General Anesthesia Research Articles

Giant Complex Odontoma Occurring Independently Within the Maxillary Sinus

Previous reports on complex odontomas in the maxillary sinus describe cases that are associated with the alveolar process and extend into the maxillary sinus. This report presents a rare case of giant complex odontoma in the maxillary sinus, arising entirely within the maxillary sinus and unassociated with the alveolar process. In this case, the lesion was surgically removed through Caldwell-Luc operation. under general anesthesia, and the bony window was closed with titanium mesh.

Anesthesia in Obese Patients and Complications

Background: Almost all ages and socioeconomic categories are affected by the complex illness known as obesity, which has major social and psychological ramifications. Global obesity rates have reached epidemic proportions and obesity plays a significant role in the burden of chronic illnesses and disabilities worldwide. The aim of the study was to assess the Anesthesia in obese patient and its Complications in a tertiary care hospital. Materials and mathods: This cross-sectional observational study was carried out in the Department of Anesthesiology, Bangabandhu Memorial Hospital (BBMH) from July 2020 to June 2022.Total sample size was 200. Adult in-patients who had undergone non-cardiac surgery and were older than 18 with a BMI greater than 30 kg/m2 met the inclusion criteria. Pregnancy, ambulatory surgery and missing or insufficient data on the desired outcomes were the exclusion criteria. Results: Mean age ±SD was 32 ± 0.9 years. About 55% of the patients were female and 45% were male. Regarding ASA classification 53.5% had 2, 45.5% had 3 and 1.0% had 4 score. Regarding coexisting disease 42.5% had hypertension, 14% had dyslipidemia, 18% had DM type-2 and 7.5% had obstructive sleep apnea. Here, type of anesthesia was 55% general anesthesia, 6% normal mask ventilation, 25% regional anesthesia, 4% total intravenous anesthesia and 10% LMA (Laryngeal Mask Airway). Regarding complication 4.5% was Reintubation, 5.5 %Pneumonia, 7.5% Upper airway obstruction, 0.5% Delay emergence respectively. 2.5% Urinary retention, 5% Oliguria, 2% Wound infection. 0.5% myocardial infarction and 0.5% Cardiac arrest occurred and no death occur inpatient respectively. Conclusion: Obesity has long been seen from a surgical standpoint as a risk factor for unfavorable post-surgical outcomes. Patients who are morbidly obese may experience respiratory adverse effects following surgery as a result of physiological disruption. The undesirable effects range depending on the surgical population. IAHS Medical Journal Vol 7(1), June 2024; 97-101

Hemodynamic assessment of intracranial atherosclerotic stenosis: comparison between invasive non-hyperemic pressure ratio and angiography-derived quantitative flow ratio

ObjectivesTo evaluate the diagnostic accuracy of the quantitative flow ratio (QFR) for hemodynamic exploration of intracranial atherosclerotic stenosis, using the invasive cerebrovascular pressure ratio (CVPR) and resting full-cycle ratio (RFR) as reference standards.Materials and methodsPatients with symptomatic unifocal intracranial atherosclerotic stenosis were included. The CVPR was defined as the ratio of the proximal and distal pressures. All patients underwent angioplasty under general anesthesia. The QFR was calculated based on digital subtraction angiography. Using the CVPR as a reference, we compared its correlation with the QFR across different degrees and locations of stenosis.ResultsThe CVPR and QFR were measured in 34 vessels of 32 patients. The QFR demonstrated a high correlation and excellent agreement(r = 0.8227, p < 0.001) with the CVPR in distal stenosis before intervention. In the subgroup with diameter stenosis >80%, the QFR showed a high correlation (r = 0.8812, p < 0.001) with the CVPR. In the anterior circulation subgroup, the QFR showed an excellent correlation (r = 0.9066, p < 0.001) with the CVPR. In the posterior circulation subgroup, the QFR showed a high correlation with the CVPR (r = 0.7706, p < 0.001). Diameter stenosis rates showed a moderate negative correlation with the CVPR.ConclusionThere was a strong correlation between the QFR and wire-based CVPR, especially for anterior circulation lesions before intervention. The QFR may serve as a predictive factor for evaluating hemodynamic changes in intracranial atherosclerotic stenosis.

