Anesthesia and pain medicine最新文献

Extubation and removal of supraglottic airway devices in pediatric anesthesia 在小儿麻醉中拔管和移除声门上气道装置

Anesthesia and pain medicine

Pub Date : 2024-07-04 DOI: 10.17085/apm.24006

Ayuko Igarashi

In pediatric anesthesia, respiratory adverse events often occur during emergence from anesthesia and at the time of endotracheal tube or supraglottic device removal. The removal of airway devices and extubation are conducted either while patients are deeply anesthetized or when patients awaken from anesthesia and have regained consciousness. The airways of children are easily irritated by external stimuli and are structurally prone to collapse, and the timing of both methods of airway device removal is similarly associated with various airway complications, including upper airway obstruction, coughing, or serious adverse events such as laryngospasm and desaturation. In current pediatric anesthesia practice, the choice of the timing and method of extubation is made by anesthesiologists. To achieve a smooth and safe recovery from anesthesia, understanding the unique characteristics of pediatric airways and the factors likely to contribute to an increased risk of perioperative complications remains essential. These factors include patient age, comorbidities, and physical conditions. The level of anesthesia and readiness for removal of airway devices should be evaluated carefully for each patient, and quick identification of airway problems and intervention is required if patients fail to maintain the airway and sufficient ventilation after removal of airway devices.

在儿科麻醉中，呼吸系统不良事件通常发生在麻醉苏醒期间以及拔除气管插管或声门上装置时。气道装置的移除和拔管是在患者深度麻醉时进行的，或者是在患者从麻醉中苏醒并恢复意识后进行的。儿童的气道很容易受到外界刺激，结构上也容易塌陷，这两种气道装置拔除方法的时机同样与各种气道并发症有关，包括上气道阻塞、咳嗽或严重不良事件（如喉痉挛和饱和度降低）。在目前的儿科麻醉实践中，拔管的时机和方法由麻醉科医生选择。要想从麻醉中顺利安全地恢复，了解儿科气道的独特特征以及可能导致围术期并发症风险增加的因素仍然至关重要。这些因素包括患者年龄、合并症和身体状况。应仔细评估每位患者的麻醉程度和移除气道装置的准备情况，如果患者在移除气道装置后无法维持气道和足够的通气，则需要快速识别气道问题并进行干预。

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引用次数: 0

Anesthetic neurotoxicity in the developing brain: an update on theinsights and implications for fetal surgery 发育中大脑的麻醉神经毒性：最新观点及对胎儿手术的影响

Anesthesia and pain medicine

Pub Date : 2024-07-04 DOI: 10.17085/apm.23128

Denise Cinquegrana, Sri Harsha Boppana, David Berman, Truc-Anh T. Nguyen, A. Baschat, Jamie Murphy, C. D. Mintz, Sri Harsha

This review describes an in-depth analysis of the neurotoxicity associated with the anesthetic agents used during fetal surgery, intending to highlight the importance of understanding the effects of general anesthetics on the developing brain, particularly in the context of open fetal surgery, where high doses are applied to facilitate surgical access and augment uterine relaxation. We examined evidence from preclinical studies in rodents and primates, along with studies in human subjects, with the results collectively suggesting that general anesthetics can disrupt brain development and lead to long-lasting neurological deficits. Our review underscores the clinical implications of these findings, indicating an association between extensive anesthetic exposure in early life and subsequent cognitive deficits. The current standard of anesthetic care for fetal surgical procedures was scrutinized, and recommendations have been proposed to mitigate the risk of anesthetic neurotoxicity. These recommendations emphasize the need for careful selection of anesthetic techniques to minimize fetal exposure to potentially harmful agents. In conclusion, while the benefits of fetal surgery in addressing immediate risks often outweigh the potential neurotoxic effects of anesthesia, the long-term developmental impacts nevertheless warrant consideration. Our analysis suggests that the use of general anesthetics in fetal surgery, especially at high doses, poses a significant risk of developmental neurotoxicity. As such, it is imperative to explore safer alternatives, such as employing different methods of uterine relaxation and minimizing the use of general anesthetics, to achieve the necessary surgical conditions. Further research, particularly in clinical settings, is essential to fully understand the risks and benefits of anesthetic techniques in fetal surgery.

