Journal of Clinical Anesthesia最新文献_第10页

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 "的来信。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-17 DOI: 10.1016/j.jclinane.2024.111658

Jie Wang MD, Xiaocou Wang MD, Congcong Huang MD

引用次数: 0

Gastric insufflation with and without an inserted gastric tube in second-generation laryngeal mask airways: A randomized controlled cross-over trial. 在第二代喉罩通气道中使用和不使用插入式胃管进行胃充气：随机对照交叉试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-17 DOI: 10.1016/j.jclinane.2024.111653

Johannes Hell MD , Grischa Schelker , Stefan Schumann PhD , Axel Schmutz PhD

Study objective

Second-generation laryngeal mask airways are equipped with an additional lumen for a gastric tube, with the intention to reduce the risk of aspiration by draining gastric content. However, the effect of an inserted gastric tube through the gastric channel on gastric insufflation, a substantial part of the pathomechanism of aspiration, during positive-pressure ventilation is not clear. We hypothesized, that an inserted gastric tube increases the risk of gastric insufflation.

Design

Single center, prospective, randomized-controlled cross-over trial.

Setting

Tertiary academic hospital in Germany.

Patients

152 patients, ASA I-III, scheduled for general anesthesia with a laryngeal mask airway.

Interventions

Gastric insufflation was investigated during an incremental pressure trial up to a maximum airway pressure of 30 cmH₂O and during oropharyngeal leak pressure measurement with and without an inserted gastric tube while one of two laryngeal mask airways with different cuff designs (inflatable or thermoelastic) was used.

Measurements

Gastric insufflation was detected with real-time ultrasound.

Main results

Frequency of gastric insufflation was higher with than without inserted gastric tube during the incremental pressure trial (10.9 % (16/147) vs. 2.7 % (4/147), p = 0.009) and during oropharyngeal leak pressure measurement (16.3 % (24/147) vs. 5.4 % (8/147), p = 0.004). Risk of gastric insufflation didn't differ between the two cuff-types (p = 0.100). Flow over the open gastric channel was associated with gastric insufflation during positive-pressure ventilation (p = 0.003) and during oropharyngeal leak pressure measurement (p = 0.049). Incidence of postoperative nausea and vomiting was higher in patients in which gastric insufflation was detected, compared to others (17.1 % (6/35) vs. 5.4 % (6/112), p = 0.037).

Conclusion

Placement of a gastric tube through the gastric channel of a second-generation laryngeal mask airway, independent of the cuff-type, increases the risk of gastric insufflation. Flow over the gastric channel indicate a higher risk of gastric insufflation and gastric insufflation may increase the risk of postoperative nausea and vomiting.

研究目的第二代喉罩通气道配有一个额外的胃管管腔，目的是通过排出胃内容物来降低吸入风险。然而，在正压通气过程中，通过胃通道插入胃管对胃充气（吸入病理机制的重要组成部分）的影响尚不清楚。我们假设，插入胃管会增加胃充气的风险。设计单中心、前瞻性、随机对照交叉试验。干预措施在使用两种不同充气罩囊设计（充气式或热塑式）的喉罩气道中的一种时，在最高气道压力为 30 cmH2O 的增压试验中以及在插入或未插入胃管的情况下测量口咽漏压时对胃充气进行了研究。主要结果在增压试验（10.9 % (16/147) vs. 2.7 % (4/147)，p = 0.009）和口咽漏压测量（16.3 % (24/147) vs. 5.4 % (8/147)，p = 0.004）期间，插入胃管比未插入胃管的胃充气频率更高。两种袖带类型的胃充气风险没有差异（p = 0.100）。在正压通气期间（p = 0.003）和口咽漏压测量期间（p = 0.049），开放胃通道的流量与胃充气有关。结论通过第二代喉罩通气道的胃通道放置胃管（与充气罩囊类型无关）会增加胃充气的风险。胃通道上方的流量表明胃充气的风险较高，而胃充气可能会增加术后恶心和呕吐的风险。

