Total Anesthesia Time Research Articles

Nonintubated laryngomicrosurgery with Transnasal Humidified Rapid-Insufflation Ventilatory Exchange: A case series

Nonintubation anaesthesia for laryngomicrosurgery (LMS) provides both excellent visualization of the surgical field and complete examination on vocal cord. However, adequate oxygenation remains challenging during nonintubated LMS. Recently, transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has been reported effectively maintaining apneic oxygenation in patient with difficult airways. The feasibility and safety of nonintubated LMS with THRIVE was evaluated in this case series. From September 2016 to February 2017, a total of 23 patients receiving nonintubated LMS were included. Anaesthesia was induced and maintained through target-controlled propofol infusion and muscle relaxation with THRIVE oxygen support. Perioperative data were collected from medical records and analysed. The mean (±SD) duration of the operation was 12.4 (±4.4) min. The mean (±SD) total anaesthesia time (from induction to emergence) was 24.1 (±6.4) min. 22 patients received nonintubated LMS with surgical satisfaction without intraoperative desaturation. One patient who underwent laryngeal tumour biopsy experienced a single episode of desaturation. A 5.5-mm tracheal tube was needed for short-term mechanical ventilation to regain SpO2 to 100%. No significant complication was noted in all patients. All patients discharged as per schedule on the next day after surgery as intubated LMS patients in our hospital. Nonintubated LMS with THRIVE is a feasible and safe alternative to intubated LMS with a small size tracheal tube to provide a better surgical field. However, for patients with easy-bleeding tumor, intubated LMS remains suggestive for better airway protection.

A study of comparison of the efficacy of 0.5 percent Levobupivacaine with a combination of 0.5 percent Levobupivacaine and hyaluronidase, in ultrasound guided axillary brachial plexus block for forearm and hand surgeries

Background: Axillary block is a regional anesthesia for surgeries at and below the elbow. Complications associated with peripheral blocks using blind approaches are addressed with advent of ultrasound guidance. Hyaluronidase drug works as a spreading factor. Combination of ultrasound guidance and hyaluronidase in addition to local anesthetics in peripheral blocks will increase efficacy and reduce complications. Objective: The objective of the study is to compare the efficacy of 0.5% Levobupivacaine with a combination of 0.5% Levobupivacaine and hyaluronidase in USG guided axillary brachial plexus block for forearm and hand surgeries with respect to: Onset of sensory and motor block, duration of sensory block and time to rescue analgesia. Materials and Methods: After institutional ethical committee clearance 60 ASA PS class 1 and 2 adult patients in age group of 18 to 60 year who underwent elective upper limb surgeries in sridevi institute of medical sciences, tumkur from October 2017 to dec 2019 were included. Any patient with history of bleeding disorders, documented neuromuscular disorders, known allergy to Local anesthetics drugs, Psychiatric patients and if on anticoagulants were excluded from the study. Patients were alternately assigned to two groups Group A and Group B each containing 30 patients Patients undergoing Ultrasound guided Axillary Brachial plexus block with. GROUP A – 20 ml of 0.5% Levobupivacaine and Hyaluronidase 300 Units (15U/ml of local anesthetic) GROUP B – 20 ml of 0.5% Levobupivacaine. The patients were given Ultrasound guided Axillary brachial plexus block. onset of sensory blockade, onset of motor blockade, sensory block duration and time to rescue analgesia were compared. Results: The mean onset of sensory block in group A was 10.10±0.9 minutes and group B was 13.33±0.9 minutes. The mean onset of motor block in group A was 11.73±1.66 minutes and in group B was 14.23±1.45 minutes. The mean duration of sensory block in group A was 7.8±1.0 hours and in group B was 10.8±2.0 hours the mean time to rescue analgesia in group A was 9.9±1.3 hours and in group B was 12.2±2.0hours. Conclusion: In ultrasound guided axillary brachial plexus block using 0.5% levobupivacaine, addition hyaluronidase reduces onset of sensory and motor block time therefore shortens the total anaesthetic time before the operation. It also reduces the duration of post operative sensory block time and time to requirement of rescue analgesia.

