BMC Anesthesiology最新文献

Background: Subarachnoid anesthesia is the primary anesthetic method for elective cesarean section surgery, characterized by rapidly taking effect and reliable analgesia. However, subarachnoid anesthesia is prone to cause a high block level, resulting in a high incidence of maternal hypotension. How to reduce the incidence of maternal hypotension under subarachnoid anesthesia is a practical problem that needs to be solved urgently in clinical practice.

Methods: This prospective cohort study was performed at Nantong Maternal and Child Health Care Hospital in China between January and July 2023. This study compared the incidence of hypotension in pregnant women undergoing subarachnoid anesthesia during elective cesarean section in four groups, including group A (control group) with 10 mg of 10% glucose solution; Group B with 5 mg 10% glucose solution group; Group C with 4 mg 10% glucose solution group; Group D with 2 mg 10% glucose solution group. Each group was given a dose of 10 mg Ropivacaine with a concentration of 0.5% and a volume of 2 ml. The primary outcome was the incidence of maternal hypotension. The secondary outcomes were the plane of anesthesia, abdominal wall muscle relaxation degree and the incidence of adverse events.

Results: Data from 74 (18, A group; 26, B group; 15, C group; 15, D group) participants were analyzed. Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women (P = 0.152). The plane of anesthesia gradually shifted from T4 to T10 as the specific gravity of ropivacaine decreased (P < 0.01). Satisfaction about abdominal wall muscle relaxation degree gradually decreased with the decrease of the specific gravity of ropivacaine (P = 0.04). And the incidence of adverse events gradually increased with the decrease of the specific gravity of ropivacaine (P = 0.027).

Conclusions: Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women.

Background: Endotracheal intubation (ETI) is a life-saving procedure that must be accurately carried on to guard against complications. Presbyopia leads to difficulty in viewing close objects and may obstacle proper intubation even with the best hands.

Purpose: This study supposed that the use of video-laryngoscope (VL) may provide better intubation conditions for presbyopic anesthetists and targets to evaluate the neonates and infants' intubation success rates (ISR) by anesthetists aged ≥ 45 years using the C-MAC VL compared to the standard laryngoscope (SL).

Methods: Thirty-one neonates with an age of 18.2 ± 5.2 days and a body weight of 4.5 ± 0.3 kg and 103 infants aged 8.6 ± 1 months and weighing 9.4 ± 1.5 kg were randomly categorized into the SL group that received ETI using the SL and the VL group had intubated using the C-MAC^® (Karl Storz, Germany) VL with the standard Miller blade and flexible Stylet (2 mm PORTEX^® stylet; Smiths Medical International Ltd., UK) to strengthen the endotracheal tube (ETT) and adjust its curvature as C-shaped. The study outcomes included the frequency of successful intubation and the number of intubation attempts.

Results: The ISR was significantly (P < 0.001) higher with significantly (P = 0.0037) lower frequency of using assistance maneuvers with VL. The mean score of the anesthetist's difficulty rating was significantly (P < 0.001) higher with SL (2.7 ± 2) than with VL (1.27 ± 1.27). Times for the full intubation process were significantly (P < 0.001) shorter with VL than SL. The 1st attempt success rate was significantly (P = 0.0195) higher with VL than SL (86.6% vs. 67.2%). The frequency of maneuver-related complications was insignificantly (P = 0.116) reduced with the use of VL (4.5%) than with SL (12%). The ISR showed a negative significant correlation (r=-0.973, P = 0.005) with the anesthetist's age.

Conclusion: Neonatal and infantile intubation using VL is feasible and easy to handle by aged anesthetists and allows higher ISR and 1st attempt rate with minimal need for external assistant maneuvers and maneuver-related complications. VL might be more appropriate for the presbyopic pediatric anesthetists than the SL.

Limitations: The limitations of the study are the small sample size of anesthetists and the use of one type of VLs.

Background: Anesthesia can lead to functional cognitive impairment, which can seriously affect postoperative recovery. To investigate the effect and mechanism of quercetin (Que) in anesthetized rats, the study provided a new therapeutic idea for the prevention of cognitive dysfunction caused by anesthesia.

