Safe Anesthesia Research Articles

Prediction of blood pressure changes during surgical incision using the minimum evoked current of vascular stiffness value under sevoflurane anesthesia

Necessary and sufficient opioids should be administered for safe and stable anesthesia. However, opioid sensitivity varies among individuals. We previously reported that sympathetic responses to nociceptive stimuli under propofol anesthesia could be predicted by measuring the minimum evoked current of the vascular stiffness value (MECK). However, this result has only been proven under propofol anesthesia. We propose that MECK could be used under anesthesia with a volatile anesthetic. Thirty patients undergoing laparotomy with sevoflurane anesthesia received 0.7 minimum alveolar concentration (MAC) sevoflurane and intravenous remifentanil at a constant concentration of 2 ng/mL, followed by tetanic stimulation, to measure MECK. After tetanic stimulation, the same anesthetic conditions were maintained, and the rate of change in systolic blood pressure (ROCBP) during the skin incision was measured. The correlation coefficient between the MECK and ROCBP during skin incision under sevoflurane anesthesia was R = − 0.735 (P < 0.01), similar to that in a previous study with propofol (R = − 0.723). Thus, a high correlation was observed. The slope of the linear regression equation was − 0.27, similar to that obtained in the study on propofol (− 0.28). These results suggest that, as with propofol anesthesia, MECK can be used as a predictive index for ROCBP under 0.7 MAC sevoflurane anesthesia.Clinical trial registration: Registry, University hospital Medical Information Network; registration number, UMIN000047425; principal investigator’s name, Noboru Saeki; date of registration, April 8, 2022.

Children's Anaesthesia and perioperative care challenges, and innovations

The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2–4)Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5–7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).1.Improved perioperative care must include anaesthesia and nursing to improve perioperative outcomes for children.2.Perioperative care for children in LMICs is predominantly by non-physician anaesthesia providers or non-specialty-trained anaesthesiologists.3.There is a need to train physician anaesthesia leaders to direct and oversee the care of children undergoing anaesthesia4.Infrastructure and equipment for the safe provision of paediatric anaesthesia/perioperative care are usually wanting/often times inadequate and inappropriate.5.The GICS OReCS document provides a valuable guide for the bare minimum requirements for the provision of safe paediatric anaesthetic and surgical care services, starting at the district hospital.6.Equipment donations should be conscientious, in consultation with local leads. Considerations will include biomedical support for maintenance, availability of spare parts, and electrical compatibility, among others.7.Context-specific innovations have been shown to work in LMICs and include paediatric anaesthesia courses for all providers and simulation-based training using low technology.8.Any worthwhile programs aimed at improving anaesthetic and surgical care for children need to ultimately fit into national healthcare systems.

13 years of hand surgery without an anesthesiologist. An analysis of efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; The assistance of anaesthesiologist is considered an inseparable part of most surgical procedures, with the exception of a small proportion of minor procedures performed under local anaesthesia. In hand surgery, a vast majority of procedures, even those lasting several hours, can be carried out under regional (brachial plexus block) or local (infiltration) anaesthesia. These can be delivered by the surgeons themselves, allowing the surgeries to be carried out without the assistance of anesthesiologists.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study was to analyze the efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists in the course of hand surgery procedures performed within the institution headed by the author of this article.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; The analysis was based on the records of anesthesia protocols filled out by the surgeons who delivered the anesthesia and who operated on the patients. The variables considered included the efficacy of anesthesia and the anesthesia-related adverse effects and complications.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Over a period of 13 years (2010-2022), a total of 24,703 surgeries were delivered; of these, 22,228 (91%) surgeries were carried out without anesthesiologists, with anesthesia being delivered by the surgeon him/herself. The efficacy of these procedures (local anasthesia and brachial plexus blocks combined) was 99%. A total of 631 (2.8%) anesthesia-related adverse reactions were recorded, most of them being transient, requiring immediate interventions and not leading to any serious sequelae. In only 17 cases (0.07%), adverse effects resulted in cancellation and rescheduling of the elective surgery.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; Pre-surgical anesthesia as delivered prior to hand surgery procedures by the surgeons without the assistance of anesthesiologists is effective and safe while being associated with numerous benefits for patients, surgeons and the health care system's budget.&lt;/br&gt.