ANESTHESIA OF AQUARIUM-HOUSED WALRUS ( ODOBENUS ROSMARUS): A CASE SERIES.

Walruses are a challenging species to anesthetize as a result of their large mass, limited access for drug delivery, unique physiology, and small number of reports describing anesthetic procedures. Three aquarium-housed walruses ( Odobenus rosmarus) ranging in age from 3 to 11 yr old (344-1,000 kg) were anesthetized for dental or ophthalmic surgical procedures, with one animal anesthetized twice and one anesthetized three times. Preanesthetic medication was with intramuscular midazolam (0.1-0.2 mg/kg) and meperidine (2-3 mg/kg). A catheter was placed in the extradural intravertebral vein, and anesthesia was induced with propofol to effect. Orotracheal intubation was performed and anesthesia maintained with isoflurane in oxygen using a circle breathing system connected to a ventilator. Intermittent positive pressure ventilation was used in all procedures. For the ophthalmic surgery, the neuromuscular blocking agent, cisatracurium, was given intravenously to provide a central eye and optimal surgical conditions. The neuromuscular block was antagonized with edrophonium. Total anesthesia times ranged from 1.5 to 6 hr. Midazolam and meperidine were antagonized with flumazenil and naltrexone, respectively, in five of six cases. Nonsteroidal anti-inflammatory agents were provided for analgesia. Recoveries were calm and uneventful. The described anesthetic protocols and case management were successful under the conditions encountered.

Stereotactic body radiation therapy for heart-base tumors in six dogs

IntroductionHeart-base tumors are increasingly treated with radiotherapy, yet safety and efficacy are incompletely understood. This case series describes outcomes after stereotactic body radiation therapy (SBRT) for presumed chemodectoma. AnimalsSix pet dogs. MethodsA retrospective study was performed, including dogs with a clinical diagnosis of chemodectoma and treatment with three-fraction SBRT (30 Gy total). ResultsHeart-base tumors, presumed or confirmed to be chemodectomas, were diagnosed via histopathology or imaging. Treatment was delivered with intensity modulation and cone-beam computed tomography–based image guidance, using a linear accelerator and robotic couchtop. Intrafraction respiratory motion was managed with either neuromuscular blockade and breath-holding (n = 3) or high-frequency jet ventilation (n = 3); mean total anesthesia times for each technique were 165 and 91 min per fraction, respectively. Four tumors were assessed after SBRT; tumor volume decreased by 30–76%. Possible treatment-related complications included cough, tachyarrhythmias, and congestive heart failure. Two dogs experienced sudden death 150 and 294 days after SBRT. Three dogs are alive 408–751 days after SBRT, and one dog died of unrelated disease 1,228 days after SBRT. ConclusionsThis SBRT protocol resulted in rapid tumor volume reduction, and jet ventilation effectively reduced treatment delivery times. However, cardiac arrhythmias (presumably tumor or treatment associated) and sudden death were common after SBRT. Therefore, SBRT is a potentially useful treatment but may not be appropriate for dogs with incidentally diagnosed, slowly growing tumors, which are not causing cardiovascular disturbances. Longer follow-up and larger case numbers are needed to more completely define safety and impact of treatment on long-term survivability.

