Pub Date : 2025-01-01DOI: 10.1016/j.accpm.2024.101465
Guillaume Mortamet , Christophe Milési , Michael Levy
{"title":"Significance of ongoing enhancement of Pediatric Intensive Care Unit follow-up. Authors’ reply","authors":"Guillaume Mortamet , Christophe Milési , Michael Levy","doi":"10.1016/j.accpm.2024.101465","DOIUrl":"10.1016/j.accpm.2024.101465","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101465"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883250","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101463
Mikhael Giabicani , Emmanuel Weiss , Frédérique Claudot , Gérard Audibert , Scarlett-May Ferrié , Pierre-François Perrigault , Ellen M. Robinson , Mildred Z. Solomon , Marta Spranzi , Marie-France Mamzer
Context
In European and Anglo-Saxon countries, life-sustaining treatment (LST) limitation decisions precede more than 80% of ICU deaths. However, there is now increasing evidence of disagreement and conflict between clinical teams and family members over LST limitation decisions. In some cases, these conflicts are brought to the courts. The aim of this study was to provide a descriptive and qualitative analysis of cases brought to the French courts.
Methods
We conducted a retrospective national observational study. All identified cases of emergency recourse to the judge in the context of LST limitation decisions in France between 2005 and 2022 were included.
Results
Seventy-six cases were investigated by the judge, with an increasing number over the years. The LST limitation decisions contested by the relatives were mainly decisions to withdraw treatment (78%) concerning patients with neurological injury (76%). The judge successively assessed the compliance with the legal decision-making process and the characterization of the inappropriateness of treatments. The latter was assessed by the judge using medical and non-medical criteria. In all, the medical decision was upheld in 29 cases (38%) and over-ruled in 20 cases (26%). Thirteen cases (17%) were finally settled out of court, and 14 patients (18%) died before the end of the investigation. The qualitative analysis highlighted opposing moral values and principles put forward by family members and physicians.
Conclusion
The growing incidence and deeply intertwined elements of these conflicts call for more policy and research to resolve them before they go to court.
{"title":"Intractable conflicts over end-of-life decisions: A descriptive and ethical analysis of French case-law","authors":"Mikhael Giabicani , Emmanuel Weiss , Frédérique Claudot , Gérard Audibert , Scarlett-May Ferrié , Pierre-François Perrigault , Ellen M. Robinson , Mildred Z. Solomon , Marta Spranzi , Marie-France Mamzer","doi":"10.1016/j.accpm.2024.101463","DOIUrl":"10.1016/j.accpm.2024.101463","url":null,"abstract":"<div><h3>Context</h3><div>In European and Anglo-Saxon countries, life-sustaining treatment (LST) limitation decisions precede more than 80% of ICU deaths. However, there is now increasing evidence of disagreement and conflict between clinical teams and family members over LST limitation decisions. In some cases, these conflicts are brought to the courts. The aim of this study was to provide a descriptive and qualitative analysis of cases brought to the French courts.</div></div><div><h3>Methods</h3><div>We conducted a retrospective national observational study. All identified cases of emergency recourse to the judge in the context of LST limitation decisions in France between 2005 and 2022 were included.</div></div><div><h3>Results</h3><div>Seventy-six cases were investigated by the judge, with an increasing number over the years. The LST limitation decisions contested by the relatives were mainly decisions to withdraw treatment (78%) concerning patients with neurological injury (76%). The judge successively assessed the compliance with the legal decision-making process and the characterization of the inappropriateness of treatments. The latter was assessed by the judge using medical and non-medical criteria. In all, the medical decision was upheld in 29 cases (38%) and over-ruled in 20 cases (26%). Thirteen cases (17%) were finally settled out of court, and 14 patients (18%) died before the end of the investigation. The qualitative analysis highlighted opposing moral values and principles put forward by family members and physicians.</div></div><div><h3>Conclusion</h3><div>The growing incidence and deeply intertwined elements of these conflicts call for more policy and research to resolve them before they go to court.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101463"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923469","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101453
Yijun Liu , Wei Ma , Yunxia Zuo , Qian Li
Background
There is still debate over whether opioid-free anaesthesia (OFA) can improve the patient-reported quality of recovery (QoR).
