Preferred Anesthesia Research Articles

Prevalance of Shivering Among Parturients Receiving Intrathecal Tramadol During Cesarean Section

Introduction: Spinal anesthesia is popular and preferred anesthesia of choice during cesarean section. Shivering is one of the inevitable complications of spinal anesthesia (which occurs due to heat loss and redistribution of body heat from core to periphery). T.he incidence of post-spinal shivering reported to be 40%-60%. Although shivering may have beneficial thermoregulatory effects, it places the body under increased physiological stress as it increases body oxygen demand by 3-4 folds, and increases metabolic rate, heart rate, blood pressure and even cause hypoxia, hypercapnia and lactic acidosis. Ideally, this should be prevented by pharmacological methods that are economically and practically feasible in all settings. Therefore, this study was conducted using tramadol 20 mg intrathecally along with bupivacaine prophylactically to prevent shivering after spinal anesthesia. Methods: This prospective observational study was carried out in 200 patients posted for emergency as well as routine cesarean delivery who received intrathecal Tramadol along with Bupivacaine at NMCTH. Shivering if present was noted and graded using a five-point intensity scale by Wrench et al. Result: Post-spinal shivering was observed in 36 (18%) patients. Among them, 22 (11%) patients had grade 1; 8 (4%) patients had grade 2; 6 (3%) patients had grade 3 shivering. None of the patients had grade 4 shivering. All patients had MOAA/S of 5, indicating that all the patients were fully awake and alert during the intraoperative period. Intraoperative nausea was seen in 26 (13%) patients while 14 (7%) patients had vomiting. None of the patients complaint of pruritus. Conclusion: The prevalence of post spinal shivering in patients who received intrathecal tramadol in our study was 18 %, which is lower as compared to studies conducted in parturient who did not receive intrathecal tramadol along with bupivacaine.

Pain Level and Analgesic Requirements in Patients Who Underwent Vaginal Pelvic Floor Surgery following General or Spinal Anesthesia

Objective: This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent general anesthesia (GA) or spinal anesthesia (SA) during vaginal pelvic floor surgeries. Design: This was a retrospective cohort study. Participants/Materials, Setting, Methods: Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery. Results: During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, p = 0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p = 0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient’s age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR = 0.33, p = 0.008) and mid-urethral sling placement (aOR = 0.37, p = 0.004). Limitations: This is a retrospective study, thus the choice of anesthesia may be biased. Conclusion: SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.

Generation of preoperative anaesthetic plans by ChatGPT-4.0: a mixed-method study

BackgroundRecent advances in artificial intelligence (AI) have enabled development of natural language algorithms capable of generating coherent texts. We evaluated the quality, validity, and safety of this generative AI in preoperative anaesthetic planning. MethodsIn this exploratory, single-centre, convergent mixed-method study, 10 clinical vignettes were randomly selected, and ChatGPT (OpenAI, 4.0) was prompted to create anaesthetic plans, including cardiopulmonary risk assessment, intraoperative anaesthesia technique, and postoperative management. A quantitative assessment compared these plans with those made by eight senior anaesthesia consultants. A qualitative assessment was performed by an adjudication committee through focus group discussion and thematic analysis. Agreement on cardiopulmonary risk assessment was calculated using weighted Kappa, with descriptive data representation for other outcomes. ResultsChatGPT anaesthetic plans showed variable agreement with consultants' plans. ChatGPT, the survey panel, and adjudication committee frequently disagreed on cardiopulmonary risk estimation. The ChatGPT answers were repetitive and lacked variety, evidenced by the strong preference for general anaesthesia and absence of locoregional techniques. It also showed inconsistent choices regarding airway management, postoperative analgesia, and medication use. While some differences were not deemed clinically significant, subpar postoperative pain management advice and failure to recommend tracheal intubation for patients at high risk for pulmonary aspiration were considered inappropriate recommendations. ConclusionsPreoperative anaesthetic plans generated by ChatGPT did not consistently meet minimum clinical standards and were unlikely the result of clinical reasoning. Therefore, ChatGPT is currently not recommended for preoperative planning. Future large language models trained on anaesthesia-specific datasets might improve performance but should undergo vigorous evaluation before use in clinical practice.

Best perioperative practices in the management of obstructive sleep apnea patients undergoing ambulatory surgery.

