Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Efficacy of ultrasound guided sphenopalatine ganglion block in management of emergence agitation after sinoscopic nasal surgery: a randomized double-blind controlled study","authors":"Rasha Hamed ,&nbsp;Loay Gamal ,&nbsp;Saeid Elsawy ,&nbsp;Mohammed Abdelmoneim Baker ,&nbsp;Yara Hamdy Abbas","doi":"10.1016/j.accpm.2024.101429","DOIUrl":"10.1016/j.accpm.2024.101429","url":null,"abstract":"<div><h3>Background</h3><div>Nasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA.</div></div><div><h3>Objectives</h3><div>This study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption.</div></div><div><h3>Patients and methods</h3><div>This double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side.</div></div><div><h3>Results</h3><div>A significant decrease in the incidence of EA was found in G1 compared to G2 (20% <em>vs</em>. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h <em>vs</em>. 3 h).</div></div><div><h3>Conclusion</h3><div>SPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery.</div></div><div><h3>Registration</h3><div>National Clinical Trial Registry, NCT04168879.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101429"},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376183","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}

{"title":"Effect of perioperative erythropoietin on postoperative morbidity and mortality after cardiac surgery: a meta-analysis of randomized controlled trials","authors":"Dana Abraham ,&nbsp;Dror B. Leviner ,&nbsp;Tom Ronai ,&nbsp;Naama Schwartz ,&nbsp;Amos Levi ,&nbsp;Erez Sharoni","doi":"10.1016/j.accpm.2024.101428","DOIUrl":"10.1016/j.accpm.2024.101428","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiac surgery is known to have high rates of perioperative red blood cell (RBC) transfusions which are associated with increased postoperative mortality and morbidity. Perioperative erythropoietin (EPO) has been suggested to lower perioperative RBC transfusions, and the effect on postoperative morbidity or mortality is unknown.</div></div><div><h3>Methods</h3><div>The registered study protocol is available on PROSPERO (CRD42022314538). We searched the Pubmed, EMbase, and Cochrane CENTRAL databases for randomized controlled trials (RCT) of EPO in cardiac surgery. Outcomes were short-term mortality, acute kidney injury (AKI), re-operation, cerebrovascular accident (CVA), perioperative myocardial infarction (MI), infectious complications, and RBC transfusions. RCT studies of perioperative EPO that reported at least one prespecified outcome of interest were included.</div></div><div><h3>Results</h3><div>A total of 21 RCT’s (n = 2,763 patients) were included. Mortality analysis included 17 studies (EPO 1,272 patients, control 1,235) and showed no significant difference (risk difference (RD) 0.0004, 95%CI: −0.016, 0.009). EPO did not reduce the incidence of AKI (RD −0.006, 95% CI: −0.038, 0.026) and reoperation (RD 0.001, 95% CI: −0.013, 0.015). The incidence of CVA (RD −0.004, 95% CI: −0.015, 0.007) and perioperative MI (RD −0.008, 95% CI: −0.021, 0.005) was similar between the groups.</div></div><div><h3>Conclusions</h3><div>Although EPO had been proven to reduce perioperative RBC transfusions, we did not find that it reduces the incidence of postoperative short-term mortality, AKI, and reoperation. The study results support that perioperative EPO is also safe, with no rise in thrombotic events, including CVA and perioperative MI.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101428"},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376182","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}

