Revista espanola de anestesiologia y reanimacion最新文献

英文中文

Strategy for the management of acute postoperative pain in day surgery centres in Spain. DUCMA 2.0. project 西班牙日间手术中心术后急性疼痛管理策略。DUCMA 2.0.项目。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-11-01 DOI: 10.1016/j.redare.2024.07.005

M. Zaballos , A. Reyes , J.M. Cordero , M. Sánchez Hernández , L.A. Hidalgo , F. Docobo Durantez , D. Morales-Garcia

Introduction

Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain.

Methods

A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country.

Results

We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs.

Conclusions

The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery.

导言：充分治疗术后急性疼痛是非卧床手术的质量要求之一，而术后急性疼痛处理不佳与延迟出院、非计划入院和出院后延迟入院有关。本研究旨在了解西班牙非住院手术室（ASU）术后疼痛管理的组织策略：结果：我们共招募了 133 个非住院手术单位，其中包括西班牙的 133 个非住院手术单位：我们招募了 133 个 ASU，其中 85 个回答了有关术后疼痛管理的问题。在回答问题的 ASU 中，80% 制定了具体的疼痛管理方案，37.6% 提供了有关镇痛计划的术前信息。88.2% 的 ASU 在设施内进行术后疼痛评估，只有 56.5% 的 ASU 在家中进行评估。所有 ASU 都使用多模式镇痛方案，但 68.2% 的 ASU 报告使用阿片类药物治疗中度至重度疼痛。接受调查的 ASU 很少使用家庭侵入性镇痛策略：DUCMA 的研究突出表明，日间手术的疼痛治疗实践在我国仍是一项挑战，而且并不总是符合国家指导方针。研究结果表明，有必要制定相关策略，以改善日间手术的临床实践并统一疼痛管理。

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引用次数: 0

National survey on perioperative monitoring of direct oral anticoagulants: MonACOD survey 关于直接口服抗凝剂围手术期监测的全国调查：MonACOD 调查

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.04.014

引用次数: 0

Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge 经腔途径植入主动脉内假体。新的麻醉挑战。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.05.003

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach.

The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence.

We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

与传统的开腹手术治疗相比，近年来血管内治疗技术的巨大进步使急性主动脉综合征的治疗受益匪浅。然而，血管内治疗要取得成功，患者必须有足够的血管通路。那些血管解剖结构不佳的病例必须考虑进行开腹手术，而开腹手术的发病率很高，甚至需要拒绝手术。最近，一种新的腹主动脉手术方法被描述为适用于无法获得其他血管通路、绝对或相对不适合经胸手术的患者。主动脉综合征的麻醉处理方法众所周知，尽管有多种选择，但所有这些方法的安全性和有效性都已得到证实。新手术方法的实施和可能出现的新并发症对麻醉医生来说是一个挑战，而目前几乎没有科学依据。我们介绍了西班牙首例经腔主动脉内假体植入术、其麻醉影响以及文献综述。

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引用次数: 0

The efficacy of the ultrasound-guided retrolaminar block versus the classic paravertebral block in patients undergoing unilateral inguinal hernioplasty: a randomized controlled study 在单侧腹股沟疝成形术患者中，超声引导视网膜阻滞与传统椎旁阻滞的疗效：随机对照研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.03.008

Background

In daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty.

Methods

The 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications.

Results

Demographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR.

Conclusion

The PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications.

