Hasil untuk "Anesthesiology"

S. Kinsella, B. Carvalho, R. A. Dyer et al.

1 Consultant, Department of Anaesthesia, St Michael’s Hospital, Bristol, UK 2 Professor, Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA 3 Professor Emeritus, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa 4 Senior Consultant, Department of Anaesthesia, Hamad Women’s Hospital, Doha, Qatar 5 Clinical Associate Professor, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Australia 6 Professor, D epartement d’Anesth esie-R eanimation, Hôpital Antoine B ecl ere, Clamart, France 7 Assistant Professor, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA 8 Professor and Senior Consultant, Department of Women’s Anaesthesia, KKWomen’s and Children’s Hospital, Singapore 9 Chair, Department of Anesthesiology, UZ Leuven, Leuven, Belgium 10 Professor of Anesthesiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium 11 Consultant, Department of Anaesthesia and Intensive Care Medicine, King’s College Hospital NHS Foundation Trust, London, UK

Johannes Martinus Huitink

Katja Nickel, Christian Thoben, Christiane E. Beck et al.

Abstract Background Volatile anesthetics are known to be potent greenhouse gases and a significant source of per-and polyfluoroalkyl substances (PFAS) “forever chemical” pollution. The latter is arguably an additional strong reason to stop the emission of anesthetic exhaust gases into the atmosphere on its own. In clinical practice large proportions of used volatile anesthetics are released into the environment via anesthetic gas scavenging systems. Anesthetic gas adsorbers have been developed to bind volatile anesthetics for later extraction and reusage. They may have the potential to replace anesthetic gas scavenging systems which would have a beneficial effect on the energy consumption of hospitals. However, studies are needed to ensure effective elimination of volatile anesthetics via anesthetic gas adsorbers without gas scavenging systems. Objective To evaluate an anesthetic gas adsorber during simulated ventilation. Design A bench study. Setting An anesthesia machine was connected to an anesthetic gas adsorber (CONTRAfluran™ system, Zeosys Medical, Luckenwalde, Germany) without the use of an anesthetic gas scavenging system. A test lung was ventilated with sevoflurane and oxygen. Sevoflurane concentrations in parts per million (ppm) were detected directly from the anesthetic gas adsorber exhaust outlet using ion mobility spectrometry with gas chromatographic preseparation. A total of 6 experiments were conducted with alternating fresh gas flows, sevoflurane concentrations, humidified air and CO2 insufflation. Main outcome measures Absolute sevoflurane concentration. Results Sevoflurane concentration remained < 1 ppm as long as the canisters were not saturated. At higher fresh gas flow, the breakthrough time of the anesthetic gas adsorber decreased proportionately. Humidified air and CO2 insufflation had only a minor influence on the breakthrough time. Conclusion The anesthetic gas adsorber did not leak relevant sevoflurane concentrations through the exhaust outlet when used without an anesthetic gas scavenging system. When the canister came close to saturation, the post adsorber exhaust sevoflurane concentration progressively increased–indicated by first the yellow-light and subsequently the red-light warning of the anesthetic gas adsorber system. Continuation of the ventilation with a fully saturated canister resulted in ambient room contamination of up to 12.4 ppm sevoflurane, which though undesirable is still low when compared to mask induction.

Carly E. Byrd, Jennifer E. Schramm, Jun Yang et al.

ABSTRACT Cellular communication network 2 (CCN2) is a secreted matricellular protein associated with pulmonary arterial hypertension (PAH) but has not been studied relative to PAH severity, outcomes, or right ventricle (RV) structure and function in a large human cohort and preclinical animal model. This study assessed the associations between CCN2 and PAH severity, survival, hemodynamic measurements, and cardiovascular dysfunction. Serum CCN2 levels were compared in 2548 adults with PAH and 216 controls. CCN2 levels in PAH patients were compared to functional and hemodynamic measurements, and survival outcomes. RV‐pulmonary artery coupling and RV morphology were also assessed in a small subset of patients via pressure–volume loops and cardiac magnetic resonance imaging. In a preclinical PAH model, plasma CCN2 levels were compared between ventricles with PAH progression. CCN2 mRNA levels in both ventricles in the preclinical model were measured to compare with morphologic histologic variables. CCN2 serum levels were significantly higher in PAH compared to controls (p < 0.0001). Higher CCN2 levels were associated with reduced RV contractility (p = 0.003). Higher CCN2 levels were associated with worse 6MWD (p = 0.035), and higher risk of mortality or transplant (p = 0.025). In the preclinical model, prepulmonary CCN2 plasma levels increased with the progression of disease. CCN2 mRNA levels in the RV were associated with decreased RV capillary density (p = 0.015) and increased RV fibrosis (p = 0.045). Though more investigation is needed, it appears that CCN2 plays a role in the development of PAH and potentially in RV maladaptation in PAH.

