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Comment on "Retro superior costotransverse ligament space block as an effective analgesia after laparoscopic gastrectomy". 上肋横韧带后间隙阻滞是另一种横突间阻滞。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-12 DOI: 10.4097/kja.24283
Raghuraman M Sethuraman
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引用次数: 0
Effect of lipid emulsion on vasoconstriction induced by epinephrine or norepinephrine in isolated rat aorta. 脂质乳液对离体大鼠主动脉由肾上腺素或去甲肾上腺素引起的血管收缩的影响
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.4097/kja.24093
Soo Hee Lee, Kyeong-Eon Park, Kibaek Eum, Yeran Hwang, Seong-Ho Ok, Gyujin Sim, Dumidu Perera, Henri K M Ravald, Youngho Park, Susanne K Wiedmer, Ju-Tae Sohn

Background: Epinephrine (EPI) or norepinephrine (NOR) is widely used to treat cardiovascular collapse during lipid emulsion (LE) resuscitation for drug toxicity. However, the effect of LE on the vasoconstriction caused by EPI or NOR remains unknown. The purpose of this study was to examine the effect of an LE (Intralipid) on the vasoconstriction caused by EPI and NOR in isolated rat aorta.

Methods: The effect of LE on the vasoconstriction caused by EPI or NOR in isolated rat aorta was examined. Additionally, the effect of LE on the calcium increase caused by EPI or NOR was investigated. The distribution constant (KD: lipid to aqueous phase) of EPI or NOR between a LE (1%) and an aqueous phase was determined.

Results: LE (1 and 2%) did not significantly alter vasoconstriction caused by EPI or NOR in isolated endothelium-intact aorta. Moreover, the LE did not significantly alter the increased calcium level caused by EPI or NOR. The log KD of EPI in the LE (1%) was -0.71, -0.99, and -1.00 at 20, 50, and 100 mM ionic strength, respectively. The log KD of NOR in the LE (1%) was -1.22, -1.25, and -0.96 at 20, 50, and 100 mM ionic strength, respectively.

Conclusions: Taken together, the Intralipid emulsion did not alter vasoconstriction induced by EPI or NOR that seems to be due to the hydrophilicity of EPI or NOR, leading to sustained hemodynamic support produced by EPI or NOR used during LE resuscitation.

背景:肾上腺素(EPI)或去甲肾上腺素(NOR)被广泛用于治疗药物中毒的脂质乳剂(LE)复苏过程中的心血管衰竭。然而,LE 对 EPI 或 NOR 引起的血管收缩的影响仍然未知。本研究的目的是探讨一种脂质乳剂(Intralipid)对EPI和NOR在离体大鼠主动脉中引起的血管收缩的影响:方法:研究了LE对EPI或NOR引起的离体大鼠主动脉血管收缩的影响。此外,还研究了 LE 对 EPI 或 NOR 引起的钙增加的影响。测定了 EPI 或 NOR 在 LE(1%)和水相之间的分布常数(KD:脂相到水相):结果:LE(1% 和 2%)没有明显改变 EPI 或 NOR 在离体内皮接触主动脉中引起的血管收缩。此外,LE 对 EPI 或 NOR 引起的钙水平升高也无明显改变。在 20、50 和 100 mM 离子强度下,LE(1%)中 EPI 的对数 KD 分别为-0.71、-0.99 和-1.00。在 20、50 和 100 mM 离子强度下,LE(1%)中 NOR 的对数 KD 分别为-1.22、-1.25 和 -0.96:综上所述,Intralipid乳液不会改变EPI或NOR诱导的血管收缩,这似乎是由于EPI或NOR的亲水性所致,从而导致在LE复苏过程中使用EPI或NOR产生持续的血流动力学支持。
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引用次数: 0
Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study. 经导管主动脉瓣置换术后在监测麻醉护理下使用雷马唑仑与右美托咪定对恢复的影响:倾向得分匹配、非劣效性研究。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-23 DOI: 10.4097/kja.24138
Ji-Hyeon Kim, Jae-Sik Nam, Wan-Woo Seo, Kyung-Woon Joung, Ji-Hyun Chin, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi

Background: Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR.

