Hasil untuk "Anesthesiology"

P. White, W. L. Way, A. Trevor

Wang M, Wang T, Wu N et al.

Mei Wang,1,2 Tianqi Wang,1 Nan Wu,2 Yutao Zhang,3,4 Jindi Jia,1 Shengguo Zhao,1,2 Jie Yan,1,2 Airong Wang,1 Dajiang Yuan1,5 1College of Anesthesiology, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 2Department of Anesthesiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 3College of Second Clinical Medical, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 4Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 5Department of the Party Committee, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, People’s Republic of ChinaCorrespondence: Dajiang Yuan, Department of the Party Committee, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, People’s Republic of China, Tel +86-186-3617-1219, Email yuandajiang@sina.comPurpose: To investigate whether patient-controlled sedation (PCS) with remimazolam provides more precise sedation control and superior overall outcomes compared to conventional sedation (CS) in elderly patients undergoing lower limb surgery under spinal anesthesia.Patients and Methods: 120 patients aged ≥ 65 years (ASA physical status II~III) were randomized to receive either PCS (n=60) or CS (n=60). PCS received a loading dose (1 mg), background infusion (0.75 mg·h− 1), and patient-demand boluses (0.5 mg; lockout interval 60s). CS received a loading dose (0.05~0.1 mg·kg− 1) followed by a continuous infusion (0.1~0.3 mg·kg− 1·h− 1). The primary outcome was the proportion of patients who maintained optimal sedation, defined as a Ramsay Sedation Scale score of 3~4 with supportive bispectral index (BIS) monitoring. Secondary outcomes included onset/recovery time, hemodynamics, drug consumption, adverse events, and satisfaction.Results: The proportion maintaining optimal sedation was higher in the PCS group (100% vs 88.3%, P < 0.05). PCS also showed lower total drug use, shorter recovery time (both P < 0.001), and higher scores for comfort, satisfaction, and cooperation (all P < 0.05). Hemodynamic stability was better in the PCS group, with higher mean arterial pressure at T2 through T6 timepoints (mean difference 4.5 mmHg, P = 0.019) and a lower hypotension incidence (10.0% vs 23.3%, P = 0.050).Conclusion: For elderly patients undergoing lower limb surgery under spinal anesthesia, patient-controlled sedation with remimazolam facilitates more precise sedation control. It ensures a higher proportion of optimal sedation depth while reducing drug consumption, accelerating recovery, and enhancing patient comfort and satisfaction. Under the conditions of this study, this approach constitutes a safe, effective, and individualized sedation strategy.Keywords: remimazolam, patient-controlled sedation, elderly, spinal anesthesia

Gan-min Wang, Gan-min Wang, Wei Tao et al.

BackgroundPneumococcal infections remain a leading cause of preventable deaths among children and adolescents aged <20 years. Despite a global decrease in burden, significant regional and socioeconomic disparities, as well as long-term trends, are not fully understood.MethodsWe used data from the Global Burden of Disease Study 2021 (GBD 2021) to evaluate mortality and disability-adjusted life years (DALYs) attributable to pneumococcal infections among those aged 0–19 years across global, regional, and 204 national settings from 1990 to 2021. Temporal trends were assessed using estimated annual percentage change (EAPC), and Spearman correlation examined associations with the sociodemographic index (SDI). Decomposition analysis quantified the contributions of demographic and epidemiological drivers. Health inequality was assessed via the slope index of inequality (SII) and concentration index (CI). A Bayesian age-period-cohort (BAPC) model projected future burden to 2036.ResultsIn 2021, pneumococcal infections caused 179,354 deaths (95% UI: 142,347–217,280) and 15,757,828 DALYs (95% UI: 12,500,395–19,088,138) among individuals aged 0–19 years, with the highest burden in children under 5. From 1990 to 2021, global age-standardized mortality rate (ASMR) dropped from 36.18 to 6.80 per 100,000 (EAPC –4.89, 95% CI: −5.23 to −4.54). High-middle SDI regions had the largest decline (EAPC –8.63%), while Oceania had the smallest (EAPC –2.20%). Epidemiological changes were the main drivers of burden reduction, partly offset by population growth. The SII for ASMR and age-standardized DALY rate (ASDR) decreased from −83.91 to −11.19 and from −7,395.42 to −975.38, respectively, indicating a reduction in absolute inequality, while the CI for both increased from 0.47 to 0.55, suggesting a growing relative concentration of burden in high-SDI countries despite the persistently high absolute burden in low-SDI regions. BAPC projections indicate the global ASMR will fall to 1.59 per 100,000 (95% UI: 0.82–2.35) by 2036.ConclusionOver the past 30 years, the global burden of pneumococcal disease among children and adolescents has significantly declined. However, high burdens persist in low-SDI regions and among children under 5, with increasing relative inequalities. Strengthening vaccination coverage, healthcare systems, and interventions for high-risk populations is essential to further reduce the global burden.

