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Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis. 腹部微创手术的无阿片麻醉:系统综述、荟萃分析和试验序列分析。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-11-05 DOI: 10.1007/s12630-024-02831-0
Carlos A B da Silveira, Ana C D Rasador, Heitor J S Medeiros, Eric Slawka, Lucca Gesteira, Lucas C Pereira, Sara Amaral

Purpose: Opioid anesthesia is commonly employed in minimally invasive surgeries but is associated with adverse effects, including postoperative nausea and vomiting (PONV). Opioid-free anesthesia aims to mitigate these issues. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing opioid and opioid-free anesthesia in minimally invasive abdominal surgeries.

Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for randomized controlled trials (RCTs) comparing these approaches. Our primary outcomes were adverse effects (PONV, bradycardia), while secondary outcomes were pain, opioid consumption, and postanesthesia care unit (PACU) length of stay (LOS). We performed a TSA to investigate the conclusiveness of the results.

Results: We included 26 RCTs encompassing 2,025 patients, with 1,009 (49%) in the opioid-free anesthesia group. Opioid-free anesthesia reduced PONV significantly (risk ratio, 0.55; 95% confidence interval [CI], 0.40 to 0.74; P < 0.001), but we found no significant differences in bradycardia rates. We found nonclinically relevant higher pain scores for opioid anesthesia (mean difference [MD], -0.9; 95% CI, -1.7 to -0.2; P = 0.01) and opioid consumption at 2 hr post surgery (MD, -5.4 mg oral morphine equivalents; 95% CI, -9.1 to -1.8; P = 0.004). We also noted a reduced time to first analgesia (MD, 88 min; 95% CI, 18 to 159; P = 0.01). We found no differences in PACU LOS. The TSA confirmed the sample size's adequacy in showing PONV reduction with opioid-free anesthesia.

Conclusion: Opioid-free anesthesia showed a significant reduction in PONV and a decrease in opioid consumption during the first 2 hr postoperatively, suggesting it can be an alternative to opioid anesthesia in minimally invasive abdominal surgeries.

Study registration: PROSPERO ( CRD42023492385 ); first submitted 18 December 2023.

目的:阿片类药物麻醉通常用于微创手术,但会产生不良反应,包括术后恶心和呕吐(PONV)。无阿片麻醉旨在减轻这些问题。我们进行了一项系统综述、荟萃分析和试验序列分析(TSA),比较了腹部微创手术中的阿片类和无阿片类麻醉:我们在 Cochrane Central Register of Controlled Trials、MEDLINE 和 Embase 中检索了比较这些方法的随机对照试验 (RCT)。我们的主要结果是不良反应(PONV、心动过缓),次要结果是疼痛、阿片类药物用量和麻醉后护理病房(PACU)的住院时间(LOS)。我们进行了一项TSA,以调查研究结果的确凿性:结果:我们纳入了 26 项 RCT,涉及 2,025 名患者,其中无阿片类药物麻醉组有 1,009 人(49%)。无阿片麻醉可显著降低 PONV(风险比为 0.55;95% 置信区间 [CI],0.40 至 0.74;P 结论:无阿片麻醉可显著降低 PONV(风险比为 0.55;95% 置信区间 [CI],0.40 至 0.74):无阿片麻醉显著降低了PONV,减少了术后2小时内阿片类药物的用量,这表明无阿片麻醉可以替代阿片类药物麻醉用于微创腹部手术:研究注册:PROSPERO ( CRD42023492385 );2023 年 12 月 18 日首次提交。
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引用次数: 0
Methods for determining optimal positive end-expiratory pressure in patients undergoing invasive mechanical ventilation: a scoping review. 有创机械通气患者最佳呼气末正压的确定方法:范围综述。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-11-20 DOI: 10.1007/s12630-024-02871-6
Stefan Edginton, Natalia Kruger, Henry T Stelfox, Laurent Brochard, Danny J Zuege, Jonathan Gaudet, Kevin Solverson, Helen Lee Robertson, Kirsten M Fiest, Daniel J Niven, Christopher J Doig, Sean M Bagshaw, Ken Kuljit S Parhar

Purpose: There is significant variability in the application of positive end-expiratory pressure (PEEP) in patients undergoing invasive mechanical ventilation. There are numerous studies assessing methods of determining optimal PEEP, but many methods, patient populations, and study settings lack high-quality evidence. Guidelines make no recommendations about the use of a specific method because of equipoise and lack of high-quality evidence. We conducted a scoping review to determine which methods of determining optimal PEEP have been studied and what gaps exist in the literature.

