Hasil untuk "Anesthesiology"

Christiana Owiredua, Ida Flink, Brittany Evans et al.

Abstract. Introduction:. A sizeable number of adolescents with recurrent pain frequently miss school, yet the trajectories of absenteeism and their correlates remain unclear. We aimed to explore trajectories of school absenteeism due to pain among adolescents with recurrent pain, and predictors and correlates of the trajectories. Methods:. A prospective cohort design with 3 yearly measurement points between 2016 and 2018 was used. The sample included 873 Swedish upper secondary school adolescents (mean age = 16.5 years; 60.8% girls; 11.7% immigrants) with recurrent pain (headache, abdominal and/or musculoskeletal pain ≥1/wk for 6 months). Predictors were sociodemographic variables, pain characteristics, depressive symptoms, and stressors in the school context. Distal outcomes were perceived future work ability and overall future expectancy. Results:. We identified 3 trajectories of absenteeism through latent class growth analysis: persistently high absenteeism (18.1%), persistently low absenteeism (49.4%), and persistently no absenteeism (32.5%). Pain intensity and school-related stressors independently predicted absenteeism trajectories. Compared with the other trajectories, the persistently high absenteeism subgroup had more negative perceived future work ability and overall future expectancy. Conclusion:. A substantial subgroup of adolescents showed a stable pattern of high absenteeism across their upper secondary education, which was associated with overall negative expectancies for the future and specifically future work ability. Therefore, there is a need to identify this subgroup and intervene early in the life course to prevent long-term disadvantages in education, employment, and overall well-being.

Ali Dabbagh, A. Sassan Sabouri

Madhusudan P. Singh, Meenalotchini P. Gurunthalingam, Ayushee Gupta et al.

Background and Aims: Postoperative nausea and vomiting (PONV) is a common complication after surgery. Preventing PONV in high-risk patients often requires a multimodal approach combining antiemetic drugs with diverse mechanisms. While aprepitant, a neurokinin-1 receptor antagonist, is recognised as highly effective for PONV prevention, uncertainties remain regarding its effectiveness. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The analysis assessed the effectiveness of aprepitant (A), aprepitant plus ondansetron (AO) and aprepitant plus dexamethasone and ondansetron (ADO) in preventing PONV compared to ondansetron alone (O) or in combination with dexamethasone (DO). Results: In the analysis of 12 studies involving 2729 patients, aprepitant demonstrated significant efficacy in preventing PONV compared to ondansetron alone (A versus [vs.] O: PONV incidence 12.5% vs. 28.5%, relative risk [RR] = 0.45, P < 0.001; complete response rate 55.97% vs. 50.35%, RR = 1.13, P = 0.010). The combination of aprepitant with ondansetron (AO) also showed a significantly lower incidence of PONV compared to ondansetron alone (11.3% vs. 26.8%, RR = 0.43, P < 0.001) and a higher complete response rate (38.1% vs. 26.84%, RR = 1.41, P = 0.020). In addition, ADO significantly reduced PONV incidence compared to DO (ADO vs. DO: 13.63% vs. 35.38%, RR = 0.38, P = 0.006). Conclusion: Aprepitant, whether used alone or in combination with ondansetron or both ondansetron and dexamethasone, consistently outperforms ondansetron in achieving a complete response as it lowers vomiting rates and reduces the need for rescue therapy during the crucial 24–48-h postoperative period.

Karthik Tiruthani, Carlos Cruz‐Teran, Jasper F. W. Chan et al.

