Endotracheal Anesthesia Research Articles

Surgical treatment of giant false aneurysm of the axillary artery

Vascular damage is an important aspect in the structure of injuries. Untimely medical care in patients with peripheral artery damage is often followed by development of false aneurysm. This event may be complicated by aneurysm rupture and bleeding, peripheral arterial thromboembolism, hematoma infection and neuropathy following adjacent nerved compression. We report surgical treatment of a patient with giant false aneurysm of the left axillary artery following a knife wound 1 year ago. The patient did not appeal for qualified medical care and ensured haemostasis at home. The patient underwent surgery under endotracheal anaesthesia. Debridement of hematoma, closure of arterial wall defect and wound drainage were carried out through an approach in the upper and middle third of the left shoulder.

Modern methods of early diagnosis of tumors of the larynx and pharynx

To analyze the effectiveness of various methods of endoscopic and molecular diagnostics of malignant neoplasms of the larynx and pharynx. A study was conducted In the Department of ENT Oncology of the National State Research Center of Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, which involved 46 patients with suspected malignant neoplasms of the larynx and pharynx. All patients underwent direct laryngoscopy under endotracheal anesthesia with simultaneous NBI-endoscopy, spies examination, contact endoscopy, and fluorescence testing, followed by biopsy and tissue sampling for microRNA concentration analysis, as well as blood sampling for SCCA concentration.

Positive Impact of Intraoperative Epidural Ropivacaine Infusion on Oncologic Outcomes in Pancreatic Cancer Patients Undergoing Pancreatectomy: A Retrospective Cohort Study.

Background: Previous literatures have demonstrated that regional anesthesia such as epidural anesthesia may affect long-term survival of cancer patients. In the present study, we conducted a retrospective cohort study to investigate the survival impact of intraoperatively epidural ropivacaine infusion on pancreatic ductal adenocarcinoma (PDAC) patients.Methods: PDAC patients who underwent pancreatic surgery in Zhongshan Hospital Fudan University from January, 2015 to June, 2018 were included. The surgical procedure was performed under combined endotracheal general anesthesia and thoracic epidural anesthesia, and patient-controlled epidural analgesia (PCEA) with 0.12% ropivacaine was given after surgery for further pain control. Patients were divided into two groups according to their intraoperative epidural ropivacaine concentration: high (0.375%-0.5%) and low (0.15%-0.25%). Survival outcome was compared between groups.Results: A total of 215 patients were enrolled and their baseline characteristics were balanced between groups, except that patients with high concentration ropivacaine received higher total dose opioid and had longer operative time. Resected PDAC patients who were administrated with high concentration ropivacaine through epidural catheter intraoperatively had improved overall survival (median overall survival, mOS, high VS low, 37.6 VS 23.7 months, p=0.04). High epidural ropivacaine concentration was an independent prognostic factor (hazard ratio [HR]=0.65, 95% confidence interval [CI], 0.44-0.94; p=0.03). Subgroups analyses shown that T3M0 PDAC patients with preoperative CA 19-9 higher than 200 U/ml, negative resection margin, and those without tumor deposit and adjuvant radiotherapy could benefit from high concentration of ropivacaine.Conclusion: Intraoperatively epidural infusion with high concentration of ropivacaine was associated with improved OS in PDAC patients undergoing pancreatectomy.

Clinical Study of Preemptive Analgesia with Hydromorphine on Postoperative Analgesia in Patients with Laparoscopic Hysterectomy