This review is timely due to the increasing prevalence of obstructive sleep apnea (OSA) among patients undergoing ambulatory surgery, necessitating updated perioperative management strategies to improve outcomes and reduce complications. Recent studies emphasize the importance of risk stratification using tools like STOP-Bang, highlighting the association between high-risk OSA and increased perioperative complications. Intraoperative management strategies, including the preference for regional anesthesia and careful monitoring of neuromuscular blockade, have been shown to mitigate risks. Postoperative protocols, particularly continuous monitoring, are crucial in preventing opioid-induced respiratory depression. Effective management of OSA in ambulatory surgery requires a multidisciplinary approach, encompassing preoperative screening, tailored intraoperative techniques, and vigilant postoperative monitoring. Implementing guidelines and protocols can significantly enhance patient safety and outcomes.

Intrathecal Nalbuphine versus Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Hip Arthroplasty

Abstract Background Hip surgeries are one of the most cost-effective and consistently successful surgeries performed in orthopedics. Hip surgeries provide reliable outcomes for patients suffering from end-stage degenerative hip osteoarthritis (OA), specifically pain relief, functional restoration, and overall improved quality of life. Subarachnoid block is the preferred anesthesia for hip surgeries, being simple to perform and economical with rapid onset. Objective To compare intrathecal fentanyl in patients undergoing hip arthroplasty with nalbuphine as intrathecal adjuvant to 0.5% hyperbaric bupivacaine. The primary endpoint was the postoperative analgesia as assessed by VAS. The secondary outcomes were the onset and duration of sensory and motor blockade, hemodynamic changes, and incidence of side effects (bradycardia/ hypotension/ pruritus/ shivering/ respiratory depression/sedation). Patients and Methods This prospective double-blinded randomized clinical trial was conducted at Ain Shams University Hospitals from February 2022 until February 2023. Results As regard analgesic efficacy, there was increase pain in the two groups over the periods, but the most increase was in the fentanyl compared with nalbuphine group. There was a statistically significant difference between groups according to VAS score after 2:3 to 3:3 hours, while the rest times have insignificant difference. Sixteen patients received rescue analgesia with Fentanyl within 6h postoperatively, whereas six patients received with Naluphine which was found to be highly significant. Conclusion From our study we can conclude that there was increase pain in the two groups over the periods, but the most increase was in the fentanyl compared with nalbuphine group. There was a statistically significant difference between groups according to VAS score after 2:3 to 3:3 hours, while the rest times have insignificant difference. Sixteen patients received rescue analgesia with Fentanyl within 6h postoperatively, whereas six patients received with Naluphine which was found to be highly significant.

Comparison of nerve block and spinal anesthesia in second toe pulp free flap surgery for fingertip reconstruction.

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.

Impact of an interdisciplinary process to increase utilization of neuraxial anesthesia for cesarean delivery: A retrospective database analysis

BackgroundNeuraxial anesthesia is the preferred anesthesia mode for cesarean delivery (CD). The primary study aim was to study the rate of neuraxial anesthesia for cesarean delivery before and after educational strategies were implemented, focusing on neuraxial anesthesia use for CD. MethodsWe performed a retrospective analysis of the mode of anesthesia for CD. Educational strategies to inform about neuraxial anesthesia for CD included interdisciplinary daily handovers and ward rounds, and interdisciplinary academic meetings and simulation sessions. We retrieved data from the hospital electronic record for mode of anesthesia for CD, intravenous supplementation, to assess the impact of our strategies on neuraxial anesthesia use for CD (2014–2023). ResultsThe rate of neuraxial anesthesia increased from 89.8% in 2014 to 96.3% in 2023, with corresponding decrease in general anesthesia from 10.2% to 4.5% for all CD. The use of labor epidural augmentation for unplanned CD increased from 31.9% to 55.1%. Intravenous supplementation with spinal anesthesia for unplanned CD increased from 18.1% to 32.1%. ConclusionsThis study demonstrates the utility of educational strategies to increase neuraxial anesthesia use and highlights the importance of proactive interdisciplinary labor management.