Balazs R. Varga, Sarah M. Bernhard, Amal El Daibani et al.

Abstract Chronic pain and opioid overdose deaths highlight the need for non-addictive analgesics with novel mechanisms. The δ opioid receptor (δOR) is a promising target, as it lacks the respiratory depression associated with µ opioid receptor (µOR) agonists. However, early δOR full agonists caused seizures, limiting their clinical use. Partial δOR agonists may offer more controlled receptor activation than full agonists, but their development has been hindered by uncertainty regarding the molecular mechanism of partial agonism. Here we show that C6-Quino, a bitopic ligand developed through structure-based design, acts as a selective δOR partial agonist. Functional studies reveal that C6-Quino shows differential activity at G-protein and arrestin pathways and interacts with the sodium binding pocket, confirmed through cryo-EM analysis. C6-Quino demonstrates oral activity, analgesic activity in chronic pain models without causing δOR-related seizures and µOR-related adverse effects which have limited opioid usage in recent times. This discovery outlines a new strategy for developing δOR-targeted analgesics and provides a framework for optimizing signaling profiles of other Class A GPCRs.

Amit P. Shah, Prashant Nasa, Syed M. Ahmed et al.

The All India Difficult Airway Association developed clinical practice statements utilising the Delphi method among experts for specific interventions in the management of unanticipated difficult airways in adult, obstetric, and paediatric populations, as well as for the management of at-risk extubations, where existing evidence was either weak or absent. A Steering Committee consisting of nine airway experts and a Delphi methodologist convened a panel of 24 experts, from whom anonymous responses were collected via an online Delphi survey. Consensus was defined as at least 75% experts voting for a particular option in multiple-choice statements, and agreement (scores of 5–7) or disagreement (scores of 1–3) on a nominal 7-point Likert scale statement. The stability of responses between consecutive rounds was assessed using the Kruskal–Wallis test or Chi-square test, with a P value of greater than or equal to 0.05 indicating stability. Twenty-three experts completed four Delphi rounds conducted from 27 December 2024 to 25 January 2025. Of the 26 statements considered, 23 (88%) achieved both consensus and stability. Of note, the statement regarding the maximum number of attempts permitted for supraglottic airway insertion in adults to mitigate airway management-related complications did not achieve consensus among experts; however, the Steering Committee voted unanimously for a maximum of three attempts. From the 23 statements that achieved expert consensus and the statement that received the maximum vote during the adjudication process by the Steering Committee, 24 expert clinical statements were drafted. Future research is necessary to evaluate the impact of these clinical practice statements and to address the remaining uncertainties.

Haruka Tachibana, Nobuhiko Ohashi, Gaku Okumura et al.

Andrea Romera, Lourdes Barragán, Lucía Álvarez-Baena et al.

