General Anesthesia Research Articles

Association of preoperative cognitive frailty with postoperative complications in older patients under general anesthesia: a prospective cohort study

BackgroundCognitive frailty (CF) is characterized by the coexistence of physical frailty and cognitive impairment, and it is associated with adverse health outcomes. Older adults are particularly vulnerable to CF due to factors such as age-related brain changes and the presence of comorbidities.ObjectiveTo investigate the effect of preoperative CF on postoperative complications in older patients.MethodsThis prospective cohort study was conducted among 253 patients aged 60–85 years, who underwent elective orthopedic and abdominal surgery (with a postoperative hospital stay of ≥ 3 days) at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. CF was assessed using the Montreal Cognitive Assessment (MoCA) for the cognitive status and the Fried criteria for five frailty scales. Participants were split into four groups: Group A (neither frailty nor cognitive impairment), Group B (frailty without cognitive impairment), Group C (cognitive impairment without frailty), and Group D (cognitive frailty). The primary outcome was postoperative complications, while secondary outcomes included mobility disability, prolonged hospital stay (PLOS), re-operation and 90-day readmission.ResultsThe median age (interquartile range) of participants was 69 (65–73) years, of which 40.3% were male. The prevalence of CF was 17.8%. The incidence of postoperative complications was 18.2% in Group A, 50.0% in Group B, 37.4% in Group C, and 75.6% in Group D. Multivariate analysis revealed that, compared to the control group (without cognitive impairment or frailty), patients with CF had a significantly higher risk of postoperative complications (OR, 12.86; 95%CI, 4.23–39.08). “Patients with frailty without cognitive impairment” had an increased risk (OR, 6.53; 95%CI, 2.04–20.9), while “those with cognitive impairment without frailty” also showed a higher risk (OR, 3.46; 95%CI, 1.57–7.64).ConclusionsCognitive frailty is significantly associated with an increased risk of postoperative adverse outcomes in older patients undergoing orthopedic and abdominal surgeries with general anesthesia. It indicates that clinicians should pay much attention to these older adults with CF.

Variants for dosing of rocuronium taken into obesity during general anesthesia in gynecological laparoscopic surgery

The objective was to identify the optimal method of dosing the muscle relaxant rocuronium during gynecological laparoscopic surgery in obese patients.Materials and methods. The study included 36 women with obesity II–III degree, which performed elective gynecological laparoscopic surgery. They were divided into 3 groups. In group 1, rocuronium were dosed at the rate of 0.6 mg/kg of ideal body weight calculated by the Lorentz formula. In group 2, rocuronium were dosed at the rate of 0.6 mg/kg of actual body weight. In group 3, rocuronium were dosed at the rate of 22.5 mg/m2 of body surface area. The comparison group (group 0) included 20 patients with body mass index equal to 18.5–25 kg/m2.Results. The shortest time for the onset of deep neuromuscular block was noted in groups 2 and 3, and the longest, comparable to the indicator in group 0, was in group 1 (p < 0.05). The time from rocuronium administration to the onset of restoration of neuromuscular conduction was the shortest in group 1: 22 [20; 25] minutes, and the longest in group 2: 40 [35; 45] min. There was no statistically significant difference in the dosing of rocuronium in obese patients at body surface area in group 3 compared with dosing for actual weight in group 0: 27 [22; 29] and 27 [25; 33] min, respectively. The recovery time of neuromuscular conduction from TOF = 1 to TOF = 25% was the shortest in group 1 (23 [18; 24] min) and was significantly different from the value in groups 2 and 3, as well as in patients of group 0. In groups 0, 2, 3, values of this indicator were identical. The recovery index did not differ significantly in all four groups.Conclusion. Dosing rocuronium in obese patients based on body surface area has an advantage for comparison over dosing based on both actual and ideal body weight, resulting in greater predictability of neuromuscular block dynamics.

