BMC Anesthesiology最新文献

This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. Participants were divided into four groups based on their serum chloride concentrations. The primary outcomes assessed were mortality rates at 30, 90, and 180 days post-admission to the ICU. Analytical methods included Kaplan-Meier survival curves, Cox proportional hazards regression models, and Restricted Cubic Spline (RCS) analyses to delineate the relationship between serum chloride concentrations and patient outcomes. The study cohort comprised 10,996 patients, with observed mortality rates of 12.78% at 30 days, 17.14% at 90 days, and 20.32% at 180 days. Kaplan-Meier analyses revealed significant disparities in survival rates across the quartiles of serum chloride during the follow-up intervals (p < 0.001). The results from the multivariable Cox regression suggested a substantial inverse association between high serum chloride levels and decreased mortality at 30 days (hazard ratio [HR]: 0.96; 95%confidence interval [CI]: 0.95-0.97; P < 0.001), 90 days (HR: 0.97; 95% CI: 0.96-0.98; P < 0.001), and 180 days (HR: 0.97; 95% CI: 0.96-0.98; P < 0.001). Particularly, patients in the highest quartile of serum chloride faced significantly lower mortality risks compared to those in the lowest quartile (30 days HR = 0.65, 90 days HR = 0.71, 180 days HR = 0.69, P < 0.001). RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods.Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality.These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride's impact on clinical outcomes in this setting.

Background: In medicine, Artificial intelligence has begun to be utilized in nearly every domain, from medical devices to the interpretation of imaging studies. There is still a need for more experience and more studies related to the comprehensive use of AI in medicine. The aim of the present study is to evaluate the ability of AI to make decisions regarding anesthesia methods and to compare the most popular AI programs from this perspective.

Methods: The study included orthopedic patients over 18 years of age scheduled for limb surgery within a 1-month period. Patients classified as ASA I-III who were evaluated in the anesthesia clinic during the preoperative period were included in the study. The anesthesia method preferred by the anesthesiologist during the operation and the patient's demographic data, comorbidities, medications, and surgical history were recorded. The obtained patient data were discussed as if presenting a patient scenario using the free versions of the ChatGPT, Copilot, and Gemini applications by a different anesthesiologist who did not perform the operation.

Results: Over the course of 1 month, a total of 72 patients were enrolled in the study. It was observed that both the anesthesia specialists and the Gemini application chose spinal anesthesia for the same patient in 68.5% of cases. This rate was higher compared to the other AI applications. For patients taking medication, it was observed that the Gemini application presented choices that were highly compatible (85.7%) with the anesthesiologists' preferences.

Conclusion: AI cannot fully master the guidelines and exceptional and specific cases that arrive in the course of medical treatment. Thus, we believe that AI can serve as a valuable assistant rather than replacing doctors.

Background: Intravenous anesthesia with high-flow nasal cannula (HFNC) has been reported to benefit oxygen reserves and enhance postoperative recovery in surgeries requiring low neuromuscular blockade. This study investigated whether HFNC improves recovery quality in elderly undergoing ureteroscopic holmium laser lithotripsy (UHLL).

Methods: We enrolled 106 elderly patients undergoing UHLL, with 96 patients (48 per group) included in the final analysis. Patients were randomly assigned (1:1, stratified by sex) to receive either HFNC (HFNC group) or laryngeal mask airway (LMA) assisted general anesthesia (LMA group). The primary outcome was the Quality of Recovery 15-questionnaire (QoR-15) scores. Secondary outcomes included PACU stay duration, time to out-of-bed mobilization, length of hospital stay, airway dryness scores, surgeons' satisfaction, and postoperative complications.

Results: Compared to the LMA group, the HFNC group achieved significantly higher QoR-15 scores (125.5 [118.3-130.0] vs. 136.5 [126.3-139.0]; difference = -9, 95%CI, -11 to -5; P < 0.001) on the first postoperative day. For secondary outcomes, the HFNC group had a shorter PACU stay (difference = 11.6 min, 95% CI, 10.4-12.8 min), earlier out-of-bed mobilization (difference = 31.8 min, 95% CI, 30.6-33.1 min), lower mouth (difference = 2, 95% CI, 1-3) and throat dryness scores (difference = 2, 95% CI, 1-3) at 30 min post-operation, and lower rates of postoperative sore throat (14.6% vs. 0%; P = 0.019) and cough with sputum (odds ratio [OR] = 9.4, 95% CI, 1.1-78.4). No significant differences were observed between the groups for other measures.

