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Chewing gum to treat postoperative nausea and vomiting in female patients: a multicenter randomized trial. 用口香糖治疗女性患者术后恶心和呕吐:一项多中心随机试验。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-30 DOI: 10.1097/ALN.0000000000005283
Jai N Darvall, Anurika P De Silva, Britta von Ungern-Sternberg, David A Story, Andrew J Davidson, Megan L Allen, An Tran-Duy, Cindy Schultz-Ferguson, Vi Ha, Sabine Braat, Kate Leslie

Background: Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU).

Methods: We conducted a multicenter, randomized, controlled non-inferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged ≥12 years undergoing volatile anesthetic-based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized anti-emetic prophylaxis was administered. Patients who developed PONV in the PACU were randomized to either 15 min of chewing gum or 4 mg of intravenous ondansetron. The primary outcome was cessation of nausea, retching or vomiting, with no recurrence nor rescue medication for 2 h after administration of the randomized intervention (i.e., complete response).

Results: Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum-treated patients achieved the primary outcome (absolute risk difference [95% confidence interval (CI)] -17.3 [-30.4 to -4.3] %), not reaching our prespecified non-inferiority limit. Time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI] 0.53 [0.34, 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI] 14.07 [1.65, 26.49]).

Conclusions: Chewing gum cannot be recommended as an alternative to ondansetron for treatment of PONV in female patients administered antiemetic prophylaxis.

背景:术后恶心和呕吐(PONV)是全身麻醉后的常见症状,会影响患者的预后、对护理的满意度和医疗成本。我们的目的是比较一种新疗法口香糖和一种广泛使用的静脉注射药物昂丹司琼,以治疗麻醉后护理病房(PACU)女性患者的 PONV:我们在澳大利亚和新西兰的 17 家医院开展了一项多中心随机对照非劣效性试验。年龄≥12岁、因腹腔镜手术或乳房手术而接受挥发性麻醉药全身麻醉的女性患者均被纳入试验范围。患者均按规定接受了止吐预防治疗。在 PACU 中出现 PONV 的患者被随机分配到咀嚼口香糖 15 分钟或静脉注射 4 毫克昂丹司琼的治疗方案中。主要结果是患者停止恶心、反胃或呕吐,且在接受随机干预后 2 小时内不再复发或服用抢救药物(即完全反应):在 865 名登记患者中,218 人接受了随机干预。在按方案进行的分析中,105 例昂丹司琼治疗患者中有 50 例(47.6%)与 103 例口香糖治疗患者中有 31 例(30.1%)相比达到了主要结果(绝对风险差异[95% 置信区间 (CI)]-17.3[-30.4 至 -4.3]%),未达到我们预先规定的非劣效性限值。随机接受口香糖治疗的患者完全应答时间更长(危险比[95% CI] 0.53 [0.34, 0.83]),术后24小时内接受止吐药的可能性更大(绝对风险差异[95% CI] 14.07 [1.65, 26.49]):结论:不建议用口香糖替代昂丹司琼治疗接受止吐药预防的女性患者的PONV。
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引用次数: 0
Four-factor Prothrombin Complex Concentrate Use for Bleeding Management in Adult Trauma. 使用四因子凝血酶原复合物浓缩物治疗成人创伤出血。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-30 DOI: 10.1097/ALN.0000000000005230
Lidia Mora, Marc Maegele, Oliver Grottke, Andreas Koster, Philipp Stein, Jerrold H Levy, Gabor Erdoes
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引用次数: 0
Preoperative Strategies for Patients on Glucagon-like Peptide-1 Receptor Agonists Navigating Current Controversies and Future Directions. 使用胰高血糖素样肽-1 受体激动剂患者的术前策略:当前争议与未来方向。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-29 DOI: 10.1097/ALN.0000000000005222
Girish P Joshi
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引用次数: 0
The effect of intraoperative midazolam on postoperative delirium in older surgical patients: a prospective, multicentre cohort study. 术中使用咪达唑仑对老年手术患者术后谵妄的影响:一项前瞻性多中心队列研究。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-29 DOI: 10.1097/ALN.0000000000005276
Hao Li, Chang Liu, Yu Yang, Qing-Ping Wu, Jun-Mei Xu, Di-Fen Wang, Jing-Jia Sun, Meng-Meng Mao, Jing-Sheng Lou, Yan-Hong Liu, Jiang-Bei Cao, Chong-Yang Duan, Wei-Dong Mi

Background: Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium (POD) in older patients undergoing non-cardiac surgery.

