Anesthesia Usage Research Articles

Abstract WP31: Site Experience and Relation to Outcome in the TRevo ACute Ischemic StroKe Thrombectomy Registry: Higher Volumes Translate in Better Outcomes

Background and Purpose: It remains unclear how experience influences outcomes after the advent of stent-retriever technology. We studied the relationship between site experience and outcomes in the TRevo ACute Ischemic StroKe (TRACK) multicenter registry. Methods: The 24 sites that enrolled patients in the TRACK registry were trichotomized into: low volume (enrolling 1-23 cases, less than 2 cases/ month), medium volume (24-47 cases, 2-4 cases/ month), and high volume sites (> 48 cases, > 4 cases/ month). Demographics, baseline features, and key prognostic presentation characteristics were compared across the three volume strata. Results: The 624 TRACK registry patients were divided into three sub groups: low (n=188 patients, 30.1%), medium (n=175, 28.1%), and high (n=261, 41.8%) volume centers. There were no significant differences in terms of age (mean, 66±16 vs. 67±14 vs. 65±15, p=0.2), baseline NIHSS (mean, 17.6±6.5 vs. 16.8±6.5 vs. 17.6±6.9, p=0.43) or site of occlusion across the 3 groups. Times from stroke onset to groin puncture were shorter in the medium volume sites (310 min) but similar in the low vs. high volumes sites (397 vs. 378 min). Higher efficiency and better outcomes were seen in higher volumes sites as demonstrated by faster times from groin puncture to reperfusion (mean, 89 vs. 82 vs. 65 min, p<0.0001), lower general anesthesia usage (60% vs. 70% vs. 59%, p=0.06), higher balloon guide catheter use (40% vs. 36% vs. 59%, p=<0.0001), higher reperfusion rates (mTICI ≥2b, 75.8% vs. 79.4% vs. 83.9%, p=0.10), and higher rates of good outcome (90-day mRS≤2, 39% vs. 50% vs. 53.4%, p=0.02). There were no appreciable differences in sICH (4.5% vs. 9.8% vs. 7.3%, p=0.2) or 90-day mortality (20.3% vs. 25% vs. 17.1%, p=0.2). After adjustments in multivariate analysis, there were significantly higher chances of achieving good outcomes in high vs. low volume (OR: 1.7, 95%CI 1.04-2.75, p=0.035) and medium vs. low volume (OR: 1.8, 95%CI 1.1-2.9, p=0.03) centers but there were no significant differences between high and medium volume centers (p=0.84). Conclusions: Clinical volumes have a significant influence in terms of efficiency and outcomes across stroke centers.

Increased Anesthesia Usage in a Large-Volume Endoscopy Unit: Patient Acuity Is Not the Main Predictor.

The use of monitored anesthesia care (MAC) for colonoscopy sedation continues to increase. This study examined trends during a 9-year period in the use of MAC and explored which patient variables may have influenced these trends. This was a retrospective review of all colonoscopies performed in our hospital-based endoscopy unit from 2003 through 2012. We determined whether MAC was used and if not, which quantitative doses of sedative agents were used. Several patient-related variables were evaluated for correlation. Data were analyzed (t test, χ(2), logistic regression) using SAS statistical software. Between January 2003 and October 2012, we identified 37,803 performed colonoscopies. The use of MAC increased significantly, from 0.38% in 2003 to 10.0% in 2012 (P < 0.0001). For cases in which conscious sedation was used, the mean doses of sedatives did not change significantly over time. Although there was an association between certain patient variables (female sex; higher American Society of Anesthesiologists class; diagnostic procedures; and pulmonary, psychiatric, renal or cerebrovascular diseases) and the use of MAC, the greatest predictor of MAC use was the year of the procedure. After adjusting for the patient variables that were examined, the odds of using MAC increased by approximately 1.5 times per year from 2003 through 2012. The adjusted odds of using MAC in 2012 were 35.8 times higher than in 2003. The use of MAC for colonoscopies performed in our endoscopy unit increased significantly from 2003 to 2012. Although increased MAC use was associated with some patient variables, it was most significantly associated with the year of the procedure. This suggests that there were other nonpatient-related factors influencing its use.

