Anaesthesiology intensive therapy最新文献

The obesity paradox, suggesting improved survival in obese individuals compared to those with normal weight, remains debated, particularly in sepsis. While it has been explored in clinical and experimental settings, conclusive evidence is lacking. This study systematically reviews and meta-analyses the relationship between obesity and survival in murine sepsis models. This systematic review and meta-analysis following PRISMA guidelines included studies from PubMed/Medline (up to January 31, 2025) comparing sepsis survival in obese and non-obese mice. All eligible murine studies were systema-tically reviewed, whereas only those employing diet induced obesity (DIO) and cecal ligation and puncture (CLP) were pooled in the meta-analysis and meta-regression. Twenty-one studies (38 survival experiments) met the criteria: CLP (n = 14), intraperitoneal lipopolysaccharide (n = 7), and other bacterial inoculation models (n = 17). Across all models, obesity increased survival in 10, decreased it in 9, and had no effect in 19 experiments. Quantitative synthesis of 10 CLP-DIO experiments (159 obese vs. 149 lean mice) showed no overall mortality difference (P = 0.391). Meta-regression explained 86% of heterogeneity: later highfat diet (HFD) initiation and longer feeding reduced mortality, whereas older age at sepsis induction increased mortality (all P < 0.001). Across the studies, obesity exerted mixed effects; pooled analysis of CLP DIO experiments showed no survival benefit. Variability among studies was associated with time related factors: age at HFD initiation, feeding duration, and age at sepsis induction, highlighting the need to investigate these relationships and to develop a time point standardized CLP DIO sepsis model.

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH), a severe form of hemorrhagic stroke, poses significant diagnostic and management challenges, particularly in predicting and managing cerebral vasospasm and delayed cerebral ischemia. This study explores the predictive value of near-infrared spectroscopy (NIRS) in high-grade aSAH patients.

Material and methods: This observational study included 16 high-grade aSAH patients treated at a single institution from June 2020 to November 2023. Neuromonitoring incorporated daily transcranial Doppler and continuous NIRS, alongside routine computed tomography perfusion. The primary endpoint was the occurrence of major cerebral vasospasms detected by digital subtraction angiography preceded by a decrease in regional oxygen saturation as indicated by NIRS.

Results: Among the participants, vasospasms were most prevalent in the internal carotid artery (56.3%), followed by the middle cerebral artery (50%). NIRS detected alterations in 43.8% of the cohort, with 25% occurring before vasospasm onset. A correlation between early NIRS alterations and specific vasospasm locations was identified.

Conclusions: Conclusions: While NIRS shows potential for continuous, non-invasive monitoring of cerebral oxygenation, its utility in predicting vasospasms is limited. The findings underscore the importance of integrating NIRS with other neuromonitoring modalities to enhance predictive accuracy and patient management in aSAH. Large-scale studies are necessary to establish protocols and intervention thresholds.

The use of volatile anesthetics as an alternative sedation modality in the intensive care unit (ICU) has gained traction over the last several years. Volatile agents such as sevoflurane and isoflurane possess favorable pharmacokinetic and pharmacodynamic properties that make them suitable choices for titration of sedation in patients requiring mechanical ventilation. Several studies have continued to demonstrate their efficacy and safety particularly when assessing wake-up times and times to extubation in contrast to various intravenous sedatives. Leveraging the pharmacodynamic properties of the volatile agents may also be beneficial in certain disease states. As there are devices currently available to enable delivery of volatile anesthetics to patients in the ICU, ongoing studies exist to determine how to best use this sedation modality. This review outlines the recent evidence and discusses perspectives on volatile-based sedation for critically ill patients.

Introduction: Dexmedetomidine is administered intravenously, intrathecally, and intramuscularly to enhance the effect of subarachnoid anesthesia. In this study, we investigated the effect of intranasal dexmedetomidine on the characteristics of spinal anesthesia.

Material and methods: In this double-blinded randomized control study, 60 patients undergoing orthopedic surgery under spinal anesthesia were allocated to two groups. Group A received intranasal dexmedetomidine 1 μg kg^-1 20 minutes (min) before the subarachnoid block. Group B received intranasal normal saline 20 min before the subarachnoid block. Time for the onset of sensory and motor blockade, two-segment regression time, and request of first rescue analgesia were noted. Sedation scores using the Ramsay Sedation Scale (RSS), adverse effect and hemodynamic parameters were assessed.

Results: The onset of sensory block and motor block did not differ significantly between the groups. However, two-segment regression time was significantly longer in Group A than in Group B (113.17 ± 14.11 min vs. 94.13 ± 9.59 min, respectively; P < 0.001), and the time for first rescue analgesia was significantly longer in Group A than in Group B (3.97 ± 1.56 min vs. 2.56 ± 0.76 min, respectively; P < 0.001). The overall mean heart rate and mean arterial pressure were comparable between the two groups with stable hemodynamics. The visual analogue scale score in Group A was low (P < 0.001). Intraoperatively, at 30 min and 60 min, the change in RSS score was found to be statistically significant (P < 0.001).

Conclusions: Intranasal dexmedetomidine prolongs the effect of subarachnoid anesthesia, provides stable hemodynamics with arousable sedation, and offers a noninvasive, better-tolerated alternative compared to other invasive routes of administration.

Introduction: Evaluation of ultrasound (US)-guided disc block used to diagnose discogenic pain, as described in case reports. The study aimed to ascertain the noninferiority of US-guided lumbar disc block to conventional discography in the diagnosis of discogenic low back pain (DLBP).

Material and methods: The reports of 418 patients undergoing lumbar fusion for DLBP were stratified into a US group receiving US-guided lumbar disc block and a control group receiving fluoroscopy (FL)-assistant discography via a propensity-score matched method in a 1 : 1 ratio. The primary endpoint was the confirmatory rate defined as the rate of clinical success following surgery measured by a numerical pain rating scale score ≤ 2 and an Oswestry Disability Index score ≤ 15 at the 1-month follow-up point. Secondary outcomes included needle insertions until contrast given, procedure time, radiation dosages and adverse events.

Results: The confirmatory rates for disc block and discography were 71.8% and 73.2% (difference = -1.3%, 95% confidence interval [CI]: -9.9%, 7.2%, P = 0.353). The lower bound of 95% CI did not cross the noninferiority margin of 10%. There were fewer needle insertions (median 2, IQR: 1-3 vs. 5, IQR: 4-6, P < 0.001), shorter procedure times (8.94 ± 2.28 vs. 16.13 ± 3.39 min, P < 0.001) and lower radiation dosage (1689.56 ± 898.54 vs. 8293.50 ± 1039.09 μGy m² , P < 0.001) in the US group than the control group. No serious adverse events were observed.

Conclusions: US-guided lumbar disc block was not inferior to conventional discography as a diagnostic modality in the evaluation of DLBP being considered for surgery. Given that the sonographic method provided advantages in terms of facilitation of needle insertion, reduced procedure time, and attenuated radiation exposure, it might be an alternative option for surgery decision making.