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英文中文

Xenon anaesthesia is associated with a reduction in frontal electroencephalogram peak alpha frequency

BJA open

Pub Date : 2024-12-01 DOI: 10.1016/j.bjao.2024.100358

Steven McGuigan , Andria Pelentritou , David A. Scott , Jamie Sleigh

Background

Administration of conventional anaesthetic agents is associated with changes in electroencephalogram (EEG) oscillatory dynamics, including a reduction in the peak alpha frequency. Computational models of neurones can reproduce such phenomena and are valuable tools for investigating their underlying mechanisms. We hypothesised that EEG data acquired during xenon anaesthesia in humans would show similar changes in peak alpha frequency and that computational neuronal models of recognised cellular actions of xenon would be consistent with the observed changes.

Methods

EEG recordings were obtained for 11 participants from a randomised controlled trial of xenon anaesthesia and for 21 participants from a volunteer study of xenon administration. The frontal peak alpha frequency was calculated for both cohorts at awake baseline and during xenon administration. In silico simulations with two computational models of neurones were performed to investigate how xenon antagonism of hyperpolarisation-activated cyclic nucleotide-gated channel 2 (HCN2) and glutamatergic excitatory neurotransmission would influence peak alpha frequency.

Results

Compared with awake baseline, frontal peak alpha frequency was significantly lower during xenon administration in the randomised controlled trial cohort, median (inter-quartile range) frequency 7.73 Hz (7.27–8.08 Hz) vs 8.81 Hz (8.35–9.03 Hz), P=0.012, and the volunteer cohort, 8.69 Hz (8.34–8.98 Hz) vs 9.41 Hz (9.11–9.92 Hz), P=0.001. In silico simulations with both computational models suggest that antagonism of HCN2 and glutamatergic excitatory neurotransmission are associated with a reduction in peak alpha frequency.

Conclusions

Xenon administration is associated with a reduction of peak alpha frequency in the frontal EEG. In silico simulations utilising two computational models of neurones suggest that these changes are consistent with antagonism of HCN2 and glutamatergic excitatory neurotransmission.

Clinical trial registration

The Australian New Zealand Clinical Trials Registry: ANZCTR number 12618000916246.

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引用次数: 0

Moderate or severe pain in recovery after major elective surgery: A pilot retrospective analysis to identify those at risk

BJA open

Pub Date : 2024-12-01 DOI: 10.1016/j.bjao.2024.100361

Andy Yuet Meng Ng, Thomas Emery

引用次数: 0

Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study 小儿心脏手术中无血浆血红蛋白与术后急性肾损伤之间的关系：一项前瞻性观察研究

BJA open

Pub Date : 2024-10-26 DOI: 10.1016/j.bjao.2024.100348

Takanobu Sakura, Tomoyuki Kanazawa, Tatsuhiko Shimizu, Kazuyoshi Shimizu, Tatsuo Iwasaki, Hiroshi Morimatsu

Background

Acute kidney injury (AKI) is a common complication among patients requiring cardiopulmonary bypass (CPB) during paediatric cardiac surgery. Plasma-free haemoglobin (PFH) produced by haemolysis during CPB contributes to AKI. This study aimed to determine the association between PFH and postoperative AKI during paediatric cardiac surgery requiring CPB.

Methods

This prospective, single-centre, observational study included children aged <5 yr who underwent cardiac surgery requiring CPB. PFH was measured pre-CPB, every 30 min during CPB, after modified ultrafiltration, on ICU admission, and once a day at 1–3 days after surgery. The study outcome included the relationship between peak PFH concentrations and the development of postoperative AKI up to 3 days after surgery. Additionally, multivariable analysis was performed to determine the risk factors for AKI.

