Successful Anesthesia Research Articles

Successful emergency separation of premature omphalopagus conjoined twins: an anaesthetic experience

Anaesthesia for early emergency separation of premature conjoined twins is extremely rare as surgery generally done electively between 2 to 4 months of age. However, urgent separation may be needed due to life-threatening complications. We report a case of successful early separation of premature omphalopagus twins at 36 weeks of gestational age with a combined weight of 2.7 kg. To the best of our knowledge, this was the lowest weight yet reported of successful surgical separation in Malaysia. Early separation was indicated as extrauterine twin-to-twin transfusion with unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma potentially risked impending life-threatening organ failures. Anaesthesia for the separation of premature conjoined twins in the emergency setting requires extensive multidisciplinary discussion and planning. Factors predicting difficult anaesthesia in this case were the twins’ size and age as well as duration of anaesthesia. Two separate anaesthetic teams were required with all team members well versed in the operative workflow. Simultaneous airway management, prevention of hypothermia, and vigilant haemodynamic monitoring are key to successful anaesthesia in premature conjoined twin separation.

A pilot study of local anesthesia training using a mixed-reality haptic fidelity model.

One of the most difficult local anesthetic blocks to master in dentistry is the inferior alveolar nerve block (IANB). Historically, dental students have practiced local anesthesia on one another. At the University of Colorado, these practice sessions have been limited to one required laboratory session. The predictability and confidence of student IANB success have not been high in the past. Therefore, the objective of this study was to investigate the impact of a novel IANB simulator, built on a three dimensional (3D)-printed mixed-reality haptic model, for second-year dental students to practice on prior to their laboratory session. Thirty-nine student participants volunteered to practice with the IANB simulator. Participants were divided into two groups, Group A and Group B. Self-reported confidence and injection-specific accuracy were measured during IANB simulator practice and the laboratory session. During lab, partner numbness was assessed as a measure of IANB success. Groups A (n = 20) and B (n = 19) practiced with the simulator before and after laboratory, respectively. Injection domains were not assessed during Group B's practice with the IANB simulator. Self-reported confidence increased for both groups (p < 0.001). However, for anesthetic success, Group A exhibited significantly greater success (52.6%) than Group B (17.6%) (p = 0.029). Self-reported confidence in performing an IANB improved and higher anesthetic success was achieved for Group A. Further investigation is necessary to determine the long-term impact of using the IANB simulator in dental education.

Local Anesthetic Efficacy in Marijuana Users and Nonusers: A Pilot Study.

Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers. Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals. A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia. No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.

Thoracal Segmental Spinal Anesthesia for Lower Back Lipoma Excision

Background: General anesthesia is the most preferred anesthetic management for lower back surgery, considering the location and practicality. However, multiple studies showed that regional anesthesia, particularly thoracal segmental, spinal anesthesia, had more advantages compared to general anesthesia. Case presentation: We report a 19-year-old woman admitted to the OR for infected lipoma in lower back region, located in thoracal 12th, who underwent successful thoracal segmental spinal anesthesia. Conclusion: This is an original case report which showed significance of thoracal segmental spinal anesthesia and the advantages compared to general anesthesia.

Complete repeat cytoreduction under regional anesthesia in a patient with myasthenia gravis: a clinical case

The article summarizes the published data on the prevalence, pathogenesis, features of clinical presentation, and treatment of myasthenia gravis and myasthenic crises. Particular attention is paid to the anesthesia method choice and perioperative management of patients with myasthenia gravis. A clinical case of successful combined spinal-epidural anesthesia for complete repeat cytoreductive surgery in a patient with moderate myasthenia gravis is presented.

Association Between Single-nucleotide Polymorphisms in Candidate Genes and Success of Pulpal Anesthesia after Inferior Alveolar Nerve Block

