Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study

BackgroundWorldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique.AimsThe primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively.MethodsThis was a prospective study with a retrospective control group, approved by the Friuli–Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis.ResultsWe recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery.ConclusionUltrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration:ClinicalTrial.gov (NCT04475458, 17 July 2020)

CHEMICAL, TECHNOLOGICAL AND BIOLOGICAL FEATURES OF AN EXOPOLYSACCHARIDE FROM LEUCONOSTOC MESENTEROIDES

Microbial exopolysaccharides (EPS) from lactic acid bacteria have received great interest in both the industrial and research fields, due to their technological properties (e.g., water binding capacity, stabilizers, ...) and biological activities (e.g., antimicrobial, antioxidant, ...) [1,2]. For this reason, the research of new EPS with peculiar technological properties and biological activity is of great interest. In this study, chemical characteristics, technological properties, and antimicrobial activity of an EPS (EPS_O) from a Leuconostoc mesenteroides strain of dairy origin were investigated. One- and two-dimensional NMR, DOSY and FT-IR revealed that EPS_O was a high molecular weight dextran (about 108 Da) with a very compact appearance, as evidenced by SEM. EPS_O was characterized by high water- and oil-holding capacity (784 and 496% respectively) and high solubility in water (about 99%). The thermal stability of EPS_O was also investigated by DSC analysis revealing the melting peak at 147 °C and the Tg at 83 °C. When EPS_O (50 mg/mL) was put in contact with water cold gelation occurred resulting in a weak gel as confirmed by rheological analysis. Antimicrobial activity of EPS_O was also investigated against Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Salmonella enterica and Listeria monocytogenes through the observation of the turbidimetric growth kinetics. EPS_O displayed significant activity on L. monocytogenes decreasing the cell concentration at the end of the growth. All these characteristics could highlight the potential use of EPS_O as a promising ingredient to improve food characteristics and bioactivities

Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice

In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine