Anesthesiology Research and Practice最新文献

Objectives: Over 1.5 million adolescents undergo surgery each year in the United States. While surgery is performed to improve pain and physical functioning, there may be temporary disability and an increased reliance on caregivers during recovery. Caregivers not accustomed to providing this level of care for adolescents used to greater independence may struggle. We sought to better understand the dyadic experience of at-home care for adolescent patients after nonemergency surgery. Methods: We conducted semi-structured interviews with adolescent patients aged between12and 17 years and an associated caregiver, separately, 2 weeks following nonemergency surgery at a tertiary care pediatric hospital. Interviews were analyzed using latent manifest content analysis concurrent with data collection. Recruitment occurred until thematic saturation was reached. Results: Semi-structured interviews were conducted among 31 adolescent-caregiver dyads. Sixteen caregivers and 12 adolescents described needing or providing help with activities of daily living (ADLs) and/or instrumental ADLs. Four themes emerged: (1) caregiver feelings of overwhelm, primarily among those helping with ADLs; (2) care activities described as something a "good caregiver" does contrasted with the more neutral way in which adolescents described needing help; (3) discrepancies between caregiver and adolescent perspectives regarding increased family interactions resulting from needing or providing care; and (4) the importance of peer friendships to adolescents throughout surgical recovery. Discussion: Half of the adolescents and caregivers reported providing or requiring significant assistance with basic care needs after surgery. While some caregivers felt overwhelmed, others derived satisfaction from being a "good" caregiver and increased family time; adolescents felt more neutral about these interactions. Connections with friends (in-person or online) were helpful to adolescents. Results suggest that interventions directed toward improving caregiver support and helping them find positive aspects of caregiving, as well as encouraging adolescent connection with their friends may improve the perceived quality of recovery in this population.

Purpose: A quality improvement initiative was developed, implemented, and evaluated to improve pediatric postsurgical pain management and reduce hospital length of stay. Methods: An interdisciplinary working group developed the novel integrated pediatric perioperative pain (IP3) pathway adhering to the 3P approach to pain management. Preoperative psychological intervention, patient and caregiver education, standardized medication ordersets, and early identification of increased pain were the focus. Length of stay, opioid consumption, and achievement of physiotherapy goals were compared pre- and postpathway for children undergoing posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Results: The prepathway (n = 34) and postpathway (n = 29) groups were well matched for age, gender, weight, number of levels fused, and socioeconomic status. Postpathway, length of stay in the intensive care unit (pre 1.06 days and post 0.76 days, p ≤ 0.01) and length of hospital stay (pre 6.24 days and post 5.11 days, p ≤ 0.01) significantly decreased. Standardized physiotherapy goals were achieved earlier postpathway implementation. Day of surgery postoperative opioid consumption was reduced in the postpathway group. Discussion: Implementation of the IP3 pathway resulted in significant improvement in pain management for children undergoing major orthopedic surgery. Shortened hospital stay, earlier achievement of physiotherapy goals, and reduced initial opioid consumption were realized. Future efforts will focus on applying this pathway to other pediatric surgeries, optimizing surgical scheduling, and enhancing staff education.

Background: Magnesium sulfate reduces opioid use and its associated side effects. However, no consensus exists on whether the optimal dosing should be based on actual body weight or adjusted ideal body weight. The primary objective of this study was to compare postoperative analgesia after magnesium sulfate infusion, using doses calculated based on actual body weight versus adjusted ideal body weight. Methods: This prospective, randomized, double-blind, controlled clinical trial included 75 participants who underwent target-controlled intravenous general anesthesia. The participants were divided into three groups: a control group (CG), a group receiving magnesium sulfate calculated by actual body weight (AWG), and a group receiving magnesium sulfate calculated based on the adjusted ideal body weight (IWG). Results: The AWG had significantly lower pain scores than the CG (p < 0.001) and IWG (p=0.017). Opioid use was similar between the AWG and IWG, but significantly higher in the CG (AWG = IWG, p=0.08; CG > AWG, p < 0.001; CG = IWG, p 0.03). The increase in magnesium concentration did not reach clinically relevant levels. Neuromuscular blockade latency decreased in the groups receiving magnesium sulfate (p < 0.001 in both comparisons) compared to the CG. Conclusion: Calculating the dose of magnesium sulfate based on actual body weight enhances postoperative analgesia. The increase in magnesium concentration was not clinically significant and did not interfere with the action of cisatracurium in the groups receiving magnesium sulfate. Trial Registration: ClinicalTrials.gov identifier: NCT04645719.

