Anesthetic Experience Research Articles

Application of Cervical Epidural Anesthesia and Analgesia to the Patient with 90% Burnt Surface Area.

Patients with an extremely large, burnt surface area have a high mortality rate. The follow-up, treatment and intraoperative anesthesia practices of these patients in the ICU pose serious challenges. In this case, the experience of anesthesia and analgesia using cervical epidural anesthesia, which is not frequently used in anesthesia routine, applied to a patient with a 90% burnt surface area is shared. It was aimed to evaluate the contribution of effective non-opioid analgesia, early mobilization and nutrition applied to the patient's recovery.

Anesthesia methods for full-endoscopic lumbar discectomy: a review.

Full-endoscopic lumbar discectomy under local anesthesia is major trends for the treatment of lumbar disc herniation in spine minimally invasive surgery. However, sometimes local anesthesia is not enough for analgesic in surgery especially in interlaminar approach. This study summarizes the current study of anesthesia methods in full-endoscopic lumbar discectomy. Local anesthesia is still the most common anesthesia method in full-endoscopic lumbar discectomy and the comparison group for other anesthesia methods due to high safety. Compared to local anesthesia, Epidural anesthesia is less applied in full-endoscopic lumbar discectomy but reports better intraoperative pain control and equivalent safety due to the motor preservation and pain block characteristic of ropivacaine. General anesthesia can achieve totally pain block during surgery but nerve injury can not be ignored, and intraoperative neuromonitoring can assist. Regional anesthesia application is rare but also reports better anesthesia effects during surgery and equivalent safety. Anesthesia methods for full-endoscopic lumbar discectomy should be based on patient factors, surgical factors, and anesthesiologist factors to achieve satisfactory anesthesia experience and successful surgery.

Anesthesia management of patients undergoing thoracic endovascular aortic repair: A retrospective analysis of single center.

Thoracic endovascular aortic repair (TEVAR) is a new alternative surgical treatment for aortic pathologies, which is more minimally invasive. The aim of current study was to summarize the single-center experience of general anesthesia for patients undergoing TEVAR. In adult patients undergoing surgery for congenital heart disease, the strategy of "fast-track" anesthesia with early extubation in theater is associated with a shorter intensive care unit (ICU) stay, and lower health-care-related costs. Fast-track anesthesia has not been assessed in patients under TEVAR. Adult patients who received general anesthesia for TEVAR in our center from January 2020 to December 2020 were included. Baseline characteristics, airway management, anesthetic techniques and major complications were collected. A total of 204 (171 male, mean age 58.1 ± 11.5 years) patients met inclusion criteria for this study. The distribution of pathologies included 29 descending thoracic aneurysms, 87 type B dissections, and 88 intramural hematoma/perforating aortic ulcer. Etomidate was the induction agent in 190 (93.1%) patients, compared with propofol in 16 (7.8%). Cisatracurium was the muscle relaxant in 201 (98.5%), compared with rocuronium in 3 (1.5%). Midazolam (benzodiazepines) was given to 124 (60.8%) patients during anesthesia induction. General anesthesia was maintained with sevoflurane in 85.3% (174) patients, dexmedetomidine in 201 (98.5%) and propofol in 204 (100%). Postoperative length of stay (LOS) in the hospital was 6.0 (5.0-7.8) days. LOS in the ICU was 23.0 (20.0-27.8) hours. Overall neurologic event rate was 2.0% (n = 4) (spinal cord ischemia 1.5% [n = 3]; stroke 0.5% [n = 1]). After matching, patients who received "fast-track" anesthesia had a shorter LOS in ICUs (21.0 [18.0-24.0] vs 24.0 [20.0-44.0] hours; P = .005), and a shorter postoperative LOS in hospital (5.0 [4.0-7.0] vs 6.0 [5.0-8.0] days; P = .001). There were no in-hospital deaths. Fast-track anesthesia is feasible and safe in patients underwent TEVAR. This management strategy is associated with shorter LOS of ICU and total postoperative hospital stays. An early extubation strategy should be implemented for hemodynamically stable patients.

