Anaesthesia Critical Care & Pain Medicine最新文献

英文中文

Comparison of the bispectral indices of patients receiving remimazolam and propofol for general anesthesia: a randomized crossover trial 比较接受瑞马唑仑和异丙酚全身麻醉的患者的双光谱指数：随机交叉试验。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-15 DOI: 10.1016/j.accpm.2024.101377

Chen Yang , Jing Jiao , Yuyan Nie , Wenyu Shao , Hongwei Zhang , Shaoqiang Huang

Background

Remimazolam is a safe and effective new benzodiazepine sedative that has unique advantages in anesthesia induction and maintenance. The differences in the electroencephalogram bispectral index (BIS) during general anesthesia between propofol and remimazolam deserve further exploration.

Methods

Single-center randomized crossover study. Patients who required multiple hysteroscopic surgery were randomly assigned to use remimazolam (0.27 mg/kg for induction and 1 mg/kg/h for maintenance) first and then propofol (2.0 mg/kg for induction and 6 mg/kg/h for maintenance) during hysteroscopic surgery again 3 months later, or in the opposite order. Both drugs were used at the latest ED₉₅ for unconsciousness. The BIS values (primary endpoint), intraoperative conditions, and incidence of adverse reactions (secondary endpoints) were compared at each time point. BIS values were analyzed with a mixed model of repeated measurements (MMRM).

Results

Seventeen patients completed the study. The lowest BIS value in the remimazolam regimen was significantly higher than that in the propofol regimen (p = 0.001). The MMRM analysis of the BIS values revealed significant differences between the regimens at each time point (p < 0.001). The intraoperative diastolic blood pressure and heart rate changes were smaller, the recovery was faster, and there were fewer adverse reactions and less injection pain, but a greater incidence of intraoperative body movement and hiccups, in the remimazolam regimen.

Conclusion

The trial indicated that remimazolam maintained a higher BIS level than propofol. The correlation between the BIS and the depth of anesthesia induced by remimazolam needs to be further studied.

Trial registration

This trial is registered at ClinicalTrials.gov: ChiCTR2200064551

背景：雷马唑仑是一种安全有效的新型苯二氮卓镇静剂，在麻醉诱导和维持中具有独特的优势。丙泊酚和雷马唑仑在全身麻醉期间脑电图双谱指数（BIS）的差异值得进一步探讨：方法：单中心随机交叉研究。需要多次接受宫腔镜手术的患者被随机分配到先使用瑞马唑仑（0.27 mg/kg 用于诱导，1 mg/kg/h 用于维持），然后在 3 个月后再次接受宫腔镜手术时使用异丙酚（2.0 mg/kg 用于诱导，6 mg/kg/h 用于维持），或者使用相反的顺序。两种药物的使用剂量均为昏迷的最新 ED95。比较了每个时间点的 BIS 值（主要终点）、术中情况和不良反应发生率（次要终点）。BIS 值采用重复测量混合模型（MMRM）进行分析：17名患者完成了研究。瑞马唑仑方案的最低 BIS 值明显高于异丙酚方案（p = 0.001）。对 BIS 值进行的 MMRM 分析表明，各时间点的方案之间存在显著差异（p 结论：BIS 值与异丙酚方案之间存在显著差异（p = 0.001）：试验表明，与异丙酚相比，雷马唑仑能维持更高的 BIS 水平。BIS与雷马唑仑诱导的麻醉深度之间的相关性有待进一步研究：本试验已在 ClinicalTrials.gov 注册：ChiCTR2200064551。

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引用次数: 0

Cefazolin dilemma in perioperative setting. Balancing surgical prophylaxis and allergic reactions 围手术期的头孢唑啉难题。在手术预防和过敏反应之间取得平衡

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-12 DOI: 10.1016/j.accpm.2024.101375

Jose Julio Laguna

引用次数: 0

β-Lactam allergy management: A practical approach for clinical decision-making β-内酰胺过敏管理：临床决策实用方法》。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-11 DOI: 10.1016/j.accpm.2024.101371

