Safe Anesthesia Research Articles

Retracted: Meta-Analysis of Anesthetic Efficacy and Safety of Propofol in Craniotomy Patients.

[This retracts the article DOI: 10.1155/2022/6318051.].

Anaesthetic implications of intra-operative Indocyanine Green use in pediatric surgery

IntroductionThe use of Indocyanine Green (ICG) dye for fluorescent guided surgery is increasing in children. In many cases, ICG is injected intravenously peri-operatively and is known to falsely alter peripheral oxygenation readings because of interference with the measured red/infrared absorbance ratio of pulsatile blood. MethodsThe study occurred at a single centre tertiary children's hospital. ICG was delivered peri-operatively. SpO2 was monitored real-time in all patients. Blood pressure, heart rate, expired carbon dioxide and electrocardiographic data were collected from anaesthetic records. Data is median (interquartile range) ResultsTwenty-five patients(13 F;12 M) age 60(77)months and weight 17(18.7)kg were included between 01/April/2021 and 31/Nov/2022.Fifteen patients received 0.5(0.38) mg/kg ICG at induction of anesthesia with ΔSpO2 of 6(2) %. Median time to ΔSpO2 fall was 25(6) s with recovery taking 74(68) s. Time to recovery and ΔSpO2 were proportional to ICG dose/kg with r2 of 0.7993 and 0.597 and p of 0.0008 and 0.001 respectively on linear regression. Five patients had intralesional ICG and one had an enteral dose with no effect on SpO2.Eight patients had a total of 20 intraoperative bolus doses of ICG with no effect on SpO2 in 11. In 9, time to SpO2 fall was 26(12) s with ΔSpO2 of 4(1) % and recovery at 24(50) s.No corrective anaesthetic manoeuvres were required. ConclusionUnderstanding the timings of the transient artefactual fall and recovery in SpO2 following ICG injection is essential for safe anesthesia. This is the first study to evaluate this effect in children prospectively.

Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study

BackgroundIncreasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients’ families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data.MethodsWe made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018.ResultsWe performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication.ConclusionsGood quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery.

The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery—a randomized controlled trial

PurposeIn the context of the current comfort medicine and enhanced recovery after surgery, there is a demand for a new anesthesia method to reduce adverse reactions and accelerate recovery after surgery. This randomized controlled trial aimed to compare the efficacy and safety between opioid-free anesthesia (OFA) combined with ultrasound-guided intermediate cervical plexus block (ICPB) and opioid-based anesthesia in patients after thyroid surgery.MethodsIn this study, 75 patients scheduled for thyroid surgery under general anesthesia were randomly allocated into two groups. The primary outcome included the incidence of nausea within 24 h after surgery. The main secondary outcomes included the incidence of vomiting and the visual analog score (VAS) scores within 24 h after surgery as well as the quality of recovery 40 questionnaires (QoR-40) scores 24 h after surgery.ResultsIn the OFA group, the incidence of postoperative nausea was 6.1%, compared to 39.4% in the control group (p = 0.001). No patient presented with postoperative vomiting in the OFA group, while 15.2% of patients suffered from postoperative vomiting in the control group (p = 0.063). The VAS scores of patients in the postanesthetic care unit (PACU) and 2 h, 4 h, and 6 h after surgery were lower in the OFA group, and the difference is statistically significant. Besides, the VAS scores of patients at rest (p = 1.000) and during swallowing (p = 1.000) 24 h after surgery were comparable.ConclusionCompared with opioid-based anesthesia, the OFA combined with the ultrasound-guided ICPB can better improve patients' postoperative recovery, reduce nausea, and decrease pain scores.Trial registrationChinese Clinical Trial Regisrty, ChiCTR2200056344, https://www.chictr.org.cn

GENERAL ANESTHESIA IN A PATIENT WITH CHARCOT-MARIE-TOOTH DISEASE

General anesthesia organization in patients with Charcot-Marie-Tooth Sickness (CMTD) presents novel moves and contemplations because of the hidden neuromuscular and fringe sensory system association. The main objective of the case report is to establish a safe general anesthesia protocol without triggering malignant hyperthermia in a patient with Charcot-Marie-Tooth disease. A 22-year-old female student presented to the plastic surgery department with a history of progressive bilateral foot drop (more on the left than right). She had been diagnosed with CMTD 10 years previously. No surgical procedure was done previously. There was no problem other than the foot drop. The patient was NKDA and NKFA allergic, and there was no medication previously. This case underscores the complexities of managing CMTD-related symptoms, particularly foot drop, in a young female patient. The multidisciplinary collaboration between plastic surgery, orthopedics, and Anesthesiology offers a holistic approach to improving mobility and enhancing the patient's quality of life through muscle-strengthening exercises and potential surgical interventions.

