Anesthesiology and Perioperative Science最新文献

{"title":"COMET: monitoring mitochondrial shock in anesthesiology and intensive care medicine","authors":"Yan Yang,&nbsp;Wei Zhang,&nbsp;Zhengliang Ma,&nbsp;Xiaoping Gu","doi":"10.1007/s44254-024-00079-x","DOIUrl":"10.1007/s44254-024-00079-x","url":null,"abstract":"<div><p>Mitochondria, as the cellular end-users of oxygen and responsible for approximately 98% of total body oxygen consumption, play a significant role in the development of organ dysfunction during shock. Therefore, integrating information on mitochondrial oxygen homeostasis with macroscopic observations of macrocirculation and microcirculation is crucial for monitoring critically ill patients or those undergoing high-risk surgery. However, current clinical practice still lack reliable surrogate parameters for assessing mitochondrial function. The Cellular Oxygen METabolism (COMET) monitor, utilizing the protoporphyrin IX triplet state lifetime technique (PpIX-TSLT), represents the first clinical device capable of non-invasive, in vivo measurement of mitochondrial oxygen pressure and oxidative phosphorylation. Recent research suggests that implementing this real-time bedside monitoring will provide additional insights into microcirculatory dynamics and enhance patient management. This review will comprehensively detail the rationale, methodologies, evolution, and clinical applications of the technique, aiming at improving the understanding of mitochondrial pathology in daily clinical practice and facilitating the development of targeted therapeutic strategies.</p><h3>Graphical Abstract</h3>\u0000<div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00079-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of fosaprepitant for the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgery: a multicenter, randomized, double-blind study","authors":"Yingjun Zhang,&nbsp;Xiaolin Luo,&nbsp;Qisen Fan,&nbsp;Sha Zhou,&nbsp;Yinqian Kang,&nbsp;Zhongqiao Mo,&nbsp;Jierong Luo,&nbsp;Bin Zheng,&nbsp;Lan Lan,&nbsp;Jingdun Xie","doi":"10.1007/s44254-024-00075-1","DOIUrl":"10.1007/s44254-024-00075-1","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aims to investigate whether adding fosaprepitant to palonosetron and dexamethasone is effective in preventing postoperative nausea and vomiting (PONV) in high-risk patients undergoing gynecologic surgery.</p><h3>Methods</h3><p>Eligible patients undergoing gynecological surgery were randomized into two groups (1:1). One group received fosaprepitant (150 mg) and the other (control) received a placebo infusion. Both groups received a single dose of palonosetron (0.25 mg) and dexamethasone (5 mg) together with therapeutic medication. The primary endpoint was the absence of vomiting and no use of rescue antiemetics during the first 24 h after surgery; complete response rate (CRR).</p><h3>Results</h3><p>CRR was significantly higher in the fosaprepitant group compared to the control group 0–24 h after surgery (<i>P</i> = 0.037; relative risk [RR], 1.116; 95% confidence interval [CI], 1.007 to 1.235). Moreover, CRR was also significantly higher during the 24–48 h (<i>P</i> = 0.004; RR, 1.148; 95% CI, 1.045 to 1.261) and 48–72 h (<i>P</i> = 0.039; RR, 1.083; 95% CI, 1.005 to 1.168) observation periods respectively. The complete control rate was higher in the fosaprepitant group than in the control group during the 0–24 h observation period (<i>P</i> = 0.012; RR, 1.367; 95% CI, 1.067 to 1.751). Nausea and rescue antiemetic use were comparable between the two groups. The severity of vomiting was significantly higher in the fosaprepitant group than in the control group on the second day (<i>P</i> = 0.016). Dynamic pain visual analog scale score was lower in the fosaprepitant group and quality of recovery-15 scores were significantly higher in the same group during 0–24 h observation period (<i>P</i> = 0.018 and 0.005, respectively).</p><h3>Conclusions</h3><p>The triple combination of fosaprepitant, palonosetron, and dexamethasone was superior in the prevention of PONV after gynecologic surgery in high-risk patients. We suggest that for high-risk patients, a triple combination therapy may be a better choice.</p><h3>Trial registration</h3><p>Registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=171741) with No. ChiCTR2200060890 on June 13, 2022. Principal investigator: Jingdun Xie.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00075-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142600512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased use of dexmedetomidine and opioids in preterm infants—an opinion based on Curtis’s multicenter observational cohort study","authors":"Yu Cui,&nbsp;Yunxia Zuo","doi":"10.1007/s44254-024-00076-0","DOIUrl":"10.1007/s44254-024-00076-0","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00076-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142595412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in the use of dexmedetomidine for postoperative cognitive dysfunction","authors":"Meng Deng,&nbsp;Yuan Wang,&nbsp;Beibei Zheng","doi":"10.1007/s44254-024-00078-y","DOIUrl":"10.1007/s44254-024-00078-y","url":null,"abstract":"<div><p>Postoperative cognitive dysfunction, a common neurological complication in the perioperative period, seriously affects patient survival and prognosis. Its high incidence has made the study of postoperative cognitive dysfunction challenging. Whether the clinical application of dexmedetomidine, a potential neuroprotective drug, can reduce the incidence of postoperative cognitive dysfunction is controversial, although several potential mechanisms by which dexmedetomidine improves postoperative cognitive dysfunction have been identified; therefore, this remains an area in need of further exploration.