General Anesthesia Research Articles

Comparative analysis of LMA Blockbuster® clinical performance: Blind versus Miller laryngoscope-guided insertion in paediatric general anaesthesia - A double-blinded, randomised controlled trial.

The second-generation supraglottic airway device is conventionally inserted blindly, which might result in suboptimal placement. Limited literature exists on under-vision insertion techniques, particularly in paediatric patients. The primary objective of this study was to compare the oropharyngeal leak pressure (OPLP) between the blind insertion of the LMA Blockbuster® and the Miller laryngoscope-guided insertion in children. Secondary outcomes included the number of insertion attempts, haemodynamic disturbances, insertion time and airway complications. This randomised controlled trial study enroled 100 patients aged 1-4 years undergoing elective surgery. Patients were randomised into blind insertion (Group A) or Miller laryngoscope-guided insertion (Group B) of the LMA Blockbuster®. The primary outcome measure was OPLP. Insertion time, haemodynamic changes and postoperative complications were also assessed. The Chi-square, Fisher's exact and t-test were applied appropriately, with the significance level set at P < 0.05. Significantly higher mean OPLP was observed in Group B compared to Group A - 27.9 [standard deviation (SD): 1.58] cmH2O versus 25.94 (SD: 0.63) cmH2O [mean difference (MD): 1.96 (95% confidence interval {CI}: 1.48, 2.44; P < 0.001)]. Mean insertion time was longer in Group B, that is, 11.9 (SD: 1.91) s versus 8.7 (SD: 0.6) s [MD: 3.2 s; (95% CI: 2.63, 3.76; P < 0.001)]; however, the difference was not clinically relevant. First-attempt insertion, haemodynamic stability and postoperative complications were comparable (P > 0.05). Miller laryngoscope-guided under-vision insertion of LMA Blockbuster® improves alignment with epiglottic structures compared to blind insertion.

Using Google Trends to general anesthesia in pediatric dentistry

Using Google Trends to general anesthesia in pediatric dentistry

The efficacy of loco-regional ropivacaine analgesia via intercostal catheters after lung resection: a randomized, double-blind, placebo-controlled, superiority study.

Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6-8 ml/h for 72 h after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in numerical rating scale associated with pain reduction of 1.5 points. Fourteen patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the 2 groups. The mean numerical rating scale when coughing during the first 24 h postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements. NCT04939545.

Ultrasound-Guided Erector Spinae Plane Block in Elderly Patients Undergoing Total Hip Arthroplasty (THA): A Triple-blind, Randomized, Controlled Trial

BACKGROUNDTotal hip arthroplasty (THA) induces postoperative pain in elderly individuals. The erector spinae plane block (ESPB) is a novel analgesic approach for postoperative pain control. This randomized controlled trial evaluated the effectiveness of ultrasound-guided ESPB with ropivacaine in reducing pain in elderly patients undergoing THA METHODSPatients aged 60 to 80 years who had an American society of Aneshesiologists (ASA) physical status I to III were eligible for this study. There were 50 patients who were randomized into two groups: the ESPB group receiving ultrasound-guided ESPB with ropivacaine, and the control group receiving ESPB with normal saline. All patients underwent general anesthesia, and the mean arterial pressure (MAP), heart rate (HR), intraoperative opioid consumption, numerical rating scale (NRS) scores, and postoperative adverse reactions were recorded throughout the perioperative period. RESULTSA significant reduction in NRS scores was observed in the ESPB group compared to the control group at various time points, including in the recovery room and at 12 and 24 hours postoperatively (P < 0.05). When the observation period was extended to 48 hours, no significant difference in NRS scores was noted between the two groups (P > 0.05). No significant differences in MAP and HR were found between the two groups, but the ESPB group showed lower coefficients of variation (CV) for both MAP and HR. Moreover, the ESPB group demonstrated a significantly lower total remifentanil consumption than the control group. There was no significant difference in complications between these two groups (P < 0.05). CONCLUSIONSUltrasound-guided ESPB enhances the perioperative stability of mean arterial pressure and heart rate, providing effective analgesia within the initial 24 hours post-surgery, thereby reducing opioid requirements and improving overall postoperative recovery quality for elderly THA patients.

A systematic review of procedural treatments for burn scars in children: Evaluating efficacy, safety, standard protocols, average sessions and tolerability based on clinical studies.