High-Frequency Jet Ventilation During Cryoablation of Small Renal Tumours

AimTo evaluate the effect of high-frequency jet ventilation (HFJV) in place of standard intermittent positive-pressure ventilation (IPPV) on procedure duration, patient radiation dose, complication rates, and outcomes during CT-guided cryoablation of small renal tumours.Materials and MethodsOne hundred consecutive CT-guided cryoablation procedures to treat small renal tumours under general anaesthesia were evaluated—50 with standard IPPV and 50 after the introduction of HFJV as standard practice. Anaesthesia and procedural times, ionising radiation dose, complications, and 1-month post-treatment outcomes were collected.ResultsHFJV was feasible and safe in all cases. Mean procedure time and total anaesthetic time were shorter with HFJV (p = <0.0001). The number of required CT acquisitions (p = 0.0002) and total procedure patient radiation dose (p = 0.0027) were also lower in the HFJV group compared with the IPPV group. There were a total of four complications of Clavien–Dindo classification 3 or above—three in the IPPV group and one in the HFJV group. At 1-month follow-up, two cases (both in the IPPV group) demonstrated subtotal treatment. Both cases were subsequently successfully retreated with cryoablation.ConclusionBy reducing target tumour motion during CT-guided renal cryoablation, HFJV can reduce procedure times and exposure to ionising radiation. HFJV provides an important adjunct to complex image-guided interventions, with potential to improve safety and treatment outcomes.

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics.

PurposeFew data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia). We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters.MethodsWe classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C) or separate (group S). Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications.ResultsPatients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7) or separately (n=27). No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: −58, +10 minutes; P=0.115) and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: −16, +48 minutes; P=0.307). The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394) did not differ between the groups. No postoperative complications were noted in either group.ConclusionThese preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or significant changes in postoperative outcomes.

Quantifying Anesthesia Exposure in Growing Rod Treatment for Early Onset Scoliosis.

Growing rod (GR) treatment for early-onset scoliosis requires repeated anesthesia exposure (AE). At a minimum, GR treatment requires AE for diagnostic imaging, index GR surgery, periodic lengthenings, and final fusion. Adjunct procedures and complication-related procedures also increase AE. To our knowledge, this is the first study to quantify AE in GR treatment and to establish preoperative expectations. A single-center retrospective review of 16 patients who completed GR treatment and underwent final fusion. Duration of all AE related to GR treatment for "standard" care procedures (ie, advanced imaging, index surgery, lengthenings, final fusion) and "associated" care procedures (ie, revisions, adjunctive surgical procedures, wound-related complications) were reviewed. Etiologies were classified per the classification of early-onset scoliosis. Mean total anesthesia time (TAT) was tallied and analyzed for standard care and associated care procedures. There were 5 syndromic, 8 neuromuscular, and 3 idiopathic patients. The mean age at the first AE event related to GR treatment was 7.4 years (range, 3.8 to 11 y). Mean age at the index GR surgery and final fusion was 8.1 years (range, 3.9 to 14.4 y) and 12.8 years (range, 9.7 to 19 y), respectively. The percentage of TAT for each procedural category was 7% for advanced imaging, 14% for index GR, 14% for lengthenings, 21% for final fusion, 27% for revisions, 9% for adjunct surgery, and 9% for wound complications. Standard care procedures accounted for 55% of TAT, whereas associated care procedures accounted for 45%. This study quantified expected duration of AE in GR treatment. Revisions and final fusion contributed most to TAT. Given the recent controversy of repeated AE in young children, efficiency measures should be implemented to reduce AE and avoid duplication without compromising the goals of surgical treatment. Associated care procedures accounted for 45% of the total AE. Level IV.

Incidence and risk factors of surgical site infection and septic arthritis after elective arthroscopy in horses.

