Intravenous General Anesthesia Research Articles

Application of propofol-remifentanil intravenous general anesthesia combined with regional block in pediatric ophthalmic surgery

ObjectiveThe aim of this study is to observe the anesthetic effect and safety of intravenous anesthesia without muscle relaxant with propofol-remifentanil combined with regional block under laryngeal mask airway in pediatric ophthalmologic surgery.MethodsA total of 90 undergoing ophthalmic surgery were anesthetized with general anesthesia using the laryngeal mask airway without muscle relaxant. They were randomly divided into two groups: 45 children who received propofol-remifentanil intravenous anesthesia combined with regional block (LG group), and 45 children who received total intravenous anesthesia (G group). The peri-operative circulatory indicators, awakening time after general anesthesia, postoperative analgesic effect and the incidence of anesthesia-related adverse events were respectively compared between the two groups.ResultsAll the children successfully underwent the surgical procedure. The awakening time after general anesthesia and removal time of laryngeal mask were significantly shorter in the LG group than in the G group (P < 0.05). There was no statistically significant difference in the heart rates in the perioperative period between the two groups (P > 0.05). There was no statistically significant difference in the incidence of intraoperative physical response, respiratory depression, postoperative nausea and vomiting (PONV) and emergence agitation (EA) between the two groups (P > 0.05). The pain score at the postoperative hour 2 was lower in the LG group than in the G group (P < 0.05).ConclusionPropofol-remifentanil intravenous anesthesia combined with long-acting local anesthetic regional block anesthesia, combined with laryngeal mask ventilation technology without muscle relaxants, can be safely used in pediatric eye surgery to achieve rapid and smooth recovery from general anesthesia and better postoperative analgesia. This anesthesia scheme can improve the comfort and safety of children in perioperative period, and has a certain clinical popularization value.

Understanding the variability of the electrophysiologic laryngeal adductor reflex

ObjectiveThe laryngeal adductor reflex (LAR) is vital for airway protection and can be electrophysiologically obtained under intravenous general anesthesia (IGA). This makes the electrophysiologic LAR (eLAR) an important tool for monitoring of the vagus nerves and relevant brainstem circuitry during high-risk surgeries. We investigated the intra-class variability of normal and expected abnormal eLAR. MethodsRepeated measures of contralateral R1 (cR1) were performed under IGA in 58 patients. Data on presence/absence of cR2 and potential confounders were also collected. Review of neuroimaging, pathology and clinical exam, allowed classification into normal and expected abnormal eLAR groups. Using univariate and multivariate analysis we studied the variability of cR1 parameters and their differences between the two groups. ResultsIn both groups, cR1 latencies had coefficients of variation of <2%. In the abnormal group, cR1 had longer latencies, required higher activation currents and was more frequently desynchronized and unsustained; cR2 was more frequently absent. ConclusionscR1 latencies show high analytical precision for measurements. Delayed onset, difficult to elicit, desynchronized and unsustained cR1, and absence of cR2 signal an abnormal eLAR. SignificanceUnderstanding the variability and behavior of normal and abnormal eLAR under IGA can aid in the interpretation of its changes during monitoring.

Ferritinophagy-Mediated Hippocampus Ferroptosis is Involved in Cognitive Impairment in Immature Rats Induced by Hypoxia Combined with Propofol.

Propofol is a clinically common intravenous general anesthetic and is widely used for anesthesia induction, maintenance and intensive care unit (ICU) sedation in children. Hypoxemia is a common perioperative complication. In clinical work, we found that children with hypoxemia who received propofol anesthesia experienced significant postoperative cognitive changes. To explore the causes of this phenomenon, we conducted the study. In this study, our in vivo experiments found that immature rats exposed to hypoxia combined with propofol (HCWP) could develop cognitive impairment. We performed the RNA-seq analysis of its hippocampal tissues and found that autophagy and ferroptosis may play a role in our model. Next, we verified the participation of the two modes of death by detecting the expression of autophagy-related indexes Sequestosome 1 (SQSTM1) and Beclin1, and ferroptosis-related indicators Fe2+, reactive oxygen species (ROS) and glutathione peroxidase 4 (GPX4). Meanwhile, we found that ferrostatin-1 (Fer-1), an inhibitor of ferroptosis, could improve cognitive impairment in immature rats caused by HCWP. In addition, we found that nuclear receptor coactivator 4 (NCOA4)-mediated ferritinophagy, which acted as a key junction between autophagy and ferroptosis, was also involved. Finally, our in vitro experiments concluded that autophagy activation was an upstream factor in HCWP-induced hippocampus ferroptosis through the intervention of autophagy inhibitor 3-methyladenine (3-MA). Our study was expected to provide an attractive therapeutic target for cognitive impairment that occurred after HCWP exposures.

