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Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists? 所有接受非心脏手术的肺动脉高压患者都应该由受过心胸奖学金培训的麻醉师管理吗?
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-19 DOI: 10.1177/10892532231203128
Meena Bhatia, Christopher J Scheiber, Simrat Arora, Chelsea Gustafson, Ian Funk, Craig Grosshuesch, Carter Simmers, Quefeng Li, Yutong Liu, Alan M Smeltz

Objectives: To identify differences in practice patterns and outcomes related to the induction of general anesthesia for patients with pulmonary hypertension (PH) performed by anesthesiologists who have completed a cardiothoracic fellowship (CTA group) vs those who have not (non-CTA group).

Design: Retrospective study with propensity score matching.

Setting: Operating room.

Participants: All adult patients with PH undergoing general anesthesia requiring intubation at a single academic center over 5 years.

Interventions: Patient baseline characteristics, peri-induction management variables, post-induction mean arterial pressure (MAP), and other outcomes were compared between CTA and non-CTA groups.

Methods and main results: Following propensity scoring matching, 402 patients were included in the final model, 100 in the CTA group and 302 in the non-CTA group. Also following matching, only cases of mild to moderate PH without right ventricular dysfunction remained in the analysis. Matched groups were overall statistically similar with respect to baseline characteristics; however, there was a greater incidence of higher ASA class (P = .025) and cardiology and thoracic procedures (P < .001) being managed by the CTA group. No statistical differences were identified in practice patterns or outcomes related to the induction of anesthesia between groups, except for longer hospital length of stay in the CTA group (P = .008).

Conclusions: These results provide early evidence to suggest the induction of general anesthesia of patients with non-severe PH disease can be comparably managed by either anesthesiologists with or without a cardiothoracic fellowship. However, these findings should be confirmed in a prospective study.

目的:确定已完成心胸造影研究(CTA组)的麻醉师与未完成的(非CTA组的)麻醉师对肺动脉高压(PH)患者进行全麻诱导的实践模式和结果的差异。设计:倾向评分匹配的回顾性研究。设置:手术室。参与者:所有在单一学术中心接受全麻并需要插管5年以上的PH成年患者。干预措施:比较CTA组和非CTA组的患者基线特征、诱导期管理变量、诱导后平均动脉压(MAP)和其他结果。方法和主要结果:在倾向评分匹配后,402名患者被纳入最终模型,100名被纳入CTA组,302名被纳入非CTA组。同样在匹配后,只有轻度至中度PH且无右心室功能障碍的病例仍保留在分析中。匹配组在基线特征方面总体上具有统计学相似性;然而,CTA组管理的ASA等级较高(P=.025)和心脏病学和胸部手术(P<.001)的发生率更高。在与组间麻醉诱导相关的实践模式或结果方面没有发现统计学差异,除了CTA组住院时间更长(P=0.008)。结论:这些结果提供了早期证据,表明有或没有心胸研究的麻醉师可以对非严重PH疾病患者进行全身麻醉诱导。然而,这些发现应该在前瞻性研究中得到证实。
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引用次数: 1
Pressure-Volume Loops for Reviewing Right Ventricular Physiology and Failure in the Context of Left Ventricular Assist Device Implantation. 在左心室辅助装置植入的背景下,压力-容量循环对右室生理和衰竭的回顾。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-01 DOI: 10.1177/10892532231198797
Stefaan Bouchez, Joachim Erb, Luc Foubert, Eckhard Mauermann

Right ventricular (RV) function is complex as a number of determinants beyond preload, inotropy and afterload play a fundamental role. In particular, arterial elastance (Ea), ventriculo-arterial coupling (VAC), and (systolic) ventricular interdependence play a vital role for the right ventricle. Understanding and actively visualizing these interactions in the failing RV as well as in the altered hemodynamic and morphological situation of left ventricular assist device (LVAD) implantation may aid clinicians in their understanding of RV dysfunction and failure. While, admittedly, hard data is scarce and invasive pressure-volume loop measurements will not become routine in cardiac surgery, we hope that clinicians will benefit from the comprehensive, simulation-based review of RV pathology. In particular, the aim of this article is to first, address and clarify the pathophysiologic hemodynamic factors that lead to RV dysfunction and then, second, expand upon this basis examining the changes occurring by LVAD implantation. This is illustrated using Harvi software which shows elastance, ventricular arterial coupling, and ventricular interdependence by simultaneously showing pressure volume loops of the right and left ventricle.