Erjola Likaj, Larisa Shehaj, Deniona Nunci et al.

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV) is a rare group of systemic autoimmune diseases that primarily target small blood vessels. Renal manifestations often present as pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN), which can progress to acute or chronic kidney failure and multiorgan involvement. It is frequently associated with poor outcomes. We report a case of PR3-positive ANCA-associated vasculitis complicated by rapidly progressive glomerulonephritis, acute kidney injury, and diffuse alveolar hemorrhage during the COVID-19 pandemic. This case highlights the diagnostic challenges of differentiating AAV from conditions associated with SARS-CoV-2 infection, as the clinical and radiological presentations of pulmonary-renal syndromes may overlap. The findings underscore the importance of maintaining a comprehensive differential diagnosis in patients with pulmonary and renal involvement, particularly in the post-COVID-19 era, to ensure timely and accurate management of rare autoimmune conditions such as AAV. Conclusion: ANCA-associated vasculitis (AAV) remains a diagnostic and therapeutic challenge, particularly in the post-COVID-19 era, where overlapping clinical and radiological features with SARS-CoV-2 complications can obscure timely identification. This case highlights the critical importance of maintaining a broad differential diagnosis in patients presenting with pulmonary-renal syndromes to differentiate AAV from more common conditions associated with COVID-19.

Zhi Li, Daming Yuan, Yu Yu et al.

Abstract Background Procedural sedation is essential for optimizing upper gastrointestinal endoscopy, particularly in high-risk patients with multiple underlying diseases. Respiratory and circulatory complications present significant challenges for procedural sedation in this population. This non-inferiority randomized controlled trial aims to investigate the safety and comfort of remimazolam compared to propofol for procedural sedation during upper gastrointestinal endoscopy in high-risk patients. Methods A total of 576 high-risk patients scheduled to undergo upper gastrointestinal endoscopy are planned to be enrolled in this study and randomly allocated to either the remimazolam or propofol group. The primary outcome measure is a composite endpoint, which includes (1) achieving a Modified Observer’s Alertness/Sedation scale (MOAA/S) score ≤ 3 before endoscope insertion, (2) successful completion of the endoscopic procedure, (3) the absence of significant respiratory instability during the endoscopy and treatment, and (4) the absence of significant circulatory instability during the examination. The noninferiority margin was 10%. Any adverse events (AEs) that occur will be reported. Discussion This trial aims to determine whether remimazolam is non-inferior to propofol for procedural sedation during upper gastrointestinal endoscopy in high-risk patients, regarding success rate, complication incidence, patient comfort, and satisfaction. Trial registration {2a and 2b} Chinese Clinical Trial Registry ClinicalTrials.gov ChiCTR2200066527. Registered on 7 December 2022.

