Background: This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. Methods: The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence.Results: Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). Conclusions: Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

Background. Pain control after operations is essential in decreasing the patient recovery period and potential morbidity. Prescribing opiates is very effective, but significant side effects accompany them. This study aims to examine the effect of local ketamine infiltration in decreasing pain intensity in patients undergoing transabdominal hysterectomy. Methods. In this double-blind, randomized, controlled clinical trial, a total of 92 patients undergoing transabdominal hysterectomy aged 3060years were selected and divided into two intervention and control groups randomly. For the intervention group, ketamine was injected subcutaneously into the incision site at a dose of 0.5mg/kg after the operation. In the control group, 5mg normal saline was used in the same method. Postoperative pain intensity was measured using the visual analog scale (VAS: 010). The pain score and dose of administered opioids were documented at 1, 2, 4, 6, 12, and 24hours and compared between the two groups. Results. Postoperative pain intensity was significantly lower in the intervention group than in the control group, except for hour 24. The mean amounts of administered opioids were significantly lower in the intervention group at hours 6 and 12, as well as the total amount of used opioids, and no significant side effects were documented. Conclusion. Local ketamine subcutaneous injection in the incisional site is effective and is a safe procedure for reducing pain scores in patients who underwent a transabdominal hysterectomy.

Context: Extruded lumbar disc herniations are traditionally managed surgically, whereas contained protrusions are more commonly considered suitable for percutaneous intradiscal procedures. However, extrusion itself may not be a universal contraindication to all needle-based intradiscal interventions, particularly when the fragment is non-sequestered and remains continuous with the parent disc. This narrative review evaluates the evidence, safety considerations, and clinical positioning of intradiscal procedures in extruded, non-sequestered lumbar disc herniations. Evidence Acquisition: A structured narrative review was conducted using PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, Google Scholar, reference-list screening, and selected technical or manufacturer documents. The review focused on intradiscal interventions used or debated for lumbar disc herniation with radicular symptoms, including percutaneous laser disc decompression and targeted PLDD (T-PLDD), radiofrequency nucleoplasty, oxygen-ozone (O2-O3) discolysis, gelified ethanol, and mechanical decompression devices. Epidural injections, endoscopic or open discectomy, and procedures primarily investigated for discogenic axial low back pain or the regenerative treatment of degenerative disc disease were excluded from the main synthesis. Evidence was interpreted according to study design, disc morphology, direct applicability to extruded non-sequestered herniation, clinical outcomes, and safety reporting. Results: The evidence base is limited and heterogeneous. T-PLDD and radiofrequency nucleoplasty provide the most direct, although still low-certainty, clinical evidence for extruded or uncontained herniations. Oxygen-ozone discolysis has biological plausibility, particularly through modulation of inflammation and potential facilitation of fragment resorption; however, most clinical data are derived from mixed-morphology cohorts. Gelified ethanol has encouraging observational data, including studies that permitted non-contained lesions, but extrusion-specific outcomes remain insufficient. Mechanical decompression devices differ from the other modalities because the reviewed evidence and device technical guidance primarily relate to contained herniations, free fragments are excluded in the manufacturer's technical guide, and extrapolation to extruded or sequestered lesions is not supported. Conclusions: Extrusion alone should not be considered a universal contraindication to all intradiscal interventions. Nevertheless, current evidence remains insufficient to support these procedures as alternatives to guideline-supported conservative care or surgical discectomy. Intradiscal interventions may be considered only as selective, non-first-line, intermediate options in carefully selected patients with extruded but non-sequestered lumbar disc herniations, preserved continuity with the parent disc, no progressive neurological deficit, and appropriate counseling regarding uncertain benefit and the possibility of surgical crossover. High-quality, extrusion-specific studies using standardized morphology definitions and rigorous safety reporting are needed.

Background: Sodium thiopental is commonly used for the induction of general anesthesia; however, selecting an appropriate weight descriptor for dosing in patients with BMI > 25 kg/m2 remains challenging because excess body weight and associated physiologic changes may affect anesthetic depth and dosing requirements. Objectives: To compare the effectiveness and safety of using total body weight, ideal body weight, and adjusted body weight to calculate sodium thiopental induction doses in adults with BMI > 25 kg/m2, using the bispectral index (BIS) as the primary measure of anesthetic depth and using hemodynamic responses and supplemental thiopental requirements as secondary outcomes. Methods: In this single-center randomized clinical trial, 91 adults with a body mass index greater than 25 kg/m2 were allocated to receive sodium thiopental at 5 mg/kg, calculated using total body weight, ideal body weight, or adjusted body weight. The bispectral index, heart rate, and mean arterial pressure were recorded at baseline, 1 minute after completion of the initial sodium thiopental injection, and 3 minutes after tracheal intubation. The primary outcome was the bispectral index 1 minute after completion of the initial thiopental dose. Secondary outcomes included heart rate, mean arterial pressure, total thiopental dose, and the need for supplemental thiopental boluses. Results: After the initial dose, the bispectral index differed significantly among groups (P < 0.001), with higher values in the ideal body weight group (59.81 ± 14.2) than in the total body weight group (38.75 ± 12.66) and the adjusted body weight group (44.21 ± 12.53). The mean total thiopental dose was 427.25 ± 44.17 mg in the total body weight group, 433.75 ± 125.25 mg in the ideal body weight group, and 371.93 ± 69.96 mg in the adjusted body weight group. Supplemental thiopental boluses were required in 3.3% of patients in the total body weight group, 24.1% in the adjusted body weight group, and 78.1% in the ideal body weight group; 15.6% of patients in the ideal body weight group did not achieve a BIS < 50 despite receiving a total thiopental dose of 500 mg. After intubation, the mean arterial pressure was highest in the adjusted body weight group (117.76 ± 16.98 mm Hg; P = 0.035), whereas the heart rate did not differ significantly among groups. Conclusions: Overall, adjusted body weight dosing appeared to provide a more dose-efficient induction profile, achieving clinically acceptable anesthetic depth with a lower total thiopental requirement than total body weight dosing while maintaining broadly comparable hemodynamic responses. In contrast, ideal body weight dosing at 5 mg/kg appeared less reliable in this population, as reflected by the markedly higher need for supplemental thiopental boluses and occasional failure to achieve the target bispectral index threshold. These findings support the concept that an intermediate weight descriptor may better balance the competing risks of excessive hypnotic depth with total body weight dosing and insufficient hypnotic depth with ideal body weight dosing in patients with BMI > 25 kg/m2. Adjusted body weight dosing appeared to provide a more dose-efficient induction strategy than total body weight dosing while avoiding the frequent requirement for supplemental thiopental boluses observed with ideal body weight dosing. Ideal body weight dosing at 5 mg/kg appeared less reliable in adults with BMI > 25 kg/m2 under the conditions of this study.