Intravenous Induction Of Anesthesia Research Articles

Effect of transcutaneous electrical acupoint stimulation on postoperative recovery quality in patients undergoing endoscopic sinus surgery: a randomized controlled trial

To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative recovery and pain in patients undergoing elective endoscopic sinus surgery. One hundred and six patients scheduled for elective endoscopic sinus surgery were randomly divided into an observation group and a control group, with 53 patients in each group. Patients in both groups received TEAS or sham TEAS, respectively, from 30 min before intravenous anesthesia induction until the end of surgery. Acupoints selected were bilateral Neiguan (PC 6) and Zusanli (ST 36). The quality of requirements-15 (QoR-15) scores were assessed on the day before surgery (T0) and on postoperative days 1 (T1), 2 (T2) and 3 (T3). Pain visual analogue scale (VAS) scores were recorded at T1, T2 and T3. Athens insomnia scale (AIS) scores were measured at T0, T1, T2 and T3 in the two groups. The incidence of postoperative nausea-vomiting and dizziness-headache, usage of analgesics, number of patient-controlled analgesia (PCA) pump presses, and extubating time were also recorded in the two groups. At T1, T2 and T3, the observation group had higher QoR-15 scores (P<0.01, P<0.001) and lower AIS scores (P<0.001) than the control group. At T1 and T2, the observation group had lower pain VAS scores than the control group (P<0.001). The incidence of postoperative nausea-vomiting and dizziness-headache was 24.5% (13/53) and 37.7% (20/53) in the observation group, which were lower than 56.6% (30/53) and 66.0% (35/53) in the control group (P<0.01). There were no statistically significant differences in the use of rescue analgesics or the number of PCA pump presses between the two groups (P>0.05). The extubating time was shorter in the observation group compared with that in the control group (P<0.001). TEAS could improve postoperative recovery quality, alleviate postoperative pain, improve sleep quality, and reduce the incidence of postoperative nausea and vomiting in patients undergoing elective endoscopic sinus surgery.

Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study

IntroductionAtelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS).MethodsThis propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.ResultsOf the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21–8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis.DiscussionInhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates.Trial registrationClinicalTrials.gov identifier: NCT06069414.

Comparison of inhalational and intravenous anesthesia induction on electroencephalogram and cerebral perfusion in children with congenital heart disease: A secondary analysis of a randomized controlled trial

ObjectiveThe effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction. DesignA randomized controlled trial. SettingOperation room in two tertiary hospitals. ParticipantsA cohort of 116 pediatrics patients undergoing cardiac surgery. Measurements and main resultsThe patients were randomly assigned to either the intravenous group (n=58) or the inhalational group (n=58). The inhalational group received anesthesia induction with 4-6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, while the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison to the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (P<0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (P<0.05 for all). ConclusionThe administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared to the use of intravenous medications for anesthesia induction.

Novel technique of switching TIVA and sevoflurane during epilepsy surgery for combined intraoperative motor evoked potentials monitoring and electrocorticography: an illustrative case report

BackgroundDuring epilepsy surgery, it is equally important to record electrocorticography (ECoG) for detecting epileptogenic activity and guiding brain resection, and to evaluate neuromonitoring data, particularly motor evoked potentials (MEP), for avoidance of postoperative neurological complications. However, sevoflurane, which is commonly used during recording of ECoG, may attenuate the MEP response. It enforces anesthesiologists and neurosurgeons to select one anesthetic agent over another, facilitating either ECoG or MEP monitoring.Case presentationIn the presented case of a 20-year-old man, who underwent surgery for temporal lobe epilepsy, a novel technique of neuroanesthesia was introduced, integrating initial induction of the total intravenous anesthesia (TIVA) with propofol (effect-site concentration, 2.3–3.0 μg/ml), its subsequent switching to sevoflurane (end-tidal concentration, 2.5%) for ECoG recording, and further change back to TIVA for MEP monitoring during brain resection.ConclusionsIntraoperative switch of anesthetic agents according to specific intraoperative requirements may be useful for cases of brain surgery requiring both ECoG recordings and MEP monitoring.

Inadvertent administration of intravenous anaesthesia induction agents via the intracerebroventricular, neuraxial or peripheral nerve route - A narrative review.

Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high-risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration.

