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

Purpose: The use of a quantitative neuromuscular monitor is strongly recommended by many anesthesiology societies. While most monitors are used at the hand to record responses at the adductor pollicis muscle, this site may be unavailable. We sought to compare simultaneous quantitative neuromuscular measurements obtained at the adductor pollicis (hand) and flexor hallucis brevis (foot) muscles.

Methods: We preoperatively enrolled consenting patients in a prospective cohort study, and their attending anesthesiologists managed intraoperative neuromuscular block at their discretion. The anesthesiologists placed one set of electromyography electrodes over the ulnar nerve/adductor pollicis muscle and another over the posterior tibial nerve/flexor hallucis brevis muscle. During the onset of neuromuscular blockade, simultaneous measurements were obtained every 20 sec until the train-of-four (TOF) count reached 0. At the conclusion of the operation, sugammadex recovery data were recorded every 20 sec until a TOF ratio ≥ 0.9 was achieved.

Results: Of the 103 enrolled patients, 81 had simultaneous measurements during the onset of neuromuscular blockade at the hand and foot sites. The mean paired difference between the onset times at the two sites was 31 sec (95% confidence interval [CI], 5 to 56; P = 0.02). The mean paired difference between the offset times at the two sites was -3 sec (95% CI, -56 to 50; P = 0.26).

Conclusions: While quantitative neuromuscular monitoring at the flexor hallucis brevis (foot) muscle showed some statistical differences in onset time and a recovery compared with monitoring at the adductor pollicis muscle (hand), these differences are of unclear clinical significance.

Purpose: Cardiac surgery-associated acute kidney injury (AKI) is linked to poor outcomes. An observational study from Copenhagen, Denmark identified perioperative red blood cell (RBC) transfusion as a modifiable risk factor for AKI, with a dose-dependent relationship between the number of RBC units transfused and the occurrence and severity of AKI. We aimed to externally validate those findings in a larger population.

Methods: We conducted a retrospective observational study of adult patients undergoing nonemergent on-pump cardiac surgery at Toronto General Hospital (Toronto, ON, Canada) between 2016 and 2021. Acute kidney injury was classified using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data were analyzed using inverse probability weighted logistic regression.

Results: Among 5,204 patients, 798 developed AKI, with 77% classified as stage 1, 11% as stage 2, and 12% as stage 3. Patients with AKI were older, had lower preoperative hemoglobin levels and estimated glomerular filtration rates, longer cardiopulmonary bypass duration, and lower intraoperative hemoglobin levels. Red blood cells were administered to 37% of patients, with 14% receiving plasma and 32% platelets. Only RBC transfusion, alone or combined with other blood products, was significantly associated with AKI. The transfusion of 1-2 RBC units increased the probability of stage 1 AKI by 4% and stage 2-3 AKI by 2% compared with patients not receiving RBCs. The risk was especially pronounced with the transfusion of > 2 units of RBCs, which raised the probability of stage 1 AKI by 12% and stage 2-3 AKI by 9%.

Conclusions: This study confirms previous findings that RBC transfusion is associated with postoperative AKI in cardiac surgery patients. The association was strongest among patients who received > 2 units of RBCs. Prospective studies are needed to determine the optimal strategies for transfusion in these patients and evaluate potential alternatives.

Purpose: We aimed to identify the neuraxial anesthesia failure rate of de novo single-injection spinal and combined spinal-epidural anesthesia for postpartum tubal ligation at our hospital along with variables associated with neuraxial anesthesia failure.

Methods: We conducted a single-centre retrospective cohort study of patients who underwent a postpartum tubal ligation with de novo single-injection spinal or combined spinal-epidural anesthesia from 1 January 2020 to 31 December 2022 at Baylor Scott & White Medical Center-Temple (Temple, TX, USA). We defined neuraxial anesthesia failure as conversion to general anesthesia involving the use of an endotracheal tube or supraglottic airway, administration of intravenous propofol at doses > 10 mg, intravenous fentanyl > 100 µg, or the use of inhaled nitrous oxide.

Results: During the study period, 243 patients underwent postpartum tubal ligation with single-injection spinal or combined spinal-epidural anesthesia, and 28 (11.5%) had neuraxial anesthesia failure. Using a multivariate logistic regression designed to predict neuraxial anesthesia failure using variables of interest, we found that a 5-min increase in time from spinal anesthesia placement to skin incision was associated with neuraxial anesthetic failure (adjusted odds ratio [aOR], 3.10; 95% confidence interval [CI], 2.01 to 4.79; P < 0.001) along with a 5-min increase in time from skin incision to wound closure (aOR 1.35; 95% CI, 1.10 to 1.66; P = 0.004) CONCLUSION: Patients who underwent postpartum tubal ligation under single-injection spinal or combined spinal epidural anesthesia had a neuraxial failure rate of 11.5%. Time from spinal placement to skin incision and time from skin incision to wound closure were independently associated with neuraxial anesthesia failure.