Brazilian Journal of Anesthesiology最新文献_第4页

Preoperative gastric volume assessment using ultrasound in cerebral palsy pediatric patients: a prospective observational study 使用超声波对脑瘫儿科患者进行术前胃容量评估：前瞻性观察研究

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-07-16 DOI: 10.1016/j.bjane.2024.844541

Jiwon Han , Hyo-Seok Na , Seihee Min , Hyun-Jung Shin

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.

背景虽然脑瘫是吸入的一个危险因素，但对脑瘫患儿术前禁食后残余胃容量的研究不足。我们通过超声评估脑瘫患儿术前禁食后接受矫形手术的胃容量，评估了饱胃的发生率。在半卧位和右侧卧位时，我们使用超声波获取了胃前部横截面积。计算得出的胃容积大于或等于 1.5 mL.kg-1 即为胃部饱满，吸入风险很高。主要结果是满胃发生率，次要结果是定性胃容量、根据粗大运动功能分类系统划分的疾病严重程度与残胃容量的相关性、按体重计算的胃容量以及定性胃容量。无一人出现全胃状态，每体重胃容量为 0.5 (0.4-0.7) mL.kg-1。残胃容量（p = 0.114）、每体重胃容量（p = 0.117）或胃容量定性等级（p = 0.642）与疾病严重程度无明显差异。需要进一步研究以确定此类儿童的最佳禁食时间。

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引用次数: 0

Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study 预测危重儿科创伤患者预后的儿科早期预警评分（PEWS）：一项回顾性研究

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-07-16 DOI: 10.1016/j.bjane.2024.844540

Abdulrahman Özel , Ulkem Kocoglu Barlas , Servet Yüce , Cansu Günerhan , Meltem Erol

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.

背景本研究旨在比较儿科早期预警评分（PEWS）与儿科死亡率风险-3（PRISM-3）、儿科创伤评分（PTS）和儿科格拉斯哥昏迷评分（pGCS）在判断危重儿科创伤患者临床严重程度和死亡率方面的预测价值。研究记录了患者在急诊室入院时和重症监护室随访第一天的体格检查结果、生命参数、实验室值和所有评分计算。研究包括 85 名（69.7%）男性患者和 37 名（30.3%）女性患者，所有患者的平均年龄为 75±59 个月。41名患者（33.6%）需要进行有创机械通气（IMV），11名患者（9%）需要进行肌力治疗。逻辑回归分析显示，死亡率与 PEWS（p < 0.001）、PRISM-3（p < 0.001）、PTS（p < 0.001）和 pGCS（p < 0.001）之间存在显著关联。接收者操作特征曲线分析表明，PEWS 评分（截断值为 6.5，AUC = 0.953，95% CI 0.912-0.994）对死亡率有很高的预测性，其表现与 PRISM-3 评分（截断值为 21，AUC = 0.999，95% CI 0.995-1）相似。此外，PEWS 评分在预测 IMV 和肌力治疗的需求方面也具有很高的预测性。同时，它在预测 IMV 和肌注疗法的需求方面也表现出很强的预测能力。

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引用次数: 0

Ultrasound-based airway assessment in obese patients as a valuable tool for predicting difficult airway: an observational study 肥胖患者的超声气道评估是预测困难气道的重要工具：一项观察性研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-07-10 DOI: 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.

背景：气道困难是接受手术的肥胖患者的常见病，其特征是面罩通气和插管困难。本研究旨在评估和比较超声测量的颈前软组织参数作为肥胖患者麻醉诱导期间气道困难指标的预后效果：这项前瞻性、双盲、观察性研究于 2020 年 3 月至 2022 年 3 月期间在巴利克赛尔大学医学院附属医院进行。研究共纳入 157 名年龄≥ 18 岁（体重指数≥ 30 kg.m-2）、既往未接受过头颈部手术的患者。颈前软组织测量在三个层面进行：舌骨与舌骨水平皮肤之间的最小距离（DSHB）、会厌中点与甲状舌骨膜水平皮肤之间的距离（DSE）、声带前会厌与声带水平皮肤之间的距离（DSV）。采用 Han 量表评估喉罩通气困难程度，采用 Cormack-Lehane 量表评估喉镜检查困难程度：结果：在喉镜检查困难组，DSHB、DSE 和 DSV 的平均值分别为 18.5 ± 3.5、18.3 ± 3.8 和 18.6 ± 3.4。DSHB、DSE 和 DSV 的 AUC 值分别为 0.845、0.827 和 0.850。与喉罩通气困难相比，颈前测量对喉镜检查困难的预测价值更高：结论：超声波测量可预测喉镜检查和通气困难，喉镜检查的相关性更好。

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引用次数: 0

Effects of perioperative dexmedetomidine on delayed graft function following renal transplant: a systematic review and meta-analysis 围手术期右美托咪定对肾移植术后移植功能延迟的影响：系统综述和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-07-02 DOI: 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":"74 6","pages":"Article 844534"},"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}

引用次数: 0

Neuroligins facilitate the development of bone cancer pain via regulating synaptic transmission: an experimental study 神经胶质蛋白通过调节突触传递促进骨癌疼痛的发展：一项实验研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-07-01 DOI: 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.

