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Association between Intraoperative Early Warning Score and Mortality and In-Hospital Stay in Lower Gastrointestinal Spontaneous Perforation. 下消化道自发性穿孔术中早期预警评分与死亡率和住院时间的关系
IF 1.4 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/8910198
Kazuya Takada, Yusuke Nagamine, Akira Ishii, Yan Shuo, Takumi Seike, Hanako Horikawa, Kentaro Matsumiya, Tetsuya Miyashita, Takahisa Goto

Background: Early warning scores (EWSs) can be easily calculated from physiological indices; however, the extent to which intraoperative EWSs and the corresponding changes are associated with patient prognosis is unknown. In this study, we investigated whether EWS and the corresponding time-related changes are associated with patient outcomes during the anesthetic management of lower gastrointestinal perforation.

Methods: This was a single-center, retrospective cohort study conducted at a tertiary emergency care center. Adult patients who underwent surgery for spontaneous lower gastrointestinal perforations between September 1, 2012, and December 31, 2019, were included. The National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) were calculated based on the intraoperative physiological indices, and the associations with in-hospital death and length of hospital stay were investigated.

Results: A total of 101 patients were analyzed. The median age was 70 years, and there were 11 cases of in-hospital death (mortality rate: 10.9%). There was a significant association between the intraoperative maximum NEWS and in-hospital death (odds ratio (OR): 1.60, 95% confidence interval (CI): 1.10-2.32, p=0.013) and change from initial to maximum NEWS (OR: 1.60, 95% CI: 1.07-2.40, p=0.023) in the crude analysis. However, when adjustments were made for confounding factors, no statistically significant associations were found. Other intraoperative EWS values and changes were not significantly associated with the investigated outcomes. The preoperative sepsis-related organ failure assessment score and the intraoperative base excess value were significantly associated with in-hospital death.

Conclusions: No clear association was observed between EWSs and corresponding changes and in-hospital death in cases of lower gastrointestinal perforation. The preoperative sepsis-related organ failure assessment score and intraoperative base excess value were significantly associated with in-hospital death.

研究背景:早期预警评分(ews)可以很容易地从生理指标中计算出来;然而,术中EWSs和相应的变化与患者预后的关联程度尚不清楚。在这项研究中,我们研究了EWS和相应的时间相关变化是否与下消化道穿孔麻醉治疗期间的患者预后相关。方法:这是一项在三级急救中心进行的单中心、回顾性队列研究。纳入了2012年9月1日至2019年12月31日期间因自发性下消化道穿孔接受手术的成年患者。根据术中生理指标计算国家预警评分(NEWS)和修正预警评分(MEWS),并探讨其与院内死亡和住院时间的关系。结果:共分析101例患者。年龄中位数为70岁,住院死亡11例(死亡率10.9%)。粗分析中,术中最大NEWS与院内死亡(优势比(OR): 1.60, 95%可信区间(CI): 1.10-2.32, p=0.013)以及从初始到最大NEWS的变化(OR: 1.60, 95% CI: 1.07-2.40, p=0.023)之间存在显著相关性。然而,当对混杂因素进行调整时,没有发现统计学上显著的关联。术中其他EWS值和变化与研究结果无显著相关。术前败血症相关器官衰竭评估评分和术中基础超额值与院内死亡显著相关。结论:下消化道穿孔患者ews与相应变化及院内死亡之间无明显关联。术前败血症相关脏器功能衰竭评估评分和术中基础超值与院内死亡显著相关。
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引用次数: 0
Incidence and Factors Associated with Postspinal Headache in Obstetric Mothers Who Underwent Spinal Anesthesia from a Tertiary Hospital in Western Uganda: A Prospective Cohort Study. 乌干达西部一家三级医院接受脊髓麻醉的产科母亲脊柱后头痛的发生率和相关因素:一项前瞻性队列研究
IF 1.4 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/5522444
Mohamud Jelle Osman, Joy Muhumuza, Yarine Fajardo, Andrew Kwikiriza, Baluku Asanairi, Rogers Kajabwangu, Marie Pascaline Sabine Ishimwe, Theoneste Hakizimana

Background: The proportion of obstetric mothers reporting postspinal headache (PSH) in Uganda is high. The aim of this study is to determine the incidence and factors associated with postspinal headache among obstetric patients who underwent spinal anesthesia during cesarean section at a tertiary hospital in Western Uganda.

Methods: A prospective cohort study was done on 274 consecutively enrolled obstetric patients at Fort Portal Regional Referral Hospital (FRRH) from August to November 2022. Pretested questionnaires were used to obtain the data needed for analysis. The data were entered into Microsoft Excel version 16, coded, and transported into SPSS version 22 for analysis. Descriptive statistics was used to determine the incidence of postspinal headache. Binary logistic regression was computed to obtain factors associated with postspinal headache.

Results: The overall incidence of postspinal headache was 38.3% (95% CI: 32.5-44.4). Factors with higher odds of developing postspinal headache included using cutting needle (aOR 3.206, 95% CI: 1.408-7.299, p=0.006), having a previous history of chronic headache (aOR 3.326, 95% CI: 1.409-7.85, p=0.006), having lost >1500 mls of blood intraoperatively (aOR 6.618, 95% CI: 1.582-27.687, p=0.010), initiation of ambulation >24 h after spinal anesthesia (aOR 2.346, 95% CI: 1.079-5.102, p=0.032), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (aOR 3.278, 95% CI: 1.263-8.510, p=0.015), undergoing 2 puncture attempts (aOR 7.765, 95% CI: 3.48-17.326, p ≤ 0.001), 3 puncture attempts (aOR 27.61, 95% CI: 7.671-99.377, p ≤ 0.001) and >3 puncture attempts (aOR 20.17, 95% CI: 1.614-155.635, p=0.004), those prescribed weak opioids (aOR 20.745, 95% CI: 2.964-145.212, p=0.002), nonsteroidal anti-inflammatory drug (NSAID) with nonopioids (aOR 6.104, 95% CI: 1.257-29.651, p=0.025), and NSAID with weak opioids (aOR 5.149, 95% CI: 1.047-25.326, p=0.044). Women with a body mass index (BMI) of 25-29.9 kg/m2 (aOR 0.471, 95% CI: 0.224-0.989, p=0.047) and a level of puncture entry at L3-4 (aOR 0.381, 95% CI: 0.167-0.868, p=0.022) had lower odds of developing PSH.