Source: We searched five databases for primary research reports studying methods of determining optimal PEEP among adults undergoing invasive mechanical ventilation. Data abstracted consisted of the titration method, setting, study design, population, and outcomes.

Principle findings: Two hundred and seventy-one studies with 17,205 patients met the inclusion criteria, including 73 randomized controlled trials (RCTs) with 10,733 patients. We identified 22 methods. Eleven were studied with an RCT. Studies enrolled participants within an intensive care unit (ICU) (216/271, 80%) or operating room (55/271, 20%). Most ICU studies enrolled patients with acute respiratory distress syndrome (162/216, 75%). The three most studied methods were compliance (73 studies, 29 RCTs), imaging-based methods (65 studies, 11 RCTs), and use of PEEP-FIO2 tables (52 studies, 20 RCTs). Among ICU RCTs, the most common primary outcomes were mortality or oxygenation. Few RCTs assessed feasibility of different methods (n = 3). The strengths and limitations of each method are discussed.

Conclusion: Numerous methods of determining optimal PEEP have been evaluated; however, notable gaps remain in the evidence supporting their use. These include specific populations (normal lungs, patients weaning from mechanical ventilation) and using alternate outcomes (ventilator-free days and feasibility) and they present significant opportunities for future study.

Study registration: Open Science Framework ( https://osf.io/atzqc ); first posted, 19 July 2022.

目的: 在接受有创机械通气的患者中,呼气末正压 (PEEP) 的应用存在很大差异。有许多研究对确定最佳 PEEP 的方法进行了评估,但许多方法、患者人群和研究环境都缺乏高质量的证据。由于存在等效性和缺乏高质量证据,指南并未就特定方法的使用提出建议。我们进行了一次范围审查,以确定哪些确定最佳 PEEP 的方法已被研究过,以及文献中存在哪些空白:我们在五个数据库中检索了研究有创机械通气成人最佳 PEEP 确定方法的主要研究报告。摘录的数据包括滴定方法、环境、研究设计、人群和结果:有 17205 名患者参与的 271 项研究符合纳入标准,其中包括有 10733 名患者参与的 73 项随机对照试验 (RCT)。我们确定了 22 种方法。其中 11 项研究采用了随机对照试验。研究在重症监护室(ICU)(216/271,80%)或手术室(55/271,20%)内招募参与者。大多数重症监护室研究都招募了急性呼吸窘迫综合征患者(162/216,75%)。研究最多的三种方法是顺应性(73 项研究,29 项研究)、基于成像的方法(65 项研究,11 项研究)和使用 PEEP-FIO2 表(52 项研究,20 项研究)。在 ICU RCT 中,最常见的主要结果是死亡率或氧饱和度。很少有研究对不同方法的可行性进行评估(n = 3)。本文讨论了每种方法的优势和局限性:已对许多确定最佳 PEEP 的方法进行了评估;但是,支持使用这些方法的证据仍存在明显差距。这些差距包括特定人群(正常肺、机械通气断奶患者)和使用替代结果(无呼吸机天数和可行性),它们为未来研究提供了重要机会:开放科学框架 ( https://osf.io/atzqc ); 首次发布,2022 年 7 月 19 日。
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引用次数: 0
A patient with unexplained hypoxemia after a fall diagnosed with platypnea orthodeoxia syndrome: approaches to resolving discrepancies between level of hypoxemia and clinical presentation. 一名摔倒后出现不明原因低氧血症的患者被诊断为平板性呼吸暂停正缺氧综合征:解决低氧血症程度与临床表现之间差异的方法。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI: 10.1007/s12630-024-02854-7
Vorakamol Phoophiboon, Samir Gupta, Jane Batt, Karen E A Burns

Purpose: Platypnea orthodeoxia syndrome (POS) is a rare cause of hypoxemia. Diagnosis of POS is challenging, requiring a high index of clinical suspicion, special investigations, and collaboration with multiple specialists.

