Pub Date : 2024-01-11DOI: 10.1016/j.accpm.2024.101343
Johan Schmitt , Marc Danguy des Déserts , Chloé Thill , Christophe Giacardi , Fabrice Entine
{"title":"The best way to prepare for such a CBRN conflict: Improving casualty management performance","authors":"Johan Schmitt , Marc Danguy des Déserts , Chloé Thill , Christophe Giacardi , Fabrice Entine","doi":"10.1016/j.accpm.2024.101343","DOIUrl":"10.1016/j.accpm.2024.101343","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101343"},"PeriodicalIF":5.5,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139422325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-22DOI: 10.1016/j.accpm.2023.101342
Iris J. de Heer, Hannah A.C. Raab, Stephan Krul, Gulhan Karaöz-Bulut, Robert-Jan Stolker, Frank Weber
Introduction
Propofol and sevoflurane have a long history in pediatric anesthesia. Combining both drugs at low dose levels offers new opportunities. However, monitoring the hypnotic effects of this drug combination in children is challenging, because the currently available processed EEG-based systems are insufficiently validated in young children and the co-administration of anesthetics. This study investigated electroencephalographic density spectral array monitoring during propofol/sevoflurane coadministration with fixed sevoflurane- and variable propofol dosages.
Patients and methods
We analyzed the density spectral array pattern recorded during propofol/sevoflurane anesthesia in pediatric patients from birth to 11 years of age. Data from 78 patients were suitable for analysis. The primary outcome parameter of this study was the correlation between variable propofol dosages and the expression of the four electroencephalogram frequency bands β, α, θ, and δ. The main secondary outcome parameters were the intra-operative total EEG power and the prevalence of burst suppression.
Results
In patients above the age of 1 year, a dose-dependent correlation between the propofol dosage and the relative percentage of β (−12.2%, p < 0.001) and δ (5.1%, p < 0.001) was found. There was an age-dependent trend toward increasing mean EEG power, with the most significant increase in the first year of life. In 14.1% of our patients, at least one episode of burst suppression occurred.
Conclusion
DSA-guided augmentation of propofol anesthesia with sevoflurane provides sufficient depth of anesthesia at doses usually considered sub-anesthetic in children, leading to less anesthetic drug exposure for the individual child.
{"title":"Electroencephalographic density spectral array monitoring during propofol/sevoflurane coadministration in children, an exploratory observational study","authors":"Iris J. de Heer, Hannah A.C. Raab, Stephan Krul, Gulhan Karaöz-Bulut, Robert-Jan Stolker, Frank Weber","doi":"10.1016/j.accpm.2023.101342","DOIUrl":"10.1016/j.accpm.2023.101342","url":null,"abstract":"<div><h3>Introduction</h3><p>Propofol and sevoflurane have a long history in pediatric anesthesia. Combining both drugs at low dose levels offers new opportunities. However, monitoring the hypnotic effects of this drug combination in children is challenging, because the currently available processed EEG-based systems are insufficiently validated in young children and the co-administration of anesthetics. This study investigated electroencephalographic density spectral array monitoring during propofol/sevoflurane coadministration with fixed sevoflurane- and variable propofol dosages.</p></div><div><h3>Patients and methods</h3><p>We analyzed the density spectral array pattern recorded during propofol/sevoflurane anesthesia in pediatric patients from birth to 11 years of age. Data from 78 patients were suitable for analysis. The primary outcome parameter of this study was the correlation between variable propofol dosages and the expression of the four electroencephalogram frequency bands β, α, θ, and δ. The main secondary outcome parameters were the intra-operative total EEG power and the prevalence of burst suppression.</p></div><div><h3>Results</h3><p>In patients above the age of 1 year, a dose-dependent correlation between the propofol dosage and the relative percentage of β (−12.2%, <em>p</em> < 0.001) and δ (5.1%, <em>p</em> < 0.001) was found. There was an age-dependent trend toward increasing mean EEG power, with the most significant increase in the first year of life. In 14.1% of our patients, at least one episode of burst suppression occurred.</p></div><div><h3>Conclusion</h3><p>DSA-guided augmentation of propofol anesthesia with sevoflurane provides sufficient depth of anesthesia at doses usually considered sub-anesthetic in children, leading to less anesthetic drug exposure for the individual child.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101342"},"PeriodicalIF":5.5,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352556823001509/pdfft?md5=2302834a75ebe95b8471cfe6aaa67eb2&pid=1-s2.0-S2352556823001509-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139028994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.1016/j.accpm.2023.101339
Andrzej Pruszczyk , Mateusz Zawadka , Pawel Andruszkiewicz , Luigi LaVia , Antoine Herpain , Ryota Sato , Siddharth Dugar , Michelle S. Chew , Filippo Sanfilippo
Background
Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders.
