Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study.

BACKGROUND: Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and balanced anesthesia (BA). METHODS: Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received BA, comprised of multimodal pain control brachial plexus anesthesia with light general support. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0-10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals and mean ± standard deviation. RESULTS: The mean age of patients in the WALANT group was higher than in the BA group (63 ± 17 vs. 54 ± 17, P = 0.005), and there were fewer intra-articular DRF fractures in the WALANT group than in the BA group (AO type A/B/C: 30/3/5 vs. 26/10/19, P = 0.009). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; - 8.0% [ - 15.7 to - 0.2%]) and 6-month pronation (92% vs. 100%; - 9.1% [ - 17.0 to - 1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0-22.1%]). The overall satisfaction was comparable in the WALANT and BA groups (8.7 vs. 8.5; 0.2 [ - 0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8. CONCLUSION: The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. With meticulous preoperative planning, the WALANT technique could be an alternative for DRF plating surgery in selected patients. Trial registration This retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210201).

Música perioperatoria: estado del arte y aplicabilidad en la práctica anestésica / Perioperative music therapy: state of the art and applicability in anesthesia

Introducción: La audición es un proceso complejo en el cual el sonido se convierte en energía eléctrica que se procesa e interpreta a nivel de la corteza auditiva. La musicoterapia es una ciencia de bajo costo aplicable a la anestesiología con beneficios económicos. Como coadyuvante a la terapia farmacológica permite usar menores dosis de algunos medicamentos. Objetivo: revisión no sistemática en bases de datos reconocidas. Metodología: búsqueda exhaustiva sobre revisiones sistemáticas, consensos, metaanálisis, utilizando los descriptores electrónicos en las bases de datos electrónicas: PubMed, Science Direct, OvidSP, EBSCO y SciELO. Arrojó 393 artículos, 80 relacionados con música, musicoterapia, medicina y adulto, 77 con electroencefalografía, estimulación acústica y sincronización cortical, 32 con anestesia balanceada y éteres metílicos, y 68 relacionados con música y anestesiología. Se seleccionaron solo los artículos completos para un total de 100. Se complementó con 2 textos universitarios de física. Conclusión: la música en anestesiología representa una herramienta valiosa como alternativa de tratamiento para disminuir la morbimortalidad y los costos asociados. Se necesitan estudios complementarios para determinar los alcances de ésta asociación.

Audition is a complex process in which sound transduces into electrical energy which is processed and interpreted at the auditory cortex. Music therapy is an inexpensive technique applicable to anesthesia. As an adjuvant to pharmacological interventions it allows reducing the requirements of certain medicines. Objective: a non-systematic review in recognized databases. Methodology: A thorough search of systematic reviews, consensuses and meta-analyses on electronic databases PubMed, Science Direct, OvidSP, EBSCO and SciELO using electronic descriptors. 393 articles were retrieved from the searches which included 80 related with music, music therapy, medicine and adults; 77 regarding electrencephalography, acoustic stimulation and cortical synchronization; 32 on balanced anesthesia and methyl ethers; and, 68 related with music and anesthesia. Only 100 articles were eligible for inclusion as only full text reports were considered. Two university physics textbooks were used as supplemental reading resources. Conclusions: music is a valuable adjuvant of anesthesia which can provide reduced morbidity and mortality and related costs. Further studies are needed to determine the scope of this association.

Hypnosis closed loop TCI systems in outpatient surgery. / Sistemas de TCI en circuito cerrado para la hipnosis en cirugía ambulatoria.

OBJECTIVE: Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery. PATIENTS AND METHODS: Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov-Smirnov-Lilliefors. Differences between groups were analysed by a Student-t-test or Mann-Whitney-Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan-Meier estimator and the effect size (calculated by Cohen's d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS X 10.9. RESULTS: There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5) minutes, C Group and CL Group, respectively (data are median and interquartile rank); P=.005. CONCLUSION: The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units.

Awareness and Recall During Anesthesia for Cesarean Section / 대한마취과학회지

Balanced anesthesia is being equilibrated with the maintenance of light planes of anesthesia and the relatively free utilization of muscle relaxants to prevent untoward movement of the patient in response to surgical stimuli. However, muscle relaxants per se do not contributes to the state of hypnosis or analgesia. Therfore, awareness during modern anesthesia must be seriously taken. We have given anesthesia in 175 cases for cesarean section in order to investigate intraoperative awareness. Among the 175 anesthetic cases, 13 cases had awareness of pain and 19 cases had auditor awareness. Accordingly the total incidence of awareness in our investigation was 16% which was significantly high and should be considered in clinical anesthesia practice.

