Endotracheal Anesthesia Research Articles

Effect of methoxymine on prevention and treatment of myocardial injury and cardiac function in elderly patients with hypotension during intraspinal anesthesia.

We aimed to investigate the effects of methoxamine to prevent hypotension in the elderly with intraspinal anesthesia (IA) on myocardial injury and cardiac function. A retrospective study was conducted by enrolling sixty elderly patients who underwent femoral head replacement (FHR) under IA in our hospital from August 2019 to August 2020. The patients were divided into two groups according to the random number table method. In the control group (CG) (30 patients), 5 mg of ephedrine was administered sedately when patients developed hypotension (20% below basal blood pressure). In the research group (RG) (30 cases), 2 μg/(kg·h) of methoxamine hydrochloride was given as a constant-rate pump before anesthesia, and 1 mg of methoxamine hydrochloride was administered intraoperatively if hypotension occurred. The hemodynamic [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)], myocardial injury indexes [cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), fatty acid binding protein (FABP), plasma amino-terminal brain natriuretic peptide precursor (NT-proBNP)], cardiac function indexes [systemic vascular resistance (SVR), stroke volume (SV), net percentage ejection time (ET)] were observed before anesthesia (T1), at the end of surgery (T2), and 6 h after surgery (T3) in both groups. The Bruggemann Comfort Score (BCS) and Visual Analog Scale (VAS) scores at T3, 12 h postoperatively (T4) and 24 h postoperatively (T5) in both groups were observed, and the incidence of adverse reactions to intralesional anesthesia in both groups was counted. SBP, DBP and HR at T2 were lower than those at T1 in both groups, and SBP, DBP and HR at T3 were higher than those at T2, and SBP, DBP and HR at T2 and T3 in the RG were higher than those in the CG (p<0.05). In both groups, cTnⅠ, CK-MB and FABP were higher at T2 and T3 than at T1, higher at T3 than at T2, and NT-proBNP was higher at T2 than at T1 and T3, and lower in the RG than in the CG (p<0.05). In both groups, SVR and SV at time point T2 were lower than at time point T1 and ET was higher than at time point T1, SVR and SV at time point T3 were higher than at time point T2 and ET was lower than at time point T2, SVR and SV in the RG were higher than in the CG and ET was lower than in the CG (p<0.05). VAS scores were higher in both groups at T4 and T5 than at T3, and lower in the RG than in the CG (p<0.05). Methoxamine can effectively reduce the risk of hypotension in geriatric endotracheal anesthesia, which can reduce myocardial injury and stabilize cardiac function in patients.

Characteristic dynamic functional connectivity during sevoflurane-induced general anesthesia

General anesthesia (GA) during surgery is commonly maintained by inhalational sevoflurane. Previous resting state functional MRI (rs-fMRI) studies have demonstrated suppressed functional connectivity (FC) of the entire brain networks, especially the default mode networks, transitioning from the awake to GA condition. However, accuracy and reliability were limited by previous administration methods (e.g. face mask) and short rs-fMRI scans. Therefore, in this study, a clinical scenario of epilepsy patients undergoing laser interstitial thermal therapy was leveraged to acquire 15 min of rs-fMRI while under general endotracheal anesthesia to maximize the accuracy of sevoflurane level. Nine recruited patients had fMRI acquired during awake and under GA, of which seven were included in both static and dynamic FC analyses. Group independent component analysis and a sliding-window method followed by k-means clustering were applied to identify four dynamic brain states, which characterized subtypes of FC patterns. Our results showed that a low-FC brain state was characteristic of the GA condition as a single featuring state during the entire rs-fMRI session; In contrast, the awake condition exhibited frequent fluctuations between three distinct brain states, one of which was a highly synchronized brain state not seen in GA. In conclusion, our study revealed remarkable dynamic connectivity changes from awake to GA condition and demonstrated the advantages of dynamic FC analysis for future studies in the assessments of the effects of GA on brain functional activities.

Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail

ObjectivesThe aim of the present study was to test a safety of a fixed minimal (0.5 l/min) fresh gas flow (FGF) anesthesia as a method ensuring adequate oxygenation during off-pump coronary artery bypass grafting operations. DesignA randomized, prospective study. SettingSingle-center clinical hospital affiliated with a university. Participants208 patients underwent off-pump coronary artery bypass surgery. InterventionsAll patients received endotracheal inhalational anesthesia with fixed minimal FGF. Half of them were anesthetized by sevoflurane and another half by isoflurane. The fresh (carrier) gas was pure oxygen in the control groups and a mixture of medical air and oxygen (FiO2 0.8) in the trial groups. Measurements and main resultsIn the control groups inhaled oxygen concentration changed minimally during the operation. In the trial groups in 28.8 % of cases inhaled oxygen concentration dropped below preliminary margin (0.4). Body surface area (BSA) (B = 38.7; p = 0.002) and patient's age (B = −0.47; p = 0.004) were retained into final logistic regression model as independent predictors. We divided BSA into subcategories and analyzed data by survival cox regression with Forward LR method. Patients with BSA>2.3 (Exp.B = 183) and BSA [2.2–2.3] (Exp.B = 59) had high chance to get less than 0.4 of inhaled oxygen concentration compared to the patients with BSA <2.0 (p < 0.001).Exp(B) or OR for the patients’ age as independent predictor tested in multiple logistic regression was 0.628 In other words, for every year less the patient had 1/0.628 = 1.6 times more chance to reach the preliminary low margin (0.4) of oxygenation. ConclusionsFixed minimal FGF 0.5 l/min with FiO2 0.8 may not be sufficient for the younger patients with BSA >2.0 to maintain inhaled oxygen concentration above 0.4. Using pure oxygen as a carrier gas during fixed minimal flow long term anesthesia is much safer and more reliable.

Modified anterior approach versus traditional posterior approach for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: a randomized non-inferiority clinical trial

Study objective This study was undertaken to compare the effect of the modified ultrasound-guided anterior superior laryngeal nerve block (SLNB) with the traditional ultrasound-guided posterior SLNB in providing intubation conditions during awake tracheal intubation (ATI) in patients without difficult airway. Design Randomized, assessor-blind. Registration number: ChiCTR2200058086. Setting West China Hospital of Sichuan University, Chengdu, China. Patients 104 patients aged 18–65 years, of American Society of Anesthesiologists status I-III, posted for elective general surgery with general endotracheal anesthesia. Interventions The patients were randomized into two groups (modified group, n = 52; traditional group, n = 52). Modified anterior SLNB or traditional posterior SLNB was performed under ultrasound guidance. Measurements The primary outcome was the proportion of acceptable intubation condition (AIC), which was analyzed in both per-protocol (PP) and intention-to-treat (ITT) populations. The prespecified non-inferiority margin was −4.8%. Secondary outcomes included intubation success rate on the first attempt, hemodynamic parameters during ATI, time taken for airway anesthesia and intubation, recall of intubation, patient perception of comfort, and incidence and severity of postoperative complications. Main results In the PP population, the proportion of AIC in the modified group was 49/49 (100%) and that in the traditional group was 49/49 (100%), absolute difference 0, lower limit of 1-sided 95% CI, −0.3%. In the ITT population, the primary outcomes in the modified and traditional group were 52/52 (100%) and 51/52 (98.1%), respectively, with an absolute difference of 1.9% and a lower limit of 1-sided 95% CI of −1.2%. The non-inferiority of modified ultrasound-guided anterior SLNB was confirmed in both populations. Conclusions Among adults without difficult airways during videolaryngoscope-assisted ATI, the modified ultrasound-guided anterior SLNB, compared to the traditional posterior approach, showed a statistically non-inferior effect in terms of providing AIC.

Modern approach to transfusion therapy of massive hemorrhage due to abnormally invasive placenta

