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Aim: The objective of this research was to compare two methods of conscious sedation (midazolam vs. sevoflurane) used for performing oral surgical procedures in the older adult population by analyzing dental treatment-related anxiety levels, the quality of sedation, and potential hemodynamic changes during the interventions, as well as post-recovery symptoms and patient satisfaction levels. Methods: A total of 104 patients underwent oral surgery with intravenous (age: 84.00 ± 8.410; 17 men and 36 women) and inhalation conscious sedation (age: 82.73 ± 8.809; 18 men and 33 women). Anxiety levels were recorded using the Modified Corah Dental Anxiety Scale (MDAS) and the Hamilton Anxiety Rating Scale (HARS). During the intervention, the heart rate, systolic/diastolic blood pressure, oxygen saturation, episodes of hypoxia (<90%SpO2), sedation duration, and Sedation–Agitation Scale (SAS) values were monitored. Upon completion of their treatment, all patients completed three questionnaires which evaluated their recall of the intervention, postoperative symptoms, and recommendation of the sedation method used. Results: Anxiety levels were slightly higher in the midazolam group (MDAS score: 9.60 ± 5.849; HARS score: 27.19 ± 6.802) compared to the sevoflurane group (MDAS score: 8.37 ± 5.063; HARS score: 24.92 ± 5.199), with no statistical significance (MDAS, p = 0.453/HARS, p = 0.065). No significant differences in the analyzed hemodynamic parameters were observed between the two groups. However, SAS values were significantly higher in the sevoflurane group (p = 0.006), while the sedation duration was longer in the midazolam group (p = 0.000). Postoperative symptoms, particularly gastrointestinal disturbances and dry mouth, were significantly more prevalent in the midazolam group, while there were no differences in neurological symptoms between the two groups. The majority of patients expressed a preference for either of these sedation methods. Conclusions: Sedation with agents such as midazolam and sevoflurane appears to be quite safe, given the absence of relevant hemodynamic changes. Midazolam has been shown to be effective for a longer duration, as well as to have a lower risk of developing greater digestive problems during the postoperative period. On the contrary, sevoflurane produced a greater sensation of dry mouth. Both sedative agents are perceived by the older adult population as satisfactory, recommending their use. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate risk factors for postoperative pain and nausea after open repair for primary ventral hernias. Method: A population-based registry study was conducted based on data assembled from the Swedish national ventral hernia repair register between January 2016 and December 2021and cross-matched with the Swedish perioperative register. Results: Altogether 2064 open ventral hernia repairs were registered, including 816 (39.5%) performed on women. Of these, 91 (4.4%) were registered to suffer postoperative nausea or vomiting (PONV) and 403 (19.5%) postoperative pain (PP). In both univariable and multivariable logistic regression analyses, significant predictors of postoperative nausea and pain included male gender, which was associated with lower odds of both postoperative nausea (multivariable OR: 0.30, 95% CI: 0.18–0.49, P < 0.001) and postoperative pain (multivariable OR: 0.60, 95% CI: 0.44–0.83, P = 0.002). Additional predictors of postoperative nausea included emergency surgery (multivariable OR: 4.08, 95% CI: 1.10-15.08, P = 0.035), operative time > 40 min (multivariable OR: 4.15, 95% CI: 2.24–7.69, P < 0.001). Conversely total intravenous anesthesia was associated with lower incidence of PONV (multivariable OR: 0.40, 95% CI: 0.22–0.74, P = 0.003). Other factors, such as age, BMI, smoking status, ASA classification, hernia size, surgery type, operative time, and anesthesia type, were not significantly associated with postoperative pain after adjusting for other variables. Conclusion: Postoperative nausea and vomiting (PONV) are significantly reduced with total intravenous anesthesia (TIVA) compared to inhalation anesthesia, with no notable difference in postoperative pain between the two methods. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the effectiveness of integrating GASMAN anesthesia simulation software with case-based learning (IGC) compared to traditional lecture-based learning (LBL) in teaching inhalation anesthesia to undergraduate anesthesiology students.MethodsFourth-year students from two academic years (2022, n = 110; 2023, n = 131) enrolled in a five-year anesthesiology program were assigned to either traditional lecture-based learning (LBL) or IGC groups. The LBL group received traditional lectures using PowerPoint slides, while the IGC group engaged with GASMAN anesthesia simulation software (a tool designed for anesthesia simulation and gas monitoring) combined with case-based learning. The cases used in the IGC group were structured around realistic clinical scenarios, simulating real-world challenges in inhalation anesthesia. These scenarios were integrated with the GASMAN software to provide interactive simulations, enhancing students’ understanding of pharmacokinetics and pharmacodynamics. Teaching effectiveness was evaluated through expert assessments and student feedback, with learning outcomes compared via post-course assessments.ResultsThe IGC group scored significantly higher in student evaluations in areas such as comprehending and mastering theoretical knowledge, resolving clinical challenges, nurturing clinical reasoning, increasing learning interest, enhancing learning efficiency, consolidating memory, improving analytical skills, and refining application proficiency (adjusted P < 0.001), however, there were no significant differences between the two groups in the improvement of practical skills. Post-course test scores were also higher in the IGC group for both total post-course test and subjective questions scores (adjusted P < 0.001), though no difference was found for objective question scores. After applying false discovery rate (FDR) correction, expert evaluation scores showed no significant differences between the two groups.ConclusionThe integration of GASMAN software with case-based learning significantly enhances the quality of inhalation anesthesia education by improving student engagement, critical thinking, and conceptual understanding. This approach demonstrates promise for advancing clinical education, although further research is needed to evaluate its long-term impact.

To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children. Prospective observational clinical pilot-study. University Children's Hospital of Lyon, France. Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia. After the beginning of Guedel's stage 3 of anesthesia, several settings were applied for 60 s in the following systematic order: spontaneous breathing when applying a facemask (SB-Mask), then PEEP 4 cmH 2 O, PSV 4 cmH2O above PEEP 4 cmH 2 O, and PSV 4 to 7 cmH 2 O above PEEP 4 cmH 2 O, at the anesthesiologist's discretion. Children were monitored using Electrical Impedance Tomography (EIT; Pulmovista 500, Dräger, France). Tidal volume (TV), dorsal fraction of the ventilation, and end-expiratory lung impedance (EELI) were assessed with the ventilator and EIT. Twenty-two patients were included (20 analyzed), their median [IQR] age was 21 [14–36] months. TV did not significantly differ between the settings. The increase in EELI was greater with PSV (+0.60 [0.48–0.91] arbitrary units) than with PEEP 4 cmH 2 O alone (+0.39 [0.20–0.06] arbitrary units, p = 0.005), and did not change with increased level of PSV (+0.66 [0.40–1.22] arbitrary units). The dorsal fraction of lung ventilation decreased using PSV, from 56 % [45–63] with SB-mask to 53 % [43–56] with PSV 4cmH 2 O (p = 0.002) and 47 % [40–55] with PSV 7cmH 2 O (p = 0.001). The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV. •. Effect of pressure support (PS) and PEEP on ventilation distribution during inhalational induction of anesthesia is unknown • We evaluated the effects of PEEP and PSV on lung volume and ventilation distribution using electrical impedance tomography. • PS during inhalational induction of anesthesia may restore the end-expiratory lung volume independently from the increase in tidal volume. [ABSTRACT FROM AUTHOR]