Type Of Anesthesia Research Articles

Tranexamic Acid Reduces the Amount of Blood Transfused in Revision Total Hip Arthroplasty for Vancouver B2/B3 Periprosthetic Femur Fractures.

Periprosthetic fractures around total hip arthroplasty (THA) represent a significant source of morbidity and mortality. The use of tranexamic acid (TXA) in arthroplasty is well described, yet little literature supports its role in periprosthetic femur fractures (PFFs). This study investigated the effect of preoperative TXA administration on transfusion rate and volume, length of stay, and 90-day complication rates in patients undergoing revision THA for PFF. All patients undergoing revision THA for PFF (Vancouver B2/B3) at our institution from August 2016 to June 2022 were identified. Routine TXA administration at surgical start was introduced in 2018. Patient demographics, operative time, blood product use, length of stay, and 90-day complications were collected. Patients were divided into those who received TXA preoperatively and those who did not. A total of 56 patients were included. There was no difference in age, sex, anesthetic type, fracture classification, or preoperative blood values between cohorts. TXA significantly lowered the amount of blood product required (2.3 units vs 3.2 units, P=.023). Preoperative TXA did not independently reduce length of stay; however, blood transfusion was associated with increased length of stay (7 days vs 4.7 days, P=.003). There were no differences in 90-day complications. Among patients who underwent revision THA for Vancouver B2/B3 PFF, TXA did not affect transfusion rates but did result in the use of fewer blood products without an increase in complications. We support routine use of TXA in this patient population. Future studies should assess earlier administration of TXA in the emergency department or once patients' conditions have been medically optimized. [Orthopedics. 2024;47(5):e261-e267.].

Operation-specific risk of postoperative nausea: a cross-sectional study comparing 72 procedures

ObjectivesDetermination of the procedure-specific, risk-adjusted probability of nausea.DesignCross-sectional analysis of clinical and patient-reported outcome data. We used a logistic regression model with type of operation, age, sex, preoperative opioids, antiemetic...

Preoperatif Durumluk-Sürekli Anksiyete Düzeyi ve Uygulanan Anestezi Tekniğinin Postoperatif Bulantı ve Kusmaya Etkisi

Objective: It was aimed to determine the effect of preoperative anxiety levels and anesthesia of the patients on postoperative nausea and vomiting (PONV). Methods: This study was a cross sectional research. It was conducted with 323 patients at a state hospital between April-June 2022. Data were collected with Sociodemographic and Clinical Characteristics Form, State-Trait Anxiety Inventory (STAI), and Rhodes Index of Nausea, Vomiting, and Retching. Descriptive statistics were applied to analyze the data. Results: The mean age of the patients were 50.5 ± 17.3 years, and 18.9% of them were treated in the general surgery ward. There was a significant difference in the development of PONV in the Trait Anxiety Inventory (STAI-T) severe anxiety group compared to the mild anxiety group (p=0.031) and in the State Anxiety Inventory (STAI-S) moderate anxiety group compared to the mild anxiety group (p=0.012). When anesthetic type was included in the model, there was a significant difference in the development of PONV between the STAI-S moderate and mild anxiety groups (p=0.006). State Anxiety Inventory scores were found to be effective in the group that received general and spinal anesthesia (p=0.013). Postoperative nausea and vomiting development was 41.2% in the moderate anxiety group and 21.7% in the mild anxiety group in the general and spinal anesthesia group. Conclusion: It was determined that undergoing general or spinal anesthesia increases the risk of developing PONV as the STAI-S score increases. Keywords: Surgery, anxiety, nausea, vomiting

Local Anesthesia for Endovascular Repair of Abdominal Aortic Aneurysm Allows for Accurate Graft Deployment with Durable Results

ObjectiveLocal anesthesia (LA) is sparsely used in endovascular aneurysm repair (EVAR) despite short term benefit, likely secondary to concerns over patient movement preventing accurate endograft deployment. The objective of this study is to examine the association between anesthesia type and endoleak, sac regression, reintervention, and mortality. MethodsThe Vascular Quality Initiative database was queried for all EVAR cases from 2014-2022. Patients were included if they underwent percutaneous elective EVAR with anatomical criteria within instructions for use of commercially approved endografts. Multivariable logistic regression with propensity score weighting lysis was used to determine the association between anesthesia type on the risk of any endoleak noted by intra-operative completion angiogram and sac regression. Multivariable survival analysis with propensity score weighting was used to determine the association between anesthesia type and endoleak at 1 year, long-term reintervention and mortality. Results13932 EVARs met inclusion criteria: 1075 (8%) LA and 12857 (92%) general anesthesia (GA). On completion angiogram, LA was associated with fewer rates of any endoleaks overall (16% vs 24%, p<0.001). On multivariable analysis with propensity score weighting, LA was associated with similar adjusted odds of any endoleak on intra-operative completion angiogram (OR 0.56, 95%CI 0.47-0.68) as well as combined type 1a and type 1b endoleaks (OR 0.72, 05%CI 0.47-1.09). Follow-up computed tomography imaging at 1 year was available for 4892 patients, 377 (8%) LA and 4515 (92%) GA. At 1 year, LA was associated similar rate of freedom from any endoleaks compared to GA (0.66 (95%CI 0.63-0.69) vs 0.71 (95%CI 0.70-0.72), p=0.663) and increased rates of sac regression (50% vs 45% p=0.040). On multivariable analysis with propensity score weighting, LA and GA were associated with similar adjusted odds of sac regression (OR 1.22, 05%CI 0.97-1.55). LA and GA had similar rates endoleak at 1 year (HR 0.14, 95%CI 0.63-1.07), however LA was associated with decreased hazards of combined type 1a and 1b endoleaks at 1 year (HR 0.87, 95%CI 0.80-0.96). LA and GA had similar adjusted long-term reintervention rate (HR 0.77, 95%CI 0.44-1.38) and long-term mortality (HR 1.100, 95%CI 079-1.25). ConclusionLA is not associated with increased adjusted rates of any endoleak on completion angiogram or at 1-year follow-up compared to GA. LA is associated with decreased adjusted rates of yype 1a and type1b endoleak at 1 year, but similar rates of sac regression, long term reintervention and mortality. Concerns for accurate graft deployment should not preclude use of LA and LA should be increasingly considered when deciding on anesthetic type for standard elective EVAR.

What factors influence mucocele recurrence?

ObjectiveThe purpose of this study was to identify whether age is associated with mucocele recurrence after excision. Study DesignThis retrospective cohort study consisted of 492 patients who underwent oral mucocele excision at Boston Children's Hospital from 2010 to 2022. Fisher's exact tests were used to assess association between age and mucocele recurrence. An adjusted logistic regression model was run to evaluate the impact of age on mucocele recurrence while controlling for confounders. P<0.05 was considered significant. ResultsMucocele recurrence was observed in 24 cases (4.9%). There was a significant association between age and mucocele recurrence (<7 years [2.2%] vs. 7-<13 years [2.9%] vs. 13-<18 years [9.2%] vs. >18 years [8.9%]; p=0.005). Sex, history of behavioral disorders, size of mucocele, mucocele duration, mucocele location, suture technique, and type of anesthesia were not significantly associated with recurrence (p>0.135). An adjusted logistic regression model verified a significant association between age and mucocele recurrence (OR 1.053 [95% CI: 1.019-1.088], p=0.035). ConclusionMucocele recurrence occurs infrequently in patients <7 years old and is most prevalent in the teenage to young adult patient population. For every year increase in age, the odds of mucocele recurrence increase by 5.3%.

Surgical Site Infection in the General Surgery Department of the Commune I Reference Health Center of Bamako

Objective: To study surgical site infections in the general surgery department of the CSRéf in Commune I of the Bamako district. Method: This was a 12-month prospective descriptive and analytical study from 1er June 2021 to 1er May 2022, including all patients operated on and hospitalised in the department. Results: During the study period, we recorded 80 cases of surgical site infection out of 442 patients included in the study, i.e. an overall total of 18.1%. The mean age of the patients was 32.24 years, with extremes ranging from 1 to 82 years. The rate of SSI was influenced by the surgical indication, the type of anaesthesia, the type of surgery according to the Altemeier classification, whether or not antibiotic prophylaxis and drainage were practised, and the length of postoperative hospitalisation. The majority of surgical site infections were diagnosed within the first 5-10 days postoperatively. Superficial infection was the most common (81%). E coli was the most common germ isolated from the site of infection at 49.15%. Most germs were sensitive to the combination of amoxicillin and clavulanic acid, imipenem and gentamicin.

