General Anesthesia In Patients Research Articles

Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials

BackgroundPostoperative delirium is a common neurological complication, especially in older patients undergoing surgery, which is closely related to the poor prognosis of patients. The objective was to investigate the effects of esketamine on postoperative delirium in patients with general anesthesia.MethodsThe databases of PubMed, Embase, Cochrane Library and the Chinese National Knowledge Infrastructure were searched for all available randomised controlled trials on the effects of esketamine induction on postoperative delirium in patients undergoing elective general anesthesia from inception until April 21, 2024. We used RevMan5.4 software for data analysis. Dichotomous data was analyzed by risk ratios(RR) with a 95% confidence interval(CI), and continuous data by mean differences(MD). We also evaluated the risk of literature bias using the Cochrane Bias Risk Assessment tool.ResultsWe included a total of 17 randomized controlled trials, including 1286 patients undergoing elective general anesthesia. In 17 studies, esketamine significantly reduced the incidence of postoperative delirium (RR: 0.43; 95%CI: 0.33 ~ 0.57; p < 0.001). Five studies examined the incidence of postoperative adverse events (nausea, vomiting, dizziness and resporatory depression) and showed no statistically significant difference between the esketamine group and the control group (normal saline or dexmedetomidine) (RR: 0.82; 95%CI: 0.65 ~ 1.03; p = 0.08). In addition, this study found that the esketamine group had a lower incidence of hypotension (RR: 0.24; 95%CI: 0.12 ~ 0.48; p < 0.001) and a lower score on the visual analogue scale 24 h after surgery (MD: -0.44; 95%CI: -0.54 ~ -0.33; p < 0.001).ConclusionAccording to our meta-analysis, the use of esketamine during anesthesia induction significantly reduced the incidence of postoperative delirium in patients undergoing elective general anesthesia without increasing the incidence of postoperative adverse reactions.

Topical bupivacaine effect on the response to awake extubation during emergence from general anesthesia in patients undergoing elective thyroidectomy. A randomized controlled study

BackgroundA desirable combination of smooth extubation, even with prolonged extubation, and an easy maneuver to apply is difficult to achieve. This study aimed to evaluate the efficacy of 0.5% topical bupivacaine for reducing cough, postoperative sore throat, and hemodynamic fluctuations during extubation in patients undergoing thyroidectomy. MethodsForty-eight patients scheduled for thyroidectomy were randomly assigned to two equal groups (24 each): group (C) patients received 5 ml of 0.9% normal saline topically, and group (B) patients received 5 ml of 0.5% bupivacaine topically 15 min, around the tracheal tube, before the expected end of surgery, followed by manual ventilation to obtain air bubbles distributed throughout the entire airway mucosa. The primary outcomes were the incidence and grade of cough. The secondary outcomes were the incidence and degree of postoperative sore throat, extubation time, hemodynamic changes during extubation, and side effects. ResultsThere was a statistically significant decrease in the incidence and the severity of cough in the bupivacaine group compared to the control group. Moreover, the severity of sore throat, as assessed by the VAS score, was lower in the bupivacaine group up to 12 hours postoperatively. The hemodynamic parameters significantly increased in the control group in the peri-extubation period compared to the bupivacaine group, with no difference in extubation time or side effects. ConclusionThe use of topical bupivacaine around the ETT significantly reduced the incidence and severity of cough and postoperative sore throat with less hemodynamic fluctuations during the periextubation period in patients undergoing thyroidectomy.

Reevaluating 30 cmH2O endotracheal tube cuff pressure: risks of airway mucosal damage during prolonged mechanical ventilation.

The optimal endotracheal tube (ETT) cuff pressure remains contentious. In the traditional consideration that the level 30 cmH2O is considered safe, balancing the prevention of reflux aspiration against airway mucosal damage. Whether this pressure level can cause potential damage to the airway mucosa remains to be discussed. Airway mucosa damage and structural changes at 30 cmH2O were examined in patients under general anesthesia and in rabbit mechanical ventilation models. Prior to this, we also interviewed some anesthesiologists about the level of concern about ETT cuff pressure. A total of 634 valid questionnaires suggested that anesthesiologists generally do not pay enough attention to ETT cuff pressure and the average established cuff pressure significantly exceeded 30 cmH2O. Airway mucosa images of 100 general anesthesia patients with different ventilation duration indicated that maintaining the pressure at 30 cmH2O did not cause significant damage to airway mucosa in a short period of time, while it still caused damage to airway mucosa in patients with long-term ventilation, with damage severity increasing with longer ventilation periods. This correlated strongly with postoperative sore throat (R 2 = 0.3884, p < 0.001). In rabbits, 4 h of ventilation at this pressure resulted in significant loss of ciliated epithelium and inflammation. Calculations suggested an effective dose (ED50) to prevent mucosal injury at a cuff pressure of 25.64 cmH2O (95% CI: 19.268-29.367 cmH2O). The currently established cuff pressure of 30 cmH2O is associated with airway mucosal damage in both clinical and animal models. Lowering the safety threshold of cuff pressure may be necessary to mitigate mucosal injury.

