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Description of the Current Use of Procoagulants in Pediatric Congenital Heart Surgery: An Analysis of the Pediatric Health Information Study Database. 小儿先天性心脏病手术中凝血剂使用现状的描述:儿科健康信息研究数据库分析》。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-26 DOI: 10.1213/ANE.0000000000007038
David Faraoni, Sadhana Chinnusamy, Camila Magalhaes Funatsu, David F Vener, Viviane G Nasr, James A DiNardo
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引用次数: 0
Determination of the ED90 of Dexmedetomidine Infusion to Prevent Emergence Agitation in Children Undergoing Dental Rehabilitation With Sevoflurane Anesthesia: A Biased-Coin Up-and-Down Sequential Allocation Trial. 七氟烷麻醉下接受牙科康复的儿童输注右美托咪定预防紧急激动的ED90测定:一项有偏差的硬币上下顺序分配试验。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-21 DOI: 10.1213/ANE.0000000000006626
Dan Zhou, Xu-Dong Yang, Hai-Yin Wu, Guo-Li Xiong, Li-Kuan Wang

Background: Emergence agitation (EA) is an adverse complication during early recovery from sevoflurane anesthesia. Continuous intravenous infusion of dexmedetomidine (DEX) is commonly used for EA prevention. However, a wide dose range is used for preventing EA, and the optimal dose remains unknown. This study was aimed at determining the optimal dose (the 90% effective dose [ED90]) of DEX for continuous intraoperative infusion for EA prevention in children.

Methods: We enrolled children aged 3 to 7 years who underwent dental treatment under sevoflurane anesthesia. DEX was continuously infused from the time of the establishment of the intravenous access until 5 minutes before the end of surgery. The initial DEX dose was 0.5 µg/kg/h, and subsequent dose adjustments were determined based on the response of the previous patient by using an up-down sequential allocation with a biased-coin design. The primary outcome was the ED90 for continuous DEX infusion based on the success or failure of the EA-preventing dose.

Results: Forty-five patients were enrolled in the study. The DEX dose ranged from 0.50 to 0.90 µg/kg/h. The estimated ED90 (95% confidence interval [CI]) for preventing EA was 0.74 µg/kg/h (0.67-1.05 µg/kg/h). The duration of surgery (mean ± standard deviation [SD]) was 113 ± 30 minutes. The times (mean ± SD) for extubation, time to emergence, and recovery time were 5 ± 2 minutes, 27 ± 9 minutes, and 39 ± 7 minutes, respectively.

Conclusions: The ED90 for continuous intraoperative DEX infusion for EA prevention in pediatric patients receiving dental treatment under sevoflurane anesthesia was 0.74 µg/kg/h (95% CI, 0.67-1.05 µg/kg/h).

背景:紧急躁动(EA)是七氟醚麻醉早期恢复过程中的一种不良并发症。连续静脉输注右美托咪定(DEX)通常用于预防EA。然而,广泛的剂量范围用于预防EA,最佳剂量仍然未知。本研究旨在确定用于预防儿童EA的术中持续输注DEX的最佳剂量(90%有效剂量[ED90])。方法:我们招募了3至7岁的儿童,他们在七氟醚麻醉下接受了牙科治疗。DEX从建立静脉通路开始持续输注,直到手术结束前5分钟。DEX的初始剂量为0.5µg/kg/h,随后的剂量调整是根据前一位患者的反应,通过使用有偏差硬币设计的上下顺序分配来确定的。主要结果是根据EA预防剂量的成功或失败,连续输注DEX的ED90。结果:45名患者被纳入研究。DEX的剂量范围为0.50至0.90µg/kg/h。预防EA的估计ED90(95%置信区间[CI])为0.74µg/kg/h(0.67-1.05µg/kg/小时)。手术持续时间(平均值±标准差[SD])为113±30分钟。拔管时间(平均值±SD)、苏醒时间和恢复时间分别为5±2分钟、27±9分钟和39±7分钟。结论:在七氟烷麻醉下接受牙科治疗的儿童患者中,术中持续输注DEX预防EA的ED90为0.74µg/kg/h(95%CI,0.67-1.05µg/kg/小时)。
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引用次数: 0
Analgesic Effect of Exercise on Neuropathic Pain via Regulating the Complement Component 3 of Reactive Astrocytes. 运动通过调节反应性星形胶质细胞的补体成分 3 对神经性疼痛有镇痛作用
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-01-31 DOI: 10.1213/ANE.0000000000006884
Chenghao Wang, Hui He, Tianchi Gao, Xinzheng Sun, Lixia Du, Yayue Yang, Jianyu Zhu, Yachen Yang, Yanqing Wang, Wenli Mi

Background: Exercise has been proven to be an efficient intervention in attenuating neuropathic pain. However, the underlying mechanisms that drive exercise analgesia remain unknown. In this study, we aimed to examine the role of complement component 3 (C3) in neuropathic pain and whether antinociceptive effects are produced by exercise via regulating C3 in mice.

