Efficacy and safety of ciprofol versus propofol for induction of general anaesthesia or sedation: A systematic review and meta-analysis of randomised controlled trials.

Background and Aims: Propofol has been used in medical practice as an anaesthetic drug for producing and sustaining general anaesthesia due to its advantages. However, it also has drawbacks, including injection-related discomfort. Recently, ciprofol has emerged as a promising anaesthetic drug that may overcome many drawbacks associated with propofol. In this systematic review and meta-analysis, we assess the efficacy and safety of ciprofol compared to propofol in different anaesthesia procedures. Methods: The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42023458170). Central, PubMed, EMBASE, Scopus and WOS were searched for English literature until 26 February 2024. Meta-analysis was performed using RevMan. The risk of bias was assessed using the RoB 2.0 tool. Results were reported as risk ratios (RRs), mean differences (MDs) and 95% confidence intervals (CIs). Results: Nineteen randomised controlled trials were included in our analysis, with 2841 participants. There was no difference between ciprofol and propofol in the success rate of endoscopy (RR: 1.01, 95% CI: 0.99, 1.02; P = 0.44), while ciprofol showed a significant increase in the success rate of general anaesthesia/sedation (RR: 1.01, 95% CI: 1.00, 1.02; P = 0.04). Ciprofol showed significantly lower pain on injection (RR: 0.14, 95% CI: 0.09, 0.22; P < 0.001), lower adverse events (RR: 0.80, 95% CI: 0.69, 0.92; P = 0.002) and higher patient satisfaction (standardised mean difference (SMD): 0.36, 95% CI: 0.24, 0.48; P < 0.001). Conclusion: Ciprofol exhibited a comparable efficacy to propofol in inducing general anaesthesia and sedation with fewer adverse events, less pain on injection and higher patient satisfaction. These collective findings may suggest that ciprofol can be used as an alternative drug to ensure effective general anaesthesia/sedation induction in the future.

The effect of transcutaneous electrical acupoint stimulation on postoperative awakening after general anaesthesia: a systematic review and meta-analysis.

Background: The existing body of research concerning the impact of transcutaneous electrical acupoint stimulation (TEAS) on early postoperative recovery is marked by a lack of consensus. This meta-analysis, encompassing a systematic review of randomised controlled trials, seeks to critically assess the efficacy of TEAS in relation to awakening from general anaesthesia in the postoperative period. Methods: The inclusion criteria for this study were peer-reviewed randomised controlled trials that evaluated the influence of TEAS on the process of regaining consciousness following general anaesthesia. A comprehensive search was conducted across several reputable databases, including PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure, the VIP Database, the SinoMed Database, and the WANFANG Medical Database. The search was not limited by date, extending from the inception of each database up to December 2023. The methodological quality and risk of bias within the included studies were appraised in accordance with the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1, and its associated tool for assessing risk of bias. Results: The analysis encompassed 29 studies involving a total of 2,125 patients. Participants in the TEAS group demonstrated a significantly shorter duration to achieve eye-opening [mean difference (MD), -3.16 min; 95% confidence interval (CI), -3.93 to -2.39], endotracheal extubation (MD, -4.28 min; 95% CI, -4.79 to -3.76), and discharge from the post-anaesthesia care unit (MD, -8.04 min; 95% CI, -9.48 to -6.61) when compared to the control group receiving no or sham stimulation. Additionally, the TEAS group exhibited markedly reduced mean arterial blood pressure (MD, -9.00 mmHg; 95% CI, -10.69 to -7.32), heart rate (MD, -7.62 beats/min; 95% CI, -9.02 to -6.22), and plasma concentrations of epinephrine (standardised MD, -0.81; 95% CI, -1.04 to -0.58), norepinephrine (MD, -47.67 pg/ml; 95% CI, -62.88 to -32.46), and cortisol (MD, -110.92 nmol/L; 95% CI, -131.28 to -90.56) at the time of extubation. Furthermore, the incidence of adverse effects, including agitation and coughing, was considerably lower in the TEAS group relative to the control group (odds ratio, 0.30; 95% CI, 0.22-0.40). Conclusion: The findings of this study indicate that TEAS may hold promise in facilitating the return of consciousness, reducing the interval to awakening post-general anaesthesia, and enhancing the awakening process to be more tranquil and secure with a diminished likelihood of adverse events. However, caution must be exercised in interpreting these results due to the notable publication and geographical biases present among the studies under review. There is an imperative for further high-quality, low-bias research to substantiate these observations. Systematic review registration: The review protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42022382017).