Impact of the type of anesthesia on adverse events during transcarotid artery revascularization

ObjectiveThe use of local or regional anesthesia (LRA) is encouraged during transcarotid artery revascularization (TCAR) because the procedure is performed through a small incision. LRA permits neurologic evaluation during the procedure and may reduce periprocedural cardiac morbidity compared with general anesthesia (GA). There is limited and conflicting information regarding the preferred anesthesia to use during TCAR. We compared periprocedural clinical and technical complications, and intraprocedural performance metrics of TCAR performed under GA vs LRA. MethodsPatient, lesion, physician, and procedural information was collected in a worldwide quality assurance program of consecutive TCAR procedures. A composite clinical adverse event rate (death, stroke, transient ischemic attack, myocardial infarction) and a composite technical adverse event rate (aborted procedure, conversion to carotid endarterectomy, bleeding, dissection, cranial-nerve injury, device failure) in the periprocedural period were computed. Four intraprocedural performance measures (flow-reversal time, fluoroscopy time, contrast volume, and skin-to-skin time) were recorded. Deidentified data were analyzed independently at the Center for Vascular Research, University of Maryland. Poisson regressions were used to assess the impact of anesthesia type on adverse event rates. Linear regressions were used to compare performance measures. ResultsA total of 27,043 TCARs were performed by 1456 physicians between 2012 and 2021. A majority of patients (83%) received GA, and this proportion increased over time (R2 = 0.74; P < .0001). Some physicians (33.4%) used LRA in some of their procedures; only 2.7% used LRA in all of their procedures. Clinical risk factors were more common in the LRA group (P < .0001) and anatomic risk factors in the GA group (P < .0001); these differences were adjusted for in subsequent analyses. LRA was more likely to be used by vascular surgeons and by physicians with higher prior transfemoral carotid stenting experience (P < .0001). When comparing GA vs LRA, clinical adverse events (1.49%; 95% confidence interval [CI], 1.3-1.8 vs 1.55%; 95% CI, 1.2-2.0; P = .78), technical adverse events (5.6%; 95% CI, 5.2-6.2 vs 5.3%; 95% CI, 4.5-6.3; P = .47), and intraprocedural performance measures did not differ by type of anesthesia. ConclusionsAlmost two-thirds of physicians performed TCAR exclusively under GA, and the overall proportion of procedures performed under GA increased over time. A larger fraction of patients with severe medical risk factors received LRA vs GA, whereas a larger fraction of patients with anatomic risk-factors received GA. Periprocedural clinical and technical adverse events did not differ by type of anesthesia. Intraprocedural performance metrics that drive procedural cost were similar between groups; potential differences in procedural cost driven by anesthetic choice require further study.

(182) MALLEABLE PENILE PROSTHESIS IMPLANTATION UNDER LOCAL ANESTHESIA: SURGICAL TECHNIQUE AND EARLY EXPERIENCE

Abstract Introduction Penile prosthesis (PP) is the gold-standard therapy for medication-refractory erectile dysfunction (ED) and traditionally is performed under general anesthesia. Subcoronal malleable penile prosthesis (MPP) implantation, which requires minimal dissection, can be performed under local anesthesia, particularly in patients with risk factors for general anesthesia, on anticoagulation therapy or antiplatelet therapy, or with a preference for local anesthesia. Objective We propose a technique of MPP implantation under local anesthesia and present two cases performed at our institution. Methods The surgical technique and details of the clinical cases are demonstrated in the video. Both patients received pre-operative analgesia with or without anxiolytic oral medication, an intra-operative block, and post-operative analgesia for two weeks. At 3-month and 1 month postoperative follow-up, respectively, both patients reported satisfactory results. Results The surgical technique and details of the clinical cases are demonstrated in the video. Both patients received pre-operative analgesia with or without anxiolytic oral medication, an intra-operative block, and post-operative analgesia for two weeks. At 3-month and 1 month postoperative follow-up, respectively, both patients reported satisfactory results. Conclusions MPP implantation under local anesthesia is a viable and safe option for patients who are unable or unwilling to undergo general anesthesia. Cessation of anticoagulation is not required via the subcoronal approach, and patients can reliably be discharged the same day without risks related to general anesthesia. A larger cohort and multi-center adaptation are necessary to fine-tune an optimal protocol for enhancing the patient experience with these cases. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

General anaesthesia compared to conscious sedation for first-time atrial fibrillation catheter ablation-a Danish nationwide cohort study.

