BMC Anesthesiology最新文献

{"title":"Anesthetic technique and incidence of delirium after total knee or hip arthroplasty: a nationwide cohort study.","authors":"Hey-Ran Choi, Saeyeon Kim, In-Ae Song, Tak Kyu Oh","doi":"10.1186/s12871-024-02831-z","DOIUrl":"10.1186/s12871-024-02831-z","url":null,"abstract":"<p><strong>Background: </strong>The optimal type of anesthesia for reducing postoperative delirium remains undetermined. This study aimed to assess the relationship between type of anesthesia and postoperative delirium.</p><p><strong>Methods: </strong>This retrospective national cohort study used data collected between 2016 and 2021 from the National Health Insurance Service of South Korea. Adult patients who underwent primary total hip or total knee arthroplasty under general or regional anesthesia were included. Patients with postoperative delirium were identified after arthroplasty according to the International Classification of Diseases 10th revision code for delirium (F05). The patients were divided into two groups: regional anesthesia (RA group) and general anesthesia (GA group). The primary endpoint was the incidence of postoperative delirium during hospitalization after total hip or knee arthroplasty.</p><p><strong>Results: </strong>Our study sample consisted of 664,598 patients: 474,932 in the RA group and 189,666 in the GA group. After propensity score (PS) matching, 276,582 patients (138,291 in each group) were included in the final analysis. In the PS-matched cohort, the incidence of delirium following total knee or total hip arthroplasty was 2.8% (3,842/138,291) in the GA group and 2.3% (3,147/138,291) in the RA group. In logistic regression, the RA group was associated with 18% (odds ratio: 0.82, 95% confidence interval: 0.78, 0.86; P < 0.001) lower postoperative incidence than the GA group.</p><p><strong>Conclusion: </strong>Compared to general anesthesia, regional anesthesia was associated with a decreased incidence of postoperative delirium in patients who underwent total hip or total knee arthroplasty. Our findings indicate that avoiding general anesthesia may prevent delirium after lower limb surgery.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"433"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738455","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":"Motion resistance in peripheral oxygen saturation monitoring using Biolight Analog SpO₂ compared to Masimo SpO₂: a non-inferiority study.","authors":"Ting Yang, Yong Liu, FengHua Cai, Yong Li, Muhammad Saqib Mudabbar","doi":"10.1186/s12871-024-02823-z","DOIUrl":"10.1186/s12871-024-02823-z","url":null,"abstract":"<p><strong>Background: </strong>Pulse oximeters are vital for assessing blood oxygen levels but can produce inaccurate readings during patient motion, leading to false alarms and alarm fatigue. Analog SpO₂ Technology, which uses analog waveforms to filter motion artifacts, may improve accuracy compared to digital sensors. However, the effectiveness of this technology in reducing false alarms in clinical settings remains unclear. This study assesses and compares the motion resistance of Analog SpO₂ Technology of two devices in the market.</p><p><strong>Methods: </strong>Thirty healthy adults underwent controlled experiments (Control, Linear Motion, Angular Motion) using two pulse oximeters. Linear Motion tested hand displacement impact, while Angular Motion involved rhythmic hand motions at 120 bpm and 160 bpm.</p><p><strong>Results: </strong>Both devices performed similarly in Control, with no disruptions. In Linear Motion, mild disruptions occurred, but no significant differences in SpO₂ readings or alarms. Angular Motion at 120 bpm showed stability with no alarms. At 160 bpm, Device B (Biolight Analog SpO₂) had fewer technical alarms but more SpO₂ alarms than Device A (Masimo Analog SpO₂).</p><p><strong>Conclusions: </strong>Analog SpO₂ exhibited motion resistance under static, linear and continuous waving angular motion up to 120 bpm and 160 bpm, but alarms occurred at 160 bpm with continuous tapping angular motion. These findings signify non-inferiority of either device in clinical settings. Further studies should include patients with cardiovascular and/or respiratory diseases.</p><p><strong>Trial registration: </strong>The study was submitted to and approved by the Biolight Ethics Committee (S0723), and written informed consent from all participants was obtained.