Journal of Clinical Anesthesia最新文献

{"title":"Machine learning prediction of unexpected readmission or death after discharge from intensive care: A retrospective cohort study","authors":"Thomas Tschoellitsch MD ,&nbsp;Alexander Maletzky PhD ,&nbsp;Philipp Moser PhD ,&nbsp;Philipp Seidl MSc ,&nbsp;Carl Böck PhD ,&nbsp;Tina Tomic Mahečić MD ,&nbsp;Stefan Thumfart PhD ,&nbsp;Michael Giretzlehner PhD ,&nbsp;Sepp Hochreiter PhD ,&nbsp;Jens Meier MD","doi":"10.1016/j.jclinane.2024.111654","DOIUrl":"10.1016/j.jclinane.2024.111654","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care units (ICUs) harbor the sickest patients with the utmost needs of medical care. Discharge from ICU needs to consider the reason for admission and stability after ICU care. Organ dysfunction or instability after ICU discharge constitute potentially life-threatening situations for patients.</div></div><div><h3>Methods</h3><div>This is a single center, observational, retrospective cohort study conducted at ICUs at the Kepler University Hospital in Linz, Austria. Patients aged 18 years and above admitted to the study center's ICUs between 2010 and 01-01 and 2019-10-31 were included in the study. Patients transferred to another ICU, discharged to a different hospital or home, or that died during their ICU stay were excluded. We used machine learning (ML) models to predict unplanned ICU readmission or death using an internal dataset or MIMIC-IV as training data and compared the models with the Stability and Workload Index for Transfer (SWIFT) score. Further, we evaluated the influence of features on the models using Shapley Additive Explanations.</div></div><div><h3>Results</h3><div>The best ML models achieved an area under the curve of the receiver operating characteristic (AUC-ROC) of 0.721 ± 0.029 and a high negative predictive value (NPV) of 0.990 ± 0.002. The most important features were heart rate, peripheral oxygen saturation and arterial blood pressure. Performance of the SWIFT score was worse than the ML models (best AUC-ROC 0.618 ± 0.011).</div></div><div><h3>Conclusions</h3><div>ML models were able to identify patients that will not need unplanned ICU readmission and will not die within 48 h after discharge.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111654"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433443","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":"Comparison of the clinical performance of the Ambu®AuraGain™ laryngeal mask in children undergoing surgery in the supine and prone position – A prospective, non-inferiority clinical trial","authors":"Darhae Eum ,&nbsp;Ha Yan Kim ,&nbsp;Yangjin Kim ,&nbsp;Seokyung Shin","doi":"10.1016/j.jclinane.2024.111652","DOIUrl":"10.1016/j.jclinane.2024.111652","url":null,"abstract":"<div><h3>Study objective</h3><div>Reports are limited regarding supraglottic airway (SGA) usage in children in the prone position. This study aimed to compare the clinical performance of the Ambu®AuraGain™, a 2nd generation SGA, in children undergoing surgery in the prone and supine positions. We hypothesized that oropharyngeal leak pressure (OLP) in the prone position would not be inferior to that in the supine position.</div></div><div><h3>Design</h3><div>Single-center, prospective, non-randomized controlled study.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients</h3><div>One hundred and twenty-six children, American Society of Anesthesiologists (ASA) physical status I-III, aged 2–12 years, undergoing elective surgery for 2 h or less in the supine or prone position.</div></div><div><h3>Interventions</h3><div>After induction of general anesthesia and insertion of the AuraGain, patients were positioned either supine or prone, according to type of surgery.</div></div><div><h3>Measurements</h3><div>OLP immediately after surgical positioning was measured as the primary outcome. The anatomical position of the AuraGain was evaluated using a flexible fiberoptic bronchoscope (Olympus LF-DP Tracheal Intubation Fiberscope, Melville, New York, USA). Airway maneuvers performed during placement and maintenance of the AuraGain and airway-related adverse events were recorded.</div></div><div><h3>Main findings</h3><div>The mean difference in OLP immediately after positioning was 0.048 cmH₂O (95 % confidence interval: −1.521 to 1.616), and the non-inferiority hypothesis was accepted (<em>P</em> &lt; 0.001 for non-inferiority). There was no significant difference in the anatomical position of the SGA and adverse events. Airway maneuvers were significantly more commonly performed during placement in the Prone group compared to the Supine group (51 (81.0 %) vs. 3 (4.8 %), respectively; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>OLP when using AuraGain in the prone position in children was not inferior to that in the supine position. This suggests that the AuraGain may be an effective option for children undergoing short surgical procedures in the prone position.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111652"},"PeriodicalIF":5.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417270","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 operating room extubation after cardiac surgery is associated with decreased incidence of in hospital new postoperative atrial fibrillation","authors":"Ragini G. Gupta MD,&nbsp;Shreya Patel,&nbsp;Anke Wang MD,&nbsp;Jennie Y. Ngai MD","doi":"10.1016/j.jclinane.2024.111636","DOIUrl":"10.1016/j.jclinane.2024.111636","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery.</div></div><div><h3>Design</h3><div>This is a retrospective chart review.</div></div><div><h3>Setting</h3><div>Single tertiary care hospital.</div></div><div><h3>Participants</h3><div>Cardiac surgical patients &gt;18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and main results</h3><div>Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (−1.74, 95 % CI [−2.22, −1.08], <em>p</em> &lt; 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], <em>p</em> &lt; 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure.</div></div><div><h3>Conclusions</h3><div>In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111636"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406454","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":"Perioperative Management of Adult Patients with Diabetes Wearing Devices: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Expert Consensus Statement","authors":"Adriana D. Oprea MD ,&nbsp;Smita K. Kalra MD, FHM ,&nbsp;Elizabeth W. Duggan MD, MA ,&nbsp;Linda L. Russell MD ,&nbsp;Richard D. Urman MD, MBA, FASA, FAACD ,&nbsp;Basem B. Abdelmalak MD, FASA, SAMBA-F ,&nbsp;Preethi Patel MD ,&nbsp;Kurt J. Pfeifer MD, FACP, SFHM, DFPM ,&nbsp;Paul J. Grant MD, SFHM ,&nbsp;Marina M. Charitou MD ,&nbsp;Carlos E. Mendez MD, FACP ,&nbsp;Jennifer L. Sherr MD, PhD ,&nbsp;Guillermo E. Umpierrez MD, CDCES, FACE, MACP ,&nbsp;David C. Klonoff M.D., FACP, FRCP (Edin), Fellow AIMBE","doi":"10.1016/j.jclinane.2024.111627","DOIUrl":"10.1016/j.jclinane.2024.111627","url":null,"abstract":"<div><div>In recent years, the integration of advanced diabetes technology into the care of individuals with diabetes has grown exponentially. Given their increasing prevalence, insulin-requiring people with diabetes may present to preoperative clinics or the operating rooms wearing such devices. While advantageous from a diabetes management perspective, for those unfamiliar with devices this can add another layer of complexity to diabetes management in both the outpatient and inpatient settings, particularly because of the rapidly evolving technology. Therefore, perioperative clinicians need to become familiar with diabetes technological advances, and device features and have an understanding of how they can be used in the perioperative period. This consensus statement aims to serve as an educational material as well as to serve as a guide to perioperative clinicians caring for patients wearing diabetes devices (insulin pumps and continuous glucose monitors).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111627"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400447","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":"Patient honesty about NPO status in the era of GLP-1 agonists and liberal ERAS protocols: A randomized response technique study","authors":"Lam-Phong N. Pham BA ,&nbsp;Rahul Patel MPH ,&nbsp;Charles A. King MPH ,&nbsp;Jacob Helmann BS ,&nbsp;Meghan E. Gaare MD MPH ,&nbsp;Darrin W. Clouse MD ,&nbsp;Jamie Decoster PhD ,&nbsp;John S. McNeil MD","doi":"10.1016/j.jclinane.2024.111650","DOIUrl":"10.1016/j.jclinane.2024.111650","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111650"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400437","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 low-dose norepinephrine combined with goal-directed fluid therapy on postoperative pulmonary complications in lung surgery: A prospective randomized controlled trial","authors":"Yang Gao MD ,&nbsp;Dong Ji MD ,&nbsp;Qi Fang MD ,&nbsp;Yamei Li MD,&nbsp;Keyan Wang MD,&nbsp;Jia Liu MD,&nbsp;Lei Wang MD,&nbsp;Erwei Gu MD,&nbsp;Lei Zhang MD, PhD,&nbsp;Lijian Chen MD, PhD","doi":"10.1016/j.jclinane.2024.111645","DOIUrl":"10.1016/j.jclinane.2024.111645","url":null,"abstract":"<div><h3>Study objective</h3><div>Postoperative pulmonary complications (PPCs), the predominant complications following lung surgery, are closely associated with intraoperative fluid therapy. This study investigates whether continuous low-dose norepinephrine infusion combined with goal-directed fluid therapy (GDFT) reduced the risk of PPCs after lung surgery relative to either GDFT alone or standard fluid treatment.</div></div><div><h3>Design</h3><div>A prospective, randomized controlled trial.</div></div><div><h3>Setting</h3><div>The First Affiliated Hospital of Anhui Medical University, Anhui, China.</div></div><div><h3>Patients</h3><div>The study included 184 patients undergoing elective thoracoscopic lung resection surgery.</div></div><div><h3>Interventions</h3><div>Patients were randomized into three groups based on different fluid treatment regimens: Group C received standard fluid treatment, Group G received GDFT, and Group N received continuous low-dose norepinephrine infusion combined with GDFT.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of PPCs, including respiratory infection, atelectasis, pneumothorax, pleural empyema, respiratory failure, pulmonary embolism and bronchopleural fistula, during the postoperative hospital stay. Secondary outcomes were hemodynamic variables and arterial blood gases. Additional recorded parameters included other postoperative complications such as bleeding, postoperative re-intubation, re-hospitalization within 30 days, and the length of hospital stay.