A prospective cohort study comparing monitored anesthesia care and intubated general anesthesia in cardiac surgery involving cardiopulmonary bypass

BackgroundThe aim of this study is to assess the feasibility and safety of monitored anesthesia care (MAC) versus intubated general anesthesia (IGA) for patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).MethodsThis prospective observational study included patients scheduled for cardiac surgery involving CPB at our institution between April 2012 and February 2017. The enrolled patients were categorized into MAC and IGA groups. MAC involved local anesthesia at the sternotomy site, sedation with dexmedetomidine, analgesia with remifentanil/sufentanil, and electroacupuncture (EA). Eleven patients underwent MAC, and 13 patients received IGA. There were no instances of conversion from MAC to IGA, and both groups exhibited no major complications. The demographic characteristics, baseline parameters, and operative variables were comparable between the two groups.ResultsIntraoperative opioid consumption was significantly lower in the MAC group compared to the IGA group (P < 0.001). The time to oral intake of liquids was significantly shorter in the MAC group (2.14 ± 0.90 h) compared to the IGA group (22.31 ± 3.33 h) (P < 0.001). Furthermore, the intensive care unit length of stay (ICU-LOS) and perioperative vasoactive-inotropic score (VIS) were significantly reduced in the MAC group compared to the IGA group (P < 0.001).ConclusionsMAC emerges as a safe and viable alternative to general anesthesia for specific patient groups undergoing cardiac surgery with CPB. Furthermore, it may enhance postoperative recovery and minimize postoperative complications compared to IGA.

Hand dynamometer and clinical tests to evaluate the recovery of neuromuscular conductance in atracurium versus rocuronium in patients undergoing laparoscopic surgery

Background. Postoperative muscle weakness is not unusual and may be related to postoperative complications in patients after general anesthesia. However, the clinical practice of neuromuscular conductance monitoring is uncommon among anesthesiologists.The objective was to evaluate the rate of neuromuscular recovery after atracurium and rocuronium and to determine the numerical value of grip strength using a hand dynamometer, indicating the safety of transferring a patient from the postoperative ward.study design. A prospective, observational, clinical comparison study.Materials and Methods. Upon proper authorization and approval from the local ethics committee, patients referred for laparoscopic surgery, 120 patients of the American Society of Anesthesiology (ASA) physical status I &amp;II between ages 20–49 years were randomly assigned into 2 groups of 60 each. Group I received a single atracurium dose of 0.5mg/kg of ideal body weight and Group II patients received a single rocuronium dose of 0.6mg/kg of ideal body weight. Parameters such as modified Alderete score (MAS), grip strength, and sustained head and leg lift for five seconds were compared in both groups 50 minutes after giving the reversal agent at 10-minute intervals.Results. Postoperative muscle recovery (grip strength) was faster in the atracurium group than the rocuronium group, with a p-value of 0.042 at 20 minutes, and 0.0000 for 30, 40, and 50 minutes after giving the reversal agent. The time to obtain a modified Alderete score (MAS) &gt; 8 scores was statistically insignificant with a p-value of 0.335. Positive clinical test for sustained head lift for 5 seconds was statistically insignificant within a majority of the time, except in the 20 minutes, most of the cases in the atracurium group were able to sustain head elevation for 5 seconds with a p-value of 0.021. In the 10 &amp;20 minutes, most cases in the atracurium group could sustain leg elevation for 5 seconds with a p-value of 0.015 and 0.014 respectively. However, most cases in both groups could sustain head and leg elevation for 5 seconds in the 30 minutes after giving a reversal agent.Conclusion. Compared to rocuronium, atracurium has been associated with faster muscle recovery after a single tracheal intubation dose for a short surgery. This was determined by utilizing an electronic hand dynamometer to measure grip strength. 42% grip strength from baseline might be applicable for safe discharge from the recovery room. A hand dynamometer assessment revealed more post-operative muscle weakening than a clinical evaluation.

