Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

Purpose: Brainwave entrainment with low-frequency binaural beats has shown sedative-sparing and anxiolytic effects. We sought to investigate whether the preoperative use of binaural beats could reduce the propofol dose for the induction of general anesthesia.

Methods: We enrolled patients scheduled for elective surgery under general anesthesia in a randomized controlled trial. In the preoperative waiting area, we randomized patients to hear the binaural beats with frequencies of 432 and 431 Hz in the binaural-beats group (N = 34) or silent sound in the control group (N = 35) for 20 min via stereo headphones. For the induction of general anesthesia, we administered 10 mg of propofol every 15 sec until we observed three clinical signs: the loss of response to verbal commands of "open your eyes" (primary outcome), loss of eyelash reflex, and a patient state index of ≤ 50. We collected processed frontal electroencephalography data during the intervention and assessed anxiety scores before and after the intervention.

Results: The propofol dose for the loss of response to verbal commands was lower in the binaural-beats group than in the control group (mean [standard deviation], 87 [24] mg vs 105 [32] mg; difference in means, -18 mg; 95% confidence interval, -32 to -5; P = 0.009). There were no significant differences in the delta (P = 0.63), theta (P = 0.28), alpha (P = 0.24), and beta (P = 0.85) bands of the processed frontal electroencephalograms and the anxiety scores (P = 0.50).

Conclusion: Binaural beats with a frequency of 1 Hz modestly reduced the propofol dose for the induction of general anesthesia, but we observed no significant differences in the processed frontal electroencephalograms and preoperative anxiety levels.

Study registration: ClinicalTrials.gov ( NCT05431881 ); first submitted 9 June 2022.

Purpose: We sought to conduct a systematic review to determine the diagnostic test accuracy of point-of-care ultrasound (POCUS) for the specific etiologies and subtypes of shock.

Methods: We searched MEDLINE, Embase, and the grey literature for prospective studies in adult populations with shock. We collected data on study design, patient characteristics, operator characteristics, POCUS protocol, and true and false positives and negatives, and assessed the risk of bias.

Results: We found 18 eligible studies with a total of N = 2,088 patients. The pooled sensitivity and specificity of POCUS for determining shock subtype were 90% (95% confidence interval [CI], 81 to 95) and 95% (95% CI, 90 to 97) for hypovolemic shock, 95% (95% CI, 84 to 98) and 98% (95% CI, 97 to 99) for cardiogenic shock, 78% (95% CI, 69 to 85) and 97% (95% CI, 94 to 99) for distributive shock, 94% (95% CI, 85 to 97) and 99% (95% CI, 98 to 100) for obstructive shock, and 85% (95% CI, 77 to 91) and 98% (95% CI, 91 to 100) for mixed shock (all low to moderate quality evidence). The pooled sensitivity and specificity of POCUS for determining specific shock etiologies were 78% (95% CI, 18 to 98) and 96% (95% CI, 87 to 99) for sepsis, 92% (95% CI, 71 to 98) and 99% (95% CI, 83 to 100) for pulmonary embolism, and 100% (95% CI, 69 to 100) and 100% (95% CI, 98 to 100) for cardiac tamponade. The quality of the evidence ranged from very low to moderate.

Conclusions: On the basis of very low to moderate quality evidence, POCUS may perform better at ruling in shock subtypes and specific shock etiologies than ruling them out. Point-of-care ultrasound is a promising tool for the diagnosis of shock.

Study registration: PROSPERO ( CRD42020160001 ); first submitted 1 December 2019.

Purpose: ChatGPT and other large language models (LLMs) have gained immense popularity since their commercial release in 2022, with applications in various sectors including health care. We sought to evaluate their deployment in anesthesiology and critical care in a systematic review. Our aim was to describe the integration of LLMs in the field by showcasing and categorizing their current applications, assessing their performance in patient care, and reviewing application-specific ethical and practical challenges in deployment.

Methods: Respecting Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched through PubMed®, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science®, from inception until 1 August 2024. We extracted all papers investigating LLMs in anesthesiology or critical care and reporting results. We segmented the literature into major themes and highlighted key findings and limitations.

Results: From 480 retrieved articles, we included 45 papers. The evaluated models (GPT-4, GPT-3.5, Google Bard [now Gemini], LLaMA, and others) showed diverse applications in four segments: intensive care unit, patient education, medical education, and perioperative care. Large language models, especially newer models, are promising in predicting clinical scores, navigating simple clinical scenarios, and managing preoperative anxiety. Their performance remains below the clinician level in predicting outcomes, solving complex clinical scenarios (i.e., airway management), board examinations, and generating patient-directed documents, although newer models performed better than older ones.

Conclusion: While LLMs are not yet equipped to fully assist physicians in anesthesiology and critical care, they have significant potential, and their capabilities are rapidly improving. Supervised use for select tasks can streamline patient care. Further trials are warranted as new versions of models become available.

Study registration: PROSPERO ( CRD42024567380 ); first submitted 22 July 2024.

Purpose: Pediatric intestinal transplantation is the main treatment modality for children with intestinal failure who develop severe complications including intestinal failure-associated liver disease, progressive loss of central venous access, and repeated admissions requiring critical care management. We aimed to describe the perioperative management of patients undergoing intestinal transplantation at a tertiary children's hospital between 2012 and 2023, identifying challenges and potential solutions.

Methods: We retrospectively reviewed the anesthetic management of 11 children who underwent intestinal transplantation between January 2012 and August 2023. Information collected included preoperative characteristics, intraoperative management, and postoperative outcomes.

Results: The predominant diagnosis of intestinal failure was gastroschisis (5/11, 45%), while progressive liver disease (6/11, 55%) was the main indication for transplantation. In our cohort, five patients underwent isolated intestinal transplantation, four underwent multivisceral transplantation, and two had liver and intestine transplantation. Five patients had postreperfusion syndrome, while eight (73%) patients were hypothermic (temperature [T] < 35 °C). Ten patients required at least one vasopressor/inotrope intraoperatively, with the first-line agent being norepinephrine. Three patients were extubated in the operating room; they had a median intensive care unit stay of three days. To date, the 1-year patient and graft survival rates were 91% (10/11).

Conclusions: With careful preoperative planning, judicious fluid management, and anticipation of potential hemodynamic instability, including postreperfusion syndrome, our data show that pediatric intestinal transplantation can be performed safely, with improved long-term outcomes compared with previous reports.