Journal of Anesthesia最新文献

Purpose: Both preoperative frailty and postoperative delirium (POD) are associated with higher risk of postoperative complications. But it is unclear if the effect of preoperative frailty on postoperative complications was mediated by POD.

Methods: This study was a mediation analysis of a pooled database. Patients aged ≥ 60 years who underwent elective non-cardiac surgery were enrolled. Preoperative frailty was defined as the modified frailty index (mFI) ≥ 0.27. POD was assessed twice daily within the first 3 days using the Confusion Assessment Method (CAM) for patients without intubation and the CAM for intensive care unit (CAM-ICU) for intubated patients. Major complications within postoperative 30 days were screened. Mediation analysis was employed to explore the relationships between frailty, POD, and postoperative complications.

Results: A total of 4684 patients were included. The prevalence of frailty was 10.4% (489/4684). In comparison with non-frail patients, frail patients had a higher incidence of POD (12.7% [62/489] vs 6.5% [271/4195], RR = 2.102, 95% CI 1.568-2.819, P < 0.001) and more postoperative complications (21.5% [105/489] vs 16.7% [701/4195], RR = 1.363, 95% CI 1.082-1.716, P = 0.008). The adjusted total and direct associations between frailty and postoperative complications were 5.8% (adjusted β, 95% CI, 1.8-9.5%; P < 0.001) and 5.0% (adjusted β, 95% CI, 1.1-8.7%; P = 0.004), respectively. A significant indirect association via POD was observed (adjusted β = 0.8%; 95% CI, 0.3-1.4%; P < 0.001), accounting for 13.8% of the total effect.

Conclusion: Preoperative frailty is associated with an increased risk of postoperative complications, mediated in part by early POD, in elderly patients following non-cardiac surgery. Given the modest effect size, further research is warranted to confirm these findings.

Purpose: Postoperative nausea and/or vomiting (PONV/POV) following tonsillectomy occurs in up to 89% of children without antiemetic prophylaxis. Prior systematic reviews have not evaluated the relative efficacy of ondansetron and metoclopramide for PONV/POV, including their adverse effects.

Methods: A systematic search was conducted of five databases from their inceptions to June 19, 2024. Inclusion criteria were randomized controlled trials (RCTs) comparing ondansetron and metoclopramide in pediatric patients undergoing tonsillectomy or adenotonsillectomy. The primary outcome was incidence of PONV/POV. Secondary outcomes were length of hospital stay (LOS) and adverse events including postoperative extrapyramidal reactions and delayed hospital readmissions. Pooled risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. Adjusted RRs were calculated using random-effects meta-regression. Risk of bias and certainty of evidence were assessed using Cochrane RoB 2 and GRADE, respectively. This study was registered in PROSPERO (42,024,499,702).

Results: Five RCTs met all inclusion criteria, consisting of 861 patients. Ondansetron significantly reduced risk of PONV/POV by almost 50% (RR 0.48 95% CI 0.31-0.75, moderate quality evidence), compared to metoclopramide. Intraoperative opioid dose did not impact the RR. Ondansetron also significantly shortened LOS (MD - 26.92 min 95% CI - 47.24 min to - 6.60 min, moderate quality evidence). Only two RCTs addressed readmission rates or extrapyramidal reactions, although no events occurred in either study.

Conclusion: Ondansetron is more effective than metoclopramide for PONV/POV prophylaxis, decreasing the risk of PONV/POV as well as LOS. Continued surveillance for adverse effects may be recommended when using either medication.

This prospective observational study aimed to investigate the usefulness of the self-coiling catheter for continuous interscalene brachial plexus block (CISB) in patients undergoing arthroscopic rotator cuff repair (ARCR). In 22 patients, the self-coiling tip of catheter was placed anterior to the C5 and C6 roots under ultrasound guidance. The primary outcome is the relationship between the distance from the distal side pore of the catheter to the C5/C6 nerve roots and the visual analogue scale (VAS) of postoperative pain. The distance was recorded as a positive value when the distal pore was anterior to the C5/C6 nerve roots, and as a negative value when it was posterior to the roots. The median distance from the distal pore to C5/C6 nerve roots was 5.0 [4.1, 6.5] mm at catheter placement before surgery and 0.0 [- 4.3, 2.2] mm at catheter removal the day after surgery. The distance between the distal pore and the cervical nerve roots was associated with the VAS score at catheter removal (r =- 0.455, P = 0.033). These findings suggest that the distance between the distal pore of the self-coiling catheter and the C5/C6 nerve roots may affect the analgesic effect of CISB after ARCR.

