Pub Date : 2024-03-26DOI: 10.1101/2024.03.22.24304763
Ana Gutierrez del Arroyo, Tom. E. F. Abbott, Akshaykumar Patel, Salma Begum, Priyanthi Dias, David Brealey, Rupert M. Pearse, Vikas Kapil, Gareth L. Ackland, the SPACE trial investigators
Background Hypertension therapy in older adults is often suboptimal, in part due to inadequate suppression of the renin-angiotensin-aldosterone system (RAAS). We hypothesised that distinct endotypes of RAAS activation before noncardiac surgery are associated with increased risk of myocardial injury.
{"title":"Preoperative activation of the Renin–Angiotensin system and myocardial injury in noncardiac surgery: Post Hoc Analysis of the SPACE randomised controlled Trial","authors":"Ana Gutierrez del Arroyo, Tom. E. F. Abbott, Akshaykumar Patel, Salma Begum, Priyanthi Dias, David Brealey, Rupert M. Pearse, Vikas Kapil, Gareth L. Ackland, the SPACE trial investigators","doi":"10.1101/2024.03.22.24304763","DOIUrl":"https://doi.org/10.1101/2024.03.22.24304763","url":null,"abstract":"<strong>Background</strong> Hypertension therapy in older adults is often suboptimal, in part due to inadequate suppression of the renin-angiotensin-aldosterone system (RAAS). We hypothesised that distinct endotypes of RAAS activation before noncardiac surgery are associated with increased risk of myocardial injury.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140312007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.14.24304307
Ravi Pal, Akos Rudas, Kim Sungsoo, Jeffrey Chiang, Maxime Cannesson
Arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms contain valuable clinical information and play a crucial role in cardiovascular health monitoring, medical research, and managing medical conditions. The features extracted from PPG waveforms have various clinical applications ranging from blood pressure monitoring to nociception monitoring, while features from ABP waveforms can be used to calculate cardiac output and predict hypertension or hypotension. In recent years, many machine learning models have been proposed to utilize both PPG and ABP waveform features for these healthcare applications. However, the lack of standardized tools for extracting features from these waveforms could potentially affect their clinical effectiveness. In this paper, we propose an automatic signal processing tool for extracting features from ABP and PPG waveforms. Additionally, we generated a PPG feature library from a large perioperative dataset comprising 17,327 patients using the proposed tool. This PPG feature library can be used to explore the potential of these extracted features to develop machine learning models for non-invasive blood pressure estimation.
{"title":"A signal processing tool for extracting features from arterial blood pressure and photoplethysmography waveforms","authors":"Ravi Pal, Akos Rudas, Kim Sungsoo, Jeffrey Chiang, Maxime Cannesson","doi":"10.1101/2024.03.14.24304307","DOIUrl":"https://doi.org/10.1101/2024.03.14.24304307","url":null,"abstract":"Arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms contain valuable clinical information and play a crucial role in cardiovascular health monitoring, medical research, and managing medical conditions. The features extracted from PPG waveforms have various clinical applications ranging from blood pressure monitoring to nociception monitoring, while features from ABP waveforms can be used to calculate cardiac output and predict hypertension or hypotension. In recent years, many machine learning models have been proposed to utilize both PPG and ABP waveform features for these healthcare applications. However, the lack of standardized tools for extracting features from these waveforms could potentially affect their clinical effectiveness. In this paper, we propose an automatic signal processing tool for extracting features from ABP and PPG waveforms. Additionally, we generated a PPG feature library from a large perioperative dataset comprising 17,327 patients using the proposed tool. This PPG feature library can be used to explore the potential of these extracted features to develop machine learning models for non-invasive blood pressure estimation.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140149128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-14DOI: 10.1101/2024.03.11.24304135
Yahui Li, Chunxia Zhao, Ling Zhou, Xindi Yue, Dao Wen Wang, Feng Wang
Objective To compare the long-term prognosis of patients who experienced acute ST-segment elevation myocardial infarction and underwent either late percutaneous coronary intervention (PCI) within a period of 2 days to less than 1 week or more advanced PCI within 1 week to less than 1 month. Methods We enrolled 198 patients from Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, between June 2019 and August 2022. These patients had experienced acute ST-segment elevation myocardial infarction and underwent either late PCI or more advanced PCI. Long-term follow-up was conducted through outpatient clinic visits or telephone interviews. The study endpoints included all-cause death, nonfatal myocardial infarction, and New York Heart Association class IV heart failure. We utilized the Kaplan-Meier method to illustrate the cumulative incidence of endpoint events in both patient groups. Statistical significance in survival differences was assessed using the log-rank test. Additionally, the Cox proportional risk model was employed to analyze whether the timing of late revascularization procedures had an impact on the long-term prognosis of the patients. Results Among the 198 patients included in the study, 108 underwent late PCI, while 90 underwent more advanced PCI. The majority were male (73.74%), with an average age of 62 ± 13 years. The follow-up period averaged 20 (15, 28) months, and all patients successfully completed the follow-up process. Analysis based on the Kaplan-Meier method revealed that the incidence of all-cause death [11.1% vs. 5.6%, P=0.165], nonfatal myocardial infarction [7.4% vs. 7.8%, P=0.922], New York Heart Association class IV heart failure [2.8% vs. 3.3%, P>0.999], and the composite endpoint [18.5% vs. 14.4%, P=0.444] were not statistically significant between the late PCI and more advanced PCI groups. After adjusting for factors like left ventricular ejection fraction, renin-angiotensin system inhibitors, ?-blockers, and statins, the results still indicated no statistically significant differences between the two groups in terms of rates for all-cause death, recurrent myocardial infarction, New York Heart Association class IV heart failure, and composite endpoints (P=0.05). Conclusion This study's 20 (15, 28) months follow-up suggests that patients experiencing acute ST-segment elevation myocardial infarction have a comparable prognosis regardless of whether they underwent late or more advanced PCI.