Methods
A search was conducted across Pubmed, Cochrane Library, and EMBASE until June 2024 for randomized controlled trials comparing the impact of OFA and opioid-based anaesthesia (OBA) on QoR in adult patients undergoing general anaesthesia. The primary outcome was the quality of recovery measured with the QoR scale. The secondary outcomes were the five dimensions of the QoR scale.
Results
The analysis included 15 studies, and showed that compared with OBA, OFA improved the global QoR score at postoperative 24 h (SMD 0.87; 95% CI, 0.48–1.27; I2: 92%; low-level evidence). Among them, 10 studies revealed a greater QoR-40 score at postoperative 24 h in the OFA than in the OBA (MD 6.59; 95% CI, 2.84–10.34; I2: 93%; moderate-level evidence), which exceeded the minimal clinically important difference of 6.3. Conversely, the synthetic data of 4 studies did not reveal an improvement in the global QoR-15 score at postoperative 24 h (MD 9.94; 95% CI, -0.15 to 12.35; I2: 97%; low-level evidence). Regarding different domains of scale, OFA had positive effects on physical comfort (SMD 0.75; 95% CI, 0.25–1.25; I2: 93%; moderate-level evidence) and pain (SMD 0.59; 95% CI, 0.15–1.03; I2: 91%; moderate-level evidence).
Conclusions
The meta-analysis indicate OFA can improve the quality of recovery at postoperative 24 h, particularly in terms of enhancing physical comfort and reducing pain. However, due to significant heterogeneity and moderate-to-low level of evidence, the external validity of OFA for improving postoperative recovery remains to be further validated.
Registration
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database on December 07, 2023 (CRD42023486235).
{"title":"Opioid-free anaesthesia and postoperative quality of recovery: a systematic review and meta-analysis with trial sequential analysis","authors":"Yijun Liu , Wei Ma , Yunxia Zuo , Qian Li","doi":"10.1016/j.accpm.2024.101453","DOIUrl":"10.1016/j.accpm.2024.101453","url":null,"abstract":"<div><h3>Background</h3><div>There is still debate over whether opioid-free anaesthesia (OFA) can improve the patient-reported quality of recovery (QoR).</div></div><div><h3>Methods</h3><div>A search was conducted across Pubmed, Cochrane Library, and EMBASE until June 2024 for randomized controlled trials comparing the impact of OFA and opioid-based anaesthesia (OBA) on QoR in adult patients undergoing general anaesthesia. The primary outcome was the quality of recovery measured with the QoR scale. The secondary outcomes were the five dimensions of the QoR scale.</div></div><div><h3>Results</h3><div>The analysis included 15 studies, and showed that compared with OBA, OFA improved the global QoR score at postoperative 24 h (SMD 0.87; 95% CI, 0.48–1.27; <em>I</em><sup>2</sup>: 92%; low-level evidence). Among them, 10 studies revealed a greater QoR-40 score at postoperative 24 h in the OFA than in the OBA (MD 6.59; 95% CI, 2.84–10.34; <em>I</em><sup>2</sup>: 93%; moderate-level evidence), which exceeded the minimal clinically important difference of 6.3. Conversely, the synthetic data of 4 studies did not reveal an improvement in the global QoR-15 score at postoperative 24 h (MD 9.94; 95% CI, -0.15 to 12.35; <em>I</em><sup>2</sup>: 97%; low-level evidence). Regarding different domains of scale, OFA had positive effects on physical comfort (SMD 0.75; 95% CI, 0.25–1.25; <em>I</em><sup>2</sup>: 93%; moderate-level evidence) and pain (SMD 0.59; 95% CI, 0.15–1.03; <em>I</em><sup>2</sup>: 91%; moderate-level evidence).</div></div><div><h3>Conclusions</h3><div>The meta-analysis indicate OFA can improve the quality of recovery at postoperative 24 h, particularly in terms of enhancing physical comfort and reducing pain. However, due to significant heterogeneity and moderate-to-low level of evidence, the external validity of OFA for improving postoperative recovery remains to be further validated.</div></div><div><h3>Registration</h3><div>The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database on December 07, 2023 (CRD42023486235).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101453"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822751","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101462
Pierre Mora, Aurélie Villette, Oriane Saint Aubin, Elodie Mace, Michael Bonsey, Bruno Pastene, Foucauld Isnard, Aude Charvet, Marc Leone, Laurent Zieleskiewicz
Background
Global warming presents major public health challenges, with healthcare transportation significantly contributing to carbon dioxide equivalent emissions (eCO2). While the greenhouse effects of anaesthetic gases are well-documented, the eCO2 of pre-anaesthesia consultations remains underexplored. This study aims to evaluate and propose strategies to reduce the carbon impact of these consultations at a Tertiary University Hospital.
