Anesthesiology Research and Practice最新文献

{"title":"Impact of Ketamine on Quality of Recovery after Laparoscopic Surgery: A Single-Centre Single-Blinded Trial Using the QoR-15 Questionnaire.","authors":"Helder Pereira,&nbsp;Maria Inês Graça,&nbsp;Diana Fonseca,&nbsp;Alfredo Mendes-Castro,&nbsp;Fernando Abelha","doi":"10.1155/2023/8890025","DOIUrl":"https://doi.org/10.1155/2023/8890025","url":null,"abstract":"<p><strong>Background: </strong>The quality of recovery is a cluster of patient-related outcomes that emphasise not only pain but different physical and emotional dimensions. Traditionally, ketamine is used to improve postoperative analgesia and avoid opioid consumption and opioid-related side effects.</p><p><strong>Objective: </strong>The present study sought to evaluate if intraoperative ketamine administration (as a part of multimodal analgesia) influences the quality of recovery after laparoscopic surgery.</p><p><strong>Design: </strong>A prospective two-armed, single-blinded trial. <i>Settings</i>. Tertiary single-centre trial between July 2021 and January 2022. <i>Patients</i>. From the 146 patients initially admitted to the study, 127 patients were enrolled, 60 in the ketamine group (group K) and 67 in the control group (group NK). <i>Intervention</i>. Both groups received a rigid intraoperative anaesthesia protocol; furthermore, in group K, 0.5 mg/kg of the ideal body weight of ketamine was administered. <i>Main Outcome Measures</i>. The primary outcome was to evaluate the effect of ketamine administration on the postoperative quality of recovery using the Portuguese version of the Quality of Recovery-15 (QoR-15) Questionnaire 24 h after surgery. The total score and minimal clinically significant difference (MCID) of the QoR-15 were compared. Other variables were also assessed such as the presence of emergence delirium (ED), the Numeric Rating Scale (NRS) for pain, and the presence of postoperative nausea and vomiting (PONV).</p><p><strong>Results: </strong>A total of 127 patients were allocated to the study groups, 60 in group K and 67 in group NK. Regarding the primary outcome, no differences were found in individual categories (15 items) and in the total score of QoR-15 (<i>p</i>=0.214). Concerning improvement (MCID ≥ 8) or worsening (MCID ≤ 8) in quality of recovery, no difference was found between the groups (24 vs. 32 and 6 vs. 6; <i>p</i>=0.776). Finally, no difference was found in secondary postoperative outcomes including ED (<i>p</i>=0.55), NRS (<i>p</i>=0.401), and PONV (<i>p</i>=0.55).</p><p><strong>Conclusion: </strong>In this study, the administration of ketamine in laparoscopic surgery had no impact on the quality of recovery 24 h after surgery. This trial is registered with NCT03724019.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"8890025"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9136848","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":"A Prospective Cohort Study on the Respiratory Effect on Modified Mallampati Scoring.","authors":"Rotem Naftalovich,&nbsp;Marko Oydanich,&nbsp;Janet Adeola,&nbsp;Jean Daniel Eloy,&nbsp;Daniel Rodriguez-Correa,&nbsp;George L Tewfik","doi":"10.1155/2023/2193403","DOIUrl":"https://doi.org/10.1155/2023/2193403","url":null,"abstract":"<p><strong>Background: </strong>Mallampati scoring is a common exam method for evaluating the oropharynx as a part of the airway assessment and for anticipation of difficult intubation. It partitions the oropharynx into 4 categories with scores of 1, 2, 3, and 4. Even though its reliability is known to be limited by confounding factors such as patient positioning, patient phonation, tongue protrusion, and examiner variability, the effect of respiration, i.e., inspiration and expiration, has not yet been formally studied.</p><p><strong>Methods: </strong>Mallampati scores were collected from 100 surgical patients during both inspiration and expiration and later compared to the score obtained in the medical record, determined by a board certified anesthesiologist.</p><p><strong>Results: </strong>Score deviations from the medical record reference were compared for both inspiration and expiration showing that respiration affects Mallampati scores; for some patients, the scores improved (i.e., decreased), while in others they worsened (i.e., increased). The respiratory change effect was quantified and visualized by plotting the area under the curve of the histogram of the deviations. 42% of the patients had a worsening of scores by 1 or 2 points with inspiration while 36% of the patients had a worsening of scores by 1 or 2 points with expiration.</p><p><strong>Conclusions: </strong>Mallampati scoring is commonly used in evaluating the oropharynx as a part of the airway assessment and as a screening tool for difficult intubations. However, as this study points out, the respiratory cycle substantially affects the Mallampati scoring system, with significant deviations of 1 or 2 points. In a scoring system of 4 score categories, these deviations are remarkable.