Neuromuscular Blockade Research Articles

Клиническая демонстрация особенностей анестезиологического обеспечения тотальной экстраперитонеальной паховой герниопластики

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

Evaluation of post-tetanic motor evoked potential as an augmentation technique under partial neuromuscular blockade during craniotomy

ObjectiveIn craniotomies requiring motor evoked potential (MEP) monitoring, avoiding neuromuscular blockade (NMB) is preferable, but its complete avoidance poses risks of unexpected movement. This retrospective study investigates the application of a post-tetanic MEP augmentation technique to enhance baseline recording of transcranial stimulation MEP (Tc-MEP) under partial NMB during craniotomy. MethodsTwenty-six patients were included. The level of partial NMB was maintained at a train-of-four ratio of approximately 40 %. Monophasic constant-current stimulation was applied on the craniotomy side with + 20 % of the threshold intensity. Post-tetanic Tc-MEP, involving tetanic stimulation of the median nerve 1 s before transcranial stimulation, was performed on patients who failed to record using conventional baseline recording. ResultsThe post-tetanic Tc-MEP technique successfully improved the success rate of baseline recording from 61.5 % to 100 %. Application of post-tetanic Tc-MEP significantly increased amplitudes in both the upper (p = 0.04) and lower limbs (p < 0.01) compared to before post-tetanic Tc-MEP. No patients had unexpected movements. ConclusionsThis study indicates that post-tetanic Tc-MEP enhanced the success rate of baseline recording during craniotomy under partial NMB. SignificanceThe combination of partial NMB and post-tetanic Tc-MEP could be a useful regimen for craniotomy with MEP monitoring, addressing both safety concerns and successful baseline recording.

Quantitative neuromuscular monitoring with train-of-four ratio using sonomechanomyography (SMMG): Toward more sensitive evaluation of neuromuscular blockade

In the post-anesthesia care unit, there is a high occurrence of residual neuromuscular blockade, which puts patients at risk of negative consequences such as hypoxia. Assessment based on the train-of-four ratio (TOFR) has been used to avoid residual neuromuscular blockade when the TOFR is greater than 0.9, measured at the adductor pollicis muscle (APM). The most commonly used quantitative neuromuscular monitoring (QNM) modalities include acceleromyography (AMG) and electromyography (EMG). However, the poor user-friendliness of current QNM methods hinders their widespread adoption. To overcome this, we developed a new monitoring method using ultra-fast ultrasound imaging to generate a two-dimensional map of muscle transient motion, i.e., sonomechanomyography (SMMG). SMMG of the APM and AMG of the thumb were used to get the TOFR of 20 normal adults. The results showed no significant difference between the left and right hands for both AMG and SMMG TOFR, with p-values larger than 0.05. In addition, the mean accuracy of SMMG TOFR (0.6% relative error) was higher than AMG (1.4% relative error). Moreover, the Bland–Altman plot showed that all the difference values were within the limits of agreement and the mean bias was 0.02, indicating that the two methods had a very good agreement. In particular, using SMMG did not require additional calibration before testing. Overall, the results demonstrated that the method has the potential as a new QNM approach for further clinical studies to benefit patients in need. To demonstrate its clinical potential, further studies are required to evaluate this method in patients during and post-anesthesia.

Efficient Reversal of Neuromuscular Blocking Agent-Induced Biological Functions and Side Effects by an Extended Biphen[3]arene Carboxylate.

Neuromuscular blocking agents (NMBAs) are widely administered during anethesia to prevent the patient from moving and optimize surgical conditions. Timely reversal of the muscle relaxation state induced by NMBAs at the end of surgery is necessary to recover autonomous respiration and muscle function. Herein, an extended biphen[3]arene carboxylate (ExBP3C) was designed and synthesized by a supramolecular sequestration approach as a reversal agent with high efficiency and generality against several representative NMBAs. ExBP3C exhibited robust host-guest complexation toward atracurium, rocuronium, vecuronium, pancuronium, and gallamine with an association constant of up to 108 M-1. A series of in vitro and in vivo safety tests preliminarily demonstrated that this synthetic macrocycle had good biocompatibility. Compared to sugammadex, post-treatment by an equivalent dose of ExBP3C could produce a more efficient reversal function. Additionally, a single dose of such a reversal agent was also able to completely recover overdose atracurium-induced heart rate abnormalities within 2 min.

