Search Results (16)

Background: Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. Methods: A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. Results: WALANT can provide high patient satisfaction, cost savings of 70–85%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. Conclusions: The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands. Full article

The electrical ventricular storm (VES) is defined as multiple sustained ventricular arrhythmias arising in a short time, often refractory to standard antiarrhythmic treatment. The three pillars of the physiopathogenesis of the VES are autonomic dysfunction, triggers, and an altered ventricular substrate. Incessant or highly recurrent ventricular arrhythmia impacts the hemodynamic status by worsening heart failure and increasing mortality. A stepwise, team-based, and tailored therapeutic approach is required to stop ventricular arrhythmia and regain the hemodynamic and electric stability of the patient. The authors focused on describing all currently available therapeutic approaches for VES, intending to establish the best VES therapeutic approaches. This process involves considering the patient’s specific condition, responses to previous treatments, and the potential risks and benefits of each approach. The options range from adjusting antiarrhythmic therapy to reprogramming of the ICD, sedation, epidural anaesthesia, stellate ganglia anaesthetic block, and the use of ECMO or left ventricular assist devices and radiofrequency catheter ablation. Particular attention is paid to the detailed management of genetic primary arrhythmia syndromes like long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome and Wolff–Parkinson–White syndrome, early repolarisation syndrome, right ventricular arrhythmogenic dysplasia, and idiopathic ventricular fibrillation. After overcoming the acute events of VES and obtaining hemodynamic stability, the treatment should shift toward an optimal balance of heart failure therapy, controlling the substrate by revascularisation procedures and resolving other pathology-generating ventricular arrhythmias. This article provides a comprehensive overview of ESV’s current management options using the most efficient strategies known to date. Full article

Buprenorphine has gained widespread popularity for use in rabbits, while much less is known about methadone. Our aim was to compare sedative, analgesic, and respiratory effects of methadone and buprenorphine as part of balanced anaesthesia. Forty-eight female New Zealand white rabbits undergoing calvaria defects were randomly equally assigned to receive either 0.03 mg kg⁻¹ of buprenorphine (group B) or 0.3 mg kg⁻¹ of methadone (group M) in combination with 15 mg kg⁻¹ of ketamine and 0.1 mg kg⁻¹ of dexmedetomidine SC. Fifteen minutes later, sedation was scored. A laryngeal mask was placed, and inhalational anaesthesia started. Rescue intraoperative analgesia was administered based on autonomic variations. Arterial blood gases were analysed intra- and postoperatively. Postoperative analgesia was administered if the Rabbit Grimace Scale (RbtGS) score was ≥4. The Mann–Whitney test, t-test, and relative risk followed by chi-square test were used to compare the treatment groups. Deeper sedation was observed in rabbits of group M than in those of group B. Rescue analgesia was administered intraoperatively to seven animals in group B and five in group M (p = 0.739) and postoperatively to three in group B and twelve in group M (p = 0.013). Rabbits of both groups showed short-term respiratory acidosis. RbtGS scores indicated better and longer analgesia in group B compared to group M. Full article

Background: Measuring and interpreting vital signs in pediatric patients recovering from anaesthesia, particularly those up to 36 months old, is challenging. Nurses’ decision-making regarding the level of monitoring must balance patient safety with individualized care. This study aimed to explore the perceptions of critical care nurses and registered nurse anesthetists regarding their experiences and actions when making decisions about vital sign monitoring for children in post-anesthesia care units (PACUs). Methods: A qualitative study utilizing the critical incident technique was conducted. Interviews were performed with a purposeful sample of 17 critical care nurses and registered nurse anaesthetists from two hospitals. Results: Nurses reported that the rationale for decisions concerning the need for vital sign monitoring in children was both adequate and inadequate. Actions were taken to adjust the monitoring of vital signs, optimizing conditions for assessment and ensuring the child’s safe recovery. Conclusions: The complexity of accurately monitoring children makes it challenging for nurses in the PACU to adhere to guidelines. Evidence-based care and safety are compromised when technology has limitations and is not adapted for paediatric use, leading to a greater reliance on experience and clinical assessment. This reliance on experience is crucial for reliable assessment but also entails accepting greater risks. Full article

