Anesthesiology and Perioperative Science最新文献

Mitochondria, as the cellular end-users of oxygen and responsible for approximately 98% of total body oxygen consumption, play a significant role in the development of organ dysfunction during shock. Therefore, integrating information on mitochondrial oxygen homeostasis with macroscopic observations of macrocirculation and microcirculation is crucial for monitoring critically ill patients or those undergoing high-risk surgery. However, current clinical practice still lack reliable surrogate parameters for assessing mitochondrial function. The Cellular Oxygen METabolism (COMET) monitor, utilizing the protoporphyrin IX triplet state lifetime technique (PpIX-TSLT), represents the first clinical device capable of non-invasive, in vivo measurement of mitochondrial oxygen pressure and oxidative phosphorylation. Recent research suggests that implementing this real-time bedside monitoring will provide additional insights into microcirculatory dynamics and enhance patient management. This review will comprehensively detail the rationale, methodologies, evolution, and clinical applications of the technique, aiming at improving the understanding of mitochondrial pathology in daily clinical practice and facilitating the development of targeted therapeutic strategies.

Graphical Abstract

Purpose

This study aims to investigate whether adding fosaprepitant to palonosetron and dexamethasone is effective in preventing postoperative nausea and vomiting (PONV) in high-risk patients undergoing gynecologic surgery.

Methods

Eligible patients undergoing gynecological surgery were randomized into two groups (1:1). One group received fosaprepitant (150 mg) and the other (control) received a placebo infusion. Both groups received a single dose of palonosetron (0.25 mg) and dexamethasone (5 mg) together with therapeutic medication. The primary endpoint was the absence of vomiting and no use of rescue antiemetics during the first 24 h after surgery; complete response rate (CRR).

Results

CRR was significantly higher in the fosaprepitant group compared to the control group 0–24 h after surgery (P = 0.037; relative risk [RR], 1.116; 95% confidence interval [CI], 1.007 to 1.235). Moreover, CRR was also significantly higher during the 24–48 h (P = 0.004; RR, 1.148; 95% CI, 1.045 to 1.261) and 48–72 h (P = 0.039; RR, 1.083; 95% CI, 1.005 to 1.168) observation periods respectively. The complete control rate was higher in the fosaprepitant group than in the control group during the 0–24 h observation period (P = 0.012; RR, 1.367; 95% CI, 1.067 to 1.751). Nausea and rescue antiemetic use were comparable between the two groups. The severity of vomiting was significantly higher in the fosaprepitant group than in the control group on the second day (P = 0.016). Dynamic pain visual analog scale score was lower in the fosaprepitant group and quality of recovery-15 scores were significantly higher in the same group during 0–24 h observation period (P = 0.018 and 0.005, respectively).

Conclusions

The triple combination of fosaprepitant, palonosetron, and dexamethasone was superior in the prevention of PONV after gynecologic surgery in high-risk patients. We suggest that for high-risk patients, a triple combination therapy may be a better choice.

Trial registration

Registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=171741) with No. ChiCTR2200060890 on June 13, 2022. Principal investigator: Jingdun Xie.

Postoperative cognitive dysfunction, a common neurological complication in the perioperative period, seriously affects patient survival and prognosis. Its high incidence has made the study of postoperative cognitive dysfunction challenging. Whether the clinical application of dexmedetomidine, a potential neuroprotective drug, can reduce the incidence of postoperative cognitive dysfunction is controversial, although several potential mechanisms by which dexmedetomidine improves postoperative cognitive dysfunction have been identified; therefore, this remains an area in need of further exploration.

The National Health Service (NHS) in England has set hospitals a target of achieving > 85% in a metric called ‘capped theatre utilisation’ (CTU), as central to its post-pandemic surgical waiting list recovery planning. This could serve as a model internationally, as other countries seek to improve operating theatre efficiency. Our review presents an analysis of what CTU means in the context of other measures of theatre ‘utilisation’, serving as a tutorial for clinical leaders, managers and all staff involved in theatres better to understand the metrics sometimes being used to assess their performance. We present results of a theoretical sensitivity analysis to assess how CTU values vary for hypothetical operating lists of three different structures (number of cases, their duration, and intercase gap times), as the stated start and finish times are shifted backwards and forwards in time. We then present results of our interrogation of the NHS Model Health Operating Theatres database to assess hospitals' CTU performance over three years. We discovered that in theory, CTU was especially sensitive to both stated list start times and list structure. The relationship to start time was asymmetric: early starts in one list did not compensate for loss of CTU value with late start in another list, when values were averaged across lists. This sensitivity analysis also predicted wide weekly CTU fluctuations, with values < 85% more likely than > 85%, especially for tertiary referral centres predominantly undertaking long, complex procedures. Our interrogation of the database confirmed these predictions. Moreover, we discovered many instances of implausible CTU values and underlying patterns indicating fundamental flaws in the CTU algorithm, rather than data entry errors. We conclude that CTU, and the NHS target of 85%, is not a suitable metric for operating theatre performance. It has proved unachievable in any sustainable way, and its underlying algorithm produces aberrant values. We discuss the serious consequences of basing other national policies or funding models on a fundamentally flawed metric. These results have lessons for international healthcare systems.

Purpose

A bench study to assess the elimination of sevoflurane from an anesthetic workstation using three different processing methods.

Methods

Sevoflurane concentrations from samples of the inspiratory breathing hose and air samples from within the investigation room were assessed during predetermined flush out intervals using Gas Chromatography-Ion Mobility Spectrometry. The primary objective was to determine the time to reach concentrations below 5 ppm_v.

Results

Reduction of sevoflurane volume concentrations below a threshold of 5 ppm_v was achieved within the first minute after removal of the vaporizer and the complete exchange of the soda and the breathing system and within the 15 min measurement interval after inclusion of two activated charcoal filters without a 90 s of flushing and without changing of the breathing hoses as required by the manufacturer.

Conclusions

Complete removal of the vaporizer and an exchange of the soda and the ventilation unit most quickly reduced sevoflurane concentrations, but the total processing interval may exceed 30 min. Inserted activated charcoal filters without a previous 90 s of flushing and without changing the breathing hoses followed by flushing only with raised fresh gas flow allow ventilation below trigger threshold to be reached within due time.