Pub Date : 2024-08-03DOI: 10.1016/j.bjane.2024.844547
{"title":"Point-of-Care Ultrasonography (POCUS) in obstetric anesthesia fellowship training: survey of North American programs","authors":"","doi":"10.1016/j.bjane.2024.844547","DOIUrl":"10.1016/j.bjane.2024.844547","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000691/pdfft?md5=19efc7c619466d5f83a83a5432b96645&pid=1-s2.0-S0104001424000691-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141895001","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}
Pub Date : 2024-08-03DOI: 10.1016/j.bjane.2024.844546
{"title":"The effect of gestational age on short- and long-term complications following primary esophageal atresia repair","authors":"","doi":"10.1016/j.bjane.2024.844546","DOIUrl":"10.1016/j.bjane.2024.844546","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S010400142400068X/pdfft?md5=f1001bf432adea839448f8e912940b0f&pid=1-s2.0-S010400142400068X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891107","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}
Pub Date : 2024-07-30DOI: 10.1016/j.bjane.2024.844544
{"title":"Mind the gap between low- and middle-income countries (LMICs) and high-income countries (HICs): fostering pediatric anesthesia globally","authors":"","doi":"10.1016/j.bjane.2024.844544","DOIUrl":"10.1016/j.bjane.2024.844544","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000666/pdfft?md5=fedfab0b578fa09815d6400fd0acf85e&pid=1-s2.0-S0104001424000666-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876858","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}
Pub Date : 2024-07-22DOI: 10.1016/j.bjane.2024.844543
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.
背景：术后出现谵妄仍然是接受手术的儿童所担心的一个主要问题。纳布啡是一种人工合成的激动剂-拮抗剂混合阿片类药物，据信可以降低儿童术后谵妄的发生率。研究的主要目的是探讨纳布啡对接受手术的儿童出现谵妄的影响：方法：检索 MEDLINE、EMBASE 和 CENTRAL 数据库，检索时间从开始日期起至 2023 年 4 月。结果：共纳入 8 项研究（n=1,461），其中有 1 项研究（n=1,461）对接受手术的儿童进行了纳布啡治疗，有 1 项研究（n=1,461）对接受手术的儿童进行了纳布啡治疗：八项研究（n = 1,466 名患者）符合纳入数据分析的条件。与对照组相比，我们汇总的数据显示，纳布啡组的术后谵妄发生率较低（RR = 0.38，95% CI [0.30，0.47]，p < 0.001），术后疼痛评分降低（MD = -0.98，95% CI [-1.92，-0.04]，p = 0.04）：本综述显示，使用纳布啡可显著降低手术患儿的谵妄发生率和术后疼痛评分。然而，由于样本量有限、高度异质性和证据水平较低，未来有必要进行有充分证据支持的试验，以探讨纳布啡对儿童术后谵妄的疗效。
{"title":"The effect of nalbuphine on prevention of emergence delirium in children: a systematic review with meta-analysis","authors":"","doi":"10.1016/j.bjane.2024.844543","DOIUrl":"10.1016/j.bjane.2024.844543","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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], <em>p</em> < 0.001) and reduced postoperative pain scores (MD = -0.98, 95% CI [-1.92, -0.04], <em>p</em> = 0.04).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000654/pdfft?md5=2809568b3dbaebf32204de6ff900b7c2&pid=1-s2.0-S0104001424000654-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763057","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}
Pub Date : 2024-07-19DOI: 10.1016/j.bjane.2024.844542
{"title":"Serum lactate in anhepatic patients and the impact of continuous renal replacement therapy on its clearance: a case series","authors":"","doi":"10.1016/j.bjane.2024.844542","DOIUrl":"10.1016/j.bjane.2024.844542","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000642/pdfft?md5=a16f992aaf3132a763a6bb40cd741bff&pid=1-s2.0-S0104001424000642-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735857","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}
Pub Date : 2024-07-16DOI: 10.1016/j.bjane.2024.844541
Background
Although cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting.
Methods
The patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg−1 was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume.
Results
Thirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4–0.7) mL.kg−1. No significant differences were observed in the residual gastric volume (p = 0.114), gastric volume per body weight (p = 0.117), or qualitative grade of gastric volume (p = 0.642) in relation to disease severities.