背景：慢性疼痛的基本机制涉及突触受体和神经递质的可塑性。本研究旨在调查神经胶质蛋白（NLs）在新建立的骨癌痛（BCP）模型中大鼠脊髓背角内的潜在作用。目的是探索神经胶质蛋白参与骨癌痛发生和发展的机制：方法：我们利用大鼠 BCP 模型评估了痛觉过敏性随时间的变化。方法：利用慢病毒载体在大鼠脊髓中过表达神经胶质蛋白。免疫荧光染色和全细胞膜片钳记录用于研究 NLs 在 BCP 发生过程中的作用：结果：我们观察到大鼠脊髓中 NL1 和 NL2 的表达水平降低，而 NL3 的表达水平没有降低。因此，在脊髓中过表达 NL1 或 NL2 可减轻大鼠的机械过敏性。电生理实验表明，NL1和NL2分别通过调节γ-氨基丁酸能神经元间突触和谷氨酸能神经元间突触的活性参与BCP：我们的观察揭示了 NLs 在癌症相关慢性疼痛中的作用，并进一步表明抑制机制是脊髓背角 BCP 的核心特征。这些结果为后续研究阐明 BCP 的发生和发展提供了新的视角和依据。

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引用次数: 0

Chronic pain after hospital discharge on patients hospitalized for COVID-19: an observational study COVID-19住院患者出院后的慢性疼痛：一项观察性研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-07-01 DOI: 10.1016/j.bjane.2023.08.001

Guilherme Antonio Moreira de Barros, Douglas Inomata Cardoso da Silva, Mariana Lopes Amaral Barbosa, Rafael Abbud Soares, Rodrigo Leal Alves, Claudio Lucas Miranda, Paula Danieli Lopes da Costa, Paulo do Nascimento Júnior, Norma Sueli Pinheiro Módolo

Background

There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome.

Methods

A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3 months after discharge and their hospital's health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05.

Results

Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body.

Conclusion

Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

背景：有关冠状病毒病2019（COVID-19）出院后疼痛症状的发生率和性质的研究很少，尤其是发生中重度疾病的患者。因此，本研究旨在评估因COVID-19住院后出院的患者是否存在慢性疼痛，以及慢性疼痛的存在与重症监护住院时间、人口统计学和最坏的严重急性呼吸系统综合征冠状病毒2（SARS-CoV-2）结果的风险因素之间的关系：对住院后康复的 COVID-19 患者进行了横断面观察研究。研究人员在患者出院至少 3 个月后对其进行招募，并查阅了他们在医院的健康档案。评估的变量包括人口统计学、SARS-CoV-2 感染的严重程度（考虑是否需要重症监护）以及是否存在慢性疼痛。研究结果以描述性方式显示，多变量分析以研究结果的比值比（ORs）和各自的置信区间（CIs）表示。统计显著性以 p < 0.05 为标准：在纳入的 242 人中，77 人（31.8%）报告了与 COVID-19 相关的慢性疼痛，但与感染的严重程度无关。女性和肥胖与较高的慢性疼痛风险有关，其OR值分别为2.69（置信区间[95% CI 1.4至5.0]）和3.02（95% CI 1.5至5.9）。四肢是受影响最严重的部位：结论：在医院环境中接受治疗的 COVID-19 幸存者中，慢性疼痛很常见。结论：慢性疼痛在医院环境中接受治疗的 COVID-19 存活者中很常见，女性和肥胖是导致慢性疼痛发生的风险因素。

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引用次数: 0

Glucagon-Like Peptide-1 agonists in perioperative medicine: to suspend or not to suspend, that is the question 围手术期用药中的胰高血糖素样肽-1 激动剂：暂停还是不暂停，这是一个问题。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-06-27 DOI: 10.1016/j.bjane.2024.844538

Florentino Fernandes Mendes , Lorena Ibiapina M. Carvalho , Maristela Bueno Lopes

引用次数: 0

Virtual parental presence with coaching for reducing preoperative anxiety in children: a feasibility and pilot randomized controlled trial 通过虚拟父母陪伴和辅导减轻儿童术前焦虑：可行性和试点随机对照试验。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-06-26 DOI: 10.1016/j.bjane.2024.844533

