Pub Date : 2024-08-01Epub Date: 2024-06-14DOI: 10.1007/s12630-024-02777-3
Ryan McGinn, Stuart A McCluskey, Blayne A Sayed, Toru Goto, Christopher T Chan, Patricia Murphy
Purpose: The benefits of intraoperative dialysis during orthotopic liver transplantation remain controversial. In patients with anuric renal failure and portopulmonary hypertension, maintaining venous return during caval clamping and unclamping along with minimizing fluid overload is critical to avoiding right ventricular strain and failure.
Clinical features: We present the case of a 54-yr-old female who underwent orthotopic liver transplantation for alcohol-related liver disease with acute decompensation including severe hepatorenal syndrome (anuric requiring dialysis), probable hepatopulmonary syndrome, moderate pulmonary hypertension (right ventricular systolic pressure, 44 mm Hg), hepatic encephalopathy (grade 2), and esophageal varices. Prior to incision, pulmonary arterial pressures were 48/28 (mean, 35) mm Hg with a central venous pressure of 30 mm Hg, cardiac output of 7.4 L·min-1, and pulmonary vascular resistance of 98 dynes·sec·cm-5. In the context of right ventricular strain and volume overload observed on transthoracic echocardiography, we inserted an additional dialysis catheter into the right femoral vein. We initiated dialysis using the two catheters as a circuit (femoral line to the dialysis machine; blood was reinjected via the subclavian line) acting as a limited venovenous bypass, allowing right ventricular offloading and hemodialysis throughout the case. We removed 4.5 L via hemodialysis during the surgery, while avoiding acidosis, hyperkalemia, and sodium shifts. The patient tolerated reperfusion adequately despite pre-existing right ventricular dilation and dysfunction.
Conclusion: We report on the use two hemodialysis catheters in a patient undergoing orthotopic liver transplantation as a circuit for simultaneous anuric hepatorenal syndrome and moderate pulmonary hypertension with right ventricular dilation and dysfunction. We believe this technique was instrumental in the patient's successful transplant.
目的:正位肝移植术中透析的益处仍存在争议。对于无尿肾衰竭和门静脉高压的患者,在夹闭和松开腔静脉时保持静脉回流,同时尽量减少液体超负荷是避免右心室负荷和衰竭的关键:我们报告了一例 54 岁女性患者的病例,她因酒精相关肝病接受了正位肝移植手术,术后出现急性失代偿,包括重度肝肾综合征(无尿需要透析)、可能的肝肺综合征、中度肺动脉高压(右心室收缩压 44 mm Hg)、肝性脑病(2 级)和食管静脉曲张。切开前,肺动脉压为 48/28(平均 35)毫米汞柱,中心静脉压为 30 毫米汞柱,心输出量为 7.4 升/分钟-1,肺血管阻力为 98 达因-秒-厘米-5。 鉴于经胸超声心动图观察到的右心室应变和容量超负荷,我们在右股静脉中插入了一根额外的透析导管。我们将两根导管作为一个回路(股静脉管路连接透析机;血液经锁骨下管路再注入)启动透析,将其作为一个有限的静脉旁路,在整个病例中实现右心室负荷和血液透析。手术期间,我们通过血液透析清除了 4.5 L 血液,同时避免了酸中毒、高钾血症和钠转移。尽管患者已存在右心室扩张和功能障碍,但仍能充分耐受再灌注:我们报告了在一名接受正位肝移植手术的患者身上使用两根血液透析导管,作为同时患有无尿肝肾综合征和中度肺动脉高压并伴有右心室扩张和功能障碍的患者的回路。我们相信这项技术对患者的成功移植起到了重要作用。
{"title":"Intraoperative hemodialysis with supra- and infradiaphragmatic catheters for liver transplantation.","authors":"Ryan McGinn, Stuart A McCluskey, Blayne A Sayed, Toru Goto, Christopher T Chan, Patricia Murphy","doi":"10.1007/s12630-024-02777-3","DOIUrl":"10.1007/s12630-024-02777-3","url":null,"abstract":"<p><strong>Purpose: </strong>The benefits of intraoperative dialysis during orthotopic liver transplantation remain controversial. In patients with anuric renal failure and portopulmonary hypertension, maintaining venous return during caval clamping and unclamping along with minimizing fluid overload is critical to avoiding right ventricular strain and failure.