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Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report. 经计算机断层扫描肺血管造影证实的食管镜检查过程中的静脉空气栓塞--病例报告。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-06-25 DOI: 10.4097/kja.23722.e1
Thadakorn Tantisarasart, Thara Tantichamnankul, Chanatthee Kitsiripant, Panjai Choochuen
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引用次数: 0
Damage-associated molecular patterns as a mechanism of sevoflurane-induced neuroinflammation in neonatal rodents. 损伤相关分子模式是七氟醚诱导新生啮齿动物神经炎症的一种机制。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-04-01 DOI: 10.4097/kja.23796
Young-Eun Joe, Ji Hae Jun, Ju Eun Oh, Jeong-Rim Lee

Background: General anesthesia is inevitable for pediatric patients undergoing surgery, though volatile anesthetic agents may cause neuroinflammation and neurodevelopmental impairment; however, the underlying pathophysiology remains unclear. We aimed to investigate the neuroinflammation mechanism in developing rat brains associated with sevoflurane exposure time, by identifying the specific damage-associated molecular patterns (DAMPs) pathway and evaluating the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in alleviating neuroinflammation.

Methods: A three-step experiment was conducted to investigate neuroinflammation induced by sevoflurane. First, the exposure time required for sevoflurane to cause neuroinflammation was determined. Next, the specific pathways of DAMPs involved in neuroinflammation by sevoflurane were identified. Finally, the effects of NSAIDs on sevoflurane-induced neuroinflammation were investigated. The expression of various molecules in the rat brain were assessed using immunohistochemistry, immunofluorescence, quantitative real-time polymerase chain reaction, western blot analysis, and enzyme-linked immunosorbent assay.

Results: In total, 112 rats (aged 7 days) were used, of which six rats expired during the experiment (mortality rate, 5.3%). Expression of CD68, HMGB-1, galectin-3, TLR4, TLR9, and phosphorylated NF-κB was significantly increased upon 6 h of sevoflurane exposure. Conversely, transcriptional levels of TNF-α and IL-6 significantly increased and IFN-γ significantly decreased after 6 h of sevoflurane exposure. Co-administration of NSAIDs with sevoflurane anesthesia significantly attenuated TNF-α and IL-6 levels and restored IFN-γ levels.

Conclusions: In conclusion, 6 h of sevoflurane exposure induces neuroinflammation through the DAMPs pathway, HMGB-1, and galectin-3. Co-administration of ibuprofen reduced sevoflurane-induced neuroinflammation.

背景:小儿患者接受手术时不可避免地要进行全身麻醉,尽管挥发性麻醉剂可能会引起神经炎症和神经发育障碍,但其潜在的病理生理学仍不清楚。我们的目的是通过确定特定的损伤相关分子模式(DAMPs)通路和评估非甾体类抗炎药(NSAIDs)缓解神经炎症的效果,研究发育中大鼠大脑神经炎症机制与七氟醚暴露时间的关系:研究七氟醚诱导的神经炎症的实验分为三个步骤。首先,确定了七氟烷引起神经炎症所需的暴露时间。接着,确定了七氟烷引起神经炎症的 DAMPs 的具体途径。最后,研究了非甾体抗炎药对七氟烷诱导的神经炎症的影响。采用免疫组织化学(IHC)、免疫荧光(IF)、定量实时聚合酶链反应(PCR)、Western 印迹分析和酶联免疫吸附试验(ELISA)等方法评估了大鼠大脑中各种分子的表达情况:共使用了 112 只大鼠(7 d 岁),其中 6 只大鼠在实验过程中死亡(死亡率为 5.3%)。七氟醚暴露 6 小时后,CD68、HMGB-1、galectin-3、TLR4、TLR9 和磷酸化 NF-κB 的表达量显著增加。相反,七氟醚暴露 6 小时后,TNF-α 和 IL-6 的转录水平明显升高,IFN-γ 则明显降低。在进行七氟醚麻醉的同时服用非甾体抗炎药可明显降低TNF-α和IL-6的水平,并恢复IFN-γ的水平:总之,七氟醚暴露 6 小时可通过 DAMPs 途径、HMGB-1 和 galectin-3 诱导神经炎症。同时服用布洛芬可减轻七氟烷诱导的神经炎症。
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引用次数: 0
Effect of perioperative intravenous ibuprofen versus acetaminophen on postoperative opioid consumption and pain after general anesthesia: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials. 围手术期静脉注射布洛芬与对乙酰氨基酚对术后阿片类药物消耗量和全身麻醉后疼痛的影响:随机对照试验的系统回顾和荟萃分析。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-08-01 Epub Date: 2024-05-07 DOI: 10.4097/kja.24089
Sung Hye Kim, Hyun Kang, In-Jung Jun, Hye Won Park, Byung Hoon Yoo, Yun-Hee Lim, Kye-Min Kim

