Journal of Clinical Anesthesia最新文献

{"title":"Oral ketamine for acute postoperative analgesia (OKAPA) trial: A randomized controlled, single center pilot study.","authors":"Michael Dinsmore, Kristof Nijs, Eric Plitman, Emad Al Azazi, Lashmi Venkatraghavan, Karim Ladha, Hance Clarke","doi":"10.1016/j.jclinane.2024.111690","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111690","url":null,"abstract":"<p><strong>Study objective: </strong>Although opioids represent the mainstay of treating surgical pain, their use is associated with significant side effects. There is an urgent need to find new pain relievers with safer side effect profiles. One drug that has been receiving increasing attention is ketamine. By using the oral route of administration, ketamine could potentially be used by patients in a less resource-intensive manner with similar efficacy. This study aims to examine the role of oral ketamine in improving recovery after major spine surgery.</p><p><strong>Design: </strong>A prospective, single-center, double blinded parallel arm, placebo controlled randomized feasibility trial.</p><p><strong>Setting: </strong>Toronto Western Hospital (TWH), UHN, Toronto, Canada.</p><p><strong>Patients: </strong>Adult patients (aged 18-75) undergoing multi-level lumbar spine decompression and fusion with planned overnight admission in hospital.</p><p><strong>Interventions: </strong>Study treatment (oral ketamine 30 mg) or matching placebo for three days (nine doses total) or until hospital discharge.</p><p><strong>Measurements: </strong>The primary outcome was the patient-reported Quality of Recovery-15 score (QoR-15). Secondary outcomes were opioid use, pain intensity, pain interference (PROMIS-pain interference questionnaire), mood (PHQ-9) and, side-effects (Generic Assessment of Side Effects Scale).</p><p><strong>Main results: </strong>Data from 35 patients were analyzed, of which 18 patients in the ketamine group and 17 patients in the placebo group. There were no significant differences identified in QoR-15 scores at postoperative days 1,3,7, and 30. There were also no significant differences found in pain intensity scale scores at postoperative days 1, 3, 7, and 30, and PROMIS and PHQ-9 scores at postoperative days 7 and 30. Significantly less oral opioids were used in the ketamine group compared to the placebo group on postoperative day 3 and by postoperative day 7. In addition, patients in the ketamine group spent significantly less days on oral opioids and trended to be discharged from hospital earlier.</p><p><strong>Conclusion: </strong>This pilot study demonstrated that low dose oral ketamine can be safely used as an adjunct in postoperative pain treatment to help reduce opioid consumption after major spine surgery.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"111690"},"PeriodicalIF":5.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 editor regarding \"The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial\".","authors":"Jianjun Yang, Pinguo Fu","doi":"10.1016/j.jclinane.2024.111691","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111691","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"100 ","pages":"111691"},"PeriodicalIF":5.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining standards of care for AI and clinicians alike: Regarding ChatGPT in labor analgesia management","authors":"Alejandro Fuentes ,&nbsp;Rene de la Fuente ,&nbsp;Fernando R. Altermatt","doi":"10.1016/j.jclinane.2024.111673","DOIUrl":"10.1016/j.jclinane.2024.111673","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111673"},"PeriodicalIF":5.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous vital sign monitoring on surgical wards: The COSMOS pilot","authors":"Nikola Anusic MD ,&nbsp;Alper Gulluoglu MD ,&nbsp;Elyad Ekrami MD ,&nbsp;Edward J. Mascha PhD ,&nbsp;Shuyi Li MS ,&nbsp;René Coffeng ,&nbsp;Alparslan Turan MD ,&nbsp;Amber Clemens BSN RN ,&nbsp;Christine Perez RN ,&nbsp;John W. Beard MD ,&nbsp;Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2024.111661","DOIUrl":"10.1016/j.jclinane.2024.111661","url":null,"abstract":"<div><h3>Study objectives</h3><div>Alerts for vital sign abnormalities seek to identify meaningful patient instability while limiting alarm fatigue. Optimal vital sign alarm settings for postoperative patients remain unknown, as is whether alerts lead to effective clinical responses reducing vital sign disturbances. We conducted a 2-phase pilot study to identify thresholds and delays and test the hypothesis that alerts from continuous monitoring reduce the duration of vital sign abnormalities.