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"2193403"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10469716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10155256","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":"Incidence and Factors Associated with Postspinal Headache in Obstetric Mothers Who Underwent Spinal Anesthesia from a Tertiary Hospital in Western Uganda: A Prospective Cohort Study.","authors":"Mohamud Jelle Osman,&nbsp;Joy Muhumuza,&nbsp;Yarine Fajardo,&nbsp;Andrew Kwikiriza,&nbsp;Baluku Asanairi,&nbsp;Rogers Kajabwangu,&nbsp;Marie Pascaline Sabine Ishimwe,&nbsp;Theoneste Hakizimana","doi":"10.1155/2023/5522444","DOIUrl":"https://doi.org/10.1155/2023/5522444","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The proportion of obstetric mothers reporting postspinal headache (PSH) in Uganda is high. The aim of this study is to determine the incidence and factors associated with postspinal headache among obstetric patients who underwent spinal anesthesia during cesarean section at a tertiary hospital in Western Uganda.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective cohort study was done on 274 consecutively enrolled obstetric patients at Fort Portal Regional Referral Hospital (FRRH) from August to November 2022. Pretested questionnaires were used to obtain the data needed for analysis. The data were entered into Microsoft Excel version 16, coded, and transported into SPSS version 22 for analysis. Descriptive statistics was used to determine the incidence of postspinal headache. Binary logistic regression was computed to obtain factors associated with postspinal headache.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall incidence of postspinal headache was 38.3% (95% CI: 32.5-44.4). Factors with higher odds of developing postspinal headache included using cutting needle (&lt;sup&gt;a&lt;/sup&gt;OR 3.206, 95% CI: 1.408-7.299, &lt;i&gt;p&lt;/i&gt;=0.006), having a previous history of chronic headache (aOR 3.326, 95% CI: 1.409-7.85, &lt;i&gt;p&lt;/i&gt;=0.006), having lost &gt;1500 mls of blood intraoperatively (&lt;sup&gt;a&lt;/sup&gt;OR 6.618, 95% CI: 1.582-27.687, &lt;i&gt;p&lt;/i&gt;=0.010), initiation of ambulation &gt;24 h after spinal anesthesia (&lt;sup&gt;a&lt;/sup&gt;OR 2.346, 95% CI: 1.079-5.102, &lt;i&gt;p&lt;/i&gt;=0.032), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (aOR 3.278, 95% CI: 1.263-8.510, &lt;i&gt;p&lt;/i&gt;=0.015), undergoing 2 puncture attempts (&lt;sup&gt;a&lt;/sup&gt;OR 7.765, 95% CI: 3.48-17.326, &lt;i&gt;p&lt;/i&gt; ≤ 0.001), 3 puncture attempts (&lt;sup&gt;a&lt;/sup&gt;OR 27.61, 95% CI: 7.671-99.377, &lt;i&gt;p&lt;/i&gt; ≤ 0.001) and &gt;3 puncture attempts (&lt;sup&gt;a&lt;/sup&gt;OR 20.17, 95% CI: 1.614-155.635, &lt;i&gt;p&lt;/i&gt;=0.004), those prescribed weak opioids (&lt;sup&gt;a&lt;/sup&gt;OR 20.745, 95% CI: 2.964-145.212, &lt;i&gt;p&lt;/i&gt;=0.002), nonsteroidal anti-inflammatory drug (NSAID) with nonopioids (&lt;sup&gt;a&lt;/sup&gt;OR 6.104, 95% CI: 1.257-29.651, &lt;i&gt;p&lt;/i&gt;=0.025), and NSAID with weak opioids (&lt;sup&gt;a&lt;/sup&gt;OR 5.149, 95% CI: 1.047-25.326, &lt;i&gt;p&lt;/i&gt;=0.044). Women with a body mass index (BMI) of 25-29.9 kg/m&lt;sup&gt;2&lt;/sup&gt; (&lt;sup&gt;a&lt;/sup&gt;OR 0.471, 95% CI: 0.224-0.989, &lt;i&gt;p&lt;/i&gt;=0.047) and a level of puncture entry at L3-4 (&lt;sup&gt;a&lt;/sup&gt;OR 0.381, 95% CI: 0.167-0.868, &lt;i&gt;p&lt;/i&gt;=0.022) had lower odds of developing PSH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The incidence of postspinal headache is still high as compared to the global range. This was significantly associated with needle design, amount of cerebro-spinal fluid lost, number of puncture attempts, body mass index, previous diagnosis with chronic headache, amount of intraoperative blood loss, time at start of ambulation, level of puncture entry, and class of analgesic prescribed. We recommend the use of a smaller gauge needle, preventing CSF loss, deliberate attempts to ensure successful puncture with fewer attempts, puncture attempt","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"5522444"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10435309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10404608","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":"Association between Intraoperative Early Warning Score and Mortality and In-Hospital Stay in Lower Gastrointestinal Spontaneous Perforation.","authors":"Kazuya Takada,&nbsp;Yusuke Nagamine,&nbsp;Akira Ishii,&nbsp;Yan Shuo,&nbsp;Takumi Seike,&nbsp;Hanako Horikawa,&nbsp;Kentaro Matsumiya,&nbsp;Tetsuya Miyashita,&nbsp;Takahisa Goto","doi":"10.1155/2023/8910198","DOIUrl":"https://doi.org/10.1155/2023/8910198","url":null,"abstract":"<p><strong>Background: </strong>Early warning scores (EWSs) can be easily calculated from physiological indices; however, the extent to which intraoperative EWSs and the corresponding changes are associated with patient prognosis is unknown. In this study, we investigated whether EWS and the corresponding time-related changes are associated with patient outcomes during the anesthetic management of lower gastrointestinal perforation.