Methods
In a prospective, observational study over one month, data were collected from patients attending pre-anaesthesia consultations. ECO2 emissions from transportation and electricity were calculated. To reduce emissions, several modifications to the care pathway were investigated, including teleconsultation, remote consultation, grouping of consultations, carpooling, and the promotion of public transport. The effects of current and optimised care pathways were then compared.
Results
Data from 213 patients showed that 75% attended the hospital solely for pre-anaesthesia consultations, mostly by car (82%). The mean eCO2 per consultation was 22.4 kgCO2 (95% CI: 14.6–30.2). Implementing optimisation strategies in 65% of cases could reduce emissions to 5.6 kg CO2 (95% CI: 0.2–10.9) per consultation, leading to a 74% reduction and an annual saving of 274 t of eCO2.
Discussion
Our study highlights the potential for significant reductions in the eCO2 of pre-anaesthesia consultations. The adaptation of the care pathway would largely involve grouping consultations and developing teleconsultations. These potential savings in greenhouse gas emissions are in the same order of magnitude as not using desflurane in the operating theatre and could be the next step towards greener anaesthesia.
{"title":"Potential impacts of optimised care pathways on carbon impact of anaesthesia consultation—A monocenter prospective study","authors":"Pierre Mora, Aurélie Villette, Oriane Saint Aubin, Elodie Mace, Michael Bonsey, Bruno Pastene, Foucauld Isnard, Aude Charvet, Marc Leone, Laurent Zieleskiewicz","doi":"10.1016/j.accpm.2024.101462","DOIUrl":"10.1016/j.accpm.2024.101462","url":null,"abstract":"<div><h3>Background</h3><div>Global warming presents major public health challenges, with healthcare transportation significantly contributing to carbon dioxide equivalent emissions (<em>e</em>CO<sub>2</sub>). While the greenhouse effects of anaesthetic gases are well-documented, the <em>e</em>CO<sub>2</sub> of pre-anaesthesia consultations remains underexplored. This study aims to evaluate and propose strategies to reduce the carbon impact of these consultations at a Tertiary University Hospital.</div></div><div><h3>Methods</h3><div>In a prospective, observational study over one month, data were collected from patients attending pre-anaesthesia consultations. <em>ECO2</em> emissions from transportation and electricity were calculated. To reduce emissions, several modifications to the care pathway were investigated, including teleconsultation, remote consultation, grouping of consultations, carpooling, and the promotion of public transport. The effects of current and optimised care pathways were then compared.</div></div><div><h3>Results</h3><div>Data from 213 patients showed that 75% attended the hospital solely for pre-anaesthesia consultations, mostly by car (82%). The mean <em>e</em>CO<sub>2</sub> per consultation was 22.4 kgCO2 (95% CI: 14.6–30.2). Implementing optimisation strategies in 65% of cases could reduce emissions to 5.6 kg CO<sub>2</sub> (95% CI: 0.2–10.9) per consultation, leading to a 74% reduction and an annual saving of 274 t of <em>e</em>CO<sub>2</sub>.</div></div><div><h3>Discussion</h3><div>Our study highlights the potential for significant reductions in the <em>e</em>CO<sub>2</sub> of pre-anaesthesia consultations. The adaptation of the care pathway would largely involve grouping consultations and developing teleconsultations. These potential savings in greenhouse gas emissions are in the same order of magnitude as not using desflurane in the operating theatre and could be the next step towards greener anaesthesia.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101462"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883180","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101456
Junfei Zhou , Lu Li , Chang Xu, Erxian Zhao, Jianjun Yang, Yunqi Lv
Background
The Gastro-Laryngeal Mask (Jcerity Endoscoper™ Airway) is a new airway management technique utilized in patients undergoing upper gastrointestinal endoscopy surgery under general anesthesia, but evidence of its effectiveness and safety is scarce.
