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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Haemodialysis access profile in failed kidney transplant patients: Analysis of data from the Catalan Renal Registry (1998-2016).

J Vasc Access

Data about vascular access (VA) use in failed kidney transplant (KT) patients returning to haemodialysis (HD) are limited. We analysed the VA profile of these patients, the factors associated with the likelihood of HD re-initiation through fistula (AVF) and the effect of VA in use at the time of KT on kidney graft (KTx) outcome.

Data from the Catalan Registry on failed KT patients restarting HD and incident HD patients with native kidney failure were examined over an 18-year period.

The VA profile of 675 failed KT patients at HD re-initiation compared with that before KT and with 16,731 incident patients starting HD was (%): AVF 79.3 versus 88.6 and 46.2 (p = 0.001 and p < 0.001), graft AVG 4.4 versus 2.6 and 1.1 (p = 0.08 and p < 0.001), tunnelled catheter TCC 12.4 versus 5.5 and 18.0 (p = 0.001 and p < 0.001) and non-tunnelled catheter 3.9 versus 3.3 and 34.7 (p = 0.56 and p < 0.001). The likelihood of HD re-initiation by AVF was significantly lower in patients with cardiovascular disease, KT duration >5 years, dialysed through AVG or TCC before KT, and females. The analysis of Kaplan-Meier curves showed a greater KTx survival in patients dialysed through arteriovenous access than in patients using catheter just before KT (λ2 = 5.59, p = 0.0181, log-rank test). Cox regression analysis showed that patients on HD through arteriovenous access at the time of KT had lower probability of KTx loss compared to those with catheter (hazard ratio 0.71, 95% CI 0.55-0.90, p = 0.005).

The VA profile of failed KT patients returning to HD and incident patients starting HD was different. Compared to before KT, the proportion of failed KT patients restarting HD with AVF decreased significantly at the expense of TCC. Patients on HD through arteriovenous access at the time of KT showed greater KTx survival compared with those using catheter.

Compatibility and stability of an admixture of multiple anaesthetic drugs for opioid-free anaesthesia.

Anaesthesia

The ability to combine and use drugs in a single infusion device may be useful in resource-limited settings. This study examined the chemical stabi...

Intensive care unit resources and patient-centred outcomes in severe COVID-19: a prospective single-centre economic evaluation.

Anaesthesia

During the COVID-19 pandemic, ICU bed shortages sparked a discussion about resource allocation. We aimed to analyse the value of ICU treatment of C...

The science behind banning desflurane: A narrative review.

Anaesthesiology

Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anae...

Sex Differences in In-Hospital Mortality After Open Cardiac Valve Surgery.

Anesthesia and Analgesia

Cardiac valvular disease affects millions of people worldwide and is a major cause of morbidity and mortality. Female patients have been shown to experience inferior clinical outcomes after nonvalvular cardiac surgery, but recent data are limited regarding open valve surgical cohorts. The primary objective of our study was to assess whether female sex is associated with increased in-hospital mortality after open cardiac valve operations.

Utilizing the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), we conducted a retrospective cohort study of patients who underwent open cardiac valve surgery from 2007 to 2018 in Washington, Maryland, Kentucky, and Florida; from 2007 to 2011 in California; and from 2007 to 2016 in New York. The primary objective of this study was to estimate the confounder-adjusted association between sex and in-hospital mortality (as recorded and coded by SID HCUP) after open cardiac valve surgery. We used multilevel multivariable models to account for potential confounders, including intrahospital practice patterns.

A total of 272,954 patients (108,443 women; 39.73% of sample population with mean age of 67.6 ± 14.3 years) were included in our analysis. The overall mortality rates were 3.8% for male patients and 5.1% for female patients. The confounder-adjusted odds ratio (OR) for in-hospital mortality for female patients compared to male patients was 1.41 (95% confidence interval [CI], 1.35-1.47; P < .001). When stratifying by surgical type, female patients were also at increased odds of in-hospital mortality (P < .001) in populations undergoing aortic valve replacement (adjusted OR [aOR], 1.38; 95% CI, 1.25-1.52); multiple valve surgery (aOR, 1.38; 95% CI, 1.22-1.57); mitral valve replacement (aOR, 1.22; 95% CI, 1.12-1.34); and valve surgery with coronary artery bypass grafting (aOR, 1.64; 95% CI, 1.54-1.74; all P < .001). Female patients did not have increased odds of in-hospital mortality in populations undergoing mitral valve repair (aOR, 1.26; 95% CI, 0.98-1.64; P = .075); aortic valve repair (aOR, 0.87; 95% CI, 0.67-1.14; P = .32); or any other single valve repair (aOR, 1.10; 95% CI, 0.82-1.46; P = .53).

