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.

Videolaryngoscopy during Urgent Cesarean Delivery: Association with Neonatal Intensive Care Unit Admission.

OBJECTIVES: Parturients are at increased risk for difficult airway management with subsequent fetal complications. Videolaryngoscopy was opined to be the new standard of airway care to facilitate orotracheal intubation under urgent care conditions. We examined in parturients requiring general anesthesia for urgent cesarean delivery the association of the type of laryngoscopy technique and time required to facilitate orotracheal intubation with the incidence of subsequent neonatal intensive care unit (NICU) admission. METHODS: Following institutional review board approval, 431 parturients aged 18 years and older who underwent urgent cesarean section requiring general anesthesia were entered into this study. Patient characteristics, maternal comorbidities, and indications for urgent cesarean delivery were collected from the electronic medical records from January 2013 to November 2018. Orotracheal intubation times by type of laryngoscopy (video or direct) and NICU admission rates also were collected. A measure of effect size, risk differences with 95% confidence intervals (CIs), were calculated for the likelihood of NICU admission by difficult orotracheal intubation and by type of laryngoscopy used to secure the airway. RESULTS: Videolaryngoscopy as the primary type of laryngoscopy was used in 24.1% (95% CI 20.3%-28.3%) of general anesthetics. The incidence of difficult orotracheal intubation was 4.4% (95% CI 2.8%-6.7%), with a higher incidence observed with videolaryngoscopy (8.7%) than with direct laryngoscopy (3.1%) and a risk difference of 5.6% (95% CI 0.001%-11.3%). The incidence of NICU admission was 38.4% (95% CI 34.0%-43.1%). Times for successful orotracheal intubation were longer with videolaryngoscopy. Videolaryngoscopy had a higher association for NICU admission (47%) than for direct laryngoscopy (36%), with a risk difference of 11.4% (95% CI 0.01%-22.3%). CONCLUSIONS: Videolaryngoscopy did not decrease the incidence of difficult orotracheal intubation, and it did not decrease the time associated with orotracheal intubation. Videolaryngoscopy was associated with a higher association of NICU admission. These results suggest that videolaryngoscopy does not supplant direct laryngoscopy as the standard of care for orotracheal intubation under urgent care conditions of general anesthesia for cesarean section.

Evaluation of probiotics' efficiency on cariogenic bacteria: randomized controlled clinical study.

BACKGROUND: Probiotics are live beneficial bacteria to human health and their efficiency on oral health is still being investigated. The purpose of this study was to evaluate the level of Streptococcus mutans and Lactobacillus species with and without the use of probiotics for six-months after the treatment of all dental caries under general anesthesia. METHODS: Fifty-eight pediatric patients without any systemic diseases, whose dental treatments were completed under general anesthesia (GA), were included in the study. The patients were recruited in two-groups; Group A: Patients started using probiotics after GA and Group B: Patients did not use probiotics after GA. Saliva samples were taken from all patients on the day before GA (T0), at one-month (T1), three-month (T2) and six-month (T3) follow-up after GA. The counts of cariogenic bacteria were determined by the analysis of saliva samples using real-time polymerase chain reaction. Statistical significance level was accepted as p < 0.05. RESULTS: There was statistically significant difference between Group A and B for T0, T1, T2 and T3 regarding S. mutans (p = 0.001, p = 0.04, p = 0.04, p = 0.03; p < 0.05). However, there was no statistically significant difference between groups regarding Lactobacillus species (p ≥ 0.05). CONCLUSIONS: Probiotic use and treatment of all caries significantly reduced the level of S. mutans but not Lactobacillus species. Furthermore, S. mutans decreased after cessation of probiotics, but it was not statistically significant. TRIAL REGISTRATION: Study was registered as "Effects of Probiotics on Streptococcus mutans and Lactobacillus species" with the registration number of NCT05859646 (16/05/2023) at https://www. CLINICALTRIALS: gov Protocol Registration and Results System.

Thoracoscopic wedge resection of the upper lobe of the left lung achieved by a new approach of laryngeal mask general anesthesia with preservation of spontaneous breathing: A case report.

INTRODUCTION: General laryngeal mask anesthesia with the preservation of spontaneous breathing has accelerated the advancement of the enhanced recovery after surgery concept in thoracoscopic surgery. However, the need for increased doses of anesthetic drugs to reduce laryngeal mask airway (LMA) stimulation poses challenges due to the increased risk of hypotension, respiratory depression, susceptibility to hypoxemia, and carbon dioxide retention, particularly in the lateral position. PATIENT CONCERNS: During the perioperative period, reducing the dose of anesthetic drugs while simultaneously improving LMA tolerance and preventing circulatory and respiratory depression poses a challenge. DIAGNOSES: The patient was diagnosed with a nodule in the upper lobe of the left lung. INTERVENTIONS: In this case, we chose remimazolam sedation, which mildly inhibits circulatory respiration, and used mucosal surface anesthesia in the pharynx. This approach improved the patient's tolerance to LMA, reduced the dose of anesthetic drugs, and facilitated the successful thoracoscopic wedge resection of the upper lobe of the left lung with preservation of spontaneous respiration. OUTCOMES: During 2 weeks follow-up, the patient recovered satisfactorily and did not report any discomfort. CONCLUSION: We used pharyngeal mucosal surface anesthesia and thoracic paravertebral nerve block in combination with remimazolam sedation to provide precise analgesia, moderate sedation, and successful LMA general anesthesia with preservation of spontaneous respiration in patients undergoing thoracoscopic pulmonary wedge resection.

