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Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 2194-2201页

作者： Shu-Shu Song Li Lin Li Li Xiao-Dong Han department of anesthesia and Surgery Wenzhou Central HospitalWenzhou 325099Zhejiang ProvinceChina

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in *** treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical ***,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient *** To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver *** Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was ***-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general *** were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration *** EA occurred in 51(25.5%)*** analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test ***-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed

关键词： Primary hepatocellular carcinoma resection General anesthesia Emergence agitation Risk factors Forecast Nomograph

Latest assessment methods for mitochondrial homeostasis in cognitive diseases

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Neural Regeneration Research 2024年第4期19卷 754-768页

作者： Wei You Yue Li Kaixi Liu Xinning Mi Yitong Li Xiangyang Guo Zhengqian Li department of Anesthesiology Peking University Third Hospital Peking University Third Clinical Medical College Beijing Center of Quality Control and Improvement on Clinical anesthesia anesthesia and Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care(CPAM)

Mitochondria play an essential role in neural function,such as supporting normal energy metabolism,regulating reactive oxygen species,buffering physiological calcium loads,and maintaining the balance of morphology,subcellular distribution,and overall health through mitochondrial *** the recent technological advances in the assessment of mitochondrial structure and functions,mitochondrial dysfunction has been regarded as the early and key pathophysiological mechanism of cognitive disorders such as Alzheimer’s disease,Parkinson’s disease,Huntington’s disease,mild cognitive impairment,and postoperative cognitive *** review will focus on the recent advances in mitochondrial medicine and research methodology in the field of cognitive sciences,from the perspectives of energy metabolism,oxidative stress,calcium homeostasis,and mitochondrial dynamics(including fission-fusion,transport,and mitophagy).

关键词： cognitive disorders mitochondrial dysfunction mitochondrial energy metabolism mitochondrial dynamics mitochondrial transport mitophagy mitochondrial biogenesis oxidative stress calcium homeostasis

Risk factors associated with intraoperative persistent hypotension in pancreaticoduodenectomy

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1582-1591页

作者： Xing-Jun Wang Xi-Chen Xuan Zhao-Chu Sun Shi Shen Fan Yu Na-Na Li Xue-Chun Chu Hui Yin You-Li Hu department of anesthesia and Perioperative Medicine The First Affiliated Hospital of Nanjing Medical UniversityNanjing 210029Jiangsu ProvinceChina

BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain *** To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative *** A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in *** factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas *** was defined as sustained mean arterial pressure30 min despite additional deoxyepinephrine and fluid *** Among 1596 PD patients,661(41.42%)experienced *** logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).

关键词： Risk factors Pancreaticoduodenectomy Perioperative period Intraoperative persistent hypotension Retrospective cohort study

Lung-protective ventilation in the management of congenital diaphragmatic hernia

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World Journal of Pediatric Surgery 2024年第2期7卷 73-80页

作者： Mike Traynor department of anesthesia British Columbia Children's HospitalVancouverBritish ColumbiaCanada

Prioritizing lung-protective ventilation has produced a clear mortality benefit in neonates with congenital diaphragmatic hernia(CDH).While there is a paucity of CDH-specific evidence to support any particular approach to lung-protective ventilation,a growing body of data in adults is beginning to clarify the mechanismsbehind ventilator-induced lung injury and inform safer management of mechanical ventilation in *** review summarizes the adult data and attempts to relate the findings,conceptually,to the CDH *** lessons from the adult studies are that much of the damage done during conventional mechanical ventilation affects normal lung tissue and that most of this damage occurs at the low-volume and high-volume extremes of the respiratory ***,it is important to prevent atelectasis by using sufficient positive end-expiratory pressure while also avoiding overdistention by scaling tidal volume to the amount of functional lung tissue rather than body *** early in acute respiratory distress syndrome improves outcomes,possibly because consistent respiratory mechanics facilitate avoidance of both atelectasis and overdistention—a mechanism that may also apply to the CDH ***-targeted conventional modes may be advantageous in CDH,but determining optimal tidal volume is *** high-frequency oscillatory ventilation and high-frequency jet ventilation have been used successfully as'rescue modes'to avoid extracorporeal membrane oxygenation,and a prospective trial comparing the two high-frequency modalities as the primary ventilation strategy for CDH is underway.

