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Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study. 针对顽固性颅面癌疼痛患者的鞘内给药系统:一项多中心回顾性研究
Pub Date : 2024-09-11 DOI: 10.1213/ane.0000000000007262
Dongju Long,Xinning Li,Yu Zhang,Jia Luo,Bojing Liu,Bo Hong,Fan Yang,Cong Zou,Feng Ge,Aimin Zhang,Huacheng Zhou,Yanying Xiao,Yaping Wang
BACKGROUNDPatients with craniofacial cancer frequently suffer from severe pain. The traditional intrathecal, oral, or intravenous analgesics could only provide insufficient pain relief with many side effects. Thus, a more effective analgesia approach is required. This study aimed to investigate the safety and efficacy of placing the catheter of an intrathecal morphine pump in the prepontine cistern for the treatment of craniofacial cancer pain.METHODSWe performed a retrospective study of patients with primary or metastatic craniofacial cancer pain who received the catheter placement of an intrathecal morphine pump into the prepontine cistern in eleven medical centers from September 2019 to December 2023. Friedman test and pairwise signed-rank test were used to evaluate the difference in numeric rating scale (NRS) scores, the number of breakthrough pain episodes, dose of intrathecal morphine, and dose of systemic morphine equivalents (oral, patch, intravenous) from preoperative period to postoperative days 1, 7, and 30. P values were corrected for multiple comparisons using Bonferroni test.RESULTSThe study included 33 patients. The median (interquartile range [IQR]) of NRS scores at days 1, 7, and 30 postimplant were 2.0 (1.0-3.5), 2.0 (1.0-2.0), and 1.0 (1.0-2.0), respectively, which was significantly lower than that before surgery (median, 8.0; IQR, 7.0-10.0; all P < .001). Compared to baseline number/d of breakthrough pain episodes (median, 6.0; IQR, 4.5-10.0), there was a progressive decrease in the number/d of breakthrough pain episodes at day 1, day 7, and day 30 postimplant, and the median (IQR) were 1.0 (0.0-3.0), 2.0 (0.0-3.0), and 0.0 (0.0-1.2), respectively (all P < .001). Approximately 78.8% and 96.7% of patients reported pain relief >50% at days 1 and 30 postimplant, respectively. Compared with that at day 1 postimplant, the proportion of patients with a pain relief rate >75% at day 30 postimplant also increased with continued intrathecal treatment. Compared to the dose of baseline systemic morphine equivalents (median, 228 mg.d-1; IQR, 120-408 mg.d-1), the dose of systemic morphine equivalents reduced significantly from 0(0-120) mg.d-1 at day 1 postimplant (P = .001), to 0 (0-0) mg.d-1 at days 7 and 30 postimplant (both P < .001). Few patients reported perioperative adverse events, including nausea, constipation, hypotension, urinary retention, dry mouth, headache, and sedation. No severe adverse events occurred.CONCLUSIONSPlacing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events. This procedure could be considered in patients with severe refractory craniofacial cancer pain.
