Acta Anaesthesiologica Scandinavica最新文献

{"title":"Conus medullaris termination: Assessing safety of spinal anesthesia in the L2-L3 interspace.","authors":"James E Paul, Lisa A Udovic, Kathleen Oman, Thomas Kim, Leora Bernstein, Luigi Matteliano, Nina Singh, Alexa Caldwell, Thuva Vanniyasingam, Lehana Thabane","doi":"10.1111/aas.14580","DOIUrl":"10.1111/aas.14580","url":null,"abstract":"<p><strong>Background: </strong>Classic teaching is that spinal anesthesia is safe at or below the L2-L3 interspace. To evaluate this, we sought to determine the percentage of individuals with a conus medullaris termination (CMT) level at or below the L1-L2 interspace. Further, the relationship of CMT level to age, sex, body mass index (BMI), and spinal pathology was examined, as was the reliability of using Tuffier's line (TL) as an anatomical landmark.</p><p><strong>Methods: </strong>This retrospective study evaluated magnetic resonance images of 944 adult patients to determine the CMT level. The relationship between age, sex, height, BMI, and spinal pathology and CMT level was explored by logistic regression. The correspondence of the TL line to the L4-L5 interspace and the presence of overlap with the CMT were examined using 720 lumbar x-rays of the same patient cohort.</p><p><strong>Results: </strong>Of 944 patients (mean age, 57.8 years; 49% male), 18.9% had CMT at or below the L1-L2 interspace, and spinal anesthesia at the L2-L3 interspace was found to carry a 0.7% incidence of neuraxial risk. Only the presence of congenital spinal abnormalities was found to be significantly predictive of having a CMT at or below the L1-L2 interspace. TL was found to correspond to the L4-L5 interspace in 99.8% of patients with lumbar x-rays.</p><p><strong>Conclusions: </strong>Spinal anesthesia at the L2-L3 interspace, using TL as an anatomical landmark, is safe in >99% of patients. However, caution must be exercised in all patients as demographic variables were found to be limited in predicting a low CMT level.</p><p><strong>Editorial comment: </strong>Unlike previous smaller studies, this retrospective study included MRI data from a total of 944 patients. The present study confirms that spinal anesthesia at the L2-L3 interspace or below can be considered safe. The findings indicate that Tuffier's line can be used as a reliable anatomical landmark.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14580"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062972","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":"Intubating conditions during rapid sequence induction with either rocuronium or suxamethonium in elderly patients. A randomised study.","authors":"Matias Vested, Andreas Creutzburg, Christian S Meyhoff, Marie Louise Rovsing, Tatiana Nielsen, Fabio Rosa, Eske K Aasvang, Hannah Mollerup, Thomas Fuchs-Buder, Lars Simon Rasmussen","doi":"10.1111/aas.14589","DOIUrl":"10.1111/aas.14589","url":null,"abstract":"<p><strong>Background: </strong>During rapid sequence induction, either rocuronium 1.0 mg kg^-1 or suxamethonium 1.0 mg kg^-1 can be administered to facilitate endotracheal intubation. We hypothezised that rocuronium provided a larger proportion of excellent intubating conditions compared to suxamethonium in elderly patients.</p><p><strong>Methods: </strong>A total of 90 patients 80 years or above with American Society of Anesthesiologists physical health Classes I-IV, and a body mass index < 35 kg m^-1-2 were randomised to either rocuronium 1.0 mg kg^-1 or suxamethonium 1.0 mg kg^-1 during rapid sequence induction with intubation using a video laryngoscope. After 60 s, tracheal intubating conditions were evaluated using the Fuchs-Buder scale by a blinded investigator, and the primary outcome was the proportion of patients with excellent intubating conditions. Further outcomes included first pass success rate, intubating conditions according to the intubating difficulty scale (IDS), onset time and postoperative occurrence of muscle soreness, hoarseness and sore throat.</p><p><strong>Results: </strong>All patients were evaluated for the primary outcome. Excellent intubating conditions occurred in 36 patients (73%) versus 31 (75%) in the rocuronium group and suxamethonium group, respectively (95% confidence interval [CI]: -16 to 20) (p = .82). The first pass success rate was 48 (98%) versus 40 (98%) comparing the rocuronium group with the suxamethonium group, respectively (p = .90). No difference in IDS score was found; median 0 (interquartile ranges [IQR]: 0-1) versus median 0 (IQR: 0-1) (p = .48). Onset time was significantly shorter in the suxamethonium group 99 versus 131 s (p = .01) (95% CI: 7 to 57). Finally, no difference was found in the occurrence of muscle soreness, hoarseness or sore throat postoperatively.