Oral Sedation Anesthesia Protocol for In-Office Oculoplastic Surgery.

To present an oral anesthesia protocol for in-office oculoplastic surgery and to compare safety outcomes and patient and physician experiences to ambulatory surgery center (ASC)-based surgery with intravenous sedation or general anesthesia. A prospective study was performed on consecutive patients undergoing surgery at an oculofacial plastic surgery practice. Surgery was performed in an in-office setting using our standardized oral sedation protocol or at an ASC with intravenous sedation or general anesthesia. Preoperative and postoperative surveys were conducted by patients and physicians to compare surgical experience, safety, and efficacy of our oral sedation protocol for in-office surgery in the ASC setting. Two hundred and fifty-three patients (167 in-office and 86 at ASC) underwent surgery between March and November 2022. There was no significant difference in how patients or physicians rated their experience between the 2 locations. A significantly higher proportion of ASC patients would have rather had surgery in-office (34.9% vs. 19.2%; p = 0.006). A significantly higher number of physicians in the office setting would have rather performed surgery at the ASC than the reverse (12.7% vs. 2.3%, respectfully; p = 0.007). There were no safety complications reported in either setting. Within our patient cohort, the presented oral sedation protocol provided safe and effective anesthesia for in-office oculoplastic surgery that is comparable to an ASC.

Exploring the effects of eugenol, menthol, and lidocaine as anesthetics on zebrafish glucose homeostasis

Zebrafish (Danio rerio) are widely employed as an experimental model in various scientific fields. The investigation of glucose metabolism dysfunctions has gained recent significant prominence. Considering that certain anesthetics may impact glycemic levels, it is imperative to carefully select an anesthetic that does not induce such side effects, thereby mitigating potential adverse influences on research outcomes. In this sense, this study aimed to evaluate potential glucose alterations and induction and recovery times resulting from the use of eugenol, menthol and lidocaine as anesthetics in zebrafish. A total of 150 adult male and female zebrafish were divided into ten groups, comprising a control group euthanized by rapid chilling, and three groups anesthetized with low (40 mg/L eugenol, 60 mg/L menthol, 100 mg/L lidocaine), intermediate (60 mg/L eugenol, 90 mg/L menthol, 225 mg/L lidocaine), and high (80 mg/L eugenol, 120 mg/L menthol, 350 mg/L lidocaine) anesthetic concentrations. Glucose levels and induction and recovery times were assessed. The findings reveal that eugenol and menthol did not cause glucose level alterations at any of the investigated concentrations, while lidocaine caused a non-concentration-dependent hyperglycemia. Eugenol and menthol also exhibited similar recovery times at different concentrations, while lidocaine recovery times were concentration-dependent. This study, therefore, concludes that eugenol and menthol are safe and satisfactory anesthetics for use in zebrafish research involving glucose analyses, while lidocaine use can cause biases due to altered glucose levels and safety concerns. Researchers should, therefore, carefully consider anesthetic selection to ensure reliable results in zebrafish assessments.

The Comparison of Efficacy and Safety Between General and Topical Anesthesia on Micro-Plasma Radiofrequency Treatment for Hypertrophic Scar: A Retrospective Cohort Study.

While micro-plasma radiofrequency (MPR) treatment has a significant impact on hypertrophic scars, patients often require anesthesia to alleviate substantial discomfort. Currently, patients with similar degrees of scarring may choose surface anesthesia or general anesthesia based on their personal preferences. Nevertheless, the effectiveness and safety of different anesthesia modalities remain uncertain. To assess the effectiveness and safety of both general and surface anesthesia in MPR treatment for hypertrophic scars. We conducted a retrospective cohort study involving 101 patients diagnosed with hypertrophic scars who underwent MPR with different anesthesia methods. The primary measures of efficacy included the Vancouver Scar Scale (VSS) scores assessed before the first treatment and six months after the final treatment. Pain relief was evaluated using Visual Analog Scale (VAS) scores. Safety was assessed by comparing the incidence of adverse reactions between the two groups. Patients in the general anesthesia group showed a significant difference in scar pigmentation 6months after the treatment and lower pain level than those in the surface anesthesia group in the treatment of MPR. The difference in safety was not statistically significant. After adjusting for confounding factors and propensity score matching, the outcome of VSS and VAS scores was stable. General anesthesia, as opposed to surface anesthesia, appears to enhance both the effectiveness and safety of MPR while reducing postoperative pain in the treatment of hypertrophic scars. For patients with heightened pain sensitivity, general anesthesia may be the preferred treatment option. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Anesthetic management with remimazolam in very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation plus off-pump coronary artery bypass grafting: report of two cases

