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Programmed intermittent epidural bolus: a viable alternative to traditional methods? 程序化间歇性硬膜外栓塞:传统方法的可行替代方案?
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-23 DOI: 10.4097/kja.24306
Seunguk Bang
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引用次数: 0
Use of the Disposcope endoscope for awake orotracheal intubation in an elderly patient with a large vocal cord polyp -a case report. 使用 Disposcope 内窥镜为患有巨大声带息肉的老年患者进行清醒气管插管:病例报告。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-11 DOI: 10.4097/kja.23810
Duo Yang, Sen Li, Jinxin Lan, Shujun Ye, Longsheng Zhang

Background: Vocal cord polyps are commonly encountered in the otorhinolaryngology department. The risk of anesthesia is high in patients with large vocal cord polyps. Awake intubation with appropriate airway tools provides a favorable safety profile.

Case: We present the case of a 60-year-old male patient who had been suffering from a large vocal cord polyp for 16 years. Electronic laryngoscopy revealed that the vocal cord polyp was approximately 1.5 cm in diameter. The polyp had a pedicle and demonstrated synchronous motion with respiratory excursion. It covered almost the entire glottic area during inspiration and moved away from the glottis during expiration. A Disposcope endoscope was used for awake tracheal intubation, and the surgery was completed successfully.

Conclusions: The Disposcope endoscope can be a useful option for awake orotracheal intubation in cases of anticipated difficult intubation and difficult facemask ventilation.

背景:声带息肉是耳鼻喉科常见病。巨大声带息肉患者的麻醉风险很高。使用适当的气道工具进行清醒插管具有良好的安全性:本病例是一名 60 岁男性患者的病例,他患有巨大声带息肉已有 16 年之久。电子喉镜检查显示,声带息肉直径约为 1.5 厘米。息肉有蒂,与呼吸运动同步。它在吸气时几乎覆盖整个声门区域,呼气时则远离声门。使用 Disposcope 内窥镜进行了清醒气管插管,手术顺利完成:结论:在预计插管困难和面罩通气困难的病例中,Disposcope 内窥镜是清醒气管插管的有效选择。
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引用次数: 0
Comment on "Comparison of the pericapsular nerve group block with the intra-articular and quadratus lumborum blocks in primary total hip arthroplasty: a randomized controlled trial". 就 "初级全髋关节置换术中囊周神经组阻滞与关节内和腰四肌阻滞的比较:随机对照试验 "发表评论。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-27 DOI: 10.4097/kja.24070
Anju Gupta, Nitin Choudhary, Nishkarsh Gupta
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引用次数: 0
Comparison of effects of telmisartan versus valsartan on post-induction hypotension during noncardiac surgery: a prospective observational study. 比较替米沙坦和缬沙坦对非心脏手术诱导后低血压的影响:前瞻性观察研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-05 DOI: 10.4097/kja.23658
Chung-Sik Oh, Jun Young Park, Seong-Hyop Kim

Background: Telmisartan is considered more potent than valsartan. Hemodynamic response during anesthesia induction may be influenced by anti-hypertension (HTN) medication. The present study compared the effect of anti-HTN medications on post-induction hypotension during noncardiac surgeries.

Methods: This observational study standardized the anesthetic regimen across patients, with hypotension defined as mean blood pressure (BP) of less than 65 mmHg. The hemodynamic changes within 5 min before and after endotracheal intubation, and within 10 min before and after surgical incision were measured. Transthoracic echocardiographic evaluation of the left ventricle (LV) during anesthesia induction was performed. The primary endpoint was the decline in mean BP after anesthetic administration in telmisartan and valsartan groups. Multivariate logistic regression analysis was used to identify predictors of post-induction hypotension.

Results: Data from 157 patients undergoing noncardiac surgery were analyzed. No significant differences were found in mean BP decline between the two groups during anesthesia induction. Hemodynamic changes and LV ejection fraction (EF) during anesthesia induction were similar between the groups. Age and preoperative initial mean BP in operation room (OR) were associated with post-induction hypotension in both groups.

Conclusions: The angiotensin receptor blocker (ARB) type did not influence post-induction hypotension during anesthesia induction. Age and preoperative initial mean BP in OR were associated with post-induction hypotension in patients taking ARBs.

