Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2022
Multicenter Study Observational StudyA Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study.
Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure of the brain's resistance to volatile anesthetics and hypothesized that low scores on it would be associated with postoperative delirium risk. ⋯ These results demonstrate that an intraoperative processed EEG-based measure of lower brain anesthetic resistance (ie, low DARS) is independently associated with increased postoperative delirium risk in older surgical patients.
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Anesthesia and analgesia · Jan 2022
Perioperative Opioid Consumption and Clinical Outcomes in Surgical Patients With a Pre-existing Opioid-Based Intrathecal Drug Delivery System.
Intrathecal drug delivery systems (IDDS) have been utilized for over 3 decades for management of chronic pain and spasticity. Patients with IDDS may present for surgical procedures unrelated to the IDDS device, although data are limited regarding perioperative outcomes. ⋯ Patients with opioid-based IDDS received more perioperative opioids and were more likely to receive postoperative pain service consultation compared to matched controls. There were no significant differences in clinical safety outcomes, suggesting tolerance for higher opioid doses. Further research is warranted to optimize perioperative outcomes in those with IDDS.
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Anesthesia and analgesia · Jan 2022
Meta AnalysisInflammatory Biomarker Levels After Propofol or Sevoflurane Anesthesia: A Meta-analysis.
The perioperative inflammatory response may be implicated in adverse outcomes including neurocognitive dysfunction and cancer recurrence after oncological surgery. The immunomodulatory role of anesthetic agents has been demonstrated in vitro; however, its clinical relevance is unclear. The purpose of this meta-analysis was to compare propofol and sevoflurane with respect to biomarkers of perioperative inflammation. The secondary aim was to correlate markers of inflammation with clinical measures of perioperative cognition. ⋯ Surgery induces an inflammatory response; however, the inflammatory response did not differ as a function of anesthetic technique. This absence of an effect suggests that patient and surgical variables may have a far more significant impact on the postoperative inflammatory responses than anesthetic technique. The majority of studies assessing perioperative cognition in older patients reported a benefit associated with the use of propofol; however, larger trials using homogenous outcomes are needed to demonstrate such an effect.
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Anesthesia and analgesia · Jan 2022
Validation of the Lusaka Formula: A Novel Formula for Weight Estimation in Children Presenting for Surgery in Zambia.
In children, the use of actual weight or predicted weight from various estimation methods is essential to reduce harm associated with dosing errors. This study aimed to validate the new locally derived Lusaka formula on an independent cohort of children undergoing surgery at the University Teaching Hospital in Lusaka, Zambia, to compare the Lusaka formula's performance to commonly used weight prediction tools and to assess the nutritional status of this population. ⋯ The Lusaka formula is comparable to, or better than, other age-based weight prediction tools in children presenting for surgery at the University Teaching Hospital in Lusaka, Zambia, and has the advantage that it covers a wider age range than tools with comparable accuracy. In this population, commonly used aged-based prediction tools significantly overestimate weights.
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Anesthesia and analgesia · Jan 2022
A Simple Risk Scoring System for Predicting the Occurrence of Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection.
Aspiration pneumonia after endoscopic submucosal dissection (ESD) is rare, but can be fatal. We aimed to investigate risk factors and develop a simple risk scoring system for aspiration pneumonia. ⋯ Our simple risk scoring system has 8 predictors incorporating patient-, procedure-, and sedation-related factors. This system may help clinicians to stratify patients at risk of aspiration pneumonia after ESD.