Asian journal of anesthesiology最新文献

{"title":"Practice Algorithm of Rotational Thromboelastometry-Guided (ROTEM-Guided) Bleeding Management in Liver Transplantation.","authors":"Min-Yi Tsai, Shun-Ming Chan, Nan-Kai Hung, Hou-Chuan Lai, Yao-Chia Liu, Wei-Lin Lin, Wei-Cheng Tseng, Chueng-He Lu","doi":"10.6859/aja.202403_62(1).0001","DOIUrl":"10.6859/aja.202403_62(1).0001","url":null,"abstract":"<p><p>Liver transplantation (LT) is frequently complicated by coagulopathy associated with end-stage liver disease, which is often multifactorial and associated with hemostatic disturbances affecting both the procoagulant and anticoagulant systems. This rebalanced coagulation system may lead to bleeding diathesis or increased clot formation. Conventional coagulation tests cannot reflect these complex changes because they can only illustrate deficiencies in the procoagulant system. Viscoelastic tests such as rotational thromboelastometry (ROTEM) have been used in LT and have shown useful for detecting coagulopathy and guiding transfusions. Implementation of ROTEM-guided bleeding management algorithms has proven effectiveness in reducing bleeding, transfusion needs, complication rates, and healthcare costs in LT. This document is intended to provide a practice algorithm for the management of major bleeding and coagulopathy during LT and to encourage adaptation of the guidelines to individual institutional circumstances and resources.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"12-20"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypovolemic Shock and Changes in Density Spectral Array of BIS During Hepatectomy.","authors":"Tsai-Shan Wu, Zhi-Fu Wu, Hou-Chuan Lai","doi":"10.6859/aja.202403_62(1).0007","DOIUrl":"10.6859/aja.202403_62(1).0007","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"63-65"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Factors Associated With Epidural Injections in the Management of Lumbar Spinal Stenosis and in Terms of Delaying Laminectomy: A Retrospective Study.","authors":"Yara Bou Sleiman, Souheil Hallit, Souheil Chamandi","doi":"10.6859/aja.202403_62(1).0005","DOIUrl":"10.6859/aja.202403_62(1).0005","url":null,"abstract":"<p><strong>Background: </strong>Lumbar epidural injections have been studied as symptomatic treatments for lumbar spinal stenosis (LSS). However, results about their efficacy have been controversial, and data regarding their use is scarce. Our purpose in this article is to study the efficacy of epidural injections in the management of pain and disability in patients suffering from spinal stenosis, to study the factors which can affect their efficacy, and to discuss whether they could replace surgery or not.</p><p><strong>Methods: </strong>A retrospective study between 2021 and 2022 took place in a Pain Clinic located in Notre-Dame des Secours University Hospital-Lebanon. The study was done on 128 patients, of whom 18 were excluded because they underwent laminectomy before taking the transforaminal lumbar epidural injections. Medical records were viewed. Outcome measures were checked before and after epidural injections using the numerical pain scale and the Oswestry Disability Index (ODI) scale. Physical activity was assessed with a physical activity index.</p><p><strong>Results: </strong>Back pain scores (9.46 ± 1.07 vs. 3.91 ± 3.13; P < 0.001), leg pain scores (9.31 ± 1.41 vs. 3.75 ± 3.17; P < 0.001), and ODI scores (27.45 ± 8.97 vs. 9.40 ± 9.42; P < 0.001) decreased after the injection compared to before it. A higher physical activity index was significantly associated with a decrease in back pain, leg pain, and ODI scores after epidural injection. In 57.8% of the patients, epidural injections were sufficient for pain management without the need for surgery.</p><p><strong>Conclusion: </strong>Epidural injections are effective in the management of back and leg pain associated with LSS and in improving patients' disability. Engaging in activities like walking and swimming is associated with better results. In some cases, epidural injections may replace surgery.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 1","pages":"39-45"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Cognitive Dysfunction: A Review.","authors":"Neelesh Anand, Reetika Gupta, Shashi Prakash Mishra, Manjaree Mishra","doi":"10.6859/aja.202403_62(1).0001","DOIUrl":"10.6859/aja.202403_62(1).0001","url":null,"abstract":"<p><p>Elderly patients are more vulnerable to cognitive dysfunction in the postoperative period. Patients who are apparently well in cognitive functions in the preoperative period after undergoing anesthesia in noncardiac surgery will develop symptoms of cognitive dysfunction. Postoperative cognitive dysfunction (POCD) doesn't continue for a long duration and usually undergoes self-resolution. Proper definitions and congruous tests for diagnosis are absent. Rigorous preoperative assessment of cognitive function and distinguishing risk factors are indispensable for recognizing the range of POCD and its association with surgery and anesthesia. Recent studies haven't revealed any anesthesia technique or drug which can significantly reduce the incidence of POCD. Therefore, giving accurate information to patients can be challenging.