Effect of Anesthesia Induction with Midazolam on Hemodynamics in Abdominal Hysterectomy Surgeries

Objective: The primary task of anesthesiology is to control the patient's hemodynamic values, including blood pressure and heart rate, from pre-operative to post-operative. Many drugs are used alone or in combination for induction and maintenance of anesthesia. Various hemodynamic responses may develop to these drugs. In our study, we aimed to compare the effects of midazolam and propofol used alone in intravenous anesthesia induction on hemodynamics in patients undergoing abdominal hysterectomy. Materials and Methods: A total of 60 ASA I-II patients scheduled for abdominal hysterectomy were included in the study. During anesthesia induction, midazolam (0.2 mg/kg) was administered to Group M (n:30) and propofol 1% (2 mg/kg) was administered to Group P (n:30). Noninvasive systolic blood pressure, diastolic blood pressure, mean blood pressure and minute heart rate values were recorded. Results: Systolic blood pressure was significantly lower in group P than in M during intubation, skin incision, extubation and recovery. Conclusion:As a result, anesthesia induction with intravenous 0.2 mg/kg midazolam may cause higher systolic blood pressure values than 2 mg/kg propofol. It should not be overlooked that the hemodynamic response that will occur after the use of midazolam during anesthesia monitoring will vary depending on the anesthetic drugs and doses used together.

A study to assess the effect of pretreatment with intravenous palonosetron in preventing pain on propofol injection

Background. Propofol is widely used for induction, maintenance of anaesthesia and possess many characteristics of an ideal intravenous anaesthetic agent. It is known to cause severe, sharp, stinging or burning pain on injection which is considered to be unacceptable as it can cause agitation and interfere with smooth induction of anaesthesia. In this study we are comparing Palonosetron and Normal Saline in decreasing pain on injection of propofol during intravenous induction of anaesthesia. Material and methods. One hundred adult patients belonging to ASA physical status I or II, scheduled for elective surgeries under general anaesthesia were selected and randomly allocated to two groups. Group P received Injection Palonosetron and Group S received Injection Normal Saline as pre-treatment before injection of propofol. Patients were assessed for pain on propofol injection. Haemodynamic parameters and electrocardiography were recorded at the following points of time: prior to induction, after pre-treatment,induction, and half hourly during the surgery. Results. Comparing pain during propofol injection, 32% in Palonosetron group and 4% in Normal Saline group did not have pain, 54 % in Palonosetron group and 20 % in Normal Saline group had mild pain, 12% in Palonosetron group and 48% in Normal Saline group had moderate pain, 2% in Palonosetron group and 28% in Normal Saline group had severe pain. Conclusions. Pretreatment with Palonosetron 0.075 mg reduced the incidence and severity of propofol induced pain on injection, with an added advantage of decreased post-operative nausea and vomiting without significant haemodynamic changes.

Effects of intraoperative Magnesium sulfate infusion on emergency agitation during general anesthesia in patients undergoing radical mastectomy: a randomized controlled study

BackgroundEmergency agitation is a common postoperative complication in patients under general anesthesia, which can lead to unpredictable damages such as shedding of drainage tube and bleeding from the wound. The purpose of the study is to investigate whether intraoperative infusion of Magnesium Sulfate reduces the incidence of emergency agitation (EA) in patients undergoing radical mastectomy, and to evaluate its safety and efficacy.MethodsA total of 70 patients were randomly assigned to two groups: the Magnesium group (M group) and the control group (C group). After a routine intravenous anesthetic induction, patients in the M group received a 30 mg/kg bolus of intravenous magnesium during the first hour and then a continuous infusion of 10 mg/kg ×h until the end of the surgery, patients in the C group received 0.9% saline at the same volume and rate. The sedation-agitation scale (SAS) and the visual analogue scale were used to assess agitation and pain, respectively.ResultsCompared to the C group, the M group reduced the incidence of EA significantly (odds ratio 0.26, 95% confidence interval 0.09–0.71, P = 0.009). The postoperative pain score of the magnesium sulfate group(0(0,1)) was lower than that of the control group(2(0,3)) at T0 (P = 0.011). Additionally, the M group required a lower dosage of remifentanil during surgery compared to the C group(300.4 ± 84 versus 559.3 ± 184 µg, respectively, P<0.001).Conclusionsthe intraoperative infusion of magnesium sulfate is a safe and effective method for reducing the incidence of emergency agitation in patients undergoing radical mastectomy.Trail registrationThe study was registered in Chictr.org with the identifier: ChiCTR2300070595 on 18/04/2023.

