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Song SS, Lin L, Li L, Han XD. Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer. World J Gastrointest Surg 2024; 16:2194-2201. [PMID: 39087110 PMCID: PMC11287673 DOI: 10.4240/wjgs.v16.i7.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/16/2024] [Accepted: 06/13/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors; however, it can lead to emergence agitation (EA). EA is a common complication associated with general anesthesia, often characterized by behaviors, such as crying, struggling, and involuntary limb movements in patients. If treatment is delayed, there is a risk of incision cracking and bleeding, which can significantly affect surgical outcomes. Therefore, having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia, which is beneficial for improving patient prognosis. AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer. METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital (January 2020 to December 2023) was conducted. Post-surgery, the Richmond Agitation-Sedation Scale was used to evaluate EA presence, noting EA incidence after general anesthesia. Patients were categorized by EA presence postoperatively, and the influencing factors were analyzed using logistic regression. A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves. RESULTS EA occurred in 51 (25.5%) patients. Multivariate analysis identified advanced age, American Society of Anesthesiologists (ASA) grade III, indwelling catheter use, and postoperative pain as risk factors for EA (P < 0.05). Conversely, postoperative analgesia was a protective factor against EA (P < 0.05). The area under the curve of the nomogram was 0.972 [95% confidence interval (CI): 0.947-0.997] for the training set and 0.979 (95%CI: 0.951-1.000) for the test set. Hosmer-Lemeshow test showed a good fit (χ 2 = 5.483, P = 0.705), and calibration curves showed agreement between predicted and actual EA incidence. CONCLUSION Age, ASA grade, catheter use, postoperative pain, and analgesia significantly influence EA occurrence. A nomogram constructed using these factors demonstrates strong predictive accuracy.
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Affiliation(s)
- Shu-Shu Song
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
| | - Li Lin
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
| | - Li Li
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
| | - Xiao-Dong Han
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
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Golmohammadi M, Sane S, Ghavipanjeh Rezaei S, Hosseini R, Alwaily ER, Hussien BM, Mohammadpour R, Rahmani N, Kazemi Haki B. Investigating the Effect of Dexmedetomidine in Controlling Postoperative Emergence Agitation in Children under Sevoflurane Anesthesia. Anesthesiol Res Pract 2024; 2024:6418429. [PMID: 39105128 PMCID: PMC11300049 DOI: 10.1155/2024/6418429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/15/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction Emergence agitation (EA) is one of the common problems during recovery from general anesthesia, especially in children. In this study, we investigated the effect of dexmedetomidine on the control of agitation after anesthesia with sevoflurane in children. Method This randomized control-placebo, double-blind prospective clinical trial was conducted on seventy-six children between 2 and 7 years with ASA (American Society of Anesthesiologists) class I who were candidates for elective adenoidectomy surgery and tonsillectomy. Participants were selected by an available sampling method. Patients were randomly placed in one of the two groups D (dexmedetomidine 0.5 μg/kg infusion within ten minutes) or P (placebo: normal saline infusion within ten minutes). A four-point scale evaluated agitation. Pain evaluation was done by FLACC (faces, legs, activity, cry, and consolability). The statistical software was SPSS version 23. P < 0.05 was considered statistically significant. Results The level of agitation was significantly lower in the intervention group (P < 0.05), except after 40 minutes in the PACU (Post Anesthesia Care Unit) (P=1.00). Patients in the control group experienced high pain scores when admitted at PACU, 10, 20, and 30 minutes after admission at PACU (P < 0.05). Pethidine and metoclopramide prescriptions in the intervention group were lower than in the control group (P < 0.05). Shivering occurred in five patients in the intervention group and nine in the control groups (P=0.032). Hypotension that required intervention occurred in 3 patients in the intervention group and one in the control group (P=0.024). Conclusion Our trial demonstrated that the prescription of 0.5 μg/kg of dexmedetomidine within ten minutes after intubation significantly reduced the EA frequency, pain severity, analgesic consumption, and PONV (postoperative nausea and vomiting). However, it caused delays in the emergence from anesthesia. This trial is registered with IRCT20160430027677N14.
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Affiliation(s)
- Mitra Golmohammadi
- Department of AnesthesiologyUrmia University of Medical Sciences, Urmia, Iran
| | - Shahryar Sane
- Department of AnesthesiologyUrmia University of Medical Sciences, Urmia, Iran
| | - Somayeh Ghavipanjeh Rezaei
- Department of NursingSchool of Nursing and MidwiferyMaragheh University of Medical Sciences, Maragheh, Iran
| | - Rana Hosseini
- Department of Social MedicineUrmia University of Medical Sciences, Urmia, Iran
| | - Enas R. Alwaily
- Microbiology Research GroupCollege of PharmacyAl-Ayen University, Thi-Qar, Nasiriyah, Iraq
| | - Beneen M. Hussien
- Medical Laboratory Technology DepartmentCollege of Medical TechnologyThe Islamic University, Najaf, Iraq
| | - Ramin Mohammadpour
- Department of AnesthesiologyUrmia University of Medical Sciences, Urmia, Iran
| | - Nazila Rahmani
- College of MedicalVeterinary and Life ScienceUniversity of Glasgow, Glasgow, UK
| | - Behzad Kazemi Haki
- Department of AnesthesiologyUrmia University of Medical Sciences, Urmia, Iran
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He M, Zhu Z, Jiang M, Liu X, Wu R, Zhou J, Chen X, Liu C. Risk Factors for Postanesthetic Emergence Delirium in Adults: A Systematic Review and Meta-analysis. J Neurosurg Anesthesiol 2024; 36:190-200. [PMID: 37916963 PMCID: PMC11161228 DOI: 10.1097/ana.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
Emergence delirium (ED) is delirium that occurs during or immediately after emergence from general anesthesia or sedation. Effective pharmacological treatments for ED are lacking, so preventive measures should be taken to minimize the risk of ED. However, the risk factors for ED in adults are unclear. In this systematic review and meta-analysis, we evaluated the evidence for risk factors for ED in adults. The PubMed, Scopus, Cochrane Library, Google Scholar, and Embase databases were searched for observational studies reporting the risk factors for ED in adults from inception to July 31, 2023. Twenty observational studies reporting 19,171 participants were included in this meta-analysis. Among the preoperative factors identified as risk factors for ED were age <40 or ≥65 years, male sex, smoking history, substance abuse, cognitive impairment, anxiety, and American Society of Anesthesiologists physical status score III or IV. Intraoperative risk factors for ED were the use of benzodiazepines, inhalational anesthetics, or etomidate, and surgical factors including abdominal surgery, frontal craniotomy (vs. other craniotomy approaches) for cerebral tumors, and the length of surgery. Postoperative risk factors were indwelling urinary catheters, the presence of a tracheal tube in the postanesthetic care unit or intensive care unit, the presence of a nasogastric tube, and pain. Knowledge of these risk factors may guide the implementation of stratified management and timely interventions for patients at high risk of ED. The majority of studies included in this review investigated only hyperactive ED and further research is required to determine risk factors for hypoactive and mixed ED types.
