《麻醉学》2023年1月刊，第138卷第1期

本文由“麻醉新超人"授权转载

翻译：刘郁鋆 徐医2022级麻醉学研究生

审校：赵林林 徐医附院麻醉科

AnesthesiologyJanuary 2023, Volume 138, Issue 1

Table of Contents

目录

Science, Medicine, and the Anesthesiologist

科学、医学和麻醉医师

Infographics in Anesthesiology

麻醉信息图

Does Slow and Steady Win the Race? Gaining Perspective on Preoperative β-Blocker Initiation 

稳扎稳打能赢吗?术前应用β-阻滞剂的展望

Anesthesiology CME Program

继续教育项目

Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit

获取麻醉继续医学教育学分的指导

Editorial

社论

Anesthesiology 2023: Ch-ch-ch-ch-changes 

麻醉学2023:改变不止

Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade 

论患者安全:2023年美国麻醉医师协会神经肌肉阻滞监测和拮抗实践指南

β-Blockade before Noncardiac Surgery: The Devil Is in the Details 

非心脏手术前β阻断:细节决定成败

Adjust Intraoperative Oxygen Therapy for Oxygenation Reasons Only! 

仅因氧合原因调整术中氧疗!

Practice Parameter

临床医疗参考基准

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

2023美国麻醉医师协会监测和拮抗神经肌肉阻滞的实践指南:美国麻醉医师协会神经肌肉阻滞工作组的报告

Perioperative Medicine: Clinical Science

围手术期医学:临床科学

Preoperative β-Blocker Therapy and Stroke or Major Adverse Cardiac Events in Major Abdominal Surgery: A Retrospective Cohort Study 

术前β受体阻滞剂治疗对在腹部大手术中发生卒中或重大心脏不良事件的影响:一项回顾性队列研究

ABSTRACT

Background:Perioperative β-blocker therapy has been associated with increased risk of stroke. However, the association between β-blocker initiation before the day of surgery and the risk of stroke is unknown. The authors hypothesized there would be no association between preoperative β-blocker initiation within 60 days of surgery or chronic β-blockade (more than 60 days) and the risk of stroke in patients undergoing major abdominal surgery.

Methods：Data on elective major abdominal surgery were obtained from the IBM (USA) Truven Health MarketScan 2005 to 2015 Commercial and Medicare Supplemental Databases. Patients were stratified by β-blocker dispensing exposure: (1) β-blocker–naïve, (2) preoperative β-blocker initiation within 60 days of surgery, and (3) chronic β-blocker dispensing (more than 60 days). The authors compared in-hospital stroke and major adverse cardiac events between the different β-blocker therapy exposures.

Results：There were 204,981 patients who underwent major abdominal surgery. β-Blocker exposure was as follows: perioperative initiation within 60 days of surgery for 4,026 (2.0%) patients, chronic β-blocker therapy for 45,424 (22.2%) patients, and β-blocker–naïve for 155,531 (75.9%) patients. The unadjusted frequency of stroke for patients with β-blocker initiation (0.4%, 17 of 4,026) and chronic β-blocker therapy (0.4%, 171 of 45,424) was greater than in β-blocker–naïve patients (0.2%, 235 of 155,531; P < 0.001). After propensity score weighting, patients initiated on a β-blocker within 60 days of surgery (odds ratio, 0.90; 95% CI, 0.31 to 2.04; P = 0.757) or on chronic β-blocker therapy (odds ratio, 0.86; 95% CI, 0.65 to 1.15; P = 0.901) demonstrated similar stroke risk compared to β-blocker–naïve patients. Patients on chronic β-blocker therapy demonstrated lower adjusted risk of major adverse cardiac events compared to β-blocker–naïve patients (odds ratio, 0.81; 95% CI, 0.72 to 0.91; P = 0.007), despite higher unadjusted absolute event rate (2.6% [1,173 of 45,424] vs. 0.6% [872 of 155,531]).

Conclusions：Among patients undergoing elective major abdominal surgery, the authors observed no association between preoperative β-blocker initiation within 60 days of surgery or chronic β-blocker therapy and stroke.Methods: Preoperatively, participants at one enrolling center received a single injection of ropivacaine, 0.5%, paravertebral nerve block at T3 or T4, and perineural catheter. Participants subsequently underwent an active or sham ultrasound–guided percutaneous cryoneurolysis procedure of the ipsilateral T2 to T5 intercostal nerves in a randomized, patient- and observer-masked fashion. Participants all received a continuous paravertebral block with ropivacaine, 0.2%, until the early morning of discharge (usually postoperative day 2). The primary endpoint was the average pain level measured using a 0 to 10 numeric rating scale the afternoon of postoperative day 2. Participants were followed for 1 yr.

