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Efficacy of High-Volume Low-Concentration Intraperitoneal Bupivacaine Irrigation for Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: Bupivacaine Irrigation for Analgesia. 腹腔镜胆囊切除术患者术后高容量低浓度布比卡因灌洗镇痛的疗效:布比卡因灌洗镇痛。
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4545400
Swati Panwar, Mona Arya, J S Dali, Kapil Chaudhary, Sushanto Neogi

Background: Intraperitoneal irrigation with a low-volume, high-concentration local anaesthetic in laparoscopic cholecystectomy (LC) provides less pain relief. We investigated the impact of high-volume, low-concentration bupivacaine on postoperative pain and opioid requirement. Methods: Patients undergoing LC were randomised into Group B (20 mL of 0.5% bupivacaine in 480 mL normal saline) or Group S (500 mL of normal saline). Fifteen patients were included in both the groups but one patient was excluded from Group S because of bile duct injury. The primary outcome was Duration of Analgesia (DOA). The secondary outcomes were the Numeric Pain Rating Scale (NRS) at extubation, at 15 min, 30 min and 1, 2, 4, 8, 12 and 24 h. Cumulative rescue analgesics, incidence of postoperative nausea, vomiting and shoulder pain. Results: Mean (median/range) duration of analgesia was 6.45 ± 5.57 h (6/0.15-24) in Group B vs 3.18 ± 4.21 h (0.3/0.15-12) in Group S. Cumulative requirement of rescue analgesic was higher in saline group being 56.25 ± 33.92 mg for diclofenac and 83.57 ± 66.75 mg for tramadol vis-à-vis 40.9 ± 39.17 mg and 30.00 ± 52.78 mg, respectively, in bupivacaine group. Conclusion: Irrigation of the peritoneal cavity with high-volume low-concentration bupivacaine in LC increases the duration of analgesia and decreases the analgesic requirement in the postoperative period. Trial Registration: ClinicalTrials.gov identifier: CTRI/2019/02/017802 dated 25/02/2019.

背景:在腹腔镜胆囊切除术(LC)中使用低容量、高浓度的局麻药进行腹腔内灌注,镇痛效果较差。我们研究了高容量、低浓度布比卡因对术后疼痛和阿片类药物需求的影响。方法:接受 LC 的患者被随机分为 B 组(20 mL 0.5% 布比卡因与 480 mL 生理盐水混合)或 S 组(500 mL 生理盐水)。两组均有 15 名患者,但 S 组有一名患者因胆管损伤而被排除在外。主要结果是镇痛持续时间(DOA)。次要结果是拔管时、15 分钟、30 分钟、1、2、4、8、12 和 24 小时的数字疼痛评分量表(NRS)。结果:B 组的平均镇痛持续时间(中位数/范围)为 6.45 ± 5.57 小时(6/0.15-24),而 S 组为 3.18 ± 4.21 小时(0.3/0.15-12);生理盐水组的累计镇痛药需求量更高,双氯芬酸为 56.25 ± 33.92 毫克,曲马多为 83.57 ± 66.75 毫克,而布比卡因组分别为 40.9 ± 39.17 毫克和 30.00 ± 52.78 毫克。结论在LC中使用高容量低浓度布比卡因冲洗腹腔可延长镇痛时间,减少术后镇痛剂的需求量。试验注册:ClinicalTrials.gov 标识符:CTRI/2019/02/017802,日期为2019年2月25日。
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引用次数: 0
Association Between MRI Findings of Facet Arthropathy and Synovitis With Health-Related Outcome and Pain Scores Following Therapeutic Lumbar Facet Injections. 腰椎面骨注射治疗后,面骨关节病和滑膜炎的核磁共振成像结果与健康相关结果和疼痛评分之间的关系
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-10-18 eCollection Date: 2024-01-01 DOI: 10.1155/2024/7889539
Michael S Green, Michele Van Hal, Matthew Onimus, Christopher R Hoffman, Dhruv K C Goyal, Valeria Potigailo, Khuram S Kazmi

Low back pain is a common complaint among adults. The facet joint is a major source of lumbar pain, and therapeutic facet injections have gained popularity as a minimally invasive treatment option. In addition, magnetic resonance imaging (MRI) utilization for diagnosing low back pain has increased significantly over the past few decades. Facet synovitis is an entity characterized by edema and inflammatory changes affecting the facet joints, adjacent bone marrow, and surrounding soft tissues. Although its underlying etiology remains poorly understood, recent reports suggest a high incidence in patients with arthropathy and arthritis. It is essential to explore potential correlations between specific MRI findings and outcomes after lumbar facet injections. This investigation is particularly relevant for facet synovitis, given its inflammatory nature and the common use of anti-inflammatory agents in facet injections. We investigated associations between MRI evidence of facet arthropathy and/or synovitis and the degree of improvement in health-related outcome and pain scores after therapeutic facet injections. The review was conducted on patients who received bilateral therapeutic facet injections, excluding those with prior lumbar spinal surgery or transitional segments. Facet arthropathy and synovitis were assessed on MRI by two neuroradiologists, and postprocedure outcomes such as pain and function were compared using univariate and multivariate analyses based on MRI findings. Our retrospective review indicates that patients receiving facet injections experience greater mean reduction in daily activity and workability burden scores from back pain when facet synovitis is a known portion of their pathology. The authors pose that further study could help identify patient populations that are the best candidates for therapeutic intervention. This may ultimately improve delivery of care, cost efficacy, and patient satisfaction.