Methods: Cognitively impaired rats were constructed using Isoflurane (ISO) anesthesia and treated with Que. The capacity of the rats to learn and remember was tested using the Morris water maze test. Rat hippocampal tissues were collected and analyzed for inflammatory factor concentration and miR-138-5p expression using ELISA and qRT-PCR, respectively, and the targeting link between miR-138-5p and LCN2 was verified by dual luciferase reporter.

Results: Que treatment was found to improve ISO-induced cognitive dysfunction and inhibit the level of hippocampal inflammatory factors in rats. miR-138-5p was down-regulated in rats with cognitive dysfunction, while Que treatment increased miR-138-5p expression. The study found that knockdown miR-138-5p can reverse the positive effects of Que therapy, aggravate cognitive dysfunction, and promote the secretion of TNF-α, IL-1β, and IL-6 in the hippocampus. In addition, LCN2, a target gene of miR-138-5p, was significantly up-regulated in the hippocampus after ISO induction.

Conclusion: Que may inhibit ISO-induced hippocampal neuroinflammation and ameliorate functional cognitive deficits in rats by modulating miR-138-5p/ LCN2.

Background: It remains uncertain whether the utilization of methylprednisolone during surgery effectively mitigates the occurrence of adverse outcomes. To examine the association between perioperative methylprednisolone administration and postoperative pleural effusion and pneumonia in older patients with non-small cell lung cancer.

Methods: A retrospective cohort study included non-small cell lung cancer patients aged 65 years or older undergoing thoracic surgery between January 2012 and December 2019 in China. Primary outcome was pleural effusion. Secondary outcome was postoperative pneumonia. Multivariate logistic regression models assessed the independent effects of various factors on pleural effusion and pneumonia. Propensity score matching (PSM) method reduced selection bias enhancing causal inference validity. Subgroup analyses identified potential effect heterogeneity in specific sub-populations.

Results: A total of 1951 older patients with non-small cell lung cancer were included. The incidence of postoperative pleural effusion in the methylprednisolone group before and after PSM matching was significantly lower than that in the control group (before PSM: 9.4% vs. 19.2, P < 0.001; after PSM: 9.8% vs. 18.2%, P < 0.001). There was no statistically significant difference in the incidence of postoperative pneumonia between the two groups before and after matching. After adjusting all the variables and PSM, we found that intraoperative methylprednisolone was associated with a reduction in postoperative pleural effusion in older patients with non-small cell lung cancer [odds ratio (OR) = 0.48, P < 0.001; OR = 0.47, P < 0.001]. Perioperative methylprednisolone showed consistent protective effects in all sub-populations of gender, age, surgery duration, and smoking (P all < 0.05). Logistic regression models and PSM found that methylprednisolone was not associated with postoperative pneumonia and long-term survival in older patients with non-small cell lung cancer.

Conclusion: Perioperative methylprednisolone was associated with reducing the occurrence of postoperative pleural effusions in older patients with non-small volume lung cancer, but it was not associated with pneumonia or long-term survival outcomes.

Background: Lidocaine, a widely used local anaesthetic, also serves as an adjuvant in pain management. However, its use in children is off-label. This study aimed to determine if intravenous lidocaine alleviates the haemodynamic, metabolic, and hormonal responses to intubation and laparoscopic surgery in children.

Methods: A single-centre, parallel, double-masked, randomised, placebo-controlled trial. 132 patients, aged 18 months to 18 years, with no contraindications to lidocaine administration and qualified for laparoscopic appendectomy were enrolled. The intervention studied was a lidocaine bolus of 1.5 mg⋅kg^- 1 over 5 min given before induction of anaesthesia, followed by intraoperative lidocaine infusion at 1.5 mg⋅kg^- 1⋅h^- 1 intraoperatively. Patients in the control group were administered a placebo. Mean arterial pressure, glucose, cortisol, lidocaine blood levels, lidocaine-related side effects, and intraoperative opioid requirements were analysed.

Results: 132 participants completed the trial. The number of patients who experienced an excessive cardiovascular response to induction of anaesthesia or intubation was 23 (37%) in the control group and 21 (34%) in the lidocaine group (p = 0.707). No statistically significant difference was found between the control and lidocaine groups in the hormonal and metabolic responses, as well as intraoperative fentanyl requirements. Serum lidocaine levels remained below the toxic threshold in all patients.

