Journal of Clinical Anesthesia最新文献

{"title":"Early exposure to general anesthesia may contribute to later attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis of cohort studies","authors":"Hao Zhou ,&nbsp;Wenyi Sun ,&nbsp;Liuxian Ning ,&nbsp;Jie Kang ,&nbsp;Yadong Jin ,&nbsp;Chaoxuan Dong","doi":"10.1016/j.jclinane.2024.111585","DOIUrl":"10.1016/j.jclinane.2024.111585","url":null,"abstract":"<div><h3>Study objective</h3><p>The association between early childhood exposure to general anesthesia and subsequent risk of developing attention-deficit/hyperactivity disorder remains unknown.</p></div><div><h3>Design</h3><p>A systematic review and meta-analysis of cohort studies.</p></div><div><h3>Patients</h3><p>Children undergoing general anesthesia.</p></div><div><h3>Interventions</h3><p>A comparison of any type of general anesthesia exposure, including total intravenous anesthesia, inhalation general anesthesia, and combined intravenous and inhaled anesthesia, with non-anesthetic exposures, which did not receive any exposure to anesthetic drugs, including general anesthetics as well as local anesthetics.</p></div><div><h3>Measurements</h3><p>The primary outcome measure was the risk of developing attention-deficit/hyperactivity disorder after general anesthesia exposure.</p></div><div><h3>Main results</h3><p>The results of the overall meta-analysis showed an increased risk of subsequent attention-deficit/hyperactivity disorder in children exposed to general anesthesia (RR = 1.26, 95% CI, 1.16–1.38; <em>P</em> &lt; 0.001; I² = 44.6%). Subgroup analysis found that a single exposure to general anesthesia in childhood was associated with an increased risk of developing attention-deficit/hyperactivity disorder (RR = 1.29, 95% CI, 1.19–1.40, <em>P</em> &lt; 0.001; I² = 2.6%), and the risk of attention-deficit/hyperactivity disorder was further increased after multiple general anesthesia exposures (RR = 1.61, 95% CI, 1.32–1.97, <em>P</em> &lt; 0.001; I² = 57.6%). Exposure to general anesthesia lasting 1–60 min during childhood is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (RR: 1.38, 95% CI: 1.26–1.51, <em>P</em> &lt; 0.001; I² = 0.0%). Moreover, with longer durations of exposure (61–120 min), the risk further rises (RR: 1.55, 95% CI: 1.21–1.99, <em>P</em> = 0.001; I² = 37.8%). However, no additional increase in ADHD risk was observed with exposures exceeding 120 min (RR: 1.55, 95% CI: 1.35–1.79, <em>P</em> &lt; 0.001; I² = 0.0%).</p></div><div><h3>Conclusions</h3><p>Exposure to general anesthesia during early childhood increases the risk of developing attention-deficit/hyperactivity disorder. In particular, multiple general anesthesia exposures and exposures longer than 60 min significantly increase the risk of developing ADHD.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111585"},"PeriodicalIF":5.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141993635","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":"Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion","authors":"Hélène Charbonneau MD, PhD ,&nbsp;Stéphanie Savy PhD ,&nbsp;Nicolas Savy PhD ,&nbsp;Marie Pasquié ,&nbsp;Nicolas Mayeur MD, PhD ,&nbsp;CP-PBM Study Group,&nbsp;Olivier Angles MD ,&nbsp;Vincent Balech MD ,&nbsp;Anne-Laure Berthelot MD ,&nbsp;Madeleine Croute-Bayle MD ,&nbsp;Isabelle Decramer MD ,&nbsp;David Duterque MD ,&nbsp;Valerie Julien MD ,&nbsp;Laurent Mallet MD ,&nbsp;Mimoun M'rini MD ,&nbsp;Jean-François Quedreux MD ,&nbsp;Benoit Richard MD ,&nbsp;Laurent Sidobre MD ,&nbsp;Laurence Taillefer MD ,&nbsp;Adrien Thibaud MD ,&nbsp;Giovanni Sciacca","doi":"10.1016/j.jclinane.2024.111560","DOIUrl":"10.1016/j.jclinane.2024.111560","url":null,"abstract":"<div><h3>Study objective</h3><p>The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery.</p></div><div><h3>Design</h3><p>Prospective, non-randomized, two-step protocol design.</p></div><div><h3>Setting</h3><p>Cardiac surgery department of Clinique Pasteur, Toulouse, France.</p></div><div><h3>Patients</h3><p>897 patients undergoing for elective CPB surgery.</p></div><div><h3>Interventions</h3><p>We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.