Frontiers in Anesthesiology最新文献

{"title":"Supplemental oxygen did not significantly affect two-year mortality in patients at-risk for cardiovascular complications undergoing moderate- to high-risk abdominal surgery–A follow-up analysis of a prospective randomized clinical trial","authors":"A. Taschner, E. Fleischmann, B. Kabon, Markus Falkner von Sonnenburg, Nikolas Adamowitsch, K. Horvath, T. Christian, David Emler, M. Fraunschiel, A. Graf, C. Reiterer","doi":"10.3389/fanes.2023.1108921","DOIUrl":"https://doi.org/10.3389/fanes.2023.1108921","url":null,"abstract":"Background In relatively healthy middle-aged patients, recent studies have shown that supplemental oxygen did not significantly increase one-year mortality after noncardiac surgery. If supplemental oxygen influences long-term mortality, specifically in elderly patients with cardiovascular risk-factors, remains unknown. Thus, we evaluated the effect of supplemental oxygen on two-year mortality in patients with cardiovascular risk factors undergoing moderate- to high-risk major abdominal surgery. Methods This is a follow-up study of a prospective, randomized, double-blinded, clinical trial. Two hundred fifty-eight patients, who were at least 45 years of age and at-risk for cardiovascular complications were randomly assigned to receive 80 vs. 30% oxygen during surgery and for the first two postoperative hours. Vital status was obtained from all patients 2 years after surgery using the national registry. Preoperative and postoperative maximum concentrations of NT-proBNP, Troponin T (TnT), Copeptin, von Willebrand Factor (vWF), static oxidation-reduction potential (sORP) and oxidation-reduction potential capacity (cORP) were tested for association with two-year mortality. Results The median age of patients was 74 years (25th-75th percentile 70–78 years). 25.8% (95% CI: 17.3–32.4%) of patients in the 80% oxygen group and 22.3% (95% CI: 14.8–29.1%) in the 30% oxygen group died within 2 years after surgery. No significant difference in two-year mortality was found between patients, who received 80% oxygen concentration, versus patients, who received 30% oxygen concentration (estimated hazard ratio 1.145; 95% CI 0.693–1.893; p = 0.597). Preoperative Copeptin concentrations and postoperative maximum vWF activity were significantly associated with two-year mortality (p < 0.001). Conclusion Our results are consistent with previous studies, that showed that supplemental oxygen did not increase long-term mortality. Therefore, it is becoming more evident that supplemental oxygen may not have a significant effect on long-term outcome in patients undergoing major abdominal surgery.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125179939","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":"Old issues and new challenges in cardiothoracic anesthesiology: Work in progress…","authors":"A. Pisano, Matteo Angelini, Iliyan Vlasakov, G. Landoni","doi":"10.3389/fanes.2022.1115750","DOIUrl":"https://doi.org/10.3389/fanes.2022.1115750","url":null,"abstract":"COPYRIGHT © 2023 Pisano, Angelini, Vlasakov 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. Old issues and new challenges in cardiothoracic anesthesiology: Work in progress...","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121617425","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":"Case report: Ultrasound-guided bilateral serratus anterior plane block in intensive care unit—An alternative to opioid-sparing postoperative analgesia after sternotomy in infants","authors":"Mingzhe Xu, Zhi Li, Yi He, Lijing Deng","doi":"10.3389/fanes.2023.1014421","DOIUrl":"https://doi.org/10.3389/fanes.2023.1014421","url":null,"abstract":"Introduction The high-opioid technique was applied in the setting of congenital cardiac surgery on the belief of severe pain management and analgesic limitation in children along with delayed extubation time and other side effects. Thoracic nerve blockade demonstrated superior postoperative analgesia and stable hemodynamics and lower perioperative opioid consumption and related complications in cardiac surgery. SAPB is a fascial plane block technique that is considered an alternative to paravertebral block for perioperative thoracic pain relief, targeting intercostal never. Cases presentation We present 3 cases to describe the efficacy of SAPB as an alternative to opioid-sparing analgesia performed in infant patients after sternotomy in pediatric cardiac intensive care units. It was successfully used as a part of perioperative pain management. All patients were extubated early and recovered soon with no other complications. Conclusion SAPB lowers perioperative opioid consumption and related complications in cardiac surgery with satisfactory postoperative analgesia and stable hemodynamics.