Journal of Clinical Anesthesia最新文献_第4页

Machine learning-based prediction of significant intraoperative blood loss to guide risk-adapted blood management decisions in spinal surgery 基于机器学习的重大术中出血量预测，指导脊柱手术风险适应性血液管理决策。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-03-01 Epub Date: 2026-02-16 DOI: 10.1016/j.jclinane.2026.112144

Cheng Xiao , Yunpeng Wu , Han Zang , Ren Liao , Chenxi Liao , Li Xu , Yuguang Huang

Introduction

Significant blood loss (≥ 500 mL) during spinal surgery is common and linked to greater transfusion requirements and worse outcomes. Preoperative tools for risk stratification and individualized blood-management strategies are lacking. We aimed to develop a machine-learning model predicting intraoperative significant blood loss and to assess whether a risk-adapted blood management improves clinical benefit.

Methods

We used data from 3944 spinal surgery patients at Peking Union Medical College Hospital (December 2018–October 2021) to train 26 machine-learning algorithms. We used Shapley additive explanations to identify key predictors from 49 candidate variables to train simplified models. The optimal simplified model was externally validated in 843 patients from West China Hospital. Decision-curve analysis and spline analysis were used to evaluate Cell Saver benefit across model-predicted risk.

Results

The 12-variable ranger model achieved an AUC of 0.814 (95% CI, 0.790–0.839) in the test set and 0.820 (0.785–0.854) in the external cohort. Decision-curve analysis demonstrated that the risk-adapted Cell Saver strategy provided greater net benefit than current practice. Spline analysis demonstrated that Cell Saver benefit rose with increasing predicted risk: for risk >0.53, Cell Saver use was associated with higher postoperative hemoglobin; for risk >0.58, it reduced allogeneic transfusion requirements. Among patients requiring allogeneic transfusion, Cell Saver use decreased red-cell unit volume at all risk levels, with larger reductions in higher-risk patients.

Discussion

This 12-variable machine-learning model can accurately predict significant blood loss risk in spinal surgery. Risk-adapted Cell Saver use guided by predicted risk provides greater net clinical benefit than experienced-based real-world strategy.

脊柱手术期间大量失血（≥500 mL）是常见的，并与更多的输血需求和更糟糕的结果有关。术前缺乏风险分层和个体化血液管理策略的工具。我们旨在开发一种机器学习模型来预测术中大量失血，并评估风险适应性血液管理是否能提高临床效益。方法：利用2018年12月- 2021年10月北京协和医院3944例脊柱外科患者的数据，训练26种机器学习算法。我们使用Shapley加性解释从49个候选变量中识别关键预测因子来训练简化模型。对华西医院843例患者进行了体外验证。决策曲线分析和样条分析用于评估细胞拯救方案在模型预测风险中的效益。结果：12变量游标模型在测试集中的AUC为0.814 (95% CI, 0.790-0.839)，在外部队列中的AUC为0.820（0.785-0.854）。决策曲线分析表明，风险适应性Cell Saver策略比目前的做法提供了更大的净效益。样条分析表明，Cell Saver的益处随着预测风险的增加而增加：对于风险bb0.53， Cell Saver的使用与较高的术后血红蛋白相关；对于风险bb0.58，它减少了异体输血需求。在需要同种异体输血的患者中，使用Cell Saver降低了所有风险水平的红细胞单位体积，在高风险患者中降低幅度更大。讨论：这个12变量的机器学习模型可以准确预测脊柱手术中的重大失血风险。在预测风险的指导下使用风险适应性细胞保护器比基于经验的现实世界策略提供更大的临床净收益。

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引用次数: 0

McGrath videolaryngoscopy versus direct laryngoscopy for rapid sequence intubation: A multicenter randomized clinical trial McGrath视频喉镜与直接喉镜快速插管：一项多中心随机临床试验。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.jclinane.2026.112148

Yasin Tire , Gökhan Sertçakacılar , Elyad Ekrami , Mehmet Akif Yazar , Ali Aydın Öner , Mehmet Kürşad Orhan , Abdulsamet Uğural , William M. Patterson , Şeyma Nur Güner Zengin , Merve Kılınç , Sıla Boyacıoğlu , Büşra Tok Çekmecelioğlu , Betül Kozanhan , Ruetzler Kurt

Background

Videolaryngoscopy has been proposed to improve glottic visualization and intubation success during rapid sequence intubation (RSI). Evidence on the effectiveness of the McGrath videolaryngoscope in this setting remains limited.

