Anesthesiology and Perioperative Science最新文献

Purpose

We investigated the effects of a surgical mask and an N95 mask on speech intelligibility using explicit and ambiguous sentences in Japanese. In addition, the effects of background noise specific to an operating room environment on the speech intelligibility of these sentences were also investigated.

Methods

We created 20 sets of five sentences; 10 sets consisting of explicit words, and 10 containing ambiguous words. Each set was recorded by a speaker while wearing a surgical mask or an N95 mask, combined with a face shield. A total of four combinations of speech data were created. Each subject was asked to listen to one set from each of the four combinations and write down the speech. The test was performed in normal background noise as well as in noise levels of 50, 60, and 70 dB.

Results

Twenty-eight volunteers were included in this study. In the tests for explicit sentences, intelligibility of speech with an N95 mask was significantly lower than that with a surgical mask in the presence of 60 dB noise. As for explicit sentences produced with a surgical mask, intelligibility was significantly decreased in the presence of 70 dB noise. Regarding explicit sentences produced with an N95 mask, intelligibility was significantly decreased in the presence of 60 and 70 dB noise. In the tests for ambiguous sentences, intelligibility of speech produced with an N95 mask was not significantly lower than that with a surgical mask at all noise levels. As for ambiguous sentences produced with a surgical mask, no significant decrease in intelligibility was observed at any noise level. Regarding ambiguous sentences produced with an N95 mask, intelligibility was significantly decreased in the presence of 60 and 70 dB noise.

Conclusion

Speech intelligibility was impaired both with a surgical mask and an N95 mask in the normal background noise specific in an operating room during surgery, even if the speech consisted of explicit words. The impairment of speech intelligibility was significantly exacerbated with the use of ambiguous language and in the background noise typical in an operating room environment. Speech intelligibility was further reduced with the use of an N95 mask.

Trial Registration

Registered at the University Hospital Medical Information Network Clinical Trials Registry on March 7, 2023 (UMIN R000050373).

Purpose

Disposcope is a novel fibreoptic intubation device that allows visualization of the glottis without aligning the oral, pharyngeal, and tracheal axes. This device may offer advantages in improving glottis exposure, or reducing hemodynamic disturbance, and minimizing movement of the upper cervical spine (C-spine). In this study, we aimed to evaluate laryngoscopy using Disposcope compared to Macintosh laryngoscope.

Methods

This study enrolled 60 adult patients (American Society of Anesthesiologists physical status 1 and 2), both male and female, underwent lumbar spine surgery, scheduled for general anesthesia with endotracheal intubation. We compared the Cormack and Lehane grade, hemodynamic response, and the maximal change in the angle between adjacent cervical vertebrae and cumulative upper C-spine movement between Disposcope and Macintosh laryngoscope. A crossover trial design was employed, with half of the patients being exposed to the glottis using the Macintosh laryngoscope first, followed by the Disposcope, and vice versa for the other half.

Results

The intubation time in the Disposcope group was significantly lower than that in the Macintosh laryngoscope group (P < 0.01). Using the Disposcope resulted in improved views of the glottis (Z = −4.82, P < 0.01). Cormack and Lehane grade I views were achieved with the Disposcope in more patients than the Macintosh laryngoscope (36.7% versus 13.3%, P < 0.01). Grade II views were obtained in 58.3% of patients with the Disposcope, whereas a lower percentage (43.3%) was observed with the Macintosh laryngoscope. The incidence of grade III views was significantly lower with the Disposcope than with the Macintosh laryngoscope (5% versus 33.3%, P < 0.01). Additionally, there was significantly less hemodynamic disturbance (mean arterial pressure and heart rate) with the Disposcope compared to the Macintosh laryngoscope (P < 0.01). Finally, the median cumulative upper C-spine movement was greater with the Macintosh laryngoscope than with the Disposcope (26.9° versus 9.4°, P < 0.01).

Conclusions

In comparison to the Macintosh laryngoscope, the Disposcope provided improved views of the glottis and resulted in less hemodynamic disturbance and movement of the upper C-spine during laryngoscopy in patients.

Purpose

Dexmedetomidine (Dexmed) is a highly selective alpha 2 adrenoceptor (α₂-AR) agonist with excellent sedation and analgesic effects and is frequently used in breast cancer surgery. However, the exact impact of Dexmed on breast cancer prognosis is still unclear. The primary objective of this pilot study was to explore study feasibility (recruitment and dropout rates) for future large-scale randomized controlled trial (RCT) to test the hypothesis that intraoperative Dexmed reduced recurrence-free survival (RFS) and overall survival (OS) in patients after breast cancer surgery.

