General Inhalation Anesthesia Research Articles

Клиническая демонстрация особенностей анестезиологического обеспечения тотальной экстраперитонеальной паховой герниопластики

Due to the prevalence of inguinal hernias, especially in males of working age, early rehabilitation of patients after surgical treatment of hernias is an urgent problem. Currently, anesthetic management, taking into account the technical features of minimally invasive videoendoscopic surgical interventions for abdominal hernias, should be gentle, controllable, safe and provide surgeons with maximum comfort, as well as create conditions for early rehabilitation of patients. General multicomponent low-flow inhalation anesthesia with bispectral monitoring of anesthesia and monitoring of neuromuscular block fully meets all these requirements. Clinical demonstration. The article provides a clinical demonstration of anesthetic management of total extraperitoneal inguinal hernioplasty (TEPIH) with a mesh endoprosthesis, in foreign literature - Totally Extraperitoneal (TEP), using videoendoscopic technologies in a 62-year-old patient with an inguinal hernia, a modern approach to pain relief, pain control and perioperative management is presented, the advantages of general multicomponent low-flow inhalation anesthesia using bispectral monitoring of the depth of anesthesia and monitoring of neuromuscular block are shown. All this together has allowed us to achieve optimal results of surgical treatment of the patient, early recovery and reduction of the duration of inpatient treatment. Conclusion. The clinical case presented in the article has shown that anesthetic support of the TEP operation with a mesh endoprosthesis with monitoring of the depth of anesthesia and neuromuscular conduction was gentle, controllable, which ensured a favorable course of the operation and the immediate postoperative period, and also contributed to the early rehabilitation of the patient.

Postoperative Nausea and Vomiting After Minor Oral Surgery: A Retrospective Cohort Study

Objective This study aimed to determine whether PONV rates differed over time and to identify potential differences in PONV risk factors for oral surgery patients undergoing general inhalational anesthesia (IA) or propofol-based total intravenous anesthesia (TIVA). Methods This retrospective cohort study included patients between 16 and 85 years of age and who received intubated general anesthesia with either IA or TIVA for minor oral surgery between January 2021 and July 2022. Primary outcomes were PONV overall (onset at 0–24 hours), early (onset at 0–2 hours), and late (onset at 2–24 hours). Known PONV risk factors as identified from existing literature were included for analysis. Results Data were obtained from 188 patients. A total of 41 (21.8%) patients developed overall PONV, 35 patients (18.6%) had early PONV, and 14 patients (7.4%) had late PONV. Any PONV that occurred across 2 periods was categorized in each period. IA compared with TIVA had higher overall PONV (29.6% vs 13.3%; P = .008) and early PONV (25.5% vs 11.1%; P = .034). Female sex and increased Apfel scores were associated with increased overall, early, and late PONV. Per multivariate analysis, females were 2.5 to 6 times higher than males to have overall, early, and late PONV (P < .05), and IA was 3 times higher than TIVA to have overall and early, but not late, PONV (P < .05). Conclusion Our results suggested that the method of anesthesia may impact the incidence of overall and early PONV and that female sex and increase Apfel scores correlated with increased PONV through all times.

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.

320.6: Effect of target-controlled infusion versus general inhalational anesthesia on hemodynamic parameters and post-operative outcomes among renal transplant patients: a single-center, open-label, randomized controlled trial.

320.6: Effect of target-controlled infusion versus general inhalational anesthesia on hemodynamic parameters and post-operative outcomes among renal transplant patients: a single-center, open-label, randomized controlled trial.

Evaluation of General Anesthesia and Sedation and Follow-Up Compliance in Pediatric Dental Procedures: A Comprehensive Analysis of Long-Term Outcomes and Gender Differences.