Knowledge, Practice and Self-Reported Confidence Level of Croatian Dentists in the Use of Local Anesthesia: A Cross-Sectional Study.

Objectives: To provide safe and effective local anesthesia, dentists must have knowledge of neuroanatomy, anesthesia agents, techniques, equipment, and proper use of local anesthetics. This study aims to explore the knowledge, practices, and confidence regarding local anesthetics and anesthetic techniques in dentistry. Material and Methods: The online cross-sectional questionnaire was conducted via social media, and yielded 441 responses from across the country (69.8% women and 30.2% men; 70.7% general dentists; and 29.3 specialists). The data collected included sociodemographic characteristics, knowledge, and practices pertaining to the usage of local anesthesia. The questionnaire also documents their self-assessed confidence level in applying different local anesthetic techniques and experiences with adverse reactions. The obtained data were processed by description and using a generalized linear model for regression. Results: The respondents had a median knowledge score of 6 out of a possible 14 points regarding local anesthetics in dental medicine, and their median self-confidence level in the successful application of various techniques of local anesthesia was 54 out of a maximum of 85 points. The results showed that a higher knowledge level was associated with the female gender (OR 1.83, CI 1.13-2.98, p = 0.014) and specialization in oral surgery (OR 7.04, CI 1.71-29.07, p = 0.007). In contrast, a lack of confidence in using various local anesthetic techniques was also associated with the female gender (OR 0.63, CI 0.41-0.99, p = 0.047) and specialization in orthodontics (OR 0.16, CI 0.03-0.88, p = 0.035). Of the respondents, 81.4% (n = 371) experienced a local complication, and 42.2% (n = 186) experienced a systemic complication during local anesthesia. The complications experienced cannot be associated with a lack of knowledge or self-confidence (p > 0.05). The majority of respondents (364 of the 441 total-82.5%) expressed interest in receiving further education on the topic of local anesthesia. Conclusions: The research results show that the dentists involved in the study have poor knowledge of local anesthetics and moderate self-reported confidence levels in using various local anesthetic techniques. Moreover, dentists' self-confidence in applying different techniques of local anesthesia is not related to their knowledge. Therefore, it would be necessary for dentists to undergo a continuing dental education program that enables them to enhance their skills and knowledge in local anesthesia.

Experience of general anesthesia in a patient with menstrual‐associated coronary spasm

AbstractCoronary angina due to low estrogen is relatively common around menopause, with almost no reports associated with the menstrual cycle or anesthetic management at younger ages. The patient was a 22‐year‐old woman who had developed ventricular fibrillation due to coronary spasm, resulting in cardiopulmonary arrest. She was resuscitated, and underwent ICD implantation. As her symptoms appeared at specific times during her menstrual cycle, she was diagnosed as having menstrual‐associated coronary spasm, and started taking estrogen/progesterone medication. An endometrial ablation was scheduled for endometrial hyperplasia that was caused by the medicine. The surgery was scheduled in consideration of the patient's menstrual cycle, and general anesthesia was selected as the method of anesthesia. The surgery and perioperative management were uneventful, and her postoperative course was favorable. Our case is the first to our knowledge of general anesthesia performed on a patient with menstrual‐associated coronary spasm.

Comparison of Intravenous Ketamine Dosages for Postoperative Analgesia: Efficacy and Adverse Reactions in Abdominal Hysterectomy

