Journal of Clinical Anesthesia最新文献

{"title":"New postoperative atrial fibrillation after in OR extubation after cardiac surgery - A response to a letter to the editor.","authors":"Ragini G Gupta, Jennie Y Ngai","doi":"10.1016/j.jclinane.2024.111716","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111716","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111716"},"PeriodicalIF":5.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872259","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":"Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015-2019 ACS NSQIP data.","authors":"Jane Y Xu, Hannah E Madden, Pablo Martínez-Camblor, Stacie G Deiner","doi":"10.1016/j.jclinane.2024.111730","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111730","url":null,"abstract":"<p><strong>Background: </strong>Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 < 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type.</p><p><strong>Main results: </strong>Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36-3.64) and 4.64 days (95 % CI 3.96-5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79-3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48-0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47-0.59).</p><p><strong>Conclusions: </strong>Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111730"},"PeriodicalIF":5.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872258","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":"Associations of intraoperative end-tidal CO₂ levels with postoperative outcome-secondary analysis of a worldwide observational study.","authors":"Prashant Nasa, David M P van Meenen, Frederique Paulus, Marcelo Gama de Abreu, Sebastiaan M Bossers, Patrick Schober, Marcus J Schultz, Ary Serpa Neto, Sabrine N T Hemmes","doi":"10.1016/j.jclinane.2024.111728","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111728","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO₂ (etCO₂). We examined the association of intraoperative etCO₂ levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently-sized international, prospective study named 'Local ASsessment of Ventilatory management during General Anesthesia for Surgery' (LAS VEGAS).</p><p><strong>Methods: </strong>Patients at high risk of PPCs were categorized as 'low etCO₂' or 'normal to high etCO₂' patients, using a cut-off of 35 mmHg. The primary endpoint was a composite of previously defined PPCs; the individual PPCs served as secondary endpoints. The need for unplanned oxygen was defined as mild PPCs and severe PPCs included pneumonia, respiratory failure, acute respiratory distress syndrome, barotrauma, and new invasive ventilation. We performed propensity score matching and LOESS regression to evaluate the relationship between the lowest etCO₂ and PPCs.</p><p><strong>Results: </strong>The analysis included 1843 (74 %) 'low etCO₂' patients and 648 (26 %) 'normal to high etCO₂' patients. There was no difference in the occurrence of PPCs between 'low etCO₂' and 'normal to high etCO₂' patients (20 % vs. 19 %; RR 1.00 [95 %-confidence interval 0.94 to 1.06]; P = 0.84). The proportion of severe PPCs among total occurring PPCs, were higher in 'low etCO₂' patients compared to 'normal to high etCO₂' patients (35 % vs. 18 %; RR 1.16 [1.08 to 1.25]; P < 0.001). Propensity score matching did not change these findings. LOESS plot showed an inverse relationship of intraoperative etCO₂ levels with the occurrence of PPCs.</p><p><strong>Conclusions: </strong>In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between 'low etCO₂' patients and 'normal to high etCO₂' patients, but severe PPCs occurred more often in 'low etCO₂', with an inverse dose-dependent relationship between intraoperative etCO₂ levels and PPCs.</p><p><strong>Funding: </strong>This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anesthesiology and Intensive Care (ESAIC) and the Amsterdam University Medical Centers, location 'AMC'.</p><p><strong>Registration: </strong>LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111728"},"PeriodicalIF":5.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869391","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":"Reduction of postoperative pain and opioid consumption by VVZ-149, first-in-class analgesic molecule: A confirmatory phase 3 trial of laparoscopic colectomy.","authors":"Ho-Jin Lee, Ji-Yeon Sim, Inkyung Song, Srdjan S Nedeljkovic, Duk Kyung Kim, Ah-Young Oh, Seung Zhoo Yoon, Young-Jin Moon, MiHye Park, Insun Park, Jina Kim, Sang Rim Lee, Sunyoung Cho, Jae-Hyon Bahk","doi":"10.1016/j.jclinane.2024.111729","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111729","url":null,"abstract":"<p><strong>Study objective: </strong>VVZ-149 is a small molecule that inhibits the glycine transporter type 2 and the serotonin receptor 5-hydroxytryptamine 2 A. In this Phase 3 study, we investigated the efficacy and safety of VVZ-149 as a single-use injectable analgesic for treating moderate to severe postoperative pain after laparoscopic colectomy.</p><p><strong>Design: </strong>Randomized, parallel group, double-blind, Phase 3 clinical trial (Trial no. NCT05764525).</p><p><strong>Setting: </strong>5 tertiary referral centers in South Korea.</p><p><strong>Patients: </strong>284 patients undergoing laparoscopic colectomy.