General Anesthesia Procedures Research Articles

Effect of Nebulisation with Dexmedetomidine versus Magnesium Sulphate on Haemodynamic Response to Laryngoscopy and Intubation and Incidence of Postoperative Sore Throat: A Randomised Clinical Trial

Introduction: Laryngoscopy and endotracheal intubation are essential procedures in general anaesthesia but can induce sympathetic hyperactivity, leading to transient increase in blood pressure and Heart Rate (HR). This can be particularly risky for patients with co-morbidities. Various agents, including dexmedetomidine and magnesium sulphate, have been studied for their potential to mitigate these responses. Aim: To compare the effects of preoperative nebulisation with dexmedetomidine versus magnesium sulphate on haemodynamic responses during laryngoscopy and intubation and to determine the incidence of Postoperative Sore Throat (POST) in both groups. Materials and Methods: This randomised clinical, double-blind trial was conducted at Dr. D.Y. Patil Medical College, Pune, Maharashtra, India over the period of two years. It involved 80 patients undergoing surgery under general anaesthesia, divided into two equal groups. Group A received nebulisation with dexmedetomidine (1 µg/kg) and Group B received magnesium sulphate (240 mg) diluted in 0.9% normal saline to make a 3 mL solution. Institutional ethical approval and Clinical Trials Registry India (CTRI) registration were obtained. Haemodynamic parameters including HR, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and POST were monitored. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Data were analysed using unpaired t-tests for quantitative data and Pearson’s Chi-square test for qualitative data, with significance set at p-value<0.05. Results: Before nebulisation, group A had significantly higher HR and SBP than group B (p-value=0.003 and 0.009, respectively). Postnebulisation, there were no significant differences in HR or SBP between groups. However, group A had lower DBP and MAP during and after intubation and skin incision (p-value <0.001, 0.001, and <0.001 respectively for DBP and 0.030, 0.031 and 0.002 for MAP). Group A had a lower, though not statistically significant (p-value=0.36) incidence of POST compared to group B. Conclusion: Nebulisation with dexmedetomidine and magnesium sulphate both provided effective management of haemodynamic responses during intubation. Both agents decreased the incidence of POST.

Local anesthesia with and without conscious sedation versus general anesthesia for oral surgical procedures in pediatric patients: a retrospective cross-sectional study

Objectives: To compare the effectiveness of general anesthesia versus local anesthesia with or without conscious sedation for minor oral surgery procedures in pediatric patients. Methods: We performed a retrospective chart review of 192 pediatric patients who underwent 227 minor oral surgery procedures between 2017 and 2019 at the Oral and Maxillofacial Surgery Department at Hospital Clínico Universitario in Valencia, Spain. Results: Of the 192 patients studied, 57.27% were male and 42.73% female (mean age, 9.83 years). General anesthesia was used in 51.54% of procedures, and LA with or without conscious sedation in 48.46%. Pain, occurring in 2.56% of general anesthesia procedures and 2.73% of local anesthesia procedures, was the most common complication, followed by infection (1.71% of general anesthesia procedures). Procedural success was 94.87% in the general anesthesia group and 91.82% in the local anesthesia group. No significant differences were observed in success or complication rates between the groups. Conclusions: Compared with local anesthesia with or without conscious sedation, general anesthesia does not result in lower procedural success rates or a higher risk of complications other than mild pain in pediatric dental patients.

Association of remimazolam with delirium and cognitive function: A systematic review and meta-analysis of randomised controlled trials.