Abnormally invasive placenta (AIP), or according to modern terminology PAS (placenta accrete spectrum disorders), is one of the most dangerous obstetric pathologies of pregnancy. It is quite often accompanied by massive blood loss during childbirth. Indicators of placenta accretion are increasing sharply, taking into account the frequency of delivery by cesarean section (CS).The objective: to determine the effectiveness of the blood loss recovery program in the case of delivery of pregnant women with AIP according to modern principles of transfusion therapy of massive blood loss with the use of innovative methods of surgical hemostasis.Materials and methods. At the clinical bases of the Department of Obstetrics and Gynecology N 1 of the Shupyk National Healthcare University of Ukraine during 2018–2023, 49 pregnant women with Placenta рercreta 3a,b were operated by fundal SC.The main group included 19 pregnant women with antenatally diagnosed Placenta percreta, who were delivered by fundal SC followed by hysterectomy with fallopian tubes and restoration of blood loss according to the principles of Damage Control Resuscitation – DCR (during 2021–2023) with priority given to transfusion with blood products with minimization infusion therapy; the comparison group included 30 pregnant women with a similar diagnosis and surgical approach, who had the recovery of massive blood loss in accordance with order No. 205 of the Ministry of Health of Ukraine “Obstetric bleeding” with the priority of rapid infusion therapy with crystalloids (2018-2020).Results. All pregnant women from Pl. percreta were delivered by CS and had hysterectomy at 35–37 weeks of pregnancy with lower median laparotomy and endotracheal anesthesia. The study groups did not differ in terms of the volume of surgery, but differed in the program of transfusion therapy to restore blood loss.In the main group, in which the early start of transfusion therapy using single-group fresh-frozen plasma and erythrocyte mass was applied, a significantly lower frequency of the development of the syndrome of disseminated intravascular blood coagulation, relaparotomy, cases of severe postoperative anemia and a shorter length of stay in the obstetric hospital were determined (p&lt;0.05).Conclusions. The use of innovative surgical technologies, tranexamic acid preparations and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion, according to the Damage Control Resuscitation strategy, in the development of massive intraoperative bleeding in cases of Placenta percreta allows to reduce the volume of blood loss and to prevent severe intra- and postoperative complication.

Post-extubation use of high-flow nasal oxygenation induces upper airway leak and intrathoracic sepsis after successful Bentall procedure: A case report.

In recent few years, high-flow nasal oxygenation (HFNO) has been widely used for management of acute hypoxemic respiratory failure and during postextubation periods, including after endotracheal intubation general anesthesia (ETGA). However, HFNO generates positive pressure in the injured airway following removal of endotracheal tube may cause airway leaks. This is the first case report of severe airway leak syndrome following postextubation use of HFNO in surgical patients. This case report describes a 75-year-old female with critical aortic stenosis who underwent an emergency Bentall procedure. HFNO (flow rate of 45 L/min) was applied after weaning from mechanical ventilation and removal of the endotracheal tube. At 6 hours after HFNO application, subcutaneous emphysema in the neck bilaterally and face was noted, and the emphysema extended into the supraclavicular regions. The HFNO cannula was removed soon after and the patient was re-intubated with an endotracheal tube the following day due to progressive respiratory insufficiency. Unfortunately, the patient general condition deteriorated, as the subcutaneous air collections progressed into deep tissue infections of the neck, mediastinal abscesses, and left-sided empyema. Patient received surgical interventions repeatedly to drain the mediastinal abscess and empiric antimicrobial therapy was given. The patient passed away about 2 months later due to uncontrollable sepsis. Air leaks in the upper airway can occur during the use of post-extubation HFNO use, and the resulting subcutaneous emphysema can progress to severe intrathoracic infections in surgical patients who have a sternotomy wound. Therefore, HFNO-induced subcutaneous emphysema should be treated more aggressively in open thoracic or sternotomy surgeries to prevent the development of intrathoracic sepsis.

Castleman disease. A rare clinical case of retroperitoneal tumor localization in an elderly patient

Castleman disease is an extremely rare benign disease of the lymphatic system with an estimated incidence of 1–9 cases per 1,000,000. Its etiology remains unknown; interleukin 6 (IL-6) plays an important role in pathogenesis. Castleman disease has two clinical forms: localized (up to 90 % of cases) with a favorable prognosis, treated predominantly by surgical method; generalized (up to 10 % of cases) with less favorable prognosis, treated by pharmacological therapy. The diagnosis is rarely established at the preoperative stage.The aim. To present a clinical case of diagnosis and treatment of Castleman tumor of a rare topical localization.Results. A 66-year-old patient was admitted at the Abdominal Oncology Department of the G.E. Ostroverkhov Kursk Oncology Scientific and Clinical Center.Diagnosis: Retroperitoneal mass on the right found at the preventive examination; no peripheral lymphadenopathy was detected on ultrasound and computed tomography (CT). After the examination, a preliminary diagnosis was made: Gastrointestinal stromal tumor (GIST) of the small intestine mesentery. Based on the results of the case conference, the decision was taken to perform a surgery – laparoscopic removal of the tumor under endotracheal anesthesia. For surgical approach, a fan-shaped arrangement of ports was chosen. The surgery had no complications. Intraoperative blood loss was 50.0 ml. The total operating time was 98 minutes.According to the results of the histological study, the following diagnosis was made: Castleman disease, unicentric form, hyaline-vascular variant. En bloc surgery is the standard method for the treatment of localized forms of the Castleman disease. In all cases, long-term follow-up shows a long relapse-free period in almost all patients.During follow-up examinations (ultrasound of the abdominal cavity and retroperitoneal space, CT of the abdominal cavity with contrast enhancement, CT of the chest), no disease recurrence was detected during the year of observation.Castleman disease is a rare non-clonal lymphoproliferative disease of unknown etiology. A rare case of its retroperitoneal localization indicates that in cases with an uncertain nature of the peritoneal mass, Castleman disease should be included in the differential diagnostic search.

