Esketamine use for anesthesia induction in an ectopic pregnancy patient with hemorrhagic shock:a case report

Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Therefore,it may be more suitable for patients with hypovolemic shock.Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours.Menstruation of the patient was regular,her self-reported urine pregnancy test was positive half a month earlier,and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test.Gynecological ultrasonography demonstrated no pregnancy sac in utero,confirming ectopic pregnancy.Emergency laparoscopy for ectopic pregnancy should be performed immediately.We administered esketamine for induction.Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.

The Change in Pulse Rate and Behavioral Score by Using Video Assisted Induction of Pediatric Anesthesia

Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, 75 children undergoing minor surgery were investigated in this prospective observational study. Patients were divided into three groups: group 1 was aged two to three years old, group 2 was aged four to six years old and group 3 was aged from seven to ten years old. The following three characteristics were evaluated: 1) the pulse rate at four points (the ward, the entrance at the operating room, mask notification and the mask fit);2) the behavioral score in the operating room;3) the amount of pain killers after the operation. Results: In group 1 (N = 20), there was a significant difference between the control group and the video assisted group regarding the percentage change in pulse rate based on the children’s ward when the patients looked at the mask. In group 2 (N = 26), there was no significant difference regarding any points. In group 3 (N = 29), there was a significant difference between control and video assisted group regarding the percentage change in pulse rate based on the children’s ward for all points. Also, regarding to the behavioral score, there was a significant difference between the control group and the video assisted group of all ages. However, there was no significant difference regarding the use of NSAIDs in the postoperative period between the control and the video assisted group. Conclusion: These results show that the video assisted anesthesia induction is effective for pediatric patients.

Healthcare staff as promoters of parental presence at anesthetic induction:Net Promoter Score survey

BACKGROUND Surgical intervention is usually a traumatic event that causes stress and anxiety in the pediatric patient and the family environment.To reduce the harmful effects of presurgical anxiety,parental presence during induction of anesthesia(PPIA)is one of the more notable interventions used in medical centers.However,data on this measure are difficult to evaluate and often face resistance from healthcare staff.AIM To analyze the perception of the healthcare workers after the implementation of a PPIA program.METHODS A survey was developed and sent by email to all the healthcare staff working in the children’s area of a tertiary hospital.It consisted of 14 items divided into positive aspects of PPIA and negative aspects of PPIA evaluated with the use of a Likert scale(1 to 5).The demographics of the respondents were included in the data collected.The answers to the questions were interpreted through the Net Promoter Score(NPS).The statistical analysis compared the differences in the responses to each question of the survey made by the different groups of health personnel included.RESULTS A total of 141 surveys were sent out,with a response rate of 69%.Of the total number of responses,68%were from women and 32%from men.The average age of the participants was 42.3±10.6 years.As for the positive questions about the PPIA,83%had an NPS>50,and only one had a score between 0 and 50,which means that the quality of the service was rated as excellent or good by 100%of the respondents.On the other hand,100%of the negative questions about the PPIA had a negative NPS.Responses to the question“PPIA increases patient safety”were significantly different(P=0.037),with a lower percentage of pediatric surgeons(70%)thinking that PPIA increased patient safety,compared with anesthesiologists(90%),nursing(92%),and other medical personnel(96%).CONCLUSION The personnel who participated in the PPIA program at our center were in favor of implementation.There were no validated arguments to support worker resistance to the development of the PPIA.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.