本综述深入分析了胎儿手术中使用的麻醉剂对神经系统的毒性，旨在强调了解全身麻醉剂对发育中大脑的影响的重要性，尤其是在开放性胎儿手术中，使用高剂量麻醉剂是为了方便手术入路和增强子宫松弛。我们研究了啮齿动物和灵长类动物的临床前研究证据，以及对人类受试者的研究，结果共同表明全身麻醉剂会破坏大脑发育并导致长期的神经功能缺损。我们的综述强调了这些研究结果的临床意义，表明早期大量接触麻醉剂与随后的认知障碍之间存在关联。我们对胎儿外科手术的现行麻醉护理标准进行了仔细研究，并提出了降低麻醉神经毒性风险的建议。这些建议强调了谨慎选择麻醉技术的必要性，以尽量减少胎儿暴露于潜在有害物质的机会。总之，尽管胎儿手术在应对直接风险方面的益处往往超过麻醉的潜在神经毒性影响，但其对胎儿长期发育的影响仍值得考虑。我们的分析表明，在胎儿手术中使用全身麻醉药，尤其是高剂量的麻醉药，会对胎儿的发育造成很大的神经毒性风险。因此，当务之急是探索更安全的替代方法，如采用不同的子宫松弛方法，尽量减少全身麻醉剂的使用，以达到必要的手术条件。要充分了解麻醉技术在胎儿手术中的风险和益处，必须开展进一步的研究，尤其是临床研究。

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引用次数: 0

Relationship between intraoperative requirement for anesthetics and postoperative analgesic consumption in laparoscopic colectomy: a randomized controlled double-blinded study 腹腔镜结肠切除术术中麻醉剂需求量与术后镇痛剂消耗量之间的关系：随机对照双盲研究

Anesthesia and pain medicine

Pub Date : 2024-04-25 DOI: 10.17085/apm.23146

Jun Ho Lee, A. Doo, Hyunji Oh, Hyungun Lee, Seonghoon Ko

Background: This study investigated the relationship between intraoperative requirement for an inhalational anesthetic (sevoflurane) or an opioid (remifentanil) and postoperative analgesic consumption. Methods: The study included 200 adult patients undergoing elective laparoscopic colectomy. In the sevoflurane group, the effect-site concentration of remifentanil was fixed at 1.0 ng/ml, while the inspiratory sevoflurane concentration was adjusted to maintain an appropriate anesthetic depth. In the remifentanil group, the end-expiratory sevoflurane concentration was fixed at 1.0 volume%, and the remifentanil concentration was adjusted. Pain scores and cumulative postoperative analgesic consumptions were evaluated at 2, 6, 24, and 48 h after surgery. Results: Average end-tidal concentration of sevoflurane and effect-site concentration of remifentanil were 2.0 ± 0.4 volume% and 3.9 ± 1.4 ng/ml in the sevoflurane and remifentanil groups, respectively. Cumulative postoperative analgesic consumption at 48 h postoperatively was 55 ± 26 ml in the sevoflurane group and 57 ± 33 ml in the remifentanil group. In the remifentanil group, the postoperative cumulative analgesic consumptions at 2 and 6 h were positively correlated with intraoperative remifentanil requirements (2 h: r = 0.36, P < 0.01; 6 h: r = 0.38, P < 0.01). However, there was no significant correlation in the sevoflurane group (r = 0.04, P = 0.69). Conclusions: The amount of intraoperative requirement of short acting opioid, remifentanil, is correlated with postoperative analgesic consumption within postoperative 6 h. It may be contributed by the development of acute opioid tolerance. However, intraoperative sevoflurane requirement had no effect on postoperative analgesic consumption.