To determine the incidence of infection and associated risk factors, after elective arthroscopy. Retrospective case study. Horses (n=1079) undergoing elective arthroscopy. Medical records of all horses that underwent elective arthroscopy between 2006 and 2013 were reviewed. Age, gender, breed, surgeon, number of joints operated, total anesthetic time, perioperative antimicrobial administration, and the presence and size of osteochondral fragments/subchondral lesions were recorded. For each operated joint, the development of postoperative infection (surgical site infection [SSI] and/or septic arthritis) and long-term outcome (>6 months) were recorded. Multivariate logistic regression was used to test for association between the independent variables and the dependent outcomes. A total of 1741 joints in 1079 horses underwent arthroscopy. SSI without septic arthritis occurred in 1 fetlock joint (0.14%), 1 tibiotarsal joint (0.19%), and 6 femoropatellar joints (1.67%). Thirteen joints (0.75%) were diagnosed with septic arthritis, including 1 fetlock joint (0.14%), 4 tibiotarsal joints (0.74%), and 8 femoropatellar joints (2.23%). The probability of postoperative SSI was higher when large lesions (>40 mm long) were treated, compared to medium (20-40 mm, P = .005) and small (<20 mm, P < .001) lesions. SSI was a significant risk factor for the development of septic arthritis (P < .001). Although age did not affect the incidence of SSI, increasing age was associated with a lower rate of septic arthritis rate (P = .028). Septic arthritis after elective arthroscopy was more likely in the presence of SSI and younger age. Horses with large lesions were at risk for SSI, which translated into a higher incidence of postoperative septic arthritis after femoropatellar arthroscopy.

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BackgroundPrevious studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons.Materials and methodsA retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients.ResultsSA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness.ConclusionSA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting.

A Supine Achilles Tendon Repair Decreases Total Operating Room and Anesthesia Time Without Sacrificing Outcomes

Category: Ankle, Sports, Trauma Introduction/Purpose: Achilles tendon repairs have traditionally been performed using a prone position. Prone positioning gives the surgeon easy visualization of the tendon, but may not offer the safest position for anesthesia and requires more peri-operative positioning time. We propose that the use of a supine position for primary Achilles tendon repairs offers similar surgical times, while saving non-surgical operating room time during positioning and anesthesia set-up. Methods: A retrospective review of primary Achilles tendon repairs done at our institution’s surgical sites between March of 2010 and July of 2015 was performed. Using the institutional database, 145 procedures were identified. Chart review demonstrated that 82 were performed open-supine (OS), 31 were performed open-prone(OP), and 32 were performed percutaneous-prone(PP). Surgical, non-surgical, and total operating room times were compared between the three groups. Results: Average surgical times were 32.8, 49, and 32.3 minutes for the OS, OP, and PP procedures, respectively. Total operating rooms times were 59.1, 88.9, and 76.7; while non-surgical times spent in the operating rooms were 26.3, 39.9, and 44.4 minutes for these groups, respectively. Achilles tendons repaired either OP or PP resulted in an additional 13.6 and 18.1 (average 15.9) minutes of operating room time. There was not an increase in complications with the supine procedure compared to the prone procedures. Conclusion: Primary Achilles tendon repairs can be performed effectively using an open technique in a supine position, saving non-surgical operating room time without increasing complications. The supine position may also offer a safer method of providing anesthesia to these patients by allowing the anesthesiologist a more accessible airway and decreasing the risks involved with placing an intubated patient into a prone position.

Anaesthetic depth control using closed loop anaesthesia delivery system vs. target controlled infusion in patients with moderate to severe left ventricular systolic dysfunction

ObjectivesTo compare the efficacy of anaesthetic depth control using Closed Loop Anaesthesia Delivery System (CLADS) and Target Controlled Infusion (TCI) in patients with moderate to severe left ventricular dysfunction (LVSD). DesignRandomized control trial. PatientsForty ASA III/IV adult patients with moderate to severe LVSD scheduled for open heart surgery. InterventionsPropofol was administered using CLADS or TCI for maintaining BIS of 50. Induction and maintenance doses were controlled automatically in CLADS. Dixon's up and down method was used to estimate the plasma concentration needed for induction in TCI. MeasurementPercentage of total anaesthesia time (“valid CLADS time”) for which BIS remained within ±10 of target (BIS=50). Main resultsBIS remained within ±10 of the target for a significantly longer duration of time in CLADS group (p=0.001). Performance parameters like Median Performance Error (MDPE), p=0.024; Median Absolute Performance Error (MDAPE), p=0.0212; and global score p=0.017 were significantly better in CLADS group. Total propofol consumption was significantly less in CLADS group (p=0.014). Mean value (95% CI) of EC50 and EC95 for target plasma propofol concentration for induction was 1.62 (1.45–1.79) μgml−1 and 1.87 (1.73–2.96) μgml−1 respectively using probit analysis. ConclusionsClosed loop delivery of propofol using CLADS performed significantly better than TCI in this subset of patients. Clinical trials registration no.www.ClinicalTrials.gov-NCT02645994