General Anesthesia On A Patient With Suspected Superior Vena Cava Syndrome In Cardiac Tamponade For Subxiphoid Tube Pericardiostomy: A Case Report

Induction of general anesthesia in patients with cardiac tamponade can cause significant risks. All general anesthetics are myocardial depressants, and most are peripheral vasodilators. In this report, we discussed a 61-year-old woman with pericardial effusion and other signs suggestive of cardiac tamponade, together with facial edema and engorgement of neck veins, scheduled for subxiphoid tube pericardiostomy and pericardial biopsy under general endotracheal anesthesia. The patient was intubated successfully with no noted events on induction and during the perioperative period and immediately postoperatively. To conclude, general anesthesia may be safely performed in patients with cardiac tamponade but must be tailored according to tamponade physiology and their presenting signs and symptoms.

The Relationship between Family Support and Anxiety Level in Preoperative Major Elective General Anesthesia Patients at dr. Soedomo Hospital Trenggalek

surgical process. Family support plays a crucial role in helping patients manage preoperative anxiety. The study aimed to analyze the relationship between family support and anxiety levels in patients undergoing major elective surgery with general anesthesia. The research design was cross-sectional. The study population consisted of 92 patients, with a sample size of 75 recruited through non-probability purposive sampling. The study utilized family support and Amsterdam preoperative anxiety and information Scale (APAIS) questionnaires as instruments. Data were analyzed using descriptive and inferential statistical tests, including Spearman’s rank correlation (Rho) with a p-value less than 0.05 was considered statistically significant. The results showed that almost all participant received high levels of family support (81.3%) and moderate level of preoperative anxiety (81.3%). The Spearman rank test indicated a significant relationship between family support and anxiety levels (p-value = 0.000 0.05) with a very strong, negative correlation (r = -.870). In conclusion, higher the family support is associated with lower anxiety level in preoperative patients. It is recommended that families provide consistent support during preoperative phase to help reduce patient level of anxiety.

Results of Local and General Anesthesia in Patients Undergoing Elective Endovascular Abdominal Aortic Aneurysm Repair (EVAR): A Single Center Experience

Results of Local and General Anesthesia in Patients Undergoing Elective Endovascular Abdominal Aortic Aneurysm Repair (EVAR): A Single Center Experience

Efficacy and safety of ciprofol for general anesthesia induction in female patients with frailty: a prospective randomized controlled trial

BackgroundCiprofol, a recently developed anesthetic agent, is not inferior to propofol in terms of efficacy and safety. However, most previous clinical experience with ciprofol was based on a robust population. This study aimed to investigate the efficacy and safety of ciprofol for anesthesia induction in female patients with frailty.MethodsThis prospective randomized controlled trial included patients with frailty undergoing elective general anesthesia for gynecological surgery. Frailty was assessed using the modified frailty index. The patients were randomly administered propofol (2 mg/kg) or ciprofol (0.5 mg/kg) during anesthesia induction. The depth of anaesthesia was continually monitored by the bispectral index. The primary outcome was the lowest systolic blood pressure (SBP) during anesthesia induction. Secondary outcomes included the incidence of general anesthesia induction failure and adverse events.ResultsAmong the 69 enrolled patients with frailty, 67 were included in the final analysis. The success rate of anesthesia induction was 100% in both groups. The lowest SBP was significantly higher in the ciprofol group than in the propofol group (103 [96–110] vs. 90 [85–98] mmHg, respectively; P < 0.001), suggesting that the former caused less inhibition of hemodynamics during anesthesia induction in patients with frailty. The incidence of injection pain was lower in the ciprofol group than in the propofol group (3 [8.8%] vs. 11 patients [33.3%], respectively; P = 0.014).ConclusionsThe results of this study suggest that the efficacy of ciprofol for inducing general anesthesia in patients with frailty is comparable to that of propofol, with more stable hemodynamics.Trial registrationThe trial was registered, before patient enrollment, in the Chinese Clinical Trial Registry (www.chictr.org.cn) (Clinical trial number: ChiCTR2300075271; https://www.chictr.org.cn/showproj.html?proj=205160, principal investigator’s name: Zifeng Xu, date of registration: 31/08/2023).