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Affiliation(s)
- Miao He
- Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou
- Suzhou Medical College of Soochow University, Suzhou, Jiangsu
| | - Zhaoqiong Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou
- Suzhou Medical College of Soochow University, Suzhou, Jiangsu
| | - Min Jiang
- Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Xingxing Liu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou
| | - Rui Wu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou
| | - Junjie Zhou
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou
| | - Xi Chen
- School of Health, Brooks College, Sunnyvale, CA
| | - Chengjiang Liu
- Department of General Practice, Anhui Medical University, He Fei, Anhui, China
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Gao X, Li Z, Chai J, Li S, Pan X, Liu J, Li L, Qin S, Kang Y, Zhu Y. Electroencephalographic insights into the pathophysiological mechanisms of emergence delirium in children and corresponding clinical treatment strategies. Front Pharmacol 2024; 15:1349105. [PMID: 38962301 PMCID: PMC11219819 DOI: 10.3389/fphar.2024.1349105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/26/2024] [Indexed: 07/05/2024] Open
Abstract
Emergence delirium is a common postoperative complication in patients undergoing general anesthesia, especially in children. In severe cases, it can cause unnecessary self-harm, affect postoperative recovery, lead to parental dissatisfaction, and increase medical costs. With the widespread use of inhalation anesthetic drugs (such as sevoflurane and desflurane), the incidence of emergence delirium in children is gradually increasing; however, its pathogenesis in children is complex and unclear. Several studies have shown that age, pain, and anesthetic drugs are strongly associated with the occurrence of emergence delirium. Alterations in central neurophysiology are essential intermediate processes in the development of emergence delirium. Compared to adults, the pediatric nervous system is not fully developed; therefore, the pediatric electroencephalogram may vary slightly by age. Moreover, pain and anesthetic drugs can cause changes in the excitability of the central nervous system, resulting in electroencephalographic changes. In this paper, we review the pathogenesis of and prevention strategies for emergence delirium in children from the perspective of brain electrophysiology-especially for commonly used pharmacological treatments-to provide the basis for understanding the development of emergence delirium as well as its prevention and treatment, and to suggest future research direction.
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Affiliation(s)
- Xin Gao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhichao Li
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Chai
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Si Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuanyuan Pan
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jie Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Linxing Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shangyuan Qin
- Department of Anesthesiology, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Yihan Kang
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Youzhuang Zhu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Cao Q, Fan C, Ren X, Bai S, Dong H, Wei M, Meng H. Comparison of anaesthesia-related outcomes in patients monitored by newly recruited nurse anaesthetists and anaesthesiologists: An observational study. J Clin Nurs 2024; 33:1482-1492. [PMID: 38013235 DOI: 10.1111/jocn.16940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/17/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIMS To compare anaesthesia-related outcomes between patients monitored by newly recruited nurse anaesthetists and those monitored by newly recruited anaesthesiologists. DESIGN This was a retrospective study. METHODS We conducted a retrospective study that collected demographic information on newly recruited nurse anaesthetists and anaesthesiologists between 2017 and 2022 and recorded information on patients within 6 months of monitoring. Postoperative pain, emergency agitation, nausea, and vomiting were designated anaesthesia-related outcomes. Propensity score matching was used to adjust for covariates. The study adhered to the STROBE guidelines. RESULTS The study's statistical analysis included 4483 patients monitored by 22 newly recruited nurse anaesthetists and 4959 patients monitored by 23 newly recruited anaesthesiologists. Compared with patients monitored by newly trained anaesthesiologists, the patients monitored by nurse anaesthetists were younger (42.07 ± 20.00 vs. 47.39 ± 18.45 years, p < 0.001) and had a lower body mass index (23.56 ± 4.46 vs. 24.19 ± 4.25, p < 0.001). Patients monitored by anaesthesiologists had a greater proportion of women (61.62% vs. 59.25%, p < 0.001), a high proportion of ASA III and ASA IV (17.1% vs. 8.88%, p < 0.001), and a longer mean surgery duration (78.65 ± 59.01 vs. 70.70 ± 60.65 min, p < 0.001). After propensity score matching was used to adjust for covariates, no statistically significant differences were found in the prevalence of postoperative pain, emergency agitation, or postoperative nausea and vomiting between the two groups (p < 0.05). CONCLUSION Nurse anaesthetists monitoring alone during anaesthesia maintenance is feasible and safe. The two groups had no significant differences in the incidence of postoperative pain, emergency agitation, or postoperative nausea and vomiting. RELEVANCE TO CLINICAL PRACTICE The shortage of anaesthesiologists leads to heavy work burden and high incidence of occupational burnout among anaesthesiologists. The study found that it was safe for nurse anaesthetists to perform anaesthetic monitoring alone in the operating room under the supervision of the attending anaesthesiologist and did reduce the burden of anaesthesiologists' work. The results of the current study contribute to the expansion of occupational categories for nurse anaesthetists in countries where anaesthesiologists are in short supply. It provides new ideas for hospital administrators and policy-makers to formulate medical and nursing service policies.