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00078-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142540594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choledochectomy following transcatheter aortic valve replacement for aortic valve stenosis","authors":"Hui Jia,&nbsp;Liang Guo,&nbsp;Haishan Zhang,&nbsp;Xin Chen,&nbsp;Xijia Sun,&nbsp;Wenfei Tan","doi":"10.1007/s44254-024-00074-2","DOIUrl":"10.1007/s44254-024-00074-2","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00074-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural circuits for active resilience to empathic pain","authors":"Sha Sha,&nbsp;He Liu,&nbsp;Hongxing Zhang","doi":"10.1007/s44254-024-00077-z","DOIUrl":"10.1007/s44254-024-00077-z","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00077-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tutorial on ‘capped utilisation’ as a metric and key performance target in NHS England’s Model Hospital operating theatres database: caution for international healthcare systems","authors":"Chen Zhang,&nbsp;Claire Dunstan,&nbsp;Jaideep J. Pandit","doi":"10.1007/s44254-024-00073-3","DOIUrl":"10.1007/s44254-024-00073-3","url":null,"abstract":"<div><p>The National Health Service (NHS) in England has set hospitals a target of achieving &gt; 85% in a metric called ‘capped theatre utilisation’ (CTU), as central to its post-pandemic surgical waiting list recovery planning. This could serve as a model internationally, as other countries seek to improve operating theatre efficiency. Our review presents an analysis of what CTU means in the context of other measures of theatre ‘utilisation’, serving as a tutorial for clinical leaders, managers and all staff involved in theatres better to understand the metrics sometimes being used to assess their performance. We present results of a theoretical sensitivity analysis to assess how CTU values vary for hypothetical operating lists of three different structures (number of cases, their duration, and intercase gap times), as the stated start and finish times are shifted backwards and forwards in time. We then present results of our interrogation of the NHS Model Health Operating Theatres database to assess hospitals' CTU performance over three years. We discovered that in theory, CTU was especially sensitive to both stated list start times and list structure. The relationship to start time was asymmetric: early starts in one list did not compensate for loss of CTU value with late start in another list, when values were averaged across lists. This sensitivity analysis also predicted wide weekly CTU fluctuations, with values &lt; 85% more likely than &gt; 85%, especially for tertiary referral centres predominantly undertaking long, complex procedures. Our interrogation of the database confirmed these predictions. Moreover, we discovered many instances of implausible CTU values and underlying patterns indicating fundamental flaws in the CTU algorithm, rather than data entry errors. We conclude that CTU, and the NHS target of 85%, is not a suitable metric for operating theatre performance. It has proved unachievable in any sustainable way, and its underlying algorithm produces aberrant values. We discuss the serious consequences of basing other national policies or funding models on a fundamentally flawed metric. These results have lessons for international healthcare systems.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00073-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of sevoflurane flush out and activated charcoal filtration—a bench study","authors":"Maximilian Mörtl,&nbsp;Daniel Schwaiger,&nbsp;Wolfgang Lederer,&nbsp;Florentin Weiss,&nbsp;Anesu Chawaguta,&nbsp;Helmut Wiesenhofer,&nbsp;Chris A. Mayhew,&nbsp;Veronika Ruzsanyi","doi":"10.1007/s44254-024-00072-4","DOIUrl":"10.1007/s44254-024-00072-4","url":null,"abstract":"<div><h3>Purpose</h3><p>A bench study to assess the elimination of sevoflurane from an anesthetic workstation using three different processing methods.</p><h3>Methods</h3><p>Sevoflurane concentrations from samples of the inspiratory breathing hose and air samples from within the investigation room were assessed during predetermined flush out intervals using Gas Chromatography-Ion Mobility Spectrometry. The primary objective was to determine the time to reach concentrations below 5 ppm_v.</p><h3>Results</h3><p>Reduction of sevoflurane volume concentrations below a threshold of 5 ppm_v was achieved within the first minute after removal of the vaporizer and the complete exchange of the soda and the breathing system and within the 15 min measurement interval after inclusion of two activated charcoal filters without a 90 s of flushing and without changing of the breathing hoses as required by the manufacturer.</p><h3>Conclusions</h3><p>Complete removal of the vaporizer and an exchange of the soda and the ventilation unit most quickly reduced sevoflurane concentrations, but the total processing interval may exceed 30 min. Inserted activated charcoal filters without a previous 90 s of flushing and without changing the breathing hoses followed by flushing only with raised fresh gas flow allow ventilation below trigger threshold to be reached within due time.