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New Approaches in Intravenous Anesthesia and Anesthetics—Part III
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New Approaches in Intravenous Anesthesia and Anesthetics—Part III

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (15 December 2023) | Viewed by 10598

Special Issue Editor

Dr. Keira P. Mason

E-Mail Website
Guest Editor
Harvard Medical School, Boston Children’s Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, 300 Longwood Ave., Boston, MA 02115, USA
Interests: anesthesia and safety outside the operating room; dental sedation; sedation; target-controlled infusion (TCI)
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In August 2020, we launched our Special Issue "New Approaches in Intravenous Anesthesia and Anesthetics"—Part 1 (https://www.mdpi.com/journal/jcm/special_issues/Intravenous_Anesthesia). Then, in October 2021, we launched the second part of the same Special Issue (https://www.mdpi.com/journal/jcm/special_issues/Anesthesia_and_Anesthetics_Part_II), publishing many manuscripts concerning different topics related to anesthesia. Both Special Issues included manuscripts focusing on pharmacokinetics and pharmacodynamics of sedative anesthetics, important findings on opiate use and surgical practice, recent developments in sedation in the pediatric intensive care unit, and state-of-the-art intraoperative neuromonitoring in children.

Given the enormous success of Parts I and II, I believe that it is time to move forward to creating Special Issue Part III, with the aim of collecting additional insight into anesthesia and anesthetics. The JCM journal is very keen to attract a global audience, welcoming any contributions on this subject from around the world.

We particularly welcome papers providing insight into:

  1. The pharmacokinetics and pharmacodynamics of sedatives and anesthetics;
  2. Recent developments in perioperative care;
  3. Future insights into anesthesia practice over the next decade.

We welcome both solicited and unsolicited submissions contributing to our goal.

Dr. Keira P. Mason
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sedation
  • safety
  • intravenous
  • target-controlled infusions
  • adverse events
  • future
  • regional anesthesia

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Related Special Issue

Published Papers (5 papers)

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Research

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14 pages, 744 KiB  
Article
Implementation of an Enhanced Recovery after Surgery Pathway for Transgender and Gender-Diverse Individuals Undergoing Chest Reconstruction Surgery: An Observational Cohort Study
by Nelson J. Aquino, Susan M. Goobie, Steven J. Staffa, Elizabeth Eastburn, Oren Ganor and Cathie T. Jones
J. Clin. Med. 2023, 12(22), 7083; https://doi.org/10.3390/jcm12227083 - 14 Nov 2023
Cited by 2 | Viewed by 1552
Abstract
Enhanced Recovery After Surgery (ERAS) protocols are associated with improved clinical outcomes in cisgender breast surgery patients. However, a paucity of research exists regarding transgender and gender-diverse individuals (TGD) in the ERAS framework. The primary objective of this observational cohort study is to [...] Read more.
Enhanced Recovery After Surgery (ERAS) protocols are associated with improved clinical outcomes in cisgender breast surgery patients. However, a paucity of research exists regarding transgender and gender-diverse individuals (TGD) in the ERAS framework. The primary objective of this observational cohort study is to describe the implementation of a gender-affirming ERAS protocol and its relationship to hospital length of stay (LOS) in TGD patients following chest reconstruction surgery. The secondary aim is to identify intraoperative predictors of LOS and define variables associated with adverse outcomes. We identified 362 patients in three epochs: a traditional group (n = 144), a partial ERAS implementation group (n = 92), and an ERAS group (n = 126). Exploratory multivariable median regression modeling was performed to identify independent predictors of LOS. We report that the traditional group’s median hospital LOS was 1.1 days compared to 0.3 days in the ERAS group. Intraoperative tranexamic acid administration was associated with significantly shorter LOS (p < 0.001), reduced postoperative drainage (p < 0.001), and fewer returns to the operating room within 24 h (p = 0.047). Our data suggest that implementing a multimodal ERAS gender-affirming pathway was associated with improved patient-centered surgical outcomes such as decreased return to the operating room for hematoma evacuation, higher rates of discharge home, and reduced postoperative drainage output. Full article
(This article belongs to the Special Issue New Approaches in Intravenous Anesthesia and Anesthetics—Part III)
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11 pages, 913 KiB  
Article
Remimazolam as an Adjunct to General Anesthesia in Children: Adverse Events and Outcomes in a Large Cohort of 418 Cases
by Yoshitaka Kimoto, Tatsuya Hirano, Norifumi Kuratani, David Cavanaugh and Keira P. Mason
J. Clin. Med. 2023, 12(12), 3930; https://doi.org/10.3390/jcm12123930 - 8 Jun 2023
Cited by 10 | Viewed by 1883
Abstract
Remimazolam was first approved in 2020 as a general anesthetic for adults and still does not have pediatric labeling. Our study will be the first pilot program that administers remimazolam as an adjunct to a general endotracheal anesthetic in children. Between August 2020 [...] Read more.
Remimazolam was first approved in 2020 as a general anesthetic for adults and still does not have pediatric labeling. Our study will be the first pilot program that administers remimazolam as an adjunct to a general endotracheal anesthetic in children. Between August 2020 and December 2022, electronic medical records were collected for all children who received remimazolam during anesthesia. The remimazolam dosing regimen was extrapolated from the adult package insert, with intravenous induction doses of 12 mg/kg/h administered until the desired effect was achieved. Subsequent infusions were given at a rate of 1–2 mg/kg/h, accompanied by intermittent boluses of 0.2 mg/kg, with all dosing adjustments made according to the anesthesiologist’s clinical discretion. A total of 418 children (mean 4.6 yrs, 68.7% ASA 1 and 2) underwent surgeries which averaged 81.2 min. A total of 75.2% of patients had greater than a 20% change (increase or decrease) in MAP (lowest or highest) from baseline, and 203 (49.3%) patients had greater than a 30% change (increase or decrease) in MAP (lowest or highest) from baseline. A total of 5% received ephedrine to treat unanticipated hemodynamic variability. Discharge criteria were met within an average of 13.8 min after arrival at the post-anesthesia care unit. Remimazolam may offer the benefits of rapid recovery following general endotracheal anesthesia. The risk of hemodynamic variability which necessitates and responds to ephedrine should be anticipated. Full article
(This article belongs to the Special Issue New Approaches in Intravenous Anesthesia and Anesthetics—Part III)
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Review

