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

{"title":"Correction: Anesthetic approach to pregnant patients with malaria: a narrative review of the literature.","authors":"Itay Zahavi, Meir Fons, Michal Meir, Mark Volevich, Emilia Guasch, Mark Nunnally, Sharon Einav","doi":"10.1186/s44158-024-00189-9","DOIUrl":"10.1186/s44158-024-00189-9","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876896","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":"Lung ultrasound among Expert operator'S: ScOring and iNter-rater reliability analysis (LESSON study) a secondary COWS study analysis from ITALUS group.","authors":"Enrico Boero, Luna Gargani, Annia Schreiber, Serena Rovida, Giampaolo Martinelli, Salvatore Maurizio Maggiore, Felice Urso, Anna Camporesi, Annarita Tullio, Fiorella Anna Lombardi, Gianmaria Cammarota, Daniele Guerino Biasucci, Elena Giovanna Bignami, Cristian Deana, Giovanni Volpicelli, Sergio Livigni, Luigi Vetrugno","doi":"10.1186/s44158-024-00187-x","DOIUrl":"10.1186/s44158-024-00187-x","url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasonography (LUS) is a non-invasive imaging method used to diagnose and monitor conditions such as pulmonary edema, pneumonia, and pneumothorax. It is precious where other imaging techniques like CT scan or chest X-rays are of limited access, especially in low- and middle-income countries with reduced resources. Furthermore, LUS reduces radiation exposure and its related blood cancer adverse events, which is particularly relevant in children and young subjects. The score obtained with LUS allows semi-quantification of regional loss of aeration, and it can provide a valuable and reliable assessment of the severity of most respiratory diseases. However, inter-observer reliability of the score has never been systematically assessed. This study aims to assess experienced LUS operators' agreement on a sample of video clips showing predefined findings.</p><p><strong>Methods: </strong>Twenty-five anonymized video clips comprehensively depicting the different values of LUS score were shown to renowned LUS experts blinded to patients' clinical data and the study's aims using an online form. Clips were acquired from five different ultrasound machines. Fleiss-Cohen weighted kappa was used to evaluate experts' agreement.</p><p><strong>Results: </strong>Over a period of 3 months, 20 experienced operators completed the assessment. Most worked in the ICU (10), ED (6), HDU (2), cardiology ward (1), or obstetric/gynecology department (1). The proportional LUS score mean was 15.3 (SD 1.6). Inter-rater agreement varied: 6 clips had full agreement, 3 had 19 out of 20 raters agreeing, and 3 had 18 agreeing, while the remaining 13 had 17 or fewer people agreeing on the assigned score. Scores 0 and score 3 were more reproducible than scores 1 and 2. Fleiss' Kappa for overall answers was 0.87 (95% CI 0.815-0.931, p < 0.001).</p><p><strong>Conclusions: </strong>The inter-rater agreement between experienced LUS operators is very high, although not perfect. The strong agreement and the small variance enable us to say that a 20% tolerance around a measured value of a LUS score is a reliable estimate of the patient's true LUS score, resulting in reduced variability in score interpretation and greater confidence in its clinical use.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"50"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861861","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: Value-based preoperative assessment in a large academic hospital.","authors":"Maurizio Cecconi, Giulia Goretti, Andrea Pradella, Patrizia Meroni, Martina Pisarra, Guido Torzilli, Marco Montorsi, Antonino Spinelli, Alessandro Zerbi, Carlo Castoro, Paolo Casale, Efrem Civilini, Vittorio Quagliuolo, Marco Klinger, Giuseppe Spriano, Domenico Vitobello, Leonardo Maradei, Bernhard Reimers, Federico Piccioni, Maria Rosaria Martucci, Niccolò Stomeo, Elena Vanni, Marco Babbini, Roberta Monzani, Maria Rosaria Capogreco, Michele Lagioia, Massimiliano Greco","doi":"10.1186/s44158-024-00184-0","DOIUrl":"10.1186/s44158-024-00184-0","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"49"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857310","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":"Anesthetic approach to pregnant patients with malaria: a narrative review of the literature.","authors":"Itay Zahavi, Meir Fons, Michal Meir, Mark Volevich, Emilia Guasch, Mark Nunnally, Sharon Einav","doi":"10.1186/s44158-024-00185-z","DOIUrl":"10.1186/s44158-024-00185-z","url":null,"abstract":"<p><strong>Introduction: </strong>Anesthesiologists play an important role in the management of labor and delivery during acute malaria infection. The peripartum anesthesia considerations for such cases remain unclear.</p><p><strong>Findings: </strong>Important peripartum considerations include the severity of thrombocytopenia and coagulopathy, hemodynamic status and cardiac disease, and the likelihood of central nervous system (CNS) involvement. Several antimalarial drugs may interact with perioperative medications, causing hypoglycemia, methemoglobinemia, or QT prolongation. Labor should usually not be induced. Patient volume status should be optimized pre-induction, but fluids should be administered with caution given the risk of cerebral edema. In case of CNS involvement intracranial pressure should be maintained. Case reports describe the successful use of neuraxial anesthesia but this approach requires further confirmation of safety. Despite the risks accompanying airway management in pregnancy, in some cases, general anesthesia was preferred due to the chance of CNS infection and disease complications. Tight postoperative assessments of neurological and bleeding status are indicated regardless of the mode of delivery.</p><p><strong>Conclusions: </strong>Despite the prevalence of malaria, the perioperative risk and preferred mode of anesthesia for pregnant patients with acute malaria remain under-researched and outcome data are limited.