OGC SO06 - Novel Non-metallic Fiducial marker for Radiotherapy in Oesophageal Cancer

Abstract Background Early oesophageal tumours are technically difficult to delineate on the planning computed tomography (pCT) for Image Guided Radiotherapy (IGRT). We describe the use of a novel non-metallic fiducial marker for this purpose. Method Non-metallic fiducial marker (NFM) (BioXmark) was used in 17 patients from April 2021 to November 2022 for marking tumour site prior to radical or palliative radiotherapy. NFM was injected in the sub-mucosal plane using fluoroscopy under general anaesthesia, with the patient supine and using regular injection catheter and syringes. After the initial series, further modifications to the technique improved the injection and shortened operative time. These include left lateral positioning, an ultra-fine injection catheters and micro-dosing syringes. Feedback from the treating radiation oncologists was sought for all the patients. Results Injection was successful in all the patients. In the initial series before the modifications to the technique, often the marker was a larger than anticipated due to a combination of poor visibility when the patients were supine and use of larger bore injection catheters. Once the patient position was changed along with the changes in the injection catheters and the syringes, marking was very precise. Conclusion Previously used fiducial markers are gold based. While these were visible on pCTs, they are known to cause distortion along with being expensive and cumbersome to inject. In comparison, NFM is easy to inject without the artefacts seen with metallic markers. We refined the technique further by changing the patient’s position to left lateral which afforded a improved fluoroscopic visibility. Introducing finer injection catheters and micro-dosing syringes further led to usage of lesser volume and precise marking respectively. In summary we present a series of patients whose early oesophageal tumours were marked with a NFM aiding precise delivery of radiotherapy.

The Impact of Systemic Inflammation on Recurrence in Patients with Congenital Nasolacrimal Duct Obstruction

Background/Objective: Congenital nasolacrimal duct obstruction (CNLDO) is commonly treated by probing, but recurrence remains a clinical issue. This study investigates the potential role of inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in predicting recurrence after probing in children with CNLDO. Methods: This retrospective cohort study included 172 patients who underwent initial probing for unilateral CNLDO. The patients were then categorized into two groups: those who experienced the complete resolution of symptoms after primary probing, and those who required Ritleng tube intubation due to recurrence following primary probing. Blood samples for calculating inflammatory biomarkers in all subjects were collected during general anesthesia preparation prior to initial probing. NLR, MLR, and PLR values were compared between the groups using the independent samples t-test. The predictive performance of the inflammatory biomarkers for recurrence was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 110 patients were included in the probing group, while 62 patients were in the recurrence group. The mean age at the time of the initial probing procedure was 15 ± 4.06 months in the probing group and 15.83 ± 4.02 months in the recurrence group. There was no difference in the duration of the probing procedure between the groups. The mean age at the time of Ritleng tube intubation in the recurrence group was 37.80 ± 13.34 months. The recurrence group exhibited significantly higher values in all analyzed inflammatory markers compared to the probing group, including the NLR (1.12 ± 0.56 vs. 0.86 ± 0.39, p = 0.002), MLR (0.16 ± 0.06 vs. 0.14 ± 0.06, p = 0.005), and PLR (95.13 ± 24.34 vs. 82.23 ± 22.77, p < 0.001). ROC curve analysis indicated that these inflammatory biomarkers demonstrated moderate performance in predicting recurrence. Conclusions: Recurrence following probing in children with CNLDO was associated with complete blood cell count-derived inflammatory biomarkers. The preoperative assessment of these biomarkers may aid in the individualization of disease management and inform the development of new therapeutic strategies.

Should we restrict food intake during labor? A randomized controlled trial.