This retrospective study evaluated the effectiveness of different types of general anesthesia (GA) and sedation in pediatric dental procedures, focusing on treatment outcomes and follow-up compliance with an emphasis on gender differences. Clinical records of 1582 pediatric patients, aged 0-18 years, were analyzed to examine the distribution, duration and impact of anesthesia types on dental procedure complexity. The study population was divided into three age groups: 0-6, 7-12 and 13-18 years. We assessed follow-up attendance rates by gender and anesthesia type, calculated the decayed, missing and filled (DMF) index and evaluated the need for further treatment and reasons for retreatment. Our findings indicated that general anesthesia with inhalational agents and muscle relaxants was the most frequently used method (1260 instances), followed by nitrous oxide sedation (163 instances) and sevoflurane GA with a laryngeal mask airway (158 instances). Inhalational GA with muscle relaxants had the longest average duration (2.78 h) and the highest DMF index (7.43), reflecting its use in more severe dental conditions. Gender analysis revealed a slight male predominance in using inhalational GA with muscle relaxants (55.87% male vs. 44.13% female). Female patients demonstrated higher follow-up compliance across all periods. Overall, our results highlight the importance of tailored anesthesia and sedation plans, as well as follow-up protocols, in pediatric dentistry. This study provides valuable insights for practitioners in selecting appropriate anesthesia and sedation types and developing strategies to improve follow-up compliance and treatment success.

Postoperative Delirium and Neurocognitive Disorders: Updates for Providers Caring for Cancer Patients.

To provide up to date information on postoperative delirium and neurocognitive disorders in surgical cancer patients. Established risk factors such as age, psychosocial factors, comorbidities, frailty and preexisting cognitive decline continue to exhibit associations with perioperative neurocognitive disorders (PND); novel risk factors identified recently include microbiome composition and vitamin D deficiency. Prevention measures include cognitive prehabilitation, perioperative geriatric assessment and multidisciplinary care, dexmedetomidine and multimodal analgesic techniques. Studies investigating ciprofol, remimazolam, esketamine, ramelteon and suvorexant have shown encouraging results. Controversy remains regarding the use of inhalational versus intravenous general anesthesia. Innovative approaches to address PND are a rapidly developing area of research, but more studies are needed to identify effective prevention and management interventions. Despite challenges and controversy in the field, implementation of best practice can reduce the detrimental impact of PND on patients, caregivers, and society at large.

Survival benefits of propofol-based versus inhalational anesthesia in non-metastatic breast cancer patients: a comprehensive meta-analysis

Whether the anesthesia technique, inhalational general anesthesia (IGA) or propofol-based anesthesia (PBA), influences the long-term survival of non-metastatic breast cancer (eBC) remain unclear and controversial. We carried out a literature search on 16thJuly, 2022 for studies comparing IGA and PBA in eBC undergoing standard surgery, according to PRISMA 2020. The major endpoint in our study was overall survival (OS). Seventeen studies including four randomized clinical trials and thirteen retrospective cohort studies were included in the meta-analysis. Ten studies provided data for crude OS in unweighted eBC patients (imbalance in baseline characteristics). The summarized estimate HRs of the PBA group versus the IGA group (ten studies, N = 127,774, IGA group: 92,592, PBA group: 35,182.) was 0.83 (95%CI: 0.78–0.89). Compared with IGA, PBA was associated with both better 1-year OS (two studies, N = 104,083, IGA group: 84,074, PBA group: 20,009. Pooled HR = 0.80, 0.73–0.89) and 5-year OS (six studies, N = 121,580, IGA group: 89,472, PBA group: 32,108. HR = 0.80, 0.74–0.87). Ten studies applied PSM method to balance the baseline characteristics. In these weighted patients, PBA still showed a better OS (ten studies, N = 105,459, IGA group: 79,095, PBA group: 26,364. HR = 0.93, 0.87–1.00), a better 1-year OS (two studies, N = 83,007, IGA group: 67,609, PBA group: 15,398. HR = 0.88, 0.78–0.98) and a trend towards a better 5-year OS (nine studies, N = 121,580, IGA group: 76,797, PBA group: 24,066. HR = 0.95, 0.88–1.03). Loco-regional recurrence-free survival (LRRFS) was also better in PBA group (HR = 0.73, 0.61–0.86). The present study is the first comprehensive meta-analysis to demonstrate that propofol-based anesthesia could significantly improve OS and LRRFS in non-metastatic breast cancer patients, compared with inhalational anesthesia.