</div></div><div><h3>Design</h3><div>Two-phase pilot.</div></div><div><h3>Patients</h3><div>250 adults having major non-cardiac surgery.</div></div><div><h3>Setting</h3><div>Surgical wards.</div></div><div><h3>Intervention</h3><div>All patients had routine vital sign monitoring by nurses at 4-h intervals. We initially continuously recorded clinician-blinded saturation, heart rate, and respiratory rate in 100 patients. In the second phase, we randomized 150 patients to blinded versus unblinded continuous vital sign monitoring. In unblinded patients, nurses were verbally alerted to abnormal vital signs.</div></div><div><h3>Measurements</h3><div>In the first phase, we modeled expected alarm counts using 6082 h of continuous oxygen saturation, heart rate, and respiratory rate data. Thresholds and delays targeting ∼3 alarms per patient per day were selected for phase two. Primary analysis assessed the effect of unblinded monitoring across a 5-component primary composite of cumulative durations of vital sign abnormalities. Secondary outcomes included fraction of alerts deemed meaningful by nurses and number of clinical interventions.</div></div><div><h3>Results</h3><div>In phase one, we identified alarm settings that yielded an average of 2.3 alerts per patient per day. In phase two, the average relative effect ratio of geometric duration means for vital signs exceeding thresholds was 0.75 [95 % CI: 0.51, 1.1], <em>P</em> = 0.17. Sixty alarms (82 %) were deemed useful in unblinded patients, leading to 60 % more interventions in unblinded patients.</div></div><div><h3>Conclusions</h3><div>We were able to select continuous saturation, heart rate, and respiratory rate thresholds that generated about 2 alerts per patient per day, nearly all of which were considered useful by nurses. Unblinded monitoring and nursing alerts led to interventions (mostly increasing oxygen delivery) that non-significantly reduced vital sign abnormalities by 25 %.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> registration: <span><span>NCT05280574</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111661"},"PeriodicalIF":5.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuation versus discontinuation of renin-angiotensin aldosterone system inhibitors before non-cardiac surgery: A systematic review and meta-analysis","authors":"Mushood Ahmed ,&nbsp;Eeshal Fatima ,&nbsp;Aimen Shafiq ,&nbsp;Areeba Ahsan ,&nbsp;Eeshal Zulfiqar ,&nbsp;Fouad Masood ,&nbsp;Raheel Ahmed ,&nbsp;Farah Yasmin ,&nbsp;Muhammad Sohaib Asghar","doi":"10.1016/j.jclinane.2024.111679","DOIUrl":"10.1016/j.jclinane.2024.111679","url":null,"abstract":"<div><h3>Background</h3><div>A large number of patients undergoing noncardiac surgeries are on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). The current guidelines regarding the continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting. This meta-analysis aims to evaluate whether continuing or withholding RAAS inhibitors before noncardiac surgery influences perioperative mortality and complications.</div></div><div><h3>Methods</h3><div>A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to August 30, 2024 to identify eligible randomized controlled trials (RCTs) and cohort studies. Clinical outcomes were evaluated using a random-effects model to pool odds ratios (ORs) with 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>The analysis included 16 studies with a total of 59,105 patients on RAAS inhibitors before noncardiac surgery. Withholding RAAS inhibitors was associated with a significantly lower incidence of intraoperative hypotension (OR = 0.49; 95 % CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI = 0.82 to 0.95) than continuing the therapy. However, there was no statistically significant difference in reducing mortality (OR = 1.10; 95 % CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR = 1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI = 0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between the two groups.