Objective
To assess the success rate of insertion, cardiovascular response, airway pressure, time taken for placement, nausea or vomiting, pharyngodynia, and other complications of using the new type of back-open gastroscopy laryngeal mask.
Methods
We screened 1401 patients; 105 were ineligible, and 40 declined to participate. Participants were randomly allocated into the Jcerity Endoscoper™ Airway (JEA) group and the endotracheal tube (ET) group. Among them, 1266 patients were randomly assigned to receive endotracheal intubation (n = 633) or JEA (n = 633).
Results
Compared with the ET group, the JEA group had a significantly shorter insertion time and less cardiovascular response during insertion. The time taken for extubation after anesthesia and residence time in PACU in the JEA group was shorter than in the ET group. Especially, the incidence of pharyngodynia in the JEA group was lower than that in the ET group. The satisfaction of endoscopists with the JEA reached 99.4%.
Conclusions
This study showed that the back-open JEA can not only provide a safe and effective airway guarantee for patients but also provide convenience for gastroenterologists to carry out endoscopic operations.
Trial Registration
The trial was registered before patient enrollment at the Chinese Clinical Trial Registry Center (ChiCTR2100046864, principal investigator: Yunqi Lv, date of registration: 2021-05-29). The study was conducted in the painless diagnosis and treatment center of the First Affiliated Hospital of Zhengzhou University from June 2021 to October 2023 (Date of enrolment of the first research participant:2021-06-01).
{"title":"Application of a novel gastro-laryngeal mask in upper gastrointestinal endoscopy surgery: A pilot randomized clinical trial","authors":"Junfei Zhou , Lu Li , Chang Xu, Erxian Zhao, Jianjun Yang, Yunqi Lv","doi":"10.1016/j.accpm.2024.101456","DOIUrl":"10.1016/j.accpm.2024.101456","url":null,"abstract":"<div><h3>Background</h3><div>The Gastro-Laryngeal Mask (Jcerity Endoscoper™ Airway) is a new airway management technique utilized in patients undergoing upper gastrointestinal endoscopy surgery under general anesthesia, but evidence of its effectiveness and safety is scarce.</div></div><div><h3>Objective</h3><div>To assess the success rate of insertion, cardiovascular response, airway pressure, time taken for placement, nausea or vomiting, pharyngodynia, and other complications of using the new type of back-open gastroscopy laryngeal mask.</div></div><div><h3>Methods</h3><div>We screened 1401 patients; 105 were ineligible, and 40 declined to participate. Participants were randomly allocated into the Jcerity Endoscoper™ Airway (JEA) group and the endotracheal tube (ET) group. Among them, 1266 patients were randomly assigned to receive endotracheal intubation (n = 633) or JEA (n = 633).</div></div><div><h3>Results</h3><div>Compared with the ET group, the JEA group had a significantly shorter insertion time and less cardiovascular response during insertion. The time taken for extubation after anesthesia and residence time in PACU in the JEA group was shorter than in the ET group. Especially, the incidence of pharyngodynia in the JEA group was lower than that in the ET group. The satisfaction of endoscopists with the JEA reached 99.4%.</div></div><div><h3>Conclusions</h3><div>This study showed that the back-open JEA can not only provide a safe and effective airway guarantee for patients but also provide convenience for gastroenterologists to carry out endoscopic operations.