Search Results (1,171)

Background: Difficult intubation is an important clinical problem faced by anesthesiologists and is one of the most important causes of anesthesia-related morbidity. According to various sources, the frequency of encountering a difficult airway is stated as 1–4%. Aim: We thought that difficult tracheal intubation could be predicted by photographic analysis using artificial intelligence. Methods: Sixteen photographs were taken in the preoperative period in the sitting and lying positions anteriorly, laterally, with the mouth open, with the mouth closed, with the neck straight, and with the neck extended. Intubations performed without intervention for the first time were considered easy. Intubations with external tracheal intervention and with more than one attempt were evaluated as medium. Intubations requiring more than three attempts; intubation with stylets, fiberoptic bronchoscopes, or video laryngoscopes; or cases in which patients could not be intubated and provided airway with a laryngeal mask were considered difficult. Results: In our study, the CNN (convolutional neural network) model performed well overall, with the best results generally obtained using batch sizes of 32 and 128 and learning rates ranging from 0.1 to 0.001. Conclusions: The prominent aspects of our study are that it can be conducted with an easily accessible mobile phone, can be performed at the bedside, and is successful in predicting difficult intubation. The sensitivity of methods currently used to assess difficult airways is generally low, and the likelihood of clinicians successfully identifying this condition using available information varies widely; thus far, there is no gold standard for prediction. We believe that our study will bring a different perspective to estimating the difficulty of intubation, which occupies a very important place in anesthesia practice. Full article

Background: Dental care for non-cooperative patients is a major clinical and organizational challenge, particularly in individuals with intellectual or neurodevelopmental disabilities and in patients with severe dental anxiety or phobia. When behavioral techniques are insufficient, conscious or deep sedation or general anesthesia may be required, but practical guidance on selection and care pathways remains fragmented. Methods: We combined a retrospective observational analysis from a single Italian academic center with a narrative review of the international literature. Forty-one sedation-assisted dental sessions were included. Demographics, indication for non-cooperation, sedation regimens, procedures, completion rates, and adverse events were descriptively analyzed. Results: The cohort included pediatric and adult patients; non-cooperation was mainly related to disability/neurodevelopmental conditions or severe dental phobia. Benzodiazepine-based oral or intravenous sedation, sometimes combined with low-dose propofol, enabled completion of all planned procedures without major adverse events or conversion to general anesthesia. The literature supports general anesthesia for profound non-cooperation or extensive treatment needs, but availability and waiting lists limit access; sedation is effective for selected cases with appropriate organizational support. Conclusions: An individualized stepped-care model integrating behavioral management, sedation, general anesthesia, and structured preventive recall may optimize access and outcomes within the Italian context and strengthen long-term post-treatment attendance. Full article

Takotsubo cardiomyopathy (TCM) is characterized by contractile impairment of the left ventricular apex and excessive contraction of the base of the heart, resulting in transient cardiac dysfunction. Here, we report a case of an implantable cardioverter defibrillator (ICD) that was activated for ventricular fibrillation (VF) caused by TCM one day after removal of maxillomandibular exostoses. The patient was a 53-year-old female who underwent removal of maxillomandibular exostoses in the mid-palate area, bilateral molars of the maxilla, and bilateral mandibular premolars under general anesthesia. Because the patient had a history of VF, an ICD was implanted. Removal was performed without any problems, but VF occurred on the following day, and the ICD was frequently required. Ultrasound examination suggested contractile impairment of the ventricular apex and excessive contraction of the base. Examinations led to a diagnosis of TCM using the Mayo Clinic diagnostic criteria. VF was resolved by administration of amiodarone hydrochloride. The wound in the oral cavity healed favorably, and the patient was discharged from hospital on day 33 without further occurrence of VF. This case highlights important perioperative risk assessment and anesthesia considerations for oral and maxillofacial surgeons managing medically compromised patients undergoing oral surgery. Full article

