Pub Date : 2024-05-01DOI: 10.1016/j.bjane.2023.02.003
Sinem Sari , Jack Brooker , Mateo Montalvo-Campana , Peter Shehata , Xuan Pu , Steven Insler , Kurt Ruetzler , Christopher A. Troianos , Alparslan Turan
Background
Most cardiac surgery patients experience postoperative anemia. Delirium and Atrial Fibrillation (AF) are common and independent predictors of morbidity and mortality. Few reports examine their association with postoperative anemia. This study aims to quantify the association between anemia and these outcomes in patients undergoing cardiac surgery.
Methods
This post-hoc analysis of the DECADE randomized controlled trial ran at six academic US hospitals. Patients aged 18–85 years with heart rate > 50 bpm undergoing cardiac surgery who had daily hemoglobin measurements in the first 5 Postoperative Days (POD) were included. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM – ICU), preceded by the Richmond Agitation and Sedation Scale, with patients excluded from assessment if sedated. Patients had daily hemoglobin measurements, continuous cardiac monitoring plus twice-daily 12-lead electrocardiograms, up to POD4. AF was diagnosed by clinicians blinded to hemoglobin levels.
Results
Five hundred and eighty-five patients were included. Mean postoperative hemoglobin Hazard Ratio (HR): 0.99 (95% CI 0.83, 1.19; p = 0.94) per 1 g.dL−1 hemoglobin decrease. 197 (34%) developed AF, mainly on POD = 2.3. Estimated HR = 1.04 (95% CI 0.93, 1.17; p = 0.51) per 1 g.dL−1 hemoglobin decrease.
Conclusions
Most patients undergoing major cardiac surgery were anemic in the postoperative phase. AF and delirium occurred in 34% and 12% of patients, respectively, but neither were significantly correlated with postoperative hemoglobin.
{"title":"The association of hemoglobin with postoperative delirium and atrial fibrillation after cardiac surgery: a retrospective sub-study","authors":"Sinem Sari , Jack Brooker , Mateo Montalvo-Campana , Peter Shehata , Xuan Pu , Steven Insler , Kurt Ruetzler , Christopher A. Troianos , Alparslan Turan","doi":"10.1016/j.bjane.2023.02.003","DOIUrl":"10.1016/j.bjane.2023.02.003","url":null,"abstract":"<div><h3>Background</h3><p>Most cardiac surgery patients experience postoperative anemia. Delirium and Atrial Fibrillation (AF) are common and independent predictors of morbidity and mortality. Few reports examine their association with postoperative anemia. This study aims to quantify the association between anemia and these outcomes in patients undergoing cardiac surgery.</p></div><div><h3>Methods</h3><p>This post-hoc analysis of the DECADE randomized controlled trial ran at six academic US hospitals. Patients aged 18–85 years with heart rate > 50 bpm undergoing cardiac surgery who had daily hemoglobin measurements in the first 5 Postoperative Days (POD) were included. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM – ICU), preceded by the Richmond Agitation and Sedation Scale, with patients excluded from assessment if sedated. Patients had daily hemoglobin measurements, continuous cardiac monitoring plus twice-daily 12-lead electrocardiograms, up to POD4. AF was diagnosed by clinicians blinded to hemoglobin levels.</p></div><div><h3>Results</h3><p>Five hundred and eighty-five patients were included. Mean postoperative hemoglobin Hazard Ratio (HR): 0.99 (95% CI 0.83, 1.19; <em>p</em> = 0.94) per 1 g.dL<sup>−1</sup> hemoglobin decrease. 197 (34%) developed AF, mainly on POD = 2.3. Estimated HR = 1.04 (95% CI 0.93, 1.17; <em>p</em> = 0.51) per 1 g.dL<sup>−1</sup> hemoglobin decrease.</p></div><div><h3>Conclusions</h3><p>Most patients undergoing major cardiac surgery were anemic in the postoperative phase. AF and delirium occurred in 34% and 12% of patients, respectively, but neither were significantly correlated with postoperative hemoglobin.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 744424"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000209/pdfft?md5=9d128d7a564713b20085c1344c5c1bff&pid=1-s2.0-S0104001423000209-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9173069","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}
Acute Kidney Injury (AKI) is a common complication after cardiac surgery and has been associated with poor outcomes. Dexmedetomidine (DEX) has been shown to confer direct renoprotection based on some animal and clinical studies, but data from other trials came to the opposite conclusion following cardiac surgery. This meta-analysis was conducted to evaluate the effects of perioperative DEX administration on the occurrence of AKI and the outcomes after cardiac surgery.
