Background: Direct stimulation of the afferent nerve endings in the venous endothelium is one explanation of propofol injection pain. Previous studies found that ondansetron can also block sodium channels. This effect is similar to that of lidocaine. Objective: The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method: This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18–65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg. of ondansetron in the O Group, 40 mg. of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly administered to the patients through a 20-gauge intravenous catheter placed on the hand dorsum, and then 1 min later, the small dose of propofol (50 mg.) was infused via the syringe pump at a rate of 600 ml/hr. for 30 s. Following that, the syringe pump of propofol was temporarily stopped, and the patients were asked to rate their pain at the injection site. Result: The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P < 0.01). The median pain score in the L, O, and C groups were 2 (0–4), 4 (2–5), and 4.5 (2–6), respectively (P < 0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P < 0.01). Conclusion: Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

Background: Oxidative stress and systemic inflammation during cardiac surgery can lead to postoperative complications. Although vitamin C and thiamine (vitamin B1) have individually demonstrated protective effects, their combined effects remain underexplored. This study aimed to evaluate the efficacy of combined vitamin C and B1 therapy versus that of vitamin C alone in reducing inflammatory and cardiac biomarkers and improving postoperative outcomes in patients undergoing cardiac surgery. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients scheduled for elective cardiac surgery at a tertiary care center were randomized to receive either 1000 mg vitamin C or a combination of 1000 mg vitamin C and 100 mg vitamin B1 at four perioperative time points. Primary outcomes included changes in inflammatory biomarkers [C-reactive protein, interleukin-6 (IL-6), and white blood cells], and cardiac biomarkers [creatine kinase-MB, Troponin-I, and lactate dehydrogenase]. Secondary outcomes included hemodynamic parameters and left ventricular function. Results: Compared with vitamin C alone, combined vitamin B1 and vitamin C significantly reduced postoperative cardiac biomarker levels. IL-6 levels were significantly lower immediately in the combined group; however, this effect was not sustained at 24 h post-surgery. Up to 24 h after surgery, no significant differences in hemodynamic stability or left ventricular ejection were observed between the groups. Notably, the combined therapy group demonstrated a lower incidence of postoperative arrhythmias and shorter dobutamine duration within 24 postoperatively. Conclusions: Combined vitamin C and B1 therapy significantly reduced markers of myocardial injury and early inflammatory responses (IL-6) in patients undergoing cardiac surgery, suggesting its potential as a protective agent.

Literature on risk factors for reintubation within 2 hours after planned or actual extubation is limited due to the current definition of anesthesia-related complications. This study aimed to assess risk factors and develop a predictive score for reintubation within 2 hours after planned extubation. In this matched case-control study, we collected data from patients who underwent general anesthesia with intubation and extubation at the end of surgery between 2014 and 2021. A reintubation case was defined as one occurring 2 hours after planned extubation in the operating theater, post-anesthetic care unit, or ward. A risk score was derived from the coefficients of the significant predictors in the final multivariate conditional logistic regression model. Risk scores, adjusted odds ratios (ORs), and 95% confidence intervals (CIs) were determined. Of 101,427 patients in our database who were intubated during the study period, 93,287 were eligible for inclusion, of which 107 cases and 428 controls were selected. Our risk prediction tool for postoperative reintubation had a sensitivity of 60% and a specificity of 82%. Anesthesia-specific predictors of reintubation were deep extubation (OR [95% CI]: 8.5 [1.7–42.8], score of 21) and use of fentanyl (vs morphine) (OR [95% CI]: 4.9 [1.7–13.6], score of 16), whereas use of succinylcholine (vs cisatracurium) (OR [95% CI]: 0.11 [0.01–0.99], score −22) and successful extubation within 10 minutes after anticholinesterase administration (OR [95% CI]: 0.5 [0.3–0.9], score −7) were protective factors. Intra-abdominal, vascular, intrathoracic, and airway operations were surgery-specific predictors (score of 11–14) whereas current smoking status (OR [95% CI]: 3.1 [1.3–7.6], score of 11) and pulmonary disease (OR [95% CI]: 2.4 [1.04–5.5], score of 9) were patient-specific risk factors. Our risk score for postoperative reintubation recommends performing extubation when the risk score is ≤ 37. If the risk score is > 37, extubation using the awake technique and fulfilling the criteria within 10 minutes of anticholinesterase administration under train-of-four monitoring should be considered to reduce the risk of reintubation.

Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.