Anesthesia and pain medicine最新文献

{"title":"Expert's tips on regional blocks in neonates and infants.","authors":"Vrushali Chandrashekhar Ponde, Amrita Rath, Neha Singh","doi":"10.17085/apm.23164","DOIUrl":"10.17085/apm.23164","url":null,"abstract":"<p><p>Pediatric regional anesthesia (RA) has emerged as a rapidly advancing dimension within pediatric anesthesia, demanding a continual commitment to knowledge acquisition. This review underscores the contemporary significance of this specialty, focusing on its application in neonates and infants. The primary objective of RA is to address perioperative pain effectively while preserving the delicate physiological balance, thereby enhancing overall patient care. This review explores the advantages offered by RA in this age group. Furthermore, conventional, and recently introduced techniques of RA are examined by exploring the advantages and disadvantages of these methods. The aim is to provide clinicians with a nuanced understanding of their applicability in different clinical scenarios. Additionally, the review elucidates the unique considerations associated with pediatric RA, acknowledging pediatric patients' distinctive anatomical and physiological characteristics. The exceptional cases of congenital anomalies and their implications for the choice of RA are considered. An aspect of the review is its focus on dosages of local anesthetics and the volumes required for various blocks in neonates and infants. The dosages for continuous infusion and practical issues with infusions are considered. Complications due to RA are described with their prevention and treatment. The review offers pragmatic insights into the selection criteria for various regional blocks, aiding anesthesiologists in making informed decisions tailored to individual patient needs.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"S73-S86"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790771","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 comparative study of two different doses of dexmedetomedine as an adjuvant to lignocaine in infiltration block for tympanoplasty: a triple-blinded, prospective, randomized controlled trial.","authors":"Richa Singh, Annu Choudhary, Swati Singh, Harsh Kumar","doi":"10.17085/apm.24105","DOIUrl":"10.17085/apm.24105","url":null,"abstract":"<p><strong>Background: </strong>The ideal anesthetic drug choice for local infiltration anesthesia under monitored anesthesia care must provide analgesia and patients' comfort along with a bloodless surgical field for patients. We hypothesized that dexemedetomidine can provide better visibility of the surgical field at a higher dose of 1 µg/kg than 0.5 µg/kg, along with providing sedation and analgesia.</p><p><strong>Methods: </strong>After institutional ethics committee clearance and written informed consent, this prospective, randomized, triple blind study was conducted on ninety patients, between 18- 65 years who were scheduled for tympanoplasty. The patients were randomly assigned to either the dexmedetomidine (DEX) 0.5 group or the DEX 1.0 group, and received 10 ml solution containing 2% lignocaine with 0.5 µg/kg dexmedetomidine, or the 1 µg/kg dexmedetomidine. The operative surgeon performed local infiltration using standardized 5-point infiltration technique around the auricle. The primary objective was to compare the intraoperative bleeding at the surgical site. The comparison of normally distributed variables was conducted using the Student's t-test, whereas non-normally distributed variables was compared using the Mann-Whitney U test. The analysis of qualitative data was conducted using the chisquare/Fisher's exact test. A P value less than 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The overall bleeding score was significantly higher in the DEX 0.5 group (3.21 ± 0.727) than the DEX 1.0 group (1.43 ± 0.661) (P value < 0.001). The time to first analgesic requirement and surgeon satisfaction score were also significantly higher in the DEX 1.0 group.</p><p><strong>Conclusions: </strong>Combining dexmedetomidine at a dose of 1 µg/kg with 2% lignocaine for infiltration provided improved analgesia and improved the surgical field during tympanoplasty performed under monitored anesthesia care.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"310-319"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607712","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":"Risk factors of hypotension during cesarean section with spinal anesthesia in parturients with COVID-19: a retrospective study in comparison with pregnant women without COVID-19.","authors":"Si Ra Bang, Gunn Hee Kim, Sung Jun Cho, Mi Jung Yoon","doi":"10.17085/apm.24010","DOIUrl":"10.17085/apm.24010","url":null,"abstract":"<p><strong>Background: </strong>The incidence of hypotension in parturients with coronavirus disease (COVID-19) undergoing regional anesthesia remains controversial. This study aimed to investigate the incidence of hypotension during spinal anesthesia in parturients infected with COVID-19, as well as to identify associated risk factors.</p><p><strong>Methods: </strong>This retrospective study compared COVID-19-positive parturients who underwent cesarean section under spinal anesthesia (COVID-19 group) with a control group between January 2017 and June 2022. We reviewed the medical records and collected the following information: basic patient characteristics, spinal anesthesia, and newborn-related data.