QUALITY OF LIFE OF A PATIENT AFTER ENDARTERECTOMY OF THE INTERNAL CAROTID ARTERY (ICA) FOLLOWINGAN ACUTE ISCHEMIC STROKE (AIS) DURING COVID-19

The aim of the study was to evaluate the quality of life of a patient af- terendarterectomy (CEA) of the Internal Carotid Artery (ICA) following an Acute ischemic stroke (AIS) during COVID-19.A right-handed, 51-year-old patient, a visual artist, single, in good health and no chronic illnesses to date, became infected with SARS-CoV-2 and contracted COVID-19. The presence of SARS-CoV-2 virus was confirmed by a RT PCR antigen test. The patient was hospitalized, and required mechanical ventilation at an Intensive Care Unit (ICU) before an acute ischemic stroke (AIS) onset. Except for untreated hypertension, her medical history was unremarkable. Her blood pressure was 180/100 mm Hg; her pulse was 76 beats per minute and was regular. AIS from the left middle cerebral artery (MCA) has resulted primarily in damage to the left hemisphere, and secondary effects on the right side resulting in body weakness and mild anomic aphasia. Magnetic resonance imaging (MRI) confirmed stroke and detected brain tissue damaged by an AIS. It revealed hyperintense foci in the T2 and FLAIR sequences, 21 mm in size in the left hemisphere of the brain. In search of the cause of AIS, CT angiography was performed. It revealed a large (90%) ICA occlusion. The patient was admitted to the emergency room at the Vascular Surgery Clinic with an Endovascular Subunit. The revascularization procedure (CEA) was performed under general endotracheal anesthesia with the use of the protocol and techniques (elaborated at the Department of Vascular Surgery and Endovascular Procedures, The John Paul II Hospital in Krakow). The CEA procedure improved her general health: she regained the ability to name objects and her HRQOL also improved in her perception. The improvement achieved was statistically significant. She returned to painting and functions well in society.The patient’s perception of HRQoL measured by the SF-36 domains was better after the CEA: a significant improvement in self-reported overall health has occured. The HRQoL outcome measures may be valuable in future clinical trials of comparing different methods of treatment offered after AIS.

N.M. Aleksandrov, maxillofacial surgeon, professor, major-general of medical service (to the 100th anniversary of his birth)

The aim of the investigation is to reveal scientific, clinical, pedagogical and social activity of the eminent maxillofacial surgeon Doctor of medical sciences, professor, major-general of the medical service N.M. Alexandrov and his merits in the sphere of the military dentistry.&#x0D; Material and methods. On the basis of analysis of the national literature, as well as life and professional activity and scientific labors of general, major-general of medical service N.M. Alexandrov to present his role in military dentistry development and maxillofacial surgery in Russia.&#x0D; Results. The analysis of the information about N. M. Alexandrov showed that he was one of pioneers in developing and implementing in the USSR the endotracheal anesthesia in surgical interventions on the organs and tissues of face and neck, the author of some methods of reconstructive surgeries: upper jaw resection with primary plasty; otoplasty with using the Philatov stalk and local tissue; lower lip plasty using two symmetrical upper lip flaps and others. Methods of treatment of purulent diseases of maxillofacial region and neck with the use of hyperbaric oxygenation, laser therapy and low-frequency ultrasound, laser therapy of temporomandibular joint diseases, as well as cryosurgery of new growths of face and mouth organs, a number of methods of microsurgery and electric anesthesia in dentistry, hemostatic drug "Kaprofer" were developed under his scientific guidance and introduced into the clinical practice.&#x0D; Conclusions. N.M. Alexandrov was an excellent clinician, a brilliant teacher and surgeon, a prominent scientist and organizer of military health care; his colleagues and pupils remember him today and honour his merits in the field of maxillofacial surgery and military health care.