Introduction: Following an abdominal hysterectomy, preemptive analgesia with two intravenous ketamine injections has been used as multimodal analgesia for postoperative pain. Ketamine’s ideal dosage for postoperative analgesia that has the least amount of adverse reactions is still up for discussion. Materials and Methods: This investigation was conducted at M.G.M. Medical College and M.Y. Hospital, Indore. The study included a total of 90 participants, classified as the American Society of Anesthesiologists classes 1 and 2, within the age range of 18–65 years. There were three groups made after dividing the patients with the help of the chit method so that no preference could be done. Group A was given an intravenous ketamine injection of 0.3 mg/kg, Group B was given an intravenous ketamine injection of 0.2 mg/kg, and Group C then got an intravenous ketamine injection of 0.1 mg/kg. In addition, all groups received subsequent 0.1 mg/kg ketamine injections every 30 min until the completion of the surgery. Various parameters were recorded for 24 h following the procedure, including the time to the first dosage, combined dose of rescue analgesia, combined number of doses of rescue analgesia, and incidence of adverse reactions. Results: The demographic profiles of all three groups were found to be comparable. The average time to request the first dosage of rescue analgesia was 316.33 ±66.345, 230± 44.721 & 89 ±26.698 minutes and 89 min, respectively, in Groups A, B, and C. Group A exhibited a significantly longer duration compared to Groups B and C. Postoperatively, at the 24-h mark, Group A displayed the lowest mean pain score (Visual Analog Scale) compared to Group B and Group C, with a statistically significant difference observed at P = 0.05. However, the frequency of nausea and vomiting between Groups A and B, as well as C, was not significant. Conclusion: Patients undergoing abdominal hysterectomy under spinal anesthesia experience reduced postoperative discomfort when administered intravenous ketamine at a dosage of 0.3 mg/kg, as opposed to lower doses. These results emphasize the potential benefits of higher dosage administration in enhancing postoperative analgesia in such procedures.

Our Anesthesia Experience in a Pediatric Patient with Ruptured Lung Hydatid Cyst

Hydatid cyst is a parasitic disease caused by Echinococcus granulosus and transmitted to humans mostly through canine feces. Although it can settle in every organ in the body, the lung is the most frequently involved organ in children.

Perioperative anesthetic management of premature neonates weighing less than 1500 grams undergoing transcatheter PDA (TC-PDA) closure: An institutional anesthetic experience

ObjectivesThe aim of our study is to describe the various anesthetic techniques and intraoperative management used during transcatheter closure of hemodynamically significant PDAs in VLBW premature infants weighing less than 1.5 kg and their potential impact on postoperative outcomes using a retrospective chart review. DesignA retrospective electronic medical chart review was performed in infants who underwent Transcatheter Patent Ductus Arteriosus (TC-PDA) closure at an academic institution between January 1, 2008 and October 4th 2019. Only premature patients with isolated PDA weighing less than 1500 g at the time of the procedure were included in the study. SettingSingle Institutional Hospital. ParticipantsPremature patients with isolated PDA weighing less than 1500 g at the time of the procedure. InterventionsNone. Measurements and main resultsInterprocedurally, there was no evidence of device embolization or clinically significant vascular obstruction on follow-up echocardiography, and inotropic or vasoactive infusions were not required. All patients survived and were discharged from the hospital after a mean of 86.4 ± 48.49 days (median 74, range 40–180) following initial admission to the NICU. At 7 post-operative days, freedom from ventilatory support reached 70% in all patients. Incidences of device embolization or clinically significant vascular obstruction were not noted on follow-up echocardiography. ConclusionsThough our preliminary findings show promising outcomes following TC-PDA closure relative to traditional surgical approaches, further investigations with higher patient volume are needed to validate these promising observations.

Frequency and characteristics of patients with bispectral index values of 60 or higher during the induction and maintenance of general anesthesia with remimazolam

In Korea, the approved anesthetic regimen of remimazolam starts with 6 mg/kg/h or 12 mg/kg/h until loss of consciousness, followed by maintenance at 1–2 mg/kg/h. Some patients receiving remimazolam for general anesthesia experience occasional difficulty maintaining bispectral index (BIS) value ˂ 60. This retrospective study aimed to analyze the data from patients undergoing elective surgery under remimazolam based-general anesthesia to determine the frequency and physical characteristics of patients with BIS values ˂ 60. The criterion was established for patients with a poorly maintained BIS value < 60. The frequency and physical characteristics of patients who satisfied this criterion were investigated through their medical records. The modified Brice interview was conducted within 24 h after surgery. Among the 1500 patients included in the analysis, 61 (4.1%) met the criteria for BIS ˂ 60. Based on the modified Brice interview, none of the patients with poorly maintained BIS ˂ 60 complained of intraoperative awareness based on the modified Brice interview or exhibit specific physical characteristics. These patients accounted for less than 5% of the total population studied. Notably, physical characteristics alone are insufficient to predict such patients before surgery.