Methods
We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies.
Results
We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of −1.45%[−2.10, −0.80] (p < 0.0001;I2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31;I2 = 16%), severity of sepsis (p = 0.42;I2 = 0%), and sepsis criteria (p = 0.59;I2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02;I2 = 42%).
Conclusions
We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning.
{"title":"Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: An updated systematic review and meta-analysis with trial sequential analysis","authors":"Andrzej Pruszczyk , Mateusz Zawadka , Pawel Andruszkiewicz , Luigi LaVia , Antoine Herpain , Ryota Sato , Siddharth Dugar , Michelle S. Chew , Filippo Sanfilippo","doi":"10.1016/j.accpm.2023.101339","DOIUrl":"10.1016/j.accpm.2023.101339","url":null,"abstract":"<div><h3>Background</h3><p>Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders.</p></div><div><h3>Methods</h3><p>We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies.</p></div><div><h3>Results</h3><p>We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of −1.45%[−2.10, −0.80] (<em>p</em> < 0.0001;I<sup>2</sup> = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (<em>p</em> = 0.31;I<sup>2</sup> = 16%), severity of sepsis (<em>p</em> = 0.42;I<sup>2</sup> = 0%), and sepsis criteria (<em>p</em> = 0.59;I<sup>2</sup> = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; <em>p</em> = 0.02;I<sup>2</sup> = 42%).</p></div><div><h3>Conclusions</h3><p>We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning.</p></div><div><h3>Registration</h3><p>PROSPERO number CRD42023432354</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101339"},"PeriodicalIF":5.5,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352556823001479/pdfft?md5=1a1c87b516cb12662a2b08a0376701ed&pid=1-s2.0-S2352556823001479-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138821435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.1016/j.accpm.2023.101340
Benjamin Deniau , Aude Ricbourg , Emmanuel Weiss , Catherine Paugam-Burtz , Marie-Pierre Bonnet , François Goffinet , Alexandre Mignon , Olivier Morel , Morgan Le Guen , Marie Binczak , Marie Carbonnel , Daphné Michelet , Souhayl Dahmani , Sébastien Pili-Floury , Anne Sophie Ducloy Bouthors , Alexandre Mebazaa , Etienne Gayat
Objective
Post-partum hemorrhage (PPH) is the leading preventable cause of worldwide maternal morbidity and mortality. Risk factors for psychological disorders following PPH are currently unknown. HELP-MOM study aimed to determine the incidence and identify risk factors for psychological disorders following PPH.
Methods
HELP-MOM study was a prospective, observational, national, and multicentre study including patients who experienced severe PPH requiring sulprostone. The primary endpoint was the occurrence of psychological disorders (anxiety and/or post-traumatic disorder and/or depression) following PPH, assessed at 1, 3, and 6 months after delivery using HADS, IES-R, and EPDS scales.
Results
Between November 2014 and November 2016, 332 patients experienced a severe PPH and 236 (72%) answered self-questionnaires at 1, 3, and 6 months. A total of 161 (68%) patients declared a psychological disorder following severe PPH (146 (90.1%) were screened positive for anxiety, 96 (58.9%) were screened positive for post-traumatic stress disorder, and 94 (57.7%) were screened positive for post-partum depression). In multivariable analysis, the use of intra-uterine tamponnement balloon was associated with a lower risk to be screened positive for psychological disorder after severe PPH (OR = 0.33 [IC95% 0.15−0.69], p = 0.004, and after propensity score matching (OR=0.34 [IC95% 0.12−0.94], p = 0.04)). Low hemoglobin values during severe PPH management were associated with a higher risk of being screened positive for psychological disorders. Finally, we did not find differences in desire or pregnancy between patients without or with psychological disorders occurring in the year after severe PPH.
