Mean Induction Time Research Articles

Assessing the Anaesthetic Time on Operation Theatre Utilisation and Case Cancellation

The time to perform an anaesthesia-related procedure at induction and emergence is often overlooked as part of the operation theatre (OT) utilisation time. This prospective observational study aimed to assess the estimation done by the surgeons and anaesthetists on anaesthesia times and the overall OT utilisation in our centre. This prospective observational study included elective cases from 13 surgical disciplines. The trainees, specialists and consultants from surgical and anaesthesia teams estimated the anaesthesia times separately before the surgical procedures. The actual anaesthesia, surgical, total procedural and turnover durations taken to complete the cases were documented. Operation theatre utilisations of those various surgical disciplines involved in the study were also analysed. We analysed 128 elective cases. The average mean time spent for anaesthesia procedures was 28.4 ± 14.1 min, with the mean induction time was 16.0 ± 9.8 min and the mean emergence time was 12.5 ± 8.6 min. Both anaesthetists and surgeons overestimated the anaesthetic times, but anaesthetists estimated closer to the actual anaesthetic times (r = 0.64 vs r = 0.49, respectively). There was no significant difference in the estimated anaesthetic times between different experience levels. All the surgical disciplines had average OT utilisation exceeding 90%, indicating overutilisation. A total of 12 cases (7.1%) were cancelled. Most cases were cancelled due to exceeded allocated block OT times (7 cases) or unavailability of ICU beds (2 cases). We concluded that OTs exceeding the given OT time is the most frequent reason for cancelling elective surgical cases on the day of surgery.

Ketamine-butorphanol-medetomidine for the immobilisation of free-living hyenas (Crocuta crocuta).

Free-ranging spotted hyenas (Crocuta crocuta) are immobilised for a variety of purposes, including wildlife-human conflict mitigation, research, and veterinary treatment. Combinations of tiletamine-zolazepam (Zoletil) and medetomidine are commonly used for immobilisation of hyenas, however, recovery times are long. In this descriptive study, a total of 20 adult or subadult free-ranging hyenas were immobilised near Skukuza in the Kruger National Park using ketamine, butorphanol, and medetomidine. The goal of the study was to evaluate a suitable dose and measure cardiorespiratory effects of this combination. The quality of induction and recovery were scored using an established scoring system from 1 (excellent) to (poor). Twelve of the 20 hyenas were given an induction score of 1 (excellent), five an induction score of 2 (good), and three an induction score of 3 (fair). Of the animals with induction score = 1, the mean drug dose was 1.17 mg/kg ketamine, 0.25 mg/kg butorphanol and 0.03 mg/kg medetomidine, and the mean induction time and time to handling 6:25 minutes and 9:46 minutes respectively. The mean recovery time (from reversal to standing) was 10:16 min, which is shorter than what has been reported for tiletaminezolazepam- based combinations in hyenas. Most hyenas were bradycardic (< 40 beats per minute) and the mean PaO2 69.5 mmHg. Three hyenas, one with induction score = 2, and two with induction scores = 3 spontaneously recovered at 33, 44 and 56 minutes post approach respectively. Regardless of induction time, all hyenas reached a level of surgical anaesthesia while immobilised. Overall, ketamine-butorphanol-medetomidine (KBM) was effective in immobilising hyenas but induction times varied, and animals were bradycardic during immobilisation.

Blood collection under anesthesia, peripheral blood cells, plasma biochemistry, and plasma protein electrophoresis in a living fossil: the Spotted Ratfish (Hydrolagus colliei).