腰痛是成年人的常见病。面关节是腰痛的主要来源,面关节注射治疗作为一种微创治疗方法已越来越受欢迎。此外,在过去几十年中,用于诊断腰痛的磁共振成像(MRI)也大幅增加。面关节滑膜炎是一种以影响面关节、邻近骨髓和周围软组织的水肿和炎症变化为特征的疾病。虽然其病因尚不清楚,但最近的报告显示,关节病和关节炎患者的发病率很高。探讨特定磁共振成像结果与腰椎面骨注射后疗效之间的潜在相关性至关重要。考虑到关节面滑膜炎的炎症性质以及关节面注射中抗炎药物的普遍使用,这项研究对关节面滑膜炎尤为重要。我们研究了磁共振成像显示的面关节病和/或滑膜炎与治疗性面注射后健康相关结果和疼痛评分的改善程度之间的关联。研究对象为接受双侧治疗性切面注射的患者,不包括曾接受过腰椎手术或过渡节段的患者。两名神经放射科医生通过核磁共振成像对面关节病和滑膜炎进行了评估,并根据核磁共振成像结果进行了单变量和多变量分析,对疼痛和功能等术后结果进行了比较。我们的回顾性研究表明,当已知面滑膜炎是患者病理的一部分时,接受面注射的患者因背痛而导致的日常活动和工作能力负担评分的平均降低幅度更大。作者认为,进一步的研究有助于确定哪些患者最适合接受治疗干预。这最终可能会改善护理服务、成本效益和患者满意度。
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引用次数: 0
Use of a Nasal Cannula as a Preoxygenation Adjunct: A Randomized Crossover Study. 使用鼻导管作为预吸氧辅助工具:一项随机交叉研究。
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1155/2024/7873142
Murphy Joel, Suvajit Podder, Savan Kumar Nagesh, Ramyatha Aithal, Aditya R Devalla, Shaji Mathew

Background: Preoxygenation prior to induction of general anesthesia is intended to increase the oxygen reserve in the lungs. This technique delays the onset of hypoxemia during the placement of the tracheal tube.

Objective: To observe the benefits of oxygen through nasal cannula when used as an adjunct during preoxygenation.

Methods: We enrolled 30 healthy volunteers and conducted a sequence of six preoxygenation tests. These included 3-minute tidal volume breathing and 8 vital capacity breaths, with and without oxygen flowing through the nasal cannula as an adjunct. Subjects were kept at a supine position with a face mask on their faces. Their baseline vitals were measured and end-tidal O2 (ETO2) was recorded at the end of each test. The comfort of each technique was also assessed.

Results: When comparing the efficacy of the two preoxygenation methods, we found that the addition of oxygen through the nasal cannula improved the efficacy of preoxygenation with both the 3-minute tidal volume breathing method and the 8 vital capacity method (p < 0.001). The three-minute tidal volume breathing technique had higher end-tidal oxygen when compared to the eight vital capacity breaths.

Conclusions: The administration of oxygen through a nasal cannula during preoxygenation improves the efficacy of preoxygenation in healthy volunteers. Tidal volume breathing for three minutes achieves a higher end-tidal oxygen concentration compared to eight vital capacity breaths over one minute.

背景:全身麻醉诱导前的预吸氧旨在增加肺部的氧气储备。这项技术可延迟气管插管过程中低氧血症的发生:观察在预吸氧过程中通过鼻导管辅助吸氧的益处:方法:我们招募了 30 名健康志愿者,并进行了 6 次预吸氧测试。这些测试包括 3 分钟潮气量呼吸和 8 次生命容量呼吸,分别使用和不使用鼻导管辅助供氧。受试者保持仰卧姿势,脸上戴着面罩。测量受试者的基线生命体征,并在每次测试结束时记录潮气末氧气(ETO2)。此外,还对每种技术的舒适度进行了评估:结果:在比较两种预吸氧方法的效果时,我们发现通过鼻插管添加氧气提高了 3 分钟潮气量呼吸法和 8 生命容量法的预吸氧效果(p < 0.001)。与八次生命容量呼吸法相比,三分钟潮气量呼吸法的潮气末氧量更高:结论:在预吸氧过程中通过鼻插管给氧可提高健康志愿者预吸氧的效果。与一分钟内八次生命容量呼吸相比,三分钟潮气量呼吸可获得更高的潮气末氧浓度。
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引用次数: 0
Weight-Based Standardized Sugammadex Dosing in Pediatrics: A Quality Improvement Initiative to Improve Compliance with Dosing Guidelines and Reduce Waste and Cost. 基于体重的儿科舒格迈司标准化剂量:一项旨在提高用药指南合规性并减少浪费和成本的质量改进计划》(A Quality Improvement Initiative to Improve Compliance with Dosing Guidelines and Reduce Waste and Cost.
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-08-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/6049114
Sydney E S Brown, Michael Meyer, Andrea Meyer, Ruth Cassidy, Xinyi Zhao, Deborah Wagner, Laura Wetzel, Douglas A Colquhoun

Methods: Sugammadex vials were fractionated into 25, 50, or 100 mg aliquots, which would be distributed to anesthesia staff by pharmacy staff in approximate 2 mg/kg of actual body weight doses (±10%). We analyzed changes in sugammadex waste and dosing practices 1/1/2019 to 3/15/2023 pre/postintervention (4/1/2021). We gauged dose appropriateness using last train of four (TOF) prior to sugammadex administration.