IntroductionPediatric post-thyroidectomy hypocalcemia management varies significantly from hospital to hospital. The current study has two aims: first, we evaluate demographic data in all pediatric patients submitted to thyroid surgery in our Spanish tertiary hospital over 20 years; secondly, we describe the way that hypocalcemia was diagnosed and treated in that period and present a multidisciplinary protocol for perioperative management of this condition.MethodsThis is a retrospective and observational study of all patients from 0 to 16 years old who underwent thyroid surgery from 2000 to 2020 at our institution. Demographic, surgical and electrolyte data were recorded from the electronic database.ResultsFrom 2000 to 2016, pediatric thyroid surgery at our institution was performed on 33 patients without a consistent approach or standard electrolyte management. A protocol for perioperative management of these patients was introduced in 2017, and applied to 13 patients. In 2019, the protocol was assessed and updated following a case of symptomatic hypocalcemia. From 2000 to 2016, 47 pediatric patients in all underwent thyroid surgery. We registered eight asymptomatic hypocalcemias. One child developed symptomatic hypocalcemia. Two patients have permanent hypoparathyroidism.DiscussionOur incidence of general complications following thyroidectomy was low; hypocalcemia was the most prevalent. All the cases of hypocalcemia submitted to the protocol were identified early by iPTH measurements. Intraoperative iPTH levels and percentage drop from baseline could help stratify patients according to their risk of hypocalcemia. High risk patients require immediate postoperative supplementation, including calcitriol and calcium carbonate.

Bassant Abdelhamid, Marina Matta, Ashraf Rady et al.

Karen Mackintosh, Paul McConnell

Abstract In recent decades, there has been an increase in life expectancy in children with life-limiting conditions. Ideally, parents and clinicians would work together to ensure the best care for these children. Several cases have appeared in the media in recent years where conflict has risen between parents and healthcare professionals acting in the ‘best interests’ of children, which have resulted in court action. However, the legislation itself promotes conflict. Similar laws exist across Europe based on Article 24 of the UN Convention on the Rights of the Child. The aim of the Children’s Act 1989 in the UK was to place the ‘child’s welfare’ as the ‘paramount consideration’. It has prevented draconian care and supervision orders, which can only be made if the child is at risk of ‘significant harm’. This threshold does not apply to healthcare teams. Healthcare decisions are based on ‘best interests’, which are not explicitly defined. This sets the threshold for progression to court action much lower, and due to a lack of definitive definition of what ‘best interests’ are, this has unfortunately escalated conflict rather than resolve it. Healthcare institutions have been criticised for not utilising alternative approaches first, such as mediation. We propose an alternative approach based on collaboration, reasonableness and the threshold of significant harm, which we have explored in this review. Conflict management frameworks are a tool that can be used to recognise early signs of conflict and develop strategies to prevent escalation at ward level. They can be tailored to individual institutions and utilise content-oriented and empathetic communication strategies through designated clinicians. They should offer guidance on when to refer to the courts. Parental wishes should be assessed on whether they represent significant harm or not. If not, they cannot simply be wrong. Acknowledgement of the ‘reasonableness’ of parental requests can be a key factor which is diffusing conflict. Therefore, setting the threshold for state intervention at ‘significant harm’ rather than ‘best interests’ would help to reduce the number of these cases progressing to courts.

Dev Raveendran, Jahan C. Penny-Dimri, Reny Segal et al.

Abstract Background Hyperbilirubinemia following cardiac surgery is a common phenomenon and is of emerging interest in prognostic factor research. This systematic review and meta-analysis evaluated the association between post-operative hyperbilirubinemia (PH) and mortality and morbidity in cardiac surgery patients. Methods Ovid Medline and Ovid Embase were searched from inception to July 2020 for studies evaluating the prognostic significance of PH following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each study and pooled using random effects inverse variance modelling to assess in-hospital mortality. Standardised mean differences were pooled to assess Intensive Care Unit (ICU) and hospital length of stay (LOS). Qualitative analysis was performed to assess ventilation requirements and long-term mortality. Meta-regression was used to assess inter- and intra-study heterogeneity. Results 3251 studies satisfied the selection criteria, from which 12 studies incorporating 3876 participants were included. PH significantly predicted in-hospital mortality with a pooled OR of 7.29 (95% CI 3.53, 15.09). Multiple pre-defined covariates contributed to the prognostic significance of PH, however only aortic cross-clamp time (p < 0.0001) and number of transfusions (p = 0.0001) were significant effect modifiers. PH significantly predicted both ICU LOS (Mean difference 1.32 [95% CI 0.04–2.6]) and hospital LOS (Mean difference 1.79 [95% CI 0.36–3.21]). Qualitative analysis suggested PH is associated with increased post-operative ventilation requirements and reduced long-term survival rates. Conclusions Hyperbilirubinemia is a cost-effective, widely available prognostic marker of adverse outcomes following cardiac surgery, albeit with residual sources of heterogeneity.

