Anesthesiology and Perioperative Science最新文献

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

Bibliometric analysis is a widely used method to identify and evaluate the trends and characteristics of the scientific publications in a specific research field. A large volume of literature has been published in the field of malignant hyperthermia (MH). However, no bibliometric studies have been conducted to describe the characteristics of highly cited articles on MH. Therefore, this study aims to identify the 100 most frequently cited articles about malignant hyperthermia, describe their characteristics, and investigate research trends. Searches were performed in Web of Science Core Collection, Google Scholar, and Scopus from January 1900 to March 2023, with no language limitation. The 100 most frequently cited articles were selected and analyzed. Characteristics including publication year, journal, impact factor, authors, authors countries, citation number, journal citation indicator, study design, and topics were analyzed. For the 100 most cited articles, the number of times each article was cited ranged from 84 to 1254, with a median of 133. The number of articles published peaked in the decade of 1990s (n = 30). The articles were published in 39 journals, with Anesthesiology leading with 13 publications and then the British Journal of Anaesthesia with 12 publications. The authors were from 21 countries, led by the United States (n = 37). Forty articles focused on genetic susceptibility screening, 27 articles were about MH etiology, and 11 articles were about diagnosis and treatment. The mortality rate of MH and dantrolene availability are known to be uneven worldwide. This may partly be explained by the fact that scientific publications primarily report by authors from developed countries. This bibliometric analysis highlights the characteristics of the most influential research related to malignant hyperthermia, providing a reference for conducting future research.

Purpose

In patients with a radial arterial catheter, underdamping of the pressure signal is common and responsible for an overestimation of systolic arterial pressure (SAP). The maximum rate of the arterial pressure rise during systole (dP/dt_MAX) has been proposed to assess left ventricular systolic function. The impact of underdamping on dP/dt_MAX is likely but has never been quantified.

Methods

We analyzed data from 70 critically ill patients monitored with a radial catheter in whom underdamping of the arterial pressure waveform was confirmed by the Gardner’s method. Invasive SAP and dP/dt_MAX were recorded at baseline and after the correction of underdamping with a resonance filter.

Results

With resonance filtering, SAP decreased from 159 ± 25 to 139 ± 22 mmHg (p < 0.001) and dP/dt_MAX from 2.0 ± 0.6 to 1.1 ± 0.3 mmHg/ms (p < 0.001). The underdamping-induced overestimation of SAP (delta-SAP) ranged from 6 to 41 mmHg (mean 21 ± 9 mmHg or + 15%) and the overestimation of dP/dt_MAX (delta-dP/dt_MAX) ranged from 0.2 to 2.0 mmHg/ms (mean 0.9 ± 0.4 mmHg/ms or + 84%). A significant linear relationship (p < 0.001, r = 0.6) was observed between delta-SAP and delta-dP/dt_MAX such that the higher was delta-SAP, the higher was delta-dP/dt_MAX.

Conclusions

Radial arterial pressure underdamping has a major impact on dP/dt_MAX. In case of underdamping, the overestimation of dP/dt_MAX is > fivefold higher than SAP overestimation. Therefore, caution should be exercised before using radial dP/dt_MAX as a marker of left ventricular systolic function.

Trial registration

Registered at ClinicalTrials.gov on December 22, 2021 (NCT05166993).

Graphical Abstract

Sleep disturbances are risk factors for postoperative delirium (POD), and sleep interventions have been proposed as potential preventive measures. However, the effectiveness of sleep interventions in preventing POD is uncertain. We performed a systematic literature search using the PubMed, Embase, and Cochrane Library databases from inception until December 24, 2022. We included randomized controlled trials on sleep interventions and POD in adult surgery patients. The screening of titles, abstracts, and full texts was performed independently by two reviewers. Another two reviewers independently performed the data extraction and assessed the risk of bias. Pooled-effect estimates were calculated with a random effect model. Our primary outcome was POD, which was assessed with the confusion assessment method (CAM), CAM for the intensive care unit (CAM-ICU), or other delirium assessment tools. We used trial sequential analysis to control for type I and II statistical errors. We also conducted prespecified subgroup analyses, according to the type of intervention, efficacy of the intervention on postoperative sleep, sample size, participant age, delirium assessment tool used, and the type of surgery. Data were obtained from 25 trials, including 4799 participants. Sleep interventions had a statistically significant difference in the incidence of POD (relative risk (RR) = 0.60; 95% confidence interval (CI), 0.46–0.77; I² = 58%). Stratified analyses indicated that the beneficial effects of sleep interventions were evident in trials where the interventions promoted postoperative sleep (RR = 0.51; 95% CI, 0.36–0.71) as compared to trials that did not (RR = 1.01; 95% CI, 0.77–1.31) (p-value for interaction between subgroups = 0.004). Our primary analysis demonstrated that in adult patients following elective surgery, interventions that improved postoperative sleep, as compared to the standard care or placebo groups, were associated with a lower risk of POD. However, such evidences are limited by the heterogeneity among trials and the small sample sizes of some trials.

Graphical Abstract