</p><p><strong>Interventions: </strong>A continuous 10-h intravenous infusion of VVZ-149 (n = 141) or placebo (n = 143) administered after emergence from anesthesia.</p><p><strong>Measurements: </strong>Pain intensity was assessed using a numeric rating scale (NRS) from the start of infusion for 48 h. The primary efficacy measure was the Sum of Pain Intensity Difference (SPID) for the first 12 h after the start of drug infusion. Other efficacy measures included SPID at other time points, opioid consumption via on-demand patient-controlled analgesia (PCA) and rescue medication, and proportion of patients who did not require rescue opioids for 48 h post-dose.</p><p><strong>Main results: </strong>Pain relief as measured by SPID was significantly improved by 35 % in the VVZ-149 group compared to the placebo group at 6 h (p = 0.0193) and 12 h (p = 0.0047) after the start of infusion. Significantly lower pain intensity scores were observed between 4-10 h in the VVZ-149 group compared to the placebo group (p = 0.0007), reaching mild pain (mean NRS <4) at 8 h. VVZ-149 alleviated pain during the first 12 h post-dose with 30.8 % less opioid consumption and 60.2 % fewer PCA requests when compared with placebo. A higher proportion of patients receiving VVZ-149 were rescue opioid-free during 2-6 h (p = 0.0026) and 6-12 h (p = 0.0024) compared with the placebo group. VVZ-149 administration in post-colectomy patients was generally safe and well tolerated.</p><p><strong>Conclusions: </strong>When compared to placebo, VVZ-149 infusion demonstrated a significant reduction of pain within the first 12 h after surgery with a substantial decrease in opioid use. VVZ-149 rapidly lowers the pain intensity starting at as early as 4 h post-dose, allowing subjects to experience mild pain levels from 8 h through 48 h. Therefore, the analgesic effect of VVZ-149 was shown to effectively relieve pain and reduce opioid use for treating moderate to severe pain in the early postoperative care setting.</p><p><strong>Registration number: </strong>Trial Number NCT05764525.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111729"},"PeriodicalIF":5.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869393","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":"Intertransverse process block (ITPB) at the retro-superior costotransverse ligament (retro-SCTL) space: Evaluation of local anesthetic spread using MRI and sensory blockade in healthy volunteers.","authors":"Pawinee Pangthipampai, Palanan Siriwanarangsun, Jatuporn Pakpirom, Ranjith Kumar Sivakumar, Manoj Kumar Karmakar","doi":"10.1016/j.jclinane.2024.111718","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111718","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space - the medial retro-SCTL space block.</p><p><strong>Methods: </strong>Ten healthy volunteers received a single-injection ultrasound-guided medial retro-SCTL space block at the T4-T5 level using a mixture of 10 ml 0.5 % bupivacaine with 0.5 ml gadolinium. At 15 min, they underwent a high resolution, fat suppressed, T1 weighted MRI scan of the cervicothoracic spine. Loss of sensation to cold was assessed at 15 and 60 min, and then hourly for 5-h, after the block.</p><p><strong>Results: </strong>MRI showed consistent (100 %) spread of local anesthetic to the intercostal and paravertebral spaces, anterolateral aspect of the vertebral body (sympathetic chain), costotransverse space, neural foramina, and epidural space in all participants. However, sensory blockade was variable across the ipsilateral hemithorax. Hypoesthesia was more common than anesthesia in both the anterior (median [IQR], 3.5 [2-5] vs 0 [0-1.25], p < 0.001) and posterior (median [IQR], 6[3-7] vs 2[1-3], p < 0.001) hemithorax. Additionally, more dermatomes exhibited anesthesia in the posterior compared to the anterior hemithorax (median [IQR], 2[1-3] vs 0[0-1.25], p = 0.01). A variable number of contralateral dermatomes were also affected in 3 (30 %) volunteers. There was no statistically significant correlation between the local anesthetic spread and the number of hypoesthetic (r = 0.53, p = 0.11) or anesthetic (r = 0.09, p = 0.78) dermatomes on the ipsilateral hemithorax.</p><p><strong>Conclusions: </strong>A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111718"},"PeriodicalIF":5.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864433","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":"Establishing optimal methodology for studying chatbots in clinical decision making: A new frontier.","authors":"Nada Ismaiel, Brendan Carvalho, Pervez Sultan","doi":"10.1016/j.jclinane.2024.111707","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111707","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111707"},"PeriodicalIF":5.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854287","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":"Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study.","authors":"Viviane Lauret, Claude Guerin, Sirine Boussena, Mathilde De-Queiroz, Lionel Bouvet, Florent Baudin","doi":"10.1016/j.jclinane.2024.111710","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111710","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children.