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An Open-label Clinical Study of Brief Submaximal Cardiopulmonary Testing in Pre-surgical Evaluation: Feasibility of implementation 在手术前评估中进行简短的最大限度以下心肺测试的开放标签临床研究:实施的可行性
Pub Date : 2024-01-26 DOI: 10.1101/2024.01.24.24301611
Zyad James Carr, Daniel Agarkov, Judy Li, Jean Charchaflieh, Andres Brenes-Bastos, Jonah Freund, Jill Zafar, Robert B Schonberger, Paul Heerdt
Objectives: We tested the logistic feasibility of integrating brief submaximal cardiopulmonary exercise testing (smCPET) in a pre-surgical evaluation (PSE) clinic. Design: Prospective open-label clinical device trial. Setting: Pre-surgical evaluation clinic.Participants: 43 participants who met criteria of i) age > 60 years old, ii) revised cardiac risk index of <2, iii) self-reported metabolic equivalents (METs) of >4.6 (i.e. ability to climb 2 flights of stairs), and iv) presenting for noncardiac surgery. Interventions: Pre-intervention self-reported METs, Duke Activity Status Index (DASI) surveys, smCPET trial, Borg survey of perceived exertion, and post-intervention survey. Measurements: Feasibility endpoints were 1) operational efficiency as measured by length of time of experimental session < 20 minutes, 2) no more than moderate perceived physical exertion as quantified by a modified Borg survey of perceived exertion of <7 in the absence of observed complications, 3) high participant satisfaction with smCPET task execution, represented as a score of >8, and 4) high patient satisfaction with scheduling of smCPET testing, represented as a score of >8. Results: Session time was 16.9 minutes (+/-6.8). Post-test modified Borg survey was 5.35 (+/-1.8), corresponding to moderate perceived exertion. Satisfaction [on a scale of 1 (worst) to 10 (best)] regarding ease of smCPET tasks was 9.6 (+/-0.7) and mean patient satisfaction with smCPET scheduling was 9.5 (+/-1.5). Operational efficiency was achieved after 10-15 experimental sessions. Conclusions: Our findings suggest that smCPET integration in a PSE clinic; 1) is time efficient 2) shows high participant satisfaction with task, and 3) rapidly achieved operational efficiency.
目的:我们测试了将简短的亚最大限度心肺运动测试(smCPET)纳入手术前评估(PSE)诊所的后勤可行性。设计:前瞻性开放标签临床设备试验。地点:手术前评估诊所:手术前评估诊所:43名符合以下标准的参与者:i)年龄为60岁;ii)修订后的心脏风险指数为2;iii)自我报告的代谢当量(METs)为4.6(即爬两层楼梯的能力);iv)前来接受非心脏手术。干预措施:干预前自我报告的 METs、杜克活动状态指数 (DASI) 调查、smCPET 试验、博格体力感觉调查以及干预后调查。测量:可行性终点为:1)以实验时间长度< 20分钟衡量操作效率;2)在没有观察到并发症的情况下,感知体力消耗不超过中度,以改良的博格感知消耗调查(< 7)量化;3)参与者对smCPET任务执行的高满意度,以> 8分表示;4)患者对smCPET测试安排的高满意度,以> 8分表示。结果:测试时间为 16.9 分钟(+/-6.8)。测试后的修正博格调查为 5.35(+/-1.8),相当于中度体力消耗。患者对 smCPET 任务难易程度的满意度[从 1(最差)到 10(最佳)]为 9.6(+/-0.7),患者对 smCPET 时间安排的平均满意度为 9.5(+/-1.5)。经过 10-15 个实验疗程后达到了运行效率。结论:我们的研究结果表明,将 smCPET 整合到 PSE 诊所中:1)节省时间;2)参与者对任务的满意度高;3)可快速提高运行效率。
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引用次数: 0
Ratios Of Submitted Charge Amounts To Medicare Allowed Amounts Have Variably Worsened For Anesthesiologists And Certified Registered Nurse Anesthetists Serving Medicare Beneficiaries Across The United States During 2013-2021 Period 2013-2021 年期间,全美为医疗保险受益人服务的麻醉师和注册麻醉师提交的收费金额与医疗保险允许金额之比出现不同程度的恶化
Pub Date : 2024-01-17 DOI: 10.1101/2024.01.17.24301422
Deepak Gupta, Yara Ismaeil
Background Interstate variations among anesthesia providers in terms of their submitted charge amounts with corresponding Medicare allowed amounts have not been recently explored.
