Duration of Exposure to General Endotracheal Anesthesia during Cesarean Deliveries at Term and Perinatal Complications

Objective To examine whether the duration of time from initiation of general endotracheal anesthesia (GETA) to delivery for cesarean deliveries (CDs) performed is related to perinatal outcomes. Study Design This is a retrospective study of patients with singleton nonanomalous gestations undergoing CD ≥37 weeks of gestation under GETA with reassuring fetal status at a single tertiary care center from 2000 to 2016. Duration from GETA initiation until delivery was calculated as the time interval from GETA induction to delivery (I-D), categorized into tertiles. Outcomes for those in the tertile with the shortest I-D were compared with those in the other two tertiles. The primary perinatal outcome was a composite of complications (continuous positive airway pressure or high-flow nasal cannula for ≥2 consecutive hours, inspired oxygen ≥30% for ≥4 consecutive hours, mechanical ventilation, stillbirth, or neonatal death ≤72 hours after birth). Secondary outcomes were 5-minute Apgar score <7 and a composite of maternal morbidity (bladder injury, bowel injury, and extension of hysterotomy). Bivariable and multivariable analyses were used to compare outcomes. Results Two hundred eighteen maternal–perinatal dyads were analyzed. They were dichotomized based on I-D ≤4 minutes (those in the tertile with the shortest duration) or >4 minutes. Women with I-D >4 minutes were more likely to have prior abdominal surgery and less likely to have labored prior to CD. I-D >4 minutes was associated with significantly increased frequency of the primary perinatal outcome. This persisted after multivariable adjustment. In bivariable analysis, 5-minute Apgar <7 was more common in the group with I-D >4 minutes, but this did not persist in multivariable analysis. Frequency of maternal morbidity did not differ. Conclusion When CD is performed at term using GETA without evidence of nonreassuring fetal status prior to delivery, I-D interval >4 minutes is associated with increased frequency of perinatal complications. Key Points

Optimization of the approach to conducting tonsillectomy

Actuality: Recurrent tonsillitis considers to be one of the most common ENT diseases. Tonsillectomy as the method of recurrent tonsillitis’ treatment is being performed as usual as 20% of all surgeries in ENT departments. The critical criteria for the success of tonsillectomy for the surgeon are the frequency of perioperative complications, long-term results of treatment, and the patient's recovery time. For the patient, those criteria are the severity of pain, psychoemotional stress, the time spent in the hospital, and how fast he can return to his daily life routine. The factors that significantly affect the outcome of tonsillectomy are the choice of anesthetic management and perioperative medical hemostatic support. Aim: Our study aimed to optimize the approach to carry out tonsillectomy by preoperative application of the tranexamic acid 10% solution and optimize the approach to choosing between endotracheal anesthesia and local anesthesia. Materials and methods: Clinical studies were made among 212 patients with recurrent tonsillitis who went through a bilateral tonsillectomy. The patients were divided into three groups. The 1st group included 54 patients undergoing tonsillectomy using endotracheal anesthesia with the administration of tranexamic acid at the rate of 10 mg/kg of body weight. The 2nd group consisted of 97 patients undergoing tonsillectomy using local anesthesia. A 3rd (control) group included 61 patient undergoing tonsillectomy using endotracheal anesthesia. The first and control (3rd) groups of patients were compared to assess the efficacy of using tranexamic acid.Factors such as the duration of the surgery, the amount of blood loss, intraoperative events, the number of incidents of primary and secondary bleeding, and laboratory data were considered. The second and control (third) groups were compared to evaluate the impact of anesthetic management. We considered the factors such as duration of surgery, the amount of blood loss, intraoperative events, number of incidents of primary and secondary bleeding, assessment of pain syndrome, necessity of analgesics administration, length of hospital stay, and recovery period. Conclusions: tonsillectomy surgery using local anesthesia requires less time to perform, has less blood loss, fewer intraoperative events, and lessincidents of primary and secondary bleeding. The average level of pain is higher in patients using endotracheal anesthesia. The use of tranexamic acid 10% significantly reduces the amount of blood loss, helps to reduce intraoperative complications, and lower the emergence of postoperative bleeding and its intensity.