Conclusions: Although the studied intervention appears to be safe, with no clinical side effects observed and serum lidocaine levels remaining below the toxic threshold, its intraoperative administration is not recommended, as it does not demonstrate any significant benefit during the anaesthesia period when compared to placebo.

Trial registration number: NCT05238506. The date of first registration: 14/02/2022.

Introduction: In a low-income country, the impact of preoperative anemia on postoperative mortality among noncardiac surgery patients is little understood. As a result, we aim to investigate the association between preoperative anemia and postoperative mortality in noncardiac surgery patients in Northwest Ethiopia.

Methods: This is a prospective follow-up study of 3506 noncardiac surgery patients who were included in the final analysis between June 1, 2019, and July 1, 2021. We used a propensity score-match analysis to group anemic and non-anemic patients. The propensity score match analysis took into account age, gender, comorbidities, American Society of Anesthesiologists physical status, urgency of surgery, and trauma. Patients with and without preoperative anemia were divided into a 1:1 ratio in a propensity score balance. The association between preoperative anemia and postoperative mortality was determined using adjusted odds ratios and 95% confidence interval.

Results: This study included 3506 noncardiac surgery patients, of which 1532 (43.7%) had preoperative anemia. The propensity score-matching results reveal that one-to-one nearest neighbour propensity score matching without replacement was successful for 1351 pairs of surgical patients. The postoperative 28-day mortality rate for anemic patients was 53 (3.9%), with (OR:1.63; 95% CI: 1.05-2.54).

Conclusion: The study found that patients undergoing noncardiac surgery in Northwest Ethiopia had a higher rate of preoperative anemia than those in high-income countries. Preoperative anemia had a significant association with 28-day mortality after surgery.

Objective: The objective of this study is to investigate bacterial proliferation within the internal circuits of anesthesia machines in post-anesthesia care units (PACUs) following the implementation of the new protocol, where 'a single dedicated external circuit is used for each individual patient.' This measure was introduced during the COVID-19 pandemic, in alignment with a novel prevention and control strategy.

Methods: Using the observational technique, we analyzed anesthesia machines in PACUs between July and September 2022. The internal circuits of the anesthesia machines were disinfected every two weeks. Samples were obtained from the internal circuits on the 3rd, 5th, 7th, 10th, 12th, and 14th day following disinfection for bacterial culture. Changes in the positivity rate of bacteria in the internal circuits over time were analyzed using the generalized estimating equation. The anesthesia machines were divided into the positive group (n = 9) and the negative group (n = 41) based on the sampling results on the 14th day after disinfection. Risk factors for positive bacterial culture results in anesthesia machines in PACUs were analyzed using single-factor modified Poisson analysis and multi-factor modified Poisson regression analysis.

Results: The positivity rates of the internal circuits of anesthesia machines in PACUs on the 3rd, 5th, 7th, 10th, 12th, and 14th day following disinfection were 10%, 14%, 12%, 20%, 16%, and 18% respectively. There were no statistically significant differences when the positive rates of the next five time points and the third day were compared (P > 0.05). Risk factors for the contamination in the internal circuits of anesthesia machines was the number of elderly patients and the overall surgical use duration, with the difference was statistically significant (P < 0.025).

Conclusion: Amid the COVID-19 pandemic, characterized by the adoption of new prevention and control protocols, the disinfection interval for internal circuits of anesthesia machines in PACUs may potentially be extended. However, the emphasis of disinfection should still be placed on those anesthesia machines that have been used for a longer cumulative surgical duration and by a higher number of elderly patients over 60 years old. This approach ensures that resources are allocated effectively.

Background: High-frequency, high-intensity transcutaneous electrical nerve stimulation (HFHI TENS, i.e. 80 Hz and 40-60 mA) is an effective, fast-acting pain relief modality after elective surgery, offering pain relief within 5 min. Few studies have explored patients' perspectives on using TENS in the post-anesthesia care unit. This study investigates patients' experiences and perceptions of TENS as a complementary approach to traditional pharmacological pain management in postoperative care.

Method: Patients undergoing elective laparoscopic cholecystectomy were offered TENS as an alternative to conventional pain treatment with IV opioids. Twenty participants attended telephone semi-structured telephone interviews a median of 12 days after surgery. Data were analysed using a thematic analysis according to Braun and Clark.

