Revista Espanola de Anestesiologia y Reanimacion最新文献

英文中文

Comparación de la administración intranasal de dexmedetomidina y ketamina para premedicación pediátrica: estudio aleatorizado 比较右美托咪定和氯胺酮在儿科预处理中的鼻内给药：一项随机研究。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redar.2024.02.003

Introduction and objectives

Paediatric patients are given premedication to decrease preoperative anxiety, allow smooth induction, and prevent postoperative psychological insult and behavioural changes. A child-friendly method of administration is therefore needed.

We administered the Faces, Legs, Activity, Cry and Consolability (FLACC) scale in patients receiving intranasal dexmedetomidine and ketamine to compare their reactions to insertion of a catheter for induction of general anaesthesia in the operating room.

Methods

This prospective, double-blind, randomized controlled trial was conducted at a tertiary care center. One hundred patients, 2-10 years of age, ASA physical status 1 and 2, scheduled for general anaesthesia were enrolled. Presedation behaviour was assessed using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF). Patients in Group D received dexmedetomidine 1 mcg/kg intranasally, and patients in Group K received ketamine 5 mg/kg intranasally. After 45 minutes, patients were transferred to the operating table where intravenous cannulation was performed and patient response to needle insertion was assessed using the FLACC scale. Vital signs, including heart rate, respiratory rate, and blood oxygen levels were monitored. Side effects such as náusea, vomiting, and agitation were also recorded.

Results

The FLACC score was significantly higher in Group D vs. Group K (P=.001). Mean heart rate was significantly (P=.001) lower in Group D vs. Group K. However, adverse events occurred in 8% of patients who received ketamine.

Conclusions

Intranasal ketamine at a dose of 5 mg/kg is clinically more effective for premedication in children aged 2-10 years compared with intranasal dexmedetomidine at a dose of 1 mcg/kg.

导言和目的对儿科患者进行术前用药是为了减少术前焦虑，使诱导顺利进行，并防止术后心理损伤和行为改变。我们对接受右美托咪定和氯胺酮鼻内注射的患者进行了脸部、腿部、活动、哭泣和安慰（FLACC）量表测试，以比较他们在手术室插入导管进行全身麻醉诱导时的反应。100 名年龄在 2-10 岁之间、ASA 身体状况为 1 级和 2 级、计划接受全身麻醉的患者参加了试验。使用改良的耶鲁术前焦虑量表简表（mYPAS-SF）对预兆行为进行评估。D 组患者鼻内注射右美托咪定 1 毫克/千克，K 组患者鼻内注射氯胺酮 5 毫克/千克。45 分钟后，患者被转移到手术台，在手术台上进行静脉插管，并使用 FLACC 量表评估患者对针头插入的反应。监测生命体征，包括心率、呼吸频率和血氧水平。结果 D 组的 FLACC 评分明显高于 K 组（P=.001）。结论5毫克/千克剂量的氯胺酮与1微克/千克剂量的右美托咪定相比，用于2-10岁儿童的临床预处理更有效。

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引用次数: 0

Estudio comparativo entre el bloqueo costoclavicular con inyección simple (con técnica corner pocket) y con doble inyección: ensayo aleatorizado de no inferioridad y de brazos paralelos 肋锁关节阻断单次注射（角袋技术）与双次注射的比较研究：随机非劣效性平行臂试验。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.08.008

Background

Previous studies have shown that ultrasound-guided costoclavicular block may require a double shot to provide adequate, rapid sensory and motor blockade. In this trial, we hypothesized that if the corner pocket approach (between the axillary artery and median cord) is used instead of the central approach (at the midpoint of the 3 cords) when performing single-shot costoclavicular block, the onset of blockade would be non-inferior to the double-shot technique.

Method

Ninety patients undergoing upper limb surgery were randomized to 2 groups for ultrasound-guided costoclavicular block (CCB) at a tertiary hospital. One group received ultrasound guided single-shot CCB using the corner pocket approach and other received ultrasound guided double-shot – the first shot at the centre of the 3 cords and the second between the axillary artery and the median cord. An observer blinded to group assignment recorded blockade onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points).

