Elective Anesthesia Research Articles

Adverse events during general anesthesia at the university hospital center (CHU) “Hôpital du Mali”

Objective: To evaluate the incidence of adverse events during general anesthesia and to describe their progression. Methodology: Cross sectional study with retrospective collection over 6 months at the Mali Hospital University Hospital. It included all patients who underwent elective or urgent surgeries under general anesthesia (GA) with tracheal intubation. Vital parameters and details of incidents and accidents were collected and analyzed. Results: During the study period, 723 anesthesia procedures were performed, of which 339 were GA, a prevalence of 46.9%. Among these patients, 149 (43.9%) experienced at least one AE. The mean age was 28 ± 19.9 years old [3 days old; 85 years old], with a sex ratio ~1. AEs occurred during elective anesthesia in 68.4%. The primary surgical specialties were thoracic/cardiovascular surgery (40.4%) and neurosurgery (37.8%). Patients were classified as American Society of Anesthesiologists-2 (ASA 2) in 49.5%. Pharmacological premedication was administered in 84.7%. The intravenous hypnotics used included propofol (85.5%), thiopental (8%), and ketamine (6.5%). Inhalation agents used were isoflurane (99.4%) and halothane (0.6%). Vecuronium (95.5%) was the most commonly used muscle relaxant, while suxamethonium (4.5%) was used for intubation. AEs predominantly occurred during induction and maintenance of anesthesia, with hypotension (84.6%), desaturation, hypertension, and cardiac arrest being the most common. Delayed awakening was observed in 5.6%, including one instance of unrecovered cardiac arrest (0.6%). The overall mortality rate due to AEs was 0.6%. Conclusion: Adverse events are common during GA, particularly during induction and entretien phases, and are associated with a mortality rate of 0.6%. Keywords: Adverse events, GA, Incidence, Mali.

Laryngeal mask vs. laryngeal tube trial in paediatric patients (LaMaTuPe): a single-blinded, open-label, randomised-controlled trial.

In hypoxemic children with difficult airway, or for minor elective procedures, the use of a supraglottic airway device may be preferred to endotracheal intubation, whether with a laryngeal mask or laryngeal tube. Second-generation laryngeal masks may offer a better safety profile. Whether they should be preferred to laryngeal tubes is unknown. This study aimed to compare the efficacy and safety of second-generation laryngeal masks and laryngeal tubes in children. This randomised-controlled trial was conducted in a single university hospital in children <18 years undergoing elective anaesthesia in urology, minor paediatric surgery and gynaecology. Patients were 1 : 1 randomised to the laryngeal mask or laryngeal tube group. Children were allocated a second-generation laryngeal tube or a second-generation laryngeal mask as the primary airway device. The primary endpoint was insertion time. Secondary endpoints included first-attempt success, overall success and complications, which included hypoxia (SpO2 < 90%), laryngospasm, bronchospasm, aspiration and bleeding. In total, 135 patients were randomised, with 61 allocated to the laryngeal tube and 74 to the laryngeal mask group, with a median age of 5.4 and 4.9 years, respectively. Median insertion time was significantly longer in the laryngeal tube group (37 vs. 31 s; difference of medians: 6.0 s; 95% confidence interval: 0.0-13.0). The laryngeal tube had a significantly lower first-attempt (41.0%) and overall success rate (45.9%) than the laryngeal mask (90.5% and 97.3%, respectively). Those allocated to the laryngeal tube group had a higher ratio of complications (27.8%) compared to the laryngeal mask group (2.7%). This randomised-controlled trial reported that in children undergoing elective anaesthesia, the use of a laryngeal tube was associated with a longer insertion time.