Background: The insertion of a laryngeal mask airway (LMA) using a laryngoscope-guided technique has produced inconsistent outcomes. The use of laryngoscope guidance in facilitating LMA insertion needs further investigation. This meta-analysis compared its effectiveness and safety against standard blind insertion. Method: We systematically searched PubMed, Cochrane Library, Web of Science, and Ovid Medline for randomized controlled trials comparing laryngoscope-guided (Group L) and blind LMA insertion (Group B). The primary outcome measured was fiberoptic staging. The secondary outcomes included oropharyngeal leak pressure (OLP), insertion time, success rate on the first attempt, and the incidence of postoperative sore throat and blood staining. Results: Nine RCTs (1016 patients) were analyzed. The fiberoptic staging in Group L was found to be significantly higher than that in Group B (RR = 1.54; 95% CI: 1.14-2.08; p=0.005). In addition, the OLP of Group L is significantly higher than that of Group B (MD = 2.10 cmH₂O; 95% CI: 0.38 cmH₂O-3.83 cmH₂O; p=0.02). The success rate for the first attempt was also higher in Group L (RR = 1.14; 95% CI: 1.06-1.22; p=0.0005). The insertion time (MD = 3.92 s; 95% CI: -6.69 s-14.52 s; p=0.47), the incidence of sore throat (RR = 0.90; 95% CI: 0.50-1.65; p=0.74), and the incidence of blood staining (RR = 1.19; 95% CI: 0.29-4.79; p=0.81) did not demonstrate statistically significant differences. Conclusion: The use of LMA with laryngoscope guidance may improve fiberoptic staging and OLP and increase the success rate of first-attempt insertion, without significantly raising the incidence of sore throat or blood staining in anesthetized patients.

Background: Following sedation or general anesthesia, emergent agitation (EA) presents as a sequence of abrupt, complicated psychomotor problems marked by perceptual abnormalities, delusions, and disorientation. Studies have proved that melatonin significantly decreases the incidence of postoperative agitation in children after anesthesia. The primary objective of this study was to compare the effectiveness of two doses of oral melatonin as a premedication for orientation score, induction compliance, and emergency agitation of children undergoing surgeries. Methods: In this double-blinded randomized controlled trial, 126 children, aged 4-14, of either sex, with an ASA I or II, scheduled for elective surgery were randomly assigned to get either melatonin 0.4 mg/kg (Group M4) or melatonin 0.2 mg/kg (Group M2), with 63 kids in each group. All children have had the same anesthetic strategy. As a primary outcome, orientation score, induction compliance to intravenous induction anesthesia, and decreased emergency agitation were assessed. Results: Both groups were comparable in terms of demographic characteristics and baseline data. Orientation scores were similar between the groups. Preoperatively, all patients were oriented in both time and place. The two groups had no statistically significant difference according to induction compliance distribution (p=0.065). There was a statistically significant difference in agitation behavior after 5, 10, and 15 min postoperatively in M 4, 2, and total participants (p < 0.001). Conclusion: In pediatric surgical patients, the melatonin dosage does not affect children's compliance with induction but impacts their postoperative behavior by reducing the likelihood of agitation. Administering oral melatonin before surgery could potentially aid in managing postoperative delirium in children.

Objective: This study aimed to develop a predictive model for weaning failure in critically ill patients at high altitudes. Methods: Data of patients requiring invasive mechanical ventilation admitted to the Department of Intensive Care Medicine of Xizang Autonomous Region People's Hospital from January 1, 2023, to November 31, 2023, were retrospectively collected as the train set. The patients were weaned according to the conventional clinical strategy and divided into successful and failed weaning groups. Univariate analysis was performed between the weaning success and weaning failure groups. Indicators with inter-group differences were included in the Lasso regression for further screening and then included in the multivariate logistic regression analysis to establish independent risk factors. Subsequently, a nomogram prediction model was constructed. Data of patients from December 1, 2023, to April 30, 2024, were retrospectively collected as a validation set to verify the prediction model. Results: A total of 226 patients were included in the train set, of which 61 (27.0%) had weaning failure. The length of intensive care unit stay, mechanical ventilation time, mortality, and medical costs of patients in the weaning failure group were higher than those in the success group. After univariate comparison and Lasso regression, hypertension, lower serum albumin, sequential organ failure assessment (SOFA) score, tidal volume, and respiratory rate were identified as independent risk factors for weaning failure. The area under the receiver operating characteristic curve was 0.895 (95% confidence interval (CI): 0.848-0.943) in the training set and 0.886 (95% CI: 0.814-0.958) in the validation set. Conclusions: Hypertension, lower serum albumin, higher SOFA scores, smaller tidal volumes, and faster respiratory rates were independent risk factors for weaning failure in critically ill patients living in high-altitude areas. A prediction model for weaning failure was constructed, and it showed good prediction efficiency after verification.

