Minerva anestesiologica最新文献

Background: Acute kidney injury (AKI) is a major health burden after cardiac surgery. Renal vasoconstriction and venous congestion can be assessed via transesophageal echocardiography (TEE). The primary objective is to determine feasibility of measuring intraoperative Renal resistive index (RRI) and portal vein pulsatility fraction (PF) by TEE. The secondary objectives are to determine the association between RRI and/or PF and postoperative AKI, Intensive Care Unit (ICU) length of stay, hospital length of stay, and 30-day mortality.

Methods: This is a prospective observational study at a single center University setting in adult patients undergoing elective cardiac surgery. Intraoperative RRI and PF measurements were obtained prior to CPB, after CPB, and after chest closure.

Results: Eighty patients met eligibility criteria and consented. Overall feasibility rate was 91% (73/80), RRI measured in 96% (77/80) and PF measured in 94% (75/80). Further analyses was conducted in 69 patients. RRI prior to CPB significantly correlated with AKI ([OR][95% CI] 2.15 [1.07-4.33], P=0.03) with an AUC of 0.68 ([95%CI] 0.55-0.81, P=0.02). Post-chest closure RRI>0.75 significantly correlated with AKI ([OR][95% CI] 3.54 [1.18-10.62], P=0.02). Combination of the three timepoints significantly associated with AKI ([AUC][95% CI] 0.71 [0.58-0.84], P=0.007). PF did not significantly correlate with AKI.

Conclusions: This study demonstrates high feasibility for obtaining intraoperative TEE measurement of RRI and PF and significant correlation between postoperative AKI with pre CPB RRI, post chest closure RRI, and the combination of RRI at the three timepoints.

Background: Frail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery.

Methods: An RCT study was conducted. Frail patients scheduled for elective surgery were randomized to receive either pre-surgical conditioning protocol (PCP) or standard preoperative care. PCP included nursing, anesthetic, and geriatric assessment, nutritional intervention, and physical training for 4-weeks preoperatively. A nurse followed both groups until discharge criteria were met. The primary outcome was postoperative LOS. Secondary outcomes were nutritional status, preoperative frailty status (frailty phenotype-FP) after PCP, and postoperative complications up to three months categorized according to the Clavien-Dindo Classification. Means and medians between the control and intervention groups were compared, with statistical significance set at α=5%.

Results: Thirty-four patients were to intervention and Thirty-seven to the control group. In the intervention group, adherence to prehabilitation was 90%. The median LOS after surgery was three days in both groups, without finding statistically significant differences between groups (P=0.754), although there was a trend towards lower LOS in the urologic surgery subgroup. We found a significant reduction in frailty status after PCP (FPpre=2.4±0.5 and FPpost=1.7±0.5, P<0.001). Nutritional status significantly improved in frail patients after prehabilitation (MNAbasal=9.0±2.5 and MNApost=10.6±2.6), P=0.028. The intervention group had less severe postoperative complications, which were not statistically significant.

Conclusions: The PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.

Introduction: The COVID-19 pandemic has emphasized the need for effective management of severe acute respiratory distress syndrome (ARDS) using veno-venous extracorporeal membrane oxygenation (VV-ECMO). This meta-analysis aims to compare the effectiveness and outcomes of ECMO in patients with COVID-19 ARDS versus those with non-COVID ARDS, assessing its role in different respiratory virus infections.

Evidence acquisition: A systematic search was conducted in PubMed, Web of Science, and other relevant databases up to June 30, 2023, to identify studies comparing ECMO use in COVID-19 and non-COVID ARDS cases. This analysis adheres to PRISMA guidelines, with studies rigorously selected based on predefined inclusion and exclusion criteria and assessed for bias using validated tools.

Evidence synthesis: The meta-analysis included 24 studies with 2,121 patients, revealing that non-COVID ARDS patients treated with ECMO had a lower mortality risk compared to those with COVID-19 ARDS. Specifically, the overall pooled risk difference in survival was -0.11 (95% CI: -0.17 to -0.05, P<0.001), indicating a statistically significant advantage for non-COVID patients. The standardized mean difference for ECMO duration was significantly longer in COVID-19 patients (SMD=0.70, 95% CI: 0.32 to 1.08, P<0.001), reflecting more prolonged treatment needs.

Conclusions: ECMO serves as a vital intervention in severe ARDS, with differential effectiveness observed between COVID-19 and non-COVID patients. The study's findings underline the need for precise patient selection and tailored ECMO application across different viral etiologies. These insights are crucial for enhancing clinical strategies and resource allocation during ongoing and future pandemics.

