Journal of Clinical Anesthesia最新文献

英文中文

Benefit of intraoperative intravenous lidocaine on cognitive function following noncardiac surgery: An updated meta-analysis. 术中静脉注射利多卡因对非心脏手术后认知功能的益处：最新荟萃分析。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-03 DOI: 10.1016/j.jclinane.2024.111647

Ying-Jen Chang, Li-Chen Chang, Kuo-Mao Lan

引用次数: 0

Esketamine in postoperative recovery: Reliable for negative emotional relief, ambiguous for cognitive function. Esketamine 在术后恢复中的作用：对负面情绪缓解的作用可靠，对认知功能的作用不明确。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-02 DOI: 10.1016/j.jclinane.2024.111641

Mingzhen Wang, Jiahao Liu, Rui Dong

引用次数: 0

Response to comment on: “Effect of remimazolam versus propofol on hypotension after anesthetic induction in patients undergoing coronary artery bypass grafting: A randomized controlled trial” 对以下评论的回应"雷马唑仑与异丙酚对冠状动脉旁路移植术患者麻醉诱导后低血压的影响：随机对照试验"

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-01 DOI: 10.1016/j.jclinane.2024.111643

引用次数: 0

National trends in perioperative epidural analgesia use for surgical patients 全国外科手术患者围手术期硬膜外镇痛的使用趋势

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-01 DOI: 10.1016/j.jclinane.2024.111642

Study objective

Newer regional anesthesia techniques and minimally invasive surgeries have yielded decreased postoperative pain scores, potentially leading to decreased need for perioperative epidural analgesia. Limited literature is available on trends in usage rates of epidurals. The objective of this study was to identify trends in perioperative epidural analgesia rates among multiple fields of surgery.

Methods

All patients undergoing general, thoracic, urologic, plastic, vascular, orthopedic, or gynecological surgery in 2014–2020 were included from the National Surgical Quality Improvement Program database of over 700 hospitals in the U.S. and 11 different countries. Annual trends in epidural analgesia for all surgeries and each surgical specialty were assessed by mixed effects multivariable logistic regression. The odds ratios (OR) and 99 % confidence intervals (CI) were reported.

Results

There were 3,111,435 patients from 2014 to 2020 that were included in the final analysis, in which 107,209 (3.4 %) received perioperative epidural analgesia. Among all surgeries combined, epidural use throughout the study period decreased (OR 0.98 per year, 99 % CI 0.97–0.98, P < 0.001). When only analyzing the surgeries with the top 5 most frequent epidural use per specialty, there was no statistically significant trend in epidural utilization (OR 0.99 per year, 99 % CI 0.99–1.00, P = 0.09). However, there was an increasing trend in epidural utilization in general surgery (OR 1.05 per year, 99 % CI 1.03–1.07, P < 0.001) and vascular surgery (OR 1.08 per year, 99 % CI 1.05–1.10, P < 0.001).

Conclusion

Rates of perioperative epidural analgesia use has decreased in recent years overall, however, among surgeries within the general surgery and vascular surgery specialty, utilization has increased for procedures that have the highest rates of usage.

研究目的更新的区域麻醉技术和微创手术降低了术后疼痛评分，从而有可能减少围术期硬膜外镇痛的需求。有关硬膜外镇痛使用率趋势的文献有限。本研究的目的是确定多个外科领域围术期硬膜外镇痛率的趋势。方法从美国和 11 个不同国家的 700 多家医院的国家外科质量改进计划数据库中纳入 2014-2020 年接受普外科、胸外科、泌尿外科、整形外科、血管外科、骨科或妇科手术的所有患者。通过混合效应多变量逻辑回归评估了所有手术和各外科专科硬膜外镇痛的年度趋势。结果从2014年到2020年，共有3,111,435名患者被纳入最终分析，其中107,209人（3.4%）接受了围手术期硬膜外镇痛。在所有手术中，硬膜外镇痛的使用在整个研究期间都有所减少（OR 每年 0.98，99 % CI 0.97-0.98，P <0.001）。如果只分析每个专科硬膜外麻醉使用最频繁的前五位手术，硬膜外麻醉使用率没有统计学意义上的显著趋势（OR 每年 0.99，99 % CI 0.99-1.00，P = 0.09）。结论近年来，围术期硬膜外镇痛的使用率总体上有所下降，但在普外科和血管外科的手术中，使用率最高的手术的硬膜外镇痛使用率有所上升。