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

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

Effects of Total Intravenous Anesthesia on Circadian Rhythms in Patients Undergoing Cardiac Transcatheter Closure

Objective To evaluate the effects of total intravenous anesthesia on the circadian rhythms in the patients undergoing cardiac transcatheter closure. Methods Thirty patients undergoing cardiac transcatheter closure under elective intravenous anesthesia were included in this study.Paired t-tests were performed to compare the mRNA levels of the genes encoding circadian locomotor output cycles kaput(CLOCK),brain and muscle ARNT-1 like protein-1(BMAL1),cryptochrome 1(CRY1),and period circadian clock 2(PER2),the Munich Chronotype Questionnaire(MCTQ)score,and the Pittsburgh Sleep Quality Index(PSQI)score before and after anesthesia.Multiple stepwise regression analysis was performed to screen the factors influencing sleep chronotype and PSQI total score one week after surgery. Results The postoperative mRNA level of CLOCK was higher [1.38±1.23 vs.1.90±1.47;MD(95%CI):0.52(0.20-0.84),t=3.327,P=0.002] and the postoperative mRNA levels of CRY1 [1.56±1.50 vs.1.13±0.98;MD(95%CI):-0.43(-0.81--0.05),t=-2.319,P=0.028] and PER2 [0.82±0.63 vs.0.50±0.31;MD(95%CI):-0.33(-0.53--0.12),t=-3.202,P=0.003] were lower than the preoperative levels.One week after surgery,the patients presented advanced sleep chronotype [3:03±0:59 vs.2:42±0:37;MD(95%CI):-21(-40--1),t=-2.172,P=0.038],shortened sleep latency [(67±64)min vs.(37±21)min;MD(95%CI):-30.33(-55.28--5.39),t=-2.487,P=0.019],lengthened sleep duration [(436±83)min vs.(499±83)min;MD(95%CI):62.80(26.93-98.67),t=3.581,P=0.001],increased sleep efficiency [(87.59±10.35)% vs.(92.98±4.27)%;MD(95%CI):5.39(1.21-9.58),t=2.636,P=0.013],decreased sleep quality score [1.13±0.78 vs.0.80±0.71;MD(95%CI):-0.33(-0.62--0.05),t=-2.408,P=0.023],and declined PSQI total score [6.60±3.17 vs.4.03±2.58;MD(95%CI):-2.57(-3.87--1.27),t=-4.039,P<0.001].Body mass index(BMI)(B=-227.460,SE=95.475,t=-2.382,P=0.025),anesthesia duration(B=-47.079,SE=18.506,t=-2.544,P=0.017),and mRNA level of PER2(B=2815.804,SE=1080.183,t=2.607,P=0.015)collectively influenced the sleep chronotype,and the amount of anesthesia medicine(B=0.067,SE=0.028,t=2.385,P=0.024)independently influenced the PSQI one week after surgery. Conclusion Total intravenous anesthesia can improve sleep habits by advancing sleep chronotype.BMI,anesthesia duration,and mRNA level of PER2 collectively influence sleep chronotype one week after surgery.The amount of anesthesia medicine independently influences the PSQI total score one week after surgery.

Does Preoperative Coffee Consumption Prevent Intraoperative Hypotension in Cesarean Section Surgeries?

In this study, we evaluated the effects of a cup of coffee given to patients before surgery in a cesarean section by means of intraoperative hypotension, ephedrine requirement, and the incidence of post-dural puncture headache (PDPH). A total of 140 patients undergoing elective cesarean sectionwith spinal anesthesia were included in this study. Participants who drank a single cup of filtered coffee two hours before spinal anesthesia were included in the coffee group, and those who drank water were in the control group. In each group, 70 patients were included. Hemodynamic parameters were recorded every three to five minutes after spinal anesthesia. Intraoperative use of ephedrine was recorded. The PDPH was monitored for three days. The incidence of intraoperative hypotension was 48.6% in the coffee group and 71.4% in the control group (p = 0.006). The rate of ephedrine usage (25.7%) was significantly lower in the coffee group (p = 0.001). The incidence of PDPH in the first 24 hours (2.9%) was significantly lower in the coffee group (11.4%). The visual analog scale (VAS) score was similar between groups (p = 0.048, p > 0.05). Consumption of a single cup of coffee before spinal anesthesia reduced the incidence of intraoperative hypotension and the rate of ephedrine usage in cesarean sections.