Efficacy of Ultrasound-Guided Intercostal Nerve Block on Pain Management and Physiological Outcomes in Breast Cancer Mastectomy: A retrospective study.

To evaluate the efficacy of ultrasound-guided intercostal nerve block in managing pain and physiological responses in patients undergoing radical mastectomy for breast cancer. A retrospective study analyzed 120 patients scheduled to undergo radical mastectomy in our hospital between January 2022 and December 2023. Depending on the type of anesthesia received, participants were assigned to the experimental group (60 patients) to receive ultrasound-guided intercostal nerve block and intravenous general anesthesia, or the control group (60 patients) to receive intravenous general anesthesia only. Both groups will utilize patient-controlled intravenous analgesia (PCIA) postoperatively. We will monitor and compare hemodynamic parameters, SpO2, and bispectral index (BIS) at multiple time points, and assess postoperative pain, inflammatory markers, PCIA utilization, and adverse reaction incidence. Comparative analysis showed distinct trends in heart rate, mean arterial pressure (MAP), BIS, and SpO2 across various surgical stages between groups. Notably, MAP values were consistently higher and less variable in the experimental group during surgery (P < .05). Pain assessments at 4, 12, and 24 hours postoperatively in both quiet and coughing states revealed significantly milder pain in the experimental group (P < .05). Preoperative inflammatory markers (PGE2, TNF-α, IL-6, MCP-1) were similar between groups; however, 24 hours post-surgery, the experimental group showed significantly lower levels of PGE2, IL-6, and MCP-1 (P < .05). Sufentanil consumption during surgery and PCIA use were notably lower in the experimental group (P < .05). The experimental group also experienced fewer anesthesia-related adverse reactions (8.33%) compared to the control group (25.00%) (P < .05). Ultrasound-guided intercostal nerve block significantly improves hemodynamic stability, reduces postoperative inflammatory markers, lowers the need for sufentanil, and minimizes adverse reactions in patients undergoing radical mastectomy for breast cancer.

Safety and feasibility of early drinking water after general anesthesia recovery in patients undergoing daytime surgery.

BACKGROUND: Patients who are recovering from general anesthesia commonly exhibit symptoms such as dry lips, throat irritation, and thirst, prompting a desire to drink water in the post-anesthesia care unit (PACU). In this study, we aimed to evaluate the therapeutic effects and any potential complications of administering varying quantities of water to such patients. The primary objectives are to assess the safety and feasibility of early water intake after general anesthesia, specifically in the context of daytime surgery. METHODS: A total of 200 nongastrointestinal patients who underwent outpatient surgery were randomly assigned to four groups: Group A (drinking < 1 ml/kg), Group B (drinking 1-2 ml/kg), Group C (drinking > 2 ml/kg), and Group D (no water intake). We monitored changes in the assessment parameters before and after water consumption, as well as the incidence of post-drinking nausea and vomiting, and compared these outcomes among the four groups. RESULTS: Water intake led to a significant reduction in thirst, oropharyngeal discomfort, and pain scores and a notable increase in the gastric antrum motility index (MI), exhibiting statistical significance compared to the values before drinking (p < 0.05). Remarkably, higher water consumption correlated with enhanced gastrointestinal peristalsis. There was a significant difference in the antral MI among groups B, C, and A (p < 0.05). The occurrence of nausea and vomiting did not significantly differ among groups A, B, C, and D (p > 0.05). Early water consumption enhanced patient satisfaction with medical care, significantly varying from Group D (p < 0.05). CONCLUSION: Non-gastrointestinal surgical patients who passed pre-drinking water assessments post GA(general anesthesia)recovery could safely ingest moderate amounts of water in the PACU. Early water intake is both safe and feasible, effectively fostering swift postoperative recovery.

Oxidative stress in relation to serotonin under general anaesthesia in dogs undergoing ovariectomy.

