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Copyright of Die Anaesthesiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve. Materials and methods: In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken. Results: In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively. Conclusion: Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate. [ABSTRACT FROM AUTHOR]

People all around the world suffer from low back pain (LBP), which frequently results in disability and a lower quality of life. Myths and misconceptions around LBP are still prevalent in both the general public and hospital settings, despite its ubiquitous prevalence. Through dispelling these myths and advocating for evidence-based knowledge, medical professionals can enhance patient education, lessen stigma, and anxiety related to life with post-traumatic stress disorder and enable more successful management techniques. Furthermore, dispelling myths regarding low back pain in the broader public can enable people to actively participate in their own care and support improved outcomes for those who have this crippling illness. The purpose of this evaluation of the literature is to identify and dispel prevalent misconceptions about LBP by examining the available data. [ABSTRACT FROM AUTHOR]

Background: Anaphylactic cardiovascular collapse is complicated by aortocaval compression during pregnancy, exacerbated by neuraxial anesthesia. Despite recommendations to administer perioperative antibiotics before anesthesia, common practice in Japan involves administering them after anesthesia induction. We report a case of possible antibiotics-induced anaphylaxis just before anesthesia for cesarean delivery. Case presentation: A 24-year-old woman at 37 weeks of gestation presented for a scheduled repeat cesarean under spinal anesthesia. After starting administration of cefazolin prior to anesthesia, she developed anaphylactic symptoms. Hypotension refractory to adrenaline necessitated conversion to an emergency cesarean section under general anesthesia. A neonate was delivered with favorable Apgar scores. Post-delivery, the mother's hemodynamics stabilized significantly. Elevated plasma tryptase confirmed anaphylaxis. Both mother and infant were discharged without further complications. Conclusions: This case emphasizes the importance of administering prophylactic antibiotic before anesthesia in mitigating severity of shock induced by anaphylaxis and the crucial role of prompt emergency cesarean in achieving successful outcomes. [ABSTRACT FROM AUTHOR]

Background: Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section. Methods: In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves. Results: Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15–6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14–4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72–10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06–1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49–0.57) and 0.56 (95%CI 0.51–0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively. Conclusion: In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability. Trial registration: Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

To prospectively investigate the effect of music therapy on patient's anxiety and pain level during retrograde intrarenal surgery under spinal anesthesia. 286 patients aged above 18 years, who underwent Retrograde Intrarenal Surgery (RIRS) under spinal anesthesia for renal or ureteral calculi were evaluated between January 2023 and June 2023 by a prospective, randomized, controlled clinical protocol. Patients were randomized into 2 groups. Group 1 included patients, who listened to music, and Group 2 was comprised of patients, who were not allowed to listen to music. Visual Analog Scale (VAS) results and pain sensation, anxiety level, together with the results of State-Trait Anxiety Inventory (STAI), a self-reported anxiety inventory, were captured. The number of patients, who were randomized to the music group (Group 1) and non-music group (Group 2) was 144 and 142, respectively. Mean heart rate in Group 1 and Group 2 was 60 ± 4.19 and 70 ± 8.36, respectively (p = 0.02), indicative of the fact that mean heart rate was significantly lower in the music group. Heart rate measured post-operatively within the first hour subsequent to the procedure was similar in both groups (p < 0.05). The VAS score was significantly lower in Group 1. STAI score in Group 1 and Group 2 was 45.51 ± 2.968 and 49.16 ± 1.88, respectively. Therefore, there was a statistically significant difference (p < 0.001). Music therapy during the RIRS procedure under spinal anesthesia was associated with a significantly decrease in pain and anxiety scores in patients. [ABSTRACT FROM AUTHOR]

Background: Although subdural hematoma is a rare complication after spinal anesthesia, there have been no reports of an intracranial epidural hematoma after cesarean section with spinal anesthesia. Case presentation: A 32-year-old nulliparous woman at the 35th week of a twin pregnancy underwent an emergency cesarean section due to her first contraction. She had no preoperative complications and the spinal anesthesia was uneventful, with 0.5% bupivacaine 12 mg and fentanyl 15 µg from the L3/4 intervertebral space. She complained of headache and nausea 15 min after spinal anesthesia, demonstrating a consciousness disturbance after surgery. Computed tomography 2 h after the cesarean section revealed an intracranial epidural hematoma. She underwent decompressive craniotomy 1 h later. Conclusion: This case highlights the possible development of an intracranial epidural hematoma in low-risk obstetric patients. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic created a massive shift in how health care systems interact with COVID testing for patients. To avoid delay in accessing second trimester surgical abortion at our hospital (St. Paul's Hospital Millennium Medical College) during this pandemic, dilation and evacuation (D&E) procedures were attended as emergency cases, instead of as elective surgical procedures, which then required adherence to the universal preoperative COVID-19 testing protocol. This study aimed at documenting the experience of this unique abortion service adjustment in response to the COVID-19 pandemic. Methods: This was a retrospective descriptive study conducted at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, from April 1, 2021 to July 31, 2021. We reviewed second trimester surgical abortion cases managed with D& E procedures, performed under spinal anesthesia using the emergency COVID-19 pre-operative testing protocol. Data were analyzed using SPSS version 23 and simple descriptive statistics were applied. Percentages and proportions were used to present the results. Results: Nineteen cases of second trimester D&E cases were reviewed. The median gestational age of the abortion clients was 21.57 weeks. Eight of 19 cases had cervical preparation with overnight intra-cervical Foley catheter placement while the rest 11 (57.9%) cases had their cervical preparation with Laminaria. The median time interval from initial evaluation of the abortion client to time of doing D& E procedure was 21.83 h. Conclusion: Surgical abortion service reorganization enabled abortion clients to access dilation and evacuation procedures within 24 h of their initial presentation. This prevented significant delays in accessing abortion care that could otherwise have occurred as a result of adhering to the preoperative COVID-19 testing protocols applied to elective surgeries. [ABSTRACT FROM AUTHOR]

Background and Aims: Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold‐Jarisch reflex do not fully explain SA‐related cardiopulmonary complications. Reduction in FEV1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV1 following SA and adverse intraoperative cardiopulmonary complications. Materials and Methods: A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV1% predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV1% < 10% and ∆FEV1% ≥ 10%) based on reductions (∆) in FEV1% predicted following SA. Logistic regression analyses were used to examine associations between ∆FEV1% and intraoperative hypoxia, hypotension, bradycardia, and nausea/vomiting, with adjustments for age, gender, and BMI. Results: The mean FEV1% predicted following SA was lower than the mean FEV1% predicted before SA (83.42 vs. 95.31, p = 0.001). In a fully adjusted model, ∆FEV1% ≥ 10% was associated with an increased risk of hypoxia [AOR 13.55; 95% CI, 1.07–171.24, p = 0.044]. The positive associations between ∆FEV1% ≥ 10% and hypotension [2.02 (0.33–12.46), 0.449], bradycardia [1.10 (0.28–4.25), 0.895] and nausea/vomiting [9.74 (0.52–183.94), 0.129] were not statistically significant. Conclusion: Reduction in FEV1% predicted following SA was associated with adverse intraoperative outcomes. FEV1 may play an important role in the association between SA and cardiopulmonary complications. [ABSTRACT FROM AUTHOR]