</p><p><strong>Clinical features: </strong>We present the case of a 54-yr-old female who underwent orthotopic liver transplantation for alcohol-related liver disease with acute decompensation including severe hepatorenal syndrome (anuric requiring dialysis), probable hepatopulmonary syndrome, moderate pulmonary hypertension (right ventricular systolic pressure, 44 mm Hg), hepatic encephalopathy (grade 2), and esophageal varices. Prior to incision, pulmonary arterial pressures were 48/28 (mean, 35) mm Hg with a central venous pressure of 30 mm Hg, cardiac output of 7.4 L·min<sup>-1</sup>, and pulmonary vascular resistance of 98 dynes·sec·cm<sup>-5</sup>. In the context of right ventricular strain and volume overload observed on transthoracic echocardiography, we inserted an additional dialysis catheter into the right femoral vein. We initiated dialysis using the two catheters as a circuit (femoral line to the dialysis machine; blood was reinjected via the subclavian line) acting as a limited venovenous bypass, allowing right ventricular offloading and hemodialysis throughout the case. We removed 4.5 L via hemodialysis during the surgery, while avoiding acidosis, hyperkalemia, and sodium shifts. The patient tolerated reperfusion adequately despite pre-existing right ventricular dilation and dysfunction.</p><p><strong>Conclusion: </strong>We report on the use two hemodialysis catheters in a patient undergoing orthotopic liver transplantation as a circuit for simultaneous anuric hepatorenal syndrome and moderate pulmonary hypertension with right ventricular dilation and dysfunction. We believe this technique was instrumental in the patient's successful transplant.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1165-1171"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322133","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}
Pub Date : 2024-08-01Epub Date: 2024-07-01DOI: 10.1007/s12630-024-02794-2
Adom Bondzi-Simpson, C J Lindo, Luckshi Rajendran, Jill Campbell, Victoria Cheung, David N Parente, Richard Ahn, Michael Ko
{"title":"Addition of an erector spinae plane block to intercostal nerve blockade for postoperative analgesia after video-assisted thoracic surgery: a preliminary retrospective institutional review.","authors":"Adom Bondzi-Simpson, C J Lindo, Luckshi Rajendran, Jill Campbell, Victoria Cheung, David N Parente, Richard Ahn, Michael Ko","doi":"10.1007/s12630-024-02794-2","DOIUrl":"10.1007/s12630-024-02794-2","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1183-1185"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494419","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}
Pub Date : 2024-08-01Epub Date: 2024-06-13DOI: 10.1007/s12630-024-02781-7
Fei Wu, Seth A Klapman, Lucinda L Everett, Braden Kuo, Ion A Hobai
{"title":"In reply: Comment on: Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study.","authors":"Fei Wu, Seth A Klapman, Lucinda L Everett, Braden Kuo, Ion A Hobai","doi":"10.1007/s12630-024-02781-7","DOIUrl":"10.1007/s12630-024-02781-7","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1174"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319133","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}
Pub Date : 2024-08-01Epub Date: 2024-07-10DOI: 10.1007/s12630-024-02797-z
Eoin McFadden, Juan J Ronco, Gordon Finlayson, Anastasia Hadjivassiliou, Stephen Ho, Darren Klass, Gerald Legiehn, Lindsay Machan, Dennis Parhar, Kali Romano, Sonny Thiara
{"title":"Transvenous catheter-directed embolectomy for pulmonary embolism.","authors":"Eoin McFadden, Juan J Ronco, Gordon Finlayson, Anastasia Hadjivassiliou, Stephen Ho, Darren Klass, Gerald Legiehn, Lindsay Machan, Dennis Parhar, Kali Romano, Sonny Thiara","doi":"10.1007/s12630-024-02797-z","DOIUrl":"10.1007/s12630-024-02797-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1163-1164"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581660","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}
Pub Date : 2024-08-01Epub Date: 2024-03-19DOI: 10.1007/s12630-024-02745-x
M Omair Rahman, Emannuel Charbonney, Ryan Vaisler, Abubaker Khalifa, Waleed Alhazzani, Kiera Gossack-Keenan, Allan Garland, Timothy Karachi, Erick Duan, Sean M Bagshaw, Maureen O Meade, Chris Hillis, Peter Kavsak, Karen Born, Lawrence Mbuagbaw, Deborah Siegal, Tina Millen, Damon Scales, Andre Amaral, Shane English, Victoria A McCredie, Peter Dodek, Deborah J Cook, Bram Rochwerg