Remimazolam Reduces Vasopressor Use Post-Induction and During Maintenance of General Anesthesia in Patients Undergoing Laparoscopic Gynecology: A Propensity Score-Matched Analysis.

Objectives: Laparoscopic gynecological surgeries are commonly performed under general anesthesia and can induce cardiovascular depression and hypotension, requiring vasopressor support. Remimazolam, a novel ultra-short-acting benzodiazepine, is used to treat minimal cardiovascular depression. This study compared the hemodynamic effects of remimazolam and sevoflurane anesthesia in patients undergoing laparoscopic gynecological surgery. Methods: A retrospective analysis was conducted on 474 patients who underwent laparoscopic gynecological surgery at Korea University Anam Hospital between September 2021 and December 2022. The patients were categorized into two groups based on the anesthetic agent used: remimazolam or sevoflurane. Hemodynamic parameters, vasopressor use, and intraoperative variables were compared between anesthetic agents. Propensity score matching was applied to account for potential confounders, and logistic regression was utilized to assess the relationship between anesthesia type and outcomes. Results: Remimazolam anesthesia was linked to a significantly lower incidence of vasopressor use compared to sevoflurane-based anesthesia (3.7% vs. 19.5%, p < 0.0001). The odds of requiring vasopressor support were significantly lower during the post-induction and maintenance phases in the remimazolam group. Furthermore, hemodynamic stability, particularly systolic and mean arterial pressures, was better maintained with remimazolam than sevoflurane. Conclusions: Remimazolam provides superior hemodynamic stability and reduces the need for vasopressor support during laparoscopic gynecological surgery compared with sevoflurane.

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

To investigate the effects of supraglottic airway tools such as classical laryngeal mask (cLMA) and I-gel, which can be used without the need for muscle relaxation in the airway management of general anesthesia patients, on the otolaryngeal system. This prospective randomised study was conducted at Karadeniz Technical University Hospital, Faculty of Medicine, Trabzon, Turkey, during November 2020 to December 2021. Eighty-nine patients in the American Society of Anesthesiologists (ASA) grade I-II group, who would undergo elective surgery under general anesthesia, were randomized into two groups, namely Group cLMA and Group I-gel. cLMA and I-gel were used for airway management of the patients. After anesthesia induction, tympanometric measurements were taken at regular intervals for middle ear pressures of both ears. While air way pressures, SpO2 and EtCO2 values were within normal limits, there were no differences in terms of complications. In tympanometric measurements, middle ear pressure increase was statistically higher in the cLMA group than in the I-gel group (p <0.001). We think that I-gel may be a more advantageous supra glottic airway device in terms of otolaryngeal effecs and middle ear pressure in theair way management during short surgical procedures.

Locoregional Versus General Anesthesia in Prolonged Carotid Endarterectomy: A Propensity Score-Matched Study from the American College of Surgeons National Surgical Quality Improvement Program Database from 2011 to 2022

