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Ambulatory pediatric adenotonsillectomy. 门诊小儿腺样体切除术。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-12-16 DOI: 10.1007/s12630-024-02872-5
Calvin Lo, Kimmo Murto

Purpose: This Continuing Professional Development module aims to help the general anesthesiologist recognize common pitfalls in ambulatory pediatric adenotonsillectomy and perform appropriate risk stratification, analgesic management, and disposition planning.

Principal findings: Pediatric adenotonsillectomy is a widely performed procedure. An updated approach to preoperative risk assessment of commonly associated comorbidities allows the practitioner to anticipate and plan for adverse events. Risks include obstructive sleep apnea, airway hyperresponsiveness, asthma, recent upper respiratory tract infections, obesity, and young age. Risk-modifying interventions consist of delaying surgery, preoperative bronchodilator therapy, recognizing the limitations of volatile agents, and referral of high-risk patients to specialized pediatric centres. Appropriate selection of intraoperative and postoperative analgesia can optimize patient comfort, avoid readmission, and limit adverse events such as postoperative hemorrhage or respiratory depression.

Conclusions: Ambulatory pediatric adenotonsillectomy is a common surgical procedure, performed both in the community as well as tertiary care pediatric centres. To optimize outcomes in this heterogenous patient population, anesthesiologists must risk stratify and anticipate perioperative respiratory adverse events.

目的:本持续专业发展模块旨在帮助全麻医师认识到门诊儿科腺扁桃体切除术中常见的陷阱,并进行适当的风险分层、镇痛管理和处置计划。主要发现:儿童腺扁桃体切除术是一种广泛实施的手术。一种更新的方法,术前风险评估的共同相关的合并症允许医生预测和计划不良事件。风险包括阻塞性睡眠呼吸暂停、气道高反应性、哮喘、近期上呼吸道感染、肥胖和年轻。降低风险的干预措施包括延迟手术,术前支气管扩张剂治疗,认识到挥发性药物的局限性,以及将高危患者转介到专门的儿科中心。适当选择术中及术后镇痛可优化患者舒适度,避免再入院,限制术后出血或呼吸抑制等不良事件。结论:门诊小儿腺扁桃体切除术是一种常见的外科手术,在社区和三级保健儿科中心都可以进行。为了优化这一异质性患者群体的预后,麻醉医师必须对围手术期呼吸不良事件进行风险分层和预测。
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引用次数: 0
Guidelines to the Practice of Anesthesia-Revised Edition 2025.
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2025-02-03 DOI: 10.1007/s12630-024-02906-y
Gregory R Dobson, Anthony Chau, Justine Denomme, Samantha Frost, Giuseppe Fuda, Conor Mc Donnell, Robert Milkovich, Andrew D Milne, Kathryn Sparrow, Yamini Subramani, Christopher Young

Overview: The Guidelines to the Practice of Anesthesia-Revised Edition 2025 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine the publication and distribution of the Guidelines. The Guidelines are subject to revision and updated versions are published annually. The Guidelines supersede all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

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引用次数: 0
The prevalence and predictors of discharge opioid overprescribing in opioid-naïve patients after breast, gynecologic, and head and neck cancer surgery: a prospective cohort study. 乳腺癌、妇科癌症和头颈部癌症术后阿片类药物无效患者出院时阿片类药物超量使用的发生率和预测因素:一项前瞻性队列研究。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-12 DOI: 10.1007/s12630-024-02819-w
Kenny Kwon Ho Lee, Saima Siddiqui, Gillian Heller, Jonathan Clark, Amanda Johns, Jonathan Penm

Purpose: The management of pain following cancer-related surgeries involves the use of opioid analgesics. Nevertheless, there is little evidence characterizing the utility and prescription patterns of opioids after these procedures. Our primary aim was to identify patients from three types of cancer surgery who were overprescribed with opioids. The secondary aim was to determine the potential predictors of overprescribing in the same period.