Pain after laparoscopic hysterectomy can lead to strong stress response, increase blood pressure and heart rate, restless during the awakening period. Preemptive analgesia is one of the methods to relieve postoperative pain. The purpose of this study is to explore the feasibility and safety of hydromorphine hydrochloride in preemptive analgesia, and to provide reference for clinical application. Two hundred American Society of Anesthesiologists I-II patients undergoing laparoscopic hysterectomy under endotracheal intubation general anesthesia from September 2019 to October 2020 were randomly divided into observation group (n=100) and control group (n=100) according to random number table. Patients in both groups were given intravenous rapid induction tracheal intubation combined with general anesthesia. 15 min before skin incision, hydromorphinone hydrochloride 15 μg/kg (diluted to 10 ml with normal saline) was injected intravenously in the observation group, while normal saline 10 ml was injected into the control group. Visual analogue score was used to evaluate the analgesic effect after tracheal extubation. Venous blood samples were taken 5 min before anesthesia and after extubation, and the levels of plasma epinephrine, norepinephrine and dopamine were measured. The mean arterial pressure and heart rate of the two groups were recorded before anesthesia, after operation, immediately after extubation, 10 min after extubation and 30 min after extubation. Ramsay sedation scale was used to evaluate the sedation of patients with 10 min, 30 min and 1 h after endotracheal tube extubation. Riker Sedation-Agitation Scale was used to observe the occurrence of restlessness in the recovery period within 24 h after operation. There was no significant difference in basic characteristics between the two groups (p>0.05). Visual analogue score: compared with the control group, the visual analogue scores at 10 min after extubation, 30 min after extubation, 1 h, 2 h, 4 h, 6 h and 12 h after endotracheal tube extubation in the observation group were significantly lower than those in the control group. There was no significant difference in the levels of plasma epinephrine, norepinephrine and dopamine between the two groups before anesthesia. After extubation, the levels of plasma epinephrine, norepinephrine and dopamine in the 5 min control group were significantly higher than those in the observation group (p<0.05). Hemodynamics (mean arterial pressure and heart rate in the control group were significantly higher than those in the observation group after operation, immediately after extubation, 10 min after extubation and 30 min after extubation in mean arterial pressure and heart rate): groups, and the difference was statistically significant. There was no significant difference in spontaneous respiratory recovery time and extubation time between the two groups (p>0.05). Ramsay sedation score: there was no difference between the two groups. Preemptive analgesia with hydromorphine hydrochloride in patients undergoing laparoscopic hysterectomy under general anesthesia has good analgesic effect, less postoperative adverse reactions, and can effectively inhibit cardiovascular reactions during recovery.

Опыт применения дексмедетомидина для седоанальгезии при проведении ринохирургических вмешательств

The aim of this work was to study the possibility of rhinosurgical interventions using the drug dexmedetomidine for controlled sedoanalgesia. Materials and methods: 118 rhinological interventions (polysinusotomy, pansinusotomy, septoplasty) were performed under combined sedation: 56 with dexmedetomidine and 62 with sibazone. Intraoperatively, the amount of narcotic analgesic and local anesthetic, pain level and depth of sedation, hemodynamic and respiratory parameters, bleeding intensity and operating visibility were considered; in the postoperative period - the level of pain, bleeding when removing tampons from the nose, satisfaction of the surgeon and the patient. Results: during sedanalgesia with dexmedetomidine, the optimal level of sedation was achieved, the amount of narcotic and local anesthetic was reduced, hemodynamic parameters were comfortable for the surgeon (lower than in the control group, blood pressure), which, first of all, provided good operational visibility. In the postoperative period, there was a higher satisfaction of the patient and the surgeon with the performed anesthetic aid. Conclusions: sedoanalgesia with the drug dexmedetomidine can be used in uncomplicated cases during rhinosurgical interventions as an alternative to endotracheal anesthesia, providing optimal pain relief and comfortable work of the surgeon.

Airway Management for Initial PEG Insertion in the Pediatric Endoscopy Unit: A Retrospective Evaluation of 168 Patients.

PurposePercutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS).MethodsAll patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist.ResultsThis study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4–5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11–2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08–1.33) and anesthesia time (eβ=1.50, 95% CI=1.30–1.74) in adjusted models.ConclusionStudy results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.