Results

Of the 101 patients assessed for eligibility, 90 were recruited over 1 year (February 2022 to January 2023), with 45 in each group. Onset time was 22.1±3.1 min in the single-shot group and 22.4±2.9 min in the double-shot group. This difference was insignificant (p=0.3).

Conclusion

Time to onset of blockade and full anaesthesia are similar in single-shot corner pocket CCB and double-shot CCB. Further studies are required to determine the minimum effective volume of local anaesthetic required for the described technique.

背景以前的研究表明，超声引导下的肋锁阻滞可能需要双针才能提供充分、快速的感觉和运动阻滞。在本试验中，我们假设在进行单次肋锁关节阻滞时，如果使用角袋方法（腋动脉和正中脊髓之间）而不是中央方法（三条脊髓的中点），阻滞的开始时间将不会劣于双针技术。方法在一家三甲医院接受上肢手术的 90 名患者被随机分为两组，接受超声引导下的肋锁关节阻滞（CCB）。一组在超声引导下使用角袋法进行单次阻滞，另一组在超声引导下进行双次阻滞--第一次阻滞在三条脊索的中心，第二次阻滞在腋动脉和正中脊索之间。结果在101名通过资格评估的患者中，有90人在一年内（2022年2月至2023年1月）被招募，每组45人。单发组的发病时间为 22.1±3.1 分钟，双发组为 22.4±2.9 分钟。结论单发角袋CCB和双发CCB的阻滞起始时间和完全麻醉时间相似。需要进一步研究以确定所述技术所需的最小有效局麻药量。

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引用次数: 0

Modelos de aprendizaje automático basados en ecografía y exploración física para la evaluación de la vía aérea 基于超声波和体格检查的气道评估机器学习模型

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.12.002

Purpose

To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters.

Methods

This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values.

Results

We recruited 400 patients. Cormack-Lehanne patients ≥ III had higher age, BMI, cervical circumference, Mallampati class membership ≥ III, and bite test ≥ II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the «Classic Model» achieved the highest AUC-ROC value among all the models [0.75 (0.67-0.83)], this difference being statistically significant compared to the rest of the ultrasound models.

Conclusions

The use of machine learning models for diagnosing difficult airways is a real possibility, although it is still in a very preliminary stage of development.

Clinical Registry

ClinicalTrials.gov: NCT04816435.

目的展示机器学习模型在利用临床和超声参数预测困难气道方面的实用性。方法这是一个前瞻性非连续性队列，对象是接受择期手术的患者。我们收集了年龄、性别、体重指数、OSA、Mallampatti、甲状腺距离、咬合试验、宫颈周径、宫颈超声测量值和喉镜检查后的 Cormack-Lehanne 分级作为预测变量。我们对预测变量与 Cormack-Lehanne 分级的关系进行了单变量分析，并对每个预测变量分别和组合应用随机森林技术设计了机器学习模型。我们发现了每种设计的 AUC-ROC、灵敏度、特异性以及阳性和阴性预测值。Cormack-Lehanne≥Ⅲ级患者的年龄、体重指数、宫颈周径、Mallampati分级≥Ⅲ级和咬合试验≥Ⅱ级均较高，其超声测量值也明显较高。基于体格检查的机器学习模型获得的 AUC-ROC 值优于超声测量值，但未达到统计学意义。我们称之为 "经典模型 "的物理变量组合在所有模型中获得了最高的 AUC-ROC 值 [0.75 (0.67-0.83)]，与其他超声模型相比，这一差异具有统计学意义：NCT04816435。

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引用次数: 0

Protocolo de un ensayo clínico sobre la efectividad del bloqueo del nervio pudendo con y sin neuroestimulación para la disminución del dolor posthemorroidectomía 有无神经刺激的阴部神经阻滞术对减轻肿瘤切除术后疼痛的有效性临床试验方案。

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.11.009

A. Soto Sánchez , O. Cano Valderrama , I. Vilela Ferrer , N. Díaz Jiménez , M. Hernández Barroso , P.L. Bravo García , G. Hernández Hernández , J.J. Balanzá

Introduction

Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation.

Methods

The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected.

Results

Not avaliable until the end of the study.

Conclusions

The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.