Methods: In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%.

Results: The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: -0.6% [-6.7%, 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine.

Conclusions: In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.

背景:在监测麻醉护理(MAC)下进行经导管主动脉瓣置换术(TAVR)强调早期恢复。雷马唑仑是一种新型苯二氮卓类药物,恢复时间短。本研究假设,就TAVR术后恢复而言,雷马唑仑不劣于右美托咪定:在这项回顾性观察研究中,对 2020 年 7 月至 2022 年 7 月期间在一家三级学术医院接受 MAC 下 TAVR 的患者进行了雷马唑仑与右美托咪定的比较。主要研究结果是 TAVR 术后的及时康复,即术后第一天内从重症监护室出院。采用倾向得分匹配法比较雷马唑仑和右美托咪定的及时恢复情况,非劣效性差值为-10%:研究共纳入 464 名患者,其中 218 人接受了雷马唑仑治疗,246 人接受了右美托咪定治疗。经过倾向评分匹配后,每组各有164名患者纳入分析。在TAVR术后及时恢复方面,雷马唑仑的效果不劣于右美托咪定(雷马唑仑组164例中有152例[92.7%],右美托咪定组164例中有153例[93.3%],风险差异[95% CI]:-0.6% [-6.7% to 5.5%])。与右美托咪定相比,使用瑞马唑仑可减少术后使用血管加压剂/肌注(164例中的21例[12.8%]对164例中的39例[23.8%])和临时起搏器(TPM)(164例中的76例[46.3%]对164例中的108例[65.9%]):结论:对于在 MAC 下接受 TAVR 的患者,就及时恢复而言,雷马唑仑不优于右美托咪定。雷马唑仑可能与更好的术后恢复情况有关,包括对血管抑制剂/肌注和TPM的需求较少。
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引用次数: 0
Ramped versus sniffing position for Ambu® AuraGainTM insertion in patients with obesity: a randomized controlled study. 在肥胖症患者中插入 Ambu® AuraGain™ 时采用斜坡体位还是嗅觉体位:随机对照研究。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-19 DOI: 10.4097/kja.24255
Hye-Won Jeong, Hong-Beom Bae, Leyeoin Lee, Woojeong Lee, Joungmin Kim

Background: The ramped position facilitates mask ventilation and endotracheal intubation in patients with obesity. This study aimed to determine whether the ramped position improves supraglottic airway (SGA) insertion in patients with obesity.

Methods: In this prospective, randomized, single-center trial, 48 obese patients undergoing elective surgery were randomized into either ramped or sniffing position groups. The Ambu® AuraGainTM (Ambu A/S), a second-generation SGA, was used. The primary outcome was the time required for the AuraGain insertion. Secondary outcomes included ease and number of insertion attempts, oropharyngeal leak pressure (OLP), and complications. The number needed to treat (NNT) was calculated to ensure ease of insertion.

Results: The time required for the AuraGain insertion was significantly shorter in the ramped group than in the sniffing group (13.0 [11.0, 16.0] vs. 24.0 [21.0, 28.0], P < 0.001). The insertion was easier in the ramped group than in the sniffing group (23/24 vs. 13/24, NNT = 2.4 [95% CI, 1.6, 5.0], P = 0.003). The first-attempt success rate was higher in the ramped group than in the sniffing group, although the difference was not statistically significant (22/24 vs. 18/24, P = 0.319). The OLP and postoperative complication rates were not significantly different between the groups.

Conclusions: The ramped position reduced the time required for the AuraGain insertion in obese patients while providing comparable airway sealing without increasing adverse events. Therefore, a ramped position may be a more suitable option for SGA insertion in this population.