Background: Surgical fear is present in many patients awaiting surgery. However, a validated Italian version of the Surgical Fear Questionnaire (SFQ) was not available yet. Therefore, the aim of this study was to translate the SFQ into Italian and to test its reliability and validity.

Methods: Design: prospective cohort study on Italian-speaking Swiss patients scheduled for a minimally invasive spinal procedure or spinal surgery. After forward and back translation and a pilot test, reliability and validity of the 8-item SFQ was assessed using the intraclass correlation coefficient, (ICC), Cronbach's alpha, confirmatory factor analysis (CFA), and Spearman's correlation coefficient.

Results: Results on 63 patients revealed median SFQ-total scores of 22 (minimum-maximum: 0-68) at inclusion and 22.5 (0-70) one week before surgery. Test-retest reliability between first and second SFQ-total score was high, ICC=0.947 (95% CI: 0.912-0.968). Internal consistency of the SFQ-total score at both assessment times were high, Cronbach's alphas 0.916 and 0.931 respectively. This was also the case for the subscale short-term fear, item 1-4 and long-term fear, item 5-8 (range 0.853-0.909). CFA-results for a one-factor and a two-factor model favored the two-factor model. Correlations with pain catastrophizing, other anxiety measures, and health status were weak and only state anxiety assessed by PROMIS reached statistical significance.

Conclusions: We conclude that the Italian version of the SFQ is suitable for use in practice and has a high reliability. Validity and sensitivity need additional testing on a larger population.

Introduction: Emergence agitation following general anesthesia poses significant risks to both patients and medical staff. While extensive research has explored the efficacy of magnesium sulfate (MgSO4) in managing pediatric emergence agitation, its effectiveness in adults remains uncertain. Therefore, this meta-analysis seeks to evaluate the efficacy of MgSO4 in mitigating emergence agitation following general anesthesia in adult populations.

Evidence acquisition: A systematic search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases to identify randomized controlled trials (RCTs) comparing MgSO4 or placebo infusion during surgical procedures involving adult patients under general anesthesia. Key outcomes assessed included the incidence of emergence agitation, agitation severity scores, extubation duration, and postoperative nausea and vomiting (PONV). Statistical analyses were conducted using Review Manager 5.4.1 (Cochrane, London, UK), with heterogeneity evaluated using I2 statistics. Significance was defined at P<0.05 for Odds Ratios (OR), mean differences (MD), and standard mean differences (SMD).

Evidence synthesis: Five RCTs encompassing 605 participants were included. MgSO4 resulted in a lower emergence agitation incidence (OR=0.29 [95% CI: 0.12;0.72]; P=0.007). There were no significant differences between groups for patient's agitation severity scores (SMD=-0.69 [95% CI: -1.82; 0.44]; P=0.23), extubation time (MD=1.16 [95% CI: -1.06; 3.37]; P=0.30), or PONV incidence (OR=0.52 [95% CI: 0.15-1.76]; P=0.29).

Conclusions: Magnesium sulfate infusion during general anesthesia was associated with lower incidence of emergence agitation in adults. However, no significant differences were observed regarding emergence agitation severity scores, PONV, or extubation time.

Background: This research aimed to assess the analgesic efficacy of ultrasound-guided rhomboid intercostal block (RIB) or serratus plane block (SPB) versus IV opioid among modified radical mastectomy (MRM) patients.

Methods: One hundred and five female patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status II-III scheduled for unilateral MRM were randomly allocated into three equal groups: 1) control group (received IV basal analgesia); 2) SPB group (received ipsilateral SPB); and 3) RIB group (received ipsilateral RIB).

Results: Visual Analogue Scale (VAS) was significantly increased in control group compared to SPB group at Post-Anesthesia Care Unit (PACU) (1 [1-2], 0 [0-1]), 2 h (4 [3-4], 0 [0-1]), and 4 h (3 [3-4], 2 [1-2]) postoperative in control and SPB groups, respectively; and in comparison with RIB group at PACU (0 [0-1]), 2 h (1 [0-1]), 4 h, (1 [1-2]), 6 h (1 [1-2]), and 8 h (2 [1-2]), postoperative. VAS was significantly increased in SPB group at 6 h (4 [3-4]), and 8 h (4 [3.25-4]), compared to RIB group with P<0.0001. Time of first analgesic requirement (minutes) was significantly delayed in RIB (720 [480-720]) and SPB (360 [360-360]) groups in comparison with control group (60 [60-120]) and in RIB group in comparison with SPB group. The total postoperative 24 h morphine consumption (mg) was significantly increased in control group (15.69±1.64) when compared to SPB (9.6±1.42) and RIB (6.51±1.36) groups and in SPB group when compared to RIB group.

