Journal of Clinical Anesthesia最新文献

{"title":"New set of indicators with consensus definition for anaesthesia-related severe morbidity: A scoping review followed by a Delphi study","authors":"Marie-Pierre Bonnet ,&nbsp;Perrine Guckert ,&nbsp;Cécile Boccara ,&nbsp;Chafia Daoui ,&nbsp;Hélène Beloeil ,&nbsp;on behalf of the SFAR research network","doi":"10.1016/j.jclinane.2024.111626","DOIUrl":"10.1016/j.jclinane.2024.111626","url":null,"abstract":"<div><h3>Study objective</h3><p>Monitoring anaesthesia-related severe morbidity constitutes a good opportunity for assessing quality and safety of care in anaesthesia. Several recent studies attempted to describe and define indicators for anaesthesia-related severe morbidity with limitations: no formal experts' consensus process, overlap with surgical complications, no consensual definitions, inapplicability in clinical practice. The aim of this study was to provide a set of indicators for anaesthesia-related severe morbidity based on outcomes and using clinically useful consensual definitions.</p></div><div><h3>Design</h3><p>1/ scoping review of studies published in 2010–2021 on outcomes of anaesthesia-related severe morbidity with different definitions;</p><p>2/ International experts' consensus on indicators for anaesthesia-related severe morbidity with specific definitions using a Delphi process.</p></div><div><h3>Main results</h3><p>After including 142 studies, 68 outcomes for anaesthesia-related severe morbidity were identified and organized in 34 indicators divided into 8 categories (cardiovascular, respiratory, sepsis, renal, neurological, medication error, digestive and others). The indicators were then submitted to the experts. After 2 Delphi rounds, the 26 indicators retained by the experts with their corresponding consensual definition were: acute heart failure, cardiogenic shock, acute respiratory distress syndrome, pulmonary embolism and thrombosis, bronchospasm or laryngospasm, pneumonia, inhalation pneumonitis, pneumothorax, difficult or impossible intubation, atelectasis, self-extubation or accidental extubation, sepsis or septic shock, transient ischemic attack, postoperative confusion or delirium, post-puncture headache, medication error, liver failure, unplanned intensive care unit admission, multiple-organ failure.</p></div><div><h3>Conclusions</h3><p>This study provides a new consensual set of indicators for anaesthesia-related severe morbidity with specific definitions, that could be easily applied in clinical practice as in research.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111626"},"PeriodicalIF":5.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024002551/pdfft?md5=be8df1715f6454db5d6d33e288b2039a&pid=1-s2.0-S0952818024002551-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240173","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":"Increased adoption of video laryngoscopy and the decrease in ‘difficult airway’ through the COVID-19 pandemic: A retrospective study","authors":"Matthew T. Hunter (MD) ,&nbsp;David W. Boorman (MS) ,&nbsp;Danielle McFarlane (MD) ,&nbsp;Thanayi Barone Smith (MD)","doi":"10.1016/j.jclinane.2024.111607","DOIUrl":"10.1016/j.jclinane.2024.111607","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111607"},"PeriodicalIF":5.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240176","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, “Effects of esketamine on postoperative negative emotions and early cognitive disorders in patients undergoing non-cardiac thoracic surgery: A randomized controlled trial”","authors":"Uzay Cagatay,&nbsp;Mahindra Bandari","doi":"10.1016/j.jclinane.2024.111610","DOIUrl":"10.1016/j.jclinane.2024.111610","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111610"},"PeriodicalIF":5.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240177","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":"Impact of intravenous steroids on subjective recovery quality after surgery: A meta-analysis of randomized clinical trials","authors":"Kuo-Chuan Hung ,&nbsp;Li-Chen Chang ,&nbsp;Chun-Ning Ho ,&nbsp;Jheng-Yan Wu ,&nbsp;Chih-Wei Hsu ,&nbsp;Chien-Ming Lin ,&nbsp;I-Wen Chen","doi":"10.1016/j.jclinane.2024.111625","DOIUrl":"10.1016/j.jclinane.2024.111625","url":null,"abstract":"<div><h3>Study objective</h3><p>Quality of postoperative recovery is a crucial aspect of perioperative care. This meta-analysis aimed to evaluate the efficacy of intravenous steroids in improving the quality of recovery (QoR) after surgery, as measured by validated QoR scales.