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Airway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. However, such guidelines have intrinsic limitations due to the lack of supporting evidence in various fields of airway management. Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients. [ABSTRACT FROM AUTHOR]

Background: In this study, we wanted to assess the type of anesthesia and reason for selecting the particular anesthesia, monitoring anesthesia-related perioperative complications, its effects on maternal and neonatal health, determine the most preferred mode of anesthesia used for cesarean section, determine the incidence of perioperative anesthesia-related complication and outcome after anesthesia-related complications, and maternal and fetal outcome in terms of morbidity and mortality after anesthesia. Materials and Methods: This was a hospital-based prospective observational study conducted among 735 consecutive cases undergoing cesarean section under general anesthesia (GA)/regional anesthesia both elective and emergency in the department of obstetrics and gynecology of a tertiary care hospital, over a period of one year, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Hypotension was the most frequent complication associated with spinal anesthesia. The percentage of patients having intraoperative hypotension in GA (11.1%) was lower than the percentage of patients having intraoperative hypotension in spinal anesthesia (19.2%). This difference is significant with a P value of < 0.01. Twenty-eight patients at the end of surgery complained of pain because of wearing of spinal level. Two cases of bronchospasm and two cases of shivering were seen in the immediate postextubation period in patients of GA. Twenty-four (3.3%) neonates had low appearance, pulse, grimace, activity, and respiration (APGAR) score and 59 (8%) neonates required Neonatal intensive care unit (NICU) admission. Fifteen neonates required resuscitation because of poor cry. Six were managed with bag and mask ventilation, four neonates required temporary intubation, and five neonates were shifted intubated to NICU. Conclusions: Spinal anesthesia is the choice of anesthesia for category 2 and onward cesarean sections. GA is the choice for category 1 cesarean section. Intraoperative hypotension is the commonest complication with all types of anesthesia, but if treated well is associated with no adverse outcomes. The maternal outcome is good with all types of anesthesia. Category 1 cesarean section is associated with low APGAR and increased NICU admissions in neonates. Pre-existing illness in the mother changes the choice of anesthesia. [ABSTRACT FROM AUTHOR]

Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients. Trial registration number: ChiCTR2300078283 04/12/2023. [ABSTRACT FROM AUTHOR]

Background and Aims: Perioperative dental injury is a known yet preventable complication. We assessed the anesthesiologists' awareness of the predisposing factors, preventive measures, and subsequent management of these injuries, should they occur. Material and Methods: A prospective cross-sectional survey was conducted on 385 anesthesiologists practicing in Delhi-NCR to assess their awareness on prevention and management of perioperative dental injuries. A questionnaire comprising 35 questions designed to determine preanesthetic practices, knowledge of dental injury predisposing factors, preventive measures, injury management, and documentation was filled and the collected data was analyzed. Results: Dental risk assessment was always or mostly performed by 93% anesthesiologists. Most anesthesiologists (93%) felt it would be more informative and clearer if preexisting dental condition is noted on a dental chart. Dental consultation was always advised by 14% anesthesiologists for patients with loose or diseased tooth. Limited mouth opening (71%), intubation (98%), and use of laryngoscope (96%) were found to be associated with dental injury. For dental injury prevention, 74% anesthesiologists padded teeth with gauze and 51% preferred to use a video laryngoscope. Knowledge regarding handling and management of avulsed tooth was lacking in most anesthesiologists. Postanesthesia dental status was documented always by only 11%. However, 71% always documented dental injury. Conclusions: Using dental chart in preanesthetic evaluation sheet improves documentation. Anesthesiologists need to be sensitized to the benefits of preanesthetic dental consultation for vulnerable teeth. They need awareness about correct handling and need of immediate reimplantation of avulsed tooth and documentation of postanesthesia dental status. [ABSTRACT FROM AUTHOR]

Objective: We explored the use of ultrasonography in determining the minimal transverse diameter of the subglottic airway (MTDSA) for the purpose of choosing an appropriate model of reinforced cuffed endotracheal tube. Methods: A total of 110 pediatric patients who received general anesthesia and tracheal intubation for selective surgeries at the hospital from February 2019 to February 2022 were chosen. They were then randomly assigned to three groups: 39 in the MTDSA group, 35 in the age formula group, and 36 in the height formula group. We assessed how accurately the appropriate endotracheal tube model was predicted in each group and compared their predictive performance. Results: The age range of the enrolled pediatric patients was 3–6 years old. The ultrasonic measurement method demonstrated a prediction accuracy of 87.18%, while the age formula method and height formula method exhibited lower accuracy rates of 54.29% and 47.22%, respectively. Notably, the ultrasonic measurement method outperformed the other two methods significantly (P < 0.05). In the MTDSA group, 2 patients had their catheters changed during anesthesia, and the proportion of patients who changed their catheters was 5.13%. In the MTDSA group, 6 catheters were replaced, and the frequency of catheter replacement was 15.38%. In contrast, these percentages were much higher in the age formula group, at 31.43% and 45.71%, and in the height formula group, at 36.11% and 52.78%. The latter two groups had significantly higher values than the MTDSA group (P < 0.05). Regarding complications such as hoarseness, laryngeal edema, aspiration, and laryngospasm, the MTDSA group experienced a notably lower total incidence of 7.69% compared to the 37.14% in the age formula group and 41.67% in the height formula group, demonstrating statistical significance (P < 0.05). Conclusion: The ultrasonic measurement technique employed in MTDSA exhibits impressive precision when it comes to forecasting the specific model of a reinforced cuffed endotracheal tube for pediatric patients. This enhanced accuracy contributes significantly to minimizing the need for tube replacements during anesthesia and the associated complications. It holds immense importance in assisting clinicians in selecting the most appropriate pediatric endotracheal tube model for anesthesia induction. [ABSTRACT FROM AUTHOR]

Mathematical patient models play a profound role in the managing and understanding of anaesthesia. This article proposes a patient model for simulating anaesthetic uptake, i.e. the storing of anaesthetic gases in the human body, thus extending a well known four compartment model from literature. Real time data is used for the simulation, from which the sevoflurane concentration is extracted. The exhaled concentrations from the model and the data are compared. A literature model is extended with ratios of compartmental perfusion, the introduction of coefficients representing diffusion and the change of the solubility coefficient. The extended and the literature model are applied to five training data sets, with prior optimization of the parameters that have the most impact. Afterwards, both models are validated on five additional data sets. The results of the extended model are mostly better than the results of the literature model. Therefore, the extensions improve the model for the used data, but need to be validated with a larger amount of data. [ABSTRACT FROM AUTHOR]

Supraglottic carcinoma presents significant challenges in airway management during general anesthesia. We report a case of a 26-year-old female with extensive supraglottic growth undergoing a biopsy. Awake fiber-optic intubation was performed due to the risk of airway obstruction and difficulty with direct laryngoscopy. Upper airway anesthesia was achieved with nebulized lignocaine and the spray-as-you-go technique. Successful intubation was followed by an uneventful surgical procedure and a smooth recovery. This case highlights the efficacy and safety of awake fiber-optic intubation in managing difficult airways in patients with supraglottic tumors, minimizing complications and enhancing patient outcomes.