目的 比较急性ST段抬高型心肌梗死患者在2天至1周内接受晚期经皮冠状动脉介入治疗（PCI）或在1周至1个月内接受更高级PCI治疗的长期预后。方法 我们在2019年6月至2022年8月期间从华中科技大学同济医学院附属同济医院招募了198名患者。这些患者都曾经历过急性ST段抬高型心肌梗死，并接受了晚期PCI或更先进的PCI治疗。通过门诊就诊或电话访谈进行长期随访。研究终点包括全因死亡、非致死性心肌梗死和纽约心脏协会 IV 级心力衰竭。我们采用 Kaplan-Meier 法来说明两组患者终点事件的累积发生率。生存率差异的统计学意义采用对数秩检验进行评估。此外，还采用了 Cox 比例风险模型来分析晚期血管重建手术的时机是否会对患者的长期预后产生影响。结果 在纳入研究的198名患者中，108人接受了晚期PCI，90人接受了更高级的PCI。大多数患者为男性（73.74%），平均年龄为 62±13 岁。随访时间平均为 20（15，28）个月，所有患者均顺利完成了随访过程。基于卡普兰-梅耶法的分析显示，全因死亡[11.1% vs. 5.6%，P=0.165]、非致死性心肌梗死[7.4% vs. 7.8%，P=0.922]、纽约心脏协会Ⅳ级心衰[2.8% vs. 3.3%，P>0.999]和复合终点[18.5% vs. 14.4%，P=0.444]的发生率在PCI晚期组和PCI晚期组之间无统计学意义。在对左心室射血分数、肾素-血管紧张素系统抑制剂、阻断剂和他汀类药物等因素进行调整后，结果显示两组在全因死亡、复发性心肌梗死、纽约心脏协会 IV 级心衰和复合终点的发生率方面仍无统计学差异（P=0.05）。结论 本研究 20 个月（15 个月，28 个月）的随访结果表明，急性 ST 段抬高型心肌梗死患者无论接受晚期还是更晚期的 PCI 治疗，其预后都相当。
{"title":"Advanced and more advanced revascularization in STEMI patients: which is better?","authors":"Yahui Li, Chunxia Zhao, Ling Zhou, Xindi Yue, Dao Wen Wang, Feng Wang","doi":"10.1101/2024.03.11.24304135","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304135","url":null,"abstract":"Objective To compare the long-term prognosis of patients who experienced acute ST-segment elevation myocardial infarction and underwent either late percutaneous coronary intervention (PCI) within a period of 2 days to less than 1 week or more advanced PCI within 1 week to less than 1 month. Methods We enrolled 198 patients from Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, between June 2019 and August 2022. These patients had experienced acute ST-segment elevation myocardial infarction and underwent either late PCI or more advanced PCI. Long-term follow-up was conducted through outpatient clinic visits or telephone interviews. The study endpoints included all-cause death, nonfatal myocardial infarction, and New York Heart Association class IV heart failure. We utilized the Kaplan-Meier method to illustrate the cumulative incidence of endpoint events in both patient groups. Statistical significance in survival differences was assessed using the log-rank test. Additionally, the Cox proportional risk model was employed to analyze whether the timing of late revascularization procedures had an impact on the long-term prognosis of the patients. Results Among the 198 patients included in the study, 108 underwent late PCI, while 90 underwent more advanced PCI. The majority were male (73.74%), with an average age of 62 ± 13 years. The follow-up period averaged 20 (15, 28) months, and all patients successfully completed the follow-up process. Analysis based on the Kaplan-Meier method revealed that the incidence of all-cause death [11.1% vs. 5.6%, P=0.165], nonfatal myocardial infarction [7.4% vs. 7.8%, P=0.922], New York Heart Association class IV heart failure [2.8% vs. 3.3%, P>0.999], and the composite endpoint [18.5% vs. 14.4%, P=0.444] were not statistically significant between the late PCI and more advanced PCI groups. After adjusting for factors like left ventricular ejection fraction, renin-angiotensin system inhibitors, ?-blockers, and statins, the results still indicated no statistically significant differences between the two groups in terms of rates for all-cause death, recurrent myocardial infarction, New York Heart Association class IV heart failure, and composite endpoints (P=0.05). Conclusion This study's 20 (15, 28) months follow-up suggests that patients experiencing acute ST-segment elevation myocardial infarction have a comparable prognosis regardless of whether they underwent late or more advanced PCI.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140129447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-09DOI: 10.1101/2024.03.07.24303826
Stefan Borik, Hau-Tieng Wu, Kirk H. Shelley, Aymen A. Alian
Object: This work aims to introduce a novel method to mitigate the global phase deviation inherent in photoplethysmography imaging (PPGI) due to hemodynamics. Method: We model the facial vascular network captured by a consumer camera as a two-dimensional manifold, where the complex dynamics of the vascular tree lead to intricate phase variations across skin sites. Utilizing PPGI, we sample the vector field on the facial manifold encoding these intricate phase variations over different skin sites resulting from blood volume modulations. We propose leveraging the graph connection Laplacian (GCL) technique to quantify the global phase deviation, with the hypothesis that correcting this deviation can improve the quality of the PPGI signal and that the phase deviation encodes valuable anatomical and physiological information. Result: The proposed algorithm yields a higher-quality global PPGI signal by correcting the global phase deviation estimated by GCL, emphasizing waveform features such as the dicrotic notch. The perfusion map, with the global phase deviation estimated by GCL as intensity, reflects skin perfusion dynamics influenced by varying travel distances and anatomical structures. Conclusion: This algorithm enhances the quality of the global PPGI signal, facilitating the analysis of morphological parameters and showing promise for advancing PPGI applications in scientific research and clinical practice.