Discussion
Severe PPH was associated with significant psychosocial morbidity including anxiety, post-traumatic disorder, and depression. This should engage a psychological follow-up. Large cohorts are urgently needed to confirm our results.
{"title":"Association of severe postpartum hemorrhage and development of psychological disorders: Results from the prospective and multicentre HELP MOM study","authors":"Benjamin Deniau , Aude Ricbourg , Emmanuel Weiss , Catherine Paugam-Burtz , Marie-Pierre Bonnet , François Goffinet , Alexandre Mignon , Olivier Morel , Morgan Le Guen , Marie Binczak , Marie Carbonnel , Daphné Michelet , Souhayl Dahmani , Sébastien Pili-Floury , Anne Sophie Ducloy Bouthors , Alexandre Mebazaa , Etienne Gayat","doi":"10.1016/j.accpm.2023.101340","DOIUrl":"10.1016/j.accpm.2023.101340","url":null,"abstract":"<div><h3>Objective</h3><p>Post-partum hemorrhage (PPH) is the leading preventable cause of worldwide maternal morbidity and mortality. Risk factors for psychological disorders following PPH are currently unknown. HELP-MOM study aimed to determine the incidence and identify risk factors for psychological disorders following PPH.</p></div><div><h3>Methods</h3><p><span><span>HELP-MOM study was a prospective, observational, national, and multicentre study including patients who experienced severe PPH requiring sulprostone. The primary endpoint was the occurrence of psychological disorders (anxiety and/or post-traumatic disorder and/or depression) following PPH, assessed at 1, 3, and 6 months after delivery using </span>HADS, IES-R, and </span>EPDS scales.</p></div><div><h3>Results</h3><p>Between November 2014 and November 2016, 332 patients experienced a severe PPH and 236 (72%) answered self-questionnaires at 1, 3, and 6 months. A total of 161 (68%) patients declared a psychological disorder following severe PPH (146 (90.1%) were screened positive for anxiety, 96 (58.9%) were screened positive for post-traumatic stress disorder, and 94 (57.7%) were screened positive for post-partum depression). In multivariable analysis, the use of intra-uterine tamponnement balloon was associated with a lower risk to be screened positive for psychological disorder after severe PPH (OR = 0.33 [IC95% 0.15−0.69], <em>p</em><span> = 0.004, and after propensity score matching (OR=0.34 [IC95% 0.12−0.94], </span><em>p</em> = 0.04)). Low hemoglobin values during severe PPH management were associated with a higher risk of being screened positive for psychological disorders. Finally, we did not find differences in desire or pregnancy between patients without or with psychological disorders occurring in the year after severe PPH.</p></div><div><h3>Discussion</h3><p>Severe PPH was associated with significant psychosocial morbidity including anxiety, post-traumatic disorder, and depression. This should engage a psychological follow-up. Large cohorts are urgently needed to confirm our results.</p></div><div><h3>Registration</h3><p>ClinicalTrials.gov under number <span>NCT02118038</span><svg><path></path></svg>.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101340"},"PeriodicalIF":5.5,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138821315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.1016/j.accpm.2023.101338
Romaric Larcher , Agathe Boudet , Claire Roger , Fanny Villa , Paul Loubet
{"title":"Mycoplasma pneumoniae is back! Is it the next pandemic?","authors":"Romaric Larcher , Agathe Boudet , Claire Roger , Fanny Villa , Paul Loubet","doi":"10.1016/j.accpm.2023.101338","DOIUrl":"10.1016/j.accpm.2023.101338","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 1","pages":"Article 101338"},"PeriodicalIF":5.5,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-05DOI: 10.1016/j.accpm.2023.101336
Mirza Kovacevic , Visnja Nesek Adam , Senada Causevic
Background
To assess 28-day survival in two pilot groups of septic shock patients with euthyroid sick syndrome (ESS) supplemented with triiodothyronine (T3).