Conclusions: The incidence of postspinal headache is still high as compared to the global range. This was significantly associated with needle design, amount of cerebro-spinal fluid lost, number of puncture attempts, body mass index, previous diagnosis with chronic headache, amount of intraoperative blood loss, time at start of ambulation, level of puncture entry, and class of analgesic prescribed. We recommend the use of a smaller gauge needle, preventing CSF loss, deliberate attempts to ensure successful puncture with fewer attempts, puncture attempt

背景:在乌干达,报告脊髓后头痛(PSH)的产科母亲比例很高。本研究的目的是确定在乌干达西部一家三级医院剖宫产手术中接受脊髓麻醉的产科患者中脊髓后头痛的发生率和相关因素。方法:对2022年8月至11月在Fort Portal地区转诊医院(FRRH)连续入组的274例产科患者进行前瞻性队列研究。使用预测问卷来获得分析所需的数据。将数据输入Microsoft Excel version 16进行编码,再传送到SPSS version 22进行分析。描述性统计用于确定脊髓后头痛的发生率。计算二元逻辑回归以获得与脊柱后头痛相关的因素。结果:脊柱后头痛的总发生率为38.3% (95% CI: 32.5-44.4)。发生脊髓后头痛的高危因素包括:使用切针(aOR 3.206, 95% CI: 1.408-7.299, p=0.006)、既往有慢性头痛史(aOR 3.326, 95% CI: 1.409-7.85, p=0.006)、术中失血量>1500毫升(aOR 6.618, 95% CI: 1.582-27.687, p=0.010)、脊髓麻醉后>24小时开始活动(aOR 2.346, 95% CI: 1.079-5.102, p=0.032)、允许2-3滴脑脊液(aOR 3.278, 95% CI: 0.032);1.263-8.510, p=0.015)、2次穿刺尝试(aOR 7.765, 95% CI: 3.48-17.326, p≤0.001)、3次穿刺尝试(aOR 27.61, 95% CI: 7.671-99.377, p≤0.001)和>3次穿刺尝试(aOR 20.17, 95% CI: 1.614-155.635, p=0.004)、处方弱阿片类药物(aOR 20.745, 95% CI: 2.964-145.212, p=0.002)、非甾体抗炎药(NSAID)联合非阿片类药物(aOR 6.104, 95% CI: 1.256 -29.651, p=0.025)、非甾体抗炎药(NSAID)联合弱阿片类药物(aOR 5.149, 95% CI: 1.047-25.326, p=0.044)。体重指数(BMI)为25-29.9 kg/m2 (aOR 0.471, 95% CI: 0.224-0.989, p=0.047)和L3-4穿刺水平(aOR 0.381, 95% CI: 0.168 -0.868, p=0.022)的女性患PSH的几率较低。结论:与全球范围相比,脊髓后头痛的发病率仍然很高。这与针头设计、脑脊液流失量、穿刺次数、体重指数、既往慢性头痛诊断、术中出血量、开始走动时间、穿刺水平和处方镇痛药类别显著相关。我们建议使用较小尺寸的针头,防止脑脊液丢失,慎重尝试以更少的次数确保穿刺成功,在L3-4处穿刺,减少术中出血量,早期下床,并处方足够的镇痛药以减少脊髓后头痛的发生率。
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引用次数: 0
ICU-Managed Patients' Epidemiology, Characteristics, and Outcomes: A Retrospective Single-Center Study. icu管理患者的流行病学、特征和结果:一项回顾性单中心研究。
IF 1.4 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/9388449
Ahmed Muhammad Bashir, Marian Muse Osman, Hawa Nuradin Mohamed, Ifrah Adan Hilowle, Halima Abdulkadir Ahmed, Abdirahman Abdikadir Osman, Osman Abubakar Fiidow

Background: Resources are limited, and it is exceedingly difficult to provide intensive care in developing nations. In Somalia, intensive care unit (ICU) care was introduced only a few years ago.

Purpose: In this study, we aimed to determine the epidemiology, characteristics, and outcome of ICU-managed patients in a tertiary hospital in Mogadishu.

Methods: We retrospectively evaluated the files of 1082 patients admitted to our ICU during the year 2021.

Results: The majority (39.7%) of the patients were adults (aged between 20 and 39 years), and 67.8% were male patients. The median ICU length of stay was three days (IQR = 5 days), and nonsurvivors had shorter stays, one day. The mortality rate was 45.1%. The demand for critical care services in low-income countries is high.

Conclusion: The country has a very low ICU bed capacity. Critical care remains a neglected area of health service delivery in this setting, with large numbers of patients with potentially treatable conditions not having access to such services.

背景:资源有限,在发展中国家提供重症监护极其困难。在索马里,重症监护病房(ICU)护理几年前才开始实行。目的:在本研究中,我们旨在确定摩加迪沙一家三级医院icu管理患者的流行病学、特征和预后。方法:回顾性分析2021年我院ICU收治的1082例患者的资料。结果:20 ~ 39岁的成人占绝大多数(39.7%),男性占67.8%。ICU的中位住院时间为3天(IQR = 5天),非幸存者的住院时间更短,为1天。死亡率为45.1%。低收入国家对重症监护服务的需求很高。结论:我国ICU病床容量很低。在这种情况下,重症监护仍然是卫生服务提供的一个被忽视的领域,大量患有潜在可治疗疾病的患者无法获得此类服务。
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引用次数: 0
The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study. 甲状腺手术后未被报道的术后痛苦:吞咽困难,发音困难和颈部疼痛-横断面研究。
IF 1.4 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/1312980
Hunduma Jisha Chawaka, Zenebe Bekele Teshome

Background and aims: Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery.

