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Anesth. Res., Volume 1, Issue 2 (September 2024) – 9 articles

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11 pages, 375 KiB  
Review
Prediction of Postoperative Complications after Major Lung Resection: A Literature Review
by Loizos Roungeris, Guram Devadze, Christina Talliou and Panagiota Griva
Anesth. Res. 2024, 1(2), 146-156; https://doi.org/10.3390/anesthres1020014 - 23 Sep 2024
Cited by 1 | Viewed by 2059
Abstract
Background: Lung resection is the primary treatment option for many patients with lung cancer; however, it is a high-risk surgery with many potentially lethal perioperative complications. The aim of this review is to examine the capability of forced expiratory volume in one second [...] Read more.
Background: Lung resection is the primary treatment option for many patients with lung cancer; however, it is a high-risk surgery with many potentially lethal perioperative complications. The aim of this review is to examine the capability of forced expiratory volume in one second (FEV1), diffusing capacity of the lung for carbon monoxide (DLCO), maximal oxygen uptake in exercise (VO2max), and maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) to predict postoperative lung function. Methods: A literature review was performed using PubMed and the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines. The research included articles after 2000. Experimental studies on animals, studies before 2000, and studies in a language other than English were excluded. Results: A total of 11 studies were included in this review. The main findings were highlighted. In addition, the optimal threshold values of FEV1, DLCO, VO2max, and PImax as well as PEmax were discussed. Conclusions: Preoperative FEV1, DLCO, VO2max, and PImax as well as PEmax have all proven to be independent risk factors for the prediction of postoperative morbidity, mortality, and cardiopulmonary complications after lung resection surgery. Full article
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18 pages, 616 KiB  
Review
Fluids, Vasopressors, and Inotropes to Restore Heart–Vessel Coupling in Sepsis: Treatment Options and Perspectives
by Francesca Innocenti, Vittorio Palmieri and Riccardo Pini
Anesth. Res. 2024, 1(2), 128-145; https://doi.org/10.3390/anesthres1020013 - 14 Sep 2024
Cited by 1 | Viewed by 1487
Abstract
Sepsis is a complex syndrome with heterogeneous clinical presentation and outcome, characterized by an abnormal inflammatory response, potentially leading to multiorgan damage and hemodynamic instability. Early resuscitation with fluids and timely control of the source of sepsis are key treatment targets in septic [...] Read more.
Sepsis is a complex syndrome with heterogeneous clinical presentation and outcome, characterized by an abnormal inflammatory response, potentially leading to multiorgan damage and hemodynamic instability. Early resuscitation with fluids and timely control of the source of sepsis are key treatment targets in septic patients. Recommendations on when to add vasopressors and inotropes are mostly empirical and anecdotal, therefore remaining a topic of debate. This narrative review was developed to present and discuss current options in the early management of hemodynamic derangement induced by sepsis. We discuss the strengths and drawbacks of the recommended treatment with fluids and how to optimize volume resuscitation in order to avoid fluid overload or under-resuscitation. The choice and timing of vasopressor use represent hot topics in the early management of septic patients. We describe the advantages and limitations of the early introduction of vasopressors and new catecholamine-sparing strategies. We conclude with a description of the inotropes, considering that the heart plays a key role in the pathophysiology of septic shock. Full article
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11 pages, 2556 KiB  
Article
Suppression of the Excitability of Nociceptive Secondary Sensory Neurons Following Systemic Administration of Astaxanthin in Rats
by Risako Chida, Sana Yamaguchi, Syogo Utugi, Yukito Sashide and Mamoru Takeda
Anesth. Res. 2024, 1(2), 117-127; https://doi.org/10.3390/anesthres1020012 - 2 Sep 2024
Viewed by 933
Abstract
Although astaxanthin (AST) has demonstrated a modulatory effect on voltage-gated Ca2+ (Cav) channels and excitatory glutamate neuronal transmission in vitro, particularly on the excitability of nociceptive sensory neurons, its action in vivo remains to be determined. This research sought to determine if [...] Read more.
