Anesthesia Outcomes Research Articles

FEASIBILITY OF NEW CMR POST-PROCESSING SOFTWARE PROTOTYPES IN ASSESSING THE RIGHT HEART AND TRICUSPID FUNCTION

<h3>Introduction</h3> As right heart dysfunction is frequently encountered in cardiac surgical cases, increasing attention is being paid to pre-operative right atrial and ventricular (RV) dysfunction and secondary tricuspid insufficiency for optimal patient risk evaluation and decision-making. However, cardiac evaluations have long focused on the left side of the heart, and consequently there is a void of post-processing analysis techniques designed to assess the right heart, limiting the information available. Indications for cardiovascular magnetic resonance (CMR) prior to surgical interventions are rapidly increasing. CMR is ideal for right heart assessments as it is not limited by acoustic windowing issues yet lags behind other modalities such as echo and CT for assessing the tricuspid valve. Advancements with CMR software can quantify tricuspid annular excursion in 2D planes using a rapid-automated long-axis strain prototype. A second new technique is 4D-flow CMR, which has the potential to overcome the limitations posed by the through plane and angular motion of the valve. 4D flow measures blood trajectories and velocity in any direction over the entire cardiac cycle, yet it was designed for aortic and left ventricular measures. We investigated the feasibility of a 4D-blood flow prototype for measuring trans-tricuspid flow in relation to other novel right heart rapid-automated long-axis parameters. <h3>Methods</h3> In 30 healthy controls and 15 cardiovascular patients with an RV fractional area change between 30-50% and no known severe valve disease, a 4D-flow block encompassing the entire heart was imaged with CMR. Using a prototype dynamic-valve-tracking module, a contour was placed on the tricuspid annulus of the 4D images throughout the entire cardiac cycle. Forward and backwards flow through the valve was measured, with a specific focus on max flow during early diastole (E). A second prototype for rapid-automated long-axis strain analysis was implemented to measure the atrio-tricuspid annular motion (A-TAM) defined as the change in the longitudinal extent from the roof of the right atrium to the tricuspid valve, and for the tricuspid annular plane systolic excursion (TAPSE). <h3>Results</h3> One patient was excluded from flow analysis due to poor gating. In all remaining exams, an E wave was detected, and maximal tricuspid flow was 307±70ml/s in controls, and 251±79ml/s in patients (p=0.025). Moreover, with 4D analysis, mild tricuspid insufficiency was observed in 6/14 (43%) patients with a regurgitant fraction of 5% or more, which was not observed in controls. Patients also demonstrated reduced right atrial and ventricular function shown by a reduced A-TAM (28±13% vs 14±10%, p<0.001) and TAPSE (25±4 vs 17±5mm, p<0.001) in patients compared to controls. <h3>Conclusion</h3> In this feasibility analysis, dynamic flow analysis can be applied to CMR 4D-blood flow acquisitions of the right heart to measure tricuspid valve flow patterns and quantify tricuspid insufficiencies. Further comparisons of analysis with these prototypes to gold-standard techniques, and the association of these markers with anaesthesia outcomes are required for further validation.

The short-term outcomes of nonintubated anesthesia compared with intubated anesthesia in single-port video-assisted lung surgery in enhanced recovery after thoracic surgery: results from a single-center retrospective study.

Nonintubated anesthesia avoids invasive tracheal intubation operations and reduces trauma. in addition, it has advantages in lung surgery in some patients with poor lung function, in line with the concept of rapid recovery. However, few studies have discussed the clinical significance of Enhanced recovery after surgery (ERAS) combined with nonintubated anesthesia in single-port video-assisted thoracoscopic surgery (VATS). We conducted a retrospective study to examine the safety and availability of nonintubated anesthesia single-port video-assisted lung surgery (NI-SP-VALS) combined with ERAS programs in patients. This was a single-center retrospective study. All patients were preoperatively diagnosed with lung nodules and underwent NI-SP-VALS or intubated anesthesia SP-VALS (I-SP-VALS) combined with ERAS programs between July 2021 and March 2022. Short-term postoperative outcomes were compared in 2 cohorts. In total, 272 patients were included. Among them, 91 patients received NI-SP-VALS combined with ERAS programs (observation group), and 181 underwent intubation anesthesia (control group). Baseline data were statistically different between the two groups, and 1:1 propensity score matching (PSM) matching was used. A total of 73 patients remained in each group after PSM, and baseline characteristics were not significantly different between the 2 cohorts. The time of hospital stay [4.00 (4.00-5.00) vs. 44.50 (0.00-5.75) d; P=0.029] and catheter stay [0.50 (0.20-2.00) vs. 2.00 (2.00-2.00) d; P<0.001] were significantly shorter, the white blood cell count (WBC) [9.45 (8.08-11.30) vs. 11 (8.50-12.80)/L; P=0.009] and the lowest SpO2 in operation [96.00 (94.00-97.50) vs. 97.00 (95.00-98.50); P=0.035] were also lower in the nonintubated group than those of the intubated group. No differences were observed in variables of intraoperation, other routine blood indexes, postoperative drainage, postoperative medicine use, postoperative symptoms, complications, hospitalization expenses, postoperative follow-up index, or self-assessment of anxiety. The data after PSM shows that compared with intubated anesthesia, NI-SP-VALS combined with ERAS programs is safe and effective. Nonintubated anesthesia promotes rapid recovery of patients and reduces postoperative inflammatory reactions. Hence, nonintubated anesthesia may conform to the idea of ERAS and has application value in thoracic surgery.