导言痔疮是最常见的肛肠病，发病率占成年人口的 44%。最有效的治疗方法是手术，但术后疼痛率也最高，在最初的 24-48 小时内，中度至重度疼痛率为 30-40%。因此，必须采取措施改善这种情况，例如使用局麻药进行阴部神经阻滞。然而，阴部神经的多变性有时会导致阻滞效果不佳，因此需要寻求神经定位方法来提高成功率。本研究的主要目的是比较痔切除术后（24 小时），在解剖参照物引导下和神经刺激引导下进行阴股神经阻滞的患者术后即刻的疼痛情况。方法本项目拟在常规临床实践条件下进行单中心、三盲、随机临床疗效试验。试验对象包括西班牙一家三级医院的 18 岁以上痔疮患者，这些患者均为药物治疗难治性痔疮、无症状的 III-IV 级和 II 级痔疮患者，这些患者对保守治疗无效，并且是大型门诊手术的手术补助对象。将收集人口统计学变量、痔疮病理学变量、手术细节、术前口头数字疼痛量表和手术并发症。结果直到研究结束前都无法提供。结论尽管神经刺激器的使用尚未得到充分研究，但在解剖标志引导下进行的阴部神经阻滞已被证明有助于痔切除术后的疼痛控制，我们相信它可能会改善效果。

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引用次数: 0

Bloqueo del ganglio impar para el dolor crónico relacionado con el cáncer: revisión de la literatura actual 神经节阻滞治疗慢性癌症相关疼痛：现有文献综述

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2024.01.004

J. Oliveira , G. Bem , A. Agrelo

Oncologic chronic pain is often difficult to control, especially in anatomical areas with multiple and complex innervation, such as the pelvic/perineal region. The ganglion impar block (GIB) is a procedure with growing interest and varied applicability. It has been used in several benign and malignant causes of pelvic and perineal pain refractory to pharmacological treatment. We conducted a review of all articles published in PUBMED® until the 30th of October 2022 regarding GIB in oncologic pain. 19 articles were identified with a total of 278 patients. Both chronic cancer pain and chronic postcancer treatment pain patients were included. We reviewed the various techniques, approaches, and therapeutic options that were employed. No serious adverse effects were reported. GIB appears to be an effective and safe procedure that should be considered in patients with intractable perineal cancer-related pain.

肿瘤慢性疼痛往往难以控制，尤其是在具有多处复杂神经支配的解剖区域，如骨盆/会阴区域。神经节阻滞（GIB）是一种日益受到关注且适用性广泛的手术。它已被用于多种良性和恶性盆腔和会阴疼痛的药物治疗。我们对截至 2022 年 10 月 30 日在 PUBMED® 上发表的所有有关肿瘤疼痛 GIB 的文章进行了回顾。共发现 19 篇文章，涉及 278 名患者。其中包括慢性癌症疼痛和慢性癌症治疗后疼痛患者。我们回顾了所采用的各种技术、方法和治疗方案。没有严重不良反应的报道。GIB 似乎是一种有效且安全的治疗方法，患有顽固性会阴癌相关疼痛的患者应考虑使用。

引用次数: 0

Factores de riesgo para PPC en cirugía abdominal laparoscópica no robótica frente a la laparoscópica robótica (LapRas): Razonamiento y protocolo mediante un análisis a nivel de paciente de LAS VEGAS y AVATaR 非机器人腹腔镜与机器人腹腔镜腹部手术（LapRas）中CLP的风险因素：利用 LAS VEGAS 和 AVATaR 进行的患者层面分析得出的理由和方案

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2024.01.008

Introduction

Postoperative pulmonary complications (PPC) vary in different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non-robotic versus laparoscopic robotic abdominal surgery.

Methods and analysis

LapRas (Risk Factors for PPCs in Laparoscopic Non-Robotic vs Laparoscopic Robotic Abdominal Surgery) analyses harmonized data from two observational studies on abdominal surgery patients and PPCs: Local ASsessment of VEntilatory management during General Anaesthesia for Surgery (LAS VEGAS), and Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR). The primary endpoint is the occurrence of one or more PPC within the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay, and in-hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the groups are driven by differences in duration of anaesthesia and/or the intensity of mechanical ventilation.

Ethics and dissemination

This analysis will address a clinically relevant research question by comparing laparoscopic and robotic surgery. No additional ethical committee approval is required for this meta-analysis. Data will be shared with the scientific community in the form of abstracts and original articles submitted to peer-reviewed journals.

