General Anesthesia Research Articles

Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A Retrospective Comparative Study.

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery.

Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomised, non-inferiority trial.

Support for the treatment of uncomplicated appendicitis with non-operative management rather than surgery has been increasing in the literature. We aimed to investigate whether treatment of uncomplicated appendicitis with antibiotics in children is inferior to appendicectomy by comparing failure rates for the two treatments. In this pragmatic, multicentre, parallel-group, unmasked, randomised, non-inferiority trial, children aged 5-16 years with suspected non-perforated appendicitis (based on clinical diagnosis with or without radiological diagnosis) were recruited from 11 children's hospitals in Canada, the USA, Finland, Sweden, and Singapore. Patients were randomly assigned (1:1) to the antibiotic or the appendicectomy group with an online stratified randomisation tool, with stratification by sex, institution, and duration of symptoms (≥48 h vs <48 h). The primary outcome was treatment failure within 1 year of random assignment. In the antibiotic group, failure was defined as removal of the appendix, and in the appendicectomy group, failure was defined as a normal appendix based on pathology. In both groups, failure was also defined as additional procedures related to appendicitis requiring general anaesthesia. Interim analysis was done to determine whether inferiority was to be declared at the halfway point. We used a non-inferiority design with a margin of 20%. All outcomes were assessed in participants with 12-month follow-up data. The trial was registered at ClinicalTrials.gov (NCT02687464). Between Jan 20, 2016, and Dec 3, 2021, 936 patients were enrolled and randomly assigned to appendicectomy (n=459) or antibiotics (n=477). At 12-month follow-up, primary outcome data were available for 846 (90%) patients. Treatment failure occurred in 153 (34%) of 452 patients in the antibiotic group, compared with 28 (7%) of 394 in the appendicectomy group (difference 26·7%, 90% CI 22·4-30·9). All but one patient meeting the definition for treatment failure with appendicectomy were those with negative appendicectomies. Of those who underwent appendicectomy in the antibiotic group, 13 (8%) had normal pathology. There were no deaths or serious adverse events in either group. The relative risk of having a mild-to-moderate adverse event in the antibiotic group compared with the appendicectomy group was 4·3 (95% CI 2·1-8·7; p<0·0001). Based on cumulative failure rates and a 20% non-inferiority margin, antibiotic management of non-perforated appendicitis was inferior to appendicectomy. None.

Impact of dental treatments under general anesthesia on oral health-related quality of life in children: a comprehensive meta-analysis

BackgroundChildren’s oral health significantly impacts their overall well-being, daily activities, and social interactions. Dental treatments under general anesthesia are often required for extensive dental problems, special health care needs, or dental phobias, particularly in pediatric populations. The objective of this meta-analysis was to systematically review and synthesize existing research on how dental treatments under general anesthesia affect the oral health-related quality of life (OHRQoL) in children.MethodsThe electronic databases such as PubMed, EMBASE, Ovid MEDLINE, Web of Science, and Scopus were systematically reviewed following PRISMA guidelines to identify studies evaluating OHRQoL changes after dental treatments under general anesthesia. Studies involving ECOHIS and COHRQoL scales in pre- and postoperative assessments were included. The mean differences between scale measurements before and after dental treatments under general anesthesia were reported as the standard mean difference (SMD), and effect sizes for Hedges’ g were classified as follows: small effect (0.2), medium effect (0.5), large effect (0.8). All meta-analysis statistical computation was carried out using the Hartung-Knapp-Sidik-Jonkman method for the random effects model.ResultsA total of 36 papers satisfied the inclusion criteria and were subsequently included in the investigation. In the pooled analysis, treatments under general anesthesia in children improved OHRQoL (ECOHIS) in the short term with a significantly large effect size (SMD = 1.66, 95% CI: 1.07–2.24, p < 0.001; τ2 = 2.18, I2 = 98.9, p < 0.001). Similarly, dental treatment under general anesthesia increased the COHRQoL score in children with a significantly large effect size (SMD = 1.32, 95% CI: 0.81–1.84, p < 0.001; τ2 = 0.78, I2 = 97.3, p < 0.001).ConclusionThe findings of this meta-analysis suggest that there was evidence that OHRQoL of children receiving dental treatment under general anesthesia improves with a large effect size in the short-term following treatment.

