Articles: operative.
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Curr Opin Anaesthesiol · Nov 2024
The autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders.
Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with postoperative neurocognitive disorder (PNCD). The vagal cholinergic anti-inflammatory pathway (CAP) has been hypothesized to play a role in POD/PNCD and may be a target for interventions such as transcutaneous auricular stimulation (taVNS). We aim to review associations of heart rate variability (HRV) as an indicator of vagal function with POD and postoperative immune reaction as well as taVNS as a potential preventive intervention for POD. ⋯ Our review provides no evidence that CAP suppression is associated with POD/PNCD. Future studies should consider that high vagal tone may also mediate immunosuppression in surgical patients, yielding an increased risk for postoperative infections. Although taVNS is a promising approach to prevent POD/POCD, future studies should take these concerns into account.
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Minerva anestesiologica · Nov 2024
Comparison of remimazolam and propofol on postoperative subjective quality of recovery in patients undergoing general anesthesia: a meta-analysis of randomized controlled trials.
Remimazolam, a recently approved drug for surgical sedation and general anesthesia, has been compared with propofol in previous studies regarding its efficacy as a general anesthetic. However, the question of whether remimazolam demonstrates non-inferiority to propofol in postoperative subjective quality of recovery (QoR) among patients under general anesthesia has not been definitively answered. ⋯ Remimazolam is similar to propofol in terms of postoperative subjective QoR for patients receiving general anesthesia.
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Antibiotics play a crucial role in preventing surgical site infections, yet adherence to Infectious Disease Society of America (IDSA) guidelines varies widely. This qualitative study aimed to explore factors influencing perioperative antibiotic administration and assess the potential impact of a clinical decision support (CDS) tool on guideline adherence. ⋯ Non-adherence to antibiotic guidelines in the perioperative setting often results from a lack of structured workflow. Our interviews provide a foundation for developing a clinical decision support tool tailored to provider needs, aiming to improve user satisfaction and promote better adherence to perioperative antibiotic guidelines.
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Minerva anestesiologica · Nov 2024
Comparison of dexmedetomidine, ketamine, and magnesium sulfate for the prevention of emergence agitation following sevoflurane-based anesthesia in pediatric cardiac catheterization.
Emergence agitation (EA) is non-purposeful agitation that occurs during the early stages of general anesthesia recovery. This randomized, double-blinded trial aimed to compare the effect of dexmedetomidine, ketamine, and magnesium sulfate on the severity of EA following sevoflurane-based anesthesia in pediatric cardiac catheterization. We examined the fixed doses and assessed the severity of agitation using the Pediatric Anesthesia Emergence Delirium Scale (PAED) score. ⋯ Dexmedetomidine exhibited higher efficacy than ketamine and magnesium sulfate in reducing the severity of postoperative EA. However, ketamine and magnesium sulfate demonstrated comparable efficacy, exceeding that of the control group.