Conclusions: HFNC can improve recovery quality in elderly patients after UHLL compared to LMA-assisted general anesthesia.

Trial registration: This trial was registered on July 20, 2023, in the Chinese Clinical Trial Registry (ChiCTR2300073757).

Background: There is controversy surrounding the influence of dexmedetomidine on the recovery of postoperative gastrointestinal dysfunction in patients under general anesthesia. The main purpose of this meta-analysis is to evaluate the effect of dexmedetomidine administration during the perioperative period on the recovery of gastrointestinal function in patients under general anesthesia.

Methods: A systematic review and meta-analysis with trial sequential analysis was performed to identify randomized controlled trials comparing dexmedetomidine administration with placebo for the recovery of gastrointestinal function. The primary outcomes were gastrointestinal function; first oral feeding time; incidences of postoperative nausea and vomiting, postoperative nausea, and postoperative vomiting; time to first bowel sound; time to first flatus; and time to first defecation. The secondary outcome was the length of hospital stay.

Results: A total of 20 studies comparing 2,470 participants were included in this meta-analysis. Perioperative dexmedetomidine administration did not result in a significant reduction in the time to first oral feeding (MD= -7.91, 95% CI = - 16.45 to 0.62, P = 0.07). However, dexmedetomidine administration was associated with a decreased incidence of postoperative nausea and vomiting (RR = 0.72, 95% CI = 0.58 to 0.88, P = 0.001), time to first flatus (MD= -6.73, 95% CI= -10.31 to -3.15, P = 0.0002), and time to first defecation (MD= -12.01, 95% CI = -22.40 to -1.61, P = 0.02).

Conclusions: Perioperative dexmedetomidine administration can promote the recovery of gastrointestinal function and reduce the length of hospital stay after abdominal surgery. The optimal dose and timing of dexmedetomidine and the influence on non-abdominal surgery need further investigation.

Trial registration: The study protocol was registered in the PROSPERO database (registration number: CRD42023443708) on July 9, 2023.

Background: Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) is a trunk block that has been gaining attention for managing postoperative pain following abdominal surgeries since its first report in 2019. We conducted a scoping review on M-TAPA, aiming to comprehensively evaluate existing research, identify the gaps in knowledge, and understand the implications of M-TAPA.

Methods: This scoping review was conducted using databases including PubMed, Embase, Cochrane, and CINAHL to evaluate the clinical efficacy of M-TAPA on April 19, 2024. Background and outcomes including anesthetized dermatomes, postoperative pain, opioid consumption, quality of recovery, duration to perform, and plasma local anesthetic concentrations were assessed. All reports involving patients, including randomized controlled trials, observational studies, case series, and case reports regarding M-TAPA, were included without language or age restrictions. The included studies were analyzed based on their methodology and clinical relevance.

Results: Anesthetized dermatomes were mainly observed in anterior cutaneous branch T7-11. Lateral cutaneous branch T8-10 also anesthetized; however, the probability was lower than anterior cutaneous branch area. M-TAPA has been investigated mostly in laparoscopic cholecystectomy; although its potential to outperform non-block and wound infiltration has been suggested, it did not clearly outperform the transversus abdominis plane block.

Conclusions: M-TAPA may be considered a promising technique for postoperative pain management in upper abdominal laparoscopic surgeries. Further studies are warranted to elucidate the precise mechanisms and broader surgical applications.

Objectives: To explore the effect of mild cognitive impairment (MCI) and MCI with sleep disorders on the potency of sevoflurane anesthesia in the elderly.

Design: Prospective study methods. Dixon up-and-down methods.

Setting: Comprehensive public tertiary hospital, Cangzhou City, Hebei Province, China.