Optimising diagnostics for hard-of-hearing infants: factors associated with successful MRI scanning without general anaesthesia.

Scanning during infancy is often required in otology, preferably without general anaesthesia. This study aims to determine the success rate of MRI of the head without general anaesthesia for infants, and to identify predictors for a successful scan. Data was extracted from the electronic patient file for patients who received MRI of the head without general anaesthesia between 01-01-2019 and 31-12-2022 at an age younger than 6 months. Each MRI-session was dichotomised into success (i.e., of sufficient quality to answer the clinical question) or failure, and success percentages were calculated. A logistic regression analysis was performed to determine the association between success and variables of interest, which were selected based on interviews with medical specialists. Eighty-seven patients were included, showing an overall success rate of 75.9% for MRI of the head without anaesthesia. Success rates for MRI brain were higher than for MRI cerebellopontine angle (CPA), respectively 91.2% and 66.0% (p = 0.013). For MRI CPA the odds of success decreased for infants aged 3-5 months, compared to infants under 2 months (respectively 84.6% and 48.1%, p = 0.009). For MRI CPA the success percentage was lower for boys (51.9%) than for girls (80.8%, p = 0.039). Time of day and hearing loss showed no significant effect on the success rate. Obtaining MRI of the head without anaesthesia for infants under six months is feasible. For MRI CPA the success rate is higher for infants scanned at a younger age, as well as for female infants compared to male infants.

Effect of Dental Throat Pack Used Under General Anesthesia in Children with Special Healthcare Needs on Postoperative Nausea, Vomiting, and Sore Throat: A Randomized Clinical Trial.

Background/Objective: Throat packs are widely used during orofacial surgery to reduce the frequency of postoperative nausea and vomiting (PONV). However, evidence supporting their use is mixed, with associated risks such as postoperative sore throat and the possibility of being forgotten in situ. Methods: The aim of this study is to evaluate the effectiveness of throat packs in preventing PONV and postoperative sore throat during dental treatments under general anesthesia in children with special healthcare needs (SHCNs). Eighty children with SHCNs were randomized into two groups: throat packing (Group TP, n = 41) and no throat packing (Group n-TP, n = 39). A throat pack was used in Group TP, and PONV and sore throat were evaluated at 1, 2, and 4 h postoperatively. Statistical Package for Social Sciences (SPSS) version 23.0 was used for data analysis. The registration number at ClinicalTrials.gov is NCT06169306, registered on 28 December 2023. Results: Patients in Group n-TP showed significantly higher PONV values at 1 and 2 h postoperatively (p < 0.001, p = 0.019, respectively). Visual Analog Scale (VAS) values were also significantly higher in Group TP at 1 and 2 h postoperatively (p < 0.001, p = 0.002, respectively). Conclusions: Using throat packs in dental treatments under general anesthesia for children with SHCNs reduced the incidence of PONV but increased the incidence of postoperative sore throat.

Comparison of the Effects of Sugammadex Recommended Dose (2 mg/kg) and Fixed Dose of 200 mg on the Reversal of Moderate Neuromuscular Block and Recovery Profile in Adult Patients.

Background and Objectives: Neuromuscular blocking agents are essential to ensure optimal surgical conditions during general anesthesia. Sugammadex, a selective binding agent, is widely used to reverse neuromuscular blockade. While weight-based dosing (2 mg/kg for moderate blockade) is recommended, many clinicians administer a fixed dose of 200 mg in clinical practice, potentially leading to overdosing. This study aimed to compare the efficacy and recovery profiles of weight-based and fixed-dose sugammadex in patients undergoing general anesthesia. Materials and Methods: In this randomized controlled trial, 20 patients were divided into two groups: the recommended dose group (R group, 2 mg/kg) and the fixed dose group (F group, 200 mg). Primary outcomes included time to achieve a normalized train-of-four (TOF) ratio of 0.9. Secondary outcomes included recovery time, time to spontaneous respiration, response to verbal commands and extubation, and adverse events. Results: The median time to achieve a normalized TOF ratio of 0.9 was 2.3 min in the R group and 2.0 min in the F group (p = 0.529). Secondary outcomes, including recovery time and time to extubation showed no significant differences. Adverse events were minimal and comparable between groups. Conclusions: The fixed-dose sugammadex (200 mg) demonstrated similar efficacy and safety to weight-based dosing (2 mg/kg) in reversing moderate neuromuscular blockade. These findings do not allow abandoning the recommendation of adjustment for body weight, particularly in patients with low body weight or comorbidities.