Delirium is an organic mental syndrome significantly associated with long-term cognitive decline, increased hospital stays and higher mortality. This systematic review of randomised controlled trials (RCTs) with meta-analysis assesses the association of remimazolam with postoperative cognitive function and delirium compared with non-benzodiazepine hypnotics. Systematic review of RCTs with meta-analysis. PubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024. Adult patients undergoing general anaesthesia or sedation procedures; use of remimazolam as the primary hypnotic or as an adjunct, administered via intermittent bolus or continuous infusion; comparison with other hypnotics or sedatives; evaluation of cognitive function or delirium. Twenty-three RCTs with 3598 patients were included. The incidence of delirium was not significantly different between remimazolam and other sedatives in general anaesthesia and sedation procedures [n = 3261; odds ratio (OR) = 1.2, 95% confidence interval (CI), 0.76 to 1.91; P = 0.378843; I2 = 17%]. Regarding cognitive function evaluation, remimazolam showed no difference compared with the control group in Mini-Mental State Examination (MMSE) scores on the first postoperative day (n = 263; mean difference = 0.60, 95% CI, -1.46 to 2.66; P = 0.5684; I2 = 90%) or on the third postoperative day (n = 163; mean difference = 1.33, 95% CI, -0.72 to 3.38; P = 0.2028; I2 = 93%). Remimazolam exhibited superiority over the control group in MMSE scores on the seventh postoperative day (n = 247; mean difference = 0.53, 95% CI, 0.30 to 0.75; P < 0.0001; I2 = 28%). Remimazolam does not increase the incidence of delirium or cognitive impairments compared with non-benzodiazepine hypnotics. However, the analysis showed that the type of surgery significantly influenced the incidence of delirium. Additionally, remimazolam was associated with better short-term postoperative cognitive function. PROSPERO CRD42024532751.

Improving Safety and Reducing Clinical Errors in Anesthesia: Which Checklist Is Your Choice?

The safety of the beating heart is a health service that means the absence of clinical errors during the implementation of health care. The period of anesthesia is identified as one of the most critical phases for patients requiring general anesthesia, carrying the potential for critical clinical errors that may have irreversible consequences. This study's main objective was to conduct a concise assessment of the anesthesia checklists utilized to enhance patient safety during general anesthesia procedures. To accomplish this, a comprehensive search was conducted using relevant keywords spanning from 1990 to 2023 across databases including PubMed, Springer, Google Scholar, Web of Science, Scopus, online libraries, and the Cochrane library. Initially, 188 studies were identified at the outset of the research, and among these, 13 studies that focused on the development of checklists for anesthesia safety were scrutinized. Included articles were reviewed separately and divided into 3 categories; Specific vs. Generalized Scope, Single-Stage vs. Multi-Stage, Single-Factor vs. Multi-Factor. According to the findings from these studies, the systematic and proper utilization of all available checklists can contribute to improved safety. However, due to the specialization of surgical procedures and the increasing emphasis on patient safety over the past decade, there has been a shift in the compilation of anesthesia checklists from being broad and general to becoming specific, transitioning from single-stage to multi-stage, and evolving from single-factor to multi-factor checklists.

Ganglioside GM1 Alleviates Propofol-Induced Pyroptosis in the Hippocampus of Developing Rats via the PI3K/AKT/NF-κB Signaling Cascade.

In pediatric and intensive care units, propofol is widely used for general anesthesia and sedation procedures as a short-acting anesthetic. Multiple studies have revealed that propofol causes hippocampal injury and cognitive dysfunction in developing animals. As is known, GM1, a type of ganglioside, plays a crucial role in promoting nervous system development. Consequently, this study explored whether GM1 mitigated neurological injury caused by propofol during developmental stages and investigated its underlying mechanisms. Seven-day-old SD rats or PC12 cells were used in this study for histopathological analyses, a Morris water maze test, a lactate dehydrogenase release assay, Western blotting, and an ELISA. Furthermore, LY294002 was employed to explore the potential neuroprotective effect of GM1 via the PI3K/AKT signaling cascade. The results indicated that GM1 exerted a protective effect against hippocampal morphological damage and pyroptosis as well as behavioral abnormalities following propofol exposure by increasing p-PI3K and p-AKT expression while decreasing p-p65 expression in developing rats. Nevertheless, the inhibitor LY294002, which targets the PI3K/AKT cascade, attenuated the beneficial effects of GM1. Our study provides evidence that GM1 confers neuroprotection and attenuates propofol-induced developmental neurotoxicity, potentially involving the PI3K/AKT/NF-κB signaling cascade.

