Sevoflurane and desflurane effects on early cognitive function after low-risk surgery: A randomized clinical trial.

BACKGROUND AND OBJECTIVES: Deleterious effects on short-term and long-term quality of life have been associated with the development of postoperative cognitive dysfunction (POCD) after general anesthesia. Yet, the progress in the field is still required. Most of the studies investigate POCD after major surgery, so scarce evidence exists about the incidence and effect different anesthetics have on POCD development after minor procedures. In this study, we compared early postoperative cognitive function of the sevoflurane and desflurane patients who experienced a low-risk surgery of thyroid gland. MATERIALS AND METHODS: Eighty-two patients, 40 years and over, with no previous severe cognitive, neurological, or psychiatric disorders, appointed for thyroid surgery under general anesthesia, were included in the study. In a random manner, the patients were allocated to either sevoflurane or desflurane study arms. Cognitive tests assessing memory, attention, and logical reasoning were performed twice: the day before the surgery and 24 h after the procedure. Primary outcome, magnitude of change in cognitive testing, results from baseline. POCD was diagnosed if postoperative score decreased by at least 20%. RESULTS: Median change from baseline cognitive results did not differ between the sevoflurane and desflurane groups (-2.63%, IQR 19.3 vs. 1.13%, IQR 11.0; p = .222). POCD was detected in one patient (1.22%) of the sevoflurane group. Age, duration of anesthesia, postoperative pain, or patient satisfaction did not correlate with test scores. Intraoperative temperature negatively correlated with total postoperative score (r = -0.35, p = .007). CONCLUSIONS: Both volatile agents proved to be equivalent in terms of the early cognitive functioning after low-risk thyroid surgery. Intraoperative body temperature may influence postoperative cognitive performance.

The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review.

BACKGROUND: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. METHODS: A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. RESULTS: The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. CONCLUSIONS: Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients.

Current Recommendations for Airway Management Techniques in COVID-19 Patients without Respiratory Failure Undergoing General Anaesthesia: A Nonsystematic Literature Review.

SUMMARY BACKGROUND: Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged, many articles have been published on airway management for coronavirus disease 2019 (COVID-19) patients. However, there is a lack of clear and concise conceptual framework for working with infected patients without respiratory failure undergoing general anaesthesia compared to noninfected patients. The aim of this article is to review current literature data on new challenges for anaesthesia providers, compare standard airway management techniques protocols with new data, and discuss optimisation potential. MATERIALS AND METHODS: Literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: anaesthesia, preoxygenation, airway management, difficult airway, SARS-CoV-2, COVID-19. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 41 articles were chosen for detailed analysis. Summarised and analysed data are presented in the article. RESULTS: SARS-CoV-2 has unique implications for airway management techniques in patients without respiratory failure undergoing general anesthesia. Main differences with the standard practice include: institutional preparedness, team composition principles, necessary skills, equipment, drugs, intubation and extubation strategies. Failed or difficult intubation is managed with predominance of emergency front of neck access (FONA) due to increased aerosol generation. CONCLUSIONS: Airway management techniques in COVID-19 patients without respiratory failure are more challenging than in noninfected patients undergoing general anaesthesia. Safe, accurate and swift actions avoid unnecessary time delay ensuring the best care for patients, and reduce risk of contamination for staff. Appropriate airway strategy, communication, minimisation of time for aerosol generating procedures and ramped-up position aid to achieve these goals. During the pandemic, updated available literature data may change clinical practice as new evidence emerges.

Oxidant/Antioxidant Status of Breast Cancer Patients in Pre- and Post-Operative Periods.

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate the level of oxidative stress before and after breast cancer surgery. MATERIALS AND METHODS: Malondialdehyde (MDA) level was tested using a thiobarbituric acid (TBA) assay based on the release of a color complex due to TBA reaction with MDA. The glutathione S-transferase (GST) activity was evaluated by enzymatic conjugation of reduced glutathione (GSH) with 1-chloro-2,4-dinitrobenzene. The level of total glutathione (reduced GSH and oxidized GSSG) was detected using a recycling system by 5,5-dithiobis(2-nitrobenzoic acid). The levels of the indices were determined in the serum of 52 patients before surgery, two hours and five days after surgery, and in 42 healthy women. RESULTS: In the patients over 50 years old the level of MDA was higher after surgery in comparison with before surgery, and GST activity was lower in comparison with the control. The GSH + GSSG level in both ages groups after surgery was lower than in the control. Significant differences of MDA level were detected in patients with stage III after surgery compared to the control. The level of GSH + GSSG was significantly lower in the patients with I-III stages compared to the control. CONCLUSION: The most expressed changes demonstrate the significance of MDA as a marker to evaluate oxidative stress in breast cancer patients. The degree of oxidative stress depends on the patient's age and stage of disease.

Comparison of preoxygenation efficiency with Intersurgical Economy and Intersurgical QuadraLite anaesthetic face masks.