Multidisciplinary approach in the treatment of patients with bilio-pleuro-pulmonary fistulas

Summary Post-opbilio-pleuro-pulmonary fistulas are extremely rare, but a serious complication can develope vena few year safter surgery. The article presents the experience of effective stage-by-stage separation of bilio-pleuro-pul-monary fistulas that occurred in patients at various times after surgical interventions on the liver. The purpose of the article was to analyze, develop and generalize mod-ern endoscopic methods of treatment in patients with hepatic pathology complicated by the development of bilio-pleuro-pulmonary fistulas. Materials and methods of the study: clinical observations of two patients who were admitted for inpatient treatment in the differen-tial diagnostic department of the State Medical Institu-tion «TB Dispensary» of the Ministry of Health of the KBR (Kabardino-Balkarskaya Republic) in 2020 and 2021 are presented. Two patients developed pleuro-pulmonary complications after surgical interventions on the liver. The severity of the patients‘ condition at admission was due to increasing respiratory insufficiency as a result of the development of bilateral aspiration pneumonia, which prevented endotracheal anesthesia and abdomi-nal surgical interventions. The patients underwent tem-porary endoscopic valvularbronchoblocking in combina-tion with selective drainage of the pleural cavity. When assessing the condition of patients 24–48 hours after the interventions, positive clinical dynamics, relief of bilioph-thysis, elimination of biliothorax were noted, and dur-ing the control X-ray examination in the postoperative period, closure of the bilio-pleural and broncho-pleural fistulas was noted. Thus, this method allowed to stop the aspiration syndrome and achieve clinical stabilization of patients, which made it possible to prepare them for radi-cal surgical interventions aimed at the final elimination of pathological bilio-pleuro-pulmonary communication. For the first time, the tactics of a complex step-by-step ap-proach to the treatment of this category of patients was used, aimed at temporarily delineating the vicious biliary-respiratory communication. In the article, the algorithm is proposed, step-by-step examination and treatment of patients with biliopleuro-pulmonary fistulas, to prepare patients for radical surgical interventions. The proposed therapeutic and diagnostic algorithm can be recom-mended for use in medical institutions with specialized hospitals.

Opioid-Free Anesthesia in the Perioperative Setting-A Preliminary Retrospective Matched Cohort Study.

Anesthesiologists have long used multimodal analgesia for effective pain control. Opioid-sparing anesthetics are gaining popularity among practitioners in light of increasing concerns for both immediate opioid side effects and the long-term opioid misuse among susceptible patients. Currently, there is a critical gap in knowledge regarding outcomes after an opioid-free anesthetic (OFA) during general anesthesia. We hypothesized that an opioid-free general anesthetic will not be inferior to a traditional opioid anesthetic (OA) as measured by the perioperative outcomes of postanesthesia care unit (PACU) duration, 12-hour postoperative summed pain intensity (SPI12) scores, total morphine equivalent doses (MEDs) utilized in the 12-hour postoperative inpatient (MED12) and total MEDs utilized in the 90-day outpatient periods (MED90). Patients were included if they were ≥18 years old, met criteria for American Society of Anesthesiologists classification I-IV, received general endotracheal anesthesia from a single anesthesia provider for a surgical operation in 2016, did not receive intraoperative administration of opioids, and were recovered in the PACU. A total of 25 patients were included in the OFA group and 29 control patients in the OA group (n = 54). A retrospective chart review of intraoperative records, perioperative pain scores, and medication utilization (inpatient and outpatient) was performed to obtain the data for the analysis of the primary outcomes. In both OFA and OA groups, the continuous outcomes were not normally distributed. Subsequent bivariate tests of the indicated OA versus OFA age (d = 0.58), surgery duration (d = 0.24), and preoperative pain score (d = 0.51) warranted inclusion in the multinomial regression. Surgical duration was not significantly associated with the primary outcomes. However, the continuous variables of age and preoperative Defense and Veterans Pain Rating Scale score were associated with differences in primary outcomes. Every 1-year increase in the age was associated with a 5.06 increase in SPI12 and 5.73 mg increase in MED12. Every 1-point increase in the preoperative Defense and Veterans Pain Rating Scale score was associated with an 8.45 minutes increase in PACU duration, 11.25 increase in SPI12, 17.85 mg increase in MED12, and 20.83 mg increase in MED90. In regard to the primary outcomes, there was a lack of significant differences between the OFA and OA groups in all outcomes (PACU duration, mean SPI12, MED12, and MED90). To our knowledge, this is the first matched cohort study directly comparing an OFA with a traditional anesthetic for general anesthesia in a wide range of surgical and clinical scenarios. There was no significant difference in SPI12 between the OFA group and OA group, suggesting that patients' subjective pain was similar immediately after surgery whether or not they received intraoperative opioids. Concurrently, no "catch-up" effect was observed as the PACU duration; MED12 and MED90 were not different between the OFA and OA groups. However, there were many covariates identified in this study because of the small sample size or each group. Additional research is needed to explore if these findings can be extrapolated to a larger more heterogeneous population. Our preliminary work suggests that eliminating patient exposure to opioids in the intraoperative period does not have a deleterious effect on perioperative patient outcomes.

