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JG Farrell and The Lung: An early description of intensive care delirium in literature. 法雷尔与肺:重症监护谵妄的早期文献描述。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231178836
John G O'Connell, Finbarr J Condon-English, Brian P O'Brien
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引用次数: 0
Intraoperative 'pressure field' haemodynamic monitoring in a patient with severe aortic regurgitation having laparoscopic robot-assisted colorectal surgery. 对一名接受腹腔镜机器人辅助结直肠手术的重度主动脉瓣反流患者进行术中 "压力场 "血流动力学监测。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-17 DOI: 10.1177/0310057X241263115
Walston R Martis, Charles Allen, Rajib Ahmed, Hilmy Ismail, Stephen Woodford, Bernhard Riedel

Laparoscopic robot-assisted colorectal surgery can pose significant haemodynamic challenges for patients with severe aortic regurgitation. The increased afterload caused by pneumoperitoneum and aortic compression, along with concurrent factors like hypercarbia, Trendelenburg positioning and ventilatory impairment, can worsen aortic regurgitation, leading to myocardial ischaemia and heart failure. Transoesophageal echocardiography (TOE) assists haemodynamic management intraoperatively but requires subspecialist skills and enables limited inferences to be drawn regarding the impact of afterload on myocardial performance. Minimally invasive haemodynamic monitoring enabling real-time visualisation of a patient's 'pressure field' has been suggested as a potential adjunct or alternative to TOE, with the added advantage of providing continuous quantitative information about both stroke volume and the afterload to ventricular ejection in a single visualisation. We describe an example of successful concurrent use of pressure field haemodynamic monitoring and TOE in a patient with severe aortic regurgitation having a prolonged laparoscopic robot-assisted pelvic exenteration.

腹腔镜机器人辅助结肠直肠手术会对患有严重主动脉瓣反流的患者造成巨大的血流动力学挑战。腹腔积气和主动脉压迫导致的后负荷增加,加上高碳酸血症、特伦德伦堡体位和通气障碍等并发因素,会加重主动脉瓣反流,导致心肌缺血和心力衰竭。经食道超声心动图(TOE)有助于术中的血流动力学管理,但需要亚专业技能,而且只能有限地推断出后负荷对心肌功能的影响。微创血流动力学监测可实时显示患者的 "压力场",被认为是 TOE 的潜在辅助或替代方法,其额外优势是可在单次显示中提供有关每搏量和心室射血后负荷的连续定量信息。我们描述了一个成功同时使用压力场血流动力学监测和 TOE 的病例,患者患有严重的主动脉瓣反流,正在接受长时间的腹腔镜机器人辅助骨盆外展手术。
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引用次数: 0
Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia. 在恢复现场会议的过程中最大限度地实现环境可持续性:澳大利亚悉尼 2500 人麻醉会议报告。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-05 DOI: 10.1177/0310057X241264576
Fran Lalor, Shanel L Cameron, Tanya Selak, Stefan Jm Dieleman

The COVID-19 pandemic disrupted medical conferences, where restrictions on public gatherings resulted in the postponement or cancellation of in-person meetings. Virtual events emerged as a substitute, providing a mechanism for scientific collaboration and continuing medical education with the additional benefit of low environmental impact. However, digital events may not meet all the needs of delegates, such as professional networking and social connection. In this report, we describe the methods used to minimise the carbon footprint of the 2023 Australian and New Zealand College of Anaesthetists' Annual Scientific Meeting, a conference with approximately 2000 in-person and 500 virtual delegates. A core group led the initiative, with all conference participants invited to contribute to this goal. A prospective prediction of carbon generation was undertaken, followed by the implementation of strategies to minimise and then measure the total carbon footprint of the event. Post-event calculations assessed the conference as better than carbon-neutral; however, delegate travel was not included in the analysis and therefore this result is tempered. Off-site workshops including virtual offerings were also not included in the analysis. We encourage medical conference organisers to collaborate with all stakeholders to embed low carbon-generation choices for their meetings where education, networking and social needs are also met.