A Prospective Randomised Comparative Study of Baska Mask and I-Gel for Airway Management in Elective Surgeries: Focus on Airway Sealing Pressure, Insertion Time, and Haemodynamic Response

Introduction: General anesthetic procedure requires a safe and open airway. Endotracheal intubation is the gold standard for airway management; it is being replaced by supraglottic airway devices because they are easy to introduce, better tolerated and results in a lesser haemodynamic response. As both the Baska mask and I-gel have a non-inflatable self-sealing mechanism, these two devices were compared in our study in terms of time taken for insertion, airway sealing pressure, the number of attempts, hemodynamic changes, and complications. Methods: A Prospective comparative study was conducted on 90 patients (45 in each group), aged 18-60 years, undergoing elective surgeries under general anesthesia at Tertiary care Hospital, Madurai. Patients were randomized into two groups using the computer generated statistical software STATA version14 (Texas, USA): Group B: Airway was secured by insertion of Baska mask. Group I: Airway was secured by insertion of I Gel. Following assessments were done to evaluate the SAD: Time taken to insert the device, airway sealing pressure, rate of successful insertion, number of attempts, Haemodynamic parameters, laryngopharyngeal morbidity. Data were analyzed using Student t-tests and chi-square tests, with p &lt; 0.05 considered significant. Results: The mean airway sealing pressure of the Baska mask (26.1+6.1 cmH2O) was significantly higher than that of the I-gel (23.1± 5.9 cmH2O) with a P value of 0.019 which was statistically significant. In our study the time taken to insert the device, for Baska mask it was 18.9+4.1 seconds and for the I gel it was 17.2±5.1 seconds with a P value of 0.089 which was statistically insignificant. In our study there was no statistical difference between Baska mask and I-gel groups in regards to hemodynamic changes (Heart rate and Mean arterial pressure). This may be due to the same stress response produced by the both devices. Conclusion: Baska mask is superior to I-gel in positive pressure ventilation under general anaesthesia for short surgical procedures with statistically significant higher airway sealing pressure though it has comparable time of insertion, haemodynamic changes and laryngopharyngeal morbidity.

Embolic Materials' Comparison in Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score-Matched Analysis of 1070 Cases.

Multiple preferences exist for embolic materials selection in middle meningeal artery embolization (MMAE) for chronic subdural hematoma with limited comparative literature data. Herein, we compare different embolic materials. Consecutive patients undergoing MMAE for chronic subdural hematoma at 14 North-American centers (2018-2023) were classified into 3 groups: (a) particles, (b) Onyx, (c) n-butyl cyanoacrylate (n-BCA). The end points were unplanned rescue surgery, radiographic success (≥50% reduction in hematoma thickness at last imaging "minimum of 2 weeks"), and major complications. Initial unmatched analysis compared the 3 groups; subsequent propensity score matching (PSM) compared particles vs liquid embolics (groups b and c combined). Additional subgroup PSM analyses compared particles vs Onyx, particles vs n-BCA, and Onyx vs n-BCA. All matched analyses controlled for age, sex, concurrent surgery, previous surgery, hematoma thickness, midline shift, pretreatment antithrombotics, and baseline modified Rankin Scale. Eight hundred and seventy-two patients (median age 73 years, 72.9% males) underwent 1070 MMAE procedures. Onyx was most used (41.4%), then particles (40.3%) and n-BCA (15.5%). Surgical rescue rates were comparable between particles, Onyx, and n-BCA (9.8% vs 7% vs 11.7%, respectively, P = .14). Similarly, radiographic success (78.8% vs 79.3% vs 77.4%; P = .91) and major complications (2.4% vs 2.3% vs 2.5%; P = .83) were comparable. The PSM comparing particles vs liquid generated 128 matched pairs; general anesthesia and bilateral procedures were significantly higher in particles (37.8% vs 21.3%; P = .004 and 39.8% vs 27.3%; P = .034, respectively). No differences in surgical rescue, radiographic improvement, or major complications were noted (P > .05). Concurrently, PSM comparing particles vs Onyx, particles vs n-BCA, and Onyx vs n-BCA, resulted in 112, 42, and 40 matched pairs, respectively, without differences in surgical rescue, radiographic success, or major complications (P > .05). We found no differences in radiological improvement, surgical rescue, or major complications between embolic materials in MMAE. Current randomized trials are exclusively using liquid embolics, and these data suggest that future trials involving particles are likely to produce similar outcomes.