背景:替米沙坦被认为比缬沙坦更有效。麻醉诱导期间的血流动力学反应可能会受到抗高血压(HTN)药物的影响。本研究比较了抗高血压药物对非心脏手术诱导后低血压的影响:这项观察性研究对不同患者的麻醉方案进行了标准化,低血压定义为平均血压(BP)低于 65 mmHg。测量了气管插管前后 5 分钟内和手术切口前后 10 分钟内的血流动力学变化。在麻醉诱导期间对左心室(LV)进行经胸超声心动图评估。主要终点是替米沙坦组和缬沙坦组麻醉后平均血压的下降情况。多变量逻辑回归分析用于确定诱导后低血压的预测因素:结果:分析了 157 名非心脏手术患者的数据。两组患者在麻醉诱导期间的平均血压下降无明显差异。两组患者在麻醉诱导期间的血流动力学变化和左心室射血分数(EF)相似。两组患者的年龄和术前手术室(OR)初始平均血压均与诱导后低血压有关:结论:在麻醉诱导期间,血管紧张素受体阻滞剂(ARB)的类型不会影响诱导后低血压。服用血管紧张素受体阻滞剂的患者的年龄和术前手术室初始平均血压与诱导后低血压有关。
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引用次数: 0
Comparison of lung aeration loss in open abdominal oncologic surgeries after ventilation with electrical impedance tomography-guided PEEP versus conventional PEEP: a pilot feasibility study. 电阻抗断层扫描引导 PEEP 与传统 PEEP 通气后开放式腹部肿瘤手术肺通气损失的比较:一项试验性可行性研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-05 DOI: 10.4097/kja.23858
A R Karthik, Nishkarsh Gupta, Rakesh Garg, Sachidanand Jee Bharati, M D Ray, Vijay Hadda, Sourabh Pahuja, Seema Mishra, Sushma Bhatnagar, Vinod Kumar

Background: Existing literature lacks high-quality evidence regarding the ideal intraoperative positive end-expiratory pressure (PEEP) to minimize postoperative pulmonary complications (PPCs). We hypothesized that applying individualized PEEP derived from electrical impedance tomography would reduce the severity of postoperative lung aeration loss, deterioration in oxygenation, and PPC incidence.

Methods: A pilot feasibility study was conducted on 36 patients who underwent open abdominal oncologic surgery. The patients were randomized to receive individualized PEEP or conventional PEEP at 4 cmH2O. The primary outcome was the impact of individualized PEEP on changes in the modified lung ultrasound score (MLUS) derived from preoperative and postoperative lung ultrasonography. A higher MLUS indicated greater lung aeration loss. The secondary outcomes were the PaO2/FiO2 ratio and PPC incidence.

Results: A significant increase in the postoperative MLUS (12.0 ± 3.6 vs 7.9 ± 2.1, P < 0.001) and a significant difference between the postoperative and preoperative MLUS values (7.0 ± 3.3 vs 3.0 ± 1.6, P < 0.001) were found in the conventional PEEP group, indicating increased lung aeration loss. In the conventional PEEP group, the intraoperative PaO2/FiO2 ratios were significantly lower but not the postoperative ratios. The PPC incidence was not significantly different between the groups. Post-hoc analysis showed the increase in lung aeration loss and deterioration of intraoperative oxygenation correlated with the deviation from the individualized PEEP.

Conclusions: Individualized PEEP appears to protect against lung aeration loss and intraoperative oxygenation deterioration. The advantage was greater in patients whose individualized PEEP deviated more from the conventional PEEP.

