Brazilian Journal of Anesthesiology最新文献_第2页

Oscillatory ventilation enhances oxygenation and reduces inflammation in an animal model of acute respiratory distress syndrome: an experimental study 在急性呼吸窘迫综合征动物模型中，振荡通气可增强氧合和减少炎症：一项实验研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844576

Luiz Alberto Forgiarini Junior , Luiz Felipe Forgiarini , Arthur de Oliveira Paludo , Rodrigo Mariano , Mikael Marcelo de Moraes , Elaine Aparecida Felix , Cristiano Feijó Andrade

Background

This study aims to compare the use of variable mechanical ventilation with conventional mechanical ventilation in a porcine model of ARDS induced by oleic acid.

Methods

The animals were divided into two groups (n = 6), Conventional Ventilation (CO) and variable ventilation with Bi-Oscillatory PEEP (BiPEEP). ARDS was induced using intravenous oleic acid (0.15 mL.kg⁻¹). After, the animals were evaluated during 180 minutes and, measurements were taken every 30 minutes until the end of the observation period. The animals in the CO group were then ventilated under controlled pressure (Tidal Volume target at 6 mL.kg⁻¹) and 5 cm H₂O PEEP. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cm H₂O every 4 respiratory cycles. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) were evaluated. Histological samples were collected from the upper and the lower portion of the left lungs and analyzed separately.

Results

BiPEEP improved lung compliance and PaO₂ in comparison to control (p < 0.05). The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. IL8 was significantly increased in the lung base of CO group in relation to BiPEEP group and it was reduced in the apex of BiPEEP group in comparsion to CO group. The BiPEEP group showed less changes in histopathological patterns.

Conclusion

Variable ventilation with bi-oscillatory level of PEEP demonstrated a potential ventilatory strategy for lung protection in an experimental model of ARDS.

背景：本研究旨在比较可变机械通气与传统机械通气在油酸诱导的猪 ARDS 模型中的应用：本研究旨在比较可变机械通气与传统机械通气在油酸诱导的猪 ARDS 模型中的应用：方法：将动物分为两组（n = 6），即常规通气组（CO）和双振荡 PEEP 可变通气组（BiPEEP）。使用静脉注射油酸（0.15 mL.kg-1）诱导 ARDS。之后，在 180 分钟内对动物进行评估，每隔 30 分钟测量一次，直至观察期结束。CO 组动物随后在可控压力（潮气量目标值为 6 mL.kg-1）和 5 cm H2O PEEP 的条件下通气。可变通气的特点是每 4 个呼吸周期 PEEP 从 5 cm H2O 波动到 10 cm H2O。对通气参数、血液动力学参数、氧化应激、抗氧化酶、白细胞介素 8（IL8）和 17-a（IL17a）进行了评估。从左肺上部和下部采集组织学样本并分别进行分析：结果：与对照组相比，BiPEEP 改善了肺顺应性和 PaO2（P < 0.05）。氧化应激和抗氧化酶水平无显著差异。组间 IL17a 无差异。CO 组与 BiPEEP 组相比，IL8 在肺底部明显升高，而 BiPEEP 组与 CO 组相比，IL8 在肺顶部有所降低。BiPEEP 组的组织病理学模式变化较小：结论：在 ARDS 实验模型中，双振荡 PEEP 水平的可变通气显示了一种潜在的肺保护通气策略。

{"title":"Oscillatory ventilation enhances oxygenation and reduces inflammation in an animal model of acute respiratory distress syndrome: an experimental study","authors":"Luiz Alberto Forgiarini Junior , Luiz Felipe Forgiarini , Arthur de Oliveira Paludo , Rodrigo Mariano , Mikael Marcelo de Moraes , Elaine Aparecida Felix , Cristiano Feijó Andrade","doi":"10.1016/j.bjane.2024.844576","DOIUrl":"10.1016/j.bjane.2024.844576","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to compare the use of variable mechanical ventilation with conventional mechanical ventilation in a porcine model of ARDS induced by oleic acid.</div></div><div><h3>Methods</h3><div>The animals were divided into two groups (n = 6), Conventional Ventilation (CO) and variable ventilation with Bi-Oscillatory PEEP (BiPEEP). ARDS was induced using intravenous oleic acid (0.15 mL.kg<sup>−1</sup>). After, the animals were evaluated during 180 minutes and, measurements were taken every 30 minutes until the end of the observation period. The animals in the CO group were then ventilated under controlled pressure (Tidal Volume target at 6 mL.kg<sup>−1</sup>) and 5 cm H<sub>2</sub>O PEEP. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cm H<sub>2</sub>O every 4 respiratory cycles. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) were evaluated. Histological samples were collected from the upper and the lower portion of the left lungs and analyzed separately.</div></div><div><h3>Results</h3><div>BiPEEP improved lung compliance and PaO<sub>2</sub> in comparison to control (p < 0.05). The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. IL8 was significantly increased in the lung base of CO group in relation to BiPEEP group and it was reduced in the apex of BiPEEP group in comparsion to CO group. The BiPEEP group showed less changes in histopathological patterns.</div></div><div><h3>Conclusion</h3><div>Variable ventilation with bi-oscillatory level of PEEP demonstrated a potential ventilatory strategy for lung protection in an experimental model of ARDS.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844576"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The hidden cost of hypotension: redefining hemodynamic management to improve patient outcomes 低血压的隐性成本：重新定义血流动力学管理以改善患者预后。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844581