{"title":"Propofol does not alter the protein binding and unbound concentration of lidocaine at clinically targeted plasma concentrations in vitro – A short communication","authors":"Angela R Tognolini ,&nbsp;Jason A Roberts ,&nbsp;Saurabh Pandey ,&nbsp;Steven C Wallis ,&nbsp;Victoria A Eley","doi":"10.1016/j.accpm.2024.101419","DOIUrl":"10.1016/j.accpm.2024.101419","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous lidocaine is increasingly used as an analgesic adjunct during general anaesthesia. Lidocaine is highly protein-bound and changes to binding can alter drug efficacy or toxicity. We aimed to measure the effect of various propofol and lidocaine plasma concentration combinations on the protein binding and concentration of lidocaine <em>in vitro</em>.</div></div><div><h3>Methods</h3><div>Known targeted concentrations of propofol and lidocaine were added to drug-free human plasma <em>in vitro</em>. Samples were prepared and analysed in various clinically relevant concentration combinations; propofol at 0, 2, 4 and 6 µg/mL, and lidocaine at 1, 3 and 5 µg/mL. The total and unbound concentrations of lidocaine were measured by ultra-high performance liquid chromatography-mass spectrometry and percentage protein binding was determined. Data were presented as mean and standard deviation (SD) and differences between groups analysed.</div></div><div><h3>Results</h3><div>The overall mean protein binding of lidocaine was 68.8% (SD 5.5, range 57.5–80.9%). Beta regression analysis revealed no statistically significant difference in lidocaine percentage binding across a range of propofol and lidocaine concentration combinations.</div></div><div><h3>Conclusion</h3><div>Propofol did not alter the unbound and free pharmacologically active proportion of lidocaine at different clinically targeted concentrations of propofol and lidocaine in plasma <em>in vitro</em>. The percentage of plasma protein binding of lidocaine in this study was consistent with previously published results.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101419"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876429","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}

{"title":"The efficacy of magnesium sulphate in preventing laryngospasm in paediatric patients undergoing general anaesthesia: A systematic review and meta-analysis of randomised control trials","authors":"Mohammad Ahmed Rasheed ,&nbsp;Danyal Memon ,&nbsp;Clare Keaveney Jimenez ,&nbsp;Asad Zafar ,&nbsp;Haaris Shiwani","doi":"10.1016/j.accpm.2024.101413","DOIUrl":"10.1016/j.accpm.2024.101413","url":null,"abstract":"<div><h3>Background</h3><div>Laryngospasm is sustained closure of the airways and can be a life-threatening condition. Magnesium sulphate is postulated to reduce the incidence of laryngospasm if administered peri-operatively. This systematic review and meta-analysis was performed to assess the efficacy of magnesium sulphate in preventing peri-operative laryngospasm in paediatric patients undergoing non-cardiac surgery.</div></div><div><h3>Methods</h3><div>Four databases and a trial registry were searched. Inclusion criteria were paediatric patients undergoing general anaesthesia. Exclusion criteria were patients who underwent cardiopulmonary bypass during surgery. The intervention of interest was the peri-operative administration of magnesium sulphate. The intervention was compared to either a placebo or other pharmacological agent.</div><div>The primary outcome was the incidence of laryngospasm. A meta-analysis of all studies was performed. Sub-group analysis was subsequently performed.</div></div><div><h3>Results</h3><div>A total of 953 patients from 13 trials were included in this study. Nine RCTs administered magnesium intravenously and 4 RCTs administered magnesium locally. Laryngospasm rates were 6% lower in the magnesium group (OR 0.48 [95% CI 0.25–0.96], <em>p</em> = 0.04) compared to control in the pooled data. Subgroup analysis showed laryngospasm rates were lower by 12.5% (Odds Ratio 0.26 [CI 0.09–0.76], <em>p</em> = 0.01) in the local magnesium group. Subgroup analysis of studies that only administered intravenous magnesium did not show a statistically significant difference in the incidence of laryngospasm (OR 0.73 [95% CI 0.33–1.63], <em>p</em> = 0.44).</div></div><div><h3>Conclusions</h3><div>This review shows a potential role for magnesium in the prevention of laryngospasm in paediatric patients undergoing general anaesthesia. There is a correlation between local administration of magnesium and reduction in laryngospasm rates. Further studies are required to assess the efficacy of intravenous magnesium in prevention of laryngospasm.</div></div><div><h3>Registration</h3><div>Prospective Register of Systematic Reviews (PROSPERO); PROSPERO ID CRD42022307868 (<span><span>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022307868</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101413"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876431","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}