Background: Cancer treatment that is commonly used is surgical resection. Anesthesia is necessary for surgery to take place, but the anesthetic methods used can have an impact on the cancer's ability to spread and return following the procedure. The present study was conducted to assess role of Anesthesia with multiple comorbidities in oncology patients. Materials & Methods: The study was carried out on 56 patients who underwent any type of cancer resection surgery of both genders. Parameters such as type of cancer, recurrence etc. was recorded. Results: Out of 56 patients, males were 36 and females were 20. Type of cancer was bladder cancer in 3, breast cancer in 14, colorectal cancer in 6, esophageal cancer in 3, gastric cancer in 1, hepatocellular carcinoma in 5, ovarian cancer in 3, and prostate cancer in 21 patients. The difference was significant (P< 0.05). Type of anesthesia used was epidural anesthesia in 10, general anesthesia in 5, both EA+GA in 34 and spinal anesthesia in 7 patients. The difference was significant (P< 0.05). Local recurrence was seen in 2, cancer recurrence in 3 and distant recurrence in 2 cases. The difference was significant (P< 0.05). Conclusion: RA, used alone or adjunctively with GA, is associated with a lower risk of cancer recurrence. [ABSTRACT FROM AUTHOR]

We present the case of a successful application of combined adductor canal block (ACB) and sacral erector spinae plane (S‑ESP) block for the management of a patient suffering from severe hemophilia A with an end‑stage arthropathy who underwent total knee replacement. The implementation of a tailored protocol, not incorporating neuraxial techniques, such as spinal anesthesia, facilitated optimal intra‑ and postoperative pain management and expedited postoperative recovery and rehab without motor weakness and side effects, highlighting the potential benefit of such strategy in selected cases. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Cerebrospinal fluid (CSF)-venous fistulas (CVFs) are increasingly identified as a cause of spontaneous intracranial hypotension (SIH). Lateral decubitus digital subtraction myelography (LD-DSM) and CT myelography (LD-CTM) are mainly used for detection, but the most sensitive method is yet unknown. Objective To compare LD-DSM with LD-CTM for diagnostic yield of CVFs. Methods Patients with SIH diagnosed with a CVF between January 2021 and December 2022 in which the area of CVF(s) was covered by both diagnostic modalities were included. LD-CTM immediately followed LD-DSM without repositioning the spinal needle, and the second half of the contrast agent was injected at the CT scanner. Patients were awake or mildly sedated. Retrospectively, two neuroradiologists evaluated data independently and blinded for the presence of CVF. Results Twenty patients underwent a total of 27 combined LD-DSM/LD-CTM examinations (4/20 with follow-up and 3/20 with bilateral examinations). Both raters identified significantly more CVFs with LD-CTM than with LD-DSM (rater 1: 39 vs 9, P<0.001; rater 2: 42 vs 12, P<0.001). Inter-rater agreement was substantial for LD-DSM (κ=0.732) and LD-CTM (κ=0.655). The results remained significant after considering the senior rating for cases of disagreement (39 vs 10; P<0.001), and no CVF detected on LD-DSM was missed on LD-CTM. Conclusion In this study, LD-CTM has a higher diagnostic yield for the detection of CVFs than LD-DSM and should supplement LD-DSM, but further studies are needed. LD-CTM can be easily acquired in awake or mildly sedated patients with the second half of contrast injected just before CT scanning, or it may be considered as a stand-alone investigation. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the clinical practice of physicians working in obstetric setting toward postoperative nausea and vomiting (PONV) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia. Methods: We conducted this online survey to all active members of the Japan Society of Obstetric Anesthesiology and Perinatology (JSOAP), where leads academic society in obstetric anesthesia in Japan. The questionnaire was developed using the Delphi method. The survey included questions about routine practices for PONV prevention, the use of neuraxial opioids, optimal practices, and perceived obstacles. The email sent three times every 2 weeks as a reminder. Results: A total of 1046 e‐mails were sent, and 307 JSOAP members responded to the survey (29.3%). More than half of responders (62.7%) used neuraxial opioids with intrathecal morphine being the most frequent. They had a higher rate of multimodal PONV prophylaxis compared with who did not use neuraxial opioids for postoperative analgesia (19.9% vs 6.7%). Metoclopramide was the commonest medication for PONV prevention, and there was a significant difference in the use of 5‐hydroxytryptamine receptor antagonists (19.9% vs. 8.6%, p = 0.012). We observed that 80% of physicians reported the routine administration of prophylaxis for PONV for CD. Among these, 20% indicated the use of two or more agents. Conversely, in the cohort not administering neuraxial opioids, only 6.7% reported the use of two or more agents. Conclusion: The online survey showed that the physicians using neuraxial opioids for CD had a higher proportion of multimodal PONV management involving two or more agents. [ABSTRACT FROM AUTHOR]

Background: Dural ectasia is a common manifestation of neurofibromatosis type 1. Although there have been reports of unsuccessful spinal anesthesia due to dual ectasia in Marfan syndrome, reports describing similar unsuccessful spinal anesthesia in neurofibromatosis type 1 are lacking. Case presentation: A parturient with neurofibromatosis type 1 was scheduled for a repeat cesarean section. During a previous cesarean section, she had experienced a failed spinal anesthesia, which resulted in a conversion to general anesthesia. Preoperative lumbar magnetic resonance imaging revealed dural ectasia, which was speculated to be the cause of the previous spinal anesthesia failure. Therefore, combined spinal-epidural anesthesia was implemented. Because the block level of spinal anesthesia was insufficient as predicted, supplemental administration of epidural anesthesia successfully provided adequate analgesia for the surgery. Conclusions: Combined spinal-epidural anesthesia can be useful for the management of cesarean sections in patients with neurofibromatosis type 1-associated dural ectasia. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the effects of caffeine consumption and sleep on post-spinal headache after spinal anesthesia. Background: Post-spinal headache is among the most well-known and common complications of spinal anesthesia. Although caffeine consumption is recommended to prevent headache after spinal anesthesia, caffeine does not prevent headache and causes sleep-related problems. No study in the literature found a correlation between sleep and caffeine consumption after spinal anesthesia and post-spinal headache. Methods: The research is a descriptive and cross-sectional study. The study sample comprised 425 patients who underwent elective surgery in a research hospital. The research data were collected by face-to-face interviews between April 2021 and December 2023. The "Sociodemographic and Clinical Characteristics Form," "Richard-Campbell Sleep Scale," "Insomnia Severity Index," and "Visual Analog Scale" were used in data collection. Factors affecting post-spinal headache were determined using binary logistic regression analysis. Results: According to the binary logistic regression, the insomnia severity score (OR = 1.234; p <.001), sleep quality score (OR =.992; p <.01), postoperative sleep duration (OR =.619; p <.05), and not consuming coffee (OR =.035; p <.001) are statistically significant predictors of post-spinal headache and explain 57.7% of the variance. A one-unit increase in patients' insomnia severity increased the probability of experiencing a post-spinal headache by 23.4%. With a one-unit increase in sleep quality, there was an 8% decrease in the probability of experiencing spinal headache, and a 3.81% decrease in the probability of experiencing post-spinal headache with an increase in sleep duration after surgery. The probability of experiencing post-spinal headache was 0.35 times higher in individuals who did not consume caffeine after surgery than in those who consumed it. Conclusion: The present study demonstrated that insomnia severity and sleep quality were more effective than caffeine consumption in preventing post-spinal headache. Insomnia and decreased sleep quality may cause a significant burden in developing post-spinal headache in patients and may cause post-spinal headache to be observed more frequently. Therefore, the use of caffeine in preventing or reducing post-spinal headache may adversely affect the duration and quality of sleep and increase the severity of insomnia. [ABSTRACT FROM AUTHOR]

