Anesthesiology Research and Practice最新文献

Background: Postoperative nausea and vomiting (PONV) remain as common and unpleasant and highly distressful experience following ear, nose, and throat surgery. During ENT surgery, the incidence of PONV could be significantly reduced in patients who receive dexamethasone and propofol as prophylaxis. However, the comparative effectiveness of the two drugs has not been assessed. The aim of this study was to compare the effectiveness of propofol and dexamethasone for prevention of PONV in ear, nose, and throat surgery.

Methods: This study was conducted in 80 patients, with ASA I and II, aged 18-65 years, and scheduled for ENT surgery between December 20, 2017, and March 20, 2018. Patients were randomly assigned to Group A and Group B. Immediately after the procedure, Group A patients received single dose of intravenous (IV) dexamethasone (10 mg/kg) and Group B patients were given propofol (0.5 mg/kg, IV), and equal follow-up was employed. The incidence of PONV was noted at 6th, 12th, and 24th hour of drug administration. Independent t-test and Mann-Whitney test were used for comparison of symmetric numerical and asymmetric data between groups, respectively. Categorical data were analyzed with the chi-square test, and p value of < 0.05 was considered as level of significance.

Results: The incidences of PONV throughout the 24-hour postoperative period were 35% in the propofol group and 25% in the dexamethasone group. Statistical significance was found in incidence of PONV (0% versus 22.5%) and use of antiemetic (0% versus 5%) between dexamethasone and propofol groups, respectively, at 12-24 hours. Over 24 hours, 5% in dexamethasone group and 12.5% in propofol group developed moderate PONV, while none of the participants felt severe PONV.

Conclusions: Dexamethasone was more effective than propofol to prevent PONV with lower requirements of rescue antiemetics.

Background: Postspinal hypotension is the most common complication after spinal anesthesia for cesarean section (CS). Hypotension mainly occurs due to the reductions of vascular tone leading to decreased systemic vascular resistance and decreased venous return. The aim of this study was to assess the effectiveness of leg elevation (LE) as a method of prevention of postspinal hypotension in patients who undergo cesarean section under spinal anesthesia.

Methods: This is a single-center parallel-randomized controlled trial study, and 52 full-term parturients scheduled for elective cesarean section who meets inclusion criteria were included in the study. The randomization sequence was created by a researcher not participating in patient management using a computer random generator. The participant was randomly assigned to the leg elevation group (n = 26) or to the control group (n = 26) of usual perioperative care.

Results: The proportions of patients who develop hypotension are lower (8 (33.3%)) in the leg elevation group than the control group (15 (62.5%)) with an X ² (1, N = 48) = 4.09, P=0.043. The relative risk of developing postspinal hypotension in the leg elevation group compared to the control group was 0.47 (95% CI, 0.28-1.00). The proportion of severe hypotension was significantly decreased in the leg elevation group at a P value of 0.02.

Conclusion: Performing leg elevation immediately after spinal anesthesia reduced the incidence of hypotension. The trial is registered with PACTR201908713181850.

Background: Enlarged uterus can compress the inferior vena cava and cause hypotension when lying supine. Previous studies have shown a positive association between the abdominal circumference and size of the uterus. Therefore, the aim of this study was to evaluate the relationship between abdominal circumference and incidence of hypotension during cesarean section under spinal anesthesia.

Methods: The study cohort comprised women undergoing cesarean section under spinal anesthesia. Patients were divided into two groups according to the median abdominal circumference (<101 cm and ≥101 cm). Hypotension was defined as a systolic blood pressure of <90 mmHg or mean arterial pressure of <65 mmHg. The primary outcome of this study was the relationship between the incidence of hypotension and the abdominal circumference after spinal anesthesia in term pregnant women.