Methods: A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness.

Result: Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and p = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and p = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and p ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and p = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p ≤ 0.001).

Conclusion: The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.

背景和目的:术后声音改变、吞咽困难、咽喉疼痛和颈部疼痛是甲状腺手术后最常见的主诉。然而,很少重视这一问题,特别是在高度观察到手术和麻醉服务未满足需求的地方,即,这个问题很少得到关注,特别是在观察到手术和麻醉服务差距的国家。因此,本研究旨在确定甲状腺手术后声音变化和相关投诉的大小和相关因素。方法:对2021年6月1日至12月30日行甲状腺手术的151例患者进行横断面研究。在患者恢复意识后的术后期间检索数据。结果:在151名参与者中,98名(64.9%)患者在甲状腺手术后24小时内抱怨声音改变或吞咽困难和颈部疼痛。年龄≥30岁者占58.3%,平均年龄33.7±8.3岁,女性102岁(67.5%)。甲状腺手术后颈部疼痛最多(52.3%),其次是声音改变(38.4%)和吞咽困难(37.7%)。甲状腺手术后吞咽困难与患者术中频繁出现低血压(AOR = 23.24, 95% CI 4.6-116.7, p = 0.01)、手术类型(全甲状腺切除术)(AOR = 8.62, 95% CI 1.21-61.50, p = 0.03)和ETT较大(AOR = 4.92, 95% CI 1.34-18.01, p = 0.02)显著相关。术后嗓音改变与气管内管较大(AOR = 15.47, 95% CI 3.4 ~ 69.5, p≤0.001)、手术时间超过2小时(AOR = 7.34, 95% CI 1.5 ~ 35.1, p = 0.01)、术中低血压(AOR = 23.24, 95% CI 4.6 ~ 116.7, p≤0.001)相关。结论:甲状腺切除术后颈部疼痛、咽喉不适主诉高于64.9%。术中低血压、失血、ETT体积利用率高和手术时间是确定的可能的危险因素,必须尽可能减少。术后必须考虑病人的放心。
{"title":"The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study.","authors":"Hunduma Jisha Chawaka,&nbsp;Zenebe Bekele Teshome","doi":"10.1155/2023/1312980","DOIUrl":"https://doi.org/10.1155/2023/1312980","url":null,"abstract":"<p><strong>Background and aims: </strong>Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness.</p><p><strong>Result: </strong>Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and <i>p</i> = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and <i>p</i> = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and <i>p</i> = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and <i>p</i> ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and <i>p</i> = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and <i>p</i> ≤ 0.001).</p><p><strong>Conclusion: </strong>The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10388295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anticipated vs. Experienced Pain at Site of Spinal Needle Insertion in Patients Undergoing Elective Lower Segment Caesarean Section: Perspective from Resource-Limited Region. 选择性下节段剖宫产患者脊髓针插入部位的预期疼痛与经历疼痛:来自资源有限地区的视角。
IF 1.4 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/5516346
Waleed Bin Ghaffar, Fauzia Minai

Background: Despite significant advantages, approximately 20% of pregnant patients refuse spinal anaesthesia in caesarean section due to fear of spinal needle prick. Studies have shown that the patient's expectation of pain is higher than what they experience in real. The objective was to evaluate the difference between anticipated and actually experienced pain at the spinal needle insertion site in spinal anaesthesia for pregnant women undergoing elective lower segment caesarean section (ELSCS).

Method: The cross-sectional study was conducted in a labour room suite of a tertiary care hospital.

Results: A total of 50 patients scheduled for ELSCS were included. The median experienced pain at the site of spinal needle insertion was significantly low as compared to anticipated pain (P value < 0.01). For the identification of predictors impacting the anticipated and experienced pain, univariate and multivariate regression models were applied. Amsterdam Preoperative Anxiety and Information Scale ≥11 for anticipated pain showed a statistically significant positive correlation in univariate (coefficient: 2.59; 95% CI: 1.49 to 3.68; P value < 0.001) and multivariable analyses (coefficient: 2.51; 95% CI: 1.36 to 3.67; P value < 0.001). Thus, anxiety was associated with statistically significant higher anticipated pain.

Conclusion: In conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain at the site of spinal needle insertion in ELSCS.

背景:尽管有明显的优势,但约20%的孕妇因害怕脊髓针刺痛而拒绝剖腹产。研究表明,病人对疼痛的预期高于他们在现实中所经历的。目的是评估孕妇择期下段剖宫产(ELSCS)脊髓麻醉时预期和实际经历的脊髓针插入部位疼痛的差异。方法:横断面研究在某三级医院产房套房进行。结果:共纳入50例计划进行ELSCS的患者。结论:综上所述,在ELSCS中,产科人群中预期与实际经历的脊髓针插入部位疼痛存在显著差异。
{"title":"Anticipated vs. Experienced Pain at Site of Spinal Needle Insertion in Patients Undergoing Elective Lower Segment Caesarean Section: Perspective from Resource-Limited Region.","authors":"Waleed Bin Ghaffar,&nbsp;Fauzia Minai","doi":"10.1155/2023/5516346","DOIUrl":"https://doi.org/10.1155/2023/5516346","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advantages, approximately 20% of pregnant patients refuse spinal anaesthesia in caesarean section due to fear of spinal needle prick. Studies have shown that the patient's expectation of pain is higher than what they experience in real. The objective was to evaluate the difference between anticipated and actually experienced pain at the spinal needle insertion site in spinal anaesthesia for pregnant women undergoing elective lower segment caesarean section (ELSCS).</p><p><strong>Method: </strong>The cross-sectional study was conducted in a labour room suite of a tertiary care hospital.</p><p><strong>Results: </strong>A total of 50 patients scheduled for ELSCS were included. The median experienced pain at the site of spinal needle insertion was significantly low as compared to anticipated pain (<i>P</i> value < 0.01). For the identification of predictors impacting the anticipated and experienced pain, univariate and multivariate regression models were applied. Amsterdam Preoperative Anxiety and Information Scale ≥11 for anticipated pain showed a statistically significant positive correlation in univariate (coefficient: 2.59; 95% CI: 1.49 to 3.68; <i>P</i> value < 0.001) and multivariable analyses (coefficient: 2.51; 95% CI: 1.36 to 3.67; <i>P</i> value < 0.001). Thus, anxiety was associated with statistically significant higher anticipated pain.</p><p><strong>Conclusion: </strong>In conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain at the site of spinal needle insertion in ELSCS.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10093459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial. 肌注氯胺酮对鼻术后躁动的影响:一项前瞻性双盲随机对照试验。
IF 1.4 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/2286451
Husam A Almajali, Ali M Abu Dalo, Nidal M Al-Soud, Ali Almajali, Abdelrazzaq Alrfooh, Thani Alawamreh, Hamza Al-Wreikat