Objective: This prospective, descriptive, cross-sectional study aimed to establish kaolin-based thromboelastography reference values for previously known healthy third-trimester pregnancy patients. Methods: The study included 280 patients aged 18-38 years who were admitted to labor or scheduled for elective c-sections. Blood specimens collected via IV catheters were immediately mixed with reagents, placed in coagulation cups, and subjected to 60 min of testing at 37°C using a Haemonetics TEG 5000 system. The Hoffman regression method calculated the reference values; furthermore, effect size determination was done using Cohen's δ for comparison of data from other sources. Results: Patients had a median age of 26 (IQR 22-31), and their thromboelastography profile exhibited reference values for: R time (1-7 min), clot kinetics (1-2), angle (59°-82°), maximum amplitude (60-86 mm), and clot lysis at both 30 min (0%-6%) and 60 min (0%-8%). Results revealed significant differences in various thromboelastography parameters when comparing local patient cohorts against published reports, mainly European and North American counterparts. Shorter reaction times, enhanced clot kinetics, larger angles, and higher maximum amplitude, curve amplitude at 30 min, and amplitude at 60 min indicated distinct coagulation profiles and behaviors in the northeastern region of Mexico. Conclusion: Reference values for the Northern region of Mexico have been calculated and are characterized by a shorter clot reaction time, faster clot dynamics, higher angle values, overall greater curve amplitude, and no differences in enzymatic lysis activity compared to samples from other geographic regions.

Background: Anaesthesia providers in all contexts need to be able to communicate with colleagues to meet a variety of clinical and professional needs, including physical help, advice and support as well as learning, supervision and mentorship. Such communication can be regarded as a 'social resource' which underpins anaesthesia providers' practice, but which has not itself been extensively studied. The objective of this scoping review is to provide an overview of the literature related to communication among anaesthesia providers to meet clinical and professional goals, focusing on the modalities, contexts and purposes or outcomes of such communication, as well as which providers are involved. Methods: We conducted a scoping review using the JBI methodology to examine the current literature available, searching the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL and Google Scholar. Papers were eligible for inclusion where they primarily addressed the subject of communication between trained anaesthesia providers for any clinical or professional purpose (excluding purely social interactions). Data were charted for the location and cadre of providers represented, means of communication and the situation, purposes and outcomes of communication. Results: 3872 records were identified for screening, and 225 papers were ultimately included. Communication was reported both as a variable influencing a wide range of clinical and nonclinical outcomes and as an outcome in itself which might be modified by other factors. It was also considered in a smaller group of studies as a resource with varying availability to anaesthesia providers. Physician providers were well represented in included documents, but nurse anaesthetists, clinical officers and other nonphysician, nonnurse anaesthetists were far less commonly included. The majority of identified studies on communication between anaesthesia providers originated from and related to high-income countries. Conclusion: Communication between anaesthesia providers affects all aspects of their practice and has implications for both patient outcomes and workforce capacity. More research is necessary to understand how the availability of communication as a resource affects patient care and health worker well-being, particularly in low- and middle-income contexts and among nonphysician anaesthesia providers.

Background: Pain management is an integral part of recovery after major abdominal surgeries. Traditionally, epidural analgesia is used for postoperative pain management in major abdominal surgeries. However, intravenous lidocaine has recently been proven to be a good alternative. However, there is very limited evidence comparing their efficacy in major abdominal surgery. The aim of this review is to compare the effectiveness of epidural analgesia with intravenous lidocaine in reducing pain and opioid consumption following major abdominal surgery. Methods: We searched PubMed and Cochrane Library from inception to May 2024 to identify studies that match our topic. We performed all statistical analyses using RevMan. The primary outcome was pain scores. The other outcomes were opioid requirements, postoperative nausea and vomiting, hospital stay duration, and time to pass flatus. Results: Seven studies (six randomized clinical trials and one observational study; n = 643) were included. Our results suggest that epidural bupivacaine significantly reduced pain scores during the first 24 h postoperatively as compared with the patients who received intravenous lidocaine (Std. mean difference: -0.23; 95% confidence interval [CI]: -0.40, -0.06; and p=0.008). There was no difference at 48 h (Std. mean difference: -0.09; 95% CI: -0.27, 0.08; and p=0.028) and 72 h intervals (Std. mean difference: -0.08; 95% CI: -0.25, 0.09; and p=0.037). Conclusion: Our study shows that epidural analgesia, particularly epidural bupivacaine, provides superior pain relief as compared to intravenous lidocaine during the first 24 h postoperatively. However, there was heterogeneity among studies. Thus, in future, large standardized randomized controlled trials are required.