Method Of Anesthesia Research Articles

Effective and Economical Option of Anesthesia in Retrograde Intrarenal Surgery.

There is only limited data in the literature showing the effect of anesthesia methods on the success of retrograd intrarenal surgery. The aim of this study was to compare and evaluate retrograd intrarenal surgery cases performed under spinal and general anesthesia in terms of effectiveness, cost, hospitalization time and complications. A total of 337 patients who underwent retrograd intrarenal surgery due to kidney stones between 2014 and 2019 were retrospectively evaluated. In our study, the patients were divided into two groups according to the anesthesia method administered: Group 1 consisted of 172 patients who received spinal anesthesia and Group 2 comprised 165 patients administered general anesthesia. Both groups were compared in terms of demographic data, localization and size of stone, radiographic stone density, operation time, complications, need for postoperative analgesia, length of hospitalization, and stone free rate. The cost of general anesthesia was significantly higher compared to that of spinal anesthesia (p < 0.001). The analgesia application administered within the first six postoperative hours was significantly higher in the general anesthesia group (p < 0.001). In other findings, there was no statistically significant difference between the two groups. Retrograd intrarenal surgery can be performed with similar safety and effectiveness under both general and spinal anesthesia. However, spinal anesthesia seems to be more advantageous due to the patients' lower need for analgesics in the early postoperative period and the lower cost of the anesthetics used.

Rapid dissolution microneedle based on polyvinyl alcohol/chitosan for local oral anesthesia

At present, the main clinical methods of oral local anesthesia are direct injection of anesthetic and surface ointment. However, the pain and fear caused by the injection, the discomfort of topical anesthetic creams, and the scour and moist oral environment during the procedure pose great challenges to oral anesthesia. Herein, we designed a Lido-PVP/PVA DMNP microneedle (MN) for oral local anesthesia. The microneedle tip was consisted of Polyvinylpyrrolidone/Polyvinyl alcohol (PVP/PVA), which can quickly dissolve and release the lidocaine hydrochloride (Lido) drug within 5 min to achieve rapid anesthesia. The backing was composed of polyvinyl alcohol/chitosan (PVA/CS), and its excellent adhesion can overcome saliva erosion and anchor firmly to the oral mucosa, significantly improving the utilization rate of drugs, as well as the patient compliance. MNs have good mechanical properties for tissue insertion while possessing high drug loading (3 mg/MNs). Von Frey tests proved that MNs showed a faster and more effective local anesthetic effect (anesthesia takes effect at 5 min) compared to cream (anesthesia takes effect at 30 min). In addition, the excellent biocompatibility and no skin irritation endowed Lido-PVP/PVA DMNP MNs a great potential for oral local anesthesia in the oral cavity.

Descending Neurogenic Evoked Potentials Monitoring Is an Effective Alternative in Spinal Deformity Surgery Under Inhaled Anesthesia

To evaluate the reliability of descending neurogenic evoked potentials (DNEP) monitoring in spinal deformity surgery under inhaled anesthesia. A total of 180 consecutive patients who underwent spinal deformity surgery in our scoliosis center from July 2014 to August 2016 were reviewed. Intraoperative monitoring including somatosensory evoked potentials (SEP), motor evoked potentials (MEP), and DNEP was conducted routinely throughout operation. Patients were divided into 2 groups according to anesthesia methods: group A (n= 72, inhaled anesthesia, SEP/DNEP) and group B (n= 108, total intravenous anesthesia, SEP/MEP/DNEP). Intraoperative monitoring data were collected and analyzed. Positive alerts were observed in 26 patients (14.5%), of whom 18 (10%) were confirmed as true-positive events in the study population. No false-negative events were recorded. In group A, the sensitivity and specificity of SEP and DNEP were 100% and 93.8% and 100% and 98.5%, respectively. For group B, the sensitivity and specificity of SEP/MEP and DNEP were 100% and 95.9% and 100% and 98%, respectively. DNEP monitoring seemed to be effective for the detection and prevention of iatrogenic neurologic deficits during spinal deformity surgery. This study indicates that DNEP was an effective alternative in spinal deformity surgery under inhaled anesthesia.