</p><p><strong>Conclusion: </strong>No important difference in intubating conditions was found during rapid sequence induction after the administration of either rocuronium 1.0 mg kg^-1 or suxamethonium 1.0 mg kg^-1 in patients 80 years or above.</p><p><strong>Editorial comment: </strong>This reports a superiority trial comparing standardised doses of rocuronium and suxamethonium at 60 s for quality of intubating conditions in the rapid sequence context, and this in an elderly cohort. The findings showed no difference between the drugs concerning intubation outcomes, though the onset or time to peak effect was shorter for suxamethonium, again demonstrated in a cohort 80 years old or older.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14589"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254457","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":"Comparison of plasma concentration and sedative effect of sublingual and intranasal dexmedetomidine in children: A double-blind randomised controlled study.","authors":"Armanullah Khan, Renu Sinha, Kanil Ranjith Kumar, Trimurty Velpandian, Souvik Maitra, Bikash Ranjan Ray","doi":"10.1111/aas.14583","DOIUrl":"10.1111/aas.14583","url":null,"abstract":"<p><strong>Background: </strong>Pharmacokinetics and sedative effects of sublingual dexmedetomidine have not been established in children. The primary aim was to compare peak plasma concentration, time to reach peak plasma concentration and area under the curve with 2 μg/kg sublingual and intranasal dexmedetomidine. The secondary aims were to compare the depth of sedation, parental separation anxiety, mask acceptance, heart rate changes, analgesic requirements and recovery time with 2 μg/kg sublingual and intranasal dexmedetomidine in children.</p><p><strong>Method: </strong>Thirty children between 2 and 12 years, weighing 10-30 kg, scheduled for surgeries were divided into two groups. Thirty minutes before the induction of anaesthesia, children were premedicated with 2 μg/kg dexmedetomidine either by intranasal drops (Group N) or sublingual wafer (Group S). Five venous blood samples were collected to measure dexmedetomidine plasma concentrations at 15, 30, 45, 60 and 120 min from dexmedetomidine administration. Sedation, parental separation anxiety, mask acceptance and heart rate were recorded. Recovery, pain and fentanyl requirements were assessed.</p><p><strong>Results: </strong>Demographic data was comparable. Median interquartile range (IQR) dexmedetomidine peak plasma concentration in Group N (0.764 [0.650-0.820]) ng/mL was significantly higher than in Group S (0.593 [0.364-0.754]) ng/mL (p = .014). Plasma concentration was significantly higher at 30 and 45 min in Group N as compared to Group S (p < .05). The median (IQR) time to reach peak plasma concentration was shorter in Group N (45 [45-120]) minutes than in Group S (60 [45-60]) minutes, (p = .814). The median (IQR) area under the concentration-time curve was significantly higher in Group N (1.062 [0.848-1.20]) ng/mL.h in comparison to Group S (0.866 [0.520-1.05]) ng/mL.h (p = .031). Comparable sedation was achieved at 25 min in both groups. No child required treatment for decreased heart rate. Parental separation anxiety, mask acceptance, recovery and analgesic requirements were comparable.</p><p><strong>Conclusions: </strong>Intranasal 2 μg/kg dexmedetomidine resulted in significantly higher peak plasma concentration and time to reach peak plasma concentration than sublingual wafers. Sublingual and intranasal dexmedetomidine resulted in comparable sedation, parental separation and mask acceptance.</p><p><strong>Editorial comment: </strong>This study compared the pharmacokinetics and sedative effects of sublingual versus intranasal dexmedetomidine in children, finding that intranasal administration resulted in significantly higher peak plasma concentration and faster time to peak concentration. Both routes achieved comparable sedation, parental separation anxiety scores and mask acceptance, with no significant adverse effects observed.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14583"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062866","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":"Tactical Emergency Medical Services in Copenhagen, Denmark: A mixed methods design study introducing a new concept.","authors":"Jonas Erasmus Egede Glahn, Kim Minh Michael Heltø, Henrik Alstrøm, Marian Christin Petersen, Rune Gärtner","doi":"10.1111/aas.70003","DOIUrl":"10.1111/aas.70003","url":null,"abstract":"<p><strong>Aims and objectives: </strong>The purpose of this study was to introduce the concept of Tactical Emergency Medical Services (TEMS) in Denmark and to explore the TEMS providers' and the Danish Police Forces' confidence in the TEMS concept in case of a terrorist attack within the Capital Region of Denmark.