The preventive effect of 5-hydroxytryptamine-3 receptor antagonist on blood pressure reduction and postoperative nausea and vomiting during general anesthesia induction: A double-blinded, randomized controlled trial

Study objectiveAdministering a 5-hydroxytryptamine-3 receptor (5-HT3) at anesthesia induction may aid in achieving hemodynamic stability during general anesthesia induced using opioids. Therefore, we aimed to evaluate the effect of ramosetron, a 5-HT3 antagonist, administered on hypotension at the induction of total intravenous anesthesia (TIVA) with propofol and remifentanil. Additionally, we aimed to compare the impact of ramosetron administration at anesthesia induction versus that at the end of the surgery on postoperative nausea and vomiting (PONV). DesignPatients were randomly allocated to the Induction group (administration of ramosetron [0.3 mg/5 ml] at anesthesia induction and normal saline [5 ml] at the end of the surgery) or End group (administration of normal saline [5 ml] at anesthesia induction and ramosetron [0.3 mg/5 ml] at the end of the surgery). Hemodynamic status, PONV, and postoperative pain were assessed. SettingOperating room, post-anesthetic care unit, and general ward. Patients: In total, 176 non-smoking patients without any past medical history undergoing laparoscopic gynecological surgeries under TIVA were included in the study. MeasurementsBlood pressure (BP), heart rate, PONV, visual analog scale (VAS). Main resultsThe Induction group exhibited significantly higher BP at anesthesia induction and required significantly lower doses of phenylephrine and ephedrine during anesthesia than the End group had. However, PONV and postoperative pain were similar between the two groups. ConclusionsAdministering ramosetron at anesthesia induction resulted in significantly better hemodynamic stability with significantly lesser requirement of phenylephrine and ephedrine than administering at the end of the surgery did. Therefore, we recommend ramosetron administration at anesthesia induction rather than at the end of the surgery to prevent PONV and the decrease in the mean BP during TIVA with propofol and remifentanil.

Effect of intravenous induction with different doses of Esketamine combined with propofol and sufentanil on intraocular pressure among pediatric strabismus surgery: a randomized clinical trial

BackgroundIt is well-established that maintaining stable intraocular pressure (IOP) within the normal range during ophthalmic surgery is important. Esketamine is a commonly used drug in pediatric general anesthesia due to its good analgesic and sedative effects. However, its application in ophthalmic surgery is limited because it can increase IOP. The effect of esketamine combined with other common anesthetics on IOP has been underinvestigated. This study aimed to investigate the effect of different doses of esketamine combined with propofol and sufentanil on IOP during intravenous induction of general anesthesia for pediatric strabismus surgery.MethodsA total of 181 children with strabismus undergoing unilateral eye surgery under general anesthesia were recruited. Intravenous induction included the use of sufentanil 0.1 µg/kg, propofol 3 mg/kg, and esketamine. Base on the dosage of esketamine, the patients were randomly allocated into three groups: esketamine low (EL) group with 0.25 mg/kg (n = 62), esketamine high (EH) group with 0.5 mg/kg (n = 60), and normal saline (NS) group (n = 59). Hemodynamic parameters, respiratory parameters, and IOP of the non-surgical eye were recorded and compared among the three groups at different time points: before induction (T0), 1 min after induction but before laryngeal mask insertion (T1), immediately after laryngeal mask insertion (T2), and 2 min after laryngeal mask insertion (T3).ResultsThere were no significant differences in age, gender, body mass index (BMI), and respiratory parameters among the three groups at T0. The IOP at T1, T2, and T3 was lower than that at T0 in all three groups. The EH group (12.6 ± 1.6 mmHg) had a significantly higher IOP than the EL group (12.0 ± 1.6 mmHg) and the NS group (11.6 ± 1.7 mmHg) at T1. However, no difference was found between the EL and NS groups at any time point. Systolic blood pressure (SBP) and heart rate (HR) at T1, T2, and T3 were lower than at baseline, and SBP and HR were higher at T2 than at T1. Additionally, the EH group had a significantly higher HR at T1 than the other two groups. There was no significant difference in diastolic blood pressure (DBP) among the three groups at any time point.ConclusionPropofol combined with sufentanil significantly decreased IOP during the induction of general anesthesia. Although a dose of 0.5 mg/kg esketamine elevated IOP compared to the low-dose and control groups after induction, the IOP remained lower than baseline. 0.25 mg/kg esketamine combined with propofol and sufentanil had little effect on IOP. Therefore, we advocate that a maximum dose of 0.5 mg/kg esketamine combined with propofol and sufentanil will not elevate IOP compared to baseline in pediatric strabismus surgery.Trial registrationThe registration number is ChiCTR2200066586 at Chictr.org.cn. Registry on 09/12/2022.