背景：本研究调查了术中对吸入麻醉剂（七氟烷）或阿片类药物（瑞芬太尼）的需求量与术后镇痛药消耗量之间的关系。研究方法研究对象包括 200 名接受择期腹腔镜结肠切除术的成年患者。在七氟醚组中，瑞芬太尼的效应部位浓度固定为 1.0 纳克/毫升，同时调整吸入七氟醚的浓度以保持适当的麻醉深度。在瑞芬太尼组中，呼气末七氟烷浓度固定为 1.0 体积%，同时调整瑞芬太尼浓度。在术后 2、6、24 和 48 小时对疼痛评分和术后累积镇痛药消耗量进行评估。结果显示七氟醚组和瑞芬太尼组的七氟醚平均潮气末浓度和瑞芬太尼效应部位浓度分别为 2.0 ± 0.4 volume% 和 3.9 ± 1.4 ng/ml。术后48小时，七氟醚组和瑞芬太尼组的累计术后镇痛剂消耗量分别为55±26毫升和57±33毫升。瑞芬太尼组术后2小时和6小时的累积镇痛剂消耗量与术中瑞芬太尼需求量呈正相关（2小时：r = 0.36，P < 0.01；6小时：r = 0.38，P < 0.01）。然而，七氟醚组没有明显的相关性（r = 0.04，P = 0.69）。结论术中短效阿片类药物瑞芬太尼的需求量与术后6小时内的镇痛剂消耗量相关。然而，术中所需的七氟醚对术后镇痛药的消耗量没有影响。

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引用次数: 0

Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial 在接受腹腔镜胆囊切除术的患者中联合使用氯胺酮和右美托咪定进行无阿片麻醉：随机对照试验

Anesthesia and pain medicine

Pub Date : 2024-04-19 DOI: 10.17085/apm.23097

Vishnuraj K R, Kunal Singh, N. Sahay, C. Sinha, Amarjeet Kumar, Neeraj Kumar

Background: Opioids administered as bolus doses or continuous infusions are widely used by anesthesiologists worldwide for major and day care surgeries. Opioid-free anesthesia is a multimodal anesthesia and analgesia technique that does not use opioid drugs, thereby benefitting patients from opioid-related adverse effects. In this study, we compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia.Methods: This study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with forty-four participants in each group. The opioid-free anesthesia group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas the opioid-based group was administered fentanyl with conventional general anesthesia. The primary outcome was to compare the total amount of fentanyl consumed by both groups during the 6 h postoperative period following extubation. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes.Results: Both the groups had similar demographic characteristics. The opioid-free group required less postoperative analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at the sixth postoperative hour (opioid-free group 152 ± 28.2 vs. opioid group 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV.Conclusions: The opioid-free anesthesia technique in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in the first two hours of the postoperative period and was associated with decreased PONV.

背景：阿片类药物以栓剂或持续输注的方式被世界各地的麻醉医生广泛用于大型手术和日间护理手术。无阿片麻醉是一种不使用阿片类药物的多模式麻醉和镇痛技术，从而使患者免受阿片类药物相关不良反应的影响。在这项研究中，我们比较了计划在无阿片麻醉和阿片麻醉下进行择期腹腔镜胆囊切除术的患者的术后镇痛需求：本研究纳入了88名年龄在18-60岁之间、美国麻醉医师协会身体状况为1级和2级、接受择期腹腔镜胆囊切除术的患者。参与者被随机分为两组，每组 44 人。无阿片类药物麻醉组采用氯胺酮和右美托咪定静脉注射，而阿片类药物麻醉组采用芬太尼和常规全身麻醉。主要结果是比较两组在术后拔管后 6 小时内的芬太尼总用量。术后恶心和呕吐（PONV）发作情况和生命体征在整个术后期间均有记录，以分析次要结果：结果：两组患者的人口统计学特征相似。无阿片类药物组在术后 2 小时内所需的镇痛剂量较少（61.4 ± 17.4 对 79.0 ± 19.4，P < 0.001），这在统计学上有显著意义。不过，术后第六小时两组的芬太尼用量相当（无阿片组 152 ± 28.2 vs. 阿片组 164 ± 33.4，P = 0.061）。与无阿片组4.5%的参与者相比，阿片组34%的参与者出现了中度PONV：结论：在接受腹腔镜胆囊切除术的患者中，无阿片类药物麻醉技术减少了术后头两小时的镇痛需求，并降低了PONV。

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引用次数: 0

How does circadian rhythm affect postoperative pain after pediatric acute appendicitis surgery? 昼夜节律如何影响小儿急性阑尾炎术后疼痛？

