Minerva anestesiologica最新文献

Background: Following surgical procedures, over 80% of patients experience acute pain, with half of them expressing dissatisfaction with pain relief. The modern approach to surgical treatment and pain management increasingly relies on implementing multimodal analgesia, which includes the use of adjuvants in addition to long-acting local anesthetics (such as ropivacaine). This double-blind randomized study evaluated the analgesic effect of magnesium sulfate added to ropivacaine in the sciatic nerve block at the popliteal level for bunion correction surgery.

Methods: In this double-blind study, fifty patients were enrolled and randomized in a 1:1 ratio to receive ropivacaine and MgSO4 200 mg or ropivacaine and physiological solution. The primary endpoint was the duration of sensory block.

Results: A statistically significant difference was observed in the onset time for sensory block (9.2 minutes vs. 21.8 minutes, P<0.001) and its duration (18.2 hours vs. 13.9 hours, P<0.001) between the two groups. Between 12 and 24 hours postoperatively, the maximum NRS pain scores in the magnesium group were lower than those in the control group (IQR [range]) 2 (2-3.8 [0-6.5]) vs. 6.7 (5.6-7.9 [2.7-9.2], P<0.001). The need for additional opioids after 12-24 hours was significantly higher in patients in the physiological solution group compared to those in the magnesium group.

Conclusions: Our results suggest that magnesium added to the local anesthetic extends sensory block duration, reduces postoperative pain, improves the quality of analgesia, decreases the need for additional opioids. Further studies are needed to confirm these preliminary findings.

This article examines how clinical reasoning about the critical patient is currently treated and draws attention to some critical issues already often highlighted in the literature. Traditional approaches to clinical reasoning, even when applied to critical patients, prioritize identifying structured diseases. In contrast, the critical care setting demands an alternative approach that aligns with the intensivist's goal of supporting or substituting vital organ functions. In this manuscript, we emphasized the reasons that make it primary for intensivists to obtain a diagnosis of function in order to act therapeutically. Moreover, we highlighted the challenges posed by diagnostic errors, often attributed to cognitive biases and shortcomings in clinical reasoning, which can adversely affect patient outcomes and resource utilization. We also discussed the complexities of clinical decision-making in emergency medical services, where physicians must perform rapid actions in the face of incomplete information and high uncertainty. We underscore the limitations of traditional information technology tools in facilitating practical clinical reasoning, advocating for the integration of relevant data that directly informs on organ function and pathophysiological mechanisms. This discourse emphasizes a deep understanding of physiology and pathophysiology as foundational for practical clinical reasoning in critical care. Finally, we propose a structured assessment method that prioritizes pinpointing the compromised organ function, elucidating the pathophysiological mechanism responsible, hypothesizing potential causes, and testing these hypotheses to guide therapeutic interventions. This approach aligns clinical reasoning with the intensivist's goal: supporting and restoring vital functions in the critically ill patient.

Background: The aim of this paper was to compare the impact of continuous infusion of ciprofol versus propofol on postoperative awakening in elderly patients following hip replacement surgery.

Methods: Patients were randomized into two groups (N.=45 each): the ciprofol group and the propofol group. The ciprofol group received ciprofol for anesthesia induction and maintenance, while the propofol group underwent anesthesia induction and maintenance using propofol. The primary outcome was awakening time. Secondary outcomes included spontaneous breathing recovery time, extubation time, time to modified Aldrete Score ≥9, modified observer's assessment of alertness/sedation (MOAA/S) scores, anesthetic dosage, volume of fluid replacement, urine output and administration of vasoactive drugs.

Results: The Ciprofol group exhibited a significantly prolonged awakening time (11.0±6.4 min vs. 7.4±4.3 min, P=0.003), spontaneous breathing recovery time (9.9±6.3 min vs. 5.9±4.3 min, P=0.001), and extubation time (12.0 [8.0-16.0] min vs. 8.5 [6.0-11.0] min, P=0.005), and reduced requirement for intraoperative fluid replacement (728.9±254.2 mL vs. 908.3±287.5 mL, P=0.003), increased urine output (235.1±102.1 mL vs. 173.5±106.2 mL, P=0.007), decreased likelihood of vasoactive drug administration (15/30 vs. 28/14, P=0.002). No significant differences were observed between the two groups in terms of reaching a modified Aldrete Score ≥9, MOAA/S scores at 0, 5, 15, or 30 minutes post-extubation, or occurrence of adverse reactions (P>0.05). The dosage of remifentanil was significantly higher in the ciprofol group [5.4 (2.7-7.4) μg·kg^-1·h^-1 vs. 3.4 (1.9-4.3) μg·kg^-1·h^-1, P=0.004], with a mean maintenance dose of ciprofol at 0.8 mg·kg^-1·h^-1 (range: 0.5 to 1.2 mg·kg^-1·h^-1).

Conclusions: Compared to propofol, the administration of ciprofol in elderly patients following hip replacement surgery is associated with prolonged awakening time, spontaneous breathing recovery time, and extubation. The average intravenous maintenance dosage of ciprofol in geriatric patients under general anesthesia was 0.8 mg·kg^-1·h^-1.

The fascia, a continuous structure around the whole body across various anatomical locations, remains underexplored in regional anesthesia. The pelvic fascia is a particularly controversial and complicated anatomical structure. It holds significant relevance not only for surgeons but also in the realms of regional anesthesia and pain management. Many regional nerve blocking techniques in the pelvis are closely related to fascial anatomy, such as fascia iliaca compartment block, circum-psoas block, inferior hypogastric plexus block, and ganglion impar block. The continuity of fascia and interfascial spaces profoundly influences both the efficacy of blockades and the incidence of complications. A thorough understanding of pelvic fascia anatomy is crucial for understanding the potential pathways and barriers for spread of local anesthetics, enhancing analgesia, and minimizing side effects. Currently, a systematic discussion of pelvic fascia from the perspective of regional anesthesia and pain therapy is notably absent. This narrative review aims to consolidate knowledge on the anatomy of pelvic fascia pertinent to regional anesthesia and pain management, detailing relevant pelvic nerves, and associated peripheral nerve blocking techniques.