Methods

Interviews with patients were performed during the anesthetic preoperative visit for informed consent. Adult females scheduled for a mastectomy due to primary breast cancer were 1:1 randomised to saline (Group Control) or Dexmed (Group Dexmed) treatment groups. The primary outcomes were descriptions of study feasibility (recruitment and dropout rates). We also performed a preliminary analysis of RFS (time from surgery to the earliest date of recurrence/metastasis) and OS (time from surgery to the date of all-cause death) and collected data on percentages/numbers of circulating immune cells at pre- and 24 h post-operation.

Results

A total of 964 patients were screened; 40% (385/964) met the inclusion criteria, among which 39% (150/385) were enrolled and randomly assigned to either Group Control (n = 75) or Group Dexmed (n = 75). The median follow-up duration was 49 months (interquartile range (IQR): 34–58 months) for Group Control and 48 months (IQR: 33–60 months) for Group Dexmed. Five percent (5%, 8/150) patients were lost to follow-up and 1% (2/150) died. There was no significant difference in RFS and OS. The percentage/number of natural killer (NK), B and T-cell subsets and the CD4⁺/CD8⁺ ratio were similar between groups at 24 h post-operation.

Conclusion

The pilot study was feasible to deliver. In a future definitive trial, the lower recruitment rate may be improved by increasing the number of anesthesiologists involved in the study. The study about the effects of Dexmed on long-term prognoses of breast cancer patients that is planned to follow this pilot study is a large-scaled randomized control study with the aim of providing evidence-based guidelines for rational use of Dexmed in patients undergoing breast cancer surgery.

Trial registration

Registered at ClinicalTrials.gov on October 20, 2016 (ID: NCT03109990).

Graphical Abstract

The purpose of this review is to report on the perioperative uses of intravenous (IV) ketamine based on literature from the last five years (2018–2022). We searched MEDLINE, Embase and PubMed databases from 1st January 2018 till 15th September 2022. We primarily reviewed randomized control trials and systematic reviews with or without meta-analyses where IV ketamine was used as part of an anesthetic regimen perioperatively for general or regional anesthesia. We included studies with both pediatric and/or adult participants. We did not examine the quality of the randomized controlled trials (RCTs) included in our review. Perioperative IV ketamine consistently reduced postoperative opioid requirement especially in the early postoperative period, however, the duration of this effect was variable in different surgeries and patient populations. This effect was seen in breast, obstetric, bariatric, and orthopedic surgeries. The effect was minimal in pediatric and thoracic surgeries. It has a valuable role in multi-modal analgesic regimen, especially in orthopedic and spine procedures. Considerable heterogeneity was noted with regards to the dosage of IV ketamine. Bolus doses ranged from 0.15 to 1 mg·kg⁻¹ and infusion doses ranged from 2 to 5 ug·kg⁻¹·min⁻¹. Its role in prevention of chronic post-surgical pain is still under investigation. Intravenous ketamine also reduced postoperative depressive symptoms in specific patient populations. It also reduced shivering associated with spinal anesthesia. It has a potential role in prevention of emergence agitation and postoperative delirium. In conclusion, IV ketamine has a versatile range of beneficial clinical effects in perioperative practice. The most widely studied are its analgesic effects which are of variable intensity amongst different surgical specialties and subset of patients. Despite its long history of use, fresh uses of IV ketamine continue to be reported. More trials are needed to better understand ideal dosing and patient subsets that will benefit most from these effects.

Purpose

While coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, millions of patients with COVID-19 have recovered and returned to their families and work, although the key factors of sequela-free survival remain unknown. Here we determine key factors associated with sequela-free survival of patients with COVID-19.

Methods

Sequela-free survival is defined as having none of the long-term sequelae measured with the Activity of Daily Living (ADL) Scale, modified Medical Research Council (mMRC) Dyspnoea Scale, New York Heart Association (NYHA) classification, Self-rating Depression Scale (SDS), Carcinologic Handicap Index (CHI) and Modified Telephone Interview for Cognitive Status (TICS-M). Multivariable logistic regression was used to examine the key factors of sequela-free survival.

Results

The follow-up period for the 464 patients was 10 August to 30 September 2020. Of these, 424 patients completed the assessment of all scales. 30.2% (128 of 424) were categorised as sequela-free at follow-up. The most common sequelae were psychosocial problems (254 [57.7%]), respiratory function abnormality (149 [32.6%]) and cardiac function abnormality (98 [21.5%]). Risk factors associated with COVID-19 sequelae were anaemia on admission, longer duration from the onset of symptoms to admission and increasing of age, whereas anaemia treatment was a protective factor against sequelae. A haemoglobin level of < 113 g/L for female patients or < 92 g/L for male patients at admission discriminated a likely higher risk of any COVID-19 sequelae.