A Child Develops Drop Foot after Spinal Anaesthesia.

To the Editor, Spinal anesthesia has been used with children since 1909 (1). In 1950, a study reported that a cooperative child is likely to be a good subject for spinal anesthesia in cases where premedication may be inadequate (2). A nine-year-old girl weighing 20 kgs and with a height of 126 cm was diagnosed with acute appendicitis. An emergency operation was planned. Her medical history was normal except for a productive cough and runny nose over the previous three days. In the preoperative physical examination, rales in the lungs, extensive tenderness and distension in the abdomen were found. Thirty minutes before the operation, midazolam 0.05 mg/kg was given for premedication. A non-traumatic lumbar puncture was performed using a 26 G (Atraucan, 50 mm Braun Melsungen AG, Germany) pediatric spinal needle in the sitting position. At first at-tempt a clear cerebrospinal fluid flowed out, then 0.2 mg/kg of heavy bupivacaine was applied into the subarachnoid space between the third and fourth lumbar vertebrae. Sensorial block dermatome was checked using a pinprick test. When the level reached T8, the operation was started. The patient was hemodynamically stable during the operation and was in the recovery room for 30 minutes. In the sixth postoperative hour, she developed weakness in her left ankle, with muscle strength loss in the dorsiflexion (1/5), eversion (1/5), plantar flexion (3/5), toe dorsiflexion (1/5), and plantar flexion (3/5). Accompanying sensory deficit in the dorsum and anterolateral tibial part of the left leg (L5 and S1 dermatomes) was observed. Lumbar magnetic resonance imaging and computed tomography revealed normal findings. Postoperative 1st and 20th day electromyography showed no pathologic findings. A course of 25 mg/kg ga bapentin three times a day and vitamin B complex twice a day were prescribed. Physical therapy, including passive stretching, range of motion, balance, and strengthening exercises were performed. For the left anterior tibialmuscle, electrical stimulation was applied daily for 15 minutes. In neurological examination, improvement in muscle deficit was observed. Muscle strength was 4/5 in all of the muscles involved. Discharged with a home-based treatment program, she was able to walk without support on the 70th day. Although publications about complications of spinal anesthesia in children exist (3), there are few reports indicating safe and effective usage of spinal anesthesia (4,5). Transient neurological damage usually develops without pain or paresthesia during the lumbar puncture, as in our case. In differential diagnosis of neurological damage after spinal anesthesia, possible diagnosis of epidural hematoma, epidural abscess, anterior spinal artery syndrome, adhesivear-achnoiditis, caudaequina syndrome should be excluded. We excluded all these diagnoses with the help of a physical examination and MRI. Since the patient was in a supine position and had no history of any intramuscular injection, neurologic damage due to malpositioning or intramuscular injection were also excluded. In case of complications, a multidisciplinary approach is necessary for prompt and correct diagnosis, as well as to initiate the most appropriate mode of therapy for optimal results in the shortest time.

Practice Variations in Anesthesia for Carotid Endarterectomies and Associated Outcomes.

The authors' aim was to assess practice variations in anesthesia for carotid endarterectomies (CEA) and report outcomes. A retrospective cohort study. A multi-institutional setting. Patients who underwent CEA. None. Using the National Anesthesia Clinical Outcomes Registry of the Anesthesia Quality Institute, CEAs performed from 2010 to 2014 were identified, and a logistic regression model was fitted to determine if various patient, intraoperative, and provider characteristics were associated with usage of regional anesthesia (RA) versus general anesthesia (GA) (primary outcome) as the primary anesthetic in CEAs. The majority of CEAs were performed under GA (31,003 GA v 1,968 RA). American Society of Anesthesiologists class III-V patients were more likely to receive RA than class I-II (odds ratio 1.63, 95% confidence interval 1.39-1.91). Also, board certification status was associated with utilization of RA (odds ratio 2.95, 95% confidence interval 2.59-3.36). Among various facility types, community hospitals had the highest rates of RA use for CEAs. Secondary outcomes studied included extended recovery room stay, unexpected intensive care admissions, inadequate pain control, and postoperative nausea/vomiting. The usage of RA over GA was associated only with decreased postoperative nausea/vomiting. This study was the first to use the National Anesthesia Clinical Outcomes Registry to evaluate practice trends in the utilization of RA versus GA in CEAs. Patient comorbidities, as well as type of anesthesia provider, were associated with the usage of RA.