FP8.2 - Sustainability Within the Abscess Pathway

Abstract Background Global warming and the current climate crisis remain a threat to global health. It is estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to general anaesthetic (GA) gases, which contributes to ongoing ozone depletion. Aims To review current practices in managing abscesses and improve sustainability within the abscess pathway in our trust. Methods Retrospective data on all patients who underwent incision and drainages (I&amp;D) between January – July 2022 were collected and analysed. A new abscess pathway was introduced in June 2023 and departmental teaching provided to junior doctors on incision and drainage of abscesses under local anaesthetic (LA). Data on patients who underwent I&amp;D between June – September 2023 were collected and analysed to assess the impact of the new abscess pathway. Results In the first-cycle audit, 162 patients underwent I&amp;D, of which 119 (92%) were done under GA. Of these, 71 (60%) were suitable for LA I&amp;Ds, 91% were admitted for their procedures. The estimated carbon footprint was 4525kg CO2e/year. In the second-cycle audit, 68 patients underwent I&amp;D, of which 37 (76%) were done under GA. Of these, 31 (46%) were suitable for LA I&amp;Ds, 41% were admitted for their procedures. The estimated carbon footprint was 3735kg CO2e/year. Conclusions Following implementation of the new abscess pathway, we reduced the number of patients having general anaesthetic procedures and inpatient admission. This not only improves the sustainability of our practice, but makes treatment and recovery quicker for patients, and has a lower financial burden.

Can silver diamine fluoride reduce invasive treatments with general anesthesia?

This study aims to retrospectively evaluate the differences in dental treatments rendered in general anesthesia (GA) for patients who did or did not receive application of silver diamine fluoride (SDF) prior to GA. 1559 patients (≤6 years) who completed treatment with GA for caries at University of California San Francisco (UCSF) between 2015 and 2019 were included in the study. At baseline patients' electronic health record was reviewed to collect planned treatment, complete dental treatment and demographics. Patients were identified as SDF group (N = 335, 21.49%) or comparison (N = 1224, 78.51%). Dental treatments rendered were compared between the SDF and comparison group with multi-variable regression, including variables for demographics and clinical findings at baseline. The initial analysis identified variations in gender, age, dental pain, pulp involvement, and initial treatment plans between the SDF and comparison groups at baseline. In an unadjusted analysis, the SDF group displayed a statistically significant increase in the number of crown procedures but a notable decrease in the number of pulp therapy and extraction treatments completed (p < 0.05). An adjusted multivariable model affirmed the inverse relationship between SDF application and completion of pulp therapy and extractions at the time of GA (p < 0.05). No significant association was identified with the total number of crowns needed and SDF. The model further indicated a positive correlation between the total count of pulp therapy and extractions completed with patient age and the wait-time for GA. In conclusion, pre-GA application of SDF to carious primary teeth is negatively correlated with completed pulp therapy and extraction. SDF application prior to dental treatment with GA may be a valuable tool to reduce invasive dental procedures in GA.

Incidence and type of voluntary reported perianesthetic medication errors in community veterinary clinics in Calgary, Canada.

To collect medication error (ME) data during the perianesthetic period from small animal clinics. 6 small animal general practice veterinary clinics. Small animal general practice veterinary clinics were recruited in this prospective observational study, with staff given a presentation on medical errors and instructed on how to submit medication error reports to an online reporting system. Errors were classified according to type and timing. A total of 2,728 general anesthesia or sedation procedures were performed, with 49 ME reports submitted. One duplicated report of the same error was excluded, resulting in a ME rate of 1.8%. Most reports (69% [33/48]) were near misses. The remaining 31% were MEs that reached the patient but did not cause harm. Wrong dose errors were the most common type (63% [30/48]), of which 80% (24/30) were calculation errors. Premedication/sedation and maintenance were the most reported stages, at 47% (20/43) and 23% (10/43), respectively. None of the MEs reported resulted in an adverse event, with an approximately 2:1 ratio of near-miss to no-harm MEs. The observed patterns of MEs reported, including type and timing, represent a target for further education. These results quantify the ME rate in general practice veterinary clinics, providing an initial benchmark for MEs during the perianesthetic period.

The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality-A protocol for an observational pilot study.