{"title":"Graph connection Laplacian allows for enhanced outcomes of consumer camera based photoplethysmography imaging","authors":"Stefan Borik, Hau-Tieng Wu, Kirk H. Shelley, Aymen A. Alian","doi":"10.1101/2024.03.07.24303826","DOIUrl":"https://doi.org/10.1101/2024.03.07.24303826","url":null,"abstract":"Object: This work aims to introduce a novel method to mitigate the global phase deviation inherent in photoplethysmography imaging (PPGI) due to hemodynamics. Method: We model the facial vascular network captured by a consumer camera as a two-dimensional manifold, where the complex dynamics of the vascular tree lead to intricate phase variations across skin sites. Utilizing PPGI, we sample the vector field on the facial manifold encoding these intricate phase variations over different skin sites resulting from blood volume modulations. We propose leveraging the graph connection Laplacian (GCL) technique to quantify the global phase deviation, with the hypothesis that correcting this deviation can improve the quality of the PPGI signal and that the phase deviation encodes valuable anatomical and physiological information. Result: The proposed algorithm yields a higher-quality global PPGI signal by correcting the global phase deviation estimated by GCL, emphasizing waveform features such as the dicrotic notch. The perfusion map, with the global phase deviation estimated by GCL as intensity, reflects skin perfusion dynamics influenced by varying travel distances and anatomical structures.\u0000Conclusion: This algorithm enhances the quality of the global PPGI signal, facilitating the analysis of morphological parameters and showing promise for advancing PPGI applications in scientific research and clinical practice.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140070313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.05.24303735
Ravi Pal, Akos Rudas, Sungsoo Kim, Jeffrey Chiang, Anna Barney, Maxime Cannesson
Background and Objective: Detection of the dicrotic notch (DN) within a cardiac cycle is essential for assessment of cardiac output, calculation of pulse wave velocity, estimation of left ventricular ejection time, and supporting feature-based machine learning models for noninvasive blood pressure estimation, and hypotension, or hypertension prediction. In this study, we present a new algorithm based on the iterative envelope mean (IEM) method to detect automatically the DN in arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms. Methods: The algorithm was evaluated on both ABP and PPG waveforms from a large perioperative dataset (MLORD dataset) comprising 17,327 patients. The analysis involved a total of 1,171,288 cardiac cycles for ABP waveforms and 3,424,975 cardiac cycles for PPG waveforms. To evaluate the algorithm's performance, the systolic phase duration (SPD) was employed, which represents the duration from the onset of the systolic phase to the DN in the cardiac cycle. Correlation plots and regression analysis were used to compare the algorithm with an established DN detection technique (second derivative). The marking of the DN temporal location was carried out by an experienced researcher using the help of the find_peaks function from the scipy PYTHON package, serving as a reference for the evaluation. The marking was visually validated by both an engineer and an anesthesiologist. The robustness of the algorithm was evaluated as the DN was made less visually distinct across signal-to-noise ratios (SNRs) ranging from -30 dB to -5 dB in both ABP and PPG waveforms. Results: The correlation between SPD estimated by the algorithm and that marked by the researcher is strong for both ABP (R2(87343) =.99, p<.001) and PPG (R2(86764) =.98, p<.001) waveforms. The algorithm had a lower mean error of dicrotic notch detection (s): 0.0047 (0.0029) for ABP waveforms and 0.0046 (0.0029) for PPG waveforms, compared to 0.0693 (0.0770) for ABP and 0.0968 (0.0909) for PPG waveforms for the established 2nd derivative method. The algorithm has high accuracy of DN detection for SNR of >= -9 dB for ABP waveforms and >= -12 dB for PPG waveforms indicating robust performance in detecting the DN when it is less visibly distinct. Conclusion: Our proposed IEM- based algorithm can detect DN in both ABP and PPG waveforms with low computational cost, even in cases where it is not distinctly defined within a cardiac cycle of the waveform (DN-less signals). The algorithm can potentially serve as a valuable, fast, and reliable tool for extracting features from ABP and PPG waveforms. It can be especially beneficial in medical applications where DN-based features, such as SPD, diastolic phase duration, and DN amplitude, play a significant role.