</p></div><div><h3>Design</h3><p>Meta-analysis of randomized controlled trials (RCTs).</p></div><div><h3>Setting</h3><p>Operating room.</p></div><div><h3>Intervention</h3><p>The use of a single dose of intravenous steroids as a supplement to general anesthesia.</p></div><div><h3>Patients</h3><p>Adult patients undergoing surgery.</p></div><div><h3>Measurements</h3><p>A literature search was conducted using electronic databases (e.g., MEDLINE and Embase) from their inception to June 2024. Randomized controlled trials (RCTs) comparing intravenous steroids with placebo or no treatment in adult patients undergoing surgery under general anesthesia were included. The primary outcome was the QoR scores on postoperative days (POD) 1 and 2–3, as assessed by validated QoR scales (QoR-15 and QoR-40). Secondary outcomes included QoR dimensions, analgesic rescue, pain scores, and postoperative nausea and vomiting (PONV).</p></div><div><h3>Main results</h3><p>Eleven RCTs involving 951 patients were included in this study. The steroid group showed significant improvements in global QoR scores on POD 1 (standardized mean difference [SMD]: 0.52; 95 % confidence interval[CI]: 0.22 to 0.82; <em>P</em> = 0.0007) and POD 2–3 (SMD: 0.50; 95 % CI: 0.19 to 0.81; <em>P</em> = 0.001) compared to the control group. Significant improvements were also observed in all QoR dimensions on POD 1, with the effect sizes ranging from small to moderate. Intravenous steroids also significantly reduced the analgesic rescue requirements (RR: 0.77; 95 % CI: 0.67 to 0.88; <em>P</em> = 0.0003), postoperative pain scores (SMD: -0.41; 95 % CI: −0.68 to −0.14; <em>P</em> = 0.003), and PONV incidence (RR: 0.73; 95 % CI: 0.56 to 0.95; <em>P</em> = 0.02).</p></div><div><h3>Conclusions</h3><p>Intravenous administration of steroids significantly improved QoR after surgery. The benefits of steroids extend to all dimensions of QoR and important clinical outcomes such as analgesic requirements, pain scores, and PONV. These findings support the use of steroids as an effective strategy to enhance the postoperative recovery quality.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111625"},"PeriodicalIF":5.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240174","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":"Optimal dosage of ketamine as an adjuvant to regional anesthesia","authors":"I-Wen Chen ,&nbsp;Chia-Li Kao ,&nbsp;Kuo-Chuan Hung","doi":"10.1016/j.jclinane.2024.111628","DOIUrl":"10.1016/j.jclinane.2024.111628","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111628"},"PeriodicalIF":5.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240175","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":"Comparison of the efficacy and safety of ciprofol and propofol for ERCP anesthesia in older patients: A single-center randomized controlled clinical study","authors":"Guopeng Ding ,&nbsp;Li Wang ,&nbsp;Wantong Zhao ,&nbsp;Yugang Diao ,&nbsp;Dandan Song","doi":"10.1016/j.jclinane.2024.111609","DOIUrl":"10.1016/j.jclinane.2024.111609","url":null,"abstract":"<div><h3>Study objectives</h3><p>Ciprofol is a novel agonist at the gamma-aminobutyric acid-A (GABA_A) receptor, exhibiting better cardiovascular stability and rapid recovery. The objective of this study was to compare the efficacy and safety of ciprofol and propofol for endoscopic retrograde cholangiopancreatography (ERCP) anesthesia in older patients.</p></div><div><h3>Design</h3><p>A single-center, randomized, parallel controlled clinical study.</p></div><div><h3>Setting</h3><p>General Hospital of Northern Theater Command.</p></div><div><h3>Patients</h3><p>We recruited 284 patients and intended to conduct ERCP from November 2021 to June 2022.