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Affiliation(s)
- Qinqin Cao
- Department of Anaesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Chengjuan Fan
- Department of Nephrology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Xiaolei Ren
- Data Centre, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Shuling Bai
- Department of Anaesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Hemin Dong
- Department of Anaesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Min Wei
- Medical Consortium Service Centre, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Haihong Meng
- Department of Anaesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
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Yu S, Wen Y, Lin J, Yang J, He Y, Zuo Y. Combined rectus sheath block with transverse abdominis plane block by one puncture for analgesia after laparoscopic upper abdominal surgery: a randomized controlled prospective study. BMC Anesthesiol 2024; 24:58. [PMID: 38336613 PMCID: PMC10854179 DOI: 10.1186/s12871-024-02444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Rectus sheath block (RSB) and transversus abdominis plane block (TAPB) have been shown to reduce opioid consumption and decrease postoperative pain scores in abdominal surgeries. However, there are no reports about the one-puncture technique of RSB combined with TAPB for perioperative pain management during laparoscopic upper abdominal surgery. METHODS A total of 58 patients were randomly assigned to the control group (C), the TAP group (T), and the one-puncture technique of RSB combined with TAPB group (RT). The patients in group C did not receive any regional block. The patients in group T received ultrasound-guided subcostal TAPB with 30 mL of 0.33% ropivacaine on each side. The patients in the RT group received a combination of RSB and TAPB with 15 mL of 0.33% ropivacaine in each plane by one puncture technique. All patients received postoperative patient-controlled intravenous analgesia (PCIA) after surgeries. The range of blocks was recorded 20 min after the completion of the regional block. The postoperative opioid consumption, pain scores, and recovery data were recorded, including the incidence of emergence agitation (EA), the times of first exhaust and off-bed activity, the incidence of postoperative nausea and vomiting, dizziness. RESULTS The range of the one-puncture technique in group RT covered all areas of surgical incisions. The visual analogue scale (VAS) score of the RT group is significantly lower at rest and during coughing compared to groups T and C at 4, 8, 12, and 24 h after surgery, respectively (P < 0.05). The consumption of sufentanil and the number of postoperative compressions of the analgesic pumps at 24 and 48 h in the RT group are significantly lower than those in groups T and C (P < 0.05). The incidence of EA in the RT group is significantly lower than that in groups T and C (P < 0.05). CONCLUSION The one-puncture technique of RSB combined with TAPB provides effective postoperative analgesia for laparoscopic upper abdominal surgery, reduces the incidence of EA during PACU, and promotes early recovery. TRIAL REGISTRATION ChiCTR, ChiCTR2300067271. Registered 3 Jan 2023, http://www.chictr.org.cn .
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Affiliation(s)
- Shan Yu
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
- Department of Anesthesiology, Armed Police Forces Hospital of Sichuan, Leshan, 614000, China
| | - Yaling Wen
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jing Lin
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jinghao Yang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yihang He
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Youbo Zuo
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Li J, Zhu H, Wang Y, Chen J, He K, Wang S. Remifentanil is Superior to Propofol for Treating Emergence Agitation in Adults After General Anesthesia. Drug Des Devel Ther 2024; 18:341-350. [PMID: 38344258 PMCID: PMC10859049 DOI: 10.2147/dddt.s433155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background Emergence agitation (EA) is one of the most common complications in clinical general anesthesia during recovery in adults. Remifentanil and propofol can reduce the incidence of EA, but with no randomized controlled trial to evaluate their effectiveness for treating EA. This study aims to compare the effectiveness of remifentanil and propofol for treating EA following general anesthesia. Patients and methods Among 152 randomized patients with a mean of 49.5 years, and 99 (65.1%) of them being male, 149 were divided into two groups for subsequent analysis. The remifentanil group (Group R, n = 74) received a 0.5μg kg-1 remifentanil infusion followed by a 0.05μg kg-1 min-1 infusion until 15 minutes, after the onset of agitation. The propofol group (Group P, n = 75) received a 1mg kg-1 propofol infusion once agitation occurred. Emergence agitation was assessed using the Riker Sedation Agitation Score, with a score of ≥5 defining emergence agitation. During the post-anesthesia care unit (PACU), the recurrence of emergence agitation, time to extubation, and discharge from PACU were evaluated. Results The incidence of reoccurring emergence agitation was lower in Group R (29.7%) compared with Group P (49.3%), with an odds ratio of 0.44 (95% CI 0.22-0.85; P=0.014). The time to extubation was shorter in Group R (mean 12min, range 8-15 min) compared with Group P (mean 17min, range 13-21 min) (P<0.001), as was the time discharge from the PACU (mean 30.5 min, range 25-40 min) vs Group P (mean 37.5 min, range 31-50 min) (P=0.001). Conclusion Treatment of emergence agitation in adults with remifentanil infusion is more effective than propofol, with a shorter time to extubation and discharge from PACU.
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Affiliation(s)
- Jun Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
| | - Hongrui Zhu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
| | - Yu Wang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Soochow, People’s Republic of China
| | - Jiaqi Chen
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
| | - Keqiang He
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
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Shen X, Yu H, Chen K, Xue Q, Lu J, Xie Z. Association between severe preoperative hearing impairment and postoperative emergence agitation among elderly patients undergoing middle ear surgery. J Clin Anesth 2023; 91:111254. [PMID: 37689025 DOI: 10.1016/j.jclinane.2023.111254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/26/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Hearing impairment is an established independent risk factor for delirium.Whether preoperative hearing impairment is associated with postoperative emergence agitation (POEA) in elderly patients remains unknown. This study aimed to investigate the association between preoperative hearing impairment and POEA in elderly patients undergoing ear surgery. METHODS This prospective observational study was carried out at an otologic centre in a tertiary hospital between July 15, 2020, and February 28, 2021. Data of 417 elderly patients who underwent microscopic and endoscopic middle ear surgery were analyzed. Pure tone average was used to assess preoperative hearing function, with a PTA ≥ 50 dB indicating severe hearing impairment. POEA was measured using the Richmond Agitation-Sedation Scale. Multiple logistic regression was used to determine the association between preoperative hearing function and POEA. RESULTS Of the 417 participants, 45.8% were men, and the median age was 64 (interquartile range: 62-67) years old. Severe preoperative hearing impairment was present in 113 patients (27.1%), and POEA occurred in 42 patients (10.1%). Multiple logistic regression analysis indicated that severe preoperative hearing impairment was associated with an increased risk of POEA (odds ratio: 2.031; 95% confidence interval: 1.044-3.954, P = 0.037). CONCLUSION Pending confirmative studies, these findings suggest that severe preoperative hearing impairment could serve as an independent predictor of POEA in older patients undergoing middle ear surgery. These results highlight the need for further research to better understand the biomarker and pathogenesis of POEA, leading to identification of targeted interventions of POEA and improvement of postoperative outcomes in patients.