BackgroundRemimazolam is a short-acting benzodiazepine with small circulatory depression. We used remimazolam for general anesthesia management in two very elderly patients undergoing hybrid surgery of transcatheter aortic valve implantation (TAVI) plus off-pump coronary artery bypass grafting (OPCABG).Case presentationA 96-year-old man (case 1) and a 92-year-old woman (case 2) had complex coronary artery disease (CAD) and severe aortic stenosis (AS) and were scheduled for TAVI plus OPCAB. Anesthesia in both patients was induced with 6 mg/kg/h remimazolam and fentanyl and maintained with 0.3 mg/kg/h and 0.5 mg/kg/h remimazolam and fentanyl, respectively. Although catecholamines were required, we successfully maintained circulation during the induction of anesthesia and the procedures of OPCAB and TAVI. Both patients were discharged without complications.ConclusionRemimazolam can be a useful option for safe general anesthesia in very elderly patients when performing hybrid surgery.

High-quality training of anaesthesiologist-resuscitator is one of main components of safety of anaesthesia

Purpose. To conduct an analysis and research aimed at improving the safety of patients during anesthesia by optimizing training in clinical residency in the specialty of anesthesiology and resuscitation. Particular attention was paid to the human factor, as one of the causes of errors and complications in anesthesiology and resuscitation.Material and methods. An additional and more detailed analysis of error factors is carried out using a list of associated error factors. We have developed a special questionnaire for an anonymous survey of clinical residents and anesthesiologists and resuscitators. With its help, we intended to find out what personal qualities an ‘ideal’ anesthesiologist-resuscitator should have.Results. A more in-depth analysis data showed that the most common cause of errors was a lack of practice, in second place there are personal factors, in third place there is a lack of knowledge, and in at last place there are organizational factors. According to the results of an anonymous survey of clinical residents and anesthesiologists, it was established that ‘knowledge’ and ‘skills (abilities)’ are the main factors in ensuring the safety of patients during anesthesia.Conclusions. Questioning should be recognized as an objective, simple and not requiring additional financial costs way to assess a number of social qualities and factors. Training and educating them of the necessary personal qualities of anesthesiologists and resuscitators is one of the most important components of ensuring the safety of anesthesia.

Combined multiple regional anesthesia for microwave ablation of liver Tumors: Initial experience

ObjectiveThis study aims to assess the feasibility and safety of combined multiple regional anesthesia (CMRA) as a potential strategy to decrease pain and reliance on intravenous analgesics during and after ultrasound-guided microwave ablation (US-guided-MWA) of liver tumors. MethodsA cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain. ResultsAll patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups. ConclusionCMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.

Risks and benefits of anesthesia for combined pediatric procedures in the NIH undiagnosed diseases program

PurposeThe NIH Undiagnosed Diseases Program (UDP) aims to provide diagnoses to patients who have previously received exhaustive evaluations yet remain undiagnosed. Patients undergo procedural anesthesia for deep phenotyping for analysis with genomic testing. MethodsA retrospective chart review was performed to determine the safety and benefit of procedural anesthesia in pediatric patients in the UDP. Adverse perioperative events were classified as anesthesia-related complications or peri-procedural complications. The contribution of procedures performed under anesthesia to arriving at a diagnosis was also determined. ResultsFrom 2008 to 2020, 249 pediatric patients in the UDP underwent anesthesia for diagnostic procedures. The majority had a severe systemic disease (American Society for Anesthesiology status III, 79%) and/or a neurologic condition (91%). Perioperative events occurred in 45 patients; six of these were attributed to anesthesia. All patients recovered fully without sequelae. Nearly half of the 249 patients (49%) received a diagnosis, and almost all these diagnoses (88%) took advantage of information gleaned from procedures performed under anesthesia. ConclusionsThe benefits of anesthesia involving multiple diagnostic procedures in a well-coordinated, multidisciplinary, research setting, such as in the pediatric UDP, outweigh the risks.

