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Elhadjene N, Grand N, Azarnoush K, Petrosyan A, Raissouni K, Campisi S, Sandri F, Palao JC, Awad S, Magand C, Molliex S, Ollier E, Morel J, Lanoiselee J. Regional anaesthesia via parasternal catheters inserted preoperatively and postoperative delirium after cardiac surgery: A prospective unrandomised clinical trial. Eur J Anaesthesiol 2024; 41:447-450. [PMID: 38357808 DOI: 10.1097/eja.0000000000001973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
VISUAL ABSTRACT http://links.lww.com/EJA/A927.
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Affiliation(s)
- Nory Elhadjene
- From the Département d'Anesthésie-Réanimation et Médecine Périopératoire (NE, NG, FS, JCP, SA, CM, SM, JM, JL), Département de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire de Saint-Etienne (KA, AP, KR, SC), Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne (EO), Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité (NE, JM), INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France (SM, EO, JL)
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Makkad B, Heinke TL, Sheriffdeen R, Khatib D, Brodt JL, Meng ML, Grant MC, Kachulis B, Popescu WM, Wu CL, Bollen BA. Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2. Anesth Analg 2023; 137:26-47. [PMID: 37326862 DOI: 10.1213/ane.0000000000006506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pain after cardiac surgery is of moderate to severe intensity, which increases postoperative distress and health care costs, and affects functional recovery. Opioids have been central agents in treating pain after cardiac surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure. This Practice Advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of cardiac surgical patients. This Practice Advisory provides recommendations for providers caring for patients undergoing cardiac surgery. This entails developing customized pain management strategies for patients, including preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various cardiac surgical procedures. The literature related to this field is emerging, and future studies will provide additional guidance on ways to improve clinically meaningful patient outcomes.
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Affiliation(s)
- Benu Makkad
- From the Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raiyah Sheriffdeen
- Department of Anesthesiology, Medstar Washington Hospital Center, Washington, DC
| | - Diana Khatib
- Department of Anesthesiology, Weil Cornell Medical College, New York, New York
| | - Jessica Louise Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University, New York, New York
| | - Wanda Maria Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher L Wu
- Department of Anesthesiology, Hospital of Special Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce Allen Bollen
- Missoula Anesthesiology, Missoula, Montana
- The International Heart Institute of Montana, Missoula, Montana
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Réhabilitation améliorée après chirurgie cardiaque adulte sous CEC ou à cœur battant 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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King M, Stambulic T, Hassan SMA, Norman PA, Derry K, Payne DM, El Diasty M. Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta-analysis. J Card Surg 2022; 37:3729-3742. [PMID: 36098374 DOI: 10.1111/jocs.16882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Inadequate pain control after median sternotomy leads to reduced mobilization, increased respiratory complications, and longer hospital stays. Typically, postoperative pain is controlled by opioid analgesics that may have several adverse effects. Parasternal intercostal block (PSB) has emerged as part of a multimodal strategy to control pain after median sternotomy. However, the effectiveness of this intervention on postoperative pain control and analgesic use has not been fully established. METHODS AND RESULTS We conducted a meta-analysis to assess the effect of PSB on postoperative pain and analgesic use in adult cardiac surgery patients undergoing median sternotomy. PubMed, Embase, Google Scholar, and the Cochrane database were searched with the following search strategy: ([postoperative pain] or [pain relief] OR [analgesics] or [analgesia] or [nerve block] or [regional block] or [local block] or [regional anesthesia] or [local anesthetic] or [parasternal block] and [sternotomy]) and (humans [filter]). Inclusion criteria were: patients who underwent cardiac surgery via median sternotomy, age >18 and parasternal block (continuous and single dose). Exclusion criteria were: noncardiac surgery, nonparasternal nerve blocks, and the use of NSAIDS in parasternal block. Quality assessment was performed by three independent reviewers via the Cochrane risk of bias assessment tool. Of 1165 total citations, 18 were found to be relevant. Of these 18 citations, 7 citations (N = 2223 patients) reported postoperative pain scores in an extractable format and 11 citations (N = 2155 patients) reported postoperative opioid use in an extractable format. For postoperative opioid use, morphine equivalent doses were calculated for all studies and postoperative pain scores were standardized to a 10-point visual analog scale for comparison between studies; both these were reported as total opioid use or cumulative score ranging from 24 to 72 h postoperative. All data analyses were run using a random effects model, using a restricted maximum likelihood estimator, to obtain summary standardized mean differences with 95% confidence interval (CI's). For studies which only reported median and interquatile range (IQR), the median was standard deviation was estimated by IQR/1.35. Following median sternotomy both postoperative pain (SMD [95% CI] -0.49 [-0.92 to -0.06]) and postoperative morphine equivalent use (SMD [95% CI] -1.68 [-3.11 to -0.25]) were significantly less in the PSB group. CONCLUSION Our meta-analysis suggests that parasternal nerve block significantly reduces postoperative pain and opioid use.
