Brazilian Journal of Anesthesiology最新文献

英文中文

Assessment of superior vena cava diameter and collapsibility index in liver transplantation: a prospective observational study 肝移植中上腔静脉直径和塌陷指数的评估：一项前瞻性观察研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-10-09 DOI: 10.1016/j.bjane.2024.844563

Background

Superior Vena Cava (SVC) diameter and collapsibility index, dynamic measures of fluid responsiveness, have been successfully utilized as echocardiographic indices for fluid responsiveness in ventilated septic patients. Whether these measurements are correlated with Central Venous Pressure (CVP) measurements in liver transplant patients is unknown. We sought to assess the correlation of maximum and minimum SVC diameter and SVC collapsibility index measurements obtained intraoperatively by Transesophageal Echocardiography (TEE) with those of simultaneously recorded CVP measurements obtained through a right atrial port of a pulmonary artery catheter. The secondary aim of the study was to assess the correlation between SVC measurements and simultaneously obtained thermodilution cardiac index measurements.

Methods

Single center prospective observational trial of patients with end stage liver disease undergoing liver transplantation in an academic tertiary care center.

Results

The minimum SVC exhibited a mild significant correlation with CVP as did the maximum SVC. The correlation between the SVC collapsibility index and CVP was not significantly different from zero. In our secondary analysis, the correlation between minimum SVC diameter and cardiac index was determined to be weak but non-zero as was the correlation between the maximum SVC diameter and cardiac index. The correlation between SVC collapsibility index and cardiac index was not different from zero.

Conclusion

While statistically significant, the weak clinical correlation of intraoperative SVC measurements obtained by TEE make them unsuitable as a replacement for central venous pressure or thermodilution cardiac index measurements in liver transplant recipients.

背景：上腔静脉（SVC）直径和塌陷度指数是液体反应性的动态测量指标，已被成功用作脓毒症通气患者液体反应性的超声心动图指标。这些测量值与肝移植患者的中心静脉压（CVP）测量值是否相关尚不清楚。我们试图评估术中通过经食道超声心动图（TEE）获得的最大和最小SVC直径以及SVC塌陷度指数测量值与通过肺动脉导管右心房端口同时记录的CVP测量值之间的相关性。研究的第二个目的是评估 SVC 测量值与同时获得的热稀释心脏指数测量值之间的相关性：方法：在一家学术性三级医疗中心对接受肝移植的终末期肝病患者进行单中心前瞻性观察试验：结果：最小 SVC 与 CVP 呈轻度显著相关，最大 SVC 也是如此。SVC塌陷指数与CVP之间的相关性与零无显著差异。在我们的二次分析中，最小 SVC 直径与心脏指数之间的相关性较弱，但不为零，最大 SVC 直径与心脏指数之间的相关性也是如此。SVC塌陷指数与心脏指数之间的相关性与零无差异：通过 TEE 获得的术中 SVC 测量值虽然具有统计学意义，但其临床相关性较弱，因此不适合取代肝移植受者的中心静脉压或热稀释心脏指数测量值。

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引用次数: 0

The debate on antifibrinolytics in liver transplantation: always, never, or sometimes? 关于肝移植中抗纤维蛋白溶解剂的争论：总是、从不还是有时？

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-26 DOI: 10.1016/j.bjane.2024.844562

引用次数: 0

Comparison of propofol-ketamine and propofol-fentanyl combinations for sedation in patients undergoing gastrointestinal endoscopy: a randomized clinical trial 比较异丙酚-氯胺酮和异丙酚-芬太尼组合对胃肠道内窥镜检查患者的镇静作用：随机临床试验。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-19 DOI: 10.1016/j.bjane.2024.844561

引用次数: 0

Intraoperative hypotension and postoperative delirium in elderly male patients undergoing laryngectomy: a single-center retrospective cohort study 接受喉切除术的老年男性患者术中低血压和术后谵妄：一项单中心回顾性队列研究

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-12 DOI: 10.1016/j.bjane.2024.844560

Background

Postoperative delirium (POD) is a common, transient postoperative cognitive dysfunction in elderly patients. The relationship between POD and intraoperative hypotension remains unclear. This study aims to determine if intraoperative hypotension predicts POD in elderly male patients undergoing laryngectomy.

Methods

This study included male patients over 65 years old who underwent laryngectomy between April 2018 and January 2022. The Confusion Assessment Method (CAM) was used to diagnose delirium. Intraoperative hypotension was defined as a Mean Arterial Pressure (MAP) during surgery that was less than 30% of the preoperative level for at least 30 minutes. The relationship between intraoperative hypotension and POD incidence was adjusted for patient demographics and surgery-related factors.