Background: Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counseling patients on anesthesia for this procedure. We designed an Option Grid™-style conversation aid, My Anesthesia Choice─Hip Fracture, to promote shared decision making in this interaction. This study will refine the aid and evaluate its implementation and effectiveness in clinical practice. Methods: The study will be conducted over 2 phases: qualitative interviews with relevant clinicians and patients to refine the aid, followed by a stepped wedge cluster randomized trial of the intervention at 6 settings in the US. Primary outcomes will include the percentage of eligible patients who receive the intervention (intervention reach) and the change in quality of patient/clinician communication (intervention effectiveness). Secondary outcomes addressing other RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) domains will also be collected. Outcomes will be compared between baseline data and an active implementation period and then compared between the active implementation period and a sustainment period. Implementation strategies are guided by three constructs from the Practical, Robust Implementation and Sustainability Model (PRISM): intervention, recipients, and implementation and sustainability infrastructure. Discussion: This is a novel, large-scale trial evaluating and implementing a shared decision-making conversation aid for anesthesia choices. Strong buy-in from site leads and expert advisors will support both the success of implementation and the future dissemination of results and the intervention. Results from this study will inform the broader implementation of this aid for patients with hip fractures and can lead to the development and implementation of similar conversation aids for other anesthesia choices. Trial registration: ClinicalTrials.gov, NCT06438640 [ABSTRACT FROM AUTHOR]

Copyright of Fudan University Journal of Medical Sciences is the property of Fudan University Journal of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Hip fracture surgeries in patients present significant challenges, particularly in managing pain during spinal anesthesia positioning. The Pericapsular Nerve Group Block (PENG) has shown promise in addressing this issue, but the ideal volume of local anesthetic for PENG is still uncertain. In our study, we aimed to analyze the effects of administering PENG block with two different volumes on analgesic quality for patients undergoing hip fracture surgery. Methods: In this prospective, randomized controlled trial, the effects of administering a PENG block with 20 mL versus 30 mL of local anesthetic in patients undergoing hip fracture surgery under spinal anesthesia were compared. The primary outcome was pain during spinal anesthesia positioning, and secondary outcomes included postoperative pain scores and opioid consumption. Results: A total of 60 patients were analyzed, with 30 in each group. Critical parameters such as the time of spinal anesthesia administration and the satisfaction of the anesthesiologist showed no significant differences (p=0.918; p=0.741, respectively). NRS scores recorded before, during, and after the positioning for spinal anesthesia exhibited similar patterns (p=0.290; p=0.247; p=0.288, respectively). The cumulative opioid requirements did not exhibit a statistically significant difference at 24 hours (p = 0.098). Quadriceps weakness was significantly more in the PENG-30 group 6 hours after surgery but had recovered by the 9th hour (p= 0.004). Conclusion: In patients undergoing hip fracture surgery, the effects of applying the PENG block with 20 mL or 30 mL of local anesthetic are comparable in terms of positioning for spinal anesthesia and postoperative analgesic requirements. [ABSTRACT FROM AUTHOR]

Introduction: The use of push-dose vasopressors to treat anesthesia-induced hypotension is a common evidence-based practice among anesthesiologists. In more recent years, the use of push-dose vasopressors has transitioned to the emergency department (ED) and critical care setting. There is debate on the best choice of a push-dose vasopressor, with push-dose epinephrine or phenylephrine being more commonly used. This scoping review evaluated publications regarding the clinical use of push-dose norepinephrine. Methods: We queried research studies in both PubMed and Google Scholar on the use of push-dose norepinephrine in human subjects, with numerous randomized controlled trials that compare norepinephrine to other vasopressors including phenylephrine, ephedrine, and epinephrine. Results: A large majority of the studies were performed in the setting of spinal anesthesia prior to cesarean section, while several involved the administration of general anesthesia, with limited-to-no literature in the emergency and critical care setting. Of the 27 studies that we included in the review, 17 were randomized controlled trials. These studies demonstrated that norepinephrine was safe and effective. Conclusion: Prior research has demonstrated the superiority of norepinephrine as a pressor of choice for various shock states. In this review, the safety and efficacy of push-dose norepinephrine is demonstrated, and favorable hemodynamic markers are shown in comparison to other agents. In addition, there are some safety and efficiency benefits to using push-dose norepinephrine from an administration standpoint, as well as clinically in decreased need for repeat doses. Further high-quality studies in the emergency and critical care realm would be beneficial to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Shivering is a common complication during neuraxial anesthesia, leading to metabolic and cardiovascular challenges. Existing treatments vary in effectiveness, and this study compares intravenous tramadol and nalbuphine, both administered with midazolam, for shivering control. Objectives: To evaluate and compare the efficacy of IV tramadol and IV nalbuphine, alongside midazolam, in controlling post-spinal anesthesia shivering. Materials and Methods: A prospective, randomized comparative clinical study involving 100 patients undergoing various surgical procedures under spinal anesthesia. Patients were divided into two groups to receive either IV Tramadol or IV Nalbuphine with midazolam. Parameters like shivering severity, time to cessation, recurrence, and side effects were recorded and analyzed. Results: Both tramadol and nalbuphine effectively controlled shivering with comparable response times and side effect profiles. There was no significant difference in the incidence of nausea, vomiting, and sedation between the groups. Hemodynamic stability was maintained throughout the study. Conclusion: IV tramadol and IV nalbuphine, in conjunction with midazolam, are effective in controlling post-spinal anesthesia shivering, with similar efficacy and safety profiles. They provide valuable options for clinicians in managing this common anesthetic complication. Further research is encouraged for more refined application in diverse patient populations. [ABSTRACT FROM AUTHOR]

Introduction: Ventricular arrhythmia is commonly provoked by acute cardiac ischemia through sympathetic exaggeration and is often resistant to anti-arrhythmic therapies. Thoracic epidural anesthesia has been reported to terminate fatal ventricular arrhythmia; however, its underlying mechanism is unknown. Methods: Rats were randomly divided into four groups: sham, sham plus bupivacaine, ischemia/reperfusion (IR), and IR plus bupivacaine groups. Bupivacaine (1 mg/mL, 0.05 mL/100 g body weight) was injected intrathecally into the L5–L6 intervertebral space prior to establishing a myocardial IR rat model. Thereafter, cardiac arrhythmia, cardiac function, myocardial injury, and electrical activities of the heart and spinal cord were evaluated. Results: Intrathecal bupivacaine inhibited spinal neural activity, improved heart rate variability, reduced ventricular arrhythmia score, and ameliorated cardiac dysfunction in IR rats. Furthermore, intrathecal bupivacaine attenuated cardiac injury and myocardial apoptosis and regulated cardiomyocyte autophagy and connexin-43 distribution during myocardial IR. Conclusion: Our results indicate that intrathecal bupivacaine blunts spinal neural activity to prevent cardiac arrhythmia and dysfunction induced by IR and that this anti-arrhythmic activity may be associated with regulation of autonomic balance, myocardial apoptosis and autophagy, and cardiac gap junction function. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effect of different routes of norepinephrine (NE) administration on maternal hypotension in pregnant females undergoing spinal anesthesia for caesarean section. 208 pregnant women were divided randomly into 4 groups (n=52). Bolus 4 µg/ml NE was administered intravenous (iv) immediately after spinal anesthesia in Group PB (Prophylactic Bolus). In Group PI (Prophylactic Infusion), 1 ml of saline solution was applied promptly after spinal anesthesia and then the NE infusion was started at 1 ml/min. In Group TB (Treatment Bolus), 1 ml Physiological Saline (PS) was administered after 1 ml/min infusion of PS immediately after spinal anesthesia and then 1 ml/min NE bolus when blood pressure decreased by 20% after the entry. In Group TBI (Treatment Bolus Infusion), 1 ml PS was administered after 1 ml/min infusion of PS immediately after spinal anesthesia, 1 ml NE and then 1 ml/min NE infusion was initiated when blood pressure decreased by 20% after the entry. At the 4th, 6th, and 8th minutes, the PI Group exhibited higher systolic and mean blood pressures than the other groups (p<.001). Additionally, hypotension was statistically lower in the PI Group than in PB, TB, TBI groups (p<.001), and episodes of hypotension, ephedrine required and extra NE boluses given were statistically lower in the PI Group than in the other groups (p<.001). Umbilical vein (UV) pH values were lower in the TBI Group at compared to the other groups (p<.001). It is suggested that a prophylactic infusion of 4 µg/min of NE in the prevention of hypotension following spinal anesthesia for cesarean section will reduce the possibility of maternal hypotension and better maintain fetal well-being than a prophylactic bolus, a treatment bolus or a posttreatment bolus infusion at the same dose. [ABSTRACT FROM AUTHOR]