Increase in life expectancy in the world leads to an increase in the number of patients with multimorbidity who will require surgical intervention and anesthesia in the future. The desire of specialists to meet the high standards of clinical guidelines when performing medical interventions is often associated with the risk of complications, especially when providing emergency medical care. Complications during surgical interventions and anesthesia can be observed in institutions of any level and when providing care by any specialists.The aim. To assess the main risk factors that can cause complications when providing anesthesia.Materials and methods. The study was conducted in accordance with international reporting requirements for reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was performed in PubMed and Cochrane Controlled Clinical Trials Register. The method of searching by references was used to select the articles. The search strategy did not include limitations of the language, type and date of the article. Inclusion criteria: full-text publications devoted to the influence of risk factors on the incidence of complications when providing anesthesia care. Exclusion criteria: brief summaries; abstracts without a full-text version; publications without key words.Results. The review assessed the most common risk factors causing complications during anesthesia and ways to reduce them.

Background: Hypotension is most common complication of spinal anesthesia for patient undergoing LSCS. Hypotension can cause adverse outcome for both maternal and fetal. Early detection and treatment for hypotension to improve maternal and fetal outcome. Perfusion index (P.I) during spinal anesthesia for predicting hypotension in a patient undergoing LSCS. Methodology: In this study, 40 parturient belonging to ASA2 posted for elective LSCS. Under spinal anesthesia with adjusted dose of hyperbaric bupivacaine 0.5% at the L2-L3 or L3-L4 interspace. MAP, HR, Spo2 and P.I. were recorded at 1 minute interval after the SAB up to 10 minute and then 5 minute interval till end of surgery and compared with baseline hemodynamics parameter and perfusion index. Results: Mean age of the case is 26.925 with 4.95 sd. Mean SBP for 640 entries is 107.39 with 12.11 sd. Mean P.I. for 640 entries is 3.56 with 2.04 sd. There is a significant negative correlation (p<0.0001) between SBP and P.I. suggesting that P.I. increased in patient with hypotension. There is a statistically significant mean difference between before and after oxytocin bolus with hemodynamic variable of SBP, DBP, MAP SPO2 and P.I. Conclusion: The P.I. is useful tool for predicting hypotension in parturient undergoing LSCS under spinal anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. Methods: After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. Results: After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4 g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. Conclusion: EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes. [ABSTRACT FROM AUTHOR]

Background and aims. The purpose of this study is to analyze the sitting position and the park-bench position for intra-anesthesia complications in pediatric patients undergoing neurosurgery for posterior fossa lesions. Our goal is to highlight the risks associated with each of these positions under general anesthesia to aid in clinical decision making for optimal patient outcomes with regard to postoperative complications. Methods. We retrospectively reviewed 41 pediatric patients (1 to 18 years old) undergoing posterior fossae surgery in the sitting (32) and park-bench (9) positions between January 2015 and December 2021. The majority of patients (15) who underwent surgery in the sitting position had fourth ventricular tumors (28.12%) and cerebellopontine tumors (18.76%) that required the sitting position. Results. Of 32 patients operated on in the sitting position, 23 (71.78%) developed anesthetic complications, compared to 8 patients in the park-bench group (88.89%). Venous air embolism occurred in only 6.25% of patients in the sitting group. Compared to the sitting position, no cases of gas embolism were documented in the park-bench position. However, transient episodes of gas embolism cannot be excluded due to the higher incidence of hemodynamic instability (44.44%), need for additional fluid therapy (44.44%) and vasopressor support (11.11%), decreased CO2 (22.22%) and oxygen desaturation (22.22%). Patients who underwent surgery in the sitting position had a longer duration of surgery [247.5 min IQR (172.75 - 325.25)] and a longer duration of anesthesia [331 min IQR (237.5 - 423.25)]. Pneumocephalus (4, 12.5%) and postoperative hematoma (3, 9.38%) were the most common postoperative complications in patients who underwent surgery in the sitting position. In the park-bench group, three patients had postoperative complications, including postoperative hematoma (2, 25%) and hydrocephalus (1, 12.5%). Conclusions. The incidence of anesthetic complications is lower in the sitting position compared to the park-bench position. Although there was no documented gas embolism in the park-bench position, the lower rate of venous air embolism in the sitting position may suggest a better control or a lower risk in this position. However, the sitting position has a less frequent occurrence of hemodynamic instability than the park-bench position. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia and to construct a nomogram predictive model. Methods: This retrospective study included 292 patients who underwent gastrointestinal endoscopy under acupuncture anesthesia at the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from June 2020 to May 2023. Logistic regression analysis was used to identify risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia. A nomogram prediction model was constructed using the RMS package of R4.1.2 software based on the independent risk factors identified. The predictive performance of the model was assessed using consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Results: Seventy-five patients (25.68%) had complications. Body mass index (BMI), history of cardiovascular diseases, fasting time, history of respiratory diseases, and Sedation-Agitation Scale (SAS) score were identified as risk factors for complications. Based on this risk, a nomogram predictive model was constructed. The C-index of the nomogram model was 0.927. Calibration curve showed a good consistency between actual observations and nomogram predictions. The ROC curve area under curve (AUC) was 0.927 (95% CI: 0.895-0.959), indicating a certain predictive value for the occurrence of complications. When the optimal cut-off value was selected, the sensitivity and specificity of the model were 77.0% and 92.0%, respectively, indicating that the predictive model was effective. Conclusions: BMI, history of cardiovascular disease, fasting time, history of respiratory disease, and SAS score are independent risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia. The constructed nomogram predictive model has a good performance in predicting the occurrence of complications in patients undergoing gastrointestinal endoscopy with under acupuncture anesthesia. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the impact of multimodal analgesia on postoperative complications and opioid prescription on a national level. Methods: This retrospective cross-sectional study included n = 1,307,923 hysterectomies (01/2006–12/2022, Premier Healthcare claims data). Multimodal analgesia was defined as opioid use with the addition of non-opioid analgesic modes, grouped into four categories: opioid-only and 1, 2, or 3 or more additional non-opioid analgesics. Multivariable regression models measured associations between multimodal categories and outcomes (composite/respiratory/cardiac/gastrointestinal/genitourinary, and CNS complications, oral morphine milligram equivalents [MME], and length of hospital stay [LOS]). Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: Overall, 84.3% (1,102,812/1,307,923) received multimodal analgesia, of which 58.9%, 28.0%, and 13.1% received 1, 2, or 3 or more additional non-opioid analgesics, respectively. The odds of any composite complication (any ≥1 complication) decreased with the addition of 1, 2, 3, or more analgesic modalities (versus opioid-only): OR 0.66 (CI 0.64; 0.68), OR 0.63 (CI 0.61; 0.66), OR 0.65 (CI 0.62; 0.67), respectively. Similar patterns existed for respiratory, cardiac, and genitourinary complications. Opioid prescription decreased incrementally with 1,2, 3, or more non-opioid analgesic modalities by 9.51 mg (CI 11.16; 7.86) and 15.29 mg (CI 17.21; 13.37) and 29.35 mg (CI 31.79; 26.91) cumulative MME. LOS was reduced by 0.52 days (CI 0.54; 0.51), 0.49 days (CI 0.51; 0.47), and 0.40 days (CI 0.43; 0.38), respectively. Costs were reduced by $765 (CI 817; 714) or $479 (CI 539; 419) with 1 or 2 multimodal modes. Conclusions: These findings suggest substantial benefits of multimodal analgesia, including significant decreases in serious complications (especially respiratory, cardiac, and genitourinary), opioid consumption, and hospitalizations. Multimodal analgesia may facilitate safe and efficient pain management with optimized opioid consumption. [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]

