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  • 1.

    【2hr】Effect of local anesthesia (with lidocaine vs bupivacaine) on cognitive function in patients undergoing elective cataract surgery

    包量

    机译 局部麻醉（利多卡因与布比卡因联合使用）对择期白内障手术患者认知功能的影响
    摘要：PurposePostoperative cognitive dysfunction has gained much attention over the last years. Multiple clinical trials have attempted to differentiate the effect of local vs general anesthesia on postoperative cognitive function. The aim of this work was to study the effect of local anesthesia with lidocaine vs bupivacaine on cognitive function
  • 2.

    【2hr】The addition of intrathecal morphine to a transversus abdominis plane block with liposome bupivacaine provides more effective analgesia than transversus abdominis plane block with liposome bupivacaine alone: a retrospective study

    包量

    机译 回顾性研究：鞘内注射吗啡比单独使用布比卡因脂质体的横贯腹平面阻滞更有效的镇痛作用
    摘要：ObjectiveThe purpose of this study was to determine if the standardization of using liposomal bupivacaine in transversus abdominis plane (LB TAP) blocks eliminated the benefit of intrathecal morphine (ITM) in patients after undergoing a cesarean section.
  • 3.

    【2hr】Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients

    包量

    机译 脊髓麻醉引起的低血压是由老年患者的中风量减少引起的
    摘要：BackgroundHypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine.
  • 4.

    【2hr】Comparison of subcutaneous dexmedetomidine versus clonidine as an adjuvant to spinal anesthesia: a randomized double blind control trial

    包量

    机译 皮下右美托咪定与可乐定作为脊髓麻醉佐剂的比较：一项随机双盲对照试验
    摘要：Background: Alpha-2 adrenergic agonists like clonidine and dexmedetomidine prolong the duration of postoperative analgesia and improve the quality of subarachnoid block (SAB) when used as adjuvant in various routes. However, addition of these drugs by IV or intrathecal routes are known to cause hemodynamic instability. The subcutaneous (SC) route provides similar efficacy as IV administration with less hemodynamic instability and prolonged effect.Aims: To compare the efficacy of clonidine and dexmedetomidine as adjuvants to SAB when used subcutaneously.Materials and methods: A total of 90 patients were randomized into one of the three groups: Group P received 1 ml of Normal saline SC, Group D received 0.5 mcg/kg of dexmeditomedine SC and Group C received 1 mcg/kg of clonidine SC respectively after SAB with 3ml of 0.5% hyperbaric bupivacaine (15 mg). Time of onset of sensory and motor block, intraoperative hemodynamics, postoperative VAS scores, Richmond agitation sedation scale, duration of postoperative analgesia and mean paracetamol requirement in 24 hours were recorded.Results: Mean duration of postoperative analgesia was prolonged in group D (838.10±348.22 minutes) and group C (816.67±230.48 minutes) when compared to group P (332.10±110.91 minutes). Total paracetamol consumption was less in group D (1400.00±770.13 mg) and group C (1600.00±674.66 mg), whereas it was 1900.00±758.86 mg in group P. Hemodynamic parameters, maximum sensory level attained, and time to attain maximum sensory levels were comparable among the two groups.Conclusion: Both subcutaneous clonidine and dexmedetomidine prolonged the duration of postoperative analgesia and reduced analgesic requirements when used as adjuvants to SAB with stable hemodynamics, hence both of these drugs can be used effectively as adjuvants to SAB.
  • 5.

    【2hr】Effect of hypotensive hypovolemia and thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume in pigs: a blinded, randomized controlled trial

    包量

    机译 降压性低血容量和胸膜硬膜外麻醉对血浆心房利钠肽的影响，以表明猪的中枢血容量存在偏差：一项盲法，随机对照试验
    摘要：PurposeChanges in plasma pro-atrial natriuretic peptide (proANP) may indicate deviations in the central blood volume (CBV). We evaluated the plasma proANP response to hypotensive hypovolemia under the influence of thoracic epidural anesthesia (TEA) in pigs. We hypothesized that plasma proANP would decrease in response to hypotensive hypovolemia and that TEA would aggravate the proANP response, reflecting a further decrease in CBV.
  • 6.

    【2hr】Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma

    包量

    机译 锯齿状平面阻滞对胸外伤后疼痛评分和肺活量的影响
    摘要：Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis.Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center.Methods: Our hospital’s Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 2018. Data were compared in each patient as a matched pair for the time periods before and after undergoing SPB. Thirty-four patients with similar baseline characteristics were enrolled.Results: The median number of rib fractures was 7. Ordinal pain scores were found to be improved 4 hrs after SPB from median 7/10 to 3/10 (P<0.001). Incentive spirometry (IS) volumes recorded 4 and 24 hrs postserratus plane block showed a median increase of 150 and 175 mL from baseline, respectively (P<0.001). IS volumes recorded at 48 hrs showed a median increase of 300 mL from baseline (P<0.001). Respiratory rate decreased from a median value of 24.5 to 16 breaths/min (P<0.001). SpO2 was improved at 24 hrs from median 96% to 99% (P<0.001).Conclusion: SPB improves pain scores and IS volumes in MRF. Because it is not limited by patient positioning or anticoagulation and has a better safety profile, it may offer a viable alternative to neuraxial techniques. Additional studies are necessary to evaluate its efficacy compared to neuraxial techniques.
  • 7.

