Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC). A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017. Adult patients (18–79 years) with American Society of Anesthesiology (ASA) physical status I–II were randomly assigned to 0.5 μg/kg/h DEX infusion from induction of anaesthesia to extubation (Group D; n = 30) or normal saline infusion (Group C; n = 30). The primary efficacy outcomes were postoperative morphine consumption. Secondary efficacy outcomes included: time to first use of rescue analgesia; postoperative morphine consumption; intraoperative fentanyl consumption; time from end of surgery to extubation; lengths of intensive care unit (ICU) and general ward stay; degree of postoperative pain 3, 6, 12 and 24 h after surgery; incidence of persistent post-surgical pain. DEX infusion was associated with a decrease in postoperative morphine consumption (p = 0.001), lower incidence of severe postoperative pain (odds ratio [OR] 9, 95% confidence interval [CI] 1.1–77, p = 0.04) and significantly longer time to first use of rescue analgesia (p = 0.001). Group D also had significantly lower fentanyl consumption both intraoperatively (p = 0.001) and in the time from end of surgery to extubation (p = 0.001) plus decreased incidence of persistent post-surgical pain (OR 14.5, 95% CI 1.7–122, p = 0.005). The incidence of postoperative nausea and vomiting was lower in Group D than Group C (OR 5, 95% CI 1.1–26, p = 0.005). Median pain intensity did not differ between the groups 3, 6, 12 or 24 h after surgery and there were no inter-group differences in the lengths of ICU stay or overall hospital stay between groups. The incidence of hypertension was significantly higher in Group C (OR 13.8, 95% CI 4–48, p < 0.0001); there were no inter-group differences in incidences of hypotension and bradycardia. Intraoperative DEX infusion is safe and effective for improving analgesia during and after elective LC. DEX appears to significantly reduce the number of patients with severe postoperative pain, postoperative morphine consumption and prolong time to first use of rescue analgesia. ClinicalTrials.gov: Retrospectively registered on July 7, 2017, NCT03211871 .

Dexmedetomidine (DEX) is a centrally acting alpha-2-adrenoceptor agonist that has potential in the management of alcohol withdrawal syndrome (AWS) owing to its ability to produce arousable sedation and to inhibit the adrenergic system without respiratory depression. The objective of this randomized controlled study was to evaluate whether addition of DEX to benzodiazepine (BZD) therapy is effective and safe for AWS patients in the intensive care unit (ICU). Eligible participants were randomly assigned to intervention (Group D; n = 36) or control (Group C; n = 36). In Group D, DEX infusion was started at a dose of 0.2–1.4 μg/kg/h and titrated to achieve the target sedation level (–2 to 0 on the Richmond Agitation Sedation Scale (RASS)) with symptom-triggered BZD (10 mg diazepam bolus) was used as needed. Patients in Group C received only symptom-triggered 10 mg boluses of diazepam. The primary efficacy outcomes were 24-h diazepam consumption and cumulative diazepam dose required over the course of the ICU stay; secondary outcomes included length of ICU stay, sedation and communication quality and haloperidol requirements. Median 24-h diazepam consumption during the study was significantly lower in Group D (20 vs. 40 mg, p < 0.001), as well as median cumulative diazepam dose during the ICU stay (60 vs. 90 mg, p < 0.001). The median percentage of time in the target sedation range was higher in Group D (median 90 % (90–95) vs. 64.5 % (60–72.5; p < 0.001). DEX infusion was also associated with better nurse-assessed patient communication (<0.001) and fewer patients requiring haloperidol treatment (2 vs. 10 p = 0.02). One patient in Group D and four in Group C were excluded owing to insufficient control of AWS symptoms and use of additional sedatives (p = 0.36). There were no severe adverse events in either group. Spontaneous breathing remained normal in all patients. Bradycardia was a common adverse event in Group D (10 vs. 2; p = 0.03). DEX significantly reduced diazepam requirements in ICU patients with AWS and decreased the number of patients who required haloperidol for severe agitation and hallucinations. DEX use was also associated with improvement in diverse aspects of sedation quality and the quality of patient communication. Trial registration: ClinicalTrials.gov: NCT02496650

