European Journal of Anaesthesiology最新文献

Background: The effectiveness of head mounted real-time ultrasound displays (hereafter referred to as 'smart glasses') in improving hand-eye coordination in less experienced individuals, such as trainees in anaesthesia, is unclear.

Objectives: To compare the first-attempt success rate of smart glasses-assisted ultrasound-guided paediatric radial artery catheterisation with conventional ultrasound guided catheterisation performed by anaesthesiology trainees.

Design: Prospective randomised controlled trial.

Settings: Tertiary university hospital from September 2021 to February 2023.

Patients: One hundred and twenty-two paediatric patients (age <7 years, weight ≥3 kg) who required radial artery cannulation during general anaesthesia.

Interventions: The participants were randomly assigned to either the ultrasound screen group (control) or the smart glasses group prior to radial artery catheterisation.

Main outcome measures: The primary outcome was the first attempt success rate. Secondary outcomes included the number of attempts, use of transfixion technique, overall complication rate, and clinical anaesthesiology (CA) year of the operators.

Results: A total of 119 paediatric patients were included in the analysis. The smart glasses group exhibited higher first-attempt success rate than did the control group (89.8% [53/59] vs. 71.7% [43/60]; P  = 0.023; odds ratio (OR) 3.49; (95% confidence interval (CI) 1.27-9.6). The overall number of attempts [median, 1; interquartile range (IQR), 1-1; range, 1-3 vs. median, 1; IQR, 1-2; range, 1-4; P   =  0.006], use of transfixion technique (12/59 [20.3%] vs. 28/60 [46.7%]; P  = 0.002), and overall complication rate (6.8% [4/59] vs. 30.0% [18/60]; P  = 0.002) were lower in the smart glasses group than in the control group. However, among paediatric anaesthesiology fellows (CA 5 years), the first- (89.3% [25/28] vs. 80.8% [21/26]; P  = 0.619) and second-attempt success rates (96.4% [27/28] vs. 80.8% [21/26]; P  = 0.163) did not differ between the two groups.

Conclusions: Smart glasses-assisted ultrasound guided radial artery catheterisation improved the first attempt success rate among anaesthesiology trainees, reducing the number of attempts and overall complication rates in small paediatric patients. Smart glasses were more effective for anaesthesia residents (CA 2-4 years) but were not effective for paediatric anaesthesiology fellows (CA 5 years).

Trial registration: ClinicalTrials.gov (NCT05030649) ( https://classic.clinicaltrials.gov/ct2/show/NCT05030649 ).

Background: Opioids play an important role in peri-operative pain management. However, opioid use is challenging for healthcare practitioners and patients because of concerns related to opioid crises, addiction and side effects.

Objective: This review aimed to identify and synthesise the existing evidence related to adults' experiences of opioid use in postoperative pain management.

Design: Systematic scoping review of qualitative studies. Inductive content analysis and the Theoretical Domains Framework (TDF) were applied to analyse and report the findings and to identify unexplored gaps in the literature.

Data sources: Ovid MEDLINE, PsycInfo, Embase, CINAHL (EBSCO), Cochrane Library and Google Scholar.

Eligibility criteria: All qualitative and mixed-method studies, in English, that not only used a qualitative approach that explored adults' opinions or concerns about opioids and/or opioid reduction, and adults' experience related to opioid use for postoperative pain control, including satisfaction, but also aspects of overall quality of a person's life (physical, mental and social well being).

Results: Ten studies were included; nine were qualitative ( n  = 9) and one used mixed methods. The studies were primarily conducted in Europe and North America. Concerns about opioid dependence, adverse effects, stigmatisation, gender roles, trust and shared decision-making between clinicians and patients appeared repeatedly throughout the studies. The TDF analysis showed that many peri-operative factors formed people's perceptions and experiences of opioids, driven by the following eight domains: Knowledge, Emotion, Beliefs about consequences, Beliefs about capabilities, Self-confidence, Environmental Context and Resources, Social influences and Decision Processes/Goals. Adults have diverse pain management goals, which can be categorised as proactive and positive goals, such as individualised pain management care, as well as avoidance goals, aimed at sidestepping issues such as addiction and opioid-related side effects.

