Anesthesiology and Perioperative Science最新文献

Sleep is an essential physiological process that promotes physical recovery and helps consolidate learning and memory. Common manifestations of sleep disturbances include insomnia, hypersomnia, circadian rhythm disorders, and parasomnias, all of which impair cognitive function, particularly in the elderly. Cognitive impairment is a significant factor that threatens the quality of life in the elderly, and there is currently no effective treatment for conditions such as dementia. The relationship between sleep and cognition is complex. Studies have shown that sleep disorders adversely affect cognitive function and increase the incidence of cognitive decline. This article focuses on sleep disturbances and their effects on the cognition of the elderly by reviewing research conducted over the past 20 years and describing potential mechanisms. Additionally, we explore the relationship between sleep and cognition during the perioperative period, aiming to identify strategies for optimizing perioperative sleep quality. We believe this review provides a deeper understanding of the association between sleep and cognition and offers a new perspective for perioperative management.

Purpose

Low back pain (LBP) is a common and recurring public health problem that affects sufferers both physically and mentally and warrants further research. A succession of studies have suggested a plausible role for inflammatory cytokines in the pathogenesis of LBP. To date, there is no conclusive mechanism explaining how inflammatory cytokines affects LBP.

Methods

A bidirectional two-sample Mendelian randomization (MR) investigation was undertaken in two stages. The initial phase encompassed 41 inflammatory cytokines as the exposure, with LBP as the outcome, and the subsequent phase adopted the inverse approach. A total of 41 blood inflammatory cytokines were extracted from the genome-wide association study meta-analysis database, encompassing 8,293 individuals. Data pertaining to LBP were acquired from the Finnish biobank. Primary findings were computed using inverse-variance weighting (IVW), while sensitivity analyses accounting for pleiotropy and invalid instruments were conducted utilizing the weighted-median estimator, MR-Egger, and MR Pleiotropy RESidual Sum and Outlier.

Results

Our results suggest that higher levels of Macrophage migration inhibitory factor (MIF) as well as lower levels of C-C motif chemokine ligand 3 (CCL3) are associated with an increased risk of LBP (odds ratio [OR] = 1.134, 95% confidence interval [CI ]= 1.032–1.245, P = 0.009; OR = 0.887, 95% CI = 0.803–0.980, P = 0.018). Moreover, there was no heterogeneity and horizontal pleiotropy observed in the sensitivity analysis. In contrast, in studies of the effect of LBP on inflammatory cytokines, genetically determined LBP had no causal effect on 41 inflammatory cytokines (IVW P > 0.05).

Conclusions

Our study confirms that the levels of circulating MIF and CCL3 may be regarded as valuable circulating inflammatory biomarkers for the management of LBP in clinical practice and as potential molecules for future mechanistic investigation and drug target identification.

High-flow nasal cannula (HFNC) has been widely promoted during the COVID-19 pandemic to circumvent invasive mechanical ventilation. While there are several reported benefits, randomized trials demonstrate inconsistent variable success. We hypothesize that this is due to variable stopping criteria. This systematic review’s purpose is to review these criteria and investigate any associations with HFNC outcomes. We searched PubMed and EMBASE for all English-language randomized controlled trials (RCTs) published from January 1, 2007, to December 31, 2022, focusing on respiratory rate as a threshold for escalation of respiratory support. Subgroup analysis was conducted based on trial failure criteria, and intubation and mortality benefits were studied. Fisher’s exact test was performed following a 5% level of significance. Of the 22 RCTs included, 4 (18.2%) reported significant intubation benefits and 1 (0.05%) reported significant mortality benefit. The presence of objective failure criteria with a prespecified high respiratory rate threshold (35 breaths per minute or higher) had a significant effect on intubation rate reduction (P = 0.02). However, this result might be limited by the heterogeneity of the included studies. Further RCTs are required to confirm this conclusion. Given that a high respiratory rate threshold was associated with a reduction of intubation without increasing mortality, we hypothesize that among patients receiving HFNC who were eventually not intubated, the avoidance of intubation led to better clinical outcomes, while among eventually intubated patients, delays led to poorer outcomes.

