Anaesthesiology intensive therapy最新文献

Introduction: Data concerning anaesthesia for endourology are rare, and options for it are numerous. Thus, identifying the optimal anaesthesia regimen remains challenging. With this study we aimed to provide the means for selecting optimal anaesthesia for endourology procedures.

Material and methods: This was a randomised, open-label, controlled study conducted in a single tertiary hospital. Inclusion criteria: American Society of Anesthesiologists (ASA) physical status/risk category I-III, and scheduled surgery time < 60 minutes. Exclusion criteria: contraindications or lack of consent for one of the anaesthesia types, intellectual disabilities, pregnancy, breastfeeding, and refusal to participate. The participants were divided into 3 groups: G1, spinal anaesthesia (SPA) with bupivacaine; G2, SPA with prilocaine; G3, total intravenous anaesthesia (TIVA) with remifentanil and propofol. The primary outcome measure was time to ambulation, while the secondary outcome measures included perioperative hypotension. The results are presented as mean ± SD or median [IQR].

Results: In total, 117 patients completed the study. The time to ambulation (minutes) was significantly different between all groups: 187.95 ± 49.82, 161.05 ± 46.28, and 129.14 ± 63.75 min, for G1, G2 and G3, respectively. The mean arterial pressure drop from baseline during the procedure was most pronounced in G3 (35% [30-44], P < 0.001) and lowest in G2 (18% [12-27], P < 0.001 vs. G3, NS vs. bupivacaine). Machine-learning models were trained and demonstrated satisfactory performance in predicting the time spent in recovery.

Conclusions: In the context of endourological surgery, the time required for ambulation was shortest when using TIVA, while SPA with hyperbaric prilocaine provides the closest approximation to optimal anaesthesia.

Introduction: Among the numerous scores for difficult intubation assessment, there is no single score that is specific for laryngeal surgery. The parameters identified by this research will provide a foundation for developing a new score for preoperative airway assessment specific for laryngeal surgery.

Material and methods: This prospective pilot clinical study included 50 patients over 18 scheduled for microscopic laryngeal surgery. The following anesthesiological and surgical parameters were analyzed: flexible laryngoscopy, general and clinical data, inter-incisor gap (IIG), modified Mallampati score (MMP), S-lux, thyromental distance, sternomental distance, mandibular measurements, etc. Difficult intubation was defined according to the Intubation Difficulty Scale (IDS), and the patients were divided into difficult (DI) and normal (NI) intubation.

Results: According to the IDS scale, 17 (34%) intubations were characterized as difficult. Patients in the DI group were male ( P = 0.033) and had apnea during sleep ( P = 0.021). Other statistically significant parameters were IIG below 4 cm, reclination, neck girth, and MMP. Flexible laryngoscopy showed a high statistical significance of P = 0.0001. These parameters have an AUC of 0.955, with χ 2 = 43.268, P < 0.0001.

Conclusions: The combination of the statistically significant parameters shows excellent accuracy in laryngeal surgery. This combination can form a basis to develop a preoperative airway assessment score specific to laryngeal surgery.

Introduction: In the era of problems with resistant bacteria strains, pharmacokinetic (PK) modelling offers ways to optimise antibiotic therapy and minimise the risk of resistance development. This bibliometric study aimed to investigate trends in PK modelling stu-dies. The goal was to provide researchers with comprehensive insight and identify future needs.

Material and methods: We used Bibliometrix, VOSviewer, and CiteSpace to analyse Web of Science articles on antibiotic PK modelling from 1983 to March 2023.

Results: We analysed 968 papers following the inclusion criteria and built a keywords co-occurrence map and timeline. The average annual growth rate of subject-related publications was 35.56% between 1983 and 2022, maintaining a continuous upward trend. Roberts J.A., Lipman J., and Wallis S.C. are the three most productive and impactful authors (82, 57, 34 articles, and h-index of 30, 25, 15, respectively). The United States leads in this field of research (29.13% of papers). The most relevant affiliations are the University of Queensland, Royal Brisbane and Women's Hospital, and Monash University. The top three most productive and impactful journals are Antimicrobial Agents and Chemotherapy, Journal of Antimicrobial Chemotherapy, and International Journal of Antimicrobial Agents (181, 83, 47 articles and h-index of 42, 30, 18, respectively). Most articles by keyword clustered on meropenem, vancomycin, and amikacin. Moreover, therapeutic drug monitoring, resistance, antibiotic dosing, target attainment, the intensive care unit, and paediatrics are the most trending aspects.

Conclusions: Given the results of this study, we expect to see a steady increase in interest in exploiting the potential of PK modelling for optimising antibiotic therapy.