Conclusions: Both rhomboid intercostal and serratus anterior plane blocks were efficient for analgesia after modified radical mastectomy. However, RIB had better analgesic efficacy compared to SPB.

Background: Epidural block may be facilitated by ultrasound (US), particularly in pediatrics. Our goal was to compare pre-procedural US with traditional palpation for epidural block in pediatrics undergoing midabdominal urological procedures.

Methods: A total of 110 patients (1 to 12 years of age) with physical status Class I and II were enrolled in this study. Patients were randomly assigned to 2 equal groups (US and palpation; 55 subjects in each group) using the permuted block randomization method with randomly selected block sizes of four and six. Study subjects and outcomes evaluators were blinded to the study group. The primary outcome was the rate of successful epidural block at the first needle pass.

Results: There was a significant increase in success rate of the epidural block at the first needle pass in US group compared with the palpation group, 80% and 47.3% respectively, 95% Confidence Interval (2.379-8.35), P value ˂0.001. The epidural space detection time was shorter significantly in the US group compared to the palpation group. The procedural complications (unintentional vascular puncture and epidural puncture) did not occur in the 2 groups.

Conclusions: Preprocedural US facilitated epidural block in pediatrics undergoing mid-abdominal urological operations compared with conventional techniques.

Introduction: Remimazolam, a recently approved drug for surgical sedation and general anesthesia, has been compared with propofol in previous studies regarding its efficacy as a general anesthetic. However, the question of whether remimazolam demonstrates non-inferiority to propofol in postoperative subjective quality of recovery (QoR) among patients under general anesthesia has not been definitively answered.

Evidence acquisition: PubMed, Embase, and Cochrane Library databases were systematically searched for all published randomized controlled trials (RCTs) comparing the efficacy of remimazolam and propofol. The primary outcome assessed was the quality of recovery (QoR-15, QoR-40) on postoperative days (POD) 1-3. Secondary outcomes included the duration until consciousness recovery, extubation time, incidence of postoperative nausea and vomiting (PONV), and length of hospital stay.

Evidence synthesis: The analysis involved 10 RCTs with a total of 1077 patients. Remimazolam showed comparable QoR scores to propofol on POD1 (nine trials, standardized mean difference [SMD]: 0.14, 95% confidence interval [CI]: -0.15 to 0.44, P=0.34), POD 2 (two trials, SMD: 0.09, 95% CI: -0.18 to 0.36, P=0.5), and POD 3 (four trials, SMD: 0.17, 95% CI: -0.51 to 0.85, P=0.62). Subgroup and sensitivity analyses confirmed the robustness of these findings. Furthermore, no significant differences were observed in recovery time for consciousness, extubation duration, incidence of PONV, or length of hospital stay between the remimazolam and propofol groups.

Conclusions: Remimazolam is similar to propofol in terms of postoperative subjective QoR for patients receiving general anesthesia.

Background: Shoulder arthroscopy, a standard orthopedic procedure, often results in severe postoperative pain, leading to high opioid consumption and delayed recovery. Various analgesic methods, including peripheral nerve blocks, manage this pain. The pericapsular nerve group block is a relatively new technique whose efficacy in shoulder surgeries has yet to be extensively studied. This study aimed to assess the impact of the pericapsular nerve group block on postoperative recovery quality following shoulder arthroscopy, as measured by the Quality of Recovery-15 score.

Methods: A randomized, prospective, controlled, multicenter study was conducted with 60 patients undergoing unilateral shoulder arthroscopy. Participants were allocated to either Group P (patients receiving the pericapsular nerve group block and multimodal analgesia) or Group C (patients receiving only multimodal analgesia). The primary outcome measured was the Quality of Recovery-15 score 24 hours post-surgery. Secondary outcomes included postoperative numeric rating scale scores, the requirement for rescue analgesia, time to first rescue analgesia, postoperative complications, the necessity for antiemetics, and patient satisfaction.

Results: The median Quality of Recovery-15 score was significantly higher in Group P compared to Group C (120±10 vs. 89±11; P<0.001). Additionally, Group P exhibited lower pain scores at rest and during movement, a decreased need for rescue analgesia, and an extended duration before the first rescue analgesia was required. Postoperative nausea and vomiting were less common in Group P, and patient satisfaction scores were notably higher in this group.

Conclusions: The pericapsular nerve group block significantly enhances postoperative recovery quality, reduces pain and opioid consumption, and improves patient satisfaction without significant complications.