Comparison of long-term clinical and radiologic outcomes of AperFix and fixed loop device fixation in anterior cruciate ligament reconstruction: A retrospective study.

Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups (P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used (P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups (P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.

Comparative Histological Assessment of Zinc Oxide Nanoparticles and Low-Power Laser Treatment at 810nm Wavelength on the Recovery of Second-Degree Burn Wounds in Rat Models.

Background: The utilization of zinc oxide nanoparticles is thought to augment wound healing because of their antibacterial characteristics and capacity to stimulate cellular regeneration, especially in instances of minor burn injuries. On the other hand, it has been shown that tissue regeneration is aided by low-power laser therapy via photobiomodulation. Zinc oxide nanoparticles and low-power laser therapy are the two therapeutic modalities that will be compared in this study in order to assess how well they promote healing after burn injury and provide important new information on improved wound care techniques. Methods: For this investigation, thirty male Wistar rats weighing 230 ± 25 grams each were split into three groups. Every rat received general anesthesia before the experiment. A stainless-steel rod was put to the rats' skin after being heated for 20 min in a boiling water bath to cause superficial second-degree burns. The control group functioned as a reference point for comparison and did not receive any treatment intervention. Over the course of a week, zinc oxide nanoparticles were applied topically to the second group. For one week, the third group received daily therapy with a diode laser at a dosage of 10 J/cm.1 Histological and clinical exams were performed after the therapy period to evaluate the impact of the therapies. Results: The experimental groups that received low-power laser therapy (third group) and zinc oxide nanoparticles (second group) showed a substantial increase in wound contraction in relation to the control group, based on macroscopic observations. One rat from the second group showed notable indications of full wound healing on day 21. The treated rats showed the highest rate of lesion contraction, indicating that wound treatment happened at least 7 days faster in these rats than in the other groups. After 21 days, the third group's epidermis fully epithelized and formed a layer of keratinization. Furthermore, there was enhanced angiogenesis and significant fibroblast proliferation; large-scale fibrosis was also commonly seen. Conclusion: Zinc oxide nanoparticles promoted wound healing and accelerated connective tissue regeneration faster than other groups when applied to second-degree superficial burns. This research implies that the use of zinc oxide nanoparticles may be a therapeutic approach that shows promise for treating burn injuries and improving patient outcomes.

Comparison of Inter-Incisor Distance as a Predictor of Difficult Intubation in Men and Women-A Prospective Observational Study.

Most of the studies on difficult intubation and laryngoscopy focused on American and European populations. However, Indians have distinct anthropometric characteristics compared to these populations. This study aims to determine the gender difference in inter-incisor distance (IID) cut-off marks to assess the ease of intubation in the Indian population. A prospective observational study was conducted on 516 patients scheduled for elective surgery under general anesthesia with endotracheal intubation. Preoperative assessments included IID, thyromental distance, neck circumference, sternomental distance (SMD), thyrohyoid distance, mentohyoid distance, and modified mallampatti grading. Intubation difficulty scores (IDSs) were assessed during intubation. The optimal cut-off values of inter incisor gap and difficult intubation were analyzed by receiver operating characteristic curve analysis. The total cohort was grouped into males (Group 1 [n = 258]) and females (Group 2 [n = 258]). Males had a significantly higher mean age (P = 0.04) and weight (P = 0.00) than females. Difficult intubation incidence was 16.3% of males and 6.2% of females. Increased IID (P = 0.039), decreased SMD (P = 0.046), and males (P = 0.002) are identified as predictors of difficult intubation.IID and IDS showed greater specificity than sensitivity, with significant cut-off values of 4.25 and 1.50, respectively. The cut-off value of IID did not show a significant difference in gender variation. Despite the low IID in females, intubation difficulties were not observed compared to males.

Neurocritical Care Rapid Response Team Providing Critical Care Support During Mechanical Thrombectomy of Emergent Large Vessel Occlusion Stroke.