BACKGROUND: Sufficient preoxygenation prevents arterial oxygen desaturation prior to intubation. An optimally sealed facemask is necessary for fast preoxygenation. The study was aimed at comparing the efficiency of preoxygenation using two different face masks. MATERIALS AND METHODS: In 2018, a prospective study was conducted. Patients were classified into two groups: group A - Intersurgical Economy face masks, group B - Intersurgical QuadraLite masks. The circuit was flushed with 100% O2 for 30s, preoxygenation started with flow of 8l/min, FiO2100. The patients were asked to breathe deeply. Fentanyl (1-2 mcg/kg) was administered to increase mask toleration. End-tidal oxygen concentration (EtO2) ≥90% was the goal. EtO2 was monitored after 30, 60, 90, 120, 180, 210, 240, 270 and 300 seconds. Data was analyzed using the Independent-Samples T-test and the Mann-Whitney-U test. RESULTS: Twelve patients were enrolled in group A and 19 in group B. Differences in sex, age, BMI and Mallampati class in the groups were statistically insignificant (p = 0.13, 0.39, 0.65, 0.43 respectively). Patients assigned to ASA I - 25.8% (n = 8->2/6), ASA II - 71.0 % (n = 22->10/12), ASA III - 3.2% (n = 1->0/1), p = 0.64. The success rate of preoxygenation to EtO290 within 5 min was statistically significantly different in the groups, with 33.3% in group A and 94.7% in group B (p < 0.01). Mean time to EtO290 was 228.3 ± 104.0/164.4 ± 84.3. Mean EtO2 after: 30s - 56.0 ± 13.5/69.3 ± 11.2 (p < 0.01); 60s - 63.8 ± 15.3/76.1 ± 11.7 (p = 0.02), 90s - 67.8 ± 17.7/80.7 ± 10.1 (p = 0.03); 120s-69.6 ± 18.2/83.4 ± 10.0 (p = 0.03), 150s-71.1 ± 19.0/87.1 ± 6.5 (p = 0.01); 180s - 72.9 ± 16.8/88.5 ± 5.3 (p = 0.01), 210s - 72.6 ± 18.0/89.2 ± 5.1 (p < 0.01); 240s - 74.17 ± 15.4/90.0 ± 4.3 (p < 0.01), 270s-76.3 ± 16.3/90.2 ± 3.6; 300s - 77.8 ± 14.6/90.2 ± 1.5 (p < 0.01). CONCLUSIONS: Preoxygenation was significantly more efficient and faster with Intersurgical QuadraLite face masks.

Effects of sevoflurane and desflurane on early cognitive changes after thyroid surgery: interim results.

The study is being conducted at the 1st Department of Anaesthesiology, the Centre of Abdominal Surgery, the Centre of Anaesthesiology, Intensive Care and Pain Management of Vilnius University Hospital Santaros Klinikos. BACKGROUND: These are primary results of a randomized double-blinded study comparing postoperative changes in cognitive functions and the effect of desflurane and sevoflurane on these changes. MATERIALS AND METHODS: The study includes patients of ≥40 years of age undergoing elective thyroid surgery under general anaesthesia. Patients were randomly allocated to either sevoflurane or desflurane group. Cognitive testing (memory, attention, and reasoning tasks) was performed a day before surgery and repeated 24 hours postoperatively. A decrease of 20% in the postoperative score was considered as postoperative cognitive dysfunction (POCD). RESULTS: At present 38 patients are included in the study. Median decrease in the postoperative score was 2.7% (IQR 16.7). The incidence of POCD was 2.6%. Significantly decreased memory scores were observed in 15.8% of patients. Both study groups were comparable based on demography, duration of anaesthesia, intraoperative opioids, postoperative pain, and satisfaction. No difference was found in the cognitive score comparing sevoflurane and desflurane groups, except for memory tasks where the sevoflurane group performed worse (p = 0.01).The age or the duration of anaesthesia did not affect postoperative scores. Postoperative satisfaction negatively correlated with the memory score (r = -0.35, p = 0.03). Postoperative satisfaction correlated with the reasoning score (r = -0.55; p < 0.01) and the total score (r = -0.42; p = 0.03) in the sevoflurane group. Likewise, temperature in the sevoflurane group correlated with the memory score (r = -0.58; p = 0.02). CONCLUSIONS: The desflurane group performs better in memory tasks, but no such advantage is found in the total cognitive score. In contrast to the age or anaesthesia duration, intraoperative temperature and postoperative satisfaction may affect postoperative cognitive performance.

Use of Magnetic Resonance Imaging in Evaluating Fetal Brain and Abdomen Malformations during Pregnancy.

Magnetic resonance imaging (MRI) is used as a clarifying technique after a high-resolution ultrasound examination during pregnancy. Combining ultrasound with MRI, additional diagnostic information is obtained or ultrasound diagnosis is frequently corrected. High spatial resolution provides accurate radiological imaging of internal organs and widens possibilities for detecting perinatal development disorders. The safety of MRI and the use of intravenous contrast agent gadolinium are discussed in this article. There is no currently available evidence that MRI is harmful to the fetus, although not enough research has been carried out to prove enduring safety. MRI should be performed when the benefit outweighs the potential side effects. The narrative review includes several clinical cases of fetal MRI performed in Vilnius University Hospital Santaros Clinics.

Comparison of different anesthetic regimens in patients undergoing laparoscopic adjustable gastric banding operations: a prospective randomized trial.

BACKGROUND AND OBJECTIVE: Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations. MATERIAL AND METHODS: In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m(2)), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO2) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO2 in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting. RESULTS: The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3) CONCLUSIONS: Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study.