背景：在日常手术实践中，腹股沟疝气成形术是一种常见的手术，术后经常伴有剧烈疼痛。已有多种区域阻滞用于此类手术后的镇痛。视网膜阻滞（RLB）是椎旁阻滞（PVB）的一种变体，可提供出色的镇痛效果并降低并发症风险。这项前瞻性试验比较了 PVB 和 RLB 在腹股沟疝成形术中的镇痛效果：根据在超声引导下在 T12 水平进行的阻滞，将 56 名患者随机分为两组：PVB组（28例）和RLB组（28例）。首次镇痛前的时间是我们的主要结果。其他结果包括阻滞时间、术中血流动力学参数变化、术后VAS、24小时吗啡消耗量、患者满意度以及阻滞相关并发症的发生率：结果：两组患者的人口统计学数据相当。结果：两组患者的人口统计学数据具有可比性，但使用 RLB 时阻滞所需的时间明显缩短（P与 RLB 相比，PVB 的围手术期镇痛效果更佳，这表现在首次抢救镇痛药的持续时间更长、疼痛评分更好、阿片类药物用量更少，而阻滞相关并发症没有明显增加。

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引用次数: 0

Use of cannabinoids for acute postoperative pain 使用大麻素治疗急性术后疼痛。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.05.004

Doubts about the efficacy of medicinal cannabis in the treatment of acute postoperative pain are well justified, at least in light of the information gathered from Google Scholar, Clinical Trials, PubMed, and Cochrane databases.The conflation of cannabis and cannabinoids engenders not only normative but also medical implications. Despite cannabinoids having evinced their efficacy in the treatment of various pathologies, they have yet to demonstrate such in the context of acute postoperative pain.

The burgeoning corpus of research on this subject does instill a modicum of hope in this regard; nevertheless, the manifold methodological approaches employed obfuscate the prospect of reaching unequivocal conclusions.Given the current status of this matter, this article abstains from making a definitive pronouncement either in favor of or against the role of pharmaceuticals incorporating cannabinoid compounds in the management of acute postoperative pain.

至少从 Google Scholar、Clinical Trials、PubMed 和 Cochrane 数据库收集的信息来看，对药用大麻治疗急性术后疼痛疗效的怀疑是有道理的。尽管大麻素在治疗各种病症方面已显示出疗效，但在急性术后疼痛方面尚未显示出疗效。有关这一主题的研究成果不断涌现，确实在这方面带来了些许希望；然而，所采用的多种方法阻碍了得出明确结论的前景。考虑到这一问题的现状，本文不会对含有大麻素化合物的药物在急性术后疼痛治疗中的作用做出肯定或否定的表态。

引用次数: 0

Machine learning models based on ultrasound and physical examination for airway assessment 基于超声波和体格检查的气道评估机器学习模型。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.05.006

Purpose

To demonstrate the utility of machine learning models for predicting difficult airways using clinical and ultrasound parameters.

Methods

This is a prospective non-consecutive cohort of patients undergoing elective surgery. We collected as predictor variables age, sex, BMI, OSA, Mallampatti, thyromental distance, bite test, cervical circumference, cervical ultrasound measurements, and Cormack-Lehanne class after laryngoscopy. We univariate analyzed the relationship of the predictor variables with the Cormack-Lehanne class to design machine learning models by applying the random forest technique with each predictor variable separately and in combination. We found each design's AUC-ROC, sensitivity, specificity, and positive and negative predictive values.

Results

We recruited 400 patients. Cormack-Lehanne patients ≥ III had higher age, BMI, cervical circumference, Mallampati class membership ≥ III, and bite test ≥ II and their ultrasound measurements were significantly higher. Machine learning models based on physical examination obtained better AUC-ROC values than ultrasound measurements but without reaching statistical significance. The combination of physical variables that we call the “Classic Model” achieved the highest AUC-ROC value among all the models [0.75 (0.67−0.83)], this difference being statistically significant compared to the rest of the ultrasound models.

Conclusions

The use of machine learning models for diagnosing VAD is a real possibility, although it is still in a very preliminary stage of development.

Clinical registry

ClinicalTrials.gov: NCT04816435.

