Minerva anestesiologica最新文献

Background: Optimizing post-cesarean recovery is crucial to facilitate neonatal care and improve maternal well-being. Post-cesarean neuraxial analgesia regimes are widely used, but can be resource-intensive, not always feasible nor effective. Tramadol, with its dual mechanism of action and favorable safety profile, may offer an alternative. This study compared a tramadol-based continuous intravenous analgesia regimen with an epidural-based regimen with local anesthetics in terms of functional recovery and postoperative outcomes.

Methods: This prospective observational cohort study was carried out in women undergoing C-sections. Patients received either continuous intravenous infusion of tramadol and ondansetron (TRON) or patient-controlled epidural analgesia with ropivacaine (EPI). Patients were consecutively enrolled until the calculated sample size for each group was reached. The primary outcome was functional recovery at 24 hours, assessed using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included recovery over 48 hours, obstetric-specific recovery (ObsQoR-10) at 24 hours, pain scores, adverse effects, and chronic pain at 90 days.

Results: A total of 312 patients were analyzed (156 per group). QoR-15 scores were higher in TRON compared to EPI (adjusted mean difference (AMD): 8.6 [95% CI: 4.7-12.0]; P<0.001 at 24 h and 12.0 [95% CI: 5.8-15.0]; P<0.001 at 48 h). ObsQoR-10 scores also favored TRON (AMD: 13 [95% CI: 10-16]; P<0.001). Pain control was slightly better in the TRON group and adverse effects were more frequent in the EPI group.

Conclusions: The TRON strategy offers an effective alternative for post-cesarean analgesia, with fewer side effects and easier postpartum care management. The addition of ondansetron likely played a key role.

Background: Postoperative emergence delirium (ED), a frequent complication following general anesthesia, poses significant clinical risks including traumatic injuries and cardiorespiratory compromise. The primary objective of this study was to evaluate the effects of laryngeal mask airway versus endotracheal intubation on the incidence of ED in pediatric patients undergoing endoscopic-assisted coblation adenoidectomy. The secondary objective of this study was to evaluate and compare additional intraoperative and postoperative outcomes.

Methods: A total of 78 patients aged three - six years undergoing same-day endoscopic-assisted coblation adenoidectomy under general anesthesia were randomly allocated to either laryngeal mask airway group (Group L) or endotracheal intubation group (Group T). ED and pain were assessed using the Pediatric Anesthesia Emergence Delirium (PAED) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale, respectively. The primary outcome was the incidence of ED within 30 minutes post-extubation. The secondary outcomes included the highest FLACC score, vital signs, the duration of surgery, anesthesia time, extubation time, length of Post-Anesthesia Care Unit (PACU) stay, adverse events post-extubation, sore throat score, and the satisfaction levels of ward nurses and caregivers.

Results: The incidence of ED was significantly lower in Group L than in Group T (15.4% vs. 41%, P<0.05). The systolic blood pressure (106.8±14.4 mmHg vs. 122.5±17.6 mmHg), diastolic blood pressure (60.9±12.6 mmHg vs. 76.8±16.7 mmHg), and heart rate (99.8±15.4 beats/min vs. 111.4±16.6 beats/min) in Group L were significantly lower than those in Group T at post-intubation (P<0.05 for all). The extubation time (6.1±2.0 min vs. 8.6±2.1 min) and length of stay in PACU (12.5±6.1 min vs. 15.8±7.1 min) were significantly shorter in Group L compared with Group T (P<0.05 for both). The incidence of airway complications (2.6% vs. 30.8%) and hypoxemia (2.6% vs. 20.5%) were significantly lower in Group L compared to Group T after extubation (P<0.05 for both). The sore throat score at discharge was significantly lower in Group L than in Group T (0 [0 to 2] vs. 2 [0 to 4], P<0.05). Additionally, nurses' overall satisfaction was significantly higher in Group L than Group T (5 [5 to 5] vs. 5 [2 to 5], P<0.05).

Conclusions: The use of laryngeal mask airway effectively reduces the incidence of ED in children undergoing same-day endoscopic-assisted coblation adenoidectomy compared to endotracheal intubation. Additionally, it provides several advantages, including shorter extubation time, attenuated hemodynamic responses to intubation stress, and reduced rates of airway complications and postoperative sore throat.

Introduction: Total hip and knee arthroplasties are among the most common surgeries worldwide. Advances in anesthesia and pain management have enabled fast-track pathways, with spinal anesthesia increasingly preferred over general anesthesia. Bupivacaine has been the traditional local anesthetic of choice; however, mepivacaine has gained attention due to its shorter recovery profile. We conducted a systematic review and meta-analysis comparing spinal mepivacaine versus bupivacaine in total joint arthroplasty.

Evidence acquisition: We searched MEDLINE, Embase, Web of Science, and Cochrane databases for studies comparing spinal mepivacaine and bupivacaine in total joint arthroplasty. Statistical analyses were performed using R (version 4.2.2). Quality assessment and risk of bias were performed according to Cochrane recommendations.

Evidence synthesis: We included 13 studies comprising 4,167 adult patients, with 1,564 (37.5%) receiving spinal mepivacaine. Mepivacaine led to significantly faster motor function recovery (mean difference [MD] -30.70 min; 95% CI -44.71 to -16.70 min; P<0.01) and earlier ambulation (MD -51.60 min; 95% CI -96.50 to -6.70 min; P=0.02). It was also associated with shorter facility length of stay (LOS) (MD -4.36 hours; 95% CI -6.25 to -2.48 hours; P<0.01), though no difference was observed in post-anesthesia care unit LOS (MD -31.02 min; 95% CI -64.25 to 2.20 min; P=0.07).

Conclusions: This meta-analysis suggests that mepivacaine spinal anesthesia for total joint arthroplasty may provide faster recovery and earlier home discharge. However, these findings should be interpreted with caution due to the potential risk of bias in most included studies.