Abstract Soluble angiotensin‐converting enzyme 2 (ACE2) can act as a decoy molecule that neutralizes severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) by blocking spike (S) proteins on virions from binding ACE2 on host cells. Based on structural insights of ACE2 and S proteins, we designed a “muco‐trapping” ACE2‐Fc conjugate, termed ACE2‐(G4S)6‐Fc, comprised of the extracellular segment of ACE2 (lacking the C‐terminal collectrin domain) that is linked to mucin‐binding IgG1‐Fc via an extended glycine‐serine flexible linker. ACE2‐(G4S)6‐Fc exhibits substantially greater binding affinity and neutralization potency than conventional full length ACE2‐Fc decoys or similar truncated ACE2‐Fc decoys without flexible linkers, possessing picomolar binding affinity and strong neutralization potency against pseudovirus and live virus. ACE2‐(G4S)6‐Fc effectively trapped fluorescent SARS‐CoV‐2 virus like particles in fresh human airway mucus and was stably nebulized using a commercial vibrating mesh nebulizer. Intranasal dosing of ACE2‐(G4S)6‐Fc in hamsters as late as 2 days postinfection provided a 10‐fold reduction in viral load in the nasal turbinate tissues by Day 4. These results strongly support further development of ACE2‐(G4S)6‐Fc as an inhaled immunotherapy for COVID‐19, as well as other emerging viruses that bind ACE2 for cellular entry.

Azriel Osherov, Enrique Gallego-Colon, Ella Shaviv et al.

Abstract Background Giant coronary artery aneurysms are rare conditions with potentially devastating consequences. We report a case of the largest documented giant right coronary artery (RCA) aneurysm to date. Case presentation A 57-year-old male patient visited our outpatient clinic for abdominal pain and exertional dyspnea. Computed tomography identified a 10.2 × 9.8 cm RCA aneurysm with RCA pressure waves were similar to aortic pressures. After discussion by the cardiac team, elective resection with ligation of the proximal and distal ends of the RCA was performed due to the presence of adequate collaterals. Conclusion We highlight the challenges related to the management of patients presenting with giant coronary artery aneurysms. Optimal management strategies and outcomes for such rare cardiovascular conditions implies the need for standardised management guidelines.

S. Kendale, Prathamesh Kulkarni, A. Rosenberg et al.

What We Already Know about This Topic The ability to predict postinduction hypotension remains limited and challenging due to the multitude of data elements that may be considered Novel machine-learning algorithms may offer a systematic approach to predict postinduction hypotension, but are understudied What This Article Tells Us That Is New Among 13,323 patients undergoing a variety of surgical procedures, 8.9% experienced a mean arterial pressure less than 55 mmHg within 10 min of induction start While some machine-learning algorithms perform worse than logistic regression, several techniques may be superior Gradient boosting machine, with tuning, demonstrates a receiver operating characteristic area under the curve of 0.76, a negative predictive value of 19%, and positive predictive value of 96% Background: Hypotension is a risk factor for adverse perioperative outcomes. Machine-learning methods allow large amounts of data for development of robust predictive analytics. The authors hypothesized that machine-learning methods can provide prediction for the risk of postinduction hypotension. Methods: Data was extracted from the electronic health record of a single quaternary care center from November 2015 to May 2016 for patients over age 12 that underwent general anesthesia, without procedure exclusions. Multiple supervised machine-learning classification techniques were attempted, with postinduction hypotension (mean arterial pressure less than 55 mmHg within 10 min of induction by any measurement) as primary outcome, and preoperative medications, medical comorbidities, induction medications, and intraoperative vital signs as features. Discrimination was assessed using cross-validated area under the receiver operating characteristic curve. The best performing model was tuned and final performance assessed using split-set validation. Results: Out of 13,323 cases, 1,185 (8.9%) experienced postinduction hypotension. Area under the receiver operating characteristic curve using logistic regression was 0.71 (95% CI, 0.70 to 0.72), support vector machines was 0.63 (95% CI, 0.58 to 0.60), naive Bayes was 0.69 (95% CI, 0.67 to 0.69), k-nearest neighbor was 0.64 (95% CI, 0.63 to 0.65), linear discriminant analysis was 0.72 (95% CI, 0.71 to 0.73), random forest was 0.74 (95% CI, 0.73 to 0.75), neural nets 0.71 (95% CI, 0.69 to 0.71), and gradient boosting machine 0.76 (95% CI, 0.75 to 0.77). Test set area for the gradient boosting machine was 0.74 (95% CI, 0.72 to 0.77). Conclusions: The success of this technique in predicting postinduction hypotension demonstrates feasibility of machine-learning models for predictive analytics in the field of anesthesiology, with performance dependent on model selection and appropriate tuning.