</p><p><strong>Background: </strong>Terrorist attacks pose a major challenge to prehospital emergency medical services when it comes to reaching trapped victims. The threat to healthcare professionals limits access and creates a so-called therapeutic vacuum, leading to delayed treatment and evacuation of victims and ultimately increases mortality.</p><p><strong>Methods: </strong>This study used a mixed methods triangulation approach, integrating qualitative data from an interview study and quantitative data from a register study. The interview study consisted of 18 semistructured interviews conducted across three interview groups (Copenhagen TEMS physicians/paramedics, senior on-site commanders, and tactical and medical officers from the Copenhagen Police Department) with six participants in each group. Data from the interview study were analyzed using thematic framework analysis. The register study used data from the TEMS database, including 61 assignments from 2019 to 2020, that were analyzed using descriptive statistics.</p><p><strong>Results: </strong>The interview study found three core themes in each interview group. The main findings included insights on the advantages of having healthcare professionals in the warm zone, the prerequisites for the concept's success, TEMS's cooperation with the Danish Police Force, and challenges concerning healthcare providers inside tactical zones. The participants expected TEMS' presence inside the warm zone could improve triage and medical treatment, free police resources, increase police safety, optimize preparedness of the health sector, and significantly reduce the therapeutic vacuum. Data from the register study demonstrated that TEMS have had prior assignments in the warm and hot zones.</p><p><strong>Conclusion: </strong>All participating groups have high confidence in TEMS to close the gap of the therapeutic vacuum and deliver advanced physician and paramedic-based tactical medicine inside the warm zone in case of a terrorist attack in Copenhagen, Denmark.</p><p><strong>Editorial comment: </strong>This study includes both provider interviews and registry data to support insight into processes of Tactical Emergency Medicine. The authors discuss possible advantages of having emergency medical personnel in the major incident area early to support a coordinated response.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70003"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439698","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":"Clinical leadership education-A scoping review protocol.","authors":"Naja Vaaben, Peter Dieckmann, Ann Merete Møller","doi":"10.1111/aas.14591","DOIUrl":"10.1111/aas.14591","url":null,"abstract":"<p><strong>Introduction: </strong>Leadership is a key skill for physicians, but studies show that many junior doctors feel unprepared for the role as a leader. In recent years, there has been increasing interest and research into the training and development of clinical leadership, revolving around leadership in situations with direct patient care and as opposed to the administrative leadership of a department. However, the lack of consensus on how best to teach leadership, how the education should be structured, as well as a standardized definition and measure for good leadership, complicates training, assessment, and comparison of approaches in both research and education.</p><p><strong>Objective: </strong>The aim of this study is to map out the existing body of research on leadership education for physicians and medical students and identify any gaps in this literature.</p><p><strong>Methods: </strong>The scoping review will follow the Arksey and O'Malley (Arksey and O'Malley, Int J Soc Res Methodol. 2005; 8(1):19-32) framework, Joanna Briggs Institute methodology (JBI Manual for Evidence Synthesis-JBI Global Wiki) and PRISMA_ScR (Tricco et al., Ann Intern Med. 2018; 169(7):467-473). A systematic search will be conducted across the following databases: PubMed, Cochrane, Embase, Ebsco, Medline, and Google scholar. Two independent reviewers will screen titles and abstracts, then review the full texts of articles. Data will be extracted and presented in line with the review questions.</p><p><strong>Strengths and limitations of this study: </strong>The study will use a structured approach, as guided by Arksey and O'Malley and JBI methodology. Studies not written in English, Danish, German, Swedish, and Norwegian will be translated using available software. This review will not include a formal assessment of the study quality or meta-analysis, as it is a scoping review.