《麻醉与镇痛》2023年1月刊，第136卷第1期

本文由“麻醉新超人"授权转载

翻译：张   丽 徐医2022级麻醉学研究生

审校：赵林林 徐医附院麻醉科

January 2023 - Volume 136 - Issue 1

Featured Articles

Infographic

Gender Gap: A Call for Women Leaders

性别差距：呼吁女性领导者

Defining the Aims of Perioperative Nursing Research in Africa

确定非洲围手术期护理研究的目标

Editorial

How Did They Get There? What Perspectives From the Top Tell Us About Developing Women Leaders in Academic Anesthesiology

她们是怎么做到的？用高度思维探讨如何成为学术麻醉学领域的女性领导者Global Perioperative Care: From Prioritization to Patient Impact

全球围手术期照护：优先排序对患者的影响

Original Clinical Research Report

Gender Gap: A Qualitative Study of Women and Leadership Acquisition in Anesthesiology

性别差距：麻醉学领域中女性获得领导力的定性研究

Nurses’ Priorities for Perioperative Research in Africa

非洲护士围手术期研究的重点

Respiratory Adverse Events After LMA® Mask Removal in Children: A Randomized Trial Comparing Propofol to Sevoflurane

儿童摘除LMA®面罩后的呼吸不良事件：一项比较丙泊酚与七氟醚的随机试验

Longitudinal Profiling of Plasma Cytokines and Its Association With Postoperative Delirium in Elderly Patients Undergoing Major Lower Limb Surgery: A Prospective Observational Study

接受下肢大手术的老年患者血浆细胞因子的纵向分析及其与术后谵妄的关系：一项前瞻性观察性研究

Review Articles

Systematic Review Article

Efficacy of Presurgical Interventions to Promote Smoking Cessation: A Systematic Review

术前干预促进戒烟的有效性：一项系统综述

Original Research Articles

Original Clinical Research Report

Anesthetic Preferences for Cardiac Anesthesia: A Survey of the Society of Cardiovascular Anesthesiologists

心脏麻醉的麻醉偏好：心血管麻醉医师协会的调查

BACKGROUND:

Volatile anesthetics have been historically preferred for cardiac anesthesia, but the evidence for their superiority to intravenous agents is mixed. We conducted a survey to better understand the current state of practice and the rationale behind provider preferences for anesthesia for cardiac surgery with cardiopulmonary bypass. We hypothesized that anesthetic preference would vary considerably among surveyed providers without a clear majority, as would the rationale behind those preferences.

METHODS:

Email invitations were sent to members of the Society of Cardiovascular Anesthesiologists, who were asked to identify the anesthetics or sedatives they typically prefer to administer during induction, prebypass, bypass, postbypass, and postoperative periods and why they prefer those agents. Members’ beliefs regarding the importance of anesthetics on postoperative outcomes were also assessed.

RESULTS:

Invitations were sent on 2 separate dates to 3328 and 3274 members, of whom 689 (21%) responded. The median (interquartile range [IQR]) respondent age was 45 (37–56) years, 79% were men, and 75% were fellowship trained. The most frequently chosen drug for induction was propofol (80%). Isoflurane was the most frequently selected primary agent for the prebypass (57%), bypass (62%), and postbypass periods (50%). Sevoflurane was the second most frequently selected (30%; 17%, and 24%, respectively). Propofol was the third most frequently selected agent for the bypass (14%) and postbypass periods (17%). Ease of use was the most frequently selected reason for administering isoflurane and sevoflurane for each period. During bypass, the second most frequently selected rationale for using isoflurane and sevoflurane was institutional practice. A total of 76% responded that the perfusionist typically delivers the bypass anesthetic. Ischemic preconditioning, organ protection, and postoperative cognitive function were infrequently selected as rationales for preferring the volatile anesthetics. Most respondents (73%) think that anesthetics have organ-protective properties, especially isoflurane (74%) and sevoflurane (59%), and 72% believed that anesthetic choice contributes to patient outcome. The median (IQR) agreement (0 = strongly disagree to 100 = strongly agree) was 72 (63–85) for the statement that “inhaled anesthetics are an optimal maintenance anesthetic for cardiac surgery.”

CONCLUSIONS:

In a survey of cardiac anesthesiologists, a majority of respondents indicated that they prefer volatile anesthetics for maintenance of anesthesia, that anesthetic selection impacts patient outcomes, and that volatile anesthetics have organ-protective properties. The members’ rationales for preferring these agents possibly reflect that practical considerations, such as ease of use, effectiveness, and institutional practice, also influence anesthetic selection during cardiac surgery in addition to considerations such as organ protection.