Methods: We conducted the study at a single cancer referral hospital. Opioid-naïve patients with breast, gynecologic, or head and neck cancer were studied. Patients were considered opioid-naïve if they had a history of opioid use ≤ 30 mg oral morphine equivalent daily dose for less than seven days in the preceding three months before surgery. We recruited eligible participants by convenience sampling on the wards until at least 102 patients were included in the final analysis. After discharge, we followed up on the participants on day 7 via telephone using a structured proforma including questions to identify the last date and amount of opioid dose taken. The equivalent days of opioid use were calculated by their 24-hr use before discharge and the number of doses prescribed for discharge. Our primary outcome was the prevalence of overprescribing in the three surgical specialties defined as the number of patients taking less than 50% of discharge opioids within the first seven days after discharge. We examined the predictors on incidents of overprescribing using multivariable Poisson regression as the secondary outcome.

Results: We recruited 119 patients, and 107 patients were included in the final analysis. There were 59/107 (55%) patients found to be overprescribed with opioids. At discharge, they exhibited lower mean numerical rating scale pain scores, lower mean pain severity scores, higher equivalent days of opioids prescribed, and not used opioids in the last 24 hr before discharge. The incidence of overprescribing was 2.4 times greater for patients prescribed with opioids without 24-hr opioid use (relative risk [RR], 2.38; 95% confidence interval [CI], 1.30 to 4.35; P = 0.005). Similarly, the incidence of overprescribing was 1.7 times greater for patients who had opioids 24 hr before discharge and were supplied with opioids for five equivalent days or more at the time of discharge (RR, 1.67; 95% CI, 1.09 to 2.56; P = 0.02).

Conclusion: Our study shows that the majority of recruited patients undergoing breast, gynecologic, or head and neck cancer surgery were overprescribed opioids. Individualized assessments on patients' 24-hr opioid requirements before discharge and supplying for less than five days are important considerations to reduce overprescribing in opioid-naïve patients after cancer surgery.

目的:癌症相关手术后的疼痛治疗需要使用阿片类镇痛药。然而,几乎没有证据表明这些手术后阿片类药物的用途和处方模式。我们的主要目的是找出三种癌症手术中阿片类药物处方过量的患者。次要目的是确定同期超量处方的潜在预测因素:我们在一家癌症转诊医院开展了这项研究。研究对象为乳腺癌、妇科癌症或头颈部癌症的阿片类药物无效患者。如果患者在手术前三个月内有阿片类药物使用史,且每日口服吗啡剂量≤30 毫克吗啡当量,且使用时间少于七天,则被视为阿片类药物无效患者。我们在病房通过方便抽样的方式招募符合条件的参与者,直到至少有 102 名患者被纳入最终分析。出院后,我们在第 7 天通过电话对参与者进行了随访,随访时使用了结构化问卷,其中包括确定最后一次服用阿片类药物的日期和剂量的问题。阿片类药物的等效使用天数是根据出院前 24 小时的使用量和出院处方的剂量计算得出的。我们的主要结果是三个外科专科的超量用药率,即出院后头七天内服用出院阿片类药物不足 50%的患者人数。作为次要结果,我们使用多变量泊松回归研究了过度用药事件的预测因素:我们招募了 119 名患者,最终分析包括 107 名患者。其中59/107(55%)名患者被发现过度使用阿片类药物。出院时,他们的疼痛评分均值较低,疼痛严重程度评分均值较低,阿片类药物处方等效天数较高,出院前 24 小时内未使用阿片类药物。开具阿片类药物处方但 24 小时内未使用阿片类药物的患者的超量用药发生率是普通患者的 2.4 倍(相对风险 [RR],2.38;95% 置信区间 [CI],1.30 至 4.35;P = 0.005)。同样,出院前 24 小时使用过阿片类药物且出院时已使用阿片类药物五天或五天以上的患者,其超量用药的发生率是正常人的 1.7 倍(RR,1.67;95% CI,1.09 至 2.56;P = 0.02):我们的研究表明,大多数接受乳腺癌、妇科癌症或头颈部癌症手术的患者都超量服用了阿片类药物。出院前对患者 24 小时阿片类药物需求量进行个性化评估,并在少于五天的时间内供应阿片类药物,是减少癌症术后阿片类药物过敏患者过量用药的重要考虑因素。
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引用次数: 0
The gender gap in academic anesthesiology and critical care medicine: a systematic review. 学术麻醉学和重症监护医学的性别差距:系统回顾。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-12-20 DOI: 10.1007/s12630-024-02897-w
Alessandro De Cassai, Francesca Rubulotta, Marko Zdravkovic, Sindi Mustaj, Joana Berger-Estilita

Purpose: Gender disparities in academia are a growing concern, impacting various disciplines, including health care. We aimed to investigate gender-based differences in academic performance, leadership roles, and academic distinction within anesthesiology and critical care medicine.