Accurate perioperative glucose monitoring is essential in dogs undergoing general anesthesia, yet most validation studies of handheld glucometers have been performed under stable outpatient conditions. This prospective clinical validation study evaluated the analytical agreement, diagnostic performance, and ISO 15197 compliance of a human-calibrated (Accu-Chek) and a veterinary-specific (Centrivet GK) handheld glucometer compared with a laboratory spectrophotometric reference method in 34 anesthetized dogs (99 paired measurements per device). Linear mixed-effects modeling demonstrated significant method effects (p < 0.001), with the veterinary-specific device overestimating glucose concentrations relative to the reference method (β = 20.79 mg/dL; 95% CI: 8.08–33.50; p = 0.001), whereas the human-calibrated device did not differ significantly (β = 7.18 mg/dL; 95% CI: −5.53–19.89; p = 0.267). Bland–Altman analysis showed mean bias of 4.44 mg/dL (95% CI: 0.73–8.16) for the human-calibrated device and 22.72 mg/dL (95% CI: 18.22–27.21) for the veterinary-specific device. Passing–Bablok regression identified proportional bias only for the veterinary-specific device (slope 1.19; 95% CI: 1.01–1.34). ISO compliance was 69.7% and 39.4%, respectively. For hyperglycemia detection, AUC values were 0.9566 (95% CI: 0.8955–1.0000) and 0.9757 (95% CI: 0.9479–1.0000); for hypoglycemia, 0.8567 (95% CI: 0.7557–0.9578) and 0.7376 (95% CI: 0.6056–0.8697). In anesthetized dogs, the human-calibrated device demonstrated superior analytical robustness, whereas the veterinary-specific device showed greater bias and variability. Full article

Background and Objectives: Minor otologic procedures in adults are often performed under local anesthesia, either via injection or topical application, thereby avoiding general anesthesia-associated risks. This study aims to compare pain levels with the use of a lidocaine spray versus lidocaine injections. Materials and Methods: Fifty adult patients underwent local anesthetic myringotomy and ventilation tube placement, 30 unilaterally, and 20 bilaterally. Lidocaine injections were administered to 29 patients, and 21 received a lidocaine spray. Postoperatively, they were asked to mark their perceived pain level on a visual analogue scale (VAS, 0–100 mm), verbal rating scale (VRS, 0–3), and numeric rating scale (NRS, 0–10). Data normality was assessed using the Shapiro–Wilk test, continuous variables were analyzed using analysis of variance (ANOVA), and VRS outcomes were analyzed using binary logistic regression. A p-value ≤ 0.05 indicated statistical significance. Results: Pain levels were low in both groups, although consistently lower in the topical lidocaine group. The average VAS score was 23.14 mm (±14.69) for injection versus 9.76 mm (±11.41) for topical anesthesia (ANOVA, p = 0.002), while NRS scores averaged at 2.41 (±1.57) and 1.19 (±1.17), respectively (ANOVA, p = 0.009), indicating significantly lower pain with topical lidocaine. Logistic regression of the VRS indicated the same trend, although it did not reach statistical significance (OR = 0.153, 95% CI:0.017–1.389, p = 0.095). Conclusions: Lidocaine spray was associated with lower pain levels compared to lidocaine injections in patients undergoing myringotomy and ventilation tube placement. Our findings suggest that topical anesthesia may represent an effective alternative, offering a less invasive approach and reducing the needle-related psychological distress of patients. Full article

Background/Objectives: Wide Awake Local Anesthesia No Tourniquet (WALANT) and ultrasound-guided peripheral nerve blocks (PNBs) are increasingly used alternatives to general anesthesia for hand and forearm surgery. While WALANT is commonly perceived as a time-efficient and resource-sparing technique, comparative data regarding patient satisfaction, perioperative pain, and time-related outcomes remain inconsistent. This study aimed to compare WALANT and ultrasound-guided supraclavicular peripheral nerve block techniques with respect to patient satisfaction, perioperative pain, time-related parameters, and surgeon-related outcomes in elective hand and forearm extremity surgery. Methods: This prospective comparative observational study included 80 adult patients undergoing elective hand or forearm surgery. Patients received either WALANT or ultrasound-guided supraclavicular brachial plexus block according to patient preference. The primary outcome was overall patient satisfaction assessed within 24 h postoperatively. Secondary outcomes included block performance time, waiting time, total anesthesia-related time, intraoperative and postoperative pain scores, additional sedation requirements, postoperative numbness, willingness to choose the same anesthetic technique again, safety outcomes and surgeon satisfaction. Results: Overall patient satisfaction was significantly higher in the peripheral nerve block group compared with the WALANT group (median [IQR]: 90 [85–100] vs. 80 [70–90], p < 0.0001). Intraoperative and postoperative pain scores were also significantly lower in the peripheral nerve block group. Although block performance time was longer with the peripheral nerve block, waiting time and total anesthesia-related time were significantly shorter compared with WALANT. Surgeon satisfaction and the need for additional intraoperative sedation did not differ significantly between groups. Conclusions: In elective hand and forearm surgery, ultrasound-guided supraclavicular peripheral nerve block was associated with higher patient satisfaction, lower pain scores, and shorter total anesthesia-related time compared with WALANT. Surgical satisfaction scores were similar with both anesthetic techniques. Considering the heterogeneity of clinical settings and procedural requirements, as well as cost and resource utilization considerations, anesthetic technique selection should be individualized. Full article