Comparison of Hepatic and Renal Functions during Intraoperative Sedation with Remimazolam in Elderly Patients under Intrathecal Anesthesia

Background: Remimazolam mesylate for injection (RM) is a new benzodiazepine sedative drug. The aim of this trial was to evaluate the effects of drug metabolism on patients’ hepatic and renal functions by comparing liver and renal function laboratory tests 24 hours before and 24 hours after surgery when using Remimazolam mesylate for injection (RM) for intraoperative sedation. Methods: 40 surgical patients who underwent prostate electrocision under elective intrathecal anesthesia were included in this trial. Changes in the patients’ perioperative hepatic and renal function indexes were analyzed using paired t-tests to assess the safety of Remimazolam mesylate for injection (RM) used for sedation in elderly patients under intrathecal anesthesia. Results: The patients’ preoperative 24-hour ALT (u/L) was 18.10 ± 4.97; the postoperative 24-hour ALT (u/L) was 18.08 ± 5.72; P = 0.975. The preoperative 24-hour AST (u/L) was 18.83 ± 4.89; the postoperative 24-hour AST (u/L) was 19.73 ± 4.91; P = 0.358. The preoperative 24-hour TBil (μmol/L) was 10.34 ± 6.16; the postoperative 24-hour TBil (μmol/L) was 12.03 ± 5.25; P = 0.008. The preoperative 24-hour sCr (μmol/L) was 79.43 ± 26.31; the postoperative 24-hour sCr (μmol/L) was 71.80 ± 22.93; P = 0.001. The preoperative 24-hour BUN (mmol/L) was 5.85 ± 1.75; the postoperative 24-hour BUN (mmol/L) was 4.83 ± 1.71; P &lt; 0.001. The preoperative 24-hour GFR (ml/min) was 82.73 ± 29.88; the postoperative 24-hour GFR (ml/min) was 125.23 ± 60.02; P &lt; 0.001. Important vital signs of the patients during the trial were stable, and laboratory tests of liver and renal function showed no abnormal changes of clinical significance. Conclusion: The intraoperative vital signs of the patients were stable, and no significant adverse reactions were observed in liver and kidney functions when Remimazolam mesylate for injection (RM) was used for intrathecal anesthesia-assisted sedation in elderly patients.

Behavioral training and mirroring techniques to prepare for elective anesthesia in children with autism spectrum disorder: a prospective evaluation of implemented program.

Children with autism spectrum disorder (ASD) often require multiple interventions receiving general anesthesia during their lifetimes. However, a single negative experience may trigger and/or aggravate anxiety and subsequent development of unwanted behavior. This monocentric study assessed the compliance with mask induction of children with ASD who followed a preoperative preparation using behavioral training with positive reinforcement technique and use of mirroring technique. Prospective observational study including all children with ASD scheduled for day case treatment receiving general anesthesia, from November 2019 to August 2022. The primary outcome was Induction Compliance Checklist (ICC) score. The secondary outcomes were child's anxiety in the operating room assessed by the modified Yale Anxiety Scale (mYPAS), the comportment of the child in the recovery room, parental satisfaction about perioperative management (0 to 10 numerical scale) and the satisfaction of the caregivers about anesthetic management (0 to 10 numerical scale). Behavioral changes were assessed one month after the procedure when possible. In total, 43 children from one to 17 years old were included. Median ICC score was 3 [1-6]. Induction Compliance was considered as excellent in 18.6% of patients, good in 39.5%, fair in 14.0% and poor in 27.9%. Seven patients (16.3%) needed restraint during induction. The use of behavioral and mirroring techniques implemented as a preparation program for children with ASD could facilitate mask induction of anesthesia. Such a preparation achieves good to excellent compliance in almost 60% of patients.