Results

Out of 428 male patients, 77 (18.0%) developed POD, and 166 (38.8%) experienced intraoperative hypotension. Surgery duration ≥ 300 minutes (OR = 1.873, 95% CI 1.041–3.241, p = 0.036), intraoperative hypotension (OR = 1.739, 95% CI 1.039–2.912, p = 0.035), and schooling (OR = 2.655, 95% CI 1.338–5.268) were independent risk factors for POD. The association between intraoperative hypotension and POD was significantly influenced by surgery duration (p for interaction = 0.008), with a stronger association in prolonged surgeries (adjusted OR = 4.902; 95% CI 1.816–13.230).

Conclusions

Intraoperative hypotension and low education level are associated with an increased risk of POD in elderly male patients undergoing laryngectomy, especially with prolonged surgery duration.

背景术后谵妄（POD）是老年患者术后常见的短暂认知功能障碍。POD 与术中低血压之间的关系仍不清楚。本研究旨在确定术中低血压是否可预测接受喉切除术的老年男性患者的 POD。方法本研究纳入了 2018 年 4 月至 2022 年 1 月间接受喉切除术的 65 岁以上男性患者。采用意识模糊评估法（CAM）诊断谵妄。术中低血压定义为手术期间平均动脉压（MAP）低于术前水平的30%，持续时间至少30分钟。根据患者人口统计学和手术相关因素调整了术中低血压与 POD 发生率之间的关系。手术时间≥300分钟（OR = 1.873，95% CI 1.041-3.241，P = 0.036）、术中低血压（OR = 1.739，95% CI 1.039-2.912，P = 0.035）和学龄（OR = 2.655，95% CI 1.338-5.268）是POD的独立风险因素。结论术中低血压和低教育水平与接受喉切除术的老年男性患者发生 POD 的风险增加有关，尤其是在手术时间较长的情况下。

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引用次数: 0

The efficacy of buprenorphine compared with dexmedetomidine in spinal anesthesia: a systematic review and meta-analysis 丁丙诺啡与右美托咪定在脊髓麻醉中的疗效比较：系统综述和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-08 DOI: 10.1016/j.bjane.2024.844557

Background

This study compares dexmedetomidine and buprenorphine as potential adjuvants for spinal anesthesia. Dexmedetomidine enhances sensory block and minimizes the need for pain medication, while buprenorphine, a long-acting opioid, exhibits a favorable safety profile compared to traditional opioids.

Methods

PubMed, Cochrane and EMBASE were systematically searched in December 2023. Eligibility criteria: RCTs with patients scheduled for lower abdominal, pelvic, or lower limb surgeries; undergoing spinal anesthesia with a local anesthetic and buprenorphine or dexmedetomidine.

Results

Eight RCTs involving 604 patients were included. Compared with dexmedetomidine, buprenorphine significantly reduced time for sensory regression to S1 (Risk Ratio [RR = -131.28]; 95% CI -187.47 to -75.08; I² = 99%) and motor block duration (RR = -118.58; 95% CI -170.08 to -67.09; I² = 99%). Moreover, buprenorphine increased the onset time of sensory block (RR = 0.42; 95% CI 0.03 to 0.81; I² = 93%) and increased the incidence of postoperative nausea and vomiting (RR = 4.06; 95% CI 1.80 to 9.18; I^² = 0%). No significant differences were observed in the duration of analgesia, onset time of motor block, time to achieve the highest sensory level, shivering, hypotension, or bradycardia.

Conclusions

The intrathecal administration of buprenorphine, when compared to dexmedetomidine, is linked to reduction in the duration of both sensory and motor blocks following spinal anesthesia. Conversely, buprenorphine was associated with an increased risk of postoperative nausea and vomiting and a longer onset time of sensory block. Further high-quality RCTs are essential for a comprehensive understanding of buprenorphine's effects compared with dexmedetomidine in spinal anesthesia.