Efficacy and safety of several common drugs in the treatment of acute respiratory distress syndrome: A systematic review and network meta-analysis

Background: This study aimed to compare the effectiveness and safety of neuromuscular blockers, mesenchymal stem cells (MSC), and inhaled pulmonary vasodilators (IV) for acute respiratory distress syndrome through a network meta-analysis of randomized controlled trials (RCTs). Methods: We searched Chinese and English databases, including China National Knowledge Infrastructure, The Cochrane Library, PubMed, and EMbase, with no time restrictions. We conducted a network meta-analysis and reported the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included 27 clinical RCTs, all of which were two-arm trials, totaling 3492 patients. We selected 28-day mortality as the primary outcome measure, whereas 90-day mortality, ventilator-free days, and oxygenation served as secondary outcome measures for analysis and comparison. Results: We selected 3 treatment modalities and evaluated their clinical trials in comparison with the standard control group. For the 28-day in-hospital mortality, we included 21 RCTs, involving 2789 patients. Compared to standard treatment, neuromuscular blockers were associated with reduced 28-day hospital mortality (odds ratios [OR] 0.52, 95% confidence intervals [CI] (0.31, 0.88)), while IV and MSC were not associated with reduced hospital mortality (OR 0.89, 95% CI (0.50, 1.55); OR 0.90, 95% CI (0.49, 1.66)). In terms of 90-day mortality, days free of mechanical ventilation, and improvement in oxygenation, there were no significant differences compared to standard treatment with neuromuscular blockers, MSC, and IV. Conclusion: Neuromuscular blockers significantly reduced the 28-day mortality rate in acute respiratory distress syndrome patients. However, in terms of 90-day mortality, ventilator-free days, oxygenation improvement, IV, MSC, and neuromuscular blockers did not significantly improve.

Analysis of characteristics of patients whose sugammadex claims were denied by the Auto Insurance Claims Review Department of Korean Health Insurance Review & Assessment Service: a retrospective single-center review.

Recently, there have been many cases where sugammadex used in traffic accident patients has been deducted from auto insurance claims. This study aims to investigate the characteristics of sugammadex deductions through retrospective analysis. We included patients who underwent general anesthesia after traffic accidents at our institution between January 2019 and December 2023. Data for patients for whom sugammadex payments were deducted from the Auto Insurance Claims Review Department of the Korean Health Insurance Review and Assessment Service were obtained from the hospital's insurance department, and electronic medical records were analyzed. The characteristics of neuromuscular blockade (NMB) and its reversal, including administration time and dosage of neuromuscular blockading agent (NMBA) and reversal agent, intraoperative neuromuscular transmission (NMT) monitoring results, and reasons for sugammadex use, were assessed and analyzed. A total of 251 patients deducted sugammadex payments during the study period. The deduction rate significantly decreased from 88-100% in previous years to 43.4% in 2023. Sugammadex was used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). Sugammadex was mostly used to reverse deep NMB (55.1%) and in high-risk patients (23.1%). NMT monitoring was documented in 81.3% of cases, with 38.9% showing deep NMB and 33.3% showing moderate NMB. Despite improved NMT documentation after 2021, sugammadex payment deductions persisted. Sugammadex payment deductions occur despite clinical necessity, particularly in deep and moderate NMB cases. Thorough documentation may help reduce these deductions. Collaboration between healthcare providers and policymakers is required to use reversal agents guided by clinical evidence.

Safety and efficacy of remimazolam tosilate for general anaesthesia in paediatric patients undergoing elective surgery: a multicentre, randomised, single-blind, controlled trial.