Clinical features: We describe an 86-yr-old male who presented to the emergency department with hip pain after a witnessed fall. He was noted to be hypoxemic at presentation with a peripheral oxygen saturation (SpO2) of 84% on room air, with an inadequate increase in oxygenation after administration of a fractional concentration of inspired oxygen (FIO2) of 1.00. A chest radiograph, computed tomography pulmonary angiogram, and Doppler ultrasound of the liver were unremarkable. In the supine position with an FIO2 of 0.65, his SpO2 and arterial partial pressure of oxygen (PaO2) (96% and 74 mm Hg, respectively) increased significantly relative to the seated position (84% and 50 mm Hg, respectively). Contrast transthoracic echocardiography (TTE) showed a large patent foramen ovale (PFO) with right-to-left shunt. Transthoracic echocardiography showed rotation of the patient's heart, enabling direct alignment of the inferior vena cava with the PFO, creating a large anatomical right-to-left shunt in the seated position. Right heart catheterization confirmed a large PFO with normal right-sided heart pressures. He was treated with a septal occlusion and his SpO2 in the seated position improved immediately. The patient was discharged home without requiring supplemental oxygen.

Conclusions: Platypnea orthodeoxia syndrome is a rare presentation of hypoxemia. Positional changes in oxygenation are the cardinal feature of POS. Discordance between lung imaging and the severity of hypoxemia should prompt investigation for an intracardiac shunt, which can occur in POS even in the absence of increased right-sided heart pressures. Either contrast TTE or transesophageal echocardiography is necessary to make this diagnosis.

目的:呼吸暂停正缺氧综合征(POS)是一种罕见的低氧血症病因。POS 的诊断极具挑战性,需要临床高度怀疑、特殊检查以及与多位专家合作:临床特征:我们描述了一名 86 岁的男性患者,他在一次目睹的摔倒后因髋部疼痛到急诊科就诊。他在就诊时出现低氧血症,在室内空气中的外周血氧饱和度(SpO2)为 84%,在给予 1.00 的吸入氧分数浓度(FIO2)后血氧饱和度增加不足。胸片、计算机断层扫描肺血管造影和肝脏多普勒超声检查均无异常。仰卧位时,FIO2 为 0.65,他的 SpO2 和动脉血氧分压(PaO2)(分别为 96% 和 74 mm Hg)比坐位时(分别为 84% 和 50 mm Hg)显著增加。对比经胸超声心动图(TTE)显示有一个大的卵圆孔(PFO),并伴有右向左分流。经胸超声心动图显示患者心脏旋转,使下腔静脉与 PFO 直接对准,在坐位上形成了一个解剖学上的巨大右向左分流。右心导管检查证实存在巨大的 PFO,但右侧心脏压力正常。他接受了房间隔闭塞治疗,坐位时的 SpO2 立即得到改善。患者出院回家后无需补充氧气:结论:侧卧位正侧卧位缺氧综合征是一种罕见的低氧血症。体位性氧合变化是 POS 的主要特征。肺部成像与低氧血症的严重程度不一致,应及时检查是否存在心内分流,即使没有右侧心脏压力升高,POS 也可能出现心内分流。要做出这一诊断,必须进行造影剂 TTE 或经食道超声心动图检查。
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引用次数: 0
Maintenance infusion rate of oxytocin after initial 1-IU bolus for elective Cesarean delivery: a dose-finding study. 择期剖宫产术中首次注射 1-IU 催产素后的维持输注率:一项剂量摸底研究。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-19 DOI: 10.1007/s12630-024-02828-9
Linda Boonstra, Jose C A Carvalho, William Turner, Kristi Downey, Xiang Y Ye, Jackie Thomas, Mrinalini Balki

Purpose: The purpose of our study was to determine the minimum effective dose of oxytocin maintenance infusion required to maintain adequate uterine tone in 90% of patients (ED90) after administration of the initial bolus at elective Cesarean delivery (CD) under spinal anesthesia.