176 Efficiency of Spinal Anesthesia in Comparison to General Anesthesia in Lumbar Spine Surgery

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS &gt;544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P &lt; 0.001), total anesthesia time (145.6 vs. 217.5 min., P &lt; 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P &lt; 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P &lt; 0.001), and length of hospital stay (1.5 vs. 3.1 days, P &lt; 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P &lt; 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P &lt; 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.

Chemical Immobilization of Free-ranging Yellow Armadillos (Euphractus sexcinctus) for Implantation of Intra-abdominal Transmitters.

Free-ranging yellow armadillos (Euphractus sexcinctus) from the Brazilian Pantanal were captured for surgical implantation of intra-abdominal radio transmitters. During March 2014, 11 animals were chemically immobilized with a combination of intramuscular ketamine hydrochloride, xylazine hydrochloride, midazolam maleate, and atropine sulfate. The mean induction time and initial heart rate in males was higher than in females. The sex of armadillos did not affect the respiratory rate, which increased from the beginning to end of the monitoring time. The rectal temperatures of females remained almost unchanged, whereas the rectal temperatures of males suffered a slight drop through the procedure. The mean (±SD) total surgical time was 50±6.5 min, and the total anesthetic recovery time was 2.5±0.5 h. The armadillos were monitored for 24 h after surgery and released at their capture site. The anesthetic association was effective, promoting muscle relaxation and analgesia that allowed the performance of surgical procedures.

Assessing Quality and Safety in Pediatric Supracondylar Humerus Fracture Care.

Recently, there has been an emphasis on improving quality, safety, and value in the delivery of health care in the United States. The American Board of Orthopedic Surgery (ABOS) has developed a performance improvement questionnaire (PIQ) for orthopaedic surgeons managing pediatric supracondylar humerus fracture (PSCHF). Using the supracondylar PIQ as a guide, this study evaluates the process of measuring the outcomes and variations in care to PSCHF patients among pediatric orthopaedic surgeons. An 88-question survey incorporating the ABOS PIQ was administered to 35 pediatric orthopaedic surgeons at 3 institutions. A retrospective chart review of patients who received operative management of a PSCHF during 2013 was performed. Each of the 17 eligible surgeons supplied 5 patients for a total of 85 patients. Medical records and radiographic imaging were reviewed using the ABOS PIQ data collection sheet. This data collection sheet encompasses the preoperative assessment, intraoperative treatment and assessment, and clinical and radiographic outcomes of patients with PSCHF. A total of 35 surgeons from 6 hospitals completed the online PSCHF survey. Uniform consensus among all 35 surgeons was identified in 21/79 of the questions (27%). Consensus among surgeons within a hospital group but not with surgeons from the other groups was identified in 39/79 (49%) of the questions. No consensus among the surveyed surgeons could be identified in 19/79 (24%) of the questions. For the 85 PSCHF patients the average age was 6 years, and 37% of fractures were type II, 57% of fractures were type III, and there was 1 flexion type. Ninety percent of the patients received a preoperative dose of antibiotics and the postoperative immobilization placed in the operating room was changed in the clinic before pin removal in 58% of the cases. Pins were removed at 3 weeks in 60%, 4 weeks in 30%, 5 weeks in 7%, and after 5 weeks in 3% of the patients and no malunions occurred. Pin tract infection occurred in 2 patients (2.4%). The procedure time ranged from 13 to 171 minutes, with a median time of 37 minutes. Total anesthesia time ranged from 32 to 233 minutes, with a median of 72 minutes. The number of outpatient follow-up visits ranged from 2 to 7 visits, with a median of 3 visits. The number of postoperative radiographs obtained ranged from 1 to 14, with a median of 3 studies. Four patients (5%) returned to the operating room for a repeat surgery. The survey responses from the surgeons at 6 different hospitals demonstrate that there is still considerable variation in care among surgeons, even for such a routine injury. Our chart review also revealed substantial variation in care with subsequent quality and cost-implications. The variations in operating room time, anesthesiology time, number of postoperative visits, number of radiographs ordered, and the initial intraoperative immobilization, all point to opportunities for standardization and lowering of costs. Level IV.

Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy.

OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive method for thermal destruction of benign or malignant tissue that has been used for selective amygdalohippocampal ablation for the treatment of temporal lobe epilepsy. The authors report their initial experience adopting a real-time MRI-guided stereotactic platform that allows for completion of the entire procedure in the MRI suite. METHODS Between October 2014 and May 2016, 17 patients with mesial temporal sclerosis were selected by a multidisciplinary epilepsy board to undergo a selective amygdalohippocampal ablation for temporal lobe epilepsy using MRgLITT. The first 9 patients underwent standard laser ablation in 2 phases (operating room [OR] and MRI suite), whereas the next 8 patients underwent laser ablation entirely in the MRI suite with the ClearPoint platform. A checklist specific to the real-time MRI-guided laser amydalohippocampal ablation was developed and used for each case. For both cohorts, clinical and operative information, including average case times and accuracy data, was collected and analyzed. RESULTS There was a learning curve associated with using this real-time MRI-guided system. However, operative times decreased in a linear fashion, as did total anesthesia time. In fact, the total mean patient procedure time was less in the MRI cohort (362.8 ± 86.6 minutes) than in the OR cohort (456.9 ± 80.7 minutes). The mean anesthesia time was significantly shorter in the MRI cohort (327.2 ± 79.9 minutes) than in the OR cohort (435.8 ± 78.4 minutes, p = 0.02). CONCLUSIONS The real-time MRI platform for MRgLITT can be adopted in an expedient manner. Completion of MRgLITT entirely in the MRI suite may lead to significant advantages in procedural times.

Associations between maternal size and health outcomes for women undergoing caesarean section: a multicentre prospective observational study (The MUM SIZE Study)

ObjectivesTo investigate associations between maternal body mass index (BMI) at delivery (using pregnancy-specific BMI cut-off values 5 kg/m2 higher in each of the WHO groups) and clinical, theatre utilisation and...

A previously published propofol-remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery.

Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil–propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2 and the other <4. We hypothesized that both models would predict regained responsiveness (RR) after video-assisted thoracic surgery (VATS) to reduce total anesthesia time and make early extubation clinically relevant. We included 30 patients undergoing VATS received total intravenous anesthesia (TIVA) combined with thoracic epidural anesthesia (TEA). Pharmacokinetic profiles were calculated using Tivatrainer. Model predictions were compared with observations to evaluate the accuracy and precision of emergence model predictions. The mean (standard deviation) differences between when a patient responded to their name and the time when the model predicted a 50% probability of patient response were 30.80 ± 17.77 and 13.71 ± 11.35 minutes for the OAA/S <2 model and <4 model, respectively. Both models had a limited ability to predict patient response in our patients. Both models identified target concentration pairs predicting time of RR in volunteers and some elective surgeries, but another model of epidural and intravenous anesthetic combinations may be needed to predict time of RR after VATS under TIVA with TEA.

Increased Total Anesthetic Time Leads to Higher Rates of Surgical Site Infections in Spinal Fusions.

