Survey of Anesthesiology最新文献

{"title":"Preoperative Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers: Do We Have Enough “VISION” to Stop It?","authors":"M. London","doi":"10.1097/01.sa.0000525653.70599.b4","DOIUrl":"https://doi.org/10.1097/01.sa.0000525653.70599.b4","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76716683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Disruption in the World of Neuromuscular Blockade: What Is the “State of the Art?”","authors":"M. Naguib, Ken Johnson","doi":"10.1097/01.SA.0000525660.70880.8D","DOIUrl":"https://doi.org/10.1097/01.SA.0000525660.70880.8D","url":null,"abstract":"morbidity. The risks associated with NMBA could be almost completely eliminated if adequate neuromuscular function measured by a TOF ratio of greater than 0.90 was obtained before allowing emergence from anesthesia and tracheal extubation. Hence, neuromuscular function assessment with a PNS is mandatory whenever either depolarizing or nondepolarizing NMBAs are used to reduce risk of residual block.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80657230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Statistical Model for Protamine Titration: Effects on Coagulation in Cardiac Surgical Patients","authors":"Oskar Hällgren, S. Svenmarker, M. Appelblad","doi":"10.1097/01.sa.0000525620.39586.68","DOIUrl":"https://doi.org/10.1097/01.sa.0000525620.39586.68","url":null,"abstract":"as tramadol pharmacology will ensure the optimal pain management without adverse effects or toxicity. The possibility of misuse, withdrawal symptoms, and adverse effects are greater in the case of tramadol because of its unique simultaneous opioid agonist action and serotonin and norepinephrine reuptake inhibitory effects, which increases the potential for drug interactions. A more thorough understanding of tramadol's pharmacology and pharmacokinetics including the effect of CYP genetic polymorphisms will ensure more targeted prescribing practices. In addition, both patients and practitioners should be aware of the potential for drug interactions, possibility of addiction, toxicity risks, and risk of withdrawal. Hopefully, increased knowledge in these areas will improve the possibility of making an optimal decision regarding the use of this drug.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78218037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Double Blind Randomized Placebo-Controlled Clinical Trial of the Pectoral Nerves (Pecs) Block Type II","authors":"B. Versyck, G. Geffen, P. V. Houwe","doi":"10.1097/SA.0000000000000338","DOIUrl":"https://doi.org/10.1097/SA.0000000000000338","url":null,"abstract":"STUDY OBJECTIVE The aim of this clinical trial was to test the hypothesis whether adding the pectoral nerves (Pecs) block type II to the anesthetic procedure reduces opioid consumption during and after breast surgery. DESIGN A prospective randomized double blind placebo-controlled study. SETTING A secondary hospital. PATIENTS 140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection. INTERVENTIONS Patients were randomized to receive either a Pecs block with levobupivacaine 0.25% (n=70) or placebo block with saline (n=70). MEASUREMENTS The pain levels were evaluated by Numeric Rating Scale (NRS) pain scores at 15-minute intervals during the post anesthesia care unit stay time (PACU), at 2-hour intervals for the first 24h on the ward and at 4-hour intervals for the next 24h. Intraoperative and postoperative opioid consumption were recorded during the full stay. Patient satisfaction was evaluated upon discharge using a 10-point scale. MAIN RESULTS Intraoperative sufentanil requirements were comparable for the Pecs and placebo group (8.0±3.5μg and 7.8±3.0μg, P=0.730). Patients in the Pecs group experienced significantly less pain than patients in the control group (P=0.048) during their PACU stay. Furthermore, patients in the Pecs group required significant less postoperative opioids (9.16±10.15mg and 14.97±14.38mg morphine equivalent, P=0.037) and required significant fewer postsurgical opioid administration interventions than patients in the control group (P=0.045). Both patient-groups were very satisfied about their management (9.6±0.6 and 9.1±1.8 on a 10-point scale, P=0.211). CONCLUSIONS The Pecs block reduces postsurgical opioid consumption during the PACU stay time for patients undergoing breast surgery.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78631093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Raising the Alarm on Brain Attacks in Surgical Patients: Are We Doing Enough to Prevent and Treat Postoperative Strokes?","authors":"L. Glance, R. Holloway","doi":"10.1097/01.sa.0000527523.87797.b0","DOIUrl":"https://doi.org/10.1097/01.sa.0000527523.87797.b0","url":null,"abstract":"This editorial provides an overview of the study by Christiansen et al, which demonstrates that a history of acute ischemic stroke within 3 months of emergency noncardiac, nonintracranial surgery significantly increased the risk of a postoperative stroke using data from the Danish National Patient Registry. The incidence of postoperative stroke was reported at 0.1% to 0.7%, with the risk declining as more time elapsed between the ischemic event and surgery. Despite the study limitations, this research by Christiansen et al on vulnerability to stroke after surgery supports the need for further research using different approaches and diverse populations to support the validation of the risk. Awareness of the risk of stroke, new neurologic deficits, and clear procedures with stroke teams and perioperative and surgical teams should be in place to ensure better patient outcomes. When undergoing elective surgery, especially in high-risk patients/ procedures, management must be done in close conjunction with stroke teams and comprehensive stroke centers where neuroendovascular specialists and advanced neuroimaging capabilities are readily available to ensure a better quality of care, as well as a better quality of life postprocedure. As of 2017, across America, there are 121 comprehensive stroke centers. When a specialized center is not readily accessible, a protocol to manage at-risk patients via technology, such as telestroke consultation, must be implemented. Currently, the guidelines for preventing postoperative stroke are provided by the Society for Neuroscience in Anesthesiology and Critical Care consensus statement (supported but not endorsed by the American Society of Anesthesiologists). These guidelines have been minimally disseminated in comparison to the information from theAmerican StrokeAssociation. Because of the potential for severe impact on the life of a patient, surgical patients at risk of postoperative stroke must be managed with as much importance given to preventing a recurrent stroke as with dealing with the medical condition being treated.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90913474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remifentanil Tolerance and Hyperalgesia: Short-term Gain, Long-term Pain?","authors":"E. Yu, D. H. Tran, S. W. Lam, M. Irwin","doi":"10.1097/SA.0000000000000313","DOIUrl":"https://doi.org/10.1097/SA.0000000000000313","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76383676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STR-324, a Stable Analog of Opiorphin, Causes Analgesia in Postoperative Pain by Activating Endogenous Opioid Receptor-dependent Pathways","authors":"P. Sitbon, A. C. Elstraete, Leila Hamdi, V. Juárez-Pérez, J. Mazoit, D. Benhamou, C. Rougeot","doi":"10.1097/01.sa.0000521825.85774.2d","DOIUrl":"https://doi.org/10.1097/01.sa.0000521825.85774.2d","url":null,"abstract":"Opiorphin is a natural human peptide with strong analgesic properties. These analgesic effects thought to result in a reduction in enkephalin hydrolysis secondary to the compound inhibition of enkephalinase. The purpose of this study was to demonstrate that opiorphin and its stable analog STR-324 are promising analgesics that may be the solution to the quest for a new class of effective, yet safe, painkillers. Inhibitors of enkephalin breakdown could potentially be a class of longacting painkillers with a better safety profile than direct opioid receptor agonists. Although their efficacy in postoperative pain models has not been established, both opiorphin and STR-324 reduced mechanical hypersensitivity through opioid receptor–mediated mechanisms without adverse cardiorespiratory effects in a rat incisional pain model. The demonstrationwas done via the Brennanmodel of plantar incision–induced hypersensitivity with examination of the postsurgical analgesic response to mechanical and thermal stimuli in rats with 7 days of continuously intravenously infused drugs There were a total of 8 to 10 rats per group (mechanical and thermal). Antinociception caused by opiorphin was compared with that of morphine and STR-324, and the expression of spinal c-Fos and the role of opioid receptor–dependent pathways were specifically targeted. Tests were also conducted to assess any manifestation of adverse respiratory and hemodynamic effects with opiorphin. It was found that intravenously administered opiorphin infusion significantly decreased responses to mechanical stimuli postsurgery from days 1 to 4 at 143to 175-kPa mean ranges compared with 23to 30-kPa mean ranges for vehicle (P < 0.05). During this period, no adverse effects in respiratory rate, oxygen saturation, arterial pressure, or heart rate were induced by opiorphin. STR-324 repeatedly demonstrated inhibition of mechanical and thermal hyperalgesia with a potency similar to that of opiorphin. STR-324 significantly reduced the number of pain-evoked spinal c-Fos immunoreactive nuclei that could be identified after immunostaining. Through the use of mechanistic analyses, it was also demonstrated that the opioid antagonist naloxone reversed the antinociceptive effect of STR-324. In conclusion, a significant antinociceptive effect of intravenous opiorphin and STR-324 was demonstrated in a postoperative","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80802933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of maternal presence during anesthesia induction on salivary cortisol levels in children undergoing tonsillectomy and/or adenoidectomy.","authors":"H. Ozdogan, S. Çetinalp, G. Kuran, O. Tuğal, Murat Tahiroglu, Ummuhan E. Herdem, Süheyl Haytoğlu","doi":"10.1097/SA.0000000000000335","DOIUrl":"https://doi.org/10.1097/SA.0000000000000335","url":null,"abstract":"OBJECTIVE\u0000Although parental presence during anesthesia induction is suggested to diminish operative stress level in children, there have been conflicting results about this strategy. The aim of this study was to evaluate the effects of maternal presence during induction on operative stress level in children who had tonsillectomy and/or adenoidectomy by determining the salivary cortisol levels.\u0000\u0000\u0000DESIGN\u0000Non-randomized clinical study.\u0000\u0000\u0000SETTING\u0000Preoperative and postoperative recovery rooms, operating room.\u0000\u0000\u0000PATIENTS\u0000The study included 48 children between the ages of 5-12years who underwent tonsillectomy and/or adenoidectomy.\u0000\u0000\u0000INTERVENTIONS\u0000The patients were divided into 2 groups. The children in group 1 were separated from their mothers at the preparation room. The children in group 2 stayed together with their mothers till the anesthesia induction.