    【2hr】Evaluation of the attitudes of surgeons about regional anesthesia: a survey study

    包量

    机译 评估外科医生对区域麻醉的态度：一项调查研究
    摘要：BackgroundThe intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations.
  • 8.

    【2hr】Celiac plexus block as a diagnostic tool in suspected pediatric median arcuate ligament syndrome

    包量

    机译 腹腔神经丛阻滞作为疑似儿科弓状韧带综合症的诊断工具
    摘要：We report the use of celiac plexus block (CPB) as a diagnostic aid in the evaluation of median arcuate ligament syndrome (MALS) in a pediatric patient. MALS is a rare cause of severe, debilitating, abdominal postprandial pain associated with nausea, vomiting, occasional diarrhea, unintentional weight loss, and abdominal bruit. MALS is a diagnosis of exclusion, after multiple investigations. This is the first case report where CPB was used to confirm candidacy for corrective surgery in the pediatric population and has served as the cornerstone in diagnosis of MALS.
  • 9.

    【2hr】Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures

    包量

    机译 氯普鲁卡因双侧臂丛神经阻滞术治疗双侧Rad骨骨折
    摘要：We report a case of a 41-year-old male with anticipated difficult airway undergoing a repair of a bilateral radial fracture under bilateral sequential brachial plexus block. Anesthesiologists are reluctant to perform bilateral blocks because of the fear of complications like diaphragmatic paralysis, local anesthetic (LA) toxicity, and pneumothorax. We advise that with the correct application of LA pharmacokinetics, careful patient selection and usage of ultrasound, bilateral blocks can be done safely. We used chloroprocaine as an LA in one of the blocks to reduce the dose required for the more toxic LAs. chloroprocaine’s fast metabolism also helped us to prevent the overlapping of peak plasma concentration of different LAs. To our knowledge, this is the first reported case in the literature where chloroprocaine was used for bilateral brachial plexus block.
  • 10.

    【2hr】A clearer view on postoperative cognitive dysfunction? [Letter]

    包量

    机译 术后认知功能障碍的观点更清晰吗？ [信]
    摘要：
  • 11.

    【2hr】Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist

    包量

    机译 改善非手术麻醉的术中切换：麻醉医师的挑战和解决方案
    摘要：Permanent transitions of care from one anesthesia provider to another are associated with adverse events and mortality. There are currently no available data on how to mitigate these poor patient outcomes other than to reduce the occurrence of such handoffs. We used data from an ambulatory surgery center to demonstrate the steps that can be taken to achieve this goal. First, perform statistical forecasting using many months of historical data to create optimal, as opposed to arbitrary shift durations. Second, consider assigning the anesthesia providers designated to work late, if necessary, to the ORs estimated to finish the earliest, rather than latest. We performed multiple analyses showing the quantitative advantage of this strategy for the ambulatory surgery center with multiple brief cases. Third, sequence the cases in the 1 or 2 ORs with the latest scheduled end times so that the briefest cases are finished last. If a supervising anesthesiologist needs to be relieved early for administrative duties (eg, head of the group to meet with administrators or surgeons), assign the anesthesiologist to an OR that finishes with several brief cases. The rationale for these recommendations is that such strategies provide multiple opportunities for a different anesthesia provider to assume responsibility for the patients between cases, thus avoiding a handoff altogether.
  • 12.

    【2hr】Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks

    包量

    机译 麻醉技术：着重于腹横肌平面（TAP）块
    摘要：Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24–48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.
  • 13.

    【2hr】Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist [Corrigendum]

    包量

    机译 改善非手术麻醉的术中切换：麻醉医师的挑战和解决方案[更正]
    • 作者：
    • 刊名：Local and Regional Anesthesia
    • 2019年第期
    摘要：
  • 14.

    【2hr】Evaluation Of The Attitudes Of Surgeons About Regional Anesthesia: A Survey Study [Corrigendum]

    包量

    机译 外科医生对区域麻醉态度的评估：一项调查研究[更正]
    • 作者：
    • 刊名：Local and Regional Anesthesia
    • 2019年第期
    摘要：
  • 15.