Eric B. Lineburger , Deepak K. Tempe , Luiz Guilherme V. da Costa , G. Burkhard Mackensen , Fabio V. Papa , Carlos Galhardo Jr. , Mohamed R. El Tahan , Marcello F. Salgado-Filho , Rodrigo Diaz , André P. Schmidt

引用次数: 0

A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation 大规模输血和大出血方案的全面审查：起源，核心原则和实际实施。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-12-25 DOI: 10.1016/j.bjane.2024.844583

David Silveira Marinho , Denise Menezes Brunetta , Luciana Maria de Barros Carlos , Luany Elvira Mesquita Carvalho , Jessica Silva Miranda

Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called “Damage Control Resuscitation”. This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding.

直到本世纪初，在选择性手术或失血情况下，出血管理是类似的：使用凝血试验来指导血液制品的订购，在等待这些结果的同时，建议使用晶体药物进行积极的复苏。用这种策略处理的严重出血的高死亡率表明需要一种特殊的复苏计划。因此，建议对这些患者进行修改，以开发一种新的临床方法，称为“损害控制复苏”。该策略包括四个原则：损伤控制手术、晶体最小化、允许性低血压和止血复苏。后者包括使用抗纤溶剂，纠正止血的先决条件（钙、pH值和温度）以及早期和快速恢复血液制品的血管内容量。为了能够及时提供和输血血液制品，需要在不同医院地区采取同步的具体行动，这些行动通常是通过《大规模输血规程》或最近更名为《大出血规程》来组织的。虽然这一系列行动代表了范式的变化，但其历史演变、理论基础、术语和操作要素等基本方面尚未得到充分探讨。考虑到这些工具的广泛应用范围（急诊科、介入放射科、手术室和军事领域），在上述方案的实施中，从概念到执行和管理，整合所有涉及严重出血情景的专业人员是至关重要的。本文综述了与麻醉医师、输血服务和其他涉及重症出血患者护理的领域相关的MHP方面。

{"title":"A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation","authors":"David Silveira Marinho , Denise Menezes Brunetta , Luciana Maria de Barros Carlos , Luany Elvira Mesquita Carvalho , Jessica Silva Miranda","doi":"10.1016/j.bjane.2024.844583","DOIUrl":"10.1016/j.bjane.2024.844583","url":null,"abstract":"<div><div>Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called “Damage Control Resuscitation”. This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844583"},"PeriodicalIF":1.7,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis 直立脊柱平面阻滞（ESPB）在小儿心脏手术中的疗效：一项系统综述和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-11-29 DOI: 10.1016/j.bjane.2024.844579

Verônica Pustrelo Damião , Priscila Pechim Andrade , Leonardo Saraiva Guimarães de Oliveira , Angélica de Fátima Assunção Braga , Vanessa Henriques Carvalho

Background

Erector Spinae Plane Block (ESPB) effectively reduces pain scores for sternotomy in adults. However, evidence is insufficient to assert that the same result occurs in children. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ESPB in pediatric cardiac surgeries.

Methods

Systematic Medline, Embase and Cochrane searches were conducted for studies that compared ESPB versus no block or sham block for pediatric cardiac surgery under sternotomy. The primary outcome was cumulative opioid consumption for up to 48 hours. Statistical analyses were carried out with the use of RStudio version 1.2.1335. Heterogeneity was assessed by Cochran's Q test and I² statistics. Quality assessment and risk of bias assessment complied with Cochrane recommendations.

