Brazilian Journal of Anesthesiology最新文献

英文中文

The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study 术前情绪压力简测筛选术前不良心理特征并预测术后阿片类药物的使用：一项观察性研究

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-03-01 DOI: 10.1016/j.bjane.2023.02.004

Rogério Boff Borges , Wolnei Caumo , Caroline Bavaresco , Luciana Paula Cadore Stefani , Vinicius Souza dos Santos , Stela Maris de Jezus Castro

Background

The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use.

Methods

This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery.

Results

We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%–90.3%) and specificity of 93.5% (91.5–95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity.

Conclusions

These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.

背景术前情绪压力简明测量法（B-MEPS）是一种适用于术前情绪压力（PES）的筛查工具。然而，个性化决策需要对改进版 B-MEPS 进行实际解读。因此，我们提出并验证了 B-MEPS 对 PES 进行分类的临界点。此外，我们还评估了这些临界点是否能筛查术前适应不良心理特征并预测术后阿片类药物的使用情况。方法这项观察性研究由另外两项主要研究的样本组成，分别有 1009 人和 233 人参加。潜类分析利用 B-MEPS 项目得出了情绪压力亚组。我们通过尤登指数（Youden index）比较了成员与 B-MEPS 分数的关系。我们将截断点与术前抑郁症状严重程度、疼痛灾难化、中枢敏感化和睡眠质量进行了并行标准验证。我们选择了轻度、中度和重度三个等级的模型。B-MEPS评分的尤登指数点-0.1663和0.7614将患者划分为重度，灵敏度为85.7%（80.1%-90.3%），特异度为93.5%（91.5%-95.1%）。B-MEPS 评分的临界点具有令人满意的并发和预测标准有效性。它们提供了一种简单的工具，用于识别与适应不良心理特征相关的严重术前情绪应激反应患者，这些心理特征可能会影响患者对疼痛的感知和术后阿片类镇痛药的使用。

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引用次数: 0

Accuracy of closed-loop and open-loop propofol delivery systems by bispectral index monitoring in breast surgery patients: a prospective randomized trial 通过双谱指数监测乳腺手术患者使用闭环和开环异丙酚给药系统的准确性：一项前瞻性随机试验

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-03-01 DOI: 10.1016/j.bjane.2023.05.003

Tian Xie, Yong Wang, Yuhua Liu, Junjie Li, Weijing Li, Hongmeng Xu

Background

This randomized and controlled prospective study tested the hypothesis that closed-loop Target-Controlled Infusion (TCI) of propofol would be associated with better system performance when compared with open-loop controlled delivery of propofol.

Methods

Patients scheduled for elective breast surgery were randomly assigned to two groups: a closed-loop group, in which propofol infusion was performed by a closed-loop TCI system that used the Bispectral Index (BIS) as a feedback parameter to titrate the rate of propofol infusion, and an open-loop group, in which propofol infusion was performed manually and guided by the bispectral index.

Results

A total of 156 patients were recruited for this study (closed-loop group n = 79; open-loop group n = 77). The Global Score (GS) of the closed-loop group was lower than that of the open-loop group (34.3 and 42.2) (p = 0.044). The proportions of time with a BIS value between 40 and 60 were almost identical in the closed-loop group and the open-loop group (68.7 ± 10.6% and 66.7 ± 13.3%) (p = 0.318). The individuals in the closed-loop group consumed more propofol compared with those in the open-loop group (7.20 ± 1.65 mg.kg⁻¹.h⁻¹ vs. 6.03 ± 1.31 mg.kg⁻¹.h⁻¹, p < 0.001). No intraoperative recall, somatic events or adverse events occurred. No significant difference in heart rate was observed between the two groups (p = 0.169).

Conclusion

The closed-loop protocol was associated with lower BIS variability and lower out-of-range BIS values, at the cost of a greater consumption of propofol when compared to the open loop group.

Register number

ChiCTR-INR-17010399.

背景这项随机对照前瞻性研究检验了一种假设，即与开环控制的异丙酚给药相比，闭环异丙酚目标控制输注（TCI）系统的性能更好。方法将计划进行择期乳房手术的患者随机分配到两组：一组为闭环组，由闭环 TCI 系统进行异丙酚输注，该系统使用双谱指数 (BIS) 作为反馈参数来调整异丙酚输注的速度；另一组为开环组，由人工进行异丙酚输注，并以双谱指数为指导。结果本研究共招募了 156 名患者（闭环组 n = 79；开环组 n = 77）。闭环组的总体评分（GS）低于开环组（分别为 34.3 和 42.2）（p = 0.044）。闭环组和开环组 BIS 值介于 40 和 60 之间的时间比例几乎相同（68.7 ± 10.6% 和 66.7 ± 13.3%）（p = 0.318）。与开环组相比，闭环组消耗的异丙酚更多（7.20 ± 1.65 mg.kg-1.h-1 vs. 6.03 ± 1.31 mg.kg-1.h-1, p <0.001）。无术中回忆、躯体事件或不良事件发生。两组心率无明显差异（p = 0.169）。结论与开环组相比，闭环方案与较低的 BIS 变异性和较低的超范围 BIS 值相关，但代价是异丙酚的消耗量更大。

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引用次数: 0

Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial☆ 全髋关节置换术中超声引导经肌腰四头肌阻滞的罗哌卡因最低有效浓度：随机临床试验☆。

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-03-01 DOI: 10.1016/j.bjane.2023.08.005

Jian Hu , Xingcheng Li , Qiuru Wang , Jing Yang

Objective

This trial aimed to identify the Minimum Effective Concentration (MEC₉₀, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).