Participants: 70 elderly patients scheduled for elective unilateral breast cancer surgery and finally analyzed 58 patients, including 30 patients with MCI (group M) and 28 patients with MCI with sleep disorders (group MS).

Outcome measures: The required minimum alveolar concentration (MAC) value of sevoflurane in the two groups was determined using the Dixon up-and-down method. The MAC value of sevoflurane and its 95% confidence interval (CI) were calculated using the logistic regression method. Serum melanin-concentrating hormone concentrations were determined by Elisa kits.

Results: The MAC value of sevoflurane in group M was 1.43 (95% CI 1.05-1.61%), and the MAC value of sevoflurane in group MS was 1.93 (95% CI 1.78-2.08%), There were notable differences between the two groups (P < 0.0001). The level of melanin-concentrating hormone (MCH) in the MS group was significantly lower than that in the M group (21.52 ± 3.82 vs. 37.17 ± 3.66 pg/ml, P < 0.0001). There was a significant negative correlation between MCH levels and the probability of body movement during skin incision (OR = 0.844, 95% CI: 0.715-0.996, P = 0.045).

Conclusions: Patients with MCI with sleep disorders required higher doses of sevoflurane than those with MCI alone. Changes in anesthetic requirements may be related to changes in MCH levels.

Background: This study explores the correlation between nutritional status, as determined by the Geriatric Nutritional Risk Index (GNRI), and the incidence of postoperative delirium (POD) in patients undergoing gastric surgery.

Methods: Data were obtained from the MIMIC-IV 2.2 database for patients aged 18 years or older who underwent gastric surgery. Patients were categorized into the malnourished group (GNRI < 98) and the non-malnourished group (GNRI ≥ 98). Multivariable logistic regression was performed to assess the association between GNRI and POD, and various potential confounders were adjusted to ensure the robustness of the results. Non-linear relationships between GNRI and POD risk were evaluated through restricted cubic spline (RCS) analysis. Subgroup analyses were conducted to examine the effect of GNRI on POD across different patient categories, and interactions were calculated. Propensity score matching (PSM) was employed to reduce confounding bias.

Results: The study included a total of 4,818 patients, of whom 1,133 (23.5%) developed POD. Patients with a GNRI < 98 had a significantly higher risk of POD compared with those with a GNRI ≥ 98 (odds ratio (OR): 2.21, 95% confidence interval (CI): 1.93-2.53, p < 0.001). Even after adjustment for relevant confounders, GNRI remained significantly associated with POD (OR:1.24, 95% CI: 1.04-1.48, p < 0.001). This association was further supported by the results from PSM (OR:1.23, 95% CI: 1.01-1.51, p = 0.045). RCS analysis demonstrated a non-linear relationship between GNRI and POD risk (p < 0.05). Subgroup analyses revealed significant interactions within the cardiovascular disease, renal replacement therapy, benzodiazepine medication, and vasoactive drug subgroups (p for interaction < 0.05). After the patient population was adjusted to individuals aged 65 and older, this correlation remained significant (p for interaction < 0.05).

Conclusions: This study identifies a significant association between GNRI and the incidence of POD in patients undergoing gastric surgery. Improving nutritional status before surgery may lower the risk of developing POD.

Objective: This study aimed to observe the impact of Tthoracic paravertebral nerve blockade(TPVB) at left T7 level on the α7nAChR-dependent cholinergic anti-inflammatory pathway in patients undergoing thoracoscopic lobectomy.

Methods: Scheduled thoracoscopic lung surgery patients at the First Affiliated Hospital of Nanchang University from August to September 2023 were divided into two groups according to the surgical site. The experimental group underwent left T7 paravertebral nerve blockade (LTPVB group), while the control group underwent right T7 paravertebral nerve blockade (RTPVB group). Relevant clinical data were collected, and Doppler ultrasound was used to measure the resistive index (RI) of the splenic artery before and after blockade. Additionally, perioperative α7nAChR levels and the expression levels of the inflammatory factors IL-1β, IL-6, and TNF-α were determined.