{"title":"An algorithm to detect dicrotic notch in arterial blood pressure and photoplethysmography waveforms using the iterative envelope mean method","authors":"Ravi Pal, Akos Rudas, Sungsoo Kim, Jeffrey Chiang, Anna Barney, Maxime Cannesson","doi":"10.1101/2024.03.05.24303735","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303735","url":null,"abstract":"Background and Objective: Detection of the dicrotic notch (DN) within a cardiac cycle is essential for assessment of cardiac output, calculation of pulse wave velocity, estimation of left ventricular ejection time, and supporting feature-based machine learning models for noninvasive blood pressure estimation, and hypotension, or hypertension prediction. In this study, we present a new algorithm based on the iterative envelope mean (IEM) method to detect automatically the DN in arterial blood pressure (ABP) and photoplethysmography (PPG) waveforms. Methods: The algorithm was evaluated on both ABP and PPG waveforms from a large perioperative dataset (MLORD dataset) comprising 17,327 patients. The analysis involved a total of 1,171,288 cardiac cycles for ABP waveforms and 3,424,975 cardiac cycles for PPG waveforms. To evaluate the algorithm's performance, the systolic phase duration (SPD) was employed, which represents the duration from the onset of the systolic phase to the DN in the cardiac cycle. Correlation plots and regression analysis were used to compare the algorithm with an established DN detection technique (second derivative). The marking of the DN temporal location was carried out by an experienced researcher using the help of the find_peaks function from the scipy PYTHON package, serving as a reference for the evaluation. The marking was visually validated by both an engineer and an anesthesiologist. The robustness of the algorithm was evaluated as the DN was made less visually distinct across signal-to-noise ratios (SNRs) ranging from -30 dB to -5 dB in both ABP and PPG waveforms.\u0000Results: The correlation between SPD estimated by the algorithm and that marked by the researcher is strong for both ABP (R2(87343) =.99, p<.001) and PPG (R2(86764) =.98, p<.001) waveforms. The algorithm had a lower mean error of dicrotic notch detection (s): 0.0047 (0.0029) for ABP waveforms and 0.0046 (0.0029) for PPG waveforms, compared to 0.0693 (0.0770) for ABP and 0.0968 (0.0909) for PPG waveforms for the established 2nd derivative method. The algorithm has high accuracy of DN detection for SNR of >= -9 dB for ABP waveforms and >= -12 dB for PPG waveforms indicating robust performance in detecting the DN when it is less visibly distinct.\u0000Conclusion: Our proposed IEM- based algorithm can detect DN in both ABP and PPG waveforms with low computational cost, even in cases where it is not distinctly defined within a cardiac cycle of the waveform (DN-less signals). The algorithm can potentially serve as a valuable, fast, and reliable tool for extracting features from ABP and PPG waveforms. It can be especially beneficial in medical applications where DN-based features, such as SPD, diastolic phase duration, and DN amplitude, play a significant role.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140055210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-27DOI: 10.1101/2024.02.25.24303333
Micah K de Valle, Michael Adkison, Ruhi Maredia, Cooper Stevenson, Shobana Murugan
Introduction Local Anesthetic Systemic Toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnancy from nonpregnant patients. Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression. Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (RR, 1.96 [95% CI 1.44 - 2.66], p<0.01) and significantly lower risk of cardiac excitation (RR, 0.38 [95% CI 0.22-0.63], p<0.01), prodromal symptoms (RR, 0.17 [95% CI 0.09 - 0.33], p<0.01), central nervous system excitation (RR, 0.44 [95% CI 0.21-0.90], p=0.02), and central nervous system depression (RR, 0.24 [95% CI 0.13-0.48], p<0.01) than nonpregnant cohorts. Conclusion Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.