T. Egan, H. Lemmens, P. Fiset et al.

Brandon L. Boring, Alison Richter, Vani A. Mathur

Abstract. Introduction:. Experiencing stress can contribute to unfavorable pain experiences, but outcomes vary across individuals. Evidence suggests that a person's specific reactivity to stressful events may influence pain responses. Previous studies measuring physiological stress reactivity have found associations with pain both clinically and in the laboratory. However, the time and cost required for testing physiological stress reactivity may limit clinical application. Objective:. Self-reported perception of one's own stress reactivity has been shown to correlate with physiological stress reactivity in relation to health outcomes and may represent a valuable tool in clinical pain assessment. Methods:. Using data from the Midlife in the US survey, we selected participants who did not have chronic pain at baseline (n = 1512) and who had data at follow-up 9 years later. Stress reactivity was assessed using a subscale of the Multidimensional Personality Questionnaire. We conducted a binary logistic regression to determine the odds of developing chronic pain, controlling for demographics and other health-related variables. Results:. Results indicate that higher reported stress reactivity at baseline increased the odds of developing chronic pain at follow-up (odds ratio (OR) = 1.085, 95% confidence interval (CI) (1.021, 1.153), P = 0.008), with the only other significant predictor being the number of chronic conditions (OR = 1.118, 95% CI (1.045, 1.197), P = 0.001). Conclusion:. Findings provide evidence for the predictive criterion validity of self-reported stress reactivity in the context of chronic pain risk. More generally, with increased need for virtual assessment and care, self-reported stress reactivity may be a useful, time-efficient, and cost-efficient tool for predicting pain outcomes in research and clinical contexts.

Reza Baghbanian, Mohsen Savaie, Farhad Soltani et al.

Introduction: Effective antiviral medications with minimal side effects has received scholarly attention since the start of the COVID-19 pandemic. Ivermectin, a long-time anti-parasitic drug, has been proven through laboratory tests to have anti-COVID-19 effects. Objectives: This study investigated the effects of inclusion of ivermectin to the standard treatment of mechanically ventilated patients. Patients and Methods: This study is a double-blinded, randomized, placebo-controlled clinical trial that was conducted on COVID-19 patients, in Ahvaz, Iran, from March 2020 to September 2021. Intubated COVID-19 patients who met the inclusion criteria were randomly allocated into two groups, placebo (n = 29) and the ivermectin-treated (n = 31). The primary outcome was the mortality, and the secondary outcomes were pulmonary compliance and vital signs. Results: Two groups were similar regarding demographic characteristics such as age, gender, the length of time since the onset of symptoms before intubation, the level of lactate dehydrogenase (LDH) in the blood. Moreover, the difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, and interleukin 6 (IL-6) was not significant between the two groups. Regarding mortality rate, no significant difference between the two groups was detected. Furthermore, O2 saturation on day 5 was significantly higher in the ivermectin group as opposed to the control group (P=0.008). No statistically significant difference was found between the two groups regarding respiratory rate, heart rate, systolic and diastolic blood pressure, and lung compliance (dynamic and static). Conclusion: Regarding the importance of blood oxygen saturation in COVID-19 patients, our results showed no significant effect of ivermectin in the treatment of ventilated COVID-19 patients, suggesting that its addition to the standard COVID-19 treatment either is ineffective or has no synergistic effect. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (Identifier: IRCT20190417043295N2; https://www.irct.ir/trial/57603, ethical code#IR.AJUMS. REC.1400.234).

Kedir Abdureman Hassen, Micheal Alemayehu Nemera, Andualem Wubetie Aniley et al.