Although astaxanthin (AST) has demonstrated a modulatory effect on voltage-gated Ca2+ (Cav) channels and excitatory glutamate neuronal transmission in vitro, particularly on the excitability of nociceptive sensory neurons, its action in vivo remains to be determined. This research sought to determine if an acute intravenous administration of AST in rats reduces the excitability of wide-dynamic range (WDR) spinal trigeminal nucleus caudalis (SpVc) neurons in response to nociceptive and non-nociceptive mechanical stimulation in vivo. In anesthetized rats, extracellular single-unit recordings were carried out on SpVc neurons following mechanical stimulation of the orofacial area. The average firing rate of SpVc WDR neurons in response to both gentle and painful mechanical stimuli significantly and dose-dependently decreased after the application of AST (1–5 mM, i.v.), and maximum suppression of discharge frequency for both non-noxious and nociceptive mechanical stimuli occurred within 10 min. These suppressive effects persisted for about 20 min. These results suggest that acute intravenous AST administration suppresses the SpVc nociceptive transmission, possibly by inhibiting Cav channels and excitatory glutamate neuronal transmission, implicating AST as a potential therapeutic agent for the treatment of trigeminal nociceptive pain without side effects. Full article
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7 pages, 630 KiB  
Case Report
C-MAC Video Stylet Assisted Endotracheal Intubation in Sedated but Spontaneously Breathing Patients Using Remimazolam and Trachospray Device: A Report of Two Cases
by Richard L. Witkam, Jörg Mühling, Rebecca Koch, Jörgen Bruhn and Lucas T. van Eijk
Anesth. Res. 2024, 1(2), 110-116; https://doi.org/10.3390/anesthres1020011 - 2 Sep 2024
Viewed by 1548
Abstract
The C-MAC video stylet (Karl Storz KG, Tuttlingen, Germany) is proposed as a successor to the familiar retromolar intubation endoscope. With its flexible tip, it may be especially useful for patients with a limited mouth opening. An awake or sedated airway management technique [...] Read more.
The C-MAC video stylet (Karl Storz KG, Tuttlingen, Germany) is proposed as a successor to the familiar retromolar intubation endoscope. With its flexible tip, it may be especially useful for patients with a limited mouth opening. An awake or sedated airway management technique is often preferred when a difficult airway is anticipated. Due to the challenges in preparation, sedation, topical airway anesthesia and the execution of such an airway management technique itself, these techniques are often clinically underused. The C-MAC video stylet seems to be well suited for an awake or sedated airway approach, as its handling is easier and faster than a flexible fiberscope. It does not exert pressure on the tongue as direct laryngoscopy or video laryngoscopy do. We report two cases of a difficult airway in which intubation was performed by using the C-MAC video stylet in sedated, spontaneously breathing patients. After a low dose of 3 mg midazolam IV, remimazolam was administered continuously (0.46–0.92 mg/kg/h). This was supplemented with a low dose of remifentanil (0.04–0.05 µg/kg/min). The Trachospray device (MedSpray Anesthesia BV, Enschede, The Netherlands) was used for topicalization of the upper airway by means of 4 mL of lidocaine 5%. In addition, a further 5 mL of lidocaine 5% was sprayed via an epidural catheter advanced through the oxygenation port of the C-MAC video stylet for further topicalization of the vocal cords and proximal part of the trachea. The well-coordinated steps described in these two cases may represent a blueprint and a good starting point for future studies with a larger number of patients. Full article
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19 pages, 1165 KiB  
Review
Enhancing Neuroprotection in Cardiac and Aortic Surgeries: A Narrative Review
by Debora Emanuela Torre and Carmelo Pirri
Anesth. Res. 2024, 1(2), 91-109; https://doi.org/10.3390/anesthres1020010 - 23 Aug 2024
Viewed by 1308
Abstract
Background: Neurological injury poses a significant challenge in aortic surgery, encompassing spinal cord injury from thoraco-abdominal aorta intervention or stroke post-surgery on the arch and ascending aorta. Despite ample literature and proposals, a fully effective strategy for preventing or treating neurological injury remains [...] Read more.