Remimazolam is an ultra-short-acting benzodiazepine sedative drug. This study aimed to compare the efficacy and safety of remimazolam with propofol for induction and maintenance of general anaesthesia in children undergoing elective surgery. Children (aged 3-6 y, ASA physical status 1 or 2, BMI 14-25 kg.m-2) undergoing elective surgery under general anaesthesia with tracheal intubation were eligible for inclusion. Children were allocated randomly using a web-based system to receive either remimazolam or propofol in a 3:1 ratio. After receiving fentanyl 3 μg.kg-1, children received their allocated drug for both induction and maintenance of general anaesthesia. Induction doses were remimazolam 0.3 mg.kg-1 or propofol 2.5 mg.kg-1, with a second dose given should they not achieve loss of consciousness. After neuromuscular blockade and tracheal intubation, maintenance anaesthesia was achieved with an infusion either remimazolam 1-3 mg.kg-1.h-1 or propofol 4-12 mg.kg-1.h-1, alongside a remifentanil infusion (0.1-0.5 μg.kg-1.min-1) titrated to surgical stimulus and haemodynamic parameters. Primary outcomes were the incidence of successful induction and maintenance of anaesthesia. Secondary outcomes included: time to loss of consciousness, awakening and tracheal extubation; incidence of emergence delirium and moderate or severe pain in post-anaesthesia care unit; incidence of negative behaviour change after surgery at postoperative day 3; and incidence of adverse events. A total of 187 children were analysed (140 allocated to remimazolam and 47 to propofol). All children achieved successful induction of anaesthesia. Successful maintenance of anaesthesia was achieved in 139 (99%) children who received remimazolam compared with 46 (98%) who received propofol (rate difference 1.4%, 95%CI -2.9-5.8%, p = 0.441). Adverse events occurred in 27 (19%) children who received remimazolam and 23 (49%) who received propofol. Remimazolam was well tolerated for the induction and maintenance of general anaesthesia in pre-school-age children and was non-inferior to propofol.

Retraction Note: Effect of neuromuscular blockade reversal on post-operative urinary retention following inguinal herniorrhaphy.

Retraction Note: Effect of neuromuscular blockade reversal on post-operative urinary retention following inguinal herniorrhaphy.

Intrathecal Pethidine Plus Dexamethasone Versus Intrathecal Bupivacaine in Lower Extremity Orthopedic Surgeries: A Randomized Clinical Trial

Background: Spinal anesthesia remains the preferred technique for lower abdominal and orthopedic procedures. Objectives: This study compares the effects of an intrathecal injection of pethidine combined with dexamethasone versus intrathecal bupivacaine alone in patients undergoing lower extremity orthopedic surgeries. Methods: In this prospective, randomized, controlled, double-blinded study, 46 participants scheduled for elective lower extremity orthopedic surgeries were randomly allocated into two groups. Group PD (n = 23) received an intrathecal injection of 1 mg/kg preservative-free pethidine combined with 4 mg dexamethasone, diluted with 0.9% sodium chloride saline to a total volume of 3 mL. Group B (n = 23) received an intrathecal injection of 3 mL (15 mg) of 0.5% hyperbaric bupivacaine alone. The primary outcome measured was the time to the first need for rescue analgesia. Secondary outcomes included spinal anesthesia characteristics, intraoperative hemodynamic stability, and incidence of perioperative adverse events. Results: The time to first need for rescue analgesia was significantly longer in Group PD (7.76 ± 0.79 hours) compared to Group B (4.48 ± 0.63 hours). Differences in the onset of sensory and motor blocks between Group PD (6.39 ± 1.12 and 10.09 ± 2.23 minutes, respectively) and Group B (6.43 ± 1.99 and 9.96 ± 2.33 minutes, respectively) were statistically non-significant. However, the regression time for sensory and motor blocks was significantly shorter in Group PD compared to Group B (146.74 ± 15.35 and 119.56 ± 14.13 minutes vs. 188.44 ± 6.84 and 168.04 ± 5.25 minutes, respectively). Incidence of hypotension and shivering was also less frequent in Group PD than in Group B. Conclusions: Intrathecal administration of 1 mg/kg pethidine plus 4 mg dexamethasone provided improved spinal anesthesia, with extended postoperative analgesia, minimal intraoperative hemodynamic disturbances, and reduced incidence of shivering compared to bupivacaine alone in patients undergoing lower extremity orthopedic surgeries. This approach may be particularly beneficial for patients with hypersensitivity to ester or amide local anesthetics, offering a cost-effective alternative to standard local anesthetics.

The effect of intravenous lidocaine infusion on subarachnoid anesthesia in patients undergoing total knee replacement: a randomised controlled trial.

