Postanesthetic Period Research Articles

Тошнота и рвота после сочетанной анестезии с применением ксенона в амбулаторной стоматологии у детей: ретроспективное наблюдательное исследование

INTRODUCTION: According to the literature, the incidence of PONV is 2 times higher in children compared to adults. In the studies conducted, there are conflicting data on the pro-emetogenic and anti-emetogenic properties of xenon. OBJECTIVES: To study the effect of xenon on the incidence of PONV in the early post-anesthesia period using it in combined anesthesia when performing oral sanitation in children. MATERIALS AND METHODS: Retrospective, observational study included 113 children of both sexes (42 girls, 71 boys). All children underwent combined inhalation anesthesia using xenon in conjunction with local anesthesia by articaine. RESULTS: According to the results of the study, the incidence of PONV was 4.4 %, whereas the estimated PONV was 30 % in 68 % of children from the presented sample of patients before anesthesia. CONCLUSIONS: In outpatient dental practice, when performing combined anesthesia with the use of xenon, the incidence of PONV is within 4 %. The choice of inhalation anesthetic xenon in children in terms of the incidence of postoperative nausea and vomiting is justified and can be recommended in outpatient practice.

Impact of Prewarming on Maintaining Perioperative Body Temperature: A Randomized Clinical Trial

PurposeTo determine the prewarming effect on body temperature in the perioperative period of patients undergoing conventional abdominal surgery and the level of thermal comfort. DesignA randomized controlled clinical trial. MethodsA Brazilian oncology hospital located in São Paulo. A total of 99 patients aged 18 years or over undergoing elective conventional abdominal surgeries, with a minimum duration of 1 hour of anesthesia. The study was carried out from 2019 to 2021. Patients were randomized into 3 groups: prewarming with a blanket and cotton sheet (control; n = 33); prewarming with a forced-air warming system for 20 minutes (intervention 1; n = 33); prewarming with a forced-air warming system for 30 minutes (intervention 2; n = 33). Central temperature was measured by a zero-heat-flux temperature sensor every 20 minutes from the preoperative period until the surgery end time. The level of thermal comfort was determined through self-report during the preanesthetic and postanesthetic periods. FindingsThere was a significant difference between the temperatures between the groups (P = .048), with evidence of greater benefit in maintaining the temperature in the group that received the prewarming intervention for 20 minutes. There was no significant difference between the percentage of temperatures below 36 °C among the groups (P = .135). Patients in the intervention groups were more comfortable during the postanesthetic recovery period than those in the control group (P = .048). Only 7 (8.24%) patients had postoperative chills (P = .399) and more than half of these incidents occurred in the control group (4; 13.3%). ConclusionsPrewarming for 20 minutes obtained the best results, showing the lowest average of temperature episodes below 36 °C during the intraoperative period and greater thermal comfort as reported by patients.

Effects of general anesthesia on airway immune cell function in an equine in vivo model

ObjectiveComplications from general anesthesia, including pneumonia and decreased wound healing, are influenced by changes in immune cell function secondary to sedatives and anesthetics. It was hypothesized that immune cell function would be depressed in the early postanesthetic period. The objective was to investigate airway immune cell function before and after a general anesthetic episode in an equine in vivo model using ex vivo cell stimulations with lipopolysaccharide (LPS) for assessment of immune function. Study designProspective experimental study. AnimalsSix healthy, adult, institution-owned horses. MethodsEach horse underwent a bronchoalveolar lavage (BAL) 3 days before and immediately after a 2 hour general anesthetic. The BAL fluid was examined for cytology, total nucleated cell count and isolation of immune cells. Airway immune cells were treated with LPS or media (control) for 6 hours and supernatant was analyzed via a commercially available immunoassay for cytokines [tumor necrosis factor alpha (TNFα), interleukin (IL)-1β, IL-6, interferon gamma (IFNγ) and CXC motif chemokine ligand 8 (CXCL8)]. Data were compared using t-tests and Mann–Whitney tests. ResultsBefore anesthesia (baseline), LPS stimulation induced a significant increase in all cytokines of interest, except CXCL8, versus control samples. Unstimulated cells, after an anesthetic episode, had a significant 1.8-fold increase in IL-1β (p = 0.029), and a significant decrease in IL-6 and TNFα (p = 0.028 and 0.033, respectively) versus baseline. Following anesthesia, stimulated cells had a significant decrease in IL-6 and TNFα (p = 0.037 and 0.042, respectively) versus baseline. Conclusions and clinical relevanceThis study supports the use of an equine in vivo model to assess airway immune cell function in relation to general anesthetic use.