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768280","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":"Anesthetic gases environmental impact, anesthesiologists' awareness, and improvement opportunities: a monocentric observational study.","authors":"Ludovico Furlan, Pietro Di Francesco, Patrick Del Marco, Jacopo Fumagalli, Chiara Abbruzzese, Giacomo Grasselli","doi":"10.1186/s44158-024-00183-1","DOIUrl":"10.1186/s44158-024-00183-1","url":null,"abstract":"","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"47"},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768281","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":"Carbon footprint in trauma surgery, is there a way to reduce it?","authors":"Elize W Lockhorst, Philip M J Schormans, Cornelis A S Berende, Pieter Boele van Hensbroek, Dagmar I Vos","doi":"10.1186/s44158-024-00181-3","DOIUrl":"10.1186/s44158-024-00181-3","url":null,"abstract":"<p><strong>Background: </strong>Inhaled anaesthetic agents like sevoflurane contribute for approximately 5% to healthcare's carbon footprint. Previous studies suggested that the use of these agents should be minimized. Although multiple trauma surgeries can be performed under regional anaesthesia, most are performed under general anaesthesia. This study aims to evaluate the environmental benefits of using regional anaesthesia over general anaesthesia and to compare the associated complication rates.</p><p><strong>Methods: </strong>This retrospective study included all trauma patients (≥ 18 years) who underwent surgical intervention for hand, wrist, hip, or ankle fractures from 2017 to 2021. The hypothetical environmental gain was calculated based on the assumption that all surgeries were performed under regional anaesthesia. Complication rates were compared between regional and general anaesthesia.</p><p><strong>Results: </strong>Of the 2,714 surgeries, 15% were hand, 26% wrist, 36% hip, and 23% ankle fractures. General anaesthesia was used in 95%, regional in 5%. Switching this 95% to regional anaesthesia would reduce the sevoflurane use by 92 k, comparable to driving 406,553 km by car. The complication rate was higher with general anaesthesia compared to regional (7.7% vs 6.9%, p = 0.75).</p><p><strong>Conclusion: </strong>The potential gain of the reduction of sevoflurane in trauma surgeries which can be performed under regional anaesthesia can be significant.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"46"},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11256432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636022","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":"Perioperative management of Takotsubo cardiomyopathy: an overview.","authors":"Marta Pillitteri, Etrusca Brogi, Chiara Piagnani, Giuseppe Bozzetti, Francesco Forfori","doi":"10.1186/s44158-024-00178-y","DOIUrl":"10.1186/s44158-024-00178-y","url":null,"abstract":"<p><p>Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621863","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":"BART, the new robotic assistant: big data, artificial intelligence, robotics, and telemedicine integration for an ICU 4.0.","authors":"Maria Grazia Bocci, Raffaella Barbaro, Valentina Bellini, Christian Napoli, Luigino Jalale Darhour, Elena Bignami","doi":"10.1186/s44158-024-00180-4","DOIUrl":"10.1186/s44158-024-00180-4","url":null,"abstract":"<p><p>We are in the era of Health 4.0 when novel technologies are providing tools capable of improving the quality and safety of the services provided. Our project involves the integration of different technologies (AI, big data, robotics, and telemedicine) to create a unique system for patients admitted to intensive care units suffering from infectious diseases capable of both increasing the personalization of care and ensuring a safer environment for caregivers.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11242008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592293","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":"Value-based preoperative assessment in a large academic hospital.","authors":"Maurizio Cecconi, Giulia Goretti, Andrea Pradella, Patrizia Meroni, Martina Pisarra, Guido Torzilli, Marco Montorsi, Antonino Spinelli, Alessandro Zerbi, Carlo Castoro, Paolo Casale, Efrem Civilini, Vittorio Quagliuolo, Marco Klinger, Giuseppe Spriano, Domenico Vitobello, Leonardo Maradei, Bernhard Reimers, Federico Piccioni, Maria Rosaria Martucci, Niccolò Stomeo, Elena Vanni, Marco Babbini, Roberta Monzani, Maria Rosaria Capogreco, Michele Lagioia, Massimiliano Greco","doi":"10.1186/s44158-024-00161-7","DOIUrl":"10.1186/s44158-024-00161-7","url":null,"abstract":"<p><strong>Background: </strong>Value-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system's focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs.</p><p><strong>Methods: </strong>We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs.</p><p><strong>Results: </strong>A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51-72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes.</p><p><strong>Conclusions: </strong>We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560407","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":"Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach.","authors":"Giulia Fierro, Barbara Milan, Elena Buelli, Dario Bugada, Erika Casarotta, Francesco Rizzo, Laura Ongaro, Paolo Gritti, Fabio Previdi, Ferdinando Luca Lorini","doi":"10.1186/s44158-024-00177-z","DOIUrl":"10.1186/s44158-024-00177-z","url":null,"abstract":"<p><strong>Background: </strong>Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy.</p><p><strong>Methods: </strong>We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating \"not satisfied\" to 5, denoting \"completely satisfied\"), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed.</p><p><strong>Results: </strong>The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine.</p><p><strong>Conclusions: </strong>Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.</p>","PeriodicalId":73597,"journal":{"name":"Journal of Anesthesia, Analgesia and Critical Care (Online)","volume":"4 1","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556060","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}