Considerations during intravenous sedation in geriatric dental patients with dementia.

We retrospectively assessed the usability and precautions required during intravenous sedation (IVS) for dental treatment in geriatric outpatients with dementia. We investigated the intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from the standpoint of local anesthesia usage, water usage during treatment, and content of treatment. Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n = 65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001). Water usage cases, such as for caries treatment, needed longer sedation and treatment times, resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p < 0.05). All the scheduled dental treatments in dementia patients were smoothly performed under IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives, and hemodynamic fluctuations caused by invasive procedures under local anesthesia. In the future, with the growing need for dental procedures in dementia patients, dentists will require training in the general management of such patients.

Effect of isoflurane on somatosensory evoked potentials in a rat model.

Somatosensory evoked potentials (SEPs) are widely used in the clinic as well as research to study the functional integrity of the different parts of sensory pathways. However, most general anesthetics, such as isoflurane, are known to suppress SEPs, which might affect the interpretation of the signals. In animal studies, the usage of anesthetics during SEP measurements is inevitable due to which detailed effect of these drugs on the recordings should be known. In this paper, the effect of isoflurane on SEPs was studied in a rat model. Both time and frequency properties of the cortical recordings generated by stimulating the tibial nerve of rat's hindlimb were investigated at three different isoflurane levels. While the anesthetic agent is shown to generally suppress the amplitude of the SEP, the effect was found to be nonlinear influencing more substantially the latter part of waveform. This finding will potentially help us in future work aiming at separating the effects of anesthetics on SEP from those due to injury in the ascending neural pathways.

Procedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?

Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation's 'Safe Surgery Saves Lives' initiative including the 'Surgical Safety Checklist'. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.

Eighteen-Point Abobotulinum Toxin A Upper Face Rejuvenation

To report the method and results of 18-point Abobotulinum toxin A (ABO-BTA, Dysport) upper face rejuvenation on 845 subjects. In a retrospective chart review, all subjects (the first cycle of injection) with ABO-BTA upper face rejuvenation from 2003 to 2009 were included. Excluded were subjects with facial spastic disorders, injection after upper face lifting, and aberrant regeneration of facial nerves. Upper face rejuvenation included 18 points of injection at forehead creases (4), frown lines (5), bunny line (1), crow's feet (4 on both sides), and lower eyelid crease (4 on both sides). They were revisited in 10 to 14 days for assessment of the effects and possible touch-up injection. Demographics, year of injection, topical anesthetic usage, touch-up injection, and adverse effects (AE) were recorded. There were 845 subjects (85.8% women) whose age was below 40 in 49.3%. All but 68 (8%) were happy with the touch-up visit, 10 to 14 days after injection. Touch-up injection was performed in 8% of subjects mainly for the eyebrow asymmetry. AE (22/845, 2.6%) were bruise (15/845, 1.8%), blepharoptosis (3/845, 0.3%), remained eyebrow asymmetry after touch-up injection (2/845, 0.2%), and headache (2/845, 0.2%). They were significantly more in subjects with touch-up injection, younger than 40 years, and in the first and second year of experience (especially for the bruise). Eighteen-point ABO-BTA upper face rejuvenation had a low rate of AE in this series in which majority was bruise at the lateral canthal area. They were significantly more in the first years of experience, subjects younger than 40, and who had touch-up injections.

