Daily Anesthesiology Research Analysis

BACKGROUND: Advances in regional anesthesia techniques and the widespread use of ultrasound guidance have enabled safe and effective anesthesia for ambulatory breast cancer surgery, eliminating the general anesthesia-associated systemic effects. We therefore compared regional anesthesia with dexmedetomidine sedation to general anesthesia on the 15-item postoperative quality of recovery (QoR-15). METHODS: Ninety-six patients scheduled for breast-conserving surgery and sentinel lymph node biopsy were randomly assigned to regional anesthesia with sedation or general anesthesia. In patients assigned to regional anesthesia, a 0.3% ropivacaine solution was used for pectoral and intercostal nerve blocks, followed by a dexmedetomidine infusion. In other patients, standardized general anesthesia was maintained with a laryngeal mask airway. The primary outcome was the QoR-15 score 6 h after surgery. Secondary outcomes included QoR-15 scores at 2 and 24 h; pain scores obtained using the numerical rating scale (NRS) at 2, 6, and 24 h; and the incidence of postoperative complications. RESULTS: At postoperative hour 6, QoR-15 scores were significantly and meaningfully higher in patients given regional anesthesia [142 (136, 146)] than those assigned to general anesthesia [132 (127, 135), p < 0.01]. Regional anesthesia patients also had significantly higher QoR-15 scores at 2 and 24 h postoperatively. Two hours after surgery, regional anesthesia patients had lower pain scores at rest and during movement, needed less rescue analgesia [13 (27%) versus 27 (56%), p < 0.01], and had fewer experienced nausea and vomiting [1 (2%) versus 13 (27%), p < 0.01]. Moreover, patients assigned to regional anesthesia had fewer episodes of hypotension and smaller hemodynamic fluctuations during skin incision. In contrast, there were no significant differences in the incidences of postoperative hypotension and bradycardia in patients randomized to regional and general anesthesia. CONCLUSIONS: Recovery quality after breast-conserving surgery combined with sentinel lymph node biopsy was better with regional anesthesia combined with dexmedetomidine sedation than with general anesthesia. Regional anesthesia also improved pain control, intraoperative hemodynamic stability, and decreased nausea and vomiting.

OBJECTIVE: Precise localization of the cricothyroid membrane in obese women is challenging. This randomized comparative study aimed to evaluate the neck-extended position versus the modified ramped position in terms of success rate, time required, and perceived difficulty in identifying the cricothyroid membrane in anesthetized obese female patients. METHODS: After the induction of anesthesia in 112 obese female patients, the cricothyroid membrane was identified using the laryngeal handshake technique in the neck-extended or modified ramped position. In the neck-extended position, a pillow was placed beneath the shoulders in the supine position. The modified ramped position was achieved by combining a ramped position with full head extension using a specialized pillow. The success rate of accurate identification of the cricothyroid membrane, time required to locate the cricothyroid membrane center, and the subjective difficulty of cricothyroid membrane palpation were recorded. RESULTS: The success rate of accurate identification of the cricothyroid membrane was significantly higher in the modified ramped position than in the neck-extended position (77% vs. 48%, respectively; P = 0.002). The time required for localization of the cricothyroid membrane center did not differ between the neck-extended and modified ramped positions (46.0 [23.2] s vs. 41.0 (15.0) s, respectively; P = 0.562). The subjective difficulty of cricothyroid membrane palpation as perceived by anesthesiologists was significantly lower in the modified ramped position than in the neck-extended position (P = 0.019). CONCLUSION: The modified ramped position facilitated accurate identification of the cricothyroid membrane and reduced the difficulty of cricothyroid membrane palpation in anesthetized obese female patients compared with the neck-extended position.

BACKGROUND: General anesthesia for cesarean delivery requires balancing adequate maternal anesthetic depth against fetal drug exposure. The relationship between induction-to-delivery time, maternal anesthetic concentration, and fetal sevoflurane exposure remains incompletely characterized. METHODS: In this prospective observational study, 16 women undergoing elective cesarean delivery under general anesthesia were enrolled. Paired maternal and umbilical blood samples were analyzed by headspace gas chromatography-mass spectrometry at delivery. Our primary investigation was the correlation between induction-to-delivery time and feto-maternal ratio. RESULTS: Mean induction-to-delivery time was 3.3 ± 1.1 min (range 1.5-5.3). Mean feto-maternal ratio was 0.2 ± 0.16. Induction-to-delivery time correlated with feto-maternal ratio (P < 0.001). Each additional minute increased fetal exposure by 52%. Neither end-tidal concentration nor maternal blood sevoflurane levels predicted fetal blood concentrations. In exploratory analysis, fetal sevoflurane concentration showed no evidence of large effects on Apgar scores (r = -0.06, P = 0.830) or umbilical pH (r = 0.41, P = 0.110). All neonates achieved an Apgar score of at least 8 at 10 min; no acidosis occurred. CONCLUSIONS: Induction-to-delivery time was strongly associated with fetal sevoflurane exposure. End-tidal monitoring reflects maternal anesthetic depth but does not predict fetal drug levels. Given the limited sample size, the clinical implications for neonatal outcomes remain uncertain. Minimizing induction to delivery time may reduce fetal exposure, but this requires confirmation in larger studies.