Quality Of Anesthesia Research Articles

Regional versus systemic dexmedetomidine as an adjuvant to lidocaine for intravenous regional anaesthesia in healthy volunteers: a randomized crossover study

Background Dexmedetomidine enhances the quality and duration of lidocaine intravenous regional anaesthesia (IVRA). However, the two administration routes have not been directly compared regarding effects on tourniquet tolerance time with lidocaine IVRA. Additionally, it remains unclear whether the prolonged tourniquet tolerance stems from the direct peripheral action of dexmedetomidine or indirect systemic analgesic effects. Methods We conducted forearm IVRA in 12 healthy volunteers using a crossover design on two separate study days. One day, the systemic dexmedetomidine group received an intravenous infusion of 0.5 μg/kg dexmedetomidine (20 mL) in one arm, followed by 0.5% lidocaine (25 mL) forearm IVRA in the contralateral arm. On the other day, the regional dexmedetomidine group received an intravenous 0.9% saline infusion (20 mL) in one arm, followed by combined 0.5% lidocaine (25 mL) and 0.5 μg/kg dexmedetomidine forearm IVRA in the opposite arm. After a two-week washout period, participants crossed over to receive the alternate treatment. The primary outcome was tourniquet tolerance time, from initiating IVRA until the patient-reported tourniquet pain numerical rating scale exceeded three. Results The tourniquet tolerance time was longer with regional versus systemic dexmedetomidine (36.9 ± 7.6 min vs 23.3 ± 6.2 min, respectively), with a 13.6 min mean difference (95% CI: 10.8 to 16.4 min, p < 0.001). Regional dexmedetomidine also hastened sensory onset and extended sensory recovery compared to systemic administration. Delayed sedation after tourniquet release occurred in 5 of 12 subjects receiving regional dexmedetomidine. Conclusion The addition of regional dexmedetomidine to lidocaine prolonged tourniquet tolerance time in forearm IVRA to a greater extent compared to systemic dexmedetomidine in healthy volunteers. Trial registration Chinese Clinical Trial Registry, ChiCTR2300067978.

Pharmacokinetics of dexmedetomidine in anaesthetized horses following repeated subcutaneous administration and intravenous constant rate infusion

BackgroundThe inclusion of dexmedetomidine (DEX) within a balanced general anaesthesia protocol is effective in improving the clinical outcome and recovery quality of anaesthesia in horses. This study aimed to determine the pharmacokinetic profile of DEX following repeated subcutaneous (SC) administration at 2 µg/kg every 60 min till the end of the procedure in comparison to intravenous constant rate infusion (CRI) at 1 µg/kg/h in anaesthetized horses undergoing diagnostic procedures up to the end of the diagnostic procedure.ResultsIn the CRI and SC groups DEX maximum concentrations (Cmax) were 0.83 ± 0.27 ng/mL and 1.14 ± 0.71 ng/mL, respectively, reached at a time (Tmax) of 57.0 ± 13.4 min and 105.5 ± 29.9 min. Mean residence time to the last measurable concentration (MRTlast) was 11.7 ± 6.2 and 55.8 ± 19.7 min for the CRI group and SC groups, respectively. The apparent elimination half-life was 18.0 ± 10.0 min in the CRI group and 94.8 ± 69.8 min for the SC group, whereas the area under the curve (AUC0-last) resulted 67.7 ± 29.3 and 83.2 ± 60.5 min*ng/mL for CRI and SC group, respectively. Clearance was 16.26 ± 8.07 mL/min/kg for the CRI group. No signs of adverse effects were recorded in both groups.ConclusionsThe pharmacokinetic profile of DEX following repeated SC administration in anaesthetized horses was comparable to intravenous CRI administration during the intranaesthetic period and beneficial during the recovery phase from general anaesthesia. The SC route could be considered as an alternative to CRI for improving the recovery quality of equine patients undergoing general anaesthesia.