Cochlear implantation surgery with conscious sedation in the very elderly: a feasibility study comparing cochlear implant outcomes in general anaesthesia (GA) and local anaesthesia (LA) cohorts

Background: To characterize outcomes of very elderly patients who have had cochlear implant (CI) surgery under awake conditions with local anaesthesia (LA)/conscious sedation with patients who underwent CI surgery under general anaesthesia (GA), as a preliminary feasibility study prior to a more detailed investigation.

Intrapartum Epidural Anesthesia and Obstetric Outcome in Nulliparous Women with Term Labor: An analysis of 2 years’ Experience

Aim: to ascertain whether labour profiles and delivery outcomes of nulliparous women who received epidural analgesia were comparable to those of women whose labour was managed with alternative forms of pain relief. Patients and Methods: a prospective, randomised, controlled clinical study carried out in Saudi German and Elhussine University hospitals. Recruitment was open to 100 nulliparous women planning a vaginal delivery of a term singleton foetus. Results: 100 women, with gestational age of 37–41 completed weeks, were chosen at random to receive either continuous epidural analgesia (EPI) or alternative forms of pain relief (NEPI). Compared to the EPI group, the NEPI group's labour took less time to deliver (P&lt;0.05). The first stage's mean duration was 3.7 ± 1.1 hours compared to 4.8 ± 3.1 hours (P &lt; 0.05), while the second stage's mean duration was 102.4 ± 9.3 minutes compared to 132.1 ± 15.8 minutes (p &lt; 0.05). The mean NEPI dose of oxytocin was 10.5 ± 2.3 units, while the mean EPI dose was 15.6 ± 2.5 units (p &lt; 0.05). While NEPI groups had higher rates of spontaneous vaginal deliveries and caesarean sections than EPI groups, NEPI groups required fewer surgical deliveries overall (p &lt; 0.05). VAS scores during labour were less significantly in EPI group (p &lt; 0.05). Conclusion: Regardless of their intention to labour, nulliparous women use epidural analgesia frequently. Other pain management techniques are linked to a slight but statistically significant decrease in the average length of labour and the rate of surgical delivery in women who do not plan to use epidural analgesia as their primary analgesic modality.

Anesthetic management of patients with class 3 obesity undergoing elective Cesarean delivery: a single-centre historical cohort study

PurposeThe preferred neuraxial anesthetic technique for patients with class 3 obesity undergoing elective Cesarean delivery is still under debate. We aimed to describe the anesthetic technique used in our tertiary institution across body mass index (BMI) groups and different surgical incisions.MethodIn this historical cohort study, we reviewed medical records of patients with a BMI ≥ 40 kg·m–2 undergoing elective Cesarean delivery between July 2014 and December 2020. We collected data on patient characteristics, anesthetic and surgical technique, and procedural times. For data analysis, we stratified patients by BMI into three different groups: 40.0–49.9 kg·m–2, 50.0–59.9 kg·m–2, and ≥ 60.0 kg·m–2.ResultsWe included 396 deliveries, distributed as follows: 258 with a BMI 40.0–49.9 kg·m–2, 112 with a BMI 50.0–59.9 kg·m–2, and 26 with a BMI ≥ 60.0 kg·m–2. For patients with a BMI 40.0–49.9 kg·m–2, the anesthetic technique of first choice was predominantly spinal anesthesia (71%), whereas for those with a BMI ≥ 60.0 kg·m–2, spinal anesthesia was never used as the anesthetic of first choice. With regard to the surgical incision, spinal anesthesia was almost exclusively used for patients undergoing Pfannenstiel incision and was rarely used for a higher supra- or infraumbilical transverse or midline incision. The overall incidence of general anesthesia was low (7/396, 1.8%). Anesthetic time, surgical time, and operating room time increased almost twofold in patients with a BMI ≥ 60.0 kg·m–2 compared with those with a BMI of 40.0–49.9 kg·m–2.ConclusionNeuraxial anesthesia was successfully used in approximately 98% of patients with class 3 obesity undergoing elective Cesarean delivery. The choice of regional anesthesia technique varied with increasing BMI and with the planned surgical incision. Procedural times increased with increasing BMI. This information should prove useful for comparing anesthetic choices and outcomes in this challenging population.