Methods: We conducted a prospective, double-blind dose-finding study with biased coin up-down design. Immediately after delivery, a 1-IU oxytocin bolus was administered, followed by a maintenance infusion. The obstetrician assessed the uterine tone by palpation as satisfactory or unsatisfactory. In case of unsatisfactory response, the dose for the next patient was increased by 2 IU·hr-1. For satisfactory response, the dose for the next patient was either decreased by 2 IU·hr-1 with a probability of 1/9, or remained unchanged. The primary outcome was a satisfactory uterine tone from five minutes after delivery until discharge from postanesthesia care unit. The secondary outcomes were blood loss, need for additional uterotonics, and side effects.

Results: We analyzed data for 40 patients. The ED90 of oxytocin maintenance infusion was 4.5 IU·hr-1 (95% confidence interval, 3.3 to 5.5) based on the isotonic regression estimator. The median [interquartile range] blood loss was 861 [553-1,181] mL; 18% received additional uterotonics, and 38% developed hypotension post delivery.

Conclusion: Based on the results of this dose-finding study, we recommend a maintenance infusion rate of 4.5 IU·hr-1 following an oxytocin bolus of 1 IU for adequate uterine tone in pregnant patients undergoing elective CDs. This infusion rate is four-fold lower than that required without an initial bolus.

Study registration: ClinicalTrials.gov ( NCT04946006 ); first submitted 25 June 2021.

目的:我们的研究目的是确定在脊髓麻醉下择期剖宫产(CD)时,在给予初始栓剂后维持 90% 患者足够子宫张力(ED90)所需的催产素维持输注最小有效剂量:我们进行了一项前瞻性双盲剂量调查研究,采用了偏向硬币上下的设计。分娩后立即注射 1-IU 催产素,然后进行维持输注。产科医生通过触诊评估子宫张力是否满意。如果反应不满意,下一位患者的剂量增加 2 IU-hr-1。如果反应令人满意,下一位患者的剂量要么减少 2 IU-hr-1(概率为 1/9),要么保持不变。主要结果是,从分娩后 5 分钟到从麻醉后护理病房出院,子宫张力令人满意。次要结果是失血量、是否需要额外使用子宫收缩剂以及副作用:我们分析了 40 名患者的数据。根据等张回归估算,催产素维持输注的 ED90 为 4.5 IU-hr-1(95% 置信区间,3.3 至 5.5)。失血量的中位数[四分位间范围]为 861 [553-1,181] mL;18%的产妇接受了额外的子宫收缩剂,38%的产妇在分娩后出现低血压:根据这项剂量摸底研究的结果,我们建议在注射 1 IU 催产素后,以 4.5 IU-hr-1 的输注速度维持足够的子宫张力。该输注率比不注射催产素的情况下所需的输注率低四倍:研究注册:ClinicalTrials.gov(NCT04946006);2021 年 6 月 25 日首次提交。
{"title":"Maintenance infusion rate of oxytocin after initial 1-IU bolus for elective Cesarean delivery: a dose-finding study.","authors":"Linda Boonstra, Jose C A Carvalho, William Turner, Kristi Downey, Xiang Y Ye, Jackie Thomas, Mrinalini Balki","doi":"10.1007/s12630-024-02828-9","DOIUrl":"10.1007/s12630-024-02828-9","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of our study was to determine the minimum effective dose of oxytocin maintenance infusion required to maintain adequate uterine tone in 90% of patients (ED<sub>90</sub>) after administration of the initial bolus at elective Cesarean delivery (CD) under spinal anesthesia.</p><p><strong>Methods: </strong>We conducted a prospective, double-blind dose-finding study with biased coin up-down design. Immediately after delivery, a 1-IU oxytocin bolus was administered, followed by a maintenance infusion. The obstetrician assessed the uterine tone by palpation as satisfactory or unsatisfactory. In case of unsatisfactory response, the dose for the next patient was increased by 2 IU·hr<sup>-1</sup>. For satisfactory response, the dose for the next patient was either decreased by 2 IU·hr<sup>-1</sup> with a probability of 1/9, or remained unchanged. The primary outcome was a satisfactory uterine tone from five minutes after delivery until discharge from postanesthesia care unit. The secondary outcomes were blood loss, need for additional uterotonics, and side effects.</p><p><strong>Results: </strong>We analyzed data for 40 patients. The ED<sub>90</sub> of oxytocin maintenance infusion was 4.5 IU·hr<sup>-1</sup> (95% confidence interval, 3.3 to 5.5) based on the isotonic regression estimator. The median [interquartile range] blood loss was 861 [553-1,181] mL; 18% received additional uterotonics, and 38% developed hypotension post delivery.</p><p><strong>Conclusion: </strong>Based on the results of this dose-finding study, we recommend a maintenance infusion rate of 4.5 IU·hr<sup>-1</sup> following an oxytocin bolus of 1 IU for adequate uterine tone in pregnant patients undergoing elective CDs. This infusion rate is four-fold lower than that required without an initial bolus.</p><p><strong>Study registration: </strong>ClinicalTrials.gov ( NCT04946006 ); first submitted 25 June 2021.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1363-1371"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301816","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}
引用次数: 0
Comparison of the modified Mallampati classification score versus the best visible Mallampati score in the prediction of difficult tracheal intubation: a single-centre prospective observational study. 在预测气管插管困难方面,比较改良马兰帕蒂分类评分与最佳可见马兰帕蒂评分:一项单中心前瞻性观察研究。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-15 DOI: 10.1007/s12630-024-02815-0
Jean-Luc Hanouz, Valentin Lefrançois, Mariam Boutros, Anne Lise Fiant, Thérèse Simonet, Clément Buléon