A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data

ObjectiveThe i-gel supraglottic airway device (Intersurgical, Berkshire, UK) is commonly used in the United States and worldwide for prehospital airway management. Previous research has suggested that a sex-based method of size selection (4.0 for female patients and 5.0 for male patients) is superior to a weight-based method in patients undergoing elective anesthesia. Our objective was to compare a sex-based i-gel size selection strategy with a weight-based strategy using real-world prehospital data. MethodsThe ESO Data Collaborative 2018 to 2022 dataset was used. All initial i-gel insertion attempts in patients > 18 years of age were evaluated for inclusion. Insertion attempts were excluded if age, sex, weight, success, or device size was not documented. Logistic regression was used to compare the rate of insertion failure on the first attempt for the group placed in alignment with the weight-based but not sex-based method with the group placed in alignment with the sex-based but not weight-based method. ResultsAfter the application of the exclusion criteria, 39,867 initial i-gel insertion attempts were included. The overall rate of failure was 6.5% (2,585/39,867). The rate of unsuccessful i-gel placement was similar when i-gel devices were placed in alignment with a sex-based size selection method in comparison to i-gel placement in alignment with a weight-based selection strategy (6.0% vs. 6.4%). Logistic regression analysis did not reveal a significant difference between groups (odds ratio: 1.08; 95% confidence interval: 0.95-1.23). ConclusionThe use of a sex-based method of i-gel size selection may be equivalent with respect to the rate of unsuccessful i-gel placement on the first attempt in comparison to a weight-based method.

Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review

(Anesth Analg. October 6, 2023. doi: 10.1213/ANE.0000000000006669. Online ahead of print) The process of informed consent upholds the principle of patient autonomy, rooted in US constitutional principles of privacy and noninterference. It has been legally required in the United States since 1914, ensuring that individuals have the right to determine what happens to their bodies, as Schloendorff v. New York Society Hospital ruled. The recent US Supreme Court decision on abortion has raised concerns about maternal-fetal conflicts and the rights of pregnant patients to undergo elective anesthesia and surgery. Ethical and legal requirements for informed consent in medical testing vary, with challenges in addressing routine laboratory testing. Not all medical tests carry the same ethical implications, but they should all consider beneficence, nonmaleficence, and patient autonomy. Focusing on the need for preanesthesia pregnancy testing remains a concern in anesthesia and surgery practices. The primary premise is preventing harm to the fetus, but this must be supported by medical evidence and adhere to ethical standards. No study conclusively demonstrates that anesthetic agents significantly increase rates of early human fetal loss or malformations. There is no evidence that anesthetic drugs are generally teratogenic or pose a significant risk of harm to the fetus. While such risks are small, they cannot be guaranteed to be absent.

Consistency analysis of consciousness index and bispectral index in monitoring the depth of sevoflurane anesthesia in laparoscopic surgery.