</p><p><strong>Results: </strong>Compared with the control group, the COVID-19 group did not show any significant differences in terms of hypotension occurrence and vasopressor usage. A positive correlation was noted in the COVID-19 group between heart rate and duration of hospital stay (P < 0.001, Spearman's rho = 0.422). In subgroup analysis of the COVID-19 group, group with a baseline heart rate ≥ 100 (group H) had lower Apgar scores at 1 min, longer hospital stays, and more severe COVID-19 symptoms than the with a baseline heart rate < 100 (group L). Moreover, in group H, there was a positive correlation between the heart rate and the lowest systolic blood pressure after spinal anesthesia (P = 0.012, Spearman's rho = 0.528).</p><p><strong>Conclusions: </strong>Parturients with COVID-19 do not appear to have a higher risk of hypotension during cesarean section under spinal anesthesia than those without COVID-19. Given the close association between preoperative heart rate and extent of hypotension in parturients with COVID-19 undergoing spinal anesthesia, vigilant monitoring of vital signs by anesthesiologists is crucial during the perioperative period.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"326-332"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607850","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":"What is your optimal target of oxygen during general anesthesia in pediatric patients?","authors":"Sung-Ae Cho","doi":"10.17085/apm.23103","DOIUrl":"10.17085/apm.23103","url":null,"abstract":"<p><p>The optimal oxygen target during general anesthesia remains difficult to define in pediatric and adult patients. Although access to pediatric patients has become difficult owing to a decrease in birth rate, pediatric anesthesia remains an important part of anesthesiology, and oxygenation related to general anesthesia is an essential part of any anesthesiologist. The use of oxygen has increased survival rates in adults and children; however, the side effects related to oxygen use have also increased. This review addresses the considerations of oxygenation in pediatric patients undergoing general anesthesia.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"S5-S11"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753798","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":"Early extubation after pediatric cardiac surgery.","authors":"Shu Qi Tham, Evangeline H L Lim","doi":"10.17085/apm.23154","DOIUrl":"10.17085/apm.23154","url":null,"abstract":"<p><p>Early extubation after pediatric cardiac surgery has come full circle from being practiced in the early days of pediatric cardiac surgery, falling out of favor with opioid-heavy cardiostable anesthesia, and resurfacing again in more recent times as part of enhanced recovery after surgery practice. Early extubation is variably defined, but is mostly accepted as extubation that occurs within 6-8 h from the end of surgery. In recent years, the debate has shifted from early extubation in the intensive care unit to immediate extubation in the operating theatre. In this review, we examined the benefits and pitfalls of early and immediate extubation, factors that influence the success of early extubation, and potential guidelines for practice and implementation.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"S61-S72"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790767","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":"Effective and safe pediatric sedation.","authors":"Young-Eun Jang, Jin-Tae Kim","doi":"10.17085/apm.24046","DOIUrl":"10.17085/apm.24046","url":null,"abstract":"<p><p>Pediatric sedation is a crucial tool for minimizing pain and anxiety during procedures and examinations in children. However, it is not without risks. This review provides a comprehensive review of pediatric sedation, including both established practices and recent advancements. A thorough pre-procedural evaluation is crucial to mitigate these risks. Skilled healthcare professionals trained in pediatric sedation are paramount to ensure a safe and effective procedure. The choice of sedative medication depends on various factors, such as the type of procedure and the patient's medical condition. Medications, used alone or in combination, offer sedation with varying onset times and durations. Non-pharmacological approaches can complement pharmacological sedation and further reduce potential complications. Preventing sedation-related complications requires a multidisciplinary approach. This includes collaborative decision-making, vigilant monitoring throughout the procedure, and a focus on patient safety. Recovery involves ensuring the child returns to their baseline status before discharge, following established criteria. In conclusion, successful pediatric sedation hinges on a comprehensive strategy. This strategy encompasses a thorough evaluation, skilled personnel, appropriate medication selection, vigilant monitoring, and a focus on patient safety throughout the process. By following these steps, we can minimize risks and achieve successful outcomes.