A multi-channel device for high-density target-selective stimulation and long-term monitoring of cells and subcellular features in C. elegans.

Selective cell ablation can be used to identify neuronal functions in multicellular model organisms such as Caenorhabditis elegans. The optogenetic tool KillerRed facilitates selective ablation by enabling light-activated damage of cell or subcellular components in a temporally and spatially precise manner. However, the use of KillerRed requires stimulating (5 min-1 h), culturing (~24 h) and imaging (often repeatedly) a large number of individual animals. Current manual manipulation methods are limited by their time-consuming, labor-intensive nature, and their usage of anesthetics. To facilitate large-scale selective ablation, culturing, and repetitive imaging, we developed a densely-packed multi-channel device and used it to perform high-throughput neuronal ablation on KillerRed-expressing animals. The ability to load worms in identical locations with high loading efficiency allows us to ablate selected neurons in multiple worms simultaneously. Our device also enables continuous observation of animals for 24 h following KillerRed activation, and allows the animals to be recovered for behavioural assays. We expect this multi-channel device to facilitate a broad range of long-term imaging and selective illumination experiments in neuroscience.

Procedural sedation and analgesia in children undergoing digestive endoscopic procedures - paediatrician or anaesthesiologist?

Endoscopic procedures of the gastrointestinal tract were successfully introduced into paediatric practice in the 1970s. Recent expansive development has become useful for improvement of both diagnosis and treatment in many children with gastrointestinal diseases. Most of these procedures are performed under procedural sedation (PSA) knowing anatomical, physiological and psychological differences and requiring good experience from the paediatrician and anaesthesiologist. These principles help to provide the procedure safely and minimise adverse events, which are greater the smaller the child is. Procedural sedation and analgesia in healthy children can be performed by a paediatrician, but children with congenital defects and serious coexisting diseases (ASA ≥ III) and also during the usage of anaesthetics (e.g. propofol), should be managed by an anaesthesiologist.

Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review.

Over the last decades the demand for hip surgery, be it elective or in a traumatic setting, has greatly increased and is projected to expand even further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome, showing favorable results in the usage of regional vs general anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While there still remains a scarcity of data investigating perioperative outcomes and anesthesia, most studies concur on a positive outcome in overall mortality, thromboembolic events, blood loss and transfusion requirements when comparing regional to general anesthesia. Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system.

Local anesthetic lidocaine induces apoptosis in human corneal stromal cells in vitro.

To demonstrate the apoptosis-inducing effect of lidocaine on human corneal stromal (HCS) cells in vitro, and provide experimental basis for safety anesthetic usage in clinic of ophthalmology. In vitro cultured HCS cells were treated with lidocaine at different doses and times, and their morphology was monitored successively with inverted phase contrast microscopy. The membrane permeability of them was detected by acridine orange/ethidium bromide (AO/EB) double staining. The DNA fragmentation of them was examined by agarose gel electrophoresis, and their ultrastructure was observed by transmission electron microscopy (TEM), respectively. Exposure to lidocaine at doses from 0.3125g/L to 20g/L induced morphological changes of HCS cells such as cytoplasmic vacuolation, cellular shrinkage, and turning round, and elevated membrane permeability of these cells in AO/EB staining. The change of morphology and membrane permeability was dose- and time-dependent, while lidocaine at dose below 0.15625g/L could not induce these changes. Furthermore, lidocaine induced DNA fragmentation and ultrastructural changes such as cytoplasmic vacuolation, structural disorganization, chromatin condensation, and apoptotic body appearance of the cells. Lidocaine has significant cytotoxicity on human corneal stromal cells in vitro in a dose- and time-dependent manner by inducing apoptosis of these cells. The established experimental model and findings based on this model here help provide new insight into the apoptosis-inducing effect of local anesthetics in eye clinic.