Purpose: The ordering of routine blood test panels in advance is common in intensive care units (ICUs), with limited consideration of the pretest probability of finding abnormalities. This practice contributes to anemia, false positive results, and health care costs. We sought to understand practices and attitudes of Canadian adult intensivists regarding ordering of blood tests in critically ill patients.
Methods: We conducted a nationwide Canadian cross-sectional survey consisting of 15 questions assessing three domains (global perceptions, test ordering, daily practice), plus 11 demographic questions. The target sample was one intensivist per adult ICU in Canada. We summarized responses using descriptive statistics and present data as mean with standard deviation (SD) or count with percentage as appropriate.
Results: Over seven months, 80/131 (61%) physicians responded from 77 ICUs, 50% of which were from Ontario. Respondents had a mean (SD) clinical experience of 12 (9) years, and 61% worked in academic centres. When asked about their perceptions of how frequently unnecessary blood tests are ordered, 61% responded "sometimes" and 23% responded "almost always." Fifty-seven percent favoured ordering complete blood counts one day in advance. Only 24% of respondents believed that advanced blood test ordering frequently led to changes in management. The most common factors perceived to influence blood test ordering in the ICU were physician preferences, institutional patterns, and order sets.
Conclusion: Most respondents to this survey perceived that unnecessary blood testing occurs in the ICU. The survey identified possible strategies to decrease the number of blood tests.
{"title":"A Canadian survey of perceptions and practices related to ordering of blood tests in the intensive care unit.","authors":"M Omair Rahman, Emannuel Charbonney, Ryan Vaisler, Abubaker Khalifa, Waleed Alhazzani, Kiera Gossack-Keenan, Allan Garland, Timothy Karachi, Erick Duan, Sean M Bagshaw, Maureen O Meade, Chris Hillis, Peter Kavsak, Karen Born, Lawrence Mbuagbaw, Deborah Siegal, Tina Millen, Damon Scales, Andre Amaral, Shane English, Victoria A McCredie, Peter Dodek, Deborah J Cook, Bram Rochwerg","doi":"10.1007/s12630-024-02745-x","DOIUrl":"10.1007/s12630-024-02745-x","url":null,"abstract":"<p><strong>Purpose: </strong>The ordering of routine blood test panels in advance is common in intensive care units (ICUs), with limited consideration of the pretest probability of finding abnormalities. This practice contributes to anemia, false positive results, and health care costs. We sought to understand practices and attitudes of Canadian adult intensivists regarding ordering of blood tests in critically ill patients.</p><p><strong>Methods: </strong>We conducted a nationwide Canadian cross-sectional survey consisting of 15 questions assessing three domains (global perceptions, test ordering, daily practice), plus 11 demographic questions. The target sample was one intensivist per adult ICU in Canada. We summarized responses using descriptive statistics and present data as mean with standard deviation (SD) or count with percentage as appropriate.</p><p><strong>Results: </strong>Over seven months, 80/131 (61%) physicians responded from 77 ICUs, 50% of which were from Ontario. Respondents had a mean (SD) clinical experience of 12 (9) years, and 61% worked in academic centres. When asked about their perceptions of how frequently unnecessary blood tests are ordered, 61% responded \"sometimes\" and 23% responded \"almost always.