</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study conducted at a tertiary emergency care center. Adult patients who underwent surgery for spontaneous lower gastrointestinal perforations between September 1, 2012, and December 31, 2019, were included. The National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) were calculated based on the intraoperative physiological indices, and the associations with in-hospital death and length of hospital stay were investigated.</p><p><strong>Results: </strong>A total of 101 patients were analyzed. The median age was 70 years, and there were 11 cases of in-hospital death (mortality rate: 10.9%). There was a significant association between the intraoperative maximum NEWS and in-hospital death (odds ratio (OR): 1.60, 95% confidence interval (CI): 1.10-2.32, <i>p</i>=0.013) and change from initial to maximum NEWS (OR: 1.60, 95% CI: 1.07-2.40, <i>p</i>=0.023) in the crude analysis. However, when adjustments were made for confounding factors, no statistically significant associations were found. Other intraoperative EWS values and changes were not significantly associated with the investigated outcomes. The preoperative sepsis-related organ failure assessment score and the intraoperative base excess value were significantly associated with in-hospital death.</p><p><strong>Conclusions: </strong>No clear association was observed between EWSs and corresponding changes and in-hospital death in cases of lower gastrointestinal perforation. The preoperative sepsis-related organ failure assessment score and intraoperative base excess value were significantly associated with in-hospital death.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"8910198"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10480023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177846","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 Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study.","authors":"Hunduma Jisha Chawaka,&nbsp;Zenebe Bekele Teshome","doi":"10.1155/2023/1312980","DOIUrl":"https://doi.org/10.1155/2023/1312980","url":null,"abstract":"<p><strong>Background and aims: </strong>Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness.</p><p><strong>Result: </strong>Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and <i>p</i> = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and <i>p</i> = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and <i>p</i> = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and <i>p</i> ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and <i>p</i> = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and <i>p</i> ≤ 0.001).</p><p><strong>Conclusion: </strong>The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"1312980"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10388295","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":"ICU-Managed Patients' Epidemiology, Characteristics, and Outcomes: A Retrospective Single-Center Study.","authors":"Ahmed Muhammad Bashir,&nbsp;Marian Muse Osman,&nbsp;Hawa Nuradin Mohamed,&nbsp;Ifrah Adan Hilowle,&nbsp;Halima Abdulkadir Ahmed,&nbsp;Abdirahman Abdikadir Osman,&nbsp;Osman Abubakar Fiidow","doi":"10.1155/2023/9388449","DOIUrl":"https://doi.org/10.1155/2023/9388449","url":null,"abstract":"<p><strong>Background: </strong>Resources are limited, and it is exceedingly difficult to provide intensive care in developing nations. In Somalia, intensive care unit (ICU) care was introduced only a few years ago.</p><p><strong>Purpose: </strong>In this study, we aimed to determine the epidemiology, characteristics, and outcome of ICU-managed patients in a tertiary hospital in Mogadishu.</p><p><strong>Methods: </strong>We retrospectively evaluated the files of 1082 patients admitted to our ICU during the year 2021.</p><p><strong>Results: </strong>The majority (39.7%) of the patients were adults (aged between 20 and 39 years), and 67.8% were male patients. The median ICU length of stay was three days (IQR = 5 days), and nonsurvivors had shorter stays, one day. The mortality rate was 45.1%. The demand for critical care services in low-income countries is high.</p><p><strong>Conclusion: </strong>The country has a very low ICU bed capacity. Critical care remains a neglected area of health service delivery in this setting, with large numbers of patients with potentially treatable conditions not having access to such services.