Survey of Anesthesiology最新文献

{"title":"Determination of ED50 of hydromorphone for postoperative analgesia following cesarean delivery.","authors":"G. Lynde","doi":"10.1097/01.sa.0000515850.94080.6f","DOIUrl":"https://doi.org/10.1097/01.sa.0000515850.94080.6f","url":null,"abstract":"BACKGROUND\u0000Morphine is the most common opioid injected into the intrathecal space for postoperative analgesia following cesarean delivery, but ongoing medication shortages have resulted in limited availability. One proposed morphine alternative is hydromorphone. Studies investigating its use in post-cesarean analgesia are limited. This study was conducted to determine the median effective dose of intrathecal hydromorphone 12h postpartum.\u0000\u0000\u0000METHODS\u0000Twenty healthy women undergoing elective cesarean delivery were recruited into this study. Hydromorphone doses were determined using the up-down sequential method. The study dose of hydromorphone started at 6μg and was raised or lowered by 2μg depending on the 12-h efficacy of the preceding participant's dose. Pain scores of <3/10 were considered successful and the subsequent patient received a lower dose. Participants received 0.5% bupivacaine 12.5mg, fentanyl 25μg, and the study dose of hydromorphone as a single intrathecal injection.\u0000\u0000\u0000RESULTS\u0000Ten of 20 participants reported an effective hydromorphone dosage 12h post-injection. The median effective hydromorphone dosage was 4.6μg (95% CI 3.72 to 5.48μg) based on participants' reported visual analog pain scores of <3/10. No significant side effects or adverse outcomes were observed.\u0000\u0000\u0000CONCLUSION\u0000Intrathecal hydromorphone may be an effective alternative to morphine for post-cesarean pain management. The amount of intrathecal hydromorphone necessary to provide analgesia at 12h postoperatively may be significantly lower than doses currently in use. Further research should be performed to identify the optimal dose of intrathecal hydromorphone for post-surgical pain relief.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74493161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of body mass index in acute respiratory distress syndrome.","authors":"Davide Chiumello, Davide Chiumello, A. Colombo, I. Algieri, C. Mietto, E. Carlesso, F. Crimella, M. Cressoni, Michael Quintel, L. Gattinoni, L. Gattinoni","doi":"10.1097/01.sa.0000504593.63316.78","DOIUrl":"https://doi.org/10.1097/01.sa.0000504593.63316.78","url":null,"abstract":"BACKGROUND\u0000Obesity is associated in healthy subjects with a great reduction in functional residual capacity and with a stiffening of lung and chest wall elastance, which promote alveolar collapse and hypoxaemia. Likewise, obese patients with acute respiratory distress syndrome (ARDS) could present greater derangements of respiratory mechanics than patients of normal weight.\u0000\u0000\u0000METHODS\u0000One hundred and one ARDS patients were enrolled. Partitioned respiratory mechanics and gas exchange were measured at 5 and 15 cm H2O of PEEP with a tidal volume of 6-8 ml kg(-1) of predicted body weight. At 5 and 45 cm H2O of PEEP, two lung computed tomography scans were performed.\u0000\u0000\u0000RESULTS\u0000Patients were divided as follows according to BMI: normal weight (BMI≤25 kg m(-2)), overweight (BMI between 25 and 30 kg m(-2)), and obese (BMI>30 kg m(-2)). Obese, overweight, and normal-weight groups presented a similar lung elastance (median [interquartile range], respectively: 17.7 [14.2-24.8], 20.9 [16.1-30.2], and 20.5 [15.2-23.6] cm H2O litre(-1) at 5 cm H2O of PEEP and 19.3 [15.5-26.3], 21.1 [17.4-29.2], and 17.1 [13.4-20.4] cm H2O litre(-1) at 15 cm H2O of PEEP) and chest elastance (respectively: 4.9 [3.1-8.8], 5.9 [3.8-8.7], and 7.8 [3.9-9.8] cm H2O litre(-1) at 5 cm H2O of PEEP and 6.5 [4.5-9.6], 6.6 [4.2-9.2], and 4.9 [2.4-7.6] cm H2O litre(-1) at 15 cm H2O of PEEP). Lung recruitability was not affected by the body weight (15.6 [6.3-23.4], 15.7 [9.8-22.2], and 11.3 [6.2-15.6]% for normal-weight, overweight, and obese groups, respectively). Lung gas volume was significantly lower whereas total superimposed pressure was significantly higher in the obese compared with the normal-weight group (1148 [680-1815] vs 827 [686-1213] ml and 17.4 [15.8-19.3] vs 19.3 [18.6-21.7] cm H2O, respectively).\u0000\u0000\u0000CONCLUSIONS\u0000Obese ARDS patients do not present higher chest wall elastance and lung recruitability.