Catheter ablation (CA) is a well-established treatment option for atrial fibrillation (AF), where sedation and analgesia are pivotal for patient comfort and lesion formation. The impact of anaesthesia type on AF recurrence rates remains uncertain. This study aimed to examine AF recurrence rates depending on conscious sedation (CS) vs. general anaesthesia (GA) during CA. Utilizing nationwide data from the Danish healthcare registries, we conducted this cohort study involving adults (≥18 years) undergoing first-time CA for AF between 2010 and 2018. Patients were categorized by anaesthesia type (CS or GA), with the primary endpoint being AF recurrence, defined by a composite endpoint of either antiarrhythmic drug (AAD) prescriptions, AF-related hospital admissions, electrical cardioversions, or AF re-ablation. The impact of anaesthesia type was evaluated using multivariable Cox proportional hazards analysis. The study cohort comprised 7957 (6421 CS and 1536 GA) patients. Persistent AF, hypertension, and heart failure, as well as use of AAD, were more prevalent in the GA group. Cumulative incidences of recurrent AF were higher in the CS group at 1 (46% vs. 37%) and at 5 (68% vs. 63%) years. Multivariate analysis revealed CS as significantly associated with increased risk of AF recurrence at 5-year follow-up [hazard ratio 1.26 (95% confidence interval 1.15-1.38)], consistent across paroxysmal and persistent AF subtypes. This nationwide cohort study suggests a higher risk of AF recurrence with CS during CA compared to GA. These results advocate for considering GA as the preferred anaesthesia type for improved CA outcomes.

Spinal anesthesia in children: an educational review

Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

Is a Failed Spinal Attempt Associated With a Worse Clinical Course Following Primary Total Hip and Knee Arthroplasty?

BackgroundSpinal anesthesia (SA) is the preferred anesthesia modality for total joint arthroplasty (TJA). However, studies establishing SA as preferential may be subject to selection bias given that general anesthesia (GA) is often selectively utilized on more difficult, higher-risk operations. The optimal comparison group, therefore, is the patient converted to GA due to a failed attempt at SA. The purpose of this study was to determine risk factors and outcomes following failed SA with conversion to GA during primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). MethodsA consecutive cohort of 4,483 patients who underwent primary TJA at our institution was identified (2,004 THA and 2,479 TKA). Of these patients, 3,307 underwent GA (73.8%), 1,056 underwent SA (23.3%), and 130 patients failed SA with conversion to GA (2.90%). Primary outcomes included rescue analgesia requirement in the postanesthesia care unit (PACU), time to ambulation, pain scores in the PACU, estimated blood loss, and 90-day complications. ResultsRisk factors for SA failure included older age and a higher comorbidity burden. Failure of SA was associated with increased estimated blood loss, rescue intravenous opioid use, and time to ambulation when compared to the successful SA group in both THA and TKA patients (P < .001). The anesthesia modality was not associated with significant differences in PACU pain scores. The 90-day complication rate was similar between the failed SA and GA groups. There was a higher incidence of postoperative pain prompting unplanned visits and thromboembolism when comparing failed SA to successful SA in both THA and TKA patients (P < .05). ConclusionsIn our series, patients who had failed SA demonstrated inferior outcomes to patients receiving successful SA and similar outcomes to patients receiving GA who did not have an SA attempt. This emphasizes the importance of success in the initial attempt at SA for optimizing outcomes following TJA.

Effective concentration (EC50) of sevoflurane for intraocular pressure measurement in anaesthetised children with glaucoma: A dose-finding study.

Sevoflurane, a preferred anaesthetic for children, exhibits a dose-dependent reduction in intraocular pressure (IOP). However, consensus is lacking regarding optimal end-tidal sevoflurane concentration for safe IOP measurement. This study aimed to identify the concentration at which IOP measurement could be attempted without inducing movements in paediatric patients after inhalational induction. Two paediatric groups (1-12 months and 12-36 months) with glaucoma undergoing examination under anaesthesia were recruited. After induction with 8% sevoflurane and 100% oxygen, the first child had an end-tidal sevoflurane concentration maintained at 2% for 4 min, followed by IOP measurement. Success was defined as 'no movement', and subsequent concentrations (adjusted in 0.2% steps) were determined using the Dixon and Massey method based on the previous patient's responses. The study included 75 children. The effective concentration of sevoflurane causing 'no movement' during IOP measurement in 50% of the study population for successful IOP measurement was 1.98% (95% confidence interval [CI] 1.63, 2.17, P = 0.017) for 1-12 months group and 0.55% (95% CI 0.39, 0.66, P = 0.002) for 12-36 months group. Probit regression analysis yielded effective concentration of sevoflurane causing 'no movement' during IOP measurement in 95% of the study population values of 2.47% (95% CI 2.24, 4.58, P = 0.017) for 1-12 months group and 0.94% (95% CI 0.78, 1.57, P = 0.002) for 12-36 months group. In paediatric patients, a higher end-tidal sevoflurane concentration of 2% is needed for IOP measurement in 1-12 months age group compared to 0.5% required in 12-36 months age group, achieving success in 50% of the study population.

Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Anesthesia Preferences and Outcomes in Saudi Arabian Healthcare: A Cross-Sectional Study.

Anesthesia choice is critical in ensuring optimal surgical outcomes and patient satisfaction. We aimed to investigate anesthesia preferences, trends, and outcomes in elective surgeries within Saudi Arabian healthcare settings. A cross-sectional survey-based study was conducted among anesthesia residents and attending anesthesiologists across Saudi Arabia. Participants provided demographic information and responded to questions regarding anesthesia preferences, trends, and outcomes. Descriptive statistics were used to summarize the data, and logistic regression analysis was employed to identify factors associated with anesthesia preference. The survey was completed by 572 healthcare professionals in Saudi Arabia. Among participants, 51.7% (n=296) preferred general anesthesia, while 48.3% (n=276) favored regional anesthesia for elective surgeries. Factors influencing anesthesia choice included patient preference, surgical complexity, and resource availability. Over half of the respondents reported an increase in regional anesthesia preference over the past five years, although some perceived inadequate training in this area. Common barriers to regional anesthesia adoption included equipment availability, patient reluctance, and limited training opportunities. Postoperative recovery was perceived as quicker with regional anesthesia by 52.3% (n=299) of participants, with postoperative nausea and vomiting being the most common complication associated with general anesthesia. Multivariable logistic regression analysis revealed that participants above 50 years had lower odds of preferring regional anesthesia, while those perceiving training adequacy in regional anesthesia as adequate had higher odds of preferring it (OR=0.64, 95% CI: 0.41-0.98, p=0.041; OR=1.58, 95% CI: 1.21-2.05, p=0.001, respectively). This study provides insights into anesthesia practice patterns in Saudi Arabian healthcare settings. Individualized anesthesia care, ongoing training in regional anesthesia, and evidence-based decision-making are essential to optimize perioperative outcomes and patient satisfaction.

Anesthetic approach to trauma patients in the city hospital after the 2023 Maraş earthquake.

The February 6, 2023, Kahramanmaraş earthquake caused significant destruction across our country. More than 50,000 people lost their lives, thousands were injured, and health facilities were damaged. Victims were transferred to hospitals in other provinces for treatment. This study evaluates the anesthesia approach applied to the injured who were transferred to our tertiary hospital. We retrospectively reviewed the data of patients who underwent surgery between February 6 and February 20, 2023. The study included earthquake victims who underwent emergency trauma surgery, aged 10 years and above. We recorded the date of admission to the hospital, demographic information, type of surgery, surgical site, anesthesia technique, preference for peripheral block, laboratory values, dialysis and intensive care needs, and survival rates. Data analysis was performed using the IBM® Statistical Package for the Social Sciences (SPSS®) Version 26.0. A total of 375 cases were included in the study. Of these, 323 patients underwent surgery for extremity injuries, and 35 for vertebral injuries. Among the extremity injuries, 61.6% were to the lower extremities, and 17.1% to the upper extremities. Debridement was performed on 147 patients, fasciotomy on 49 patients, and amputation on 33 patients. General anesthesia was applied to 352 patients, spinal anesthesia to 19 patients, and sedoanalgesia to four patients. Peripheral nerve block was performed on 33 patients. Dialysis treatment was administered to 105 patients. Twenty-six patients were lost during the treatment process. There were no intraoperative patient deaths. The predominance of extremity injuries among earthquake victims increases the inclination towards regional anesthesia. Incorporating Plan A blocks into basic anesthesia skills could enhance the preference for regional anesthesia in disaster situations. Furthermore, transferring the injured to advanced centers may reduce morbidity.

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy.

Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols. We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway. Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches. Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.