背景：

吸入麻醉剂历来是心脏麻醉的首选，但其优于静脉麻醉剂的证据不一。我们进行了一项调查，用来更好地了解当前的实践状况以及对体外循环心脏手术麻醉偏好背后的理由。我们猜测，在小数量的调查者的中麻醉偏好有很大差异，这些偏好背后的理由也是如此。

方法：

我们向心血管麻醉师协会的成员发送了电子请帖，确定他们通常更喜欢在诱导期、搭桥前、搭桥中、搭桥后和术后使用的麻醉剂或镇静剂，以及他们为什么更喜欢这些药物。我们还评定了成员对麻醉剂对于术后结局重要性的看法。

结果：

请帖分别于2个日期发送给协会的3328名和3274名成员，其中689名（21%）做出了回应。答复者年龄中位数（四分位距[IQR]）为45（37-56）岁，79%为男性，75%接受过培训。最常选择的诱导药物是丙泊酚（80%）。异氟醚是搭桥前（57%）、搭桥期（62%）和搭桥后（50%）最常选择的主要药物。七氟醚是第二常用药（分别为30%;17%和24%）。丙泊酚是搭桥期（14%）和搭桥后（17%）的第三大常选择的药物。易用性是每个时期选用异氟醚和七氟醚的最常见的原因。在搭桥期间，使用异氟醚和七氟醚的第二个最常选择的理由是医院惯例。共有76%的人回答说体外循环治疗师通常会提供搭桥的麻醉剂。缺血性预处理、器官保护和术后认知功能很少被选为首选吸入麻醉药的理由。大多数受访者（73%）认为麻醉剂具有器官保护特性，尤其是异氟醚（74%）和七氟烷（59%），72%的人认为麻醉剂的选择有助于患者的预后。对于“吸入麻醉剂是心脏手术的最佳维持麻醉剂”这一说法，同意的中位数（IQR）为72（63-85）（0 =强烈不同意100=非常同意）。

结论：

在对于心脏麻醉医生的调查中，大多数受访者表示他们更喜欢使用吸入麻醉剂来维持麻醉，麻醉剂的选择会影响患者的预后，并且吸入麻醉剂具有器官保护特性。协会成员们偏向选择这些药物的理由可以反映出，除了考虑器官保护等方面的因素外，实际考虑因素如易用性、有效性和机构实践，也会影响心脏手术期间的麻醉剂选择。

Volatile Versus Total Intravenous Anesthesia on Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery: A Randomized Clinical Trial

吸入麻醉与全凭静脉麻醉对于成人心脏瓣膜手术患者术后谵妄中的比较：一项随机临床试验

BACKGROUND:

The effect of anesthesia regimens on postoperative delirium after on-pump cardiac valve surgery is yet undetermined. This study aimed to evaluate the effect of volatile anesthesia compared with propofol-based total intravenous anesthesia (TIVA) on the occurrence of delirium after on-pump cardiac valve surgery.

METHODS:

This randomized clinical trial was conducted at a university academic hospital in China, from February 2019 to January 2021. Patients scheduled for on-pump cardiac valve surgery or combined valve with coronary artery bypass grafting (CABG) surgeries were randomly assigned to receive anesthesia maintenance with either a volatile anesthetic (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was the incidence of delirium during the first 7 days after surgery, assessed using the confusion assessment method for the intensive care unit (ICU). The secondary outcomes included duration of delirium, subtypes of delirium, 30-day mortality, pain score, major morbidity (including cerebral infarction, respiratory failure, and pneumonia), duration of mechanical ventilation, and lengths of ICU and hospital stay. The statistical analysis of the primary outcome variable was by Pearson’s χ 2 test.

RESULTS:

Among the 684 patients analyzed (mean age, 53.8 years; 381 [55.7%] women), 676 were assessed for the primary outcome. Postoperative delirium occurred in 63 of 337 (18.7%) patients receiving volatile anesthesia versus 76 of 339 (22.4%) patients receiving propofol-based TIVA (relative risk, 0.80; 95% confidence interval [CI], 0.55–1.16; P = .231). There were no significant differences between the groups in any of the secondary outcomes.

CONCLUSIONS:

Among patients undergoing on-pump cardiac valve surgery, anesthesia maintenance with a volatile agent did not result in significantly fewer occurrences of postoperative delirium than propofol-based TIVA.

