Anesthesiology Research and Practice最新文献

Purpose: A quality improvement initiative was developed, implemented, and evaluated to improve pediatric postsurgical pain management and reduce hospital length of stay. Methods: An interdisciplinary working group developed the novel integrated pediatric perioperative pain (IP3) pathway adhering to the 3P approach to pain management. Preoperative psychological intervention, patient and caregiver education, standardized medication ordersets, and early identification of increased pain were the focus. Length of stay, opioid consumption, and achievement of physiotherapy goals were compared pre- and postpathway for children undergoing posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Results: The prepathway (n = 34) and postpathway (n = 29) groups were well matched for age, gender, weight, number of levels fused, and socioeconomic status. Postpathway, length of stay in the intensive care unit (pre 1.06 days and post 0.76 days, p ≤ 0.01) and length of hospital stay (pre 6.24 days and post 5.11 days, p ≤ 0.01) significantly decreased. Standardized physiotherapy goals were achieved earlier postpathway implementation. Day of surgery postoperative opioid consumption was reduced in the postpathway group. Discussion: Implementation of the IP3 pathway resulted in significant improvement in pain management for children undergoing major orthopedic surgery. Shortened hospital stay, earlier achievement of physiotherapy goals, and reduced initial opioid consumption were realized. Future efforts will focus on applying this pathway to other pediatric surgeries, optimizing surgical scheduling, and enhancing staff education.

Background: Magnesium sulfate reduces opioid use and its associated side effects. However, no consensus exists on whether the optimal dosing should be based on actual body weight or adjusted ideal body weight. The primary objective of this study was to compare postoperative analgesia after magnesium sulfate infusion, using doses calculated based on actual body weight versus adjusted ideal body weight. Methods: This prospective, randomized, double-blind, controlled clinical trial included 75 participants who underwent target-controlled intravenous general anesthesia. The participants were divided into three groups: a control group (CG), a group receiving magnesium sulfate calculated by actual body weight (AWG), and a group receiving magnesium sulfate calculated based on the adjusted ideal body weight (IWG). Results: The AWG had significantly lower pain scores than the CG (p < 0.001) and IWG (p=0.017). Opioid use was similar between the AWG and IWG, but significantly higher in the CG (AWG = IWG, p=0.08; CG > AWG, p < 0.001; CG = IWG, p 0.03). The increase in magnesium concentration did not reach clinically relevant levels. Neuromuscular blockade latency decreased in the groups receiving magnesium sulfate (p < 0.001 in both comparisons) compared to the CG. Conclusion: Calculating the dose of magnesium sulfate based on actual body weight enhances postoperative analgesia. The increase in magnesium concentration was not clinically significant and did not interfere with the action of cisatracurium in the groups receiving magnesium sulfate. Trial Registration: ClinicalTrials.gov identifier: NCT04645719.

Background: The insertion of a laryngeal mask airway (LMA) using a laryngoscope-guided technique has produced inconsistent outcomes. The use of laryngoscope guidance in facilitating LMA insertion needs further investigation. This meta-analysis compared its effectiveness and safety against standard blind insertion. Method: We systematically searched PubMed, Cochrane Library, Web of Science, and Ovid Medline for randomized controlled trials comparing laryngoscope-guided (Group L) and blind LMA insertion (Group B). The primary outcome measured was fiberoptic staging. The secondary outcomes included oropharyngeal leak pressure (OLP), insertion time, success rate on the first attempt, and the incidence of postoperative sore throat and blood staining. Results: Nine RCTs (1016 patients) were analyzed. The fiberoptic staging in Group L was found to be significantly higher than that in Group B (RR = 1.54; 95% CI: 1.14-2.08; p=0.005). In addition, the OLP of Group L is significantly higher than that of Group B (MD = 2.10 cmH₂O; 95% CI: 0.38 cmH₂O-3.83 cmH₂O; p=0.02). The success rate for the first attempt was also higher in Group L (RR = 1.14; 95% CI: 1.06-1.22; p=0.0005). The insertion time (MD = 3.92 s; 95% CI: -6.69 s-14.52 s; p=0.47), the incidence of sore throat (RR = 0.90; 95% CI: 0.50-1.65; p=0.74), and the incidence of blood staining (RR = 1.19; 95% CI: 0.29-4.79; p=0.81) did not demonstrate statistically significant differences. Conclusion: The use of LMA with laryngoscope guidance may improve fiberoptic staging and OLP and increase the success rate of first-attempt insertion, without significantly raising the incidence of sore throat or blood staining in anesthetized patients.

