Anesthesiology Research and Practice最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

Background: Traumatic brain injury (TBI) is a disruption to normal brain functions caused by traumas such as collisions, blows, or penetrating injuries. There are factors affecting patient outcomes that also have a predictive value. Limited data from low-middle income countries showed a high number of poor outcomes in TBI patients. The corticosteroid randomisation after significant head injury (CRASH) prognostic model is a predictive model that uses such factors and is often used in developed countries. The model has an excellent discriminative ability. However, there is still a lack of studies on its use in surgical patients in low-middle income countries. This study aimed to evaluate the CRASH model's validity to predict 14-day mortality of TBI patients who underwent surgery in low-middle income countries.

Methods: This retrospective analytical observational study employed total sampling including all TBI patients who underwent surgery with general anesthesia from January to December 2022. Statistical analysis was performed by applying Mann-Whitney and Fisher exact tests, while the model's discriminative ability was determined through the area under the curve (AUC) calculations.

Results: 112 TBI patients were admitted during the study period, and 74 patients were included. Independent statistical analysis showed that 14-day mortality risk, age, Glasgow Coma Scale score, TBI severity, pupillary response, and major extracranial trauma had a significant individual correlation with patients' actual mortality outcome (p < 0.05). The AUC analysis revealed an excellent mortality prediction (AUC 0.838; CI 95%).

Conclusion: The CRASH prognostic model performs well in predicting the 14-day mortality of TBI patients who underwent surgery in low-middle income countries.