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Chest compressions as a rescue manoeuvre to maintain aortic valve opening during left ventricular distention syndrome on venoarterial ECMO 在静脉-动脉 ECMO 患者出现左心室扩张综合征时,将胸外按压作为维持主动脉瓣开放的抢救手段。
Pub Date : 2024-08-01 DOI: 10.1016/j.redare.2024.02.028
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引用次数: 0
Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study 接受心脏手术的急性肾损伤高危患者的尿酸和急性肾损伤:一项前瞻性多中心研究。
Pub Date : 2024-08-01 DOI: 10.1016/j.redare.2024.04.019

Purpose

It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.

Design

Multicenter prospective international cohort study.

Setting

Fourteen university hospitals in Spain and the United Kingdom.

Participants

We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017.

Interventions

None.

Measurements and main results

AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81–3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93–1.19, P = .37).

Conclusions

Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

目的:目前尚不清楚术前血清尿酸(SUA)升高是否会在心脏手术相关急性肾损伤(AKI)(CSA-AKI)的发生中发挥作用。我们进行了一项队列研究,以评估术前高尿酸血症对罹患 SC-AKI 高风险患者 AKI 的影响:多中心前瞻性国际队列研究:地点:西班牙和英国的 14 家大学医院:2017年7月至12月,根据克利夫兰评分≥4分,我们连续研究了261名CSA-AKI高危患者:无:采用AKIN标准定义AKI。采用多变量逻辑回归模型和倾向得分匹配配对分析来确定术前高尿酸血症(≥7 mg/dL)与 AKI 之间的调整关联。190例患者(72.8%)术前AUS升高(≥7 mg/dL),145例患者(55.5%)发生CSA-AKI。在多变量逻辑回归模型中,高尿酸血症与 AKI 风险的显著增加无关(调整后的比值比 [OR]:1.58; 95% 置信区间 [CI]:0.81-3; p = 0.17).在对140名患者进行倾向评分匹配分析时,高尿酸血症组发生AKI的调整后几率相似(OR 1.05,95%CI 0.93-1.19,P = 0.37):结论:在这批接受心脏手术的高危患者中,高尿酸血症与AKI风险增加无关。
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引用次数: 0
Postoperative hypotension: Is intraoperative use of dexmedetomidine safe in frail patients? 术后低血压:术中使用右美托咪定对体弱患者安全吗?
Pub Date : 2024-08-01 DOI: 10.1016/j.redare.2024.05.002
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引用次数: 0
Continuous PENG block in an oncologic patient with bilateral femoral avascular necrosis 对一名双侧股骨头血管性坏死的肿瘤患者进行连续 PENG 阻滞。
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2024.02.020
A. Server, V. Sánchez, E. Schmucker, Á. Mesas, J. Medel

The PENG block (pericapsular nerve group) is a recently described technique to address the innervation of the hip, one of the most complex anatomical regions to treat at the locoregional level.

We present the case of a patient with acute lymphoblastic leukaemia complicated by avascular necrosis of the bilateral femoral head and previous history of severe chronic pain with probable central sensitization to opioids and a severe thrombocytopenia due to myelotoxicity from chemotherapy treatment.

Given the need for orthopaedic surgery to manage femoral necrosis and in anticipation of complex perioperative pain management, a multimodal strategy was planned including bilateral ultrasound-guided continuous PENG blocks to achieve proper pain control in the perioperative period and promote early recovery. The operation and initial recovery were uneventful and the patient was discharged to the ward within 24 h and started early rehabilitation as planned. The patient had a successful recovery with good functionality.