\" Fifty-seven percent favoured ordering complete blood counts one day in advance. Only 24% of respondents believed that advanced blood test ordering frequently led to changes in management. The most common factors perceived to influence blood test ordering in the ICU were physician preferences, institutional patterns, and order sets.</p><p><strong>Conclusion: </strong>Most respondents to this survey perceived that unnecessary blood testing occurs in the ICU. The survey identified possible strategies to decrease the number of blood tests.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1137-1144"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177963","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}
Pub Date : 2024-08-01Epub Date: 2024-06-13DOI: 10.1007/s12630-024-02780-8
Glenio B Mizubuti, Leopoldo Muniz da Silva, Saullo Queiroz Silveira, Ian Gilron, Anthony M-H Ho
{"title":"Comment on: Association of glucagon-like peptide receptor 1 agonist therapy with the presence of gastric contents in fasting patients undergoing endoscopy under anesthesia care: a historical cohort study.","authors":"Glenio B Mizubuti, Leopoldo Muniz da Silva, Saullo Queiroz Silveira, Ian Gilron, Anthony M-H Ho","doi":"10.1007/s12630-024-02780-8","DOIUrl":"10.1007/s12630-024-02780-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1172-1173"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319132","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}
Pub Date : 2024-08-01Epub Date: 2024-07-03DOI: 10.1007/s12630-024-02776-4
Elad Dana, Hadas K Dana, Charmaine De Castro, Luz Bueno Rey, Qixuan Li, George Tomlinson, James S Khan
Purpose: Hypotension after induction of general anesthesia is common and is associated with significant adverse events. Identification of patients at high risk can inform the use of preoperative mitigation strategies. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CI) and maximal diameter (dIVCmax) in predicting postinduction hypotension and to identify their predictive performance across different threshold ranges.
Methods: We searched MEDLINE, PubMed®, and Embase from inception to March 2023 for prospective observational studies exploring the performance of IVC-CI and dIVCmax in predicting postinduction hypotension in adults presenting for elective surgery under general anesthesia. We excluded studies reporting on IVC parameters predicting postinduction hypotension in the obstetric patient population or exclusively in patients with obesity. Trials screening and data extraction were conducted independently. We performed meta-analyses to identify the performance of IVC parameters in predicting postinduction hypotension, followed by subgroup analyses that sought the IVC-CI range with the highest hierarchical summary receiver-operating characteristic area under the curve (HSROC-AUC). We used a bivariate random effects model to calculate summary estimates. We evaluated study quality using Newcastle-Ottawa scores and certainty of evidence using the GRADE framework.
Results: We included 14 studies involving 1,166 patients. Pooled sensitivity and specificity of the IVC-CI to predict postinduction hypotension was 0.68 (95% confidence interval [CI], 0.55 to 0.79; coverage probability, 0.91) and 0.78 (95% CI, 0.69 to 0.85; coverage probability, 0.9), respectively, with an HSROC-AUC of 0.80 (95% CI, 0.68 to 0.85, high quality of evidence). An IVC-CI threshold range of 40-45% had an HSROC-AUC of 0.86 (95% CI, 0.69 to 0.93, high quality of evidence).
Conclusions: Preoperative IVC-CI is a strong predictor of postinduction hypotension. We recommend that future studies use an IVC-CI threshold of 40-45% (low certainty of evidence). Future studies are needed to establish whether ultrasound-guided preoperative optimization improves outcomes in high-risk patients.
Study registration: PROSPERO ( CRD42022316140 ); first submitted 10 March 2022.