To evaluate whether consuming food during labor influences its outcomes. This randomized controlled study included healthy, laboring patients at 37-41weeks of gestation. After epidural anesthesia, patients were randomized into groups of eating at will versus drinking clear fluids only. The primary composite outcome included unplanned cesarean delivery, the need for general anesthesia, asphyxia, postpartum fever, and prolonged postpartum admission (more than 5days). Secondary outcomes included the need for oxytocin, length of the second stage of labor, postpartum analgesia requirements, and early maternal and neonatal outcomes. Sample size analysis indicated that 126 patients needed to be randomized to detect a statistically significance difference between the groups. A total of 129 patients were randomized: 58 to the fluids-only group and 71 to the food group. The groups had similar basic characteristics. The composite outcome of complications attributed to eating during labor and delivery was comparable between groups. Labor progression and the need for oxytocin augmentation were similar in both groups. The groups had comparable fetal heart rate tracings, modes of delivery, maternal and neonatal outcomes, and complications. None of the patients in the study experienced aspiration or an indication for general anesthesia. While our data suggest that eating during labor does not adversely affect labor progression or outcomes, we recommend a cautious approach, allowing patients autonomy while considering individual risk factors. The study has been registered in the primary clinical trial registry on 02/12/2023. ISRCTN trial number ISRCTN11794106, registration number 44513. https://www.isrctn.com/ISRCTN11794106 .

Effects of clowning on anxiety, stress, pain, and hormonal markers in paediatric patients.

Clowning has been used in many hospitals, particularly for children. Studies suggest the effectiveness of this methodology, but more evidence is needed. The aim of this study was to evaluate the impact of a humour therapy intervention on biological markers, pain and anxiety levels in paediatric patients. Three different clinical contexts were chosen to assess the effect of clowning interventions: patients who were subjected to venepuncture (group 1), patients undergoing general anesthesia for any cause (group 2)and patients hospitalized in the pediatric ward without distinction of their disease (group 3). Groups 1 and 2 were divided into control (C) and intervention (I) subgroups. A saliva sample was taken from all the children to measure oxytocin and cortisol levels by ELISAs. Validated scales and crying time were used to determine pain, stress, and anxiety levels. Children in group 3 were assessed before and after the intervention, employing the same methods. A total of 272 patients were included. The children in group 1 (n = 125) were 7.7 ± 3.2 years old, and 53.6% were females. 48% were in the I group, which showed decreased cortisol levels and increased oxytocin levels. The I group exhibited a decrease in perceived pain and crying time. The children in group 2 (n = 69) were aged 7.1 ± 3.5 years, and 36% were females. 51% were in the I group, which showed increased oxytocin levels and decreased cortisol levels, acute stress levels, perceived pain, and crying time. The children in group 3 (n = 78) were 8.6 ± 3.3 years old, and 54% of the children were females. There was an increase in oxytocin levels and a decrease in cortisol levels, stress levels and perceived pain following the intervention. This study suggested that an intervention based on clowning is an effective strategy for decreasing pain, stress, and anxiety levels in paediatric patients in different clinical contexts. These findings support the implementation of humour therapy programs in paediatric units.

Comparison of iRoot BP Plus and mineral trioxide aggregate for pulpotomy in primary molars under general anesthesia: a 3-year retrospective study

Background Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years. Aim This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate. Methods In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn & Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes. Results PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P = 0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P = 0.006). Conclusion Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars.

Effects of GlideScope, Pentax Airway Scope, and Macintosh Blade on the incidence of postoperative sore throat: a cohort study of 9,881 patients.

Postoperative sore throat (POST) is a common complaint after general anesthesia. POST is defined by the presence of a self-reported foreign body sensation or a painful sensation in the throat after general anesthesia. This condition may affect recovery and patient satisfaction and is associated with many factors, including intubation tools. Previous studies have reported conflicting results on POST. This retrospective cohort study, with sample size of 9,881 patients, was conducted to confirm the hypothesis that the use of video laryngoscopy (VL) is associated with a lower incidence of POST compared with direct laryngoscopy (DL). Data were extracted from a prospectively maintained quality improvement database. A total of 9,881 patients were included in the study. Statistical analysis was conducted for comparisons of demographic characteristics and to determine the effect of intubation tools on the incidence of POST. The patients had similar baseline demographic characteristics. Compared with DL, VL was associated with a lower incidence of POST (12.98% vs. 17.49%, P < 0.001). In addition, the use of Pentax Airway Scope (AWS) was associated with a lower incidence of POST compared with the use of GlideScope (GVL, 8.14% vs. 16.25%, P < 0.001). To better adjust for possible confounding factors, mixed-effects generalized linear model analysis revealed that older age (odds ratio [OR]: 0.995, 95% confidence interval [CI]: 0.992-0.999, P = 0.006), AWS compared to DL (OR: 0.416, 95% CI: 0.350-0.494, P < 0.001), and male sex (OR: 0.836, 95% CI: 0.747-0.935, P = 0.002) are associated with reduced incidence of POST. Compared with DL, VL is associated with a lower incidence of POST. In addition, the use of AWS is associated with a lower incidence of POST compared with the use of GVL. Retrospectively registered, NCT06515808, date of registration: 23/07/2024.