Abdominal surgery such as ovariectomy is a traumatic event that can cause oxidative stress. The aim of the present study was to evaluate the concentration of serotonin in relation to ovariectomy-induced oxidative stress in dogs undergoing general anesthesia. Thirty-two female dogs, under general anesthesia, received meloxicam before surgery (0.2 mgkg-1 SC) and after surgery (0.1 mgkg-1 OS every 24 h). The physiological, hematological, and biochemical parameters: glycemia, aspartate transaminase (AST), alanine aminotransferase (ALT), total protein, albumin and BUN were evaluated. Oxidative stress was determined by malondialdehyde (MDA) assay, catalase (CAT), superoxide dismutase (SOD), myeloperoxidase (MPO) and butyrylcholinesterase (BuChe) at baseline, 36 and 48 h after the last administration of meloxicam. Serotonin (5-HT) concentration was also evaluated at baseline, 36 and 48 h after the last administration of meloxicam. Responses to surgical stimulus were evaluated. Physiological and hematological parameters they fell within the normal ranges for anesthetized dogs. Glycemia increased, albumin levels decreased after surgery. No rescue analgesia was required. MDA and 5-HT concentrations significantly increased from the baseline at 36 and 48 h after surgery (p < .001). 5-HT levels could be used as an indicator for oxidative stress induced by surgery and it might be employed for objectively quantifying the well-being of the surgical patient.

Comparison of safety of general anesthesia and intravenous sedation during third-molar extraction surgery.

This study compared the safety of general anesthesia (GA) and intravenous sedation (IVS) in patients who underwent extraction of one or more third molars. Data from 1260 patients (GA group, n = 1043; IVS group, n = 217) were retrospectively analyzed, including demographics, preoperative data, intraoperative hemodynamic parameters (blood pressure, heart rate, and oxygen saturation level), and medications administered intraoperatively and postoperatively. The incidence of intraoperative circulatory variations, surgery and anesthesia durations, postoperative complications, and medication use were assessed and compared. The GA group had longer anesthesia and surgery durations, a higher incidence of hypotension, and a higher frequency of postoperative analgesic use than the IVS group. Dexmedetomidine was the most frequently used sedative agent. The IVS group had a lower incidence of intraoperative hypotension but they had a higher need for vasopressors in the recovery room. Both anesthesia methods maintained satisfactory oxygen saturation levels and sufficient anesthesia throughout the procedure, but they showed different characteristics regarding the duration of surgery and anesthesia duration, hemodynamic stability, and postoperative analgesic needs. IVS may be preferable for patients at risk of cardiovascular complications such as hypotension or tachycardia during surgery.

Safety of propofol-assisted deep extubation in the dental treatment of children-a retrospective, observational study.

PURPOSE: Awake extubation and deep extubation are commonly used anesthesia techniques. In this study, the safety of propofol-assisted deep extubation in the dental treatment of children was assessed. MATERIALS AND METHODS: Children with severe caries who received dental treatment under general anesthesia and deep extubation between January 2017 and June 2023 were included in this study. Data were collected on the following variables: details and time of anesthesia, perioperative vital signs, and incidence of postoperative complications. The incidence of laryngeal spasm (LS) was considered to be the primary observation indicator. RESULTS: The perioperative data obtained from 195 children undergoing dental treatment was reviewed. The median age was 4.2 years (range: 2.3 to 9.6 years), and the average duration of anesthesia was 2.56 h (range 1 to 4.5 h). During intubation with a videoscope, purulent mucus was found in the pharyngeal cavity of seven children (3.6%); LS occurred in five of them (2.6%), and one child developed a fever (T = 37.8 °C) after discharge. Five children (2.6%) experienced emergence agitation (EA) in the recovery room. Also, 13 children (6.7%) experienced epistaxis; 10 had a mild experience and three had a moderate experience. No cases of airway obstruction (AO) and hypoxemia were recorded. The time to open eyes (TOE) was 16.3 ± 7.2 min. The incidence rate of complications was 23/195 (11.8%). Emergency tracheal reintubation was not required. Patients with mild upper respiratory tract infections showed a significantly higher incidence of complications (P < 0.001). CONCLUSIONS: Propofol-assisted deep extubation is a suitable technique that can be used for pediatric patients who exhibited non-cooperation in the outpatient setting. Epistaxis represents the most frequently encountered complication. Preoperative upper respiratory tract infection significantly increases the risk of complications. The occurrence of EA was notably lower than reported in other studies.

Comparison of remimazolam tosilate and propofol during induction and maintenance of general anesthesia in patients undergoing laparoscopic cholecystectomy: a prospective, single center, randomized controlled trial.

BACKGROUND: Remimazolam tosilate (RT) is a new, ultrashort-acting benzodiazepine. Here, we investigated the efficacy and safety of RT for general anesthesia in patients undergoing Laparoscopic Cholecystectomy (LC). METHODS: In this study, 122 patients undergoing laparoscopic cholecystectomy were randomly allocated to receive either remimazolam tosilate (Group RT) or propofol group (Group P). RT was administered as a slow bolus of 0.3 mg kg- 1 for induction, followed by 1.0-2.0 mg kg- 1 h- 1 for maintenance of general anesthesia. Propofol was started at 2 mg kg- 1 and followed by 4-10 mg kg- 1 h- 1 until the end of surgery. The primary outcome was the time to bispectral index (BIS) ≤ 60. The secondary outcome included the time to loss of consciousness (LoC), and the time to extubation. Adverse events were also assessed. RESULTS: A total of 112 patients were recruited for study participation. Among them, the time to BIS ≤ 60 in Group RT was longer than that in Group P (Group RT: 89.3 ± 10.7 s; Group P: 85.9 ± 9.7 s, P > 0.05). While the time to LoC comparing remimazolam and propofol showed no statistical significance (Group RT: 74.4 ± 10.3 s; Group P: 74.7 ± 9.3 s, P > 0.05). The time to extubation in Group RT was significantly longer than that in Group P (Group RT: 16.0 ± 2.6 min; Group P: 8.8 ± 4.3 min, P < 0.001). Remimazolam tosilate had more stable hemodynamics and a lower incidence of hypotension during general anesthesia. CONCLUSIONS: Remimazolam tosilate can be safely and effectively used for general anesthesia in patients undergoing Laparoscopic Cholecystectomy. It maintains stable hemodynamics during induction and maintenance of general anesthesia compared with propofol. Further studies are needed to validate the findings. TRIAL REGISTRATION: Chictr.org.cn ChiCTR2300071256 (date of registration: 09/05/2023).