We found an association between female patients and increased confounder-adjusted odds of in-hospital mortality after open cardiac valve surgery. More research is needed to better understand and categorize these important outcome differences. Future research should include observational analysis containing granular and complete patient- and surgery-specific data.

Digitization of Symbol-Denoted Blood Pressure Data From Intraoperative Paper Health Records in a Low-Middle-Income Country Using Deep Image Segmentation and Associated Postoperative Outcomes: A Feasibility Study.

Anesthesia and Analgesia

In low-middle-income countries (LMICs), perioperative clinical information is almost universally collected on paper health records (PHRs). The lack of accessible digital databases limits LMICs in leveraging data to predict and improve patient outcomes after surgery. In this feasibility study, our aims were to: (1) determine the detection performance and prediction error of the U-Net deep image segmentation approach for digitization of hand-drawn blood pressure symbols from an image of the intraoperative PHRs and (2) evaluate the association between deep image segmentation-derived blood pressure parameters and postoperative mortality and length of stay.

A smartphone mHealth platform developed by our team was used to capture images of completed intraoperative PHRs. A 2-stage deep image segmentation modeling approach was used to create 2 separate segmentation masks for systolic blood pressure (SBP) and diastolic blood pressure (DBP). Iterative postprocessing was utilized to convert the segmentation mask results into numerical SBP and DBP values. Detection performance and prediction errors were evaluated for the U-Net models by comparison with ground-truth values. Using multivariate regression analysis, we investigated the association of deep image segmentation-derived blood pressure values, total time spent in predefined blood pressure ranges, and postoperative outcomes including in-hospital mortality and length of stay.

A total of 350 intraoperative PHRs were imaged following surgery. Overall accuracy was 0.839 and 0.911 for SBP and DBP symbol detections, respectively. The mean error rate and standard deviation for the difference between the actual and predicted blood pressure values were 2.1 ± 4.9 and -0.8 ± 3.9 mm Hg for SBP and DBP, respectively. Using the U-Net model-derived blood pressures, minutes of time where DBP <50 mm Hg (odds ratio [OR], 1.03; CI, 1.01-1.05; P = .003) was associated with an increased in-hospital mortality. In addition, increased cumulative minutes of time with SBP between 80 and 90 mm Hg was significantly associated with a longer length of stay (incidence rate ratio, 1.02 [1.0-1.03]; P < .05), while increased cumulative minutes of time where SBP between 140 and 160 mm Hg was associated with a shorter length of stay (incidence rate ratio, 0.9 [0.96-0.99]; P < .05).

In this study, we report our experience with a deep image segmentation model for digitization of symbol-denoted blood pressure from intraoperative anesthesia PHRs. Our data support further development of this novel approach to digitize PHRs from LMICs, to provide accessible, curated, and reproducible data for both quality improvement- and outcome-based research.

Photomotor Responses in Zebrafish and Electrophysiology Reveal Varying Interactions of Anesthetics Targeting Distinct Sites on Gamma-Aminobutyric Acid Type A Receptors.

Anesthesiology

Etomidate, barbiturates, alphaxalone, and propofol are anesthetics that allosterically modulate GABAA receptors via distinct sets of molecular binding sites. Two-state concerted co-agonist models account for anesthetic effects and predict supra-additive interactions between drug pairs acting at distinct sites. Some behavioral and molecular studies support these predictions, while other findings suggest potentially complex anesthetic interactions. We therefore evaluated interactions among four anesthetics in both animals and GABAA receptors.

We used video assessment of photomotor responses in zebrafish larvae and isobolography to evaluate hypnotic drug pair interactions. Voltage-clamp electrophysiology and allosteric shift analysis evaluated co-agonist interactions in α1β3γ2L receptors activated by GABA vs. anesthetics [log(d, AN):log(d, GABA) ratio]. Anesthetic interactions at concentrations relevant to zebrafish were assessed in receptors activated with low GABA.

In zebrafish larvae, etomidate interacted additively with both propofol and the barbiturate R-mTFD-MPAB (mean ± SD α = 1.0 ± 0.07 and 0.96 ± 0.11 respectively, where 1.0 indicates additivity), while the four other drug pairs displayed synergy (mean α range 0.76 to 0.89). Electrophysiologic allosteric shifts revealed that both propofol and R-mTFD-MPAB modulated etomidate-activated receptors much less than GABA-activated receptors [log(d, AN):log(d, GABA) ratios = 0.09 ± 0.021 and 0.38 ± 0.024, respectively], while alphaxalone comparably modulated receptors activated by GABA or etomidate [log(d) ratio = 0.87 ± 0.056]. With low GABA activation, etomidate combined with alphaxalone was supra-additive (n = 6; P = 0.023 by paired t-test), but etomidate plus R-mTFD-MPAB or propofol was not.