Acute ischemic stroke with medium and large vessel occlusion is a leading cause of morbidity and mortality, in which timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. Effective analgosedation and hemodynamic management during MT are critical to patient outcomes and typically managed by anesthesia. Because of inconsistent anesthesia support at our institution, we implemented a dedicated neurocritical care rapid response team (NCC-RRT) to manage these aspects of care. The primary outcome of our study was door-to-groin puncture time, before and after the implementation of the NCC-RRT. Secondary outcomes included door-to-recanalization time, patient disposition status, and the need for emergent anesthesia support. We conducted a prospective analysis of patients with acute ischemic stroke undergoing MT at a comprehensive stroke center between January 2021 and December 2023. The study compared two periods: era 1 (pre-NCC-RRT, January to October 2021) and era 2 (post-NCC-RRT, December 2021 to December 2023). We excluded inpatient stroke alerts and patients intubated at outside hospitals. The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support. A total of 373 patients were included in the study, with 86 patients in era 1 and 287 in era 2. The implementation of the NCC-RRT was associated with a statistically significant reduction in median DGP and door-to-recanalization times by 11.7% and 12.6%, respectively. NCC-RRT was also associated with a 21.4% increase in general anesthesia utilization, and no patients required emergent anesthesia support. The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.

Comparison between general anesthesia and thoracic spinal anesthesia in total laparoscopic hysterectomy

Comparison between general anesthesia and thoracic spinal anesthesia in total laparoscopic hysterectomy

Bone lesion cryotherapy: pictorial review and review of current evidence.

Over the last two decades the development of small probes has enabled percutaneous use of cryotherapy. Cryotherapy, also known as cryoablation, enables the treatment of much larger lesions than other thermal ablation techniques, particularly when using multiple evenly spaced probes. Using rapid cooling to as low as -200 degrees Celsius (at the tip of the probe), reliable, and predictable necrosis can be induced. Probes are usually percutaneously inserted under computed tomography (CT) guidance under sedation or general anaesthesia, often as a day case. The procedure is safe with severe complications occurring rarely; the commonest complication is neural injury in lesions closely related to neurovascular bundles. Cryotherapy has been applied to the symptomatic and occasionally curative treatment of bone metastases and a range of primary bone lesions. This review summarises the published evidence base for the use of cryotherapy in metastatic and primary bone lesions and describes the experience with cryotherapy at the Royal Orthopaedic Hospital, Birmingham, a quaternary bone tumour referral hospital, where cryotherapy has been used for 3 years.

Hoarseness following heart valve replacement under general anesthesia: Bilateral tapia’s syndrome as a rare cause

The Article Abstract is not Available.

EVALUATION OF EFFECTIVENESS OF PULSE OXIMETER PERFUSION INDEX OVER ANAL SPHINCTER TONE AS AN ASSESSMENT TOOL IN PREDICTING SUCCESSFUL CAUDAL BLOCK IN PEDIATRIC PATIENTS-A PROSPECTIVE OBSERVATIONAL STUDY

Objective: Caudal epidural block is widely used in pediatric surgeries for analgesia below the umbilicus. Traditional assessment methods like loss of anal sphincter tone are subjective and may not provide reliable feedback. The perfusion index (PI), measured non-invasively via the Masimo Radical-7 Pulse CO-Oximeter, may offer an objective alternative to predict block success. Methods: In this prospective observational study, 50 pediatric patient’s aged 1 to 10 y undergoing elective lower abdominal surgeries received caudal epidural blocks under general anesthesia. Baseline PI values were recorded using the Masimo Radical-7 Pulse CO-Oximeter with the probe attached to the big toe. Measurements were taken at 1-minute intervals for 10 min post-block. Anal sphincter tone was assessed concurrently using a three-point qualitative scale by a blinded anesthesiologist. The primary outcome was the change in PI compared to baseline and its correlation with block success. Results: Significant increases in PI values were observed in patients with successful caudal blocks. An increase in PI of more than 50% from baseline was associated with a 95% success rate of the block. The perfusion index showed a higher predictive value for block success (AUC = 0.88) compared to anal sphincter tone assessment (AUC = 0.72). The correlation between increased PI and successful block indicates that PI is a reliable indicator of caudal block efficacy. Conclusion: The pulse oximeter perfusion index, measured using the Masimo Radical-7 monitor, is a more effective and objective tool than anal sphincter tone assessment in predicting successful caudal blocks in pediatric patients. Incorporating PI monitoring into perioperative care can provide immediate and reliable feedback, potentially improving anesthesia outcomes in children.