Conclusion
Children with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.
{"title":"Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective observational study","authors":"","doi":"10.1016/j.bjane.2024.844541","DOIUrl":"10.1016/j.bjane.2024.844541","url":null,"abstract":"<div><h3>Background</h3><p>Although cerebral palsy is a risk factor for aspiration, there is insufficient research on residual gastric volume after preoperative fasting in children with cerebral palsy. We evaluated the incidence of a full stomach by ultrasound assessment of the gastric volume in children with cerebral palsy who underwent orthopedic surgery after preoperative fasting.</p></div><div><h3>Methods</h3><p>The patients fasted for 8 h for solid foods and 2 h for clear liquids. We obtained the gastric antral cross-sectional area using ultrasound in the semi-recumbent and right lateral decubitus positions. A calculated stomach volume > 1.5 mL.kg<sup>−1</sup> was considered as full, which poses a high aspiration risk. The primary outcome was the incidence of full stomach, and the secondary outcomes were the qualitative gastric volume, correlation of disease severity categorized according to the Gross Motor Function Classification System with the residual gastric volume, gastric volume per body weight, and qualitative gastric volume.</p></div><div><h3>Results</h3><p>Thirty-seven pediatric patients with cerebral palsy, scheduled for elective orthopedic surgery, were included for analysis. Full-stomach status was observed in none, and the gastric volume per body weight was 0.5 (0.4–0.7) mL.kg<sup>−1</sup>. No significant differences were observed in the residual gastric volume (<em>p</em> = 0.114), gastric volume per body weight (<em>p</em> = 0.117), or qualitative grade of gastric volume (<em>p</em> = 0.642) in relation to disease severities.</p></div><div><h3>Conclusion</h3><p>Children with cerebral palsy who fasted preoperatively had empty or nearly empty stomachs. Further studies are required to determine the optimal fasting duration for such children.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000630/pdfft?md5=ebf06fc62f4cae340660c055a9b4e6a5&pid=1-s2.0-S0104001424000630-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707773","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}
Pub Date : 2024-07-16DOI: 10.1016/j.bjane.2024.844540
Background
This study aimed to compare the predictive value of Pediatric Early Warning Score (PEWS) to Pediatric Risk of Mortality-3 (PRISM-3), Pediatric Trauma Score (PTS), and Pediatric Glasgow Coma Score (pGCS) in determining clinical severity and mortality among critical pediatric trauma patients.
Method
A total of 122 patients monitored due to trauma in the pediatric intensive care unit between 2020 and 2023 were included in the study. Physical examination findings, vital parameters, laboratory values, and all scoring calculations for patients during emergency room admissions and on the first day of intensive care follow-up were recorded. Comparisons were made between two groups identified as survivors and non-survivors.
Results
The study included 85 (69.7%) male and 37 (30.3%) female patients, with an average age of 75 ± 59 months for all patients. Forty-one patients (33.6%) required Invasive Mechanical Ventilation (IMV) and 11 patients (9%) required inotropic therapy. Logistic regression analysis revealed a significant association between mortality and PEWS (p < 0.001), PRISM-3 (p < 0.001), PTS (p < 0.001), and pGCS (p < 0.001). Receiver operating characteristics curve analysis demonstrated that the PEWS score (cutoff > 6.5, AUC = 0.953, 95% CI 0.912–0.994) was highly predictive of mortality, showing similar performance to the PRISM-3 score (cutoff > 21, AUC = 0.999, 95% CI 0.995–1). Additionally, the PEWS score was found to be highly predictive in forecasting the need for IMV and inotropic therapy.
Conclusion
The Pediatric Early Warning Score serves as a robust determinant of mortality in critical pediatric trauma patients. Simultaneously, it demonstrates strong predictability in anticipating the need for IMV and inotropic therapy.
