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The recommended dose of ephedrine in adults (0.1 mg kg−1) frequently fails to treat hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age. The aim of this study was to determine the optimal dose of ephedrine in this population for the treatment of hypotension after induction of general anaesthesia with sevoflurane. We conducted a multicentre, prospective, randomised, open-label, controlled, dose-escalation trial. Subjects were randomised if presenting a >20% change from baseline in MAP. Six cohorts of 20 subjects each were enrolled. Ten subjects in the first cohort received 0.1 mg kg−1 i. v. (reference dose). For each subsequent cohort, 10 subjects were assigned to the next higher dose (consecutively 0.6, 0.8, 1, 1.2, and 1.4 mg kg−1 i. v.), and the other subjects were assigned to one or more doses already investigated in previous cohorts. The primary outcome was the return of MAP to >80% of baseline at least once within 10 min after ephedrine administration. A total of 119 infants (25% females), with a mean age (standard deviation) of 2.7 (1.3) months, received their allocated dose of ephedrine. The optimal dose of ephedrine was 1.2 mg kg−1, with a percentage of success of 65.5% (95% confidence interval, 35.6–86.4). The doses of ephedrine investigated did not induce adverse events. Doses of ephedrine much higher (∼10-fold) than those used in adults are necessary in neonates and infants for the treatment of hypotension after induction of general anaesthesia with sevoflurane. NCT02384876. [ABSTRACT FROM AUTHOR]

'Depth of anaesthesia' monitors claim to measure hypnotic depth during general anaesthesia from the EEG, and clinicians could reasonably expect agreement between monitors if presented with the same EEG signal. We took 52 EEG signals showing intraoperative patterns of diminished anaesthesia, similar to those that occur during emergence (after surgery) and subjected them to analysis by five commercially available monitors. We compared five monitors (BIS, Entropy-SE, Narcotrend, qCON, and Sedline) to see if index values remained within, or moved out of, each monitors' recommended index range for general anaesthesia for at least 2 min during a period of supposed lighter anaesthesia, as observed by changes in the EEG spectrogram obtained in a previous study. Of the 52 cases, 27 (52%) had at least one monitor warning of potentially inadequate hypnosis (index above range) and 16 of the 52 cases (31%) had at least one monitor signifying excessive hypnotic depth (index below clinical range). Of the 52 cases, only 16 (31%) showed concordance between all five monitors. Nineteen cases (36%) had one monitor discordant compared with the remaining four, and 17 cases (33%) had two monitors in disagreement with the remaining three. Many clinical providers still rely on index values and manufacturer's recommended ranges for titration decision making. That two-thirds of cases showed discordant recommendations given identical EEG data, and that one-third signified excessive hypnotic depth where the EEG would suggest a lighter hypnotic state, emphasizes the importance of personalised EEG interpretation as an essential clinical skill. [ABSTRACT FROM AUTHOR]

The gold standard of caesarean section anaesthesia is regional anaesthesia, which is associated with fewer complications and significantly lower mortality. However, the issue of general anaesthesia cannot be omitted, which is still a procedure applicable in the maternity ward in emergency situations - i.e., when there is a direct threat to the life of the mother or child, when there is no time to perform regional anaesthesia (the time of blockade is always uncertain, it may last a few or several minutes - even with a properly performed procedure) and with contraindications to regional anaesthesia. Unfortunately, general anaesthesia of pregnant women is associated miejscowith a much greater number of complications not only compared to regional anaesthesia, but also compared to general anaesthesia performed in a standard, non-pregnant population. This is associated with a more frequent occurrence of difficult intubations or intraoperative awakenings. The effect of general anaesthesia on the condition of the newborn is also significant. Since moving away from general anaesthesia in obstetrics will never be possible, the question should be asked - what to do to maximize patient safety? Which drugs will carry the least risk of complications? What is the optimal algorithm for general anaesthesia for caesarean section? Should it be changed? [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to present our experience in liver transplantation recipients and renal transplantation recipients during caesarean section. Methods: Retrospective data regarding liver transplantation recipients and renal transplantation recipients who underwent caesarean section between January 1997 and January 2017 have been collected from the hospital records. Results: Fourteen live births occurred from 5 liver transplantation recipients and 9 renal transplantation recipients, all of them from caesarean section. The mean maternal age (28.4 ± 4.0 years vs. 29.2 ± 4.1 years, P = .38), body weight before conception (57.4 ± 8.8 kg vs. 64.5 ± 8.2 kg, P = .48), and the time from transplantation to conception (99.0 ± 50.7 months vs. 101.0 ± 57.5 months, P = .46) were similar for 5 liver transplantation recipients and 9 renal transplantation recipients, respectively. Four caesarean sections were performed under general anaesthesia, whereas spinal anaesthesia was used in 10 patients. The mean birth weight was similar (2502 ± 311g vs. 2161 ± 658 g, P = .3). There were 3 premature deliveries in liver transplantation recipients versus 6 premature deliveries in renal transplantation recipients and 2 low-birth-weight infants (<2500 g) in liver transplantation recipients versus 4 in renal transplantation recipients among 14 newborns. Infants small for gestational age were diagnosed in 9/14 (3 liver transplantation recipients versus 6 renal transplantation recipients, P = 1). Conclusion: General and regional anaesthesia can be safely used during caesarean delivery of liver transplantation recipients and renal transplantation recipients without increased risk of graft losses. Prematurity and low birth weight were mainly due to the cytotoxic drugs for immunosuppression. There are no differences in liver transplantation recipients and renal transplantation recipients for maternal and foetal complications according to our data. [ABSTRACT FROM AUTHOR]

A meta-analysis influenced by two recent large randomised controlled trials (REGAIN and RAGA) concluded that little, if any, difference in commonly measured outcomes exists between patients administered spinal or general anaesthesia for their hip fracture surgery. We explore whether there is genuinely no difference, or what the methodological problems in research might be that prevent any real difference from being observed. We also discuss the need for greater nuance in future research to determine how anaesthetists might deliver perioperative care towards improving postoperative recovery trajectories in patients following hip fracture. [ABSTRACT FROM AUTHOR]

Corticotropin-releasing factor (CRF) neurones in the paraventricular nucleus (PVN) of the hypothalamus (PVNCRF neurones) can promote wakefulness and are activated under anaesthesia. However, whether these neurones contribute to anaesthetic effects is unknown. With a combination of chemogenetic and molecular approaches, we examined the roles of PVNCRF neurones in isoflurane anaesthesia in mice and further explored the underlying cellular and molecular mechanisms. PVN neurones exhibited increased Fos expression during isoflurane anaesthesia (mean [standard deviation], 218 [69.3] vs 21.3 [7.3]; P <0.001), and ∼75% were PVNCRF neurones. Chemogenetic inhibition of PVNCRF neurones facilitated emergence from isoflurane anaesthesia (11.7 [1.1] vs 13.9 [1.2] min; P =0.001), whereas chemogenetic activation of these neurones delayed emergence from isoflurane anaesthesia (16.9 [1.2] vs 13.9 [1.3] min; P =0.002). Isoflurane exposure increased CRF protein expression in PVN (4.0 [0.1] vs 2.2 [0.3], respectively; P<0.001). Knockdown of CRF in PVNCRF neurones mimicked the effects of chemogenetic inhibition of PVNCRF neurones in facilitating emergence (9.6 [1.1] vs 13.0 [1.4] min; P =0.003) and also abolished the effects of chemogenetic activation of PVNCRF neurones on delaying emergence from isoflurane anaesthesia (10.3 [1.3] vs 16.0 [2.6] min; P <0.001). Acute, but not chronic, stress delayed emergence from isoflurane anaesthesia (15.5 [1.5] vs 13.0 [1.4] min; P =0.004). This effect was reversed by chemogenetic inhibition of PVNCRF neurones (11.7 [1.6] vs 14.7 [1.4] min; P =0.001) or knockdown of CRF in PVNCRF neurones (12.3 [1.5] vs 15.3 [1.6] min; P =0.002). CRF neurones in the PVN of the hypothalamus neurones modulate isoflurane anaesthesia and acute stress effects on anaesthesia through CRF signalling. [ABSTRACT FROM AUTHOR]