</p></div><div><h3>Measurements</h3><p>The PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.</p></div><div><h3>Main results</h3><p>After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44–0.79] and 0.44 [95% CI 0.32–0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.</p></div><div><h3>Conclusions</h3><p>This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111560"},"PeriodicalIF":5.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984863","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 nitrous oxide use on parturient recall of neuraxial analgesia risks","authors":"Emily E. Sharpe MD ,&nbsp;Lindsay L. Warner MD ,&nbsp;Benjamin D. Brakke DO ,&nbsp;Paul R. Davis MD ,&nbsp;David M. Finkel MD ,&nbsp;Christopher M. Burkle MD, JD ,&nbsp;Andrew C. Hanson MS ,&nbsp;Rochelle J. Pompeian MD ,&nbsp;Katherine W. Arendt MD ,&nbsp;Yvonne S. Butler Tobah MD ,&nbsp;Hans P. Sviggum MD","doi":"10.1016/j.jclinane.2024.111579","DOIUrl":"10.1016/j.jclinane.2024.111579","url":null,"abstract":"<div><h3>Study objective</h3><p>Nitrous oxide affects memory and recall. We aimed to determine if using nitrous oxide during labor affected patients' ability to learn and recall the risks and benefits of neuraxial analgesia.</p></div><div><h3>Design</h3><p>Single-center, prospective cohort study.</p></div><div><h3>Setting</h3><p>Labor and delivery unit in a large academic medical center.</p></div><div><h3>Patients</h3><p>Nulliparous patients with spontaneous or planned induction of labor.</p></div><div><h3>Interventions</h3><p>Parturients chose whether to use nitrous oxide during labor. At the discussion for epidural consent, 4 risks were described: headache, infection, nerve damage, bleeding.</p></div><div><h3>Measurements</h3><p>Labor pain score, time from nitrous oxide discontinuation, and cervical dilation were documented at the discussion of epidural risks. Patients were assessed for unprompted recall and prompted recall of epidural risks on postpartum day 1 and unprompted recall at postpartum week 6. The number and proportion of patients who indicated each true risk (unprompted and prompted recall) or distractor (prompted recall only) were summarized by treatment group and results compared using Pearson χ² tests.</p></div><div><h3>Main results</h3><p>Of the 403 enrolled patients, 294 (73%) did not use nitrous oxide, and 109 (27%) did. The 2 groups were similar except women who used nitrous oxide were more likely to be cared for by midwives and had higher pain scores at their epidural request. Scores for unprompted or prompted recall of epidural risks were not different between women who received or did not receive nitrous oxide. All 4 risks were recalled unprompted by only 3% in the nitrous oxide group and by 6% in the group not receiving nitrous oxide (<em>P</em> = .18).</p></div><div><h3>Conclusions</h3><p>The use of nitrous oxide for labor analgesia does not adversely influence a parturient's ability to recall the risks of epidural placement. Patients who receive nitrous oxide for labor analgesia should be considered eligible to provide consent for subsequent procedures.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111579"},"PeriodicalIF":5.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916859","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":"In response","authors":"Zhen Zhang ,&nbsp;Dong-Xin Wang","doi":"10.1016/j.jclinane.2024.111555","DOIUrl":"10.1016/j.jclinane.2024.111555","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111555"},"PeriodicalIF":5.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916860","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 “Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery”","authors":"Fanli Liu MD ,&nbsp;Xiaocou Wang MD ,&nbsp;Pinguo Fu MD","doi":"10.1016/j.jclinane.2024.111577","DOIUrl":"10.1016/j.jclinane.2024.111577","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111577"},"PeriodicalIF":5.