目的：证明机器学习模型在利用临床和超声参数预测困难气道方面的实用性：这是对接受择期手术的患者进行的前瞻性非连续性队列研究。我们收集了年龄、性别、体重指数、OSA、Mallampatti、甲状腺距离、咬合试验、宫颈周径、宫颈超声测量值和喉镜检查后的 Cormack-Lehanne 分级作为预测变量。我们对预测变量与 Cormack-Lehanne 分级的关系进行了单变量分析，并对每个预测变量分别和组合应用随机森林技术设计了机器学习模型。我们发现了每种设计的AUC-ROC、灵敏度、特异性以及阳性和阴性预测值：我们招募了 400 名患者。Cormack-Lehanne≥Ⅲ级患者的年龄、体重指数、宫颈周径、Mallampati分级≥Ⅲ级和咬合试验≥Ⅱ级均较高，其超声测量值也明显较高。基于体格检查的机器学习模型获得的 AUC-ROC 值优于超声测量值，但未达到统计学意义。我们称之为 "经典模型 "的物理变量组合在所有模型中获得了最高的 AUC-ROC 值[0.75（0.67-0.83）]，与其他超声模型相比，这一差异具有统计学意义：结论：使用机器学习模型诊断 VAD 确实是一种可能，尽管它仍处于非常初步的发展阶段：临床注册：ClinicalTrials.gov：临床注册：ClinicalTrials.gov：NCT04816435。

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引用次数: 0

A comparative study between single injection (corner pocket approach) and double injection costoclavicular block: A randomized parallel arm, non-inferiority trial 单次注射（角袋法）与双次注射肋锁关节阻滞的比较研究：随机平行臂、非劣效试验。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.04.009

Background

Previous studies have shown that ultrasound guided costoclavicular block may require a double shot to provide adequate, rapid sensory and motor blockade. In this trial, we hypothesized that if the corner pocket approach (between axillary artery and median cord) is used instead of the central approach (at the midpoint of the 3 cords) when performing single-shot costoclavicular block, the onset of blockade would be non-inferior to the double-shot technique.

Method

Ninety patients undergoing upper limb surgery were randomized to 2 groups for ultrasound-guided costoclavicular block (CCB) at a tertiary hospital. One group received ultrasound guided single-shot CCB using the corner pocket approach and other received ultrasound guided double-shot – the first shot at the centre of the 3 cords and the second between the axillary artery and the median cord. An observer blinded to group assignment recorded blockade onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points).

Results

Of the 101 patients assessed for eligibility, 90 were recruited over period of 1 year (February 2022 to January 2023), with 45 in each group. Onset time was 22.1 ± 3.1 min in the single-shot group and 22.4 ± 2.9 min in the double-shot group. This difference was insignificant (P = .3).

Conclusion

Time to onset of blockade and full anaesthesia are similar in single-shot corner pocket CCB vs double-shot CCB. Further studies are required to determine the minimum effective volume of local anaesthetic required for the described technique.

背景以前的研究表明，超声引导下的肋锁阻滞可能需要双针才能提供充分、快速的感觉和运动阻滞。在这项试验中，我们假设在进行单次肋锁关节阻滞时，如果使用角袋方法（腋动脉和正中脊髓之间）而不是中央方法（三条脊髓的中点），阻滞的开始时间将不会劣于双次技术。方法在一家三甲医院接受上肢手术的 90 名患者被随机分为两组，接受超声引导下的肋锁关节阻滞（CCB）。一组在超声引导下使用角袋法进行单次阻滞，另一组在超声引导下进行双次阻滞--第一次阻滞在三条脊索的中心，第二次阻滞在腋动脉和正中脊索之间。结果在101名通过资格评估的患者中，有90人在一年内（2022年2月至2023年1月）被招募，每组45人。单发组的发病时间为 22.1 ± 3.1 分钟，双发组为 22.4 ± 2.9 分钟。结论单发角袋 CCB 与双发 CCB 的阻滞起效时间和完全麻醉时间相似。需要进一步研究以确定所述技术所需的最小有效局麻药量。

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引用次数: 0

QT-prolongation in patients with severe COVID-19 is multicausal and not limited to anti-SARS-CoV-2 drugs 严重 COVID-19 患者的 QT 延长是多原因造成的，并不局限于抗 SARS-CoV-2 药物。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.04.002

