Brazilian Journal of Anesthesiology最新文献

Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial 地塞米松或氯硝柳胺作为椎间臂丛神经阻滞的辅助剂对预防肩部手术后反跳痛的疗效：随机临床试验。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-11-24 DOI: 10.1016/j.bjane.2024.844575

Layana Vieira Nobre , Leonardo Henrique Cunha Ferraro , Juscelino Afonso de Oliveira Júnior , Vitória Luiza Locatelli Winkeler , Luis Flávio França Vinhosa Muniz , Hiago Parreão Braga , Plínio da Cunha Leal

Background

Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain.

Methods

This was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure.

Results

The incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain.

Conclusion

The administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.

背景：反跳痛被认为包括镇痛不足引起的痛觉疼痛和区域麻醉引起的痛觉减退。添加辅助剂可预防反跳痛。本研究旨在确定在进行椎间孔阻滞时，在局麻药中添加地塞米松或氯硝西泮能否预防反跳痛：这是一项多中心、前瞻性、平行分组、随机临床试验，研究对象是在超声引导下接受椎间阻滞单次注射 0.375% 布比卡因和肩部手术全身麻醉的患者，他们被随机分配到无添加剂（对照组）、氯尼丁（30 微克）或地塞米松（4 毫克）组。主要结果是反跳痛，其定义为突然发作的疼痛、中度至重度疼痛（VAS ≥7）且口服药物后疼痛无改善，其次是休息时的 VAS 疼痛、所需的解救性镇痛、不良事件或并发症的发生以及组间满意度调查评估。术后2、4、6、12、24和48小时对反跳痛和休息时疼痛进行评估：对照组、地塞米松组和氯尼替丁组的反跳痛发生率分别为 41.2% (95% CI 25.9-57.9)、28.6% (95% CI 16.7-43.3) 和 23.3% (95% CI 12.6-37.6)，组间无统计学差异（P 值 = 0.22）。此外，从麻醉阻滞到首次出现疼痛症状的时间或术后疼痛的严重程度在各组之间没有明显差异：结论：使用地塞米松或氯尼丁作为局部麻醉的硬膜外辅助用药进行单次椎间孔阻滞并不能显著降低反跳痛的发生率。

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引用次数: 0

Comparative effectiveness of anterior and posterior approaches for interscalene brachial plexus block: A systematic review and meta-analysis 椎间臂丛阻滞前后入路的有效性比较：系统回顾和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-11-17 DOI: 10.1016/j.bjane.2024.844574

Luis Eduardo Ciconini , Theodoro Beck , Catreen Abouelsaad , Karandip Bains , Mauren F. Carbonar

Introduction

Interscalene Brachial Plexus Blocks (ISBPB) are highly effective forms of anesthesia for surgeries involving the upper arm, shoulder, and neck. Recently, there has been a growing interest in comparing the advantages and limitations of the anterior and posterior approaches.

Methods

This systematic review and meta-analysis aimed to determine whether the anterior or posterior approach to ISBPB offers a clinical advantage regarding complete block rates and time to block completion. We included randomized controlled trials comparing the anterior and posterior techniques for ISBPB while excluding studies with overlapping populations, comparisons of blocks other than interscalene, and articles written in a non-English language.

Results

The search strategy identified 2229 articles, of which six Randomized Controlled Trials (RCTs) met the inclusion criteria for the meta-analysis. A total of 414 patients were included, with 210 patients in the anterior group and 204 in the posterior group. The Odds Ratio (OR) for a complete sensory block between the two techniques did not reach statistical significance (OR = 0.56 [0.20, 1.58], 95% CI, p = 0.27). Similarly, the Standardized Mean Difference (SMD) for the time to complete the block also did not reach statistical significance (SMD: -0.77 [-2.12, 0.59], 95% CI, p = 0.27). Heterogeneity for complete block was not significant (I² = 0%), while procedure time showed high heterogeneity (I² = 97%).

Conclusion

Both techniques have shown effectiveness in providing surgical analgesia. The choice of technique should be determined by the provider's comfort and proficiency, as well as ensuring the highest level of safety for the patient.