Intravenous lidocaine is a non-opioid analgesic adjunct for perioperative pain relief. The aim of our study was to explore whether concurrent administration of intravenous lidocaine prolongs the duration of sensory block during total knee replacement (TKR) under spinal anaesthesia. This prospective randomized double blind controlled trial was conducted on 28 patients (14 in lidocaine group and 14 in the control group) undergoing unilateral TKR under spinal anesthesia. In the lidocaine group, intravenous lidocaine 1.5mg·kg-1 followed by an infusion of 1.5mg·kg-1·h-1 was administered intraoperatively after spinal anesthesia. The primary outcome was the duration of sensory block of spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic, postoperative visual analog scale (VAS) scores and postoperative analgesia requirement in 24h after surgery. The duration of sensory and motor block was longer in the lidocaine group (Mean ± SD; 112.50 ± 5.80min versus 78.21 ± 9.12min;p < 0.001 and 237.14 ± 9.14min versus 215.00 ± 10.12min;p < 0.001, respectively). Time to requirement of first rescue analgesia was 184.29 ± 9.38min in the lidocaine group and 127.14 ± 23.35min in the control group (p < 0.001). VAS scores were lower in the lidocaine group at 4, 8, 12 and 24h after surgery (p < 0.00001, p < 0.00001, p < 0.00006, p = 0.032, respectively). Requirement of additional analgesia in the first 24h was higher in the control group. There were no clinical signs to suggest lidocaine toxicity in any patient. During unilateral TKR under spinal anaesthesia, concurrent use of intravenous lidocaine prolonged sensory block and reduced postoperative analgesic requirements.

Spontaneous breathing-induced lung injury in mechanically ventilated patients.

Recent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury. Recent clinical and experimental studies have shown that vigorous spontaneous breathing during mechanical ventilation can potentially injure the lungs due to high transpulmonary pressure, the Pendelluft phenomenon, increased pulmonary perfusion, and patient-ventilator asynchrony. A definitive approach to minimize spontaneous breathing-induced lung injury is the systemic use of neuromuscular blocking agents; however, there is a risk of muscle atrophy. Alternatively, partial paralysis, bilateral phrenic nerve blockade, and sedatives may be useful for decreasing force generation from the diaphragm while maintaining muscle function. A higher positive end-expiratory pressure (PEEP) and prone positioning may reduce force generation from the diaphragm by decreasing neuromechanical efficiency. Several potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.

Comparative Study to Evaluate the Efficacy of Dexmedetomidine and Magnesium Sulfate as Adjuvants to 0.5% of Hyperbaric Bupivacaine in Patient Undergoing Abdominal Hysterectomy by Spinal Anesthesia: A Randomized, Double-blind Study

Abstract Objective: Abdominal hysterectomy is a common gynecological procedure. While spinal anesthesia offers pain relief, its short analgesic effect is limiting. In this context, there are not many research that examined magnesium sulfate, dexmedetomidine, and 0.5% hyperbaric bupivacaine. Our research addresses this gap as “Comparing Dexmedetomidine and Magnesium Sulfate as Adjuvants to Hyperbaric Bupivacaine for Abdominal Hysterectomy”. Methods: Ninety patients with the American Society of Anesthesiologists Classification I and II, aged 30–60, planned for abdominal hysterectomy were randomized to either dexmedetomidine or magnesium sulfate or control group as adjuvants to hyperbaric bupivacaine. The primary objective was to find the effectiveness of the anesthesia in terms of both sensory and motor blocks (onset, duration, and severity), with the secondary objective was to find out any other associated complications. Results: In comparison to the magnesium sulfate group, the dexmedetomidine group’s anesthetic effect began significantly more immediately and persisted much longer (P &lt; 0.001). The groups did not vary statistically significant in terms of side effects or hemodynamic instability. Conclusion: Adjuvants such as dexmedetomidine or magnesium sulfate along with hyperbaric bupivacaine, for abdominal hysterectomy under spinal anesthesia, provide effective anesthesia. Dexmedetomidine (10 μg) and magnesium sulfate (100 mg) both showed safe intrathecal adjuvant usage. Remarkably, dexmedetomidine surpasses magnesium sulfate by swiftly inducing sensory and motor blocks, extending their duration, and enhancing analgesia. Notably, both adjuncts yield no adverse effects. Overall, these findings underscore the potential of dexmedetomidine as a more effective adjuvant in spinal anesthesia protocols for abdominal hysterectomy procedures.

Effect of dural puncture epidural technique combined with programmed intermittent epidural bolus on labor analgesia: A randomized, double-blind, parallel-group, controlled clinical trial.

