Incidence of Postoperative Cognitive Dysfunction Following Inhalational Vs. Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis.

Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, i.e., evaluations up to 30 days postoperative, and neurocognitive disorder, i.e., assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1,913 articles yielded 12 studies with a total of 3,639 individuals. For the secondary objective, five studies with a total of 751 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.60 (95% CI = 0.40 - 0.91; p = 0.02), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Giving the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.

A Comparison Between the Adductor Pollicis Muscle and the Abductor Digiti Minimi Muscle Using Electromyography AF-201P in Rocuronium-Induced Neuromuscular Block: A Prospective Comparative Study

Background The AF-201P, a new electromyography (EMG)-based neuromuscular monitor has been developed recently. The aim of this clinical study was to compare two ulnar nerve innervated muscles: the adductor pollicis (AP) muscle and the abductor digiti minimi (ADM) muscle during the recovery from rocuronium-induced neuromuscular block by using EMG AF-201P. Methods Twenty patients undergoing surgery with general anesthesia were enrolled in the study. During total intravenous general anesthesia, train-of-four (TOF) and post-tetanic counts (PTC) responses following 0.9 mg/kg rocuronium administration were concurrently monitored at the AP and the ADM muscles with EMG AF-201P on the opposite arms. At the end of the surgery, sugammadex 2 mg/kg was administered when TOF counts of 2 was observed at both muscles. The primary outcome of the study was time from administration of rocuronium to first appearance of PTC response (first PTC). The secondary outcomes of the study were time from administration of rocuronium to first reappearance of TOF response (first TOF), time from first PTC to first TOF (PTC-TOF time), time to reappearance of TOF counts of 2, and time from administration of sugammadex to TOF ratio ≥ 0.9. Agreement between the two muscles was assessed using the Bland-Altman analysis. Data are expressed as mean ± standard deviation. Results Nineteen patients were included in the analysis. Time for appearance of the first PTC was significantly faster at the ADM muscle than the AP muscle (32.4 ± 13.1min vs 24.4 ± 11.4min, p = 0.006). Interval time between the first PTC and the first TOF was significantly longer with the ADM muscle than the AP muscle (19.4 ± 7.3min vs 12.4 ± 10.6min, p = 0.019). There were no significant differences in time to TOF counts of 2 and sugammadex-facilitated recovery between the two muscles. Bland-Altman analyses showed acceptable ranges of bias and limits of agreement of the two muscles. Conclusions The ADM muscle showed a good agreement with the AP muscle during rocuronium-induced neuromuscular block but faster recovery of PTC response when using EMG. Trial registration : UMIN-CTR (Registration No. UMIN000044904). Registered 19 July 2021 -Retrospectively registered,

Choice of anesthetic support components for children during MRI procedures

Introduction. An MRI-scan in early childhood requires anesthesia to create complete immobility of the patient due to the high incidence of artifacts with an MRI duration of 40 to 60 minutes. The purpose of the work is to select the components of anesthetic support in children from one month to three years old with MRI. Materials and methods. The object of the study was 33 patients aged one month to three years with congenital and acquired brain pathology. Anesthetic management intravenous general anesthesia without mechanical ventilation. Anesthesia in 11 (33.3%) patients of group 1 midazolam 0.5% 0.3 mg/kg, in 12 (36.4%) patients of group 2 midazolam 0.5% at a dose of 0.3 mg/kg + ketamine 5% 1.5 mg/kg, and in 10 (30.3%) patients of group 3 midazolam 0.5% at a dose of 0.3 mg/kg + propofol 2 mg/kg. Results. Group 1 patients achieved a sedation level on the RASS scale of 2.2 0.1 points with preservation of sound and tactile sensitivity, spontaneous involuntary movements limbs in 72.7% of cases. Group 2 patients had a lack of motor activity, consciousness - an assessment on the RASS scale 4.6 0.4 points, BIS 59.4 1%, increased in blood pressure by 7.3%, and normal without depression of respiratory function. Group 3 patients required careful titration of each subsequent dose, constant monitoring of breathing and hemodynamics, and, if necessary, maintaining adequate ventilation during the induction stage. Conclusion. The most rational components for anesthesia support in young children during MRI scanning are midazolam solutions at a dose of 0.3 mg/kg and ketamine at 1.5/kg.

Effect of Depth of Total Intravenous General Anesthesia on Intraoperative Electrically Evoked Compound Action Potentials in Cochlear Implantation Surgery

Purpose. This study aims to compare the effect of the depth of total intravenous anesthesia (TIVA) on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in cochlear implant operations. Methods. Prospectively, a total of 39 patients aged between 1 and 48 years who were scheduled to undergo cochlear implantation surgeries were enrolled in this study. Every patient received both light and deep TIVA during the cochlear implant surgery. The e-ECAP thresholds were obtained during the light and deep TIVA. Results. After comparing the e-ECAP means for each electrode (lead) between the light and deep anesthesia, no significant differences were detected between the light and deep anesthesia. Conclusion. The depth of TIVA may have no significant influence on the e-ECAP thresholds as there was no statistical difference between the light and deep anesthesia.

Dynamics of indices of cerebral oximetry in various procedures of general anesthesia on stages of transduodenal endoscopic operative interventions in patients, suffering obturation jaundice

Objective. To study the impact of separate anesthesiological procedures on cerebral oxygenation on stages of transduodenal endoscopic operative interventions in patients, suffering obturation jaundice. Маterials and methods. A monitoring investigation for the cerebral oxygenation state was conducted in patients of three investigated groups in conditions of various procedures of general anesthesia. Моnitoring of cerebral oxygenation was done, using the monitoring system, named INVOS 500B. In patients of Group I the intravenous general anesthesia with propofol and fentanyl in conditions of a secured spontaneous respiration with the oxygen inhalation was applied; in patients of Group II - intravenous general anesthesia, using propofol, fentanyl and atracurium besylate in conditions of a controlled mechanical ventilation (СМV) via a standard endotracheal tube; in patients of Group III - a deep analgosedation, using propofol and fentanyl in conditions of supportive pulmonary ventilation in a regime of synchronized intermittent mandatory ventilation (SIMV) via gastrolaryngeal tube. Results. In patients of Group I on the main stage of the operative intervention the cerebral oxygenation index (rSpO2) have lowered by 24.2% respectively initial value and by 37.8% - repectively the value while beginning of the operation. In patients of Groups ІІ and ІІІ a controlled index on all stages of the operation persisted stable. Conclusion. Advantage must be given to general anesthesia in a SIMV pulmonary regime via gastrolaryngeal tube.