The latest medical research on Anesthesiology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about anesthesiology gathered by our medical AI research bot.
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Goal-directed versus Standard Fluid Therapy to Decrease Ileus after Open Radical Cystectomy: A Prospective Randomized Controlled Trial.Anesthesiology
Postoperative ileus is a common complication of intraabdominal surgeries, including radical cystectomy with reported rates as high as 32%. Perioperative fluid administration has been associated with improvement in postoperative ileus rates, but it is difficult to generalize because earlier studies lacked standardized definitions of postoperative ileus and other relevant outcomes. The hypothesis was that targeted individualized perioperative fluid management would improve postoperative ileus in patients receiving radical cystectomy.
This is a parallel-arm, double-blinded, single-center randomized trial of goal-directed fluid therapy versus standard fluid therapy for patients undergoing open radical cystectomy. The primary outcome was postoperative ileus, and the secondary outcome was complications within 30 days post-surgery. Participants were at least 21 yr old, had a maximum body mass index of 45 kg/m and no active atrial fibrillation. The intervention in the goal-directed therapy arm combined preoperative and postoperative stroke volume optimization and intraoperative stroke volume variation minimization to guide fluid administration, using advanced hemodynamic monitoring.
Between August 2014 and April 2018, 283 radical cystectomy patients (142 goal-directed fluid therapy and 141 standard fluid therapy) were included in the analysis. Postoperative ileus occurred in 25% (36 of 142) of patients in the goal-directed fluid therapy arm and 21% (30 of 141) of patients in the standard arm (difference in proportions, 4.1%; 95% CI, -5.8 to 13.9; P = 0.418). There was no difference in incidence of high-grade complications between the two arms (20 of 142 [14%] vs. 23 of 141 [16%]; difference in proportions, -2.2%; 95% CI, -10.6 to 6.1; P = 0.602), with the exception of acute kidney injury, which was more frequent in the goal-directed fluid therapy arm (56% [80 of 142] vs. 40% [56 of 141] in the standard arm; difference in proportions, 16.6%; 95% CI, 5.1 to 28.1; P = 0.005; P = 0.170 after adjustment for multiple testing).
Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Postoperative ileus is a common complication after intraabdominal surgeriesPrevious studies have found mixed evidence for benefit in goal-[LINE SEPARATOR]directed intraoperative fluid therapy over standard fluid therapy WHAT THIS ARTICLE TELLS US THAT IS NEW: In a randomized trial of goal-directed versus standard fluid therapy in patients having radical cystectomy, there was no difference in the primary outcome of postoperative ileusThere was no difference between fluid therapies in the secondary outcome of high-grade complications.
Autopilots in the Operating Room: Safe Use of Automated Medical Technology.Anesthesiology
Automated medical technology is becoming an integral part of routine anesthetic practice. Automated technologies can improve patient safety, but ma...
Preoperative Frailty Predicts Postoperative Neurocognitive Disorders After Total Hip Joint Replacement Surgery.Anesthesia and Analgesia
Frailty is a reduced capacity to recover from a physiologically stressful event. It is well established that preoperative frailty is associated with poor postoperative outcomes, but it is unclear if this includes cognitive decline following anesthesia and surgery. This retrospective observational study was a secondary analysis of data from a previous study (the Anaesthesia, Cognition, Evaluation [ACE] study). We aimed to identify if preoperative frailty or prefrailty is associated with preoperative and postoperative neurocognitive disorders or postoperative cognitive dysfunction.
The ACE study enrolled 300 participants aged ≥60 scheduled for elective total hip joint replacement and who underwent a full neuropsychological assessment at baseline and 3 and 12 months postoperatively. We applied patient data to 2 frailty models; both were based on an accumulation of deficits score: the reported Edmonton frail scale (REFS) and the comprehensive geriatric assessment-frailty index (CGA-FI) based on the comprehensive geriatric assessment. We calculated these 2 scores using baseline data collected from the medical history, demographic and clinical data as well as self-reported questionnaires. Some items on the REFS (3 of 18 or 17%) and the CGA-FI (37 of 51 or 27%) did not have an equivalent item in the ACE data.