Labor analgesia can be achieved by different approaches. The efficacy and safety of combined dural puncture epidural (DPE) with program intermittent epidural bolus (PIEB) are not well characterized. This study aimed to compare the efficacy and safety of DPE combined with PIEB vs epidural (EP) combined with PIEB for labor analgesia. We performed a prospective, randomized, double-blind, parallel-group, controlled clinical trial. Eligible pregnant nulliparous women received either DPE combined with PIEB (group D) or epidural combined with PIEB (group E) for labor analgesia. Analgesia was initiated with 0.1% ropivacaine + 0.3 µg/mL sufentanil and maintained with PIEB at 12 mL/h. Primary outcome was the proportion of women with adequate analgesia within 10 minutes after the initiation of analgesics. Secondary outcomes (time to achieve analgesia, time to first request for additional analgesic, proportion of women required additional analgesic or epidural catheter adjustment and resetting, total labor duration, total analgesic consumption, level of anesthesia, and motor block), side effects, and patient satisfaction were also documented. Out of 174 enrolled women, 160 were included in the analysis. Baseline characteristics were comparable. The proportion of women who achieved adequate analgesia in group D was significantly greater than that in group E (38.8% vs 20.0%, P < .05). Compared with group E, group D also showed advantages in faster adequate analgesic achievement, more likely to reach adequate analgesia, a longer time to maintain analgesia, lesser requirements for additional analgesic, and better sensory blocks. There were no significant inter-group differences in other outcome measures. Compared with epidural and PIEB mode, DPE and PIEB mode achieved better analgesia without increasing maternal or neonatal side-effects during labor.

A Phase I Study of the Pharmacokinetics, Pharmacodynamics, and Safety of Liposomal Bupivacaine for Sciatic Nerve Block in the Popliteal Fossa for Bunionectomy.

This trial assessed the pharmacokinetics, pharmacodynamics, and safety of liposomal bupivacaine given via ultrasound-guided popliteal sciatic nerve block with or without immediate-release bupivacaine hydrochloride in adults having bunionectomies. Forty-five adults were enrolled into four sequential cohorts: (1) liposomal bupivacaine 266 mg with bupivacaine hydrochloride 50 mg; (2) liposomal bupivacaine 133 mg with bupivacaine hydrochloride 50 mg; (3) liposomal bupivacaine 266 mg; or (4) bupivacaine hydrochloride 100 mg. Outcomes included pharmacokinetics (e.g., bupivacaine maximum plasma concentration [Cmax]), onset and duration of motor and sensory nerve block, and safety. Liposomal bupivacaine admixed with bupivacaine hydrochloride produced biphasic bupivacaine plasma disposition profiles with two distinct peaks. Geometric mean Cmax of the early peak ranged from 235 to 421 ng/mL and the geometric mean of the late Cmax was ∼30%-50% lower than the early peak. Median time to sensory block onset was 18 to 29 min in all cohorts. Sensory blocks lasted about twice as long with liposomal bupivacaine (median, 119-167 h) than with bupivacaine hydrochloride alone (median, 67 h). There were no serious adverse events. In conclusion, liposomal bupivacaine provided prolonged sensory nerve block when given as popliteal sciatic nerve blocks with or without bupivacaine hydrochloride, and bupivacaine plasma concentrations were well below the lower bound of the toxicity threshold of 2000 ng/mL for all cohorts.

COMPARISON OF ANESTHETIC EFFECT OF PLAIN ROPIVACAINE VERSUS DEXMEDETOMIDINE AS AN ADJUVANT TO ROPIVACAINE IN USG-GUIDED SUPRACLAVICULAR BLOCK FOR UPPER LIMB SURGERIES