An orientation strategy providing repeated verbal reminders of time, place, and person has been widely used for the non-pharmacological management of delirium. We hypothesised that using this strategy could reduce emergence agitation and improve recovery profiles. This prospective observer-blinded RCT included male and female patients aged 18–70 yr undergoing minimally invasive abdominal surgery. During emergence from general anaesthesia, subjects in the orientation group (n =57) were provided a repeated reminder, including orientation: '(Patient's name), you are now recovering from general anaesthesia after surgery at Seoul National University Hospital, open your eyes!' via noise-cancelling headphones, whereas those in the control group (n =57) only heard their name: '(Patient's name), open your eyes!'. The primary outcome was the incidence of emergence agitation (Riker sedation agitation scale [SAS] ≥5). The incidence of dangerous agitation (SAS=7), maximal SAS score in the operating room, and recovery profile until 24 h postoperatively were evaluated as secondary outcomes. The incidence of emergence agitation in the operating room was significantly lower in the orientation group than in the control group (16/57 [28.1%] vs 38/57 [66.7%]; relative risk [95% confidence interval], 0.5 [0.3–0.7]; P <0.001). The incidence of dangerous agitation (0 [0.0%] vs 10 [17.5%], P =0.001) and the median maximal SAS score (4 [4–5] vs 5 [4–6], P <0.001) were also lower in the orientation group. Secondary outcomes, other than agitation-related variables, were comparable between the two groups. Repeated verbal stimulation of orientation may serve as a simple and easily applicable strategy to reduce emergence agitation after general anaesthesia. NCT05105178. [ABSTRACT FROM AUTHOR]

Left-sided frontal alpha asymmetry on electroencephalograms, which indicates decreased relative left-hemispheric activity, has been associated with depression, anxiety, and stress responsivity. We aimed to evaluate the association between perioperative measures of frontal alpha asymmetry and quality of recovery (QoR) after surgery. We enrolled 110 female patients undergoing thyroidectomy and recorded perioperative electroencephalograms. The power of the prefrontal alpha band (8–13 Hz) was measured in the Fp1 and Fp2 leads. Left-sided frontal alpha asymmetry was defined as a higher alpha band power in Fp1 than in Fp2 and vice versa. QoR was assessed using the QoR-15 score on the day before surgery and postoperative days 1 and 2. The primary study endpoint was a difference in postoperative global QoR-15 score between preoperative left-sided and right-sided alpha asymmetry groups. The predictability of frontal alpha asymmetry for poor QoR-15 score was also evaluated. The global QoR-15 score showed a significant group-by-time interaction, and post-hoc analysis revealed significantly lower scores on postoperative days 1 (P=0.006) and 2 (P<0.001) in the left-sided frontal alpha asymmetry group. In the multivariate logistic regression analysis, preoperative left-sided frontal alpha asymmetry was associated with a 3.3-fold increased risk of the lowest tertile for the postoperative day 1 QoR-15 score (95% CI: 1.31–8.24; P=0.011). Preoperative left-sided frontal alpha asymmetry was independently associated with a lower postoperative QoR-15 score in female patients undergoing thyroidectomy, highlighting the potential role of preoperative frontal electroencephalography in predicting patient-centred outcomes after surgery. KCT0006586 (http://cris.nih.go.kr/). [ABSTRACT FROM AUTHOR]

There is a scarcity of data available in Malaysia regarding the utilization of GA for management of dental caries among paediatric patients. This study aims to investigate the dental records of paediatric patients treated under general anaesthesia (GA) for caries management at Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur. This is a retrospective cross-sectional study between January 2017 to December 2019 on patients who underwent caries dental treatment with ICD-10 Code K02.9 under GA. Data extracted includes demographic data, referral source, comorbidities, treatment done and dental treatment procedural time. Mean age of children treated is 5.91 years. Males were higher with 62.1%. Majority of the referrals are from internal referral with 65%. 60% of the children had comorbidities. 94.3% of children had extraction of their primary teeth. Mean dental treatment time was 52.87 minutes. Younger children utilized dental GA more often than older ones. More than half of the cases required extraction of deciduous teeth. There is also high utilization of GA among medically ill patients. Oral health of children with medical illness is often neglected because of their systemic disease and ongoing medical treatment. By the time the child gets a dental treatment, it is too late to save the tooth. [ABSTRACT FROM AUTHOR]

Background: Endotracheal tube (ETT) is inserted into the trachea to maintain airway patency. Maintaining adequate ETT cuff pressure is important to ensure a proper seal to lower the risk of aspiration and tracheal trauma. This study was designed to assess the frequency of inappropriate ETT cuff pressure at the time of intubation and variation in ETT pressure at the end of a prolonged surgery. Methods: This study was conducted in the Department of Anaesthesiology, Aga Khan University from October 2019 to March 2020. All adult patients of both genders, undergoing prolonged surgery under general anaesthesia were included. Patients were intubated with an appropriate size ETT, and the cuff was inflated with air. ETT cuff pressure was measured after intubation and, at the end of prolonged surgery to assess any variation. Results: Fifty-eight patients were included, of which 37 (63.8%) were female. The mean age was 47.36 years. The frequency of inappropriate ETT cuff pressure at the time of intubation was found in thirty-five (60.3%) patients, which was corrected to 25 cm H2O before the start of surgery. At the end of the surgery, forty-one (70.7%) patients showed an increase in ETT cuff pressures with the majority (33%) having a variation of 51-70 (81-100 cm H2O). Conclusion: The frequency of inappropriate ETT cuff pressure at the time of intubation was found in thirty-five (60.3%) patients. In six (10.3%) patients, ETT cuff pressure was below 20 cm H2O while in twenty-nine (50%) patients, ETT cuff pressure was above 30 cm H2O. In forty-one (70.7%) patients ETT cuff pressure was abnormally high that is >30 cm H2O at the end of prolonged surgical procedures. [ABSTRACT FROM AUTHOR]

Unsettled behaviors characterize the early phase after general anaesthesia in the pediatric population in up to 80% of cases. Emergence delirium (ED) and acute pain are the two most relevant sources of this phenomenon. Research and clinical guidelines are difficult to implement due to the variability of the definition of unsettled behavior and measurement of the different components. The most probable incidence of ED is between 10% and 20%, and the potential risk factors could be summarized as young age, male gender, preoperative anxiety, baseline sleep-disordered breathing, volatile anaesthesia and ENT or ophthalmologic surgery. Self-reporting behavioral and observational scales are unable to reliably differentiate between ED and pain in a child who is not fully awake, making correct treatment choices difficult. This may lead to an undertreatment of pain in agitated children or to the overuse of opioids for self-limiting ED. This paper considers the current knowledge on the identification and treatment of ED and pain and provides a pragmatic approach for daily practice. [ABSTRACT FROM AUTHOR]

Introduction: Children with Special Healthcare Needs (CSHCN) are considered difficult to maintain oral hygiene and challenging for caregivers and dentists to attain cooperation in dental treatment under general anaesthesia. Family Impact Scale (FIS) and Parental-Caregiver Perceptions Questionnaire (P-CPQ) are useful tools to assess patient's oral health quality of life and caregivers perception. Aim: To assess the impact of dental treatment under general anaesthesia on the quality of life and oral hygiene of CSHCNs, as perceived by caregivers. Materials and Methods: This prospective follow-up survey study was carried out at Dammam Medical Complex, Saudi Arabia, from December 5th, 2019 to December 15th, 2021. The CSHCN of either gender, aged 12 years, and falling within the American Academy of Pediatric Dentistry (AAPD) definition of special-needs patients referred for invasive procedures under general anaesthesia (American Society of Anaesthesiologists (ASA) class I or II), were included. The baseline and, after a one-year follow-up, information obtained from two surveys that were altered from Thompson's P-CPQ and FIS were decoded into the numeric ordinal scales Never ("0"), Once or Twice ("1"), Sometime ("2"), Always ("3"), and Daily ("4"). Analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 84 participants were caregivers of CSHCN who underwent dental procedures under General Anaesthesia (GA), of whom 77 (91.7%) were mothers and 7 (8.3%) were fathers of the CSHCN. The mean age of children was 8.29±2.14 years (Range= 3-12 years); 38 (45.2%) were males and 46 (54.8%) were females. The median FIS after treatment was zero, compared to the median before treatment which was 2, revealing a significant impact on being absent from work, a child requiring more care, the impact of presence, sleeping disturbances, feeling angry, feeling guilty, and a child disputing or blaming either parent (p<0.001). Following the pattern of one year post-treatment FIS, median was 0 (Never) for all items including halitosis, pain, food trapped in palate and teeth, swallow, breath, time, sleep, irritable, frustrating, nervous, shy, absent, laugh, and continue school (p<0.001). Conclusion: The modified FIS and P-CPQ evaluations before and after dental treatment under GA revealed a significant improvement in the oral health quality of life for those CSHCN, as well as the impact on their caregivers. Regular check-ups would be useful for early and non invasive intervention without GA. [ABSTRACT FROM AUTHOR]

