Anaesthesiology intensive therapy最新文献

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures are being performed more and more frequently. Since these procedures carry an indirect risk of perioperative complications, practice standards are warranted to minimise the incidence of adverse events. A survey-based study was carried out to identify the patterns of anaesthesiology practice in Polish hospitals.

Methods: A survey was conducted among anaesthetists nationwide using the LimeSurvey application. The questions concerned the intraoperative and postoperative periods and focused mainly on the determination of anaesthetic methods for total joint replacement (TJR) procedures and postoperative pain management. Questionnaires included both single and multiple-choice questions.

Results: A total of 258 responses from anaesthetists from 112 Polish healthcare institutions were included in the analysis. The subarachnoid block is performed by 86.0% of anaesthetists for TKA and 88.0% for THA. For TKA procedures, 30.6% of respondents state that they do not perform any additional peripheral block, and for THA this percentage is 44.6%. The most commonly performed peripheral nerve block for TKA is the femoral nerve block (46.5%) and for THA it is the fascia iliaca compartment block (42.6%). More than 90% of anaesthetists report routine use of systemic analgesics in TJR, with opioid use exceeding 80%.

Conclusions: The study showed that anaesthetic perioperative care in Poland requires several modifications to better adhere to clinical standards. The most important issues include increasing the number of regional blocks, decreasing the use of opioid analgesics for post-operative pain management and introducing perioperative troponin screening.

Background: As a multimodal anesthesia adjuvant, magnesium sulfate (MgSO4) plays an important role in the anesthetic arsenal, due to its properties and substantial synergistic effects with other drugs such as opioids, hypnotics and neuromuscular blocking drugs (NMBD). Rocuronium is a non-depolarizing NMBD used widely in general anesthesia, and its association with MgSO4 is still a concern. This study aimed to evaluate the influence of MgSO4 at a dose of 30 mg kg-1 on the pharmacodynamic characteristics of rocuronium.

Methods: It was a double-blinded, randomized controlled trial in adult female patients scheduled for open hysterectomies with total intravenous anesthesia. Patients were allocated randomly to receive MgSO4 (30 mg kg-1) diluted in 100 mL of saline, 10 minutes before induction, or 100 mL of saline. Primary outcome: Influence of MgSO4 on latency (onset time), clinical duration (CD25%) and time to recover 90% of T4/T1 - train of four (TOF = 0.9). In total, 70 patients were enrolled, 35 per group.

Results: The baseline characteristics were similar. A comparative analysis showed a significant difference between the groups regarding latency in seconds (lower with MgSO4) 40.00 (35-45 [30-68]) compared to saline 53.00 (50-60 [40-90]) (P < 0.001), CD25% in minutes (longer with MgSO4) 61.00 (53-70 [30-110]), saline 38.00 (35-48 [30-87 (P <0.001), and TOF = 0.9 in minutes, longer with MgSO4 98.00 (88-111 [53-176]), saline 60.00 (55-78 [44-130]) (P < 0.001). MgSO4 was found to reduce opioid consumption in the postanesthetic care unit.

Conclusions: The strong impact of MgSO4 on the pharmacodynamics of rocuronium confirms the indispensable role of quantitative neuromuscular blockade monitoring to guide reversal.

Background: Dural puncture epidural anesthesia (DPEA) has become effective during normal labor. There were insufficient data about DPEA during cesarean section (CS).

Methods: A total of 110 ASA I and II parturients aged 20-35 years old underwent scheduled CS using DPEA with either 25G or 27G Whitacre needles. A T10 sensory block was achieved and maintained using a low concentration of bupivacaine with fentanyl through the epidural catheter until the end of surgery. Epidural extension anesthesia was initiated inside the operating room. The primary outcome was time taken from the start of epidural extension until achievement of bilateral T6 sensory block. The secondary outcome was quality of DPEA (composite).

Results: The primary outcome, median (IQR) time to surgical anesthesia, was 9.12 (8.71-18.54) minutes in the 25G-DPEA group and 14.18 (12.43-23.56) minutes in the 27G-DPEA group. The difference in the onset time of sensory block between the 2 groups was 5.06 (3.72-5.02) min, which was statistically significant (HR: 2.3; 95% CI: 1.79-3.14%; P < 0.0001). Failure of DPEA was observed in 9 of 55 parturients (16.4%) in the 25-DPEA group compared with 37 of 55 parturients (67.3%) in the 27-DPEA group (OR = 0.095; 95% CI: 0.04-0.24 %; P < 0.0001). Adverse effects and neonatal outcomes were comparable between the two groups.

