Journal of Anesthesia最新文献

{"title":"The concept of \"fictitious weight\" in pharmacokinetic simulations and target-controlled infusion.","authors":"Shinju Obara","doi":"10.1007/s00540-024-03413-6","DOIUrl":"10.1007/s00540-024-03413-6","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"733-737"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel stimulating electrode attachment method designed to maintain electromyography-based neuromuscular monitoring detectability during laparoscopic surgery: a single-center randomized, double-blind, controlled pilot study.","authors":"Shohei Kaneko, Madoka Makino, Yurika Kawazoe, Shuntaro Sato, Akira Iwamizu, Ryu Narimatsu, Hikari Yamaguchi, Kana Miyagawa, Taiga Ichinomiya, Hiroaki Murata, Osamu Yoshitomi, Tetsuya Hara","doi":"10.1007/s00540-024-03397-3","DOIUrl":"10.1007/s00540-024-03397-3","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluated the electromyography (EMG)-based neuromuscular monitoring detectability of our novel stimulating electrode attachment method compared to the original Nihon-Kohden (Tokyo, Japan) attachment method.</p><p><strong>Methods: </strong>This single-center randomized, double-blind, controlled pilot study enrolled 32 patients aged ≥ 18 years, undergoing scheduled laparoscopic surgery. The EMG electrode NM-345Y™ was attached to one forearm using the Nihon-Kohden method (Pattern N-K) and the other forearm using our novel method (Pattern Cross). The allocation to each attachment method was determined post-randomization. In Pattern Cross, the NM-345Y™ was attached such that the line connecting the anode and cathode crosses the ulnar nerve. Patients received 0.9 mg/kg rocuronium after calibration with the forearm in 90-degree supination. Following tracheal intubation, the forearm was positioned in 0-degree pronation. Intraoperatively, 0.2 mg/kg rocuronium was administered if the train-of-four (TOF) count one persisted for 1 min on either side. Post-surgery, the forearm position was returned to 90-degree supination, and rocuronium was antagonized with sugammadex. TOF and post-tetanic count (PTC) were simultaneously measured bilaterally every 15 s and 5 min, respectively, from post-calibration to tracheal extubation.</p><p><strong>Results: </strong>The time to first PTC appearance was significantly shorter by 33 min in the Pattern Cross group than in the Pattern N-K group (95% Confidence interval: 1-66, p = 0.043). Following sugammadex administration, TOF ratios ≥ 0.9 were achieved in 72% of patients in the Pattern N-K group and 97% of those in the Pattern Cross group (p = 0.025).</p><p><strong>Conclusions: </strong>Crossing the line connecting the anode and cathode with the ulnar nerve stabilizes EMG-based neuromuscular monitoring detectability.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"811-820"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric cardiac surgery: machine learning models for postoperative complication prediction.","authors":"Rémi Florquin, Renaud Florquin, Denis Schmartz, Philippe Dony, Giovanni Briganti","doi":"10.1007/s00540-024-03377-7","DOIUrl":"10.1007/s00540-024-03377-7","url":null,"abstract":"<p><strong>Purpose: </strong>Managing children undergoing cardiac surgery with cardiopulmonary bypass (CPB) presents a significant challenge for anesthesiologists. Machine Learning (ML)-assisted tools have the potential to enhance the recognition of patients at risk of complications and predict potential issues, ultimately improving outcomes.</p><p><strong>Methods: </strong>We evaluated the prediction capacity of six models, ranging from logistic regression to support vector machine, using a dataset comprising 33 variables and 1364 subjects. The Area Under the Curve (AUC) and the F1 score served as the primary evaluation metrics. Our primary objectives were twofold: first, to develop an effective prediction model, and second, to create a user-friendly comprehensive model for identifying high-risk patients.</p><p><strong>Results: </strong>The logistic regression model demonstrated the highest effectiveness, achieving an AUC of 83.65%, and an F1 score of 0.7296, with balanced sensitivity and specificity of 77.94% and 76.47%, respectively. In comparison, the comprehensive three-layer decision tree model achieved an AUC of 72.84%, with sensitivity (79.41%) comparable to more complex models.</p><p><strong>Conclusion: </strong>Our machine learning-assisted tools provide an additional perspective and enhance the predictive capabilities of traditional scoring methods. These tools can assist anesthesiologists in making well-informed decisions. Furthermore, we have successfully demonstrated the feasibility of creating a practical white-box model. The next steps involve conducting clinical validation and multicenter cross-validation.</p><p><strong>Trial registration: </strong>NCT05537168.