The aim: The aim of the present study is to evaluate the hemodynamic stability of propofol ketamine versus etomidate ketamine during induction of anaesthesia in peritonitis cases posted for emergency surgery. Methods: Sixty patients with peritonitis, posted for emergency surgery under general anaesthesia, were randomly allocated to two groups. Group propofol ketamine (P + K) comprised of 30 patients (n = 30) were induced with propofol 1 mg/kg and ketamine 0.75 mg/kg IV. Group etomidate ketamine (E + K) comprised 30 patients induced with etomidate 0.3 mg/kg and ketamine 0.75 mg/kg. The hemodynamic effects of the combination of the drugs in both groups were compared before and after induction. Results: The change in saturation (SPO2) and Heartrate between the groups P + K & group E + K before induction and after intubation was similar in both groups. There was a statistically insignificant fall in systolic blood pressure (SBP) and diastolic blood pressure (DBP), and mean arterial pressure (MAP) in group P + K before and after induction when compared to group E + K. Conclusions: The propofol ketamine and etomidate ketamine combinations have a similar haemodynamic profile and are equally effective in maintaining haemodynamic stability during induction and intubation. [ABSTRACT FROM AUTHOR]

Reducing perioperative anxiety and controlling pain in children are essential to optimise recovery and outcomes for both children and their parents. By acting on sensory and affective modulation of anxiety and pain, hypnosis is widely used in medical care, especially in anaesthesia. This randomised controlled clinical trial was designed to compare general anaesthesia and intraoperative hypnosis support for perioperative management of children undergoing superficial surgery. Children aged 7–16 yr scheduled for day-case superficial surgery were included and randomly assigned to one of the following two groups: general anaesthesia group or hypnosis group. The primary outcome was length of hospital stay. Child and parent anxiety, child pain, and the occurrence of postoperative negative behavioural changes were also evaluated. Sixty children of mean age 10.3 (standard deviation: 2.6) yr were enrolled in the study. Hypnosis was successful in all but one case. The median (25th–75th percentile) length of hospital stay was shorter in the hypnosis group (120 [95–145] vs 240.5 [218–275] min; P <0.001). The general anaesthesia group was associated with a greater incidence of high levels of preoperative anxiety in children (30 vs 11%; P =0.001) and parents (55 vs 30%; P =0.05). Pain scores did not differ between groups. No negative postoperative behavioural changes were reported. In children aged 7–16 yr, hypnosis appears to be feasible and accepted. The quality of the perioperative experience and the rapid recovery support the use of hypnosis as an effective and safe alternative to general anaesthesia for paediatric superficial surgery. NCT02505880. [ABSTRACT FROM AUTHOR]

Preclinical studies have indicated that anaesthesia is an independent risk factor for dementia, but the clinical associations between dementia and different types of general anaesthesia or regional anaesthesia remain unclear. We conducted a population-based cohort study using propensity-score matching to compare dementia incidence in patients included in the Taiwanese National Health Insurance Research Database who received various anaesthetic types for hip fracture surgery. Patients aged ≥65 yr who received elective hip fracture surgery from 2002 to 2019 were divided into three groups receiving either inhalational anaesthesia (GA), total intravenous anaesthesia–general anaesthesia (TIVA-GA), or regional anaesthesia (RA), and matched in a 1:1 ratio. The incidence rates of dementia were then determined. Propensity-score matching yielded 89 338 patients in each group (N =268 014). Dementia incidence rates in the inhalational GA, TIVA–GA, and RA groups were 4821, 3400, and 2692 per 100 000 person-years, respectively. The dementia incidence rate ratio (95% confidence interval [CI]) for inhalational GA to TIVA–GA was 1.19 (1.14–1.25), for inhalational GA to RA was 1.51 (1.15–1.66), and for TIVA–GA to RA was 1.28 (1.09–1.51). The incidence rate ratios of dementia amongst older adults undergoing hip fracture surgery were higher for those receiving general anaesthesia than for those receiving regional anaesthesia, with inhalational anaesthesia associated with a higher incidence rate ratio for dementia than total intravenous anaesthesia (TIVA). [ABSTRACT FROM AUTHOR]

Background: Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture. Aim: The aim was to compare the risk of complication of neuraxial anaesthesia with that of general anaesthesia in patients undergoing hip fracture surgery. Methods: This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered at PROSPERO (CRD42022337384). The study included eligible randomised controlled trials published before February 2022. Data synthesis was performed to compare the differences between general and neuraxial anaesthesia. Meta-regression analysis was performed to investigate the influence of the publication year. A subgroup analysis was performed based on patient age and the anaesthetic technique used. A grading of recommendations, assessment, development and evaluations assessment was performed to assess the quality of each outcome. Results: Twenty randomised controlled trials and 4802 patients were included. Data synthesis revealed significant higher risk of acute kidney injury in the general anaesthesia group (P = 0.01). There were no significant differences between the two techniques in postoperative short-term mortality (P = 0.34), delirium (P = 0.40), postoperative nausea and vomiting (P = 0.40), cardiac infarction (P = 0.31), acute heart failure (P = 0.34), pulmonary embolism (P = 0.24) and pneumonia (P = 0.15). Subgroup analysis based on patient age and use of sedative medication did not reveal any significant differences. Meta-regression analysis of the publication year versus each adverse event revealed no statistically significant differences. Conclusion: A significantly higher risk of postoperative acute kidney injury was found in patients receiving general anaesthesia. This study revealed no significant differences in terms of postoperative mortality and other complications between general and neuraxial anaesthesia. The results were consistent across the age groups. [ABSTRACT FROM AUTHOR]

Background: Pnuemoperitonium in laparoscopy is associated with cardiorespiratory changes. Combination of epidural with General anaesthesia (GA) will offer benefit of hemodynamic control and perioperative analgesia. We aimed to study the efficacy of Combined Epidural- General Anaesthesia (CEGA) with pre-emptive activation over general anaesthesia in laparoscopic cholecystectomies. Methods: In this prospective double blind –randomised study, 90 surgical inpatients were studied in two study groups. Group GE-(n=45) received Lumbar Epidural analgesia with ropivacaine 0.2% along with GA and Group G (n=45) received only GA. Heart rate (HR), Mean arterial Pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), Capnogram (ETCO2), saturation (spo2), VAS score, Ramsay sedation score, requirement of propofol, muscle relaxants and analgesics were studied. Results: Statistical analysis was carried out with SPSS version 20. Statistical value of p

Objective: To compare I-gel Supraglottic Airway with ProSeal-Laryngeal Mask Airway in anaesthetized paralyzed patients regarding mean insertion time and frequency of ease of insertion. Study design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital, Multan Pakistan, from Jun to Dec 2018. Methodology: Ninety-two patients aged 20-50 years, of either gender undergoing procedures in supine and lithotomy positions under general anaesthesia were included. In Group-A, ProSeal-Laryngeal Mask Airway was inserted, and in GroupB, the anaesthetists inserted I-gel Supraglottic Airway. Insertion time and ease of insertion in terms of successful insertion on the first attempt were noted. Results: Out of these 92 patients, 54(58.7%) were male, and 38(41.3%) were female. The median insertion time was 22 seconds with an interquartile range (Q3-Q1) of 17.53 in Group-A patients and 14 seconds in Group-B patients with an interquartile range of 3(p

Objective: To determine the effect of Dexamethasone on post-operative delirium in adults following general anaesthesia among patients operated at Pakistan Navy Hospital Shifa. Study Design: Prospective comparative study. Place and Duration of Study: Anaesthesia and Pain Medicine Departments, Pakistan Navy Hospital Shifa, Karachi Pakistan, from Oct 2019 to Jan 2021. Methodology: Patients operated in the main operation theatre of our hospital during the study period without any complication fulfilling the exclusion/inclusion criteria, were included in the study. They were randomly divided into two groups, with Group-A receiving 4mg Dexamethasone and other routine pre-anaesthetic medications. In contrast, Group-B just received the routine pre-anaesthetic medications but no Dexamethasone. An independent assessor assessed post-operative delirium using the Confusion assessment method (CAM). Results: A total of 250 patients were included in the study, which met the inclusion criteria. The mean age of the study participants was 34.419±4.329 years. 27(10.8%) patients showed post-operative delirium, while 223(89.2%) did not show postoperative delirium on the Confusion assessment method. The chi-square test revealed that none of the factors studied, including the administration of pre-operative Dexamethasone, had any statistically significant relationship with the presence or absence of delirium among the target population (p-value >0.05). Conclusion: Delirium was a fairly common finding in adult patients 24 hours after routine surgical procedures. None of the factors studied, including Dexamethasone, was related to the presence or absence of delirium in our study.

