Extubation Time Research Articles

Effect of dexmedetomidine on postoperative nausea and vomiting in patients under general anaesthesia: an updated meta-analysis of randomised controlled trials

ObjectivesTo explore the effect of dexmedetomidine (DEX) on postoperative nausea and vomiting (PONV) in adult patients after general anaesthesia.DesignSystematic review and meta-analysis.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs) comparing...

Effect of sugammadex on postoperative nausea and vomiting after surgery for intracranial aneurysm

Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),>0.5-2.0 hours(T2),>2.0-6.0 hours (T3),>6.0-12.0 hours (T4) and >12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). The results regarding the occurrence of complications in patients with different levels of PONV at different time intervals after surgery in the two groups were as follows: in the T3 time period of group N, a significant difference was observed only in the occurrence of postoperative complications among patients with different levels of PONV (χ2=24.786, P<0.01). However, in the T4 time period, significant differences were found in the occurrence of postoperative complications among both the same level and different level PONV patients (χ2=15.435, 15.435, both P<0.01). Significant differences were also observed in the occurrence of postoperative complications among the same level and different level PONV patients in both the T3 and T4 time periods of group S (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.

Septorinoplasti Olgularında Sevofluran İnhalasyon Anestezisi ve Propofol İle Uygulanan Total İntravenöz Anestezinin Postoperatif Boğaz Ağrısı ve Bulantı-Kusma Açısından Karşılaştırılması

Objective: The objective of this prospective observational study was to compare the use of inhalation anesthesia with sevoflurane and total intravenous anesthesia with propofol in terms of sore throat and postoperative nausea/vomiting in elective septorhinoplasty cases under general anesthesia. Methods: This study was conducted using the data of 52 participating patients. Following induction of anesthesia, Group 1 (n=26) received sevoflurane inhalation and remifentanil infusion, while Group 2 (n=26) received intravenous propofol and remifentanil infusion. The presence of nausea/vomiting, the presence and severity of sore throat, extubation times, and the number of patients who were given additional analgesics and antiemetics were recorded at the end of operation. Results: Within post-anesthesia care unit, Group 2 had less sore throat at the postoperative 2nd, 6th, and 12th h (p values, respectively: 0,014; 0,004; 0,015; 0,044. The number of patients receiving additional analgesics in the postoperative period was 19 in Group 1 and 9 in Group 2 (p=0.005). The results of the groups in terms of postoperative nausea/vomiting were similar. Conclusion: In septorhinoplasty operations, total intravenous anesthesia with propofol resulted in less sore throat and reduced postoperative analgesic use compared to inhalation anesthesia with sevoflurane. Keywords: Sore throat, nausea and vomiting, propofol, septorhinoplasty, sevoflurane, TIVA

DEXMEDETOMIDINE/ FENTANYL INFUSION IN OPEN CARDIAC SURGERIES

Background: patients of open heart surgeries are now a days extudated early for fasttraking &amp; improve patient outcome. Aims and Objectives: To compare the efficacy of dexmedetomidine/ fentanyl for sedoanalgesia&amp; time ro extubation in post-operative adult cardiac surgical patients. Methods: A prospective randomized double-blind study involving 60 adult patients undergoing open heart surgery were divided into two groups, each involving 30 patients. One group received fentanyl at 1 µg/kg/h (Group A) and the other received dexmedetomidine at 0.5 µg/kg/h (Group B) for post-operative sedation with intermittent rescue dose of fentanyl 0.5 µg/kg bolus in either group as rescue analgesia as per requirement. The efficacy of sedation was assessed using the Ramsay sedation score. The time taken for extubation from the stoppage of infusion was noted.Patients were enrolled in two Randomised groups of 30 patients each. With occasional rescue doses of fentanyl 0.5 g/kg bolus in either group as needed, one group (Group A) received fentanyl at 1 g/kg/h and the other (Group B) received dexmedetomidine at 0.5 g/kg/h for postoperative sedation. The Ramsay sedation score was used to evaluate the effectiveness of the sedation. It was noticed how long it took to extubate once the infusion was stopped. Results: Haemodynamic parameters between the two groups were comparable. Sedation scores between fentanyl and dexmedetomidine groups were comparable. Average time (in minutes) required for extubation was 100.04 (±43.6 SD) in the dexmedetomidine group compared with 159.4 (±93.3 SD) in the fentanyl group. The difference in mean time for extubation was statistically significant. Conclusions: As compare to fentanyl , Dexmedetomidine facilitates adequate sedation for mechanical ventilation and also provide early extubation.

