Hasil untuk "Anesthesiology"

E. Ahn, Hyun Kang

Systematic reviews and meta-analyses present results by combining and analyzing data from different studies conducted on similar research topics. In recent years, systematic reviews and meta-analyses have been actively performed in various fields including anesthesiology. These research methods are powerful tools that can overcome the difficulties in performing large-scale randomized controlled trials. However, the inclusion of studies with any biases or improperly assessed quality of evidence in systematic reviews and meta-analyses could yield misleading results. Therefore, various guidelines have been suggested for conducting systematic reviews and meta-analyses to help standardize them and improve their quality. Nonetheless, accepting the conclusions of many studies without understanding the meta-analysis can be dangerous. Therefore, this article provides an easy introduction to clinicians on performing and understanding meta-analyses.

Li-cai Zhang, Jian-li Song, Li-quan Qiu et al.

IntroductionThe efficacy and safety of intranasal insulin (INI) for preventing postoperative delirium (POD) remain uncertain.MethodsWe searched PubMed, Web of Science, Cochrane Library, Embase, and registers from inception to July 1, 2025, for randomized controlled trials (RCTs) enrolling adult surgical patients that compared INI with control (saline) investigating the efficacy of INI for POD prevention. The risk of bias was assessed using the revised Cochrane Risk of Bias tool (RoB 2), and the certainty of evidence was evaluated with the GRADE framework. Primary and secondary outcomes were POD incidence and a comprehensive set of secondary measures (including cognitive scores, hypoglycemia rates, pain scores, and inflammatory markers), respectively.ResultsA meta-analysis of 7 randomized trials (n = 765) showed that INI significantly reduced the incidence of POD within 3 days postoperatively (RR = 0.35; 95% CI: 0.26–0.46; P < 0.001; I2 = 0%) and improved cognitive recovery (MMSE mean difference = 0.99; 95% CI: 0.52–1.47; P < 0.001; I2 = 1.7%). INI also reduced early postoperative interleukin-6 (IL-6) levels without affecting the incidence of hypoglycemia or pain scores.ConclusionINI may protect perioperative cognitive function, reduce POD incidence within 3 days postoperatively, and alleviate postoperative inflammation without increasing hypoglycemia risk. However, larger-scale, randomized, multicenter trials are needed to confirm clinical efficacy and establish optimal protocols.Clinical trial registrationThe protocol for this meta-analysis is available in PROSPERO (CRD42024614995).

Duygu Kayar Calili, Demet Bolukbasi, Seval Izdes

<i>Background and Objectives</i>: Although nutritional status is critical to the clinical outcomes of septic patients, studies on this topic are limited. We aim to assess the prognostic value of five nutritional screening tools (NSTs) for septic patients both at the time of admission to the intensive care unit (ICU) and five days later. <i>Materials and Methods</i>: This prospective observational study included adult septic patients in the ICU. Patients were divided into two groups: survivors and non-survivors. Clinical, laboratory characteristics, and NST values [The Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), Nutritional Risk Screening (NRS-2002), Geriatric Nutritional Risk Index (GNRI), and Nutrition Risk in the Critically Ill (NUTRIC)] were recorded at admission and on Day-5, and intergroup and intragroup comparisons were performed. <i>Results</i>: A total of 126 patients were included in this study: 97 in the survival group and 29 in the non-survival group. The non-survivors had higher CONUT and NUTRIC scores and lower PNI scores. Multivariate analysis found higher Day-5 NUTRIC scores independently associated with mortality. ROC analysis identified NUTRIC > 6 as a mortality predictor. <i>Conclusions</i>: Although several markers differed significantly between survivors and non-survivors, our findings show that a high Day-5 NUTRIC score was the only factor independently associated with mortality among NSTs.

Zhiwei Zhang, Wenyan Duan, Wenguang Feng et al.

Krafthöfer J, Fabig SC, Baron R et al.

