Journal of Clinical Anesthesia最新文献

英文中文

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。

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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

Letter to the editor regarding “Comparison of the efficacy and safety of ciprofol and propofol for ERCP anesthesia in older patients: A single-center randomized controlled clinical study” 致编辑的信，内容涉及 "比较异丙酚和丙泊酚用于老年患者ERCP麻醉的有效性和安全性：单中心随机对照临床研究"。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-08 DOI: 10.1016/j.jclinane.2024.111648

Chui-Yu Li, Wen-Xi Xie, Zhi-Yuan Chen

引用次数: 0

Re: “Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial” 关于"全身利多卡因与竖脊平面阻滞改善腹腔镜胆囊切除术后的恢复质量：随机对照试验"。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-07 DOI: 10.1016/j.jclinane.2024.111649

Sisi Chen , Bin Qian

引用次数: 0

Comment on: “Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial” 评论"全身利多卡因与竖脊平面阻滞改善腹腔镜胆囊切除术后的恢复质量：随机对照试验"。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

Pub Date : 2024-10-07 DOI: 10.1016/j.jclinane.2024.111640

Pranjali Kurhekar, Raghuraman M. Sethuraman, Geetha Soundarya UdayaKumar, Neeta Parlikar, Vidhya Narayanan

引用次数: 0

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

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

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

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

引用次数: 0

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

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia

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

Mingzhen Wang , Jiahao Liu , Rui Dong

引用次数: 0

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Journal of Clinical Anesthesia

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