A newly developed recovery-enhancing device improves recovery scores during emergence from general anesthesia in horses: a randomized trial.

OBJECTIVE: To compare the quality of recovery in horses emerging from general anesthesia with or without the assistance of a novel device (recovery-enhancing device [RED]) designed to minimize high-energy falls. ANIMALS: 20 mixed-breed horses, between July 1, 2023, and January 24, 2024. METHODS: A computer-controlled belay system designed to slow the acceleration of a horse during a fall was evaluated in this study. Horses were randomly assigned to 1 of 2 treatment groups: RED (belay, assisted) or FREE (unassisted). An inertia-measuring unit was fitted to all horses and data were live streamed and recorded onto a computer for further analysis. Recoveries were scored using the composite grading scale (CGS; 0 to 100) by 3 independent observers. Two additional unitless recovery scores (RS and RS'), based on accelerometry values (high accelerations, less desirable), were calculated for each recovery. All the recovery scores were compared between the 2 treatment groups. RESULTS: Composite grading scale scores were 26 ± 10 and 46 ± 13 in the RED and FREE groups, respectively (P = .001). The RS was 120 ± 79 and 198 ± 34 for the RED and FREE treatment groups, respectively (P = .015). The RS' was 32 (7 to 50) and 46 (28 to 44) for the RED and FREE treatment groups, respectively (P = .038). CLINICAL RELEVANCE: The RED improves the recovery scores compared with unassisted recoveries. This device may lead to a potential reduction in the number and severity of injuries in horses and personnel involved during the recovery period.

Effects of oxycodone hydrochloride and dezocine on hemodynamics and levels of inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia

Abstract We aimed to compare the effects of oxycodone hydrochloride and dezocine on hemodynamics and inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia. A total of 246 patients were divided into group A and B (n=123). Hemorheology indices were recorded 5 min after anesthesia (T0), 1 min after pneumoperitoneum (T1), when position was changed 5 min after pneumoperitoneum (T2), 15 min after pneumoperitoneum (T3), 1 min (T4) and 5 min (T5) after position was restored. Visual analogue scale scores 1, 2, 6, 12, 24 and 48 h after operation were recorded. Postoperative adverse reactions and visceral pain were observed. The expression levels of inflammatory factors were detected by enzyme-linked immunosorbent assay 12 h after operation. Compared with group A, group B had higher heart rate and mean arterial pressure at T2, lower central venous pressure and cardiac output at T1-T3, and higher systemic vascular resistance at T1-T5 (P<0.05). The incidence rate of pain syndrome in group A was lower (P<0.05). Group A had lower tumor necrosis factor-alpha and interleukin-6 expression levels and higher interleukin-10 level than those of group B (P<0.05). For gynecological laparoscopic surgery, oxycodone preemptive analgesia has superior outcomes to those of dezocine

Comparison of the efficacy of supraglottic airway devices in low-risk adult patients: a network meta-analysis and systematic review.

Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear. We conducted a systematic review and network meta-analysis to evaluate the efficacy of various SADs. We searched electronic databases for randomized controlled trials comparing at least two types of SADs published before December 2019. The primary outcomes were oropharyngeal leak pressure (OLP), risk of first-attempt insertion failure, and postoperative sore throat rate (POST). We included 108 studies (n = 10,645) comparing 17 types of SAD. The Proseal laryngeal mask airway (LMA), the I-gel supraglottic airway, the Supreme LMA, the Streamlined Liner of the Pharynx Airway, the SoftSeal, the Cobra Perilaryngeal Airway, the Air-Q, the Laryngeal Tube, the Laryngeal Tube Suction II, the Laryngeal Tube Suction Disposable, AuraGain, and Protector had significantly higher OLP (mean difference ranging from 3.98 to 9.18 cmH2O) compared with that of a classic LMA (C-LMA). The Protector exhibited the highest OLP and was ranked first. All SADs had a similar likelihood of first-attempt insertion failure and POST compared with the C-LMA. Our findings indicate that the Protector may be the best SAD because it has the highest OLP.Systematic review registration PROSPERO: CRD42017065273.

Ventilation strategies for front of neck airway rescue: an in silico study.