导言局部麻醉系统毒性（LAST）是局部麻醉的一种罕见并发症。由于妊娠期的生理变化，妊娠是一个危险因素。分娩和妊娠紊乱可掩盖或延迟 LAST 的症状，从而延缓适当的干预。本研究在一个较大的队列中对 LAST 进行了检查，并确定了有助于区分妊娠与非妊娠患者 LAST 的特征。组群在年龄、种族、肥胖状况、糖尿病、代谢紊乱、局麻药类型以及心血管、肝脏、肾脏和呼吸系统疾病方面进行了匹配。结果包括 LAST 的前驱症状以及心脏和中枢神经系统兴奋和抑制症状。孕妇组群的心脏抑郁风险明显更高（RR，1.96 [95% CI 1.44 - 2.66]，p<0.01），而心脏兴奋风险明显更低（RR，0.38 [95% CI 0.22-0.63]，p<0.01）、前驱症状（RR，0.17 [95% CI 0.09-0.33]，p<0.01）、中枢神经系统兴奋（RR，0.44 [95% CI 0.21-0.90]，p=0.结论与非妊娠患者相比，LAST 妊娠患者更有可能表现出心脏抑郁，而较少表现出前驱症状、心脏兴奋、中枢神经系统兴奋和抑郁。妊娠期间的生理变化以及及时发现和治疗可能是造成这些差异的原因。这些发现凸显了 LAST 的多变性以及妊娠如何影响其临床表现。
{"title":"Local Anesthetic Systemic Toxicity in Pregnancy: A Retrospective Cohort Analysis","authors":"Micah K de Valle, Michael Adkison, Ruhi Maredia, Cooper Stevenson, Shobana Murugan","doi":"10.1101/2024.02.25.24303333","DOIUrl":"https://doi.org/10.1101/2024.02.25.24303333","url":null,"abstract":"Introduction\u0000Local Anesthetic Systemic Toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnancy from nonpregnant patients.\u0000Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression.\u0000Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (RR, 1.96 [95% CI 1.44 - 2.66], p<0.01) and significantly lower risk of cardiac excitation (RR, 0.38 [95% CI 0.22-0.63], p<0.01), prodromal symptoms (RR, 0.17 [95% CI 0.09 - 0.33], p<0.01), central nervous system excitation (RR, 0.44 [95% CI 0.21-0.90], p=0.02), and central nervous system depression (RR, 0.24 [95% CI 0.13-0.48], p<0.01) than nonpregnant cohorts.\u0000Conclusion\u0000Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139977609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1101/2024.02.20.24303112
Yoshio Tatsuoka, Zyad James Carr, Sachidhanand Jayakumar, Hung-Mo Lin, Zili He, Adham Farroukh, Paul M. Heerdt
Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPC). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study of 164 patients with mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of procedure and a control cohort (N=1981), undergoing elective inpatient abdominal surgery or endoscopic procedures under general anesthesia. The primary outcome was PPC, and the secondary outcomes were PPC sub-composites; respiratory failure (RF), pneumonia (PNA), aspiration pneumonia/pneumonitis (ASP), pulmonary embolism (PE), length of stay (LOS), and 30-day mortality. Results: PPC was higher in the PH cohort (29.9% vs. 11.2%, p<0.001). When sub-composites were analyzed, higher rates of RF (19.3% vs. 6.6%, p<0.001) and PNA (11.2% vs. 5.7%, p=0.01) were observed. After OW, PH was still associated with higher PPC [RR 1.66, 95% CI (1.05 - 2.71), p=0.036] and increased LOS (median 8.0 days vs. 4.9 days) but not 30-day mortality. Sub-cohort analysis showed no difference in PPC between pre- and post-capillary PH patients. Conclusions: After covariate balancing, PH was associated with a higher risk for PPC and pro-longed LOS. This elevated PPC risk should be considered during preoperative risk assessment.
