Combined General Anesthesia Research Articles

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

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

High frequency variability index in predicting postoperative pain in video/robotic-assisted thoracoscopic surgery under combined general anesthesia and peripheral nerve block: an observational study.

The high frequency variability index (HFVI)/analgesia nociception index (ANI) is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This observational study investigated whether intraoperative HFVI/ANI correlates with postoperative pain in patients performed with nerve block under general anesthesia in video/robotic-assisted thoracoscopic surgery (VATS/RATS). We investigated whether maximum postoperative pain at rest and postoperative morphine consumption are associated with HFVI/ANI just before extubation, mean HFVI/ANI during anesthesia, the difference in HFVI/ANI between before and 5min after the start of surgery, and the difference in HFVI/ANI between before and 5min after the nerve block. Data obtained from 48 patients were analyzed. We found no significant association between HFVI/ANI just before extubation and postoperative Numerical Rating Scale (NRS) score. Receiver operating characteristic curve analysis revealed that moderate (NRS > 3) or severe (NRS > 7) postoperative pain could not be predicted by HFVI/ANI just before extubation. In addition, there were no associations between postoperative morphine consumption and HFVI/ANI at any time points. The present study demonstrated that it is difficult to predict the degree of postoperative pain in patients undergoing VATS/RATS under general anesthesia combined with peripheral nerve block, by using HFVI/ANI obtained at multiple time points during general anesthesia.

Clinical and morphological analysis of splenic neoplasms

The relevance of this study arises from the pressing need for a deeper investigation into the morphological aspects of identifying focal and localised lesions in the spleen. The spleen performs several vital functions, including immune, haematological, storage, metabolic, haemostatic, hormonal, and antiblastic roles, among others. Therefore, this study aimed to determine the clinical characteristics of splenic tumour lesions and their structural changes, as well as to identify the macroscopic appearance of the organ post-splenectomy. In diagnosing splenic diseases, a key instrumental method was employed – ultrasound examination with Doppler imaging – which enabled comprehensive investigation, analysis, and characterisation of parenchymal pathologies. Animals underwent clinical examinations during routine health checks or upon presentation of symptoms. When a splenic neoplasm was detected, surgical treatment was carried out, specifically through an open laparotomy and splenectomy. The surgery was performed under combined general anaesthesia (using both non-inhalational and inhalational anaesthetics). The intraoperatively collected material from the affected organ was subjected to histological examination. It was found that the pathomorphosis of splenic lesions varies, and the author's pathological and histological studies highlight the key morphological characteristics of the neoplasms. Accordingly, any splenic neoplasm can pose a life-threatening condition for several reasons: organ rupture and haemorrhage, organ torsion, and malignancy, among others. The findings are crucial for verifying splenic pathology, enabling the establishment of a definitive clinical diagnosis, facilitating treatment of the animal, and extending its lifespan. The practical significance of the results lies in identifying the need for comprehensive clinical and morphological investigations in diagnosing splenic diseases, as well as examining histological preparations for cellular and tissue changes. In veterinary medicine, the method of surgical treatment for splenic lesions in animals may be a subject of debate. In contrast, in human medicine, established protocols exist for performing organ-destructive operations such as splenectomy (by open or laparoscopic approach), organ-preserving procedures like splenic resection or splenectomy with autotransplantation of splenic tissue into the greater omentum (by open or laparoscopic approach), and percutaneous punctures for splenic cysts

Relationship between epidural catheter migration beneath the skin and subcutaneous fat thickness assessed using postoperative CT imaging: a retrospective cross-sectional study.