The Index of Consciousness (IoC) is a new monitoring index of anesthesia depth reflecting the state of consciousness of the brain independently developed by China. The research on monitoring the depth of anesthesia mainly focuses on propofol, and bispectral index (BIS) is a sensitive and accurate objective index to evaluate the state of consciousness at home and abroad. This study mainly analyzed the effect of IoC on monitoring the depth of sevoflurane anesthesia and the consistency and accuracy with BIS when monitoring sevoflurane maintenance anesthesia. To investigate the monitoring value of the Index of Consciousness (IoC) for the depth of sevoflurane anesthesia in laparoscopic surgery. The study population consisted of 108 patients who experienced elective whole-body anesthesia procedures within the timeframe of April 2020 to June 2023 at our hospital. Throughout the anesthesia process, which encompassed induction and maintenance using inhaled sevoflurane, all patients were diligently monitored for both the Bispectral Index (BIS) and the Index of Consciousness (IoC). We conducted an analysis to assess the correlation between IoC and BIS throughout the anesthesia induction process and from the maintenance phase to the regaining of consciousness. To evaluate the predictive accuracy of IoC and BIS for the onset of unconsciousness during induction and the return of consciousness during emergence, we employed receiver operating characteristic (ROC) curve analysis. The mean difference between BIS and IoC, spanning from the pre-anesthesia induction phase to the completion of propofol induction, was 1.3 (95% Limits of Agreement [-53.4 to 56.0]). Similarly, during the interval from the initiation of sevoflurane inhalation to the point of consciousness restoration, the average difference between BIS and IoC was 0.3 (95% LOA [-10.8 to 11.4]). No statistically significant disparities were observed in the data acquired from the two measurement methodologies during both the anesthesia induction process and the journey from maintenance to the regaining of consciousness (P > 0.05). The outcomes of the ROC curve analysis disclosed that the areas under the curve (AUC) for prognosticating the occurrence of loss of consciousness were 0.967 (95% CI [0.935-0.999]) for BIS and 0.959 (95% CI [0.924-0.993]) for IoC, with optimal threshold values set at 81 (sensitivity: 88.10%, specificity: 92.16%) and 77 (sensitivity: 79.55%, specificity: 95.45%) correspondingly. For the prediction of recovery of consciousness, the AUCs were 0.995 (95% CI [0.987-1.000]) for BIS and 0.963 (95% CI [0.916-1.000]) for IoC, each associated with optimal cutoff values of 76 (sensitivity: 92.86%, specificity: 100.00%) and 72 (sensitivity: 86.36%, specificity: 100.00%) respectively. The monitoring of sevoflurane anesthesia maintenance using IoC demonstrates a level of comparability to BIS, and its alignment with BIS during the maintenance phase of sevoflurane anesthesia is robust. IoC displays promising potential for effectively monitoring the depth of anesthesia.

Medical Students' Knowledge and Perception of Anesthesia: An Insight Into Anesthesiology as a Career Choice.

Introduction Anesthesia is an important specialty in the medical field responsible for caring for patients before, during, and after operations. It involves monitoring vital signs, managing pain levels, and regulating consciousness. There are various subspecialties of anesthesia, including general anesthesia, intensive care medicine, cardiac anesthesia, and pain medicine, among others. This study aims to assess and evaluate the knowledge and perceptions of medical students regarding the role of anesthesiologists and the factors influencing their career choices. Methods A descriptive cross-sectional study was conducted with 379 clinical-year medical students from colleges of medicine across Saudi Arabia. An online questionnaire consisting of 26 items was distributed among the medical students. The questionnaire included sociodemographic characteristics, factors influencing the choice of a career in anesthesiology, and perceptions related to the role of anesthesia. Statistical analysis was performed using RStudio [R Core Team (2021), R version 4.3.1, R Foundation for Statistical Computing, Vienna, Austria]. Categorical variables were presented using frequencies and percentages, while numerical variables were expressed using the median and interquartile ranges (IQRs). Results Among the 379 clinical-year medical students surveyed, a majority of participants (59.6%) reported undergoing a mandatory rotation in anesthesia during their fifth or sixth (final) year of medical school. It is noteworthy that good knowledge was significantly associated with having a mandatory rotation in anesthesia during the fifth or sixth year, with 96.0% of students who had a mandatory rotation demonstrating good knowledge, compared to 88.2%of those who did not. A smaller proportion (1.3%) opted for an elective anesthesia rotation during this period. Among those who undertook an elective clinical rotation in anesthesia, all respondents (100.0%) reported undertaking the elective rotation for three weeks or more and stated that this rotation inspired them to pursue a career in anesthesia. Regarding the factors influencing the choice of residency programs, a controllable lifestyle, particularly the ability to control work hours, emerged as the most influential factor, with 96.8%of participants considering it as such. This was followed by income (91.6%), the presence of a doctor-patient relationship (72.6%), and the prestige of the specialty (69.7%). Conclusion The medical students demonstrated reasonably good knowledge of the anesthesiologist's role, which can be attributed, in part, to the mandatory rotation in anesthesia. In terms of factors influencing career choice, a good lifestyle was found to be the most influential, followed by income, the doctor-patient relationship, and the prestige of the specialty.

