Pterygopalatine fossa block and dexmedetomidine as components of stress-limiting anesthesia in ophthalmic surgery

BACKGROUND: To date, surgical interventions continue to be accompanied by a high proportion of complications and even death. In half of the cases, mortality and serious postoperative complications could have been prevented. After a comprehensive study of the factors affecting the prolongation of hospitalization and rehabilitation (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), surgical stress response was identified as the most significant inducer of dysfunction among various organs and systems. General anesthesia, in its classical sense, is not able to provide patients with complete protection against surgical trauma. Comprehensive protection can be obtained through a combination of general and local anesthesia and stress-protective drugs. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the proposed scheme of stress-limiting anesthesia in ophthalmic surgery patients with corneal transplantation. MATERIALS AND METHODS: This study provides a comparative characterization of the severity of the stress response and pain syndrome in patients operated under the conditions of classical general anesthesia (group K) and those who received the scheme of stress-limiting anesthesia (group DB). Multicomponent anesthesia was administered in both groups. Sibazone was used for sedation in group K, whereas dexmedetomidine was used in group DB. The patients in group DB underwent local anesthesia before surgery. The main criteria for assessing the results were as follows: hemodynamic stability, blood glucose, level of venous blood leukocytes, and severity of pain according to the VAS in the postoperative period. RESULTS: Both schemes helped avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. The analysis of blood glucose and leukocyte counts showed that patients in group K had a more significant deviation for both indicators from the preoperative level than those in group DB. In the study of pain syndrome, group K showed higher levels of pain according to the VAS than group DB. CONCLUSION: The scheme of stress-limiting anesthesia enables the control of postoperative pain without the additional use of narcotic analgesics and blockades in the postoperative period.

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STRESS-LIMITING ANESTHESIA IN OPHTHALMOSURGERY

World Science ◽

10.31435/rsglobal_ws/30032021/7511 ◽

2021 ◽

Author(s):

Mynka N. V. ◽

Kobelyatskyy Yu. Yu.

Keyword(s):

Blood Glucose ◽

Stress Response ◽

General Anesthesia ◽

Surgical Stress ◽

Pain Syndrome ◽

Control Group ◽

Surgical Trauma ◽

Complete Protection ◽

Surgical Stress Response ◽

Anesthesia Group

Despite the significant advances made by modern anesthesiology in the perioperative management of patients, surgical interventions are still accompanied by a high proportion of complications and even deaths. At the same time, it is known that in 50% of cases mortality and serious postoperative complications could be prevented. After performing a thorough study of the factors affecting the increase in hospitalization and postoperative recovery (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), it was determined that the surgical stress response is the most significant inducer of dysfunction of various organs. and systems. To date, it has been established that general anesthesia in its classical sense does not allow achieving complete protection of the patient from surgical trauma. More complete protection can be achieved by combining general anesthesia with regional blockages and adjuvant drugs with stress-protective properties. In the present study, we compared the severity of the surgical stress response and pain syndrome in patients operated on under conditions of multicomponent balanced general anesthesia (group K) with patients who received a stress-limiting anesthesia regimen (group DB). In both groups, multicomponent anesthesia was performed, in group K, sibazone was used for sedation, in group DB, dexmedetomidine was used. Also, patients of the DB group underwent regional blockade (blockade of the pterygo-palatine fossa) before surgery. The main criteria for evaluating the results were: hemodynamic stability, blood glucose, the level of venous blood leukocytes and the severity of pain according to the VAS in the postoperative period. Both schemes made it possible to avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. When analyzing blood glucose and leukocyte counts, it was found that patients in the control group had a more significant deviation of both indicators from the preoperative level than in the stress-limiting anesthesia group. In the study of pain syndrome, it was determined that in the control group the level of pain according to the VAS was higher at all stages of the study compared to patients in the group of stress-limiting anesthesia.