With advancements in sedation techniques,painless gastrointestinal endoscopy has expanded from a diagnostic role to surgeries. This study aims to explore strategies for enhancing patient satisfaction, improving safety, and reducing complications. Tailoring preoperative assessments beyond American Society of Anesthesiologists classification is crucial, especially for the elderly and pediatric populations. Integration of scales and point-of-care testing (POCT) provides a precise baseline evaluations. Optimizing anesthetic strategies through improved drug selection and enhanced perioperative monitoring follows accurate patient evaluations. While post-procedural follow-up is essential, existing studies in this area are limited. This article outlines current painless gastrointestinal endoscopy technology, emphasizing POCT establishment, personalized monitoring, and optimized anesthesia strategies for a positive impact on patient outcomes.

Purpose

Ventilator care bundles are effective in the prevention of ventilator-associated pneumonia (VAP). However, the compliance of these bundles in intensive care units (ICUs) remains poorly studied. This study investigates the Medical Information Mart for Intensive Care (MIMIC)-IV cohort’s compliance with the Institute for Healthcare Improvement (IHI) bundle and its resulting association with VAP incidence.

Methods

This is a retrospective cohort study of the MIMIC-IV database. Patients with > 48 h of invasive mechanical ventilation (IMV) were included. Diagnosis of VAP was identified with the International Classification of Diseases (ICD)-9 and ICD-10 codes. Compliance rates to the IHI bundle were extracted. The association of the IHI bundle and its individual interventions with VAP incidence was analyzed with univariate and multivariate analysis.

Results

8270 patients were included, of which 1328 (16.1%) had VAP. 25 patients (0.3%) had full compliance to the IHI bundle. 137 patients (1.7%) received no interventions from the bundle. Gastroprophylaxis had the lowest (2.1%) while head elevation had the highest (89.3%) compliance rates. In patients receiving the IHI bundle, each additional intervention was associated with lower VAP incidence (OR [odds ratio] = 0.906, 95% CI [confidence interval] 0.847–0.969). Appropriate sedation levels (OR = 0.765, 95% CI 0.661–0.885) and the use of heat and moisture exchanger (HME) filters (OR = 0.862, 95% CI 0.745–0.998) were individually associated with reduced VAP incidence, while active humidification was individually associated with increased VAP incidence (OR = 1.139, 95% CI 1.001–1.296).

Conclusion

The use of the IHI bundle was associated with a lower incidence of VAP, but compliance with the bundle was poor. Appropriate sedation and HME filters were individually associated with reduced VAP incidence. Better compliance with the IHI bundle may reduce VAP rates in mechanically ventilated patients.

Graphical Abstract

Purpose

The addition of intrathecal morphine to general anesthesia for laparoscopic colorectal surgery is an effective method of providing analgesia. However, the analgesia duration of approximately 24 hours poses the risk of rebound pain on the second postoperative day. Therefore, this study aimed to investigate the patients' perception on postoperative pain management using the International Pain Outcomes questionnaire on both the first and second postoperative day.

Methods

This prospective single-center cohort study was conducted between November 2020 and March 2021 and included forty patients. The primary outcome was a difference in postoperative pain on the first and second postoperative day. Secondary outcomes included opioid consumption, interference of pain with activities, side effects, and patients’ perception and satisfaction with pain treatment.

Results

The intensity of postoperative pain did not increase on the second postoperative day NRS [numeric rating scale] 5 (2–7 [0–10]) vs 5 (3–7 [1–10]), p=0.414), but the percentage of time spent in severe pain increased (20% (10-40 [0-90]) vs 30% (20-50 [0-80]), p=0.010). There was no difference in opioid consumption (6 mg (0–12) [0–42] vs 6 mg (0–12) [0–29], p=0.914). Pruritis (NRS 2 (0–6 [0–10]) vs 0 (0–3 [0–8]), p=0.001) and dizziness (NRS 2 (0–7 [0–10]) vs 0 (0–2 [0–9]), p=0.002) decreased on the second postoperative day. Patients reported high satisfaction during the first two days after surgery (NRS 8 (7–9) [0–10] vs 8 (7–9) [0–10], p=0.395).

Conclusion

Intrathecal morphine is a suitable analgesic modality in laparoscopic colorectal surgery within an enhanced recovery after surgery program, without causing important rebound pain. Pain scores, however, may be further reduced by adding non-opioid analgesics.