Acta Anaesthesiologica Scandinavica最新文献

{"title":"Are labor epidural catheters after a combined spinal epidural (CSE) technique more reliable than after a traditional epidural? A retrospective review of 9153 labor epidural catheters.","authors":"Viktoria Sakova, Elina Varjola, James Pepper, Riina Jernman, Antti Väänänen","doi":"10.1111/aas.14542","DOIUrl":"10.1111/aas.14542","url":null,"abstract":"<p><strong>Background: </strong>The combined spinal epidural (CSE) technique may associate with a lower failure rate of epidural catheters compared to traditional epidural catheters. This may be significant for the parturients as failure of neuraxial analgesia has been associated with a negative impact on birth experience.</p><p><strong>Methods: </strong>In this one-year retrospective study, the failure rate of epidural catheters was compared between 3201 and 5952 epidural catheters after initiation of neuraxial analgesia by the CSE or traditional epidural technique, respectively. Parturient background information, labor parameters, and neuraxial interventions were collected from 9153 parturients. Failure was defined as replacement of a used epidural catheter by new regional analgesia procedures or general anesthesia during intrapartum cesarean delivery. The primary outcome was the failure rate of epidural catheters. The secondary outcome was the time from the initial analgesia intervention to the epidural catheter replacement and progression of labor during this time.</p><p><strong>Results: </strong>The CSE method was used at an earlier stage of labor, and the parturients were more often primiparous and undergoing induced labor. Earlier onset of analgesia, obesity, induced labor, anesthesiologist experience, and cesarean delivery were found to be significant cofactors for catheter failure. The unadjusted failure rate was 168/3201 (5.2%) and 223/5952 (3.7%) (OR 1.42 [1.16-1.75]) after initiation of analgesia by CSE or traditional epidural method. After controlling for the stage of labor, body mass index, induction of labor, and anesthesiologist's experience level, the adjusted OR for epidural catheter replacement was 1.04 (0.83-1.29) p = .736. The mean (SD) time until epidural catheter failure was 6.3 (4.4) and 4.0 (4.1) hours following initiation of analgesia by CSE or traditional epidural technique, respectively (p < .001). Cervical dilatation progressed from 4.3 (1.4) to 6.4 (2.1) cm and 5.1 (1.5) to 6.7 (1.7) cm between primary neuraxial analgesia and epidural catheter replacement.</p><p><strong>Conclusion: </strong>CSE technique was not associated with a better survival rate of epidural catheters for provision of analgesia or epidural top-up anesthesia for intrapartum CD. In addition, the time to replacement of the catheter was significantly longer when analgesia was initiated with the CSE technique. Maternal satisfaction scores were lower if catheters required replacement.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14542"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of intraoperative methadone in robot-assisted cystectomy on postoperative opioid requirements: A randomized clinical trial.","authors":"Camilla Gaarsdal Uhrbrand, Damir Salskov Obad, Bente Thoft Jensen, Jørgen Bjerggaard Jensen, Kristian Dahl Friesgaard, Lone Nikolajsen","doi":"10.1111/aas.14545","DOIUrl":"10.1111/aas.14545","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management is a challenge after robot-assisted cystectomy (RAC). Methadone has a long duration of action, and we therefore hypothesized that a single dose of intraoperative methadone would reduce postoperative opioid requirements and pain intensity in bladder cancer patients undergoing RAC.</p><p><strong>Methods: </strong>We conducted a blinded randomized controlled clinical trial from July 2020 to August 2023. Patients scheduled to undergo RAC because of bladder cancer were randomized to receive intraoperative methadone (0.15 mg/kg^-1) or morphine (0.15 mg kg^-1) 1 h before endotracheal extubation. The primary outcome was opioid requirements after 24 h. Secondary outcomes were opioid requirements after 3 h, pain intensity at rest and during coughing, postoperative nausea and vomiting (PONV), sedation, hypoxemia, hypoventilation, time spent in the post-anesthetic care unit, and patient satisfaction.</p><p><strong>Results: </strong>A total of 114 patients were randomized. Data from 99 patients (14 females, 85 males; mean age 69.8 ± 8.9 years) were available for analysis; 52 received methadone and 47 received morphine. Opioid consumption was similar between the methadone group and morphine group at 3 h (median, mg, 45 (IQR 30 to 75) vs. 45 (IQR 15 to 82.5) p = .97) and at 24 h (median, mg, 125 (IQR 75 to 198.5) versus 105 (IQR 72 to 157.5), p = .29). Pain intensity was significantly lower in the morphine group at 48 h compared with the methadone group. Patient satisfaction at 24 h was increased in the methadone group compared with the morphine group (median, (IQR), NRS; 9 (IQR 7 to 10) versus 7 (IQR 4 to 9), p = .020). There were no differences between treatment groups in terms of time spent in the post-anesthetic care unit and the occurrence of opioid-related side effects.</p><p><strong>Conclusion: </strong>A single dose of intraoperative methadone does not reduce postoperative opioid requirements compared with a single dose of morphine in bladder cancer patients undergoing RAC.