Introduction: Subarachnoid block is the most commonly used anaesthetic technique for caesarean sections. Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anaesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. The aim of this study is to assess the incidence of postdural puncture headache in the median and paramedian approach using 25G Whitacre spinal needle in pregnant females undergoing caesarean section. Materials and methods: After obtaining institutional ethical committee approval,100 patients of ASA I and ASAII of pregnant women undergoing caesarean section belonging to age group of 18-35 years randomized by computer generated numbers into two groups (50 each) after fulfilling inclusion criteria. The patients were randomized to receive spinal anaesthesia by either a median (n=50) approach or paramedian approach (n=50). After informed written consent, all patients were premedicated with Inj.Metoclopromide 10mg and all patients received 500ml of Normal saline intravenously over 30minutes before the procedure. Each patient received 9-12mg of hyperbaric bupivacaine with 25G Whitacre spinal needle either through median approach(group M, n=50) or paramedian approach(group PM, n=50).The patients were followed for 48 hours for PDPH, presence of PDPH was assessed by visual numerical analogue scale. Results: Out of total 100 caesarean section patients, six patients developed PDPH. 4/50(8%) had PDPH in median approach and 2/50(4%) had PDPH in paramedian approach. However the difference in incidence of PDPH in both median and paramedian approaches is not statistically significant (p value=0.4000) and the severity of PDPH in both groups was of mild degree. Conclusion: Even though we noticed the incidence of PDPH is less with 25G Whitacre spinal needle in paramedian approach compared to median approach, but there was no significant statistical difference on incidence of PDPH using 25 G Whitacre spinal needle between median and paramedian approach in caesarean section patients. [ABSTRACT FROM AUTHOR]

Introduction Inguinal hernia most frequent problem in human being adult as well as children suffer with it. Inguinal hernia repair done under “anesthesia” {such as local anesthesia, spinal anesthesia, nerve block, epidural anesthesia, & general anesthesia}, depending upon number of variables i.e. patient’s acceptance, surgeon’s preference, safety, practicality and cost effectiveness. Objectives To compare nerve block versus spinal Anesthesia in Lichtenstein tension-free mesh inguinal hernia repair Methods The Present study, conducted as a hospital-based comparative prospective study at the Department of General Surgery, Muzaffarnagar Medical College & Hospital, Muzaffarnagar, U.P., aimed to investigate the efficacy of two different anesthesia techniques in inguinal hernia repair. Over an 18-month period, 100 patients meeting the inclusion criteria. The study utilized a combination of ilioinguinal and iliohypogastric nerve blocks alongside field blocks for anesthesia administration, ensuring proper analgesia and relaxation. Cases were grouped based upon fitness for spinal anesthesia, comorbidities, and patient preference. Group A underwent mesh repair under spinal anesthesia, while Group B received nerve block via inguinal field block technique. Results In the <40 year group, Nerve Block accounts for 2.0% of cases while Spinal Anaesthesia accounts for 10.0%. In the 41-50year group, Nerve Block represents 64.0% of cases, whereas Spinal Anaesthesia represents 60.0%. In the >50 age group, Nerve Block represents 34.0% of cases, and Spinal Anesthesia represents 30.0%. On comparison of seroma occurrence between Group A and Group B revealed interesting insights. In Group A, comprising 50 cases, 45 cases (90.0%) exhibited seroma, while 5 cases (10.0%) did not. Similarly, in Group B, consisting of another 50 cases, 47 cases (94.0%) showed seroma, with 3 cases (6.0%) without it. When considering both groups collectively, out of 100 cases, 92 cases (92.0%) had seroma, while 8 cases (8.0%) did not. Conclusion We came to the conclusion that all patients with primary inguinal hernias benefit from Lichtenstein mesh repair performed under local anesthesia for a number of reasons. Simpleness, dependability, efficacy, safety, a smooth recovery period marked by easily managed pain, a prompt return to full range of activities, and high patient satisfaction are a few of these. [ABSTRACT FROM AUTHOR]

Aims: We aimed to compare the analgesic efficacy of oral clonidine vs intrathecal clonidine added as an adjuvant to 0.5% hyperbaric bupivacaine spinal anesthesia in cesarean section Materials and Methods: A prospective randomized double blind controlled studyenrolled 50 patients for elective caesarean sections under spinal anesthesia and were allocated into 2 groups (25 each) after fulfilling the inclusion and exclusion criteria. Group O received 0.5% hyperbaric bupivacaine 2cc(10mg) plus 0.5 cc NS intrathecally and 200µg oral clonidine was given 90 mins before spinal anesthesia and group I received 0.5 % Hyperbaric bupivacaine 2cc(10mg) + 45 µg (0.5cc) of clonidine intrathecally with oral vitamin c tablets 90 mins before spinal anesthesia. Results: Both the groups had comparable demographics in age, height,weight, BMI. There was a statistically significant difference in terms of duration of analgesia between the two groups. Duration of analgesia was prolonged more in Group I than in Group O with a p value 0.0001.There was a statistically significant difference in terms of onset of sensory and motor blockade which was faster in Group I than in Group O. (P=0.0001). There was a statistically significant difference in terms of duration of sensory and motor blockade which was prolonged in Group I than in Group O. (P=0.0001). There was a significant reduction in pulse rate and hypotensive episodes encountered with Group O than Group I which was statistically significant. The sedation, fetal well being and adverse effects were all comparable between the two groups. Conclusion: Intrathecal clonidine when added as an adjuvant to hyperbaric bupivacaine prolongs the duration of analgesia, sensory and motor block than oral clonidine without significant adverse effects. [ABSTRACT FROM AUTHOR]