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Affiliation(s)
- Xia Shen
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, PR China
| | - Huiqian Yu
- Department of Otorhinolaryngology, Eye & ENT Hospital of Fudan University, Shanghai, PR China
| | - Kaizheng Chen
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, PR China
| | - Qineng Xue
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, PR China
| | - Jin Lu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, PR China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
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Zhang J, Ma G, Peng S, Hou J, Xu R, Luo L, Hu J, Yao N, Wang J, Huang X. Risk Factors and Predictive Models for Peripherally Inserted Central Catheter Unplanned Extubation in Patients With Cancer: Prospective, Machine Learning Study. J Med Internet Res 2023; 25:e49016. [PMID: 37971792 PMCID: PMC10690529 DOI: 10.2196/49016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Cancer indeed represents a significant public health challenge, and unplanned extubation of peripherally inserted central catheter (PICC-UE) is a critical concern in patient safety. Identifying independent risk factors and implementing high-quality assessment tools for early detection in high-risk populations can play a crucial role in reducing the incidence of PICC-UE among patients with cancer. Precise prevention and treatment strategies are essential to improve patient outcomes and safety in clinical settings. OBJECTIVE This study aims to identify the independent risk factors associated with PICC-UE in patients with cancer and to construct a predictive model tailored to this group, offering a theoretical framework for anticipating and preventing PICC-UE in these patients. METHODS Prospective data were gathered from January to December 2022, encompassing patients with cancer with PICC at Xiangya Hospital, Central South University. Each patient underwent continuous monitoring until the catheter's removal. The patients were categorized into 2 groups: the UE group (n=3107) and the non-UE group (n=284). Independent risk factors were identified through univariate analysis, the least absolute shrinkage and selection operator (LASSO) algorithm, and multivariate analysis. Subsequently, the 3391 patients were classified into a train set and a test set in a 7:3 ratio. Utilizing the identified predictors, 3 predictive models were constructed using the logistic regression, support vector machine, and random forest algorithms. The ultimate model was selected based on the receiver operating characteristic (ROC) curve and TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) synthesis analysis. To further validate the model, we gathered prospective data from 600 patients with cancer at the Affiliated Hospital of Qinghai University and Hainan Provincial People's Hospital from June to December 2022. We assessed the model's performance using the area under the curve of the ROC to evaluate differentiation, the calibration curve for calibration capability, and decision curve analysis (DCA) to gauge the model's clinical applicability. RESULTS Independent risk factors for PICC-UE in patients with cancer were identified, including impaired physical mobility (odds ratio [OR] 2.775, 95% CI 1.951-3.946), diabetes (OR 1.754, 95% CI 1.134-2.712), surgical history (OR 1.734, 95% CI 1.313-2.290), elevated D-dimer concentration (OR 2.376, 95% CI 1.778-3.176), targeted therapy (OR 1.441, 95% CI 1.104-1.881), surgical treatment (OR 1.543, 95% CI 1.152-2.066), and more than 1 catheter puncture (OR 1.715, 95% CI 1.121-2.624). Protective factors were normal BMI (OR 0.449, 95% CI 0.342-0.590), polyurethane catheter material (OR 0.305, 95% CI 0.228-0.408), and valved catheter (OR 0.639, 95% CI 0.480-0.851). The TOPSIS synthesis analysis results showed that in the train set, the composite index (Ci) values were 0.00 for the logistic model, 0.82 for the support vector machine model, and 0.85 for the random forest model. In the test set, the Ci values were 0.00 for the logistic model, 1.00 for the support vector machine model, and 0.81 for the random forest model. The optimal model, constructed based on the support vector machine, was obtained and validated externally. The ROC curve, calibration curve, and DCA curve demonstrated that the model exhibited excellent accuracy, stability, generalizability, and clinical applicability. CONCLUSIONS In summary, this study identified 10 independent risk factors for PICC-UE in patients with cancer. The predictive model developed using the support vector machine algorithm demonstrated excellent clinical applicability and was validated externally, providing valuable support for the early prediction of PICC-UE in patients with cancer.
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Affiliation(s)
- Jinghui Zhang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guiyuan Ma
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sha Peng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jianmei Hou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ran Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lingxia Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaji Hu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Nian Yao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiaan Wang
- Vascular Access Department, Hainan Provincial People's Hospital, Hainan, China
| | - Xin Huang
- Department of Nursing, Affiliated Hospital of Qinghai University, Qinghai, China
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10
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Luo D, Zhou Y, Yue Z, Shi M, Shao L, Hui K, Gu Z, Duan M. Factors responsible for unanticipated hypertension during emergence from general anesthesia. Chin Med J (Engl) 2023; 136:2263-2265. [PMID: 37612244 PMCID: PMC10508461 DOI: 10.1097/cm9.0000000000002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Dongxue Luo
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Yaqing Zhou
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Zichuan Yue
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Min Shi
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Luyi Shao
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Kangli Hui
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Zhongya Gu
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Manlin Duan
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu 210019, China
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11
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Liang HH, Lu YW, Ou XX, Shi H, She YJ, Zhang MX. Effect of ice popsicle treatment on emergence agitation in children undergoing oral surgery with sevoflurane anaesthesia: A prospective randomized controlled study. J Pediatr Nurs 2023; 72:9-15. [PMID: 37030043 DOI: 10.1016/j.pedn.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Emergence agitation is a common postoperative complication during recovery in children. The purpose of this study is to explore whether the use of ice popsicle could prevent emergence agitation in children undergoing oral surgery with sevoflurane anaesthesia. DESIGN AND METHODS In this prospective randomized controlled study, 100 children undergoing oral surgery were randomly assigned to Group 1 which received ice popsicle after emergence (intervention, n = 50) or Group 2 which received verbal encouragement from their parents (control, n = 50). The primary outcome was the 2-hour postoperative incidence of EA. RESULTS Group 1 had a significant lower incidence of emergence agitation (22% vs 58%, P < 0.001) compared with Group 2. The mean agitation score was significantly lower in Group 1 vs Group 2 at 10 minutes (1.64 vs 2.12, P = 0.024) and 20 min (1.60 vs 2.14, P = 0.004) after emergence. The peak agitation and pain scores were significantly lower in Group 1 than in Group 2 (P < 0.001). CONCLUSIONS Findings from this study suggest that ice popsicle is an effective, cheap, pleasurable, and easily administered method for alleviating emergence agitation in paediatric patients after oral surgery under general anaesthesia. These results are worthy of confirmation in other surgeries. PRACTICE IMPLICATIONS This approach is highly accepted by both children and their parents, and our findings support the effectiveness of ice popsicle in relieving emergence agitation and pain after oral surgery in children. CLINICAL TRIALS REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800015634.
