Journal of Anaesthesiology, Clinical Pharmacology最新文献

Background and aims: Hemidiaphragmatic paralysis (HDP) may impair the pulmonary function, which could be a substantial issue in individuals suffering from underlying lung disease or compromised lung function. Hence, several diaphragm-sparing methods have been used to avoid HDP after brachial plexus blocks. Although various studies have reported a lower incidence of HDP with costoclavicular block (CCB) compared to supraclavicular block (SCB), a systematic review and meta-analysis to confirm the potential benefits has not been done. Therefore, we analyzed the association of HDP with CCB and SCB.

Material and methods: The incidence of HDP was the primary outcome, and the change in diaphragmatic thickness fraction (DTF), change in hemidiaphragm excursion, and change in peak expiratory flow rate (PEFR) were the secondary outcomes. Six full texts of the articles were selected in the systematic review and meta-analysis of 263 patients who received CCB and 269 patients who received SCB.

Results: The incidence of HDP after CCB was significantly lower than that associated with SCB (16 vs. 115), risk difference: -0.41 (95% confidence interval [CI]: -0.48 to -0.34; P < 0.001) without heterogeneity (I² = 0%). Contractility was more preserved in CCB, and hence, thickness of the diaphragm was more during inspiration. The mean difference in DTF% between the two groups was 33.58 (95% CI: 20.68-46.48). PEFR was more preserved in CCB when compared to SCB: standardized mean difference: 0.46 (95% CI: -0.20-0.72; P = 0.24, I ² = 29%; fixed effect model).

Conclusion: The incidence of HDP after CCB was significantly lesser than that after SCB.

Background and aims: Paediatric burn injuries are distressing and traumatic experiences for children and their families. Managing these patients requires a multidisciplinary approach, with anesthesiologists playing a crucial role in providing pain relief and reducing anxiety during surgical interventions. This prospective observational study aimed to evaluate pain and anxiety levels in children admitted with burns requiring surgical interventions.

Material and methods: Fifty pediatric patients aged 7 to 14 years were enrolled in the study. Perioperative parameters, including a etiology, severity, and total burn surface area involved, were evaluated. Preoperative pain scores were evaluated using the following pain assessment scales: the numerical pain rating scale (NPRS) and revised faces, legs, activity, cry, and consolability (FLACC) scale. Preoperative anxiety was measured using the revised child anxiety and depression scale (RCADS-25). Both the parent and child versions of the RCADS-25 were conducted separately in an understandable language.

Results: There was a significant association between pain levels and specific types of burn injuries, with high-voltage burns and deep partial-thickness burns being more distressing. Anxiety levels were higher in children undergoing debridement, superficial skin grafting, and amputation compared to other surgical procedures, emphasizing the importance of addressing the psychological well-being of burn patients.

Conclusions: Significantly higher pain scores were observed in pediatric patients with high-voltage electric burns compared to those with thermal burns. Patients undergoing debridement surgeries reported high pain scores in both the preoperative and postoperative periods. Anxiety scores were significantly higher in patients undergoing amputation, debridement, and skin grafting surgeries.

Background and aims: Postoperative delirium (POD) is a prevalent and serious complication in elderly patients undergoing surgery, contributing to prolonged hospital stays and increased morbidity. While the exact mechanism remains elusive, growing evidence suggests the involvement of the cholinergic system in delirium pathogenesis.

Material and methods: This observational study aimed to investigate the association between cholinergic biomarkers and POD in elderly patients under regional anesthesia. Eighty-seven patients scheduled for surgery under regional anesthesia were enrolled. Baseline cognitive function was assessed using the Mini-Mental State Examination preoperatively. POD assessment was conducted in the postoperative care unit on days 1, 2, 3, and 7 by using the Confusion Assessment Method. Severity of delirium was evaluated using the Memorial Delirium Assessment Scale. Plasma levels of choline acetyltransferase (ChAT), acetylcholinesterase (AChE), and butyrylcholinesterase (BuChE) were measured preoperatively and 24 hours postoperatively.