简介：臂丛神经阻滞（ISBPB）是上臂、肩部和颈部手术的高效麻醉方式。近来，人们对比较前路和后路的优势和局限性越来越感兴趣：本系统综述和荟萃分析旨在确定 ISBPB 的前路或后路方法在完全阻滞率和阻滞完成时间方面是否具有临床优势。我们纳入了比较前路和后路 ISBPB 技术的随机对照试验，同时排除了人群重叠的研究、椎间孔以外的阻滞比较以及非英语撰写的文章：搜索策略共发现 2229 篇文章，其中 6 项随机对照试验 (RCT) 符合荟萃分析的纳入标准。共纳入 414 名患者，其中前路组 210 名，后路组 204 名。两种技术之间完全感觉阻滞的比值比（OR）未达到统计学意义（OR = 0.56 [0.20, 1.58], 95% CI, p = 0.27）。同样，完成阻滞时间的标准化均值差（SMD）也未达到统计学意义（SMD：-0.77 [-2.12, 0.59]，95% CI，p = 0.27）。完全阻滞的异质性不显著（I2 = 0%），而手术时间的异质性较高（I2 = 97%）：结论：两种技术都能有效提供手术镇痛。结论：这两种技术在提供手术镇痛方面都很有效。选择哪种技术应根据提供者的舒适度和熟练程度以及确保患者的最高安全水平来决定。

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引用次数: 0

Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study 重症监护病房接受经验性抗菌药物治疗的患者确诊感染的发生率和预测因素：一项回顾性队列研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-10-24 DOI: 10.1016/j.bjane.2024.844567

Luis Carlos Maia Cardozo Júnior , Larissa Bianchini , Jakeline Neves Giovanetti , Luiz Marcelo Almeida de Araújo , Yuri de Albuquerque Pessoa dos Santos , Bruno Adler Maccagnan Pinheiro Besen , Marcelo Park

Background

Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay.

Methods

retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in São Paulo, Brazil. We included all adult patients given a new empirical antimicrobial during their ICU stay. We excluded patients using prophylactic or microbiologically guided antimicrobials. Primary outcome was infection status, defined as confirmed, probable, possible, or discarded. In a multivariable analysis, we explored variables associated with confirmed infection.

Results

After screening 1721 patients admitted to the ICU from November 2017 to November 2022, we identified 398 new antimicrobial prescriptions in 341 patients. After exclusions, 243 antimicrobial prescriptions for 206 patients were included. Infection was classified as confirmed in 61 (25.1%) prescriptions, probable in 39 (16.0%), possible in 103 (42.4%), and discarded in 40 (16.5%). The only factor associated with infection was deltaSOFA (OR = 1.18, 95% CI 1.02 to 1.36, p = 0.022).

Conclusion

Suspected infection in the ICU is frequently not confirmed. Clinicians should be aware of the need to avoid premature closure and revise diagnosis after microbiological results. Development and implementation of new tools for faster infection diagnosis and guiding of antimicrobial prescription should be a research priority.

背景：重症监护病房（ICU）中的感染诊断是一项挑战，因为全身炎症的病症范围广、病情严重、现有诊断方法的延迟和不精确。因此，我们试图分析在重症监护室住院期间使用经验性抗菌药后确诊感染的发生率和预测因素。方法：对巴西圣保罗一家学术性三甲医院前瞻性收集的重症监护室数据进行回顾性队列分析。我们纳入了所有在重症监护室住院期间使用了新经验性抗菌药物的成人患者。我们排除了使用预防性或微生物指导性抗菌药物的患者。主要结果是感染状态，定义为确诊、可能、可能或放弃。在一项多变量分析中，我们探讨了与确诊感染相关的变量：在对 2017 年 11 月至 2022 年 11 月期间入住重症监护室的 1721 名患者进行筛查后，我们在 341 名患者中发现了 398 个新的抗菌药物处方。排除后，纳入了 206 名患者的 243 份抗菌药物处方。61张处方（25.1%）被归类为确诊感染，39张（16.0%）被归类为可能感染，103张（42.4%）被归类为可能感染，40张（16.5%）被归类为放弃感染。唯一与感染相关的因素是 deltaSOFA（OR = 1.18，95% CI 1.02 至 1.36，p = 0.022）：结论：重症监护病房中的疑似感染经常得不到证实。结论：重症监护室中的疑似感染经常得不到确诊，临床医生应意识到避免过早结案的必要性，并在微生物学结果出来后对诊断进行修订。开发和实施新工具以加快感染诊断和指导抗菌药物处方应成为研究重点。