Utilization of deep neuromuscular blockade combined with reduced abdominal pressure in laparoscopic radical gastrectomy for gastric cancer: An academic perspective.

Few studies have examined the specific efficacy of deep neuromuscular blockade (NMB) combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy (LRG) in the elderly. To investigate the application effect of deep neuromuscular blockade (NMB) combined with reduced pneumoperitoneum pressure in LRG for gastric cancer (GC) in elderly patients and its influence on inflammation. Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed. Among them, 45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group, while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group. The two groups were compared in the changes of the Leiden-surgical rating scale score, serum tumor necrosis fact-α (TNF-α) and interleukin 6 (IL-6) before and after therapy. The visual analogue scale (VAS) was adopted for evaluating the shoulder pain of patients at 8 h, 24 h and 48 h after the operation. The driving pressure of the two groups at different time points was also compared. Additionally, the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room, TOF% = 90% time and post-anesthetic recovery room (PACU) stay time were all recorded, and adverse PACU-associated respiratory events were also recorded. The postoperative hospitalization time and postoperative expenses of the two groups were counted and compared. No significant difference was found between the two groups at the time of skin incision, 60 minutes since the operation and abdominal closure after surgery (P > 0.05). The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery (P < 0.05). Additionally, the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum (P < 0.05). Additionally, the two groups were similar in terms of the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room and TOF% = 90% time (P > 0.05), and the observation group showed significantly lower TNF-α and IL-6 Levels than the control group at 24 h after therapy (P < 0.05). Moreover, the incidence of adverse events was not significantly different between the two groups (P > 0.05), and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group (P < 0.05). Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction, without hindering the surgical vision and increasing adverse PACU-associated respiratory events, and can thus shorten the hospitalization time and treatment cost for patient.

Comparision of Laryngeal Mask Airway and Endotracheal Tube for Post-Operative Sore Throat and Hoarseness of Voice

Objective: To compare effectiveness of Laryngeal mask airway versus endotracheal tube to evaluate post-operative sore throat and hoarseness of voice among anesthetized adults. Study Design: Prospective comparative study Place and Duration of Study: Operation Theatre Complex, Surgical Ward 1 and 2, Combined Military Hospital, Lahore Pakistan, from Jun to Oct 2020. Methodology: A total of 70 patients of both gender undergoing elective surgeries were included. Afterwards a lottery method was applied to segregate patients randomly into Group-L and Group-T. In Group-L, airway was secured with laryngeal mask airway while in Group-T, airway was secured with endotracheal tube. Hoarseness of voice was evaluated at time of extubation and 24 hours post extubation. Results: Demographic data was comparable in both groups. Mean time of anesthesia was 71.31±22.87 and 82.86±32.34 minutes for Group-L and Group-T respectively with p-value of 0.09. Sore throat was seen in 12(34.29%) patients in Group-L as compared to 19(51.43%) in Group-T (p-value=0.094). Hoarseness of voice was seen in 3(8.57%) patients in Group-L as compare to 13(37.14%) in Group-T (p-value= 0.005). Conclusion: There was less occurrence of postoperative sore throat and hoarseness of voice in patients undergoing elective surgery with laryngeal mask airway as compared with endotracheal tube.

Comparison of the Jcerity endoscoper airway and the endotracheal tube in endoscopic esophageal variceal ligation: a prospective randomized controlled trial

Various airway techniques have been used in endoscopic esophageal variceal ligation (EVL). In this respect, Jcerity endoscoper airway (JEA) is a novel laryngeal mask airway that is designed for use in gastrointestinal endoscopy. In the present study, 164 patients who underwent EVL were randomly divided into JEA group or endotracheal tube (ETT) group (ratio: 1:1). Success rate of endoscopic procedure, endoscope insertion time, procedure duration, recovery time, airway technique extubation time, anesthesia costs, hospital stay duration, complications, and hemodynamic parameters were recorded. The success rate of EVL in the JEA group was noninferior to that in the ETT group (98.8% vs. 100.0%). The airway insertion time, anesthesia duration, and recovery time were significantly shorter in the JEA group than in the ETT group (p < 0.001). Furthermore, the blood pressure during extubation was more stable in the JEA group (p < 0.001). Moreover, there were less heart rate variations during intubation (p < 0.005) and extubation (p < 0.05) in the JEA group. Nonetheless, the endoscopists’ satisfaction scores were comparable between the two groups. Overall, our findings suggest that JEA is efficient and safe for clinical use in EVL.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031892, Registered April 13, 2020, https://www.chictr.org.cn/searchproj.html.

Bedside electrical impedance tomography (EIT) for early assessment of lung function in liver transplantation.

Early extubation after liver transplantation is recommended by the Enhanced Recovery After Surgery Society (ERAS guideline 2022) as the benefit to avoid prolonged mechanical ventilation and associated complications. The timing of extubation is challenged by early postoperative hypoxia due to both preoperative and surgical status. Timely identifying the cause of hypoxia, typically including hepatopulmonary syndrome (HPS), pulmonary edema, atelectasis, and effusion is critical to prevent delayed extubation, especially in cases with HPS. As a radiation-free bedside approach, electrical impedance tomography (EIT) facilitates real-time lung ventilation and perfusion(V/Q) monitoring, however, the applicability of EIT V/Q monitoring for the assessment of HPS and its value for the management of hypoxia after liver transplantation has never been reported. Under this context, we took the lead in monitoring V/Q with EIT for a 12-year-old girl diagnosed with HPS who suffered intra and post liver transplantation hypoxia at the bedside. Our image raises key points for physicians that: 1) V/Q measurement of intrapulmonary shunts with bedside EIT holds the potential to identify HPS, a novel application that requires clinical validation. 2) EIT helps timely identify hypoxia after liver transplantation to support early individualized respiratory interventions. To our knowledge, V/Q monitoring by EIT is increasingly used in respiratory therapy, especially for ARDS PEEP titration, pulmonary embolism detection and lung transplantation assessment. However, The potential of EIT in liver transplant patients has been rarely studied. Our images might provide a novel and convenient approach to diagnosis HPS at bedside and offer new clinical applications for EIT imaging techniques.

Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy.

To observe the clinical effect of botulinum toxin type A (BTA) injection into the salivary glands of the severe neurological patients with tracheotomy METHODS: Seven patients with severe neurological disorders after tracheotomy and obvious drooling symptoms were enrolled. BTA was injected into bilateral parotid glands and submandibular glands under the guidance of ultrasound. Unstimulated salivary flow rate (uSFR) and Drooling Severity and Frequency Scale (DSFS) were used to evaluate drooling before injection, 1 week, and 4 weeks after injection. We compared the extubation time, time of changing from balloon cannula to metal cannula, hospitalization time and incidence of recurrent pulmonary infection between these patients and other patients accepted conventional curation. (1) The drooling severity scale (DSFS-S), the drooling frequency scale (DSFS-F), the drooling frequency and severity scale total score (DSFS-T) were significantly lower at 4 weeks after BTA injection compared to prior-treatment (p<.001). (2) uSFR of 1 week and 4 weeks were both statistically decreased than the untreated condition (p<.001). (3) Compared with the conventional group, the time of changing from balloon cannula to metal cannula was shortened obviously (p<.05) and incidence of recurrent pulmonary infection was clearly decreased (p<.05) after BTA treatment CONCLUSION: Ultrasound-guided BTA injection into salivary glands can effectively reduce saliva secretion. We also found that the time of changing cannula was shortened obviously and the incidence of recurrent pneumonia infection was reduced. BTA injection of salivary glands to cure drooling could advance to the clinical therapy in severe neurological patients after tracheotomy.

Comparison of remimazolam-remifentanil and propofol-remifentanil during laparoscopic cholecystectomy.