A retrospective evaluation of characterization, clinical course and anaesthesia management of emergency trauma surgical patients during first wave of COVID-19 pandemic at a tertiary care center in India

: The COVID-19 pandemic resulted in nationwide lockdown followed by phased unlock to break the chain of transmission of the SARS-CoV-2 virus in India. Management of emergency trauma patients has been particularly challenging for anaesthesiologists in order to treat these high risk group of patients and preventing cross infection to healthy patients as well as health care personnel. : It is a single centre retrospective observational cohort study conducted at tertiary care hospital in North India in the patients who underwent emergency trauma surgeries during 31 March 2020-31 May 2020(Lockdown) and compared with data from 1 June 2020-31 July 2020(Unlock). To compare the effect of lockdown and unlock during first wave of Covid-19 pandemic on the volume of emergency trauma surgical patients operated within 24 hours of admission.: To evaluate the difference between the two periods of lockdown and unlock a) in the mortality rates b) covid status c) the length of hospital stay d) the mechanism of injury e)severity of injury f)proportion of aerosol generating procedures (AGP) utilized and g)demographics of the patients. Our anaesthesia experience of managing the patients differently in the pandemic, identify areas for improvement, particularly in terms of minimising exposure and optimising resource usage in the management of such emergency patients in the event of a future healthcare crisis is also discussed. Over the 2 periods of lockdown and unlock there was no statistical difference in number, age or sex distribution of the patients presenting for emergency trauma surgery. Number of covid positive patients were slightly higher during unlock but it was statistically insignificant (p=0.07) and the number of patients died during unlock was also higher during unlock as compared to lockdown but statistically insignificant(p=0.3). The median injury severity score and length of stay was also not statistically significant between two periods. Road traffic accidents were most common type of injury in both the groups, self-inflicted injury occurred in 5 patients during lockdown and zero during unlock, none of these showed a significant difference (p &amp;#62; 0.06). General anaesthesia was the most common anaesthesia technique used in both the periods.Emergency trauma surgeries will continue to occur even in different phases of pandemics, anaesthesiologists should plan and prepare appropriately to provide anaesthesia and emergency care to these patients and prevent cross infection in healthy patients and health care workers.

Modern possibilities of upper extremity regional anesthesia

Today, regional anesthesia is widely used during surgical interventions in orthopedic surgery. Blockades of individual nerves and plexuses are used. Objective. To introduce readers: surgeons, orthopedists-traumatologists with the possibilities of regional anesthesia like an adequate method of analgesia during upper limb interventions. Methods. Relevant literature from PubMed, Scopus, Google Scholar databases and own experience of regional anesthesia were analyzed. The results. The work describes the effect of regional anesthesia on the nervous, respiratory, cardiovascular and coagulation systems. Information about blocks of peripheral nerves of the upper extremities: interscalene, supraclavicular, subclavian, axillary. Their advantages and disadvantages were analyzed. Interscalene block is not recommended for patients with severe lung disease due to the risk of respiratory failure. Complications of this analgesia include: phrenic nerve block (up to 100 %), sympathetic chain block and Horner's syndrome. Also, possible accidental injection into the vertebral artery. Indications for the supraclavicular block are operations on the hand, forearm, elbow and shoulder. Complications — phrenic nerve block (17‒50 %), recurrent laryngeal blockade (22 %), pneumothorax (0.6‒6.1 %). When planning anesthesia, the accompanying pathology of the patient and his general condition should be taken into account. Particular care is required when the patient is taking anticoagulants. Risk of bleeding and thrombosis should be carefully assessed. Special attention should be paid to the toxicity of local anesthetics and ways to eliminate it. Conclusions. Regional anesthesia can be used in the pre-, intra- and postoperative periods. Sometimes it’s the only method that permit surgical intervention. It is necessary to understand all the advantages and limitations to ensure high quality of patient care.