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74806870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Dead Space Is Associated With Increased Mortality in Critically Ill Children","authors":"A. Bhalla, S. Belani, Dennis Leung, C. Newth, R. Khemani","doi":"10.1097/01.sa.0000504599.99381.9d","DOIUrl":"https://doi.org/10.1097/01.sa.0000504599.99381.9d","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75879692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnesium sulfate improves postoperative analgesia in laparoscopic gynecologic surgeries: a double-blind randomized controlled trial.","authors":"A. M. Sousa, G. M. Rosado, Jose de S Neto, G. Guimarães, H. Ashmawi","doi":"10.1097/SA.0000000000000296","DOIUrl":"https://doi.org/10.1097/SA.0000000000000296","url":null,"abstract":"STUDY OBJECTIVE\u0000The aim of this study is to compare the analgesic effect of intravenous infusion of magnesium sulfate to ketorolac during laparoscopic surgeries.\u0000\u0000\u0000DESIGN\u0000Double-blind randomized controlled trial.\u0000\u0000\u0000SETTING\u0000University-affiliated teaching hospital.\u0000\u0000\u0000PATIENTS\u0000Sixty women submitted to laparoscopic gynecologic oncology surgeries.\u0000\u0000\u0000INTERVENTIONS\u0000Intravenous ketorolac 30 mg in bolus followed by saline infusion (group K), intravenous magnesium sulfate 20 mg/kg in bolus followed by magnesium 2 mg kg(-1) h(-1) (group M) or intravenous saline solution 20 mL in bolus followed by saline infusion during the entire procedure (group S).\u0000\u0000\u0000MEASUREMENTS\u0000Postoperative pain, nausea, vomiting, sedation, opioid consumption, time to first dose of analgesic.\u0000\u0000\u0000MAIN RESULTS\u0000Magnesium sulfate reduced opioid consumption compared with placebo in the postoperative, but not in the intraoperative, period. Nausea, not vomiting, was reduced in ketorolac but not in the magnesium group. Pain intensity was higher in placebo than in the other 2 groups during all periods of observation. In the first 60 minutes, pain intensity was lower in the magnesium than in the ketorolac or the placebo group.\u0000\u0000\u0000CONCLUSION\u0000Intraoperative magnesium sulfate improves postoperative pain control, acting as an opioid-sparing adjuvant, and is similar to ketorolac 30 mg administered in the beginning of surgery.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78486485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding Repeated Attempts at Tracheal Intubation: Can Videolaryngoscopes Be the Answer?","authors":"T. Asai","doi":"10.1097/01.sa.0000513244.79834.b3","DOIUrl":"https://doi.org/10.1097/01.sa.0000513244.79834.b3","url":null,"abstract":"Tracheal intubation is a common practice. But multiple attempts can cause airway obstruction and ensuing complications. Guidelines have strongly advised against making multiple tracheal intubation attempts. Many techniques have been described to improve the chances of successful intubation with traditional laryngoscopes (Macintosh and Miller). However, the rate of difficulty has not been significantly reduced. With the modern technological advancements, devices such as video laryngoscopes, fiberoptic bronchoscopes, supraglottic airways (as a conduit for tracheal intubation), lighted stylets, and optical stylets offer alternate options. Aziz et al developed a survey on alternate options used in instanceswhere the conventional methods such as laryngoscope had failed. The authors wanted to retrospectively ascertain the success rates of intubation using these modern devices. A total number of 1427 cases were reviewed. It was observed that video laryngoscopes had the highest success rate (92%) when compared with supraglottic airways (78%), fiberoptic bronchoscope (78%), lighted stylets (77%), and optical stylets (67%). However, because this study was retrospective, selection bias could not be ruled out, and definitive conclusion should not be drawn. Although video","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83059366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overinflation of the Cuff and Pressure on the Neck Reduce the Preventive Effect of Supraglottic Airways on Pulmonary Aspiration: An Experimental Study in Human Cadavers","authors":"M. Hensel, W. Schmidbauer, D. Geppert, S. Sehner, G. Bogusch, T. Kerner","doi":"10.1097/SA.0000000000000256","DOIUrl":"https://doi.org/10.1097/SA.0000000000000256","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86050053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"To Reverse or Not To Reverse?\": The Answer Is Clear!","authors":"G. Murphy, A. Kopman","doi":"10.1097/01.sa.0000513239.94409.ee","DOIUrl":"https://doi.org/10.1097/01.sa.0000513239.94409.ee","url":null,"abstract":"<zdoi;10.1097/ALN.0000000000001280> Anesthesiology, V 125 • No 4 611 October 2016 B y the late 1980s, it was well recognized that undetected postoperative residual neuromuscular block (PRNB) was a common occurrence in most postanesthesia care units (PACUs).1–4 However, an editorial in 1989 noted that there was little, if any, objective evidence to validate the hypothesis that PRNB was associated with long-term or even transient adverse respiratory outcomes.5 In the two and a half decades since the editorial by Miller5 was published, outcome data regarding this important patient safety issue have slowly accumulated, but the relevant database