The causes of epidural catheter migration beneath the skin have not been previously investigated. We hypothesized that greater subcutaneous fat thickness might be associated with increased catheter migration beneath the skin. We conducted a retrospective cross-sectional study of patients who had undergone combined general and epidural anesthesia, selecting individuals who received thoracic and abdominal CT scans within the first 5 postoperative days. Needle depth was defined as the distance from the needle tip to the skin surface when the anesthesiologist determined that the needle tip had reached the epidural space. We measured the length of the epidural catheter from the skin surface to the epidural space (catheter length), and subcutaneous fat thickness (fat thickness) using CT imaging. Migration distance was calculated by subtracting needle depth from catheter length. We analyzed 127 patients (72 males), all undergoing epidural catheter insertion in the left lateral decubitus position via a paramedian approach. The median age of the patients was 71years. Epidural catheters were postoperatively found to substantially curve beneath the skin. Regression analysis revealed no significant influence of fat thickness on catheter length (regression coefficient 0.10, 95% confidence interval [CI]: - 0.17, 0.38). However, it indicated a positive correlation between fat thickness and needle depth (regression coefficient 0.50, 95% CI: 0.30, 0.70), and a negative correlation between fat thickness and migration distance (regression coefficient - 0.40, 95% CI: - 0.65, - 0.14). We found a negative correlation between epidural catheter migration beneath the skin and subcutaneous fat thickness. Anesthesiologists should be aware of the possibility of substantial subcutaneous curving of the catheter, especially in patients with scant subcutaneous fat.

Anaesthetic management of a patient with idiopathic pulmonary arterial hypertension, suprasystemic pulmonary artery pressures and carcinoma of the ascending colon.

A 35-year-old woman with severe pulmonary arterial hypertension underwent open hemicolectomy with cholecystectomy under combined general and epidural anaesthesia. Intra-operative pulmonary artery pressure, as measured by Swan-Ganz catheter, was suprasystemic and managed with inodilators. She developed postoperative right ventricular dysfunction requiring inotropes, incremental pulmonary vasodilators and prolonged oxygen supplementation. One year after surgery, she is recurrence-free with oxygen saturations of 88-90% on air. This case highlights that with meticulous care and multidisciplinary team input, patients with severe pulmonary arterial hypertension can have favourable outcomes after major cancer surgery.

Successful Anesthetic Management in a Viable 26-week Extrauterine Abdominal Pregnancy

ABSTRACT Extrauterine abdominal pregnancies occur when the fertilized ovum implants directly into the peritoneal cavity. They are rare, with its incidence being just 1 in 10,000 live births worldwide, and only 0.43% of all documented ectopic pregnancies in the Philippines. This poses a challenge in anesthesia because of the risk of massive hemorrhage the abnormal implantation brings about. This case report presents the anesthetic management of a 29-year-old G3P2 (2002) diagnosed case of 26-week and 5-day gestation viable abdominal pregnancy who underwent abdominal fetal extraction under combined general and epidural anesthesia. Along with the utilization of a multidisciplinary approach, goal-directed fluid therapy, and massive transfusion protocol, this management has been shown to be successful and safe for both the mother and the fetus.

Technical aspects of performing laparoscopic hernioplasty in the treatment of large ventral hernias

Laparoscopic hernioplasty is a promising treatment option for ventral hernias. The technique of intraperitoneal mesh placement (IPOM) is the most extensively studied and widely used for the closure of a defect during laparoscopic hernia repair. The large size of the defect and its diameter exceeding 10 cm are limiting factors in the selection of minimally invasive techniques for hernioplasty. The process of suturing the hernia prior to the placement of the mesh, as well as the technique used to fix it, show controversial results in terms of postoperative quality of life and the risk of recurrence. Objective — to study the technical aspects of performing laparoscopic prosthetic hernioplasty using the IРOM technique for the surgical treatment of patients with large primary ventral hernias (PVH) and postoperative incisional ventral hernias (IVH). Materials and methods. The study included a total of 84 patients who were undergoing treatment at the clinical base of the Department of General Surgery No. 2 of Bogomolets National Medical University. There were 51 (60.7%) women and 33 (39.3%) men. The average age was 58.73±10.9 years. All patients were operated on for large ventral hernias. Of these, 52 (61.9%) patients had surgery for PVH (umbilical hernia, line alba hernia), while 32 (38.1%) — for IVH. In 56 (66.7) patients, the width of the hernia defect was > 10 cm, of which 24 (28.6%) patients had PVH. In these patients, 4 weeks before surgery, 100 units of botulinum toxin type A (BTA) were injected intramuscularly into the muscles of the anterior abdominal wall in accordance with the methodology developed in the clinic. All patients underwent laparoscopic prosthetic hernioplasty with IPOM under general combined anesthesia. Control examinations of patients were carried out 2 weeks, 1 month, 6 months, and 1 year after the operation. Results. All patients underwent IPOM, while 38 (45.2%) patients underwent laparoscopic IPOM with suturing of the defect, 36 (42.9%) patients underwent IPOM with suturing the hernia defect before placing the mesh (IPOM+), and 10 (11.9%) patients underwent IPOM without suturing the defect. 32 (38.1%) patients were aged 65 years, including 10 patients who did not undergo suturing of the defect before the mesh placement. After the injection of BTA, the number of patients with a defect width of ≥10 cm decreased to 15 (17.8%). All of these patients had a defect smaller than 15 cm. The average duration of surgery for IPOM without hernia suturing was 60.00±11.30 min; for IPOM with laparoscopic suturing, it was 108.16±40.29 min; for IPOM+ with open suturing, it was152.08±40.64 min. The average length of stay in the hospital after surgery was higher in the group of patients who underwent hernioplasty using the IPOM+ technique compared to other techniques (p <0.001). In the early postoperative period, the complication rate was 13.1%; all cases were classified as minor (Grade I, II, IIIa) according to the Clavien–Dindo classification. Conclusions. Laparoscopic hernioplasty using the IPOM is a safe and reliable method for large ventral hernia repair. Administering preoperative BTA injections enables the reduction of the defect and facilitates the execution of laparoscopic hernioplasty in patients with a primary hernia size of ≥10 cm.

