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

Catecholamines, essential neurotransmitters and hormones, play a critical role in the body's physiological response to stress and are pivotal in the management of various clinical conditions, particularly in critical care settings. This narrative review delves into the pharmacological properties of catecholamines, including their mechanisms of action, pharmacokinetics, and pharmacodynamics. Key clinical applications of catecholamines, especially in the cardiovascular and immune systems, are highlighted, emphasizing their roles in modulating heart rate, vascular tone, and immune responses during critical conditions such as sepsis and septic shock. Additionally, the review explores catecholamines' immunomodulatory effects and their interactions with other therapeutic agents, such as corticosteroids, in the management of septic shock. Further research is suggested to optimize catecholamine usage and improve patient outcomes in critical care settings.

Glucagon-like peptide-1 receptor agonists are a class of drugs that mimic a natural incretin hormone released by the intestine after meals, and they are well-suited for treating type 2 diabetes. Glucagon-like peptide-1 receptor agonists also lead to satiety and appetite reduction through action on the brain's appetite regulation centers, leading to weight loss in obese patients. However, because glucagon-like peptide-1 receptor agonists work to slow gastric emptying, a safety concern has been raised in patients undergoing deep sedation or general anesthesia regarding gastric aspiration, and considering their long half-life in the blood, they are difficult to manage in the perioperative period. The purpose of this review is (i) to explore the present knowledge about the risk of aspiration before anesthesia; (ii) to describe the method for evaluating the presence of liquid and food in the stomach before surgery; and (iii) to balance the actual warning with the opportunity for future discovery about their benefits.

Background: Obesity is a global epidemic, projected to affect 4 billion people by 2035. Anesthesia regimens, including volatile anesthetics and total intravenous anesthesia (TIVA), impact postoperative outcomes, particularly in obese patients who face increased risks of complications. Volatile anesthetics are often associated with higher rates of postoperative nausea and vomiting (PONV), while TIVA may improve recovery but can increase costs and present additional challenges. This systematic review and meta-analysis evaluate the effects of these anesthesia methods on perioperative outcomes, including hemodynamic stability, recovery, and PONV, in this high-risk population.

Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024547776) studies were identified through PubMed, Web of Science, Scopus, China National Knowledge Infrastructure, CINDAHL, Cochrane, EMBASE, and Google Scholar. Two reviewers independently extracted data and assessed the risk of bias. A meta-analysis using a random-effects model was conducted.

Results: Thirteen studies with 1072 participants were included. Inhalational anesthesia significantly increases PONV (RR, 2.09; 95% CI, 1.21-3.60; p = 0.01; I² = 34%) and intraoperative heart rate (MD, 3.49; 95% CI, 0.01-6.97; p < 0.01; I² = 67.6%) compared to TIVA. Other outcomes, including mean arterial pressure, duration of intensive care unit stay, recovery time, opioid use, and pain, showed no significant differences between TIVA and inhalational anesthesia in the present analysis.

Conclusion: TIVA appears to improve perioperative outcomes in obese patients by reducing PONV and intraoperative heart rate, highlighting its potential advantages in clinical practice. Further research is needed to address variability and establish evidence-based guidelines for anesthesia management in this high-risk population.

Systematic review registration number in prospero: CRD42024547776.

Background: Effective postoperative pain management is crucial in caesarean delivery (CD) to enhance recovery, minimize opioid use, and improve maternal outcomes. Intrathecal morphine (ITM) is widely used but can cause side effects, such as pruritus and nausea. Posterior quadratus lumborum block (QLB) has emerged as a potential alternative for postoperative analgesia. This study compared the analgesic efficacy and side-effect profiles of ITM and posterior QLB in patients with CD.

Methods: This prospective observational study included parturients who underwent elective CD under spinal anesthesia. Participants were allocated to receive either ITM (100 µg) or bilateral posterior QLB with 0.25% bupivacaine (25 mL per side). The primary outcome was cumulative intravenous morphine consumption 24 h post-surgery. The secondary outcomes included NRS pain scores at rest and during activity at 0, 3, 6, 12, and 24 h, the time to first opioid request, the number of patients requiring rescue analgesia, nausea and vomiting scores, pruritus scores, and scores on the Obstetric Quality of Recovery Scale (ObsQoR-11 T) at 24 h and 48 h postoperatively.

Results: Sixty patients were included in the analysis, with 30 patients in each group. The primary outcome, 24-h cumulative intravenous morphine consumption, was comparable between the ITM and posterior QLB groups (6 [10] mg vs. 8.2 [7.1] mg, p = 0.134). The secondary outcomes, including NRS pain scores at rest and during activity, time to first opioid request, number of patients requiring rescue analgesia (1 vs. 0; p = 0.313), nausea and vomiting scores, pruritus scores (0 [1] vs. 0 [0]; p = 0.234), and ObsQoR-11 T scores at 24 h (95.5 [14] vs. 87.5 [16]; p = 0.49) and 48 h (102 [13] vs. 97 [18]; p = 0.203), were not significantly different between the groups.

Conclusion: Both ITM and posterior QLB provide effective postoperative analgesia in patients with CD, with comparable analgesic outcomes and side-effect profiles. ITM remains a practical choice because of its ease of administration, whereas subsequent QLB serves as a viable alternative for patients intolerant to neuraxial opioids.

