Current Issue : January-March Volume : 2026 Issue Number : 1 Articles : 5 Articles
Background/Objectives: Some patients undergoing vitreoretinal surgery (VRS) require general anesthesia (GA), despite the possibility of developing intolerable postoperative pain perception (IPPP). Intraoperative rescue opioid analgesia (IROA) administration during GA poses a risk of perioperative nausea and vomiting (PONV), which may result in suprachoroidal hemorrhage with permanent visual impairment. Adequacy of Anesthesia (AoA) optimizes intraoperative IROA titration. Intravenous preemptive analgesia (IPA) with cyclooxygenase-3 (COX-3) inhibitors is added to GA to reduce the IROA dose. In this additional analysis, we assessed the impact of preemptive analgesia with COX-3 inhibitors, administered alongside GA with AoA-guided IROA, on the incidence of PONV, oculocardiac reflex (OCR), and oculoemetic reflex (OER) in patients undergoing VRS as secondary outcomes. Methods: A total of 165 patients scheduled for VRS were randomly assigned to receive AoA-guided GA combined with IPA at a single dose of 1 g of paracetamol (acetaminophen) or 2.5 g of metamizole or both. A total of nine patients were excluded due to technical problems with the intraoperative surgical pleth index (SPI) measurement, inability to report postoperative pain, and postoperative arousal resulting in a loss of follow-up in Stage 5. Results: Regardless of the group assignment, AoA guidance of GA resulted in PONV in 4%, OCR in 10%, and OER in 0% of the 153 analyzed patients undergoing VRS. No significant differences were observed between the groups regarding the type of IPA. PONV was observed in 2.11% (3/142) of patients with zero, one, or two risk factors of PONV, as compared to 27% (3/11) of patients with at least three PONV risk factors, assessed using the Apfel score. Conclusions: IPA with both paracetamol and metamizole did not demonstrate a benefit in reducing the analyzed adverse events compared with their single use in patients undergoing VRS under AoA guidance during GA. Surprisingly, PONV was hardly observed in patients with zero, one, or two PONV risk factors assessed by the Apfel score who underwent AoA-guided VRS during GA with IPA using one or two COX-3 inhibitors....
Remifentanil is a potent opioid characterized by a unique pharmacokinetic profile that makes it well-suited for analgesia in obstetrics. When administered in a patient-controlled analgesia (PCA) modality, remifentanil has become a recognized and versatile alternative for labor pain relief in cases where epidural analgesia is contraindicated or is declined by the parturient. It offers mild to moderate pain relief, effectively decreasing pain from severe levels to a more manageable, moderate intensity. Remifentanil can be administered promptly and acts quickly, making it particularly useful in rapidly progressing or advanced labor. It can also benefit women with anxiety or tokophobia, as its sedative, anxiolytic, and euphoric effects help reduce pain perception and facilitate coping during labor. While it is not superior to epidural analgesia in terms of analgesic efficacy, remifentanil-PCA has obtained a role as a complementary pain-relieving option in several obstetric situations. Remifentanil-PCA is associated with high patient satisfaction, which is closely linked to realistic counseling and proper expectation management. The safety profile for both mother and neonate has been established; however, safety depends on cautious incremental dosing tailored to sedation levels, the use of supplemental oxygen, rigorous monitoring, and avoiding background infusion. Vigilant supervision by healthcare providers is essential, ideally supported by the continuous presence of an anesthesia team in the labor ward....
Background/Objectives: Despite an increase in the number of women medical graduates, gender disparities persist in academic anaesthesiology. Women in medical science face challenges in publications, research funding, editorial board membership, and peer review, and they remain under-represented, particularly in senior authorship and leadership positions. Methods: This repeated cross-sectional bibliometric analysis examined global trends and cross-country differences in the representation of women as first, co-, and senior authors of peer-reviewed articles published in five high-impact anaesthesiology journals over three decades, with a focus on developments in recent years. Gender was assigned to authors’ first names algorithmically in two steps (Gender API and NamSor). Results: A total of 7571 publications were analysed, comprising 37,738 authors. Women constituted 11,732 (31.09%) authorships in total, and men consistently accounted for a substantial majority among authors (p < 0.001). Despite a significant overall increase in authorship by women—peaking in 2022 at 590 (36.88%) first authors, 2245 (37.85%) coauthors, and 402 (28.05%) senior authors (all p < 0.001)—stagnation was observed in recent years, with no significant changes for first and co-authors after 2016 (p > 0.05). Countrylevel analysis revealed few significant differences, with Japan consistently reporting the lowest percentages of women authors. Conclusions: This study underscores persistent gender disparities in academic anaesthesiology, despite a moderate increase in authorship by women over three decades. Gender disparity remains a global issue, and the recent stagnation highlights the necessity for more comprehensive efforts and innovative strategies to foster a more inclusive research community in academic anaesthesiology....
The teaching of medical history, once central to medical education, has been progressively displaced by science- and competency-focused curricula. In anesthesiology, despite the presence of historical scholarship and institutional resources, the history of this specialty is rarely used as a formal educational tool. This narrative review explores how historical narratives can support the development of professionalism and professional identity in anesthesia training. An exploratory search of the literature revealed no prior studies explicitly linking anesthesia history to professional identity formation, underscoring a gap in current scholarship. Drawing on the foundational literature in medical education and selected historical examples, including figures such as Crawford Long, Henry Beecher, and Virginia Apgar, this review illustrates how reflective engagement with historical episodes can deepen ethical awareness, foster identity formation, and contextualize the evolving role of the anesthesiologist. It proposes a theoretical framework and strategies for integrating historical content into anesthesia curricula and argues that historical reflection can complement existing methods for teaching professionalism. The history of anesthesia, when purposefully employed, offers a powerful means to humanize training, support critical reflection, and better prepare trainees for the ethical and professional challenges of contemporary practice....
Background: Postoperative nausea and vomiting (PONV) can have significant consequences on postoperative recovery and quality of care. The aim of our study was to investigate the association between anesthetic agents, antiemetic prophylaxis with dexamethasone (APD), and the occurrence of postoperative nausea and vomiting. Method: We conducted a case-control study (Cases: patients who received APD; Controls: patients who did not receive APD) including 108 patients who underwent surgery in the ENT, traumatology, and gynecology departments of Laquintinie Hospital in Douala. Sociodemographic data and the frequency of PONV within 48 hours post-surgery were collected in both groups and analyzed using R software. Fisher’s exact test was used to assess the association between anesthetic agents, APD, and the occurrence of PONV (95% CI, alpha = 5%). Results: The mean age of patients was 39.8 ± 10.2 years, with a male predominance (54.6%). PONV occurred in 7 (13%) patients in the case group and in 19 (35.2%) in the control group. Fentanyl (p = 0.012) and Halothane (p = 0.008) were significantly associated with the occurrence of PONV, while no significant association was found with Thiopental (p = 0.174), Propofol (p = 0.245), Ketamine (p = 0.108), or Isoflurane (p = 0.604). Conclusion: Anesthetic agents such as thiopental, propofol, ketamine, and isoflurane, when combined with DAP, may have effects on reducing the frequency of PONV....
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