Full-endoscopic lumbar discectomy under local anesthesia is major trends for the treatment of lumbar disc herniation in spine minimally invasive surgery. However, sometimes local anesthesia is not enough for analgesic in surgery especially in interlaminar approach. This study summarizes the current study of anesthesia methods in full-endoscopic lumbar discectomy. Local anesthesia is still the most common anesthesia method in full-endoscopic lumbar discectomy and the comparison group for other anesthesia methods due to high safety. Compared to local anesthesia, Epidural anesthesia is less applied in full-endoscopic lumbar discectomy but reports better intraoperative pain control and equivalent safety due to the motor preservation and pain block characteristic of ropivacaine. General anesthesia can achieve totally pain block during surgery but nerve injury can not be ignored, and intraoperative neuromonitoring can assist. Regional anesthesia application is rare but also reports better anesthesia effects during surgery and equivalent safety. Anesthesia methods for full-endoscopic lumbar discectomy should be based on patient factors, surgical factors, and anesthesiologist factors to achieve satisfactory anesthesia experience and successful surgery.

Background: Pre-eclampsia has always been a challenge to the anaesthesiologist, in terms of choosing which type of anaesthesia to prefer. This present study was done to evaluate the maternal and foetal outcome in patients of caesarean section for pre-eclampsia under spinal and general anaesthesia. Methods: This prospective study was conducted in 60 parturients, ASA 1 and 2 who underwent caesarean section for pre-eclampsia. These parturients were randomly and divided into two groups, Group S receiving spinal anesthesia and Group G receiving general anesthesia. For maternal outcome, the parturients were monitored for Blood Pressure, Heart Rate, Oxygen Saturation. Post-operative ICU admissions, convulsions, and pulmonary edema chances were seen. For fetal outcome, APGAR score was noted at 1 minute and 5 minutes after birth of child. Results: The systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were comparable in both the groups in the pre-operative period and at induction. However, intraoperatively, these parameters were significantly lower in the spinal anaesthesia group as compared to general anesthesia group (p

Introduction: Several pharmacological and non-pharmacological ways have been used to prevent Post-Operative Sore Throat (POST). Post-Operative Sore Throat (POST) can be prevented with or without medical management. Dexmedetomidine is a selective alpha 2 adrenergic agonists which can be used for pre-operative nebulization to prevent POST. Dexmedetomidine absorption will be greater through transmucosal route as it is a highly lipid soluble agent. It is a highly lipid soluble agent with good systemic absorption during transmucosal administration. Aim: To assess the efficacy of dexmedetomidine nebulisation in reducing POST in patient who require general anaesthesia with endotracheal intubation. Materials and Methods: This randomized control study was conducted from January 2022 to March 2022. There were 60 patients separated into 2 groups and 30 patients in each. The patients were of age more than 18 years and belonged to American society of Anesthesiology (ASA) grade I and II, posted for elective surgery under general anesthesia. Group D was given dexmedetomidine 50 mcg (1 ml) with 3 ml of saline and made it total volume of 4 ml nebulisation and Group C was given 4 ml of saline nebulisation. Sore throat was evaluated at 0, 2nd,4th,6th,12th and 24th hour after extubation, during the post-operative period. Results: Mean age (SD) of patients in group D was 33.5±12.9 years and that in group C was 36.83±14.5years (P value=0.23). During post operative period, the severeness of sore throat was remarkably lesser in Group D especially from 4th hour upto 24th hour. Severeness of POST was remarkably lesser in group D compared to group C patients over the 4th -24th hours. Conclusion: Dexmedetomidine nebulisation given prior to surgery is beneficial in reducing POST, with minimal haemodynamic disturbance. Dexmedetomidine in nebulised form is therefore a safe option for lowering POST.

Background: General anaesthesia is associated with neurocognitive deficits in infants after noncardiac surgery. Disturbances in cerebral perfusion as a result of systemic hypotension and impaired autoregulation may be a potential cause. Our aim was to study cerebral blood flow (CBF) velocity continuously during general anaesthesia in infants undergoing noncardiac surgery and compare variations in CBF velocity with simultaneously measured near-infrared spectroscopy (NIRS), blood pressure, and heart rate. Methods: NeoDoppler, a recently developed ultrasound system, was used to monitor CBF velocity via the anterior fontanelle during induction and maintenance of general anaesthesia until the start of surgery, and during recovery. NIRS, blood pressure, and heart rate were monitored simultaneously and synchronised with the NeoDoppler measurements. Results: Thirty infants, with a median postmenstrual age at surgery of 37.6 weeks (range 28.6–60.0) were included. Compared with baseline, the trend curves showed a decrease in CBF velocity during induction and maintenance of anaesthesia and returned to baseline values during recovery. End-diastolic velocity decreased in all infants during anaesthesia, on average by 59%, whereas peak systolic- and time-averaged velocities decreased by 26% and 45%, respectively. In comparison, the reduction in mean arterial pressure was only 20%. NIRS values were high and remained stable. When adjusting for mean arterial pressure, the significant decrease in end-diastolic velocity persisted, whereas there was only a small reduction in peak systolic velocity. Conclusions: Continuous monitoring of CBF velocity using NeoDoppler during anaesthesia is feasible and may provide valuable information about cerebral perfusion contributing to a more targeted haemodynamic management in anaesthetised infants.

Background: There are no current recommendations for oxygen titration in patients with stable coronary artery disease. This study investigates the effect of iatrogenic hyperoxia on cardiac function in patients with coronary artery disease undergoing general anaesthesia. Methods: Patients scheduled for elective coronary artery bypass graft surgery were prospectively recruited into this randomised crossover clinical trial. All patients were exposed to inspired oxygen fractions of 0.3 (normoxaemia) and 0.8 (hyperoxia) in randomised order. A transoesophageal echocardiographic imaging protocol was performed during each exposure. Primary analysis investigated changes in 3D peak strain, whereas secondary analyses investigated other systolic and diastolic responses. Results: There was no statistical difference in systolic function between normoxaemia and hyperoxia. However, the response in systolic function to hyperoxia was dependent on ventricular function at normoxaemia. Patients with a normoxaemic left ventricular (LV) global longitudinal strain (GLS) poorer than the derived cut-off (>–15.4%) improved with hyperoxia (P

Background: Thoracic spinal anaesthesia for upper extremity surgery is rarely performed and exceptional procedure. We report a case in which thoracic spinal anaesthesia (T3–T4 intervertebral space) was performed successfully in a paediatric patient with distal radius fracture ORIF surgery. Case presentation: A 15 years old man with distal radius fracture ORIF was scheduled to undergo remove of implant. His parents did not want to have general anaesthesia because complication of postoperative pulmonary complications, patient has allergy and asthmatic potential. We proposed thoracic spinal anaesthesia with small dose bupivacaine 0.5% hyperbaric (5 mg). Conclusions: Thoracic spinal anaesthesia with small dose bupivacaine 0.5% hyperbaric at the cervical level (C4) may offer an alternative option when general anaesthesia or conventional regional techniques are contraindicated or equipment unavailable to perform peripheral nerve block. [ABSTRACT FROM AUTHOR]

Wolf-Hirschhorn Syndrome (WHS), also known as Chromosome 4 deletion syndrome, is a rare hereditary disease with a prevalence of 1 in 50,000. It occurs due to the microdeletion of the short arm of chromosome 4, specifically the 4p16.3 domain. Patients with WHS exhibit diverse phenotypes, including growth retardation, developmental delay, congenital heart disease, and convulsions, depending on the amount of deleted genetic material. This case report focuses on a 25-year-old male who was admitted for cataract extraction and posterior chamber intraocular lens implantation. Through gene analysis, the patient was diagnosed with WHS. He exhibited micrognathia, a short neck, kyphoscoliosis, seizure disorder, and mental retardation. Additionally, he had severe kyphoscoliosis, which resulted in restrictive lung disease. These abnormalities posed significant challenges for anaesthetic management. To ensure a successful general anaesthesia, adequate preparedness for difficult airway management was crucial. A thorough cardiovascular and neuromuscular examination was conducted preoperatively to rule out associated anomalies and minimise complications. The patient's perioperative antiepileptic cover was continued. Extubation proved challenging due to the patient's mental retardation and restrictive lung disease. This case underscores the importance of effective anaesthetic management for patients with this rare condition undergoing cataract surgery under general anaesthesia. [ABSTRACT FROM AUTHOR]

Shaw and colleagues, who are medical historians, have published a detailed review of the social history of the British Journal of Anaesthesia (BJA) to celebrate its first 100 years. In this editorial, we note some additional contributions and financial details that are relevant to the development of the BJA into the international high-impact journal it is today. [ABSTRACT FROM AUTHOR]

