General Anesthesia Procedures Research Articles

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.

Investigating the Effects of Fentanyl and Nitroglycerin on Hemodynamic Changes During Laryngoscopy: A Randomized Trial

Background: Laryngoscopy is the required procedures in general anesthesia that can cause cardiovascular disorders for the patient. Various pharmacological methods are used to reduce unwanted laryngoscopy responses. Objectives: The present study aimed to compare the effects of fentanyl and nitroglycerin spray on hemodynamic responses during laryngoscopy. Methods: In a clinical trial study, 40 patients were divided into two groups. In one group of patients, intravenous fentanyl (2 µg/kg) was given and in the other group, 2 puffs sublingually nitroglycerin spray was given in addition to receiving fentanyl. Hemodynamic variables were measured at one minute before and after laryngoscopy. The data was analyzed using SPSS version 19 software. Results: The study data showed that there is no statistically significant difference between the study groups in terms of demographics. Systolic and diastolic blood pressure, as well as heart rate decreased significantly in the group of receiving simultaneous fentanyl and nitroglycerin in comparison to the group receiving fentanyl alone. Conclusions: The results of our study showed that the administration of nitroglycerin spray with fentanyl more weakened the cardiovascular responses induced by laryngoscopy.

Antiemetics Commonly Prescribed in Children Undergoing Dental Treatment Under General Anaesthesia- A Retrospective Cohort Study

Background: Postoperative nausea and vomiting (PONV) are the most widely recognized unfavorable impact of pediatric anaesthesia and medical procedure Numerous antiemetic drugs are utilized for preventive treatment. They have different biochemical collaborations and inconveniences, yet there is still a weakness about which drugs are best with the least side effects. Aim: The aim of the current study is to find the antiemetics commonly prescribed in children undergoing dental procedures in general anaesthesia. Materials and Methods: The retrospective study was led in a private dental school, Chennai, India. Moral endorsement was obtained from the Institutional audit board before the beginning of the review. Information was gathered from DIAS (Dental Information Archiving Software) and the board framework records of the children under 18 years old who were treated under broad anaesthesia between September 2020 and February 2021 which was placed in the systemic way. A comfort test of 100 children going through dental treatment under general anaesthesia who were endorsed with antiemetics were remembered for the review. Information gathered with following boundaries like age, gender, antiemetics given. The classification of information was done in excel sheets and imported to SPSS. Results: Among 100 children treated under general anaesthesia, 56 were males and 44 were females. As a total count male were higher with a percentage of 56% when compared to females with 44%. 65% of ondansetron and 35% of metoclopramide antiemetic drugs were commonly prescribed in children undergoing dental treatment in general anaesthesia. Conclusion: There is high-certainty evidence that ondansetron drugs decrease vomiting, and moderate - assurance evidence that metoclopramide drugs probably reduce vomiting.

Diagnostika heterotopické žaludeční sliznice horního jícnu a její vliv na sliznici hrtanu

Introduction: Heterotopic gastric mucosa of the proximal esophagus (IP – inlet patch) is an islet of gastric mucosa close to the upper esophageal sfincter. Its cells may be able to produce acids and digestive enzymes. Methodology: Prospective study from 2020–2021 follows patients of groups A and B who underwent gastroduodenal endoscopic procedure or direct esophagoscopy in general anesthesia. In group C, patients with confirmed inlet patch underwent ENT videoendoscopic procedure to asses any laryngeal mucosa damage. Results: The prevalence of IP in our group was determined to be 4.87%. We diagnosed 40 IPs out of 821 examinations performed. Group C does not show any signs of laryngeal mucosal damage in patients with inlet patch. Conclusion: The prevalence of IP in the Nový Jičín region was 4.87%. In our study group, we didn’t find any significant laryngeal mucosal damage in patients with IP. t is necessary to think about IP in patients with laryngopharyngeal reflux without the effect of conservative therapy as a possible cause of difficulties. In the treatment of extraoesophageal reflux, which is difficult to influence with conservative therapy, it is advisable to supplement the gastrofibroscopic examination with a focus on the evidence of IP and its biopsy. Keywords: heterotopic gastric mucosa – inlet patch – GERD – extraesophageal reflux – rigid esophagoscopy

General Versus Nongeneral Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years.