背景:现有文献缺乏有关理想术中呼气末正压(PEEP)的高质量证据,无法最大限度地减少术后肺部并发症(PPCs)。我们假设,应用由电阻抗断层扫描(EIT)得出的个体化 PEEP 可降低术后肺通气损失的严重程度、氧合作用的恶化以及 PPC 的发生率:对 36 名接受开放式腹部肿瘤手术的患者进行了一项试验性可行性研究。这些患者被随机分配接受个体化 PEEP 或 4 cm H2O 的常规 PEEP。主要结果是个体化 PEEP 对术前和术后肺部超声波检查得出的改良肺部超声波评分 (MLUS) 变化的影响。MLUS 越高表明肺通气损失越大。次要结果是 PaO2/FIO2 比值和 PPC 发生率:结果:常规 PEEP 组术后 MLUS 明显增加(12 ± 3.6 vs 7.9 ± 2.1,P < 0.001),术后与术前 MLUS 值差异明显(7.0 ± 3.3 vs 3.0 ± 1.6,P < 0.001),表明肺通气损失增加。在常规 PEEP 组,术中 PaO2/FIO2 比率显著降低,但术后比率没有显著降低。两组的 PPC 发生率无明显差异。事后分析表明,肺通气损失的增加和术中氧合情况的恶化与偏离个体化 PEEP 有关:结论:个体化 PEEP 似乎可以防止肺通气损失和术中氧合恶化。个体化 PEEP 与常规 PEEP 偏差较大的患者的优势更大。
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引用次数: 0
Intraoperative tourniquet-induced hyperthermia in a pediatric patient: a forgotten association -a case report. 一名儿科患者术中止血带引发的高热:一种被遗忘的关联。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-01-04 DOI: 10.4097/kja.23655
Tarek Tageldin, Muhammad Jaffar Khan, Temur Baykuziyev, Haitham Ahmed

Background: The intraoperative use of tourniquets is associated with several complications, including hyperthermia. We present the first documented case of tourniquet-induced hyperthermia in a pediatric patient at our institution.

Case: A 5-year-old female with no past medical history underwent tendon release surgery for congenital talipes equinovarus under general anesthesia. Following inflation of a pneumatic tourniquet to a pressure of 250 mmHg on her left thigh, the patient experienced a gradual increase in body temperature. Despite the implementation of cooling measures, the temperature continued to increase until it plateaued. The hyperthermia gradually resolved upon deflation of the tourniquet.

Conclusions: Tourniquet-induced hyperthermia should be considered as a potential cause of intraoperative hyperthermia, particularly in the absence of typical signs of malignant hyperthermia. Early recognition and appropriate management, including deflation of the tourniquet and implementation of cooling measures, are crucial for preventing potential complications associated with hyperthermia.

背景:术中使用止血带会引发多种并发症,包括高热。本院记录了首例止血带诱发高热的儿科病例:病例:一名既往无病史的 5 岁女性在全身麻醉下接受了先天性马蹄内翻足的肌腱松解手术。在左大腿上的气压止血带压力达到 250 mmHg 后,患者的体温逐渐升高。尽管采取了降温措施,但体温仍持续上升,直至稳定下来。止血带放气后,高热症状逐渐缓解:结论:止血带引发的高热应被视为术中高热的潜在原因,尤其是在没有恶性高热典型症状的情况下。早期识别和适当处理,包括放掉止血带和采取降温措施,对于预防与高热相关的潜在并发症至关重要。
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引用次数: 0
Efficacy of intraoperative blood salvage and autotransfusion in living-donor liver transplantation: a retrospective cohort study. 活体肝移植术中血液抢救和自体输血的疗效:一项回顾性倾向匹配病例对照研究。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-12 DOI: 10.4097/kja.23599
Jongchan Lee, Sujung Park, Jae Geun Lee, Sungji Choo, Bon-Nyeo Koo

Background: Liver transplantation (LT) may be associated with massive blood loss and the need for allogeneic blood transfusion. Intraoperative blood salvage autotransfusion (IBSA) can reduce the need for allogeneic blood transfusion. This study aimed to investigate the effectiveness of blood salvage in LT.

Methods: Among 355 adult patients who underwent elective living-donor LT between January 1, 2019, and December 31, 2022, 59 recipients without advanced hepatocellular carcinoma received IBSA using Cell Saver (CS group). Based on sex, age, model for end-stage liver disease (MELD) score, preoperative laboratory results, and other factors, 118 of the 296 recipients who did not undergo IBSA were matched using propensity score (non-CS group). The primary outcome was the amount of intraoperative allogenic red blood cell (RBC) transfusion. Comparisons were made between the two groups regarding the amount of other blood components transfused and postoperative laboratory findings.