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20 pages, 2196 KiB  
Review
Considerations for Intravenous Anesthesia Dose in Obese Children: Understanding PKPD
by James Denzil Morse, Luis Ignacio Cortinez and Brian Joseph Anderson
J. Clin. Med. 2023, 12(4), 1642; https://doi.org/10.3390/jcm12041642 - 18 Feb 2023
Cited by 1 | Viewed by 2193
Abstract
The intravenous induction or loading dose in children is commonly prescribed per kilogram. That dose recognizes the linear relationship between volume of distribution and total body weight. Total body weight comprises both fat and fat-free mass. Fat mass influences the volume of distribution [...] Read more.
The intravenous induction or loading dose in children is commonly prescribed per kilogram. That dose recognizes the linear relationship between volume of distribution and total body weight. Total body weight comprises both fat and fat-free mass. Fat mass influences the volume of distribution and the use of total body weight fails to recognize the impact of fat mass on pharmacokinetics in children. Size metrics alternative to total body mass (e.g., fat-free and normal fat mass, ideal body weight and lean body weight) have been proposed to scale pharmacokinetic parameters (clearance, volume of distribution) for size. Clearance is the key parameter used to calculate infusion rates or maintenance dosing at steady state. Dosing schedules recognize the curvilinear relationship, described using allometric theory, between clearance and size. Fat mass also has an indirect influence on clearance through both metabolic and renal function that is independent of its effects due to increased body mass. Fat-free mass, lean body mass and ideal body mass are not drug specific and fail to recognize the variable impact of fat mass contributing to body composition in children, both lean and obese. Normal fat mass, used in conjunction with allometry, may prove a useful size metric but computation by clinicians for the individual child is not facile. Dosing is further complicated by the need for multicompartment models to describe intravenous drug pharmacokinetics and the concentration effect relationship, both beneficial and adverse, is often poorly understood. Obesity is also associated with other morbidity that may also influence pharmacokinetics. Dose is best determined using pharmacokinetic–pharmacodynamic (PKPD) models that account for these varied factors. These models, along with covariates (age, weight, body composition), can be incorporated into programmable target-controlled infusion pumps. The use of target-controlled infusion pumps, assuming practitioners have a sound understanding of the PKPD within programs, provide the best available guide to intravenous dose in obese children. Full article
(This article belongs to the Special Issue New Approaches in Intravenous Anesthesia and Anesthetics—Part III)
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Other