Evaluation of lung homogeneity in neonates and small infants during general anaesthesia using electrical impedance tomography: a prospective observational study.

Background: Prolonged mechanical ventilation can create heterogeneous ventilation patterns, which increase the risk of lung injury in infants. However, little is understood about the risk of brief exposure to mechanical ventilation during anaesthesia. The aim of this prospective observational study was to describe the regional pattern of lung ventilation during general anaesthesia in healthy neonates and infants, using electrical impedance tomography. Methods: Twenty infants (age 3 days to 12 months), without known lung disease and receiving general anaesthesia with endotracheal intubation for supine positioned surgery, were included in the study. Anaesthesia and ventilation management was at the discretion of the treating clinician. Standardised lung imaging using electrical impedance tomography was made at six time points during anaesthesia from induction to post-extubation. At each time point, the gravity-dependent and right-left lung centre of ventilation was calculated. Results: Tidal ventilation favoured the dorsal lung regions at induction, with a median (inter-quartile range) centre of ventilation (CoV) of 58.2 (53.9-59.3)%. After intubation, there was a redistribution of ventilation to the ventral lung, with the greatest change occurring early in surgery: CoV of 53.8 (52.3-55.2)%. After extubation, CoV returned to pre-intubation values: 56.5 (54.7-58)%. Across all time points, the pattern of ventilation favoured the right lung. Conclusions: General anaesthesia creates heterogenous patterns of ventilation similar to those reported during prolonged mechanical ventilation. This potentially poses a risk for lung injury that may not be recognised clinically. These results suggest the need to better understand the impact of general anaesthesia on the developing lung. Clinical trial registration: Australian New Zealand Clinical Trials Registry (ACTRN 12616000818437, 22 June 2016).

Changes in Blood Volume and Oxygenation in Lower Limb Tissue in Patients Maintaining the Lithotomy Position Under General Anaesthesia.

To investigate the effect of the lithotomy position on lower limb circulation under general anaesthesia, near-infrared spectroscopy (NIRS) was used to measure changes in blood volume and oxygenation in thigh tissue in patients (n = 35) under general anaesthesia in the lithotomy position. The NIRS measurement items, including total haemoglobin concentration (total-Hb), tissue haemoglobin index (nTHI), and tissue oxygenation index (TOI) in the thigh, were recorded for 60 min, while the patients were in the lithotomy position. The correlation between changes in each measurement item and patient characteristics, elevation of the lower extremities, and cardiorespiratory indices were evaluated. Data obtained from 24 patients were analysed. The median values (quartile deviation) of changes in total-Hb, nTHI, and TOI during the 60-min period from baseline were + 3.09 (1.99) µmol/L, +0.08 (0.03) a.u., and + 2.25 (1.75) %, respectively, all of which were significantly increased (p < 0.05). Regression analysis showed that no factor was significantly associated with the increase in any measurement item. The present results suggest that circulation in thigh tissue tends to shift towards hyperaemia during 60 min of general anaesthesia in the lithotomy position, regardless of patient background factors or changes in cardiorespiratory conditions.

A Case Report of Changes in Regional Cortical Blood Volume and Oxygenation During Induction of General Anaesthesia with Sevoflurane Versus Propofol in a Paediatric Moyamoya Disease, Evaluated by Near-Infrared Spectroscopy.