Usefulness of discharge standards in outpatients undergoing sedative endoscopy: a propensity score-matched study of the modified post-anesthetic discharge scoring system and the modified Aldrete score

BackgroundThis study aimed to evaluate the usefulness of discharge standards in outpatients undergoing sedative endoscopy by comparing the modified post-anesthetic discharge scoring system (MPADSS) and the modified Aldrete score.MethodsWe prospectively enrolled 376 outpatients who underwent gastrointestinal endoscopy under midazolam sedation; 181 outpatients were assessed regarding discharge after sedative endoscopy using the MPADSS (group M), and 195 patients were assessed by the modified Aldrete score (group A). The clinical characteristics, types of endoscopy, endoscopic outcomes, and anesthesia outcomes were evaluated between the two groups. We compared discharge score, recovery time, and adverse events using propensity-score matching.ResultsPropensity-score matching created 120 matched pairs. The proportion of patients who had a recovery time within 60 min after endoscopy was significantly higher in group A than that in group M (42.5% versus 25.0%, respectively; P < 0.01). The proportion of patients who required > 120 min of recovery time after endoscopy was significantly lower in group A than that in group M (0.0% versus 5.0%, respectively; P = 0.03). However, significantly more patients had drowsiness at discharge in group A compared with group M (19.1% versus 5.0%, respectively; P < 0.01). There was no significant difference in the adverse event rate within 24 h of discharge between the groups.ConclusionsPatients assessed by the modified Aldrete score were allowed to discharge earlier than those assessed by the MPADSS. However, a patient’s level of consciousness should be assessed carefully, especially in patients who visit the hospital alone.

Neurodevelopmental outcomes after prenatal exposure to anaesthesia for maternal surgery: a propensity-score weighted bidirectional cohort study.

Up to 1% of pregnant women undergo anaesthesia for non-obstetric surgery. This study investigated neurodevelopmental outcomes after prenatal anaesthesia for maternal surgery. A bidirectional cohort study of children born between 2001 and 2018 was performed: neurodevelopmental outcomes of children who had received prenatal anaesthesia for maternal surgery were prospectively compared with unexposed children, with exposure status being assessed retrospectively. Children exposed to anaesthesia for obstetric and fetal surgery were excluded. The primary outcome was the global executive composite of the behaviour rating inventory of executive function score. Our secondary outcomes were: total problems; internalising problems and externalising problems derived from the child behaviour checklist; psychiatric diagnoses; and learning disorders. In 90% of exposed children, there was a single mean (SD) antenatal anaesthesia exposure lasting 91(94) min. There was a broad spectrum of indications, with abdominal surgery being most frequent. Parents of 129 exposed (response rate 68%) and 453 unexposed (response rate 63%) children participated. There were no arguments for non-response bias. After propensity weighting, there were no statistically significant differences in primary outcome, with a weighted mean difference (95%CI) of exposed minus unexposed children of 1.9 (-0.4-4.2), p = 0.10; or any of the secondary outcomes. Sensitivity analyses confirmed the robustness. Exploratory analyses, however, showed significant differences in certain subgroups for the primary outcome, (e.g. for intra-abdominal surgery, exposure duration > 1 h) and some cognitive subdomains (e.g. working memory and attention). This bidirectional cohort study, the largest investigation on the subject to date, has found no evidence in the general population for an association between prenatal exposure to anaesthesia and impaired neurodevelopmental outcomes.