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14545"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic postsurgical pain following gastrointestinal surgery - A scoping review.","authors":"Amalie Rosendahl, Ida Marie Barsøe, Veronica Ott, Birgitte Brandstrup, Thordis Thomsen, Ann Merete Møller","doi":"10.1111/aas.14560","DOIUrl":"10.1111/aas.14560","url":null,"abstract":"<p><strong>Background: </strong>Chronic postsurgical pain (CPSP) has a great impact on quality of life and socioeconomic status. The mechanisms behind CPSP remain poorly understood, however type of surgical intervention seems to play a role. Gastrointestinal surgeries are common procedures, yet research in CPSP following gastrointestinal surgery is limited. The objective of this scoping review was to map the current literature on CPSP following gastrointestinal surgery, identifying how CPSP have been investigated, and which evidence gaps exist.</p><p><strong>Methods: </strong>This scoping review followed a pre-published protocol and PRISMA-ScR guidelines. A search was carried out in Medline, Embase, CINAHL, Cochrane Central, Clinicaltrials.Gov, and Google Scholar. Eligible studies were original studies involving adults, undergoing gastrointestinal surgery, who had a pain assessment ≥30 days postoperatively. A two-phase screening process and data charting were done by two independent reviewers.</p><p><strong>Results: </strong>A total of 53 studies were included, published between 2001 and 2024, predominantly across Europe and Asia. The range of CPSP prevalence reported was 3.3%-46.1%. Only half the studies clearly defined CPSP, and the timing and manner of pain assessment varied considerably. Twenty-seven studies assessed risk factors for developing CPSP: preoperative pain and acute postoperative pain were consistently significant.</p><p><strong>Conclusions: </strong>There was a wide consensus on CPSPs' negative impact on quality of life. CPSP following gastrointestinal surgery is prevalent and significantly impacts quality of life. Standardized definitions and methodologies to improve the comparability and reliability of the findings across studies are needed. Future research should focus on CPSP following specific surgical procedures to develop tailored prevention and treatment strategies.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14560"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin requirement trajectories during COVID-19 versus non-COVID-19 critical illness-A retrospective cohort study.","authors":"Navid Soltani, Henrike Häbel, Anca Balintescu, Marcus Lind, Jonathan Grip, Ragnar Thobaben, David Nelson, Johan Mårtensson","doi":"10.1111/aas.14536","DOIUrl":"10.1111/aas.14536","url":null,"abstract":"<p><strong>Background: </strong>The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality.</p><p><strong>Results: </strong>The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR.</p><p><strong>Conclusion: </strong>In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14536"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings from the 2024 Scandinavian Society of Anaesthesia and Intensive Care Congress in Oulu, Finland: Abstracts.","authors":"","doi":"10.1111/aas.14529","DOIUrl":"10.1111/aas.14529","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14529"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing the culture of chaos.","authors":"Martin I Sigurdsson","doi":"10.1111/aas.14563","DOIUrl":"10.1111/aas.14563","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14563"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient controlled epidural analgesia during labor: Protocol for a scoping review.","authors":"Magnus Grønbæk Henriksen, Nikoline Svensson, Ann Merete Møller","doi":"10.1111/aas.14548","DOIUrl":"10.1111/aas.14548","url":null,"abstract":"<p><strong>Background: </strong>Childbirth remains one of the most painful experiences for women. Patient-controlled epidural analgesia provides the women in labor with self-control and thereby a shorter time interval between onset of pain and administration of analgesia, thus potentially improving the childbirth experience. This scoping review aims to investigate PCEA during labor involving maternal satisfaction, risks of adverse effects and obstetric interventions by mapping the evidence and identifying gaps in the current evidence base.</p><p><strong>Methods: </strong>The forthcoming review will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) and the JBI methodology for scoping reviews. A systematic search will be carried out across major peer-reviewed databases and gray literature will be sought. All study types involving women in labor receiving PCEA will be eligible for inclusion. The extracted data will be charted regarding trial characteristics, population/participation characteristics, interventions, outcomes, and key findings.</p><p><strong>Results: </strong>The results will be presented through relevant tables, figures, and graphs when appropriate. Alongside this, we present the data descriptively to explain how the results align with the objectives of the review.