Evaluation of Gastric pH and Gastrin Concentrations in Horses Subjected to General Inhalation Anesthesia in Dorsal Recumbency.

The prevalence of gastric disorders in high-performance horses, especially gastric ulceration, ranges from 50 to 90%. These pathological conditions have negative impacts on athletic performance and health. This study was designed to evaluate changes in gastric pH during a 24 h period and to compare gastrin concentrations at different time points in horses undergoing general inhalation anesthesia and dorsal recumbency. Twenty-two mixed-breed mares weighing 400 ± 50 kg and aged 8 ± 2 years were used. Of these, eight were fasted for 8 h and submitted to 90 min of general inhalation anesthesia in dorsal recumbency. Gastric juice samples were collected prior to anesthesia (T0), and then at 15 min intervals during anesthesia (T15-T90). After recovery from anesthesia (45 ± 1 min), samples were collected every hour for 24 h (T1 to T24) for gastric juice pH measurement. During this period, mares had free access to Bermuda grass hay and water and were fed a commercial concentrate twice (T4 and T16). In a second group (control), four non-anesthetized mares were submitted to 8 h of fasting followed by nasogastric intubation. Gastric juice samples were then collected at T0, T15, T30, T45, T60, T75, and T90. During this period, mares did not receive food or water. After 45 min, mares had free access to Bermuda grass hay and water, and gastric juice samples were collected every hour for four hours (T1 to T4). In a third group comprising ten non-fasted, non-anesthetized mares with free access to Bermuda grass hay and water, gastric juice samples were collected 30 min after concentrate intake (T0). In anesthetized mares, blood gastrin levels were measured prior to anesthesia (8 h fasting; baseline), during recovery from anesthesia, and 4 months after the anesthetic procedure, 90 min after the morning meal. Mean values of gastric juice pH remained acidic during general anesthesia. Mean pH values were within the physiological range (4.52 ± 1.69) and did not differ significantly between time points (T15-T90; p > 0.05). After recovery from anesthesia, mean gastric pH values increased and remained in the alkaline range throughout the 24 h period of evaluation. Significant differences were observed between T0 (4.88 ± 2.38), T5 (7.08 ± 0.89), T8 (7.43 ± 0.22), T9 (7.28 ± 0.36), T11 (7.26 ± 0.71), T13 (6.74 ± 0.90), and T17 (6.94 ± 1.04) (p < 0.05). The mean gastric juice pH ranged from weakly acidic to neutral or weakly alkaline in all groups, regardless of food and water intake (i.e., in the fasted, non-fasted, and fed states). Mean gastric pH measured in the control group did not differ from values measured during the 24 h post-anesthesia period or in the non-fasted group. Gastrin concentrations increased significantly during the post-anesthetic period compared to baseline (20.15 ± 7.65 pg/mL and 15.15 ± 3.82 pg/mL respectively; p < 0.05). General inhalation anesthesia and dorsal recumbency did not affect gastric juice pH, which remained acidic and within the physiological range. Gastric juice pH was weakly alkaline after recovery from anesthesia and in the fasted and fed states. Serum gastrin levels increased in response to general inhalation anesthesia in dorsal recumbency and were not influenced by fasting. Preventive pharmacological measures are not required in horses submitted to general anesthesia and dorsal recumbency.

