Anaesthesiology intensive therapy最新文献

Introduction: Unfractionated heparin (UFH) is the traditional anticoagulant of choice in critically ill COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO). Nadroparin, a low molecular weight heparin, potentially offers advantages such as predictable pharmacokinetics and reduced bleeding risks compared to UFH, with complex pharmacokinetics, influencing activated partial thromboplastin and causing substantial haemorrhagic risks. Bleeding, the most common adverse event during ECMO, is associated by many with increased activated partial thromboplastin time.

Material and methods: This retrospective, bicentric analysis involved 38 consecutive ECMO-supported COVID-19 patients from two Polish hospitals. The study compared 27 patients receiving UFH and 11 patients treated with 5700 IU of nadroparin administered subcutaneously twice daily. Thrombotic and haemorrhagic complications were assessed to determine the safety and feasibility of each anticoagulant.

Results: Resistance to flow throughout the therapy in the ECMO membrane oxygenator was significantly lower in the group anticoagulated with UFH (1.74 mmHg × minute × L^-1 [1.38-2.6] vs. 6.13 mmHg × minute × L^-1 [5.93-14.81]; P < 0.001). However, the number of transfused red blood cell packs in the aforementioned group was significantly greater (10 units [5-17] vs. 4 units [2-8]; P = 0.027), and the haemoglobin level after ECMO therapy was significantly lower (7.8 g dL^-1 [6.9-8.8] vs. 10.2 g dL^-1 [8.5-12.2]; P = 0.003). Moreover, there was a higher number of life-threatening events in the UFH group.

Conclusions: UFH anticoagulation may provide better flow optimization in the oxygenator, but the risk of life-threatening bleeding may increase. The present findings need to be fully elucidated in prospective studies on a larger critically ill population supported with respiratory ECMO.

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.