Effectiveness of Levodropropizine on Post-Operative Sore Throat After Endotracheal Intubation for Head and Neck Surgery: A Double-Blind Randomized Controlled Trial

ABSTRACT&#x0D; Objective: To determine the effectiveness of levodropropizine in reducing the incidence of post-operative sore throat (POST) among ear, nose, throat, head and neck (ENT-HNS) patients undergoing general endotracheal anesthesia.&#x0D; Methods:Design: Double-Blind, Randomized, Placebo Controlled TrialSetting: Tertiary Government Training Hospital Participants: Sixty (60) ENT-HNS patients aged between 19 to 60 years old admitted to the Southern Philippines Medical Center from January to March 2019 for surgeries on benign thyroid tumors, benign submandibular gland tumors and tonsils requiring orotracheal intubation were randomized into control and treatment groups of 30 patients each.&#x0D; Results: There was a statistically significant difference (p=.0016) in the incidence of POST 6 hours after surgery between control (25/30; 83%) and treatment (16/30; 53.33%) groups. However, confounders such as length and type of surgery (more females and tonsillectomy cases in the control group) were not fully eliminated by randomization.&#x0D; Conclusion: Perioperative levodropropizine significantly decreases the incidence of moderate (as well as mild) postoperative sore throat. It was not shown to decrease the incidence of severe sore throat. A larger cohort (adjusted for other confounders) may better describe the benefit of this treatment.

Endovascular Thrombectomy for Large Vessel Occlusions in Covid-19 Patients

INTRODUCTIONCovid 19 infections has been shown to be associated with a range of thromboembolic disease that has implications for the neuro-endovascular management of large vessel occlusions.METHODSFive consecutive Covid-19 positive patients presented with large vessel occlusions to our institution. Covid-19 testing was performed using nasal swab. All thrombectomy cases was performed under general endotracheal anesthesia using a stent-aspiration combination as primary thrombectomy technique. The technical details of each case and the angiographic outcome are described. Routine labs including D-dimer, platelet count, coagulation panel (aPTT, INR), Interleukin 6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were evaluated in all patients. Rotational thrombelastography (ROTEM) was performed on the patients' blood samples to assess real-time clot formation/dissolution properties.RESULTSFour patients had anterior circulation large vessel occlusions and one patient had both anterior and posterior circulation occlusions. Mean age was 52.8 years and 80% were males. TICI 3 revascularization was achieved in one patient, TICI 2B achieved in two patients andTICI 2A in two patients. In our cohort, patients were on average 52.8 years old and presented with a median NIHSS of 27. All our patients had very proximal occlusions. Three patients presented with intra-cranial ICA occlusions. Two patients presented with a tandem carotid bulb thrombus in conjunction with an intracranial vessel occlusion. One patient had an ICA terminus occlusion with a concomitant basilar occlusion. Second, the intravascular clots in all our patients were prone to fragment and migrate into both new vascular territories and into distal downstream vasculature. Distal emboli into a different territory (anterior cerebral artery occlusion) was seen in two two of our five patients (40%) and distal emboli into a downstream territory was seen in all five patients (100%). An average of 2.7 pstent-retriever passes was needed to achieve a final TICI revascularization of IIb or better.CONCLUSIONCovid-19 patients are predisposed to a hypercoagulable state. When presenting with large vessel occlusions, these patients present unique challenges that make successful revascularization difficult.