ARTERIAL CATHETERIZATION IN GREAT APES.

Anesthesia is frequently required to provide appropriate medical care to captive great apes. Anesthetic safety can be optimized through placement of an arterial catheter, which allows direct measurement of arterial blood pressure and easy sampling of arterial blood for blood-gas analysis. Arterial catheterization in great apes can be achieved through palpation-guided or ultrasound-guided placement with or without a modified Seldinger technique. Potential sites for arterial catheterization include the anterior tibial artery, caudal tibial and posterior saphenous arteries, dorsal pedal artery, femoral artery, radial artery, and brachial artery. Arterial catheterization is recommended for lengthy great ape anesthetic procedures or those involving invasive procedures.

Combined spinal and epidural anaesthesia for open radical cystectomy: A controlled study.

To evaluate the feasibility of loco-regional anaesthesia and to compare perioperative outcomes between loco-regional and standard general anaesthesia in patients with bladder cancer undergoing open radical cystectomy (ORC). A single-surgeon cohort of 60 consecutive patients with bladder cancer undergoing ORC with an enhanced recovery after surgery protocol between May 2020 and December 2021 was analysed. A study group of 15 patients operated on under combined spinal and epidural anaesthesia was compared with a control group of 45 patients receiving standard general anaesthesia. Intraoperative outcomes were haemodynamic stability, estimated blood loss, intraoperative red blood cell transfusion rate, and anaesthesia time. Postoperative outcomes were pain assessment 24 h after surgery, time to mobilisation, return to oral diet, time to bowel function recovery, length of stay and rate of 90-day complications. No patients required conversion from loco-regional to general anaesthesia. All patients in both groups were haemodynamically stable. No significant differences between groups were observed for all other intraoperative outcomes, except for a shorter anaesthesia time in the study versus control group (250 vs. 290 min, p = 0.01). Pain visual score 24 h after surgery was significantly lower in the study versus control group (0 vs. 2, p < 0.001). No significant differences were observed for all other postoperative outcomes, with a comparable time to bowel function recovery (5days in each group for stool passage), and 90-day complication rate (46.6% vs. 42.2% for the study vs. control group, p = 0.76). Our exploratory, controlled study confirmed the feasibility, safety and effectiveness of a pure loco-regional anaesthesia in patients with bladder cancer undergoing ORC. No significant differences were observed in intra- and postoperative outcomes between loco-regional and general anaesthesia, except for a significantly shorter anaesthesia time and greater pain reduction in the early postoperative period for the former.

Incidents relating to paediatric regional anaesthesia in the first 8000 cases reported to webAIRS.

Regional anaesthesia is an essential tool in the armamentarium for paediatric anaesthesia. While largely safe and effective, a range of serious yet preventable adverse events can occur. Incidence and risk factors have been described, but few detailed case series exist relating to paediatric regional anaesthesia. Across Australia and New Zealand, a web-based anaesthesia incident reporting system enables voluntary reporting of detailed anaesthesia-related events in adults and children. From this database, all reports involving paediatric regional anaesthesia (age less than 17 years) were retrieved. Perioperative events and their outcomes were reviewed and analysed. When offered, the reported contributing or alleviating factors relating to the case and its management were noted. This paper provides a summary of these reports alongside an evidence review to support safe practice. Of 8000 reported incidents, 26 related to paediatric regional anaesthesia were identified. There were no deaths or reports of permanent harm. Nine reports of local anaesthetic systemic toxicity were included, seven equipment and technical issues, six errors in which regional anaesthesia made an indirect contribution and four logistical and communication issues. Most incidents involved single-shot techniques or a neuraxial approach. Common themes included variable local anaesthetic dosing, cognitive overload, inadequate preparation and communication breakdown. Neonates, infants and medically complex children were disproportionately represented, highlighting their inherent risk profile. A range of preventable incidents are reported relating to patient, systems and human factors, demonstrating several areas for improvement. Risk stratification, application of existing dosing and administration guidelines, and effective teamwork and communication are encouraged to ensure safe regional anaesthesia in the paediatric population.

