Explore the vast range of titles available.

Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, ie, evaluations up to 30 days postoperative, and neurocognitive disorder, ie, assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a metaanalysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1913 articles yielded ten studies with a total of 3390 individuals. For the secondary objective, four studies with a total of 480 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.46 (95% CI = 0.26-0.81; p = 0.01), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Given the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question. Keywords: postoperative cognitive dysfunction, POCD, total intravenous anesthesia, TIVA, inhalational anesthesia, postoperative complications, psychometric tests

Backgroung: breast cancer is a leading cause of morbidity and mortality among women worldwide. Emerging evidence suggests that anesthetic techniques used during cancer surgery may modulate perioperative immune and inflammatory responses, influencing tumor biology and long-term outcomes. Propofol-based total intravenous anesthesia has been associated with immunomodulatory properties that may affect pathways involved in tumor recurrence.  Objective: this protocol describes a systematic review and meta-analysis of randomized controlled trials (RCTs) designed to evaluate the effects of propofol-based anesthesia, compared with volatile anesthetics, on biomarkers related to tumor recurrence in adult patients undergoing breast cancer surgery.  Methods: the review will be conducted in accordance with PRISMA guidelines. A comprehensive search will be performed in Scopus, Web of Science, MEDLINE/PubMed, Embase, CINAHL, and Cochrane databases, without restrictions on language or publication date. Eligible RCTs will report perioperative changes in biomarkers reflecting: (a) systemic inflammatory response (interleukin-6, tumor necrosis factor-alpha, interleukin-10); (b) antitumor cellular immunity (natural killer cell activity, CD4+ and CD8+ lymphocyte counts); (c) tumor biology and recurrence potential (circulating tumor cells and HER/HER2 expression). Study selection, data extraction, and risk-of-bias assessment will be conducted independently using Rayyan, RoB 2, and GRADE. Quantitative synthesis will be performed if appropriate, using random-effects meta-analysis.  Expected significance: the findings of this review may inform clinical decision-making regarding anesthetic choice in oncologic surgery and contribute to evidence-based perioperative strategies to minimize the risk of tumor recurrence in breast cancer patients. Introdução: o câncer de mama é uma das principais causas de morbidade e mortalidade entre mulheres em todo o mundo. Evidências emergentes sugerem que as técnicas anestésicas utilizadas durante a cirurgia oncológica podem modular as respostas imunes e inflamatórias perioperatórias, influenciando a biologia tumoral e os desfechos a longo prazo. A anestesia intravenosa total à base de propofol tem sido associada a propriedades imunomoduladoras que podem afetar vias envolvidas na recorrência tumoral.  Objetivo: este protocolo descreve uma revisão sistemática e metanálise de ensaios clínicos randomizados (ECRs) concebidos para avaliar os efeitos da anestesia à base de propofol, em comparação com anestésicos voláteis, sobre biomarcadores relacionados à recorrência tumoral em pacientes adultas submetidas à cirurgia de câncer de mama.  Método: a revisão será conduzida de acordo com as diretrizes PRISMA. Uma busca abrangente será realizada nas bases de dados Scopus, Web of Science, MEDLINE/PubMed, Embase, CINAHL e Cochrane, sem restrições de idioma ou data de publicação. Ensaios clínicos randomizados (ECR) elegíveis deverão relatar alterações perioperatórias em biomarcadores que reflitam: (a) resposta inflamatória sistêmica (interleucina-6, fator de necrose tumoral alfa, interleucina-10); (b) imunidade celular antitumoral (atividade de células natural killer, contagem de linfócitos CD4+ e CD8+); (c) biologia tumoral e potencial de recorrência (células tumorais circulantes e expressão de HER/HER2). A seleção dos estudos, a extração de dados e a avaliação do risco de viés serão realizadas independentemente utilizando Rayyan, RoB 2 e GRADE. A síntese quantitativa será realizada, quando apropriado, utilizando metanálise de efeitos aleatórios.  Significado esperado: os achados desta revisão podem auxiliar na tomada de decisões clínicas em relação à escolha anestésica em cirurgia oncológica e contribuir para estratégias perioperatórias baseadas em evidências para minimizar o risco de recorrência tumoral em pacientes com câncer de mama.