引用次数: 0

Risk factors for PPCs in laparoscopic non–robotic vs. laparoscopic robotic abdominal surgery (LapRas): rationale and protocol for a patient–level analysis of LAS VEGAS and AVATaR 腹腔镜非机器人腹部手术 (LapRas) 与腹腔镜机器人腹部手术 (LapRas) 中 PPC 的风险因素：LAS VEGAS 和 AVATaR 患者层面分析的原理和方案。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.07.001

Introduction

Postoperative pulmonary complications (PPCs) vary amongst different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non–robotic versus laparoscopic robotic abdominal surgery.

Methods and analysis

LapRas (Risk Factors for PPCs in Laparoscopic Non–robotic vs Laparoscopic robotic abdominal surgery) incorporates harmonized data from 2 observational studies on abdominal surgery patients and PPCs: ‘Local ASsessment of VEntilatory management during General Anaesthesia for Surgery’ (LAS VEGAS), and ‘Assessment of Ventilation during general AnesThesia for Robotic surgery' (AVATaR). The primary endpoint is the occurrence of one or more PPCs in the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay and in–hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non–robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the two groups are driven by differences in duration of anesthesia and/or the intensity of mechanical ventilation.

Ethics and dissemination

This analysis will address a clinically relevant research question comparing laparoscopic and robotic assisted surgery. No additional ethical committee approval is required for this metanalysis. Data will be shared with the scientific community by abstracts and original articles submitted to peer-reviewed journals.

Registration

The registration of this post-hoc analysis is pending; individual studies that were merged into the used database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.

简介：不同手术技术的术后肺部并发症（PPCs）各不相同。我们旨在比较腹腔镜非机器人与腹腔镜机器人腹部手术后肺部并发症的发生率：LapRas（腹腔镜非机器人与腹腔镜机器人腹部手术 PPCs 的风险因素）整合了两项腹部手术患者和 PPCs 观察性研究的统一数据："手术全身麻醉期间通气管理的局部评估"（LAS VEGAS）和 "机器人手术全身麻醉期间通气评估"（AVATaR）。主要终点是术后前五天内出现一种或多种 PPC。次要终点包括每种 PPC 的发生率、住院时间和院内死亡率。我们将使用逻辑回归模型来确定腹腔镜非机器人腹部手术与腹腔镜机器人腹部手术发生 PPC 的风险因素。我们将研究麻醉时间和/或机械通气强度的不同是否会导致两组间发生 PPCs 的差异：这项分析将解决一个与临床相关的研究问题，对腹腔镜手术和机器人辅助手术进行比较。这项荟萃分析无需获得伦理委员会的额外批准。数据将通过向同行评审期刊提交摘要和原创文章的方式与科学界共享：这项事后分析的注册工作尚未完成；合并到所用数据库中的单项研究已在 clinicaltrials.gov 注册：LAS VEGAS 的标识符为 NCT01601223，AVATaR 的标识符为 NCT02989415。

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引用次数: 0

Extubation failure: Upper airway obstruction by chewing gum. A case report 拔管失败：口香糖导致上气道阻塞。病例报告。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2024-10-01 DOI: 10.1016/j.redare.2024.02.006

Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.

拔管失败可能由不同的并发症导致，其中大部分在文献中都有详细描述，如喉水肿。异物阻塞气道是一种不太常见的意外并发症，其检测对医护人员来说仍是一项挑战。在本病例报告中，我们描述了一名因机动车事故被送入重症监护室的患者，由于误诊为上气道异物阻塞，导致拔管失败并进行了气管造口术。因此，在对这些患者进行医学影像和临床评估时，应考虑对异物进行筛查。最后，充气罩囊漏气试验、超声波检查和视频喉镜检查可作为识别可疑异物的重要辅助手段。

引用次数: 0

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