RTH Supraptomo

Angka Kematian Ibu di Indonesia terhitung 305:100.000 kelahiran dan 25% penyebabnya adalah hipertensi. Preeklampsia berat (PEB) adalah kondisi munculnya hipertensi dan proteinuria setelah usia kehamilan 20 minggu. PEB dapat diukur keparahannya dengan hipoalbumin dan dapat menyebabkan hemolisis. Sindrom HELLP merupakan komplikasi dari PEB. Sectio Caesarea Transperitoneal Profunda (SCTP) adalah persalinan buatan di mana janin dilahirkan melalui insisi dinding depan perut di segmen bawah rahim. Indikasi dilakukannya SCTP diantaranya adanya PEB disertai dengan tanda gawat ibu (Sindrom HELLP, tanda impending). Wanita 31 tahun G2P1A0 usia kehamilan 32+4 minggu dengan Preeklampsia Berat Superimposed, HELLP Syndrome hipoksia fetal, riwayat SC 11 tahun lalu, belum dalam persalinan, dengan konjungtivitis sinistra, hipoalbumin (2,8), status fisik ASA IIE direncanakan untuk dilakukan SCTP emergensi. Regional Anesthesia Subarachnoidal Block (RASAB) digunakan pada tindakan SCTP dengan kombinasi levobupivacaine dan fentanyl. Persalinan dengan SCTP menggunakan anestesi regional karena prosesnya cepat, nyaman selama operasi, kualitas analgesia lebih baik pada post operasi, dan fluktuasi hemodinamik lebih stabil. Levobupivacaine memblokade natrium channel neuronal yang mencegah depolarisasi dan bersifat reversibel pada saraf sensorik dan motorik. Kombinasi fentanyl menghasilkan efek blok sensorik lebih lama dengan onset spinal anestesi yang sama. Selain itu, ia juga memperpanjang durasi blok sensorik tanpa memperpanjang durasi blok motorik sehingga nyeri pada pasien dapat berkurang tanpa mengganggu fungsi motoriknya.

Maricruz Perezamador del Cueto, Crisenry Brito

Daisuke Akagi, Kai Murase

Abstract Background To overcome the anatomical limitation of a narrow aorta and short length from the renal artery to the terminal aorta, unibody endograft AFX2 and iliac branch endoprosthesis (IBE) can be combined. Case presentation Case 1: The first patient was an 89-year-old woman who had a right saccular common iliac artery (CIA) aneurysm (38 mm); the abdominal aorta was not aneurysmal (diameter, 19 mm). The right CIA’s origin was 10 mm in diameter. A bifurcated AFX2 was placed in an ordinary manner. Then, IBE was inserted in the right leg of the AFX2. Case 2: The second patient was an 87-year-old man diagnosed with an abdominal aortic aneurysm (55 mm), right dissecting CIA aneurysm (20 mm), and right hypogastric artery aneurysm (22 mm) extending to the bifurcation of the superior and inferior gluteal arteries. The length between the renal artery and terminal aorta was 107 mm. The beginning of the right CIA was segmentally stenotic (13 mm). A bifurcated AFX2 was placed in the infrarenal aorta; IBE was advanced to the origin of the right limb of the AFX2. To control the type 1b endoleak, the right superior gluteal artery was embolized with coils and internal iliac components were deployed toward the inferior gluteal artery. Satisfactory results were obtained in both cases. Conclusion The AFX2 main body and IBE could be combined to preserve hypogastric blood flow and overcome anatomical limitations.

Matthew Boyko, Benjamin F. Gruenbaum, Ilan Shelef et al.

Abstract Traumatic brain injury (TBI) affects millions of people worldwide, many of whom are affected with post-TBI mood disorders or behavioral changes, including aggression or social withdrawal. Diminished functionality can persist for decades after TBI and delay rehabilitation and resumption of employment. It has been established that there is a relationship between these mental disorders and brain injury. However, the etiology and causal relationships behind these conditions are poorly understood. Rodent models provide a helpful tool for researching mood disorders and social impairment due to their natural tendencies to form social hierarchies. Here, we present a rat model of mental complications after TBI using a suite of behavioral tests to examine the causal relationships between changes in social behavior, including aggressive, hierarchical, depressive, and anxious behavior. For this purpose, we used multivariate analysis to identify causal relationships between the above post-TBI psychiatric sequelae. We performed statistical analysis using principal component analysis, discriminant analysis, and correlation analysis, and built a model to predict dominant-submissive behavior based on the behavioral tests. This model displayed a predictive accuracy of 93.3% for determining dominant-submissive behavior in experimental groups. Machine learning algorithms determined that in rats, aggression is not a principal prognostic factor for dominant-submissive behavior. Alternatively, dominant-submissive behavior is determined solely by the rats’ depressive-anxious state and exploratory activity. We expect the causal approach used in this study will guide future studies into mood conditions and behavioral changes following TBI.

Mark K. Simmonds, Bruce D. Dick, Michelle J. Verrier et al.

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (<i>p</i> = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (<i>p</i> = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (<i>p</i> = 0.024). CPAQ-A scores were significantly increased (<i>p</i> < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (<i>p</i> < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (<i>p</i> = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement.