Retromolar intubation for the general anesthesia of maxillofacial fracture patients.

BACKGROUND: Evaluate the possibility of retromolar intubation for general anesthesia in patients with maxillofacial fractures. METHODS: The medical records of 54 patients with maxillofacial fractures who visited the Oral and Maxillofacial Surgery Department of Nantong First People's Hospital from January 2020 to August 2022 were collected. The retromolar areas of each patient were measured from the coronal CT images, and correlated with the patient's age, sex, type of fracture (i.e., maxillary fracture, mandibular fracture, or complex fracture of multiple maxillofacial bones), and the presence of the third molar (verified from 3D CT). The dimensions of the retromolar areas were finally compared with the outer diameter (OD) of standard endotracheal tubes (ETTs), most importantly the size 7.5 ETT (OD 10.3 mm) for male and the size 7.0 ETT (OD 9.8 mm) for female. RESULTS: The survey included 38 male and 16 female patients, with an average age of 44.1 and 54.3 years, respectively. The dimensions of the retromolar area (height × width) were as follows: male, (9.39 ± 1.77) mm × (12.08 ± 0.98) mm on the left and (9.81 ± 2.23) mm × (11.77 ± 1.08) mm on the right; female, (8.82 ± 1.53) mm × (10.51 ± 1.00) mm on the left and (9.73 ± 1.60) mm × (10.63 ± 1.58) mm on the right. The width was always larger than the OD of the routinely used ETT, but the height could be smaller by less than 1 mm. However, the oral mucosa can be compressed to allow the ETT to fit in the retromolar area. CONCLUSIONS: The retromolar area provided appropriate space to place a reinforced ETT for patients with maxillofacial fractures needing general anesthesia that must not interfere with intermaxillary ligation. Retromolar intubation can help maxillofacial fracture surgeries that focus on occlusal restoration.

Study on the preventive effect of dexmedetomidine on anesthetic associated sleep disturbance in young to middle-aged female patients undergoing hysteroscopy: a study protocol for a crossover randomized controlled trial.

BACKGROUND: Postoperative sleep disturbance has a potentially detrimental effect on postoperative recovery. Perioperative patients are affected by several factors. General anesthesia induces a non-physiological state that does not resemble natural sleep. Exposure to propofol/sevoflurane can lead to desynchronization of the circadian rhythm, which may result in postoperative sleep disturbance characterized by mid-cycle advancement of sleep and daytime sleepiness. Dexmedetomidine is a highly selective α2-adrenoceptor agonist with a unique sedative effect that facilitates the transition from sleep to wakefulness. Basic research has shown that dexmedetomidine induces deep sedation, similar to physical sleep, and helps maintain forebrain connectivity, which is likely to reduce delirium after surgery. The aim of this study is to evaluate the influence of exposure to the mono-anesthetic propofol on the development of postoperative sleep disturbance in young and middle-aged female patients undergoing hysteroscopy and whether prophylactic administration of dexmedetomidine influences reducing postoperative sleep disturbance. METHODS: This prospective randomized controlled trial (RCT) will include 150 patients undergoing hysteroscopy at the First Affiliated Hospital of Xiamen University. Participants will be randomly assigned to three groups in a 1:1:1 ratio. The dexmedetomidine group will have two subgroups and will receive a nasal spray of 0.2 µg/kg or 0.5 µg/kg 25 min before surgery, while the control group will receive a saline nasal spray. Three groups will undergo hysteroscopy with propofol-based TIVA according to the same scheme. Sleep quality will be measured using a wearable device and double-blind sleep assessments will be performed before surgery and 1, 3, and 7 days after surgery. SPSS 2.0 is used for statistical analysis. A χ2 test is used to compare groups, and t-test is used to determine statistical the significance of continuous variables. DISCUSSION: The purpose of this study is to investigate the incidence of propofol-associated sleep disorders and to test a combination of dexmedetomidine anesthesia regimen for the prevention of postoperative sleep disorders. This study will help to improve patients' postoperative satisfaction and provide a new strategy for comfortable perioperative medical treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT06281561. Registered on February 24, 2024.

