Frontiers in Anesthesiology最新文献

{"title":"Role of non-invasive imaging in perioperative neurocognitive disorders","authors":"M. S. Vandiver","doi":"10.3389/fanes.2023.1195175","DOIUrl":"https://doi.org/10.3389/fanes.2023.1195175","url":null,"abstract":"Perioperative Neurocognitive disorders, including delirium and long-term cognitive dysfunction following surgery, are an ever-increasing focus of investigation for anesthesiologists and researchers. The desire to bring patients safely through the perioperative period with an absolute minimum impact of the anesthetic, surgery, and post-operative period on the patient's functional status has brought a high level of scrutiny to entities that most impact patients. Perioperative neurocognitive disorders (PND) have the potential to vastly alter patient functional status after surgery and anesthesiologists are often the first physician asked about the effects this may have on the patient during the informed consent process. While the underlying mechanisms of PND are not well understood, more tools are being brought to bear with non-invasive imaging shedding light on the pathophysiology of PND. In this narrative mini-review, we discuss the current investigation into PND with a focus on non-invasive imaging and preventative strategies that are being employed to better protect patients.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122509009","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":"Race, ethnicity and postoperative pain in pediatric cancer patients: a single-institution retrospective study","authors":"P. Owusu-Agyemang, Lei Feng, J. Cata","doi":"10.3389/fanes.2023.1187234","DOIUrl":"https://doi.org/10.3389/fanes.2023.1187234","url":null,"abstract":"Background Studies have suggested racial and ethnic-based disparities in the intensity of postoperative pain experienced by patients. The objective of this study was to compare the peak and average post-anesthesia care unit (PACU) pain intensity scores of children of non-Hispanic (NH) White race to those of children of other racial/ethnic groups. Methods Single-institution retrospective study of children (≤18 years) who had undergone cancer-related surgical procedures from June 2016 through April 2022. Multivariable logistic regression was used to assess the association between race/ethnicity and the peak and average PACU pain intensity scores. Results Of the 1,009 unique patients, 74 (7.3%) were Asian, 93 (9.2%) were NH-Black, 310 (30.7%) were Hispanic/Latino, 51 (5.1%) identified as “Other” race (NH-Other), and 481 (47.7%) were NH-White. The median age [interquartile range (IQR)] was 13.7 years (IQR, 8.2–16.6), and 517 (51.2%) were female. In the multivariable analysis, the association between race/ethnicity and a peak PACU pain score greater than 3 was not significant (p = 0.062 for overall effect of race). However, upon comparing the peak PACU pain scores of children of other racial/ethnic groups to NH-White children, NH-Black children were 50.1% less likely than NH-White children to have a peak PACU pain score greater than 3 (odds ratio [OR], 0.499, 95% confidence interval [CI], 0.304–0.818; p = 0.006). Patient race/ethnicity was not associated with an average PACU pain score greater than 3 (p = 0.778). In the sub-group analysis of children who had undergone orthopedic or open abdominal surgeries, the proportions of children with peak and average PACU pain scores which were greater than 3 were not significantly different across racial/ethnic groups (p = 0.250 and p = 0.661, respectively). Conclusions In this retrospective study of children who had undergone cancer-related surgery, NH-Black children had significantly lesser odds than NH-White children of having a peak PACU pain score of moderate or severe intensity. However, in the sub-group analysis of children who had undergone orthopedic or open abdominal procedures, peak and average PACU pain scores were not significantly different across racial/ethnic groups.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133592994","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":"Intraoperative hemodynamic optimization using the hypotension prediction index vs. goal-directed hemodynamic therapy during elective major abdominal surgery: the Predict-H multicenter randomized controlled trial","authors":"J. V. Lorente, J. Ripollés-Melchor, I. Jiménez, Alejandra I. Becerra, Irene Mojarro, Paula Fernández-Valdes-Bango, M. A. Fuentes, A. Moreno, Maria E. Agudelo, Angel Villar-Pellit de la Vega, A. Ruiz-Escobar, Azahara Cortés, Rocio Venturoli, Ana Quintero, Guadalupe Acedo, A. Abad-Motos, Peña Gómez, A. Abad-Gurumeta, M. Monge-García","doi":"10.3389/fanes.2023.1193886","DOIUrl":"https://doi.org/10.3389/fanes.2023.1193886","url":null,"abstract":"Background Intraoperative hypotension (IOH) is associated with increased morbidity and mortality after major abdominal surgery but remains significant even when using goal-directed hemodynamic therapy (GDHT) protocols. The Hypotension Prediction Index (HPI) is a machine learning-derived parameter that predicts arterial hypotension. We tested the hypothesis that an HPI-based protocol reduces the duration and severity of hypotension compared with a GDHT protocol during major abdominal surgery. Methods This is a parallel-arm double-blinded multicenter randomized trial involving adult patients undergoing elective major abdominal surgery at five centers. Patients were optimized according to a previously recommended GDHT protocol (GDHT group) or the HPI value (HPI group). Hemodynamic optimization in both groups started 15 min after the surgical incision. The primary outcome was the intraoperative time-weighted average of mean arterial