A safe induction method of general anaesthesia for paediatric moyamoya disease patients has not been fully established. We had the opportunity to administer general anaesthesia twice to a two-year-old girl diagnosed with moyamoya disease. We used different induction methods for general anaesthesia at each session, i.e. slow induction with sevoflurane and rapid induction with propofol, and were able to evaluate changes in her left regional cortical blood volume (rCBV) and oxygenation (rCBO) during both anaesthesia inductions using near-infrared spectroscopy (NIRS). The mean change value of total-Hb (rCBV) (mean ± SD; µmol/L) in the rapid induction was lower than that in the slow induction (-0.54 ± 1.43 vs. 1.82 ± 1.74). However, the TOI (rCBO) levels during both anaesthesia inductions were constantly higher than these respective baseline values (64% in the slow induction, 71% in the rapid induction), and these mean change values in each of the anaesthesia induction were about the same. The present results suggested that both the slow induction method with sevoflurane and the rapid induction method with propofol might be safe and effective for anaesthesia induction in paediatric patients with moyamoya disease.

Assessing the Efficacy of Thoracic Erector Spinae Plane Block for Postoperative Analgesia in Lumbosacral Spine Surgery: A Prospective Quasi-experimental Study.

Background and aims Optimal postoperative care and analgesia are the key factors in the management of cases of lumbosacral spine surgery. The erector spinae plane (ESP) block is a recently evolving entity and has a dynamic role in postoperative pain management. However, its role in the management of pain in lumber spinal surgeries is still not clear, and the literature remains anecdotal. Therefore, we planned to study the efficacy of ultrasound-guided preoperative ESP block at the T12 level using levobupivacaine for perioperative analgesia in lumbosacral spine surgeries. Methods A total of 60 patients scheduled for elective or emergency lumbosacral spine surgery were divided into two groups - the GA group received standard general anesthesia (GA) and the GA+ESP group received standard general anesthesia along with ultra-sound guided ESP block at the T12 level with a bilateral injection of 20 ml 0.25% levobupivacaine. Perioperative analgesia was assessed by total intra-operative fentanyl dose and frequency, intra-operative hemodynamic parameters, post-operative numeric rating scale (NRS) scores, time of first systemic rescue analgesia, tramadol usage, mobilization day, and hospital stay duration.  Results Intraoperative fentanyl sparing was observed in 83% of the GA+ESP group compared to 33% in the GA group. Postoperative tramadol sparing was observed in 80% of the GA+ESP group compared to 26.7% of the GA group. Twenty-four-hour postoperative NRS scores >3/10 were observed in 20% of the GA+ ESP group compared to 73.3% of the GA group. Conclusion In this study, superior perioperative analgesia, opioid-sparing effect, and decreased requirement of postoperative rescue analgesia were observed with ESP block.

Comparison of Hemodynamic and Recovery Profile Between Segmental Thoracic Spinal and General Anesthesia in Upper Abdominal and Breast Surgeries: A Systematic Review and Meta-Analysis.