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.

Perioperative mortality of emergency and elective surgical patients in a low-income country: a single institution experience

BackgroundThe perioperative mortality rate is an indicator of access to safe anesthesia and surgery. Studies showed higher perioperative mortality rates among low- and middle-income countries. But the specific causes and factors contributing to perioperative death have not been adequately studied in the Ethiopian context.MethodsThis is a retrospective institutional study of the largest academic medical center in Ethiopia. Data of all patients who were admitted to surgical wards or intensive care and underwent surgical interventions were evaluated for perioperative mortality rate determination. All mortality cases were then evaluated in depth.ResultsOf the 3295 patients evaluated, a total of 148 patients (4.5%) died within 30 days of surgery. By the 7th postoperative day, 69.5% of the perioperative mortality had already occurred. Septic shock contributed to 54.2% of deaths. Emergency surgery patients had more than a twofold higher mortality rate than elective surgery patients (p value < 0.001) and had a 2.6-fold higher rate of dying within 7 days of surgery (p value of 0.02). Patients with ASA performance status of 3 or more had a 1.7-fold higher rate of death within 72 h of surgery (p value of 0.015).ConclusionMore than two thirds of patients died within 7 postoperative days. More emergency patients died than elective counterparts, and emergency cases had a higher rate of dying within 7 days of surgery. Poor ASA performance score was associated with earlier postoperative death. Further prospective multi-institutional studies are warranted to elucidate the factors that contribute to higher postoperative mortality in low-income country patients.

Perioperative Death within 24 Hours: An Analysis of 2,000 Incident Reports of the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study

Background: Perioperative death is one of the indicators of anesthetic patient safety. The perioperative death rate has dramatically declined with the modern anesthetic techniques and perioperative medicine. Objective: To study contributing factors, factors minimizing incidents, and suggested corrective strategies. Materials and Methods: The present study was part of the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study, focusing on the incidents of perioperative death within 24 hours. The perioperative incidents from 22 tertiary hospitals across Thailand were gathered monthly. Two senior anesthesiologists reviewed the reports. Any discrepancy was solved by discussion for a consensus. Results: Of the first 2,000 incident reports in the PAAd Thai Study, there were 404 (20.2%) incident reports of 24 hours perioperative death. Extreme age of less than one year in 6.2% and more than 80 years in 8.2%, with ASA physical status of 3 or more in 97% while 51.2% occurred in the age group between 20 to 64 years. General anesthesia was the main anesthetic technique among fatal cases in 94.1% of the cases. Ninety-one cases (22.5%) occurred in the operating theatre with anesthesiology team witness. The high-risk surgeries with fatal outcomes were general surgery in 46.2%, cardiac surgery in 12.5%, neurological surgery in 11.6%, and endoscopic procedure in 3.2%. Exsanguination in 52.7%, particularly after traffic accident was the major cause of death followed by cardiac factors in 27.2%, and sepsis in 23%. Intraoperative death had higher proportion of exsanguination at 72.5% than postoperative death at 43% (p&lt;0.001). Postoperative death had higher proportion of sepsis-related death and brain death than intraoperative death at 27.5% versus 7.7% (p&lt;0.001), and 20.8% versus 5.5% (p=0.001), respectively. The factor-related death included Patient in 97.8%, Surgical in 42.3%, Anesthetic in 19.3%, and Systematic factors in 31.4%. Fatal causes were considered as preventable in 28.7%, particularly by surgical safety checklist in 18.1%. Conclusion: The multicenter study revealed a high proportion of 24 hours. perioperative death was commonly caused by exsanguination. Postoperative death was related to patient condition. Suggested corrective strategies were quality assurance activity, improved supervision, additional training, ICU availability, and more guidelines and compliance to guidelines including surgical safety checklists. Keywords: Mortality; Perioperative death; Incident report; Surgical safety checklists; Adverse event; Incident report