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"430"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726114","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":"Inferior vena cava thrombosis in patients undergoing extracorporeal membrane oxygenation: a case series and literature review.","authors":"Chengchao Peng, Su Wang, You Shang, Le Yang, Xiaojing Zou","doi":"10.1186/s12871-024-02827-9","DOIUrl":"10.1186/s12871-024-02827-9","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) is mainly used for support of patients with cardiopulmonary collapse. The increasing use of ECMO has shown promising outcomes; however, it still carries the risk of significant complications. Inferior vena cava (IVC) thrombosis is an underestimated complication.</p><p><strong>Methods: </strong>We described a series of 5 ECMO patients diagnosed with IVC thrombosis in our institution. An electronic literature search of the PubMed, Cochrane Library and Web of Science databases. A total of 12 cases were identified.</p><p><strong>Results: </strong>The occurrence of IVC thrombosis in ECMO patients is not uncommon. In our case series, elevated CRP and PCT levels and activated partial thromboplastin times (aPTT) of less than 50 s during ECMO operation were observed. In the literature review, a higher proportion of veno-arterial (VA) ECMO application (67%; 8/12) was presented in patients with IVC thrombosis. Eight patients (73%; 8/11) were monitored for anticoagulation using either aPTT or a combination of aPTT and ACT, with all aPTT measurements achieving the target range for anticoagulation. The mainstay of treatment for IVC thrombosis was anticoagulation alone (75%; 9/12). After the treatment, IVC thrombosis disappeared in the majority of patients (75%; 9/12) and there was no thrombosis-related mortality.</p><p><strong>Conclusion: </strong>Factors such as elevated CRP and PCT levels, low aPTT levels, and the use of VA ECMO may contribute to the development of ECMO-related IVC thrombosis. Monitoring of anticoagulation with aPTT alone or in combination with ACT during ECMO may have inherent limitations. Anticoagulation alone may be an effective treatment for IVC thrombosis.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"437"},"PeriodicalIF":2.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738527","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":"The potency-ratio of ciprofol and propofol under procedural sedation and anesthesia for outpatient hysteroscopy during cervical dilation: a study using up-and-down sequential allocation method.","authors":"Lin Jin, Cui-Cui Jiao, Xiao-Ping Chen, Li-Hong Sun, Yu Zhang, Xin-Zhong Cheng, Jin-Zhong Wang, Xiao-Wei Qian","doi":"10.1186/s12871-024-02793-2","DOIUrl":"10.1186/s12871-024-02793-2","url":null,"abstract":"<p><strong>Background: </strong>Ciprofol(HSK3486) is a novel 2,6-disubstituted phenol derivate, a short-acting intravenous sedative, which has similar efficacy characteristics as propofol with less incidence of side effect. Both ciprofol and propofol are often used in outpatient hysteroscopic surgery for sedation. However, the relative potency of these two drugs has not been fully determined in this context.</p><p><strong>Objective: </strong>Our study aimed to investigate the potency-ratio of ciprofol and propofol under procedural sedation and anesthesia in restraining reaction of outpatient hysteroscopy dilatation.</p><p><strong>Methods: </strong>The ED50 (effective dose in 50% of subjects) value for ciprofol and propofol were calculated by Up-and-Down Sequential Allocation Method. 60 healthy patients undergoing daytime hysteroscopy were randomly divided into two groups, which were intravenously injected with ciprofol at an initial dose of 0.4 mg/kg (group C) or propofol at an initial dose of 2 mg/kg (group P) at 2 min after intravenous injection of sufentanil 0.15ug/kg. A successful response is defined as the absence of patient movement in the case of cervical dilation. Conversely, the presence of patient movement is defined as failure. After successful or failed responses, each follow-up patient in the corresponding group was reduced or increased with propofol 0.5 mg/kg or ciprofol 0.1 mg/kg, respectively.</p><p><strong>Results: </strong>The estimated ED50 value for ciprofol and propofol in restraining reaction of hysteroscopy dilatation was 0.444 mg/kg (95% CI, 0.385-0.503 mg/kg) and 1.985 mg/kg (95% CI, 1.801-2.170 mg/kg), respectively. The incidence of respiratory depression, hypoxemia and injection pain in ciprofol was significantly lower than those in propofol.