Anesthesia and pain medicine

Pub Date : 2024-04-11 DOI: 10.17085/apm.23038

Faruk Ci Cekci, Mehmet Sargın, Fatma Özcan Siki

Background: Pain intensity has been reported to fluctuate throughout the day in various clinical situations. This study aimed to evaluate the relationship between postoperative pain and circadian rhythm after pediatric acute appendicitis surgery.Methods: Two hundred patients, aged 6–18 years, undergoing acute appendicitis surgery were included in this prospective observational study. The patients were divided into four groups according to the time they underwent surgery: the night group, 01:01–07:00; morning group, 07:01–13:00; afternoon group, 13:01–19:00; and evening group, 19:01–01:00. Intraoperative and postoperative vital signs, postoperative 24-h Wong–Baker Faces Pain Rating Scale (FACEs) scores, and the amount of analgesic required were recorded.Results: A total of 186 patients were analyzed in the study. There was no statistically significant difference in the demographic characteristics of the patient groups. Additionally, no differences were observed in intraoperative and postoperative vital signs among the four groups. However, patients in the night group had significantly higher FACEs values than those in the other groups at each time point (1st, 3rd, 6th, and 12th h) up to 12 h (P = 0.007, P = 0.023, P = 0.048, and P = 0.003, respectively). The amount of analgesic required in the night group was statistically higher than in the other groups until 12 h (P = 0.002, P < 0.001, P = 0.002, and P = 0.004, respectively).Conclusion: A relationship was found between acute appendicitis operations performed at night (01:01 to 07:00) under general anesthesia and circadian rhythm in children. We believe that considering circadian time in the relief of postoperative pain would be beneficial.

背景：据报道，在不同的临床情况下，疼痛强度在一天中会有所波动。本研究旨在评估小儿急性阑尾炎术后疼痛与昼夜节律之间的关系：这项前瞻性观察研究纳入了 200 名接受急性阑尾炎手术的 6-18 岁患者。根据手术时间将患者分为四组：夜间组，01:01-07:00；上午组，07:01-13:00；下午组，13:01-19:00；夜间组，19:01-01:00。记录术中和术后生命体征、术后 24 小时黄-贝克面孔疼痛评分量表（FACEs）评分和所需镇痛剂量：研究共分析了 186 名患者。两组患者的人口统计学特征无明显差异。此外，四组患者的术中和术后生命体征也无差异。不过，在 12 小时内的每个时间点（第 1、3、6 和 12 小时），夜间组患者的 FACEs 值明显高于其他组（分别为 P = 0.007、P = 0.023、P = 0.048 和 P = 0.003）。从统计学角度看，夜间组所需的镇痛剂量高于其他组，直至 12 小时（分别为 P = 0.002、P < 0.001、P = 0.002 和 P = 0.004）：结论：研究发现，在夜间（01:01 至 07:00）进行全身麻醉的急性阑尾炎手术与儿童的昼夜节律有关。我们认为，在缓解术后疼痛时考虑昼夜节律将是有益的。

{"title":"How does circadian rhythm affect postoperative pain after pediatric acute appendicitis surgery?","authors":"Faruk Ci Cekci, Mehmet Sargın, Fatma Özcan Siki","doi":"10.17085/apm.23038","DOIUrl":"https://doi.org/10.17085/apm.23038","url":null,"abstract":"Background: Pain intensity has been reported to fluctuate throughout the day in various clinical situations. This study aimed to evaluate the relationship between postoperative pain and circadian rhythm after pediatric acute appendicitis surgery.Methods: Two hundred patients, aged 6–18 years, undergoing acute appendicitis surgery were included in this prospective observational study. The patients were divided into four groups according to the time they underwent surgery: the night group, 01:01–07:00; morning group, 07:01–13:00; afternoon group, 13:01–19:00; and evening group, 19:01–01:00. Intraoperative and postoperative vital signs, postoperative 24-h Wong–Baker Faces Pain Rating Scale (FACEs) scores, and the amount of analgesic required were recorded.Results: A total of 186 patients were analyzed in the study. There was no statistically significant difference in the demographic characteristics of the patient groups. Additionally, no differences were observed in intraoperative and postoperative vital signs among the four groups. However, patients in the night group had significantly higher FACEs values than those in the other groups at each time point (1st, 3rd, 6th, and 12th h) up to 12 h (P = 0.007, P = 0.023, P = 0.048, and P = 0.003, respectively). The amount of analgesic required in the night group was statistically higher than in the other groups until 12 h (P = 0.002, P < 0.001, P = 0.002, and P = 0.004, respectively).Conclusion: A relationship was found between acute appendicitis operations performed at night (01:01 to 07:00) under general anesthesia and circadian rhythm in children. We believe that considering circadian time in the relief of postoperative pain would be beneficial.","PeriodicalId":7801,"journal":{"name":"Anesthesia and pain medicine","volume":"19 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715768","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

