Asian journal of anesthesiology最新文献

Background: Fascia iliaca compartment block (FICB) is one of the regional blocks used to reduce postoperative pain after total hip arthroplasty (THA). Administration of dexamethasone in the loading dose might lengthen pain-free duration and reduce anesthetic consumption.

Methods: Sixty patients undergoing THA with spinal anesthesia and patient-controlled FICB were randomly assigned to receive either 20 mL of 0.25% ropivacaine with 8 mg dexamethasone (Group D, n = 30) or 20 mL of 0.25% ropivacaine alone (Group C, n = 30). Postoperative pain scores, analgesic use, and side effects were assessed over 72 hours.

Results: Postoperative visual analogue scale scores did not differ significantly between groups. The time to first bolus was longer in Group D than in Group C (407.10 ± 305.68 vs. 308.63 ± 212.99 minutes; P < 0.05). Total ropivacaine consumption over 72 hours was lower in Group D (210.33 ± 79.64 mg) compared to Group C (288.00 ± 91.32 mg), with a similar reduction in bolus frequency (14.53 ± 7.96 vs. 22.30 ± 9.13). The incidence of adverse events, including quadriceps weakness, local effects, and other side effects, was low and comparable between groups.

Conclusion: The addition of dexamethasone to ropivacaine for FICB after THA can significantly provide a longer duration of analgesia with a lower amount of anesthetic.

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.

Background: Difficult airway management (DAM) presents a complex array of challenges inherent in establishing and maintaining a patient's airway during medical procedures or emergencies. Consequences of compromised DAM are profound, ranging from hypoxia, and aspiration, to cardiac arrest. Despite the ongoing progress and innovation in airway management, DAM remains a significant clinical challenge. Performing a bibliometric analysis of the most cited articles in this domain offers quantitative and qualitative insights into the landscape and trend of key research; our analysis revealed an increasing focus on video laryngoscopy research over the past decade, with a notable surge in studies related to airway management during infectious disease outbreaks in recent years.

Methods: We performed a bibliometric analysis of the 100 most-cited articles on DAM (Top100DAM) published between 2011 and 2022, sourced from both PubMed and Web of Science databases. Employing social network analysis, we identified key associated topics and cluster terms. Cluster terms are broad categories encompassing related topic terms. Topic terms are specific keywords or phrases found in the articles. Citation counts were estimated for each article, and cluster-specific reviews were generated using the Medical Query Expert software.

Results: The Top100DAM comprised 53 topic terms spanning 11 cluster terms. "Anesthesiology" stood out as the most frequently featured cluster, and "betacoronavirus" had the highest Impact Factor. There was a significant correlation between the counts between the inferred citation based on cluster terms and the observed citation (Pearson's R = 0.06, P = 0.02). To visualize, the network visualization and Sankey diagrams were used to illustrate the characteristics of the articles. The generated summary, utilizing natural language processing techniques, underscored the role of fiber-optic technology and video laryngoscopy in addressing DAM. During the COVID-19 pandemic, experts recommended the provision of supplemental oxygen and the prioritization of video laryngoscopy for anticipated DAM scenarios. Notably, the most cited articles predominantly concentrated on the importance of practice driven by guidelines and protocols for clinicians and anesthesiologists to manage difficult airways effectively.

Conclusion: DAM plays a central role in anesthesiology research, with a significant emphasis on guideline development, technological advancements like video laryngoscopy, and adapting practices for infectious disease scenarios. The increased publication volume and high citation rates during the COVID-19 pandemic underscore how ongoing research and innovation have accelerated, refining DAM practices. Articles with high citation rates mostly pertain to guidelines, illustrating their substantial impact on clinical practice and the necessity for studies to base their discus

Background: Propofol has been associated with metabolic acidosis in case reports. However, the results of studies in patients undergoing non-cardiac surgery are controversial. On the other hand, there have been no randomized controlled studies addressing this issue in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this study, we investigated whether propofol was associated with metabolic acidosis in patients undergoing cardiac surgery with CPB.

Methods: Forty patients undergoing cardiac surgery with CPB were randomly assigned to receive total anesthesia with propofol (intervention group) or sevoflurane (control group), respectively. Except for this, the anesthetic and surgical management was the same in all patients. The primary outcomes were the changes in arterial blood pH, base excess, HCO_3^-, and lactate levels during surgery. The secondary outcomes included serum aspartate transaminase (AST), alanine transaminase (ALT), urea, and creatinine levels, as well as the proportion of patients with increased liver enzymes and kidney damage at the end of surgery, and the proportion of patients with arrhythmia during surgery.

Results: The rate of metabolic acidosis with high lactate at the end of surgery in the propofol group (intervention group) was statistically higher than that in the sevoflurane group (control group). Nevertheless, no difference in serum AST, ALT, urea, and creatinine levels between the two groups, and the proportions of patients with increased liver enzymes and kidney damage at the end of surgery, as well as the proportion of patients with arrhythmia during surgery.

Conclusion: Total anesthesia with propofol was associated with metabolic acidosis but did not significantly affect increased liver enzymes, kidney damage, and arrhythmias when compared with the control group in patients undergoing cardiac surgery with CPB.

Background: Accidental awareness during general anesthesia (AAGA) is rare but can lead to psychological distress, including post-traumatic stress disorder (PTSD). Limited data exists from East Asia, where cultural factors may influence symptom expression. This study examined the incidence, contributing factors, and one-year psychological outcomes of AAGA in a Taiwanese tertiary center.

Methods: We reviewed 18,976 patients who received general anesthesia at National Taiwan University Hospital in 2020. AAGA cases were identified via routine postoperative interviews and anesthesia record reviews. One year later, follow-up telephone interviews were conducted using the Chinese version of the PTSD Symptom Scale-Interview for DSM-5 (PSS-I-5), along with a culturally adapted emotional experience questionnaire.

Results: Seven patients (0.037%) were classified as definite or possible AAGA. Most events occurred during intubated general anesthesia or propofol sedation. Human errors, such as delayed drug administration or intravenous disconnection, contributed to over half the cases. Of the four patients who completed one-year PTSD screening, none met diagnostic criteria, though two recalled vivid intraoperative experiences and later changed their anesthesia preferences. Cultural factors may have influenced symptom reporting.

Conclusion: Though no PTSD diagnoses were identified, AAGA had lasting effects on patient preferences. The findings highlight the need for structured follow-up and culturally sensitive care to better recognize and manage AAGA-related distress.