BackgroundThe factors determining peak susceptibility of the developing brain to anaesthetics are unclear. It is unknown why postnatal day 7 (P7) male rats are more vulnerable to anaesthesia-induced memory deficits than littermate females. Given the precocious development of certain regions in the female brain during the neonatal critical period, we hypothesised that females are susceptible to anaesthetic brain injury at an earlier time point than previously tested.MethodsFemale rats were exposed to isoflurane (Iso) 1 minimum alveolar concentration or sham anaesthesia at P4 or P7. Starting at P35, rats underwent a series of behavioural tasks to test their spatial and recognition memory. Cell death immediately after anaesthesia was quantified by Fluoro-Jade C staining in select brain regions, and developmental expression of the chloride transporters KCC2 and NKCC1 was analysed by immunoblotting in male and female rats at P4 and P7.ResultsFemale rats exposed to Iso at P4 displayed impaired spatial, object-place, -context, and social recognition memory, and increased cell death in the hippocampus and laterodorsal thalamus. Female rats exposed at P7 exhibited only decreased performance in object-context compared with control. The ratio of NKCC1/KCC2 expression in cerebral cortex was higher in P4 females than in P7 females, and similar to that in P7 males.ConclusionsFemale rats exposed to Iso at P4 are sensitive to anaesthetic injury historically observed in P7 males. This is consistent with a comparably immature developmental state in P4 females and P7 males. The window of anaesthetic vulnerability correlates with sex-specific cortical expression of chloride transporters NKCC1 and KCC2. These findings suggest that both sex and developmental age play important roles in determining the outcome after early anaesthesia exposure.

Abstract Background The non-muscle-invasive bladder cancer is a common malignancy of the urinary system. Many patients relapse after transurethral resection surgery. Different anaesthesia techniques may influence a patient’s immune system during the perioperative time. In this study, we examined the effects of different anaesthesia techniques on the prognosis of primary non-muscle-invasive bladder cancer after transurethral resection surgery. Methods In the period 2008 to 2017, a total of 926 patients suffered primary non-muscle-invasive bladder and underwent transurethral resection of bladder tumour surgery for the first time. These patients were divided into two groups according to the techniques that were used. There were 662 patients in the general anaesthesia group, who received propofol, opioid drugs (fentanyl family), non-depolarizing muscle relaxants, and sevoflurane, and 264 patients in the epidural anaesthesia group, who had an epidural catheter placed in the L2-L3 or L3-L4 interspace with a combination of lidocaine and ropivacaine or bupivacaine. We analyzed the influence factors that might affect prognosis and compared the recurrence-free survival time and the progression between the two groups. Results The differences between the two groups in recurrence rate and progression rate were not statistically significant. Progression-free survival time of the epidural anaesthesia group was longer. Multivariate regression analysis showed that anaesthesia techniques were not independent influencing factors for recurrence and progression. Conclusions It was not found that anaesthesia techniques affected the recurrence or progression of patients with primary non-muscle-invasive bladder cancer after transurethral resection of bladder tumour.

Abstract Background A balanced anaesthetic protocol is a common concept in modern veterinary anaesthesia and aims to maintain good intraoperative cardiopulmonary function. In horses, alpha-2-agonists produce sedation and analgesia and have been shown to reduce inhalational anaesthetic requirements when administered intravenously. Furthermore, these drugs can improve recovery quality. Preliminary investigations of subcutaneous dexmedetomidine administration in humans demonstrated a reduced haemodynamic impact if compared with the intravenous route suggesting that dexmedetomidine is adequately absorbed with both administration routes. The aim of the study was to compare two different dexmedetomidine (DEX) administration routes: intravenous constant rate infusion (CRI) versus repeated subcutaneous (SC) injections on cardiopulmonary function and recovery in anaesthetized horses. Results No significant differences between groups in heart rate and systolic arterial pressure were detected. A significantly higher mean and diastolic arterial pressure were detected in the SC group at T25 (p = 0.04; p = 0.02), T75 (p = 0.02; p = 0.009), and T85 (p = 0.001; p = 0.005). In SC group there was a significantly lower dobutamine infusion rate (p = 0.03) and a significantly higher urinary output (p = 0.02). Moreover, recovery quality was higher (p = 0.01). Conclusions Cardiopulmonary effects in both groups were comparable and within clinical ranges with less dobutamine requirement in the subcutaneous group. Recovery was of better quality with fewer attempts in horses receiving subcutaneous dexmedetomidine. The present study suggests that intravenous constant rate infusion and subcutaneous repeated administration of dexmedetomidine at indicated dosage can be useful in balanced anaesthesia without any systemic or local adverse effects; moreover, in healthy horses undergoing general anaesthesia, repeated subcutaneous dexmedetomidine administration may be a suitable alternative if constant rate infusion is not feasible.

Background: Laryngoscopy and tracheal intubation are frequently associated with sympathetic stress response. Lignocaine and esmolol are useful to decrease the sympathetic response to laryngoscopy and intubation. Aims and Objectives: The aim of the study was to study the effectiveness of lignocaine and esmolol administered intravenously before laryngoscopy and intubation in attenuating the sympathetic response. Materials and Methods: The prospective, randomized, and controlled study was conducted in Maharajah’s Institute of Medical Sciences Hospital for a period of 18 months from January 2016 to June 2017. A clinical comparative study of attenuation of sympathetic response to laryngoscopy and intubation was done in 90 patients posted for elective surgeries. The sample size estimation is calculated based on findings from the previous study done by Singh et al., (2013).Group I was control group. In this group, no drug was administered. Group II was lignocaine group. Here, patients received 1.5mg/kg lignocaine i.v. bolus. Group III was esmolol group. All patients in this group received 2mg/kg i.v. bolus. Statistical Analysis: Descriptive data presented as Mean±SD and in percentage. Pair-wise comparison between the groups was done by “Z” test. For all tests,“Z” value of >1.96 was considered significant and “P’

Background: Although both spinal and general anaesthesia provides good anaesthesia for cervical conization, spinal anaesthesia delays the return of lower limb movements and urinary function, whereas general anaesthesia requires the patient to be unconscious. It is unclear which anaesthetic technique is more conducive to early postoperative recovery in patients undergoing cervical conization. Patients and methods: 140 patients undergoing cervical conization underwent either laryngeal mask general anaesthesia (LMA, n = 70) or spinal anaesthesia (SA, n = 70). In the LMA group, an i-gel mask was used for airway management. In the SA group, spinal anaesthesia was received with 0.75% ropivacaine (15 mg) in the L3-4 interval. The quality of recovery score (QoR-15) was the primary endpoint of the study. Secondary endpoints included incidence of adverse 24-h analgesia (NRS>3); return of lower limb activity; first bed activity and feeding; and the number of catheters removed at 6, 12 and 24 h postoperatively. Result: The LMA group significantly improved QoR-15 scores (136.62 ± 11.02 vs 119.97 ± 12.75; P 3) within 24 h postoperatively (20% vs 42.8%, P = 0.006); reduced time in bed (15.62 ± 3.83 h vs 18.27 ± 5.57 vs, P = 0.001); improved patient satisfaction (86% vs 27%; P

Objective: To compare masked uncontrolled hypertension (MUCH) (n=16) and adequately controlled hypertension (ACH) (n=21) patients regarding their haemodynamic response to induction, incision and extubation, and evaluate the risk of perioperative recurrent adverse cardiovascular events in a prospective observational study. Material and Methods: After home blood pressure (BP) monitoring, patients were classified as MUCH or ACH using objective criteria. Perioperative haemodynamic parameters were monitored. Recurrent adverse event risks were evaluated using total-time and gap-time recurrent-event analysis. Results: BP responses to induction were qualitatively similar in the two groups, but with an exaggerated response following incision and extubation in the MUCH group. Risks of recurrent hypertensive events were higher in MUCH than in ACH patients during the intraoperative and emergence periods, with hazard ratios [95% confidence intervals] of 2.10 [1.21, 3.64] and 4.73 [1.12, 19.89] from total-time models, and 1.84 [1.20, 2.84] and 5.91 [1.45, 24.11] from gap-time models; the risk of recurrent bradycardia was higher during emergence, 4.08 [1.22, 13.59] from total-time and 4.88 [1.77, 13.45] from gap-time models. In contrast, the risk of recurrent hypotension was significantly lower in the MUCH patients during induction. Conclusion: Compared to ACH, MUCH patients were at increased risk of recurrent hypertensive events during the intraoperative and emergence periods, and of recurrent bradycardia during emergence.

