BMC Anesthesiology最新文献

Background: APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings.

Methods: This retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes.

Results: 20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR - 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO₂- removal between both modes.

Conclusion: Despite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.

Objective: Opioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection.

Methods: This study was a randomized controlled double-blind trial. 92 adult patients of both sex with Child class (A) liver cirrhosis aged 18 to 65 years entering and completing the study. We excluded patients with renal or cardiac dysfunction or contraindications from study medications.46 patients in the opioid-sparing group (OS) receiving ketamine and dexmedetomidine infusions and 46 patients in the opioid-based (OB) group as controls. The main outcome measures: were intra-operative fentanyl requirements, postoperative fentanyl requirements, visual analogue pain scores, postoperative nausea, vomiting, ileus, desaturation, intra-operative hemodynamic events, and ICU stay were recorded.

Results: The total intra-operative fentanyl consumption was significantly lower in the OS group compared with the OB group, 183.2 ± 35.61 µg and 313.5 ± 75.06 µg, respectively, P < 0.001. The postoperative 1st 48 h fentanyl consumption was significantly lower in the OS group compared with the OB group, 354.5 ± 112.62 µg and 779.1 ± 294.97 ± µg, respectively, P < 0.001. Visual analogue scores were significantly better in the OS group at the early 2-hour assessment point postoperatively. The postoperative adverse events were significantly more frequent in the opioid-based group. ICU stay was significantly shorter in the OS group.

Conclusions: Administering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays.

Background: Timely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

Methods: From September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model's performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts.

Results: After multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880-0.891) in the training cohort and 0.883 (95% CI: 0.875-0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit.

Conclusions: Our predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.

Background: Inadequate or excessive nociceptive control during general anesthesia can result in significant adverse outcomes. Using traditional clinical variables, such as heart rate, systolic blood pressure, and respiratory rate, to assess and manage nociceptive responses is often insufficient and could lead to overtreatment with both anesthetics and opioids. This study evaluated the feasibility and effectiveness of three nociception monitoring techniques Nociception Level Index (NOL), Skin Conductance Algesimeter (SCA) and heart rate monitoring in patients undergoing image-guided, minimally invasive abdominal interventions under general anesthesia.

Method: This prospective observational study collected data from 2022 to 2024. All patients were anesthetized according to the department's routine, and predetermined events were recorded. Two commercially available nociception monitors, the PMD-200 from Medasense (NOL) and PainSensor from MedStorm (SCA), were used, and their data were collected along with various hemodynamic parameters. The three nociception monitoring techniques were compared during predetermined events.

Result: A total of 49 patients were included in this study. NOL and SCA demonstrated higher responsiveness than HR for all events except for skin incision. The comparison of the values above and below the threshold for each nociceptive stimulus showed significance for all measurements using the SCA and NOL. However, using HR as a surrogate for nociception with a threshold of a 10% increase from baseline, the difference was significant only at skin incision. There was no variation in the peak values attributable to differences in patients' age. Weight was a significant predictor of the peak NOL values.

Conclusion: NOL and SCA demonstrated superior sensitivity and responsiveness to nociceptive stimuli compared to HR, effectively detecting significant changes in nociceptive thresholds across various stimuli, although responses during skin incision showed no such advantage.

Trial registration: Clinical trial - NCT05218551.

Background: Emergence agitation EA is a state of confusion and harmful aggressiveness during recovery. It is a common complication after rhinoplasty, with risk of trauma, bleeding, and hemodynamic instability. Dexmedetomidine and gabapentin premedication could improve the quality of recovery after rhinoplasty.

Methods: One hundred fifty-three participants (ASA I-II, both sexes and age 18-40 years) scheduled for rhinoplasty were randomized into three groups. Group C didn't receive premedication, Group D received intramuscular (IM) dexmedetomidine, and Group G received oral gabapentin. The degree of EA by Riker sedation-agitation scale (RSAS) during recovery, pain severity, and adverse events recorded.

Results: The results showed statistically significant differences in EA scores with the lowest values in group D (p-value 0.002). Moreover, the incidence of EA was 17.6% (9/51) in Group D, 41.2% (21/51) in Group G, and 56.9% (29/51) in Group C with P value < 0.001 and significant differences in VAS score at 4, 8, and 12 h with the highest median (range) values in group C 4(3-6) in comparison to group D 2(1-3) and group G 2(1-3) and p-value < 0.001; no significant differences in adverse events.

Conclusions: IM dexmedetomidine premedication was more efficient than gabapentin in the reduction of the emergence agitation incidence, severity, and postoperative pain scores after rhinoplasty in adults.

Clinical trial registration number id: NCT05626998 on 25/11/2022.

Background: Halo-pelvic traction is a relatively safe treatment for preoperative spinal deformity correction in patients with severe scoliosis. Common device-related complications include local infection, back discomfort, and nerve compression symptoms. However, there are potential risks of mechanical compression of bronchial structures, especially in patients with severe thoracic lordosis and scoliosis, which can lead to life-threatening airway obstruction.

Case presentation: A 11-year-old boy diagnosed with neurofibromatosis received preoperative halo-pelvic traction for forty days with a Cobb angle reduced from 99° to 51°. On operation day, he experienced near-complete airway obstruction and hypoxemia post-anesthesia induction, which was successfully resolved by releasing the traction. The posterior correction surgery was performed as scheduled and the child was extubated uneventfully.