Effects of intravenous xylazine versus dexmedetomidine premedication with ketamine-midazolam-isoflurane anaesthesia for castration in horses

The objectives of this research was to study the sedation and anaesthetic characteristics of intravenous xylazine and dexmedetomidine combined with ketamine-midazolam-isoflurane and to evaluate the cardiopulmonary effects during the anaesthetic period. Stallions were premedicated with xylazine (1.1 mg/kg IV) in Group 1 and dexmedetomidine (3.5 µg/kg IV) in Group 2. Sedation quality was evaluated and scored. General anaesthesia was achieved with ketamine (2.2 mg/kg IV) and midazolam (0.1 mg/kg IV) in both groups and anaesthesia was maintained with isoflurane inhalant in fresh oxygen gas flow (6-8 L/min). All the stallions underwent an orchiectomy by the half- closed method. Cardiovascular variables and pulmonary variables were recorded using multi gas vital sign monitor. Anaesthetic parameters, reflex status and quality of muscle relaxation were assessed. After the surgical procedure, recovery was monitored and scored on 6 point scale. Sedation score and quality was clinically better in Group 2. The difference in cardiopulmonary variables was statistically not significant. However, statistically significant changes were noticed between two groups with regard to some blood gas values during the intra-operative and at 15 min post anaesthetic period. Quality of muscle relaxation was better in group 2. Recovery was not significant. Overall quality of anaesthesia and recovery was almost similar in both the groups. In conclusion, both drug combinations produced satisfactory results for castration in the horses studied. In this study, dexmedetomidine at 3.5 µg/kg and xylazine at 1.1 mg/kg sedative doses did not result in much significant changes compared to one other.

Stir-up Regimen After General Anesthesia in the Postanesthesia Care Unit: A Nurse Led Stepped Wedge Cluster Randomized Control Trial

To implement a standardized Stir-up Regimen (deep breathing, coughing, repositioning, mobilization [moving arms/legs], assessing and managing pain and nausea) within the first 30minutes of arrival in the postanesthesia care unit (PACU), with a goal of decreasing recovery time in the immediate postanesthesia period (Phase I). A pragmatic stepped wedge cluster randomized control trial. Initially, data were collected on time in Phase I in three PACUs (control). Subsequently, the same three units were randomized to sequentially transition to the Stir-up Regimen (intervention). A stepped wedge cluster randomized control trial design was used to implement a standardized Stir-up Regimen in three PACUs in an academic hospital for adult patients who received at least 30minutes of general anesthesia. The measured outcome was the PACU time in minutes from patient arrival to when the patient met Phase I discharge criteria. Differences between intervention and control groups were evaluated using a generalized mixed-effects model. Nurses were educated about the Stir-up Regimen in team huddles, in-services, video demonstrations, email notifications and reminders, and immediate feedback at the bedside. Implementation science principles were used to assess the adoption of the Stir-up Regimen through a presurvey, postsurvey and spot-check observations in all three PACUs. A total of 5,809 PACU adult patient admissions were included: control group (n=2,860); intervention group (n=2,949); males (n=2,602), and females (n=3,206). The intervention was associated with a reduction in overall mean Phase I recovery time of 4.9minutes (95% CI: -8.4 to -1.4, P=.007). One PACU decreased time by 9.6minutes (95% CI: -15.3 to -4.0, P<.001). The other units also reduced Phase I recovery time, but this did not reach statistical significance. The spot-check observations confirmed the intervention was adopted by the nurses, as most interventions were nurse-initiated versus patient-initiated during the first 30minutes in PACU. Standardization of a Stir-up Regimen within 30minutes of patient PACU arrival resulted in decreased Phase I recovery time.

Effects of dexmedetomidine at different dosages on perioperative haemodynamics and postoperative recovery quality in elderly patients undergoing hip replacement surgery under general anaesthesia: a randomized controlled trial

BackgroundDexmedetomidine could provide some advantages to prevent postoperative complications in elderly patients undergoing under general anaesthesia. However, dexmedetomidine inhibits haemodynamics to some extent due to its sympathetic inhibition.ObjectiveTo evaluate the effects of different doses of dexmedetomidine on haemodynamics during surgery and recovery after general anaesthesia in elderly patients undergoing hip replacement.MethodsThis was a prospective randomized double-blind controlled clinical trial. Eligible patients were randomly allocated into comparative groups (normal saline (NS) and midazolam (MD), n = 30) and dexmedetomidine groups at different doses (D0.25/D0.5/D0.75, n = 30). In the D0.25/D0.5/D0.75 groups, dexmedetomidine was administered at different initial loading doses (0.25/0.5/0.75 μg/kg for 15 min) following 0.5 μg/kg/h continuous infusion until the end of the operation. In the MD group, patients were administered 0.03 mg/kg midazolam at the beginning of anaesthesia induction.ResultsCompared to the MD and NS groups, there were significant decreases in MAP in the D0.5 and D0.75 groups at many time points, such as skin incision, end of operation, and from extubation until 30 min after extubation (P < 0.05); there were also significant decreases in HR in the D0.5 and D0.75 groups at time points including anaesthesia induction, end of operation, and from extubation to 2 h after operation (P < 0.05). In the D0.25 group, there were few differences in the changes in MAP and HR compared to the MD and NS groups during the entire perioperative period (P > 0.05). Moreover, the percentage of patients whose MAP and HR decreased > 20% of baseline was higher in the D0.75 and D0.5 groups than that in all other groups. Compared to the NS group, from the beginning to the end of the operation, the 95% confidence interval (CI) of RR for MAP below > 20% of baseline in the D0.5 and D0.75 groups was greater than 1. In particular, the CI of the RR in the D0.75 group was greater than 1 until the patient awoke from general anaesthesia (P < 0.05). In addition, the CI of the RR for HR below > 20% of baseline in the D0.5 group was greater than 1 compared to the NS group at the time of induction and extubation (P < 0.05). There was no significant difference in the possibility of developing hypotension or bradycardia in the MD or D0.25 groups compared to the NS group (P > 0.05). The recovery quality of patients during the post-anaesthesia period was also observed. No differences were observed among all the groups in the time to awakening or extubation after general anaesthesia (P > 0.05). According to the Riker Sedation-agitated Scale, dexmedetomidine significantly alleviated emergency agitation or delirium compared to NS (P < 0.05). In addition, the scores in the D0.5 and D0.75 groups were lower than those in the D0.25 group (P < 0.05).ConclusionDexmedetomidine could alleviate the agitation of elderly patients undergoing hip replacement after intravenous general anaesthesia combined with inhaled sevoflurane without delayed recovery. However, it is necessary to be vigilant about the haemodynamic inhibition of the drug at high dosages throughout the perioperative period. Dexmedetomidine 0.25–0.5 μg/kg as the initial loading dose followed by 0.5 μg/kg/h continuous infusion might provide comfortable recovery after general anaesthesia with slight haemodynamic inhibition.Trail registrationClinicalTrial.gov, No. NCT05567523. Registered 05 October 2022, https://clinicaltrials.gov/ct2/show/NCT05567523?term=NCT05567523&draw=2&rank=1.

Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence.

Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence.

General anesthesia does not induce ultrasonographic changes in the pleura of healthy adult horses anesthetized for elective magnetic resonance imaging.

To compare thoracic ultrasonographic findings in healthy horses before and after general anesthesia for elective MRI utilizing a recently developed ultrasonographic scoring system to aid clinicians in the early identification of pneumonia following anesthesia. 13 adult horses > 3 years of age. Prior to anesthesia, horses underwent a thorough physical examination, CBC, thoracic radiography, and thoracic ultrasonography. Horses were then anesthetized for elective MRI, and thoracic ultrasonography was repeated within 3 hours after recovery. Thoracic ultrasonographic findings were scored utilizing a recently developed scoring system, and scores were compared before and after anesthesia. There was no significant difference identified in total thoracic ultrasonography score before and after anesthesia, and there was no correlation between thoracic ultrasonography score following anesthesia and the body weight of the horse, the time recumbent, and the dependent side. In healthy horses undergoing anesthesia for elective imaging, there was no significant change in thoracic ultrasonographic findings 3 hours after recovery from anesthesia. These data can aid clinicians in determining the clinical significance of ultrasonographic changes in the lung in the immediate postanesthetic period.

Spanish version of the Pediatric Anesthesia Emergence Delirium scale: translation and cross-cultural adaptation

BackgroundEmergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile). MethodsA five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale. ResultsThe PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach’s alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3–10 years).ConclusionsThe translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children.