THE FREQUENCY OF HYPOTHERMIA IN LAPAROSCOPIC PARTIAL GASTRECTOMY AT CHO RAY HOSPITAL, YEAR 2021

Introduction: Currently, the hypothermia in laparoscopic gastrectomy has not been given due attention, leading to a high rate of postoperative hypothermia. Therefore, the care, monitoring and intervention to reduce the rate of hypothermia during and after surgery is one of the issues that need attention. Objectives: The study was carried out with 2 objectives: (1) Determining the rate of hypothermia in patients during laparoscopic partial gastrectomy at Cho Ray Hospital; (2) Understanding risk factors for hypothermia in laparoscopic partial gastrectomy patients. Methods: Descriptive cross-sectional study on 65 laparoscopic partial gastrectomy patients under general endotracheal anesthesia, from February 2021 to July 2021. The temperature was continuously measured and noted every 30 minutes from induction to the end of surgery by esophageal probe. Results: In the study, all patients were under endotracheal anesthesia, The proportion of the age group 70 years and older is 35.38%, the rate of male 76.92%. The average anesthetic time was 166,77±44,05 minutes, the mean surgery time was 145,0±42,70 minutes. The average temperature of the operating room is 23,79°C. The rate of 87,69% of patients was warmed with just a sheet. Research results show that the rate of hypothermia in patients after surgery is 72,31%. Factors related to the rate of hypothermia include age group over 70, smoking, method of warming, BMI, operating room temperature. Conclusion: Need to monitor the body-temperature and use continously critacal warming methods the prevent the hypothermia during and after gastrectomy surgery patients.

Ovarian Cysts Management Following Laparoscopic Surgery

Objective: To analyze diagnostic and surgical outcomes in patients with extremely large ovarian cysts treated by laparoscopic surgery. Methods: A total of 120 cases of large adnexal masses and suspected for malignancy were treated laparoscopically at the at general surgery department of Liaquat University of Medical & Health Sciences. Under endotracheal anesthesia, all surgeries were performed using nasogastric tubes in the stomach. An incision of approximately 1.5 centimeter was made at the supraumbilical or umbilical region and peritoneal cavity was approached. The intra-abdominal approach in all cases was cautiously standardized. The resection of the adnexal mass was performed as per routine method. Results: 12 females were premenopausal and 8 were postmenopausal. 12 women presented with the signs of urinary retention, urinary urgency and abdominal pain. Incidental sonography detected cysts in 8 patients which were asymptomatic. The average volume of the resected cystic fluid was 3000ml (range 900 to 9000 ml). The specimens of frozen section were obtained within the surgical procedure in all patients except 2 patients having para-ovarian cysts. The histopathology presented mucinous benign cystadenoma. There was no blood loss and related other complications reported in all operations. Conclusion: Laparoscopic management of large ovarian cyst observed to a effective, feasible and less complicated surgical option. However accurate selection and diagnosis of the patients, the any ovarian cyst size can be treated easily via laparoscopic surgery.

Maternal and perinatal outcomes in repeated cesarean section

Aim. To analyze the maternal and perinatal outcomes in repeated caesarean section. The first group included 50 laboring women who received combined endotracheal anesthesia for a repeat cesarean section. The second group included 50 laboring women who received spinal anesthesia during the operative delivery. The condition of 100 newborns born by repeated cesarean section was studied.Results. In postpartum period in the women of first group very often, develop endometritis (24%), in second group – 36%, hematometra in first group we see in 12%, in second – 26%. Tracheobronhitis occur in first group among 30%. Research of the condition and course of early neonatal period in newborns showed, that combined anesthesia initiates pathological course of this period. The main complications were asphyxia (28%), and neurological disorders (22%).Conclusions. Different types of analgesia initiate different types of complications in the postoperative period, but better neonatal outcomes with the use of regional anesthesia techniques qualify them as the anesthesia method of choice for repeat cesarean section.

Urgent surgery for COVID-19–positive pediatric patient

Background We present a case of COVID-19–positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure. Case presentation A 12-year-old, COVID-19–positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor. Conclusion Spinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19–positive patient in perioperative setting to avoid minimize the risk to healthcare providers.

Features Of Endotracheal Anesthesia

This article is devoted to giving a complete overview of the various diseases that the human body in life experiences through the respiratory tract.