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Post-induction hypotension (PIH) is a common and potentially serious complication of general anesthesia. This meta-analysis (Prospero registration number: CRD42024566321) aimed to evaluate the predictive efficacy of the perfusion index (PI) for PIH in patients undergoing general anesthesia. A comprehensive literature search was performed using multiple electronic databases (Google Scholar, EMBASE, Cochrane Library, and MEDLINE). Studies involving adult patients undergoing general anesthesia, with the PI measured before anesthesia induction and reporting PIH incidence, were included. The primary outcome was the diagnostic accuracy of the PI in predicting the probability of PIH. The secondary outcome was the pooled PIH incidence. Eight studies with 678 patients were included. The pooled incidence of PIH was 44.8% (95% confidence interval [CI]: 29.9%–60.8%). The combined sensitivity and specificity of the PI for predicting PIH were 0.84 (95% CI: 0.65–0.94) and 0.82 (95% CI: 0.70–0.90), respectively. The summary receiver operating characteristic (sROC) analysis revealed an area under curve of 0.89 (95% CI: 0.86–0.92). The Deek's funnel plot asymmetry test indicated no significant publication bias. The PI demonstrates high predictive efficacy for PIH in patients undergoing general anesthesia, indicating that it can be a valuable tool for identifying those at risk of PIH. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated anesthesia-related rigid bronchoscopy complications in children. Topics explored include the medical history of the pediatric patients involved in the study, the primary and secondary outcomes recorded such as hypoxemia, agitation during recovery, and laryngospasm, and the vital signs reported before and during anesthesia administration.

Background: External oblique intercostal block (EOIB) is effective in relieving pain in the T6 to T10 dermatomes; however, there is limited evidence comparing EOIB with conventional regional anesthesia. In this randomized controlled trial, it was hypothesized that EOIB would provide more effective analgesia than wound infiltration (WI) in laparoscopic gastrectomy. Methods: Thirty-two patients (aged 20–85 years) with American Society of Anesthesiologists Performance Status of 1 to 2, scheduled for laparoscopic gastrectomy, were randomly divided into EOIB and WI groups. Both procedures were performed using 40 mL of 0.25% levobupivacaine. The primary outcome was the numerical rating scale (NRS) score 12 h postoperatively. Secondary outcomes were NRS at 2, 24, and 48 h postoperatively, variation in quality of recovery-15 score on postoperative days 1 and 2 from preoperative baseline, postoperative fentanyl consumption, and variation in World Health Organization Disability Assessment Scale 2.0 scores between baseline and 3 months postoperatively. Plasma concentrations of levobupivacaine and pinprick sensation in the T4–11 dermatomes post-EOIB were evaluated to determine the exploratory endpoints. Results: There were no differences in the NRS scores 12 h postoperatively at rest and during movement between the EOIB and WI groups (mean standard deviation 1.3 [1.1] vs. 1.5 [1.4] and 3.1 [1.6] vs. 3.8 [1.7], respectively). Secondary outcomes did not differ significantly between the groups. The time to peak plasma concentration of levobupivacaine following EOIB was 45 min. Conclusions: No significant differences in NRS scores were observed between the analgesic effects of EOIB and WI at 12 h postoperatively. [ABSTRACT FROM AUTHOR]

Orthognathic surgery has a high incidence of postoperative nausea (PON) and vomiting (POV), delaying mobility initiation and postoperative recovery. Bleeding is another risk associated with this surgical procedure. We aimed to compare total intravenous anesthesia (TIVA) and volatile anesthesia in patients undergoing orthognathic surgery in terms of postoperative nausea and vomiting (PONV) incidence and hemodynamic changes. This retrospective study included 82 patients who underwent bilateral sagittal split ramus osteotomies at Saga University Hospital between April 2016 and April 2021. We compared the effects of TIVA and volatile anesthesia on PONV onset after surgery, acute postoperative hemodynamic changes (blood pressure and heart rate), and factors contributing to PONV. PON was significantly lower in the TIVA group than in the volatile anesthesia group. The total dose of fentanyl contributed to the onset of POV, while the onset of PON was associated with low volumes of fluid infusion and urine in the TIVA and volatile anesthesia groups, respectively. Furthermore, post-extubation hemodynamic change was significantly smaller in the TIVA group than in the volatile anesthesia group. Therefore, TIVA could have a reduced risk of PONV and hemodynamic changes in patients undergoing orthognathic surgery. Employing TIVA could mitigate perioperative complications and enhance patient safety. [ABSTRACT FROM AUTHOR]