Identify of Preoperative and Postoperative Complication of Planned Management and Emergency Management of Patients with PAS Disorder

Background: Placenta accreta spectrum (PAS) often results in significant blood loss and peripartum hysterectomy; the mother may not survive. In many cases, timely prenatal diagnosis allows for careful birth planning in a specialized facility with a highly qualified multidisciplinary team. This has been shown to reduce maternal morbidity. Scheduled deliveries are associated with lower rates of bleeding and emergency procedures when compared to emergency deliveries. Objective: The aim of this study is to identify the preoperative and postoperative complication of planned management and emergency management of patients with PAS disorder. Methods: The cross-sectional comparative study was conducted in the Department of Obstetrics &amp; Gynaecology, Dhaka Medical College Hospital, Dhaka from 18th January 2020 to 17th July 2020. A total of 84 patients diagnosed as a case of PAS disorder (antenatally and peroperative diagnosed) and scheduled for planned management or emergency management of PAS were included according to inclusion and exclusion criteria. 42 planned management of PAS disorder patients as Group A and 42 emergency management of PAS disorder patients as Group B. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, mean ± SD of age was calculated 26.3 ± 4.3 years for Group – A and 28.1 ± 3.2 years for Group – B. Urban population were predominant in group-A. About 30 (70.0%)) patients in group-A and 10 (23.8%) patients in group-B came from urban. Large number of respondents 22 (52.4%) and 10 (50.0%) were housewife in both groups. Among the patients, the lower class 18 (42.9%) and 23 (54.8%) comprised the major percentage of the patients in both groups. More participants in Group-A 29 (69.00%) received ANC regularly than Group B 10 (23.80%), the difference was statistically significant (p&lt;0.05). In group-A maximum patients presented with only USG findings of PAS disorders and with APH or without APH 26 (61.8%). In group-B, PPH and internal haemorrhage 10 (23.8) was noted predominantly. The mild anemia was more in 23 (54.8%) patients in group A and 16 (38.1%) patients in group B which was statistically significant (p &lt; 0.001). More participants in Group-B 26 (61.9%) required early termination, whereas majority of group A 35 (83.3%) was terminated at 35-36 weeks. There was a statistically significant difference between groups. Maximum patients were managed by peripartum hysterectomy 35 (82.0%) and 31 (73.8%) in group A &amp; B respectively. Presence of multidisciplinary team was arranged in 38 (90.4%) in group A and 18 (42.9%) in group B. General anesthesia and CV line was given in 36 (85.7%) patients in group-A and 27 (64.3%) patients in group-B. Massive blood transfusion was needed in 23 (54.8%) patients in Group B &amp; only 3 (7.1%) patients in Group A. Placenta acreta was present 11 (26.2%) patients in group A and 7 (16.7%) patients in group B. Placenta percreta with bladder invasion and peroperative bladder injury was higher in group-B patients. More than 3 L blood was transfused 3 (7.1%) patients in group A and 23 (54.8%) patients in group B. PPH, Sepsis, Re-exploration, DIC and ICU admission were the significant complication in Group-B patients, reported 41 (95.0), 4 (9.5%), 8 (19.0%), 9 (21.4%) and 21 (50.0%) of women and in less complication in Group A 13 (31.0), 0%, 0%, 1 (2.3) and 4 (9.5). In this study mortality rate was 2 (4.8%) in group-B (due to irreversible shock &amp;DIC). Poor outcomes were significantly higher in group-B. NICU admission for prematurity was required in 9 (21.4%) of the babies in group-A and 23 (54.8%) babies of group-B. Birth asphyxia was observed in 4 (9.5%) of the babies in group-A and 13 (31.0%) in Group-B. Conclusion: Prenatal diagnosis and placenta preservation may be linked to lower rates of morbidity in mothers. For morbidly adherent placenta linked with placenta previa, we advise hysterectomy as the preferred course of therapy following extremely thorough prenatal counseling. Maternal problems and fetal outcomes may be improved by early risk factor identification and proactive management.

Trends in changing the structure of anesthesia at the advanced stages of medical care in modern armed conflict

The objective was to analyze the structure of anesthesia provided to the wounded at the advanced stages of medical care in the active phase of hostilities.Materials and methods. A retrospective analysis of the medical data of anesthesia was performed. The data on the structure of anesthesia in military medical organizations of 1–3 levels in the zone of a special military operation for the period from 01.2023 to 07.2024 were analyzed.Results. In the structure of combat trauma, with the need for surgical intervention, gunshot wounds amounted to 85.2%, there was a predominance of combined (71.5%) and multiple (19.8%) wounds.The low proportion of combined general anesthesia and the lack of use of inhalation anesthesia at some stages is explained by the special conditions of care. Regional anesthesia (RA), including as part of combined anesthesia, in the structure of anesthesia at the stages of emergency specialized surgical care amounted to 34.5%, and at the stages of qualified surgical care – 25.4%. The lowest rates of RA use were at the stages of level 1, as well as at the stages of level 2 with a 100% flow of primary wounded.Conclusion. RA occupies a significant share in the structure of anesthesia at the military stages of medical evacuation; an increase in the frequency of its use is possible due to the introduction of ultrasonic navigation.