Methods
We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for Randomized Controlled Trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were Mechanical Ventilation (MV) duration, Intensive Care Unit (ICU) Length Of Stay (LOS), hospital LOS and mortality.
Results
Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI (Odds Ratio [OR = 0.66]; 95% Confidence Interval [95% CI 0.48–0.91]; p = 0.01), and there was no significant difference between groups in postoperative mortality (OR = 0.63; 95% CI 0.32–1.26; p = 0.19), MV duration (Weighted Mean Difference [WMD = -0.44]; 95% CI -1.50–0.63; p = 0.42), ICU LOS (WMD = -1.19; 95% CI -2.89–0.51; p = 0.17), and hospital LOS (WMD = -0.31; 95% CI -0.76–0.15; p = 0.19).
Conclusions
Perioperative DEX reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to DEX administration.
背景：急性肾损伤（AKI）是心脏手术后常见的并发症，与不良预后有关。根据一些动物和临床研究，右美托咪定（DEX）可直接保护肾脏，但其他试验的数据却得出了与心脏手术相反的结论。本荟萃分析旨在评估围手术期使用DEX对心脏手术后AKI发生率和预后的影响：我们在 EMBASE、PubMed 和 Cochrane CENTRAL 等数据库中检索了有关心脏手术后成人患者使用 DEX 治疗 AKI 的随机对照试验 (RCT)。主要结果是 AKI 发生率。次要结果是机械通气（MV）持续时间、重症监护室（ICU）住院时间、住院时间和死亡率：荟萃分析收集了 15 项试验，共 2907 名患者参与了研究。与对照组相比，DEX可降低术后AKI的发生率（Odds Ratio [OR = 0.66]; 95% Confidence Interval [95% CI 0.48-0.91]; p = 0.01），组间术后死亡率无显著差异（OR = 0.63; 95% CI 0.32-1.26; p = 0.19）、MV持续时间（加权平均差[WMD = -0.44]; 95% CI -1.50-0.63; p = 0.42）、ICU LOS（WMD = -1.19; 95% CI -2.89-0.51; p = 0.17）和住院LOS（WMD = -0.31; 95% CI -0.76-0.15; p = 0.19）：结论：围手术期DEX可降低接受心脏手术的成年患者术后AKI的发生率。结论：围手术期使用DEX可降低心脏手术成人患者术后AKI的发生率，但使用DEX后死亡率、MV持续时间、ICU LOS和住院时间均无明显下降。
{"title":"Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery? A meta-analysis of randomized controlled trials","authors":"Chunxiao Zhao , Shuo Liu , Huiquan Zhang , Mengqi Gao","doi":"10.1016/j.bjane.2023.07.003","DOIUrl":"10.1016/j.bjane.2023.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Acute Kidney Injury (AKI) is a common complication after cardiac surgery and has been associated with poor outcomes. Dexmedetomidine (DEX) has been shown to confer direct renoprotection based on some animal and clinical studies, but data from other trials came to the opposite conclusion following cardiac surgery. This meta-analysis was conducted to evaluate the effects of perioperative DEX administration on the occurrence of AKI and the outcomes after cardiac surgery.</p></div><div><h3>Methods</h3><p>We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for Randomized Controlled Trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were Mechanical Ventilation (MV) duration, Intensive Care Unit (ICU) Length Of Stay (LOS), hospital LOS and mortality.</p></div><div><h3>Results</h3><p>Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI (Odds Ratio [OR = 0.66]; 95% Confidence Interval [95% CI 0.48–0.91]; <em>p</em> = 0.01), and there was no significant difference between groups in postoperative mortality (OR = 0.63; 95% CI 0.32–1.26; <em>p</em> = 0.19), MV duration (Weighted Mean Difference [WMD = -0.44]; 95% CI -1.50–0.63; <em>p</em> = 0.42), ICU LOS (WMD = -1.19; 95% CI -2.89–0.51; <em>p</em> = 0.17), and hospital LOS (WMD = -0.31; 95% CI -0.76–0.15; <em>p</em> = 0.19).</p></div><div><h3>Conclusions</h3><p>Perioperative DEX reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to DEX administration.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 744446"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423000702/pdfft?md5=ef98eecea417b1784db31948f1487694&pid=1-s2.0-S0104001423000702-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9885898","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 : 2024-04-17DOI: 10.1016/j.bjane.2024.844503
Ana G.G. Vale , Catia S. Govêia , Gabriel M.N. Guimarães , Laíze R. Terra , Luís C.A. Ladeira , Guilherme A. Essado
Background
The incidence of arterial hypotension during induction of general anesthesia is influenced by the method of propofol administration, but there is a dearth of randomized clinical trials comparing bolus injection and target-controlled infusion in relation to arterial hypotension. This study seeks to compare the incidence of arterial hypotension between these two methods of propofol administration.