Methods: This observational cross-sectional hospital-based study aimed to determine the prevalence of anesthesia-related postoperative undesirable outcomes among patients undergoing surgery. A structured data collection form was employed to document the anesthetic technique, type and dosage of anesthetic drugs, vital sign recordings, number of episodes of hypotension and bradycardia, and pulse oximetry value for each surgical patient in all sites at the hospitals. The principal investigator and trained nurses accessed the patient's chart after a forty-eight-hour postoperative period to collect relevant data for the participants. The primary outcome was to determine the total number of patients who suffered from postoperative adverse outcomes that were deemed an outcome of the anesthetic techniques. Conclusion: Our study revealed a high prevalence of anesthesia-related POD in hospitals in the UK between 2006 and 2009. For groups 2 and 3, the prevalence rate was 188.5-370.4 per 1,000 people per year and 183.7-426.1 per 1,000 people per year, respectively. The assigned ICD-9-CM codes of anesthesia that were responsible for generating PPODUOs contributed 5-48% and 2-44% to the group 2 and 3 subgroups, respectively. The ODA vascular access anesthetic technique was the most common neural block technique in group 2 with short-term insurers, while PNB brachial anesthetic was the most common type used in group 3 with Medicare insurers. The combination of anesthesia types ODA and PNB brachial also accounted for 21-46% in group 2 and 9-24% in group 3. Anesthesia related POD showed variations in three different age categories. Our data indicated a moderate surveillance bias rate, and 95-96% of the intraoperative outcomes were responsible for the POD. Therefore, strategies for preventing such outcomes after or before surgery are accordingly changed. Data collected clinically were adequate and covered the main coverage of other studies on the same topic. So, our data could provide useful information for further management of PPODUOs that occur during perioperative periods. More than half of our patients developed PPODUOs within seven days postoperatively. Therefore, recognition of the symptoms and prevention of the occurrence of events contributing to PPODUOs are paramount for reducing healthcare expenses and the duration of the patient's need for care. We hope our study will pave the way for future studies in developing numerous practical enhancements in the perioperative arena. Introduction: Anesthesia-related postoperative undesirable outcomes (AR-POU) are the unwanted and unexpected conditions that occur in a patient during the time from the induction of anesthesia to 48 hours after the patient comes to the recovery unit following surgery. The purpose of this study is to determine the prevalence and risk factors of anesthesia-related postoperative undesirable outcomes (AR-POUs) and their correlation with the pediatric age group and the American Society of Anesthesiologists (ASA) class. Patients who will be operated on at the study location are interviewed one day preoperatively in order to collect the data needed for this research. The investigators have reached the conclusion that by answering some questions, a possible link can be detected in children who might suffer complications during and after surgery and in those who finish their surgery without being exposed to any complications. To the best of our knowledge, this is the first study that determined the anesthesia-related POU in the pediatric age group in our country and that investigated the relationship between the pediatric patient and the ASA class of the patient. The purpose of this study is to determine the prevalence and risk factors of POU and their correlation with the age of the patients in the pediatric age group. The conclusion is that by answering some questions, a possible link can be detected in children who might suffer complications during and after surgery and in those who finish their surgery without being exposed to any complications. [ABSTRACT FROM AUTHOR]

We report a case of a young male patient with a history of Takotsubo cardiomyopathy following polytrauma. On presentation, the patient had a tracheal stent placement for tracheal injury. The patient was again posted for removal of tracheal stent, by rigid bronchoscopy. During the procedure patient had a recurrence of cardiomyopathy, requiring inotropes and post-operative ventilatory support. 2D echo showed apical ballooning of the heart. The patient improved by inotropes and later on Lasix 10 mg IV. He was extubated after 2 days. [ABSTRACT FROM AUTHOR]

Background: The most often used anesthetics for pediatric surgery are propofol and sevoflurane. These general anesthetics' main side effects are postoperative discomfort, nausea and vomiting, and agitation during the recovery room. The safety of sevoflurane and propofol in pediatric surgery has been compared in numerous clinical investigations, although the findings were unclear. So, this study aimed to compare effective outpatient surgery in pediatrics with reducing emergence agitation, delirium, and anesthesia complications by comparing effects Propofol or sevoflurane on recovery outcome for outpatient surgery in pediatrics. Methods: This Randomized, double-blind clinical study was conducted on 40 cases planned for outpatient surgery in pediatrics attended the anesthesia, intensive care, and pain management department in Zagazig University Hospitals throughout six months started from March 2023 to September 2023. All Cases were chosen from Zagazig University Hospitals' outpatient clinics who were willing to have an elective outpatient surgery. Results: There was significant shorter extubation time and discharge time in the Propofol group compared to Sevoflurane group. Otherwise there were no significant differences between groups regards other parameters. There was significantly lower heart rate in the Propofol group from basal reading until 45 minute of operation time compared to Sevoflurane group. Conclusions: When compared to sevoflurane anesthesia, children who underwent propofol anesthesia had lower chances of emerging anxiety, postoperative nausea and vomiting, and postoperative discomfort. In comparison to sevoflurane-based anesthetic, the propofol regimen provided a more relaxing recovery and reduced postoperative respiratory problems in infants undergoing outpatient surgery. [ABSTRACT FROM AUTHOR]

To perform a systematic review of the characteristics and outcomes of conscious sedation and local anesthesia for various urologic procedures. Urologic care has much to gain from the routine integration of ambulatory surgery via loco-sedative anesthetic techniques for both surgeon and patient. A comprehensive systematic literature search was conducted on PubMed, and Scopus databases following PRISMA criteria from June to August 2021. Articles were included if they were English, prospective, randomized, or nonrandomized controlled trials that used local anesthetic or conscious sedation for urologic interventions in adult patients. Additionally, included studies provided primary data on the use loco-sedative anesthesia and the efficacy and complications. All studies included were further reviewed to assess the biases and conflicts of interests. Thirty-two studies with 6897 patients were included in the review. Mean patient age was 46.4 years. The most common anesthetic and analgesic relief was the use of local anesthetic with 1% lidocaine. The majority used lidocaine as an injection, whereas the second most common route of administration was a topical cream. However, there was significant heterogeneity in the type of local or conscious sedation method and whether a combination was used. 44.4% of the studies used the visual analog scale as their primary endpoint. All the studies reported an 83%-100% successful procedure rate without note of significant sedation-related complications. Given the high efficacy rates, loco-sedative anesthesia is a promising technique for urologic interventions and should be further investigated to determine whether it may become be the standard of care. [ABSTRACT FROM AUTHOR]

Chemical immobilization is a fundamental aspect of wildlife conservation and can be extremely detrimental if proper protocols are not administered. This report compares the duration of different stages of anesthesia in striped hyena (Hyaena hyaena) immobilized with different combinations of ketamine (2.5-3 mg/kg)-medetomidine (0.035-0.04 mg/kg), ketamine (6-8 mg/kg)-xylazine (0.7-0.8 mg/kg) and butorphanol (0.2 mg/kg)-medetomidine (0.02 mg/kg)-midazolam (0.2 mg/kg) combinations. In total, 3 striped hyenas with different clinical conditions were anesthetized nine times. The time of induction, anesthesia, recovery, and physiological parameters were evaluated. Atipamezole (0.1-0.18 mg/kg), naltrexone (0.3 mg/kg), and flumazenil (0.003 mg/kg) were used to antagonize the effects of anesthetic drugs. Results revealed that both combinations of ketamine-medetomidine and butorphanol-medetomidinemidazolam were more effective and predictable in induction, anesthesia, and recovery phases as compared to ketamine-xylazine. Also, several sorts of adverse effects like vomiting, decreasing the percentage of SpO2, and reducing rectal temperature were observed while using the ketamine-xylazine combination. The physiological parameters haven't been a noticeable difference as well as stages of chemical immobilization, in two combinations of ketamine-medetomidine and butorphanol-medetomidine-midazolam. [ABSTRACT FROM AUTHOR]