Segmental thoracic spinal anesthesia (STSA) has been described primarily as case reports for performing upper abdominal and thoracic surgeries in significant respiratory comorbid patients. A few comparative studies have recently evaluated the technique as an advantageous alternative to general anesthesia (GA). However, there is no systematic evaluation and comparison of the techniques. The present systematic review evaluated the hemodynamic, comfort, and satisfaction of patients undergoing abdominal and thoracic surgeries under STSA and GA. PubMed, CENTRAL, Google Scholar Advanced, and citation tracking were performed to find suitable articles that compared STSA and GA. The primary objective-related data were hypotension and bradycardia. The secondary objective-related data in the context of postoperative nausea vomiting (PONV), pain, rescue analgesics, sedation requirement, satisfaction, and comfort were assessed. Meta-analysis was performed for dichotomous data on hypotension, bradycardia, and PONV; odds ratio (OR) and 95% confidence interval (CI) were reported. Data of 394 patients from six studies were evaluated. Patients undergoing upper abdominal and breast surgeries under STSA had significantly higher odds of hypotension (Fixed-Effect Model OR 12.23, 95% CI 2.81-53.28; I2 =0%, and the Random Effects Model OR 12.01, 95% CI 2.75-52.52; I2 =0%) and bradycardia (Fixed-Effect Model OR 10.95, 95% CI 2.94-40.74, I2 =0%, and the Random Effects Model OR 9.97, 95% CI 2.61-38.08; I2 =0%) but lower odds of PONV (Fixed-Effect Model OR 0.24, 95% CI 0.13-0.43; I2 =0%, and the Random Effects Model OR 0.24, 95% CI 0.13-0.45; I2 =0%). Most of the patients undergoing STSA were given intravenous sedation to overcome anxiety and discomfort. Overall, patient satisfaction was on par with GA. However, few surgeons were unenthusiastic about the technique while performing axillary clearances due to bothering twitches from cautery. STSA led to early post-anesthesia care unit (PACU) discharge and provided better pain control, lowering the need for rescue analgesics and opioid consumption in the first 24-hour postoperative period. STSA is associated with very high odds of hypotension and bradycardia as compared to GA. On the other hand, STSA demonstrated superior pain control, reduced opioid requirements, shorter PACU stays, and significantly reduced risk of PONV. Nevertheless, STSA patients mostly require sedation to make the patient comfortable.

Effects of Music Therapy on Postoperative Pain Perception in Patients Undergoing Abdominal Surgeries Under General Anesthesia: A Prospective Controlled Randomized Comparative Clinical Study.

Background Music therapy has been shown to reduce the need for sedation and analgesics, as well as lower plasma cortisol and epinephrine levels in patients undergoing regional anesthesia. This study evaluates the efficacy of perioperative music therapy in reducing pain perception and its impact on cortisol levels. Materials and methods This prospective randomized control trial was conducted at the tertiary care center in Western Maharashtra. Sixty adult patients (males/females) undergoing elective lower abdomen surgery were included and randomized equally into two groups to listen to music using headphones at a preselected volume (Group M) or to use only headphones without any music played (Group C) for 2 hours in the preoperative, intraoperative, and postoperative periods. Demographic information, anthropometric (height, weight), and biochemical (serum cortisol) measurements were performed. American Society of Anesthesiologists (ASA) grades 1 and 2, and patients aged 18 to 65 years were included. Pain perception was assessed using the Visual Analog Scale (VAS). Results The demographic data, including mean age, BMI, ASA status, average duration of anesthesia, and average duration of surgery, were comparable between the two groups. Group M showed improved control of systolic blood pressure (SBP) at 10- and 30-minute post-induction of general anesthesia and had a significantly lower VAS score (p < 0.05). Additionally, patient satisfaction was higher in Group M (81.4%) compared to Group C (51.4%) with a p-value of < 0.05. Intraoperative awareness was non-significant between the groups. Conclusion Music therapy is a safe, cost-effective, and efficacious method for reducing pain perception and can be used in conjunction with other treatments for postoperative pain management.

Sex dependence of postoperative pulmonary complications - A post hoc unmatched and matched analysis of LAS VEGAS.

STUDY OBJECTIVE: Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of 'Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study' (LAS VEGAS) to evaluate differences between females and males with respect to PPCs. DESIGN, SETTING AND PATIENTS: Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs. MAIN RESULTS: The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81-1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89-1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts. CONCLUSIONS: In this conveniently-sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes. REGISTRATION: LAS VEGAS was registered at clinicaltrial.gov (study identifier NCT01601223).

Prolonged Lower Limb Dystonia and Dysphonia Following General Anesthesia in a Patient on Hydroxyzine.

