Journal of Anesthesia最新文献

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.

Purpose: Desflurane and sevoflurane are widely used for general anesthesia; however, it remains uncertain if sevoflurane might be preferable for patients with chronic respiratory inflammatory diseases. This study compared postoperative outcomes of desflurane and sevoflurane following gastrointestinal cancer surgery in patients with chronic obstructive pulmonary disease (COPD) or asthma.

Methods: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database (April 2011-March 2022), identifying patients with COPD or asthma who underwent gastrointestinal cancer surgery. The primary outcome was postoperative pulmonary complications, including pneumonia, respiratory failure, mechanical ventilation > 24 h, and unplanned reintubation within 7 days after surgery. Secondary outcomes were in-hospital mortality and postoperative stay. We conducted propensity score overlap weighting and instrumental variable analyses adjusted for confounders.

Results: We identified 24,243 COPD and 16,199 asthma patients. Propensity score overlap weighting showed no significant association between desflurane and increased postoperative pulmonary complications in COPD [adjusted risk difference (aRD) - 0.57%; 99% confidence interval (CI), - 1.8% to 0.60%] or asthma (aRD, - 0.62%; 99% CI, - 1.8% to 0.59%). In-hospital mortality did not differ significantly between groups in COPD (aRD, - 0.24%; 99% CI, - 0.76% to 0.29%) or asthma (aRD, 0.07%; 99% CI, - 0.45% to 0.59%). The postoperative stay also showed no significant association between the desflurane and sevoflurane groups.

Conclusions: Desflurane-based anesthesia was not associated with increased postoperative pulmonary complications and mortality compared to sevoflurane in patients with chronic respiratory diseases undergoing gastrointestinal cancer surgery. However, further studies using reliable diagnostic criteria to assess COPD or asthma are warranted.

Purpose: The purpose of this study was to investigate the association between body mass index (BMI) and changes in pain scores among elderly patients with chronic pain. The pain disability assessment scale (PDAS) and the pain catastrophizing scale (PCS) were employed as assessment tools.

Methods: A single-center, retrospective cohort study was conducted at a university hospital multidisciplinary pain center from 2017 to 2020, involving 180 patients aged ≥ 65 years with noncancer pain persisting for at least 3 months. Patients were classified into three groups according to BMI: low (BMI < 18.5), standard (18.5 ≤ BMI < 25), and high (BMI ≥ 25). Initial, 3-month, and 6-month PDAS and PCS scores were collected and analyzed using mixed-effects models.

Results: No significant differences were observed in PDAS scores across BMI groups. However, PCS scores were significantly higher in the low BMI group. Furthermore, no significant differences were detected in PDAS and PCS scores based on the interaction between BMI group and time point (month).

Conclusion: Among elderly patients with chronic pain, the low BMI group exhibited a significantly higher PCS score, while PDAS scores did not vary based on the BMI group. No differences were detected in treatment-related changes over time across BMI groups.