Nongeneral anesthesia (non-GA) spine surgery is growing in popularity and has facilitated earlier postoperative recovery, reduced cost, and fewer complications compared with spine surgery under general anesthesia (GA). Changes in reimbursement policies have been demonstrated to correlate with clinical practice; however, they have yet to be studied for GA vs non-GA spine procedures. We aimed to investigate trends in physician reimbursement for GA vs non-GA spine surgery in the United States. We queried the ACS-NSQIP for GA and non-GA (regional, epidural, spinal, and anesthesia care/intravenous sedation) spine surgeries during 2011-2020. Work relative value units per operative hour (wRVUs/h) were retrieved for decompression or stabilization of the cervical, thoracic, and lumbar spine. Propensity score matching (1:1) was performed using all baseline variables. We included 474 706 patients who underwent spine decompression or stabilization procedures. GA was used in 472 248 operations, whereas 2458 operations were non-GA. The proportion of non-GA spine operations significantly increased during the study period. Operative times ( P < .001) and length of stays ( P < .001) were shorter in non-GA when compared with GA procedures. Non-GA lumbar procedures had significantly higher wRVUs/h when compared with the same procedures performed under GA (decompression; P < .001 and stabilization; P = .039). However, the same could not be said about cervicothoracic procedures. Lumbar decompression surgeries using non-GA witnessed significant yearly increase in wRVUs/h ( P < .01) contrary to GA ( P = .72). Physician reimbursement remained stable for procedures of the cervical or thoracic spine regardless of the anesthesia. Non-GA lumbar decompressions and stabilizations are associated with higher and increasing reimbursement trends (wRVUs/h) compared with those under GA. Reimbursement for cervical and thoracic surgeries was equal regardless of the type of anesthesia and being relatively stable during the study period. The adoption of a non-GA technique relative to the GA increased significantly during the study period.

1044 Feasibility of Anterior Abdominal Wall Hernia (Excluding Groin Hernia) Repair Under Local Anaesthetic

Abstract Aim Abdominal wall herniae (AWH) are usually performed under general anaesthetic, with limited literature on repair under local anaesthetic (LA). Local anaesthetic procedures may require higher surgical expertise which may compromise learning opportunities for trainees. We aim to explore the feasibility of performing AWH repairs under LA by evaluating patient satisfaction, impact on training opportunities and resource implications. Method Consecutive patients were counselled for AWH repair under LA and informed consent was obtained, with no exclusions based on BMI, type and size of the hernia. Surgery was performed by a trainee under supervision or a consultant. Ease of agreement to have surgery under LA, apprehension, pain and overall satisfaction with the procedure were assessed using a five-point Likert scale. Procedure duration and time to discharge were compared with the conventional general anesthetic procedures within the unit. Results Twenty patients underwent day-case AWH repair under LA. All patients agreed to surgery under LA. Nineteen (95%) patients reported no pain or apprehension during the procedure. Eighteen (90%) were happy or satisfied with the overall experience. Sixteen (80%) procedures were performed by a trainee. There was a median of 23 minutes less for theatre time and 62 min less for recovery time with LA. No postoperative problems were reported. Conclusions It is feasible to treat majority of abdominal wall herniae under LA, with high overall patient satisfaction, without compromising training opportunities. There are potential cost-savings by reduced theatre and recovery time utilization.

Anesthetic Approaches and Perioperative Complications of Total Hip Arthroplasty in Gaucher Disease: A Control-Matched Retrospective-Cohort Study.

Gaucher disease's (GD) pathophysiology generates anesthetic concerns in total hip joint arthroplasty (THA), and due to its rareness, data on perioperative risks are scarce. This 22-year study at a large reference center addresses anesthetic management and perioperative outcomes in GD. This retrospective-cohort study assessed anesthetic success and safety in 30 THA patients, comparing them with a control-matched group. Data on clinical characteristics, perioperative events, and outcomes were collected. The primary outcome was the success rate of anesthesia induction performance at first attempt. Secondary outcomes were difficult intraoperative course and hemodynamic management, and the development of postoperative complications. The age, sex, weight, body mass index, and primary-to-revision hip arthroplasty ratio were similar in both groups. There was no significant difference at all-type anesthesia first initiation attempt success. No particular preference by staff anesthetists for general anesthesia or neuraxial procedures was observed. The GD group showed a significantly higher mean of intraoperative packed Red Blood Cell units administered ((0.73 vs. 0.18); (p = 0.038)), higher intraoperative and postoperative platelet transfusion incidence ((5/30 [16.7%] vs. 0/56 [0.00%]; p = 0.004) and (3/30 [10%] vs. 0/56 [0%]; p = 0.040)), and longer mean recovery room length of stay (426 ± 412 vs. 175 ± 140; p = 0.004). Postoperative complications were not significantly different.