Background: Ibuprofen and acetaminophen are widely used as adjuvant analgesics for postoperative pain. This meta-analysis compared the effects of intravenous (IV) ibuprofen and acetaminophen on postoperative opioid consumption and pain intensity after general anesthesia.

Methods: PubMed/MEDLINE, EMBASE, and Cochrane Library databases were searched to identify relevant studies published up to May 2023. Randomized controlled trials comparing the effects of perioperative IV ibuprofen and acetaminophen on postoperative opioid consumption and pain after general anesthesia were included in the meta-analysis and trial sequential analysis (TSA).

Results: Eight studies with 494 participants were included. Compared to IV acetaminophen, IV ibuprofen significantly reduced 24 h opioid consumption, presented as morphine equivalents (mean difference [MD]: -6.01 mg, 95% CI [-8.60, -3.42], P < 0.00001, I2 = 55%), and pain scores (on a scale of 0-10) at 4-6 h (MD: -0.83, 95% CI [-1.29, -0.37], P = 0.0004, I2 = 65%) and 12 h (MD: -0.38, 95% CI [-0.68, -0.08], P = 0.01, I2 = 11%) postoperatively. These results were statistically significant in TSA. Pain scores at 24 h postoperatively and side effects were not significantly different between the two groups in the meta-analysis, and TSA revealed that the sample size was too small to adequately evaluate the effects, requiring further studies for conclusive results.

Conclusions: Perioperative IV ibuprofen reduced 24 h opioid consumption and pain severity up to 12 h postoperatively compared to acetaminophen. Additional research is required to assess pain intensity beyond 12 h and side effects.

背景:布洛芬和对乙酰氨基酚被广泛用作术后疼痛的辅助镇痛药。这项荟萃分析比较了静脉注射布洛芬和对乙酰氨基酚对术后阿片类药物消耗量和全身麻醉后疼痛强度的影响:方法:检索了 PubMed/MEDLINE、EMBASE 和 Cochrane Library 数据库,以确定截至 2023 年 5 月发表的相关研究。荟萃分析和试验序列分析(TSA)纳入了比较围手术期静脉注射布洛芬和对乙酰氨基酚对术后阿片类药物消耗量和全身麻醉后疼痛影响的随机对照试验(RCT):结果:共纳入8项研究,494名参与者。与静脉注射对乙酰氨基酚相比,静脉注射布洛芬可显著减少 24 小时阿片类药物的消耗量(以吗啡当量表示)(平均差 [MD]:-6.01 毫克,95% CI [-8.60,-3.42],P < 0.00001,I2 = 55%),以及术后 4-6 h(MD:-0.83,95% CI [-1.29,-0.37],P = 0.0004,I2 = 65%)和 12 h(MD:-0.38,95% CI [-0.68,-0.08],P = 0.01,I2 = 11%)的疼痛评分(0-10 分)。这些结果在 TSA 中具有统计学意义。在荟萃分析中,两组患者术后24小时的疼痛评分和副作用没有显著差异,TSA显示样本量太小,无法充分评估效果,需要进一步研究才能得出结论:结论:与对乙酰氨基酚相比,围手术期静脉注射布洛芬可减少术后24小时阿片类药物的用量和术后12小时内的疼痛严重程度。需要进行更多的研究来评估 12 小时后的疼痛强度和副作用。
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引用次数: 0
Neuroprotective effect of erythropoietin on anesthesia-induced neurotoxicity through the modulation of autophagy in Caenorhabditis elegans. 促红细胞生成素通过调节草履虫自噬对麻醉诱导的神经毒性的神经保护作用
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-15 DOI: 10.4097/kja.23789
Bon-Wook Koo, Hyun-Jung Shin, Sooyoung Jeon, Jung Hyun Bang, Sang-Hwan Do, Hyo-Seok Na