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Comparative Study of Intra Operative Blood Sugar Level in Spinal Anesthesia and General Anesthesia in Patients undergoing Elective Surgery

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i2.20945 ◽

2018 ◽

Vol 3 (2) ◽

pp. 458-462

Author(s):

Akriti Bajracharya ◽

Surendra Mohan Sharma ◽

Surinder Nath Bawa ◽

Lalit Kumar Rajbanshi ◽

Batsalya Arjyal

Keyword(s):

Blood Glucose ◽

Stress Response ◽

Comparative Study ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Blood Sugar ◽

Blood Sugar Level ◽

Capillary Blood ◽

Capillary Blood Glucose ◽

Anesthesia Group

Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced more increase in blood sugar level compared to base line value which was statistically significant (P<0.05). Similarly, Glycaemia was significantly higher in the General anesthesia group (p < 0.05) when compared with Spinal Anesthesia group suggesting poor control of stress response during general anesthesia.Conclusion: Based on capillary blood glucose level, spinal anesthesia proved more effective in suppressing stress response as compared to general anesthesia in elective surgical patients. BJHS 2018;3(2)6: 458-462

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Evaluation Of Anxiety During Nasal Pack Removal In Patients Operated Under Local Versus General Anesthesia

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2018070 ◽

2018 ◽

Vol 08 (04) ◽

pp. 226-230

Author(s):

Amer Sabih Hydri ◽

Muhammad Junaid Alam ◽

Iqbal Hussain Udaipurwala ◽

Furqan Mirza

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Rating Scale ◽

Military Hospital ◽

General Anesthesia Group ◽

Nasal Pack ◽

Assessment Scores ◽

Anesthesia Group ◽

Group B ◽

Hamilton Anxiety

Objective: To evaluate the anxiety experienced before, during and after conventional paraffin gauze nasal pack removal in patients operated under local versus general anesthesia. Study design: Comparative study. Place and duration of study: Department of ENT, Combined Military Hospital Sialkot and PAF Hospital Shorkot from July 2017 to June 2018. Material and methods: A total of 120 patients planned for Septoplasty were enrolled and divided into two groups. Sixty patients were to be operated under local anesthesia (Group A) while the other 60 were undergoing the same procedure under general anesthesia (Group B). Conventional paraffin gauze nasal packing was done for 24 hours in all 120 patients. Hamilton Anxiety Rating Scale (HAM-A) was used to determine the patients’ anxiety in both groups, 1 hour pre-operatively, immediately before and 1 hour after nasal pack removal. Results: The mean Hamilton Anxiety Scale assessment scores in both groups were of ‘mild’ category. The highest scores in both groups were observed immediately before nasal pack removal, with a range of 15-18, while the lowest scores in both groups were documented one hour after pack removal with a range of 13-16. Anxiety level in patients operated under general anesthesia was slightly lower than patients administered local anesthesia mean score of 16.40 ± 0.763 vs 17.21 ± 0.666 (p<0.001). Conclusion: Anxiety during nasal pack removal is mainly associated with prior pain experienced during nasal pack insertion. It is recommended that proper analgesia, adequate topical anesthesia, gentle insertion would make this process less distressing and will subsequently result in less anxiety at its removal.

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The Effect of Sevoflurane Anesthesia for Dental Procedure on Neurodevelopment in Children: A Prospective, Equivalence, Controlled Trial

10.21203/rs.3.rs-78114/v1 ◽

2020 ◽

Author(s):

Pinping Zhou ◽

Chao Zhang ◽

Guijin Huang ◽

Yuan Hu ◽

Wenzhu Ma ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Primary Outcome ◽

Controlled Trial ◽

Age Groups ◽

Outcome Data ◽

Clinical Trial Registry ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference

Abstract Background: Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to investigate whether DGA in children has an adverse effect on neurodevelopment.Methods: In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurodevelopment of children at six months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. Predefine the 95% CI of a difference in means within five (1/3 SD) as the equivalence margin.Results: The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110 – 160). There was equivalence in means of FSIQ score between the general anesthesia group and the local anesthesia group (local minus general anesthesia 0.46, 95% CI -2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother's education could affect the primary outcome.Conclusions: In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurodevelopment at six months after surgery compared with awake-local anesthesia. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018, http://www.chictr.org.cn/showproj.aspx?proj=24830.

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Clinical, Surgical Characteristics and Long-Term Outcomes of Lumbar Hernia.