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top 100 Most-Cited Articles on Difficult Airway Management From 2011 to 2022: A Bibliometric Analysis.","authors":"Lawrence Huang, Steven H Hsu, Yi Ting Chuang, Yu Hsuan Tang, Hsien Yung Lai","doi":"10.6859/aja.202403_62(1).0006","DOIUrl":"10.6859/aja.202403_62(1).0006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Difficult airway management (DAM) presents a complex array of challenges inherent in establishing and maintaining a patient's airway during medical procedures or emergencies. Consequences of compromised DAM are profound, ranging from hypoxia, and aspiration, to cardiac arrest. Despite the ongoing progress and innovation in airway management, DAM remains a significant clinical challenge. Performing a bibliometric analysis of the most cited articles in this domain offers quantitative and qualitative insights into the landscape and trend of key research; our analysis revealed an increasing focus on video laryngoscopy research over the past decade, with a notable surge in studies related to airway management during infectious disease outbreaks in recent years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a bibliometric analysis of the 100 most-cited articles on DAM (Top100DAM) published between 2011 and 2022, sourced from both PubMed and Web of Science databases. Employing social network analysis, we identified key associated topics and cluster terms. Cluster terms are broad categories encompassing related topic terms. Topic terms are specific keywords or phrases found in the articles. Citation counts were estimated for each article, and cluster-specific reviews were generated using the Medical Query Expert software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Top100DAM comprised 53 topic terms spanning 11 cluster terms. \"Anesthesiology\" stood out as the most frequently featured cluster, and \"betacoronavirus\" had the highest Impact Factor. There was a significant correlation between the counts between the inferred citation based on cluster terms and the observed citation (Pearson's R = 0.06, P = 0.02). To visualize, the network visualization and Sankey diagrams were used to illustrate the characteristics of the articles. The generated summary, utilizing natural language processing techniques, underscored the role of fiber-optic technology and video laryngoscopy in addressing DAM. During the COVID-19 pandemic, experts recommended the provision of supplemental oxygen and the prioritization of video laryngoscopy for anticipated DAM scenarios. Notably, the most cited articles predominantly concentrated on the importance of practice driven by guidelines and protocols for clinicians and anesthesiologists to manage difficult airways effectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;DAM plays a central role in anesthesiology research, with a significant emphasis on guideline development, technological advancements like video laryngoscopy, and adapting practices for infectious disease scenarios. The increased publication volume and high citation rates during the COVID-19 pandemic underscore how ongoing research and innovation have accelerated, refining DAM practices. Articles with high citation rates mostly pertain to guidelines, illustrating their substantial impact on clinical practice and the necessity for studies to base their discus","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 1","pages":"46-62"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Propofol on Metabolic Acidosis in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass.","authors":"Vu Thanh Lam, Nguyen Minh Ly","doi":"10.6859/aja.202412_62(4).0005","DOIUrl":"10.6859/aja.202412_62(4).0005","url":null,"abstract":"<p><strong>Background: </strong>Propofol has been associated with metabolic acidosis in case reports. However, the results of studies in patients undergoing non-cardiac surgery are controversial. On the other hand, there have been no randomized controlled studies addressing this issue in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this study, we investigated whether propofol was associated with metabolic acidosis in patients undergoing cardiac surgery with CPB.</p><p><strong>Methods: </strong>Forty patients undergoing cardiac surgery with CPB were randomly assigned to receive total anesthesia with propofol (intervention group) or sevoflurane (control group), respectively. Except for this, the anesthetic and surgical management was the same in all patients. The primary outcomes were the changes in arterial blood pH, base excess, HCO_3^-, and lactate levels during surgery. The secondary outcomes included serum aspartate transaminase (AST), alanine transaminase (ALT), urea, and creatinine levels, as well as the proportion of patients with increased liver enzymes and kidney damage at the end of surgery, and the proportion of patients with arrhythmia during surgery.</p><p><strong>Results: </strong>The rate of metabolic acidosis with high lactate at the end of surgery in the propofol group (intervention group) was statistically higher than that in the sevoflurane group (control group). Nevertheless, no difference in serum AST, ALT, urea, and creatinine levels between the two groups, and the proportions of patients with increased liver enzymes and kidney damage at the end of surgery, as well as the proportion of patients with arrhythmia during surgery.</p><p><strong>Conclusion: </strong>Total anesthesia with propofol was associated with metabolic acidosis but did not significantly affect increased liver enzymes, kidney damage, and arrhythmias when compared with the control group in patients undergoing cardiac surgery with CPB.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 4","pages":"216-226"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accidental Awareness During General Anesthesia: A One-Year Follow-Up on Incidence, Risk Factors, and Cultural Context in a Taiwanese Tertiary Center.","authors":"Yin-Tien Kao, Yun-Yi Tsai, Man-Ling Wang","doi":"10.6859/aja.202412_62(4).0004","DOIUrl":"10.6859/aja.202412_62(4).0004","url":null,"abstract":"<p><strong>Background: </strong>Accidental awareness during general anesthesia (AAGA) is rare but can lead to psychological distress, including post-traumatic stress disorder (PTSD). Limited data exists from East Asia, where cultural factors may influence symptom expression. This study examined the incidence, contributing factors, and one-year psychological outcomes of AAGA in a Taiwanese tertiary center.