Methods
A total of 95 septic shock patients with ESS were divided according to values of the thyroid hormones into low T3 and low T3T4 groups. Among 48 patients with low T3, 24 (50%) were randomized to T3 for 4 days and 24 (50%) to placebo. Among 47 patients with low T3T4, 24 (51%) were randomized to T3 for 4 days and 23 (49%) to placebo. The analysis included 28-day survival as the primary outcome and laboratory with hemodynamics as the secondary outcomes. Laboratory data were analyzed on the day of admission (T0), on the first (T1), third (T2) and seventh day (T3) with hemodynamics analyzed for the first four days.
Results
In the low T3 population, 18 (75%) patients receiving T3 died at day 28 compared with 8 (33.3%) patients receiving placebo (p = 0.004). In the low T3T4 population, 6 (25%) patients receiving T3 died in ICU compared with 12 (52.1%) patients receiving placebo (p = 0.039). Oral T3 treatment increased mean arterial pressure values at day 1, day 3 and day 7 in the low T3T4 population, (p = 0.015, =0.005 and =0.042 respectively), and had no significant effect on these values in the low T3 population.
Conclusion
T3 supplementation was associated with a low 28-day mortality rate in patients with low T3T4 but with increased mortality in patients with low T3 ESS. These results suggest caution before initiating thyroid supplementation in septic patients.
{"title":"Triiodothyronine hormone supplementation therapy in septic shock patients with euthyroid sick syndrome: two pilot, placebo-controlled, randomized trials","authors":"Mirza Kovacevic , Visnja Nesek Adam , Senada Causevic","doi":"10.1016/j.accpm.2023.101336","DOIUrl":"10.1016/j.accpm.2023.101336","url":null,"abstract":"<div><h3>Background</h3><p>To assess 28-day survival in two pilot groups of septic shock patients with euthyroid sick syndrome (ESS) supplemented with triiodothyronine (T3).</p></div><div><h3>Methods</h3><p>A total of 95 septic shock patients with ESS were divided according to values of the thyroid hormones into low T3 and low T3T4 groups. Among 48 patients with low T3, 24 (50%) were randomized to T3 for 4 days and 24 (50%) to placebo. Among 47 patients with low T3T4, 24 (51%) were randomized to T3 for 4 days and 23 (49%) to placebo. The analysis included 28-day survival as the primary outcome and laboratory with hemodynamics as the secondary outcomes. Laboratory data were analyzed on the day of admission (T0), on the first (T1), third (T2) and seventh day (T3) with hemodynamics analyzed for the first four days.</p></div><div><h3>Results</h3><p>In the low T3 population, 18 (75%) patients receiving T3 died at day 28 compared with 8 (33.3%) patients receiving placebo (<em>p</em> = 0.004). In the low T3T4 population, 6 (25%) patients receiving T3 died in ICU compared with 12 (52.1%) patients receiving placebo (<em>p</em> = 0.039). Oral T3 treatment increased mean arterial pressure values at day 1, day 3 and day 7 in the low T3T4 population, (<em>p</em> = 0.015, =0.005 and =0.042 respectively), and had no significant effect on these values in the low T3 population.</p></div><div><h3>Conclusion</h3><p>T3 supplementation was associated with a low 28-day mortality rate in patients with low T3T4 but with increased mortality in patients with low T3 ESS. These results suggest caution before initiating thyroid supplementation in septic patients.</p></div><div><h3>Registration</h3><p>ClinTrials.gov (NCT05270798).</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101336"},"PeriodicalIF":5.5,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352556823001443/pdfft?md5=7e2c95e0cf70684a7b02bc1802704041&pid=1-s2.0-S2352556823001443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138493716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-05DOI: 10.1016/j.accpm.2023.101337
Ji Hyeon Lee , Jiyoun Lee , Sang Heon Park , Sung-Hee Han , Jin-Hee Kim , Jin-Woo Park
Background
General anaesthesia can immobile patients during interventional neuroradiology to improve image quality. Remimazolam, an ultrashort-acting benzodiazepine, is advantageous for haemodynamic stability. This study compared remimazolam and propofol anaesthesia during neuroradiology procedures regarding intraoperative hypotensive events and rapid recovery.