Source: We conducted electronic searches for relevant articles published in PubMed, CENTRAL, Scopus, Web of Science, Embase, Education Resources Information Center, PsychINFO, and ProQuest from database inception until 23 June 2024. Three researchers conducted blinded assessments using predefined inclusion and exclusion criteria, with discrepancies resolved through discussion. We reported descriptive statistics for quantitative data from the included research articles.

Principal findings: Our initial screening identified 37,311 studies, 71 of which met the specified inclusion criteria and were therefore evaluated. Analysis of academic publishing trends revealed a gradual increase in the proportion of women as coauthors, first authors (in anesthesiology, the increase ranged from 7% to 17%, and in critical care medicine the increase was 4%), last authors, and corresponding authors. Despite these improvements, women remain underrepresented on the editorial boards of top journals. Although an increase in the representation of women as abstract presenters at conferences was noted, gender disparities persist in senior authorship roles.

Conclusion: Gender disparities are evident in academic leadership positions within anesthesiology and critical care medicine, with few women holding editor-in-chief positions and underrepresentation of women on editorial boards. We observed similar gaps in departmental and scientific society leadership roles. The distribution of awards, prizes, and grants remains skewed, indicating persistent gender imbalances in academic distinction. While progress has been made in certain areas, substantial gaps persist in scholarly publishing, leadership, and academic distinction.

Study registration: PROSPERO ( CRD42022377524 ); first submitted 20 November 2022.

目的:学术界的性别差异日益受到关注,影响到包括卫生保健在内的各个学科。我们的目的是调查基于性别的差异在学术表现,领导角色和学术区分麻醉学和重症监护医学。来源:我们对PubMed, CENTRAL, Scopus, Web of Science, Embase, Education Resources Information Center, PsychINFO和ProQuest从数据库建立到2024年6月23日发表的相关文章进行了电子检索。三位研究人员采用预先确定的纳入和排除标准进行盲法评估,通过讨论解决差异。我们对纳入的研究文章的定量数据进行描述性统计。主要发现:我们的初步筛选确定了37311项研究,其中71项符合指定的纳入标准,因此进行了评估。对学术出版趋势的分析显示,女性作为共同作者、第一作者(在麻醉学中,增幅从7%到17%不等,在重症医学中,增幅为4%)、最后作者和通讯作者的比例逐渐增加。尽管取得了这些进步,但在顶级期刊的编辑委员会中,女性的代表性仍然不足。虽然注意到妇女在会议上作为摘要演讲人的人数有所增加,但在高级作者角色方面仍然存在性别差异。结论:在麻醉学和重症监护医学的学术领导职位中,性别差异明显,担任主编职位的女性很少,编辑委员会中女性的代表性不足。我们观察到在部门和科学社会领导角色方面也存在类似的差距。奖项、奖金和补助金的分配仍然不平衡,表明在学术成就方面存在性别不平衡。虽然在某些领域取得了进展,但在学术出版、领导力和学术成就方面仍存在巨大差距。研究注册:PROSPERO (CRD42022377524);首次提交于2022年11月20日。
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引用次数: 0
Intraoperative hypoglycemia among adults with intraoperative glucose measurements: a cross-sectional multicentre retrospective cohort study. 术中测量血糖的成人术中低血糖症:一项横断面多中心回顾性队列研究。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2024-08-13 DOI: 10.1007/s12630-024-02816-z
Matthew J Griffee, Aleda M Leis, Nathan L Pace, Nirav Shah, Sathish S Kumar, Graciela B Mentz, Lori Q Riegger

Purpose: Intraoperative hypoglycemia is presumed to be rare, but generalizable multicentre incidence and risk factor data for adult patients are lacking. We used a multicentre registry to characterize adults with intraoperative hypoglycemia and hypothesized that intraoperative insulin administration would be associated with hypoglycemia.

