Journal of Clinical Anesthesia最新文献

{"title":"New postoperative atrial fibrillation after cardiac surgery: Revealing new risk factors","authors":"C. Aydın , M. Engin , I. Sivri , A. Demirkıran","doi":"10.1016/j.jclinane.2024.111684","DOIUrl":"10.1016/j.jclinane.2024.111684","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111684"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721534","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":"Is there a relationship between anesthesia/surgery and dementia?","authors":"Guillermo Lema MD , Fabrissio Grandi","doi":"10.1016/j.jclinane.2024.111682","DOIUrl":"10.1016/j.jclinane.2024.111682","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111682"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721536","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 on ‘Aspirin is associated with improved outcomes in patients with sepsis-induced myocardial injury: An analysis of the MIMIC-IV database’","authors":"Dandan Gu , Shaoyang Huang","doi":"10.1016/j.jclinane.2024.111683","DOIUrl":"10.1016/j.jclinane.2024.111683","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111683"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721535","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":"Comparison between thoracic epidural analgesia VS patient controlled analgesia on chronic postoperative pain after video-assisted thoracoscopic surgery: A prospective randomized controlled study","authors":"Ling Jiang M.D ,&nbsp;Chengyu Wang M.D ,&nbsp;Jie Tong M.D ,&nbsp;Xiaodan Han pH.D ,&nbsp;Changhong Miao pH.D ,&nbsp;Chao Liang pH.D","doi":"10.1016/j.jclinane.2024.111685","DOIUrl":"10.1016/j.jclinane.2024.111685","url":null,"abstract":"<div><h3>Study objective</h3><div>To test the hypothesis that thoracic epidural anesthesia and analgesia (TEA) reduces the incidence of chronic postoperative pain (CPSP) after video-assisted thoracoscopic surgery (VATS).</div></div><div><h3>Design</h3><div>A single-center, single-blind, randomized controlled trial was conducted.</div></div><div><h3>Setting</h3><div>The study was conducted in the operating room, with follow-up assessments performed in the ward. Telephone was used to follow the long-term outcomes.</div></div><div><h3>Patients</h3><div>231 patients ≥18 years of age and scheduled for VATS.</div></div><div><h3>Interventions</h3><div>Patients were randomized into two groups, including an epidural block (EPI) group (general anesthesia with patient-controlled epidural analgesia) and a general anesthesia with patient-controlled intravenous analgesia (PCIA) group.</div></div><div><h3>Measurements</h3><div>The primary endpoint was the incidence of CPSP at 3 months postoperatively. CPSP data, including acute pain, neuropathic pain, depression, and side effects, were collected at 3 and 6 months postoperatively through telephone follow-up.</div></div><div><h3>Main results</h3><div>A total of 231 patients were analyzed, including 114 in the PCIA group and 117 in the EPI group. Sixty-six patients (56.4 %) in the PCIA group and 33 patients (28.9 %) in the EPI group experienced chronic pain at 3 months postoperatively. The odds ratio (OR) was 0.31 (95 % confidence interval [CI], 0.18 to 0.54; <em>P</em> &lt; 0.0001). After adjusting for confounding factors, the adjusted OR was 0.28 (95 % CI, 0.16 to 0.50, <em>P</em> &lt; 0.001). Six months postoperatively, 50 (42.7 %) and 17 (14.9 %) patients in the PCIA and EPI groups, respectively, were diagnosed with CPSP (<em>P</em> &lt; 0.0001).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111685"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721606","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":"Personalized perioperative blood pressure management in patients having major non-cardiac surgery: A bicentric pilot randomized trial","authors":"Alina Bergholz ,&nbsp;Linda Grüßer ,&nbsp;Wiam T.A.K. Khader ,&nbsp;Pawel Sierzputowski ,&nbsp;Linda Krause ,&nbsp;Marc Hein ,&nbsp;Julia Wallqvist ,&nbsp;Sebastian Ziemann ,&nbsp;Kristen K. Thomsen ,&nbsp;Moritz Flick ,&nbsp;Philipp Breitfeld ,&nbsp;Moritz Waldmann ,&nbsp;Ana Kowark ,&nbsp;Mark Coburn ,&nbsp;Karim Kouz ,&nbsp;Bernd