Background: Chronic progressive external ophthalmoplegia (CPEO) belongs to the group of mitochondrial encephalomyopathies. Anaesthesia for patients with CPEO may be associated with an increased risk due to known drug effects on mitochondrial metabolism. Therefore, the aim of this analysis was to evaluate anaesthesiological concepts in patients with CPEO requiring ophthalmic surgery. Methods: This is a retrospective, monocentric cohort analysis of eleven patients with CPEO undergoing ophthalmic surgery either with general anaesthesia or local anaesthesia in a German university hospital from January 2012 to February 2022. Results: A total of twelve ophthalmic surgery procedures were performed in eleven adult patients with CPEO. Six patients underwent surgery after receiving local anaesthesia (LA cohort). Five patients underwent six surgical procedures under general anaesthesia (GA cohort). In five cases within the GA cohort, propofol and remifentanil were used for the maintenance of anaesthesia. In one case, balanced anaesthesia with desflurane and remifentanil was used. The median duration of general anaesthesia was 37.5 min (range, 25–65 min). Patients stayed in the recovery room for a median of 48.5 min (range, 35–70 min). All patients were discharged on the first postoperative day. No relevant complications occurred in either the LA or GA cohort. Conclusion: Both local and general anaesthesia are feasible concepts for patients with CPEO undergoing ophthalmic surgery. Propofol, at least with a short duration (less than one hour) of use, appears to be a feasible hypnotic drug in CPEO patients. Full article

Abalone Haliotis midae are distributed from the cold, hypercapnic waters of the dynamic Benguela Current Large Marine Ecosystem to the relatively warm, normocapnic waters of the Agulhas Current. The species supports an important fishery as well as a thriving aquaculture industry. Due to the relatively low capacity to regulate their acid–base balance and their need to calcify shell and radula, abalone are especially vulnerable to increasing ocean acidification. Exposure to acidified seawater, i.e., hypercapnia, also occurs during the farming operation and can originate from (a) changes in influent seawater, (b) pH decrease by accumulation of waste products, and (c) intentional hypercapnia for anaesthesia using CO₂-saturated seawater for size grading. Currently, these are acute exposures to hypercapnia, but increasing ocean acidification can cause chronic exposure, if not mitigated. Wild South African abalone are already exposed to periodic hypercapnia during ocean upwelling events and will be more so in the future due to progressive ocean acidification. This study investigated the acute pH effects in isolation as an initial step in studying the acute physiological response of H. midae to provide a mechanistic basis for the design of complex multifactorial studies, imitating more closely what occurs on farms and in the natural habitat. The major findings relevant to the above conditions are as follows: 1. Acute exposure to hypercapnia induces a reversible, unbuffered respiratory acidosis. 2. The impact of acute hypercapnia is size-dependent and potentially fatal. 3. Exposure to extreme, short hypercapnia during anaesthesia causes a rapid imbalance in the acid–base state but a rapid subsequent recovery. LC₅₀ for small, medium and large abalone range from pH 6.27 to 6.03, respectively, and sub-lethal levels from pH 6.8 to 6.2. These results can be used by abalone aquaculture farms to mitigate/avoid the impact of acute (and chronic) hypercapnia but also to standardise their anaesthesia method. They are also a proxy to estimate the effects on wild populations. Full article

Background: The surgical treatment of advanced ovarian cancer is associated with extensive tissue trauma, prolonged operating times and a considerable volume shift. It, therefore, represents a challenge for anaesthesiological management. Aim: The aim of this single-centre, retrospective, observational study was to investigate whether intraoperative extensive volume supply influences postoperative outcomes and long-term survival. Methods: The study included 73 patients with a mean (SD) age of 63 (13) years who underwent extensive tumour-reducing surgery for ovarian cancer between 2012 and 2015. The effect of the intraoperative fluid balance on postoperative complications, such as anastomotic insufficiency or pleural effusions, was investigated using logistic regression. Further, the influence of fluid balance, lactate and creatinine levels on 5-year survival was analysed in a Cox regression model. Associations between anaesthesia time and the intraoperative fluid balance were examined using Spearman’s rank correlation coefficients. Results: The mean (SD) postoperative fluid balance in the considered patient cohort was 9.1 (3.4) litres (l) at a mean (SD) anaesthesia time of 529 (106) minutes. Cox regression did not reveal a statistically significant effect of the fluid balance, but it did reveal a statistically significant association between the lactate level 24 h following surgery and the 5-year survival (HR [95%-CI] fluid balance: 0.97 [0.85, 1.11]; HR [95%-CI] lactate: 1.79 [1.24, 2.58]). According to logistic regression, the intraoperative fluid balance was associated with an increased chance of postoperative complications in the considered patient cohort (OR [95%-CI] 1.28 [1.1, 1.54]). Conclusions: We could not detect a negative impact of an increased fluid balance on 5-year survival, but a negative impact on postoperative complications was found in our patient cohort. Full article

