Anaesthesia Critical Care & Pain Medicine最新文献

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).

Background: Proximal femur fractures (PFF) are common in the elderly, representing a significant public health issue. This study aims to define the epidemiology and morbidity of PFF and identify factors associated with 90-day mortality in patients with osteoporotic PFF.

Methods: We conducted a retrospective, bicentric, observational study in Marseille from November 2018 to June 2023, including patients operated for osteoporotic PFF. Clinical, biological, therapeutic, and socio-economic data were collected to analyse their influence on 90-day mortality and construct a mortality predictive model using a neural network.

Results: During the study period, 2,442 patients were included, the mean age at diagnosis being 81 (13.7) years. The 279 (11.4%)non-survivors at 90 days were older (87.2 (0.8) vs. 79.8 (0.3) years; p < 0.0001), predominantly males (36.6% vs. 27.8%; p = 0.003), and had higher Charlson score (1[0-3] vs. 1[0-2]; p < 0.0001) and ASA score (3[3-3] vs. 3[2-3]; p < 0.0001). No significant differences were found in the use of cement, type of anaesthesia, and socio-economic level. A neural network predictive model for 90-day mortality included age, gender, ASA score, perioperative confusion, and haemoglobin, creatinine, and albumin at inclusion. The model performed with an area under the receiving operating characteristic curve of 0.91 [0.91-0.92], sensitivity of 50.5%, specificity of 75.0%, positive predictive value of 20.6%, and negative predictive value of 92.1% on the test set.

Conclusion: Our results provide interesting elements to optimize the perioperative management of these patients. The future perspectives include validating the predictive model on external cohorts and integrating new variables to improve its accuracy.

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.