Objectives: Perioperative pain management is very important to achieve patient satisfaction. The objectives of the current study were to compare the anesthetic effects of dexmedetomidine and plain ropivacaine as an adjuvant to ropivacaine for upper limb surgeries in the supraclavicular brachial plexus block in terms of hemodynamic responses, quality, onset, and duration of sensory and motor block, post-operative pain management and side effects/complications if any. Methods: Sixty adult patients scheduled for upper limb surgeries were randomized into Group A and Group B of 30 patients each. Patients in Group A received 0.5% Ropivacaine 20 mL+5 mL normal saline and Group B received 0.5% ropivacaine 20 mL+0.5 mL (50 μg) dexmedetomidine+4.5 mL normal saline. The primary objective of our study was to compare the groups in terms of quality of block, onset, and duration of sensory and motor block and post-operative pain management. The secondary objective was to compare the intraoperative hemodynamic changes and post-operative adverse effects. Results: Time taken in the onset of the sensory as well as motor block in both the groups was statistically significantly more in Group A compared to Group B. The duration of the sensory as well as the motor block was much higher in Group B compared to Group A with a statistically significant difference. The total duration of analgesia was slightly higher in Group A compared to Group B. The mean numerical rating scale was significantly lower in Group B compared to Group A at all-time intervals till 24 h. No major side effects were observed with study drugs. Conclusion: The study confirmed that dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block hastens the onset of the sensory as well as motor block and prolongs the duration of the sensory as well as the motor block in the upper limb surgeries.

Assessing the efficacy of sugammadex based on ideal body weight for reversal of moderate neuromuscular blockade in obstetric patients across different BMI categories: A prospective study

Background: This investigation aimed to evaluate the effectiveness of administering 2 mg/kg intravenous (IV) sugammadex, dosed according to the ideal body weight (IBW) of obstetric patients across three different BMI groups, for the reversal of neuromuscular blockade caused by rocuronium.Materials and Method: A total of ninety female patients, who were categorized as American Society of Anesthesiologists (ASA) II and were 18 years or older, participated in this study. These patients were all scheduled to undergo elective cesarean sections under general anesthesia, providing a well-defined cohort for our investigation. Participants were separated into three groups according to their BMI: Group 1 (n=30) consisted of patients with a BMI less than 30 kg/m², Group 2 (n=30) included those with a BMI ranging from 30 to 39.9 kg/m², and Group 3 (n=30) comprised patients with a BMI over 40 kg/m². At the end of the surgery, each patient received intravenous sugammadex at 2 mg/kg based on ideal body weight, with additional doses as needed, while recording the total amount administered and the times for extubation, motor responses, and first breastfeeding.Results: The total sugammadex dose was found to be notably higher in Group 3 (p=0.002). The time required to reach a Train of Four (TOF) ratio greater than 90% was similar across the groups (p=0.120). However, the recorded durations between sugammadex administration and extubation, accurate motor response, and the time to first breastfeeding significantly differed between the groups.Conclusions: We found that IV sugammadex 2 mg/kg, administered according to the IBW of patients, was effective for reversing moderate neuromuscular blockade in patients of weight categories. However, administering a sugammadex dose of IBW+25% appears to be safer for class III obese patients.

How does intravenous ondansetron affect motor and sensory block in spinal anesthesia administered with intrathecal levobupivacaine? A prospective randomized controlled study

Background: Spinal anesthesia is commonly performed in surgical procedures, and ondansetron, frequently used as an antiemetic, is often administered to manage postoperative nausea and vomiting. Given their frequent co-administration, we sought to investigate the potential effects of intravenous ondansetron on the block characteristics of spinal anesthesia performed with levobupivacaine.Materials and Method: In this prospective, randomized controlled study, forty patients were divided into two groups: Group L (spinal anesthesia with levobupivacaine) and Group OL (spinal anesthesia with levobupivacaine plus intravenous ondansetron).Results: Our findings showed that while motor block duration was similar between the groups (p&gt;0.05), sensory block duration was significantly shorter in the ondansetron group (p&lt;0.05). There were no significant differences in patient demographics or hemodynamic parameters between the groups (p&gt;0.05).Conclusions: The shortened sensory block with ondansetron administration may be clinically undesirable as it could limit the intended duration of anesthesia. We recommend administering ondansetron at the end of surgery to avoid this effect. Further studies are required to confirm these findings and clarify the mechanisms involved.

Sub-Tenon's anesthesia in equine cataract surgery and vitrectomy: a retrospective case series (2018-2022).

