Anaesthesia Critical Care & Pain Medicine最新文献

Background: The Sacubitril-Valsartan combination (SVC) has been gaining an important role in the treatment of heart failure with reduced ejection fraction. We aimed to evaluate the immediate postoperative hemodynamic profile of patients usually treated with the SVC and undergoing elective cardiac surgery.

Materials and methods: This single-center retrospective study was conducted from January 2022 to March 2024 in cardiac surgery. All consecutive patients treated with SVC were compared to unexposed patients, selected by propensity score matching in a 1:2 ratio. The propensity score was estimated using a logistic regression adjusted for age, sex, creatinine clearance, preoperative critical illness, acute coronary syndrome <90 days, left ventricular ejection fraction, surgery, and cardiopulmonary bypass time. The primary outcome was the Vasoactive-Inotropic Score (VIS) during the first 24 hours postoperatively.

Results: We included 28 exposed and 56 non-exposed patients. We found no significant difference in 24 -h VIS (Exposed: 21.5 ± 15; Non-exposed: 21.4 ± 18; p = 0.86). We found no significant difference in VIS during the first 5 days, norepinephrine duration, dobutamine duration, lactate change, vascular filling, fluid balance, the occurrence of acute renal failure, duration of mechanical ventilation, and length of stay in intensive care. These results were similar in the subgroup of patients undergoing off-pump coronary artery bypass surgery. However, a difference smaller than 10 VIS points cannot be excluded.

Conclusion: In this exploratory study in cardiac surgery, preoperative treatment with SVC was not associated with increased vasoplegia and vasoactive drug consumption.

Objective: The French Society of Anaesthesia and Intensive Care (SFAR) and the French Society of Clinical Pharmacy (SFPC) have joined forces to propose recommendations for professional practice in the prevention of medication errors in anaesthesia and intensive care DESIGN: A group of 19 French experts from the French Society of Anaesthesia and Intensive Care (SFAR) and the French Society of Clinical Pharmacy (SFPC) was assembled. Potential conflicts of interest were formally declared at the outset of the recommendations development process, which was conducted independently of any industry funding. The authors followed the GRADE→ (Grading of Recommendations Assessment, Development and Evaluation) methodology to assess the level of evidence in the literature.

Methods: 4 fields were defined: 1) Work environment and processes; 2) Human and organizational factors; 3) Post-hoc risk management; 4) The problem of drug shortages. For each field, the recommendations aimed to answer several questions formulated by the experts according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive 20-year bibliographic search was conducted, using predefined keywords in accordance with the PRISMA recommendations. Due to the very small number of studies that could provide the necessary power to answer the most important judgment criterion (i.e., medication errors), it was decided, prior to drafting the recommendations, to adopt the format of Professional Practice Guidelines (PPG) rather than Formalized Expert Recommendations. The recommendations were then voted on by all the experts using the GRADE grid method.

Results: For all questions, recommendations could be formulated, either for the entire field of the question or partially. The EXPERT synthesis work and the application of the GRADE method resulted in 29 recommendations concerning the prevention of medication errors in anaesthesia and intensive care. After a round of voting and incorporating a few adjustments, a strong agreement was reached on all the recommendations.

Conclusion: There was strong agreement among the experts on providing recommendations aimed at preventing medication errors in anaesthesia and intensive care.

Background: Effective postoperative pain control is essential for recovery. Pain has long been considered the "fifth vital sign" in the United States, making its assessment routinely documented. However, data on pain and opioid consumption following robotic-assisted surgeries remain limited despite their widespread adoption. This study evaluated pain scores and opioid consumption in patients undergoing intermediate-risk robotic-assisted abdominal, urological, or gynecological procedures. We hypothesized that pain would be minimal (numerical rating scale (NRS < 4)) and opioid use low (< 5 morphine milligram equivalents (MME) within 24 h post-surgery).

Methods: This historical cohort study included consecutive adult patients who underwent intermediate-risk robotic-assisted abdominal, urological, or gynecological surgery between 2013 and 2024. Co-primary endpoints were the maximal NRS and total opioid consumption (MME) at the end of the day of surgery (POD 0). Secondary endpoints included maximal NRS and total MME at the end of postoperative day 1 (POD 1) and the incidence of nausea and vomiting (PONV) in the post-anesthesia care unit.

Results: Among 9,978 cases (57% urological, 34% gynecological, 9% abdominal), median [Q1-Q3] maximal NRS and total MME were 7 [5-8] and 10 mg [4-7] and 8 mg [0-12] on POD 1. PONV occurred in 11% of patients CONCLUSIONS: Contrary to the initial hypothesis, patients undergoing intermediate-risk robotic-assisted procedures experienced higher-than-expected pain scores and moderate opioid consumption on the day of surgery, emphasizing the need to optimize multimodal analgesic strategies for robotic surgery in our center.