Anesthesiology Research and Practice最新文献

[This corrects the article DOI: 10.1155/2024/4885678.].

Background: Globally, anesthesiologists and nurse anesthetists collaborate closely during anesthesia administration. However, there is a scarcity of guidelines detailing the division of tasks and responsibilities between these two professions. The Norwegian Standard for the Safe Practice of Anesthesia (NSA) was developed jointly by the Norwegian Association of Anesthesiologists and the Norwegian Association of Nurse Anesthetists as a consensus guideline to safeguard satisfactory anesthetic practice. This study aimed to explore the experiences and perspectives of anesthesiologists and nurse anesthetists regarding the NSA. Methods: The study employed a cross-sectional, observational design, utilizing a questionnaire. A purposive sampling strategy was employed, inviting all members of the two associations (N = 3300) to participate in a web-based survey. Data were analyzed using the Statistical Package for the Social Sciences, Version 28. Descriptive statistics and independent samples t-tests were utilized to analyze the data. A two-sided p value of ≤ 0.05 was considered statistically significant. Results: In total, 823 respondents (24.9%) completed the questionnaire in September 2024. The results indicate several areas for improvement to achieve the recommended standards of anesthetic practice as outlined by the NSA. Statistically significant differences were observed between responses from anesthesiologists and nurse anesthetists. Approximately two-thirds of respondents reported the NSA as relevant to their daily work, and between 13 and 30 percent had experienced or were aware of situations where the standard was utilized in root cause analyses of adverse anesthetic events. Conclusion: The findings suggest that the NSA is employed in clinical practice. However, assuming the NSA ensures satisfactory anesthetic practice, there are several areas requiring improvement. Given the overlapping roles and responsibilities of anesthesiologists and nurse anesthetists, the NSA may serve as a model for similar guidelines in other countries.

Background: Optimal sedation and analgesia management in mechanically ventilated (MV) children post-abdominal surgery remain controversial. This study compared the efficacy and safety of fentanyl versus dexmedetomidine infusion in this population. Methods: A randomized, double-blinded study enrolled 54 MV children aged 4-11 years post-open abdominal surgeries. Patients received either fentanyl (1 μg/kg bolus, 1-5 μg/kg/h infusion) in Group F or dexmedetomidine (1 μg/kg bolus, 0.2-0.7 μg/kg/h infusion) in Group D. Hemodynamic parameters, sedation (COMFORT-B scale), pain (FLACC scale), and weaning times were assessed. Results: Group D showed significantly lower mean arterial pressure and heart rates from 6 to 24 h post-intervention (p < 0.05). Oxygen saturation remained similar between groups. Dexmedetomidine provided superior sedation (COMFORT-B: 7 [6-8] vs. 8 [7-8], p=0.022) and analgesia (FLACC: 1 [1-2.5] vs. 2 [2-3], p=0.005). However, dexmedetomidine achieved faster weaning (25.89 ± 2.01 vs. 29.19 ± 1.44 h, p < 0.001) and higher extubation times (51.93 ± 4.84 vs. 43.78 ± 5.32 min, p < 0.001). Conclusions: While dexmedetomidine offered better sedation and pain control, fentanyl facilitated quicker weaning and extubation from MV and better hemodynamics in postoperative MV children after open abdominal surgeries. Trial Registration: ClinicalTrials.gov identifier: NCT06994273.

Background: Nasotracheal intubation (NTI) is commonly used in maxillofacial trauma but carries a high risk of bleeding and airway complications, particularly with direct laryngoscopy (DL). Video laryngoscopy (VL) provides better glottic visualization and may reduce airway trauma. This study compares VL and DL for NTI in maxillofacial trauma patients, focusing on bleeding severity, intubation efficiency, and complications. Methods: This randomized controlled trial included 64 patients undergoing NTI for maxillofacial trauma, randomly assigned to VL or DL. The primary outcome was nasal and oropharyngeal bleeding severity, assessed using Fromme's scale. Secondary outcomes included first-pass success rate, intubation time, need for adjunctive maneuvers (Magill forceps and cervical spine extension), and intubation-related complications. All intubations were performed under general anesthesia following standardized airway preparation. Results: VL resulted in significantly lower nasal and oropharyngeal bleeding severity, with no bleeding (score 0) observed in 43.8% of the VL patients versus 12.5% of the DL group (p=0.005). VL also resulted in shorter intubation times (51.9 ± 7.9 s vs. 58.1 ± 8.7 s; p=0.003). The need for adjunctive maneuvers was significantly lower in the VL group (p < 0.001), and severe complications such as fractured teeth or deep lip injuries occurred more frequently in the DL group (p=0.02). The first-pass success rate was higher in the VL group (96.9%) than in the DL group (78.1%) though the difference was not statistically significant (p=0.058). Conclusion: VL demonstrated superior intubation efficiency and reduced bleeding severity compared with DL in maxillofacial trauma patients. Given its safety advantages and reduced need for adjuncts, VL appears to be a preferable technique for NTI in maxillofacial trauma though further multicenter studies are ensured. Trial Registration: ClinicalTrials.gov identifier: NCT06386757.