Conclusions

Only one third COVID-19 survivors were sequela-free. Anaemia on admission, longer duration from the onset of symptoms to admission and increasing of age were the risk factors of any long-term sequela. Anaemia treatment was associated with beneficial outcomes in COVID-19 survivors.

Postoperative pulmonary complications (PPCs) arise from a complex interplay of patient, surgical, and anesthesia-related factors. Despite their significant impact, there are currently no standardized guidelines recommending a comprehensive preoperative approach to assessing patients with PPC risk factors. Preoperative pulmonary evaluation (PPE) plays a pivotal role in identifying underlying patient conditions, undiagnosed diseases and optimal treatments. PPE involves systematic identification of patient, surgical, and anesthesia-related risk factors. Severe PPCs include atelectasis, pneumonia, respiratory failure, pulmonary embolism, and worsening chronic lung disease. Surgical urgency, type, duration, approach of the surgical procedure, and comorbidities influence PPC rates, with cardiac, thoracic, abdominal, and vascular surgeries being particularly vulnerable.

Patient-related risk factors encompass non-pulmonary and pulmonary factors. Aging populations increase surgical demand, with advanced age and frailty predicting higher morbidity and mortality risks. Conditions like congestive heart failure, obesity, obstructive sleep apnea, and smoking heighten PPC risks. Asthma, chronic obstructive pulmonary disease, interstitial lung diseases, pulmonary hypertension, previous pulmonary thromboembolism, acute respiratory infections, and COVID-19 impact pulmonary risk profiles. Surgery and anesthesia-related risk factors include the site of surgery, operation time, and emergency surgery. Surgery near the diaphragm elevates PPC risk, while longer operation times correlate with increased PPC incidence. Emergency surgeries pose challenges in risk assessment. Anesthetic techniques influence outcomes, with regional anesthesia often preferable. Neuromuscular blocking agents impact PPCs, and protective ventilation strategies can mitigate complications.

As current literature lacks a comprehensive approach to PPE, in this review, we present a comprehensive approach to preoperative pulmonary approach to surgical patients to help in risk stratification, further optimization, as well as shared decision making between the surgeon and the patients and their family prior to consenting for a major surgical procedure.

Graphical Abstract

The swift advancement of technology has led to the widespread utilization of artificial intelligence (AI) in the diagnosis of diseases and prediction of prognoses, particularly in the field of intensive care unit (ICU) and Anesthesia. Numerous evidential data have demonstrated the extensive potential of AI in monitoring and predicting patient outcomes in these fields. Using bibliometric analysis, this study provides an overview of the current state of knowledge regarding the application of AI in ICU and Anesthesia and investigates prospective avenues for future research. Web of Science Core Collection was queried on May 6, 2023, to select articles and reviews regarding AI in ICU and Anesthesia. Subsequently, various analytical tools including Microsoft Excel 2022, VOSviewer (version 1.6.16), Citespace (version 6.2.R2), and an online bibliometric platform were employed to examine the publication year, citations, authors, countries, institutions, journals, and keywords associated with this subject area. This study selected 2196 articles from the literature. focusing on AI-related research within the fields of ICU and Anesthesia, which has increased exponentially over the past decade. Among them, the USA ranked first with 634 publications and had close international cooperation. Harvard Medical School was the most productive institution. In terms of publications, Scientific Reports (impact factor (IF) 4.996) had the most, while Critical Care Medicine (IF 9.296) had the most citations. According to numerous references, researchers may focus on the following research hotspots: “Early Warning Scores”, “Covid-19″, “Sepsis” and “Neural Networks”. “Procalcitonin” and “Convolutional Neural Networks” were the hottest burst keywords. The potential applications of AI in the fields of ICU and Anesthesia have garnered significant attention from scholars, prompting an increase in research endeavors. In addition, it is imperative for various countries and institutions to enhance their collaborative efforts in this area. The research focus in the upcoming years will center on sepsis and coronavirus, as well as the development of predictive models utilizing neural network algorithms to improve well-being and quality of life in surviving patients.

Graphical Abstract

Difficult airway management has been the focus in the field of anesthesiology. Clinical research in difficult airway management has made some progress in the last 10 years. We searched the relevant literature and summarized the latest clinical research in the field of difficult airway management in this review to provide some practice strategies for difficult airway management for anesthesiologists as well as a range of professionals.

Graphical Abstract