Methods
This prospective, randomized, single-center, non-blinded study included 60 patients (aged 35 to 55 years), classified as ASA physical status I or II, who were undergoing non-cardiac surgeries. They were randomly allocated using a computer to two groups based on the method of propofol administration during the induction of general anesthesia: the Target Group, receiving target-controlled infusion at 4 μg.mL−1, and the Bolus Group, receiving a bolus infusion of 2 mg.kg−1. Both groups also received midazolam 2 mg, fentanyl 3 μg.kg−1, and rocuronium 0.6 mg.kg−1. Over the first 10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were recorded every 2 minutes.
Results
Twenty-seven patients remained in the TCI group, while 28 were in the Bolus group. Repeated measure analysis using mixed-effects models could not reject the null hypothesis for the effect of group-time interactions in MAP (p = 0.85), HR (p = 0.49), SR (p = 0.44), or qCON (p = 0.72). The difference in means for qCON (60.2 for TCI, 50.5 for bolus, p < 0.001), MAP (90.3 for TCI, 86.2 for bolus, p < 0.006), HR (76.2 for TCI, 76.9 for bolus, p = 0.93), and SR (0.01 for TCI, 5.5 for bolus, p < 0.001), irrespective of time (whole period means), revealed some significant differences.
Conclusion
Patients who received propofol bolus injection exhibited a lower mean arterial pressure, a greater variation in the level of consciousness, and a higher suppression rate compared to those who received it as a target-controlled infusion. However, the interaction effect between groups and time remains inconclusive.
{"title":"Comparison of arterial hypotension incidence during general anesthesia induction – target-controlled infusion vs. bolus injection of propofol: a randomized clinical trial","authors":"Ana G.G. Vale , Catia S. Govêia , Gabriel M.N. Guimarães , Laíze R. Terra , Luís C.A. Ladeira , Guilherme A. Essado","doi":"10.1016/j.bjane.2024.844503","DOIUrl":"10.1016/j.bjane.2024.844503","url":null,"abstract":"<div><h3>Background</h3><p>The incidence of arterial hypotension during induction of general anesthesia is influenced by the method of propofol administration, but there is a dearth of randomized clinical trials comparing bolus injection and target-controlled infusion in relation to arterial hypotension. This study seeks to compare the incidence of arterial hypotension between these two methods of propofol administration.</p></div><div><h3>Methods</h3><p>This prospective, randomized, single-center, non-blinded study included 60 patients (aged 35 to 55 years), classified as ASA physical status I or II, who were undergoing non-cardiac surgeries. They were randomly allocated using a computer to two groups based on the method of propofol administration during the induction of general anesthesia: the Target Group, receiving target-controlled infusion at 4 μg.mL<sup>−1</sup>, and the Bolus Group, receiving a bolus infusion of 2 mg.kg<sup>−1</sup>. Both groups also received midazolam 2 mg, fentanyl 3 μg.kg<sup>−1</sup>, and rocuronium 0.6 mg.kg<sup>−1</sup>. Over the first 10 minutes of anesthesia induction, Mean Arterial Pressure (MAP), Heart Rate (HR), level of Consciousness (qCON), and Suppression Rate (SR) were recorded every 2 minutes.</p></div><div><h3>Results</h3><p>Twenty-seven patients remained in the TCI group, while 28 were in the Bolus group. Repeated measure analysis using mixed-effects models could not reject the null hypothesis for the effect of group-time interactions in MAP (<em>p</em> = 0.85), HR (<em>p</em> = 0.49), SR (<em>p</em> = 0.44), or qCON (<em>p</em> = 0.72). The difference in means for qCON (60.2 for TCI, 50.5 for bolus, <em>p</em> < 0.001), MAP (90.3 for TCI, 86.2 for bolus, <em>p</em> < 0.006), HR (76.2 for TCI, 76.9 for bolus, <em>p</em> = 0.93), and SR (0.01 for TCI, 5.5 for bolus, <em>p</em> < 0.001), irrespective of time (whole period means), revealed some significant differences.</p></div><div><h3>Conclusion</h3><p>Patients who received propofol bolus injection exhibited a lower mean arterial pressure, a greater variation in the level of consciousness, and a higher suppression rate compared to those who received it as a target-controlled infusion. However, the interaction effect between groups and time remains inconclusive.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 4","pages":"Article 844503"},"PeriodicalIF":1.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000253/pdfft?md5=f5db07c12017ce725a202a262a6c0eb1&pid=1-s2.0-S0104001424000253-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792555","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 : 2024-04-09DOI: 10.1016/j.bjane.2024.844502
Eugênio dos Santos Neto , Pedro Paulo de Alcantara Pedro , Maria do Socorro de Sousa Cartágenes , José Osvaldo Barbosa Neto , João Batista Santos Garcia
Background
This study aimed to investigate the analgesic impact of S(+)-ketamine on pain behavior and synovial inflammation in an osteoarthritis (OA) model.