Development of a compounded propofol nanoemulsion using multiple non-invasive process analytical technologies

Propofol is the preferred anaesthetic for induction and maintenance of sedation in critically ill mechanically ventilated COVID-19 patients. However, during the outbreak of the COVID-19 pandemic, regular supply chains could not keep up with the sudden increase in global demand, causing drug shortages. Propofol is formulated as an oil-in-water emulsion which is administered intravenously. This study explores the extemporaneous preparation of a propofol emulsion without specialized manufacturing equipment to temporally alleviate such shortages. A commercially available lipid emulsion (IVLE, SMOFlipid 20 %), intended for parenteral nutrition, was used to create a propofol loaded nanoemulsion via addition of liquid propofol drug substance and subsequent mixing. Critical quality attributes such as mean droplet size and the volume-weighted percentage of large-diameter (>5µm) droplets were studied. The evolution of droplet size and propofol distribution was monitored in situ and non-destructively, maintaining sterility, using Spatially Resolved Dynamic Light Scattering and Near Infrared Spectroscopy, respectively. Using response surface methodology, an optimum was found for a 4 % w/v propofol formulation with a ∼15 min mixing time in a flask shaker at a 40° shaking angle. This study shows that extemporaneous compounding is a viable option for emergency supply of propofol drug product during global drug shortages.

A low-cost device for cryoanesthesia of neonatal rodents

Studying the development of neural circuits in rodent models requires surgical access to the neonatal brain. Since commercially available stereotaxic and anesthetic equipment is designed for use in adults, reliable targeting of brain structures in such young animals can be challenging. Hypothermic cooling (cryoanesthesia) has been used as a preferred anesthesia approach in neonates. This commonly involves submerging neonates in ice, an approach that is poorly controllable. We have developed an affordable, simple to construct device – CryoPup – that allows for fast and robust cryoanesthesia of rodent pups. CryoPup consists of a microcontroller controlling a Peltier element and a heat exchanger. It is capable of both cooling and heating, thereby also functioning as a heating pad during recovery. Importantly, it has been designed for size compatibility with common stereotaxic frames. We validate CryoPup in neonatal mice, demonstrating that it allows for rapid, reliable and safe cryoanesthesia and subsequent recovery. This open-source device will facilitate future studies into the development of neural circuits in the postnatal brain.

Investigating the effects of the COVID-19 pandemic on obstetric anesthesia and perioperative outcomes in cesarean section surgery

Aim: In the literature, studies comparing the preferred anesthesia methods and related parameters in obstetric anesthesia during the pandemic period with the pre-pandemic period are limited. I n this study, primarily in patients who gave birth by cesarean section before and during the COVID-19 (Coronavirus disease 19) pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, length of hospital stay, clinical urgency of the patients and ASA (American Society of Anesthesiologists) scores. In addition, in patients who underwent cesarean section with positive and negative PCR (Polymerase Chain Reaction) tests during the COVID-19 pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, hospital stay, clinical urgency of the cases and ASA scores.&#x0D; Material and Method: In this retrospective, single-center study, we noted down and compared types of cesarean section (elective or emergency), anesthesia techniques (spinal, spinal+epidural, or general anesthesia), and patients’ ages, ASA scores, PCR test results, postoperative complications (e.g., pneumonia, excessive postpartum bleeding), and lengths of hospital stay.&#x0D; Results: We carried out this study with the data of 2,406 women, 1,458 of whom gave birth before the pandemic. The findings revealed that the rate of developing complications, the length of hospital stay, the number of patients with an ASA score of 3 and above, and the use of spinal anesthesia significantly increased during the pandemic. Moreover, 182 women were COVID-19-positive among a total of 948 applicants during the pandemic. Although the ASA scores and complication rates were significantly higher among those with a positive PCR test result, the length of hospital stay was similar between the patients by their PCR test results. &#x0D; Conclusion: Our findings revealed a significant decrease in spinal + epidural anesthesia, which was frequently adopted before, in cases with cesarean section during the pandemic. Spinal anesthesia was mostly used alone. Despite increased complication rates in PCR-positive patients with higher ASA scores undergoing cesarean section, we concluded no significant change in the length of hospital stay. In cases of increased risk of infection and transmission (e.g., pandemic), neuraxial blocks may be preferred as an anesthesia technique to minimize the risk of infection in emergency obstetric operations. It should also be noted that the risk of developing postoperative complications always be high during pandemics.