Journal of Anesthesia, Analgesia and Critical Care (Online)最新文献

{"title":"Fascial plane blocks for cardiothoracic surgery: a narrative review.","authors":"Paolo Capuano, Giuseppe Sepolvere, Antonio Toscano, Paolo Scimia, Simona Silvetti, Mario Tedesco, Luca Gentili, Gennaro Martucci, Gaetano Burgio","doi":"10.1186/s44158-024-00155-5","DOIUrl":"10.1186/s44158-024-00155-5","url":null,"abstract":"<p><p>In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery.This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols.In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable devices for postoperative monitoring in surgical ward and the chain of liability.","authors":"Valentina Bellini, Marco Brambilla, Elena Bignami","doi":"10.1186/s44158-024-00154-6","DOIUrl":"10.1186/s44158-024-00154-6","url":null,"abstract":"<p><p>Perioperative medicine is undergoing many changes with the introduction of new technologies. Wearable devices are among them. These novel tools are providing an additional possibility for perioperative monitoring. However, in order to ensure that the introduction of wearable device in surgical wards does not lead to additional challenges for healthcare professionals, a careful implementation plan should be drawn up by a multidisciplinary team. In addition, a chain of liability should also be established a priori to facilitate their use and avoid ambiguity in the occurrence of a critical event.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10921714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary shunt in critical care: a practical approach with clinical scenarios.","authors":"Davide Raimondi Cominesi, Mario Forcione, Matteo Pozzi, Marco Giani, Giuseppe Foti, Emanuele Rezoagli, Francesco Cipulli","doi":"10.1186/s44158-024-00147-5","DOIUrl":"10.1186/s44158-024-00147-5","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary shunt refers to the passage of venous blood into the arterial blood system bypassing the alveoli-blood gas exchange. Pulmonary shunt is defined by a drop in the physiologic coupling of lung ventilation and lung perfusion. This may consequently lead to respiratory failure.</p><p><strong>Main body: </strong>The pulmonary shunt assessment is often neglected. From a mathematical point of view, pulmonary shunt can be assessed by estimating the degree of mixing between oxygenated and deoxygenated blood. To compute the shunt, three key components are analyzed: the oxygen (O₂) content in the central venous blood before gas exchange, the calculated O₂ content in the pulmonary capillaries after gas exchange, and the O₂ content in the arterial system, after the mixing of shunted and non-shunted blood. Computing the pulmonary shunt becomes of further importance in patients on extracorporeal membrane oxygenation (ECMO), as arterial oxygen levels may not directly reflect the gas exchange of the native lung.</p><p><strong>Conclusion: </strong>In this review, the shunt analysis and its practical clinical applications in different scenarios are discussed by using an online shunt simulator.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10916277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To evaluate the analgesic effectiveness of bilateral erector spinae plane block versus thoracic epidural analgesia in open cardiac surgeries approached through midline sternotomy.","authors":"Hilal Ahmad Bhat, Talib Khan, Arun Puri, Jatin Narula, Altaf Hussain Mir, Shaqul Qamar Wani, Hakeem Zubair Ashraf, Suhail Sidiq, Saima Kabir","doi":"10.1186/s44158-024-00148-4","DOIUrl":"10.1186/s44158-024-00148-4","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of the erector spinae plane (ESP) block in mitigating postoperative pain has been shown for a range of thoracic and abdominal procedures. However, there is a paucity of literature investigating its impact on postoperative analgesia as well as its influence on weaning and subsequent recovery in comparison to thoracic epidural analgesia (TEA) in median sternotomy-based approach for open-cardiac surgeries and hence the study.</p><p><strong>Methods: </strong>Irrespective of gender or age, 74 adult patients scheduled to undergo open cardiac surgery were enrolled and randomly allocated into two groups: the Group TEA (thoracic epidural block) and the Group ESP (bilateral Erector Spinae Plane block). The following variables were analysed prospectively and compared among the groups with regard to pain control, as determined by the VAS Scale both at rest (VAS_R) and during spirometry (VAS_S), time to extubation, quantity and frequency of rescue analgesia delivered, day of first ambulation, length of stay in the intensive care unit (ICU), and any adverse cardiac events (ACE), respiratory events (ARE), or other events, if pertinent.