remains quite sparse. In this issue of ANestHesIology, Bulka et al.6 provide an important addition to the small list of studies that attempt to examine the long-term consequences of PRNB. They report two main findings: (1) the use of neuromuscular blocking agents (NMBAs) was associated with a higher absolute rate of postoperative pneumonia (PoP) when compared to matched cases where patients did not receive relaxants and (2) failure to reverse NMBAs at the end of surgery was associated with a 2.25-fold increase in the incidence of PoP. Why should these findings be less than surprising? Bulka et al.6 noted that the incidence rate ratio (1.79) for PoP was significantly higher in patients who received NMBAs. This observation is consistent with the findings from several large database investigations, which have described an association between intraoperative NMBA use and major morbidity and mortality. More than 60 yr ago, Beecher and todd7 reported that the risk of death related to anesthesia was six times higher in patients receiving NMBAs compared to those administered no muscle relaxants. An analysis of data collected over a 10-yr period (1967 to 1976) involving 240,483 anesthetics revealed that “respiratory inadequacy after myoneural blockade” was the second most common cause of death after surgery.8 similarly, a study from great Britain reported that postoperative respiratory failure secondary to dosing of NMBAs was a primary cause of mortality.9 In a large prospective study, the use of the long-acting NMBA pancuronium entailed a higher risk of postoperative pulmonary complications.10 More recent studies reported that patients administered NMBAs had a higher risk of postoperative desaturations and need for reintubation11 and that those given high doses of NMBAs had an increased risk of postoperative respiratory complications.12 The increased incidence of morbidity and mortality reported in patients administered NMBAs is likely secondary to PRNB. Incomplete neuromuscular recovery during a vulnerable postoperative period (between tracheal extubation and achieving a train-of-four [toF] ratio of less than 0.9 in the PACU) may impair upper airway patency, protective airway reflexes, breathing, swallowing, and coughing, resulting in an increased risk of significant respiratory events (like PoP) and death. Data demon","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77535572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring for the Jehovahʼs Witness Parturient","authors":"C. Mason, C. Tran","doi":"10.1097/SA.0000000000000253","DOIUrl":"https://doi.org/10.1097/SA.0000000000000253","url":null,"abstract":"A llogeneic blood transfusion is considered by Jehovah's Witnesses to be a violation of God's law, and this can present many ethical, legal, and health concerns when medical care is needed. Especially in cases dealing with childbirth, where substantial blood loss can occur, having an efficient and effective plan and line of communication between the parturient and her caregivers is crucial to ensure the most beneficial outcome for the patient while respecting her constitutionally protected right to make an informed choice about her medical treatment. The authors of this article reviewed concepts and care options as they related to the perioperative care of a Jehovah's Witness parturient. Courts have upheld that competent pregnant women have the right of bodily self-determination and therefore can refuse blood transfusion. This article established the importance of having a patient's care preferences and directives clearly expressed. For example, patients may do this in writing by using an advance health care directive, which would clearly delineate their personal decisions not only on blood transfusion but also in regard to derivatives of plasma or cellular blood components and autologous blood management, which are “conscience” items on which Witnessesmake individual decisions. Although patients have the right to decline treatments, the physician also has a duty to disclose any risks associated with refusing a treatment and to educate patients on alternative treatments. Communication between parturients and their medical caregivers is key throughout the entire treatment process. This article suggests using a perioperative surgical home model to coordinate care throughout the entire surgical experience as this model is fitting for the unique needs of the Jehovah's Witness population. The use of pharmacologic therapies is also recommended when alternatives to blood transfusion are needed. The authors of this article also suggest several options for reducing perioperative transfusion requirements and medical options for Jehovah's Witness patients who experience a massive hemorrhage. Blood conservation techniques should be considered as Jehovah's Witnesses have differing opinions about what treatments are allowed. Although some Jehovah's