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Background: The Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) is an open procedure in which the mesh is placed in the preperitoneal space and is therefore associated with less chronic post-operative inguinal pain. TREPP is primarily performed under general or spinal anesthesia, however, it is also possible to perform under sedation and local anesthesia with potentially advantages. This retrospective feasibility pilot study investigates the safety and efficiency of TREPP under local anesthesia in the outpatient clinic in comparison with Lichtenstein. Methods: Between 2019 and 2022, all patients who underwent an elective inguinal hernia repair under local anesthesia in the outpatient clinic operation theatre were assessed. 34 patients in the TREPP group and 213 patients in the Lichtenstein group were included. Outcomes were complications, operating time, theatre time, and early inguinal hernia recurrence within 8 weeks and 6 months post-operatively. Results: No significant differences in complications such as wound infection, hematoma, seroma, urine retention and early recurrence between TREPP and Lichtenstein were found. Post-operative pain at 8 weeks was not significantly higher after Lichtenstein (8.8% vs. 18.8%, P = 0.22). Operating time (21.0 (IQR: 16.0-27.3) minutes vs. 39.0 (IQR: 31.5–45.0) minutes, P < 0.001) and theatre time (37.5 (IQR: 30.8–42.5) minutes vs. 54.0 (IQR: 46.0–62.0) minutes, P < 0.001) was significantly shorter for TREPP. Conclusion: This pilot study showed that TREPP appears to be feasible to perform safely under local anesthesia with comparable complication rates and substantially shorter operation time than Lichtenstein. These results justify further research with a larger study population and a longer period of follow up in order to provide firm conclusions. [ABSTRACT FROM AUTHOR]

Neuromuscular diseases (NMDs) in childhood represent a markedly heterogenous group of acquired and congenital diseases, many of which are rare. Due to extramuscular complications of NMDs, pediatric patients often require anesthesia for medical procedures. The specific management of NMDs during perioperative periods requires the collaboration of an experienced anesthesiologist and several other experts involved in patient care. It is essential also for neurologists to be familiar with the challenges that anesthesia brings to NM patients. Improper management of anesthesia in an inadequately prepared and equipped workplace can lead to patient endangerment, possibly irreversible deterioration of the patient's condition. The article provides general recommendations for perioperative management of patients with NMDs, specific complications associated with anesthesia, and recommendations for selected NMDs. A comprehensive overview of anesthetic management in NMDs may help to improve the neurologist´s orientation in the care for this rare group of patients. [ABSTRACT FROM AUTHOR]

Current management of anesthesia‐associated complications falls short in terms of both efficacy and safety. Nanomaterials with versatile properties and unique nano‐bio interactions hold substantial promise as therapeutics for addressing these complications. This review conducts a thorough examination of the existing nanotherapeutics and highlights the strategies for developing prospective nanomedicines to mitigate anesthetics‐related toxicity. Initially, general, regional, and local anesthesia along with the commonly used anesthetics and related prevalent side effects are introduced. Furthermore, employing nanotechnology to prevent and alleviate the complications of anesthetics is systematically demonstrated from three aspects, that is, developing 1) safe nano‐formulization for anesthetics; 2) nano‐antidotes to sequester overdosed anesthetics and alter their pharmacokinetics; 3) nanomedicines with pharmacodynamic activities to treat anesthetics toxicity. Finally, the prospects and challenges facing the clinical translation of nanotherapeutics for anesthesia‐related complications are discussed. This work provides a comprehensive roadmap for developing effective nanotherapeutics to prevent and mitigate anesthesia‐associated toxicity, which can potentially revolutionize the management of anesthesia complications. [ABSTRACT FROM AUTHOR]

Background: COVID-associated mucormycosis (CAM) is an emerging complication in COVID-19 patients. These patients undergoing surgery may face high anesthesia-related risks. We aimed to determine the prevalence and risk factors for perioperative anaesthesia complications in CAM patients undergoing surgery. Objectives: This study was carried out to determine the prevalence of perioperative anaesthesia complications in CAM patients undergoing surgery and identify associated risk factors. Materials & Methods: We retrospectively analyzed 715 CAM patients who underwent surgery at a tertiary hospital in India from April 2021 to July 2021. In this study, the type of mucormycosis, comorbidities, perioperative anesthesia complications, airway management issues, and mortality were recorded and analyzed. Result: The overall anaesthesia complication rate was 51.89%. The most frequent complications were hypertension (21.53%), difficult airway (16.91%), requirement of postoperative respiratory support (13.14%), noninvasive ventilation (6.57%), reintubation (4.47%), hypotension (10.06%), and delayed recovery (9.23%). Rhinosinusitis (51.05%) and rhino-orbital mucormycosis (21.54%) predominated. Major comorbidities were diabetes (66.85%), cardiac involvement (72.73%), and chronic respiratory disease (58.74%). Increasing age, high ASA status, extensive infections, diabetes, and respiratory illness predicted complications. Mask ventilation was difficult in 17.76% and intubation in 10.91% of patients. Mortality was 5.45% within 24 hours and 12.73% by 72 hours postoperatively. Conclusion: Perioperative anesthesia complications are common in CAM surgery patients, especially those with comorbidities and extensive disease. Individualized management plans are essential to optimize airway, respiratory, hemodynamic, and metabolic parameters for mitigating morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The most significant medications in dentistry are local anesthetics, and intraoral local anesthesia is arguably the most used dental procedure. However, complications have also been reported. Aim: Evaluation of ocular complications in intraoral anesthesia. Materials and Methods: It was a prospective study involving 2,400 patients undergoing different dental procedures that were performed under intraoral local anesthesia over a 12‑month period. There was a thorough ocular evaluation of all patients by ophthalmologist before and after the administration of intraoral local anesthesia. Results: There were different types of ocular complications reported including accommodation disturbance, amaurosis, diplopia, enophthalmos, miosis, mydriasis, ophthalmoplegia, and ptosis. The most common ocular complication was diplopia contributing 40.1% of all ocular complications. It was followed by ptosis (16.9%), mydriasis (14.9%), and amaourosis (13.2%). Conclusion: The most common ocular complication in intraoral local anesthesia was diplopia. [ABSTRACT FROM AUTHOR]

Case report of an 81-year-old patient who suffered an eye perforation during retrobulbar anesthesia before her cataract surgery. The patient presented with eye hypotony and had her surgery canceled. After the complementary examination and image exams, the hypothesis of globe perforation with retinal detachment was confirmed, and the patient underwent a posterior vitrectomy. The objective of this case report is to present the characteristic findings and management of this rare but well-known complication. [ABSTRACT FROM AUTHOR]