Anesthetic Management of Renal Tumor with Level 3 Inferior Vena Cava Extension at a University Hospital in Vietnam: A Case Report

Background: Renal tumors with inferior vena cava (IVC) invasion pose significant challenges for surgical and anesthetic management. This report presents the anesthetic management of a patient with a level 3 IVC-invading renal tumor, emphasizing the complexity and multidisciplinary approach required. Case Presentation: A 55-year-old woman with a large left renal tumor causing complete obstruction of the left renal vein and near-total obstruction of the IVC was admitted for surgery. Multidisciplinary planning included a nephrectomy with removal of tumor from the IVC. The patient underwent general anesthesia with extensive hemodynamic monitoring and fluid management to mitigate potential blood loss and cardiovascular instability. The surgery, lasting 5 h, involved successful radical nephrectomy, tumor removal from the IVC, and resection of liver metastases. Postoperative recovery was without complications, and the patient was discharged 7 days. Conclusion: Managing anesthesia for renal tumors with IVC invasion requires careful preoperative planning, invasive monitoring, and multidisciplinary approach.

Effectiveness of intranasal versus intravenous dexmedetomidine for attenuation of hemodynamic responses of laryngoscopy and endotracheal intubation in patients undergoing general anaesthesia: Randomized controlled trial

Effectiveness of intranasal versus intravenous dexmedetomidine for attenuation of hemodynamic responses of laryngoscopy and endotracheal intubation in patients undergoing general anaesthesia: Randomized controlled trial

Intervention and Effect of Targeted Anesthesia Nursing Measures on Post-operative Emergence Agitation in Elderly Patients Undergoing General Anesthesia

To explore the effect of targeted anesthesia nursing measures on emergence agitation (EA) in elderly patients who were anesthetized by general anesthesia. In this study, 186 cases of elderly patients admitted to Deyang People's Hospital for general anesthesia surgery from March 2022 to March 2024 were selected prospectively, and the 186 patients included in the study were randomly divided into the control group (n=93) and the observation group (n=93) according to the method of randomized numerical table. Routine nursing measures were adopted in the resuscitation period of the control group; targeted anesthetic nursing measures were adopted in the resuscitation period of the observation group; routine nursing measures were adopted in the resuscitation period of the control group. The control group used conventional nursing measures during the resuscitation period after anesthesia, and the observation group used targeted anesthesia nursing measures during the resuscitation period after anesthesia, the incidence of EA, the incidence of EA-related complications, patient satisfaction and the incidence of hypothermia during anesthesia resuscitation in the two groups were compared. The results show that the incidence of EA in the observation group with targeted anesthesia nursing measures was significantly lower than that in the control group (P &lt; 0.05), the incidence of EA-related complications in the observation group with targeted anesthesia nursing measures was significantly lower than that in the control group (P &lt; 0.05), the satisfaction score in the observation group with targeted anesthesia nursing measures was significantly higher than that in the control group (P &lt; 0.05), and the rate of hypothermia during resuscitation of the patients in the observation group with targeted anesthesia nursing measures was significantly lower than that in the control group (P &lt; 0.05). The incidence of hypothermia during anesthesia resuscitation in the observation group was significantly lower than that in the control group (P &lt; 0.05). In summary, targeted anesthesia nursing interventions can effectively reduce the incidence of postoperative EA, the incidence of EA-related adverse events and hypothermia during resuscitation in elderly patients, and improve patient satisfaction, which is worthy of application and promotion.

Perioperative Management of Patients with Preeclampsia: A Comprehensive Review.

Preeclampsia is a common condition of pregnancy characterized by hypertension complicated by cerebral, cardiac, hepatic, renal, hematologic, and placental dysfunction. Patients with preeclampsia frequently undergo cesarean delivery, the most common major surgical procedure in the world. They represent a high-risk perioperative cohort suffering significant preventable morbidity and mortality. This review focuses on the anesthesiologist's role, through a perioperative lens, in reducing maternal complications through management of hypertension and strategies for preserving the function of the brain, heart, liver, kidney, hematologic and coagulation systems, and placenta in patients with preeclampsia undergoing cesarean delivery. Preeclampsia-specific resuscitation, individualized fluid administration, safe neuraxial and general anesthesia, and management of intraoperative bleeding are discussed along with strategies for postoperative analgesia, thromboprophylaxis, and antihypertensive agents in patients who breastfeed. This review discusses recently recognized postoperative deterioration in maternal mental health, the possibility of myocardial injury after cesarean delivery, and the need for long-term cardiometabolic follow-up.