The mean age (standard deviation [SD]) was 70.1 years (6.6) with more women (197 [66%]). Using the REFS model, 40 of 300 (13.3%) patients were classified as vulnerable, mild, or moderately frail. Using the CGA-FI model, 69 of 300 (23%) were classified as intermediate or high frailty. The REFS and the CGA-FI were strongly correlated (r = 0.75; P < .01) with 34 of 300 (11%) meeting criteria for frailty by both the REFS and the CGA-FI.Frailty or prefrailty was associated with cognitive decline at 3 and 12 months using the REFS (odds ratio [OR], 1.51, 95% confidence interval [CI], 1.02-2.23 and OR, 2.00, 95% CI, 1.26-3.17, respectively) after adjusting for baseline mini-mental state examination (MMSE), smoking, hypertension, diabetes, history of acute myocardial infarction (AMI), and estimated intelligence quotient (IQ). Age did not modify this association. After adjusting for multiple comparisons, 3-month cognitive decline was no longer significantly associated with baseline frailty.
This retrospective analysis demonstrates an association between baseline frailty and postoperative neurocognitive disorders, particularly using the more extensive REFS scoring method. This supports preoperative screening for frailty to risk-stratify patients, and identify and implement preventive strategies and to improve postoperative outcomes for older individuals.
Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting.Anesthesia and Analgesia
This consensus statement presents a comprehensive and evidence-based set of guidelines for the care of postoperative nausea and vomiting (PONV) in ...
Pre-procedural ultrasound-guided evaluation of left internal jugular vein and brachiocephalic vein: Experience on infants <1 year.J Vasc Access
Pre-procedural evaluation of central veins prior to cannulation with ultrasound is essential to reduce the complication rates as well as to increas...
Thinking outside the (acrylic) box: a framework for the local use of custom-made medical devices.Anaesthesia
Before the COVID-19 pandemic, clinicians were already adept at creating workarounds for day-to-day shortages of equipment, inventively cobbling tog...
Anaphylaxis in pregnancy: a population-based multinational European study.Anaesthesia
Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lackin...
Managing the R0 of Covid-19: mathematics fights back.Anaesthesia
Perhaps for the first time in history, a single statistical measure is now dictating the entirety of UK government policy. The 'basic reproduction ...
Isoflurane Exposure in Juvenile Caenorhabditis elegans Causes Persistent Changes in Neuron Dynamics.Anesthesiology
Animal studies demonstrate that anesthetic exposure during neurodevelopment can lead to persistent behavioral impairment. The changes in neuronal function underlying these effects are incompletely understood. Caenorhabditis elegans is well suited for functional imaging of postanesthetic effects on neuronal activity. This study aimed to examine such effects within the neurocircuitry underlying C. elegans locomotion.
C. elegans were exposed to 8% isoflurane for 3 h during the neurodevelopmentally critical L1 larval stage. Locomotion was assessed during early and late adulthood. Spontaneous activity was measured within the locomotion command interneuron circuitry using confocal and light-sheet microscopy of the calcium-sensitive fluorophore GCaMP6s.
C. elegans exposed to isoflurane demonstrated attenuation in spontaneous reversal behavior, persisting throughout the animal's lifespan (reversals/min: untreated early adulthood, 1.14 ± 0.42, vs. isoflurane-exposed early adulthood, 0.83 ± 0.55; untreated late adulthood, 1.75 ± 0.64, vs. isoflurane-exposed late adulthood, 1.14 ± 0.68; P = 0.001 and 0.006, respectively; n > 50 animal tracks/condition). Likewise, isoflurane exposure altered activity dynamics in the command interneuron AVA, which mediates crawling reversals. The rate at which AVA transitions between activity states was found to be increased. These anesthetic-induced effects were more pronounced with age (off-to-on activity state transition time (s): untreated early adulthood, 2.5 ± 1.2, vs. isoflurane-exposed early adulthood, 1.9 ± 1.3; untreated late adulthood, 4.6 ± 3.0, vs. isoflurane-exposed late adulthood, 3.0 ± 2.4; P = 0.028 and 0.008, respectively; n > 35 traces acquired from more than 15 animals/condition). Comparable effects were observed throughout the command interneuron circuitry, indicating that isoflurane exposure alters transition rates between behavioral crawling states of the system overall. These effects were modulated by loss-of-function mutations within the FoxO transcription factor daf-16 and by rapamycin-mediated mechanistic Target of Rapamycin (mTOR) inhibition.