Background: Neurological injury poses a significant challenge in aortic surgery, encompassing spinal cord injury from thoraco-abdominal aorta intervention or stroke post-surgery on the arch and ascending aorta. Despite ample literature and proposals, a fully effective strategy for preventing or treating neurological injury remains elusive. This narrative review aims to analyze the most common neuroprotective strategies implemented for aortic arch surgery and aortic surgery. Results: Results from the reviewed studies showed that several strategies, including deep hypothermia cardiac induction (DHCA) and cerebral perfusion techniques (retrograde cerebral perfusion, RCP, and selective anterograde cerebral perfusion, SACP) aim to mitigate these risks. Monitoring methods such as electroencephalogram (EEG), somatosensory evoked potential (SEPs), and near-infrared spectroscopy (NIRS) offer valuable insights into cerebral function during surgery, aiding in the management of hypothermia and perfusion. Pharmacological agents and blood gas management (pH stat vs. alpha stat, hematocrit level, glycemic control) are crucial in preventing post-operative complications. Additionally meticulous management of atheromatous debris is essential to minimize embolic risks during surgery. Methods: For this narrative review, PubMed, Scopus, and Medline have been used to search articles about neuroprotection strategies in aortic and aortic arch surgeries. The search was narrowed to articles between 1975 and 2024. A total of 3418 articles were initially identified to be potentially relevant for this review. A total of 66 articles were included and were found to match the inclusion criteria. Conclusions: While an overabundance of neuroprotection strategies exists for cardiac surgery, particularly in procedures involving the aorta and the arch, their efficacy varies, with some well-documented and others still under scrutiny. Further research is imperative to advance our comprehension and refine prevention techniques for cardiac-surgery-related brain injury. This is crucial given its substantial contribution to both mortality and, notably, post-operative morbidity. Full article
(This article belongs to the Special Issue Anesthesia, Pain, and Monitoring: Past and Future)
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11 pages, 1145 KiB  
Article
A Retrospective Observational Study of Post-Induction Low Systolic Blood Pressure and Associated Patient and Perioperative Factors in Infants Undergoing General Anesthesia for Inguinal Hernia Repair
by Olivia Nelson, Lezhou Wu, Jessica A. Berger, Ian Yuan, Asif Padiyath, Paul A. Stricker, Fuchiang Rich Tsui and Allan F. Simpao
Anesth. Res. 2024, 1(2), 80-90; https://doi.org/10.3390/anesthres1020009 - 1 Aug 2024
Viewed by 1354
Abstract
Background: Infants are at risk of cerebral hypoperfusion from low blood pressure during anesthesia. We conducted a retrospective observational study to determine the patient and perioperative factors associated with low systolic blood pressure (SBP) in healthy infants. Methods: We obtained perioperative data of [...] Read more.
Background: Infants are at risk of cerebral hypoperfusion from low blood pressure during anesthesia. We conducted a retrospective observational study to determine the patient and perioperative factors associated with low systolic blood pressure (SBP) in healthy infants. Methods: We obtained perioperative data of 266 infants aged 0–6 months who underwent inguinal hernia repair between January 2015 and March 2019 at our institution. SBP was analyzed during two phases: the preparation phase (20 min before procedure start until incision) and the surgical phase (15 to 35 min after procedure start). Low SBP was defined as a value lower than two standard deviations below the 50th percentile for a phase- and weight-specific reference value. Results: Low SBP was observed in 11% (29/265) and 5% (13/259) of patients during the preparation and surgical phases, respectively. Neuromuscular blockade use was associated with normal SBP in both phases (regression coefficient β = 6.15 and p = 0.002, regression coefficient β = 6.52 and p < 0.001, respectively). SBP was more strongly associated with weight than with age (ratio of adjusted standardized regression coefficient = 2.0 in both phases). After controlling for covariates, patients given neuromuscular blockade had significantly fewer low SBP measurements during the preparation phase (regression coefficient β = −1.99 and p < 0.001). Conclusions: With respect to patient factors, in healthy infants under general anesthesia, weight was more strongly associated with SBP than age. A neuromuscular blocking agent administered during anesthesia induction was associated with fewer low SBP measurements in the preparation phase. Full article
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13 pages, 2158 KiB  
Article
Ultrasound-Guided Interphalangeal Injection (US-IPI) of Mucoid Cysts as a Non-Surgical Option: Technical Notes and Clinical Efficacy
by Eliodoro Faiella, Elva Vergantino, Domiziana Santucci, Amalia Bruno, Giuseppina Pacella, Vincenzo Panasiti, Bruno Beomonte Zobel and Rosario Francesco Grasso
Anesth. Res. 2024, 1(2), 67-79; https://doi.org/10.3390/anesthres1020008 - 1 Aug 2024
Viewed by 1780
Abstract
Digital mucous cysts (DMCs) are common soft tissue tumors affecting interphalangeal joints. Various treatment options exist, with surgical excision being the standard. Ultrasound-guided cortisone (CC) injection into the distal interphalangeal (DIP) joint has been proposed as a therapeutic alternative. This study aims to [...] Read more.