[Dental treatment under general anesthesia among pediatric patients in 120 consecutive cases: a retrospective study].

PURPOSE： To investigate the clinical features of children who received treatment under dental general anesthesia (DGA). METHODS: The clinical records of dental patients below 18 years old who were treated under DGA at the Department of Pediatric Dentistry, Affiliated Dental Hospital of Kunming Medical University during June 2017 to November 2019 were obtained, including the baseline information, causes for DGA, anesthesia methods, intubation methods, treatment items, treatment time and follow-up visits. SPSS 26.0 software package was used to analyze the data. RESULTS: A total of 120 patients were included, 58.3% were males, and children aged 3 to 6 years showed the highest demand for DGA (85.0%). Fear of dental treatment, ineffective non-drug behavior management was the main causes for DGA in young children, while the most common causes for children over 6 years old to choose DGA were mental retardation (38.9%) and patients' needs(38.9%). The average number of teeth treated was (15.16±3.42) for each child, and the average time for treating one tooth was 12.26 min. Restoration, root canal treatment and primary teeth pre-forming crown(including anterior preformed resin transparent crown and posterior preformed metal crown) were the main treatment items. At 1-week follow-up visits, 98.3% of children had no discomfort. During 2017 to 2019, there was an increasing tendency in the number of patients who chose DGA in the authors' institute. CONCLUSIONS： The dental issues of children with fear of dental treatment, ineffectiveor non-drug behavior management or mental retardation can be treated under DGA conveniently, safely and efficiently. The acceptance rate of DGA among pediatric patients is on the rise. DGA training programs and related support projects are needed to meet the treatment demands among patients in less developed areas.

Postoperative evaluation of special needs and healthy patients with endodontic treatment under general anesthesia: a retrospective research.

BACKGROUND: This retrospective clinical study was undertaken to comparatively evaluate the number of restorative treatments, endodontic treatments, and tooth extractions performed for patients under general anesthesia due to dental anxiety or special needs between 2015 and 2022 and to examine the pain, bleeding, nausea, and vomiting data of those patients. METHODS: In total, 1165 patients underwent dental treatment under general anesthesia in the faculty hospital. Those under the age of 15 and with no endodontic procedure planned (n = 918) were excluded, followed by those with incomplete data (n = 25) and those without endodontic treatment (n = 25). Patients who underwent at least one endodontic treatment were finally included in the study (n = 184). Patients were divided into two groups: healthy and with special needs. Dental treatments were recorded as endodontic, restorative, and teeth extractions. Endodontic treatments were classified according to the tooth type (premolar, molar, and incisors). The composite restorations were classified as anterior, occlusal (O), occluso-distal (OD) or occluso-mesial (OM), and mesio-occluso-distal (MOD) restorations and patients' post-treatment pain, nausea, vomiting, and bleeding were recorded. The data were analyzed statistically. RESULTS: Among the 184 patients included in the study, 70 (38%) were healthy, and 114 (62%) had special needs. Postoperative bleeding was observed more in patients with special needs (χ2 = 4.189, p < 0.05), whereas pain was observed more in healthy patients (U = 2922.00, p < 0.05). While the number of anterior, O, and MOD restorations was higher in patients with special needs, the number of OD or OM restorations was higher in healthy patients (χ2 = 74.877, p < 0.05). CONCLUSIONS: Patients with special needs undergo a greater number of restorative treatments compared to control patients, which may be associated with the inadequate oral hygiene care of such patients. However, restorative treatment is mostly indicated for such patients in our faculty hospital, which may indicate that a conservative approach is taken. Additionally, the finding that postoperative bleeding was more severe in this group of patients compared to the control group in this study may emphasize the need to consider more possible complications after general anesthesia in these patients.

The Influence of Piriform Recess Instillation with Lidocaine Before Bronchoscopy on Post-General Anesthesia Cough: A Randomized Controlled Trial.

Background and Importance: Postoperative cough is a common complication of general anesthesia after bronchoscopy. The aim of the present study was to determine the safety profile and efficacy of piriform recess instillation with lidocaine in reducing the incidence of coughing. Objective: To what extent could piriform recess instillation with lidocaine decrease the incidence of cough at 10min after extubation? Outcome Measures and Analysis: Eighty-eight consecutive patients were equally randomized to a lidocaine group receiving piriform recess instillation with 2mL 2% lidocaine, and a normal saline group receiving piriform recess instillation with 2mL saline. The primary outcome was the incidence of cough after extubation, and the secondary outcomes were throat score at 10 min and 6 h after extubation assessed by the numerical rating scale, cough severity at 10 min and 6 h after extubation assessed by the Visual Analog Scale (VAS), 24 h 40-item Quality of Recovery Score (QoR-40), and subject-rated satisfaction score on a VAS. Main Results: Compared with saline group, the incidence of cough in lidocaine group was significantly lower (63.6% vs 86.4%, P=0.014). The sore throat score at 10 min after extubation was significantly lower (0[0,0] vs 1[0,2], P<0.001). The subject-rated overall anesthesia satisfaction score was significantly higher (84.8[±6.2] vs 76.6[±8.6], P<0.001). The severity of cough at 10 min after extubation was significantly lower (Mild: 36.4% vs 11.4%, P=0.006; Severe: 9.1% vs 43.2%, P<0.001). There was no significant difference in the sore throat score at 6 h after extubation, severity of cough at 6 h after extubation, or QoR-40 at 24 h after extubation between the two groups. Conclusion: Piriform recess instillation with lidocaine before bronchoscopy is a simple and effective method for reducing early cough intensity and alleviating early sore throat. At 6 hours, there were no differences observed between the groups. Clinical Trial Registration: Chinese Clinical Trial Registry (identifier: ChiCTR2200067087).