Background Spinal anesthesia is commonly used in various surgical procedures but is often associated with hypotension, which can lead to significant complications. The Inferior Vena Cava Collapsibility Index (IVCCI) and Caval Aorta Index (CAI) are potential predictors of fluid responsiveness and can help anticipate hypotension after spinal anesthesia. This study aims to evaluate the efficacy of IVCCI and CAI in predicting hypotension following spinal anesthesia. Materials and Methods A total of 100 patients scheduled for elective surgeries under spinal anesthesia were enrolled in this prospective clinical study. Preoperative IVCCI and CAI measurements were obtained using ultrasound. Spinal anesthesia was administered using 0.5% bupivacaine. Blood pressure was monitored every 5 minutes for 30 minutes post-anesthesia. Hypotension was defined as a systolic blood pressure decrease of more than 20% from baseline or below 90 mmHg. Statistical analysis was performed using logistic regression to assess the predictive value of IVCCI and CAI for hypotension. Results Out of 100 patients, 35 developed hypotension after spinal anesthesia. The mean IVCCI for the hypotensive group was 45%, compared to 25% in the non-hypotensive group (p < 0.01). The mean CAI was 0.8 in the hypotensive group and 0.6 in the non-hypotensive group (p < 0.05). Logistic regression analysis revealed that both IVCCI and CAI were significant predictors of hypotension, with IVCCI having a higher predictive accuracy (AUC = 0.85) compared to CAI (AUC = 0.78). Conclusion The Inferior Vena Cava Collapsibility Index and Caval Aorta Index are effective predictors of hypotension following spinal anesthesia. IVCCI, in particular, demonstrates superior predictive accuracy. Incorporating these indices into preoperative assessments may enhance the management and prevention of hypotension, improving patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of additional local infiltration of dexamethasone and lidocaine among post-cesarean parturient underwent spinal anesthesia compared to the control group. Materials and Methods: This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between June and November 2022. Singleton pregnant women who underwent cesarean delivery were randomized into 3 groups: dexamethasone (D), lidocaine (L), and control groups (C). Before skin closure, D, L and C group received infiltration of 16 mg of dexamethasone, 2% lidocaine with adrenaline and none, respectively. A visual analog scale (VAS, 0-10) was used for the evaluation of post-cesarean pain at two, four, six, eight, twelve, and twenty-four hours. VAS, demographic, and obstetric data were collected for analysis. Additional opioid was recorded for secondary outcome. Results: A total of 279 participants were recruited and divided into 3 groups. Half of the participants (151/279) were nulliparity. Other demographics were similar. Subjects in the D group had lower moderate to severe pain after 6 hours onwards and less additional opioid requirement compared to the C and L groups significantly. Subjects in the L group had lower moderate to severe pain than the C group at 4 hours after surgery. Postoperative complications were comparable among the groups. Conclusion: Local dexamethasone infiltration could reduce and prolong post-cesarean pain relief within 24 hours after cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of additional local infiltration of dexamethasone and lidocaine among post-cesarean parturient underwent spinal anesthesia compared to the control group. Materials and Methods: This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between June and November 2022. Singleton pregnant women who underwent cesarean delivery were randomized into 3 groups: dexamethasone (D), lidocaine (L), and control groups (C). Before skin closure, D, L and C group received infiltration of 16 mg of dexamethasone, 2% lidocaine with adrenaline and none, respectively. A visual analog scale (VAS, 0-10) was used for the evaluation of post-cesarean pain at two, four, six, eight, twelve, and twenty-four hours. VAS, demographic, and obstetric data were collected for analysis. Additional opioid was recorded for secondary outcome. Results: A total of 279 participants were recruited and divided into 3 groups. Half of the participants (151/279) were nulliparity. Other demographics were similar. Subjects in the D group had lower moderate to severe pain after 6 hours onwards and less additional opioid requirement compared to the C and L groups significantly. Subjects in the L group had lower moderate to severe pain than the C group at 4 hours after surgery. Postoperative complications were comparable among the groups. Conclusion: Local dexamethasone infiltration could reduce and prolong post-cesarean pain relief within 24 hours after cesarean delivery. [ABSTRACT FROM AUTHOR]

Background: Subarachnoid blockade is a safe, reliable, and inexpensive technique that provides surgical anesthesia along with prolonged post-operative analgesia. The quality of subarachnoid block is enhanced by the addition of intrathecal adjuvants, such as fentanyl citrate and magnesium sulfate to hyperbaric levobupivacaine. Aims and Objectives: The aim of this study was to compare the effects of fentanyl and magnesium sulfate as adjuvants to 0.5% hyperbaric levobupivacaine in orthopedic surgeries under subarachnoid block. Materials and Methods: This prospective randomized study included 90 American Society of Anesthesiologists Grade I and II patients aged 18-60 years undergoing orthopedic surgeries. Group LS received 3 mL 0.5% levobupivacaine heavy+0.5 mL normal saline. Group LF received 3 mL 0.5% levobupivacaine heavy+fentanyl 25 µg, and Group LM, 3 mL 0.5% levobupivacaine heavy+magnesium sulphate 50 mg+0.4 mL normal saline. The onset and duration of sensory and motor block and intraoperative hemodynamics were recorded. In the post-operative period, duration of analgesia, Visual Analog Scales scores, and side effects were observed. Results: The onset of sensory block was 4.04±0.74 min in Group LM (P<0.001) as compared to Groups LF (2.01±0.23 min) and LS (2±0.24 min). The onset of motor blockade took 5±1.14 min in the control group, 7.01±0.94 in group LF, and 8.11±1.33 min in group LM (P<0.001). The duration of analgesia in group LS was 183.73±12.08 min, 317±18.6 min in group LF, and 219.43±20.89 in group LM (P<0.001). Conclusion: The addition of fentanyl and magnesium as adjuvants enhanced the quality of subarachnoid block when added to hyperbaric levobupivacaine. The duration of analgesia was longest in fentanyl, followed by magnesium and then control. The incidence of side effects was greatest in fentanyl, followed by control and nil in magnesium. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is the technique of choice for transurethral resection of the prostate (TURP) surgeries. Levobupivacaine, an S-enantiomer of bupivacaine, is less cardiotoxic than bupivacaine; therefore, a low dose of local anesthetic with fentanyl as an adjuvant has been used to decrease toxicity and increase efficacy. Aims and Objectives: The aim of this study was to compare and evaluate the efficacy of hyperbaric bupivacaine 0.5%, isobaric levobupivacaine 0.5%, and hyperbaric levobupivacaine 0.5% with fentanyl as an adjuvant. Materials and Methods: One hundred and five patients scheduled for elective TURP surgeries were randomly divided into three groups. Group BH (n=35) received 1.5 mL of 0.5% hyperbaric bupivacaine with 25 µg of fentanyl, Group LH (n=35) received 1.5 mL of 0.5% hyperbaric levobupivacaine with 25 µg of fentanyl, and Group LP (n=35) received 1.5 mL of 0.5% isobaric levobupivacaine with 25 µg of fentanyl intrathecally. Results: The onset of sensory and motor block was earlier and the duration of analgesia and motor block were longer in the BH group (P<0.001) as compared to LH and LP groups. The demographic data, duration of surgery, heart rate, SpO2, pruritus, and shivering were comparable between the groups (P>0.05). The visual analog scale score was higher in the LP group. Hypotension, nausea, and vomiting were seen in the BH group. Conclusion: Hyperbaric is better than isobaric group due to quicker onset and longer duration. Levobupivacaine is better than bupivacaine in terms of the early mobilization and a lesser incidence of side effects, making hyperbaric levobupivacaine a better alternative to isobaric levobupivacaine and hyperbaric bupivacaine. [ABSTRACT FROM AUTHOR]