The administered dose of dexmedetomidine may occasionally fail to produce the anticipated sedative effects. Therefore, a subsequent dose or administration of another sedative may enhance sedation; however, patient safety may be affected. The safety of seven different drugs administered at the following time point after an insufficient dose of dexmedetomidine was evaluated in a crossover, blind, experimental study that included six healthy adult cats. All cats received an initial dose of dexmedetomidine and a subsequent dose of either dexmedetomidine (Group DD), NS 0.9% (DC), tramadol (DT), butorphanol (DBT), buprenorphine (DBP), ketamine (DK), or midazolam (DM). Animal safety was assessed using repeated blood gas analysis and measurement of electrolytes, glucose, cardiac troponin I, and creatinine to evaluate cardiac, respiratory, and renal function. The median values of creatinine, cardiac troponin I, pH, partial pressure of carbon dioxide, potassium, and sodium did not change significantly throughout the study. Heart rate was significantly decreased in all groups after administration of the drug combinations, except for in the DK group. Respiratory rate decreased significantly after administration of the initial dose of dexmedetomidine and in the DBP and DM groups. The partial pressure of oxygen, although normal, decreased significantly after the administration of dexmedetomidine, whereas the median concentration of glucose increased significantly following the administration of dexmedetomidine. The results of our study suggest that the drug combinations used did not alter the blood parameters above normal limits, while cardiac and renal function were not compromised. Therefore, a safe level of sedation was achieved. However, the administration of dexmedetomidine reduced the partial pressure of oxygen; thus, oxygen supplementation during sedation may be advantageous. Additionally, the increase in glucose concentration indicates that dexmedetomidine should not be used in cats with hyperglycaemia, whereas the decrease in haematocrit suggests that dexmedetomidine is not recommended in anaemic cats. Full article

Opioid-free anaesthesia (OFA) is general anaesthesia based on the use of several non-opioid molecules that aim to have an analgesic effect, decrease the sympathetic response, decrease hormonal stress, and decrease the inflammatory response during surgery. Although this approach to anaesthesia is regularly used in clinical practice, it remains a novel approach. The literature on this anaesthesia modality finds a number of positive effects on cardiac, respiratory, and cognitive function but no randomised study evaluated these effects during cardiac surgery where there is a high incidence of postoperative complications. The main aim of the study is to compare OFA vs. standard balanced opioid general anaesthesia on the incidence of postoperative complications and the length of stay in intensive care and hospital. OFACAR is a multicentric, randomised, controlled, superiority, single-blind, two parallel-arm clinical trial in patients undergoing cardiac surgery with cardiopulmonary bypass. We compared a balanced general anaesthesia without opioids (OFA group) vs. a balanced opioid general anaesthesia with sufentanil (control group). One hundred and sixty patients will be enrolled in each treatment group. The primary endpoint is a composite one which corresponds to the occurrence of at least one of the postoperative complications, defined according to European standards within 30 days after surgery. Recruitment started in September 2019, and data collection is expected to end in November 2024. Full article

Limitations in the global anaesthesia workforce contribute to the emigration of skilled anaesthesiologists from lower-income to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aimed to explore the challenges experienced by anaesthesiologists in Punjab, Pakistan’s most populous province, and the potential changes to encourage their retention. We conducted a qualitative study, conducting semi-structured interviews with 25 purposively sampled consultant anaesthesiologists working in Punjab and analysing data thematically. Reported professional challenges and reasons consultant anaesthesiologists chose to work abroad differed between public and private sectors, each sector providing distinct challenges that compromised anaesthesia workforce numbers and quality. Key concerns were security, promotion/incentive structures, and gender inequalities in public hospitals versus inadequate salary and facilities, surgeon dependency, and the lack of out-of-theatre practice in private hospitals that minimized the scope and earnings of anaesthesiologists within Pakistan. Our findings help contextualise Pakistan’s anaesthesia workforce crisis, indicating public-sector improvements could include increasing security in hospital premises, performance-based incentives, and qualification-dependent promotion, while private-sector improvements could include decreasing surgeon dependency, fixing salary percentages by surgical case, and encouraging direct patient-anaesthesiologist relationships. National and subnational interventions to promote anaesthesiology, along with public awareness campaigns, could additionally raise its profile and encourage retention. Full article

