Anaesthesia Critical Care & Pain Medicine最新文献

{"title":"Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: A cohort study","authors":"Jiayue Xu ,&nbsp;Qiao He ,&nbsp;Mingqi Wang ,&nbsp;Zichen Wang ,&nbsp;Wenkai Wu ,&nbsp;Li Lingling ,&nbsp;Wen Wang ,&nbsp;Xin Sun","doi":"10.1016/j.accpm.2024.101441","DOIUrl":"10.1016/j.accpm.2024.101441","url":null,"abstract":"<div><h3>Background</h3><div>Sedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality.</div></div><div><h3>Methods</h3><div>A cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models.</div></div><div><h3>Results</h3><div>In total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% <em>vs.</em> 11.0%; pooled adjusted HR 0.78, 95% CI 0.66−0.94) and hospital mortality (16.0% <em>vs.</em> 14.1%; 0.86, CI 0.74–1.00); and CDS was associated with higher ventilator mortality (32.8% <em>vs.</em> 7.0%; 4.65, 3.91–5.53), ICU mortality (40.6% <em>vs.</em> 11.0%; 3.39, 2.95–3.90) and hospital mortality (46.8% <em>vs.</em> 14.1%; 3.27, 2.89–3.71) than CLS. All HRs were qualitatively consistent in both cohorts.</div></div><div><h3>Conclusions</h3><div>Compared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101441"},"PeriodicalIF":3.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid free versus opioid sparing strategies for multimodal antinociception during laparoscopic colectomy: a randomised controlled trial","authors":"Vincent Collange ,&nbsp;Jean Baptiste Berruet ,&nbsp;Frederic Aubrun ,&nbsp;Marie Poiblanc ,&nbsp;Eric Olagne ,&nbsp;Nadège Golliet Mercier ,&nbsp;Sebastien Parent ,&nbsp;Philippe Noel ,&nbsp;Simon Devillez ,&nbsp;Maya Perrou ,&nbsp;Joanna Ramadan ,&nbsp;Sean Coeckelenbergh ,&nbsp;Alexandre Joosten","doi":"10.1016/j.accpm.2024.101436","DOIUrl":"10.1016/j.accpm.2024.101436","url":null,"abstract":"<div><h3>Background</h3><div>It remains unclear whether opioid-free anesthesia (OFA), when compared to opioid-sparing anesthesia (OSA), reduces postoperative opioid consumption while still providing adequate pain control. We thus tested the hypothesis that patients having an OFA strategy during laparoscopic colectomy would require less postoperative opioids when compared to an OSA strategy.</div></div><div><h3>Methods</h3><div>This single-center, prospective randomized controlled superiority trial, randomly allocated consecutive patients undergoing laparoscopic colectomy to receive either sevoflurane-dexmedetomidine anesthesia with a continuous infusion of lidocaine and ketamine (OFA group) or sevoflurane-sufentanil boluses anesthesia with a continuous infusion of lidocaine (OSA group). Both groups received multimodal antinociception with boluses of dexamethasone, lidocaine, and ketamine during anesthesia induction, as well as acetaminophen, ketoprofen, and nefopam before the end of the surgery. OFA patients also received a dose of magnesium sulfate during induction. The primary outcome was cumulative opioid consumption at 48 h after surgery, expressed in oral morphine equivalents (OME). Secondary exploratory outcomes were pain scores, opioid-related adverse events, and patient quality of life (WHODAS score).</div></div><div><h3>Results</h3><div>Of the 160 randomized patients, 155 were included in a modified intention-to-treat analysis. Median [Q1–Q3] OME consumption at 48 h after surgery did not differ between groups (9 [0–30] mg for OFA <em>vs.</em> 14 [0–30] mg for OSA; <em>p</em> = 0.861). Key secondary outcomes were not different between groups except a three time higher incidence of bradycardia in the OFA group.</div></div><div><h3>Conclusions</h3><div>In patients undergoing laparoscopic colectomy with a multimodal antinociception protocol, OFA, when compared to OSA, did not decrease postoperative opioid consumption.</div></div><div><h3>Clinical trial registry and number</h3><div>NCT05031234.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101436"},"PeriodicalIF":3.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of preoperative lung ultrasound score for the prediction of major adverse cardiac events in elderly patients undergoing HIP surgery under spinal anesthesia: The LUSHIP multicenter observational prospective study","authors":"Luigi Vetrugno ,&nbsp;Enrico Boero ,&nbsp;Paola Berchialla ,&nbsp;Francesco Forfori ,&nbsp;Mattia Bernardinetti ,&nbsp;Savino Spadaro ,&nbsp;Gianmaria Cammarota ,&nbsp;Andrea Bruni ,&nbsp;Eugenio Garofalo ,&nbsp;Marco Tescione ,&nbsp;Cristian Deana ,&nbsp;Nicola Federici ,&nbsp;Lisa Mattuzzi ,&nbsp;Francesco Meroi ,&nbsp;Luca Flaibani ,&nbsp;Andrea Cortegiani ,&nbsp;Federico Longhini ,&nbsp;Alessandro Cavarape ,&nbsp;Daniele Guerino Biasucci ,&nbsp;Stefano D’Incà ,&nbsp;Erika Taddei","doi":"10.1016/j.accpm.2024.101432","DOIUrl":"10.1016/j.accpm.2024.101432","url":null,"abstract":"<div><h3>Background and objective</h3><div>We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA).</div></div><div><h3>Methods</h3><div>Prospective, observational multicenter study of 11 Italian hospitals on patients aged &gt;65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy.</div></div><div><h3>Results</h3><div>A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 <em>vs.</em> 4.97 ± 4.90 (<em>p</em> &lt; 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (<em>p</em> &lt; 0.001), MICA scores (<em>p</em> = 0.001) and ASA classes (<em>p</em> &lt; 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55–9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, <em>p</em> &lt; 0.001.</div></div><div><h3>Conclusions</h3><div>The preoperative LUS score, with its high negative predictive value, could improve patients’ risk stratification when used alone or add further value to the RCRI score.</div></div><div><h3>Registration</h3><div>Registered at clinicaltrials.gov as NCT04074876.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101432"},"PeriodicalIF":3.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid uptake of adjunctive corticosteroids for critically ill adults with septic shock following publication of ADRENAL trial. A multicenter, retrospective analysis of prescribing practices in Queensland Intensive Care Units","authors":"Kyle C. White ,&nbsp;Anis Chaba ,&nbsp;Jason Meyer ,&nbsp;Mahesh Ramanan ,&nbsp;Alexis Tabah ,&nbsp;Antony G. Attokaran ,&nbsp;Aashish Kumar ,&nbsp;James McCullough ,&nbsp;Kiran Shekar ,&nbsp;Peter Garrett ,&nbsp;Philippa McIlroy ,&nbsp;Siva Senthuran ,&nbsp;Stephen Luke ,&nbsp;Kevin B. Laupland ,&nbsp;on behalf of the Queensland Critical Care Research Network (QCCRN)","doi":"10.1016/j.accpm.2024.101435","DOIUrl":"10.1016/j.accpm.2024.101435","url":null,"abstract":"<div><h3>Background</h3><div>Septic shock is common and associated with significant morbidity and mortality. The ADRENAL trial examined the use of hydrocortisone in patients with septic shock, demonstrating no difference in patient-centred outcomes but a decrease in the time to shock resolution. The change in clinical practice related to the publication of the ADRENAL trial is currently unknown.</div></div><div><h3>Methods</h3><div>A retrospective cohort study examining the use of hydrocortisone in patients with septic shock was conducted in 12 intensive care units (ICUs). A segmented linear regression was performed to identify a stepwise change in hydrocortisone administration and 90-day mortality associated with the publication of the ADRENAL trial.</div></div><div><h3>Results</h3><div>We included 4,198 patients with a mean age of 58 years (standard deviation, SD17), and the median noradrenaline equivalent score (NEE) was 0.07 μg/kg/min (IQR 0.02–0.17). Segmented regression analysis for hydrocortisone administration identified two breakpoints, 3 months before and 6 months after publication, leading to three periods: Pre-publication, Transition, and Post-publication. Compared to the pre-publication period, the Transition and Post-publication cohorts had a higher proportion of hydrocortisone administration (28% <em>vs.</em> 34% <em>vs.</em> 43%; <em>p</em> &lt; 0.0001). Furthermore, after adjustment for temporal change, the transition period had a significant change in the slope of the proportion of patients receiving hydrocortisone (−0.1% per month <em>vs.</em> +1.4% per month; <em>p</em> = 0.026), whereas this was not statistically significant during the post-publication period (+0.1% per month, p = 0.66). After adjusting for confounders, the Transition and Post-publication periods were independently associated with an increase in hydrocortisone (OR 1.4, 95% CI 1.14–1.77; <em>p</em> = 0.0015 and OR 2.03; 95% CI 1.74–2.36; <em>p</em> &lt; 0.001, respectively). Furthermore, after adjusting for confounders, when compared to the Pre-transition period, the use of hydrocortisone was associated with a statistically significant decrease in 90-day mortality (14% <em>vs.</em> 24% absolute difference, aHR for hydrocortisone effect −0.81; 95% CI 0.65–0.99; <em>p</em> = 0.044).