Janika Krafthöfer,1 Sophie-Charlotte Fabig,1 Ralf Baron,1 Janne Gierthmühlen1,2 1Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, Germany; 2Department for Anesthesiology and Surgical Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, GermanyCorrespondence: Janika Krafthöfer, Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, Kiel, 24105, Germany, Tel +49 431 500 23911, Fax +49 431 500 20914, Email janika.krafthoefer@web.deBackground: Pain leads to activation of the autonomic nervous system and thus, among other things, to pupillary reflex dilation (PRD). Previous studies have already confirmed a correlation between the perception of pain and the pupillary reaction, measured using pupillometry. However, the previous study populations were under the influence of medication for analgesia in perioperative setting or suffered from pain. This study examines the relationship between pupillary reaction and pain perception in healthy controls and addresses the question of whether endogenous pain inhibition, clinically tested by conditioned pain modulation (CPM), can be quantified using pupillometry.Methods: Forty-two healthy volunteers (21 females, 21 males, mean age 27.9 ± 5.8 years, range 20– 39 years) were included in this study. The PRD, as a measure of the pupillary reaction (variance from the base diameter in percent), was investigated during baseline, heat application and during CPM testing and results compared to the reported pain intensity on the numerical rating scale (NRS).Results: The volunteers showed higher variances under painful conditions compared to the measurement at rest corresponding to higher sympathetic activity during pain. Volunteers with a higher variance, ie a stronger pupillary reaction, gave higher pain ratings than subjects with a lower pupil variance. However, there was no correlation between the NRS and PRD. PRD and pain ratings during CPM were significantly lower compared to heat pain application alone. However, there was no correlation between the calculated CPM effect and the PRD.Conclusion: Pupillometry is capable of objectively reflecting the pain response, eg pain relief through CPM testing. However, the CPM effect calculated from the subjective pain ratings and the objective PRD measurements is not associated suggesting that both measure different aspects of pain perception. It must be discussed whether the CPM effect can be the correct measure for the functionality of the pain system.Keywords: conditioned pain modulation, descending control, pupillary reaction, pain, sympathetic nervous system

Xia Cao, Xu Ding, Huihui Sun et al.

Background: The aim of this study was to determine whether dexmedetomidine can reduce the circulatory response in laparoscopic uterine fibroids (UF) surgery. Our purpose was to investigate the effect of dexmedetomidine on the circulatory response in laparoscopic UF surgery. Methods: This was a randomized controlled study of 214 patients age range of 40–60 years, American Society of Anesthesiologists (ASA) 1–2 grade, undergoing elective laparoscopic UF surgery at Fuxing Hospital, Capital Medical University from January 2020 to October 2023. Patients were randomly allocated to the non-dexmedetomidine group (Group1) and dexmedetomidine group (Group2). The mean arterial pressure (MAP) and heart rate (HR) were measured: when entering the operation room (MAP1, HR1), immediately at the time of local pituitrin injection (MAP2, HR2), and at 5 minutes after injection of pituitrin (MAP3, HR3). The medications and dosages (propofol, urapidil hydrochloride, fluid) used during the operation were recorded as well as the recovery (drowsiness, chills, nausea, vomiting, dysphoria) after the operation. Total mean time from the beginning of the operation to pituitrin injection (Time1) and recovery time after peaking blood pressure with pituitrin injection (Time2) were also recorded. Results: There were no significant differences in age, height, weight, size and number of UFs, and the location of uterine fibroids between the two groups. There were no differences between the groups for MAP1, MAP2, HR1, HR2, HR3, and Time1 (all p > 0.05), but the dexmedetomidine group was smaller in MAP3 (p = 0.041) and Time2 (p = 0.000) than the non-dexmedetomidine group. There were significant differences in MAP3-MAP1 (p = 0.025), propofol (p = 0.011), and urapidil hydrochloride (p = 0.000) between the two groups. The dexmedetomidine group was smaller in chills (p = 0.002), nausea (p = 0.000), vomiting (p = 0.04), and dysphoria (p = 0.024) than the non-dexmedetomidine group. Conclusions: Dexmedetomidine maintains a stable hemodynamic response and is beneficial to postoperative recovery in laparoscopic UF surgery. Clinical Trial Registration: The study has been registered on https://classic.clinicaltrials.gov/ (registration number: NCT03524950).

Ernil Hansen, Burkhard Peter, Thomas G. Wolf et al.

Amarjeet Kumar, Chandni Sinha, Ajeet Kumar et al.

Barbora Bircak-Kuchtova, Ha-Yeun Chung, Jonathan Wickel et al.

Abstract Sepsis is the most common cause of admission to intensive care units worldwide. Sepsis patients frequently suffer from sepsis-associated encephalopathy (SAE) reflecting acute brain dysfunction. SAE may result in increased mortality, extended length of hospital stay, and long-term cognitive dysfunction. The diagnosis of SAE is based on clinical assessments, but a valid biomarker to identify and confirm SAE and to assess SAE severity is missing. Several blood-based biomarkers indicating neuronal injury have been evaluated in sepsis and their potential role as early diagnosis and prognostic markers has been studied. Among those, the neuroaxonal injury marker neurofilament light chain (NfL) was identified to potentially serve as a prognostic biomarker for SAE and to predict long-term cognitive impairment. In this review, we summarize the current knowledge of biomarkers, especially NfL, in SAE and discuss a possible future clinical application considering existing limitations.