右心室(RV)的功能是复杂的,许多决定因素超出了前负荷,肌力和后负荷发挥基本作用。特别是,动脉弹性(Ea)、心室-动脉耦合(VAC)和(收缩)心室相互依赖对右心室起着至关重要的作用。了解和积极观察这些相互作用在衰竭的左心室以及左心室辅助装置(LVAD)植入后血流动力学和形态学的改变可能有助于临床医生理解左心室功能障碍和衰竭。然而,不可否认的是,硬数据很少,有创压力-容量环路测量不会成为心脏手术的常规方法,我们希望临床医生能从全面的、基于模拟的右心室病理回顾中受益。特别是,本文的目的是首先解决和澄清导致左室功能障碍的病理生理血流动力学因素,然后,在此基础上进一步探讨左室辅助装置植入后发生的变化。通过同时显示左、右心室的压力容积循环,哈维软件显示了弹性、心室动脉耦合和心室相互依赖。
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引用次数: 1
Surgical Considerations in Shone Complex. Shone复合体的手术注意事项。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-26 DOI: 10.1177/10892532231203372
Roderick Yang, Christina L Greene

Shone complex is defined by 4 anomalies: parachute mitral valve, supravalvar mitral ring, subaortic stenosis, and coarctation of the aorta. Establishing a clear definition is one of the principal challenges in the study of Shone complex as not all patients have all lesions. The essential feature of Shone complex is multilevel left-sided obstruction involving both the left ventricular inflow and outflow. This anatomic variability is reflected in the clinical presentation as signs of left ventricular inflow obstruction are often masked by outflow obstruction and the multilevel nature of the condition is thus underappreciated. Surgical treatment is often stepwise addressing the outflow obstruction first. In this review, geared to the pediatric cardiac anesthesiologist, we review the pathophysiology, diagnosis, treatment, and outcomes of Shone complex.

Shone复合体由4种异常定义:降落伞二尖瓣、瓣上二尖瓣环、主动脉瓣下狭窄和主动脉缩窄。建立一个明确的定义是研究Shone复合体的主要挑战之一,因为并非所有患者都有所有病变。Shone复合体的基本特征是多水平的左侧梗阻,包括左心室流入和流出。这种解剖变异性反映在临床表现中,因为左心室流入梗阻的迹象往往被流出梗阻所掩盖,因此对这种情况的多层次性认识不足。外科治疗通常是先逐步解决流出道阻塞。在这篇针对儿科心脏麻醉师的综述中,我们回顾了Shone综合征的病理生理学、诊断、治疗和结果。
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引用次数: 1
Preoperative Sildenafil in Pediatric Patients Undergoing Congenital Heart Surgeries: A Systematic Review and Meta-Analysis. 接受先天性心脏外科手术的儿童患者术前西地那非:系统回顾和荟萃分析。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-10-16 DOI: 10.1177/10892532231205752
Yusuf Ananda Fikri, Eka Prasetya Budi Mulia, Faris Wahyu Nugroho