Analysis of the efficacy of subclinical doses of esketamine in combination with propofol in non-intubated general anesthesia procedures - a systematic review and meta-analysis

BackgroundThe number of non-intubated general anesthesia outside the operating room is growing as the increasing demand for comfort treatment. Non-intubated general anesthesia outside the operating room requires rapid onset of anesthesia, smoothness, quick recovery, and few postoperative complications. Traditional anesthetic regimens (propofol alone or propofol and opioids/dezocine/midazolam, etc.) have severe respiratory and circulatory depression and many systemic adverse effects. In this paper, we compare the effectiveness and safety of propofol and subclinical doses of esketamine with other traditional regimens applied to non-intubated general anesthesia through a systematic review and meta-analysis.MethodsWe searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and Sinomed databases for the period from January 2000 to October 2022. We rigorously screened the literature according to predefined inclusion and exclusion criteria, while risk assessment of the studies was performed using The Cochrane Collaboration’s tool, and statistical analysis of the data was performed using RevMan 5.4 software. The main outcome indicators we evaluated were the various hemodynamic parameters and incidence of various adverse effects between the experimental and control groups after induction of anesthesia.ResultsAfter a rigorous screening process, a total of 14 papers were included in the final meta-analysis. After risk bias assessment, three of the papers were judged as low risk and the others were judged as having moderate to high risk. Forest plots were drawn for a total of 16 indicators. Meta-analysis showed statistically significant differences in HR’ WMD 3.27 (0.66, 5.87), MAP’ WMD 9.68 (6.13, 13.24), SBP’ WMD 5.42 (2.11, 8.73), DBP’ WMD 4.02 (1.15, 6.88), propofol dose’ SMD -1.39 (-2.45, -0.33), hypotension’ RR 0.30 (0.20, 0.45), bradycardia’ RR 0.33 (0.14, 0.77), hypoxemia or apnea’ RR 0.45 (0.23, 0.89), injection pain’ RR 0.28 (0.13, 0.60), intraoperative choking’ RR 0.62 (0.50, 0.77), intraoperative body movements’ RR 0.48 (0.29, 0.81) and overall incidence of adverse reactions’ RR 0.52 (0.39, 0.70).The indicators that were not statistically different were time to wake up’ WMD − 0.55 (-1.29, 0.19), nausea and vomiting 0.84’ RR (0.43, 1.67), headache and dizziness’ RR 1.57 (0.98, 2.50) and neuropsychiatric reaction’ RR 1.05 (0.28, 3.93). The funnel plot showed that the vast majority of studies fell within the funnel interval, but the symmetry was relatively poor.ConclusionIn non-intubated general anesthesia, the combination of subclinical doses of esketamine and propofol did reduce circulatory and respiratory depression, injection pain, and other adverse effects, while the incidence of esketamine’s own side effects such as neuropsychiatric reactions did not increase, and the combination of the two did not cause the occurrence of new and more serious adverse reactions, and the combination of the two was safe and effective.Trial registrationPROSPREO registration number: CRD 42022368966.

An independent audit of electroconvulsive therapy patient information leaflets in Northern Ireland, Scotland and Wales.

To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent. To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40-item accuracy measure used in the England audit. The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long-term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the 'most effective treatment' and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives. Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits.

Переваги тангенціального висічення з одночасною аутодерматопластикою для лікування опікових ран