Background: Total intravenous anaesthesia (TIVA) is a technique in which induction and maintenance of anaesthesia is achieved with intravenous (IV) drug alone avoiding volatile agents. In this process, the patient either breaths spontaneously or with bag mask ventilation combined with oxygen. AIMS AND Objective: To compare Propofol -Ketamine and Propofol -Butorphanol for TIVA in short surgical procedures in terms of their Hemodynamic stability, Postoperative sedation, Pain on injection with Propofol & Post operative nausea and vomiting. Material And Methods: This prospective, comparative study was conducted in 50 patients (18 - 60 years of age), ASA grade I and II, scheduled for elective surgery of duration less than 1hour. Patients were randomly divided into two groups : Group B-P receive inj.Butorphanol 20 ug/ kg + inj.Propofol 1.5 mg/kg and Group K-P receive inj. Ketamine 1mg/kg + inj. Propofol 1.5 mg/kg and Anesthesia was maintained with injection Propofol in the dose of 9mg/kg/hour. Results: Demographic data were comparable between two groups. Both groups were comparable in Hemodynamic parameters however in Group-BP there was decrease in mean blood pressure which was statistically insignificant. The incidence of sedation was more in group BP (36%) as compared to group KP (24%) but difference was statistical insignificant. In group BP, the incidence of pain was 4%, where as in group KP it was 36 % and this was statistical significant and the incidence of PONV is comparable in both groups. Conclusion: we concluded that both groups were comparable in terms of their Hemodynamic stability, Postoperative sedation and PONV but the Pain on injection with Propofol was significantly less in group BP (p value <0.01)

•Pediatric bipolar disorder (PBD) is a severe form of psychopathology whose brain alterations are not fully understood.•This study analyzed brain activity and structural differences using Resting-state Regional Homogeneity (ReHo) and Grey Matter Concentration (GMC) in 58 PBD patients and 21 healthy controls (HC) with a data fusion machine leanring approach.•A Fronto-medial network and a Temporo-posterior network showed increased ReHo and GMC in PBD patients compared to HC, and positively correlated with depression scores.•Differences between PBD Type I and Type II were also found in occipito-cerebellar and fronto-parietal networks, with Type I showing increased ReHo and GMC in the occipito-cerebellar region. Pediatric bipolar disorder (PBD) is a highly debilitating condition, characterized by alternating episodes of mania and depression, with intervening periods of remission. Limited information is available about the functional and structural abnormalities in PBD, particularly when comparing type I with type II subtypes. Resting-state brain activity and structural grey matter, assessed through MRI, may provide insight into the neurobiological biomarkers of this disorder. In this study, Resting state Regional Homogeneity (ReHo) and grey matter concentration (GMC) data of 58 PBD patients, and 21 healthy controls matched for age, gender, education and IQ, were analyzed in a data fusion unsupervised machine learning approach known as transposed Independent Vector Analysis. Two networks significantly differed between BPD and HC. The first network included fronto- medial regions, such as the medial and superior frontal gyrus, the cingulate, and displayed higher ReHo and GMC values in PBD compared to HC. The second network included temporo-posterior regions, as well as the insula, the caudate and the precuneus and displayed lower ReHo and GMC values in PBD compared to HC. Additionally, two networks differ between type-I vs type-II in PBD: an occipito-cerebellar network with increased ReHo and GMC in type-I compared to type-II, and a fronto-parietal network with decreased ReHo and GMC in type-I compared to type-II. Of note, the first network positively correlated with depression scores. These findings shed new light on the functional and structural abnormalities displayed by pediatric bipolar patients.