Methods: In this study, using a spared nerve injury (SNI)-induced neuropathic pain mice model, C57BL/6J mice were divided into 3 groups: Sham mice, SNI mice, and SNI + Exercise (Ex) mice with 30-minute low-intensity aerobic treadmill running (10 m/min, no inclination). Paw withdrawal threshold; thermal withdrawal latency; and glial fibrillary acidic protein, C3, tumor necrosis factor-α, and interlukin-1β expression in the spinal cord were monitored. C3 knockout (KO) mice were further used to verify the role of C3 in neuropathic pain.

Results: von Frey test, acetone test, and CatWalk gait analysis revealed that treadmill exercise for 4 weeks reversed pain behaviors. In addition, exercise reduced astrocyte reactivity (SNI mean = 14.5, 95% confidence interval [CI], 12.7-16.3; SNI + Ex mean = 10.3, 95% CI, 8.77-11.9, P = .0003 SNI + Ex versus SNI) and inflammatory responses in the spinal cord after SNI. Moreover, it suppressed the SNI-induced upregulation of C3 expression in the spinal cord (SNI mean = 5.46, 95% CI, 3.39-7.53; SNI + Ex mean = 2.41, 95% CI, 1.42-3.41, P = .0054 SNI + Ex versus SNI in Western blot). C3 deficiency reduced SNI-induced pain and spinal astrocyte reactivity (wild type mean = 7.96, 95% CI, 6.80-9.13; C3 KO mean = 5.98, 95% CI, 5.14-6.82, P = .0052 C3 KO versus wild type). Intrathecal injection of recombinant C3 (rC3) was sufficient to produce mechanical (rC3-Ex mean = 0.77, 95% CI, 0.15-1.39; rC3 mean = 0.18, 95% CI, -0.04 to 0.41, P = .0168 rC3-Ex versus rC3) and cold (rC3-Ex mean = 1.08, 95% CI, 0.40-1.77; rC3 mean = 3.46, 95% CI, 1.45-5.47, P = .0025 rC3-Ex versus rC3) allodynia in mice. Importantly, exercise training relieved C3-induced mechanical and cold allodynia, and the analgesic effect of exercise was attenuated by a subeffective dose of intrathecal injection of C3.

Conclusions: Overall, these results suggest that exercise suppresses neuropathic pain by regulating astroglial C3 expression and function, thereby providing a rationale for the analgesic effect of exercise as an acceptable alternative approach for treating neuropathic pain.

背景:运动已被证明是减轻神经性疼痛的有效干预措施。然而,运动镇痛的潜在机制仍然未知。在这项研究中,我们旨在研究补体成分 3(C3)在神经病理性疼痛中的作用,以及运动是否通过调节小鼠体内的 C3 而产生镇痛效果:本研究使用神经损伤(SNI)诱导的神经病理性疼痛小鼠模型,将 C57BL/6J 小鼠分为 3 组:假小鼠、SNI 小鼠和 SNI + 运动(Ex)小鼠,进行 30 分钟低强度有氧跑步机跑步(10 米/分钟,无倾角)。监测爪退缩阈值、热退缩潜伏期以及脊髓中胶质纤维酸性蛋白、C3、肿瘤坏死因子-α和interlukin-1β的表达。结果:von Frey 试验、丙酮试验和 CatWalk 步态分析表明,连续 4 周的跑步机运动可逆转疼痛行为。此外,运动降低了星形胶质细胞的反应性(SNI 平均值 = 14.5,95% 置信区间 [CI],12.7-16.3;SNI + Ex 平均值 = 10.3,95% 置信区间 [CI],8.77-11.9,P = .0003 SNI + Ex 与 SNI 相比)和 SNI 后脊髓的炎症反应。此外,它还抑制了 SNI 诱导的脊髓中 C3 表达的上调(在 Western 印迹中,SNI 平均值 = 5.46,95% CI,3.39-7.53;SNI + Ex 平均值 = 2.41,95% CI,1.42-3.41,P = .0054 SNI + Ex 与 SNI 相比)。C3 缺乏会降低 SNI 诱导的疼痛和脊髓星形胶质细胞反应性(野生型平均值 = 7.96,95% CI,6.80-9.13;C3 KO 平均值 = 5.98,95% CI,5.14-6.82,P = .0052 C3 KO 与野生型相比)。鞘内注射重组 C3(rC3)足以产生机械效应(rC3-Ex 平均值 = 0.77,95% CI,0.15-1.39;rC3 平均值 = 0.18,95% CI,-0.04 至 0.41,P = .0168 rC3-Ex 与 rC3 相比)和小鼠冷(rC3-Ex 平均值 = 1.08,95% CI,0.40-1.77;rC3 平均值 = 3.46,95% CI,1.45-5.47,P = .0025 rC3-Ex 与 rC3 相比)过敏症。重要的是,运动训练能缓解 C3 引起的机械和冷异感症,而亚有效剂量的鞘内注射 C3 会减弱运动的镇痛效果:总之,这些结果表明,运动可通过调节星形胶质细胞 C3 的表达和功能来抑制神经性疼痛,从而为运动的镇痛作用提供了理论依据,使其成为治疗神经性疼痛的一种可接受的替代方法。
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引用次数: 0
Quality of Recovery After Unplanned and Planned Cesarean Deliveries: A Prospective Observational Study Using the Obstetric Quality of Recovery-10 Tool. 非计划和计划剖宫产后的恢复质量:使用产科恢复质量-10 工具的前瞻性观察研究。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-21 DOI: 10.1213/ANE.0000000000006876
Juan F Morales, Andrea Gomez, Jose Carvalho, Xiang Y Ye, Kristi Downey, Naveed Siddiqui

