Acta Anaesthesiologica Scandinavica最新文献

{"title":"High-flow via a tracheostomy tube and speaking valve during weaning from mechanical ventilation and tracheostomy.","authors":"Peter H Egbers,&nbsp;Anna-Liisa Sutt,&nbsp;Jenny E Petersson,&nbsp;Liza Bergström,&nbsp;Eva Sundman","doi":"10.1111/aas.14305","DOIUrl":"10.1111/aas.14305","url":null,"abstract":"<p><strong>Background: </strong>Weaning from mechanical ventilation and tracheostomy after prolonged intensive care consume enormous resources with optimal management not currently well described. Restoration of respiratory flow via the upper airway is essential and early cuff-deflation using a one-way valve (OWV) is recommended. However, extended OWV use may cause dry airways and thickened secretions which challenge the weaning process. High-flow therapy via the tracheostomy tube (HFT-T) humidifies inspired air and may be connected via an in-line OWV (HFT-T-OWV) alleviating these problems. We aim to provide clinical and experimental data on the safety of HFT-T-OWV along with a practical guide to facilitate clinical use during weaning from mechanical ventilation and tracheostomy.</p><p><strong>Methods: </strong>Data on adverse events of HFT-T-OWV were retrieved from a quality register for patients treated at an intensive care rehabilitation center between 2019 and 2022. Benchtop experiments were performed to measure maximum pressures and pressure support generated by HFT-T-OWV at 25-60 L/min flow using two different HFT-T adapters (interfaces). In simulated airway obstruction using a standard OWV (not in-line) maximum pressures were measured with oxygen delivered via the side port at 1-3 L/min.</p><p><strong>Results: </strong>Of 128 tracheostomized patients who underwent weaning attempts, 124 were treated with HFT-T-OWV. The therapy was well tolerated, and no adverse events related to the practice were detected. The main reason for not using HFT-T-OWV was partial upper airway obstruction using a OWV. Benchtop experiments demonstrated HFT-T-OWV maximum pressures <4 cmH₂ O and pressure support 0-0.6 cmH₂ O. In contrast, 1-3 L/min supplemental oxygen via a standard OWV caused pressures between 84 and 148 cmH₂ O during simulated airway obstruction.</p><p><strong>Conclusions: </strong>Current study clinical data and benchtop experiments indicate that HFT-T-OWV was well tolerated and appeared safe. Pressure support was low, but humidification may enable extended use of a OWV without dry airway mucosa and thickened secretions. Results suggest the treatment could offer advantages to standard OWV use, with or without supplementary oxygen, as well as to HFT-T without a OWV, for weaning from mechanical ventilation and tracheostomy. However, for definitive treatment recommendations, randomized clinical trials are needed.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1403-1413"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10150190","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":"Carbon dioxide: A stronger driver of cardiac output than oxygen?","authors":"Jacob Karlsson,&nbsp;Mats Wallin,&nbsp;Magnus Hallbäck,&nbsp;Per-Arne Lönnqvist","doi":"10.1111/aas.14310","DOIUrl":"10.1111/aas.14310","url":null,"abstract":"Dear Editor, The regulation of breathing by the gases oxygen (O2) and carbon dioxide (CO2) has since long been established, showing that CO2, to a much larger extent than O2, governs the respiratory effort. However, the effect of the same gases in the regulation of cardiac output (CO) has received limited scientific interest. Due to the fundamental importance of oxygen for the well-being of the organism, it has become accepted that it is O2 that mainly governs CO. However, extra-corporeal circulation experiments in animals, which can tightly and individually alter the levels of O2 and CO2 in the blood, have shown that increasing CO2 results in a substantial increase in CO, whereas a reduction of O2 will need to be pronounced to trigger a later and more moderate increase in CO (please confer with regulation of respiration). Further, for logistic reasons, it seems quite unlikely that respiration and circulation would be controlled by two different gas parameters (CO2—respiration; O2—circulation) since this would create great difficulty in achieving optimal ventilation/perfusion matching in the lung, which is a prerequisite for optimal gas exchange. Therefore, it would be more logical if both respiration and circulation were controlled by the same gas, that is, CO2. If accepting the above, then removal of CO2 is the fundamental gaseous driver of circulation and the resulting increased O2 uptake is a passive secondary phenomenon to the increased