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"747-755"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the article by Hassabelnaby et al.","authors":"Jing Yuan, Bin Shi, Lufei Huang","doi":"10.1007/s00540-024-03372-y","DOIUrl":"10.1007/s00540-024-03372-y","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"889"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy ameliorates neuropathic pain through suppression of microglia and upregulation of the δ-opioid receptor in the anterior cingulate cortex in late-pregnant mice.","authors":"Atsushi Sawada, Michiaki Yamakage","doi":"10.1007/s00540-024-03402-9","DOIUrl":"10.1007/s00540-024-03402-9","url":null,"abstract":"<p><strong>Purpose: </strong>Pregnancy-induced analgesia develops in late pregnancy, but its mechanisms are unclear. The anterior cingulate cortex (ACC) plays a key role in the pathogenesis of neuropathic pain. The authors hypothesized that pregnancy-induced analgesia ameliorates neuropathic pain by suppressing activation of microglia and the expression of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, and by upregulating opioid receptors in the ACC in late-pregnant mice.</p><p><strong>Methods: </strong>Neuropathic pain was induced in non-pregnant (NP) or pregnant (P) C57BL/6JJmsSlc female mice by partial sciatic nerve ligation (PSNL). The nociceptive response was evaluated by mechanical allodynia and activation of microglia in the ACC was evaluated by immunohistochemistry. The expressions of phosphorylated AMPA receptors and opioid receptors in the ACC were evaluated by immunoblotting.</p><p><strong>Results: </strong>In von Frey reflex tests, NP-PSNL-treated mice showed a lower 50% paw-withdrawal threshold than NP-Naïve mice on experimental day 9. No difference in 50% paw-withdrawal threshold was found among the NP-Naïve, NP-Sham, P-Sham, and P-PSNL-treated mice. The number of microglia in the ACC was significantly increased in NP-PSNL-treated mice compared to NP-Sham mice. Immunoblotting showed significantly increased expression of phosphorylated AMPA receptor subunit GluR1 at Ser831 in NP-PSNL-treated mice compared to NP-Sham mice. Immunoblotting also showed significantly increased δ-opioid receptor in the ACC in P-Sham and P-PSNL-treated mice compared to NP-Sham mice.</p><p><strong>Conclusion: </strong>Pregnancy-induced analgesia ameliorated neuropathic pain by suppressing activation of microglia and the expression of phosphorylated AMPA receptor subunit GluR1 at Ser831, and by upregulation of the δ-opioid receptor in the ACC in late-pregnant mice.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"828-838"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new and simplified extraoral approach for inferior alveolar nerve block: a cadaveric study and clinical case reports.","authors":"Kunitaro Watanabe, Joho Tokumine, Miki Nagase, George Matsumura, Ryuji Sawada, Sakura Kinjo, Tomoko Yorozu","doi":"10.1007/s00540-024-03396-4","DOIUrl":"10.1007/s00540-024-03396-4","url":null,"abstract":"<p><strong>Purpose: </strong>Inferior alveolar nerve (IAN) and lingual nerve (LN) blocks are commonly performed using the intraoral landmark techniques. However, these methods have a risk of unanticipated nerve and arterial injury or a higher failure rate. We developed a novel extraoral approach for the IAN and LN blocks, the \"inferior alveolar nerve block mandibular angle approach (IANB-MA),\" using ultrasound guidance. The mechanism of action of this nerve block was examined anatomically, and its clinical feasibility was reported.</p><p><strong>Methods: </strong>We performed the IANB-MA on four cadavers using different dye volumes (2, 4, 6 and 8 mL). The ultrasound probe was placed on the lower edge of the mandibula of each cadaver, and the needle was advanced to the mandibular inner surface. Blue acrylic paint solution was injected, and its spread was evaluated by dissection.</p><p><strong>Results: </strong>Our study showed that the medial pterygoid muscle fascia was stained in all cadavers. The dye reached the LN consistently, and the IAN was stained with higher volumes (6 mL and 8 mL). The pterygomandibular space was filled with 6 mL and 8 mL of the dye. The IANB-MA successfully reduced pain in three patients with trigeminal neuralgia, tongue or jaw pain.</p><p><strong>Conclusions: </strong>The IANB-MA is a novel ultrasound-guided approach to the IAN and the LN. The clinical feasibility and effectiveness of this technique were confirmed in our patients. It may be a good alternative analgesic approach to other conventional approaches.