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129735040","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":"Sugammadex shortens the time to extubate and discharge from PACU in patients with tracheobronchial stenosis undergoing rigid bronchoscopy procedures: A retrospective cohort study","authors":"Xiaofei Lu, Tingting Li, Xu Chen, Meiying Xu, Jingxiang Wu, Yuwei Qiu","doi":"10.3389/fanes.2022.1116271","DOIUrl":"https://doi.org/10.3389/fanes.2022.1116271","url":null,"abstract":"Introduction Incomplete reversal of neuromuscular blocking drugs can delay patients' rapid recovery and lead to adverse events in the postoperative period, especially in high-risk patients. Sugammadex as a reversal agent, may offer distinct advantages to the scenario where residual neuromuscular blockade may be poorly tolerated. We aimed to investigate the efficacy of sugammadex compared with neostigmine on perioperative outcomes in patients with preoperative tracheal stenosis undergoing rigid bronchoscopy. Method We conducted a retrospective cohort study of adults who were diagnosed with primary or secondary tracheobronchial stenosis, and scheduled for interventional therapy under rigid bronchoscopy, at Shanghai Chest Hospital between December 2016 and July 2020. The exposure was categorized into two groups according to the antagonists of muscle relaxants administered after surgery: Group neostigmine vs. Group sugammadex. The primary outcome was the time to extubate after surgery, and the second outcome was the time to discharge from PACU. Perioperative adverse events were recorded. Results A total of 98 patients undergoing rigid bronchoscopy procedures were included. Patients in Group sugammadex showed less time to extubate (11 [8, 17] vs. 16 [12, 22] min, P = 0.003) and discharge from PACU (27 [20, 33] vs. 32.5 [24, 44] min, P = 0.013) than in Group neostigmine. The incidence and duration of hypotension during the procedure in Group sugammadex were significantly lower than that in Group neostigmine (18.5 vs. 40.8%, P = 0.038; 0 [0, 0] vs. 0 [0, 8] min, P = 0.036 respectively). Conclusions Sugammadex shortens the time to extubate and discharge from PACU in patients with tracheobronchial stenosis, accelerating postoperative recovery.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130708401","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":"Case report: Ruptured aortic sinus aneurysm with left coronary artery aneurysm-right atrial fistula","authors":"Wei-guo Xiong, Wei-Zen Long, Linda J. Tang, Jin Liu, Hai B Song","doi":"10.3389/fanes.2022.987378","DOIUrl":"https://doi.org/10.3389/fanes.2022.987378","url":null,"abstract":"A 50-year-old women presented with a history of fatigue after activities. Transthoracic echocardiography showed a 2.8 cm dilatation at the ostium of the left coronary artery and a 7.1 × 7.4 cm cyst-like aneurysm at the upper back of the left atrium, interlinking an anomalous fistula from the left coronary artery to the right atrial appendage, accompanied by moderate mitral and tricuspid regurgitation. Cardiac 3D-computed tomography confirmed the diagnosis of a ruptured aortic sinus aneurysm (RASA) and a giant left coronary artery aneurysm fistula to the right atrium. A transesophageal echocardiogram and surgical vision confirmed these findings. Surgeries, including RASA repair, coronary artery bypass grafting, and mitral and tricuspid valvuloplasty, were then performed. The procedures proceeded successfully, and the patient fully recovered and was discharged home.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129211252","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":"Blood and coagulation product disposition in the modern era: An international multicenter survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC)","authors":"D. Gerber, D. Bolliger, S. Agarwal, F. Zulauf, G. Erdoes","doi":"10.3389/fanes.2022.995963","DOIUrl":"https://doi.org/10.3389/fanes.2022.995963","url":null,"abstract":"Study objective Perioperative transfusion is associated with reduced survival and increased morbidity and mortality. Several studies report wide variation in clinical transfusion practice. However, the influence of simple, practical factors–such as which blood products are available, and when - is often disregarded. We hypothesized that these practical issues are relevant confounders of transfusion decisions. Design Web-based survey. Setting Multi-institutional. Participants Members of the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) society reached by monthly newsletter in November 2020. Interventions No interventions. Measurements Survey responses. Main results The newsletter was opened by 429 members. We collected 51 complete surveys, resulting in a response rate of 11.9%. 