Pulmonary hypertension: Key aspects in preoperative management

Pulmonary hypertension, characterized by increased pressure in the pulmonary vasculature, can stem from various causes. This condition strains the thin-walled right ventricle of the heart, leading to potential dilation and reduced function over time. Anesthesiologists encounter challenges when managing PH patients during surgery, as the right ventricle poorly responds to inotropic support and undergoes additional stress from surgical conditions. Pulmonary hypertension requires multidisciplinary management in the perioperative setting to ensure appropriate and safe care of patients.Ensuring safe anesthesia for patients with pulmonary hypertension entails careful planning, including a thorough history and physical examination, preoperative testing, optimization of the disease and comorbidities, and comprehensive risk assessment. It is crucial to identify signs and symptoms of progressing pulmonary hypertension and right heart dysfunction. Symptomatic patients with undiagnosed pulmonary hypertension will benefit from referrals to specialists for further evaluation and testing.Diagnostic tools such as electrocardiograms, echocardiography, and right heart catheterization offer valuable information for anesthetic planning and risk assessment. They provide insight into the severity of pulmonary hypertension. Right heart catheterization allows direct measurement of hemodynamic parameters, guiding treatment decisions. Hemodynamic classification distinguishes between pre-capillary, post-capillary, and combined pre- and post-capillary pulmonary hypertension. Another categorization method is clinical grouping based on underlying pathological characteristics, which helps tailor management and treatment choices.This article underscores the significance of perioperative management and the need for a comprehensive evaluation and multidisciplinary approach in patients with pulmonary hypertension. It provides valuable information for anesthesiologists and other healthcare professionals involved in the care of these patients, with a focus on preoperative assessment, risk stratification, and treatment considerations.

Local anaesthesia vs. general anaesthesia for percutaneous microwave ablation in hepatocellular carcinoma: efficacy, safety, and cost analysis.

To compare the efficacy, safety, and cost of local anaesthesia and general anaesthesia modalities for percutaneous microwave ablation as a curative treatment for hepatocellular carcinoma patients. This comparative, retrospective study analysed 175 patients who were treated for hepatocellular carcinoma (HCC) from July 2015 to September 2020. Conventional transcatheter arterial chemoembolization (cTACE) combined with sequential percutaneous microwave ablation (MWA) was performed on every lesion in every patient. Patients were divided into two cohorts according to the anaesthesia modality applied during MWA. To investigate the differences in efficacy between the two groups, overall survival (OS) and local recurrence-free survival (LRFS) were estimated by the Kaplan-Meier method and compared by the log-rank test. Cost and safety between the two groups were also compared accordingly. There were 105 patients with 128 HCC lesions in the local anaesthesia (LA) group and 70 patients with 107 lesions in the general anaesthesia (GA) group. There were no significant differences in OS (P = 0.798) or LRFS (P = 0.406) between the two groups. Fifty-two pairs of patients were matched with 77 lesions in the GA group and 67 lesions in the LA group after PSM. There was no significant difference in OS (P = 0.522) or LRFS (P = 0.410) between the two groups. Compared to the LA group, the GA group had longer operations, consumed more medical resources, had a heavier financial burden, and experienced more anaesthesia adverse events. There was no significant difference in the incidence of post-ablation pain (p=0.487), fever (P=0.678), nausea or vomiting (P=0.808), mild liver dysfunction (P=0.753), haemolytic uraemic syndrome (P=0.595), pleural effusion (P=0.622), liver abscess (0.544), asymptomatic perihepatic fluid (0.703) or subcapsular liver hemorrhage (P=0.666) between the two groups. Due to the higher cost and adverse events of general anaesthesia, local anaesthesia may be more suitable for ablation procedures for HCC patients within the Milan criteria.

Provision of Safe Anesthesia in Magnetic Resonance Environments: Degree of Compliance with International Guidelines in Saudi Arabia.

The lack of local guidelines and regulations for the administration of anesthesia in magnetic resonance imaging (MRI) units presents a potential risk to patient safety in Saudi Arabia. Hence, this study aimed to evaluate the extent to which hospitals in Saudi Arabia follow international guidelines and recommendations for the safe and effective administration of anesthesia in an MRI environment. This study used a questionnaire that was distributed to 31 medical facilities in Saudi Arabia that provided anesthesia in MRI units. The findings of the study revealed that the mean compliance with the 17 guidelines across the 31 sites was 77%; 5 of the 31 sites (16.1%) had a compliance rate of less than 50% with the recommended guidelines. Only 19.4% of the institutes provided general safety education. Communication breakdowns between anesthesia providers and MRI teams were reported. To conclude, this survey highlights the status of anesthesia standards in Saudi Arabian MRI units and emphasizes areas that require better adherence to international guidelines. The results call for targeted interventions, including the formulation of specific national anesthesia guidelines for MRI settings. Communication breakdowns between anesthesia providers and MRI teams were reported at a rate of 83.9% during the administration of a gadolinium contrast agent. There were additional breakdowns, particularly for high-risk patients with implants, such as impaired respirators (74.2%), thus requiring further investigation due to potential safety incidents during MRI procedures. While considering the limitations of this study, such as potential biases and the low response rate, it provides a valuable foundation for refining protocols and promoting standardized practices in Saudi Arabian healthcare.