</div></div><div><h3>Conclusion</h3><div>Publication of the ADRENAL trial changed clinical practice in Queensland ICUs with increased prescription of hydrocortisone for patients with septic shock with an associated reduction in mortality.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101435"},"PeriodicalIF":3.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is artificial intelligence prepared for the 24-h shifts in the ICU?","authors":"Filipe André Gonzalez ,&nbsp;Cristina Santonocito ,&nbsp;Tomás Lamas ,&nbsp;Pedro Costa ,&nbsp;Susana M. Vieira ,&nbsp;Hugo Alexandre Ferreira ,&nbsp;Filippo Sanfilippo","doi":"10.1016/j.accpm.2024.101431","DOIUrl":"10.1016/j.accpm.2024.101431","url":null,"abstract":"<div><div>Integrating machine learning (ML) into intensive care units (ICUs) can significantly enhance patient care and operational efficiency. ML algorithms can analyze vast amounts of data from electronic health records, physiological monitoring systems, and other medical devices, providing real-time insights and predictive analytics to assist clinicians in decision-making. ML has shown promising results in predictive modeling for patient outcomes, early detection of sepsis, optimizing ventilator settings, and resource allocation. For instance, predictive algorithms have demonstrated high accuracy in forecasting patient deterioration, enabling timely interventions and reducing mortality rates. Despite these advancements, challenges such as data heterogeneity, integration with existing clinical workflows, and the need for transparency and interpretability of ML models persist. The deployment of ML in ICUs also raises ethical and legal considerations regarding patient privacy and the potential for algorithmic biases.</div><div>For clinicians interested in the early embracing of AI-driven changes in clinical practice, in this review, we discuss the challenges of integrating AI and ML tools in the ICU environment in several steps and issues: (1) Main categories of ML algorithms; (2) From data enabling to ML development; (3) Decision-support systems that will allow patient stratification, accelerating the foresight of adequate individual care; (4) Improving patient outcomes and healthcare efficiency, with positive society and research implications; (5) Risks and barriers to AI-ML application to the healthcare system, including transparency, privacy, and ethical concerns.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101431"},"PeriodicalIF":3.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a sepsis risk index supporting early identification of ICU-acquired sepsis: an observational study","authors":"Scott M. Pappada ,&nbsp;Mohammad Hamza Owais ,&nbsp;John J. Feeney ,&nbsp;Jose Salinas ,&nbsp;Benjamin Chaney ,&nbsp;Joan Duggan ,&nbsp;Tanaya Sparkle ,&nbsp;Shaza Aouthmany ,&nbsp;Bryan Hinch ,&nbsp;Thomas J. Papadimos","doi":"10.1016/j.accpm.2024.101430","DOIUrl":"10.1016/j.accpm.2024.101430","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is a threat to global health, and domestically is the major cause of in-hospital mortality. Due to increases in inpatient morbidity and mortality resulting from sepsis, healthcare providers (HCPs) would accrue significant benefits from identifying the syndrome early and treating it promptly and effectively. Prompt and effective detection, diagnosis, and treatment of sepsis requires frequent monitoring and assessment of patient vital signs and other relevant data present in the electronic health record.</div></div><div><h3>Methods</h3><div>This study explored the development of machine learning-based models to generate a novel sepsis risk index (SRI) which is an intuitive 0–100 marker that reflects the risk of a patient acquiring sepsis or septic shock and assists in timely diagnosis. Machine learning models were developed and validated using openly accessible critical care databases. The model was developed using a single database (from one institution) and validated on a separate database consisting of patient data collected across multiple ICUs.</div></div><div><h3>Results</h3><div>The developed model achieved an area under the receiver operating characteristic curve of 0.82 and 0.84 for the diagnosis of sepsis and septic shock, respectively, with a sensitivity and specificity of 79.1% [75.1, 82.7] and 73.3% [72.8, 73.8] for a sepsis diagnosis and 83.8% [80.8, 86.5] and 73.3% [72.8, 73.8] for a septic shock diagnosis.