</div></div><div><h3>Conclusion</h3><div>Withholding RAAS inhibitors before noncardiac surgery reduces intraoperative hypotension and AKI with nonsignificant effects on mortality and MACE.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111679"},"PeriodicalIF":5.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating prevalence and trajectory of functional disability in older surgical patients: An observational cohort study","authors":"Ellene Yan HBSc ,&nbsp;Nina Butris MSc ,&nbsp;Yasmin Alhamdah MSc ,&nbsp;Paras Kapoor MSc ,&nbsp;Leif Erik Lovblom PhD ,&nbsp;Jean Wong MD ,&nbsp;Sazzadul Islam MSc ,&nbsp;Aparna Saripella MSc ,&nbsp;David F. Tang-Wai MD CM ,&nbsp;Linda Mah MD MHSc ,&nbsp;Shabbir M.H. Alibhai MD MSc ,&nbsp;David He MD PhD ,&nbsp;Frances Chung MD","doi":"10.1016/j.jclinane.2024.111681","DOIUrl":"10.1016/j.jclinane.2024.111681","url":null,"abstract":"<div><h3>Study objectives</h3><div>To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability.</div></div><div><h3>Design</h3><div>Multicenter prospective study.</div></div><div><h3>Setting</h3><div>Remote preoperative and postoperative assessments.</div></div><div><h3>Patients</h3><div>307 older patients aged ≥65 years undergoing non-cardiac surgery.</div></div><div><h3>Measurements</h3><div>Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 on an online survey, with a score ≥ 16 % exceeding a patient-acceptable symptom state and ≥ 35 % indicating significant, or at least moderate, severity.</div></div><div><h3>Main results</h3><div>We found that 133 (43 %) patients exhibited preoperative functional disability exceeding a patient-acceptable level, with 42 (14 %) experiencing clinically significant, or at least moderate, functional disability. The Functional Disability group showed greater improvement in function than the No-disability group. Specifically, over 60 % of participants in the Functional Disability group showed significant improvement at 90 and 180 days postoperatively, with 40 % being disability-free. However, 12 % of the Functional Disability group and 9 % of the No-disability group experienced a clinically important worsening in functional disability at 180 days postoperatively. Preoperative functional disability and depression were associated with nearly 6- and 4-fold higher odds of functional disability at 180 days, respectively.</div></div><div><h3>Conclusions</h3><div>Patients with preoperative functional disability experienced greater postoperative improvement in functional disability than the No-disability group. Preoperative evaluation of functional disability informs perioperative care and recovery for patients and clinicians.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111681"},"PeriodicalIF":5.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Desflurane versus sevoflurane on graft outcome of patients with cirrhosis receiving steatotic liver graft in deceased donor liver transplantation","authors":"Insun Park ,&nbsp;Eun-Ki Min ,&nbsp;Bon-Nyeo Koo ,&nbsp;Jae Hyon Park ,&nbsp;Deok Gie Kim ,&nbsp;Dong Jin Joo ,&nbsp;Jae Geun Lee","doi":"10.1016/j.jclinane.2024.111674","DOIUrl":"10.1016/j.jclinane.2024.111674","url":null,"abstract":"<div><h3>Study objective</h3><div>This study aimed to analyze the effects of two volatile anesthetic agents, desflurane and sevoflurane, on graft outcomes in patients undergoing deceased donor liver transplantation (DDLT) for cirrhosis, with a specific focus on fatty grafts.</div></div><div><h3>Design</h3><div>A retrospective observational study.</div></div><div><h3>Setting</h3><div>A tertiary hospital (Severance Hospital, Korea).</div></div><div><h3>Patients</h3><div>This study included 151 patients with liver cirrhosis who underwent DDLT for cirrhosis between January 2006 and December 2022.</div></div><div><h3>Interventions</h3><div>Patients were grouped according to maintenance anesthesia received (desflurane or sevoflurane), the model for end-stage liver disease (MELD) score, and macrovesicular steatosis (MVS) of the liver graft.</div></div><div><h3>Measurements</h3><div>Survival curves were constructed from the date of surgery to graft failure or death. After propensity score matching (PSM), Cox regression analysis was used to compare hazards ratios (HR) for 5-year graft and overall survival. Subgroup analyses were performed for the MELD score and MVS of the liver graft. Incidences of 1-month acute rejection and early allograft dysfunction (EAD) were also compared between the two groups.