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Affiliation(s)
- Hui-Hong Liang
- Department of Anaesthesiology and Operation Room Nursing, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - You-Wei Lu
- Department of Anaesthesiology and Operation Room Nursing, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Xing-Xu Ou
- Department of Anaesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Hui Shi
- Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Ying-Jun She
- Department of Anaesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Mei-Xue Zhang
- Department of Anaesthesiology and Operation Room Nursing, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China.
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12
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Wang N, Hao J, Zhang J, Du J, Luo Z. Risk factors for emergence agitation during the awakening period in elderly patients after total joint arthroplasty: a retrospective cohort study. BMJ Open 2023; 13:e068284. [PMID: 37164475 PMCID: PMC10174031 DOI: 10.1136/bmjopen-2022-068284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES This study aimed to explore the incidence and risk factors for emergence agitation (EA) in elderly patients who underwent total joint arthroplasty (TJA) under general anaesthesia, and to assess their predictive values. DESIGN Single-centre retrospective cohort study. SETTING A 1600-bed general tertiary hospital in China. PARTICIPANTS This study enrolled 421 elderly patients scheduled for elective primary TJA under general anaesthesia. PRIMARY AND SECONDARY OUTCOME MEASURES EA was assessed using the Richmond Agitation Sedation Scale during the awakening period after surgery in the post-anaesthesia care unit. Risk factors for EA were identified using univariate and multivariable logistic analyses. The receiver operating characteristic (ROC) curve was used to assess the predictive values of the risk factors for EA. RESULTS The incidence of EA in elderly patients who underwent TJA was 37.6%. According to the multivariable logistic analysis, postoperative pain (95% CI: 1.951 to 3.196), male sex (95% CI: 1.781 to 6.435), catheter-related bladder discomfort (CRBD) (95% CI: 4.001 to 15.392) and longer fasting times for solids (95% CI: 1.260 to 2.301) and fluids (95% CI: 1.263 to 2.365) were independent risk factors for EA. As shown by the ROC analysis, postoperative pain and fasting times for solids and fluids had good predictive values, with areas under the ROC curve equalling 0.769, 0.753 and 0.768, respectively. CONCLUSIONS EA is a common complication after TJA in elderly patients. Some risk factors, including postoperative pain, male sex, CRBD and longer fasting times, can increase the incidence of EA. These risk factors may contribute to identifying high-risk patients, which facilitates the development of effective strategies to prevent and treat EA. TRIAL REGISTRATION NUMBER ChiCTR1800020193.
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Affiliation(s)
- Naigeng Wang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianhong Hao
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Zhang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Du
- Second Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Zhenguo Luo
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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13
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Bai P, Zang X, Liu R, Wang L, Dai C, Yang G. In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study. Nurse Educ Pract 2023; 70:103660. [PMID: 37178479 DOI: 10.1016/j.nepr.2023.103660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
AIM To evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations. BACKGROUND The amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence. DESIGN This was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators. METHODS A total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment. RESULTS Nursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group. CONCLUSIONS In-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.
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Affiliation(s)
- Ping Bai
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Xianxian Zang
- Teaching Office, Peking University School of Nursing, Beijing 100191, China
| | - Ruili Liu
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Lu Wang
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Chao Dai
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - Guoyong Yang
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China.
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14
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Lapointe AP, Li D, Hudetz AG, Vlisides PE. Microstate analyses as an indicator of anesthesia-induced unconsciousness. Clin Neurophysiol 2023; 147:81-87. [PMID: 36739618 DOI: 10.1016/j.clinph.2023.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The objective of this study was to identify differences in electroencephalographic microstate topographies across three perioperative phases: anesthetic pre-induction, surgical anesthesia, and post-anesthesia care unit (PACU) admission. METHODS Whole-scalp 16-channel electroencephalographic recordings were taken throughout the perioperative period on n = 22 adult, non-cardiac surgical patients. RESULTS Several differences between perioperative periods were identified. Most notably, during surgical anesthesia, patients demonstrated increased mean duration and, consequently, a reduction in the occurrence of microstates when compared to both preoperative baseline and PACU admission. We also observed the presence of microstate F with propofol anesthesia during surgery, which had been previously identified with propofol infusion in laboratory settings using human volunteers. Finally, we observed inverse age effects with mean occurrence and duration of microstates, particularly during PACU recovery. CONCLUSIONS Microstate duration is significantly increased during surgery compared to both pre-induction and PACU recovery. These data suggest that microstate topographies may be useful in monitoring anesthetic depth. SIGNIFICANCE This work highlights the potential for microstate analysis in the perioperative setting. We identified distinct topographical signatures across perioperative periods and with increasing age, which is predictive of post-operative delirium.