The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Surgical interventions in hip fracture have been associated with multiple adverse events, including perioperative hypotension and mortality, making the choice of the anesthetic method for this procedure crucial. There is still no consensus on whether regional (RA) or general (GA) anesthesia should be used to maintain hemodynamic stability and more favorable outcomes. Therefore, this meta-analysis examines the differences between RA and GA groups in the incidence of mortality, intraoperative hypotension, and other intra- and postoperative complications. The comparison is essential given the rising global prevalence of hip fractures and the need to optimize anesthesia strategies for improved patient outcomes, particularly in an aging population. We followed PRISMA guidelines (PROSPERO #CRD42022320413). We conducted the search for studies published in English before March 2022 in PubMed, Google Scholar, and the Cochrane Library. We included RCTs that compared general and regional anesthesia in adult patients having hip fracture surgical interventions. The primary outcome was perioperative mortality. The secondary outcomes were peri- or postoperative complications and duration of hospital stay. We conducted a meta-analysis in RevMan (version 5.4). We examined the quality of the methodology with the Cochrane risk of bias 2 tool, while the quality of evidence was determined with GRADE. Fifteen studies with 4110 patients were included. Our findings revealed no significant difference between general and regional anesthesia in risk of perioperative mortality (RR = 1.42 [0.96, 2.10], p-value = 0.08), intraoperative complications, or duration of hospital length of stay. Our results suggest that regional anesthesia and general anesthesia have comparable safety and can be used as alternatives based on specific patient requirements.

Anesthesiology support of rabbits during surgical interventions on the diges-tive apparatus

In today's veterinary medicine, animals such as ferrets, rabbits, and rodents must be considered not only productive animals for producing fur and meat but also as small pets, just like dogs and cats. Among the most common breeds of rabbits kept in urban dwellings are the following: English Spotted, Black Spotted and Chocolate, Lionhead White, Dwarf Dutch White, Pointed Dutch, Spotted and Beaver. Rabbit owners are increasingly turning to veterinarians for general condition assessment and treatment. They count on a high level of medical and surgical care. Therefore, veterinarians often have to treat these animals, and usually, due to the characteristics of patients, medical manipulations require anesthesia. That is why the topic of how to carry out full-fledged inhalation and intravenous anesthetic support with support during surgical intervention in rabbits and successful exit from anesthesia was raised. This article discusses the methods of anesthesia and the nuances of its provision. The article compared two types of anesthesia and confirmed the high safety of anesthesia for rabbits with experience and transparent patient monitoring under anesthesia. They developed recommendations for anesthesia care according to the study's conclusion. They described the list of equipment necessary to ensure successful anesthesia and the required drugs for anesthesia with their dosage. Based on the results of research and discussion, it was determined that intravenous anesthesia for rabbits in the absence of inhalation anesthesia is also possible. Still, inhalation anesthesia is safer and better controlled, and it also requires premedication with analgesic drugs. Intravenous anesthesia is less controlled, but its successful provision is possible with strict adherence to the conditions of anesthesiological support and monitoring of the patient.

The advantages of general anesthesia subthalamic deep brain stimulation for Parkinson's disease in the enhanced recovery after surgery: A randomized clinical trial.

With advancements in imaging and microelectrode recording techniques, general anesthesia (GA) has emerged as an alternative option for Parkinson's disease (PD) patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS). In this study, we compared the advantages and disadvantages of using GA and local anesthesia for STN-DBS in enhanced recovery after surgery (ERAS). Surgical outcomes of STN-DBS were evaluated using the unified PD rating scales (UPDRS). CT and magnetic resonance imaging scans are used to evaluate intracranial conditions. State-trait anxiety inventory and hospital anxiety and depression scale are used to evaluate patients' perioperative psychology. Anesthesia method does not significantly impact the accuracy of microelectrode placement or the improvement of postoperative symptoms. However, the local anesthesia group had a higher incidence of intracranial air, as well as higher rates of postoperative complications such as headache, dizziness, vomiting, and delirium. GA effectively alleviated preoperative anxiety and resulted in lower levels of perioperative anxiety and psychological stress compared to local anesthesia. Additionally, the GA group had shorter surgery duration, earlier ambulation, and a shorter average hospital stay. DBS under GA is safe and effective. Due to shorter surgical duration, reduced occurrence of perioperative complications, effective reduction of preoperative anxiety, and faster postoperative recovery, DBS under GA is better aligned with the concept of ERAS.

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.

Regional Anesthesia for Acute Pain Treatment in Pre-Hospital and In-Hospital Emergency Medicine.

