Anaesthesia Critical Care & Pain Medicine最新文献

Background: Videolaryngoscopes with hyper-angulated blades improve glottic visualisation in patients with cervical spine immobilisation but may complicate blade insertion and tracheal tube (TT) advancement. We compared the head-elevated (HE) and head-neutral (HN) position during GlideScope®-guided intubation under manual in-line stabilisation (MILS).

Methods: In this randomised crossover trial, 180 adult patients undergoing elective surgery were allocated to HN or HE groups. Under MILS, videolaryngoscopy was performed in both positions, but intubation was attempted only in the second designed position. The HE position was achieved by elevating the back section of the table to align the external auditory meatus and sternal notch.

Results: Intubation was attempted in 177 patients with 100% success. Median intubation time was shorter in HE group than HN group (27.2 [23.4-34.3] vs. 31.5 [27.0-40.5] s; difference -4.5 s, 95% CI -7.5 to -1.8; P =  0.001). The modified intubation difficulty scale was lower in HE group (1 [0-1]) than HN group (2 [1-3]; P <  0.001). The need for optimisation manoeuvres was less frequent in the HE position for GlideScope® blade insertion (5.6% vs. 13.9%; P =  0.0001) and for TT advancement (31.8% vs. 58.4%; P <  0.001). Laryngeal view was superior in the HE position, with a higher mean percentage of glottic opening score (42.9 ± 35.6% vs. 26.8 ± 32.3%; P <  0.0001) and a greater proportion of easy modified Cormack-Lehane grades (83.8% vs. 64.8%; P <  0.0001).

Conclusion: The HE position significantly improved intubation efficiency and technical ease using a hyper-angulated videolaryngoscope under MILS.

Trial registration: ClinicalTrials.gov identifier: NCT05671978.

Importance: Sedation is a cornerstone therapeutic option for the control of intracranial hypertension in patients with traumatic brain injury. However, the absence of specific recommendations regarding the choice of agents, their combinations, or dosing strategies contributes to the heterogeneity of sedation practices, which may be applied at varying levels of therapeutic intensity (Tier 0, 1, 2, 3).

Objective: To describe the sedative molecules and their combinations used in the treatment of ICH in TBI in France.

Methods: From May 1 to August 31, 2024, a questionnaire was sent to French senior physicians working in intensive care units of level 1 trauma centers.

Results: A total of 115 responses were obtained. At the initial tier of therapeutic intensity, the most frequently reported sedations were midazolam (n = 52, 45%) and propofol (n = 43, 37%). For analgesia, sufentanil was the predominant agent (96%). The most common combination at the first tier was midazolam/propofol/sufentanil (n = 78, 69%). Forty-eight respondents (42%) reported escalating to a higher level of sedation at Tier Two, most often with midazolam/propofol/ketamine/sufentanil (n = 35, 73%). Sixty-four respondents (56%) reported using barbiturate coma for intracranial hypertension refractory to Tier Two therapy CONCLUSION: This study describes a high level of heterogeneity in the use of sedation agents, their maximum doses, and their monitoring in the treatment of traumatic ICH among neurointensivists in France.

Considering biological sex is essential for assessing perioperative risk and tailoring anesthetic care, yet this issue remains under-addressed. Preoperative risk scores rarely incorporate sex, despite growing evidence of sex-based differences across the perioperative continuum. Sex influences both anesthetic pharmacokinetics and pharmacodynamics. Women exhibit reduced sensitivity to propofol, experience more rapid emergence from general anesthesia, but demonstrate increased sensitivity to opioids and neuromuscular blockers like rocuronium. Postoperatively, women experience more severe and chronic pain, yet exhibit lower mortality rates. Complication profiles also vary by sex and type of surgery. This narrative review aims to summarize current evidence on sex-related differences in anesthesia and highlights key gaps in the literature according to recent considerations. While emerging data suggest meaningful sex-based variations, further research is needed to elucidate underlying mechanisms and promote a more personalized approach to perioperative management.

Background: Pain after laparoscopic hiatus hernia repair (LHHR) is multifactorial, with parietal pain representing up to 70% of its origin. Opioid induced postoperative nausea and vomiting (PONV) is of great concern, as it may predispose to anatomical failure and the need for revision. This study evaluated the opioid sparing value of the recto-intercostal fascial plane block (RIFPB) in this manner.

Methods: A randomized, double-blind, controlled trial was conducted on 44 patients who were assigned equally into a RIFPB group [20 mL of bupivacaine (0.25%) for each side] and a control group [(C), without block]. The primary aim was the total 24 h opioid consumption post-surgery, and secondary outcomes included intraoperative fentanyl consumption, postoperative pain scores, PONV incidence, and patient satisfaction scores.

Results: The RIFPB group had significantly lower 24-h postoperative morphine consumption than the control group (9 ± 3 mg vs. 20.8 ± 6.9 mg); P <  0.001. The median (IQR) fentanyl dose was significantly lower in the RIFPB group than in group C, 0.5 (0 -1) vs. 2 (1-2) µg/kg; P <  0.001. The RIFPB group had a significantly prolonged time to first morphine request (P <  0.001), lower postoperative pain scores at all assessment time points (P <  0.05) except at 8 h after surgery, a higher median value of patient satisfaction scores (4 vs. 3; P <  0.001), and a lower incidence of PONV, P =  0.034.

Conclusion: The RIFPB reduced the intraoperative nociception and the 24-h postoperative opioid consumption after LHHR. Also, it delayed the need for rescue morphine; reduced pain scores, PONV incidence, and increased patient satisfaction after surgery.

Registration: ClinicalTrials.gov (NCT06820216).