The effect of hyperoxia on ventilation during recovery from general anesthesia: A randomized pilot study for a parallel randomized controlled trial

Study objectiveWhile supplemental O2 inhalation corrects hypoxemia, its effect on post-anesthesia ventilation remains unknown. This pilot trial tested the hypothesis that hyperoxia increases the time spent with a transcutaneous PCO2 (TcPCO2) > 45 mmHg, compared with standard O2 supplementation. DesignSingle-blinded, parallel two-arm randomized pilot trial. SettingUniversity hospital. Patients20 patients undergoing robotic-assisted laparoscopic nephrectomy. MeasurementsAfter institutional approval and informed consent, patients were randomized to receive O2 titrated to arterial saturation (SpO2): 90–94% (Conservative O2, N =10), or to SpO2 > 96% (Liberal O2, N = 10) for up to 90 min after anesthesia. Continuous TcPCO2, respiratory inductance plethysmography (RIP), and SpO2, were recorded. We calculated the percentage of time at TcPCO2 > 45 mmHg for each patient and compared the two groups using analysis of covariance, adjusting for sex, age, and body mass index. We also estimated the sample size required to detect the between-group difference observed in this pilot trial. RIP signals were used to calculate apnea/hypopnea index (AHI), which was then compared between two groups. Main resultsThe mean percentage of time with a TcPCO2 > 45 mmHg was 80.6% for the Conservative O2 (N=9) and 61.2% for the Liberal O2 (N=10) group [between-group difference of 19.4% (95% CI: −18.7% to 57.6%), P = 0.140]. With an observed effect size of 0.73, we estimated that 30 participants per group are required, to demonstrate this difference with a power of 80% at a two-sided alpha of 5%. Means SpO2 were 94.5% and 99.9% for the Conservative O2 and the Liberal O2 groups, respectively. AHI was significantly higher in the Conservative O2, compared with the Liberal O2 group (median AHI: 16 vs. 3; P = 0.0014). ConclusionsHyperoxia in the post-anesthesia period reduced the time spent at TcPCO2 > 45 mmHg and significantly decreased AHI, while mean SpO2 ranged inside the a priori defined limits. Trial registrationClinicalTrials.gov identifier: NCT04723433

Emergence delirium and caregiver anxiety: A non-existent link?

Emergence delirium (ED) is a common, transient uncooperative and disoriented state during the post-anaesthesia period. It is potentially dangerous for the child, and distressing for their caregivers and health staff. Numerous risk factors have been established, however the proposed link between increased preoperative caregiver anxiety and ED is yet to be demonstrated.This observational study aimed to determine the incidence of ED following tonsillectomy in Albury-Wodonga, a regional Australian centre, and establish whether there is a link between ED and caregiver anxiety.An ED incidence of 32.1% (95% CI 20.3–46.0%) was recorded. More significantly, no evidence of a link with caregiver anxiety could be detected. This result is contrary to expectation, and demonstrates the need for a further, much larger, investigation.

Laser Application for Management of Traumatic Ulcers Following Local Anesthesia in Children

Prolonged local anaesthesia in soft perioral tissues may sometimes lead to accidental lip biting in small children forming a traumatic ulcer. Healing of such ulcers has been reported to enhance with treatment using low level laser therapy (LLLT). This case report describe two cases of traumatic ulcers due to lip bite following inferior alveolar nerve block caused during post anaesthesia period that were treated by LLLT. It resulted in better healing and lower pain, thus helping in healing and repair of the tissue.

Answer to Caravaggi et al. (2021)