Usefulness of ultrasound-guided serratus-anterior block in prevention of postoperative pain after breast surgery. A cohort study

ObjectiveTo evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. MethodologyA prospective cohort study was conducted on 195 adult patients undergoing breast oncological surgery under general anesthesia (Group G, n = 96) or combined general anesthesia with superficial serratus anterior plane block (Group L, n = 99).Validated preoperative data, which are predictors of chronic postoperative pain of patients, were recorded (type of surgery, age, pain in the area of the intervention and the other regions; anesthetic-surgical data, analgesic doses used, duration of surgery; pain intensity (EVN scale) at immediate postoperative period, 24 h, seven days and one month after the surgery, and complications. ResultsPain intensity, measured by the EVN scale, had a mean of 1.02 +/− 1.656 in the Postoperative Unit; 1.20 +/− 1.448 at 24 h; 0.76 +/− 1208 seven days; and 0.34 +/− 0.757 one month after surgery.Patients were operated under general anesthesia (n = 96) or general anesthesia combined with the interfascial block (n = 99). Significant differences (p < 0.05) were found in age, height, and VAS scale in PACU. Ten complications were recorded, six in Group L and four in Group G. There were no differences between groups in complications. ConclusionsSuperficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.

Effect of Regional Anesthesia on Oncological Outcomes (Meta-Analysis)

Metastatic processes remain the main cause of deaths in oncology. Methods of anesthesia, in particular regional anesthesia, are considered as potential modulators of the immune response and metastatic spread. The ambiguity of the available data on the effect of regional and general anesthesia on metastatic spread is partly due to the fact that general anesthetic in combined anesthesia is quite often not taken into account, and this, in turn, masks the possible influence of regional anesthesia.The purpose of this meta-analysis was to make a comparative assessment of the effect of general anesthesia and general anesthesia in combination with regional anesthesia on the relapse-free and overall survival of cancer patients after surgery.Materials and methods. We analyzed 8 randomized controlled trials involving 1822 patients and comparing the groups of cancer patients who were operated either under general anesthesia (total intravenous (TIVA) or inhalation (IA)), or general anesthesia in combination with regional anesthesia (TIVA+RA or IA+RA, respectively). Trial using combinations of inhaled and intravenous anesthetics was excluded from the analysis for a more accurate assessment of the effect of regional anesthesia. The study complies with the recommendations of the Cochrane Community and PRISMA standards. The protocol was registered on the INPLASY platform. We used PubMed, Google Scholar and CENTRAL databases. We used a subgroup analysis and GRADE tool to assess the quality of evidence.Results. There were no statistically significant differences in relapse-free and overall survival when comparing different anesthesia methods. For a relapse-free survival, comparing TIVA vs TIVA+RA resulted in no significant difference : OR=1.20 [95% CI 0.92-1.55]; when IA vs IA+RA were compared, OR=1.10 [95% CI 0.94-1.29]. Similar results were obtained for overall survival.Conclusion. Based on the meta-analysis results, regional anesthesia had no effect on relapse-free and overall survival in oncosurgery patients.