Saugel","doi":"10.1016/j.jclinane.2024.111687","DOIUrl":"10.1016/j.jclinane.2024.111687","url":null,"abstract":"<div><h3>Study objective</h3><div>We hypothesize that personalized perioperative blood pressure management maintaining intraoperative mean arterial pressure (MAP) above the preoperative mean nighttime MAP reduces perfusion-related organ injury compared to maintaining intraoperative MAP above 65 mmHg in patients having major non-cardiac surgery. Before testing this hypothesis in a large-scale trial, we performed this bicentric pilot trial to determine a) if performing preoperative automated nighttime blood pressure monitoring to calculate personalized intraoperative MAP targets is feasible; b) in what proportion of patients the preoperative mean nighttime MAP clinically meaningfully differs from a MAP of 65 mmHg; and c) if maintaining intraoperative MAP above the preoperative mean nighttime MAP is feasible in patients having major non-cardiac surgery.</div></div><div><h3>Design</h3><div>Bicentric pilot randomized trial.</div></div><div><h3>Setting</h3><div>University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and RWTH Aachen University Hospital, Aachen, Germany.</div></div><div><h3>Patients</h3><div>Patients ≥ 45 years old having major non-cardiac surgery.</div></div><div><h3>Interventions</h3><div>Personalized blood pressure management.</div></div><div><h3>Measurements</h3><div>Proportion of patients in whom preoperative automated nighttime blood pressure monitoring was possible; proportion of patients in whom the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg (difference &gt; ±10 mmHg); intraoperative time-weighted average MAP below the preoperative mean nighttime MAP.</div></div><div><h3>Main results</h3><div>We enrolled 105 patients and randomized 98 patients. In 98 patients (93 %), preoperative automated nighttime blood pressure monitoring was possible. In 83 patients (85 %), the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg. The median time-weighted average MAP below the preoperative mean nighttime MAP was 3.29 (1.64, 6.82) mmHg in patients assigned to personalized blood pressure management.</div></div><div><h3>Conclusions</h3><div>It seems feasible to determine the effect of personalized perioperative blood pressure management maintaining intraoperative MAP above the preoperative mean nighttime MAP on postoperative complications in a large multicenter trial.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111687"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721532","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":"Comparative efficacy of intravenous treatments for perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: A systematic review and Bayesian network meta-analysis of randomised-controlled trials","authors":"Guillermina Ferrea ,&nbsp;David T. Monks ,&nbsp;Preet Mohinder Singh ,&nbsp;Kelly Fedoruk ,&nbsp;Narinder Pal Singh ,&nbsp;Lindsay Blake ,&nbsp;Brendan Carvalho ,&nbsp;Pervez Sultan","doi":"10.1016/j.jclinane.2024.111680","DOIUrl":"10.1016/j.jclinane.2024.111680","url":null,"abstract":"<div><h3>Introduction</h3><div>Shivering affects 52 % of patients undergoing caesarean delivery under neuraxial anaesthesia. Despite extensive research focused on its prevention, there is still no consensus regarding optimal pharmacological treatment. This systematic review and network meta-analysis aims to compare available intravenous treatments of perioperative shivering in patients undergoing caesarean delivery under neuraxial anaesthesia.</div></div><div><h3>Methods</h3><div>We searched seven databases (PubMed MEDLINE, Scopus, Web of Science, Embase, LILACS, Cochrane CRCT and <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>) for randomised controlled trials comparing intravenous treatments of perioperative shivering during caesarean delivery and performed a Bayesian model network meta-analysis. We assessed study quality using the Cochrane risk of bias assessment tool. The primary outcome evaluated in this meta-analysis was shivering control (cessation or significant reduction in intensity), and secondary outcomes included time to shivering control, shivering recurrence, and incidence of maternal nausea.