This report describes the safe and effective handling under anesthesia, blood collection and main clinical pathology values determination for three adult Spotted Ratfish (Hydrolagus colliei) (two males and one female) successfully maintained under human care for more than 20 years. The anesthetic MS-222 diluted in tamponed salt water at 50 ppm provided deep narcosis with mean induction and recovery times of 5 and 20 min, allowing safe handling and blood collection in the three animals sampled. Major leukocyte types were similar to other teleost and elasmobranch species, identifying lymphocytes as the predominant leukocyte (75.5%), followed by the fine eosinophilic granulocytes (10.25%), the coarse eosinophilic granulocytes (9.75%), and a small percentage of monocytes (5.50%). Plasma biochemistry values in this species were like those seen in elasmobranchs, with the highest levels of blood urea nitrogen described in any Chondrichthyes (mean 679.7 mmol/l). Plasma protein electrophoresis analysis in the Spotted Ratfish showed five consistent fractions, like those previously described in other fish species, with a negligible quantity of proteins migrating in the region equivalent to albumin, and with fraction 4 (mean 53.20%) as the predominant fraction. Despite the limitations imposed by the small sample size and the challenging access to the studied species under human care, this study will shed light on and enhance clinical knowledge regarding Ratfish handling, anesthesia, blood collection, and analysis. It aims to deliver a comprehensive clinical pathology description, presenting valuable data for professionals engaged in the care and management of Chimaerans.

A MIXTURE OF NALBUPHINE, AZAPERONE, AND MEDETOMIDINE FOR IMMOBILIZING RINGTAILS (BASSARISCUS ASTUTUS).

We evaluated a combination of nalbuphine HCl (40 mg/mL), azaperone tartrate (10 mg/mL), and medetomidine HCl (10 mg/mL), a combination known as NAM or NalMed-A, in 23 ringtails (Bassariscus astutus) during 29 handling events for a radio-collaring study in southern Oregon, US, from August 2020 to March 2022. The combination was delivered to ringtails by hand injection at 0.075 mL NAM per estimated 1 kg body mass. The mean (± standard deviation, SD) dosage calculated post hoc was 3.366 (±0.724) mg/kg nalbuphine, 0.841 (±0.181) mg/kg medetomidine, and 0.841 (±0.181) mg/kg azaperone. All captured ringtails were effectively immobilized with a mean (SD) induction time of 13.24 (±3.57) min. The medetomidine and nalbuphine components were antagonized with a combination of atipamezole and naltrexone HCl with a mean (SD) recovery time of 2.48 (±1.94) min. This combination appeared to be safe and effective for immobilizing ringtails with a low volume dose, smooth antagonism, and rapid recovery. In addition, NAM does not contain any drugs that are US Drug Enforcement scheduled, which makes it useful for immobilization procedures by wildlife professionals in the US.

COMPARISON OF KETAMINE-MIDAZOLAM AND KETAMINE-MIDAZOLAM-BUTORPHANOL PREMEDICATION PRIOR TO SEVOFLURANE ANESTHESIA IN WOODCHUCKS (MARMOTA MONAX).

Cardiovascular disease is a frequent cause of death in the critically endangered Vancouver Island marmots (Marmota vancouverensis). This warrants the use of anesthetic protocols with minimal cardiovascular adverse effects. In this study, 12 adult male woodchucks (Marmota monax) were used as models for Vancouver Island marmots. The objective was to compare the physiological effects of two premedication protocols during induction and maintenance of anesthesia with sevoflurane. The two premedications were ketamine 10 mg/kg and midazolam 0.5 mg/kg (KM) or ketamine 10 mg/kg, midazolam 0.5 mg/kg, and butorphanol 1.0 mg/kg (KMB), administered intramuscularly prior to mask induction. Each marmot underwent three anesthetic events and protocols were assigned using a blinded randomized crossover design. Heart rate, respiratory rate, oxygen saturation, and body temperature were recorded throughout, and blood gases were assessed following induction. Resistance to induction was scored and time to induction was recorded. Although mask induction with sevoflurane was successful in all events (mean induction time of 2.1 min), KMB premedication resulted in a faster induction (mean induction time reduced by 1.2 ± 0.3 min) and lower resistance scores. Both protocols resulted in significant cardiovascular and respiratory depression; however, animals that received KMB were more hypercapnic than KM by 8.8 ± 2.8 mm Hg (P = 0.03) (mean venous partial pressure of carbon dioxide [PvCO2] for all: 79.9 mm Hg). In conclusion, if shorter induction times are desired, KMB premedication is preferred. However, cardiorespiratory variables including blood pressure should be monitored, and endotracheal intubation is recommended to allow for ETCO2 monitoring and provision of intermittent positive pressure ventilation.