Background: The anti-oxidative, anti-inflammatory, and anti-apoptotic effects of erythropoietin may provide neuroprotective effects. Erythropoietin also modulates autophagy signaling that may play a role in anesthesia-induced neurotoxicity (AIN). Herein, we investigated whether AIN can be attenuated by the neuroprotective effect of erythropoietin in the Caenorhabditis elegans (C. elegans).

Methods: Synchronized worms were divided into the control, Iso, EPO, and EPO-Iso groups. The chemotaxis index (CI) was evaluated when they reached the young adult stage. The lgg-1::GFP-positive puncta per seam cell were used to determine the autophagic events. The erythropoietin-mediated pathway of autophagy was determined by measuring the genetic expression level of let-363, bec-1, atg-7, atg-5, and lgg-3.

Results: Increased lgg-1::GFP puncta were observed in the Iso, EPO, and EPO-Iso groups. In the Iso group, only the let-363 level decreased significantly as compared to that in the control group (P = 0.009). bec-1 (P < 0.001), atg-5 (P = 0.012), and lgg-3 (P < 0.001) were expressed significantly more in the EPO-Iso group than in the Iso groups. Repeated isoflurane exposure during development decreased the CI. Erythropoietin could restore the decreased CI by isoflurane significantly in the EPO-Iso group.

Conclusions: Erythropoietin showed neuroprotective effects against AIN and modulated the autophagic pathway in C. elegans. This experimental evidence of erythropoietin-related neuroprotection against AIN may be correlated with the induced autophagic degradation process that was sufficient for handling enhanced autophagy induction in erythropoietin-treated worms.

背景:促红细胞生成素的抗氧化、抗炎和抗凋亡作用可能具有神经保护作用。红细胞生成素还能调节自噬信号,而自噬信号可能在麻醉诱导的神经毒性(AIN)中发挥作用。在此,我们研究了红细胞生成素的神经保护作用是否可减轻优雅鼠(C. elegans)的 AIN:方法:将同步化蠕虫分为对照组、Iso 组、EPO 组和 EPO-Iso 组。方法:将同步蠕虫分为对照组、Iso组、EPO组和EPO-Iso组,在它们达到幼虫期时评估趋化指数(CI)。用每个接缝细胞中的 lgg-1::GFP 阳性点来确定自噬事件。通过测量 let-363、bec-1、atg-7、atg-5 和 lgg-3 的基因表达水平,确定了促红细胞生成素介导的自噬途径:结果:在Iso组、EPO组和EPO-Iso组观察到lgg-1::GFP点的增加。Bec-1(P<0.001)、atg-5(P<0.012)和 lgg-3(P<0.001)在 EPO-Iso 组的表达明显高于 Iso 组。发育过程中反复暴露于异氟醚会降低 CI。在EPO-Iso组中,红细胞生成素可明显恢复异氟醚导致的CI下降:结论:红细胞生成素具有抗 AIN 的神经保护作用,并能调节秀丽隐杆线虫的自噬途径。这一与促红细胞生成素相关的抗 AIN 神经保护作用的实验证据可能与诱导的自噬降解过程有关,该过程足以处理促红细胞生成素处理蠕虫中增强的自噬诱导。
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引用次数: 0
Sudden ventricular fibrillation due to absence of pericardium in left upper lobectomy -a case report. 左上叶切除术中心包缺失导致的突发性心室颤动:病例报告。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-01-16 DOI: 10.4097/kja.23625
Guo-Cao Wang, Xi-Rong Li, Ning Huang, Hai-Tao Tian

Background: Congenital absence of the pericardium (CAP) is a rare cardiac abnormality. As pericardial defects are usually asymptomatic, most cases are diagnosed during surgery or on autopsy. The patient in this case was found to have CAP during thoracoscope.