Methods
Animals were grouped as follows: OA-Saline (n = 24) and OA-Ketamine (n = 24), OA induced via intra-articular sodium monoiodoacetate (MIA); a Non-OA group (n = 24) served as the control. On the 7th day post OA induction, animals received either saline or S(+)-ketamine (0.5 mg.kg−1). Behavioral and histopathological assessments were conducted up to day 28.
Results
S(+)-ketamine reduced allodynia from day 7 to 28 and hyperalgesia from day 10 to 28. It notably alleviated weight distribution deficits from day 10 until the end of the study. Significant walking improvement was observed on day 14 in S(+)-ketamine-treated rats. Starting on day 14, OA groups showed grip force decline, which was countered by S(+)-ketamine on day 21. However, S(+)-ketamine did not diminish synovial inflammation.
Conclusion
Low Intra-articular (IA) doses of S(+)-ketamine reduced MIA-induced OA pain but did not reverse synovial histopathological changes.
{"title":"The effect of low dose intra-articular S(+) ketamine on osteoarthritis in rats: an experimental study","authors":"Eugênio dos Santos Neto , Pedro Paulo de Alcantara Pedro , Maria do Socorro de Sousa Cartágenes , José Osvaldo Barbosa Neto , João Batista Santos Garcia","doi":"10.1016/j.bjane.2024.844502","DOIUrl":"https://doi.org/10.1016/j.bjane.2024.844502","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to investigate the analgesic impact of S(+)-ketamine on pain behavior and synovial inflammation in an osteoarthritis (OA) model.</p></div><div><h3>Methods</h3><p>Animals were grouped as follows: OA-Saline (n = 24) and OA-Ketamine (n = 24), OA induced via intra-articular sodium monoiodoacetate (MIA); a Non-OA group (n = 24) served as the control. On the 7<sup>th</sup> day post OA induction, animals received either saline or S(+)-ketamine (0.5 mg.kg<sup>−1</sup>). Behavioral and histopathological assessments were conducted up to day 28.</p></div><div><h3>Results</h3><p>S(+)-ketamine reduced allodynia from day 7 to 28 and hyperalgesia from day 10 to 28. It notably alleviated weight distribution deficits from day 10 until the end of the study. Significant walking improvement was observed on day 14 in S(+)-ketamine-treated rats. Starting on day 14, OA groups showed grip force decline, which was countered by S(+)-ketamine on day 21. However, S(+)-ketamine did not diminish synovial inflammation.</p></div><div><h3>Conclusion</h3><p>Low Intra-articular (IA) doses of S(+)-ketamine reduced MIA-induced OA pain but did not reverse synovial histopathological changes.</p></div><div><h3>IRB approval number</h3><p>23115 012030/2009-05.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844502"},"PeriodicalIF":1.3,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000241/pdfft?md5=8dd8de13116d6acf2227e97190a8eb7c&pid=1-s2.0-S0104001424000241-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140551496","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 : 2024-04-05DOI: 10.1016/j.bjane.2024.844501
Xixi Cai , Le Liu , Fangfang Xia , Thomas J. Papadimos , Quanguang Wang
Introduction
Cardiac arrest or arrhythmia caused by bupivacaine may be refractory to treatment. Apelin has been reported to directly increase the frequency of spontaneous activation and the propagation of action potentials, ultimately promoting cardiac contractility. This study aimed to investigate the effects of apelin-13 in reversing cardiac suppression induced by bupivacaine in rats.
