BMC Anesthesiology最新文献

{"title":"Efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy: a prospective, randomized, double-blind controlled clinical trial.","authors":"Lizhu Xiao, Zhenghua Zhang, Jing Lu, Zhaoguo Liu, Jiaoling Zhang, Lu Kang, Jiefu Tang, Xiaohua Zou","doi":"10.1186/s12871-024-02779-0","DOIUrl":"10.1186/s12871-024-02779-0","url":null,"abstract":"<p><strong>Background: </strong>We explored the efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy.</p><p><strong>Methods: </strong>A total of 195 patients who underwent painless colonoscopy surgery were randomly divided into three groups: the propofol deep sedation group (group DS), the sufentanil combined with propofol for conscious sedation (group CS₁) and the esketamine combined with propofol for conscious sedation (group CS₂). The primary outcomes of this study included the incidence of hypoxemia, hypotension, hypertension, and bradycardia and excellent and good rates of anaesthesia during colonoscopy. The secondary outcomes included perioperative changes in vital signs (MAP, HR, and SpO₂), anaesthesia induction time, dischargeable time, patient and endoscopist satisfaction scores, and incidence of postoperative nausea and vomiting (PONV), drowsiness, dizziness, propofol injection pain, assisted ventilation and vasoactive medications.</p><p><strong>Results: </strong>The incidence of intraoperative hypoxemia in the DS group was significantly greater than that in the CS₁ and CS₂ groups (χ2 = 7.081, P = 0.029). The incidence of hypotension in the CS₂ group was significantly lower than that in the DS and CS₁ groups (χ2 = 16.278, P < 0.001). The risk of hypoxemia was 5.727 times higher in Group DS than in Group CS₂ (OR 5.727; 95%CI 1.203-27.273), and the risk of hypotension was 9.864 times higher in Group DS than in Group CS₂ (OR 9.864; 95%CI 2.770-35.120). The risk of hypotension in Group CS₁ was 5.167 times that in Group CS₂ (OR 5.167; 95%CI 1.396-19.117). The incidence of propofol injection pain, assisted ventilation, ephedrine usage and drowsiness in the DS group was significantly greater than that in the CS₁ and CS₂ groups (χ2 = 57.618, P < 0.001; χ2 = 9.544, P = 0.008; χ2 = 14.820, P = 0.001; χ2 = 37.257, P < 0.001). The incidence of dizziness during recovery in the CS₁ group was significantly greater than that in the DS and CS₂ groups (χ2 = 6.594, P = 0.037). The dischargeable time in the DS group was significantly greater than that in the CS₁ and CS₂ groups (F = 53.039, P < 0.001). The satisfaction scores of the endoscopist and patients in the DS group were significantly lower than those in the CS₁ and CS₂ groups (F = 17.390, P < 0.001; F = 19.282; P < 0.001).</p><p><strong>Conclusions: </strong>In conclusion, esketamine combined with propofol for conscious sedation can be safely and effectively used for painless colonoscopy and has fewer complications.It is recommended for painless colonoscopy.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An interrater reliability analysis of preoperative mortality risk calculators used for elective high-risk noncardiac surgical patients shows poor to moderate reliability.","authors":"Jacqueline E M Vernooij, Lian Roovers, René van der Zwan, Benedikt Preckel, Cor J Kalkman, Nick J Koning","doi":"10.1186/s12871-024-02771-8","DOIUrl":"10.1186/s12871-024-02771-8","url":null,"abstract":"<p><strong>Background: </strong>Multiple preoperative calculators are available online to predict preoperative mortality risk for noncardiac surgical patients. However, it is currently unknown how these risk calculators perform across different raters. The current study investigated the interrater reliability of three preoperative mortality risk calculators in an elective high-risk noncardiac surgical patient population to evaluate if these calculators can be safely used for identification of high-risk noncardiac surgical patients for a preoperative multidisciplinary team discussion.</p><p><strong>Methods: </strong>Five anesthesiologists assessed the preoperative mortality risk of 34 high-risk patients using the preoperative score to calculate postoperative mortality risks (POSPOM), the American College of Surgeons surgical risk calculator (SRC), and the surgical outcome risk tool (SORT). In total, 170 calculations per calculator were gathered.</p><p><strong>Results: </strong>Interrater reliability was poor for SORT (ICC (C.I. 95%) = 0.46 (0.30-0.63)) and moderate for SRC (ICC = 0.65 (0.51-0.78)) and POSPOM (ICC = 0.63 (0.49-0.77). The absolute range of calculated mortality risk was 0.2-72% for POSPOM, 0-36% for SRC, and 0.4-17% for SORT. The coefficient of variation increased in higher risk classes for POSPOM and SORT. The extended Bland-Altman limits of agreement suggested that all raters contributed to the variation in calculated risks.