Methods

A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC₉₀, MEC₉₅ and MEC₉₉ were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method.

Results

Based on the analysis of 52 patients, MEC₉₀, MEC₉₅, and MEC₉₉ of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334–0.372%), 0.363% (95% CI 0.351–0.383%), and 0.373% (95% CI 0.363–0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients.

Conclusions

For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.

目的本试验旨在确定 30 毫升罗哌卡因的最小有效浓度（MEC90，即能为 90% 的患者提供成功阻滞的浓度），用于在接受全髋关节置换术（THA）的患者中进行单次超声引导下经肌腰椎四头肌阻滞（QLB）。方法一项双盲随机剂量探索研究，采用偏置硬币设计上下顺序法，每位患者的局麻药浓度取决于前一位患者的反应。阻滞成功的定义是抵达病房 6 小时后运动时的数字评分量表（NRS）得分≤ 3。如果阻滞成功，则下一位受试者接受较小剂量（概率为 0.11）或相同剂量（概率为 0.89）的 0.025% 罗哌卡因；否则，下一位受试者接受较高浓度（概率为 0.025%）的 0.025% 罗哌卡因。MEC90、MEC95和MEC99是通过等容回归法估算的，相应的95%置信区间（95% CI）是通过引导法计算的。结果根据对52例患者的分析，估计罗哌卡因用于QLB的MEC90、MEC95和MEC99分别为0.352%（95% CI 0.334-0.372%）、0.363%（95% CI 0.351-0.383%）和0.373%（95% CI 0.363-0.386%）。结论对于在超声引导下进行经肌 QLB 的 THA 患者，30 毫升容量的 0.352% 罗哌卡因可为 90% 的患者提供成功的阻滞。要验证这一浓度，还需要进一步的剂量测定研究和大样本量的研究。

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引用次数: 0

Metoprolol for prevention of bucking at orotracheal extubation: a double-blind, placebo-controlled randomised trial 美托洛尔用于预防气管插管时的龅牙：一项双盲、安慰剂对照随机试验

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-03-01 DOI: 10.1016/j.bjane.2023.07.012

Murilo Neves de Queiroz , Fabrício Tavares Mendonça , Maurício Vargas de Matos , Rafael Santos Lino , Luiz Sérgio Fernandes de Carvalho

Background

Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation.

Methods

Randomized, double-blinded, placebo-controlled trial. Setting: Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. Sample: 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I–III aged 18–80 years. Patients were randomly assigned to receive intravenous metoprolol 5 mg IV or placebo at the end of surgery. The primary outcome was the proportion of patients who developed bucking secondary to endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes included coughing, bronchospasm, laryngospasm, Mean Blood Pressure (MAP), and Heart Rate (HR) levels.

Results

Two hundred and seven participants were included in the final analysis: 102 in the metoprolol group and 105 in the placebo group. Patients who received metoprolol had a significantly lower risk of bucking (43.1% vs. 64.8%, Relative Risk [RR = 0.66], 95% Confidence Interval [95% CI 0.51–0.87], p = 0.003). In the metoprolol group, 6 (5.9%) patients had moderate/severe coughing compared with 33 (31.4%) in the placebo group (RR = 0.19; 95% CI 0.08–0.43, p < 0.001).

Conclusion

Metoprolol reduced the risk of bucking at extubation in patients undergoing general anesthesia compared to placebo.

背景拔管时的呼吸反应可导致严重的术后并发症。β-受体阻滞剂（如美托洛尔）可干扰咳嗽途径。然而，美托洛尔能否有效控制拔管时的呼吸反射仍不清楚。本研究旨在评估静脉注射美托洛尔对减轻气管插管时呼吸反应的疗效。地点位于巴西巴西利亚的三级转诊中心。招募：2021 年 6 月至 2021 年 12 月。样本：222名美国麻醉医师协会（ASA）身体状况为I-III级的男女患者，年龄在18-80岁之间。患者在手术结束后被随机分配接受静脉注射美托洛尔 5 毫克或安慰剂。主要结果是在拔管时因气管导管刺激气管粘膜而继发反跳的患者比例。次要结果包括咳嗽、支气管痉挛、喉痉挛、平均血压（MAP）和心率（HR）水平。结果227名参与者被纳入最终分析：美托洛尔组102人，安慰剂组105人。接受美托洛尔治疗的患者降压风险明显降低（43.1% 对 64.8%，相对风险 [RR = 0.66]，95% 置信区间 [95% CI 0.51-0.87]，P = 0.003）。结论与安慰剂相比，美托洛尔可降低全身麻醉患者拔管时出现呛咳的风险。