</p><p><strong>Conclusion: </strong>The ED50 of ciprofol and propofol in preventing hysteroscopy dilatation reaction was 0.444 mg/kg (95% CI, 0.385-0.503 mg/kg) and 1.985 mg/kg (95% CI, 1.801-2.170 mg/kg) for outpatient hysteroscopy. The potency-ratio of ciprofol and propofol observed in our study was 1.0:4.5(95%CI,1:3.9-1:5.1).</p><p><strong>Trial registration: </strong>The study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date19/11/22 Trial ID ChiCTR2200065954).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"426"},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726118","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 low-dose dexmedetomidine to prolong spinal anesthesia in elderly patients: a prospective randomized controlled study.","authors":"Lisa Sangkum, Sivaporn Termpornlert, Choosak Tunprasit, Chatchayapa Rathanasutthajohn, Rojnarin Komonhirun, Sasima Dusitkasem","doi":"10.1186/s12871-024-02815-z","DOIUrl":"10.1186/s12871-024-02815-z","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia for transurethral resection of the prostate (TURP) has a short duration, which poses challenges for postoperative pain management. The present study aimed to investigate the effects of intravenous (IV) dexmedetomidine at a dosage of 0.4 µg/kg in prolonging the duration of spinal anesthesia and minimizing postoperative pain in elderly patients undergoing TURP.</p><p><strong>Methods: </strong>This prospective randomized controlled trial enrolled 38 patients aged 60-80 years who underwent elective TURP with spinal anesthesia. The patients were randomly assigned to two treatment groups: Group D received IV 0.4 µg/kg dexmedetomidine, whereas Group C received IV normal saline after spinal anesthesia administration. The primary outcome was the time to 2-dermatome regression.</p><p><strong>Results: </strong>The 2-dermatome regression time was longer in Group D than in Group C (104.44 ± 16.97 min vs. 80.63 ± 15.59 min, p < 0.05). The peak sensory block levels were significantly higher in Group D [T7 (T6-T8)] than in Group C [T10 (T7-T10)] (p = 0.017). The incidence of hypotension and bradycardia and postoperative pain at 0, 6, 12, and 24 h were not different between two groups.</p><p><strong>Conclusion: </strong>Intravenous dexmedetomidine at a dosage of 0.4 µg/kg significantly prolongs the duration of spinal sensory blockade. Although postoperative analgesia was not different, it provided hemodynamic stability without increasing the side effects.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"427"},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726111","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":"Anaesthetic management of an infant with MEGD(H)EL syndrome undergoing cochlear implant.","authors":"Nashwa Ahmed","doi":"10.1186/s12871-024-02812-2","DOIUrl":"10.1186/s12871-024-02812-2","url":null,"abstract":"<p><strong>Background: </strong>The syndrome has these features: 3-methylglutaconic aciduria (MEG), deafness(D), encephalopathy (E), Leigh-like syndrome (L). This disorder is caused by biallelic mutations in serine active site-containing protein 1 (SERAC1) gene. When these patients experience hepatopathy (H) in addition to the above manifestations, the syndrome is referred to as MEGD(H)EL. The pathology of this syndrome shares features with diverse types of inborn errors of metabolism.</p><p><strong>Case presentation: </strong>We discussed the anaesthetic management of an infant 2-year-old suffering from MEGD(H)EL syndrome undergoing cochlear implant. We discuss the pathology, genetics and significant aspects of this sporadic disease which is important for anaesthesiologist.</p><p><strong>Conclusions: </strong>The usage of dexmedetomidine as the main anaesthetic drug might have the benefit of a non-triggering anaesthetic agent in patients with a mitochondrial disease. Mixture of dexmedetomidine and ketamine provide an effective combination for procedural sedation, predominantly in select populations who are at a high risk of perioperative complications due to underlying co-morbid conditions.