\u0000</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00072-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142409516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of opioids on hospital stay and mortality in patients undergoing abdominal surgeries","authors":"Lucas Maia,&nbsp;Isabella Chaves,&nbsp;Heitor Medeiros,&nbsp;Glauco Francisco Silva,&nbsp;Wallace Andrino da Silva","doi":"10.1007/s44254-024-00071-5","DOIUrl":"10.1007/s44254-024-00071-5","url":null,"abstract":"<div><h3>Purpose</h3><p>Postoperative pain management is a critical aspect of surgical care, significantly influencing patient recovery and outcomes. This study aims to evaluate the impact of opioid use on hospital stay and mortality rates among patients undergoing abdominal surgeries in Brazil, where healthcare disparities may affect postoperative outcomes.</p><h3>Methods</h3><p>This observational cross-sectional study was conducted at the University Hospital Onofre Lopes in Natal, Brazil. We included 385 patients aged 18 years or older who underwent abdominal surgery in 2023. Data were collected from medical records, focusing on analgesic therapy, opioid types, dosages, and patient demographics. Statistical analyses were performed using JAMOVI software.</p><h3>Results</h3><p>Opioid consumption was prevalent among the cohort, with 89.6% of patients receiving opioids postoperatively. Tramadol was the most frequently administered opioid, followed by nalbuphine and morphine. Patients treated with morphine had a significantly extended median hospital stay (15.5 days) compared to those receiving tramadol or nalbuphine (2 days). Morphine use was also associated with a higher mortality rate, with these patients being 16 times more likely to die compared to those on weaker opioids. Older age and extended hospital stays were additional risk factors for increased mortality.</p><h3>Conclusion</h3><p>Opioids were used extensively in this cohort as the main analgesic drug for postoperative pain management after abdominal surgeries. Use was associated with prolonged hospital stay and higher probability of death.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00071-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142414053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective study of the efficacy of methylprednisolone vs. triamcinolone in lumbar epidural steroid injections for the treatment of low back pain due to degenerative disc disease","authors":"Zachary R. Higgins,&nbsp;Shuchita Garg,&nbsp;Timothy Burroughs,&nbsp;Katherine A. Qualls,&nbsp;Jun-Ming Zhang,&nbsp;Judith A. Strong","doi":"10.1007/s44254-024-00069-z","DOIUrl":"10.1007/s44254-024-00069-z","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;A common low back pain treatment is epidural injection of corticosteroids. The nominal target of anti-inflammatory corticosteroid drugs is the glucocorticoid receptor (GR). In vitro studies show many clinically used steroids also activate the mineralocorticoid receptor (MR) with substantial potency. Based on preclinical studies, this may have pro-inflammatory and pro-nociceptive effects that counter the desired GR effects. Of two outpatient pain clinics associated with the University of Cincinnati Department of Anesthesiology, one primarily used methylprednisolone while the other used mainly triamcinolone for epidural steroid injections. We hypothesized that triamcinolone would give better outcomes because in vitro, ratio of MR/GR potency is about 10 fold less favorable for methylprednisolone.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We conducted a retrospective chart review of adults receiving lumbar epidural steroid injection for low back pain due to degenerative disc disease at the two pain clinics. For subjects treated at the first clinic, we obtained basic demographics, smoking history, 2 primary outcomes (patient-rated percent improvement in pain levels, and injection outcome rated as poor, partial, or good), and pain ratings (0–10 scale) before and after injection. For analysis, a subset of subjects from the second clinic was matched as closely as possible (sex, age, race, and ethnicity) to those from the first clinic.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Eighty-six subjects from the first clinic were identified, of whom fifty-five met inclusion criteria. Review of 83 potentially matched subjects from the second clinic yielded 37 subjects. From this combined set of subjects, 44 receiving triamcinolone and 48 receiving methylprednisolone were obtained. Matching was effective in avoiding significant differences between the two drug groups in age, weight, sex, race, and body mass index, however, the incidence of smoking (current and former) was significantly higher in the methylprednisolone group (who were primarily from clinic 1). The injection responses codified on a 0–2 scale, where 0 indicated a poor response, 1 a partial response with a second injection recommended, and 2 a good response where no further treatment was recommended at the 1 month follow up point, were not significantly different between the groups (Mann–Whitney, &lt;i&gt;p&lt;/i&gt; = 0.44) although the triamcinolone group overall had slightly better responses. However, the patient-reported percent improvement after the injection was significantly better for the triamcinolone than for methylprednisolone (60% ± 5.3 vs. 42% ± 4.9), as was the pain ratings (0–10 scale) after the injection (5.0 ± 0.5 vs. 6.3 ± 0.3). A marked demographic difference between the two clinics in smoking rates was not controlled for in subject matching but accounting for smoking status did not affect the observed differences between the two steroids.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Differences in the two primary outcomes, pa","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-024-00069-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142410268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}