Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

Patients admitted to intensive care unit (ICU) after non-traumatic subarachnoid hemorrhage (SAH) represent a group with distinctive characteristics and few data are available on long-term outcome in this population. We conducted a single-center retrospective study in an Italian intensive care unit. All patients with non-traumatic SAH (ICD-9-CM Diagnosis Code 430) admitted to ICU were included. Disability and quality of life were evaluated via telephone interview after 12-15 months after initial bleeding using GOSE and EuroQoL, respectively. Baseline and clinical course characteristics were analyzed to evaluate relation with poor outcome defined as GOSE ≤ 3. Final population consisted of 38 patients. Twenty-four patients (63.2%) had favorable outcome (GOSE ≥ 4). Among 29 patients (76.3%) who survived at 1 year, median EQ-5D Index was 0.743 (IQR 0.287), while median EQ-VAS was 74.79 (IQR 18.5). Median EQ-5D Index and median EQ-VAS were higher among patients with favorable outcome (EQ-5D Index p = 0.037, EQ-VAS p = 0.003). Among baseline characteristics, only HH scale showed a significant relation with disability at one year (p = 0.033). Between complications occurred during ICU-stay only early HICP was related with unfavorable outcome (p = 0.028). Higher HH scale and early HICP were related with unfavorable outcome. Among patients with unfavorable outcome, quality of life has a broad range of variability, and this result should be taken into account when reporting patient-centered outcomes.

Background: In the last decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been gaining in popularity for intraoperative support during lung transplant (LT), being advocated for routinely use also in uncomplicated cases. Compared to off-pump strategy and, secondarily, to traditional cardiopulmonary bypass (CPB), V-A ECMO seems to offer a better hemodynamic stability and oxygenation, while data regarding blood product transfusions, postoperative recovery, and mortality remain unclear. This systematic review and network meta-analysis aims to evaluate the comparative efficacy and safety of V-A ECMO and CPB as compared to OffPump strategy during LT.

Methods: A comprehensive literature search was conducted across multiple databases (PubMed Embase, Cochrane, Scopus) and was updated in February 2024. A Bayesian network meta-analysis (NMA), with a fixed-effect approach, was performed to compare outcomes, such as intraoperative needing of blood products, invasive mechanical ventilation (IMV) duration, intensive care unit (ICU) length of stay (LOS), surgical duration, needing of postoperative ECMO, and mortality, across different supports (i.e., intraoperative V-A (default (d) or rescue (r)) ECMO, CPB, or OffPump).

Findings: Twenty-seven observational studies (6113 patients) were included. As compared to OffPump surgery, V-A ECMOd, V-A ECMOr, and CPB recorded a higher consumption of all blood products, longer IMV durations, prolonged ICU LOS, surgical duration, and higher mortalities. Comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. The lowest rate of postoperative ECMO was recorded after OffPump surgery, while no differences were found comparing different extracorporeal supports. Finally, older age, male gender, and body mass index ≥ 25 kg/m² negatively impacted on RBC transfusions, ICU LOS, surgical duration, need of postoperative ECMO, and mortality, regardless of the intraoperative extracorporeal support investigated.

Interpretation: This comparative network meta-analysis highlights that OffPump overperformed ECMO and CPB in all outcomes of interest, while, comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. Older age, male gender, and higher BMI negatively affect several outcomes across different intraoperative strategies, regardless of the intraoperative extracorporeal support investigated. Future prospective studies are necessary to optimize and standardize the intraoperative management of LT.

Background: Persistent idiopathic facial pain (PIFP) can be challenging, both in its diagnosis, which appears to be purely exclusionary, and in its treatment, which currently lacks a gold standard. Amitriptyline is considered a first-line therapy, although not always effective. Recent insights into the role of dopamine in facial pain suggest that a novel therapeutic approach could target the dopamine system.

Methods: This study aimed to retrospectively evaluate the efficacy of treatment with amitriptyline-perphenazine association in patients with severe PIFP. Thirty-one patients were given a regimen dose of amitriptyline-perphenazine at dosages ranging between 10/2 and 20/4 mg and were then retrospectively analyzed. We evaluated the following outcomes, referred to the last week prior to follow-up visits: NRS score for pain intensity (minimum, maximum, and average), the number of attacks, and SF-36 questionnaire for quality of life. Comparisons were made between pre- and post-treatment.