Methods: We conducted a cross-sectional retrospective multicentre cohort study. We searched the Multicenter Perioperative Outcomes Group registry to identify adult patients with intraoperative hypoglycemia (glucose < 3.3 mmol·L-1 [< 60 mg·dL-1]) from 1 January 2015 to 31 December 2019. We evaluated characteristics of patients with intraoperative glucose measurements and with intraoperative hypoglycemia.

Results: Of 516,045 patients with intraoperative glucose measurements, 3,900 (0.76%) had intraoperative hypoglycemia. Diabetes mellitus and chronic kidney disease were more common in the cohort with intraoperative hypoglycemia. The odds of intraoperative hypoglycemia were higher for the youngest age category (18-30 yr) compared with the odds for every age category above 40 yr (odds ratio [OR], 1.57-3.18; P < 0.001), and were higher for underweight or normal weight patients compared with patients with obesity (OR, 1.48-2.53; P < 0.001). Parenteral nutrition was associated with lower odds of hypoglycemia (OR, 0.23; 95% confidence interval [CI], 0.11 to 0.47; P < 0.001). Intraoperative insulin use was not associated with hypoglycemia (OR, 0.996; 95% CI, 0.91 to 1.09; P = 0.93).

Conclusion: In this large cross-sectional retrospective multicentre cohort study, intraoperative hypoglycemia was a rare event. Intraoperative insulin use was not associated with hypoglycemia.

目的:术中低血糖症被认为是罕见的,但缺乏针对成人患者的可推广的多中心发病率和风险因素数据。我们利用多中心登记来描述术中低血糖症成人患者的特征,并假设术中胰岛素用药与低血糖症有关:我们进行了一项横断面回顾性多中心队列研究。我们搜索了多中心围手术期结果组登记,以确定从 2015 年 1 月 1 日至 2019 年 12 月 31 日期间术中低血糖(葡萄糖-1 [< 60 mg-dL-1])的成人患者。我们评估了术中血糖测量结果和术中低血糖患者的特征:结果:在 516,045 名进行了术中血糖测量的患者中,3,900 人(0.76%)出现了术中低血糖。糖尿病和慢性肾病在术中低血糖患者中更为常见。与 40 岁以上各年龄组相比,最年轻的年龄组(18-30 岁)发生术中低血糖的几率更高(几率比 [OR],1.57-3.18;P 结论:术中低血糖的发生率与年龄有关:在这项大型横断面回顾性多中心队列研究中,术中低血糖是一种罕见情况。术中使用胰岛素与低血糖症无关。
{"title":"Intraoperative hypoglycemia among adults with intraoperative glucose measurements: a cross-sectional multicentre retrospective cohort study.","authors":"Matthew J Griffee, Aleda M Leis, Nathan L Pace, Nirav Shah, Sathish S Kumar, Graciela B Mentz, Lori Q Riegger","doi":"10.1007/s12630-024-02816-z","DOIUrl":"10.1007/s12630-024-02816-z","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative hypoglycemia is presumed to be rare, but generalizable multicentre incidence and risk factor data for adult patients are lacking. We used a multicentre registry to characterize adults with intraoperative hypoglycemia and hypothesized that intraoperative insulin administration would be associated with hypoglycemia.</p><p><strong>Methods: </strong>We conducted a cross-sectional retrospective multicentre cohort study. We searched the Multicenter Perioperative Outcomes Group registry to identify adult patients with intraoperative hypoglycemia (glucose < 3.3 mmol·L<sup>-1</sup> [< 60 mg·dL<sup>-1</sup>]) from 1 January 2015 to 31 December 2019. We evaluated characteristics of patients with intraoperative glucose measurements and with intraoperative hypoglycemia.</p><p><strong>Results: </strong>Of 516,045 patients with intraoperative glucose measurements, 3,900 (0.76%) had intraoperative hypoglycemia. Diabetes mellitus and chronic kidney disease were more common in the cohort with intraoperative hypoglycemia. The odds of intraoperative hypoglycemia were higher for the youngest age category (18-30 yr) compared with the odds for every age category above 40 yr (odds ratio [OR], 1.57-3.18; P < 0.001), and were higher for underweight or normal weight patients compared with patients with obesity (OR, 1.48-2.53; P < 0.001). Parenteral nutrition was associated with lower odds of hypoglycemia (OR, 0.23; 95% confidence interval [CI], 0.11 to 0.47; P < 0.001). Intraoperative insulin use was not associated with hypoglycemia (OR, 0.996; 95% CI, 0.91 to 1.09; P = 0.93).</p><p><strong>Conclusion: </strong>In this large cross-sectional retrospective multicentre cohort study, intraoperative hypoglycemia was a rare event. Intraoperative insulin use was not associated with hypoglycemia.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"119-131"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977344","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
Anesthetic management of a patient with VACTERL association after failed spinal block for Cesarean delivery.
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-01-01 Epub Date: 2025-01-28 DOI: 10.1007/s12630-024-02905-z
Alexandra O MacNeil, Michael Smyth, Simon Ash, Allana Munro
{"title":"Anesthetic management of a patient with VACTERL association after failed spinal block for Cesarean delivery.","authors":"Alexandra O MacNeil, Michael Smyth, Simon Ash, Allana Munro","doi":"10.1007/s12630-024-02905-z","DOIUrl":"10.1007/s12630-024-02905-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"214-216"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061590","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
Remimazolam in the perioperative setting: an answer in search of an ideal question. 雷马唑仑在围手术期的应用:一个寻找理想问题的答案。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-12-23 DOI: 10.1007/s12630-024-02899-8
Kendra L Derry, Duminda N Wijeysundera
{"title":"Remimazolam in the perioperative setting: an answer in search of an ideal question.","authors":"Kendra L Derry, Duminda N Wijeysundera","doi":"10.1007/s12630-024-02899-8","DOIUrl":"https://doi.org/10.1007/s12630-024-02899-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883737","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 remimazolam and sevoflurane for general anesthesia during transcatheter aortic valve implantation: a randomized trial. 雷马唑仑和七氟醚在经导管主动脉瓣植入术中全麻的比较:一项随机试验。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-12-23 DOI: 10.1007/s12630-024-02900-4
So Harimochi, Kohei Godai, Mayumi Nakahara, Akira Matsunaga