We understand and share the same concerns raised by Caravaggi et al. (2021), since we are all scientists, and we take scientific rigour seriously in our work. The paper published by Araujo et al. (2021) had authorization for scientific activities issued by SISBIO/ICMBio/MMA (no. 46031-4) and it was approved by two Ethics Committee on Animal Use (Federal University of Mato Grosso do Sul, no. 727/2015, and Federal University of Viçosa, no. 79/2015). Such authorizations were amended to the Acknowledgements in the version paged on 27 November 2020, before been assigned to an issue. In this way, the paper not only did not neglect ethics but was approved by three recognized research institutions. The authors of the questioned paper have been working for two or more decades generating data from free-living captures for conservation. Data on animal welfare, degree of injury, use of baits or attractants, response time, degree of risk to the animal and the team, among others, are systematically collected by experienced researchers from our group. Such data were part of the original manuscript but were removed when transformed into Practical Tools. We look forward to the opportunity of MEE to present this data in full, as our right of reply to Caravaggi et al. (2021) is limited to 3,000 characters. Some of the questions probably came from people with extreme theoretical knowledge. The statement that ‘Foot snares can pose a greater risk of injury to animals than cage traps’ clearly demonstrates little experience in the field. Cage traps are no longer the golden method to capture large felids due to low efficiency, higher costs, and risks of teeth and claw injuries. Araujo et al. (2021) describe several modifications and procedures that reduce the risk of injuries by foot snare traps. All the capture methods were evaluated not only by our researchers but also by Ethics Committees and Brazilian government agencies and were not neglected in this manuscript. Unfortunately, questions that come from theoretical extrapolations with no connection to the field reality can delay the conservation efforts and go against the One Conservation concept described by Pizzutto et al. (2021). Access to threatened species is the best way to generate data that allow a real diagnosis of the species in situ and suggests policies for its conservation. In the case of the jaguar, the greater the number of captures, the greater the chances of making the right decisions, and the greater the number of individual genetics collected and stored in germplasm banks. The isolation of populations and the extremely low number of jaguars in biomes such as the Caatinga and the Atlantic Forest justify the urgency of capturing. Fish broth and/or roar device were used as an attractant in 40 captures. In only one there was any injury to the animal: paw oedema, immediately treated by veterinarians and without compromising its health. The safety of the team is also a concern but taking some precautions such as not entering the area of imminent risk and paying attention to the presence of other animals reduces the chances of accidents to almost zero. Regarding animal welfare, the discussion should be based on the five domains model for animal welfare assessment and monitoring (Mellor et al., 2020), and foot snare traps do not compromise any physical/functional domains. Therefore, they do not promote negative mental experiences, as the rare, mild transient oedema in the paws does not compromise the ability to walk. The injury is much lighter than those that occur due to intraspecific and interspecific conflicts in nature. Furthermore, the anaesthetic protocol produces retrograde amnesia for the pre-anaesthetic period—eliminating negative mental experiences of the foot snare—and anterograde amnesia for the post-anaesthetic period (Gruber & Reed, 1968). Another strategy that reduces animal injuries and distress is frequent remote monitoring—at least every hour—allowing access to the animal within a maximum of 3 hours of capture. Finally, we believe that technical training combined with practical experience allows researchers to develop the intuition inherent in science. None of the authors have any conflicts of interest to declare. The peer review history for this article is available at https://publons.com/publon/10.1111/2041-210X.13706.

Analysis of the effect of dexmedetomidine combination with regional anesthesia on the cognitive state in the post-anesthesia period in ophthalmic surgery

Given a reduced cognitive reserve in patients in ophthalmic surgery, an anesthesiologist should pay special attention when choosing a method of anesthesia to prevent the development of postoperative cognitive dysfunction. The concept of multimodal anesthesia makes it possible to reduce the total number of narcotic analgesics and ataractics used intraoperatively while maintaining an adequate level of anesthesia and sedation, both intraoperatively and in the postoperative period. In ophthalmic surgery, regional anesthesia (pterygopalatine fossa blockade) is used before surgery in combination with infusion of dexmedetomidine. Materials and methods. The study was conducted at the premises of Dnipropetrovsk Regional Clinical Ophthalmologic Hospital, 61 patients were examined after penetrating keratoplasty. The age of the subjects ranged from 18 to 60 years (mean age of 52.1 ± 2.0 years). Patients were randomized into two groups. Group d (n = 30) are patients who received anesthesia according to the following scheme: premedication for 40 min — infusion of dexmedetomidine, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously; induction — propofol 2–2.5 mg/kg fractionally until the onset of the clinical signs of anesthesia, fentanyl 0.005% 0.1 mg; relaxation on the background of atracurium besylate 0.3–0.6 mg/kg, tracheal intubation; maintenance of anesthesia: oxygen — sevoflurane mixture with FiO2 50–55 %, end-expired sevoflurane 1.4–1.8 vol.% (1–1.5 minimum alveolar concentration), use of low-flow technique. In the second group (db, n = 31), anesthesia was performed as in group d with the addition of pterygopalatine fossa blockade. Group d included 18 (60 %) men and 12 (40 %) women, mean age of 49.5 ± 2.5 years; db group — 16 (51.61 %) men and 15 (48.39 %) women (p = 0.583 according to the chi-square), mean age of 55.5 ± 3.2 years (p = 0.142 according to the t-test). Results. A comparative analysis of changes in cognitive status between db and d groups has shown no significant changes (p &lt; 0.05) at different stages of neuropsychological testing. When considering the results of testing to assess short-term verbal memory in db and d groups, there was a 25 % decrease in the first 6 hours after surgery. After all, in d group, the indicators remained low compared to baseline until the 7th day of the postoperative period, while in the db group the recovery of short-term memory occurred one day after surgery. In both groups, the result of the Luria test on day 21 exceeded the baseline by 12.5 % in both groups. Examination using visual analogue scale has demonstrated that patients in db group felt better than those in d group. Conclusions. Thus, we see that the combination of dexmedetomidine with regional anesthesia in addition to less impact on the cognitive state improves the subjective well-being in the postoperative period in patients in ophthalmic surgery. Due to this, another link of influence on the etiological factors of postoperative cognitive dysfunction formation seems to appear.

