Journal of Anesthesia最新文献

We previously reported that administering local anesthetic into the space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess (SEDIC) at the 10th intercostal space via the re-modified thoracoabdominal nerves block through the perichondrial approach (RM-TAPA) effectively anesthetizes the lower abdomen (T9-T12). However, the analgesic area obtained by RM-TAPA was distinct from prior reports of M-TAPA, which achieved broader analgesic effects from T4 to L1. The aim of this study was to verify the range of analgesic effects when local anesthetics are administered into the SEDIC at the 9th intercostal space, which was estimated to be close to the needle tip of the M-TAPA, in ten healthy volunteers. Each volunteer received 20 mL of 0.2% ropivacaine into the SEDIC at the 9th intercostal space, and sensory blockade was assessed 1 h post-injection using a pinprick test. RM-TAPA performed at the 9th intercostal space provided adequate analgesia from T6 to T10. The analgesic effect on the lateral cutaneous branches was more pronounced on the right side than on the left. These findings imply that optimizing needle position and injection site in RM-TAPA, tailored to specific surgical needs, represents a refinement in perioperative pain management strategies.

Purpose: Intraoperative monitoring can be used to prevent postoperative urinary dysfunction due to surgical manipulation. However, preoperative neurological dysfunction and young age make monitoring challenging. Therefore, in this study, we evaluated the efficacy of combining two monitoring methods, the bulbocavernosus reflex (BCR) and motor-evoked potential from the external anal sphincter (EAS-MEP) in assessing urinary function in the same pediatric patients during untethering surgery.

Methods: We retrospectively identified pediatric patients (aged < 6 years) who underwent BCR and EAS-MEP monitoring during untethering surgery between October 2013 and March 2022. Anesthesia was maintained using propofol or sevoflurane/opioid without neuromuscular blockade.

Results: We identified 18 pediatric patients who underwent BCR and EAS-MEP monitoring during untethering surgery. Our results showed that the baseline success rates were 78%, 61%, and 89% for BCR, EAS-MEP, and the concomitant use of BCR and EAS-MEP, respectively. Furthermore, of the 18 pediatric patients, the two patients with new urinary dysfunction required postoperative urinary catheterization, and the three patients with worsened preoperative urinary dysfunction showed an increased frequency of catheterization. The accuracy of the BCR and EAS-MEP monitoring for the same patients was 93% and 91%, respectively.

Conclusion: The accuracy of BCR and EAS-MEP monitoring is similar in pediatric untethering surgery, and the concomitant use of BCR and EAS-MEP improves continuous intraoperative monitoring compared with using only one method.

Access to epidural analgesia remains limited, particularly for high-risk underserved US women. Our scoping review aims to identify barriers experienced by US underserved and rural pregnant women in gaining access to epidurals and to review the scope of current interventions that exist to address these concerns. The Arksey and O'Malley York methodology was used as guidance for this review and consists of five steps: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. The Joanna Briggs Institute (JBI) recommendations were also used for the extraction, analysis, and presentation of results in this scoping review. 10 studies were retained for analysis. Of the various SDOH identified, those related to social and community context had the highest rates, and among the SDOH, race was the most prevalent. Barriers encountered by US underserved and rural maternal populations in accessing epidural analgesia fell at the individual level (n = 27), followed by organizational (n = 25), interpersonal (n = 18), social/political (n = 17), and community levels (n = 10). Major themes in future directions were identified through qualitative thematic analysis to address gaps in access and utilization of epidural analgesia in underserved US women. SDOH and systemic barriers play a role in hindering access to and utilization of epidural analgesia. Efforts to improve access to epidural analgesia through multifaceted, culturally responsive, and systemic interventions are required to address informational gaps and structural challenges.

Purpose: Helicopter Emergency Medical Services (HEMS) provide rapid prehospital care for patients with severe trauma and acute medical conditions. Airway management (including tracheal intubation, placement of supraglottic airway [SGA] device, cricothyrotomy, and bag-valve-mask [BVM] ventilation) and respiratory management (including mechanical ventilation and thoracostomy) are critical strategies used in prehospital settings. Although data on airway or respiratory management in patients who were treated by HEMS teams that are staffed by physicians in Japan are limited, this study aimed to describe the proportion and clinical characteristics of such patients using a nationwide registry.

Methods: We conducted a nationwide cohort study with a retrospective design, analyzing data from the Japanese Society for Aeromedical Services Registry between April 2020 and March 2023. Patients who underwent prehospital airway or respiratory management were included in this study. Data regarding age, sex, diagnosis, cardiac arrest, type of telecommunication, and airway or respiratory management were also collected. Descriptive statistics were used for analyses.

Results: Among 54,140 patients treated by HEMS, 7477 (13.8%) underwent airway or respiratory management. The median age of the patients was 69 years, and 67.8% were male. The most frequent age group was 60-79 years (42.7%), and trauma was the most common diagnosis (35.4%). The most common management was orotracheal intubation (8.7%), followed by BVM ventilation (2.3%), mechanical ventilation (1.9%), thoracostomy (performed either via needle or chest tube) (1.0%), and SGA device placement (0.2%).

Conclusion: This nationwide study revealed that airway or respiratory management was required in 13.8% of HEMS patients in Japan, particularly among older adults and those with trauma.

Purpose: This study aimed to elucidate how the admission of patients with coronavirus disease-2019 (COVID-19) to the intensive care unit (ICU) impacts the mortality rate and management of patients without COVID-19 in the ICU, focusing on the condition of patients during and after ICU admission, which has not been sufficiently evaluated.

Methods: This multicenter retrospective cohort study was conducted across 33 ICU facilities in Japan, using data from the Japanese Intensive Care Patient Database for fiscal years 2018-2020. Patients without COVID-19 were admitted to ICUs that also treated patients with COVID-19 during the study period. Of the 68,620 patients without COVID-19, 11,503 were admitted during the COVID-19 period. The primary outcome was in-hospital mortality. The secondary outcomes included ICU mortality, off-hour ICU discharge, ICU discharge with mechanical ventilation, and incidence of tracheotomy.

Results: Adjusted analyses revealed no significant difference in in-hospital mortality (adjusted odds ratio [aOR] = 0.90; p = 0.071) but lower ICU mortality (aOR = 0.75; p = 0.001) during the COVID-19 period. The COVID-19 period was associated with increased off-hour ICU discharges (aOR = 1.37; p < 0.001), higher tracheotomy rates (aOR = 1.45; p = 0.018), and increased ICU discharges requiring mechanical ventilation (aOR = 1.21; p = 0.006). Moreover, ICU bed occupancy rates were lower in patients without COVID-19.

Conclusion: In-hospital mortality in patients without COVID-19 during the COVID-19 period was not significantly different from that during the non-COVID-19 period. While ICU mortality decreased, the tracheostomy rate, rate of patients requiring ventilators at the time of ICU discharge, and rate of transfer to other facilities increased.