背景：本研究比较了右美托咪定和丁丙诺啡作为脊髓麻醉的潜在辅助药物。右美托咪定能增强感觉阻滞，最大限度地减少对止痛药的需求，而丁丙诺啡作为一种长效阿片类药物，与传统阿片类药物相比具有良好的安全性：方法：2023 年 12 月对 PubMed、Cochrane 和 EMBASE 进行了系统检索：研究对象为计划接受下腹部、骨盆或下肢手术的患者；接受局部麻醉剂和丁丙诺啡或右美托咪定的脊髓麻醉：结果：共纳入了 8 项研究，涉及 604 名患者。与右美托咪定相比，丁丙诺啡可显著缩短感觉回退至 S1 的时间（风险比 [RR = -131.28]; 95% CI -187.47 to -75.08; I2 = 99%）和运动阻滞持续时间（RR = -118.58; 95% CI -170.08 to -67.09; I2 = 99%）。此外，丁丙诺啡增加了感觉阻滞的起始时间（RR = 0.42；95% CI 0.03 至 0.81；I2 = 93%），并增加了术后恶心和呕吐的发生率（RR = 4.06；95% CI 1.80 至 9.18；I² = 0%）。在镇痛持续时间、运动阻滞开始时间、达到最高感觉水平的时间、哆嗦、低血压或心动过缓方面未观察到明显差异：结论：与右美托咪定相比，鞘内注射丁丙诺啡可缩短脊髓麻醉后感觉和运动阻滞的持续时间。相反，丁丙诺啡会增加术后恶心和呕吐的风险，并延长感觉阻滞的开始时间。要全面了解丁丙诺啡与右美托咪定在脊髓麻醉中的效果比较，必须进一步进行高质量的研究性试验。

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引用次数: 0

Comparison of the recovery profile of sufentanil and remifentanil in total intravenous anesthesia: a systematic review and meta-analysis of randomized controlled trials 舒芬太尼和瑞芬太尼在全静脉麻醉中的恢复情况比较：随机对照试验的系统回顾和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-07 DOI: 10.1016/j.bjane.2024.844558

Introduction

Remifentanil is a short-acting opioid and can be administered during surgery without the risk of delayed postoperative recovery but concerns about hyperalgesia and the shortages of remifentanil lead anesthetists to consider long-acting opioids for Total Intravenous Anesthesia (TIVA). Sufentanil is a more potent opioid with a longer context-sensitive half-life but can promote good postoperative analgesia due to its residual effect. This meta-analysis aimed to compare the recovery profile of remifentanil and sufentanil for TIVA.

Methods

The search strategy was performed in PubMed, CENTRAL, and Web of Science for RCTs comparing sufentanil and remifentanil as part of TIVA in adults undergoing noncardiac surgery. Risk of bias and the quality of evidence were performed using RoB2 and GRADEpro, respectively. The primary outcome was time to tracheal extubation. Secondary analyses included postoperative analgesia, respiratory depression, and Postoperative Nausea and Vomiting (PONV).

Results

Sufentanil increases the time to extubate, MD = 4.29 min; 95% CI: 2.33 to 6.26; p = 0.001. It also reduces the need for postoperative rescue analgesia, logOR = -1.07; 95% CI: -1.62 to -0.52; p = 0.005. There were no significant differences between both opioids for PONV, logOR = 0.50; 95% CI: -0.10 to 1.10; p = 0.10 and respiratory depression, logOR = 1.21; 95% CI: -0.42 to 2.84; p = 0.15.

Conclusion

Sufentanil delays the time to tracheal extubation compared with remifentanil but is associated with a reduced need for postoperative rescue analgesia. No significant differences were observed between the two opioids in terms of postoperative respiratory depression or PONV.

简介：瑞芬太尼是一种短效阿片类药物，可在手术过程中使用，且无术后恢复延迟的风险，但对痛觉减退的担忧和瑞芬太尼的短缺导致麻醉师考虑在全静脉麻醉（TIVA）中使用长效阿片类药物。舒芬太尼是一种效力更强的阿片类药物，具有更长的环境敏感半衰期，但由于其残留效应，可促进良好的术后镇痛。本荟萃分析旨在比较瑞芬太尼和舒芬太尼在 TIVA 中的恢复情况：方法：在PubMed、CENTRAL和Web of Science中对比较舒芬太尼和瑞芬太尼作为TIVA一部分用于接受非心脏手术的成人的RCT进行了检索。分别使用RoB2和GRADEpro对偏倚风险和证据质量进行了评估。主要结果是气管拔管时间。次要分析包括术后镇痛、呼吸抑制和术后恶心呕吐（PONV）：结果：舒芬太尼延长了拔管时间，MD = 4.29 分钟；95% CI：2.33 至 6.26；P = 0.001。它还减少了术后抢救镇痛的需求，logOR = -1.07; 95% CI: -1.62 to -0.52; p = 0.005。两种阿片类药物在 PONV（logOR = 0.50；95% CI：-0.10 至 1.10；p = 0.10）和呼吸抑制（logOR = 1.21；95% CI：-0.42 至 2.84；p = 0.15）方面无明显差异：与瑞芬太尼相比，舒芬太尼可延长气管拔管时间，但可减少术后抢救镇痛的需求。两种阿片类药物在术后呼吸抑制或 PONV 方面无明显差异。