Safety of the LMA®Gastro™ for Endoscopic Retrograde Cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GETA, primarily due to the need for additional airway maneuvers. The increasing use of non-operating room (OR) anesthesia and the perception of a higher incidence of adverse outcomes in non-OR areas has led to the development of devices to improve safety while maintaining efficiency. The purpose of this study was to evaluate if the LMA Gastro™ could be used as a safe alternative to tubeless anesthesia for successfully completing ERCPs. Eligible subjects were identified within the patient population at MD Anderson Cancer Center. Inclusion criteria consisted of adult patients (≥18 years old) scheduled for elective ERCP with TIVA. This was a prospective observational study in which the following data were collected: number of attempts and time to successful supraglottic airway (SGA) placement, vital signs, peripheral oxygen saturation (SpO2), median end-tidal CO2, practitioner satisfaction, and any complications. A total of 30 patients were included in this study. The overall rate of successful SGA placement within 3 attempts was 96.7% (95% confidence interval [CI], 82.8-99.9) or 29/30. The rate of successful ERCP with SGA placement within 3 attempts was 93.3% (95% CI, 77.9-99.2) or 28/30. Both the gastroenterologist and anesthesiologist reported satisfaction with the device in 90% of the cases (in 66.7% of the cases both anesthesiologist and gastroenterologist scored the device a 7/7 for satisfaction). Patients maintained an SpO2 of 95%-100% from induction to discharge, with the exception of 1 patient who had an SpO2 of 93%. The median end-tidal CO2 during the procedure for all patients was 35 mm Hg. Observed aspiration did not occur in any patient. Symptoms of hoarseness (13.3%), mouth soreness (6.7%), sore throat (6.6%), and minor bleeding/cuts/redness/change in taste to the tongue (3.3%) were determined through patient questioning before postanesthesia care unit (PACU) discharge. Our study suggests that the LMA Gastro might be a safe alternative for ERCP procedures. There was a high level of practitioner satisfaction. Only minor complications, such as hoarseness, mouth or throat soreness, or minor trauma to the tongue were experienced by patients. Similar incidences of complications may occur with GETA and tubeless anesthesia. The procedure was well tolerated by all patients; all patients maintained adequate oxygenation and required only minimal blood pressure support.

Influence of Body Temperature on Bispectral Index-Guided Anesthetic Management in Off-Pump Coronary Artery Bypass Grafting

