Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2021
Meta AnalysisThe Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis.
Both frailty and postoperative delirium (POD) are common in elective surgical patients 65 years of age and older. However, the association between preoperative frailty and POD remains difficult to characterize owing to the large number of frailty and POD assessment tools used in the literature, only a few of which are validated. Furthermore, some validated frailty tools fail to provide clear score cutoffs for distinguishing frail and nonfrail patients. We performed a meta-analysis to estimate the relationship between preoperative frailty and POD. ⋯ This meta-analysis provides evidence for a significant association between preoperative frailty and POD in elective surgical patients age 65 years or older.
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Anesthesia and analgesia · Aug 2021
Randomized Controlled TrialApplication of a High-Flow Nasal Cannula for Prevention of Postextubation Atelectasis in Children Undergoing Surgery: A Randomized Controlled Trial.
General anesthesia-induced atelectasis is common, and persistent postoperative atelectasis is associated with pulmonary complications. We aimed to evaluate the preventive effects of a high-flow nasal cannula (HFNC) on postoperative atelectasis and respiratory complications in infants and small children. ⋯ Preventive use of HFNC after surgery improves the lung ultrasound score and reduces postoperative atelectasis compared to conventional oxygen therapy in infants and small children.
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Anesthesia and analgesia · Aug 2021
Randomized Controlled TrialRifampin Reduces the Plasma Concentrations of Oral and Intravenous Hydromorphone in Healthy Volunteers.
Several opioids are metabolized by the inducible cytochrome P450 (CYP) 3A isozymes. Coadministration with strong inducers of drug metabolism, such as rifampin, can dramatically reduce systemic exposure to these opioids. As the CYP metabolism of hydromorphone is of minor importance, we studied in healthy volunteers whether hydromorphone would be an effective analgesic for patients who concomitantly receive the prototypical enzyme inducer rifampin. ⋯ Rifampin significantly reduces the concentrations of oral and intravenous hydromorphone. This interaction is due to an increase in the first-pass and systemic metabolism of hydromorphone, likely involving induction of uridine 5'-diphospho- glucuronosyltransferase enzymes by rifampin. The enhancement of hydromorphone elimination should be considered when managing pain of patients who are treated with strong enzyme inducers.
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Anesthesia and analgesia · Aug 2021
Randomized Controlled Trial Multicenter StudyPrevention of Cardiac Surgery-Associated Acute Kidney Injury by Implementing the KDIGO Guidelines in High-Risk Patients Identified by Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial.
Prospective, single-center trials have shown that the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations in high-risk patients significantly reduced the development of acute kidney injury (AKI) after surgery. We sought to evaluate the feasibility of implementing a bundle of supportive measures based on the KDIGO guideline in high-risk patients undergoing cardiac surgery in a multicenter setting in preparation for a large definitive trial. ⋯ Implementation of a KDIGO-derived treatment bundle is feasible in a multinational setting. Furthermore, moderate to severe AKI was significantly reduced in the intervention group.
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Anesthesia and analgesia · Aug 2021
Review Comparative StudyComparing Central Venous Blood Gas to Arterial Blood Gas and Determining Its Utility in Critically Ill Patients: Narrative Review.
Arterial blood gas (ABG) analysis is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body. However, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Central venous blood gas (VBG) is a potentially more accessible alternative to ABG sampling. ⋯ We concluded that central VBG parameters of pH and Pco2 are potentially good surrogates for determining arterial pH and Pco2 in a stable patient without severe acid-base disturbances. Furthermore, central VBG can be used as a useful screening tool for arterial hypercapnia. In addition, we derived an adjustment formula for ABG conversion from central VBG: (1) arterial pH = venous pH + 0.05 units and (2) arterial Pco2 = venous Pco2 - 5 mm Hg.