PENG阻滞(髋关节周围神经群)是最近描述的一种用于治疗髋关节神经支配的技术,髋关节是局部治疗最复杂的解剖区域之一。我们介绍了一例急性淋巴细胞白血病患者的病例,该患者因双侧股骨头无血管性坏死而并发症,既往有严重的慢性疼痛病史,可能对阿片类药物有中枢过敏反应,化疗引起的骨髓毒性导致血小板严重减少。鉴于需要进行骨科手术治疗股骨头坏死,并预计围手术期疼痛治疗将十分复杂,因此计划采用多模式策略,包括双侧超声引导下连续PENG阻滞,以在围手术期实现适当的疼痛控制,促进患者早日康复。手术和初期恢复顺利,患者在 24 小时内出院,并按计划开始早期康复。患者恢复顺利,功能良好。
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引用次数: 0
Management of peri-surgical anemia in elective surgery. Conclusions and recommendations according to Delphi-UCLA methodology 择期手术围手术期贫血的管理。根据 Delphi-UCLA 方法得出的结论和建议
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2024.04.015
V. Moral , A. Abad Motos , C. Jericó , M.L. Antelo Caamaño , J. Ripollés Melchor , E. Bisbe Vives , J.A. García Erce , on behalf of the Expert Panel selected to carry out the Delphi Method

Introduction

Preoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The “Patient Blood Management” (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM.

Objective

To make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice.

Material and Methods

A coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety.

Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants).

In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14).

The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations.

Stati

导言术前贫血影响着约三分之一的手术患者。贫血会增加输血风险,影响短期和中期功能预后,增加合并症、并发症和费用。患者血液管理"(PBM)计划是对患者进行多学科综合管理,被视为优质护理的典范,其基本目标之一是纠正围术期贫血。PBM 已被纳入手术患者的强化恢复计划:最近的《2021 年术后强化恢复路径》(西班牙语:RICA 2021)包括近 30 项有关 PBM 的间接建议。目标采用兰德/加州大学洛杉矶分校德尔菲法编制一份共识文件,以提高 RICA 2021 有关 PBM 建议在日常临床实践中的渗透率和优先级。材料和方法成立一个由来自血液学-血液治疗学、麻醉学和内科学的 6 名专家组成的协调小组,这些专家在贫血和 PBM 方面具有专长。采用德尔菲-兰德/加州大学洛杉矶分校的方法制定了一份调查问卷,以便就目前改善围手术期贫血管理的关键领域和优先专业行动达成共识。调查问题摘自 RICA 2021 路径中的 PBM 建议。参与者是应邀从 AWGE-GIEMSA 科学会议的发言者和 PBM 相关工作组的国家代表(塞维利亚文件、SEDAR HTF 部分和 RICA 2021 途径参与者)中选出的:在第一轮调查中,匿名在线问卷共有 28 个问题:其中 20 个是关于 ERAS 指南中的 PBM 概念(2 个是关于一般 PBM 组织,10 个是关于术前贫血的诊断和治疗,3 个是关于术后贫血的管理,5 个是关于输血标准),8 个是关于有待研究的方面。回答采用 10 分制(0 分:非常不同意,10 分:非常同意)。参与者还可以提出他们认为合适的其他意见。除了一个问题(问题 14)外,所有问题的平均得分都超过了 9 分,因此这些问题被认为是一致同意的。第二轮调查包括 37 个问题,是对第一轮调查的问题进行重新编排并吸收了参与者的意见后产生的。第二轮调查包括 37 个问题,这些问题是对第一轮调查问题的重新制定,并纳入了参与者的意见。第二轮调查包括 2 个关于 PBM 计划一般组织的问题、15 个关于术前贫血诊断和治疗的问题、3 个关于术后贫血管理的问题、6 个关于输血标准的问题,以及 11 个关于有待未来调查的方面的问题。统计处理:将每个调查问题的平均值、中位数和 25-75 分位间值列表(表 1、表 2 和表 3)。除 3 项建议外,其他建议均在 8 分以上,大多数建议的平均分在 9 分或以上。这些建议分为1.- "对所有有潜在出血风险的外科手术患者(包括孕妇)进行术前贫血检测和病因诊断是非常重要和必要的"。2.- "术前治疗贫血应充分提前,并提供所有必要的血液捐助,以纠正这种状况"。3.- "对于中度贫血(Hb 8-10 g/dL)且病情稳定的患者,术前输注任何单位的包装红细胞都是不合理的,因为这些患者可能要进行出血手术,而手术时间又不能延迟"。4.- "建议普及外科和产科患者输注红细胞的限制性标准"。5.- "应治疗术后贫血,以改善术后效果,加快术后短期和中期恢复"。结论在大多数问题上都达成了广泛共识,具有最大的接受度、较强的证据水平和较高的推荐度。我们的工作有助于确定适合在每家医院和所有患者中实施 PBM 计划的举措和绩效。
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引用次数: 0
New logo of the “Societat Catalana d’Anestesiologia, Reanimació i Terapèutica del Dolor”, after 70 years of history 加泰罗尼亚麻醉、复苏和疼痛治疗协会 "在走过 70 年历程后的新徽标
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2024.04.016
X. Sala-Blanch , C. Morros , R. Adalia , M. Bausili
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引用次数: 0
Before lumbar surgery is blamed for pneumocephalus, alternative causes must be thoroughly ruled out 在将气胸归咎于腰椎手术之前,必须彻底排除其他原因。
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2024.02.026
J. Finsterer
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引用次数: 0
Extensive extradural pneumorrhachis related to obstetric analgesia 与产科镇痛有关的硬膜外广泛性肺出血
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2023.09.009
M.J. Garcia-Cebrián , I.M. Fontan-Atalaya , J. Garcia-Perez , B. Fernandez-Torres

Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia.We describe a very extensive extradural pneumorrachis (T9-S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symptomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described.

先天性硬膜外积气是一种罕见的临床现象,但麻醉医师在使用空气技术鉴定硬膜外腔时应注意这种可能性。尽管在大多数已发表的病例中,硬膜外积气是无症状的,但也有相关神经系统后果的描述,如脑膜刺激、根性疼痛、单侧下肢无力、马尾综合征、截瘫和四肢瘫痪。我们描述了一名产钳助产后会阴部疼痛剧烈且不典型的患者发生的与产科镇痛有关的广泛硬膜外积气(T9-S1)。我们的目的是综合整理现有的科学证据,分析预防措施,总结症状性疾病最合适的诊断、随访和治疗技术,其中包括高浓度吸氧、高压氧疗法、经皮或手术减压。
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引用次数: 0
Effect of coadministration of 10 mg/kg calcium chloride and neostigmine on extubation time: A randomized controlled trial 联合使用 10 毫克/千克氯化钙和新斯的明对拔管时间的影响:随机对照试验。
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2024.04.004
S. Elkenany, M.M. Alseoudy, M.E. Elshehawi, S. Bakrey, M. Aboelela

Introduction and objectives

Some studies investigating the effect of calcium on neostigmine-induced recovery of neuromuscular blockade have shown that this combination promotes neuromuscular recovery, but does not significantly affect the incidence of postoperative residual curarization and time to extubation. This study aimed to evaluate the effects of 10 mg/kg calcium chloride co-administered with neostigmine on early recovery and time to extubation.

Patients and methods

This prospective, randomized, double-blinded, placebo-controlled study included 88 ASA I–II patients aged between 18 and 65 years who were scheduled for elective surgery lasting at least 1 h under general anaesthesia in which 10 mg/kg of calcium chloride or the same volume of normal saline was co-administered with 5 μg/kg of neostigmine at the end of surgery. Time to extubation (time from neostigmine administration to extubation), time from neostigmine administration to TOF ratio (TOFr) 0.9 (neuromuscular recovery), and the incidence of residual neuromuscular blockade (RNMB) and other adverse effects were recorded.

Results

Median (Q1, Q3) extubation time was significantly shorter in the calcium group vs. the placebo group (6.5 min [5.52–7.43] vs. 9.78 min [8.35–11]), P < .001. Median neuromuscular recovery time in the calcium group was 5 min vs. 7.1 min in the placebo group, P < .001. Patients in the calcium group had significantly higher TOFr and lower incidence of RNMB at 5 and 10 min vs. the placebo group, and no significant side effects.

Conclusion

Calcium chloride at a dose of 10 mg/kg co-administered with neostigmine promotes early neuromuscular recovery and reduces time to extubation by about 32%.