Methods
A rat model of cardiac suppression was established by a 3-min continuous intravenous infusion of bupivacaine at the rate of 5 mg.kg−1.min−1, and serial doses of apelin-13 (50, 150 and 450 μg.kg−1) were administered to rescue cardiac suppression to identify its dose-response relationship. We used F13A, an inhibitor of Angiotensin Receptor-Like 1 (APJ), and Protein Kinase C (PKC) inhibitor chelerythrine to reverse the effects of apelin-13. Moreover, the protein expressions of PKC, Nav1.5, and APJ in ventricular tissues were measured using Western blotting and immunofluorescence assay.
Results
Compared to the control rats, the rats subjected to continuous intravenous administration of bupivacaine had impaired hemodynamic stability. Administration of apelin-13, in a dose-dependent manner, significantly improved hemodynamic parameters in rats with bupivacaine-induced cardiac suppression (p < 0.05), and apelin-13 treatment also significantly upregulated the protein expressions of p-PKC and Nav1.5 (p < 0.05), these effects were abrogated by F13A or chelerythrine (p < 0.05).
Conclusion
Exogenous apelin-13, at least in part, activates the PKC signaling pathway through the apelin/APJ system to improve cardiac function in a rat model of bupivacaine-induced cardiac suppression.
{"title":"Apelin-13 reverses bupivacaine-induced cardiotoxicity: an experimental study","authors":"Xixi Cai , Le Liu , Fangfang Xia , Thomas J. Papadimos , Quanguang Wang","doi":"10.1016/j.bjane.2024.844501","DOIUrl":"https://doi.org/10.1016/j.bjane.2024.844501","url":null,"abstract":"<div><h3>Introduction</h3><p>Cardiac arrest or arrhythmia caused by bupivacaine may be refractory to treatment. Apelin has been reported to directly increase the frequency of spontaneous activation and the propagation of action potentials, ultimately promoting cardiac contractility. This study aimed to investigate the effects of apelin-13 in reversing cardiac suppression induced by bupivacaine in rats.</p></div><div><h3>Methods</h3><p>A rat model of cardiac suppression was established by a 3-min continuous intravenous infusion of bupivacaine at the rate of 5 mg.kg<sup>−1</sup>.min<sup>−1</sup>, and serial doses of apelin-13 (50, 150 and 450 μg.kg<sup>−1</sup>) were administered to rescue cardiac suppression to identify its dose-response relationship. We used F13A, an inhibitor of Angiotensin Receptor-Like 1 (APJ), and Protein Kinase C (PKC) inhibitor chelerythrine to reverse the effects of apelin-13. Moreover, the protein expressions of PKC, Nav1.5, and APJ in ventricular tissues were measured using Western blotting and immunofluorescence assay.</p></div><div><h3>Results</h3><p>Compared to the control rats, the rats subjected to continuous intravenous administration of bupivacaine had impaired hemodynamic stability. Administration of apelin-13, in a dose-dependent manner, significantly improved hemodynamic parameters in rats with bupivacaine-induced cardiac suppression (<em>p</em> < 0.05), and apelin-13 treatment also significantly upregulated the protein expressions of p-PKC and Nav1.5 (<em>p</em> < 0.05), these effects were abrogated by F13A or chelerythrine (<em>p</em> < 0.05).</p></div><div><h3>Conclusion</h3><p>Exogenous apelin-13, at least in part, activates the PKC signaling pathway through the apelin/APJ system to improve cardiac function in a rat model of bupivacaine-induced cardiac suppression.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844501"},"PeriodicalIF":1.3,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S010400142400023X/pdfft?md5=64b95cf8c618c291285d66448c72f6bc&pid=1-s2.0-S010400142400023X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140542610","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 : 2024-03-29DOI: 10.1016/j.bjane.2024.844500
Gabriel Isaac Pereira de Castro , Renata Sayuri Ansai Pereira de Castro , Rodrigo Moreira e Lima , Bruna Nogueira dos Santos , Lais Helena Navarro e Lima
Background
There is no consensus on the most effective strategy for Postoperative Pulmonary Complication (PPC) reduction. This study hypothesized that a Goal-Directed Fluid Therapy (GDFT) protocol of infusion of predetermined boluses reduces the occurrence of PPC in patients undergoing elective open abdominal surgeries when compared with Standard of Care (SOC) strategy.
