Journal of Clinical Anesthesia最新文献

{"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}

{"title":"The clinical application of transcutaneous carbon dioxide monitoring during rigid bronchoscopy or microlaryngeal surgery in children","authors":"Jan J. van Wijk M.D. ,&nbsp;Norani H. Gangaram-Panday M.D. ,&nbsp;Willem van Weteringen M.D. ,&nbsp;Bas Pullens M.D., Ph.D ,&nbsp;Simone E. Bernard M.D. ,&nbsp;Sanne E. Hoeks Ph.D ,&nbsp;Irwin K.M. Reiss M.D., Ph.D ,&nbsp;Robert J. Stolker M.D., Ph.D ,&nbsp;Lonneke M. Staals M.D., Ph.D","doi":"10.1016/j.jclinane.2024.111692","DOIUrl":"10.1016/j.jclinane.2024.111692","url":null,"abstract":"<div><h3>Study objective</h3><div>During rigid bronchoscopies and microlaryngeal surgery (MLS) in children, there is currently no reliable method for managing ventilation strategies based on carbon dioxide (CO₂) levels. This study aimed to investigate the effects of the clinical implementation of transcutaneous CO₂ (tcPCO₂) monitoring during rigid bronchoscopies or MLS.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting</h3><div>Operating theatre of a tertiary pediatric hospital, from January 2019 to March 2021.</div></div><div><h3>Patients</h3><div>Children with an age &lt; 18 years, undergoing rigid bronchoscopy or MLS, were eligible for inclusion. Children with tracheostomy and/or skin conditions limiting tcPCO₂ monitoring were excluded.</div></div><div><h3>Interventions</h3><div>TcPCO₂ monitoring was performed in two groups; blinded before clinical implementation (control group) and visible for ventilation management after clinical implementation (tcPCO₂ group).</div></div><div><h3>Measurements</h3><div>The total tcPCO₂ load outside of the normal range (35–48 mm Hg) was calculated as the area under the curve (AUC) and compared between the groups. Anesthesiologists in the tcPCO₂ group received a questionnaire after each procedure.</div></div><div><h3>Main results</h3><div>A total of 120 patients were included. No significant differences were found between the two groups in the AUC during the procedure (19,202 (7,863–44,944) vs 17,737 (9,800–47,566) mm Hg · s, <em>P</em> = 0.84) or between different ventilation strategies. The maximal tcPCO₂ level was 69.2 (62.1–81.2) mm Hg in the control group and 71.1 (62.8–80.8) mm Hg, (<em>P</em> = 0.85) in the tcPCO₂ group. Spontaneous breathing was associated with lower tcPCO₂ levels. The general satisfaction score of tcPCO₂ monitoring rated by the anesthesiologist was 8.19 (0.96).</div></div><div><h3>Conclusions</h3><div>TcPCO₂ levels reached approximately twice the upper limit of the normal range during rigid bronchoscopy and MLS. Availability of tcPCO₂ monitoring did not affect these high levels, despite adjustments in strategy. However, tcPCO₂ monitoring provides valuable insight in CO₂ load and applied ventilation strategies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111692"},"PeriodicalIF":5.0,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703305","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":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(24)00326-X","DOIUrl":"10.1016/S0952-8180(24)00326-X","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111697"},"PeriodicalIF":5.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700764","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":"Oral ketamine for acute postoperative analgesia (OKAPA) trial: A randomized controlled, single center pilot study","authors":"Michael Dinsmore MD, PhD, FRCPC ,&nbsp;Kristof Nijs MD, MSc ,&nbsp;Eric Plitman PhD ,&nbsp;Emad Al Azazi MD, PhD ,&nbsp;Lashmi Venkatraghavan MD, DNB, FRCA, FRCPC ,&nbsp;Karim Ladha MD, MSc ,&nbsp;Hance Clarke MD","doi":"10.1016/j.jclinane.2024.111690","DOIUrl":"10.1016/j.jclinane.2024.111690","url":null,"abstract":"<div><h3>Study objective</h3><div>Although opioids represent the mainstay of treating surgical pain, their use is associated with significant side effects. There is an urgent need to find new pain relievers with safer side effect profiles. One drug that has been receiving increasing attention is ketamine. By using the oral route of administration, ketamine could potentially be used by patients in a less resource-intensive manner with similar efficacy. This study aims to examine the role of oral ketamine in improving recovery after major spine surgery.</div></div><div><h3>Design</h3><div>A prospective, single-center, double blinded parallel arm, placebo controlled randomized feasibility trial.</div></div><div><h3>Setting</h3><div>Toronto Western Hospital (TWH), UHN, Toronto, Canada.</div></div><div><h3>Patients</h3><div>Adult patients (aged 18–75) undergoing multi-level lumbar spine decompression and fusion with planned overnight admission in hospital.</div></div><div><h3>Interventions</h3><div>Study treatment (oral ketamine 30 mg) or matching placebo for three days (nine doses total) or until hospital discharge.</div></div><div><h3>Measurements</h3><div>The primary outcome was the patient-reported Quality of Recovery-15 score (QoR-15). Secondary outcomes were opioid use, pain intensity, pain interference (PROMIS-pain interference questionnaire), mood (PHQ-9) and, side-effects (Generic Assessment of Side Effects Scale).