Preventive Effect of Pretreatment with Intravenous Metoclopramide on Incidence of Post Laparoscopic Surgery Nausea and Vomiting

Introduction: Common complications following anesthesia include Postoperative nausea and vomiting (PONV), which leads to patient dissatisfaction and discomfort. The incidence of PONV after inhalational general anesthesia is up to 30% [1]. When anesthetics are used with no prophylaxis, and in certain high-risk patients, the incidence of PONV can reach up to 70% [2]. Furthermore, laparoscopic surgeries are associated with an even higher incidence of PONV (40%-75%) [3]. This makes PONV one of the most prevalent post-operational complaints [4].Methods: This case control study includes 79 patients with high PONV risk scores scheduled for laparoscopic cholecystectomy under general anesthesia in Duhok hospitals. 40 patients received 8 mg (2ml) metoclopramide intravenously as pretreatment, while 39 patients received normal saline (2ml) as the control group. After 48 hours, we called patients and asked them about the incidence and severity of PONV.Result: statically insignificant differences in the incidence of PONV between both groups (p-value 0.91). The incidence of PONV in this study was (27.8%) which correlates with the PONV risk score mean (2.48) and was statistically significant with a p-value of less than 0.01 and a 95% confidence score (2.13, 18.32).Conclusion: PONV risk score is effective in the prediction of the incidence of PONV, and Metoclopramide is ineffective as a single drug in the prevention of PONV in high-risk patients.

Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns.

Understanding the intricate relationship between cancer clinicopathological features and anesthetics dosage is crucial for optimizing patient outcomes and safety during surgery. This retrospective study investigates this relationship in patients with non-small cell lung cancer (NSCLC) undergoing video-assisted thoracic surgery (VATS). A comprehensive analysis of medical records was undertaken for NSCLC patients who underwent VATS with intravenous compound inhalation general anesthesia. Patients were categorized based on histological, chemotherapy, radiotherapy, and epidural anesthesia factors. Statistical analysis was performed to compare the differences between the groups. The results revealed compelling insights. Specifically, patients with lung adenocarcinoma (LUAD) undergoing VATS exhibited higher dosages of rocuronium bromide and midazolam during general anesthesia, coupled with a shorter post-anesthesia care unit (PACU) stay compared to those with squamous cell carcinoma (sqCL). Furthermore, chemotherapy patients undergoing VATS demonstrated diminished requirements for phenylephrine and remifentanil in contrast to their non-chemotherapy counterparts. Similarly, radiotherapy patients undergoing VATS demonstrated a decreased necessity for rocuronium bromide compared to non-radiotherapy patients. Notably, patients who received epidural anesthesia in combination with general anesthesia manifested reduced hydromorphone requirements and prolonged hospital stays compared to those subjected to general anesthesia alone. In conclusion, the findings from this study indicate several important observations in diverse patient groups undergoing VATS. The higher dosages of rocuronium bromide and midazolam in LUAD patients point to potential differences in drug requirements among varying lung cancer types. Additionally, the observed shorter PACU stay in LUAD patients suggests a potentially expedited recovery process. The reduced anesthetic requirements of phenylephrine and remifentanilin chemotherapy patients indicate distinct responses to anesthesia and pain management. Radiotherapy patients requiring lower doses of rocuronium bromide imply a potential impact of prior radiotherapy on muscle relaxation. Finally, the combination of epidural anesthesia with general anesthesia resulted in reduced hydromorphone requirements and longer hospital stays, suggesting the potential benefits of this combined approach in terms of pain management and postoperative recovery. These findings highlight the importance of tailoring anesthesia strategies for specific patient populations to optimize outcomes in VATS procedures.

Bridging the mismatch: observing the introduction of new anesthesia technology for a low-resource environment.

The objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments with limited clinical perioperative resources, on the choice of general anesthesia technique and safe anesthesia practice in a tertiary-care hospital in Sierra Leone. We introduced an anesthesia machine (UAM) into Connaught Hospital, Freetown, Sierra Leone. We conducted a prospective observational study of anesthesia practice and an examination of perioperative clinical parameters among surgical patients at the hospital to determine the usability of the device, its impact on anesthesia capacity, and changes in general anesthesia technique. We observed a shift from the use of ketamine total intravenous anesthesia to inhalational anesthesia. This shift was most demonstrable in anesthesia care for appendectomies and surgical wound management. In 10 of 17 power outages that occurred during inhalational general anesthesia, anesthesia delivery was uninterrupted because inhalational anesthesia was being delivered with the UAM. Anesthesia technologies tailored to overcome austere environmental conditions can support the delivery of safe anesthesia care while maintaining fidelity to recommended international anesthesia practice standards.

Evaluation of Gastric pH and Gastrin Concentrations in Horses Subjected to General Inhalation Anesthesia in Dorsal Recumbency.

The prevalence of gastric disorders in high-performance horses, especially gastric ulceration, ranges from 50 to 90%. These pathological conditions have negative impacts on athletic performance and health. This study was designed to evaluate changes in gastric pH during a 24 h period and to compare gastrin concentrations at different time points in horses undergoing general inhalation anesthesia and dorsal recumbency. Twenty-two mixed-breed mares weighing 400 ± 50 kg and aged 8 ± 2 years were used. Of these, eight were fasted for 8 h and submitted to 90 min of general inhalation anesthesia in dorsal recumbency. Gastric juice samples were collected prior to anesthesia (T0), and then at 15 min intervals during anesthesia (T15-T90). After recovery from anesthesia (45 ± 1 min), samples were collected every hour for 24 h (T1 to T24) for gastric juice pH measurement. During this period, mares had free access to Bermuda grass hay and water and were fed a commercial concentrate twice (T4 and T16). In a second group (control), four non-anesthetized mares were submitted to 8 h of fasting followed by nasogastric intubation. Gastric juice samples were then collected at T0, T15, T30, T45, T60, T75, and T90. During this period, mares did not receive food or water. After 45 min, mares had free access to Bermuda grass hay and water, and gastric juice samples were collected every hour for four hours (T1 to T4). In a third group comprising ten non-fasted, non-anesthetized mares with free access to Bermuda grass hay and water, gastric juice samples were collected 30 min after concentrate intake (T0). In anesthetized mares, blood gastrin levels were measured prior to anesthesia (8 h fasting; baseline), during recovery from anesthesia, and 4 months after the anesthetic procedure, 90 min after the morning meal. Mean values of gastric juice pH remained acidic during general anesthesia. Mean pH values were within the physiological range (4.52 ± 1.69) and did not differ significantly between time points (T15-T90; p > 0.05). After recovery from anesthesia, mean gastric pH values increased and remained in the alkaline range throughout the 24 h period of evaluation. Significant differences were observed between T0 (4.88 ± 2.38), T5 (7.08 ± 0.89), T8 (7.43 ± 0.22), T9 (7.28 ± 0.36), T11 (7.26 ± 0.71), T13 (6.74 ± 0.90), and T17 (6.94 ± 1.04) (p < 0.05). The mean gastric juice pH ranged from weakly acidic to neutral or weakly alkaline in all groups, regardless of food and water intake (i.e., in the fasted, non-fasted, and fed states). Mean gastric pH measured in the control group did not differ from values measured during the 24 h post-anesthesia period or in the non-fasted group. Gastrin concentrations increased significantly during the post-anesthetic period compared to baseline (20.15 ± 7.65 pg/mL and 15.15 ± 3.82 pg/mL respectively; p < 0.05). General inhalation anesthesia and dorsal recumbency did not affect gastric juice pH, which remained acidic and within the physiological range. Gastric juice pH was weakly alkaline after recovery from anesthesia and in the fasted and fed states. Serum gastrin levels increased in response to general inhalation anesthesia in dorsal recumbency and were not influenced by fasting. Preventive pharmacological measures are not required in horses submitted to general anesthesia and dorsal recumbency.

Some Acute Phase Proteins and Biochemistry Parameters of Female Dogs Affected with Pyometra

Some Acute Phase Proteins and Biochemistry Parameters of Female Dogs Affected with Pyometra

Anesthesia for non-obstetric surgery during late term pregnancy in mares.