Jennifer S. Gewandter, Robert H. Dworkin, Dennis C. Turk et al.

Abstract. Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (ie, surgery, viral infection, injury, and toxic or noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

Patrick M. Honore, Herbert D. Spapen, Paul Marik et al.

Phillip E. Vlisides, Phillip E. Vlisides, Bryan Kunkler et al.

Background: Stroke is a devastating perioperative complication without effective methods for prevention or diagnosis. The objective of this study was to analyze evidence-based strategies for detecting cerebrovascular vulnerability and injury in a high-risk cohort of non-cardiac surgery patients.Methods: This was a single-center, prospective cohort study. Fifty patients undergoing non-cardiac surgery were recruited −25 with known cerebrovascular disease and 25 matched controls. Neurologic vulnerability was measured with intraoperative cerebral oximetry as the primary outcome. Perioperative neurocognitive testing and serum biomarker analysis (S-100β, neuron specific enolase, glial fibrillary acid protein, and matrix metalloproteinase-9) were measured as secondary outcomes.Results: Cerebral desaturation events (an oximetry decrease ≥20% from baseline or &lt;50% absolute value for ≥3 min) occurred in 7/24 (29%) cerebrovascular disease patients and 2/24 (8.3%) controls (relative risk 3.5, 95% CI 0.81–15.2; P = 0.094). Cognitive function trends were similar in both groups, though overall scores (range: 1,500–7,197) were ~1 standard deviation lower in cerebrovascular patients across the entire perioperative period (−1,049 [95% CI −1,662, −436], P &lt; 0.001). No significant serum biomarker differences were found between groups over time. One control patient experienced intraoperative hypoxic-ischemic injury, but no robust biomarker or oximetry changes were observed.Conclusions: Cerebrovascular disease patients did not demonstrate dramatic differences in cerebral oximetry, cognitive trajectory, or molecular biomarkers compared to controls. Moreover, a catastrophic hypoxic-ischemic event was neither predicted nor detected by any strategy tested. These findings support the need for novel research into cerebrovascular risk and vulnerability.

Li-Qin Li, Cong Wang, Mei-Dan Fang et al.

Abstract Background Several studies have investigated the effects of dexamethasone on post-operative cognitive dysfunction (POCD) or post-operative delirium (POD); however, their conclusions have been inconsistent. Thus, we conducted a meta-analysis to determine the effects of dexamethasone on POCD and POD in adults following general anaesthesia. Methods The Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to 16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were searched for randomised controlled trials that evaluated the incidence of POCD and POD following dexamethasone administration in adults (age ≥ 18 years) under general anaesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess the quality of the evidence. Results Five studies were included (three studies with 855 participants in the dexamethasone group and 538 participants in the placebo group for the incidence of POCD, and two studies with 410 participants in the dexamethasone group and 420 participants in the placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00; 95% CI [confidence interval: 0.51, 1.96], P = 1.00, I 2 = 77%) or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I 2 = 0%). However, both analyses had some limitations because of limited evidence and clinical heterogeneity, and we considered the quality of the evidence for the post-operative incidence of POCD and POD to be very low. Conclusions This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative preventive strategies for POCD and POD, as well as a better understanding of the pathophysiology of those complex syndromes, are still needed to make progress in this field. Trial registrationr This study is registered with PROSPERO, 23 October 2018, number CRD42018114552. Available from https://www.crd.york.ac.uk/PROSPERO/#recordDetails.

Takashige Yamada, Takashige Yamada, Susana Vacas et al.

An increasing number of patients require precise intraoperative hemodynamic monitoring due to aging and comorbidities. To prevent undesirable outcomes from intraoperative hypotension or hypoperfusion, appropriate threshold settings are required. These setting can vary widely from patient to patient. Goal-directed therapy techniques allow for flow monitoring as the standard for perioperative fluid management. Based on the concept of personalized medicine, individual assessment and treatment are more advantageous than conventional or uniform interventions. The recent development of minimally and noninvasive monitoring devices make it possible to apply detailed control, tracking, and observation of broad patient populations, all while reducing adverse complications. In this manuscript, we review the monitoring features of each device, together with possible advantages and disadvantages of their use in optimizing patient hemodynamic management.