Burn trauma remains an important health problem, among which thermal burns of the limbs are one of the most common and complex due to the need to restore limb function and reduce aesthetic defects. Early tangential excision with simultaneous autodermoplasty is a complex technique that is also a significant stress for the patient, but it allows achieving all the set goals. Purpose - to evaluate the effectiveness of tangential excision with simultaneous autodermoplasty for treating burn wounds compared to the classical method of treatment. Materials and methods. The study included 24 patients with burns of the upper and/or lower limbs, from which two groups were formed: an experimental group (12 patients) and a control group (12 patients) who were equal in terms of patient sex, age, etiology of burn wounds, affected area. Tangential excision with simultaneous autodermoplasty was applied to patients in the experimental group, while delayed sequential necrectomy, xenoplasty (if necessary), and delayed autodermoplasty were performed on patients in the control group. Results. Patients in the experimental group stayed in the hospital for an average of 10.5±4.5 days, which was almost half as long as in the control group (20.2±3.5 days). The number of surgical interventions in the experimental group was 1.3±0.5 operations, while in the control group it was 2.7±0.8 operations, and the number of general anesthesia procedures in the experimental group was significantly lower (1.3±0.5) than in the control group (4.6±1.1; p&lt;0.05). In the experimental group, the number of dressings for each injury was 4.3±1.6, while in the control group it was almost three times as many (12.7±3.0; p&lt;0.05). The duration of healing of burn wounds in the experimental group was 13.3±4.3 days, which was shorter than in the control group (24.2±3.9 days; p&lt;0.05). The prevalence rate of infectious complications in the experimental group was 21.1% (4 cases), while in the control group it was significantly higher (58.8%). However, the prevalence rate of other complications, such as lysis of skin grafts, was only slightly lower in the experimental group (15.8%, or 3 cases) compared to the control group (29.4%, or 5 cases). 2 (18.2%) burn wounds in the experimental group required secondary reconstruction, while in the control group, 7 (70.0%) wounds required it. Conclusions. Treatment of burn wounds of the upper and/or lower limbs using the method of tangential excision with simultaneous autodermoplasty allows for a reduction in the length of hospital stay, a decrease in the number of surgical interventions, general anesthesia procedures, dressing changes, and ensures faster wound healing, as well as reduces the frequency of complications and the need for secondary reconstruction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Risk factors for postoperative hypoxemia during transport to the postanesthesia care unit and influence of transport monitoring : A retrospective propensity score-matched databank analysis

Within acentral operating room area, after general anesthesia (GA) patients are at risk of hypoxemia during transport to the postanesthesia care unit (PACU); however, specific risk factors have not been conclusively clarified and uniform recommendations for monitoring vital signs during transport within acentral operating room area complex do not exist. The purpose of this retrospective database analysis was to identify risk factors for hypoxemia during this transport and to determine whether the use of transport monitoring (TM) affects the initial value of peripheral venous oxygen saturation (SpO2) in the PACU. This analysis was performed on aretrospectively extracted dataset of procedures in GA within acentral operating room area of atertiary care hospital from 2015 to 2020. The emergence from GA was conducted in the operating room with subsequent transport to the PACU. The transport distance was between 31and 72m. Risk factors for initial hypoxemia in the PACU, defined as peripheral oxygen saturation (SpO2) below 90%, were determined using multivariate analysis. After splitting the dataset into patients without TM (group OM) and with TM (group MM) and propensity score matching, the influence of TM on initial SpO2 and the Aldrete score after arrival in the PACU were examined. From atotal of 22,638 complete datasets included in the analysis, 8 risk factors for initial hypoxemia in PACU were identified: age > 65years, body mass index (BMI) > 30 kg/m2, chronic obstructive pulmonary disease (COPD), intraoperative airway driving pressure (∆p) > 15 mbar and positive endexpiratory pressure (PEEP) > 5 mbar, intraoperative administration of along-acting opioids, first preoperative SpO2 < 97%, and last SpO2 < 97% measured after emergence from anesthesia before transport. At least 1 risk factor for postoperative hypoxemia was present in 90% of all patients. After propensity score matching, 3362 datasets per group remained for analysis of the influence of TM. Patients transported with TM revealed ahigher SpO2 at PACU arrival (MM 97% [94; 99%], OM 96% [94; 99%], p < 0.001). In a subgroup analysis, this difference between groups remained in the presence of one or more risk factors (MM 97% [94; 99%], OM 96% [94; 98%], p < 0.001, n = 6044) but was not detectable in the absence of risk factors for hypoxemia (MM 97% [97; 100%], OM 99% [97; 100%], p < 0.393, n = 680). Furthermore, the goal of an Aldrete score > 8 at PACU arrival was achieved significantly more often in monitored patients (MM 2830 [83%], OM: 2665 [81%], p = 0.004). Critical hypoxemia (SpO2 < 90%) at PACU arrival had an overall low occurrence within propensity matched datasets and showed no difference between groups (MM: 161 [5%], OM 150 [5%], p = 0.755). According to these results, consistent use of TM leads to ahigher SpO2 and Aldrete score at PACU arrival, even after a short transport distance within an operating room area. Consequently, it appears to be reasonable to avoid unmonitored transport after general anesthesia, even for short distances.