</p><p><strong>Conclusion: </strong>The current results indicate that the preoperative risk calculators POSPOM, SRC, and SORT exhibit poor to moderate interrater reliability. These calculators are not sufficiently accurate for clinical identification and preoperative counseling of high-risk surgical patients. Clinicians should be trained in using mortality risk calculators. Also, clinicians should be cautious when using predicted mortality estimates from these calculators to identify high-risk noncardiac surgical patients for elective surgery.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How China anesthesiologists document and communicate difficult airway management.","authors":"Xiang Luo, Dong Yang, Xiao-Ming Deng, Qian-Yu Wang, Xi-Yu Du","doi":"10.1186/s12871-024-02739-8","DOIUrl":"10.1186/s12871-024-02739-8","url":null,"abstract":"<p><strong>Background: </strong>According to the Chinese Society of Anesthesiology, it is recommended that patients with difficult airways be documented and notified, which will provide healthcare professionals with a direct reference when managing airways. However, compliance with this initiative remains unclear. This study was conducted to investigate the current status and need for difficult airway notification at Plastic Surgery Hospital and to explore the factors contributing to noncompliance.</p><p><strong>Methods: </strong>Anesthesiologists, surgeons, and patients in Plastic Surgery Hospital were administered separate questionnaires regarding notification of difficult airway management. Participants were surveyed regarding their attitudes and current practices regarding difficult airway notification. In addition, questions were asked regarding the barriers that contribute to noncompliance.</p><p><strong>Results: </strong>A total of 632 valid responses were obtained and analyzed, giving a response rate of 99.21%. 399 patients (89.46%) felt it was very important for anesthesiologists to inform them about their difficult airway, and 91.03% felt it was very important for them to receive a letter of their airway assessment. However, twenty-two anesthesiologists (64.7%) reported verbally informing less than 50% of patients about their difficult airway after surgery, and only four anesthesiologists informed all patients they encountered. Most surgeons (91.22%) and anesthesiologists (91.18%) believe that it is vital to inform patients verbally, while 114 surgeons (77.03%) and 31 anesthesiologists (91.18%) believe that it is essential to complete a difficult airway notification alert. Among the factors causing noncompliance, 17 (34.69%) believed that absence of mandatory rules, 9 (18.37%) believed that increased workload, and 8 (16.33%) believed that notification methods were lacking.</p><p><strong>Conclusions: </strong>The compliance to difficult airway notification remains low in Plastic Surgery Hospital despite the high incidence of difficult airways. Although anesthesiologists, surgeons, and patients are strongly in favor of it. Among the barriers to compliance were the absence of a well-developed notification system and a means of notification such as an alert form for difficult airways. This may spur the anesthesiology society to publish the notification system.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector spinae plane block for laparoscopic surgeries: a systematic review and meta-analysis.","authors":"Soroush Oraee, Shahryar Rajai Firouzabadi, Ida Mohammadi, Mohammadreza Alinejadfard, Hossein Golsorkh, Sara Hatami","doi":"10.1186/s12871-024-02775-4","DOIUrl":"10.1186/s12871-024-02775-4","url":null,"abstract":"<p><strong>Background: </strong>Erector spinae plane block (ESPB) is a novel analgesic technique that can reduce post-operative pain and postoperative opioid consumption in laparoscopic surgeries.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, and Web of Science on November 17th, 2023 for clinical trials comparing ESPB with other analgesic techniques or placebo for laparoscopic surgeries. We meta-analyzed post-operative pain at rest, postoperative opioid consumption, time to first rescue analgesic request, and postoperative nausea and vomiting using a random effects model.