Mo-Yeol Kang, Seong-Sik Cho, Seong-Soo Choi et al.

Objectives This study explores the interaction between ergonomic risk factors and long working hours on musculoskeletal symptoms by additive and multiplicative scales.Design We used the data of the fifth Korean Working Condition Survey (KWCS). The KWCS is a cross-sectional study.Setting To represent the entire Korean working population, the probability proportion stratified cluster sampling method was used. The face-to-face interview was carried out with a structured questionnaire.Main outcomes and measures To assess the combined effect of ergonomic risk factors and long working hours on musculoskeletal symptoms, the relative excess risk due to interaction (RERI) and the ratio of ORs were calculated using multiple survey-weighted logistic analysis and postestimation commands.Results The OR for musculoskeletal symptoms was 1.75 (95% CI 1.28 to 1.39) for exposure to long working hours, 3.49 (95% CI 3.06 to 3.99) for exposure to ergonomic risk factors and 5.07 (95% CI 4.33 to 5.93) for coexposure to long working hours and ergonomic risk factors. The RERI was 0.82 (95% CI 0.11 to 1.53) and the ratio of ORs was 0.83 (95% CI 0.50 to 1.14)Conclusion Our findings suggest that coexposure to both ergonomic risk factors and long working hours has a supra-additive interaction effect on musculoskeletal symptoms. Regulations on working hours and workplace interventions might reduce the musculoskeletal diseases of workers.

Xin Xu, En Zhou, Jun Zheng et al.

BackgroundN6-methyladenosine (m6A) RNA modification plays a critical role in gastric cancer (GC). However, the relationship between the m6A “eraser”, FTO, and ALKBH5, and the prognosis of GC still remains unclear. This study aimed to evaluate the effect of FTO and ALKBH5 on the prognosis of patients and their potential roles in GC.Materials and MethodsA total of 738 GC samples with clinical information obtained from two independent datasets were included and divided into training set and testing set. Differential expression analysis of the m6A “eraser” related genes was performed. The LASSO Cox regression model was constructed to analyze the m6A “eraser” related risk genes. The univariate and multivariate Cox regression model were employed to identify the independent prognostic factors. Kaplan-Meier method was used for survival analysis. A nomogram model was then carried out to predict the prognosis of GC patients. Additionally, GO and KEGG analyses were conducted to identify the potential role of the m6A “eraser” related genes in GC. The relative proportion of 22 different genotypes in immune infiltrating cells was calculated by CIBERSORT algorithm.ResultsIn total, nine m6A “eraser” related risk genes and risk scores were obtained and calculated. Patients in high-risk group demonstrated significantly worse prognosis than those in low-risk group. Age, stage, and risk score were considered as independent prognostic factors. The nomogram model constructed accurately predicted the 3-year and 5-year overall survival (OS) of patients. Furthermore, m6A “eraser” might play a functional role in GC. The expression of m6A “eraser” leads to changes in tumor immune microenvironment.ConclusionsFTO and ALKBH5 showed association with the prognosis of GC. The m6A “eraser” related genes, which is considered as a reliable prognostic and predictive tool, assists in predicting the OS in GC patients.

Hiroki Hosogoshi, Kazunori Iwasa, Takaki Fukumori et al.