{"title":"Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study","authors":"","doi":"10.1016/j.bjane.2024.844540","DOIUrl":"10.1016/j.bjane.2024.844540","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to compare the predictive value of Pediatric Early Warning Score (PEWS) to Pediatric Risk of Mortality-3 (PRISM-3), Pediatric Trauma Score (PTS), and Pediatric Glasgow Coma Score (pGCS) in determining clinical severity and mortality among critical pediatric trauma patients.</p></div><div><h3>Method</h3><p>A total of 122 patients monitored due to trauma in the pediatric intensive care unit between 2020 and 2023 were included in the study. Physical examination findings, vital parameters, laboratory values, and all scoring calculations for patients during emergency room admissions and on the first day of intensive care follow-up were recorded. Comparisons were made between two groups identified as survivors and non-survivors.</p></div><div><h3>Results</h3><p>The study included 85 (69.7%) male and 37 (30.3%) female patients, with an average age of 75 ± 59 months for all patients. Forty-one patients (33.6%) required Invasive Mechanical Ventilation (IMV) and 11 patients (9%) required inotropic therapy. Logistic regression analysis revealed a significant association between mortality and PEWS (<em>p</em> < 0.001), PRISM-3 (<em>p</em> < 0.001), PTS (<em>p</em> < 0.001), and pGCS (<em>p</em> < 0.001). Receiver operating characteristics curve analysis demonstrated that the PEWS score (cutoff > 6.5, AUC = 0.953, 95% CI 0.912–0.994) was highly predictive of mortality, showing similar performance to the PRISM-3 score (cutoff > 21, AUC = 0.999, 95% CI 0.995–1). Additionally, the PEWS score was found to be highly predictive in forecasting the need for IMV and inotropic therapy.</p></div><div><h3>Conclusion</h3><p>The Pediatric Early Warning Score serves as a robust determinant of mortality in critical pediatric trauma patients. Simultaneously, it demonstrates strong predictability in anticipating the need for IMV and inotropic therapy.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000629/pdfft?md5=eafbeb8c48dead44f09b701368c1ad6c&pid=1-s2.0-S0104001424000629-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705525","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}
Pub Date : 2024-07-10DOI: 10.1016/j.bjane.2024.844539
Background
Difficult airway, characterized by difficult mask ventilation and intubation, is common in obese patients undergoing surgery. The purpose of this study was to evaluate and compare the prognostic efficiency of ultrasound-measured anterior cervical soft tissue parameters as an indicator of difficult airway during anesthesia induction in obese patients.
Methods
This prospective, double-blind, observational study was conducted at Balikesir University Faculty of Medicine Hospital between March 2020 and March 2022. A total of 157 patients age ≥ 18 (BMI ≥ 30 kg.m-2), without previous head and neck surgery were included in the study. Anterior cervical soft tissue measurements were performed at three levels; minimum distance between the hyoid bone and skin at the level of the hyoid bone; (DSHB), distance between the midpoint of the epiglottis and skin at the level of the thyrohyoid membrane; (DSE), distance between the anterior commissure of vocal cords and skin at the vocal cord level; (DSV). The Han scale was used to assess difficult mask ventilation and the Cormack-Lehane scale was used to assess difficult laryngoscopy.
Results
In the difficult laryngoscopy group, the mean values of DSHB, DSE and DSV were 18.5 ± 3.5, 18.3 ± 3.8, and 18.6 ± 3.4, respectively. The AUC values for DSHB, DSE, and DSV were 0.845, 0.827, and 0.850, respectively. Anterior cervical measurements showed a better predictive value for difficult laryngoscopy compared to difficult mask ventilation.
Conclusion
Ultrasonographic measurements were predictive for difficult laryngoscopy and ventilation with better correlation in laryngoscopy.