Results

Of 179 patients, 74 (41%) developed postoperative AKI. Patients who developed AKI had significantly higher peak PFH concentrations (80 mg dl⁻¹ [inter-quartile range, 50–132.5] vs 60 mg dl⁻¹ [40–100]; P=0.006). Multivariable analysis did not identify peak PFH concentrations as an independent risk factor for postoperative AKI (odds ratio [OR] 1.00; 95% confidence interval [CI]: 0.99–1.00; P=0.268). Factors associated with postoperative AKI were age in months (OR 0.96; 95% CI: 0.94–0.99; P=0.007) and CPB duration (OR 1.02; 95% CI: 1.01–1.02; P<0.001).

Conclusions

There was an association between postoperative AKI and CPB time rather than PFH. Perioperative peak PFH concentrations were significantly higher in patients with postoperative AKI after paediatric cardiac surgery requiring CPB.

背景急性肾损伤（AKI）是儿科心脏手术中需要进行心肺旁路术（CPB）的患者常见的并发症。CPB 期间溶血产生的无血浆血红蛋白（PFH）是导致 AKI 的原因之一。本研究旨在确定需要进行 CPB 的儿科心脏手术中 PFH 与术后 AKI 之间的关系。方法这项前瞻性、单中心、观察性研究纳入了接受需要进行 CPB 的心脏手术的 5 岁儿童。在 CPB 前、CPB 期间每 30 分钟、改良超滤后、ICU 入院时以及术后 1-3 天每天测量一次 PFH。研究结果包括 PFH 峰值浓度与术后 3 天内发生术后 AKI 的关系。结果在179名患者中，74人（41%）发生了术后AKI。发生 AKI 的患者的 PFH 峰值浓度明显更高（80 毫克/升 [四分位间范围，50-132.5] vs 60 毫克/升 [40-100]；P=0.006）。多变量分析并未发现峰值 PFH 浓度是术后 AKI 的独立风险因素（几率比 [OR] 1.00；95% 置信区间 [CI]：0.99-1.00；P=0.268）。与术后 AKI 相关的因素是以月为单位的年龄（OR 0.96；95% CI：0.94-0.99；P=0.007）和 CPB 持续时间（OR 1.02；95% CI：1.01-1.02；P<0.001）。需要 CPB 的儿科心脏手术后出现术后 AKI 的患者围术期 PFH 峰值浓度明显更高。

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引用次数: 0

Oxygen insufflation via the working channel during tracheal intubation guided by a flexible optical scope and benefits, dangers, and future of the method: a narrative review 在气管插管过程中，在柔性光学镜的引导下通过工作通道充氧，以及该方法的益处、危险和前景：叙述性综述

BJA open

Pub Date : 2024-10-17 DOI: 10.1016/j.bjao.2024.100346

Alexandre Garioud, Michael Seltz Kristensen

When performing tracheal intubation guided by a flexible optical scope, the operator may lose the anatomical orientation and hypoxia may occur. Oxygen insufflation through the working channel of the flexible optical scope is used by anaesthetists to prevent blurring of the lens and to prevent hypoxia. However, fatal iatrogenic injuries from this method are reported. Our aim is to review the current literature on oxygen insufflation through the working channel during tracheal intubation guided by a flexible optical scope, to identify its benefits and the source of its dangers, and ultimately to provide a basis for the development of a safer technique. We conducted a literature search of databases, guidelines, and textbooks using search terms related to oxygen insufflation through the working channel during intubation guided by a flexible optical scope. Clinical trials confirm that the technique results in better visibility and better oxygenation during intubation. Gastric rupture and pneumothorax were the most frequent types of injury. We identified that oxygen insufflation without pressure limitation during accidental misplacement of the flexible optical scope in the oesophagus, deep in the lower airways, or via a tear of the airway mucosa was the cause of barotrauma. We conclude that a delivered pressure below 40 cm H₂O will likely carry a low risk of serious adverse outcomes. The technique in its current form seems unsafe, and future research should aim at developing a system that delivers oxygen at pressures respecting gastric and airway physiologic pressure thresholds with a flow sufficient to obtain the documented advantages of the technique.