Background. Pulmonary hypertension (PH) is a common complication of congenital heart disease (CHD). With early surgical intervention, outcomes have improved over the last two decades. Persistent PH, however, may still occur following surgery. Sildenafil has been shown to be beneficial for postoperative pulmonary hypertensive crises. The role of preoperative sildenafil in controlling postoperative PH is poorly elucidated. This study aimed to evaluate the effect of preoperative sildenafil on pediatric patients undergoing congenital heart surgeries. Methods. A comprehensive literature search was conducted in scientific databases. We included randomized controlled trials which assessed the effect of preoperative sildenafil in pediatric patients with CHD undergoing repair surgeries. Primary outcomes were pre- and postoperative differences in mean pulmonary arterial pressure (mPAP) and mean pulmonary artery/aortic pressure ratio (PA/Ao ratio). Results. Four studies (n = 233) were retained for the final analysis. Dose of sildenafil ranged from .3 to .5 mg/kg every 4-6 hours via oral/nasogastric route, with timing of administration varied from 1 to 2 weeks before surgery. Compared to controls, preoperative sildenafil was associated with greater reduction in postoperative mPAP (MD -5.02; 95% CI [-8.91, -1.13]) and mean PA/Ao ratio (MD -.11; 95% CI [-.17, -.06]). Shorter CPB time, ICU length of stay, and duration of mechanical ventilation were also observed in the sildenafil group. Conclusion. Preoperative sildenafil is beneficial in reducing PAP, thereby reducing the risk of postoperative PH crisis. Further studies are warranted to identify the optimal dosage and timing of administration of sildenafil in CHD patients prior to surgery.

背景肺动脉高压(PH)是先天性心脏病(CHD)的常见并发症。通过早期手术干预,在过去的二十年里,结果有所改善。然而,手术后仍可能出现持续性PH。西地那非已被证明对术后肺动脉高压危象有益。术前西地那非在控制术后PH中的作用尚不清楚。本研究旨在评估术前西地那非对接受先天性心脏手术的儿童患者的影响。方法。在科学数据库中进行了全面的文献检索。我们纳入了随机对照试验,评估了术前西地那非对接受修复手术的儿童冠心病患者的影响。主要结果是术前和术后平均肺动脉压(mPAP)和平均肺动脉/主动脉压比(PA/Ao比)的差异。后果保留了四项研究(n=233)进行最终分析。西地那非的剂量范围为每4-6小时0.3至0.5 mg/kg,通过口服/鼻胃途径,给药时间为手术前1至2周。与对照组相比,术前西地那非与术后mPAP(MD-5.02;95%CI[8.91,-1.13])和平均PA/Ao比率(MD-1.11;95%CI[-.17,-.06])的降低有关。西地那非组的CPB时间、ICU住院时间和机械通气持续时间也较短。结论术前西地那非有利于降低PAP,从而降低术后PH危象的风险。需要进一步的研究来确定CHD患者在手术前给予西地那非的最佳剂量和时间。
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引用次数: 1
Tracheal Bronchus and Successful Right-Sided Isolation With a Bronchial Blocker. 气管支气管和成功的右侧支气管阻断隔离。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-01-10 DOI: 10.1177/10892532231151461
Jonathan E Tang, Caroline E Tybout, Lidia M Csernak, Hamdy Awad, Pamela P Benavidez, Michael K Essandoh

The presence of a tracheal bronchus, which is often incidentally discovered, complicates endotracheal intubation and lung isolation during thoracic surgery. Prior reports of successful right-sided lung isolation in the presence of tracheal bronchus required utilization of a double lumen tube. Although right-sided lung isolation was required in our case, due to other patient factors, it was determined that a double lumen tube of a suitable size would be unlikely to be placed safely and successfully. We describe the successful use of a Rüsch EZ-Blocker bronchial blocker in obtaining right-sided isolation in a patient with a difficult airway and tracheal bronchus.

气管支气管的存在,通常是偶然发现的,使胸部手术中的气管插管和肺部隔离变得复杂。先前关于在存在气管支气管的情况下成功分离右侧肺的报道需要使用双腔管。尽管在我们的病例中需要右侧肺隔离,但由于其他患者因素,已确定不太可能安全成功地放置合适尺寸的双腔管。我们描述了在气道和气管支气管困难的患者中成功使用Rüsch EZ阻断剂支气管阻断剂获得右侧隔离。
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引用次数: 1
Perioperative Point of Care Ultrasound for Hemodynamic Assessment: A Narrative Review. 围手术期护理点超声血流动力学评估:叙述性综述。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-03-21 DOI: 10.1177/10892532231165088
Caitlin A Bradley, Chris Ma, McKenzie M Hollon

While transesophageal echocardiography (TEE) has traditionally been used in perioperative care, there is growing evidence supporting point of care ultrasound (POCUS) for the anesthesiologist in guiding patient care. It is a quick way to non-invasively evaluate hemodynamically unstable patients and ascertain their state of shock, determine volume status, and guide resuscitation in cardiac arrest. In addition, through use of POCUS, the anesthesiologist is able to identify signs of chronic heart disease to provide a more tailored and safer approach to perioperative care.

虽然经食道超声心动图(TEE)传统上用于围手术期护理,但越来越多的证据支持麻醉师在指导患者护理方面的护理点超声(POCUS)。这是一种非侵入性评估血液动力学不稳定患者、确定其休克状态、确定容量状态和指导心脏骤停复苏的快速方法。此外,通过使用POCUS,麻醉师能够识别慢性心脏病的迹象,为围手术期护理提供更具针对性和更安全的方法。
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引用次数: 3
Endobronchial Intubation With the King Vision® and McGrath® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath). 新手在模拟简易和困难航空中使用King Vision®和McGrath®喉镜进行支气管内插管(eKingMath)。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-03-22 DOI: 10.1177/10892532231163963
Alaa M Khidr, Jumana Masoudi, Sarah AlAboud, Mashael Alshahrani, Aziza Bokhari, Massimiliano Sorbello, Ivana Zdravkovic, Mohamed A Khalil, Saeed Al Shadowy, Talal Al Ghamdi, Abdulmohsen Al'ghamdi, Summayah Fallatah, Mohamed R El Tahan

Objective. The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial intubations can be improved with constant training as assessed by measuring the learning curves. We hypothesized that the time to DLT intubation would be reduced over the intubation attempts. Design. A crossover manikin study. Settings. University-affiliated hospital. Participants. Forty-two novice medical students unfamiliar with DLT intubation. Interventions. Participants were randomly allocated to two sequences, including DLT intubation, using King Vision and McGrath VLs. Each participant completed 100 DLT intubation attempts on both simulated easy and difficult airways on two different mannikins using the study devices (25 attempts for each). Measurements and Main Results. The primary outcome was the time to DLT intubation. The secondary outcomes included the best glottic view, optimizing maneuvers, and intubation first-pass success. The use of King Vision VL was associated with a significantly shorter time to DLT intubation (P < 0.044 and P < 0.05, respectively) and a higher percentage of glottic opening (POGO) compared to the McGrath VL (P < 0.011 and P < 0.002, respectively) in the simulated "easy" and "difficult" over most of the intubation attempts. In the simulated "easy" airway, the first-pass success ratio was higher when using the King Vision VL (median [Minimum-Maximum] 100% [100%-100%] and 100% [88%-100%], P = 0.012). Conclusion. Novice medical students developed skills over intubation attempts, meaning achievement of a faster DLT intubation, better laryngeal exposure, and higher success rate on simulated "easy" and "difficult" airways. A median of 9 DLT intubations was required to achieve a 92% or greater DLT intubation success rate.

客观的使用视频喉镜(VL)进行双腔管(DLT)支气管内插管的能力可以通过测量学习曲线来评估的持续训练来提高。我们假设DLT插管的时间会随着插管次数的增加而缩短。设计交叉人体模型研究。设置。大学附属医院。参与者。四十二名不熟悉DLT插管的医学新手。干预措施。参与者被随机分配到两个序列,包括DLT插管,使用King Vision和McGrath VLs。每个参与者使用研究设备在两个不同的人体模型上完成了100次模拟易气道和难气道的DLT插管尝试(每次25次)。测量和主要结果。主要结果是DLT插管时间。次要结果包括最佳声门视野、优化操作和插管首次通过成功。在大多数插管尝试中,与McGrath VL(分别为P<0.011和P<0.002)相比,King Vision VL的使用与DLT插管时间显著缩短(分别为P<0.044和P<0.05)和声门开放率(POGO)更高有关。在模拟的“易”气道中,使用King Vision VL时,首次通过成功率更高(中位数[最小-最大值]100%[100%-100%]和100%[88%-100%],P=0.012)。结论。初学医的学生在插管尝试中培养了技能,这意味着实现了更快的DLT插管,更好的喉部暴露,以及更高的模拟“容易”和“困难”气道的成功率。平均需要9次DLT插管才能实现92%或更高的DLT插管成功率。
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引用次数: 1
Native Whole Blood (TRUE-NATEM) and Recalcified Citrated Blood (NATEM) Reference Value Validation with ROTEM Delta. 用ROTEM-Delta验证天然全血(TRUE-NATEM)和再钙化柠檬酸血(NATEM)参考值。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-01-11 DOI: 10.1177/10892532231151528
Uzung Yoon