BackgroundCarotid endarterectomy (CEA) is an effective treatment for carotid stenosis. Previous studies yielded conflicting findings regarding postoperative outcomes after CEA when comparing those under general and locoregional anesthesia. However, these findings may be influenced by an inherent selection bias, as general anesthesia is frequently selected for more complex CEA. To counteract this selection bias, this study compared the 30-day outcomes of locoregional and general anesthesia in patients who underwent prolonged CEA. MethodsAdult patients undergoing CEA were identified in ACS-NSQIP targeted database from 2011-2022. Only cases with prolonged operative times (over third quartile) were selected. Patients who had symptomatic and asymptomatic carotid stenosis were examined separately. A 1:3 propensity-score matching was used to address pre-operative differences between patients under locoregional and general anesthesia to assess thirty-day postoperative outcomes. Moreover, factors associated with prolonged CEA were identified by multivariable logistic regression. ResultsAmong symptomatic patients who underwent prolonged CEA, 246 and 4,286 were under locoregional and general anesthesia, respectively. In asymptomatic patients, 388 had locoregional anesthesia and 5,137 had general anesthesia. After propensity-score matching, patients under locoregional and general anesthesia had comparable 30-day mortality (symptomatic: 1.63% vs 0.81%, p=0.28; asymptomatic: 0.77% vs 0.52%, p=0.70) and stroke (symptomatic: 4.88% vs 4.34%, p=0.72; asymptomatic: 1.29% vs 1.46%, p=1.00). All other 30-day outcomes were comparable between groups, except for symptomatic patients under locoregional had shorter operation time (p<0.01) and asymptomatic patients under locoregional had lower cranial nerve injury (2.06% vs 4.90%, p=0.02). High-risk anatomical factors, male sex, younger age, and certain comorbidities were associated with prolonged operative times. ConclusionPatients under both types of anesthesia had mostly comparable 30-day postoperative outcomes, including mortality and stroke, for both symptomatic and asymptomatic patients. Therefore, locoregional and general anesthesia appear to be equally effective in CEA cases characterized by anticipated complexity and, consequently, prolonged operative times.

Feasibility and radial artery occlusion rate of sheathless distal transradial access using balloon guide catheters.

Distal transradial access (dTRA), performed through an anatomical snuffbox, minimizes post-procedural burdens of endovascular treatments. However, despite the benefits of balloon-guide catheters (BGCs), their use in dTRA is limited by their small radial artery diameter. Herein, we evaluated the feasibility and radial artery occlusion (RAO) rate of 8Fr BGCs used in sheathless dTRA. This retrospective study reviewed patients treated with sheathless dTRA using an 8Fr Optimo at a single center between July 2023 and May 2024. dTRA procedures were performed under general anesthesia in patients not requiring urgent treatment. The RAO was assessed using ultrasonography 24h after the procedure. The demographic and procedural characteristics were compared between the radial artery patency and occlusion groups. Of 170 patients, 50 underwent dTRA, and 43 (86%) completed the procedure. RAO occurred in 12/43 (28%) patients with dTRA. Univariate and receiver operating characteristic curve analyses demonstrated that the median radial artery diameter was significantly smaller in the RAO group (P < 0.001), with an optimal cut-off value of 2.4mm to predict RAO. Complications included minor cerebral ischemia in two patients, but no severe ischemia was observed. Sheathless dTRA using an 8Fr Optimo BGC is feasible, but the risk of RAO should be noted, particularly in patients with small radial artery diameters. This study suggests a radial artery diameter cutoff value of 2.4mm to predict RAO, aiding access decisions for large-bore BGC. Further multicenter prospective studies are warranted to confirm these findings and assess long-term outcomes.

A Comparative Study between the Analgesic Efficacy of Ultrasound Guided Interscalene Block vs General Anesthesia in Patients Undergoing Shoulder Arthroscopy

Abstract Background Shoulder arthroscopy can effectively treat a number of injuries and diseases of the shoulder on an ambulatory basis. Although shoulder arthroscopy is considered minimally invasive, it is associated with severe intraoperative and postoperative pain. Hence, it requires adequate analgesia and muscle relaxation for the procedure. For shoulder arthroscopy, regional anesthesia is better than general anesthesia (GA) because of the extended postoperative analgesia and rapid recovery towards discharge. Aim of the Work to compare the analgesic efficacy of ultrasound guided Interscalene block alone without GA VS general anesthesia as regards the postoperative pain management, analgesics requirements and hospital stay during shoulder arthroscopy. Patients and Methods Type of Study: a prospective, randomized, comparative study. Study Setting: After obtaining approval from the Research Ethical Committee of Ain Shams University, this study will be conducted in the operating theatres of Ain Shams University Hospitals. Study Period: Six months (started from FEB. 2023 to AUG. 2023). Results In our study, regarding VAS score among the studied patients, The pain threshold score using VAS score at different times postoperatively showed non-significant difference between the ISB all times, with p-values &amp;lt;0.001 for VAS 1, VAS 6, VAS 12, VAS 18 except at VAS 24 HR a significant difference at p value 0.887 was found but still the VAS score was less than 4, So, no pain killers were given. Surprisingly a reported improvement in expression of postoperative pain was noticed later on. This is may be due to the very dense block offered by interscalene brachial plexus block. Regarding the assessment of patient„s vital data represented in the heart rate and mean arterial blood pressure our study shows highly statistically significant higher mean in group G compared to group I according to heart rate from at0hr to after 20hrs with p-value &amp;lt;0.05, while after 24hrs insignificant with p-value &amp;gt;0.05 NS with almost the same results for mean arterial blood pressure. Our study demonstrates that ISB provides a better hemodynamic stability postoperatively regarding the control of heart rate avoiding the unwanted catastrophic tachycardia and lower mean arterial blood pressure while maintain adequate desirable tissue perfusion without the need of toxic mega opioid rescue doses. Conclusion Ultrasound guided ISB for shoulders arthroscopic surgical operation provides greater pain-free period, lesser opioid requirement, and lesser PACU stay duration in patients receiving this block