BACKGROUND: During induction of general anaesthesia a 'cannot intubate, cannot oxygenate' (CICO) situation can arise, leading to severe hypoxaemia. Evidence is scarce to guide ventilation strategies for small-bore emergency front of neck airways that ensure effective oxygenation without risking lung damage and cardiovascular depression. METHODS: Fifty virtual subjects were configured using a high-fidelity computational model of the cardiovascular and pulmonary systems. Each subject breathed 100% oxygen for 3 min and then became apnoeic, with an obstructed upper airway. When arterial haemoglobin oxygen saturation reached 40%, front of neck airway access was simulated with various configurations. We examined the effect of several ventilation strategies on re-oxygenation, pulmonary pressures, cardiovascular function, and oxygen delivery. RESULTS: Re-oxygenation was achieved in all ventilation strategies. Smaller airway configurations led to dynamic hyperinflation for a wide range of ventilation strategies. This effect was absent in airways with larger internal diameter (≥3 mm). Intrapulmonary pressures increased quickly to supra-physiological values with the smallest airways, resulting in pronounced cardio-circulatory depression (cardiac output <3 L min-1 and mean arterial pressure <60 mm Hg), impeding oxygen delivery (<600 ml min-1). Limiting tidal volume (≤200 ml) and ventilatory frequency (≤8 bpm) for smaller diameter cannulas reduced dynamic hyperinflation and gas trapping, preventing cardiovascular depression. CONCLUSIONS: Dynamic hyperinflation can be demonstrated for a wide range of front of neck airway cannulae when the upper airway is obstructed. When using small-bore cannulae in a CICO situation, ventilation strategies should be chosen that prevent gas trapping to prevent severe adverse events including cardio-circulatory depression.

Seizure-like movements caused by residual sevoflurane inside the anesthesia machine: A case report.

RATIONALE: Sevoflurane-induced seizures are most often caused by high concentrations of sevoflurane during anesthesia induction. However, in this case, we found a rare case of seizure-like movements caused by residual sevoflurane inside the anesthesia machine. Therefore, we propose that the detection of residual anesthesia-inhaled drugs should be included in pre-anesthesia checkout procedures. PATIENT CONCERNS: An 11-year-old girl with a history of epilepsy was scheduled for emergency appendectomy under general anesthesia. The patient presented with seizure-like movements caused by residual sevoflurane inside the anesthesia machine after pre-oxygenation during rapid sequence induction. DIAGNOSES: Based on the clinical presentation and previous history of seizures, sevoflurane-induced seizures were diagnosed. INTERVENTIONS: A washout procedure was performed by turning the oxygen flow up to 10L/min to wash out the residual sevoflurane from the anesthesia machine. OUTCOMES: The seizures ceased spontaneously, and the vital signs of the patient were stable during the washout procedure. Rapid sequence anesthesia induction and total intravenous anesthesia maintenance were uneventful. Surgery was performed as planned, and there were no postoperative problems. The patient was discharged after 4 days without complications and was well on follow-up. LESSONS: The check-up procedure of residual anesthesia-inhaled drugs inside the anesthesia machine should be included in the checkout design guidelines, or else the washout procedure should be performed in the pre-anesthesia checkout procedures.

A pharmacodynamic model of tidal volume and inspiratory sevoflurane concentration in children during spontaneous breathing.

PURPOSE: High concentrations of sevoflurane causes respiratory depression, mainly due to the decrease in tidal volume (TV) during spontaneous ventilation. The purpose of this study was to identify clinical variables that affect the relationship between TV and sevoflurane concentration, and to establish a population pharmacodynamic modelling approach to TV and sevoflurane concentration in children. A prospective observational study involving 48 patients (≤ 6 years of age) scheduled to undergo general anesthesia using laryngeal mask airway was performed. When the inspiratory sevoflurane concentration reached 2 vol%, the vaporizer was increased to 4 vol% for 5 min, then sevoflurane was decreased to 2 vol% for 5 min. During the study period, TV, end-tidal carbon dioxide, and sevoflurane concentration were recorded every 30 s. Pharmacodynamic analysis using a sigmoid Emax model was performed to assess the TV-sevoflurane concentration relationship. To collapse hysteresis of the pharmacokinetic and pharmacodynamic relationship, the semicompartmental model was applied which does not require a structural model for equilibration delay causing the hysteresis. TV decreased with increasing inspiratory sevoflurane concentrations. Hysteresis between the TV and sevoflurane concentration was observed and was accounted for when the model was developed. Initial TV and maximal reduction in TV were related to body weight. The γ (a steepness of the concentration-response relation curve) was 8.78 and the keo, (a first-order rate constant determining the equilibrium between the end-tidal sevoflurane concentration and effect site sevoflurane concentration) was 2.27 min-1. Changes in TV were correlated with sevoflurane concentration with spontaneous breathing during sevoflurane anesthesia. The initial and maximal TV were related to body weight, in a pediatric population.

Use of an Ultra-slim Gastroscope to Accomplish Endoscopist-Facilitated Rescue Intubation During ERCP: A Novel Approach to Enhance Patient and Staff Safety.