{"title":"Pulmonary Hypertension and the Risk of 30-day Postoperative Pulmonary Complications after Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score Weighted Cohort Analysis.","authors":"Yoshio Tatsuoka, Zyad James Carr, Sachidhanand Jayakumar, Hung-Mo Lin, Zili He, Adham Farroukh, Paul M. Heerdt","doi":"10.1101/2024.02.20.24303112","DOIUrl":"https://doi.org/10.1101/2024.02.20.24303112","url":null,"abstract":"Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPC). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study of 164 patients with mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of procedure and a control cohort (N=1981), undergoing elective inpatient abdominal surgery or endoscopic procedures under general anesthesia. The primary outcome was PPC, and the secondary outcomes were PPC sub-composites; respiratory failure (RF), pneumonia (PNA), aspiration pneumonia/pneumonitis (ASP), pulmonary embolism (PE), length of stay (LOS), and 30-day mortality. Results: PPC was higher in the PH cohort (29.9% vs. 11.2%, p<0.001). When sub-composites were analyzed, higher rates of RF (19.3% vs. 6.6%, p<0.001) and PNA (11.2% vs. 5.7%, p=0.01) were observed. After OW, PH was still associated with higher PPC [RR 1.66, 95% CI (1.05 - 2.71), p=0.036] and increased LOS (median 8.0 days vs. 4.9 days) but not 30-day mortality. Sub-cohort analysis showed no difference in PPC between pre- and post-capillary PH patients. Conclusions: After covariate balancing, PH was associated with a higher risk for PPC and pro-longed LOS. This elevated PPC risk should be considered during preoperative risk assessment.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139954557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-18DOI: 10.1101/2024.02.16.24302948
Jakub Werner, Olga Klementova, Jan Bruthans, Jaromir Macoun, Tomasz Gaszynski, Tomas Henlin, Will Donaldson, Erik Lichnovsky, Shiva Arava, Ana M Lopez, Raquel Berge, Pavel Michalek
The i-gel Plus supraglottic airway represents the next generation of the i-gel device. The aim of this international multicentre prospective cohort study was to evaluate its performance in adult patients during elective procedures in various surgical disciplines under general anaesthesia. The primary outcome of the study was the overall success rate of insertion allowing effective airway management, ventilation, and oxygenation. The secondary outcomes included perioperative performance of the device and the incidence of postoperative adverse events. The data of the first 1000 patients from our study (455 males and 545 females) are presented. These patients were mostly operated on in the supine position (83.3%) with a minority of them being in the lateral or lithotomy positions. The overall success rate was 98.6%, with a first-attempt success rate of insertion of 88.1%. A significant difference between males and females was seen for the overall success rate, 97.4% vs. 99.6% (p=0.002) but not for the successful insertion on the first attempt (p=0.97) The mean oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor increasing the risk of first-attempt failure was low experience of the operator (p<0.001). The insertion of the device was rated by 80.3% as being either very easy or easy. Fibreoptic assessment through the i-gel Plus showed a full view of the vocal cords in 67.8% of patients, a partial view in 21.9% and a downfolded epiglottis in 9.4% of patients. A gastric tube was inserted in 11.2% of patients with a 99.1% success rate. Perioperative complications included desaturation below 85% in 0.6%, traces of blood on the device in 7.4%, laryngospasm in 0.5% and gastric contents inside the cuff in 0.2% of patients. There were no clinical signs of aspiration and a 0.1% incidence of bronchospasm. Severe postoperative sore throat was recorded in 1.4%, and long-term hoarse voice in 0.2% of patients. All patients with moderate and serious postoperative complaints are being followed up by phone at 3 and 6 months. The i-gel Plus seems to be an effective supraglottic airway device providing a high success rate of insertion, sufficient oropharyngeal seal pressure, and a reasonably low incidence of complications.
i-gel Plus 声门上气道是新一代 i-gel 装置。这项国际多中心前瞻性队列研究的目的是评估 i-gel Plus 在成人患者全身麻醉下进行各种外科择期手术时的性能。研究的主要结果是插入的总体成功率，从而实现有效的气道管理、通气和供氧。次要结果包括设备的围手术期表现和术后不良事件的发生率。本文介绍了我们研究的前 1000 名患者（455 名男性和 545 名女性）的数据。这些患者大多采用仰卧位进行手术（83.3%），少数采用侧卧位或截石位。总体成功率为 98.6%，首次插入成功率为 88.1%。男性和女性的总体成功率存在明显差异，分别为 97.4% 和 99.6%（P=0.002），但首次插入成功率没有差异（P=0.97）。增加首次尝试失败风险的唯一独立因素是操作者经验不足（p<0.001）。80.3%的人认为插入装置非常简单或容易。通过 i-gel Plus 进行的光纤评估显示，67.8% 的患者能看到声带全貌，21.9% 的患者能看到声带部分，9.4% 的患者会厌下垂。11.2%的患者插入了胃管，成功率为99.1%。围手术期并发症包括：0.6% 的患者饱和度低于 85%，7.4% 的患者装置上有血迹，0.5% 的患者出现喉痉挛，0.2% 的患者袖带内有胃内容物。没有吸入的临床症状，支气管痉挛发生率为 0.1%。1.4% 的患者在术后出现严重咽喉痛，0.2% 的患者出现长期声音嘶哑。所有有中度和严重术后不适症状的患者都将在 3 个月和 6 个月后接受电话随访。i-gel Plus 似乎是一种有效的声门上气道装置，插入成功率高，口咽密封压力足够，并发症发生率相当低。