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引用次数: 0

Hybrid ultrasound and landmark technique for thoracic paravertebral block: a clinical image 胸椎旁阻滞的混合超声和地标技术：临床图像。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-06 DOI: 10.1016/j.bjane.2024.844555

引用次数: 0

Kidney transplantation and perioperative complications: a prospective cohort study 肾移植与围手术期并发症：一项前瞻性队列研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-05 DOI: 10.1016/j.bjane.2024.844556

Background

Kidney transplant recipients face complex perioperative challenges due to comorbidities from chronic kidney disease. This study aimed to assess perioperative complications in kidney transplant recipients and evaluate the association between the Charlson Comorbidity Index (CCI) and complication severity using the Clavien-Dindo (CD) classification.

Methods

A prospective cohort study conducted at a tertiary hospital in South Brazil from September 2020 to March 2022, including 230 adult kidney transplant recipients. Data on demographics, comorbidities, and complications were collected. Complications were categorized using the CD scale, and their relationship with CCI was analyzed using univariate and multivariate Cox regression.

Results

Mean age was 49.2 ± 12.7 years, with 58.7% male recipients. The mean CCI score was 3.65 ± 1.5 points. Intraoperative complications occurred in 10.9% of patients, with notable issues including bleeding and airway difficulties. In the immediate postoperative period, 9.1% required urgent dialysis. In the 30-day follow-up, 57.8% had delayed graft function, 21.7% infections, 11.3% had vascular complications, and the mortality was 1.7%. CCI was not a significant predictor of severe complications; however, congestive heart failure was strongly associated with severe complications (HR = 6.6 95% CI 2.6–6.7, p < 0.001).

Conclusions

Despite a low overall comorbidity profile, kidney transplant recipients faced significant perioperative challenges. The lack of a significant association between the CCI score and severe complications suggests that traditional risk assessment tools may not fully capture the risks specific to the early postoperative period in kidney transplantation, and future research should focus on developing more refined risk assessment models for chronic kidney disease patients.

背景：肾移植受者因慢性肾脏病合并症而面临复杂的围手术期挑战。本研究旨在评估肾移植受者的围手术期并发症，并使用克拉维恩-丁多（CD）分类法评估查尔森综合症指数（CCI）与并发症严重程度之间的关联：2020年9月至2022年3月在巴西南部的一家三级医院进行的前瞻性队列研究，包括230名成年肾移植受者。研究收集了有关人口统计学、合并症和并发症的数据。并发症采用CD量表进行分类，并采用单变量和多变量考克斯回归分析其与CCI的关系：平均年龄（49.2±12.7）岁，男性受者占58.7%。平均 CCI 得分为 3.65±1.5 分。10.9%的患者出现了术中并发症，主要问题包括出血和气道困难。术后初期，9.1%的患者需要紧急透析。在30天的随访中，57.8%的患者出现移植物功能延迟，21.7%出现感染，11.3%出现血管并发症，死亡率为1.7%。CCI不是严重并发症的重要预测因素；但充血性心力衰竭与严重并发症密切相关（HR = 6.6 95% CI 2.6-6.7，P < 0.001）：尽管肾移植受者的总体合并症较低，但他们在围手术期仍面临巨大挑战。CCI评分与严重并发症之间没有明显关联，这表明传统的风险评估工具可能无法完全捕捉到肾移植术后早期的特殊风险，未来的研究应侧重于为慢性肾病患者开发更精细的风险评估模型。

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引用次数: 0

Pediatric emergence delirium is linked to increased early postoperative negative behavior within two weeks after adenoidectomy: an observational study 一项观察性研究：腺样体切除术后两周内小儿出现谵妄与术后早期消极行为增加有关。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-01 DOI: 10.1016/j.bjane.2021.03.008

Background

The aim of this prospective multicenter observational study was to measure the incidence of postoperative pediatric emergence delirium and to investigate the occurrence of early postoperative negative behavior within two weeks after outpatient adenoidectomy in preschool children.