Etomidate enhances cerebellar CF-PC synaptic plasticity through CB1 receptor/PKA cascade in vitro in mice

Etomidate (ET) is a widely used intravenous imidazole general anesthetic, which depresses the cerebellar neuronal activity by modulating various receptors activity and synaptic transmission. In this study, we investigated the effects of ET on the cerebellar climbing fiber-Purkinje cells (CF-PC) plasticity in vitro in mice using whole-cell recording technique and pharmacological methods. Our results demonstrated that CF tetanic stimulation produced a mGluR1-dependent long-term depression (LTD) of CF-PC excitatory postsynaptic currents (EPSCs), which was enhanced by bath application of ET (10 µM). Blockade of mGluR1 receptor with JNJ16259685, ET triggered the tetanic stimulation to induce a CF-PC LTD accompanied with an increase in paired-pulse ratio (PPR). The ET-triggered CF-PC LTD was abolished by extracellular administration of an N-methyl-(D)-aspartate (NMDA) receptor antagonist, D-APV, as well as by intracellular blockade of NMDA receptors activity with MK801. Furthermore, blocking cannabinoids 1 (CB1) receptor with AM251 or chelating intracellular Ca2+ with BAPTA, ET failed to trigger the CF-PC LTD. Moreover, the ET-triggered CF-PC LTD was abolished by inhibition of protein kinase A (PKA), but not by inhibition of protein kinase C inhibiter. The present results suggest that ET acts on postsynaptic NMDA receptor resulting in an enhancement of the cerebellar CF-PC LTD through CB1 receptor/PKA cascade in vitro in mice. These results provide new evidence and possible mechanism for ET anesthesia to affect motor learning and motor coordination by regulating cerebellar CF-PC LTD.

The Outcomes of Peripherally Inserted Central Catheter (PICC) Insertion in Pediatric Patients at Siriraj Hospital

Objective: Peripherally Inserted Central Catheters (PICC) are widely used for intermediate to long term venous access. Venipunctures and catheterizations in pediatric patients can be challenging and traumatizing to children’s veins due to frequent and painful needle sticks. This study aims to demonstrate the outcomes of PICC insertion and management in pediatric patients by the Anesthesia Line Service Team (ALiST) at Siriraj Hospital. Materials and Methods: This is a retrospective, descriptive study collecting data from January 2018 to December 2021. The inclusion criteria were pediatric patients aged 15 years and under, body weight equal to or exceeding 5 kg with no history of previous complicated central venous accesses. The primary outcome is the success rate of insertion. Results: 124 PICCs were inserted in pediatric patients. The median age of patients was 5.0 years, with a median height of 107.8 cm, and a median weight of 10.0 kg. The successful insertion rate was 96.92%, and all insertions were inserted using ultrasound-guided technique, with or without fluoroscopy. No acute complications were noted during insertion. Most patients received either intravenous sedation (39.5%) or general anesthesia (26.6%) during the procedure. The mean duration of catheter indwelling was 66.48 days. Reasons for removal of PICC included completion of therapy and patient demise (70.97%), catheter malformation (8.06%), accidental removal (4.03%), infection (8.06%), and patient non-adherence (1.61%). Conclusion: Our research demonstrates a notably high rate of successful PICC placement among pediatric patients, with data indicating a minimal occurrence of complications and an extended duration of catheter usage.

Inhaled anesthesia associated with reduced mortality in patients with stage III breast cancer: A population-based study.

Patients diagnosed with stage III breast cancer often undergo surgery, radiation therapy, and chemotherapy as part of their treatment. The choice of anesthesia technique during surgery has been a subject of interest due to its potential association with immune changes and prognosis. In this study, we aimed to compare the mortality rates between stage III breast cancer patients undergoing surgery with propofol-based intravenous general anesthesia and those receiving inhaled anesthetics. Using data from Taiwan's National Health Insurance Research Database and Taiwan Cancer Registry, we identified a cohort of 10,896 stage III breast cancer patients. Among them, 1,506 received propofol-based intravenous anesthetic maintenance, while 9,390 received inhaled anesthetic maintenance. To ensure comparability between the two groups, we performed propensity-score matching. Our findings revealed a significantly lower mortality rate in patients who received inhaled anesthetics compared to those who received propofol-based intravenous anesthesia. Sensitivity analysis further confirmed the robustness of our results. This study suggests that inhaled anesthesia technique is associated with a lower mortality rate in clinical stage III breast cancer. Further research is needed to validate and expand upon these results.