</p><p><strong>Design: </strong>Prospective observational clinical pilot-study.</p><p><strong>Setting: </strong>University Children's Hospital of Lyon, France.</p><p><strong>Patients: </strong>Children without significant comorbidity (ASA 1 or 2) undergoing planned or unplanned surgery with inhalational induction of anesthesia.</p><p><strong>Intervention: </strong>After the beginning of Guedel's stage 3 of anesthesia, several settings were applied for 60 s in the following systematic order: spontaneous breathing when applying a facemask (SB-Mask), then PEEP 4 cmH₂O, PSV 4 cmH2O above PEEP 4 cmH₂O, and PSV 4 to 7 cmH₂O above PEEP 4 cmH₂O, at the anesthesiologist's discretion.</p><p><strong>Measurements: </strong>Children were monitored using Electrical Impedance Tomography (EIT; Pulmovista 500, Dräger, France). Tidal volume (TV), dorsal fraction of the ventilation, and end-expiratory lung impedance (EELI) were assessed with the ventilator and EIT.</p><p><strong>Main results: </strong>Twenty-two patients were included (20 analyzed), their median [IQR] age was 21 [14-36] months. TV did not significantly differ between the settings. The increase in EELI was greater with PSV (+0.60 [0.48-0.91] arbitrary units) than with PEEP 4 cmH₂O alone (+0.39 [0.20-0.06] arbitrary units, p = 0.005), and did not change with increased level of PSV (+0.66 [0.40-1.22] arbitrary units). The dorsal fraction of lung ventilation decreased using PSV, from 56 % [45-63] with SB-mask to 53 % [43-56] with PSV 4cmH₂O (p = 0.002) and 47 % [40-55] with PSV 7cmH₂O (p = 0.001).</p><p><strong>Conclusion: </strong>The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111710"},"PeriodicalIF":5.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854290","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":"Supraglottic jet oxygenation and ventilation on hypoxemia risk: A trial sequential analysis.","authors":"Chien-Ming Lin, Ping-Hsin Liu, Li-Chen Chang","doi":"10.1016/j.jclinane.2024.111712","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111712","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111712"},"PeriodicalIF":5.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828874","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":"Assessing the safety of tramadol use in breastfeeding women undergoing perioperative care.","authors":"Betul Kozanhan, Munise Yildiz, Mahmut Sami Tutar","doi":"10.1016/j.jclinane.2024.111711","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111711","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111711"},"PeriodicalIF":5.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824271","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":"Optimizing neuromuscular block monitoring and reversal: A large-scale quality improvement initiative in a diverse healthcare setting.","authors":"Pavel Goriacko, Jerry Chao, Philipp Fassbender, Maíra I Rudolph, Paul Beechner, Harshal Shukla, Vicken Yaghdjian, Curtis Choice, Frank Aroh, Mark Sinnett, Ibraheem M Karaye, Matthias Eikermann","doi":"10.1016/j.jclinane.2024.111709","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111709","url":null,"abstract":"<p><strong>Background: </strong>Residual neuromuscular block (NMB) after anesthesia poses significant risk to patients, which can be reduced by adhering to evidence-based practices for the dosing, monitoring, and reversal of NMB. Incorporation of best practices into routine clinical care remains uneven across providers and institutions, prompting the need for effective implementation strategies.</p><p><strong>Methods: </strong>An interdisciplinary quality improvement initiative aimed to optimize NMB reversal practices across a large multi-campus urban medical center. Using the Institute for Healthcare Improvement (IHI) framework, interventions were designed to increase Train-of-Four (TOF) monitoring and promote evidence-based and cost-effective use of the NMB reversal agents. Process and outcome measures were tracked through Plan-Do-Study-Act (PDSA) cycles. Qualitative interviews provided insights into clinician perspectives.</p><p><strong>Results: </strong>The study encompassed 35,198 surgical cases utilizing NMB agents. The interventions led to a sustained increase in TOF monitoring from 42 % to 83 %. Significant increases were also observed in TOF ratio documentation and utilization of sugammadex. Postoperative respiratory complication rates decreased by 41 % (RR 0.59, 95 % CI 0.32-0.96) over the course of the initiative. The most pronounced increases in TOF monitoring were associated with financial incentives for the achievement of department-wide target monitoring rate.</p><p><strong>Conclusion: </strong>This initiative demonstrates successful large-scale integration of quantitative TOF monitoring and evidence based NMB management across a diverse medical center, while highlighting important barriers in implementation. These findings contribute to the broader discussion on translating evidence into practice, offering insights for improving patient care and safety through tailored implementation strategies.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"111709"},"PeriodicalIF":5.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822272","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}