Methods: This study included patients aged ≥ 65 years who received general anaesthesia between April 2020 and April 2022 in multiple hospitals across China. POD occurring within 7 days was assessed using the 3-minute Diagnostic Interview for Confusion Assessment Method (3D-CAM). Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of POD, presented as risk ratio (RR) and 95% confidence intervals (CI). Kaplan-Meier cumulative incidence curve was plotted to compare the distribution of time to POD onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and POD.

Results: In all, 5,663 patients were included, of whom 723 (12.8%) developed POD. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and POD among older population (unadjusted RR=0.96, 95% CI: 0.90-1.30, P=0.38; adjusted RR=1.09, 95% CI: 0.91-1.33, P=0.35). Kaplan-Meier curve showed no difference in the distribution of time to POD onset (Hazard ratio [HR]=1.02, 95%CI: 0.88-1.18, P=0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with POD in the specific subgroups of patients.

Conclusions: Intraoperative administration of midazolam may not be associated with an increased risk of POD in older patients undergoing non-cardiac surgery.

背景:咪达唑仑是一种短效苯二氮卓类药物,常用于围术期环境。本研究旨在探讨术中使用咪达唑仑对接受非心脏手术的老年患者术后谵妄(POD)的潜在影响:本研究纳入了 2020 年 4 月至 2022 年 4 月期间在中国多家医院接受全身麻醉的年龄≥ 65 岁的患者。采用 3 分钟意识障碍诊断访谈评估法(3D-CAM)对 7 天内发生的 POD 进行评估。基于随机效应的单变量和多变量Logistic回归模型用于确定咪达唑仑用药与POD发生之间的关系,以风险比(RR)和95%置信区间(CI)表示。绘制了 Kaplan-Meier 累计发病率曲线,以比较接受和未接受咪达唑仑治疗的患者之间 POD 发病时间的分布情况。根据特定人群进行了分组分析,以探讨咪达唑仑与 POD 之间的关系:总共纳入了 5,663 名患者,其中 723 人(12.8%)出现了 POD。基于不同医院随机效应的单变量和多变量逻辑回归分析表明,在老年人群中,咪达唑仑用药与 POD 之间无显著关联(未调整 RR=0.96,95% CI:0.90-1.30,P=0.38;调整 RR=1.09,95% CI:0.91-1.33,P=0.35)。卡普兰-梅耶曲线显示,POD发病时间分布无差异(危险比[HR]=1.02,95%CI:0.88-1.18,P=0.82)。亚组分析结果显示,术中咪达唑仑治疗与特定亚组患者的POD无关:结论:在接受非心脏手术的老年患者中,术中使用咪达唑仑可能与 POD 风险增加无关。
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引用次数: 0
Preprocedure Care of Patients on Glucagon-like Peptide-1 Receptor Agonists: A Multisociety Clinical Practice Guidance. 使用胰高血糖素样肽-1 受体激动剂患者的术前护理:多协会临床实践指南》。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-29 DOI: 10.1097/ALN.0000000000005231
Girish P Joshi, Teresa LaMasters, Tammy L Kindel
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引用次数: 0
Perioperative Management of Patients Taking Glucagon-like Peptide-1 Receptor Agonists: Applying Evidence to Clinical Practice. 服用胰高血糖素样肽-1 受体激动剂患者的围手术期管理:将证据应用于临床实践。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-29 DOI: 10.1097/ALN.0000000000005204
Adriana D Oprea, Guillermo E Umpierrez, BobbieJean Sweitzer, David L Hepner
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引用次数: 0
Antithrombin Levels during Venoarterial ECMO: Reply. 静脉动脉 ECMO 期间的抗凝血酶水平:回复。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-28 DOI: 10.1097/ALN.0000000000005229
Alexandre Mansour, Thomas Lecompte, Nicolas Nesseler, Isabelle Gouin-Thibault
{"title":"Antithrombin Levels during Venoarterial ECMO: Reply.","authors":"Alexandre Mansour, Thomas Lecompte, Nicolas Nesseler, Isabelle Gouin-Thibault","doi":"10.1097/ALN.0000000000005229","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005229","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Poem for Henry. 献给亨利的诗
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-28 DOI: 10.1097/ALN.0000000000005236
Justin C Cordova
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引用次数: 0
Antithrombin Levels during Venoarterial ECMO: Comment. 静脉动脉 ECMO 期间的抗凝血酶水平:评论。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-28 DOI: 10.1097/ALN.0000000000005228
Gennaro Martucci, Shu Y Lu, Yuko Mishima, Kenichi A Tanaka
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引用次数: 0
Life and Death in the Land of Women. 女人国度的生与死
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-10-28 DOI: 10.1097/ALN.0000000000005196
Adriana L Grossman
{"title":"Life and Death in the Land of Women.","authors":"Adriana L Grossman","doi":"10.1097/ALN.0000000000005196","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005196","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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