背景:斜坡体位有利于肥胖患者的喉罩通气和气管插管。本研究旨在确定斜坡体位是否能改善肥胖患者的声门上气道(SGA)插入:在这项前瞻性、随机、单中心试验中,48 名接受择期手术的肥胖患者被随机分为斜坡体位组和嗅觉体位组。使用的是第二代 SGA Ambu® AuraGain™(Ambu A/S, Ballerup, Denmark)。主要结果是插入 AuraGain 所需的时间。次要结果包括插入的难易程度和尝试次数、口咽漏压(OLP)和并发症。为确保插入的简易性,计算了治疗所需次数(NNT):结果:斜坡组插入 AuraGain 所需的时间明显短于嗅吸组(13.0 [11.0-16.0] vs. 24.0 [21.0-28.0],P < 0.001)。斜坡组比嗅吸组更容易插入(23 / 24 vs. 13 / 24,NNT = 2.4 [95% CI, 1.6-5.0],P = 0.003)。斜坡组的首次尝试成功率高于嗅吸组,但差异无统计学意义(22 / 24 vs. 18 / 24,P = 0.319)。两组的OLP和术后并发症发生率无明显差异:斜坡式体位减少了肥胖患者插入 AuraGain 所需的时间,同时提供了相当的气道密封性,而不会增加不良反应。因此,斜坡式体位可能更适合在这类人群中插入 SGA。
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引用次数: 0
Pediatric sedation and monitored anesthesia care: from chloral hydrate to remimazolam. 小儿镇静和监测麻醉护理:从水合氯醛到瑞咪唑仑。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-23 DOI: 10.4097/kja.24632
Won-Jung Shin
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引用次数: 0
Transcatheter ventilation with a modified Rapid-O2 oxygen insufflation device. 使用改良的 Rapid-O2 氧气充气装置进行经导管通气。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-09-27 DOI: 10.4097/kja.24095
Jaewon Jang, Hye Jin Kim, Hyun Joo Kim, Wyun Kon Park

Background: The Rapid-O2 oxygen insufflation device® (Rapid-O2) was designed primarily for rescue oxygenation in cannot intubate, cannot oxygenate (CICO) events; thus, hypercapnia is inevitable. Rapid-O2 was modified to enhance ventilation using the Venturi effect during expiration.

Methods: To determine the most effective combination of inner catheters (20 G, 18 G, 16 G, 14 G, and 2-mm inner diameter [ID] transtracheal catheter [TTC]) and insufflation catheters (16 G, 14 G, and 2-mm ID TTC) for achieving optimum ventilation, insufflating and expiratory flows were measured at an oxygen flow rate of 15 L/min. The insufflating and expiratory pressures were measured at 6-15 L/min. The flows and pressures were measured using a gas flow analyzer. The insufflating and expiratory times were measured using a trachea-lung model to obtain minute volumes. To assess the improvement by modifying the Rapid-O2, minute volumes were measured using the Rapid-O2.

Results: The most appropriate inner catheter was 18 G. The insufflating pressures ranged from 97 (2-mm ID TTC) to 377 cmH2O (16 G) at 15 L/min. During expiration, similar negative pressures of 50 cmH2O were measured in the insufflation catheters at 15 L/min. At lung compliance of 100 ml/cmH2O, the minute volumes through a 2-mm ID and 14 G insufflation catheters were 7.0 and 5.37 L/min, respectively, at 15 L/min. The minute volumes were significantly greater in modified Rapid-O2.

Conclusions: Modified Rapid-O2 provided sufficient minute volumes in adults using a 14 G or 2-mm ID insufflation catheter at 15 L/min, demonstrating its potential for ventilation in CICO events.