</div></div><div><h3>Trial Registration</h3><div>The trial was registered before patient enrollment at the Chinese Clinical Trial Registry Center (ChiCTR2100046864, principal investigator: Yunqi Lv, date of registration: 2021-05-29). The study was conducted in the painless diagnosis and treatment center of the First Affiliated Hospital of Zhengzhou University from June 2021 to October 2023 (Date of enrolment of the first research participant:2021-06-01).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101456"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873085","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 : 2025-01-01DOI: 10.1016/j.accpm.2024.101455
Natalie V.E. Anderson , William G.F. Ditcham , Barry S. Clements , Britta S. von Ungern-Sternberg
Tracheostomy tubes act as foreign bodies, predisposing the surrounding airway to respiratory infections. Initial treatment for infections is topical – nebulized tobramycin – although guidelines for standardized treatment are lacking. To quantify tobramycin delivery to simulated, tracheostomized children to inform future administration guidelines. A breathing simulator was programmed for volume-controlled ventilation at 6 mL.kg−1, for a 3 kg and a 16 kg child representing under or over 6-yrs, respectively. Nebulized tobramycin doses based on current guidelines for non-tracheostomized children (80 mg, or 300 mg, under and over 6-yrs, respectively) were delivered using standard hospital protocol, collected on filters, and assayed with chromatography to quantify average tobramycin delivered dose from six replicate measurements. The jet nebulizer delivered more tobramycin than the vibrating mesh nebulizer from an 80 mg (ages <6-yrs) dose for both a 3 kg child: 2.1 vs. 0.7 mg (3 mm, p = 0.047) and a 16 kg child: 8.7 vs. 3.5 mg (5 mm size, p = 0.022), 11.4 vs. 8.3 mg (4 mm size, p = 0.2). The jet nebulizer delivered more tobramycin than the vibrating mesh nebulizer from a 300 mg dose for both a 3 kg child: 8.4 vs. 3.7 mg (3 mm, p = 0.00076) and a 16 kg child: 33.2 vs. 25 mg (5 mm, p = 0.2) but not for a 16 kg child: 39.4 vs. 46.5 mg (4 mm, p = 0.18) The low amount and poor distribution of drug delivered warrants consideration and review of dosing regimens for treatment. Future research should investigate improving the efficiency of drug delivery to tracheostomized children and the safety and efficacy of higher-dosage regimens.
{"title":"Jet versus vibrating mesh nebulizer for tobramycin aerosol in spontaneously breathing children with tracheostomies: A simulation study","authors":"Natalie V.E. Anderson , William G.F. Ditcham , Barry S. Clements , Britta S. von Ungern-Sternberg","doi":"10.1016/j.accpm.2024.101455","DOIUrl":"10.1016/j.accpm.2024.101455","url":null,"abstract":"<div><div>Tracheostomy tubes act as foreign bodies, predisposing the surrounding airway to respiratory infections. Initial treatment for infections is topical – nebulized tobramycin – although guidelines for standardized treatment are lacking. To quantify tobramycin delivery to simulated, tracheostomized children to inform future administration guidelines. A breathing simulator was programmed for volume-controlled ventilation at 6 mL.kg<sup>−1</sup>, for a 3 kg and a 16 kg child representing under or over 6-yrs, respectively. Nebulized tobramycin doses based on current guidelines for non-tracheostomized children (80 mg, or 300 mg, under and over 6-yrs, respectively) were delivered using standard hospital protocol, collected on filters, and assayed with chromatography to quantify average tobramycin delivered dose from six replicate measurements. The jet nebulizer delivered more tobramycin than the vibrating mesh nebulizer from an 80 mg (ages <6-yrs) dose for both a 3 kg child: 2.1 <em>vs.