Guillermo Capote Guerrero, Domingo Angel Labrada Tapia, Yudelmis Yolanda Espinosa Moracén et al.

<span style="font-family: Verdana,Arial,Helvetica,sans-serif; font-size: small;"><strong>Introducción:</strong> las pacientes obstétricas constituyen una población saludable, aunque las afecciones coincidentes y diversos trastornos relacionados con la gestación pueden asociarse a una morbilidad y mortalidad importantes. La anestesia neuroaxial espinal es un método anestésico, de preferencia en la obstétrica que no está exenta de riesgos. <br /> <strong>Objetivo</strong> : exponer la conducta anestésica en una paciente cesareada por sufrimiento fetal agudo, con una complicación neurológica. <br /> <strong>Caso Clínico</strong> : se presenta el caso de una paciente de 31 años de edad, con antecedentes aparentes de salud, que fue anunciada de urgencias para realizar césarea por sufrimiento fetal agudo. Se le practicó bloqueo neuroaxial espinal con trocar número 25, en posición sentada previa toma de signos vitales. A las 48 horas comenzó con cefalea frontooccipital bilateral, que aumentaba con la posición sentada. No resolvió con la medicación indicada y se le realizó parche hemático. Fue dada de alta y a los 21 día llegó con cefalea intensa acompañada de vómitos y malestar general y toma neurológica. <strong> <br /> Conclusiones </strong> . la cefalea pospunción es la complicación más frecuente de la anestesia neuroaxial espinal, que aparece 24 a 48 horas despues y que puede desaparecer sin tratamiento médico, pero aquellas que no mejoran con la medicación y que aumentan en intensidad y en cualquier posición hay que sospechar la presencia de un hematoma subdural por lo que se debe indicar TAC, sobre todo en las que se realizan en posición sentada. </span>

Anko Antabak, Nikša Matković, Lana Stanić et al.

Treatment of clavicle fracture is principally outpatient. Operative treatment is accompanied by the need for more x-rays and possible complications. Fractures with absolute indications for operative treatment occur only sporadically and these indications are relatively clear, but children often undergo surgery because of relative indications (shortening, fragment displacement, multifragmentary fractures), which are open to debate. In a retrospective study on 256 children, of 44 (17%) patients that received operative treatment only one 17-year-old boy had an absolute indication for surgical intervention. Other indications were fragment distraction (22 mm on average), age, associated injuries, and multifragmentary fracture. The placement of K-wire of appropriate thickness is often difficult, since the wire tends to bend and break, and patients have to undergo two additional operations of plate and screw fixation and later removal. In this retrospective study, we considered the advantages of using titanium or an elastic steel pin. All patients had favorable outcome, although some experienced numbness around the operation scar (4.5%), skin infections around the wire (15%), and/or the implanted K-wire damage (7%).

L. Viola, Smokey J Clay, P. Samuels

Esther K. Wolthuis, Alexander P. J. Vlaar, Goda Choi et al.

Preventing tissue-factor-(TF-) mediated systemic coagulopathy improves outcome in models of sepsis. Preventing TF-mediated pulmonary coagulopathy could attenuate ventilator-induced lung injury (VILI). We investigated the effect of relative TF deficiency on pulmonary coagulopathy and inflammation in a murine model of VILI. Heterozygous TF knockout (TF+/−) mice and their wild-type (TF+/+) littermates were sedated (controls) or sedated, tracheotomized, and mechanically ventilated with either low or high tidal volumes for 5 hours. Mechanical ventilation resulted in pulmonary coagulopathy and inflammation, with more injury after mechanical ventilation with higher tidal volumes. Compared with TF+/+ mice, TF+/− mice demonstrated significantly lower pulmonary thrombin-antithrombin complex levels in both ventilation groups. There were, however, no differences in lung wet-to-dry ratio, BALF total protein levels, neutrophil influx, and lung histopathology scores between TF+/− and TF+/+ mice. Notably, pulmonary levels of cytokines were significantly higher in TF+/− as compared to TF+/+ mice. Systemic levels of cytokines were not altered by the relative absence of TF. TF deficiency is associated with decreased pulmonary coagulation independent of the ventilation strategy. However, relative TF deficiency does not reduce VILI and actually results in higher pulmonary levels of inflammatory mediators.