在柔性光学瞄准镜的引导下进行气管插管时，操作员可能会失去解剖方向，从而导致缺氧。麻醉师会通过柔性光学瞄准镜的工作通道充入氧气，以防止镜片模糊和缺氧。然而，有报道称这种方法会造成致命的先天性损伤。我们的目的是回顾目前关于在柔性光学镜引导下进行气管插管时通过工作通道充氧的文献，找出其优点和危险来源，最终为开发更安全的技术提供依据。我们对数据库、指南和教科书进行了文献检索，并使用了与在柔性光学镜引导下插管时通过工作通道充氧相关的检索词。临床试验证实，该技术能在插管过程中实现更好的可视性和更好的充氧。胃破裂和气胸是最常见的损伤类型。我们发现，在柔性光学镜意外误入食道、下呼吸道深部或气道粘膜撕裂时，在没有压力限制的情况下充氧是造成气压创伤的原因。我们的结论是，低于 40 厘米 H2O 的输送压力很可能会带来较低的严重不良后果风险。该技术目前的形式似乎并不安全，未来研究的目标应该是开发一种系统，在尊重胃和气道生理压力阈值的压力下输送氧气，并提供足够的流量，以获得该技术已被证实的优势。

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引用次数: 0

Incidence and trajectories of subclinical and KDIGO-defined postoperative acute kidney injury in patients undergoing major abdominal surgery 腹部大手术患者亚临床和 KDIGO 定义的术后急性肾损伤的发生率和轨迹

BJA open

Pub Date : 2024-10-14 DOI: 10.1016/j.bjao.2024.100345

Jakob Zeuchner , Louise Elander , Jessica Frisk , Michelle S. Chew

Background

Postoperative acute kidney injury is a common occurrence among patients undergoing major abdominal surgery and is associated with adverse outcomes. The effect of an incremental increase in serum creatinine concentration not meeting the KDIGO criteria for acute kidney injury is poorly studied. We evaluated the incidence and trajectories of postoperative subclinical acute kidney injury (sPO-AKI), acute kidney injury (PO-AKI), acute kidney disease (PO-AKD), and their relationships with chronic kidney disease (CKD), major adverse kidney events (MAKE30), and all-cause mortality at 30 days after surgery.

Methods

In a pre-planned, nested cohort sub study of the Myocardial Injury in Noncardiac Surgery in Sweden (MINSS) study, we included 588 patients from two hospitals. We determined the incidence of PO-AKI, PO-AKD, and CKD according to the ADQI-POQI consensus criteria. sPO-AKI was defined as a 25–49% increase in serum creatinine concentration within 7 days of surgery.

Results

A total of 59 (10.2%) patients fulfilled the criteria for sPO-AKI, 41 (7.1%) patients for PO-AKI, 29 (6.2%) for PO-AKD, and 6 (1.2%) for CKD. Similar proportions of patients with sPO-AKI and PO-AKI developed PO-AKD. An association was identified between the combined group of sPO-AKI and PO-AKI and 30-day mortality (Cramer's V: 0.1, P=0.037). PO-AKD (Cramer's V: 0.4, P<0.001) was associated with MAKE30 and 30-day mortality. All patients with CKD had pre-existing PO-AKD.

Conclusions

Subclinical postoperative kidney injury not fulfilling the KDIGO criteria occurred in every 10th patient, and one in 14 suffered from PO-AKI after major abdominal surgery. A majority of PO-AKD cases was preceded by sPO-AKI and PO-AKI. Early kidney injuries were associated with longer-term adverse outcomes including MAKE30, 30-day mortality, and CKD.

