Regional anesthesia for geriatric population

Anesthesia videos in geriatric and elderly patients on YouTube: content, quality, reliability, and usefulness assessment

Purpose

This study aimed to assess the quality, reliability, content, and usefulness of YouTube videos related to anesthesia in geriatric and elderly patients.

Methods

Using Google Trends, the most popular search terms in the past five years, "geriatric anesthesia" and "anesthesia in the elderly," were identified. A search on YouTube using these terms initially yielded 200 of the most viewed videos for each term. After applying exclusion criteria, 87 videos were included for detailed analysis. Major themes and topics related to anesthesia in geriatric and elderly patients were identified using a pre-determined qualitative thematic analysis method. The usefulness of the videos was assessed using the specially developed Geriatric and Elderly Anesthesia Usefulness Score (GAEUS). The overall quality and reliability of the videos were evaluated using the Global Quality Scale (GQS) and the Modified DISCERN Scale (M-DISCERN), respectively. The average of the quality, reliability, and usefulness scores calculated by the researchers was used for consistency analysis.

Results

In our study, 48.3% (42) of the videos on geriatric and elderly patients concerning anesthesia on YouTube were created by personal blogs. The quality of the videos was measured using the GQS, with a mean score of 3.34 and a median of 3 (range: 1-5), showing no significant difference according to the video source (p = 0.166). Reliability was assessed using the M-DISCERN scale, with a mean score of 3.37 and a median of 3.50 (range: 1-5), again showing no significant difference according to the video source (p = 0.097). Usefulness was measured using the GAEUS score, with a mean score of 15.30 and a median of 12.5 (range: 2-63), which showed a significant difference according to the video source (p = 0.000). The average duration of videos with low usefulness was 31.59 minutes (range: 5-44), while the average duration of moderately and highly useful videos was 59.37 minutes (range: 19.44-119.05). This duration difference was statistically significant (u = 2.569, p = 0.010).

Conclusion

In our study, we examined YouTube videos covering anesthesia topics for geriatric and elderly patients. The highest usefulness scores were obtained from personal blogs; however, all sources generally showed low usefulness. The quality of the videos was assessed using the GQS, and their reliability was evaluated with the M-DISCERN. On both scales, the videos showed moderate performance across all sources. These findings indicate a need for more comprehensive and informative content on YouTube, especially for the education of healthcare professionals and patients. To better address the needs of elderly patients, the richness of content and educational value of these videos should be enhanced.

Safe Use of Intraspinal Anesthesia in Geriatric Orthopedic Surgery and Its Effect on Coagulation Factors

OBJECTIVE

This study aimed to observe the safe use of intraspinal anesthesia in geriatric orthopedic surgery and its effect on coagulation factors.

METHODS

The anesthesia indices, cognitive functions, hemodynamic indicators, along with coagulation function indices were compared. The duration of anesthesia was compared between the two groups. Adverse reactions occurring in the two groups of patients were compared.

RESULTS

The time to awaken, time to open eyes, time to the verbal statement, the onset of anesthesia, duration of sensory blockade, and duration of motor nerve blockade were shorter while the duration of analgesia was longer in the observation group than in the control group. The observation group's postoperative Mini-Mental State Examination scores were higher than those of the control group. Heart rate and mean arterial pressure of the patients in the observation group at 10 min after anesthesia and at the end of surgery were lower versus those in the control group. The observation group had lower levels of von Willebrand factor (%) and fibrinogen at 10 min after anesthesia and at the end of surgery than the control group, and lower levels of the thrombin-antithrombin complex at the end of surgery than the control group. The observation group exhibited a lower incidence of adverse reactions in contrast to the control group.

CONCLUSION

The application of intraspinal anesthesia in geriatric orthopedic surgery has a significant and remarkable effect, with less impact on patients' hemodynamics and postoperative cognitive function, and can improve patients' blood hypercoagulability.

Role of Adjuvants in Enhancing the Efficacy and Duration of Anesthesia Blocks: A Comprehensive Review

Anesthesia blocks are integral to modern pain management, offering targeted and effective relief for various surgical and procedural interventions. These techniques, including regional and peripheral nerve blocks (PNBs), involve the administration of local anesthetics to specific body areas, either through epidural, spinal, or direct nerve injections. While effective, incorporating adjuvants, substances added to local anesthetics, can significantly enhance their efficacy and prolong their duration. Adjuvants such as opioids, corticosteroids, alpha-2 agonists, and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to amplify analgesic effects, reduce the need for general anesthesia, and improve postoperative outcomes. This review explores the role of adjuvants in optimizing anesthesia blocks, examining their mechanisms of action, clinical benefits, and safety considerations. Adding adjuvants can lead to enhanced pain control, reduced dosage of local anesthetics, and fewer systemic side effects. By integrating adjuvants into anesthesia practice, clinicians can achieve more precise and sustained pain management, tailoring approaches to individual patient needs and specific procedural demands. This comprehensive review highlights current evidence on using adjuvants, their impact on anesthesia block effectiveness, and future research directions. Understanding the role of adjuvants is crucial for improving patient outcomes and advancing pain management techniques in various surgical settings.

The pericapsular nerve group block, a highly selective blockage for intracapsular hip fractures: A case series

Hip fracture is a very frequent clinical situation in the elderly and frail patient. The Pericapsular Nerve Group (PENG) has emerged as a highly selective block for the intracapsular hip fractures. We describe 44 patients with intracapsular hip fractures who underwent a PENG block in addition to spinal anaesthesia with. The main objective was to assess post-surgical pain control at the recovery room and after 24 h. Also, we considered the need for first of second analgesic rescue during the first 24 h after surgery. Only 10 patients presented mild pain at the recovery room. Up to 30 of them had pain after 24 h. However, 25 of these patients reported having mild pain. Only 9 patients required analgesic rescue for postoperative pain control. In conclusion, PENG block is a locoregional technique that allows good postoperative pain control and low opioid consumption during the postoperative period of intracapsular hip fractures.