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Background and Aims: Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine. Methods: The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel--Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables. Results: Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003). Conclusion: Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine. [ABSTRACT FROM AUTHOR]

BACKGROUND: Succinylcholine is a commonly used muscle relaxant in anaesthesia that is associated with significant side effects, including muscle fasciculations and postoperative myalgia. Succinylcholine is used to facilitate tracheal intubation, especially in emergency situations when the risk of aspiration of gastric contents is present. AIM AND OBJECTIVE: This research paper investigates the effect of administering magnesium sulfate in conjunction with propofol induction on succinylcholine-induced fasciculations and myalgia. MATERIAL & METHODS: A total of 80 adult patients scheduled for elective surgery under general anaesthesia were divided into two groups (group I and II). The group I patients were treated with magnesium sulphate (40 mg/kg weight) in 10 ml volume while Group II patients were pretreated with normal saline (0.9% in 10 ml volume). They were given slowly intravenously over a period of 10 mim. Then Anesthesia was induced with fentanyl 1.5 mcg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculation and Myalgia were observed after 24 hours of surgery. They were graded as nil, mild, moderate and severe. RESULTS: The overall incidence of muscle fasciculation in group I was 52.5% while it was 100% in group II. In group I, 22.5%,12 % mild and moderate muscle fasciculation were developed and no severe cases of fasciculation were observed. While in group II, 52.5% moderate, 40 % mild and 7.5% severe muscle fasciculation were observed. Postoperative myalgia was observed after 24 hrs, and it was observed that patients of Group I were not showing any sign and symptoms of myalgia while in group II, 12.5% were mild, 7.5% were moderate and 80% were negative for myalgia. CONCLUSION: The study found that the administration of magnesium sulfate significantly reduced both the incidence and severity of succinylcholine-induced fasciculations and myalgia, suggesting a beneficial role for magnesium sulfate in anesthesia protocols. [ABSTRACT FROM AUTHOR]

Problem identification: Perioperative emergencies, although infrequent, may lead to significant morbidity and mortality associated with anaesthesia and/or surgery. Human factor errors account for between 43 to 65 per cent of sentinel events in the perioperative environment. Cognitive aids were introduced to reduce a user's cognitive workload and assist in adherence to key interventions during emergencies. Despite the availability of these aids, implementation of their use remains low. This integrative literature review will identify the barriers to and facilitators of the implementation of cognitive aids during perioperative emergencies. Literature search: An electronic database search of EBSCO databases (CINAHL Complete, Health Source: Nursing/Academic Edition, MEDLINE, MEDLINE Complete), Pubmed and Scopus were conducted to obtain contemporary literature. Duplicates were removed and inclusion and exclusion criteria were applied. A total of 14 articles were identified for inclusion. Data evaluation and synthesis: Included articles were critically analysed and appraised using the JBI critical appraisal tools to assess for the methodological quality of the research, and the National Health and Medical Research Council (NHMRC) evidence hierarchy to assess for reliability and validity. A data extraction table (literature matrix) was used to record the article's author, date of publication, research title, population, study design, level of evidence, key findings, implications for practice and limitations. This aided in synthesis of the selected studies, thematic analysis and drawing conclusions. Implications for practice: Strong design and staff education were identified as facilitators of cognitive aid implementation while poor design and lack of organisational support were identified as barriers to cognitive aid implementation. Nursing leaders and educators have a vital role to play in gaining organisational support to provide staff education and training and develop appropriately designed cognitive aids. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is making giant strides in the medical domain, and the field of anaesthesia is not untouched. Enhancement in technology, especially AI, in many fields, including medicine, has proven to be far superior, safer and less erratic than human decision-making. The intersection of anaesthesia and AI holds the potential for augmenting constructive advances in anaesthesia care. AI can improve anaesthesiologists' efficiency, reduce costs and improve patient outcomes. Anaesthesiologists are well placed to harness the advantages of AI in various areas like perioperative monitoring, anaesthesia care, drug delivery, post-anaesthesia care unit, pain management and intensive care unit. Perioperative monitoring of the depth of anaesthesia, clinical decision support systems and closed-loop anaesthesia delivery aid in efficient and safer anaesthesia delivery. The effect of various AI interventions in clinical practice will need further research and validation, as well as the ethical implications of privacy and data handling. This paper aims to provide an overview of AI in perioperative monitoring in anaesthesia. [ABSTRACT FROM AUTHOR]

Robert Mortimer Glover's contribution as the first to identify the anaesthetic effects of chloroform went unrecognized for over 130 years. Posterity now remembers Glover as the first to experimentally demonstrate the effects of chloroform, and yet, the scope and impact of the work for which he is remembered remains largely undiscussed. This historical article returns to Glover's dissertation, for which he won the Harveian Prize in 1842, and examines its experimental findings in their historical context. Departing from the body of literature which emphasizes the clinical orientation of early anaesthesiological research, it revisits the theoretical and methodological foundations of Glover's study, which, first and foremost, sought to examine the possibility of an analogy between chemical structure and physiological effect. In doing so, it establishes that Glover was not merely the first to realize the physiological effects of chloroform or even merely the earliest figure to recognize the effects of bromoform, potassium bromide, and "bromide of mercury," over two decades before Henry Behrend's or Protheroe Smith's classic papers. My examination concludes that Glover may have been the first to propose the existence of a unique class of anaesthetic compounds, establishing Glover as an early representative of anaesthetic pharmacology as a collective body of research and clinical practice. [ABSTRACT FROM AUTHOR]

This document is a summary of a search conducted on various databases to find relevant articles on the topic of metamizole (also known as dipyrone) and its use in dogs and cats for pain relief. The search yielded three relevant papers, which were reviewed to assess the effectiveness and safety of metamizole for postoperative pain management in cats and dogs. The studies found that metamizole may help reduce postoperative pain levels in healthy cats and dogs undergoing ovariohysterectomy, but it was not effective as the sole analgesic in dogs. The studies did not find any evidence of higher incidence of side effects with metamizole use. However, the studies had limitations such as small sample sizes and lack of detail on randomization and blinding techniques. The document emphasizes that the application of this evidence should consider multiple factors and individual circumstances. The authors encourage library patrons to contribute to the evidence base by sharing their information needs or writing knowledge summaries. The document concludes with a disclaimer stating that the opinions expressed in the summaries are those of the authors and not necessarily reflective of the views of the organization. [Extracted from the article]