need to excrete CO2. The aim of this communication was to re-evaluate our previous animal data to potentially find further data in support of CO2 being the main gaseous driver of circulation, in the context of normal circulation.","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1439-1440"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208354","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":"Remimazolam for sedation: A protocol for a systematic review with meta-analysis, trial sequential analysis, and GRADE approach.","authors":"Lasse Stehr-Pingel,&nbsp;Mathias Maagaard,&nbsp;Casper Duevang Tvarnø,&nbsp;Lars Peter Kloster Andersen,&nbsp;Jakob Hessel Andersen,&nbsp;Ole Mathiesen","doi":"10.1111/aas.14316","DOIUrl":"10.1111/aas.14316","url":null,"abstract":"Procedural sedation aims to facilitate a successful diagnostic or therapeutic procedure. The pharmacokinetic properties and pharmacodynamic effects need to be taken into consideration when choosing the ideal sedative. Midazolam and propofol are frequently employed. However, they are associated with respiratory depression with increasing dosage. Also, midazolam has a potentially unpredictable pharmacodynamic response and propofol may cause hypotension and injection site pain. Remimazolam may provide a superior alternative due to its rapid pharmacodynamic profile and insignificant circulatory effects.","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1432-1438"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10353669","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":"Ketamine for postoperative pain treatment in spinal surgery: Systematic review with meta-analysis and trial sequential analysis.","authors":"Anders Schou Tornøe,&nbsp;Alison Holten Pind,&nbsp;Christina Cleveland Westerdahl Laursen,&nbsp;Cheme Andersen,&nbsp;Mathias Maagaard,&nbsp;Ole Mathiesen","doi":"10.1111/aas.14307","DOIUrl":"10.1111/aas.14307","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to assess the beneficial and harmful effects of perioperative pain treatment with ketamine in patients undergoing spinal surgery.</p><p><strong>Methods: </strong>We searched Medline, Embase, and CENTRAL from inception until 15 February 2023 for randomised clinical trials comparing ketamine with placebo or no intervention in patients undergoing spinal surgery. The primary outcomes were cumulative opioid consumption at 24 h postoperatively and serious adverse events. We adhered to recommendations of the Cochrane Collaboration and performed meta-analysis, Trial Sequential Analysis (TSA) to assess the risks of random errors, risk of bias assessment to evaluate the risks of systematic errors, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>We included a total of 28 randomised clinical trials enrolling 2110 participants providing data for our pre-defined outcomes. Twenty-three trials enrolled adult participants and 5 trials enrolled paediatric participants. Three trials were at low risk of bias. Meta-analysis and TSA of trials including adults showed that ketamine versus placebo or no intervention seemed to reduce the cumulative 24-h opioid consumption (mean difference -17.57 mg; TSA-adjusted 95% confidence interval, -24.22 to -10.92; p < .01; low certainty of evidence), and there was no evidence of a difference of ketamine versus placebo or no intervention on the risk of serious adverse events (risk ratio 2.16; 96.7% confidence interval, 0.35 to 13.17; p = .36; very low certainty of evidence).</p><p><strong>Conclusion: </strong>In adults undergoing spinal surgery, ketamine may reduce cumulative 24-h opioid consumption. Ketamine may increase the occurrence of serious adverse events, but the evidence was very uncertain.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1306-1321"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892645","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":"Hypotension during transsphenoidal pituitary surgery associated with increase in plasma levels of brain injury markers.","authors":"Martin Thorsson,&nbsp;Tobias Hallén,&nbsp;Daniel S Olsson,&nbsp;Kaj Blennow,&nbsp;Henrik Zetterberg,&nbsp;Gudmundur Johannsson,&nbsp;Thomas Skoglund,&nbsp;Jonatan Oras","doi":"10.1111/aas.14315","DOIUrl":"10.1111/aas.14315","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing pituitary surgery may experience short- and long-term postoperative morbidity. Intraoperative factors such as hypotension might be a contributing factor. Our aim was to investigate the association between intraoperative hypotension and postoperative plasma levels of tau, neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) as markers of perioperative brain injury.