Anesthesia and analgesia
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Anesthesia and analgesia · May 2024
Respiratory Depression Following Intraoperative Methadone: A Retrospective Cohort Study.
Methadone is used as a perioperative analgesic in the management of postoperative pain. Despite positive outcomes from randomized trials favoring methadone, concerns about its safety persist, particularly regarding respiratory depression (RD) and excessive sedation. In this study, we compared the incidence of naloxone administration between patients administered intraoperative methadone and those administered intraoperative morphine as a measure of severe RD. Time spent at the postanesthesia care unit (PACU) was used as a proxy variable for excessive sedation. ⋯ The incidence of naloxone administration to treat severe RD was low. No difference was observed in the odds of naloxone administration to treat severe RD between patients administered intraoperative methadone or intraoperative morphine. Intraoperative methadone was associated with longer stays at the PACU; however, this result should be interpreted with care. Our findings suggest that intraoperative methadone has a safety profile comparable to that of morphine with regard to severe RD.
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Anesthesia and analgesia · May 2024
Randomized Controlled TrialSugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade in Patients With Severe Renal Impairment: A Randomized, Double-Blinded Study.
Sugammadex is not advised for patients with severe renal impairment, but has been shown in a variety of other populations to be superior to neostigmine for reversal of neuromuscular blockade. The objective of this study was to determine if reversal of rocuronium-induced neuromuscular blockade with sugammadex versus reversal of cisatracurium-induced neuromuscular blockade with neostigmine results in a faster return to a train-of-four ratio (TOFR) ≥90% in patients with severe renal impairment. ⋯ In patients with severe renal impairment, neuromuscular blockade with rocuronium followed by reversal with sugammadex provides a significantly faster return of neuromuscular function compared to cisatracurium and neostigmine, without any major adverse effects.
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Anesthesia and analgesia · May 2024
Nociception Effect on Frontal Electroencephalogram Waveform and Phase-Amplitude Coupling in Laparoscopic Surgery.
Electroencephalographic pattern changes during anesthesia reflect the nociception-analgesia balance. Alpha dropout, delta arousal, and beta arousal with noxious stimulation have been described during anesthesia; however, data on the reaction of other electroencephalogram signatures toward nociception are scarce. Analyzing the effects of nociception on different electroencephalogram signatures may help us find new nociception markers in anesthesia and understand the neurophysiology of pain in the brain. This study aimed to analyze the electroencephalographic frequency pattern and phase-amplitude coupling change during laparoscopic surgeries. ⋯ Alpha dropout during noxious stimulation is observed in laparoscopic surgeries under sevoflurane. In addition, the modulation index of delta-alpha coupling decreases during noxious stimulation and recovers after the administration of rescue opioids. Phase-amplitude coupling of the electroencephalogram may be a new approach for evaluating the nociception-analgesia balance during anesthesia.
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Anesthesia and analgesia · May 2024
The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study.
Postoperative delirium (POD) is a common form of postoperative brain dysfunction, especially in the elderly. However, its risk factors remain largely to be determined. This study aimed to investigate whether (1) preoperative diabetes is associated with POD after elective orthopedic surgery and (2) intraoperative frontal alpha power is a mediator of the association between preoperative diabetes and POD. ⋯ This study suggests that preoperative diabetes is associated with an increased risk of POD in older patients undergoing major orthopedic surgery, and that low intraoperative alpha power partially mediates such association.