Journal of Anesthesia最新文献

Purpose: To examine the ramifications of both the modified and traditional subcostal anterior quadratus lumborum block (SQLB) on postoperative analgesia in individuals undergoing laparoscopic nephrectomy.

Methods: Forty-six individuals slated for elective laparoscopic nephrectomy under general anesthesia were randomly assigned to acquire either traditional or modified SQLB using 20 mL of 0.5% ropivacaine. The primary outcome was intravenous morphine-equivalent intake during the first 24 h following surgery. Secondary outcomes included sensory block dermatomes, numerical rating scale (NRS) scores, the total number of patient-controlled analgesia (PCA) demands, rescue analgesic use, and complications related to opioids and nerve block.

Results: The modified SQLB group had significantly lower morphine-equivalent consumption compared to the traditional SQLB group within the initial 24 h after surgery (23.1 ± 4.3 vs. 34.7 ± 6.8 mg, P < 0.001). The modified SQLB also resulted in a greater number of dermatome segments of sensory block at 5, 10, and 15 min after block (P < 0.05), lower NRS pain scores at rest and during coughing at 6, 24, and 48 h (P < 0.001), and reduced usage of rescue analgesics as well as total PCA demands (P < 0.05). No significant differences were observed in the incidence of complications related to opioids or the nerve block procedure between the two groups.

Conclusions: Ultrasound-guided modified SQLB confers significantly superior analgesic advantages over the traditional SQLB for patients undergoing laparoscopic nephrectomy, culminating in a marked reduction in postoperative opioid consumption and more efficacious pain management.

Purpose: Perioperative respiratory adverse event (PRAE) is one of the most common complications in pediatric anesthesia. We aimed to evaluate the efficacy of perioperative pharmacological interventions to prevent the development of PRAE in children undergoing noncardiac surgery.

Methods: PubMed, Embase, Cochrane Library and ClinicalTrials.gov were searched for randomized controlled trials (RCT) of prophylactic pharmacological interventions for PRAE among surgical children from inception to 5 August 2024. Pairwise meta-analyses were conducted to compare the effects of an intervention with placebo or another intervention on overall PRAE and their subtypes, including laryngospasm, bronchospasm, oxygen desaturation, airway obstruction, coughing and stridor. Risk of bias was assessed using the Cochrane Collaboration tool.

Results: Seven categories of prophylactic interventions were identified. Twenty-nine RCTs with 4452 children were included. Compared with placebo, lidocaine reduced the odds ratio (OR) of overall PRAE ( 0.27 [95% CI] [0.17, 0.42]) and laryngospasm (0.38 [0.22, 0.67]); dexmedetomidine reduced the OR of PRAE (0.31 [0.12, 0.76]), laryngospasm (0.31 [0.10, 0.91]), coughing (0.24 [0.14, 0.41]) and oxygen desaturation (0.54 [0.35, 0.84]); β₂-adrenoreceptor agonists reduced the OR of PRAE (0.45 [0.24, 0.83]), coughing (0.36 [0.13, 0.95]) and oxygen desaturation (0.66 [0.45, 0.98]). Compared with sevoflurane induction, intravenous propofol induction lowered the OR of PRAE (0.35 [0.16, 0.74]), laryngospasm (0.17 [0.06, 0.48]) and airway obstruction (0.32 [0.17, 0.63]).

Conclusions: The meta-analysis demonstrated prophylactic potential of lidocaine, dexmedetomidine, β₂-adrenoreceptor agonists and propofol induction technique against PRAE, but it should be interpreted cautiously due to inconsistent PRAE definition and correlation of subtypes within the composite outcome.

Trial registration: PROSPERO (CRD42020220028). Registered 11 December 2020. Updated 3 September 2024.

Purpose: Intracellular Ca²⁺ imaging is a valuable tool for studying neuronal activity; however, its application in the spinal cord of mature animals remains underdeveloped. This study aimed to establish an intracellular Ca²⁺ imaging method in adult rat spinal cord slices without complex genetic modifications and characterize primary afferent-evoked intracellular Ca²⁺ responses in spinal dorsal horn neurons.

Methods: L5 lumbar spinal cord slices from adult rats were stained with a Ca²⁺ indicator. The relationship between intracellular Ca²⁺ signals and electrophysiological responses induced by dorsal root stimulation was examined. Additionally, the effects of analgesics, anesthetics, and hyperalgesics on the Ca²⁺ responses were analyzed.

Results: Monophasic intracellular Ca²⁺ responses were observed with A-fiber intensity stimulation, while biphasic responses were noted with C-fiber intensity stimulation. These responses were not photobleached after repeated measurements (n = 12). The rising phase of Ca²⁺ responses coincided with action potential generation, whereas the falling phase did not. Dorsal root stimulation-induced Ca²⁺ responses were significantly suppressed by morphine (10 μM, 43.9 ± 4.9% of control, n = 8) but not by remimazolam (10 μM, 98.0 ± 2.0% of control, n = 8). Conversely, bicuculline (40 μM, 288.4 ± 48.4% of control, n = 10) and high concentrations of tranexamic acid (3, 10 mM, 132.6 ± 19.9%, 152.6 ± 25.3%, respectively, n = 8) significantly enhanced Ca²⁺ responses.

