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Pawel Ratajczyk,1 Bartosz Dominikowski,2 Agnieszka Czylkowska,3 Bartlomiej Rogalewicz,3 Cezary Kulak,4 Tomasz Gaszynski1 1Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; 2Institute of Electrical Engineering Systems, Lodz University of Technology, Lodz, Poland; 3Institute of General and Ecological Chemistry, Lodz University of Technology, Lodz, Poland; 4Medical Simulation Center, Medical University of Lodz, Lodz, PolandCorrespondence: Tomasz Gaszynski, Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Kopcinskiego Str 22, Lodz, 90-153, Poland, Email tomasz.gaszynski@umed.lodz.plIntroduction: The aim of the article is to determine the appropriate concentration of desflurane to effectively counteract the increase in blood pressure resulting from surgical stress. In medical practice, this increase is often limited by using additional doses of opioid drugs. Additional medications or higher doses of those already used may adversely affect your health. During anesthesia, physician must note the use of drugs and remember them, especially those that he has recently administered, which affect his concentration. For this purpose, the authors decided to propose support for the selection of desflurane concentration so that frequent use of opioid drugs is not necessary. The authors used a system based on AI issues to accomplish this task. The learned system supports the anesthesiologist’s work by imitating him.Patients and Methods: The proposed method for selecting the desflurane concentration is based on a fuzzy controller. This system includes a learning mechanism that allows for minimizing the operating error. The main advantage of this system is the ability to build a function allowing the selection of anesthesia parameters without knowledge of the mathematical description of the process. To accomplish this task, you need an expert who will provide information in the construction of logical if-then sentences (points in space). The fuzzy controller connects the points in the consideration space appropriately, generating a hypersurface. The algorithm test was performed only by computer without the participation of patients.Results: The operation of the proposed algorithm was verified by computer simulation. The authors of the article analyzed the compliance of the obtained results with the table provided by the expert. The desflurane concentration values obtained by computer simulation are similar to those given in the table Minimal driver error does not affect the patient’s clinical response. This error results from the functions used in the fuzzy system and its settings. The results of the performance test of the proposed algorithm are presented in a time course, and it has the shape of a step function. The work proposes a function that allows you to enter the time needed for the body’s reaction to reach the desired Etdes level.Conclusion: In this study, a controller was created to support the selection of the concentration of desflurane allowing for a reduction in blood pressure (resulting from surgical stress). The results obtained by computer simulation provide valuable insights for optimizing anesthesia. This system can also be used as an important simulation program for teaching purposes.Keywords: fuzzy logic, anesthetic support, desflurane, mathematical models of desflurane

Background: Pulse oximetry is a standart of anesthesia for perioperative monitoring. Due to the principles of Hb oxygen dissociation curve, peripheral oxygen saturation has an approximate sensitivity and specificity of 90% for the detection of hypoxemia., Objectives: The primary outcome of the study was to evaluate ORi Ⓡ as an early parameter to determine hypoxia in morbidly obese patients. The secondary outcome was to compare the effectiveness of ORi Ⓡ with SpO 2 in non-obese patients., Design: Prospective, observational study., Setting: Department of elective operating room at tertiary hospital., Patients and Methods: Observational study included written informed consent from 51 patients with 19 < BMI < 25 kg/m 2 and 51 patients with BMI > 40 kg/m 2 undergoing an elective surgery requiring tracheal intubation. In addition to standard monitors, an ORi sensor was placed and baseline values were recorded. The patients were preoxygenated until end tidal expiratory oxygen concentration is reached to 90%. After anesthesia induction and tracheal intubation, the breathing circuit was not connected tracheal tube until the SpO 2 decreased to 95%. Shapiro-Wilk, Pearson Chi-square, t-test, and Mann Whitney U test were used for the study., Main Outcome Measures: Times of tolerable apnea, ORi Ⓡ and SpO 2 values at the end of preoxygenation, beginning of intubation, beginning of the ORi alarm, when SpO 2 reached 95%, and when ORi reaches a plateau., Sample Size: 102 patients., Results: The alert period: time to reach ORi Ⓡ from 0.24 to a value of 95% SpO 2 was observed as 32 s in morbidly obese patients and 94 s in patients with a normal body mass index. The SpO 2 alert period was determined as time difference between 97% and 95% SpO 2 . The data were recorded as 15 s and 36 s, respectively. It was observed that tolerable apnea, ORi Ⓡ , SpO 2 and added alert times were longer in patients with normal BMI compared to morbidly obese patients., Conclusions: As a result, ORi Ⓡ can provide an early warning to prevent unexpected hypoxia before saturation begins to decrease in morbidly obese patients., Limitations: Inability to perform arterial blood gas sampling in the time periods when we looked at the parameters to determine the relationship between ORi Ⓡ and PaO 2 ., Gov Identifier: NCT05480748 registered 2022-07-29., (© 2024. The Author(s).)

The primary objective of this in vitro study was to prevent the risk of toxicity associated with bupivacaine, widely used in clinical practice, by using magnesium (Mg), a readily available and cost-effective element, as an adjuvant. We hypothesized that Mg might exhibit a protective effect against cytotoxicity in a colon cell culture model under conditions of bupivacaine-induced LAST. Our secondary aim was to investigate its effect on genotoxicity, apoptosis, and iROS. CCD-18Co cells were used in our study. Control group (group C), Bupivacaine group (group B), Magnesium group (group M), and Bupivacaine+Mg group (group BM) were created. The viability of CCD-18Co cells incubated for 24 h in group C was determined to be 100%. These cells were evenly divided, and bupivacaine was administered to group B at concentrations of 5 to 300 μM. In group M, doses of Mg at 0.625 to 320 mEq were added. It was determined that the maximum viability was observed at a Mg dose of 40 mEq ( p < 0.05). In group BM, bupivacaine was administered at the same concentrations in combination with Mg (40 mEq), and cell viability was measured. DNA damage, apoptosis, and iROS were assessed at concentrations of bupivacaine by administering 40 mEq Mg. In group B, viability decreased dose-dependently in CCD-18Co ( p < 0.05, p < 0.01, p < 0.001). In group BM, the viability decreased in cells at increasing concentrations compared to group C ( p < 0.05, p < 0.01, p < 0.001), but the viability was affected positively compared to group B ( p < 0.05). In group B, DNA damage increased ( p < 0.05, p < 0.001). In group BM, DNA damage increased ( p < 0.05, p < 0.001). However, in group BM, DNA damage levels were reduced compared to group B ( p < 0.05, p < 0.01). In group B, apoptosis increased ( p < 0.05, p < 0.001); in group BM, apoptosis increased ( p < 0.001) compared to group C. However, in group BM, apoptosis decreased compared to group B ( p < 0.05). iROS increased in group B ( p < 0.05, p < 0.01, p < 0.01) and group BM ( p < 0.05, p < 0.01, p < 0.001) compared to the group C. However, in group BM, iROS decreased in comparison to group B ( p < 0.05). In conclusion, Mg exhibits a protective effect against bupivacaine-induced toxicity.

The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI > 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack-Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac-Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg/m 2 and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463.