Results

Five studies, involving 328 patients (3 Randomized Controlled Trials [RCT], and 2 cohorts) were included. Of the 328 patients, 160 (48.7%) underwent ESPB. There were significant reductions in cumulative opioid consumption up to 48 hours after ESPB (SMD -0.68; 95% CI -1.13 – -0.23; p < 0.01). In the following outcomes ESPB failed to show superiority: postoperative nausea and vomiting (OR = 0.56; 95% CI 0.25–1.23; p = 0.54), fever (OR = 0.75; 95% CI 0.24–2.31; p = 0.58), length of intensive care unit stay in hours (MD -2.42; 95% CI -5.47–0.64; p < 0.01] and length of hospital stay in days (MD -0.87; 95% CI -2.69–0.96; p = 0.02). Only one cohort study had a high risk of bias.

Conclusion

ESPB potentially reduces postoperative pain by significant reductions in cumulative opioid consumption up to 48 hours in pediatric cardiac surgery patients.

背景：直立脊柱平面阻滞（ESPB）可有效降低成人胸骨切开术的疼痛评分。然而，证据不足以断言儿童也会出现同样的结果。本系统综述和荟萃分析的目的是评估ESPB在小儿心脏手术中的疗效。方法：系统的Medline， Embase和Cochrane检索了比较ESPB与无阻滞或假阻滞在小儿胸骨切开心脏手术中的研究。主要终点是长达48小时的阿片类药物累积消耗。使用RStudio 1.2.1335版本进行统计分析。异质性采用Cochran’s Q检验和I2统计量进行评估。质量评估和偏倚风险评估符合Cochrane的建议。结果：纳入5项研究，共328例患者（3项随机对照试验[RCT]， 2个队列）。在328例患者中，160例（48.7%）接受了ESPB。ESPB后48小时内，累计阿片类药物消耗显著减少(SMD -0.68；95% ci -1.13 -0.23；P < 0.01)。在以下结果中，ESPB未能显示出优势：术后恶心和呕吐(OR = 0.56；95% ci 0.25-1.23；p = 0.54)，发热(OR = 0.75；95% ci 0.24-2.31；p = 0.58)、重症监护病房住院时间(MD -2.42；95% ci -5.47-0.64；p < 0.01]、住院天数(MD -0.87；95% ci -2.69-0.96； = 0.02页)。只有一项队列研究存在高偏倚风险。结论：ESPB可能通过显著减少儿童心脏手术患者长达48小时的阿片类药物累积消耗来减轻术后疼痛。

{"title":"Efficacy of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis","authors":"Verônica Pustrelo Damião , Priscila Pechim Andrade , Leonardo Saraiva Guimarães de Oliveira , Angélica de Fátima Assunção Braga , Vanessa Henriques Carvalho","doi":"10.1016/j.bjane.2024.844579","DOIUrl":"10.1016/j.bjane.2024.844579","url":null,"abstract":"<div><h3>Background</h3><div>Erector Spinae Plane Block (ESPB) effectively reduces pain scores for sternotomy in adults. However, evidence is insufficient to assert that the same result occurs in children. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ESPB in pediatric cardiac surgeries.</div></div><div><h3>Methods</h3><div>Systematic Medline, Embase and Cochrane searches were conducted for studies that compared ESPB versus no block or sham block for pediatric cardiac surgery under sternotomy. The primary outcome was cumulative opioid consumption for up to 48 hours. Statistical analyses were carried out with the use of RStudio version 1.2.1335. Heterogeneity was assessed by Cochran's Q test and I<sup>2</sup> statistics. Quality assessment and risk of bias assessment complied with Cochrane recommendations.</div></div><div><h3>Results</h3><div>Five studies, involving 328 patients (3 Randomized Controlled Trials [RCT], and 2 cohorts) were included. Of the 328 patients, 160 (48.7%) underwent ESPB. There were significant reductions in cumulative opioid consumption up to 48 hours after ESPB (SMD -0.68; 95% CI -1.13 – -0.23; p < 0.01). In the following outcomes ESPB failed to show superiority: postoperative nausea and vomiting (OR = 0.56; 95% CI 0.25–1.23; p = 0.54), fever (OR = 0.75; 95% CI 0.24–2.31; p = 0.58), length of intensive care unit stay in hours (MD -2.42; 95% CI -5.47–0.64; p < 0.01] and length of hospital stay in days (MD -0.87; 95% CI -2.69–0.96; p = 0.02). Only one cohort study had a high risk of bias.</div></div><div><h3>Conclusion</h3><div>ESPB potentially reduces postoperative pain by significant reductions in cumulative opioid consumption up to 48 hours in pediatric cardiac surgery patients.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844579"},"PeriodicalIF":1.7,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative effects of ciprofol and propofol on perioperative outcomes: a systematic review and meta-analysis of randomized controlled trials 环丙酚和异丙酚对围手术期预后的比较影响：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 : 2024-11-26 DOI: 10.1016/j.bjane.2024.844578