</em> 0.7 mg (3 mm, <em>p</em> = 0.047) and a 16 kg child: 8.7 <em>vs.</em> 3.5 mg (5 mm size, <em>p</em> = 0.022), 11.4 <em>vs.</em> 8.3 mg (4 mm size, <em>p</em> = 0.2). The jet nebulizer delivered more tobramycin than the vibrating mesh nebulizer from a 300 mg dose for both a 3 kg child: 8.4 <em>vs.</em> 3.7 mg (3 mm, <em>p</em> = 0.00076) and a 16 kg child: 33.2 <em>vs.</em> 25 mg (5 mm, <em>p</em> = 0.2) but not for a 16 kg child: 39.4 <em>vs.</em> 46.5 mg (4 mm, <em>p</em> = 0.18) The low amount and poor distribution of drug delivered warrants consideration and review of dosing regimens for treatment. Future research should investigate improving the efficiency of drug delivery to tracheostomized children and the safety and efficacy of higher-dosage regimens.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"44 1","pages":"Article 101455"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873124","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 : 2024-10-22DOI: 10.1016/j.accpm.2024.101446
Anne Godier, Dominique Lasne, Gilles Pernod, Normand Blais, Fanny Bonhomme, Fanny Bounes, Alex Bourguignon, Ariel Cohen, Emmanuel de Maistre, Pierre Fontana, Jean-Philippe Galanaud, Delphine Garrigue Huet, Alexandre Godon, Isabelle Gouin-Thibault, Samia Jebara, Silvy Laporte, Thomas Lecompte, Dan Longrois, Jerrold H Levy, Grégoire Le Gal, Yves Gruel, Alexandre Mansour, Anne-Céline Martin, Mikael Mazighi, Pierre-Emmanuel Morange, Serge Motte, François Mullier, Philippe Nguyen, Nadia Rosencher, Stéphanie Roullet, Pierre-Marie Roy, Jean-François Schved, Marie-Antoinette Sevestre, Pierre Sié, Sophie Susen, Charles Tacquard, André Vincentelli, Paul Zufferey, Patrick Mismetti, Pierre Albaladejo
Background: Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.
Objective: A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.
Methods: The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.
Results: 78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.
Conclusions: These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.
{"title":"Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network.","authors":"Anne Godier, Dominique Lasne, Gilles Pernod, Normand Blais, Fanny Bonhomme, Fanny Bounes, Alex Bourguignon, Ariel Cohen, Emmanuel de Maistre, Pierre Fontana, Jean-Philippe Galanaud, Delphine Garrigue Huet, Alexandre Godon, Isabelle Gouin-Thibault, Samia Jebara, Silvy Laporte, Thomas Lecompte, Dan Longrois, Jerrold H Levy, Grégoire Le Gal, Yves Gruel, Alexandre Mansour, Anne-Céline Martin, Mikael Mazighi, Pierre-Emmanuel Morange, Serge Motte, François Mullier, Philippe Nguyen, Nadia Rosencher, Stéphanie Roullet, Pierre-Marie Roy, Jean-François Schved, Marie-Antoinette Sevestre, Pierre Sié, Sophie Susen, Charles Tacquard, André Vincentelli, Paul Zufferey, Patrick Mismetti, Pierre Albaladejo","doi":"10.1016/j.accpm.2024.101446","DOIUrl":"https://doi.org/10.1016/j.accpm.2024.101446","url":null,"abstract":"<p><strong>Background: </strong>Any surgical procedure carries a risk for venous thromboembolism (VTE), albeit variable. Improvements in medical and surgical practices and the shortening of care pathways due to the development of day surgery and enhanced recovery after surgery, have reduced the perioperative risk for VTE.