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14591"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481992","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":"Hypotension after anesthesia induction in patients taking tricyclic antidepressants-A case series.","authors":"Mads Lodsgaard, Birgitte Bech Melchiors, Mogens Krøigaard, Lene Heise Garvey","doi":"10.1111/aas.70001","DOIUrl":"10.1111/aas.70001","url":null,"abstract":"<p><strong>Background: </strong>Hypotension is commonly observed after induction of anesthesia. Risk factors for intraoperative hypotension include higher ASA class, older age, propofol use, combined general/regional anesthesia, emergency surgery, and use of antihypertensives. Patients who are treated with tricyclic antidepressants (TCAs) may develop severe hypotension in connection with surgery and anesthesia, not responding to vasopressors such as phenylephrine and ephedrine, and use of adrenaline or noradrenaline are necessary to restore the blood pressure. Anaphylaxis may be suspected due to the rapid onset and resistance to usual treatments leading to referral for allergy investigation. The aim of this paper was to identify and describe the clinical characteristics of patients referred to the Danish Anesthesia Allergy Center (DAAC) with perioperative hypotension, without elevation in tryptase, and with negative allergy investigations, who were on regular treatment with TCAs. The pharmacological mechanism behind this phenomenon will also be explored.</p><p><strong>Methods: </strong>Patients were identified from the DAAC database. Patients with hypotension (systolic blood pressure <75 mmHg) as the only symptom and negative allergy investigations and patients on antidepressants were included. The study period was 2011-2019.</p><p><strong>Results: </strong>Ten patients were identified. Hypotension occurred after anesthesia induction, the median time from induction to the onset of hypotension was 7.5 min. Eight needed adrenaline or noradrenaline to restore blood pressure. No allergen was identified on detailed investigation and serum tryptase was not significantly elevated.</p><p><strong>Conclusion: </strong>Monosymptomatic perioperative hypotension without a significant increase in serum tryptase can be caused by TCAs and this is an important differential diagnosis to anaphylaxis. In patients on regular treatment with TCA perioperative hypotension responds well to noradrenaline or adrenaline but less well to vasopressors such as phenylephrine and ephedrine used perioperatively.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70001"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432165","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":"Intraoperative opioid administrations, rescue doses in the post-anaesthesia care unit and clinician-perceived factors for dose adjustments in adults: A Danish nationwide survey.","authors":"Trang Xuan Minh Tran, Mik Wetterslev, Anders Kehlet Nørskov, Christian Sylvest Meyhoff, Markus Harboe Olsen, Theis Skovsgaard Itenov, Ole Mathiesen, Anders Peder Højer Karlsen","doi":"10.1111/aas.70000","DOIUrl":"10.1111/aas.70000","url":null,"abstract":"<p><strong>Background: </strong>The impact of demographic- and surgical factors on individual perioperative opioid requirements is not fully understood. Anaesthesia personnel adjust opioid administrations based on their own clinical experience, expert opinions and local guidelines. This survey aimed to assess the current practice of anaesthesia personnel regarding intraoperative opioid treatment for postoperative analgesia and rescue opioid dosing strategies in the post-anaesthesia care unit in Denmark.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey with 37 questions addressing pain management and opioid-dosing strategies. Local site investigators from 46 of 47 public Danish anaesthesia departments distributed the survey. Data collection took place from 5 February to 30 April 2024.</p><p><strong>Results: </strong>Of the 4187 survey participants, 2025 (48%) answered. Intra- and postoperative opioid doses were adjusted based on chronic pain, age, preoperative opioid use, body weight and type of surgery. Between 84% and 89% of respondents adhered to and had perioperative pain management guidelines available. Respondents preferred intraoperative fentanyl (44%) and morphine (36%) to prevent postoperative pain. Median intraoperative intravenous morphine equivalents ranged from 0.12 to 0.38 mg/kg in clinical scenarios. In these cases, the following variables were assembled in different combinations to assess their impact on dosing: age (30 vs. 65 years), sex (female vs. male), ASA score (1 vs. 3) and type of surgery (anterior cruciate ligament vs. laparoscopic cholecystectomy surgery). Respondents preferred intravenous morphine and fentanyl for moderate and severe postoperative pain, respectively. Median postoperative rescue doses were 0.06-0.12 mg/kg in clinical scenarios based on shifting combinations of the variables: age (30 vs. 65 years), ASA score (1 vs. 3) and degree of expected pain (moderate vs. severe).