Results: Thirty-one patients over 35 were screened. At baseline, average NRS was 5 ± 0.93 (CI 95%: 4.6-5.3), and the median number of breakthrough episodes over last week was 5 ± 1.57 (CI 95%: 4-6) with a maximum NRS = 9 ± 0.89 (CI 95%: 8-9). After treatment, average NRS was 4.1 ± 0.93 (CI 95%: 3.8-4.5; p < 0.001), maximum NRS was 6.1 ± 1.60 (CI 95%: 5.5-6.6), and the median number of attacks was 4 ± 0.99 (IC 95%: 3-4) (p < 0.001). Regarding SF-36 questionnaire, the most improved parameters were quality of life related to pain (25.89 ± 12.48 vs 31.19 ± 13.44; p < 0.001) and physical function (69.56 ± 17.84 vs 84.17 ± 20.99; p < 0.001).

Conclusion: Despite limitations, the pain scores, the frequency of the attacks, and quality of life were found to be significantly improved after treatment. Although results are not broad based given the small sample size, the combination of amitriptyline and perphenazine may be an effective and well-tolerated treatment in patients with PIFP. It is abundantly clear that dopaminergic pathways play a key role in pain modulation, yet the underlying mechanisms have not been fully understood, requiring further investigation.

Background: Mastectomy and breast-conserving surgery are key interventions for breast cancer, a leading cause of cancer-related mortality in women. Many undergoing breast surgery experience postoperative pain compromising their functionality and quality of life. While multiple pain management strategies are available, evidence comparing the erector spinae (ESPB) and serratus anterior plane blocks (SAPB) for improving post-surgical pain management in breast cancer surgery patients is limited. Therefore, we investigated the efficacy and safety of these two regional anesthesia techniques.

Methods: After PROSPERO registration, we systematically searched PubMed, Google Scholar, and Cochrane Library until May 2024. Risk ratios (RR) were calculated for dichotomous outcomes and standard mean differences (SMD) or mean differences (MD) were computed for continuous data. RevMan Review Manager 5.4.1 was used for the data analysis and generation of forest plots as well as funnel plots. The Cochrane Risk of Bias tool 2.0 (18) and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines were used to appraise and evaluate the evidence (19).

Results: A total of 9 randomized control trials enrolling 550 patients were included. Static pain scores at 0, 6, 8, 12, and 24 h after surgery, dynamic pain scores computed at 0, 8, 12, and 24 h after surgery and area under the curve (AUC) static pain score at all time points between 0 and 24 h (SMD (HKSJ 95% CI) - 0.27 [- 0.99, 0.45]) did not significantly vary with either plane block. Postoperative morphine consumption in the first 24 h and the number of patients requesting analgesia were significantly greater in those receiving SAPB [MD: - 1.41 (95% C.I. - 2.70, - 0.13), p = 0.03] and [RR: 1.28 (95% C.I. 1.00, 1.63), p = 0.05], respectively. The time to first postoperative analgesic use was significantly greater among those administered ESPB [MD: 1.55 h, (95% C.I. 1.02, 2.09), p < 0.01]. Patient satisfaction scores and the incidence of nausea and vomiting were similar across both groups.

Conclusions: While pain scores with either block are comparable, ESPB reduces postoperative morphine consumption and may be the favorable option in breast cancer patients undergoing surgery.

Introduction: Respiratory adverse events are common during the sedation of preterm babies, often needing active airway support. During magnetic resonance imaging, this occurrence could extend the acquisition time, with a negative impact on the thermic and metabolic homeostasis. The aim of the study is to verify if lying in a lateral position instead of supine could improve the safe quality of sedation, without worsening the quality of imaging.

Methods: This study was performed as a single-center, prospective study at a university-affiliated tertiary care center. A consultant provided deep sedation with sevoflurane 3-4% delivered by an external mask, in the lateral decubitus position. All patients were evaluated for the incidence of apnea and desaturation, quality of imaging obtained, the timing of imaging acquisition, and thermic and metabolic homeostasis.

Results: We enrolled 23 consecutive preterm babies born < 37 weeks gestational age, candidates for sedation for elective brain magnetic resonance imaging. All patients completed the radiological procedure in 30 min (SD ± 6.39 min) without complications requiring exam interruption. Only one patient (4%) experienced a transient desaturation, while 2 neonates (9%) showed apnea lasting > 20 s. On average, there was a 1 °C decrease in body temperature and full enteral feeding was resumed within 1.5 h. Neuroradiologists rated the quality of the images obtained as high.

Conclusions: Lateral lying seems to be a viable option for sedated preterm babies during magnetic resonance imaging with a low risk of intervention for apnea and a reduced impact on thermic and metabolic homeostasis. Quality of imaging would be preserved maintaining correct scheduling of standard care.

Trial registration: The study was registered at www.

Clinicaltrials: gov before enrollment (NCT05776238 on December, 21th 2023).