</div></div><div><h3>Main results</h3><div>Among 151 eligible patients, 49 patients remained in each group after PSM, with 14 (28.6 %) graft failures and deaths occurring in each group. In matched analysis, sevoflurane showed poorer 5-year graft and overall survival compared to desflurane in recipients of graft with ≥10 % MVS, and this trend was significant in patients with MELD score of ≥35. In Cox regression model, compared to desflurane sevoflurane showed a propensity score-matched HR of 5.8 (95 % CI, 1.13–30.50 for both 5-year graft and overall survival. Additionally, sevoflurane showed an increased risk of 1-month acute rejection; however, no difference was observed for EAD.</div></div><div><h3>Conclusions</h3><div>Sevoflurane as a maintenance agent during DDLT in recipients with high MELD scores and fatty grafts may be associated with poorer outcomes compared to desflurane.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111674"},"PeriodicalIF":5.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of remimazolam versus dexmedetomidine for patients undergoing flexible fiberoptic bronchoscopy: A randomized, clinical trial","authors":"Laiying Zhou ,&nbsp;Jingcheng Zou ,&nbsp;Xue Li ,&nbsp;Xiaozhuo Zuo ,&nbsp;Mengting Gu ,&nbsp;Kai Sun ,&nbsp;Wen Fan ,&nbsp;Yuanyuan Yao ,&nbsp;Min Yan","doi":"10.1016/j.jclinane.2024.111677","DOIUrl":"10.1016/j.jclinane.2024.111677","url":null,"abstract":"<div><h3>Study objective</h3><div>Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB).</div></div><div><h3>Design</h3><div>Randomized controlled trial.</div></div><div><h3>Setting</h3><div>University hospital.</div></div><div><h3>Patients</h3><div>Between April 2021 and September 2022, patients undergoing painless flexible fiberoptic bronchoscopy were recruited.</div></div><div><h3>Interventions</h3><div>The patients were randomly assigned with a 1:1 ratio to remimazolam-remifentanil group (RR group) or dexmedetomidine-remifentanil group (DR group).</div></div><div><h3>Measurements</h3><div>The primary outcome was the procedure interruption rate during bronchoscopy. Secondary outcomes were hemodynamic changes, resuscitation time, rescue medication usage rate and dose, satisfaction scores of patients and bronchoscopists, operation-related complications, and adverse events.</div></div><div><h3>Main results</h3><div>A total of 363 patients were included for final analysis. The interruption rates of bronchoscopy were 8.2 % in the RR group and 39.2 % in the DR group (<em>P</em> &lt; 0.05). The rescue medication usage rate (4.4 % vs. 38.7 %, <em>P</em> &lt; 0.05) and dose (1.51 ± 8.15 mg vs. 13.17 ± 18.86 mg, <em>P</em> &lt; 0.05) were lower in the RR group compared with the DR group. The incidence of oxygen desaturation was significantly lower in the RR group than in the DR group (14.3 % vs. 44.2 %, <em>P</em> &lt; 0.05). Hemodynamic changes in patients in the DR group were significant, with longer recovery time and lower satisfaction scores for both inpatients and bronchoscopists (<em>P</em> &lt; 0.05), compared with the RR group. However, there were no significant differences between groups in terms of operation-related complications (<em>P</em> &gt; 0.05) except for postoperative dizziness, which was more common in the DR group (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Remimazolam is effective and safe in painless flexible fiberoptic bronchoscopy. It allows a lower procedure interruption rate and incidence of oxygen desaturation, providing better hemodynamic stability compared to dexmedetomidine.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111677"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study","authors":"Yuxian Wang BS ,&nbsp;Yilin Wei BS ,&nbsp;Guannan Chen M.D., Ph.D ,&nbsp;Zhiyao Wang M.D., Ph.D ,&nbsp;Yu Fan MS ,&nbsp;Jie Wang MS ,&nbsp;Yuanjun Yang BS ,&nbsp;Di Zhou M.D., Ph.D ,&nbsp;Ming Zhong M.D., Ph.D","doi":"10.1016/j.jclinane.2024.111678","DOIUrl":"10.1016/j.jclinane.2024.111678","url":null,"abstract":"<div><h3>Objective</h3><div>Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.</div></div><div><h3>Design</h3><div>Single-centered, prospective, unblinded, randomized, parallel-group clinical trial.