Minerva anestesiologica最新文献

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.

Background: Despite recent advancements, ensuring the successful placement and safe ventilation of second-generation supraglottic airway devices (SAD) remains challenging, particularly in pediatric patients. This study aims to compare three LMA ProSeal insertion techniques to assess their impact on placement effectiveness in children, as measured by oropharyngeal leak pressure (OLP). This study hypothesized that different insertion techniques would have a statistically significant effect on OLP in pediatric patients.

Methods: This was a prospective, randomized, controlled trial conducted at a single-center university hospital from October 2023 to April 2024. A total of 150 children aged 1-10 years undergoing short surgical procedures (≤90 minutes) were enrolled. After inserting the LMA ProSeal via standard technique (SD group), direct laryngoscopy (DL group), or videolaryngoscopy (VL group), OLP was measured by detecting air leaks at the thyroid cartilage while closing the valve up to 30 cmH2O. A fiberoptic bronchoscope was used to evaluate the glottic view.

Results: Of the 159 screened patients, 150 were analyzed per protocol. OLP was significantly higher in the VL group (median [Q1-Q3], 26 [24.2-27] cmH2O) compared to the DL group (23 [21.2-24] cmH2O) and SD group (21 [20-22] cmH2O) (P<0.001). The DL group showed significantly higher OLP than the SD group (P=0.001). Fiberoptic imaging scores were higher in the VL group than in the other groups (P<0.001). The first-attempt success rate of SAD insertion was comparable between the VL and DL groups (94% each), but lower in the SD group (86%) (p=0.290). The SAD insertion time was significantly longer in the VL and DL groups compared to the SD group (median [Q1-Q3], 21 [19.2-22] s; 21 [19-22] s; 14 [13-16] s respectively, P<0.001), although there was no significant difference between VL and DL. The number of additional maneuvers during SAD placement was similar between the VL and DL groups but lower in the SD group (P=0.008).

Conclusions: Videolaryngoscopy resulted in the highest OLP and the best fiberoptic views, ensuring superior SAD placement. Direct laryngoscopy improved placement over the standard technique but was less effective than videolaryngoscopy.

Postoperative analgesia is a crucial component in optimized postoperative recovery protocols, especially in laparoscopic surgery, a minimally invasive technique that reduces surgical trauma and accelerates recovery. The transversus abdominis plane block has been proposed as an alternative to thoracic epidural analgesia, which, although effective, is associated with significant side effects such as hypotension, urinary retention, and muscle weakness. However, the current literature lacks a systematic synthesis directly comparing these two analgesic techniques following laparoscopic surgery of the abdomen. This study aims to evaluate the effectiveness of transversus abdominis plane block to thoracic epidural analgesia in postoperative pain control, with a particular focus on functional outcomes and hospital length of stay. A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in the PROSPERO database (CRD42024508473). Randomized controlled trials (RCTs) comparing the transversus abdominis plane block and thoracic epidural analgesia in adult patients undergoing laparoscopic surgery were selected. The primary outcome analyzed was static pain at 24 hours, while secondary outcomes included static pain at 0-2 hours, dynamic pain at 0-2 and 24-36 hours, opioid consumption, time to first mobilization, time to first flatus, and hospital length of stay. A total of 264 articles were identified, of which five RCTs (N.=400 patients) met the inclusion criteria. The analysis showed no significant differences in pain control between the transversus abdominis plane block and thoracic epidural analgesia in the first 24 postoperative hours (Cohen's d=-0.12, 95% CI: -0.48; 0.24) or in total opioid consumption (Cohen's d=-0.09, 95% CI: -0.45; 0.26). However, the transversus abdominis plane block was associated with faster functional recovery, with a significant reduction in time to first flatus (Cohen's d=-0.61, 95% CI: -1.15; -0.07, P=0.027) and time to first mobilization (Cohen's d=-0.76, 95% CI: -1.25; -0.27, P=0.003). No significant differences were found in hospital length of stay (Cohen's d=-0.14, 95% CI: -0.50; 0.22). The transversus abdominis plane block provides effective analgesia and promotes faster functional recovery compared to thoracic epidural analgesia. Given these advantages, it may represent a valid alternative in optimized postoperative recovery protocols. However, further high-quality studies are needed to confirm its efficacy and define standardized guidelines for its use in laparoscopic surgery.

Background: This single center study analyzed epidemiology, outcomes, and three-year quality of life (QoL) of critically ill COVID-19 patients requiring a possibly life-saving VV-ECMO.