Methods

In this multicenter, patient-blinded, randomized trial, 400 adults undergoing elective non-cardiac surgery requiring RSI were assigned to McGrath videolaryngoscopy (VL, n = 193) or direct laryngoscopy (DL, n = 201). The primary outcome was glottic visualization using the modified Cormack–Lehane (CL) classification. Secondary outcomes included first-attempt intubation success, number of attempts, intubation failure, and time to intubation. Safety outcomes included airway injury and postoperative complications.

Results

Glottic visualization did not differ significantly between groups (Grade 1 view: VL 46.6% vs DL 42.3%; OR 1.24, 95% CI 0.85–1.79; P = 0.26). First-attempt success was similar (VL 86.5% vs DL 87.6%; P = 0.76). Intubation failure occurred in 1.6% of VL and 0.5% of DL cases (P = 0.29). Median time to intubation was longer with VL (35 s vs 30 s; HR 1.27; 95% CI 1.04–1.56; P = 0.016). Rates of airway trauma and postoperative complications were low and comparable.

Conclusions

In adult patients undergoing RSI, McGrath videolaryngoscopy did not improve glottic visualization or first-pass intubation success compared with direct laryngoscopy, and was associated with a modestly longer intubation time. Adverse events were infrequent and similar. These findings suggest that the routine use of McGrath for RSI may not confer clinical benefit in low-risk elective surgical populations.

背景：在快速序列插管（RSI）中，视频喉镜检查被提出用于提高声门的可视性和插管成功率。关于McGrath视频喉镜在这种情况下的有效性的证据仍然有限。方法：在这项多中心、患者盲法、随机试验中，400名接受选择性非心脏手术需要RSI的成年人被分配到McGrath视频喉镜检查（VL, n = 193）或直接喉镜检查（DL, n = 201）。主要结果是使用改良的Cormack-Lehane （CL）分类观察声门。次要结果包括首次插管成功、插管次数、插管失败和插管时间。安全性结果包括气道损伤和术后并发症。结果：两组间声门显像无显著差异（1级显像：VL 46.6% vs DL 42.3%; OR 1.24, 95% CI 0.85-1.79; P = 0.26）。首次尝试成功率相似（VL 86.5% vs DL 87.6%; P = 0.76）。VL患者插管失败发生率为1.6%，DL患者为0.5% （P = 0.29）。VL患者到插管的中位时间较长（35 s vs 30 s; HR 1.27; 95% CI 1.04-1.56; P = 0.016）。气道创伤和术后并发症的发生率较低且具有可比性。结论：与直接喉镜检查相比，McGrath视频喉镜检查并没有改善声门显像或首次插管成功率，并且插管时间较长。不良事件发生率低且相似。这些发现表明，在低风险的选择性手术人群中，常规使用McGrath治疗RSI可能不会带来临床益处。

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引用次数: 0

No simple answer: Choosing regional analgesia for hip fracture pain 没有简单的答案：选择局部镇痛髋部骨折疼痛

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-03-01 Epub Date: 2026-01-23 DOI: 10.1016/j.jclinane.2026.112135

Saumith Menon BA , Dario Bugada MD PhD, ESRA-DRA , Edward R. Mariano MD, MAS, FASA, FASRA

引用次数: 0

Culture under pressure: Barriers, burnout, and leadership in perioperative care 压力下的文化：围手术期护理的障碍、倦怠和领导力。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-03-01 Epub Date: 2026-02-02 DOI: 10.1016/j.jclinane.2026.112143

Michael R. Ebbert

引用次数: 0

"Further studies are needed": Scientific convention or editorial evasion? A critical appraisal of an overused phrase in medical publishing. “需要进一步研究”：科学惯例还是编辑回避？对医学出版中一个被滥用的短语的批判性评价。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-02-05 DOI: 10.1016/j.jclinane.2026.112141

Zeynep Kayhan, Elvin Kesimci

引用次数: 0

Impact of a multimodal awareness campaign on preoperative fasting times and postoperative recovery: A prospective before-after study 多模式意识运动对术前禁食时间和术后恢复的影响：一项前瞻性的前后研究

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-20 DOI: 10.1016/j.jclinane.2025.112104

Paul Tauzi, Emilie Wargnier, Jeremy Klotz, Marie Dubillot, Sigismond Lasocki, Emmanuel Rineau

Introduction

Application of preoperative fasting rules appears insufficient despite the impact of excessive fasting on patient comfort and morbidity. Primary endpoint of the study was fasting durations before and after a multimodal awareness campaign about fasting rules.