The Effects of Intra-Operative Lidocaine Infusion on Post Operative Pain and Morphine Consumption Following Major Gynaecological Surgeries Under General Anaesthesia

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Major gynaecological surgeries are associated with considerable postoperative pain, which remains a challenge for many practitioners. Multimodal forms of analgesia significantly reduce the requirement of opioids for pain management. Despite its local anaesthetic effects, lidocaine infusion improves postoperative pain and morphine consumption following gynaecological surgeries. &amp;lt;i&amp;gt;Materials and methods&amp;lt;/i&amp;gt;: Sixty patients were assigned randomly into 2 groups (A and B) with 30 patients per group. Group A received intravenous lidocaine 1.5 mg/kg at induction via a bolus injection and 1.5 mg/kg/hr in normal saline infusion from onset of surgery to the end of surgery, while the control group (Group B) received equal volume of normal saline at the same timelines. Pain scores were assessed postoperatively using the numerical rating scale and the cumulative morphine consumed postoperatively were also measured. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The mean pain scores were significantly higher in the Saline Group than in the Lidocaine group. The cumulative morphine consumption after 48 hours was significantly reduced in the study group 4.87 ± 1.80 mg vs 14.13 ± 4.10 mg (P&amp;lt;0.0001). Conclusion: The administration of a bolus dose (1.5 mg/kg) of intravenous lidocaine at induction and a continuous intravenous infusion of 1.5 mg/kg/hr from onset of surgery till skin closure reduced the postoperative pain intensity and morphine consumption in patients undergoing major gynaecological surgeries under general anaesthesia.

Knowledge, fear and acceptance rate of spinal anesthesia among pregnant women scheduled for cesarean section: a cross-sectional study from a tertiary care hospital in Karachi.

Worldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital. This cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis. A total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36-37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%). The present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia. Not applicable.

Unusual Foreign Body in the Middle Ear: Surgical Removal of a Live Ant Entering the Tympanic Cavity Through an Ear Drum Perforation

This case report details the unusual occurrence of a live ant invading the middle ear cavity through a pre-existing perforation in the tympanic membrane of a 42-year-old female patient. She presented to an outpatient clinic with symptoms of sudden-onset tinnitus (“ringing”) and a foreign body sensation in her left ear. Otomicroscopy revealed an oval-shaped perforation in the posterior part of the left tympanic membrane, through which a dark, moving foreign object was observed in the middle ear. The object was identified as a live ant. Initial attempts to remove the insect under local anesthesia were unsuccessful, necessitating the patient’s admission for surgery. Under general anesthesia, an endoscopic tympanotomy was performed, and the ant was successfully removed without complications. The patient recovered and was discharged the following day. At her follow-up appointment, she remained symptom-free. This case highlights the rare yet possible occurrence of live foreign bodies entering the middle ear through tympanic perforations and the need for timely surgical intervention to prevent complications.

Abstract 4144517: Feasibility of Deep Sedation for Catheter Ablation of Atrial Fibrillation Using Pulsed Field Ablation

