Journal of Anesthesia最新文献

Background: One-lung ventilation (OLV) is an essential technique in thoracic surgery, and double-lumen endobronchial tubes (DLTs) are commonly used. While right-sided DLTs are useful in specific situations, few studies have investigated the prevalence of their use. This study aimed to investigate the current practice of OLV and right-sided DLT usage among anesthesiologists in Japan.

Methods: A nationwide cross-sectional survey was conducted in September 2024, targeting 1444 hospitals certified by the Japanese Society of Anesthesiologists. Questionnaires were mailed to anesthesiology departments, inquiring about OLV practices, right-sided DLT usage, challenges, and desired improvements. Responses were collected via postal mail or web, and data were analyzed using descriptive statistics and Chi-square tests.

Results: A total of 768 institutions responded (response rate: 53.2%). Among 761 valid responses, 74.9% performed OLV, and DLTs were the most frequently used device (94.7%). Approximately half (45.8%) of the institutions performing OLV reported never using right-sided DLTs. Frequently recognized challenges included insertion difficulty, positioning difficulty, and unfamiliarity, and 42.1% of institutions expressed a willingness to increase the use of right-sided DLTs if these challenges were resolved. Institutions with a higher annual volume of OLV cases tended to use right-sided DLTs more frequently, but the proportion of institutions unfamiliar with right-sided DLTs was not associated with the number of OLV cases performed.

Conclusion: OLV is widely practiced in Japan, primarily using DLTs, while the use of right-sided DLTs is limited. Concerns over technical difficulties and complications may hinder the use of right-sided DLTs.

The global healthcare sector accounts for approximately 4.4% of the total greenhouse gas emissions, with anesthesiology contributing disproportionately through volatile anesthetic agents whose global warming potentials range from 130 (sevoflurane) to 2540 (desflurane). This narrative review examines the environmental implications of contemporary anesthetic practice and evaluates evidence-based strategies for sustainable anesthesia delivery. Desflurane has a global warming potential approximately 20-fold greater than sevoflurane, making it the most environmentally damaging volatile anesthetic in clinical use. Total intravenous anesthesia (TIVA) produces substantially lower emissions at approximately 0.4 kg CO₂-equivalent/h, compared with 3.1-3.8 kg CO₂-equivalent/h for volatile-based techniques. Low-flow anesthesia techniques may reduce volatile agent consumption by 50-75% without compromising patient safety. Current evidence suggests that sustainable anesthesia practices can substantially reduce environmental impact while maintaining optimal patient safety. Strategies such as eliminating desflurane use, implementing low-flow techniques, and increasing TIVA utilization represent immediately implementable interventions with established safety profiles and demonstrated economic benefits. Implementation in diverse healthcare settings, including Asian contexts, requires tailored approaches considering regional practice patterns and resource availability.

Background: Surgical smoke produced by the use of an electrosurgical unit may have a negative effect to patients and healthcare workers in the operating room, but studies on this problem are insufficient.

Methods: In 100 situations in which patients were undergoing four types of surgery under general anesthesia, the count of airborne particles (in 1.415 L) was measured using a particle counter to see possible differences at the patients and at the anesthesiologists, during different types of surgery, and at several locations.

Results: The airborne particles during the use of an electrosurgical unit were significantly higher than before its use, both at the patient's head (median: 56/L vs 3,514/L; 95%CI for the median difference: 769-7,699/L) and at the anesthesiologist's position (230/L vs 6,907/L; 95%CI for the median difference: 2,945-13,196/L) (p < 0.0001). The airborne particles were significantly higher during cardiovascular surgery than during open abdominal surgery (median difference in increase: 8,439/L), significantly higher during open abdominal surgery than during head and neck surgery (2,654/L), and significantly higher during head and neck surgery than during laparoscopic surgery (1,442/L) (all p < 0.0001), and were high anywhere in the operating room and even outside the operating room door (always > 2,000/L).

Conclusions: During the use of an electrosurgical unit, both the patients and healthcare workers are at increased risk of being exposed to high concentrations of airborne particles derived from surgical smoke.

Purpose: Predicting postpartum hemorrhage risk can be useful in clinical settings. We aimed to develop and validate a clinical prediction model for postpartum hemorrhage in patients who undergo elective cesarean section.

Methods: This retrospective observational study included patients who underwent elective cesarean section between January 2008 and September 2021. The primary outcome to be predicted was postpartum hemorrhage, defined as blood loss of ≥ 1500 mL during surgery. We used data prior to January 2018 for the development cohort and after for the validation cohort. We then constructed a multivariate logistic regression model. The model performance, including discrimination and calibration, was evaluated and its diagnostic ability was assessed.

Results: Of the 4070 patients, 860 (21.0%) had postpartum hemorrhage. The predictors were twin pregnancy, benign uterine disease, assisted reproduction, gestational diabetes mellitus, placenta previa, nulliparity, and neonatal weight > 3000 g. In the validation cohort, the prediction model C-statistic was 0.780 (95% confidence interval [CI] 0.745-0.816). We developed a simple scoring system to divide the patients into three risk groups (low, moderate, and high). If the cut-off risk score was set to moderate, the negative likelihood ratio was low (0.221, 95% CI 0.108-0.374); conversely, if the cut-off risk score was set to high, the positive likelihood ratio was high (5.882, 95% CI 3.750-9.333).

Conclusion: The model we developed can stratify the risk of postpartum hemorrhage and assist in clinical decision-making. Future studies are required to validate the performance of our model.

Purpose: Weaning from invasive mechanical ventilation (IMV) is challenging and has multiple causes. The diaphragm is the main respiratory muscle for inspiration. This prospective study aimed to determine the value of standardized diaphragm ultrasound (DUS) measurements [diaphragm excursion (DE), diaphragm thickness fraction (DTF), diaphragmatic rapid shallow breathing index (D-RSBI), rapid shallow diaphragmatic index (RSDI)] in predicting extubation success in intensive care patients, both individually and in combination with conventional indices [rapid shallow breathing index (RSBI), dynamic compliance (Cdyn), airway occlusion pressure, semi-quantitative cough strength score]. To isolate diaphragm contribution, only neurologically intact patients (Glasgow Coma Scale > 14) with adequate airway protection reflexes were included. The second aim was to examine the relationship between IMV and DUS measurements.

Methods: 151 patients on IMV for > 24 h and eligible for spontaneous breathing trial (SBT) were evaluated. Following exclusion criteria, patients underwent SBT in pressure support ventilation mode (positive end-expiratory pressure 5 cmH₂O, pressure support 8 cmH₂O). During SBT, mechanical ventilation parameters and diaphragm ultrasound measurements were recorded. Extubation failure was defined as need for reintubation or non-invasive ventilation.

Results: DE and DTF were significantly higher, D-RSBI was lower in patients with successful extubation. There was no difference in RSDI. Multivariate logistic regression was statistically significant, odds ratios (10.018, 1.109, 1.094) were found for DE, DTF, Cdyn, respectively. The only significant correlation between IMV and DUS was DTF-tidal volume (r = - 0.500).

Conclusion: A standardized multiparametric model, combining DUS with conventional indices, provides moderate predictive accuracy for extubation success. Integrating DUS into weaning protocols can improve extubation readiness.