Influence of a chronic beta-blocker therapy on perioperative opioid consumption – a post hoc secondary analysis

BackgroundBeta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.MethodsA post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.ResultsA total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.ConclusionsChronic BB therapy was not associated with a reduced perioperative opioid consumption.Trial registrationThis study was registered at ClinicalTrials.gov (NCT02265263) on the 15.10.2014 with the principal investigator being Univ.-Prof. Dr. med. Claudia Spies.

Optimizing nonintubated laryngeal microsurgery: The effectiveness and safety of superior laryngeal nerve block with high-flow nasal oxygen-A prospective cohort study.

Laryngeal microsurgery (LMS) typically requires intubated general anesthesia (ITGA). Although nonintubated general anesthesia (NIGA) with high-flow nasal oxygen (HFNO) can be applied with LMS, a muscle relaxant is required, which can cause apnea and hypercapnia. This study evaluated the effectiveness of a superior laryngeal nerve block (SLNB) in improving safety during LMS. This prospective cohort study enrolled a cumulative total of 61 adult patients received LMS under intravenous general anesthesia and allocated to three groups: ITGA group (n = 18), which patients performed intubation; neuromuscular blocking (NMB) group (n = 21), which patients administrated muscle relaxant without intubation and superior laryngeal nerve block (NB) group (n = 22), which patients performed SLNB without intubation or muscle relaxant. The average (SD) values of PaCO 2 after surgery in ITGA, NMB, and NB group were 50.8 (7.5), 97.5 (24.9), and 54.8 (8.8) mmHg, respectively. The mean postoperative pH values were 7.33 (0.04), 7.14 (0.07), and 7.33 (0.04), respectively. The results were all p < 0.001, and the average pH value of the NMB group was lower than that of the ITGA and NB groups. During the LMS, the mean heart rate (HR) (93.9 [18.1] bpm) and noninvasive blood pressure systolic (NBPs) (143.5 [28.2] mmHg) in the NMB group were higher than those in the ITGA group (HR = 77.4 [13.5] bpm and NBPs = 132.7 [20.8] mmHg) and NB group (HR = 82.3 [17.4] bpm and NBPs = 120.9 [25.0] mmHg). The results of p value by HR and NBPs are p < 0.001. The PaCO 2 and pH values are similar between ITGA group and NB group. Our approach of using HFNO with SLNB was successful for performing nonintubated LMS, enabling the patients to maintain spontaneous breathing and effectively eliminate CO 2 . This approach reduces the risks of hypercapnia and acidosis even when the duration of LMS exceeds 30 minutes.

Propofol-induced anesthesia involves the direct inhibition of glutamatergic neurons in the lateral hypothalamus.

Propofol is the most widely used intravenous general anesthetic; however, the neuronal circuits that mediate its anesthetic effects are still poorly understood. Glutamatergic neurons in the lateral hypothalamus have been reported to be involved in maintenance of arousal and consciousness. Using Vglut2-Cre transgenic mice, we recorded this group of cells specifically and found that propofol can directly inhibit the glutamatergic neurons, and enhance inhibitory synaptic inputs on these cells, thereby reducing neuronal excitability. Through chemogenetic interventions, we found that inhibition of these neurons increased the duration of propofol-induced anesthesia and reduced movement in the animals after the recovery of right reflex. In contrast, activating this group of cells reduced the duration of propofol anesthesia and increased the animals' locomotor activity after the recovery of right reflex. These results suggest that propofol-induced anesthesia involves the inhibition of glutamatergic neurons in the lateral hypothalamus.

Retracted: The Use of BT-ESD Technology under General Intravenous Anesthesia in the Treatment of Nonmuscle Invasive Bladder Cancer and the Effect of PI3K/Akt Signaling Pathway on Tumor Recurrence.

[This retracts the article DOI: 10.1155/2021/8860745.].