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引用次数: 0

Letter to the editor regarding “Intraoperative hypotension during liver transplantation and postoperative outcomes: Retrospective cohort study” 致编辑的信，内容涉及 "肝移植术中低血压与术后结果：回顾性队列研究"

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-16 DOI: 10.1016/j.jclinane.2024.111655

Luyuan Yao , Zhihuan Luo

引用次数: 0

Machine learning prediction of unexpected readmission or death after discharge from intensive care: A retrospective cohort study 重症监护出院后意外再入院或死亡的机器学习预测：回顾性队列研究

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-14 DOI: 10.1016/j.jclinane.2024.111654

Thomas Tschoellitsch MD , Alexander Maletzky PhD , Philipp Moser PhD , Philipp Seidl MSc , Carl Böck PhD , Tina Tomic Mahečić MD , Stefan Thumfart PhD , Michael Giretzlehner PhD , Sepp Hochreiter PhD , Jens Meier MD

Background

Intensive care units (ICUs) harbor the sickest patients with the utmost needs of medical care. Discharge from ICU needs to consider the reason for admission and stability after ICU care. Organ dysfunction or instability after ICU discharge constitute potentially life-threatening situations for patients.

Methods

This is a single center, observational, retrospective cohort study conducted at ICUs at the Kepler University Hospital in Linz, Austria. Patients aged 18 years and above admitted to the study center's ICUs between 2010 and 01-01 and 2019-10-31 were included in the study. Patients transferred to another ICU, discharged to a different hospital or home, or that died during their ICU stay were excluded. We used machine learning (ML) models to predict unplanned ICU readmission or death using an internal dataset or MIMIC-IV as training data and compared the models with the Stability and Workload Index for Transfer (SWIFT) score. Further, we evaluated the influence of features on the models using Shapley Additive Explanations.

Results

The best ML models achieved an area under the curve of the receiver operating characteristic (AUC-ROC) of 0.721 ± 0.029 and a high negative predictive value (NPV) of 0.990 ± 0.002. The most important features were heart rate, peripheral oxygen saturation and arterial blood pressure. Performance of the SWIFT score was worse than the ML models (best AUC-ROC 0.618 ± 0.011).

Conclusions

ML models were able to identify patients that will not need unplanned ICU readmission and will not die within 48 h after discharge.

背景重症监护病房（ICU）收治的都是最需要医疗护理的病人。从重症监护室出院需要考虑入院原因和重症监护室护理后的稳定性。ICU出院后器官功能障碍或不稳定可能会危及患者的生命。方法这是一项在奥地利林茨开普勒大学医院 ICU 进行的单中心、观察性、回顾性队列研究。研究对象包括2010年1月1日至2019年10月31日期间入住研究中心重症监护室的18岁及以上患者。不包括转入其他重症监护室、出院到其他医院或家中的患者，也不包括在重症监护室住院期间死亡的患者。我们使用内部数据集或 MIMIC-IV 作为训练数据，使用机器学习（ML）模型预测非计划 ICU 再入院或死亡，并将模型与转院稳定性和工作量指数（SWIFT）评分进行比较。结果最佳 ML 模型的接收者操作特征曲线下面积 (AUC-ROC) 为 0.721 ± 0.029，负预测值 (NPV) 为 0.990 ± 0.002。最重要的特征是心率、外周血氧饱和度和动脉血压。SWIFT评分的性能比ML模型差（最佳AUC-ROC为0.618 ± 0.011）。结论ML模型能够识别不需要非计划ICU再入院且不会在出院后48小时内死亡的患者。

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引用次数: 0

Comparison of the clinical performance of the Ambu®AuraGain™ laryngeal mask in children undergoing surgery in the supine and prone position – A prospective, non-inferiority clinical trial 比较 Ambu®AuraGain™ 喉罩在儿童仰卧位和俯卧位手术中的临床表现 - 一项前瞻性、非劣效性临床试验

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-11 DOI: 10.1016/j.jclinane.2024.111652

Darhae Eum , Ha Yan Kim , Yangjin Kim , Seokyung Shin

Study objective

Reports are limited regarding supraglottic airway (SGA) usage in children in the prone position. This study aimed to compare the clinical performance of the Ambu®AuraGain™, a 2nd generation SGA, in children undergoing surgery in the prone and supine positions. We hypothesized that oropharyngeal leak pressure (OLP) in the prone position would not be inferior to that in the supine position.