Case: We present the unusual case of a 69-year-old patient with CAP who experienced sudden ventricular arrhythmia and developed ventricular fibrillation during left upper lobectomy. Surgical operations, the lateral decubitus position, and other external stimuli may be important risk factors for ventricular fibrillation. The patient regained sinus rhythm soon after intrathoracic cardiac compression and pharmacological treatment, including lidocaine spray (2%, 10 ml) administered to the heart surface. The surgery was then completed without any additional instances of ventricular arrhythmia.

Conclusions: Patients with CAP are more susceptible to cardiac-related adverse events during thoracotomy or thoracoscopy. Treatment of ventricular arrhythmias that occur during lung resection in patients with CAP should be emphasized.

背景:先天性心包缺失(CAP)是一种罕见的心脏畸形。由于心包缺损通常没有症状,大多数病例都是在手术或尸检时被诊断出来的。本病例中的患者在胸腔镜检查时被发现患有 CAP:本病例是一例不寻常的病例,69 岁的 CAP 患者在进行左上肺叶切除术时突发室性心律失常并发展为心室颤动。手术操作、侧卧位和其他外部刺激可能是室颤的重要危险因素。经过胸腔内心脏加压和药物治疗(包括在心脏表面喷洒利多卡因(2%,10 毫升))后,患者很快恢复了窦性心律。随后,手术顺利完成,未再发生室性心律失常:结论:CAP 患者在进行开胸手术或胸腔镜手术时更容易发生与心脏相关的不良事件。结论:CAP 患者在胸廓切开术或胸腔镜手术中更容易发生与心脏相关的不良事件,因此应重视治疗 CAP 患者在肺切除术中出现的室性心律失常。
{"title":"Sudden ventricular fibrillation due to absence of pericardium in left upper lobectomy -a case report.","authors":"Guo-Cao Wang, Xi-Rong Li, Ning Huang, Hai-Tao Tian","doi":"10.4097/kja.23625","DOIUrl":"10.4097/kja.23625","url":null,"abstract":"<p><strong>Background: </strong>Congenital absence of the pericardium (CAP) is a rare cardiac abnormality. As pericardial defects are usually asymptomatic, most cases are diagnosed during surgery or on autopsy. The patient in this case was found to have CAP during thoracoscope.</p><p><strong>Case: </strong>We present the unusual case of a 69-year-old patient with CAP who experienced sudden ventricular arrhythmia and developed ventricular fibrillation during left upper lobectomy. Surgical operations, the lateral decubitus position, and other external stimuli may be important risk factors for ventricular fibrillation. The patient regained sinus rhythm soon after intrathoracic cardiac compression and pharmacological treatment, including lidocaine spray (2%, 10 ml) administered to the heart surface. The surgery was then completed without any additional instances of ventricular arrhythmia.</p><p><strong>Conclusions: </strong>Patients with CAP are more susceptible to cardiac-related adverse events during thoracotomy or thoracoscopy. Treatment of ventricular arrhythmias that occur during lung resection in patients with CAP should be emphasized.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"401-404"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of analgesic effects between programmed intermittent epidural boluses and continuous epidural infusion after cesarean section: a randomized controlled study. 剖宫产术后程序化间歇硬膜外注射与连续硬膜外输注镇痛效果的比较:随机对照研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.4097/kja.23726
Yu Jeong Bang, Heejoon Jeong, RyungA Kang, Ji-Hee Sung, Suk-Joo Choi, Soo-Young Oh, Tae Soo Hahm, Young Hee Shin, Yeon Woo Jeong, Soo Joo Choi, Justin Sangwook Ko

Background: This study aimed to compare the analgesic effects of programmed intermittent epidural boluses (PIEB) and continuous epidural infusion (CEI) for postoperative analgesia after elective cesarean section (CS).

Methods: Seventy-four women who underwent elective CS were randomized to receive either PIEB or CEI. The PIEB group received 4 ml-intermittent boluses of 0.11% ropivacaine every hour at a rate of 120 ml/h. The CEI group received a constant rate of 4 ml/h of 0.11% ropivacaine. The primary outcome was the pain score at rest at 36 h after CS. Secondary outcomes included the pain scores during mobilization, time-weighted pain scores, the incidence of motor blockade, and complications-related epidural analgesia during 36 h after CS.

