Asian journal of anesthesiology最新文献

Background: The purpose of this retrospective study was to determine the effect of surgical operation, age at surgery, sex hormones, and anesthesia modality on the risk of dementia in both sexes.

Methods: Data of females aged between 30 and 70 years old who were diagnosed with dysmenorrhea and underwent hysterectomy/myomectomy or without surgery, and males with benign prostate hyperplasia (BPH) with or without transurethral resection of the prostate (TURP) were identified from the National Health Insurance Research Database 2000-2016. The effect of age at surgery, surgery type, and anesthesia modality on dementia risk was assessed using Cox regression analyses.

Results: Among the 855,893 subjects, 10,242 developed dementia. Surgery at older age increased dementia risk in both sexes. Among females, hysterectomy/myomectomy was not significantly associated with dementia risk, although myomectomy was associated with a lower risk for dementia than hysterectomy. In males, TURP significantly increased the risk of dementia.

Conclusion: Men with BPH and women with dysmenorrhea who were older at surgery have a higher risk of dementia. Regardless of the anesthetic method, surgery increased the risk of dementia in men. Among the data of women, although the surgery factor was not significantly associated with dementia risk, women with myomectomy had a lower risk of dementia than the ones with hysterectomy. These findings together contributed to risk stratification for each sex in such surgical settings.

Background: Most of the studies on difficult intubation and laryngoscopy focused on American and European populations. However, Indians have distinct anthropometric characteristics compared to these populations. This study aims to determine the gender difference in inter-incisor distance (IID) cut-off marks to assess the ease of intubation in the Indian population.

Methods: A prospective observational study was conducted on 516 patients scheduled for elective surgery under general anesthesia with endotracheal intubation. Preoperative assessments included IID, thyromental distance, neck circumference, sternomental distance (SMD), thyrohyoid distance, mentohyoid distance, and modified mallampatti grading. Intubation difficulty scores (IDSs) were assessed during intubation. The optimal cut-off values of inter incisor gap and difficult intubation were analyzed by receiver operating characteristic curve analysis.

Results: The total cohort was grouped into males (Group 1 [n = 258]) and females (Group 2 [n = 258]). Males had a significantly higher mean age (P = 0.04) and weight (P = 0.00) than females. Difficult intubation incidence was 16.3% of males and 6.2% of females. Increased IID (P = 0.039), decreased SMD (P = 0.046), and males (P = 0.002) are identified as predictors of difficult intubation.IID and IDS showed greater specificity than sensitivity, with significant cut-off values of 4.25 and 1.50, respectively.

Conclusion: The cut-off value of IID did not show a significant difference in gender variation. Despite the low IID in females, intubation difficulties were not observed compared to males.

We presented two cases in which patients with chronic heart failure experienced significant hypotension and respiratory distress during the left lateral decubitus position before spinal anesthesia for orthopedic surgery.

Many cancer patients have their main tumors surgically removed with the goal of curing them, or as part of palliative care. When a patient receives general anesthesia, the side effects of the administered chemotherapy regimens must be considered, especially those that may have significant repercussions during anesthetic care. The aim of this study is to review the existing literature to identify adverse effects of chemotherapy and known interactions between chemotherapy and anesthetic drugs, analyze the mechanisms underlying these interactions, and discuss relevant clinical implications. This integrative review searched for articles using the search terms: chemotherapy, anesthetic drugs, interaction, adverse effects, and drug combination. Negative perioperative outcomes may be related to the chemotherapy. Regarding the type of oncological surgery, factors such as blood loss, hypothermia, and extended operative time influence the increase in morbimortality. Many anesthetic drugs are related to immunomodulation and interact with chemotherapy, which may get better or worse cancer patients. It is crucial for anesthetists to have a comprehensive understanding of the potential adverse effects of chemotherapy drugs and their interactions with anesthetics.

Background: The withdrawal or continuation of angiotensin II receptor blockers (ARBs) before surgery continues to be debated. We hypothesized that this is because ARBs with different half-lives have not been studied individually. This retrospective study aimed to clarify whether the degree of hypotension during anesthesia induction differs among ARBs with different half-lives.