Design

Single-center, prospective, non-randomized controlled study.

Setting

Operating room.

Patients

One hundred and twenty-six children, American Society of Anesthesiologists (ASA) physical status I-III, aged 2–12 years, undergoing elective surgery for 2 h or less in the supine or prone position.

Interventions

After induction of general anesthesia and insertion of the AuraGain, patients were positioned either supine or prone, according to type of surgery.

Measurements

OLP immediately after surgical positioning was measured as the primary outcome. The anatomical position of the AuraGain was evaluated using a flexible fiberoptic bronchoscope (Olympus LF-DP Tracheal Intubation Fiberscope, Melville, New York, USA). Airway maneuvers performed during placement and maintenance of the AuraGain and airway-related adverse events were recorded.

Main findings

The mean difference in OLP immediately after positioning was 0.048 cmH₂O (95 % confidence interval: −1.521 to 1.616), and the non-inferiority hypothesis was accepted (P < 0.001 for non-inferiority). There was no significant difference in the anatomical position of the SGA and adverse events. Airway maneuvers were significantly more commonly performed during placement in the Prone group compared to the Supine group (51 (81.0 %) vs. 3 (4.8 %), respectively; P < 0.001).

Conclusion

OLP when using AuraGain in the prone position in children was not inferior to that in the supine position. This suggests that the AuraGain may be an effective option for children undergoing short surgical procedures in the prone position.

研究目的有关儿童俯卧位使用声门上气道（SGA）的报道很有限。本研究旨在比较第二代 SGA Ambu®AuraGain™ 在俯卧位和仰卧位接受手术的儿童中的临床表现。我们假设俯卧位的口咽漏压（OLP）不会低于仰卧位。设计单中心、前瞻性、非随机对照研究。干预措施诱导全身麻醉并插入 AuraGain 后，根据手术类型让患者仰卧或俯卧。使用柔性纤维支气管镜（Olympus LF-DP 气管插管纤维镜，美国纽约梅尔维尔）评估 AuraGain 的解剖位置。主要研究结果定位后即刻的 OLP 平均差异为 0.048 cmH2O（95 % 置信区间：-1.521 至 1.616），非劣效性假设成立（非劣效性 P < 0.001）。SGA 的解剖位置与不良事件无明显差异。与仰卧位组相比，俯卧位组在置管过程中更常进行气道操作（分别为 51 (81.0 %) vs. 3 (4.8 %)；P < 0.001）。这表明，AuraGain 可能是儿童在俯卧位接受短手术的有效选择。

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引用次数: 0

In operating room extubation after cardiac surgery is associated with decreased incidence of in hospital new postoperative atrial fibrillation 心脏手术后在手术室拔管与降低术后新发心房颤动的发生率有关。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-10 DOI: 10.1016/j.jclinane.2024.111636

Ragini G. Gupta MD, Shreya Patel, Anke Wang MD, Jennie Y. Ngai MD

Objectives

This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery.

Design

This is a retrospective chart review.

Setting

Single tertiary care hospital.

Participants

Cardiac surgical patients >18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record.

Interventions

None.

Measurements and main results

Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (−1.74, 95 % CI [−2.22, −1.08], p < 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], p < 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure.

Conclusions

In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.