Results: 7,889 patients 2-17 years (4,771 with documented TOF), ASA 1-4 receiving general anesthesia with a steroidal NMB medication and sugammadex reversal. Pre- and postintervention mean doses were 2.5 mg/kg (SD: 1.2) and 2.4 mg/kg (SD: 0.96), respectively. A smaller proportion of cases received standard 2 or 4 mg/kg doses (pre: 77.6 vs. post: 66.7%). Mean waste per case declined from 4.2 mg/kg (SD: 4.1) to 0.22 mg/kg (SD: 0.38). Among cases with 0 or 1 measured twitches on TOF that should receive at least 4 mg/kg, fewer received at least 3.6 mg/kg (post: 56.7% vs. pre: 66.8%), and a greater proportion received less than 2.2 mg/kg (post: 27.4% vs. pre: 20.7%). Among cases that should have received at least 2 mg/kg by TOF, the proportion of patients receiving more than 3.6 mg/kg declined from 9.5% to 5.2%. Discussion. Fractionating sugammadex vials was associated with decreases in waste, but not dose, and significant underdosing was more likely to occur. While vial fractionation could enable increased access to sugammadex and other costly medications, it may introduce unintended consequences.

方法:将舒格迈司小瓶分装成 25、50 或 100 毫克等分,由药房工作人员按实际体重约 2 毫克/千克的剂量(±10%)分发给麻醉工作人员。我们分析了干预前/干预后(2021 年 1 月 4 日)2019 年 1 月 1 日至 2023 年 3 月 15 日期间舒格迈司浪费和剂量操作的变化。我们使用苏麦丁给药前的最后四列火车(TOF)来衡量剂量的适当性:7,889 名 2-17 岁的患者(4,771 人有 TOF 记录),ASA 1-4 级,接受全身麻醉,使用类固醇 NMB 药物和苏麦丁逆转。干预前和干预后的平均剂量分别为 2.5 毫克/千克(标清:1.2)和 2.4 毫克/千克(标清:0.96)。接受 2 毫克/千克或 4 毫克/千克标准剂量的病例比例较低(干预前:77.6%;干预后:66.7%)。每个病例的平均浪费量从 4.2 毫克/千克(标度:4.1)降至 0.22 毫克/千克(标度:0.38)。在 TOF 测得抽搐次数为 0 或 1 次、应至少接受 4 毫克/千克治疗的病例中,接受至少 3.6 毫克/千克治疗的病例较少(治疗后:56.7% 对治疗前:66.8%),接受少于 2.2 毫克/千克治疗的病例比例较高(治疗后:27.4% 对治疗前:20.7%)。在本应接受至少 2 毫克/千克 TOF 治疗的病例中,接受 3.6 毫克/千克以上治疗的患者比例从 9.5%降至 5.2%。讨论对舒格迈司药瓶进行分装可减少浪费,但不能减少剂量,而且更有可能出现剂量严重不足的情况。虽然对药瓶进行分装可使更多人获得舒格迈德和其他昂贵的药物,但可能会带来意想不到的后果。
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引用次数: 0
The Effect of Preoperative Anxiety on Motor and Sensory Block Duration and Effectiveness in Spinal Anesthesia. 术前焦虑对脊髓麻醉中运动和感觉阻滞时间及效果的影响。
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-08-19 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8827780
Yadigar Yılmaz, Esra Durmayuksel, Tuna Erturk, Ferda Yılmaz Inal, Dilek Metin Yamac, Aysin Ersoy

Introduction: The aim was to evaluate the effect of preoperative anxiety on the sympathetic block that developed after spinal anesthesia and therefore the duration of motor and sensory blockade.

Materials and methods: After the approval of the ethics committee, 90 patients between the ages of 18 and 55 years who were to be operated under spinal anesthesia were included in the study. Preoperative anxiety of the patients was evaluated with the Spielberger trait and State Anxiety Scale and Visual Analog Scale (VAS). The Bromage scores of the patients were followed up intermittently. Onset time of sensory block, onset time of motor block, and motor block recovery time were recorded. Cases with bradycardia and hypotension were noted.

Results: No statistically significant correlation was found between the duration of motor block onset (5.81 ± 4 min), the sensory block onset time (0.89 ± 0.4 min), and the motor block recovery time (92.06 ± 36.9 min) with other variables. VAS (5.81 ± 2.5), STAI-1 (40.4 ± 9.8), and STAI-2 (41.69 ± 8.2) values had a statistically significant effect on the occurrence of bradycardia (14.4%). The variables of VAS, STAI-1, STAI-2, sensory block onset, motor block onset, and motor block recovery time were statistically significantly higher in women (mean 5.24 ± 2.4, 38.97 ± 9.9, 41.43 ± 8.7, 0.89 ± 0.42, 5.64 ± 3.82, and 88.77 ± 38.74 in males and mean 7.15 ± 2.1, 43.74 ± 8.9, 42.30 ± 7.0, 0.88 ± 0.27, 6.20 ± 4.35, and 99.70 ± 31.70 in females, respectively).

Conclusion: It was observed that preoperative anxiety had no effect on motor and sensory block onset and duration.

