Anesthesia and analgesia最新文献

Traumatically injured patients often require emergency intubation of their tracheas. Yet, they present distinct airway challenges, such as anatomic deformities, the need for cervical spine immobilization, diminished physiologic reserve, and logistical hurdles like limited equipment or personnel. In this patient population, both videolaryngoscopy and direct laryngoscopy offer distinct advantages and disadvantages, but current evidence remains inconclusive as to which approach is superior. We conducted a systematic review to determine whether videolaryngoscopy offered higher first-pass success rates than direct laryngoscopy for trauma patients requiring emergency intubation of their tracheas on arrival into the hospital setting. Although the data remain heterogeneous, videolaryngoscopy generally results in noninferior or improved first-pass success rates without significantly increasing complication rates. We conclude that, while providers should choose their initial airway device on an individualized basis, the use of videolaryngoscopy for initial airway management is a reasonable choice for intubation of traumatically injured patients' tracheas, particularly in the presence of cervical spine immobilization.

Background: Ultrasound-guided transforaminal (USF) injections have been proposed as a faster and more easily accessible alternative to traditional radioscopic methods for cervical radicular pain, but their efficacy and safety in cervical spine interventions remain uncertain.

Methods: Pubmed, Embase, and Cochrane Library were searched for studies comparing ultrasound (US)-guided cervical transforaminal injections versus traditional radioscopic methods of epidural injection for patients 1104. We computed standardized mean differences (SMD) for continuous pain outcomes, mean differences (MD) for neck disability index (NDI) and time procedure, odds ratios (OR) for binary outcomes, with 95% confidence intervals (CI).

Results: We included 7 studies, comprising 1104 patients. USF technique was used in 537 patients (48.6%). Pain and disability outcomes were comparable between groups, respectively (SMD = 0.15; 95% CI, -0.01 to 0.31; P = 0.04; I2 = 21%) and (MD = 0.56; 95% CI, -0.28 to 1.39; P = .03; I2 = 0%). US guidance significantly reduced vascular injection risk (OR = 0.13; 95% CI, 0.07-0.25; P < .00001; I2 = 0%) and reduced the procedure time (MD = -158; 95% CI, -228 to -90; P < .00001; I2 = 70%).

Conclusions: In 537 patients with cervical radicular pain, USF techniques were associated with a lower incidence of intravascular injection and a shorter procedure time compared with radioscopic-guided methods, while no significant differences were observed in pain or NDI outcomes.

Background: Preoperative fasting practices can influence patient outcomes. Prolonged fasting can occur due to unclear instructions, misunderstandings, anxiety, and scheduling uncertainty. The aim of this study was to determine preoperative fluid-fasting time (FFT) in clinical practice and to assess how shorter FFT could impact patients and healthcare resources.

Methods: A multicenter, retrospective observational analysis including 15,837 patients extracted from the Safe Brain Initiative care bundle (SBI-CB) database is presented. A part of the SBI-CB was to encourage FFT to be reduced to 2 hours as per guidelines. Four hospitals from Denmark and Turkey participated. Patients were >18 years old, scheduled for surgery, and able to communicate with healthcare staff. The primary outcomes were FFT, in hours, and the proportion of patients adherent to short FFT (2-4 hours) per month since the SBI-CB was initiated at each hospital. Secondary outcomes, comparing short with long (5-24 hours) FFT, included postoperative delirium in the recovery room, hospital length of stay in hours, and patient-reported outcome measures (PROMs) including thirst, pain, nausea/vomiting, stress/anxiety, and well-being. Sex, age, American Society of Anesthesia Physical Status Classification System category, surgery time, and use of general anesthesia were controlled for confounding effects by a one-to-many patient matching. Logistic and linear regressions were performed to adjust for the same confounding effects in addition to delirium at induction and site for the outcomes postoperative delirium and hospital stay.

Results: Median (Q1-Q3) FFT was 5 (4-8) hours with a mean of 6.3 hours. 40.3% of patients adhered to the short FFT protocol of 2 to 4 hours. Prolonged FFT of at least 12 hours was experienced by 11.9% of patients. A significant positive correlation between SBI-CB implementation month and adherence to short FFT was observed (r = 0.7, P < .001). When comparing matched patients with short and long FFT, median hospital stay was significantly reduced by 18.0 hours (P < .001). Using logistic regression, short FFT was associated with a significant reduction in postoperative delirium with a log odds ratio [95% confidence interval] of 0.7 [0.6-0.8], P < .001. All measured PROMs were improved significantly with most benefits observed postoperatively.

Conclusion: Adherence to a short FFT could be increased over time; however, many patients still experienced an FFT that should be considered too long. Implementation of short FFT was linked to enhanced patient outcomes and more efficient healthcare resource utilization. These findings underscore the importance of optimizing preoperative fasting practices to improve patient care and healthcare efficiency.