Early diagnosis of negative-pressure pulmonary edema presenting as diffuse alveolar hemorrhage using lung ultrasonography -A case report- 利用肺部超声波检查对表现为弥漫性肺泡出血的负压性肺水肿进行早期诊断--一份病例报告

Anesthesia and pain medicine

Pub Date : 2024-04-05 DOI: 10.17085/apm.23101

Hee Won Son, Yunho Kang, Youngick Ahn, Jimi Oh

Background: Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening condition that can occur due to a variety of disorders. Hence, rapid diagnosis and prompt initiation of appropriate treatment are imperative.Case: A 55-year-old woman with a deep neck infection underwent emergent tonsillectomy. General anesthesia and surgery proceeded uneventfully. Upon transfer to the post-anesthesia care unit, ongoing respiratory distress and occasional expectoration of blood-tinged sputum were noted. Lung ultrasonography (LUS) revealed multiple B-profiles and irregular pleural lines with subpleural consolidations. Emergent bronchoscopy with bronchoalveolar lavage was diagnostic of DAH. She underwent a comprehensive evaluation for rheumatologic and infectious etiologies of DAH, all of which yielded negative results. The patient was managed with steroids and conservative treatment. Conclusions: The integration of LUS with clinical information allows for more rapid differentiation of acute respiratory failure causes. Therefore, anesthesiologists’ awareness and utilization of LUS findings of DAH can significantly contribute to appropriate management.

背景：弥漫性肺泡出血（DAH）是一种可能危及生命的疾病，可由多种疾病引起。因此，必须快速诊断并及时采取适当的治疗措施：一名 55 岁女性因颈部深度感染接受了急诊扁桃体切除术。全身麻醉和手术顺利进行。转入麻醉后护理病房后，患者出现持续呼吸困难，并不时排出带血的痰液。肺部超声波检查（LUS）发现多处B型和不规则胸膜线，胸膜下有合并症。紧急支气管镜检查和支气管肺泡灌洗确诊为 DAH。她接受了风湿病和感染性 DAH 病因的全面评估，结果均为阴性。患者接受了类固醇和保守治疗。结论将 LUS 与临床信息相结合可更快地区分急性呼吸衰竭的病因。因此，麻醉医师对 DAH 的 LUS 发现的认识和利用可大大促进适当的管理。

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引用次数: 0

Inter-transverse process blocks-clarifications 横向工序块--说明

Anesthesia and pain medicine

Pub Date : 2024-04-05 DOI: 10.17085/apm.24017

R. Sethuraman

引用次数: 0

Association between preoperative lumbar skeletal muscle index and postoperative nausea and vomiting in patients undergoing pylorus-preserving pancreatoduodenectomy: a retrospective study 保留幽门的胰十二指肠切除术患者术前腰部骨骼肌指数与术后恶心呕吐的关系：一项回顾性研究