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"806-810"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendation for the practice of total intravenous anesthesia.","authors":"Shinju Obara, Kotoe Kamata, Masakazu Nakao, Shigeki Yamaguchi, Shuya Kiyama","doi":"10.1007/s00540-024-03398-2","DOIUrl":"10.1007/s00540-024-03398-2","url":null,"abstract":"<p><p>This Recommendation was developed by the Japanese Society of Intravenous Anesthesia Recommendation Making Working Group (JSIVA-WG) to promote the safe and effective practice of total intravenous anesthesia (TIVA), tailored to the current situation in Japan. It presents a policy validated by the members of JSIVA-WG and a review committee for practical anesthesia management. Anesthesiologists should acquire and maintain the necessary knowledge and skills to be able to administer TIVA properly. A secure venous access is critically important for TIVA. To visualize and understand the pharmacokinetics of intravenous anesthetics, use of real-time pharmacokinetic simulations is strongly recommended. Syringe pumps are essential for the infusion of intravenous anesthetics, which should be prepared according to the rules of each individual anesthesia department, particularly with regard to dilution. Syringes should be clearly labeled with content and drug concentration. When managing TIVA, particularly with the use of muscle relaxants, monitoring processed electroencephalogram (EEG) is advisable. However, the depth of sedation/anesthesia must be assessed comprehensively using various parameters, rather than simply relying on a single EEG index. TIVA should be swiftly changed to an alternative method that includes inhalation anesthesia if necessary. Use of antagonists at emergence may be associated with re-sedation risk. Casual administration of antagonists and sending patients back to surgical wards without careful observation are not acceptable.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"738-746"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High spinal block in cesarean section.","authors":"Ahmed M Hasanin, Rana M Zaki, Maha Mostafa","doi":"10.1007/s00540-024-03378-6","DOIUrl":"10.1007/s00540-024-03378-6","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"890"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasopressors in obstetrics: guidelines and good practice.","authors":"Ahmed M Hasanin, Rana M Zaki, Maha Mostafa","doi":"10.1007/s00540-024-03379-5","DOIUrl":"10.1007/s00540-024-03379-5","url":null,"abstract":"","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"893-894"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the ratio of posterior complex length to depth measured by ultrasound as a predictor of difficult spinal anesthesia for elective cesarean delivery: a prospective cohort study.","authors":"Jingfa Shi, Meng Ning, Lei Xie, Rong Zhang, Rongrong Liu, Xiuli Yang, Lijian Chen","doi":"10.1007/s00540-024-03394-6","DOIUrl":"10.1007/s00540-024-03394-6","url":null,"abstract":"<p><strong>Purpose: </strong>Ultrasound view of the interlaminar structure is likely to be associated with difficult spinal anesthesia (DSA), and a poor ultrasound view which cannot show the anterior and posterior complex predicts a difficult spinal technique. As our target site is the posterior complex, this study aimed to assess whether the ratio of posterior complex length to depth measured by ultrasound can predict DSA in cesarean delivery.</p><p><strong>Methods: </strong>Four anesthesiologists with 1-2 years of experience located and marked the puncture interspace using a traditional surface landmark. Subsequently, the ultrasound examiner located and measured the marked interspace via an oblique parasagittal ultrasound scan. The anesthesiologists, who were blinded to the ultrasound results, performed spinal anesthesia using a 25-gauge Whitacre spinal needle. The total number of attempts, including skin punctures and needle passes, was recorded and the DSA was defined as 10 unsuccessful attempts. A multivariable logistic regression analysis was used to determine the independent predictors, and receiver operating characteristic curves were constructed to evaluate the performance of the ratio of posterior complex length to depth for predicting DSA.</p><p><strong>Results: </strong>A total of 397 cesarean delivery parturients with successfully measured posterior complex were included in the analysis. DSA occurred in 64 parturients (16.1%). Reduced length [odds ratio (OR) = 0.010, 95% confidence interval (CI), 0.002-0.062, P < 0.001] and increased depth [OR = 6.127, 95% CI, 2.671-14.056, P < 0.001] of the posterior complex were independently predictive of DSA compared with body mass index, abdominal circumference, and palpable surface landmarks. The ratio of posterior complex length to depth for predicting DSA had an area under the curve of 0.86 (95% CI, 0.82-0.90). The optimal cutoff was 0.23, with a sensitivity of 86% (95% CI, 74-93%) and specificity of 72% (95% CI, 67-77%).</p><p><strong>Conclusion: </strong>The ratio of posterior complex length to depth measured by ultrasound demonstrated a considerable accuracy in predicting DSA for inexperienced anesthesiologists. A higher ratio at ultrasound is an indication to evaluate the optimal puncture body position and interspace in the clinic practice.</p><p><strong>Clinical trial registration: </strong>ChiCTR2200065171 https://www.chictr.org.cn/showproj.html?proj=180855.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":" ","pages":"787-795"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}