Ureteral stent extraction strings in children: Stratifying the risk of post operative urinary tract infection

Ureteral stents facilitate recovery and avoid external drains in pediatric ureteral reconstruction. Extraction strings avoid the need for a secondary cystoscopy and anesthetic. Due to concerns regarding febrile UTIs in children with extraction strings, we retrospectively assessed the relative risk of UTI in children with extraction strings. Our hypothesis was that stents with extraction strings do not increase the risk of UTI after pediatric ureteral reconstruction. Records of all children undergoing pyeloplasty and ureteroureterostomy (UU) from 2014 to 2021 were reviewed. The incidences of UTI, fever, and hospitalization were recorded. 245 patients mean age 6.4 years (163M:82F) underwent pyeloplasty (n=221) or UU (n=24). 42% (n=103) received prophylaxis. Of these, 15% developed UTI versus 5% of those not receiving prophylaxis (p<0.05). 42 females had prior history of UTI, compared to 20 males (p<0.05). 49 patients had an extraction string. Stents with extraction strings were removed on average 0.6 months post-op while others underwent cystoscopic removal on average 1.26 months post-op (p<0.05). 9 (18.4%) required hospitalization for febrile UTI while the stent with extraction string was in place, while only 13 (6.6%) of those without extraction string did (p<0.02). Of the 9 children with a febrile UTI in the extraction string group, 6 had history of prior UTI (46.1%), compared to only 3 (8.3%) without a prior UTI (p<0.05). With no prior UTI, there was no difference in UTI risk between those with (3, 8.3%) and without (8, 6.4%) extraction string (p=0.71). Females with prior UTI and extraction string were more likely to develop UTI than those with prior UTI and no extraction string (p=0.01). There were not enough males with history of UTI to analyze alone. There were 5 (10%) stent dislodgements in the extraction string group, 2 required further intervention with cystoscopy or percutaneous drainage. Extraction strings provide the assurance of drainage while avoiding the need for a second general anesthetic procedure. There is not an increased risk of UTI with extraction string in those without prior history of UTI, but we no longer routinely leave extraction strings if there is history of UTI. Children, particularly females, with prior history of UTI have a significantly increased risk of febrile UTIs associated with the use of extraction strings. Prophylaxis does not seem to reduce this risk. Patients with no prior UTI had no higher risk of UTI with extraction string use for pyeloplasty or UU.

Developing and centralising a nurse-led local anaesthetic transperineal biopsy service during COVID.

Transperineal (TP) biopsy has recently replaced the transrectal ultrasound (TRUS) approach as the ideal method of biopsy in the United Kingdom with growing trends to adopt. To minimise transmission of COVID-19 during the first wave of the pandemic, the British Association of Urological Surgeons Section of Oncology issued guidelines reducing general anaesthesia (GA) procedures and initiate COVID-secure 'green' site diagnostics. As a result of these guidelines and reduction in clinical diagnostics trust-wide, we ceased all TRUS diagnostics and implemented a centralised, nurse-led LA TP biopsy service. A waiting list was developed for those awaiting prostate cancer diagnostics across the network. A COVID-secure 'green' site was quickly identified with TP biopsies starting soon after. Quality improvement methodology was utilised and a run chart was used to show if changes were sustainable. Successful implementation and centralisation of a TP biopsy service occurred with TRUS guided biopsies ceasing across all sites on 12 May 2020. The procedures were carried out by urology advanced nurse practitioners under local anaesthesia with a select few occurring under GA. Centralising the service in a COVID-secure manner freed up dedicated theatre sessions and personal leading to increased efficiency elsewhere. The service was robust and was maintained upon lifting of COVID restrictions. A centralised, nurse led LA TP biopsy service in a procedural unit was implemented successfully. The service has remained resilient upon lifting of restrictions and return to business as usual. This led to improved performance across trust by freeing up valuable resources and staff to undertake more duties. The service remains highly valued trust-wide.

Multiple General Anesthesia in Children: A Systematic Review of Its Effect on Neurodevelopment.

The effect of multiple general anesthesia (mGA) procedures administered in early life is a critical theme and has led the Food and Drug Administration (FDA) to issue an alert. This systematic review seeks to explore the potential effects on neurodevelopment of mGA on patients under 4 years. The Medline, Embase and Web of Science databases were searched for publications up to 31 March 2021. The databases were searched for publications regarding "children multiple general anesthesia OR pediatric multiple general anesthesia". Case reports, animal studies and expert opinions were excluded. Systematic reviews were not included, but they were screened to identify any possible additional information. A total of 3156 studies were identified. After removing the duplicates, screening the remaining records and analyzing the systematic reviews' bibliography, 10 studies were considered suitable for inclusion. Comprehensively, a total cohort of 264.759 unexposed children and 11.027 exposed children were assessed for neurodevelopmental outcomes. Only one paper did not find any statistically significant difference between exposed and unexposed children in terms of neurodevelopmental alterations. Controlled studies on mGA administered before 4 years of age support that there might be a greater risk of neurodevelopmental delay in children receiving mGA, warranting the need for careful risk/benefit considerations.