Jiazheng Qi , Lingjing Zhang , Fanhua Meng , Xiaoyu Yang , Baoxuan Chen , Lingqi Gao , Xu Zhao , Mengqiang Luo

Background

The ideal anesthetic agents for sedation, considering their respiratory and cardiovascular benefits and other perioperative or postoperative outcomes, are still unclear. This systematic review and meta-analysis aimed to evaluate whether ciprofol has advantages over propofol for sedation, particularly concerning respiratory and cardiovascular outcomes and other relevant perioperative measures.

Methods

We conducted a comprehensive search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and two Chinese databases for randomized controlled trials comparing intravenous ciprofol and propofol for sedation. The primary outcome was the incidence of adverse respiratory events. Secondary outcomes included incidences of injection pain, hypotension, hypertension, bradycardia during surgery, perioperative nausea and vomiting, and postoperative awakening time. A random-effects model was used for more than four studies; otherwise, we employed the random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment.

Results

Intravenous ciprofol resulted in fewer adverse respiratory events than propofol (Risk Ratio [RR = 0.44]; 95% Confidence Interval [95% CI 0.35–0.55], p < 0.001, I² = 45%, low quality). It also showed a lower incidence of injection pain (RR = 0.12; 95% CI 0.08‒0.17, p < 0.001, I² = 36%, low quality), intraoperative hypotension (RR = 0.64; 95% CI 0.52–0.77, p < 0.001, I² = 58%, low quality), and nausea and vomiting than propofol (RR = 0.67; 95% CI 0.49–0.92; p = 0.01, I² = 0%, moderate quality). However, no significant differences were observed for hypertension, bradycardia, and awakening time.

Conclusions

Ciprofol may be more effective than propofol in minimizing perioperative respiratory adverse events and maintaining hemodynamic stability during sedation without prolonging recovery time.

背景：考虑到其呼吸和心血管方面的益处以及其他围手术期或术后结局，理想的镇静麻醉剂仍不清楚。本系统综述和荟萃分析旨在评估环丙酚在镇静方面是否优于异丙酚，特别是在呼吸和心血管结局以及其他相关围手术期措施方面。方法：我们对PubMed、Web of Science、Cochrane Central Register of Controlled Trials和两个中文随机对照试验数据库进行了全面检索，比较静脉注射环丙酚和异丙酚的镇静作用。主要结局是不良呼吸事件的发生率。次要结局包括注射疼痛、低血压、高血压、术中心动过缓、围术期恶心呕吐和术后苏醒时间的发生率。四项以上的研究使用了随机效应模型；否则，我们采用Hartung-Knapp-Sidik-Jonkman平差的随机效应模型。结果：静脉注射环丙酚的不良呼吸事件发生率低于异丙酚(风险比[RR = 0.44]；95%置信区间[95% CI 0.35-0.55], p < 0.001, I2 = 45%，低质量)。注射痛发生率较低(RR = 0.12；95% CI 0.08-0.17, p < 0.001, I2 = 36%，低质量)、术中低血压(RR = 0.64；95% CI 0.52-0.77, p < 0.001, I2 = 58%，低质量)，且恶心呕吐优于异丙酚(RR = 0.67；95% ci 0.49-0.92；p = 0.01,I2 = 0%，质量中等)。然而，在高血压、心动过缓和觉醒时间方面没有观察到显著差异。结论：环丙酚可能比异丙酚更有效地减少围手术期呼吸不良事件和维持镇静期间血流动力学稳定，而不延长恢复时间。

