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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
Carboxyhemoglobin in Cardiac Surgery Patients and Its Association with Risk Factors and Biomarkers of Hemolysis. 心脏手术患者的羧基血红蛋白及其与溶血风险因素和生物标志物的关系
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-03-06 DOI: 10.1213/ANE.0000000000006915
Akinori Maeda, Dinesh Pandey, Ryota Inokuchi, Sofia Spano, Anis Chaba, Atthaphong Phongphithakchai, Glenn Eastwood, Hossein Jahanabadi, Hung Vo, Siven Seevanayagam, Andrew Motley, Rinaldo Bellomo

Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with hemolysis. Yet, there is no easily available and frequently measured marker to monitor this hemolysis. However, carboxyhemoglobin (CO-Hb), formed by the binding of carbon monoxide (a product of heme breakdown) to hemoglobin, may reflect such hemolysis. We hypothesized that CO-Hb might increase after cardiac surgery and show associations with operative risk factors and indirect markers for hemolysis.

Methods: We conducted a retrospective descriptive cohort study of data from on-pump cardiac surgery patients. We analyzed temporal changes in CO-Hb levels and applied a generalized linear model to assess patient characteristics associated with peak CO-Hb levels. Additionally, we examined their relationship with red blood cell (RBC) transfusion and bilirubin levels.

Results: We studied 38,487 CO-Hb measurements in 1735 patients. CO-Hb levels increased significantly after cardiac surgery, reaching a peak CO-Hb level 2.1 times higher than baseline ( P < .001) at a median of 17 hours after the initiation of surgery. Several factors were independently associated with higher peak CO-Hb, including age ( P < .001), preoperative respiratory disease ( P = .001), New York Heart Association Class IV ( P = .019), the number of packed RBC transfused ( P < .001), and the duration of CPB ( P = .002). Peak CO-Hb levels also significantly correlated with postoperative total bilirubin levels (Rho = 0.27, P < .001).

Conclusions: CO-Hb may represent a readily obtainable and frequently measured biomarker that has a moderate association with known biomarkers of and risk factors for hemolysis in on-pump cardiac surgery patients. These findings have potential clinical implications and warrant further investigation.

背景:心肺旁路(CPB)心脏手术与溶血有关。然而,目前还没有一种容易获得且经常测量的标记物来监测这种溶血现象。然而,一氧化碳(血红素分解的产物)与血红蛋白结合形成的碳氧血红蛋白(CO-Hb)可反映这种溶血。我们假设 CO-Hb 可能会在心脏手术后增加,并与手术风险因素和溶血的间接标志物有关:我们对泵上心脏手术患者的数据进行了一项回顾性描述性队列研究。我们分析了 CO-Hb 水平的时间变化,并应用广义线性模型评估了与 CO-Hb 峰值水平相关的患者特征。此外,我们还研究了它们与红细胞(RBC)输注和胆红素水平的关系:我们对 1735 名患者的 38487 次 CO-Hb 测量结果进行了研究。心脏手术后 CO-Hb 水平明显升高,手术开始后中位数 17 小时 CO-Hb 水平达到峰值,是基线水平的 2.1 倍(P < .001)。有几个因素与较高的 CO-Hb 峰值独立相关,包括年龄(P < .001)、术前呼吸系统疾病(P = .001)、纽约心脏协会 IV 级(P = .019)、输注的包装红细胞数量(P < .001)和 CPB 持续时间(P = .002)。CO-Hb峰值水平与术后总胆红素水平也有显著相关性(Rho = 0.27,P < .001):CO-Hb可能是一种容易获得且经常测量的生物标志物,它与已知的生物标志物及泵上心脏手术患者溶血的风险因素有一定的关联。这些发现具有潜在的临床意义,值得进一步研究。
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引用次数: 0
Effects of Oxygenation Targets on Mortality in Critically Ill Patients in Intensive Care Units: A Systematic Review and Meta-Analysis. 吸氧目标对重症监护病房重症患者死亡率的影响:系统回顾与元分析》。
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI: 10.1213/ANE.0000000000006859
Lei Cao, Qi Chen, Ying-Ying Xiang, Cheng Xiao, Yu-Ting Tan, Hong Li

Background: The effects of oxygenation targets (partial pressure of arterial oxygen [Pa o2 ], arterial oxygen saturation [Sa o2 ]/peripheral oxygen saturation [Sp o2 ], or inspiratory oxygen concentration [Fi o2 ] on clinical outcomes in critically ill patients remains controversial. We reviewed the existing literature to assess the effects of lower and higher oxygenation targets on the mortality rates of critically ill intensive care unit (ICU) patients.

Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched from their dates of inception to December 31, 2022, for randomized controlled trials (RCTs) comparing lower and higher oxygenation targets for critically ill patients ≥18 years of age undergoing mechanical ventilation, nasal cannula, oxygen mask, or high-flow oxygen therapy in the ICU. Data extraction was conducted independently, and RoB 2.0 software was used to evaluate the quality of each RCT. A random-effects model was used for the meta-analysis to calculate the relative risk (RR). We used the I 2 statistic as a measure of statistical heterogeneity. Certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Results: We included 12 studies with a total of 7416 patients participating in RCTs. Oxygenation targets were extremely heterogeneous between studies. The meta-analysis found no differences in mortality between lower and higher oxygenation targets for critically ill ICU patients (relative risk [RR], 1.00; 95% confidence interval [CI], 0.93-1.09; moderate certainty). The incidence of serious adverse events (RR, 0.93; 95% CI, 0.85-1.00; high certainty), mechanical ventilation-free days through day 28 (mean difference [MD], -0.05; 95%CI, -1.23 to 1.13; low certainty), the number of patients requiring renal replacement therapy (RRT) (RR, 0.96; 95% CI, 0.84-1.10; low certainty), and ICU length of stay (MD, 1.05; 95% CI, -0.04 to 2.13; very low certainty) also did not differ among patients with lower or higher oxygenation targets.

Conclusions: Critically ill ICU patients ≥18 years of age managed with lower and higher oxygenation targets did not differ in terms of mortality, RRT need, mechanical ventilation-free days through day 28, or ICU length of stay. However, due to considerable heterogeneity between specific targets in individual studies, no conclusion can be drawn regarding the effect of oxygenation targets on ICU outcomes.

背景:氧合目标(动脉血氧分压[Pao2]、动脉血氧饱和度[Sao2]/外周血氧饱和度[Spo2]或吸入氧浓度[Fio2])对重症患者临床预后的影响仍存在争议。我们回顾了现有文献,以评估较低和较高氧合目标对重症监护病房(ICU)重症患者死亡率的影响:方法:检索了 MEDLINE、EMBASE、Cochrane 对照试验中央登记册和 Web of Science 数据库中从开始日期到 2022 年 12 月 31 日的随机对照试验 (RCT),比较了在重症监护室接受机械通气、鼻导管、氧气面罩或高流量氧疗的年龄≥18 岁的重症患者的较低和较高氧合目标。数据提取工作独立进行,并使用 RoB 2.0 软件评估每项 RCT 的质量。荟萃分析采用随机效应模型计算相对风险(RR)。我们使用 I2 统计量来衡量统计异质性。证据的确定性根据建议评估、发展和评价分级(GRADE)指南进行评估:我们纳入了 12 项研究,共有 7416 名患者参与了 RCT 研究。不同研究的吸氧目标差异极大。荟萃分析发现,ICU 重症患者的死亡率在较低和较高氧合目标之间没有差异(相对风险 [RR],1.00;95% 置信区间 [CI],0.93-1.09;中等确定性)。严重不良事件发生率(RR,0.93;95% CI,0.85-1.00;高度确定性)、第 28 天无机械通气天数(平均差 [MD],-0.05;95%CI,-1.23 至 1.13;低度确定性)、需要肾脏替代疗法(RRT)的患者人数(RR,0.96;95% CI,0.84-1.10;低确定性)、ICU住院时间(MD,1.05;95% CI,-0.04-2.13;极低确定性)在氧合目标较低或较高的患者中也没有差异:结论:在死亡率、RRT需求、第28天无机械通气天数或重症监护室住院时间方面,使用较低和较高氧合目标的≥18岁重症监护室患者没有差异。然而,由于个别研究的具体目标之间存在很大的异质性,因此无法就氧合目标对 ICU 结果的影响得出结论。
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引用次数: 0
Persistent Opioid Use After Hospital Admission From Surgery in New Zealand: A Population-Based Study. 新西兰外科手术入院后阿片类药物的持续使用:基于人群的研究
IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI: 10.1213/ANE.0000000000006911
Jiayi Gong, Peter Jones, Chris Frampton, Kebede Beyene, Amy Hai Yan Chan

Background: Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals.

Method: We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU.

Results: We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%-9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04-3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29-1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23-1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87-0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83-2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75-2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60-1.71), smoking (aOR, 1.44; 95% CI, 1.35-1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28-1.42).

Conclusions: Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery.