背景:Rapid-O2 氧气充注装置®(Rapid-O2)主要用于无法插管、无法吸氧(CICO)情况下的抢救性吸氧;因此,高碳酸血症不可避免。对 Rapid-O2 进行了改进,以便在呼气时利用文丘里效应加强通气:为了确定内导管(20 G、18 G、16 G、14 G 和 2 毫米内径的经气管导管 [TTC])和充气导管(16 G、14 G 和 2 毫米内径的经气管导管 [TTC])的最有效组合,以达到最佳通气效果,在氧气流速为 15 升/分钟时测量了充气和呼气流量。充气和呼气压力以 6-15 L/min 的速度测量。流量和压力使用气体流量分析仪进行测量。充气和呼气时间使用气管-肺模型进行测量,以获得分钟容量。为了评估改进 Rapid-O2 后的效果,使用 Rapid-O2 测量了分钟容量:最合适的内导管为 18 G。在 15 升/分钟的速度下,充气压力从 97(2 毫米内径 TTC)到 377 cmH2O(16 G)不等。呼气时,以 15 升/分钟的速度充气导管测得的负压类似,均为 50 cmH2O。在肺顺应性为 100 毫升/厘米水时,15 升/分钟时通过内径为 2 毫米和 14 G 的充气导管的分钟流量分别为 7.0 升/分钟和 5.37 升/分钟。结论:结论:使用 14 G 或 2 毫米内径充气导管,在 15 升/分钟的速度下,改良型 Rapid-O2 能为成人提供足够的分钟流量,这证明了其在 CICO 事件中的通气潜力。
{"title":"Transcatheter ventilation with a modified Rapid-O2 oxygen insufflation device.","authors":"Jaewon Jang, Hye Jin Kim, Hyun Joo Kim, Wyun Kon Park","doi":"10.4097/kja.24095","DOIUrl":"https://doi.org/10.4097/kja.24095","url":null,"abstract":"<p><strong>Background: </strong>The Rapid-O2 oxygen insufflation device® (Rapid-O2) was designed primarily for rescue oxygenation in cannot intubate, cannot oxygenate (CICO) events; thus, hypercapnia is inevitable. Rapid-O2 was modified to enhance ventilation using the Venturi effect during expiration.</p><p><strong>Methods: </strong>To determine the most effective combination of inner catheters (20 G, 18 G, 16 G, 14 G, and 2-mm inner diameter [ID] transtracheal catheter [TTC]) and insufflation catheters (16 G, 14 G, and 2-mm ID TTC) for achieving optimum ventilation, insufflating and expiratory flows were measured at an oxygen flow rate of 15 L/min. The insufflating and expiratory pressures were measured at 6-15 L/min. The flows and pressures were measured using a gas flow analyzer. The insufflating and expiratory times were measured using a trachea-lung model to obtain minute volumes. To assess the improvement by modifying the Rapid-O2, minute volumes were measured using the Rapid-O2.</p><p><strong>Results: </strong>The most appropriate inner catheter was 18 G. The insufflating pressures ranged from 97 (2-mm ID TTC) to 377 cmH2O (16 G) at 15 L/min. During expiration, similar negative pressures of 50 cmH2O were measured in the insufflation catheters at 15 L/min. At lung compliance of 100 ml/cmH2O, the minute volumes through a 2-mm ID and 14 G insufflation catheters were 7.0 and 5.37 L/min, respectively, at 15 L/min. The minute volumes were significantly greater in modified Rapid-O2.</p><p><strong>Conclusions: </strong>Modified Rapid-O2 provided sufficient minute volumes in adults using a 14 G or 2-mm ID insufflation catheter at 15 L/min, demonstrating its potential for ventilation in CICO events.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
A rare subclavian artery aneurysm potentially misidentified as the internal jugular vein in ultrasound-guided central venous catheterization-a case report. 超声引导中心静脉导管术中可能被误认为颈内静脉的罕见锁骨下动脉瘤--病例报告。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-09-13 DOI: 10.4097/kja.24468
Dae Yun Choi, Daeseok Oh

Background: Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations.

Case: An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's (CCA's) lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories.

Conclusions: Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification.