Results: Fourteen patients were diagnosed with POD. Compared to the non-POD group, the POD group exhibited significantly higher levels of ChAT and lower levels of AChE and BuChE both pre- and postoperatively (P < 0.0001). Receiver operating characteristic (ROC) curve analysis revealed that AChE, BuChE, and ChAT concentrations had high diagnostic values for POD, with BuChE being the most sensitive but least specific among the three markers.

Conclusions: This study concludes that alterations in postoperative activity of AChE, BuChE, and ChAT are associated with the development of POD in elderly patients undergoing surgery under regional anesthesia. BuChE activity showed the greatest diagnostic value among the cholinergic biomarkers assessed. These findings underscore the potential importance of cholinergic dysfunction in POD pathogenesis and highlight the diagnostic utility of assessing cholinergic biomarkers in predicting POD risk.

Background and aims: No studies have assessed the pre-emptive analgesic efficacy of pecto-intercostal fascial plane block (PIFB). We evaluated the pre-emptive analgesic efficacy of PIFB by comparing with the routine in-hospital analgesic protocol for sternotomy pain in patients undergoing cardiac surgery.

Material and methods: This prospective, randomized, double-blinded study was conducted on 90 patients undergoing elective coronary artery bypass grafting surgery. The patients were randomized into two groups as follows: 1. PIFB group (n = 45): received bilateral ultrasound-guided bilateral PIFB with 0.5% levobupivacaine and 2. no PIFB (NPIFB) group (n = 45): received routine in-hospital perioperative analgesic protocol. The primary outcome of the study was to assess the effectiveness of PIFB on the requirement of intraoperative and postoperative fentanyl. The secondary outcomes were to assess the postoperative pain score, sedation alertness, side effects, and cooperation with incentive spirometry exercises. The Chi-square test and Student's t-test were used to compare the data.

Results: The total intraoperative fentanyl consumption was significantly less in the PIFB group (587.8 ± 165.7 µg) than in the NPIFB group (935.6 ± 157.2 µg) (P < 0.0001). The postoperative pain scores, the need for rescue fentanyl, and the incidence of nausea and vomiting at different time points were significantly lower in the PIFB group. Patients in the PIFB group cooperated well with incentive spirometry exercises at various time points. There was no difference in sedation score at different time points between the two groups. No complications were noted in either group.

Conclusions: Ultrasound-guided PIFB is very effective as a pre-emptive analgesic adjunct for sternotomy pain in patients undergoing cardiac surgery.

Background and aims: Hypovolemia and hypotension are the main risk factors for the development of vasospasm or delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to compare the duration of hypovolemia and hypotension between goal-directed fluid therapy (GDFT) and standard fluid therapy (SFT) in patients undergoing endovascular therapeutic procedures for aSAH.

Material and methods: Twenty patients were enrolled in this single-center, prospective, randomized controlled, and double-blind study. Patients were randomized into the GDFT group (n = 10) and SFT group (n = 10). A cardiac output monitoring device was used in both groups to calculate the duration of hypovolemia and hypotension. Appropriate statistical tests were used, and a P value < 0.05 was considered statistically significant.

Results: The demographic profile was comparable between both the groups. Fifty percent of the study population was hypovolemic before the procedure. The total duration of hypovolemia and hypotension [median (minimum-maximum)] was 3.66 min (0-10.66) and 4 (0-30) min (P = 0.82) and 4.33 (3-6.66) min and 4.66 (3.33-7.33) min (P = 0.09) in GDFT and SFT groups, respectively. Patients in the GDFT groups received significantly lower volumes of intraprocedural crystalloids. However, the total volume of fluids used was comparable between the groups.

Conclusions: Preprocedural hypovolemia is prevalent among patients scheduled for endovascular therapeutic procedures for aSAH. Duration of intraprocedural hypovolemia and duration of hypotension is comparable between GDFT and SFT groups in patients undergoing endovascular therapeutic procedures for aSAH. Hence, GDFT offers no distinctive advantage over SFT and should be individualized to specific patient needs (and not generalized to all the patients) undergoing endovascular therapeutic procedures for aSAH.