More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even today, particularly in children and in older patients. In this study, we assess the potential role of regional anesthetic methods in improving the treatment of pain in the preclinical and clinical emergency setting. Pain-related reasons for admission were identified and quantified from emergency admission data. A structured literature search was carried out for clinical studies on the treatment of pain in the emergency setting, and a before-and-after comparison of the pain relief achieved with established vs. newer regional anesthetic methods was performed. 43% of emergency patients presented with acute musculoskeletal pain. The literature search yielded 3732 hits for screening; data on entity-specific pain therapy spectra were extracted from 153 studies and presented for the main pain regions. The degree of pain relief obtained through regional anesthetic procedures, on a nominal rating scale from 0 to 10, was 4 to 7 points for acute back and chest wall pain, >6 for shoulder pain, 5 to 7 for hand and forearm injuries, and >4 for hip fractures. These results were as good as, or better than, those obtained by analgesia/sedation with strong opioids. Modern regional anesthetic techniques can improve acute pain management in the emergency department and, to some extent, in the pre-hospital setting as well. Pain relief with these techniques is quantifiably better than with strong opioids in some clinical situations; moreover, there is evidence of further advantages including process optimization and fewer complications. Data for comparative study remain scarce because of a lack of standardization.

Effect of Regional Anesthesia on Oncological Outcomes (Meta-Analysis)

Metastatic processes remain the main cause of deaths in oncology. Methods of anesthesia, in particular regional anesthesia, are considered as potential modulators of the immune response and metastatic spread. The ambiguity of the available data on the effect of regional and general anesthesia on metastatic spread is partly due to the fact that general anesthetic in combined anesthesia is quite often not taken into account, and this, in turn, masks the possible influence of regional anesthesia.The purpose of this meta-analysis was to make a comparative assessment of the effect of general anesthesia and general anesthesia in combination with regional anesthesia on the relapse-free and overall survival of cancer patients after surgery.Materials and methods. We analyzed 8 randomized controlled trials involving 1822 patients and comparing the groups of cancer patients who were operated either under general anesthesia (total intravenous (TIVA) or inhalation (IA)), or general anesthesia in combination with regional anesthesia (TIVA+RA or IA+RA, respectively). Trial using combinations of inhaled and intravenous anesthetics was excluded from the analysis for a more accurate assessment of the effect of regional anesthesia. The study complies with the recommendations of the Cochrane Community and PRISMA standards. The protocol was registered on the INPLASY platform. We used PubMed, Google Scholar and CENTRAL databases. We used a subgroup analysis and GRADE tool to assess the quality of evidence.Results. There were no statistically significant differences in relapse-free and overall survival when comparing different anesthesia methods. For a relapse-free survival, comparing TIVA vs TIVA+RA resulted in no significant difference : OR=1.20 [95% CI 0.92-1.55]; when IA vs IA+RA were compared, OR=1.10 [95% CI 0.94-1.29]. Similar results were obtained for overall survival.Conclusion. Based on the meta-analysis results, regional anesthesia had no effect on relapse-free and overall survival in oncosurgery patients.

Awareness of Carpal Tunnel Syndrome Among the Middle-Aged Population in Riyadh, Saudi Arabia.

Background Carpal tunnel syndrome (CTS), a common and often underdiagnosed condition, imposes a significant burden on individuals, particularly in middle-aged populations. This study aims to assess the awareness and prevalence of CTS among middle-aged residents in Riyadh, highlighting the crucial need for targeted educational initiatives to address knowledge gaps. Methodology A cross-sectional study design was employed to capture a snapshot of CTS awareness and prevalence among the middle-aged population in Riyadh, Saudi Arabia. Participantsaged 40-60residing in Riyadhwere included. A self-reported questionnaire gathered data on demographics, CTS diagnosis, and awareness levels regarding symptoms, risk factors, treatment, and the impact of CTS. Statistical analysis included descriptive statistics and Chi-squared tests. Results We collected 415 valid responses to the questionnaire. The demographic profile revealed a balanced gender distribution, with 48.4% (n=201) males and 51.6% (n=214) females, and a majority (66.5%; n=276) within the 40-50 age range. A substantial 87.2% (n=362) reported no prior CTS diagnosis. Neuroimaging studies were infrequently conducted at 15.9% (n=66). Participants exhibited significant knowledge gaps, notably in the awareness of CTS diagnosis 66.3% (n=275) uncertainty, symptoms 55.4% (n=230) lack of knowledge, and risk factors 54.7% (n=227) lack of awareness. The results indicated uncertainty regarding the relationship between CTS and diabetes 63.9% (n=265) and knowledge gaps on anesthesia methods for CTS operations 64.1% (n=294). The association between age and CTS diagnosis was significant (p-value0.004), while awareness did not significantly vary with gender or age. Conclusion This study unveils a substantial lack of awareness about CTS among the middle-aged population in Riyadh, emphasizing the need for targeted educational interventions. The prevalence of CTS remains underreported, with a notable gap in understanding symptoms, risk factors, and available treatments; the findings underscore the vital importance of targeted educational programs designed to raise public awareness, bridge information gaps, and empower individuals to make informed decisions about their hand health.