Clyde T. Matava , Martina Bordini , Ben O’ Sullivan , Gabriela Alcaraz Garcia-Tejedor , Nan Gai , Guy Petroz , Conor Mc Donnell , Fahad Alam , Katie Brazel , Monica Caldeira-Kulbakas

Background

Preoperative anxiety in children causes negative postoperative outcomes. Parental presence at induction is a non-pharmacological strategy for relieving anxiety; nevertheless, it is not always possible or effective, namely when parents are overly anxious. Parental presence via video has been demonstrated to be useful in other contexts (divorce, criminal court). This study reports the feasibility of a randomized controlled trial to investigate the effect of video parental presence and parental coaching at induction on preoperative anxiety.

Methods

The study was a randomized, 2 × 2 factorial design trial examining parental presence (virtual vs. physical) and coaching (provided vs. not provided). Feasibility was assessed by enrollment rate, attrition rate, compliance, and staff satisfaction with virtual method with the NASA-Task Load Index (NASA-TLX) and System Usability Scale (SUS). For the children's anxiety and postoperative outcomes, the modified Yale Preoperative Anxiety Scale (mYPAS) and Post-Hospitalization Behavioral Questionnaire (PHBQ) were used. Parental anxiety was evaluated with the State-Trait Anxiety Inventory (STAI) questionnaire.

Results

A total of 41 parent/patient dyads were recruited. The enrollment rate was 32.2%, the attrition rate 25.5%. Compliance was 87.8% for parents and 85% for staff. The SUS was 67.5/100 and 63.5/100 and NASA-TLX was 29.2 (21.5–36.8) and 27.6 (8.2–3.7) for the anesthesiologists and induction nurses, respectively. No statistically significant difference was found in mYPAS, PHBQ and STAI.

Conclusion

A randomized controlled trial to explore virtual parental presence effect on preoperative anxiety is feasible. Further studies are needed to investigate its role and the role of parent coaching in reducing preoperative anxiety.

背景：儿童术前焦虑会导致术后不良后果。父母在诱导时在场是一种非药物缓解焦虑的策略；然而，这种策略并不总是可行或有效，即当父母过度焦虑时。在其他情况下（离婚、刑事法庭），父母通过视频在场已被证明是有用的。本研究报告了一项随机对照试验的可行性，以调查视频父母陪伴和父母在诱导时的指导对术前焦虑的影响：该研究是一项随机、2 × 2 因式设计试验，考察了父母在场（虚拟与实体）和指导（提供与不提供）。通过美国航空航天局任务负荷指数（NASA-TLX）和系统可用性量表（SUS）对虚拟方法的注册率、流失率、依从性和工作人员满意度进行可行性评估。对于儿童的焦虑和术后结果，采用了改良耶鲁术前焦虑量表（mYPAS）和住院后行为问卷（PHBQ）。父母的焦虑程度则通过国家-特质焦虑量表（STAI）问卷进行评估：共招募了 41 个家长/患者二人组。注册率为 32.2%，流失率为 25.5%。家长的依从性为 87.8%，员工的依从性为 85%。麻醉师和诱导护士的 SUS 分别为 67.5/100 和 63.5/100，NASA-TLX 分别为 29.2（21.5-36.8）和 27.6（8.2-3.7）。在 mYPAS、PHBQ 和 STAI 方面没有发现明显的统计学差异：探讨虚拟父母在场对术前焦虑的影响的随机对照试验是可行的。结论：探讨虚拟父母在场对术前焦虑的影响的随机对照试验是可行的，但还需要进一步研究虚拟父母在场在降低术前焦虑方面的作用以及父母指导在降低术前焦虑方面的作用。

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引用次数: 0

Advancing pediatric anesthesia in Brazil: reflections on research and education 推进巴西的儿科麻醉：对研究和教育的思考。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-06-25 DOI: 10.1016/j.bjane.2024.844535

Norma Sueli Pinheiro Módolo , Débora de Oliveira Cumino , Luciana Cavalcanti Lima , Guilherme Antonio Moreira de Barros

引用次数: 0

Beyond the bite: understanding and managing post-arboviral pain 超越咬伤：了解和处理病毒感染后的疼痛》（Beyond the Bite: Understanding and Managing Post-Arboviral Pain.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-06-22 DOI: 10.1016/j.bjane.2024.844526

Durval Campos Kraychete , Vinicius Borges Alencar , Eduardo Silva Reis Barreto , César Romero Antunes Júnior , Liliane Elze Falcão Lins-Kusterer , Guilherme Antonio Moreira de Barros , André P. Schmidt

引用次数: 0