Clinical case. Bilateral subtotal mandibulectomy with fusion of the tympanic part of the temporal bone with the medial surface of the angle of the mandible in a puppy

Relevance. A rare, predominantly congenital pathology Fusion of the tympanic part of the temporal bone with the medial surface of the angle of the mandible leads to irreversible pathological processes in the maxillofacial region, which significantly reduces the quality of life of the animal. The article discusses surgical correction options that can improve the dog’s quality of life. A timely procedure increased the comfort of existence and improved the general health of the animal, eliminating discomfort, otitis media and pain.Methods. The method of choice was technically complex bilateral subtotal mandibulectomy. To perform the procedure, the following were used: surgical dental instruments; dental unit with high-speed and low-speed handpieces; various types of bur. For extra- and intraoral radiography, the following were used: CR7Vet X-ray digitizer with luminoform plates (0, 1, 2, 3, 4, 5); combined general anesthesia with the use of narcotic and potent drugs.Results. The solution of this problem is possible only operationally, therefore, the method of choice was bilateral subtotal mandibulectomy, the evaluation of which served as the purpose of the study. As a result of the procedure, already on the 14th day, the dog had activity, satisfactory well-being, and no problems with taking food and water. The study of the results of the study showed that the pathology requires immediate intervention, since the outcome of the fusion of the tympanic part of the temporal bone with the medial surface of the angle of the lower jaw in a few weeks can lead to inoperable.

Cost Effectiveness General Anesthesia Combined with Scalp Block Compared to General Anesthesia in Patients Undergoing Removal Tumor Craniotomyin Dr. Sardjito Hospital

Background. Providers of anesthesia services have many opportunities to reduce these costs, of course with the aim of maintaining balance between profit, security and costs. Craniotomy surgery removal of the scalp block tumor is an alternative option that can be combined with general anesthesia. The scalp block itself can blunt stress response in craniotomy and can maintain unwanted hemodynamic instability.&#x0D; Purpose. Find out the cost effectiveness of the scalp block in craniotomy patients removing tumors at Dr. SARDJITO Hospital.&#x0D; Method. Method. Twenty patients ranging in age from 18 - 65 years with intracranial tumors who underwent tumor binding craniotomy at RSUP Dr. SARDJITO is grouped into two treatment groups with general anesthesia and general anesthesia with a combination of scalp blocks, both techniques are calculated using drugs and consumables during the operation.&#x0D; Results. Total cost on the general anesthesia combined scalp block was Rp. 1,347,276 lower Rp. 377,833 compared to general anesthesia Rp. 1,725,109 with a significant difference (p = 0.005). Similarly, the hourly cost of the group in the combined general anesthesia scalp block was Rp. 286,351 Rp. 97,107 lower than general anesthesia Rp. 383,457 with a significant difference (p = 0.038).&#x0D; Conclusion. Combination of general anesthesia and scalp block using 0.5% levobupivacaine more cost effective than general anesthesia and scalp block with placebo in supratentorial tumor patients undergoing tumor removal craniotomy.

Efficacy of Nefopam in multimodal analgesia in dogs

Pain that occurs in a surgical patient in the area of surgical intervention is called surgical pain. Postoperative analgesia is one of the most important components in the system of general intensive care, which creates comfortable living conditions for the surgical patient. In veterinary practice, the central non-opioid analgesic Nefopam has become available, which has a structural affinity for diphenhydramine (Diphenhydramine) and orphenadrine and has both spinal and supraspinal mechanisms of action. The aim of the study is to evaluate the efficacy and safety of Nefopam as part of multimodal analgesia in the postoperative period in dogs. For the study were selected 20 dogs aged 1 to 10 years who underwent radical surgery requiring multicomponent anesthesia. The animals were divided into 2 groups of 10 dogs each. Surgical interventions were performed under conditions of general combined anesthesia according to standard protocols of the clinic using neuroleptics, anesthetics, non-narcotic painkillers. In the postoperative period, a non-opioid centrally acting analgesic, Nefopam, was introduced into the scheme of multimodal analgesia in the animals of the experimental group, and Analgin was administered to the dogs of the control group. The level of pain of the visual analog scale for assessing pain according to VAS. To assess the health status of experimental animals before surgery and on the 3rd and 7th days after it, blood was taken for biochemical and clinical studies. The use of Nefopam in the complex of multimodal analgesia used in the clinic is therapeutically justified and effective. It is this kind of analgesia that makes it possible to fully and safely anesthetize patients after extensive and traumatic operations with minimal consumption of non-opioid and opioid analgesics.

