Anesthesiology Research and Practice最新文献

Background: Delirium is a common disorder among patients admitted to intensive care units. Identification of the predicators of delirium is very important to improve the patient's quality of life.

Methods: This study was conducted in a prospective observational design to build a predictive model for delirium among ICU patients in Oman. A sample of 153 adult ICU patients from two main hospitals participated in the study. The Intensive Care Delirium Screening Checklist (ICDSC) was used to assess the participants for delirium twice daily.

Result: The results showed that the incidence of delirium was 26.1%. Multiple logistic regression analysis showed that sepsis (odds ratio (OR) = 9.77; 95% confidence interval (CI) = 1.91-49.92; P < 0.006), metabolic acidosis (odds ratio (OR) = 3.45; 95% confidence interval [CI] = 1.18-10.09; P=0.024), nasogastric tube use (odds ratio (OR) 9.74; 95% confidence interval (CI) = 3.48-27.30; P ≤ 0.001), and APACHEII score (OR = 1.22; 95% CI = 1.09-1.37; P ≤ 0.001) were predictors of delirium among ICU patients in Oman (R ²=0.519, adjusted R ²=0.519, P ≤ 0.001).

Conclusion: To prevent delirium in Omani hospitals, it is necessary to work on correcting those predictors and identifying other factors that had effects on delirium development. Designing of a prediction model may help on early delirium detection and implementation of preventative measures.

Background: Critically ill patients have an increased requirement for vitamin C in sepsis and these patients have low levels of vitamin C. The researchers validated the efficacy of high-dose vitamin C intravenous infusion (IVI) in patients with sepsis requiring mechanical ventilation.

Methods: Forty patients were randomly assigned to 2 groups (20 each) in a 1 : 1 ratio in accordance with the vitamin C treatment regimen: Group I (GI): patients received 1.5 g/6 h vitamin C in 50 ml of dextrose 5% in water (D5W) IVI over 30 minutes for 4 consecutive days; Group II (GII): patients received 100 mg vitamin C/day as a first single dose in 50 ml of D5W IVI over 30 minutes and the other three subsequent doses were 50 ml of plain D5W IVI over 30 minutes for 4 consecutive days. Primary outcomes were the change in sequential organ failure assessment (SOFA) score at day 7, the incidence of ventilator-associated pneumonia (VAP), and the plasma vitamin C level. The glutathione peroxidase (GPX) activity, C-reactive protein (CRP) level, duration of vasopressor therapy, and 28-day mortality were secondary outcomes.

Results: The change in SOFA score at day 7 showed a significant difference between GI and GII (p < 0.001). The incidence of early VAP was significantly lower in GI (p=0.044). Vitamin C levels showed a significant rise in GI at day 1 and day 4 (p < 0.001 and p < 0.001, respectively). GPX activity of day 4 and day 7 was significantly higher in GI (p=0.005 and p=0.014, respectively). CRP levels of day 4 and day 7 were significantly higher in GII (p < 0.001 and p < 0.001, respectively). There was a significant difference in 28-day mortality (p=0.038) and duration of vasopressor therapy (p=0.033) in GI compared to GII.

Conclusion: The early use of high-dose vitamin C intravenous infusion in patients with sepsis requiring mechanical ventilation in combination with the standard treatment for sepsis lowered the incidence of VAP, increased the antioxidant status, and improved the illness severity. Trial Registration. This trial is registered with ClinicalTrials.gov Identifier (NCT04029675).

Objectives: Sublingual sufentanil is a novel opioid medication to treat moderate to severe pain postoperatively. This study's aim was to determine if a single dose of a sublingual sufentanil tablet (SST) is as efficacious as a single dose of intravenous (IV) fentanyl in readiness to discharge from ambulatory surgery.

Methods: This was a two-arm, parallel group, randomized prospective outcomes study conducted at a single, free-standing ambulatory surgery center. Patients aged 18-80 undergoing general anesthesia who developed a postoperative pain score of ≥ 4 were enrolled and randomized to receive either 30 mcg SST or 50 mcg IV fentanyl. After their initial randomized dose, rescue IV fentanyl followed by oral oxycodone if needed. Recovery length of stay from arrival in the postanesthesia care unit until readiness to discharge criteria was met based on phase 2 discharge criteria.