背景 最近尚未对麻醉服务提供者提交的收费金额与相应的医疗保险允许金额之间的州际差异进行探讨。
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引用次数: 0
Assessing the Incidence of Postoperative Diabetes in Gastric Cancer Patients: A Comparative Study of Roux-en-Y Gastrectomy and Other Surgical Reconstruction Techniques 评估胃癌患者术后糖尿病的发生率:Roux-en-Y胃切除术与其他外科重建技术的比较研究
Pub Date : 2024-01-15 DOI: 10.1101/2024.01.13.24301276
Tatsuki Onishi
Study objective Sleeve gastrectomy is effective in morbid obesity, and it improves glucose homeostasis. In gastric cancer patients with type 2 diabetes mellitus, gastrectomy, including total gastrectomy (TG), is beneficial for glycaemic control. However, the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative diabetes in gastric cancer patients are unclear. This study investigated the development of new-onset diabetes in these patients, focusing on different reconstruction methods.
研究目的 袖状胃切除术对病态肥胖有效,并能改善血糖稳态。对于患有 2 型糖尿病的胃癌患者,胃切除术(包括全胃切除术)有利于控制血糖。然而,胃切除术和不同的重建技术对胃癌患者术后糖尿病发病率的影响尚不明确。本研究以不同的重建方法为重点,调查了这些患者新发糖尿病的发生情况。
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引用次数: 0
Bronchoscopy in children with diffuse alveolar hemorrhage under general anesthesia with spontaneous respiration by face mask ventilation 在面罩通气自主呼吸的全身麻醉下为弥漫性肺泡出血的儿童进行支气管镜检查
Pub Date : 2023-12-06 DOI: 10.1101/2023.12.05.23299486
Ruimin Yang, Qing Wei, Xun Chen, Jing Liu, Yan Li, Jingchen Liu
Purpose: To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). Methods: A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. Results: 1. Thirty-four children who had underwent 38 bronchoscopy procedures were included. 2. General anesthesia induction was performed by bolus of propofol intravenous in all the procedures. For maintaining anesthesia, 31 procedures (81.6%) received both propofol and remifentanil intravenously infusion and the rest 7 procedures (18.4%) received propofol intravenously infusion only. An intravenous bolus of ketamine or propofol was given as an anesthetic adjuvant in 21 procedures (55.3%). Thirty-five procedures (92.1%) were successfully completed under non-tracheal intubation ventilation, whereas the rest 3 procedures (7.9%) needed change to tracheal intubation ventilation. 3. Respiratory depression was found in 7 procedures (18.4%), laryngospasm was found in 2 procedure (2.6%) and bronchospasm was found in 17 procedures (44.7%). Sixteen procedures (42.1%) developed intraoperative hypoxemia. The incidence of intraoperative hypoxemia in the procedures at the active phage of disease was significantly higher compared to those at the remission phage of the disease (P<0.05). Sixteen procedures (42.1%) developed intraoperative hypercapnia. Two procedures (5.3%) were complicated by severe pulmonary hemorrhage. Conclusions: General anesthesia with spontaneous respiration by face mask ventilation is feasible and relatively safe for the children with DAH undergoing bronchoscopy, whereas the anesthetic protocol still needs to be improved.