Results: The pain score at rest at 36 h after CS was significantly lower in the PIEB group compared with that in the CEI group (3.0 vs. 0.0; median difference: 2, 95% CI [1, 2], P < 0.001). The mean time-weighted pain scores at rest and during mobilizations were also significantly lower in the PIEB group than in the CEI group (pain at rest; mean difference [MD]: 37.5, 95% CI [24.6, 50.4], P < 0.001/pain during mobilization; MD: 56.6, 95% CI [39.8, 73.5], P < 0.001). The incidence of motor blockade was significantly reduced in the PIEB group compared with that in the CEI group (P < 0.001).

Conclusions: PIEB provides superior analgesia with less motor blockade than CEI in postpartum women after CS, without any apparent adverse events.

背景:本研究旨在比较程序性间歇硬膜外栓剂(PIEB)和连续硬膜外输液(CEI)对择期剖宫产术(CS)术后镇痛的效果:74名接受择期剖宫产术的女性被随机分配到PIEB或CEI组。PIEB 组每小时以 120 毫升/小时的速度间歇注射 4 毫升 0.11% 罗哌卡因。CEI组接受4毫升/小时的0.11%罗哌卡因恒定注射。主要结果是 CS 后 36 小时休息时的疼痛评分。次要结果包括活动时的疼痛评分、时间加权疼痛评分、运动阻滞发生率和 CS 后 36 小时内硬膜外镇痛相关并发症:CS后36小时静息时的疼痛评分,PIEB组明显低于CEI组(3.0 vs. 0.0;中位数差异,2;95% CI:1,2;P < 0.001)。PIEB组在休息时和活动时的平均时间加权疼痛评分也显著低于CEI组(休息时疼痛:平均差异,37.5;95% CI,[24.6,50.4];P <0.001;活动时疼痛:平均差异,56.6;95% CI,[39.8,73.5];P <0.001)。与CEI组相比,PIEB组的运动阻滞发生率明显降低(P < 0.001):结论:与CEI相比,PIEB能为CS后的产后妇女提供更好的镇痛效果,同时减少运动阻滞,且无任何明显的不良反应。
{"title":"Comparison of analgesic effects between programmed intermittent epidural boluses and continuous epidural infusion after cesarean section: a randomized controlled study.","authors":"Yu Jeong Bang, Heejoon Jeong, RyungA Kang, Ji-Hee Sung, Suk-Joo Choi, Soo-Young Oh, Tae Soo Hahm, Young Hee Shin, Yeon Woo Jeong, Soo Joo Choi, Justin Sangwook Ko","doi":"10.4097/kja.23726","DOIUrl":"10.4097/kja.23726","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the analgesic effects of programmed intermittent epidural boluses (PIEB) and continuous epidural infusion (CEI) for postoperative analgesia after elective cesarean section (CS).</p><p><strong>Methods: </strong>Seventy-four women who underwent elective CS were randomized to receive either PIEB or CEI. The PIEB group received 4 ml-intermittent boluses of 0.11% ropivacaine every hour at a rate of 120 ml/h. The CEI group received a constant rate of 4 ml/h of 0.11% ropivacaine. The primary outcome was the pain score at rest at 36 h after CS. Secondary outcomes included the pain scores during mobilization, time-weighted pain scores, the incidence of motor blockade, and complications-related epidural analgesia during 36 h after CS.</p><p><strong>Results: </strong>The pain score at rest at 36 h after CS was significantly lower in the PIEB group compared with that in the CEI group (3.0 vs. 0.0; median difference: 2, 95% CI [1, 2], P < 0.001). The mean time-weighted pain scores at rest and during mobilizations were also significantly lower in the PIEB group than in the CEI group (pain at rest; mean difference [MD]: 37.5, 95% CI [24.6, 50.4], P < 0.001/pain during mobilization; MD: 56.6, 95% CI [39.8, 73.5], P < 0.001). The incidence of motor blockade was significantly reduced in the PIEB group compared with that in the CEI group (P < 0.001).</p><p><strong>Conclusions: </strong>PIEB provides superior analgesia with less motor blockade than CEI in postpartum women after CS, without any apparent adverse events.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"374-383"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perioperative management of patients with cardiac implantable electronic devices. 心脏植入式电子设备患者的围手术期管理。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-01-29 DOI: 10.4097/kja.23826
Minsu Kim, Chang Hee Kwon