背景颅面癌患者经常遭受剧烈疼痛的折磨。传统的鞘内注射、口服或静脉注射镇痛药只能缓解部分疼痛,且副作用较大。因此,需要一种更有效的镇痛方法。本研究旨在探讨将鞘内吗啡泵导管置入桥脑前囊治疗颅面癌疼痛的安全性和有效性。方法 我们对 2019 年 9 月至 2023 年 12 月期间在 11 家医疗中心接受鞘内吗啡泵导管置入桥脑前囊治疗的原发性或转移性颅面癌疼痛患者进行了回顾性研究。弗里德曼检验和配对符号秩检验用于评估术前至术后第1天、第7天和第30天的数字评分量表(NRS)评分、突破性疼痛发作次数、鞘内吗啡剂量和全身吗啡当量(口服、贴敷、静脉注射)剂量的差异。使用 Bonferroni 检验对 P 值进行了多重比较校正。植入后第 1、7 和 30 天的 NRS 评分中位数(四分位数间距 [IQR])分别为 2.0 (1.0-3.5)、2.0 (1.0-2.0) 和 1.0 (1.0-2.0),明显低于术前(中位数,8.0;IQR,7.0-10.0;所有 P <.001)。与基线突破性疼痛发作次数/d(中位数,6.0;IQR,4.5-10.0)相比,植入后第 1 天、第 7 天和第 30 天的突破性疼痛发作次数/d 逐渐减少,中位数(IQR)分别为 1.0(0.0-3.0)、2.0(0.0-3.0)和 0.0(0.0-1.2)(所有 P < .001)。约 78.8% 和 96.7% 的患者在植入后第 1 天和第 30 天分别报告疼痛缓解 >50%。与植入后第 1 天相比,植入后第 30 天疼痛缓解率大于 75% 的患者比例也随着持续鞘内治疗而增加。与基线全身吗啡当量剂量(中位数,228 mg.d-1;IQR,120-408 mg.d-1)相比,全身吗啡当量剂量从植入后第1天的0(0-120)mg.d-1(P = .001)显著降至植入后第7天和第30天的0(0-0)mg.d-1(P均< .001)。少数患者报告了围手术期不良反应,包括恶心、便秘、低血压、尿潴留、口干、头痛和镇静。结论将鞘内吗啡泵的导管尖端插入颅前蓄水池可有效缓解难治性颅面癌疼痛,吗啡总剂量需求极低,不良反应极少。严重的难治性颅面癌疼痛患者可以考虑采用这种方法。
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引用次数: 0
Pro-Con Debate: Anesthesiologists Should Be Responsible for Treating Preoperative Anemia. 正反方辩论:麻醉师应负责治疗术前贫血。
Pub Date : 2024-09-09 DOI: 10.1213/ane.0000000000006854
Nadia B Hensley,Steven M Frank,Edward C Nemergut,Grant A Neely
In this Pro-Con commentary article, we discuss whether anesthesiologists should be responsible for treating preoperative anemia. This debate was proposed based on the article published in this issue of Anesthesia & Analgesia by Warner et al, which is an advisory on managing preoperative anemia endorsed by both the Society of Cardiovascular Anesthesiologists and the Society for Advancement of Patient Blood Management. All evidence suggests that anemia is not just an innocent "bystander" which can be solved by transfusion. In fact, both anemia and transfusion are independently associated with adverse outcomes, so why not avoid both? It just makes sense that patients show up for surgery with enough red blood cells to avoid needing transfusion with someone else's. Even if we agree that preoperative anemia is worth treating before surgery, the question remains who should be responsible for doing so, and therein lies the reason for this Pro-Con debate. Should it be the responsibility of the anesthesiologist, or not? Let the readers decide.
在这篇 Pro-Con 评论文章中,我们讨论了麻醉医师是否应该负责治疗术前贫血。这场辩论是基于本期《麻醉与镇痛》杂志上发表的华纳等人的文章而提出的,该文章是心血管麻醉医师学会和促进患者血液管理学会共同认可的术前贫血管理建议。所有证据都表明,贫血并不是输血就能解决的无辜 "旁观者"。事实上,贫血和输血都与不良后果独立相关,为什么不同时避免呢?患者在接受手术时应携带足够的红细胞,以避免输注他人的红细胞,这才是合理的做法。即使我们同意术前贫血值得在术前治疗,问题仍然是谁应该负责治疗,这也是这场正反辩论的原因所在。到底该不该由麻醉师负责?让读者来决定吧。
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引用次数: 0
A Randomized Trial of Shortened Air-Q Self-Pressurizing Intubating Laryngeal Airway Versus Williams Intubating Airway for Flexible Bronchoscopic Intubation. 用于灵活支气管镜插管的缩短型 Air-Q 自加压喉插管气道与威廉姆斯插管气道的随机试验。
Pub Date : 2024-09-06 DOI: 10.1213/ane.0000000000006945
Claire X Sun,Kristopher M Schroeder,Richard E Galgon
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引用次数: 0
The Use of Ultrasound in Airway Management: Video in Clinical Anesthesia 超声波在气道管理中的应用:临床麻醉视频
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000007046
Sara Hora Gomes, Robert Canelli, Francesco Corradi, José Miguel Pêgo, Maxwell B. Baker, Federico Bilotta
An abstract is unavailable.