Ultrasound Evaluation of Anterior Neck Soft-Tissue Thickness to Predict Difficult Intubation in Overweight Adult Patients Posted for Surgery under General Endotracheal Anesthesia - An Observational Study.

BACKGROUND: Ultrasonographic imaging has been recently become simple portable and non-invasive adjuvant for bedside assessment of anterior neck soft tissue thickness which when measured at different levels showed to have significant role in predicting difficult laryngoscopy. AIMS AND OBJECTIVES: Primary objective was Ultrasonographic measurement of anterior neck soft tissue thickness at 3 levels -Distance from skin to hyoid bone (DSHB) -Distance from skin to thyrohyoid membrane (DSTM) -Distance from skin to anterior commissure of vocal cord(DSAC) and to compare and correlate the findings with Cooks modification of Cormack-Lehane score in predicting difficult laryngoscopy. Secondary objective was to compare and correlate the ultrasonographic measurements with conventional airway assessment methods. MATERIALS AND METHODS: After obtaining approval from the ethical committee, 90 Patients with BMI above 25 kg /m2 was enrolled for the study. A day before the surgery a thorough Preanaesthetic evaluation and assessment of the airway is done using conventional methods. Then on the day of surgery ultrasonographic measurement of anterior neck at 3 levels was done and after inducing the patients laryngoscopy was done and Cooks modification of Cormack-Lehane score assessed. RESULTS: The optimal cut off values to predict difficult laryngoscopy was 1.26, 2 and 1.2 cms for DSHB, DSTM and DSAC respectively, and among the three skin to anterior commissure of vocal cord was observed to be best USG parameter with more area under the ROC curve. CONCLUSION: USG measurement of anterior neck soft tissue thickness can be useful in predicting difficult laryngoscopy in overweight and obese patients also it had more diagnostic accuracy than conventional methods like MMS in predicting difficult laryngoscopy.

RésuméArrière-plan L'imagerie échographique est récemment devenue un simple adjuvant portable et non invasif pour l'évaluation au lit du patient de l'épaisseur des tissus mous du cou antérieur qui, lorsqu'elle est mesurée à différents niveaux, s'est avérée avoir un rôle important dans la prédiction d'une laryngoscopie difficile. Buts et objectifs L'objectif principal était la mesure échographique de l'épaisseur des tissus mous du cou antérieur à 3 niveaux -Distance de la peau à l'os hyoïde (DSHB) -Distance de la peau à la membrane thyrohyoïdienne (DSTM) -Distance de la peau à la commissure antérieure de la corde vocale (DSAC) et pour comparer et corréler les résultats avec la modification de Cooks du score de Cormack-Lehane pour prédire une laryngoscopie difficile. L'objectif secondaire était de comparer et de corréler les mesures échographiques avec les méthodes conventionnelles d'évaluation des voies respiratoires Matériels et méthodes Après avoir obtenu l'approbation du comité d'éthique, 90 patients présentant un IMC supérieur à 25 kg/m2 ont été inclus dans l'étude. Un jour avant la chirurgie, une évaluation préanesthésique approfondie et une évaluation des voies respiratoires sont effectuées à l'aide de méthodes conventionnelles. Ensuite, le jour de la chirurgie, une mesure échographique de la partie antérieure du cou à 3 niveaux a été effectuée et après l'induction des patients, une laryngoscopie a été effectuée et la modification de Cooks du score de Cormack-Lehane a été évaluée. Résultats Les valeurs seuil optimales pour prédire une laryngoscopie difficile étaient respectivement de 1,26, 2 et 1,2 cm pour DSHB, DSTM et DSAC, et parmi les trois paramètres de la peau à la commissure antérieure de la corde vocale, il a été observé que le meilleur paramètre USG avec plus de surface sous la courbe ROC Conclusion La mesure par USG de l'épaisseur des tissus mous du cou antérieur peut être utile pour prédire une laryngoscopie difficile chez les patients en surpoids et obèses. Elle a également une plus grande précision diagnostique que les méthodes conventionnelles comme le MMS pour prédire une laryngoscopie difficile.

Comparison of the Influence of Intraoperative Use of Sevoflurane and Isoflurane on Postoperative Nausea, Vomiting, and Cough.