Effect of Effective Cough Education Video on Airway Clearance in Post General Anesthesia Patients

Background: Post-anesthesia disorders, particularly respiratory conditions related to hypoxia, can rapidly lead to fatal outcomes if not promptly identified and managed. Effective coughing techniques are essential for patients to expel phlegm efficiently. Purpose: This study aimed to evaluate the effectiveness of airway clearance in patient post-general anesthesia at RSI Purwokerto after viewing cough instruction videos. Methods: A quasi-experimental design, specifically the Pretest-Posttest Control Group Design, was employed. A total of 52 respondents were selected through purposive sampling. Data on airway clearance were collected using observation sheets. The Mann-Whitney U and Wilcoxon tests were utilized for data analysis. Results: Prior to viewing the instructional videos, the average airway clearance score was 1.03; this improved to 0.42 post-intervention. In the control group, the average score improved from 1.07 to 0.73 after education. The Wilcoxon test results indicated a significant difference in airway clearance before and after the intervention in both the experimental group (p = 0.001, p &lt; 0.05) and the control group (p = 0.003, p &lt; 0.05). Furthermore, the Mann-Whitney U test revealed a significant difference between the experimental and control groups post-intervention (p = 0.026, p &lt; 0.05). Conclusion: The findings demonstrate that viewing cough instruction videos significantly improve airway clearance in patients who have undergone general anesthesia. This intervention is effective in enhancing respiratory outcomes in this patient population at RSI Purwokerto.

Research Progress on the Current Status and Intervention Strategies of Hypoxaemia in General Anaesthesia Patients during the Postoperative Awakening Period

To introduce the current situation of the occurrence of postoperative hypoxemia during the awakening period of general anesthesia patients, to analyze the influencing factors of the occurrence of hypoxemia during the awakening period of general anesthesia patients, and to summarize the intervention strategies of hypoxemia during the awakening period of general anesthesia patients, with a view to promoting the medical personnel's understanding of the risk factors of hypoxemia during the awakening period of general anesthesia patients, and to provide references for the development of reasonable intervention programs in the future.

Machine learning-based prediction of the risk of moderate-to-severe catheter-related bladder discomfort in general anaesthesia patients: a prospective cohort study

BackgroundCatheter-related bladder discomfort (CRBD) commonly occurs in patients who have indwelling urinary catheters while under general anesthesia. And moderate-to-severe CRBD can lead to significant adverse events and negatively impact patient health outcomes. However, current screening studies for patients experiencing moderate-to-severe CRBD after waking from general anesthesia are insufficient. Constructing predictive models with higher accuracy using multiple machine learning techniques for early identification of patients at risk of experiencing moderate-to-severe CRBD during general anesthesia resuscitation.MethodsEight hundred forty-six patients with indwelling urinary catheters who were resuscitated in a post-anesthesia care unit (PACU). Trained researchers used the CRBD 4-level assessment method to evaluate the severity of a patient’s CRBD. They then inputted 24 predictors into six different machine learning algorithms. The performance of the models was evaluated using metrics like the area under the curve (AUC).ResultsThe AUCs of the six models ranged from 0.82 to 0.89. Among them, the RF model displayed the highest predictive ability, with an AUC of 0.89 (95%CI: 0.87, 0.91). Additionally, it achieved an accuracy of 0.93 (95%CI: 0.91, 0.95), 0.80 sensitivity, 0.98 specificity, 0.94 positive predictive value (PPV), 0.92 negative predictive value (NPV), 0.87 F1 score, and 0.07 Brier score. The logistic regression (LR) model has achieved good results (AUC:0.87) and converted into a nomogram.ConclusionsThe study has successfully developed a machine learning prediction model that exhibits excellent predictive capabilities in identifying patients who may develop moderate-to-severe CRBD after undergoing general anesthesia. Furthermore, the study also presents a nomogram, which serves as a valuable tool for clinical healthcare professionals, enabling them to intervene at an early stage for better patient outcomes.