Clinical Application of Bilateral Nasopharyngeal Airway in Painless Colonoscopy for Obese Patients.

This study aims to evaluate the safety and efficacy of using bilateral nasopharyngeal airways (NPA) during colonoscopic polypectomy performed under sedation anesthesia in obese patients. Ninety obese patients undergoing colonoscopic polypectomy under elective sedation anesthesia at Shanghai Shuguang Hospital were randomly allocated to two groups. Patients in group B had a nasopharyngeal airway inserted bilaterally after induction of anesthesia, whereas patients in group U had a nasopharyngeal airway inserted in only one nostril. Spontaneous breathing was maintained in both groups. The primary observation parameter was the incidence of oxygen saturation (SpO2) ≤ 92% during anesthesia, while secondary observation parameters included preoperative, intraoperative, and post-operative SpO2 levels, mean arterial pressure (MAP), heart rate (HR), dosage of propofol, duration of the operation, time to anesthesia recovery, need for emergency airway intervention, and occurrence of other adverse events. Hypoxia occurred in 5 out of 45 patients (11.1%) in group B, whereas it was observed in 14 out of 45 patients (31.1%) in group U (P < 0.05). Patients in group B exhibited higher SpO2 levels during and after surgery compared to those in group U (P<0.05). Furthermore, the decrease in intraoperative and post-operative SpO2 levels from baseline was significantly lower in group B compared to group U (P < 0.05). The number of emergency airway interventions, operation time, propofol dosage, and anesthesia recovery time were significantly lower in group B compared to group U (P<0.05). However, there were no significant differences in MAP, HR, or the incidence of adverse events between the two groups (P>0.05). The utilization of bilateral nasopharyngeal airway placement proves to be an effective strategy in decreasing the occurrence of hypoxia among obese patients undergoing colonoscopy under sedation anesthesia, thereby improving procedural safety.

Intravenous dexmedetomidine v/s tramadol on post spinal anaesthesia shivering: A randomized, double blind and interventional study

Introduction: Regional anaesthesia is widely used and safe anaesthetic technique. It leads to Intra/ post-operative shivering. There are various methods available to control. Tramadol is one of the most widely used to control shivering, however it is also associated with nausea and vomiting. Objective: To compare the efficacy of dexmedetomidine and tramadol in the treatment of post‑spinal anesthesia (SA) shivering as well as to compare their side‑effect profile. Methodology: This hospital based, prospective, randomized, double blinded, Superiority type of interventional study included 60 patients undergoing elective spinal anesthesia aged 20-60 years, ASA grade I and II, weighing 40-80 kilograms. Subjects were randomly allocated into two groups, to receive either 0.5 mcg/kg Dexmedetomidine (Group D) or 05 mg/kg Tramadol (or grpup T). The grade of shivering was assessed as per wrench (Grade 0: no shivering, Grade 1: One or more of the following: piloerection, peripheral vasoconstriction, peripheral cyanosis, but without visible muscles activity, Grade 2: Visible muscle activity confined to one muscle group, Grade 3: Visible muscle activity in more than one muscle group and Grade 4: Gross muscle activity involving the whole body). Result: Shivering was eliminated in all the patients who received either dexmedetomidine or tramadol. Time for unset of shivering and grade of shivering is quite similar in both study groups. Time to cessation of shivering was significantly earlier with dexmedetomidine (174.3±12.5) as compare with tramadol (279.6±15.9). Nausea and vomiting is found significantly higher (P value = 0.024) with tramadol.