Combined usage of intercostal nerve block and tumescent anaesthesia: An effective anaesthesia technique for breast augmentation

Patients are occasionally unhappy with the size, shape, and positioning of breast implants. An option to improve their satisfaction with breast augmentation includes directly involving them in the process with awake surgery done under nerve block and tumescence. This study describes the resultsof using such an awake anaesthesia technique in 35 patients. After the intercostal nerves dominating the Th3 to Th6 regions were anaesthetized using 0.5% bupivacaine, a tumescent solution consisting of lidocaine, epinephrine, and saline was injected around the mammary gland, and breast augmentation was conducted using silicon implants. The majority of patients (31/35) reported no pain during the procedure and all patients were able to choose and confirm their final implant size and positioning. In all cases, blood loss was less than 10 ml. No patient experienced pneumothorax or toxicity of local anaesthetics. Combined usage of the intercostal nerve block and tumescent anaesthesia effectively reduces pain during breast augmentation. Keeping patient conscious enables meeting their requests during operation, contributing to increased satisfaction. For these advantages, combined usage of the intercostal nerve block and tumescent anaesthesia is recommended as a useful anaesthetic technique for breast augmentation.

Variables Affecting Trends in Anesthesia Usage in a Large-volume Hospital-based Endoscopy Unit: Presidential Poster

Variables Affecting Trends in Anesthesia Usage in a Large-volume Hospital-based Endoscopy Unit: Presidential Poster

No Effects of Two Anesthetic Agents on Circulating Leukocyte Counts or Resistance to Trematode Infections in Larval Amphibians

Abstract Pharmacological anesthetics are used frequently in aquatic animal husbandry and research. Although several studies have investigated the effects of these anesthetic agents on immune responses in fish, none have assessed such effects in amphibians. To address this disparity, we exposed Osteopilus septentrionalis tadpoles to 0.005% benzocaine, 0.1% tricaine methanesulfonate (MS-222), or artificial spring water, and quantified circulating white blood cells and susceptibility to infection by larval trematodes. Exposure to neither MS-222 nor benzocaine elevated circulating white blood cells relative to water-exposed tadpoles. Furthermore, anesthetic treatment did not affect resistance to larval trematode infection. These results indicate that the anesthetics tested here probably do not affect tadpole immune function and should aid researchers in determining anesthetic usage.

Effect of brachytherapy technique and patient characteristics on cervical cancer implant dosimetry

Our purpose was to evaluate the relationship between brachytherapy technique and patient characteristics on dose to organs-at-risk (OARs) in patients undergoing high dose rate (HDR) brachytherapy for cervical cancer. From 1998 to 2008, 31 patients with cervical cancer with full dosimetric data were identified who received definitive external-beam radiation and HDR brachytherapy with tandem and ovoid applicators. Doses were recorded at point A, the International Commission on Radiation Units and Measurements (ICRU)-38 rectal point, the ICRU-38 bladder point, the vaginal surface, and the pelvic sidewall. Generalized estimating equations were used to determine the significance of changes in OAR to point A dose ratios with differences in brachytherapy technique or patient characteristics. Patients underwent a median of 5 brachytherapy procedures (range, 3 to 5), with a total of 179 procedures for 31 patients. For all brachytherapy treatments, the average ratios between the doses for the rectal, bladder, vaginal surface, and pelvic sidewall reference points to those at point A were 0.49, 0.59, 1.15, and 0.17, respectively. In general, decreased OAR dose was associated with a lower stage, younger age, increased ovoid size, increased tandem length, and earlier implant number. Increased tandem curvature significantly increased bladder dose and decreased rectal dose. Intravenous anesthesia usage was not correlated with improved dosimetry. This study allowed identification of patient and procedure characteristics influencing OAR dosing. Although the advent of 3-dimensional (3D) image-guided brachytherapy will bring new advances in treatment optimization, the actual technique involved at the time of the brachytherapy implant procedure will remain important.

