minutes. Statistical analysis was performed using the GenStat software and included repeated measures analysis and ANOVA. Significance was considered when p < 0.05. The data showed a significant time-by-gender interaction with female dogs experienced a greater degree of heat loss than male dogs at T60 (p<0.01), T90 (p<0.01) and T120 (p<0.01). At recovery, female average temperature was higher than in males (p<0.01). There was no significant difference in body temperature when other covariates were used in the analysis. The core body temperature of female dogs decreased significantly over time compared to males, with the most pronounced differenced during the intraoperative period. However, the study’s retrospective nature and limited sample size may influence the generalizability of these findings.

Comparison of nerve block and spinal anesthesia in second toe pulp free flap surgery for fingertip reconstruction.

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.

Lameness of horses is effectively ameliorated with a low volume of mepivacaine administered as a palmar digital nerve block.

To determine the effect of 1.5 mL 2% mepivacaine, 0.75 mL 2% mepivacaine, and a combination of 0.75 mL 2% mepivacaine with epinephrine (1:200,000 solution) administered over each palmar digital nerve (PDN) to 6 horses with naturally occurring lameness caused by digital pain. In a crossover study design, 6 horses with forefoot-related lameness were randomly assigned to 1 of 3 groups. Each group received, on different study days, a PDN block using 1.5 mL of 2% mepivacaine, 0.75 mL 2% mepivacaine, or 0.75 mL of a combination of 2% mepivacaine and epinephrine (1:200,000 solution) injected over each nerve. The horses' gait while trotting was analyzed with an inertial, sensor-based motion-analysis system immediately before treatment. The assigned treatment was then administered to the lame forelimb, after which the gait was reevaluated at 5-minute intervals for 15 minutes. All 3 treatments significantly reduced lameness scores at all gait evaluations, but the effect of treatment on the lameness score did not differ significantly among treatments. 0.75 mL of mepivacaine hydrochloric acid injected over each PDN was as effective as twice that volume in decreasing the lameness score of horses with digital pain. The 0.75-mL solution of mepivacaine/epinephrine injected over each nerve did not significantly improve the anesthetic effect of mepivacaine. For a palmar digital nerve block, a lower-than-commonly-recommended volume of 2% mepivacaine effectively ameliorates digital pain. This finding invites investigation as to whether administering a low volume of local anesthetic will more precisely localize pain.

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer.

Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy. However, due to the physiological characteristics of elderly patients, the safety of perioperative anesthesia needs special attention. As an α2-adrenergic receptor agonist, dexmedetomidine (Dex) has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure, inhibitory effect on inflammation, and sedative and analgesic effects. Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer. To investigate the anesthetic effects of Dex during radical surgery for colon cancer under general anesthesia in elderly patients. A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital, Qingdao, China were recruited and divided into two groups: A and B. In group A, Dex was administered 30 min before surgery, while group B received an equivalent amount of normal saline. The hemodynamic changes, pulmonary compliance, airway pressure, inflammatory factors, confusion assessment method scores, Ramsay Sedation-Agitation Scale scores, and cellular immune function indicators were compared between the two groups. Group A showed less intraoperative hemodynamic fluctuations, better pulmonary compliance, and lower airway resistance compared with group B. Twelve hours after the surgery, the serum levels of TLR-2, TLR-4, IL-6, and TNF-α in group A were significantly lower than those of group B (P < 0.05). After extubation, the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients, indicating a higher level of sedation. The incidence of delirium was significantly lower in group A than in group B (P < 0.05). The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

The evaluation of anaesthetic efficacy of Coriandrum sativum essential oils in three-spotted tilapia (Oreochromis andersonii): a study of fish size and water temperature