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Affiliation(s)
- Morgan King
- Queen's School of Medicine, Kingston, Ontario, Canada
| | | | | | - Patrick A Norman
- Kingston General Health Research Institute, Kingston, Ontario, Canada
| | - Kendra Derry
- Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada
| | - Darrin M Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Mohammad El Diasty
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
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Jang BH, So KY, Kim SH. Analgesic Effects of Continuous Wound Infusion Combined with Intravenous Patient-Controlled Analgesia for Thoracic Surgery: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116920. [PMID: 35682503 PMCID: PMC9180066 DOI: 10.3390/ijerph19116920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
Continuous wound infusion analgesia (CWA) with local anesthetics is a loco-regional anesthetic approach for multimodal analgesia management in surgical procedures. This study analyzed whether the combination of intravenous patient-controlled analgesia (PCA) and CWA would be more effective than PCA alone for postoperative analgesia and in preventing chronic postsurgical pain syndrome (PSPS) after thoracic surgeries. We enrolled 166 patients after propensity score matching, the PCA alone (PCA group, n = 83) and the combination of PCA and CWA (PCA-CWA group, n = 83), through a review of electronic medical records. The primary endpoint was the numeric rating scale (NRS) at postoperative days 1, 2, 3, 4, and 5. The secondary endpoint was the presence of PSPS at 3 and 6 months postoperatively. The NRS were lower in the PCA-CWA group than in the PCA group throughout the postoperative period (p < 0.001). The sedation incidence was lower in the PCA-CWA group (1.2%) than in the PCA group (9.6%) (p = 0.034), and there was no significant difference in other postoperative complications or in the incidence of PSPS (p = 1.000). The combination of intravenous PCA and CWA is an effective postoperative analgesic modality for thoracic surgery.
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Affiliation(s)
- Bo Hyun Jang
- Department of Medicine, Graduate School, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea;
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Keum Young So
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea
- Correspondence: ; Tel.: +82-62-220-3223
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Mertes PM, Kindo M, Amour J, Baufreton C, Camilleri L, Caus T, Chatel D, Cholley B, Curtil A, Grimaud JP, Houel R, Kattou F, Fellahi JL, Guidon C, Guinot PG, Lebreton G, Marguerite S, Ouattara A, Provenchère Fruithiot S, Rozec B, Verhoye JP, Vincentelli A, Charbonneau H. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med 2022; 41:101059. [PMID: 35504126 DOI: 10.1016/j.accpm.2022.101059] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. METHODS Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. CONCLUSIONS Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
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Affiliation(s)
- Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation, d'Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | - Christophe Baufreton
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France; MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
| | - Lionel Camilleri
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
| | - Thierry Caus
- Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
| | - Didier Chatel
- Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
| | - Bernard Cholley
- Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
| | - Alain Curtil
- Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
| | | | - Rémi Houel
- Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Fehmi Kattou
- Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France; University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France; INSERM, LNC UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Sophie Provenchère Fruithiot
- Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France; Centre d'Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
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Study on the Risk Factors of Pulmonary Infection after Laparoscopic Surgery and Analysis of the Detection Results of Drug-Resistant Bacteria. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6510068. [PMID: 35340242 PMCID: PMC8956428 DOI: 10.1155/2022/6510068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate and analyze the risk of pulmonary infection after laparoscopic surgery and the detection results of drug-resistant bacteria. With the laparoscopic technology developing rapidly in recent years and people's minimally invasive concept improving continuously, laparoscopic radical surgery has been widely used in the treatment of a variety of diseases. Laparoscopic surgery has the probability of causing complications. In order to avoid this, the risk factors after surgery were analyzed, and the drug-resistant bacteria were analyzed for accurate prevention and treatment. A total of 600 patients who underwent elective laparoscopic surgery in our hospital from January 2017 to September 2021 were included in the study. The risk factors and pathogen distribution of pulmonary infection were analyzed. The risk factors of pulmonary infection after laparoscopic surgery were hypoproteinemia, diabetes mellitus, pulmonary disease history, and perioperative blood transfusion. The main pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Streptococcus pneumoniae. In clinical work, relevant nursing intervention measures can be developed for the above factors, so as to reduce the incidence of pulmonary infection. This study finds the risk factors for pulmonary infection after surgery, and the common drug-resistant bacteria has an indicative and guiding effect on the formulation of nursing management measures.