Methods

This observational prospective study assessed liquid and solid fasting durations and their impact on recovery before and after a multimodal and multidisciplinary awareness campaign against excessive fasting. Fasting durations and data related to comfort and rehabilitation were collected at the admission to the operating room and on Day 1. Primary endpoint was the comparison of liquid and solid fasting times between the two groups. Secondary endpoints included quality of recovery.

Results

365 patients were included in the study in adult surgical departments, 185 during phase 1 from February to April 2023 and 179 during phase 2 from June to July 2023. Liquid fasting time were reduced in phase 2 with 7.5 [4.5–12.8] hours and 6.3 [3.7–11.3] hours in phase 1 and 2 (p < 0.001). Median solid fasting times were not reduced with 14.3 [12.3–17.0] hours in phase 1 versus 14.3 [12.4–16.5] in phase 2 (p = 0.66). Mean FQoR-15 recovery score was better in phase 2 compared to phase 1 (133 [CI 95 %: 129,6–136,1] vs 123 [CI 95 %: 119,3–125,8] respectively, p < 0.001).

Conclusions

After a multimodal awareness campaign, both median preoperative liquid fasting time and quality of recovery score were improved. However, the median solid fasting time was not reduced, calling for additional measures to further improve patient care.

尽管过度禁食对患者的舒适度和发病率有影响，但术前禁食规则的应用似乎不足。该研究的主要终点是禁食规则多模式意识运动前后的禁食持续时间。方法：本观察性前瞻性研究评估了液体和固体禁食持续时间，以及在多模式和多学科的反过度禁食意识运动前后对恢复的影响。在进入手术室和第1天收集禁食时间和与舒适和康复相关的数据。主要终点是两组之间液体和固体禁食时间的比较。次要终点包括恢复质量。结果共纳入成人外科365例患者，其中一期185例（2023年2月至4月），二期179例（2023年6月至7月）。第二阶段液体禁食时间缩短，第一阶段为7.5[4.5-12.8]小时，第二阶段为6.3[3.7-11.3]小时（p < 0.001）。中位固体禁食时间没有减少，第一阶段为14.3[12.3-17.0]小时，第二阶段为14.3[12.4-16.5]小时（p = 0.66）。2期患者的平均FQoR-15恢复评分优于1期患者（133 [CI 95%: 129,6 - 136,1] vs 123 [CI 95%: 119,3 - 125,8], p < 0.001）。结论多模式认知运动后，术前中位禁食时间和恢复评分质量均有提高。然而，中位固体禁食时间没有减少，需要采取额外措施进一步改善患者护理。

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引用次数: 0

Comparison of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for preoperative analgesia in elderly patients with hip fracture: A prospective, randomized controlled study 一项前瞻性、随机对照研究：囊周神经群阻滞与腹股沟上筋膜髂隔室阻滞用于老年髋部骨折患者术前镇痛的比较。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-01 DOI: 10.1016/j.jclinane.2025.112082

Haiming Liao , Zhen Wan , Jingjing Su, Dong Han, Wentao Lin, Muzhao Yu, Ge Sun, Fuhu Song, Jun Zhou

Background

Position changes due to the implementation of neuraxial anesthesia before hip fracture surgery may cause severe pain, and increases the occurrence of perioperative adverse events, especially for weak elderly patients with cardiovascular and other diseases. Iliaca fascia block (FICB) is commonly used method to control the pain caused by position changes, and has been proven to have a good analgesic effect. However, pain control is not ideal due to ultrasound positioning and fascia diffusion of anesthetic. The pericapsular nerve group (PENG) block is a new method for pain control after hip fracture surgery. And also performed in emergency departments for early multimodal analgesia and is increasingly being taught to emergency physicians[1, 2]. However, there are few studies on analgesia before spinal anesthesia in hip fracture surgery, and there is a lack of comparison of the analgesic effect and benefits between the PENG block and FICB in elderly patients with hip fracture. This study employed ultrasound-guided supra-inguinal fascia iliaca block (sFICB), aimed to compare the analgesic effects of PENG and sFICB before spinal canal block in elderly patients with hip fractures undergoing surgery.