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引用次数: 0

Pharmacological and non-pharmacological interventions in patients undergoing nasal surgeries for prevention of emergence agitation: a systematic review and network meta-analysis 为预防鼻腔手术患者出现躁动而采取的药物和非药物干预措施：系统综述和网络荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-10-16 DOI: 10.1016/j.bjane.2024.844565

Gustavo R.M. Wegner , Bruno F.M. Wegner , Henrik G. Oliveira , Luis A. Costa , Luigi W. Spagnol , Valentine W. Spagnol , Gilberto T.F. de Oliveira Filho

Background

Emergence agitation is a common complication after nasal surgeries, marked by increased agitation and a heightened risk of injuries. Factors like urinary catheter, endotracheal tube, postoperative pain, and younger age contribute to its occurrence. Due to the variety of preventive approaches reported in the literature, a network meta-analysis is essential.

Methods

This systematic review employs a network meta-analysis design, following Cochrane Handbook and PRISMA-NMA criteria. Inclusion criteria involve randomized controlled studies on pharmacological and non-pharmacological interventions for preventing emergence agitation in nasal surgeries. Electronic searches, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, without language or date restrictions, were conducted. Two independent reviewers selected studies, and data extraction was performed using standardized tables. Bayesian NMA, MetaInsight web app, and Cochrane Foundation Risk of Bias Assessment Tool were applied for data analysis and bias assessment.

Results

After a rigorous selection process, 17 Randomized Controlled Trials (RCTs) encompassing 2,122 patients and 14 interventions were included. The best ranked treatments identified were intraoperative dexmedetomidine (1 μg.kg-¹ for 10 minutes as a bolus, followed by 0.4 μg.kg^-1.h^-1), bilateral nasociliary and maxillary nerve block, ketamine (0.5 mg.kg^-1 administered 20 minutes before the end of surgery), nasal compression for 40 minutes before anesthesia induction, and suction above the cuff of the endotracheal tube.

Conclusions

Both pharmacological and non-pharmacological interventions emerged as effective strategies in mitigating emergence agitation after nasal surgeries, offering clinicians valuable options for improving postoperative outcomes in this patient population.

背景：出院躁动是鼻腔手术后常见的并发症，主要表现为躁动加剧和受伤风险增加。导尿管、气管插管、术后疼痛和年龄较小等因素都是导致其发生的原因。由于文献中报道的预防方法多种多样，因此进行网络荟萃分析至关重要：本系统综述采用网络荟萃分析设计，遵循 Cochrane 手册和 PRISMA-NMA 标准。纳入标准包括有关预防鼻腔手术中出现躁动的药物和非药物干预措施的随机对照研究。电子检索包括 PubMed、Scopus、Embase、Cochrane Library 和 Web of Science，无语言和日期限制。两名独立审稿人对研究进行筛选，并使用标准表格进行数据提取。贝叶斯NMA、MetaInsight网络应用程序和Cochrane基金会偏倚风险评估工具被用于数据分析和偏倚评估：经过严格筛选，共纳入 17 项随机对照试验 (RCT)，包括 2,122 名患者和 14 项干预措施。结果：经过严格的筛选过程，共纳入了17项随机对照试验（RCT），涉及2122名患者和14项干预措施，其中排名最好的治疗方法是术中使用右美托咪定（1 μg.kg-1，持续10分钟作为栓剂，之后为0.4 μg.kg-1.h-1）、双侧鼻睫和上颌神经阻滞、氯胺酮（0.5 mg.kg-1，手术结束前20分钟给药）、麻醉诱导前40分钟鼻腔按压和气管插管袖带上方抽吸：药物和非药物干预都是减轻鼻腔手术后出现躁动的有效策略，为临床医生改善这类患者的术后效果提供了宝贵的选择。

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引用次数: 0

Intraoperative hypotension during critical phases of liver transplantation and its impact on acute kidney injury: a retrospective cohort study 肝移植关键阶段的术中低血压及其对急性肾损伤的影响：一项回顾性队列研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-10-16 DOI: 10.1016/j.bjane.2024.844566

Matthanja Bieze , Amir Zabida , Eduarda Schutz Martinelli , Rebecca Caragata , Stella Wang , Jo Carroll , Markus Selzner , Stuart A McCluskey

Introduction

Acute Kidney Injury (AKI) following Liver Transplantation (LT) is associated with prolonged ICU and hospital stay, increased risk of chronic renal disease, and decreased graft survival. Intraoperative hypotension is a modifiable risk factor associated with postoperative AKI. We aimed to determine in which phase of LT hypotension has the strongest association with AKI: the anhepatic or neohepatic phase.