Managing postoperative pain while minimizing opioid-related adverse drug events (ORADEs) remains a significant challenge. The OPI•AID Zone Tool is proposed as a novel clinical decision support tool that - both graphically and in a scoring-system -represents the relationship between pain management and the occurrence of ORADEs, aiming to enhance patient outcomes in postoperative care. The OPI•AID Zone Tool places pain scoreon the x-axis and an ORADE score on the y-axis, and stratifies patients into five zones to reflect the composite impact of pain severity and ORADEs on the quality of postoperative patient care. The study will have two key aims: (1) to explore whether the OPI•AID Zone Tool can function as a composite outcome measure for postoperative pain and ORADEs, and (2) to evaluate the use of the OPI•AID Zone Tool in visual presentations and for evaluation of patients' postoperative pain management quality. This prospective observational cohort study will include 200 adults undergoing various surgical procedures in general anesthesia with a subsequent stay in the post-anesthesia care unit (PACU) at Bispebjerg Hospital, Denmark. Substudy 1 primary outcome: To assess whether a zone score in the OPI•AID Zone Tool is associated with patient-perceived health (EQ VAS), quality of recovery (QoR-PACU), and time to discharge readiness in PACU, and if the zone score has a stronger association than pain and ORADE score in themselves. Substudy 2 primary outcome: To assess how the use of intraoperative non-opioid analgesics impact where patients are placed in the OPI•AID Zone Tool's XY scatterplot right after surgery. To assess if patients who receive more comprehensive non-opioid analgesic basic regimens, generally fall into lower zones. The OPI•AID Zone Tool could potentially be a valuable clinical decision-making tool for optimizing postoperative care by simultaneously addressing pain management and the risk of ORADEs. By computing a composite measure of these two critical outcomes, the tool could guide more nuanced and patient-centered analgesic regimens, potentially improving patient satisfaction and operational efficiency in postoperative settings. The tool's applicability will be explored in this observational pilot and followed up in a planned series of studies (opiaid.dk).

Recurrent respiratory papillomatosis: comparing in-office and operating room treatments.

We report the management of recurrent respiratory papillomatosis (RRP) employing a protocol that includes both office-based (OB) and general anaesthesia (GA) procedures. Quality of life (QoL) outcomes in the OB cohort were compared to those obtained from an historical cohort treated only under GA. Patients affected by RRP from 2019 until 2023 ("new protocol") and from 2012 to 2019 ("historical protocol") were enrolled. In both groups the Derkay site score (DSS) was calculated. In patients adhering to the new protocol, questionnaires measuring QoL were prospectively administered (voice handicap hindex-10 [VHI-10] along with a specific questionnaire to measure the tolerance to the OB procedures). A cost analysis was also performed. In all, 35 patients composed the new protocol cohort and 13 the historical. In the first group, patients underwent a median of 4 treatments. At 2 years, 68% of patients were treated exclusively in the office. Overall, for the new protocol, median DSS and VHI-10 after one year were both significantly lower than those at baseline [2 vs 4 and 3 vs 14, respectively; p < 0.001]. No differences were found between the new and the historical protocol cohorts considering DSS over time. Treatment of RRP may be conducted successfully in an office-based setting reducing healthcare costs.

Pipeline embolization device placement under local versus general anesthesia: a propensity score-matched study.

Pipeline embolization device (PED) placement for the treatment of intracranial aneurysms is safe and effective under general anesthesia (GA). However, GA is associated with certain risks, longer procedural time, and higher hospital cost. The authors aimed to compare clinical outcomes and hospital cost between GA and local anesthesia (LA) procedures in patients who underwent PED placement for intracranial aneurysm treatment. This retrospective study analyzed the charts of 216 patients with 223 intracranial aneurysms treated using the PED from June 2022 to March 2023. Cases were grouped according to type of anesthesia administered (LA or GA). Propensity score matching (PSM) was used to balance the groups to minimize confounding bias. Eighty-four patients with 88 aneurysms were treated under LA, and 132 patients with 135 aneurysms were treated under GA. The complication rate and modified Rankin Scale score at 6 months were similar in both groups. Procedural time was significantly shorter with LA both before (87.47 ± 22.68 minutes vs 118.90 ± 46.80 minutes, p < 0.001) and after (84.75 ± 16.77 minutes vs 110.02 ± 38.56 minutes, p < 0.001) PSM. LA eliminates the need for postanesthesia recovery. Hospital cost was significantly lower in the LA group both before ($30,820.74 ± $3216.93 vs $32,846.62 ± $4731.50, p = 0.001) and after ($30,127.83 ± $2763.12 vs $33,874.41 ± $3163.56, p = 0.002) PSM. PED placement under LA can achieve satisfactory outcomes similar to those of PED placement under GA; however, the use of LA reduces procedural time and hospital cost.