BACKGROUND: ERCP is often performed under monitored anesthesia care (MAC) rather than general anesthesia (GA), with patients positioned semi-prone on the fluoroscopy table. Rarely, a MAC ERCP must be converted to GA due to hypoxia or retained food in the stomach. In these circumstances, standard intubation is associated with a significant delay and potential for patient/staff injury during repositioning. We report a novel endoscopist-driven approach to intubation during ERCP using an ultra-slim, flexible gastroscope with an endotracheal tube backloaded onto it. MATERIALS AND METHODS: We identified patients who underwent ERCP from 2014 to 2019, and MAC to GA conversion events. Mode of intubation (standard vs. endoscopist-facilitated) and patient/procedure characteristics were evaluated. All endoscopist-facilitated intubations were performed under anesthesiologist supervision. RESULTS: A total of 3409 patients underwent ERCP; 1568 (46%) GA and 1841 (54%) MAC. Of these, 42 (2.3%) required intubation during ERCP and 16 underwent endoscopist-facilitated intubation due to retained food in the stomach and/or hypoxia. In 3 patients, aspirated material was suctioned from the trachea and bronchi using the ultra-slim gastroscope. Immediate post-procedure extubation was successful in all endoscopist-facilitated intubation patients and none exhibited radiographic evidence of aspiration pneumonia. CONCLUSIONS: Endoscopist-facilitated intubation using an ultra-slim flexible gastroscope is feasible and expeditious for MAC to GA conversion during ERCP. This technique is readily accomplished in the semi-prone position, while standard intubation requires patient transfer from fluoroscopy table to gurney, with associated delay/risks. These data suggest that further study of this approach is warranted, and this may be the most favorable approach for intubation during ERCP.

Impact of Dental Rehabilitation Under General Anesthesia on Oral Health-Related Quality-of-Life and Dental Anxiety in Turkish Children

ABSTRACT Objective: To analyze children's and parents' oral health-related quality of life (OHRQoL) and children's dental fears before and after the dental rehabilitation under general anesthesia (DRGA). Material and Methods: 104 parents and their 3 to 13-year-old children (5.90 ± 2.42) who received DRGA were surveyed before and after DRGA. The children were divided into two groups: Group 1 - healthy children (n=43) and Group 2 - children with medical problems (n=61). After recording their socio-demographic information, parents completed a self-administered questionnaire named Early Childhood Oral Health Impact Scale (ECOHIS), which includes two main parts - Child Impact Section (CIS) and Family Impact Section (FIS). On the other hand, the children received a dentist-administered questionnaire named Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and Frankle Behavior Scale (FBS). For statistical analyses, Wilcoxon Signed-Rank, Mann Whitney-U, Kruskal-Wallis, and Spearman's Correlation tests were used. Results: A statistically significant decrease in all CIS, FIS, ECOHIS and CFSS-DS scores was observed after DRGA (p<0.01). This decline was greater in healthy children than in children with systemic problems (p<0.01). Conclusion: Children's and parents' OHRQoL showed better results after DRGA. The decreases in dental anxiety in children were observed after DRGA.

Comparison of the Baska mask and the i-gel supraglottic airway devices in patients undergoing elective surgery.

INTRODUCTION: The Baska mask and i-gel are two new types of second-generation supraglottic airway devices. The aim of this study was to compare these two devices in terms of quality of insertion, quality of ventilation and post-insertion complications. MATERIAL AND METHODS: A total of 80 adult patients who were scheduled for elective surgery under general anaesthesia were randomised to two groups: Group BM: Baska mask (n = 40) and Group IG: i-gel (n = 40). The assessment focused on ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP) and post-insertion complications. RESULTS: Group IG showed a significantly shorter median insertion time (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; P < 0.001), a higher percentage in the 'very easy' ease of insertion category (62.5% vs. 10.0%; P < 0.001), a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003) and a higher percentage in the no post-operative throat pain category (67.5% vs. 32.5%; P = 0.011) than Group BM. However, Group BM showed a significantly higher generated PAP than Group IG (12.7 [1.8] and 11.5 [2.2] cm H2O, respectively; P = 0.010). There were no significant differences in other parameters. CONCLUSIONS: The i-gel was better than the Baska mask in terms of ease of insertion, speed of insertion, fewer corrective manoeuvres and less post-operative throat pain. However, the Baska mask had a better cuff seal, as shown by a higher generated PAP.

The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19.

The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.

The "BURP" maneuver improves the glottic view during laryngoscopy but remains a difficult procedure.