Summary: The dedication of the international anaesthetic community to reducing the environmental impact of healthcare is important and to be celebrated. When this is underpinned by robust science, it has the potential to make a real difference. However, volatile anaesthetic agents have been widely promoted in the medical literature as damaging to the climate, leading to a drive to remove them from clinical practice. This is based on notional 'CO2‐equivalent' values created using the simple emission metric known as the global warming potential. Here, we assert that when proper consideration is given to the science of climate change, volatile anaesthetic gas emissions cannot be simply equated to real carbon dioxide emissions, and that their climate impact is vanishingly small. This paper gives anaesthetists a framework to make informed choices founded on climate science and calls for attention to be refocused on the urgent need to reduce the real carbon dioxide emissions associated with healthcare. [ABSTRACT FROM AUTHOR]

Background: Perioperative neurocognitive disorders are often neglected and undiagnosed. There are known risk factors for these disorders (e.g., higher levels of frailty, cognitive decline before surgery). However, these factors are usually not assessed in the daily clinical setting. One of the main reasons for this lack of examination is the absence of a suitable cognitive function test that can be used in acute clinical settings. The primary aim of this study was to determine correlations between preoperative and postoperative scores on three cognitive tests (the Mini Mental State Exam (MMSE), the Clock Drawing Test (CDT) and the Test of Gestures (TEGEST). Methods: This was a prospective, monocentric, observational study that included one cohort of patients aged 65 years and older. Patients underwent acute or elective surgical operations. Preanaesthesia tests were administered. After the operation, the patients completed the same tests between the 2nd postoperative day and discharge. Preoperative and postoperative cognitive test scores were assessed. Results: This study included 164 patients. The arithmetic mean age was 74.5 years. The strongest correlations were observed between MMSE scores and TEGEST scores (r = 0.830 before and 0.786 after surgery, P < 0.001). To compare the MMSE and the TEGEST, the MMSE was divided into 2 categories—normal and impaired—and good agreement was found among 76.2% of the participants (ϰ = 0.515). If the TEGEST scoring system was changed so that scores of 4–6 indicated normal cognition and scores of 0–3 indicated cognitive impairment, the level of agreement would be 90.8%, ϰ = 0.817. Only 5.5% of the patients had impaired MMSE scores and normal TEGEST scores, whereas 3.7% of the respondents normal MMSE scores and impaired TEGEST scores. Conclusion: According to our results, the TEGEST is a suitable option for assessing cognitive functioning before surgery among patients who are at risk of developing perioperative neurocognitive disorders. This study revealed that it is necessary to change the rating scale for the TEGEST so that scores of 4–6 indicate normal cognition and scores of 0–3 indicate cognitive impairment. In clinical practice, the use of the TEGEST may help to identify patients at risk of perioperative neurocognitive disorders. [ABSTRACT FROM AUTHOR]

Background: Inhaled anaesthetic agents like sevoflurane contribute for approximately 5% to healthcare's carbon footprint. Previous studies suggested that the use of these agents should be minimized. Although multiple trauma surgeries can be performed under regional anaesthesia, most are performed under general anaesthesia. This study aims to evaluate the environmental benefits of using regional anaesthesia over general anaesthesia and to compare the associated complication rates. Methods: This retrospective study included all trauma patients (≥ 18 years) who underwent surgical intervention for hand, wrist, hip, or ankle fractures from 2017 to 2021. The hypothetical environmental gain was calculated based on the assumption that all surgeries were performed under regional anaesthesia. Complication rates were compared between regional and general anaesthesia. Results: Of the 2,714 surgeries, 15% were hand, 26% wrist, 36% hip, and 23% ankle fractures. General anaesthesia was used in 95%, regional in 5%. Switching this 95% to regional anaesthesia would reduce the sevoflurane use by 92 k, comparable to driving 406,553 km by car. The complication rate was higher with general anaesthesia compared to regional (7.7% vs 6.9%, p = 0.75). Conclusion: The potential gain of the reduction of sevoflurane in trauma surgeries which can be performed under regional anaesthesia can be significant. [ABSTRACT FROM AUTHOR]

Background: Using anaesthetics is an important application in aquaculture especially where the fish transportation, vaccination, grading, sorting activities and many other handling operations have been conducted during the different stages of production periods in the farms or hatcheries. Objectives: This study aimed to evaluate the efficacy of oregano essential oil (OO) as an anaesthetic for Nile tilapia and to determine the optimal concentration and post‐application stress effects compared to clove oil (CO). Methods: Nile tilapia juveniles were exposed to different concentrations of OO (20–40–60–80–100 mg L−1) and CO (50 mg L−1) for different time periods to determine the optimal concentration and exposure time. After the effective concentration of OO was determined, in the second experiment, stress parameters (glucose, plasma cortisol) were analysed after 0, 2, 6, 12 and 24 h of application. The results compared to the control group and CO results. Results: The study found that OO which has carvacrol compound higher than 78% was an efficient anaesthetic for Nile tilapia, and the effective concentration was found to be 60 mg L−1. No significant differences were found between opercular beats in any concentration of OO and CO. Basal glucose level in blood without anaesthesia application and recorded at 39.33 mg dL−1 and significantly lower than OO and CO at first two sampling points, 0 and 2 h (p < 0.05). According to plasma cortisol level results, although CO experimental group showed secondary stress response at 12 h (17.91 ± 4.21 ng mL−1), OO and CO group cortisol levels decreased at 24 h after anaesthesia application 7.13 ± 0.14and 7.01 ± 0.54 ng mL−1, respectively, below the control group cortisol concentration (12.28 ± 1.81 ng mL−1). Conclusions: These findings have important implications for the aquaculture industry as the use of OO as an anaesthetic could reduce the stress and mortality associated with traditional anaesthetics. Further research is needed to evaluate the efficacy of OO as an anaesthetic agent for other fish species and to determine the optimal concentration and exposure time for different species. [ABSTRACT FROM AUTHOR]

John Davies Thomas (1844-1893) described a two-ounce drop-bottle for chloroform in 1872 while he was a resident medical officer at University College Hospital, London. After working as a ship's surgeon, he settled in Australia. In May 1875, Thomas presented a paper on the mortality from ether and chloroform at a meeting of the Medical Society of Victoria in Melbourne, Victoria. Surveys conducted in Europe and North America had established that the mortality from chloroform was eight to ten times higher than that from ether. At that time, chloroform was the most widely administered anaesthetic in Australia. Thomas' paper was published in The Australian Medical Journal and reprinted by the Medical Society of Victoria for distribution to hospitals in the Colony of Victoria. Later that year, Thomas moved to Adelaide, South Australia, where he may have been influential at the Adelaide Hospital in ensuring that ether was administered more often than chloroform. It does not appear that Thomas' papers on anaesthesia had a significant effect on the conduct of anaesthesia in Victoria or New South Wales. [ABSTRACT FROM AUTHOR]