</div></div><div><h3>Results</h3><div>Twenty randomised controlled trials, with a total of 1983 patients, were included in this analysis. Network estimates of odds ratios (OR [95 % Credible Interval]) of effective treatment of shivering compared with saline were: dexmedetomidine (38.1 [14.2 to 111.5]), tramadol (33.6 [15.1 to 81.8]), nalbuphine (26.2 [10.8 to 80.2]), meperidine (20.9 [6.2 to 73.1]), ondansetron (6.6 [2.2 to 23.2]), and clonidine (3.2 [0.6 to 14.9]). The rank order of interventions by surface area under the cumulative ranking curve scores (in parenthesis) for shivering control was dexmedetomidine (0.87) &gt; tramadol (0.85) &gt; nalbuphine (0.74) &gt; meperidine (0.66) &gt; ondansetron (0.41) &gt; clonidine (0.3) &gt; amitriptyline (0.03). Dexmedetomidine was also the top-ranked intervention for time to shivering control, shivering recurrence and maternal nausea. We judged the certainty in the evidence to be moderate for dexmedetomidine and nalbuphine, and low for all other interventions.</div></div><div><h3>Conclusion</h3><div>This network meta-analysis identified four effective intravenous treatments for shivering in patients undergoing caesarean delivery under neuraxial anaesthesia: dexmedetomidine, tramadol, nalbuphine and meperidine. Dexmedetomidine was the top-ranked intervention for all outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111680"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721537","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":"Patient/anesthesiologist intersubjective experiences and intravenous supplementation during elective cesarean delivery: A prospective patient-reported outcome study","authors":"S. Orbach-Zinger ,&nbsp;E. Olliges ,&nbsp;A. Garren ,&nbsp;K. Azem ,&nbsp;S. Fein ,&nbsp;P. Heesen ,&nbsp;H. Sharvit ,&nbsp;R. Shani ,&nbsp;Z. Haitov ,&nbsp;J. Ronel ,&nbsp;Y. Binyamin","doi":"10.1016/j.jclinane.2024.111689","DOIUrl":"10.1016/j.jclinane.2024.111689","url":null,"abstract":"<div><h3>Introduction</h3><div>This prospective, observational study investigated the impact of patient/anesthesiologist interactions and socioeconomic factors on administering intravenous analgesics and anxiolytics during elective Cesarean delivery under spinal anesthesia. The study explored the role of emotional experiences and psychosocial characteristics on intraoperative administration of intravenous adjuncts.</div></div><div><h3>Methods</h3><div>The study included 502 patient/anesthesiologist dyads from two hospitals in Israel. Patients and anesthesiologists completed questionnaires assessing pain, anxiety, medication requests, and subjective experiences. Logistic regression models were used to analyze associations between variables and medication administration.</div></div><div><h3>Results</h3><div>Out of 502 patients, 110 (21.9 %) received intravenous supplementation. Only 40.6 % of patients who requested analgesics received them, while anxiolytics were administered four times more often than analgesics. Patients with higher salaries and those speaking the same language as the anesthesiologist were less likely to receive supplementation. Anesthesiologists feeling more attached to or close to patients were more likely to administer medication, while those motivated to protect patients were less likely.</div></div><div><h3>Conclusion</h3><div>The study revealed a substantial gap between patient requests for analgesics and their administration, as well as an overreliance on anxiolysis compared to analgesia. Unconscious attitudes related to patient factors and subjective physician perceptions played a role in medication decisions. The findings emphasize the need for better pain assessment and management training, and awareness of implicit biases in healthcare settings. Future research should investigate optimal communication strategies and address unconscious attitudes to improve patient-centered care.