A retrospective data analysis was performed on 17 eyes from 13 horses which underwent a sub-Tenon's injection to facilitate phacoemulsification or pars plana vitrectomy under general anesthesia between 2018 and 2022. All procedures were performed by the same veterinary ophthalmologist. Seven eyes received a sub-Tenon's dose of 7 ml lidocaine (XylocainÒ, 2 % lidocaine hydrochloride, Germany, Aspen Germany GmbH), and 10 eyes received 7 ml mepivacaine (MepinaestÒ purum 2 %, mepivacaine hydrochloride, Switzerland, Gebro Pharma GmbH). Statistical analysis compared onset and duration of globe centralization and pupil mydriasis between the two groups. Intraoperative and postoperative complications were also assessed. Mepivacaine had a significantly later onset of action regarding globe centration and mydriasis (8,9 minutes vs. 6 minutes), but also a significantly longer duration of globe centration than lidocaine (31,5 minutes vs. 15,6 minutes). There were no statistically relevant differences between solutions regarding duration of pupil dilation (40,4 minutes for 2 % lidocaine vs. 69,2 minutes for 2 % mepivacaine). Chemosis occurred in all 17 eyes. Surgical complications included corneal epithelial defects (5), retinal detachment (5), lens opacification (5), temporary blindness during recovery (3) and glaucoma (2). Sub-Tenon's anesthesia is a feasible alternative to systemic neuromuscular blockade and retrobulbar block anesthesia for surgical procedures on the equine globe. A controlled prospective in vivo study is needed to further evaluate effects and risks.

A Comparative Study Of Intrathecal 0.5% Hyperbaric Bupivacaine And Intrathecal 0.75% Hyperbaric Ropivacaine In Lower Abdominal Surgeries.

Background: Spinal anaesthesia has been widely used since its introduction in 1898 due to its safety and advantages over general anaesthesia. However, traditional agents like bupivacaine have some disadvantages, including cardiovascular effects and longer duration of action. Ropivacaine has emerged as a potential alternative with reduced cardiovascular toxicity. The study was aimed to compare the efficacy and suitability of 0.75% hyperbaric ropivacaine with 0.5% hyperbaric bupivacaine in patients undergoing lower limb and endoscopic urological surgeries, evaluating onset, quality, duration of block, and incidence of complications. Materials and Methods: A prospective randomized trial was conducted with 130 patients (65 per group) aged 16-60 years, ASA grades 1 &amp; 2. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine, while Group R received 3.0 ml of 0.75% hyperbaric ropivacaine. Onset of anaesthesia, quality of block, duration, hemodynamic parameters, and complications were assessed. Results: Ropivacaine showed faster sensory and motor recovery, better hemodynamic stability, and fewer side effects compared to bupivacaine. The onset of sensory block was slightly faster with bupivacaine (2.17 vs 2.54 minutes), but ropivacaine had a shorter duration of sensory (114.7 vs 158 minutes) and motor block (112 vs 130 minutes). Ropivacaine group experienced less hypotension (4.6% vs 7.7%) and no bradycardia or vomiting compared to the bupivacaine group. Conclusion: Hyperbaric ropivacaine 0.75% was found to be a comparable and safer alternative to hyperbaric bupivacaine 0.5% for patients undergoing lower abdominal surgery, offering faster recovery and better hemodynamic stability

Comparative Study Of Fentanyl Versus Tramadol As Adjuvant With Low Dose Local Anaesthetic Ropivacaine (0.1%) For Epidural Labour Analgesia

Background: Epidural nerve block is widely used for labor analgesia because of its effective pain relief, reduced maternal stress response, improved parturient satisfaction, and potential ability to provide anesthesia. The quality of analgesiais improved with the combined use of a local anesthetic and an opioid when combined with the use of either agent alone. An example of avcombination epidural therapy that provides excellent sensory block with relatively little motor block includes a co-administration of ropivacaine and fentanyl or tramadol. Materials and Methods: The study was carried out at the Department of Anaesthesiology, Katihar Medical College &amp; Hospital, Katihar, Bihar, study was done for 1 Year, 100 individuals were enrolled, Group F (Fentanyl Group) with 50 patients received Ropivacaine and Fentanyl and Group T (Tramadol Group) with 50 patients received a Ropivacaine and Tramadol. Every variable was subjected to statistical analysis within the same individual and between 2 treatment categories using a suitable biostatistical methodology. Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 23.54±2.5, mean age in group T (ropivacaine with tramadol) was 23.86±2.17, and weight in group F was 56.78±2.75 and group T was 56.68±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (p&gt;0.05). More side effects were seen in group F. Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.