Methods
This single-masked randomised-controlled study included 76 participants who underwent elective endovascular embolisation in a single centre. Patients were randomised between a continuous remimazolam infusion (n = 38) or a target-controlled propofol infusion group (n = 38). In the remimazolam group, flumazenil (0.2 mg) was administered at the end of the procedure. Phenylephrine was titrated to maintain the mean arterial pressure within ± 20% of the baseline value. The primary outcome was the total phenylephrine dose during the procedure.
Results
The total phenylephrine dose was 0.0 [0.0–30.0] μg in the remimazolam group and 30.0 [0.0–205.0] μg in the propofol group (p = 0.001). Hypotensive events were observed in 11 (28.9%) patients in the remimazolam group and 23 (60.5%) patients in the propofol group (p = 0.001). Recovery times to spontaneous breathing, eye-opening, extubation, and orientation were shorter in the remimazolam group than in the propofol group (all p < 0.001).
Conclusions
Remimazolam anaesthesia showed superior haemodynamic stability compared with propofol anaesthesia during neuroradiology procedures. Systematic use of flumazenil enabled rapid recovery from remimazolam anaesthesia.
Registration
University Hospital Medical Information Network Clinical Trials Registry; Registration number: UMIN000047384; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000054046
{"title":"Comparison between remimazolam and propofol anaesthesia for interventional neuroradiology: a randomised controlled trial","authors":"Ji Hyeon Lee , Jiyoun Lee , Sang Heon Park , Sung-Hee Han , Jin-Hee Kim , Jin-Woo Park","doi":"10.1016/j.accpm.2023.101337","DOIUrl":"10.1016/j.accpm.2023.101337","url":null,"abstract":"<div><h3>Background</h3><p><span><span>General anaesthesia can immobile patients during </span>interventional neuroradiology<span> to improve image quality. Remimazolam, an ultrashort-acting </span></span>benzodiazepine<span>, is advantageous for haemodynamic<span> stability. This study compared remimazolam and propofol<span> anaesthesia during neuroradiology procedures regarding intraoperative hypotensive events and rapid recovery.</span></span></span></p></div><div><h3>Methods</h3><p><span>This single-masked randomised-controlled study included 76 participants who underwent elective endovascular embolisation in a single centre. Patients were randomised between a continuous remimazolam infusion (n = 38) or a target-controlled propofol infusion group (n = 38). In the remimazolam group, </span>flumazenil<span> (0.2 mg) was administered at the end of the procedure. Phenylephrine<span> was titrated to maintain the mean arterial pressure within ± 20% of the baseline value. The primary outcome was the total phenylephrine dose during the procedure.</span></span></p></div><div><h3>Results</h3><p>The total phenylephrine dose was 0.0 [0.0–30.0] μg in the remimazolam group and 30.0 [0.0–205.0] μg in the propofol group (<em>p</em> = 0.001). Hypotensive events were observed in 11 (28.9%) patients in the remimazolam group and 23 (60.5%) patients in the propofol group (<em>p</em><span> = 0.001). Recovery times to spontaneous breathing, eye-opening, extubation, and orientation were shorter in the remimazolam group than in the propofol group (all </span><em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Remimazolam anaesthesia showed superior haemodynamic stability compared with propofol anaesthesia during neuroradiology procedures. Systematic use of flumazenil enabled rapid recovery from remimazolam anaesthesia.</p></div><div><h3>Registration</h3><p><span>University Hospital Medical Information Network Clinical Trials Registry; Registration number: UMIN000047384; URL: </span><span>https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000054046</span><svg><path></path></svg></p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101337"},"PeriodicalIF":5.5,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138493680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-02DOI: 10.1016/j.accpm.2023.101333
Karim Lakhal , Jérôme E. Dauvergne , Hélène Messet-Charriere , Mai-Anh Nay , Toufik Kamel , Grégoire Muller , Vincent Robert-Edan , Bertrand Rozec , Stephan Ehrmann , Sophie Jacquier , Thierry Boulain
Background
Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance.
Methods
Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT).
Results
Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance.
Conclusions
Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema.
Registration
ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic.clinicaltrials.gov/ct2/show/NCT04269382.