</p><p><strong>Results: </strong>ESPB significantly reduced opioid consumption compared to placebo (SMD, (95CI), p-value; -1.837, (-2.331, -1.343), < 0.001) and also compared to transversus abdominis plane block (TAPB) (SMD, (95CI), p-value; -1.351, (-1.815, -0.887), < 0.001) but not quadratus lumborum plane block (QLB) (SMD, (95CI), p-value; 0.022, (-0.241, 0.286), 0.869). ESPB also significantly reduced participant-reported pain scores at rest at 24h post-operation compared to placebo (SMD, (95CI), p-value; -0.612, (-0.797, -0.428), < 0.001) and TAPB (SMD, (95CI), p-value; -0.465, (-0.767, -0.162), < 0.001), however, there was a significant increase in pain score compared to QLB (SMD, (95CI), p-value; 1.025, 0.156, 1.894), 0.021). A statistically significant increase in time to first rescue analgesic in ESPB groups compared to placebo and TAPB groups was observed in our meta-analysis. There was a lower post-operative nausea and vomiting rate in the ESPB groups compared to placebo groups, yet a comparable rate with QLB and TAPB groups was observed in the meta-analysis.</p><p><strong>Conclusion: </strong>ESPB is an effective and safe analgesic technique for managing post-operative pain and opioid consumption in laparoscopic surgeries compared to placebo, reducing postoperative nausea or vomiting as well. Compared to other techniques, ESPB has a similar efficacy to QLB, except for the pain score at 24 h post-operation, but appears to be superior to TAPB as an analgesic technique in laparoscopic surgeries, with a similar safety profile.</p><p><strong>Trial registration: </strong>Prospero registration ID: CRD42024508363. Link: https://www.crd.york.ac.uk/PROSPERO/#recordDetails.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe cervical hematoma following central venous puncture under ultrasound guidance in a patient with acute myeloid leukemia: a rare case report.","authors":"Pinguo Fu, Xiaocou Wang, Chaowei Chen","doi":"10.1186/s12871-024-02782-5","DOIUrl":"10.1186/s12871-024-02782-5","url":null,"abstract":"<p><p>We report the case of a 56-year-old male diagnosed with acute myeloid leukemia who developed a severe cervical hematoma following an ultrasound-guided right internal jugular vein catheterization. Despite receiving platelet transfusions prior to the procedure, the patient experienced progressive hematoma enlargement, leading to respiratory distress. Further investigations, including carotid Computed Tomography Angiography (CTA), ruled out arterial injury, but thromboelastography revealed severe coagulation dysfunction. The patient subsequently developed cerebral hemorrhage and died despite intensive care interventions.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of visual lung recruitment manoeuvres guided by trans-oesophageal lung ultrasound on atelectasis after thoracoscopic lobectomy: a randomised, single-blind, prospective study.","authors":"Furong Bai, Mingliang Yi, Min Cai, Cong Zhao, Xujie Jiang, Hong Yin","doi":"10.1186/s12871-024-02777-2","DOIUrl":"10.1186/s12871-024-02777-2","url":null,"abstract":"<p><strong>Background: </strong>Although the incidence of postoperative atelectasis could be reduced using lung recruitment manoeuvres, it remains high. We hypothesised that intraoperative visual lung recruitment guided by trans-oesophageal lung ultrasound would be more effective than the conventional method for managing postoperative atelectasis.</p><p><strong>Methods: </strong>In this randomised, controlled, prospective study, 84 patients undergoing thoracoscopic lobectomy were recruited from Affiliated Chengdu Fifth People^'s Hospital (teaching hospital) in China. Patients were grouped into trans-oesophageal lung ultrasound-guided (Group G, n = 42) and control (Group C, n = 42) groups.</p><p><strong>Methods: </strong>Lung recruitment was performed after anaesthesia induction, before chest closure and before the endotracheal tube extubation. In Group C, recruitment pressure was controlled at 30 cm H₂O for 10 s (performed thrice); in Group G, the pressure was controlled at 30 cm H₂O (performed thrice), and the tidal volume did not exceed 20 ml kg^-1 until no atelectasis was detected by trans-oesophageal ultrasound. The primary outcome was lung ultrasound scores measured at the post anaesthesia care unit 30 min after extubation. The secondary outcomes included the oxygenation index (30 min after extubation) and the incidence of atelectasis (30 min after extubation and 3 days after surgery).</p><p><strong>Results: </strong>The final analysis included 79 patients. The lung ultrasound score was significantly higher in the control group than in the ultrasound-guided group 30 min after extubation (Group C vs. Group G, 8.6 ± 2.6 vs. 6.5 ± 2.0, P < 0.001). No significant difference in the oxygenation indexes 30 min after extubation was observed between the groups (P = 0.074); however, the incidence of atelectasis 30 min after extubation significantly differed between the two groups (Group C vs. Group G, 57% vs. 33%, P = 0.031). The incidence of atelectasis 3 days after surgery did not significantly differ between the two groups (Group C vs. Group G, 45% vs. 28%, P = 0.122).