Responsiveness to Infusion Load under Regional Anesthesia after Off-Pump Coronary Artery Bypass Graft Surgery

Objective. To evaluate the effect of erector spinae plane block (ESPB) and epidural anesthesia on responsiveness to infusion load after coronary bypass surgery on a beating heart.Materials and methods. A prospective randomized single-center study included 45 patients who were grouped into 3 equal arms based on anesthesia techniques: general anesthesia in combination with ESPB (GA+ESPB), general anesthesia and epidural anesthesia (GA+EA) and general anesthesia without regional techniques (GA). Patient’s response to volume loading was assessed using dynamic and orthostatic tests after transfer from the operating room and at the end of the first postoperative day. Passive leg raise (PLR) and standard bolus injection tests were done at the first stage; changes in hemodynamic parameters during verticalization were additionally evaluated at the second stage. Patients with 10% cardiac index (CI) increase after PLR test and 15% increase after bolus injection test were categorized as responders.Results. The concordance of obtained results in PLR and bolus injection tests for the GA+ESPB, GA+ EA and GA groups at the first stage was 0.53 (95% CI 0.12–0.94), 0.68 (95% CI 0.30–1.00) and 0.61 (CI 0.24–0.99), at the second stage — 0.70 (0.32–1.00), 0.84 (95% CI 0.55–1.00) and 0.82 (95% CI 0.47–1.00), respectively. There were no differences in distribution of responders between the groups. CI dynamics did not differ between the groups during verticalization, and there were no associations of CI changes during verticalization with the preceding PLR test results. The dynamics of troponin T and NT-proBNP did not differ between the groups.Conclusion. Methods of regional anesthesia (SPB or EA) do not significantly affect the responsiveness to infusion therapy in the postoperative period after coronary bypass surgery on a beating heart.

Comparison of the effect of combined general and regional anesthesia on the cognitive functions of women of reproductive age: retrospective observational study

BACKGROUND: Depression and cognitive dysfunction in the postoperative period may be associated with pregnancy, surgery, and type of anesthetic support.&#x0D; OBJECTIVE: To perform a comparative assessment of the effect of combined general and regional anesthesia on memory and attention in pregnant and nonpregnant women.&#x0D; MATERIALS AND METHODS: The study involved 120 women of reproductive age who were admitted for surgery. According to the indications, they received various anesthesia types depending on their somatic status. The cognitive potential of the patients and indicators of memory and attention, anxiety, and depression were evaluated using specially selected tests before surgery and three days after surgery. The effect of anesthesia on pregnant women during planned operative delivery was studied, and planned interventions in gynecology were used for comparison.&#x0D; RESULTS: The MOS test scores in all groups were reduced, and they indicated a reduced cognitive potential in nonpregnant women [26.2 (26.9; 25.5) and 24 (24.59; 23.44)] under general anesthesia (p 0.003) and pregnant women [25.2 (25.7; 24.7) and 24.6 (25.36; 23.84)] under general anesthesia (p 0.004). After the operation under OA, the results worsened, and statistical differences were revealed. The level of attention in pregnant women decreased according to the results of the Wexler test after surgery in the general anesthesia group [4.5 (5.1; 3.9) and 3 (3.46; 2.54), p 0.006], and in the regional anesthesia group, the results decreased but to a lesser extent degree [5 (5.8; 4.2) and 3.5 (4.2; 2.8, p 0.005], showing statistical difference. According to the results of the Benton test after surgery in the general anesthesia group, visual short-term memory decreased in pregnant women [6.15 (6.75; 5.55) and 4 (4.86; 3.14), p 0.002], and in the regional anesthesia group, the results decreased, but to a lesser extent [6.2 (6.9; 5.5) and 4.5 (5.2; 3.8, p 0.012], and statistical differences were noted.&#x0D; CONCLUSION: The effect of combined general and regional anesthesia led to the development of cognitive dysfunction, increased depression, and changes in memory and attention.