Analysis of contributing factors and nursing interventions for postoperative agitation following general anesthesia in thoracotomy patients.

To analyze the factors influencing agitation during emergence from general anesthesia in patients undergoing thoracotomy and to explore corresponding nursing interventions to optimize the postoperative recovery process. This study included 200 patients who underwent thoracotomy with general anesthesia at our hospital between January 12, 2022, and June 1, 2023. After surgery, all patients were closely monitored in the Intensive Care Unit (ICU). Based on their agitation status during emergence from anesthesia, patients were divided into 2 groups: an observation group (87 cases with agitation) and a control group (113 cases without agitation). We performed univariate analysis and multivariate logistic regression to identify risk factors for agitation. Based on these findings, we proposed targeted nursing strategies to address the causes of agitation, prevent complications, and meet patient care needs. Univariate analysis showed significant differences between the observation and control groups regarding age, propofol dosage, duration of surgery, infusion volume, and preoperative cognitive dysfunction (P < .05). Multivariate logistic regression identified 3 key risk factors: age over 60 years, surgery duration over 2 hours, and preoperative cognitive dysfunction. Based on these findings, we developed targeted nursing strategies to reduce the incidence of agitation and promote smooth recovery. Agitation during emergence from general anesthesia in patients undergoing thoracotomy is closely related to factors such as age and surgery duration. Developing personalized nursing plans based on these factors can enhance postoperative monitoring and care, thereby reducing agitation and improving recovery quality.

Incidences of Rocuronium Use during Anesthetic Induction in Adult Patients Undergoing Orthopedic Surgery Using Supraglottic Airway Devices: A Retrospective Analysis.

Background/Objectives: Neuromuscular blocking agents (NMBAs) are not usually necessary during the induction of general anesthesia in patients using supraglottic airway (SGA) devices. In this study, we assessed the incidences of rocuronium use in adult patients undergoing general anesthesia using SGA devices. Methods: From September 2022 to August 2023, the medical records of adult patients (≥19 years) who underwent orthopedic surgery using SGA devices were retrospectively investigated. The incidences of rocuronium use during anesthetic induction were analyzed according to the anesthetic induction drug. The association of rocuronium use during anesthesia was analyzed in terms of demographic (age, sex, height, and weight), surgical (surgical time), and anesthetic factors (premedication, anesthetic agent, anesthetic time). Results: In total, 321 patients were enrolled. The incidence rate of rocuronium use during anesthetic induction was 28.3%. In the subgroup analysis, patients receiving total intravenous anesthesia (TIVA) with propofol (PPF) and remifentanil showed a markedly lower incidence (14.4%) than the other anesthetic groups. Premedication or short anesthetic duration was associated with lower incidences of rocuronium use. Demographic and other anesthetic factors did not seem to affect the incidences of rocuronium use during anesthesia. Conclusions: The incidence of rocuronium use during anesthetic induction with SGA devices was significantly lower with the PPF-TIVA compared to that using remimazolam-TIVA or inhalational anesthesia. Premedication with midazolam and shorter operation times were associated with a significantly lower incidence of rocuronium use.

The role of supraglottic airway devices for caesarean section under general anaesthesia. A scoping literature review with a proposed algorithm for the appropriate use of supraglottic airway devices for caesarean sections.