We conducted a non-inferiority study to assess the postoperative quality of recovery (QoR) in elderly patients receiving ciprofol or propofol total intravenous anesthersia(TIVA)after elective laparoscopic major abdominal surgery, with QoR-15 scores as the main measure. A prospective, double-blind, randomized non-inferiority trial was conducted in the theater, post-anesthesia care unit (PACU), and the ward. 144 elderly patients (age ≥ 65 years) were randomly assigned to either the ciprofol group or the propofol group. The ciprofol group received continuous infusion of ciprofol with remifentanil, and the propofol group received infusion of propofol with remifentanil. The primary outcome was the QoR-15 on the first postoperative day (POD1), assessed in both intention-to-treat and per-protocol populations, with the mean difference between groups compared to a non-inferiority threshold of −8. Additional assessments included QoR-15 scores on POD2, 3, and 5 for both analysis sets. Other evaluated perioperative value factors included hemodynamic parameters and injection discomfort in the intention-to-treat analysis. A linear mixed model was utilized to examine the impact of group-time interactions on hemodynamic data and QoR-15. The QoR-15 scores on POD1 in the ciprofol group were non-inferior to those in the propofol group both in intention-to-treat set (mean [95 %CI], 95.9[93.7–98.2] vs. 95.6 [93.3–97.8]; mean difference [95 % CI], 0.4 [−2.8–3.5]; P<0.001 for noninferiority) and per-protocol set (mean [95 %CI], 96.7 [94.4–99.0] vs. 95.7 [93.4–98.0]; mean difference [95 % CI], 1.0 [−2.2–4.3]; P<0.001 for noninferiority). Comparable outcomes were noted on postoperative days 2, 3, and 5 following the procedure in both analysis sets. Additionally: compared with propofol group, the occurrence of injection pain was lower (2.8 % vs. 27.8 %, P < 0.001); the hypotension was less frequent (33.3 % vs. 54.2 %, P = 0.012); the bradycardia was more common (38.9 % vs. 23.6 %, P = 0.048). Ciprofol is not inferior to propofol in QoR. Ciprofol can be suitably administered to elderly patients undergoing elective laparoscopic major abdominal surgery. •Ciprofol is a novel intravenous anesthetic agent.•Ciprofol offers a comparable quality of recovery to propofol, with reduced injection pain, more stable intraoperative hemodynamics.•For elderly patients with cardiovascular diseases undergoing major laparoscopic surgery, ciprofol may be preferable to propofol.

To evaluate whether estimating propofol requirement before surgery using a target-controlled infusion (TCI) model-based algorithm could reduce waste whilst maintaining workflow. Retrospective cohort study with in silico TCI-TIVA simulations using the Eleveld model at fixed effect-site targets (Cet 2.5–4.0 μg.ml−1) or a Cet corresponding to an estimated BIS of 45 (ECBIS45). Monte-Carlo simulation examined uncertainty in surgical duration estimates. University tertiary care provider. 229 adult patients undergoing general anesthesia with conventional propofol TIVA with manually adjusted infusion rate. Primary endpoint: predicted propofol amount for TCI and waste associated with three drawing-up strategies (50 ml vial only, 20 ml vial only, and vial combination based on estimated requirements). Secondary endpoint: relative number of syringe changes. Propofol requirements predicted using Cet 3.0 and ECBIS45 were similar to actual consumption. Algorithm-guided drawing-up produced significantly lower predicted waste than conventional TIVA practice (p < 0.0001, CI = −61.0 to −27.0 mg/procedure for Cet 3.0; p = 0.001, CI = −60.0 to −26.7 mg/procedure for ECBIS45), comparable to the 20 ml vial-only strategy but requiring fewer syringe changes. Waste remained significantly lower despite surgical duration estimation errors up to 20% for Cet 3.0 (p = 0.007) and 30% for ECBIS45 (p = 0.01). Using the Eleveld TCI model to estimate pre-operative propofol requirements could significantly reduce waste and avoid excessive syringe changes, even when surgical duration is uncertain. [Display omitted] •Pre-operative estimation of propofol requirements using the Eleveld TCI model matched actual consumption during TIVA.•Algorithm-guided preparation significantly reduced predicted waste without increasing the number of syringe changes.•Results remained robust despite uncertainty in estimated surgical duration, supporting its practical clinical applicability

Adult autistic patients schedule for operation need special care such as detailed preanesthetic consultation, specific physical evaluation and careful choice of anesthesia technique. They are very difficult to manage in anesthesia procedure setting because they have very different reactions to any change in routine. They also had pronounced abnormal anatomy possibility than children especially in the face bones that could influence the airway passage. The aim of this case report is to present total intravenous anesthesia (TIVA) as a choice of anesthesia techniques which is best suited for the adult autistic patient. This technique uses intravenous anesthesia drugs, propofol and fentanyl, for anesthesia induction and maintenance and avoid the use of anesthesia gasses. The rarity of this technique used in autistic patient lead to a very limited literature in anesthesia technique in adult autism patient.