Intravenous dexmedetomidine v/s tramadol on post spinal anaesthesia shivering: A randomized, double blind and interventional study

Introduction: Regional anaesthesia is widely used and safe anaesthetic technique. It leads to Intra/ post-operative shivering. There are various methods available to control. Tramadol is one of the most widely used to control shivering, however it is also associated with nausea and vomiting. Objective: To compare the efficacy of dexmedetomidine and tramadol in the treatment of post‑spinal anesthesia (SA) shivering as well as to compare their side‑effect profile. Methodology: This hospital based, prospective, randomized, double blinded, Superiority type of interventional study included 60 patients undergoing elective spinal anesthesia aged 20-60 years, ASA grade I and II, weighing 40-80 kilograms. Subjects were randomly allocated into two groups, to receive either 0.5 mcg/kg Dexmedetomidine (Group D) or 05 mg/kg Tramadol (or grpup T). The grade of shivering was assessed as per wrench (Grade 0: no shivering, Grade 1: One or more of the following: piloerection, peripheral vasoconstriction, peripheral cyanosis, but without visible muscles activity, Grade 2: Visible muscle activity confined to one muscle group, Grade 3: Visible muscle activity in more than one muscle group and Grade 4: Gross muscle activity involving the whole body). Result: Shivering was eliminated in all the patients who received either dexmedetomidine or tramadol. Time for unset of shivering and grade of shivering is quite similar in both study groups. Time to cessation of shivering was significantly earlier with dexmedetomidine (174.3±12.5) as compare with tramadol (279.6±15.9). Nausea and vomiting is found significantly higher (P value = 0.024) with tramadol.

Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients.

Anorectal diseases are common in the population and include internal, external, and mixed hemorrhoids. Although hemorrhoid surgery is a brief operation, anesthesia, anesthetic drugs, drug concentrations, and anesthesia level control are closely related to postoperative uroschesis. For hemorrhoid surgery, a single spinal block with ropivacaine is commonly used that blocks the S2-S4 parasympathetic nervous system, which in turn governs the voiding reflex, causing postoperative urinary retention; this affects the recovery of patients. This study was performed to investigate the effects of two doses ropivacaine that provided satisfactory analgesia and muscle relaxation and inhibited adverse reflexes on urinary retention after hemorrhoidectomy. The study included 200 male patients who underwent anorectal surgery with American Society of Anesthesiologists (ASA) grade I-II single elective spinal anesthesia between March 2021 and March 2022. Patients were randomly assigned to 2 groups using a random number table: Group A (n = 100) received 10 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml), and Group B (n = 100) received 15 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml). The anal sphincter exhibited good relaxation, and no obvious traction pain or significant difference in the time of muscle strength recovery was observed between the 10 mg and 15 mg 0.5% ropivacaine groups (P > 0.05). The 10 mg 0.5% ropivacaine group had shorter time of micturition exceeding 100 ml and lower voiding International Prostate Symptom Score than the 15 mg 0.5% ropivacaine group (P < 0.01). Single spinal anesthesia with 10 mg 0.5% ropivacaine not only provides satisfactory anesthetic effect for hemorrhoidectomy but also has less influence on postoperative uroschesis and is worthy of clinical application. The study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR2,100,043,686) on February 27, 2021.

Comparative evaluation of two doses of phenylephrine infusion to prevent intra-operative nausea and vomiting during elective obstetric spinal anesthesia

Comparative evaluation of two doses of phenylephrine infusion to prevent intra-operative nausea and vomiting during elective obstetric spinal anesthesia

Promotion of a venous thromboembolism prevention protocol at a perioperative management center

Perioperative venous thromboembolism (VTE) is a potentially fatal complication, making preoperative VTE diagnosis and secondary thromboprophylaxis important. This study was performed to investigate the impact of promotion of a preoperative VTE protocol at a perioperative management center (PMC) on detecting the preoperative VTE rate and subsequent treatment. This retrospective study involved patients aged ≥20 years who underwent elective anesthesia. The patients were divided into two groups: the pre-PMC group (January to October 2014, before the opening of the PMC) and the post-PMC group (January to December 2019, after the opening of the PMC). The rates of preoperative lower-limb compression ultrasonography (CUS), VTE detection, anticoagulation therapy, and new postoperative pulmonary embolism (PE) were compared between the two groups. The pre-PMC and post-PMC groups comprised 3737 and 5388 patients, respectively. The preoperative CUS and VTE detection rates were significantly higher in the post-PMC than pre-PMC group (7.2% and 1.43% vs. 25.6% and 3.93%, respectively; P<0.001). There was no significant difference in the rate of anticoagulation therapy in patients with preoperative VTE (88.9% vs. 84.7%, P=0.43). Heparin and direct oral anticoagulants were primarily used in the pre-PMC and post-PMC groups, respectively. The efficacy and safety were comparable between the two groups. No new postoperative PE was detected in either group. Promotion of the preoperative VTE protocol led by the PMC increased the rates of preoperative CUS and preoperative VTE detection. This may aid in secondary thromboprophylaxis in the preoperative period and prevention of postoperative PE.