Efficacy of mini-endoscopic combined intrarenal surgery for pediatric kidney calculi: a single center retrospective study

Management of large pediatric kidney calculi (PKC) is challenging. This study aimed to evaluate the efficacy and safety of miniature endoscopic combined intrarenal surgery (mini-ECIRS) for PKC. We retrospectively analyzed mini-ECIRS in 16 pediatric patients undergoing kidney stone treatment between November 2014 and October 2023 to determine its safety, efficacy, and associated outcomes. The median age was 50.50 (interquartile range: 36.75, 84.75) months, and the mean stone size was 21.63 ± 11.65 mm. The stone-free rate was 81.25%. The median decrease in hemoglobin level on the day after surgery was 1.10 (0.80, 1.55), and no patient required a blood transfusion. The median number of general anesthesia procedures was 2.00 (2.00, 2.00). Postoperative complications included fever in two patients and difficulty in removing the ureteral stent in one patient. In this cohort, five patients underwent pre-stenting under general anesthesia before mini-ECIRS. Age was significantly lower in the pre-stenting group than in the non-pre-stenting (P < 0.01); however, there were no significant differences in operative time, stone-free rate, total number of general anesthesia procedures, hemoglobin loss, or postoperative hospital stay between the groups. Mini-ECIRS was found to be a safe and efficient treatment method with a high stone removal rate in pediatric patients.

Experiencing anesthesia and surgery early in life impairs cognitive and behavioral development.

The impact of anesthesia and surgery on neurocognitive and behavioral development in infants and children remains inadequately understood. To investigate the impact of early-life exposure to general anesthesia and surgery on cognitive and behavioral development. Children aged 0-3 years who underwent general anesthesia and surgical procedures between 2012 and 2015 were included. The cognitive and behavioral development of these children at ages 4-6 years was assessed. Age-, race-, and gender-matched children from the same geographic region, who did not undergo general anesthesia or surgery, served as the control group. The Wechsler Preschool Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was used to evaluate children's total intelligence quotient (FSIQ) and specific cognitive domains. The Gesell Development Schedules (GSCH) and Child Behavior Checklist (CBCL) were employed to assess behavioral and personality development. Additionally, the study analyzed the effects of various factors including anesthesia drugs, surgery duration, number of surgeries, age, weight, ethnicity, and gender on postoperative neurocognitive and behavioral outcomes. The study included 447 children with anesthesia/surgical exposure (AS) and 459 children in the control group. Analysis of cognitive and behavioral development showed a significant difference in the working memory index (WMI) between the AS and control groups (p < 0.05). Exploratory findings indicated that children administered remifentanil exhibited lower developmental quotient (DQ) values, whereas those given fentanyl showed higher (worse) Child Behavior Checklist (CBCL) total scores. Moreover, increased anesthesia/surgical exposures, younger age and lower body weight at exposure, and longer surgery durations were associated with cognitive and behavioral developmental challenges. This study examined the impact of early-life exposure to surgery and anesthesia on postoperative cognitive and behavioral development. Findings indicate that higher frequency of exposure to surgery and anesthesia, younger age, and lower body weight at exposure could negatively influence cognitive and behavioral development. Furthermore, variations in the effects of different anesthetics on behavior and cognition were observed. Caution is advised regarding the use of opioid analgesics such as remifentanil and fentanyl for more rigorous clinical applications.

The effects of ketoprofen and meloxicam on oxidative stress through the glutathione pathway after ketamine-xylazine anesthesia and ulcer induction in rats: A comparative study