Comparison of intravenous nalbuphine and dexmedetomidine in combination with lidocaine aerosol inhalation in awake direct laryngoscopy: a randomized, double-blind, placebo-controlled trial

BackgroundThe airway should be thoroughly and accurately evaluated before anesthesia induction and endotracheal intubation. Awake direct laryngoscopy (ADL) can provide rapid, accurate, and intuitive airway assessment, especially for suspected difficult airways, and sometimes eliminates the need for fiberoptic intubation in some suspicious difficult airway cases. However, an optimal regimen has not been determined.MethodsIn this double-blind, controlled study, prior to ADL, 60 patients scheduled for general anesthesia were randomly allocated to receive 0.75 μg/kg of dexmedetomidine (Dex group, n = 20), 0.15 mg/kg of nalbuphine (Nal group, n = 20), or a placebo (control group, n = 20) intravenously over 10 min. At the same time, all study subjects received nebulized lidocaine for 15 min. The primary outcome was patient tolerance as assessed by a 5-point ADL comfort score, while secondary outcomes included satisfaction, coughing, pain, nausea and vital signs.ResultsPatients undergoing ADL in the Nal group had higher tolerance scores than those in the control and Dex groups [4 (3,4) vs. 3 (2,2.75), P < 0.017, and 4 (3,4) vs. 2 (2,2,75), P < 0.001, respectively] and higher satisfaction [7 (6,8) vs. 4 (3,5.75), P < 0.017, and 7 (6,8) vs. 5.5 (5,6), P < 0.001, respectively]. Additionally, the Nal group had significantly fewer adverse events, such as pain and nausea than the control and Dex groups. The sedation score and peripheral oxygen and saturation were significantly higher in the Nal group than in the Dex group, with no difference between the Nal and control groups (P < 0.001, P = 0.159, respectively).ConclusionsIntravenous nalbuphine in combination with lidocaine aerosol inhalation significantly improved patient tolerance and satisfaction while reducing nausea, coughing, pain, sedation, and SpO2 levels during ADL.

Potential Impacts of Dried Green Coleus forskolin Leaves on Thermo-tolerance Parameters, Blood and Plasma Profiles in Anesthetized Mice

Background: Transient negative side effects of hypothermia, hyperglycemiaand bradycardia due to general anesthesia using diazepam and xylazine drugs has been reported in mice. Methods: Twenty albino male mice of 31.52±0.25 g body weight were classified into two groups; control group (G1) fed basal control diet versus C. forskolin group fed basal control diet containing C. forskolin leaves (G2; 1.5%) for four weeks. The mice were general anesthetized using xylazine and diazepam (XD) drugs (13.3 mg/kg BW diazepam and 26.6 mg/kg BW xylazine). Changes of rectal temperature (°C), glucose (mg/dl), pulse rate (pulse/min.) and partial pressure of oxygen (SPO2) were recorded at 0.0, 0.5h, 1.0h, 2.0h, 3.0h, 5.0h and 7.0h over general anesthesia. In addition, blood samples were collected and were subjected to blood and plasma analyses. Result: The results indicated that dietary C. forskolin caused significant decrease (P less than 0.05) in glucose values in addition to significant increase (P less than 0.05) in rectal temperature, pulse rate and SPO2 during the period hypothermia, hyperglycemiaand bradycardia over general anesthesia. In addition, values of blood (RBCs, WBCs, PCV and Hb) and plasma parameters (TP, BUN, creatinine, AST and ALT, LDH) were normal due to C. forskolin supplementation compared to control diet. It could be concluded that 1.5% C. forskolin supplementation modulates thermo-tolerance responses, blood glucose indices, blood and plasma metabolites over general anesthesia.