The relationship between inflammatory markers and mortality in patients undergoing proximal femoral nail fixation for intertrochanteric femur fractures

Aim: This study aimed to investigate the predictability of mortality based on biomarkers measured using complete blood count in geriatric patients who underwent proximal femoral nail fixation for intertrochanteric femur fractures.&#x0D; &#x0D; Methods: We included in this retrospective study 247 patients who had undergone proximal femoral nailing due to osteoporotic intertrochanteric femur fracture. The patients were divided into two groups according to 1-year mortality outcome: group A, survivors (n=162), and group B, deceased patients (n=85). Preoperative demographic information, the number of days until surgery, C-reactive protein (CRP) level, hemoglobin level, platelet-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammatory index (SII) were recorded.&#x0D; &#x0D; Results: No statistically significant differences were found between the groups in terms of sex, type of anesthesia, leukocyte count, and neutrophil level (p&gt;0.05), but statistically significant differences were found in age, number of days until surgery, CRP level, hemoglobin level, lymphocyte count, and platelet count (p

Is it safe to use telephone for anaesthesia consultation in high-risk patients before non-invasive surgery? A pilot study in ophthalmology.

Although telemedicine with video support for preoperative evaluation has been found effective, there is limited research on anaesthesia consultation by phone without video support, particularly among high-risk patients. To evaluate the effectiveness, safety and potential benefits of performing pre-anaesthesia evaluation by phone before eye surgery in patients having non-invasive surgery, we performed an observational study in a French teaching hospital. All elective patients having elective ophthalmic surgery were included to have a consultation by phone instead of an in-person consultation, regardless of the type of anaesthesia or ASA score. The incidence of day-of-surgery cancellations, patient satisfaction and time/distance saved through phone consultations were assessed. From February to October 2022, data of 3480 patients were analyzed, including 370 (11%) high-risk patients (ASA 3-4). Anaesthesia-related day-of-surgery cancellation rate was 0.5% (n = 20) due to non-compliance with pre-operative instructions. No cancellation was due to inadequate pre-operative evaluation. No difference in cancellation rate was observed between low-risk patients and high-risk patients. Telephone consultations saved patients a mean of 126 min and 86 km. A younger age, an active status and living far from the hospital were associated with phone consultation preference. Phone anaesthesia consultation seems to be effective and safe before ophthalmic surgery, regardless of patient's perioperative risk. In addition, phone consultation provides significant time and distance savings. Our results must be confirmed through a multicentric randomised study comparing phone and traditional consultation in ophthalmology as well as in other non-invasive surgical procedures in a high-risk patients population.

Associations of dexamethasone's effect on morphine consumption after total knee arthroplasty-Subgroup analyses.

The DEXamethasone twice for pain treatment after Total Knee Arthroplasty (DEX-2-TKA) trial showed that adding one and two doses of 24 mg intravenous dexamethasone to paracetamol, ibuprofen and local infiltration analgesia, reduced morphine consumption (primary outcome) within 48 h after TKA. We aimed to explore the differences in the effect of dexamethasone on morphine consumption in different subgroups. Quantile regression adjusted for site was used to test for significant interaction between the predefined dichotomised subgroups and treatment group. The subgroups were defined based on baseline data: sex (male/female), age (≤65 years/>65 years), American Society of Anaesthesiologists (ASA)-score (ASA I + II/III), visual analogue score of preoperative pain at rest (≤30 mm/>30 mm), pain during mobilisation (≤30 mm/>30 mm), type of anaesthesia (spinal anaesthesia/general anaesthesia and spinal converted to general anaesthesia), and prior daily use of analgesics (either paracetamol and/or NSAID/neither). These analyses were supplemented with post hoc multivariate linear regression analyses. Test of interaction comparing sex in the pairwise comparison between DX2 (dexamethasone [24 mg] + dexamethasone [24 mg]) versus placebo (p = .02), showed a larger effect of dexamethasone on morphine consumption in male patients compared to females. Test of interaction comparing age in the pairwise comparison between DX1 (dexamethasone [24 mg] + placebo) versus placebo (p = .04), showed a larger effect of dexamethasone on morphine consumption in younger patients (≤65 years) compared to older. All remaining subgroup analyses showed no evidence of a difference. The supplemental multivariate analyses did not support any significant interaction for sex (p = .256) or age (p = .730) but supported a significant interaction with the type of anaesthesia (p < .001). Our results from the quantile regression analyses indicate that the male sex and younger age (≤65 years) may be associated with a larger analgesic effect of dexamethasone than the effects in other types of patients. However, this is not supported by post-hoc multivariate linear regression analyses. The two types of analyses both supported a possible interaction with the type of anaesthesia.