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Affiliation(s)
- Andrew P Lapointe
- Hotchkiss Brain Institute, Cummins School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; Department of Radiology, Cummins School of Medicine, University of Calgary, Teaching Research and Wellness Building, Experimental Imaging Centre (Level P2E), 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Anesthesiology, Center for Consciousness Science, University of Michigan, USA.
| | - Duan Li
- Department of Anesthesiology, Center for Consciousness Science, University of Michigan, USA
| | - Anthony G Hudetz
- Department of Anesthesiology, Center for Consciousness Science, University of Michigan, USA
| | - Phillip E Vlisides
- Department of Anesthesiology, Center for Consciousness Science, University of Michigan, USA
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15
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Li Q, Fan J, Zhang W. Low-dose esketamine for the prevention of emergency agitation in children after tonsillectomy: A randomized controlled study. Front Pharmacol 2022; 13:991581. [PMID: 36605396 PMCID: PMC9807658 DOI: 10.3389/fphar.2022.991581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Emergency agitation is a common postoperative complication in pediatric patients after general anesthesia. The aim of this study was to explore the effects of a low dose of esketamine on emergency agitation in children following tonsillectomy. Materials and Methods: Eighty children were recruited prospectively to this study and divided into the esketamine group and the control group (40 cases in each group). The induction and maintenance of anesthesia were the same in both groups. At the end of surgery, the esketamine group received 0.25 μg/kg esketamine, while the control group received the same volume of normal saline. The extubation time, time to eye opening, Ramsay sedation scale and time to discharge from the post-anesthesia care unit (PACU) were recorded during post-anesthesia care unit. Postoperative complications, such as emergency agitation, respiratory depression, hypertension, tachycardia, nightmares, nausea, and vomiting, were also recorded. Results: The incidence of emergency agitation was lower in the esketamine group compared with that in the control group (5% vs. 27.5%, p = 0.006). The time to eye opening was longer in the esketamine group than in the control group (17.2 ± 2.7 vs. 15.5 ± 2.3 min, p = 0.005). However, the extubation time and time to discharge from PACU were similar between the two groups. Conclusion: Low-dose of esketamine decreases the incidence of emergency agitation in children after tonsillectomy without delaying extubation time and increasing the postoperative side effects. (www.chictr.org.cn, registration number: ChiCTR2100054178).
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Affiliation(s)
- Qi Li
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiaming Fan
- Department of Anesthesiology, Women and Children’s Hospital of Jiaxing University, Jiaxing, China,*Correspondence: Jiaming Fan, ; Wangping Zhang,
| | - Wangping Zhang
- Department of Anesthesiology, Women and Children’s Hospital of Jiaxing University, Jiaxing, China,*Correspondence: Jiaming Fan, ; Wangping Zhang,
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16
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Meng T, Lin X, Li X, Yue F, Zhang Y, Wang Y, Gu J, Yang Z, Yu H, Lv K, Liang S, Li X, Zhu W, Yu G, Li T, Ren Y, Li Y, Xu J, Xu W, Wang S, Wu J. Pre-anesthetic use of butorphanol for the prevention of emergence agitation in thoracic surgery: A multicenter, randomized controlled trial. Front Med (Lausanne) 2022; 9:1040168. [PMID: 36582294 PMCID: PMC9792474 DOI: 10.3389/fmed.2022.1040168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background Emergence agitation (EA) is common in patients after general anesthesia (GA) and is associated with poor outcomes. Patients with thoracic surgery have a higher incidence of EA compared with other surgery. This study aimed to investigate the impact of pre-anesthetic butorphanol infusion on the incidence of EA in patients undergoing thoracic surgery with GA. Materials and methods This prospective randomized controlled trial (RCT) was conducted in 20 tertiary hospitals in China. A total of 668 patients undergoing elective video-assisted thoracoscopic lobectomy/segmentectomy for lung cancer were assessed for eligibility, and 620 patients were enrolled. In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. Patients in the intervention group received butorphanol 0.02 mg/kg 15 min before induction of anesthesia. Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of EA after 5 min of extubation, and EA was evaluated using the Riker Sedation-Agitation Scale (RSAS). The incidence of EA was determined by the chi-square test, with a significance of P < 0.05. Results In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. The incidence of EA 5 min after extubation was lower with butorphanol treatment: 9.8% (29 of 296) vs. 24.5% (75 of 306) in the control group (P = 0.0001). Patients who received butorphanol had a lower incidence of drug-related complications (including injecting propofol pain and coughing with sufentanil): 112 of 296 vs. 199 of 306 in the control group (P = 0.001) and 3 of 296 vs. 35 of 306 in the control group (P = 0.0001). Conclusion The pre-anesthetic administration of butorphanol reduced the incidence of EA after thoracic surgery under GA. Clinical trial registration [http://www.chictr.org.cn/showproj.aspx?proj=42684], identifier [ChiCTR1900025705].
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Affiliation(s)
- Tao Meng
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaowen Lin
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ximing Li
- Department of Anesthesiology, Linyi People’s Hospital, Linyi, China
| | - Fangli Yue
- Department of Anesthesiology, Weifang People’s Hospital, Weifang, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, Zibo, China
| | - Yingbin Wang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianhua Gu
- Department of Anesthesiology, Jinan People’s Hospital, Jinan, China
| | - Zaiqi Yang
- Department of Anesthesiology, Taian City Central Hospital, Taian, China
| | - Hongli Yu
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin, China
| | - Kun Lv
- Department of Anesthesiology, Jining No.1 People’s Hospital, Jining, China
| | - Shengyong Liang
- Department of Anesthesiology, Feicheng People’s Hospital, Feicheng, China
| | - Xingda Li
- Department of Anesthesiology, Linyi Central Hospital, Linyi, China
| | - Weibo Zhu
- Department of Anesthesiology, Binzhou People’s Hospital, Binzhou, China
| | - Gang Yu
- Department of Anesthesiology, Binzhou Central Hospital, Binzhou, China
| | - Tao Li
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yujia Ren
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yandong Li
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jianjun Xu
- Department of Anesthesiology, Daqing Oilfield General Hospital, Daqing, China
| | - Weimin Xu
- Department of Anesthesiology, Shengli Oilfield Central Hospital, Dongying, China
| | - Shu Wang
- Department of Anesthesiology, Benxi Central Hospital, Benxi, China
| | - Jianbo Wu
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, China,Department of Anesthesiology and Perioperative Medicine, Qilu Hospital Dezhou Hospital, Shandong University, Dezhou, China,*Correspondence: Jianbo Wu,
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17
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Chima AM, Mahmoud MA, Narayanasamy S. What Is the Role of Dexmedetomidine in Modern Anesthesia and Critical Care? Adv Anesth 2022; 40:111-130. [PMID: 36333042 DOI: 10.1016/j.aan.2022.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dexmedetomidine's unique sedative properties have led to its widespread use. Dexmedetomidine has a beneficial pharmacologic profile including analgesic sparing effects, anxiolysis, sympatholysis, organ-protective effects against ischemic and hypoxic injury, and sedation which parallels natural sleep. An understanding of predictable side effects, effects of age-related physiologic changes, and pharmacokinetic and pharmacodynamic effects of dexmedetomidine is crucial to maximize its safe administration in adults and children. This review focuses on the growing body of literature examining advances in applications of dexmedetomidine in children and adults.