IntroductionThe present study aimed to investigate the possible association between the single-nucleotide polymorphisms (SNPs) in the SCN9A, SCN10A, SCN11A, OPRM1, and COMT genes and the success rate of pulpal anesthesia after inferior alveolar nerve block (IANB). MethodsA total of 70 patients (45 females and 25 males) presenting mandibular molar teeth with symptomatic irreversible pulpitis were included. Saliva samples were collected from the participants before the application of IANB. A standard IANB was performed with 1.8 mL 4% articaine with 1:100,000 epinephrine. Endodontic treatment was initiated 15 minutes after injection, and the patients were asked to report their pain level during the procedure on a 170-mm Heft-Parker visual analog scale. If the patient recorded a pain level of lower than 54 on the visual analog scale (no pain or mild pain), the anesthesia was considered successful. The DNA isolation and genotyping were performed, and the association between rs4286289, rs6746030, rs6795970, rs6801957, rs11709492, rs1799971, rs1799973, rs4680, rs6269, rs4633, and rs740603 SNPs and the success rate of anesthesia was investigated. ResultsThe anesthesia success rate was significantly lower for the GG genotypes (45%) than the GA and AA genotypes (90%) for rs6795970 in the SCN10A gene. Additionally, the A allele for rs6795970 and the T allele for rs6801957 in the SCN10A gene were significantly associated with higher anesthesia success rates. ConclusionsSNPs in the SCN10A gene affect the success rate of pulpal anesthesia after IANB.

Evaluating the Association of Anesthesia Type with Postoperative Complications in Patients Undergoing Ankle Fracture Repair

Category: Ankle Introduction/Purpose: General and neuraxial anesthesia are both successful anesthesia techniques used in many orthopaedic procedures. Neuraxial anesthesia involves local anesthetics placed around the central nervous system (CNS) and spinal anesthesia is a subtype where the anesthetic is injected into intrathecal space. General anesthesia is usually recommended in ambulatory surgeries for its rapid onset of action. However, current literature shows contradicting complication profiles between these two anesthesia types. The purpose of this study was to compare the complications and length of hospital stay between patients who underwent general anesthesia versus neuraxial anesthesia during the repair of ankle fractures. Methods: Patients undergoing open reduction and internal fixation (ORIF) for ankle fracture from 2014 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were stratified into 2 cohorts: general anesthesia and neuraxial anesthesia. In this analysis, demographics data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate analyses and multivariable logistical regression were performed. Results: Of 3,585 patients who underwent operative treatment for ankle fracture, 3,315 patients (92.5%) had general anesthesia and 270 (7.5%) had neuraxial anesthesia. Compared to patients who had general anesthesia, those who had neuraxial anesthesia were more likely to be older (58.0 vs 49.6 years old; p&lt;0.001), Caucasian (80.0% vs 71.9%; p=0.001), and have an ASA classification of III (38.1% vs 25.0%; p&lt;0.001). On bivariate analyses, patients who had neuraxial anesthesia were more likely to develop pulmonary complications (p=0.173) or extended length of stay more than 5 days (p=0.342) compared to the general anesthesia group. Following adjustment on multivariate analyses, the neuraxial anesthesia cohort no longer had increased likelihood of pulmonary complications or extended length of stay compared to the general anesthesia group. Conclusion: Prior studies have shown that neuraxial anesthesia methods are as effective as general anesthesia with fewer short- term outcomes. When compared to patients who underwent general anesthesia during ORIF for ankle fracture, neuraxial anesthesia patients experienced no significant increases in postoperative complications or extended length of hospital stay. In terms of the variables we explored in the NSQIP database, healthy ankle fracture patients could also benefit from neuraxial anesthetic methods, and they should be considered for this anesthetic type regardless of their lack of comorbidities that would make them high risk for general anesthesia.

Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis.

Symptomatic irreversible pulpitis is a painful clinical condition with a broad inflammatory component. Dental anesthesia in these patients is affected by the inflammatory process, reporting a high incidence of anesthesia failure. The aim of this systematic review and meta-analytical evaluation was to determine the effect of pre-treatment with tramadol in patients with symptomatic irreversible pulpitis, as well as for pain control and adverse effects. This study was registered in PROSPERO (ID: CRD42021279262). PubMed was consulted to identify clinical investigations comparing tramadol and placebo/local anesthetics in patients with symptomatic irreversible pulpitis. Data about the anesthesia, pain control, and adverse effects were extracted. Both the anesthetic success index and the adverse effects of local tramadol and placebo were compared with the Mantel–Haenszel test and odds ratio. Data analysis showed that the local administration of tramadol increased the anesthetic success rate when compared to placebo in patients with symptomatic irreversible pulpitis (n = 228; I2 = 0; OR = 2.2; 95% CIs: 1.30 to 3.79; p < 0.004). However, local administration of tramadol increased the risk of adverse effects when compared to placebo/local anesthetics (n = 288; I2 = 0; OR = 7.72; 95% CIs: 1.37 to 43.46; p < 0.02). In conclusion, this study shows that the local administration of tramadol increases the anesthetic success index when compared to placebo in patients with symptomatic irreversible pulpitis.