Clinical characteristics of elderly hip fracture patients with chronic cerebrovascular disease and construction of a clinical predictive model for perioperative pneumonia

IntroductionThe recovery of cerebrovascular disease (CVD) will increase the incidence of perioperative pneumonia (POP). However, there is limited research on POP in elderly patients with hip fractures complicated by CVD. Therefore, our research focuses on the following two issues: (1) What are the clinical features of elderly patients with hip fractures combined with CVD? (2) What are the predictive factors for the occurrence of POP in such patients? HypothesisMale, femoral neck fracture and hypoalbuminemia can be predictive factors for the development of POP after hip fracture in CVD patients. Material and methodsThis is a nested case-control study that included patients aged 65 to 105 years with CVD who had a hip fracture between January 2021 and January 2023. According to the occurrence of POP, they were divided into case group and control group. Collecting data includes demographic information, clinical data, and surgical information. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to select variables. The constructed predictive model was transformed into a nomogram. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). ResultsWe ultimately included 714 patients, 69.3% female, with a median age of 80 years. Asymptomatic cerebral infarction (ACI) is the most common CVD (55.7%). More patients developed intertrochanteric fractures than femoral neck fractures (57.1 vs. 42.9%). In total, 606 patients (84.9%) underwent surgery. The most common perioperative complications were anemia (76.9%) and hypoalbuminemia (71.8%). POP (20.0%) was more common preoperatively (89.5%). Factors such as fracture type, surgical wait time, implant used for surgery, and anesthesia type did not differ between the presence or absence of postoperative pneumonia. 143 patients with POP served as the case group. Five hundred and seventy one patients did not develop POP and served as the control group. The predictors of POP were male (OR 1.699,95%CI 1.150–2.511, p<0.05), femoral neck fracture (OR 2.182,95%CI 1.491–3.192, p<0.05), and hypoalbuminemia (OR 3.062, 95%CI 1.833–5.116, p<0.05). This model has good discrimination, calibration, and clinical practicality. DiscussionIn this study, we constructed a clinical prediction model for the occurrence of POP in CVD combined with hip fracture in the elderly, with risk factors including gender, fracture type and perioperative hypoproteinemia. Therefore, we can take effective preventive measures against the occurrence of POP in patients with these factors in our clinical work. Level of proofIV; nested case-control study.

Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis

ObjectiveAn emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes.MethodThis was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured.ResultsOf the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed.ConclusionCompared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.

Does choice of anesthesia during stage 1 sacral neuromodulation testing influence outcomes?

Staged sacral neuromodulation (SNM) testing has been shown to have a high rate of progression to permanent implantation for the management of voiding dysfunction. Stage 1 lead placement (SNM-I) can be performed under monitored anesthesia care (MAC) or general anesthesia (GA). MAC allows for interpretation of sensory and motor responses to optimize lead placement while GA only permits for motor assessment. However, patient discomfort and movement can make lead placement challenging during MAC. Herein we evaluate whether the anesthesia type impacts the progression rate to permanent implantation (SNM-II). A retrospective chart review was performed for patients who underwent SNM-I in the operating room for wet overactive bladder between 2005 and 2023. Patients were divided into two groups based on the type of anesthesia used, MAC or GA. Clinical variables and progression to SNM-II were compared between cohorts. Progression to SNM-II was based on ≥50% symptomatic improvement during a 1-2 week trial period following SNM-I. Of 121 patients included in the study, 95 (79%) underwent MAC and 26 (21%) GA for SNM-I. No difference in the progression rate to SNM-II was noted between groups (MAC, 68/95 patients, 72%; GA, 19/26, 73%; p = 0.39). We also found no difference when comparing the GA group to the 26 most recent MAC patients (MAC, 20/26 patients, 77%; GA, 19/26, 73%; p = 0.48). Types of anesthesia for SNM-I did not affect rate of progression to SNM-II. The result lends support to the reliance on motor responses alone for lead placement during SNM-I.