Methods
Randomized, prospective, controlled study, conducted from May 2012 to December 2014, with ASA I, II or III patients undergoing open abdominal surgeries, lasting at least 120 min, under general anesthesia, randomized into the SOC and the GDFT group. In the SOC, fluid administration was according to the anesthesiologist's discretion. In the GDFT, the intervention protocol, based on bolus infusion according to blood pressure and delta pulse pressure, was applied. Patients were postoperatively evaluated by an anesthesiologist blinded to the group allocation regarding PPC incidence, mortality, and Length of Hospital Stay (LOHS).
Results
Forty-two patients in the SOC group and 43 in the GDFT group. Nineteen patients (45%) in the SOC and 6 in the GDFT (14%) had at least one PPC (p = 0.003). There was no difference in mortality or LOHS between the groups. Among the patients with PPC, four died (25%), compared to two deaths in patients without PPC (3%) (p = 0.001). The LOHS had a median of 14.5 days in the group with PPC and 9 days in the group without PPC (p = 0.001).
Conclusion
The GDFT protocol resulted in a lower rate of PPC; however, the LOHS and mortality did not reduce.
{"title":"Fluid therapy and pulmonary complications in abdominal surgeries: randomized controlled trial","authors":"Gabriel Isaac Pereira de Castro , Renata Sayuri Ansai Pereira de Castro , Rodrigo Moreira e Lima , Bruna Nogueira dos Santos , Lais Helena Navarro e Lima","doi":"10.1016/j.bjane.2024.844500","DOIUrl":"10.1016/j.bjane.2024.844500","url":null,"abstract":"<div><h3>Background</h3><p>There is no consensus on the most effective strategy for Postoperative Pulmonary Complication (PPC) reduction. This study hypothesized that a Goal-Directed Fluid Therapy (GDFT) protocol of infusion of predetermined boluses reduces the occurrence of PPC in patients undergoing elective open abdominal surgeries when compared with Standard of Care (SOC) strategy.</p></div><div><h3>Methods</h3><p>Randomized, prospective, controlled study, conducted from May 2012 to December 2014, with ASA I, II or III patients undergoing open abdominal surgeries, lasting at least 120 min, under general anesthesia, randomized into the SOC and the GDFT group. In the SOC, fluid administration was according to the anesthesiologist's discretion. In the GDFT, the intervention protocol, based on bolus infusion according to blood pressure and delta pulse pressure, was applied. Patients were postoperatively evaluated by an anesthesiologist blinded to the group allocation regarding PPC incidence, mortality, and Length of Hospital Stay (LOHS).</p></div><div><h3>Results</h3><p>Forty-two patients in the SOC group and 43 in the GDFT group. Nineteen patients (45%) in the SOC and 6 in the GDFT (14%) had at least one PPC (<em>p</em> = 0.003). There was no difference in mortality or LOHS between the groups. Among the patients with PPC, four died (25%), compared to two deaths in patients without PPC (3%) (<em>p</em> = 0.001). The LOHS had a median of 14.5 days in the group with PPC and 9 days in the group without PPC (<em>p</em> = 0.001).</p></div><div><h3>Conclusion</h3><p>The GDFT protocol resulted in a lower rate of PPC; however, the LOHS and mortality did not reduce.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 4","pages":"Article 844500"},"PeriodicalIF":1.3,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000228/pdfft?md5=c8ad0071a7100e86aca972abfac00f6a&pid=1-s2.0-S0104001424000228-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140330430","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 : 2024-03-22DOI: 10.1016/j.bjane.2024.844495
Shirley Andrade Santos , Fernando Souza Nani , Elaine Imaeda de Moura , Diogo Lima de Carvalho , Guilherme Jorge Mattos Miguel , Cristiane Maria Federicci Haddad , Joaquim Edson Vieira , Victor Bunduki , Mário Henrique Burlacchini de Carvalho , Rossana Pulcineli Vieira Francisco , Daniel Dante Cardeal , Hermann dos Santos Fernandes
Background
Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as β2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair.
Methods
Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery.
Results
Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 ± 0.05 vs. 7.396 ± 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 ± 12.76 mg.dL−1 vs. 13.06 ± 6.35 mg.dL−1, for atosiban, p = 0.001) levels.
Conclusions
Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.