Investigating the scope and costs of dental treatment provided under general anaesthesia among children with congenital heart disease.

To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost. A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures. Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason. Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.

EVALUATION OF LAPAROTOMY SURGERY WOUND HEALING IN DOGS USING THERMOGRAPHIC ANALYSIS

This study aimed to develop the use of thermographic analysis to evaluate wound healing for laparotomy surgery in animals. The experiment used nine adult dogs 5 males and 4 females, bodyweight 5-10 kg) that had undergone the same general anesthesia and laparotomy procedures. Evaluation of wound healing was performed at 24, 48, and 72 hours after surgery and 7 days after operations using a digital thermal camera. During each thermographic evaluation period, blood samples were taken for analysis of total leukocytes and leukocyte differential. The results of thermal imaging were compared with the values of inflammatory cells and the clinical condition of wound healing. Comparison of thermographic analysis with inflammatory status was evaluated using the regression equation and showed a strong correlation coefficient (Y= -0.4847 + 40.14, R2= 0.867), that is, the higher the temperature, the lower the inflammation. The conclusion of study is that thermographic analysis can be used to evaluate wound healing of laparotomy surgery in dogs.

Price analysis of medicines used in general anesthesia before and after the SARS-CoV-2 pandemic: a retrospective observational study

Objectives: with the emergence of the pandemic in early 2020, there was an increase in the prices of medicines used in hospital anesthetic procedures. The main objective of this study was to assess the variations in prices of anesthetics used in general anesthesia procedures between the periods prior to and after the beginning of the SARS-CoV-2 pandemic. Methods: we investigated 105 anesthesic records of exploratory laparotomies or laparoscopic procedures performed in a private hospital in southern Brazil and analyzed the prices of medicines used in two general anesthesia techniques: total intravenous anesthesia (TIVA) and balanced anesthesia with anesthetic gases. We obtained the price of anesthetic procedures from records issued in the final trimesters of 2019, 2020, and 2021 (33, 43, and 29, respectively). Results: a statistically significant difference in prices was seen between periods for both techniques. The price of TIVA in 2019 was R$ 229.30/hour, in 2020 it was R$ 472.13/hour, and in 2021 it was R$ 247.38/hour. For balanced anesthesia, this price was R$ 66.32/hour in 2019, R$ 109.97/hour in 2020, and R$ 90.30/hour in 2021. In a post hoc analysis, significant differences were observed in the hourly prices of TIVA between 2019–2020 (p=0.01) and 2020–2021 (p=0.04); for balanced anesthesia, this was seen only in the 2019–2020 period (p=0.02). Conclusion: this study demonstrated significant increases in the mean prices of general anesthesia administered via intravenous (up to 36.36%) or inhalation (up to 89.47%) routes for exploratory laparotomies performed before and after the beginning of the SARS-CoV-2 pandemic in a private hospital in southern Brazil. However, no statistical difference in the hourly prices was observed between 2019 and 2021 for both anesthetic techniques.

Comparison of the effects of TIVA and inhalation anesthetic techniques on olfactory functions and olfactory memory: a randomized prospective study

Purpose: This study aimed to investigate the effects of different general anesthesia procedures on postoperative olfactory functions and olfactory memory.&#x0D; Materials and Methods: This prospective study was conducted with 97 patients. Patients were divided into three groups based on anesthesia induction and maintenance technique: Group P (induction and maintenance with propofol), Group PS (induction with propofol, maintenance with sevoflurane), and Group S (induction with sevoflurane, maintenance with sevoflurane). Butanol threshold and olfactory identification tests were administered 30 minutes (min) before the operation (T1) and 30 min (T2), 8 hours (h) (T3) and 24 h (T4) after the operation.&#x0D; Results: Butanol threshold values were increased at the T2 time point compared to baseline in all groups, which returned to baseline values at T3 only in Group P. There was a significant difference between Group P and Group S in terms of butanol threshold values at all time points except T1. When olfactory identification increased at T3 and T4 compared to baseline in Group P, there was a significant difference between T2, T3, and T4 time points in Group S, and between T2 and T3 time points in Group PS as compared to Group P.&#x0D; Conclusion: Propofol only causes a temporary impairment in olfactory functions in the early period and does not alter olfactory memory.