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.

Geometric morphometrics and machine learning from three-dimensional facial scans for difficult mask ventilation prediction.

Unanticipated difficult mask ventilation (DMV) is a potentially life-threatening event in anesthesia. Nevertheless, predicting DMV currently remains a challenge. This study aimed to verify whether three dimensional (3D) facial scans could predict DMV in patients scheduled for general anesthesia. The 3D facial scans were taken on 669 adult patients scheduled for elective surgery under general anesthesia. Clinical variables currently used as predictors of DMV were also collected. The DMV was defined as the inability to provide adequate and stable ventilation. Spatially dense landmarks were digitized on 3D scans to describe sufficient details for facial features and then processed by 3D geometric morphometrics. Ten different machine learning (ML) algorithms, varying from simple to more advanced, were introduced. The performance of ML models for DMV prediction was compared with that of the DIFFMASK score. The area under the receiver operating characteristic curves (AUC) with its 95% confidence interval (95% CI) as well as the specificity and sensitivity were used to evaluate the predictive value of the model. The incidence of DMV was 35/669 (5.23%). The logistic regression (LR) model performed best among the 10 ML models. The AUC of the LR model was 0.825 (95% CI, 0.765-0.885). The sensitivity and specificity of the model were 0.829 (95% CI, 0.629-0.914) and 0.733 (95% CI, 0.532-0.819), respectively. The LR model demonstrated better predictive performance than the DIFFMASK score, which obtained an AUC of 0.785 (95% CI, 0.710-0.860) and a sensitivity of 0.686 (95% CI, 0.578-0.847). Notably, we identified a significant morphological difference in the mandibular region between the DMV group and the easy mask ventilation group. Our study indicated a distinct morphological difference in the mandibular region between the DMV group and the easy mask ventilation group. 3D geometric morphometrics with ML could be a rapid, efficient, and non-invasive tool for DMV prediction to improve anesthesia safety.

Early warning for SpO2 decrease by the oxygen reserve index in neonates and small infants.

Continuously assessing the oxygenation levels of patients to detect and prevent hypoxemia can be advantageous for safe anesthesia, especially in neonates and small infants. The oxygen reserve index (ORI) is a new parameter that can assess oxygenation through a relationship with arterial oxygen partial pressure (PaO2 ). The aim of this study was to examine whether the ORI provides a clinically relevant warning time for an impending SpO2 (pulse oximetry hemoglobin saturation) reduction in neonates and small infants. ORI and SpO2 were measured continuously in infants aged <2 years during general anesthesia. The warning time and sensitivity of different ORI alarms for detecting impending SpO2 decrease were calculated. Subsequently, the agreement of the ORI and PaO2 with blood gas analyses was assessed. The ORI of 100 small infants and neonates with a median age of 9 months (min-max, 0-21 months) and weight of 8.35 kg (min-max, 2-13 kg) were measured. For the ORI/PaO2 correlation, 54 blood gas analyses were performed. The warning time and sensitivity of the preset ORI alarm during the entire duration of anesthesia were 84 s (25th-75th percentile, 56-102 s) and 55% (95% CI 52%-58%), and those during anesthesia induction were 63 s (40-82 s) and 56% (44%-68%), respectively. The positive predictive value of the preset ORI alarm were 18% (95% CI 17%-20%; entire duration of anesthesia) and 27% (95% CI 21%-35%; during anesthesia induction). The agreement of PaO2 intervals with the ORI intervals was poor, with a kappa of 0.00 (95% CI = [-0.18; 0.18]). The weight (p = .0129) and height (p = .0376) of the infants and neonates were correlated to the correct classification of the PaO2 interval with the ORI interval. The ORI provided an early warning time for detecting an impending SpO2 decrease in small infants and neonates in the defined interval in this study. However, the sensitivity of ORI to forewarn a SpO2 decrease and the agreement of the ORI with PaO2 intervals in this real-life scenario were too poor to recommend the ORI as a useful early warning indicator for this age group.