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912858","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":"Analgesic efficacy and safety of erector spinae plane block in pediatric patients undergoing elective surgery: A systematic review and Meta-analysis of randomized controlled trials","authors":"So Mee Park MD ,&nbsp;Hyo Sung Kim MD ,&nbsp;Byung Gun Lim MD, PhD","doi":"10.1016/j.jclinane.2024.111575","DOIUrl":"10.1016/j.jclinane.2024.111575","url":null,"abstract":"<div><h3>Study objective</h3><p>Ultrasound-guided erector spinae plane block (ESPB) is commonly used for perioperative analgesia in adults; however, its analgesic efficacy and safety in pediatric patients remain uncertain. This review aimed to determine whether ultrasound-guided ESPB can improve analgesic efficacy and safety in pediatric surgery.</p></div><div><h3>Design</h3><p>Meta-analysis of randomized controlled trials.</p></div><div><h3>Setting</h3><p>Perioperative setting.</p></div><div><h3>Patients</h3><p>Pediatric patients undergoing elective surgery under general anesthesia.</p></div><div><h3>Interventions</h3><p>We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, KoreaMed, Web of Science, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases for eligible published randomized controlled studies (RCTs) comparing ESPB with controls (no block or other block) in pediatric patients undergoing elective surgery under general anesthesia.</p></div><div><h3>Measurements</h3><p>The primary outcome was cumulative opioid consumption after surgery. Other outcomes included intraoperative opioid consumption, time to first request for rescue analgesia, number of patients requiring rescue analgesics, and pain scores after surgery. The safety outcomes were the incidences of bradycardia, hypotension, and postoperative vomiting.</p></div><div><h3>Main results</h3><p>The analysis included 17 RCTs comprising 919 participants: 461 in the ESPB group, 269 in the no-block group (no block/sham block), and 189 in the other block group. Compared with the control group (no block and other blocks), ESPB significantly reduced the cumulative opioid consumption (intravenous morphine milligram equivalents) after surgery (standardized mean difference = −1.51; 95% confidence interval, −2.39 to −0.64; <em>P</em> = 0.0002; I² = 92.9%) and intraoperative opioid consumption, and lowered average pain scores up to 24 h after surgery. ESPB extended the time to the first request for rescue analgesia and decreased the number of patients requiring rescue analgesics. Furthermore, ESPB lowered the pain score at most time points for 24 h after surgery, improved parental satisfaction, and reduced the incidence of postoperative vomiting compared with that in no block/sham block.</p></div><div><h3>Conclusions</h3><p>ESPB provides effective and safe perioperative analgesia in pediatric patients undergoing elective surgery under general anesthesia.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111575"},"PeriodicalIF":5.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916858","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 remimazolam versus propofol on hypotension after anesthetic induction in patients undergoing coronary artery bypass grafting: A randomized controlled trial","authors":"Jae-Woo Ju ,&nbsp;Dong Ju Lee ,&nbsp;Jaeyeon Chung ,&nbsp;Seohee Lee ,&nbsp;Youn Joung Cho ,&nbsp;Yunseok Jeon ,&nbsp;Karam Nam","doi":"10.1016/j.jclinane.2024.111580","DOIUrl":"10.1016/j.jclinane.2024.111580","url":null,"abstract":"<div><h3>Study Objective</h3><p>There is scarce evidence on the hemodynamic stability of remimazolam during anesthetic induction in patients with significant coronary artery disease. This study aims to compare the effects of remimazolam and propofol on post-induction hypotension in patients undergoing coronary artery bypass grafting (CABG).</p></div><div><h3>Design</h3><p>Randomized controlled trial.</p></div><div><h3>Setting</h3><p>Tertiary teaching hospital.</p></div><div><h3>Patients</h3><p>Adult patients undergoing isolated CABG.</p></div><div><h3>Interventions</h3><p>Patients were randomly allocated to received either remimazolam (<em>n</em> = 50) or propofol (n = 50) for anesthetic induction. The remimazolam group received an initial infusion at 6 mg/kg/h, which was later adjusted to 1–2 mg/kg/h to maintain a bispectral index of 40–60 after loss of consciousness. In the propofol group, a 1.5 mg/kg bolus of propofol was administered, followed by 1–1.5% sevoflurane inhalation as needed to achieve the target bispectral index.