</p><p><strong>Results: </strong>Clinical and demographic variables were similar in both groups. Both groups had overall good pain control, as determined by the VAS scale both at rest (VAS_R) and with spirometry (VAS_S) with Group ESP demonstrating superior pain regulation compared to Group TEA during the post-extubation period at 6, 9, and 12 h, respectively (P > 0.05). Although statistically insignificant, the postoperative mean rescue analgesic doses utilised in both groups were comparable, but there was a higher frequency requirement in Group TEA. The hemodynamic and respiratory profiles were comparable, except for a few arrhythmias in Group TEA. With comparable results, early recovery, fast-track extubation, and intensive care unit (ICU) stay were achieved.</p><p><strong>Conclusions: </strong>The ESP block has been found to have optimal analgesic effects during open cardiac surgery, resulting in a decreased need for additional analgesic doses and eliminating the possibility of a coagulation emergency. Consequently, it presents itself as a safer alternative to the potentially invasive thoracic epidural analgesia (TEA).</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10905884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of extracorporeal blood purification therapies and sequential extracorporeal support in patients with septic shock (EROICASS): a study protocol for a national, non-interventional, observational multicenter, prospective study.","authors":"Silvia De Rosa, Fiorenza Ferrari, Massimiliano Greco, Vincenzo Pota, Michele Umbrello, Antonella Cotoia, Laura Pasin, Federico Nalesso, Gianluca Paternoster, Gianluca Villa, Sergio Lassola, Sara Miori, Andrea Sanna, Vicenzo Cantaluppi, Marita Marengo, Fabrizio Valente, Marco Fiorentino, Giuliano Brunori, Giacomo Bellani, Antonino Giarratano","doi":"10.1186/s44158-024-00153-7","DOIUrl":"10.1186/s44158-024-00153-7","url":null,"abstract":"<p><strong>Background: </strong>Septic shock, a critical condition characterized by organ failure, presents a substantial mortality risk in intensive care units (ICUs), with the 28-day mortality rate possibly reaching 40%. Conventional management of septic shock typically involves the administration of antibiotics, supportive care for organ dysfunction, and, if necessary, surgical intervention to address the source of infection. In recent decades, extracorporeal blood purification therapies (EBPT) have emerged as potential interventions aimed at modulating the inflammatory response and restoring homeostasis in patients with sepsis. Likewise, sequential extracorporeal therapy in sepsis (SETS) interventions offer comprehensive organ support in the setting of multiple organ dysfunction syndrome (MODS). The EROICASS study will assess and describe the utilization of EBPT in patients with septic shock. Additionally, we will evaluate the potential association between EBPT treatment utilization and 90-day mortality in septic shock cases in Italy.</p><p><strong>Methods: </strong>The EROICASS study is a national, non-interventional, multicenter observational prospective cohort study. All consecutive patients with septic shock at participating centers will be prospectively enrolled, with data collection extending from intensive care unit (ICU) admission to hospital discharge. Variables including patient demographics, clinical parameters, EBPT/SETS utilization, and outcomes will be recorded using a web-based data capture system. Statistical analyses will encompass descriptive statistics, hypothesis testing, multivariable regression models, and survival analysis to elucidate the associations between EBPT/SETS utilization and patient outcomes.</p><p><strong>Conclusions: </strong>The EROICASS study provides valuable insights into the utilization and outcomes of EBPT and SETS in septic shock management. Through analysis of usage patterns and clinical data, this study aims to guide treatment decisions and enhance patient care. The implications of these findings may impact clinical guidelines, potentially improving survival rates and patient outcomes in septic shock cases.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast-track anesthesia and outcomes in hepatopancreatic cancer surgery: a retrospective analysis.","authors":"Sebastiano Mercadante, Fabrizio David, Lucio Mandalà, Patrizia Villari, Pietro Mezzatesta, Alessandra Casuccio","doi":"10.1186/s44158-024-00152-8","DOIUrl":"10.1186/s44158-024-00152-8","url":null,"abstract":"<p><strong>Aim: </strong>To assess the feasibility of a fast-track anesthesia protocol for hepatopancreatobiliary cancer surgery.</p><p><strong>Methods: </strong>Retrospective analysis of consecutive sample of patients who underwent hepatopancreatic surgery for cancer for a period of 12 months in a high volume cancer center. Blended anesthesia was performed for most patients who were then observed in a recovery room area until achieving a safety score.</p><p><strong>Results: </strong>Data of 163 patients were examined. Fifty-six and 107 patients underwent surgery for pancreatic cancer and liver surgery for primary tumor or metastases, respectively. Most patients were ASA 3. The mean durations of anesthesia and surgery were 322 min (SD 320) and 296 min (SD 133), respectively. Extubation was performed in the operating room in 125 patients. Post-operatory invasive ventilation was maintained in the recovery room in fifteen patients for a mean duration of 72.7 min (SD148.2). Only one patient was admitted to intensive care for 15 h. NIV was performed in three patients for a mean duration of 73.3 min (SD 15.3). The mean recovery room staying was 79 min (SD 80). The mean hospital postoperative stay was a mean of 8.1 days (SD 5.7). No complications were found in 144 patients. Globally, mortality rate was 3%.