Bilateral Change in Vertical Hoof Force Distribution in Horses with Unilateral Forelimb Lameness before and after Successful Diagnostic Anaesthesia.

Simple SummaryLameness is the most common cause of reduced performance in equids. Therefore, its detection, accurate diagnosis, and appropriate treatment are important for animal welfare and economics. Subjective evaluation of a lame horse by visual assessment is prone to error. To objectify the examination, several computer-based systems have been developed. While kinematic investigations focus on the detection of movement asymmetries (e.g., of head, pelvis, withers) with the help of position sensors, kinetic examinations are based on pressure measurement under the hooves. In the current study, horses with unilateral forelimb lameness were equipped with a non-invasive pressure measurement system on both forelimbs simultaneously. Bilateral vertical force distribution (in kg) was evaluated during all phases of stance (landing, midstance, breakover) before and after diagnostic anaesthesia. Vertical force was reduced on the lame limb compared to the sound limb before diagnostic anaesthesia. After positive diagnostic anaesthesia, asymmetries were neutralised: vertical force increased on the lame limb, with breakover being most affected. In conclusion, the current pressure measurement system can be used to objectify lameness examinations in a clinical setting. Both lameness and diagnostic anaesthesia influence the particular phases of stance differently. This might contribute to a better understanding of equine gait and lead to individually optimised shoes.Kinetic examinations of horses with induced lameness as well as the effect of perineural anaesthesia in sound horses have shown promise, but clinical studies regarding the effect of diagnostic anaesthesia during the different stance phases are rare. Fourteen horses with unilateral forelimb lameness were examined with the Hoof™ System during trot to assess vertical force distribution (in kg) affecting both front hooves before and after diagnostic anaesthesia during landing, midstance, and breakover. For statistical analysis, a covariance analysis with repeated measurements regarding the limb (lame/sound) as well as anaesthesia (before/after) and the covariable body weight was performed. The p-values for the pairwise comparisons were adjusted using the Bonferroni–Holm correction (p < 0.05). For all phases of the stance, a significant interaction between the factors limb and anaesthesia was shown. Before diagnostic anaesthesia, vertical force was significantly reduced on the lame limb compared to the sound limb during landing (−25%, p < 0.001), midstance (−20%, p < 0.001) and breakover (−27%, p < 0.001). After anaesthesia, the difference between both forelimbs was not significant anymore for all phases. The vertical force on the lame limb increased significantly after positive anaesthesia during the whole stance phase, with breakover being most affected (+27%, p = 0.001). Pressure measurements with the Hoof™ System can be used to evaluate the effect of diagnostic anaesthesia in a clinical setting with pain-related vertical force asymmetries being neutralised after diagnostic anaesthesia. Breakover is the main event influenced by lameness.

Comparison of buffered and non‑buffered lidocaine: pH and pain perception

Commonly used local anaesthetic (LA) solutions in the field of dentistry are acidic, and have been known to cause pain and a burning sensation. The present study aimed to determine the pH levels of commercially available LA solutions with and without adrenaline and 8.4% sodium bicarbonate‑buffered LA solution, and to evaluate the pain during the administration of buffered and non‑buffered LA solutions. For this purpose, 20 patients with deep dentinal carious lesions with pulpal involvement affecting the bilateral posterior teeth and requiring the administration of a local nerve block were randomly selected to receive buffered and non‑buffered LA agents on either side, respectively. The patients were instructed to score the pain perceived during LA administration with the aid of a visual analogue scale (VAS) score of 1‑10. All the data obtained were subjected to statistical analysis. The results revealed that the LA solution of 2% lignocaine with 1:80,000 adrenaline buffered with sodium bicarbonate had a mean (± SD) pH level of 6.92±0.34 and non‑buffered LA solution had a mean pH level of 3.49±0.26. As per the VAS, a greater level of pain was reported during the non‑buffered LA administration (3.15±1.27) compared to the buffered LA administration (1.40±0.68). Buffered local anaesthetics were more likely than non‑buffered solutions to achieve successful anaesthesia [95% confidence interval (CI), 1.09‑2.41; P&lt;0.001]. On the whole, the present study demonstrates that a significant reduction in the pain perceived in patients during the administration of LA agents buffered with sodium bicarbonate when used during pulpal involvement.

Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double-blind single-centre clinical trial.

The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4ml 4% articaine hydrochloride with 1:100 000 adrenalin (n=165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre-disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

A Review of Anesthesia for Lung Transplantation.