{"title":"Inferior vena cava ultrasound to predict hypotension after general anesthesia induction: a systematic review and meta-analysis of observational studies.","authors":"Elad Dana, Hadas K Dana, Charmaine De Castro, Luz Bueno Rey, Qixuan Li, George Tomlinson, James S Khan","doi":"10.1007/s12630-024-02776-4","DOIUrl":"10.1007/s12630-024-02776-4","url":null,"abstract":"<p><strong>Purpose: </strong>Hypotension after induction of general anesthesia is common and is associated with significant adverse events. Identification of patients at high risk can inform the use of preoperative mitigation strategies. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CI) and maximal diameter (dIVC<sub>max</sub>) in predicting postinduction hypotension and to identify their predictive performance across different threshold ranges.</p><p><strong>Methods: </strong>We searched MEDLINE, PubMed®, and Embase from inception to March 2023 for prospective observational studies exploring the performance of IVC-CI and dIVC<sub>max</sub> in predicting postinduction hypotension in adults presenting for elective surgery under general anesthesia. We excluded studies reporting on IVC parameters predicting postinduction hypotension in the obstetric patient population or exclusively in patients with obesity. Trials screening and data extraction were conducted independently. We performed meta-analyses to identify the performance of IVC parameters in predicting postinduction hypotension, followed by subgroup analyses that sought the IVC-CI range with the highest hierarchical summary receiver-operating characteristic area under the curve (HSROC-AUC). We used a bivariate random effects model to calculate summary estimates. We evaluated study quality using Newcastle-Ottawa scores and certainty of evidence using the GRADE framework.</p><p><strong>Results: </strong>We included 14 studies involving 1,166 patients. Pooled sensitivity and specificity of the IVC-CI to predict postinduction hypotension was 0.68 (95% confidence interval [CI], 0.55 to 0.79; coverage probability, 0.91) and 0.78 (95% CI, 0.69 to 0.85; coverage probability, 0.9), respectively, with an HSROC-AUC of 0.80 (95% CI, 0.68 to 0.85, high quality of evidence). An IVC-CI threshold range of 40-45% had an HSROC-AUC of 0.86 (95% CI, 0.69 to 0.93, high quality of evidence).</p><p><strong>Conclusions: </strong>Preoperative IVC-CI is a strong predictor of postinduction hypotension. We recommend that future studies use an IVC-CI threshold of 40-45% (low certainty of evidence). Future studies are needed to establish whether ultrasound-guided preoperative optimization improves outcomes in high-risk patients.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022316140 ); first submitted 10 March 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1078-1091"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499765","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}
Pub Date : 2024-08-01Epub Date: 2024-04-12DOI: 10.1007/s12630-024-02735-z
Subin Yim, Chang Ik Choi, Insun Park, Bon Wook Koo, Ah Young Oh, In-Ae Song
Purpose: Maintaining hemodynamic stability during cardiac ablation under general anesthesia is challenging. Remimazolam, a novel ultrashort-acting benzodiazepine, is characterized by maintaining comparatively stable blood pressure and does not influence the cardiac conduction system, which renders it a reasonable choice for general anesthesia for cardiac ablation. We aimed to evaluate whether remimazolam is associated with a decreased incidence of intraoperative hypotension compared with desflurane.
Methods: In this single-centre, parallel-group, prospective, single-blind, randomized clinical trial, we randomized patients (1:1) into a remimazolam group (remimazolam-based total intravenous anesthesia) or desflurane group (propofol-induced and desflurane-maintained inhalational anesthesia) during cardiac ablation procedures for arrhythmia. The primary outcome was the incidence of intraoperative hypotensive events, defined as mean arterial pressure of < 60 mm Hg at any period.
