Journal of Anesthesia最新文献

Purpose: Ciprofol, a novel intravenous anesthetic with GABAA affinity akin to propofol, lacks characterized electroencephalogram (EEG) oscillation profiles during anesthesia.

Methods: This prospective observational study included 54 patients undergoing surgery, divided into two groups: 30 adults (18-64 years) and 24 elderly (≥ 65 years). The EEG monitor recorded frontal region EEG, and we analyzed spectral power, wavelet coherence, and phase-amplitude coupling (PAC) across various states.

Results:  In the awake state, the spectral analysis power, wavelet coherence, and PAC were similar between the patient groups. Under anesthesia, both groups exhibited dominant slow oscillation (SO) and alpha oscillations, but the elderly group showed significantly lower alpha power (adult 4.367 [1.492-6.059] vs. elderly 1.729 [- 2.340-4.096], P < 0.001) and wavelet coherence (adult 0.0375 [0.0092-0.0935] vs. elderly 0.0073 [0.0030-0.0235], P = 0.041) compared to the adult group. During the recovery period, the restoration of beta/gamma activity and the increase in the intensity of the SO-alpha modulation index (MI) indicated a gradual recovery of consciousness. Frontal alpha power showed age dependency under ciprofol-maintained general anesthesia. Alpha-band wavelet coherence and the SO-alpha MI exhibited no significant age dependence, and the PAC pattern weakened with age.

Conclusion: This study characterizes the EEG neural oscillation dynamics during ciprofol-induced general anesthesia. Despite the physiological decline in spectral power associated with increasing age, wavelet coherence and PAC demonstrate remarkable stability across different age cohorts. These findings support their potential as reliable, age-independent biomarkers for monitoring the depth of anesthesia.

Purpose: The initial distribution volume of glucose (IDVG) has been proposed as a useful indicator of central extracellular fluid (ECF) volume. The IDVG's behavior under vasoconstrictor treatment is unclear. We investigated the effects of noradrenaline and arginine vasopressin (AVP) on the IDVG in pigs under normal and lipopolysaccharide (LPS)-induced septic shock states.

Methods: 12 anesthetized pigs underwent hemodynamic monitoring. The IDVG was measured as a one-compartment model after an intravenous injection of glucose (2 g). Noradrenaline and AVP were administered to increase the pigs' blood pressure under non-septic (n = 6) and LPS-induced septic (n = 6) states. Cardiac output (CO), intrathoracic blood volume (ITBV), IDVG index (mL/kg), and other cardiac preload-related parameters were also measured. One-way repeated measures ANOVA and Fisher's LSD test were used to compare the groups' values and Pearson's correlation coefficients were used to analyze the correlations between the CO and the parameters.

Results: In the non-septic animals, noradrenaline significantly increased the CO and the IDVG index, whereas AVP significantly decreased these parameters. The IDVG index and the CO in the non-septic state were strongly positively correlated (r = 0.74, p < 0.01). In the LPS-induced sepsis state, the CO and the IDVG index significantly decreased 4 h after the LPS administration, and noradrenaline increased the CO but not the IDVG index, whereas AVP significantly decreased the IDVG index without decreasing the CO. A strong positive correlation between the IDVG index and the CO remained in the septic state (r = 0.76, p < 0.01).

Conclusion: IDVG may reflect changes in central ECF volume, which is related to venous return, even in conditions requiring vasoconstrictor therapy.

Purpose: This study aimed to investigate whether residual kidney function (RKF) influences perioperative hemodynamic stability in hemodialysis patients. Although anesthesiologists have had the clinical impression that RKF contributes to more stable blood pressure during induction of general anesthesia, this association has not been demonstrated. We hypothesized that RKF was associated with less hypotension at induction.

Methods: We conducted a single-center retrospective study of hemodialysis patients undergoing elective surgery under general anesthesia. RKF was defined as urine output ≥ 100 mL/day. The primary outcome was the lowest systolic blood pressure (SBP) during induction. Propensity score matching was performed. Independent predictors of hypotension were identified using multivariable logistic regression.

Results: Of 1,086 patients screened, 882 were analyzed (RKF + 335; RKF- 527). After matching, 160 patients were included in each group. In the matched cohort, the lowest SBP was higher in the RKF + group (111 ± 32 vs. 105 ± 30 mmHg; p = 0.044). In the full cohort, both the lowest SBP (112 ± 30 vs. 103 ± 29 mmHg; p < 0.001) and the decrease (28 ± 33 vs. 37 ± 31 mmHg; p < 0.001) were more favorable in the RKF + group, with lower phenylephrine use (0.09 ± 0.19 vs. 0.16 ± 0.35 mg; p = 0.001). Logistic regression confirmed RKF, surgery type, and preoperative SBP as independent predictors.

Conclusions: RKF was associated with higher SBP at induction of general anesthesia, independent of anesthetic and vasopressor doses. Preoperative assessment of RKF may help identify dialysis patients at risk of induction-related hypotension.

We conducted a narrative review of the Transitional Pain Service (TPS) to (1) synthesize current evidence on its effectiveness and (2) identify key prerequisites for future TPS implementation. Chronic post-surgical pain (CPSP) is a significant and potentially preventable postoperative complication following major surgery. Established at Toronto General Hospital in 2014, the TPS represents a novel multidisciplinary model designed to mitigate CPSP risk and reduce opioid dependence. A comprehensive search of OVID Medline, supplemented by manual hand-searching, was performed using terms related to transitional pain, postoperative pain management, opioids, and chronic pain. Searches were restricted to English language human studies published from 2014 onward. Fourteen articles met inclusion criteria. Across the literature, TPS interventions consistently demonstrated reductions in postoperative pain and opioid consumption, along with improvements in functional and psychological outcomes. The TPS provides an essential multimodal approach to postoperative care, supporting long-term reductions in opioid use and chronic pain burden. Key prerequisites are proposed to guide successful implementation in future clinical settings.

Purpose: Intentional placement of an epidural catheter toward the operative side can produce a predominantly ipsilateral effect, which may benefit patients undergoing unilateral knee surgery. In this study, we retrospectively evaluated the success rate and efficacy of intentional ipsilateral epidural catheter placement in patients undergoing anterior cruciate ligament reconstruction (ACLR).

Methods: With IRB approval, we retrospectively analyzed existing clinical data that had been routinely collected from patients who underwent ACLR and received intentional ipsilateral epidural catheter placement combined with spinal anesthesia between January 2021 and December 2023. All epidural catheters were advanced toward the operative side and used for continuous infusion for 3 days. Catheter tip position was evaluated by X-ray on postoperative day (POD) 1. Pain scores on the Numerical Rating Scale (NRS), analgesic requirements, distribution of sensory blockade, motor function, and complications through POD4 were evaluated.

Results: Of 307 patients undergoing ACLR, 297 patients were included in the analysis. Catheters were inserted between the T11/12 and L1/2 intervertebral spaces. X-rays revealed that the epidural catheter tip was located on the operated side in 274 patients (92.3%). An ipsilateral-dominant sensory block covering lumbar segments was observed in more than 90% of patients throughout 3 PODs. Median NRS scores during mobilization remained below 3 with epidural infusion, and 263 patients (88.6%) could perform active straight leg raise on the operative side on POD1.

Conclusion: Intentional ipsilateral epidural catheter placement demonstrated a high success rate, provided motor-sparing and satisfactory analgesia in patients undergoing ACLR.