In both zebrafish and GABAA receptors, anesthetic drug pairs interacted variably, ranging from additivity to synergy. Pairs including etomidate displayed corresponding interactions in animals and receptors. Some of these results challenge simple two-state co-agonist models and support alternatives where different anesthetics may stabilize distinct receptor conformations, altering the effects of other drugs.

Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study.

Anesthesia and Analgesia

Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs).

Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs.

We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care.

We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.

A model to predict difficult airway alerts after videolaryngoscopy in adults with anticipated difficult airways - the VIDIAC score.

Anaesthesia

A model to classify the difficulty of videolaryngoscopic tracheal intubation has yet to be established. The videolaryngoscopic intubation and diffi...

Effects of the tip structure of temporary indwelling catheters on blood recirculation at various blood flow rates and diameters of the mock blood vessel.

J Vasc Access

The aim of the present study was to determine the effects of the tip structure of the catheters used for hemodialysis on blood recirculation at varying blood flow rates and diameters of the mock blood vessel in a well-defined in vitro experimental system, focusing on reverse connection mode.

A mock circulatory circuit was created with silicon tubing (15 or 20 mm), a circulatory pump, connected through the catheter to dialysis circuit and dialyzer attached to dialysis machine. The tip of the inserted catheter was fixed to the center of the silicone tube, and 3 L of pig blood was poured into the blood side of the dialyzer and the recirculation rates were measured at blood flow rates of 100, 150, and 200 mL/min. Five types of commercially available catheters were used: (A) Argyle™, (B) Gentle Cath™ (Hardness gradient type), (C) Gentle Cath™, (D) Niagara™, and (E) Power-Trialysis®.

In the case of reverse connection mode, (1) the recirculation rates were lower in the catheter with a relatively large side hole (catheter C, 17%), catheters with a greater distance between the end hole and side hole (catheters C and D, 25%), and catheter with a symmetrical tip structure (catheter E, 10%) as compared with those in catheters A and B (40% and 25%); (2) increase of the blood flow rate in the dialysis machine was associated with a reduced recirculation rate; and (3) a wider inner diameter of the mock blood vessel and faster flow rate in the vessel were associated with a reduced recirculation rate.

The lowest recirculation was observed with the catheter with symmetrical holes, which produces a helical blood flow line that does not intersect with the blood streamline flowing out to the blood supply hole.

Airway management in penetrating thoracic trauma.

Anaesthesiology Intensive Therapy

Penetrating thoracic trauma accounts for 20-25% of all deaths due to trauma in the first four decades of life. About 33% of deaths from thoracic tr...

Treatment outcomes in Polish COVID-19 patients requiring hospitalisation in the intensive care unit: a single-centre retrospective study.

Anaesthesiology Intensive Therapy

COVID-19 has disturbed the functioning of Polish healthcare for the past two years. Due to the high proportion of patients requiring admission to the intensive care unit (ICU), these wards are particularly overwhelmed and are considered the bottleneck of the healthcare system. The aim of this study was to describe clinical outcomes of critically ill patients treated in a single tertiary ICU in Poland, assess factors associated with mortality and compare outcomes of patients treated during the 2nd and 3rd waves of the pandemic.

This is a retrospective single-centre study including patients admitted to the ICU between October 2020 and May 2021 (the 3rd wave) with confirmed SARS-CoV-2 infection. Patients were followed up until death or 90 days after ICU admission. The co-primary endpoints of this study included ICU, 30-day and 90-day mortality.

We enrolled 108 patients at a mean age of 64.3 (SD = 12) years, the majority of whom were male (63.9%). Mortality in the ICU, after 30 days and 90 days was 44.4% (48/108), 50.0% (54/108), and 57.9% (62/108), respectively. Mortality at 90 days was associated with increasing age (OR = 3.97, 95% CI: 1.87-8.41) and was significantly higher during the 2nd wave (65.6 vs. 46.5%, log-rank P = 0.043) compared to the 3rd wave of the pandemic.

This retrospective single-centre study confirms the high mortality rate among critically ill patients with COVID-19. Moreover, it suggests a significant association between 90-day mortality and increasing age as well as differences in mortality between the 2nd and 3rd waves of the pandemic in Poland.