BMC Anesthesiology最新文献

Background: Frailty has been consistently implicated as a pivotal factor in the onset of delirium following anesthesia and surgery. Nonetheless, a comprehensive understanding of the relationship between frailty and delirium remains to be elucidated. This study addresses that knowledge gap.

Methods: A comprehensive search of literature databases identified 43 relevant studies involving 14,441 participants. The studies were subjected to a rigorous quality assessment using the Newcastle-Ottawa Scale. Statistical analysis was conducted using Review Manager (v5.4.1), including subgroup and sensitivity analyses.

Results: Meta-analysis revealed a significant association between preoperative physical frailty and postoperative delirium (pooled odds ratio: 2.47; 95% confidence interval: 2.04-2.99; I² = 46.7%). The baseline frailty rate was 34.0% (4,910/14,441), while the overall incidence of postoperative delirium was 20% (2,783/14,441). Subgroup analyses based on characteristics such as race, frailty-assessment tools, and surgical types were conducted to explore potential sources of heterogeneity. This meta-analysis provided compelling evidence supporting a notable link between preoperative physical frailty and an increased risk of postoperative delirium in older surgical patients. Early identification through frailty screening can enable targeted interventions, potentially enhancing overall management and individualized treatment. Integrating frailty assessment into preoperative evaluation may improve predictive accuracy in surgical planning and anesthesia management.

Conclusions: Future research could focus on optimizing the integration of frailty assessment into preoperative protocols for timely intervention and improved patient outcomes.

Trial registration: The review protocol was registered with PROSPERO (CRD42023390486), date of registration: Aug 11, 2023.

Background: This study aimed to explore the factors associated with the length of in-hospital stay (LOS) in allergic rhinitis (AR).

Methods: Patients with AR and related data were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The influencing factors of LOS were determined by correlation analysis and linear regression. We ranked the importance of significant variables. Finally, mediation analysis was performed to explore the potential mediating factors associated with LOS.

Results: This retrospective study enrolled 937 patients diagnosed with AR. Correlation analysis showed that 10 variables were closely correlated with the LOS. Linear regression further showed that albumin, white blood cell (WBC), red blood cell (RBC), red cell distribution width (RDW), total Ca, and monocyte were independently related to the LOS (all P < 0.05). After considering comorbidities, monocyte, albumin, WBC, RBC, total Ca, and Charlson comorbidity index were independent factors for LOS (all P < 0.05). The permutation importance exhibited that monocyte was the most important variable. Finally, mediation analysis demonstrated that WBC played a mediating role in the relationship between monocytes and LOS.

Conclusion: Monocyte level is related to the LOS of patients with AR, and their relationship can be mediated by WBC. Medical and nursing staff can stratify AR management according to monocyte levels to make crucial clinical decisions and shorten LOS.

Clinical trial: Not applicable.

Background: This study aimed to compare the efficacy and safety of ciprofol-induced doses based on three indices: total body weight (TBW), ideal body weight (IBW), and lean body weight (LBW) in patients with obesity undergoing gastroscopy.

Methods: In a single-centre, prospective, randomised study conducted at an endoscopy centre, a total of 108 patients aged 18-65 years who underwent painless gastroscopy and had a body mass index (BMI) of 28-39.9 kg/m² were included. Patients with obesity from the intended study population were randomised to receive a ciprofol infusion (0.4 mg/kg) for the induction of anaesthesia based on TBW (Group T), IBW (Group I), or LBW (Group L). A Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale score of < 1 was considered a marker of loss of consciousness, prompting gastroscopy. The primary outcomes were the success rate of anaesthesia for the procedures, and that of general anaesthesia achieved using the initial dose. Secondary outcomes included the frequency of remedial sedation, total ciprofol dose, and adverse events RESULTS: The procedure success rate was 100% in all three groups. Compared to Group L, the general anaesthesia success rate achieved with the initial dose was higher and the frequency of remedial sedation was lower in Groups T and I. Compared to Group L, fewer patients in Group T required additional medication. Compared to Group T, the occurrence of hypoxaemia was lower in the remaining two groups, and Group L had a lower incidence of posterior tongue drops and hypotension.