Background: General anesthesia (GA) plays a key role in pediatric dentistry by enabling comprehensive dental treatment in children who cannot be adequately managed using conventional behavioral techniques, local anesthesia, or sedation. While previous reviews have primarily focused on safety outcomes and adverse events, less attention has been given to patterns of GA utilization and their broader clinical and public health implications. Objective: The objective was to synthesize and critically analyze contemporary evidence on utilization patterns, clinical indications, and treatment characteristics associated with GA in pediatric dentistry and to interpret variability in GA use as a clinical and health-system indicator. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in EBSCOhost, Scopus, and the Cochrane Library to identify observational studies published between 2015 and 2025 reporting clinical data on pediatric dental treatment under GA. Results: Twenty-two observational studies met the inclusion criteria. Severe early childhood caries was the most frequently reported indication for GA, followed by behavioral management difficulties and treatment of children with special health care needs. Reported utilization rates varied widely across healthcare systems. Conclusions: GA remains an essential modality for managing complex pediatric dental cases; however, variability in utilization appears to reflect differences in preventive access, disease burden, and health-system organization. Interpreting GA use as a healthcare utilization indicator may support improved preventive strategies and policies aimed at reducing repeated GA exposure in vulnerable pediatric populations. Full article

Background and Clinical Significance: Needle fracture during inferior alveolar nerve block is a rare complication, but it can nevertheless result in serious complications, especially when the fragment migrates into deep anatomical spaces like the pterygomandibular region. Accurate localization and safe retrieval are vital in preventing infection, chronic pain, neurovascular injury, and long-term functional impairment. Case Presentation: We present a case of a 27-year-old patient who had a fractured needle fragment from a local anesthetic procedure retained in the left pterygomandibular space. Cone beam computed tomography (CBCT) was carried out to verify the presence of the metallic foreign body and to define its exact three-dimensional position in relation to adjacent bone and soft tissue landmarks. The approach was transoral, and the surgery was done under general anesthesia. During the surgery C-arm fluoroscopy was used to help guide localization and retrieval, along with the help of radiopaque reference markers to assist in determining the trajectory. The fragment was removed without any issue. After the surgery, the patient’s condition improved well, and he showed no signs of functional deficits. Conclusions: The management of broken needle fragments in the pterygomandibular space can be safely and effectively done using a combination of preoperative CBCT and intraoperative C-arm guidance. This technique allows for exact location determination, minimizes unnecessary dissection of the tissue, and will make the surgery safer in complicated areas. Full article

Background/Objectives: Tidal volume is determined by height and sex in adults under mechanical ventilation, and it serves as the foundation for implementing a lung-protective ventilation strategy. In children, tidal volume is often calculated based on actual body weight, without established guidelines regarding the predictors of lung volume. The aim of this study was to identify the key predictors of lung volume in children aged 0–5 years. Methods: This retrospective study involved 51 children aged 0–5 years who underwent chest computed tomography (CT) and surgery under general anesthesia between 2014 and 2024. The total lung volume was calculated using three-dimensional segmentation of the CT images. Linear regression models were used to assess predictors, including height, weight, age, sex, and body mass index (BMI). Model performance was evaluated using the adjusted R-squared and Akaike Information Criterion (AIC). Bootstrap validation with 2000 iterations was used to validate model reliability. Results: Height was the strongest predictor of lung volume (adjusted R-squared: 0.5621), and it showed a collinearity with age. The final model included age and sex as the covariates. The Bootstrap validation confirmed the model’s reliability. Conclusions: Age and sex are key predictors of the CT-derived total lung volume in children aged 0–5 years. Further studies are required to validate these findings. In addition, research is needed to derive and validate a tidal volume equation based on these predictors and assess the influence of this equation on clinical outcomes such as atelectasis, oxygenation, and inflammatory markers in pediatric surgery. Full article