Abstract Background Chronic pain is a major health problem, and cognitive behavioral therapy (CBT) is its recommended treatment; however, efforts to develop CBT programs for chronic pain and assess their feasibility are remarkably delayed in Asia. Therefore, we conducted this pilot study to develop a basic individualized CBT for chronic pain (CBT-CP) and assessed its feasibility for use in Japan. Methods Our study was an open-labeled before–after trial without a control group conducted cooperatively in five Japanese tertiary care hospitals. Of 24 outpatients, 15, age 20–80, who experienced chronic pain for at least three months were eligible. They underwent an eight-session CBT-CP consisting of relaxation via a breathing method and progressive muscle relaxation, behavioral modification via activity pacing, and cognitive modification via cognitive reconstruction. The EuroQol five-dimensional questionnaire five level (EQ5D-5 L) assessment as the primary outcome and quality of life (QOL), pain severity, disability, catastrophizing, self-efficacy, and depressive symptoms as secondary outcomes were measured using self-administered questionnaires at baseline, post-treatment, and 3-month follow-up. Intention-to-treat analyses were conducted. Results Effect size for EQ5D-5 L score was medium from baseline to post-treatment (Hedge’s g = − 0.72, 90% confidence interval = − 1.38 to − 0.05) and up to the 3-month follow-up (g = − 0.60, CI = − 1.22 to 0.02). Effect sizes for mental and role/social QOL, disability, catastrophizing, self-efficacy, and depressive symptoms were medium to large, although those for pain severity and physical QOL were small. The dropout rate was acceptably low at 14%. No severe adverse events occurred. Conclusion The findings suggest that CBT-CP warrants a randomized controlled trial in Japan. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000020880 . Registered on 04 February 2016.

Shelly B Borden, Molly K Groose, Mark J Robitaille et al.

Medication shortages are a clinical reality that force changes in practice patterns leading to unintended consequences. Potential solutions to any drug shortage require a thoughtful, multidisciplinary and often creative approach. Here, we report a case of unintentional epinephrine overdose leading to an unstable cardiac arrhythmia and our subsequent development of a visual cue system to prevent future errors. A 56-year-old man with a history of rectal adenocarcinoma presented for low anterior resection and creation of diverting loop ileostomy. Epidural placement was requested by the surgical team, and following administration of a second test dose (created by the physician), the patient experienced supraventricular tachycardia with heart rates of 200-210 BPM for approximately 2 minutes. This rhythm then converted to atrial fibrillation with rapid ventricular response with heart rate of 150-170 BPM. The patient was stabilized after cardioversion. Later evaluation of medication administration revealed that the second epidural test dose inadvertently contained 100 mcg epinephrine instead of the intended 10 mcg dose. The test dose had to be created because the original ampule with the kit had been utilized. Since this time, our kits have no test dose, and this shortage is concerning for increased provider error. We suggest a novel visual cue system that may prevent unintentional epinephrine overdoses in the setting of regional anesthesia.

van der Veen GJ, Slagt C

Gijsbert J van der Veen, Cornelis Slagt Department of Anaesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands Fathy et al1 rightfully emphasize the importance of postoperative cognitive dysfunction&nbsp;(POCD) as it is associated with longer length of in-hospital stay and an increased&nbsp;mortality in the first year after surgery.2,3 However, in contrast to the conclusion made&nbsp;by Fathy et al, it is not anesthesia and surgery that are risk factors for the development&nbsp;of POCD.4 Baseline patient characteristics (education level, age, frailty) and in-hospital&nbsp;delirium are major contributors for the development of POCD.2&ndash;4 Subsequently there&nbsp;were no differences found in the incidence of POCD between regional vs general&nbsp;anesthesia.5 Although Fathy et al target a very vulnerable patient group with respect&nbsp;to risk factors of developing POCD, it is very unlikely, in relation to the aforementioned,&nbsp;that there will be a difference in incidence between two local anesthetics. Fathy&nbsp;et al confirm this in their own study;1 there is a similar (nonsignificant) incidence of&nbsp;POCD in patients receiving lidocaine and in patients receiving bupivacaine during&nbsp;cataract surgery. So, the challenge in the prevention of POCD is not in the anesthetic&nbsp;technique or drug, but in the identification and treatment of modifiable risk factors&nbsp;and postoperative delirium. View the original paper by Fathy and colleagues

Erkan Kaba, Mehmet Oguzhan Ozyurtkan, Kemal Ayalp et al.