</p></div><div><h3>Measurements</h3><p>The primary outcome was the area under the curve (AUC) below the baseline mean arterial pressure (MAP) during the first 10 min after anesthetic induction. Secondary outcomes included the AUC for MAP &lt;65 mmHg and the requirement for vasopressors.</p></div><div><h3>Main Results</h3><p>The remimazolam group demonstrated a significantly lower AUC under the baseline MAP compared to the propofol group (mean [SD], 169.8 [101.0] mmHg·min vs. 220.6 [102.4] mmHg·min; mean difference [95% confidence interval], 50.8 [10.4–91.2] mmHg·min; <em>P</em> = 0.014). Additionally, the remimazolam group had a reduced AUC for MAP &lt;65 mmHg (7.3 [10.3] mmHg·min vs. 13.9 [14.9] mmHg·min; <em>P</em> = 0.007) and a lower frequency of vasopressor use compared to the propofol group (60% vs. 88%, <em>P</em> = 0.001).</p></div><div><h3>Conclusions</h3><p>Remimazolam may offer improved hemodynamic stability during anesthetic induction in patients undergoing CABG, suggesting its potential advantage over propofol for patients with significant coronary artery disease in terms of hemodynamic stability.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111580"},"PeriodicalIF":5.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912856","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":"Desflurane versus sevoflurane anesthesia and postoperative recovery in older adults undergoing minor- to moderate-risk noncardiac surgery – A prospective, randomized, observer-blinded, clinical trial","authors":"Alexander Taschner (M.D.) ,&nbsp;Edith Fleischmann (M.D.) ,&nbsp;Katharina Horvath (M.D.) ,&nbsp;Nikolas Adamowitsch (M.D.) ,&nbsp;David Emler (M.D.) ,&nbsp;Thomas Christian (M.D.) ,&nbsp;Nicole Hantakova (M.D.) ,&nbsp;Beatrix Hochreiter (BSc.) ,&nbsp;Laura Höfer (M.S.) ,&nbsp;Magdalena List (M.S.) ,&nbsp;Barbara Rossi (M.S.) ,&nbsp;Florian W. Zenz (M.S.) ,&nbsp;Giulia Zanvettor (M.S.) ,&nbsp;Oliver Zotti (M.S.) ,&nbsp;Alexandra Graf (Ph.D.) ,&nbsp;Melanie Fraunschiel (MSc.) ,&nbsp;Christian Reiterer (M.D., Ph.D.)","doi":"10.1016/j.jclinane.2024.111576","DOIUrl":"10.1016/j.jclinane.2024.111576","url":null,"abstract":"<div><h3>Study objective</h3><p>The effect of volatile anesthetics on postoperative recovery in older adults is still not entirely clear. Thus, we evaluated the effect of desflurane versus sevoflurane anesthesia on speed of postoperative recovery in older adults eligible for same-day discharge. We further evaluated the incidence of postoperative nausea and vomiting (PONV), bispectral index (BIS) values, and S100<img>B concentrations.</p></div><div><h3>Design</h3><p>Single-center, prospective, observer-blinded, randomized clinical trial.</p></div><div><h3>Setting</h3><p>Operating room.</p></div><div><h3>Patients</h3><p>190 patients ≥65 years of age and scheduled for minor- to moderate-risk noncardiac surgeries.</p></div><div><h3>Interventions</h3><p>Goal-directed administration of desflurane versus sevoflurane for maintenance of anesthesia with an intraoperative goal of BIS 50 ± 5.</p></div><div><h3>Measurements</h3><p>The primary outcome was the time to anesthesia recovery, which was defined as the time between arrival at the post-anesthesia care unit (PACU) and reaching criteria for discharge from PACU, based on modified Aldrete score ≥ 12 points. Modified Aldrete scores were assessed at PACU arrival and thereafter in five-minute intervals. PONV was evaluated during PACU stay and the first three postoperative days, BIS values were recorded during PACU stay, and S100<img>B values were measured before and after surgery, and on the second postoperative day.</p></div><div><h3>Main results</h3><p>95 patients were randomized to receive desflurane, and 95 patients to receive sevoflurane. We did not observe a significant difference in median duration of postoperative recovery between the groups (desflurane: 0 min [0;0]; sevoflurane: 0 min [0;0]; <em>p</em> = 0.245). 77 patients (81.1%) in the desflurane group and 84 patients (88.4%) in the sevoflurane group already had Aldrete scores ≥12 points upon arrival at PACU (<em>p</em> = 0.277). There was also no significant difference in the incidences of PONV (<em>p</em> = 0.606), postoperative BIS values (<em>p</em> = 0.197), and postoperative maximum S100<img>B concentrations (<em>p</em> = 0.821) between the groups.