Journal of clinical anesthesia
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Review Meta Analysis Comparative Study
Postoperative delirium under general anaesthesia by remimazolam versus propofol: A systematic review and meta-analysis of randomised controlled trials.
Remimazolam, an ultra-short-acting benzodiazepine, has similar clinical effects to propofol for sedation in general anaesthesia. However, it remains uncertain whether remimazolam could increase postoperative delirium (POD) compared with propofol. ⋯ Perioperative remimazolam administration did not increase POD and reduced the risk of intraoperative hypotension compared to propofol. Further large-scale RCTs are warranted to explore the association of remimazolam and POD. Systematic review protocol: PROSPERO CRD42024544122.
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Observational Study
Pressure support ventilation improves ventilation during inhalational induction of anesthesia in children: A pilot study.
To evaluate the impact of positive end-expiratory pressure (PEEP) with or without pressure support ventilation (PSV) on the lung volume and the ventilation distribution during inhalational induction of anesthesia in children. ⋯ The ventilator settings used during inhalational induction of anesthesia in children have an impact on lung ventilation. PSV during inhalational induction of anesthesia in children may restore the end-expiratory lung volume independently from the increase in TV.
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Observational Study
Mitochondrial oxygenation monitoring and acute kidney injury risk in cardiac surgery: A prospective cohort study.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication of cardiac surgery and is associated with increased morbidity and mortality. Recent guidelines emphasize the need for new monitoring methods to facilitate targeted CSA-AKI prevention and treatment strategies. In vivo real-time measurement of mitochondrial oxygen tension (mitoPO2), could potentially fulfil this role during cardiac surgery, as suggested in our previous pilot study. ⋯ This study highlighted the association between mitoPO2 and the onset of CSA-AKI. Extended durations below the mitoPO2 threshold of 25 mmHg significantly correlate with an elevated CSA-AKI risk. Using mitoPO2 as a monitoring tool shows promise in potentially predicting and possibly preventing CSA-AKI when used as a treatment trigger in cardiac surgery patients.
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Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure. ⋯ Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.