Results: Participants expressed that TENS provided reassurance and relaxation, calmed them, and gave them a sense of control over their pain. Participants perceived a greater degree of autonomy as TENS could be administered independently. They conveyed a preference for TENS, which they experienced as a safe and fast-acting alternative to opioids, despite its limitations in managing severe pain and rapid offset upon discontinuation.

Conclusion: To our knowledge, this is the first study that describes patients' views on managing postoperative pain using TENS in the post-anesthesia care unit. This study indicates that patients desire alternatives to drugs for pain control in the postoperative setting. TENS has advantages, such as a rapid onset and offset and supporting patient autonomy, as well as drawbacks, such as being ineffective when pain is too severe. TENS could be included within the routine multimodal analgesia framework for person-centred postoperative pain management.

Trial registration: The participants in the current study were retrospectively registered and recruited from a randomized controlled trial (RCT; registered at ClinicalTrials.gov: NCT04114149).

Background: Sufentanil is commonly used to induce general anaesthesia due to its rapid onset of action, strong analgesic effect, long-lasting effect, and stable haemodynamics; however, it often induces cough, increasing the risk of anaesthesia. This study aimed to investigate the preventive effect of low-dose esketamine on sufentanil-induced cough.

Methods: This randomised, double-blind, placebo-controlled clinical study was conducted at the Air Force Medical Center between September 2023 and May 2024. A total of 100 adult patients (ASA of Anaesthesiologists class I-II) required general anaesthesia for elective surgery. The patients were randomly assigned to two groups: the esketamine group (Group E, n = 50), receiving 0.2 mg/kg esketamine intravenously, and the control group (Group C, n = 50), receiving an equal volume of normal saline. The incidence and severity of sufentanil-induced cough were assessed 1 min after administering of 0.5 μg/kg sufentanil intravenously. Heart rate (HR), mean arterial pressure (MAP), and adverse reactions were recorded at four time points: before esketamine administration (T0), 3 min after esketamine administration (T1), 1 min after endotracheal intubation (T2), and 3 min after endotracheal intubation (T3). The results were analyzed using appropriate statistical methods.

Results: A total of 100 eligible patients were screened, of which 99 participated in this study (1 patient refused to participate), 50 in Group E, and 49 in Group C. The incidence of cough in Group E (6.0%) was significantly lower than that in Group C (34.7%) (P < 0.001), and the severity of cough was also significantly milder than that in Group C (P = 0.038). The differences in the HR and MAP levels at T₀, T₁, T₂, and T₃ between the two groups were not statistically significant (P > 0.05). Two patients in Group C experienced chest wall stiffness, while no adverse reactions were observed in Group E. The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05).

Conclusion: Low-dose esketamine (0.2 mg/kg) can significantly reduce the incidence of sufentanil-induced cough during the induction of general anaesthesia in patients, with a small impact on haemodynamics, no adverse reactions, and good safety.

Background: Postoperative sore throat is a common complication following general anesthesia. This study aimed to investigate the impact of preoperative topical magnesium sulfate spraying in the oropharyngeal region on postoperative sore throat following gynecological laparoscopic surgery.

Methods: The study included 58 patients scheduled for gynecologic laparoscopic surgery at Xuzhou Medical University Affiliated Hospital. Patients were randomly assigned to either the magnesium sulfate group or the control group, with 29 patients in each group. In the magnesium sulfate group, 25% magnesium sulfate was sprayed at a dose of 15 mg/kg on the mucous membrane of the pharynx and posterior wall of the larynx near the glottis using a laryngoscope under visual guidance during intubation; in the control group, an equal volume of normal saline was used instead. The primary outcome measure was the overall incidence of postoperative sore throat 48 h after surgery.

Results: The overall incidence of postoperative sore throat in the magnesium sulfate group was lower than that in the the control group (20.0% vs. 66.7%, P < 0.001). At time points T1 (P < 0.001), T2 (P = 0.02), and T3 (P = 0.015), the incidence of postoperative sore throat in the the magnesium sulfate group was also lower than that in the the control group.

Conclusion: This study confirmed that preoperatively spraying magnesium sulfate locally in the Oropharyngeal Region can reduce the frequency and severity of postoperative sore throat.

Trial registration: The study was registered at Chictr.org.cn with the number ChiCTR2400087240 on 07/23/2024.