Managing burn scars in children presents significant challenges. This study investigates effective treatment methods for burn scars, focusing on efficacy, safety, standard protocols and tolerability. Major databases such as PubMed, Scopus and Web of Science were thoroughly searched up to August 2024, emphasizing procedural treatments for burn scars in children. Key data collected included participant demographics, sample sizes, intervention methods, follow-up protocols, treatment effectiveness and reported adverse events. A total of 256 children were assessed, with all procedural treatments yielding satisfactory outcomes. Among the various methods, trapeze-flap plasty and percutaneous collagen induction showed improvements in all patients. In the laser treatment group, which included 161 children, the Vancouver Scar Scale (VSS) score reduction ranged from 55.55% to 76.31%, with outcomes rated as good (24.61%) to excellent (60%). Laser treatment using local anaesthesia proved to be well tolerated by children. Our findings indicate that various methods-including trapeze-flap plasty, percutaneous collagen induction, phototherapy and fractional CO2 laser-demonstrate a relatively good response and an acceptable safety profile. Notably, light-based therapies/lasers may serve as safe, effective and tolerable options for scar treatment in this age group, often eliminating the need for general anaesthesia.

Impact of general anesthesia type on chronic postsurgical pain following video-assisted thoracoscopic surgery for lung cancer: a retrospective propensity-matched cohort study.

Anesthetic agents are potential modifiable factors that can mitigate chronic postsurgical pain (CPSP) development. This study aimed to investigate the association between propofol-based total intravenous anesthesia (TIVA) and the occurrence of CPSP following video-assisted thoracoscopic surgery (VATS) for lung cancer resection. This single-center retrospective cohort study included adult patients with lung cancer who underwent elective VATS between January 2018 and December 2022. Patients were divided based on the maintenance anesthetic used (propofol vs. sevoflurane). The primary outcome was the presence of CPSP, defined as any level of surgical site pain recorded within 3-6 months postoperatively. The authors investigated the association between anesthetic agents and CPSP using propensity score matching with stabilized inverse probability of treatment weighting (sIPTW) to adjust for confounders. Additionally, multivariable logistic regression was used to further adjust for intraoperative opioid use that sIPTW could not account for. The robustness of these associations was evaluated using the E-value. Of the 833 patients analyzed, 461 received propofol and 372 sevoflurane. The overall incidence of CPSP was 43.3%. After sIPTW, the use of TIVA was significantly associated with a lower incidence of CPSP (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.57-0.99, P = 0.041), and remained significant after adjusting for intraoperative remifentanil equivalent dose (OR: 0.73, 95% CI: 0.55-0.96, P = 0.026). The E-values were 1.08 and 1.17, respectively. Propofol-based TIVA is associated with reduced CPSP occurrence in VATS for lung cancer. Further prospective studies are needed to confirm the results.

Is there a difference in outcome of TJA when regional versus general anesthesia are used?

Is there a difference in outcome of TJA when regional versus general anesthesia are used?

A comparative randomized study on effect of bispectral index versus end-tidal anesthetic gas concentration-guided protocol on time to tracheal extubation for isoflurane based general anesthesia

A comparative randomized study on effect of bispectral index versus end-tidal anesthetic gas concentration-guided protocol on time to tracheal extubation for isoflurane based general anesthesia

TCT-241 Elective General Anesthesia for Patients Undergoing Complex and High-Risk Intervention in Indicated Patients (CHIP) Percutaneous Coronary Interventions

TCT-241 Elective General Anesthesia for Patients Undergoing Complex and High-Risk Intervention in Indicated Patients (CHIP) Percutaneous Coronary Interventions

Comparison of surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescent.

This study aimed to compare the surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescents, radiographically and clinically. This study included consecutive 67 children and adolescents who underwent open reduction and internal fixation using metal or bioabsorbable screws for the distal tibia physeal fracture. All patients underwent preoperative radiographs, three-dimensional computed tomography scans, and postoperative follow-up teleradiogram. Patients were divided into metal (N = 40) and bioabsorbable groups (N = 27). We compared the surgical outcomes between the two groups in terms of clinical and radiographic outcomes, length of hospital stays, and medical cost. Follow-up duration were significantly longer in the metal group than that in the bioabsorbable group. There was no significant difference in the incidence of growth arrest after surgery and the scores of the Oxford Ankle and Foot Questionnaire between the two groups. However, the total hospital stay was significantly longer in the metal group (5.2 ± 4.8 days) compared to the bioabsorbable group (2.6 ± 0.5 days). Medical costs were significantly higher in the bioabsorbable group than in the metal group with a difference of 397 US dollars. The use of bioabsorbable screws exhibited therapeutic effects equivalent to that of metal screws for pediatric distal tibia physeal fractures regarding clinical and radiological outcomes. Moreover, it had the advantage of avoiding the need for repeated general anesthesia and secondary operation for implant removal. Therefore, the use of bioabsorbable screws may be a favourable surgical option for treating pediatric fractures.