背景:与有创技术相比，无创动脉压力监测更容易、更快，但可能会牺牲一些可靠性。对于Clearsight™系统(Edwards生命科学公司)来说尤其如此，该系统可以实现连续监测。我们对其不良表现的风险因素进行了评估。方法:纳入有动脉导管且平均动脉压稳定(MAP)超过5分钟的患者。收集了6对有创和Clearsight的MAP测量结果，并计算了两种技术之间的偏差。Clearsight™系统的不良性能被定义为测量和显示MAP失败或显示错误MAP(单个偏差>5 mmHg)。采用血流灌注指数(PI)和毛细血管再充盈时间(CRT)评估指尖血流灌注。结果:152例ICU患者(MAP为81±14 mmHg，去甲肾上腺素78例[51%])，78例(51%)Clearsight™系统表现不佳:19例(13%)患者MAP显示失败，59例(44%)患者MAP显示错误。在多因素分析中，PI≤0.85%(校正优势比[aOR]=2.94[95%可信区间(95% ci):1.34;6.45])、CRT >4秒(aOR=5.28 [95% ci 1.39;20.05])、手部水肿(aOR=2.06 [95% ci 1.01;4.21])与表现不佳的可能性较高相关。心律失常(aOR=1.39 [95%CI 0.64;3.02])等被测变量与表现不佳无关。结论:半数纳入的患者Clearsight™系统表现不佳。我们的研究结果提醒，对于PI低(≤0.85%)、CRT延长(>4秒)或手部水肿的患者，不要使用指套动脉压监测。注册:NCT04269382。
{"title":"Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study","authors":"Karim Lakhal , Jérôme E. Dauvergne , Hélène Messet-Charriere , Mai-Anh Nay , Toufik Kamel , Grégoire Muller , Vincent Robert-Edan , Bertrand Rozec , Stephan Ehrmann , Sophie Jacquier , Thierry Boulain","doi":"10.1016/j.accpm.2023.101333","DOIUrl":"10.1016/j.accpm.2023.101333","url":null,"abstract":"<div><h3>Background</h3><p>Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance.</p></div><div><h3>Methods</h3><p><span>Patients with an arterial catheter<span> and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). </span></span>Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT).</p></div><div><h3>Results</h3><p>Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine<span> in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis<span>, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance.</span></span></p></div><div><h3>Conclusions</h3><p>Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema.</p></div><div><h3>Registration</h3><p>ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. <span>https://classic.clinicaltrials.gov/ct2/show/NCT04269382</span><svg><path></path></svg>.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 2","pages":"Article 101333"},"PeriodicalIF":5.5,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-02DOI: 10.1016/j.accpm.2023.101334
David Sommerfield , Aine Sommerfield , Daisy Evans , R. Nazim Khan , Abbie Luke , Shyan Vijayasekaran , Paul Bumbak , Hayley Herbert , Britta S von Ungern-Sternberg
Background
Despite the use of dual antiemetic agents, postoperative nausea and vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects postoperatively in young children.
Methods
Prospective, open-label randomised controlled trial of 240 patients, 2–16 years. Patients administered a confectionary jelly snake to chew postoperatively were compared with a control group. The primary outcome was the number of episodes of vomiting within 6 h of the operation on an intention-to-treat basis. Secondary outcomes: incidence of nausea, vomiting at 6 and 24 h, rescue antiemetic use, acceptability, delayed discharge.
Results
233 patients were randomised to receive the confectionary snake (snake group, 118) or standard care (control group, 115). The number of vomiting episodes in 6 h was similar between groups on an intention-to-treat basis, with 39 episodes across 22 (19%) patients in the control group and 31 across 19 (16%) patients in the snake group (p = 0.666). From post anaesthetic care unit until 24 h there was no difference in doses of antiemetics or delayed discharge due to PONV. A secondary as per protocol analysis did not change this result.
Conclusions
Chewing of confectionery jelly snakes within one hour of waking following adenotonsillectomy with vapour-maintained anaesthesia and two prophylactic antiemetics did not further reduce the incidence of early vomiting.
Registration
prospective registration at the Australia and New Zealand Clinical Trials Registry (ACTRN12618000637246).
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