Analysis of pressure-induced deviation of the cricothyroid membrane among pediatric patients

BackgroundsHypoxemia develops more quickly in children than in adults due to their high oxygen consumption relative to their body weight and small functional residual capacity. Therefore, cricothyroid puncture must be performed promptly in cannot-intubate and cannot-ventilate situations. However, the success rate of cricothyroid puncture in children is &amp;lt;1%. We hypothesized that the low success rate of cricothyroid puncture in children may be related to the cricothyroid membrane's hypermobility. The aim of the present study was to measure the deviation of the cricothyroid membrane from the midline when applying compressive pressure.MethodsAfter obtaining institutional ethics committee approval, written informed consent was obtained from the patients’ parents. Children aged from 1 month to 15 years who had undergone scheduled operations under general anesthesia and with an American Society of Anesthesiologists Physical Status Classification grade of 1 or 2 were enrolled in this study. The patients were divided into the following four different age groups: 1 month–1 year, 2–4 years, 5–10 years, and 11–15 years. After the intravenous injection of fentanyl, propofol, and rocuronium, the airway was identified using a linear hockey stick ultrasound probe. The cricothyroid membrane was compressed with a force of 5 newtons (N), and cricothyroid membrane deflection was recorded. The primary outcome was the cricothyroid membrane deviation from the midline relative to the tracheal diameter.ResultsTwenty patients were enrolled in this study. No adverse events were noted. The mean cricothyroid membrane deviations from the midline divided by the tracheal diameter was 0.16 ± 0.09, 0.05 ± 0.04, 0.04 ± 0.04, and 0.02 ± 0.03 in children aged 1 month–1 year, 2–4 years, 5–10 years, and 11–15 years, respectively.ConclusionThe cricothyroid membrane deviation due to the application of a compressive force to the overlying skin tended to be larger in younger patients.

Minimalist approach to left atrial appendage occlusion through three-dimensional intracardiac echocardiography: Procedural steps and single-center experience

Atrial fibrillation (AF), the most prevalent arrhythmia worldwide, is associated with an annual risk of ischemic stroke of up to 5%, with approximately 98% of thrombi originating from the left atrial appendage (LAA). Direct oral anticoagulants or vitamin K antagonists remain the gold standard for preventing systemic thromboembolism in patients with AF. LAA occlusion (LAAO) is an alternative stroke prevention technique for patients with AF who cannot tolerate long-term anticoagulation. Percutaneous LAAO typically employs a multimodal imaging approach with contrast fluoroscopy and transesophageal echocardiography (TEE) for visualization, device selection and deployment, and complication monitoring. TEE is also used for follow-up imaging. However, it necessitates general anesthesia or deep sedation and is associated with a high risk of adverse events. Three-dimensional intracardiac echocardiography (3D ICE) has been proposed as a viable alternative to TEE for LAAO procedures. In this review, we summarized the current evidence regarding ICE guidance in LAAO procedures. We also presented a case series of consecutive patients presenting at our center who underwent LAAO, which was performed by a single operator using a minimalist approach of moderate sedation, 3D ICE, and same-day discharge. We also presented a summary of the minimalist approach to LAAO using 3D ICE and detailed procedural steps of 3D ICE catheter manipulation for successful LAAO intervention.

Effect of small dose esketamine on perioperative neurocognitive disorder and postoperative depressive symptoms in elderly patients undergoing major elective noncardiac surgery for malignant tumors: A randomized clinical trial.