Background: Thromboelastography is a viscoelastic test of whole blood hemostasis. Currently, no reference value exists for native whole blood and recalcified citrated blood without activators. The aim of this study was to compare the results of ROTEM® tests using fresh native blood without decalcification "TRUE-NATEM" with those using decalcified citrated blood "NATEM" and provide reference values for each. Methods: Inclusion criteria were healthy adult volunteers (18-65 years). Exclusion criteria were any medical condition or medication affecting coagulation. Native whole blood testing was defined as "TRUE-NATEM-test." For recalcified citrated blood testing, the NATEM function was used on ROTEM®. Result: The reference value for TRUE-NATEM was CT: 872-1595s, A10: 14-34 mm, A20: 26-48 mm, CFT: 314-839s, MCF: 34-55 mm, and alpha angle: 17-40°. The reference value for NATEM was CT: 757-1327s, A10: 19-43 mm, A20: 33-55 mm, CFT: 219-615s, MCF: 37-61 mm, alpha angle: 24-51°, and ML: 0-3%. When comparing the reference value of NATEM to TRUE-NATEM, the CT and CFT values are decreased and the MCF and alpha angle are increased. The recalcification process of citrated blood in NATEM shows significant activation of coagulation. Female healthy volunteers had enhanced coagulation when activators were used. Age-related statistical difference was seen when activators were used. Ethnicity did not show any difference on the ROTEM values. Conclusion: We determined the reference value for native whole blood and recalcified whole blood using ROTEM®. A significant discrepancy in native whole blood and recalcified citrated blood coagulation was found. Our study underlines the importance of native whole blood as the gold standard reference value in coagulation.

背景:血栓弹性成像是一种全血止血的粘弹性测试。目前,不含激活剂的天然全血和难钙化柠檬酸血没有参考价值。本研究的目的是比较使用未脱钙的新鲜天然血液“TRUE-NATEM”和使用脱钙柠檬酸血液“NATEM”的ROTEM®测试结果,并为每种测试提供参考值。方法:纳入标准为健康成年志愿者(18-65岁)。排除标准为任何影响凝血的疾病或药物。天然全血检测被定义为“真正的NATEM检测”。对于顽固的柠檬酸盐血液检测,在ROTEM®上使用NATEM功能。结果:TRUE-NATEM的参考值为CT:872-1595s,A10:14-34mm,A20:26-48mm,CFT:314-839s,MCF:34-55mm,α角:17-40°。NATEM的参考值为CT:757-1327s,A10:19-43mm,A20:33-55mm,CFT:219-615s,MCF:37-61mm,α角:24-51°,ML:0-3%。当将NATEM的参考值与TRUE-NATEM进行比较时,CT和CFT值减小,MCF和α角增大。柠檬酸血在NATEM中的再钙化过程显示出显著的凝血激活。当使用激活剂时,女性健康志愿者的凝血功能增强。当使用激活剂时,发现了与年龄相关的统计差异。种族对ROTEM值没有任何差异。结论:我们使用ROTEM®确定了天然全血和难钙化全血的参考值。发现天然全血和难钙化的柠檬酸盐凝血存在显著差异。我们的研究强调了天然全血作为凝血黄金标准参考值的重要性。
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引用次数: 1
Refractory Hypotension During Implantation of a 70 mL Total Artificial Heart in a Patient With Pectus Excavatum: A Case Report. 一例挖掘胸肌患者植入70mL全人工心脏期间的顽固性低血压:一例报告。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-02-20 DOI: 10.1177/10892532231157529
Brendon Hart, Nahush A Mokadam, Karina Anam, Samiya Saklayen, Galina Dimitrova, Alix Zuleta-Alarcon, Jordan Holloway, Hamdy Awad, David Convissar, Michael Essandoh