</div></div><div><h3>Main results</h3><div>Group N showed a significantly lower PPCs incidence during hospitalization compared to Group C (11.5 % vs 27.9 %; odds ratio, 2.98; 95 % confidence interval, 1.17–8.31; <em>P</em> = 0.023). No significant difference in PPCs was found between Group N and Group G (11.5 % vs 14.5 %; odds ratio, 1.31; 95 % confidence interval, 0.46–3.91; <em>P</em> = 0.616). Additionally, there were no significant differences among the three groups in the components of PPCs. Group N showed higher mean arterial pressure and stroke volume index intraoperatively compared to Group C.</div></div><div><h3>Conclusions</h3><div>Continuous low-dose norepinephrine infusion combined with GDFT reduced PPCs incidence in elective lung surgery patients compared with standard fluid management, but showed no difference compared to GDFT alone.</div></div><div><h3>Clinical trial registration</h3><div>ChiCTR2200064081.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111645"},"PeriodicalIF":5.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400436","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":"Compensatory response of the radial and ulnar arteries after radial artery cannulation in hypertensive patients","authors":"Xinpeng Xu ,&nbsp;Zhiwei Wang ,&nbsp;Hongying He ,&nbsp;Wenyan Shi ,&nbsp;Wei Zeng ,&nbsp;Zhaoqiong Zhu ,&nbsp;Xingkui Liu ,&nbsp;Zhao Wang ,&nbsp;Yi Zhang","doi":"10.1016/j.jclinane.2024.111646","DOIUrl":"10.1016/j.jclinane.2024.111646","url":null,"abstract":"<div><h3>Background</h3><div>Limited literature exists on the vascular reactivity of the radial and ulnar arteries in hypertensive patients following radial artery cannulation. This study assessed the vascular reactivity of the radial and ulnar arteries by comparing Doppler images and laser speckle contrast imaging (LSCI) obtained from both normotensive and hypertensive patients after radial artery cannulation under general anesthesia.</div></div><div><h3>Methods</h3><div>This study recruited 99 normotensive and 99 hypertensive patients who required arterial cannulation under general anesthesia. In the course of research, to evaluate the impact of hypertension on arterial reactivity, we employed duplex Doppler ultrasonography to measure the inner diameter (ID), resistance index (RI) and mean volume flow (MVF) of both arteries at five different time points. We equally performed perfusion of thumb and little finger by laser speckle contrast imaging.</div></div><div><h3>Results</h3><div>After radial artery cannulation, the hypertensive group showed less increase in radial ID and less decrease in RI compared to the normotensive group. The MVF increase was also less pronounced in hypertensive patients, while both groups demonstrated equivalent ulnar ID changes, and the normotensive group exhibited a more significant decrease in RI and a greater MVF increase. Thumb perfusion decreased post-cannulation in both groups, with the hypertensive group showing a less robust recovery. Little finger perfusion increased after artery cannulation in both groups, but the hypertensive group's increase was lower. The incidence of vasospasm in the hypertensive group is higher than that in the normotensive group.</div></div><div><h3>Conclusions</h3><div>The radial and ulnar arteries in hypertensive patients may lack a compensatory response to radial artery cannulation during general anesthesia.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111646"},"PeriodicalIF":5.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390925","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":"Letter to the editor regarding “Comparison of the efficacy and safety of ciprofol and propofol for ERCP anesthesia in older patients: A single-center randomized controlled clinical study”","authors":"Chui-Yu Li,&nbsp;Wen-Xi Xie,&nbsp;Zhi-Yuan Chen","doi":"10.1016/j.jclinane.2024.111648","DOIUrl":"10.1016/j.jclinane.2024.111648","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111648"},"PeriodicalIF":5.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390926","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":"Re: “Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial”","authors":"Sisi Chen ,&nbsp;Bin Qian","doi":"10.1016/j.jclinane.2024.111649","DOIUrl":"10.1016/j.jclinane.2024.111649","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111649"},"PeriodicalIF":5.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390927","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":"Comment on: “Systemic lidocaine versus erector spinae plane block for improving quality of recovery after laparoscopic cholecystectomy: A randomized controlled trial”","authors":"Pranjali Kurhekar,&nbsp;Raghuraman M. Sethuraman,&nbsp;Geetha Soundarya UdayaKumar,&nbsp;Neeta Parlikar,&nbsp;Vidhya Narayanan","doi":"10.1016/j.jclinane.2024.111640","DOIUrl":"10.1016/j.jclinane.2024.111640","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111640"},"PeriodicalIF":5.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390909","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}