Prospective Evaluation of Suprazygomatic Maxillary Nerve Block in Cleft Palate Repair

INTRODUCTION: Nerve block techniques anecdotally provide superior analgesia while avoiding complications of opioids after cleft palate repair. We performed a prospective, randomized, controlled trial to compare the efficacy of a suprazygomatic maxillary nerve block (SMB) vs local anesthesia (LA) in decreasing postoperative opioid consumption. METHODS: Patients undergoing primary palatoplasty between March and November 2021 were randomized to receive either (1) SMB with 0.15 ml/kg of 0.2% ropivacaine per side and palatal injection of saline with 1:400,000 epinephrine or (2) LA using 2 ml/kg of 0.125% bupivacaine with 1:400,000 epinephrine. Paired t-tests compared pain scores (Face, Legs, Activity, Crying and Consolability [FLACC]), opioid consumption (morphine milligram equivalents [MME]), oral intake for the first 24 hours postoperatively (POD1), and length of stay (LOS; Table). Table. - A Comparison of Postoperative Outcomes Between the Nerve Block and Local Anesthesia Outcome parameter Local SMB p Value FLACC Scores POD1 2.60 1.64 0.04* Intraoperative MME 2.27 1.99 0.29 MME on POD1 2.21 1.55 0.24 Time to opioid administration (min.) 122.71 151.43 0.32 Time to oral intake (min.) 114.14 310.28 0.03* Total oral intake on POD1 (ml) 567.85 442.14 0.18 LOS (hrs.) 29 28.28 0.35 RESULTS: Fifteen patients met all study endpoints (n = 7 SMB; n = 8 LA). Mean ages at the time of repair were 11.96 (SMB) and 11.17 (LA) months. SMB patients demonstrated lower mean FLACC (1.64 SMB vs 2.60 LA; p = 0.04), yet no significant difference in MME (1.55 SMB vs 2.21 LA; p = 0.24) or in time to opioid administration postoperatively (151.43 min. SMB vs 122.71 min. LA; p = 0.32). SMB patients displayed longer time to oral intake postoperatively (310.3 min. SMB vs 114.1 min. LA; p = 0.03), but no difference in total intake (p = 0.18). CONCLUSION: SMB at the time of cleft palate repair may decrease postoperative pain scores, yet worsen the immediate ability to feed after surgery. Using pain scores to guide and standardize narcotic administration may lead to lower opioid consumption after SMB.

Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study.

Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge regarding patient-reported outcomes (PROs). This study aimed to determine the impact of opioid-sparing anesthesia and opioid-based anesthesia on PROs among gynecologic patients within an enhanced recovery after surgery (ERAS) program. We formed a single-center historical cohort from patients enrolled in another study who underwent open gynecologic surgery on an ERAS program from November 2014 to December 2020 (n = 2,095). We identified two cohorts based on the type of balanced anesthesia administered: 1) opioid-sparing anesthesia defined as the continuous infusion of dexmedetomidine and ketamine (adjuvants) during surgery or 2) opioid-based anesthesia (no adjuvants). We measured the quality of postoperative recovery using the MD Anderson Symptom Inventory (MDASI), a 29-item validated tool that was administered preoperatively, daily while admitted, and weekly after discharge until week 6. The primary outcome was interference with walking. We matched both cohorts and used a multilevel linear mixed-effect model to evaluate the effect of opioid-sparing anesthesia on the primary outcome. In total, 498 patients were eligible (159 in the opioid-sparing anesthesia cohort and 339 in the opioid-based anesthesia cohort), of whom 149 matched pairs were included in the final analysis. Longitudinal assessment showed no significant or clinically important difference in interference with walking (P = 0.99), general activity (P = 0.99), or other PROs between cohorts. Median [interquartile range (IQR)] intraoperative opioid administration (expressed as morphine milligram equivalents [MME]) among matched patients in the opioid-sparing anesthesia cohort was 30 [25-55] mg vs 58 [8-70] mg in the opioid-based anesthesia cohort (P < 0.01). Patients in the opioid-sparing anesthesia cohort had a lower opioid consumption in the postanesthesia care unit than those in the opioid-based anesthesia cohort (MME, 3 [0-10] mg vs 5 [0-15] mg; P < 0.01), but there was no significant difference between cohorts in total postoperative opioid consumption (MME, 23 [0-94] mg vs 35 [13-95] mg P = 0.053). In this single-center historical cohort study, opioid-sparing anesthesia had no significant or clinically important effects on interference with walking or other PROs in patients undergoing gynecologic surgery compared with opioid-based anesthesia. Opioid-sparing anesthesia was associated with less short-term opioid consumption than opioid-based anesthesia.

A Review of the Usage and Post-surgical Outcomes of Anesthesia for Laser In Situ Keratomileusis (LASIK) Procedure.