Witness parturients may consent to the use of acute normovolemic hemodilution and blood cell salvage, other Witnesses may have stricter specifications. Anesthetic and surgical techniques should be executed in a way that decreases blood loss. Again, the authors emphasize communication between patients and caregivers to expedite any necessary interventions in the threat or event of hemorrhage. The care of a Jehovah's Witness parturient must encompass all medical, ethical, and legal considerations. This article stresses the establishment of a communicative and comprehensive model early in the antepartum period that can be maintained throughout","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80842158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-lumen tubes and auto-PEEP during one-lung ventilation.","authors":"J. Spaeth, M. Ott, W. Karzai, A. Grimm, S. Wirth, Stefan Schumann, T. Loop","doi":"10.1097/01.sa.0000490231.29771.01","DOIUrl":"https://doi.org/10.1097/01.sa.0000490231.29771.01","url":null,"abstract":"BACKGROUND\u0000Double-lumen tubes (DLT) are routinely used to enable one-lung-ventilation (OLV) during thoracic anaesthesia. The flow-dependent resistance of the DLT's bronchial limb may be high as a result of its narrow inner diameter and length, and thus potentially contribute to an unintended increase in positive end-expiratory pressure (auto-PEEP). We therefore studied the impact of adult sized DLTs on the dynamic auto-PEEP during OLV.\u0000\u0000\u0000METHODS\u0000In this prospective clinical study, dynamic auto-PEEP was determined in 72 patients undergoing thoracic surgery, with right- and left-sided DLTs of various sizes. During OLV, air trapping was provoked by increasing inspiration to expiration ratio from 1:2 to 2:1 (five steps). Based on measured flow rate, airway pressure (Paw) and bronchial pressure (Pbronch), the pressure gradient across the DLT (ΔPDLT) and the total auto-PEEP in the respiratory system (i.e. the lungs, the DLT and the ventilator circuit) were determined. Subsequently the DLT's share in total auto-PEEP was calculated.\u0000\u0000\u0000RESULTS\u0000ΔPDLT was 2.3 (0.7) cm H2O over the entire breathing cycle. At the shortest expiratory time the mean total auto-PEEP was 2.9 (1.5) cm H2O (range 0-5.9 cm H2O). The DLT caused 27 to 31% of the total auto-PEEP. Size and side of the DLT's bronchial limb did not impact auto-PEEP significantly.\u0000\u0000\u0000CONCLUSIONS\u0000Although the DLT contributes to the overall auto-PEEP, its contribution is small and independent of size and side of the DLT's bronchial limb. The choice of DLT does not influence the risk of auto-PEEP during OLV to a clinically relevant extent.\u0000\u0000\u0000CLINICAL TRIAL REGISTRATION\u0000DRKS00005648.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84816560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut†.","authors":"L. L. Asserhøj, H. Mosbech, M. Krøigaard, L. H. Garvey","doi":"10.1097/01.sa.0000490336.54904.62","DOIUrl":"https://doi.org/10.1097/01.sa.0000490336.54904.62","url":null,"abstract":"BACKGROUND\u0000Propofol is thought to be a potential cause of allergic reactions in patients allergic to egg, soy or peanut, since current formulations contain an emulsion that includes egg lecithin and soybean oil. However, other than six case reports lacking in confirmatory evidence of an allergic reaction, there is no evidence linking the two types of allergies. The aim of this study was to examine the frequency of propofol allergy and to investigate if patients with specific immunoglobulin E (IgE) to egg, soy or peanut tolerated propofol.\u0000\u0000\u0000METHODS\u0000Study A examined the frequency of propofol allergy in 273 patients systematically investigated for suspected perioperative allergic reactions. Of these, 153 had been exposed to propofol and underwent skin tests and intravenous provocation. Study B retrospectively investigated propofol exposure and tolerance in 520 adult patients with a positive specific IgE to egg, soy or peanut.\u0000\u0000\u0000RESULTS\u0000Four of the 153 propofol-exposed patients (2.6%) investigated in study A were diagnosed with propofol allergy. Of these, three tested positive only on intravenous provocation. None of the four had allergic symptoms when eating egg, soy or peanut and none had detectable levels of specific IgE to egg or soy in their serum. In study B we found no signs of allergic reactions towards propofol in 171 retrieved anaesthetic charts from 99 patients with specific IgE to egg, soy or peanut.\u0000\u0000\u0000CONCLUSION\u0000No connection between allergy to propofol and allergy to egg, soy or peanut was found. The present practice of choosing alternatives to propofol in patients with this kind of food allergy is not evidence based and should be reconsidered.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89355519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}