Introduction. Mechanical ventilation (MV) is a backbone and major supportive modality in intensive care units (ICUs) even though it has side effects and complications. Knowledge of nurses about mechanical ventilators and good practice of nursing care for the ventilated patient plays a crucial role in improving the effectiveness of mechanical ventilation, preventing harm, and optimizing the patient outcome. This study intended to assess the knowledge regarding MV and the practice of ventilator care among nurses working in the ICU. Method. A descriptive cross-sectional study design was conducted. All nurses working in the intensive care unit of selected governmental hospitals were included in the study. The data were collected from March 1 to 30, 2021 with structured and pretested self-administered questionnaires. The collected data were evaluated with SPSS version 26 software. The variables, which have an independent association with poor outcomes, were identified based on OR, with 95% CI and a p value less than 0.05. Results. Of 146 nurses who participated in the study, 51.4% were males. About 71.4% had a BSc in nursing and 57.5% of them had training related to MV. More than half (51.4%) of nurses had poor knowledge regarding MV and the majority (58.9%) of them had poor practice in ventilatory care. The educational level (AOR, 5.1; 95% CI, 1.190–22.002) was positively associated with knowledge. Likewise, the educational level (AOR 5.0 (1.011–24.971)) and work experience (AOR 4.543 (1.430–14.435)) were positively associated with the practice of nurses. Conclusions. Knowledge regarding mechanical ventilators and the practice of ventilatory care among nurses in the selected public hospitals was poor. The educational levels were found statistically associated with both the knowledge and practice of nurses. To improve nursing care offered for MV patients, upgrading the educational level of intensive care nurses plays a vital role.

Yixu Deng, Meilin Weng, Jun zhang

Abstract Background The impact of preoperative anemia on a survival outcome and the importance of correcting preoperative anemia in patients with colorectal cancer (CRC) remain controversial. This study aimed to explore how preoperative anemia affects the long-term survival of patients undergoing colorectal cancer surgery. Methods This was a retrospective cohort study in which adult patients underwent surgical resection for colorectal cancer between January 1, 2008, and December 31, 2014, at a large tertiary cancer center. A total of 7436 patients were enrolled in this study. Anemia was defined according to the diagnostic criteria of China (hemoglobin level < 110 g/L for women and < 120 g/L for men). The median follow-up time was 120.5 months (10.0 years). Inverse probability of treatment weighting (IPTW) using the propensity score was used to reduce selection bias. Overall survival (OS) and disease-free survival (DFS) were compared between patients with and without preoperative anemia using the Kaplan–Meier estimator and the weighted log-rank test based on IPTW. Univariate and multivariate Cox proportional hazards models were used to assess factors associated with OS and DFS. Multivariable Cox regression was also used to assess red blood cell (RBC) transfusion associations between preoperative anemia and outcomes. Results After IPTW adjustment, clinical profiles were similar, except that tumor location and TNM stage remained imbalanced between the preoperative anemia and preoperative non-anemia groups (p < 0.001). IPTW analysis showed that the 5-year OS rate (71.3 vs. 78.6%, p < 0.001) and the 5-year DFS rate (63.9 vs. 70.9%, p < 0.001) were significantly lower in the preoperative anemia group. Multivariate analysis showed that preoperative anemia was associated with poorer OS and DFS, while RBC transfusion may improve OS (hazard ratio [HR] 0.54, p = 0.054) and DFS (HR 0.50, p = 0.020) in CRC patients with preoperative anemia. Conclusions Preoperative anemia is an independent risk factor for survival in patients undergoing colorectal surgery. Strategies to reduce preoperative anemia in patients with CRC should be considered.