Perioperative neurocognitive disorder and postoperative depressive symptoms are significant complications after surgery. Studies have indicated that esketamine possesses neuroprotective and antidepressant qualities. This trial included 209 patients aged 60 to 86 years undergoing tumor resection who received esketamine (Group E) or not (Group C) during and after surgery. In group E, patients were given an intravenous dose of 0.5 mg/kg of esketamine 10 minutes after induction of general anaesthesia. In addition, esketamine (2 mg/kg) in combination with sufentanil was used for PCIA during 48 hours postoperatively. On the other hand, saline was used as a substitute for esketamine in group C. Cognitive function was evaluated using neuropsychological tests and telephone interview for cognitive status-modified, and symptoms of depression were assessed using Hamilton Depression Rating Scale 17. Compared to Group C, patients in Group E exhibited lower rates of depressive symptoms at 3, 7, and 90 days post-surgery (53.9% vs 67.7%, 26.3% vs 47.9%, and 13.3% vs 28.4%). Group E also showed decreased time for Trail Making Test on days 7 and 90. However, there were no significant differences in the incidence of delirium 1 to 5 days post-surgery or cognitive impairment 90 days post-surgery between the 2 groups (12.1% vs 10.9% and 8.4% vs 9.7%). Intraoperative low-dose esketamine and postoperative low-dose esketamine combined with sufentanil for patient-controlled intravenous analgesia has been shown to improve postoperative analgesia, alleviate postoperative depressive symptoms, and aid in the recovery of social executive ability. However, this approach did not reduce the incidence of postoperative delirium or postoperative cognitive dysfunction.

Use of cast index and three-point index in paediatric both bone forearm fractures: a prospective study

Introduction The majority of paediatric both bone forearm fractures are treated with manipulative reductions and casting; loss of reduction is one of the most commonly reported complications. We aimed to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures.Materials and methods This prospective observational study was conducted at the Department of Orthopedics, Kalpana Chawala Government Medical College in Karnal to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures. In the present study, 55 patients 16 years old were included irrespective of sex with distal both bones forearm fractures, managed by closed reduction and casting were included.Results Fracture reduction failure was observed in 32.7 % of the patients. Both three-point index and cast index were found to be significantly higher in patients with reduction failure. It was observed that at 2 weeks Area under curve (ROC Curve) for Cast index and Three point index was 0.72 and 0.85 respectively. At 4 weeks, Area under curve for Cast index and Three point index was 0.77 and 0.84 respectively and at 6 weeks 0.74 and 0.86 respectively. Thus, in the present study, CI and 3PI had similar predictability for fracture reduction failure.Discussion There are a few limitations of our study: We could not observe the patients for a longer period of time to know re-modelling in the long term. We did not take in to consideration the severity of fracture, type of anesthesia used (conscious sedation versus General Anesthesia) and the fracture configuration while assessing the outcomes. We also did not collect information about anthropometric parameters like child weight and diameter of the forearm.Conclusion The three-point index and cast index are clinically useful tools to assess the quality of cast molding following closed reduction of pediatric forearm fractures and to predict re-displacement in distal forearm fractures.

Analysis of postoperative nausea and vomiting in patients with lung cancer undergoing thoracoscopic surgery under general anesthesia and its influencing factors: a observational study

ObjectiveTo investigate the current situation and influencing factors of postoperative nausea and vomiting (PONV) in lung cancer patients undergoing thoracoscopic surgery under general anesthesia, providing a reference for developing targeted PONV prevention and management strategies.MethodsUsing a consecutive sampling method, 200 lung cancer patients who underwent their first thoracoscopic surgery under general anesthesia between November 18, 2021, and March 1, 2022, at a tertiary class A cancer hospital in Liaoning Province, China, were selected. The occurrence of PONV within 24 h post-operation was assessed using WHO Postoperative Nausea and Vomiting Rating Criteria. Patient general information, surgical and medication data were systematically collected to analyze the independent influencing factors of PONV.ResultsAmong the 200 patients undergoing thoracoscopic lung cancer surgery under general anesthesia, 75 (37.5%) experienced PONV. Logistic regression analysis indicated that being female, having a history of motion sickness, and a history of PONV were independent risk factors for the occurrence of PONV in these patients. Long-acting antiemetics such as penehyclidine hydrochloride and methylprednisolone were protective factors against PONV.ConclusionThe incidence of PONV in patients undergoing thoracoscopic lung cancer surgery under general anesthesia is relatively high. Nursing staff should focus on female patients and those with a history of motion sickness and PONV. Comprehensive preoperative assessments should be conducted, exploring multimodal analgesia and applying integrated prevention measures to reduce the occurrence of PONV and promote the rapid recovery of patients.