Sedation is common during digestive endoscopy to provide comfort and pain relief for patients. However, the use of sedation in endoscopy also poses potential risks, and recent issues have been raised regarding its safety and administration. This literature review paper will discuss the most recent developments in the field of sedation in digestive endoscopy, including the adverse events that might be associated with sedation and how to manage it, the legal issues associated with administration, the impact of COVID-19 on sedation practices, and sedation in special situations. It will also touch upon the current guidelines and recommendations for sedation, including the importance of patient selection and monitoring and the need for training and certification for endoscopists administering sedation. The review will also analyse studies evaluating the safety and efficacy of various sedation techniques, including propofol, midazolam, and others. It will examine the benefits and drawbacks of these agents. [ABSTRACT FROM AUTHOR]

Adequate patient positioning is of paramount importance in neurosurgery. Complications related to the position are common and make up for more than 16% of the claims towards anaesthesiologists and neurosurgeons. This paper aims to provide the anaesthesiologist with a practical guide to avoid common pitfalls related to the patient positioning process. We performed a systematic review of the medical literature for the identification, screening, and inclusion of articles. The bibliographic search was conducted on June 1st, 2021 by two of the authors. In this review, we included articles indexed by MEDLINE, Cochrane Library, or Google Scholar. We retrieved a total of 5706 unique papers from our initial search. However, after the initial screening, 5363 papers were removed is not related to our research leaving a total of 343 papers. We examined the full text of all the 343 articles including 68 of them in the final qualitative analysis. In this review we examine the most common neurosurgical positions: supine, sitting, lateral, park-bench, prone, jack-knife, and knee-chest. For each of them, the proper positioning and related complications are described. Particular attention is given to the prevention and management of these complications, providing a practical guide for clinicians. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases. Methods: We searched the PubMed database from 1 January 2001 to 9 October 2021 for peer‐review papers published in English on the use, and success rates, of flexible bronchoscopy as the first‐line treatment for foreign body aspiration cases. This process identified 243 potential papers. Results: We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23 studies and laryngeal mask airways were mostly used in 10/23 studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets. Conclusion: Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies. [ABSTRACT FROM AUTHOR]

Simple Summary: Medetomidine and dexmedetomidine, commonly used in veterinary practice, induce sedation, muscle relaxation and analgesia. Reduced heart rate is one of the most common side effects of these anaesthetics. Other undesirable effects include increased vascular resistance, deterioration of blood supply to some tissues, and a decrease in cardiac output. These effects can be fatal in a critically ill patient. This study aimed to compare the haemodynamically depressive effects of butorphanol-medetomidine and butorphanol-dexmedetomidine combinations on echocardiographic parameters during propofol anaesthesia in dogs and to determine which anaesthetic produces fewer adverse cardiovascular effect. This study compared the effects of butorphanol-medetomidine and butorphanol-dexmedetomidine combinations on echocardiographic parameters during propofol anaesthesia in dogs. The dogs were randomly divided into two groups. In the butorphanol-medetomidine (BM) group, butorphanol (0.2 mg/kg) and medetomidine (15 μg/kg) were intravenously administered; in the butorphanol-dexmedetomidine (BD) group, butorphanol (0.2 mg/kg) and dexmedetomidine (7.5 μg/kg) was used. Anaesthesia was induced with propofol and maintained with a constant-rate infusion of propofol (0.2 mg/kg/min). The echocardiographic parameters were assessed in conscious dogs (T0). Echocardiography was conducted again at 10 min post premedication (T1), followed by assessments at 30 (T2), 60 (T3), and 90 (T4) mins. The dogs were subjected to diagnostic procedures (radiography, computed tomography) under anaesthesia. A significant reduction in heart rate and cardiac output was noted in both groups at T1. There was no significant difference in the stroke volume between the BM and BD groups. The application of butorphanol-dexmedetomidine caused a significant increase in the left ventricular internal diameter in diastole and the diameter of the left atrium compared to that caused by butorphanol-medetomidine. This study documented that butorphanol-medetomidine and butorphanol-dexmedetomidine combinations caused similar reductions in heart rate and cardiac output in both groups. 'New´ valvular regurgitation occurred following their administration. [ABSTRACT FROM AUTHOR]

Background: Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidocaine suppresses opioid-induced cough in children, but its use is limited due to anaesthetists' concern about its toxicity. Therefore, this study aimed to evaluate the effect of dose-dependent IV lidocaine on sufentanil-induced cough (SIC) in paediatric patients. Methods: A total of 188 patients aged 3–12 years scheduled for elective tonsillectomy with or without adenoidectomy were enrolled and divided into four groups depending on different dose of lidocaine: A (0 mg.kg-1), B (1 mg.kg-1), C (1.5 mg.kg-1), and D (2 mg.kg-1). The primary outcome was the SIC grade observed during the induction of general anaesthesia. The secondary outcomes were the incidence of SIC, mean arterial pressure, and heart rate at T0, T1, T2, T3, T4, and T5. Results: The SIC grade was significantly different between groups A and D (P = 0.04) and between groups B and D (P = 0.03). Moreover, the incidence of SIC in groups A, B, C, and D was 81%, 87%, 68%, and 64%, respectively, and the difference between groups B and C (P = 0.03) and between groups B and D (P = 0.0083) was statistically significant. No statistical differences were observed in the hemodynamic parameters between the groups. The incidence of severe cough was statistically different between group D and group A (P < 0.0001), between group D and group B (P < 0.0001), and between group D and group C (P < 0.0001) respectively. Conclusions: Lidocaine suppresses SIC in a dose-dependent manner without severe adverse events. IV lidocaine can be used in paediatric patients safely and efficiently, and the median effective dose was 1.75 mg/kg. Trial registration: This study was approved by the Institutional Review Board of Yichang Central People's Hospital (HEC-KYJJ-2020-038-02), The trial was registered at www.chictr.org.cn (ChiCTR2100053006). [ABSTRACT FROM AUTHOR]