COVID-19 大流行扰乱了医学会议,对公众集会的限制导致现场会议推迟或取消。虚拟活动作为一种替代出现,为科学合作和继续医学教育提供了一种机制,并具有对环境影响小的额外优势。然而,数字活动可能无法满足代表们的所有需求,如专业网络和社交联系。在本报告中,我们介绍了为最大限度减少 2023 年澳大利亚和新西兰麻醉师学院科学年会的碳足迹而采用的方法,该会议约有 2000 名亲临现场的代表和 500 名虚拟代表。会议由一个核心小组领导,并邀请所有与会者为这一目标做出贡献。会议对碳排放量进行了前瞻性预测,随后实施了将碳排放量降至最低的战略,并对会议的总碳足迹进行了测量。会后的计算结果表明,会议的碳排放量优于碳中和水平;但是,代表们的差旅并未包括在分析中,因此这一结果有所减弱。包括虚拟产品在内的场外研讨会也未纳入分析范围。我们鼓励医学会议组织者与所有利益相关者合作,在会议中选择低碳发电,同时满足教育、网络和社交需求。
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引用次数: 0
Two episodes of delayed emergence in a healthy young man. 一名健康的年轻人两次延迟出院。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-17 DOI: 10.1177/0310057X241275126
James R Nielsen, Anil Keshava
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引用次数: 0
Reference value models for predicting preoperative six-minute walk test in patients scheduled for abdominal and pelvic cancer surgery. 预测腹部和盆腔癌症手术患者术前六分钟步行测试的参考值模型。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-17 DOI: 10.1177/0310057X241267907
Preet Gs Makker, Cherry Koh, Michael J Solomon, Nabila Ansari, Neil Pillinger, Linda Denehy, Bernhard Riedel, Lara Edbrooke, Jess Crowe, Duminda N Wijeysundera, Brian H Cuthbertson, Daniel Steffens

Preoperative assessment of functional capacity with the six-minute walk test (6MWT) allows for estimation of surgical risk and targeted triage to prehabilitation services. Patient with abdominal and pelvic cancers have worse preoperative function compared with the general population. However, six-minute walk distance (6MWD) reference values from cancer patients are unknown, which limits the interpretation of 6MWT in this population. This study aimed to establish an explanatory reference value model for preoperative 6MWD in patients with abdominal or pelvic cancers undergoing elective surgery. Adult patients undergoing surgery for abdominal or pelvic cancers at major international hospitals were included. The 6MWT was assessed before surgery using a standardised protocol. Anthropometric data including age, sex, height, weight and body mass index (BMI) were collected and included in multiple linear regression analysis to model preoperative 6MWD. A total of 742 patients were included. Age, height and BMI were correlated with 6MWD. Six regression models were estimated, including two from the entire cohort, two from the subset of males and two from the subset of females. A sex-neutral model was the most representative, explaining 15% of the variance in 6MWD (6MWD = 761.00-3.00 * Age (years) -2.86 * BMI (kg/m2) - 48.09 * Sex (M1, F2)). The explored regression models, using anthropometric variables, poorly explained the variance between measured and modelled 6MWD, which suggests that these models have no clinical utility in the cancer population. Consideration of additional, non-anthropometric variables may improve regression modelling of preoperative 6MWD in patients in abdominal and pelvic cancers.

通过六分钟步行测试(6MWT)对术前功能进行评估,可以估计手术风险并有针对性地将患者分流到康复服务机构。与普通人相比,腹部和盆腔癌症患者的术前功能较差。然而,癌症患者的六分钟步行距离(6MWD)参考值尚不清楚,这限制了对该人群 6MWT 的解释。本研究旨在为接受择期手术的腹部或盆腔癌症患者术前 6MWD 建立一个解释性参考值模型。研究对象包括在国际大医院接受腹部或盆腔癌症手术的成年患者。手术前采用标准化方案对 6MWT 进行评估。收集包括年龄、性别、身高、体重和体重指数(BMI)在内的人体测量数据,并将其纳入多元线性回归分析,以建立术前 6MWD 模型。共纳入了 742 名患者。年龄、身高和体重指数与 6MWD 相关。共估算了六个回归模型,其中两个来自整个队列,两个来自男性子集,两个来自女性子集。性别中性模型最具代表性,可解释 6MWD 变异的 15%(6MWD = 761.00-3.00 * 年龄(岁)-2.86 * BMI(kg/m2)-48.09 * 性别(M1,F2))。使用人体测量变量建立的回归模型无法很好地解释 6MWD 测量值与模型之间的差异,这表明这些模型在癌症人群中没有临床应用价值。考虑其他非人体测量变量可能会改善腹部和盆腔癌症患者术前 6MWD 的回归模型。
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引用次数: 0
The effect of deep versus awake removal of the laryngeal mask airway on the incidence of emergence delirium in paediatric tonsillectomy: A randomised controlled trial. 在小儿扁桃体切除术中,深喉与清醒拔除喉罩气道对出现谵妄的影响:随机对照试验。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-17 DOI: 10.1177/0310057X241275114
Dhruv Kapoor, Eliza A Tweddle, Luke Baitch