Conclusions: Induction doses of ciprofol based on TBW or IBW provided better anaesthesia than doses based on LBW for gastroscopy in patients with obesity. LBW-based induction doses of ciprofol improved cardiovascular stability and respiratory safety, whereas IBW-based induction doses of ciprofol reduced respiratory depression.

Trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2300073539 first registration date 13/07/2023).

Background: The supraglottic airway device (SAD) is nowadays widely used as a ventilation device. The GMA-Tulip is a new non-inflatable SAD used to establish short-term artificial airway for general anesthesia or cardiopulmonary resuscitation. In the present study, we compare the clinical performance of the GMA-Tulip and the LMA Supreme for lateral total hip arthroplasty in geriatric patients.

Methods: In 70 anesthetized and paralyzed adult patients, the GMA-Tulip (n = 35) or the LMA Supreme (n = 35) was inserted. The primary outcome was oropharyngeal leak pressure (OLP). The secondary outcomes included the peak airway pressure (PAP), insertion time, insert resistance, number of insertion attempt and manipulations, glottic exposure grading, and incidence of perioperative complications.

Results: The GMA group had a significantly higher OLP and lower PAP at the 4 measurement points than did the Supreme group (P < 0.05). Compared with that in the supine position, the OLP of the two groups was significantly lower in the lateral position (P < 0.05). The LMA Supreme had a longer insert time (36(32,39) vs. 18(15,22) sec; P < 0.001) and was inserted more difficultly (P < 0.05). The sore throat scores one hour after surgery at the LMA Supreme was higher than that at the GMA-Tulip (P < 0.05), but the incidence of blood staining was not different between the two groups (P = 0.106).

Conclusions: The GMA-Tulip and LMA Supreme both provided considerable ventilation efficiency during lateral total hip arthroplasty in geriatric patients. Our data showed that new non-inflatable laryngeal mask GMA-Tulip has a higher OLP and demonstrated a shorter time to successful placement and a lower sore throat score one hour after surgery compared with the LMA Supreme.

Trial registration: The trial was retrospectively registered on August 30, 2024 in the Chinese Clinical Trial Registry, registration number ChiCTR2400088996 (30/08/2024).

Background: Pericardiectomy is the curative treatment for constrictive pericarditis, yet postoperative low cardiac output syndrome (LCOS) may occur. The application of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in post-pericardiectomy refractory LCOS has limited case reports, and its effectiveness and safety remain unclear. This study aims to provide evidence for the effectiveness of ECMO in treating post-pericardiectomy refractory LCOS.

Methods: Nine cases of post-pericardiectomy ECMO from two high-volume pericardiectomy centers in China were retrospectively reviewed. Meanwhile, a literature search was performed in PubMed and Embase on December 4, 2024. After screening, 5 articles were finally included for data extraction and comprehensive analysis.

Results: Case Series: There were 4 cases of tuberculous etiology, 1 with a history of cardiac surgery, and 4 idiopathic cases. All patients were in New York Heart Association class III - IV at baseline. All the patients undertwent pericardiectomy via median sternotomy, and 5 patients underwent concomitant valve procedures. One patient failed to wean from the cardiopulmonary bypass (CPB) and was transferred to femoral VA-ECMO. Eight patients received femoral VA-ECMO support 4-96 h after surgery due to refractory LCOS. All the patients survived to discharge with good neurological outcomes after 120-192 h of ECMO support. Two patient were lost to follow-up, and the rest 7 patients survived to follow-up with a mean follow-up of 56 months.

Literature review: 4 case reports and 1 retrospective study were identified. In the retrospective study of 69 patients, 8 received ECMO during or after pericardiectomy with a hospital mortality rate of 63%. The four Patients of the 4 case reports were all survival at hospital discharge.

Conclusions: VA-ECMO might be effective for refractory LCOS after pericardiectomy in patients with constrictive pericarditis, and could improve survival rates.