背景:术后持续使用阿片类药物(POU)很常见,并与死亡率和发病率的增加有关。目前还没有基于人群的研究对新西兰(NZ)未使用过阿片类药物的手术患者进行持续使用阿片类药物的调查。本研究旨在确定在新西兰所有医院接受手术的阿片类药物无效患者中POU的发生率和风险因素:我们纳入了2007年1月至2019年12月期间在新西兰任何一家医院接受手术且未同时确诊外伤并在出院后接受阿片类药物治疗的所有阿片类药物无效患者。如果患者在索引日期前365天内未获得过阿片类药物配给,或之前未诊断出阿片类药物使用障碍,则被视为阿片类药物天真患者。主要结果是 POU 的发生率,先验定义为出院后 91 天至 365 天内阿片类药物的使用情况。我们使用多变量逻辑回归来确定 POU 的风险因素:我们确定了 1789,407 名接受手术且未同时诊断为外伤的患者;377,144 人(21.1%)获得了阿片类药物处方,260,726 名患者符合条件并纳入分析。在纳入最终样本的患者中,有23656人(9.1%;95%置信区间[CI],9.0%-9.2%)出现了POU。与阿片类药物处方方式相关的风险因素包括:出院后更换为不同的阿片类药物(调整后的几率比[aOR],3.21;95% CI,3.04-3.38)、出院时接受多种阿片类药物(aOR,1.37;95% CI,1.29-1.45)以及较高的口服吗啡总当量(>400 毫克)(aOR,1.23;95% CI,1.23-1.45)。相反,出院时获得非阿片类镇痛药处方的患者发生 POU 的几率较低(aOR,0.91;95% CI,0.87-0.95)。不同种族之间的差异很小。与 POU 风险增加相关的其他风险因素包括:接受神经外科手术(aOR,2.02;95% CI,1.83-2.24)、较高的并发症负担(aOR,1.90;95% CI,1.75-2.07)、术前非手术镇痛(aOR,0.91;95% CI,0.87-0.95)、术后镇痛(aOR,0.91;95% CI,0.87-0.95)。结论:术前使用非阿片类镇痛药(aOR,1.65;95% CI,1.60-1.71)、吸烟(aOR,1.44;95% CI,1.35-1.54)和术前使用催眠药(aOR,1.35;95% CI,1.28-1.42):每11名未使用过阿片类药物的患者中就有1人在手术出院时使用阿片类药物,并出现POU。与阿片类药物处方方式有关的潜在可调整风险因素包括出院后更换阿片类药物、接受多种阿片类药物以及出院时阿片类药物总剂量较高。临床医生应在手术前后与患者讨论发生 POU 的可能性,并在手术后出院时开具镇痛处方时考虑发生 POU 的潜在可调节风险因素。
{"title":"Persistent Opioid Use After Hospital Admission From Surgery in New Zealand: A Population-Based Study.","authors":"Jiayi Gong, Peter Jones, Chris Frampton, Kebede Beyene, Amy Hai Yan Chan","doi":"10.1213/ANE.0000000000006911","DOIUrl":"10.1213/ANE.0000000000006911","url":null,"abstract":"<p><strong>Background: </strong>Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals.</p><p><strong>Method: </strong>We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU.</p><p><strong>Results: </strong>We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%-9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04-3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29-1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23-1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87-0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83-2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75-2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60-1.71), smoking (aOR, 1.44; 95% CI, 1.35-1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28-1.42).</p><p><strong>Conclusions: </strong>Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"701-710"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142596","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
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。
{"title":"Analgesic Effect of Exercise on Neuropathic Pain via Regulating the Complement Component 3 of Reactive Astrocytes.","authors":"Chenghao Wang, Hui He, Tianchi Gao, Xinzheng Sun, Lixia Du, Yayue Yang, Jianyu Zhu, Yachen Yang, Yanqing Wang, Wenli Mi","doi":"10.1213/ANE.0000000000006884","DOIUrl":"10.1213/ANE.0000000000006884","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"840-850"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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":" ","pages":"832-839"},"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
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。
{"title":"Characterizing Chronic Pain and Adverse Childhood Experiences in the Lesbian, Gay, Bisexual, Transgender, or Queer Community.","authors":"Nikita Shirsat, Nicole Finney, Sami Strutner, Joseph Rinehart, K Elliott Higgins, Shalini Shah","doi":"10.1213/ANE.0000000000006922","DOIUrl":"10.1213/ANE.0000000000006922","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"821-831"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982189","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
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。
{"title":"Efficacy of Single-Bolus Administration of Remimazolam During Induction of Anesthesia in Patients Undergoing Cardiac Surgery: A Prospective, Single-Center, Randomized Controlled Study.","authors":"Sou-Hyun Lee, Jae-Sik Nam, Dae-Kee Choi, Ji-Hyun Chin, In-Cheol Choi, Kyungmi Kim","doi":"10.1213/ANE.0000000000006861","DOIUrl":"10.1213/ANE.0000000000006861","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"770-780"},"PeriodicalIF":4.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139691025","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}
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Anesthesia and analgesia
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