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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
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 Medicine 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。
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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 Medicine 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 Medicine 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
Renal implications of pneumoperitoneum in laparoscopic surgery: mechanisms, risk factors, and preventive strategies. 腹腔镜手术中腹腔积气对肾脏的影响:机制、风险因素和预防策略。
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2024-04-26 DOI: 10.4097/kja.24011
G. Villa, Marco Fiorentino, Eleonora Cappellini, S. Lassola, Silvia De Rosa
Pneumoperitoneum, which is established for laparoscopic surgery, has systemic implications on the renal system and may contribute to acute kidney injury or postoperative renal dysfunction. Specifically, when the pressure exceeds 10 mmHg, pneumoperitoneum decreases renal blood flow, leading to renal dysfunction and temporary oliguria. The renal effects of pneumoperitoneum stem from both the direct effects of increased intra-abdominal pressure and indirect factors such as carbon dioxide absorption, neuroendocrine influences, and tissue damage resulting from oxidative stress. While pneumoperitoneum can exacerbate renal dysfunction in patients with pre-existing kidney issues, preserving the function of the remaining kidney is crucial in certain procedures such as laparoscopic live donor nephrectomy. However, available evidence on the effects of pneumoperitoneum on renal function is limited and of moderate quality. This review focuses on exploring the pathophysiological hypotheses underlying kidney damage, mechanisms leading to oliguria and kidney damage, and fluid management strategies for surgical patients during pneumoperitoneum.
腹腔镜手术会产生腹腔积气,对肾脏系统有全身性影响,可能导致急性肾损伤或术后肾功能障碍。具体来说,当压力超过 10 mmHg 时,腹腔积气会减少肾血流量,导致肾功能障碍和暂时性少尿。腹腔积气对肾脏的影响既来自腹腔内压力增加的直接影响,也来自二氧化碳吸收、神经内分泌影响和氧化应激导致的组织损伤等间接因素。虽然腹腔积气会加重已有肾脏问题的患者的肾功能障碍,但在某些手术(如腹腔镜活体肾切除术)中,保留剩余肾脏的功能至关重要。然而,有关腹腔积气对肾功能影响的现有证据非常有限,且质量一般。本综述主要探讨肾脏损伤的病理生理学假说、导致少尿和肾脏损伤的机制以及腹腔积气期间手术患者的液体管理策略。
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引用次数: 0
Response to: 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". 回应:关于 "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 "的评论。
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2024-04-25 DOI: 10.4097/kja.24215
Tayfun Et, Muhammet Korkusuz
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引用次数: 0
Assessment of fluid infusion rate using a pulse oximeter: a pilot study. 使用脉搏血氧仪评估输液速度:一项试验研究。
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2024-04-24 DOI: 10.4097/kja.23489
Yeiheum Park, Sungho Moon
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引用次数: 0
Ultrasound mapping of soft tissue vascular anatomy proximal to the larynx: a prospective cohort study. 喉部近端软组织血管解剖超声绘图:一项前瞻性队列研究。
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2024-04-23 DOI: 10.4097/kja.23900
A. De Cassai, Margherita Iuzzolino, Silvia De Pinto, Giovanni Zecchino, T. Pettenuzzo, A. Boscolo, Eugenio Biamonte, P. Navalesi, Marina Munari
BackgroundBleeding incidents during percutaneous dilatational tracheostomy are concerning, and most cases occur in patients with unrecognized and unanticipated anatomical variations in the vascular anatomy. However, the extent of this variation remains unclear. To address this knowledge gap, our study aimed to comprehensively map laryngeal vascular anatomy in a cohort of adult patients.MethodsUltrasound assessments of the soft tissue in the neck were performed, spanning from the thyroid cartilage to the third tracheal ring and extending 2 cm laterally on both sidesperformed. We subdivided this area into 12 zones comprising four medial and eight lateral sections. A pre-planned form was used to document the presence of arteries or veins in each zone. The results are reported as odds ratios, 95% CIs, and corresponding P-values.ResultsFive-hundred patients were enrolled from August 14, 2023, to November 13, 2023, at the University Hospital of Padua. Arteries and veins were identified in all investigated zones (varying from a minimum of 1.0%-46.4%). The presence of invessels progressively increased from the cricothyroid membrane to the third tracheal ring and from the midline to the paramedian laryngeal area.ConclusionsGiven the prevalence of arteries and veins, particularly in areas where tracheostomies are commonly performed, we strongly advocate for routine ultrasound assessments before such procedures are performed.