Effect of classical laryngeal mask or I-gel use on otolaryngeal system in ambulatory inhalation general anesthesia: A prospective study

Objective: To investigate the effects of supraglottic airway tools such as classical laryngeal mask (cLMA) and I-gel, which can be used without the need for muscle relaxation in the airway management of general anesthesia patients, on the otolaryngeal system. Methods: This prospective randomised study was conducted at Karadeniz Technical University Hospital, Faculty of Medicine, Trabzon, Turkey, during November 2020 to December 2021. Eighty-nine patients in the American Society of Anesthesiologists (ASA) grade I-II group, who would undergo elective surgery under general anesthesia, were randomized into two groups, namely Group cLMA and Group I-gel. cLMA and I-gel were used for airway management of the patients. After anesthesia induction, tympanometric measurements were taken at regular intervals for middle ear pressures of both ears. Results: While air way pressures, SpO2 and EtCO2 values were within normal limits, there were no differences in terms of complications. In tympanometric measurements, middle ear pressure increase was statistically higher in the cLMA group than in the I-gel group (p &lt;0.001). Conclusions: We think that I-gel may be a more advantageous supra glottic airway device in terms of otolaryngeal effecs and middle ear pressure in theair way management during short surgical procedures. doi: https://doi.org/10.12669/pjms.40.10.8416 How to cite this: Saylan S, Cobanoglu HBY. Effect of classical laryngeal mask or I-gel use on otolaryngeal system in ambulatory inhalation general anesthesia: A prospective study. Pak J Med Sci. 2024;40(10):2299-2304. doi: https://doi.org/10.12669/pjms.40.10.8416 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The effect of deep versus awake removal of the laryngeal mask airway on the incidence of emergence delirium in paediatric tonsillectomy: A randomised controlled trial.

Emergence delirium, characterised by inconsolable crying, perceptual disturbances and thrashing, occurs in young children during the recovery phase from general anaesthesia. Our aim was to determine whether timing of laryngeal mask airway removal (deeply anaesthetised versus awake) influenced the incidence of emergence delirium in children after tonsillectomy. A single-centre, randomised controlled trial was conducted at Albury Wodonga Health, a regional hospital in Australia. Included patients were two to seven years old, American Society of Anesthesiologists physical status classification 1-2, undergoing elective tonsillectomy (with or without adenoidectomy or grommet insertion) under general anaesthesia. Patients were randomised to have their laryngeal mask removed whilst deeply anaesthetised (in the operating theatre) or after awakening (in the post-anaesthesia care unit (PACU)). Pediatric Anesthesia Emergence Delirium score was determined at 5 and 20 min after eye opening, and frequency of complications (cough, vomiting, excessive salivation, oxygen desaturation and laryngospasm) in the PACU were recorded. Sixty-two patients were randomised to deep laryngeal mask removal and 62 to awake. In the awake versus deep groups, 33 (53%) versus 40 (65%) participants had emergence delirium at 5 min (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.30 to 1.29, P = 0.20). At 20 min, 18 (29%) vs. 19 (31%) participants had emergence delirium (OR 0.93, 95% CI 0.43 to 2.00, P = 0.88). A greater incidence of most PACU complications was observed in the awake versus deep group; cough (24% vs. 8%), vomiting (8% vs. 0%), excessive salivation (23% vs. 8%) and oxygen desaturation (16% vs. 0%). We found no significant difference between the two techniques in terms of preventing emergence delirium. However, other PACU complications were more frequent with awake removal.

Single-Stage Image-Guided Percutaneous Ablation with Thoracoscopic Resection for Multiple Pulmonary Lesions in a Hybrid Operating Room: A Retrospective Study.

Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym2. The median hospital postoperative length of stay was 2 days. The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions.