Efficacy of Dexmedetomidine Combined with Bupivacaine in Supraclavicular Block Versus Bupivacaine alone in Upper Limb Surgery

Objective: To compare the efficacy of Dexmedetomidine combined with Bupivacaine in supraclavicular block versus Bupivacaine alone in upper limb surgeries&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration Of Study: Anaesthesia Department, Combined Military Hospital Quetta, Pakistan, from Sep to Feb 2022.&#x0D; Methodology: Patients planning to undergo plating of radius fractures were included. The patients were divided into two equal sets (n=20) by purposive sampling and marked as Group-A and Group-B. Patients in both groups received supraclavicular block under ultrasound guidance and general endotracheal anaesthesia followed by that. In the first Group,Bupivacaine plain (0.125%) was used to block the brachial plexus, and in the second Group, Bupivacaine (0.125%) with adjuvant Dexmedetomidine (1ug/kg) was given respectively. The visual analogue scale was used to measure pain perception in both groups. &#x0D; Results: The duration of analgesia in the Dexmedetomidine Group was 10 ±0.925 hours and 5.68 ±0.471hours in Bupivacaine Group, which holds statistical significance (p-value&lt;0.001). The demographics, surgery-related parameters (duration and type of surgery), block related parameters (onset of block and time taken to block) were similar in both study groups.&#x0D; Conclusion: We concluded that Dexmedetomidine prolongs the duration of analgesia significantly when used as an adjuvant Bupivacaine in supraclavicular brachial plexus block.

Remimazolam as an Adjunct to General Anesthesia in Children: Adverse Events and Outcomes in a Large Cohort of 418 Cases.

Remimazolam was first approved in 2020 as a general anesthetic for adults and still does not have pediatric labeling. Our study will be the first pilot program that administers remimazolam as an adjunct to a general endotracheal anesthetic in children. Between August 2020 and December 2022, electronic medical records were collected for all children who received remimazolam during anesthesia. The remimazolam dosing regimen was extrapolated from the adult package insert, with intravenous induction doses of 12 mg/kg/h administered until the desired effect was achieved. Subsequent infusions were given at a rate of 1-2 mg/kg/h, accompanied by intermittent boluses of 0.2 mg/kg, with all dosing adjustments made according to the anesthesiologist's clinical discretion. A total of 418 children (mean 4.6 yrs, 68.7% ASA 1 and 2) underwent surgeries which averaged 81.2 min. A total of 75.2% of patients had greater than a 20% change (increase or decrease) in MAP (lowest or highest) from baseline, and 203 (49.3%) patients had greater than a 30% change (increase or decrease) in MAP (lowest or highest) from baseline. A total of 5% received ephedrine to treat unanticipated hemodynamic variability. Discharge criteria were met within an average of 13.8 min after arrival at the post-anesthesia care unit. Remimazolam may offer the benefits of rapid recovery following general endotracheal anesthesia. The risk of hemodynamic variability which necessitates and responds to ephedrine should be anticipated.

PERIOPERATIVE CONCERNS OF VENTRICULOATRIAL SHUNT - A RETROSPECTIVE ANALYSIS OF 40 CASES

Background: Ventriculo -peritoneal [VP] shunt is the most commonly used cerebrospinal uid (CSF) diversion procedure for the management of hydrocephalus. However, when the absorption of CSF from the peritoneum is defective, it results in abdominal distension with CSF ascites. In such cases, an alternate diversion procedure - the ventriculo-atrial [VA] shunt – may be performed. However, this procedure is also associated with several perioperative problems like arrhythmias, air embolism and infection. Materials and methods: A retrospective analysis of 40 cases on the perioperative concerns of VA shunt procedures, performed in our institute, was done. Indication of the shunt, preoperative status &amp; work -up, intraoperative adverse events &amp; management and immediate post-operative complications were assessed. Out of the 40 patients, there were 25 male Results: s and 15 females and there were a total of 12 paediatric patients. Blocked shunt, abdominal infection and CSF ascites were common indications for VA shunt. All patients received general endotracheal anaesthesia with preoperative hypovolemia correction. Intraoperative tachycardia and arrhythmia were noted. Various Conclusion : preoperative concerns like distended abdomen and compromised respiration increase risk of VA shunt procedures. A better understanding of the underlying disease pathology and anticipation of related complications along with cautious and meticulous management can help prevent most of the complications of VA shunt procedure and thereby improve outcome