导言研究的目的是评估术前焦虑对脊髓麻醉后交感神经阻滞的影响,进而评估运动和感觉阻滞的持续时间:经伦理委员会批准后,90 名年龄在 18 岁至 55 岁之间的脊髓麻醉手术患者被纳入研究。采用斯皮尔伯格特质与状态焦虑量表和视觉模拟量表(VAS)对患者的术前焦虑进行评估。对患者的 Bromage 评分进行间歇性跟踪。记录感觉阻滞开始时间、运动阻滞开始时间和运动阻滞恢复时间。记录了心动过缓和低血压病例:结果:运动阻滞起始时间(5.81 ± 4 分钟)、感觉阻滞起始时间(0.89 ± 0.4 分钟)和运动阻滞恢复时间(92.06 ± 36.9 分钟)与其他变量之间没有统计学意义上的相关性。VAS(5.81 ± 2.5)、STAI-1(40.4 ± 9.8)和 STAI-2(41.69 ± 8.2)值对心动过缓(14.4%)的发生有显著统计学影响。女性的 VAS、STAI-1、STAI-2、感觉阻滞起始时间、运动阻滞起始时间和运动阻滞恢复时间等变量在统计学上显著高于男性(平均值为 5.24±2.4、38.97±9.9、41.43±8.7、0.男性的平均值分别为(5.24±2.4)、(38.97±9.9)、(41.43±8.7)、(0.89±0.42)、(5.64±3.82)和(88.77±38.74);女性的平均值分别为(7.15±2.1)、(43.74±8.9)、(42.30±7.0)、(0.88±0.27)、(6.20±4.35)和(99.70±31.70):据观察,术前焦虑对运动和感觉阻滞的发生和持续时间没有影响。
{"title":"The Effect of Preoperative Anxiety on Motor and Sensory Block Duration and Effectiveness in Spinal Anesthesia.","authors":"Yadigar Yılmaz, Esra Durmayuksel, Tuna Erturk, Ferda Yılmaz Inal, Dilek Metin Yamac, Aysin Ersoy","doi":"10.1155/2024/8827780","DOIUrl":"10.1155/2024/8827780","url":null,"abstract":"<p><strong>Introduction: </strong>The aim was to evaluate the effect of preoperative anxiety on the sympathetic block that developed after spinal anesthesia and therefore the duration of motor and sensory blockade.</p><p><strong>Materials and methods: </strong>After the approval of the ethics committee, 90 patients between the ages of 18 and 55 years who were to be operated under spinal anesthesia were included in the study. Preoperative anxiety of the patients was evaluated with the Spielberger trait and State Anxiety Scale and Visual Analog Scale (VAS). The Bromage scores of the patients were followed up intermittently. Onset time of sensory block, onset time of motor block, and motor block recovery time were recorded. Cases with bradycardia and hypotension were noted.</p><p><strong>Results: </strong>No statistically significant correlation was found between the duration of motor block onset (5.81 ± 4 min), the sensory block onset time (0.89 ± 0.4 min), and the motor block recovery time (92.06 ± 36.9 min) with other variables. VAS (5.81 ± 2.5), STAI-1 (40.4 ± 9.8), and STAI-2 (41.69 ± 8.2) values had a statistically significant effect on the occurrence of bradycardia (14.4%). The variables of VAS, STAI-1, STAI-2, sensory block onset, motor block onset, and motor block recovery time were statistically significantly higher in women (mean 5.24 ± 2.4, 38.97 ± 9.9, 41.43 ± 8.7, 0.89 ± 0.42, 5.64 ± 3.82, and 88.77 ± 38.74 in males and mean 7.15 ± 2.1, 43.74 ± 8.9, 42.30 ± 7.0, 0.88 ± 0.27, 6.20 ± 4.35, and 99.70 ± 31.70 in females, respectively).</p><p><strong>Conclusion: </strong>It was observed that preoperative anxiety had no effect on motor and sensory block onset and duration.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2024 ","pages":"8827780"},"PeriodicalIF":1.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Operating Room Noise Environment and Behavior in Children Undergoing General Anesthesia: A Randomized Controlled Trial. 手术室噪音环境与接受全身麻醉儿童的行为:随机对照试验
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4838649
Marc Bozych, Nguyen K Tram, Julie Rice-Weimer, Richard S Cartabuke, Joseph D Tobias, Jamie Huffman, Christian Mpody, Joshua C Uffman

Background: Excessive operating room noise impairs communication, distracts from monitoring equipment, and may increase patient and provider stress.

Aim: This study investigates the effects of reduced noise on perioperative behavior in children undergoing general anesthesia and on anesthesia provider response time.

Methods: Healthy children (the American Society of Anesthesiologists class I-II), 2-8 years of age, and their anesthesia providers were randomized into a control or treatment group exposed to reduced stimulation during induction and emergence. Primary outcomes were patient behavior and provider response time. Secondary outcomes were postoperative pain scores, provider responses exceeding 30 seconds, and median and maximum noise exposure.

Results: 64 children (27 females and 37 males) were randomized into a control or treatment group, of whom 32 (50%) underwent tonsillectomy/adenoidectomy and 32 (50%) underwent dental procedures. The average age was 4.6 (SD 1.43) years. Children exposed to reduced noise were less likely to be "fussy about eating" (p=0.042), more "interested in what goes on around them" (p=0.008), and had fewer temper tantrums (p=0.004) on postoperative day one or two and on postoperative day five, six, or seven. No other differences were found between groups in behavioral assessment scores or provider response times.

Conclusions: Our study is the first to show that a low-stimulus environment improves postdischarge behavior. Provider response time was unaffected by reduced noise, and the average and peak noise exposure levels did not exceed national safety guidelines. This trial is registered with NCT03507855 and NCT03504553.

