Journal of Clinical Anesthesia最新文献

{"title":"Spinal cord ischemia after ESP block","authors":"Alessandro De Cassai","doi":"10.1016/j.jclinane.2024.111662","DOIUrl":"10.1016/j.jclinane.2024.111662","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111662"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501298","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}

{"title":"Rationale for assessing preoperative anxiety as part of the preoperative evaluation process.","authors":"Paul F White, Ofelia Loani Elvir-Lazo","doi":"10.1016/j.jclinane.2024.111656","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111656","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111656"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501293","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}

{"title":"Impact of emergence delirium on long-term survival in older patients after major noncardiac surgery: A longitudinal prospective observational study","authors":"Bing-Yan Cai M.D. ,&nbsp;Shu-Ting He M.D. ,&nbsp;Yan Zhang M.D. ,&nbsp;Jia-Hui Ma Ph.D ,&nbsp;Dong-Liang Mu M.D. ,&nbsp;Dong-Xin Wang M.D., Ph.D","doi":"10.1016/j.jclinane.2024.111663","DOIUrl":"10.1016/j.jclinane.2024.111663","url":null,"abstract":"<div><h3>Study objective</h3><div>To test the hypothesis that emergence delirium might be associated with worse long-term survival.</div></div><div><h3>Design</h3><div>A longitudinal prospective observational study.</div></div><div><h3>Setting</h3><div>A tertiary hospital in Beijing, China.</div></div><div><h3>Patients</h3><div>A total of 942 patients aged 65–90 years who were admitted to post-anesthesia care unit (PACU) after major noncardiac surgery under general anesthesia.</div></div><div><h3>Exposures</h3><div>Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay.</div></div><div><h3>Measurements</h3><div>Patients were followed up once a year for at least 3 years. Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals. Associations between emergence delirium and long-term survivals were analyzed with the Cox proportional hazard models.</div></div><div><h3>Main results</h3><div>Among enrolled patients, 915 completed perioperative assessments; 906 completed long-term follow-up (mean age 72 years; 60 % [545/906] male; 73 % [660/906] cancer surgery). At the end of follow-up (median 43 months), there were 69 deaths in 331 patients (21 %) with emergence delirium versus 114 deaths in 575 patients (20 %) without: unadjusted hazard ratio 1.10 (95 % CI: 0.81 to 1.48); <em>P</em> = 0.547; adjusted hazard ratio 0.96 (95 % CI: 0.70 to 1.32); <em>P</em> = 0.797. Recurrence-free survival was 73/331 (22 %) in patients with emergence delirium versus 121/575 (21 %) without: unadjusted hazard ratio 1.08 (95 % CI: 0.81 to 1.45); <em>P</em> = 0.598; adjusted hazard ratio 0.94 (95 % CI: 0.69 to 1.28); <em>P</em> = 0.695. Event-free survival was 159/331 (48 %) in patients with emergence delirium versus 268/575 (47 %) without: unadjusted hazard ratio 1.06 (95 % CI: 0.87 to 1.29); <em>P</em> = 0.563; adjusted hazard ratio 0.98 (95 % CI: 0.80 to 1.21); <em>P</em> = 0.875.</div></div><div><h3>Conclusions</h3><div>We did not find significant association between emergence delirium and worse long-term survival in older patients after general anesthesia and major surgery mainly for cancer. The effects of emergence delirium on long-term outcomes deserve further investigation.</div><div><strong>Clinical trial registrations</strong>: <span><span>www.chictr.org.cn</span><svg><path></path></svg></span>; ChiCTR-OOC-17012734.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111663"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501296","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}

{"title":"The perioperative care in liver transplantation multicenter database: Building the foundation for research collaboration in liver transplantation","authors":"Dieter Adelmann M.D., Ph.D. ,&nbsp;Mallika Reddy ,&nbsp;George P. Zhou M.D. ,&nbsp;Kyota Fukazawa M.D., Ph.D. ,&nbsp;Ryan Wang M.D. ,&nbsp;Cale Kassel M.D. ,&nbsp;Christine Nguyen-Buckley M.D. ,&nbsp;Javier Bastidas M.D., M.Sc ,&nbsp;Lorenzo De Marchi M.D., FASE ,&nbsp;Elizabeth A. Wilson M.D. ,&nbsp;Ryan Nazemian M.D., Ph.D. ,&nbsp;Ana Fernandez-Bustamante M.D., Ph.D., FASA ,&nbsp;Alexandra Anderson M.D. ,&nbsp;Ryan M. Chadha M.D. ,&nbsp;Jiapeng Huang M.D., Ph.D. ,&nbsp;Marina Moguilevitch M.D. ,&nbsp;Elizabeth Townsend M.D., Ph.D. ,&nbsp;David M. Rosenfeld M.D. ,&nbsp;Rishi P. Kothari M.D.","doi":"10.1016/j.jclinane.2024.111651","DOIUrl":"10.1016/j.jclinane.2024.111651","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111651"},"PeriodicalIF":5.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501299","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}

{"title":"Postoperative quality of recovery comparison between ciprofol and propofol in total intravenous anesthesia for elderly patients undergoing laparoscopic major abdominal surgery: A randomized, controlled, double-blind, non-inferiority trial","authors":"Zenghui Liang MMed ,&nbsp;Jing Liu MMed ,&nbsp;Shuhan Chen MMed ,&nbsp;Xiaona Zhao MMed ,&nbsp;Gezi Chen MMed ,&nbsp;Yanle Xie MMed ,&nbsp;Dongmei Wang MMed ,&nbsp;Fei Xing MMed ,&nbsp;Yuanyuan Mao MMed ,&nbsp;Wei Zhang MD ,&nbsp;Zhongyu Wang MD ,&nbsp;Jingjing Yuan MD","doi":"10.1016/j.jclinane.2024.111660","DOIUrl":"10.1016/j.jclinane.2024.111660","url":null,"abstract":"<div><h3>Study objectives</h3><div>We conducted a non-inferiority study to assess the postoperative quality of recovery (QoR) in elderly patients receiving ciprofol or propofol total intravenous anesthersia(TIVA)after elective laparoscopic major abdominal surgery, with QoR-15 scores as the main measure.</div></div><div><h3>Design</h3><div>A prospective, double-blind, randomized non-inferiority trial was conducted in the theater, post-anesthesia care unit (PACU), and the ward.</div></div><div><h3>Participants</h3><div>144 elderly patients (age ≥ 65 years) were randomly assigned to either the ciprofol group or the propofol group.</div></div><div><h3>Interventions</h3><div>The ciprofol group received continuous infusion of ciprofol with remifentanil, and the propofol group received infusion of propofol with remifentanil.</div></div><div><h3>Outcome measures</h3><div>The primary outcome was the QoR-15 on the first postoperative day (POD1), assessed in both intention-to-treat and per-protocol populations, with the mean difference between groups compared to a non-inferiority threshold of −8. Additional assessments included QoR-15 scores on POD2, 3, and 5 for both analysis sets. Other evaluated perioperative value factors included hemodynamic parameters and injection discomfort in the intention-to-treat analysis. A linear mixed model was utilized to examine the impact of group-time interactions on hemodynamic data and QoR-15.</div></div><div><h3>Main results</h3><div>The QoR-15 scores on POD1 in the ciprofol group were non-inferior to those in the propofol group both in intention-to-treat set (mean [95 %CI], 95.9[93.7–98.2] vs. 95.6 [93.3–97.8]; mean difference [95 % CI], 0.4 [−2.8–3.5]; <em>P</em>&lt;0.001 for noninferiority) and per-protocol set (mean [95 %CI], 96.7 [94.4–99.0] vs. 95.7 [93.4–98.0]; mean difference [95 % CI], 1.0 [−2.2–4.3]; <em>P</em>&lt;0.001 for noninferiority). Comparable outcomes were noted on postoperative days 2, 3, and 5 following the procedure in both analysis sets. Additionally: compared with propofol group, the occurrence of injection pain was lower (2.8 % vs. 27.8 %, <em>P</em> &lt; 0.001); the hypotension was less frequent (33.3 % vs. 54.2 %, <em>P</em> = 0.012); the bradycardia was more common (38.9 % vs. 23.6 %, <em>P</em> = 0.048).</div></div><div><h3>Conclusions</h3><div>Ciprofol is not inferior to propofol in QoR. Ciprofol can be suitably administered to elderly patients undergoing elective laparoscopic major abdominal surgery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111660"},"PeriodicalIF":5.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466708","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}