Many studies have investigated the state of the health of healthcare workers during the acute period of the pandemic. Yet, few studies have assessed the health of such professionals after the pandemic and in a less dramatic period. This study involved a particular sample represented by residents in anaesthesia–resuscitation and psychiatry at a university in northern Italy particularly affected by the pandemic. The objectives were to investigate some indicators of health and well-being and compare the two groups of trainees. Using Google Forms, the following tests were proposed: the General Health Questionnaire, Maslach Burnout Inventory, Subjective Happiness Scale, Satisfaction with Life Scale, Coping Inventory for Stressful Situations, Brief Resilience Scale, State-Trait Anxiety Inventory, as well as an ad hoc questionnaire. A qualifying element of the work was the discussion of the results with the trainees. Various strengths have emerged, such as high values of resilience and job satisfaction; a positive assessment of the support received from the work team; an articulate use of coping strategies; and good levels of happiness and satisfaction with life, in both specialities. However, a widespread anxiety also emerged, which appears to be more attributable to concerns about professional evaluation, rather than the pandemic itself. In summary, the trainees seem to have found a fair amount of personal balance, whereas the relationship with the patient seems to be more compromised. In the comparison between specialities, the only significant differences are the levels of depersonalisation and resilience, both of which are higher in anaesthetists. Full article

Closed reduction followed by spica casting is a conservative treatment for developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) can verify proper closed reduction of the dysplastic hip. Our aim was to find prognostic factors in the first MRI to predict the possible outcome of the initial treatment success by means of ultrasound monitoring according to Graf and the further development of the hip dysplasia or risk of recurrence in the radiological follow-up examinations. A total of 48 patients (96 hips) with DDH on at least one side, and who were treated with closed reduction and spica cast were included in this retrospective cohort study. Treatment began at a mean age of 9.9 weeks. The children were followed for 47.4 months on average. We performed closed reduction and spica casting under general balanced anaesthesia. This was directly followed by MRI to control the position/reduction of the femoral head without anaesthesia. The following parameters were measured in the MRI: hip abduction angle, coronal, anterior and posterior bony axial acetabular angles and pelvic width. A Graf alpha angle of at least 60° was considered successful. In the radiological follow-up controls, we evaluated for residual dysplasia or recurrence. In our cohort, we only found the abduction angle to be an influencing factor for improvement of the DDH. No other prognostic factors in MRI measurements, such as gender, age at time of the first spica cast, or treatment involving overhead extension were found to be predictive of mid-term outcomes. This may, however, be due to the relatively small number of treatment failures. Full article

Visual-Patient-avatar, an avatar-based visualisation of patient monitoring, is a newly developed technology aiming to promote situation awareness through user-centred design. Before the technology’s introduction into clinical practice, the initial design used to validate the concept had to undergo thorough examination and adjustments where necessary. This mixed qualitative and quantitative study, consisting of three different study parts, aimed to create a design with high user acceptance regarding perceived professionalism and potential for identification while maintaining its original functionality. The first qualitative part was based on structured interviews and explored anaesthesia personnel’s first impressions regarding the original design. Recurrent topics were identified using inductive coding, participants’ interpretations of the vital sign visualisations analysed and design modifications derived. The second study part consisted of a redesign process, in which the visualisations were adapted according to the results of the first part. In a third, quantitative study part, participants rated Likert scales about Visual-Patient-avatar’s appearance and interpreted displayed vital signs in a computer-based survey. The first, qualitative study part included 51 structured interviews. Twenty-eight of 51 (55%) participants mentioned the appearance of Visual-Patient-avatar. In 23 of 51 (45%) interviews, 26 statements about the general impression were identified with a balanced count of positive (14 of 26) and negative (12 of 26) comments. The analysis of vital sign visualisations showed deficits in several vital sign visualisations, especially central venous pressure. These findings were incorporated into part two, the redesign of Visual-Patient-avatar. In the subsequent quantitative analysis of study for part three, 20 of 30 (67%) new participants agreed that the avatar looks professional enough for medical use. Finally, the participants identified 73% (435 of 600 cases) of all vital sign visualisations intuitively correctly without prior instruction. This study succeeded in improving the original design with good user acceptance and a reasonable degree of intuitiveness of the new, revised design. Furthermore, the study identified aspects relevant for the release of Visual-Patient-avatar, such as the requirement for providing at least some training, despite the design’s intuitiveness. The results of this study will guide further research and improvement of the technology. The study provides a link between Visual-Patient-avatar as a scientific concept and as an actual product from a cognitive engineering point of view, and may serve as an example of methods to study the designs of technologies in similar contexts. Full article