Anesthetic efficacy and safety of ropivacaine 0.75% versus bupivacaine 0.5% for spinal anesthesia in patients undergoing lower limb orthopedic surgery

Background: Ropivacaine, a new amino-amide local anesthetic agent, is similar in chemical structure to bupivacaine. The low solubility of ropivacaine leads to greater sensory-motor differentiation by blocking sensory nerve fiber more readily than motor nervefibers. Early recovery of motor function is associated with decreased incidence of venous thromboembolism and early mobilization. Aims and Objectives: The present study aimed to compare the anesthetic efficacy and safety of hyperbaric ropivacaine 0.75% with hyperbaric bupivacaine 0.5% in spinal anesthesia in patients undergoing lower limb orthopedic surgery. Materials and Methods: A total of 60 patients aged between 18 and 60 years of either sex, ASA I and II, undergoing elective lower limb orthopedic surgery were randomly divided into two groups, ropivacaine (R) and bupivacaine (B) group. Group R received 3 mL of 0.75% hyperbaric ropivacaine and group B received 3 mL 0.5% hyperbaric bupivacaine intrathecally. The efficacy in terms of onset and duration of anesthesia, quality of anesthesia, and hemodynamic and safety in terms of complications were noted. Results: Group R produced faster onset of sensory block (ropivacaine 2.6±0.53 min; bupivacaine 3±0.56 min; P&lt;0.006) and the mean duration of sensory block was significantly lesser compared to Group B (Ropivacaine 121.16±7.73 min; Bupivacaine 180.34±11.56 min; P&lt;0.0001). Patients in Group R has significantly more rapid recovery of a motor blockade than Group B (ropivacaine 149.5±8.64 min; bupivacaine 210.17±13.19 min; P&lt;0.0001). Conclusion: Hyperbaric ropivacaine 0.75% was found to be a comparable alternative to hyperbaric bupivacaine 0.5% in patients undergoing lower limb orthopedic surgery.

Safety of Non-Operating Room Anesthesia With Propofol Sedation in Three Pediatric Patients With Central Sleep Apnea.

Children with central sleep apnea may require sedation for procedures, including brain imaging as part of the evaluation of apnea. However, the safety of deep sedation without a protected airway is not known in this patient population. In this case series, we present 3 children with central sleep apnea who were sedated with propofol for brain imaging in a non-operating room setting. All 3 did well with no complications; those with a home oxygen requirement were on oxygen during the procedure but none experienced apnea, desaturation, or respiratory distress. While obstructive sleep apnea is a known contraindication to deep sedation with propofol, it may be safe in pediatric patients with central sleep apnea. Deep sedation may be a good option for these patients, thereby avoiding the need for general anesthesia and placement of an advanced airway.

Efficacy and safety of articaine in 3-year-old children for dental procedures: a protocol for a clinical randomised control trial in Saudi Arabia

IntroductionDespite the wide use of articaine in paediatric dentistry owing to its proven effectiveness and safety, articaine application in children <4 years remains controversial due to a lack of data...

Anesthetic management of a case of pulmonary alveolar proteinosis for whole lung lavage

Abstract Pulmonary Alveolar Proteinosis (PAP) is a rare disease of the lungs characterized by deposition of lipo-proteinaceous material in the alveoli. This leads to reduced lung compliance and V/Q mismatch, causing respiratory failure. Patients with PAP may be posted for Whole Lung Lavage (WLL) under anesthesia, which is a challenging case for anesthetists. Preexisting respiratory failure is complicated by requirement of single lung ventilation with the help of double lumen tube during the procedure. Intraoperative ventilation is difficult and is managed with blood gas and airway pressure monitoring. Some degree of hypoxemia and hypercapnia may have to be tolerated. Large volumes of fluid are instilled into the lung which may cause hypothermia, hypervolemia, and electrolyte disturbances. These patients frequently require elective ventilation and intensive care admission in the postoperative period. We report the case of a young woman with PAP, posted for unilateral WLL under anesthesia. We wish to highlight the possible challenges posed by this case and how to conduct a safe anesthesia for this patient.

Improving Complex Brachytherapy Efficiency in the Current Financial Climate.

