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Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015–2019 ACS NSQIP data 虚弱是延长术后住院时间的独立危险因素:2015-2019年ACS NSQIP数据的回顾性分析
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111730
Jane Y. Xu MPH , Hannah E. Madden BS , Pablo Martínez-Camblor PhD , Stacie G. Deiner MD

Background

Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.

Study design

We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 < 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type.

Main results

Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36–3.64) and 4.64 days (95 % CI 3.96–5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79–3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48–0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47–0.59).

Conclusions

Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.
背景:虚弱是一种生理应激恢复能力下降的综合征,与特定手术术后住院时间(LOS)的增加有关。然而,文献缺乏对手术过程中虚弱和LOS之间关系的大规模分析。研究设计:我们使用美国外科医师学会国家手术质量改进计划(ACS NSQIP®)的数据,对2015年至2019年期间接受住院手术(包括急诊手术)的65岁以上患者进行了回顾性队列研究。用改良的5项衰弱指数(mFI-5)来衡量的衰弱被归类为非衰弱(mFI-5)。体弱多病患者比例较高的是黑人(10%比5.5%)、西班牙裔(6.1%比3.8%)、ASA IV/V级(23.3%比9.1%)、营养不良(2.7%比1.9%)和接受血管手术(16.5%比8.3%)。除了减肥手术外,他们在所有手术过程中都经历了更长的中位LOS。未经调整的分析显示,与mFI-5评分为0相比,mFI-5评分为4和5分别与中位LOS增加3.5天(95% CI 3.36-3.64)和4.64天(95% CI 3.96-5.32)相关。在调整分析中,虚弱仍然是中位LOS增加的重要危险因素,与mFI-5评分为0相比,mFI-5评分为5与3天的延长相关(95% CI 2.79-3.22)。亚组分析显示,mFI-5评分每增加1分,与急诊手术(0.5天,95% CI 0.48-0.52)和下肢搭桥手术(0.53天,95% CI 0.47-0.59)中位LOS增加的相关性最强。结论:即使在调整了患者和手术协变量后,虚弱也是老年手术患者术后长期LOS的独立危险因素。其他导致LOS增加的独立危险因素包括紧急手术、营养不良和ASA等级升高。
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引用次数: 0
Reduction of postoperative pain and opioid consumption by VVZ-149, first-in-class analgesic molecule: A confirmatory phase 3 trial of laparoscopic colectomy 一流镇痛分子VVZ-149减少术后疼痛和阿片类药物消耗:腹腔镜结肠切除术的确证性3期试验
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111729
Ho-Jin Lee M.D., Ph.D. , Ji-Yeon Sim M.D., Ph.D. , Inkyung Song Ph.D. , Srdjan S. Nedeljkovic M.D. , Duk Kyung Kim M.D., Ph.D. , Ah-Young Oh M.D., Ph.D. , Seung Zhoo Yoon M.D., Ph.D. , Young-Jin Moon M.D., Ph.D. , Mi-Hye Park M.D., Ph.D. , Insun Park M.D., Ph.D. , Jina Kim M.S. , Sang Rim Lee M.S. , Sunyoung Cho Ph.D. , Jae-Hyon Bahk M.D., Ph.D.

Study objective

VVZ-149 is a small molecule that inhibits the glycine transporter type 2 and the serotonin receptor 5-hydroxytryptamine 2 A. In this Phase 3 study, we investigated the efficacy and safety of VVZ-149 as a single-use injectable analgesic for treating moderate to severe postoperative pain after laparoscopic colectomy.

Design

Randomized, parallel group, double-blind, Phase 3 clinical trial (Trial no. NCT05764525).

Setting

5 tertiary referral centers in South Korea.

Patients

284 patients undergoing laparoscopic colectomy.

Interventions

A continuous 10-h intravenous infusion of VVZ-149 (n = 141) or placebo (n = 143) administered after emergence from anesthesia.

Measurements

Pain intensity was assessed using a numeric rating scale (NRS) from the start of infusion for 48 h. The primary efficacy measure was the Sum of Pain Intensity Difference (SPID) for the first 12 h after the start of drug infusion. Other efficacy measures included SPID at other time points, opioid consumption via on-demand patient-controlled analgesia (PCA) and rescue medication, and proportion of patients who did not require rescue opioids for 48 h post-dose.