Methods: Demographics, clinical and technical data from adult critical COVID-19 VV-ECMO patients were prospectively analyzed (March 2020-January 2022). QoL was yearly assessed by the 'Medical Outcomes Study 36-item Short Form Health Survey' (SF-36) questionnaire. Hospital Anxiety and Depression Scales were measured. Return to work (RTW) was monitored. Multivariate linear regression analyzed factors influencing SF-36 physical (PCS) and mental component summary (MCS) scores.

Results: Forty-eight patients were included, median age was 51 [42.8-57.2] years. Clinical Frailty Scores were 1(33%), 2(44%) or 3(23%). At ECMO initiation, median SOFA score was 11.0 [9.0-12.0]. ECMO support lasted for a median duration of 16 [11.8-28.8] days. Median ICU and hospital stay was 32.0 [21.0-45.0] and 67.0 [58.0-130.0] days. One-year mortality was 33.3% without additional mortality after three years. PCS scores were lower than in general healthy population at one (P<0.001), two (P=0.037) and three (P<0.010) years. MCS scores were equivalent and higher at three years (P=0.015). Anxiety was present in 10/29 (34.5%) and 4/29 (13.8%) had symptoms of depression three years after ECMO initiation. RTW was possible in 13 out of 23 (56,5%), working prior to critical COVID-19.

Conclusions: Three-year mortality after VV-ECMO for critical COVID-19 was 33.3%. Physical health was impaired, but mental health remained comparable to the general population, with relatively low anxiety and depression levels. RTW was possible in 56.5%.

Background: Adequate postoperative pain management is an important part of perioperative care in terms of patient comfort and faster recovery. Unfortunately, pediatric patients frequently experience high levels of postoperative pain, also at home after outpatient surgery. Assessment and management of pain could be achieved through a smartphone application. However, it is uncertain whether children and their caregivers see benefit in such an application.

Methods: This prospective cohort study included children, aged one month to 18 years, who required ENT, urological or orthopedic surgery in ambulatory care over a 12-week period. Participants received a questionnaire, consisting of smartphone application-related questions and questions about pain in the week following surgery. One week after the operation, the participants were called to submit their responses to this questionnaire.

Results: Of 244 eligible participants, 129 were included of which 107 remained for analysis. More than 80% of participants indicated that a smartphone application could help them estimate and treat their child's postoperative pain at home. Regarding potential components, the ability to contact the hospital seemed to be most important. Regarding the incidence of pain, at day 1, 65.4% of all patients had moderate to severe pain. By the end of the first week, this percentage is still 15.9%.

Conclusions: It seems necessary to pay more attention to the assessment and treatment of postoperative pain in children. A smartphone application may help managing this common problem after outpatient surgery. Future studies should focus on developing a smartphone application tailored to the need of young patients and their caregivers, and evaluating the outcomes for improving pain management.

Background: Anterior cervical discectomy and fusion (ACDF) is one of the effective surgical treatments for cervical spondylosis. However, this condition is associated with moderate postoperative pain. Appropriate pain management is crucial to enhance patients' postoperative recovery quality. We aimed to compare the effects of intermediate cervical plexus block (ICPB) and superficial cervical plexus block (SCPB) on the postoperative recovery quality of patients undergoing ACDF.

Methods: In this single-center randomized controlled trial, 90 eligible patients (ASA I-II) were screened; 80 were randomized to ICPB (N.=40) or SCPB (N.=40) group after exclusions. Following general anesthesia induction, patients received either ICPB or SCPB with 10 mL 0.25% ropivacaine. The primary outcome measure was recovery quality at 24 h postoperatively, assessed using the Quality of Recovery scale (QoR-15) scale. Secondary outcomes included post-anesthesia care unit (PACU) discharge time, resting/movement pain (Numeric Rating Scale [NRS] 0-10) at 2, 6, 12 and 24 h, intraoperative remifentanil consumption, time to first rescue analgesia, postoperative butorphanol use and nausea/vomiting incidence.

Results: The ICPB group demonstrated significantly higher 24 h QoR-15 scores (mean: 126.1±6.1 vs. 120.5±7.8; mean difference: 5.6; 95% CI: 2.4 to 8.7; P<0.001), prolonged time to first analgesia request (13.6 vs. 11.8 hours; P=0.010), reduced butorphanol consumption (1 vs. 1.5 mg; P=0.020), and lower movement NRS scores at all timepoints (P<0.05). Postoperative nausea and vomiting incidence was lower with ICPB (15% vs. 35%; P=0.039). No significant differences occurred in resting pain or PACU stay.

Conclusions: Compared with those who had SCPB, patients who received ICPB experienced a mild but statistically significant improvement in the quality of postoperative recovery, particularly in terms of reduced movement-related pain, decreased analgesic use, and lower incidence of nausea and vomiting.