{"title":"An evaluation of the i-gel Plus supraglottic airway device in elective patients: the interim results from a prospective international multicentre study","authors":"Jakub Werner, Olga Klementova, Jan Bruthans, Jaromir Macoun, Tomasz Gaszynski, Tomas Henlin, Will Donaldson, Erik Lichnovsky, Shiva Arava, Ana M Lopez, Raquel Berge, Pavel Michalek","doi":"10.1101/2024.02.16.24302948","DOIUrl":"https://doi.org/10.1101/2024.02.16.24302948","url":null,"abstract":"The i-gel Plus supraglottic airway represents the next generation of the i-gel device. The aim of this international multicentre prospective cohort study was to evaluate its performance in adult patients during elective procedures in various surgical disciplines under general anaesthesia. The primary outcome of the study was the overall success rate of insertion allowing effective airway management, ventilation, and oxygenation. The secondary outcomes included perioperative performance of the device and the incidence of postoperative adverse events. The data of the first 1000 patients from our study (455 males and 545 females) are presented. These patients were mostly operated on in the supine position (83.3%) with a minority of them being in the lateral or lithotomy positions. The overall success rate was 98.6%, with a first-attempt success rate of insertion of 88.1%. A significant difference between males and females was seen for the overall success rate, 97.4% vs. 99.6% (p=0.002) but not for the successful insertion on the first attempt (p=0.97) The mean oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor increasing the risk of first-attempt failure was low experience of the operator (p<0.001). The insertion of the device was rated by 80.3% as being either very easy or easy. Fibreoptic assessment through the i-gel Plus showed a full view of the vocal cords in 67.8% of patients, a partial view in 21.9% and a downfolded epiglottis in 9.4% of patients. A gastric tube was inserted in 11.2% of patients with a 99.1% success rate. Perioperative complications included desaturation below 85% in 0.6%, traces of blood on the device in 7.4%, laryngospasm in 0.5% and gastric contents inside the cuff in 0.2% of patients. There were no clinical signs of aspiration and a 0.1% incidence of bronchospasm. Severe postoperative sore throat was recorded in 1.4%, and long-term hoarse voice in 0.2% of patients. All patients with moderate and serious postoperative complaints are being followed up by phone at 3 and 6 months. The i-gel Plus seems to be an effective supraglottic airway device providing a high success rate of insertion, sufficient oropharyngeal seal pressure, and a reasonably low incidence of complications.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139902982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.1101/2024.01.29.24301926
James S Cho, Devaunsh M Thaker, Rohan Jotwani, David Hao
Background Extended reality technology, encompassing augmented reality, mixed reality, and virtual reality, has the potential to enhance the teaching and performance of neuraxial procedures. The diverse applications of extended reality include immersive simulations and novel modes of procedural navigation. Objectives This scoping review aims to explore the preclinical, clinical, and educational applications of extended reality for neuraxial procedures while suggesting directions for future research. Evidence review A systematic search was conducted across PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar until December 2023. Additional sources were identified via citation searching of relevant articles. The findings are reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Findings 41 studies, including three pending clinical trials were included. The majority of included studies were published after 2015. Extended reality technology was applied in diverse ways for teaching, simulation, and navigation, but only four of the completed studies described clinical use. For the display of visuals, computer screens were most commonly used, followed by head-mounted devices, laser projectors, and semi-transparent mirrors. Conclusions Interest in utilizing extended reality technology for neuraxial procedures is growing. Preliminary work shows promise for this technology in both education and clinical practice, but achieving accurate image registration without disrupting existing workflows remains an ongoing barrier to clinical testing. Additional research is needed to assess the cost-effectiveness and reliability of this technology.