</p></div><div><h3>Interventions</h3><p>Patients scheduled for ERCP were randomly assigned to two groups (n = 142 each): ciprofol group (anesthesia induction 0.3–0.4 mg/kg, anesthesia maintenance 0.8–1.2 mg/kg/h) and propofol group (anesthesia induction 1.5–2.0 mg/kg, anesthesia maintenance 4-12 mg/kg/h).</p></div><div><h3>Measurements</h3><p>The primary outcome was sedation success rate, defined as the proportion of patients with successful anesthesia induction. Secondary outcomes encompassed the time of successful induction, the time of complete recovery, the time of leaving the room and the incidence rate of adverse events (hypoxemia, hypotension and injection pain).</p></div><div><h3>Main results</h3><p>The success rate of sedation in both groups was 100 %. The 95 % CI of the difference of sedation success rate was (− 2.63 %, 2.63 %), and the lower limit was greater than the non-inferiority limit of −8 %.The time of successful sedation induction in ciprofol group (38.4 ± 6.5 s) was longer than that in propofol group (30.6 ± 6.2 s, <em>p</em> &lt; 0.05).The time of complete recovery in ciprofol group (12.8 ± 5.8 min) was shorter than that in propofol group (16.9 ± 5.0 min, <em>p</em> &lt; 0.05). The time of leaving the room in ciprofol group (21.8 ± 5.8 min) was shorter than those in propofol group (25.9 ± 5.1 min, <em>p</em> &lt; 0.05). The incidence of injection pain in ciprofol group (2 %) was lower than that in the propofol group (25 %, <em>p</em> &lt; 0.05). Other outcomes didn't show statistical differences.</p></div><div><h3>Conclusions</h3><p>Compared with propofol, ciprofol exhibited a comparable level of sedation in older patients undergoing ERCP, and recovery was safe and rapid with less injection pain.</p><p>Trial registration: <span><span>www.chictr.org.cn</span><svg><path></path></svg></span> (Registration number ChiCTR2100053386, Registration date November 20, 2021).</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111609"},"PeriodicalIF":5.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024002381/pdfft?md5=07e9244f3e48f9335440f009699cf2db&pid=1-s2.0-S0952818024002381-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240172","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":"Response to letter to the editor regarding “low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery”","authors":"Sarah Dehne MD ,&nbsp;Lina Kirschner MD ,&nbsp;Moritz J. Strowitzki MD, PhD ,&nbsp;Samuel Kilian MSc, PhD ,&nbsp;Laura C. Kummer MSc ,&nbsp;Martin A. Schneider MD ,&nbsp;Christoph W. Michalski MD ,&nbsp;Markus W. Büchler MD ,&nbsp;Markus A. Weigand MD ,&nbsp;Jan Larmann MD, PhD","doi":"10.1016/j.jclinane.2024.111591","DOIUrl":"10.1016/j.jclinane.2024.111591","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111591"},"PeriodicalIF":5.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172183","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":"An automated dispensing cabinet alert influences anesthesia provider medication preparation in a remifentanil waste reduction initiative","authors":"Laura R. Wooten RN ,&nbsp;Matthew J. Sadlowsky RN ,&nbsp;Jeffrey M. Oberhansley APRN, CRNA, DNAP ,&nbsp;John C. Matulis III DO, MPH ,&nbsp;Nathan J. Brinkman PharmD, RPh ,&nbsp;Darrel R. Schroeder MS","doi":"10.1016/j.jclinane.2024.111611","DOIUrl":"10.1016/j.jclinane.2024.111611","url":null,"abstract":"<div><h3>Study Objective</h3><p>To decrease the occurrence of remifentanil waste of 1 mg or more (1 full vial) by 25 % in our surgical division while maintaining satisfaction of 60 % of providers by using a remifentanil mixing workflow.</p></div><div><h3>Design</h3><p>A time series–design quality improvement initiative targeted preventable remifentanil waste. A period of active interventions, followed by a pause and reinstatement of a system intervention, was used to validate its effectiveness.</p></div><div><h3>Setting</h3><p>An academic medical center in the US with 1219 inpatient beds, performing 144,418 surgical cases in 2019 and 127,341 surgical cases in 2020, in 148 operating rooms.</p></div><div><h3>Interventions</h3><p>Individual- and system-level interventions provided education on the issues of preventable waste, access to a remifentanil dose calculator, and an automated dispensing cabinet (ADC) alert to halt wasteful practice.