The Relationship between the Timing of Sugammadex Administration and the Upper Airway Obstruction during Awakening from Anesthesia: A Retrospective Study

Background and Objectives: The harmonization of recovery of consciousness and muscular function is important in emergence from anesthesia. Even if muscular function is recovered, tracheal extubation without adequate recovery of consciousness may increase the risk of respiratory complications. In particular, upper airway obstruction is one of the common respiratory complications and can sometimes be fatal. However, the association between the timing of sugammadex administration and the upper airway obstruction that can occur during awakening from anesthesia has rarely been studied. Materials and Methods: The medical records of 456 patients who had surgery under general endotracheal anesthesia (GETA) at the Haeundae Paik Hospital between October 2017 and July 2018 and who received intravenous sugammadex to reverse rocuronium-induced neuromuscular blockade were analyzed. The correlations between bispectral index (BIS) and minimum alveolar concentration (MAC) at the time of sugammadex administration, the incidence of complications, and the time to tracheal extubation were analyzed to investigate how different timings of sugammadex administration affected upper airway obstruction after tracheal extubation. Conclusions: The effect of BIS and the duration from anesthetic discontinuation to sugammadex administration on upper airway obstruction was not statistically significant. However, the odds ratio of complication rates with MAC < 0.3 compared with MAC ≥ 0.3 was 0.40 (95% confidence interval 0.20 to 0.81, p = 0.011), showing a statistically significant increase in risk with MAC ≥ 0.3 for upper airway obstruction.

Comparative analysis of oral cavity sanation in children under general anesthesia and inhalation anesthesia with nitrogen oxide

The aim of this study was to carry out a comparative analysis of the volume of dental intervention under conditions of combined endotracheal anesthesia and inhalation anesthesia of nitrous oxide in pediatric dentistry.Materials and methods. Within the framework of this study, the results of oral cavity sanitation were analyzed in 300 patients aged 2 to 5 years. The median age was 3.7 years. The participants were divided into 2 equal samples: 150 patients underwent sanitation under general anesthesia (anesthesia group), 150 under conditions of inhalation anesthesia of nitrous oxide (sedation group). In the sedation group, there were 83 (55.3%) boys and 67 (44.7%) girls, in the anesthesia group – 89 participants (59.3%) were male, and 61 (40.7%) were female. The patients included in this study had comparable dental status. Also, when performing dental interventions in both groups, according to indications, local anesthesia was performed: children under 4 years old – lidocaine, children over 4 years old – articaine.Results. Based on the results of the analysis of the data obtained, it was found that the number of visits required for full-fledged dental treatment was statistically significantly lower in the anesthesia group compared to the sedation group: thus, all patients who underwent combined endotracheal anesthesia required only one visit to the clinic for necessary treatment. But it was also found that the total time of dental treatment differed depending on the anesthetic aid used: in the anesthesia group, it usually took from 1 to 2 hours (in 98% of patients), during this time a complete sanitation of the oral cavity was carried out, and in the sedation group varied more widely, with half of the patients in the range from 30 minutes to 1 hour (14% and 36.7% of children, respectively), but the number of visits for complete oral cavity sanitation increased to 8.Conclusions. In the present work, it was revealed that dental treatment under general anesthesia in children was more effective than the same treatment under conditions of inhalation anesthesia of nitrous oxide with preserved consciousness. The use of combined endotracheal anesthesia allows to reduce the number of visits to the clinic and avoid refusals from further dental treatment. General anesthesia was also more effective than sedation in terms of the number of cured teeth with caries, chronic pulpitis and extracted teeth. Nitrous oxide inhalation anesthesia provides partial retention of consciousness, is more manageable and better tolerated by children.

Experience with dexmedetomidine for sedanalgesia during rhinosurgery

The aim of this work was to study the possibility of rhinosurgical interventions using the drug dexmedetomidine for controlled sedoanalgesia. Materials and methods: 118 rhinological interventions (polysinusotomy, pansinusotomy, septoplasty) were performed under combined sedation: 56 with dexmedetomidine and 62 with sibazone. Intraoperatively, the amount of narcotic analgesic and local anesthetic, pain level and depth of sedation, hemodynamic and respiratory parameters, bleeding intensity and operating visibility were considered; in the postoperative period - the level of pain, bleeding when removing tampons from the nose, satisfaction of the surgeon and the patient. Results: during sedanalgesia with dexmedetomidine, the optimal level of sedation was achieved, the amount of narcotic and local anesthetic was reduced, hemodynamic parameters were comfortable for the surgeon (lower than in the control group, blood pressure), which, first of all, provided good operational visibility. In the postoperative period, there was a higher satisfaction of the patient and the surgeon with the performed anesthetic aid. Conclusions: sedoanalgesia with the drug dexmedetomidine can be used in uncomplicated cases during rhinosurgical interventions as an alternative to endotracheal anesthesia, providing optimal pain relief and comfortable work of the surgeon.