The Syncardia total artificial heart system is the only commercially approved durable device for treating biventricular heart failure patients awaiting heart transplantation. Conventionally, the Syncardia total artificial heart system is implanted based on the distance from the anterior aspect of the 10th thoracic vertebra to the sternum and the patient's body surface area. However, this criterion does not account for chest wall musculoskeletal deformities. This case report describes a patient with a pectus excavatum who developed compression of the inferior vena cava after Syncardia total artificial heart implantation and how transesophageal echocardiography guided chest wall surgery to accommodate the total artificial heart system.

Syncardia全人工心脏系统是唯一一种商业批准的耐用设备,用于治疗等待心脏移植的双心室心力衰竭患者。传统上,根据从第10胸椎的前部到胸骨的距离和患者的体表面积来植入Syncardia全人工心脏系统。然而,这一标准并不适用于胸壁肌肉骨骼畸形。本病例报告描述了一名患有漏斗胸的患者,他在Syncardia全人工心脏植入术后出现下腔静脉压迫,以及经食道超声心动图如何指导胸壁手术以适应全人工心脏系统。
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引用次数: 1
Embracing Scrutiny: The Importance of Critical Evaluation and Transparency in Research. 接受审查:研究中批判性评价和透明度的重要性。
IF 1.4 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-14 DOI: 10.1177/10892532231189788
Ross S Hanson, Ollin G Venegas, Lindsey A Alverson, Benjamin A Abrams, Miklos D Kertai
In its 1952 second annual report, the fledgling National Science Foundation framed the process of technological innovation as a “sequence [consisting] of basic research, applied research, and development... each of the successive stages [depending] upon the preceding.” Medical advancement has proven no exception to this, and the relationship between basic science, applied research, and clinical development underpins the modern framework of evidencebased medicine. As much as we may bias toward thinking of this sequence as linear, it is imperative that we also look at innovation critically and publish studies that detail what doesn’t work. This issue of Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) is true to this ethos and encompasses the entirety of this arc. We present both positive and negative Original Research spanning basic science in thromboelastographic testing, applied research in arterial line ultrasound and video laryngoscopy training, as well as clinical development of lung isolation devices and opioid sparing cardiothoracic anesthetic techniques. Rounding this out is an excellent review of perioperative point of care ultrasound (POCUS) for hemodynamic assessment and 2 case reports describing ingenuity in the face of the unexpected. Finally, we present a retraction of a previously published study to correct the evidence-based medical record as well as reflect on the risks inherent in stepping away from the process of innovation framed by the National Science Foundation so many years ago. In the first Original Research article, Mathew et al report the results of the first pairwise meta-analysis of clinical outcomes for opioid-free anesthesia (OFA) vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery. Including 919 patients across 8 studies, they found that OFA in cardiovascular surgery patients was associated with significantly reduced postoperative nausea and vomiting (PONV), inotrope need, and non-invasive ventilation while there was no observed difference in 24-hour pain scores, 48-hour morphine equivalent consumption, or length of hospital stay. Interestingly, these same trends were not observed in thoracic surgery patients, among whom there was no significant difference in any of the explored outcomes. In this first meta-analysis of OFA techniques specific to cardiothoracic surgical patients, the findings echo similar patterns of reduced PONV in the absence of increased pain scores across multiple surgical specialties. Taken together with literature demonstrating reductions in long-term opioid dependence and concurrent improvements in clinical outcomes and patient satisfaction with cardiac Enhanced Recovery After Surgery (ERAS), this study offers compelling support of OFA techniques within cardiothoracic-specific Enhanced Recovery After Surgery programs. While innovation is a constant driver of clinical care improvement and medical device development, not all novel techniques and t
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引用次数: 0
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Seminars in Cardiothoracic and Vascular Anesthesia
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