Effect of Intrathecal versus Intravenous Dexamethasone on Quality of Spinal Anesthesia in Lower Limb Orthopedic Surgery

Effect of Intrathecal versus Intravenous Dexamethasone on Quality of Spinal Anesthesia in Lower Limb Orthopedic Surgery

Electrocardiographic, clinical and haematological evaluation of propofol and xylazine-ketamine anaesthesia in Goat

Limited information is available to ascertain the quality of intravenous anaesthetic regime predominantly practised in goats for short term surgical interventions. Clinical, electrocardiographic and haematological studies were conducted on twelve female Barbari crossbred goats, aged 2–4 years to assess the anaesthetic quality of propofol and xylazine-ketamine combination. Onset, duration and recovery from anaesthesia, clinical parameters (rectal temperature, pulse and respiratory rates), electrocardiography (ECG) and oxyhemoglobin (HbO2) saturation were assessed at 0, 10, 60, 120 min and haematological parameters at 0, 60, 180 min after propofol (4 mg/kg) and xylazine (0.05 mg/kg)-ketamine (4 mg/kg) were administered intravenously. Clinical and haematological parameters except lymphocyte count decreased. With stable plane of propofol anaesthesia, ECG amplitudes and heart rate increased while ECG intervals decreased. After ketamine induction, P wave amplitude, ECG intervals increased whereas R wave amplitude, heart rate decreased. Rectal temperature and pulse rate were better maintained in goats receiving propofol anaesthesia. Xylazine-ketamine exerted subtle deviation from pre-anaesthetic cardiovascular, respiratory, haematological parameters

Effects of different anesthetic depths monitored by processed EEG analysis on glandular secretion in patients undergoing laparoscopic total hysterectomy

BackgroundThe objective of this study was to find ways to reduce intraoperative glandular secretion in patients by observing the effects of different depths of anesthesia on glandular secretion under Narcotrend monitoring (NT), to reduce the use of unnecessary anticholinergic drugs, and to improve the quality of anesthesia and patient comfort.MethodsNinety patients who underwent total laparoscopic hysterectomy were randomly divided into three groups. Group L: intraoperative maintenance of anesthesia depth D0–D2, group M: intraoperative maintenance of anesthesia depth E0–E1, group H: long tocopherol 0.01 mg/kg was administered intravenously 10 min before surgery without monitoring the depth of anesthesia, and the mean arterial pressure (MAP), heart rate (HR), and adverse effects were compared in each group at six time points. The salivary secretion and respiratory gland secretion were compared among the groups.ResultsSalivary secretion under general anesthesia decreased in all three groups compared with the basal value (P &amp;lt; 0.05), with the smallest decrease in group L (P &amp;lt; 0.05) and the largest decrease in group H (P &amp;lt; 0.001). The amount of respiratory gland secretion during the whole operation was from more to less in the order of group L, group M and group H. The dry mouth visual analogue scale (VAS) scores were lower in groups L and M than in group H (P &amp;lt; 0.05).ConclusionGeneral anesthesia suppresses the patient's glandular secretion, and the suppression becomes more pronounced as the anesthesia deepens. Maintaining the depth of anesthesia E0–E1 can effectively reduce the patient's glandular secretion, more stable intraoperative vital signs, and more comfortable patient awakening period without increasing the incidence of adverse reactions.Chinese Clinical Trial Registryhttp://www.chictr.org.cn/showproj.aspx?proj=147905, identifier ChiCTR2200055422.

Effect of dexmedetomidine on convalescence quality after general anesthesia and postoperative delirium, and on cognitive function in elderly patients undergoing lower limb surgery

Purpose: To investigate the effect of different doses of dexmedetomidine on the quality of postoperative recovery, incidence of postoperative delirium, and cognitive function in elderly patients undergoing lower limb surgery.&#x0D; Methods: A total of 112 patients who received treatment in the Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Hothot, China from January 2021 to January 2023 were divided into 3 groups, consisting of low-dose group (35 patients received 0.2 mg/kg), medium-dose group (39 patients received 0.4 mg/kg), and high-dose group (38 patients received 0.6 mg/kg). Parameters including, convalescence quality of general anesthesia, incidence of postoperative delirium, adverse reactions, Mini- mental State Examination (MMSE) scores, sedation effect (Ramsay), analgesia effect (visual analogue scale (VAS)), and stress indices, viz, norepinephrine (NE), epinephrine (E), and cortisol (COR) levels), were evaluated and compared.&#x0D; Results: There was no significant difference in tracheal extubation time, recovery time of spontaneous breathing, calling eye-opening time, or full awakening time among the three groups (p &gt; 0.05). However, MMSE score was significantly higher in low-dose group on days 1 and 3 after surgery (p &lt; 0.05) and VAS scores were significantly higher in low-dose group at 12 and 24 h after recovery compared to other groups (p &lt; 0.05). Ramsay score was significantly higher in high-dose group (p &lt; 0.05). Levels of NE, E, and COR were significantly lower in medium-dose group compared to other groups (p &lt; 0.05). Incidence of adverse reactions were significantly lower in low and medium-dose groups compared to high- dose group (p &lt; 0.05).&#x0D; Conclusion: Medium-dose dexmedetomidine demonstrates favorable sedative and analgesic effects with minimal impact on cognitive function and stress response in elderly patients undergoing lower limb surgery. Furthermore, it does not affect quality of postoperative recovery nor incidence of postoperative delirium. More large-scale, randomized controlled studies are needed to confirm these results.