关键词： protective congenital hernia

Cost burden following esophagectomy:A single centre observational study

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 2255-2269页

作者： Vered Buchholz Dong Kyu Lee David S Liu Ahmad Aly Stephen A Barnett Riley Hazard Peter Le Benjamin Kioussis Vijayaragavan Muralidharan Laurence Weinberg department of Surgery Austin HealthMelbourne 3084VictoriaAustralia department of Anesthesiology and Pain Medicine Dongguk University Ilsan HospitalSeoul 14566GoyangSouth Korea department of Surgery Austin HealthThe University of MelbourneMelbourne 3084VictoriaAustralia department of anesthesia Austin HealthMelbourne 3084VictoriaAustralia department of anesthesia Austin HospitalHeidelberg 3084VictoriaAustralia department of Critical Care The University of MelbourneMelbourne 3084VictoriaAustralia

BACKGROUND Cost analyses of patients undergoing esophagectomy is valuable for identifying modifiable expenditure drivers to target and curtail costs while improving the quality of *** aimed to define the cost-complication relationship after esophagectomy and delineate the incremental contributions to *** To assess the relationship between the hospital costs and potential cost drivers post esophagectomy and investigate the relationship between the cost-driving variables(predicting variables)and hospital costs(dependent variable).METHODS In this retrospective single center study,the severity of complications was graded using the Clavien-Dindo(CD)classification *** esophagectomy complications were categorized and defined according to consensus *** costing data included the in-hospital costs of the index admission and any unplanned admission within 30 postoperative *** used correlation analysis to assess the relationship between key clinical variables and hospital costs(in United States dollars)to identify cost drivers.A mediation model was used to investigate the relationship between these variables and hospital *** A total of 110 patients underwent primary esophageal *** median admission cost was $47822.7(interquartile range:35670.2-68214.0).The total effects on costs were $13593.9(95%CI:10187.1-17000.8,P<0.001)for each increase in CD severity grade,$4781(95%CI:3772.7-5789.3,P<0.001)for each increase in the number of complications,and $42552.2(95%CI:8309-76795.4,P=0.015)if a key esophagectomy complication *** esophagectomy complications drove the costs directly by $11415.7(95%CI:992.5-21838.9,P=0.032).CONCLUSION The severity and number of complications,and the development of key esophagectomy complications significantly contributed to total hospital *** institutional initiatives and strategies are needed to enhance patient outcomes and minimize costs.

关键词： anesthesia Esophagectomy Complications Cancer Surgery

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

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Pharmacology & Pharmacy 2024年第6期15卷 223-235页

作者： Md. Saiful Islam Khan Md. Abir Tazim Chowdhury Farzana Fardousi Munama Magdum Md. Ahaduzzaman Taneem Mohammad Shamima Akter Suriya Akter Md. Saiful Islam Azad Md. Mozaffer Hossain M. Abdur Rahman department of Cardiothoracic anesthesia Evercare Hospital Dhaka Bangladesh department of Cardiothoracic and Vascular Surgery Evercare Hospital Dhaka Bangladesh department of Pathology National Institute of Cancer Research & Hospital Dhaka Bangladesh department of Preventive and Social Medicine National Institute of Preventive and Social Medicine Dhaka Bangladesh department of anesthesia Sheikh Sayera Khatun Medical College Gopalgonj Bangladesh department of anesthesia Dhaka Medical College Dhaka Bangladesh department of anesthesia Combined Military Hospital Dhaka Bangladesh department of Cardiac anesthesia National Institute of Cardiovascular Disease Dhaka Bangladesh department of anesthesia Bangladesh Medical College Dhaka Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propo

关键词： Emergence Agitation (EA) General anesthesia Propofol Fentanyl Pediatric Patients Pediatric anesthesia Emergence Delirium (PAED) Score Bangladesh

Noninvasive Respiratory Strategies in Patients with Acute Hypoxemic Respiratory Failure and COVID-19 in Gabon: A Prospective Observational Study

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Open Journal of Emergency Medicine 2024年第1期12卷 18-27页