The Incidence of Intraoperative Hypotension and the Importance of Timely Detection

Aims: Intraoperative hypotension (IOH) is a common condition faced by anesthesiologists intraoperatively which poignanting patients undergoing surgery under general and neuraxial anesthesia. Its occurrence is associated with dangerous morbid situations found perioperatively that can lead into fatal complications, such as acute kidney failure, direct myocardial injury, and even can end in mortality. Despite advanced closed hemodynamic monitoring and protocols utilizing goal directed therapy, recent trend of management is remaining reactive. Anesthesiologists tend to intervene when the episode of hypotension has already occurred. This literature review aimed to discuss the incidence of intraoperative hypotension and its urgency to overcome intraoperatively.&#x0D; Conclusion: The incidence of IOH varies based on the type of surgery, type of anesthesia and fragility of the patient, for example having comorbidities. Due to the rapid development of IOH which is unwanted, the effort reducing the hypotensive burden intraoperatively, as soon as possible is mandatory. By carefully predicting and preventing IOH through closed monitoring of patient’s blood pressure will surely improve patient outcome and prevent adverse unwanted post-operative event.

Analysis of biomarkers of stress in the perioperative period during surgical treatment for abdominal wall hernias

Background. Pain impairs the patient’s quality of life after surgery and, causing a significant stress, affects life expectancy. Many biomarkers (albumin, hemoglobin, glucose level, C-reactive protein) are used to objectively assess stress, but their levels depending on the type of analgesia and their role in predicting the course of the postoperative period have not been fully studied. Aim: to conduct a comparative analysis of biomarkers of stress in patients undergoing surgery for abdominal wall hernias depending on the type of perioperative analgesia. Materials and methods. Sixty-three patients who underwent surgical treatment for abdominal wall hernias took part in the study. They were divided into 3 groups according to the method of anesthesia (general, neuraxial and regional blockades). At different stages of the perioperative period, the dynamics of stress biomarkers such as cortisol and blood glucose was studied. Results. Before the operation, the blood glucose level did not differ significantly in three groups. During the traumatic period of surgical treatment, stress-induced hyperglycemia developed, its level did not depend on the type of anesthesia performed, and 24 hours after the operation, the level of glycemia significantly decreased to normal one. A significant increase in cortisol was registered in group 1. At the same time, on the contrary, the blood cortisol level decreased in patients of groups 2 and 3. After 24 hours, the blood cortisol level decreased to normal values, and in all groups, it was lower than that before surgery. Conclusions. Regardless of the type of anesthetic management, an increase in blood glucose levels was recorded in patients of all three groups during surgical treatment for abdominal wall hernias. Patients undergoing regional abdominal wall blocks had lower levels of stress biomarkers after surgery and 24 hours postoperatively compared to general anesthesia.

Propofol-based total intravenous anesthesia is associated with less postoperative recurrence than desflurane anesthesia in thyroid cancer surgery.

The effects of anesthesia in patients undergoing thyroid cancer surgery are still not known. We investigated the relationship between the type of anesthesia and patient outcomes following elective thyroid cancer surgery. This was a retrospective cohort study of patients who underwent elective surgical resection for papillary thyroid carcinoma between January 2009 and December 2019. Patients were grouped according to the type of anesthesia they received, desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival/recurrence curves were presented from the date of surgery to death/recurrence. Univariable and multivariable Cox regression models were used to compare hazard ratios for recurrence after propensity matching. A total of 621 patients (22 deaths, 3.5%) under desflurane anesthesia and 588 patients (32 deaths, 5.4%) under propofol anesthesia were included. Five hundred and eighty-eight patients remained in each group after propensity matching. Propofol anesthesia was not associated with better survival compared to desflurane anesthesia in the matched analysis (P = 0.086). However, propofol anesthesia was associated with less recurrence (hazard ratio, 0.38; 95% confidence interval, 0.25-0.56; P < 0.001) in the matched analysis. Propofol anesthesia was associated with less recurrence, but not mortality, following surgery for papillary thyroid carcinoma than desflurane anesthesia. Further prospective investigation is needed to examine the influence of propofol anesthesia on patient outcomes following thyroid cancer surgery.

Tranexamic Acid in Tumescence for Cervicofacial Rhytidectomies.

Cervicofacial rhytidectomies are one of the most common procedures in the United States. There are many different methods and techniques involved, but all aim to minimize blood loss and procedure time. In our study, we investigated the addition of tranexamic acid (TXA) to tumescent anesthesia during rhytidectomy procedures. Our objective was to analyze the difference in mean procedure time and estimated blood loss in patients undergoing both general and other anesthesia types, with and without the addition of TXA, while maintaining patient safety. Seventy-four patients underwent a standard superficial musculoaponeurotic system plication technique rhytidectomy, with 60 patients undergoing general anesthesia and the remaining 14 undergoing other anesthesia types. Forty patients were treated without TXA, whereas the remaining 34 were treated with TXA. Although the difference was not statistically significant, the addition of TXA resulted in a lower procedure time and estimated blood loss. Within anesthesia type, there was also a slight difference that TXA decreased blood loss and procedure time. We did find that general anesthesia type does significantly impact procedure time and estimated blood loss, when compared with other anesthesia types, independent of TXA use. The use of tumescent TXA may allow for a faster procedure with less blood loss, although further studies with a larger sample size are needed.

Сравнительный анализ влияния общей и спинальной анестезии на акушерские исходы при плановом кесаревом сечении

Objective. To determine which type of anesthesia, general or spinal, causes less amount of blood loss in elective cesarean section. Patients and methods. An observational randomized controlled study including 300 women was conducted at the Al-Zahraa University Maternity Hospital. Two patient groups were identified: group G (general anesthesia) (n = 150) and group S (spinal anesthesia) (n = 150). All patients underwent elective cesarean section with identical operative steps by the same surgeon. Anesthesia, general or spinal, was standard. Data were collected, including age, parity, pre- and postoperative heart rate and blood pressure, pre- and postoperative complete blood count (on day 3), type of anesthesia, duration of surgery, complications (atonic postpartum hemorrhage, uterine extension), postoperative urinary output, need for blood transfusion, fainting and headache attacks, time to breastfeeding, ambulation, and passing flatus. Data on postoperative analgesia were also obtained, including time to first analgesic request and number of doses taken. The amount of intraoperative blood loss was estimated using the acute normovolemic hemodilution technique. Results. When using changes in hemoglobin levels to estimate blood loss, group S showed statistically significantly less blood loss than group G, with a mean difference of 103.7 mL (p &lt; 0.05). When using hematocrit levels, group S showed statistically significantly less blood loss than group G, with a mean difference of 114 mL (p &lt; 0.05). Headache attacks were more frequent in group S (78) than in group G (19) (p &lt; 0.05). Group S started breastfeeding 5 hours earlier than group G (p &lt; 0.05). Group S started postoperative ambulation 4 hours earlier than group G (p &lt; 0.05). There were no statistically significant differences between both groups regarding time to first analgesic request, heart rate, blood pressure, urinary output, and fainting attacks in the postoperative period. Conclusion. Spinal anesthesia has certain advantages over general anesthesia: higher postoperative hemoglobin and hematocrit levels, less intraoperative blood loss, less postoperative pain, less need for analgesia, earlier ambulation, and earlier initiation of breastfeeding. Key words: spinal anesthesia, general anesthesia, cesarean section

Perioperative Dysrhythmias in Adult Patients for Non Cardiac Surgery: A Prospective Cohort Study