Lateral Decubitus Positioning For Shoulder Arthroscopy

Background: Lateral decubitus positioning is a frequently employed technique to perform shoulder arthroscopy. Proper patient positioning and equipment setup is crucial to ensure a safe and efficient surgery. Indications: The common indications for performing a shoulder arthroscopy in the lateral decubitus position include anterior shoulder stabilization, posterior shoulder stabilization, superior labrum anterior to posterior (SLAP) repair, diagnostic arthroscopy for internal impingement, and arthroscopic capsular release for adhesive capsulitis. Technique Description: After undergoing general endotracheal anesthesia in the supine position on a standard operating room table, the patient is rotated into the lateral decubitus position with the operative arm facing upward. The patient’s head is supported with a pillow to ensure a neutral position. The nonoperative arm is flexed forward and rests on a padded arm board. The sides of a bean bag are applied to the patient’s torso to maintain the lateral decubitus position, and the bean bag is deflated to remain rigid. An axillary roll is placed under the axilla, and foam pads are placed below the “down leg” and between both legs. A commercial arm jack is positioned on the anterior, proximal side of the operating room table to allow for 20° of shoulder abduction, which maximizes the glenohumeral joint space. Results: Advantages of the lateral decubitus position over the beach chair position include improved access to the anterior, inferior, and posterior glenoid; more ergonomic positioning for the operating surgeon; lower risk for patient cerebral hypoperfusion; and reduced rates of recurrent instability following arthroscopic stabilization in comparison to procedures performed in the beach chair position. Disadvantages of the lateral decubitus position include risk of traction-related neurovascular injury, requirement of an arm suspension device, and increased difficulty in rotating the shoulder intraoperatively. Discussion/Conclusion: Lateral decubitus positioning is commonly used to achieve a circumferential view of the glenohumeral joint in shoulder arthroscopy. This surgical position yields several advantages for the operating surgeon and has been shown to be associated with improved clinical outcomes after shoulder instability surgery. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Effects of total intravenous anesthesia with etomidate and propofol on postoperative cognitive dysfunction

Increased incidence of postoperative cognitive dysfunction (POCD) is observed in elderly patients underwent intravenous anesthesia (TIVA) with endotracheal intubation. Modulation of anesthetics compatibility may reduce the severity of POCD. Elderly patients scheduled for TIVA with endotracheal intubation were randomly divided into the control group (1.00‑2.00 mg/kg propofol) and the etomidate and propofol combination group (1.00‑2.00 mg/kg propofol and 0.30 mg/kg etomidate). Serum cortisol, S100β, and neuron-specific enolase (NSE), interleukin (IL)-6, and IL-10 were monitored during or after the operation. Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were utilized to assess the severity of POCD. 63 elderly patients in the etomidate and propofol combination group and 60 patients in the control group were enrolled, and there was no significant difference in gender, American Society of Anesthesiologists (ASA) physical status, surgical specialty, intraoperative blood loss, and operation time between the two groups. Significantly increased serum cortisol, S100β, NSE, IL-6, and reduced MMSE and MoCA scores were detected in the control group at different time points after the operation (0-72 h post operation) when compared to those before the operation. Similar trends for these observed factors were found in the etomidate and propofol combination group. In addition, the etomidate and propofol combination group showed better effects in reducing the serum levels of cortisol, S100β, NSE, IL-6, and increasing the MMSE and MoCA scores when compared to the control group. The present study demonstrates that the combination of propofol with etomidate could alleviate POCD in elderly patients underwent TIVA with endotracheal intubation anesthesia.

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

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

Assessment of stress response due to C-Mac D-blade guided videolaryngoscopic endotracheal intubation and docking of da Vinci surgical robot using perfusion index in patients undergoing transoral robotic oncosurgery.