{"title":"Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study","authors":"Shirley Andrade Santos , Fernando Souza Nani , Elaine Imaeda de Moura , Diogo Lima de Carvalho , Guilherme Jorge Mattos Miguel , Cristiane Maria Federicci Haddad , Joaquim Edson Vieira , Victor Bunduki , Mário Henrique Burlacchini de Carvalho , Rossana Pulcineli Vieira Francisco , Daniel Dante Cardeal , Hermann dos Santos Fernandes","doi":"10.1016/j.bjane.2024.844495","DOIUrl":"10.1016/j.bjane.2024.844495","url":null,"abstract":"<div><h3>Background</h3><p>Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as β2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair.</p></div><div><h3>Methods</h3><p>Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery.</p></div><div><h3>Results</h3><p>Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 ± 0.05 vs. 7.396 ± 0.02 for atosiban, <em>p</em> = 0.006) and higher arterial lactate (28.33 ± 12.76 mg.dL<sup>−1</sup> vs. 13.06 ± 6.35 mg.dL<sup>−1</sup>, for atosiban, <em>p</em> = 0.001) levels.</p></div><div><h3>Conclusions</h3><p>Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 3","pages":"Article 844495"},"PeriodicalIF":1.3,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000174/pdfft?md5=dbaa845b4aa6c764f06ad927577cbfab&pid=1-s2.0-S0104001424000174-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195268","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 : 2024-03-01DOI: 10.1016/j.bjane.2023.11.003
Getúlio Rodrigues de Oliveira Filho, Victor Medeiros Benincá
Introduction
This study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency.
Methods
Anonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h0. Residents whose curves reached h0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up.
Results
Thirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27–78 [4–132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13–24 [13–24]).
Conclusions
The LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.
{"title":"Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study","authors":"Getúlio Rodrigues de Oliveira Filho, Victor Medeiros Benincá","doi":"10.1016/j.bjane.2023.11.003","DOIUrl":"10.1016/j.bjane.2023.11.003","url":null,"abstract":"<div><h3>Introduction</h3><p>This study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency.</p></div><div><h3>Methods</h3><p>Anonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h<sub>0</sub>. Residents whose curves reached h<sub>0</sub> were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up.</p></div><div><h3>Results</h3><p>Thirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27–78 [4–132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13–24 [13–24]).</p></div><div><h3>Conclusions</h3><p>The LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 2","pages":"Article 744473"},"PeriodicalIF":1.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423001185/pdfft?md5=d92aed10921eeac2f8fa66031b01d206&pid=1-s2.0-S0104001423001185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650563","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 : 2024-03-01DOI: 10.1016/j.bjane.2023.09.005
Desire T. Maioli , Cristiano F. Andrade , Clovis T. Bevilacqua Filho , André P. Schmidt
{"title":"High-flow nasal therapy: a game-changer in anesthesia and perioperative medicine?","authors":"Desire T. Maioli , Cristiano F. Andrade , Clovis T. Bevilacqua Filho , André P. Schmidt","doi":"10.1016/j.bjane.2023.09.005","DOIUrl":"10.1016/j.bjane.2023.09.005","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 2","pages":"Article 744466"},"PeriodicalIF":1.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423001008/pdfft?md5=c5d3540aa947c25085c52fac2e4f1b70&pid=1-s2.0-S0104001423001008-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180619","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 : 2024-03-01DOI: 10.1016/j.bjane.2023.11.004
Federico Almonacid-Cardenas , Eva Rivas , Moises Auron , Lucille Hu , Dong Wang , Liu Liu , Deborah Tolich , Edward J. Mascha , Kurt Ruetzler , Andrea Kurz , Alparslan Turan
Background
Anemia is common in the preoperative setting and associated with increased postoperative complications and mortality. However, it is unclear if preoperative anemia optimization reduces postoperative complications. We aimed to assess the association between preoperative anemia optimization and a composite endpoint of major cardiovascular, renal, and pulmonary complications and all-cause mortality within 30 days after noncardiac surgery in adult patients.
Methods
In this retrospective analysis preoperative anemia was defined as hemoglobin concentration below 12.0 g.dl−1 in women and 13.0 g.dl−1 in men within 6 months before surgery. A propensity score-based generalized estimating equation analysis was used to determine the association between preoperative anemia optimization and the primary outcome. Moreover, mediation analysis was conducted to investigate whether intraoperative red blood cell transfusion or duration of intraoperative hypotension were mediators of the relation between anemia optimization and the primary outcome.