Circumcision: Perspective in a Nigerian teaching hospital

The practice and pattern of male infants circumcised is influenced by culture, religion and socio-economic classification. The debate about the benefits and risks of circumcision has made a hospital-based practice the most acceptable. The objective of this study is to evaluate the ages, indications, co-morbidity, types and methods of circumcision, usage and mode of anaesthesia and outcome of male circumcision at a tertiary health centre in Nigeria. A retrospective review of male circumcision in a paediatric surgery unit was done from January 2002 to December 2007. The data was analysed using SPSS software version 15. There were 438 boys with age ranged between 6 days and 10 years (median 28 days, mean 53.6 days standard deviation 74.2). Neonatal circumcision (<29 days) was 201 (46%) and 318 (72.6%) of the children were circumcised by the 3 rd month of live. Religion or tradition were the major indicators in 384 (87.7%) patients while phimosis 38 (8.7%), paraphimosis 4 (1%), redundant post circumcision skin 10 (2.3%) and defective prepuce in 2 (0.5%) were other indications. Plastibel™ (PD) was used in 214 (48.9%), classical circumcision 194 (44.2%), guillotine technique (GT) and Gomco™ 10 (2.3%) cases each while 10 (2.3%) had a refashioning/re-excision post previous circumcision. There was an increase in use of PD, drop in the use of GT; and increase in the number of circumcision done over the years. Only 39.7% had anaesthesia administered and complication rate was 6.7%. Neonatal circumcision was highest in the hospital-based circumcision practice, which allowed the expected ideals in the use of devices in a tertiary health centre. However, the low rate of anaesthetic use is unacceptable.

Intermittent Epidural Bolus Compared with Continuous Epidural Infusions for Labor Analgesia

The current standard labor epidural analgesic regimens consist of a local anesthetic in combination with an opioid delivered via continuous epidural infusion (CEI). With CEI local anesthetic, doses may be large with resulting profound motor blockade potentially affecting the incidence of instrumental deliveries. In this systematic review of randomized controlled trials (RCTs), we compared the effect of intermittent epidural bolus (IEB) to standard CEI dosing with or without patient-controlled epidural analgesia on patient satisfaction, the need for manual anesthesia interventions, labor progression, and mode of delivery in healthy women receiving labor epidural analgesia. A systematic review of RCTs that compared CEI with IEB for labor analgesia was performed. The articles were evaluated for validity, and data were extracted by the authors and summarized using odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (CIs). Nine RCTs were included in this systematic review. Three hundred forty-four subjects received CEI, whereas 350 subjects received IEB labor analgesia. All 9 studies were deemed to be low risk of bias. There was no statistical difference detected between IEB and CEI in the rate of cesarean delivery (OR, 0.87; 95% CI, 0.56-1.35), duration of labor (MD, -17 minutes; 95% CI, -42 to 7), or the need for anesthetic intervention (OR, 0.56; 95% CI, 0.29-1.06). IEB did result in a small but statistically significant reduction in local anesthetic usage (MD, -1.2 mg bupivacaine equivalent per hour; 95% CI, -2.2 to -0.3). Maternal satisfaction score (100-mm visual analog scale) was higher with IEB (MD, 7.0 mm; 95% CI, 6.2-7.8). IEB is an appealing concept; current evidence suggests IEB slightly reduces local anesthetic usage and improves maternal satisfaction. Given the wide CIs of the pooled results for many outcomes, definite conclusions cannot be drawn for those outcomes, but there is also a potential that IEB improves instrumental delivery rate and need of anesthesia interventions. More study is required to conceptualize the ideal IEB regimen and investigate its effect on labor analgesia and obstetric outcomes.

An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review.

Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of medicine for the prevention and management of pain. They are also accompanied by various adverse effects which should be well known and be able to be controlled by the clinician. The article reviews the types of agents used as local anesthetics and their effects on the human body.

The Impact Of General Anesthesia Usage During HDR Intracavitary Brachytherapy For Cervical Cancer On The Quality Of Applications

The Impact Of General Anesthesia Usage During HDR Intracavitary Brachytherapy For Cervical Cancer On The Quality Of Applications