</p><p><strong>Conclusion: </strong>Respondents preferred fentanyl and morphine for postoperative pain control with considerable variation in choice of opioid and morphine equivalent dose. Respondents expressed that guidelines were highly available and strongly adhered to. Opioid dosing was predominantly guided by chronic pain, age, preoperative opioid use, body weight and type of surgery.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e70000"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456553","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":"Exploring management reasoning when discharging high-risk postoperative patients from the post-anaesthesia care unit.","authors":"Lea Baunegaard Hvidberg, Hejdi Gamst-Jensen, Karlen Bader-Larsen, Nicolai Bang Foss, Eske Kvanner Aasvang, Martin Grønnebæk Tolsgaard","doi":"10.1111/aas.14590","DOIUrl":"10.1111/aas.14590","url":null,"abstract":"<p><strong>Introduction: </strong>Decision-support tools for detecting physiological deterioration are widely used in clinical medicine but have been criticised for fostering a task-oriented culture and reducing the emphasis on clinical reasoning. Little is understood about what influences clinical decisions aided by decision-support tools, including professional standards, policies, and contextual factors. Therefore, we explored management reasoning employed by anaesthesiologists and PACU nurses in the post-anaesthesia care unit during the discharge of high-risk postoperative patients.</p><p><strong>Methods: </strong>A qualitative constructivist study, conducting 18 semi-structured with 6 anaesthesiologists and 12 nurses across three Danish teaching hospitals. We analysed data through thematic analysis, utilising Michael Lipsky's theory of \"street-level bureaucracy\" in combination with David A. Cook's Management Reasoning Framework as a sensitising concept.</p><p><strong>Results: </strong>Standards are frequently ambiguous, requiring interpretation and prioritisation. This allows for professional discretion by circumventing established policies, reducing task-oriented culture and enhancing the clinical reasoning processes. However, discretion in management reasoning depends on whether the clinician is inclined to uphold or adjust policies to maintain professional standards, influencing discharge decisions.</p><p><strong>Conclusion: </strong>While decision-support tools offer cognitive aid and help standardise patient trajectories, they also limit professional discretion in management reasoning and can potentially compromise care and treatment. This highlights the need for a balanced approach that considers both the benefits and limitations of these tools in clinical decision-making.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14590"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187634","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":"A descriptive, retrospective single-centre study of air-leak syndrome in intensive care unit patients with COVID-19.","authors":"Alice Löwing Jensen, Jacob Litorell, Jonathan Grip, Martin Dahlberg, Eva Joelsson-Alm, Sandra Jonmarker","doi":"10.1111/aas.14582","DOIUrl":"10.1111/aas.14582","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute respiratory failure is the predominant presentation of intensive care unit (ICU) patients with COVID-19, and lung protective strategies are recommended to mitigate additional respiratory complications such as air-leak syndrome. The aim of this study is to investigate the prevalence, type, and timing of air-leak syndrome with regards to associated factors and patient outcome in patients with COVID-19 in ICUs at a large Swedish emergency hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included all adult patients admitted to an ICU for COVID-19-related respiratory failure at Södersjukhuset between March 6, 2020, and June 6, 2021. Primary outcomes were proportion of patients diagnosed with air-leak syndrome and its different types of manifestations, and timing of diagnoses in relation to ICU admission and initiation of invasive ventilation. Secondary outcomes included the highest level of respiratory support prior to the diagnosis of air-leak syndrome, patient characteristics and treatment variables associated with air-leak syndrome, and 90-day mortality for patients with air-leak syndrome compared to those without.