INTRODUCTION: Postoperative nausea, vomiting, and cough are the most common adverse effects of general anesthesia resulting in high discomfort to the patient resulting in uneasiness during the recovery period. This study aimed to compare the influence of intraoperative use of sevoflurane and isoflurane on postoperative nausea, vomiting, and cough. MATERIALS AND METHODS: After approval from the institutional ethical committee, this quantitative observational institutional study was conducted on all patients aged between 18 and 65 years undergoing surgery under general anesthesia at KMC Hospital, Mangalore. Patients were allocated into the sevoflurane group or isoflurane group. RESULTS: All demographic parameters such as age, sex, American Society of Anesthesiologists physical status, and duration were comparable (P > 0.05). The sevoflurane group had higher number of patients (11 [14.86%]) with postoperative nausea at 0 h as compared isoflurane group (7 [9.45%]). Two patients in the isoflurane group reported postoperative vomiting at 0 h, whereas no patient in the sevoflurane group reported vomiting. For cough, a statistically significant correlation was seen between the two groups (P = 0.000) with majority of patients in the isoflurane group, i.e., 50 (67.6%) patients reporting cough at 0 h while only 15 (20.3%) reported cough in the sevoflurane group. CONCLUSION: Sevoflurane was found to be better than isoflurane in terms of postoperative nausea vomiting and cough immediately after emergence in our study. Isoflurane cause the emergence of cough whereas no significant difference in nausea and vomiting was observed in both groups.

Résumé Introduction:Les nausées, vomissements et toux postopératoires sont les effets indésirables les plus courants de l'anesthésie générale, entraînant un inconfort élevé pour le patient, entraînant un malaise pendant la période de récupération. Cette étude visait à comparer l'influence del'utilisation peropératoire du sévoflurane et de l'isoflurane sur les nausées, vomissements et toux postopératoires.Méthode:Après approbation du comité d'éthique institutionnel, cette étude institutionnelle observationnelle quantitative a été menée sur tous les patients âgés de 18 à 65 ans subissant une intervention chirurgicale sous anesthésie générale à l'hôpital KMC de Mangalore. Les patients ont été répartis dans le groupe sévoflurane ou le groupe isoflurane.Résultats:Tous les paramètres démographiques comme l'âge, le sexe, l'ASA PS et la durée étaient comparables. ( P > 0,05) Le groupe sévoflurane avait un nombre plus élevé de patients [11 (14,86 %)] présentant des nausées postopératoires à 0 heure par rapport au groupe isoflurane [7 (9,45 %)]. 2 patients du groupe Isoflurane ont signalé des vomissements postopératoires à 0 heure alors qu'aucun patient du groupe Sévoflurane n'a signalé de vomissements. Pour la toux, une corrélation statistiquement significative a été observée entre les deux groupes ( P = 0,000) avec une majorité de patients dansle groupe isoflurane, c'est-à-dire 50 (67,6 %) patients signalant une toux à 0 heure, alors que seulement 15 (20,3 %) ont signalé une toux dans le groupe sévoflurane.Conclusion:Le sévoflurane s'est révélé meilleur que l'isoflurane en termes de nausées, vomissements et toux postopératoires immédiatement après l'émergence dans notre étude. L'isoflurane provoque une toux d'émergence alors qu'aucune différence significative en termes de nausées et de vomissements n'a été observée dans les deux groupes.

[Brainstem auditory evoked responses in horses with hearing loss and during general anesthesia]. / Hör- und Hirnstammfunktionsprüfung beim Pferd: Resultate bei ausgewählten klinischen Szenarien.

INTRODUCTION: The brainstem auditory evoked response (BAER) is a diagnostic approach to examine the hearing system of horses objectively. The aim of this BAER examination was the diagnosis of conductive or sensorineural hearing loss or deafness in horses with external otitis, head trauma, headshaking, tinnitus or skittish horses with eye disease. Brainstem dysfunction is induced by intracranial hypotension. BAER was used in horses with colic surgery which had a low arterial blood pressure during general anesthesia. The endoscopic finding of the guttural pouch was the ipsilateral mild to severe hypertrophy of the tympanostylohyoideum in horses with external otitis or head trauma. The otoscopic examination of standing sedated horses was done before BAER. The cartilagineous and osseous part of the external ear canal in horses with external otitis were obstructed with exsudate and tympanic membranes were not visible. Horses with right sided external otitis: right moderate to severe conductive hearing loss (significantly prolonged latencies of I, III, V and interpeak latencies I-III, I-V, III-V; thresholds of hearing levels 60 to 80 dB right); horses with left sided external otitis: left severe conductive hearing loss (no correct identification of BAER peaks, latencies not measurable, 80 dB); horse with left sided head trauma: severe left sided conductive hearing loss (blood in the left external ear canal, no visible tympanic membrane, no correct identification of BAER peaks, latencies not measurable, 80 dB); horses with head shaking: mild sensorineural hearing loss on both sides (on both sides osseous parts II/III with keratin scales of the junction, visible tympanic membranes, significantly prolonged V, I-III, I-V, 40 dB); moderate to severe skittish horses with chronic eye disease (mostly left sided equine recurrent uveitis): moderate sensorineural hearing loss on both sides (normal otoscopical findings, significantly prolonged latencies and interpeak latencies left; I-V, III-V right, 60 dB, pathological involvement in the auditory pathway of the brainstem between the cochlear nucleus and colliculus caudalis); horse with a tinnitus on both sides: mild sensorineural hearing loss on both sides (normal otoscopical findings, prolonged V, I-III, I-V, III-V, 40 dB, pathology of auditory nerve, cochlear nucleus and above the level of this nucleus); American paint horses: sensorineurale deafness on both sides (normal otoscopical findings, absent BAER peaks, isoelectric lines and 80 dB on both sides). The prolonged latencies of I, III and V including interpeak latencies I-III only left and I-V and III-V on both sides in horses with laparotomy during general anesthesia were associated with low arterial blood pressure (62 mmHg, median). These findings could demonstrate a hypotension in the brainstem too. The BAER could be a technical tool during general anesthesia for normalizing the arterial blood pressure and brainstem function to prevent imbalance of body movements after general anesthesia.