Results: 75 patients were analyzed. Readiness to discharge from the recovery room was not significantly different between either group (IV fentanyl median 65 minutes; IQR 56-89; SST 73 min, IQR 58-89; p=0.903). There was no significant difference in the amount of morphine equivalents (MME) of rescue opioids needed (IV fentanyl median rescue MME of 22.5, IQR 13.1-23.4; SST median rescue MME of 15.0, IQR 7.5-30.0; p=0.742). The change in pain from PACU initially, and on discharge was not significantly different (IV fentanyl initial pain minus pain on discharge median 3, IQR 2-4; SST initial pain minus pain on discharge median 4, IQR 2-5.5; p=0.079). There was no difference in the six-item screener and the Overall Benefit of Analgesic Survey Score. Discussion. In conclusion, patients who received a sublingual sufentanil 30 mcg tablet had no significant differences in PACU length of stay or rescue analgesic usage when compared to intravenous fentanyl 50 mcg.

Background: Postoperative pulmonary complications are a wide variety of disorders that affect normal respiratory functions, which in turn lead to morbidity and mortality. The extent to which it occurs is not yet studied in most clinical settings. This study assessed the incidence and risk factors of postoperative pulmonary complications in patients undergoing abdominal surgery under general anesthesia.

Methods: A multicenter, prospective cross-sectional study was conducted at Menelik II, Tikur Anbessa Specialized, Zewditu Memorial, and Yekatit 12 Memorial hospitals after obtaining ethical clearance from each hospital. The study recruited a total of 287 participants using systematic random sampling. The data collection tool included sociodemographic, surgical, and anesthetic factors. Participants were followed for 7 days postoperatively, and any respiratory problems were recorded once identified. The collected data were entered and analyzed using SPSS version 26. Both bivariate and multivariate logistic regressions were used for analysis. A p value of <0.05 was considered statistically significant.

Results: About 33% of the participants that underwent abdominal surgery developed postoperative pulmonary complications. Age > 65 years (AOR = 12.091, 95% CI = 3.310-44.169), duration of surgery >3 hours (AOR = 11.737, 95% CI = 3.621-38.039), preoperative oxygen saturation <94% (AOR = 10.671, 95% CI = 3.794-30.016), and postoperative serum albumin level <3.5 g/dl (p value <0.001) were associated with postoperative pulmonary complications significantly. Conclusion and Recommendations. The incidence of postoperative pulmonary complications after abdominal surgeries was high. Age >65years, duration of surgery >3 hours, preoperative SpO2% <94%, cigarette smoking, and postoperative serum albumin level <3.5 g/dl were factors strongly associated with postoperative pulmonary complications. We recommend special care for elderly patients, limit the surgical duration to less than 3 hours, treat the underlying cause of desaturation, and correct postoperative serum albumin to prevent the occurrence of postoperative pulmonary complications.

Background: Nearly one in five hundred babies unexpectedly need resuscitation at birth, and the need for resuscitation is often unpredictable. A large majority of these deaths occur in low-resource settings and are preventable. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Therefore, producing skilled health professionals in teaching institutions is mandatory to perform this activity.

Objective: The study aimed a pre- and post-evaluation of knowledge and clinical skills performance of anesthesia students completing simulation-based neonatal resuscitation training at a Teaching Referral Hospital.

Methods: A pre-post-intervention study was conducted on undergraduate final-year anesthesia students at Comprehensive and Specialized Teaching Referral Hospital, Ethiopia. We used a validated checklist to follow the students' performance (American Heart Association, 2005, and Ogunlesi et al., 2012). The data were collected through this checklist. The collected data were analyzed with statistical package for social sciences (SPSS) version 20. Categorical variables were analyzed with chi-square test, and a p-value <0.05 was considered as statistically significant.

Results: A total of 51 students participated in the study. Twenty of them were females. The pre-intervention knowledge of the respondents about aspects of evaluation for neonatal resuscitation was 90.2%, and post-intervention was 94.1%; the knowledge of the respondents about aspects of appropriate actions at pre- and post-interventions was 73.4% and 83.1%, respectively. Conclusions and recommendations: This study showed that there was improvement of post-interventions knowledge and clinical skills of undergraduate anesthesia students for both aspects of evaluation and appropriate actions for neonatal resuscitation. We recommend that students who attached clinical anesthesia practice should take at least simulation-based training at skill laboratories timely.