Background: The costoclavicular block is an upcoming approach in blocking the brachial plexus for upper limb surgeries. The addition of dexamethasone and dexmedetomidine to the local anesthetic mixture can prolong the duration of analgesia of brachial plexus block. We compared the addition of three different adjuvants-dexamethasone, dexmedetomidine, and dexamethasone-dexmedetomidine combination with bupivacaine in costoclavicular block. Methods: We randomized 105 patients undergoing elective hand and forearm surgery under ultrasound guided costoclavicular block. Along with the local anesthetics, Group D patients received 4 mg dexamethasone, Group X patients received 1 µg/kg dexmedetomidine, and Group D-X patients received 4 mg dexamethasone and 1 µg/kg dexmedetomidine. The primary outcome analyzed was the analgesic duration. The secondary outcomes studied were the duration of sensory and motor block, time to onset of sensory and motor block, sedation scores, and adverse effects. Results: The duration of analgesia was significantly prolonged in Group D-X when compared to that in Group X and Group D [(19 h; IQR, 18.5-19.0 h) versus (16 h; IQR, 15.5-16.5 h) versus (13 h, IQR, 12-14 h) p value < 0.001]. The duration of sensory block was significantly prolonged in Group D-X compared to that in Group X and Group D [(15 h, IQR, 15-16 h) versus (13 h, IQR, 12-14 h) versus (10 h, IQR, 10-11 h) p value < 0.001]. Similarly, the duration of motor block was prolonged in Group D-X compared to that in Group X and Group D [(16 h; IQR: 16-17.5 h) versus (14 h; IQR; 13-15 h) versus (11 h; IQR: 11-12 h) with significant p value < 0.001. Also, the time to onset of sensory and motor block was earlier in Group D-X. The sedation scores were not significant, and no adverse events were observed. Conclusion: Addition of dexamethasone and dexmedetomidine together to a local anesthetic in ultrasound guided costoclavicular block resulted in faster onset with longer analgesic and sensorimotor block duration. Trial Registration: Clinical Trials Registry-India: CTRI/2024/01/061072.

Background: Previous studies have highlighted the association between chronic kidney disease (CKD) and the increased incidence of postoperative acute kidney injury (AKI). However, the risk factor and incidence of postoperative AKI in patients with CKD undergoing elective surgery remained unclear. This retrospective study aimed to evaluate the perioperative predictors of postoperative AKI in patients with CKD. Methods: Data from 137 patients with CKD, defined by an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m², who underwent elective surgery under general or regional anesthesia between November 2018 and October 2023, were retrospectively reviewed. Patients were placed on a peripheral arterial catheter, and dual arterial blood gas analysis was performed within 30 min before and after surgery. Patients undergoing cardiac surgery, emergency surgery, preoperative renal replacement therapy, as well as those with missing data, were excluded from the study. Both general and local anesthesia modalities were included in the analysis. Results: The incidence of postoperative AKI was 24%. All cases of AKI were classified as Stage 1. Preoperative ischemic heart disease (odds ratio: 2.660, 95% CI: 1.16-6.10, p=0.00207) and lower eGFR (odds ratio: 0.947, 95% CI: 0.915-0.980, p=0.00181) were associated with increased risk of postoperative AKI. More patients who developed postoperative AKI converted to maintained dialysis compared to patients who did not develop AKI (15% vs. 2.1%, p=0.0021). Conclusions: History of ischemic heart disease and preoperative lower eGFR and may serve as risk factors for postoperative AKI in CKD patients.

Background: Total knee arthroplasty (TKA) is a surgical intervention that relieves patients experiencing severe pain and joint dysfunction. Objective: The aim is to evaluate ultrasound-guided genicular nerve block (GNB) paired with infiltration between the popliteal artery and the capsule of the posterior knee IPACK block in comparison with adductor canal block (ACB) regarding the analgesia effectiveness and postoperative functional outcomes and rehabilitation parameters for TKA. Methods: This randomized controlled trial enrolled 50 individuals of both genders with American Society of Anesthesiologists Class I-III, planned for TKA with spinal anesthesia. The patients were randomly allocated into two groups of 25 each. Group A underwent an ultrasound-guided GNB combined with an IPACK block, while Group B received an ACB. The amount of morphine consumed postoperatively during the initial 48 h was the main outcome. Additional outcomes encompassed postoperative knee range of motion (ROM), straight leg raising (SLR), and time up and go (TUG) test. Results: Group A patients exhibited significantly lower pain perception scores at 6 and 12 h (p < 0.001) and lower 48 h morphine dose in comparison to Group B (p < 0.001). Group A had significantly better results in ROM and TUG tests on the first and second days (p < 0.001). No significant difference was observed in patients achieving SLR on Day 1 (p=0.999). Overall, Group A had a faster recovery regarding ROM and TUG and better SLR by Day 2. Group A had better satisfaction. Conclusions: In TKA, combined IPACK and GNB offer superior postoperative analgesia, reduced opioid use, and improved functional outcomes compared to ACB. Trial Registration: ClinicalTrials.gov identifier: NCT06423339.