The intersection of complex airway management and intraoperative venovenous extracorporeal membrane oxygenation (VV-ECMO) presents a unique challenge, demanding a comprehensive understanding of both domains. This study examines patients undergoing complex airway surgical procedures under anesthesia with concurrent ECMO between January 2023 and May 2024. It focuses on the challenges during surgery, perioperative complications, and critical care outcomes with tailored anesthesia approaches in four clinical scenarios: 1) Tracheal stenosis requiring resection and anastomosis, 2) pulmonary alveolar proteinosis necessitating whole lung lavage, 3) carcinoma esophagus infiltrating the tracheal lumen causing upper airway obstruction and stridor managed with tumor debulking and stenting, and 4) adenoid cystic carcinoma of the trachea causing central airway obstruction with progressive stridor needing intratracheal stent placement. ECMO has become essential in advancing modern-day thoracic surgery's scope and safety. The case series underscores the critical role of ECMO in facilitating surgery by ensuring adequate gas exchange and maintaining hemodynamic stability and contributes to the evolving understanding of perioperative strategies, complications, and outcomes of various airway pathologies and guiding future approaches to enhance overall patient care.

Background and aims: Effective mask ventilation is vital in pediatric patients due to anatomical and physiological differences between the adult and pediatric airways. The classical C-E method has drawbacks, such as soft tissue compression below the mandible and leaks on the unsupported side. This study evaluates a novel single-handed technique, the C-M method, which aims to improve airway seal and reduce complications. Hence, this study aimed to compare the efficacy of the novel C-M method with the C-E method in generating exhaled tidal volumes (mL/kg) during mask ventilation in pediatric patients.

Material and methods: This prospective crossover study involved pediatric patients aged 1-5 years scheduled for elective surgery under general anesthesia. Each method was tested with the ventilator in pressure control mode at 15 cm H₂O, a respiratory rate of 20 breaths/min, and an I: E ratio of 1:2 for five breaths each. Data collected included tidal volumes, audible mask leak, need for oropharyngeal airways, failed ventilation instances, ease of performance, and gastric insufflation.

Results: The mean tidal volumes generated were 9.89 mL/kg for the C-E technique and 10.43 mL/kg for the C-M technique. A two-tailed t-test showed a P value > 0.05, indicating no statistically significant difference. No instances of failed ventilation were reported. Analysis of the other variables showed no significant differences.

Conclusions: The C-M method is an equally effective alternative for mask ventilation in pediatric patients. It provides comparable tidal volumes and safety to the C-E method, which may enhance airway management in this age group.

Background and aims: This study aimed to compare the prophylactic effect of intravenous ondansetron versus ephedrine on hypotension related to spinal anesthesia of cesarean section. The primary outcome was the incidence of maternal hypotension; secondary outcomes were the incidence of nausea and vomiting, the number of vasopressors required, and surgeon satisfaction.

Material and methods: This randomized, double-blind clinical trial study included 120 parturients with ASA physical status I or II who were eligible for elective cesarean section. They were randomly assigned to two groups: receiving ephedrine (10 mg in 10 mL normal saline 0.9% IV) and ondansetron (8 mg in 10 mL normal saline 0.9% IV). The patients were monitored for changes in hemodynamic parameters during surgery and recovery.

Results: Among 120 parturients included in this clinical trial, the incidence of hypotension (20% decrease in systolic blood pressure) was significantly lower in the ephedrine group (21.7%) than in the ondansetron group (60%) (P < 0.001). In addition, the incidence of fall of mean arterial pressure to below 60 mmHg was significantly lower in the ephedrine group (3.3%) than in the ondansetron group (18.3%) (P = 0.016) during surgery. Prophylactic administration of ephedrine also significantly decreased the need for rescue vasopressor compared to ondansetron group (P < 0.001). No difference was observed in the rate of complications and surgeon satisfaction among groups (P = 0.228 and 0.36, respectively).

Conclusions: We found that 10 mg IV ephedrine has a significantly greater prophylactic effect than 8 mg IV ondansetron on spinal-induced hypotension during elective cesarean section.