研究目的本研究旨在描述心脏手术后室内拔管的风险和益处：这是一项回顾性病历审查：参与者：年龄大于 18 岁的心脏手术患者：年龄大于18岁的心脏手术患者。排除标准包括：在 ICU 拔管 6 小时后的患者、有先天性心脏病（CHD）病史的患者、到达手术室前插管的患者、包括循环停止和/或选择性脑灌注在内的手术、心胸移植以及术中死亡的患者。通过医院的电子病历收集去身份化数据：干预措施：无：收集了 726 名患者的围手术期数据，其中 303 人（42%）在手术室拔管。根据专家的临床推理，利用协变量建立了多变量回归模型。与快速通道拔管相比，手术室内拔管与指标住院时间的缩短独立相关（-1.74，95 % CI [-2.22，-1.08]，p 结论：手术室内拔管与指标住院时间的缩短相关（-1.74，95 % CI [-2.22，-1.08]，p）：OR内拔管与缩短住院时间和减少新发院内心房颤动有关。

{"title":"In operating room extubation after cardiac surgery is associated with decreased incidence of in hospital new postoperative atrial fibrillation","authors":"Ragini G. Gupta MD, Shreya Patel, Anke Wang MD, Jennie Y. Ngai MD","doi":"10.1016/j.jclinane.2024.111636","DOIUrl":"10.1016/j.jclinane.2024.111636","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery.</div></div><div><h3>Design</h3><div>This is a retrospective chart review.</div></div><div><h3>Setting</h3><div>Single tertiary care hospital.</div></div><div><h3>Participants</h3><div>Cardiac surgical patients >18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and main results</h3><div>Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (−1.74, 95 % CI [−2.22, −1.08], <em>p</em> < 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], <em>p</em> < 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure.</div></div><div><h3>Conclusions</h3><div>In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111636"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perioperative Management of Adult Patients with Diabetes Wearing Devices: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Expert Consensus Statement 佩戴设备的成年糖尿病患者的围手术期管理：围手术期评估与质量改进学会（SPAQI）专家共识声明。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-10 DOI: 10.1016/j.jclinane.2024.111627

Adriana D. Oprea MD , Smita K. Kalra MD, FHM , Elizabeth W. Duggan MD, MA , Linda L. Russell MD , Richard D. Urman MD, MBA, FASA, FAACD , Basem B. Abdelmalak MD, FASA, SAMBA-F , Preethi Patel MD , Kurt J. Pfeifer MD, FACP, SFHM, DFPM , Paul J. Grant MD, SFHM , Marina M. Charitou MD , Carlos E. Mendez MD, FACP , Jennifer L. Sherr MD, PhD , Guillermo E. Umpierrez MD, CDCES, FACE, MACP , David C. Klonoff M.D., FACP, FRCP (Edin), Fellow AIMBE

In recent years, the integration of advanced diabetes technology into the care of individuals with diabetes has grown exponentially. Given their increasing prevalence, insulin-requiring people with diabetes may present to preoperative clinics or the operating rooms wearing such devices. While advantageous from a diabetes management perspective, for those unfamiliar with devices this can add another layer of complexity to diabetes management in both the outpatient and inpatient settings, particularly because of the rapidly evolving technology. Therefore, perioperative clinicians need to become familiar with diabetes technological advances, and device features and have an understanding of how they can be used in the perioperative period. This consensus statement aims to serve as an educational material as well as to serve as a guide to perioperative clinicians caring for patients wearing diabetes devices (insulin pumps and continuous glucose monitors).

近年来，先进的糖尿病技术在糖尿病患者护理中的应用呈指数级增长。鉴于其日益普及，需要使用胰岛素的糖尿病患者可能会佩戴此类设备前往术前诊所或手术室。虽然从糖尿病管理的角度来看这是件好事，但对于那些不熟悉设备的人来说，这可能会给门诊和住院环境中的糖尿病管理增加另一层复杂性，特别是由于技术的快速发展。因此，围手术期临床医生需要熟悉糖尿病技术的发展和设备的功能，并了解如何在围手术期使用这些设备。本共识声明旨在为围术期临床医生提供一份教育材料和指南，帮助他们护理佩戴糖尿病设备（胰岛素泵和连续血糖监测仪）的患者。

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引用次数: 0

Patient honesty about NPO status in the era of GLP-1 agonists and liberal ERAS protocols: A randomized response technique study 在使用 GLP-1 激动剂和宽松的 ERAS 方案的时代，患者对 NPO 状态的诚实态度：随机反应技术研究。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-10 DOI: 10.1016/j.jclinane.2024.111650