The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures - part II.

The second part of the study was to assess the effects of the types of anaesthesia along with multimodal analgesia on the stability of vital functions at the critical moment of awakening from anaesthesia. The material comprised the medical records at the Department of Anaesthesiology and Intensive Care in Szczecin. The anaesthesia record forms and recovery room observation charts of 150 patients from the Gynaecology Clinic who had undergone category III and IV surgical procedures between October 2018 and January 2019 were selected for analysis. The patients were divided into three groups: 1. Patients given multimodal analgesia with non-opioid and opioid analgesics. 2. Patients given multimodal analgesia with non-opioid analgesics and adjuvants. 3. Patients given multimodal analgesia with non-opioid and opioid analgesics, as well as neuraxial anaesthesia. The average minimum heart rate in the operating room was 63.92 in group I, 61.48 in group II, and 62.34 in group III. The most common cause of bradycardia during surgery was insufflation. The average SBP prior to surgery was similar in groups I and II - 128.74 and 128.66, respectively. The average maximum values during surgery were 135.24 in group I, 139.34 in group II, and 142.32 in group III. At the time of discharge from the post-anaesthetic care unit, all the patients from the study group had achieved an Aldrete score of 10. Following the anaesthesia, 24% of the patients in group I, 22% in group II, and 28% in group III required oxygen therapy. When using multimodal analgesia, the time required to fully awaken even after extensive surgical procedures was no longer than two hours.

FEATURES OF COGNITIVE STATUS OF OPHTHALMIC PATIENTS AS A PREDICTOR OF POSTOPERATIVE COGNITIVE DYSFUNCTIONS

The influence of the chosen method of anesthesia on cognitive functions in the postoperative period is investigated in the article. Cognitive status analysis was performed using neuropsychological testing: Frontal Assessment Battery (FAB), short-term mental status assessment scale (Mini-MentalStateExamination - MMSE). The evaluation was performed in 3 stages: on the eve of surgery, 7 days after it and on the 21st day of the postoperative period. Patients were divided into two groups: group k - patients received general anesthesia with narcotic analgesics and benzodiazepines in premedication for 40 minutes, maintenance of anesthesia - sevoflurano - oxygen mixture on a low gas stream. minutes before surgery. Estimation of the depth of analgesia was monitored using ANI (Analgesia Nociception Index, index of analgesia with nociceptive effect), evaluation of the depth of sedation - by BIS (Bispectral index, Bispectral index). Patients in both groups were statistically comparable by gender and age. Given the comparative analysis of changes in neuropsychological testing on the FAB scale, the average in the group using dexmedetomidine increased by 13.3% relative to baseline. After a comparative analysis of neuropsychological testing on the MMSE scale, the indicators in the group using dexmedetomid while in the group with the "classical" method of anesthesia, they did not change significantly. Based on the data obtained, it can be argued that the use of dexmedetomidine, as a component of multimodal analgesia, has a positive effect on the state of cognitive functions in the post-anesthetic period.

The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures - part I.