Effects of Alfaxalone on the Induction and Maintenance of Total Intravenous Anesthesia in Gentoo Penguins (Pygoscelis papua).

Systemic anesthesia in penguins is often achieved using inhalation anesthetic agents alone, and information on injectable drugs for systemic anesthesia is limited. General anesthesia with a minimal effect on circulatory dynamics is necessary to perform noninvasive examinations and treatments in animals, including penguins. In this study, alfaxalone (ALFX), an injectable anesthetic agent, was examined to establish the optimal anesthetic method for gentoo penguins (Pygoscelis papua). Alfaxalone was administered intravenously through the metatarsal vein, and anesthesia was maintained by a constant rate infusion (CRI). A biological monitor was used to record numerous clinical indices, and the anesthetic depth was evaluated every 5 minutes during anesthesia; the CRI was adjusted until the optimal anesthetic depth was obtained. Anesthesia depth was assessed, and the CRI rate was adjusted. The CRI was stopped, and the time until recovery was recorded. Blood samples were collected to analyze plasma concentrations of ALFX. The mean total dose of ALFX required for anesthetic induction was 9 ± 1.9 mg/kg, the intubation time was 126 ± 21 seconds, and the maintenance infusion rate of ALFX was 0.3 ± 0.08 mg/kg/min. The time from discontinuation of anesthesia to extubation was 42 ± 23 minutes, and the time to recovery was 90 ± 33 minutes. Significant changes in the heart rate and blood pressure were not observed during the anesthetic events. The plasma concentration of ALFX under stable anesthesia was 6734 ± 4386 ng/mL (range, 3315-14 326 ng/mL). Although anesthesia using ALFX tended to result in a prolonged time to recovery in gentoo penguins, rapid induction of anesthesia and stable hemodynamics during anesthetic maintenance were achieved. Therefore, ALFX may be considered a suitable anesthetic method for noninvasive examinations and treatments in penguins.

Evaluation of Anaesthetic Indices and Physiological Variables Following Total Intravenous Anaesthesia with Acepromazine-Butorphanol-Propofol Combination in Dogs

The study determined the anaesthetic and physiological effects of Acepromazine-Butorphanol-Propofol (ABP-combination) and propofol alone (PRO alone) in dogs. Ten clinically healthy dogs were randomly assigned to two groups to evaluate the anaesthetic and physiological effects following ABP-combination and PRO-alone anaesthesia administered intravenously (iv). Acepromazine at 0.02mg/kg and Butorphanol at 0.05mg/kg iv were used to premedicate the dogs and Propofol at 4mg/kg for induction five minutes after premedication in ABP-combination group while Propofol alone at 6mg/kg for total intravenous anaesthesia (TIVA) induction without premedication. Onset of anaesthesia, duration of anaesthesia time to standing, onset and duration of analgesia and duration of intubation were measured, whereas temperature, heart rate and respiratory rates were measured before induction of anaesthesia and at five minutes interval during anaesthesia. All the anaesthetic indices were significantly (p&lt;0.05) different between groups while onset and duration of analgesia was recorded in ABP group only. Significantly (p&lt;0.05) longer duration of anaesthesia was produced by ABP-combination compared with PRO-alone. Time to standing were significantly different (p&lt;0.05) between the two treatments. The onset and duration of analgesia was 5.0±2.0 and 33.6±3.2 min. following ABP-combination but no analgesia recorded with PRO-alone. There was significant decrease (p&lt;0.05) in rectal temperature and respiratory rate from the baseline in ABP-combination group but not significant in PRO-alone group. There was significant (p&lt;0.05) difference in heart rates between groups. ABP-combination TIVA provided longer duration of anaesthesia and analgesia with minimal effects on vital parameters. The dogs recovered from the anaesthesia uneventfully. The ABP-combination can be evaluated for clinical procedures in dog.