背景:方法:将 2 至 8 岁的健康儿童(美国麻醉医师协会 I-II 级)及其麻醉医师随机分为对照组和治疗组,对照组在诱导和唤醒过程中减少刺激,治疗组在诱导和唤醒过程中减少刺激。主要结果是患者的行为和提供者的反应时间。次要结果是术后疼痛评分、提供者超过 30 秒的反应以及噪音暴露的中位数和最大值:64 名儿童(27 名女性和 37 名男性)被随机分为对照组或治疗组,其中 32 人(50%)接受了扁桃体切除术/腺样体切除术,32 人(50%)接受了牙科手术。平均年龄为 4.6(标准差 1.43)岁。在术后第一或第二天以及术后第五、六或七天,噪音较小的儿童不太可能 "挑食"(p=0.042),对周围发生的事情更 "感兴趣"(p=0.008),发脾气的次数也较少(p=0.004)。在行为评估得分或提供者反应时间方面,各组之间没有发现其他差异:我们的研究首次表明,低刺激环境可以改善出院后的行为。医疗服务提供者的反应时间不受噪音降低的影响,平均和峰值噪音暴露水平均未超过国家安全准则。该试验已在 NCT03507855 和 NCT03504553 上注册。
{"title":"Operating Room Noise Environment and Behavior in Children Undergoing General Anesthesia: A Randomized Controlled Trial.","authors":"Marc Bozych, Nguyen K Tram, Julie Rice-Weimer, Richard S Cartabuke, Joseph D Tobias, Jamie Huffman, Christian Mpody, Joshua C Uffman","doi":"10.1155/2024/4838649","DOIUrl":"10.1155/2024/4838649","url":null,"abstract":"<p><strong>Background: </strong>Excessive operating room noise impairs communication, distracts from monitoring equipment, and may increase patient and provider stress.</p><p><strong>Aim: </strong>This study investigates the effects of reduced noise on perioperative behavior in children undergoing general anesthesia and on anesthesia provider response time.</p><p><strong>Methods: </strong>Healthy children (the American Society of Anesthesiologists class I-II), 2-8 years of age, and their anesthesia providers were randomized into a control or treatment group exposed to reduced stimulation during induction and emergence. Primary outcomes were patient behavior and provider response time. Secondary outcomes were postoperative pain scores, provider responses exceeding 30 seconds, and median and maximum noise exposure.</p><p><strong>Results: </strong>64 children (27 females and 37 males) were randomized into a control or treatment group, of whom 32 (50%) underwent tonsillectomy/adenoidectomy and 32 (50%) underwent dental procedures. The average age was 4.6 (SD 1.43) years. Children exposed to reduced noise were less likely to be \"fussy about eating\" (<i>p</i>=0.042), more \"interested in what goes on around them\" (<i>p</i>=0.008), and had fewer temper tantrums (<i>p</i>=0.004) on postoperative day one or two and on postoperative day five, six, or seven. No other differences were found between groups in behavioral assessment scores or provider response times.</p><p><strong>Conclusions: </strong>Our study is the first to show that a low-stimulus environment improves postdischarge behavior. Provider response time was unaffected by reduced noise, and the average and peak noise exposure levels did not exceed national safety guidelines. This trial is registered with NCT03507855 and NCT03504553.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2024 ","pages":"4838649"},"PeriodicalIF":1.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11343623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness Assessment of Bispectral Index Monitoring Compared with Conventional Monitoring in General Anesthesia: A Systematic Review and Meta-Analysis. 全身麻醉中双频谱指数监测与传统监测的效果评估:系统综述与元分析》。
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-08-07 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5555481
Yichun Gu, Jiajun Hao, Jiangna Wang, Peng Liang, Xinyi Peng, Xiaoxiao Qin, Yunwei Zhang, Da He

Background and Objective. The Bispectral Index (BIS) is utilized to guide the depth of anesthesia monitoring during surgical procedures. However, conflicting results regarding the benefits of BIS for depth of anesthesia monitoring have been reported in numerous studies. The purpose of this meta-analysis and systematic review was to assess the effectiveness of BIS for depth of anesthesia monitoring. Search Methods. A systematic search of Ovid-MEDLINE, Cochrane, and PubMed was conducted from inception to April 20, 2023. Clinical trial registers and grey literature were also searched, and reference lists of included studies, as well as related review articles, were manually reviewed. Selection Criteria. The inclusion criteria were randomized controlled trials without gender or age restrictions. The control groups used conventional monitoring, while the intervention groups utilized BIS monitoring. The exclusion criteria included duplicates, reviews, animal studies, unclear outcomes, and incomplete data. Data Collection and Analysis. Two independent reviewers screened the literature, extracted data, and assessed methodological quality, with analyses conducted using R 4.0 software. Main Results. Forty studies were included. In comparison to the conventional depth of anesthesia monitoring, BIS monitoring reduced the postoperative cognitive dysfunction risk (RR = 0.85, 95% CI: 0.73∼0.99, P = 0.04), shortened the eye-opening time (MD = -1.34, 95% CI: -2.06∼-0.61, P < 0.01), orientation recovery time (MD = -1.99, 95% CI: -3.62∼-0.36, P = 0.02), extubation time (MD = -2.54, 95% CI: -3.50∼-1.58, P < 0.01), and postanesthesia care unit stay time (MD = -7.11, 95% CI: -12.67∼-1.55, P = 0.01) and lowered the anesthesia drug dosage (SMD = -0.39, 95% CI: -0.63∼-0.15, P < 0.01). Conclusion. BIS can be used to effectively monitor the depth of anesthesia. Its use in general anesthesia enhances the effectiveness of both patient care and surgical procedures.