Remimazolam is a novel benzodiazepine with fast onset and short half-life. We compared the effects of remimazolam and propofol on recovery profiles for general anesthesia in patients undergoing laparoscopic cholecystectomy. We randomly assigned 108 patients to either a remimazolam (n=54) or propofol (n=54) group. Remimazolam and propofol were used for induction and maintanance of anesthesia. Following anesthesia, we recorded the time until an Aldrete score of 9 was achieved. The time to reach a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 2 and the time from the end of anesthesia to eye opening time, recovery time of orientation, time to spontaneous breathing, extubation time, and the time required for analgesics were measured. Heart rate, blood pressure, and bispectral index were assessed before, during, and after pneumoperitoneum. We included 101 patients in the analysis. In the remimazolam group, it took longer to reach an Aldrete score of 9 after the drug infusion ended (P = 0.031). There was no difference in the time to reach MOAA/S 2 between the two groups. The time to eye opening, recovery time of orientation, and time required for analgesics were longer and heart rate was higher in the remimazolam group. Neither blood pressure, nor extubation time differed between groups. Remimazolam and propofol provided safe induction and maintenance of anesthesia in patients undergoing laparoscopic cholecystectomy. The recovery time from anesthesia with remimazolam is longer than that with propofol. Fewer hemodynamic changes were observed with remimazolam, but further studies are needed.

Effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery: a double-blind, randomized trial

AimTo investigate the effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery with cardiopulmonary bypass (CPB).MethodsA total of 180 patients undergoing elective heart valve surgery with CPB were randomly divided into four groups: 45 in group P (intravenous penehyclidine hydrochloride 0.02 mg/kg 10 min before anesthesia induction and at the beginning of CPB, total 0.04 mg/kg); 43 in group D (dexmedetomidine 0.5 μg/kg/h after induction of anesthesia until the end of anesthesia); 44 in group PD ( penehyclidine hydrochloride 0.04 mg/kg combined with dexmedetomidine 0.5 μg/kg/h intravenously during anesthesia); and 43 in group C (same amount of normal saline 10 min before and after anesthesia induction, to the end of anesthesia, and at the beginning of CPB). The main outcomes were the incidence and severity of postoperative pulmonary complications (PPCs). The secondary outcomes were: (1) extubation time, length of stay in intensive care, and postoperative hospital stay, and adverse events; and (2) pulmonary function evaluation indices (oxygenation index and respiratory index) and plasma inflammatory factor concentrations (tumor necrosis factor-α, interleukin-6, C-reactive protein and procalcitonin) during the perioperative period.ResultsThe incidence of PPCs in groups P, D and PD after CPB was lower than that in group C (P < 0.05), and the incidence in group PD was significantly lower than that in groups P and D (P < 0.05). The scores for PPCs in groups P, D and PD were lower than those in group C (P < 0.05).ConclusionCombined use of penehyclidine hydrochloride and dexmedetomidine during anesthesia reduced the occurrence of postoperative pulmonary dysfunction, and improved the prognosis of patients undergoing heart valve surgery with CPB.Trial registrationThe trial was registered in the Chinese Clinical Trial Registry on 3/11/2020 (Registration No.: ChiCTR2000039610).

Is a soft tissue reinforcing mesh necessary in immediate prosthetic breast reconstruction for early breast cancer in patients with low-volume breast? A single-center, retrospective Chinese clinical study.

It is controversial as to whether soft tissue reinforcement mesh should be used for immediate prosthetic breast reconstruction after nipple-sparing mastectomy for low-volume breast early breast cancer (LVBEBC) in Chinese adult women. We collected data on 89 patients with LVBEBC who underwent such a surgery and divided them into two groups: 39 patients in the totally subpectoral prosthesis-only breast reconstruction group (simple group) and 50 patients in the prosthesis-combined titanium-coated polypropylene mesh (TCPM) group (or the so-called "dual plane" or "mesh-assisted partially subpectoral breast reconstruction group") (combined group). The results demonstrated no difference in operative time, intraoperative bleeding, and postoperative complications between the two groups; however, total drainage volume and extubation time were less and shorter, respectively, in the combined group. The median follow-up time was 18.6months without local recurrence or distant metastasis in both groups. At 24months after surgery, the excellent and good rates of breast reconstruction were higher in the combined group. However, patients' BMI, breast morphology, and breast volume of 300mL or more had an effect on the shape of the reconstructed breast; in addition, in patients with higher BMI, conical breast morphology, and breast volume over 300mL, the shape of the breast was more perfect with the prosthesis combined with TCPM reconstruction.Trial registration: This retrospective study was "retrospectively registered" in the Sixth Affiliated Hospital of South China University of Technology of China on March 15, 2022 (No. 2022018) and in the National Medical Research Registry filing system of China ( https://www.medicalresearch.org.cn ) (No. MR-44-22-003618).