Purpose: Cesarean section may result in adverse psychosocial and behavioral outcomes because women put considerable emphasis on the process of birth. Virtual reality treatment has been shown by many studies to reduce anxiety and improve patient satisfaction. Therefore, we designed a randomized controlled trial to investigate whether the application of virtual reality technology during cesarean section can reduce maternal anxiety and improve satisfaction. Methods: We recruited 128 women undergoing elective cesarean delivery with proposed spinal anesthesia and randomly assigned them to either virtual reality or routine care. The virtual reality intervention was a virtual reality program tailored specifically for women undergoing cesarean section. Primary outcome was the change in anxiety score (change = preoperative–intraoperative score). Secondary outcomes included patient satisfaction score, requirement of intraoperative sedative and analgesic drugs, and respiratory rate. Results: The change in anxiety score in the virtual reality group was significantly higher than that in the routine care group (30 [20, 47.5] vs 10 [− 10, 23.8], respectively; P < 0.001, with Hodges–Lehmann median difference estimate of 20 (95% confidence interval CI, 15–30)). There were no significant differences between the two groups in patient satisfaction scores, the requirement of intraoperative sedative and analgesic drugs, and respiratory rate and side effects. Conclusion: Virtual reality treatment could reduce the anxiety of women undergoing elective cesarean section, which is beneficial to the mother and baby. Trialregistration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2200061936) on July 11, 2022, and can be reached at https://www.chictr.org.cn/showprojEN.html?proj=173329. [ABSTRACT FROM AUTHOR]

Background and Objectives: The incidence of proximal femoral fractures (PFFs) is rising, causing significant morbidity and mortality. Regional anesthesia (RA)'s benefits include the avoidance of intubation and mechanical ventilation, decreased blood loss, and improved analgesia. General anesthesia (GA) offers improved hemodynamic stability. This study examines the in-hospital post-surgical morbidity and mortality seen in PFFs in a cohort of the elderly undergoing GA or RA. Materials and Methods: This is a retrospective cohort study of 319 PFF patients older than 65 years over a single year. Results: In total, 73.7% of patients underwent GA. The patient characteristics were identical between groups, except for smoking. Hypertension was the most frequent comorbidity, followed by hyperlipidemia, NIDDM, and IHD. The overall patient complication rate was 11.4%. Pneumonia was the most common complication (5.1% in GA, 8.4% in RA). A total of 0.9% of patients required ICU admission. Overall, the in-hospital mortality rate was 2.3%, with no statistically significant difference between GA and RA. The GA and RA cohorts were similar in terms of their patient demographics, medical history, and preoperative parameters. In total, 73% of surgeries were under GA. No statistically significant differences were found in total anesthesia time or complication rates. Conclusions: We did not find a difference between general and spinal anesthesia regarding complication rates, anesthesia time, or morbidity. General anesthesia remains best suited for patients receiving anticoagulation treatment and undergoing semi-urgent surgery, but, other than that, the mode of anesthesia administered remains up to the anesthesiologist's preference. [ABSTRACT FROM AUTHOR]

Background and Objectives: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for nephrolithiasis. RIRS is performed via a monitor screen displaying a magnified surgical site. Respiration can affect the stability of the surgical view during RIRS because the kidneys are close to the diaphragm. The purpose of this trial is to compare the effect of anesthesia type on the stability of the surgical view during RIRS between spinal anesthesia and general anesthesia. Materials and Methods: Patients were allocated to the general anesthesia group or spinal anesthesia group. During surgery, movement of the surgical field displayed on the monitor screen was graded by the first assistant on a 10-grade numeric rating scale (0–10). Next, it was also graded by the main surgeon. After surgery, we evaluated the discomfort with the anesthesia method for all patients. Results: Thirty-four patients were allocated to the general anesthesia group and 32 patients to the spinal anesthesia group. The average values of the two surgeons for surgical field oscillation grade showed vision on the monitor screen was more stable in the general anesthesia group than the spinal anesthesia group (3.3 ± 1.6 vs. 5.0 ± 1.6, p < 0.001). The degrees of the inconvenience of the surgery did not differ between the groups (0.7 ± 1.8 vs. 1.6 ± 2.6, p = 0.114), even though more patients reported inconvenience with a grade of 3 or more in the spinal anesthesia group (8.8% vs. 28.1%, p = 0.042). Conclusions: In terms of the visualization of the surgical site, general anesthesia might provide a more stable surgical view during RIRS compared to spinal anesthesia without increasing inconvenience induced by the type of anesthesia. [ABSTRACT FROM AUTHOR]

Nephrolithiasis, or kidney stone disease, is a significant global health issue in urology, requiring effective management strategies. The management of nephrolithiasis through flexible ureteroscopy (fURS) is increasingly gaining acceptance; however, it is associated with significant costs related to consumables, pharmacotherapy, specialized equipment, and general anesthesia (GA). Limited resources and the need to optimize the cost effectiveness ratio have driven the shift to day-case procedures, offering financial and operational benefits and improving patient satisfaction. This outpatient care approach addresses clinical and economic challenges. For same-day discharge, spinal anesthesia (SA) is essential for fURS, as GA does not permit safe immediate discharge. This retrospective study investigates the feasibility of same-day discharge following fURS procedures performed under SA. Analyzing data from 401 patients who underwent 414 fURS procedures between January 2020 and December 2023, this study aims to evaluate whether same-day discharge is a viable option compared to conventional fURS under GA. The primary objectives are to assess the outcomes, including efficacy, stone-free rate (SFR), pain management, and complication rates, in the context of same-day discharge. Additionally, this study seeks to identify patient and kidney stone characteristics that may influence the suitability of one-day fURS under SA. Outcomes will be measured using the Dindo–Clavien (D-C) classification and Visual Analog Scale (VAS) scores post-procedure. [ABSTRACT FROM AUTHOR]

Background Quality of life (QoL) may be affected due to various reasons such as low back or leg pains with accompanying neurologic problems. Lumbar disk surgery is one of the most common performed surgeries to relieve those symptoms. Various anesthetic techniques can be used safely to perform lumbar disk surgeries. Properties that make an anesthetic technique good are mainly the quick onset and returning of the effects. This large retrospective study with patients who have undergone lumbar disk surgery under spinal anesthesia aims to evaluate the perioperative and postoperative parameters of the spinal anesthesia and review the literature. Methods Cases operated under spinal anesthesia between January 2017 and December 2020 were investigated, and 617 patients who underwent simple lumbar disk surgery were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were recorded. Visual analog scale (VAS) and QoLscores were obtained before and after the operation. Results There were 282 (45.7%) male and 335 (54.3%) female patients with a mean age of 39.48 ± 16.71 years (range: 18–58 years) at symptom onset. The mean operating time was 46.3 minutes (range: 22–68 minutes). Average blood loss was 85 mL (range: 55–125 mL). All the patients were mobilized 6 to 12 hours after surgery. In our patient group, there were both high- and normal-risk groups in terms of the ASA physical status. During the clinical follow-up, a statistically significant improvement was found for the VAS and QoL scores (p < 0.05). Conclusions In this large retrospective study, our results have confirmed that spinal anesthesia is at least comparable to general anesthesia and even superior to it in some aspects. [ABSTRACT FROM AUTHOR]