Purpose: The modified Mallampati classification is part of the preoperative airway risk assessment. Inconsistency in the way it is examined may contribute to heterogeneity in its diagnostic performance. The best visible Mallampati score could reduce interobserver heterogeneity but its diagnostic characteristics remain unknown.

Methods: During preoperative anesthesia consultation of adult patients with a senior anesthesiologist, we compared the modified Mallampati classification score vs the best visible Mallampati score using cervical extension, tongue in, and phonation. The primary outcome was the diagnostic characteristic of the modified Mallampati classification score vs the best visible Mallampati score as predictors of difficult orotracheal intubation (more than two direct laryngoscopies or need for an alternate device). We performed a multivariable analysis to identify independent predictors of difficult orotracheal intubation in the tested cohort.

Results: Difficult orotracheal intubation occurred in 77/3,243 (2.4%) patients. A best visible Mallampati score was obtained in 1,596 (49.2%) patients. Sensitivity and specificity of the modified Mallampati classification score for predicting difficult orotracheal intubation were 0.56 (95% confidence interval [CI], 0.44 to 0.66) and 0.69 (95% CI, 0.68 to 0.71), respectively. By comparison, the best visible Mallampati score was less sensitive (difference, -0.30; 95% CI, -0.19 to -0.30; P < 0.001) but more specific (difference, 0.24; 95% CI, 0.22 to -0.25; P < 0.001). In patients with difficult orotracheal intubation, 53% were incorrectly reclassified as low risk by the best visible Mallampati score.

Conclusion: Compared with the modified Mallampati classification score, the best visible Mallampati score decreased sensitivity for predicting difficult orotracheal intubation and falsely classified half of the patients with difficult orotracheal intubation. Taking the risks associated with difficult airways into account, our findings indicate that a careful examination of the modified Mallampati classification is required during the global preoperative airway examination.

Study registration: ClinicalTrials.gov ( NCT02788253 ); 9 February 2016.