Methods

This was a single-center, observer-blind, prospective, and randomized controlled study. A total of 64 elderly patients with hip fractures ≥65 years old were enrolled. Before undergoing intrathecal block, the patients were randomly divided into 2 groups: P group (PENG block)and F group(sFICB block).

Results

The success rate was 68.75 % in the F group, and 90.62 % in the P group (P < 0.05). Compared with the F group, the numeric rating scale (NRS) scores of the P group were significantly decreased (P < 0.05), and the time to perform the nerve block and spinal anesthesia were shorter (P < 0.05) in the P group. There was no significant difference in vital signs, pain relief, morphine consumption within 2 days after the operation, and adverse reactions between the 2 groups.

Conclusion

PENG block before spinal anesthesia has a better analgesic effect in elderly patients undergoing hip fracture surgery as compared to sFICB. The success rate of PENG is also significantly greater than that of sFICB.

背景：髋部骨折手术前实施轴向麻醉导致体位改变，可能引起剧烈疼痛，并增加围手术期不良事件的发生，尤其是老年体弱合并心血管等疾病患者。髂筋膜阻滞（FICB）是控制体位变化引起疼痛的常用方法，已被证明具有良好的镇痛效果。然而，由于超声定位和麻醉的筋膜扩散，疼痛控制并不理想。囊周神经阻滞是髋骨骨折术后疼痛控制的一种新方法。也在急诊科进行早期多模态镇痛，并越来越多地被教授给急诊科医生[1,2]。然而，关于脊柱麻醉在髋部骨折手术前镇痛的研究较少，且缺乏对老年髋部骨折患者PENG阻滞与FICB镇痛效果和获益的比较。本研究采用超声引导下腹股沟上筋膜髂阻滞（sFICB），目的是比较老年髋部骨折手术患者椎管阻滞前PENG与sFICB的镇痛效果。方法：这是一项单中心、观察者盲、前瞻性、随机对照研究。共纳入64例≥65岁的老年髋部骨折患者。在行鞘内阻滞前，将患者随机分为2组：P组（PENG阻滞）和F组（sFICB阻滞）。结果：F组成功率为68.75%，P组成功率为90.62%。(P)结论：腰麻前PENG阻滞对老年髋部骨折手术患者的镇痛效果优于sFICB。PENG的成功率也明显大于sFICB。

{"title":"Comparison of pericapsular nerve group block and supra-inguinal fascia iliaca compartment block for preoperative analgesia in elderly patients with hip fracture: A prospective, randomized controlled study","authors":"Haiming Liao , Zhen Wan , Jingjing Su, Dong Han, Wentao Lin, Muzhao Yu, Ge Sun, Fuhu Song, Jun Zhou","doi":"10.1016/j.jclinane.2025.112082","DOIUrl":"10.1016/j.jclinane.2025.112082","url":null,"abstract":"<div><h3>Background</h3><div>Position changes due to the implementation of neuraxial anesthesia before hip fracture surgery may cause severe pain, and increases the occurrence of perioperative adverse events, especially for weak elderly patients with cardiovascular and other diseases. Iliaca fascia block (FICB) is commonly used method to control the pain caused by position changes, and has been proven to have a good analgesic effect. However, pain control is not ideal due to ultrasound positioning and fascia diffusion of anesthetic. The pericapsular nerve group (PENG) block is a new method for pain control after hip fracture surgery. And also performed in emergency departments for early multimodal analgesia and is increasingly being taught to emergency physicians[1, 2]. However, there are few studies on analgesia before spinal anesthesia in hip fracture surgery, and there is a lack of comparison of the analgesic effect and benefits between the PENG block and FICB in elderly patients with hip fracture. This study employed ultrasound-guided supra-inguinal fascia iliaca block (sFICB), aimed to compare the analgesic effects of PENG and sFICB before spinal canal block in elderly patients with hip fractures undergoing surgery.</div></div><div><h3>Methods</h3><div>This was a single-center, observer-blind, prospective, and randomized controlled study. A total of 64 elderly patients with hip fractures ≥65 years old were enrolled. Before undergoing intrathecal block, the patients were randomly divided into 2 groups: P group (PENG block)and F group(sFICB block).</div></div><div><h3>Results</h3><div>The success rate was 68.75 % in the F group, and 90.62 % in the P group (<em>P</em> < 0.05). Compared with the F group, the numeric rating scale (NRS) scores of the P group were significantly decreased (P < 0.05), and the time to perform the nerve block and spinal anesthesia were shorter (P < 0.05) in the P group. There was no significant difference in vital signs, pain relief, morphine consumption within 2 days after the operation, and adverse reactions between the 2 groups.</div></div><div><h3>Conclusion</h3><div>PENG block before spinal anesthesia has a better analgesic effect in elderly patients undergoing hip fracture surgery as compared to sFICB. The success rate of PENG is also significantly greater than that of sFICB.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112082"},"PeriodicalIF":5.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661217","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