作者： Ghislain Edjo Nkilly Raphael Okoue Ondo Fernande Manga Stéphane Oliveira Jean Marcel Mandji-Lawson Romain Tchoua department of Emergency anesthesia Resuscitation Omar Bongo Ondimba Army Training Hospital Libreville Gabon department of anesthesia and Resuscitation Libreville University Hospital Center Libreville Gabon department of anesthesia and Resuscitation Akanda Army Training Hospital Libreville Gabon

Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO2/FiO2 ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanic

关键词： Respiratory Failure COVID 19-Intensive Care Units Military Hospital Gabon

Postoperative Analgesia and Cesarean Section under General anesthesia: Multicenter Study

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Open Journal of Anesthesiology 2024年第1期14卷 1-12页

作者： Ghislain Edjo Nkilly Raphael Okoue Ondo Pascal Christian Nze Obiang Stéphane Oliveira Jean-Marcel Mandji-Lawson Romain Tchoua department of anesthesia and Intensive Care Omar Bongo Ondimba Army Training Hospital (HIAOBO) Libreville Gabon department of anesthesia and Intensive Care Jeanne Ebori Fondation Libreville Gabon department of anesthesia and Intensive Care Akanda Army Training Hospital Libreville Gabon

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia

关键词： Cesarean General anesthesia Morphine Parietal Infiltration Epidural Catheter Transversus Abdominis Plane Block Intravenous Analgesia

Dosage Formula in anesthesia for Manual Intrauterine Aspiration Post-Abortion in Resource-Limited Settings

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Pharmacology & Pharmacy 2024年第4期15卷 71-80页

作者： Serge Ibula Rivain Iteke Berthe Barhayiga Doddie Tsansya Roger Cishugi Jean Jacques Kalongo Sandra Sagboze Jean Paul Cikwanine Dieudonné Sengeyi ISTM/Bukavu anesthesia-Resuscitation Section CIMAC Hospital Center in Goma Goma The Democratic Republic of the Congo department of anesthesia-Resuscitation University of Lubumbashi Lubumbashi The Democratic Republic of the Congo department of anesthesia-Resuscitation University of Kinshasa Kinshasa The Democratic Republic of the Congo department of Gyneco-Obstetrics University of Kinshasa Kinshasa The Democratic Republic of the Congo anesthesia-Resuscitation department Panzi Hospital Bukavu The Democratic Republic of the Congo

Setting: Provincial General Reference Hospital of Bukavu, General Reference Hospital of Panzi, General Reference Hospital of Ciriri, General Reference Hospital of Nyatende and Biopharm Hospital Center. Objective: Contribute to the improvement of the anesthetic ECP of patients benefiting from MVA for incomplete abortion, Describe the methodology used for adoption of the dosage formula in anesthesia for MVA, present the mathematical demonstration leading to the dosage formula in anesthesia for MVA. Materials and Methods: Our study was descriptive by mathematical demonstration of obtaining the equilibrium constant of the dosage formula of bipuvacaine 0.1% and Fentanyl 50 µg% adapted to the weight and specific size of patients treated anesthetically in MVA cases for incomplete abortion. We also carried out an operational research by first determining the interval where our equilibrium constant is included and secondly by means of the ends of the intervals found correlated to the ends of intervals of possible weights and sizes in the being normal human female of childbearing age to arrive at the real numerical value of the equilibrium constant of the BUKAVU Dosage Formula in the case of anesthesia for MVA during the management of incomplete abortions. Results: TWO-STAGE OPERATIONAL RESEARCH: • Determination of the interval where the equilibrium constant x = −0.95 x x by crossing the means between the extremes of volumes of anesthetic drugs giving a satisfactory sensory block without hemodynamic disturbance and the extremes of normal weight and height for women of childbearing age. We ended up with X = 0.37. Conclusion: At the end of our study which had the general objectives of contributing to the improvement of the anesthetic PEC of patients receiving MVA for incomplete abortion and specific objectives of describing the methodology used for adoption of the dosage formula in anesthesia for MVA and present the mathematical demonstration which resulted in the dosage formul

关键词： Dosage anesthesia Intrauterine Aspiration DR Congo