背景和目的。双光谱指数(BIS)用于指导手术过程中的麻醉深度监测。然而,许多研究都报道了有关 BIS 对麻醉深度监测的益处的相互矛盾的结果。本荟萃分析和系统综述旨在评估 BIS 对麻醉深度监测的有效性。检索方法。从开始到 2023 年 4 月 20 日,对 Ovid-MEDLINE、Cochrane 和 PubMed 进行了系统检索。此外,还检索了临床试验登记簿和灰色文献,并人工审阅了纳入研究的参考文献目录以及相关综述文章。筛选标准。纳入标准为随机对照试验,无性别和年龄限制。对照组使用常规监测,干预组使用 BIS 监测。排除标准包括重复、综述、动物研究、结果不明确和数据不完整。数据收集与分析。两名独立审稿人筛选文献、提取数据、评估方法学质量,并使用 R 4.0 软件进行分析。主要结果。共纳入 40 项研究。与传统的麻醉深度监测相比,BIS 监测降低了术后认知功能障碍风险(RR = 0.85,95% CI:0.73∼0.99,P = 0.04),缩短了睁眼时间(MD = -1.34,95% CI:-2.06∼-0.61,P <0.01),定向恢复时间(MD = -1.99,95% CI:-3.62∼-0.36,P = 0.02)、拔管时间(MD = -2.54,95% CI:-3.50∼-1.58,P <0.01)和麻醉后护理单元停留时间(MD = -7.11,95% CI:-12.67∼-1.55,P = 0.01),并降低了麻醉药物剂量(SMD = -0.39,95% CI:-0.63∼-0.15,P <0.01)。结论BIS 可用于有效监测麻醉深度。在全身麻醉中使用 BIS 可提高患者护理和手术过程的有效性。
{"title":"Effectiveness Assessment of Bispectral Index Monitoring Compared with Conventional Monitoring in General Anesthesia: A Systematic Review and Meta-Analysis.","authors":"Yichun Gu, Jiajun Hao, Jiangna Wang, Peng Liang, Xinyi Peng, Xiaoxiao Qin, Yunwei Zhang, Da He","doi":"10.1155/2024/5555481","DOIUrl":"10.1155/2024/5555481","url":null,"abstract":"<p><p><i>Background and Objective</i>. The Bispectral Index (BIS) is utilized to guide the depth of anesthesia monitoring during surgical procedures. However, conflicting results regarding the benefits of BIS for depth of anesthesia monitoring have been reported in numerous studies. The purpose of this meta-analysis and systematic review was to assess the effectiveness of BIS for depth of anesthesia monitoring. <i>Search Methods</i>. A systematic search of Ovid-MEDLINE, Cochrane, and PubMed was conducted from inception to April 20, 2023. Clinical trial registers and grey literature were also searched, and reference lists of included studies, as well as related review articles, were manually reviewed. <i>Selection Criteria</i>. The inclusion criteria were randomized controlled trials without gender or age restrictions. The control groups used conventional monitoring, while the intervention groups utilized BIS monitoring. The exclusion criteria included duplicates, reviews, animal studies, unclear outcomes, and incomplete data. <i>Data Collection and Analysis</i>. Two independent reviewers screened the literature, extracted data, and assessed methodological quality, with analyses conducted using R 4.0 software. <i>Main Results</i>. Forty studies were included. In comparison to the conventional depth of anesthesia monitoring, BIS monitoring reduced the postoperative cognitive dysfunction risk (RR = 0.85, 95% CI: 0.73∼0.99, <i>P</i> = 0.04), shortened the eye-opening time (MD = -1.34, 95% CI: -2.06∼-0.61, <i>P</i> < 0.01), orientation recovery time (MD = -1.99, 95% CI: -3.62∼-0.36, <i>P</i> = 0.02), extubation time (MD = -2.54, 95% CI: -3.50∼-1.58, <i>P</i> < 0.01), and postanesthesia care unit stay time (MD = -7.11, 95% CI: -12.67∼-1.55, <i>P</i> = 0.01) and lowered the anesthesia drug dosage (SMD = -0.39, 95% CI: -0.63∼-0.15, <i>P</i> < 0.01). <i>Conclusion</i>. BIS can be used to effectively monitor the depth of anesthesia. Its use in general anesthesia enhances the effectiveness of both patient care and surgical procedures.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2024 ","pages":"5555481"},"PeriodicalIF":1.6,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Maternal Satisfaction and Associated Factors with Postcesarean Section Pain Management: A Cross-Sectional Study. 剖腹产后疼痛管理的产妇满意度及相关因素:一项横断面研究
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-08-02 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4885678
Biruk Adie Admass, Fikadu Tadesse Diress, Demeke Yilkal Fentie, Nigussie Simeneh Endalew

Background: Maternal satisfaction with pain management after cesarean delivery serves as an indicator of the quality of care. Assessing the level of satisfaction with postcesarean delivery pain management is paramount for both the mother and the healthcare institution. This study aimed to assess maternal satisfaction with postcesarean section pain management and associated factors at the Comprehensive Specialized Hospital in Northwest, Ethiopia, in 2023.

Methods: An institution-based cross-sectional study was conducted from April to June 2023, involving 424 study participants. A consecutive sampling method was utilized for participant selection. Data were entered into Epidata and then exported to SPSS version 25 for analysis. Descriptive and analytic statistics were employed. Both bivariable and multivariable logistic regression analyses were conducted to identify factors associated with maternal satisfaction regarding postcesarean section pain management. Variables with a p value of <0.2 in the bivariable analysis were included in the multivariable analysis. In the multivariable analysis, variables with a p value of <0.05 were considered statistically significant. Crude odds ratio and adjusted odds ratio with 95% confidence intervals were calculated to demonstrate the strength of the association.

Results: A total of 424 participants were included in the study with a response rate of 97.8%. The overall maternal satisfaction with postcesarean section pain management was 80.2% (95% CI: 76.1%-83.8%). Urban residence, elective cesarean section, mild pain, two and above previous history of cesarean section, and waiting less than 30 minutes to get analgesia were associated with maternal satisfaction with postcesarean section pain management.

Conclusion: The overall maternal satisfaction with postcesarean section pain management was promising. Urban residence, elective cesarean section, previous history of cesarean section, mild pain, and waiting less than 30 minutes to get analgesia were predictor factors for maternal satisfaction with postcaesarian section pain management. We recommend that the stakeholders should give attention to enhancing maternal satisfaction.

背景:产妇对剖宫产后疼痛管理的满意度是衡量护理质量的一个指标。评估产妇对剖宫产后疼痛管理的满意度对产妇和医疗机构都至关重要。本研究旨在评估 2023 年埃塞俄比亚西北部综合专科医院的产妇对剖腹产后疼痛管理的满意度及相关因素:方法:2023 年 4 月至 6 月进行了一项以医院为基础的横断面研究,共有 424 名研究参与者。研究采用连续抽样法选择参与者。数据输入 Epidata,然后导出到 SPSS 25 版进行分析。采用了描述性和分析性统计方法。我们进行了双变量和多变量逻辑回归分析,以确定与产妇对剖宫产后疼痛管理满意度相关的因素。结果:本研究共纳入 424 名参与者,回复率为 97.8%。产妇对剖腹产后疼痛管理的总体满意度为 80.2%(95% CI:76.1%-83.8%)。城市居民、择期剖宫产、轻度疼痛、两次及两次以上剖宫产史、等待镇痛时间少于 30 分钟与产妇对剖宫产后疼痛管理的满意度有关:结论:产妇对剖宫产术后疼痛管理的总体满意度很高。城市居民、择期剖宫产、既往剖宫产史、轻度疼痛和等待镇痛时间少于 30 分钟是产妇对剖宫产后疼痛管理满意度的预测因素。我们建议相关人员应重视提高产妇的满意度。
{"title":"Maternal Satisfaction and Associated Factors with Postcesarean Section Pain Management: A Cross-Sectional Study.","authors":"Biruk Adie Admass, Fikadu Tadesse Diress, Demeke Yilkal Fentie, Nigussie Simeneh Endalew","doi":"10.1155/2024/4885678","DOIUrl":"https://doi.org/10.1155/2024/4885678","url":null,"abstract":"<p><strong>Background: </strong>Maternal satisfaction with pain management after cesarean delivery serves as an indicator of the quality of care. Assessing the level of satisfaction with postcesarean delivery pain management is paramount for both the mother and the healthcare institution. This study aimed to assess maternal satisfaction with postcesarean section pain management and associated factors at the Comprehensive Specialized Hospital in Northwest, Ethiopia, in 2023.</p><p><strong>Methods: </strong>An institution-based cross-sectional study was conducted from April to June 2023, involving 424 study participants. A consecutive sampling method was utilized for participant selection. Data were entered into Epidata and then exported to SPSS version 25 for analysis. Descriptive and analytic statistics were employed. Both bivariable and multivariable logistic regression analyses were conducted to identify factors associated with maternal satisfaction regarding postcesarean section pain management. Variables with a <i>p</i> value of <0.2 in the bivariable analysis were included in the multivariable analysis. In the multivariable analysis, variables with a <i>p</i> value of <0.05 were considered statistically significant. Crude odds ratio and adjusted odds ratio with 95% confidence intervals were calculated to demonstrate the strength of the association.</p><p><strong>Results: </strong>A total of 424 participants were included in the study with a response rate of 97.8%. The overall maternal satisfaction with postcesarean section pain management was 80.2% (95% CI: 76.1%-83.8%). Urban residence, elective cesarean section, mild pain, two and above previous history of cesarean section, and waiting less than 30 minutes to get analgesia were associated with maternal satisfaction with postcesarean section pain management.</p><p><strong>Conclusion: </strong>The overall maternal satisfaction with postcesarean section pain management was promising. Urban residence, elective cesarean section, previous history of cesarean section, mild pain, and waiting less than 30 minutes to get analgesia were predictor factors for maternal satisfaction with postcaesarian section pain management. We recommend that the stakeholders should give attention to enhancing maternal satisfaction.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2024 ","pages":"4885678"},"PeriodicalIF":1.6,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Investigating the Effect of Dexmedetomidine in Controlling Postoperative Emergence Agitation in Children under Sevoflurane Anesthesia. 研究右美托咪定对控制七氟醚麻醉下儿童术后躁动的影响
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/6418429
Mitra Golmohammadi, Shahryar Sane, Somayeh Ghavipanjeh Rezaei, Rana Hosseini, Enas R Alwaily, Beneen M Hussien, Ramin Mohammadpour, Nazila Rahmani, Behzad Kazemi Haki

Introduction: Emergence agitation (EA) is one of the common problems during recovery from general anesthesia, especially in children. In this study, we investigated the effect of dexmedetomidine on the control of agitation after anesthesia with sevoflurane in children.

Method: This randomized control-placebo, double-blind prospective clinical trial was conducted on seventy-six children between 2 and 7 years with ASA (American Society of Anesthesiologists) class I who were candidates for elective adenoidectomy surgery and tonsillectomy. Participants were selected by an available sampling method. Patients were randomly placed in one of the two groups D (dexmedetomidine 0.5 μg/kg infusion within ten minutes) or P (placebo: normal saline infusion within ten minutes). A four-point scale evaluated agitation. Pain evaluation was done by FLACC (faces, legs, activity, cry, and consolability). The statistical software was SPSS version 23. P < 0.05 was considered statistically significant.

Results: The level of agitation was significantly lower in the intervention group (P < 0.05), except after 40 minutes in the PACU (Post Anesthesia Care Unit) (P=1.00). Patients in the control group experienced high pain scores when admitted at PACU, 10, 20, and 30 minutes after admission at PACU (P < 0.05). Pethidine and metoclopramide prescriptions in the intervention group were lower than in the control group (P < 0.05). Shivering occurred in five patients in the intervention group and nine in the control groups (P=0.032). Hypotension that required intervention occurred in 3 patients in the intervention group and one in the control group (P=0.024).