When laser in situ keratomileusis (LASIK) surgery is employed for myopia, hyperopia, and astigmatism, the process requires the usage of anesthetics to ensure that there is minimal patient harm and negative consequences once the procedure is complete. Statistical analysis was conducted as part of this review to evaluate the application of and distinctions between the different analgesics used for LASIK surgery by compiling and filtering information from multiple research studies. Topically administered oxybuprocaine and proparacaine were found to be the most commonly used anesthetics for LASIK, according to the data included in the review. It was also determined that there were no significant differences in terms of patient outcomes and drug concentrations when proparacaine was substituted for oxybuprocaine. This is particularly intriguing given their different chemical compositions. Temporary dry eyes were the most commonly reported adverse effect of LASIK when the anesthetic was employed. Perhaps cocaine derivatives produce similar anesthetic and post-surgical effects, but further investigations are needed to verify this hypothesis.

Changes in Head, Withers, and Pelvis Movement Asymmetry in Lame Horses as a Function of Diagnostic Anesthesia Outcome, Surface and Direction

Evaluation of diagnostic anesthesia during equine lameness examination requires comparison of complex movement patterns and can be influenced by expectation bias. There is limited research about how changes in movement asymmetries after successful analgesia are affected by different exercise conditions. Movement asymmetry of head, withers and pelvis was quantified in N = 31 horses undergoing forelimb or hindlimb diagnostic anesthesia. Evaluation on a straight line and a circle was performed with subjective diagnostic anesthesia outcome and quantitative changes recorded. Mixed linear models (P < .05) analyzed the differences in movement asymmetry before/after diagnostic anesthesia - random factor: horse, fixed factors: surface (soft, hard), direction (straight, inside, outside, inside-outside average), diagnostic anesthesia outcome (negative, partially positive, positive) and two-way interactions. Forelimb diagnostic anesthesia influenced primary movement asymmetry (all head and withers parameters) and compensatory movement asymmetry (two pelvic parameters) either individually (P≤.009) or in interaction with surface (P≤.03). Hindlimb diagnostic anesthesia influenced primary movement asymmetry (all pelvic parameters) and compensatory movement asymmetry (two head and two withers parameters) either individually (P≤.04) or in interaction with surface (P≤.01;) or direction (P≤.006). Direction was also significant individually for two pelvic parameters (P≤.04). Changes in primary movement asymmetries after partially positive or positive outcomes indicated improvement in the blocked limb. Compensatory changes were mostly in agreement with the ‘law of sides’. The changes were more pronounced on the hard surface for hindlimb lameness and on the soft surface for forelimb lameness. Withers asymmetry showed distinct patterns for forelimb and hindlimb lameness potentially aiding clinical decision-making.

Effects of ultrasound-guided brachial plexus block in combination with sevoflurane general anesthesia via laryngeal mask on upper limb tumor and fracture surgery for children based on inflammatory stress response

Sevoflurane is used successfully for general anesthesia via laryngeal mask on upper limb tumors like osteosarcoma and Ewings sarcoma and fractures in orthopedic care centers. With the advancement in interventional radiology, many procedures are now available to support surgeons to carry out such procedures without complications. In this study, we tried to evaluate the effects of ultrasound-guided brachial plexus block in combination with sevoflurane general anesthesia via laryngeal mask for upper limb tumor (osteosarcoma in the metaphysic of long bones of upper limb and Ewing sarcoma-second most malignant tumor in children) and fracture surgery in children based on inflammatory stress response. Eighty-six children who were admitted to undergo surgery for upper limb tumor and fractures from June 2018 to November 2019 were selected and divided into control and study groups according to anesthesia methods (n= 43). The control group received only sevoflurane superficial general anesthesia via laryngeal mask, besides which the study group received ultrasound-guided brachial plexus block. The surgical, anesthetic outcomes and adverse reactions were compared. Pain was assessed by the visual analogue scale (VAS) 4 h, 8 h and 12 h after surgery. The serum levels of interleukin-1β (IL-1β), IL-10, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), epinephrine (E), norepinephrine (NE), cortisol (Cor) and insulin (Ins) were measured before surgery, on the day of surgery and 3 days after surgery, respectively. Compared with the control group, the surgical time and recovery time of the study group were shorter, the pain occurred later, the intraoperative respiration was slower, and the incidence rate of adverse reactions was significantly lower. The VAS scores of the study group were significantly lower than those of the control group 4 h, 8 h and 12 h after surgery. The IL-1β, IL-10, CRP, TNF-α, E, NE, Cor, and Ins levels of the study group were also significantly lower than those of the control group on the day of surgery and 3 days after surgery. Observations of this study suggest that sevoflurane superficial general anesthesia via laryngeal mask in combination with brachial plexus block can be used in the upper limb tumor removal and fracture surgery for children. This strategy has the advantages of short recovery time, few adverse reactions, obvious sedative and analgesic effects, and low inflammatory stress response.