Abstract Background Perioperative hypothermia is not uncommon in surgical patients due to anesthetic-induced inhibition of thermoregulatory mechanisms and exposure of patients to cold environment in the operating rooms. Core temperature reduction up to 35°C is often seen in off-pump coronary artery bypass graft (OP-CABG) surgery. Anesthetic depth can be monitored by using bispectral (BIS) index. The present study was performed to evaluate the influence of mild hypothermia on the anesthetic depth using BIS monitoring and correlation of BIS with end-tidal anesthetic concentration at varying temperatures during OP-CABG. Materials and Methods In a prospective observational study design in a tertiary care teaching hospital, patients who underwent elective OP-CABG under endotracheal general anesthesia, were included in the study. Standard technique of anesthesia was followed. BIS, nasopharyngeal temperature, and end-tidal anesthetic concentration of inhaled isoflurane was recorded every 10 minutes. The BIS was adjusted to between 45 and 50 during surgery. Results There were 40 patients who underwent OP-CABG during the study period. The mean age was 51.2 ± 8.7 years, mean body mass index 29.8 ± 2.2, and mean left ventricular ejection fraction was 55.4 ± 4.2%. Anesthetic requirement as guided by BIS between 45 and 50 correlated linearly with core body temperature (r = 0.999; p &lt; 0.001). The mean decrease in the body temperature at the end of 300 minutes was 2.2°C with a mean decrease in end-tidal anesthetic concentration of 0.29%. The reduction in end-tidal anesthetic concentration per degree decrease in temperature was 0.13%. None of the patients reported intraoperative recall. Conclusion In this study, BIS monitoring was used to guide the delivery concentration of inhaled anesthetic using a targeted range of 45 to 50. BIS monitoring allowed the appropriate reduction of anesthetic dosing requirements in patients undergoing OP-CABG without risk of awareness. There was a significant reduction in anesthetic requirements associated with reduction of core temperature. The routine use of BIS is recommended in OP-CABG to titrate anesthetic requirement during occurrence of hypothermia and facilitate fast-track anesthesia in this patient population.

S0905 Prospective Multicenter International Trial Evaluating Performance of Disposable Elevator Cap Duodenoscope During Endoscopic Retrograde Cholangiopancreatography (deCAP Trial)

INTRODUCTION: Persistent contamination of elevator mechanism despite reprocessing has resulted in outbreaks of infection with multidrug-resistant organisms following Endoscopic Retrograde Cholangiopancreatography (ERCP). Novel duodenoscope with disposable elevator cap (DEC) might reduce these infections. We tested performance of DEC-duodenoscope in patients undergoing ERCP. METHODS: We conducted a prospective case-series study of outcomes of ERCP using DEC duodenoscope at two academic medical centers. Six endoscopists (experience 1 to 10+ years) and nurse/technicians participated in the study. Outcomes analyzed included evaluation of pre-procedure set up, post procedure reprocessing by nurse/technicians. ERCP outcomes included successful completion of ERCP, endoscopist rating on ERCP performance characteristics as well as ERCP maneuvers, and adverse events. RESULTS: This is an interim analysis of 108 consecutive ERCPs (Female 66%, 71/108) performed during the study period of May and June 2020. Most common indication was choledocholithiasis (60%, 65/108) and a majority of patients had native papilla (65%, 70/108). 32% of procedures were performed by fellows, while 68% of procedures were performed by attending physicians. Majority of ERCPs were of ASGE ERCP complexity Grade 2 (73%, 79/108). The mean cannulation time was 5.85 mins (SD: ± 7.97 mins) while the mean time to complete the procedure was 26 mins (SD: ± 17.66 mins). All ERCPs were performed under propofol guided deep sedation or general endotracheal anesthesia. All ERCPs were successfully completed without need to change scope . In one case, given inability to pass the instrument via the elevator channel, ERCP scope was removed, same cap was reattached, and then procedure could be successfully completed. Overall performance rating for DEC duodenoscope was 99%-100% in 17 ERCP performance characteristics and 100% in 10 ERCP maneuvers (Table 1). When evaluated by nurse or technician, overall performance rating of DEC duodenoscope was 97%-99% in various pre-procedure, intraprocedural and post-procedure tasks (Table 2). CONCLUSION: We conclude that most endoscopists with varying level of experience, could easily complete various complex ERCP tasks with DEC duodenoscope. This innovative design has the potential to reduce ERCP related infectious outbreak.Table 1.: Rating on ERCP Performance Characteristics and ERCP ManeuversTable 2.: Rating by nurse of technician for pre-procedure set up, intraprocedural performance and post-procedure reprocessing steps