Prediction of postoperative patient deterioration and unanticipated intensive care unit admission using perioperative factors.

Currently, no evidence-based criteria exist for decision making in the post anesthesia care unit (PACU). This could be valuable for the allocation of postoperative patients to the appropriate level of care and beneficial for patient outcomes such as unanticipated intensive care unit (ICU) admissions. The aim is to assess whether the inclusion of intra- and postoperative factors improves the prediction of postoperative patient deterioration and unanticipated ICU admissions. A retrospective observational cohort study was performed between January 2013 and December 2017 in a tertiary Dutch hospital. All patients undergoing surgery in the study period were selected. Cardiothoracic surgeries, obstetric surgeries, catheterization lab procedures, electroconvulsive therapy, day care procedures, intravenous line interventions and patients under the age of 18 years were excluded. The primary outcome was unanticipated ICU admission. An unanticipated ICU admission complicated the recovery of 223 (0.9%) patients. These patients had higher hospital mortality rates (13.9% versus 0.2%, p<0.001). Multivariable analysis resulted in predictors of unanticipated ICU admissions consisting of age, body mass index, general anesthesia in combination with epidural anesthesia, preoperative score, diabetes, administration of vasopressors, erythrocytes, duration of surgery and post anesthesia care unit stay, and vital parameters such as heart rate and oxygen saturation. The receiver operating characteristic curve of this model resulted in an area under the curve of 0.86 (95% CI 0.83-0.88). The prediction of unanticipated ICU admissions from electronic medical record data improved when the intra- and early postoperative factors were combined with preoperative patient factors. This emphasizes the need for clinical decision support tools in post anesthesia care units with regard to postoperative patient allocation.

Paracetamol Versus Ondansetron for Prevention of Postoperative Shivering in Liposuction Surgeries Under Combined General Epidural Anaesthesia: A Randomized Controlled Trial.

Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia. One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects. The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a P value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (P <0.001). Tympanic temperature and complications were comparable between the groups with no significant differences. Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.

Comparison of median and paramedian technique of thoracic epidural anaesthesia in patients undergoing laparotomy under combined general and epidural anaesthesia - A prospective observational study.

Most studies have found that lumbar epidural catheterisation is technically easier with a paramedian than median approach. There is scant literature comparing the two approaches to the epidural space in the mid-thoracic spine. This study aims to compare the median versus paramedian approaches in the location of epidural space in the T7-9 region in patients undergoing laparotomy under combined general and epidural anaesthesia. A prospective observational study was conducted after ethical approval and written informed consent on 70 patients undergoing major abdominal surgery. The patients received epidural analgesia either through a median or paramedian approach (Group M, n = 35 and Group P, n = 35). The primary objective was the incidence of successful epidural catheter placement in the first attempt. The secondary objectives were the overall success rate, the requirement of change of intervertebral space, approach or operator and complications associated with the procedure. Sixty-seven patients were analysed. Epidural catheter was placed successfully in the first attempt in 40% of patients in Group M and 78.1% in Group P (P = 0.003). The overall success rate was 74.3% in Group M and 87.5% in Group P (P = 0.223). The number of attempts in Group M was more (one attempt 14, two 6, three 5 and four 1) as compared to Group P (one 25, two 2, three 1 and four 0) (P = 0.014). The incidence of complications was comparable between the groups. Epidural catheter insertion was technically easier in paramedian as compared to the median approach in T7-9 thoracic region with no difference in complications.

