Indian Journal of Anaesthesia最新文献

Background and aims: The optimal perioperative management of patients chronically using renin-angiotensin system inhibitors (RASIs) is still uncertain. This study aims to compare the outcomes of withholding versus continuing RASIs before surgery, focusing on efficacy and safety.

Methods: A systematic review and meta-analysis synthesising evidence from randomised controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until September 2024. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes by using the risk ratio (RR) with a 95% confidence interval (CI).

Results: Ten RCTs with 3,740 patients were included. There was no statistical difference between both groups regarding the incidence of major adverse cardiac events (MACE) [Risk ratio (RR): 0.99; 95% confidence interval (CI): 0.84, 1.16; P = 0.88], all-cause mortality (RR: 0.88; 95% CI: 0.44, 1.78; P = 0.72), myocardial infarction (MI) (RR: 1.67; 95% CI: 0.61, 4.58; P = 0.32), heart failure/acute pulmonary oedema (RR: 1.87; 95% CI: 0.51, 6.84; P = 0.34), stroke (RR: 1.22; 95% CI: 0.35, 4.24; P = 0.75), postoperative hypotension (RR: 0.85; 95% CI: 0.66, 1.10; P = 0.22), perioperative hypertension (RR: 1.21; 95% CI: 1.00, 1.46; P = 0.05), and acute kidney injury (AKI) (RR: 1.01; 95% CI: 0.80, 1.26; P = 0.97). However, withholding RASIs was significantly associated with a decreased incidence of intraoperative hypotension (RR: 0.82; 95% CI: 0.75, 0.89; P < 0.001).

Conclusion: Stopping RASIs in patients undergoing surgery was not associated with a higher risk of postoperative complications, such as MACE, all-cause mortality, myocardial infarction, heart failure/acute pulmonary oedema, stroke, or AKI. Conversely, discontinuing RASIs notably reduced the incidence of intraoperative hypotension.

Background and aims: The age-dependent decline in sevoflurane's minimum alveolar concentration is well established. However, the relationship between ageing and its hypnotic potency at the effect-site concentration (Ceff) remains unclear. This study aimed to evaluate the impact of ageing on sevoflurane's hypnotic potency and induction kinetics during the wash-in period.

Methods: This prospective observational study enroled 83 female patients stratified by age into four decades: 30-39, 40-49, 50-59, and 60-69 years. Anaesthesia was induced using 5% sevoflurane in a non-rebreathing manner. We continuously recorded bispectral index (BIS) values and end-tidal sevoflurane concentrations during the 4 min wash-in period, with Ceff values calculated through pharmacokinetic modelling. Subsequently, the end-tidal concentration was maintained at 1.5% for 20 min (10 min equilibration + 10 min stabilisation) at 2 L/min to achieve a cerebral steady-state, and the final stabilised BIS value was calculated. One-way ANOVA with Bonferroni post-hoc correction or Kruskal-Wallis test was used to compare continuous variables. Pearson's Chi-square test was used to compare categorical variables, with the significant difference set at P < 0.05.

Results: During the wash-in period, the 60-69-year group exhibited a prolonged time from awakening to BIS 50 compared to younger cohorts (P < 0.05 or < 0.01). Ceff values exhibited progressively delayed kinetics with increasing age, but Ceff values of sevoflurane at BIS 50 were not different across the four age groups (P > 0.05). At a steady state of 1.5% sevoflurane anaesthesia, the intergroup analysis revealed no significant variations in BIS values.

Conclusion: The hypnotic potency of sevoflurane is preserved among female patients aged 30-69 years despite delayed induction kinetics in older individuals.

Background and aims: Subclavian vein cannulation is a commonly performed procedure in the operating room. Ultrasound-guided supraclavicular subclavian vein cannulation can be done using either an in-plane or out-of-plane approach. This study compares the in-plane technique with a novel anterior out-of-plane technique. The primary objective of the study was to compare the first-pass success rate between the anterior out-of-plane technique approach and the in-plane approach for ultrasound-guided subclavian vein cannulation.

Methods: This single-centre, open-label, randomised controlled trial included 128 patients undergoing elective surgeries that required central vein cannulation. Patients were randomised to either the anterior out-of-plane or in-plane technique for ultrasound-guided subclavian central venous access. First-pass success rates, puncture and cannulation times, needle redirections, additional punctures, and complications were recorded and compared between groups. Continuous variables were analysed using independent-sample t-tests, and categorical variables with Chi-square tests. Normality was confirmed by the Shapiro-Wilk test; P values < 0.05 were considered statistically significant.

Results: Successful cannulation was achieved in 119 patients. The first-pass success rate was significantly higher with the anterior out-of-plane approach (95%) compared to the in-plane approach (77%) (P < 0.05). The out-of-plane approach demonstrated shorter puncture [9 (SD: 3) seconds] and cannulation times [148 (SD: 31) seconds) compared to the in-plane approach [17 (SD: 9) seconds and 185 (SD: 32) seconds, respectively]. Additionally, fewer needle redirections, punctures, and complications, including arterial punctures (1 vs 5), were observed with the out-of-plane approach.

Conclusion: Ultrasound-guided supraclavicular subclavian vein cannulation is more successful and efficient using this novel anterior out-of-plane approach compared to the standard in-plane approach.