Symptoms During or Shortly After Isolated Carpal Tunnel Release and Problems Within 24?hours After Surgery

This study used the National Survey of Ambulatory Surgery (NSAS) database to measure the incidence of and risk factors for symptoms in the ambulatory surgery center and problems within 24 h after isolated carpal tunnel release (CTR). The NSAS contained records on 400,000 adult patients with carpal tunnel syndrome who were treated with CTR in 2006, based on ICD-9 codes. The type of anesthesia used and factors associated with symptoms and problems were sought in bivariate and multivariable statistical analyses. The mean duration of the procedure was 16 ± 8.8 min. Only 5 % were performed under local anesthesia without sedation, 45 % with IV sedation, 28 % regional anesthesia, and 19 % general anesthesia. Symptoms in the ambulatory surgery center or a problem within 24 h after discharge were recorded in 10 % of patients, all of them minor and transient, including difficulties with pain and its treatment. The strongest risk factors were male sex, age of 45 years and older, and participation of an anesthesiologist. Local anesthesia and regional anesthesia were associated with more perioperative symptoms and postoperative problems. Most CTR are performed with some sedation in the United States. CTR is a safe procedure: one in 10 patients will experience a minor issue in the perioperative or immediate postoperative period.     

EEG power spectral density under Propofol and its association with burst suppression,a marker of cerebral fragility

ObjectiveUnder General Anesthesia (GA), age and Burst Suppression (BS) are associated with cognitive postoperative complications, yet how these parameters are related to per-operative EEG and hypnotic doses is unclear. In this prospective study, we address this question comparing age and BS occurrences with a new score (BP_TIVA) based on Propofol doses, EEG and alpha-band power spectral densities, evaluated for SEF₉₅ = 8–13 Hz.Methods59 patients (55 [34–67] yr, 67% female) undergoing neuroradiology or orthopedic surgery were included. Total IntraVenous Anesthesia was used for Propofol and analgesics infusion. Cerebral activity was monitored from a frontal electrodes montage EEG.ResultsBP_TIVA was inversely correlated with age (Pearson r = −0.78, p < 0.001), and was significantly lower (p < 0.001) when BS occurred during the GA first minutes (induction). Additionally, the age-free BP_TIVA score was better associated with BS at induction than age (AUC = 0.94 versus 0.82, p < 0.05).ConclusionWe designed BP_TIVA score based on hypnotics and EEG. It was correlated with age yet was better associated to BS occurring during GA induction, the latter being a cerebral fragility sign.SignificanceThis advocate for an approach based on evaluating the cerebral physiological age (« brain age ») to predict postoperative cognitive evolution.     

Anesthetic management of parturients with Arnold Chiari malformation-I: a multicenter retrospective study

BackgroundConsensus regarding the safest mode of delivery and anesthetic management for parturients with Arnold Chiari malformation-I (ACM-I) remains controversial. This study assessed their anesthetic management and reported anesthetic complications during hospitalization for delivery.MethodsThis was a multicenter, retrospective, cohort study of patients with ACM-I undergoing vaginal or cesarean delivery. Data were obtained from the electronic databases of four United States academic institutions using International Classification of Diseases (ICD) codes from 2007–2017 at three sites and 2004–2017 at one site. The primary outcome was anesthetic complications.ResultsData were analyzed for 185 deliveries in 148 patients. Diagnosis of ACM-I was made prior to delivery in 147 (80%) cases. Pre-delivery neurosurgical consultation for management of ACM-I was performed in 53 (36%) patients. Pre-existing symptoms were recorded for 89 (48%) of the deliveries. Vaginal deliveries occurred in 80 (43%) cases, and 62 women (78%) received neuraxial labor analgesia. Cesarean delivery was performed in 105 (57%) cases, of which 70 women (67%) had neuraxial anesthesia and 34 (32%) received general anesthesia. Post-dural puncture headache was reported in three (2%) patients who had neuraxial anesthesia, and in two (12%) patients with syringomyelia. There was one (3%) reported case of aspiration pneumonia with general anesthesia.ConclusionsThe findings suggest that anesthetic complications occur infrequently in patients with ACM-I regardless of the anesthetic management. Although institutional preference in anesthetic and obstetric care appears to drive patient management, the findings suggest that an individualized approach has favorable outcomes in this population.     