The safety and efficacy between remimazolam and propofol in intravenous anesthesia of endoscopy operation: a systematic review and meta-analysis.

Propofol is the most widely used intravenous anesthetic in endoscopic surgery, but is associated with several adverse reactions. Public research has shown that remimazolam, a safe general anesthetic, is increasingly being used as a substitute for propofol in clinical operations. Our meta-analysis aimed to analyze whether the adverse reaction rate of remimazolam in endoscopic surgery is acceptable and whether the surgical success rate is not lower than that of propofol. This meta-analysis examined the adverse events and efficacy of remimazolam vs. propofol during endoscopic surgery. MEDLINE, Embase, ClinicalTrials.gov, and Google Scholar were comprehensively searched. Seven studies comparing remimazolam and propofol were included in our meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane manual were used to assess the quality of the results published in all included studies to ensure that our meta-analysis results are reliable and worthwhile. Compared to propofol, the use of remimazolam reduced postoperative injection pain [relative risk (RR)=0.06, 95% confidence interval (CI): 0.03-0.12, P <0.00001], postoperative hypotension (RR=0.45, 95% CI: 0.28-0.73, P =0.001), and postoperative respiratory depression (RR=0.20, 95% CI: 0.08-0.47, P =0.0002); however, it also slightly reduced the success rate of the operation [risk difference (RD)=-0.02, 95% CI: -0.04 to -0.01, P =0.0007]. There were no significant differences in the occurrence of bradycardia symptoms after the operation (RD=-0.01, 95% CI: -0.03 to 0.01, P =0.35), recovery time after the operation [standardized mean difference (SMD)=0.68, 95% CI: -0.43 to 1.80, P =0.23] or discharge time (SMD=0.17, 95% CI: -0.58 to 0.23, P =0.41). We also performed a subgroup analysis of each corresponding outcome. Our analysis showed that remimazolam may be a safer shock option than propofol for endoscopic surgery. However, further research is required to determine their utility.

Safety in obstetric anesthesia requires more research and support

Safety in obstetric anesthesia requires more research and support

Wireless Sensors in General Anesthesia- An Update

Wireless sensor networks (WSNs) give wireless connectivity with computing power to monitor patients, during anesthesia in surgery. A Boyle's Continuous anesthesia machine administers anesthetic gases in combination with oxygen and real-time monitoring of oxygen saturation in blood, EEG, Body temperature, Blood pressure, heart rate, and evolved carbon dioxide (Depth of anesthesia Do A) to help anesthesiologists plan safe anesthesia. Medical sensors are attached to the patient's body to collect the patient's physiological data. Wireless transmission of the collected data to a medical staff's portable device. This update gives insight into recent developments in Wireless Networking Sensors in Critical Surgery including Anesthesia, WSN Architecture, Challenges, Network Security (Encryption) developments in Smart Medical Systems with a general domain of remote patient monitoring, focused on anesthesiology care in particular how WSN and IOT will help Anesthesia in automated administration and monitoring

Blended (Combined Spinal and General) vs. General Anesthesia for Abdominal Hysterectomy: A Retrospective Study.