Immobilization of Raccoons (Procyon lotor) with Nalbuphine, Medetomidine, and Azaperone.

Chemical immobilization is widely used by wildlife and veterinary professionals for the safe handling of animals. A combination of nalbuphine (40 mg/mL), azaperone (10 mg/mL), and medetomidine (10 mg/mL), known as NAM, is a low-volume combination with field immobilization practicality and fewer regulations restricting its use in the US than some other drug combinations. We evaluated the safety and effectiveness of NAM as an immobilizing agent for raccoons (Procyon lotor). From May 2021 to February 2022, 16 adult raccoons were captured in cage traps and immobilized with 0.3 mL NAM intramuscularly (12 mg nalbuphine, 3 mg medetomidine, and 3 mg azaperone, regardless of body weight). After administration, time to sedation was measured; body temperature, heart rate, respiratory rate, and oxygen saturation were monitored and recorded every 5 min for 20 min. Each raccoon was weighed; the dose administered was calculated (range 2.2-4.1 mg/kg, mean 3 mg/kg). Mean induction time was 6 min (4-17 min); time to recovery following administration of 15 mg atipamezole, 7.5 mg naltrexone for reversal, was 10 min (6-18 min). Heart rate, oxygen saturation, and respiration rate remained steady during immobilization. Rectal temperature steadily declined. Overall, NAM appeared to be a practical option for raccoon immobilization, providing rapid induction and reversal as well as adequate sedation for short-term handling and minimally invasive sampling.

Comparative evaluation of propofol, thiopentone and etomidate on induction time, intubation response and recovery time during laparoscopic surgery under general Anaesthesia

: Optimal choice of inducing agent can partially modify the post induction hypotension, having a reported incidence of 9-40% in various studies. So, we compared the induction and recovery profile of the routinely available induction agents.This prospective randomized, comparative study was carried out on 120, ASA 1 and II patients undergoing routine laparoscopic cholecystectomy. Patient received either thiopentone 5 mg/kg, propofol 2.0 mg/kg or 0.3mg/kg injection etomidate at induction in group T, P and E respectively. The time taken from the administration of inducing agent to loss of eyelash reflex was noted. Heart rate, systolic, diastolic and mean arterial pressure, SpO2 was recorded at 1, 2, 3, 4, 5, 6 minutes and every five minutes after intubation. Steward score and the vitals were noted every 5 minutes after extubation till 30 minutes. It was noted that how long it took to get a Steward score of 6.The mean induction time (sec) was 49.85 ±2.54 in group T, 43.45 ±2.66 in group P and 52.675 ±2.11 in group E. (p&amp;#60;0.0001). The increase in mean heart rate from baseline upon induction and intubation was (10%, 31% in group T), (3%, 23% in group E) and (-7%, 16% in group P) (p&amp;#60;0.0001). Post induction decrease in systolic, diastolic and mean blood pressures observed in group T was (-9%, -4.5%, -6%), (-12.8%, -9.8%, -11%), in group P and (-4.6%, -1.7%, -2.9%) in group E. (p&amp;#60;0.0001). Post intubation increase in systolic, diastolic and mean blood pressures was (21.76%, 18%, 19.7%) in group T, (16%, 8.1%, 11.7%) in group E and (9.6%, 0%, 4%) in group P. Mean recovery time in min was 5.87 ±0.23 min with propofol, 6.97 ±0.28 with etomidate and 8.96 ±0.28 with thiopentone. (p&amp;#60;0.0001). : Amongst the three agents, we recommend propofol as preferred agent for induction due to faster induction, better attenuation of intubation response, faster recovery and stable hemodynamic parameters.

