Journal of Anesthesia最新文献

Purpose: The purpose of this study was to compare the postoperative analgesic outcomes of ultrasound-guided single-shot, ultrasound-guided continuous, or surgeon-performed direct-vision single-shot approaches to paravertebral block (PVB).

Methods: We retrospectively analyzed the data of the adults who underwent video-assisted thoracoscopic surgery (VATS) for lung resection at a university hospital. They were categorized into those who underwent ultrasound-guided single-shot PVB (PVB-US), ultrasound-guided continuous PVB with catheter infusion (PVB-US-Cath), and surgeon-performed intraoperative single-shot PVB under thoracoscopic visualization (PVB-VATS). The primary outcome was the number of rescue analgesic administrations within 24 h of admission to the post-anesthesia care unit (PACU). The secondary outcomes were rescue analgesic use within 24-48 h and pain scores at PACU admission and on the mornings of postoperative days (PODs) 1 and 2.

Results: Of the 489 eligible patients, the data of 385 were included in the final analysis (PVB-US, n = 53; PVB-US-Cath, n = 249; PVB-VATS, n = 83). The median (IQR) numbers of rescue analgesic doses within 24 h for the PVB-US, PVB-US-Cath, and PVB-VATS groups were 1 (1-3), 2 (1-3), and 2 (0-3), respectively (p = 0.6880). Rescue analgesic use during 24-48 h and NRS pain scores at the PACU and on PODs 1 and 2 did not significantly differ between the groups.

Conclusion: This study found no statistically significant differences in the postoperative analgesic outcomes of the ultrasound-guided single-shot, ultrasound-guided continuous, and surgeon-performed direct-vision single-shot PVB techniques for VATS. Given the predominantly mild and short-lived nature of pain after VATS, a technically simple single-shot strategy may offer an optimal balance between efficacy, feasibility, and procedural efficiency.

Purpose: Hypertensive surgical patients face heightened perioperative cardiovascular risk, and propofol often induces hypotension. This trial aimed to compare remimazolam and propofol for hemodynamic stability in hypertensive patients undergoing non-cardiac surgery, and explore underlying cardiac and vascular mechanisms via continuous monitoring.

Methods: This randomized single-blind trial enrolled 122 adults with controlled hypertension undergoing elective non-cardiac surgery, assigned to remimazolam-based or propofol-based total intravenous anesthesia. Primary outcomes were intraoperative hypotension episodes (mean arterial pressure < 65 mmHg or a > 20% decrease from baseline), norepinephrine bolus frequency and total dose. Hemodynamics were continuously tracked by Continuous Non-Invasive Arterial Pressure Monitor 500, with anesthesia depth maintained at a bispectral index of 40-60.

Results: Baseline characteristics were comparable. The remimazolam group had fewer hypotension episodes (remimazolam group vs. propofol group, median episodes [interquartile range, IQR], 2 [0-3] vs. 3 [1-5]; p = 0.003), fewer norepinephrine boluses (1 [0-3] vs. 3 [1-5]; p = 0.001), and lower total dose (8 µg [0-24] vs. 24 µg [8-40]; p < 0.001). Remimazolam showed non-significant trends toward smaller reductions in cardiac output (CO, - 8.10% vs. - 13.10%, p = 0.35) and systemic vascular resistance (SVR, - 10.83% vs. - 14.91%, p = 0.46). Extubation time and post-anesthesia care unit stay were similar.

Conclusion: For hypertensive patients, remimazolam provides superior hemodynamic stability over propofol, evidenced by fewer hypotensive episodes, reduced norepinephrine requirements, and attenuated perturbations in CO and SVR, without delaying recovery. It represents a valuable anesthetic alternative for this high-risk cohort.

Background: Chronic post-surgical pain (CPSP) is a prevalent complication following video-assisted thoracic surgery (VATS), significantly affecting long-term patient outcomes. This study aimed to evaluate the influence of uniport versus multiport VATS on the incidence of CPSP and postoperative recovery at six months.

Methods: Patients were stratified into uniport and multiport VATS groups, with propensity score matching (PSM). The primary endpoint was the incidence of CPSP at six months. The secondary endpoints comprise the short-term recovery outcomes within 30 days postoperatively, the quality of life at six months and group-based trajectory modeling to characterize pain trajectories over six months.

Results: After PSM, 222 patients (111 per group) were included in the final analysis. A significant difference in postoperative pain intensity {3(1.8-4) vs 4(3-5), P = 0.007} was observed on postoperative day 3 (POD3). However, no significant difference in CPSP incidence at six months was detected between the uniport and multiport VATS groups. Multivariate logistic regression analysis of the entire cohort identified a high pain score on POD3 as an independent risk factor for CPSP development. Pain trajectory analysis revealed three distinct postoperative pain patterns over the six-month period. Patients in the high pain trajectory required more remedial analgesia and were more likely to develop CPSP.

Conclusions: Uniport VATS was not associated with a lower incidence of CPSP compared to multiport VATS at six months postoperatively. A high pain score on POD3 emerged as a significant predictor of CPSP.