Management of Elective Cesarean Section Anesthesia in HIV-Positive Patients

Management of Elective Cesarean Section Anesthesia in HIV-Positive Patients

Clinical Features and Management of Patients Admitted for Emergency Surgery at Tertiary Care Hospital during COVID-19 Pandemic

Nobel coronavirus disease 2019 (COVID-19) is an infectious disease and impact on health service was vast. Most of the health services, hospitals and clinics were providing emergency services only. The aim of this study was to assess sign and symptoms and surgical emergency management performed in Department of Surgery and Department of Obstetrics and Gynecology in a tertiary care hospital. A retrospective descriptive study was conducted among suspected and proven COVID- 19 patients admitted in Patan Academy of Health Sciences, Lalitpur. Clinical data of all patients admitted for emergency conditions extracted from the medical records were included in the study. A total of 130 patients admitted for surgery were selected by using convenient sampling method. Mean age of the patients was 29.56±8.87 years. Most of the patients (72.3%) had visited Obstetrics and Gynecology department and 21.5% in Surgery department during the study periods. Among 130 patients 84 (64.6%) had to undergo emergency and elective Lower Segment Caesarean Section (LSCS) and spinal anesthesia was administered for83.1% of the cases. Appendectomy was performed in 15 (11.5%) patients. During COVID-19 pandemic, surgical procedures were limited to urgent surgical service. Most common emergency surgeries were LSCS, Appendicitis and surgical emergency management was lower segment caesarean section and appendectomy.

Wildfire Smoke Exposure Is Associated with Adverse Respiratory Events under General Anesthesia in At-risk Pediatric Patients.

Increasing wildfire activity worldwide has led to exposure to poor air quality and numerous detrimental health impacts. This study hypothesized an association between exposure to poor air quality from wildfire smoke and adverse respiratory events under general anesthesia in pediatric patients. This was a single-center retrospective double-cohort study examining two significant wildfire events in Northern California. Pediatric patients presenting for elective surgery during periods of unhealthy air quality were compared with those during periods of healthy air quality. The primary exposure, unhealthy air, was determined using local air quality sensors. The primary outcome was the occurrence of an adverse respiratory event under anesthesia. Secondary analysis included association with other known risk factors for adverse respiratory events. A total of 625 patients were included in the analysis. The overall risk of a respiratory complication was 42.4% (265 of 625). In children without a history of reactive airway disease, the risk of adverse respiratory events did not change during unhealthy air periods (102 of 253, 40.3%) compared with healthy air periods (95 of 226, 42.0%; relative risk 0.96 [0.77 to 1.19], P = 0.703). In children with a history of reactive airway disease, the risk of adverse respiratory events increased from 36.8% (25 of 68) during healthy air periods to 55.1% (43 of 78) during periods with unhealthy air (1.50 [1.04 to 2.17], P = 0.032). The effect of air quality on adverse respiratory events was significantly modified by reactive airways disease status (1.56 [1.02 to 2.40], P = 0.041). Pediatric patients with underlying risk factors for respiratory complications under general anesthesia had a greater incidence of adverse respiratory events during periods of unhealthy air quality caused by wildfire smoke. In this vulnerable patient population, postponing elective anesthetics should be considered when air quality is poor.