</p><p><strong>Objective: </strong>A collaborative working group of experts in perioperative haemostasis updated in 2024 the recommendations for the Prevention of perioperative venous thromboembolism published in 2011.</p><p><strong>Methods: </strong>The addressed questions were defined by 40 experts (GIHP, SFAR, SFTH and SFMV) and formulated in a PICO format. They performed the literature review and formulated recommendations according to the Grading of GRADE system. Recommendations were then validated by a vote determining the strength of each recommendation. Of note, these recommendations do not cover all surgical specialties. Especially, thromboprophylaxis in cardiac surgery, neurosurgery and obstetrics is not addressed.</p><p><strong>Results: </strong>78 recommendations were formalized into 17 sections, including patient-related VTE risk factors, types of surgery, extreme body weight, renal impairment, mechanical prophylaxis, distal deep vein thrombosis; 27 were found to have a high level of evidence (GRADE 1) and 41 a low level of evidence (GRADE 2) and 10 were expert opinion. All had strong agreement among the experts.</p><p><strong>Conclusions: </strong>These guidelines help to weigh the perioperative risk for VTE (which includes the risk associated to surgery and the patient-related risk) against the adverse effects of thromboprophylaxis, either pharmacological or mechanical. This includes particularly the bleeding risk induced by antithrombotic drugs as well as costs.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101446"},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511034","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 : 2024-10-16DOI: 10.1016/j.accpm.2024.101445
Chang-Hoon Koo , Soowon Lee , Subin Yim , Yu Kyung Bae , Insun Park , Ah-Young Oh
Background
Some anaesthetists wonder whether confirming a train-of-four ratio (TOFR) ≥0.9 is necessary when using sugammadex to antagonise neuromuscular blockade (NMB). In this study, we aimed to determine whether using sugammadex at the recommended dose under neuromuscular monitoring (NMM) would ensure complete recovery, even without further NMM.
Methods
This prospective observational study included 51 patients who underwent robot-assisted surgery under general anaesthesia between March and May 2023. At the end of surgery, sugammadex was administered (2 mg/kg for a train-of-four (TOF) count ≥1 and 4 mg/kg for a TOF count = 0 and a post-tetanic count ≥1). NMM was discontinued, and subsequent recovery was completed at the discretion of the attending anaesthetist. TOFR was measured twice immediately upon admission to the post-anaesthesia care unit (PACU). The primary outcome was the incidence of a non-normalised TOFR (nTOFR) <0.9 upon arrival in PACU. The secondary outcomes were the incidences of a nTOFR <0.7 or 1.0, symptoms/signs of residual NMB (diplopia, dyspnoea, and desaturation) and recovery profiles in PACU.
Results
The incidence of a nTOFR <0.9 upon arrival in PACU was 5.9% (3/51 patients). No patient had a nTOFR <0.7, and 47.1% (24 patients) had a nTOFR <1.0, but no patients showed clinical symptoms/signs of residual NMB.
Conclusions
When the recommended dose of sugammadex was administered under qualitative NMM, residual NMB at the time of PACU arrival occurred frequently, indicating that quantitative NMM is necessary to ensure adequate recovery.