</div></div><div><h3>Setting</h3><div>Surgical suite of a university-affiliated teaching hospital.</div></div><div><h3>Patients</h3><div>Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.</div></div><div><h3>Measurements</h3><div>EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T₀), 15 min after OLV(T₁), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T₂). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.</div></div><div><h3>Results</h3><div>Mean arterial pressure (<em>p</em> &lt; 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (<em>p</em> = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO₂/FiO₂) from T₀ to T₁ in both groups. The PaO₂/FiO₂ in the TEB group was significantly lower after epidural administration of the local anesthetic (<em>p</em> &lt; 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T₂ (<em>p</em> &lt; 0.05). TEB increased non-ventilated perfusion distribution(p &lt; 0.05), and Shunt-EIT % (p &lt; 0.05) and reduced Matched Region % (p &lt; 0.05), while Dead Space-EIT % remained (<em>p</em> = 0.499).</div></div><div><h3>Conclusions</h3><div>Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.</div><div>Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04730089</span><svg><path></path></svg></span>. Registration on January 25th, 2021.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111678"},"PeriodicalIF":5.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of inspiratory oxygen fraction during driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery: A randomized controlled trial","authors":"Yu-Tong Zhang ,&nbsp;Yang Han ,&nbsp;Hui-Jia Zhuang ,&nbsp;Ai-Min Feng ,&nbsp;Liang Jin ,&nbsp;Xue-Fei Li ,&nbsp;Hong Yu ,&nbsp;Hai Yu","doi":"10.1016/j.jclinane.2024.111676","DOIUrl":"10.1016/j.jclinane.2024.111676","url":null,"abstract":"<div><h3>Study objective</h3><div>The aim of the present study was to determine the effect of 30 % fraction of inspired oxygen (FIO₂) compared with 80 % FIO₂ in the context of driving pressure-guided ventilation strategy on pulmonary complications following open abdominal surgery.</div></div><div><h3>Design</h3><div>A single-center, prospective, randomized controlled trial.</div></div><div><h3>Setting</h3><div>Tertiary university hospital in China.</div></div><div><h3>Patients</h3><div>514 adult patients, ASA I-III and scheduled for major open abdominal surgery under general anesthesia.</div></div><div><h3>Interventions</h3><div>Patients were randomly assigned to receive either 30 % or 80 % FIO₂ during the intraoperative period. All patients received driving pressure-guided ventilation strategy, including low tidal volume and individualized PEEP set at lowest driving pressure.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of a composite of pulmonary complications within the 7 days postoperatively. The severity of pulmonary complications, extrapulmonary complications, and other secondary outcomes were also assessed.</div></div><div><h3>Main results</h3><div>Of 1553 patients assessed for eligibility, 514 patients were randomly assigned and analyzed with intention-to-treat principle. Patients receiving 30 % FIO₂ had a significantly lower incidence of postoperative pulmonary complications (PPCs) compared to those receiving 80 % FIO₂ (46.3 %<em>vs.</em> 64.6 %; RR, 0.72; 95 % CI, 0.61–0.84; <em>P</em> &lt; 0.001). The severity score of PPCs was significantly reduced in the 30 % FIO₂ group compared with that in the 80 % FIO₂ group within the 7 postoperative days (<em>P</em> &lt; 0.001). Dynamic compliance was significantly greater in 30 % FIO₂ group at the end of surgery (56 [48–66] <em>vs.</em> 53 [46–62], <em>P</em> = 0.027). More patients in the 80 % FIO₂ group developed oxygen desaturation (SpO₂ &lt; 94 %) on air intake during PACU stay (18.5 %<em>vs.</em> 30.4 %; RR, 0.61; 95 % CI, 0.44–0.84; <em>P</em> = 0.002; 30 % FIO₂ group <em>vs.</em>80 % FIO₂ group).</div></div><div><h3>Conclusions</h3><div>In patients undergoing open abdominal surgery, using a 30 % FIO₂, compared with 80 % FIO₂, in context of driving pressure-guided ventilation strategy, intraoperatively reduced the incidence and severity of pulmonary complications within the first 7 postoperative days.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111676"},"PeriodicalIF":5.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}