Purpose: In patients with herpes zoster-associated pain (ZAP), magnetic resonance imaging (MRI) has revealed T2 high-signal intensity zones (MRI T2 HIZ) in the dorsal horn of the spinal cord, associated with postherpetic neuralgia (PHN). We retrospectively analyzed the relationship between PHN and MRI T2 HIZ in patients with refractory ZAP in the subacute phase who underwent temporary spinal cord stimulation therapy (tSCS).

Methods: This single-center, case-control study included patients who underwent tSCS for refractory ZAP between 2010 and 2018. MRIs were re-assessed for the presence of T2 HIZ in the dorsal horn of the spinal cord. Patients were divided into T2 HIZ( +) and T2 HIZ(-) groups. Patients with a numerical rating score (NRS) ≥ 3 at the last visit were defined as PHN. The NRS values and the incidence rate of PHN were compared between the two groups.

Results: Of the 67 cases extracted, 38 were included in the analysis: 22 in T2 HIZ( +) group and 16 in T2 HIZ(-) group. No significant differences were observed in background factors between the two groups. However, the T2 HIZ( +) group had a significantly higher NRS at the final visit (T2 HIZ( +):3.8 ± 2.1, T2 HIZ(-):1.4 ± 1.5; P < 0.05) and had significantly more patients with PHN than the T2 HIZ(-) group (T2 HIZ( +) vs. T2 HIZ(-), 15/22 (68%) vs. 3/16 (19%); odds ratio = 8.67; 95% confidence interval, 1.7-63.3).

Conclusion: T2HIZ is detected in more than half of refractory ZAP, and pain is more likely to remain after tSCS treatment in the T2HIZ( +) group.

Acute kidney injury (AKI), particularly during cardiac surgery, severely affects patient outcomes, yet current diagnostics using serum creatinine levels delay detection. This study investigates real-time urinary oxygen tension (PuO₂) as an alternative early marker and correlates it with renal medullary oxygen tension for potential AKI prediction. We developed a modified 3-way silicone urinary catheter designed for more reliable urine collection and evaluated its performance in terms of PuO₂ measurement accuracy. The results of the experiment showed that the improved catheter enabled continuous urine collection, but it was suggested that the oxygen permeability of the silicone material may have caused an increase in PuO₂ level. These results suggest that material selection, particularly oxygen permeability, has a significant impact on PuO₂ measurements and highlight the need for alternative low-permeability materials to improve the reliability of PuO₂-based AKI diagnostics.

Purpose: The purpose of this study was to compare the success rate, measurement duration and the accuracy of inflationary non-invasive blood pressure (iNIBP, Nihon Koden Corp, Tokyo, Japan) during general anesthesia between the subjects with sinus rhythm (SR) and atrial fibrillation (AF) against invasive arterial pressure (IAP).

Methods: iNIBP was determined every 5 min and IAP was continuously monitored in 30 subjects with sinus rhythm and 30 subjects with atrial fibrillation. The outcomes of this study were the success rate, the measurement duration of iNIBP and the accuracy of iNIBP in reference to IAP and 5 pair of data from each subject. The accuracy was assessed with concordance correlation coefficient and Bland-Altman method.

Results: The success rate of iNIBP was 45% and 59% (p < 0.01) with AF and SR, respectively. Measurement duration of iNIBP was not different between AF and SR group. The Lin concordance correlation coefficient of mean blood pressure of iNIBP against IAP of SR group and AF group was 0.83 and 0.77, respectively. The mean bias (SD) of mean blood pressure of iNIBP against IAP of SR group and AF group was 5.8 (8.9) mmHg and 7.1 (11.5) mmHg, respectively. The precision was significantly wider in AF group.

Conclusion: Presence of AF decreased the incidence of successful determination of blood pressure during cuff inflation. The accuracy of mean blood pressure determination was not considerably affected except for the wider limits of agreement.