Brazilian Journal of Anesthesiology最新文献

Background

Maintaining normocapnia during mechanical ventilation in anesthetized children during laparoscopic surgeries is highly recommended. There is a debate regarding the use of capnography (ETCO₂) as a trend monitor for evaluation of arterial carbon dioxide levels (PaCO₂). We analyzed the relationship between ETCO₂ and PaCO₂ with time in elective pediatric laparoscopic surgeries.

Methods

This study was a prospective observational cohort analysis of 116 paired comparisons between PaCO₂ and ETCO₂ computed from 29 children (ASA I, 12...72 months). Arterial blood samples were withdrawn before, at 15...minutes and 30...minutes during pneumoperitoneum and 1...minute after deflation. ETCO₂ value was recorded simultaneously, while arterial blood was withdrawn. PaCO₂...ETCO₂ relationship was evaluated by Pearson's correlation coefficients and Bland Altman Method of agreement.

Results

Out of the 116 comparisons analyzed, a PaCO₂...ETCO₂ difference beyond 0 to ..± 5...mmHg was recorded in 71 comparisons (61.2%) with negative difference in 34 comparisons (29.3%). A positive significant correlation between PaCO₂ and ETCO₂ was recorded before (r...=...0.617, p...=...0.000) and at 15...minutes (r...=...0.582, p...=...0.001), with no significant correlation at 30 minutes (r...=...0.142, p...=...0.461), either after deflation (r...=...0.108, p...=...0.577). Bland-Altman plots showed agreement between ETCO₂ and PaCO₂ before inflation with mean PaCO₂-ETCO₂ difference 0.14........5.6...mmHg (limits of 95% agreement -10.84...11.2, simple linear regression testing p-value 0.971), with no agreement at 15...minutes (0.51........7.15, -13.5...14.5, p...=...0.000), 30...minutes. (2.62........7.83, -12.73...17.97, p...=...0.000), or after deflation (1.81........6.56, -10.93...14.55, p...=...0.015).

Conclusion

Usage of capnography as a trend monitor in pediatric laparoscopic surgeries may not be a reliable surrogate for PaCO₂ levels.

Trial registration

Clinical Trials. gov (Identifier: NCT03361657)

Although epidural catheter insertion under ultrasound (US) guidance in the pediatric age group has been reported in the literature, it is yet to be adopted widely in clinical practice. The incomplete fusion of bones in pediatric patients provides an acoustic window for the US. The epidural space in children is at shallow depth, hence a high-frequency probe, which provides better resolution can be used. We present a case series in which real-time US-guided epidural catheter placement was performed in 10 infants in lower thoracic and upper lumbar interspaces. We reiterate that the use of real-time US during epidural catheter placement in patients increases the success rate of epidural catheter placement while decreasing procedural complications.

Background

The primary aim of this proof-of-concept study was to investigate whether the Cardiac Power Index (CPI) could be a novel alternative method to assess fluid responsiveness in the prone position.

Methods

Patients undergoing scheduled elective lumbar spine surgery in the prone position under general anesthesia were enrolled in the criteria of patients aged 19–75 years with American Society of Anesthesiologists (ASA) physical status I–II. The hemodynamic variables were evaluated before and after changes in posture after administering a colloid bolus (5 mL.kg⁻¹) in the prone position. Fluid responsiveness was defined as an increase in the Stroke Volume Index (SVI) ≥ 10%.

Results

A total of 28 patients were enrolled. In responders, the CPI (median [1/4Q–3/4Q]) decreased to 0.34 [0.28–0.39] W.m⁻² (p = 0.035) after the prone position. After following fluid loading, CPI increased to 0.48 [0.37–0.52] W.m⁻² (p < 0.008), and decreased SVI (median [1/4Q–3/4Q]) after prone increased from 26.0 [24.5–28.0] mL.m⁻² to 33.0 [31.0–37.5] mL.m⁻² (p = 0.014). Among non-responders, CPI decreased to 0.43 [0.28–0.53] W.m⁻² (p = 0.011), and SVI decreased to 29.0 [23.5–34.8] mL.m⁻² (p < 0.009). CPI exhibited predictive capabilities for fluid responsiveness as a receiver operating characteristic curve of 0.78 [95% Confidence Interval, 0.60–0.95; p = 0.025].

Conclusion

This study suggests the potential of CPI as an alternative method to existing preload indices in assessing fluid responsiveness in clinical scenarios, offering potential benefits for responders and non-responders.

Background

Postoperative sore throat is one of the main postoperative complaints in patients undergoing tonsillectomy. As the primary outcome, we aimed to determine whether endotracheal tube cuffs filled with alkalinized lidocaine are associated with a lower incidence of postoperative sore throat and anesthesia emergence phenomena in children undergoing tonsillectomy or adenotonsillectomy. We also assessed the potential additional benefits of IV dexamethasone in reducing postoperative laryngotracheal morbidity.

Methods

This is a clinical prospective, randomized, controlled trial. Patients were randomly allocated to one of four groups, as follows: air – endotracheal tube cuff filled with air; air/dex – endotracheal tube cuff filled with air and intravenous dexamethasone; lido – endotracheal tube cuff filled with alkalinized lidocaine; and lido/dex – endotracheal tube cuff filled with alkalinized lidocaine and intravenous dexamethasone. Perioperative hemodynamic parameters and the incidence of postoperative nausea and vomiting, coughing and hoarseness were recorded. Postoperative sore throat was assessed in the postanesthetic care unit and 24 hours post tracheal extubation.

Results

In total, 154 children aged 4–12 years, ASA physical status I or II, undergoing general anesthesia for elective tonsillectomy and adenotonsillectomy, were assessed for postoperative sore throat in this study. The incidence of postoperative sore throat 24 hours after tracheal extubation was significantly lower in the lido/dex group compared to groups air and air/dex (p = 0.01). However, no additional reduction in these symptoms was observed from the intravenous administration of dexamethasone when comparing the lido and lido/dex groups. Similarly, there were no differences among groups regarding perioperative hemodynamic variables or postoperative nausea and vomiting, coughing, and hoarseness during the study period.

Conclusion

Intracuff alkalinized lidocaine, associated with intravenous dexamethasone, might be effective in reducing sore throat 24 hours post-tonsillectomy or adenotonsillectomy in children when compared to the use of air as the cuff insufflation media.

Background

Emergence delirium remains a major postoperative concern for children undergoing surgery. Nalbuphine is a synthetic mixed agonist-antagonist opioid, which is believed to reduce the incidence of emergence delirium in children. The primary objective was to examine the effect of nalbuphine on emergence delirium in children undergoing surgery.

Methods

Databases of MEDLINE, EMBASE, and CENTRAL were searched from their starting dates until April 2023. Randomized Clinical Trials (RCT) and observational studies comparing nalbuphine and control in children undergoing surgery were included.

Results

Eight studies (n = 1466 patients) were eligible for inclusion of data analysis. Compared to the control, our pooled data showed that the nalbuphine group was associated with lower incidence of emergence delirium (RR = 0.38, 95% CI [0.30, 0.47], p < 0.001) and reduced postoperative pain scores (MD = -0.98, 95% CI [-1.92, -0.04], p = 0.04).

Conclusions

This review showed the administration of nalbuphine is associated with significant decrease in the incidence of emergence delirium and postoperative pain scores among children undergoing surgery. However, due to limited sample size, high degree of heterogeneity and low level of evidence, future adequately powered trials are warranted to explore the efficacy of nalbuphine on emergence delirium among the pediatric population.