Background: Microtubules (MTs) have been postulated as one of the molecular targets underlying loss of consciousness induced by inhalational anesthetics. Microtubule-targeting chemotherapy drugs and opioids affect MT stability and function. However, the impact of prolonged administration of these drugs on anesthetic potency and anesthesia induction and emergence times remain unelucidated.

Methods: Epothilone D, paclitaxel, vinblastine or opioid morphine were administered alone for a prolonged period (> 2 weeks) to male CD1 mice and their sensitivity to incremental concentrations of isoflurane were examined using loss of righting reflex (LORR) response as a measure of sensivity. The induction and emergence time after administration and termination of fixed concentration of isoflurance (1.2%) were also assessed.

Results: Compared with saline treatment, epothilone D and vinblastine induced a leftward (more sensitive) shift of LORR response curves (95% confidence intervals for EC50: epothilone D, 0.75[0.73, 0.77] vs. saline, 0.97[0.96, 0.98]; vinblastine, 0.74[0.73, 0.75] vs. saline, 0.98[0.97, 0.99]). In contrast, morphine caused a rightward (more resistant) LORR response curve (morphine, 1.16[1.15, 1.17] vs. saline, 0.97[0.96, 0.98]), while paclitaxel produced a marginal but significant rightward shift of LORR (paclitaxel, 1.05[1.03, 1.06] vs. saline, 0.98[0.97, 0.99]). At concentration of 1.2% isoflurane, morphine treatment prolonged (275 ± 50) and vinblastine treatment reduced (96.5 ± 26) the anesthetic induction latency (in second) relative to saline treatment (211 ± 39). The latency of emergence from anesthesia was shorter in morphine (58 ± 20) and vinblastine-treated (98 ± 43) mice compared to saline (176 ± 50) treatment. The induction or emergence latencies of epothilone D or paclitaxel treatment did not differ from saline treatment between groups.

Conclusions: Microtubule-modulating drugs can affect not only sensitivity but also induction and emergence times to inhalational anesthetic isoflurane in mice. This study highlights a possible role of MTDs in modulating anesthetic effects in disparate directions, which has implications for anesthetic concentrations that should be used for induction, maintenance and emergence of anesthesia. These findings in rodents may have relevance to the perioperative care of cancer patients who receive MT-targeting chemotherapy drugs or even opioids for pain for prolonged periods.

Background: By exceeding planetary environmental boundaries, multiple global crises have become imminent in the 21st century. The healthcare system is a contributor to the climate crisis, accounting for approximately 5% of greenhouse gas emissions in Western countries. In anaesthetic clinics, desflurane, a highly potent greenhouse gas and volatile anaesthetic with no compelling indications, accounts for up to two thirds of total emissions. Its use can be drastically reduced using simple measures. In the present study, we investigated whether a relevant and timely reduction in use could be achieved by dismounting desflurane vaporisers and providing information to the team without restricting its use.

Methods: The study was conducted in a German university hospital with approximately 1250 beds, over a 12-month period between 2021 and 2022, with a comparison to the corresponding periods of the previous years up to 2017. The interventions were, first, the removal of desflurane vaporisers, and second, staff education on the climate impact of volatile anaesthetics. The primary outcome variable was the reduction of hypnotic-related emissions in CO₂ equivalents per anaesthetic procedure.

Results: Prospective data collection and interventions were conducted from 28 March 2021 to 27 March 2022. The amount of CO₂ equivalent emissions per procedure in the form of volatile anaesthetics was reduced by 86% compared with the year before the interventions (p < 0.001). Interestingly, there was already a 52.1% reduction in the year before the procedure (p < 0.001). There were no significant changes in the use of sevoflurane or propofol. Hypnotic-related costs decreased by €14,549, whereas extubation time did not change significantly.

Conclusions: Removal of desflurane vaporisers and staff training can quickly and significantly reduce the emissions of an anaesthesia department in a large German teaching hospital. This may also reduce the costs.