Conclusions: 25G-DPEA resulted in faster onset and improved block quality during epidural extension compared with 27G-DPEA. Further studies are needed to confirm these findings in the setting of intra-partum CS.

The objective of the study was to assess the analgesic effects of dexamethasone (DEX) added to peripheral nerve block in knee surgery. We searched for relevant randomized controlled trials (RCTs) in PubMed and the Cochrane Database of Systematic Reviews. The latest search was done on September 11, 2024. Search terms included knee surgery, regional anesthesia, and DEX. Data extraction, statistical analysis, and risk of bias assessment followed established protocols. Seven RCTs with 551 patients were included. In the DEX 4 mg group, no reduction of pain at rest was found. However, for the DEX 8 mg group, pain management at rest was more effective; the mean difference (MD) with 95% CI was -0.34 [-0.50, -0.18]. For pain with movement, the model favors the DEX 4 mg group (MD with 95% CI was -1.03 [-1.84, -0.22]). Only one study reported the differences in pain intensity scores with movement between the DEX 8 mg and control groups. For morphine consumption, the model did not reveal any reduction in the DEX 4 mg group (MD -0.68 [-1.87, 0.5]) or DEX 8 mg group (MD -10.44 [-23.92, 3.03]). Pain with movement may be reduced with a lower dose, and pain without movement with a higher dose of DEX.

Introduction: Urine output is markedly reduced by isoflurane, but it is unclear whether the decrease is a specific effect of volatile anaesthetics. Therefore, this study compared the diuretic response to crystalloid volume loading during surgical procedures performed with volatile anaesthetics or intravenous anaesthesia.

Material and methods: Data from two clinical trials in which patients were randomized between isoflurane and propofol anaesthesia (open thyroid surgery, n = 29) and between sevoflurane and propofol anaesthesia (open hysterectomy; n = 25) were analysed. Urine volume was measured and the diuretic response to volume loading with 1.7-1.8 L of Ringer's solution over 30 min was studied by population volume kinetic analysis. The kinetic method used 631 measurements of plasma dilution based on blood haemoglobin and plasma albumin and 138 measurements of urine output to quantify the diuretic response to volume loading in the four study groups.

Results: The urine output after 150 min of thyroid surgery was 132 (77-231) mL in the propofol group and 218 (80-394) mL in the isoflurane group ( P = 0.50; median and interquartile range). The corresponding volumes were 50 (45-65) mL for propofol and 60 (34-71) mL for sevoflurane at 90 min in the hysterectomy patients ( P = 0.81). The kinetic analysis, which corrected for differences in infused volume, body weight, and plasma volume expansion, did not reveal any statistically significant differences in diuretic response to volume loading between the two inhaled anaesthetics and intravenous anaesthesia.

Conclusions: Isoflurane and sevoflurane did not affect urine output more strongly than propofol.

Introduction: Costoclavicular brachial plexus block has become a procedure of choice for surgical anaesthesia or analgesia in upper limb surgery. The technique is not standardised yet, and two approaches are currently employed: the medial and lateral approach. Our study aims to compare the two approaches in terms of performance time and patient-specific clinical outcomes.

Material and methods: The primary outcome assessed was performance time. The secondary outcomes were imaging time, needling time, block onset time, total anaesthesia time, anaesthesia success, and performer difficulty score.

Results: Of 59 patients, 30 patients were randomized to Group M and 29 patients were randomized to Group L. We conducted statistical analysis using a modified intention-to-treat approach. The mean ± SD for performance time (in minutes) was 11.9 ± 3.8 in Group M and 9.4 ± 4.1 in Group L with a difference between means (95% CI) of 2.4 (0.3 to 4.5) ( P < 0.05). The median (interquartile range) needling time of Group M was 9.5 minutes (5-16) vs. 7 (4-19) in Group L ( P = 0.035). Among patients, 40%, 26.67%, 33.3% in Group M had grade 3, 2, 1 performer difficulty whereas 10.3%, 37.9%, 51.7% in Group L had grade 3, 2, 1 performer difficulty, respectively ( P = 0.032). The mean performance time was 9.95 minutes in patients with body mass index (BMI) 25 ( P = 0.0243).

Conclusions: Our study revealed that the medial approach has no significant advantage over the lateral approach with regards to performance time, imaging time, needling time, and performer difficulty. Both performance time and performer difficulty increase with BMI and depth of the cords, with a larger difference in the medial approach.

Introduction: Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period.

Material and methods: This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period.

Results: The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008).

Conclusions: Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.

Introduction: Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes.

Material and methods: The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed.

Results: A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities.

Conclusions: We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.