{"title":"Preoperative anaesthesia and other team meetings for complex cases: a narrative review","authors":"Antoine Baumann ,&nbsp;Dan Benhamou","doi":"10.1016/j.accpm.2024.101421","DOIUrl":"10.1016/j.accpm.2024.101421","url":null,"abstract":"<div><h3>Background</h3><div>The conventional two-step process for surgical procedures – surgical followed by anaesthetic consultation - may not adequately address the needs of complex cases involving high-risk patients or procedures, leading to increased risks of adverse events. Although surgical team meetings (STM) and multidisciplinary team meetings (MDTM) were implemented many years ago, anaesthesia team meetings (ATM) have recently emerged as potential solutions to enhance perioperative management.</div></div><div><h3>Purpose</h3><div>We aim to systematically review and summarize the existing literature that reflects the main theoretical approaches, practices, effects, and clinical relevance of preoperative team meetings - with specific consideration to preoperative ATM - in managing difficult cases.</div></div><div><h3>Methods</h3><div>We performed a narrative review of the literature (1980–2024) to identify studies focusing on the practice and the impact of preoperative meetings on patient outcomes, compliance with treatment plans, and teamwork quality. We provide here a qualitative synthesis of the findings.</div></div><div><h3>Results</h3><div>Fourteen studies were identified: 11 consider preoperative multidisciplinary team meeting (MDTM), 2 consider preoperative surgical team meeting (STM), and only one anaesthesia team meeting (ATM).</div></div><div><h3>Conclusions</h3><div>There is currently not enough robust evidence that preoperative team meetings clearly improve hard patient’s outcome parameters. And the place for ATM does not appear to have been studied to date. There is a need for well-designed studies to explore the impact of preoperative ATM on clinical practice improvement, quality of care, and patient outcomes.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101421"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890599","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}

{"title":"How green is my reusable bronchoscope?","authors":"Nicolas Massart ,&nbsp;Christophe Millet ,&nbsp;Hélène Beloeil ,&nbsp;Pierre Fillatre ,&nbsp;Caroline Rouxel ,&nbsp;Magalie Daudin ,&nbsp;Nicolas Coullier ,&nbsp;Véronique Marie ,&nbsp;Elodie Peguet ,&nbsp;Pierre Bardoult","doi":"10.1016/j.accpm.2024.101420","DOIUrl":"10.1016/j.accpm.2024.101420","url":null,"abstract":"<div><h3>Introduction</h3><div>Single-use bronchoscopes have replaced reusable ones in many institutions. This study aimed to evaluate the environmental and financial impacts of both strategies: reusable and single-use bronchoscopes.</div></div><div><h3>Material and methods</h3><div>We conducted a pragmatic study in a 21-bed polyvalent ICU, in Saint-Brieuc, Bretagne, France. The eco-audit consisted of estimating greenhouse gas (GHG) emissions, considering the life cycle of each strategy. Greenhouse gas (GHG) emissions related to construction, packaging, transport and waste elimination were compared between 2 devices: the reusable bronchoscope, a Pentax® FI-16RBS that was disinfected twice daily; and the single-use bronchoscope, the bronchoflex agile® from TSC.</div></div><div><h3>Results</h3><div>For the reusable bronchoscope, GHG emissions were marginally impacted by the number of bronchoscopies performed (from 185 kg eq.CO₂ per year to 192 kg eq.CO₂ for 10 or 110 bronchoscopies per year). For the reusable device, GHG emissions directly depended on the number of bronchoscopies performed with 3.82 kg eq.CO₂ emitted per bronchoscopy. The breakeven point for the reusable bronchoscope was estimated at 50 bronchoscopies in terms of GHG emissions and 96 bronchoscopies for financial considerations.</div></div><div><h3>Conclusion</h3><div>Considering current practice in our ICU, reusable bronchoscopes have lower GHG emissions when used more than 50 times a year and a lower cost when used more than 96 times a year as compared with single-use bronchoscopes.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101420"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876425","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}

