Evaluation of Hemodynamic Changes and Fluid Response during Anesthesia in Lumbar Disc Hernias with Pleth Variability Index (PVI).

The study aimed to assess the pleth variability index (PVI) in patients undergoing lumbar disc herniation surgery under general and spinal anesthesia, exploring its correlation with fluid responsiveness, position, and hemodynamic parameters. Methods: This prospective study included 88 ASA 1-2 patients, aged 18-65, undergoing 1-3 h elective lumbar disc herniation surgery. Patients in groups GA and SA were observed for demographic, operative, and hemodynamic parameters at specified time points. (3) Results: PVI values were comparable between the GA and SA groups. After 250 mL of fluid loading, both groups showed a significant decrease in basal PVI at T2. Prone positions in GA exhibited higher PI values than in SA. The transition from a prone to supine position maintained PVI, while pulse and MAP decreased.; (4) Conclusions: PVI values were comparable in elective lumbar disc herniation surgery with general and spinal anesthesia. Both groups exhibited significant a PVI decrease at T2 after 250 mL of fluid loading, indicating fluid responsiveness. In general anesthesia, the prone position showed a lower MAP and higher PI values compared to spinal anesthesia. PVI and PI, sensitive to general anesthesia changes, could have beneficial additions to standard hemodynamic monitoring in spinal anesthesia management.

The effects of dexmedetomidine on trauma-induced secondary injury in rat brain.

BACKGROUND: The objective of this study was to investigate the effect of dexmedetomidine (Dex), a sedative drug with little or no depressant effect on respiratory centers, on secondary injury in rat brain tissue by means of the Na+/K+ ATPase enzyme, which maintains the cell membrane ion gradient; malondialdehyde, an indicator of membrane lipid peroxidation; glutathione, an indicator of antioxidant capacity; and histopathological analyses. METHODS: Eighteen rats were randomized into three groups: the trauma group received anesthesia, followed by head trauma with a Mild Traumatic Brain Injury Apparatus; the Trauma+Dex group received an additional treatment of 100 µg/kg intraperitoneal dexmedetomidine daily for three days; the Control group received anesthesia only. RESULTS: The highest MDA levels compared to the Control group were found in the Trauma group. Mean levels in the Trauma+Dex group were lower, albeit still significantly high compared to the Control group. Glutathione levels were similar in all groups. Na/K-ATPase levels were significantly lower in the Trauma group compared to both the Control group and the Trauma+Dex group. Histopathologic findings of tissue degeneration including edema, vascular congestion and neuronal injury, and cleaved caspase-3 levels were lower in the Trauma+Dex group compared with the Trauma group. CONCLUSIONS: Dexmedetomidine administered during the early stage of traumatic brain injury may inhibit caspase-3 cleavageHowever, the mechanism does not seem to be related to the improvement of MDA or GSH levels.

Comparison of the Efficacy of Two Different Plane Blocks in Isolated Bypass Surgery: A Prospective Observational Study.

OBJECTIVE: This study evaluated the effects of serratus anterior plane block (SPB) and its combination with transverse thoracic muscle plane block (TTPB) on analgesia, opioid consumption, incentive spirometry performance, and patient comfort. DESIGN: A prospective, observational study. SETTING: A university hospital. PARTICIPANTS: Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Patients who received intravenous patient-controlled analgesia only were labeled as the control group. Patients who received additional SPB were labeled as the SPB group, and patients who received additional SPB and TTPB were labeled as the SPB+TTPB group. The visual analog scores for pain (VAS), time to first analgesic requirement, total tramadol requirement, incentive spirometry values, and patient comfort indices were recorded during the first 36 postoperative hours. MEASUREMENTS AND MAIN RESULTS: From October 2020 to October 2021, data from 95 patients were analyzed. The VAS score was lower in the SPB+TTPB group at 0, 14, and 18 hours (p < 0.001, p = 0.028, p = 0.047, respectively). Time to first analgesic was longer in the SPB+TTPB group (8 hours v 0-2 hours, p = 0.001). Total tramadol consumption was similar among groups. Incentive spirometer performance was superior in the SPB+TTPB group (p < 0.001). The SPB group had similar success at 0, 14, and 18 hours. CONCLUSION: Although pain scores and opioid consumption were similar, the addition of TTPB to SPB improved pain scores during patient mobilization and incentive spirometry capacity.