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Affiliation(s)
- Adaora M Chima
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
| | - Mohamed A Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Suryakumar Narayanasamy
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Emergence delirium after intracranial neurosurgery- a prospective cohort study. J Clin Neurosci 2022; 104:12-17. [PMID: 35933784 DOI: 10.1016/j.jocn.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The primary objective of this study was to estimate the incidence of emergence delirium (ED) including hypo- and hyperactive ED, after intracranial neurosurgery. Secondary objective was to identify perioperative risk factors of ED in these patients. METHODS This prospective observational study was conducted at an academic neurosciences hospital. All consecutive adult patients (age ≥ 18 years) with a preoperative Glasgow Coma Scale score of 15 undergoing elective intracranial surgery under general anesthesia during the six-month period from October 2020 to March 2021 were included in this study. Perioperative patient data were collected till one hour after surgery. ED was defined as per Riker's sedation agitation score (SAS) as hyperactive ED when SAS was >4 and hypo active ED when SAS was <4 on a 1 to 7 scale. RESULTS Data of 320 patients were analyzed in this study. The overall incidence of ED was 22 % (71/320), with incidence of hyperactive ED of 4.3 % (n = 14) and hypoactive ED of 18 % (n = 57). The risk factors for ED were preoperative delirium (odds ratio [OR], 95 % confidence interval [CI] and p value of 4.41, 1.3-15.19, and 0.002), education level (OR = 2.21, [0.98-4.94], p = 0.05), minimum alveolar concentration of inhalational anesthetic (OR = 1.47, [1.17-1.88], p = 0.002), postoperative nausea and vomiting (OR = 4.56, [2.04-10.32], p = 0.001), and body weight (OR = 1.69, [1.1-2.68], p = 0.02). Hyperactive ED was predicted by preoperative delirium (OR = 5.28, [1.12-21.21], p = 0.024) and low education level (OR = 4.35, [1.2-17.04], p = 0.027). CONCLUSIONS Atleast one in five patients undergoing brain surgery under anesthesia develop ED. Addressing modifiable risk factors might reduce ED.
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Mi X, Hong J, Li Z, Liu T, Wang Q, Zhou J, Li Y, Wang X, Yuan Y, Yang N, Han Y, Zhou Y, Guo X, Li Y, Han D. Identification of Serum Biomarkers Associated With Emergence Agitation After General Anesthesia in Adult Patients: A Metabolomics Analysis. Front Med (Lausanne) 2022; 9:828867. [PMID: 35402462 PMCID: PMC8983911 DOI: 10.3389/fmed.2022.828867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Emergence agitation (EA) is a conscious disturbance after general anesthesia in adult patients that can lead to severe respiratory or circulatory complications and serious physical injury to patients and caregivers. However, the pathophysiological mechanisms underlying EA remain unclear. The present study aimed to identify serum metabolites with significant alterations in EA patients after general anesthesia and enable inferences on their associations with EA. Methods EA patients were identified by Richmond Agitation-Sedation Scale (RASS) ≥ + 2 among a cohort of adult patients who received elective surgery under general anesthesia in Peking University Third Hospital between 01 June 2020 and 30 December 2020. We further selected sex-, age-, and surgery type-matched non-EA control patients at a 1:1.5 ratio. Postoperative serum samples were collected from both groups of patients. An untargeted metabolic method was used to identify differences in serum metabolomic profiles between the EA patients and the non-EA patients. Results A total of 19 EA patients and 32 matched non-EA patients were included in the study. After screening and mapping with a database, 12 metabolites showed significant postoperative alterations in EA patients compared with non-EA patients, and were mainly involved in lipid, fatty acid and amino acid metabolism pathways. Receiver operating characteristic curve analyses indicated that vanillic acid, candoxatril, tiglylglycine, 5-methoxysalicylic acid, decanoylcarnitine, and 24-epibrassinolide may be involved in EA pathogenesis after general anesthesia. Conclusion In this study, we found differences in the serum levels of vanillic acid, candoxatril, tiglylglycine, 5-methoxysalicylic acid, decanoylcarnitine, and 24-epibrassinolide involved in fatty acid metabolism, lipid metabolism, and amino acid metabolism pathways in EA patients compared with non-EA patients, which may demonstrate an EA pathogenesis-associated molecular pattern and contribute toward better understanding of EA occurrence.