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17 pages, 2915 KiB  
Systematic Review
Comparison of Remimazolam–Flumazenil versus Propofol for Recovery from General Anesthesia: A Systematic Review and Meta-Analysis
by Quantong Wu, Fuchao Xu, Jie Wang and Ming Jiang
J. Clin. Med. 2023, 12(23), 7316; https://doi.org/10.3390/jcm12237316 - 26 Nov 2023
Cited by 9 | Viewed by 1944
Abstract
(1) Purpose: to systematically evaluate the recovery following sedation and anesthesia with remimazolam combined with flumazenil in comparison to propofol. (2) Methods: Electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, were systematically searched from their inception up to 22 [...] Read more.
(1) Purpose: to systematically evaluate the recovery following sedation and anesthesia with remimazolam combined with flumazenil in comparison to propofol. (2) Methods: Electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, were systematically searched from their inception up to 22 October 2023. Included in this analysis were randomized controlled trials (RCT) that compared remimazolam–flumazenil with propofol for the recovery from sedation and anesthesia in adults. The risk of bias was assessed using the Cochrane risk of bias tool. Pooled risk ratios (RR) or mean differences (MD) along with their corresponding 95% confidence intervals (CI) were calculated using either fixed-effects or random-effects models, and the results were visualized in forest plots. (3) Results: Nine RCTs involving 745 patients who underwent general anesthesia in three different countries were included. Compared to propofol, the remimazolam–flumazenil combination shortened the emergence time (MD = −4.34 min, 95% CI = [−6.88, −1.81], p = 0.0008, low certainty), extubation time (MD = −4.26 min, 95% CI = [−6.81, −1.7], p = 0.0011, low certainty), and the post-anesthesia care unit (PACU) stay (MD = −4.42 min, 95% CI = [−7.45, −1.38], p = 0.0044, low certainty), while reducing the incidence of respiratory depression (RR = 0.2, 95% CI = [0.04, 0.89], p = 0.03, high certainty) after general anesthesia. However, this combination was associated with a higher incidence of re-sedation (RR = 4.15, 95% CI = [1.31, 13.13], p = 0.01, moderate certainty). (4) Conclusions: Based on the existing evidence, the combination of remimazolam and flumazenil accelerates recovery from general anesthesia and lowers the risk of respiratory depression compared to propofol. However, it is important to consider the higher risk of re-sedation when using this combination in clinical practice. Due to limitations in the quality of the evidence, it is advisable to interpret the results of meta-analyses with caution. Full article
(This article belongs to the Special Issue New Approaches in Intravenous Anesthesia and Anesthetics—Part III)
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11 pages, 2190 KiB  
Systematic Review
Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis
by Filippo D’Amico, Gaia Barucco, Margherita Licheri, Gabriele Valsecchi, Luisa Zaraca, Marta Mucchetti, Alberto Zangrillo and Fabrizio Monaco
J. Clin. Med. 2022, 11(23), 6955; https://doi.org/10.3390/jcm11236955 - 25 Nov 2022
Cited by 8 | Viewed by 2303
Abstract
Introduction: Recent studies showed that balanced opioid-free anesthesia is feasible and desirable in several surgical settings. However, in thoracic surgery, scientific evidence is still lacking. Thus, we conducted the first systematic review and meta-analysis of opioid-free anesthesia in this field. Methods: The primary [...] Read more.
Introduction: Recent studies showed that balanced opioid-free anesthesia is feasible and desirable in several surgical settings. However, in thoracic surgery, scientific evidence is still lacking. Thus, we conducted the first systematic review and meta-analysis of opioid-free anesthesia in this field. Methods: The primary outcome was the occurrence of any complication. Secondary outcomes were the length of hospital stay, recovery room length of stay, postoperative pain at 24 and 48 h, and morphine equivalent consumption at 48 h. Results: Out of 375 potentially relevant articles, 6 studies (1 randomized controlled trial and 5 observational cohort studies) counting a total of 904 patients were included. Opioid-free anesthesia compared to opioid-based anesthesia, was associated with a lower rate of any complication (74 of 175 [42%] vs. 200 of 294 [68%]; RR = 0.76; 95% CI, 0.65–0.89; p < 0.001; I2 = 0%), lower 48 h morphine equivalent consumption (MD −14.5 [−29.17/−0.22]; p = 0.05; I2 = 95%) and lower pain at 48 h (MD −1.95 [−3.6/0.3]; p = 0.02, I = 98%). Conclusions: Opioid-free anesthesia in thoracic surgery is associated with lower postoperative complications, and less opioid demand with better postoperative analgesia at 48 h compared to opioid-based anesthesia. Full article
(This article belongs to the Special Issue New Approaches in Intravenous Anesthesia and Anesthetics—Part III)
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