</div></div><div><h3>Conclusion</h3><div>The SRI provides critical care HCPs with an intuitive quantitative measure related to the risk of a patient having or acquiring a life-threatening infection. Evaluation of the SRI over time may provide HCPs the ability to initiate protective interventions (<em>e.g.</em>, targeted antibiotic therapy).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101430"},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of ultrasound guided sphenopalatine ganglion block in management of emergence agitation after sinoscopic nasal surgery: a randomized double-blind controlled study","authors":"Rasha Hamed ,&nbsp;Loay Gamal ,&nbsp;Saeid Elsawy ,&nbsp;Mohammed Abdelmoneim Baker ,&nbsp;Yara Hamdy Abbas","doi":"10.1016/j.accpm.2024.101429","DOIUrl":"10.1016/j.accpm.2024.101429","url":null,"abstract":"<div><h3>Background</h3><div>Nasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA.</div></div><div><h3>Objectives</h3><div>This study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption.</div></div><div><h3>Patients and methods</h3><div>This double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side.</div></div><div><h3>Results</h3><div>A significant decrease in the incidence of EA was found in G1 compared to G2 (20% <em>vs</em>. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h <em>vs</em>. 3 h).</div></div><div><h3>Conclusion</h3><div>SPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery.</div></div><div><h3>Registration</h3><div>National Clinical Trial Registry, NCT04168879.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101429"},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of perioperative erythropoietin on postoperative morbidity and mortality after cardiac surgery: a meta-analysis of randomized controlled trials","authors":"Dana Abraham ,&nbsp;Dror B. Leviner ,&nbsp;Tom Ronai ,&nbsp;Naama Schwartz ,&nbsp;Amos Levi ,&nbsp;Erez Sharoni","doi":"10.1016/j.accpm.2024.101428","DOIUrl":"10.1016/j.accpm.2024.101428","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiac surgery is known to have high rates of perioperative red blood cell (RBC) transfusions which are associated with increased postoperative mortality and morbidity. Perioperative erythropoietin (EPO) has been suggested to lower perioperative RBC transfusions, and the effect on postoperative morbidity or mortality is unknown.</div></div><div><h3>Methods</h3><div>The registered study protocol is available on PROSPERO (CRD42022314538). We searched the Pubmed, EMbase, and Cochrane CENTRAL databases for randomized controlled trials (RCT) of EPO in cardiac surgery. Outcomes were short-term mortality, acute kidney injury (AKI), re-operation, cerebrovascular accident (CVA), perioperative myocardial infarction (MI), infectious complications, and RBC transfusions. RCT studies of perioperative EPO that reported at least one prespecified outcome of interest were included.</div></div><div><h3>Results</h3><div>A total of 21 RCT’s (n = 2,763 patients) were included. Mortality analysis included 17 studies (EPO 1,272 patients, control 1,235) and showed no significant difference (risk difference (RD) 0.0004, 95%CI: −0.016, 0.009). EPO did not reduce the incidence of AKI (RD −0.006, 95% CI: −0.038, 0.026) and reoperation (RD 0.001, 95% CI: −0.013, 0.015). The incidence of CVA (RD −0.004, 95% CI: −0.015, 0.007) and perioperative MI (RD −0.008, 95% CI: −0.021, 0.005) was similar between the groups.</div></div><div><h3>Conclusions</h3><div>Although EPO had been proven to reduce perioperative RBC transfusions, we did not find that it reduces the incidence of postoperative short-term mortality, AKI, and reoperation. The study results support that perioperative EPO is also safe, with no rise in thrombotic events, including CVA and perioperative MI.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 6","pages":"Article 101428"},"PeriodicalIF":3.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propofol does not alter the protein binding and unbound concentration of lidocaine at clinically targeted plasma concentrations in vitro – A short communication","authors":"Angela R Tognolini ,&nbsp;Jason A Roberts ,&nbsp;Saurabh Pandey ,&nbsp;Steven C Wallis ,&nbsp;Victoria A Eley","doi":"10.1016/j.accpm.2024.101419","DOIUrl":"10.1016/j.accpm.2024.101419","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous lidocaine is increasingly used as an analgesic adjunct during general anaesthesia. Lidocaine is highly protein-bound and changes to binding can alter drug efficacy or toxicity. We aimed to measure the effect of various propofol and lidocaine plasma concentration combinations on the protein binding and concentration of lidocaine <em>in vitro</em>.