背景术后急性肾损伤是腹部大手术患者的常见病，与不良预后有关。对于不符合 KDIGO 急性肾损伤标准的血清肌酐浓度递增所产生的影响，目前研究较少。我们评估了术后亚临床急性肾损伤（sPO-AKI）、急性肾损伤（PO-AKI）、急性肾脏病（PO-AKD）的发生率和轨迹，以及它们与慢性肾脏病（CKD）、主要不良肾脏事件（MAKE30）和术后 30 天全因死亡率的关系。方法在瑞典非心脏手术心肌损伤（MINSS）研究的一项预先计划的巢式队列子研究中，我们纳入了两家医院的 588 名患者。我们根据 ADQI-POQI 共识标准确定了 PO-AKI、PO-AKD 和 CKD 的发生率。结果共有 59 名（10.2%）患者符合 sPO-AKI 标准，41 名（7.1%）患者符合 PO-AKI 标准，29 名（6.2%）患者符合 PO-AKD 标准，6 名（1.2%）患者符合 CKD 标准。sPO-AKI和PO-AKI患者发展为PO-AKD的比例相似。sPO-AKI 和 PO-AKI 合并组与 30 天死亡率之间存在关联（Cramer's V：0.1，P=0.037）。PO-AKD（Cramer's V：0.4，P<0.001）与 MAKE30 和 30 天死亡率相关。结论不符合 KDIGO 标准的亚临床术后肾损伤每 10 例患者中就有 1 例，腹部大手术后每 14 例患者中就有 1 例患有 PO-AKI。大多数 PO-AKD 病例在发生之前都有 sPO-AKI 和 PO-AKI。早期肾损伤与长期不良后果相关，包括MAKE30、30天死亡率和CKD。

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引用次数: 0

Deep learning models using intracranial and scalp EEG for predicting sedation level during emergence from anaesthesia 利用颅内和头皮脑电图预测麻醉后镇静水平的深度学习模型

BJA open

Pub Date : 2024-10-12 DOI: 10.1016/j.bjao.2024.100347

Lichy Han , David A. Purger , Sarah L. Eagleman , Casey H. Halpern , Vivek Buch , Samantha M. Gaston , Babak Razavi , Kimford Meador , David R. Drover

Background

Maintaining an appropriate depth of anaesthesia is important for avoiding adverse effects from undermedication or overmedication during surgery. Electroencephalography (EEG) has become increasingly used to achieve this balance. Investigating the predictive power of intracranial EEG (iEEG) and scalp EEG for different levels of sedation could increase the utility of EEG monitoring.

Methods

Simultaneous iEEG, scalp EEG, and Observer's Assessment of Alertness/Sedation (OAA/S) scores were recorded during emergence from anaesthesia in seven patients undergoing placement of intracranial electrodes for medically refractory epilepsy. A deep learning model was constructed to predict an OAA/S score of 0–2 vs 3–5 using iEEG, scalp EEG, and their combination. An additional five patients with only scalp EEG data were used for independent validation. Models were evaluated using the area under the receiver-operating characteristic curve (AUC).

Results

Combining scalp EEG and iEEG yielded significantly better prediction (AUC=0.795, P<0.001) compared with iEEG only (AUC=0.750, P=0.02) or scalp EEG only (AUC=0.764, P<0.001). The validation scalp EEG only data resulted in an AUC of 0.844. Combining the two modalities appeared to capture spatiotemporal advantages from both modalities.

Conclusions

The combination of iEEG and scalp EEG better predicted sedation level than either modality alone. The scalp EEG only model achieved a similar AUC to the combined model and maintained its performance in additional patients, suggesting that scalp EEG models are likely sufficient for real-time monitoring. Deep learning approaches using multiple leads to capture a wider area of brain activity may help augment existing EEG monitors for prediction of sedation.