Airway management under general anesthesia for infants and young children with the first and second branchial syndrome featuring unilateral mandibular dysplasia: A case series of 8 children

ObjectiveTo investigate and summarize the airway management methods for infants and young children of the first and second branchial syndrome featuring mandibular dysplasia, and to evaluate the auxiliary effect of direct laryngoscope and video laryngoscope during tracheal intubation. MethodsFrom March 2017 to March 2022, 8 cases with the first and second branchial syndrome featuring absent or hypoplastic mandibular ascending ramus that underwent cleft palate repair or transverse facial cleft repair under general anesthesia were retrospectively reviewed and summarized. The information such as demographic data, preoperative airway assessment, mask ventilation effect, anesthesia method, anesthesiologist's evaluation of laryngoscope exposure and intubation, operation method, operation time, and extubation time was collected. ResultsThe median age of the 8 children was 12 months; none of them had limitation of mouth opening, 4 had snoring during sleep, 2 had unilateral absence of the ascending ramus of the mandible, and 6 had partial absence. Of the 8 children, 3 underwent cleft palate repair, and 5 underwent transverse facial cleft repair. During anesthesia induction, 1 case of mask ventilation was graded as Grade 2, and the other 7 cases were graded as Grade 1; the Cormack-Lehane (C-L) grade of glottic exposure by direct laryngoscope was graded as Grade 3 (3 cases) and Grade 4 (5 cases), and the C-L grade by video laryngoscope was graded as Grade 1 (4 cases) and Grade 2 (4 cases). All the children completed video laryngoscope-assisted intubation successfully in one time. The extubation was completed smoothly, without complications related to anesthesia. The median operation time was 50 minutes, and the median time from end of operation to extubation was 240 seconds. ConclusionFor anesthesia of infants and children with the first and second branchial syndrome, especially those with hypoplasia of the mandible, a comprehensive preoperative assessment is needed, and direct laryngoscope may lead to difficulty in glottic exposure, and adequate planning for difficult airway management is necessary.

Ulinastatin, A Multivalent Serine Protease Inhibitor, Improves Recovery of Pancreatic Cancer Patients Undergoing Laparoscopic Surgery

We aimed to explore the effect of an intravenous infusion of lidocaine combined with ulinastatin on perioperative analgesia and recovery for pancreatic cancer patients undergoing laparoscopic surgery. Postoperative extubation time, time of stay in the recovery room after anesthesia, gastrointestinal function recovery time, and hospital stay in the observation group were all lower in the group receiving ulinastatin. Also, there was a decrease in the Visual Analogue Scale scores for pain at rest and cough in the group receiving ulinastatin. The serum levels of pro-inflammatory cytokines interleukin-6, interleukin-8, and tumor necrosis factor-α were lower in the group receiving ulinastatin. In summary, ulinastatin improves the effect of lidocaine on perioperative analgesia and postoperative recovery of pancreatic cancer without additional side effects during laparoscopic-assisted surgery.

Effect of perioperative application of dexmedetomidine on post-operative stress reaction, pain and prognostic adverse effects in patients undergoing gynaecological laparoscopy.