Safety and effectiveness of regional anesthesia compared with anesthetic techniques not using regional anesthesia on outcomes after free tissue flap surgery: a systematic review protocol.

This systematic review will aim to evaluate the evidence on the effectiveness of regional anesthesia, when compared with general anesthesia alone, on the outcomes of free flap surgeries. Free flap procedures involve complete separation of a flap of tissue from its native vascular bed, followed by reimplantation to a recipient site on the body. Optimal perfusion and successful neovascularization are crucial to survival of the grafted flap. Currently, no best-practice recommendations exist regarding the use of regional anesthesia in free flap surgeries. Regional anesthesia techniques have the potential to alter blood flow and neuroendocrine responses to surgical stress, which may impact perfusion and survival of free flap grafts. This potential for augmentation or hindrance of flap perfusion may have a significant impact on patient outcomes, thus meriting systematic review. The review will include both experimental and observational (analytical only) study designs that examine the vascular outcomes of regional anesthesia compared with general anesthesia alone in free flap surgery. The databases to be searched include PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Embase, and gray literature sources. Identified studies will be independently assessed by two reviewers utilizing JBI critical appraisal tools. Data will be extracted using a standardized data matrix. Certainty of findings will be conducted using the Grading of Recommendations Assessment, Development and Evaluation approach. Narrative synthesis will be compiled and meta-analysis completed, where possible. PROSPERO CRD42021283584.

Feasibility of intraoperative quantitative neuromuscular blockade monitoring in children using electromyography

Quantitative train-of-four (TOF) monitoring remains essential in optimizing anesthetic outcomes by assessing the depth and recovery from neuromuscular blockade. Despite this, residual neuromuscular blockade, defined as a TOF ratio <0.90, remains a concern in both adult and pediatric patients. Quantitative TOF monitoring has seen limited use in infants and children primarily due to a lack of effective equipment. This study evaluates a new electromyography (EMG)-based TOF monitor in pediatric patients undergoing inpatient surgical procedures including laparoscopic (restricted arm access) surgery. Pediatric patients undergoing inpatient surgery requiring the administration of neuromuscular blocking agents (NMBAs) were enrolled. The EMG electrodes were placed along the ulnar nerve on the volar aspect of the arm to provide neurostimulation. The muscle action potentials from the abductor digiti minimi muscle were recorded. Neuromuscular responses were recorded by the device throughout surgery at 20-s intervals until after tracheal extubation. Data recorded on the monitor's built-in memory card were later retrieved and analyzed. The study cohort included 100 pediatric patients (62% male). The average age was 11 years (IQR: 8, 13) and the average weight was 39.6 kg (30, 48.7). Automatic detection of supramaximal stimulus was obtained in 95% of patients. The muscle action potential mean baseline amplitude (in mV) was 7.5 mV (6, 9.2). The baseline TOF ratio was 100% (100, 104). After administration of a neuromuscular blocking agent, monitoring of the TOF ratio was successful in 93% of the patients. After antagonism of neuromuscular blockade, monitoring was possible in 94% of patients when using an upgraded algorithm. The baseline amplitude recovered to 6.5 mV (5, 7.8), and the TOF ratio recovered to a mean of 90.1% (90,97) before tracheal extubation. Our results indicate that neuromuscular monitoring can be performed intraoperatively in pediatric patients weighing between 20 and 60 kg using the new commercially available EMG-based monitor. Automatic detection of neuromuscular stimulating parameters (supramaximal current intensity level and baseline amplitude of the muscle action potential) by an adult neuromuscular monitor is feasible in pediatric patients receiving nondepolarizing neuromuscular blocking agents.

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in limb-salvage surgery for osteosarcoma: A retrospective analysis.

Previous studies have demonstrated that anesthetic techniques can affect the outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective limb-salvage surgery for osteosarcoma (OS). This was a retrospective cohort study of patients who underwent elective limb-salvage surgery for OS between January 2007 and December 2018. Patients were grouped according to the administration of propofol-based total intravenous anesthesia (TIVA) or desflurane (DES) anesthesia. Kaplan–Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were applied to compare the hazard ratios (HRs) for death after propensity matching. Subgroup analyses were done for postoperative recurrence, metastasis, and tumor–node–metastasis (TNM) staging. A total of 30 patients (17 deaths, 56.7%) who received DES anesthesia and 26 (4 deaths, 15.4%) who received TIVA were eligible for analysis. After propensity matching, 22 patients were included in each group. In the matched analysis, patients who received TIVA had better survival with a HR of 0.30 (95% confidence interval [CI], 0.11–0.81; P = .018). Subgroup analyses also showed significantly better survival in the presence of postoperative metastasis (HR, 0.24; 95% CI, 0.06–0.87; P = .030) and with TNM stage II to III (HR, 0.26; 95% CI, 0.09–0.73; P = .011) in the matched TIVA group. In addition, patients administered with TIVA had lower risks of postoperative recurrence and metastasis than those administered with DES anesthesia in the matched analyses. Propofol-based TIVA was associated with better survival in patients who underwent elective limb-salvage surgery for OS than DES anesthesia. Prospective studies are needed to assess the effects of TIVA on oncological outcomes in patients with OS.

Optimization of anesthetic decision-making in ERAS using Bayesian network.

Enhanced recovery after surgery (ERAS) can accelerate patient recovery. However, little research has been done on optimizing the ERAS-related measures and how the measures interact with each other. The Bayesian network (BN) is a graphical model that describes the dependencies between variables and is also a model for uncertainty reasoning. In this study, we aimed to develop a method for optimizing anesthetic decisions in ERAS and then investigate the relationship between anesthetic decisions and outcomes. First, assuming that the indicators used were independent, the effects of combinations of single indicators were analyzed based on BN. Additionally, the impact indicators for outcomes were selected with statistical tests. Then, based on the previously selected indicators, the Bayesian network was constructed using the proposed structure learning method based on Strongly Connected Components (SCC) Local Structure determination by Hill Climbing Twice (LSHCT) and adjusted according to the expert’s knowledge. Finally, the relationship is analyzed. The proposed method is validated by the real clinical data of patients with benign gynecological tumors from 3 hospitals in China. Postoperative length of stay (LOS) and total cost (TC) were chosen as the outcomes. Experimental results show that the ERAS protocol has some pivotal indicators influencing LOS and TC. Identifying the relationship between these indicators can help anesthesiologists optimize the ERAS protocol and make individualized decisions.

Electroacupuncture Stimulation Suppresses Postoperative Inflammatory Response and Hippocampal Neuronal Injury.

Postoperative cognitive dysfunction (POCD) is consequence of anesthesia and surgery that primarily affects older people. The prevention and treatment of POCD has drawn an increasing attention in recent decades. Here, we established the animal model mimicked POCD after femoral fracture surgery, and analyze the effect of acupuncture stimulation on postoperative cognitive function after femoral fracture surgery. Compared with the mock group, the cognitive function performance was significantly decreased both in the anaesthesia group and the surgery group, between which the symptoms were more severe in the surgery group. The peripheral inflammation response and the neuron impairment and inflammation response in the hippocampus were observed in the surgery group, but only peripheral inflammation response was detected in the anaesthesia group. These findings indicated the POCD was the synergistic outcome of anaesthesia and surgical stimulation but with different pathogenic mechanism. The surgery with mental tri-needles (surgery+MTN) group outperformed the surgery group in terms of cognitive function performance. The peripheral inflammation response and the neuron impairment and inflammation response in the hippocampus was significantly reduced by the electroacupuncture stimulation. Our findings indicated the protection of electroacupuncture form POCD after femoral fracture surgery is related to the inhibition of inflammation response and neuron impairment.

Surgical and anaesthetic outcomes of paediatric splenectomies at a tertiary care institution in South India: a retrospective cohort.

Splenectomies though well-established in the successful management of several resistant haemoglobinopathies, have not been studied in detail in the paediatric population to assess the outcomes. We conducted this review to primarily assess the surgical and anaesthetic outcomes of paediatric splenectomies and secondarily highlight factors predictive for a high-risk splenectomy. A 5year retrospective chart review was made, and patient follow-up was done jointly using the hospital electronic medical records and telephonic calls. A p value of < 0.05 was considered significant. Among the 69 splenectomised children, 61% were male and the overall mean age was 10.2years. The cohort consisted of patients with thalassemia (46%), ITP (30%), haemolytic anemia (19%) and 1 child each with lymphoma, splenic cyst and Kassabach Meritt syndrome. Most (96%) were electively operated and 23% were performed laparoscopically. 61% received intravenous analgesia and the mean volume of fluid administered intra-operatively was 21ml/kg. There was no documented OPSI, and there was one mortality. The mean follow-up period was 43months and the overall survival rate was 98.5%. Splenectomy was associated with a promising overall outcome. A greater pre-operative transfusion requirement, a larger sized spleen and increased fluid administration intra-operatively, were associated with a worse outcome.