背景保持适当的麻醉深度对于避免手术过程中用药不足或用药过度造成的不良影响非常重要。脑电图（EEG）越来越多地被用于实现这一平衡。研究颅内脑电图（iEEG）和头皮脑电图对不同镇静水平的预测能力可以提高脑电图监测的实用性。方法在七名因药物难治性癫痫而接受颅内电极置入手术的患者麻醉苏醒期间同时记录iEEG、头皮脑电图和观察者警觉/镇静评估（OAA/S）评分。利用 iEEG、头皮脑电图和它们的组合，构建了一个深度学习模型来预测 0-2 与 3-5 的 OAA/S 评分。另外五名只有头皮脑电图数据的患者被用于独立验证。结果与仅使用 iEEG（AUC=0.750，P=0.02）或仅使用头皮脑电图（AUC=0.764，P<0.001）相比，头皮脑电图和 iEEG 的组合预测效果明显更好（AUC=0.795，P<0.001）。仅验证头皮脑电图数据的 AUC 为 0.844。结论 iEEG 和头皮脑电图的结合比单独使用任何一种模式都能更好地预测镇静水平。仅头皮脑电图模型的 AUC 与组合模型相似，并在更多患者中保持其性能，这表明头皮脑电图模型可能足以用于实时监测。使用多导线捕捉更广泛的大脑活动区域的深度学习方法可能有助于增强现有的脑电图监护仪对镇静的预测能力。

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引用次数: 0

Association of preoperative to postoperative change in cerebrospinal fluid fibrinogen with postoperative delirium 脑脊液纤维蛋白原从术前到术后的变化与术后谵妄的关系

BJA open

Pub Date : 2024-10-05 DOI: 10.1016/j.bjao.2024.100349

Thomas Payne , Jennifer Taylor , David Kunkel , Katherine Konieczka , Frankie Ingram , Kaj Blennow , Henrik Zetterberg , Robert A. Pearce , Anke Meyer-Franke , Niccolò Terrando , Katerina Akassoglou , Robert D. Sanders , Richard C. Lennertz

Background

We aimed to assess perioperative changes in fibrinogen in the cerebrospinal fluid (CSF), their association with markers of blood–brain barrier breakdown and neuroinflammation, and their association with postoperative delirium severity.

Methods

We conducted a secondary analysis of the Interventions for Postoperative Delirium-Biomarker 2 (IPOD-B2, NCT02926417) study, a prospective observational cohort study. We included 24 patients aged >21 yr undergoing aortic aneurysm repair. CSF samples were obtained before (n=24) and after surgery (n=13), with some participants having multiple postoperative samples. Our primary outcome was the perioperative change in CSF fibrinogen. Delirium was assessed using the Delirium Rating Scale-Revised-98.

Results

CSF fibrinogen increased after surgery (P<0.001), and this was associated with an increase in CSF/plasma albumin ratio (β=1.09, 95% CI 0.47–1.71, P=0.004). The peak change in CSF fibrinogen was associated with the change in CSF interleukin (IL)-10 and IL-12p70. The peak change in CSF fibrinogen was associated with the change in CSF total tau (β=0.47, 95% CI 0.24–0.71, P=0.002); however, we did not observe an association with postoperative delirium severity (incidence rate ratio = 1.20, 95% CI 0.66–2.17, P=0.540).

Conclusions

Our preliminary findings support the hypothesis that fibrinogen enters the brain via blood-brain barrier disruption, promoting neuroinflammation and neuronal injury. However, we did not observe an association between cerebrospinal fluid fibrinogen and peak delirium severity in this limited cohort.

背景我们旨在评估围手术期脑脊液（CSF）中纤维蛋白原的变化、它们与血脑屏障破坏和神经炎症标志物的关联以及它们与术后谵妄严重程度的关联。方法我们对一项前瞻性观察性队列研究--术后谵妄干预-生物标志物 2（IPOD-B2，NCT02926417）研究进行了二次分析。我们纳入了 24 名年龄为 21 岁、接受主动脉瘤修补术的患者。我们在手术前（24 人）和手术后（13 人）采集了 CSF 样本，其中一些参与者在术后采集了多个样本。我们的主要结果是围手术期 CSF 纤维蛋白原的变化。结果手术后CSF纤维蛋白原增加（P<0.001），这与CSF/血浆白蛋白比值的增加有关（β=1.09，95% CI 0.47-1.71，P=0.004）。CSF 纤维蛋白原的峰值变化与 CSF 白细胞介素（IL）-10 和 IL-12p70 的变化相关。CSF纤维蛋白原的峰值变化与CSF总tau的变化相关（β=0.47，95% CI 0.24-0.71，P=0.002）；但是，我们没有观察到纤维蛋白原与术后谵妄严重程度相关（发病率比=1.20，95% CI 0.66-2.17，P=0.540）。然而，在这个有限的队列中，我们并未观察到脑脊液纤维蛋白原与谵妄严重程度峰值之间存在关联。