Trends in volatile anesthetic sevoflurane and desflurane usage and its impact on carbon emissions: A six-year audit at National Taiwan University Hospital (2018–2023)

This short communication presents an audit of anesthetic gas usage at National Taiwan University Hospital from 2018 to 2023. Using descriptive statistics and trend analysis, the data reveals trends in the consumption of sevoflurane and desflurane, associated costs, and their corresponding carbon emissions. A significant decrease in desflurane usage contributed to a 42.4% reduction in carbon dioxide equivalent (CO2e) emissions per general anesthesia case from 2018 to 2023. The findings underscore the importance of sustainable practices in anesthesia to align with global efforts to reduce carbon emissions.

Cardiac index as a surrogate marker for anxiety in pediatric patients undergoing ambulatory endoscopy: a prospective cohort study

Objective.Pediatric patients undergoing medical procedures often grapple with preoperative anxiety, which can impact postoperative outcomes. While healthcare providers subjectively assess anxiety, objective quantification tools remain limited. This study aimed to evaluate two objective measures-cardiac index (CI) and heart rate (HR) in comparison with validated subjective assessments, the modified Yale Preoperative Anxiety Scale (mYPAS) and the numeric rating scale (NRS).Approach.In this prospective, observational cohort study, children ages 5-17 undergoing ambulatory endoscopy under general anesthesia underwent simultaneous measurement of objective and subjective measures at various time points: baseline, intravenous placement, two-minutes post-IV placement, when departing the preoperative bay, and one-minute prior to anesthesia induction.Main Results.Of the 86 enrolled patients, 77 had analyzable CI data and were included in the analysis. The median age was 15 years (interquartile range 13, 16), 55% were female, and most were American Society of Anesthesiologists (ASA) Physical Status 2 (64%), and had previous endoscopies (53%). HR and CI correlated overall (r= 0.65, 95% CI: 0.62, 0.69;p< 0.001), as did NRS and mYPAS (r= 0.39, 95% CI: 0.34, 0.44;p< 0.001). The correlation between HR and CI was stronger with NRS (r= 0.24, 95% CI: 0.19, 0.29;p< 0.001; andr= 0.13, 95% CI: 0.07, 0.19;p< 0.001, respectively) than with mYPAS (r= 0.06, 95% CI: 0.00, 0.11;p= 0.046; andr= 0.08, 95% CI: 0.02, 0.14;p= 0.006, respectively). The correlation with mYPAS for both HR and CI varied significantly in both direction and magnitude across the different time points.Significance.A modest yet discernable correlation exists between objective measures (HR and CI) and established subjective anxiety assessments.

Multicenter analysis of the efficacy of early cholecystectomy and preoperative cholecystostomy for severe acute cholecystitis: a retrospective study of data from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology

BackgroundSevere acute cholecystitis (AC) is a challenging disease because it comprises coexisting systemic infections that lead to vital organ dysfunction. This study evaluated the optimal surgical timing and efficacy of preoperative percutaneous cholecystostomy (PC) for patients with severe AC.MethodsData of 142 patients who underwent cholecystectomy for severe AC between 2011 and 2021 were retrospectively collected from the multi-institutional database of the Hiroshima Surgical Study Group of Clinical Oncology. Patients were divided into the early cholecystectomy (EC) group (within 72 h of symptom onset) and delayed cholecystectomy (DC) group. They were also subdivided into the upfront cholecystectomy group and preoperative PC before cholecystectomy group. The diagnosis and severity of AC were graded according to the Tokyo Guidelines 2018. Clinicopathological variables and outcomes were compared.ResultsNo significant differences in age, body mass index, American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index between the EC and DC groups were observed. Preoperative drainage was more commonly performed for the DC group than for the EC group. Local severe AC features were more commonly detected in the DC group than in the EC group. The postoperative outcomes of the EC and DC groups were comparable. Compared to the PC before cholecystectomy group, the upfront cholecystectomy group included more patients with ASA physical status ≥ 3 and more patients who used oral warfarin. Warfarin usage and cardiovascular dysfunction rates of the PC after cholecystectomy group were higher than those of the upfront cholecystectomy group. PC was associated with significantly less intraoperative bleeding and shorter hospital stays.ConclusionsPatients who can tolerate general anesthesia are good candidates for EC. Patients who use warfarin and those with cardiovascular dysfunction are considered to be at high risk for postoperative complications; therefore, to prevent AC recurrence during the waiting period, PC before cholecystectomy during the same admission is more appropriate than upfront cholecystectomy for these patients.