{"title":"Is quantitative neuromuscular monitoring mandatory after administration of the recommended dose of sugammadex? A prospective observational study","authors":"Chang-Hoon Koo , Soowon Lee , Subin Yim , Yu Kyung Bae , Insun Park , Ah-Young Oh","doi":"10.1016/j.accpm.2024.101445","DOIUrl":"10.1016/j.accpm.2024.101445","url":null,"abstract":"<div><h3>Background</h3><div>Some anaesthetists wonder whether confirming a train-of-four ratio (TOFR) ≥0.9 is necessary when using sugammadex to antagonise neuromuscular blockade (NMB). In this study, we aimed to determine whether using sugammadex at the recommended dose under neuromuscular monitoring (NMM) would ensure complete recovery, even without further NMM.</div></div><div><h3>Methods</h3><div>This prospective observational study included 51 patients who underwent robot-assisted surgery under general anaesthesia between March and May 2023. At the end of surgery, sugammadex was administered (2 mg/kg for a train-of-four (TOF) count ≥1 and 4 mg/kg for a TOF count = 0 and a post-tetanic count ≥1). NMM was discontinued, and subsequent recovery was completed at the discretion of the attending anaesthetist. TOFR was measured twice immediately upon admission to the post-anaesthesia care unit (PACU). The primary outcome was the incidence of a non-normalised TOFR (nTOFR) <0.9 upon arrival in PACU. The secondary outcomes were the incidences of a nTOFR <0.7 or 1.0, symptoms/signs of residual NMB (diplopia, dyspnoea, and desaturation) and recovery profiles in PACU.</div></div><div><h3>Results</h3><div>The incidence of a nTOFR <0.9 upon arrival in PACU was 5.9% (3/51 patients). No patient had a nTOFR <0.7, and 47.1% (24 patients) had a nTOFR <1.0, but no patients showed clinical symptoms/signs of residual NMB.</div></div><div><h3>Conclusions</h3><div>When the recommended dose of sugammadex was administered under qualitative NMM, residual NMB at the time of PACU arrival occurred frequently, indicating that quantitative NMM is necessary to ensure adequate recovery.</div></div><div><h3>Registration</h3><div>ClinicalTrials, NCT 05760560.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101445"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478216","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 : 2024-10-16DOI: 10.1016/j.accpm.2024.101444
Umar Akram , Zain Ali Nadeem , Haider Ashfaq , Eeshal Fatima , Hamza Ashraf , Muhammad Ahmed Raza , Shahzaib Ahmed , Arsalan Nadeem , Sana Rehman , Muhammad Hassan Ahmad
Background
Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.
Methods
A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.
Results
A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD −0.65, p = 0.04) and 48 h (MD −0.55 points, p < 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.
Conclusions
Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine’s potential benefits for chronic pain management.
{"title":"Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis","authors":"Umar Akram , Zain Ali Nadeem , Haider Ashfaq , Eeshal Fatima , Hamza Ashraf , Muhammad Ahmed Raza , Shahzaib Ahmed , Arsalan Nadeem , Sana Rehman , Muhammad Hassan Ahmad","doi":"10.1016/j.accpm.2024.101444","DOIUrl":"10.1016/j.accpm.2024.101444","url":null,"abstract":"<div><h3>Background</h3><div>Video-assisted thoracoscopic surgery (VATS) reduces postoperative discomfort and expedites recovery compared to open thoracotomy. Effective postoperative pain management is crucial to enhance recovery and reduce complications. Ketamine, an NMDA receptor antagonist, has shown promise, though its efficacy in VATS remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of ketamine in reducing acute pain in VATS patients.</div></div><div><h3>Methods</h3><div>A comprehensive search of MEDLINE (PubMed), CENTRAL, Embase, Science Direct, Scopus, and clinicaltrials.gov was conducted. Eligible studies were randomized controlled trials (RCTs) comparing intraoperative intravenous ketamine with normal saline in VATS patients and reporting postoperative pain scores. Statistical analyses were performed using R version 4.3.3. Cochrane risk of bias (RoB2) tool was used to assess the quality of included studies.</div></div><div><h3>Results</h3><div>A total of 10 RCTs with 1151 participants were included. Ketamine was associated with a significant reduction in postoperative pain at 12 (MD −0.65, p = 0.04) and 48 h (MD −0.55 points, p < 0.01) post-surgery. No significant difference was observed in pain scores within the first 3 h, at 6 and 12 h, 24-h postoperative opioid consumption, urine output, surgery duration, rescue analgesia, mean arterial pressure, infusion volume, heart rate, extubation time, and blood loss. The certainty of evidence ranged from moderate to low across the outcomes.</div></div><div><h3>Conclusions</h3><div>Intraoperative intravenous ketamine effectively reduces acute postoperative pain in VATS patients but does not significantly impact opioid consumption, hemodynamic parameters, and adverse events. Large-scale studies are needed to confirm these findings and explore ketamine’s potential benefits for chronic pain management.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD42024527858).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101444"},"PeriodicalIF":3.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478215","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}
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