Introduction: Children with Special Healthcare Needs (CSHCN) are considered difficult to maintain oral hygiene and challenging for caregivers and dentists to attain cooperation in dental treatment under general anaesthesia. Family Impact Scale (FIS) and Parental-Caregiver Perceptions Questionnaire (P-CPQ) are useful tools to assess patient’s oral health quality of life and caregivers perception. Aim: To assess the impact of dental treatment under general anaesthesia on the quality of life and oral hygiene of CSHCNs, as perceived by caregivers. Materials and Methods: This prospective follow-up survey study was carried out at Dammam Medical Complex, Saudi Arabia, from December 5th, 2019 to December 15th, 2021. The CSHCN of either gender, aged 12 years, and falling within the American Academy of Pediatric Dentistry (AAPD) definition of special-needs patients referred for invasive procedures under general anaesthesia (American Society of Anaesthesiologists (ASA) class I or II), were included. The baseline and, after a one-year follow-up, information obtained from two surveys that were altered from Thompson’s P-CPQ and FIS were decoded into the numeric ordinal scales Never (“0”), Once or Twice (“1”), Sometime (“2”), Always (“3”), and Daily (“4”). Analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 84 participants were caregivers of CSHCN who underwent dental procedures under General Anaesthesia (GA), of whom 77 (91.7%) were mothers and 7 (8.3%) were fathers of the CSHCN. The mean age of children was 8.29±2.14 years (Range= 3-12 years); 38 (45.2%) were males and 46 (54.8%) were females. The median FIS after treatment was zero, compared to the median before treatment which was 2, revealing a significant impact on being absent from work, a child requiring more care, the impact of presence, sleeping disturbances, feeling angry, feeling guilty, and a child disputing or blaming either parent (p

Background: During clinical anaesthesia, the administration of analgesics mostly relies on empirical knowledge and observation of the patient's reactions to noxious stimuli. Previous studies in healthy volunteers under controlled conditions revealed EEG activity in response to standardised nociceptive stimuli even at high doses of remifentanil and propofol. This pilot study aims to investigate the feasibility of using these standardised nociceptive stimuli in routine clinical practice. Methods: We studied 17 patients undergoing orthopaedic trauma surgery under general anaesthesia. We evaluated if the EEG could track standardised noxious phase-locked electrical stimulation and tetanic stimulation, a time-locked surrogate for incisional pain, before, during, and after the induction of general anaesthesia. Subsequently, we analysed the effect of tetanic stimulation on the surgical pleth index as a peripheral, vegetative, nociceptive marker. Results: We found that the phase-locked evoked potentials after noxious electrical stimulation vanished after the administration of propofol, but not at low concentrations of remifentanil. After noxious tetanic stimulation under general anaesthesia, there were no consistent spectral changes in the EEG, but the vegetative response in the surgical pleth index was statistically significant (Hedges' g effect size 0.32 [95% confidence interval 0.12–0.77], P=0.035). Conclusion: Our standardised nociceptive stimuli are not optimised for obtaining consistent EEG responses in patients during clinical anaesthesia. To validate and sufficiently reproduce EEG-based standardised stimulation as a marker for nociception in clinical anaesthesia, other pain models or stimulation settings might be required to transfer preclinical studies into clinical practice. Clinical trial registration: DRKS00017829.

Background: The multiple modes of SARS-CoV-2 transmission including airborne, droplet, contact and faecal–oral transmissions that cause coronavirus disease 2019 (COVID-19) contribute to a public threat to the lives of people worldwide. Heavy aerosol production by coughing and the big peak expiratory flow in patients with respiratory infections (especially SARS-CoV-2) during recovery from general anaesthesia are the highest risk factors for infection in healthcare workers. To perform sedation before extubation significantly reduced the incidence of coughing during recovery from general anaesthesia. However, there are few studies on endotracheal tube removal under BIS-guided sedation in postanaesthesia care unit (PACU). We speculated that the BIS-guided sedation with dexmedetomidine and propofol would better prevent coughing caused by tracheal extubation and reducing peak expiratory flow. Methods: Patients with general anaesthesia were randomly assigned to Group S (dexmedetomidine was infused in the operating room for 30 min, and the bispectral index (BIS) value was maintained 60–70 by infusion propofol at 0.5~1.5 μg/ml in the PACU until the endotracheal tubes were pulled out) and Group C (no dexmedetomidine and propofol treatment, replaced with the saline treatment). The incidence of coughing, agitation and active extubation, endotracheal tube tolerance and the peak expiratory flow at spontaneous breathing and at extubation were assessed. Results: A total of 101 patients were randomly assigned to Group S (51 cases) and Group C (50 cases). The incidence of coughing, agitation and active extubation was significantly lower (1(51), 0(51) and 0(51), respectively) in Group S than (11(50), 8(50) and 5(50), respectively) in Group C (p < 0.05 or p < 0.01, respectively); the scores of cough were significantly reduced (1(1, 1)) in Group S than (1(1, 2)) in Group C (p < 0.01); and the endotracheal tube tolerance was significantly improved (0(0, 1)) in Group S than (1(1, 3)) in Group C (p < 0.001). The peak expiratory flow at spontaneous breathing and at extubation was significantly reduced (5(5, 7) and 6.5(6, 8), respectively) in Group S than (8(5, 10) and 21(9, 32)) in Group C (p < 0.001). Conclusions: BIS-guided sedation with dexmedetomidine and propofol significantly prevented coughing and reduced peak expiratory flow during recovery from general anaesthesia, which may play an important role in preventing medical staff from contracting COVID-19. Trial registration: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) "retrospectively registered". [ABSTRACT FROM AUTHOR]

The aim of this study was to develop a protocol for oral pre-operative registration and dental risk assessment by the anaesthesiologist, determining its reliability through the inter-observer agreement between a senior dental student and an internal physician specializing in anaesthesiology. A convenience sample consisting of 35 patients was selected. These were observed during the anaesthesiology consultation, at Hospital de São João, Porto, Portugal. The protocol included a self-administered questionnaire and a brief clinical examination by the two observers. A descriptive analysis (qualitative and quantitative variables) was performed. The Fleiss Kappa index was used to measure the degree of agreement between the two observers. In most of the parameters defined, the agreement presented Kappa index values between 0.6 and 1, corresponding to good and excellent correlation, respectively. The general oral status was considered "poor", with a great number of missing teeth, namely the upper central and lateral incisors. The proposed pre-anaesthetic protocol can be a reliable tool for the anaesthesiologists, which suggests the relevancy of incorporating interdisciplinary training between future health professionals. Further research is needed to assess its implementation, providing information about the pre-operative oral status, preventing intraoperative damage and potential medicolegal litigation. [ABSTRACT FROM AUTHOR]

Background and Aims: Catheter-related bladder discomfort (CRBD) is identified as a major concern after surgery as it can lead to increased morbidity and prolonged hospital stay. A suitable agent to prevent and treat postoperative CRBD is not yet established, and the literature is scarce in this regard. So, we aimed to find the efficacy of various drugs in preventing CRBD after elective surgery. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the study, and electronic databases like PubMed Central, Cochrane database and Embase were searched. The methodological quality of selected studies was assessed by the Cochrane Collaboration risk of bias tool. Review Manager 5.4.1 was used for statistical analysis. Results: The meta-analysis revealed that antimuscarinic agents were able to lower the incidence of CRBD significantly at 0 hour, 1 hour, 2 hours and 6 hours (P < 0.01) after the surgery. Tramadol was effective at 1 hour, 2 hours and 6 hours postoperatively (P < 0.01), whereas ketamine was effective at 2 and 6 hours (P < 0.01) postoperatively. Antiepileptic drugs (pregabalin and gabapentin) were able to lower the incidence of CRBD at 0 hour (P < 0.01), 1 hour (P < 0.05), 2 hours (P < 0.05) and 6 hours (P < 0.01) postoperatively while dexmedetomidine at 0 hour (P < 0.01) and 2 hours (P < 0.01) after the surgery. Injections paracetamol, amikacin and diphenhydramine were also shown to reduce the incidence of CRBD in separate randomised controlled trials. Conclusion: The current meta-analysis showed that antimuscarinic agents, tramadol, pregabalin, gabapentin, paracetamol and dexmedetomidine are effective in significantly reducing the incidence of postoperative CRBD. [ABSTRACT FROM AUTHOR]