背景:麻醉医师进行中心静脉导管插入术存在意外穿刺动脉等风险。本病例报告重点介绍了在超声引导下颈内静脉(IJV)入路时发现的罕见锁骨下动脉瘤(SAA),强调了识别解剖变异的重要性:一位 88 岁的女性,患有高血压和心房颤动,计划进行腰椎椎板切除术和后路融合术。术前评估显示患者右下叶有肺不张和轻度主动脉硬化。在进行右侧 IJV 导管超声检查时,在颈总动脉(CCA)外侧观察到两根直径不同的血管。较大的血管在颈部上方消失,彩色多普勒显示动脉搏动。术后颈部计算机断层扫描证实右侧为 SAA,左侧颅内动脉有一个 5 毫米的囊状动脉瘤。患者无血管疾病、外伤或相关家族病史:结论:麻醉医师在进行内瘘导管插入术时应注意解剖结构的变化。多普勒超声对于准确识别动脉至关重要。
{"title":"A rare subclavian artery aneurysm potentially misidentified as the internal jugular vein in ultrasound-guided central venous catheterization-a case report.","authors":"Dae Yun Choi, Daeseok Oh","doi":"10.4097/kja.24468","DOIUrl":"https://doi.org/10.4097/kja.24468","url":null,"abstract":"<p><strong>Background: </strong>Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations.</p><p><strong>Case: </strong>An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's (CCA's) lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories.</p><p><strong>Conclusions: </strong>Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Effects of opioid-sparing general anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery. 节省阿片类药物的全身麻醉对腹腔镜妇科手术术后恶心和呕吐的影响。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-08-23 DOI: 10.4097/kja.24336
Sun Woo Nam, Sang-Hwan Do, Jung-Won Hwang, Insun Park, Insung Hwang, Hyo-Seok Na

Background: In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery.

Methods: Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day (POD) 1.

Results: A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups.

Conclusions: OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.

背景:本研究旨在探讨阿片类药物保留麻醉(OSA)能否减轻腹腔镜妇科手术患者的术后恶心和呕吐(PONV):接受择期腹腔镜妇科手术的成人患者被随机分配到使用阿片类药物麻醉(OUA)组或OSA组。在OUA组,全身麻醉期间使用瑞芬太尼作为阿片类药物。在 OSA 组中,除了在气管插管时单次使用 5 μg/kg 阿芬太尼外,没有使用其他阿片类药物。两组患者在麻醉后护理病房(PACU)均优先使用多模式静脉注射非阿片类镇痛方案。主要结果是根据术后第 1 天(POD)前的症状评估 PONV 发生率:本研究共纳入了 120 名患者。与 OUA 组相比,OSA 组在 PACU 中的恶心发生率明显降低(OSA 组为 31.7%,OUA 组为 51.7%,P = 0.026)。在PACU住院期间,OSA组的疼痛评分和阿片类镇痛药用药发生率较低,因此需要阿片类镇痛药抢救的患者人数显著减少(3.3% vs. 18.3%,P = 0.008)。两组患者在术中生命体征、血流动力学干预、PACU和住院时间方面没有明显差异:结论:OSA能明显减轻腹腔镜妇科手术患者的术后恶心、疼痛评分以及在PACU抢救镇痛剂的需求,同时不会增加血液动力学的不稳定性。
{"title":"Effects of opioid-sparing general anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery.","authors":"Sun Woo Nam, Sang-Hwan Do, Jung-Won Hwang, Insun Park, Insung Hwang, Hyo-Seok Na","doi":"10.4097/kja.24336","DOIUrl":"https://doi.org/10.4097/kja.24336","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to investigate whether opioid-sparing anesthesia (OSA) reduces postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecological surgery.</p><p><strong>Methods: </strong>Adult patients undergoing elective laparoscopic gynecological surgery were randomly assigned to either the opioid-using anesthesia (OUA) or the OSA groups. In the OUA group, remifentanil was administered as an opioid during general anesthesia. In the OSA group, apart from a single dose of 5 μg/kg of alfentanil for tracheal intubation, no other opioids were used. In both groups, a multimodal intravenous non-opioid analgesic regimen was used preferentially in the post-anesthesia care unit (PACU). The primary outcome was the incidence of PONV, assessed by symptoms until the postoperative day (POD) 1.</p><p><strong>Results: </strong>A total of 120 patients were included in this study. The incidence of nausea in the PACU was significantly lower in the OSA group compared to in the OUA group (31.7% in the OSA group vs. 51.7% in the OUA group, P = 0.026). Pain scores and the incidence of opioid analgesic administration were lower in the OSA group during PACU stay, resulting in a significantly lower number of patients requiring rescue opioid analgesics (3.3% vs. 18.3%, P = 0.008). There were no significant differences in intraoperative vital signs, hemodynamic interventions, or duration of PACU and hospital stay between the two groups.</p><p><strong>Conclusions: </strong>OSA significantly reduced postoperative nausea, pain scores, and the need for rescue analgesics in the PACU without increasing hemodynamic instability in patients undergoing laparoscopic gynecological surgery.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial. 左侧鼻气管插管中的反向插管方向与鼻衄:随机对照试验。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-08-21 DOI: 10.4097/kja.24337
Jun-Young Park, Jihion Yu, Chan-Sik Kim, Taeho Mun, Woo Shik Jeong, Jong Woo Choi, Kichang Lee, Young-Kug Kim