Case Report: Dental treatment under general anesthesia and dental management of a child with congenital ichthyosis

Case Report: Dental treatment under general anesthesia and dental management of a child with congenital ichthyosis

Clinical Consequences of Delayed Gastric Emptying With GLP-1 Receptor Agonists and Tirzepatide.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are established therapeutics for type 2 diabetes and obesity. Among other mechanisms, they slow gastric emptying and motility of the small intestine. This helps limiting postprandial glycemic excursions and reducing chylomicron formation and triglyceride absorption. Conversely, motility effects may have detrimental consequences, e.g., retained gastric contents at endoscopy or general anesthesia, potentially complicated by pulmonary aspiration, or bowel obstruction. We searched the PubMed database for studies involving GLP-1RA therapy and adverse gastrointestinal/biliary events. Retained gastric contents at the time of upper gastrointestinal endoscopy are found more frequently with GLP-1 RAs, but rarely are associated with pulmonary aspiration. Well-justified recommendations for the peri-procedural management of GLP-1RAs (e.g., whether to withhold these medications, and for how long) are compromised by limited evidence. Important aspects to be considered are (a) their long half-lives, (b) the capacity of GLP-1 receptor agonism to slow gastric emptying even at physiological GLP-1 concentrations, (c) tachyphylaxis observed with prolonged treatment, and (d) the limited effect on gastric emptying in individuals with slow gastric emptying before initiating treatment. Little information is available on the influence of diabetes mellitus itself (i.e., in the absence of GLP-1 RA treatment) on retained gastric contents and pulmonary aspiration. Prolonged fasting periods regarding solid meal components, point-of-care ultrasound examination for retained gastric content, and the use of prokinetic medications like erythromycin may prove helpful, and are an important area needing further study to increase patient safety for those treated with GLP-1 RAs.

Expert opinion on candidacy for bone conduction hearing implants Osia System and Baha Connect System.

&lt;b&gt;Introduction:&lt;/b&gt; Bone conduction hearing implants (BCHI) are a widely used rehabilitation solution for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD).&lt;b&gt;Aim:&lt;/b&gt; This expert review presents candidacy criteria considerations when choosing between active transcutaneous bone-conduction hearing devices (Osia&lt;sup&gt;&lt;/sup&gt; System) and passive percutaneous bone-conduction hearing devices (Baha&lt;sup&gt;&lt;/sup&gt; Connect System) to help streamline the decision-making process in those contexts where economics have a major impact on professionals' and patients' choice.&lt;b&gt;Methods:&lt;/b&gt; Eight experts participated in two online surveys and two virtual meetings to discuss real-world clinical experience to highlight treatment approaches and factors considered when counseling the patients and selecting an optimal BCHI solution. Key considerations for decision-making were recorded following consensus from all experts.&lt;b&gt;Conclusions:&lt;/b&gt; Aspects in decision making include the requirement to use local &lt;i&gt;versus&lt;/i&gt; general anesthesia for the implantation procedure, bone thickness, considerations for future magnetic resonance imaging (MRI) procedures, and patient preference. Increased risk of skin infections, requirements for cleaning and managing the implant site, particularly for those with limited dexterity, as well as esthetic concerns could make the Baha&lt;sup&gt;&lt;/sup&gt; Connect System unsuitable for some patients. In these cases, the Osia&lt;sup&gt;&lt;/sup&gt; System may provide clear advantages, particularly in patients for whom good hearing performance is a priority, and this would need to be discussed individually with the patient in a multidisciplinary setting. Conversely, for patients requiring minimally invasive surgery, who have contraindications for general anesthesia or require frequent head MRI scans in the future, the Baha Connect System may be more suitable.

A Case of Multiple Tongue Hamartomas with Cleft Palate: 7 Years of Follow-Up.

Hamartoma is a congenital benign lesion commonly found in the lungs, kidneys, colon, and other regions, but it is seldom seen in the oral cavity. Multiple hamartoma occurrences in the tongue are particularly rare. This article describes a 7-day-old female infant with multiple tongue tumors and a cleft palate, who had difficulty feeding and subsequently underwent tumor removal under general anesthesia. Nine months later, a cleft palate repair was performed. No genetic abnormalities were detected in the genetic testing. After the tumor removal, follow-ups were conducted every year to observe any recurrence of the tumors, the morphology and function of the tongue, and any systemic abnormalities. After 7 years of follow-up, there was no recurrence of the tumors, and the morphology and function of the tongue were normal, with no systemic diseases found. It is crucial to conduct multidisciplinary consultations for children diagnosed with multiple tongue hamartomas and to monitor their overall development while addressing oral lesions.