Balanced Anesthesia with Controlled Tramadol-Infusion / 대한마취과학회지

Tramadol(Tridol) was developed by Grunenthal GmbH as a new non-narcotic analgesic agent. It was used as a new anesthetic agent by Stoffregen who works in Hage, West Germany, instead of neurolept-anesthetics which make sometimes cause severe post-anesthetic respiratory insufficiency. From September to December 1982, 40 cases of balanced anesthesia with controlled tramadol infusion were performed at Chung Ang Univ. Hospital. The anesthetic results were compared with 72 cases of halothane anesthesia: 1) During anesthetic induction, changes of systolic blood pressure were similar in both 2 groups, but the heart rate was stabler in the tramsdol group. 2) Tramadol has little effect on muscular relaxation. 3) Tramadol anesthesia has very rapid post-anesthetic consciousness recovery time and this little respiratory depression. 4) Post-operative pain was minor in tramadol anesthesia compared to neurolept-anesthesia. 5) The technique of use was very simple, safe and economically cheap in balanced anesthesia with controlled tramadol-infusion.

A Clinical Study of Anesthesia for Cesarean Section / 대한마취과학회지

Anesthesia for cesarean section involves consideration of Loth maternal and fetal welfare. The choice of anesthesia for cesarean section is controversial. Regional analgesic techniques may be least harmful to the fetus, but suffer definite drawbacks; they are time-consuming, and therefore not always applicable when urgent surgery is indicated; are associated with a definite failure rate even in skilled hands, and require considerable technical ability and practice. Recently there has been progressive increase in the use of balanced anesthesia for cesarean section, it produces little or no hemodynamic and acid-base disturbance in the mother and infant if administered skillfully. The value of muscle relaxants to facilitate endotracheal intubation and pulmonary ventilation and to permit the use of light general anesthesia. From November, 1971 to October, 1973 there were 1,432 deliveries, of which 1,284 were delivered vaginally and 148 (10.3%) by cesarean section. Of the cesarean section group, 139 were performed under general anesthesia and 9 were performed under regional anesthesia. The characteristic difference for our series was that most of all cases were emergency cesarean section (71.6%). The major indication for surgery was that of a previous cesarean section (45.3%), the second most common cause was dystocia (42.9%), and the others are as following order; Hemorrhage (5.4%), toxemia (3.4%), and others (3.4%). In our study, we adopted two different general anesthetic techniques for cesarean section. Patients were randomly assigned to two groups: Group I: 112 patients, thiopental-succinylcholine-nitrous oxide-oxygen (67:33) anesthesia. Group II: 25 patients, thiopental-succinylcholine-nitrous oxide-oxygen (50:50) supplemented with 0.5~1.0% of halothane anesthesia. All patients were pre-oxygenated for 3 5 minutes and anesthesia was then induced with thiopental sodium 125~250mg, followed by succinylcholine 40~50 mg to facilitate intubation. Pressure was maintained on the cricoid cartilage to prevent regurgitation following loss of consciousness. After the affects of succinylcholine showed signs of wearing off, relaxation was maintained with 0.1% succinylcholine drip or 40~80 mg of gallamine. Anesthesia was maintained with nitrous oxide 4 l/min. and oxygen 2 l/min. and/or nitrous oxide 2 l/min. and oxygen 2 l/min. supplemented with 0.5~1.0% of halothane. Respiration was carefully controlled by manually so as not to producing hyperventilation. The clinical condition of newbron infant in general anesthesia series of 135 cases, mean minute apgar score were good (7~10) in 91.8 percent, fair (4~6) in 6.7 per cent, and poor (1~3) in 1.5 per cent. And 90.4 per cent of babies born within 10 minutes of induction to delivery time interval (IDI) had mean apgar score of 8. 8, 5.8 per cent were delivered after 11 to 15 minutes of IDI with decreased mean apgar score of 7.6, and 3.7 per cent were delivered after over 15 minutes of IDI had mean apgar score of 7. 6. A short IDI appears to be advantageous from the standpoint of the newborn. Of the 144 infants, 6. 9 per cent of newbron infants(10) received intermittent positive pressure breathing by face mask and 3.5 per cent(5) received oxygen through an endotracheal tube for the resuscitation. Neonatal death occurred only 1(0.69%) case out of 144 infants, which caused by severe fetal. distres associated with toxemia of pregnancy. There were no maternal death or anesthetic complication.. At the conclusion, the technique of general anesthesia with thiopental-succinylcholine-nitrous oxide-oxygen and/or supplemented with 0.5~1.0% of halothane was proved to be safe for mother and child, and showing a wide acceptance of general anesthesia for cesarean section(94%) at the Kyung Hee University Hospital.