Fixed 2-min time versus train of four–guided intubation following administration of rocuronium: Comment on study by Renew JR et al 罗库溴铵给药后固定2分钟时间与四导气管插管：Renew JR等研究的评论。

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-29 DOI: 10.1016/j.jclinane.2025.112118

Habib Md Reazaul Karim (MD, DNB, IDCCM, FNIV) , Pradipta Bhakta (MD, MNAMS, FCAI, EDRA, EDIC, FNIV) , Mohan Mugawar (MD, FCAI, FRCA, EDIC)

引用次数: 0

Application of ultrasound-guided regional blocks in the perioperative period of hip arthroplasty: A systematic review and network meta-analysis 超声引导区域阻滞在髋关节置换术围手术期的应用：系统综述和网络荟萃分析

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-27 DOI: 10.1016/j.jclinane.2025.112110

Sisi Wang, Ziyi Wu, Yanhong Song, Xinyi Yang, Ping Zhao

Purpose

This Bayesian network meta-analysis (NMA) aimed to compare the perioperative efficacy of various ultrasound-guided regional blocks in individuals on total hip arthroplasty (THA).

Methods

An extensive search was implemented across PubMed, Cochrane Library, Web of Science, and Embase up to December 9, 2024. Randomized controlled trials (RCTs) were selected to appraise postoperative analgesia and complications following ultrasound-guided lumbar plexus block (LPB), suprainguinal fascia iliaca block (SIFIB), pericapsular nerve group block (PENG), femoral nerve block (FNB), fascia iliaca block (FIB), quadratus lumborum block (QLB), erector spinae plane block (ESPB), periarticular injection (PAI), and saline control (CONTROL). Primary outcomes encompassed scores of movement-evoked pain (MEP) and pain at rest (PAR) within 12 and 24 h postoperatively.Secondary outcomes encompassed postoperative morphine equivalent consumption and the incidence of nausea and vomiting. Statistical analyses were carried out utilizing R 4.4.2 and Stata 18.

Results

Eighteen studies (2016–2024) involving 1424 participants were included. Network analysis revealed that, for the primary outcome, The MEP scores in the PAI, PENG, and QLB groups were significantly lower within 12 and 24 h postoperatively.No significant differences were discovered in PAR scores within 12 h or 24 h postoperatively. Within the bupivacaine subgroup, the QLB group had lower consumption of morphine within 24 h postoperatively. Compared to others, the QLB group had the lowest consumption of morphine during the hospital stay.In terms of postoperative nausea and vomiting (PONV), regional blockade had a statistically substantial difference against the placebo control cohort.

Conclusion

No single regional block technique demonstrated superiority across all postoperative outcomes. Ultrasound-guided QLB was particularly effective in reducing morphine consumption, alleviating pain, and decreasing PONV. PAI and PENG also demonstrated efficacy in reducing postoperative pain and consumption of morphine. Future large-scale multi-center RCTs are necessary to further validate these findings.

目的：本贝叶斯网络荟萃分析（NMA）旨在比较不同超声引导区域阻滞在个体全髋关节置换术（THA）围手术期的疗效。方法在PubMed、Cochrane Library、Web of Science和Embase上进行广泛检索，截止到2024年12月9日。采用随机对照试验（RCTs）评价超声引导下腰丛阻滞（LPB）、腹股沟上髂筋膜阻滞（SIFIB）、囊周神经群阻滞（PENG）、股神经阻滞（FNB）、髂筋膜阻滞（FIB）、腰方肌阻滞（QLB）、竖立者脊柱平面阻滞（ESPB）、关节周注射（PAI）、生理盐水对照（control）术后镇痛及并发症。主要结果包括术后12和24小时内运动诱发疼痛（MEP）和静息疼痛（PAR）评分。次要结局包括术后吗啡当量消耗和恶心呕吐发生率。采用r4.4.2和Stata 18进行统计学分析。结果共纳入18项研究（2016-2024），1424名受试者。网络分析显示，对于主要结局，PAI、PENG和QLB组的MEP评分在术后12和24小时内显著降低。术后12 h和24 h的PAR评分无明显差异。在布比卡因亚组中，QLB组术后24 h内吗啡用量较低。与其他组相比，QLB组在住院期间吗啡用量最低。在术后恶心呕吐（PONV）方面，局部阻断组与安慰剂对照组相比有统计学上的显著差异。结论没有单一区域阻滞技术在所有术后结果中表现出优越性。超声引导QLB在减少吗啡消耗、减轻疼痛和降低PONV方面特别有效。PAI和PENG在减少术后疼痛和吗啡消耗方面也显示出疗效。未来需要进行大规模多中心随机对照试验来进一步验证这些发现。