Background and Aims: Short-term hypotension after general anaesthesia can negatively impact surgical outcomes. This study compared the predictive potential of the pleth variability index (PVI), pulse pressure variability (PPV), and perfusion index (PI) for anaesthesia-induced hypotension. This study's primary objective was to evaluate the predictive potential of PI, PVI, and PPV for hypotension. Methods: This observational study included 140 adult patients undergoing major abdominal surgery under general anaesthesia. Mean arterial pressure, heart rate, PVI, PPV, and PI were collected at 1-min intervals up to 20 min post anaesthesia induction. Hypotension was assessed at 5-min and 15-min intervals. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic performance and best cut-off for continuous variables in predicting a dichotomous outcome. Statistical significance was kept at P < 0.05. Results: Hypotension prevalence within 5 and 15 min of anaesthesia induction was 36.4% and 45%, respectively. A PI cut-off of <3.5 had an area under the ROC curve (AUROC) of 0.647 (P = 0.004) for a 5-min hypotension prediction. The PVI's AUROC was 0.717 (P = 0.001) at cut-off >11.5, while PPV's AUROC was 0.742 (P = 0.001) at cut-off >12.5. At 15 min, PVI's AUROC was 0.615 (95% confidence interval 0.521-0.708, P = 0.020), with 54.9% positive predictive value and 65.2% negative predictive value. Conclusion: PVI, PPV, and PI predicted hypotension within 5 min after general anaesthesia induction. PVI had comparatively higher accuracy, sensitivity, specificity, and positive predictive value than PI and PPV when predicting hypotension at 15 min. [ABSTRACT FROM AUTHOR]

Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the epidemiology of medical emergencies occurring in the intensive care unit (ICU). The aim of this study is to draw attention to the importance of auditing emergency events in the ICU. We hypothesised that emergency events occurring in the ICU would be clustered during periods of decreased medical and nursing attention and would occur in patients who had a higher illness severity and a greater risk of death. Methods: A retrospective observational cohort study was carried out in a 36-bed tertiary intensive care unit. The data capture all intensive care patients admitted to the ICU from 1 January to 1 December 2020. The number of emergency events occurring during each clock hour was correlated with ICU shift staffing patterns. In-hospital mortality and illness severity scores for patients experiencing emergency events were compared with those for all other ICU patients. Results: Serious medical emergencies were most frequent during the day, specifically during the morning ICU round (30% of all such events occurred between 08:00 and 12:00 hours), and there were peaks of incidence in the hour following each nursing and medical shift handover (following shift change times at 08:00, 15:00 and 21:00 hours). Agitation-related emergency events were least frequent during the periods of nursing day shift and afternoon shift overlap (07:00–08:00 hours and 13:00–15:00 hours). Patients who experienced serious medical emergency events in the ICU had a higher in-hospital mortality rate (28.3%) compared with the overall ICU mortality of 10.5% (OR = 4.89, 95% CI: 3.04–7.86). Conclusions: Patients who deteriorate suddenly in the ICU have greater illness severity and a significantly increased risk of death. The incidence of serious emergency events correlates with patterns of ICU staffing and work routines. This has implications for rostering, clinical workflow and education program design. What is known about the topic? Some common quality assurance indicators may underrepresent the true incidence of critical events or their impact on ICU team workload, given that often only adverse outcomes are captured Our study is significant because it captures all such workload. What does this paper add? By identifying periods of peak internal emergency activity, our study demonstrates the utility of collecting internal ICU emergency data for purposes of roster coordination. What are the implications for practitioners? We propose consistent senior medical presence and minimised non-essential interruptions during the hours of peak activity. Our method is easily reproducible and our findings, although from a single centre, are broadly generalisable, given that we discuss their similarity with other published works. [ABSTRACT FROM AUTHOR]

The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways. [ABSTRACT FROM AUTHOR]

Vasectomy is considered a permanent form of contraception for men that can help reduce reproductive inequality. Its underutilisation in the context of the threats it may pose to perceptions of traditional masculinity has been closely investigated, but the lived experience of the procedure itself has been largely overlooked. This paper examines the experience of having a vasectomy in Israel, focusing on the recommended form of anaesthesia. Drawing on 15 semi-structured interviews with Israeli men who have experienced vasectomy, we found that the choice of anaesthesia has a significant impact on the meaning and experience of vasectomy. Unlike the widespread use of local anaesthesia during vasectomy in other countries, vasectomy in Israel is performed almost exclusively under twilight sedation administered intravenously. Based on our findings, we argue that framing vasectomy as an operation that requires sedation is related to views of masculinity and reproduction. Our data suggest that vasectomy in Israel is constituted as a potentially traumatic event, and anaesthesia is employed to protect patients from feelings of embarrassment and discomfort. We conclude that the prevailing method of sedation perpetuates the silencing and marginalisation of vasectomy as a contraceptive method, and consequently, its very limited accessibility in Israel. [ABSTRACT FROM AUTHOR]

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Simple Summary: Craniotomy is a commonly performed surgical procedure in neuroscientific research that causes substantial pain in laboratory animals. The animals' invidious situation has received little previous attention, and therefore, to respect the 3R guidelines, including the minimisation of the animals' pain and suffering, we aimed to improve the conventional anaesthetic and analgesic regimens. The anti-nociceptive effects of four different drug combinations in laboratory mice undergoing general anaesthesia for craniotomies were investigated. Specifically, the efficacy of dexmedetomidine, which is known to have analgesic, sedative, and cardiorespiratory stabilising properties in other species, was evaluated. Our study demonstrated the beneficial effects of dexmedetomidine in mice as the signs of nociception were mitigated in the respective treatment groups. Pain refinement represents an important aspect of animal welfare in laboratory animals. Refining analgesia regimens in mice undergoing craniotomy has been sparsely investigated. Here, we sought to investigate the effect of dexmedetomidine in combination with other analgesic drugs on intraoperative anti-nociceptive effects and cardiorespiratory stability. All mice were anaesthetised with isoflurane and received local lidocaine infiltration at the surgical site. Mice were randomised into treatment groups consisting of either carprofen 5 mg kg−1 or meloxicam 5 mg kg−1 with or without dexmedetomidine 0.1 mg kg−1 administered subcutaneously. Intra-anaesthetic heart rates, breathing rates, isoflurane requirements, and arterial oxygen saturations were continuously monitored. We found that administration of dexmedetomidine significantly improved heart and breathing rate stability during two of four noxious stimuli (skin incision and whisker stimulation) compared to non-dexmedetomidine-treated mice and lowered isoflurane requirements throughout anaesthesia by 5–6%. No significant differences were found between carprofen and meloxicam. These results demonstrate that dexmedetomidine reduces nociception and provides intra-anaesthetic haemodynamic and respiratory stability in mice. In conclusion, the addition of dexmedetomidine to anaesthetic regimes for craniotomy offers a refinement over current practice for laboratory mice. [ABSTRACT FROM AUTHOR]