Simon H. Armanious, Gamal A. Abdelhameed

Background. Articaine has been used in many dental and ophthalmic outpatient procedures. In the era of ultrasound-guided regional techniques, we searched for short and potent local anesthetic for patients undergoing ambulatory upper limb procedures. However, studies about articaine efficacy in brachial plexus block are limited. In this study, we compared its safety and efficacy against bupivacaine as a commonly used anesthetic agent for ultrasound-guided supraclavicular brachial plexus block. Methods. This randomized prospective study was performed at Ain Shams University Hospital from January to March 2020. A total of 117 patients aged 20 to 60 years, with the American Society of Anesthesiologists physical status I and II, were enrolled in the study. Patients were randomly allocated into two groups: in group A, patients received 30 ml articaine 2%, and in group B, patients received 30 ml of bupivacaine 0.5%. We measured motor and sensory block duration as a primary outcome. Other secondary outcomes such as onset of block, duration of analgesia, patient satisfaction, and time to home discharge readiness were also measured. Results. We analyzed data collected from 97 patients. The motor block duration was significantly shorter in group A (165.73 ± 20.33 min) than in group B (220.27 ± 37.73 min). The onset of motor block was faster in group A (8.73 ± 4.33 min), and the postoperative VAS score was lower in group B. Patients in group A achieved an earlier home discharge of 289.67 ± 2.73 min. Conclusion. Earlier resolution of articaine block makes it more favorable than bupivacaine for ambulatory surgery. This trial is registered with (NCT04189198).

Archna Koul, Deepanjali Pant, Sneha Nathany

Riveros-Perez E, Arthur ME, Jain A et al.

Efrain Riveros-Perez, Mary E Arthur, Ankit Jain, Vikas Kumar, Alexander Rocuts Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA Problem: Passing the American Board of Anesthesiology (ABA) basic examination is required to progress through anesthesiology training in USA. Failing the test may be related to medical knowledge gaps, presence of negative psychosocial factors, and/or individual approaches to learning. This article describes the experience of development and implementation of a multifaceted remediation program (MRP) in residents who failed the ABA basic test. Intervention: This is a retrospective analysis of four cases of residents who failed the ABA basic test between 2016 and 2017. The MRP is described. Pedagogical diagnosis, objectives, teaching strategies and assessment, and their constructive alignment are presented. Information regarding test performance is also presented. Context: This study involves accredited anesthesiology residency program in USA. Outcomes: Four subjects (11% of program residents) failed the ABA basic test. Superficial approach to learning was observed in 100% of cases. The total possible number of participants was 4. The actual number of participants was 4, and the response rate was 100%. Four residents fell under 10th percentile on the first attempt, and 100% passed the test on the second attempt. There was 38% improvement in the number of failed keywords between the two attempts. Lessons learned: Implementation of the MRP developed at our institution is successful to remediate anesthesiology residents who fail the ABA basic examination. We learned that the deep analysis of learning approaches, psychosocial factors, and medical knowledge gaps can be used to develop a remediation program based on the constructive alignment between objectives, curriculum, and assessment. Keywords: remediation, medical education, anesthesiology residency, learning, evaluation

Ahmad Salimzadeh, Alireza Jalali-Farahani, Mohammadjavad Alishiri et al.

Accessibility to all levels of information technology has experienced rapid progress in recent years, particularly in the health sector. Rapid penetration into this technology has led to changes in lifestyles and changes in the working procedures of institutions. In 2014, the number of Internet users reached 3 billion, and this number is predicted to exceed 8 billion in 2018. Statistics estimate the number of Iranian users of the Internet to be about 45 million. In 2014, more than 80% of Internet users searched for health information. Today, the Internet plays a vital role in providing such health services as education, disease management, support, basic medical treatment decisions, and doctor-patient communication.