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引用次数: 0

Randomized clinical trial between two sedation protocols during transcatheter aortic valve replacement procedures: Ketamine and Propofol versus Remifentanil and Dexmedetomidine 经导管主动脉瓣置换术中两种镇静方案的随机临床试验：氯胺酮和异丙酚与瑞芬太尼和右美托咪定

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2026-02-01 Epub Date: 2025-12-27 DOI: 10.1016/j.jclinane.2025.112116

Anna Castellari M.D , Matteo Lucchelli M.D , Mattia Gomarasca M.D , Valentina Salice M.D , Francesca Orsenigo M.D , Bedrana Moro Salihovic M.D , Federico Mondin M.D , Claudia Castiglioni M.D , Alessandro Calzolari M.D , Giovanni Mistraletti M.D

Objectives

To compare efficacy and safety of two different sedation protocols during Transcatheter Aortic Valve Replacement (TAVR); Ketamine and Propofol (KETOFOL) versus Remifentanil and Dexmedetomidine (REMIDEX).

Design

Monocentric, prospective, randomized and controlled trial.

Setting

University hospital.

Participants

231 patients were enrolled in the trial.

198 patients were included in the final analysis.

Interventions

Patients enrolled underwent procedural sedation according to one of the two possible drug combinations, KETOFOL vs REMIDEX, assigned through randomization. During the procedure intervention times and clinical parameters were recorded. After the procedure incidence of postoperative adverse events were recorded.

Measurements and main results

REMIDEX group showed a higher trend in the raw incidence of respiratory acidosis (67.7 % vs 54.3 %). The correlation was confirmed in the multivariate logistic regression analysis, with an increased risk of developing respiratory acidosis in the REMIDEX group (OR 1.864 %, 95 % CI 1.014–3.427). Patients in the REMIDEX group showed significantly longer induction times. REMIDEX group required a greater number of pharmacological adjustments, had a higher incidence of intraoperative agitation, and more episodes of desaturation. No other differences were observed in any of the other intraoperative or postoperative safety indicators.

Conclusions

Both protocols showed a low and comparable incidence of cardiovascular adverse events and postoperative complications such as POD and POCD. KETOFOL protocol appears to offer greater sedative stability and seems to be more protective regarding the incidence of respiratory adverse events.

目的比较经导管主动脉瓣置换术（TAVR）中两种不同镇静方案的疗效和安全性；氯胺酮和异丙酚（KETOFOL）与瑞芬太尼和右美托咪定（REMIDEX）。设计：单中心、前瞻性、随机对照试验。SettingUniversity医院。231名患者参加了这项试验。198例患者纳入最终分析。干预：根据随机分配的两种可能的药物组合（酮fol vs REMIDEX）中的一种，入组患者接受了程序性镇静治疗。在手术过程中记录干预次数和临床参数。记录手术后不良事件的发生率。测量和主要结果：remidex组呼吸性酸中毒的原始发生率有较高的趋势（67.7% vs 54.3%）。多因素logistic回归分析证实了相关性，REMIDEX组发生呼吸性酸中毒的风险增加（OR 1.844%, 95% CI 1.014-3.427）。REMIDEX组患者诱导时间明显延长。REMIDEX组需要更多的药理学调整，术中躁动发生率更高，去饱和发作次数更多。其他术中或术后安全指标均无差异。结论两种方案均显示心血管不良事件和术后并发症（如POD和POCD）的发生率较低且相当。酮fol方案似乎提供了更大的镇静稳定性，似乎对呼吸不良事件的发生率更有保护作用。

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引用次数: 0