A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system. The purpose of this qualitative interview study was to understand anaesthetists' perspectives on the carbon footprint of anaesthesia, and views on shifting practice towards more environmentally sustainable options. Anaesthetists were recruited from four hospitals in Western Sydney, Australia. Data were organised according to the capability–opportunity–motivation model of behaviour change. Twenty-eight anaesthetists were interviewed (July−September 2021). Participants' age ranged from 29 to 62 years (mean 43 years), 39% were female, and half had completed their anaesthesia training between 2010 and 2019. Challenges to the wider use of greener anaesthetic agents were identified across all components of the capability–opportunity–motivation model: capability (gaps in clinician skills and experience, uncertainty regarding research evidence); opportunity (norms, time, and resource pressures); and motivation (beliefs, habits, responsibility and guilt). Suggestions for encouraging a shift to more environmentally friendly anaesthesia included access to education and training, implementing guidelines and audit/feedback models, environmental restructuring, improving resource availability, reducing low value care, and building the research evidence base on the safety of alternative agents and their impacts on patient outcomes. We identified opportunities and challenges to reducing the carbon footprint of anaesthesia in Australian hospitals by way of system-level and individual behavioural change. Our findings will be used to inform the development of communication and behavioural interventions aiming to mitigate carbon emissions of healthcare. [ABSTRACT FROM AUTHOR]

Background: Clinical registries are pivotal for advancing patient care and clinical research. The prospective Point of Care Ultrasound Registry (PURE) is a unique, pioneering initiative that aims to accumulate essential ultrasound data through a dedicated collection tool. This study investigates user satisfaction with the implementation of PURE, a first-of-its-kind registry, focusing on a spectrum of implementation outcomes. Methods: Using a cross-sectional survey approach, this study evaluated diverse implementation metrics such as acceptability, appropriateness, adoption, accessibility, feasibility, efficacy and efficiency. Statistical analyses were conducted to determine the overall user satisfaction with the implementation of this novel registry. Results: The study yielded a mean implementation score (IS) of 3.83 (95% CI 3.59-4.07). Effectiveness (E) had a mean score of 1.93 (95% CI 1.80-2.05) and Cumulative Implementation Factor (A) averaged 1.90 (95% CI 1.78-2.03). Notably, 11 of the 30 participants achieved an IS above 4, with a predominant 21 of 30 surpassing an IS of 3.8. Nevertheless, the scores for efficiency and feasibility, registered at 0.392/0.625 and 0.165/0.250, respectively, indicate areas for improvement. Conclusion: While PURE represents an innovative step forward in point-of-care ultrasound (POCUS) data collection, its initial implementation did not fully resonate with user satisfaction expectations. Significant possibilities for enhancement lie particularly within the efficiency and feasibility sectors. To improve its utility, measures such as optimising the data collection tool, bolstering training programmes, merging with existing systems, and implementing thorough evaluation and feedback processes are recommended. A nuanced understanding of the time pressure faced by anaesthetists during data input can provide valuable insights into further areas of potential refinement. [ABSTRACT FROM AUTHOR]

Background: Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia. The aim is to investigate feasibility of HFNO use during anaesthesia for flexible bronchoscopy to reduce frequency of rescue oxygenation and hypoxaemia. Methods: BUFFALO is a bi-centre, unmasked, randomised controlled, parallel group, protocol for a pilot trial comparing HFNO techniques to standard practice during anaesthesia. Children (n = 81) aged > 37 weeks to 16 years presenting for elective bronchoscopy who fulfil inclusion but not exclusion criteria will be randomised prior to the procedure to HFNO or standard care oxygenation post induction of anaesthesia. Maintenance of anaesthesia with HFNO requires total venous anaesthesia (TIVA) and with standard, either inhalational or TIVA at discretion of anaesthetist in charge of the patient. Outcomes will include the feasibility of recruitment and adherence to trial procedures, acceptability of the intervention of the protocol and completion rates of data collection methods. Discussion: Findings of this trial will determine feasibility to plan for a larger multicentre randomised clinical trial and support the feasibility of the proposed study procedures. Trial registration: BUFFALO trial was registered with Australia and New Zealand Clinical Trials Registry (TRN12621001635853) on 29 November 2021 and commenced recruitment in May 2022. https://www.anzctr.org.au/. The primary manuscript will be submitted for publication in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

Background: Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic–induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy. Method: We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST. Results: After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died. Conclusion: Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data—including adverse events—to enable clinicians to conduct risk–benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice. [ABSTRACT FROM AUTHOR]

Background: The study was conducted to evaluate the cardiopulmonary functions in dog under propofol, ketamine and isoflurane anaesthesia premedicated with dexmedetomidine and butorphanol. Methods: Four groups of dogs (A,B,C and D) comprising of six animals in each groups were premedicated with glycopyrrolate @ 0.01 mg/kg, dexmedetomidine @5µg/kg IV and Butorphanol @ 0.1mg/kg IV. Induction was done with propofol (A and B) and with ketamine (C and D). The anaesthesia was maintained with isoflurane (A and C), propofol (B) and ketamine (D). The cardiopulmonary functions were recorded at 0 minute (before premedication) and 20 minutes, 40 minutes and 60 minutes. Result: The heart rate decreased significantly in Group B while there was a significant gradual increase in heart rate in Group D. A significant decrease in respiratory rate was observed in all the groups with a lowest value in group D. The systolic pressure decreased significantly in Group A, B and C but in Group D, the systolic pressure decreased initially at 20 minute. The diastolic pressure decreased significantly in Group A and Group B and but in group D, the diastolic pressure decreased at 20 minute. A significant decrease in mean arterial pressure was recorded in Group A, B and C. In Group D, a decrease in the mean arterial pressure was noticed at 20 minute. The SpO2 level remained near the base line values with slight variation in Group A and C where as the values remained at lower level from the base line value in Group B and D. The EtCO2 level showed non-significant changes in Group A and C. In Group B and D, the EtCO2 levels increased non-significantly with the highest value recorded in Group D. The ECG parameters remained within the normal limit with slight variation according to the heart rate. [ABSTRACT FROM AUTHOR]