</p></div><div><h3>Measurements</h3><p>Preventable remifentanil waste was identified as disposing of intravenous infusion bags containing 1 mg or more or 1 full vial or more of unused medication. Data were retrieved from ADC reports. A preimplementation and postimplementation survey of anesthesia providers assessed workflow attitudes, perceptions, and satisfaction surrounding remifentanil mixing.</p></div><div><h3>Main Results</h3><p>Preventable remifentanil waste (≥1 mg or ≥ 1 full vial) decreased significantly from 22.0 % of cases using remifentanil at baseline to 16.7 % of cases using remifentanil (odds ratio, 0.71; 95 % CI, 0.60–0.84; <em>P</em> &lt; .001) during the final data collection. Individual-level interventions of education, remifentanil dose calculator, and practice champions did not significantly affect waste while unpaired from the system intervention of the ADC alert.</p></div><div><h3>Conclusions</h3><p>The implementation of an ADC alert reduced preventable remifentanil waste among anesthesia providers.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111611"},"PeriodicalIF":5.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229594","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":"Response of Letter to the Editor Regarding “Postoperative delirium risk in patients with hyperlipidemia: A prospective cohort study”","authors":"Yue Zhao BS ,&nbsp;Yuling Tang MD ,&nbsp;Xiaoxia Duan PhD","doi":"10.1016/j.jclinane.2024.111619","DOIUrl":"10.1016/j.jclinane.2024.111619","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111619"},"PeriodicalIF":5.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229595","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":"Impacted fetal head at cesarean delivery","authors":"Sophie C. Ragbourne ,&nbsp;Elinor Charles ,&nbsp;Maria Herincs ,&nbsp;Francesca Elwen ,&nbsp;Neel Desai","doi":"10.1016/j.jclinane.2024.111598","DOIUrl":"10.1016/j.jclinane.2024.111598","url":null,"abstract":"<div><h3>Purpose</h3><p>Impacted fetal head (IFH) can be defined as the deep engagement of the fetal head in the maternal pelvis at the time of cesarean delivery that leads to its difficult or impossible extraction with standard surgical maneuvers. In this narrative review, we aimed to ascertain its incidence, risk factors, management and complications from the perspective of the anesthesiologist as a multidisciplinary team member.</p></div><div><h3>Methods</h3><p>Databases were searched from inception to 24 January 2023 for keywords and subject headings associated with IFH and cesarean delivery.</p></div><div><h3>Results</h3><p>IFH has an incidence of 2.9–71.8 % in emergency cesarean section. Maternal risk factors are advanced cervical dilatation, second stage of labor and oxytocin augmentation. Anesthetic and obstetric risk factors include epidural analgesia and trial of instrumental delivery and junior obstetrician, respectively. Neonatal risk factors are fetal malposition, caput and molding. Current evidence indicates a lack of confidence in the management of IFH across the multidisciplinary team. Simple interventions in IFH include lowering the height or placing the operating table in the Trendelenburg position, providing a step for the obstetrician and administering pharmacological tocolysis. Maternal complications are postpartum hemorrhage and bladder injury while neonatal complications include hypoxic brain injury, skull fracture and death. Surgical complications are reviewed to remind the anesthesiologist to anticipate and prepare for potential problems and manage complications in a timely manner.</p></div><div><h3>Conclusion</h3><p>The anesthesiologist has a fundamental role in the facilitation of delivery in IFH. We have proposed an evidence based management algorithm which may be referred to in this emergency situation.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111598"},"PeriodicalIF":5.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024002277/pdfft?md5=89a3f95e53fdd2524910bd05bd8f3b6b&pid=1-s2.0-S0952818024002277-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229477","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}