10.21203/rs.3.rs-107783/v1 ◽

2020 ◽

Author(s):

Chaoyong Shen ◽

Guixiang Zhang ◽

Sen Zhang ◽

Yuan Yin ◽

Bo Zhang ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Lumbar Hernia ◽

Consecutive Series ◽

Long Term Outcomes ◽

Anesthesia Group ◽

History Of ◽

Group A ◽

Group B

Abstract Background/AimLumbar hernia is extremely rare which resulting from a defect in the abdominal wall. Due to its rarity, there is no established optimal treatment available for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients in our hospital. MethodsPatients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. ResultsA consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46.4%) and 15 females (53.6%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6±14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39.3%), 15 (53.6%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89.3%) and 3 (10.7%) patients. General anesthesia was applied in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5±1.3 days vs. 7.1±3.2 days, p=0.001), as well as total hospitalization expenses between the two groups (8309.3±1467.1 CNY vs. 19117.3±8116.1 CNY, p<0.001). ConclusionsLumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia, and it may be more suitable than general anesthesia in some selected cases.

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Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

PLoS ONE ◽

10.1371/journal.pone.0257279 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257279

Author(s):

Guangquan An ◽

Yiwen Zhang ◽

Nuoya Chen ◽

Jianfeng Fu ◽

Bingsha Zhao ◽

...

Keyword(s):

Blood Glucose ◽

General Anesthesia ◽

Pain Threshold ◽

Thoracoscopic Surgery ◽

Glucose Levels ◽

Video Assisted ◽

Blood Glucose Levels ◽

Anesthesia Group ◽

Intraoperative Pain ◽

Video Assisted Thoracoscopic Surgery

Background Reducing intra-operative opioid consumption benefits patients by decreasing postoperative opioid-related adverse events. We assessed whether opioid-free anesthesia would provide effective analgesia-antinociception monitored by analgesia index in video-assisted thoracoscopic surgery. Methods Patients (ASA Ⅰ-Ⅱ, 18–65 years old, BMI <30 kg m−2) scheduled to undergo video-assisted thoracoscopic surgery under general anesthesia were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine, sevoflurane plus thoracic paravertebral blockade or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and thoracic paravertebral blockade. The primary outcome variable was pain intensity during the operation, assessed by the depth of analgesia using the pain threshold index with the multifunction combination monitor HXD‑I. Secondary outcomes included depth of sedation monitoring by wavelet index and blood glucose concentration achieved from blood gas. Results One hundred patients were randomized; 3 patients were excluded due to discontinued intervention and 97 included in the final analysis. Intraoperative pain threshold index readings were not significantly different between group OFA and group OA from arriving operation room to extubation (P = 0.86), while the brain wavelet index readings in group OFA were notably lower than those in group OA from before general anesthesia induction to recovery of double lungs ventilation (P <0.001). After beginning of operation, the blood glucose levels in group OFA increased compared with baseline blood glucose values (P < 0.001). The recovery time and extubation time in group OFA were significantly longer than those in group OA (P <0.007). Conclusions This study suggested that our OFA regimen achieved equally effective intraoperative pain threshold index compared to OA in video-assisted thoracoscopic surgery. Depth of sedation was significantly deeper and blood glucose levels were higher with OFA. Study’s limitations and strict inclusion criteria may limit the external validity of the study, suggesting the need of further randomized trials on the topic. Trial registration: ChiCTR1800019479, Title: "Opioid-free anesthesia in video-assisted thoracoscopic surgery lobectomy".