Main results

Pain relief as measured by SPID was significantly improved by 35 % in the VVZ-149 group compared to the placebo group at 6 h (p = 0.0193) and 12 h (p = 0.0047) after the start of infusion. Significantly lower pain intensity scores were observed between 4–10 h in the VVZ-149 group compared to the placebo group (p = 0.0007), reaching mild pain (mean NRS <4) at 8 h. VVZ-149 alleviated pain during the first 12 h post-dose with 30.8 % less opioid consumption and 60.2 % fewer PCA requests when compared with placebo. A higher proportion of patients receiving VVZ-149 were rescue opioid-free during 2–6 h (p = 0.0026) and 6–12 h (p = 0.0024) compared with the placebo group. VVZ-149 administration in post-colectomy patients was generally safe and well tolerated.

Conclusions

When compared to placebo, VVZ-149 infusion demonstrated a significant reduction of pain within the first 12 h after surgery with a substantial decrease in opioid use. VVZ-149 rapidly lowers the pain intensity starting at as early as 4 h post-dose, allowing subjects to experience mild pain levels from 8 h through 48 h. Therefore, the analgesic effect of VVZ-149 was shown to effectively relieve pain and reduce opioid use for treating moderate to severe pain in the early postoperative care setting.
Registration number: Trial Number NCT05764525
研究目的:VVZ-149是一种抑制甘氨酸转运蛋白2型和血清素受体5-羟色胺2a的小分子。在这项3期研究中,我们研究了VVZ-149作为一次性注射镇痛药治疗腹腔镜结肠切除术后中至重度术后疼痛的有效性和安全性。设计:随机、平行组、双盲、3期临床试验(试验号:NCT05764525)。设置:韩国5个三级转诊中心。患者:284例患者行腹腔镜结肠切除术。干预措施:麻醉苏醒后连续10小时静脉输注VVZ-149 (n = 141)或安慰剂(n = 143)。测量方法:从开始输注48小时开始,采用数值评定量表(NRS)评估疼痛强度。主要疗效测量是药物开始输注后前12小时的疼痛强度差和(SPID)。其他疗效指标包括其他时间点的SPID,通过按需患者控制镇痛(PCA)和救援用药的阿片类药物消耗,以及给药后48小时不需要阿片类药物的患者比例。主要结果:与安慰剂组相比,VVZ-149组在开始输注后6小时(p = 0.0193)和12小时(p = 0.0047), SPID测量的疼痛缓解明显改善35%。与安慰剂组相比,VVZ-149组在4-10小时之间的疼痛强度评分显著降低(p = 0.0007),达到轻度疼痛(平均NRS)。结论:与安慰剂组相比,VVZ-149输注在手术后最初12小时内疼痛显著减轻,阿片类药物的使用显著减少。早在给药后4小时,VVZ-149就能迅速降低疼痛强度,使受试者在8小时至48小时内经历轻度疼痛。因此,VVZ-149的镇痛作用被证明可以有效缓解疼痛,减少阿片类药物在术后早期护理中治疗中度至重度疼痛的使用。注册号:试验号NCT05764525。
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引用次数: 0
Cerebral oximetry index indicates delirium or stroke after carotid endarterectomy: An observational study 脑氧饱和度指数表明颈动脉内膜切除术后谵妄或中风:一项观察性研究。
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111733
Muhan Li , Tingting Ma , Xueke Yin , Xin Zhang , Tenghai Long , Min Zeng , Juan Wang , Qianyu Cui , Shu Li , Daniel I. Sessler , Rong Wang , Yuming Peng

Backgrounds

The cerebral oximetry index (COx) uses near-infrared spectroscopy to estimate cerebral autoregulation during cardiac surgery. However, the relationship between intraoperative loss of cerebral autoregulation and postoperative delirium or stroke remains unclear in patients recovering from carotid endarterectomy (CEA).

Methods

Our prospective observational cohort study enrolled patients scheduled for CEA. COx was estimated as the coefficient of a continuous, moving Spearman correlation between mean arterial pressure and cerebral oxygen saturation. A receiver operating characteristics curve with Youden's index identified the optimal COx threshold for predicting a composite of postoperative delirium or new-onset overt stroke.

Results

One hundred and forty patients scheduled for CEA were enrolled. The incidence of delirium was 10.7 % (15/140) and the incidence of stroke was 3.6 % (5/140), including 1 patient who had both. The cumulative anesthesia time when COx exceeded 0.3 was longer in patients with complications than those without. When COx > 0.6, the corresponding predictive ability was AUC = 0.69, Youden index = 0.61, P = 0.0003, with a positive predictive value of 100 %. In the post hoc subgroup analyses, before clamping, the greatest increase in the risk was observed when COx > 0.7 for 20 min (Odds ratio = 3.10, 95 % CI 2.20, 3.78). In contrast, COx was not predictive during clamping. After clamping, the optimal COx threshold was 0.4 (AUC = 0.85, Youden index = 0.82, P < 0.0001), with the positive predictive value being 100 %.

Conclusions

COx is a promising metric for predicting postoperative delirium or new-onset overt stroke in patients having CEA. The optimal COx threshold was 0.7 in the pre-clamping phase and 0.4 in the post-clamping phase.
背景:脑氧饱和度指数(COx)使用近红外光谱来评估心脏手术过程中大脑的自动调节。然而,在颈动脉内膜切除术(CEA)恢复期患者中,术中大脑自我调节功能丧失与术后谵妄或卒中的关系尚不清楚。方法:我们的前瞻性观察队列研究纳入了计划进行CEA的患者。COx作为平均动脉压和脑氧饱和度之间连续移动的Spearman相关系数进行估计。患者工作特征曲线与约登指数确定了预测术后谵妄或新发明显卒中复合的最佳COx阈值。结果:纳入140例CEA患者。谵妄的发生率为10.7%(15/140),卒中的发生率为3.6%(5/140),其中1例患者两者兼有。有并发症的患者累积麻醉时间大于无并发症的患者。当COx > 0.6时,对应的预测能力为AUC = 0.69,约登指数= 0.61,P = 0.0003,阳性预测值为100%。在事后亚组分析中,在钳夹前,当COx >.7持续20分钟时,风险增加最大(优势比= 3.10,95% CI 2.20, 3.78)。相比之下,COx不能预测夹紧过程。夹持后,最佳COx阈值为0.4 (AUC = 0.85, Youden指数= 0.82,P)。结论:COx是预测CEA患者术后谵妄或新发明显卒中的一个有希望的指标。最佳COx阈值在钳位前为0.7,钳位后为0.4。
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引用次数: 0
Individual FiO2 guided by SPO2 prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial 一项随机对照试验:SPO2引导下的个体FiO2可预防结直肠手术中的高氧并减少术后肺不张。
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111732
Xia Wei , Xia Kang , Lijun Zhang , Jinzhu Huang , Weiyu Feng , Pengyu Duan , Bing Zhang

Study objective

To determine whether individualized fraction of inspired oxygen (iFiO2) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO2.

Design

This was a single-center, prospective, randomized study.

Setting

This study was conducted in a single tertiary care hospital in China.

Patients

A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.

Interventions

The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO2 group) or individualized FiO2 based on physiological SpO2 (iFiO2 group).

Measurements

The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO2, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO2), and pulmonary shunt fraction (Qs/Qt) were considered.

Main results

The LUS was significantly lowered in the iFiO2 group (5 [4, 7]) compared with the fFiO2 group (8 [4, 10]) (P = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO2 group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO2 group (P = 0.025). At the end of surgery, PaO2, A-aDO2, and Qs/Qt were significantly reduced in patients in the iFiO2 group compared with those in the fFiO2 group.

Conclusions

The use of iFiO2 during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.
Clinical trial registration: ChiCTRT2100049615.
研究目的:确定相对于60% FiO2,个体化吸氧分数(iFiO2)是否能改善择期腹腔镜结直肠手术后肺不张。设计:这是一项单中心、前瞻性、随机研究。背景:本研究在中国的一家三级医院进行。患者:共有84名符合条件的住院患者在2021年8月至2022年5月期间接受了选择性腹腔镜结直肠手术。干预措施:患者被随机分配接受固定比例的吸入氧(fFiO2组)或基于生理SpO2的个体化FiO2 (iFiO2组)。测量:主要结果是拔管后30分钟的肺超声评分(LUS)。次要结局包括住院时间、入住重症监护病房、麻醉后护理病房的时间、术后第三天与术前比较的肺活量比、恶心和呕吐的发生率、术后手术部位感染。此外,考虑气道板压、气道峰值压、肺动态顺应性、PaO2、氧合指数、肺泡-动脉氧张力梯度(A-aDO2)和肺分流分数(Qs/Qt)。主要结果:iFiO2组LUS(5[4,7])较fFiO2组(8[4,10])显著降低(P = 0.03)。根据判断肺不张的标准,ffo2组有25例(62.5%)出现明显的肺不张,而iFiO2组有15例(37.5%)出现明显的肺不张(P = 0.025)。手术结束时,iFiO2组患者PaO2、A-aDO2、Qs/Qt较ffo2组明显降低。结论:术中使用iFiO2可显著降低全麻下腹腔镜结直肠手术患者的LUS和肺不张。临床试验注册:ChiCTRT2100049615。
{"title":"Individual FiO2 guided by SPO2 prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial","authors":"Xia Wei ,&nbsp;Xia Kang ,&nbsp;Lijun Zhang ,&nbsp;Jinzhu Huang ,&nbsp;Weiyu Feng ,&nbsp;Pengyu Duan ,&nbsp;Bing Zhang","doi":"10.1016/j.jclinane.2024.111732","DOIUrl":"10.1016/j.jclinane.2024.111732","url":null,"abstract":"<div><h3>Study objective</h3><div>To determine whether individualized fraction of inspired oxygen (iFiO<sub>2</sub>) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO<sub>2</sub>.</div></div><div><h3>Design</h3><div>This was a single-center, prospective, randomized study.</div></div><div><h3>Setting</h3><div>This study was conducted in a single tertiary care hospital in China.</div></div><div><h3>Patients</h3><div>A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.</div></div><div><h3>Interventions</h3><div>The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO<sub>2</sub> group) or individualized FiO<sub>2</sub> based on physiological SpO<sub>2</sub> (iFiO<sub>2</sub> group).</div></div><div><h3>Measurements</h3><div>The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO<sub>2</sub>, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO<sub>2</sub>), and pulmonary shunt fraction (Qs/Qt) were considered.</div></div><div><h3>Main results</h3><div>The LUS was significantly lowered in the iFiO<sub>2</sub> group (5 [4, 7]) compared with the fFiO<sub>2</sub> group (8 [4, 10]) (<em>P</em> = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO<sub>2</sub> group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO<sub>2</sub> group (<em>P</em> = 0.025). At the end of surgery, PaO<sub>2</sub>, A-aDO<sub>2</sub>, and Qs/Qt were significantly reduced in patients in the iFiO<sub>2</sub> group compared with those in the fFiO<sub>2</sub> group.</div></div><div><h3>Conclusions</h3><div>The use of iFiO<sub>2</sub> during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.</div><div>Clinical trial registration: ChiCTRT2100049615.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111732"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894790","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}
引用次数: 0
Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial 术中生理盐水量与乳酸林格氏液量对急性肾损伤的影响:SOLAR试验的二次分析。
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2025.111744
Leonardo Marquez M.D. , Sara Medellin M.D. , Lu Wang M.S. , Kamal Maheshwari M.D. , Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. , Daniel I. Sessler M.D.
Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.

Objective

Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.

Design

Secondary analysis of a single-center multiple cross-over cluster trial.

Setting

Intraoperative care.

Patients

We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.

Interventions

Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.

Measurements

The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.

Main results

The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or > 4 L of lactated Ringer's solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.

Conclusions

While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.
非心脏手术后急性肾损伤(AKI)很常见。手术过程中,生理盐水和乳酸林格氏液都可用于容量置换。生理盐水会减少肾血流量并引起高氯血症性酸中毒,而乳酸林格则不会。两种液体体积适中时,AKI的发生率相似。但仍不清楚大剂量生理盐水是否会引起AKI。目的:评价术中晶体体积是否改变AKI风险与治疗组的关系。设计:单中心多交叉聚类试验的二次分析。设置:术中护理。患者:我们招募了8616名在一家大型学术机构接受过结直肠或骨科手术的成年人。干预措施:患者组术中交替使用生理盐水或乳酸林格氏液。测量:主要结果是急性肾损伤(AKI)发生率与术中晶体体积(0- 1,1 - 2,3 -4或4+升)和晶体类型的关系。我们的次要终点是术后24小时内血清氯浓度的变化。主要结果:给予0- 1,1 -2或3-4 L生理盐水或乳酸林格液的患者发生AKI的风险无显著差异。相比之下,给予2-3或4升乳酸林格氏液的患者发生AKI的风险高于给予生理盐水的患者。在所有容量类别中,给予生理盐水的患者血浆氯浓度逐渐高于给予乳酸林格氏液的患者。结论:虽然生理盐水明显引起容量依赖性高氯血症,但我们没有发现证据支持大量生理盐水引起AKI的理论。因此,两种液体在术中使用似乎都是合理的。
{"title":"Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial","authors":"Leonardo Marquez M.D. ,&nbsp;Sara Medellin M.D. ,&nbsp;Lu Wang M.S. ,&nbsp;Kamal Maheshwari M.D. ,&nbsp;Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. ,&nbsp;Daniel I. Sessler M.D.","doi":"10.1016/j.jclinane.2025.111744","DOIUrl":"10.1016/j.jclinane.2025.111744","url":null,"abstract":"<div><div>Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.</div></div><div><h3>Objective</h3><div>Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.</div></div><div><h3>Design</h3><div>Secondary analysis of a single-center multiple cross-over cluster trial.</div></div><div><h3>Setting</h3><div>Intraoperative care.</div></div><div><h3>Patients</h3><div>We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.</div></div><div><h3>Interventions</h3><div>Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.</div></div><div><h3>Main results</h3><div>The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or &gt; 4 L of <em>lactated Ringer's</em> solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.</div></div><div><h3>Conclusions</h3><div>While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111744"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965160","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
Assessing the safety of tramadol use in breastfeeding women undergoing perioperative care 评估曲马多在母乳喂养妇女围手术期护理中的安全性。
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111711
Betul Kozanhan, Munise Yildiz, Mahmut Sami Tutar
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引用次数: 0
Artificial neural networks and machine learning in anesthesia and perioperative medicine: Reflections on the 2024 Nobel prize in physics 麻醉和围手术期医学中的人工神经网络和机器学习:对2024年诺贝尔物理学奖的思考。
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111737
Yahui Xu , Nie Zhang
{"title":"Artificial neural networks and machine learning in anesthesia and perioperative medicine: Reflections on the 2024 Nobel prize in physics","authors":"Yahui Xu ,&nbsp;Nie Zhang","doi":"10.1016/j.jclinane.2024.111737","DOIUrl":"10.1016/j.jclinane.2024.111737","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111737"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894686","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
Intertransverse process block (ITPB) at the retro-superior costotransverse ligament (retro-SCTL) space: Evaluation of local anesthetic spread using MRI and sensory blockade in healthy volunteers 后上肋横韧带(后sctl)间隙的横突间阻滞(ITPB):用MRI和感觉阻滞评价健康志愿者局麻药的扩散。
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.jclinane.2024.111718
Pawinee Pangthipampai MD , Palanan Siriwanarangsun MD , Jatuporn Pakpirom MD , Ranjith Kumar Sivakumar MD , Manoj Kumar Karmakar MD

Background

This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space – the medial retro-SCTL space block.

Methods

Ten healthy volunteers received a single-injection ultrasound-guided medial retro-SCTL space block at the T4-T5 level using a mixture of 10 ml 0.5 % bupivacaine with 0.5 ml gadolinium. At 15 min, they underwent a high resolution, fat suppressed, T1 weighted MRI scan of the cervicothoracic spine. Loss of sensation to cold was assessed at 15 and 60 min, and then hourly for 5-h, after the block.

Results

MRI showed consistent (100 %) spread of local anesthetic to the intercostal and paravertebral spaces, anterolateral aspect of the vertebral body (sympathetic chain), costotransverse space, neural foramina, and epidural space in all participants. However, sensory blockade was variable across the ipsilateral hemithorax. Hypoesthesia was more common than anesthesia in both the anterior (median [IQR], 3.5 [2–5] vs 0 [0–1.25], p < 0.001) and posterior (median [IQR], 6[3–7] vs 2[1–3], p < 0.001) hemithorax. Additionally, more dermatomes exhibited anesthesia in the posterior compared to the anterior hemithorax (median [IQR], 2[1–3] vs 0[0–1.25], p = 0.01). A variable number of contralateral dermatomes were also affected in 3 (30 %) volunteers. There was no statistically significant correlation between the local anesthetic spread and the number of hypoesthetic (r = 0.53, p = 0.11) or anesthetic (r = 0.09, p = 0.78) dermatomes on the ipsilateral hemithorax.

Conclusions

A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax.
背景:本研究评估了局部麻醉剂的扩散,使用MRI和感觉阻滞,在上肋横韧带后(后- sctl)间隙内侧进行横突间阻滞(ITPB)后-内侧后- sctl间隙阻滞。方法:10例健康志愿者在超声引导下,采用0.5%布比卡因10 ml加钆0.5 ml的混合物,在T4-T5水平进行内侧逆行sctl间隙阻滞。15分钟后,他们接受了高分辨率、脂肪抑制、T1加权的颈胸椎MRI扫描。在阻滞后的15和60分钟评估对寒冷的感觉丧失,然后每小时评估一次,持续5小时。结果:MRI显示局麻药在所有参与者的肋间和椎旁间隙、椎体前外侧(交感神经链)、肋横间隙、神经孔和硬膜外间隙的分布一致(100%)。然而,同侧半胸的感觉阻滞是不同的。结论:在T4-T5水平注射10.5 ml局麻药,单次注射内侧后sctl间隙阻滞,持续扩散到同侧肋间和椎旁间隙、交感神经链、肋横间隙、神经孔和硬膜外间隙,但产生同侧感觉阻滞,其变化性和后半胸比前半胸更宽。
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引用次数: 0
Difficult airway management in 25 hospitals across China: A multicenter cross-sectional study
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-29 DOI: 10.1016/j.jclinane.2025.111766
Zhi-hang Tang MD , Qi Chen MD , Wei Huang MD , Jia-nan Wang MD , Xiao-hua Zou PhD , Yang Xiao PhD , Xiao-tong Shi PhD , Hai-hong Deng PhD , Jing-jing Li PhD , Lun Wu PhD , Wen-zhi Liu PhD , Si-guang Hu PhD , Zheng-yang Zhou PhD , Heng-ning Qi PhD , Guo-hui Luan Phd , Wei Luo PhD , Yong Wang PhD , Wu-hua Ma Phd

Study objective

Difficult airway management is a significant challenge in clinical anesthesia, critical care, and emergency medicine. Inadequate management can lead to severe complications including organ damage and death. This study assessed the variability in difficult airway management across China and focused on how patient and operator factors influenced outcomes in operating rooms.

Design

A multicenter observational cross-sectional study.

Setting

This study was conducted from November 2022 to November 2023 and included 25 secondary and tertiary hospitals across various regions in China.

Patients

In the total of 181,399 general anesthesia patients, 384 (0.21 %) were identified as having difficult airways.

Interventions

Data were gathered from a specialized questionnaire comprising four sections with 27 questions and analyzed using logistic regression in SPSS to identify key factors that influenced effective management of difficult airways.

Measurements

This study focused on preoperative assessment, anesthesia selection, intubation attempts, and contingency planning for difficult airway management practices among anesthesiologists.

Main results

In anticipated difficult airways, rapid sequence induction was used in 51.7 % of the cases, maintaining spontaneous breathing under general anesthesia in 11.1 %, and awake intubation in 36 %. For unanticipated difficult airways, 95.9 % of the anesthesiologists opted for rapid sequence induction. Limited mouth opening was the most common cause of difficult airways and obesity and ankylosing spondylitis were identified as significant factors. The logistic regression analysis identified the type of difficult airway, anesthesiologist experience, and assessment methods as key factors influencing the first attempt intubation success.

Conclusions

The accuracy of difficult airway assessment and first attempt intubation success is influenced by both patient-related factors and the anesthesiologist's expertise. Regional and institutional variability in decision-making and tool selection underscores the critical need for standardized guidelines and comprehensive training to enhance airway management outcomes across diverse clinical settings in China.
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引用次数: 0
Percentage contribution of anesthetic induction on total case fresh gas flow under inhalational anesthesia: A retrospective cohort study
IF 5 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-24 DOI: 10.1016/j.jclinane.2025.111767
Yael Frank , Franklin Dexter , Carlos E. Guerra-Londono
{"title":"Percentage contribution of anesthetic induction on total case fresh gas flow under inhalational anesthesia: A retrospective cohort study","authors":"Yael Frank ,&nbsp;Franklin Dexter ,&nbsp;Carlos E. Guerra-Londono","doi":"10.1016/j.jclinane.2025.111767","DOIUrl":"10.1016/j.jclinane.2025.111767","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111767"},"PeriodicalIF":5.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038962","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
期刊
Journal of Clinical Anesthesia
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