Emergence delirium, characterised by inconsolable crying, perceptual disturbances and thrashing, occurs in young children during the recovery phase from general anaesthesia. Our aim was to determine whether timing of laryngeal mask airway removal (deeply anaesthetised versus awake) influenced the incidence of emergence delirium in children after tonsillectomy. A single-centre, randomised controlled trial was conducted at Albury Wodonga Health, a regional hospital in Australia. Included patients were two to seven years old, American Society of Anesthesiologists physical status classification 1-2, undergoing elective tonsillectomy (with or without adenoidectomy or grommet insertion) under general anaesthesia. Patients were randomised to have their laryngeal mask removed whilst deeply anaesthetised (in the operating theatre) or after awakening (in the post-anaesthesia care unit (PACU)). Pediatric Anesthesia Emergence Delirium score was determined at 5 and 20 min after eye opening, and frequency of complications (cough, vomiting, excessive salivation, oxygen desaturation and laryngospasm) in the PACU were recorded. Sixty-two patients were randomised to deep laryngeal mask removal and 62 to awake. In the awake versus deep groups, 33 (53%) versus 40 (65%) participants had emergence delirium at 5 min (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.30 to 1.29, P = 0.20). At 20 min, 18 (29%) vs. 19 (31%) participants had emergence delirium (OR 0.93, 95% CI 0.43 to 2.00, P = 0.88). A greater incidence of most PACU complications was observed in the awake versus deep group; cough (24% vs. 8%), vomiting (8% vs. 0%), excessive salivation (23% vs. 8%) and oxygen desaturation (16% vs. 0%). We found no significant difference between the two techniques in terms of preventing emergence delirium. However, other PACU complications were more frequent with awake removal.

在全身麻醉后的恢复阶段,幼儿会出现以哭闹不止、知觉障碍和惊跳为特征的谵妄。我们的目的是确定喉罩气道拔除的时间(深度麻醉与清醒状态)是否会影响扁桃体切除术后儿童出现谵妄的发生率。澳大利亚地区医院阿尔伯里沃东加卫生院开展了一项单中心随机对照试验。参加试验的患者年龄在两岁到七岁之间,美国麻醉医师协会身体状况分类为1-2级,在全身麻醉下接受择期扁桃体切除术(带或不带腺样体切除术或扣环植入术)。患者被随机分配在深度麻醉时(在手术室)或苏醒后(在麻醉后护理病房(PACU))摘除喉罩。在睁眼后 5 分钟和 20 分钟测定小儿麻醉后谵妄评分,并记录 PACU 中并发症(咳嗽、呕吐、唾液分泌过多、氧饱和度降低和喉痉挛)的发生频率。62名患者被随机分配到深喉喉罩摘除组,62名患者被随机分配到清醒组。在清醒组和深喉切除组中,分别有 33 人(53%)和 40 人(65%)在 5 分钟内出现谵妄(几率比(OR)为 0.63,95% 置信区间(CI)为 0.30 至 1.29,P = 0.20)。20分钟时,18(29%)对19(31%)名参与者出现谵妄(OR 0.93,95% CI 0.43 至 2.00,P = 0.88)。大多数 PACU 并发症的发生率在清醒组和深部麻醉组之间有较大差异:咳嗽(24% 对 8%)、呕吐(8% 对 0%)、唾液分泌过多(23% 对 8%)和氧饱和度降低(16% 对 0%)。我们发现这两种技术在防止出现谵妄方面没有明显差异。不过,清醒移除术的 PACU 并发症发生率更高。
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引用次数: 0
Fibreoptic intubation in children and young people in resource-limited settings: A case series during a humanitarian aid operation in Guinea. 在资源有限的环境中为儿童和青少年进行光纤插管:几内亚人道主义援助行动中的系列病例。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-10-17 DOI: 10.1177/0310057X241272111
Raphael Laurent, Eva Kardous, Oumar R Diallo, Charles Collet, Hervé Benateau, René Allary, Florent Baudin
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引用次数: 0
Mimicking the Eleveld propofol target-controlled infusion model using the Marsh model with weight adjustment in a super-obese patient. 在超级肥胖患者中使用带有体重调整功能的马什模型模拟 Eleveld 异丙酚靶控输注模型。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-23 DOI: 10.1177/0310057X241275122
George Zhong, Sarah J Wong
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引用次数: 0
Evaluation of enhanced recovery room care models. 评估康复室强化护理模式。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-23 DOI: 10.1177/0310057X241275110
Guy L Ludbrook, Nick Koning, Tarik Sammour
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引用次数: 0
ChatGPT-4's capability in addressing multiple-choice questions within the primary examination of the Australian and New Zealand College of Anaesthetists. ChatGPT-4 解决澳大利亚和新西兰麻醉师学院初级考试中多项选择题的能力。
IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-09-23 DOI: 10.1177/0310057X241266625
Steven C Cai, Alpha Ms Tung
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引用次数: 0
期刊
Anaesthesia and Intensive Care
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