Objective • To investigate the effect of esketamine combined with propofol on patient hemodynamics and its safety in hysteroscopy anesthesia. Methods • A total of 186 hysteroscopic patients admitted to our hospital from January 2021 to January 2022 were selected, and the patients were divided into group K and Group P according to a completely random number table, with 93 cases each. In short, all patients are uniformly numbered and adequately intermixed, according to the prescribed sampling starting point and order, the sample unit numbers were successively drawn from the random number table, until the extraction to the required sample size. Group K was given esketamine combined with propofol intravenously, and group P was given sufentanil combined with propofol intravenously. The changes in respiratory circulation [heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2)] at the time of entering the operating room (T0), at the beginning of surgery (T1), 10 minutes after surgery(T2), and 10 minutes after the end of surgery (T3) were compared between the two groups, as well as the total time of surgery, the time to wake up after surgery, the amount of propofol used intraoperatively and the proportion of additional propofol were compared. The numerical rating scale (NRS) was used to assess the pain level of patients in both groups at different times after awakening and the occurrence of intraoperative and postoperative adverse reactions such as body movement, respiratory depression, bradycardia, injection site pain, nausea and vomiting, and dizziness were counted in both groups. Results • There were no significant changes in MAP, HR, and SpO2 in Group K at all moments compared with T0 (P > .05), MAP, HR and SpO2 in Group P at T1 and T2 were lower than those at T0 (P < .05). MAP, HR, and SpO2 were significantly lower in Group P at T1 and T2 moments compared with Group K, suggesting that circulatory depression was more pronounced in Group P at T1 and T2 moments (P < .05) and was not conducive to postoperative recovery. Compared with group P, the postoperative recovery time of group K was significantly shorter, and the dosage of propofol and the proportion of additional propofol were significantly lower (P < .05) which was beneficial to the health of patients. The pain level was significantly lower in Group K at 5, 15, and 30 minutes after awakening than in Group P (P < .05). The incidence of adverse reactions such as intraoperative motion, respiratory depression, bradycardia, injection site pain, and dizziness was significantly lower in group K than in group P (P < .05), and there was no significant difference in the incidence of nausea and vomiting between the two groups (P > .05), and prove that esketamine combined with propofol used for anesthesia which have high safety as well as more effective. Conclusion • The use of esketamine compounded with propofol in hysteroscopy anesthesia has less effect on the patient’s circulatory and respiratory systems. This protocol can improve the postoperative analgesic effect of anesthesia in patients, reduce the amount of propofol during surgery, have fewer adverse effects and mild symptoms, is safe and effective, and can be used in clinical practice. [ABSTRACT FROM AUTHOR]

Pituitary‐dependent hypersomatotropism is rarely diagnosed in dogs and surgical treatment is not reported. A 6‐year‐10‐month male neutered Patterdale Terrier presented with polyuria, polydipsia, progressive pharyngeal stertor, excessive hair growth and widened facial features and paws. Serum insulin‐like growth factor‐1 concentration via radioimmunoassay was consistent with hypersomatotropism (1783 ng/mL). A pituitary mass was identified on magnetic resonance and computed tomography imaging. Six weeks later, glucosuria, starved hyperglycemia and serum fructosamine above the reference range (467.6 μmol/L, RI 177‐314) were documented, consistent with diabetes mellitus. Transsphenoidal hypophysectomy was performed under general anesthesia without complications. Pituitary histopathology identified an acidophil neoplasm, with positive immunostaining for growth hormone. Postoperatively, there was rapid resolution of clinical, biochemical and morphologic changes of hypersomatotropism with persistence of diabetes mellitus. This case demonstrates successful resolution of hypersomatotropism with ongoing diabetes mellitus in a dog after surgical treatment by transsphenoidal hypophysectomy. [ABSTRACT FROM AUTHOR]

Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons. [ABSTRACT FROM AUTHOR]

Purpose: To describe variation in local anesthesia techniques and complications over a 10-year period for cataract surgery in the United Kingdom. Setting: Reporting centers to the Royal College of Ophthalmologists (RCOphth) National Ophthalmology Database (NOD). Design: Retrospective cross-sectional register-based study. Methods: Data from the RCOphth NOD were used. Eligible for analysis were 1 195 882 cataract operations performed using local anesthesia between April 1, 2010, and March 31, 2020, in 80 centers. Results: Overall, topical anesthesia alone was used in 152 321 operations (12.7%), combined topical and intracameral in 522 849 (43.7%), sub-Tenon in 461175 (38.6%), and peribulbar/retrobulbar in 59 537 (5.0%). In National Health Service (NHS) institutions, 48.3% of operations were topical with/without intracameral vs 88.7% in independent sector treatment centers (ISTCs). 45.9% were sub-Tenon in NHS vs 9.6% in ISTCs. 5.8% were peribulbar/retrobulbar in NHS vs 1.7% in ISTCs. Anesthetic complication rates decreased from2.7% in the 2010 NHS year to 1.5% in the 2019 NHS year (overall, 2.1% for NHS; 0.2% for ISTCs). Overall anesthetic complication rates were 0.3%, 0.3%, 3.5%, and 3.1% for topical alone, combined topical/intracameral, sub-Tenon, and peribulbar/retrobulbar, respectively. Complication rates were higher for sharp-needle anesthesia (peribulbar/retrobulbar) in patients taking warfarin rather than direct oral anticoagulants (4.8% vs 3.1%; P = .024). Considerable variation was observed between centers on anesthetic choices and anesthetic complication rates. Conclusions: Combined topical and intracameral is the most common choice of anesthesia for cataract surgery in the United Kingdom and is associated with lower anesthetic-related complication rates than sub-Tenon and peribulbar/retrobulbar anesthesia. Variation in the anesthetic choice exists between centers and between NHS and ISTC sectors. [ABSTRACT FROM AUTHOR]

Abstract Objective Dexmedetomidine is a medication that has analgesic, sedative, and anti-anxiety properties. In the clinical, it is often used to prevent common complications associated with strabismus surgery, including postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex. However, its effectiveness and side effects of the present studies are different. The sample sizes of the present studies on the prevention of complications of dexmedetomidine are small. Therefore, this study evaluates the efficacy of dexmedetomidine in preventing anesthesia-related complications in strabismus surgery through a systematic review and meta-analysis. Methods Literature was retrieved from 10 commonly used databases and randomized controlled trials published up to May 2022 were sought. The included studies compared the intervention effects of dexmedetomidine versus placebo on anesthesia-related complications in surgery. The occurrence rates of postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex in patients undergoing strabismus surgery were evaluated. Statistical analyses and forest plots were generated using Review Manager and STATA software. Binary outcomes were measured using relative risk (RR) with a 95% confidence interval for each outcome. The Cochrane risk of bias tool was used to assess the bias and risk in the studies that met the inclusion criteria. Results A total of 13 articles were ultimately included in the analysis, comprising 1,018 patients who underwent strabismus surgery. The dexmedetomidine group, compared to the placebo group, demonstrated significant reductions in the incidence of postoperative delirium (RR = 0.73, P = 0.001), severe postoperative delirium (RR = 0.45, P = 0.005), postoperative nausea and vomiting (RR = 0.48, P