pressure under 65 mmHg (TWA-MAP < 65 mmHg). Other metrics for IOH and secondary outcomes, including TWA below individual baseline values of intraoperative tissue oxygenation (StO2), postoperative AKIRisk, postoperative complications, length of stay, and 30-day mortality, were explored. Results Eighty patients were randomized (40 patients in each group). TWA-MAP < 65 mmHg was 0.06 (25th–75th interquartile range: 0–0.27) mmHg in the GDTH group vs. 0 (0–0.04) mmHg in the HPI group (p = 0.015). Total time with MAP < 65 mmHg per patient was 4.6 (0–21) min in the GDHT group and 0 (0–3) min in the HPI group (p = 0.008). The TWA below the baseline StO2 was 0.40% (0.12%–2.41%) in the GDHT group and 0.95% (0.15%–3.20%) in the HPI group (p = 0.353). The AKIRisk values obtained in the GDHT group were 0.30 (0.14–0.53) and 0.34 (0.15–0.67) in the GDHT and HPI groups (p = 0.731), respectively. Both groups had similar postoperative complications, length of stay, and 30-day mortality. Conclusions An HPI-based protocol reduced intraoperative hypotension compared with a standard GDHT protocol, with no differences in tissue oxygenation and postoperative AKIRisk.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130649172","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":"Editorial: Editors’ showcase: cardiothoracic anesthesiology","authors":"V. Lomivorotov, G. Landoni","doi":"10.3389/fanes.2023.1197222","DOIUrl":"https://doi.org/10.3389/fanes.2023.1197222","url":null,"abstract":"COPYRIGHT © 2023 Lomivorotov and Landoni. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117270731","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":"Hypotension prediction index: From reactive to predictive hemodynamic management, the key to maintaining hemodynamic stability","authors":"J. Ripollés-Melchor, A. Ruiz-Escobar, Paula Fernández-Valdes-Bango, J. V. Lorente, I. Jiménez-López, A. Abad-Gurumeta, Laura Carrasco-Sánchez, M. Monge-García","doi":"10.3389/fanes.2023.1138175","DOIUrl":"https://doi.org/10.3389/fanes.2023.1138175","url":null,"abstract":"Intraoperative hypotension is common and has been associated with adverse events, including acute kidney failure, myocardial infarction, and stroke. Since blood pressure is a multidimensional and measurable variable, artificial intelligence and machine learning have been used to predict it. To date, studies have shown that the prediction and prevention of hypotension can reduce the incidence of hypotension. This review describes the development and evaluation of an artificial intelligence predictive algorithm called Hypotension Prediction (HPI), which can predict hypotension up to 15 min before it occurs.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129138139","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":"A patient blood management perspective on Anemia in the obese patient journey","authors":"G. Duarte, Wenhua Wei, Gavin Cho","doi":"10.3389/fanes.2023.1172018","DOIUrl":"https://doi.org/10.3389/fanes.2023.1172018","url":null,"abstract":"Obesity and anemia are increasing prevalence around the globe. They can interplay and are both associated with high morbidity and poorer clinical outcomes. Inflammation and iron deficiency are important contributors to anemia in obese patients. Furthermore, obesity surgery can trigger high blood loss, increased demand for blood transfusions and long-term nutrient deficiency. Patient blood management programs have been crucial in improving patients' clinical results whilst minimizing costs in many different settings, such as orthopedic surgery, cardiovascular surgery, pregnancy and intensive care unit patients. In this mini-review, we will discuss applications of patient blood management principles in caring of obese individuals during the patient journey.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131141682","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":"Anesthesia and rare neuromuscular diseases","authors":"Jovan Z. Radeka, M. Stojanovic, Milena N. Vasilijic, Milica Randjelović, R. Jankovic","doi":"10.3389/fanes.2023.1159436","DOIUrl":"https://doi.org/10.3389/fanes.2023.1159436","url":null,"abstract":"Neuromuscular diseases, although rare in the general population, can be present in people who need to undergo surgery and anesthesia. Fortunately, the possibility of early diagnosis, new therapeutic approaches and the application of a multidisciplinary approach have significantly extended the life expectancy of such patients. The presence of such a disorder represents a challenge in anesthesiology practice, both during the preparation for surgery itself, the operative procedure and postoperative recovery in intensive care units. A basic understanding of the main disorders of the disease and their potential interactions with the anesthetic itself and the necessary agents in anesthesiology is necessary in order to reduce the risk of perioperative morbidity and mortality, with the aim of reducing the possibility of complications. Rare muscle diseases are very difficult to classify in a standard way because of the variability of their etiology and pathology. This work focuses on a number of muscle diseases such as Dubowitz syndrome, rhabdomyosarcoma in children, spinal muscular atrophy, Kennedy's disease, Congenital muscular dystrophy of the Ullrich type (UCMD), Sotos syndrome, Polymyositis and Setleis syndrome, Nemaline rod myopathy, Pompe disease, Emery-Dreifuss muscular dystrophy (EDMD). The medical literature on anesthetic techniques and perioperative complications was reviewed. Given that they can have a very unfavorable effect on the course of general anesthesia in particular and that these diseases can cause very serious, even life-threatening complications, an adequate anesthesiological approach is very important to reduce the possibility of the mentioned complications. A multidisciplinary approach is imperative for such patients before and after surgery, whether it is performed under analgosedation, some type of regional or general anesthesia. The operative procedure itself must be performed in institutions that are adequately equipped to treat such patients and by personnel who have experience in treating them.