Introduction: The vulnerable perioperative period is prone to the development of a heterogeneous group of conditions characterised by abnormal electrical activity in the heart, termed as cardiac dysrhythmias. Aim: To determine the incidence of dysrhythmias in the perioperative period, identify predisposing factors, evaluate the effect of anaesthesia, analyse haemodynamic consequences, and document the treatment provided. Materials and Methods: A prospective cohort study involving 9666 adult patients undergoing non cardiac surgery was conducted in the Department of Anaesthesiology at Lokmanya Tilak Municipal College and General Hospital, Sion, Mumbai, Maharsahtra, India from January 2012 to December 2013. Parameters studied included preoperative clinical data (history, examination, and relevant investigations), type of anaesthesia, occurrence of dysrhythmias, and clinical outcomes of persistent dysrhythmias or those requiring treatment. Data was collected prospectively and analysed using Statistical Package for Social Sciences (SPSS) software version 15.0. Results: The overall incidence of dysrhythmias was 1.2%. Consistent factors included age over 40 years (68.1%), male gender (52.59%), gastrointestinal and orthopaedic procedures (65.5%), preoperative hypertension (25%), and patients receiving general anaesthesia (61.2%). Most patients were classified as American Soceity of Anesthesiologists (ASA) Class-I and II (93.97%) and underwent elective surgery (61.21%). The majority (81.89%) of dysrhythmias occurred intraoperatively and were ventricular in origin (68.97%). Unstable haemodynamic conditions [Systolic Blood Pressure (SBP) &lt;90 mmHg, Heart Rate (HR) &lt;50 /min and/or Ventricular Premature Contraction (VPCs) &gt;5/min or multifocal VPCs)] were observed in 56.9% of patients. Of patients with ventricular dysrhythmias, 57% exhibited unstable haemodynamics. Treatment was provided to 84.48% of patients, with 74.14% responding positively, leading to the termination of dysrhythmias. Anticholinergics were used in 40.52% of treatment modalities. The majority of dysrhythmias were transient 80 (68.9%) patients, and 83 of patients had a favourable outcome. Unfortunately, 5 (6.9%) of patients could not be revived, with three patients 3 (2.5%) succumbing in the operating room. Mortality was not directly linked to the dysrhythmia but was due to underlying causes. Conclusion: Transient intraoperative ventricular cardiac dysrhythmias are common in adult patients undergoing noncardiac surgeries. Therefore, it is crucial to identify highrisk patients, analyse contributing factors, and promptly correct issues under expert medical guidance.

Assessment of the sedative effect of various anesthetics in Coregonus Peled (Gmelin, 1789) in aquaculture

The sedative effect of four anesthetic agents in whitefish was studied. It is shown that the effect of anesthetics causes a number of consistent behavioral and physiological reactions in fish, reflecting the change in the state of their body. For most technological fish-breeding processes, it is necessary for fish to stay in a state of muscle relaxation while maintaining respiratory rhythm. These requirements are met by the sedation stage, which is observed with all types of anesthesia in peled. It has been established that the use of some of the tested drugs is incorrect in anesthesia in general in whitefish and in pelage in particular. Thus, the use of sodium thiopental is unacceptable, due to the uncontrolled suppression of the respiratory function of fish under the action of this agent. The use of lidocaine is characterized by prolonged induction, which does not correspond to the temporary norms of fish anesthesia. Among the tested drugs, propofol has sufficient anesthetic efficacy, which is confirmed by the temporary indicators of induction/ recovery, the depth and manageability of anesthesia, and low indicators of respiratory depression. Eugenol can serve as an alternative to propofol, which is cost-effective when working with mass material that requires large financial costs. In general, the choice of anesthetic and the adjustment of its doses depend on the specific task facing the fish breeder-ichthyopathologist.

Endoscopic vacuum therapy: pitfalls, tips and tricks, insights, and perspectives.

This article provides a comprehensive review of the use of endoscopic vacuum therapy (EVT) in the management of transmural gastrointestinal (GI) defects (TGIDs) and its future perspectives, such as pre-emptive EVT and novel indications, including GI bleeding and large gastroduodenal ulcers management. This review is based on the available literature data and personal experience to demystify the mentioned limitations of EVT as technical difficulties related to the procedure, possible patients' complaints, and institutions' concerns, by sharing several tips and tricks to overcome EVT-related challenges that may discourage endoscopists from using this live-saving technique, and consequently, restricting patients to receive this therapy, which may lead to undesired outcomes. Several factors, such as placement techniques, EVT type selection, management during its use, EVT system exchanges, device removal, type of anesthesia, and how to avoid EVT-related adverse events are described in detail. Additionally, this review discusses good ways to promote effective communication with patients and relatives, surgeons, and multidisciplinary team. EVT possesses a unique mechanism of action including macro/micro deformation, changes in perfusion (stimulating angioneogenesis), exudate control, and bacterial clearance, promoting healing. EVT has an adequate safety profile and higher clinical success rate compared to any other endoscopic therapy for TGID. Additionally, pre-emptive EVT and its novel indications are promising due to its satisfactory effectiveness in initial studies. Therefore, detailing some practical solutions obtained by years of experience may collaborate to widespread EVT adoption, providing less-invasive treatment for several critical conditions to more patients worldwide.