Results: The study cohort comprised 100 women. The incidence of hypotension did not differ between the groups (71.42% in the smaller vs. 78.43% in the larger abdominal circumference group, p=0.419). However, the decrease in mean arterial pressure and its percentage decrease from baseline were greater in the larger than in the smaller abdominal circumference group (change in mean arterial pressure: 28.33 mmHg (18.66-33.67) in the smaller vs. 36.67 mmHg (23.34-43.34) in the larger abdominal circumference group, p=0.004; percentage decrease: 31.41% (22.74-39.22) in the smaller vs. 38.47% (28.00-44.81) in the larger abdominal circumference group, p=0.022).

Conclusions: Large abdominal circumference in pregnancy is associated with greater decreases in mean arterial pressure from baseline. However, the incidence of hypotension defined by standard criteria did not differ between larger and smaller abdominal circumference groups.

Background: The primary aim was to identify the incidence of intra-abdominal hypertension (IAH) and primary abdominal compartment syndrome (1^oACS) of abdominopelvic injury patients at Thammasat University Hospital (TUH), Thailand, and the secondary objective was to evaluate those factors that contributed to developing these conditions.

Methods: The retrospective cohort of 38 abdominopelvic injury cases was admitted to the intensive care unit at Thammasat University Hospital, from January 1^st to December 31^st, 2018. The bladder pressure was recorded every 4 hours until the urethral catheter was removed. Data of age, gender, weight, height, body mass index, injury mechanisms, initial vital signs, imaging, laboratory data, blood component requirements, abdominal organs involved, treatments including surgery and intervention radiology, abbreviated injury scale (AIS) and injury severity score (ISS), length of ICU stays, and results of treatment were all analyzed.

Results: The patients were mostly young (mean age 31.5 years), male (68.4%), and suffering from blunt trauma (89.5%). The mean maximum bladder pressure was 8.3 ± 5.2 mmHg. Six patients (15.8%) developed IAH, and one patient (2.6%) was diagnosed with 1^oACS. Two patients expired. The multivariate analysis showed the patient who had initial Cr ≥ 1.5 g/dL, lower extremity including pelvis AIS ≥3, and ISS >15 was significantly associated with the developing of IAH.

Conclusions: The incidence of IAH and 1^oACS was 15.8% and 2.6%. Predicted factors to find developing IAH were initial Cr ≥ 1.5 g/dL, lower extremity AIS ≥3, and ISS >15. We should consider awareness of IAH and 1^oACS in abdominopelvic injury patients.

Background: This study was designed to investigate and compare the effective doses of dexmedetomidine for sedation in parturient patients who underwent Cesarean section (CS) and nonpregnant women who underwent elective gynecologic surgery.

Methods: The study comprised 60 females aged between 25 and 35. They were divided into two groups. The parturient group received a bolus dose of dexmedetomidine over 15 min after the delivery of the fetus and placenta. In the nonpregnant women group, a bolus of dexmedetomidine was administered intravenously upon the completion of spinal anesthesia. The subsequent dose required by patients in each group was then determined through a modified two-stage Dixon up-and-down sequential method. Probit analysis was used to calculate the ED50 and the ED95 of dexmedetomidine for adequate sedation.

Results: The ED50 of dexmedetomidine for adequate sedation in parturient patients was 1.58 μg/kg (1.51-1.66 μg/kg); in nonpregnant women, it was 0.96 μg/kg (0.91-1.01 μg/kg) (95% CI). The ED95 of dexmedetomidine in parturients was 1.80 μg/kg (1.70-2.16) μg/kg and that of nonpregnant women was 1.10 μg/kg (1.04-1.30 μg/kg) (95% CI). The ED50 in parturients was significantly higher than that in nonpregnant women (P < 0.05).

Conclusion: The ED50 of dexmedetomidine for target sedation in parturients who received spinal anesthesia for CS is greater than 1.5 times that in nonpregnant women who received spinal anesthesia for lower abdominal gynecologic surgery. This study postulates that the dose of dexmedetomidine required to achieve optimal sedation following spinal anesthesia is much higher in parturients than in nonpregnant women undergoing gynecologic surgeries. This trial is registered with NCT02111421.