The use of cardiac implantable electronic devices (CIEDs) has increased significantly in recent years. Consequently, more patients with CIEDs will undergo surgery during their lifetime, and thus the involvement of anesthesiologists in the perioperative management of CIEDs is increasing. With ongoing advancements in technology, many types of CIEDs have been developed, including permanent pacemakers, leadless pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy-pacemakers/defibrillators, and implantable loop recorders. The functioning of CIEDs exposed to an electromagnetic field can be affected by electromagnetic interference, potential sources of which can be found in the operating room. Thus, to prevent potential adverse events caused by electromagnetic interference in the operating room, anesthesiologists must have knowledge of CIEDs and be able to identify each type. This review focuses on the perioperative management of patients with CIEDs, including indications for CIED implantation to determine the baseline cardiovascular status of patients; concerns associated with CIEDs before and during surgery; perioperative management of CIEDs, including magnet application and device reprogramming; and additional perioperative provisions for patients with CIEDs. As issues such as variations in programming capabilities and responses to magnet application according to device can be challenging, this review provides essential information for the safe perioperative management of patients with CIEDs.

近年来,心脏植入式电子设备(CIED)的使用率大幅上升。因此,越来越多的 CIED 患者将在有生之年接受手术治疗,麻醉医生在 CIED 围手术期管理中的参与度也在不断提高。随着技术的不断进步,已开发出多种类型的 CIED,包括永久起搏器、无引线起搏器、植入式心脏除颤器、心脏再同步治疗起搏器/除颤器和植入式循环记录器。暴露在电磁场中的植入式心律转复除颤器的功能可能会受到电磁干扰的影响,而手术室中就有潜在的电磁干扰源。因此,为防止手术室内电磁干扰造成的潜在不良事件,麻醉医师必须了解 CIED 的相关知识,并能够识别每种类型的 CIED。本综述重点关注CIED患者的围术期管理,包括CIED植入的适应症,以确定患者的心血管基线状态;术前和术中与CIED相关的问题;CIED的围术期管理,包括磁铁应用和设备重新编程;以及CIED患者围术期的其他规定。由于不同设备的编程能力和对磁铁应用的反应等问题可能具有挑战性,本综述为 CIED 患者的安全围术期管理提供了重要信息。
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引用次数: 0
Response to "Comment on Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis". 回应对 "关于腹腔镜胆囊切除术的单次区域麻醉:系统综述和网络荟萃分析 "的评论。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-19 DOI: 10.4097/kja.23703
Alessandro De Cassai, Federico Geraldini
{"title":"Response to \"Comment on Single-shot regional anesthesia for laparoscopic cholecystectomies: a systematic review and network meta-analysis\".","authors":"Alessandro De Cassai, Federico Geraldini","doi":"10.4097/kja.23703","DOIUrl":"10.4097/kja.23703","url":null,"abstract":"","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"406-407"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of preemptive and preventive intravenous acetaminophen on opioid consumption in pediatrics undergoing posterior spinal fusion surgery: a randomized controlled trial. 在接受脊柱后路融合手术的儿科患者中,比较预先静脉注射对乙酰氨基酚和预防性静脉注射对乙酰氨基酚对阿片类药物消耗量的影响:随机对照试验。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-20 DOI: 10.4097/kja.23747
Yeon Ju Kim, Ha-Jung Kim, Sehee Kim, Hyungtae Kim, Choon Sung Lee, Chang Ju Hwang, Jae Hwan Cho, Young-Jin Ro, Won Uk Koh

Background: Posterior spinal fusion (PSF), commonly used for adolescent idiopathic scoliosis (AIS), causes severe postoperative pain. Intravenous (IV) administration of acetaminophen has shown promise for opioid-sparing analgesia; however, its analgesic effect and optimal timing for its standard use remain unclear. Our study aimed to evaluate the analgesic effect and optimal timing of IV acetaminophen administration in pediatric and adolescent patients undergoing PSF and requiring adequate pain control.