Effective doses of ciprofol combined with alfentanil in inhibiting responses to gastroscope insertion, a prospective, single-arm, single-center study

BackgroundCiprofol is a novel intravenous sedative and anesthetic. Studies have shown that it features a rapid onset of action, a fast recovery time, slight inhibition of respiratory and cardiovascular functions, and a low incidence of adverse reactions. This study aims to explore the median effective dose (ED50) and the 95% effective dose (ED95) of ciprofol in inhibiting responses to gastroscope insertion when combined with a low dose of alfentanil, and to evaluate its safety, to provide a reference for the rational use of ciprofol in clinical practices.MethodsWe included 25 patients aged 18–64 years of either sex who underwent gastroscopy under intravenous general anesthesia, with a Body Mass Index (BMI) 18–28 kg/m2, and an American Society of Anesthesiologists (ASA) grade I or II. In this study, the dose-finding strategy of ciprofol followed a modified Dixon’s up-and-down method with an initial dose of 0.30 mg/kg and an increment of 0.02 mg/kg. Ciprofol was administered after intravenous injection of 7 µg/kg of alfentanil, and 2 min later a gastroscope was inserted. When the insertion response of one participant was positive (including body movement, coughing, and eye opening), an escalation of 0.02 mg/kg would be given to the next participant; otherwise, a de-escalation of 0.02 mg/kg would be administered. The study was terminated when negative response and positive response alternated 8 times. A Probit model was used to calculate the ED50 and ED95 of ciprofol in inhibiting responses to gastroscope insertion when combined with alfentanil. Patients’ recovery time, discharge time, vital signs and occurrence of adverse reactions were recorded.ResultsThe ED50 of single-dose intravenous ciprofol injection with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED95 was 0.247 mg/kg. Patients’ recovery time and discharge time were 11.04 ± 1.49 min and 9.64 ± 2.38 min, respectively. The overall incidence of adverse reactions was 12%.ConclusionThe ED50 of ciprofol combined with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED95 was 0.247 mg/kg. Ciprofol showed a low incidence of anesthesia-related adverse events.Trial registrationhttp://www.chictr.org.cn (ChiCTR2200061727).

Anaesthesia and brain development: a review of propofol-induced neurotoxicity in pediatric populations.

With the advancement of medical technology, there are increasing opportunities for new-borns, infants, and pregnant women to be exposed to general anaesthesia. Propofol is commonly used for the induction of anaesthesia, maintenance of general intravenous anaesthesia and sedation of intensive-care children. Many previous studies have found that propofol has organ-protective effects, but growing evidence suggests that propofol interferes with brain development, affecting learning and cognitive function. The purpose of this review is to summarize the latest progress in understanding the neurotoxicity of propofol. Evidence from case studies and clinical studies suggests that propofol has neurotoxicity on the developing brain. We classify the findings on propofol-induced neurotoxicity based on its damage mechanism. We end by summarizing the current protective strategies against propofol neurotoxicity. Fully understanding the neurotoxic mechanisms of propofol can help us use it at a reasonable dosage, reduce its side effects, and increase patient safety.

Apoptotic mechanism of development inhibition in zebrafish induced by esketamine

Esketamine, a widely used intravenous general anesthetic, is also employed for obstetric and pediatric anesthesia, and depression treatment. However, concerns regarding esketamine abuse have emerged. Moreover, the potential in vivo toxicity of esketamine on growth and development remains unclear. To address these concerns, we investigated the effects of esketamine exposure on developmental parameters, cell apoptosis, and gene expression in zebrafish. Esketamine exposure concentration-dependently decreased the heart rate and body length of zebrafish embryos/larvae while increasing the hatching rate and spontaneous movement frequency. Developmental retardation of zebrafish larvae, including shallow pigmentation, small eyes, and delayed yolk sac absorption, was also observed following esketamine treatment. Esketamine exposure altered the expression of apoptosis-related genes in zebrafish heads, primarily downregulating bax, caspase9, caspase3, caspase6, and caspase7. Intriguingly, BTSA1, a Bax agonist, reversed the anti-apoptotic and decelerated body growth effects of esketamine in zebrafish. Collectively, our findings suggest that esketamine may hinder embryonic development by inhibiting embryonic apoptosis via the Bax/Caspase9/Caspase3 pathway. To the best of our knowledge, this is the first study to report the lethal toxicity of esketamine in zebrafish. We have elucidated the developmental toxic effects of esketamine on zebrafish larvae and its potential apoptotic mechanisms. Further studies are warranted to evaluate the safety of esketamine in animals and humans.