The aim of this study was to analyse the effect of perioperative dexmedetomidine (DEX) application on stress response, post-operative pain and prognosis in patients undergoing gynaecologic laparoscopy. One hundred and sixty-eight patients admitted for gynaecologic laparoscopic surgery from May 2020 to November 2022 were included in the study. The patients were randomly divided into pre-operative DEX group (n = 56), intraoperative DEX group (n = 56) and post-operative DEX group (n = 56) according to the application of DEX in the perioperative period. The visual analogue scale (VAS), time awake, extubation time, pneumoperitoneum time, post-anaesthesia care unit (PACU) stay time and Richmond agitation-sedation scale score (RASS) were recorded. Patients in both the pre-operative and intraoperative DEX groups had substantially shorter wakeup and extubation times than those in the post-operative DEX group. Patients in the pre-operative DEX group had considerably shorter wakeup and extubation times than those in the intraoperative DEX group, and their pneumoperitoneum time was significantly shorter than that of the post-operative DEX group (P < 0.001). The RASS scores of the pre-operative DEX group and intraoperative DEX group were significantly lower than those of the post-operative DEX group at 1 h, 6 h and 12 h after surgery. Meanwhile, at all time periods, the RASS scores of patients in the pre-operative DEX group were considerably lower than those in the intraoperative DEX group (P < 0.01). The VAS scores of patients in the pre-operative DEX group and intraoperative DEX group were evidently lower than those in the post-operative DEX group at 0.5 h, 2 h and 12 h postoperatively, and the VAS scores of patients in the pre-operative DEX group were markedly lower than those in the intraoperative DEX group (P < 0.001). The incidence of nausea and vomiting was significantly lower in the pre-operative DEX group than in the intraoperative DEX group and the post-operative DEX group at 0-2 h, >2-12 h and >12-24 h postoperatively (P < 0.001). The incidence of nausea and vomiting in the intraoperative DEX group was significantly lower than that in the post-operative DEX group from 0 to 2 h after surgery (P < 0.05). The incidence of adverse reactions was not significantly different amongst the three groups of patients (P > 0.05). Pre-operative and intraoperative application of DEX can help reduce post-operative pain and stress responses, help patients recover quickly after surgery and improve patient prognosis, especially the pre-operative application of DEX.

Comparing postoperative analgesia of bilateral serratus anterior plane block and thoracic paravertebral block for children following the Nuss procedure: protocol for a randomised, double-blind, non-inferiority clinical trial

IntroductionThe Nuss procedure, despite being a minimally invasive surgery, is regarded as one of the most painful surgical procedures in children, and postoperative pain control remains a major clinical issue...

Effect of preemptive ultrasound-guided TAP block on intraoperative analgesic requirements in patients undergoing laparoscopic gynecological surgeries under general anesthesia: A prospective, randomized controlled study

Background: Pain could lead to an increased consumption of opioids intraoperatively as well as postoperatively with subsequent side effects and prolonged post-operative recovery. Transverse abdominus plain (TAP) block is commonly used for post-operative analgesia. We wanted to study the effect of TAP block, when given as pre-emtive analgesia. Aims and Objectives: The study was conducted to ascertain the benefit TAP block when given before surgical incision. The primary objective was to study the intraoperative fentanyl requirement in patients undergoing Laparoscopic gynecological surgeries. The secondary objectives was to analyze the Intra-operative hemodynamic parameters, time needed to extubate the patient, sedation score, visual analog scale (VAS) scores, and the time of first rescue analgesia. Materials and Methods: Sixty-two eligible female patients posted for total laproscopic hysterectomy or Laproscopic-assisted Vaginal Hysterectomy coming were divided into two groups. Group A – Standard General Anaesthesia with pre-operative TAP block. Group B- Standard General Anaesthesia. Whenever there was 15% rise in heart rate (HR) or mean blood pressure (MBP) above the baseline, 20 mcg bolus of fentanyl was given. Total intra-operative Fentanyl consumption, intraoperative HR and MBP, time needed to extubate, post-operative sedation, VAS score, and time of first rescue analgesia was noted. Results: There was no difference in the demographic profile between two groups. The mean intraoperative fentanyl required was significantly higher in Group B (140.33±12.17 mcg) than in Group A (101.33±5.07 mcg). HR and MBP were lower in Group A throughout the procedure. The mean time of extubation was 5.4 min and 15.77 min in Group A and B. The mean sedation score observed was significantly higher up to 30 min in Group B. Mean Time of first rescue analgesia in Group A was 452.90±110.46 min and Group B was 240±89.13 min. Conclusion: Pre-operative TAP block given in laparoscopic gynecological surgeries decreases intraoperative fentanyl consumption leading to early extubation and causes less sedation in early post-operative period.

Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia

Background Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety. Aim To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP). Patients and methods In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery. The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications. Results There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min. Conclusion The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.

Safety and feasibility of ultrasound-guided serratus anterior plane block and intercostal nerve block for management of post-sternotomy pain in pediatric cardiac patients: A prospective, randomized trial

BackgroundPostoperative analgesia in the cardiothoracic ICU has traditionally relied on intravenous opioids. Thoracic nerve blocks are attractive alternatives for analgesia that reduce the requirement for opioids, but their safety and feasibility remain unclear. MethodsSixty children were allocated randomly to three groups: group C received intravenous opioids alone, while group SAPB (deep serratus anterior plane block) and group ICNB (intercostal nerve block) received opioids combined with ultrasound-guided regional nerve blocks (0.2% ropivacaine 2.5 mg.kg−1) after patients were transferred to the ICU. The primary outcome was opioid requirement in the first 24 h after surgery. Other outcomes included the postoperative FLACC scale value, tracheal extubation time, and plasma ropivacaine concentrations after the block. ResultsThe mean [sd] cumulative dose of opioids administered postoperatively within 24 h in the SAPB (168.6 [76.9] μg.kg−1) and ICNB groups (170.0 [86.8] μg.kg−1) were significantly lower by nearly 53% than those in group C (359.3 [125.3] μg.kg−1, p = 0.000). The tracheal extubation time was shorter in the regional block groups than that in the control group, but the difference was not statistically significant (p = 0.177). The FLACC scale values at 0, 1, 3, 6, 12, and 24 h post-extubation were similar in the three groups. The mean peak plasma ropivacaine concentrations in the SAP and ICNB groups were 2.1 [0.8] and 1.8 [0.7] mg.L−1, respectively, 10 min post-block and then slowly decreased. No noticeable complications associated with regional anesthesia were observed. ConclusionsUltrasound-guided SAPB and ICNB provided safe and satisfactory early postoperative analgesia while reducing opioid consumption following sternotomy in pediatric patients. Clinical trial registrationChinese Clinical Trial Registry ChiChiCTR2100046754.

Meta-analysis of the effect of entropy-assisted general anesthesia on the quality of postoperative recovery.

To evaluate the effect of the quality of postoperative anesthetic resuscitation in patients with entropy index monitoring assisted general anesthesia versus standard clinical practice. The randomized controlled trials on the application of entropy index monitoring in general anesthesia were searched in PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and other databases by computer. The data were collected from inception to January 2022. Two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria and used Cochrane's risk-of-bias assessment criteria to evaluate the quality of the literature. The evaluation indicators included respiratory recovery time, extubation time, consciousness recovery time, emergence agitation, postoperative nausea and vomiting (PONV), and intraoperative awareness. The RevMan 5.4.1 software was used for the meta-analysis of the data. A total of 860 patients from 10 eligible randomized controlled trials were included in this study. The results showed that compared with the control group, the respiratory recovery time (MD = -3.37, 95% CI: -5.09 to -1.85, P < .0001), extubation time (MD = -4.57, 95% CI: -6.08 to -3.95, P < .00001), and consciousness recovery time (MD = -4.95, 95% CI: -7.21 to -2.70, P < .00001) in the entropy index group were significantly shortened. The incidence of emergence agitation in the entropy index group (RR = 0.23, 95% CI: 0.11-0.47, P < .0001) decreased significantly. The incidence of PONV (RR = 0.46, 95% CI: 0.27-0.79, P = .004) was significantly reduced. However, the incidence of intraoperative awareness (RR = 0.33, 95% CI: 0.04-3.16, P = .34) wasn't significantly different. The application of the entropy index can improve the recovery quality of patients under general anesthesia, not only shortening the postoperative recovery time but also reducing the occurrence of agitation and PONV. It does not affect the incidence of intraoperative awareness.