A Prospective, Randomized, Double-blinded Study on the Comparison of Propofol and Ketofol (Combination of Ketamine and Propofol) for Modified Electroconvulsive Therapy

ABSTRACT Background and Aims: Modified electroconvulsive therapy is routinely used to treat complicated psychiatric disorders. Its therapeutic effect is directly proportional to induced seizure duration but it is associated with hemodynamic disturbances. The aim of this study was to evaluate the effect of a ketamine + propofol combination (“ketofol”) for electroconvulsive therapy and to compare these with the effects of propofol alone. Methods: In this prospective study, 60 patients aged 18–60 years with American Society of Anesthesiologists (ASA) Ι and ΙΙ for psychiatric disorders were included. Patients were divided into two groups (30 each). Group P received propofol at 10 mg/ml and group K received ketofo at 10 mg/ml (ketamine 5 mg/ml and propofol 5 mg/ml in a 1:1 ratio). Motor/electroencephalography (EEG) seizure duration, induction time, hemodynamic variables, recovery time, agitation score, and complications were recorded. Standard qualitative and quantitative tests were used to compare the data (e.g., unpaired student t-test, Chi-squared test, etc). A P value of &lt; 0.05 was considered to be significant. Results: The mean duration of (motor/EEG) seizure was statistically significantly high in the ketofol group compared to the propofol group (P = 0.0001/0.0001). The mean induction time was significantly less in the ketofol group compared to propofol group (P = 0.0001). The recovery time was significantly early in group K patients compared to group P (P = 0.004). The ketofol group was more hemodynamically stable with comparable agitation score and side effects than patients in the propofol group. Conclusion: In modified ECT, ketofol was associated with longer seizure duration, lesser induction time, better hemodynamic stability, early recovery with comparable post ECT agitation and adverse effects compared to propofol alone.

Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction.

Dexmedetomidine (DEX) is a sedative with greater preservation of cognitive function, reduced respiratory depression, and improved patient arousability. This study was designed to investigate the performance of DEX during anesthesia induction and to establish an effective DEX induction strategy, which could be valuable for multiple clinical conditions. Patients undergoing abdominal surgery were involved in this dose-finding trial. Dixon's up-and-down sequential method was employed to determine the effective dose of DEX to achieve the state of "loss of consciousness", and an effective induction strategy was established with continuous infusion of DEX and remifentanil. The effects of DEX on hemodynamics, respiratory state, EEG, and anesthetic depth were monitored and analyzed. Through the strategy mentioned, the depth of surgical anesthesia was successfully achieved by DEX-led anesthesia induction. The ED50 and ED95 of the initial infusion rate of DEX were 0.115 and 0.200 μg/kg/min, respectively, and the mean induction time was 18.3 min. The ED50 and ED95 of DEX to achieve the state of "loss of consciousness" were 2.899 (95% CI: 2.703-3.115) and 5.001 (95% CI: 4.544-5.700) μg/kg, respectively. The mean PSI on the loss of consciousness was 42.8 among the patients. During anesthesia induction, the hemodynamics including BP and HR were stable, and the EEG monitor showed decreased α and β powers and increased θ and δ in the frontal and pre-frontal cortices of the brain. This study indicated that continuous infusion of combined DEX and remifentanil could be an effective strategy for anesthesia induction. The EEG during the induction was similar to the physiological sleep process.