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Hu M, Wang Y, Hao B, Gong C, Li Z. Evaluation of Different Pain-Control Procedures for Post-cardiac Surgery: A Systematic Review and Network Meta-Analysis. Surg Innov 2022; 29:269-277. [PMID: 35061568 DOI: 10.1177/15533506211068930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective To identify superior pain-control procedures for postoperative patients who undergo cardiac surgeries. Methods Literature searches were conducted in globally recognized databases, including MEDLINE, EMBASE and Cochrane Central, to identify randomized controlled trials (RCTs) investigating pain-control procedures after cardiac surgeries. The parameters evaluating analgesic efficacy and postoperative recovery, namely, the pain score and ICU stay, were quantitatively pooled and estimated using Bayesian methods. The values of the surface under the cumulative ranking (SUCRA) probabilities regarding each parameter were calculated to enable the ranking of various pain-control procedures. Node-splitting analysis was performed to test the inconsistency of the main results, and the publication bias was assessed by examining the funnel-plot symmetry. Results After a detailed review, 13 RCTs containing 7 different procedures were included in the network meta-analysis. After pooling the results together, an erector spinae plane block (ESPB) and a local parasternal block (LPB) plus target-controlled infusion (TCI) presented the best analgesic effects for reducing pain at rest (SUCRA, .47) and during movement (SUCRA, .52), respectively, while the former also achieved the shortest ICU stay (SUCRA, .48). Moreover, the funnel-plot symmetries showed no inconsistencies or obvious publication bias in the current study. Conclusions The current evidence indicates that ESPB is a potential superior analgesic strategy for post-cardiac surgery patients. To verify this conclusion further, it is imperative to obtain more high-quality evidence and conduct relevant investigations in the future.
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Affiliation(s)
- Mengjie Hu
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan , China
| | - Yuqi Wang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin , China
| | - Bihai Hao
- School of Nursing, Huanggang Polytechnic College, Huanggang , China
| | - Cheng Gong
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan , China
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan , China
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Sun Y, Luo X, Yang X, Zhu X, Yang C, Pan T, Du Y, Zhang R, Wang D. Benefits and risks of intermittent bolus erector spinae plane block through a catheter for patients after cardiac surgery through a lateral mini-thoracotomy: A propensity score matched retrospective cohort study. J Clin Anesth 2021; 75:110489. [PMID: 34481363 DOI: 10.1016/j.jclinane.2021.110489] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE A lateral mini-thoracotomy approach to cardiac surgery causes severe and complicated postoperative pain compared to the sternotomy approach. In this study we assessed the benefits and risks of intermittent bolus erector spinae plane block (ESPB) via a catheter for patients who underwent cardiac surgery through a lateral mini-thoracotomy. DESIGN A propensity score-matched retrospective cohort study. SETTING University hospital. PATIENTS 452 consecutive patients that underwent cardiac surgery through a lateral mini-thoracotomy from 2018 to 2020. INTERVENTIONS Patients who received intermittent bolus ESPB through a catheter for 3 days (ESPB group, n = 93) were compared with patients who did not receive any regional anesthesia (Control group, n = 174) after propensity score matching. MEASUREMENTS The primary endpoint was postoperative in-hospital cumulative opioid consumption (calculated as oral morphine milligram equivalents, MME). The secondary outcomes were intraoperative sufentanil doses, therapeutic use of antiemetic, pulmonary infection (assessed using a modified clinical pulmonary infection score, CPIS), durations of ICU and hospital stays, and ESPB related/unrelated complications. MAIN RESULTS There is a lower oral MME in the ESPB group, 266 ± 126 mg in the ESPB group vs. 346 ± 105 mg in the control group (95% CI -113 to -46; P < 0.01). Fewer patients received therapeutic antiemetic agents in the ESPB group (30% vs. 42%, odds ratio 0.58; 95% CI 0.34 to 0.99; P = 0.04). The modified CPIS in the ESPB group is lower: 1.4 ± 0.9 vs. 2.0 ± 1.0 (95% CI -0.9 to -0.3; P < 0.01) on postoperative day 1; 1.6 ± 0.9 vs. 2.0 ± 0.9 (95% CI -0.7 to -0.2; P < 0.01) on postoperative day 2. The observed complications associated with ESPB include pneumothorax (1%), staxis around stomas (5%), hypotension (1%), catheter displacement (3%), and catheter obstruction (2%). None of the patients had any adverse outcomes. CONCLUSION Intermittent bolus ESPB is relatively safe and correlated with a reduction in the use of opioids and antiemetics for cardiac surgery through a lateral mini-thoracotomy.