Is Epidural technique using bupivacaine associated with morphine in a bitch submitted to ovariohysterectomy and excisional biopsy of a nodule in the vulva: Case report

Locoregional techniques are considered an increment for general anesthesia, since they promote efficient analgesia in the intraoperative period, resulting in a decrease in the dose of general anesthetics utilized, and of analgesic rescue in the postoperative period. This report aims to evaluate the effects of an anesthetic protocol, aiming to observe the physiological variables, duration and quality of anesthesia, in a bitch submitted to ovariohysterectomy and excisional biopsy of a nodule in the vulva, with acepromazine and methadone as premedication, propofol as the anesthesia inducing agent combined with epidural associations of bupivacaine-morphine. The patient was seen at the Veterinary Hospital with complaints of a nodule in the vulvar region with evolution of growth for 1 year. The patient was then referred to the surgery department for ovariohysterectomy and excisional biopsy of the nodule in the vulvar region. Therefore, it is concluded that the technique that uses morphine associated with bupivacaine is recommended for ovariohysterectomy and soft tissue surgery, as it presents nociceptive blockade, relaxation, and results in greater comfort for the animal during the trans- and post-operative periods.

A comparative study of intrathecal levobupivacaine-clonidine and bupivacaine in the quality of anesthesia for patients undergoing hernioplasty

Background: Bupivacaine is most commonly used amino-amide drug for subarachnoid block in hernioplasty. Levobupivacaine has similar pharmacological activity to that of bupivacaine with minimal cardiotoxicity. Clonidine, an α2 adrenergic agonist, potentiates the action of local anesthetics when used intrathecally and enhances post-operative analgesia. Aims and Objectives: This prospective, comparative, observational study was aimed to compare the effects of 0.5% levobupivacaine with clonidine and 0.5% hyperbaric bupivacaine in patients undergoing hernioplasty for the quality of surgical anesthesia and hemodynamic changes with any significant intraoperative complications. Materials and Methods: After receiving approval from the institutional ethics committee and written informed consent, 80 male patients aged between 18 and 60 years, BMI &lt;30 kg/m2, height&gt;150 cm, and American society of anesthesiologists physical status1 and 2 posted for elective hernioplasty were enrolled into two equal groups of 40 patients, group LC and group B. Patients in group LC received 15 mg 0.5% isobaric levobupivacaine with 30 μg clonidine and patients in group B received 15 mg hyperbaric bupivacaine intrathecally. SPSS version 20 was used for analysis, and P&lt;0.05 was considered statistically significant. Results: In group LC, onsets of both sensory and motor blocks were delayed, whereas durations of motor and sensory block with analgesia were longer. Tachycardia, hypotension, nausea, vomiting, and shivering were observed greater in numbers in group B, whereas incidence of bradycardia was more in group LC. Conclusion: Prolonged duration of sensory and motor block, prolonged analgesic effect, and hemodynamic stability without any significant adverse effects may make this combination a better alternative to hyperbaric bupivacaine for hernioplasty.