General anesthesia in spontaneous respiration with intravenous ketamine in patients undergoing pulsed-field ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Thermal ablation of atrial fibrillation (AF) by means of radiofrequency or cryo-balloon is usually performed under general anesthesia, deep sedation, or conscious sedation at operator’s discretion and based on the general condition of the patient. However, a standardized sedation protocol when performing a non-thermal ablation, such as pulsed-field ablation (PFA) through irreversible cellular electroporation, has not been well established. Purpose We report our preliminary experience of a general anesthesia in spontaneous respiration protocol with ketamine used at a high-volume center during ablation of AF with a new PFA system. Methods All consecutive patients (pts) undergoing AF ablation with PFA at our center were included. Our sedation protocol consists of intravenous administration of midazolam (1+1 mg), fentanyl (25+25+25+25 mcg/kg) at low doses before local anesthesia with lidocaine (200mg) administration. Patients underwent sedation under spontaneous respiration by administering oxygen (4-6 l/min) through a face mask with nasal cannula. Local anesthesia was performed before the percutaneous femoral venous access. Soon after the trans-septal puncture, heparin (1 mg/kg) and atropine (1 mg, to mitigate anticipated bradycardia) were injected, followed by a second bolus of midazolam (1 mg). Ketamine adjunct (1 mg/kg) was then injected about 5 minutes before the first PFA delivery which was titrated to effect based on patient’s condition, response and changes in vital signs (total ketamine adjunction of 2 mg/kg). For quantitative assessment the Numeric Rating Scale for Pain (NRS) was applied. For qualitative assessment a 3-levels satisfaction evaluation was retrieved. The ablation endpoint was PVI as assessed by entrance and exit block. Results Forty-two pts were included in this analysis (mean age of 66±9 years,72% were male, CHA2DS2VASc score=2 [IQR 1–3], median body mass index 24[20-48]kg/m2, 35% had respiratory diseases – e.g. asthma, OSAS, COPD –). At baseline, before sedation, mean systolic blood pressure was 140.5+20.1mmHg and mean oxygen saturation was 97.9+2.1%. PVI was achieved in all the patients. The number of PFA applications to reach PVI was 33.4+3 (time to PVI = 25+4min). In two cases additional PFA lesion sets were deployed outside the PVs. Lab occupancy time was 122±32min, skin-to-skin time was 78±35min and fluoroscopy time was 23±14min. All the patients achieved a NRS ≤ 3. Satisfaction level was found to be acceptable in all procedures by both the patient and the primary operator (Score equal to 0). No major procedure-related adverse events were reported. Conclusion The PFA procedure has a short execution time. The standardized anesthetic protocol with the administration of drugs with rapid onset and pharmacological offset at low doses was effective and safe with an optimal degree of patient and operator satisfaction.

Peri-procedural anesthesia and patient pain experience in pulmonary vein isolation by means of very high power short duration radiofrequency ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation (vHPSD) may reduce ablation times and improve patient tolerability, permitting pulmonary vein (PV) isolation under mild conscious sedation. Purpose Evaluate the anesthetic drugs use and patients ‘pain experience during vHPSD PV isolation. Methods Thirty-three consecutive patients, with paroxysmal atrial fibrillation (AF), treated with QDot Micro catheter and vHPSD (90 w for 4 s) (vHPSD Group), were compared with the last 33 consecutive patients, with paroxysmal AF, treated with a surround flow contact force-sensing catheter guided by the ablation index (450 at anterior and superior sites at 50 W, 330 at posterior and inferior sites at 40 W) (AI Group). Anesthetic drugs (midazolam and fentanyl) use were compared as well as pain experience, measured using a 0-10 scale. Results All PVs were isolated. PV isolation ablation time in the vHPSD Group (5.9±1.4 min) was shorter than in the AI Group (25±11 min, p&amp;lt;0.001). Pain experience was significantly lower in vHPSD group (4.5±2 vs 6.6±1.8, p&amp;lt; 0.001). No patients required general anesthesia; fentanyl use was required in 4 vHPSD Group patients vs 25 AI Group patients (p&amp;lt;0.001). A lower dose of midazolam was required in vHPSD Group (2.3±1.2 mg vs 3.6±1.7 mg, p &amp;lt; 0.001). Conclusions vHPSD radiofrequency ablation for PVI can be performed under conscious sedation using only benzodiazepine in most of patients without compromising patient pain experience.