Anesthesia and pain medicine

Pub Date : 2024-04-05 DOI: 10.17085/apm.23142

Hyun Il Kim, Ki Jun Kim, Sangil Kim, Hae Dong Kim, S. H. Kim

Background: Sarcopenia is associated with postoperative complications; however, its impact on the quality of postoperative recovery, such as postoperative nausea and vomiting (PONV) and pain, remains unclear. We investigated the association of preoperative lumbar skeletal muscle mass index (LSMI) with PONV, postoperative pain, and complications.Methods: Medical records of 756 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) were retrospectively reviewed. The skeletal muscle areas were measured on abdominal computed tomography (CT) images. LSMI was calculated by dividing the skeletal muscle area by the square of the patient’s height. We analyzed the correlations between preoperative LSMI calibrated with confounding variables and PONV scores, PONV occurrence, pain scores, rescue analgesic administration, postoperative complications, and length of hospital stay.Results: The median (1Q, 3Q) LSMI was 47.72 (40.74, 53.41) cm2/m2. The incidence rates of PONV according to time period were as follows: post-anesthesia care unit, 42/756 (5.6%); 0–6 h, 54/756 (7.1%); 6–24 h, 120/756 (15.9%); 24–48 h, 46/756 (6.1%); and overall, 234/756 (31.0%). The incidence of PONV was inversely correlated with LSMI 24–48 h post-surgery and overall. LSMI and PONV scores were negatively associated 6–24 h and 24–48 h post-surgery. There was no association between LSMI and postoperative pain scores, rescue analgesic administration, complications, or length of hospital stay. Conclusions: Preoperative LSMI was associated with PONV in patients undergoing PPPD. Therefore, LSMI measured on preoperative abdominal CT can be a predictive indicator of PONV. Appropriate PONV prophylaxis is necessary in patients with low LSMI before PPPD.

背景：肌肉疏松症与术后并发症有关，但其对术后恢复质量的影响，如术后恶心呕吐（PONV）和疼痛，仍不清楚。我们研究了术前腰部骨骼肌质量指数（LSMI）与PONV、术后疼痛和并发症的关系：方法：回顾性分析了756名接受保留幽门胰十二指肠切除术（PPPD）患者的病历。通过腹部计算机断层扫描（CT）图像测量骨骼肌面积。LSMI的计算方法是骨骼肌面积除以患者身高的平方。我们分析了经混杂变量校准的术前 LSMI 与 PONV 评分、PONV 发生率、疼痛评分、镇痛药用量、术后并发症和住院时间之间的相关性：LSMI中位数（1Q，3Q）为47.72（40.74，53.41）平方厘米/平方米。不同时间段的 PONV 发生率如下：麻醉后护理单元，42/756（5.6%）；0-6 h，54/756（7.1%）；6-24 h，120/756（15.9%）；24-48 h，46/756（6.1%）；总体，234/756（31.0%）。PONV 发生率与术后 24-48 小时 LSMI 和总体情况成反比。术后 6-24 小时和 24-48 小时 LSMI 和 PONV 评分呈负相关。LSMI与术后疼痛评分、抢救镇痛剂用量、并发症或住院时间之间没有关联。结论：术前 LSMI 与 PPPD 患者的 PONV 相关。因此，术前腹部 CT 测量的 LSMI 可以作为 PONV 的预测指标。对于术前 LSMI 较低的患者，有必要在 PPPD 术前采取适当的 PONV 预防措施。

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引用次数: 0

Electroconvulsive therapy and muscle relaxants. 电休克疗法和肌肉松弛剂。

Anesthesia and pain medicine

Pub Date : 2023-10-01 Epub Date: 2023-07-14 DOI: 10.17085/apm.23018

Hong Seuk Yang, Kyoung-Woon Joung

the editor, “the Electroconvulsive therapy in a catatonia patient: succinylcholine or no succinylcholine?” Neuromuscular blocking agents are important drugs for electroconvulsive therapy (ECT) to prevent possible musculoskeletal complications of ECT, such as hyperkalemia, myalgia, dislocation, and fracture. Succinylcholine is more effective because it typically has a fast onset and short duration of action. However succinylcholine may induce myalgia, hyperkalemia, and malignant hyperthermia [1]. Therefore, the anesthetic provider should preoperatively evaluate the patients’ physical status and laboratory tests, and select anesthetics with neuromuscular blocking agents [2,3]. Nicotinic acetylcholine receptors (nAChRs) on the neuromuscular junction are upor down-regulated in neuromuscular diseases, burns, and upper or lower motor nerve injury. Upregulation of nAChRs increases sensitivity to depolarizing neuromuscular blocking agents (e.g., succinylcholine), while downregulation increases resistance to depolarizing neuromuscular blocking agents [4]. Supersensitivity to nAChR agonists (e.g., acetylcholine or succinylcholine) was observed throughout the muscle membrane. The increase in nAChRs after denervation is more profound and occurs more quickly than with simple immobilization [4]. In this case, succinylcholine was avoided because of the risk of life-threatening hyperkalemia resulting from the upregulation of nAChRs secondary to long-term immobilization, as the patient had been immobilized due to catatonia for the past 6 months. Glycopyrrolate (0.2 mg), propofol (80 mg), and atracurium (15 mg) were administered. I-gel insertion and propofol infusion were started for maintenance until recovery from the neuromuscular blockade in the first and second ECT sessions, respectively. In the third ECT session, succinylcholine was used instead of atracurium to monitor, diagnose, and manage the hyperkalemia. The intraoperative course remained uneventful with no electrocardiographic changes suggestive of hyperkalemia [1]. In this Letter to the Editor Anesth Pain Med [Epub ahead of print] https://doi.org/10.17085/apm.23018 pISSN 1975-5171 • eISSN 2383-7977