</p><p><strong>Conclusion: </strong>PCEA offers women greater autonomy during childbirth, making it essential to examine its effects and potential risks. By mapping current evidence regarding PCEA, this review aims to identify knowledge gaps and provide insights to enhance maternal care and improve childbirth experiences.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14548"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to detection of serious adverse events by continuous vital sign monitoring versus clinical practice.","authors":"Marie Said Vang Jensen, Vibeke Ramsgaard Eriksen, Søren Straarup Rasmussen, Christian Sylvest Meyhoff, Eske Kvanner Aasvang","doi":"10.1111/aas.14541","DOIUrl":"10.1111/aas.14541","url":null,"abstract":"<p><strong>Background: </strong>Continuous vital sign monitoring detects far more severe vital sign deviations (SVDs) than intermittent clinical rounds, and deviations are to some extent related to subsequent serious adverse events (SAEs). Early detection of SAEs is pivotal to allow for effective interventions but the time relationship between detection of SAEs by continuous vital sign monitoring versus clinical practice is not well-described at the general ward.</p><p><strong>Aim: </strong>To quantify the time difference between detection of SAEs by continuous vital sign monitoring and clinical suspicion of deterioration (CSD) in major abdominal surgery patients.</p><p><strong>Methods: </strong>Five hundred and five patients had their vital signs continuously monitored in combination with usual clinical practice consisting of National Early Warning Score assessments at least every 8'th hour, assessments during rounds, and other kinds of staff-patient interactions. The primary outcome was the time difference between the first chart note of CSD versus the first SVD, detected by continuous vital sign monitoring, in patients with a subsequent confirmed SAE during or up to 48 h after end of continuous vital sign monitoring.</p><p><strong>Results: </strong>Out of the 505 continuously monitored patients, 142 patients had a combination of both postoperative SAE, CSD and SVD, and thus were included in the primary analysis. The median time from the first SVD to SAE was 42.8 h (interquartile range 19.8-72.1 h) compared to 13 minutes (interquartile range - 4.8 to 3.5 h) for CSD with a median difference of 48.1 h (95% confidence interval 43.0-54.8 h), p-value < .001.</p><p><strong>Conclusion: </strong>Continuous vital sign monitoring detects signs of oncoming SAEs in the form of SVD hours before CSD, potentially allowing for earlier and more effective treatments to reduce the extent of SAEs.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14541"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute amiodarone-induced pulmonary toxicity in adult ICU patients with new-onset atrial fibrillation-A systematic review.","authors":"Theodor Ling-Vannerus, Conni Skrubbeltrang, Olav L Schjørring, Morten H Møller, Bodil S Rasmussen","doi":"10.1111/aas.14535","DOIUrl":"10.1111/aas.14535","url":null,"abstract":"<p><strong>Background: </strong>New-onset atrial fibrillation or flutter (NOAF) is a common arrhythmia in adult intensive care unit (ICU) patients. Intravenous amiodarone is one of the most used anti-arrhythmic drugs, despite its risk of inducing acute amiodarone-induced pulmonary toxicity (APT). We aimed to outline the body of evidence on acute APT in ICU patients with NOAF.</p><p><strong>Methods: </strong>We performed a systematic search using the population, intervention, comparison, and outcome (PICO) approach. We included studies of adults admitted to the ICU, who developed NOAF during their ICU stay, were treated with amiodarone, and reported on acute APT, irrespective of research design. The CASE guidelines were applied to evaluate the quality of the included studies, and study results are reported in accordance with the preferred reporting items for systematic reviews and meta-analyses.</p><p><strong>Results: </strong>No randomised controlled trials or observational studies were identified. Nine case reports and one retrospective case series of fatal outcomes in ICU patients treated with amiodarone for NOAF constituted the evidence base. The quality of the included studies was high with a mean of 10 (range 8-12) of the 13 CASE guideline criteria fulfilled. The studies included a total of 16 critically ill adults who was diagnosed with acute APT after a mean of 9 days (range 2-20 days) following initiation of amiodarone with a mean total dose of amiodarone of 4553 mg (range 1100-13,500 mg) predominantly administrated intravenously. Three out of nine patients in the case reports died in the ICU during the amiodarone treatment. No long-term follow-up was conducted for the survivors.</p><p><strong>Conclusion: </strong>Acute APT in adult ICU patients treated with amiodarone for NOAF is poorly described and is based on a total of 16 reported cases. Additional studies assessing the safety of amiodarone in critically ill adults with NOAF in the ICU is warranted.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"e14535"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric anesthesia outcomes in Scandinavia: Everything sorted after APRICOT and NECTARINE?","authors":"Tom G Hansen, Thomas Engelhardt","doi":"10.1111/aas.14561","DOIUrl":"10.1111/aas.14561","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 1","pages":"e14561"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}