M. Meng, K. Arendt

Maternal morbidity and mortality as a result of cardiac disease is increasing in the United States. Safe management of pregnancy in women with heart disease requires appropriate anesthetic, cardiac, and obstetric care. The anesthesiologist should risk stratify pregnant patients based upon cardiac disease etiology and severity in order to determine the appropriate type of hospital and location within the hospital for delivery and anesthetic management. Increased intrapartum hemodynamic monitoring may be necessary and neuraxial analgesia and anesthesia is typically appropriate. The anesthesiologist should anticipate obstetric and cardiac emergencies such as emergency cesarean delivery, postpartum hemorrhage, and peripartum arrhythmias. This clinical review answers practical questions for the obstetric anesthesiologist and the nonsubspecialist anesthesiologist who regularly practices obstetric anesthesiology. The safe management of pregnancy in women with heart disease requires appropriate anesthetic, cardiac, and obstetric care. This clinical review discusses current trends in obstetric anesthesia management. Supplemental Digital Content is available in the text.

E. Kharasch, J. Clark

Fashions come and fashions go. Changes in clothing, automobiles and restaurants follow popular trends and are often periodic and cyclical. Ideally, medical change is driven not by fashion but instead by concepts of effectiveness and safety, and that these improve and refine as better data become available. Trends hold true also in anesthesia practice, where for example intraoperative opioid selection has swung from long-duration to ultra-short duration and then at least partially back again.1. Recent years have witnessed a new fashion in anesthesiology – “opioid-free anesthesia”. For some, the opioid pendulum has swung clear past rational opioid use in balanced anesthesia, to eliminating opioids intraoperatively and sometimes also postoperatively (“opioid-free analgesia”). Eradicating opioids from intraoperative and postoperative analgesic plans has been termed a “movement”,2 and like many “movements” it has attracted passionate proponents and spirited debate.3,4 Nevertheless, clinical research and peer-reviewed evidence on the potential benefits and risks of opioid-free anesthesia have remained scant, needed, and called for.5–7

A. Guerguerian, Minako Sano, M. Todd et al.

From the *Department of Critical Care Medicine, The Hospital for Sick Kids, University of Toronto, Toronto; †Department of Anesthesiology, Division of Cardiac Anesthesiology, The Hospital for Sick Kids, University of Toronto, Toronto; ‡Department of Surgery, Division of Cardiothoracic Surgery, The Hospital for Sick Kids, University of Toronto, Toronto; §Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts; ¶Department of Pediatrics, UTSouthwestern Medical Center, Dallas, Texas; ‖Chris Hani Baragwanath Academic Hospital, Johannesburg, Africa; #Children’s Hospital Bambino Gesù, Rome, Italy; **National University Health System, Singapore; and ††University of Florida, Gainesville, Florida. Submitted for consideration November 2020; accepted for publication in revised form November 2020. Disclosure: The authors have no conflicts of interest to report. Correspondence: Anne-Marie Guerguerian, MD, PhD, Critical Care Medicine, Hospital for Sick Children, 686 Bay St, Toronto, ON M5G 0A4, Canada. Email: anne-marie.guerguerian@sickkids.ca. Copyright © ELSO 2021 DOI: 10.1097/MAT.0000000000001345 Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines

J. Apfelbaum, J. Hawkins, Madhulika Agarkar et al.

Anesthesiology, V 124 • No 2 270 February 2016 P RACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to the clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open-forum commentary, and clinical feasibility data. This document updates the “Practice Guidelines for Obstetric Anesthesia: An Updated Report by the ASA Task Force on Obstetric Anesthesia,” adopted by ASA in 2006 and published in 2007.†