Lam-Phong N. Pham BA , Rahul Patel MPH , Charles A. King MPH , Jacob Helmann BS , Meghan E. Gaare MD MPH , Darrin W. Clouse MD , Jamie Decoster PhD , John S. McNeil MD

引用次数: 0

Effect of low-dose norepinephrine combined with goal-directed fluid therapy on postoperative pulmonary complications in lung surgery: A prospective randomized controlled trial 小剂量去甲肾上腺素联合目标导向液体疗法对肺部手术术后肺部并发症的影响：前瞻性随机对照试验。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-09 DOI: 10.1016/j.jclinane.2024.111645

Yang Gao MD , Dong Ji MD , Qi Fang MD , Yamei Li MD, Keyan Wang MD, Jia Liu MD, Lei Wang MD, Erwei Gu MD, Lei Zhang MD, PhD, Lijian Chen MD, PhD

Study objective

Postoperative pulmonary complications (PPCs), the predominant complications following lung surgery, are closely associated with intraoperative fluid therapy. This study investigates whether continuous low-dose norepinephrine infusion combined with goal-directed fluid therapy (GDFT) reduced the risk of PPCs after lung surgery relative to either GDFT alone or standard fluid treatment.

Design

A prospective, randomized controlled trial.

Setting

The First Affiliated Hospital of Anhui Medical University, Anhui, China.

Patients

The study included 184 patients undergoing elective thoracoscopic lung resection surgery.

Interventions

Patients were randomized into three groups based on different fluid treatment regimens: Group C received standard fluid treatment, Group G received GDFT, and Group N received continuous low-dose norepinephrine infusion combined with GDFT.

Measurements

The primary outcome was the incidence of PPCs, including respiratory infection, atelectasis, pneumothorax, pleural empyema, respiratory failure, pulmonary embolism and bronchopleural fistula, during the postoperative hospital stay. Secondary outcomes were hemodynamic variables and arterial blood gases. Additional recorded parameters included other postoperative complications such as bleeding, postoperative re-intubation, re-hospitalization within 30 days, and the length of hospital stay.

Main results

Group N showed a significantly lower PPCs incidence during hospitalization compared to Group C (11.5 % vs 27.9 %; odds ratio, 2.98; 95 % confidence interval, 1.17–8.31; P = 0.023). No significant difference in PPCs was found between Group N and Group G (11.5 % vs 14.5 %; odds ratio, 1.31; 95 % confidence interval, 0.46–3.91; P = 0.616). Additionally, there were no significant differences among the three groups in the components of PPCs. Group N showed higher mean arterial pressure and stroke volume index intraoperatively compared to Group C.

Conclusions

Continuous low-dose norepinephrine infusion combined with GDFT reduced PPCs incidence in elective lung surgery patients compared with standard fluid management, but showed no difference compared to GDFT alone.

Clinical trial registration

ChiCTR2200064081.

研究目的：术后肺部并发症（PPCs）是肺部手术后的主要并发症，与术中输液治疗密切相关。本研究探讨了持续低剂量去甲肾上腺素输注结合目标导向液体疗法（GDFT）是否比单独使用目标导向液体疗法或标准液体疗法降低了肺部手术后肺部并发症的风险：前瞻性随机对照试验：地点：中国安徽省安徽医科大学第一附属医院：研究纳入了 184 名接受选择性胸腔镜肺切除手术的患者：根据不同的输液治疗方案将患者随机分为三组：C组接受标准液体治疗，G组接受GDFT治疗，N组接受持续低剂量去甲肾上腺素输注联合GDFT治疗：主要结果是术后住院期间 PPCs 的发生率，包括呼吸道感染、肺不张、气胸、胸膜腔积液、呼吸衰竭、肺栓塞和支气管胸膜瘘。次要结果是血液动力学变量和动脉血气。其他记录参数包括其他术后并发症，如出血、术后再次插管、30 天内再次住院以及住院时间：主要结果：与 C 组相比，N 组住院期间的 PPCs 发生率明显较低（11.5% vs 27.9%；几率比，2.98；95% 置信区间，1.17-8.31；P = 0.023）。N 组和 G 组的 PPCs 无明显差异（11.5% vs 14.5%；几率比 1.31；95% 置信区间 0.46-3.91；P = 0.616）。此外，三组在 PPCs 的组成成分方面没有明显差异。与 C 组相比，N 组在术中显示出更高的平均动脉压和每搏容积指数：结论：与标准液体管理相比，持续低剂量去甲肾上腺素输注联合 GDFT 降低了择期肺部手术患者的 PPCs 发生率，但与单独使用 GDFT 相比没有差异：临床试验注册：ChiCTR2200064081。