Digital mucous cysts (DMCs) are common soft tissue tumors affecting interphalangeal joints. Various treatment options exist, with surgical excision being the standard. Ultrasound-guided cortisone (CC) injection into the distal interphalangeal (DIP) joint has been proposed as a therapeutic alternative. This study aims to assess the technical success and clinical efficacy of US-IPI in terms of swelling resolution and pain control. Fifty-two patients with DMCs underwent CCs DIP joint ultrasound-guided infiltration. Eighty-three percent of patients exhibited a positive response to US-IPI, with a significant reduction in NRS pain scores (p < 0.01). Persistent pain in 17% of patients was effectively managed with marked improvement after a secondary infiltration. Joint swelling was reduced in 68% of patients within 1 month, with complete resolution by 3 to 6 months. No recurrence was reported at the 6-month follow-up. Pain assessment using the Numeric Rating Scale and joint swelling evaluation were conducted at follow-ups of 2 weeks, 1, 3, and 6 months. Statistical analysis was performed to compare pre- and post-procedure NRS pain scores. Here, we show that US-IPI of DMCs is an effective therapeutic option that provides immediate pain relief and long-term aesthetic improvement, resulting in an alternative option to surgical excision. Full article
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13 pages, 595 KiB  
Systematic Review
Impact of Telemedicine on Patient-Centered Outcomes in Pediatric Critical Care: A Systematic Review
by Devon M. O’Brien, Anahat K. Dhillon and Betty M. Luan-Erfe
Anesth. Res. 2024, 1(2), 54-66; https://doi.org/10.3390/anesthres1020007 - 2 Jul 2024
Cited by 1 | Viewed by 2039
Abstract
Background: Pediatric intensive care units (ICUs) face shortages of intensivists, posing challenges in delivering specialized care, especially in underserved regions. While studies on telecritical care in the adult ICU have demonstrated decreased complications and mortality, research on telemedicine in the pediatric ICU setting [...] Read more.
Background: Pediatric intensive care units (ICUs) face shortages of intensivists, posing challenges in delivering specialized care, especially in underserved regions. While studies on telecritical care in the adult ICU have demonstrated decreased complications and mortality, research on telemedicine in the pediatric ICU setting remains limited. This systematic review evaluates the safety and efficacy of audiovisual telemedicine in pediatric ICUs, assessing patient-centered outcomes when compared to in-person intensivist care. Methods: Two reviewers independently assessed studies from PubMed, MEDLINE (Ovid), Global Health, and EMBASE on the pediatric population in the ICU setting that were provided care by intensivists via telemedicine. Studies without a comparison group of in-person intensivists were excluded. Selected studies were graded using the Newcastle–Ottawa scale and the Levels of Evidence Rating Scale for Therapeutic Studies. Results: Of the 2419 articles identified, 7 met the inclusion criteria. Strong evidence suggested that telemedicine increases access to intensive care. Moderate evidence demonstrated that telemedicine facilitates real-time clinical decision-making, reliable remote clinical assessments, improved ICU process measures (i.e., days on a ventilator, days on antibiotics), and decreased length of stay. Weaker evidence supported that telemedicine decreases complications and mortality. Conclusions: Telemedicine may serve as a promising solution to pediatric ICUs with limited intensivist coverage, particularly in low-resource rural and international settings. Full article
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10 pages, 2777 KiB  
Article
The Composition of the L5-S1 Neural Foramen on MRI—A Retrospective Cohort Study Examining the Anatomy Relevant to Transforaminal Epidural Steroid Injections
by Zachary E. Stewart, Ronald W. Mercer, Steven Staffa, F. Joseph Simeone and Ambrose J. Huang
Anesth. Res. 2024, 1(2), 44-53; https://doi.org/10.3390/anesthres1020006 - 1 Jul 2024
Viewed by 1445
Abstract
Transforaminal epidural steroid injections are commonly used for the treatment of radicular pain. Some providers opt for an antero-superior approach and others a postero-inferior approach. In this retrospective cohort study, we evaluated MRI evident anatomic differences between the antero-superior and postero-inferior neural foramen [...] Read more.
Transforaminal epidural steroid injections are commonly used for the treatment of radicular pain. Some providers opt for an antero-superior approach and others a postero-inferior approach. In this retrospective cohort study, we evaluated MRI evident anatomic differences between the antero-superior and postero-inferior neural foramen at L5-S1 that may be relevant when choosing an approach for injections. A total of 29 L5-S1 neural foramina that were targeted for transforaminal epidural steroid injections were included. Pre-procedure MRIs were assessed for the distribution of the fat within the foramen. Additionally, the presence of foraminal vessels and foraminal stenosis and the presence/absence of anterolisthesis was also observed. Final imaging data were obtained by majority opinion of three or four radiologists. There was a statistically significant difference in the distribution of foraminal fat between the postero-inferior foramen and the antero-superior foramen (p < 0.001), with more fat generally in the postero-inferior foramen. Foraminal vessels were not consistently visualized. There was weak inter-reader reliability for the presence of vessels. In conclusion, this study suggests that there is a difference in the distribution of foraminal epidural fat between the postero-inferior and antero-superior foramen at L5-S1. Through MRI, vessels are inconsistently visualized and cannot be reliably detected on conventional MRI between readers. Full article
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