Background/Objectives: Large language models (LLMs) are increasingly used for patient education, yet comparative evidence regarding their accuracy, safety, and ethical performance remains limited, particularly in high-risk fields such as anesthesiology. This study aimed to conduct a multidimensional comparison of five contemporary LLMs in answering common patient questions in anesthesiology. Methods: In this cross-sectional, comparative in silico study, 30 standardized patient questions covering general anesthesia, spinal/epidural anesthesia, and peripheral nerve blocks were submitted to ChatGPT, Gemini, Microsoft Copilot, DeepSeek, and Grok. Responses were independently evaluated under full blinding by five senior anesthesiology professors using a 5-point Likert scale across six domains: accuracy, safety, completeness, understandability, ethics, and overall assessment. Inter-rater reliability was assessed using intraclass correlation coefficients (ICC). Performance differences were analyzed using linear mixed-effects models accounting for question- and evaluator-level variability, with results reported as estimated marginal means. Results: Inter-rater agreement was good to excellent across all domains (ICC > 0.75). Significant model-related differences were observed for overall assessment, accuracy, safety, completeness, and ethics (all p < 0.001), whereas understandability did not differ significantly between models. ChatGPT achieved the highest overall performance, while Gemini demonstrated superior accuracy. Model performance varied across anesthesiology subspecialties, with significant model × topic interactions identified in multiple domains (p < 0.01). Conclusions: LLMs may serve as supportive tools for patient education in anesthesiology; however, their performance varies substantially across models and clinical contexts. Differences in accuracy, safety, and ethical performance highlight the need for cautious, context-aware integration of LLMs into clinical practice rather than their use as substitutes for anesthesiologists’ clinical judgment. Full article

Data on cardiac and hemodynamic parameters associated with preeclampsia (PE), particularly changes occurring in the immediate perioperative period, remain scarce. These changes are clinically important for the management of patients with severe PE or underlying cardiac dysfunction. Maternal hemodynamics undergo substantial alterations during cesarean section (CS) as a result of sympathetic blockade induced by spinal anesthesia, the vasodilatory effects of general anesthetics, and changes in blood flow related to aortocaval compression in the supine position and during delivery. Massive hemorrhage represents an additional factor contributing to these alterations. In routine clinical practice, maternal heart rate (HR) and blood pressure (BP) are monitored to assess circulatory status. However, a more precise evaluation can be achieved by measuring stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). These parameters are particularly relevant in cases of severe hemorrhage or hypertension, as they may facilitate targeted hemodynamic management. Overall, hemodynamic responses to cesarean delivery under spinal anesthesia appear to differ between normotensive and hypertensive pregnancies. Normotensive parturients seem to be more susceptible to pronounced hypotension following sympathetic blockade, whereas hypertensive disorders of pregnancy are associated with altered vascular reactivity and modified intraoperative hemodynamic responses. Nevertheless, interpretation of these findings remains limited by the heterogeneity of the available studies and the lack of quantitative evidence synthesis. Full article

Background and Objectives: Spinal (SA) and general anesthesia (GA) are both available for lumbar disc hernia (LDH) surgery. Patient satisfaction with anesthesia service is under-investigated and may help identify areas requiring improvement, leading to better care. Materials and Methods: A prospective, non-randomized, survey-based study was performed in patients who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (PODs) 0, 1, and 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10, and an overall satisfaction score (OSS) was calculated; a patient discomfort questionnaire was also used. Study outcomes were pain scores, satisfaction with care, and discomfort reported by SA and GA patients. Results: In total, 209 completed questionnaires in the GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics did not differ significantly between the two groups. The proportion of patients with severe pain decreased from >80% preoperatively to 6% on POD2, and pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSSs) were high: 9.71 (maximum OSS: 57% of cases) in the GA group, and 9.75 (maximum OSS: 53.7% of cases) in the SA group (p = 0.95). The ceiling effect of the patient satisfaction questionnaire had to be addressed. There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort being more prevalent in the GA group (p < 0.05). Postoperative pain was reported as a source of discomfort by >50% of patients in both the SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreased satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness, and pain. Pain on POD 0 did not influence overall patient satisfaction. An association was only found when pain persisted on POD 1 and POD 2. Conclusions: No significant differences between the two anesthesia methods were found. Patient information, anxiety management, and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed, irrespective of the anesthesia method used. Further efforts to develop optimal tools for patient satisfaction assessment are necessary. Full article