Results: The transfused allogeneic RBC for the CS group was significantly lower than that of the non-CS group (1,506.0 vs. 1,957.5 ml, P = 0.026). No significant differences in the transfused total fresh frozen plasma, platelets, cryoprecipitate, and estimated blood loss were observed between the two groups. The postoperative allogeneic RBC transfusion was significantly lower in the CS group than in the non-CS group (1,500.0 vs. 2,100.0 ml, P = 0.039). No significant differences in postoperative laboratory findings were observed at postoperative day 1 and discharge.

Conclusions: Using IBSA during LT can effectively reduce the need for perioperative allogeneic blood transfusions without causing subsequent coagulopathy.

背景:肝移植(LT)可能会导致大量失血和异体输血。术中血液挽救自体输血(IBSA)可减少异体输血的需求。本研究旨在探讨LT术中血液抢救的有效性:在2019年1月1日至2022年12月31日期间接受选择性活体捐献LT的355名成年患者中,59名没有晚期肝细胞癌的受者接受了使用细胞拯救者的IBSA(CS组)。根据性别、年龄、终末期肝病模型(MELD)评分、术前实验室结果和其他因素,对未接受 IBSA 的 296 名受者中的 118 人进行倾向评分匹配(非 CS 组)。主要结果是术中异体红细胞(RBC)输注量。两组患者在其他血液成分输注量和术后实验室检查结果方面进行了比较:结果:CS 组的异体红细胞输注量明显低于非 CS 组(1,506.0 毫升对 1,957.5 毫升,P = 0.026)。两组患者输注的总新鲜冰冻血浆(FFP)、血小板、低温沉淀物和估计失血量无明显差异。CS 组术后异体红细胞输注量明显低于非 CS 组(1,500.0 毫升对 2,100.0 毫升,P = 0.039)。术后第1天(POD1)和出院时的实验室结果无明显差异:结论:在 LT 期间使用 IBSA 可有效减少围手术期异体输血的需求,且不会引起后续的凝血病。
{"title":"Efficacy of intraoperative blood salvage and autotransfusion in living-donor liver transplantation: a retrospective cohort study.","authors":"Jongchan Lee, Sujung Park, Jae Geun Lee, Sungji Choo, Bon-Nyeo Koo","doi":"10.4097/kja.23599","DOIUrl":"10.4097/kja.23599","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) may be associated with massive blood loss and the need for allogeneic blood transfusion. Intraoperative blood salvage autotransfusion (IBSA) can reduce the need for allogeneic blood transfusion. This study aimed to investigate the effectiveness of blood salvage in LT.</p><p><strong>Methods: </strong>Among 355 adult patients who underwent elective living-donor LT between January 1, 2019, and December 31, 2022, 59 recipients without advanced hepatocellular carcinoma received IBSA using Cell Saver (CS group). Based on sex, age, model for end-stage liver disease (MELD) score, preoperative laboratory results, and other factors, 118 of the 296 recipients who did not undergo IBSA were matched using propensity score (non-CS group). The primary outcome was the amount of intraoperative allogenic red blood cell (RBC) transfusion. Comparisons were made between the two groups regarding the amount of other blood components transfused and postoperative laboratory findings.</p><p><strong>Results: </strong>The transfused allogeneic RBC for the CS group was significantly lower than that of the non-CS group (1,506.0 vs. 1,957.5 ml, P = 0.026). No significant differences in the transfused total fresh frozen plasma, platelets, cryoprecipitate, and estimated blood loss were observed between the two groups. The postoperative allogeneic RBC transfusion was significantly lower in the CS group than in the non-CS group (1,500.0 vs. 2,100.0 ml, P = 0.039). No significant differences in postoperative laboratory findings were observed at postoperative day 1 and discharge.</p><p><strong>Conclusions: </strong>Using IBSA during LT can effectively reduce the need for perioperative allogeneic blood transfusions without causing subsequent coagulopathy.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"345-352"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101931","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
Intraoperative pediatric electroencephalography monitoring: an updated review. 术中小儿脑电图监测--最新综述。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-01-17 DOI: 10.4097/kja.23843
Ian Yuan, Choon L Bong, Jerry Y Chao