This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010-0.103; p < 0.001). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359-7.944; p=0.008), longer duration of surgery (OR: 1.010; 95% CI: 1.001-1.020; p=0.031), and OSRP surgery (OR: 2.157; CI: 1.056-5.999; p=0.037). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.

本研究探讨在手术结束时以亚麻醉剂量给予肌内氯胺酮对中隔成形术和开放式中隔成形术(OSRP)后出现躁动(EA)的影响。随机选取在2022年5月至10月间接受鼻中隔成形术或OSRP的160例ASA I-II成年患者,分为两组,每组80例:氯胺酮(K组)和生理盐水(S组),S组为对照组。手术结束后立即关闭吸入剂,K组肌注含氯胺酮0.7 mg/kg的生理盐水2 ml, S组肌注生理盐水2 ml。拔管后使用Richmond躁动-镇静量表(RASS)记录麻醉苏醒时的镇静和躁动评分。生理盐水组EA的发生率高于氯胺酮组(56.3% vs. 5%;优势比(OR): 0.033;95%置信区间(CI): 0.010-0.103;P < 0.001)。与躁动发生率较高相关的变量为ASA II分类(OR: 3.286;95% (ci): 1.359-7.944;p=0.008),手术时间较长(OR: 1.010;95% ci: 1.001-1.020;p=0.031), OSRP手术(OR: 2.157;置信区间:1.056—-5.999;p = 0.037)。研究得出结论,手术结束时肌注氯胺酮剂量为0.7 mg/kg,可有效降低鼻中隔成形术和OSRP手术中EA的发生率。
{"title":"Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial.","authors":"Husam A Almajali,&nbsp;Ali M Abu Dalo,&nbsp;Nidal M Al-Soud,&nbsp;Ali Almajali,&nbsp;Abdelrazzaq Alrfooh,&nbsp;Thani Alawamreh,&nbsp;Hamza Al-Wreikat","doi":"10.1155/2023/2286451","DOIUrl":"https://doi.org/10.1155/2023/2286451","url":null,"abstract":"<p><p>This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010-0.103; <i>p</i> < 0.001). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359-7.944; <i>p</i>=0.008), longer duration of surgery (OR: 1.010; 95% CI: 1.001-1.020; <i>p</i>=0.031), and OSRP surgery (OR: 2.157; CI: 1.056-5.999; <i>p</i>=0.037). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9075303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Dexmedetomidine Low Doses with or without Midazolam in Cats: Clinical, Hemodynamic, Blood Gas Analysis, and Echocardiographic Effects. 低剂量右美托咪定加或不加咪达唑仑对猫的影响:临床、血液动力学、血气分析和超声心动图的影响
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2022-11-24 eCollection Date: 2022-01-01 DOI: 10.1155/2022/9613721
Marina Lopes Castro, Bruna Maia Cerqueira Câmara, Maira Souza Oliveira Barreto, Raphael Rocha Wenceslau, Andressa Karollini E Silva, Natália Fagundes, Renata Andrade Silva, Eutálio Luiz Mariani Pimenta, Suzane Lilian Beier

Objectives: The aim of the study is to compare the sedative, cardiorespiratory, echocardiographic, and blood gas effects of dexmedetomidine and methadone associated or not with midazolam for restraint chemistry in cats.

Methods: Eighteen healthy young cats (4.06 ± 0.48 kg) were randomly sedated with two protocols, through the intramuscular route: dexmedetomidine (5 µg.kg-1), methadone (0.3 mg. kg-1) and midazolam (0.3 mg. kg-1) (DMTM, n = 9), or dexmedetomidine (7.5 µg.kg-1) and methadone (0.3 mg. kg-1) (DMT, n = 9). The cardiorespiratory parameters were measured at baseline, 5 and 10 minutes after pharmacological latency. The sedation, analgesia, and muscle relaxation scores were assessed before and 5 minutes after pharmacological latency, while arterial blood gas analysis and echocardiography were assessed before and after 10 or 15 minutes, respectively.

Results: There was no difference between the protocols regarding the cardiorespiratory, blood gas, and echocardiographic parameters used. The scores for sedation, analgesia, and muscle relaxation also did not differ between the protocols, with the degree of sedation, analgesia, and myorelaxation considered satisfactory in both groups. A significant decrease in heart rate (HR) was observed after administration of the sedative protocols, reaching a maximum reduction at T10 (46% and 53% reduction in the DMT and DMTM groups, respectively). The reduction in HR had an impact on echocardiographic parameters such as CO, which decreased 53% and 56% in the DMT and DMTM groups, respectively. There was a significant reduction in PaO2, SaO2, ejection fraction, and fractional shortening in both protocols. SpO2 decreased significantly after 5 minutes of sedation in the DMT group, but with a minimum mean SpO2 of 92% in T5. The respiratory rate decreased significantly at 5 and 10 minutes in the DMTM group, while PaCO2 increased in both groups, indicating respiratory depression caused by the drugs. Conclusions and Relevance. The study pointed out that both sedative protocols can be recommended for clinical sedation of young and healthy cats in the doses used. However, both protocols resulted in cardiorespiratory depression in cats and also the particularities of the animals should be evaluated regarding reducing cardiac output by more than 50%.