COURSE OF INHALATION ANAESTHESIA WITH SEVOFLURANE DURING SURGICAL TREATMENT OF PATIENTS WITH MALIGNANT LUNG TUMOURS

Abstract. Aim. Study of the effect of pain intensity on the energy efficiency of blood circulation in patients with lung malignancies after operations under anesthesia using sevoflurane.&#x0D; Materials and methods. 29 patients with malignant lung formations have been examined, who underwent open surgical interventions on the volume of lob- or pneumonectomy or resection of part of the lung. The average age of the examined patients was (55±5.6) years, among them men – 17, women – 12. Pain intensity, perfusion systemic pressure, cardiac index, blood flow power, arteriovenous difference in oxygen content, blood lactate concentration, oxygen reserve, circulatory reserve have been determined. These indicators have been determined in four stages: 1) before the operation; 2) awakening; 3) the first day after surgery; 4) the fifth day after surgery.&#x0D; Results and their discussion. The intensity of pain determined by the visual analog scale (VAS) was maximum on the 1st day after surgery (4.8±0.8 points), and on the 5th day it returned to the level of the awakening stage. Analgesia was performed with morphine (0.27±0.04 mg/kg on the 1st day) and infusion of infulgan at a dose of 1 g 3 times a day. The circulatory reserve was minimal at the stage of awakening and on the 1st day after surgery (from (381±66) to (390±71) mW/m2), on the 5th day it reached the preoperative level (448±82 mW/m2). Separate indicators of blood circulation do not have a strong dependence on the level of pain that was determined by VAS, but indicators of the energy component of circulation are closely related to the severity of pain.&#x0D; Conclusions. The maximum severity of pain in patients with malignant lung formations operated under inhaled anesthesia with sevoflurane is observed on the first day after surgery. Different indicators of hemodynamics and oxygen transport are associated with the intensity of pain measured by VAS with different strengths, which makes it impossible to evaluate the effectiveness of anesthesia. Indicators of circulatory energy efficiency are closely related to the intensity of pain measured using VAS, which proves the value of using monitoring of circulatory energy indicators in assessing the quality of anesthesia.

Role of erector spinae plane block in transjugular intrahepatic portosystemic shunt procedure: A randomized controlled trial

ABSTRACT Background Anesthesia for transjugular intrahepatic portosystemic shunt (TIPS) for lowering raised portal pressure is clinically challenging. As patients, candidates for TIPS are medically complex due to chronic liver disease, adding to remote area anesthesia’s complexities. Multimodal analgesia, including erector spinae plane block (ESPB), can improve anesthesia quality with patient satisfaction. Methods Fifty-six patients scheduled for TIPS, aged 18–60 years and with Child classification A or B, were randomly allocated into two groups. The ESPB group experienced ESPB (n = 24), while the control group was introduced with sedation spontaneously breathing (n = 24). Primarily, we investigated the records of the hemodynamic profile and analgesia nociceptive index (ANI). As a secondary aim, we recorded the opioid consumption, complication incidence, and patient and interventional radiologist satisfaction scores. Results Heart rate was significantly lower in the ESPB group at the beginning of the procedure, liver puncture, and balloon dilatation events, while there were no significant differences in mean blood pressure. Analgesia assessment by ANI was significantly higher in the ESPB group indicating adequate analgesia. Opioid consumption was significantly lower in the ESPB group than in the control group. Statistical analysis for patient satisfaction showed better results in the ESPB group, while the surgeon satisfaction score showed no significant statistical differences. Conclusion ESPB could be recommended as an alternative to analgesia in TIPS and its vulnerable patients to improve safety by reducing sedation-related morbidity and complications with improving the patient’s degree of satisfaction.

Intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during cesarean section: a prospective, double-blinded, randomized trial for ED50 determination using an up-down sequential allocation method

BackgroundIntrathecal dexmedetomidine, as an adjuvant to local anesthetics, has been reported to improve the quality of spinal anesthesia and reduce the required local anesthetic dose. However, the optimal dosage regimen for intrathecal dexmedetomidine combined with plain ropivacaine for cesarean section (CS) remains undetermined. The present study aimed to determine the median effective dose (ED50) of intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during CS.MethodsSixty parturients undergoing CS were randomly assigned to either group: plain ropivacaine 8 mg (Group Rop8) or plain ropivacaine 10 mg (Group Rop10). The initial dosage of intrathecal dexmedetomidine in each group was 5 µg. The effective dose was defined as a bilateral sensory block at the level of T6 or above to pinprick attained within 10 min after intrathecal injection, without the need for supplementary intraoperative epidural anesthesia. Effective or ineffective responses were determined, followed by a 1 µg increment or decrement in the dose of intrathecal dexmedetomidine for the next parturient using up-down sequential allocation. ED50 were calculated using probit regression.ResultsThe ED50 of intrathecal dexmedetomidine with plain ropivacaine was 5.9 µg (95% confidence interval [CI], 4.9–7.4 µg) in Group Rop8 and 3.1 µg (95% CI, 0.1–4.8 µg) in Group Rop10 (P < 0.05). Hemodynamic stability, side effects, patient satisfaction and neonatal outcomes were comparable between the two groups.ConclusionsThe present data suggested that the ED50 of intrathecal dexmedetomidine as an adjuvant to 8 mg and 10 mg plain ropivacaine in spinal anesthesia during cesarean section was approximately 6 µg and 3 µg, respectively.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2200055928.