Purpose: Safe perioperative management of patients undergoing transcatheter aortic valve implantation (TAVI) is crucial. Remimazolam is a newly developed short-acting benzodiazepine. We hypothesized that combining remimazolam and flumazenil would reduce emergence time compared with sevoflurane in patients undergoing general anesthesia for TAVI.

Methods: We conducted a prospective, randomized, parallel-design, open-label, single-centre clinical trial between June 2022 and August 2023 at Kagoshima University Hospital. We allocated patients randomly to either the remimazolam/flumazenil group or the sevoflurane group. Patients in the remimazolam group received iv remimazolam whereas patients in the sevoflurane group received sevoflurane for general anesthesia maintenance. Patients in both groups received a remifentanil infusion throughout the TAVI procedure (0.2 μg·kg-1·min-1 iv). Remimazolam and sevoflurane were adjusted to maintain a Bispectral Index™ (Covidien/Medtronic, Minneapolis, MN, USA) of 40-60. In the remimazolam group, flumazenil (0.2 mg iv) was administered immediately after remimazolam discontinuation. The primary outcome was time to extubation. Secondary outcomes included intraoperative variables (hemodynamic variables and vasopressor dose), rate of intra- and postoperative complications, and recovery of muscle strength.

Results: Overall, 60 patients were enrolled, and data from 56 were included. The median [interquartile range] time to extubation was significantly shorter in the remimazolam group than in the sevoflurane group (6.5 [5.1-8.1] min vs 14.2 [10.9-15.9] min; difference in medians, -6.9 min; 95% confidence interval, -8.7 to -5.0; P < 0.001). Statistically significant differences were observed in the perfusion index (P = 0.03) and regional cerebral oxygen saturation (P = 0.03) between the groups. No significant differences between the two groups were seen in other secondary outcomes.