</p><p><strong>Methods: </strong>We reviewed 18,976 patients who received general anesthesia at National Taiwan University Hospital in 2020. AAGA cases were identified via routine postoperative interviews and anesthesia record reviews. One year later, follow-up telephone interviews were conducted using the Chinese version of the PTSD Symptom Scale-Interview for DSM-5 (PSS-I-5), along with a culturally adapted emotional experience questionnaire.</p><p><strong>Results: </strong>Seven patients (0.037%) were classified as definite or possible AAGA. Most events occurred during intubated general anesthesia or propofol sedation. Human errors, such as delayed drug administration or intravenous disconnection, contributed to over half the cases. Of the four patients who completed one-year PTSD screening, none met diagnostic criteria, though two recalled vivid intraoperative experiences and later changed their anesthesia preferences. Cultural factors may have influenced symptom reporting.</p><p><strong>Conclusion: </strong>Though no PTSD diagnoses were identified, AAGA had lasting effects on patient preferences. The findings highlight the need for structured follow-up and culturally sensitive care to better recognize and manage AAGA-related distress.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 4","pages":"204-215"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Density Spectral Array in Sugammadex-Induced Bradycardia.","authors":"Tsai-Shan Wu, Zhi-Fu Wu, Chia-Hung Wang, Yi-Hsuan Huang","doi":"10.6859/aja.202412_62(4).0006","DOIUrl":"https://doi.org/10.6859/aja.202412_62(4).0006","url":null,"abstract":"","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 4","pages":"227-229"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial Comparing Time for Tracheal and Pleural Ultrasonographic Confirmation of the Correct Placement of the Endotracheal Tube in Overweight and Obese Patients.","authors":"Neha Warkhe, Shweta Konnur, Neha Mundada, Abhay Sancheti","doi":"10.6859/aja.202412_62(4).0003","DOIUrl":"10.6859/aja.202412_62(4).0003","url":null,"abstract":"<p><strong>Background: </strong>Successful placement of an endotracheal tube (ETT) and its timely confirmation in obese patients is of utmost importance. Chest auscultation might be misleading in the obese. Considering the need for an additional efficient method, the present study compared tracheal and pleural ultrasonography (USG) for confirming ETT placement in overweight and obese patients.</p><p><strong>Methods: </strong>A prospective, comparative, randomized, single-blinded study enrolled a total of 64 overweight, obese class I and class II patients aged between 18 and 60 years, American Society of Anesthesiologists grades I or II, scheduled for elective surgeries under general anesthesia with endotracheal intubation. Patients were randomized into two groups of 32 each based on the USG technique used for confirmation of ETT placement. Group T is Tracheal USG, and Group P is Pleural USG. The primary outcome was a comparison of the time required by tracheal and pleural ultrasonography techniques for confirmation of ETT placement, while the secondary outcome was a comparison of the time required by both USG techniques with the time for auscultation and capnographic confirmation of ETT placement.</p><p><strong>Results: </strong>Tracheal USG took the least time (4.19 ± 0.89 seconds) compared to pleural USG (10.88 ± 1.16 seconds) and proved to be faster. Time taken for auscultation (P < 0.001) was longer than both USG methods, but less than capnography time. Capnographic confirmation took the maximum time when compared to USG and auscultation (P < 0.001).</p><p><strong>Conclusion: </strong>Tracheal USG provides a faster confirmation of endotracheal intubation than pleural USG in overweight and obese patients. Pleural USG has the added advantage of diagnosing endobronchial intubation.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 4","pages":"196-203"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements and Controversies in Regional Anesthesia: A Review.","authors":"Emmanuel Joran Boujeke, Nasong Anthony Luginaah, Cheng Lin","doi":"10.6859/aja.202412_62(4).0001","DOIUrl":"10.6859/aja.202412_62(4).0001","url":null,"abstract":"<p><p>Regional anesthesia offers benefits such as improved pain control and reduced opioid use, but controversies remain regarding techniques and outcomes. This review examines key debates in the field, including the necessity of circumferential spread of local anesthetics, the impact of regional anesthesia on diagnosing compartment syndrome, the choice of diluent, and the safety of performing peripheral nerve blocks (PNBs) in awake versus anesthetized patients. To explore these topics, we conducted a literature search to synthesize relevant studies and expert perspectives, offering a comprehensive analysis of current evidence. While circumferential spread may enhance block onset, studies show that it does not consistently improve success. The potential for regional anesthesia to mask compartment syndrome is not definitively supported, as ischemic pain often breaks through analgesia. Dextrose diluents accelerate sensory block onset compared to saline, though effects vary with different anesthetics. In awake versus anesthetized PNBs, sedation and general anesthesia provide safety and comfort, especially for non-cooperative patients, with no clear superiority. Overall, regional anesthesia techniques should be tailored to individual patient needs, and further research is necessary to refine best practices.</p>","PeriodicalId":8482,"journal":{"name":"Asian journal of anesthesiology","volume":"62 4","pages":"179-186"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}