Scale up of anaesthesia services in underserved rural Tanzania

BackgroundBecause of critical shortage of physician anaesthesiologists, the government of Tanzania adopted a task shifting strategy for provision of anaesthesia services. This paper describes the results of an operational study designed to increase the number of anaesthesia providers for emergency obstetric surgeries in order to reduce maternal and perinatal mortality in underserved rural Tanzania.MethodsIn 2016 a before-after cohort study was conducted in seven health centres in rural Tanzania. Five health centres received an intervention and two were selected to track secular trends (control group). Ten associate clinicians, i.e. assistant medical officers, clinical officers, and nurse midwives, from five health centres were trained in anaesthesia skills for emergency obstetric surgeries for three months followed by quarterly supportive supervision, mentoring and teleconsultation to reinforce skills. Primary and secondary outcome measures included Caesarean delivery (CD) rate, quality and safety of anaesthesia, and uptake of the educational program for anaesthesia.ResultsOut of the 2,179 CDs performed in the intervention facilities from 2016 to 2019, two women died from complications of anaesthesia. The risk of death from anaesthetic complications was 0.9 per 1000 CD (95% CI 0.1–3.3. The risk of death was not established in the control group because of inadequate documentation and records keeping. The proportion of CD performed under spinal anaesthesia in intervention facilities doubled from 28% (60/214 with 95% CI 22–35) at baseline (July 2014 – June 2016) to 57% (558/971 with 95% CI of 54–61) in year three (July 2018 - June 2019), while in the control group increased by only 40% from 19% (92/475 with 95% CI of 16–23) at baseline and 27% (68/251 with 95% CI of 22–33) in year three. In 2020I, this educational training program was then adopted by the government with minor content changes and increasing duration of training to six months.ConclusionsThis three month educational training program for associate clinicians in anaesthesia, complemented by supportive supervision, can increase the CD rate to one that fills the “unmet need” and the proportion of operations performed under spinal anaesthesia, the gold standard technique for CD. The program can be used to meet the urgent demand for anaesthesia services in other underserved areas in Africa.

Study of Dexmedetomidine as an Adjuvant to Bupivacaine- Lignocaine with Adrenaline in Supraclavicular Brachial Plexusblock

Supraclavicular brachial plexus block is a very popular mode of anesthesia for various upper limb surgeries, as it is easiest and most effective and has good post-operative analgesia. It is carried out at the level of trunks i.e7 at the middle of brachial plexus, resulting in homogenou spread of anesthetic agent throughout the plexus with a fast onset and complete block action.9 Dexmedetomidine, is potent, highly selective α2-adrenoceptor agonist, has been used as an adjuvant during regional and local anesthesia because of rapid onset of action and relatively short half-life up to 2 hours. Objective of Study: To compare the effects of addition of Dexmedetomidine to Bupivacaine- Lignocaine with Adrenaline combination for Supraclavicular brachial plexus block with regards to onset and duration of sensory block, motor block. Quality of anesthesia, analgesia and Adverse reactions if any after taking written informed consent. Observations: Onset of sensory as well as motor blockade in Dexmedetomidine group was earlier when compared to plain bupivacaine-lignocaine adrenalin group. The duration of sensory and motor blockade was significantly increased (p&lt;0.05) in Dexmedetomidine group when compared to another group. With respect to hemodynamic parameters Dexmedetomidine group provided a higher Degree of cardiovascular stability with a lesser incidence of hypotension. Result: There is earlier onset of action and longer duration of sensory; Motor block and Duration of analgesia (sensory block) was prolonged in dexmedetomidine group. Hence it is advisable to add dexmedetomidine as an adjuvant to local anesthetic combinations during supraclavicular block for prolonged anesthesia and to provide better analgesia

Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study.

The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry. In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods. We found a statistically significant reduction in total episode (-$719; 95% CI [-$1340 to -$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (-$354; 95% CI [-$582 to -$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (-$860; 95% CI [-$1222 to -$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results. Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.