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引用次数: 0

Retrospective analysis of 20 years of activity of the Brazilian malignant hyperthermia hotline service 对巴西恶性高热热线服务 20 年活动的回顾性分析。

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-02-08 DOI: 10.1016/j.bjane.2024.844482

Cezar D.S. Souza, Clea S. Almeida, Pamela V. Andrade, Joilson M. Santos, José L.G. Amaral, Helga C.A. Silva

引用次数: 0

Sizing double-lumen tubes by direct measurement of the mainstem bronchus 通过直接测量支气管主干来确定双腔管道的尺寸。

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-02-04 DOI: 10.1016/j.bjane.2024.844481

Anthony M.-H. Ho , Gregory Klar , Andrew D. Chung , Glenio B. Mizubuti

引用次数: 0

Perioperative organ dysfunction: a burden to be countered 围手术期器官功能障碍：需要克服的负担。

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-01-30 DOI: 10.1016/j.bjane.2024.844480

Ricardo Esper Treml , Henrique Tadashi Katayama , Tulio Caldonazo , Talison Silas Pereira , Luiz M. Sá Malbouisson , Maria José C. Carmona , Pedro Tanaka , João Manoel Silva Jr.

引用次数: 0

Ultrasound-guided pulsed radiofrequency for chronic shoulder pain: a prospective study 超声引导下脉冲射频治疗慢性肩痛：一项前瞻性研究

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-01-01 DOI: 10.1016/j.bjane.2021.08.006

Rita Diogo Torgal Pinto , Joana Manuela Tenreiro Pinto , Maria C..u Loureiro , Cristina Cardoso , Jos.. Pedro Assun...·o

Background and objectives

Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting.

Methods

Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient...s motor function improvement. The secondary outcome was patient satisfaction.

Results

A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient...s global impression of change superior to six.

Conclusion

This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients... satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.

背景和目的慢性肩痛是导致患者痛苦和生活质量下降的一个常见原因。治疗方法包括非药物疗法和药物疗法，以及肩胛上神经阻滞和射频等介入治疗。这项前瞻性研究旨在评估临床环境中超声引导下肩胛上神经脉冲射频治疗慢性肩痛的疗效。方法在基线、治疗后3个月和6个月使用数字疼痛评分量表评估疼痛强度，并评估患者运动功能的改善情况。结果总共有 34 名患者接受了治疗，所有患者在治疗后的数字疼痛评分表上的疼痛强度都有所减轻。从基线到术后 6 个月，静态和动态疼痛减轻率分别为 34.4% 和 36.9%。中位数百分比的减少在术后3个月和6个月都有显著的统计学意义。活动范围也有所改善，外展39.6%，屈曲24.1%，伸展29.5%。90%的患者报告说，患者......的总体变化印象优于6%。结论这项研究得出结论，超声引导下的肩胛上神经脉冲射频治疗至少在6个月内减轻了疼痛强度，同时改善了运动功能，提高了患者......的满意度。因此，这项技术是治疗慢性肩痛的有效镇痛方法。

{"title":"Ultrasound-guided pulsed radiofrequency for chronic shoulder pain: a prospective study","authors":"Rita Diogo Torgal Pinto , Joana Manuela Tenreiro Pinto , Maria C..u Loureiro , Cristina Cardoso , Jos.. Pedro Assun...·o","doi":"10.1016/j.bjane.2021.08.006","DOIUrl":"10.1016/j.bjane.2021.08.006","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting.</p></div><div><h3>Methods</h3><p>Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient...s motor function improvement. The secondary outcome was patient satisfaction.</p></div><div><h3>Results</h3><p>A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient...s global impression of change superior to six.</p></div><div><h3>Conclusion</h3><p>This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients... satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001421003341/pdfft?md5=3f0e154166b9ba77377cdc5033e89771&pid=1-s2.0-S0104001421003341-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39455170","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

How would a completely homogeneous malignant hyperthermia susceptible sample be? 一个完全同质的恶性高温敏感样本会是什么样的？

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-01-01 DOI: 10.1016/j.bjane.2023.10.001

Pamela Vieira de Andrade, Lívia Maria Valim, Joilson Moura Santos, Isac de Castro, José Luiz Gomes do Amaral, Helga Cristina Almeida da Silva

引用次数: 0

Fatigue in anesthesia workers 麻醉工作人员的疲劳

IF 1.3 4区医学 Q3 Medicine

Brazilian Journal of Anesthesiology

Pub Date : 2024-01-01 DOI: 10.1016/j.bjane.2023.09.001

Nancy Redfern , Federico Bilotta

引用次数: 0

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