Background: Use of laryngeal mask airway as an alternative to the endotracheal tube has attracted the attention of several workers with regard to intraocular pressure changes. However, the previous studies have reported different results while comparing intraocular pressure, following insertion of laryngeal mask airway or the endotracheal tube. Therefore, this systematic review and meta-analysis was aimed to generate the best possible evidence on the intraocular pressure response to endotracheal tube intubation and laryngeal mask airway insertion.

Methods: Electronic databases like PubMed, CINAHL, EMBASE, Google Scholar, Cochrane library databases, and Mednar were used. All original peer-reviewed papers which reported the mean and standard deviation of IOP before and after airway instrumentation in both groups were included. Two reviewers independently extracted the data using a standardized data extraction format for eligibility and appraised their quality. Data were analyzed using the STATA version 14 software. The pooled standard mean difference was estimated with the random-effect model. Heterogeneity between studies was assessed by the I ² statistics test. A subgroup analysis was done to assess the source of variation between the studies.

Result: A total of 47 research papers were reviewed, of which, six studies were finally included in this systematic review and meta-analysis. The overall pooled standard mean difference of intraocular pressure was 1.30 (95% CI, 0.70, 1.90), showing that LMA insertion is better than ETT intubation to maintain stable intraocular pressure. A random-effect model was employed to estimate the pooled standard mean differences due to severe heterogeneity (I ² 79.45,  p ≤ 0.001).

Conclusion: The available information suggests that the LMA provides lesser intraocular pressure response in comparison with the conventional tracheal tube.

Materials and methods: This clinical trial was conducted on 90 patients, aged 30-70 years, who had heart surgery. The participants were categorized into three groups. Group D received 1 µg/kg intravenous dexmedetomidine in 10 minutes, group L received 1.5 mg/kg lidocaine (1%) 90 seconds before intubation, and group F received 2 µg/kg fentanyl. The vital signs (HR, SBP, DBP, and MAP) were measured before intubation and 1st, 3rd, 5th, and 10th minutes after intubation. Data were analyzed with SPSS 19 software (chi-square, one-way ANOVA, or Kruskal-Wallis).

Results: The age (P=0.389) and gender distributions of patients were similar in all three groups. Dexmedetomidine significantly attenuated HR in the 3^rd (P=0.001), 5^th (P=0.001), and 10^th (P=0.003) minutes after intervention. It also reduced the systolic blood pressure in the 5^th (P=0.024) and 10^th (P=0.006) minutes. This reduction was significantly higher in the dexmedetomidine group than that in the two other groups. In addition, dexmedetomidine caused a greater reduction in MAP in the 1^st (P=0.048), 5^th (P=0.0001), and 10^th (P=0.0001) minutes. Discussion. All three medications were effective in controlling HR; however, dexmedetomidine caused bradycardia in the 3^rd, 5^th, and 10^th minutes. Lidocaine resulted in an increase in MAP in the 1^st minute after intubation; whereas, dexmedetomidine reduced MAP at the 5^th and 10^th minutes after intubation. Changes in blood pressure and mean arterial pressure in the fentanyl group was lower than the two other groups.

Conclusion: As a result, dexmedetomidine was not suitable for hemodynamic control and led to hypotension and bradycardia; on the other hand, fentanyl was more effective than two other medications in patients undergoing cardiac surgery. This trial is registered with IRCT2017013132320N1.

Background: Although anesthesia providers may plan for moderate sedation, the depth of sedation is rarely quantified. Using processed electroencephalography (EEG) to assess the depth of sedation, this study investigates the incidence of general anesthesia with variable burst suppression in patients receiving propofol for outpatient colonoscopy. The lessons learned from neuromonitoring can then be used to guide institutional best sedation practice.