Anesthesia choice and its potential impact on endoluminal functional lumen imaging probe measurements in esophageal motility disorders

The widespread use of peroral endoscopic myotomy (POEM) has revolutionized the management of esophageal motility disorders (EMDs). The introduction of an endoluminal functional lumen imaging probe (EndoFLIP, Medtronic, Dublin, Ireland) can serve as a complementary diagnostic tool to assess the mechanical properties (ie, pressure, diameter, distensibility, topography) of the esophagus. During EndoFLIP measurements, different anesthesia techniques may induce variable degrees of neuromuscular blockade, potentially affecting esophageal motility and altering the results of EndoFLIP metrics. The aim of this study was to compare the impact of using total intravenous anesthesia (TIVA) versus general anesthesia with inhalational anesthetics (GAIA) on diagnostic EndoFLIP measurements. This retrospective study included all adult patients (≥18 years) undergoing EndoFlip during the POEM procedure at our institution between February 2017 and February 2022. Differences in pressure, diameter, and distensibility index were obtained by using propofol-based TIVA versus sevoflurane-based GAIA with a 30 mL and a 60 mL balloon. The differences were divided into terciles and compared between diagnoses by using univariate comparisons and logistic regression models. A total of 49 patients were included (39% type I achalasia, 43% type II or III achalasia, and 18% jackhammer esophagus [JE]). Compared with spastic disorders (types II and III achalasia and JE), type I had lower values of pressure differences at 60 mL in univariate (3.75 vs 15.20, P= .001) and multivariate (adjusted odds ratio, .89; 95% confidence interval, .82-.978) analyses. Compared with type I, types II and III achalasia had higher rates of pressure differences at 60 mL in the univariate (9.85 vs 3.75, P= .04) analysis and nearly reached significance in the multivariate analysis (1.09; 95% confidence interval, 1-1.20). Compared with type I achalasia, JE exhibited higher values in pressure differences at 60 mL (27.7 vs 3.75, P< .001). Esophageal pressure, as measured by EndoFLIP, was significantly reduced when patients were sedated with sevoflurane-based GAIA. The use of sevoflurane-based GAIA for diagnostic EndoFLIP may potentially lead to the misclassification of spastic disorders as type I achalasia. Propofol-based TIVA should therefore be considered over sevoflurane-based GAIA for sedation during the diagnostic test.

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.

Anesthesia Options for Pediatric Endoscopy: A Review of Intravenous Sedation and General Anesthesia

Gastrointestinal (GI) endoscopy has emerged as an indispensable tool for the assessment and management of GI disorders. Intravenous (IV) sedation and General Anesthesia (GA) are both employed to alleviate patient discomfort and ensure amnesia during these procedures. Essential aspects of both methods include vigilant monitoring of consciousness levels, pulmonary ventilation, oxygenation and hemodynamics. While GI endoscopy is generally regarded as safe, there is a potential for complications. This is particularly noteworthy in the context of pediatric patients. Raising awareness of the potential complications linked to sedation during GI endoscopy in children and involving anesthesiologists in their care is pivotal to ensuring safety. Several risk factors for complications were identified, including younger age, higher ASA (American Society of Anesthesiologists) class (indicating more severe health conditions) and the use of IV sedation. Documented adverse events encompassed issues such as inadequate sedation, diminished oxygen saturation, airway blockages, episodes of apnea necessitating bag-mask ventilation, patient agitation, occurrences of bleeding and cases of organ perforation. Statistical analysis revealed that complications were less frequent when GA was used (1.2%) compared to IV sedation (3.7%). Furthermore, IV sedation was found to be independently linked to a 5.3% higher risk of cardiopulmonary complications compared to GA. Consequently, GA can be considered a safer and more efficacious choice in providing comfort and amnesia during GI endoscopy.

Oral Sedation Anesthesia Protocol for In-Office Oculoplastic Surgery.

To present an oral anesthesia protocol for in-office oculoplastic surgery and to compare safety outcomes and patient and physician experiences to ambulatory surgery center (ASC)-based surgery with intravenous sedation or general anesthesia. A prospective study was performed on consecutive patients undergoing surgery at an oculofacial plastic surgery practice. Surgery was performed in an in-office setting using our standardized oral sedation protocol or at an ASC with intravenous sedation or general anesthesia. Preoperative and postoperative surveys were conducted by patients and physicians to compare surgical experience, safety, and efficacy of our oral sedation protocol for in-office surgery in the ASC setting. Two hundred and fifty-three patients (167 in-office and 86 at ASC) underwent surgery between March and November 2022. There was no significant difference in how patients or physicians rated their experience between the 2 locations. A significantly higher proportion of ASC patients would have rather had surgery in-office (34.9% vs. 19.2%; p = 0.006). A significantly higher number of physicians in the office setting would have rather performed surgery at the ASC than the reverse (12.7% vs. 2.3%, respectfully; p = 0.007). There were no safety complications reported in either setting. Within our patient cohort, the presented oral sedation protocol provided safe and effective anesthesia for in-office oculoplastic surgery that is comparable to an ASC.