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Effect of regional anesthesia as a component of multimodal pain relief on the cognitive status of patients in ophthalmic surgery

Regional Anesthesia and Acute Pain Management ◽

10.17816/1993-6508-2021-15-1-49-56 ◽

2021 ◽

Vol 15 (1) ◽

pp. 49-56

Author(s):

Ganna S. Dorofeeva ◽

Yuriy Yu. Kobelyatskyy

Keyword(s):

General Anesthesia ◽

Regional Anesthesia ◽

Postoperative Period ◽

Cognitive Functions ◽

Gas Flow ◽

Initial Level ◽

Cognitive Status ◽

Ophthalmic Surgery ◽

Group B ◽

Group D

This article examines and analyzes the dependence of the state of the central nervous system (CNS) in the postoperative period in patients who underwent penetrating keratoplasty. MATERIAL AND METHODS: The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment BatteryFAB) and a short scale for assessing mental status (Mini-Mental State ExaminationMMSE). The results were assessed on the eve of the operation, 6 h after the operation, and 7 and 21 days after the operation. Depending on the applied method of anesthesia, several groups were identified. In group d, general anesthesia (OA) was used with dexmedetomidine infusion 40 min before surgery. In group b (before surgery), a wing-palatine fossa block was performed 20 min, in addition to general anesthesia. Anesthesia was maintained with sevofluraneoxygen mixture at a low gas flow. The groups were statistically comparable in terms of age and gender. The depth of anesthesia and sedation was assessed using the bispectral index and analgesia nociception index, respectively. RESULTS: According to the results of testing on the MMSE and FAB scales, the cognitive indicators in the first 6 h after surgery were higher in group d than in group b. However, by day 21, these indicators differed slightly (p 0.05). Thus, the following tendencies were observed in group b 6 h after the operation: a decrease in indicators on the MMSE scale by 20.8% and on the FAB scale by 28.6% from the initial level. For group d, the indicators on the MMSE scale were reduced by 8.3%, and those on the FAB scale were reduced by 13.3% at the same stage of the study. When testing on the same scales 21 days after surgery, the indicators of cognitive functions were restored to the initial level in both groups. CONCLUSION: The levels of cognitive functions of ophthalmic surgical patients after surgery involving regional anesthesia and dexmedetomidine differed significantly in the first hours of the postoperative period. After 21 days, the neuropsychological status did not differ significantly (p 0.05).

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THE INFLUENCE OF COMPLEX IMPLEMENTATION OF THE ERAS PROGRAM ON THE SURGICAL STRESS RESPONSE FACTORS IN PEDIATRIC PATIENTS UNDERGOING ELECTIVE LIMB SURGERY

Pain anesthesia and intensive care ◽

10.25284/2519-2078.3(96).2021.242139 ◽

2021 ◽

pp. 28-37

Author(s):

I.V. KYSELOVA ◽

A.V. BILIAIEV

Keyword(s):

Blood Glucose ◽

Stress Response ◽

Postoperative Period ◽

Enhanced Recovery ◽

Surgical Stress ◽

Length Of Hospital Stay ◽

Control Group ◽

Study Group ◽

Surgical Stress Response ◽

Beta Hydroxybutyrate

Surgical stress response, fluid and nutritional balance, and pain management are among the key factors influencing on the postoperative period. These areas are reflected in the Enhanced Recovery After Surgery (ERAS) concept, which is based on a set of measures aimed at minimizing the surgical stress response. The lack of ERAS recommendations for the pediatric population of surgical patients prompts to search for a solution of adaptation and implementation of the ERAS programs in children. The aim of the study. To determine the effectiveness of the complex application of the enhanced recovery after surgery by studying its influence on the factors of the surgical stress response in pediatric patients undergoing limp surgery. Materials and methods. The prospective randomized study included 47 patients aged 1 to 17 years. In the study group (n = 22), the ERAS program was used, which consisted of 14 components of preoperative, intraoperative and postoperative measures. In the control group (n = 25), the complex of all ERAS components was not purposefully applied. We compared glycaemic stress index (GSI) and length of hospital stay after surgery (LOS) as a primary outcome; secondary outcomes were fasting time after drinking fluids before induction of anesthesia, estimated fluid deficiency just before induction of anesthesia, hemodynamic parameters, the need for opioids during and after surgery, blood glucose and beta-hydroxybutyrate in the beginning and in the end of the surgery and next day morning after surgery, postoperative nausea and vomiting. Results. GSI was significantly less in the study group (1,62 ± 0,78 vs 2,12 ± 0,93, р=0,046). LOS in the study group was 37.5% less than in the control group (p = 0.002). The period of preoperative fasting and fluid deficit in the patients of the study group were shorter. The needs of fentanyl intraoperatively in the study group was 47% less (p<0.001). At the beginning of surgery, the study group had a higher blood glucose concentration and a higher systolic blood pressure. At the end of surgery, blood glucose and beta-hydroxybutyrate in the study group was lower than in the control group. In the postoperative period, 9% of patients in the study group and 36% of patients in the control group complained of nausea (p = 0.041). Linear regression analysis showed a linear relationship between the LOS after surgery and the GSI (R=0,515, R2=0,266, B=2,156, 95% CI 1,04 – 3,27, p<0,001). Results. The implementation of the ERAS program to children 1-17 years old undergoing elective limp surgery may reduce the effect of the surgical stress reaction by reducing the period of preoperative fasting, fluid deficiency, the needs of opioids and postoperative nausea. Minimizing the surgical stress response may facilitate the achievement of hospital discharge criteria and shorten the length of hospital stay in the postoperative period.