The present study aimed to determine the anaesthetic effectiveness, safety, and applicable concentrations of coriander (Coriandrum sativum) essential oils (CEO) for three-spotted tilapia (Oreochromis andersonii). For this purpose, CEO concentrations of 400, 500, and 600 µL/L were tested at two temperatures, 20.90 ± 1.19 °C and 30.60 ± 0.92 °C, on three different sizes (small, medium, and large) of the fish in duplicate glass aquaria with 200 mg/L of tricaine methanesulfonate (MS-222) served as the control. The sedative efficacy during simulated transportation experiments was also carried out. The results demonstrated that the induction and recovery time in O. andersonii anaesthetised with CEO were significantly influenced by concentration, water temperature, and fish size (P < 0.05). A concentration of 600 µL/L of CEO was found to be highly effective in inducing deep anesthesia and promoting rapid recovery in small and medium-sized fish at both water temperatures (20 and 30 °C). Based on this study, 100 µL/L of CEO is recommended for short-term transportation lasting up to 4 h, while 50 µL/L is advised for longer-distance transport. Although coriander essential oil shows anaesthetic effectiveness in three-spotted tilapia, further research is needed to fully understand the efficacy and safety of CEO across different fish species.

Creation and Expansion of Bioadhesive Transdermal Gel of Levobupivacaine Loaded Nanoparticles for Enhancement of Anesthetic Effect.

The present research work aimed to prepare a bioadhesive gel containing Levobupivacaine-loaded nanoparticles (NPs) to improve local anesthesia as transdermal patches were patient-friendly and easy to therapy. This study focuses on developing a The NPs were created using the ionotropic gelation method and assessed for particle charge, vesicle size and its distribution, and surface morphology. The improved NPs were incorporated into a gel and evaluated for their physicochemical assets. Among the NPs, NP4 was identified as the best based on its physicochemical properties. The NG-6 bioadhesive gel formulation stood out as the top gel among those tested. The NG-6 gel exhibited superior skin permeation ended 14 hours compared to other NPs. This bioadhesive transdermal gel with Levobupivacaine nanoparticles offers a promising approach to enhancing anesthetic effects.

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital.

Introduction Perioperative hypothermia is a common yet underreported complication of surgery. It results from various factors, including cold operating theaters, anesthetic effects, environmental exposure, exposed tissues, and the administration of cold intravenous or irrigation fluids. This study aims to determine the incidence of perioperative hypothermia in a district National Health Service hospital to assess the feasibility of a randomized controlled trial (RCT) for interventions to prevent hypothermia. Methods This retrospective study included the data of 200 elective surgical patients at North Manchester General Hospital from June 1, 2022, to August 1, 2022. Inclusion criteria were elective general surgery, urology, breast, and gynecology patients aged 18 to 60 years. Exclusion criteria included emergency cases and patients younger than 18 or older than 60. Temperature measurement data were collected from the anesthesia records of the patients at six phases: preoperative, pre-induction, intraoperative, post-procedure, recovery room, and post-recovery. Data collection included specialty, surgery duration, and the use of intraoperative fluid warmers. Statistical analysis was performed using StatsDirect software (StatsDirect Ltd, Wirral, UK). Results Among the 200 patients, the overall incidence of hypothermia was 4% preoperatively, 5% pre-induction, 12% intraoperatively, 11% postoperatively, 8% in recovery, and 6% post-recovery. Intraoperative hypothermia incidence was significant, given that active warming was applied to patients with preoperative hypothermia. Regression analysis showed no correlation between intraoperative temperature and the use of intraoperative fluid warmers. Pre-induction temperature was the most statistically significant predictor of intraoperative hypothermia. Conclusions This study highlights the need for active interventions to recognize and prevent perioperative hypothermia in elective surgical patients. Active pre-warming of patients, regardless of surgery type and duration, is feasible and potentially beneficial. Future research should include an RCT comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial

Abstract To observe the effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation on patients undergoing ureteroscopic holmium laser lithotripsy. One hundred and twenty patients who underwent ureteroscopic holmium laser lithotripsy in our hospital were selected and randomly divided into nasopharyngeal airway group (research group) and laryngeal mask group (control group). These patients, respectively, received intravenous anesthesia under nasopharyngeal airway and laryngeal mask-assisted ventilation. The following evaluation indexes were compared and analyzed between the two groups, including anesthetic effect, hemodynamics, stress response, postoperative recovery, adverse reactions, etc. There were no significant differences in Visual Analog Scale, hemodynamics, and stress response between the two groups at each time point (P &gt; 0.05). There were no significant differences in residence time and postoperative recovery time between the two groups (P &gt; 0.05). The difference in airway establishment time between the two groups was statistically significant (P &lt; 0.05), and cases with blood in the research group was significantly lower than those in the control group (P &lt; 0.05). Patient satisfaction in research group was significantly higher than those in the control group (P &lt; 0.05). The clinical effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation in ureteroscopic holmium laser lithotripsy is significant, which helps to stabilize patients’ hemodynamics, reduce their stress response and adverse reactions, and improve the satisfaction rate of patient.

Opioid-free anesthesia attenuates perioperative immunosuppression by regulating macrophages polarization in gastric cancer patients treated with neoadjuvant PD-1 inhibitor.

Opioid anesthesia can modulate the impaired immune response and opioid-sparing anesthesia may preserve immune functions. This study was performed to assess the effects of opioid-free anesthesia (OFA) and opioid-based anesthesia (OA) on perioperative macrophages differentiation, cytokine changes, and perioperative complications in locally advanced GC (LAGC) patients. We used quality of recovery-15 (QoR-15) questionnaire scores and visual analog scale (VAS) scores to compare postoperative quality of recovery and pain level. In addition, the adverse reactions of patients in the two groups were compared. The perioperative serum level of inflammatory cytokines and the ratio of macrophage subtypes were detected. The OFA group had significantly longer extubation time and PACU stay, whereas the OA group had significantly higher rate of hypotension, higher doses of norepinephrine, higher PONV and dizziness rate, and delayed flatus passage time. The QoR-15 score on postoperative 24 h was significantly higher in OFA group than in OA group. At the end of or after the surgery, the OFA group had higher levels of interleukin (IL)-12, IL-1β, tumor necrosis factor (TNF)-α, CD68+CD163- macrophage rate, but lower levels of IL-10, transforming growth factor (TGF)-β, and CD68+CD163+ macrophage rate, indicating OFA attenuated perioperative immunosuppression by diminishing M2 and promoting M1 macrophage polarization. And the reversal tendency is more obvious in LAGC patients with neoadjuvant PD-1 inhibitor. The OFA may attenuate perioperative immunosuppression by diminishing M2 and promoting M1 macrophage polarization in LAGC patients with neoadjuvant PD-1 inhibitor. http://gcpgl.sysucc.org.cn, identifier 2022-FXY-001.

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 &lt; 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.

Diethyl ether anaesthesia does not block local touch response in Arabidopsis thaliana

Plants can sense and respond to non-damaging mechanical stimulation such as touch, rain, or wind. Mechanical stimulation induces an increase of cytosolic calcium ([Ca2+]cyt), accumulation of phytohormones from the group of jasmonates (JAs) and activation of gene expression, which can be JAs-dependent or JAs-independent. Response to touch shares similar properties with reactions to stresses such as wounding or pathogen attack, and regular mechanical stimulation leads to changes in growth and development called thigmomorphogenesis. Previous studies showed that well-known seismonastic plants such as Venus flytrap (Dionaea muscipula) or sensitive plant (Mimosa pudica) lost their touch-induced motive responses during exposure to general volatile anaesthetic (GVA) diethyl ether. Here, we investigated the effect of diethyl ether anaesthesia on touch response in Arabidopsis thaliana. We monitored [Ca2+]cyt level, accumulation of JAs and expression of touch-responsive genes. Our results showed that none of the investigated responses was affected by diethyl ether. However, diethyl ether alone increased [Ca2+]cyt and modulated JAs-independent touch-responsive genes, thus partially activating touch response non-specifically. Together with our previous studies, we concluded that GVA diethyl ether cannot block the local rise of [Ca2+]cyt but only its systemic propagation dependent on GLUTAMATE LIKE RECEPTOR 3s (GLR3s) channels.