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Affiliation(s)
- Yanhua Sun
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Xuan Luo
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Xuelin Yang
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Xuewen Zhu
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Can Yang
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Tuo Pan
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Yingjie Du
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, No.1 Dongjiaominxiang Road, Dongchen District, Beijing, 100730, China
| | - Rui Zhang
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
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Chen J, Khazanchi R, Bearman G, Marcelin JR. Racial/Ethnic Inequities in Healthcare-associated Infections Under the Shadow of Structural Racism: Narrative Review and Call to Action. Curr Infect Dis Rep 2021; 23:17. [PMID: 34466126 PMCID: PMC8390539 DOI: 10.1007/s11908-021-00758-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
Purpose of Review The purpose of this study is to review racial and ethnic inequities in the incidence and prevention of healthcare-associated infections (HAIs) in the USA, identify gaps in the literature, and recommend future directions to mitigate these inequities. Recent Findings While some existing literature has identified the presence of racial/ethnic inequities in HAI incidence and outcomes, few studies to date have evaluated whether HAI prevention efforts have mitigated these inequities. Factors contributing to inequities in HAI prevention may include unconscious bias of healthcare professionals towards minoritized patients; socioeconomic and structural inequities disparately affecting minoritized communities; the racial segregation of quality healthcare through hospital price discrimination; divergent reimbursement rates between public and private insurers; policies or performance metrics which underfund and financially penalize safety-net hospitals; and insufficient research evaluating and addressing HAI inequities. Summary Expansion of the literature is needed to further interrogate root causes and evaluate the impact of interventions on racial/ethnic inequities in HAI incidence. Measures to mitigate inequities might include teaching healthcare workers how to recognize and mitigate unconscious biases, expanding community resources which address the social and structural determinants of health, increasing access to preventive health services, reforming federal and institutional policies to better support safety-net hospitals and disincentivize price discrimination, and improving diversity and inclusion within the health workforce.
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Affiliation(s)
- Jiabi Chen
- School of Medicine, Virginia Commonwealth University, Richmond, VA USA
| | - Rohan Khazanchi
- College of Medicine, University of Nebraska Medical Center, Omaha, NE USA.,School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Gonzalo Bearman
- Department of Internal Medicine, Division of Infectious Disease, Virginia Commonwealth University, Richmond, VA USA
| | - Jasmine R Marcelin
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE USA
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McCARTHY C, Spray D, Zilhani G, Fletcher N. Perioperative care in cardiac surgery. Minerva Anestesiol 2020; 87:591-603. [PMID: 33174405 DOI: 10.23736/s0375-9393.20.14690-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As mortality is now low for many cardiac surgical procedures, there has been an increasing focus on patient centered outcomes such as recovery and quality of life. The Enhanced Recovery After Surgery (ERAS) cardiac society recently published the first set of guidelines for cardiac surgery which will be useful as a starting point to help translate this philosophy for the benefit of those undergoing cardiac surgery. At the same time there are many advances in other areas such as mechanical circulation, diagnostics and quality metrics. We intend here to present a balanced and evidenced based review of selected aspects of current practice, encompassing both UK and international perioperative care with a focus on recent advances. For the convenience of the reader we will adopt the conventional perioperative preoperative, intraoperative and postoperative phases of care. The focus of cardiac surgical practice needs to evolve from mortality to recovery. Those specialists who work in cardiac anaesthesia and critical care are well placed to contribute to these changes. Accompanying this work is the development of technologies to improve recognition of and intervention to prevent early organ dysfunction. Measuring, benchmarking and publishing quality outcomes from cardiac surgical centres is likely to improve services and benefit our patients.