目的:提高弥漫性肺泡出血(DAH)患儿支气管镜检查期间全身麻醉的管理水平。方法:对接受过支气管镜检查的弥漫性肺泡出血患儿进行回顾性研究:对我院2021年6月至2022年6月最初在面罩通气自主呼吸全身麻醉下进行支气管镜检查的DAH患儿进行回顾性研究。研究结果1.34 名儿童接受了 38 次支气管镜检查。2.所有手术均采用异丙酚静脉注射进行全身麻醉诱导。为了维持麻醉,31例手术(81.6%)同时静脉注射了异丙酚和瑞芬太尼,其余7例手术(18.4%)仅静脉注射了异丙酚。有 21 例手术(55.3%)使用氯胺酮或丙泊酚静脉注射作为麻醉辅助剂。35例手术(92.1%)在无气管插管通气的情况下顺利完成,其余3例手术(7.9%)需要改为气管插管通气。3.7 例手术(18.4%)出现呼吸抑制,2 例手术(2.6%)出现喉痉挛,17 例手术(44.7%)出现支气管痉挛。16例手术(42.1%)出现术中低氧血症。与处于疾病缓解期的手术相比,处于疾病活动期的手术术中低氧血症的发生率明显更高(P<0.05)。16例手术(42.1%)出现术中高碳酸血症。两例手术(5.3%)并发严重肺出血。结论面罩通气配合自主呼吸的全身麻醉对于接受支气管镜检查的 DAH 患儿是可行且相对安全的,但麻醉方案仍需改进。
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引用次数: 0
Brain mineralization in postoperative delirium and cognitive decline 术后谵妄和认知能力下降的脑矿化
Pub Date : 2023-12-03 DOI: 10.1101/2023.12.02.23299086
Florian Lammers-Lietz, Friedrich Borchers, Insa Feinkohl, Stefan Hetzer, Cicek Kanar, Gunnar Lachmann, Claudia Chien, Claudia Spies, Georg Winterer, Laszlo Zaborszky, Norman Zacharias, Friedemann Paul
Delirium is a severe postoperative complication associated with poor overall and especially neurocognitive prognosis. Altered brain mineralization is found in neurodegenerative disorders but has not been studied in postoperative delirium and postoperative cognitive decline. We hypothesized that mineralization-related hypointensity in susceptibility-weighted magnetic resonance imaging (SWI) is associated with postoperative delirium and cognitive decline.We analyzed a subsample of cognitively healthy patients ≥65 years presenting for elective major surgery who underwent SWI before (N=65) and three months after surgery (N=33) as part of a subproject in the BioCog study. We measured relative SWI intensities in basal ganglia, hippocampus, and posterior basal forebrain cholinergic system (pBFCS). A post-hoc analysis of two pBFCS subregions (Ch4, Ch4p) was conducted. Patients were screened for delirium until the seventh postoperative day. Cognitive testing was performed before and three months after surgery. Preoperative relative SWI hypointensities in the basal ganglia and pBFCS were associated with increased risk for postoperative delirium after adjustment for surgery duration. After additional adjustment for age, sex, preoperative MMSE and region volume, only the association of pBFCS hypointensity and postoperative delirium remained significant. Adjusted for surgery duration, perioperative change in relative SWI intensities of the pBFCS was associated with cognitive decline three months after surgery. This association remained at a trend level after adjustments for age, sex, and region volume, but a significant independent association especially with pBFCS-subregion Ch4p was found in a post-hoc analysis.Brain mineralization, particularly in the cerebral cholinergic system, could be a pathomechanism in postoperative delirium and cognitive decline.
谵妄是一种严重的术后并发症,总体预后差,尤其是神经认知预后差。脑矿化改变在神经退行性疾病中发现,但在术后谵妄和术后认知能力下降中尚未研究。我们假设磁化加权磁共振成像(SWI)中矿化相关的低强度与术后谵妄和认知能力下降有关。作为BioCog研究子项目的一部分,我们分析了一组年龄≥65岁、接受选择性大手术的认知健康患者,他们在术前(N=65)和术后3个月(N=33)接受了SWI。我们测量了基底神经节、海马和基底前脑后胆碱能系统(pbcs)的相对SWI强度。对两个pBFCS亚区(Ch4, Ch4p)进行事后分析。患者在术后第7天进行谵妄筛查。在手术前和手术后三个月分别进行认知测试。调整手术时间后,基底节区和pBFCS的术前相对SWI低与术后谵妄的风险增加相关。在对年龄、性别、术前MMSE和区域体积进行额外调整后,只有pBFCS低血压与术后谵妄的相关性仍然显著。经手术时间调整后,围手术期pBFCS相对SWI强度的变化与术后3个月认知能力下降有关。在调整了年龄、性别和区域容量后,这种关联仍然保持在趋势水平,但在事后分析中发现了一个显著的独立关联,特别是与pbfc -亚区域Ch4p。脑矿化,特别是脑胆碱能系统,可能是术后谵妄和认知能力下降的病理机制。
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引用次数: 0
Bilateral jaw thrust usage is neither universally prevalent during laryngeal mask airway placement nor universally prevalent during anesthesia mask ventilation before laryngoscopy for endotracheal tube placement: A single anesthesia worksite observation 双颌推力的使用既不是在喉罩气道放置时普遍普遍存在,也不是在气管内插管喉镜检查前麻醉面罩通气时普遍普遍存在:一项单一麻醉工地观察
Pub Date : 2023-11-22 DOI: 10.1101/2023.11.22.23298890
Deepak Gupta, Kaya Chakrabortty, Mohamed Ismaeil
Background While placing two hands on the mask during manual or mechanical ventilation on unsecured airways, providers are not always providing bilateral jaw thrust for maintaining airway patency especially when focusing only on ensuring a good mask seal.