Medetomidine partial intravenous anaesthesia (PIVA) has not been compared to xylazine PIVA regarding quality of recovery. This clinical retrospective study compared recoveries following isoflurane anaesthesia balanced with medetomidine or xylazine. The following standard protocol was used: sedation with 7 µg·kg⁻¹ medetomidine or 1.1 mg·kg⁻¹ xylazine, anaesthesia induction with ketamine/diazepam, maintenance with isoflurane and 3.5 µg·kg⁻¹·h⁻¹ medetomidine or 0.7 mg·kg⁻¹·h⁻¹ xylazine, and sedation after anaesthesia with 2 µg·kg⁻¹ medetomidine or 0.3 mg·kg⁻¹ xylazine. Recovery was timed and, using video recordings, numerically scored by two blinded observers. Influence of demographics, procedure, peri-anaesthetic drugs, and intraoperative complications (hypotension, hypoxemia, and tachycardia) on recovery were analysed using regression analysis (p < 0.05). A total of 470 recoveries (medetomidine 279, xylazine 191) were finally included. Following medetomidine, recoveries were significantly longer (median (interquartile range): 57 (43–71) min) than xylazine (43 (32–59) min) (p < 0.001). However, the number of attempts to stand was similar (medetomidine and xylazine: 2 (1–3)). Poorer scores were seen with increased pre-anaesthetic dose of xylazine, intraoperative tetrastarch, or salbutamol. However, use of medetomidine or xylazine did not influence recovery score, concluding that, following medetomidine–isoflurane PIVA, recovery is longer, but of similar quality compared to xylazine. Full article

To evaluate the use of ketamine-medetomidine-midazolam total intravenous infusion as part of a balanced anaesthetic technique for surgical castration in horses. Five healthy Standardbred cross colts were premedicated with IV acepromazine (0.01–0.02 mg/kg), medetomidine (7 µg/kg) and methadone (0.1 mg/kg) and anaesthesia induced with IV ketamine (2.2 mg/kg) and midazolam (0.06 mg/kg). Horses were anaesthetised for 40 min with an IV infusion of ketamine (3 mg/kg/h), medetomidine (5 µg/kg/h) and midazolam (0.1 mg/kg/h) while routine surgical castration was performed. Cardiorespiratory variables, arterial blood gases, and anaesthetic depth were assessed at 5 to 10 min intervals. Post-anaesthesia recovery times were recorded, and the quality of the recovery period was assessed. The anaesthetic period and surgical conditions were acceptable with good muscle relaxation and no additional anaesthetic required. The median (range) time from cessation of the infusion to endotracheal tube extubation, head lift and sternal recumbency were 17.2 (7–35) min, 25 (18.9–53) min and 28.1 (23–54) min, respectively. The quality of anaesthetic recovery was good, with horses standing 31.9 (28–61) min after the infusion was ceased. During anaesthesia, physiological variables, presented as a range of median values for each time point were: heart rate 37–44 beats/min, mean arterial pressure 107–119 mmHg, respiratory rate 6–13 breaths/min, arterial partial pressure of oxygen 88–126 mmHg, arterial partial pressure of carbon dioxide 52–57 mmHg and pH 7.36–7.39. In conclusion, the co-administration of midazolam, ketamine and medetomidine as in IV infusion, when used as part of a balanced anaesthetic technique, was suitable for short term anaesthesia in horses undergoing castration. Full article