Background: Personalised theatre caps have been shown to improve staff communication in the operating theatre. The impact of these caps on the patient perioperative experience, particularly in Indigenous Australian patients, has not been well established. Methodology: Surgical patients and operating theatre staff at Royal Darwin Hospital in Australia were surveyed before and after the introduction of Indigenous art-themed personalised (name and role) theatre caps in October 2021 and January 2022. Staff name and role visibility in operating theatres was also audited. Results: A total of 223 staff and patients completed surveys. Most patients reported the theatre caps to be helpful (90%, 95% confidence interval [CI] 81–99) and felt more comfortable because staff were wearing them (91%, 95% CI 82–100). These results were consistent across Indigenous and non-Indigenous patients. The majority of staff agreed that personalised name and role theatre caps improved staff communication (89%, 95% CI 81–97), improved the staff-patient interaction (77%, 95% CI 67–87), and made it easier to use staff names (100%). Staff name and role visibility increased from 8 to 51% (p < 0.001) after the introduction of personalised theatre caps. Conclusions: The introduction of Indigenous art-themed personalised theatre caps for operating theatre staff at Royal Darwin Hospital improved perceived staff communication and the patient perioperative experience. [ABSTRACT FROM AUTHOR]

Simulation-based education is now recognised to be a valuable tool to impart both technical and non-technical skills to healthcare professionals of all levels. Simulation is an well accepted educational tool for cultivating teamwork skills among residents globally. Simulation-based education encompasses diverse modalities, ranging from task trainers and simulated patients to sophisticated high-fidelity patient simulators. Notably, anaesthesiologists globally were early advocates of integrating simulation into education, particularly to instruct anaesthesia residents about the intricacies of perioperative crisis resource management and collaborative interdisciplinary teamwork. Given the inherent high-risk nature of anaesthesia, where effective teamwork is pivotal to averting adverse patient outcomes, and also to improve overall outcome of the patient, simulation training becomes imperative. This narrative review delves into the contemporary landscape of simulation training in perioperative anaesthesia management, examining the pedagogical approaches, simulators, techniques and technologies employed to facilitate this training. [ABSTRACT FROM AUTHOR]

In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios. [ABSTRACT FROM AUTHOR]

The psychological impact (second victim effect) of in-theatre critical incidents is increasingly recognised. Different styles of psychological support programme have recently been published, including some utilising 'near in time' peer support. Most of these programmes either target their support to individuals, or focus on one vocational group rather than the multidisciplinary team. However, the in-theatre team consists of different craft groups who nonetheless function as a single team and are therefore 'peers'. This paper sets out the design and implementation of a critical incident peer response programme at Waikato Hospital, New Zealand, which provides peer-led group psychological first aid to full theatre teams. The programme is administered by trained representatives from multiple in-theatre craft groups including nurses, midwives, anaesthetic technicians, recovery room nurses, surgeons and anaesthetists. It emphasises team education and peer support, and has a wholly welfare focus. The programme has voluntary participation but mandatory activation triggers so that individuals do not need to seek support actively at a time when they may not recognise the need to do so. The programme is becoming embedded in the Waikato Hospital theatre culture so that participating in psychological support is normalised following a critical event. This framework is shared in the hope that it will assist other hospitals to develop welfare interventions to support full theatre teams. [ABSTRACT FROM AUTHOR]

This paper reviews the history of the College of Anaesthetists of South Africa (CASA), starting with the establishment of the College of Physicians and Surgeons of South Africa (CPSSA), the subsequent formation of the Faculty of Anaesthetists as part of the College of Surgeons of South Africa (FFACSSA), to its present form as the CASA. This review includes major milestones achieved over the years, including international recognition, key role players involved, development of examinations, medals and awards given as well as individuals honoured by the CASA. [ABSTRACT FROM AUTHOR]

Introduction. The paper describes the process of editing and validating documents on the basis of which a patient gives their informed consent for anaesthesia before surgery. Our objective was to adapt such documents to plain language standards, thanks to which they will be more accessible to an average patient. Material and methods. Two documents were drafted: Information about anaesthesia and Informed consent for anaesthesia. Within the editing process, we applied the principles of Plain Polish worked out for the Polish language. Results. Similar documents available in Polish medical institutions were collected. For the comparison of the texts, the readability formula – Plain Language Index (PLI) – recently available in Poland was used. This algorithm assesses 10 properties of the style and, based on these, it measures the simplicity of the text. Conclusions. Both documents which we designed obtained the standard of plain language (PLI 50% and more). They turned out to be the most accessible out of all the texts examined. [ABSTRACT FROM AUTHOR]

The h-index has become a criterion for progress and advancement in the career of an academic surgeon and it is especially important for the surgical community to understand the importance of calculating the h-index of a manuscript post publication in a surgical journal. It is not only becoming a criterion for promotion in the faculty in a medical institution, but also becoming an important index to decide about the suitability of editorial board members in a medical journal. Even though there are few loopholes, the h-index remains the gold standard criterion to access the quality of the author to be designated as an academic surgeon. [ABSTRACT FROM AUTHOR]

Prolapse of the gland of the third eyelid (cherry eye) is one of the most common canine-related ophthalmic conditions presented to veterinary clinics and hospitals. In most poor resource settings, veterinarians embark on excision of the gland due to possible lack of skill, necessary ophthalmic tools and a misconception of the postoperative complications associated with excision of the gland. Currently, repositioning of the prolapsed gland is the gold standard for management. The Morgan’s Pocket Technique (MPT) is one of the preferred methods for repositioning the gland. This paper presents some modifications of the MPT, which involved making two elliptical incisions above and below the point of rent or laxity on the gland’s conjunctival tissue following proper visualisation of the gland using a magnifying loop and creating a pocket for proper situation of the gland. The anaesthetic protocol adopted for the procedures as well as vital instruments and gadgets have also been highlighted. The medical records of 31 dogs (44 eyes) managed for cherry eye at the Veterinary Teaching Hospital, University of Ibadan, Nigeria from May 2013 to April 2021 were reviewed. Cherry eye was most prevalent in brachycephalic dogs with Boerboel having the highest presentation of 45.2% among others. Seventeen out of the 31 dogs were male, representing 54.8% while the rest were female. Majority of the dogs (93.5%) were below 2 years. The condition was unilateral in 18 dogs (58.1%), while 13 (41.9%) were bilateral. Before modification of the MPT in July 2018, surgery was repeated for 5 out of 23 eyes (21.7%). Following modification, no recurrences were recorded. The authors therefore recommend the modification of the MPT as well as paying attention to suture size, pattern and placement to prevent recurrence and complications. [ABSTRACT FROM AUTHOR]

Background and Aims: Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h. Methods: After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data. Results: The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5–23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2–37.7) in contrast to 13.6% (95% CI 3.5–23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively. Conclusion: Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle. [ABSTRACT FROM AUTHOR]

The article focuses on the physics behind neuromuscular monitors in anesthesia, exploring single-twitch, double-burst, and post-tetanic count techniques. Topics include the underlying physiology of neuromuscular blockade, determinants of neural stimulation, and clinical endpoints of neuromuscular blocking agents.