Submitting late-term pregnant mares to anesthesia for non-obstetric surgery raises concerns about the survival of the mother and fetus. This study aimed to evaluate and describe transient maternal and fetal hemodynamic changes during general inhalation anesthesia in mares during the last month of gestation. Nine adult mares in the last month of gestation were subjected to general inhalation anesthesia and dorsal recumbency for 90 minutes. Trans-anesthetic vital parameters, arterial hemogasometry, cardiac output, pulmonary arterial pressure, central venous pressure, and fetal heart rates were assessed at defined intervals. During various timespans of the anesthetic procedure, the mares demonstrated an increase in heart rate, mean arterial pressure, and diastolic pressure as well as a decrease in temperature. Additionally, arterial hemogasometry indicated respiratory acidosis. No changes in cardiac output were observed; however, there was a reduction in pulmonary arterial and central venous pressures and stroke volume. Fetal heart rate was significantly decreased. General inhalation anesthesia in late term pregnancy in mares in a recumbent position implies in significant hemodynamic and metabolic changes. Up to 90 minutes those changes does not seem to affect negatively the maternal-fetus prognosis.

The relationship between smoking status and salivary flow rate in inhaled general anesthesia patients at Brebes Regional Hospital

&#x0D; Background :Smoking is one of the habits that is inherent in humans because it is addictive. Active smokers in Indonesia have increased significantly in 10 years. Smoking has a negative impact on health, one of which is changes in salivary flow rate. Changes in salivary flow rate in smokers can cause complications in the airway when performing surgery using inhalation general anaesthesia. The purpose of this study was to determine the relationship between smoking status and salivary flow rate in patients with inhalation general anaesthesia.&#x0D; Method : This type of research is observational analytic with a cross sectional approach. The sample in the study was 35 respondents with 4 inclusion criteria. The sample in this study was taken with purporsive sampling technique. Data collection stimulated saliva by suction method. Data analysis using univariate and bivariate analysis, namely the Chi-Square test.&#x0D; Results : The results showed that inhalation general anaesthesia patients were more smokers with 24 respondents (68.6%) and respondents who experienced changes in salivary flow rate obtained the most respondents who experienced hypersaliva as many as 15 respondents (42.9%). The results of bivariate analysis using the Chi-Square test showed that 11 respondents (31.4%) who smoked experienced hypersaliva with a p-value of 0.000 &lt;0.05.&#x0D; Conclusion : There is a relationship between smoking status and salivary flow rate in inhalation anaesthesia patients, namely the increase in salivary flow rate in smoking respondents with inhalation general anaesthesia.

Bloqueio epidural para herniorrafia perineal bilateral em cão

In this case report, we describe the technique of epidural block with bupivacaine associated with morphine using the lumbosacral approach to correct a bilateral perineal hernia in a canine patient, 8 years old, mixed breed, not castrated. The combination of general inhalation anesthesia and epidural block was used for multimodal analgesia, reducing the doses of medication necessary to maintain the patient in the anesthetic state, thus minimizing the associated risks. The patient was carefully monitored throughout the procedure, and recovered calmly with no pain in the surgical wound.

Effects of propofol intravenous general anesthesia and inhalational anesthesia on T-lymphocyte activity after breast cancer surgery: A meta-analysis.