The Effect of Intravenous Induction of Anesthesia on the Hemodynamic Changes among Patient in Central Surgical Unit of Level-II Udayana Denpasar Hospital

Introduction: Intravenous anesthetic induction is a medically-induced technique that can cause hemodynamic disorder. The impact that occurs if hemodynamic disorders are not immediately resolved in patients with intravenous anaesthesia induction can cause an increase or decrease in blood pressure, decreased tissue perfusion, increased heart rate and arrhythmias so that it disrupts the surgical action plan. Blood pressure, Mean Arterial Pressure (MAP), and pulse should be monitored carefully during induction. We ought to examine the effect of intravenous induction of anesthesia on the hemodynamic changes among patients in the Level-II Udayana Denpasar Hospital.&#x0D; Methods: This was a descriptive cross-sectional study with a consecutive sampling technique. All patients under intravenous induction of anesthesia were considered eligible study respondents. Data were collected using an observation sheet, The number of samples in this study were 60 respondents, and the statistical test used a univariate technique by looking at the frequency distribution of the hemodynamic features of the patient's blood pressure and pulse.&#x0D; Results: Findings reported that the majority of patients were documented with normal systolic blood pressure (51: 85.0%), normal MAP (56; 93.3%), and normal pulse rate (44; 73.3%) during the intravenous induction. Low diastolic blood pressure was reported among 33 respondents (55.5%).&#x0D; Conclusion: The intravenous anesthetic induction altered the hemodynamic status among the respondents.

Effect of priming in preventing myoclonic movements after intravenous induction with etomidate in adult patients undergoing cardiac surgery: a randomised controlled interventional study

Etomidate is a hypnotic drug used as an intravenous anaesthetic induction agent. Etomidate causes myoclonic movements in 50-80% patients after induction which makes it less desirable for induction. Aim: Present study was to determine the effect of priming in preventing myoclonic movements after intravenous injection with etomidate in adult patients undergoing cardiac surgery. Materials and Methods: 108 patients ASA grade III scheduled for elective cardiac surgery were allocated randomly in two groups- Group A (n=54): Patients received induction dose of 0.3mg/kg I.V. etomidate, Group B (n=54): Patients received a priming dose of 0.03mg/kg etomidate I.V. followed after 1 minute by induction dose of 0.3 mg/kg I.V. etomidate over 20 seconds. 3 minutes after the start of induction with etomidate, patients in both groups were given injection fentanyl 4mcg/kg followed by injection Rocuronium (1mg/kg bodyweight) to facilitate tracheal intubation. The occurrence and intensity of myoclonus were observed for 3 min from the start of injection of the induction dose and graded clinically by a blinded observer as: 0=no myoclonus, 1=mild myoclonus, 2=moderate myoclonus and 3=severe myoclonus. Result: The average dose of etomidate used during induction and demographic variables were similar in both the groups. The incidence of myoclonus in priming Group (27/54 [50%] was significantly lower than in control Group (45/54 [83.33%].Myoclonus of moderate or severe grade occurred in significantly more patients in control Group (68.3%) than in priming Group (36.5%).Conclusion: Pre-treatment with etomidate (0.03 mg/kg), given 60 seconds before induction of anaesthesia is more effective in reducing the incidence of etomidate-induced myoclonus without related side-effects.

Effects of topical anesthesia with 1% tetracaine on hemodynamic responses in microlaryngosurgery

