Journal of Anesthesia最新文献

Background: Evidence regarding CO₂ absorbent performance in real clinical settings is limited. This study compared the CO₂ absorption capacity of four pre-filled CO₂ absorbent brands using two different anesthesia machines in clinical practice.

Methods: This single-center retrospective study included 3,401 surgical cases who received general anesthesia from November 2022 to January 2024. Four CO₂ absorbents-AMSORB^® Plus, SpiraLith^®, CLIC Drägersorb^® Absorber 800 + , and Drägersorb^® Free-were used in GE Avance and Dräger Primus anesthesia machines. The primary outcome was CO₂ absorption capacity, calculated based on the estimated CO₂ consumption for each patient per canister. Secondary outcomes included total number of surgical cases, cumulative anesthesia time and capacity until inspired CO₂ partial pressure (PiCO₂) reached 5 mmHg, as well as transition time from 3 to 5 mmHg.

Results: SpiraLith^® showed a higher CO₂ absorption capacity compared to AMSORB® Plus in GE Avance anesthesia machine (280.8 ± 116.9 L vs. 435.3 ± 101.6 L; mean difference 154.6 L; 95% CI, 72.5 to 236.6; p = 0.006). In Dräger Primus machines, CLIC Drägersorb^® Absorber 800 + demonstrated the highest CO₂ absorption capacity, outperforming both Drägersorb^® Free and SpiraLith^®, with considerable variability (582.5 ± 249.7 vs. 434.1 ± 138.4 vs.379.8 ± 70.4; p = 0.001). However, SpiraLith^® showed a significantly extended usage time and capacity until PiCO₂ increased from 3 to 5 mmHg when compared to the other two products.

Conclusions: In vivo performance of prefilled CO₂ absorbents may differ from previously reported in vitro results and can vary according to particle composition and device-specific conditions.

Purpose: Despite advancements in surgical patient care, postoperative pulmonary complications (PPCs) following emergency abdominal surgery remain common and are linked to increased morbidity, mortality, and healthcare costs. This study aims to identify the incidence and risk factors of PPCs following major emergency abdominal surgery.

Methods: This is a single-center observational study including patients undergoing major emergency abdominal surgery between January 1, 2021, and December 31, 2023, collecting pre-, intra-, and postoperative variables. The primary outcome was the occurrence of PPCs, and the secondary outcomes were risk factors for PPCs and 30-day mortality rates following PPCs. Multivariable logistic regression was used to identify perioperative risk factors associated with PPCs. The same analysis was used on a subgroup of patients with 'severe' PPCs.

Results: Of 1080 patients included in the study, 431 (39.9%) had at least one PPC, and 150 (13.9%) had at least one 'severe' PPC. Multivariable logistic regression identified several risk factors for developing PPCs: an increased ARISCAT score, a history of pulmonary disease, hypertension, a history of cerebral disease, increased Clinical Frailty Scale, preoperative admission to the intensive care unit, a CDC grade IV contaminated wound, intraoperative findings of perforated stomach or duodenal ulcer, need for subsequent reoperations, and protracted postoperative ileus. Patients with PPCs had a 30-day mortality rate of 21.0%, while those with 'severe' PPCs had a 30-day mortality rate of 46.3%.

Conclusion: Several independent risk factors, beyond those already established, were associated with an increased risk of PPCs.

Insertion of a gastric tube in anesthetized patients is frequently difficult. The "consecutive insertion method", in which a videolaryngoscope is inserted, a tube is inserted to the trachea and a gastric tube insertion guide (with a gastric tube in it) to the esophagus before removing the videolaryngoscope, may reduce complications associated with insertion of a gastric tube. Sixty patients were randomly allocated to the consecutive insertion method (in group C) and blind method (in group B), to compare the incidence of complications, the success rate, and insertion time. The incidence of complications was significantly lower in group C than in group B (2 vs. 12 patients) (P = 0.002). There was no significant difference in the success rate of insertion of a gastric tube between groups B and C (25 vs. 30 patients) (P = 0.052). The median apnea time was significantly longer in group C (46 vs. 35 s) (P = 0.00052), whereas the median total insertion time was significantly shorter in group C (117 vs. 138 s) (P = 0.015). Compared with blind insertion of a gastric tube, consecutive insertion of a tracheal tube and a gastric tube (through an insertion guide) would reduce the incidence of complications.