Introduction: Aortic stenosis is a cause of mortality or morbidity. It complicates the selection and management of anesthetic procedures. The aim of this study was to evaluate the efficacy, hemodynamic effects and postoperative outcome of unilateral spinal anesthesia in geriatric patients with hip fractures with moderate or severe aortic stenosis. Material and Method: A retrospective observational study was conducted on geriatric high-risk patients with cardiac conditions who underwent surgery for hip fractures under unilateral spinal anesthesia with low-dose hyperbaric bupivacaine. The study period spanned from January 2018 to December 2021. The inclusion criteria were individuals with moderate to severe aortic stenosis, as defined by the American Heart Association Criteria. Data on demographic information, cardiac pathologies, hemodynamic data, data on motor and sensory block, perioperative complications, and mortality rates at 30th and 180th days were collected. Results: Mortality rates at the 30th day and 180th day were 8.9% (n:4) and 24.4% (n:11), respectively. T6 level was predominantly obtained level of anesthesia (44.4%). Motor and sensory block formation times averaged 7.6 and 4.8 minutes, respectively. Surgical procedures were performed mostly within 1 hour (66.7%), and complications were rare (11.1% hypotension). Initial analgesic effect showed a rapid resolution, with 64.4% of patients requiring analgesic within the first hour postoperatively. Conclusion: In elderly patients with moderate to severe aortic stenosis scheduled for hip fracture surgery, we posit that unilateral spinal anesthesia with ultra-low dose is safe and effective option. [ABSTRACT FROM AUTHOR]

Introduction. The aim was to evaluate the effect of preoperative anxiety on the sympathetic block that developed after spinal anesthesia and therefore the duration of motor and sensory blockade. Materials and Methods. After the approval of the ethics committee, 90 patients between the ages of 18 and 55 years who were to be operated under spinal anesthesia were included in the study. Preoperative anxiety of the patients was evaluated with the Spielberger trait and State Anxiety Scale and Visual Analog Scale (VAS). The Bromage scores of the patients were followed up intermittently. Onset time of sensory block, onset time of motor block, and motor block recovery time were recorded. Cases with bradycardia and hypotension were noted. Results. No statistically significant correlation was found between the duration of motor block onset (5.81 ± 4 min), the sensory block onset time (0.89 ± 0.4 min), and the motor block recovery time (92.06 ± 36.9 min) with other variables. VAS (5.81 ± 2.5), STAI‐1 (40.4 ± 9.8), and STAI‐2 (41.69 ± 8.2) values had a statistically significant effect on the occurrence of bradycardia (14.4%). The variables of VAS, STAI‐1, STAI‐2, sensory block onset, motor block onset, and motor block recovery time were statistically significantly higher in women (mean 5.24 ± 2.4, 38.97 ± 9.9, 41.43 ± 8.7, 0.89 ± 0.42, 5.64 ± 3.82, and 88.77 ± 38.74 in males and mean 7.15 ± 2.1, 43.74 ± 8.9, 42.30 ± 7.0, 0.88 ± 0.27, 6.20 ± 4.35, and 99.70 ± 31.70 in females, respectively). Conclusion. It was observed that preoperative anxiety had no effect on motor and sensory block onset and duration. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia (SA) is a conventional method for proper nerve block in abdominopelvic and lower extremity surgeries. Compared to general anesthesia, SA has reduced perioperative complications significantly. The hyperbaric type of bupivacaine hydrochloride (HB) induces spinal anesthesia more efficiently with a lower incidence of life-threatening adverse reactions like Perioperative hemodynamic changes and respiratory depression. More investigations are needed to define the best dosage that provides adequate anesthesia while reducing adverse effects for each surgical procedure. Methods: This double-blinded randomized clinical trial compared the consequences of the (12.5mg,15mg,20mg) dosages of HB-bupivacaine in elective lower limb orthopedic surgery. Using block randomization, we allocated 60 participants to three (n = 20) study groups. Utilizing the same protocol of anesthesia induction, outcome variables assumed and measured as the incidence of the adverse effects (Hypotension, Anxiety, Bradycardia, Nausea and Vomiting(N/V), Hypoventilation, and Decreased o2 saturation), and the requirement for intervention to control the unwanted reaction. Addressing that, outcome variables were measured 10 times perioperatively. One-way ANOVA test, the chi2 test, or repeated measures ANOVA test with the Bonferroni adjustment were utilized as appropriate. Results: We found that the incidence of hypotension (P-value:0.02) and the N/V (P-value < 0.001) are associated with the HB-bupivacaine dosage. Contrary, our findings indicate that the incidence of apnea, bradycardia, and hypoventilation did not exhibit a significant dose-dependent pattern between the groups. Repeated measures analysis revealed significant intergroup differences for Herat rate, systolic, diastolic, and mean arterial pressure (group*time Pvalue < 0.001). The observed differences were more prominent 10–30 min after injection of HB-bupivacaine. The regression model claimed that gender (P-value:0.002) and drug dosage (P-value:0.03) significantly predict the incidence of adverse effects. Conclusion: Our results, suggest that the administration of the 12.5mg HB-bupivacaine provides adequate anesthesia while minimizing the risk of adverse events for lower limb orthopedic surgeries lasting up to 180 min. Trial registration: The study was registered at the Clinical Trial Registry Center (IRCT20160202026328N7), Registered on 2022.01.10. [ABSTRACT FROM AUTHOR]

Background: Respiratory functions may be impaired in cesarean section (C/S) delivery performed under spinal anesthesia (SA) and oxygen supplementation may be required. Therefore, we conducted a randomized controlled study aimed to evaluate the effects of different oxygen administrations in pregnant women on the lungs during C/S under SA using ultrasound and oxygen reserve index (ORI). Methods: We conducted a randomized, controlled, single-center study from May 1, 2021, to March 31, 2022. A total of 90 patients scheduled for C/S under SA were randomly divided into 3 groups. Following the SA, patients in group 0 were treated with room air, in Group 3 were administered 3 L/min O₂ with a nasal cannula (NC), in Group 6 were administered 6 L/min O₂ with a simple face mask. In addition to routine monitoring, ORI values were measured. Lung aeration was evaluated through the modified lung ultrasound score (LUS) before the procedure (T0), at minute 0 (T1), 20 (T2), and hour 6 (T3) after the procedure, and ∆LUS values were recorded. Results: After SA, the ORI values of Group 3 were higher than Group 0 at all times (p < 0.05), while the intraoperative 1st minute and the 10th, 25th and 40th minutes after delivery (p = 0.001, p = 0.027, p = 0.001, p = 0.019) was higher than Group 6. When the LUS values of each group were compared with the T0 values a decrease was observed in Group 3 and Group 6 (p < 0.001, p = 0.016). While ∆LUS values were always higher in Group 3 than in Group 0, they were higher only in T1 and T2 in Group 6. Conclusion: We determined that it would be appropriate to prefer 3 L/min supplemental oxygen therapy with NC in C/S to be performed under SA. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy in a woman with heart and chronic renal failure can lead to life-threatening complications for both mother and child. Although such cases are often delivered by cesarean section, few reports have described anesthesia methods. Case presentation: We encountered a case in which cesarean section was performed using combined spinal and epidural anesthesia for a pregnant woman with chronic renal and heart failure. The 35-year-old Japanese woman had been undergoing hemodialysis for several years. Heart failure symptoms that appeared during pregnancy initially improved with treatments such as increasing hemodialysis, but recurred. She was admitted to the intensive care unit. The initial plan was to deliver the baby after a few weeks, but further progression of heart failure became a concern. After a clinical conference among staff, a cesarean section with combined spinal and epidural anesthesia was scheduled for 24 weeks, 0 days of gestation. The anticoagulant for dialysis was also changed from heparin to nafamostat in preparation for cesarean section. Monitoring was started with central venous and radial artery pressures before induction of anesthesia. Combined spinal and epidural anesthesia was induced and the cesarean section was completed without complications. Surgery was initiated under continuous administration of phenylephrine, which was intended to avoid hypotension due to anesthesia. The hemodynamic and respiratory status of the patient remained stable postoperatively. After the cesarean section, morphine was administered epidurally and the epidural catheter was removed. Conclusion: Cesarean section was safely performed for a pregnant woman with renal and heart failure using combined spinal and epidural anesthesia. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 22-year-old female patient who experienced post-dural puncture headache (PDPH) following administration of spinal anesthesia. Topics discussed include the headache and neck pain reported by the patient three days after hospital discharge, the pain relievers prescribed to the patient to help manage pain, and the reduction in headache intensity after the sphenopalatine ganglion block procedure.