OBJECTIVE: We investigated the "BURP" maneuver's effect on the association between difficult laryngoscopy and difficult intubation, and predictors of a difficult airway. METHODS: Adult patients who underwent general anesthesia and tracheal intubation from September 2016 to May 2018 were included. The "BURP" maneuver was performed when glottic exposure was classified as Cormack-Lehane grade 3 or 4, suggesting difficult laryngoscopy. The thyromental distance, modified Mallampati score, and interincisor distance were assessed before anesthesia. RESULTS: Among this study's 2028 patients, the "BURP" maneuver decreased difficult laryngoscopies from 428 (21.1%) to 124 (6.1%) cases and increased the difficult intubation to difficult laryngoscopy ratio from 53/428 (12.4%) to 52/124 (41.9%). For laryngoscopies classified as difficult without the "BURP" maneuver, the area under the curve (AUC) of the thyromental distance, modified Mallampati score, and interincisor distance was 0.60, 0.57, and 0.66, respectively. In difficult laryngoscopies using the "BURP" maneuver, the AUC of the thyromental distance, modified Mallampati score, and interincisor distance was 0.71, 0.67, and 0.76, respectively. CONCLUSIONS: The "BURP" maneuver improves the laryngoscopic view and assists in difficult laryngoscopies. Compared with difficult laryngoscopies without the "BURP" maneuver, those with the "BURP" maneuver are more closely associated with difficult intubations and are more predictable. Trial registration: www.chictr.org.cn identifier: ChiCTR-ROC- 16009050.

Development of a prediction model for hypotension after induction of anesthesia using machine learning.

Arterial hypotension during the early phase of anesthesia can lead to adverse outcomes such as a prolonged postoperative stay or even death. Predicting hypotension during anesthesia induction is complicated by its diverse causes. We investigated the feasibility of developing a machine-learning model to predict postinduction hypotension. Naïve Bayes, logistic regression, random forest, and artificial neural network models were trained to predict postinduction hypotension, occurring between tracheal intubation and incision, using data for the period from between the start of anesthesia induction and immediately before tracheal intubation obtained from an anesthesia monitor, a drug administration infusion pump, an anesthesia machine, and from patients' demographics, together with preexisting disease information from electronic health records. Among 222 patients, 126 developed postinduction hypotension. The random-forest model showed the best performance, with an area under the receiver operating characteristic curve of 0.842 (95% confidence interval [CI]: 0.736-0.948). This was higher than that for the Naïve Bayes (0.778; 95% CI: 0.65-0.898), logistic regression (0.756; 95% CI: 0.630-0.881), and artificial-neural-network (0.760; 95% CI: 0.640-0.880) models. The most important features affecting the accuracy of machine-learning prediction were a patient's lowest systolic blood pressure, lowest mean blood pressure, and mean systolic blood pressure before tracheal intubation. We found that machine-learning models using data obtained from various anesthesia machines between the start of anesthesia induction and immediately before tracheal intubation can predict hypotension occurring during the period between tracheal intubation and incision.

Anesthetic Considerations for Automated High-Frequency Jet Ventilation During Electromagnetic Navigation Bronchoscopy.

Newly advanced diagnostic bronchoscopic procedures, such as electromagnetic navigation bronchoscopy using navigation system technology (superDimension, Medtronic), provides computed tomography referenced and computerized 3-dimensional imaging. To increase accuracy and higher diagnostic biopsy yield, electromagnetic navigation bronchoscopy necessitates special anesthetic and ventilation techniques providing the interventional pulmonologist minimal respiratory lung motion. This anesthetic meets 2 important goals by limiting almost all interference from diaphragmatic and lung movement while allowing the anesthesia provider to achieve hands-free management. Proposed here is an anesthetic ventilation technique by automated high-frequency jet ventilation (HFJV) via double-lumen micro jet endotracheal tubes. This ventilation technique delivers consistent very low tidal volumes. Automated HFJV provides the pulmonologist the advantage of more accurate navigation and target alignment in this Global Positioning System-guided biopsy procedure. The technique offers essentially no chest motion, without interrupting ventilation. Additionally, HFJV allows the anesthetist better availability to attend to total intravenous anesthesia, adjustments, and interventions. The intention of this article is to detail an anesthetic method that provides a hands-free technique that requires only one anesthesia provider.

Impact of supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery.

BACKGROUND: With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration. METHODS: The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T0), at the start of the surgical procedure (T1), 15 minutes later (T2), 30 minutes later (T3), and before the end of the surgical procedure (T4). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T5), 12 hours after surgery (T6), 24 hours after surgery (T7), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions. RESULTS: There was no significant difference with the surgical visual field of the 3 groups (P > .05). The MAP, HR and SpO2 of the 3 groups were decreased from T2 to T3 compared with T0(P < .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier (P < .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher (P < .05). The static and dynamic NRS scores were lower from T5 to T7 (P < .05). Ramsay sedation scores were higher (P < .05), and the incidence of adverse reactions was lower (P < .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T6 to T7 (P < .05). CONCLUSION: Supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery is safe and feasible.