Association Between Type of Anaesthesia and Clinical Outcome in Patients Undergoing Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms by Fenestrated and Branched Endografts

Although endovascular repair of thoraco-abdominal aortic aneurysm (TAAA) is the treatment of choice in the high risk population that is ineligible for an open surgical approach, little is known about the association between the type of anaesthesia and complications. This study compared the short term clinical outcomes of patients undergoing the visceral step of TAAA with fenestrated endograft aortic repair (FEVAR) and branched endograft aortic repair (BEVAR) under general anaesthesia (GA) with sedation with monitored care anaesthesia (MAC). This single centre, retrospective, observational study recruited 124 consecutive patients undergoing elective F/BEVAR from 2014 - 2021. The primary endpoint was the short term complication rate according to the type of anaesthesia. Secondary endpoints included: need for inotropes or vasopressors for hypotension, time spent in the operating room, and admission to the intensive care unit. Propensity score matching was generated to account for the between group imbalance in the pre-operative covariables. After propensity score matching, 42 patients under GA were matched with 42 under MAC. The two groups showed no difference in cardiac and non-cardiac complications. Among the secondary outcomes, a higher number of patients in the GA group required inotropes or vasopressors compared with MAC (33% vs. 9%; p= .031). Although GA and MAC showed the same 30 day technical success (81% vs. 83%; p= .078), non-significant lower rates of major adverse events (10% vs. 12%; p= .72), one year re-intervention (14% vs. 21%; p= .39), and one year target vessel instability (10% vs. 21%; p= .39) were observed in the GA group. Overall, the in hospital mortality rate was 4%, with no difference between GA and MAC (2% vs. 5%; p= 1.0). The type of anaesthesia seemed to have no effect on procedure success, peri-operative morbidity, or mortality in patients undergoing F/BEVAR.

Intrathecal Dexmedetomidine Combined With Ropivacaine in Cesarean Section: A Prospective Randomized Double-Blind Controlled Study.

ObjectiveThis study aimed to find the best dose of dexmedetomidine in spinal anesthesia for cesarean section.Methods120 American Society of Anesthesiologists (ASA) Class I and II parturients undergoing elective cesarean delivery under spinal anesthesia were randomly allocated into four groups treated with intrathecal ropivacaine (12 mg) alone (Group R) or in combination with dexmedetomidine 5 μg (Group RD1), 7.5 μg (Group RD2) and 10 μg (Group RD3). Characteristics of spinal anesthesia, hemodynamic changes, adverse effects, stress reactions and neonatal outcomes were recorded in the four groups.ResultsPatients in Group RD1, RD2, and RD3 had significantly longer sustained sensory and motor block time than patients in Group R. All four groups had comparable onset times of sensory and motor block. The time for the level of sensory block to lower to S1 was longer in Group RD1 (411.07 ± 106.66 min), Group RD2 (397.03 ± 125.39 min) and Group RD3 (468.63 ± 116.43 min) than in Group R (273.60 ± 88.34 min) (p < 0.001). The time to recover from motor block to a Bromage score of IV was longer in Group RD1 (353.60.07 ± 137.28 min), Group RD2 (350.57 ± 118.01 min) and Group RD3 (404.67 ± 112.83 min) than in Group R (232.70 ± 93.29) (p < 0.01). The incidence of chills was significantly lower in the Group RD1, RD2, and RD3 than in the Group R (p < 0.001). There was no significant difference in the incidence of adverse effects such as hypotension, bradycardia, nausea, vomiting, hypoxemia and pruritus in the four groups (p > 0.05). There was no statistically significant visceral traction response or fentanyl use in the four groups (p > 0.05). Phenylephrine dosing was significantly higher in Group RD2 and RD3 than in Group R (p < 0.05), and there was no significant difference in phenylephrine dosing between Group RD1 and Group R (p > 0.05). There were no statistical differences in postnatal Apgar scores (1 min, 5 min after birth) (p > 0.05). The postoperative concentrations of β-endorphin (β-EP), cortisol (Cor) and tumor necrosis factor-α (TNF-α) in the Group RD1, RD2, and RD3 were lower than that in Group R (p < 0.05).ConclusionIntrathecal 5μg of dexmedetomidine as an adjuvant to ropivacaine relieved intraoperative chills, did not increase intraoperative and postoperative adverse effects, did not increase the amount of intraoperative vasoconstrictor used, and reduced intraoperative stress reactions as well as prolonged the duration of maternal sensory and motor block, so this dose is appropriate for cesarean section.Clinical Trial Registration:[www.chictr.org.cn/], identifier [ChiCTR2200056052].