Methods

This retrospective cohort study included adult patients undergoing LT between January 2010 and June 2022. Exclusion criteria were re-do or combined transplantations, preoperative dialysis, and early graft failure or death. Primary outcome was AKI as defined by KDIGO. Hypotension was Mean Arterial Pressure (MAP) below predefined thresholds in minutes. Risk adjusted logistic regression analysis considered hypotension in 3 periods: the total procedure, anhepatic phase, and neohepatic phase.

Results

Our cohort included 1153 patients. The median MELD-NA score was 19 (IQR 11–28), and 412 (35.9%) were living-related donations. AKI occurred in 544 patients (47.2%). The unadjusted model showed an association with AKI for MAP < 60 mmHg (OR = 1.011 [1.0, 1.022], p = 0.047) and MAP < 55 mmHg (OR = 1.023 [1.002, 1.047], p = 0.040) in the anhepatic phase, and for MAP < 60 mmHg (OR = 1.032 [1.01, 1.056], p = 0.006) in the neohepatic phase. The adjusted model did not reach significance in the subgroups but did in the total procedure: MAP < 60 mmHg (OR = 1.005 [1.002, 1.008], p < 0.001) and MAP < 55 mmHg (OR = 1.008 [1.003–1.013], p = 0.004).

Conclusion

Intraoperative hypotension is independently associated with AKI following LT. This association is seen during the anhepatic phase. Maintaining MAP above 60 mmHg may improve kidney function after LT.

导言：肝移植（LT）术后急性肾损伤（AKI）与重症监护室和住院时间延长、慢性肾病风险增加以及移植物存活率降低有关。术中低血压是与术后 AKI 相关的一个可改变的风险因素。我们旨在确定低血压与 AKI 关系最大的是 LT 的哪个阶段：无肝阶段还是新肝阶段：这项回顾性队列研究纳入了2010年1月至2022年6月期间接受LT手术的成年患者。排除标准为再次移植或联合移植、术前透析、早期移植失败或死亡。主要结果为KDIGO定义的AKI。低血压是指平均动脉压（MAP）低于预定阈值（以分钟计）。风险调整后的逻辑回归分析考虑了三个时期的低血压情况：整个手术过程、无肝阶段和新肝阶段：我们的队列包括 1153 名患者。中位 MELD-NA 评分为 19（IQR 11-28），412 例（35.9%）为生活相关捐赠。544名患者（47.2%）发生了AKI。未经调整的模型显示，在无肝期，MAP < 60 mmHg（OR = 1.011 [1.0, 1.022]，p = 0.047）和 MAP < 55 mmHg（OR = 1.023 [1.002, 1.047]，p = 0.04）与 AKI 相关，而在新肝期，MAP < 60 mmHg（OR = 1.032 [1.01, 1.056]，p = 0.006）与 AKI 相关。调整后的模型在亚组中未达到显著性，但在整个手术中达到了显著性：MAP < 60 mmHg (OR = 1.005 [1.002, 1.008], p < 0.001) 和 MAP < 55 mmHg (OR = 1.008 [1.003-1.013], p = 0.004)：结论：术中低血压与LT术后AKI密切相关。结论：LT术后术中低血压与AKI密切相关。将血压维持在 60 mmHg 以上可改善 LT 术后的肾功能。

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引用次数: 0

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

Maged Y. Argalious , Sven Halvorson , John Seif , Sandeep Khanna , Mi Wang , Jacek B. Cywinski

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

Eduarda S. Martinelli , Stuart A. McCluskey , Keyvan Karkouti , Carla A. Luzzi , Matthanja Bieze , Luiz Marcelo S. Malbouisson , André P. Schmidt

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

Milena Vasconcelos Falcão, João Nogueira Neto, Ed Carlos Rey Moura, Caio Márcio Barros Oliveira, Rodrigo Pinto Diniz, Almir Vieira Dibai-Filho, Plínio da Cunha Leal

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

Yiru Wang , Kaizheng Chen , Min Ye, Xia Shen

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

Joao Marcos Cansian , Angelo Zanin D'Angelo Giampaoli , Liege Caroline Immich , André Prato Schmidt , Andrei Sanson Dias

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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