Patient experience of sexual hallucinations after propofol-induced painless abortion may lead to violence against medical personnel

Intravenous esketamine as a detumescence agent for intraoperative penile erection during urological surgeries: a retrospective clinical analysis

BACKGROUND

Intraoperative penile erection (IPE) is an uncommon yet complex issue, and numerous approaches to achieving detumescence fall short of providing consistently satisfactory outcomes. Esketamine, with its sympathomimetic properties, may offer a promising solution for managing this condition. The present study aimed to evaluated the efficiency and safety of intravenous esketamine in addressing IPE.

METHODS

We conducted a review of 3,848 patients who underwent endourological, penile or testicular surgeries under general anesthesia from 2021 to 2023, and cases with IPE and received pharmacological intervention were included in this study. Intravenous esketamine or ephedrine were preferred for managing IPE. The primary outcomes evaluated were the rate of successful penile detumescence, time to detumescence, rapid response rate, remedial measures, intraoperative hypertension, tachycardia and neuropsychiatric adverse events. Additionally, data regarding age, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, type of surgeries, anesthesia methods, medication dosage, and recovery time were documented. We performed meticulously statistical analyses to evaluate the endpoints.

RESULTS

Overall, 37 cases with IPE were assigned to an esketamine group (K group, n = 27) or an ephedrine group (E group, n = 10) based on intraoperative medication. No statistically significant differences were noted regarding age, BMI, ASA grade, type of surgeries, anesthesia methods, rate of successful penile detumescence (96.3% vs. 80.0%), recovery time or the occurrence of postoperative psychiatric complications such as dizziness, restlessness or delirium(P > 0.05). However, compared to ephedrine, esketamine produced a shorter time to detumescence (3.0 ± 0.4 min vs. 5.5 ± 1.1 min, log-rank P = 0.006)), higher rapid response rate achieved detumescence ≤ 3 min (85.2% vs. 50%, P = 0.041), and a lower incidence of cardiovascular adverse events (intraoperative hypertension and tachycardia) (P < 0.05).

CONCLUSION

Our research establishes intravenous esketamine as a practical and reliable therapeutic intervention for prompt resolution of IPE, demonstrating high clinical efficacy with rapid symptom alleviation.

Determination of the effective dose of remimazolam combined with sufentanil for inhibiting body movement during surgical abortion: An up-and-down sequential allocation trial

BACKGROUND

Remimazolam, a recently developed anesthetic characterized by its rapid and ultra-short-acting properties, exhibits pharmacological attributes that make it potentially suitable for painless surgical abortion procedures. The objective of this study was to determine the effective dose of remimazolam when administered in combination with sufentanil, with the intention of inhibiting body movement during surgical abortion. Additionally, a secondary objective was to assess the recovery profile from general anesthesia.

METHODS

The study enrolled a total of 25 healthy women aged 20 to 40, with a body mass index between 18 and 28 kg/m2, in their first trimester of pregnancy (up to 12 weeks), and American Society of Anesthesiologists status I and II. Anesthesia induction was initiated by administering sufentanil at a dose of 0.1 μg/kg. The modified Dixon up-and-down method was employed to determine the induction dose of remimazolam for each patient.

RESULTS

The 50% and 95% effective dose of remimazolam for inhibitory effects of body movement was estimated using centered isotonic regression to be 0.145 mg/kg (95% CI: 0.115, 0.207), and 0.242 mg/kg (95% CI: 0.232, 0.620), respectively. Five out of 25 (20%) experienced hiccups, with 1 patient having persistent hiccups until the end of the surgery. The mean time to first eye-opening was 51.4 ± 20.5 seconds, and the time to obey verbal command was 54.5 ± 20.6 seconds. Upon arrival at the postanesthesia care unit, 95.7% of the patients achieved a Modified Aldrete score ≥ 9.

CONCLUSIONS

The 50% and 95% effective dose of remimazolam for inhibiting body movement during surgical abortion when used in combination with 0.1 μg/kg of sufentanil were 0.145 mg/kg and 0.242 mg/kg, respectively.

The Diagnostic Spectrum of Sexual Hallucinations

ABSTRACT

Sexual hallucinations are little known, yet often extremely burdening, phenomena. In this systematic review, we summarize what is known about their phenomenology, prevalence, etiopathology, ensuing distress, and treatment options. Sexual hallucinations can be experienced as genital or orgasmic sensations, although other sensory modalities can also be involved. With the notable exception of orgasmic auras in the context of epilepsy, sexual hallucinations tend to be distressing and embarrassing in nature. Our analysis of 79 studies (together describing 390 patients) indicates that sexual hallucinations are more frequent in women than in men, with a sex ratio of 1.4:1, and that they are most prevalent in schizophrenia spectrum disorders, with rates ranging from 1.4% in recently admitted patients to 44% in chronically hospitalized patients. Other underlying conditions include epilepsy, the incubus phenomenon (possibly the most prevalent cause in the general population, associated with sleep paralysis), narcolepsy, and sedative use. As regards the sedative context, we found more medicolegal than purely medical cases, which sadly underlines that not all sexually explicit sensations experienced in anesthesia practice are indeed hallucinations. In the absence of evidence-based treatment protocols for sexual hallucinations, practice-based guidelines tend to focus on the underlying condition. Further research is needed, especially in the fields of substance abuse, posttraumatic stress disorder, and borderline personality disorder, where only anecdotal information on sexual hallucinations is available. Moreover, awareness of sexual hallucinations among health professionals needs to be improved in order to facilitate counseling, diagnosis, and treatment.

[175 years of anesthesia and narcosis-Towards a "human right to unconsciousness"]

The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.

Sexual hallucinations during conscious sedation for dentistry - an update of the phenomenon

Background Sexual hallucinations have been suggested as an infrequent side effect during sedation and cases can result in sexual assault allegations. The aim of this article is to review the literature on this rare side effect during sedation.Methods Publications were chosen using inclusion criteria: hallucinations and/or alleged sexual assaults and/or paradoxical reactions to either sedation or anaesthesia, that were of a sexual nature. Non-English language papers were excluded. Studies were analysed for: methodological quality, sedative agent, dose, population, treatment undertaken and outcome of the hallucination.Results Twenty-eight publications were reviewed. There was literature discussing sexual hallucinations to midazolam (13 studies), propofol (12 studies) and nitrous oxide (three studies). This side effect to sedative agents has a low incidence and can depend on factors like the sedation agent, dosage and type of procedure undertaken.Conclusions Current literature suggests that on rare occasions, sedation may induce sexual hallucinations and higher dosages are more likely to be implicated. In an occurrence of this side effect, presence of a third party and record-keeping is essential. Thorough patient assessment, appropriate clinician training and adhering to national dental sedation guidelines will help maintain the excellent safety record of UK dental sedation.