Introduction: General anesthesia is commonly utilized during catheter ablation of atrial fibrillation (AF) in the United States, providing patient immobility and permitting esophageal temperature management for radiofrequency ablation. Pulsed field ablation (PFA) is associated with shorter procedure time, less risk of esophageal injury, and less dependence on catheter stability compared with radiofrequency ablation. There are limited data available on performing the procedure with deep sedation as an alternative to general anesthesia with endotracheal intubation. Methods: Consecutive patients who underwent catheter ablation of AF at Endeavor Health (Chicago, IL) using pulsed field ablation (Farapulse, Boston Scientific, Marlborough, MA or PulseSelect, Medtronic, Minneapolis, MN) and deep sedation between March and May 2024 were retrospectively included in this study. Deep sedation (monitored anesthesia care) was administered by a certified registered nurse anesthetist and attending anesthesiologist, consisting of bolus and infusion dosing of propofol, dexmedetomidine, fentanyl, and midazolam at the discretion of the practitioner with continuous monitoring of vital signs and end-tidal CO2. The primary endpoint was the rate of airway complications or requirement for conversion to general anesthesia. Secondary endpoints were the rate of acute procedural success (all pulmonary veins isolated), total time in the EP lab, procedure time (from lidocaine to removal of sheaths), and non-procedure time (difference between total time in lab and procedure time). Results: A total of 40 patients (mean age 70.4 ± 13.6 years, BMI 30.2 ± 7.4, 60% females) were included in the analysis. There were no instances of airway complications or conversion from deep sedation to general anesthesia. There was a 100% rate of acute isolation of pulmonary veins. The average total time in the lab was 156.6 ± 41.5 minutes; consisting of a mean procedure time of 107.1 ± 39.7 minutes and non-procedure time 49.5 ± 10.3 minutes. Conclusions: In this initial experience at a single center, deep sedation (monitored anesthesia care) for PFA was associated with no instances of airway complications. The findings may not apply to patients with moderate or severe obstructive sleep apnea or other pulmonary diseases. Although patients generally were amnestic to the procedure, larger studies incorporating patient-reported outcomes are needed, as well as data regarding long-term clinical outcomes and cost.

Abstract 4115399: Comparative Outcomes of Local-Regional Versus General Anesthesia in Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Background: Endovascular Aortic Aneurysm Repair (EVAR) has emerged as a less invasive approach to aneurysm repair. However, the optimal anesthesia modality for elective cases—general or local-regional—remains uncertain. This meta-analysis compares the outcomes of local-regional versus general anesthesia (GA) for abdominal EVAR. Methods: We searched MEDLINE, Embase, and Cochrane databases for studies comparing local-regional and general anesthesia for EVAR up to May 2024. Following the PRISMA protocol, 1,796 articles were screened. Endpoints included 30-day mortality, type I endoleaks, length of hospital stay (LHS), and Intensive Care Unit (ICU) admissions. A random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was used for binary endpoints and mean difference (MD) for continuous endpoints. Heterogeneity was assessed using Q and I2 statistics. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence. Results: Sixteen cohort studies, encompassing 70,654 patients treated with EVAR after excluding overlapping populations, were included. All groups had similar demographics, American Society of Anesthesiologists physical status, and aneurysm type. The mean age was 73.6 years, and 88.1% were male. Local-regional anesthesia was associated with significantly lower 30-day all-cause mortality (OR 0.74; 95% CI 0.55 to 0.99; p=0.049; I2=0, Figure A), shorter LHS (MD -0.72 days; 95% CI -1.29 to -0.15; p=0.01; I2=87%), and less ICU admissions (OR 0.53; 95% CI 0.31 to 0.93; p=0.027; I2=98%). There was no increase in endoleaks in the local-regional group (OR 0.78; 95% CI 0.55 to 1.09; p=0.143; I2=29%, Figure B). The GRADE rated this evidence as moderate certainty and high importance. Conclusion: Local-regional anesthesia may be preferable to general anesthesia for EVAR, as it reduces 30-day mortality, ICU admissions, and hospital stay length without increasing the risk of type I endoleaks.

The efficacy and safety of ciprofol versus propofol in patients undergoing painless hysteroscopy: a randomized, double-blind, controlled trial.

Studies have reported that ciprofol has the advantage of reducing injection pain compared to propofol during gastroscopy, colonoscopy, and fiberoptic bronchoscopy. The effect of ciprofol on the injection pain in painless hysteroscopy needs to further explore. A double-blind randomized controlled trial (RCT) was designed, and patients were recruited from the First Central Hospital of Baoding from March 2024 to June 2024. The eligible participants were allocated into ciprofol group (ciprofol combined with alfentanil) and propofol group (propofol combined with alfentanil) at 1:1 ratio. The primary outcome was injection pain. The secondary outcomes included sedation success rate, anesthesia success rate, adverse events, patient satisfaction, and comparison of vital signs before and after administration. A total of 217 participants were included for analysis, with 109 participants in the ciprofol group and 108 participants in the propofol group. The injection pain rate of ciprofol group (18.35%) was significantly lower than the propofol group (40.74%). Both the ciprofol group and propofol group had 100% of the sedation success rate. The anesthesia success rate between the two groups was comparable (P > 0.05). The rate of adverse events was lower (27.52% vs. 45.37%) and patient satisfaction was higher (9.84 ± 0.45 vs. 9.65 ± 0.85) in the ciprofol group than the propofol group. In addition, values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in propofol group were significantly lower than those in ciprofol group at the time of cervical dilation and consciousness recovery. Ciprofol exhibits comparable efficacy to that of propofol, and is associated with less injection pain rate, fewer adverse events, higher patient satisfaction, and more stable hemodynamics when used for general anesthesia during the painless hysteroscopy. NCT06413862.

Abstract 4148095: The Impact of Body-Mass Index on Ventricular Tachycardia Outcomes Post-Catheter Ablation

Background: In recent years, catheter ablation has emerged as a sustainable, first-line therapy for the management of ventricular tachycardia (VT). Given the rise of the “obesity paradox” theory in atrial ablation outcomes, we sought to study the effect of BMI on patients undergoing structural VT ablation. Purpose: To assess the outcomes of VT ablation, specifically VT recurrence, in patients with elevated vs. normal BMI. Methods: Clinical characteristics and demographic data were collected for VT patients who underwent ablation at Mayo Clinic Rochester from 2012-2022. Patient BMI was classified as non-obese (&lt;30 kg/m2), obese (30-40 kg/m2), and morbidly obese (≥40 kg/m2). The endpoint was a composite of initial monomorphic VT recurrence and repeat ablation after adjusting for age, sex, and comorbidities. Results: A total of 399 patients underwent 508 ablations. 51.4% of ablations had a BMI &lt;30, 39.2% were between 30-40, and 9.4% were ≥40. There was a greater prevalence of hypertension and type 2 diabetes mellitus in morbidly obese patients (p &lt;0.01). Morbidly obese individuals also had a significantly increased rate of general anesthesia during ablation and long VT cycle lengths. The Kaplan-Meier curve demonstrates no statistically significant differences in time to VT recurrence among the three BMI groups (p = 0.324). Neither morbid-obesity (aHR= 1.20; CI = 0.94-1.56, p = 0.14) nor nonmorbid-obesity (aHR = 0.92; CI = 0.76-1.10, p = 0.4), compared to non-obesity was a significant independent predictor of VT recurrence or repeat ablation on multivariate regression after adjusting for age, sex and comorbidities. Conclusion: There was no significant association between BMI groups and VT recurrence or repeat ablation, and no difference in complications. We did not find the obesity paradox to be relevant for VT ablation in our patient population. Further study would be needed with larger samples to corroborate these findings.

Safe Anesthesia Practices for Minimally Invasive, Image-guided Procedures: CT, MRI, and Ultrasound

Background: The demand for minimally invasive, image-guided procedures, such as CT, MRI, and ultrasound, is increasing. Understanding the role of anesthesia in enhancing patient safety, comfort, and procedural success is essential. Methods: This study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, over two years, involving 150 patients. Anesthesia techniques were categorized as general anesthesia, sedation, and local anesthesia. Patient outcomes, complications, and satisfaction scores were recorded and analyzed. Results: In this study, general anesthesia was administered to 65 patients (43.3% of cases), sedation was used for 56 patients (37.3%), and local anesthesia was applied to 29 patients (19.3%). The overall procedural success rate was high, at 141 successful completions (94%), with minor complications occurring in 7 patients (4.7%) and major complications in 2 patients (1.3%). Patient satisfaction scores indicated that 96 participants (64%) reported being very satisfied with their anesthesia experience, while 45 patients (30%) indicated they were satisfied. These findings highlight the effectiveness and safety of the selected anesthesia practices in minimally invasive, image-guided procedures, demonstrating a strong correlation between appropriate anesthesia techniques and positive patient outcomes. The data underscore the importance of tailored anesthesia protocols to enhance procedural success and patient satisfaction in this clinical setting. Conclusion: The study demonstrates that tailored anesthesia practices can achieve high success rates and patient satisfaction in minimally invasive, image-guided procedures. Despite the low incidence of complications, ongoing research is needed to refine anesthesia protocols and explore advanced, image-guided techniques to further enhance patient safety and comfort.