Purpose: To evaluate the efficacy and safety of idiopathic epiretinal membrane (ERM) surgery in patients aged over 80 years.Methods: Consecutive patients who underwent pars plana vitrectomy (PPV) combined with ERM and internal limiting membrane (ILM) peeling with retrobulbar anesthesia were recruited. Based on age, the patients were divided into the elderly group (≥ 80 years of age) and the control group (< 80 years of age). The best-corrected visual acuity (BCVA) and surgical complications were regarded as the main measurement indicators.Results: This study included 43 eyes from 43 patients aged 80 to 91 years and 86 eyes from 86 patients aged 54 to 79 years. Surgical intervention substantially improved BCVA both in the elderly and control groups (p = 0.005 and p < 0.001, respectively). Statistical analyses showed no significant difference in the incidence of surgical complications between the two groups (p = 0.631). The operations in either group were not delayed or canceled for the reason of complications of retrobulbar anesthesia, severe anxiety, or physical discomfort in the perioperative period. Moreover, no patient required a second operation. Also, no stroke, myocardial infarction, or death occurred during the follow-up period. All the surgical complications were treated satisfactorily.Conclusion: Our outcomes indicate that PPV combined with ERM and ILM peeling with retrobulbar anesthesia is effective and safe in elderly patients aged 80 years or older. Based on age alone, we believe that advancing age should not be the risk factor for idiopathic ERM surgery. [ABSTRACT FROM AUTHOR]

Purpose: The current study compares articaine 4% with lidocaine 2% in terms of injection pain and effectiveness of anesthesia when treating permanent mandibular first molars (PMFMs) affected by molar incisor hypomineralization (MIH). In addition to comparing the complications of local anesthesia for both solutions. Methods: The sample included 20 children. Each child was randomly assigned to either articaine 4% or lidocaine 2% in their first session with the other solution being used at the subsequent session. Injection pain and the effectiveness of anesthesia were assessed using the Wong-Baker Faces® Pain Rating Scale and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Parents were asked to report any complications of local anesthesia. The Wilcoxon-matched pairs signed-rank test was used to analyze the data. Results: Patients experienced greater pain when receiving articaine 4% injections according to both scales, differences were statistically significant when using the Wong-Baker Faces® Pain Rating scale (p < 0.05). Whereas, the FLACC scale did not show such differences (P > 0.05). Although there were no significant differences between the two solutions regarding the effectiveness of local anesthesia according to both scales (P > 0.05), articaine 4% was clinically found to be more effective than lidocaine 2%. No complications of local anesthesia were reported. Conclusions: Articaine 4% injection was more painful than lidocaine 2%. However, both solutions were effective in anesthetizing PMFMs affected by MIH and without anesthetic complications in the studied sample. Trial registration: Clinical trial, NCT05200884, (https://clinicaltrials.gov/ct2/show/NCT05200884). [ABSTRACT FROM AUTHOR]

Purpose: To discuss potential causes of broken dental needles during dental anesthesia and features of this complication, including the anatomical location of fragments in tissues, symptoms, complications, and therapeutic approaches. Methods: Twelve cases of broken dental needles occurring during dental anesthesia and subsequently referred to Hospital de Base do Distrito Federal, Brazil, between 1992 and 2019 were selected. In addition, similar cases reported in the literature over the past 50 years were reviewed. Results: Needle fractures occur most frequently during inferior alveolar nerve blocks and in younger patients. The leading cause is unexpected patient movement during the anesthetic procedure. The needle fragment is most commonly found in the pterygomandibular space or the deep spaces of the head and neck region. Needle migration is a particular concern; although rare, it is unpredictable and potentially life-threatening. Conclusions: Needle fracture is an intraoperative complication which has the potential to cause severe patient damage. It is essential that practitioners have knowledge of this possible complication and understand the technical considerations for its prevention. The existing literature and the results of this case series analysis suggest that removal of the fractured needle fragment should be attempted as soon as possible. [ABSTRACT FROM AUTHOR]

The corresponding absolute number of complications reported by these hospitals ranged from <11 to 20. 1 TABLE Incidence of not present on admission anesthesia-related complications - State Inpatient Databases (SID) Q4 2015-2018. Incidence and between-center heterogeneity of anesthesia-related complications in pediatric populations documented in administrative data: A retrospective study Only 59 of 568 hospitals (representing 76.2% of cases in the dataset) reported at least one anesthesia complication; of the 59 hospitals reporting complications, rates varied widely (independent of the number of cases), with the majority reporting complication rates of less than 0.3%: median: 0.3% (IQR 0.1% to 0.8%), range 0.03% to 10.0% (Figure 1). [Extracted from the article]

Although several guidelines recommend measuring blood tryptase and histamine concentrations to diagnose perioperative anaphylaxis (POA), tryptase measurement is more common. The appropriate timing of blood collection and the diagnostic threshold for histamine measurement are still controversial. To address these issues, histamine concentrations in patients with anaphylaxis and those with anaphylaxis-uncertain were compared in our previous study, the Japanese Epidemiologic Study for Perioperative Anaphylaxis (JESPA). However, because we could not rule out the possibility that the anaphylactic-uncertain group included anaphylactic patients, histamine concentrations were measured in patients who underwent general anesthesia with no complications as controls in the present study. Histamine levels were measured at anesthesia induction (baseline), 30 min (first point), and 2 h (second point) after the start of surgery in 30 control patients. Histamine concentrations in controls were lower than in patients with POA in JESPA at the first and second points. At the first point, a threshold of 1.5 ng/ml resulted in sensitivity of 77% and specificity of 100%. A threshold of 1.1 ng/ml at the second point resulted in sensitivity of 67% and specificity of 87%. Measurement of histamine concentrations within two hours after symptom onset might help diagnose POA. [ABSTRACT FROM AUTHOR]

This study assessed postoperative mortality, morbidity, and complications associated with anesthesia administration for gynecologic oncology abdominal surgery and investigated the risk factors for the development of these complications We conducted a retrospective cohort study analyzing the data of patients who underwent elective gynecologic oncology surgery between 2010 and 2017. The demographic data; comorbidities; preoperative anemia; Charlson Comorbidity Index; anesthesia management; complications; preoperative, intraoperative, and postoperative periods; mortality; and morbidity were investigated. The patients were classified as surviving or deceased. Subgroup analyses of patients with endometrial, ovarian, cervical, and other cancers were performed. We analyzed 416 patients; 325 survived and 91 were deceased. The postoperative chemotherapy rates (p < 0.001), and postoperative blood transfusion rates (p = 0.010) were significantly higher in the deceased group, while the preoperative albumin levels were significantly lower in the deceased group (p < 0.001). Infused colloid amount was higher in the deceased group of endometrial (p = 0.018) and ovarian cancers (p = 0.017). Perioperative patient management for cancer surgery requires a multidisciplinary approach led by an anesthesiologist and surgeon. Any improvement in the duration of hospital stay, morbidity, or recovery rate depends on the success of the multidisciplinary team. Cancer surgeries in the female reproductive system can sometimes cause severe complications, including death. Proper anesthesia management is crucial to reducing such negative outcomes. This study looked at patient records to understand the factors that led to bad results with anesthesia. Researchers focused on both pre-surgery preparations and post-surgery care. They found that factors like needing a blood transfusion, wound infections, getting chemotherapy after surgery, and low blood albumin levels increased the death rate. Strict monitoring of fluid balance and blood circulation during surgery improved survival chances. The work begins long before the operating theater. Anesthesiologists should carefully assess patients before surgery, and teamwork between the anesthesiologist and surgeon is vital throughout treatment. Identifying risks, taking precautions, and minimizing high-risk interventions can decrease the days passed at the hospital, improve recovery, and reduce deaths from surgery complications. [ABSTRACT FROM AUTHOR]