Background: Following sedation or general anesthesia, emergent agitation (EA) presents as a sequence of abrupt, complicated psychomotor problems marked by perceptual abnormalities, delusions, and disorientation. Studies have proved that melatonin significantly decreases the incidence of postoperative agitation in children after anesthesia. The primary objective of this study was to compare the effectiveness of two doses of oral melatonin as a premedication for orientation score, induction compliance, and emergency agitation of children undergoing surgeries. Methods: In this double-blinded randomized controlled trial, 126 children, aged 4-14, of either sex, with an ASA I or II, scheduled for elective surgery were randomly assigned to get either melatonin 0.4 mg/kg (Group M4) or melatonin 0.2 mg/kg (Group M2), with 63 kids in each group. All children have had the same anesthetic strategy. As a primary outcome, orientation score, induction compliance to intravenous induction anesthesia, and decreased emergency agitation were assessed. Results: Both groups were comparable in terms of demographic characteristics and baseline data. Orientation scores were similar between the groups. Preoperatively, all patients were oriented in both time and place. The two groups had no statistically significant difference according to induction compliance distribution (p=0.065). There was a statistically significant difference in agitation behavior after 5, 10, and 15 min postoperatively in M 4, 2, and total participants (p < 0.001). Conclusion: In pediatric surgical patients, the melatonin dosage does not affect children's compliance with induction but impacts their postoperative behavior by reducing the likelihood of agitation. Administering oral melatonin before surgery could potentially aid in managing postoperative delirium in children.

Background: Postoperative nausea and vomiting (PONV) are major adverse consequences following laparoscopic cholecystectomy. Several drugs have been used to combat its occurrence. Objective: This study aimed to show the efficacy of the intraperitoneal route and compare different antiemetic effects of dexamethasone, dexmedetomidine, and their combination on PONV after laparoscopic cholecystectomy under general anesthesia in a tertiary care hospital. Design: Prospective randomized triple-blind study. Setting: The trial was conducted at Benha University Hospitals. The trial was done from August 2023 to April 2024. Patients: Two hundred and forty patients aged 20-50 years, Apfel Score 1, the American Society of Anesthesiologists (ASA) physical status Classification I or II who underwent laparoscopic cholecystectomy. Exclusion criteria were a history of psychotic illnesses, Parkinson's disease, motion disorder, and a history of chemotherapy. Interventions: Patients were randomized equally into four groups. Group I (control group) received 20 mL normal saline, Group II (dexamethasone group) received 8 mg dexamethasone, Group III (dexmedetomidine group) received dexmedetomidine 1mic/kg, and Group IV (combination group) received the combination of both dexamethasone (8 mg) + dexmedetomidine (1mic/kg). The medications were diluted in 20 mL normal saline. Main Outcome Measures: The incidence of PONV encountered by patients in the first 24 h following surgery was recorded. Results: Nausea was reported in 26 (43.33%), 10 (16.67%), 11 (18.33%), and 6 (10%) in Groups I, II, III, and IV, respectively. Vomiting was observed in 25 (41.67%), 11 (18.33%), 10 (16.67%), and five (8.33%) in Groups I, II, III, and IV, respectively. Antiemetic medication was required for 24 (40%), 11 (18.33%), 12 (20%), and eight (13.33%) in Groups I, II, III, and IV, respectively. Nausea, vomiting, and antiemetics requirements differed significantly among the four groups (p value < 0.05). Conclusions: Intraperitoneal administration of dexamethasone and dexmedetomidine either alone or in combination decreased the incidence of PONV among patients scheduled for laparoscopic cholecystectomy. Trial Registration: ClinicalTrials.gov identifier: NCT05988671.

Background: Ambulatory surgery is increased in numbers, healthcare costs are reduced, and patient safety is high when patient characteristics and type of surgery are properly evaluated. To maintain efficiency and patient safety, anesthesia and surgery must be optimized. The bispectral index (BIS) is a widely used and simplified measure of the depth of anesthesia and may provide a more stable anesthesia and avoid insufficient levels of anesthesia. We investigated whether BIS-guided anesthesia could increase the frequency of excellent overview of the surgical field. Methods: This is a single-center double-blinded randomized clinical trial. We enrolled patients undergoing gynecologic laparoscopies on a benign indication from April 2019 to March 2021. Using closed envelopes, patients were randomized to receive either a BIS-assisted anesthesia, or to receive anesthesia without BIS monitoring (i.e., control group). Surgeons graded their surgical field overview using a four-grade numerical scale at three predefined time points. The primary outcome was the proportion of patients graded with an excellent surgical overview. Results: We included 160 women: 80 patients were randomized to the BIS group and 80 to the control group. There was no statistically significant difference between groups in excellent surgical overview at any time point. Among secondary outcomes, a lower remifentanil consumption in the control group was found in comparison with the BIS group. Conclusions: This trial found no clinically relevant differences regarding surgical overview quality during gynecological laparoscopic surgery when using BIS to titrate anesthesia. To our knowledge, this is the first study investigating this aspect. Trial Registration: ClinicalTrials.gov identifier: NCT03911544.

