Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Background and Objectives: The study was designed to compare the propofol-sparing effect, intraoperative haemodynamic profiles, and recovery profiles during propofol– remifentanil total intravenous anaesthesia (TIVA) with remimazolam or dexmedetomidine co-administered as an adjuvant. Materials and Methods: After the remifentanil target concentration of 5 ng/mL had been achieved and endotracheal intubation was completed, the R group was intravenously administered 1 mg remimazolam/kg/hr, the D group was given 0.5 μg dexmedetomidine/kg/hr, and the control (C) group was given 1 mL normal saline/kg/hr. The allocated experimental drug infusion was initiated immediately after intubation and maintained until termination of the two target-controlled infusions of propofol and remifentanil. The propofol-sparing effect, intraoperative haemodynamic profiles and recovery profiles were assessed in the three groups. Results: The R group had the lowest requirement of propofol and the C group had the highest requirement of propofol. Haemodynamic profiles were similar among the groups. However, the total phenylephrine dose administered to maintain haemodynamic stability was significantly lower in the R group than in the D group and C group. Recovery profiles did not significantly differ between the groups. Conclusions: The co-administration of remimazolam or dexmedetomidine as an adjuvant in propofol–remifentanil TIVA reduced propofol requirements. While recovery profiles, including recovery times, postoperative pain, and postoperative nausea and vomiting, were similar among the groups, remimazolam was associated with a reduced phenylephrine requirement despite similar haemodynamic profiles....
Background: Epidural anesthesia (EA) has gained prominence in rapid postoperative recovery protocols for cardiac surgery, aiming to reduce opioid use, shorten intensive care stays, and improve patient outcomes. This prospective randomized controlled trial evaluated the protective effects of EA combined with general anesthesia (GA + EA) compared to GA alone in patients undergoing off-pump coronary artery bypass grafting (CABG). Methods: Sixty male patients undergoing elective off-pump CABG were randomized into two groups: GA (n = 30) and GA + EA (n = 30). Surgical procedures were standardized using bilateral internal mammary arteries skeletonized with an ultrasonic scalpel. Patients in the GA + EA group received thoracic EA at the T2–T3 level, confirmed radiologically, with continuous bupivacaine infusion. Results: Significant benefits were observed in the GA + EA group, including shorter mechanical ventilation duration (4.59 vs. 5.72 h; p = 0.011) and reduced hospital stay (5.43 vs. 6.73 days; p = 0.001). Internal mammary artery blood flow measurements were significantly higher in the GA + EA group (p<0.001). Plasma aldosterone levels were significantly lower in GA + EA patients, indicating reduced stress-induced hormonal responses (left artery: 13.38 vs. 17.68 ng/dL, p = 0.005; right artery: 12.77 vs. 18.37 ng/ dL, p = 0.003). Long-term outcomes demonstrated superior major adverse cardiovascular event (MACE)-free survival in the GA + EA group (p<0.001). Cox regression analysis confirmed that GA + EA independently reduced cardiovascular risk, even after adjusting for age, ejection fraction, and dopamine levels (HR = 0.0118,p<0.001). Higher aldosterone levels significantly correlated with increased MACE risk (p<0.05). Conclusions: The study highlights aldosterone suppression as a potential mechanism underlying EA’s cardioprotective effects, emphasizing its role in enhancing recovery and reducing cardiovascular complications. Despite limitations such as small sample size and single-center design, findings strongly support integrating EA into cardiac surgical practice....