We present a case of prolonged lower limb movement disorder following general anesthesia in a female patient in her early forties. She presented with vigorous, regular synchronous, rhythmic, and jerky movements during the immediate postoperative period lasting around forty minutes. Her past anesthetic history suggests varying degrees of postoperative movement disorders. Our patient was on long-term hydroxyzine for her skin condition. She had uneventful anesthetics before the prescription of hydroxyzine for her skin condition. All post-anesthetic dystonic events were reported while she was on hydroxyzine. Dystonic reactions during the perioperative period are rare and mostly occur during induction and emergence, which usually be transient. Our patient had prolonged lower limb dystonia resulting in severe muscular pain and lethargy for a few days. Further, she once developed transient aphasia and prolonged dysphonia following total intravenous anesthesia. This clinical finding could be a part of spasmodic laryngeal dystonia, which has not been reported previously. We correlate this rare postoperative dystonic reaction with propofol and possibly with the concurrent use of hydroxyzine. As differential diagnosis can widely vary, the correlation of clinical findings with movement disorders is important for the diagnosis. Alterations of anesthetic techniques avoiding propofol and holding hydroxyzine are advisable in such rare clinical situations. Early diagnosis of perioperative movement disorders will prompt specific treatments, such as anticholinergic medications, for dystonia.

Battle of the Gases: How Air and Nitrous Oxide Affect Endotracheal Tube Cuff Pressure During General Anesthesia.

Background Endotracheal tube (ETT) cuff pressure changes during general anesthesia. Endotracheal cuff pressure ideally should be maintained between 20 and 30 cm of H2O. Cuff pressure of less than 25 cm of H2O increases the chances of aspiration while pressure of more than 40 cm of H2O causes tracheal mucosa damage. The study aimed to monitor and compare variations of endotracheal cuff pressure during general anesthesia with oxygen-air or oxygen-nitrous oxide. Methods This prospective, randomized, double-blinded, observational study was conducted on 40 patients. After approval from the institutional ethics subcommittee, 40 patients of either gender, aged 18-60 years, belonging to ASA grades I and II, who were undergoing elective surgery under general anesthesia, were enrolled in this study. The patients were randomly divided into two groups, with 20 in each group. In Group A, oxygen-air and Group N, oxygen-nitrous oxide was used as a gaseous mixture in general anesthesia with ETT. The ETT cuff pressure was recorded with the help of a cuff manometer at intervals of five, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after intubation. If pressure was more than 40 cm of H2O, it was reduced to 25-30 cm of H2O. Data were collected and analyzed using methods described in Primer of Biostatistics by Stanton A. Glantz. Quantitative data were analyzed using the Student's t-test. Qualitative data were analyzed using the chi-square test. Results An increase in cuff pressure was noted more in Group N as compared to Group A. The pressure in the endotracheal cuff started to gradually increase after 30-40 minutes in Group N after intubation, while in Group A, there was no significant increase. The average number of times the cuff deflated was 0.2 ± 0.41 in Group A and 1.55 ± 0.51 in Group N, which was highly significant. Conclusion Changes in endotracheal cuff pressure were observed when using different gas mixtures for inflation. Specifically, cuff pressure increased with oxygen and nitrous oxide compared to oxygen with air. This suggests that anesthetic gas composition can impact cuff pressure, potentially affecting tracheal mucosal perfusion and patient safety. Therefore, regular monitoring and adjustment of cuff pressure is crucial, especially when using nitrous oxide, to prevent complications and ensure optimal patient care.

New methods needed to investigate the potential adverse effects of anaesthesia on neurological development in childhood.

The issue of potentially harmful effects of neurotoxicity or anaesthesia management on children undergoing general anaesthesia is still not resolved. Studies have so far been limited by methodological problems. In a retrospective cohort study, a new noninvasive method was used to demonstrate visual processing changes in children with a single previous exposure to anaesthesia. We need new noninvasive methods that can be used before and after exposure to anaesthesia and surgery to detemine possible effects on long-term neurodevelopment.