72% of participants reported having a local algorithm for the use of blood products and coagulation factors. Latency in the time of blood product delivery / availability and the possibility to store or return unused products were most often reported as having an influence on transfusion practice. For point-of-care test availability, 86% of addressees reported rotational thromboelastometry / -elastography, 76% hemoglobin tests, 24% international normalized ratio (INR) measurement and 22% platelet function testing. Six percent of the respondents did not have access to point-of-care tests. The majority of addressees reported that they were able to obtain more than 10 allogeneic blood products simultaneously (63%). Packed red blood cells were available with a delay of 10–15 min and platelets with a delay of 15–20 min. Conclusions Our survey indicates a wide variability in the logistics of perioperative transfusion practice. The information gained could provide a solid basis for future improvements of the guidelines, but also in local transfusion practices.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133672828","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":"Trends in research on the perioperative use of acupuncture in the last 20 years: A CiteSpace-based bibliometric analysis and literature review","authors":"Minjuan Zhang, Zhuoma Cairen, Junbao Zhang, Yun Wang, Zhihong Lu","doi":"10.3389/fanes.2022.962280","DOIUrl":"https://doi.org/10.3389/fanes.2022.962280","url":null,"abstract":"Objective Research on acupuncture-related techniques in the perioperative period has been increasing in the last 20 years. In this research, a bibliometric analysis was performed to review the application of acupuncture for perioperative medicine and to evaluate the trends in research on the perioperative use of acupuncture. Methods CiteSpace was used to analyze published papers on the perioperative use of acupuncture in the Web of Science database from 2001 to 2021. The research trends were evaluated based on the number of publications, keywords, journals, countries, institutions, and authors. Moreover, collaborative networks and reference co-citation network maps were analyzed. Results A total of 719 related studies were included in the analyses. The number of annual publications has gradually been increasing. Evidence-Based Complementary and Alternative Medicine published the most (49 articles). Regarding the cited journals, Anesthesia & Analgesia ranked first in terms of frequency (361), while Pain ranked first in terms of centrality (0.71). China (284) and the China Medical University (26) published the most. Wang Yu (21 articles) was the most active author, while Lee A (116) was the most co-cited author. The most co-cited reference was a meta-analysis of acupuncture for post-operative pain (212). The “post-operative cognitive dysfunction” cluster was new research directions that had recently emerged. Pain-related keywords had the highest frequency in keywords about indications. Conclusion Research on perioperative acupuncture is a promising field, and more cooperation in global scientific research is needed. Our results may help researchers in identifying potential collaborators, research frontiers, and hot topics.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"137 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116372117","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":"Case report: Nasal polyp exfoliated into the tracheal tube in a patient with a difficult airway during nasotracheal intubation","authors":"Fu-Rong Bai, Shuang Zhang, M. Yi","doi":"10.3389/fanes.2022.975523","DOIUrl":"https://doi.org/10.3389/fanes.2022.975523","url":null,"abstract":"Background Difficult airway has always been one of the greatest challenges for anesthesiologists. Patients with difficult airways and severe obstructive sleep apnea-hypopnea syndrome (OSAHS) often find themselves in life-threatening danger before their artificial airway is established and after their artificial airway is removed. Case presentation The study reported a case of nasal polyps shedding into the tracheal tube when nasotracheal intubation in a patient diagnosed with a difficult airway and OSAHS; the patient was being prepared for a transoral tonsillectomy under general anesthesia. The uniqueness of this case was that nasal polyps were scraped off using the tracheal tube during nasotracheal intubation, and detected in real-time; this ultimately prevented an airway foreign body obstruction. Reviewing the literature on intubation methods for difficult airways, awake endotracheal intubation guided by fiberoptic bronchoscopy remains to be the gold standard for airway management. Additionally, nasotracheal intubation can provide more operating space for oral surgery. In this case, the unexpected nasal polyp fell off into the tracheal tube during intubation, as is visualized on the following pictures. This fortunate event prevented the nasal polyp from falling into the trachea and bronchus. Conclusion It is necessary to rule out any nasal abnormalities in patients requiring nasotracheal intubation; otherwise, blind nasal intubation may be dangerous.