双水平气道正压无创通气用于老年患者全麻恢复期的呼吸支持

目的研究双水平气道正压(BiPAP)通气在老年患者全麻恢复期呼吸支持的可行性。方法30例择期手术的老年患者随机分为BiPAP组与对照组,每组15例。在术前、拔管后、吸氧或无创通气1h后三个时点比较血液动力学、动脉血气分析参数和呼吸动力学指标。结果两组患者血液动力学的各项指标在各时点差异无显著意义;BiPAP组无创通气1h后PaCO2较拔管后降低,与对照组吸氧1h后比PaCO2低;拔管后两组患者PaO2较术前降低,BiPAP组吸氧1h可提高PaO2。BiPAP无创通气1h后,VTi、VE、Cdyn升高,RAWm降低;而对照组吸氧1h后较拔管后无明显改善。结论老年患者短期BiPAP面罩支持无创通气耐受性好,对血液动力学无明显影响,可以改善通气和氧合,降低气道阻力,提高肺顺应性。     

听觉诱发电位指数、脑电双频指数对异丙酚麻醉下患者术中体动反应的预测

目的评价听觉诱发电位指数(AAI)、脑电双频指数(BIS)预测异丙酚麻醉下患者术中体动反应的可能性。方法择期行妇科手术全麻患者28例,ASAⅠ或Ⅱ级,年龄24-62岁,体重46- 71 kg,术前2 h口服咪达唑仑10 mg,入室后以血浆靶浓度3．5μg/ml靶控输注异丙酚、静脉注射芬太尼2μg／kg及维库溴铵0．1 mg／kg麻醉诱导,气管插管后,调整异丙酚血浆靶浓度维持BIS 40-60。切皮后不再追加肌松剂,观察患者术中头面部及四肢的体动反应,记录体动反应发生前、后2min内BIS、AAI的最大值(BISmax、AAImax)及此时段内BIS>75、AAI>40的次数及出现时间。记录术中当BIS>75、AAI>40时前、后2 min内有无体动反应发生及发生时间。结果12例出现体动反应,体动前、后2 min内BISmax为63±16(4例BIS>75,33．3％),AAImax为48±11(12例AAI>40,100％)。麻醉维持过程中,出现14次BIS>75,并发体动反应4次(28．5％),BIS反应时间较体动时间滞后(84±19)s;出现AAI>40者28次,并发体动者12次(42．8％),AAI反应时间较体动时间滞后(13±3)s。结论异丙酚麻醉下BIS、AAI反应时间较体动发生时间滞后,不能预测术中体动反应的发生。     

肾上腺素对氯普鲁卡因硬膜外阻滞患者药效学和药代动力学的影响

目的观察1:20万肾上腺素对3％盐酸氯普鲁卡因硬膜外阻滞患者药效学和药代动力学的影响。方法择期行下腹部手术患者20例,ASAⅠ或Ⅱ级,随机分为2组(n=10):盐酸氯普鲁卡因组(C组)和盐酸氯普鲁卡因加肾上腺素组(CE组)。分别用3％氯普鲁卡因6 mg·kg-1(C组)和含 1:20万肾上腺素3％氯普鲁卡因6 mg·kg-1(CE组)硬膜外阻滞,记录局麻药的起效时间、运动阻滞起效时间和给药后20min时运动阻滞程度;分别在给药前及给药后3、6、9、11、13、15、17、20、30、45、60、 90min采取桡动脉血1．5ml,高效液相色谱法检测血浆氯普鲁卡因浓度,经计算机软件拟合血药浓度 -时间曲线,并计算各项药代动力学参数。结果两组局麻药的起效时间、运动阻滞起效时间和运动阻滞程度差异无统计学意义。C、CE组血药浓度峰值(Cmax)分别为0．49±0．47、(0．32±0．22)mg· L-1,达峰值时间(Tmax)分别为8±3、(9±4)min;血药浓度曲线下面积(AUC)分别为10±6、(7±4)μg· min·ml-1;清除速率常数(K)分别为0．32±0．21、(0．36±0．32)min-1;两组间Cmax、Tmax、AUC及K比较差异无统计学意义(P>0．05)。结论 1:20万肾上腺素对3％盐酸氯普鲁卡因硬膜外阻滞的药代动力学和药效学没有影响。