Conclusions: Airway obstruction is a rare but severe complication of halo-pelvic traction, emphasizing the importance of careful airway management and continuous monitoring in pediatric patients with spinal deformities. Ensuring thorough preoperative evaluations and being prepared for potential airway emergencies are crucial steps in optimizing patient outcomes during such complex orthopedic interventions.

Background: Postoperative nausea and vomiting (PONV) are common complications following general anesthesia, particularly in gynecological laparoscopic surgeries. This study aims to evaluate the effect of intraoperative noise isolation on PONV incidence.

Method: This single-center, prospective, randomized controlled trial will enroll 192 adult patients undergoing laparoscopic gynecological surgery. Patients will be randomly assigned in a 1:1 ratio and stratified by age into either the control group (Group C), without noise-cancelling headphones, or a noise reduction group (Group NR), using noise-cancelling headphones from anesthesia induction until the end of surgery. All patients will receive intraoperative dexamethasone and ondansetron prophylaxis. The primary outcome is the incidence of PONV within 48 h post-surgery. Secondary outcomes include PONV severity at 24 and 48 h, antiemetic use, pain scores, need for rescue analgesia, Quality of Recovery-15 (QoR-15) scores, Richards-Campbell Sleep Questionnaire (RCSQ) scores, hemodynamic interventions, extubation time, length of stay in PACU and hospital, adverse events (hypertension, hypotension, bradycardia, tachycardia, desaturation after extubation, postoperative shivering, emergence agitation, allergic reactions, severe arrhythmias arrhythmia, cardiac arrest, hypothermia), patient satisfaction, and postoperative complications based on the Postoperative Morbidity Survey (POMS). Analyses will be conducted using modified intention-to-treat (mITT) and per-protocol (PP) populations.

Discussion: We hypothesize that intraoperative use of noise-cancelling headphones will reduce PONV incidence in patients undergoing gynecological laparoscopic surgery. The findings could enhance postoperative care protocols for thoracoscopic gynecological procedures.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2400087460).

Background: This study aimed to compare the effectiveness of the NoSAS, STOP-Bang, and Berlin scoring systems, which are utilized to predict obstructive sleep apnea syndrome (OSAS), in forecasting difficult airway management. Additionally, the study sought to determine which of these scoring systems is the most practical and effective for this purpose.

Methods: Following the ethics committee approval, preoperative NoSAS, STOP-Bang, and Berlin scores were calculated for 420 patients aged 18 years and older who were scheduled for tracheal intubation. Mask ventilation and intubation were performed by research assistant with a minimum of two years of experience. Detailed examinations and recordings were conducted, including demographic data, neck circumference, OSAS diagnosis, history of difficult intubation, comorbidities, ASA classification, Mallampati classification, and Cormack-Lehane grade. Subsequently, the predictive efficacy of these three scoring systems for difficult mask ventilation and difficult intubation was compared.

Results: In our study, 83 patients (19.8%) were classified as having difficult mask ventilation, and 101 patients (24.0%) were classified as having difficult intubation. The NoSAS score demonstrated a higher predictive power compared to the other scoring systems for difficult mask ventilation and difficult intubation. The cut-off value for the NoSAS score was determined to be 6.5 for predicting difficult mask ventilation and 7.5 for predicting difficult intubation.

Conclusion: The routine implementation of the NoSAS score, an easy-to-use, rapid and objective tool primarily developed for OSAS screening, is likely to be effective in preoperatively identifying difficult airways in patients undergoing general anesthesia.

Background: Postoperative headache is a medical condition that has a strong association with future recurrence and chronic headache, higher morbidity and mortality, extended hospital stays, poor quality of life and high financial burden. Despite, having these consequences, there are limited studies in the study area.

Objective: This study aimed to assess the incidence and associated factors of postoperative headache among adult elective surgical patients at the University of Gondar Comprehensive Specialized Hospital Northwest Ethiopia, April 9 to 20 June 2022.

Methods: An institution -based follow- up study was conducted from April 9 to June 20, 2022, at the University of Gondar Comprehensive Specialized Hospital, after ethical approval and 424 patients were included. Postoperative headache was assessed with patient interview and the response was dichotomized as present or absent. Data was collected through chart review and patient interviews using a questionnaire. Data was entered into Epidata 4.6.0 and statistical analysis was performed using stata version 14.01. Descriptive statistics was conducted to summarize patient information and determine the outcome's incidence. Binary logistic regression was conducted to identify factors associated with postoperative headache. Variables with P-value < 0.05 were considered statistically significant.

Results: The overall incidence of postoperative headache in the first three postoperative days was 54.3% (228) and the response rate was 99%. Previous history of headache (AOR = 4.83, CI = 2.42 9.73), prolonged fasting (AOR = 2.28, CI = 1.44-3.60), general anesthesia (AOR = 1.96, CI = 1.25-3.07), intraoperative hypotension (AOR = 1.74,CI = 1.06-2.88), being female (AOR = 1.62,CI = 1.06-2.54) and caffeine consumption(AOR = 1.60,CI = 1.02-2.52) were significant factors associated with postoperative headache and most of patients 89(21.2%) had moderate headache.

Conclusion and recommendations: More than half of patients were suffered from postoperative headache. Use of general anesthesia, having prior history of headache, being female, intraoperative hypotension, caffeine consumption and prolonged preoperative fasting were strongly associated with postoperative headache. The problem needs regular assessment and treatment.