{"title":"Ultrasound-based airway assessment in obese patients as a valuable tool for predicting difficult airway: an observational study","authors":"","doi":"10.1016/j.bjane.2024.844539","DOIUrl":"10.1016/j.bjane.2024.844539","url":null,"abstract":"<div><h3>Background</h3><p>Difficult airway, characterized by difficult mask ventilation and intubation, is common in obese patients undergoing surgery. The purpose of this study was to evaluate and compare the prognostic efficiency of ultrasound-measured anterior cervical soft tissue parameters as an indicator of difficult airway during anesthesia induction in obese patients.</p></div><div><h3>Methods</h3><p>This prospective, double-blind, observational study was conducted at Balikesir University Faculty of Medicine Hospital between March 2020 and March 2022. A total of 157 patients age ≥ 18 (BMI ≥ 30 kg.m<sup>-2</sup>), without previous head and neck surgery were included in the study. Anterior cervical soft tissue measurements were performed at three levels; minimum distance between the hyoid bone and skin at the level of the hyoid bone; (DSHB), distance between the midpoint of the epiglottis and skin at the level of the thyrohyoid membrane; (DSE), distance between the anterior commissure of vocal cords and skin at the vocal cord level; (DSV). The Han scale was used to assess difficult mask ventilation and the Cormack-Lehane scale was used to assess difficult laryngoscopy.</p></div><div><h3>Results</h3><p>In the difficult laryngoscopy group, the mean values of DSHB, DSE and DSV were 18.5 ± 3.5, 18.3 ± 3.8, and 18.6 ± 3.4, respectively. The AUC values for DSHB, DSE, and DSV were 0.845, 0.827, and 0.850, respectively. Anterior cervical measurements showed a better predictive value for difficult laryngoscopy compared to difficult mask ventilation.</p></div><div><h3>Conclusion</h3><p>Ultrasonographic measurements were predictive for difficult laryngoscopy and ventilation with better correlation in laryngoscopy.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000617/pdfft?md5=1445ea1d75c66de18707cb5017702d61&pid=1-s2.0-S0104001424000617-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602329","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}
Pub Date : 2024-07-02DOI: 10.1016/j.bjane.2024.844534
Background
Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.
Methods
Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.
Results
Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%).
Conclusions
This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.
背景：右美托咪定是一种高选择性α-2肾上腺素受体激动剂，具有镇静和镇痛作用，最近的研究表明它具有肾脏保护特性。右美托咪定可降低移植功能延迟的发生率，并有助于有效控制肾移植后的疼痛。本系统综述的主要目的是评估右美托咪定是否能降低肾移植患者移植物功能延迟的发生率：方法：对包括 MEDLINE、EMBASE 和 CENTRAL 在内的数据库进行了全面检索，检索时间从开始到 2023 年 3 月。纳入标准包括所有随机临床试验（RCT）和观察性研究，对接受肾移植手术的成年患者进行右美托咪定与对照组的比较。排除病例系列和病例报告：共有 10 项 RCT（涉及 1,358 名患者）符合数据综合的资格标准。与对照组相比，右美托咪定组的移植物功能延迟发生率显著降低（OR = 0.71，95% CI 0.52-0.97，p = 0.03，GRADE：极低，I2 = 0%）。右美托咪定还显著延长了开始抢救性镇痛的时间（MD = 6.73，95% CI 2.32-11.14，p = 0.003，GRADE：极低，I2 = 93%），并减少了肾移植后吗啡的总体用量（MD = -5.43，95% CI -7.95--2.91，p < 0.0001，GRADE：极低，I2 = 0%）。与对照组相比，右美托咪定组的心率（MD = -8.15，95% CI -11.45 to -4.86，p < 0.00001，GRADE：很低，I2 = 84%）和平均动脉压（MD = -6.66，95% CI -11.27 to -2.04，p = 0.005，GRADE：很低，I2 = 87%）显著下降：这项荟萃分析表明，右美托咪定有可能降低移植功能延迟的发生率，与对照组相比，右美托咪定在成人肾移植手术中的镇痛效果更好。然而，高度的异质性和样本量的不足突出表明，今后需要进行充分的试验来证实这些发现。
{"title":"Effects of perioperative dexmedetomidine on delayed graft function following renal transplant: a systematic review and meta-analysis","authors":"","doi":"10.1016/j.bjane.2024.844534","DOIUrl":"10.1016/j.bjane.2024.844534","url":null,"abstract":"<div><h3>Background</h3><p>Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.</p></div><div><h3>Methods</h3><p>Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.</p></div><div><h3>Results</h3><p>Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, <em>p</em> = 0.03, GRADE: Very low, I<sup>2</sup> = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, <em>p</em> = 0.003, GRADE: Very low, I<sup>2</sup> = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, <em>p</em> < 0.0001, GRADE: Very low, I<sup>2</sup> = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, <em>p</em> < 0.00001, GRADE: Very low, I<sup>2</sup> = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, <em>p</em> = 0.005, GRADE: Very low, I<sup>2</sup> = 87%).</p></div><div><h3>Conclusions</h3><p>This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000563/pdfft?md5=46fdc47c6ff8452713c73241e99369fa&pid=1-s2.0-S0104001424000563-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536071","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}
Pub Date : 2024-07-01DOI: 10.1016/j.bjane.2023.02.001
Xianqiao Xie , Yang Li , Shanchun Su , Xiaohui Li , Xueqin Xu , Yan Gao , Minjing Peng , Changbin Ke
Background
The underlying mechanism of chronic pain involves the plasticity in synaptic receptors and neurotransmitters. This study aimed to investigate potential roles of Neuroligins (NLs) within the spinal dorsal horn of rats in a newly established Bone Cancer Pain (BCP) model. The objective was to explore the mechanism of neuroligin involved in the occurrence and development of bone cancer pain.