The hepatoprotective potential of resveratrol in an experimental model of ruptured abdominal aortic aneurysm via oxidative stress and apoptosis.

The mortality rate in ruptured abdominal aortic aneurysms can today be reduced through cardiovascular surgery. However, ischemia and reperfusion-induced tissue damage develop due to aortic cross-clamping applied during surgery. The present study aimed to reduce oxidative stress-induced hepatic damage resulting from ischemia and reperfusion due to aortic cross-clamping during surgery by means of resveratrol administration. Forty male Sprague-Dawley rats were randomly assigned into four groups: control (healthy), glycerol+ischemia/reperfusion (I/R) (sham), I/R, and I/R + Resveratrol. In all groups scheduled for I/R, 60 min of shock was followed by 60 min of ischemia. In the I/R + Resveratrol group, 10 mg/kg of resveratrol was administered 15 min before ischemia and immediately before reperfusion via the intraperitoneal route. In addition, 120 min of reperfusion was applied under anesthesia after ischemia in all groups. Intralobar and interlobar necrosis, vascular congestion, and edematous fields resulting from aortic occlusion were present. Liver tissue malondialdehyde (MDA) levels and cleaved caspase-3 positivity increased, while glutathione (GSH) levels decreased. However, resveratrol administration reduced intralobular and interlobar necrosis, vascular congestion and edematous fields, cleaved caspase-3 positivity, and MDA levels, and increased GSH levels. Our findings suggest that resveratrol is effective against aortic occlusion-induced liver injury by reducing oxidative stress and apoptosis.

Comparison of the Effects of Minimal and High-Flow Anaesthesia on Cerebral Perfusion During Septorhinoplasty.

OBJECTIVE: The aim of this study was to analyse the effects of minimal-and high-flow anaesthesia on cerebral oxygenation during septorhinoplasty with controlled hypotension using near-infrared spectroscopy. METHODS: Eighty patients scheduled for septorhinoplasty under general anaesthesia with controlled hypotension were randomised into two groups: minimal-flow (MF) or high-flow (HF). Both groups received desflurane anaesthesia to maintain bispectral index values at 40%-50% and 0.25-0.5 µg kg-1 min-1 i.v. remifentanyl infusion to maintain mean arterial blood pressure between 55 and 65 mmHg. The MF group received 5 L min-1 of fresh gas flow for the first 10 mins then the gas flow was reduced 0.4 L min-1. The HF group received 2 L min-1 of fresh gas flow throughout. Haemodynamic parameters and cerebral oxygen saturation were measured. RESULTS: There were no statistical differences in demographic variables, duration of anaesthesia and surgery, time to extubation and proceeding to an Aldrete score of 9. There were no statistical differences in haemodynamic parameters, end-tidal CO2 and cerebral oxygen saturation. The amount of desflurane used in the MF group was significantly lower than that used in the HF group (30.5±9.8 mL vs. 48.5±12.1 mL; p<0.05). CONCLUSION: MF and HF anaesthesia did not lead to any difference in cerebral oxygen saturation in patients undergoing septorhinoplasty with controlled hypotension. MF anaesthesia may thus be used as safely as HF anaesthesia is.