</p></div><div><h3>Conclusions</h3><p>Despite previous reports, we did not observe significant faster recovery times after desflurane anesthesia. Both volatile anesthetics may be appropriate for same-day discharge in older adults.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111576"},"PeriodicalIF":5.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024002058/pdfft?md5=72f9f53f0ec76c4b2ddf1fe26c5b4bd3&pid=1-s2.0-S0952818024002058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912855","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":"Impact of preoperative QTc interval prolongation on short-term postoperative outcomes: A retrospective study","authors":"Chun-Ning Ho ,&nbsp;Wei-Chu Chung ,&nbsp;Chia-Li Kao ,&nbsp;Chih-Wei Hsu ,&nbsp;Kuo-Chuan Hung ,&nbsp;Chia-Hung Yu ,&nbsp;Jen-Yin Chen ,&nbsp;I-Wen Chen","doi":"10.1016/j.jclinane.2024.111574","DOIUrl":"10.1016/j.jclinane.2024.111574","url":null,"abstract":"<div><h3>Study objective</h3><p>Although a prolonged heart rate-corrected QT interval (QTcI) is associated with an increased risk of mortality in the general population, its prognostic value in surgical patients remains unclear. We aimed to examine whether preoperative QTcI prolongation predicts short-term postoperative outcomes in elderly patients undergoing noncardiac surgery.</p></div><div><h3>Design</h3><p>The study was a retrospective analysis using the TriNetX network database.</p></div><div><h3>Setting</h3><p>Operating room.</p></div><div><h3>Intervention</h3><p>Assessment and categorization of preoperative QTcI.</p></div><div><h3>Patients</h3><p>Data of patients aged ≥65 years who underwent non-cardiac surgery between 2010 and 2023 were analyzed.</p></div><div><h3>Measurements</h3><p>Patients were categorized into four groups based on preoperative QTcI: long (500-600 ms), borderline (460-500 ms), high-normal (420-460 ms) and control (370-420 ms) groups. The groups were compared using a propensity score-matched analysis. The primary outcome was the all-cause 90-day mortality risk. The secondary outcomes included 90-day risks of postoperative new-onset atrial fibrillation (Af), ventricular arrhythmias (VAs), emergency visits, hospital readmissions, and pneumonia.</p></div><div><h3>Results</h3><p>In total, data on 519,929 patients were collected in this study. Pairwise comparisons showed that all QTcI prolongation groups demonstrated a heightened incidence of postoperative mortality, arrhythmias, and other complications compared to the control group. Patients with a long QTcI had a 3-fold higher risk of mortality (hazard ratio [HR] = 3.124, <em>p</em> &lt; 0.001), Af (HR = 3.059, p &lt; 0.001), and VAs (HR = 3.617, <em>p</em> &lt; 0.001) than controls. The risks of emergency visits (HR = 1.287, <em>p</em> &lt; 0.001), hospital readmissions (HR = 1.591, p &lt; 0.001), and pneumonia (HR = 1.672, p &lt; 0.001) were also higher in the long QTcI group than in the control group. A dose-dependent response was evident between QTcI and mortality as well as arrhythmia risk.</p></div><div><h3>Conclusion</h3><p>Preoperative QTcI screening effectively risk-stratifies elderly surgical patients, with a QTcI≥500 ms being strongly predictive of short-term postoperative mortality and other complications. Incorporating QTcI assessment into the preoperative evaluation may guide perioperative monitoring and management.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111574"},"PeriodicalIF":5.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912857","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":"Variable volume-controlled ventilation: Did we find the needle in the haystack?","authors":"Alessia Pedoto MD, FASA ,&nbsp;Mohamed R. El Tahan MD","doi":"10.1016/j.jclinane.2024.111568","DOIUrl":"10.1016/j.jclinane.2024.111568","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"97 ","pages":"Article 111568"},"PeriodicalIF":5.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901985","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}