Study on Effect of Laryngeal Mask Anesthesia and Endotracheal Intubation Anesthesia on Elderly Patients Undergoing Laparoscopic Gallbladder Surgery

Objective: To analyze the effect of laryngeal mask anesthesia and endotracheal intubation anesthesia in elderly laparoscopic gallbladder surgery. Methods: 100 subjects of the experiment came from elderly patients with gallbladder stones admitted from September 2016 to September 2019 in our hospital. There were group A and group B of 50 cases each, and were used tube anesthesia and laryngeal mask anesthesia, then comparing the anesthesia effect. Results: Statistical significance(P&lt;0.05): Air pressure and end-respiratory carbon dioxide partial pressure index changes when immediately after insertion, immediately after removal, 3 minutes after removal; heart rate, mean arterial pressure, airway pressure, and end-expiratory carbon dioxide index changes when 3 minutes after insertion and immediately before removal; blood glucose and cortisol changes when after insertion, immediately before removal and min after removal. No statistical significance(P&gt;0.05): Changes in heart rate, mean arterial pressure, airway pressure, and end-expiratory carbon dioxide indexes before insertion; changes in blood glucose and cortisol indexes before insertion. Conclusion: It is more ideal for elderly patients with abdominal cavity and gallbladder surgery to have laryngeal mask anesthesia, which can effectively keep blood circulation stable and have promotion value.

Contralateral approach to transverse-sigmoid sinus stenting.

Endovascular dural venous sinus stenting (DVSS) has emerged as a safe and effective therapy for idiopathic intracranial hypertension (IIH) in patients with transverse-sinus stenosis associated with an elevated mean pressure gradient (MPG). The typical antegrade approach, jugular to sigmoid to transverse, is not always technically feasible due to the degree of stenosis and other anatomic factors. To this point, there has been no reported cases of contralateral DVSS. We describe four cases of DVSS from a contralateral transverse-sigmoid sinus approach. We describe 4 patients presenting with symptoms of IIH between 2019 and 2020 who we treated with contralateral transverse-sigmoid sinus stenting. Cases were reviewed for clinical data including initial presenting symptoms, devices used, other attempted IIH treatments, and follow up symptoms. Four female patients were identified and treated under general endotracheal anesthesia. Stenoses measured 72%, 78%, 67%, and 70% with MPGs across the transverse-sigmoid sinus of 19, 16, 9 and 13 mmHg, respectively. Post-stenting MPGs were 1, 0, 1 and 1 mmHg, respectively. Three patients had complete resolution of symptoms and 1 had partial resolution. No complications occurred. This case series demonstrates successful transverse-sigmoid sinus stenting from the contralateral dural sinus and provides an alternative approach to DVSS in patients with IIH.

A Comparison of Spinal Anesthesia Versus Monitored Anesthesia Care With Local Anesthesia in Minimally Invasive Fetal Surgery

(Anesth Analg. 2020;130:409–415) The most common minimally invasive fetal surgeries are selective fetoscopic laser photocoagulation to treat twin-to-twin transfusion syndrome and radiofrequency ablation using twin-reversed arterial perfusion sequence. The anesthetic techniques for these surgeries have evolved from general endotracheal anesthesia to spinal anesthesia with or without intravenous sedation in the United States, though in some other countries local anesthesia infiltration is used. This study aimed to compare spinal anesthesia and local anesthesia with or without sedation in these 2 surgeries in terms of safety and efficacy.

Relationship Between Propofol Target Concentrations, Bispectral Index, and Patient Covariates During Anesthesia.