Florian Blanchard , Sarah Guegan , Laurent Chouchana , Etienne Canouï , Caroline Charlier

引用次数: 0

Comment on Effect of continuous infusion of hypertonic saline solution on survival of patients with brain injury: a systematic review and meta-analysis 评论：持续输注高渗盐水对脑损伤患者存活率的影响：系统综述和荟萃分析。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-11 DOI: 10.1016/j.accpm.2024.101369

Xueying Tan , Jieying Tan

引用次数: 0

Association of medical care capacity and the patient mortality of septic shock: a cross-sectional study 医疗护理能力与脓毒性休克患者死亡率的关系：一项横断面研究。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-08 DOI: 10.1016/j.accpm.2024.101364

Lu Wang , Xudong Ma , Yehan Qiu , Yujie Chen , Sifa Gao , Huaiwu He , Longxiang Su , Shabai Dai , Yanhong Guo , Wenhu Wang , Guangliang Shan , Yaoda Hu , Dawei Liu , Zhi Yin , Chang Yin , Xiang Zhou , on behalf of China National Critical Care Quality Control Centre Group (China-NCCQC)

Background

Hospitals with higher septic shock case volume demonstrated lower hospital mortality. We conducted this study to investigate whether this phenomenon was only caused by the increase in the number of admissions or the need to improve the medical care capacity in septic shock at the same time.

Methods

Seven-hundred and eighty-seven hospitals from China collected in a survey from January 1, 2021 to December 31, 2021. Medical care capacity for septic shock was explored by patients with septic shock in intensive care units (ICU) divided into beds, intensivists, and nurses respectively.

Main results

The proportion of ICU patients with septic shock was negatively associated with the patient mortality of septic shock (Estimate [95%CI], −0.2532 [-0.5038, -0.0026]) (p-value 0.048). The ratios of patients with septic shock to beds, intensivists, and nurses were negatively associated with mortality of septic shock (Estimate [95%CI], −0.370 [−0.591, −0.150], −0.136 [−0.241, −0.031], and −0.774 [−1.158, −0.389]) (p-value 0.001, 0.011 and < 0.001). Severe pneumonia, the most common infection that caused a septic shock, correlated positively with its mortality (Estimate [95%CI], 0.1002 [0.0617, 0.1387]) (p-value < 0.001).

Conclusions

Hospitals with higher medical care capacity for septic shock were associated with lower hospital mortality.

背景：脓毒性休克病例量较多的医院的住院死亡率较低。我们开展了这项研究，以探讨这一现象是否仅由入院人数增加引起，还是需要同时提高脓毒性休克的医疗护理能力：方法：调查收集了中国 787 家医院 2021 年 1 月 1 日至 2021 年 12 月 31 日的数据。主要结果：重症监护病房（ICU）脓毒性休克患者按床位、重症医生和护士分别划分，探讨了脓毒性休克的医疗护理能力：ICU脓毒性休克患者的比例与脓毒性休克患者的死亡率呈负相关（估计值[95%CI]，-0.2532 [-0.5038，-0.0026]）（P 值为 0.048）。脓毒性休克患者与病床、重症监护医师和护士的比率与脓毒性休克死亡率呈负相关（估计值[95%CI]、-0.370 [-0.591、-0.150]、-0.136 [-0.241、-0.031]和-0.774 [-1.158、-0.389]）（P值分别为0.001、0.011和<0.001）。重症肺炎是导致脓毒性休克的最常见感染，与死亡率呈正相关（估计值[95%CI]，0.1002 [0.0617, 0.1387]）（P值<0.001）：结论：脓毒性休克医疗护理能力越强的医院，其住院死亡率越低。

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引用次数: 0

Exploring congestion endotypes and their distinct clinical outcomes among ICU patients: A post-hoc analysis 探索重症监护病房患者的拥挤内型及其不同的临床结果：事后分析

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-08 DOI: 10.1016/j.accpm.2024.101370

Pierre-Gregoire Guinot , Dan Longrois , Stefan Andrei , Maxime Nguyen , Belaid Bouhemad , CodOrea study group

Background

In the intensive care unit (ICU) patients, fluid overload and congestion are associated with worse outcomes. Because of the heterogeneity of ICU patients, we hypothesized that there may exist different endotypes of congestion. The aim of this study was to identify endotypes of congestion and their association with outcomes.