Study of penehyclidine for the prevention of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy under general anesthesia: a randomized, prospective, double-blind trial.

To investigate the efficacy of penehyclidine (PHC) for preventing postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) under general anesthesia. In this prospective study, 219 patients who were scheduled to undergo LSG were randomly assigned to three cohorts: the control cohort (received normal saline), the infusion cohort (administered 0.25mg of PHC intravenously followed by an additional 0.25mg through an intravenous analgesia pump for 48h after LSG), and the bolus cohort (received a single intravenous dose of 0.5mg of PHC). The study outcomes included the incidence of PONV within the first 48h postoperatively, the severity and intensity of PONV, side effects and postoperative recovery outcomes. Univariate and multivariate logistic analyses were performed to identify independent risk factors associated with PONV. Compared with the control cohort, both the infusion and bolus cohorts presented considerably lower incidences of PONV (61.64% vs. 12.33% vs. 38.36%, P < 0.05), as well as significantly decreased PONV severities (P < 0.05) and intensities (P < 0.05). There were no significant differences in side effects and postoperative recovery outcomes among the three cohorts, with the exception of dry mouthand the administration of rescue antiemetic therapy (P < 0.05). Additionally, the Apfel risk score and PHC intervention were identified as independent risk factors associated with PONV incidence following LSG (P < 0.05). PHC effectively prevented PONV occurrence and reduced its severity in LSG patients without decreasing postoperative recovery outcomes, particularly in the infusion cohort.

Hypothalamic corticotropin-releasing hormone neurons modulate sevoflurane anesthesia and the post-anesthesia stress responses

General anesthesia (GA) is an indispensable procedure necessary for safely and compassionately administering a significant number of surgical procedures and invasive diagnostic tests. However, the undesired stress response associated with GA causes delayed recovery and even increased morbidity in the clinic. Here, a core hypothalamic ensemble, corticotropin-releasing hormone neurons in the paraventricular nucleus of the hypothalamus (PVHCRH neurons), is discovered to play a role in regulating sevoflurane GA. Chemogenetic activation of these neurons delay the induction of and accelerated emergence from sevoflurane GA, whereas chemogenetic inhibition of PVHCRH neurons accelerates induction and delays awakening. Moreover, optogenetic stimulation of PVHCRH neurons induce rapid cortical activation during both the steady and deep sevoflurane GA state with burst-suppression oscillations. Interestingly, chemogenetic inhibition of PVHCRH neurons relieve the sevoflurane GA-elicited stress response (e.g., excessive self-grooming and elevated corticosterone level). These findings identify PVHCRH neurons modulate states of anesthesia in sevoflurane GA, being a part of anesthesia regulatory network of sevoflurane.

Hypothalamic corticotropin-releasing hormone neurons modulate sevoflurane anesthesia and the post-anesthesia stress responses.

General anesthesia (GA) is an indispensable procedure necessary for safely and compassionately administering a significant number of surgical procedures and invasive diagnostic tests. However, the undesired stress response associated with GA causes delayed recovery and even increased morbidity in the clinic. Here, a core hypothalamic ensemble, corticotropin-releasing hormone neurons in the paraventricular nucleus of the hypothalamus (PVHCRH neurons), is discovered to play a role in regulating sevoflurane GA. Chemogenetic activation of these neurons delay the induction of and accelerated emergence from sevoflurane GA, whereas chemogenetic inhibition of PVHCRH neurons accelerates induction and delays awakening. Moreover, optogenetic stimulation of PVHCRH neurons induce rapid cortical activation during both the steady and deep sevoflurane GA state with burst-suppression oscillations. Interestingly, chemogenetic inhibition of PVHCRH neurons relieve the sevoflurane GA-elicited stress response (e.g., excessive self-grooming and elevated corticosterone level). These findings identify PVHCRH neurons modulate states of anesthesia in sevoflurane GA, being a part of anesthesia regulatory network of sevoflurane.