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134345478","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":"Psychiatric outcomes following ketamine administration for orthopedic surgical anesthesia","authors":"Alec E. Mansour, Elijah W. Hale, Daniel S. Saks","doi":"10.3389/fanes.2022.1041959","DOIUrl":"https://doi.org/10.3389/fanes.2022.1041959","url":null,"abstract":"Background Ketamine is a non-barbiturate general anesthetic commonly used in a variety of medical settings for pain and sedation. Its use in treatment for psychiatric illnesses has been increasing in recent years, showing promise in reducing depressive and suicidal symptoms in patients, particularly surgical patients. However, it has a history of association with schizophrenia-like and psychotomimetic symptoms following administration, particularly in patient populations with previous mental illness and youths. Objective Using a retrospective cohort study of patient records from a large health database, we sought to investigate psychiatric outcomes in age-specific cohorts following ketamine administration for orthopedic surgical anesthesia. Methods This was a retrospective analysis of the TriNetX health database. We identified all patients undergoing orthopedic surgeries with anesthesia. We then performed four total group analyses between cohorts of patients receiving ketamine and cohorts not receiving ketamine. We had three sets of analysis based on age stratification and one ageless: pediatric (<18 years), adult (18–60 years), elderly (>60 years), and a reference analysis of all patients. Results In 406,384 patients studied, nearly every measured event displayed an increased risk for patients receiving ketamine as part of their anesthesia. Apart from anhedonia, which had a decreased risk of occurrence, every event displayed increased incidence in at least two of the cohorts. For all but one event, nicotine use, the significant differences between groups were in concordance with each other. Conclusion Our findings suggest ketamine use should be investigated further in different age groups and corresponding psychiatric outcomes.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126174452","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":"Myocardial protection with glucose-insulin potassium in patients with acute coronary syndromes requiring coronary artery bypass grafting: A case series","authors":"E. Christoph, H. Andres, Putzu Alessandro, Cikirikcioglu Mustafa, Licker Marc","doi":"10.3389/fanes.2022.963380","DOIUrl":"https://doi.org/10.3389/fanes.2022.963380","url":null,"abstract":"Emergent cardiac surgery in patients with acute coronary syndrome (ACS) is always a challenging task for surgeons, anesthesiologists and patients. As “time is muscle,” early revascularization by percutaneous coronary intervention (PCI) has been largely advocated to salvage myocardial ischemic cells. In cases judged not suitable for PCI, on-pump coronary artery bypass grafting (CABG) is indicated with cardioplegic arrest and eventually anesthetic preconditioning to enhance myocardial protection. In these high-risk emergent procedures, adjuvant interventions to cardioplegic arrest are aimed to maximize the chance of cardiac functional recovery. Although the infusion of glucose-insulin-potassium (GIK) has demonstrated interesting cardioprotective effects in animal models of myocardial ischemia and in patients undergoing elective cardiac surgery, this cardioprotective strategy has not yet been adopted largely and has been ignored so far in emergent myocardial revascularization procedures. In this case series, we describe the effects of GIK on left ventricular performance assessed by transesophageal echocardiography in four patients with ACS who required emergent CABG surgery. The GIK solution of 20 g glucose, 20 UI insulin and 10 mEq potassium chloride was infused twice over 30 min, first after anesthesia induction and later after aortic unclamping. The systolic performance was assessed after anesthesia induction and after each GIK infusion using the 3D left ventricular ejection fraction, as well as the global longitudinal and circumferential strain. The diastolic function was assessed based on mitral inflow patterns (E-and A-waves) as well as flow propagation velocity.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115248665","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}