Comparison of accuracy between augmented reality/mixed reality techniques and conventional techniques for epidural anesthesia using a practice phantom model kit

BackgroundThis study used an epidural anesthesia practice kit (model) to evaluate the accuracy of epidural anesthesia using standard techniques (blind) and augmented/mixed reality technology and whether visualization using augmented/mixed reality technology would facilitate epidural anesthesia.MethodsThis study was conducted at the Yamagata University Hospital (Yamagata, Japan) between February and June 2022. Thirty medical students with no experience in epidural anesthesia were randomly divided into augmented reality (-), augmented reality (+), and semi-augmented reality groups, with 10 students in each group. Epidural anesthesia was performed using the paramedian approach with an epidural anesthesia practice kit. The augmented reality (-) group performed epidural anesthesia without HoloLens2Ⓡ and the augmented reality (+) group with HoloLens2Ⓡ. The semi-augmented reality group performed epidural anesthesia without HoloLens2Ⓡ after 30 s of image construction of the spine using HoloLens2Ⓡ. The epidural space puncture point distance between the ideal insertion needle and participant’s insertion needle was compared.ResultsFour medical students in the augmented reality (-), zero in the augmented reality (+), and one in the semi-augmented reality groups failed to insert the needle into the epidural space. The epidural space puncture point distance for the augmented reality (-), augmented reality (+), and semi-augmented reality groups were 8.7 (5.7–14.3) mm, 3.5 (1.8–8.0) mm (P = 0.017), and 4.9 (3.2–5.9) mm (P = 0.027), respectively; a significant difference was observed between the two groups.ConclusionsAugmented/mixed reality technology has the potential to contribute significantly to the improvement of epidural anesthesia techniques.

Effect of regional versus general anesthesia on thirty-day outcomes following carotid endarterectomy: a cohort study.

The effect of regional versus general anesthesia on carotid endarterectomy outcomes is debated. This study assesses the effect of anesthetic technique on major morbidity and mortality and additional secondary endpoints following carotid endarterectomy. This was a retrospective propensity-matched-cohort analysis investigating elective carotid endarterectomy patients in the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program ( n =37204). The primary endpoint was 30-day mortality and major morbidity, defined as stroke, myocardial infarction, or death. Secondary endpoints included minor morbidity, bleeding events, healthcare resource utilization, and length of hospital stay. Univariate, multivariable, and survival analyses were applied. The 1:1 propensity-matched-cohort included 8304 patients (4152 in each group). Regional anesthesia was associated with similar incidences of major morbidity and mortality [odds ratio (OR), 0.81 (95% CI, 0.61-1.09); P = 0.162] and unplanned resource utilization [OR, 0.93 (95% CI, 0.78-1.11); P = 0.443], but lower incidences of minor morbidity [OR, 0.60 (95% CI, 0.44-0.81); P < 0.001] and bleeding events [OR, 0.49 (95% CI, 0.30-0.78); P = 0.002], and a shorter length of hospital stay [1.4 vs. 1.6 days; mean difference, -0.16 days (95% CI, -0.25 to -0.07); P < 0.001]. On multivariable analysis, regional anesthesia remained independently predictive of minor morbidity [adjusted odds ratio (AOR), 0.58 (95% CI, 0.42-0.79); P = 0.001] and bleeding events [AOR, 0.49 (95% CI, 0.30-0.77); P = 0.003]. Significance was maintained on survival analysis for these two endpoints. A mortality benefit was observed on univariate [OR, 0.50 (95% CI, 0.25-1.00); P = 0.045], multivariable [AOR, 0.49 (95% CI, 0.24-0.96); P = 0.043], and survival analysis ( P = 0.045). Carotid endarterectomy patients receiving regional anesthesia experience favorable outcomes compared to propensity-matched general anesthesia controls.