研究目的本研究的目的是比较右美托咪定和美沙酮与咪达唑仑联合或不联合对猫的镇静、心肺功能、超声心动图和血气效应:对 18 只健康的幼猫(4.06 ± 0.48 千克)随机采用两种方法进行肌肉注射镇静:右美托咪定(5 微克/千克-1)、美沙酮(0.3 毫克/千克-1)和咪达唑仑(0.3 毫克/千克-1)(DMTM,n = 9),或右美托咪定(7.5 微克/千克-1)和美沙酮(0.3 毫克/千克-1)(DMT,n = 9)。分别在基线、药理潜伏期后 5 分钟和 10 分钟测量心肺参数。镇静、镇痛和肌肉松弛评分分别在药理潜伏前和药理潜伏后 5 分钟进行评估,动脉血气分析和超声心动图分别在药理潜伏前和药理潜伏后 10 或 15 分钟进行评估:结果:不同方案使用的心肺功能、血气和超声心动图参数没有差异。两组患者的镇静、镇痛和肌松评分也无差异,镇静、镇痛和肌松程度均令人满意。使用镇静方案后,心率(HR)明显下降,在 T10 时达到最大降幅(DMT 组和 DMTM 组分别下降了 46% 和 53%)。心率的降低对超声心动图参数也有影响,如 CO,DMT 组和 DMTM 组分别降低了 53% 和 56%。在两种方案中,PaO2、SaO2、射血分数和分数缩短率都明显下降。DMT 组在镇静 5 分钟后 SpO2 明显下降,但 T5 的平均 SpO2 最低为 92%。DMTM组的呼吸频率在5分钟和10分钟后明显下降,而两组的PaCO2均上升,这表明药物导致了呼吸抑制。结论和意义。研究指出,两种镇静方案在使用剂量上都可推荐用于年轻健康猫咪的临床镇静。不过,这两种方案都会导致猫的心肺功能抑制,而且还应该评估动物的特殊性,以确定心输出量是否减少了 50%以上。
{"title":"Effect of Dexmedetomidine Low Doses with or without Midazolam in Cats: Clinical, Hemodynamic, Blood Gas Analysis, and Echocardiographic Effects.","authors":"Marina Lopes Castro, Bruna Maia Cerqueira Câmara, Maira Souza Oliveira Barreto, Raphael Rocha Wenceslau, Andressa Karollini E Silva, Natália Fagundes, Renata Andrade Silva, Eutálio Luiz Mariani Pimenta, Suzane Lilian Beier","doi":"10.1155/2022/9613721","DOIUrl":"10.1155/2022/9613721","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study is to compare the sedative, cardiorespiratory, echocardiographic, and blood gas effects of dexmedetomidine and methadone associated or not with midazolam for restraint chemistry in cats.</p><p><strong>Methods: </strong>Eighteen healthy young cats (4.06 ± 0.48 kg) were randomly sedated with two protocols, through the intramuscular route: dexmedetomidine (5 <i>µ</i>g.kg<sup>-1</sup>), methadone (0.3 mg. kg<sup>-1</sup>) and midazolam (0.3 mg. kg<sup>-1</sup>) (DMTM, <i>n</i> = 9), or dexmedetomidine (7.5 <i>µ</i>g.kg<sup>-1</sup>) and methadone (0.3 mg. kg<sup>-1</sup>) (DMT, <i>n</i> = 9). The cardiorespiratory parameters were measured at baseline, 5 and 10 minutes after pharmacological latency. The sedation, analgesia, and muscle relaxation scores were assessed before and 5 minutes after pharmacological latency, while arterial blood gas analysis and echocardiography were assessed before and after 10 or 15 minutes, respectively.</p><p><strong>Results: </strong>There was no difference between the protocols regarding the cardiorespiratory, blood gas, and echocardiographic parameters used. The scores for sedation, analgesia, and muscle relaxation also did not differ between the protocols, with the degree of sedation, analgesia, and myorelaxation considered satisfactory in both groups. A significant decrease in heart rate (HR) was observed after administration of the sedative protocols, reaching a maximum reduction at T10 (46% and 53% reduction in the DMT and DMTM groups, respectively). The reduction in HR had an impact on echocardiographic parameters such as CO, which decreased 53% and 56% in the DMT and DMTM groups, respectively. There was a significant reduction in PaO<sub>2</sub>, SaO<sub>2</sub>, ejection fraction, and fractional shortening in both protocols. SpO<sub>2</sub> decreased significantly after 5 minutes of sedation in the DMT group, but with a minimum mean SpO<sub>2</sub> of 92% in T5. The respiratory rate decreased significantly at 5 and 10 minutes in the DMTM group, while PaCO<sub>2</sub> increased in both groups, indicating respiratory depression caused by the drugs. <i>Conclusions and Relevance</i>. The study pointed out that both sedative protocols can be recommended for clinical sedation of young and healthy cats in the doses used. However, both protocols resulted in cardiorespiratory depression in cats and also the particularities of the animals should be evaluated regarding reducing cardiac output by more than 50%.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9715331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35257007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Strategy for Calculating Magnesium Sulfate Dose in Obese Patients: A Randomized Blinded Trial. 肥胖患者硫酸镁剂量计算策略:一项随机盲法试验。
IF 1.4 Q2 Medicine Pub Date : 2022-11-08 eCollection Date: 2022-01-01 DOI: 10.1155/2022/8424670
Sebastião E Silva Filho, Omar S Klinsky, Miguel A M C Gonzalez, Sandro Dainez, Flavio Angelis, Joaquim E Vieira

Background: Magnesium sulfate has analgesic properties during the postoperative period. However, there is a knowledge gap in pharmacology related to the use of the real, ideal, or corrected ideal body weight to calculate its dose in obese patients. This trial compared postoperative analgesia using actual and corrected ideal body weight.