Background: There is a paucity of literature examining the differences between patient-reported outcome measures after planned and unplanned cesarean delivery using a validated quality of recovery tool. The Obstetric Quality of Recovery-10 (ObsQoR-10) scoring tool has been validated to quantify functional recovery after cesarean delivery. We aimed to use the ObsQoR-10 to compare the postoperative recovery characteristics of patients undergoing planned and unplanned cesarean deliveries.

Methods: We conducted a prospective single-center observational study. Patients undergoing planned and unplanned cesarean deliveries under neuraxial anesthesia were asked to complete the ObsQoR-10 questionnaire 24 hours, 48 hours, and 1 week postpartum. We collected information on total in-hospital postoperative opioid consumption and patients´ perception of readiness for discharge at 24 and 48 hours postpartum. Additionally, patient characteristics were collected to assess their correlation with our findings.

Results: We included 112 patients (56 in each group). No statistical differences in ObsQoR-10 scores at 24 hours, 48 hours, and 1 week postpartum were observed between the planned and unplanned cesarean deliveries. Additionally, there was no difference between the groups in patients' perception of readiness for hospital discharge at 24 and 48 hours and opioid consumption in the first 2 days after surgery. Most patients in both groups did not think they would be ready for discharge at 24 hours postpartum. Analysis of the individual components of ObsQoR-10 at 24 hours showed a difference in the responses assessing the severity of shivering (higher in unplanned cesarean deliveries) and the ability to look after personal hygiene (lower in unplanned cesarean deliveries).

Conclusions: As assessed by the ObsQoR-10, no significant difference in the quality of recovery was observed between patients undergoing planned and unplanned cesarean delivery.

背景:使用经过验证的恢复质量工具来研究计划内和计划外剖宫产后患者报告的结果测量之间的差异的文献很少。产科恢复质量-10(ObsQoR-10)评分工具已通过验证,可量化剖宫产后的功能恢复情况。我们旨在使用 ObsQoR-10 比较计划内和计划外剖宫产患者的术后恢复特征:我们进行了一项前瞻性单中心观察研究。我们要求在神经麻醉下接受计划内和计划外剖宫产的患者在产后 24 小时、48 小时和 1 周内填写 ObsQoR-10 问卷。我们收集了院内术后阿片类药物总消耗量以及患者对产后 24 小时和 48 小时出院准备情况的感知。此外,我们还收集了患者的特征,以评估其与我们研究结果的相关性:我们共纳入了 112 名患者(每组 56 人)。计划内和计划外剖宫产患者在产后 24 小时、48 小时和 1 周的 ObsQoR-10 评分没有统计学差异。此外,两组患者在 24 小时和 48 小时时对出院准备情况的感知以及术后头两天的阿片类药物消耗量也没有差异。两组患者中的大多数人都认为他们在产后 24 小时内还没有准备好出院。对24小时时ObsQoR-10各组成部分的分析表明,对颤抖严重程度(非计划剖宫产者较高)和照顾个人卫生能力(非计划剖宫产者较低)的评估存在差异:结论:根据ObsQoR-10的评估,计划内和计划外剖宫产患者的恢复质量没有明显差异。
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引用次数: 0
Clinical Decision Support as a Prevention Tool for Medication Errors in the Operating Room: A Retrospective Cross-Sectional Study. 临床决策支持作为手术室用药错误的预防工具:回顾性横断面研究。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI: 10.1213/ANE.0000000000007058
Lynda D Amici, Maria van Pelt, Laura Mylott, Marin Langlieb, Karen C Nanji

Background: Medication errors in the operating room have high potential for patient harm. While electronic clinical decision support (CDS) software has been effective in preventing medication errors in many nonoperating room patient care areas, it is not yet widely used in operating rooms. The purpose of this study was to determine the percentage of self-reported intraoperative medication errors that could be prevented by CDS algorithms.