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111689"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721607","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":"Intraoperative high and low blood pressures are not associated with delirium after cardiac surgery: A retrospective cohort study","authors":"Manila Singh MD ,&nbsp;Jessica Spence MD ,&nbsp;Karan Shah MS ,&nbsp;Andra E. Duncan MD, MS ,&nbsp;Donna Kimmaliardjuk MD ,&nbsp;Daniel I. Sessler MD ,&nbsp;Andrej Alfirevic MD, FASE","doi":"10.1016/j.jclinane.2024.111686","DOIUrl":"10.1016/j.jclinane.2024.111686","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the associations between high and low intraoperative time-weighted average mean arterial pressures before, during and after cardiopulmonary bypass on postoperative delirium.</div></div><div><h3>Design</h3><div>Single center retrospective cohort study.</div></div><div><h3>Setting</h3><div>Operating rooms and postoperative care units.</div></div><div><h3>Patients</h3><div>11,382 patients, 18 years of age or older who had cardiac surgery requiring cardiopulmonary bypass between January 2017 and December 2020 at the Cleveland Clinic Main Campus.</div></div><div><h3>Interventions</h3><div>All cardiac surgery requiring bypass except procedures requiring deep hypothermic circulatory arrest.</div></div><div><h3>Measurements</h3><div>Post operative delirium was assessed from 12 to 96 h postoperatively, using the Confusion Assessment Method and brief Confusion Assessment Methods. Hypotension and hypertension were defined as time-weighted average mean arterial pressure &lt; 60 and &gt; 80 mmHg.</div></div><div><h3>Main results</h3><div>Postoperative delirium occurred in 678 (6.0 %) of 11,382 patients. Confounder-adjusted associations, using multivariable logistic regression models, between hypotension (time-weighted average mean arterial pressure &lt; 60 mmHg) and hypertension (time-weighted average mean arterial pressure &gt; 80 mmHg) and postoperative delirium were not statistically significant or clinically meaningful before, during, or after the cardiopulmonary bypass.</div></div><div><h3>Conclusions</h3><div>This large single-center cohort analysis found no evidence that exposure to high or low blood pressures during various intraoperative phases of cardiac surgery are associated with postoperative delirium.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111686"},"PeriodicalIF":5.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721602","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":"Liposomal Ropivacaine: A new frontier in postoperative analgesia","authors":"Haitao Lv ,&nbsp;Li Fu ,&nbsp;Rui Dong","doi":"10.1016/j.jclinane.2024.111694","DOIUrl":"10.1016/j.jclinane.2024.111694","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111694"},"PeriodicalIF":5.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703306","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":"Acute kidney disease and postoperative glycemia variability in patients undergoing cardiac surgery: A multicenter cohort analysis of 8,090 patients","authors":"Lihai Chen MD, PhD ,&nbsp;Jie Sun MD, PhD ,&nbsp;Siyu Kong BS ,&nbsp;Qilian Tan MD ,&nbsp;Xuesheng Liu MD, PhD ,&nbsp;Yi Cheng BS ,&nbsp;Fan Yang BS ,&nbsp;Xuan Yin BS ,&nbsp;Chen Zhang BS ,&nbsp;Jiacong Liu BS ,&nbsp;Lanxin Hu BS ,&nbsp;Yali Ge MD, PhD ,&nbsp;Hongwei Shi MD, PhD ,&nbsp;Jifang Zhou MD, PhD, MPH","doi":"10.1016/j.jclinane.2024.111706","DOIUrl":"10.1016/j.jclinane.2024.111706","url":null,"abstract":"<div><h3>Background</h3><div>No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD.</div></div><div><h3>Methods</h3><div>We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days.</div></div><div><h3>Results</h3><div>During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (<em>p</em>&lt;0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 - 1.27) for SD; SHR: 1.30 (95% CI: 1.20 - 1.40) for TOR). GV was correlated with persistent AKD, while no statistically significant association was observed between GV and delayed AKD. Unique cutoff thresholds were calculated for each GV metric to provide a quantitative indicator of high GV, enhancing its practical utility.</div></div><div><h3>Conclusions</h3><div>Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111706"},"PeriodicalIF":5.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721608","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}