Minerva anestesiologica最新文献

Background: The incidence of postoperative delirium (POD) has been reported to be up to 53% following cardiac surgery. This trial aimed to determine the effect of perioperative administration of pregabalin versus dexmedetomidine (DEX) on the POD incidence in elderly patients planned for cardiac surgery, together with other secondary outcome measures. We hypothesized that pregabalin, with its sedative analgesic effects, would be non-inferior to DEX regarding POD prevention.

Methods: This randomized, double-blind, parallel-controlled, non-inferiority trial was conducted on 60 elderly cases planned for cardiac surgery. The cases were randomly assigned equally into a pregabalin group (group P) and DEX group (group D). The non-inferiority margin was set to 20%. The primary outcome was the POD incidence. Secondary endpoints included analgesic profile, sedation scale, and adverse events.

Results: Pregabalin was non-inferior to DEX regarding the reduction in the incidence of POD (17.86% vs. 21.43%; risk difference, -3.6%; two-sided 95% CI, - 24.25% to 17.41%; meeting non-inferiority criteria). POD onset and duration showed an insignificant difference between the groups. The total morphine consumption in the first 48 hours after surgery was significantly lower in group P (25.64±7.04 mg) than in group D (34.66±9.25 mg; 95% CI, -13.42 to -4.61; P=0.0001). Both groups were insignificantly different regarding the visual analog scale score, sedation agitation scale measurements, recovery time, and adverse events.

Conclusions: Pregabalin is non-inferior to DEX in terms of delirium prevention after cardiac surgeries with comparable sedative effects, but it has a superior analgesic profile in the form of a significantly lower 48-hour opioid dose.

Background: Propofol consumption during total intravenous anesthesia (TIVA) is influenced by patient's gender and females consume greater amount than males. As gender difference on propofol consumption during TIVA has only been assessed with manually titrated or target-controlled infusion, its validation with automated delivery systems, is desirable. This study evaluated effects of gender differences on propofol consumption during automated propofol TIVA administered by closed-loop anesthesia delivery system (CLADS).

Methods: The enrolled patients (N.=80) were allocated to two groups based on gender- males and females, and all received automated propofol TIVA by CLADS. Cumulative intraoperative propofol consumption (primary outcome variable), anesthesia depth consistency, anesthesia delivery system performance, intraoperative hemodynamics (heart rate, mean blood pressure), recovery from anesthesia (time-to-eye-opening, time-to-tracheal extubation), and postoperative sedation (secondary outcome variables); were analyzed.

Results: While no difference was found for propofol consumption during induction (males: 1.5±0.5 mg/kg versus females: 1.4±0.4 mg/kg, P=0.628) and maintenance (males: 4.9±1.3 mg/kg/h versus females: 4.9±0.8 mg/kg/h, P=0.457) based on total body weight, when calculated by lean body weight; females exhibited significantly greater propofol consumption for induction (males: 1.9±0.6 mg/kg versus females: 2.2±0.5 mg/kg, P<0.001) and maintenance (males: 6.4±1.5 mg/kg/h versus females: 7.8±1.3 mg/kg/h, P<0.001). Time to eye-opening (males: 7.2 [5.2, 9.3] minutes versus females: 4.6 [3.1, 6.7] minutes, P<0.001) and the time to tracheal-extubation (males: 8.1 [6.4, 10.5] minutes versus females: 6.4 [4.5, 9.1] minutes, P=0.010) were significantly lower in females.

Conclusions: While females consumed greater amount of propofol for induction and maintenance of propofol TIVA, they exhibited faster recovery than males.

Background: The impact of dexmedetomidine on postoperative delirium (POD) remains a subject of debate in elderly patients undergoing noncardiac surgeries. This study aimed to assess the efficacy and safety of dexmedetomidine infusion without an induction dose in reducing the incidence of POD while maintaining hemodynamic stability in geriatric patients undergoing major surgeries. The loading dose was omitted based on the hypothesis that continuous dexmedetomidine infusion without a loading dose would lower the incidence of POD while preserving cardiovascular safety.

Methods: This randomized, double-blind clinical trial was conducted on 122 elderly patients, belonging to the American Society of Anesthesiologists I or II physical status, who were scheduled for major noncardiac surgeries. Patients were randomly allocated into two equal groups. Patients in Group I received 0.5 μg/kg/h of dexmedetomidine, diluted in 50 mL of isotonic normal saline, while patients in Group II received 50 mL of isotonic normal saline as a placebo. The primary outcome was the incidence of POD. Secondary outcomes included intraoperative and postoperative hemodynamics.