Background: The aim of this study was to evaluate how anaesthesiologists manage a “cannot intubate, can ventilate” (CI) and “cannot intubate, cannot ventilate” (CICV) scenarios, and how following simulation training will affect their guideline adherence, skills and decision-making immediately after training and 6 months later. Methods: A prospective controlled study was conducted from July to December 2022. Anaesthesiologists who applied for the continuous medical education course “Difficult Airway Management” were involved in the study. Each volunteer participated in two simulation scenarios (CI, CICV) with structural debriefing after each scenario. After the first simulation round, volunteers were trained in difficult airway management according to DAS guidelines, using the same equipment as during the simulation. The participants repeated the simulation scenarios the day after the training and six months later. The primary and secondary endpoints were compared between three rounds: initial simulation (Group 1), immediately after training (Group 2), and six months after training (Group 3). Results: A total of 24 anaesthesiologists consented to participate in the study and completed the initial survey form. During the first session, 83.3% of participants had at least one major deviation from the DAS protocol. During the first CICV scenario, 79% of participants made at least one deviation from the DAS protocol. The second time after simulation training, significantly better results were achieved: the number of anaesthesiologists, who attempted more than 3 laryngoscopies decreased (OR = 7 [1.8–26.8], p = 0.006 right after training and OR = 3.9 [1.06–14.4], p = 0.035 6 month later); the number, who skipped the supralaryngeal device attempt, call for help and failure to initiate surgical airway also decreased. Simulation training also significantly decreases the time to call for help, cricothyroidotomy initiation time, and mean desaturation time and increases the odds ratio of successful cricothyroidotomy (OR 0.02 [0.003–0.14], p < 0.0001 right after training and OR = OR 0.02 [0.003–0.16] 6 months after training). Conclusions: Anaesthesiologists usually display major deviations from DAS guidelines while managing CI and CICV scenarios. Simulation training improves their guideline adherence, skills, and decision-making when repeating the simulation immediately after training and 6 months later. Study registration: NCT05913492, clinicaltrials.gov, 22/06/2023.

Background: Proximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia. Methods: We included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6–8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6–8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence. Results: There were no differences in the duration of ICU stay - gr.1 72 [70–75], gr.2 74 [72–76], gr.3 72 [70–75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170–184], gr.2170 [148–188], gr.3178 [144–200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0–5] mg versus 15 [10–20] and 20 [15–25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0–1] vs. 3 [2–4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7–9] vs. 6 [5–7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery – sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01–77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2–91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium. Conclusion: Perioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed. Trial registration: Clinicaltrials.gov: NCT04648332, first registration date 1/12/2020.

The issues regarding the use of artificial intelligence (AI) and academic integrity are important contemporary topics. There are no clear regulations governing the use of AI in academic institutions in Ukraine. This study aimed to explore the perceptions of medical students, interns, and PhD candidates about academic misconduct and AI use. The cross-sectional study was conducted online via survey in October-December 2024. The participants were medical students, interns, and medical PhD students of the Bogomolets National Medical University in Kyiv, Ukraine. Among 244 study participants, the majority (84%) reported using AI for academic purposes, with ChatGPT being the most commonly used tool. AI was primarily employed for information searches (70%), while a smaller proportion admitted using it for academic dishonesty, such as writing essays (14%) or submitting pre-written assignments (9%). Nearly half (51%) of participants reported having cheated on tests previously. Opinions on AI’s impact on academic integrity were divided, with 36% considering AI use as misconduct, 26% perceiving it as acceptable, and 38% undecided. Most participants viewed AI as beneficial for learning and work, with 37% indicating they would continue using AI professionally. Perceived AI’s advantages included time efficiency, enhanced learning, and accessibility, while concerns were raised about errors, lack of critical thinking, over-dependence, and ethical risks. These results highlight the widespread adoption of AI among medical students, interns, and PhD candidates for academic purposes, with both notable advantages and significant ethical and practical concerns. Considering the prevalent use of AI for academic work among medical students, interns and PhD students in Ukraine, national rules are needed to define which uses of AI constitute academic dishonesty and academic misconduct.