Results: Overall, we enrolled 96 patients between 2 August 2022 and 19 May 2023 (47 and 49 patients in the remimazolam and desflurane groups, respectively). The remimazolam group showed a significantly lower incidence of hypotensive events (14/47, 30%) than the desflurane group (29/49, 59%; relative risk [RR], 0.5; 95% confidence interval [CI], 0.31 to 0.83; P = 0.004). Remimazolam was associated with a lower requirement for bolus or continuous vasopressor infusion than desflurane was (23/47, 49% vs 43/49, 88%; RR, 0.56; 95% CI, 0.41 to 0.76; P < 0.001). No between-group differences existed in the incidence of perioperative complications such as nausea, vomiting, oxygen desaturation, delayed emergence, or pain.
Conclusions: Remimazolam was a viable option for general anesthesia for cardiac ablation. Remimazolam-based total intravenous anesthesia was associated with significantly fewer hypotensive events and vasopressor requirements than desflurane-based inhalational anesthesia was, without significantly more complications.
Study registration: ClinicalTrials.gov (NCT05486377); first submitted 1 August 2022.
{"title":"Remimazolam to prevent hemodynamic instability during catheter ablation under general anesthesia: a randomized controlled trial.","authors":"Subin Yim, Chang Ik Choi, Insun Park, Bon Wook Koo, Ah Young Oh, In-Ae Song","doi":"10.1007/s12630-024-02735-z","DOIUrl":"10.1007/s12630-024-02735-z","url":null,"abstract":"<p><strong>Purpose: </strong>Maintaining hemodynamic stability during cardiac ablation under general anesthesia is challenging. Remimazolam, a novel ultrashort-acting benzodiazepine, is characterized by maintaining comparatively stable blood pressure and does not influence the cardiac conduction system, which renders it a reasonable choice for general anesthesia for cardiac ablation. We aimed to evaluate whether remimazolam is associated with a decreased incidence of intraoperative hypotension compared with desflurane.</p><p><strong>Methods: </strong>In this single-centre, parallel-group, prospective, single-blind, randomized clinical trial, we randomized patients (1:1) into a remimazolam group (remimazolam-based total intravenous anesthesia) or desflurane group (propofol-induced and desflurane-maintained inhalational anesthesia) during cardiac ablation procedures for arrhythmia. The primary outcome was the incidence of intraoperative hypotensive events, defined as mean arterial pressure of < 60 mm Hg at any period.</p><p><strong>Results: </strong>Overall, we enrolled 96 patients between 2 August 2022 and 19 May 2023 (47 and 49 patients in the remimazolam and desflurane groups, respectively). The remimazolam group showed a significantly lower incidence of hypotensive events (14/47, 30%) than the desflurane group (29/49, 59%; relative risk [RR], 0.5; 95% confidence interval [CI], 0.31 to 0.83; P = 0.004). Remimazolam was associated with a lower requirement for bolus or continuous vasopressor infusion than desflurane was (23/47, 49% vs 43/49, 88%; RR, 0.56; 95% CI, 0.41 to 0.76; P < 0.001). No between-group differences existed in the incidence of perioperative complications such as nausea, vomiting, oxygen desaturation, delayed emergence, or pain.</p><p><strong>Conclusions: </strong>Remimazolam was a viable option for general anesthesia for cardiac ablation. Remimazolam-based total intravenous anesthesia was associated with significantly fewer hypotensive events and vasopressor requirements than desflurane-based inhalational anesthesia was, without significantly more complications.</p><p><strong>Study registration: </strong>ClinicalTrials.gov (NCT05486377); first submitted 1 August 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1067-1077"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872929","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}
Pub Date : 2024-08-01Epub Date: 2024-05-21DOI: 10.1007/s12630-024-02771-9
Roopal Rai, Jacob J Wiseman, Anthony Chau, Sam M Wiseman
Purpose: Guidelines recommend that health-related information for patients should be written at or below the sixth-grade level. We sought to evaluate the readability level and quality of online patient education materials regarding epidural and spinal anesthesia.
Methods: We evaluated webpages with content written specifically regarding either spinal or epidural anesthesia, identified using 11 relevant search terms, with seven commonly used readability formulas: Flesh-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed the quality of the reading materials using the Brief DISCERN tool.