Lung transplantation is the only treatment option for patients with end-stage lung disease. Although more than 4,000 lung transplants are performed every year worldwide, the standardized protocols contain no guidelines for monitoring during lung transplantation. Specific anesthetic concerns are associated with lung transplantation, especially during critical periods, including anesthesia induction, the initiation of positive pressure ventilation, the establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Anesthetic management according to the special risks associated with a patient’s existing lung disease and surgical stage is the most important factor. Successful anesthesia in lung transplantation can improve hemodynamic stability, oxygenation, ventilation, and outcomes. Therefore, anesthesiologists must have expertise in transesophageal echocardiography, extracorporeal life support, and cardiopulmonary anesthesia and understand the pathophysiology of end-stage lung disease and the drugs administered. In addition, communication among anesthesiologists, surgeons, and perfusionists during surgery is important to achieve optimal patient results.

Moderate sedation with single-dose remimazolam tosilate in elderly male patients undergoing transurethral resection of the prostate with spinal anesthesia: a prospective, single-arm, single-centre clinical trial

BackgroundRemimazolam tosilate (RT) is a newly listed benzodiazepine for sedation and anesthesia featuring quick onset of effects, short maintenance and recovery times, which is currently under research. This trial was conducted to determine the median effective dose (ED50) and the 95% effective dose (ED95) of single-dose remimazolam for moderate sedation in elderly patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia, and to evaluate its efficacy and safety.MethodsThirty male patients aged 65–80 years old were recruited for selective TURP. Remimazolam was administered intravenously to pain-free patients (VAS score < 1) within 1 min of successful spinal anesthesia by the same anesthesiologist. We used modified Dixon’s up-and-down sequential allocation method to determine the ED50 and ED95 of the agent with an initial dosage of 0.1 mg/kg. Successful sedation was defined as an MOAA/S score ≤ 3 and above 1. A score of > 3 was deemed as failed sedation. Recruitment continued until ten independent pairs (from successful sedation to failed sedation) would give a reliable estimation of the ED50 and ED95 of RT and their 95% confidence intervals.ResultsThe ED50 of remimazolam was 0.063 (95% C.I. 0.045–0.073) mg/kg. Its ED95 was 0.079 (95% C.I. 0.07–0.137) mg/kg. Remimazolam was safe in its application.ConclusionsA single-dose of RT proves to be safe for assisted sedation during TURP in elderly male patients under spinal anesthesia with a lower incidence of adverse events. Its ED50 and ED95 were 0.063 mg/kg and 0.079 mg/kg, respectively.Trial registrationhttp://www.chictr.org.cn (ChiCTR2100051912).

The effect of successful hindlimb diagnostic anaesthesia on thoracolumbar displacement measured with kinematic analysis of horses trotting in hand

The effect of successful hindlimb diagnostic anaesthesia on thoracolumbar displacement measured with kinematic analysis of horses trotting in hand

Octogenarian with Severe Left Ventricular Dysfunction and Cardiac Resynchronization TherapyDefibrillator Device: Successful Anesthesia Management for Hip Arthroplasty

Cardiac resynchronization therapy has emerged as a key component in management of advanced heart failure with reduced ejection fraction in selected subset of geriatric patients. The burgeoning burden of comorbidities, complexity of these devices and aging population presenting for surgeries necessitates peri-operative physicians to be cognizant and confident to handle these challenging cases. Limited literature about anesthesia management of patients implanted with these devices add to the situational challenge. We present a case of elderly gentleman with ischemic cardiomyopathy and cardiac resynchronization therapy-defibrillator device who underwent hip replacement under general anesthesia. Understanding the disease and the device are the crucial and definitive exigencies to manage such cases.

Dexamethasone Increases the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis.

Inferior alveolar nerve block (IANB) has a high failure rate in subjects with symptomatic irreversible pulpitis (SIP). It has been suggested that drugs with anti-inflammatory activity could improve the efficacy of the anesthetic used for IANB. The aim of this study was to assess the effect of dexamethasone on the success of dental anesthesia in patients with SIP. An information search was performed using PubMed and Google Scholar. The risk of bias of the included studies was evaluated with the Cochrane Collaboration’s risk-of-bias tool. The anesthetic success rate, pain intensity (VAS), and adverse effects were extracted. Data were analyzed using the Mantel–Haenszel test and odds ratio or the inverse variance and standardized mean difference. Dexamethasone increased the anesthetic success in comparison with placebo (n = 502; p < 0.001; OR = 2.59; 95% CIs: 1.46 to 4.59). Moreover, patients who were given dexamethasone had lower pain scores at 6 h (n = 302; p < 0.001; MD= −1.43; 95% CIs: −2.28 to −0.58), 12 h (n = 302; p < 0.0001; MD = −1.65; 95% CIs: −2.39 to −0.92), and 24 h (n = 302; p < 0.0008; MD = −1.27; 95% CIs: −2.01 to −0.53) when compared with placebo. In conclusion, the systemic administration of dexamethasone increases the anesthetic success rate and improves pain management in patients with SIP.

