Anaesthesiology intensive therapy最新文献

Introduction: Laryngeal mask airway-blockbuster (LMA-BT) is a relatively new supraglottic airway device (SGAD). In this study, we compared LMA-BT with I-Gel LMA for efficacy of blind tracheal intubation.

Material and methods: We conducted a single-blind prospective study after ethical approval. One hundred American Society of Anesthesiology (ASA) Grade I-III (age 18-60 years) patients scheduled for elective surgery under general anaesthesia with endotracheal intubation were included and randomly divided into 2 groups. Blind tracheal intubation was performed through LMA-BT ( n = 50) and I-Gel ( n = 50) in groups 1 and 2, respectively. The primary aim was to evaluate the first pass success rate of blind tracheal intubation through the LMAs. The secondary objectives noted were attempts and ease of LMA insertion, total time taken for LMA insertion, airway seal pressure of LMA, ease of NGT insertion through LMA, fibre-optic grading of laryngeal view through LMA, overall success rate and time of intubation through LMA, time for LMA removal, and complications, if any.

Results: In the LMA-BT group, the first pass success rate ( P < 0.019) and the overall success rate of intubation ( P < 0.005) were significantly higher than in the I-Gel group. Using LMA-BT also resulted in statistically significant shorter intubation time ( P < 0.0001) with higher airway seal pressure as compared to I-Gel ( P < 0.001). The difference in the first attempt insertion, number of insertion attempts, ease and time of LMA insertion and removal after intubation, and postoperative complications were comparable among the groups.

Conclusions: LMA-BT is a superior device as compared to I-Gel LMA as a conduit for blind tracheal intubation.

Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as impenetrable by ultrasound. Only during the recent several years has the approach to the use of such tool in clinical daily routines changed dramatically to offer so-called point-of-care ultrasonography (POCUS). Both vertical and horizontal artefacts became valuable sources of information about the patient's clinical condition, assisting therefore the medical practitioner in differential diagnosis and monitoring of the patient. What is important is that the information is delivered in real time, and the procedure itself is non-invasive. The next stage marking the progress made in this area of diagnostic imaging is the development of arti-ficial intelligence (AI) based on machine learning algorithms. This article is intended to present the available, innovative solutions of the ultrasound systems, including Smart B-line technology, to ensure automatic identification process, as well as interpretation of B-lines in the given lung area of the examined patient. The article sums up the state of the art in ultrasound artefacts and AI applied in POCUS.

Introduction: Patients suffering from severe chronic pain often have problems finding an appropriate combination of painkillers. We retrospectively evaluated the effectiveness and safety of pulsed radiofrequency ablation (pRFA) of the genicular nerves in 96 patients with knee osteoarthritis (KO). We hypothesized that age, sex, and body mass index (BMI) may influence the quality of the pRFA treatment.

Material and methods: A diagnostic blockade with total volume of 9 ml of 1% lidocaine (WZF, Poland) combined with 4 mg of dexamethasone with subsequent pRFA with a radio frequency of 300-500 kHz under ultrasound guidance was used during the procedure. The study participants were assessed during regular monthly visits until 12 months.

Results: The nerves' ultrasound identification was successful in 90.62% of the cases. According to the numeric rating scale (NRS), pain was reduced by 50% or more in 64.06% of the cases. The average pain relief period lasted just over 7 and a half months. There were no pRFA-related complications or side effects of the drugs used.

Conclusions: pRFA seems to be safe and effective for the treatment of chronic pain in KO. The outcome of the treatment may be related to the patient's age (block duration increased with patient age) and sex (in women, the therapeutic effect was more effectively prolonged) in our study group. There was also higher effectiveness of pRFA in high-BMI patients, which was close to statistical significance ( P = 0.053).

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.