目的:改良马兰帕蒂分类法是术前气道风险评估的一部分。检查方法的不一致可能会导致其诊断效果的异质性。最佳可见 Mallampati 评分可减少观察者间的异质性,但其诊断特征仍不清楚:方法:在资深麻醉师对成年患者进行术前麻醉会诊时,我们比较了改良的 Mallampati 分类评分与使用颈椎伸展、伸舌和发音的最佳可见 Mallampati 评分。主要结果是改良马兰帕蒂分类评分与最佳可见马兰帕蒂评分的诊断特征,作为困难气管插管(超过两次直接喉镜检查或需要备用装置)的预测指标。我们进行了一项多变量分析,以确定受试者队列中气管插管困难的独立预测因素:结果:77/3,243(2.4%)名患者发生了气管插管困难。1,596名患者(49.2%)获得了最佳可见Mallampati评分。改良马兰帕蒂分类评分预测困难气管插管的灵敏度和特异度分别为 0.56(95% 置信区间 [CI],0.44 至 0.66)和 0.69(95% 置信区间,0.68 至 0.71)。相比之下,最佳可见 Mallampati 评分的灵敏度较低(差值为-0.30;95% CI 为-0.19 至-0.30;P 结论:与改良 Mallampati 评分相比,最佳可见 Mallampati 评分的灵敏度较高:与改良的 Mallampati 分级相比,最佳可见 Mallampati 评分降低了预测困难气管插管的灵敏度,并错误地将一半的困难气管插管患者归类。考虑到困难气道的相关风险,我们的研究结果表明,在术前气道全面检查中需要仔细检查改良的 Mallampati 分级:研究注册:ClinicalTrials.gov ( NCT02788253 );2016 年 2 月 9 日。
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引用次数: 0
Comment on "Prevention of hypotension after induction of general anesthesia using point-of-care ultrasound to guide fluid management: a randomized controlled trial". 就 "使用护理点超声波指导液体管理以预防全身麻醉诱导后的低血压:随机对照试验 "发表评论。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-30 DOI: 10.1007/s12630-024-02805-2
Minghao Chen, Beibei Zhang, Qingwei Meng
{"title":"Comment on \"Prevention of hypotension after induction of general anesthesia using point-of-care ultrasound to guide fluid management: a randomized controlled trial\".","authors":"Minghao Chen, Beibei Zhang, Qingwei Meng","doi":"10.1007/s12630-024-02805-2","DOIUrl":"10.1007/s12630-024-02805-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1423-1424"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333267","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}
引用次数: 0
Point-of-care ultrasonography in Ukraine: a survey of anesthesiologists-intensivists participating in ultrasonography courses. 乌克兰的护理点超声波检查:对参加超声波检查课程的麻醉师和麻醉师的调查。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1007/s12630-024-02789-z
Vladyslav Dieiev, Sergii Dubrov, José L Díaz-Gómez, Rom A Stevens, Pedro Salinas, Vadim Gudzenko, Nataliya Matolinets, Olga Kravets, Daria Krishtafor, Oleksandr Pavlysh, Stepan Cherniaiev, Aliaksei Pustavoitau

Purpose: Despite the potential value of point-of-care ultrasonography (POCUS) in resource-limited environments, it is not widely used in low- and middle-income countries compared with high-income countries. We sought to evaluate the current POCUS practice of Ukrainian anesthesiologists who attended POCUS courses to guide future POCUS training in Ukraine.

Methods: We conducted a 25-question web-based survey. It was distributed to 255 participants of POCUS courses held in Ukraine in 2023. The survey sections described current POCUS practice, perception of POCUS value, POCUS skills self-assessment, and perceived barriers to implementing POCUS in clinical practice.

Results: Two hundred and forty-four out of 255 course participants completed the survey, representing 214 unique respondents. Those who self-rated their skills identified themselves as either novices or beginners in areas of POCUS knowledge (118/157, 75%), image acquisition (110/158, 70%), image interpretation (117/158, 74%), and integration into clinical decision-making (105/155, 68%). Among all survey responders, 55% (118/214) reported using POCUS for vascular access procedures, 45% (97/214) for trauma assessment, and 44% (93/214) for regional anesthesia. Reported barriers to POCUS implementation included lack of ultrasound devices (101/214, 47%) and lack of trained faculty (112/214, 52%).

Conclusion: Among anesthesiologists who participated in POCUS courses in Ukraine, the majority were in early stages of ultrasound practice. Respondents identified POCUS applications not currently practiced and evaluated barriers to POCUS use. Based upon these survey findings, we propose the following measures in Ukraine: 1) developing a standardized national POCUS curriculum; 2) increasing the number of experienced instructors of POCUS; and 3) acquiring ultrasound devices to support clinical applications of POCUS, especially in the Central, Southern, and Eastern regions.