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引用次数: 0

Compensatory response of the radial and ulnar arteries after radial artery cannulation in hypertensive patients 高血压患者桡动脉插管后桡动脉和尺动脉的补偿反应。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-09 DOI: 10.1016/j.jclinane.2024.111646

Xinpeng Xu , Zhiwei Wang , Hongying He , Wenyan Shi , Wei Zeng , Zhaoqiong Zhu , Xingkui Liu , Zhao Wang , Yi Zhang

Background

Limited literature exists on the vascular reactivity of the radial and ulnar arteries in hypertensive patients following radial artery cannulation. This study assessed the vascular reactivity of the radial and ulnar arteries by comparing Doppler images and laser speckle contrast imaging (LSCI) obtained from both normotensive and hypertensive patients after radial artery cannulation under general anesthesia.

Methods

This study recruited 99 normotensive and 99 hypertensive patients who required arterial cannulation under general anesthesia. In the course of research, to evaluate the impact of hypertension on arterial reactivity, we employed duplex Doppler ultrasonography to measure the inner diameter (ID), resistance index (RI) and mean volume flow (MVF) of both arteries at five different time points. We equally performed perfusion of thumb and little finger by laser speckle contrast imaging.

Results

After radial artery cannulation, the hypertensive group showed less increase in radial ID and less decrease in RI compared to the normotensive group. The MVF increase was also less pronounced in hypertensive patients, while both groups demonstrated equivalent ulnar ID changes, and the normotensive group exhibited a more significant decrease in RI and a greater MVF increase. Thumb perfusion decreased post-cannulation in both groups, with the hypertensive group showing a less robust recovery. Little finger perfusion increased after artery cannulation in both groups, but the hypertensive group's increase was lower. The incidence of vasospasm in the hypertensive group is higher than that in the normotensive group.

Conclusions

The radial and ulnar arteries in hypertensive patients may lack a compensatory response to radial artery cannulation during general anesthesia.

背景：有关高血压患者桡动脉插管后桡动脉和尺动脉血管反应性的文献有限。本研究通过比较正常血压和高血压患者在全身麻醉下桡动脉插管后获得的多普勒图像和激光斑点对比成像（LSCI），评估桡动脉和尺动脉的血管反应性：本研究招募了 99 名血压正常和 99 名高血压患者，他们都需要在全身麻醉下进行动脉插管。在研究过程中，为了评估高血压对动脉反应性的影响，我们采用了双工多普勒超声技术，在五个不同的时间点测量了两条动脉的内径（ID）、阻力指数（RI）和平均体积流量（MVF）。我们同样通过激光斑点对比成像对拇指和小指进行了灌注：结果：桡动脉插管后，与正常血压组相比，高血压组的桡动脉内径增加较少，RI下降较少。高血压患者的 MVF 增加也不明显，而两组患者的尺动脉内径变化相当，正常血压组的 RI 下降更明显，MVF 增加更大。两组患者的拇指灌注量在动脉封堵后都有所下降，而高血压组的恢复较慢。动脉插管后，两组的小指灌注量均有所增加，但高血压组的增幅较小。高血压组血管痉挛的发生率高于正常血压组：结论：高血压患者的桡动脉和尺动脉可能对全身麻醉期间的桡动脉插管缺乏代偿反应。

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引用次数: 0