Comparing anesthesia modes in major burns: Total intravenous anesthesia versus general anesthesia - A cross-sectional study in a Central Indian government hospital

Background: Burn injuries remain a significant public health concern, causing complex trauma. Early excision and skin grafting are standard in burn management to reduce infection and scarring. The choice of anesthesia is critical for optimal pain control and hemodynamic stability. Aims and Objectives: This study aims to compare total intravenous anesthesia (TIVA) and general anesthesia (GA) in patients of major burns. Materials and Methods: The study was conducted in the Department of Anaesthesia, M.G.M. Medical College and M.Y. Hospital, Indore, over a period of 12 months. One hundred and twenty patients with 10–12% total burn area were included and randomized into two groups of 60 patients each. Group T patients received TIVA and Group G patients received GA. Results: Both the groups were comparable with respect to age, gender, and baseline vitals. The mean heart rate, systolic and diastolic blood pressure, and mean MAP were significantly higher in Group G at 0, 30, and 60 min. In Group T, all patients achieved an Aldrete score of 9 or more within 10 min. Pain was more prevalent in Group G patients, and the comparison was found to be statistically significant. The mean time to first rescue analgesia in Group T was later than Group G, and the difference was found to be statistically significant. Conclusion: From the results, we may conclude that TIVA provides superior hemodynamic stability, shorter post-anesthesia unit recovery time, and improved analgesia compared to GA. However, there are lacunae in the literature, hence we recommend that larger studies comparing these two anesthesia modes be conducted before generalizing the present findings to the general population.

The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial.

To observe the effect of iliac fascia space block combined with esketamine intravenous general anesthesia in proximal femoral nail antirotation (PFNA) of the elderly. Eighty elderly patients who underwent PFNA were randomly divided into experimental group and control group. In the experimental group, iliac fascial block combined with esketamine and propofol intravenous general anesthesia was used to keep spontaneous breathing. The control group used iliac fascia block combined with remifentanil and propofol intravenous general anesthesia to maintain spontaneous breathing. Record important indexes such as heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), visual analogue score (VAS) scores, etc. at different moment during the operation. Trial data showed that there were significant differences in HR, MAP, and SpO2 between the two groups at the beginning of operation, and there was no significant difference in VAS scores between the two groups at each moment after surgery, and there were significant differences in the number of vasopressor applications, length of hospital stay, and QoR-15 scores between the two groups, and there were significant differences in the incidence of total adverse reactions and the incidence of hypotension. The trial indicated that patients in the experimental group have more stable hemodynamics and lower stress response, which is conducive to rapid recovery after surgery.

Personalized asymmetric multiple PID to automatize the procedure of intravenous general anesthesia

General anesthesia has improved considerably over the years due to the automation of drug perfusion through closed-loop control which provided numerous advantages regarding efficiency and patient safety. This work describes the implementation and Validation of a control algorithm based on a multiple-input and multiple-output proportional–integral–derivative (MIMO-PID) controller. The main objective is to keep patients closer to the desired range of monitor values into satisfactory anesthetic state.The MIMO-PID decides the drug perfusion of propofol, remifentanil, and rocuronium based on the bispectral index, noxious stimulation response, and neuromuscular blockade monitorization. The main MIMO-PID variant is based on a feed-forward target which is used to define the asymmetric errors. The asymmetry allows different errors to be defined in each branch of each single-input and single-output proportional–integral–derivative. The MIMO-PID is tuned using the criterion of integral absolute error and their performance is evaluated through a range of experiments applying different metrics to evaluate monitors and drug perfusions. The satisfactory anesthetic state is achieved during the induction phase of anesthesia; however, we also had situations with a low relative deviation from the registered median values. We obtained good results by using a strict disturbance rejection.The controller was able to mitigate the surgery influence on the anesthetics effects when there were less than 20, the patient remained close to the desired anesthetic state. In the presence of significant or more numerous stimuli, the controller was able to achieve a satisfactory anesthetic state within a short period of typically less than 7 min.