Background and Aims: Videolaryngoscopes with varying characteristics with regard to angulation of blades and video configurations are now available. However, the contribution of each of these in improving ease of intubation is quite different. We evaluated the role of video camera in the performance of laryngoscopy by using the universal serial bus (USB) videolaryngoscope in patients with predicted difficult airway. Methods: Sixty patients in the age group of 25 to 65 years having Mallampati grade III or IV were randomly allocated to two groups. All patients were American Society of Anesthesiologists physical status grade I or II and planned for elective surgical procedure under general anesthesia. USB videolaryngoscope or Macintosh laryngoscope was used for intubation as per group allotted. Comparison of time of endotracheal intubation was our primary outcome measure and it was calculated from the time the laryngoscope tip passes the incisors to the initial appearance of capnography wave. Rate of successful intubation, number of attempts needed for successful tube placement, optimisation manoeuvres used, changes in haemodynamic parameters and airway injuries were evaluated as secondary outcomes. Results: Time for intubation was shorter in the Macintosh group than the USB group (P = 0.024). The incidence of successful intubation was similar in both groups (P = 0.079). USB group required lesser number of attempts for tube placement (P = 0.047). The incidence of airway injuries was similar in both the groups. Conclusion: USB videolaryngoscope reduces the number of attempts required for successful endotracheal intubation compared to Macintosh laryngoscope though it increases the time for intubation in patients with predicted difficult airway. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The objective of this single-centre, open, randomized control trial was to compare the patients' satisfaction with local anaesthesia (LA) or general anaesthesia (GA) for video-assisted thoracoscopy. METHODS Patients with indication for video-assisted thoracoscopy pleural management, mediastinal biopsies or lung wedge resections were randomized for LA or GA. LA was administered along with no or mild sedation and no airway devices maintaining spontaneous breathing, and GA was administered along with double-lumen tube and one-lung ventilation. The primary end point was anaesthesia-related satisfaction according to psychometrically validated questionnaires. Patients not willing to be randomized could attend based on their desired anaesthesia, forming the preference arm. RESULTS Fifty patients were allocated to LA and 57 patients to GA. Age, smoking habits and lung function were similarly distributed in both groups. There was no significant difference between the 2 groups with regard to patient satisfaction with anaesthesiology care (median 2.75 vs 2.75, P  = 0.74), general perioperative care (2.50 vs 2.50, P  = 0.57), recovery after surgery (2.00 vs 2.00, P  = 0.16, 3-point Likert scales). Surgeons and anaesthesiologists alike were less satisfied with feasibility (P  < 0.01 each) with patients in the LA group. Operation time, postoperative pain scales, delirium and complication rate were similar in both groups. LA patients had a significantly shorter stay in hospital (mean 3.9 vs 6.0 days, P  < 0.01). Of 18 patients in the preference arm, 17 chose LA, resulting in similar satisfaction. CONCLUSIONS Patients were equally satisfied with both types of anaesthesia, regardless of whether the type of anaesthesia was randomized or deliberately chosen. LA is as safe as GA but correlated with shorter length of stay. Almost all patients of the preference arm chose LA. Considering the benefits of LA, it should be offered to patients as an equivalent alternative to GA whenever medically appropriate and feasible. [ABSTRACT FROM AUTHOR]

Introduction: Haemodynamic stress response to direct laryngoscopy and endotracheal intubation have been well established. Both gabapentin and esmolol facilitates in attenuating this stress response through different mechanisms. Aim: To compare the efficacy of gabapentin and esmolol in reducing the haemodynamic stress response to laryngoscopy and intubation. Materials and Methods: The present single centre, randomised clinical trial was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from May 2022 to August 2022 among 90 American Society of Anesthesiologists (ASA) I and II patients. The patients were divided into two groups, group G and group E. In group G, tablet gabapentin 800 mg given three hours before surgery while injection normal saline 10 mL intravenously was given two minutes prior to induction. Group E received tablet placebo three hours before surgery and injection esmolol 1.5 mg/kg diluted upto 10 mL was given intravenously two minutes prior to induction. The baseline Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) and the change at 1, 2, 5 and 10 minutes after laryngoscopy and intubation was observed. Comparison of continuous variables between two groups was done using independent t-test and comparison of percentages between two or more groups was done using Chi-square test. Results: The mean age of group G and group E was 41.52±9.87 years and 38.54±10.06 years, respectively. Male to female ratio in group G and group E was 20:25 and 21:24, respectively. There was no significant difference in haemodynamic response to intubation between both gabapentin group and esmolol group. However, the esmolol group had more falls in all haemodynamic parameters such as HR, SBP, DBP and MAP (<20%) intraoperatively. Conclusion: Both esmolol and gabapentin were effective in attenuating the stress response to laryngoscopy and endotracheal intubation when used as premedication. But there was more decrease in HR and blood pressure intraoperatively, when injection esmolol was used. [ABSTRACT FROM AUTHOR]

Objective: Cricoid pressure, a manoeuver used to prevent pulmonary aspiration during rapid sequence induction, can result in deterioration of laryngeal view and increased haemodynamic changes. Its effect on laryngoscopy force remains unevaluated. The study aimed to assess the impact of cricoid pressure on laryngoscopy force and intubation characteristics during rapid sequence induction. Methods: Seventy American Society of Anaesthesiologists I/II patients, both sexes, aged 16-65, having non-obstetric emergency surgery were randomly assigned to the cricoid group, which received 30 N cricoid pressure during rapid sequence induction, and the sham group, which received 0 N pressure. Propofol, fentanyl, and succinylcholine were used to produce general anaesthesia. The primary outcome was the peak force of laryngoscopy. Secondary outcomes were the laryngoscopic view, time to execute endotracheal intubation, and intubation success rate. Results: With the application of cricoid pressure, the peak forces of laryngoscopy increased significantly, with a mean difference (95% CI) of 15.5 (13.8-17.2) N. With and without CP, the mean peak forces were 40.758 (4.2) and 25.2 (2.6) N, respectively, P < .001. Without cricoid pressure, the intubation success rate was 100%, compared to 85.7% with cricoid pressure, P = .025. The proportions of CL1/2A/2B patients with and without cricoid pressure were 5/23/7 and 17/15/3, respectively, with P = .005. With cricoid pressure, there was a considerable increase in intubation duration, with a mean difference (95% CI) of 24.4 (2.2-19.9) seconds. Conclusion: Cricoid pressure increases peak forces during laryngoscopy, resulting in worse intubation characteristics. This demonstrates the need of exercising care while performing this manoeuver. [ABSTRACT FROM AUTHOR]

Background: It remains controversial whether general anaesthetic drugs contribute to perioperative neurocognitive disorders in adult patients. Preclinical studies have generated conflicting results, likely because of differing animal models, study protocols, and measured outcomes. This scoping review of preclinical studies addressed the question: 'Do general anaesthetic drugs cause cognitive deficits in adult animals that persist after the drugs have been eliminated from the brain?'Methods: Reports of preclinical studies in the MEDLINE database published from 1953 to 2021 were examined. A structured review process was used to assess original studies of cognitive behaviours, which were measured after treatment (≥24 h) with commonly used general anaesthetic drugs in adult animals.Results: The initial search yielded 380 articles, of which 106 were fully analysed. The most frequently studied animal model was male (81%; n=86/106) rodents (n=106/106) between 2-3 months or 18-20 months of age. Volatile anaesthetic drugs were more frequently studied than injected drugs, and common outcomes were memory behaviours assessed using the Morris water maze and fear conditioning assays. Cognitive deficits were detected in 77% of studies (n=82/106) and were more frequent in studies of older animals (89%), after inhaled anaesthetics, and longer drug treatments. Limitations of the studies included a lack of physiological monitoring, mortality data, and risk of bias attributable to the absence of randomisation and blinding.Conclusions: Most studies reported cognitive deficits after general anaesthesia, with age, use of volatile anaesthetic drugs, and duration of anaesthesia as risk factors. Recommendations to improve study design and guide future research are presented. [ABSTRACT FROM AUTHOR]

Whilst the general presumption of the public is that general anaesthesia prevents awareness of any sensory stimuli, Lennertz and colleagues have shown in this issue of the British Journal of Anaesthesia that 11% of young adults were able to respond to auditory commands when neuromuscular blocking drugs were prevented from reaching one arm using the isolated forearm technique. This occurred with anaesthetic regimens that followed usual clinical practice in each of the 10 countries that enrolled patients, and it was significantly more common in women than in men. This high incidence demands attention. Further characterisation of the experience of these patients is essential to our understanding of the state of general anaesthesia. [ABSTRACT FROM AUTHOR]