Elective Cesarean Section under General Anesthesia Experience in more than 5,000 Patients at Melinda Women Hospital Bandung-Indonesia

BACKGROUND: Despite the safe nature of the procedure, cesarean section (CS) is still associated with higher maternal mortality and morbidity rates. CS can be performed under spinal, epidural, combined spinal and epidural, or general anesthesia. The choice of anesthesia for CS is still a matter of debate due to its side effects on mothers and neonates. Success in the selection of anesthesia in CS is seen in maternal and neonatal outcomes, where the Apgar score is used for assessing neonates in the first and fifth minutes. AIM: This study aimed to determine the effect of general anesthesia in cesarean section as measured by Apgar score. SUBJECT AND METHODS: This was a cross-sectional analytical retrospective study on a total sample of 7,131 patients who underwent elective cesarean section under general anesthesia during 18 years (July 2004–June 2022) at Melinda Women Hospital Bandung Indonesia. In this study, data from medical records were used to analyze neonatal and maternal outcomes. RESULTS: Of the 7,131 CS under general anesthesia cases, no maternal death or difficult ventilation was found; however, the incidence of postoperative nausea and vomiting (PONV) (15), difficult intubation (6), hypotension (5), and need for blood transfusion (5), and postoperative analgesia (all cases) were observed in the mothers. In neonates, neonatal death caused by IUFD and severe congenital disease (3), and a mean neonatal Apgar score of 9 and 10 at 1 and 5 min were identified. CONCLUSION: No low Apgar score is found as the effect of general anesthesia in cesarean section.

Peripheral and cerebral inflammation induced by repeated anesthesia and surgery do not cause impairment of learning and memory in middle‑aged mice.

Postoperative cognitive dysfunction is a postoperative complication of the central nervous system that reduces quality of life and increases mortality in perioperative patients, especially among elderly patients. Many studies have shown that the incidence of postoperative cognitive impairment in adults induced by one‑time anesthesia and surgery is very low, while multiple experiences of anesthesia and surgery can induce cognitive impairment in the developing brain. However, the effect of multiple experiences of anesthesia and surgery on cognitive function over a short period in middle‑aged mice, i.e., 6 to 8 months old, remains unclear. In this study, we explored whether the cognitive function of mice aged 6-8 months is impaired after multiple operations. Middle‑aged mice (6 to 8 months old) healthy male C57BL/6 mice underwent exploratory laparotomy under isoflurane anesthesia. Morris water maze testing was performed after the operations. Blood and brain samples were collected at 6 h, 24 h, and 48 h after the operations. Serum IL‑6, IL‑1, and S‑100β concentrations were detected by ELISA. The expressions of ChAT, AChE, and Aβ in the hippocampus were measured by western blot. Up‑regulation of Iba1 and GFAP, respectively, indicated activation of microglia and astrocytes in the hippocampus. Expression of Iba1 and GFAP was examined by immunofluorescence. The present results revealed that serum IL‑6, IL‑1β, and S‑100β concentrations were enhanced after multiple instances of anesthesia and surgery, and microglia and astrocytes in the hippocampus were activated. However, learning and memory were not impaired in the middle‑aged mice by multiple experiences of anesthesia and surgery. There were no changes in ChAT, AChE, and Aβ in the hippocampus after multiple experiences of anesthesia/surgery. Taken together, we suggest that although multiple anesthesia/surgery procedures can induce peripheral inflammation, neuroinflammation, and transient cerebral injury, it is insufficient to impair learning and memory in middle‑aged mice.

Favorable Safety Experience of Local Dental Anesthesia in ICD Recipients with Cardiac Channelopathies

Background Dental anesthetic management in implantable cardioverter defibrillator (ICD) recipients with cardiac channelopathies (CCh) can be challenging due to the potential risk of life-threatening arrhythmias and appropriate ICD therapies during procedural time. Objectives The present study assessed the hypothesis that the use of local dental anesthesia with 2% lidocaine with 1:100,000 epinephrine or without a vasoconstrictor can be safe in selected ICD and CCh patients, not resulting in life-threatening events (LTE). Methods Restorative dental treatment under local dental anesthesia [...]

