Journal of Anesthesia最新文献

Purpose

A normal pressure extubation technique (no lung inflation before extubation), proposed by the Japanese Society of Anesthesiologists to prevent droplet infection during the coronavirus disease 2019 (COVID-19) pandemic, could theoretically increase postoperative pneumonia incidence compared with a positive pressure extubation technique (lung inflation before extubation). However, the normal pressure extubation technique has not been adequately evaluated. This study compared postoperative pneumonia incidence between positive and normal pressure extubation techniques using a dataset from the University of Tsukuba Hospital.

Methods

In our hospital, the extubation methods changed from positive to normal pressure extubation techniques on March 3, 2020 due to the COVID-19 pandemic. Thus, we compared the risk of postoperative pneumonia between the positive (April 1, 2017 to December 31, 2019) and normal pressure extubation techniques (March 3, 2020 to March 31, 2022) using propensity score analyses. Postoperative pneumonia was defined using the International Classification of Diseases, 10th Edition (ICD-10) codes (J13–J18), and we reviewed the medical records of patients flagged with these ICD-10 codes (preoperative pneumonia and ICD-10 codes for prophylactic antibiotic prescriptions for pneumonia).

Results

We identified 20,011 surgeries, including 11,920 in the positive pressure extubation group (mean age 48.2 years, standard deviation [SD] 25.2 years) and 8,091 in the normal pressure extubation group (mean age 47.8 years, SD 25.8 years). The postoperative pneumonia incidences were 0.19% (23/11,920) and 0.17% (14/8,091) in the positive and normal pressure extubation groups, respectively. The propensity score analysis using inverse probability weighting revealed no significant difference in postoperative pneumonia incidence between the two groups (adjusted odds ratio 0.98, 95% confidence interval 0.50 to 1.91, P = 0.94).

Conclusions

These results indicated no increased risk of postoperative pneumonia associated with the normal pressure extubation technique compared with the positive pressure extubation technique.

Clinical trial number

Clinical trial number: UMIN000048589 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055364

Purpose

Careful perioperative temperature management is important because it influences clinical outcomes. In pediatric patients, the esophageal temperature is the most accurate indicator of core temperature. However, it requires probe insertion into the body cavity, which is mildly invasive. Therefore, a non-invasive easily and continuously temperature monitor system is ideal. This study aimed to assess the accuracy of Temple Touch Pro™ (TTP), a non-invasive temperature monitoring using the heat flux technique, compared with esophageal (Tesoph) and rectal (Trect) temperature measurements in pediatric patients, especially in infants and toddlers.

Methods

This single-center prospective observational study included 40 pediatric patients (< 3 years old) who underwent elective non-cardiac surgery. The accuracy of TTP was analyzed using Bland–Altman analysis and compared with Tesoph or Trect temperature measurements. The error was within ± 0.5 °C and was considered clinically acceptable.

Results

The bias ± precision between TTP and Tesoph was 0.09 ± 0.28 °C, and 95% limits of agreement were – 0.48 to 0.65 °C (error within ± 0.5 °C: 94.0%). The bias ± precision between TTP and Trect was 0.41 ± 0.38 °C and 95% limits of agreement were – 0.35 to 1.17 °C (error within ± 0.5 °C: 68.5%). In infants, bias ± precision with 95% limits of agreement were 0.10 ± 0.30 °C with – 0.50 to 0.69 °C (TTP vs. Tesoph) and 0.35 ± 0.29 °C with – 0.23 to 0.92 °C (TTP vs. Trect).

Conclusion

Core temperature measurements using TTP in infants and toddlers were more accurate with Tesoph than with Trect. In the future, non-invasive TTP temperature monitoring will help perioperative temperature management in pediatric patients.

Purpose: This study aimed to determine whether the combination of H₂ gas inhalation and administration of hydrogen-rich acetated Ringer's solution (HS) could protect against ischemic spinal cord injury in rabbits.

Methods: In Experiment 1, rabbits were randomly assigned to a 1.2% H₂ gas group, HS group, 1.2% H₂ gas + HS group (combination group), or control group (n = 6 per group). The H₂ concentration of HS was 0.65 mM. H₂ was inhaled for 60 min, starting 5 min before reperfusion. HS (20 mL/kg) was divided into six bolus injections at 10-min intervals, starting 5 min before reperfusion. Spinal cord ischemia was produced by occluding the abdominal aorta for 15 min. Neurologic and histopathologic evaluations were performed 7 days after reperfusion. In Experiment 2, H₂ concentrations in spinal cord tissue according to the administration of 1.2% H₂ gas or HS were compared by measuring the electric current through a platinum needle electrode (n = 2). In Experiment 3, rabbits were assigned to a 2% H₂ gas group or control group (n = 6 per group). Spinal cord ischemia was produced and neurologic and histopathologic evaluations were performed as in Experiment 1.

Results: There were no significant differences among the groups in the neurologic and histopathologic outcomes in Experiments 1 and 3. Bolus administration of HS (10 mL) transiently increased the current to only 1/30th and 1/27th of the plateau current with 1.2% H₂ gas inhalation in two animals.

Conclusion: These results suggest that the combination of 1.2% H₂ gas inhalation and administration of a hydrogen-rich solution does not protect against ischemic spinal cord injury and that the increase in H₂ concentration in spinal cord tissue after administration of HS is very low compared to 1.2% H₂ gas inhalation.