J. Biebuyck, J. Pennant, P. White

Renu Bala

Eugenio Martínez Hurtado, Miriam Sánchez Merchante

Desde que Macintosh (1.943) y Miller (1.941) crearon sus Laringoscopios Directos (LD) se han hecho muchos intentos para mejorar estas técnicas y equipo según ha ido avanzando la tecnología. Con el surgimiento de los videolaringoscopios (VL), que permiten una visión de la entrada de la glotis independiente de la línea de visión, especialmente los que poseen palas anguladas, se ha visto que ya no se podían aplicar las limitaciones tradicionales para la laringoscopia directa. La mejor evidencia disponible sobre la incidencia de dificultad encontrada durante la laringoscopia directa viene dada por un metaanálisis de 50.760 pacientes en los que la dificultad en la laringoscopia directa se encontró en el 5,8% de los sujetos (IC 95% 4,5-7,5). Este metanálisis excluía a todos los pacientes cuyas vías respiratorias eran “anatómicamente anormales” o en los que el LD se planteó como inapropiado. La definición de laringoscopia difícil incluyó a todos los sujetos con Cormack y Lehane (CL) 3 o mayor. En cuanto a la incidencia real de intubación difícil en este grupo de laringoscopia difícil, se presume menor de 5,8% ya que muchos pacientes con un CL 3 fueron intubados con éxito mediante laringoscopia directa y el uso de una bujía elástica si se tenía cierta experiencia. Por lo que habría un 95% de tasa de éxito de intubación mediante laringoscopia directa. Y es contra este elevado porcentaje de éxito contra el que los nuevos métodos de videolaringoscopia deben evaluarse.

Tajossadat Allameh, Mitra JabalAmeli, Khadijeh Lorestani et al.

Background: Women candidate for cesarean section experience a high degree of anxiety due to fear of anesthesia and its complications. On the other hand, post-operative pain induces unfavorable psychosomatic effects. Pharmaceutical and non-pharmaceutical approaches, like listening to music, use to decrease these adverse effects. Regard to the belief of Muslims to Quran sound, we assessed its effect on the grade of pain and anxiety of the patients underwent cesarean section with regional anesthesia. Methods: In a case-controlled clinical trail, 64 candidates of cesarean section were included. Cases were exposed to Quran sound but the controls did not expose. The degree of pain and anxiety were compared during and after operation between two groups. Findings: There was no statistically significant difference between the groups in sedation score, heart rate, respiratory rate and vomiting (P > 0.050). Recovery duration in controls was significantly longer (P < 0.001). Pain was significantly lower in cases at 1, 2 and 24 hours after the surgery (P < 0.050). Mean arterial pressure was significantly lower in cases before, during, and after the (P < 0.050). Anxiety score was higher in controls during and 1 hour after the surgery (P = 0.001). The level of satisfaction between the groups was statistically different (P < 0.001). Conclusion: Quran sound decreased the degree of anxiety and pain, and increased the patients’ satisfaction.

Maria de Fátima Oliveira dos Santos, Maria das Graças Melo Fernandes, Eduardo Sérgio Soares Sousa et al.

JUSTIFICATIVA E OBJETIVOS: Os princípios da ética orientam a forma de ser e agir do profissional, particularmente no estabelecimento da relação médico-paciente, e por isso, demandam constante reflexão. Nesse sentido, o propósito deste estudo é analisar vivências éticas de anestesiologistas em sua interação com o paciente sob seus cuidados. MÉTODO: Estudo exploratório, que envolveu 16 médicos anestesiologistas com exercício profissional em um hospital universitário de João Pessoa, Paraíba. Os dados foram coletados por meio de entrevista semiestruturada e analisados qualitativamente com o uso da técnica de análise de conteúdo. RESULTADOS: Os achados do estudo evidenciam que as vivências éticas dos participantes do estudo na relação médico-paciente foram classificadas em cinco categorias temáticas: respeito ao paciente, tratamento humanizado, tratamento igualitário, sigilo profissional e respeito à autonomia do paciente. CONCLUSÕES: Conclui-se que os entrevistados reconhecem a ética e os valores humanísticos que devem pautar a relação com seus pacientes.

Desh Deepak Panwar, Rakesh Garg, S R Goel et al.

Renu Sinha, Chitra Rajeswari Thangaswamy, Thilaka Muthiah et al.

We report prolonged desaturation in a child with Down syndrome (DS) and atrial septal defect due to undiagnosed interstitial lung disease. An 18-month-old child with DS was scheduled for bilateral lens aspiration for cataract. The child had atrial septal defect and hypothyroidism. He also had delayed milestones and hypotonia with episodes of recurrent respiratory tract infection necessitating repeated hospitalization. Preoperative evaluation was unremarkable. General anaesthesia and controlled ventilation using proseal laryngeal mask airway was instituted. He had uneventful intraoperative period. In the postoperative period, the child had desaturation 1 hour after surgery on discontinuation of oxygen supplementation by face mask, which improved with oxygen therapy. Supplemental oxygen via face mask was continued and weaned off over several days. On further evaluation, the child was diagnosed as having interstitial lung disease. He improved and discharged from the hospital 15 days after the surgery with room air saturation of 90%.