{"title":"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”.","authors":"Jie Wang MD,&nbsp;Xiaocou Wang MD,&nbsp;Congcong Huang MD","doi":"10.1016/j.jclinane.2024.111658","DOIUrl":"10.1016/j.jclinane.2024.111658","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111658"},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445567","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}

{"title":"Gastric insufflation with and without an inserted gastric tube in second-generation laryngeal mask airways: A randomized controlled cross-over trial.","authors":"Johannes Hell MD ,&nbsp;Grischa Schelker ,&nbsp;Stefan Schumann PhD ,&nbsp;Axel Schmutz PhD","doi":"10.1016/j.jclinane.2024.111653","DOIUrl":"10.1016/j.jclinane.2024.111653","url":null,"abstract":"<div><h3>Study objective</h3><div>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.</div></div><div><h3>Design</h3><div>Single center, prospective, randomized-controlled cross-over trial.</div></div><div><h3>Setting</h3><div>Tertiary academic hospital in Germany.</div></div><div><h3>Patients</h3><div>152 patients, ASA I-III, scheduled for general anesthesia with a laryngeal mask airway.</div></div><div><h3>Interventions</h3><div>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.</div></div><div><h3>Measurements</h3><div>Gastric insufflation was detected with real-time ultrasound.</div></div><div><h3>Main results</h3><div>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), <em>p</em> = 0.009) and during oropharyngeal leak pressure measurement (16.3 % (24/147) vs. 5.4 % (8/147), <em>p</em> = 0.004). Risk of gastric insufflation didn't differ between the two cuff-types (<em>p</em> = 0.100). Flow over the open gastric channel was associated with gastric insufflation during positive-pressure ventilation (<em>p</em> = 0.003) and during oropharyngeal leak pressure measurement (<em>p</em> = 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), <em>p</em> = 0.037).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111653"},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding “Intraoperative hypotension during liver transplantation and postoperative outcomes: Retrospective cohort study”","authors":"Luyuan Yao ,&nbsp;Zhihuan Luo","doi":"10.1016/j.jclinane.2024.111655","DOIUrl":"10.1016/j.jclinane.2024.111655","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111655"},"PeriodicalIF":5.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441074","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}

{"title":"Machine learning prediction of unexpected readmission or death after discharge from intensive care: A retrospective cohort study","authors":"Thomas Tschoellitsch MD ,&nbsp;Alexander Maletzky PhD ,&nbsp;Philipp Moser PhD ,&nbsp;Philipp Seidl MSc ,&nbsp;Carl Böck PhD ,&nbsp;Tina Tomic Mahečić MD ,&nbsp;Stefan Thumfart PhD ,&nbsp;Michael Giretzlehner PhD ,&nbsp;Sepp Hochreiter PhD ,&nbsp;Jens Meier MD","doi":"10.1016/j.jclinane.2024.111654","DOIUrl":"10.1016/j.jclinane.2024.111654","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>ML models were able to identify patients that will not need unplanned ICU readmission and will not die within 48 h after discharge.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111654"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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","authors":"Darhae Eum ,&nbsp;Ha Yan Kim ,&nbsp;Yangjin Kim ,&nbsp;Seokyung Shin","doi":"10.1016/j.jclinane.2024.111652","DOIUrl":"10.1016/j.jclinane.2024.111652","url":null,"abstract":"<div><h3>Study objective</h3><div>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.</div></div><div><h3>Design</h3><div>Single-center, prospective, non-randomized controlled study.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients</h3><div>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.</div></div><div><h3>Interventions</h3><div>After induction of general anesthesia and insertion of the AuraGain, patients were positioned either supine or prone, according to type of surgery.</div></div><div><h3>Measurements</h3><div>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.</div></div><div><h3>Main findings</h3><div>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 (<em>P</em> &lt; 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; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111652"},"PeriodicalIF":5.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417270","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}