Increasing evidence suggests that total intravenous anaesthesia (TIVA) may be the preferred anaesthetic for cancer resection surgery. To assist the preparation of a randomised controlled trial (RCT) examining Volatile (versus TIVA) Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) we developed an 18-question electronic survey to investigate practice patterns and perspectives (emphasising indications, barriers, and impact on cancer outcomes) of TIVA versus inhalational general anaesthesia in Australasia. The survey was emailed to 1,000 (of 5,300 active Fellows) randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. The response rate was 27.5% (n=275). Of the respondents, 18% use TIVA for the majority of cases. In contrast, 46% use TIVA 20% of the time or less. Respondents described indications for TIVA as high risk of nausea, neurosurgery, and susceptibility to malignant hyperthermia. Lack of equipment, lack of education and cost were not considered barriers to TIVA use, and a significant proportion (41%) of respondents would use TIVA more often if setup were easier. Of the respondents, 43% thought that TIVA was associated with less cancer recurrence than inhalational anaesthesia, while 46% thought that there was no difference. Yet, only 29% of respondents reported that they use TIVA often or very often for cancer surgery. In Australasia, there is generally a low frequency of TIVA use despite a perception of benefit when compared with inhalational anaesthesia. Anaesthetists are willing to use TIVA for indications where sufficient evidence supports a meaningful level of improvement in clinical outcome. The survey explores attitudes towards use of TIVA for cancer surgery and demonstrates equipoise in anaesthetists' opinions regarding this indication. The inconsistent use of TIVA in Australasia, minimal barriers to its use, and the equipoise in anaesthetists' opinions regarding the effect of TIVA versus inhalational anaesthesia on cancer outcomes support the need for a large prospective RCT.

Background The major goals of anesthesia in patients with severe traumatic brain injury (TBI) are—maintenance of hemodynamic stability, optimal cerebral perfusion pressure, lowering of ICP, and providing a relaxed brain. Although both inhalational and intravenous anesthetics are commonly employed, there is no clear consensus on which technique is better for the anesthetic management of severe TBI. Methods Ninety patients, 18–60 years of age, of either gender, with GCS < 8, posted for emergency evacuation of acute subdural hematoma were enrolled in this prospective trial, and they were randomized into two groups of 45 each. Patients in group P received propofol infusion at 100–150 mcg/kg/min for maintenance of anesthesia and those in group I received ≤ 1 MAC of isoflurane. Hemodynamic parameters were monitored in all patients. ICP was measured at the dural opening and brain relaxation was assessed by the operating surgeon on a four-point scale (1-perfectly relaxed, 2-satisfactorily relaxed, 3-firm brain, and 4-bulging brain) at the dural opening. It was reassessed at dural closure. Results Brain relaxation, both at dural opening and closure, was significantly better in patients who received propofol compared to those who received isoflurane. ICP was significantly lower (25.47 ± 3.72 mmHg vs. 23.41 ± 3.97 mmHg) in the TIVA group. Hemodynamic parameters were well maintained in both groups. Conclusions In patients with severe TBI, total intravenous (Propofol)-based anesthesia provided better brain relaxation, maintained a lower ICP along with better hemodynamics when compared to inhalational anesthesia. Clinical trial registration Clinical trials registry (NCT03146104).

A universal pharmacokinetic model was developed from pooled paediatric and adult data (40.6 postmenstrual weeks, 70.8 years, 3.1–152 kg). A three-compartment pharmacokinetic model with first-order elimination was superior to a two-compartment model to describe these pooled dexmedetomidine data. Population parameter estimates (population parameter variability%) were clearance (CL) 0.9 L/min/70 kg (36); intercompartmental clearances (Q2) 1.68 L/min/70 kg (63); Q3 0.62 L/min/70 kg (90); volume of distribution in the central compartment (V1) 25.2 L/70 kg (103.9); rapidly equilibrating peripheral compartment (V2) 34.4 L/70 kg (41.8); slow equilibrating peripheral compartment (V3) 65.4 L/70 kg (62). Obesity was best described by fat-free mass for clearances and normal fat mass for volumes with a factor for fat mass (FfatV) of 0.293. Models describing dexmedetomidine pharmacokinetics in adults can be applied to children by accounting for size (allometry) and age (maturation). This universal dexmedetomidine model is applicable to a broad range of ages and weights: neonates through to obese adults. Lean body weight is a better size descriptor for dexmedetomidine clearance than total body weight. This parameter set could be programmed into target-controlled infusion pumps for use in a broad population.