Objective: To observe the effects of topical anesthesia with 1% tetracaine on hemodynamic responses in general anesthesia patients undergoing microlaryngosurgery. Methods: From October 2021 to December 2021, 92 patients (46 males and 46 females) in Beijing Tongren Hospital, with a median age [M (Q1, Q3)] of 51 (42, 57) years who scheduled for microlaryngosurgery under general anesthesia, were divided into two groups (n=46 in each group) using the random number table method. Group T received topical anesthesia with 1% tetracaine at the root of the tongue and epiglottis and glottis on the basis of general intravenous anesthesia induction, with 0.5 ml at each position, while the control group (group C) received equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of patients entering the operating room (baseline), after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation. The recovery profiles, including time to recover breathing, time to open eyes, time to extubation and adverse reactions were evaluated during recovery period. Results: The MAP of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation were (99.4±12.9), (78.5±8.8), (79.2±10.2), (100.6±17.0), (101.9±14.7), (100.8±13.9), (97.4±12.1), (107.3±16.8) mmHg (1 mmH=0.133 kPa), respectively, while in group C were (99.5±11.6), (80.9±12.8), (90.5±16.0), (109.5±20.4), (108.0±18.9), (103.7±15.5), (100.1±13.3), (114.2±17.3) mmHg, respectively. The two critical time points of MAP after intubation and immediately suspending laryngoscopy in group C were significantly higher than group T (P<0.05).The HR of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation was (71.3±10.6), (66.0±10.1), (69.5±11.4), (61.3±14.2), (69.8±9.8), (71.0±10.6), (70.6±11.0), (78.8±11.6) bmp, respectively, while in group C were (73.1±10.9), (67.8±9.9), (79.5±12.9), (57.1±18.1), (69.2±12.8), (71.4±11.7), (70.7±11.5), (85.3±13.0) bmp, respectively. The two critical time points of HR after intubation and after extubation in group C were significantly higher than that of group T (P<0.05). The time to recover breathing in the two groups was (11.8±3.5) min and (11.3±4.6) min, respectively. The time to open eyes was (12.0±3.3) min and (11.5±5.0) min, respectively. The time to extubation was (13.2±3.7) min and (12.6±4.9) min, respectively. There were no statistically significant difference in time to recovery between the two groups (P>0.05). Likewise, there were no toxic reactions to local anesthetics, respiratory depression, hypoxemia, laryngospasm and cough occurred in either group. Conclusion: Topical anesthesia with 1% tetracaine can effectively reduce the hemodynamic changes without influencing patient's recovery, and does not increase the incidence of adverse reactions.

Quantitative evaluation of aerosol generation from upper airway suctioning assessed during tracheal intubation and extubation sequences in anaesthetized patients

SummaryBackgroundOpen respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence.AimTo assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients.MethodsThis prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3–10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation.FindingsAerosol was reliably detected {median 65 [interquartile range (IQR) 39–259] particles/L} above background [median 4.8 (IQR 1–7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0–12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30–75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600–4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300–1826) particles/L, P<0.0001].ConclusionUpper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.

Propofol anesthesia concentration rather than abrupt behavioral unresponsiveness linearly degrades responses in the rat primary auditory cortex.

Despite extensive knowledge of its molecular and cellular effects, how anesthesia affects sensory processing remains poorly understood. In particular, it remains unclear whether anesthesia modestly or robustly degrades activity in primary sensory regions, and whether such changes are linked to anesthesia drug concentration versus behavioral unresponsiveness, which are typically confounded. Here, we used slow gradual intravenous propofol anesthesia induction together with auditory stimulation and intermittent assessment of behavioral responsiveness while recording epidural electroencephalogram, and neuronal spiking activity in primary auditory cortex (PAC) of eight rats. We found that all main components of neuronal activity including spontaneous firing rates, onset response magnitudes, onset response latencies, postonset neuronal silence duration, late-locking to 40Hz click-trains, and offset responses, gradually changed in a dose-dependent manner with increasing anesthesia levels without showing abrupt shifts around loss of righting reflex or other time-points. Thus, the dominant factor affecting PAC responses is the anesthesia drug concentration rather than any sudden, dichotomous behavioral state changes. Our findings explain a wide array of seemingly conflicting results in the literature that, depending on the precise definition of wakefulness (vigilant vs. drowsy) and anesthesia (light vs. deep/surgical), report a spectrum of effects in primary regions ranging from minimal to dramatic differences.

English

BACKGROUND Propofol is an appropriate intravenous anaesthetic induction agent for rapid induction and suppression of airway reflexes and is widely used for laryngeal mask airway insertion. Sevoflurane is a halogenated, non-pungent and non-explosive liquid anaesthetic agent with low blood gas solubility administered by inhalation for use in induction and maintenance of general anaesthesia. We wanted to compare the characteristics of sevoflurane and propofol for the induction of anaesthesia and laryngeal mask airway (LMA) insertion. METHODS We conducted a randomized control study among 70 patients (n=35 in each group) undergoing elective surgery. Patients were anaesthetised with either vital capacity breaths of 8% sevoflurane with 50% N2O and O2 or IV propofol, with loss of eyelash reflex considered as the end point of induction. RESULTS Both the drugs produced almost similar rapid loss of consciousness (propofol-45.29 ± 11.98 sec, sevoflurane-51.03±14.68 sec). The LMA was inserted more rapidly in propofol group (20.43±9.460 sec) than in the sevoflurane group (34.37 ± 17.338 sec), p=0.018. The score for jaw opening was better in the propofol group (2.94 ± 0.236) than in the sevoflurane group (2.66 ± 0.482), p=0.000. The ease of LMA insertion score was better in the propofol group (2.91 ± 0.284) than in the sevoflurane group (2.66 ± 0.482), p=0.008. Both groups had stable haemodynamic parameters. CONCLUSIONS Propofol was more favourable than sevoflurane for laryngeal mask airway insertion due to better jaw relaxation and less insertion time. However, sevoflurane is an alternative to propofol as an induction agent for laryngeal mask airway insertion. KEY WORDS Propofol, Sevoflurane, Laryngeal Mask Airway.