没有摘要。
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引用次数: 0
In Response 回应
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000007154
Stephen Jackson, James M. Hunter, Gail A. Van Norman
An abstract is unavailable.
没有摘要。
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引用次数: 0
A Process-Based Standardization of an Intraoperative Escalation Protocol in Anesthesiology 麻醉学术中升级规程的流程标准化
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000006782
Shilen P. Thakrar, Christin Kim, Olga Suarez-Winowiski, Sergio B. Navarrete, Kenneth F. Potter, Praveen Prasanna, Jamie P. Graham, Mofya S. Diallo, Laura Lahaye, Alice A. Tolbert Coombs
ads to “near-misses,” adverse outcomes, and serious safety events (SSEs). The principles of an escalation culture have been used successfully in other highly reliable industries such as aviation, military, and manufacturing. We discuss here the introduction of a unique and compelling thought-process for developing an intraoperative escalation protocol that is specifically tailored for our institution. Inspired by a critical intraoperative event, this departmental protocol was developed based on an analysis of multispecialty literature and expert opinion to decrease the incidence of SSEs. It includes a stepwise approach and incorporates patient-specific information to guide team members who encounter dynamic clinical situations. The implementation of the protocol has facilitated continuous quality improvement through iterative education, improving communication, and enhancing decision-making. Concurrently, we have plans to incorporate technology and electronic decision support tools to enhance real-time communication, monitor performance, and foster a culture of safety....
升级文化的原则已成功应用于航空、军事和制造等其他高可靠性行业。升级文化的原则已成功应用于航空、军事和制造等其他高可靠性行业。在此,我们将讨论如何引入一个独特而令人信服的思维过程,以制定专为本机构量身定制的术中升级方案。受一个关键术中事件的启发,我们在分析多科文献和专家意见的基础上制定了这一部门协议,以降低 SSE 的发生率。它包括一个循序渐进的方法,并结合了患者的具体信息,为遇到动态临床情况的团队成员提供指导。协议的实施通过反复教育、改善沟通和提高决策水平,促进了质量的持续改进。与此同时,我们还计划采用技术和电子决策支持工具来加强实时沟通、监控绩效并培养安全文化....。
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引用次数: 0
Persistent Opioid Use in New Zealand: Insight From a Universal Health System 新西兰持续使用阿片类药物的情况:全民医疗系统的启示
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000007189
Naveen Nathan
An abstract is unavailable.
没有摘要。
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引用次数: 0
Remote Monitoring and Artificial Intelligence: Novel Technologies and New Threats 远程监控与人工智能:新技术与新威胁
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000007176
Fredrik Granholm, Derrick Tin, Richard Staynings, Gregory R. Ciottone
An abstract is unavailable.
没有摘要。
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引用次数: 0
In Response 回应
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000007177
Max Feinstein, Daniel Katz, Samuel Demaria, Ira S. Hofer
An abstract is unavailable.
没有摘要。
{"title":"In Response","authors":"Max Feinstein, Daniel Katz, Samuel Demaria, Ira S. Hofer","doi":"10.1213/ane.0000000000007177","DOIUrl":"https://doi.org/10.1213/ane.0000000000007177","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"94 7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In Response 回应
Pub Date : 2024-09-04 DOI: 10.1213/ane.0000000000007148
Sherry Y. Jin, Allana Munro, Dolores M. McKeen, Vishal Uppal
An abstract is unavailable.
没有摘要。
{"title":"In Response","authors":"Sherry Y. Jin, Allana Munro, Dolores M. McKeen, Vishal Uppal","doi":"10.1213/ane.0000000000007148","DOIUrl":"https://doi.org/10.1213/ane.0000000000007148","url":null,"abstract":"An abstract is unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Anesthesia & Analgesia
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