Methods: In this retrospective cross-sectional study, we obtained safety reports involving medication errors documented by anesthesia clinicians between August 2020 and August 2022 at a 1046-bed tertiary care academic medical center. Reviewers classified each medication error by its stage in the medication use process, error type, presence of an adverse medication event, and its associated severity and preventability by CDS. Informational gaps were corroborated by retrospective chart review and disagreements between reviewers were resolved by consensus. The primary outcome was the percentage of errors that were preventable by CDS. Secondary outcomes were preventability by CDS stratified by medication error type and severity.

Results: We received 127 safety reports involving 80 medication errors, and 76/80 (95%) of the errors were classified as preventable by CDS. Certain error types were more likely to be preventable by CDS than others ( P < .001). The most likely error types to be preventable by CDS were wrong medication (N = 36, 100% rated as preventable), wrong dose (N = 30, 100% rated as preventable), and documentation errors (N = 3, 100% rated as preventable). The least likely error type to be preventable by CDS was inadvertent bolus (N = 3, none rated as preventable).

Conclusions: Ninety-five percent of self-reported medication errors in the operating room were classified as preventable by CDS. Future research should include a randomized controlled trial to assess medication error rates and types with and without the use of CDS.

背景:手术室用药错误极有可能对患者造成伤害。虽然电子临床决策支持(CDS)软件已在许多非手术室患者护理领域有效预防了用药错误,但在手术室尚未得到广泛应用。本研究的目的是确定可通过 CDS 算法预防的自我报告的术中用药错误的百分比:在这项回顾性横断面研究中,我们获得了一家拥有 1046 张病床的三级医疗学术医疗中心的麻醉临床医生在 2020 年 8 月至 2022 年 8 月期间记录的涉及用药错误的安全报告。审查人员根据用药过程的阶段、错误类型、是否存在不良用药事件以及相关严重性和 CDS 的可预防性对每个用药错误进行了分类。信息缺失通过回顾性病历审查得到证实,审查人员之间的分歧通过协商一致的方式解决。主要结果是可通过 CDS 预防的错误百分比。次要结果是按用药错误类型和严重程度分层的 CDS 可预防性:我们收到了 127 份安全报告,涉及 80 个用药错误,其中 76/80 个错误(95%)被归类为可通过 CDS 预防。与其他错误类型相比,某些错误类型更有可能通过 CDS 预防(P < .001)。最有可能通过 CDS 预防的错误类型是错误用药(36 例,100% 可预防)、错误剂量(30 例,100% 可预防)和文档错误(3 例,100% 可预防)。最不可能通过 CDS 预防的错误类型是用药不慎(3 例,无一例被评为可预防):结论:在自我报告的手术室用药错误中,有 95% 被归类为 CDS 可预防的错误。未来的研究应包括随机对照试验,以评估使用和不使用 CDS 的用药错误率和类型。
{"title":"Clinical Decision Support as a Prevention Tool for Medication Errors in the Operating Room: A Retrospective Cross-Sectional Study.","authors":"Lynda D Amici, Maria van Pelt, Laura Mylott, Marin Langlieb, Karen C Nanji","doi":"10.1213/ANE.0000000000007058","DOIUrl":"10.1213/ANE.0000000000007058","url":null,"abstract":"<p><strong>Background: </strong>Medication errors in the operating room have high potential for patient harm. While electronic clinical decision support (CDS) software has been effective in preventing medication errors in many nonoperating room patient care areas, it is not yet widely used in operating rooms. The purpose of this study was to determine the percentage of self-reported intraoperative medication errors that could be prevented by CDS algorithms.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, we obtained safety reports involving medication errors documented by anesthesia clinicians between August 2020 and August 2022 at a 1046-bed tertiary care academic medical center. Reviewers classified each medication error by its stage in the medication use process, error type, presence of an adverse medication event, and its associated severity and preventability by CDS. Informational gaps were corroborated by retrospective chart review and disagreements between reviewers were resolved by consensus. The primary outcome was the percentage of errors that were preventable by CDS. Secondary outcomes were preventability by CDS stratified by medication error type and severity.</p><p><strong>Results: </strong>We received 127 safety reports involving 80 medication errors, and 76/80 (95%) of the errors were classified as preventable by CDS. Certain error types were more likely to be preventable by CDS than others ( P < .001). The most likely error types to be preventable by CDS were wrong medication (N = 36, 100% rated as preventable), wrong dose (N = 30, 100% rated as preventable), and documentation errors (N = 3, 100% rated as preventable). The least likely error type to be preventable by CDS was inadvertent bolus (N = 3, none rated as preventable).</p><p><strong>Conclusions: </strong>Ninety-five percent of self-reported medication errors in the operating room were classified as preventable by CDS. Future research should include a randomized controlled trial to assess medication error rates and types with and without the use of CDS.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
End-Tidal Control Versus Manual Control of Inhalational Anesthesia Delivery: A Randomized Controlled Noninferiority Trial. 潮气末控制与人工控制吸入麻醉给药:随机对照非劣效性试验。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-19 DOI: 10.1213/ANE.0000000000007132
Melissa D McCabe, Guy de L Dear, Matthew A Klopman, Kritika Garg, Melinda S Seering