Anaesthesia Concepts in Patients with Chronic Progressive External Ophthalmoplegia Undergoing Ophthalmic Surgery-A Retrospective Cohort Analysis.

BACKGROUND: Chronic progressive external ophthalmoplegia (CPEO) belongs to the group of mitochondrial encephalomyopathies. Anaesthesia for patients with CPEO may be associated with an increased risk due to known drug effects on mitochondrial metabolism. Therefore, the aim of this analysis was to evaluate anaesthesiological concepts in patients with CPEO requiring ophthalmic surgery. METHODS: This is a retrospective, monocentric cohort analysis of eleven patients with CPEO undergoing ophthalmic surgery either with general anaesthesia or local anaesthesia in a German university hospital from January 2012 to February 2022. RESULTS: A total of twelve ophthalmic surgery procedures were performed in eleven adult patients with CPEO. Six patients underwent surgery after receiving local anaesthesia (LA cohort). Five patients underwent six surgical procedures under general anaesthesia (GA cohort). In five cases within the GA cohort, propofol and remifentanil were used for the maintenance of anaesthesia. In one case, balanced anaesthesia with desflurane and remifentanil was used. The median duration of general anaesthesia was 37.5 min (range, 25-65 min). Patients stayed in the recovery room for a median of 48.5 min (range, 35-70 min). All patients were discharged on the first postoperative day. No relevant complications occurred in either the LA or GA cohort. CONCLUSION: Both local and general anaesthesia are feasible concepts for patients with CPEO undergoing ophthalmic surgery. Propofol, at least with a short duration (less than one hour) of use, appears to be a feasible hypnotic drug in CPEO patients.

Effectiveness of preventive intervention programmes aiming to improve oral health in children who have undergone caries-related dental extractions: a rapid review.

OBJECTIVE: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. METHODS: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. RESULTS: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. CONCLUSION: Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.

Update on the effect of dental general anaesthesia on neurocognition in children.

Dental general anaesthesia provides a comfortable treatment modality for children with early childhood caries and children's dental anxiety, but US Food and Drug Administration safety warnings have raised concerns about the neurotoxicity of general anaesthetic drugs. Currently, anaesthetic drugs have been found to impair neurocognitive function in animals, with possible mechanisms including cell damage, cell loss and impaired neuronal network function. The outcomes of clinical studies on the neurocognitive effects of surgical general anaesthesia in children have been inconsistent. However, studies focusing on dental general anaesthesia in children suggest that it does not affect neurocognitive function. In general, a growing number of studies suggest that dental general anaesthesia does not affect neurocognitive development in children. Moreover, dental general anesthesia should be used as normal when other behavioural management is unavailable.

Comparison of the recovery quality between remimazolam and propofol after general anesthesia: systematic review and a meta-analysis of randomized controlled trials.

Introduction: To evaluate the recovery quality between remimazolam and propofol after general anesthesia surgery. Methods: We included eligible randomized controlled trials (RCTs) in EMBASE, PubMed, Cochrane Central, Scopus, and Web of Science up to June 26, 2024 for comparison the recovery quality of remimazolam and propofol after general anaesthesia. The primary outcomes were the total Quality of Recovery-15 (QoR-15) and five dimensions of QoR-15 on postoperative day 1 (POD1). Secondary outcomes were adverse events, the Quality of Recovery-40 (QoR-40) on POD1, and the intraoperative and postoperative time characteristics. Results: Thirteen RCTs with a total of 1,305 patients were included in this meta-analysis. Our statistical analysis showed that remimazolam group had higher QoR-15 score on POD1, with no significant difference (Mean Difference (MD) = 1.24; 95% confidence interval (CI), [-1.67-4.15]; I2 = 75%; P = 0.41). In the five dimensions of QoR-15, remimazolam group was superior to propofol group in terms of physical independence (MD = 0.79; 95% CI [0.31-1.27]; I2 = 0%; P = 0.001). Remimazolam group was lower than propofol group in incidence of hypotension (Risk Ratio (RR) = 0.48; 95% CI [0.40-0.59]; I2 = 14%; P < 0.00001), bradycardia (RR = 0.18; 95% CI [0.08-0.38]; I2 = 0%; P < 0.0001) and injection pain (RR = 0.03; 95% CI [0.01-0.12]; I2 = 48%; P < 0.00001), respectively. The intraoperative and postoperative time characteristics and the QoR-40 were similar in the two groups. Conclusions: Our analysis showed that the recovery quality of the remimazolam group after general anaesthesia was similar to propofol group, while the incidence of adverse events was low in remimazolam group. As a potential anesthetic, remimazolam can be used in place of propofol for surgical general anesthesia.