Altered locomotive behavior and activity dynamics indicate a persistent effect on interneuron dynamics and circuit function in C. elegans after developmental exposure to isoflurane. These effects are modulated by a loss of daf-16 or mTOR activity, consistent with a pathologic activation of stress-response pathways. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Experimental data in laboratory animals demonstrate that early life exposure to anesthetics can induce lasting neurobehavioral and cognitive alterationsThe neurobiological bases of these alterations are incompletely understoodCaenorhabditis elegans is a well suited experimental model for long-term functional imaging of neurons after anesthesia exposure WHAT THIS ARTICLE TELLS US THAT IS NEW: Exposure of Caenorhabditis elegans to isoflurane for 3 h during the first larval stage results in lifelong attenuation in spontaneous crawling reversal behaviorThese effects correlate with persistently altered activity dynamics of command interneurons mediating crawling reversalsGenetic dissection of potential underlying mechanisms reveals that these effects are modulated by a loss of daf-16 or mechanistic Target of Rapamycin (mTOR) activity, consistent with a persistent pathologic activation of stress-response pathways.
Intracavitary electrocardiography-guided positioning of central vascular access device can spare unnecessary ionizing radiation exposure in pediatric patients.J Vasc Access
Most hospital protocols-including those of our own institute-require the use of radiography to validate tip position in every central vascular access device placement. This study evaluated whether unnecessary ionizing radiation exposure could be spared in the pediatric population when intracavitary electrocardiography is used to guide catheter placement.
Retrospective study of intracavitary electrocardiography-guided central vascular access device placements in our pediatric surgery department between 2013 and 2018. We evaluated the operating time, success in positioning the catheter, and accuracy of final tip position. We also assayed the effects of catheter type and of catheter access point on operating time, success, accuracy, and complications. We applied the chi-square test for statistical analysis.
In total, 622 interventions of central vascular access device placements were evaluated; 340 intracavitary electrocardiography-guided central vascular access device placements were included in the study. The electrocardiography method successfully positioned the tip of the catheter in 316/340 (92.94%) of placements. Where intracavitary electrocardiography placement was successful, radiography confirmed accuracy of tip position in 314/316 (99.41%) of placements.
When electrocardiography-guided positioning is uneventful and a valid P-Wave pattern is seen, postprocedure radiograph imaging for verification is unnecessary. Any effort should be made to upgrade hospital policies according to evidences and newest guidelines to spare pediatric patients harmful exposure to radiation by limiting the use of radiography only to selected cases.
Evaluation of the risk factors on time to phlebitis- and nonphlebitis-related failure when peripheral venous catheters were replaced as clinically indicated.J Vasc Access
This study aimed to determine the frequency of peripheral venous catheter-related complications and the risk factors that have an impact on the time of peripheral venous catheter failure when they were replaced as clinically indicated.
This was a prospective observational study. The demographic and clinical characteristics of the patients, as well as the catheter specifications, were recorded. All the catheters were followed-up at 12-h intervals for the development of complications. Two different peripheral venous catheters were used in the study. The catheter dwell times were estimated using Kaplan-Meier analysis. The logrank test was utilized to investigate the catheter dwell times by univariate analyses. Variables with a significance level of less than 0.20 were taken into Cox regression analysis.
Our results revealed that phlebitis and nonphlebitis complications occurred more frequently within the first 96 h. No significant difference was observed in the occurrence time of phlebitis, nonphlebitis, and composite failures. The use of a locally manufactured catheter, unsuccessful first attempt, poor skin integrity, after-hours' insertion, the use of sterile gauze dressing were all associated with shorter catheter survival rates.
We observed no difference on the time to phlebitis or nonphlebitis symptoms with clinically indicated replacement of peripheral venous catheters. We found a significant difference in survival rates between locally manufactured and imported peripheral venous catheters. Our identified risk factors should be taken into account to reduce peripheral venous catheter-related complications and to increase dwell time.
Technologies to optimize the care of severe COVID-19 patients for healthcare providers challenged by limited resources.Anesthesia and Analgesia
Healthcare systems are belligerently responding to the new Coronavirus Disease 2019 (COVID-19). The severe acute respiratory syndrome (SARS co-V2) ...