Pain and postoperative nausea and vomiting are among the most unpleasant sensations experienced after surgery. Patients after gynaecological surgery are at higher risk for both complications. Former methods of pain management based mainly on opioid administration were much less safe, especially for elderly patients. In addition, they generated an even greater increase of postoperative nausea and vomiting. Multimodal therapies in anesthesiology are currently being used more and more often. These include both multimodal postoperative pain management and multimodal prophylaxis of postoperative nausea and vomiting. The aim of the study was to assess the benefits of the methods used for gynaecological patients in the immediate postanesthetic period. The research material is an analysis of medical documentation of 150 patients from the gynaecology clinic who underwent surgical procedures of categories III and IV from October 2018 and until January 2019, carried out in one of the clinical hospitals in Szczecin at the Anesthesiology and Intensive Care Clinic. Patients were divided into 3 groups: 1. Patients who received multimodal analgesia using non-opioid and opioid analgesics. 2. Patients who received multimodal analgesia using non-opioid and opioid analgesics and adjuvants. 3. Patients who received multimodal analgesia using non-opioid and opioid analgesics and central blockade. The highest age was in the third group at 57.48 years of age, 50.86 in the second group, and 47.8 in the first group. Healthy patients classified as ASA 1 accounted for 14% of group I, 18% of group II and 10% of group III. Patients with severe systemic disease (ASA 3) constituted 30% of group III 18%, of group II and 8% of group I. Upon leaving the operating room, as many as 80% of the patients from groups II and III did not feel any pain. In group I was 52%. When entering the recovery room, 26% of the patients in group I, 10% in group III, and 8% in group II rated their pain as higher than 5. The most used antiemetic medication in the studied facility was ondansetron. In group II it was given to 36 (72%) patients, in group III to 23 (46%) patients, and 13 (26%) patients in group I. In the postanaesthetic care unit, 9 (18%) patients in group III, 6 (12%) patients in group I, and 3 (6%) patients in group II received ondansetron. Metoclopramide was given only to patients in group III - one intraoperatively, and the other in the recovery room. Multimodal analgesia is effective in pain treatment. The use of PONV prevention is used for gynaecological patients. The analysis of the surgical records facilitated the recognition of patient needs.

Prolonged anesthesia alters brain synaptic architecture

Prolonged medically induced coma (pMIC) is carried out routinely in intensive care medicine. pMIC leads to cognitive impairment, yet the underlying neuromorphological correlates are still unknown, as no direct studies of MIC exceeding ∼6 h on neural circuits exist. Here, we establish pMIC (up to 24 h) in adolescent and mature mice, and combine longitudinal two-photon imaging of cortical synapses with repeated behavioral object recognition assessments. We find that pMIC affects object recognition, and that it is associated with enhanced synaptic turnover, generated by enhanced synapse formation during pMIC, while the postanesthetic period is dominated by synaptic loss. Our results demonstrate major side effects of prolonged anesthesia on neural circuit structure.

An observational study of hypoactive delirium in the post-anesthesia recovery unit of a pediatric hospital.

Hypoactive delirium is present when an awake child is unaware of his or her surroundings, is unable to focus attention, and appears quiet and withdrawn. This condition has been well-described in the intensive care setting but has not been extensively studied in the immediate post-anesthetic period. To determine if hypoactive emergence delirium occurs in the recovery unit of a pediatric hospital, and if so, what proportion of emergence delirium is hypoactive in nature. We conducted an observational study using the Cornell Assessment of Pediatric Delirium in a cohort of 4424 children recovered at a tertiary pediatric hospital. The incidence of emergence delirium detected using the Pediatric Anesthetic Emergence Delirium (PAED) scale was also recorded for comparison. There were 74 cases of emergence delirium detected during the study period using the Cornell Assessment of Pediatric Delirium (1.7%). Only 57 cases were detected using the Pediatric Anesthetic Emergence Delirium scale. The additional 17 cases detected using the Cornell Assessment of Pediatric Dlirium represent cases of hypoactive delirium. In this cohort of pediatric patients, 23% of all cases of emergence delirium were hypoactive in nature. The significance of hypoactive delirium in this population is unknown; however, previous studies have shown that emergence delirium can result in post-operative behavior changes and may affect compliance with future episodes of care. However, hypoactive delirium is often missed without active screening. The prevalence detected in this study therefore suggests hypoactive delirium warrants further investigation.