背景经皮扩张气管造口术中的出血事件令人担忧,大多数病例发生在血管解剖结构存在未识别和未预期的解剖变异的患者身上。然而,这种变异的程度仍不清楚。为了填补这一知识空白,我们的研究旨在全面绘制一组成年患者的喉部血管解剖图。方法对颈部软组织进行超声评估,评估范围从甲状软骨到第三气管环,并向两侧延伸 2 厘米。我们将这一区域细分为 12 个区,包括 4 个内侧区和 8 个外侧区。我们使用预先计划好的表格来记录每个区域是否存在动脉或静脉。结果帕多瓦大学医院在 2023 年 8 月 14 日至 11 月 13 日期间招募了 500 名患者。在所有调查区域都发现了动脉和静脉(最低为 1.0%,最高为 46.4%)。从环甲膜到第三气管环,从中线到喉旁区,血管的存在率逐渐增加。结论鉴于动脉和静脉的普遍存在,尤其是在气管造口术常用的区域,我们强烈主张在进行此类手术前进行常规超声评估。
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引用次数: 0
The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: a prospective randomized controlled trial. 瑞马唑仑与七氟醚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。
IF 2.9 4区 医学 Q1 Medicine Pub Date : 2024-04-19 DOI: 10.4097/kja.23939
Y. Yoo, Jae Hong Park, K. Lee, Ah Hyeon Yi, Tae Kyun Kim
BackgroundPostoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia.MethodsIn this prospective randomized controlled trial (RCT), participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR-15) score at 24-h postoperatively.ResultsForty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups.ConclusionsCompared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery.
背景术后恶心和呕吐(PONV)是指手术后 24 小时内或在麻醉后护理病房(PACU)内发生的恶心和呕吐。先前的研究报告称,使用较新的苯二氮卓(BDZ)催眠药雷美马唑仑进行麻醉可减少 PONV。在这项研究中,我们比较了七氟醚和瑞马唑仑在全身麻醉后的 PONV 发生率。在这项前瞻性随机对照试验(RCT)中,年龄在 20-80 岁之间、接受择期腹腔镜胆囊切除术或半结肠切除术的患者被随机分配到瑞马唑仑组或七氟醚组。主要结果是术后 24 小时内的 PONV 发生率。次要结果包括术后30分钟的PONV、术后追加止吐药的使用情况以及术后24小时的恢复质量-15(QOR-15)评分。术后24小时内,雷马唑仑组的PONV发生率明显低于七氟醚组(雷马唑仑组与七氟醚组的PONV发生率分别为5%与45%,P=0.003)。手术后24小时内使用地塞米松(一种抢救性止吐药)的比例在瑞马唑仑组大大低于七氟醚组(瑞马唑仑组为0%,七氟醚组为30%,P = 0.020)。结论与七氟醚相比,选择使用瑞马唑仑作为术中催眠药可降低腹腔镜手术后24小时内PONV的发生率,减少止吐药的使用。
{"title":"The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: a prospective randomized controlled trial.","authors":"Y. Yoo, Jae Hong Park, K. Lee, Ah Hyeon Yi, Tae Kyun Kim","doi":"10.4097/kja.23939","DOIUrl":"https://doi.org/10.4097/kja.23939","url":null,"abstract":"Background\u0000Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia.\u0000\u0000\u0000Methods\u0000In this prospective randomized controlled trial (RCT), participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR-15) score at 24-h postoperatively.\u0000\u0000\u0000Results\u0000Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups.\u0000\u0000\u0000Conclusions\u0000Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery.","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684207","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
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Korean Journal of Anesthesiology
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