Breast cancer is one of the most common cancers in women. General anesthesia is a commonly used anesthesia method for breast cancer surgery, and studies have confirmed that general anesthesia can induce immunosuppression in breast cancer patients and increase the metastasis rate of tumors. However, the difference between the effects of intravenous general anesthesia and inhalation anesthesia on the function of T-lymphocytes is still controversial, and it is necessary to explore reasonable anesthesia methods to reduce immunosuppression caused by surgery and anesthesia. Databases (Embase, PubMed, Cochrane Library, CBM, CNKI, and Wanfang) were searched (up to October 2022) for randomized controlled trials (RCTs) comparing intraoperative inhalation anesthesia and propofol intravenous anesthesia in breast cancer patients, with the outcome of T-lymphocyte subsets. The meta-analysis was performed by STATA 14.0. Six RCTs with 352 patients were included in the study. Compared with inhalation anesthesia, there was no difference in T-lymphocyte subsets between the two groups immediately after surgery, but the activities of CD4+ T cells in patients with propofol anesthesia were higher (standard mean difference [SMD] = 0.234, 95% confidence interval [CI]: 0.003-0.466, P = 0.047, I2 = 44.1%) than those under inhalation anesthesia 1 day after surgery, and CD4+/CD8+ activities in patients with propofol anesthesia were higher (SMD = 304, 95% CI: 0.072-0.537, P = 0.010, I2 = 48.0%) than those under inhalation anesthesia 1 day after surgery. There were no differences in the effects of propofol and inhalation anesthetics on T-lymphocytes immediately after surgery, but the inhibitory effects of inhalation anesthetics on CD4+ and CD4+/CD8+ cells were stronger 1 day after surgery.

Seeing is Believing: Chasing Sevoflurane Vapor Trails

PurposeSevoflurane is an inhalational general anesthetic that has been used recently to treat chronic, painful lesions, reportedly supporting analgesia and wound healing. The potential for repeated exposure to off-gassed sevoflurane vapor, especially outside the air-conditioned operating theatre environment, is of some concern. DesignThis paper explores the qualitative and quantitative pathing of off-gassed sevoflurane from a topically applied liquid source. MethodsUsing a small, unventilated test-box (total volume 0.5 m3) with infra-red imaging and gas-analysing, we investigated the spatial distribution of sevoflurane vapor following complete vaporization of a 20 mL liquid sample. Utilizing the infra-red absorption of sevoflurane, it was possible to visualize (as an apparent reduction in temperature) the streaming path of the sevoflurane vapor. Sevoflurane levels (%) in the test-box were measured using an infra-red gas analyzer. FindingsIn keeping with its higher density than air, sevoflurane vapor was seen to “waterfall” from the liquid source and accumulate in the bottom of the test-box. Sevoflurane vapor concentration was minimal above the liquid source. When extrapolated to a larger (unventilated) room, we estimate that the sevoflurane concentration would be less than 10 ppm one centimetre above the liquid pool. With vacuum extraction, these levels would be even lower. ConclusionsDue to sevoflurane’s tendency to accumulate on the floor, it is concluded that topical application of liquid sevoflurane posses virtually no risk to off-gas exposure in unventilated spaces.

Comparison of Facemask Ventilation Quality Between the Three-Finger Grip and the Three-Finger Grip Plus the Newly-Devised Submental Maneuver in Infants: A Double-Blind, Randomized Controlled Trial

Background: Mask ventilation is one of the most important aspects of managing and maintaining a patient's airway. Performing good mask ventilation can avoid the need for intubation. Objectives: This study aimed to compare the ventilation quality of two different mask-holding techniques in infants: The three-finger grip and the three-finger grip plus the newly-devised submental maneuver. Methods: This double-blind, randomized controlled trial included 90 infants under 1 year of age undergoing elective surgery under general inhalation anesthesia in Tehran Children's Medical Center. Each patient was randomly allocated to one of the interventional groups, and general anesthesia was induced using one of the mask-holding techniques before intubation. Demographic data for each patient was collected. Expired tidal volume (VTE) was assessed quantitatively by the Drager machine and then classified into three groups of quality of breath flow as either good (5 - 7 mL/kg), fair (3 - 5 mL/kg), or bad (&lt; 3 mL/kg). Results: In this study, VTE was shown to be statistically significantly better in the submental maneuver compared with the three-finger grip. Good, fair, and bad qualities were recorded for 30, 15, and 0 patients in the three-finger grip group and 39, 6, and 0 patients in the submental maneuver group, respectively (P = 0.025). Classifying patients into four groups of body mass index (BMI), 10 - 14, 15 - 19, 20 - 24, and 25 - 29, we compared VTE between the two techniques within each group. The results showed that in the BMI group of 20 - 24, the quality of breath flow was statistically significantly better in the submental maneuver (P = 0.047). Conclusions: Adding the submental maneuver to the three-finger grip seems to provide better expired tidal volume in infants. Also, it seems that in children with higher BMI and larger submental soft tissue, the submental maneuver provides better ventilation quality than the three-finger grip.