Abstract Background To investigate the feasibility and efficacy of salvage lung resection and describe the possible indications and contraindications in patients with primary lung cancer. Methods Thirty patients undergoing anatomical salvage lung resection were classified into three groups: GI, patients with progressive lung tumor despite definitive chemo- and/or radiotherapy; GII, patients who underwent emergency resection; and GIII, patients in whom neoadjuvant or definitive chemo- and/or radiotherapy was contraindicated because of severe comorbidities. The groups were compared based on, peri- and postoperative factors, and survival rates. Results The morbidity rate was 70%. Revision surgery was required in 23% of patients. Morbidity was affected by lower hematocrit and hemoglobin levels (P = 0.05). Mean hospital stay was 11 ± 4 days, which was longer in patients in whom complications developed (P = 0.0003). The in-hospital or 30-day mortality rate was 3%. Mean relapse-free survival and overall survivals were 14 ± 12 and 19 ± 13 months. Conclusion Patients with progression of the persistent primary tumor after definitive chemo- and/or radiotherapy can undergo salvage lung resection with acceptable mortality and high morbidity rates, if the tumor is considered resectable. Other indications may be considered for salvage lung resection based on each patient’s specific evaluation.

Dirk Rüsch, Christian Arndt, Leopold Eberhart et al.

Abstract Background It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. Methods Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40–60) or to a weight-related (2 mg.kg− 1) manual administration of propofol for induction of general anesthesia. The primary endpoint was the incidence of hypotension following the administration of propofol. Secondary endpoints included the degree of hypotension and correlations between BIS and drop in mean arterial pressure (MAP). Incidences were analyzed with Fisher’s Exact-test. Results Of the 240 patients enrolled into this study, 235 predominantly non-geriatric (median 48 years, 25th – 75th percentile 35–61 years) patients without severe concomitant disease (88% American Society of Anesthesiology physical status 1–2) undergoing ear, nose and throat surgery, ophthalmic surgery, and dermatologic surgery were analyzed. Patients who were manually administered propofol guided by BIS (n = 120) compared to those who were given propofol by weight (n = 115) did not differ concerning the incidence of hypotension (44% vs. 45%; p = 0.87). Study groups were also similar regarding the maximal drop in MAP compared to baseline (33% vs. 30%) and the proportion of hypotensive events related to all measurements (17% vs. 19%). Final propofol induction doses in BIS group and NON-BIS group were similar (1.93 mg/kg vs. 2 mg/kg). There was no linear correlation between BIS and the drop in MAP at all times (r < 0.2 for all) except for a weak one at 6 min (r = 0.221). Conclusion Results of our study suggest that a BIS-guided compared to a weight-adjusted manual administration of propofol for induction of general anesthesia in non-geriatric patients will not lower the incidence and degree of arterial hypotension. Trial registration German Registry of Clinical Trials (DRKS00010544), retrospectively registered on August 4, 2016.