First in Japan: Training Curriculum for Perianesthesia Nurses and Their Clinical Practice

Problem DefinitionJapan is dealing with a superageing society found nowhere else in the world. This problem is provoking other complex issues such as aggravation of patients’ condition, and a shortage of anesthesiologists leading to overwork. Strategies to Address the ProblemAs a solution, our hospital established the PeriAnesthesia Nurse (PAN) for the first time in Japan. Unlike the United States and other developed countries in Europe, Japan did not have a license for nurses specialized in anesthesia. Thus, in collaboration with a graduate school of nursing, our hospital started a perianesthesia nursing course within the advanced practice nurse's training curriculum in 2010. At the graduate school, students take specialized lectures on anesthesia with a curriculum that focuses on risk management. On graduation, they work together with anesthesiologists in the department of anesthesiology and perform anesthesia-related tasks under the medical specialist's supervision. Their main duties include preoperative anesthesiology outpatient, surgical anesthesia, acute pain service (APS) for postoperative periods, and labor analgesia, and they collaborate with various specialists inside and outside of the operating room. Evaluation and ResultsOutcomes of patient care after the introduction of PAN have been observed. PAN provides persuasive explanations and guidance seamlessly to the patients by taking advantage of their experience in anesthesia and the scientific thinking they've acquired in graduate school. This paper reports on the training and clinical practice of perianesthesia nurses in Japan as a measure to improve the quality of perioperative medical care as well as the safety of patients.

Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthroplasty: A matched-pair cohort analysis

Study objectiveIt has not yet been established whether total hip arthroplasty complications are associated with anesthetic technique (spinal versus general). This study assessed the effect of spinal versus general anesthesia on health care resource utilization and secondary endpoints following total hip arthroplasty. DesignPropensity-matched cohort analysis. SettingAmerican College of Surgeons National Surgical Quality Improvement Program participating hospitals from 2015 to 2021. PatientsPatients undergoing elective total hip arthroplasty (n = 223,060). InterventionsNone. MeasurementsThe a priori study duration was 2015 to 2018 (n = 109,830). The primary endpoint was 30-day unplanned resource utilization, namely readmission and reoperation. Secondary endpoints included 30-day wound complications, systemic complications, bleeding events, and mortality. The impact of anesthetic technique was investigated with univariate analyses, multivariable analyses, and survival analyses. Main resultsThe 1:1 propensity-matched cohort included 96,880 total patients (48,440 in each anesthesia group) from 2015 to 2018. On univariate analysis, spinal anesthesia was associated with a lower incidence of unplanned resource utilization (3.1% [1486/48440] vs 3.7% [1770/48440]; odds ratio [OR], 0.83 [95% CI, 0.78 to 0.90]; P < .001), systemic complications (1.1% [520/48440] vs 1.5% [723/48440]; OR, 0.72 [95% CI, 0.64 to 0.80]; P < .001), and bleeding events requiring transfusion (2.3% [1120/48440] vs 4.9% [2390/48440]; OR, 0.46 [95% CI, 0.42 to 0.49]; P < .001). On multivariable analysis, spinal anesthesia remained an independent predictor of unplanned resource utilization (adjusted odds ratio [AOR], 0.84 [95% CI, 0.78 to 0.90]; c = 0.646), systemic complications (AOR, 0.72 [95% CI, 0.64 to 0.81]; c = 0.676), and bleeding events (AOR, 0.46 [95% CI, 0.42 to 0.49]; c = 0.686). Hospital length of stay was also shorter in the spinal anesthesia cohort (2.15 vs 2.24 days; mean difference, −0.09 [95% CI, −0.12 to −0.07]; P < .001). Similar findings were observed in the cohort from 2019 to 2021. ConclusionsTotal hip arthroplasty patients receiving spinal anesthesia experience favorable outcomes compared to propensity-matched general anesthesia patients.