Conclusion: It is desirable to understand the complexity of adults' experiences of pain management especially with opioid use and to support adults in achieving their pain management goals by implementing an individualised approach, effective communication and patient-clinician relationships. However, there is a dearth of studies that examine patients' experiences of postoperative opioid use and their involvement in opioid usage decision-making. A summary is provided regarding adults' experiences of peri-operative opioid use, which may inform future researchers, healthcare providers and guideline development by considering these factors when improving patient care and experiences.

Background: Induction of general anaesthesia has many potential triggers for peri-operative myocardial ischaemia including the acute disturbance of blood gases that frequently follows alterations in breathing and ventilation patterns. Free-breathing oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) imaging may provide the opportunity to continuously quantify the impact of such triggers on myocardial oxygenation.

Objective: To investigate the impact of breathing patterns that simulate induction of general anaesthesia on myocardial oxygenation in awake healthy adults using continuous OS-CMR imaging.

Design: Prospective observational study.

Setting: Single-centre university hospital. Recruitment from August 2020 to January 2022.

Participants: Thirty-two healthy volunteers younger than 45 years old were recruited. Data were analysed from n  = 29 (69% male individuals).

Intervention: Participants performed a simulated induction breathing manoeuvre consisting of 2.5 min paced breathing with a respiration rate of 14 breaths per minute, followed by 5 deep breaths, then apnoea for up to 60s inside a magnetic resonance imaging scanner (MRI). Cardiac images were acquired with the traditional OS-CMR sequence (OS bh-cine ), which requires apnoea for acquisition and with two free-breathing OS-CMR sequences: a high-resolution single-shot sequence (OS fb-ss ) and a real-time cine sequence (OS fb-rtcine ).

Main outcome measures: Myocardial oxygenation response at the end of the paced breathing period and at the 30 s timepoint during the subsequent apnoea, reflecting the time of successful intubation in a clinical setting.

Results: The paced breathing followed by five deep breaths significantly reduced myocardial oxygenation, which was observed with all three techniques (OS bh-cine -6.0 ± 2.6%, OS fb-ss -12.0 ± 5.9%, OS fb-rtcine -5.4 ± 7.0%, all P  < 0.05). The subsequent vasodilating stimulus of apnoea then significantly increased myocardial oxygenation (OS bh-cine 6.8 ± 3.1%, OS fb-ss 8.4 ± 5.6%, OS fb-rtcine 15.7 ± 10.0%, all P  < 0.01). The free-breathing sequences were reproducible and were not inferior to the original sequence for any stage.

Conclusion: Breathing manoeuvres simulating induction of general anaesthesia cause dynamic alterations of myocardial oxygenation in young volunteers, which can be quantified continuously with free-breathing OS-CMR. Introducing these new imaging techniques into peri-operative studies may throw new light into the mechanisms of peri-operative perturbations of myocardial tissue oxygenation and ischaemia.

Visual abstract: http://links.lww.com/EJA/A922.

Background: Climate change has emerged as the single biggest global health threat of the twenty-first century. Nitrous oxide accounts for the largest carbon footprint amongst our use of anaesthetic gas. It is a potent greenhouse gas possessing a global warming potential of approximately 265 times that of carbon dioxide. Despite recent curtailment of its use, it remains extensively employed as an analgesic for women in labour.

Objectives: Assessment of the opinions of post-natal women and staff on nitrous oxide use and to investigate whether knowledge of its environmental harm would influence their choice of labour analgesia.

Design: Postnatal women and healthcare staff were invited to participate in a survey of nitrous oxide use as a labour analgesic and knowledge of its effect of the environment.

Setting: A single-centre study in a major obstetric tertiary referral centre in Ireland in 2021.

Main outcome measures: To evaluate the awareness and perceptions of postnatal women and staff regarding the environmental impact of nitrous oxide and if it would affect their decision to use it in the future.

Results: One hundred postnatal women and 50 healthcare staff completed the survey. One hundred and six post-natal women were invited to complete the survey, resulting in a response rate of 94%. Knowledge of nitrous oxide's environmental impact was low. After receiving information, 46% of patients were more inclined to seek epidural or request it earlier (54%) to limit their nitrous oxide use, while 51% would choose an alternative analgesia to avoid nitrous oxide altogether. Overwhelmingly, 99% believed they had the right to know about these harmful effects when choosing an analgesic option.

Conclusions: Patients should be informed of the environmental impact of nitrous oxide antenatally, empowering them to make informed decision on a climate friendly analgesic option if they wish.