Stability of unilaterally adrenalectomized rats to anaesthesia using xylazine-ketamine as a model

The stability of every patient to anaesthesia is crucial to a successful surgery and full recovery. This study evaluated the stability of unilaterally adrenalectomized rats to anaesthesia using Xylazine-Ketamine as a model. Twelve female Wistar rats were randomly assigned to two groups of 6 each. Group 1 were the sham group which underwent laparotomy only, while group 2 had their left adrenal glands excised. Three weeks post-adrenalectomy, the animals in both groups were anaesthetized according to standard technique. Anaesthetic parameters assessed include the induction time, time to attain surgical plane of anaesthesia, duration of surgical plane of anaesthesia, duration of anaesthesia, rectal temperature and respiratory rate. Results showed that the mean induction time, time to attain surgical plane of anaesthesia and duration of anaesthesia were not significantly different (p&gt;0.05) between the two groups. The pedal withdrawal reflex (PWR) and the whiskers movement (WM) were used to evaluate the duration of surgical plane of anaesthesia. The duration of surgical plane of anaesthesia determined by the PWR was significantly (p≤0.05) higher in the unilaterally adrenalectomized rats. There were also significant decreases in rectal temperature and respiratory rate when the unilaterally adrenalectomized groups were compared to the controls. From the results, the unilaterally adrenalectomized rats were comparatively as stable to Xylazine-Ketamine anaesthetic protocol as their intact counterparts, at three weeks post-adrenalectomy. However, there may be need to exercise caution when choosing an anaesthetic protocol for unilaterally adrenalectomized animals with special considerations given the depth and duration of anaesthesia required for a procedure and the length of time post-adrenalectomy.

An exploratory study of distractions during the induction phase of pediatric procedural sedation with propofol.

Distractions are a leading cause of disturbance to workflow during medical care. Distractions affecting the anesthetic team in the operating room are frequent and have a negative impact on patient care one-fifth of the time. The objective of this study was to evaluate the frequency, source, target, and impact of distractions during the induction phase of pediatric procedural sedation outside the operating room. Distractions were analyzed during propofol induction for oncology procedures from 45 video recordings. Distraction was defined as any event that disturbs or has potential to disturb the sedation team from performing their primary tasks. The type of distraction was cataloged into communication, coordination, extraneous events, equipment, layout, and usability. A five-point Likert scale was used to quantify the impact on the sedation team or its members. All patients had a diagnosis of acute lymphocytic leukemia and had a mean age of 8.4 years. Five hundred and sixty-seven distractions occurred and averaged 12.6 events (±5.6) per induction (mean induction time 3 min 12 s). Extraneous events were most common, accounting for 55% (312/567) of all distractions. Most distractions had an impact on the sedation team's workflow, resulting in multitasking (46%, n = 262), and in either brief or complete disruption from a primary task (17%). Sedation nurses were impacted most often, 62% of the time. Coordination and usability issues resulted in the greatest negative impact, mean ± SD, 3.7 ± 1.0 and 3.5 ± 0.9, respectively. There was no significant association between distractions and adverse events or induction length. Distractions are common during procedural sedation, with extraneous events being most frequent. Coordination issues within the team and usability problems had the greatest negative impact on sedation team workflow. Nurses were the most frequent target. Distractions impacted sedation team workflow but had no association with patient outcomes.

Nitrous Oxide Influence on Induction of Anaesthesia with Sevoflurane

Objective: To find out if the addition of Nitrous Oxide to Sevoflurane significantly reduces induction time and to study the effect of Nitrous Oxide on the frequency of adverse events during induction.&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration of Study: Operation Theatre Complex, PAF Hospital Mushaf Sargodha Pakistan from Jul to Sep 2018.&#x0D; Methodology: One hundred adult indoor patients undergoing elective surgeries were included in the study. Their ages were from 18 to 34yrs, and all fell in ASA I and II category. In Group-A, 43 and Group- B, 57 patients were enrolled. Sevoflurane at a high concentration of 8% was given to all patients for induction. In Group-A, 100% oxygen was used as a vehicle, while in Group-B, 70% Nitrous Oxide and 30% oxygen were used as vehicles. Induction time was measured from switching Sevoflurane to when the patients’ arms fell horizontal. We documented adverse effects, including coughing, laryngospasm,bronchospasm, fall in SpO2 &lt;94%, apnea, excitation (head or limb movements), bradycardia and arrhythmias were documented.&#x0D; Results: Mean induction time was 59.00±13.00s and 58.00±8.00s in Groups A and B, respectively. The difference was statistically insignificant (p-value=0.874). Similarly, there was no significant difference in adverse events between the two groups.&#x0D; Conclusion: We concluded that adding Nitrous Oxide has no clinically significant advantage in the induction of anaesthesia with Sevoflurane in adults.