Conclusions: Compared with sevoflurane, a combination of remimazolam and flumazenil significantly reduced the time to extubation in patients undergoing general anesthesia for TAVI. Therefore, remimazolam may be a suitable choice for general anesthesia in patients undergoing TAVI.

Study registration: UMIN.ac.jp ( UMIN000047892 ); first posted 30 May 2022.

目的:经导管主动脉瓣植入术(TAVI)患者围手术期的安全管理至关重要。雷马唑仑是一种新开发的短效苯二氮卓类药物。我们假设,与七氟醚相比,雷马唑仑和氟马西尼联合使用可以减少TAVI全麻患者的急救时间。方法:我们于2022年6月至2023年8月在鹿儿岛大学医院进行了一项前瞻性、随机、平行设计、开放标签、单中心临床试验。我们将患者随机分配到雷马唑仑/氟马西尼组或七氟醚组。雷马唑仑组给予静脉注射雷马唑仑,七氟醚组给予七氟醚维持全身麻醉。两组患者在TAVI过程中均输注瑞芬太尼(0.2 μg·kg-1·min-1 iv)。调整雷马唑仑和七氟醚以维持双谱指数™(Covidien/Medtronic, Minneapolis, MN, USA)为40-60。在雷马唑仑组,在雷马唑仑停药后立即给予氟马西尼(0.2 mg iv)。主要观察指标为拔管时间。次要结果包括术中变量(血流动力学变量和血管加压剂剂量)、术中和术后并发症的发生率以及肌肉力量的恢复。结果:共纳入60例患者,数据来自56例。雷马唑仑组拔管时间的中位数[四分位数范围]明显短于七氟醚组(6.5 [5.1-8.1]min vs 14.2 [10.9-15.9] min;中位数差异-6.9 min;95%置信区间为-8.7 ~ -5.0;结论:与七氟醚相比,雷马唑仑联合氟马西尼可显著减少TAVI全麻患者拔管时间。因此,雷马唑仑可能是TAVI患者全身麻醉的合适选择。研究注册:min .ac.jp (UMIN000047892);最早发布于2022年5月30日。
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引用次数: 0
The burden of COVID-19 care in community and academic intensive care units in Ontario, Canada: a retrospective cohort study. 加拿大安大略省社区和学术重症监护病房COVID-19护理负担:一项回顾性队列研究
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-12-17 DOI: 10.1007/s12630-024-02894-z
Daniel Pestana, Divya Joshi, Erick Duan, Robert Fowler, Jennifer Tsang, Alexandra Binnie

Purpose: During the COVID-19 pandemic, neighbourhoods with high material deprivation and high proportions of racialized Canadians were disproportionately affected by COVID-19. Many of these neighbourhoods were served by community hospitals. We sought to compare the burden of COVID-19 care in community and academic intensive care units (ICUs) in Ontario, Canada.

Methods: We included all adult patients admitted to Ontario ICUs with COVID-19 between 1 March 2020 and 31 July 2021 in a retrospective cohort study. We compared patient volumes, demographics, interventions, and outcomes between community hospital corporations (CHCs) and academic hospital corporations (AHCs).

Results: During the first three waves of the pandemic, 9,651 adult ICU admissions for COVID-19 were reported across 72 hospital corporations in Ontario: 6,902 (71.5%) in CHCs and 2,749 (28.5%) in AHCs. Days of ICU care per baseline ICU bed were highest in large CHCs (> 10 baseline ICU beds) relative to AHCs and small CHCs (median [interquartile range], 73.7 [53.8-110.6] vs 42.2 [32.7-71.8] vs 21.4 [7.2-40.3]; Kruskal-Wallis test, P < 0.001). Among direct ICU admissions, CHC patients had greater severity of illness whereas among transfer ICU admissions, AHC patients were more severely ill. In a multivariable logistic regression model, mortality was similar among patients with index admission to a CHC or AHC; however, patients with index admission to an AHC were more likely to receive extracorporeal membrane oxygenation (adjusted odds ratio, 6.16; 95% confidence interval, 4.72 to 8.11).