Connected consciousness, assessed by response to command, occurs in at least 5% of general anaesthetic procedures and perhaps more often in young people. Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18–40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes. This was an international, multicentre prospective cohort study using the isolated forearm technique to assess connected consciousness shortly after tracheal intubation. Of 344 enrolled subjects, 338 completed the study (mean age, 30 [standard deviation, 6.3] yr; 232 [69%] female). Responses after intubation occurred in 37/338 subjects (11%). Females (13%, 31/232) responded more often than males (6%, 6/106). In logistic regression, the risk of responsiveness was increased with female sex (odds ratio [OR adjusted ]=2.7; 95% confidence interval [CI], 1.1–7.6; P =0.022) and was decreased with continuous anaesthesia before laryngoscopy (OR adjusted =0.43; 95% CI, 0.20–0.96; P =0.041). Responses were more likely to occur after a command to respond (and not to nonsense, 13 subjects) than after a nonsense statement (and not to command, four subjects, P =0.049). Connected consciousness occured after intubation in 11% of young adults, with females at increased risk. Continuous exposure to anaesthesia between induction of anaesthesia and tracheal intubation should be considered to reduce the incidence of connected consciousness. Further research is required to understand sex-related differences in the risk of connected consciousness. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of the elderly regimen of intravenous sedation (IVS) with midazolam for people with Alzheimer's disease (>65 years old) who required dental extraction. Materials and methods: This was a retrospective clinical series of people with late, middle and early stages of Alzheimer's disease who had dental extraction under IVS with midazolam. Demographic characteristics such as age, gender and past medical history of the patients were collected from the medical records. Non‐invasive blood pressure, oxygen saturation measured via pulse oximetry and heart rate before and after dental treatment were also collected for each patient. The mental capacity of each patient was assessed using the Mental Capacity Act's four steps. All patients had dental extraction under local anaesthesia and IVS with midazolam. Each patient was injected 1 mg of midazolam over 30 s; pause for 4 min and an additional 0.5 mg increment was added every 2 min until adequate sedation was reached with a minimum of 90% of oxygen saturation. The quality of sedation was assessed using Ellis Sedation Scores. Results: Midazolam dosage varied between 0.5 and 1.5 mg. All patients showed good (grade II) quality of sedation level as measured by Ellis Sedation Scores. This helped to deliver safe dental extraction. Conclusions: As the association between general anaesthesia and cognitive level in people with Alzheimer's disease is mixed and still needs further studies, this retrospective clinical series study showed that people with Alzheimer's can benefit from the elderly regimen of IVS with midazolam in providing safe and effective dental extraction when delivered properly. [ABSTRACT FROM AUTHOR]

Background: Practitioner's knowledge and parental perspectives on dental general anaesthesia (GA) have been surveyed separately in the past. But in daily routine both need to collaborate for the benefit of the child. The aim of this paper was to compare parental and practitioner's acceptance of GA with special focus on identifying factors which influence their differences in decision making. Methods: Questionnaires were conducted among 142 participants in a specialized paediatric dental clinic in Germany from February 2020 to February 2021. 51 German practitioners from private practices and clinics participated. Data collection included: age, gender, experience with GA, fear of GA, risk evaluation and indications for GA. Results: There were no gender related differences in decision making. Emotional factors are present in parents of younger children. Parents are more likely to express fear and uncertainty regarding GA than dentists. Prior experience with GA significantly decreases fears in GA for parents. Both agree that extent of the treatment and low compliance are a suitable indication for GA. Dentists are more likely to accept GA due to a mental disability than parents. Parents were more likely to accept GA than dentists when multiple extractions were needed (regardless of compliance) or acute pain was present. Conclusions: A significant divergence in risk evaluation, acceptance and decision-making could be found in parents compared to dentists. Influencing factors are previous experience, younger age of the child, lack of knowledge and indication for GA. [ABSTRACT FROM AUTHOR]

Background: Coughing caused by tracheal extubation is common following general anaesthesia. Heavy aerosol production by coughing during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) may be one of the highest risk factors for infection in healthcare workers. The application of local anaesthetics to the endotracheal tube is an effective method to reduce coughing. The most commonly used anaesthetics are compound lidocaine/prilocaine cream and tetracaine spray. However, coughing still occurs when the two anaesthetics are used alone. We speculated that the application of compound lidocaine/prilocaine combined with tetracaine spray would better prevent coughing caused by tracheal extubation. Methods: Patients scheduled for laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anaesthesia were randomly assigned to Group C (saline spray), Group L (2 g compound lidocaine/prilocaine cream contains 5 mg of lidocaine and 5 mg prilocaine)), Group T (tetracaine) and Group F (compound lidocaine/prilocaine cream combined with tetracaine). The incidence of coughing, the endotracheal tube tolerance assessment, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were recorded and analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the plasma concentrations of epinephrine and norepinephrine were measured immediately before extubation and 1 min after extubation. Results: A total of 211 patients were randomly assigned to Group C (53 cases), Group L (52 cases), Group T (52 cases) and Group F (54 cases). The primary result is assessment of the incidence of cough. The patients emerged from general anaesthesia, 96% of Group C had cough, which was significantly reduced in Group L (61.5%, P < 0.001), Group T (75%, P < 0.05) and Group F (22.2%, P < 0.001). Group F had a significantly reduced incidence of cough compared to Group L and Group T (P < 0.05 or P < 0.01, respectively). The secondary results were assessed. The endotracheal tube tolerance score in Group C ((1, 3) 4, P < 0.001) was higher than Group L ((0, 1) 2), Group T ((0, 1.25) 3) and Group F ((0, 0) 1). Group F had a significantly lower score than Group L and Group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in Group C (96.2% and 71.7%, respectively, P < 0.001) than Group L (48.1% and 15.4%, respectively), Group T (61.5% and 26.9%, respectively) and Group F (17.3% and 7.7%, respectively). Blood pressure, HR and plasma concentrations of epinephrine and norepinephrine were significantly higher in Group C than in all other groups at the time of extubation and 1 min after extubation (P < 0.001). Group F exhibited significantly reduced blood pressure, heart rate and plasma concentrations of epinephrine and norepinephrine compared to Group L and Group T (P < 0.05, P < 0.01 or P < 0.001, respectively). The incidence of postoperative pharyngeal pain and the incidence of postoperative cough were not significantly different among the groups. Conclusions: Compound lidocaine/prilocaine cream combined with tetracaine may be a more effective approach for preventing coughing and stabilising circulation during extubation following general anaesthesia. This may play an important role in preventing medical staff from contracting respiratory infectious diseases. Trial registration: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09–04-2022) "retrospectively registered". [ABSTRACT FROM AUTHOR]

Background: Transversus abdominis plane block is a regional anaesthesia technique. It provides analgesia after abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of lower abdominal wall skin and muscles via local anaesthetic deposition above transverses abdominus muscle. We evaluated the efficacy of TAP block with Ropivacaine and Bupivacaine for post operative analgesia in abdominal surgery, a double blind, prospective randomized controlled trial. Materials and Methods: 80 patients undergoing elective lower abdominal surgeries under general anaesthesia were randomized to undergo Tap block with Ropivacaine (n=40) or Bupivacaine (n=40). Tap block was performed at the end of surgery using 20ml of 0.5% Ropivacaine or 0.25% Bupivacaine each side. Each patient was assessed postoperatively by a blinded observer at 30mins, 1, 3, 6, 12 & 24 hrs in ward. Result: The results in both groups were comparable clinically as well as statistically. Mean pain scores at 2, 4, 6, 12, 24, 48 hours in ropivacaine group were 4.00 (3.0 - 7.0), 0.00 (0.0 - 3.0), 0.00 (0.0 - 3.0) and 0.00 (0.0-0.0) .There was statistically significant (P<0.05) difference in VAS, lower in Group B(.5% Ropivacaine) compared to group A (0.25% Bupivacaine), during surgery at 3 hour and at 12 hours (P= <0.0001), there was no statistically significant differences observed from 1 to 2 hours, 4 to 9 hours and 24 to 72 hours (p>0.05). Conclusion: We conclude that 0.5% Ropivacaine provided longer duration of analgesia than 0.25% Bupivacaine when used in TAP block for patients undergoing abdominal surgery. Both drugs have a good safety profile. Both drugs show outstanding clinical utility in terms of reliability and effective analgesia. [ABSTRACT FROM AUTHOR]

Recent development in science has led to a significant improvement in safety for the anaesthetic management of children. Enhanced recovery after surgery is one of the novel approaches aiming to enhance paediatric surgical outcomes and their quick recovery. Preoperative counselling, minimal fasting, and no routine pharmacological premedication are critical components of enhanced recovery after surgery. As anaesthetists, management of airway is our priority and introduction of paraoxygenation in addition to preoxygenation has resulted in reduction in desaturation episodes during periods of apnoea. Safe care has been made possible by improvements in monitoring, equipment, medications, techniques, and resuscitation protocols. We are motivated to collect more evidence regarding ongoing disputes and issues, such as the effect of anaesthesia on neurodevelopment. [ABSTRACT FROM AUTHOR]