Comparison of King Vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial / Comparação entre o videolaringoscópio King Vision e o laringoscópio Macintosh: um ensaio clínico prospectivo randomizado e controlado

Abstract Background and objectives We compared the efficiency of the King Vision video laryngoscope and the Macintosh laryngoscope, when used by experienced anesthesiologists on adult patients with varying intubating conditions, in a prospective randomized controlled clinical trial. Methods A total of 388 patients with an American Society of Anesthesiologists physical status of I or II, scheduled for general anesthesia with endotracheal intubation. Each patient was intubated with both laryngoscopes successively, in a randomized order. Intubation success rate, time to best glottic view, time to intubation, time to ventilation, Cormack-Lehane laryngoscopy grades, and complications related to the laryngoscopy and intubation were analyzed. Results and conclusions First pass intubation success rates were similar for the King Vision and the Macintosh (96.6% vs. 94.3%, respectively, p > 0.05). King Vision resulted in a longer average time to glottic view (95% CI 0.5-1.4 s, p < 0.001), and time to intubation (95% CI 3-4.6 s, p < 0.001). The difference in time to intubation was similar when unsuccessful intubation attempts were excluded (95% CI 2.8-4.4 s, p < 0.001). Based on the modified Mallampati class at the preoperative visit, the King Vision improved the glottic view in significantly more patients (220 patients, 56.7%) compared with the Macintosh (180 patients, 46.4%) (p < 0.001). None of the patients had peripheral oxygen desaturation below 94%. Experienced anesthesiologists may obtain similar rates of first pass intubation success and airway trauma with both laryngoscopes. King Vision requires longer times to visualize the glottis and to intubate the trachea, but does not cause additional desaturation.

Resumo Justificativa e objetivos Comparamos a eficiência do videolaringoscópio King Vision e do laringoscópio Macintosh, quando usados por anestesiologistas experientes em pacientes adultos com diferentes condições de intubação, em um estudo clínico prospectivo randomizado e controlado. Métodos Foram selecionados 388 pacientes com estado físico ASA I ou II (de acordo com a classificação da American Society of Anesthesiologists - ASA), programados para anestesia geral com intubação traqueal. Cada paciente foi intubado com ambos os laringoscópios sucessivamente, em uma ordem aleatória. A taxa de sucesso da intubação, o tempo até a melhor visibilização da glote, o tempo de intubação, o tempo de ventilação, a classificação de Cormack-Lehane (graus) e as complicações relacionadas à laringoscopia e intubação foram analisados. Resultados e conclusões As taxas de sucesso na intubação na primeira tentativa foram similares para o King Vision e o Macintosh (96,6% vs. 94,3%, respectivamente, p > 0,05). As médias dos tempos até a melhor visibilização da glote (IC 95% 0,5-1,4 s, p < 0,001) e de intubação (IC 95% 3-4,6 s, p < 0,001) foram maiores no King Vision. A diferença no tempo de intubação foi semelhante quando as tentativas malsucedidas de intubação foram excluídas (IC 95% 2,8-4,4 s, p < 0,001). Com base na classificação de Mallampati modificada na consulta pré-operatória, o King Vision melhorou significativamente a visibilização da glote em mais pacientes (220 pacientes, 56,7%) em comparação com o Macintosh (180 pacientes, 46,4%) (p < 0,001). Nenhum dos pacientes apresentou dessaturação periférica de oxigênio abaixo de 94%. Os anestesiologistas experientes podem obter taxas semelhantes de sucesso na primeira tentativa de intubação e de traumas das vias aéreas com ambos os laringoscópios. O King Vision requer tempos mais longos até a visibilização da glote e de intubação traqueal, mas não causa dessaturação adicional.

Unilateral Isolated Hypoglossal Nerve Palsy Caused by Gunshot Injury.

Cranial nerve palsies after gunshot injury are not uncommon. However, in the literature, only 1 patient with isolated hypoglossal nerve paralysis caused by gunshot has been published. The authors describe a 34-year-old man suffering from unilateral isolated hypoglossal nerve palsy caused by gunshot injury as a second reported patient. The bullet entered maxillary sinus, and caused condylar fracture, then ended up C1-2 interspace. The bullet was surgically removed by a posterior approach. It is important to pay attention to hypoglossal nerve injury when confronted with a gunshot wound. The authors recommend early and sufficient surgical decompression.

Complication of Peribulbar Block: Brainstem Anaesthesia.

Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment.