Anaesthesiology intensive therapy最新文献

Introduction: Oral domperidone is a prokinetic drug that enhances gastric emptying, which has a positive effect in decreasing gastric residual volume (GRV), subsequently decreasing the risk of pulmonary aspiration. This study aimed to assess the effect of preoperative oral domperidone on gastric residual volume, detected by ultrasound for patients undergoing elective surgery under general anesthesia.

Material and methods: This randomized double-blinded controlled placebo trial was conducted in 40 patients who were randomly assigned to two equal groups: the domperidone group (D) ( n = 20): patients received 400 mL of apple juice as a clear fluid, two hours preoperatively, and an oral domperidone 10 mg tablet; and the placebo group (P) ( n = 20): patients received 400 mL of apple juice as a clear fluid two hours preoperatively with a placebo tablet. Gastric residual volume detected by ultrasound was the primary outcome and postoperative nausea and vomiting (PONV) was the secondary outcome.

Results: There was no statistically significant difference in the mean gastric residual volume detected by ultrasound between groups after 1 hour ( P > 0.05). However, the mean gastric residual volume detected by ultrasound after 2 hours was statistically significantly lower with domperidone (55.95 ± 6.72 mL) than with the placebo group (70.22 ± 13.00 mL) ( P < 0.05). There was no statistically significant difference between groups regarding PONV, with a P -value > 0.05.

Conclusions: Preoperative oral domperidone intake was effective in decreasing the GRV measured by ultrasound.

Introduction: Our previous study revealed racial differences in the tracheal length of cardiac paediatric patients between Germany and Japan. The current study was conducted in two stages, aiming to determine whether the tracheal length differs between cardiac and non-cardiac paediatric patients and whether the results could also be generalised to adults.

Material and methods: The first stage was a retrospective observational evaluation of 335 cardiac and 275 non-cardiac paediatric patients in Japan. The tracheal length, the distance between the vocal cords and carina tracheae, was measured on preoperative chest radiographs taken in the supine position. The second stage was a validation process including 308 Japanese patients. Endotracheal intubation was performed based on the results of the first-stage investigation.

Results: It was revealed that the tracheal length ranged from 7 to 11% of the body height in both the cardiac and non-cardiac Japanese paediatric patients. None of 308 Japanese paediatric and adult patients underwent single-lung intubation after the endotracheal tube was inserted at a depth of 7% of the body height at the vocal-cord level, corresponding to the minimum tracheal length for Japanese patients. The distance between the endotracheal tube tip and carina tracheae on postoperative chest radiographs was generally less than 4% of the body height across all paediatric and adult Japanese patients.

Conclusions: The current study demonstrated that endotracheal intubation avoiding single-lung intubation can be achieved by inserting endotracheal tubes to the minimum tracheal length for a specific ethnic group at the vocal-cord level in paediatric patients, including neonates and premature infants, as well as adults.

Heart rate variability (HRV) is a measure that shows the variation in time between consecutive heartbeats - a physiological phenomenon controlled by the autonomic nervous system. Over the years the analysis of this parameter has been used in many fields of medicine, including anaesthesiology, for scientific and research purposes. We carried out a review of the available literature on the applicability of HRV assessment in anaesthesiology. Several potential applications of HRV in clinical anaesthesia have been identified and proven feasible. As a non-invasive and relatively easy method to gauge the autonomic nervous system, HRV analysis can provide the anaesthesiologist with additional datapoints, potentially useful in assessing efficacy of a blockade and adequacy of analgesia, and in predicting adverse events. However, interpretation of HRV and generalizability of research findings can be problematic due to the multiplicity of factors that influence this parameter and bias in methods introduced by the researchers.

Introduction: The plethysmographic variability index (PVI) is a dynamic approach for assessing volume status. This study aims to compare conventional fluid management and PVI based goal-directed fluid management (GDFM) during elective spine surgery in the prone position.

Material and methods: Sixty-six adult patients, ASA I-II, scheduled for elective lumbar spine procedures under general anaesthesia in the prone position were included. Patients were randomly divided into either the Conventional Group with the conventional fluid management protocol or the PVI Group with the PVI-based GDFM protocol. The total amount of intraoperative crystalloid administered was set as a primary outcome. Intraoperative PVI and perfusion index (PI), mean arterial pressure (MAP), heart rate (HR), the incidence of hypotension after prone positioning in both groups and data from arterial blood gas samples (immediately after induction of anaesthesia [T1] and immediately postoperatively [T2]) were set as secondary outcomes.

Results: The total amount of intraoperative crystalloids, blood transfusion, urine output, and fluid balance were similar in the two groups ( P -values 0.443, 0.317 and 0.273, respectively). The perioperative MAP and HR values showed no significant differences between the two groups at all time points of measurements. The values of pH, PaO 2 , PaCO 2 , HCO 3 , lactate and haemoglobin showed no statistically significant difference between the two groups. The blood lactate value at T2 was significantly increased when compared to T1 values in the two groups.

Conclusions: PVI dependent goal-directed fluid management (GDFM) therapy did not reduce the intraoperative total crystalloid administration or requirements for blood transfusion when compared to conventional fluid management using a fixed fluid rate in patients undergoing spine surgery in a prone position. Clinical trial registration: The study was registered at clinicaltrials.gov (NCT05239286).

Background: Paediatric patients are a population with a high level of anxiety. The prevention of perioperative stress in a frightened child is important to render the child calm and cooperative for smoother induction. Intranasal premedication is easy and safe, and the drug is rapidly absorbed into the systemic circulation, ensuring early onset of sedation in children and good effectiveness.

Methods: 150 patients in the age group 2-4 years, ASA class I, undergoing elective surgical procedures were enrolled. The patients were randomly divided into 3 groups: a DM group (receiving intranasal dexmedetomidine 1 µg kg -1 and midazolam 0.12 mg kg -1 ), a DK group (receiving intranasal dexmedetomidine 1 µg kg -1 and keta-mine 2 mg kg -1 ), and an MK group (receiving intranasal midazolam 0.12 mg kg -1 and ketamine 2 mg kg -1 ). After 30 minutes of administration of the drugs, the patients were assessed for parent separation anxiety, sedation, ease of IV cannulation, and mask acceptance.

Results: The comparison among the 3 groups showed a statistically significant difference for ease of IV cannulation and mask acceptance at 30 minutes, with a P -value of 0.010 with CI of 0.0-0.02, and P -value 0.007 with CI 0.0-0.02, respectively. The parent separation anxiety and sedation score at 30 minutes was statistically insignificant with a P -value of 0.82 with CI of 0.03-0.14 and P -value 0.631 with CI of 0.38-0.58, respectively.

Conclusions: The combination of midazolam and ketamine had a better clinical profile for premedication as compared to other combination drugs used in our study in terms of IV cannulation and acceptance of masks with a comparable decrease in separation anxiety from parents and adequate sedation.

Introduction: The present study was carried out to evaluate the efficacy of ultrasound-guided triple nerve block (ilioinguinal, iliohypogastric, and genitofemoral) versus unilateral subarachnoid block for adult male patients undergoing unilateral inguinal hernia surgery.

Material and methods: Sixty ASA I-III adult male patients > 18 years old, scheduled for unilateral inguinal hernia surgery were randomly allocated into 2 groups of 30 patients each. In Group A ( n = 30) the patients received ultrasound-guided nerve block (ilioinguinal, iliohypogastric, and genitofemoral), and in Group B ( n = 30) the patients received unilateral subarachnoid block. The primary outcome was to assess postoperative analgesic efficacy (visual analogue scale [VAS] scores at rest and during coughing/ambulation). The secondary outcomes were time to first rescue analgesia with morphine, the total dose of morphine used as rescue analgesia, urinary retention, time to first micturition, time to first unassisted walking, and time to discharge from the surgical recovery room.

Results: The mean pain scores at 1, 2, 4, and 6 hours during rest and during coughing/ambulation were significantly lower in Group A when compared to patients in Group B ( P < 0.001). There was no requirement for rescue analgesic opioids in Group A ( P < 0.001). Mean time to first micturition and mobilization occurred earlier in Group A, leading to early discharge from the recovery room ( P < 0.001). No major side effects were observed in any of the study groups.

Conclusions: Ultrasound-guided triple nerve block technique can be used as a sole anaesthetic technique for inguinal hernia surgery because it not only provides optimal anaesthesia intra-operatively but also has a favourable analgesic and opioid-sparing efficacy in the early postoperative period with minimal adverse effects.

Introduction: Although manifestation of SARS-CoV-2 infection in children is gene-rally mild or asymptomatic, anaesthetic implications of the infection in children are still a matter of concern. Single reports suggest that patients with SARS-CoV-2 infection are at higher risk of anaesthetic complications.

Material and methods: We performed a retrospective, case control study analysing the risk of general anaesthesia in SARS-CoV-2 infected children admitted to a tertiary paediatric university hospital for the purpose of urgent procedures requiring anaesthesia  between April 1st and September 30 th , 2021. The control group consisted of  SARS-CoV-2 negative children consecutively anaesthetised for the same reasons during the first month of observation. Our hypothesis was: general anaesthesia can be safely performed in SARS-CoV-2 infected children. Study endpoints: primary - anaesthetic respiratory complications (bronchospasm, laryngospasm, intraoperative desaturation below 94%, desaturation below 94% after awakening, unplanned postoperative mechanical ventilation); secondary - hospital length of stay, thrombotic, cardiac, haemorrhagic events, ICU admission, deaths during hospitalisation.

Results: The examined group consisted of 58 SARS-CoV-2 infected children, the matched control group of 198 patients. The rate of complications in both groups was very low, with no significant difference between the groups. The only differences observed were a higher frequency of desaturations in the awakening period and longer time of hospitalisation in SARS-CoV-2 infected patients. Multivariate logistic regression analysis showed that physical status of the patient and duration of the procedure were the main factors influencing the risk of complications.

Conclusions: In our experience anaesthesia of SARS-CoV-2 infected children can be safely performed.