Background: Precise anesthesia delivery helps ensure amnesia, analgesia, and immobility. Conventionally, the end-tidal anesthetic concentration is maintained through manual adjustment of the fresh gas flow and anesthetic vaporizer output. Some anesthesia delivery systems can deliver and maintain clinician-selected end-tidal anesthetic agent (EtAA) concentration using a modified closed-loop system. We evaluated the performance of an End-tidal Control (EtC) system on the Aisys CS 2 anesthesia machine (GE HealthCare). We hypothesized EtC anesthetic delivery would be noninferior to manually controlled anesthetic delivery.

Methods: The Multi-site Anesthesia randomized controlled STudy of End-tidal control compared to conventional Results (MASTER) Trial evaluated anesthetic delivery in 210 adult patients receiving inhaled anesthesia. Patients were randomized to either EtC or manual control (MC) anesthetic delivery. The primary objective was to determine whether, compared to conventional anesthesia practice, EtC achieves and maintains clinician-specified EtAA and end-tidal oxygen (Et o2 ) concentrations within defined noninferiority limits. Noninferiority was concluded if the lower limit of the 95% confidence interval (CI) of the difference between the percent duration within the acceptable range (5% of steady state or a margin of ~10% of each agent's minimum alveolar concentration) for EtC and MC was ≥ -5% for both EtAA and Et o2 . Secondary objectives included performance measures: response time: time required to attain 90% of the first desired EtAA, overshoot: amount the controller (or vaporizer delivery) exceeded the desired EtAA, and accuracy: average deviation from the desired EtAA.

Results: EtC achieved and sustained targeted EtAA and Et o2 concentrations within the noninferiority threshold. The EtAA was within 5% of the desired value 98% ± 2.05% of the time with EtC compared to 45.7% ± 31.7% of the time with MC (difference 52.3% [95% CI, 45.9%-58.6%], P < .0001). For Et o2 , EtC was within the noninferiority limit 86.3% ± 22.8% of the time compared with MC at 41% ± 33.3% ( P < .0001, difference 45.3% [95% CI, 36.1%-54.5%]). The median response time for achieving 90% of the initial EtAA desired value was 75 seconds with EtC and 158 seconds with MC ( P = .0013). EtC exhibited a median overshoot of 6.64% of the selected EtAA concentration, whereas MC often failed to reach the clinician's desired value. The difference in median percent deviation from desired EtAA value was 15.7% ([95% CI, 13.5%-19.0%], P < 0001).

Conclusions: EtC achieves and maintains the EtAA and Et o2 concentration in a manner that is noninferior to manually controlled anesthesia delivery.