Effects of different anesthesia methods on perioperative immune function and long-term regression of patients undergoing thoracoscopic radical esophagectomy for esophageal cancer

ObjectiveThis study investigated the effects of different anesthetic methods on perioperative immune function and long-term regression of patients undergoing thoracoscopic radical surgery for esophageal cancer. MethodsData from 147 patients undergoing thoracoscopic radical surgery for esophageal cancer in our hospital from January 2017 to June 2019 were selected for retrospective analysis. Patients were divided into control (intravenous anesthesia combined with an epidural block, n = 83) and observation (intravenous anesthesia combined with a thoracic paravertebral nerve block, n = 64) groups. The use of relevant drugs during the surgery, indexes of the peripheral blood T-lymphocyte subpopulation at different time points (before induction of anesthesia, at the completion of surgery, 24 h postoperatively, and 48 h postoperatively), and 3-year postoperative survival were compared between the two groups. ResultsData on propofol and remifentanil use during surgery were not significantly different (P > 0.05) between the two groups. The proportion of vasoactive drug use was lower in the observation group than in the control group (P < 0.05). Differences in data for CD3+, CD4+, and CD4+/CD8+ cells between time points were significant (F = 13.256, 20.307, 18.035, P < 0.05), while those between the two groups were not (F = 1.005, 1.135, 1.204, P > 0.05). There was no interaction between data processing factors and time between the control and observation groups in CD3+, CD4+, and CD4+/CD8+ cells (F = 0.358, 0.778, 1.107, P > 0.05). The median overall survival time was 21.988 (95 % confidence interval: 18.436–25.541) and 26.978 (95 % confidence interval: 20.124–33.833) months in the control and observation groups, respectively, with a significant difference between the two groups (Log-rank χ2 = 3.925, P < 0.05). ConclusionsBoth anesthetic methods achieve satisfactory anesthetic results and reduce postoperative stress and immunosuppression. However intravenous anesthesia combined with an epidural block can increase the incidence of intraoperative hypotension in the patients, thoracic paravertebral nerve block combined with general anesthesia is more favorable for maintaining intraoperative blood pressure and heart rate stability, as well as for postoperative survival.

Conscious sedation anesthesia using different doses of remifentanil combined with dexmedetomidine for peritoneal dialysis catheter implantation

Background Conscious sedation anesthesia (CSA) is an anesthetic method during peritoneal dialysis catheter implantation. However, lack of optimal CSA strategies for patients with end-stage renal disease (ESRD). This study aimed to evaluate the analgesic effects and safety of CSA using different doses of remifentanil combined with dexmedetomidine during peritoneal dialysis catheter insertion. Methods Patients who underwent peritoneal dialysis (PD) catheter placement via open surgical incision were retrospectively analyzed and divided into three groups based on the tertile dose of remifentanil. The bispectral index (BIS) was used to monitor the depth of anesthesia. Data regarding clinical findings, the effects of anesthesia, and the incidence of drug-related adverse effects were collected. Results In total, 102 patients completed the surgery successfully and safely. The dose of remifentanil was 0.02–0.07 μg/kg/min, 0.08–0.13 μg/kg/min, and 0.14–0.20 μg/kg/min in Groups A, B, and C, respectively. Only seven patients reported mild pain during the surgery. No significant differences were observed among the numeric rating scale scores of the three groups (p > 0.05). Intraoperative hemodynamics were stable. The incidence of respiratory depression was 8.3%, 20.0%, and 41.9% in Groups A, B, and C, respectively (p < 0.01). The incidence of gastrointestinal symptoms in Group C (51.6%) was higher than that in Groups A and B (p < 0.05). Conclusion Low-dose remifentanil (0.02–0.07 μg/kg/min) combined with dexmedetomidine achieved satisfactory anesthetic effects with fewer adverse drug reactions during PD catheter implantation, indicating its potential for use in patients undergoing PD catheter placement.