    【2hr】Local anesthetics for brain tumor resection: current perspectives

    包量

    机译 脑肿瘤切除术的局麻药：当前观点
    摘要：This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain. The only identified causative factor predicting higher postoperative pain scores is infratentorial surgery. Postoperative analgesia can be achieved with multimodal pain management where local anesthesia is associated with lower postoperative pain intensity, reduction in opioid requirement and prevention of development of chronic pain. In awake craniotomy patients, sufficient local anesthesia is a cornerstone of the procedure. An awake craniotomy and brain tumor resection can be carried out completely under local anesthesia only. However, the use of sedative drugs is common to improve patient comfort during craniotomy and closure. Local anesthesia for craniotomy can be performed by directly blocking the six different nerves that provide the sensory innervation of the scalp, or by local infiltration of the surgical site and the placement of the pins of the Mayfield clamp. Direct nerve block has potential complications and pitfalls and is technically more challenging, but mostly requires lower total doses of the local anesthetics than the doses required in surgical-site infiltration. Due to a lack of comparative studies, there is no evidence showing superiority of one technique versus the other. Besides the use of other local anesthetics for analgesia, intravenous lidocaine administration has proven to be a safe and effective method in the prevention of coughing during emergence from general anesthesia and extubation, which is especially appreciated after brain tumor resection.
  • 16.

    【2hr】Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies

    包量

    机译 瑞芬太尼诱导的术后痛觉过敏：当前的机制和治疗策略的观点
    摘要：The use of remifentanil in clinical practice offers several advantages and it is used for a wide range of procedures, ranging from day-surgery anesthesia to more complex procedures. Nonetheless, remifentanil has been consistently linked with development of opioid-induced hyperalgesia (OIH), which is described as a paradoxical increase in sensitivity to painful stimuli that develops after exposure to opioid treatment. The development of OIH may cause several issues, delaying recovery after surgery and preventing timely patient’s discharge. Moreover, it causes patient’s discomfort with higher pain scores, greater use of analgesics, and associated side effects. Remifentanil is the opioid most convincingly associated with OIH, and hereby we provide a review of remifentanil-induced hyperalgesia, describing both the underlying mechanisms involved and the available studies investigating experimental and clinical pharmacologic approaches aiming at reducing its incidence and degree.
  • 17.

    【2hr】Local anesthetic systemic toxicity: current perspectives

    包量

    机译 局麻药全身毒性：当前观点
    摘要：Local anesthetic systemic toxicity (LAST) is a life-threatening adverse event that may occur after the administration of local anesthetic drugs through a variety of routes. Increasing use of local anesthetic techniques in various healthcare settings makes contemporary understanding of LAST highly relevant. Recent data have demonstrated that the underlying mechanisms of LAST are multifactorial, with diverse cellular effects in the central nervous system and cardiovascular system. Although neurological presentation is most common, LAST often presents atypically, and one-fifth of the reported cases present with isolated cardiovascular disturbance. There are several risk factors that are associated with the drug used and the administration technique. LAST can be mitigated by targeting the modifiable risk factors, including the use of ultrasound for regional anesthetic techniques and restricting drug dosage. There have been significant developments in our understanding of LAST treatment. Key advances include early administration of lipid emulsion therapy, prompt seizure management, and careful selection of cardiovascular supportive pharmacotherapy. Cognizance of the mechanisms, risk factors, prevention, and therapy of LAST is vital to any practitioner using local anesthetic drugs in their clinical practice.
  • 18.

    【2hr】Frailty and anesthesia – risks during and post-surgery

    包量

    机译 身体虚弱和麻醉-手术期间和手术后的风险
    摘要：Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.
  • 19.

    【2hr】Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

    包量

    机译 区域麻醉以改善儿科手术患者的术后镇痛效果：随机对照试验的最新系统评价
    摘要：Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regional anesthesia minimized postoperative pain and reduced opioid consumption. Only a few surgical procedures (cholecystectomy, inguinal hernia repair, and non-laparoscopic major abdominal surgery) reported no significant difference in the postoperative pain relief compared with the standard anesthetic management. The growing number of randomized controlled trials in the pediatric literature is very promising; however, additional confirmation is needed to reinforce the use of specific regional anesthesia techniques to provide optimal postoperative pain relief for a few surgical procedures (reconstructive ear surgery, chest wall deformity, hypospadias, umbilical hernia, cleft palate repair) in pediatric patients. More randomized controlled trials are needed to establish regional anesthesia as an essential component of postoperative analgesia management in children.
  • 20.

    【2hr】Effect of warming anesthetic on pain perception during dental injection: a split-mouth randomized clinical trial

    包量

    机译 加热麻醉剂对牙科注射过程中疼痛感的影响：一项裂口随机临床试验
    摘要：BackgroundThe purpose of this study is to determine the effectiveness of warming anesthesia on the control of the pain produced during the administration of dental anesthesia injection and to analyze the role of Transient Receptor Potential Vanilloid-1 nociceptor channels in this effect.
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