{"title":"Association of preoperative to postoperative change in cerebrospinal fluid fibrinogen with postoperative delirium","authors":"Thomas Payne , Jennifer Taylor , David Kunkel , Katherine Konieczka , Frankie Ingram , Kaj Blennow , Henrik Zetterberg , Robert A. Pearce , Anke Meyer-Franke , Niccolò Terrando , Katerina Akassoglou , Robert D. Sanders , Richard C. Lennertz","doi":"10.1016/j.bjao.2024.100349","DOIUrl":"10.1016/j.bjao.2024.100349","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to assess perioperative changes in fibrinogen in the cerebrospinal fluid (CSF), their association with markers of blood–brain barrier breakdown and neuroinflammation, and their association with postoperative delirium severity.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of the Interventions for Postoperative Delirium-Biomarker 2 (IPOD-B2, NCT02926417) study, a prospective observational cohort study. We included 24 patients aged >21 yr undergoing aortic aneurysm repair. CSF samples were obtained before (<em>n</em>=24) and after surgery (<em>n</em>=13), with some participants having multiple postoperative samples. Our primary outcome was the perioperative change in CSF fibrinogen. Delirium was assessed using the Delirium Rating Scale-Revised-98.</div></div><div><h3>Results</h3><div>CSF fibrinogen increased after surgery (<em>P</em><0.001), and this was associated with an increase in CSF/plasma albumin ratio (β=1.09, 95% CI 0.47–1.71, <em>P</em>=0.004). The peak change in CSF fibrinogen was associated with the change in CSF interleukin (IL)-10 and IL-12p70. The peak change in CSF fibrinogen was associated with the change in CSF total tau (β=0.47, 95% CI 0.24–0.71, <em>P</em>=0.002); however, we did not observe an association with postoperative delirium severity (incidence rate ratio = 1.20, 95% CI 0.66–2.17, <em>P</em>=0.540).</div></div><div><h3>Conclusions</h3><div>Our preliminary findings support the hypothesis that fibrinogen enters the brain via blood-brain barrier disruption, promoting neuroinflammation and neuronal injury. However, we did not observe an association between cerebrospinal fluid fibrinogen and peak delirium severity in this limited cohort.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100349"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of introduction of point-of-care viscoelastic testing on transfusion practice in major obstetric haemorrhage 引入护理点粘弹性测试对产科大出血输血实践的影响

BJA open

Pub Date : 2024-10-01 DOI: 10.1016/j.bjao.2024.100316

A. Phillips, F. Breckenridge

引用次数: 0

Incidence of early postoperative cognitive dysfunction and overall patient and surgical risks in older patients undergoing cardiac surgery 接受心脏手术的老年患者术后早期认知功能障碍的发生率以及患者和手术的总体风险

BJA open

Pub Date : 2024-10-01 DOI: 10.1016/j.bjao.2024.100317

Chyanis Vongseenin, Nicha Wongratanakarn, Wacharin Sindhvananda

引用次数: 0

Major haemorrhage: fluid communication to stem the flow 大出血：输液止血

BJA open

Pub Date : 2024-10-01 DOI: 10.1016/j.bjao.2024.100321

A. Bundy, C. Rooney, C. Henderson, S. Meredith, G. Scotland

引用次数: 0

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