Intraoperative electroencephalography (EEG) monitoring under pediatric anesthesia has begun to attract increasing interest, driven by the availability of pediatric-specific EEG monitors and the realization that traditional dosing methods based on patient movement or changes in hemodynamic response often lead to imprecise dosing, especially in younger infants who may experience adverse events (e.g., hypotension) due to excess anesthesia. EEG directly measures the effects of anesthetics on the brain, which is the target end-organ responsible for inducing loss of consciousness. Over the past ten years, research on anesthesia and computational neuroscience has improved our understanding of intraoperative pediatric EEG monitoring and expanded the utility of EEG in clinical practice. We now have better insights into neurodevelopmental changes in the developing pediatric brain, functional connectivity, the use of non-proprietary EEG parameters to guide anesthetic dosing, epileptiform EEG changes during induction, EEG changes from spinal/regional anesthesia, EEG discontinuity, and the use of EEG to improve clinical outcomes. This review article summarizes the recent literature on EEG monitoring in perioperative pediatric anesthesia, highlighting several of the topics mentioned above.

儿科麻醉下的术中脑电图(EEG)监测已开始引起越来越多的关注,其原因是儿科专用脑电图监测仪的出现,以及人们认识到基于患者运动或血流动力学反应变化的传统剂量方法往往会导致剂量不精确,尤其是对年龄较小的婴儿,他们可能会因麻醉过度而出现不良反应(如低血压)。脑电图可直接测量麻醉剂对大脑的影响,而大脑是诱导意识丧失的目标终末器官。在过去的十年中,麻醉和计算神经科学研究提高了我们对术中小儿脑电图监测的认识,并扩大了脑电图在临床实践中的应用。现在,我们对小儿大脑发育期的神经发育变化、功能连接、使用非专有脑电图参数指导麻醉剂量、诱导过程中癫痫样脑电图变化、脊髓/区域麻醉引起的脑电图变化、脑电图不连续性以及使用脑电图改善临床预后有了更深入的了解。这篇综述文章总结了有关围手术期儿科麻醉中脑电图监测的最新文献,重点介绍了上述几个主题。
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引用次数: 0
Alternatives to the P value: connotations of significance. P 值的替代方案:显著性的内涵。
IF 2.9 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-04-29 DOI: 10.4097/kja.23630
Junyong In, Dong Kyu Lee

The statistical significance of a clinical trial analysis result is determined by a mathematical calculation and probability based on null hypothesis significance testing. However, statistical significance does not always align with meaningful clinical effects; thus, assigning clinical relevance to statistical significance is unreasonable. A statistical result incorporating a clinically meaningful difference is a better approach to present statistical significance. Thus, the minimal clinically important difference (MCID), which requires integrating minimum clinically relevant changes from the early stages of research design, has been introduced. As a follow-up to the previous statistical round article on P values, confidence intervals, and effect sizes, in this article, we present hands-on examples of MCID and various effect sizes and discuss the terms statistical significance and clinical relevance, including cautions regarding their use.

临床试验分析结果的统计学意义是通过数学计算和基于零假设的概率显著性检验来确定的。然而,统计意义并不总是与有意义的临床效果相一致;因此,赋予统计意义以临床相关性是不合理的。包含临床意义差异的统计结果是呈现统计意义的更好方法。因此,引入了最小临床意义差异(MCID),要求在研究设计的早期阶段就纳入最小临床相关性变化。作为上一篇关于 P 值、置信区间和效应大小的统计综述文章的后续文章,我们将在本文中介绍 MCID 和各种效应大小的实例,并讨论统计学意义和临床相关性这两个术语,包括使用时的注意事项。
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引用次数: 0
WITHDRAWN: Response to letter. 回信。
IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-20 DOI: 10.4097/kja.24145
Byungjin Choi, Ah Ran Oh, Jungchan Park, Seunghwa Lee

Ahead of Print article withdrawn by Editorial Board.

编辑委员会撤回了提前打印的文章。
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引用次数: 0
期刊
Korean Journal of Anesthesiology
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