This review aims to assess the published evidence on airway management with a supraglottic airway device (SGA) for general anaesthesia in patients requiring a caesarean section. Physiological changes during pregnancy can make airway management in parturients challenging. At the same time, pregnant patients are at risk of pulmonary aspiration due to hormonal and mechanical alterations. The standard airway management for parturients undergoing caesarean section is rapid sequence induction followed by tracheal intubation. Evidence exists that using second-generation SGA devices is well tolerated and effective in selected patients. In this review, we provide an overview of the existing evidence and provide an algorithm to make an evidence-based clinical decision on the use of SGA devices. An online literature search was performed in Medline, Embase, PubMed, Emcare, Cochrane Library and CINAHL. The search terms used were 'supraglottic airway', 'supraglottic airway device', 'supraglottic airway management', 'supraglottic tube', 'i-gel', laryngeal mask', 'laryngeal mask airway', 'LMA', 'SGA', 'Proseal', 'Supreme', 'obstetric surgery', 'obstetric operation', 'general anaesthesia', 'caesarean' or 'caesarean section', 'abdominal delivery'. Full-text articles in English, Dutch and French were included. Case reports and studies in which the surgery was not a caesarean section were excluded. The initial search yielded 815 results. Following screening, deduplication and removal of publications that were unrelated to the topic or did not fit the inclusion criteria, 13 manuscripts were included in our analysis. A total of 7722 patients were described in the articles included. In the majority of manuscripts, second-generation SGA devices were used. There were seven cases of failed insertion and a need for conversion to tracheal intubation; first-generation SGA devices were used in these cases. There were no cases of pulmonary aspiration, and only one case of gastric regurgitation was described. Growing evidence suggests that the use of second-generation SGA devices might be well tolerated as the primary method for securing the airway for caesarean sections requiring general anaesthesia, in selected patients with a low risk for aspiration and difficult intubation.

The Effect of Increased Intra-Abdominal Pressure on Hemodynamics in Laparoscopic Cholecystectomy-The Experience of a Single Centre.

Laparoscopic cholecystectomy is characterized by reduced postoperative pain, shorter hospital stays, rapid return to preoperative physical activity, and less psychological impact on the patient. During laparoscopic cholecystectomy, the intra-abdominal insufflation of carbon dioxide with secondary increase in intra-abdominal pressure can cause important hemodynamic consequences, like decreased cardiac output and blood pressure, as well as compensatory increase in heart rate. The purpose of this study is to evaluate changes in cardiovascular parameters during general anesthesia in patients undergoing laparoscopic cholecystectomy. Retrospective data from 342 patients with cholecystectomy for cholelithiasis performed at Railway Hospital Galati, Romania, were reviewed. All patients received the same intraoperative anesthetics. Female patients were 85.7% (n = 293). More than half of the patients, 53.51% (n = 183), were 40-59 years old, and only 16.37% (n = 56) were under 40 years old. Patients with a normal body mass index (BMI) represented 45.6% (n = 156), 33.3% (n = 114) were underweight, and 12% (n = 42) had grade 1 obesity (BMI 25-29.9 kg/m2). The minimum intraoperative blood pressure correlated with patient gender (p 0.015 < 0.005), with men having a higher blood pressure than women (p 0.006 < 0.05), and for BMI, a higher BMI was associated with elevated blood pressure (p 0.025 < 0.05). Older age correlated with an increased maximum intraoperative blood pressure (p < 0.001 < 0.05) and with maximum intraoperative heart rate (p 0.015 < 0.05). Patients undergoing laparoscopic cholecystectomy experienced significant hemodynamic changes with pneumoperitoneum, but this type of surgical intervention was safe for patients regardless of their age.

Differences in circulating blood volume changes during emergence from general anesthesia in transcatheter aortic valve implantation and MitraClip implantation.

We aimed to compare changes in the circulating blood volume (CBV) during emergence from general anesthesia in patients undergoing transcatheter aortic valve implantation (TAVI) and MitraClip implantation. We included 97 patients who underwent TAVI or MitraClip implantation. The primary outcome was the rate of change in the estimated CBV associated with emergence from general anesthesia. The secondary outcomes were hemoglobin and hematocrit values before and after emergence from anesthesia for each procedure. Additionally, the independent factors associated with changes in the estimated CBV were assessed using multiple regression analysis. In the TAVI group, the hemoglobin concentration increased from 9.6g/dL before emergence from anesthesia to 10.8g/dL after emergence (P < 0.001; mean difference, 1.2g/dL, 95% confidence interval [CI] 1.1-1.3g/dL). Conversely, no statistically significant change was observed in the hemoglobin concentration before and after emergence from anesthesia in the MitraClip group. The mean rate of change in the estimated CBV was - 15.4% (standard deviation [SD] 6.4%) in the TAVI group and - 2.4% (SD, 4.7%) in the MitraClip group, indicating a significant decrease in the estimated CBV in the former than in the latter (P < 0.001; mean difference, 13.0%; 95% CI 9.9-16.1%). Emergence from general anesthesia increased the hemoglobin concentration and decreased the estimated CBV in patients undergoing TAVI but did not elicit significant changes in patients undergoing MitraClip implantation. These results may provide a rationale for minimizing blood transfusions during general anesthesia in patients undergoing these procedures.