One lung ventilation in left sided cystic hygroma: Anaesthesia challenges

Cystic hygroma [CH], also called as cavernous lymphangioma is a histologically benign congenital tumor of lymphatic origin. Its presence in the cervical region,most common site [25%] poses multiple challenges to the anaesthetist which includes tumor extension in oral and thoracic cavity, restricted neck movements, airway management, haemorrhage, post-operative respiatory obstruction and coexisting anomalies [down syndrome, turner syndrome, and congenital cardiac defects]. The recommended treatment is surgical excision which can be achieved with no mortality and little morbidity. The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however requires an efficient technique for one lung ventilation. Today there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. Significant differences exist between airways of the neonate and the adult. Anaesthetic management of the airway is challenging in neonates and young infants with large neck mass like huge cystic hygroma because these patients are at risk for sudden complete airway occlusion resulting in hypoventilation and hypoxemia. We report a successful anaesthesia management in an infant undergoing video assisted thoracoscopic excision of cystic hygroma in left side of neck which was extending to anterior mediastinum under general anaesthesia.

Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.

The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.

Effects of hydrodissection on anesthesia characteristics in ultrasound guided infraclavicular brachial plexus blockade.

Background:The development of ultrasonography technology and its widespread application have increased peripheral nerve block applications, especially in limb surgeries, since it reduces complication rates and increases success rates in peripheral nerve block applications. However, even experienced physicians need to direct a large number of needles and injections for adequate local anesthetic spread, which can cause accidental vascular puncture and local anesthetic systemic toxicity. Such complications can be prevented by hydrodissection and a safer and successful anesthesia can be provided to patients in this study, it was aimed to investigate the effects of hydrodissection on anesthesia characteristics in the infraclavicular brachial plexus blockade.Materials and methods:Ninety patients were included in our study after approval by the Ethics Committee. These patients were randomly divided into 2 groups (Group I: Infraclavicular brachial plexus blockade with normal method and Group II: infraclavicular brachial plexus blockade with hydrodissection). After obtaining patient consent, monitoring and vascular access were provided. Group I patients were mixed with 30 mL of local anesthetic mixture (15 mL of distilled water and 15 mL of 0.5% bupivacaine), and Group II patients were treated with 15 mL of distilled water by hydrodissection and 15 mL of 0.5% bupivacaine anesthesia resident. Block characteristics were evaluated and recorded every 5 minutes for the first 30 minutes by a blinded observer. The sensory block score was 7, the total score was 14 or above, and the block was considered successful, and the patient was ready for surgery. Postoperative block removal times, analgesia, and complications were evaluated and recorded.Results:A significant difference was found between the sensory and motor block onset times and postoperative VAS scores between the normal and hydrodissection groups (P < .05). There were no significant differences in terms of block application times, postoperative block removal times, and complications between the groups.Conclusion:In this study, it has been shown that hydrodissection in peripheral nerve blocks does not lag in terms of block success and characteristics compared to normal methods, whereas anesthetists with less experience in peripheral nerve block experience obtain safer and more successful results in practice.

Anaesthesia for non‐cardiac surgery of a dog with tetralogy of Fallot with pulmonary atresia

AbstractTetralogy of Fallot with atresia of the pulmonary artery (ToF‐PA) is a rare congenital cardiac malformation. The life expectancy of affected canine individuals is short: in fact, only puppies or young adults with ToF‐PA are described in literature. Typically, these patients require general anaesthesia for diagnostic procedures, and are considered at high risk for anaesthesia‐related complications. The present report describes successful anaesthesia for dental surgery of a 12‐year‐old dog affected by ToF‐PA and an extracardiac shunting vessel connecting aorta and pulmonary artery. The echocardiographic findings are described and the anaesthetic protocol and the complications encountered during anaesthesia are discussed.