</div></div><div><h3>Main results</h3><div>Data from 35 patients were analyzed, of which 18 patients in the ketamine group and 17 patients in the placebo group. There were no significant differences identified in QoR-15 scores at postoperative days 1,3,7, and 30. There were also no significant differences found in pain intensity scale scores at postoperative days 1, 3, 7, and 30, and PROMIS and PHQ-9 scores at postoperative days 7 and 30. Significantly less oral opioids were used in the ketamine group compared to the placebo group on postoperative day 3 and by postoperative day 7. In addition, patients in the ketamine group spent significantly less days on oral opioids and trended to be discharged from hospital earlier.</div></div><div><h3>Conclusion</h3><div>This pilot study demonstrated that low dose oral ketamine can be safely used as an adjunct in postoperative pain treatment to help reduce opioid consumption after major spine surgery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111690"},"PeriodicalIF":5.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693025","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 “The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial”","authors":"Jianjun Yang,&nbsp;Pinguo Fu","doi":"10.1016/j.jclinane.2024.111691","DOIUrl":"10.1016/j.jclinane.2024.111691","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"Article 111691"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687227","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":"Defining standards of care for AI and clinicians alike: Regarding ChatGPT in labor analgesia management","authors":"Alejandro Fuentes ,&nbsp;Rene de la Fuente ,&nbsp;Fernando R. Altermatt","doi":"10.1016/j.jclinane.2024.111673","DOIUrl":"10.1016/j.jclinane.2024.111673","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111673"},"PeriodicalIF":5.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621309","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":"Continuous vital sign monitoring on surgical wards: The COSMOS pilot","authors":"Nikola Anusic MD ,&nbsp;Alper Gulluoglu MD ,&nbsp;Elyad Ekrami MD ,&nbsp;Edward J. Mascha PhD ,&nbsp;Shuyi Li MS ,&nbsp;René Coffeng ,&nbsp;Alparslan Turan MD ,&nbsp;Amber Clemens BSN RN ,&nbsp;Christine Perez RN ,&nbsp;John W. Beard MD ,&nbsp;Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2024.111661","DOIUrl":"10.1016/j.jclinane.2024.111661","url":null,"abstract":"<div><h3>Study objectives</h3><div>Alerts for vital sign abnormalities seek to identify meaningful patient instability while limiting alarm fatigue. Optimal vital sign alarm settings for postoperative patients remain unknown, as is whether alerts lead to effective clinical responses reducing vital sign disturbances. We conducted a 2-phase pilot study to identify thresholds and delays and test the hypothesis that alerts from continuous monitoring reduce the duration of vital sign abnormalities.</div></div><div><h3>Design</h3><div>Two-phase pilot.</div></div><div><h3>Patients</h3><div>250 adults having major non-cardiac surgery.</div></div><div><h3>Setting</h3><div>Surgical wards.</div></div><div><h3>Intervention</h3><div>All patients had routine vital sign monitoring by nurses at 4-h intervals. We initially continuously recorded clinician-blinded saturation, heart rate, and respiratory rate in 100 patients. In the second phase, we randomized 150 patients to blinded versus unblinded continuous vital sign monitoring. In unblinded patients, nurses were verbally alerted to abnormal vital signs.</div></div><div><h3>Measurements</h3><div>In the first phase, we modeled expected alarm counts using 6082 h of continuous oxygen saturation, heart rate, and respiratory rate data. Thresholds and delays targeting ∼3 alarms per patient per day were selected for phase two. Primary analysis assessed the effect of unblinded monitoring across a 5-component primary composite of cumulative durations of vital sign abnormalities. Secondary outcomes included fraction of alerts deemed meaningful by nurses and number of clinical interventions.</div></div><div><h3>Results</h3><div>In phase one, we identified alarm settings that yielded an average of 2.3 alerts per patient per day. In phase two, the average relative effect ratio of geometric duration means for vital signs exceeding thresholds was 0.75 [95 % CI: 0.51, 1.1], <em>P</em> = 0.17. Sixty alarms (82 %) were deemed useful in unblinded patients, leading to 60 % more interventions in unblinded patients.</div></div><div><h3>Conclusions</h3><div>We were able to select continuous saturation, heart rate, and respiratory rate thresholds that generated about 2 alerts per patient per day, nearly all of which were considered useful by nurses. Unblinded monitoring and nursing alerts led to interventions (mostly increasing oxygen delivery) that non-significantly reduced vital sign abnormalities by 25 %.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> registration: <span><span>NCT05280574</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111661"},"PeriodicalIF":5.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621308","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}