{"title":"Comparison of two different positions of an anaesthesiologist for ease of endotracheal intubation in adult patients: A randomised control trial","authors":"Poonam Kumari,&nbsp;Amarjeet Kumar,&nbsp;Chandni Sinha,&nbsp;Ajeet Kumar,&nbsp;Kunal Singh","doi":"10.1016/j.accpm.2024.101422","DOIUrl":"10.1016/j.accpm.2024.101422","url":null,"abstract":"<div><h3>Background and aims</h3><div>Maintaining the airway with a cuffed endotracheal tube (ETT) in the trachea remains one of the most essential anaesthesia skills. Many parameters were described to assess the difficulty of intubation in the preoperative period, but none allow the prediction of all difficult intubations. The correct posture of the anaesthesiologist is also an important factor for successful endotracheal intubation. The aim of this study was. This study aimed to compare the impact of two different positions of an anaesthesiologist (sitting <em>vs</em>. standing) at the time of endotracheal intubation.</div></div><div><h3>Methods</h3><div>One hundred ten American Society of Anaesthesiologists (ASA) Physical Status I/II patients, aged between 17 to 65 years, Mallampati grade I/II, mouth opening 39–70 mm, thyromental distance (TMD) 6–6.5 cm, and sternomental distance (SMD) &gt;13 cm, scheduled for elective laparoscopic cholecystectomy, were recruited. Patients were divided into two groups; Group I consisted of patients who underwent endotracheal intubation by an anaesthesiologist in a sitting posture, while Group II encompassed patients who underwent endotracheal intubation by anaesthesiologists in a standing posture. Assessment parameters include ease of intubation (IDS score), intubation time, intubation success rate, number of attempts, grade of laryngoscopy (Cormack Lehane score, POGO score), and complications like tooth and soft tissue damage.</div></div><div><h3>Results</h3><div>The ease of intubation was higher in group I, 1(0–1), than in group II, 1(1−2) (<em>p</em> =  0.02), and there was a significant difference between the two groups. The Cormack Lehane grade (CL) was I/IIa/IIb/III in 19/23/13/0 in group I and I/IIa/IIb/III in 13/21/18/3 in group II. The first-attempt intubation success rate for groups I and II was 94.54 % and 92.72 % respectively.</div></div><div><h3>Conclusion</h3><div>The sitting posture of an anaesthesiologist at the time of laryngoscopy provides a better intubating condition when compared with the standing posture.</div></div><div><h3>Registration</h3><div>Clinical Trial Registry - India (CTRI) CTRI/2023/03/050371.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101422"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879690","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}

{"title":"Methodological challenges in rapid molecular testing for pneumonia: Insights and future directions for performing “the perfect” study","authors":"Antoni Torres ,&nbsp;Laia Fernández-Barat","doi":"10.1016/j.accpm.2024.101415","DOIUrl":"10.1016/j.accpm.2024.101415","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101415"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876427","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}

{"title":"Combined hypoglossal and lingual nerve palsy: An unrecognized complication after orotracheal intubation for general anaesthesia. A case report of a day surgery patient and a literature review","authors":"Laure Cazenave ,&nbsp;Philippe Mahiou ,&nbsp;John Swan ,&nbsp;Philippe Clavert ,&nbsp;Johannes Barth","doi":"10.1016/j.accpm.2024.101418","DOIUrl":"10.1016/j.accpm.2024.101418","url":null,"abstract":"<div><div>Cranial nerve injury after orotracheal intubation is a rare complication, which has varied etiology. We present a case of combined unilateral hypoglossal and lingual nerve palsy after orotracheal intubation. The current literature was reviewed for the diagnostic, treatment, follow-up, and preventive measures of this complication.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101418"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879689","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}

{"title":"Universal use of videolaryngoscope for all intubations in the ICU: The time is now!","authors":"Clément Monet ,&nbsp;Philippe Richebé ,&nbsp;Samir Jaber","doi":"10.1016/j.accpm.2024.101417","DOIUrl":"10.1016/j.accpm.2024.101417","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101417"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876432","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}