背景扩展现实技术包括增强现实、混合现实和虚拟现实，有可能提高神经外科手术的教学和效果。扩展现实技术的应用多种多样，包括身临其境的模拟和新颖的手术导航模式。目的 本范围综述旨在探讨神经经颅手术中扩展现实技术的临床前、临床和教育应用，同时提出未来的研究方向。证据回顾 截至 2023 年 12 月，在 PubMed、Embase、Web of Science、Cochrane Central Register of Controlled Trials 和 Google Scholar 上进行了系统检索。通过对相关文章进行引文检索，确定了其他来源。研究结果采用《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews，PRISMA-ScR）进行报告。研究结果 共纳入 41 项研究，其中包括 3 项待定的临床试验。大部分纳入的研究发表于 2015 年之后。扩展现实技术以多种方式应用于教学、模拟和导航，但已完成的研究中只有四项介绍了临床应用。在显示视觉效果方面，最常用的是计算机屏幕，其次是头戴式设备、激光投影仪和半透明镜。结论人们对在神经外科手术中使用扩展现实技术的兴趣与日俱增。初步工作表明，该技术在教育和临床实践中都大有可为，但在不破坏现有工作流程的情况下实现准确的图像配准仍是临床测试的一个持续障碍。还需要更多的研究来评估这项技术的成本效益和可靠性。
{"title":"Extended Reality for Neuraxial Anesthesia and Pain Procedures: A Scoping Review","authors":"James S Cho, Devaunsh M Thaker, Rohan Jotwani, David Hao","doi":"10.1101/2024.01.29.24301926","DOIUrl":"https://doi.org/10.1101/2024.01.29.24301926","url":null,"abstract":"Background\u0000Extended reality technology, encompassing augmented reality, mixed reality, and virtual reality, has the potential to enhance the teaching and performance of neuraxial procedures. The diverse applications of extended reality include immersive simulations and novel modes of procedural navigation. Objectives\u0000This scoping review aims to explore the preclinical, clinical, and educational applications of extended reality for neuraxial procedures while suggesting directions for future research. Evidence review A systematic search was conducted across PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar until December 2023. Additional sources were identified via citation searching of relevant articles. The findings are reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Findings 41 studies, including three pending clinical trials were included. The majority of included studies were published after 2015. Extended reality technology was applied in diverse ways for teaching, simulation, and navigation, but only four of the completed studies described clinical use. For the display of visuals, computer screens were most commonly used, followed by head-mounted devices, laser projectors, and semi-transparent mirrors. Conclusions\u0000Interest in utilizing extended reality technology for neuraxial procedures is growing. Preliminary work shows promise for this technology in both education and clinical practice, but achieving accurate image registration without disrupting existing workflows remains an ongoing barrier to clinical testing. Additional research is needed to assess the cost-effectiveness and reliability of this technology.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139590191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.1101/2024.01.24.24301740
Chris Sun, Agnes Rigouzzo, Isabelle Constant, David holcman
The depth of anesthesia is contingent upon the concentration of administered hypnotics, but establishing an exact relationship proves challenging, given its variability among individual patients. To elucidate the connection between the depth of anesthesia and hypnotic concentration, we leverage transient EEG patterns specifically, isoelectric suppressions and power distributions within the alpha and delta frequency bands at constant concentrations. Our investigation focuses on two hypnotic: propofol and sevoflurane. In a cohort encompassing children and young adults undergoing general anesthesia, we employ segmentation algorithms to extract a diverse range of spectral representations in EEG profiles. However, as we systematically alter hypnotic concentrations, a consistent trend emerges: heightened hypnotic concentration predominantly aligns with increased delta band power and reduced alpha band power. Notably, the occurrence of isoelectric suppressions is primarily associated with elevated propofol concentrations and infrequently observed with high levels of sevoflurane. Furthermore, we observe a decrease in the maximal power frequency of the alphaband as hypnotic concentrations increase. In summary, this study offers a systematic quantification of EEG patterns corresponding to distinct concentrations of propofol and sevoflurane. These observed patterns contribute to a nuanced EEG representation of brain activity, laying the groundwork for personalized anesthesia strategies.
{"title":"EEG signatures at different propofol vs sevoflurane concentrations","authors":"Chris Sun, Agnes Rigouzzo, Isabelle Constant, David holcman","doi":"10.1101/2024.01.24.24301740","DOIUrl":"https://doi.org/10.1101/2024.01.24.24301740","url":null,"abstract":"The depth of anesthesia is contingent upon the concentration of administered hypnotics, but establishing an exact relationship proves challenging, given its variability among individual patients. To elucidate the connection between the depth of anesthesia and hypnotic concentration, we leverage transient EEG patterns specifically, isoelectric suppressions and power distributions within the alpha and delta frequency bands at constant concentrations. Our investigation focuses on two hypnotic: propofol and sevoflurane. In a cohort encompassing children and young adults undergoing general anesthesia, we employ segmentation algorithms to extract a diverse range of spectral representations in EEG profiles. However, as we systematically alter hypnotic concentrations, a consistent trend emerges: heightened hypnotic concentration predominantly aligns with increased delta band power and reduced alpha band power. Notably, the occurrence of isoelectric suppressions is primarily associated with elevated propofol concentrations and infrequently observed with high levels of sevoflurane. Furthermore, we observe a decrease in the maximal power frequency of the alphaband as hypnotic concentrations increase. In summary, this study offers a systematic quantification of EEG patterns corresponding to distinct concentrations of propofol and sevoflurane. These observed patterns contribute to a nuanced EEG representation of brain activity, laying the groundwork for personalized anesthesia strategies.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139585411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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