Scalp nerve block with ropivacaine has been shown to provide perioperative analgesia. However, the best concentration of ropivacaine is still unknown for optimal analgesic effects. We performed a prospective study to evaluate the effects of scalp nerve block with varied concentration of ropivacaine on postoperative pain and intraoperative hemodynamic variables in patients undergoing craniotomy under general anesthesia. Eighty-five patients were randomly assigned to receive scalp block with either 0.2% ropivacaine, 0.33% ropivacaine, 0.5% ropivacaine, or normal saline. Intraoperative hemodynamics and post-operative pain scores at 2, 4, 6, 24 hours postoperatively were recorded. We found that scalp blockage with 0.2% and 0.33% ropivacaine provided adequate postoperative pain relief up to 2 h, while administration of 0.5% ropivacaine had a longer duration of action (up to 4 hour after craniotomy). Scalp nerve block with varied concentration of ropivacaine blunted the increase of mean arterial pressure in response to noxious stimuli during incision, drilling, and sawing skull bone. 0.2% and 0.5% ropivacaine decreased heart rate response to incision and drilling. We concluded that scalp block using 0.5% ropivacaine obtain preferable postoperative analgesia compared to lower concentrations. And scalp block with ropivacaine also reduced hemodynamic fluctuations in craniotomy operations. About 10% to 20% patients undergoing craniotomy suffered severe pain and more than 30% experienced moderate pain as per Guilfoyle et al. 1. These experiences with pain may disturb patient sleep patterns and prolong hospital stays 2. Abrupt increases in heart rate (HR) and blood pressure (BP) resulting from dramatic stimuli like incisions, drilling, and screwing cause potential morbidities and mortalities due to elevation of intracranial pressure (ICP) in patients 3,4. Generally, opioids are used for relieving hemodynamic fluctuations and reducing postoperative pain, however, it may delay recovery time, contribute to extreme sedation, and interfere with postoperative neurological examinations. In addition, adverse effects of opioids such as nausea and vomiting, and respiratory depression may result in a rise of ICP or mask the signs of increased ICP. Since there is such an emphasis on controlling the adverse effects of opioid administration, postoperative pain after craniotomy is frequently uncontrolled 1. Easing hemodynamic perturbation and relieving postoperative pain are important concerns of neuroanesthesiologists and are also necessary components of the Enhanced Recovery After Surgery (ERAS). With advances in modern anesthesia come the development of short-acting analgesics, mainly remifentanil, transition analgesics, and conjunction analgesics that can be used instead of opioids to treat postoperative pain 5. Scalp never block (SNB), the blockage of nerves that innervate the involved region of the scalp about surgery 6 , was developed due to its potential benefits for effective regional anesthesia administration 7 , which promotes d...

BackgroundAlbumin-Bilirubin (ALBI) grade has been evaluated as an objective method to assess liver function and predict postoperative complications, particularly after hepatectomy in patients with hepatocellular carcinoma (HCC). However, ALBI grade was rarely used in evaluation in living donor liver transplantation (LDLT).Material/MethodsBetween March 2005 and November 2015, 272 consecutive patients undergoing right-lobe LDLT were enrolled in this study. According to the ALBI score used to evaluate recipients preoperatively, those patients were divided into 3 grades (I, II, and III). Demographic findings and the post-operative complication rates were collected and compared among groups.ResultsThe proportions of massive blood cell transfusions were different among those 3 grades (p<0.05). The patients in grade III had a higher risk of bacterial pneumonia and early allograft dysfunction (EAD) compared to grade I (p=0.029 and p=0.038, respectively) and grade II (p=0.006 and p=0.007, respectively). The area under the receiver operating characteristic curve of ALBI, Child-Pugh, and MELD for predicting 30-day mortality were 0.702 (95% CI: 0.644–0.756), 0.669 (95% CI: 0.580–0.697, p=0.510, versus ALBI grade), and 0.540 (95% CI: 0.580–0.697, p=0.144, versus ALBI grade), respectively.ConclusionsALBI grade was a good index for predicting post-operative complications and had a predictive ability similar to those of the Child-Pugh classification and MELD score.