Clinical utility of perfusion index (PI) has entered a new realm as a non-invasive, quantitative index of stress response to endotracheal intubation. Transoral robotic surgery (TORS) involves F-K retractor aided docking of the surgical robot producing haemodynamic and stress responses akin to laryngoscopy. We compared the stress response to videolaryngoscopy with that due to docking of da Vinci surgical robot using PI, heart rate and mean arterial pressure evaluated at specific time points post-laryngoscopy and post-docking. Twenty-six adult patients, scheduled for TORS under general endotracheal anaesthesia were included in this prospective, observational, single-centric cohort study. Statistical analysis included paired samples t-test, dotted box-whisker plots, trendlines and correlograms for comparative analysis of two stressors, laryngoscopy and docking. Baseline PI was 4.14. PI values increased post-midazolam (4.23), 1min (5.69) and 3min (6.25) post anaesthetic-induction, plummeted at laryngoscopy (3.24), remained low at 1min (3.68), 3min (4.69) thereafter, and were highest at 10min (6.17) post-laryngoscopy and predocking (6.84). Docking witnessed a fall in PI (4.1), which remained low at 1min (4.02), 3min (4.31) and 10min (4.79) post-docking. PI was significantly higher at laryngoscopy compared with PI at docking (p = 0.0044). At 1min and 3min post-laryngoscopy and post-docking, respectively, the differences in PI were statistically insignificant. PI at 10min post-laryngoscopy was significantly lower than PI at 10min post-docking (p < 0.0001). As non-invasively quantified by PI, videolaryngoscopic stress response is more intense but shorter-lived versus that due to docking. PI displays a negative correlation with haemodynamic variables. PI at laryngoscopy is a good predictor of PI at docking, enabling pre-emptive measures (fentanyl bolus; deepening of volatile anaesthesia from MAC-maintenance to MAC-intubation) anticipating the docking-induced stress response.Trial registration http://ctri.nic.in ; Identifier: CTRI/2019/11/022091.

Caudal block in combination with general anesthesia as the best method of anesthesia for large joint replacement

Operations of total hip and knee arthroplasty are currently one of the most frequent surgical interventions performed for functional rehabilitation of patients with osteoarthritis or patients who have received a fracture of the femoral neck. The best method for providing anesthesia and pain relief for total joint replacement has not been determined. Until now, a unified point of view on the choice of the optimal method of anesthesia and analgesia in surgical interventions for arthroplasty has not been formed. Purpose of the study.: To study the effectiveness of caudal anesthesia in hip and knee arthroplasty. Material and research methods: The study was conducted in the surgical clinic of the AMU in 56 patients who underwent surgery for hip and knee arthroplasty. The age of the patients varied from 57 to 99 years. Depending on the chosen anesthesia technique, the patients were divided into 2 groups: in the 1st group (n=28) endotracheal anesthesia was performed, induction of anesthesia with propofol and rocuronium bromide, anesthesia based on sevoflurane 1.0 vol% with caudal administration of ropivacaine 2 mg/kg in combinations with dexamethasone 0.2 mg/kg; group 2 (n=28 patients) underwent multicomponent endotracheal anesthesia (propofol 3 mg/kg, rocuronium bromide 0.6 mg/kg, sevoflurane 1.5–2.5 vol/% with high doses of fentanyl 5–6 µg /kg/hour. Research results: During the traumatic moment of the operation, the average heart rate in group I (general anesthesia + caudal block) was significantly lower than in group II (general anesthesia) (69.4±2.0 versus 89.40±3.0, p=0.010), but there are significant differences in SBP or DBP between the two groups. Conclusion: The inclusion of caudal blockade in the protocol of general anesthesia provides adequate pain relief, both intra- and postoperatively, in patients undergoing arthroplasty of large joints of the lower extremities.

492 Periprocedural Polypharmacy in Lumbar Fusions Performed Under Spinal Anesthesia Compared to General Anesthesia

INTRODUCTION: Lumbar spinal surgery is most often performed under general endotracheal anesthesia (GEA), however spinal anesthesia (SA) is a safe and effective alternative. Postoperative cognitive dysfunction (POCD) is a complication of GEA and the risk of POCD is associated with anesthetic modality and perioperative polypharmacy. Despite the many benefits of SA described in the literature, its efficacy in decreasing polypharmacy has not yet been determined. METHODS: Demographic and procedural data of 424 patients undergoing single TLIF via GEA (n = 186) and SA (n = 238) were extracted from our institution’s electronic medical record. We investigated perioperative medication types, number of intraoperative hypotensive episodes, vasopressor requirement, and overall number of perioperative medications used between the two patient groups. RESULTS: The number of perioperative medications differed significantly between the two cohorts with the SA cohort receiving a mean of 4.5 medications and the GEA cohort receiving a mean of 10.5 medications (p &lt; 0.0001).This reduction in perioperative medications remained significant after a multivariable analysis to control for confounders (p &lt; 0.001 for all variables). Use of vasopressors was significantly reduced in the SA cohort (p &lt; 0.001), which coincided with a significant reduction in hypotensive episodes in the SA cohort (p &lt; 0.001). Patients undergoing TLIF via GEA had 3.6 times greater odds of experiencing a hypotensive episode intraoperatively (OR = 3.62, 95% CI [2.38-5.49]). CONCLUSIONS: Spinal anesthesia is associated with a significant decrease in perioperative medications, including lower vasopressor requirements. We postulate that SA may confer superior intraoperative hemodynamic stability which lowers pressor requirements. The decrease of perioperative medications may be an important contribution in reducing the incidence of POCD in patients undergoing TLIFs.