Methods: Seventy-five obese patients scheduled to undergo laparoscopic gastroplasty or cholecystectomy under general anesthesia were randomly assigned to three groups. The patients in the control group did not receive magnesium sulfate; the other two groups received magnesium sulfate at 40 mg·kg-1 of actual body weight or corrected ideal body weight.

Results: In patients with body mass index >30 mg·kg-2 (mean body mass index ranging from 32.964 kg·m-2 to 33.985 kg·m-2, according to the groups) scheduled for video laparoscopic cholecystectomy, there were no differences in the blood magnesium concentrations in the groups receiving magnesium sulfate throughout the study, regardless of whether the strategy to calculate its dose was based on total or corrected ideal body weight. Patients in the groups receiving magnesium sulfate showed a significant reduction in morphine consumption (p ≤ 0.001) and pain scores (p=0.006) in the postoperative period compared to those in the control group. There were no significant differences in morphine consumption (p=0.323) or pain scores (p=0.082) between the two groups receiving magnesium sulfate. There were no differences in the total duration of neuromuscular block induced by cisatracurium among the three groups (p=0.181).

Conclusions: Magnesium sulfate decreased postoperative pain and morphine consumption without affecting the recovery time of cisatracurium in obese patients undergoing laparoscopic cholecystectomy. Strategies to calculate the dose based on the actual or corrected ideal body weight had similar outcomes related to analgesia and the resulting blood magnesium concentration. However, as the sample in this trial presented body mass indices ranging from 30.11 kg·m-2 to 47.11 kg/m-2, further studies are needed to confirm these findings in more obese patients, easily found in centers specialized.

背景:硫酸镁在术后具有镇痛作用。然而,对于肥胖患者使用真实、理想或校正后的理想体重来计算其剂量,药理学方面存在知识空白。本试验比较了使用实际体重和矫正后的理想体重的术后镇痛效果。方法:将75例全麻下行腹腔镜胃成形术或胆囊切除术的肥胖患者随机分为三组。对照组患者不服用硫酸镁;另外两组给予实际体重40 mg·kg-1或校正后理想体重的硫酸镁治疗。结果:在计划进行视频腹腔镜胆囊切除术的体重指数>30 mg·kg-2的患者中(平均体重指数为32.964 kg·m-2至33.985 kg·m-2,根据各组),在整个研究过程中,无论其剂量计算策略是基于总体重还是校正后的理想体重,接受硫酸镁治疗组的血镁浓度均无差异。与对照组相比,硫酸镁组患者术后吗啡用量(p≤0.001)和疼痛评分(p=0.006)均显著降低。两组患者吗啡用量(p=0.323)和疼痛评分(p=0.082)差异无统计学意义。三组间顺阿曲库铵诱导神经肌肉阻滞的总持续时间差异无统计学意义(p=0.181)。结论:硫酸镁可减轻肥胖腹腔镜胆囊切除术患者术后疼痛和吗啡用量,且不影响顺阿曲库铵的恢复时间。根据实际或修正后的理想体重计算剂量的策略与镇痛和由此产生的血镁浓度的结果相似。然而,由于本试验样本的体重指数在30.11 kg·m-2至47.11 kg/m-2之间,需要进一步的研究来证实更多肥胖患者的发现,这些发现很容易在专业中心发现。
{"title":"Strategy for Calculating Magnesium Sulfate Dose in Obese Patients: A Randomized Blinded Trial.","authors":"Sebastião E Silva Filho,&nbsp;Omar S Klinsky,&nbsp;Miguel A M C Gonzalez,&nbsp;Sandro Dainez,&nbsp;Flavio Angelis,&nbsp;Joaquim E Vieira","doi":"10.1155/2022/8424670","DOIUrl":"https://doi.org/10.1155/2022/8424670","url":null,"abstract":"<p><strong>Background: </strong>Magnesium sulfate has analgesic properties during the postoperative period. However, there is a knowledge gap in pharmacology related to the use of the real, ideal, or corrected ideal body weight to calculate its dose in obese patients. This trial compared postoperative analgesia using actual and corrected ideal body weight.</p><p><strong>Methods: </strong>Seventy-five obese patients scheduled to undergo laparoscopic gastroplasty or cholecystectomy under general anesthesia were randomly assigned to three groups. The patients in the control group did not receive magnesium sulfate; the other two groups received magnesium sulfate at 40 mg·kg<sup>-1</sup> of actual body weight or corrected ideal body weight.</p><p><strong>Results: </strong>In patients with body mass index >30 mg·kg<sup>-2</sup> (mean body mass index ranging from 32.964 kg·m<sup>-2</sup> to 33.985 kg·m<sup>-2</sup>, according to the groups) scheduled for video laparoscopic cholecystectomy, there were no differences in the blood magnesium concentrations in the groups receiving magnesium sulfate throughout the study, regardless of whether the strategy to calculate its dose was based on total or corrected ideal body weight. Patients in the groups receiving magnesium sulfate showed a significant reduction in morphine consumption (<i>p</i> ≤ 0.001) and pain scores (<i>p</i>=0.006) in the postoperative period compared to those in the control group. There were no significant differences in morphine consumption (<i>p</i>=0.323) or pain scores (<i>p</i>=0.082) between the two groups receiving magnesium sulfate. There were no differences in the total duration of neuromuscular block induced by cisatracurium among the three groups (<i>p</i>=0.181).</p><p><strong>Conclusions: </strong>Magnesium sulfate decreased postoperative pain and morphine consumption without affecting the recovery time of cisatracurium in obese patients undergoing laparoscopic cholecystectomy. Strategies to calculate the dose based on the actual or corrected ideal body weight had similar outcomes related to analgesia and the resulting blood magnesium concentration. However, as the sample in this trial presented body mass indices ranging from 30.11 kg·m<sup>-2</sup> to 47.11 kg/m<sup>-2</sup>, further studies are needed to confirm these findings in more obese patients, easily found in centers specialized.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9666020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intraoperative Analgesia with Magnesium Sulfate versus Remifentanil Guided by Plethysmographic Stress Index in Post-Bariatric Dermolipectomy: A Randomized Study. 硫酸镁与瑞芬太尼在体重减轻真皮切除术后体积脉搏图应激指数引导下术中镇痛的随机对照研究。
IF 1.4 Q2 Medicine Pub Date : 2022-10-26 eCollection Date: 2022-01-01 DOI: 10.1155/2022/2642488
S E Silva Filho, S Dainez, M A M C Gonzalez, F Angelis, J E Vieira, C S Sandes