Methods: This was a prospective observational study of 119 outpatients undergoing colonoscopy at Thomas Jefferson University Hospital (TJUH). Propofol was administered by CRNAs under anesthesiologists' supervision. The Patient State Index (PSi™) generated by the Masimo SedLine® Brain Root Function monitor (Masimo Corp., Irvine, CA) was used to assess the depth of sedation. PSi data correlating to general anesthesia with variable burst suppression were confirmed by neuroelectrophysiologists' interpretation of unprocessed EEG.

Results: PSi values of <50 consistent with general anesthesia were attained in 118/119 (99.1%) patients. Of these patients, 33 (27.7%) attained PSi values <25 consistent with variable burst suppression. The 118 patients that reached PSi <50 spent a significantly greater percentage (53.1% vs. 42%) of their case at PSi levels <50 compared to PSi levels >50 (p=0.001). Mean total propofol dose was significantly correlated to patient PSi during periods of PSi <25 (R=0.406, p=0.021).

Conclusion: Although providers planned for moderate to deep sedation, processed EEG showed patients were under general anesthesia, often with burst suppression. Anesthesiologists and endoscopists may utilize processed EEG to recognize their institutional practice patterns of procedural sedation with propofol and improve upon it.

Purpose: The aim of this study was to compare the effects of desflurane, sevoflurane, and propofol on the glottic opening area during general anesthesia using remifentanil.

Methods: Ninety patients undergoing hand and upper limb surgery combined with brachial plexus block under general anesthesia were enrolled in the study. The patients were randomized into three groups to receive desflurane (group D), sevoflurane (group S), or propofol (group P) for maintenance of anesthesia. Following induction of general anesthesia with remifentanil, continuous fiberoptic video recording around the glottis via an i-gel™ supraglottic device was started after establishing mechanical ventilation. Desflurane, sevoflurane, or propofol was administrated after video recording was started. The changes in normalized glottic opening area (n-GOA) and peak inspiratory pressure (PIP) during surgery were compared between the three groups.

Results: Intraoperative changes of n-GOA in group D showed significant differences compared with group S and group P (-0.0656 ± 0.0772 vs. -0.0076 ± 0.0499 and +0.0269 ± 0.0809, P=0.005 and P < 0.0001). The changes of PIP in group D showed significant differences compared with group S and group P (+3.7 ± 3.4 cmH₂O vs. +1.0 ± 1.3 cmH₂O and -0.3 ± 3.6 cmH₂O, P=0.002 and P < 0.0001). Four cases of relapsed glottic stenosis in group D were improved by changing desflurane to propofol.

Conclusions: Desflurane narrowed the n-GOA and increased the PIP compared to sevoflurane and propofol during general anesthesia with remifentanil. Clinicians should be aware of the possibility of glottic stenosis during desflurane-remifentanil anesthesia when the airway is secured by a supraglottic airway device without the use of neuromuscular blockade.

Background: The airway of an anesthetized child is usually maintained with an endotracheal tube or laryngeal mask airway. However, both are related with some level of pressor response which may be risky in several groups of patient.

Methods: An institutional-based prospective observational study design was employed. A systematic random sampling technique was used to select study participants. Data were entered into Epi info version 7 and transported to SPSS version 20 for analysis. Normality of the data was checked using Shapiro-Wilk tests. An independent t test was used to determine the mean differences between the two groups while the paired sample t test was used to determine the mean differences within the groups. A p value of less than 0.05 was used as a cut-off point for the presence of association.

Results: The changes in systolic and diastolic blood pressure were returned to baseline values at five and three minutes in both groups, respectively. However, the changes in the heart rate and mean arterial pressure returned to baseline values in five minutes in the ETT group and three minutes in the LMA group. At baseline, the difference in systolic blood pressure between the two groups was not statistically significant (p=0.328).

Conclusions: A significant hemodynamic pressor response was observed after the insertion of both LMA and ETT groups. However, the LMA group has less hemodynamic change as compared to the ETT group. Therefore, the practice of LMA insertion was strongly recommended.