Remimazolam Supplemented to General Anesthesia Alleviates Stress and Cognitive Impairment in Elder Patients After Hip Surgery

Stress and cognitive impairment are common postoperative complications in elder patients who have undergone hip surgery. The objective of the work is to evaluate the effects of remimazolam supplemented to combined general anesthesia in improving stress and cognitive performance. A total of 120 patients were included to receive a low dose of remimazolam (0.1 mg/kg/h) intravenously combined with general anesthesia or general anesthesia alone during hip surgery. Assessments were used for evaluating cognitive and psychological performance respectively before surgery (T0), 24 h (T5), and 72 h (T6) after surgery. Physiological parameters including mean artery pressure, heart rate, and blood oxygen levels (SpO2) were measured at T0, 30 min after anesthesia (T1), and completion of surgery (T2). Stress indexes including serum cortisol and norepinephrine levels were measured at T0, T5, and T6. The visual analog scale pain scores were also acquired at 6 h after surgery, 12 h after surgery, and T6. Serum interleukin-6 and tumor necrosis factor-α levels were acquired at T0, T2, and T6. Heart rate and SpO2 levels in the combination group were significantly improved compared to the control group. Serum cortisol and norepinephrine levels were the highest at T1 and decline over time until T5 in both groups, the two stress indexes of the combination group were significantly lower at T1 and T2. Remimazolam supplemented to combined general anesthesia demonstrated significant benefit in reducing stress and cognitive dysfunction in elder patients who underwent hip surgery.

General anesthesia and femoral nerve block versus spinal anesthesia for cemented hip arthroplasty in elderly patients: A randomized controlled trial

ABSTRACT BACKGROUND Traumatic femoral fractures are a prevalent orthopaedic issue in elderly adults. General anaesthesia (GA) vs. spinal anaesthesia are still being discussed as the best anaesthetic method for cemented hip arthroplasty (SA). This study compared the impact of spinal anaesthesia versus general anaesthesia in combination with femoral nerve block on the mean arterial blood pressure (MAP) in patients having cemented hip arthroplasty operations. AIM OF THE STUDY To compare the impact of spinal anaesthesia on elderly patients undergoing cemented hip arthroplasty operations versus general anaesthesia in combination with femoral nerve block on mean arterial blood pressure. PATIENTS AND METHODS The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202,111,575,647,784). At Ain Shams University Hospital, 60 patients receiving total hip arthroplasty were separated into two equal groups, each comprising 30 patients, for the purpose of this prospective randomised comparison study. Patients in Group (A) underwent spinal anaesthesia, while Group (B) received general anaesthesia together with an ultrasound-guided femoral nerve block. RESULTS This study showed that GA was associated with more stable readings of mean arterial blood pressure (MAP) after anesthesia induction and post cement implantation than SA (p-value = 0.04 and 0.038 respectively). CONCLUSION Patients who received general anesthesia (GA) had more stable hemodynamic parameters especially the mean arterial blood pressure (MAP) than those who received spinal anesthesia (SA).

Evaluation of the effectiveness of the erector spinae plane (ESP) block in endovideosurgical hernioplasty inguinal hernias

The objective was to evaluate the effectiveness of the erector spinae plane block (ESP-block) as a component of perioperative analgesia in endovideosurgical hernioplasty of inguinal hernias.Materials and methods. The study included 70 patients who underwent endovideosurgical plastic surgery of inguinal hernias. All patients randomly divided into the main (n=32) and control (n=38) groups, were given general combined anesthesia. In the main group, it was supplemented with the ESP-block, which was performed with ropivacaine at the L1 level. Intraoperatively, fentanyl was used for analgesia. The indication for its introduction was an increase in the Surgical Pleth Index (SPI) of more than 50. In the early postoperative period, ketoprofen and tramadol were used for analgesia, which were administered with the development of moderate and high intensity of the pain. The effectiveness of the ESP-block was evaluated by comparing the total doses of analgesic drugs that were required for analgesia during surgery and in the early postoperative period in patients of both groups.Results. In the main group, the total doses of fentanyl and ketoprofen were statistically significantly lower compared to the control group (p&lt;0.01). After surgery, tramadol was used only in patients of the control group. In some patients of the main group who required analgesia in the early postoperative period (n=15), the pain syndrome developed only 12 hours after the end of the surgery. Their intraoperative need for fentanyl did not differ from other patients of the main group (p&gt;0.05).Conclusion. In endovideosurgical hernioplasty of inguinal hernias, the use of the ESP-block as part of multimodal analgesia contributes to achieving a good level of analgesia both intra- and in the early postoperative period.