To optimize multidisciplinary collaboration in the setting of limited resources to increase the efficiency of complex brachytherapy workflow for patients with locally advanced cervical cancer. High Dose Rate (HDR) brachytherapy is a critical component in the treatment of women with locally advanced cervical cancer. The completion of HDR brachytherapy to provide a complete treatment of concurrent chemoradiation and brachytherapy of <56 days has been well established. A quality improvement (QI) initiative was born out of the need to accommodate an increasing volume of patients with locally advanced cervical cancer. The challenges addressed were: different location of the operating room (OR), HDR brachytherapy suite, MR scanner; Inconsistent OR days; Post-Anesthesia Care Unit (PACU)/transportation delays; Anesthesiology staffing constraints. The QI initiative required multidisciplinary collaboration. A new protocol was finalized which provided protected OR time, and changed analgesia from general anesthesia requiring prolonged monitoring in PACU, to a pre-procedural epidural with moderate sedation. Additionally, a dedicated anesthesiologist was assigned to discuss process improvement, and the medical history for these complex patients as it relates to anesthesia safety. The streamlined process allows the patients' physical time in PACU to be bypassed; a dedicated brachytherapy nurse competent in moderate sedation recovery accompanies the patient to CT simulation. An MR protocol was established with tentative slots secured. The primary metric was the change in the number of interstitial cases performed. Additional metrics included: total case time, anesthesiology delay, MR delay, and number of OR days where 2 complex cases are performed. Prior to initiation of QI initiative, from 01/2022-09/2022 there were 27 cases, average 3.0/month. After implementation of QI project, from 10/2022-02/2023 there were 32 cases, average 6.4/month, a 113.3% increase. Total case time decreased from baseline 9.3 hours to average 6 hours (Range: 3.8-10.6). Anesthesiology related delays were on average 18.5 minutes (Range: -15-35). MR related delays were on average 87.6 minutes (Range: 35-275). These changes now permit the flexibility of performing 2 complex interstitial cases per day, instead of one. The average days per month where two interstitial cases are performed increased from 0.4 to 1.4. As hospital systems continue to face economic constraints, it is critical that we leverage our existing resources in order to provide timely care to our patients. This QI initiative shows that despite the limitation in brachytherapy operations, systems can be changed through multidisciplinary collaboration to improve efficiencies and increase capacities while working within financial workforce constraints to provide optimal patient care.

A Comparison of the Recovery Profile of Dexmedetomidine When Administered by Different Routes in Patients Undergoing Laparoscopic Cholecystectomy – A Randomized Controlled Trial

Laparoscopic cholecystectomy is a minimally invasive procedure that demands a safe and fast-tracking anesthesia plan. A faster and smoother recovery of patients from anesthesia after a surgical procedure is critical for early discharge. Dexmedetomidine is a short-acting α2 agonist with analgesic, sedative, and anxiolytic properties. However, it is associated with prolonged sedation when administered through an intravenous route, thereby prolonging the recovery time from anesthesia. We conducted this study to compare the time to extubation after anesthesia when dexmedetomidine was administered through the conventional intravenous route and an interfascial transversus abdominus plane (TAP) block and rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy surgeries under general anesthesia. In addition, we also studied postoperative pain using the Visual analog scale (VAS). This study is a double-blinded, randomized controlled clinical trial conducted on 54 patients undergoing laparoscopic cholecystectomy. Patients were allocated to two groups. Group C received 50 micrograms of dexmedetomidine intravenously. Patients in group T received 50 micrograms of dexmedetomidine as an adjuvant to the 0.3% ropivacaine administered through the TAP block and RS block. The mean time for extubation in group C was 10.87 ± 1.71 minutes, and in group T was 4.37 ± 0.25 minutes, which was significant (p &lt; 0.05, 95% CI - 5.83 to 7.17). In addition, the median postoperative VAS in group T was significantly lower at six hours, 12 hours, and 18 hours postoperatively. Hence, we conclude that dexmedetomidine, administered in the interfascial plane for laparoscopic cholecystectomy surgery, provides a better recovery profile from general anesthesia and good postoperative pain relief.

31 Safety of Ultrasound-Guided Regional Anesthesia Performed by Emergency Physicians: A Systematic Review of Adverse Events

31 Safety of Ultrasound-Guided Regional Anesthesia Performed by Emergency Physicians: A Systematic Review of Adverse Events