Incidence of dreaming and subjective quality of general anesthesia with and without standardized stress relaxation and dream suggestion by the anesthesiologist: A prospective interventional randomized trial using an adaptive design.

Incidence of dreaming and subjective quality of general anesthesia with and without standardized stress relaxation and dream suggestion by the anesthesiologist: A prospective interventional randomized trial using an adaptive design.

The Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to the Addition of Fentanyl to Epidural Bupivacaine in Patients Undergoing Lower Limb and Pelvic Orthopedic Surgery under Combined Spinal Epidural Anesthesia

Abstract Background Epidural anesthesia is safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. Research continues concerning different techniques and drugs that could provide better surgical anesthesia and postoperative pain relief. Aim of the Work to investigate how the addition of magnesium sulphate to 0.5% bupivacaine affects duration, quality, complications and dermatome spread of anesthesia in comparison to fentanyl. Patients and Methods The current study included 50 patients who had been scheduled to undergo lower limb or pelvic orthopedic surgery under combined spinal - epidural anesthesia. The study had been done after approval of the local ethics committee and after obtaining written informed consent from all patients enrolled in the study; which had been held at Ain Shams Hospital, Faculty of Medicine. Results Pain assessment using VAS showed no statistically significant difference between the two studied groups in the first and second hours postoperative. Starting from the third hour statistical significant differences were observed between the two groups, VAS was higher in groups (M) than in group (F); (1.82 ±0.6 vs. 1.42 ±0.4 in both groups respectively. At the fourth hour; VAS was higher in groups (M) than in group (F); (2.80±0.8 vs. 1.76 ± 0.6 in both groups respectively. The incidence of complications was significantly lower among group (M) where 52% of patients had no complications at all. Conclusion the use of both magnesium and fentanyl as adjuvants to local anesthetics in epidural anesthesia is safe and effective. No significant differences regarding quality of motor block and hemodynamics. But the study shows that fentanyl is significantly a better adjuvant regarding postoperative analgesia and time for first analgesic dose. While magnesium is a significantly better adjuvant regarding complications such as nausea, vomiting and pruritis.

Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

Dural-puncture epidural (DPE) and standard epidural are common modes of neuraxial labor analgesia. Little is known about conversion of DPE-initiated labor analgesia to surgical anesthesia for cesarean delivery. To determine whether DPE provides a faster onset and better-quality block compared with the standard epidural technique for cesarean delivery. This double-blind, randomized clinical trial was conducted between April 2019 and October 2022 at a tertiary care university hospital (University of Arkansas for Medical Sciences). Participants included women aged 18 years and older undergoing scheduled cesarean delivery with a singleton pregnancy. Participants were randomized to receive DPE or standard epidural in the labor and delivery room. A T10 sensory block was achieved and maintained using a low concentration of bupivacaine with fentanyl through the epidural catheter until the time of surgery. Epidural extension anesthesia was initiated in the operating room. The primary outcome was the time taken from chloroprocaine administration to surgical anesthesia (T6 sensory block). The secondary outcome was the quality of epidural anesthesia, as defined by a composite of the following factors: (1) failure to achieve a T10 bilateral block preoperatively in the delivery room, (2) failure to achieve a surgical block at T6 within 15 minutes of chloroprocaine administration, (3) requirement for intraoperative analgesia, (4) repeat neuraxial procedure, and (5) conversion to general anesthesia. Among 140 women (mean [SD] age, 30.1 [5.2] years), 70 were randomized to the DPE group, and 70 were randomized to the standard epidural group. The DPE group had a faster onset time to surgical anesthesia compared with the standard epidural group (median [IQR], 422 [290-546] seconds vs 655 [437-926] seconds; median [IQR] difference, 233 [104-369] seconds). The composite rates of lower quality anesthesia were 15.7% (11 of 70 women) in the DPE group and 36.3% (24 of 66 women) in the standard epidural group (odds ratio, 0.33; 95% CI, 0.14-0.74; P = .007). Anesthesia initiated following a DPE technique resulted in faster onset and improved block quality during epidural extension compared with initiation with a standard epidural technique. Further studies are needed to confirm these findings in the setting of intrapartum cesarean delivery. ClinicalTrials.gov Identifier: NCT03915574.