背景:在对无固定气道进行手动或机械通气时,将双手放在口罩上,提供者并不总是提供双颌推力来维持气道通畅,特别是当只关注确保良好的口罩密封时。
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引用次数: 0
Antiemetic effect of pregabalin in breast reconstruction surgery in patients after bariatric surgery: Prospective, randomized, double-blind study 普瑞巴林在减肥手术后乳房重建手术中的止吐效果:前瞻性、随机、双盲研究
Pub Date : 2023-07-24 DOI: 10.1101/2023.07.20.23292941
Rafael Reis Fernandes, Marcello Fonseca Salgado-Filho, Guilherme Bracco Graziosi, André Nery, Flávio Távora, Alice Ramos Oliveira Da Silva, Caio Pontes De Azevedo, Nubia Verçosa, Isma Lima Cavalcanti
Introduction Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia. Pregabalin may reduce its incidence. The objective of this study was to evaluate the adjuvant antiemetic effect of pregabalin in the first 24 hours after surgery in patients undergoing breast reconstruction after bariatric surgery. Materials and Methods This prospective, randomized, double-blind study had 52 female patients aged between 18 and 64 years with physical status 1-2 of the American Society of Anesthesiologists who underwent breast reconstruction after bariatric surgery. The patients were divided into two groups. Patients in the control group received placebo, and those in the pregabalin group received 75 mg of pregabalin 2 hours before surgery and 75 mg 12 hours later. All patients received 4 mg dexamethasone and 4 mg ondansetron. The incidence of PONV was evaluated in the immediate postoperative period and 6 hours, 12 hours, and 24 hours later. The need for rescue doses of antiemetics and adverse events in the first 24 hours were recorded. Results The groups were homogeneous in clinical and treatment variables. There was no significant difference in the incidence of PONV over time in the control group (P = 0.71/no occurrence) or in the pregabalin group (P = 0.11/P = 0.26). There was no significant difference in the need for rescue antiemetic dose (P = 0.40) or in the incidence of adverse events (P = 0.51) between groups. Conclusion The administration of pregabalin in the first 24 hours after surgery did not significantly reduce PONV in patients undergoing breast reconstruction after bariatric surgery.
术后恶心呕吐(PONV)是全身麻醉后常见的并发症。普瑞巴林可降低其发生率。本研究的目的是评估普瑞巴林在减肥手术后乳房重建患者术后24小时内的辅助止吐效果。材料与方法本前瞻性、随机、双盲研究纳入52例美国麻醉医师学会(American Society of anesthesologists)的女性患者,年龄18 ~ 64岁,身体状态1-2,在减肥手术后行乳房重建。患者被分为两组。对照组患者接受安慰剂治疗,普瑞巴林组患者在手术前2小时接受75 mg普瑞巴林治疗,手术后12小时接受75 mg普瑞巴林治疗。所有患者均给予地塞米松4mg和昂丹西琼4mg。术后即刻及术后6小时、12小时、24小时评估PONV的发生率。记录前24小时止吐药的抢救剂量和不良事件。结果两组在临床和治疗变量上均具有同质性。对照组(P = 0.71/无发生)和普瑞巴林组(P = 0.11/P = 0.26)的PONV发生率随时间变化无显著差异。两组间止吐药抢救剂量需求(P = 0.40)和不良事件发生率(P = 0.51)差异无统计学意义。结论减肥手术后乳房再造患者术后24小时内给予普瑞巴林并不能显著降低PONV。
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引用次数: 0
Association of effective circulating blood volume with sublingual RBC velocity and microvessel pressure difference in anesthetized individuals: A clinical investigation and computational fluid dynamics modeling 麻醉个体有效循环血容量与舌下红细胞速度和微血管压差的关系:临床研究和计算流体动力学模型
Pub Date : 2022-05-10 DOI: 10.1101/2022.05.09.22274826
Athanasios Chalkias, Michalis Xenos
Background Although changes in effective circulatory volume may affect microcirculatory red blood cell (RBC) velocity and oxygen extraction ratio, no systemic variable has been consistently associated with hemodynamic coherence. We therefore evaluated the association between mean circulatory filling pressure and microcirculatory perfusion and oxygenation.