Caffeine has a multitude of uses in anaesthesia, and numerous studies have evaluated its efficacy and usefulness in various aspects of anaesthesia and medical practice. Its various applications in anaesthesia include its role in awakening from anaesthesia, managing post-dural puncture headache, managing post-sedation paradoxical hyper-activity in children, post-operative bowel paralysis, and apnoea in paediatric populations, that is, apnoea in infancy, paediatric obstructive apnoea, and post-anaesthetic apnoea in pre-mature infants. Though the effects of caffeine on bronchial smooth muscle, neurological, and cardio-vascular systems are well known, the relatively little-known effects on the endocrine and gastro-intestinal (GI) system have been recently taking primacy for eliciting its therapeutic benefits. The literature shows encouraging evidence in favour of caffeine, but unambiguous evidence of caffeine benefits for patients is lacking and needs further investigation. In this narrative review of literature, we summarise the available literature to provide insights into the pharmacokinetics, pharmacodynamics, clinical application of caffeine in modern anaesthetic practice, and evidence available in this field to date. An awareness of the various physiological effects, adverse effects, reported applications, and their evidence will widen the horizon for anaesthesiologists to increase its rational use and advance research in this field. Well-designed randomised controlled trials regarding the various outcomes related to caffeine use in anaesthesia should be planned to generate sound evidence and formulate recommendations to guide clinicians. [ABSTRACT FROM AUTHOR]

Introduction and Objective. General anesthesia is an integral part of many medical procedures. Its main premise is that it is completely reversible and has no effect on the human brain. Unfortunately, a number of scientific findings report potential effects of anaesthetics on the human nervous system. The aim of this review is to present the negative impact of sevoflurane (inhalation anaesthetic) and propofol (intravenous anaesthetic) on the human brain with an analysis of its mechanisms and factors, and possible methods of preventing this phenomenon. Review Methods. A review was undertaken of the most current literature using PubMed and Google Scholar databases, on the mechanism of action and the negative effects of sevoflurane and propofol on the brain and methods of its prevention. Included are both original works, reviews and case reports from Poland and worldwide. Brief description of the state of knowledge. Post-operative cognitive dysfunction affects 10-65% of patients. Sevoflurane and propofol have potentially damaging effects on the human brain. This occurs mainly through induction of neuronal cell apoptosis and disruption of synaprogenesis by affecting receptor proteins, cell organelles (mitochondria, endoplasmic reituclum) and signaling pathways (apoptotic and trophic) of neurons. However, this effect depends on the drug dose and patient-dependent factors (age, diseases, cognitive status before anaesthesia). Summary. Anaesthetics have potentially harmful effects on the human brain, although only in large and repeated doses. One should also not forget the much more notable effect of mechanical damage to tissues during surgery. In order to prevent cognitive dysfunction, both a detailed preoperative assessment of the patient's condition and the use of additional pharmacological and non-pharmacological measures during surgery are important. [ABSTRACT FROM AUTHOR]

Purpose: The need for anaesthesia or analgesia for performing hysteroscopy remains debatable. This study aimed to conduct an overview of the situation of anaesthesia for hysteroscopy in mainland China. Methods: Two questionnaires were separately designed for anaesthesiologists and gynaecologists and distributed to every medical institution that performed hysteroscopic procedures on patients with infertility in mainland China. Electronic questionnaires were distributed via WeChat, and data on anaesthesia regimen, monitoring parameters, procedure number, and other information were collected. Results: Reproductive technology is conducted by 536 institutions in mainland China. The survey received 491 responses from anaesthetists (91.6%) and 436 from gynaecologists (81.3%). In 2021, 552,225 hysteroscopies were conducted in 268 medical centres. The average percentage of hysteroscopy under anaesthesia is 63.8% in 2021, wherein 47.3% of institutions have an anaesthesia percentage of >75%. Propofol and opioid analgesics, such as fentanyl and sufentanil, were the most commonly used intravenous anaesthetics. All sedations were performed by anaesthesiologists. Monitoring parameters included pulse oxygen saturation (98.9%), electrocardiogram (91.6%) and noninvasive blood pressure (91.3%). An anaesthesiologist-to-operating room ratio of <1 was observed in 31.3% of medical institutions. Surprisingly, 52.4% of medical institutions performing hysteroscopy had no postanaesthesia care unit (PACU). Most institutions with PACU were equipped with independent oxygen sources, suction and monitors. Both rigid and flexible hysteroscopes (rigid hysteroscope, 45.1%; flexible hysteroscope, 4.5%; both types, 50.4%) were used, and the hysteroscopic diameter was ≤5 mm in 60.3% of medical centres. Conclusions: China performs a large number of hysteroscopies, and sedation is the most frequently used anesthesia regimen. However, issues such as inadequate emergency support devices, insufficient personnel and weak resuscitation management after anaesthesia, have been observed. [ABSTRACT FROM AUTHOR]

Ultrasound-guided techniques are increasingly prevalent and represent a gold standard of care. Skills such as needle visualisation, optimising the target image and directing the needle require deliberate practice. However, training opportunities remain limited by patient case load and safety considerations. Hence, there is a genuine and urgent need for trainees to attain accelerated skill acquisition in a time- and cost-efficient manner that minimises risk to patients. We propose a two-step solution: First, we have created an agar phantom model that simulates human tissue and structures like vessels and nerve bundles. Moreover, we have adopted deep learning techniques to provide trainees with live visualisation of target structures and automate assessment of their user speed and accuracy. Key structures like the needle tip, needle body, target blood vessels, and nerve bundles, are delineated in colour on the processed image, providing an opportunity for real-time guidance of needle positioning and target structure penetration. Quantitative feedback on user speed (time taken for target penetration), accuracy (penetration of correct target), and efficacy in needle positioning (percentage of frames where the full needle is visualised in a longitudinal plane) are also assessable using our model. Our program was able to demonstrate a sensitivity of 99.31%, specificity of 69.23%, accuracy of 91.33%, precision of 89.94%, recall of 99.31%, and F1 score of 0.94 in automated image labelling. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Allergology / Alergologia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: The Earth's mean surface temperature is already approximately 1.1°C higher than pre‐industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three‐stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high‐, middle‐ and low‐income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re‐evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references. [ABSTRACT FROM AUTHOR]