Comparative Study on the Anaesthetic Effect of Tiletamine-zolazepam and Propofol as an Induction Agent for Conventional and Endoscopic Abdominal Surgeries in Domestic Cats

Background: Felines have higher metabolic and heart rates than canines and therefore are considered to be the delicate subjects for anaesthesia and pain management. Major surgeries in felines require balanced anaesthesia with smooth and fast induction, longer duration of action and faster and excitement free recovery. Methods: The study was conducted on 24 clinical cases of cats, subjected to conventional and endoscopic surgeries for abdominal affections, premedicated with atropine and dexamethasone at the rate of 0.04 and 0.2 mg/kg body weight to assess the anaesthetic effect of tiletamine-zolazepam combination at the rate of 8mg/kg body weight IM in group A (n=12) and propofol @ 8 mg/kg body weight IV in group B (n=12) respectively as inducing agent to isoflurane maintained anaesthesia. Result: The mean induction time were 421.9±69.47 seconds (7.03±1.16 minutes) in group A and 56.2±0.43 seconds (0.94±0.01 minute) in group B. In both the groups quality of induction was smooth with rapid loss of all reflexes allowing easy intubation. A significant drop in rectal temperature at 15 min post induction with minimal alterations in heart rate, respiration rate and saturated oxygen level were observed. The mean time of recovery recorded were 75.91±8.1 minutes in group A and 88.2±10.2 minutes in group B. Smooth, rapid and good quality recovery was observed in both the anaesthetic groups; however, propofol-induced transitory hypothermia and shivering, lowered the quality of recovery in group B. All the physiological and hematological parameters were in normal limits.

Field Evaluation of Tiletamine-Zolazepam-Medetomidine for Immobilization of Raccoons (Procyon lotor) and Striped Skunks (Mephitis mephitis).

The effectiveness of tiletamine-zolazepam (1.7 mg/kg) plus medetomidine (0.07 mg/kg; TZM) as an immobilizing combination in raccoons (Procyon lotor; n=43) and striped skunks (Mephitis mephitis; n=7) was evaluated during October 2019. Mean (±SD) induction time for raccoons was 15.0±6.6 min. First signs of recovery (head up) occurred 12.9±6.0 min after receiving atipamezole reversal (0.35 mg/kg) and animals were standing in 30.3±16.1 min. Mean induction time for skunks was 11.7±5.8 min. Following reversal, skunks first raised their heads in 6.7±4.3 min and stood in 17.1±12.9 min. Recovery in skunks and female raccoons was not related to length of time immobilized, but male raccoons that were immobilized for longer periods of time stood faster after reversal. Raccoon heart rate (HR) remained steady during immobilization, but respiration rate (RR) and rectal temperature (RT) declined. The HR and RR were similar among males and females, but RT of male raccoons were, on average, 0.5 C higher than those of females, and rate of temperature decline was slower for males. The HR, RR, and RT of skunks declined during immobilization. Although induction times for both raccoons and skunks were longer than expected, induction and recovery were smooth, side effects were few, analgesia was adequate for nonsurgical procedures, and reversal reduced time in captivity.

HEMOLYMPH COLLECTION AND ISOFLURANE ANESTHESIA OF THE EMPEROR SCORPION (PANDINUS IMPERATOR).