</p><p><strong>Methods: </strong>Between June 2016 and October 2017, 35 patients from the Gothenburg Pituitary Tumor Study were included. For tau, NfL, and GFAP, concentrations were measured in plasma samples collected before and immediately following surgery, and on postoperative days 1 and 5. The difference between the highest postoperative value and the value before surgery was used for analysis (∆tau_peak , ∆NfL_peak , ∆GFAP_peak ). Intraoperative hypotension was defined as the area under the curve of an absolute threshold below 70 mmHg (AUC70) and a relative threshold below 20% (AUC20%) of the baseline mean arterial blood pressure.</p><p><strong>Results: </strong>Plasma tau and GFAP were highest immediately following surgery and on day 1, while NfL was highest on day 5. There was a positive correlation between AUC20% and both ∆tau_peak (r²  = .20, p < .001) and ∆NfL_peak (r²  = .26, p < .001). No association was found between AUC20% and GFAP or between AUC70 and ∆tau_peak , ∆NfL_peak or ∆GFAP_peak .</p><p><strong>Conclusion: </strong>Intraoperative relative, but not absolute, hypotension was associated with increased postoperative plasma tau and NfL concentrations. Patients undergoing pituitary surgery may be vulnerable to relative hypotension, but this needs to be validated in future prospective studies.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1363-1372"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929897","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":"The effect of intraoperative positive end expiratory pressure and tidal volume on postoperative acute kidney injury after orthopedic surgery.","authors":"Federico Almonacid-Cardenas,&nbsp;Remie Saab,&nbsp;Eitan Scher Nemirovsky,&nbsp;Eva Rivas,&nbsp;Jorge Araujo-Duran,&nbsp;Guangmei Mao,&nbsp;Wael Ali Sakr Esa,&nbsp;Kurt Ruetzler,&nbsp;Maged Argalious,&nbsp;Alparslan Turan","doi":"10.1111/aas.14314","DOIUrl":"10.1111/aas.14314","url":null,"abstract":"<p><strong>Background: </strong>To test whether higher intraoperative PEEP levels and/or higher TV levels are associated with higher incidence of postoperative AKI within the first postoperative week, in adult patients having orthopedic surgeries under general anesthesia.</p><p><strong>Methods: </strong>We conducted a sub analysis of a non-randomized alternating intervention cross over study performed in patients undergoing orthopedic surgery under general anesthesia at Cleveland Clinic, Cleveland, OH. We included four different combinations of PEEP (5 or 8 cm H₂ O) and TV (6 or 10 mL/kg of PBW) that alternated each week in the six orthopedic operating rooms. Our primary outcome was postoperative AKI defined by the KDIGO criteria with baseline creatinine as the closest preoperative value to the time of surgery obtained within 30 days and postoperative value as the highest creatinine value within 7 days after surgery. Secondary outcome was the maximum postoperative in-hospital creatinine level within seven postoperative days.</p><p><strong>Main results: </strong>A total of 1933 patients were included in the analysis. The incidence of AKI was 6.8% in the study population and similar in high TV versus low TV group and high PEEP versus low PEEP group. Neither TV nor PEEP significantly impacted AKI incidence. The estimated odds ratio of AKI comparing TV = 6 mL/kg to TV = 10 mL/kg was 0.96 (97.5% CI: 0.63, 1.46; p = .811); while the estimated odds ratio of AKI comparing PEEP = 5cm H₂ O to PEEP = 8cm H₂ O was 0.92 (97.5% CI: 0.60, 1.39; p = .623). No interaction was found between TV and PEEP on AKI. Additionally, neither TV nor PEEP had a significant effect on the seven postoperative day creatinine levels.</p><p><strong>Conclusion: </strong>Higher levels of PEEP or TV during mechanical ventilation in adult patients undergoing orthopedic surgeries under general anesthesia do not increase the odds of developing postoperative AKI within the narrow limits studied.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1348-1355"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169984","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":"Rebound pain and postoperative pain profile following brachial plexus block compared to general anaesthesia-An observational study.","authors":"Ann-Kristin Schubert,&nbsp;Thomas Wiesmann,&nbsp;Christian Volberg,&nbsp;Jenny Riecke,&nbsp;Alexander Schneider,&nbsp;Hinnerk Wulf,&nbsp;Hanns-Christian Dinges","doi":"10.1111/aas.14318","DOIUrl":"10.1111/aas.14318","url":null,"abstract":"<p><strong>Background: </strong>Regional anaesthesia has the benefit of reducing the need for systemic analgesia and therefore, potentially reducing undesired side effects. With the end of the sensory nerve block however, many patients report severe pain that requires therapy with opioids and often compromise the initial opioid sparing effect. This study aimed to characterise the postoperative pain profile and the phenomenon of rebound pain after axillary brachial plexus anaesthesia (RA) compared to general anaesthesia (GA).