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"9388449"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9873425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632874","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":"Anticipated vs. Experienced Pain at Site of Spinal Needle Insertion in Patients Undergoing Elective Lower Segment Caesarean Section: Perspective from Resource-Limited Region.","authors":"Waleed Bin Ghaffar,&nbsp;Fauzia Minai","doi":"10.1155/2023/5516346","DOIUrl":"https://doi.org/10.1155/2023/5516346","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advantages, approximately 20% of pregnant patients refuse spinal anaesthesia in caesarean section due to fear of spinal needle prick. Studies have shown that the patient's expectation of pain is higher than what they experience in real. The objective was to evaluate the difference between anticipated and actually experienced pain at the spinal needle insertion site in spinal anaesthesia for pregnant women undergoing elective lower segment caesarean section (ELSCS).</p><p><strong>Method: </strong>The cross-sectional study was conducted in a labour room suite of a tertiary care hospital.</p><p><strong>Results: </strong>A total of 50 patients scheduled for ELSCS were included. The median experienced pain at the site of spinal needle insertion was significantly low as compared to anticipated pain (<i>P</i> value < 0.01). For the identification of predictors impacting the anticipated and experienced pain, univariate and multivariate regression models were applied. Amsterdam Preoperative Anxiety and Information Scale ≥11 for anticipated pain showed a statistically significant positive correlation in univariate (coefficient: 2.59; 95% CI: 1.49 to 3.68; <i>P</i> value < 0.001) and multivariable analyses (coefficient: 2.51; 95% CI: 1.36 to 3.67; <i>P</i> value < 0.001). Thus, anxiety was associated with statistically significant higher anticipated pain.</p><p><strong>Conclusion: </strong>In conclusion, there is a remarkable difference in the obstetric population between anticipated and actually experienced pain at the site of spinal needle insertion in ELSCS.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"5516346"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10093459","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":"Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial.","authors":"Husam A Almajali,&nbsp;Ali M Abu Dalo,&nbsp;Nidal M Al-Soud,&nbsp;Ali Almajali,&nbsp;Abdelrazzaq Alrfooh,&nbsp;Thani Alawamreh,&nbsp;Hamza Al-Wreikat","doi":"10.1155/2023/2286451","DOIUrl":"https://doi.org/10.1155/2023/2286451","url":null,"abstract":"<p><p>This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010-0.103; <i>p</i> < 0.001). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359-7.944; <i>p</i>=0.008), longer duration of surgery (OR: 1.010; 95% CI: 1.001-1.020; <i>p</i>=0.031), and OSRP surgery (OR: 2.157; CI: 1.056-5.999; <i>p</i>=0.037). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2023 ","pages":"2286451"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9988369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9075303","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":"Strategy for Calculating Magnesium Sulfate Dose in Obese Patients: A Randomized Blinded Trial.","authors":"Sebastião E Silva Filho,&nbsp;Omar S Klinsky,&nbsp;Miguel A M C Gonzalez,&nbsp;Sandro Dainez,&nbsp;Flavio Angelis,&nbsp;Joaquim E Vieira","doi":"10.1155/2022/8424670","DOIUrl":"https://doi.org/10.1155/2022/8424670","url":null,"abstract":"<p><strong>Background: </strong>Magnesium sulfate has analgesic properties during the postoperative period. However, there is a knowledge gap in pharmacology related to the use of the real, ideal, or corrected ideal body weight to calculate its dose in obese patients. This trial compared postoperative analgesia using actual and corrected ideal body weight.</p><p><strong>Methods: </strong>Seventy-five obese patients scheduled to undergo laparoscopic gastroplasty or cholecystectomy under general anesthesia were randomly assigned to three groups. The patients in the control group did not receive magnesium sulfate; the other two groups received magnesium sulfate at 40 mg·kg^-1 of actual body weight or corrected ideal body weight.