A retrospective review of a consecutive series of spinal fusions comparing patient and procedural characteristics of patients who developed surgical site infections (SSIs) after spinal fusion. It is known that increased surgical time (incision to closure) is associated with a higher rate of postoperative SSIs. We sought to determine whether increased total anesthetic time (intubation to extubation) is a factor in the development of SSIs as well. In spine surgery for deformity and degenerative disease, SSI has been associated with operative time, revealing a nearly 10-fold increase in SSI rates in prolonged surgery. Surgical time is associated with infections in other surgical disciplines as well. No studies have reported whether total anesthetic time (intubation to extubation) has an association with SSIs. Surgical records were searched in a retrospective fashion to identify all spine fusion procedures performed between January 2010 and July 2012. All SSIs during that timeframe were recorded and compared with the list of cases performed between 2010 and 2012 in a case-control design. There were 20 (1.7%) SSIs in this fusion cohort. On univariate analyses of operative factors, there was a significant association between total anesthetic time (Infection 7.6 ± 0.5 hrs vs. no infection -6.0 ± 0.1 hrs, P < 0.001) and increasing operative time (infection 5.5 ± 0.4 hrs vs. no infection - 4.4 ± 0.06 hrs, P < 0.01) with infections, whereas level of pathology and emergent surgery were not significant. On multivariate logistic analysis, BMI and total anesthetic time remained independent predictors of SSI whereas ASA status and operative time did not. Increasing BMI and total anesthetic time were independent predictors of SSIs in this cohort of over 1000 consecutive spinal fusions. 3.

Safety of Secretin Administration in Children.

The aim of this study was to compare the hemodynamic parameters from the anesthesia records of children who underwent upper gastrointestinal endoscopy (esophagogastroduodenoscopy [EGD]) with and without secretin pancreatic function tests (sPFTs). The hemodynamic parameters were retrieved from an electronic anesthesia database. The secretin group consisted of 186 children, and the age- and sex-matched control group included 136 patients who did not have sPFTs. There was no difference in the demographic parameters (age and sex) between the 2 groups. The secretin group had a lower height and body mass index. The sPFT resulted in an average 3-minute extension of the endoscopic procedure. The heart rate increased during the EGD in both groups and was higher (averaged 7 beats per minute) in the secretin group than the EGD-only group. There were mild elevations on the systolic and diastolic blood pressures. None of these changes were clinically significant. There were no complications reported during the anesthesia and procedures in the 2 groups. Secretin PFT is a safe procedure. It only slightly prolongs the total procedure and anesthesia time. There were no clinically significant changes in the vital parameters in the secretin group, and there were no adverse effects recorded.

Abstract: Paravertebral Regional Blockade is Associated with Reduced Opioid Requirements and Less Post-Operative Nausea and Vomiting in Reduction Mammaplasty

PURPOSE: We evaluate the safety and effectiveness of paravertebral block (PVB) as an adjunct to general anesthesia (GA) for reduction mammaplasty. METHODS: Patients from 2011–2015 who underwent reduction mammaplasty were examined by anesthesia modality: GA alone and GA+ PVB adjunct. Demographic data, intra-operative and 6 hour post-operative opioid requirements, phase 1 and 2 pain scores, post-operative nausea and vomiting (PONV), and total anesthesia time were collected. and analyzed with contingency tables and comparisons of means and medians for categorical and continuous variables, respectively. RESULTS: We identified 264 patients who underwent reduction mammaplasty. Of these, 209 received GA alone and 55 received GA + PVB adjunct. Intra-operative opioid requirements were lower for those receiving PVB compared to GA alone (mean morphine equivalent doses of 44mg versus 35 mg, p<0.05). There was no difference in post-operative opioid requirements (mean doses of 30 versus 29 mg, p>0.05). Phase 1 pain scores were significantly lower for those receiving PVB compared to GA alone (mean 2.8 vs. 3.9, p<0.05), as were phase 2 scores (mean 3.0 vs 4.2, p<0.05). PVB was associated with considerably less PONV (14% versus 33%, p<0.05). PVB was associated with higher mean anesthetic time compared to GA alone (271 minutes vs 236 minutes; p<0.05). There were no anesthetic complications in the PVB group. CONCLUSIONS: By mitigating factors known to be associated with unplanned hospital admission and poor patient satisfaction, paravertebral regional blockade is an attractive anesthetic adjunct to breast surgery, particularly in the ambulatory setting.