Conclusion: During the pandemic, Ontario's large CHCs provided significantly more days of ICU COVID-19 care per baseline ICU bed compared with AHCs and small CHCs. Equipping large CHCs to handle ICU surges during future emerging disease outbreaks should be a priority for pandemic preparedness.

目的:在2019冠状病毒病大流行期间,物质剥夺程度高的社区和高比例的种族化加拿大人受到COVID-19的影响不成比例。许多这样的社区都有社区医院。我们试图比较加拿大安大略省社区重症监护病房和学术重症监护病房(icu)的COVID-19护理负担。方法:我们在一项回顾性队列研究中纳入了2020年3月1日至2021年7月31日期间入住安大略省icu的所有COVID-19成年患者。我们比较了社区医院公司(CHCs)和学术医院公司(AHCs)的患者数量、人口统计、干预措施和结果。结果:在前三波大流行期间,安大略省72家医院公司共报告了9,651例COVID-19成人ICU住院病例:CHCs为6,902例(71.5%),AHCs为2,749例(28.5%)。相对于AHCs和小CHCs,大CHCs (bbb10基线ICU床位)的每张基线ICU病床的ICU护理天数最高(中位数[四分位数间距],73.7 [53.8-110.6]vs 42.2 [32.7-71.8] vs 21.4 [7.2-40.3];结论:大流行期间,安大略省大型CHCs提供的每个基线ICU床位的ICU护理天数明显多于AHCs和小型CHCs。在未来新出现的疾病暴发期间,为大型卫生保健中心配备应对重症监护病房激增的设备应成为大流行防范的优先事项。
{"title":"The burden of COVID-19 care in community and academic intensive care units in Ontario, Canada: a retrospective cohort study.","authors":"Daniel Pestana, Divya Joshi, Erick Duan, Robert Fowler, Jennifer Tsang, Alexandra Binnie","doi":"10.1007/s12630-024-02894-z","DOIUrl":"https://doi.org/10.1007/s12630-024-02894-z","url":null,"abstract":"<p><strong>Purpose: </strong>During the COVID-19 pandemic, neighbourhoods with high material deprivation and high proportions of racialized Canadians were disproportionately affected by COVID-19. Many of these neighbourhoods were served by community hospitals. We sought to compare the burden of COVID-19 care in community and academic intensive care units (ICUs) in Ontario, Canada.</p><p><strong>Methods: </strong>We included all adult patients admitted to Ontario ICUs with COVID-19 between 1 March 2020 and 31 July 2021 in a retrospective cohort study. We compared patient volumes, demographics, interventions, and outcomes between community hospital corporations (CHCs) and academic hospital corporations (AHCs).</p><p><strong>Results: </strong>During the first three waves of the pandemic, 9,651 adult ICU admissions for COVID-19 were reported across 72 hospital corporations in Ontario: 6,902 (71.5%) in CHCs and 2,749 (28.5%) in AHCs. Days of ICU care per baseline ICU bed were highest in large CHCs (> 10 baseline ICU beds) relative to AHCs and small CHCs (median [interquartile range], 73.7 [53.8-110.6] vs 42.2 [32.7-71.8] vs 21.4 [7.2-40.3]; Kruskal-Wallis test, P < 0.001). Among direct ICU admissions, CHC patients had greater severity of illness whereas among transfer ICU admissions, AHC patients were more severely ill. In a multivariable logistic regression model, mortality was similar among patients with index admission to a CHC or AHC; however, patients with index admission to an AHC were more likely to receive extracorporeal membrane oxygenation (adjusted odds ratio, 6.16; 95% confidence interval, 4.72 to 8.11).</p><p><strong>Conclusion: </strong>During the pandemic, Ontario's large CHCs provided significantly more days of ICU COVID-19 care per baseline ICU bed compared with AHCs and small CHCs. Equipping large CHCs to handle ICU surges during future emerging disease outbreaks should be a priority for pandemic preparedness.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848550","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
Guest Reviewers. 客人的评论家。
IF 3.4 3区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-12-02 DOI: 10.1007/s12630-024-02892-1
{"title":"Guest Reviewers.","authors":"","doi":"10.1007/s12630-024-02892-1","DOIUrl":"https://doi.org/10.1007/s12630-024-02892-1","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775099","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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