SummaryProbit analysis was used to predict the median effective concentration (EC 50 ) and the 95% effective concentration (EC 95 ) values of levobupivacaine for caudal analgesia in children at equal volumes of injectate. Sixty children scheduled for inguinal herniorrhaphy were recruited. Anaesthesia was induced with sevofurane and nitrous oxide. Then caudal block (total volume of local anaesthetic 1 ml.kg )1 ) was performed. Patients randomly received one of six concentrations (0.08%, 0.10%, 0.12%, 0.14%, 0.16% or 0.18%) of levobupivacaine. Thereafter, inhalational anaesthetics were discontinued and intravenous midazolam 0.1 mg.kg )1 was administered to maintain sedation. The effective caudal analgesia was defined as an absence of gross movements and a haemodynamic (heart rate or blood pressure) reaction < 20% compared with baseline in response to surgical incision. Our data indicated that the EC 50 and EC 95 values of levobupivacaine for caudal analgesia were 0.109% (95% confidence intervals 0.098-0.120%) and 0.151% (95% confidence intervals 0.135-0.193%) when using the same volume (1 ml.kg )1 ), respectively. Caudal anaesthesia in children is usually performed after an inhaled or intravenous (i.v.) induction and is a useful adjunct for providing postoperative analgesia after genital, lower abdominal, and lower limb operations. It can reduce the amount of inhaled and intravenous anaesthetic required, attenuate the stress response to surgery, facilitate a rapid and smooth recovery, and provide good immediate postoperative analgesia. Levobupivacaine, the S-enantiomer of bupivacaine, has been promoted as an alternative to (with less cardiotoxicity than) racemic bupivacaine [1,2]. Despite extensive use in children [3][4][5], the optimal concentration of levobupivacaine in caudal blockade remains to be established. The minimum local analgesic concentration (MLAC) has been developed as a useful clinical measure of epidural analgesia [6,7]. Unfortunately, MLAC studies only describe one point of the dose-response curve, the effective dose in 50% of the population and do not provide information about the shape or slope of the curve. Indeed, the 95% effective concentration (EC 95 ) would often be more clinically relevant. We hypothesised that the clinical effect of levobupivacaine in caudal analgesia in children varied with the dose used (at equal volumes of injectate), and the purpose of our study was to describe the full dose-response relation of levobupivacaine in this context. MethodsAfter approval by the Hospital Research Ethics Committee and informed written consent from parents, sixty ASA status I children, aged 1-3 years scheduled for elective inguinal herniorrhaphy were enrolled. Children with neurological, neuromuscular, psychiatric or blood clotting disorders or with a known allergy to local anaesthetics were excluded.All children were starved > 6 h but not premedicated. In the operating room, the patients were monitored with electrocardiography, pulse oximetry, heart rate (HR) respiratory rate (RR), and no...

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Background Malignant hyperthermia (MH) is a rare life-threatening anesthetic emergency. With respect to the high fatality rate, difficulty in early recognition, and the lack of disease-specific drug (ie, dantrolene) in China, more effort is needed to strengthen early diagnosis and effective treatment of MH emergencies. Nowadays, mobile health (mHealth) apps are changing the way of medical practice; they can serve as an accessible tool to help anesthesiologists deal with MH crises. However, no related mHealth-based emergency system is available currently. Objective The aim of this study is to outline the protocol for the development of a WeChat applet used to design a National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China, as well as the protocol for the evaluation of the user experience and perception of the system. Methods The system adopts the client-server architecture, with a custom user interface operating as clients and the back-end system operating as the server. The client-side software was developed using uni-app technology with Vue.js-based framework, which consists of 6 modules: Quick Diagnosis, Dantrolene Mobilization, Instruction on Dantrolene Use, MH Treatment, Recovery Period Treatment, and DNA Test and Biopsy. The back-end system was developed based on the Spring framework. The system will be evaluated by administrating a modified user version of the Mobile App Rating Scale. Pilot testing will be conducted in Sichuan Province, China, and a subsequent evaluation on a national scale is planned. Results The theoretical framework design of this system was completed in August 2021. The development of the system was completed in February 2022, and the refinement is currently ongoing. Pilot testing after the implementation of the system in Sichuan Province is planned to take 2 months, and the subsequent evaluation on a national scale is planned to take 2 months. Conclusions We have described a novel approach using the WeChat applet to develop the MH-NRES. Findings from the usability testing process in the current study may lead to refinements and is expected to suggest that this system is both feasible and welcomed by anesthesiologists. Depending on the availability of research funding, this system will be extended nationally across China. International Registered Report Identifier (IRRID) PRR1-10.2196/37084