Background: Intraoperative EEG provides a noninvasive window into cortical dynamics under anesthesia, but conventional spectral analysis cannot capture nonstationary modulation patterns linked to nociceptive processing. This study applied Holo- Hilbert spectral analysis (HHSA) to characterize cross-frequency modulation patterns in relation to the Surgical Pleth Index (SPI) during general anesthesia. Methods: Frontal EEG from 134 female patients undergoing gynecologic surgery was analyzed. Ten-minute segments were first examined to define canonical modulation structures, followed by one-minute epochs synchronized with SPI values to assess dynamic changes. HHSA decomposed each epoch into amplitude modulation patterns across carrier frequencies (1/64–64 Hz). Group comparisons between pain and no-pain epochs were performed using t-tests with Bonferroni correction. A linear mixedeffects model evaluated the effects of SPI, minimum alveolar concentration (MAC), heart rate (HR), and mean arterial pressure (NIBP-m) on alpha-band modulation (8–16-Hz carrier modulated by 3–8-Hz amplitude). Results: HHSA revealed two dominant cross-frequency interactions within the alpha-carrier band (8–16 Hz): one modulated by 3–6-Hz (high-delta to theta) and another by 1–2-Hz (low-delta) oscillations, indicating layered modulation under anesthesia. During nociceptive states (SPI > 60), modulation power increased in the alpha and high-delta bands, while theta and low-delta modulation weakened. Alpha-band modulation power rose with SPI and declined with MAC. Conclusions: HHSA revealed distinct cross-frequency modulation patterns reflecting the cortical balance between nociception and analgesia. Alpha-band modulation serves as a physiologically grounded EEG marker for individualized nociception monitoring under general anesthesia....
Background: Drug administration errors are widespread in healthcare and are a major reason for malpractice claims against anesthesia service providers. The outcomes of medication errors range from no harm to grievous events such as intensive care admissions or death; nonetheless, they are preventable. In this survey, we determined the prevalence and characteristics of drug errors among anesthesia practitioners in Namibia, identified the contributing factors, and assessed their outcomes for patients. Methods: We used a cross-sectional design. A self-administered questionnaire was mailed to anesthesia service providers (specialist anesthesiologists, anesthesia registrars, and medical officers) across the 34 public hospitals and 18 private hospitals in Namibia over a period of one month. Results: Out of 122 questionnaires distributed, 112 (92%) anesthesia providers responded. A higher percentage were female (52%), and most were medical officers (56%). Among the respondents, 79% had experienced one or more medication errors during their anesthesia practice. The most common type was omission (46%), followed by the administration of a wrong drug (27%). In 69% of cases, there was no harm to the patients, while 6% had intensive care unit admissions and 1 (0.9%) died. Conclusion: We found a high prevalence of medication errors during anesthesia practice in Namibia, most due to fatigue or distractions. Most errors did not cause harm to the patients. It is imperative to increase awareness and training for prevention as well as to establish a nationally coordinated incident reporting system....
Aims: This study investigated how Sirtuin 1 (Sirt1) protects against sevoflurane- induced postoperative cognitive dysfunction (POCD) in aged rats by targeting N- acetyltransferase 10 (NAT10)- mediated mRNA acetylation and mitochondrial homeostasis. Methods: Aged rats received sevoflurane exposure and AAV- mediated Sirt1/Nat10 manipulation. We assessed autophagy (WB, LC3/TOM20 colocalization), energy metabolism (ROS/ATP, JC- 1), and Gababr1 expression (RT- qPCR, immunofluorescence). Cognitive function was evaluated using Y- maze, NORT, and MWM. scRNA- seq identified neuronal subpopulations, while RIPqPCR/ dot blot analyzed Nat10- Gababr1 mRNA interactions. Patch- clamp recordings measured IPSC_slow amplitudes. Results: Sevoflurane increased NAT10 expression and Gababr1 mRNA ac4C acetylation. Sirt1 overexpression deacetylated NAT10, restoring autophagy (↑LC3- II), reducing ROS, and improving cognition. scRNA- seq revealed SIRT1 enrichment in high- autophagy neurons. Nat10 knockdown decreased Gababr1 expression and cognitive deficits. Electrophysiology confirmed SIRT1- mediated reduction of Baclofen- induced IPSC_slow via NAT10 deacetylation. Conclusion: SIRT1 alleviates POCD by deacetylating NAT10 to reduce Gababr1 mRNA acetylation, thereby normalizing synaptic inhibition and restoring metabolic- autophagic balance. The SIRT1- NAT10- GABABR1 axis represents a novel therapeutic target for anesthesia- related neurotoxicity....
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