</p><p><strong>Results: </strong>In patients with body mass index >30 mg·kg^-2 (mean body mass index ranging from 32.964 kg·m^-2 to 33.985 kg·m^-2, according to the groups) scheduled for video laparoscopic cholecystectomy, there were no differences in the blood magnesium concentrations in the groups receiving magnesium sulfate throughout the study, regardless of whether the strategy to calculate its dose was based on total or corrected ideal body weight. Patients in the groups receiving magnesium sulfate showed a significant reduction in morphine consumption (<i>p</i> ≤ 0.001) and pain scores (<i>p</i>=0.006) in the postoperative period compared to those in the control group. There were no significant differences in morphine consumption (<i>p</i>=0.323) or pain scores (<i>p</i>=0.082) between the two groups receiving magnesium sulfate. There were no differences in the total duration of neuromuscular block induced by cisatracurium among the three groups (<i>p</i>=0.181).</p><p><strong>Conclusions: </strong>Magnesium sulfate decreased postoperative pain and morphine consumption without affecting the recovery time of cisatracurium in obese patients undergoing laparoscopic cholecystectomy. Strategies to calculate the dose based on the actual or corrected ideal body weight had similar outcomes related to analgesia and the resulting blood magnesium concentration. However, as the sample in this trial presented body mass indices ranging from 30.11 kg·m^-2 to 47.11 kg/m^-2, further studies are needed to confirm these findings in more obese patients, easily found in centers specialized.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"8424670"},"PeriodicalIF":1.4,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9666020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40712297","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":"Intraoperative Analgesia with Magnesium Sulfate versus Remifentanil Guided by Plethysmographic Stress Index in Post-Bariatric Dermolipectomy: A Randomized Study.","authors":"S E Silva Filho,&nbsp;S Dainez,&nbsp;M A M C Gonzalez,&nbsp;F Angelis,&nbsp;J E Vieira,&nbsp;C S Sandes","doi":"10.1155/2022/2642488","DOIUrl":"https://doi.org/10.1155/2022/2642488","url":null,"abstract":"<p><strong>Background: </strong>Magnesium sulfate reduces pain scores and analgesic consumption. Its use as an analgesic resource in opioid-free or opioid-sparing techniques have also been tested. The evaluation of the antinociceptive potency of drugs and doses indirectly, through hemodynamic oscillations has been questioned. A relatively new algorithm called the plethysmographic stress index has been considered sensitive and relatively specific as a parameter for assessing the need for intraoperative analgesia.</p><p><strong>Objectives: </strong>The aim of this trial was to assess the intraoperative analgesic capacity of magnesium sulfate compared to remifentanil. The secondary objectives were propofol consumption and its latency, the consumption of opioids, ephedrine, and cisatracurium. <i>Patients and Methods</i>. Forty patients scheduled for post-bariatric dermolipectomy were randomly assigned to two groups to receive total intravenous anesthesia with target-controlled hypnosis induced with propofol. Analgesia was obtained in the remifentanil group with remifentanil at an initial dose of 0.2 <i>μ</i>g·kg^-1·min^-1 and in the magnesium sulfate group with magnesium sulfate 40 mg·kg^-1 + 10 mg·kg^-1·h^-1.</p><p><strong>Results: </strong>There was no statistical hemodynamic difference between the groups before and after orotracheal intubation (<i>p</i> = 0.062) and before and after the surgical incision (<i>p</i> = 0.656). There was also no statistical difference in the variation of mean arterial pressure before and after intubation (<i>p</i> = 0.656) and before and after the surgical incision (<i>p</i> = 0.911). There was similar consumption of cisatracurium, ephedrine, and postoperative opioids between the groups. Some patients in the magnesium sulfate group needed more intraoperative fentanyl and propofol, although the latency of propofol was similar in both the groups.</p><p><strong>Conclusion: </strong>We conclude that using magnesium sulfate in intravenous general anesthesia for post-bariatric dermolipectomy is related to a significant reduction in opioid consumption without compromising hemodynamic stability. Overall, PSI monitoring was helpful in driving the analgesic strategy. The use of magnesium sulfate proved to be an important adjunct in the scenario presented, allowing the use of opioids to be avoided in certain cases. We found no statistical differences in the consumption of neuromuscular blocker and vasoconstrictor. Substituting opioids for magnesium sulfate leads to an increase in propofol consumption in the scenario presented. Studies with a larger sample are needed to corroborate the results presented and evaluate other potential advantages in reducing opioid consumption.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":" ","pages":"2642488"},"PeriodicalIF":1.4,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9629917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40458242","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}