Registration

The registration of this post-hoc analysis is pending; individual studies that were merged into the study database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.

导言术后肺部并发症（PPC）在不同的手术技术中有所不同。我们旨在比较腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术后肺部并发症的发生率。方法和分析LapRas（腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术中肺部并发症的风险因素）分析了两项腹部手术患者和肺部并发症观察性研究的统一数据：LAS VEGAS）和机器人手术全身麻醉期间通气评估（AVATaR）。主要终点是术后前五天内发生一种或多种 PPC。次要终点包括每种 PPC 的发生率、住院时间和院内死亡率。我们将使用逻辑回归模型来确定腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术发生 PPC 的风险因素。我们将研究麻醉持续时间和/或机械通气强度的不同是否会导致两组间PPCs发生率的差异。伦理与传播这项分析将通过比较腹腔镜手术和机器人手术来解决临床相关的研究问题。这项荟萃分析无需获得伦理委员会的额外批准。数据将以摘要和原创文章的形式提交给同行评审期刊，与科学界共享。注册这项事后分析的注册工作尚未完成；合并到研究数据库中的单项研究已在 clinicaltrials.gov 注册：LAS VEGAS的标识符为NCT01601223，AVATaR的标识符为NCT02989415。

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引用次数: 0

Abordaje transcava para inserción de endoprótesis aórtica. Un nuevo reto anestésico 经腔途径植入主动脉内假体。新的麻醉挑战

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.09.006

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach.

The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence.

We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

与传统的开腹手术治疗相比，近年来血管内治疗技术的巨大进步使急性主动脉综合征的治疗受益匪浅。然而，血管内治疗要取得成功，患者必须有足够的血管通路。那些血管解剖结构不佳的病例必须考虑进行开腹手术，而开腹手术的发病率很高，甚至需要拒绝手术。最近，腹主动脉的一种新方法被描述为这些不可能有其他血管通路且绝对或相对不适合经胸方法的患者的一种适应症。主动脉综合征的麻醉处理方法众所周知，尽管有多种选择，但所有这些方法的安全性和有效性都已得到证实。我们介绍了西班牙首例经腔主动脉内假体植入术、其麻醉影响以及文献综述。

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引用次数: 0

Uso de cannabinoides en el dolor agudo posoperatorio 使用大麻素治疗急性术后疼痛

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.11.004

Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases. The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain.

The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions. Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.

至少从 Google Scholar、Clinical Trials、PubMed 和 Cochrane 数据库中收集的信息来看，对药用大麻治疗急性术后疼痛疗效的怀疑是有道理的。将大麻和大麻素混为一谈不仅会产生规范性影响，还会产生医学影响。尽管大麻素在治疗各种病症方面已显示出其疗效，但在急性术后疼痛方面尚未显示出这种疗效。有关这一主题的研究成果不断涌现，确实在这方面带来了一点希望；然而，所采用的多种方法学方法模糊了得出明确结论的前景。考虑到这一问题的现状，本文不会对含有大麻素化合物的药物在急性术后疼痛治疗中的作用发表明确的赞成或反对意见。

引用次数: 0

Fracaso de la extubación: obstrucción de la vía aérea superior por chicle. Informe de un caso 拔管失败：口香糖导致上气道阻塞。病例报告

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.11.001

Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.

拔管失败可能由不同的并发症导致，其中大部分在文献中都有详细描述，如喉水肿。异物阻塞气道是一种不太常见的意外并发症，其检测对医护人员来说仍是一项挑战。在本病例报告中，我们描述了一名因机动车事故被送入重症监护室的患者，由于误诊为上气道异物阻塞，导致拔管失败并进行了气管造口术。因此，在对这些患者进行医学影像和临床评估时，应考虑对异物进行筛查。最后，充气罩囊漏气试验、超声波检查和视频喉镜检查可作为识别可疑异物的重要辅助手段。

引用次数: 0

Aneurisma del seno de Valsalva causante de cierre espontáneo de defecto del tabique ventricular congénito 瓦尔萨尔瓦窦动脉瘤导致先天性室间隔缺损自发闭合

IF 0.9 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redar.2023.03.009

引用次数: 0

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