背景:精确的麻醉给药有助于确保失忆、镇痛和不动。传统的方法是通过手动调节新鲜气体流量和麻醉剂蒸发器输出来维持潮气末麻醉浓度。一些麻醉给药系统可以使用改进的闭环系统输送并维持临床医生选择的潮气末麻醉剂(EtAA)浓度。我们评估了 Aisys CS2 麻醉机(GE HealthCare)上潮气末控制 (EtC) 系统的性能。我们假设 EtC 系统的麻醉剂给药效果不会劣于手动控制的麻醉剂给药效果:多点麻醉随机对照潮气末控制与传统结果比较研究(MASTER)试验评估了 210 名接受吸入麻醉的成人患者的麻醉给药情况。患者被随机分配到潮气末控制(ETC)或人工控制(MC)麻醉给药。主要目的是确定与传统麻醉方法相比,EtC 是否能达到并维持临床医生指定的 EtAA 和潮气末氧 (Eto2) 浓度在规定的非劣性范围内。如果 EtC 和 MC 的 EtAA 和 Eto2 在可接受范围(稳态的 5% 或每种药剂的最低肺泡浓度的 ~10% 的余量)内的持续时间百分比之差的 95% 置信区间 (CI) 的下限≥ -5%,则判定为非劣效性。次要目标包括性能测量:响应时间:达到首次预期 EtAA 的 90% 所需的时间;过冲:控制器(或蒸发器输送)超出预期 EtAA 的量,以及准确性:与预期 EtAA 的平均偏差:结果:EtC 达到并维持了目标 EtAA 和 Eto2 浓度,在非劣效阈值范围内。使用 EtC 时,EtAA 在期望值的 5% 以内的比例为 98% ± 2.05%,而使用 MC 时为 45.7% ± 31.7%(差异为 52.3% [95% CI, 45.9%-58.6%], P < .0001)。对于 Eto2,EtC 有 86.3% ± 22.8% 的时间在非劣效限内,而 MC 为 41% ± 33.3%(P < .0001,差异为 45.3% [95% CI, 36.1% - 54.5%])。达到 90% 初始 EtAA 预期值的中位响应时间,EtC 为 75 秒,MC 为 158 秒(P = .0013)。EtC 的中位超调为所选 EtAA 浓度的 6.64%,而 MC 往往达不到临床医生的期望值。与预期 EtAA 值的中位偏差百分比差异为 15.7%([95% CI, 13.5%-19.0%], P < 0001):EtC能达到并维持EtAA和Eto2浓度,其效果不亚于人工控制麻醉给药。
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引用次数: 0
Characterizing Chronic Pain and Adverse Childhood Experiences in the Lesbian, Gay, Bisexual, Transgender, or Queer Community. 描述女同性恋、男同性恋、双性恋、变性人或同性恋群体中的慢性疼痛和童年不良经历。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-27 DOI: 10.1213/ANE.0000000000006922
Nikita Shirsat, Nicole Finney, Sami Strutner, Joseph Rinehart, K Elliott Higgins, Shalini Shah

Background: Childhood adversity is associated with chronic pain in adulthood. Additionally, individuals identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report a greater prevalence of chronic pain and increased adverse childhood experiences (ACEs). While the LGTBQ+ community has a disproportionately high chronic disease burden, limited research has been conducted on the associations between chronic pain conditions or intensity and childhood adversity in this population.

Methods: In this cross-sectional study, participants were 18 years or older, LGBTQ+ identifying, and reported chronic pain. Surveys were electronically distributed from August to November 2022 via LGBTQ+ organization email listservs and social media platforms. The survey included demographics and validated questionnaires measuring chronic pain (The Chronic Pain Questionnaire) and childhood adversity (ACE score). In analysis, ACE scores of 4 or more were defined as high.

Results: Responses from 136 individuals (average age of 29 ± 7.4 years) were analyzed. The mean for participants' average pain rating in the last 6 months was 5.9 of 10. Participants' worst pain was rated at least a 7 of 10 for 80% of respondents. Half (47%) had high ACE scores, and high ACE scores were significantly associated with higher average pain scores (6.27 ± 1.79, mean difference = -2.22, P = .028, 95% confidence interval [CI], -1.2 to -0.0), and higher perceived current pain ratings (4.53 ± 2.16, mean difference = -2.78, P = .007, 95% CI, -1.9 to -0.3). Transgender and gender diverse (TGD) participants (n = 75) had higher ACE scores (3.91 ± 1.78) and current pain scores compared to cisgender individuals (3.9 ± 1.8 vs 3.0 ± 1.9, P = .009, 95% CI, 0.0-0.3). History of any sexual trauma was prevalent in 36.7% and was associated with chronic pain located in the pelvic region ( P = .016, effect size estimate 0.21). Specific histories of forced sexual and touch encounters were associated with a specific diagnosis of fibromyalgia ( P = .008, effect size estimate 0.31 and P = .037, effect size estimate 0.31, respectively).

Conclusions: Childhood adversity and chronic pain's dose-dependent relationship among our LGBTQ+ sample indicates a need to explore trauma's role in perceived pain. Given sexual trauma's association with pain location and diagnosis, type of trauma may also be crucial in understanding chronic pain development. Research into the relationships between childhood adversity, sexuality, gender identity, and chronic pain could improve chronic pain prevention and management for the LGBTQ+ community.