Methods

The study comprised 222 patients (1...7 years of age). All children received a multimodal anesthesia based on total intravenous anesthesia with propofol and remifentanil in combination with piritramid (0.1 mg.kg^-1), ibuprofen (10 mg.kg^-1), dexamethason (0.15 mg.kg^-1), and ketanest S (0.1 mg.kg^-1). We evaluated emergence delirium using the Pediatric Anesthesia Emergence Delirium Scale (PAED) at different predefined time points during the recovery period. Emergence delirium was defined as a PAED score ... 9 for the first three criteria. Additionally, we defined early postoperative negative behavior to be present when at least 5 of 27 criteria of the post hospitalization behavior questionnaire were positive.

Results

The incidence of emergence delirium following our anesthetic regime was 23%. The incidence of early postoperative negative behavior was significantly higher among patients with emergence delirium (24% vs. 11%, p = 0.04). The two categories, ..úsleep disturbance..Ñ and ..úseparation anxiety..Ñ, tested within the questionnaire for early postoperative negative behavior, were identified as the most common postoperative negative behavioral changes.

Conclusion

Emergence delirium not only plays a role immediately after surgery but is also linked to early postoperative negative behavior within two weeks after outpatient adenoidectomy. Parents should be informed that early postoperative negative behavior may occur in 1 out of 4 patients if emergence delirium was present postoperatively.

Trial Registration

DRKS ... German Clinical Trial Register ID: DRKS00013121

研究背景这项前瞻性多中心观察研究旨在测量小儿术后谵妄的发生率，并调查学龄前儿童在门诊腺样体切除术后两周内术后早期负面行为的发生率：研究对象包括 222 名患者（1-7 岁）。所有患儿均接受了多模式麻醉，即使用丙泊酚和瑞芬太尼联合吡瑞匹胺（0.1 毫克.千克-1）、布洛芬（10 毫克.千克-1）、地塞米松（0.15 毫克.千克-1）和开他尼特 S（0.1 毫克.千克-1）进行全静脉麻醉。我们使用小儿麻醉谵妄量表（PAED）在恢复期的不同预定时间点对谵妄进行评估。在前三个标准中，PAED评分≥9分为出现谵妄。此外，当住院后行为问卷的 27 项标准中至少有 5 项呈阳性时，我们将其定义为术后早期负面行为：结果：采用我们的麻醉方法后，出现谵妄的发生率为 23%。在出现谵妄的患者中，术后早期负面行为的发生率明显更高（24% 对 11%，P = 0.04）。在术后早期负面行为调查问卷中，"睡眠障碍 "和 "分离焦虑 "这两个类别被认为是最常见的术后负面行为变化：结论：新出现的谵妄不仅在手术后立即发挥作用，而且还与门诊腺样体切除术后两周内的术后早期负面行为有关。应告知家长，如果术后出现谵妄，每 4 名患者中就有 1 人可能出现术后早期负面行为：DRKS - 德国临床试验注册编号：DRKS00013121.

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引用次数: 0

Ultrasound-guided popliteal sciatic nerve block in a pediatric patient with complex regional pain syndrome: a case report 超声引导下腘坐骨神经阻滞治疗复杂区域疼痛综合征儿科患者：病例报告。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-09-01 DOI: 10.1016/j.bjane.2021.07.012

In the pediatric population, complex regional pain syndrome (CRPS) is a challenging condition that leads to chronic psychosocial dysfunction. This case is of a 12-year-old male patient, 50.ßkg, who, after twisting his right ankle, started to present intense pain. Without adequate diagnosis and treatment, his family sought a pain specialist. During the evaluation, a change in sensitivity and temperature was observed, besides hyperalgesia, allodynia, redness, edema, and motor dysfunction, being diagnosed with CRPS. Ultrasound-guided sciatic blocks were performed on the affected limb, increasing the interval between crises, reducing pain intensity, and promoting a return to daily activities.

在儿童群体中，复杂区域疼痛综合征（CRPS）是一种具有挑战性的疾病，会导致慢性社会心理功能障碍。本病例是一名 12 岁的男性患者，体重 50 公斤，在扭伤右脚踝后开始出现剧烈疼痛。在没有得到充分诊断和治疗的情况下，他的家人找到了疼痛专科医生。在评估过程中，除了痛觉减退、异物感、发红、水肿和运动功能障碍外，还观察到敏感度和温度的变化，因此被诊断为 CRPS。医生在超声引导下对他的患肢进行了坐骨神经阻滞治疗，从而延长了发作间隔时间，降低了疼痛强度，并促进了他恢复日常活动。

引用次数: 0

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