LMA Gastro™ airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients: a single-center observational study.

BACKGROUND: Nonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice. While the numbers of patients with severe comorbidities are rising constantly, gastrointestinal endoscopic interventions are moving closer to minimally invasive endoscopic surgery. The LMA Gastro™ is a new supraglottic airway device, developed specifically for upper gastrointestinal endoscopy and interventions. The aim of this study was to evaluate the feasibility of LMA Gastro™ in patients with ASA physical status ≥3 undergoing advanced endoscopic procedures. METHODS: We analyzed data from 214 patients retrospectively who received anesthesia for gastroenterological interventions. Inclusion criteria were upper gastrointestinal endoscopic interventions, airway management with LMA Gastro™ and ASA status ≥3. The primary outcome measure was successful use of LMA Gastro™ for airway management and endoscopic intervention. RESULTS: Thirtyone patients with ASA physical status ≥3, undergoing complex and prolonged upper gastrointestinal endoscopic procedures were included. There were 7 endoscopic retrograde cholangiopancreatographies, 7 peroral endoscopic myotomies, 5 percutaneous endoscopic gastrostomies and 12 other complex procedures (e.g. endoscopic submucosal dissection, esophageal stent placement etc.). Of these, 27 patients were managed successfully using the LMA Gastro™. Placement of the LMA Gastro™ was reported as easy. Positive pressure ventilation was performed without difficulty. The feasibility of the LMA Gastro™ for endoscopic intervention was rated excellent by the endoscopists. In four patients, placement or ventilation with LMA Gastro™ was not possible. CONCLUSIONS: We demonstrated the feasibility of the LMA Gastro™ during general anesthesia for advanced endoscopic procedures in high-risk patients. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00017396) Date of registration: 23rd May 2019, retrospectively registered.

Prospective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients.

BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65-90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible, <50% visual obstruction of epiglottis to vocal cords; vocal cords and posterior epiglottis visible; and vocal cords visible. We also investigated success rate and ease of insertion, insertion time, and manipulations during insertion as insertion variables, complications during maintenance and emergence periods, and postoperative pharyngolaryngeal complications including sore throat, dysphagia, and dysphonia. RESULTS: After assessing for eligibility, 48 patients were allocated to each group. Oropharyngeal leak pressures were significantly higher in the i-gel group than in the self-pressurized air-Q group (P < .001) at the 2 measurement points. The raw mean difference at initial assessment and the median difference after 10 minutes were 5.5 cm H2O (95% confidence interval, 3.3-7.6 cm H2O) and 5.0 (95% confidence interval, 2.0-7.0 cm H2O), respectively. The initial scores of fiberoptic view were similar in the 2 groups. However, the self-pressurized air-Q supraglottic airway provided a significantly improved fiberoptic view at 10 minutes after initial assessment (P = .030). We found no statistically significant differences in insertion variables and complications between the 2 groups. CONCLUSIONS: The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.

Computerized 4-choice reaction time test for the measurement of psychomotor recovery after general anesthesia.

The recovery of patients after general anesthesia is usually estimated by using clinical scores. Since there is a lack of objective methods for assessing psychomotor recovery, the aim of this study was to evaluate three psychological tests for this purpose. Patients, scheduled for ambulatory gynecological surgery, underwent 3 standard psychological tests before (T1), 15 min after the surgery (T2) and on discharge from the recovery room (T3). The tests used were Wechsler memory scale (test 1, working memory capacity), d2-test (test 2, concentration endurance) and computer-based 4-choice-reaction time (4CRT, test 3, reaction time) as well as Postanesthesia Discharge Scoring System (PADSS). The same test battery was used in healthy female volunteers, all test results were compared at the different time points. In 109 patients, working memory capacity and concentration (tests 1 and 2) decreased, the reaction time (test 3) was prolonged at T2 in comparison with T1 and T3 (P < 0.01). PADSS increased from 8 (T2) to 10 (T3) (medians, P < 0.001). Fifty-seven healthy volunteers demonstrated a practice effect in all 3 tests through the course of the study (P <0.01). 4CRT test had shortest duration and enabled computerized data processing. All three tests objectively assess the recovery of psychomotor function in patients after general anesthesia, the computer-based 4CRT seems to be the most convenient for the clinical routine.