Background: Magnesium sulfate reduces pain scores and analgesic consumption. Its use as an analgesic resource in opioid-free or opioid-sparing techniques have also been tested. The evaluation of the antinociceptive potency of drugs and doses indirectly, through hemodynamic oscillations has been questioned. A relatively new algorithm called the plethysmographic stress index has been considered sensitive and relatively specific as a parameter for assessing the need for intraoperative analgesia.

Objectives: The aim of this trial was to assess the intraoperative analgesic capacity of magnesium sulfate compared to remifentanil. The secondary objectives were propofol consumption and its latency, the consumption of opioids, ephedrine, and cisatracurium. Patients and Methods. Forty patients scheduled for post-bariatric dermolipectomy were randomly assigned to two groups to receive total intravenous anesthesia with target-controlled hypnosis induced with propofol. Analgesia was obtained in the remifentanil group with remifentanil at an initial dose of 0.2 μg·kg-1·min-1 and in the magnesium sulfate group with magnesium sulfate 40 mg·kg-1 + 10 mg·kg-1·h-1.

Results: There was no statistical hemodynamic difference between the groups before and after orotracheal intubation (p = 0.062) and before and after the surgical incision (p = 0.656). There was also no statistical difference in the variation of mean arterial pressure before and after intubation (p = 0.656) and before and after the surgical incision (p = 0.911). There was similar consumption of cisatracurium, ephedrine, and postoperative opioids between the groups. Some patients in the magnesium sulfate group needed more intraoperative fentanyl and propofol, although the latency of propofol was similar in both the groups.

Conclusion: We conclude that using magnesium sulfate in intravenous general anesthesia for post-bariatric dermolipectomy is related to a significant reduction in opioid consumption without compromising hemodynamic stability. Overall, PSI monitoring was helpful in driving the analgesic strategy. The use of magnesium sulfate proved to be an important adjunct in the scenario presented, allowing the use of opioids to be avoided in certain cases. We found no statistical differences in the consumption of neuromuscular blocker and vasoconstrictor. Substituting opioids for magnesium sulfate leads to an increase in propofol consumption in the scenario presented. Studies with a larger sample are needed to corroborate the results presented and evaluate other potential advantages in reducing opioid consumption.