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The experience of using dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.1.227950 ◽

2021 ◽

Vol 26 (1) ◽

pp. 128-135

Author(s):

N.V. Mynka ◽

Yu.Yu. Kobelyatskyy

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Postoperative Nausea ◽

Corneal Transplantation ◽

Postoperative Nausea And Vomiting ◽

Pain Syndrome ◽

Nausea And Vomiting ◽

Ophthalmic Surgery ◽

Intraoperative Pain ◽

Group D

Various techniques are applied to reduce the severity of postoperative pain and discomfort in patients. The purpose of this research work was to evaluate the effectiveness and safety of Dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. The study included 80 patients who underwent corneal transplantation on the basis of Dnepropetrovsk Regional Clinical Ophthalmologic Hospital. Patients were divided into 2 groups: control (group K) – 30 men and main (group D) – 50 ones. Multicomponent balanced anesthesia was applied in both groups. Sibazone was administered as the sedative medicine in the group K, Dexmedetomedin was administered in the group D. The main criteria for evaluating the research results were hallmarked: hemodynamic stability during surgery, the amount of administered opiates, the severity of intraoperative pain syndrome by evaluating the ANI index (ANI – analgesia nociception index), the severity of postoperative pain syndrome and the frequency of postoperative nausea and vomiting (PONV). Both schemes of anesthesia allowed avoiding pronounced fluctuations in hemodynamic parameters and gas exchange at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group K pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the surgery, while in group D the ANI index did not fall below 50. Statistically significant differences were obtained on minute 1, 2, 5, 6, and 7 of the surgery. The number of episodes of insufficient anesthesia during the most traumatic stage of the surgery in group K was statistically significantly higher than in group D. Analyzing the quality of pain relief in the postoperative period it was determined, that the level of pain on the Visual Analog Scale (VAS) after awakening in both groups was equal to 0. At the next three stages of the study (2 hours, 6 hours after surgery, and the next morning), the level of pain in group K was significantly higher than in group D. In addition, it was determined that the need for narcotic analgesics and the number of episodes of postoperative nausea and vomiting in group K was statistically significantly higher than in group D. These given data allow us to conclude that Dexmedetomedin is the effective adjuvant of the anesthesia for corneal transplantation.

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Tonsilloectomy and general anesthesia

Kazan medical journal ◽

10.17816/kazmj52763 ◽

1930 ◽

Vol 26 (3) ◽

pp. 329-329

Author(s):

B. Goland

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Surgical Trauma ◽

Intravenous Anesthesia ◽

Inhalation Anesthesia ◽

Mental Trauma

Abstracts. Otorhinolaryngology. Tonsilloectomy and general anesthesia. Hirsch (D. m. Woch., 1929, No. 9) comes to the conclusion that local anesthesia for tonsilloectomy is preferable to general anesthesia in all respects, and for the relief of mental trauma, he advises the preliminary use of skopolamin'a (0.001), eukodal'fl (0.002 ), ephetonin (0.05). If the author wishes to completely destroy the mental surgical trauma, the author prefers intravenous anesthesia of agertin'oM or pernokton'oM with the inhalation of a few drops of solasthin before ordinary inhalation anesthesia.

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