INTRODUCTION: L'examen objectif de l'audition chez le cheval est réalisé par la mesure des Potentiels Évoqués Auditifs (PEA) ou Brainstem Auditory-Evoked Response (BAER). L'objectif de ces examens est de diagnostiquer une surdité de transmission ou neurosensorielle ou une surdité chez les chevaux souffrant d'otite externe, de traumatisme crânien, de headshaking, d'acouphènes ou chez des chevaux craintifs souffrant d'une maladie oculaire. Étant donné que l'audiométrie du tronc cérébral vérifie également la fonction du tronc cérébral, des chevaux ayant subi une laparotomie et une déshydratation préopératoire ont été examinés pour détecter un dysfonctionnement du tronc cérébral dû à une baisse de la pression artérielle. L'otoscopie et l'audiométrie du tronc cérébral (système AEP Corona) ont été réalisées. Les résultats de l'otoscopie chez les chevaux atteints d'otite externe: Pars cartilaginea et ossea degré III, tympan non visible. Les résultats de l'endoscopie des poches gutturales chez les chevaux atteints d'otite externe exsudative ou de traumatisme crânien: toujours une augmentation ou une hypertrophie ipsilatérale du tympanostylohyoïdien. Les résultats de la BAER des chevaux atteints d' une otite externe à droite sont les suivants: surdité de transmission moyenne à sévère à droite (ondes I, III, V significativement prolongées, latences interpicales I-III, I-V, III-V par rapport au groupe de contrôle, valeurs limites au-dessus du seuil auditif normal 60 à 80 dB); chevaux atteints d'otite externe à gauche: surdité de transmission de haut niveau à gauche (ondes non identifiables, 80 dB à gauche); chevaux avec une fistule auriculaire à droite: surdité de perception bilatérale de bas niveau (allongement significatif des ondes III, V et des latences interpicales des deux côtés, 40 dB); cheval avec traumatisme crânien à gauche: surdité de transmission de degré élevé (à gauche, sang dans le conduit auditif externe, tympan non visible, ondes non identifiables, 80 dB); chevaux avec headshaking: surdité de perception de degré faible (des deux côtés, pars ossea de degré II, tympans visibles, allongement significatif V, I-III, I-V, 40 dB); chevaux présentant une peur et une maladie oculaire: surdité moyenne, neurosensorielle (otoscopie normale, allongement significatif de toutes les ondes et des latences interpeak à gauche, I-V, III-V à droite, 60 dB, vitesse pathologique de conduction des voies auditives dans le tronc cérébral); American Paint Horses: surdité neurosensorielle (otoscopie normale, ligne isoélectrique bilatérale des HA, 80 dB). Les ondes I, III et V prolongées et les latences interpicales I-III, I-V et III-V chez les chevaux ayant subi une laparotomie sont associées à la baisse de la pression artérielle (62 mmHg, médiane) pendant l'anesthésie générale et indiquent une hypotension dans le tronc cérébral. Pendant l'anesthésie générale, l'audiométrie du tronc cérébral offre une possibilité particulière de détecter le dysfonctionnement du tronc cérébral, de réguler la pression artérielle et de garantir un lever sans problème avec un équilibre auditif et visuel de la posture après l'anesthésie générale.

The effect of BIS-guided anaesthesia on the incidence of postoperative nausea and vomiting in children: a prospective randomized double-blind study.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients. STUDY OBJECTIVE: Evaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV. DESIGN: Prospective, randomized, double-blind study. SETTING: A single center study in university hospital in Czech republic, from June 2021 to November 2022. PATIENTS: A total of 163 children, aged 3-8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included. INTERVENTIONS: In the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS. MAIN OUTCOME MEASURE: The primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery. RESULTS: The use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27-0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20-0.54); p = 0.01, respectively]. CONCLUSIONS: BIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04466579.