IMPACT OF PARAVERTEBRAL BLOCKADE ON THE COURSE OF EARLY POSTOPERATIVE PERIOD FOLLOWING SURGICAL INTERVENTION FOR LUNG MALIGNANCIES UNDER INHALED SEVOFLURANE ANESTHESIA

The aim of the study is to investigate the impact of paravertebral blockade on the quality of anti-stress protection of general inhalation anaesthesia based on sevoflurane during operations in patients with lung malignancy. Material and methods. We examined 60 individuals of an average age 55±5.6 years, whose physical status was assessed as class II – III according to the ASA classification. The patients underwent open surgical procedures, including frontal or pneumonectomy, or partial lung resection. The patients were divided into 2 groups depending on the method of anaesthesia: SF group (sevoflurane) (n = 29) received inhaled anaesthesia with sevoflurane; SF+PVB group (n = 31) received the combination of inhaled anaesthesia with PVB. The following indicators were assessed: time of the first administration of the analgesic after surgery, pain intensity by the visual analogue scale (VAS), perfusion systemic pressure (PST), cardiac index (CI), oxygen content in arterial and venous blood, blood lactate levels, indicators of circulatory energy efficiency, cortisol, insulin and HOMA index levels. Indicators were recorded before the surgical operation, at the wake-up stage, on the 1st and 5th days following the operation. Results. In the SF+PVB group, the intensity of pain in the postoperative period was significantly lower than in the SF group. In the SF+PVB group, there was no necessity for administering narcotic analgesics on the first day, while in the SF group, the dose of morphine was 0.27±0.04 mg/kg∙day, the first administration was performed 65.5±10.3 minutes after surgery. CI during surgery and in a day was significantly higher in the SF+PVB group, and the arteriovenous difference in oxygen content was significantly lower. The energy efficiency of blood circulation at the same stages was significantly higher in the SF+PVB group. In the same group, there was a significantly lower concentration of markers of stress responses (cortisol levels and HOMA index). Conclusions. The use of paravertebral blockade under the general anaesthesia based on sevoflurane during operations in patients with lung malignancies contributes to a significant reduction in the pain intensity in the postoperative period; eliminates the need to use narcotic analgesics; provides significantly more stable hemodynamics and significantly more adequate oxygen supply during the operation and in the postoperative period; significantly reduces the intensity of stress reactions as well as significantly improves the energy efficiency of blood circulation.

Topical sevoflurane: a galenic experience

Sevoflurane is a volatile liquid from the family of ether-derived halogenated hydrocarbons that is approved for the induction and maintenance of inhalational general anesthesia in the hospital setting. This review describes the pioneering experience of a Spanish Pain Unit in the home treatment of complicated painful wounds using topical sevoflurane instillations according to a protocol approved for off-label use. Aspects of safety and efficacy, both analgesic, antimicrobial and pro-healing are addressed, and some future lines of research are discussed in terms of new formulations for topical use. After more than seven years of use of the protocol, an experience of over 70,000 applications of topical sevoflurane has been gained. In general terms, the analgesic effect appears quickly, is highly intense and persists for several hours. As a result, patients can reduce their consumption of systemic analgesics and benefit from an improvement in their quality of life. In addition, there are signs that suggest sevoflurane also possesses antimicrobial and pro-healing properties. Regarding safety, pruritus at the level of the periulcerous skin is the most frequently reported adverse effect, although it is usually transient and well-tolerated, and no systemic toxicity has been reported. Overall, the risk-benefit balance of the drug has so far been very favorable. To avoid manipulation of this volatile liquid, we have developed a new formulation of sevoflurane in gel form, which has made it possible to successfully apply sevoflurane in the context of painful pathologies where the skin remains intact. Furthermore, these types of new formulations, including sevoflurane microspheres, which we have also developed, could improve the efficacy and safety of topical sevoflurane while reducing the occupational exposure of healthcare staff. This means that the development of new formulations is a field with a very promising future.