Methods

We conducted an unsupervised hierarchical clustering analysis on 145 patients admitted to ICU to identify endotypes. We measured several parameters related to clinical context, volume status, filling pressure, and venous congestion. These parameters included NT-proBNP, central venous pressure (CVP), the mitral E/e' ratio, the systolic/diastolic ratio of hepatic veins' flow velocity, the mean diameter of the inferior vena cava (IVC) and its variations, stroke volume changes following passive leg raising, the portal vein pulsatility index, and the venous renal impedance index.

Results

Three distinct endotypes were identified: (1) “hemodynamic congestion” endotype (n = 75) with moderate alterations of ventricular function, increased CVP and left filling pressure values, and moderate fluid overload; (2) “volume overload congestion” endotype (n = 50); with normal cardiac function and filling pressure despite high positive fluid balance (fluid overload); (3) “systemic congestion” endotype (n = 20) with severe alterations of left and right ventricular functions, increased CVP and left ventricular filling pressure values. These endotypes vary significantly in ICU admission reasons, acute kidney injury rates, mortality, and length of ICU/hospital stay.

Conclusions

Our analysis revealed three unique congestion endotypes in ICU patients, each with distinct pathophysiological features and outcomes. These endotypes are identifiable through key ultrasonographic characteristics at the bedside.

Clinical trial gov

NCT04680728.

背景：在重症监护室（ICU）患者中，液体超负荷和充血与较差的预后有关。由于重症监护室患者的异质性，我们假设可能存在不同的充血内型。本研究旨在确定充血的内型及其与预后的关系：我们对 145 名入住重症监护室的患者进行了无监督分层聚类分析，以确定内型。我们测量了与临床环境、容量状态、充盈压和静脉充血相关的几个参数。这些参数包括 NT-proBNP、中心静脉压（CVP）、二尖瓣 E/e' 比值、肝静脉流速的收缩/舒张比值、下腔静脉（IVC）的平均直径及其变化、被动抬腿后的每搏容量变化、门静脉搏动指数和静脉肾阻抗指数：结果：确定了三种不同的内型：(1）"血流动力学充血 "内型（n = 75），心室功能中度改变，CVP 和左心室充盈压值升高，液体中度超负荷；（2）"容量超负荷充血 "内型（n = 50）；尽管液体高度正平衡（液体超负荷），但心功能和充盈压正常；（3）"全身充血 "内型（n = 20），左心室和右心室功能严重改变，CVP 和左心室充盈压值升高。这些内型在重症监护室入院原因、急性肾损伤率、死亡率和重症监护室/住院时间等方面均有显著差异：我们的分析揭示了 ICU 患者的三种独特充血内型，每种内型都有不同的病理生理特征和结果。这些内型可通过床旁的关键超声波特征进行识别：NCT04680728。

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引用次数: 0

Nosocomial infections after cardiac surgery in children from low- to middle- income countries operated in West-Switzerland 在瑞士西部接受手术的中低收入国家儿童心脏手术后的非医院感染。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-07 DOI: 10.1016/j.accpm.2024.101367

Vladimir L. Cousin , Raphael Joye , Tornike Sologashvili , Julie Wacker , Angelo Polito

引用次数: 0

Ten considerations about viscoelastometric tests 粘弹性测试的十项注意事项。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-07 DOI: 10.1016/j.accpm.2024.101366