Regional anesthesia in coronary artery bypass grafting: a narrative review

Coronary artery bypass grafting (CABG) is one of the most frequently performed procedures in modern cardiac surgery because it is indicated in most patients with coronary artery disease. Currently, there are no standard methods for regional anesthesia in cardiac surgery. The purpose of this review was to describe the available techniques for regional anesthesia in post-CABG. Studies published in the databases PubMed, The Cochrane Library, Google Scholar, Russian science citation index were included. Techniques reported in the literature were local blockade of the postoperative wound with local anesthetics in the anteromedial chest wall (parasternal-intercostal plane blocks), anterolateral chest wall (interpectoral plane blocks, serratus anterior plane block), and posterolateral chest wall (erector spinae plane block, thoracic paravertebral block, retrolaminar block, rhomboid intercostal block). Numerous studies demonstrate that the use of regional anesthesia as a component of multimodal anesthesia after coronary artery bypass grafting significantly improves pain relief. Blockade of the peripheral nerves of the chest wall under ultrasound guidance can be considered not only as an alternative to epidural anesthesia when not indicated or not feasible. It also contributes to early tracheal extubation, reduced duration of mechanical ventilation, adequate pain control, and a decrease in the need for narcotic analgesics, reduced postoperative nausea and vomiting, and reduced length of stay in the intensive care unit. Further research is needed to determine the optimal technique for performing interfascial blockades of the chest wall post-CABG, which would require data on the effectiveness, safety, and dosing regimen for each specific blockade.

FACTORS THAT INFLUENCE THE NEGATIVE RESULTS OF TREATMENT OF COMBATANTS' PAIN AFTER MINE-BLAST WOUNDS DURING THE WAR IN UKRAINE

Introduction: In 83.3% of cases, pain in combatants who sustained mine-blast injuries during the war in Ukraine becomes chronic. Chronic pain leads to a number of negative aspects that affect the quality of life of combatants, and when they return to military service after treatment for professions that require people to act under pressure, it increases the risk not only for them but also for their teammates and the mission. Therefore, the issue of pain chronicity in this category of patients requires further study, and the identification of factors that influence the frequency of chronicity can potentially improve the results of treatment of this category of patients.&#x0D; The aim: to identify factors that influence the negative results of pain treatment in combatants after mine-blast wounds during the war in Ukraine&#x0D; Materials and methods: We analyzed the treatment of 660 combatants with mine-blast wounds. Treatment outcomes were assessed using a visual analog scale (VAS). Groups were compared using the Mann-Whitney test and the chi-square test with a continuity correction. To analyze the association of the risk of a negative treatment outcome with the factor characteristics, we used the method of building univariate and multivariate logistic regression models. The quality of the models was assessed by the area under the ROC curve (AUC). The odds ratio was calculated to quantify the degree of influence of the factor attribute.&#x0D; Results: It was found that the factors of negative results of pain treatment in combatants with mine-blast wounds are: 1) method of pain treatment (p&lt;0.001), OR=0.06 (95% CI 0.04-0.09); 2) high intensity of pain according to VAS on admission (p&lt;0.001), OR=3.16 (95% CI 2.52-3.98); 3) anesthetic risk according to ASA (p=0.049) OR=0.67 (0.45-0. 99); 4) number of injured anatomical body parts (p=0.015), OR=1.17 (95% CI 1.03-1.32); 5) a combination of indicators: method of pain treatment, patient age and number of injured anatomical body parts AUC=0.82 (95% CI 0.79-0.85).&#x0D; Conclusions: Our study demonstrates that if combatants with mine-blast wounds use a method of pain treatment that does not provide reliable control over the intensity of pain, then during evacuation to a medical facility, such pain becomes high-intensity pain. In addition, the conditions of the injury (combat conditions) and the injury itself cause a significant anesthetic risk according to the ASA. Such patients are associated with a higher risk of chronic pain. In the future, in-depth studies are needed to demonstrate the effectiveness or benefits of combining pain management with regional anesthesia methods. High-quality pain control during the medical evacuation of wounded from the battlefield to a medical facility could potentially improve the treatment outcomes of these combatants and reduce the incidence of pain chronicity.