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"S36-S48"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790769","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":"Diagnosis and management of infections related to spinal pain interventions.","authors":"Sang Cheol Yoon, Eun Joo Choi","doi":"10.17085/apm.24140","DOIUrl":"10.17085/apm.24140","url":null,"abstract":"<p><p>Although relatively rare, infections related to spinal pain interventions pose significant risks with an increase in the frequency of these procedures. This review investigates the incidence, risk factors, and management of infections following spinal pain interventions, such as epidural steroid injections, nucleoplasty, and facet joint injections. Most of the existing literature comprises case reports and retrospective studies with limited prospective research, owing to the nature of these infections. Our analysis revealed that while the overall infection rate is low, potential complications, such as epidural abscesses and spondylodiscitis, can be severe and life-threatening. The risk factors include advanced age, diabetes, immunosuppression, and multiple spinal procedures. Early diagnosis and timely intervention are critical to prevent long-term morbidity. These findings emphasize the importance of developing standardized diagnostic algorithms and treatment guidelines to support clinicians in managing these infections effectively. Future research should focus on large-scale studies to understand the impact of these infections better and refine clinical management strategies.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"294-301"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607831","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":"Ensuring safety: a reporting system for residual narcotics in intravenous fluids.","authors":"Daeseok Oh","doi":"10.17085/apm.24111","DOIUrl":"10.17085/apm.24111","url":null,"abstract":"","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"362-364"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607833","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":"Emergence delirium: an overview with an emphasis on the use of electroencephalography in its management.","authors":"Lucy Davies, Tham Shu Qi, Agnes Ng","doi":"10.17085/apm.24013","DOIUrl":"10.17085/apm.24013","url":null,"abstract":"<p><p>Emergence delirium remains a clinically significant issue, which often leads to distress among pediatric patients, parents, and staff in the short term; and may also result in postoperative maladaptive behaviors persisting for weeks to months. Although several diagnostic tools are available, the Pediatric Anesthesia Emergence Delirium Scale is most often utilized. Many risk factors contributing to the likelihood of a pediatric patient developing emergence delirium have been identified; however, its accurate prediction remains challenging. Recently, intraoperative electroencephalographic monitoring has been used to improve the prediction of emergence delirium. Similarly, it may also prevent emergence delirium if the anesthesiologist ensures that the at-risk patient rouses only after the onset of appropriate electroencephalogram patterns, thus indicating a change to natural sleep. Prediction of at-risk patients is crucial; preventing emergence delirium may begin early during patient preparation by using non-pharmacological methods (i.e., the ADVANCE program). Intraoperative electroencephalographic monitoring can predict emergence delirium. This review also discusses a range of pharmacological treatment options which may assist the anesthesiologist in preventing emergence delirium among at-risk patients.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":" ","pages":"S87-S95"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790770","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":"Preoperative nutritional scores to predict mortality after liver transplantation: a retrospective cohort study.","authors":"Eun Jung Kim, Jin Ha Park, Soo Yeon Kim, Jin Sun Cho","doi":"10.17085/apm.24045","DOIUrl":"10.17085/apm.24045","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is a well-known risk factor for mortality and morbidity. We investigated whether preoperative malnutrition, diagnosed using an objective nutritional index, was associated with postoperative mortality in patients undergoing liver transplantation (LT).</p><p><strong>Methods: </strong>This retrospective cohort observational study assessed the preoperative nutritional status of 440 patients who underwent LT, using the Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. We evaluated the association between preoperative malnutrition and 3-year postoperative mortality using the Kaplan-Meier curve and log-rank test. In addition, we identified prognostic factors for mortality using Cox proportional hazard analysis.</p><p><strong>Results: </strong>Malnutrition was identified in 72.7% (n = 320), 66.1% (n = 291), and 97.3% (n = 428) of patients as assessed by the NRI, PNI, and CONUT score, respectively. The Kaplan- Meier survival curve demonstrated that mortality increased with the presence and severity of malnutrition risk, as assessed by the NRI and PNI, respectively; however, NRI was the only index identified as an independent risk factor for mortality, along with preoperative renal replacement therapy, platelet count, and C-reactive protein. After adjustment, lower NRI was associated with a higher risk of mortality (hazard ratio 0.97, 95% confidence interval 0.95- 0.99, P = 0.009). The malnutrition group (NRI ≤ 100) had a significantly greater incidence of postoperative acute kidney injury than that of the normal group.</p><p><strong>Conclusions: </strong>Preoperative NRI is an independent risk factor for mortality after LT, and therefore it would be a helpful tool for mortality risk stratification in patients undergoing LT.</p>","PeriodicalId":101360,"journal":{"name":"Anesthesia and pain medicine","volume":"19 4","pages":"339-348"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607849","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}