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引用次数: 0

Risk factors for severe postpartum hemorrhage requiring blood transfusion after cesarean delivery for twin pregnancy: a nationwide cohort study. 双胎妊娠剖宫产后需要输血的严重产后出血的危险因素：一项全国性队列研究。

Anesthesia and pain medicine

Pub Date : 2023-10-01 Epub Date: 2023-08-08 DOI: 10.17085/apm.23019

Gi Hyeon Seo, Jong Yeop Kim, Da Yeong Lee, Changjin Lee, Jiyoung Lee

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Twin pregnancy and cesarean delivery are well-known risk factors for PPH. However, few studies have investigated PPH risk factors in mothers who have undergone cesarean delivery for twin pregnancies. Therefore, this study investigated the risk factors associated with severe PPH after cesarean delivery for twin pregnancies.

Methods: We searched and reviewed the Korean Health Insurance Review and Assessment Service's claims data from July 2008 to June 2021 using the code corresponding to cesarean delivery for twin pregnancy. Severe PPH was defined as hemorrhage requiring red blood cell (RBC) transfusion during the peripartum period. The risk factors associated with severe PPH were identified among the procedure and diagnosis code variables and analyzed using univariate and multivariate logistic regressions.

Results: We analyzed 31,074 cesarean deliveries for twin pregnancies, and 4,892 patients who underwent cesarean deliveries for twin pregnancies and received RBC transfusions for severe PPH were included. According to the multivariate analysis, placental disorders (odds ratio, 4.50; 95% confidence interval, 4.09- 4.95; P < 0.001), general anesthesia (2.33, 2.18-2.49; P < 0.001), preeclampsia (2.20, 1.99-2.43; P < 0.001), hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome (2.12, 1.22-3.68; P = 0.008), induction failure (1.37, 1.07-1.76; P = 0.014), and hypertension (1.31, 1.18-1.44; P < 0.001) predicted severe PPH.

Conclusions: Placental disorders, hypertensive disorders such as preeclampsia and HELLP syndrome, and induction failure increased the risk of severe PPH after cesarean delivery for twin pregnancy.

背景：产后出血（PPH）是孕产妇发病率和死亡率的主要原因。双胎妊娠和剖宫产是众所周知的PPH危险因素。然而，很少有研究调查双胎剖宫产母亲的产后出血风险因素。因此，本研究调查了双胎妊娠剖宫产后发生严重产后出血的危险因素。方法：我们使用双胎剖宫产对应的代码搜索并审查了2008年7月至2021年6月韩国健康保险审查和评估服务的索赔数据。严重产后出血是指在围产期需要输注红细胞（RBC）的出血。在程序和诊断代码变量中确定与严重PPH相关的风险因素，并使用单变量和多变量逻辑回归进行分析。结果：我们分析了31074例双胎妊娠的剖宫产，包括4892例因双胎妊娠接受剖宫产并因严重产后出血接受红细胞输注的患者。根据多变量分析，胎盘疾病（比值比，4.50；95%置信区间，4.09-4.95；P<0.001）、全身麻醉（2.33,2.18-2.49；P<0.001，和高血压（1.31，1.18-1.44；P＜0.001）预测了严重的产后出血。结论：胎盘疾病、先兆子痫和HELLP综合征等高血压疾病以及引产失败增加了双胎剖宫产后发生严重产后出血的风险。

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引用次数: 0