Background: Total intravenous anaesthesia in laparoscopic surgery is safer than open laparotomy operations because propofol, a sedative hypnotic agent with excellent recovery drug and having anti-emetic properties, and new synthetic opioids (fentanyl congeners) provide excellent analgesia; hence, TIVA has become more popular in laparoscopic surgery. Method: 45 adult patients aged between 18 to 65 undergoing laparoscopic surgery were studied. A solution of propofol containing different concentrations of sufentanil (1 µgm per ml and 2 µgmper ml) was infused. Patient's HR, SBP, DBP, MAP, and peripheral O2 saturation from the anaesthesia monitor was taken as a baseline measurement. All the hemodynamic parameters were recorded intra-operatively at different intervals of duration. Results: The changes in mean values of hemodynamic values were insignificant, and only significant parameters were noted. 158.12 (± 80.9) mean value time to rescue analgesia (in minutes) Post-surgical complications are 3 (6.6%) Nausea and vomiting Conclusion: Propofol, containing different concentrations of sufentanil, provides hemodynamic stability with the least post-surgical complications; hence, total intravenous anaesthesia is an ideal substitute for inhalation anaesthesia in laparoscopic surgery because inhalation anaesthesia has a higher risk of hemodynamic instability. [ABSTRACT FROM AUTHOR]

Health production faces two forever growing challenges, the increasing demands on limited resources on one side and the increasing cost of healthcare on the other side. Effective and efficient health resources allocation is required for a safe and distributive health. Health economic analysis facilitates decision-making by offering a decision-making framework assessing which health intervention provides the maximum clinical benefits at an economic cost. [ABSTRACT FROM AUTHOR]

Awake video-assisted thoracoscopic surgery (A-VATS) enables the surgeon to penetrate the tissue via a small incision and with less contact between the lung and atmospheric pressure; postoperative respiratory functions are also less affected than in open surgery. A-VATS is a safer technique than traditional VATS and non-intubated video-assisted thoracoscopic surgery (NI-VATS) because it does not require muscle relaxants and sedoanalgesics. In particular, diagnostic VATS for pleural effusions can be easily performed over a single port using only local anaesthetic. Anaesthesia-related risks increase even more for elderly patients and those with severe comorbidities. Although there are long and risky operations in thoracic surgery, general anaesthesia is not required for some thoracic surgery procedures. However, A-VATS is limited to minor procedures. Due to regional anaesthesia and sedation, NI-VATS is a safe and effective method for many indications. The results show that this method can be applied with low mortality and morbidity. [ABSTRACT FROM AUTHOR]

We report the case of an elderly woman who developed recurring episodes of unexplained cardiocirculatory arrest. The index event appeared during surgery to fix a fracture of the ankle and consisted of bradypnea, hypotension and asystole, coherent with a Bezold–Jarisch-like cardioprotective reflex. Classical signs of acute myocardial infarction were absent. Yet, occlusion of the right coronary artery (RCA) was observed and successfully revascularized, whereupon circulatory arrests vanished. We discuss several differential diagnoses. Unexplainable circulatory failure, with sinus bradycardia and arterial hypotension, despite lack of ECG signs of ischemia or significant troponin levels, suggest the action of cardioprotective reflexes of the autonomic nervous system. Coronary artery disease is a common source. Attention to cardioprotective reflexes should be taken in the case of unexplained cardiac arrest without overt reasons. We recommend performing coronary angiography to exclude significant coronary stenosis. [ABSTRACT FROM AUTHOR]

Background: Post-operative delirium (POD) is an acute brain failure which may occur following major surgery, with serious implications for participants and caregivers. Evidence regarding optimal anaesthetic management for older participants at higher risk of POD is conflicting. We conducted a feasibility study of our protocol in 5 centres to guide sample size estimation and inform future recruitment strategies for a larger cohort study. Methods: Participants aged over 65 and scheduled for major surgery were recruited. They were assessed pre-operatively for delirium, cognitive impairment, depression, comorbidity, activity levels and alcohol use. Details of management during surgery, all medications and complications were recorded by a trainee-led research team. Participants were assessed for delirium in the immediate recovery period and then on post-operative days 1–4 using the 4 question attention test (4AT) with complications assessed at day 4 using the post-operative morbidity survey (POMS). Primary outcomes were the incident rates of POD. Secondary outcomes were number of eligible patients, recruitment rates and retention rates throughout the study, time required for data collection, preoperative risk factors assessment and daily postoperative delirium assessments. Also to assess the added value of employing the regional trainee research network (INCARNNET) to deliver the study. Specifically, what proportion of patient consent, data collection and post-operative testing is performed by anaesthesia trainees from this group, especially the success of weekend delirium assessment by trainees? A survey was completed at the end of the study by the trainees involved regarding their involvement in the study. Results: Ninety-five participants were recruited, of whom 93 completed the study. Overall, POD occurred in 9 patients. Of these, three were detected in recovery and six on post-op days 1–4. Median length of stay was 6 days. Recruitment rates were high in all but one site. 59 (62%) participants were consented by trainees and 189 (63%) of post op delirium assessments were performed by trainees. A total of six patients declined the study (in a follow up survey of trainees). Pre-existing cognitive impairment, depression and problem drinking were detected in 4(4.3%), 3(3.2%) and 5(5.37%) participants, respectively. Co-morbidity was common with 55(59%) in class three or four of the geriatric index of morbidity. Overall, from a total of 641 data points, levels of missing data were as follows, site A = 9.3%, B = 13.5%, C = 15.4%, D = 10.9%, E = 11.1% (data could not be completed retrospectively). Conclusions: A multi-centre observational cohort study of delirium carried out by UK trainee anaesthetists is feasible. Patients are content to undergo day of surgery consent and multiple short questionnaires pre-operatively. Proposed data, especially pharmacological, should be carefully considered for their relevance to modifiable mechanisms that can lead to POD. Future research to enable prognostic modelling of POD should involve large scale cohort studies of enriched populations to capture a higher POD incidence. POD remains a common complication in older persons undergoing major surgery in the UK and studies of interventions are urgently needed. Trial registration: All methods were carried out in accordance with relevant guidelines and regulations. The study was retrospectively registered with ISRCTN94663125 on 07/02/2018. [ABSTRACT FROM AUTHOR]