目的:尽管护理点超声造影术(POCUS)在资源有限的环境中具有潜在价值,但与高收入国家相比,它在中低收入国家的应用并不广泛。我们试图对参加过 POCUS 课程的乌克兰麻醉医师目前的 POCUS 实践进行评估,以指导乌克兰未来的 POCUS 培训:我们进行了一项包含 25 个问题的网络调查。调查对象为参加 2023 年在乌克兰举办的 POCUS 课程的 255 名学员。调查内容包括当前的 POCUS 实践、对 POCUS 价值的认识、POCUS 技能自我评估以及在临床实践中实施 POCUS 的障碍:在 255 名课程参与者中,有 244 人完成了调查,其中 214 人是唯一的受访者。对自己的技能进行自我评价的学员认为自己在 POCUS 知识(118/157,75%)、图像采集(110/158,70%)、图像解读(117/158,74%)和融入临床决策(105/155,68%)方面是新手或初学者。在所有调查对象中,55%(118/214)的调查对象称在血管通路手术中使用了 POCUS,45%(97/214)的调查对象称在创伤评估中使用了 POCUS,44%(93/214)的调查对象称在区域麻醉中使用了 POCUS。据报告,实施 POCUS 的障碍包括缺乏超声设备(101/214,47%)和缺乏训练有素的教师(112/214,52%):结论:在乌克兰参加过 POCUS 课程的麻醉医师中,大多数处于超声实践的早期阶段。受访者指出了目前尚未应用的 POCUS 应用,并评估了使用 POCUS 的障碍。根据这些调查结果,我们建议乌克兰采取以下措施:1)开发标准化的全国 POCUS 课程;2)增加经验丰富的 POCUS 导师人数;3)购置超声设备以支持 POCUS 的临床应用,尤其是在中部、南部和东部地区。
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引用次数: 0
Nonsteroidal anti-inflammatory drugs for analgesia in intensive care units: a survey of Canadian critical care physicians. 用于重症监护室镇痛的非甾体类消炎药:加拿大重症监护医生调查。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-23 DOI: 10.1007/s12630-024-02800-7
Kimberly B Tworek, Chen-Hsiang Ma, Dawn Opgenorth, Nadia Baig, Fernando G Zampieri, John Basmaji, Bram Rochwerg, Kimberley Lewis, Sebastian Kilcommons, Sangeeta Mehta, Kimia Honarmand, H Tom Stelfox, M Elizabeth Wilcox, Demetrios J Kutsogiannis, Kirsten M Fiest, Constantine J Karvellas, Wendy Sligl, Oleksa Rewa, Janek Senaratne, Sameer Sharif, Sean M Bagshaw, Vincent I Lau

Purpose: Opioids remain the mainstay of analgesia for critically ill patients, but its exposure is associated with negative effects including persistent use after discharge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be an effective alternative to opioids with fewer adverse effects. We aimed to describe beliefs and attitudes towards the use of NSAIDs in adult intensive care units (ICUs).

Methods: Our survey of Canadian ICU physicians was conducted using a web-based platform and distributed through the Canadian Critical Care Society (CCCS) email distribution list. We used previously described survey development methodology including question generation and reduction, pretesting, and clinical sensibility and pilot testing.

Results: We received 115 completed surveys from 321 CCCS members (36%). Nonsteroidal anti-inflammatory drugs use was most described as "rarely" (59 respondents, 51%) with the primary concern being adverse events (acute kidney injury [108 respondents, 94%] and gastrointestinal bleeding [92 respondents, 80%]). The primary preferred analgesic was acetaminophen (75 respondents, 65%) followed by opioids (40 respondents, 35%). Most respondents (91 respondents, 80%) would be willing to participate in a randomized controlled trial examining NSAID use in critical care.

Conclusions: In our survey, Canadian critical care physicians did not mention commonly using NSAIDs primarily because of concerns about adverse events. Nevertheless, respondents were interested in further studying ketorolac, a commonly used NSAID outside of the ICU, in critically ill patients.