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Affiliation(s)
| | | | | | - Nick Fletcher
- St Georges University Hospitals, London, UK.,Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, UK
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Ungerman E, Khoche S, Subramani S, Bartels S, Fritz AV, Martin AK, Subramanian H, Devarajan J, Knight J, Boisen ML, Gelzinis TA. The Year in Cardiothoracic Transplantation Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:2889-2905. [PMID: 32782193 DOI: 10.1053/j.jvca.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/11/2022]
Abstract
The highlights in cardiothoracic transplantation focus on the recent research pertaining to heart and lung transplantation, including expansion of the donor pool, the optimization of donors and recipients, the use of mechanical support, the perioperative and long-term outcomes in these patient populations, and the use of transthoracic echocardiography to diagnose rejection.
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Affiliation(s)
- Elizabeth Ungerman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Swapnil Khoche
- Department of Anesthesiology, University of California San Diego, San Diego, CA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Steven Bartels
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Mijovski G, Podbregar M, Kšela J, Jenko M, Šoštarič M. Effectiveness of wound infusion of 0.2% ropivacaine by patient control analgesia pump after minithoracotomy aortic valve replacement: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2020; 20:172. [PMID: 32682395 PMCID: PMC7368743 DOI: 10.1186/s12871-020-01093-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Local anesthetic wound infusion has become an invaluable technique in multimodal analgesia. The effectiveness of wound infusion of 0.2% ropivacaine delivered by patient controlled analgesia (PCA) pump has not been evaluated in minimally invasive cardiac surgery. We tested the hypothesis that 0.2% ropivacaine wound infusion by PCA pump reduces the cumulative dose of opioid needed in the first 48 h after minithoracothomy aortic valve replacement (AVR). METHODS In this prospective, randomized, double-blind, placebo-controlled study, 70 adult patients (31 female and 39 male) were analyzed. Patients were randomized to receive 0.2% ropivacaine or 0.9% saline wound infusion by PCA pump for 48 h postoperatively. PCA pump was programmed at 5 ml h- 1 continuously and 5 ml of bolus with 60 min lockout. Pain levels were assessed and recorded hourly by Numeric Rating Scale (NRS). If NRS score was higher than three the patient was administered 3 mg of opioid piritramide repeated and titrated as needed until pain relief was achieved. The primary outcome was the cumulative dose of the opioid piritramide in the first 48 h after surgery. Secondary outcomes were frequency of NRS scores higher than three, patient's satisfaction with pain relief, hospital length of stay, side effects related to the local anesthetic and complications related to the wound catheter. RESULTS The cumulative dose of the opioid piritramide in the first 48 h after minithoracotomy AVR was significantly lower (p < 0.001) in the ropivacaine (R) group median 3 mg (IQR 6 mg) vs. 9 mg (IQR 9 mg). The number of episodes of pain where NRS score was greater than three median 2 (IQR 2), vs 3 (IQR 3), (p = 0.002) in the first 48 h after surgery were significantly lower in the ropivacaine group, compared to control. Patient satisfaction with pain relief in our study was high. There were no wound infections and no side-effects from the local anesthetic. CONCLUSIONS Wound infusion of local anesthetic by PCA pump significantly reduced opioid dose needed and improves pain control postoperatively. We have also shown that it is a feasible method of analgesia and it should be considered in the multimodal pain control strategy following minimally invasive cardiac surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT03079830 , date of registration: March 15, 2017. Retrospecitvely registered.
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Affiliation(s)
- Gordan Mijovski
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
| | - Matej Podbregar
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Juš Kšela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Jenko
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Maja Šoštarič
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
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14
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Vidal C, Pasqualotto R, James A, Dureau P, Rasata J, Coutance G, Varnous S, Leprince P, Amour J, Bouglé A. Predictive risk factors for postoperative pneumonia after heart transplantation. BMC Anesthesiol 2020; 20:8. [PMID: 31910812 PMCID: PMC6947950 DOI: 10.1186/s12871-019-0923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients. Methods In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P < 0.05 was necessary to reject the null hypothesis. Results A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12–1.80], P < 0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20–1.70], P < 0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3–12.4], P = 0.01) and 1 year (OR: 6.8 [2.5–8.4], P < 0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP. Conclusion After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP.
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Affiliation(s)
- Charles Vidal
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France. .,Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France.
| | - Romain Pasqualotto
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Arthur James
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Pauline Dureau
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Julie Rasata
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Guillaume Coutance
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis de la Réunion, France
| | - Shaida Varnous
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis de la Réunion, France
| | - Pascal Leprince
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Allée des Topazes, 97400, Saint Denis de la Réunion, France
| | - Julien Amour
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Sorbonne Université, UMR INSERM 1166, IHU ICAN, Paris, France
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