Background: The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril.

Methods: Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy.

Results: The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk = 0.45; 95% CI: 0.24, 0.85; absolute risk reduction = 29.8%; number needed to treat = 3.36). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group.

Conclusions: The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.

背景:经左鼻孔进行鼻气管插管时鼻衄的发生率高于经右鼻孔插管。本研究评估了鼻气管导管的反向斜面和尖端方向对经左鼻孔进行鼻气管插管时鼻衄发生率的影响:接受右侧颌面外科手术、需要左侧鼻气管插管的患者被随机分配到对照组(气管导管按常规方向)或反向组(180˚反向,导管斜面朝向鼻中隔,斜面前缘(即尖端)远离鼻中隔)(两组均为37人)。主要结果是使用视频喉镜评估鼻衄的发生率:结果:反向组鼻衄发生率明显低于对照组(9 [24.3%] vs. 20 [54.1%],P = 0.009;相对风险 = 0.45;95% CI:0.24, 0.85;绝对风险降低 = 29.8%;治疗所需人数 = 3.36)。反向组鼻衄的严重程度明显降低(P = 0.002)。反向组首次尝试鼻腔通过率(P = 0.027)明显更高。反向组术后鼻腔疼痛较低(P < 0.001),患者满意度较高(P < 0.001)。两组患者均未出现气管导管相关并发症:结论:鼻气管插管的反向斜面和尖端方向降低了鼻衄的发生率和严重程度,提高了左鼻气管插管患者的满意度。
{"title":"Reverse tube direction and epistaxis in left nasotracheal intubation: a randomized controlled trial.","authors":"Jun-Young Park, Jihion Yu, Chan-Sik Kim, Taeho Mun, Woo Shik Jeong, Jong Woo Choi, Kichang Lee, Young-Kug Kim","doi":"10.4097/kja.24337","DOIUrl":"https://doi.org/10.4097/kja.24337","url":null,"abstract":"<p><strong>Background: </strong>The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril.</p><p><strong>Methods: </strong>Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy.</p><p><strong>Results: </strong>The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk = 0.45; 95% CI: 0.24, 0.85; absolute risk reduction = 29.8%; number needed to treat = 3.36). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group.</p><p><strong>Conclusions: </strong>The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Comment on "The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: a prospective randomized controlled trial". 就 "使用瑞马唑仑与七氟醚进行全身麻醉后恶心和呕吐的发生率:一项前瞻性随机对照试验 "发表评论。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-08-12 DOI: 10.4097/kja.24381
Murat Izgi, Betul Basaran
{"title":"Comment on \"The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: a prospective randomized controlled trial\".","authors":"Murat Izgi, Betul Basaran","doi":"10.4097/kja.24381","DOIUrl":"https://doi.org/10.4097/kja.24381","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Korean Journal of Anesthesiology
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