General anaesthesia compared to conscious sedation for first-time atrial fibrillation catheter ablation-a Danish nationwide cohort study.

AIMS: Catheter ablation (CA) is a well-established treatment option for atrial fibrillation (AF), where sedation and analgesia are pivotal for patient comfort and lesion formation. The impact of anaesthesia type on AF recurrence rates remains uncertain. This study aimed to examine AF recurrence rates depending on conscious sedation (CS) vs. general anaesthesia (GA) during CA. METHODS AND RESULTS: Utilizing nationwide data from the Danish healthcare registries, we conducted this cohort study involving adults (≥18 years) undergoing first-time CA for AF between 2010 and 2018. Patients were categorized by anaesthesia type (CS or GA), with the primary endpoint being AF recurrence, defined by a composite endpoint of either antiarrhythmic drug (AAD) prescriptions, AF-related hospital admissions, electrical cardioversions, or AF re-ablation. The impact of anaesthesia type was evaluated using multivariable Cox proportional hazards analysis. The study cohort comprised 7957 (6421 CS and 1536 GA) patients. Persistent AF, hypertension, and heart failure, as well as use of AAD, were more prevalent in the GA group. Cumulative incidences of recurrent AF were higher in the CS group at 1 (46% vs. 37%) and at 5 (68% vs. 63%) years. Multivariate analysis revealed CS as significantly associated with increased risk of AF recurrence at 5-year follow-up [hazard ratio 1.26 (95% confidence interval 1.15-1.38)], consistent across paroxysmal and persistent AF subtypes. CONCLUSION: This nationwide cohort study suggests a higher risk of AF recurrence with CS during CA compared to GA. These results advocate for considering GA as the preferred anaesthesia type for improved CA outcomes.

A scoping review on intraoperative and postoperative surgical castration complications in domesticated equids.

BACKGROUND: Castration is the most common surgical procedure in domesticated equids; surgical techniques used and perioperative management vary considerably. OBJECTIVES: To identify and chart the current evidence on perioperative complications associated with different methods of surgical castration in domesticated equids. STUDY DESIGN: Joanna Briggs Institute systematic scoping review. METHOD: CAB Abstracts, Medline and Embase databases were searched using terms related to equine castration complications. Two authors independently and blindly screened publications against eligibility criteria. Data on study methods, perioperative management, surgical techniques, and perioperative complications were extracted. Surgical techniques were grouped into categories depending on technique; open, closed or half-closed, and whether the parietal tunic was open or closed at the end of surgery. RESULTS: The search identified 1871 publications; 71 studies met the final inclusion criteria. The data reported 76 734 castrations, most of which were open or closed, with the vaginal tunic remaining open at the end of surgery. Twenty-five studies reported information regarding surgical techniques and perioperative management, allowing detailed charting and comparisons, of which analgesia and antimicrobial usage varied notably. Eighteen different complications were reported, with swelling or oedema being the most common. Evisceration was most commonly reported in draught breeds and Standardbreds, and the risk appeared low if the parietal tunic was closed at the end of surgery. MAIN LIMITATIONS: Grey literature and studies not available in English were not included. Existing studies varied greatly in perioperative management, surgical techniques and reporting of outcomes, making evidence consolidation problematic. CONCLUSION: A lack of consensus regarding complication definitions creates uncertainty and discrepancies between complication rates associated with different surgical techniques and perioperative management. The implementation of standardised systems for describing surgical techniques and complications is recommended for future studies. A number of studies did not follow current recommendations for perioperative analgesia and use of antimicrobials.