目的:阿片类药物仍然是重症患者镇痛的主要药物,但其暴露与负面影响有关,包括出院后的持续使用。非甾体抗炎药(NSAIDs)可能是阿片类药物的有效替代品,且不良反应较少。我们旨在描述成人重症监护病房(ICU)使用非甾体抗炎药的观念和态度:我们对加拿大 ICU 医生的调查是通过网络平台进行的,并通过加拿大重症监护学会 (CCCS) 的电子邮件分发列表进行分发。我们采用了之前介绍过的调查开发方法,包括问题的生成和缩减、预测试、临床敏感性和试点测试:我们收到了来自 321 名 CCCS 会员(36%)的 115 份填写完毕的调查问卷。非甾体类抗炎药的使用情况大多被描述为 "很少"(59 位受访者,51%),主要关注点是不良事件(急性肾损伤 [108 位受访者,94%] 和胃肠道出血 [92 位受访者,80%])。首选镇痛药是对乙酰氨基酚(75 名受访者,65%),其次是阿片类药物(40 名受访者,35%)。大多数受访者(91 名受访者,80%)愿意参与一项随机对照试验,研究非甾体抗炎药在重症监护中的应用:在我们的调查中,加拿大重症监护医生没有提到非甾体抗炎药的常用性,主要是因为担心不良反应。然而,受访者对进一步研究酮咯酸(重症监护室外常用的非甾体抗炎药)在重症患者中的应用很感兴趣。
{"title":"Nonsteroidal anti-inflammatory drugs for analgesia in intensive care units: a survey of Canadian critical care physicians.","authors":"Kimberly B Tworek, Chen-Hsiang Ma, Dawn Opgenorth, Nadia Baig, Fernando G Zampieri, John Basmaji, Bram Rochwerg, Kimberley Lewis, Sebastian Kilcommons, Sangeeta Mehta, Kimia Honarmand, H Tom Stelfox, M Elizabeth Wilcox, Demetrios J Kutsogiannis, Kirsten M Fiest, Constantine J Karvellas, Wendy Sligl, Oleksa Rewa, Janek Senaratne, Sameer Sharif, Sean M Bagshaw, Vincent I Lau","doi":"10.1007/s12630-024-02800-7","DOIUrl":"10.1007/s12630-024-02800-7","url":null,"abstract":"<p><strong>Purpose: </strong>Opioids remain the mainstay of analgesia for critically ill patients, but its exposure is associated with negative effects including persistent use after discharge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be an effective alternative to opioids with fewer adverse effects. We aimed to describe beliefs and attitudes towards the use of NSAIDs in adult intensive care units (ICUs).</p><p><strong>Methods: </strong>Our survey of Canadian ICU physicians was conducted using a web-based platform and distributed through the Canadian Critical Care Society (CCCS) email distribution list. We used previously described survey development methodology including question generation and reduction, pretesting, and clinical sensibility and pilot testing.</p><p><strong>Results: </strong>We received 115 completed surveys from 321 CCCS members (36%). Nonsteroidal anti-inflammatory drugs use was most described as \"rarely\" (59 respondents, 51%) with the primary concern being adverse events (acute kidney injury [108 respondents, 94%] and gastrointestinal bleeding [92 respondents, 80%]). The primary preferred analgesic was acetaminophen (75 respondents, 65%) followed by opioids (40 respondents, 35%). Most respondents (91 respondents, 80%) would be willing to participate in a randomized controlled trial examining NSAID use in critical care.</p><p><strong>Conclusions: </strong>In our survey, Canadian critical care physicians did not mention commonly using NSAIDs primarily because of concerns about adverse events. Nevertheless, respondents were interested in further studying ketorolac, a commonly used NSAID outside of the ICU, in critically ill patients.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1388-1396"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749835","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}
引用次数: 0
Oxytocin protocols during Cesarean delivery: optimizing the tone zone. 剖宫产过程中的催产素方案:优化音调区。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-19 DOI: 10.1007/s12630-024-02829-8
Emily E Sharpe, Hans P Sviggum
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引用次数: 0
Bedside rectus femoris ultrasound to evaluate sarcopenia in surgical patients: an observational study. 通过床旁股直肌超声波评估手术患者的肌肉疏松症:一项观察性研究。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-07 DOI: 10.1007/s12630-024-02839-6
Wariya Vongchaiudomchoke, Julien Vaillancourt, Gabriele Baldini, Alexander Amir, Tahereh Najafi Ghezeljeh, Franco Carli
{"title":"Bedside rectus femoris ultrasound to evaluate sarcopenia in surgical patients: an observational study.","authors":"Wariya Vongchaiudomchoke, Julien Vaillancourt, Gabriele Baldini, Alexander Amir, Tahereh Najafi Ghezeljeh, Franco Carli","doi":"10.1007/s12630-024-02839-6","DOIUrl":"10.1007/s12630-024-02839-6","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1429-1430"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382497","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}
引用次数: 0
期刊
Canadian Journal of Anesthesia-Journal Canadien D Anesthesie
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