With captive invertebrates increasing in popularity, a safe and effective anesthesia protocol is required for their veterinary care. This study investigated the safety and efficacy of 5% isoflurane anesthesia and 0.26 ml hemolymph collection in subadult to adult emperor scorpions (Pandinus imperator; n = 14). Each scorpion was placed in a 2-L anesthetic chamber and induced with 5% isoflurane at a flow rate of 2 L/min oxygen. Anesthetic depth was assessed by rolling the animal into dorsal recumbency and rating the response from one to four: 1 = successful coordinated righting movement, 2 = successful uncoordinated righting movement, 3 = unsuccessful righting movement, 4 = no movement. Ratings 3 and 4 were both adequate for the hemolymph collection. The mean induction time was 4.2 min to reach a level 3 depth and 10.5 min to reach a level 4 depth. All animals were clinically normal for at least 1 yr post experiment. A mean hemolymph volume drawn of 1.92% of body weight, and an anesthetic induction with 5% isoflurane, appear safe in subadult to adult emperor scorpions.

Effect of sedation using Ketamine for primary closure of pediatric facial laceration.

Pediatric lacerations are frequently encountered by plastic surgeons in the emergency room. Since pediatric patients cannot cooperate due to the anxiety and pain occurring during the suture procedure, sedation is induced. Since commonly used drugs inducing shallow sedation such as chloral hydrates are insufficient to perform procedures, the need or deep sedation has been increased. In our experience, inducing sedation with ketamine is safe and allows for accurate procedures.A total of 106 pediatric patients aged between 3 months to 5 years who visited the emergency room between August 2020 and January 2021 were included in this study. Of the 106 patients, 54 were sedated using ketamine, and the remaining 52 patients who did not cooperate were operated under local anesthesia, and these were set as the control group. The patients were intravenously injected with ketamine 1.5–2.0 mg/kg ketamine while monitoring the blood oxygen saturation, end-tidal CO2, and other vital signs. The patients were discharged as a complete awakening was confirmed by physicians.The number of patients who received sedation induced by ketamine was 54 and the number of patients who underwent the procedure without sedation was 52. The mean induction time of a single injection was 35.3 ± 11.3 minutes, and that of additional injection was 253.5 ± 54.1 minute. The total procedure time of the ketamine group was 20.3 ± 11.85 minutes, and that of the nonketamine group was 19.31 ± 10.50 minutes (P = .454). No statistically significant differences were found between the 2 groups.The need for sedation during the suture procedure in an emergenc9y room has been arising not only for reducing pain and anxiety, but also for safe and accurate procedures and scar minimization.Based on the parental satisfaction and the safety of the procedure, using ketamine is more effective than other drugs and should be used more actively.

Helicopter‐based immobilization of moose using butorphanol–azaperone–medetomidine

AbstractChemical immobilization is an important tool for the capture, study, and management of wildlife. Increased regulation of traditional opioids has necessitated a search for alternative drugs in wildlife capture. Butorphanol–azaperone–medetomidine (BAM) is one promising alternative that has been used in a range of taxa, though often on medium‐size mammals using ground‐based methods. We tested the efficacy of BAM via remote delivery from a helicopter in a wild population of moose (Alces alces shirasi) in northwestern Wyoming. In March 2020 and 2021, we immobilized male (n = 15) and female (n = 26) moose with butorphanol (0.20 mg/kg), azaperone (0.066 mg/kg), and medetomidine (0.079 mg/kg), with antagonists atipamezole (0.495–0.527 mg/kg) and naltrexone (0.124–0.151 mg/kg) to reverse immobilizations. Mean induction (x̄ ± SE; 9.2 ± 0.6 min) and mean recovery times (7.2 ± 0.5 min) were longer but still comparable to published instances of moose captured using traditional chemical immobilizers (carfentanil, etorphine, thiafentanil). All animals survived &gt;60 days post‐capture. Our findings add to a body of work demonstrating that BAM provides rapid inductions, reliable sedation, and quick reversals in a variety of taxa and by aerial remote delivery.