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引用次数: 0

Letter to the editor regarding “Effect of remimazolam versus propofol on hypotension after anesthetic induction in patients undergoing coronary artery bypass grafting: A randomized controlled trial” 致编辑的信，内容涉及 "瑞马唑仑与异丙酚对冠状动脉旁路移植术患者麻醉诱导后低血压的影响：随机对照试验"

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-09-30 DOI: 10.1016/j.jclinane.2024.111644

引用次数: 0

General anesthesia and the subsequent development of attention-deficit/hyperactivity disorder: A subgroup analysis on geographic region 全身麻醉与随后出现的注意力缺陷/多动症：地理区域分组分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-09-28 DOI: 10.1016/j.jclinane.2024.111639

引用次数: 0

Dissecting the efficacy of erector spinae plane block: A cadaveric study analysis of anesthetic spread to ventral rami 剖析竖脊肌平面阻滞的疗效：对麻醉剂扩散至腹侧韧带的尸体研究分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-09-27 DOI: 10.1016/j.jclinane.2024.111638

引用次数: 0

Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome 急性呼吸窘迫综合征患者的乳酸白蛋白比值与短期死亡率之间的关系

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-09-26 DOI: 10.1016/j.jclinane.2024.111632

Study objective

The lactate-to-albumin ratio (LAR) has been confirmed to be an effective prognostic marker in sepsis, heart failure, and acute respiratory failure. However, the relationship between LAR and mortality in patients with acute respiratory distress syndrome (ARDS) remains unclear. We aim to evaluate the predictive value of LAR for ARDS patients.

Design

A retrospective cohort study.

Setting

Medical Information Mart for Intensive Care IV (v2.2) database.

Patients.

769 patients with acute respiratory distress syndrome(ARDS).

Interventions

We divided the patients into two subgroups according to the primary study endpoint (28-days all-cause mortality): the 28-day survivors and the 28-day non-survivors.

Measures

Multivariate Cox Regression, Receiver Operator Characteristic (ROC) and Kaplan–Meier survival analysis were used to investigate the relationship between LAR and short-time mortality in patients with ARDS.

Main results

The 28-day mortality was 38 % in this study. Multivariable Cox regression analysis showed that LAR was an independent predictive factor for 28-day mortality (HR 1.11, 95 %CI: 1.06–1.16, P < 0.001). The area under curve (AUC) of LAR in the ROC was 70.34 % (95 %CI: 66.53 % - 74.15 %) that provided significantly higher discrimination compared with lactate (AUC = 68.00 %, P = 0.0007) or albumin (AUC = 63.17 %, P = 0.002) alone. LAR was also not inferior to SAPSII with the AUC of 73.44 % (95 %CI: 69.84 % - 77.04 %, P = 0.21). Additionally, Kaplan-Meier survival analysis displayed that ARDS patients with high LAR (> the cut-off value 0.9055) had a significantly higher 28-day overall mortality rate (P < 0.001) and in-hospital mortality rate (P < 0.001). However, patients in high LAR group had shorter length of hospital stay (P < 0.001), which might be caused by higher in-hospital mortality.

Conclusions

We confirmed that there was a positive correlation between LAR and 28-day mortality. This could provide anesthesiologists and critical care physicians with a more convenient tool than SAPSII without being superior for detecting ARDS patients with poor prognosis timely.