Procedural sedative effect of remimazolam in ICU patients on invasive mechanical ventilation: a randomised, prospective study

BackgroundInvasive procedures and environmental factors in the intensive care unit (ICU) may cause anxiety and discomfort in patients, who often require sedation therapy. The aim of this study was to assess the safety of remimazolam tosilate for procedural sedation in ICU patients receiving mechanical ventilation following endotracheal intubation. Eighty patients from a single centre were randomly assigned to either the propofol group or the remimazolam group. Blood tests were conducted to evaluate changes in lactate, blood lipids, liver and kidney function, and inflammatory markers, and patients’ vital signs were observed over several periods. This study compared the incidence of delirium, the impact on liver and kidney function, circulatory effects, and changes in blood lipids between the two groups. These findings have optimised the selection of medications, providing ICU patients with more options for sedation therapy.MethodsIn this single-centre randomised controlled trial, intubated patients were randomly assigned to the remimazolam group or the propofol group. Under the same analgesic regimen, the two groups received remimazolam and propofol for procedural sedation.ResultsOur primary outcome was the mean arterial pressure (MAP), which significantly differed on Days 4 and 7 (P = 0.021, control group vs. experimental group = 85.23 ± 11.24 vs. 94.36 ± 13.18, P = 0.023, 83.55 ± 8.94 vs. 92.66 ± 7.02). With respect to liver and kidney function, the ∆AST value in the remimazolam group was significantly lower than that in the control group on Day 7 (P = 0.023). There were significant differences in triglyceride (TG) levels on Days 4 and 7 (P = 0.020) and in the ∆LDL on Day 7 (P = 0.027). Furthermore, the rates of dyslipidaemia and delirium in the remimazolam group were lower than those in the propofol group (85.0%, n = 40 vs. 90.0%, n = 40; 27.5%, n = 40 vs. 55%, n = 40).ConclusionRemimazolam is a novel benzodiazepine that has demonstrated promising applications in general anaesthesia and procedural sedation; however, its use in ICU sedation is still in the early stages of research. Current evidence suggests that remimazolam is a safe sedative that is particularly well suited for patients with haemodynamic instability. Large sample-size randomised clinical trials are warranted.

Operating on the Oldest-Old: Vaginal Prolapse Surgery Outcomes in Women Over 90.

Women aged 90 years and older ("oldest-old") represent a small but growing population who may experience bothersome pelvic organ prolapse and opt for surgical repair. This study aimed to compare perioperative adverse events (AEs) within 8 weeks of prolapse surgery between women ≥90 years and younger patients. We performed a secondary analysis of a dual-center retrospective cohort study of women ≥61 years old undergoing major prolapse surgery from January 2016 to May 2023. We identified all women ≥90 years and matched them to women <90 years in a 1:4 fashion based on Charlson Comorbidity Index score and surgery type. Matching was performed without replacement. The primary outcome was a composite AE outcome, defined as all intraoperative and postoperative complications within 8 weeks of surgery. There were 24 oldest-old undergoing prolapse surgery who were matched to 96 women with mean ± standard deviation age of 77.2 ± 5.7 years. Women ≥90 years were more likely to have a lower body mass index (P < 0.01), greater preoperative prolapse stage (P = 0.049), and were less likely to have general anesthesia (P < 0.01). Patients did not differ in medical comorbidities, frailty status, concomitant hysterectomy or incontinence procedure, or length of postoperative stay. The oldest-old did not experience any intraoperative complications and had low rates of readmission (8.3%) and discharge to skilled nursing facilities (4.2%). Age ≥90 was not associated with composite AEs on multivariable analysis (adjusted odds ratio 1.60, 95% confidence interval [0.39-6.55]). Age ≥90 years does not appear to increase the risk of perioperative AEs in women with similar comorbidities.