The Relationship Between Age and The Incidence of Post Dural Puncture Headache in Post Sectio Caesarea Patients with Spinal Anesthesia

Background: Caesarean Section (CS) is a surgical procedure involving incisions in the abdominal wall and uterus. Spinal anesthesia is the preferred method due to the lower maternal morbidity and mortality risks compared to general anesthesia. However, the most common complication associated with spinal anesthesia is Post Dural Puncture Headache (PDPH), caused by a dural puncture. Age is a significant factor influencing PDPH occurrence. Patients aged 20-40 are at a higher risk, while those over 50 years have a reduced risk due to the decrease in cranial elasticity and pain sensitivity with age. Purpose: This study aims to assess the correlation between age and the incidence of PDPH following spinal anesthesia in CS patients. Methods: This study employed a cross-sectional analytic correlation design. The sample included all CS patients who received spinal anesthesia and met the study criteria, totaling 35 respondents. Data were analyzed using univariate and bivariate analysis, with the correlation significance tested at 0.05 (2-tailed). Findings: The study revealed that 14.3% of respondents experienced PDPH, while 85.7% did not. A significant correlation was found between age and PDPH incidence, with a p-value of 0.05. The highest incidence of PDPH was observed in the 20-40 age group, decreasing notably in individuals aged 50 and above. Conclusion: This study highlights that PDPH risk is highest in patients aged 20-40 and significantly decreases in patients older than 50. Age-related changes in cranial structure and pain sensitivity likely contribute to this decreased risk.

A Retrospective Evaluation of Patients Who Had Den¬tal Treatments Under General Anesthesia

Aim: This retrospective study aimed to evaluate the demographic and operational data of uncooperative healthy individuals and individuals with special needs who underwent dental treatments under sedation and general anesthesia. Methods: Data of 458 patients with special needs and 77 healthy noncooperative patients who were examined at XXX University Faculty of Dentistry between January 2022 and May 2023 and underwent dental treatments under general anesthesia were examined retrospectively. Demographic data of the patients, American Society of Anesthesiologists (ASA) scores, mallampati (MP) scores, disability status, if they have systemic diseases, type of anesthesia (sedation/general anesthesia), anesthetic agents and analgesia used, operation duration and dental treatments, were evaluated. Results: The average age of 535 patients who received dental treatment was 13.5±9.9 years and 58.1% (n=311) of the patients were male and 41.9% (n=224) were female. According to ASA scores, the distribution was 15.7% ASA I, 77.6% ASA II, and 6.7% ASA III. While 14.4% of the patients were systemically healthy, 16.7% had epilepsy, 12.9% had cerebral palsy, 12.1% had mental retardation, and 7.1% had Down syndrome. Of 7.1% had various comorbidities such as cardiological problems. Sedation was applied to 7.3% (n=39) of the patients, and general anesthesia was applied to 92.7% (n=496). The average anesthesia duration was 74.5±34.6 minutes. While the average restorative treatment applied to the patients was calculated as 6.45±3.9, tooth extraction 5.25±4.3, fissure sealant 2.44±2.5, pulp treatment 1.62±0.9; Trauma splint was applied to 3 patients. Conclusions: While pre-anesthesia evaluation is very important in determining the risks in dental general anesthesia and sedation applications, the operating conditions and the general and oral health of the patients are effective in the dental treatment decision.

Adverse events during general anesthesia at the university hospital center (CHU) “Hôpital du Mali”

Objective: To evaluate the incidence of adverse events during general anesthesia and to describe their progression. Methodology: Cross sectional study with retrospective collection over 6 months at the Mali Hospital University Hospital. It included all patients who underwent elective or urgent surgeries under general anesthesia (GA) with tracheal intubation. Vital parameters and details of incidents and accidents were collected and analyzed. Results: During the study period, 723 anesthesia procedures were performed, of which 339 were GA, a prevalence of 46.9%. Among these patients, 149 (43.9%) experienced at least one AE. The mean age was 28 ± 19.9 years old [3 days old; 85 years old], with a sex ratio ~1. AEs occurred during elective anesthesia in 68.4%. The primary surgical specialties were thoracic/cardiovascular surgery (40.4%) and neurosurgery (37.8%). Patients were classified as American Society of Anesthesiologists-2 (ASA 2) in 49.5%. Pharmacological premedication was administered in 84.7%. The intravenous hypnotics used included propofol (85.5%), thiopental (8%), and ketamine (6.5%). Inhalation agents used were isoflurane (99.4%) and halothane (0.6%). Vecuronium (95.5%) was the most commonly used muscle relaxant, while suxamethonium (4.5%) was used for intubation. AEs predominantly occurred during induction and maintenance of anesthesia, with hypotension (84.6%), desaturation, hypertension, and cardiac arrest being the most common. Delayed awakening was observed in 5.6%, including one instance of unrecovered cardiac arrest (0.6%). The overall mortality rate due to AEs was 0.6%. Conclusion: Adverse events are common during GA, particularly during induction and entretien phases, and are associated with a mortality rate of 0.6%. Keywords: Adverse events, GA, Incidence, Mali.