Introduction: Perioperative stress and exposure to anesthetics may trigger alterations in cognition. In this study, a group of women underwent neuropsychological evaluation to measure the influence of inhalational and intravenous anesthesia on linguistic performance, in the context of the perioperative inflammatory response and duration.

Material and methods: Patients undergoing elective gynecological laparoscopic operations were randomly assigned to receive either propofol-based anesthesia (PBA) or sevoflurane-based anesthesia (SBA). The Vocabulary subtest of the Polish version of the Wechsler Adult Intelligence Scale-Revised, Łatysz test [ŁT, subtests: correct words (CW) and all words (AW)], and Word Fluency Test [WFT subtest letters: F, A, S, and categories: animals (An), fruits (Fr), vegetables (Ve)] were applied before and 24 h after anesthesia. Leukocyte count and smear as well as C-reactive protein were analyzed in the same time period. Duration of anesthesia was recorded.

Results: Sixty-one patients were included in the study (PBA: 29, SBA: 32). The comparison of the pre- and postoperative difference in results between the PBA and SBA groups showed a significant difference in one test (WFT-A). A postoperative increase in the results occurred in more scales in the SBA group (ŁT-CW, ŁT-AW, WFT-A, and WFT-Ve) than in the PBA group (ŁT-AW). There were single correlations between the inflammatory markers and the results of linguistic tests. The duration of anesthesia did not influence the results of linguistic tests.

Conclusions: The linguistic performance in the perioperative period was stable, with increases noted in several of the tested domains, predominantly in the SBA group.

Introduction: Hypovolaemia is presumed to be a common risk factor of postinduction hypotension (PIH), despite worldwide improvement in preoperative volume optimization. Correct assessment of fluid status in patients undergoing general anaesthesia remains a major challenge for anaesthesiologists. Bioimpedance analysis (BIA) is a sensitive method that allows objective assessment of patient fluid status as it can detect subclinical changes. The study's main purpose was to determine the correlation between the preoperative BIA assessed fluid status and PIH.

Material and methods: This was an observational single centre study that included patients undergoing elective surgery. We defined PIH as the blood pressure decrease occurring during the first 10 minutes after induction of anaesthesia and orotracheal intubation before surgical incision. We standardized BIA evaluation, patient pre anaesthetic and preoperative preparation, technique and monitoring of anaesthesia.

Results: Our study included 115 patients. The mean age of the population was 58.1 years and the median values for total and intracellular water were 35.1 L and 19.3 L, respectively. In the univariable and multivariable analysis, only total body and intracellular water were associated with different definitions of PIH. There was no correlation between any of the BIA-derived parameters of fluid status and the duration of PIH.

Conclusions: Our study shows that in elective surgery, bioimpedance could detect subtle, subclinical fluid parameters that are associated with PIH.

Introduction: The main purpose of the study was to assess the impact of preoperative interdisciplinary assessment by the PreScheck Team on optimization of the final selection for elective cardiac surgery.

Material and methods: This is a single-centre prospective observational study. The examined population consisted of 933 adult patients planned for cardiac surgery. After the exclusion of urgent operations, the study group consisted of 288 patients planned for elective cardiac surgery within 3 months from 1.01.2023 with PreScheck assessment (PreScheck Team group 2) and a control group of 311 patients scheduled for elective cardiac surgery between 1.03.2022 and 30.06.2022 (4 months), without preoperative interdiscipli-nary assessment (No PreScheck Team group 2).

Results: Fifty-two patients (18.06%) from the study group were finally excluded from the surgery on the scheduled date. In 46 patients (88.46%) the temporary or permanent exclusion from surgery was a result of PreScheck Team assessment. In the control group 42 patients (13.5%) did not undergo surgery on the scheduled date. Twenty-seven of those patients (8.97%) were permanently excluded from cardiac surgery after admission to the hospital and required additional tests before the final clinical decision, with total hospitalization time of 146 days.

Conclusions: Pre Surgery Check (PreScheck) Team is an original concept that combines classical preoperative assessment and an outpatient prehabilitation clinic. The approach we are proposing here should be a complementary stage in the process of selection for elective cardiac surgery, in addition to the Heart Team recommendation. This two-step decision-making enables real individual risk assessment, selection of the most suitable intervention and better use of medical resources.

The physiological transformations accompanying pregnancy, compounded by the implications of obesity, pose intricate challenges for anaesthesiologists attending to obese parturients. Obesity makes it harder to successfully provide epidural analgesia to a parturient. This narrative review explains the most recent data on the safety and complications of providing labour epidural analgesia in obese expectant mothers. We have emphasised the evidence-based approaches that are the most effective for obese pregnant mothers receiving labour epidural analgesia.