A comparative study of efficacy of ropivacaine (0.75%) with adjuvants – dexmedetomidine and fentanyl in supraclavicular brachial plexus block

Background: Brachial plexus block is preferred to general anesthesia (GA) as it reduces many complications of GA, provides good intra and postoperative analgesia, adequate muscle relaxation. Addition of adjuvants along with LA is used to prolong block with improved quality of anesthesia and decrease dose of LA. This study was done to see the efficacy of Ropivacaine with dexmedetomidine and fentanyl in terms of duration of action and pain relief. Aims and Objectives: Dexmedetomidine and Fentanyl along with Ropivacaine in patients undergoing upper limb surgeries, the onset and duration of sensory and motor blockade as well as post op analgesia is compared. Materials and Methods: Prospective Randomized Comparative study with three groups randomly divided received total volume of 30 mL of drug in peripheral nerve stimulator guided supraclavicular blocks in patients undergoing upper limb surgeries. Group Dexmedetomidine received 28 cc of 0.75% Ropivacaine and Dexmedetomidine (1 mcg/kg), Group Fentanyl patients received 28 cc of 0.75% Ropivacaine and fentanyl (1 mcg/kg), whereas, group plain Ropivacaine patients received 28 cc of 0.75% Ropivacaine and 2 mL of normal saline. Haemodynamics, sensory and motor block (MB) were evaluated by VAS and modified Bromage scale. Results: The onset of sensory block and MB in the dexmedetomidine group, fentanyl group, and ropivacaine groups was 3.57±0.50 min and 4.47±0.51 min, 5.50±0.51 min and 7.53±0.51 min, and 8.07±0.79 min and 10.07±0.79 min respectively which were statistically significant. The duration of MB in the dexmedetomidine group, fentanyl group, and ropivacaine group were 6.57±0.50 h, 4.47±0.51 h, and 2.50±0.51 h respectively which was statistically significant (P=0.0000). The duration at which first postoperative analgesia was required in the dexmedetomidine group, fentanyl group, and ropivacaine group were 8.57±0.50 h, 6.57±0.50 h, and 5.30±0.47 h respectively. Conclusion: Dexmedetomidine is better as an adjuvant to Ropivacaine for brachial plexus block in terms of onset and duration.

A Comparison of Distal Nerve Blocks and Brachial Plexus Blocks in Terms of Block Success, Block-related Characteristics, Time to Discharge and Patient Satisfaction.

Background: Ultrasound-guided brachial plexus blocks (BPB) are used as an anaesthetic method in hand and wrist surgeries. The radial, median and ulnar nerves can also be selectively blocked. The objective of this retrospective cohort study was to compare distal nerve blocks (DNB) and BPB in terms of block success, block-related characteristics, time to discharge and patient satisfaction. Methods: The data of patients who underwent elective hand and wrist surgery under regional anaesthetic procedures between 01.01.2022 and 01.09.2022 were analysed. Standard multimodal analgesia was performed in all groups, in addition to either ultrasound-guided BPB or DNB. Demographic characteristics, American Society of Anaesthesiology (ASA) classes, presence of additional diseases, block and volume applied, block-related data such as block performance time, onset time, initial analgesia times, perioperative additional anaesthetic or analgesic requirement, surgery times, types of surgery, discharge times and the presence of additional complaints were recorded. In addition, the anaesthesia quality score were determined using a 5-point Likert scale. Results: There was no difference between demographic data. Average surgical time was similar between the DNB and BPB groups (46.0 ± 8.92 vs. 59.95 ± 22.04 min, p < 0.05). Block onset time was significantly lower in the DNB group (26.4 ± 2.73 vs. 32.17 ± 2.94 min, p < 0.001). When patients discharged before and after 12 hours were compared, 11/22 of the patients in the DNB group and 4/23 of the patients in the BPB group were discharged in the first 12 hours (p < 0.05). Patient satisfaction scores were similar between groups (14.22 ± 0.86 vs. 13.65 ± 1.11, p > 0.05). Conclusions: In surgeries of the hand and wrist, the radial, median and ulnar nerves can be used individually or in combination as an alternative to proximal BPB. Level of Evidence: Level III (Therapeutic).

Anesthesia quality indicators to measure and improve your practice: a modified delphi study

BackgroundImplementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice.MethodsAn initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel.ResultsThe initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome.ConclusionThis ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.