研究目的乳酸白蛋白比值（LAR）已被证实是脓毒症、心力衰竭和急性呼吸衰竭的有效预后指标。然而，LAR 与急性呼吸窘迫综合征（ARDS）患者死亡率之间的关系仍不明确。我们旨在评估 LAR 对 ARDS 患者的预测价值。干预措施我们根据主要研究终点（28 天全因死亡率）将患者分为两个亚组：28 天存活者和 28 天未存活者。措施采用多变量 Cox 回归、受体运算特征（ROC）和 Kaplan-Meier 生存分析来研究 LAR 与 ARDS 患者短期死亡率之间的关系。多变量 Cox 回归分析显示，LAR 是 28 天死亡率的独立预测因素（HR 1.11，95 %CI：1.06-1.16，P < 0.001）。在 ROC 中，LAR 的曲线下面积（AUC）为 70.34 %（95 %CI：66.53 % - 74.15 %），与乳酸（AUC = 68.00 %，P = 0.0007）或白蛋白（AUC = 63.17 %，P = 0.002）相比，LAR 的区分度明显更高。LAR 的 AUC 为 73.44 %（95 %CI：69.84 % - 77.04 %，P = 0.21），也不逊色于 SAPSII。此外，Kaplan-Meier 生存分析显示，高 LAR（>；临界值为 0.9055）的 ARDS 患者 28 天总死亡率（P <；0.001）和院内死亡率（P <；0.001）明显更高。结论我们证实 LAR 与 28 天死亡率之间存在正相关。结论我们证实 LAR 与 28 天死亡率呈正相关，这为麻醉师和重症监护医生提供了比 SAPSII 更方便的工具，但在及时发现预后不良的 ARDS 患者方面并无优势。

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引用次数: 0

Outpatient anesthesiology: A fact for the future. 门诊麻醉学：未来的事实。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-09-26 DOI: 10.1016/j.jclinane.2024.111633

Richard P Dutton

引用次数: 0

Sex dependence of postoperative pulmonary complications – A post hoc unmatched and matched analysis of LAS VEGAS 术后肺部并发症的性别依赖性 - LAS VEGAS 的非匹配和匹配后分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-09-23 DOI: 10.1016/j.jclinane.2024.111565

Study objective

Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study’ (LAS VEGAS) to evaluate differences between females and males with respect to PPCs.

Design, setting and patients

Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs.

Main results

The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81–1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89–1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts.

Conclusions

In this conveniently–sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes.

Registration

LAS VEGAS was registered at clinicaltrial.gov (study identifier NCT01601223).

研究目的男性性别与术后肺部并发症（PPCs）的发生相关性并不一致。这些研究在规模、设计、人群和术前风险方面都不尽相同。我们重新分析了 "手术全身麻醉期间通气管理本地评估研究"（LAS VEGAS）的数据库，以评估女性和男性在肺部并发症方面的差异。设计、环境和患者LAS VEGAS是一项国际观察性研究，对象是在29个国家的146家医院接受手术全身麻醉下术中通气的患者。主要终点是术后前 5 天的 PPCs 综合指数。单个 PPCs、住院时间和死亡率是次要终点。主要结果未匹配队列由9697名患者组成，其中女性5342人（55.1%），男性4355人（44.9%）。匹配队列由 6154 名患者组成，其中女性 3077 人（50.0%），男性 3077 人（50.0%）。在非匹配队列（10.0 vs 10.7%；比值比 (OR) 0.93 [0.81-1.06]；P = 0.255）和匹配队列（10.5 vs 10.0%；OR 1.05 [0.89-1.25]；P = 0.556）中，女性和男性之间的 PPC 发生率差异不大。在非配对队列中，女性较少发生新的有创通气。结论在这个规模庞大的全球队列中，在全身麻醉下接受术中通气治疗的患者中，PPC的发生率在性别上没有明显差异。注册LAS VEGAS已在clinicaltrial.gov网站注册（研究标识符为NCT01601223）。

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引用次数: 0

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