背景:童年逆境与成年后的慢性疼痛有关。此外,女同性恋、男同性恋、双性恋、跨性别者或同性恋者(LGBTQ+)报告的慢性疼痛发病率更高,童年逆境经历(ACEs)也更多。虽然 LGBTBQ+ 群体的慢性病负担过重,但有关该群体慢性疼痛状况或强度与童年逆境之间关系的研究却十分有限:在这项横断面研究中,参与者年龄在 18 岁或以上,认同 LGBTQ+ 并报告有慢性疼痛。调查问卷于 2022 年 8 月至 11 月期间通过 LGBTQ+ 组织的电子邮件列表服务和社交媒体平台以电子方式发放。调查内容包括人口统计学和测量慢性疼痛(慢性疼痛问卷)和童年逆境(ACE 评分)的有效问卷。在分析中,ACE 分数达到或超过 4 分被定义为高分:对 136 人(平均年龄为 29 ± 7.4 岁)的回答进行了分析。参与者在过去 6 个月中的平均疼痛评分为 5.9(满分 10 分)。80%的受访者对最严重疼痛的评分至少为 7 分(满分 10 分)。半数受访者(47%)的 ACE 分数较高,而 ACE 分数较高与平均疼痛评分较高(6.27 ± 1.79,平均差 = -2.22,P = .028,95% 置信区间 [CI],-1.2 至 -0.0)和感知到的当前疼痛评分较高(4.53 ± 2.16,平均差 = -2.78,P = .007,95% 置信区间 [CI],-1.9 至 -0.3)显著相关。变性和性别多元化 (TGD) 参与者(n = 75)的 ACE 评分(3.91 ± 1.78)和当前疼痛评分(3.9 ± 1.8 vs 3.0 ± 1.9,P = .009,95% CI,0.0-0.3)均高于顺性别者。36.7%的人有过性创伤史,并且与骨盆区域的慢性疼痛有关(P = .016,效应大小估计为 0.21)。特定的强迫性接触史和触摸史与纤维肌痛的特定诊断有关(P = .008,效应估计值分别为 0.31 和 P = .037,效应估计值分别为 0.31):结论:在我们的 LGBTQ+ 样本中,童年逆境与慢性疼痛之间存在剂量依赖关系,这表明有必要探讨创伤在感知疼痛中的作用。鉴于性创伤与疼痛部位和诊断的关系,创伤类型可能也是了解慢性疼痛发展的关键。研究童年逆境、性行为、性别认同和慢性疼痛之间的关系可以改善 LGBTQ+ 群体的慢性疼痛预防和管理。
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引用次数: 0
The Difficulty Implementing Evidence-Based Practice in the Perioperative Setting. 在围手术期实施循证实践的困难。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-25 DOI: 10.1213/ANE.0000000000006916
Adam J Milam, Timethia Bonner, Brittany N Burton, Brittney Williams, Mohanad R Youssef, Randi N Smith, Maxime Cannesson, Christopher Troianos, Jean-Francois Pittet
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引用次数: 0
Validation of a Novel Method for Noninvasive Mixed Venous Oxygen Saturation Monitoring in Anesthetized Children. 麻醉儿童无创混合静脉血氧饱和度监测新方法的验证。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1213/ANE.0000000000007083
Anders Svedmyr, Kristoffer Steiner, Andreas Andersson, Gunnar Sjöberg, Magnus Hallbäck, Mats Wallin, Per-Arne Lönnqvist, Jacob Karlsson

Background: Mixed venous oxygen saturation (SvO 2 ) is a critical variable in the assessment of oxygen supply and demand but is rarely used in children due to the invasive nature of pulmonary artery catheters. The aim of this prospective, observational study was to investigate the accuracy of noninvasively measured SvO 2 acquired by the novel capnodynamic method, based on differential Fick equation (Capno-SvO 2 ), against gold standard CO-oximetry.

Methods: Capno-SvO 2 was compared to SvO 2 measured by pulmonary artery blood gas CO-oximetry in children undergoing cardiac catheter interventions and subjected to moderate hemodynamic challenges. Bland-Altman analysis was used to describe the agreement of absolute values between CO-oximetry and Capno-SvO 2 , and a concordance rate was calculated to evaluate the ability of Capno-SvO 2 to track change.

Results: Twenty-five procedures were included in the study. Capno-SvO 2 showed a bias toward CO-oximetry of +3 percentage points; upper and lower limits of agreement were +11 percentage points (95% confidence interval [CI], 9-14) and -5 percentage points (95% CI, -8 to -3), respectively. The concordance rate was 92% (95% CI, 89-96).

Conclusions: In conclusion, this first clinical application of a novel concept for noninvasive SvO 2 monitoring without the need for a pulmonary artery catheter indicates that Capno-SvO 2 generates absolute values and trending capacity in close agreement with the gold standard reference method.