Association of velocity-pressure loop-derived values recorded during neurosurgical procedures with postoperative organ failure biomarkers: a retrospective single-center study.

BACKGROUND: Perioperative renal and myocardial protection primarily depends on preoperative prediction tools, along with intraoperative optimization of cardiac output (CO) and mean arterial pressure (MAP). We hypothesise that monitoring the intraoperative global afterload angle (GALA), a proxy of ventricular afterload derived from the velocity pressure (VP) loop, could better predict changes in postoperative biomarkers than the recommended traditional MAP and CO. METHOD: This retrospective monocentric study included patients programmed for neurosurgery with continuous VP loop monitoring. Patients with hemodynamic instability were excluded. Those presenting a 1-day post-surgery increase in creatinine, B-type natriuretic peptide, or troponin Ic us were labelled Bio+, Bio- otherwise. Demographics, intra-operative data, and comorbidities were considered as covariates. The study aimed to determine if intraoperative GALA monitoring could predict early postoperative biomarker disruption. RESULT: From November 2018 to November 2020, 86 patients were analysed (Bio+/Bio- = 47/39). Bio+ patients were significantly older (62 [54-69] vs. 42 [34-57] years, p < 0.0001), More often hypertensive (25% vs. 9%, p = 0.009), and more frequently treated with antihypertensive drugs (31.9% vs. 7.7%, p = 0.013). GALA was significantly larger in Bio+ patients (40 [31-56] vs. 23 [19-29] °, p < 0.0001), while CO, MAP, and cumulative time spent <65mmHg were similar between groups. GALA exhibited strong predictive performances for postoperative biological deterioration (AUC = 0.88 [0.80-0.95]), significantly outperforming MAP (MAP AUC = 0.55 [0.43-0.68], p < 0.0001). CONCLUSION: GALA under general anaesthesia prove more effective in detecting patients at risk of early cardiac or renal biological deterioration, compared to classical hemodynamic parameters.

Using cone-beam CT for appropriate nostril selection in nasotracheal intubation.

OBJECTIVES: Nasotracheal intubation is a standard blind procedure associated with various complications. The selection of the appropriate nostril is crucial to preventing most of these complications. The present study aimed to evaluate the predictive ability of cone-beam CT (CBCT) images to select the correct nostril for nasotracheal intubation. METHODS: The study encompassed 60 patients who underwent maxillofacial surgery with nasotracheal intubation under general anaesthesia. While the anaesthetist made the appropriate nostril selection clinically according to a simple occlusion test and spatula test, the radiologist made the selection after analysing various CBCT findings such as the angle and direction of nasal septum deviation (NSD), minimum bone distance along the intubation path, and the presence of inferior turbinate hypertrophy. The appropriateness of these choices made blindly at different times was evaluated using descriptive statistics, chi-squared test, and independent samples t-test. RESULTS: The study found that 83.3% of the suggested nostril intubations were successful. We also observed that intubation duration was longer when inferior turbinate hypertrophy was present (P = .031). However, there was no statistical relationship between the presence of epistaxis and septal deviation (P = .395). Nonetheless, in 64.3% of cases with epistaxis, the intubated nostril and the septum deviation direction were the same. CONCLUSIONS: Pre-operative evaluations using CBCT can aid anaesthetists for septum deviation and turbinate hypertrophy, as both can impact intubation success rates and duration.