Results
Fifty-seven hundred anemia optimized, and 8721 non-optimized patients met study criteria. The proportion of patients having any component of the composite of major complications and all-cause mortality was 21.5% in the anemia-optimized versus 18.0% in the non-optimized, with confounder-adjusted odds ratio estimate of 0.99 (95% CI 0.86‒1.15) for anemia optimization versus non-optimization, p = 0.90. Intraoperative red blood cell transfusion had a minor mediation effect on the relationship between preoperative anemia optimization and the primary outcome, whereas duration of intraoperative hypotension was not found to be a mediator.
Conclusion
Preoperative anemia optimization did not appear to be associated with a composite outcome of major in-hospital postoperative cardiovascular, renal, and pulmonary complications and all-cause in-hospital mortality.
背景:贫血在术前很常见，并与术后并发症和死亡率增加有关。然而，术前贫血优化是否能减少术后并发症尚不清楚。我们的目的是评估术前贫血优化与成人非心脏手术后30天内主要心血管、肾脏和肺部并发症及全因死亡率的复合终点之间的关系。方法:回顾性分析术前贫血定义为术前6个月内女性血红蛋白浓度低于12.0 g.dL-1，男性血红蛋白浓度低于13.0 g.dL-1。使用基于倾向评分的广义估计方程分析来确定术前贫血优化与主要结局之间的关系。此外，我们还进行了中介分析，以探讨术中红细胞输注或术中低血压持续时间是否是贫血优化与主要结局之间关系的中介因素。结果:5700例优化贫血患者，8721例未优化贫血患者符合研究标准。在贫血优化组中，出现主要并发症和全因死亡率的患者比例为21.5%，而在非优化组中为18.0%，经混杂因素调整后，贫血优化组与非优化组的优势比估计为0.99 (95% CI 0.86-1.15)， p = 0.90。术中红细胞输血对术前贫血优化和主要结局之间的关系有轻微的中介作用，而术中低血压持续时间未被发现是中介作用。结论:术前贫血优化似乎与主要住院术后心血管、肾脏和肺部并发症以及全因住院死亡率的复合结局无关。
{"title":"Association between preoperative anemia optimization and major complications after non-cardiac surgery: a retrospective analysis","authors":"Federico Almonacid-Cardenas , Eva Rivas , Moises Auron , Lucille Hu , Dong Wang , Liu Liu , Deborah Tolich , Edward J. Mascha , Kurt Ruetzler , Andrea Kurz , Alparslan Turan","doi":"10.1016/j.bjane.2023.11.004","DOIUrl":"10.1016/j.bjane.2023.11.004","url":null,"abstract":"<div><h3>Background</h3><p>Anemia is common in the preoperative setting and associated with increased postoperative complications and mortality. However, it is unclear if preoperative anemia optimization reduces postoperative complications. We aimed to assess the association between preoperative anemia optimization and a composite endpoint of major cardiovascular, renal, and pulmonary complications and all-cause mortality within 30 days after noncardiac surgery in adult patients.</p></div><div><h3>Methods</h3><p>In this retrospective analysis preoperative anemia was defined as hemoglobin concentration below 12.0 g.dl<sup>−1</sup> in women and 13.0 g.dl<sup>−1</sup> in men within 6 months before surgery. A propensity score-based generalized estimating equation analysis was used to determine the association between preoperative anemia optimization and the primary outcome. Moreover, mediation analysis was conducted to investigate whether intraoperative red blood cell transfusion or duration of intraoperative hypotension were mediators of the relation between anemia optimization and the primary outcome.</p></div><div><h3>Results</h3><p>Fifty-seven hundred anemia optimized, and 8721 non-optimized patients met study criteria. The proportion of patients having any component of the composite of major complications and all-cause mortality was 21.5% in the anemia-optimized versus 18.0% in the non-optimized, with confounder-adjusted odds ratio estimate of 0.99 (95% CI 0.86‒1.15) for anemia optimization versus non-optimization, <em>p</em> = 0.90. Intraoperative red blood cell transfusion had a minor mediation effect on the relationship between preoperative anemia optimization and the primary outcome, whereas duration of intraoperative hypotension was not found to be a mediator.</p></div><div><h3>Conclusion</h3><p>Preoperative anemia optimization did not appear to be associated with a composite outcome of major in-hospital postoperative cardiovascular, renal, and pulmonary complications and all-cause in-hospital mortality.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 2","pages":"Article 744474"},"PeriodicalIF":1.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001423001197/pdfft?md5=8a7788186706229fc5c54c789b30f5d7&pid=1-s2.0-S0104001423001197-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479700","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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