Adequate pain management for abdominal hysterectomy is a key factor to decrease postoperative morbidity, hospital length of stay and chronic pain. General anesthesia is still the most widely used technique for abdominal hysterectomy. The aim of this study was to assess the efficacy and safety of blended anesthesia (spinal and general anesthesia) compared to balanced general anesthesia in patients undergoing hysterectomy with or without lymphadenectomy for ovarian, endometrial or cervical cancer or for fibromatosis. We retrospectively collected data from adult ASA 1 to 3 patients scheduled for laparoscopic or mini-laparotomic hysterectomy with or without lymphadenectomy for ovarian, endometrial or cervical cancer or for fibromatosis. Exclusion criteria were age below 18 years, ASA > 3, previous chronic use of analgesics, psychiatric disorders, laparotomic surgery with an incision above the belly button and surgery extended to the upper abdomen for the presence of cancer localizations (e.g., liver, spleen or diaphragm surgery). The cohort of patients was retrospectively divided into three groups according to the anesthetic management: general anesthesia and spinal with morphine and local anesthetic (Group 1), general anesthesia and spinal with morphine (Group 2) and general anesthesia without spinal (Group 3). NRS was lower in the spinal anesthesia groups (Groups 1 and 2) than in the general anesthesia group (Group 3) for every time point but at 48 h. The addition of local anesthetics conferred a small but significant NRS decrease (p = 0.009). A higher percentage of patients in Group 3 received intraoperative sufentanil (52.2 ± 18 mcg in Group 3 vs. Group 1 31.8 ± 16.2 mcg, Group 2 44.1 ± 15.6, p < 0.001) and additional techniques for postoperative pain control (11.4% in Group 3 vs. 2.1% in Group 1 and 0.8% in Group 2, p < 0.001). Intraoperative hypotension (MAP < 65 mmHg) lasting more than 5 min was more frequent in patients receiving spinal anesthesia, especially with local anesthetics (Group 1 25.8%, Group 2 14.6%, Group 3 11.6%, p < 0.001), with the resulting increased need for vasopressors. Recovery-room discharge criteria were met earlier in the spinal anesthesia groups than in the general anesthesia group (Group 1 102 ± 44 min, Group 2 91.9 ± 46.5 min, Group 3 126 ± 90.7 min, p < 0.05). No differences were noted in postoperative mobilization or duration of ileus. Intrathecal administration of morphine with or without local anesthetic as a component of blended anesthesia is effective in improving postoperative pain control following laparoscopic or mini-laparotomic hysterectomy, in reducing intraoperative opioid consumption, in decreasing postoperative rescue analgesics consumption and the need for any additional analgesic technique. We recommend managing postoperative pain with a strategy tailored to the patient's physical status and the type of surgery, preventing and treating side effects of pain treatments.

Electroencephalographic monitoring of anesthesia during surgical procedures in mice using a modified clinical monitoring system

Monitoring brain activity and associated physiology during the administration of general anesthesia (GA) in mice is pivotal to guarantee postanesthetic health. Clinically, electroencephalogram (EEG) monitoring is a well-established method to guide GA. There are no established methods available for monitoring EEG in mice (Mus musculus) during surgery. In this study, a minimally invasive rodent intraoperative EEG monitoring system was implemented using subdermal needle electrodes and a modified EEG-based commercial patient monitor. EEG recordings were acquired at three different isoflurane concentrations revealing that surgical concentrations of isoflurane anesthesia predominantly contained burst suppression patterns in mice. EEG suppression ratios and suppression durations showed strong positive correlations with the isoflurane concentrations. The electroencephalographic indices provided by the monitor did not support online monitoring of the anesthetic status. The online available suppression duration in the raw EEG signals during isoflurane anesthesia is a straight forward and reliable marker to assure safe, adequate and reproducible anesthesia protocols.

The safety and efficacy of ultrasound-guided erector spinae plane block in postoperative analgesic of PCNL: A systematic review and meta-analysis.

The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia method of plane block, has a positive effect on postoperative analgesia. But evidence of ESPB in PCNL is still lacking. The objective of this study was to systematically analyze the postoperative analgesic effect of ESPB in patients receiving PCNL. The literature searching was conducted in PubMed, EMBASE, Cochrane Library and Clinical Trial Database (clinicaltrials.gov). Two independent researchers screened the included studies and extracted data. Meta-analysis was conducted by using the random-effect model with 95% confidence intervals. Chi-squared test with a significance level of 0.1 was utilized to evaluate the heterogeneity of included studies. The subgroup analysis and meta-regression analysis were conducted in studies with high heterogeneity. The publication bias was assessed based on whether there were discrepancies between prospective trial registration and reported protocols. There were 8 studies involving 456 patients assessing the efficacy of ESPB in reducing postoperative pain score of PCNL compared with no block or other blocks, such as subcutaneous infiltration, general anesthesia or TPVB intrathecal morphine. ESPB was a significantly effective and safe anesthesia method, which not only improved postoperative pain response (MD -1.76; 95% CI -2.57 to -0.94; I 2 = 85%; p<0.01), but also reduced analgesic consumption (MD -16.92; 95% CI -26.25 to -7.59; I 2 = 92.2%; p<0.01) and prolonged the time of first request for postoperative analgesia (MD 93.27; 95% CI 35.79 to 150.75; I 2 = 85.3%; p = 0.001) in patients receiving PCNL without significant postoperative complications (MD 0.80; 95% CI 0.31 to 2.03; I 2 = 0%; p = 0.404). Compared with no block or other blocks, the ESPB was a safe and effective anesthesia for patients receiving PCNL.