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of a total of 669 patients, 81 (12%) were diagnosed with air-leak syndrome. Air-leak syndrome manifested as pneumomediastinum (PMD) (n = 58, 72%), pneumothorax (PTX) (n = 43, 53%), subcutaneous emphysema (SCE) (n = 28, 35%) and pneumatocele (PC) (n = 4, 4.9%). Air-leak syndrome was diagnosed at a median of 14 days (IQR 6-22) after ICU admission and 12 days (IQR 6-19) following the initiation of invasive ventilation. The highest respiratory support prior to diagnosis was invasive ventilation (IV) in 64 patients (79%), non-invasive ventilation in two patients (2.5%), and low- or high-flow oxygen in 15 patients (19%). Multiple logistic regression showed that pulmonary disease at baseline (OR 1.87, 95% CI 1.07-3.25), a lower body mass index (OR 0.95, 95% CI 0.9-0.99), admission later compared with earlier in the pandemic (OR 3.89, 95% CI 2.14-7.08), and IV (OR 3.92, 95% CI 2.07-7.44) were associated with an increased risk of air-leak syndrome. Compared with patients not diagnosed with air-leak syndrome, patients with air-leaks had a higher mortality at 90 days after ICU admission, 46% versus 26% (p &lt;.001). However, the mortality rate differed with different air-leak manifestations, 47% for PMD, 47% for PTX, 50% for the combination of both PMD and PTX and 0% in patients with only SCE and/or PC, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In 669 ICU patients with COVID-19, 12% had one or more manifestations of air-leak syndrome. Notably, PMD, rather than PTX, was the most common manifestation, suggesting a potentially distinctive feature of COVID-19-related air-leak syndrome. Further research is needed to determine whether COVID-19 involves different pathophysiological or iatrogenic mechanisms compared with other critical respiratory conditions.&lt;/p","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14582"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397544","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":"What matters to mothers: A qualitative exploration of pain and recovery after cesarean section.","authors":"Patricia Duch, Kim Ekelund, Helene Korvenius Nedergaard","doi":"10.1111/aas.14579","DOIUrl":"10.1111/aas.14579","url":null,"abstract":"<p><strong>Background: </strong>Fast recovery after cesarean section is vital since the mother not only has to take care of herself but also the newborn. Recovery scores are useful tools to measure and compare recovery; however, standardized questionnaires may miss in-depth patient experiences. What is important to women in the postoperative period after cesarean section can vary in different populations, making it crucial to understand the specific needs of one's own population. This study aims to explore what matters most to Danish mothers during the early phase of recovery following elective cesarean section.</p><p><strong>Methods: </strong>Qualitative design: Adult, Danish-speaking women undergoing elective cesarean section under spinal anesthesia were included in three Danish hospitals. Semi-structured interviews focusing on women's experiences of recovery, pain, and mobilization both in hospital and after discharge were conducted for 4-7 days following their cesarean section. Baseline characteristics and maternal outcomes were collected from patient files. The interviews were recorded, transcribed verbatim, and analyzed using manifest content analysis.</p><p><strong>Results: </strong>In total, 25 women were interviewed a median of 6 days post cesarean section (IQR 5-8). Three themes emerged: \"Experience of being a cesarean section patient,\" \"I'm doing good - and better than expected,\" and \"Challenges when going home.\" The cesarean section itself was described as a disturbing experience. The initial days post-cesarean section were described as very painful, but hereafter, many patients expressed surprise at their rapid recovery. None used opioids after discharge. Post-discharge, having a partner's support, especially with other children to care for, was helpful, and moving from lying to sitting position and getting out of bed were noted as particularly painful. Many women requested more information and specific rehabilitation programs.</p><p><strong>Conclusions: </strong>In this qualitative study of Danish women 4-7 days after elective cesarean sections, the women described the initial days as very painful but felt that they recovered rather quickly thereafter. The study indicated a need for enhanced communication, especially regarding the experience of surgery, pain after cesarean section, and physical rehabilitation plans.</p><p><strong>Editorial comment: </strong>In this qualitative, explorative study, participants were interviewed by telephone 4-7 days following their elective cesarean section. The focus was the women's experience of recovery, pain, and mobilization, both in hospital and when going home. The findings identified a need for more information about the perioperative course, as most participants were surprised and unprepared both for the pain from other areas than the scar and for the surgery experience being unpleasant, and many requested physical rehabilitation plans.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 3","pages":"e14579"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031807","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}