Guidelines for anesthesia management for ambulatory surgery

The development of ambulatory surgery has posed a challenge to the anesthesia management. In order to standardize the management of ambulatory surgery anesthesia, the Chinese Society of Anesthesiology established an expert group of guidelines for ambulatory surgery anesthesia. By combining the international guidelines and the development status of ambulatory surgery anesthesia at home and abroad, this evidence-based guideline for ambulatory surgery anesthesia was formulated. The guideline includes nine parts: definition of ambulatory surgery, ambulatory surgery system, selection criteria for ambulatory surgery patients, preoperative pre-rehabilitation, pre-anesthesia assessment, pre-anesthesia preparation, intraoperative anesthesia monitoring, anesthesia methods, and post-anesthesia management for ambulatory surgery. A total of 26 recommendations were formed. The guideline aims to better guide the clinical practice of ambulatory surgery anesthesia and standardize the perioperative management of ambulatory surgery.

Perioperative Extracellular Brain Free-Water Changes for Older Adults Electing Total Knee Arthroplasty with General versus Spinal Anesthesia: A Pilot Study.

Recent research shows that older adults electing to undergo total knee arthroplasty with general anesthesia have a pre- to postoperative acute increase in molecular free-water within their cerebral white matter. It is unknown if this change is similar for individuals who elect spinal anesthesia methods. To explore white matter microstructural changes in a pilot sample of older adults undergoing total knee arthroplasty and receiving general or spinal anesthesia. We assessed acute perioperative changes in brain white matter free-water in a limited number of older adults electing total knee arthroplasty under spinal anesthesia (n = 5) and matched groups of older adults who received general anesthesia (n = 5) or had no surgery (n = 5). Patterns of free-water changes were also compared in the larger group of older adults electing total knee arthroplasty under general anesthesia (n = 61) and older adults with chronic knee pain who received no surgical intervention (n = 65). Our pilot results suggest older adults receiving general anesthesia had pre- to post-surgery free-water increases extensively throughout their white matter whereas those receiving spinal anesthesia appeared to have less consistent free-water increases. Our pilot results possibly suggest different patterns of perioperative brain white matter free-water changes based on anesthetic approach. We recommend future, larger studies to further examine the effects of anesthetic approach on perioperative brain free-water. The results of our study have potential implications for acute and chronic cognitive changes, perioperative complications, neurodegenerative processes including Alzheimer's disease, and understanding neuroinflammation.

General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry

(Anesth Analg. 2023;136:992–998) In Africa, maternal morality following cesarean delivery is 50× more likely compared to morality rates in high-income countries, and spinal anesthesia (SA) is the preferred anesthetic method during cesarean delivery. For parturient patients with hypertensive disorders (ie, preeclampsia, eclampsia, or gestational hypertension), there is an increased risk for adverse outcomes, including spinal epidural hematoma following SA, so thrombocytopenia should be excluded before neuraxial blockade. An accurate platelet count is necessary before SA in emergent situations of fetal distress, which can be complicated when laboratory services are unavailable or off-site. The primary aim of this study was to determine which patients received general anesthesia (GA) when the presence of thrombocytopenia was known versus suspected. The secondary aim was perioperative platelet counts of patients with suspected thrombocytopenia to determine how often GA may have been avoided in favor of SA if platelet count was known.

Continuous Sciatic Popliteal Block as Postoperative Pain Management in Patient with Closed Fracture Right Ankle Undergo ORIF PS Surgery

Introduction: Currently, foot and ankle surgeries are on the rise, and a significant challenge in these cases is the intense post-operative pain that arises from early patient mobilization. Continuous popliteal sciatic block have emerged as a solution, effectively alleviating pain from the intra-operative to post-operative stages for patients undergoing foot and ankle surgery. According to a study conducted by Ding and colleagues, continuous blocks have proven to be more effective than a single injection in providing pain relief.&#x0D; Case presentation: A 24-year-old woman diagnosed with a closed fracture of her right ankle is scheduled for open reduction internal fixation (ORIF) with a plate and screws for her right ankle. The patient has an American Society of Anesthesiologists (ASA) physical status of III and is dealing with grade II obesity. A continuous popliteal sciatic block was performed on the patient under ultrasound guidance, with the catheter tip placed outside the perineural area. Postoperatively, the patient received pain management through a regimen of 0.1% bupivacaine, 20 ml volume, administered every 4 hours. Remarkably, the patient experienced minimal pain until the 2nd day after surgery and was discharged home.&#x0D; Conclusion: The continuous popliteal sciatic block is a regional anesthetic method that offers potent pain relief for patients undergoing foot and ankle surgery. Extensive evidence supports its effectiveness and safety during administration, making it a reliable choice for pain management in these procedures.