Randomized trial comparing general anesthesia with anesthesiologist-administered deep sedation for ERCP in average-risk patients

General anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform ERCP. The definitive choice between the 2 sedative types remains to be established. This study compared outcomes of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events (SRAEs). At a tertiary referral center, patients with American Society of Anesthesiologists (ASA) class≤III were randomly assigned to undergo ERCP with MAC or GA. The main outcome was a composite of hypotension, arrhythmia, hypoxia, hypercapnia, apnea, and procedural interruption or termination defined as SRAEs. In addition, ERCP procedural time, success, adverse events, and endoscopist and patient satisfaction were compared. Of 204 randomized, 203 patients were evaluated for SRAEs (MAC, n= 96; GA, n= 107). SRAEs developed in 35% of the MAC cohort (34/96) versus 9% in the GA cohort (10/107), which was statistically significant (P< .001). Mean induction time for GA was significantly longer than that for MAC (10.3 ± 10 minutes vs 6.5 ± 10.8 minutes, respectively; P< .001). ERCP procedure time, recovery time, cannulation time and success, and procedure-related adverse events were not statistically different between the 2 sedative groups. The use of GA improved endoscopist and patient satisfaction (P< .001). GA is safe with fewer SRAEs than MAC in patients with ASA scores≤III undergoing ERCP. Apart from prolonging induction time, use of GA does not change the procedural success or ERCP-related adverse events and offers greater endoscopist and patient satisfaction. Hence, GA is a consideration in patients undergoing ERCP in this population group. (Clinical trial registration number: NCT04099693.).

Race/Ethnicity and Duration of Anesthesia for Pediatric Patients in the US: a Retrospective Cohort Study.

Previous literature has demonstrated adverse patient outcomes associated with racial/ethnic disparities in health services. Because patients/parents and providers care about the duration of anesthesia, this study focuses on this outcome. To determine the association between race/ethnicity and duration under anesthesia. In this retrospective cohort study of data from the Multicenter Perioperative Outcomes Group, White non-Latino was the reference and was compared with Black non-Latino children, Latino, Asian, Native American, Other, and "Unknown" race children. Children aged 3 to 17years. Induction duration (primary outcome), procedure-end duration, and total duration under anesthesia (secondary outcomes). Of 37,596 eligible cases, 9,610 cases with complete data were analyzed. The sample consisted of 6,894 White non-Latino patients, 1,021 Black non-Latino patients, 50 Latino patients, 287 Asian patients, 26 Native American patients, 57 "Other" race patients, and 1,275 patients of "Unknown" race. The mean induction time was 11.9min (SD 5.6min). In adjusted analysis, Black non-Latino patients had 5% longer induction and procedure-end durations than White non-Latino children (exponentiated beta coefficient [Exp (β)] 1.05, 95% CI: 1.02-1.08, p < 0.01 and Exp (β) 1.08, 95% CI 1.04-1.13, p < 0.01 respectively). White non-Latino children had shorter induction and procedure-end durations than Black children. The differences in induction and procedure-end time were small but may be meaningful on a population-health level.

Anesthesia protocol for ear surgery in Wistar rats (animal research).

ObjectiveTo formulate an anesthesia protocol for safe and satisfactory anesthesia for ear surgery in rats.MethodsThe rats were anesthetized with xylazine (10 mg/kg body weight) and ketamine at doses of 80, 50, 40, and 30 mg/kg body weight or with isoflurane anesthesia (2%–3.5% in 100% oxygen; maintenance dose 1.5%–3.5%). The anesthesia induction, surgery, and recovery time were recorded.ResultsIn total, 17 rats were induced by varying doses of ketamine‐xylazine and 28 rats with isoflurane. Mean induction time with ketamine‐xylazine was 6 ± 2.9 min compared with 3.8 ± 1.1 min with isoflurane. Mean recovery time with ketamine‐xylazine was 142.6 ± 49.3 min compared with 4.1 ± 1.2 min with isoflurane. A mortality of 4 animals after developing dyspnea was recorded with ketamine‐xylazine.ConclusionIsoflurane anesthesia offers appropriate induction and recovery times and low mortality rates for the surgeries performed. Isoflurane anesthesia offers reliable results for ear surgery in rats. However, more equipment and technical skills are needed.