{"title":"Comparative effects of ciprofol and propofol on perioperative outcomes: a systematic review and meta-analysis of randomized controlled trials","authors":"Jiazheng Qi , Lingjing Zhang , Fanhua Meng , Xiaoyu Yang , Baoxuan Chen , Lingqi Gao , Xu Zhao , Mengqiang Luo","doi":"10.1016/j.bjane.2024.844578","DOIUrl":"10.1016/j.bjane.2024.844578","url":null,"abstract":"<div><h3>Background</h3><div>The ideal anesthetic agents for sedation, considering their respiratory and cardiovascular benefits and other perioperative or postoperative outcomes, are still unclear. This systematic review and meta-analysis aimed to evaluate whether ciprofol has advantages over propofol for sedation, particularly concerning respiratory and cardiovascular outcomes and other relevant perioperative measures.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and two Chinese databases for randomized controlled trials comparing intravenous ciprofol and propofol for sedation. The primary outcome was the incidence of adverse respiratory events. Secondary outcomes included incidences of injection pain, hypotension, hypertension, bradycardia during surgery, perioperative nausea and vomiting, and postoperative awakening time. A random-effects model was used for more than four studies; otherwise, we employed the random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment.</div></div><div><h3>Results</h3><div>Intravenous ciprofol resulted in fewer adverse respiratory events than propofol (Risk Ratio [RR = 0.44]; 95% Confidence Interval [95% CI 0.35–0.55], p < 0.001, I<sup>2</sup> = 45%, low quality). It also showed a lower incidence of injection pain (RR = 0.12; 95% CI 0.08‒0.17, p < 0.001, I<sup>2</sup> = 36%, low quality), intraoperative hypotension (RR = 0.64; 95% CI 0.52–0.77, p < 0.001, I<sup>2</sup> = 58%, low quality), and nausea and vomiting than propofol (RR = 0.67; 95% CI 0.49–0.92; p = 0.01, I<sup>2</sup> = 0%, moderate quality). However, no significant differences were observed for hypertension, bradycardia, and awakening time.</div></div><div><h3>Conclusions</h3><div>Ciprofol may be more effective than propofol in minimizing perioperative respiratory adverse events and maintaining hemodynamic stability during sedation without prolonging recovery time.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844578"},"PeriodicalIF":1.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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。

{"title":"Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial","authors":"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","doi":"10.1016/j.bjane.2024.844575","DOIUrl":"10.1016/j.bjane.2024.844575","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844575"},"PeriodicalIF":1.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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。

{"title":"Comparative effectiveness of anterior and posterior approaches for interscalene brachial plexus block: A systematic review and meta-analysis","authors":"Luis Eduardo Ciconini , Theodoro Beck , Catreen Abouelsaad , Karandip Bains , Mauren F. Carbonar","doi":"10.1016/j.bjane.2024.844574","DOIUrl":"10.1016/j.bjane.2024.844574","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (I<sup>2</sup> = 0%), while procedure time showed high heterogeneity (I<sup>2</sup> = 97%).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844574"},"PeriodicalIF":1.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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。

{"title":"Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study","authors":"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","doi":"10.1016/j.bjane.2024.844567","DOIUrl":"10.1016/j.bjane.2024.844567","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844567"},"PeriodicalIF":1.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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。

{"title":"Pharmacological and non-pharmacological interventions in patients undergoing nasal surgeries for prevention of emergence agitation: a systematic review and network meta-analysis","authors":"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","doi":"10.1016/j.bjane.2024.844565","DOIUrl":"10.1016/j.bjane.2024.844565","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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-<sup>1</sup> for 10 minutes as a bolus, followed by 0.4 μg.kg<sup>-1</sup>.h<sup>-1</sup>), bilateral nasociliary and maxillary nerve block, ketamine (0.5 mg.kg<sup>-1</sup> 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844565"},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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。

{"title":"Intraoperative hypotension during critical phases of liver transplantation and its impact on acute kidney injury: a retrospective cohort study","authors":"Matthanja Bieze , Amir Zabida , Eduarda Schutz Martinelli , Rebecca Caragata , Stella Wang , Jo Carroll , Markus Selzner , Stuart A McCluskey","doi":"10.1016/j.bjane.2024.844566","DOIUrl":"10.1016/j.bjane.2024.844566","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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], <em>p</em> = 0.047) and MAP < 55 mmHg (OR = 1.023 [1.002, 1.047], <em>p</em> = 0.040) in the anhepatic phase, and for MAP < 60 mmHg (OR = 1.032 [1.01, 1.056], <em>p</em> = 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], <em>p</em> < 0.001) and MAP < 55 mmHg (OR = 1.008 [1.003–1.013], <em>p</em> = 0.004).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 6","pages":"Article 844566"},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0