Background: Epidural analgesia (EPA) is an effective anesthetic technique to overcome pain during labor. This study aimed to evaluate the current awareness of EPA among pregnant women.

Methods: We carried out a cross-sectional study using a questionnaire to measure awareness about EPA among pregnant women visiting the obstetrics and gynaecology clinic in King Abdulaziz Medical City in Jeddah. Following the results, a group of women was selected and educated by trained medical students.

Results: This study comprised 105 women. We found that 25 (23.8%) respondents revealed a complete lack of knowledge regarding EPA, 63 (60%) showed minimal awareness, and 17 (16.2%) were aware of EPA from various sources. The gravidity and history of EPA administration were significantly associated with knowledge. Multigravida women and those who had received EPA showed higher level of knowledge (p=0.048 and p < 0.001, respectively). In addition, there was a significant association between the level of education and request for EPA (p=0.027). Forty-one participants were enrolled in an educational program that explained the importance of EPA. Twenty (48.8%) women decided to undergo EPA during delivery; however, 7 (17.7%) refused and 14 (34.1%) were not sure about their decision.

Conclusion: This study revealed a lack of awareness about EPA among pregnant women. Educational programs were effective as many participants chose EPA following the educational session as a form of pain relief during labor. We recommend the implementation of routine education on EPA in vaginal delivery during antenatal visits for all pregnant women.

Background: Coadministration of different antiemetics proved to decrease postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG). This trial compared aprepitant/dexamethasone (A/D) combination vs mirtazapine/dexamethasone (M/D) combination vs dexamethasone (D) alone for prevention of PONV in morbidly obese patients undergoing LSG.

Methods: Ninety patients scheduled for LSG were randomly allocated to receive 8 mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80 mg aprepitant capsule in the A/D group or in addition to 30 mg mirtazapine tablet in the M/D group. Assessment of PONV was carried out at 0-2 h (early) and 2-24 h (late). The primary outcome was the complete response 0-24 h after surgery. Collective PONV, postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.

Results: The A/D and M/D groups were superior to the D group for a complete response within 0-24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0-24 h after surgery (P < 0.001, P < 0.001, respectively). The peak nausea scores (2-24 h) were significantly reduced in the M/D group in comparison to the D group (P=0.005). Patients in the M/D group showed high sedation scores, while those in the A/D group showed low pain scores (2-24 h) and less analgesic requirements (P < 0.001, P < 0.001, P < 0.001, respectively). The A/D and M/D groups were superior to the D group with regard to the patient satisfaction score (P < 0.001).

Conclusion: Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy. Trial Registration: ClinicalTrials.gov identifier: NCT04013386.

Background: The frequency of shivering regarding regional anesthesia is 55%. Newer effective and tolerable options for postspinal anesthesia shivering (PSAS) prophylaxis are necessary to improve patients' quality of care. This research assessed the impact of preemptive mirtazapine versus preemptive dexamethasone to decrease frequency and severity of PSAS in gynecological procedures.

Methods: 300 patients booked for gynecological procedures under spinal anesthesia (SA) were randomly apportioned into three groups (100 each) to get one preemptive dose of 30 mg mirtazapine tablet (M group), 8 mg dexamethasone diluted in 100 ml of saline infusion (D group) or placebo (C group) two hours before surgery. Incidence of clinically significant PSAS was the primary outcome. Core temperature, shivering score, hemodynamics changes, adverse events, and patient satisfaction score were documented as secondary outcomes.

Results: Compared with C group, mirtazapine and dexamethasone decreased incidence of clinically significant shivering (74% vs. 16% and 31%, respectively; P < 0.001). M and D groups had less hypotensive episodes during 5-25 min after intrathecal injection (P < 0.001). 90 min after SA, tympanic temperatures were lower than baseline values in the three groups (P < 0.001). Pruritus, nausea, and vomiting were more often in C group (P < 0.001), whereas sedation was more frequent in M group (P < 0.001). C group had the lowest satisfaction scores (P < 0.001).

Conclusion: Prophylactic administration of mirtazapine or dexamethasone attenuated shivering with minimal hazards in patients scheduled for gynecological surgeries under spinal anesthesia with priority to mirtazapine. The trial is registered with NCT03675555.