</p><p><strong>Conclusions: </strong>Lung recruitment guided by trans-oesophageal lung ultrasound can reduce lung ultrasound scores and the incidence of atelectasis at the post anaesthesia care unit 30 min after extubation. However, it does not significantly reduce the incidence of atelectasis 3 days after surgery. TRIAL REGISTRATION: Registration number: ChiCTR2200062509. Registered on 10 /8/ 2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing a modified-Postoperative Morbidity Survey for assessing morbidity after laparoscopic or robot-assisted radical prostatectomy: a retrospective observational study.","authors":"Wenping Peng, Xiaolu Sun, Shuang Zhao, Huimin Hou, Jie Bao","doi":"10.1186/s12871-024-02778-1","DOIUrl":"10.1186/s12871-024-02778-1","url":null,"abstract":"<p><strong>Background: </strong>Compared with open radical prostatectomy (RP), laparoscopic or robot-assisted RP have shown a notable decrease in the incidence of organ dysfunction or potentially life-threating complications after surgery. However, despite advances, the postoperative length of hospital stay (LOS) remains longer than desired in many cases. The Postoperative Morbidity Survey (POMS) is a simple approach to detect complications capable of prolonging LOS. The primary objective of this study was to outline the incidence and type of early morbidity following laparoscopic or robot-assisted RP using modified POMS(m-POMS). The secondary objective was to investigate the correlation between m-POMS and postoperative LOS.</p><p><strong>Methods: </strong>A retrospective study of the electronic health records was performed for all eligible patients undergoing laparoscopic or robot-assisted RP over a one-year period (August 1, 2022 to July 31, 2023). Morbidity as defined by m-POMS was collected on postoperative day 1 (POD1), POD3, POD5 and POD8. Poisson regression models were employed to assess the correlation between positive m-POMS and postoperative LOS.</p><p><strong>Results: </strong>A total of 121 patients were included. Morbidity, as measured by m-POMS, occurred on POD1 (19.01%, 95% CI [13.01%, 26.91%]), POD3 (18.81%, 95% CI [12.39%, 27.52%]), POD5 (30.23%, 95% CI [18.60%, 45.10%]) and POD8 (35.29%, 95% CI [17.31%, 58.70%]). Two prevalent domains with positive m-POMS scores were infectious and pulmonary. The occurrence of morbidity as indicated by m-POMS was correlated with longer median (IQR) postoperative LOS on POD1 7 (5, 9) versus 4 (4, 6), POD3 7 (6, 11) versus 5(4, 6), and POD5 11 (6.5, 11) versus 7(6, 9) (p < 0.05) compared with patients who did not encounter m-POMS-assessed morbidity. Regression analysis showed that m-POMS-defined morbidity was correlated with longer postoperative LOS on POD1 and POD3.</p><p><strong>Conclusions: </strong>The incidence of early morbidity, as defined by m-POMS following radical prostatectomy, was approximately 20%, with infectious and pulmonary complications being the most prevalent. Short-term morbidity assessed by m-POMS was significantly associated with prolonged LOS.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic corticosteroids for infants undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials.","authors":"Siying Wang, Yi Xu, Hai Yu","doi":"10.1186/s12871-024-02772-7","DOIUrl":"10.1186/s12871-024-02772-7","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic corticosteroids have been widely used to mitigate the inflammatory response induced by cardiopulmonary bypass (CPB). However, the impact of this treatment on clinically important outcomes in infants remains uncertain.</p><p><strong>Methods: </strong>We systematically searched databases (Medline, Embase, and Cochrane Central Register of Controlled Trials), Clinical Trials Registry, and Google Scholar from inception to March 1, 2024. Randomized controlled trials (RCTs) in which infants undergoing on-pump cardiac surgery received prophylactic corticosteroids or placebo were selected. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. Considering clinical heterogeneity between studies, the random-effects model was used for analysis. Subgroup analyses on the neonatal studies and sensitivity analyses by the leave-one-out method were also conducted.</p><p><strong>Results: </strong>Eight RCTs comprising 1,920 patients were included. Our analysis suggested no significant difference in postoperative mortality (2.1% vs. 3.3%, risk ratio (RR) = 0.71, 95% confidence interval (CI) [0.41, 1.21]). Significantly increased insulin treatment in infants (19.0% vs. 6.5%, RR = 2.78, 95% CI [2.05, 3.77]) and significantly reduced duration of mechanical ventilation in neonates (mean difference = -22.28 h, 95% CI [-42.58, -1.97]) were observed in the corticosteroids group. There were no differences between groups for postoperative acute kidney injury, cardiac arrest, extracorporeal membrane oxygenation support, low cardiac output syndrome, neurologic events, infection, or length of postoperative intensive care unit stay.