Results: We analyzed 261 webpages. The mean (standard deviation) readability scores were: FKGL = 8.8 (1.9), GFI = 11.2 (2.2), CLI = 10.3 (1.9), ARI = 8.1 (2.2), SMOG = 11.6 (1.6), FRE = 55.7 (10.8), and NDC = 5.4 (1.0). The mean grade level was higher than the recommended sixth-grade level when calculated with six of the seven readability formulas. The average Brief DISCERN score was 16.0.
Conclusion: Readability levels of online patient education materials pertaining to epidural and spinal anesthesia are higher than recommended. When we evaluated the quality of the information using a validated tool, the materials were found to be just below the threshold of what is considered good quality. Authors of educational materials should provide not only readable but also good-quality information to enhance patient understanding.
目的:指南建议为患者提供的健康相关信息的书写水平应达到或低于六年级水平。我们试图评估有关硬膜外麻醉和脊髓麻醉的在线患者教育材料的可读性水平和质量:我们使用 11 个相关搜索词和 7 个常用的可读性公式对专门针对脊髓或硬膜外麻醉编写内容的网页进行了评估:Flesh-Kincaid Grade Level (FKGL)、Gunning Fox Index (GFI)、Coleman-Liau Index (CLI)、Automated Readability Index (ARI)、Simple Measure of Gobbledygook (SMOG)、Flesch Reading Ease (FRE) 和 New Dale-Chall (NDC)。两名评估员使用简明 DISCERN 工具评估了阅读材料的质量:我们分析了 261 个网页。可读性得分的平均值(标准差)为FKGL = 8.8 (1.9),GFI = 11.2 (2.2),CLI = 10.3 (1.9),ARI = 8.1 (2.2),SMOG = 11.6 (1.6),FRE = 55.7 (10.8),NDC = 5.4 (1.0)。使用七种可读性公式中的六种计算得出的平均年级高于建议的六年级水平。简明 DISCERN 平均得分为 16.0:与硬膜外和脊髓麻醉相关的在线患者教育资料的可读性水平高于建议水平。当我们使用一种经过验证的工具对信息质量进行评估时,发现这些材料的质量略低于良好质量的标准。教育材料的作者不仅应提供可读性强的信息,还应提供高质量的信息,以加深患者的理解。
{"title":"Readability and quality assessment of online patient education materials for spinal and epidural anesthesia.","authors":"Roopal Rai, Jacob J Wiseman, Anthony Chau, Sam M Wiseman","doi":"10.1007/s12630-024-02771-9","DOIUrl":"10.1007/s12630-024-02771-9","url":null,"abstract":"<p><strong>Purpose: </strong>Guidelines recommend that health-related information for patients should be written at or below the sixth-grade level. We sought to evaluate the readability level and quality of online patient education materials regarding epidural and spinal anesthesia.</p><p><strong>Methods: </strong>We evaluated webpages with content written specifically regarding either spinal or epidural anesthesia, identified using 11 relevant search terms, with seven commonly used readability formulas: Flesh-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed the quality of the reading materials using the Brief DISCERN tool.</p><p><strong>Results: </strong>We analyzed 261 webpages. The mean (standard deviation) readability scores were: FKGL = 8.8 (1.9), GFI = 11.2 (2.2), CLI = 10.3 (1.9), ARI = 8.1 (2.2), SMOG = 11.6 (1.6), FRE = 55.7 (10.8), and NDC = 5.4 (1.0). The mean grade level was higher than the recommended sixth-grade level when calculated with six of the seven readability formulas. The average Brief DISCERN score was 16.0.</p><p><strong>Conclusion: </strong>Readability levels of online patient education materials pertaining to epidural and spinal anesthesia are higher than recommended. When we evaluated the quality of the information using a validated tool, the materials were found to be just below the threshold of what is considered good quality. Authors of educational materials should provide not only readable but also good-quality information to enhance patient understanding.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1092-1102"},"PeriodicalIF":3.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077306","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}