Theodora Wingert, Christine Lee, M. Cannesson

Ivona Brkić Gudelj, Ivan Šklebar, Dubravko Habek

Introduction: Quality assessment of provided healthcare is becoming a standard in numerous health institutions worldwide, which is beneficial for both the patient and the institution. In order to achieve this standard, it is necessary to develop quality indicators in all segments of healthcare. Postdural puncture headache is a common complication following neuraxial blocks, especially in obstetric anesthesia. If severe, it is a cause of emotional and psychological distress and must be treated by a blood patch. Aim: The aim of this study was to determine whether the number of these complications is reduced when blood patch frequency is monitored and analyzed and to assess the effect of countermeasures in order to improve the quality and safety of regional anesthesia in obstetrics. Methods: Before 2009 and during that year at the University Hospital Sveti Duh, there had been a large number of severe postdural puncture headaches after spinal anesthesia and epidural analgesia treated by a blood patch in 6.12% of cases. After noticing the rising number of blood patches, we decided to analyses data every year. We recorded all blood patches injected to obstetric patients within the period of nine year, from 2009 to 2018 and concurrently we introduced a set of measures to improve the quality of neuraxial blocks, such as the use of atraumatic 26 or 27-gauge pencil-point spinal needles and modern neuraxial blockade protocols. Data were collected from anesthesiology and gynecology protocols and analyzed with MedCalc software, version 18.1.2. Results: The frequency of blood patch applications has been reduced from 6.12% to 0.30%, which is statistically significant. The percentage of placed epidural catheters for vaginal birth increased from 21% in 2009 to 38% in 2018. Although not statistically significant, the number of pregnant women undergoing a caesarean section is also growing, while the total number of births is falling. The proportion of cesarean sections in spinal anesthesia varies from year to year. Discussion: A statistically significant decrease in the number of installed blood patches clearly indicates the positive effect of measures taken to improve quality, which could contribute to the growing interest of pregnant women in childbirth in epidural analgesia. The number of placed epidural catheters is increasing despite the decline in the total number of deliveries and the increase in the number of deliveries completed by cesarean section. Conclusion: Monitoring the incidence of severe post-puncture headaches treated with blood patches has shown great progress in improving the quality and safety of regional anesthesia and analgesia in our institution, so we believe that monitoring the number of blood patches could serve as an indicator of regional anesthesia and analgesia in obstetrics. Monitoring the number of blood patches shows that the frequency of post-puncture headaches does not correlate only with the type of needle or epidural catheter used for neuroaxial blocks, but is also a sensitive indicator of any deviations from the achieved standards. Furthermore, it indicates the need for careful analysis of causes in order to adopt and implement appropriate countermeasures.

Khaled Dibs, Joshua D. Palmer, Rahul N. Prasad et al.

BackgroundWith advances in systemic therapy translating to improved survival in metastatic malignancies, spine metastases have become an increasingly common source of morbidity. Achieving durable local control (LC) for patients with circumferential epidural disease can be particularly challenging. Circumferential stereotactic body radiotherapy (SBRT) may offer improved LC for circumferential vertebral and/or epidural metastatic spinal disease, but prospective (and retrospective) data are extremely limited. We sought to evaluate the feasibility, toxicity, and cancer control outcomes with this novel approach to circumferential spinal disease.MethodsWe retrospectively identified all circumferential SBRT courses delivered between 2013 and 2019 at a tertiary care institution for post-operative or intact spine metastases. Radiotherapy was delivered to 14–27.5 Gy in one to five fractions. Feasibility was assessed by determining the proportion of plans for which ≥95% planning target volume (PTV) was coverable by ≥95% prescription dose. The primary endpoint was 1-year LC. Factors associated with increased likelihood of local failure (LF) were explored. Acute and chronic toxicity were assessed. Detailed dosimetric data were collected.ResultsFifty-eight patients receiving 64 circumferential SBRT courses were identified (median age 61, KPS ≥70, 57% men). With a median follow-up of 15 months, the 12-month local control was 85% (eight events). Five and three recurrences were in the epidural space and bone, respectively. On multivariate analysis, increased PTV and uncontrolled systemic disease were significantly associated with an increased likelihood of LF; ≥95% PTV was covered by ≥95% prescription dose in 94% of the cases. The rate of new or progressive vertebral compression fracture was 8%. There were no myelitis events or any grade 3+ acute or late toxicities.ConclusionsFor patients with circumferential disease, circumferential spine SBRT is feasible and may offer excellent LC without significant toxicity. A prospective evaluation of this approach is warranted.

Linda Li, R. J. Yong, Alan David Kaye et al.

I. Costache, A. Pawa, Faraj W. Abdallah