\u0000\u0000\u0000MEASUREMENTS\u0000State Trait Anxiety Inventory (STAI) was performed to the mothers and children preoperatively. Salivary cortisol levels were evaluated in 4 different time frames: 1) in preparation room, 2) after anesthesia induction, 3) at the 30th minute of operation, and 4) in postoperative recovery room.\u0000\u0000\u0000MAIN RESULTS\u0000There were no statistically significant differences between groups regarding demographic features, and operation or anesthesia times. The child's or mothers' preoperative anxiety scores were not different between the groups. Salivary cortisol levels in group 1 were significantly increased after induction and in recovery room compared to those in group 2 (p: 0.001, and p: 0.02, respectively).\u0000\u0000\u0000CONCLUSIONS\u0000We have determined decreased salivary cortisol levels during anesthesia induction and recovery in the maternal presence revealing diminished stress in these periods. Further studies are warranted to determine the effects of parental presence during anesthesia induction especially on surgical outcomes.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91450409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative risk stratification of critically ill patients.","authors":"Curtis C Copeland, Andrew Young, Tristan Grogan, Eilon Gabel, Anahat K. Dhillon, Vadim Gudzenko","doi":"10.1097/SA.0000000000000337","DOIUrl":"https://doi.org/10.1097/SA.0000000000000337","url":null,"abstract":"STUDY OBJECTIVE\u0000Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure.\u0000\u0000\u0000DESIGN\u0000Retrospective cohort analysis over a 21-month period.\u0000\u0000\u0000SETTING\u0000Five adult intensive care units (ICUs) at a single tertiary medical center.\u0000\u0000\u0000PATIENTS\u0000Three hundred fifty ICU patients in respiratory failure, who underwent 501 procedures with general anesthesia.\u0000\u0000\u0000MEASUREMENTS\u0000Demographic, clinical, and surgical variables were collected from the pre-anesthesia evaluation forms and preoperative ICU charts. The primary outcome was survival to discharge.\u0000\u0000\u0000MAIN RESULTS\u0000Ninety-six patients (27%) did not survive to discharge. There were significant differences between survivors and non-survivors for ASA (3.7 vs. 3.9, p=0.001), RCRI (1.6 vs. 2.0, p=0.003), and SOFA score (8.1 vs. 11.2, p<0.001). Based on the area under the receiver operating characteristic curve for these relationships, there was only modest discrimination between the groups, ranging from the most useful SOFA (0.68) to less useful RCRI (0.60) and ASA (0.59).\u0000\u0000\u0000CONCLUSIONS\u0000This single center retrospective study quantified a high perioperative risk for critically ill patients with advanced airways: one in four did not survive to discharge. Preoperative ASA score, RCRI, and SOFA score only partially delineated survivors and non-survivors. Given the existing limitations, future research may identify assessment tools more relevant to discriminating survival outcomes for critically ill patients in the perioperative environment.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85875225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Blood Transfusion During Intracranial Aneurysm Surgery","authors":"J. Yee, A. Koht, R. McCarthy, J. Bebawy","doi":"10.1097/01.sa.0000521854.89244.42","DOIUrl":"https://doi.org/10.1097/01.sa.0000521854.89244.42","url":null,"abstract":"This single-center retrospective observational study aimed to identify risk factors associated with intraoperative blood transfusions in patients undergoing intracranial aneurysm surgery. Considering known risks associated with blood product transfusion, several organizations now have guidelines that advise a more restrictive approach to product administration than in the past. In addition, criteria for transfusion in intracranial aneurysm surgery are not well defined. The authors of this study hoped to identify risk factors for transfusion in this particular patient population and in the era of more restrictive transfusion patterns. Data from 470 consecutive patients who underwent intracranial aneurysm surgery at Northwestern Memorial Hospital (Chicago, Ill) between 2006 and 2012 were analyzed retrospectively using a multivariate binary logistic regression analysis. In this cohort, 9.5% (46 of 470) received intraoperative red blood cell (RBC) transfusions, and the median estimated blood loss in patients who had an intraoperative transfusion was 500 mL (interquartile range, 275–1000 mL) The median number of RBC units transfused was 2 (interquartile range, 1–2), and the volume transfused was 750 mL (interquartile range, 375–750 mL). Preoperative risk factors associated with transfusions were highly related to aneurysm rupture (older age [P < 0.001], lower admission hemoglobin level [P < 0.001], preoperative rupture [P < 0.001], and higher HuntHess grade [P < 0.001]). Intraoperative risk factors and independent predictors of RBC transfusion included larger aneurysm size (>10 mm; P = 0.03), intracerebral hematoma evacuation (P = 0.02), and intraventricular hemorrhage (P < 0.001). Of these, this study demonstrated that the most significant risk factors for transfusion included presenting hemoglobin of less than 11.7 g/dL and age older than 52 years. Based on the findings of this study, the authors suggest that patients with a hemoglobin less than 11.7 g/dL and those with hemoglobin between 11.7 and 14 g/dL who are older than 52 years should be cross-matched for RBCs before intracranial aneurysm surgery because they fall within the high-risk category of requiring perioperative blood transfusion.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89960995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}