Methods: This prospective, randomized, triple-blind trial was conducted in patients aged 11-20 undergoing PSF. Participants were randomized into three groups: the preemptive group (received IV acetaminophen 15 mg/kg after anesthetic induction/before surgical incision), the preventive group (received IV acetaminophen 15 mg/kg at the end of surgery/before skin closure), and the placebo group. The primary outcome was cumulative opioid consumption during the first 24 h postoperatively.

Results: Among the 99 enrolled patients, the mean ± standard deviation (SD) amount of opioid consumption during the postoperative 24 h was 60.66 ± 23.84, 52.23 ± 22.43, and 66.70 ± 23.01 mg in the preemptive, preventive, and placebo groups, respectively (overall P = 0.043). A post hoc analysis revealed that the preventive group had significantly lower opioid consumption than the placebo group (P = 0.013). However, no significant differences between the groups were observed for the secondary outcomes.

Conclusions: The preventive administration of scheduled IV acetaminophen reduces cumulative opioid consumption without increasing the incidence of drug-induced adverse events in pediatric and adolescent patients undergoing PSF.

背景:脊柱后路融合术(PSF)常用于治疗青少年特发性脊柱侧凸(AIS),会引起严重的术后疼痛。静脉注射对乙酰氨基酚有望实现阿片类药物替代镇痛,但其镇痛效果和标准使用的最佳时机仍不明确。我们的研究旨在评估接受 PSF 且需要充分止痛的儿童和青少年患者静脉注射对乙酰氨基酚的镇痛效果和最佳用药时机:这项前瞻性、随机、三盲试验在 11-20 岁接受 PSF 的患者中进行。参与者被随机分为三组:抢先组(麻醉诱导后/手术切口前静脉注射对乙酰氨基酚 15 毫克/千克)、预防组(手术结束后/皮肤闭合前静脉注射对乙酰氨基酚 15 毫克/千克)和安慰剂组。主要结果是术后 24 小时内阿片类药物的累计用量:结果:在 99 名入选患者中,抢先治疗组、预防治疗组和安慰剂组术后 24 小时内阿片类药物消耗量的平均值(± 标准差,SD)分别为 60.66 ± 23.84 毫克、52.23 ± 22.43 毫克和 66.70 ± 23.01 毫克(总 P = 0.043)。事后分析显示,预防组的阿片类药物用量明显低于安慰剂组(p = 0.013)。然而,在次要结果方面,各组间未观察到明显差异:预防性静脉注射对乙酰氨基酚可减少接受 PSF 的儿童和青少年患者的阿片类药物累积用量,同时不会增加药物引起的不良事件的发生率。
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引用次数: 0
The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study. 超声引导下髂腹股沟上筋膜室阻滞用于膝关节手术镇痛的布比卡因最低有效浓度(MEC90):一项剂量摸底研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.4097/kja.23710
Caner Genc, Serkan Tulgar, Murat Unal, Ahmet Serhat Genc, Lokman Kehribar, Basar Erdivanli, Kris Vermeylen, Ersin Koksal

Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair.

Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively.

Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]).

Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

背景:近年来,髂腹股沟上筋膜室阻滞(SFICB)在临床实践中越来越常见。这项评估者盲法剂量调查研究旨在确定布比卡因在关节镜前十字韧带修复术患者中单次注射 SFICB 的最低有效浓度(MEC90、MEC95):这项前瞻性研究在一家三级医院(术后恢复室和病房)进行。SFICB是在脊髓麻醉后进行的术后干预。采用偏向硬币设计的上下顺序法分配了 70 名患者。所有患者均在超声引导下使用不同浓度的布比卡因进行 SFICB,并采用标准的多模式镇痛。阻滞成功的定义是术后6小时在大腿中部前侧和外侧区域进行针刺试验时无疼痛或仅有触觉:根据等容回归和自举CIs,布比卡因对SFICB成功的MEC90值为0.123%(95% CI:0.098-0.191),MEC95值为0.188%(95% CI:0.113-0.223):我们的研究表明,通过 SFICB 给予布比卡因镇痛的 MEC90 和 MEC95 值分别为 0.123% 和 0.188%。使用较低浓度布比卡因的优点之一是可减少股四头肌无力。
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Korean Journal of Anesthesiology
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