Results: Postoperative delirium was observed in only one (1.64%) patient in Group I on the first postoperative day, whereas 21 (34.4%) patients in Group II experienced POD with a statistically significant difference (P<0.001). Furthermore, patients in group I exhibited a significant reduction in intraoperative mean arterial pressure and heart rate, along with a notably high incidence of intraoperative hypotension but without bradycardia. Postoperatively, the mean heart rates, the incidence of hypotension, and bradycardia were comparable between groups without the need for rescue hypotensive medications (all P>0.05).

Conclusions: In elderly patients undergoing non-cardiac surgery, dexmedetomidine infusion without an induction dose effectively and safely reduces the incidence of POD. Dexmedetomidine significantly preserves postoperative hemodynamics.

Introduction: Pediatric infraumbilical surgeries often lead to significant postoperative pain. Sacral erector spinae plane block (S-ESPB) is a novel ultrasound-guided technique that targets the sacral fascial plane and may provide extended analgesia with minimal motor block. This systematic review and meta-analysis evaluate the efficacy and safety of S-ESPB in pediatric patients compared to conventional regional techniques or no block at all.

Evidence acquisition: This review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251054390). A systematic search of PubMed, Scopus, Web of Science, and CENTRAL was conducted. Eligible studies included randomized controlled trials comparing S-ESPB to caudal blocks, penile blocks, ring blocks, or no block in pediatric patients. The primary outcome was time to first request for rescue analgesia. Secondary outcomes encompassed early postoperative (Face, Legs, Activity, Cry, Consolability) FLACC scores, 24-hour paracetamol consumption, the need for rescue analgesia, and adverse events. The risk of bias was evaluated using RoB 2, and the evidence's certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Evidence synthesis: Six trials involving 437 participants were included in the review. S-ESPB significantly prolonged the time to first request for rescue analgesia compared to caudal, ring, penile, or no block (SMD: 4.02; 95% CI: 0.92-7.11; P=0.011). Subgroup analyses revealed significantly longer durations with S-ESPB compared to caudal block (SMD: 4.64; 95% CI: 0.84-8.44), ring block (SMD: 1.61; 95% CI: 0.97-2.25), and no block (SMD: 3.97; 95% CI: 2.90-5.04). Cumulative paracetamol consumption at 24 hours was significantly reduced with S-ESPB (SMD: -2.24; 95% CI: -3.13 to -1.35; P<0.001). No significant differences were found in early pain scores or rates of rescue analgesia. Adverse events were rare and comparable to those in the control groups.

Conclusions: S-ESPB provides prolonged postoperative analgesia and reduces systemic analgesic consumption in pediatric infraumbilical surgery, with a favorable safety profile.

Bckground: Emergence agitation frequently occurs during emergence from general anesthesia and may result in potentially serious complications, especially in elderly patients. Although desflurane and sevoflurane are widely used, their differential effects on emergence agitation in elderly populations remain unclear.

Methods: In this retrospective cohort study, we analyzed 376 elderly patients (≥65 years) who underwent orthopedic surgery under general anesthesia with either sevoflurane or desflurane between August 2022 and February 2024. Propensity score matching (1:1 ratio) was performed to adjust baseline differences. Emergence agitation was defined as Ricker Sedation-Agitation Scale (RSAS) score ≥5 during emergence. Postoperative delirium was diagnosed by psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Multivariable logistic regression was used to identify independent risk factors for emergence agitation.

Results: After matching, 141 patients remained in each group. Emergence agitation occurred significantly more often in the sevoflurane group than the desflurane group (35.5% vs. 12.1%, P<0.001). RSAS scores were also higher in the sevoflurane group (P=0.037). The incidence of postoperative delirium was significantly higher in the sevoflurane group (15.6% vs. 4.3%, P=0.003). Multivariable analysis identified sevoflurane use, spinal surgery, endotracheal intubation, and ASA class III-IV as independent risk factors for emergence agitation.

Conclusions: In elderly orthopedic patients, sevoflurane was associated with significantly higher rates of emergence agitation and postoperative delirium compared to desflurane. These findings emphasize the importance of individualized anesthetic planning in the elderly, considering anesthetic pharmacological characteristics and identified risk factors of emergence agitation.