Internationally, propofol is commonly titrated by target-controlled infusion (TCI) to maintain a processed electroencephalographic (EEG) parameter (eg, bispectral index [BIS]) within a specified range. The overall variability in propofol target effect-site concentrations (CeT) necessary to maintain adequate anesthesia in real-world conditions is poorly characterized, as are the patient demographic factors that contribute to this variability. This study explored these issues, hypothesizing that the variability in covariate-adjusted propofol target concentrations during BIS-controlled anesthesia would be substantial and that most of the remaining interpatient variability in drug response would be due to random effects, thus suggesting that the opportunity to improve on the Schnider model with further demographic data is limited. With ethics committee approval and a waiver of informed consent, a deidentified, high-resolution, intraoperative database consisting of propofol target concentrations, BIS values, and vital signs from 13,239 patients was mined to identify patients who underwent general endotracheal anesthesia using propofol (titrated to BIS), fentanyl, remifentanil, and rocuronium that lasted at least 1 hour. The propofol target concentrations and BIS values 30 minutes after incision (CeT30 and BIS30) were considered representative of stable intraoperative conditions. The data were plotted and analyzed by descriptive statistics. Confidence intervals were computed using a bootstrap method. A linear model was fit to the data to test for correlation with factors of interest (eg, age and weight). A total of 4584 patients met inclusion criteria and were entered into the analysis. Of the propofol target concentrations, 95% were between 1.5 and 3.5 µg·mL-1. Higher BIS30 values were correlated with higher propofol concentrations. Except for age, all the patient-related variables analyzed entered the regression model linearly. Only 10.2% of the variability in CeT30 was explained by the patient factors of age and weight combined. Our hypothesis was confirmed. The variability in covariate-adjusted propofol CeT30 titrated to BIS in real-world conditions is considerable, and only a small portion of the remaining variability in drug response is explained by patient demographic factors. This finding may have important implications for the development of new pharmacokinetic (PK) models for propofol TCI.

Venous Thromboembolism in Plastic Surgery: Where Are We Now?

Venous Thromboembolism in Plastic Surgery: Where Are We Now?

Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension

BackgroundDural venous sinus stenting (VSS) is an effective treatment for idiopathic intracranial hypertension (IIH) in adult patients. There are no published series to date evaluating safety and efficacy of VSS...

COGNITIVE DYSFUNCTION AS A FACTOR RESTRICTING THE APPLICATION OF ACCELERATED REHABILITATION PROGRAMS FOR ELDERLY AND SENIOR PATIENTS IN OPERATIVE GYNECOLOGY

Aim: to identify risk groups for the formation of cognitive dysfunction in elderly patients after gynecological operations. Research base: City Clinical Hospital named after S.P. Botkin, Moscow, Russian Medical Academy of Continuing Professional Education. The risk groups for the formation of cognitive dysfunction in elderly and senior patients after gynecological operations are determined. Hospitalization was carried out just before the operation, the postoperative hospital bed rest varied from 2 to 4 days. Where possible, the principles of FastTrack technology were applied in the perioperative period. Materials and methods. The study involved 60 elderly and senior female patients after menopause from the age of 50 to 85 years (75,2 ± 6,3 years), who underwent surgery under conditions of endotracheal anesthesia due to benign pathology (ovarian neoplasms, genital prolapse). The principles of FastTrack – an accelerated path in surgery were applied. Before the operation and on the 2nd day after the operation, testing was performed on the MMSE (Mini-mental State Examination) scale, as well as on the questionnaire to identify Spielberger-Hanin personal and reactive anxiety. Results. It has been proven that the frequency of postoperative cognitive dysfunction increases in proportion to the age of the patients and often depends on the type of anesthetic benefit and the severity of the operation. In the group of women aged from 50 to 60, no initial cognitive impairment was found, 18 % of patients after 60 years of age have cognitive impairment, and 5 % have mild dementia. The older the patient, the more cases of postoperative cognitive impairment develops/worsens, and high levels of anxiety remain. Early discharge in such cases can cause problems. Conclusion. In risk groups, especially in patients older than 70 years with signs of widespread atherosclerosis, cerebrovascular accidents, and a history of brain injuries, it is necessary to accurately identify signs of cognitive impairment and promptly involve a neurologist and clinical psychologist to correct them, which will significantly improve the postoperative period and reduce the anxiety level