</p><p><strong>Conclusion: </strong>A program of fast-track anesthesia with a short stay in recovery room allowed to achieve a good outcome, limiting the costs of intensive care admission.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10885490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Continuous vs intermittent Non-Invasive blood pressure MONitoring in preventing postoperative organ failure (niMON): study protocol for an open-label, multicenter randomized trial.","authors":"Alberto Noto, Athanasios Chalkias, Fabiana Madotto, Lorenzo Ball, Elena Giovanna Bignami, Maurizio Cecconi, Fabio Guarracino, Antonio Messina, Andrea Morelli, Pietro Princi, Filippo Sanfilippo, Sabino Scolletta, Luigi Tritapepe, Andrea Cortegiani","doi":"10.1186/s44158-024-00151-9","DOIUrl":"10.1186/s44158-024-00151-9","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review.","authors":"Irene Coloretti, Andrea Genovese, J Pedro Teixeira, Anusha Cherian, Ricard Ferrer, Giovanni Landoni, Marc Leone, Massimo Girardis, Nathan D Nielsen","doi":"10.1186/s44158-024-00150-w","DOIUrl":"10.1186/s44158-024-00150-w","url":null,"abstract":"<p><p>Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as vasopressin, if noradrenaline doses exceed 0.5 µg/kg/min. Recently, promising results have been observed in treating refractory hypotension with angiotensin II, which has been shown to increase mean arterial pressure and has been associated with improved outcomes. This narrative review aims to provide an overview of the pathophysiology of the renin-angiotensin system and the role of endogenous angiotensin II in vasodilatory shock with a focus on how angiotensin II treatment impacts clinical outcomes and on identifying the population that may benefit most from its use.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative clear fluids fasting times in children: retrospective analysis of actual times and complications after the implementation of 1-h clear fasting.","authors":"Zaccaria Ricci, Denise Colosimo, Luca Saccarelli, Mariateresa Pizzo, Elena Schirru, Salvatore Giacalone, Paola Mancinelli, Gabriele Baldini, Paola Serio","doi":"10.1186/s44158-024-00149-3","DOIUrl":"10.1186/s44158-024-00149-3","url":null,"abstract":"<p><strong>Background: </strong>Preoperative fasting before elective pediatric surgery is a matter of ongoing debate. The objectives of this study were to evaluate the compliance to a recently implemented preoperative fasting protocol (clear fluids until 1 hour from the induction of anesthesia), to identify predictors of prolonged preoperative fasting time, and to determine whether duration of preoperative fasting was associated with adverse outcomes.</p><p><strong>Methods: </strong>Retrospective single-center study in an operating theater of a tertiary pediatric hospital.</p><p><strong>Results: </strong>In a 6-month period, 1820 consecutive patients were analyzed. The data collected in the questionnaire reporting the time of last food, milk and/or liquid intake, and eventual reasons for nonadherence was analyzed. Median (interquartile range) preoperative fasting time was 186 (110-345) min. In 502 patients (27.6%), duration of preoperative fasting to clear fluid ranged from 60 to 119 min, whereas in 616 (34%) it was 120-240 min. The reasons for not respecting fasting time rules are mostly related to communication issues or unwillingness by the patients. A significant difference in fasting times was evident between infants and children older than 10 years (188, 105-290 vs. 198, 115-362; p = 0.02). Fasting times were significantly shorter in the inpatient group and in the first scheduled patients of the morning. Clear fluids fasting times were significantly longer in patients with hypovolemia complications than in those without, 373 (185-685) vs. 180 (110-330) min (p < 0.0001). Longer fasting times to clear fluids, younger age, and scheduled surgery time were independently associated with the odds of experiencing complications.</p><p><strong>Conclusions: </strong>In this single pediatric center study, median clear fluids fasting time was three times higher (180 min) than those recommended by the preoperative fasting protocol. Compliance to the protocol was observed in approximately 1 out of 4 patients (27.6%). Longer fasting times were associated with an increased risk of complications, which might be due to dehydration and/or hypovolemia.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10865513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting equity, diversity, and inclusion in regional anesthesia academic publishing: a call to action.","authors":"Francesca Rubulotta, Thomas M Hemmerling, Sahar Bahrami","doi":"10.1186/s44158-024-00145-7","DOIUrl":"10.1186/s44158-024-00145-7","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10860263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}