背景：

麻醉方案对体外循环心脏人工瓣膜手术术后谵妄的影响尚不确定。本研究旨在评估吸入麻醉与基于丙泊酚的全静脉麻醉（TIVA）对体外循环心脏瓣膜手术后谵妄发生的影响。

方法：

这项随机临床试验于2019年2月至2021年1月在中国的一所大学附属医院进行。计划进行体外循环心脏瓣膜手术或瓣膜与冠状动脉旁路移植（CABG）联合手术的患者被随机分配分别接受吸入麻醉剂（七氟烷或地氟烷）或基于丙泊酚的TIVA的麻醉维持。主要结果是术后前7天内的谵妄发生率，使用重症监护病房（ICU）的意识模糊评估方法进行评估。次要结局包括谵妄持续时间、谵妄亚型、30天死亡率、疼痛评分、主要发病率（包括脑梗死、呼吸衰竭和肺炎）、机械通气持续时间以及ICU和住院时间。主要结局变量的统计分析由皮尔逊χ2检验进行。

结果：

在分析的684名患者中（平均年龄53.8岁;381名[55.7%]女性），676例被评估为主要结局。接受吸入麻醉的337例患者中有63例（18.7%）发生术后谵妄，而接受基于丙泊酚的TIVA的339例患者中有76例（22.4%）发生谵妄（相对风险，0.80；95%可信区间[CI]，0.55-1.16；P = 0.231）。各组之间在所有次要结局中均无显著差异。

结论：

在接受体外循环心脏瓣膜手术的患者中，与基于丙泊酚的TIVA相比，使用吸入麻醉药物维持麻醉并没有导致术后谵妄的发生率显著减少。

Thrombosis-Related Loss of Arterial Lines in the First Wave of COVID-19 and Non–COVID-19 Intensive Care Unit Patients

在第一波 COVID-19 和非 COVID-19重症监护病房的患者中与血栓形成相关的动脉波形的消失

Effect of Ice Slush on Reducing the Oculocardiac Reflex During Strabismus Surgery

冰沙对减少斜视手术时眼心反射的影响

Postcesarean Analgesia With Epidural Morphine After Epidural 2-Chloroprocaine: A Randomized Noninferiority Trial

硬膜外注射2-氯普鲁卡因后使用硬膜外吗啡进行剖宫产产后镇痛：一项随机非劣效性试验

Preventing Spinal Hypotension During Cesarean Birth With Two Initial Boluses of Norepinephrine in Chinese Parturients: A Randomized, Double-Blind, Controlled Trial

中国产妇使用两次去甲肾上腺素来预防剖宫产期间腰麻低血压：一项随机、双盲、对照试验

Association Between Anesthesia Provider Education and Carbon Footprint Related to the Use of Inhaled Halogenated Anesthetics

麻醉医师教育与使用吸入性卤化麻醉剂的碳足迹之间的关联

Laboratory Result Reference Ranges Stratified for Patient-Reported Sex and Ethnicity Are More Closely Associated With Postoperative Outcomes Than Currently Used Reference Ranges: A Retrospective Data Analysis

根据患者报告的性别和种族分层的实验室结果参考范围与目前使用的参考范围相比，术后结局的关系更密切：一项回顾性数据分析

Relationships Between Body Mass Index, Allogeneic Transfusion, and Surgical Site Infection After Knee and Hip Arthroplasty Surgery

膝关节和髋关节置换术后体重指数、异体输血与手术部位感染之间的关系

Anesthetic Practice Trends and Perceptions Toward Postoperative Delirium: A Mixed-Methods Analysis

麻醉实践趋势和对术后谵妄的看法：一项混合方法分析

Postoperative Delirium Severity and Recovery Correlate With Electroencephalogram Spectral Features

术后谵妄的严重程度与恢复和脑电图谱特征相关联

Original Laboratory Research Report

Dose Escalation Pharmacokinetic Study of Intranasal Atomized Dexmedetomidine in Pediatric Patients With Congenital Heart Disease

先天性心脏病患儿鼻内雾化右美托咪定的剂量递增药代动力学研究

Patterns and Persistence of Perioperative Plasma and Cerebrospinal Fluid Neuroinflammatory Protein Biomarkers After Elective Orthopedic Surgery Using SOMAscan

使用SOMAsscan的围手术期血浆和脑脊液神经炎症蛋白生物标志物的模式和持久性

Special Articles

The Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society for Extracorporeal Technology Clinical Practice Guidelines for the Prevention of Adult Cardiac Surgery–Associated Acute Kidney Injury

胸外科医师协会/心血管麻醉医师协会/美国体外循环技术协会预防成人心脏手术相关急性肾损伤的临床实践指南

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编辑：MiLu.米鹭

校对：Michel.米萱

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