Background: Total knee arthroplasty (TKA) is associated with intense postoperative pain, for which continuous femoral triangle block (FTB) and infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) block have been used. Genicular nerves supply sensation to a part of the knee joint that the two blocks do not affect, so we recently started adding genicular nerve blocks (GNBs) to the combination of FTB and iPACK block. In this retrospective study, we examined to see if the addition of GNBs benefited patients undergoing TKA. Methods: We conducted a retrospective analysis of data that had been collected prospectively from patients undergoing TKA and receiving our standard analgesic regimen including continuous FTB and iPACK block in our hospital. We compared patients with and without GNBs regarding intra- and postoperative data including the time needed for block performance, visual analog scale (VAS) pain scores, analgesic requirements, and adverse events. The two-tailed Student's t test, Mann-Whitney U test, chi-square test, and Fisher's exact test were used for statistical analysis. Results: Seventy-four patients including 41 and 33 patients with and without GNBs, respectively, were evaluated. The demographics of the patients were comparable. VAS pain score at rest on postoperative day 1 was not different between patients who received GNBs and those who did not (20 [0-36] vs. 25 [19-45] in median [IQR], p = 0.205). Other measurements related to postoperative pain were also similar throughout the two postoperative days. No severe complications related to blocks were observed. Conclusion: The results of this exploratory retrospective study suggest that the additional benefits of GNBs, if any, are limited for the early postoperative period when combined with continuous FTB and iPACK block in patients undergoing TKA. However, larger, sufficiently powered, and more robust clinical trials are needed to confirm the present results.

Background: Lumbar disc prolapse is a common cause of disabling low back pain. The prevalence of disc prolapses or herniation in the general population increases with age. Objective: This work aimed to evaluate the impact of transforaminal epidural steroid injection (TFESI) in lumbar disc prolapse on pain intensity, cognitive function, and miR-155 serum level. Methods: The present case-control study was conducted on 44 patients with symptomatic lumbar disc prolapse (L4-L5) and another 44 age- and sex-matched controls. Assessment of the pain intensity and functional disability was done before and 1 month after TFESI using the numeric rating scale (NRS), Oswestry disability index (ODI), and functional rating index (FRI). Cognitive assessment was done before and 1 month after TFESI. Estimation of miR-155 serum level was done for the included patients (before and 1 month after TFESI) and controls. Results: There was a statistically significant improvement in pain scales and cognitive test scores 1 month following TFESI (p value ≤ 0.05 in all comparisons). There was also a statistically significant reduction in miRNA-155 serum level in the included patients one month following TFESI (p value < 0.001). The median values for the change in NRS were 2 (1-4.75), in ODI were 18 (7-33), in FRI were 23.5 (12-31), in PALT were 1 (0-1.5), in COWAT were 2 (0.25-5), in PASAT were 3 (1.25-4), and in miRNA-155 were 0.555 (0.16-0.738). There were statistically significant correlations between miRNA-155 serum levels in the included patients and the scores of all the pain and disability scales (NRS, ODI, and FRI) and the scores of all the cognitive tests before TFESI (p value ≤ 0.05 in all correlations). Conclusion: This study highlights the epigenetic mechanisms of TFESI in lumbar disc prolapse, causing significant downregulation of miRNA-155, reduced pain intensity, and improved cognitive function. Trial Registration: ClinicalTrials.gov identifier: NCT05626283.

Introduction: Noise in the operating room (OR) is a recognized hazard, known to impair communication among staff and increase stress levels. While its effects on healthcare personnel have been studied, little is known about patient perception of noise, particularly during cesarean delivery (CD) under neuraxial anesthesia, where patients are fully conscious. This study aimed to investigate if patients undergoing CD perceive OR noise as stressful and to examine the correlation between actual noise levels and patient-reported stress. Methods: This prospective observational study was conducted on women undergoing CD at the University of Iowa Hospitals and Clinics. Eligible participants had sound levels recorded in the two ORs and completed three questionnaires 24 h postsurgery: the Weinstein Noise Sensitivity Questionnaire Short Form (WNSSF), a noise perception questionnaire, and a noise-related stress questionnaire. Noise levels were measured using a Spartan model 730 noise dosimeter, and the study analyzed the correlation between noise sensitivity, perception, and stress, as well as the effect of surgery urgency on noise levels. Results: Out of 70 participants, 67 were included in the final analysis. The ambient noise levels in the ORs were 53.4 and 58.5 dB, respectively. The mean noise sensitivity score was 17.6 (±3.9). Noise was perceived as very soft or soft by 23% of patients, comfortable by 67.8%, and loud or unpleasant by 9.2%. A significant association was found between noise sensitivity and stress (OR 1.15 [95 CI 1.03-1.31], p=0.038). Conclusions: The study found that a subset of patients experienced noise-related stress during CD, particularly those with higher noise sensitivity. These findings suggest the need for interventions to reduce OR noise or manage patient perceptions of noise.