Hashem Heshmati, Karim darvishpour

Introduction: Clinical education is one of the most important aspects of medical and paramedical students' education and has a determining role in the professional future of these students as well as other professionals in health care. So this study aimed to evaluate the effective factors in the quality of clinical education from the viewpoints of operation room and Anesthesiology students in Torbat Heydarieh University of Medical Sciences. Methods: In this descriptive cross-sectional study, a number of 115 students of operation room and Anesthesiology studying in Torbat Heydarieh university of Medical science in 2015 were selected through convenient sampling in that period of time. The data was collected through a questionnaire consisted of three parts. Part one dealt with demographic characteristics of the participants. Part two was adapted from the valid and reliable Ghorbanian`s questionnaire. Part three was a researcher- made student`s efficacy questionnaire which its validity and reliability were calculated in this study. The mean scores of the evaluated domains were between 0 and 100 and were consequently categorized at three levels: weak, medium and desirable. The collected data was analyzed using descriptive statistics and independent T-tests. Results: the mean age of the students was 21.69±1.41. The mean scores of the assessed domains were: goals and educational plans (51.03±23.77), Instructor (51.21±26.47), dealing with students (52.85±24.89), educational environment (47.85±0.288), supervision and evaluation (44.76±29.08) and self-efficacy (63.67±20.15). The mean scores of Instructor (55.88±22) and dealing with students (52/5±55.05) were the highest among Operation Room and Anesthesiology students, respectively. There was no significant difference between the two groups regarding the evaluated domains (p=0.25). Conclusion: The mean scores of goals, Instructor, dealing with students, educational environment, supervision and evaluation, and self-efficacy were in average level. Therefore, educational interventions are recommended to promote educational goals, efficacy of instructors, dealing with students, educational environment and self-efficacy of students in clinical settings.

Dario Galante, Donatella Fortarezza, Maria Caggiano et al.

Objective: The bispectral index (BIS) is a parameter derived by electroencephalography (EEG) which provides a direct measurement of the effects of sedatives and anesthetics on the brain and offers guidance on the adequacy of anesthesia. The literature lacks studies on BIS monitoring in pediatric patients with congenital brain disease undergoing general anesthesia. Clinical features: A 13-year-old child weighing 32 kg, suffering from lobar holoprosencephaly, underwent surgery in which the bispectral index (BIS) monitoring the depth of anesthesia showed an abnormal response. Detailed analysis of the trends of BIS values in the different observation times demonstrated sudden falls and repetitive values of BIS likely related to repetitive epileptiform electrical activity caused by sevoflurane. Conclusion: The BIS is a very useful monitoring tool for assessing the degree of depth of anesthesia and to analyze the electroencephalographic variations of anesthetics. Particular attention should be given to patients with congenital disorders of the central nervous system in which the BIS may give abnormal responses that do not reflect an accurate assessment of the depth of anesthesia. Resumo: Objetivo: O índice bispectral (BIS) é um parâmetro derivado por eletroencefalografia (EEG) que fornece uma medida direta dos efeitos de sedativos e anestésicos no cérebro e orientação sobre a adequação da anestesia. A literatura carece de estudos sobre a monitoração do BIS em pacientes pediátricos com doença cerebral congênita submetidos à anestesia geral. Características clínicas: Criança de 13 anos de idade, pesando 32 kg, com holoprosencefalia lobar, foi submetida à cirurgia em que a monitoração da profundidade da anestesia com o uso do BIS mostrou uma resposta anormal. A análise detalhada das tendências dos valores do BIS nos diferentes tempos de observação mostrou quedas súbitas e valores repetitivos do BIS, provavelmente relacionados à atividade elétrica epileptiforme repetitiva causada por sevoflurano. Conclusão: O BIS é uma ferramenta de monitoração muito útil para avaliar o grau de profundidade da anestesia e as variações eletroencefalográficas dos anestésicos. Atenção especial deve ser dedicada aos pacientes com doenças congênitas do sistema nervoso central nos quais o BIS pode apresentar respostas anormais que não refletem a avaliação precisa da profundidade da anestesia. Keywords: Holoprosencephaly, Bispectral index, Sevoflurane, Seizures, Palavras-chave: Holoprosencefalia, Índice bispectral, Sevoflurano, Convulsões

Turhan Kara, Ozgur Ozbagriacik, Hacer Sebnem Turk et al.

Background and objectives: Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures. Methods: 80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mgkg−1 rocuronium and monitorized with train-of-four. Group RN (n = 40) received 0.03 mgkg−1 neostigmine, Group RS (n = 40) received 2 mgkg−1 sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded. Results: There was no significant difference between the patients' characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (p = 0.001, p = 0.002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (p = 0.020). Extubation train-of-four ratio was significantly lower in Group RN (p = 0.002). Conclusion: Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.