Trial registration: The trial was registered with the German Clinical Trials Register, identifier DRKS00024973 on 12/04/2021.

Congenital epiglottic cysts, though rare, represent a recognized etiology of upper airway obstruction in neonates and infants. Airway management of large epiglottic cysts presents significant challenges due to the inherent risk of catastrophic airway compromise. We present a case of difficult airway management in a neonate with a giant congenital epiglottic cyst, detailing an effective technique for glottic visualization and successful endotracheal intubation.

Background: With the advancement of ultra-fast track anesthesia, early extubation following cardiac surgery has become a prevailing trend. While there are significant benefits associated with early extubation, its high failure rate warrants further investigation, and the effectiveness of various extubation strategies in cardiac surgery still requires validation.

Methods: An extensive literature search was performed in the PubMed, Scopus, Embase, and Web of Science databases, encompassing studies without language restrictions. Eligible studies were those that compared the outcomes of various extubation strategies.

Results: Primary outcome was the success rate of the extubation protocol. Secondary outcomes were time to extubation, intensive care unit (ICU) length of stay (LOS), complications and mortality rate. Data from 12 studies, which included a total of 1454 participants, were included in the analysis. The pairwise meta-analysis revealed that late extubation was significantly more effective than immediate extubation strategies (relative risk [RR] = 1.52, 95% confidence interval [CI] = 1.21-1.91, P = 0.0001). In the network meta-analysis (NMA), the late extubation protocol was associated with a significantly lower risk of extubation failure compared to early extubation and extubation on the table (RR = 0.76, 95% CI: 0.5-1.16; RR = 0.22, 95% CI: 0.05-0.91). Furthermore, according to the SUCRA plot, late extubation was ranked as the most effective strategy for reducing extubation failure (94%).

Conclusions: Our findings indicate that a late extubation strategy, as opposed to early (within a specified time frame) or immediate extubation, is correlate with a substantially higher rate of successful extubation. Despite this, the early extubation strategy seems to offer better cost-effectiveness and safety profiles. The selection of an appropriate extubation strategy should be personalized, taking into account the patient's preoperative characteristics and the circumstances encountered during surgery.

Trial registration: The study protocol adheres to the PRISMA statement and checklist. The protocol was registered at PROSPERO (CRD42024529051).

Background: Despite advancements in surgical techniques and perioperative care for free flap reconstructive surgery, concerns persist regarding the risk of free flap failure, with thrombosis and bleeding being the most common complications that can lead to flap loss. While perioperative anticoagulation management is crucial for optimizing outcomes in free flap reconstructive surgery, standardized protocols remain lacking. This study aims to investigate the role of anticoagulation and perioperative practices in free flap reconstructive surgery and their impact on surgical outcomes.

Methods: This retrospective, single-center study included all adult patients undergoing free flap surgery from 2009 to 2020. Patients were retrospectively divided based on intraoperative (UFH or no UFH) and postoperative anticoagulation management (UFH only, Aspirin and UFH, Aspirin only). The relationship between anticoagulation protocols, PTT values, and flap survival was assessed.

Results: A total of 489 free flap surgeries were included. Most flaps were taken from the upper extremity (49.5%), primarily for tumor-related reconstructions (85.7%). Flap loss occurred in 14.5% of cases, with a median time to flap loss of 3 days post-surgery. Intraoperative UFH (20 IU/kg) was administered to 63.6% of patients and significantly predicted flap survival (OR = 0.45, 95% CI [0.24, 0.82]). PTT values on day 1 post-surgery were significantly related to flap survival (P = 0.03), with each unit increase reducing the relative probability of flap loss by 5.2%. There was no significant difference in flap survival between patients treated with heparin alone and those treated with both heparin and aspirin. The small sample size in the aspirin-only group limited the statistical relevance of this subgroup.

Conclusion: Our findings highlight the importance of intraoperative UFH and PTT-guided postoperative management in improving free flap survival. Standardized anticoagulation protocols are essential for enhancing outcomes in free flap reconstructive surgery.