Alexandre Mansour , Anne Godier , Thomas Lecompte , Stéphanie Roullet

引用次数: 0

Relationship between muscle mass ratio and rocuronium dose required for maintaining deep neuromuscular blockade: A prospective observational study 肌肉质量比与维持深度神经肌肉阻滞所需的罗库溴铵剂量之间的关系：一项前瞻性观察研究。

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-07 DOI: 10.1016/j.accpm.2024.101368

Jiwon Han , Ah-Young Oh , Jung-Won Hwang , Sun Woo Nam

Background

Deep neuromuscular blockade (NMB) has benefits in various surgical procedures, however, precise quantitative neuromuscular monitoring is crucial for its proper maintenance and recovery. Neuromuscular blocking agent dosage relies on actual body weight (ABW), but this varies among individuals. Therefore, this study hypothesizes that there is a correlation between the rocuronium requirement for deep NMB and muscle mass ratio measured by bioelectric impedance analysis.

Methods

Ninety adult female patients undergoing laparoscopic operation were enrolled in this study. Muscle and fat masses were assessed using a body composition analyser. Deep NMB, defined as a post-tetanic count of 1–2, was maintained through the continuous infusion of rocuronium. The primary outcome involves determining the correlation between the rocuronium dose required for deep NMB and the muscle mass ratio. Conversely, secondary outcomes included assessing the relationship between the rocuronium dose for deep NMB and fat mass ratio, and ABW. Additionally, we investigated their relationship with rocuronium onset time and profound blockade duration.

Results

No relationship was observed between the muscle mass ratio and rocuronium dose required for maintaining deep NMB (r = 0.059 [95% CI = 0.153–0.267], p = 0.586). Fat mass ratio and ABW showed no correlation with the rocuronium dose, whereas rocuronium onset time was positively correlated with muscle mass ratio (r = 0.327) and negatively correlated with fat mass ratio (r = −0.302), respectively. Profound blockade duration showed no correlation with any of the assessed variables.

Conclusions

No correlation was detected between muscle mass ratio and the rocuronium dose required to achieve deep NMB.

背景：深度神经肌肉阻滞（NMB）在各种外科手术中都有益处，然而，精确的定量神经肌肉监测对其正常维持和恢复至关重要。神经肌肉阻滞剂的用量取决于实际体重（ABW），但这因人而异。因此，本研究假设深部 NMB 所需的罗库溴铵与生物电阻抗分析测得的肌肉质量比之间存在相关性：方法：本研究选取了 90 名接受腹腔镜手术的成年女性患者。使用人体成分分析仪评估肌肉和脂肪质量。通过持续输注罗库溴铵维持深度阻滞，深度阻滞的定义是泰坦后计数为 1-2。主要结果包括确定深度阻滞所需的罗库溴铵剂量与肌肉质量比之间的相关性。相反，次要结果包括评估罗库溴铵剂量、脂肪质量比和 ABW 之间的关系。此外，我们还研究了它们与罗库溴铵起效时间和深度阻滞持续时间之间的关系：结果：肌肉质量比与维持深度阻滞所需的罗库溴铵剂量之间没有关系（r = 0.059 [95% CI = 0.153 - 0.267]，p = 0.586）。脂肪质量比和 ABW 与罗库溴铵剂量无相关性，而罗库溴铵起效时间分别与肌肉质量比（r=0.327）和脂肪质量比（r=-0.302）呈正相关和负相关。深度阻滞持续时间与任何评估变量均无相关性：结论：肌肉质量比与实现深度阻滞所需的罗库溴铵剂量之间没有相关性。

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The effect of the COVID-19 pandemic on paediatric anaesthesia research as evidenced by the contrasting recruitment experiences of centres in Australia and Scotland COVID-19大流行对儿科麻醉研究的影响--从澳大利亚和苏格兰中心截然不同的招聘经验中可见一斑：作者

IF 5.5 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine

Pub Date : 2024-03-07 DOI: 10.1016/j.accpm.2024.101365

Britta S. von Ungern-Sternberg , Aine Sommerfield , David Sommerfield , Thomas Engelhardt , Graham Wilson

引用次数: 0

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