虽然有效循环容量的变化可能影响微循环红细胞(RBC)速度和氧提取比,但没有一个系统性变量与血流动力学一致性一致。因此,我们评估了平均循环充盈压力与微循环灌注和氧合之间的关系。
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引用次数: 0
Effects of Intravenous and Inhaled Anesthetics on the Postoperative Complications for the patients undergoing One Lung Ventilation 静脉和吸入麻醉药对单肺通气术后并发症的影响
Pub Date : 2022-04-01 DOI: 10.1101/2022.04.01.22273288
Jing Yang, Qinghua Huang, Rong Cao, Yu Cui
Introduction With the widely used technique of One Lung Ventilation (OLV) in patients throughout thoracic surgery, it’s unclear whether inhaled or intravenous anesthetics were associated with postoperative complications. The purpose of the current study is to compare the effects of intravenous and inhaled anesthetics on the postoperative complications within the patients suffering OLV.
在胸外科手术中,随着单肺通气(OLV)技术的广泛应用,吸入或静脉麻醉药是否与术后并发症相关尚不清楚。本研究的目的是比较静脉和吸入麻醉剂对OLV患者术后并发症的影响。
{"title":"Effects of Intravenous and Inhaled Anesthetics on the Postoperative Complications for the patients undergoing One Lung Ventilation","authors":"Jing Yang, Qinghua Huang, Rong Cao, Yu Cui","doi":"10.1101/2022.04.01.22273288","DOIUrl":"https://doi.org/10.1101/2022.04.01.22273288","url":null,"abstract":"<strong>Introduction</strong> With the widely used technique of One Lung Ventilation (OLV) in patients throughout thoracic surgery, it’s unclear whether inhaled or intravenous anesthetics were associated with postoperative complications. The purpose of the current study is to compare the effects of intravenous and inhaled anesthetics on the postoperative complications within the patients suffering OLV.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521557","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}
引用次数: 0
The external validity of four risk scores predicting 30-day mortality after surgery 预测术后30天死亡率的四项风险评分的外部效度
Pub Date : 2022-03-16 DOI: 10.1101/2022.03.15.22272450
Frederick Torlot, Chang-Yang Yew, Jennifer R. Reilly, Michael Phillips, Dieter G. Weber, Tomas B. Corcoran, Kwok M. Ho, Andrew J. Toner
Background Surgical risk prediction tools can facilitate shared-decision-making and efficient allocation of perioperative resources. Such tools should be externally validated in target populations prior to implementation.
手术风险预测工具可以促进围手术期资源的共享决策和有效分配。这些工具应在实施前在目标人群中进行外部验证。
{"title":"The external validity of four risk scores predicting 30-day mortality after surgery","authors":"Frederick Torlot, Chang-Yang Yew, Jennifer R. Reilly, Michael Phillips, Dieter G. Weber, Tomas B. Corcoran, Kwok M. Ho, Andrew J. Toner","doi":"10.1101/2022.03.15.22272450","DOIUrl":"https://doi.org/10.1101/2022.03.15.22272450","url":null,"abstract":"<strong>Background</strong> Surgical risk prediction tools can facilitate shared-decision-making and efficient allocation of perioperative resources. Such tools should be externally validated in target populations prior to implementation.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521561","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}
引用次数: 0
期刊
medRxiv - Anesthesia
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