</p><p><strong>Design: </strong>Single-centre observational, stratified cohort study.</p><p><strong>Setting: </strong>The study was conducted at University Hospital Marburg from May 2020 until September 2022.</p><p><strong>Participants: </strong>One hundred thirty-two patients receiving elective hand and forearm surgery were enrolled in this study.</p><p><strong>Interventions: </strong>Group RA received ultrasound-guided brachial plexus anaesthesia via the axillary approach with 30 mL of prilocaine 1% and 10 mL ropivacaine 0.2%. Group GA received balanced or total intravenous general anaesthesia.</p><p><strong>Main outcome measures: </strong>Primary endpoint were integrated pain scores (IPS) within 24 h postoperatively. Secondary endpoints were pain scores (NRS 0-10), morphine equivalents, patient satisfaction, quality of recovery and opioid-related side effects.</p><p><strong>Results: </strong>One hundred thirty-two patients were analysed of which 66 patients received brachial plexus block and 66 patients received general anaesthesia. Following RA significantly lower IPS were seen directly after surgery (p < .001) and during the post-anaesthesia care unit interval (p < .001) but equalised after 3 h at the ward. No overshoot in pain scores or increased opioid consumption could be detected. Patient satisfaction and postoperative recovery were comparable between both groups.</p><p><strong>Conclusion: </strong>The IPS and NRS was initially lower in the RA group, increased with fading of the block until equal to the GA group and equal thereafter. Although various definitions of rebound pain were met during this phase, the opioid sparing effect of regional anaesthesia was not counteracted by it. The incidence of episodes with uncontrolled, severe pain did not differ between groups. We found no clinical implications of rebound pain in this setting, since the RA group did not show higher pain scores than the GA group at any time point.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS00021764).</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1414-1422"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112272","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":"Pressure-controlled versus manual facemask ventilation for anaesthetic induction in adults: A randomised controlled non-inferiority trial.","authors":"Lennart Edmark,&nbsp;Emma-Karin Englund,&nbsp;Alexandra Schöttle Jonsson,&nbsp;Almira Teskeredzic Zilic,&nbsp;Per Cajander,&nbsp;Erland Östberg","doi":"10.1111/aas.14308","DOIUrl":"10.1111/aas.14308","url":null,"abstract":"<p><strong>Background: </strong>Pressure-controlled face mask ventilation (PC-FMV) with positive end-expiratory pressure (PEEP) after apnoea following induction of general anaesthesia prolongs safe apnoea time and reduces atelectasis formation. However, depending on the set inspiratory pressure, a delayed confirmation of a patent airway might occur. We hypothesised that by lowering the peak inspiratory pressure (PIP) when using PC-FMV with PEEP, confirmation of a patent airway would not be delayed as studied by the first return of CO₂ , compared with manual face mask ventilation (Manual FMV).</p><p><strong>Methods: </strong>This was a single-centre, randomised controlled non-inferiority trial. Seventy adult patients scheduled for elective day-case surgery under general anaesthesia with body mass index between 18.5 and 29.9 kg m^-2 _, American Society of Anesthesiologists (ASA) classes I-III, and without anticipated difficult FMV, were included. Before the start of pre-oxygenation and induction of general anaesthesia, participants were randomly allocated to receive ventilation with either PC-FMV with PEEP, at a PIP of 11 and a PEEP of 6 cmH₂ O or Manual FMV, with the adjustable pressure-limiting valve set at 11 cmH₂ O. The primary outcome variable was the number of ventilatory attempts needed until confirmation of a patent airway, defined as the return of at least 1.3 kPa CO₂ .</p><p><strong>Results: </strong>The return of ≥1.3 kPa CO₂ on the capnography curve was observed after mean ± SD, 3.6 ± 4.2 and 2.5 ± 1.9 ventilatory attempts/breaths with PC-FMV with PEEP and Manual FMV, respectively. The difference in means (1.1 ventilatory attempts/breaths) had a 99% CI of -1.0 to 3.1, within the accepted upper margin of four breaths for non-inferiority.