背景:硫酸镁可降低疼痛评分和镇痛药消耗。它在无阿片类药物或阿片类药物节约技术中作为镇痛资源的使用也已经过测试。通过血流动力学振荡间接评价药物和剂量的抗伤害感受效力一直受到质疑。一种相对较新的算法,称为体积脉搏图应激指数,被认为是敏感和相对特异性的参数,用于评估术中镇痛的需要。目的:本试验的目的是评估硫酸镁与瑞芬太尼的术中镇痛能力。次要目标是异丙酚消耗及其潜伏期、阿片类药物、麻黄碱和顺阿曲库铵的消耗。患者和方法。40例减肥后脱皮手术患者随机分为两组,采用丙泊酚诱导目标控制催眠的全静脉麻醉。瑞芬太尼组初始剂量为0.2 μg·kg-1·min-1,硫酸镁组初始剂量为40 mg·kg-1 + 10 mg·kg-1·h-1。结果:两组患者经气管插管前后(p = 0.062)、手术切口前后(p = 0.656)血流动力学差异均无统计学意义。两组患者插管前后平均动脉压变化(p = 0.656)、手术切口前后平均动脉压变化(p = 0.911)也无统计学差异。两组间顺阿曲库铵、麻黄碱和术后阿片类药物的用量相似。硫酸镁组的一些患者术中需要更多的芬太尼和异丙酚,尽管两组异丙酚的潜伏期相似。结论:我们得出结论,在减肥后真皮摘除术的静脉全身麻醉中使用硫酸镁与阿片类药物的消耗显著减少有关,而不影响血流动力学稳定性。总体而言,PSI监测有助于推动镇痛策略。在上述情况下,硫酸镁的使用被证明是一种重要的辅助手段,可以避免在某些情况下使用阿片类药物。我们发现神经肌肉阻滞剂和血管收缩剂的用量没有统计学差异。在上述情况下,用阿片类药物替代硫酸镁会导致异丙酚的消耗量增加。需要更大样本的研究来证实所提出的结果并评估减少阿片类药物消费的其他潜在优势。
{"title":"Intraoperative Analgesia with Magnesium Sulfate versus Remifentanil Guided by Plethysmographic Stress Index in Post-Bariatric Dermolipectomy: A Randomized Study.","authors":"S E Silva Filho,&nbsp;S Dainez,&nbsp;M A M C Gonzalez,&nbsp;F Angelis,&nbsp;J E Vieira,&nbsp;C S Sandes","doi":"10.1155/2022/2642488","DOIUrl":"https://doi.org/10.1155/2022/2642488","url":null,"abstract":"<p><strong>Background: </strong>Magnesium sulfate reduces pain scores and analgesic consumption. Its use as an analgesic resource in opioid-free or opioid-sparing techniques have also been tested. The evaluation of the antinociceptive potency of drugs and doses indirectly, through hemodynamic oscillations has been questioned. A relatively new algorithm called the plethysmographic stress index has been considered sensitive and relatively specific as a parameter for assessing the need for intraoperative analgesia.</p><p><strong>Objectives: </strong>The aim of this trial was to assess the intraoperative analgesic capacity of magnesium sulfate compared to remifentanil. The secondary objectives were propofol consumption and its latency, the consumption of opioids, ephedrine, and cisatracurium. <i>Patients and Methods</i>. Forty patients scheduled for post-bariatric dermolipectomy were randomly assigned to two groups to receive total intravenous anesthesia with target-controlled hypnosis induced with propofol. Analgesia was obtained in the remifentanil group with remifentanil at an initial dose of 0.2 <i>μ</i>g·kg<sup>-1</sup>·min<sup>-1</sup> and in the magnesium sulfate group with magnesium sulfate 40 mg·kg<sup>-1</sup> + 10 mg·kg<sup>-1</sup>·h<sup>-1</sup>.</p><p><strong>Results: </strong>There was no statistical hemodynamic difference between the groups before and after orotracheal intubation (<i>p</i> = 0.062) and before and after the surgical incision (<i>p</i> = 0.656). There was also no statistical difference in the variation of mean arterial pressure before and after intubation (<i>p</i> = 0.656) and before and after the surgical incision (<i>p</i> = 0.911). There was similar consumption of cisatracurium, ephedrine, and postoperative opioids between the groups. Some patients in the magnesium sulfate group needed more intraoperative fentanyl and propofol, although the latency of propofol was similar in both the groups.</p><p><strong>Conclusion: </strong>We conclude that using magnesium sulfate in intravenous general anesthesia for post-bariatric dermolipectomy is related to a significant reduction in opioid consumption without compromising hemodynamic stability. Overall, PSI monitoring was helpful in driving the analgesic strategy. The use of magnesium sulfate proved to be an important adjunct in the scenario presented, allowing the use of opioids to be avoided in certain cases. We found no statistical differences in the consumption of neuromuscular blocker and vasoconstrictor. Substituting opioids for magnesium sulfate leads to an increase in propofol consumption in the scenario presented. Studies with a larger sample are needed to corroborate the results presented and evaluate other potential advantages in reducing opioid consumption.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9629917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40458242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protecting the Airway and the Physician: Lessons from 214 Cases of Endotracheal Intubation Litigation. 保护气道和医生:从 214 起气管插管诉讼中汲取的教训》。
IF 1.6 Q2 ANESTHESIOLOGY Pub Date : 2022-10-18 eCollection Date: 2022-01-01 DOI: 10.1155/2022/8209644
Jean Daniel Eloy, Anna A Pashkova, Molly Amin, Christy Anthony, Daisy Munoz, Yuriy Gubenko, Shivani Patel, Anna Korban, Andrea Perales, Peter F Svider, Jean Anderson Eloy

Objective: Medicolegal examination of an intervention as common as endotracheal intubation may be valuable to physicians in many specialties. Our objectives were to comprehensively detail the factors raised in litigation to better educate physicians on strategies for minimizing liability and augmenting patient safety.

Methods: Publicly available court records were searched for pertinent litigation. Ultimately, 214 jury verdict and settlement reports were examined for various factors, including outcome, award, geographic location, defendant specialty, setting in which an injury occurred, patient demographics, and other causes of malpractice.

Results: Ninety-two cases (43.0%) were resolved in the defendant's favor, with the remaining cases resulting in out-of-court settlement or a plaintiff's verdict. Payments from these cases were considerable, averaging $2.5 M. The most frequent physician defendants were anesthesiologists (59.8%) and emergency-physicians (19.2%), although other specialties were well represented. The most common setting of injury was the operating room (45.3%). Common factors included sustaining permanent deficits (89.2%), death (50.5%), and anoxic brain injury (37.4%). Injuries occurring in labor and delivery mostly involved newborns and had among the highest awards.

Conclusions: Litigation involves injuries sustained in numerous settings. The most common factors present included sustaining permanent deficits, including anoxic brain injury. The presence of this latter injury increased the likelihood of a case being resolved with payment. Finally, deficits in informed consent were noted in numerous cases, stressing the importance of a clear process in which the physician explains specific risks (such as those detailed in this analysis), benefits, and alternatives.

目的:对像气管插管这样常见的干预措施进行医学法律审查可能对许多专业的医生都很有价值。我们的目标是全面详述诉讼中提出的因素,以便更好地教育医生采取策略,最大限度地减少责任并提高患者安全:方法:搜索公开的法院记录,查找相关诉讼。最终,对 214 份陪审团判决和和解报告进行了各种因素的检查,包括结果、赔偿金、地理位置、被告专业、发生伤害的环境、患者人口统计以及其他渎职原因:有 92 起案件(43.0%)以被告胜诉告终,其余案件则以庭外和解或原告判决告终。这些案件的赔偿金额相当可观,平均为 250 万美元。最常见的医生被告是麻醉科医生(59.8%)和急诊科医生(19.2%),但其他专科医生也占很大比例。最常见的受伤场所是手术室(45.3%)。常见因素包括永久性损伤(89.2%)、死亡(50.5%)和缺氧性脑损伤(37.4%)。在分娩过程中发生的伤害大多涉及新生儿,赔偿金额也最高:结论:诉讼涉及多种情况下发生的伤害。最常见的因素包括缺氧性脑损伤等永久性损伤。后一种损伤的存在增加了案件获得赔偿的可能性。最后,在许多案件中都发现了知情同意方面的缺陷,这强调了明确的程序的重要性,在这个程序中,医生要解释具体的风险(如本分析中详述的风险)、益处和替代方案。
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引用次数: 0
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Anesthesiology Research and Practice
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