Dynamical structure-function correlations provide robust and generalizable signatures of consciousness in humans

Resting-state functional magnetic resonance imaging evolves through a repertoire of functional connectivity patterns which might reflect ongoing cognition, as well as the contents of conscious awareness. We investigated whether the dynamic exploration of these states can provide robust and generalizable markers for the state of consciousness in human participants, across loss of consciousness induced by general anaesthesia or slow wave sleep. By clustering transient states of functional connectivity, we demonstrated that brain activity during unconsciousness is dominated by a recurrent pattern primarily mediated by structural connectivity and with a reduced capacity to transition to other patterns. Our results provide evidence supporting the pronounced differences between conscious and unconscious brain states in terms of whole-brain dynamics; in particular, the maintenance of rich brain dynamics measured by entropy is a critical aspect of conscious awareness. Collectively, our results may have significant implications for our understanding of consciousness and the neural basis of human awareness, as well as for the discovery of robust signatures of consciousness that are generalizable among different brain conditions.

Decreasing the pressure of endotracheal tube cuff slowly with a constant speed can decrease coughing incidence during extubation: a randomized clinical trial

BackgroundTo discuss whether decreasing the pressure of endotracheal tube cuff slowly with a constant speed can decrease the incidence of coughing during extubation.MethodsNinety patients undergoing elective noncardiac surgery under general anesthesia with endotracheal intubation were randomly divided into two groups: group P, the pilot balloon was connected to a syringe and an aneroid manometer through a three-way stopcock, respectively, and the decrease of cuff pressure was controlled at 3 cmH2O/s during deflating before extubation; group C, the pressure in endotracheal tube cuff was decreased suddenly with a syringe extracting the air from the cuff rapidly at once exactly before extubation. The incidence of coughing during extubation period was recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded before general anesthesia induction (T0), just before cuff deflation (T1), immediately after deflation (T2), at 1 min (T3), 3 min (T4), and 5 min after extubation (T5). The occurrence of adverse reactions was also recorded.ResultsThe initiation of coughing during extubation period occurs at immediately the time of balloon deflation. Compared with group C, the incidence of coughing was significantly decreased (P = 0.001), MAP and HR were significantly decreased at T2-T4 and T2-T5, respectively (P < 0.05 for all), and the incidence of pharyngolaryngeal discomfort after extubation was significantly reduced (P = 0.021) in group P.ConclusionsDecreasing the pressure of endotracheal tube cuff slowly with a constant speed can significantly reduce the incidence of coughing during extubating period, stabilize hemodynamics, and reduce the incidence of adverse reactions.

A Comparative Study of Intraoperative Awareness Using Modified Brice Questionnaire in Patients Undergoing Emergency and Elective Surgery under General Anaesthesia

A Comparative Study of Intraoperative Awareness Using Modified Brice Questionnaire in Patients Undergoing Emergency and Elective Surgery under General Anaesthesia

Caudal analgesia application with bupivacaine in a pediatric patient with glucose-6-phosphate dehydrogenase enzyme deficiency; case report

Glucose-6-phosphate dehydrogenase enzyme has a cells protecting feature from oxidative damage. Glucose-6-phosphate Dehydrogenase Enzyme Deficiency is a hereditary disease that causes hemolysis in cases of deficiency due to mutation in the X chromosome, due to oxidative stresses such as some drugs, chemicals or infection. The preoperative Hb of a 4-year-old patient who was to undergo circumcision surgery was determined as 8.9 g/dL. Since increased bleeding was not expected during this procedure, no attempt was made to increase the hemoglobin value. After the induction of general anesthesia with sevoflurane 8%, 1 ml/kg of 0.25% bupivacaine was administered caudally to the patient. The hemodynamic findings remained within normal limits during the surgical procedure. In the follow-up, it was determined that the pain score was low and that no additional analgesic drugs were required. Afterwards, no additional hematological abnormalities were detected and the patient was discharged two days later. We believe that during surgery, when routine monitoring measures are taken and conditions that may cause stress to the patient such as hypotension, hypoxemia, and dehydration are avoided, the patient's anesthesia and postoperative pain can be controlled with a general anesthetic gas such as sevoflurane and a local anesthetic such as bupivacaine, with attention to toxic doses.