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"428"},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726092","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":"Perioperative blood pressure variability as a risk factor for postoperative delirium in the patients receiving cardiac surgery.","authors":"Xiao Shen, Hong Tao, Wenxiu Chen, Jiakui Sun, Renhua Jin, Wenhao Zhang, Liang Hong, Cui Zhang","doi":"10.1186/s12871-024-02817-x","DOIUrl":"10.1186/s12871-024-02817-x","url":null,"abstract":"<p><strong>Background: </strong>Delirium is one of the most common neurological complications after cardiac surgery. The purpose of our study was to assess the relationship between perioperative blood pressure variability (BPV) and postoperative delirium (POD) in the patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>Adult patients received cardiac surgery and stayed in Cardiovascular Intensive Care Unit (ICU) for more than 24 h after surgery during the study period between June 2019 and December 2022 were included in this study. Baseline characteristics, perioperative hemodynamic variables and postoperative laboratory results of the cardiac patients were collected and analyzed. Perioperative BPV was quantified by calculating the standard deviation (SD) and average real variability (ARV) of blood pressure. Assessment of delirium was based on the mental status of the patients and CAM-positive. The relationship between perioperative BPV and POD was analyzed by LASSO and logistic regression using R (R package, 4.3.2).</p><p><strong>Results: </strong>The incidence of POD was 15.0% (324/2164) in the patients receiving cardiac surgery, and the average day for POD occurred at day 3 after surgery. Patients with POD had statistically lower levels of intraoperative mean blood pressure (P = 0.015) and blood pressure ARV (P < 0.001) as well as mean blood pressure at 24 h postoperatively (P = 0.003) when compared to those without. Whereas, ARV for systolic blood pressure (8.64 vs. 7.91 mmHg, P < 0.001), diastolic blood pressure (4.00 vs. 3.77 mmHg, P = 0.014) and mean blood pressure (5.23 vs. 4.94 mmHg, P = 0.001) at 24 h postoperatively was significantly higher in the patients with POD than those without. LASSO regression and further logistic regression revealed that intraoperative blood pressure ARV (OR:0.92, P < 0.001), mean central venous pressure (OR:1.05, P = 0.048) and ARV of systolic blood pressure (OR:1.17, P = 0.002) at 24 h postoperatively were independent risk factors for POD.</p><p><strong>Conclusions: </strong>Perioperative ARV, especially postoperative high ARV exposure, was associated with POD in the patients receiving cardiac surgery. Maintaining a relatively stable blood pressure after cardiac surgery might be beneficial to avoid POD in those patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"424"},"PeriodicalIF":2.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709207","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":"Clonidine and dexmedetomidine for controlled hypotension during functional endoscopic sinus surgery: a comparative study.","authors":"Erick Namegabe Mugabo, Yvette Masime Kulimushi, Gregor Pollach, Rania Abdelazim Sabra, Ragab Saad Beltagy, Furaha Nzanzu Blaise Pascal","doi":"10.1186/s12871-024-02809-x","DOIUrl":"10.1186/s12871-024-02809-x","url":null,"abstract":"<p><strong>Background: </strong>Functional endoscopic sinus surgery (FESS) is minimally invasive, ambulatory endoscopic surgical procedure usually performed in most paranasal sinus diseases. Controlled hypotension during anaesthesia (hypotensive anesthesia) improves surgical field visibility and reduces risk of injuring surrounding structures. Clonidine (C) and dexmedetomidine (D) are both used to reduce blood pressure and heart rate while maintaining tissue perfusion. This study was conducted to evaluate the efficacy of clonidine compared to dexmedetomidine for controlled hypotension during FESS.</p><p><strong>Methods: </strong>After ethical approval, 80 patients undergoing elective FESS were included in the study and randomly allocated to Group C or Group D. In Group C, 40 patients received intravenous clonidine with a loading dose of 3µg/Kg for 10 min and titrated maintenance dose of 0.4-0.8 µg/Kg/hour. In Group D patients received intravenous dexmedetomidine with a loading dose of 1µg/Kg for 10 min and titrated maintenance dose of 0.4-0.8µg/Kg/hour. The target was mean arterial blood pressure (MAP) between 55 and 65 mmHg and heart rate (HR) above 50 beats per minute. The primary outcome was blood loss. The secondary outcomes were surgical field quality assessed by Fromme Bezooart score, variations in MAP and HR intraoperatively, duration of surgery and anesthesia, and post-operative sedation assessed by Ramsay Sedation Score (RSS).