</p><p><strong>Conclusions: </strong>Current evidence does not support the routine prophylactic use of corticosteroids in infants undergoing cardiac surgery with CPB. Further large-scale research is needed to investigate the optimal agent, dosing regimen, and specific impact on various types of cardiac surgery.</p><p><strong>Trial registration: </strong>This systematic review and meta-analysis was registered at the International Prospective Register of Systematic Reviews (CRD42023400176).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between preoperative shock index and hypotension after spinal anesthesia for non-elective cesarean section: a prospective cohort study.","authors":"Shirish Silwal, Asish Subedi, Balkrishna Bhattarai, Ashish Ghimire","doi":"10.1186/s12871-024-02766-5","DOIUrl":"10.1186/s12871-024-02766-5","url":null,"abstract":"<p><strong>Background: </strong>Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section.</p><p><strong>Methods: </strong>In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves.</p><p><strong>Results: </strong>Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15-6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14-4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72-10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06-1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49-0.57) and 0.56 (95%CI 0.51-0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively.</p><p><strong>Conclusion: </strong>In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability.</p><p><strong>Trial registration: </strong>Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov .</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in pain by using lidocaine combined with esketamine in elderly patients receiving local anaesthesia for percutaneous kyphoplasty: a randomized controlled study.","authors":"Longyuan Zhou, Lei Lv, Ruilan Wu, Wenbo Mang, Lihong Hu","doi":"10.1186/s12871-024-02768-3","DOIUrl":"10.1186/s12871-024-02768-3","url":null,"abstract":"<p><strong>Background: </strong>Elderly patients often experience severe pain during percutaneous kyphoplasty under local anaesthesia. The aim of this work was to evaluate the effect of lidocaine combined with esketamine on pain improvement in elderly patients receiving local anaesthesia via percutaneous kyphoplasty.</p><p><strong>Methods: </strong>This prospective, randomized comparative trial was conducted on 66 elderly patients, aged 60-80 years, with an American Society of Anaesthesiologists (ASA) grade of I-III, I‒III and a BMI of 18.5-25 kg/m², who underwent single-level lumbar percutaneous kyphoplasty under local anaesthesia. Patients were divided into two equal groups (33 per group). Group LE received 200 mg of 1% lidocaine and 25 mg of esketamine (total volume of 20 ml), and Group L received 200 mg of 1% lidocaine (total volume of 20 ml). Patient characteristics, surgery, VAS scores, MAP, HR, MOAA/S scores, patient satisfaction and related adverse reactions were compared for the groups. The VAS scores during and after surgery were considered the primary outcome.</p><p><strong>Results: </strong>There were statistically significant differences in the VAS score between the two groups at the following time points: channel establishment by the puncture needle, balloon dilation, bone cement injection and postoperative period (P < 0.05). The VAS score decreased in the LE group, but the MAP and HR were more stable, and the difference was statistically significant (P < 0.05). The difference in the MOAA/S score between the two groups was statistically significant (P < 0.05), and the MOAA/S score in the LE group decreased. The patient satisfaction level in the LE group was 100% and 48.48% in the L group (P < 0.05). There were no related complications or adverse reactions in either group.</p><p><strong>Conclusion: </strong>The application of lidocaine combined with esketamine in local episcopal percutaneous vertebral kyphoplasty in elderly patients not only provides an effective analgesic effect but also improves surgical safety and patient comfort, which has important clinical value in promoting the optimization of surgical anaesthesia management in elderly patients.</p><p><strong>Trial registration: </strong>The study was registered at Chictr.org.cn with the number ChiCTR2400083466 on 06/12/2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}