Results: There were no significant differences in general conditions, perioperative blood pressure, heart rate, or pain VAS scores between the two groups (p > 0.05). Splenic Doppler ultrasound showed that compared to before blockade, the RI of the splenic artery in the LTPVB group significantly decreased (p < 0.05). The α7nAChR levels at 12 h and 24 h postoperatively were significantly increased (p < 0.05) in both groups, and the levels of IL-1β, IL-6, and TNF-α gradually increased over time in both groups. However, the levels were significantly lower in the LTPVB group compared to the RTPVB group at 12 h and 24 h postoperatively (p < 0.05).

Conclusion: TPVB at left T7 can activate the α7nAChR-dependent cholinergic anti-inflammatory pathway, thereby alleviating the postoperative inflammatory response in patients undergoing thoracoscopic lobectomy.

Background: Developing proficiency in ultrasound-guided nerve block (UGNB) demands an intricate understanding of cross-sectional anatomy as well as spatial reasoning, which is a big challenge for beginners. The aim of this pilot study was to evaluate the feasibility of virtual reality (VR)-facilitated anatomy education in the first performance of ultrasound-guided interscalene brachial plexus blockade among novice anesthesiologists. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial.

Methods: Twenty-one anesthesia trainees with no prior ultrasonography or nerve block training were included in this study. All participants underwent a training program encompassing theory and hands-on practice. Trainees were randomized into one of two groups: one received VR-assisted anatomy course while the other did not. Subsequently, both groups completed identical practical modules on ultrasound scanning and needle insertion. The primary end point was defined as the evaluation of trainees' performance during their initial ultrasound-guided interscalene brachial plexus block, assessed using both the Global Rating Scale (GRS) and a task-specific Checklist. The secondary end point included the improvement in scores for written multiple-choice questions (MCQs).

Results: In evaluating practical ultrasound-guided nerve block skills, the VR group significantly outperformed the control group on the task-specific Checklist (29.23 ± 3.91 vs. 24.85 ± 5.13; P < 0.05), while both groups showed comparable performance on the GRS. Additionally, post-theoretical course MCQ scores increased substantially, with post-test results significantly surpassing pre-test scores in both groups (P < 0.001). However, intergroup analysis indicated no significant difference in score improvements between the VR and control groups (21.82 ± 12.30 vs. 18.33 ± 9.68, P > 0.05).

Conclusions: Overall, the findings of this pilot study suggest that immersive virtual reality training in anatomy may contribute to improving the proficiency of ultrasound-guided brachial plexus blocks among novice anesthesiologists. Incorporating VR into future anesthesia technique training programs should be considered.

Trial registration: ClinicalTrials.gov identifier: ChiCTR2300067437. Date of Registration Jan 9, 2023.

Background: Nutritional deficiency is common in critically ill hospitalized patients. This condition may be aggravated by increased dietary requirements and deficiencies in nutrient absorption. This study aimed to evaluate the associations between the modified Nutritional Risk in Critically ill (mNUTRIC) score and mortality and morbidity in patients with sepsis.

Methods: In this prospective observational study, 78 patients with sepsis were enrolled in the general intensive care unit over a 3-month period. Demographic and clinical data and laboratory results were recorded and followed up. The nutrition of each patient was started by the nutrition team, and a modified score (mNUTRIC) was calculated. This score was used to assess the patients' nutritional status and mortality risk.

Results: The mean age of the patients was 77.2 ± 9.9 years, and the majority were men. The median mNUTRIC score was 6. The cohort was divided into two groups: 31 patients (39.7%) with low scores and 47 patients (60.3%) with high mNUTRIC scores. A high mNUTRIC score was associated with an increased need for vasoactive drugs (p < 0.001) and mechanical ventilation (p < 0.001), as well as increased acute kidney injury (p = 0.014) and prolonged hospital stay (p < 0.001) during ICU follow-up. The mNUTRIC score showed high accuracy in predicting mortality (p < 0.001).

Conclusions: In this study, to predict the prognosis of patients with sepsis in the ICU, the mNUTRIC score was associated with mortality. The inclusion of nutritional assessment scoring tools in the routine clinical evaluation of ICU patients is important.