Anesthesiology Research and Practice最新文献

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.

Background: Remimazolam is a newly developed benzodiazepine. Early recovery from anesthesia because of its ultra-short acting effect and less hemodynamic side effects has been reported as the specific advantages of remimazolam. Therefore, the maintenance of anesthesia with propofol may be sometimes switched to remimazolam anesthesia maintenance during surgery because of the risk of delayed awakening and unstable hemodynamics. In the present study, to determine the influence of switching anesthesia from propofol to remimazolam on the baseline TOF ratio, the TOF ratio under remimazolam anesthesia maintenance without any neuromuscular blocking agents was compared to that calibrated after induction of general anesthesia with propofol. Methods: Twelve patients scheduled for elective surgery under general anesthesia in the supine position were investigated. After induction of general anesthesia with remifentanil and propofol, a supraglottic airway was inserted without neuromuscular blockade, and TOF stimulation every 15 s at the adductor pollicis muscle was started with acceleromyography. After stable baseline responses to TOF stimulation being obtained for at least 10 min under propofol anesthesia, the anesthetic agent was switched to remimazolam and TOF stimulation every 15 s was maintained for a further 60 min without any interruption. In each case, the averaged TOF ratio during the last 10 min of TOF monitoring was compared to that during the 10 min immediately before the beginning of remimazolam infusion using a paired t-test. Results: There were no significant differences in the TOF ratios before and after switching anesthesia to remimazolam (1.07 ± 0.03 vs. 1.07 ± 0.03, p=0.325). Conclusion: Switching anesthesia from propofol to remimazolam does not affect the baseline TOF ratio.

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.

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.