Methods: We included patients who received general anesthesia with regular oral administration of telmisartan (group T) or valsartan (group V), which have half-lives of approximately 24 and 6 hours, respectively. The frequency of hypotension and vasopressor frequency and dose during anesthesia induction were compared between the two groups. At our hospital, ARBs were withdrawn on the day of surgery in all patients.

Results: Groups T and V included 190 and 132 patients, respectively. Patient backgrounds in group V were significantly more strongly associated with the use of calcium channel blockers. No significant differences were observed in the use of other concomitant antihypertensive medications, cardiovascular complications, or renal function. The time during which the mean arterial blood pressure was < 60 mmHg during anesthesia induction was significantly greater in group T than in group V (11 min vs. 7 min, P=0.030). The proportion of patients who used vasopressors was significantly higher in group T than that in group V (74.2% vs. 56.0%, P < 0.001).

Conclusion: Patients taking telmisartan showed more hypotensive during the induction of general anesthesia than those taking valsartan, even after withdrawal on the day of surgery.

Liver transplantation (LT) is frequently complicated by coagulopathy associated with end-stage liver disease, which is often multifactorial and associated with hemostatic disturbances affecting both the procoagulant and anticoagulant systems. This rebalanced coagulation system may lead to bleeding diathesis or increased clot formation. Conventional coagulation tests cannot reflect these complex changes because they can only illustrate deficiencies in the procoagulant system. Viscoelastic tests such as rotational thromboelastometry (ROTEM) have been used in LT and have shown useful for detecting coagulopathy and guiding transfusions. Implementation of ROTEM-guided bleeding management algorithms has proven effectiveness in reducing bleeding, transfusion needs, complication rates, and healthcare costs in LT. This document is intended to provide a practice algorithm for the management of major bleeding and coagulopathy during LT and to encourage adaptation of the guidelines to individual institutional circumstances and resources.

Background: Lumbar epidural injections have been studied as symptomatic treatments for lumbar spinal stenosis (LSS). However, results about their efficacy have been controversial, and data regarding their use is scarce. Our purpose in this article is to study the efficacy of epidural injections in the management of pain and disability in patients suffering from spinal stenosis, to study the factors which can affect their efficacy, and to discuss whether they could replace surgery or not.

Methods: A retrospective study between 2021 and 2022 took place in a Pain Clinic located in Notre-Dame des Secours University Hospital-Lebanon. The study was done on 128 patients, of whom 18 were excluded because they underwent laminectomy before taking the transforaminal lumbar epidural injections. Medical records were viewed. Outcome measures were checked before and after epidural injections using the numerical pain scale and the Oswestry Disability Index (ODI) scale. Physical activity was assessed with a physical activity index.

Results: Back pain scores (9.46 ± 1.07 vs. 3.91 ± 3.13; P < 0.001), leg pain scores (9.31 ± 1.41 vs. 3.75 ± 3.17; P < 0.001), and ODI scores (27.45 ± 8.97 vs. 9.40 ± 9.42; P < 0.001) decreased after the injection compared to before it. A higher physical activity index was significantly associated with a decrease in back pain, leg pain, and ODI scores after epidural injection. In 57.8% of the patients, epidural injections were sufficient for pain management without the need for surgery.

Conclusion: Epidural injections are effective in the management of back and leg pain associated with LSS and in improving patients' disability. Engaging in activities like walking and swimming is associated with better results. In some cases, epidural injections may replace surgery.

Elderly patients are more vulnerable to cognitive dysfunction in the postoperative period. Patients who are apparently well in cognitive functions in the preoperative period after undergoing anesthesia in noncardiac surgery will develop symptoms of cognitive dysfunction. Postoperative cognitive dysfunction (POCD) doesn't continue for a long duration and usually undergoes self-resolution. Proper definitions and congruous tests for diagnosis are absent. Rigorous preoperative assessment of cognitive function and distinguishing risk factors are indispensable for recognizing the range of POCD and its association with surgery and anesthesia. Recent studies haven't revealed any anesthesia technique or drug which can significantly reduce the incidence of POCD. Therefore, giving accurate information to patients can be challenging.