</p><p><strong>Results: </strong>Demographic data of both groups were comparable. The difference between both groups in terms of blood loss and surgical field quality was not statistically significant (p = 0.579, 1.000). MAP and HR were statistically significantly reduced to targeted level in both groups compared to baseline (p<0.001). Dexmedetomidine led to severe hypotension compared to clonidine, and the difference was statistically significant. Duration of return to baseline MAP and HR, duration of anesthesia and postoperative sedation were prolonged in group D compared to Group C.</p><p><strong>Conclusion: </strong>Clonidine and dexmedetomidine provided good to excellent quality of surgical field visibility to surgeons during FESS. Dexmedetomidine produce more hypotension and bradycardia compared to clonidine which may be preferable for controlled hypotension in the setting of ambulatory surgery. However, considering the small sample of this study which could not detect small but clinically differences between both drugs, there is a need for a much larger and multicenter study to confirm these findings.</p><p><strong>Trial registration: </strong>This trial was retrospectively registered in the Pan African Clinical Registry (pactr.samrc, ac.za) on 15 August 2024 under trial number PACTR202408565688611.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"425"},"PeriodicalIF":2.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715337","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":"Correction: 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/s12871-024-02811-3","DOIUrl":"10.1186/s12871-024-02811-3","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"423"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692769","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":"Incidence of local anesthetic systemic toxicity in patients receiving bupivacaine infiltration analgesia for total joint arthroplasty under general anesthesia: a retrospective single-center study.","authors":"Yung-Fong Tsai, Yen-Chu Lin, Pang-Hsin Hsieh, Jiin-Tarng Liou, Yung-Tai Chung, Bo-Fu Shih, Min-Wen Yang, Fu-Chao Liu, Huan-Tang Lin","doi":"10.1186/s12871-024-02816-y","DOIUrl":"10.1186/s12871-024-02816-y","url":null,"abstract":"<p><strong>Background: </strong>Local infiltration analgesia (LIA) is a crucial component of multimodal analgesia that enhances recovery after total hip arthroplasty (THA) and knee arthroplasty (TKA). However, LIA can cause fatal local anesthetic systemic toxicity (LAST). The incidences of LIA-induced LAST in different surgeries and anesthetic agents have not been well investigated.</p><p><strong>Methods: </strong>This observational study enrolled 1,267 adult patients who received LIA with bupivacaine for primary THA or TKA under general anesthesia at a single medical center between January 2020 and October 2021. LAST incidence was graded by severity: severe (refractory seizure or arrhythmia requiring lipid rescue), major (seizure or arrhythmia requiring prompt medication), and minor (all other) events. Patient demographics, surgical and anesthesia details, recovery profiles, and LAST incidences were recorded and analyzed.</p><p><strong>Results: </strong>The incidence of severe LAST events was 2.41 per 1000 in unilateral THA, 0 in TKA, and 3.16 per 1000 in the entire cohort. The odds ratio of developing major LAST events was 4.35 in patients undergoing unilateral THA compared with those undergoing unilateral TKA in a matched comparison. Patients who underwent bilateral THA had the highest risk of developing LIA-induced LAST. Additionally, patients using propofol infusion for anesthesia maintenance had a lower risk of seizures and tremors than those using sevoflurane inhalation. The odds ratio of major LAST events was 0.47 in matched comparisons.</p><p><strong>Conclusions: </strong>LIA was associated with a significantly higher risk of LAST in the THA group than in the TKA group. Propofol maintenance reduces the likelihood of seizures and tremors compared with sevoflurane inhalation. Exploring strategies to reduce the incidence of LIA-induced LAST is essential to improve perioperative patient safety.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"422"},"PeriodicalIF":2.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686068","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}