Objectives: This study aimed to assess the predictive value of perfusion index (PI) in determining the effectiveness of supraclavicular block (SCB) in children under sevoflurane or propofol general anesthesia. Methods: In this randomized controlled study, 104 children who underwent elective upper extremity surgery under sevoflurane or propofol anesthesia were scheduled to be enrolled. The primary outcome was the effects of PI in predicting the effectiveness of SCB under general anesthesia. The PI value was obtained through pulse oximetries. Secondary outcomes include hemodynamic data, supplementary opioid doses, agitation score, pain score, and postoperative complications. Results: A total of 103 pediatric patients were analyzed. PI increased rapidly after anesthesia induction, and there was no significant difference in PI in the blocked side between the propofol group (PRO group) and sevoflurane group (SEV group). At 10 min after the block, PI in the blocked side was higher than that in the unblocked side in both groups (p < 0.05). However, PI showed low sensitivity and specificity in predicting the effect of SCB at 10 min in both groups. At PACU, PI exhibited a high sensitivity (0.837 vs. 0.796) and specificity (0.721 vs. 0.898) for SCB at cutoff values of 5.91 and 6.67 in both PRO and SEV groups. The area under the receiver operating characteristic curve (AUROC) values were 0.834 (95% CI 0.750-0.918) and 0.895 (95% CI 0.832-0.959). Conclusion: PI demonstrates limited sensitivity and specificity in predicting the effect of SCB at 10 min after block under general anesthesia. However, PI may serve as a more appropriate indicator to guide the necessity for supplemental analgesia in PACU. Trial Registration: ClinicalTrials.gov identifier: NCT04216823.

Introduction: In the present study, we aimed to investigate whether the measurements of the fibrinogen-dependent clot firmness in FIBTEM-one of the rotational thromboelastometry (ROTEM) assays-during cardiopulmonary bypass (CPB) accurately predict the values after protamine administration. Materials and Methods: In this single-center retrospective observational study, we analyzed a database of patients undergoing on-pump surgeries between May 2022 and February 2024. We included patients in whom an intraoperative ROTEM examination during CPB and a follow-up examination directly after protamine infusion were performed. We excluded patients who received either fibrinogen concentrate or fresh frozen plasma between the two examinations. FIBTEM A5 values in both examinations were compared. The Wilcoxon signed rank test was used to compare non-normally distributed data. Linear regression analysis was used to investigate the relationship between the on-pump and postprotamine FIBTEM A5 values. Results: Seventy patients were included in the statistical analysis. There was a slight but statistically significant difference between FIBTEM A5 during CPB (median 16.0 mm, IQR 10.0-22.0) and after protamine administration (median 15.5 mm, IQR 8.7-22.3, p = 0.021). However, in linear regression analysis, FIBTEM A5 values during the last 30 min of the extracorporeal circulation were a significant predictor of FIBTEM A5 after protamine administration (R = 0.902, R ² = 0.813, adjusted R ² = 0.810, F(df regression, df residual) = 295.980, p < 0.001). The equation: y = 0.911x + 1 describes the line of best fit. Conclusions: Within the normal range limits, there is a very strong correlation between on-pump FIBTEM A5 values and FIBTEM A5 values after protamine administration.

Background: Back pain after delivery both under cesarean section and spontaneous vaginal delivery is the most common pregnancy-related musculoskeletal problem. There are multiple studies that emphasize the effect of epidural anesthesia and spinal anesthesia on the incidence and severity of postdelivery back pain. There are others stating no association between the two. Objective: The aim of this study is to summarize the relationship between back pain after delivery and neuraxial anesthesia. Methods: Studies identified from database: Cochrane Library, The Virtual Health Library, National Library of Medicine PubMed, Google Scholar, and citation searching with both experimental and observational study design were included. Exposed and nonexposed incidence of back pain was extracted to analyze the pooled odds ratio assessing the association of postpartum back pain and neuraxial anesthesia. Heterogeneity was checked across studies using Cochrane Q test statistic and I ². Small study effect was assessed using a funnel plot graphically and nonparametric rank correlation (Begg) test. Results: Four RCT and 11 observational studies were identified for analysis. The studies included mothers delivering under cesarean section and vaginal delivery with epidural anesthesia, spinal anesthesia, and combined spinal epidural anesthesia. Based on the 15 studies included in this meta-analysis, the pooled odds ratio according to random effect restricted maximum-likelihood model was 1.2 (95% CI (0.77-1.86)) with p value = 0.43. There was a significant heterogeneity with I ² = 97.76%, H ² = 44.58, and Cochrane Q statistics p value = 0.001. Conclusion: Our result suggests neuraxial anesthesia may not be the cause or the risk factor for the overwhelmingly high incidence of back pain women experience after delivery.