Comparative assessment of effect of two methods of spinal anesthesia on central hemodynamic parameters in elderly and senile patients in emergency vascular surgery

Objective. To improve the results of treatment of comorbid patients with acute arterial ischemia by substantiating the optimal type of spinal anesthesia for surgical intervention on the affected limb.Materials and methods. The study involved 70 patients who were treated in the Department of Vascular Surgery of Clinical Hospital of ‘Russian Railways-Medicine Co.’ in Barnaul. The patients were divided into two groups: group 1 – patients operated under conditions of bilateral (bilateral) spinal anesthesia, group 2 – patients operated under conditions of monolateral (unilateral) spinal anesthesia. All patients underwent an assessment of the level of spinal block on the Bromage scale, monitoring of central hemodynamics using a MARG-10–01 rheograph, postoperative assessment of myocardial ischemia on the ECG, acute kidney damage to control diuresis.Results. In the 2nd group, there was a sufficient sensory and motor block to perform surgery. In the intraoperative period in the group of patients who underwent unilateral blockade, the mean arterial pressure decreased by 3 mm Hg. In this regard, there was no clinically significant increase in heart rate and a decrease in the stroke index and the index of total peripheral vascular resistance. In the 1st group, the decrease in mean arterial pressure reached 20% of the original, which led to an increase in heart rate by 12% and a decrease in stroke index by 11%.Conclusions. During the perioperative period, the indicators of central hemodynamics in the group 2 were more stable compared to the group 1, they did not need the use of vasopressor drugs and crystalloids. And in the early postoperative period, patients who underwent unilateral anesthesia did not show signs of acute kidney injury. Monolateral spinal anesthesia, compared with conventional spinal anesthesia, provides more stable hemodynamics in elderly patients with acute arterial ischemia.

Local anesthesia during S-ICD implantation gives similar post procedural pain perception as sedation

Abstract Introduction The PRAETORIAN-DFT trial hypothesises that subcutaneous implantable cardioverter defibrillator (S-ICD) implant without defibrillation test (DFT) but with PRAETORIAN score is non-inferior to S-ICD implant with DFT with regard to first shock efficacy in spontaneous events. Various anesthesia protocols are used for S-ICD implant, ranging from local to general anesthesia. Sedation of the patient during S-ICD implantation is required because of DFT. Without the need for DFT, local anesthesia may suffice, thereby reducing the logistical burden associated with sedation and general anesthesia. However, data comparing the effects of various anesthesia methods are lacking. Purpose This prespecified analysis of the PRAETORIAN-DFT trial aims to investigate the effect of three different anesthesia methods on (post-)operative pain during S-ICD implant. Methods In the PRAETORIAN-DFT trial (NCT03495297), 965 patients were randomised to DFT (N=483) or no DFT with PRAETORIAN Score calculation (N=482). Choice of anesthesia protocol was per local routine and physician discretion and was listed as local anesthesia (LA), monitored anesthesia care (MAC) or general anesthesia (GA). Patients under LA who underwent DFT, had MAC or GA during the test. Pain scores were assessed using the Numerical Rating Scale (NRS), prior to implant (baseline) and at 1-3 hours, 5-7 hours and 1 day post implant. Mean change in NRS compared to baseline was calculated at every time point. Exact pain scores as well as mean change in NRS were compared between anesthesia methods using a Kruskal Wallis Test. Results Pre-implant pain questionnaires were completed by 97% of patients. In the complete study cohort, 149/965 (15%) of implants were performed under LA, 327/965 (34%) under MAC and 489/965 (51%) under GA. This distribution did not differ between the randomised arms (p=0.301). There was no difference in NRS or mean change compared to baseline between the groups at any time post implant. The mean change in NRS compared to baseline was highest at 5-7 hours post implant in all groups (Figure). Analysis with patients under LA and MAC or GA during DFT as independent group showed similar results. Conclusion There was no difference in pain perception after S-ICD implantation between implant under local anesthesia, MAC and general anesthesia. These results confirm that S-ICD implantation under local anesthesia is feasible and sedation may be no longer necessary if defibrillation testing becomes redundant.Mean changes in NRS compared to baseline