This study aimed to assess the safety, effectiveness, and comfort of operating surgeon in conducting laparoscopic cholecystectomy (LC) under spinal anaesthesia (SA) in comparison to general anaesthesia (GA). LC were conducted in 101 patients which were randomly divided via lottery method in two groups, GA (n = 50) and SA (n = 51). Operative time, surgeon's comfort, intraoperative and postoperative pain, and adverse events were compared between the groups. Two patients from GA and one from SA were removed from the study due to intraoperative complication. Mean anaesthesia time was significantly lower (p = 0.011) in the SA group (48.37 ± 10.91) as compared to the GA group (55.60 ± 16.22). Intraoperative anxiety was found in only one patient in the SA group (2% vs. 0%) who received midazolam 2 mg. Intraoperative right shoulder pain was significantly more (p < 0.001) in the SA group (50% vs. 0%) which was treated by Fentanyl 50 μg in IV boluses. Intraoperative nausea was more in the SA group (4% vs. 0%) but not significantly different. Mean VAS (visual analogue scale) was significantly lower in SA as compared to GA at 0, 3, and 6 hr (p = 0.003, <0.001, and <0.001). Mean VAS for right shoulder tip pain was significantly higher in SA as compared to GA at 0 and 3 hr (p = 0.009 and 0.045). Surgeon's comfort was higher for GA (100% vs. 94%) but not significantly different. LC under SA is feasible, safe, and with less postoperative pain and mean anaesthesia time; however, surgeon's comfort was more in the GA group. [ABSTRACT FROM AUTHOR]

Purpose: Treatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events. Methods: Registry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes. Results: 2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1–2.3)) and one-year mortality (AOR 1.4 (1.1–1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3–0.9)), but a similar one-month mortality to DOAC-patients operated under SA. Conclusion: DOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia. Material and methods: A total of 200 participants, including 100 undergoing vaginal hysterectomy with general anesthesia (group 1) and 100 with spinal anesthesia (group 2), were enrolled. A visual analog scale (VAS) was used for the postoperative pain intensity. Results: The 1st hour, 6th hour, 12th hour, and 18th hour VAS scores were higher in vaginal hysterectomy with general anesthesia than in vaginal hysterectomy with spinal anesthesia. Conclusions: Although participants undergoing VH with spinal anesthesia (preoperative state anxiety inventory score > 45) had lower pain intensity scores in the first 18 hours compared to those undergoing VH with general anesthesia, their postoperative analgesic requirements were similar. [ABSTRACT FROM AUTHOR]

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Background: Bupivacaine and Ropivacaine are the commonly used drugs in spinal anesthesia. The efficacy of these drugs along with adjuvant fentanyl, remains better but the question remains unsolved that whether bupivacaine plus fentanyl or ropivacaine plus fentanyl, which works better. Hence this study was undertaken to compare the efficacy, hemodynamic stability and side effects of these drugs for lower abdominal and lower limb surgeries. Methods: This prospective randomized, control study was conducted among patients undergoing lower abdominal and lower limb surgeries in Rohilkhand Medical College Hospital, Bareilly for elective surgical procedures. Ninety four patients were included in the study with forty seven cases in group A (0.75% hyperbaric Ropivacaine-3ml plus 25mcg fentanyl) and forty cases in group B (0.5% hyperbaric bupivacine-3ml plus 25mcg fentanyl). Data analysis was done using SPSS version 17. Results: Intrathecal 0.5% Hyperbaric bupivacaine plus fentanyl combination produces a significantly longer duration of analgesia, sensory block and motor block when compared to intrathecal hyperbaricbaric ropivacaine plus fentanyl combination. Greater hemodynamic stability was observed in Ropivacaine plus fentanyl group. Conclusion: Ropivacaine plus fentanyl provides a higher degree of hemodynamic stability plus allows early ambulation. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted for evaluating the efficacy of Intrathecal levobupivacaine and bupivacaine among patients undergoing inguinal hernia surgery under spinal anesthesia. Materials & methods: A total of 50 patients were enrolled and were randomized into two study groups as follows: Group 1- intrathecal isobaric levobupivacaine, and Group 2- intrathecal hyperbaric racemic bupivacaine. Complete demographic and clinical details of all the patients was obtained. Anthropometric examination of all the patients was done. Patients having history of any systemic illness, or any known drug allergy were excluded. Complete baseline hemodynamic and biochemical profile at baseline was evaluated. All the patients underwent type of spinal according to their respective study groups. Quality of anesthesia was assessed. Motor and sensory block characteristics were also evaluated. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients of the group 1 and group 2 was 43.8 years and 45.1 years respectively. Majority proportion of patients of both the study groups were males. Among patients of group 1, excellent and satisfactory anesthesia was seen in 84 percent and 16 percent of the patients respectively. Among patients of group 2, excellent and satisfactory anesthesia was seen in 88 percent and 12 percent of the patients respectively. Mean onset of sensory and motor block were similar for both the study groups. However; mean duration of motor block was significantly lower in group 1 (176.3 mins) in comparison to group 2 (191.7 mins). Conclusion: Levobupivacaine offered high quality of anesthesia among patients having spinal anesthesia with shorter duration of motor block, allowing quicker recovery. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted for evaluating the efficacy of Intrathecal levobupivacaine and bupivacaine among patients undergoing inguinal hernia surgery under spinal anesthesia. Materials & methods: A total of 50 patients were enrolled and were randomized into two study groups as follows: Group 1- intrathecal isobaric levobupivacaine, and Group 2- intrathecal hyperbaric racemic bupivacaine. Complete demographic and clinical details of all the patients was obtained. Anthropometric examination of all the patients was done. Patients having history of any systemic illness, or any known drug allergy were excluded. Complete baseline hemodynamic and biochemical profile at baseline was evaluated. All the patients underwent type of spinal according to their respective study groups. Quality of anesthesia was assessed. Motor and sensory block characteristics were also evaluated. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean age of the patients of the group 1 and group 2 was 43.8 years and 45.1 years respectively. Majority proportion of patients of both the study groups were males. Among patients of group 1, excellent and satisfactory anesthesia was seen in 84 percent and 16 percent of the patients respectively. Among patients of group 2, excellent and satisfactory anesthesia was seen in 88 percent and 12 percent of the patients respectively. Mean onset of sensory and motor block were similar for both the study groups. However; mean duration of motor block was significantly lower in group 1 (176.3 mins) in comparison to group 2 (191.7 mins). Conclusion: Levobupivacaine offered high quality of anesthesia among patients having spinal anesthesia with shorter duration of motor block, allowing quicker recovery. [ABSTRACT FROM AUTHOR]