导言和目的一些研究调查了钙对新斯的明诱导的神经肌肉阻滞恢复的影响,结果表明这种联合用药可促进神经肌肉恢复,但不会显著影响术后残余凝血的发生率和拔管时间。本研究旨在评估 10 毫克/千克氯化钙与新斯的明合用对早期恢复和拔管时间的影响。患者和方法这项前瞻性、随机、双盲、安慰剂对照研究纳入了 88 名年龄在 18 岁至 65 岁之间的 ASA I-II 级患者,这些患者计划在全身麻醉下接受持续至少 1 小时的择期手术,在手术结束时,10 毫克/千克氯化钙或相同体积的生理盐水与 5 微克/千克新斯的明联合给药。记录了拔管时间(从使用新斯的明到拔管的时间)、从使用新斯的明到TOF比率(TOFr)0.9(神经肌肉恢复)的时间、残余神经肌肉阻滞(RNMB)的发生率以及其他不良反应。结果钙剂组与安慰剂组相比,中位(Q1、Q3)拔管时间明显缩短(6.5 分钟 [5.52-7.43] 与 9.78 分钟 [8.35-11]),P < .001。钙剂组的中位神经肌肉恢复时间为 5 分钟,安慰剂组为 7.1 分钟,P < .001。与安慰剂组相比,钙剂组患者在 5 分钟和 10 分钟时的 TOFr 明显更高,RNMB 发生率更低,且无明显副作用。
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引用次数: 0
Anaesthesia training designs across Europe: A survey-based study from the trainees committee of the European Society of Anaesthesiology and Intensive Care 欧洲各地的麻醉培训设计:欧洲麻醉学和重症监护学会受训人员委员会的调查研究。
Pub Date : 2024-06-01 DOI: 10.1016/j.redare.2024.04.006
I. Abramovich , I. Crisan , D. Sobreira Fernandes , S. De Hert , A. Lukic , G. Norte , B. Matias , M. Majić , J. Berger-Estilita

Background

Anaesthesiology training programs in Europe vary in duration, content, and requirements for completion. This survey-based study conducted by the Trainees Committee of the European Society of Anaesthesiology and Intensive Care explores current anaesthesia training designs across Europe.

Methods

Between May and July 2018, we sent a 41-item online questionnaire to all National Trainee Representatives, members of the National Anaesthesiologists Societies Committee, and Council Representatives of the European Society of Anaesthesiology and Intensive Care (ESAIC) of all member countries. We cross-validated inconsistent data with different country representatives.

Results

Forty-three anaesthesiologists from all 39 associated ESAIC countries completed the questionnaire. Results showed considerable variability in teaching formats, frequency of teaching sessions during training, and differences in assessments made during and at the end of training. The reported duration of training was 60 months in 59% (n = 23) of participating countries, ranging from 24 months in Russia and Ukraine to 84 months in the UK.

Conclusion

This study shows the significant differences in anaesthesiology training formats across Europe, and highlights the importance of developing standardised training programs to ensure a consistent level of training and to improve patient safety. This study provides valuable insights into European anaesthesia training, and underlines the need for further research and collaboration to improve requirements.

背景欧洲的麻醉学培训项目在持续时间、内容和完成要求方面各不相同。欧洲麻醉学和重症监护学会受训人员委员会开展的这项基于调查的研究探讨了欧洲各地目前的麻醉培训设计。方法2018年5月至7月期间,我们向所有成员国的所有国家受训人员代表、国家麻醉医师学会委员会成员以及欧洲麻醉学和重症监护学会(ESAIC)理事会代表发送了一份包含41个项目的在线问卷。我们与不同国家的代表对不一致的数据进行了交叉验证。结果来自欧洲麻醉与重症监护学会所有 39 个相关国家的 43 名麻醉医师完成了问卷调查。结果显示,教学形式、培训期间教学课程的频率以及培训期间和培训结束时的评估差异很大。59%的参与国(n = 23)报告的培训时间为 60 个月,从俄罗斯和乌克兰的 24 个月到英国的 84 个月不等。本研究为欧洲麻醉培训提供了宝贵的见解,并强调了进一步研究和合作以提高要求的必要性。
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引用次数: 0
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Revista espanola de anestesiologia y reanimacion
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