Background: Social media platforms, initially developed for recreational use, have evolved into major sources for disseminating information, including medical information for patients and healthcare providers in many disciplines. This study aimed to evaluate the educational potential of YouTube® videos in teaching tracheal intubation to first-year anesthesiology residents.

Methods: This study was approved by the Ethical Committee of "University Federico II-AORN A. Cardarelli" (protocol no. 00010735). We analyzed the first 10 YouTube videos identified via the search term "tracheal intubation." Each video was evaluated for misinformation and informational completeness via a 5-item Likert scale. After providing written consent, fifty-seven first-year anesthesiology residents watched these videos and completed a 22-item questionnaire before and after viewing. Each correct answer received one point, whereas incorrect answers received 0 points, allowing for comparisons of knowledge acquisition.

Results: The videos exhibited moderate quality (median score, 3; range, 1-5) and low informational completeness (median score, 1.432; range, 1.000-2.046). Residents' scores increased modestly by one point after viewing (from 13 to 14; p < 0.001). Misinformation was positively correlated with the number of followers (beta coefficient: 0.00002, p < 0.001), video duration (beta coefficient: 0.0042, p < 0.05), and linking ratio (beta coefficient: 0.242, p < 0.05). Conversely, informational completeness was inversely correlated with video duration (beta coefficient: - 0.001121, p < 0.05) and the thumbs-up/view ratio (beta coefficient: - 67.4697, p < 0.05).

Conclusions: While YouTube® has potential as an accessible educational tool, current video selection offers limited improvement in residents' understanding of tracheal intubation. Our findings highlight the need for greater curation and better-quality control of medical educational content on YouTube® to optimize its effectiveness and provide accurate information. Institutions could play a key role in producing reliable, guideline-based videos that better support learning objectives in anesthesiology training.

Background: The prevalence of frailty is increasing as the global population continues to age. Frailty is associated with poor perioperative outcomes including increased morbidity and mortality. The purpose of this study is to examine current practices and perspectives of anesthesiogists in Italy on the provision of care for elderly surgical patients with frailty.

Methods: We conducted a national survey. Data were collected via an online questionnaire distributed by the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Responses were collected over 24 weeks between October 2022 and March 2023.

Results: Seven-hundred thirteen anesthetists completed the survey. A total of 39.8% (277) of respondents were working in university hospitals. Frailty scoring was routinely performed in 51.8% of care settings. Only 26.3% of organizations surveyed had a dedicated pathway for perioperative management of frail elderly patients. The most common method for frailty assessment was the subjective assessment by the anesthesiologist (58.3%). More than half of the participants reported the use of ERAS items in most cases. Almost half of respondents reported the use of postoperative screening tools for delirium (45% of respondents).

Discussion: While these results point to the resistance to clinical implementation of frailty assessment, they also highlight the perceived need for careful management. This can help in identifying elderly patients who may require targeted perioperative management and in ensuring the preservation of cognitive and functional status.

Parvalbumin-positive (PV⁺) interneurons (basket and chandelier cells) regulate the firing rate of pyramidal neurons in the cerebral cortex and play a key role in the generation of network oscillations in the cerebral cortex. A growing body of evidence suggest that cortical PV⁺ interneurons become overactive in chronic pain and contribute to nociceptive sensitization by inhibiting a top-down analgesic pathway. Here, we provide further support to this hypothesis showing that intracortical infusion of the GABA_A receptor antagonist, bicuculline, caused analgesia in a mouse model of chronic inflammatory pain, although it reduced pain thresholds in healthy mice. We propose that mGlu5 metabotropic glutamate receptors and perineuronal nets (PNNs) shape the activity of PV⁺ interneurons in chronic pain, generating a form of maladaptive plasticity that enhances behavioural pain responses. mGlu5 receptors might be locally targeted by drugs activated by light delivered in cortical regions of the pain matrix, whereas the density of PNNs enwrapping PV⁺ interneurons might be reduced by local activation of PNN-degrading enzyme, such as type-9 matrix metalloproteinase. These strategies, which may require invasive treatments, might be beneficial in the management of severe pain which is refractory to conventional pharmacological and non-pharmacological interventions.

Background: Surgery in the Trendelenburg position (TP) with pneumoperitoneum (PP) is beneficial in several aspects but is associated with postoperative complications, such as postoperative nausea and vomiting (PONV). The mechanism behind this is unknown, but an increase in intracranial pressure (ICP) has been suggested. There are several studies of non-invasively estimated ICP during surgery in TP with PP. The association between perioperative estimated ICP and postoperative complications has not yet been reviewed.

Methods: We performed a scoping review of peer-reviewed clinical studies reporting on both perioperative estimation of ICP and postoperative complications in patients undergoing surgery in TP with PP. The literature search was performed in February 2025 on PubMed, CINAHL, and Web of Science.

Results and conclusions: Ten of 12 included studies suggested associations between perioperative elevation of estimated ICP and postoperative complications, most notably PONV. This may have clinical implications since elevated ICP can be treated. Future research should focus on the association between perioperative ICP estimation and postoperative complications and the effects of ICP-lowering strategies on postoperative outcomes.