Conclusion: Our trial demonstrated that the prescription of 0.5 μg/kg of dexmedetomidine within ten minutes after intubation significantly reduced the EA frequency, pain severity, analgesic consumption, and PONV (postoperative nausea and vomiting). However, it caused delays in the emergence from anesthesia. This trial is registered with IRCT20160430027677N14.

前言出院后躁动(EA)是全身麻醉恢复期的常见问题之一,尤其是在儿童中。本研究探讨了右美托咪定对控制儿童七氟醚麻醉后躁动的影响:这项随机对照-安慰剂双盲前瞻性临床试验的对象是 76 名年龄在 2 到 7 岁之间、ASA(美国麻醉医师协会)Ⅰ级的儿童,他们都是选择性腺样体切除手术和扁桃体切除术的候选者。参与者是通过现有的抽样方法选出的。患者被随机分为 D 组(在十分钟内输注右美托咪定 0.5 μg/kg)或 P 组(安慰剂:在十分钟内输注生理盐水)。躁动采用四级评分法进行评估。疼痛评估采用 FLACC(脸部、腿部、活动、哭泣和可安慰性)。统计软件为 SPSS 23 版本。P<0.05为差异有统计学意义:结果:干预组患者的躁动程度明显降低(P < 0.05),但在 PACU(麻醉后护理病房)40 分钟后除外(P=1.00)。对照组患者在进入 PACU、进入 PACU 10 分钟、20 分钟和 30 分钟后疼痛评分较高(P < 0.05)。干预组的哌替啶和甲氧氯普胺处方量低于对照组(P < 0.05)。干预组有 5 名患者出现颤抖,对照组有 9 名(P=0.032)。需要干预的低血压发生率为干预组 3 例,对照组 1 例(P=0.024):我们的试验表明,在插管后十分钟内处方 0.5 μg/kg 右美托咪定可显著减少 EA 频率、疼痛严重程度、镇痛药用量和 PONV(术后恶心和呕吐)。然而,它却会导致麻醉后苏醒的延迟。该试验的注册号为 IRCT20160430027677N14。
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引用次数: 0
Assessment of Anaesthesia Teams' Non-Technical Skills in Clinical Practice before and after Simulation-Based Team Training: A Quasiexperimental Study. 在基于模拟的团队培训前后评估麻醉团队在临床实践中的非技术技能:一项准实验研究。
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2024-07-05 eCollection Date: 2024-01-01 DOI: 10.1155/2024/2021671
Anne Strand Finstad, Conrad Arnfinn Bjørshol, Ingunn Aase, Jo Røislien, Randi Ballangrud

Background: In situ simulation-based team training of non-technical skills is considered an important initiative for preventing adverse events caused by poor teamwork among healthcare personnel. This study aimed to assess the non-technical skills of anaesthesia personnel before and after in situ simulation-based team training in a clinical setting.

Methods: The study was conducted from October 2020 to June 2021 using a quasiexperimental before and after design based on video-recorded observations and ratings of anaesthesia teams' non-technical skills during anaesthesia induction in the operating room before and shortly after in situ simulation-based team training. Anaesthesia personnel were divided into 20 teams and video recorded during anaesthesia induction. The Anaesthetists' Non-technical Skills (ANTS) system was used to score the teams' non-technical skills. A paired-sample t-test was used to assess the impact of the intervention on the anaesthesia teams' scores on the various ANTS categories. Interrater agreement between the two ANTS raters was assessed using weighted kappa.

Results: At the category level, the overall scores had a statistically significant increase in performance after simulation-based team training (3.48 vs. 3.71; p < 0.001). Furthermore, scores of five of the 15 elements were significantly different. Interrater agreement revealed moderate agreement between the two raters (weighted kappa = 0.51, p value <0.001).

Conclusion: The anaesthesia teams' increased non-technical skills after simulation-based team training may indicate the transfer of knowledge from training to clinical practice. The moderate agreement between the raters could be attributed to the subjective nature of the evaluation procedure. The ANTS was originally used as an individual assessment tool; however, this study has demonstrated its potential as a team assessment tool.

背景:对非技术性技能进行原位模拟团队培训被认为是预防医护人员因团队合作不佳而导致不良事件的重要举措。本研究旨在评估麻醉人员在临床环境中接受原位模拟团队培训前后的非技术性技能:该研究于 2020 年 10 月至 2021 年 6 月进行,采用了准实验性的前后设计,基于原位模拟团队培训前后对麻醉团队在手术室麻醉诱导过程中的非技术性技能进行视频录像观察和评分。麻醉人员被分成 20 个小组,在麻醉诱导过程中进行录像。使用麻醉师非技术技能(ANTS)系统对各小组的非技术技能进行评分。采用配对样本 t 检验来评估干预措施对麻醉团队在 ANTS 各项评分上的影响。采用加权卡帕法评估了两名ANTS评分员之间的相互一致性:结果:在类别水平上,模拟团队培训后的总分在统计学上有显著提高(3.48 vs. 3.71; p < 0.001)。此外,15 个要素中有 5 个要素的得分存在明显差异。两位评分者之间的相互评分一致度为中等(加权卡帕 = 0.51,P 值 结论:麻醉团队的技术水平在模拟培训后有了明显提高(3.48 对 3.71;P < 0.001):麻醉团队在接受模拟团队培训后,非技术性技能有所提高,这可能表明知识已从培训转移到临床实践中。评分者之间的一致性一般,这可能归因于评估程序的主观性。ANTS 最初是作为个人评估工具使用的,但本研究证明了其作为团队评估工具的潜力。
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引用次数: 0
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Anesthesiology Research and Practice
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