Особливості ведення пацієнтів з абсцесом надгортанника на всіх етапах медичної допомоги

An epiglottis abscess is usually the final stage of epiglottis (epiglottitis) and surrounding tissues inflammation and can progress to life-threatening airway obstruction without treatment. The etiology of the disease can be infectious or non-infectious nature. Both with infectious and non-infectious etiology, swelling of the epiglottis occurs as a result of the accumulation of inflammatory cells in the space between the layer of squamous epithelium and the epiglottis cartilage. The lingual surface of the epiglottis and peri-epiglottis tissues have a large network of lymphatic and blood vessels, which promotes the spread of infection and the subsequent inflammatory reaction. Once the infection begins, the swelling rapidly progresses, involving the entire epiglottis of the larynx (including the epiglottis folds and the epiglottis cartilages). Clinical signs of epiglottitis vary depending on age, severity, and etiology. Purpose - is to describe a clinical case of successful care for a child with an epiglottis abscess and the optimal route of the patient at all levels of medical care. Clinical case. An ambulance delivered a patient G., born in 2005 (17 years old), to the emergency otorhinolaryngology department of the Kyiv City Children’s Clinical Hospital 1. During the examination in the emergency department with indirect laryngoscopy the diagnosis was established: abscess of the epiglottis. An epiglottis abscess was urgently dissected under endotracheal anesthesia. The difficulty of diagnosing an epiglottis abscess was that visualization of the larynx is possible only with the use of instrumental examination methods, such as indirect laryngoscopy. This method is not within the competence of a family doctor. Accordingly, the family doctor, within the limits of his competencies, appropriately used the ISPS-2 international classification, section «R» - respiratory system and code - «76» and made a diagnosis of acute tonsillitis, thereby assuming the infection etiology of the disease. The family doctor, taking into account the severity of the condition, according to the patient’s itinerary, issued a referral for urgent hospitalization, according to the child's moderate condition. In our opinion, the main reason for achieving a good clinical result was an interdisciplinary approach: a combination of correctly performed diagnostics and timely surgical intervention. We hope that this clinical example, which demonstrates the features of interdisciplinary interaction between specialists, will improve the quality of medical care for patients with epiglottis abscess. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Pediatric Fellowship-Trained Anesthesiologists Improve Anesthesia-Controlled Time in a Pediatric Endoscopy Suite.

The objective of this study was to determine the difference in anesthesia-controlled time (ACT) between subspecialty-trained pediatric anesthesiologists and general anesthesiologists during esophagogastroduodenoscopy (EGD) and colonoscopy. We hypothesized pediatric anesthesiologists would demonstrate a shorter ACT compared to general anesthesiologists. We conducted a retrospective analysis of pediatric endoscopy cases requiring general endotracheal anesthesia within our pediatric sedation unit from 2017 to 2020. Demographic and procedural variables were collected and assessed for potential confounding. The imbalance in baseline variables was controlled for utilizing a generalized linear model (GLM). The GLM had a model fit of adjusted R2 = 0.146 and was statistically significant with P < 0.001. A priori power analysis was performed for a 2-tailed independent means t test with alpha = 0.05, and Power = 0.80, which revealed a minimum sample size of 64 patients per group to detect a mean difference of 3 minutes of ACT. A total of 269 cases met inclusion criteria. Adjusted results demonstrated fellowship-trained pediatric anesthesiologists were associated with a 3.7-minute (95% CI: 2.005-5.478; P < 0.001) reduction in ACT when compared to general practice anesthesiologists. Patient age was associated with a 0.4-minute (95% CI: -0.558 to -0.243; P < 0.001) decrease in ACT for each advancing year in age. We observed an association between the subspecialty training of the anesthesiology provider and ACT for EGDs and colonoscopies. When EGDs and colonoscopies are performed under the supervision of pediatric anesthesiologists, ACT reduction potentially reduces cost and improves efficiency.