背景:混合静脉血氧饱和度(SvO2)是评估供氧和需氧的一个关键变量,但由于肺动脉导管的侵入性而很少用于儿童。这项前瞻性观察研究的目的是探讨基于费克微分方程的新型帽动力法(Capno-SvO2)与黄金标准二氧化碳氧饱和度测量法无创测量 SvO2 的准确性:方法:在接受心脏导管介入治疗和中度血流动力学挑战的儿童中,将 Capno-SvO2 与肺动脉血气 CO- 氧饱和度测量法测量的 SvO2 进行比较。使用 Bland-Altman 分析描述 CO- 氧饱和度与 Capno-SvO2 绝对值的一致性,并计算一致性率以评估 Capno-SvO2 跟踪变化的能力:结果:这项研究共纳入了 25 例手术。Capno-SvO2 与 CO-oximetry 的偏差为 +3 个百分点;一致性的上限和下限分别为 +11 个百分点(95% 置信区间 [CI],9-14)和 -5 个百分点(95% CI,-8--3)。一致率为 92% (95% CI, 89-96):总之,无需肺动脉导管的无创 SvO2 监测新概念的首次临床应用表明,Capno-SvO2 生成的绝对值和趋势能力与金标准参考方法非常接近。
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引用次数: 0
Efficacy of Single-Bolus Administration of Remimazolam During Induction of Anesthesia in Patients Undergoing Cardiac Surgery: A Prospective, Single-Center, Randomized Controlled Study. 心脏手术患者在麻醉诱导期间单次服用雷马唑仑的疗效:一项前瞻性、单中心、随机对照研究。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-05 DOI: 10.1213/ANE.0000000000006861
Sou-Hyun Lee, Jae-Sik Nam, Dae-Kee Choi, Ji-Hyun Chin, In-Cheol Choi, Kyungmi Kim

Background: Remimazolam is a recently marketed ultrashort-acting benzodiazepine. This drug is considered safe and effective during general anesthesia; however, limited information is available about its effects on patients undergoing cardiac surgery. Therefore, the present study was conducted to evaluate the efficacy and hemodynamic stability of a bolus administration of remimazolam during anesthesia induction in patients undergoing cardiac surgery.

Methods: Patients undergoing elective cardiac surgery were randomly assigned to any 1 of the following 3 groups: anesthesia induction with a continuous infusion of remimazolam 6 mg/kg/h (continuous group), a single-bolus injection of remimazolam 0.1 mg/kg (bolus 0.1 group), or a single-bolus injection of remimazolam 0.2 mg/kg (bolus 0.2 group). Time to loss of responsiveness, defined as modified Observer's Assessment of Alertness/Sedation Scale <3, and changes in hemodynamic status during anesthetic induction were measured.

Results: Times to loss of responsiveness were 137 ± 20, 71 ± 35, and 48 ± 9 seconds in the continuous, bolus 0.1, and bolus 0.2 groups, respectively. The greatest mean difference was observed between the continuous and bolus 0.2 groups (89.0, 95% confidence interval [CI], 79.1-98.9), followed by the continuous and bolus 0.1 groups (65.8, 95% CI, 46.9-84.7), and lastly between the bolus 0.2 and bolus 0.1 groups (23.2, 95% CI, 6.6-39.8). No significant differences were found in terms of arterial blood pressures and heart rates of the patients.

Conclusions: A single-bolus injection of remimazolam provided efficient anesthetic induction in patients undergoing cardiac surgery. A 0.2 mg/kg bolus injection of remimazolam resulted in the shortest time to loss of responsiveness among the 3 groups, without significantly altering the hemodynamic parameters. Therefore, this dosing can be considered a favorable anesthetic induction method for patients undergoing cardiac surgery.

背景介绍雷马唑仑是最近上市的一种超短效苯并二氮杂卓。这种药物在全身麻醉中被认为是安全有效的,但有关其对心脏手术患者影响的信息却很有限。因此,本研究旨在评估心脏手术患者麻醉诱导期间栓塞给药瑞马唑仑的疗效和血液动力学稳定性:接受择期心脏手术的患者被随机分配到以下3组中的任意一组:持续输注6 mg/kg/h的雷马唑仑(持续组)、单次注射0.1 mg/kg的雷马唑仑(栓剂0.1组)或单次注射0.2 mg/kg的雷马唑仑(栓剂0.2组)进行麻醉诱导。反应性丧失时间,定义为改良的观察者警觉性评估/镇静量表结果:持续组、栓剂 0.1 组和栓剂 0.2 组的反应消失时间分别为 137 ± 20 秒、71 ± 35 秒和 48 ± 9 秒。连续用药组和栓剂 0.2 组的平均差异最大(89.0,95% 置信区间 [CI],79.1-98.9),其次是连续用药组和栓剂 0.1 组(65.8,95% CI,46.9-84.7),最后是栓剂 0.2 组和栓剂 0.1 组(23.2,95% CI,6.6-39.8)。患者的动脉血压和心率无明显差异:结论:对接受心脏手术的患者来说,单次栓剂注射雷马唑仑可提供高效的麻醉诱导。在三组患者中,0.2 毫克/千克栓剂注射雷马唑仑使患者在最短时间内丧失反应能力,且不会明显改变血液动力学参数。因此,这种剂量可被视为对心脏手术患者有利的麻醉诱导方法。
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引用次数: 0
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Anesthesia and analgesia
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