Journal of Anesthesia最新文献

Background: We compared the effect of three levels of end-expiratory pressure on the incidence of gastric insufflation during face-mask ventilation in patients with obesity.

Methods: This randomized controlled trial included adult obese patients undergoing elective non-cardiac surgery under general anesthesia with neuromuscular blockade. Patients were randomized to receive either zero-end-expiratory pressure (ZEEP group), 4-cmH₂O positive end-expiratory pressure (PEEP) (low-PEEP group), or 8-cmH₂O PEEP (high-PEEP group) during volume-controlled mask ventilation. Gastric antral cross-sectional area (CSA) was assessed using ultrasonography before induction of anesthesia and after intubation. The percentage of change (delta) in the CSA was calculated and gastric insufflation was considered significant when the delta CSA was > 30%. The primary outcome was the incidence of gastric insufflation. Secondary outcomes were antral CSA before induction of anesthesia and after intubation in addition to ventilatory variables (end-tidal CO₂, peak airway pressure, and tidal volume) during face-mask ventilation.

Results: We analyzed data from 160 patients. The antral CSA increased after intubation in all groups. The incidence of gastric insufflation was higher in the high-PEEP group (32/54[59%]) than that in the ZEEP group (6/52[12%]) and low-PEEP group (15/54[28%]). Delta CSA, antral CSA after intubation, and incidence of gastric insufflation were not significantly different between the ZEEP and low-PEEP groups. Ventilatory variables were comparable between the groups.

Conclusion: In obese paralyzed patients, gastric insufflation can occur during face-mask ventilation whatever the level of end-expiratory pressure; however, the use of ZEEP or 4-cmH₂O PEEP was associated with lower incidence of gastric insufflation compared to 8-cmH₂O PEEP.

Clinical trial registration: Clinical trial registration at clinicaltrials.gov NCT05979129. https://classic.

Clinicaltrials: gov/ct2/show/NCT05979129.

Purpose: Nitrous oxide (N₂O) reportedly lessens postoperative pain and neuropathic pain by counteracting N-methyl-D-aspartate (NMDA) receptors. Surgeries such as postoperative lumbar posterior intervertebral fusion (PLIF) can induce severe pain, including neuropathic pain-like symptoms. Here, we investigated the impact of intraoperatively administered N₂O on postoperative pain and other symptoms following PLIF.

Methods: During PLIF surgery, the patients received either N2O 60% or air, with the inhaled oxygen concentration set at 0.4. For postoperative pain management, patients were administered fentanyl (4 µg/kg), acetaminophen, and flurbiprofen during surgery. Additionally, an intravenous patient-controlled analgesia device delivering fentanyl was connected. Postsurgical pain and other symptoms were evaluated based on the numerical rating scale (NRS), amount of fentanyl used, rate of adjuvant analgesic use, and numbness.

Results: Eighty patients were randomly assigned to either the control (air) group (n = 34) or the N₂O group (n = 39). No differences in patient background, postoperative low back pain NRS (air: 3.5 (2-6.25) vs N₂O: 4 (2-6) at 24 h, median (interquartile range), P = 0.655), or pain and numbness in the lower limbs were detected between groups. No differences in fentanyl use at 48 h (air: 330 (165-525) µg, N₂O: 225 (120-390) µg; P = 0.15). At 1 month after surgery, the two groups exhibited similar low back pain, lower limb pain, and numbness symptoms.

Conclusions: Intraoperative administration of N₂O did not improve acute or subacute postoperative nociceptive or neuropathic pain after PLIF and did not decrease the use of postoperative analgesics.

Purpose: To appraise the therapeutic impact of high-voltage pulsed radiofrequency (HVPRF) on the management of refractory unilateral cervical radicular pain.

Methods: The study was conducted on 100 patients who had refractory chronic unilateral cervical radicular pain. Patients were divided into two equal groups (50 patients each): group (S): standard-voltage pulsed radiofrequency (SVPRF); and group (H): HVPRF. All patients received ultrasound-guided PRF on the affected cervical nerve root, either SVPRF in group (S) or HVPRF in group (H). The primary outcome was to assess the number of patients who experienced successful pain relief at 6 months' post-intervention, which is defined as ≥ 50% reduction of visual analog scale (VAS) from pre-intervention level. Secondary outcome was to assess the impact of treatment on neck disability index (NDI) which was evaluated before treatment, 1, 3, and 6 months after the procedure.

Results: VAS and NDI values were significantly reduced in group (H) in comparison to group (S) at all follow-ups. After 6 months, all patients in group (H) showed a clinically meaningful response with ≥ 50% decrease in VAS score. Conversely, no participants in group (S) attained a comparable decrease in their VAS scores.

Conclusion: HVPRF could significantly reduce pain and functional disabilities compared to SVPRF up to 6 months after intervention in patients suffering from unilateral resistant cervical radiculopathy. IRB number: Fayoum Faculty of Medicine Research Ethical Committee, approval no. R 427. Research registration number: Registry for Clinical Trials (NCT05749185).

Purpose: Minimally invasive cardiac surgery (MICS) involves fewer complications than median sternotomy. However, difficulties in post-MICS analgesia can undermine these advantages. The serratus anterior plane block (SAPB), an effective analgesic for thoracic surgery, could benefit post-MICS analgesia using programmed intermittent bolus infusion (PIBI). We investigated whether PIBI with SAPB can reduce post-MICS fentanyl administration and evaluated its safety profile.

Methods: This randomized, double-blind, controlled trial included 20 patients (age 20-80 years; Eastern Cooperative Oncology Group Performance Status 0-II; scheduled for elective MICS) randomly allocated to two groups (SAPB or control). All patients underwent preoperative SAPB with catheterization, followed by either 20 mL 0.25% ropivacaine or saline bolus every 6 h postoperatively. All patients received intravenous fentanyl via patient-controlled analgesia. Blood samples were collected 10, 20, 30, and 60 min after preoperative ropivacaine infusion; during and after cardiopulmonary bypass; and on postoperative days 1-5. The primary outcome was cumulative fentanyl consumption up to postoperative day 5. Secondary outcomes included numerical rating scale scores, rehabilitation preoperatively and postoperatively, postoperative nausea and vomiting, ropivacaine toxicity, and PIBI with SAPB complications.

Results: After excluding three patients, data from 17 patients were analyzed. No significant difference in cumulative fentanyl consumption on postoperative day 5 was observed (SAPB: median [interquartile range], 512 µg [457-753] vs. control: 654 µg [439-982], P = 0.96). Serum ropivacaine concentration remained below the toxicity threshold.

Conclusion: PIBI with SAPB did not reduce post-MICS fentanyl consumption, and serum ropivacaine concentration did not reach the toxicity threshold.