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126985090","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 effect of ultrasound-guided erector spinae plane block combined with dexmedetomidine for postoperative pain management in lumbar spine surgery: A case-based discussion","authors":"F. Coppolino, P. Sansone, Carmela Porfidia, M. Passavanti, V. Pota, L. G. Giaccari, C. Aurilio, M. Pace","doi":"10.3389/fanes.2023.984225","DOIUrl":"https://doi.org/10.3389/fanes.2023.984225","url":null,"abstract":"Background Ultrasound-guided erector spinae plane blocks (US-ESPB) can be valid resources of simple and safe execution in a multimodal approach to postoperative pain management in lumbar spine surgery. It has been shown that the use of multimodal anesthesia reduces the use of intraoperative and postoperative opioids, and also improves analgesia. A growing body of evidence supports that the adjuvant use of dexmedetomidine in locoregional anesthesia significantly prolongs the analgesia and potentiates the effect of the block, without clinically significant side effects. Case presentation A series of six consecutive patients received bilateral ultrasound-guided erector spinae plane blocks with local anesthetics and dexmedetomidine as part of a multimodal analgesic therapy after lumbar spine surgery. Treatment adequacy was evaluated using numerical rating scale (NRS) and overall benefit of analgesic score (OBAS); overall the observed results were satisfactory for all patients. Conclusion Bilateral US-ESPB appears to be helpful in providing adequate postoperative analgesia after lumbar spine surgery. It is simple and safe, and so it is unique when compared to other blockages. The addition of Dexmedetomidine as an adjuvant seems to improve analgesic effectiveness and durability.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131360405","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":"Anesthetic implications in porphyrias","authors":"Milica Randjelović, M. Stojanovic, Jovan Z. Radeka, Milena N. Vasilijic, R. Jankovic","doi":"10.3389/fanes.2023.1149949","DOIUrl":"https://doi.org/10.3389/fanes.2023.1149949","url":null,"abstract":"The porphyrias are a group of disorders related to deficient heme biosynthesis, caused by malfunction of certain enzymes in the synthesis pathway. Erythropoietic porphyrias present with cutaneous symptoms and do not affect the nervous system. Hepatic porphyrias develop acute attacks with mild to severe neurovisceral symptoms, dramatic course, and rare, but possibly lethal outcomes. Anesthetic management of patients suffering from hepatic porphyria is challenging regarding the possibility of triggering or worsening the acute attack with medications that induce or maintain anesthesia. The medications are labeled as safe or unsafe according to laboratory experiments, clinical studies, case reports and experience. In this paper, we discuss underlying pathophysiology, presentation, therapy recommendations and anesthetic implications related to porphyrias.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"156 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132322274","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 effect of a mesenteric traction syndrome on internal carotid artery blood flow","authors":"N. Olesen, A. H. Egesborg, H. Frederiksen, L. Svendsen, N. Secher","doi":"10.3389/fanes.2023.1101013","DOIUrl":"https://doi.org/10.3389/fanes.2023.1101013","url":null,"abstract":"Purpose During abdominal surgery, manipulation of internal organs may induce a “mesenteric traction syndrome” (MTS) including a triad of flushing, hypotension, and tachycardia that lasts for approximately 30 min. We evaluated whether MTS affects internal carotid artery blood flow. Methods This prospective cohort study included 27 patients aged 65 ± 11 years (mean ± SD) undergoing stomach resection (n = 12), esophageal resection (n = 14), or gastro-entero anastomosis (n = 1) during propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound determined internal carotid artery blood flow, laser Doppler flowmetry assessed forehead skin blood flow, and near-infrared spectroscopy determined cerebral oxygenation. Development of MTS was defined by flushing within 60 min after incision. Results Seven patients developed MTS 22 [20–26; median (IQR)] min after incision and at that time the change in heart rate (to 87 ± 13 vs. 70 ± 11 bpm; P = 0.0007) and skin blood flow (to 214 (134–269) vs. 84 (59-112 PU; P = 0.0044) was higher in the patients who developed MTS as compared to those who did not, while mean arterial pressure (63 ± 13 vs. 64 ± 14 mmHg; P = 0.1433), cerebral oxygenation (69 ± 9% vs. 63 ± 10%; P = 0.2485), and internal carotid artery flow (225 ± 53 vs. 203 ± 69 ml/min; P = 0.9529) were similar. Conclusion Hemodynamic perturbations are observed in some patients in response to manipulation of the viscera, but the development of MTS appears not to influence internal carotid artery flow. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02951273?term=NCT02951273&rank=1, identifier: NCT02951273.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115023109","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}