Methods
Using our rat BCP model, we assessed pain hypersensitivity over time. Quantitative real-time polymerase chain reaction and Western blot analysis were performed to investigate NL expression, and NLs were overexpressed in the rat spinal cord using lentiviral vectors. Immunofluorescence staining and whole-cell patch-clamp recordings were deployed to investigate the role of NLs in the development of BCP.
Results
We observed reduced expression levels of NL1 and NL2, but not of NL3, within the rat spinal cord, which were found to be associated with and essential for the development of BCP in our model. Accordingly, NL1 or NL2 overexpression in the spinal cord alleviated mechanical hypersensitivity of rats. Electrophysiological experiments indicated that NL1 and NL2 are involved in BCP via regulating γ-aminobutyric acid-ergic interneuronal synapses and the activity of glutamatergic interneuronal synapses, respectively.
Conclusions
Our observations unravel the role of NLs in cancer-related chronic pain and further suggest that inhibitory mechanisms are central features of BCP in the spinal dorsal horn. These results provide a new perspective and basis for subsequent studies elucidating the onset and progression of BCP.
{"title":"Neuroligins facilitate the development of bone cancer pain via regulating synaptic transmission: an experimental study","authors":"Xianqiao Xie , Yang Li , Shanchun Su , Xiaohui Li , Xueqin Xu , Yan Gao , Minjing Peng , Changbin Ke","doi":"10.1016/j.bjane.2023.02.001","DOIUrl":"10.1016/j.bjane.2023.02.001","url":null,"abstract":"<div><h3>Background</h3><p>The underlying mechanism of chronic pain involves the plasticity in synaptic receptors and neurotransmitters. This study aimed to investigate potential roles of Neuroligins (NLs) within the spinal dorsal horn of rats in a newly established Bone Cancer Pain (BCP) model. The objective was to explore the mechanism of neuroligin involved in the occurrence and development of bone cancer pain.</p></div><div><h3>Methods</h3><p>Using our rat BCP model, we assessed pain hypersensitivity over time. Quantitative real-time polymerase chain reaction and Western blot analysis were performed to investigate NL expression, and NLs were overexpressed in the rat spinal cord using lentiviral vectors. Immunofluorescence staining and whole-cell patch-clamp recordings were deployed to investigate the role of NLs in the development of BCP.</p></div><div><h3>Results</h3><p>We observed reduced expression levels of NL1 and NL2, but not of NL3, within the rat spinal cord, which were found to be associated with and essential for the development of BCP in our model. Accordingly, NL1 or NL2 overexpression in the spinal cord alleviated mechanical hypersensitivity of rats. Electrophysiological experiments indicated that NL1 and NL2 are involved in BCP via regulating γ-aminobutyric acid-ergic interneuronal synapses and the activity of glutamatergic interneuronal synapses, respectively.</p></div><div><h3>Conclusions</h3><p>Our observations unravel the role of NLs in cancer-related chronic pain and further suggest that inhibitory mechanisms are central features of BCP in the spinal dorsal horn. These results provide a new perspective and basis for subsequent studies elucidating the onset and progression of BCP.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000179/pdfft?md5=634d9d68e7f0485116382d1c55dc2285&pid=1-s2.0-S0104001423000179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485784","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}
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