</p><p><strong>Conclusion: </strong>Following induction of general anaesthesia, PC-FMV with PEEP was used without delaying a patent airway as confirmed with capnography, if moderate pressures were used.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1356-1362"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9836900","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":"Glutamate infusion associated with reduced rises of p-Copeptin after coronary surgery: Substudy of GLUTAMICS II.","authors":"Rolf Svedjeholm,&nbsp;Gabriele Ferrari,&nbsp;Farkas Vanky,&nbsp;Örjan Friberg,&nbsp;Jonas Holm","doi":"10.1111/aas.14303","DOIUrl":"10.1111/aas.14303","url":null,"abstract":"<p><strong>Background: </strong>Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG.</p><p><strong>Methods: </strong>A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10-20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes.</p><p><strong>Results: </strong>We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02).</p><p><strong>Conclusions: </strong>Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1373-1382"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045423","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":"Should videolaryngoscopy become standard practice to facilitate tracheal intubation in anaesthesia, critical care and emergency care?","authors":"Markus B Skrifvars","doi":"10.1111/aas.14309","DOIUrl":"10.1111/aas.14309","url":null,"abstract":"Airway management may be the most important skill of the anaesthesiologist and the critical care and emergency physician. The successful passing of an endotracheal tube intubation (ETI) into the trachea facilitates oxygenation and ventilation and protects patients from aspiration of gastric content. Not unexpectedly, ETI is also associated with complications, including hypoxia, hypotension, oesophageal placement and even cardiac arrest. Some of these complications may be related to the administration of the drugs used to facilitate ETI, but failure to place the tube may result in hypoxia, hypoventilation and ultimately cardiac arrest. The proportion of successful intubations on the first attempt has been seen as a performance measure, and not unexpectedly, with more intubation attempts, the prevalence of complications increases. In recent years, the use of videolaryngoscopy has emerged as a means of facilitating ETI, and its use is a part of many airway protocols, both in hospital and in pre-hospital settings. Recently, two important large randomized controlled trials have been published examining the use of videolaryngoscopy compared with direct laryngoscopy. The first was the DEVICE trial published this June in the New England Journal of Medicine. The study, conducted in the United States, randomized 1400 patients needing intubation in the emergency department to ETI with videolaryngoscopy or direct laryngoscopy. The study included specialists in emergency medicine, intensive care and a minority of anaesthetists. The primary outcome was the proportion of successful intubations on the first attempt. The sample size assumed a first-pass intubation rate of 80%; therefore, the study was powered to be able to show a 5% absolute difference with the use of videolaryngoscopy. The study included several secondary endpoints, such as the prevalence of hypoxia and hypotension, and the need for vasopressors and cardiac arrest following the procedure. The study was stopped early after an interim analysis showed the efficacy of the videolaryngoscopy compared with direct laryngoscopy after the inclusion of 1420 patients. The study showed a 15% difference (number needed to treat of 6–7) in achieving the first success of ETI. The ETI was performed by 370 unique operators, with an average experience of around 50 intubations. Before the ETI procedure, about 70%–80% of the ETI were predicted to be easy or moderately easy according to an assessment of the patient by the operator. Importantly, most of the operators already had previous experience with the use of videolaryngoscopy. In addition, the passing of the intubation tube was, in most cases, performed with the help of a bougie or stylet. This may be important, as a previous study that did not use these airway adjuncts with a similar frequency failed to show the superiority of videolaryngoscopy over direct laryngoscopy. With regard to the secondary endpoints, there were no statistically significant differences i","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":" ","pages":"1292-1293"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9822492","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}