</div></div><div><h3>Methods</h3><div>Known targeted concentrations of propofol and lidocaine were added to drug-free human plasma <em>in vitro</em>. Samples were prepared and analysed in various clinically relevant concentration combinations; propofol at 0, 2, 4 and 6 µg/mL, and lidocaine at 1, 3 and 5 µg/mL. The total and unbound concentrations of lidocaine were measured by ultra-high performance liquid chromatography-mass spectrometry and percentage protein binding was determined. Data were presented as mean and standard deviation (SD) and differences between groups analysed.</div></div><div><h3>Results</h3><div>The overall mean protein binding of lidocaine was 68.8% (SD 5.5, range 57.5–80.9%). Beta regression analysis revealed no statistically significant difference in lidocaine percentage binding across a range of propofol and lidocaine concentration combinations.</div></div><div><h3>Conclusion</h3><div>Propofol did not alter the unbound and free pharmacologically active proportion of lidocaine at different clinically targeted concentrations of propofol and lidocaine in plasma <em>in vitro</em>. The percentage of plasma protein binding of lidocaine in this study was consistent with previously published results.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101419"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of magnesium sulphate in preventing laryngospasm in paediatric patients undergoing general anaesthesia: A systematic review and meta-analysis of randomised control trials","authors":"Mohammad Ahmed Rasheed ,&nbsp;Danyal Memon ,&nbsp;Clare Keaveney Jimenez ,&nbsp;Asad Zafar ,&nbsp;Haaris Shiwani","doi":"10.1016/j.accpm.2024.101413","DOIUrl":"10.1016/j.accpm.2024.101413","url":null,"abstract":"<div><h3>Background</h3><div>Laryngospasm is sustained closure of the airways and can be a life-threatening condition. Magnesium sulphate is postulated to reduce the incidence of laryngospasm if administered peri-operatively. This systematic review and meta-analysis was performed to assess the efficacy of magnesium sulphate in preventing peri-operative laryngospasm in paediatric patients undergoing non-cardiac surgery.</div></div><div><h3>Methods</h3><div>Four databases and a trial registry were searched. Inclusion criteria were paediatric patients undergoing general anaesthesia. Exclusion criteria were patients who underwent cardiopulmonary bypass during surgery. The intervention of interest was the peri-operative administration of magnesium sulphate. The intervention was compared to either a placebo or other pharmacological agent.</div><div>The primary outcome was the incidence of laryngospasm. A meta-analysis of all studies was performed. Sub-group analysis was subsequently performed.</div></div><div><h3>Results</h3><div>A total of 953 patients from 13 trials were included in this study. Nine RCTs administered magnesium intravenously and 4 RCTs administered magnesium locally. Laryngospasm rates were 6% lower in the magnesium group (OR 0.48 [95% CI 0.25–0.96], <em>p</em> = 0.04) compared to control in the pooled data. Subgroup analysis showed laryngospasm rates were lower by 12.5% (Odds Ratio 0.26 [CI 0.09–0.76], <em>p</em> = 0.01) in the local magnesium group. Subgroup analysis of studies that only administered intravenous magnesium did not show a statistically significant difference in the incidence of laryngospasm (OR 0.73 [95% CI 0.33–1.63], <em>p</em> = 0.44).</div></div><div><h3>Conclusions</h3><div>This review shows a potential role for magnesium in the prevention of laryngospasm in paediatric patients undergoing general anaesthesia. There is a correlation between local administration of magnesium and reduction in laryngospasm rates. Further studies are required to assess the efficacy of intravenous magnesium in prevention of laryngospasm.</div></div><div><h3>Registration</h3><div>Prospective Register of Systematic Reviews (PROSPERO); PROSPERO ID CRD42022307868 (<span><span>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022307868</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 5","pages":"Article 101413"},"PeriodicalIF":3.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}