Objective: Dexmedetomidine is a medication that has analgesic, sedative, and anti-anxiety properties. In the clinical, it is often used to prevent common complications associated with strabismus surgery, including postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex. However, its effectiveness and side effects of the present studies are different. The sample sizes of the present studies on the prevention of complications of dexmedetomidine are small. Therefore, this study evaluates the efficacy of dexmedetomidine in preventing anesthesia-related complications in strabismus surgery through a systematic review and meta-analysis. Methods: Literature was retrieved from 10 commonly used databases and randomized controlled trials published up to May 2022 were sought. The included studies compared the intervention effects of dexmedetomidine versus placebo on anesthesia-related complications in surgery. The occurrence rates of postoperative delirium, postoperative nausea and vomiting, postoperative pain, and oculocardiac reflex in patients undergoing strabismus surgery were evaluated. Statistical analyses and forest plots were generated using Review Manager and STATA software. Binary outcomes were measured using relative risk (RR) with a 95% confidence interval for each outcome. The Cochrane risk of bias tool was used to assess the bias and risk in the studies that met the inclusion criteria. Results: A total of 13 articles were ultimately included in the analysis, comprising 1,018 patients who underwent strabismus surgery. The dexmedetomidine group, compared to the placebo group, demonstrated significant reductions in the incidence of postoperative delirium (RR = 0.73, P = 0.001), severe postoperative delirium (RR = 0.45, P = 0.005), postoperative nausea and vomiting (RR = 0.48, P < 0.0001), and the need for supplemental analgesia postoperatively (RR = 0.60, P = 0.004). Additionally, subgroup analysis revealed that intravenous administration of dexmedetomidine significantly reduced the incidence of oculocardiac reflex (RR = 0.50, P = 0.001). In contrast, intranasal administration of dexmedetomidine did not have a significant effect on the incidence of oculocardiac reflex (RR = 1.22, P = 0.15). There was a significant difference between the subgroups (P = 0.0005, I2 = 91.7%). Conclusion: Among patients undergoing strabismus surgery, the use of dexmedetomidine can alleviate postoperative delirium and reduce the incidence of postoperative nausea and vomiting, as well as postoperative pain. Moreover, intravenous administration of dexmedetomidine can lower the occurrence rate of the oculocardiac reflex. [ABSTRACT FROM AUTHOR]

Laparoscopic surgery (LS) is superior to conventional laparotomy due to its advantages, such as less trauma, early mobilization, minimal blood loss, less scarring, reduced postoperative pain, shorter postoperative recovery time and hospital stay, and lower mortality and morbidity. Significant hemodynamic, cardiopulmonary, and physiological changes occur in the systems due to increased intra-abdominal pressure and hypercarbia after carbon dioxide insufflation is applied for pneumoperitoneum (PP) during LS. The main goals in anesthesia management are understanding the primary pathophysiology, optimizing functional status and hemodynamics, and managing comorbidities. To minimize the effects and impacts of PP in patients who will undergo LS, as in every patient, comprehensive preoperative evaluation should be carried out by multidisciplinary approach that includes an anesthesiologist and surgeon. Our review emphasizes the importance of pathophysiological and systemic changes during LS performed by applying PP and summarizes the recovery and postoperative complications of anesthesia methods applied in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Anesthesiologist's assistance is considered an inseparable part of most surgical procedures, except for minor operations performed under local anesthesia. In hand surgery, most of the operations can be performed under regional (brachial plexus block) or local (infiltration) anesthesia. These procedures can be carried out by the surgeons themselves, which allows them to operate without the assistance of an anesthesiologist. The objective of this study was an analysis of the efficacy and safety of anesthesia to operations in hand surgery performed by surgeons, without the assistance of anesthesiologists. Materials and Methods: This analysis was based on records of anesthesia protocols completed by the surgeons who performed the procedure and who operated on the patients. The following variables were considered: efficacy of anesthesia, adverse effects associated with anesthesia and complications. Results: Over a 10-year period (2013-2022), a total of 16,583 procedures were performed, of which 5638 (34%) were carried out under anesthesia by surgeons, without the assistance of anesthesiologists. The efficacy of these procedures (local and brachial plexus blocks) was 98%. A total of 203 (3.6%) anesthesia-related events were noted, most of which were transient, requiring emergency intervention and without serious consequences. In only 12 cases (0.02%) adverse effects led to cancellation and postponement of the planned operation. Conclusion: Anesthesia for operations in hand surgery performed by surgeons themselves and without the assistance of anesthesiologists is effective and safe and is associated with numerous benefits for patients, surgeons, and the budget of the medical care system. [ABSTRACT FROM AUTHOR]

This letter addresses potential cardiovascular changes following spinal anesthesia. High spinal anesthesia with a T4 sensory blockade can lead to decreased venous return, reduced right atrial pressure, and bradycardia. These effects result from diminished sympathetic activity, increased parasympathetic activity, and inhibition of cardiac accelerator fibers. In some cases, bradycardia following spinal anesthesia may progress to cardiac arrest. Therefore, patients receiving high spinal anesthesia should be monitored closely. [ABSTRACT FROM AUTHOR]

Perioperative neurocognitive disorders (PND) is a common surgical anesthesia complication characterized by impairment of memory, attention, language understanding and social ability, which can lead to a decline in the quality of life of patients, prolong the hospitalization period and increase the mortality rate. PND has a high incidence rate, which has a great impact on postoperative recovery and quality of life of patients, and has caused a heavy economic burden to society and families. In recent years, PND has become an important public health problem. The high risk population of PND is more prone to gut microbiota imbalance, and gut microbiota may also affect the inflammatory response of the central nervous system through the microbiota-gut-brain axis. Meanwhile, Neuroinflammation and immune activation are important mechanisms of PND. Regulating gut microbiota through probiotics or fecal bacteria transplantation can significantly reduce neuroinflammation, reduce the abnormal activation of immune system and prevent the occurrence of PND. This review summarizes the research progress of gut microbiota and PND, providing basis for the prevention and treatment of PND. [ABSTRACT FROM AUTHOR]