Given that oxidative stress (OS) occurs as one of the complications of general anesthesia and surgical procedures, practicing the best and safest anesthesia regimen can have a significant share in various surgeries. So, this study compared the effects of non-steroidal anti-inflammatory drugs (NSAIDs) such as ketoprofen (KTP) and meloxicam (MLX) on OS through the glutathione pathway after the ketamine-xylazine (K-X) anesthesia and ulcer induction in rats to suggest post-operative regimens with promising analgesic and anti-inflammatory effects.80 healthy adult male Wistar rats, were examined in this study. To obtain the baseline value cardiac blood collected of five rats, and the remaining 75 animals were randomized into three groups of 25, including (i) the control group receiving physiological serum, (ii) the experimental group 1 taking KTP, (iii) the experimental group 2, administered by MLX and all three groups received K-X combination IP after 30 min. Then, a full-thickness ulcer was induced under standard conditions, and the blood samples were collected from groups at T0, T30m, T60m, T24h, and T48h. The serum levels of the desired markers were measured. The study results revealed that the administration of K-X as an anesthetic agent made some changes in the markers of the OS-related glutathione (GSH) pathway. Moreover, KTP and MLX, significantly (p < 0.05) augmented the reduced GSH (rGSH), lowered the GSSG, increased the total values of the glutathione disulfide (GSSG) and the rGSH, reduced the rGSH/GSSG ratio, and accelerated the glutathione peroxidase (GPx) activity, but they had high inhibitory effects on the glutathione reductase (GR). Accordingly, both drugs could maintain the balance between the OS markers, caused by general anesthesia. In general, KTP can be a suitable regimen in surgeries wherein analgesia is of importance for less than 24 h, but MLX can be a preferable option if longer analgesia is needed for more than 24 h.

Wide-Awake Hand Trauma Surgery: Designing Strategies to Optimise Patient Experience.

The regional hand trauma service in Greater Manchester, United Kingdom, underwent significant reorganisation early in the COVID-19 pandemic, with a shift from predominantly general anaesthesia (GA) procedures to the adoption of a Wide-Awake Local Anaesthetic No Tourniquet (WALANT) technique. We implemented strategies targeted towards optimising patient experience, largely applicable to most healthcare settings. Four domains were explored: (i) compliance in timing to nationally agreed treatment guidelines, (ii) the role of patient information leaflets, (iii) the introduction of a post-operative analgesia protocol, and (iv) broadly evaluating the environmental impact following the implementation of a same-day 'see and treat' service. Following reorganisation to a predominantly WALANT service, we observed an increase in compliance with nationally agreed standards for the treatment of common hand injuries. Patient education and peri-operative counselling reduced anxiety, whereas post-operative pain was better managed with the introduction of an analgesic protocol.Using a travel carbon calculator, it can be inferred that there are significant reductions in carbon emissions generated when patients are evaluated and treated on the same day as their clinical presentation. It is widely acknowledged that WALANT benefits patients and the healthcare system. We contemplated whether further incremental changes in clinical practice could further improve patient experience. Given our findings, we advocate a multi-modal approach with a greater focus on patient outcomes (trials are currently underway, e.g., WAFER) supplemented by universally accepted validated patient-reported outcome measures (PROMs).

Patterns of anatomical injury and anaesthesia procedures in wounded Ukrainian soldiers from Anti-Terrorist Operation/Operation Joint Forces: 2014–2021

IntroductionThe study aims to analyse the causes and anatomical patterns of explosive and gunshot wounds in Ukrainian soldiers acquired during the Anti-Terrorist Operation/Operation Joint Forces. We also investigated how general...

Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation

BackgroundRezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.MethodsWe propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.ResultsPreliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.ConclusionsWe demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.

Introducing and Studying the Materials and Methods of Anesthesia and Analgesia in Ancient Iran.

In ancient Iran, humans have been looking for ways to anesthetize, control, and reduce pain to perform surgeries to treat diseases, which is evident in ancient scientists' medical and nonmedical works. Although modern anesthesia expanded with the introduction of ether into this process, this great success was achieved after years of suffering and with the efforts of scientists throughout history who have played an essential role in advancing this knowledge. In ancient Iran, may (wine) was one of the materials of anesthesia, as in the Avesta, and Minooye Kherad, the properties of wine as an anesthetic are mentioned. Marijuana and Haoma were also used as other substances. The creation of a "hypnotic sponge" in ancient times made general anesthesia and many surgical procedures possible in subsequent centuries. In the history of medicine in Iran, various terms such as Mokhadir (anesthetic), Monavim (sedative), Mosabbit (hypnotic), and Mosakkin (pain relief) have been used to control pain. The purpose of this research was to introduce and study the materials and methods of anesthesia and analgesia in ancient Iran. The results show that anesthesia owes its early progress in part to the works of early Iranian practitioners.