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Affiliation(s)
- Xinning Mi
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jingshu Hong
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Taotao Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Qian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jiansuo Zhou
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yitong Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yi Yuan
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yue Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- *Correspondence: Yue Li,
| | - Dengyang Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Dengyang Han,
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Kamei N, Higo S, Mizuno T, Mori K, Sakamoto A, Ozawa H. Identification of Brain Regions Activated by Sevoflurane and Propofol and Regional Changes in Gene Expression. Acta Histochem Cytochem 2022; 55:37-46. [PMID: 35444347 PMCID: PMC8913278 DOI: 10.1267/ahc.21-00091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/13/2021] [Indexed: 01/01/2023] Open
Abstract
General anesthetics have different efficacies and side effect incidences based on their mechanism of action. However, detailed comparative studies of anesthetics are incomplete. In this study, target brain regions and gene expression changes in these brain regions were determined for sevoflurane and propofol to understand the mechanisms that cause differences among anesthetics. Rats were anesthetized with sevoflurane or propofol for 1 hr, and brain regions with anesthesia-induced changes in neuronal activity were examined by immunohistochemistry and in situ hybridization for c-Fos. Among the identified target brain regions, gene expression analysis was performed in the habenula, the solitary nucleus and the medial vestibular nucleus from laser microdissected samples. Genes altered by sevoflurane and propofol were different and included genes involved in the incidence of postoperative nausea and vomiting and emergence agitation, such as Egr1 and Gad2. GO enrichment analysis showed that the altered genes tended to be evenly distributed in all functional category. The detailed profiles of target brain regions and induced gene expression changes of sevoflurane and propofol in this study will provide a basis for analyzing the effects of each anesthetic agent and the risk of adverse events.
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Affiliation(s)
- Nobutaka Kamei
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School
| | - Shimpei Higo
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School
| | - Tomoki Mizuno
- Department of Anesthesiology and Pain Medicine, Graduate school of Medicine, Nippon Medical School
| | - Keisuke Mori
- Department of Anesthesiology and Pain Medicine, Graduate school of Medicine, Nippon Medical School
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain Medicine, Graduate school of Medicine, Nippon Medical School
| | - Hitoshi Ozawa
- Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School
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Wang Q, Zhou J, Liu T, Yang N, Mi X, Han D, Han Y, Chen L, Liu K, Zheng H, Zhang J, Lin X, Li Y, Hong J, Li Z, Guo X. Predictive Value of Preoperative Profiling of Serum Metabolites for Emergence Agitation After General Anesthesia in Adult Patients. Front Mol Biosci 2021; 8:739227. [PMID: 34746231 PMCID: PMC8566542 DOI: 10.3389/fmolb.2021.739227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/20/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Emergence agitation (EA) in adult patients under general anesthesia leads to increased postoperative complications and heavy medical burden. Unfortunately, its pathogenesis has not been clarified until now. The purpose of the present study was to explore the relationship between preoperative serum metabolites and EA. Methods: We used an untargeted metabolic analysis method to investigate the different metabolomes in the serum of EA patients and non-EA patients undergoing elective surgical procedures after the induction of general anesthesia. A Richmond Agitation-Sedation Scale score ≥ +2 was diagnosed as EA during postoperative emergence. Non-EA patients were matched with EA patients according to general characteristics. Preoperative serum samples of the two groups were collected to investigate the association between serum metabolites and EA development. Results: The serum samples of 16 EA patients with 34 matched non-EA patients were obtained for metabolic analysis. After screening and alignment with databases, 31 altered metabolites were detected between the two groups. These metabolites were mainly involved in the metabolism of lipids, purines, and amino acids. Analyses of receiver-operating characteristic curves showed that the preoperative alterations of choline, cytidine, glycerophosphocholine, L-phenylalanine, oleamide, and inosine may be associated with adult EA. Conclusion: Multiple metabolic abnormalities (including those for lipids, purines, and amino acids) and other pathological processes (e.g., neurotransmitter imbalance and oxidative stress) may contribute to EA. Several altered metabolites in serum before surgery may have predictive value for EA diagnosis. This study might afford new metabolic clues for the understanding of EA pathogenesis.
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Affiliation(s)
- Qian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jiansuo Zhou
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Taotao Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Ning Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xinning Mi
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Dengyang Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Lei Chen
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Kaixi Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Hongcai Zheng
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jing Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiaona Lin
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yitong Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jingshu Hong
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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Martinotti G, Bonanni L, Barlati S, Miuli A, Sepede G, Prestia D, Trabucco A, Palumbo C, Massaro A, Olcese M, D'Ardes D, Cipollone F, Amore M, Bondi E, Russo M, Carrarini C, Onofrj M, Sensi SL, Vita A, di Giannantonio M. Delirium in COVID-19 patients: a multicentric observational study in Italy. Neurol Sci 2021; 42:3981-3988. [PMID: 34318364 PMCID: PMC8316107 DOI: 10.1007/s10072-021-05461-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/03/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Although recent data show that SARS-CoV-2 infection seems to affect the central nervous system (CNS), little is known about the neuropsychiatric effects resulting from this condition. In addition to the well-known neurotrophism of coronaviruses, recent evidence shows also that the "cytokine storm" induced by the infection is at the basis of the neuroinflammation of the CNS. Furthermore, prolonged hospitalization, polypharmacotherapy, and isolation could be at the basis of the onset of delirium in hospitalized COVID patients. This multicentric observational study explores the incidence of the onset of delirium in an Italian cohort of SARS-CoV-2 positive inpatients. METHODS Data were collected in the COVIDhospitals of Brescia, Bergamo, Chieti, and Genova. Different socio-demographic, medical, neurological, and pharmacological parameters were collected. As a rapid screening for delirium, the 4AT scale was used. Eighty COVID-19 inpatients (mean age 74.7 ± 14.5 years) met the inclusion criteria (confirmed positivity to the SARS-CoV-2 virus; the presence of delirium and/or psychomotor agitation and/or new onset of other neuropsychiatric symptoms during hospitalization). RESULTS The majority of these patients (68.8%) had "hyperactive delirium" subtype. Polypharmacotherapy, current treatment with corticosteroids, and higher age were associated with delirium severity. CONCLUSION These data provide an insight into the onset of delirium among COVID-19 patients underlining the need for monitoring, especially in elderly patients, the neuropsychiatric symptoms, and the therapy in order to have shorter hospitalization times and better outcomes.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
- Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Hatfield, Herts, UK
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Miuli
- Department of Mental Health, ASL Lanciano-Vasto-Chieti, Viale Amendola 47, Chieti, Italy.
| | - Gianna Sepede
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Davide Prestia
- Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alice Trabucco
- Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Claudia Palumbo
- Department of Psychiatry, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Damiano D'Ardes
- Department of Medicine and Aging Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mario Amore
- Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Emi Bondi
- Department of Psychiatry, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Stefano Luca Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
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