Background: Pembrolizumab is a novel immunotherapy agent that improves oncological outcomes for various cancers. This study aimed to investigate immune-related adverse events (irAEs) that occurred after neoadjuvant chemotherapy (NAC) with pembrolizumab for triple-negative breast cancer (TNBC) and to identify fatal irAEs that should be addressed before surgery under general anesthesia. Methods: A total of 82 patients who received NAC with pembrolizumab followed by surgery were reviewed based on their medical records. All irAEs during NAC were evaluated and classified into nine categories: systemic, dermatologic, central nervous, musculoskeletal, endocrine, gastrointestinal, respiratory, ocular, and hematologic systems. Clinicopathologic characteristics were compared between patients with and without irAEs, and cases in which surgery was postponed due to irAEs were reviewed and analyzed. Results: Fifty-nine patients (72.0%) experienced irAEs after NAC with pembrolizumab. The mean NAC period was 140.3 days, with a 39.8-day window to surgery. The most common and second most common irAEs were myalgia (n = 33, 40.3%) and skin rash/dermatitis (n = 31, 37.8%), respectively. There were 1 case (1.2%) of adrenal insufficiency and 16 cases (19.5%) of thyroid dysfunction as irAEs. In 6 cases (7.3%), surgery was postponed due to irAEs [systemic (n = 2, 33.3%); endocrine (n = 3, 50.0%); increased transaminase (n = 1, 16.7%)], with a mean delay of 64.5 days (range, 57–80 days). Conclusions: IrAEs following NAC with pembrolizumab in TNBC were diverse and included those severe enough to affect the timing of surgery under general anesthesia. These irAEs should be monitored continuously during NAC and detected early to address them when they occur. Full article

Introduction: Balancing hypnosis and antinociception during general anesthesia remains challenging, as traditional clinical and hemodynamic signs incompletely reflect cortical and nociceptive processing. Electroencephalogram (EEG)-derived indices such as qCON (hypnosis) and qNOX (nociception probability) (Quantium Medical, Barcelona, Spain), as well as their predecessors IoC1 (Index of consciousness) and IoC2 (Angel-6000 A multi-parameter Anesthesia Monitor, Shenzen Weihao Kang Medical Technology Co., Ltd., Shenzen, Guangdong, China), have been developed to provide a dual assessment of anesthetic state. Their clinical role, technical limitations, and impact on drug titration, however, remain incompletely defined. Methods: A structured narrative review was conducted based on studies investigating IoC/qCON and qNOX in the context of anesthetic depth or nociception monitoring. Studies were grouped into three thematic domains: (1) validation against clinical or EEG standards, (2) use in guiding anesthetic or opioid administration, and (3) technical characteristics, including signal delay and pharmacodynamic modeling implications. Results: Sixteen studies met inclusion criteria. Eight validation studies demonstrated that IoC/qCON correlates strongly with clinical sedation scales and established EEG-derived indices such as BIS and entropy. Five interventional studies evaluating drug titration found limited impact of qCON-guided hypnosis control on anesthetic consumption but more consistent effects of qNOX/IoC2 guidance on opioid dosing and intraoperative stability. Three technical investigations showed that qCON exhibits processing delays on the order of tens of seconds that can be accounted for by incorporating monitor lag into pharmacodynamic analyses. Conclusions: qCON and qNOX provide complementary EEG-based indices of hypnosis and cortical nociceptive responsiveness. Evidence supports their validity as indicators of anesthetic brain state but highlights technical limitations, such as processing delay and susceptibility to physiologic factors. Their optimal clinical use lies in multimodal monitoring strategies that integrate EEG besides classic clinical and monitoring parameters. Full article

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols. Full article