A comparative randomized study of awareness during two anesthetic induction techniques in old aged patients using isolated forearm technique

Background &amp; Objective: Awareness under anesthesia is defined as intraoperative consciousness and/or postoperative recall of surgical events. The isolated forearm technique (IFT) is a technique that has the ability to assess consciousness of the external world through a verbal command during general anesthesia. It provides live information about the presence of consciousness.&#x0D; We compared inhalational induction technique versus intravenous induction technique regarding awareness during laryngoscopy and intubation in elderly patients.&#x0D; Design: A prospective, randomized trial&#x0D; Methodology: A total of 50 patients scheduled for elective surgery under general anesthesia; aged 60 to 80 years were recruited. Patients were randomized into either Group A (inhalational induction group) or Group B (total intravenous induction group). Awareness reaction using IFT technique was observed during laryngoscopy and intubation phase to identify awareness incidence. A patient was considered a responder if IFT score &gt; 2.&#x0D; Results: At laryngoscopy and intubation phase, 32% of cases had an awareness reaction in intravenous induction group (Group B): While in the inhalational induction group (Group A), only 8% of cases had an awareness reaction. Additionally, none of the patients, suffered from postoperative explicit recall as detected by modified Brice questionnaire (MBQ).&#x0D; Conclusions: On the basis of the results of our study, we conclude that intravenous induction of general anesthesia may subject old aged patients to a higher incidence of awareness when compared to inhalational induction technique.&#x0D; Trial Registration: NCT05019560&#x0D; Abbreviations: TIVA - Total intravenous anesthesia; IFT - Isolated forearm technique; MBQ - Modified Brice questionnaire; BISTM -Bispectral Index™; ETAC - End-tidal anesthetic concentration; MAC – Minimum alveolar concentration&#x0D; Key words: Awareness; The modified Brice questionnaire; Elderly patients; Isolated forearm technique; Sevoflurane; TIVA&#x0D; Citation: Ibrahim TH, Ayoub AH, Ibrahim IM, Ismaiel MAA, Mostafa RH. A comparative randomized study of awareness during two anesthetic induction techniques in old aged patients using isolated forearm technique. Anaesth. pain intensive care 2022;26(1):81-88.&#x0D; DOI: 10.35975/apic.v26i1.1772&#x0D; Received: November 14, 2021, Reviewed: December 18, 2021, Accepted: December 22, 2021

Pre-treatment with lignocaine and ondansetron for prevention of pain on propofol injection: A prospective, double blinded, randomised comparative study

Background: Propofol is widely used for induction and maintenance of anaesthesia as well as for intensive care unit (ICU) sedation. One of its persistent side effects that still remains of concern today is the vascular pain associated with its injection. It causes significant distress to the patient and interfere with smooth induction of anaesthesia. Various pharmacological and nonpharmacological interventions have been done to eliminate pain on propofol injection (POPI). In this study we compared lignocaine and ondansetron in decreasing POPI during intravenous induction of anaesthesia. Material and methods: One hundred adult patients belonging to American society of Anaesthesiology (ASA) physical status I and II, scheduled for elective surgeries under general anaesthesia were selected and randomly allocated in to two groups. Group 1 received intravascular injection of lignocaine 0.1 mg/kg and Group 2 received injection ondansetron 0.1mg/kg as pre-treatment. A tourniquet was put before giving the pre-treatment followed by injection propofol for both the groups. Patients were assessed for pain during injection of propofol. Heart rate, blood pressure, and oxygen saturation were recorded at peri-induction and postoperatively. Results: The results showed no pain following propofol injection in 54% (Group 1, lignocaine group) and 60% (Group 2, ondansetron group); moderate pain in 10% in both the groups; severe pain in 2% (Group 1) and 6% (Group 2), of the patients. No significant haemodynamic changes were observed in both the groups. Conclusion: Pre-treatment with ondansetron is as effective as lignocaine in reducing POPI.