Conclusion: This is a simple and effective approach to examining the effects of drugs that target the spinal cord and investigating nociceptive transmission and modulation mechanisms in the spinal dorsal horn.

Background: This study evaluated the ability of diaphragmatic excursion (DE), measured 2 h after extubation, to predict the need for resumption of ventilatory support within 48 h in surgical critically ill patients.

Methods: This prospective observational study included adult surgical critically ill patients intubated for > 24 h and extubated after a successful spontaneous breathing trial. Sonographic measurement of the DE was performed 2 h after extubation. Patients were followed up for 48 h after extubation and were divided into reintubation group and successful weaning group. The primary outcome was DE's ability to predict the need for resumption of ventilatory support using the area under receiver characteristic curve (AUC) analysis.

Results: Data from 70 patients were analyzed and 25/70 (36%) patients needed reintubation. DE was lower in the reintubation group than the successful weaning group. The AUC (95% confidence interval) for the ability of DE to predict the need for resumption of ventilatory support was 0.98(0.92-1.00) and 0.97(0.89-1.00) for the right and left side, respectively. At cutoff values of 20.8 and 19.8 mm, the right and left DE had positive predictive values of 92% and 88% and negative predictive values of 96% and 93%, respectively.

Conclusion: Among surgical critically ill patients undergoing weaning from invasive mechanical ventilation, DE obtained 2h after extubation is an accurate predictor for the need for resumption of ventilatory support. Diaphragmatic excursion < 20-21 mm could predict the need for resumption of ventilatory support with a positive predictive value of 88-92% and negative predictive value of 93-96%.

Purpose: We investigated whether patients who have been issued a do-not-attempt-resuscitation order (DNAR) preoperatively (hereafter, DNAR patients) are informed of the DNAR code change when they undergo anesthesia. We also conducted a survey of the awareness of medical staff regarding perioperative DNARs, and investigated the current situation at a single-center in Japan.

Methods: For DNAR patients managed by anesthesiologists from January 2019 to September 2022, we retrospectively investigated whether the patient was informed of the DNAR code change or the DNAR was automatically suspended without explanation. Next, in July 2023, a questionnaire survey on perioperative DNARs was conducted among all medical staff at our center.

Results: Among the 4,164 cases managed by anesthesiologists during the study period, 100 DNAR patients (2.4%) were identified. Of these, 27 patients received an explanation about the DNAR code change before surgery. Multivariate analysis showed that female patients (odds ratio [OR] 5.3, 95% confidence interval [CI] 3.8-6.7; p = 0.023) and patients with low Barthel Index (OR 0.98, 95% CI 0.96-0.99; p = 0.010) tended to receive explanations about DNAR code changes. In the questionnaire survey, 25% of the 1,051 respondents answered that DNAR code changes should be explained to patients before surgery.

Conclusion: In clinical practice, 27% of DNAR patients were informed of DNARs code change before surgery. Perioperative advance care planning should be further promoted in clinical practice by creating guidelines and training programs regarding perioperative DNARs.

Purpose: Unplanned hospital admission following pediatric day surgery is a crucial quality indicator. This study examined the incidence, related risks, interventions, and outcomes of unplanned hospital admission following pediatric day surgery among children in Japan.

Methods: This single-center, retrospective study analyzed data of 14,529 pediatric patients under the age of 18 years who underwent day surgery between August 2007 and December 2022. Unplanned hospital admission was defined as an overnight hospital stay that was not planned preoperatively, including patients who returned to the emergency department and required admission within 24 h of discharge. Reasons for unplanned hospital admission and interventions were categorized, and risk factors were identified using logistic regression.

Results: The incidence of unplanned hospital admission was 0.19%. The most common reasons for unplanned hospital admission were anesthetic-related, particularly postoperative nausea and vomiting (36%), which was managed primarily with intravenous fluids (36%) and antiemetic medications (21%). Medical and surgical factors were next most common. Logistic regression identified longer operation time (adjusted Odds ratio 1.03; 95% confidence interval [1.01, 1.04]; P < 0.001) and exit from the operating room after 15:00 (adjusted Odds ratio 29.3; 95% confidence interval [7.09, 121]; P < 0.001) as significant risk factors for unplanned hospital admission.

Conclusion: Unplanned hospital admission was most commonly anesthetic-related and was managed with intravenous fluids and antiemetic medications. Longer operation time and later exit from the operating room were significant risk factors. These findings can guide targeted strategies to further reduce unplanned hospital admission and improve pediatric day surgery quality.