本文摘要：

背景：围手术期β受体阻滞剂治疗与卒中风险增加有关。然而，手术前开始使用β受体阻滞剂与卒中风险之间的关系尚不清楚。作者假设术前在手术前60天内开始使用β受体阻滞剂或慢性β受体阻滞剂治疗(超过60天)与接受腹部大手术的患者卒中风险之间没有关联。

方法：择期腹部大手术的数据来自IBM(美国)Truven健康市场扫描2005年至2015年商业和医疗保险补充数据库。

患者按β -阻滞剂配药暴露程度进行分层:(1)未使用β受体阻滞剂，(2)术前60天内开始使用β受体阻滞剂(3)慢性β -阻滞剂配药使用(超过60天)。作者比较了不同β受体阻滞剂治疗暴露之间的住院中风和主要不良心脏事件。

结果:204,981例患者接受了腹部大手术。β-受体阻滞剂暴露情况如下:4026例(2.0%)患者在手术前60天内开始使用β受体阻滞剂，45424例(22.2%)患者接受慢性β-受体阻滞剂治疗，155531例(75.9%)患者未使用β-受体阻滞剂。β受体阻滞剂围术期起始治疗(0.4%，4026例中17例)和慢性β受体阻滞剂治疗(0.4%，45,424例中171例)的未调整卒中率高于未使用β受体阻滞剂患者(0.2%，155,531例中235例;P < 0.001)。倾向评分加权后，患者在手术前60天内开始使用β-阻滞剂(优势比，0.90;95% CI, 0.31 ~ 2.04;P = 0.757)或慢性β阻滞剂治疗(优势比，0.86;95% CI, 0.65 ~ 1.15;P = 0.901)显示出与未使用β受体阻滞剂患者相似的卒中风险。与未使用β受体阻滞剂的患者相比，接受慢性β受体阻滞剂治疗的患者显示出较低的主要不良心脏事件调整风险(优势比，0.81;95% CI, 0.72 ~ 0.91;P = 0.007)，尽管未调整的绝对事件率较高(2.6%[45,424中的1,173]vs. 0.6%[155,531中的872])。

结论：在接受择期腹部大手术的患者中，作者观察到患者在术前60天内开始使用β受体阻滞剂或慢性β受体阻滞剂治疗与卒中之间没有关联。

Wildfire Smoke Exposure Is Associated with Adverse Respiratory Events under General Anesthesia in At-risk Pediatric PatientsPerioperative Supplemental Oxygen and Postoperative Nausea and Vomiting: Subanalysis of a Trial, Systematic Review, and Meta-analysis 

野火烟雾暴露与高危患儿全麻下不良呼吸事件、围术期吸氧和术后恶心和呕吐相关:试验亚组分析、系统回顾和Meta分析

Lidocaine Intraoperative Infusion Pharmacokinetics during Partial Hepatectomy for Living Liver Donation 

活体肝部分切除术中输注利多卡因的药代动力学

Pain Medicine: Clinical Science

疼痛医学:临床科学

Ultrasound-guided Percutaneous Cryoneurolysis to Treat Chronic Postamputation Phantom Limb Pain: A Multicenter Randomized Controlled Trial

超声引导下冷冻神经消融术治疗截肢后慢性幻肢痛:一项多中心随机对照试验

ABSTRACT

Background：Postamputation phantom pain is notoriously persistent with few validated treatments. Cryoneurolysis involves the application of low temperatures to reversibly ablate peripheral nerves. The authors tested the hypothesis that a single cryoneurolysis treatment would decrease phantom pain 4 months later.

Methods：The authors enrolled patients with a lower-limb amputation and established phantom pain. Each received a single-injection femoral and sciatic nerve block with lidocaine and was subsequently randomized to receive either ultrasound-guided percutaneous cryoneurolysis or sham treatment at these same locations. The primary outcome was the change in average phantom pain intensity between baseline and 4 months as measured with a numeric rating scale (0 to 10), after which an optional crossover treatment was offered. Investigators, participants, and clinical staff were masked to treatment group assignment with the exception of the treating physician performing the cryoneurolysis, who had no subsequent participant interaction.

Results：Pretreatment phantom pain scores were similar in both groups, with a median [quartiles] of 5.0 [4.0, 6.0] for active treatment and 5.0 [4.0, 7.0] for sham. After 4 months, pain intensity decreased by 0.5 [–0.5, 3.0] in patients given cryoneurolysis (n = 71) versus 0 [0, 3] in patients given sham (n = 73), with an estimated difference (95% CI) of –0.1 (–1.0 to 0.7), P = 0.759. Following their statistical gatekeeping protocol, the authors did not make inferences or draw conclusions on secondary endpoints. One serious adverse event occurred after a protocol deviation in which a femoral nerve cryolesion was induced just below the inguinal ligament—instead of the sensory-only saphenous nerve—which resulted in quadriceps weakness, and possibly a fall and clavicle fracture.

Conclusions：Percutaneous cryoneurolysis did not decrease chronic lower extremity phantom limb pain 4 months after treatment. However, these results were based upon the authors’ specific study protocol, and since the optimal cryoneurolysis treatment parameters such as freeze duration and anatomic treatment location remain unknown, further research is warranted.

本文摘要：

背景：截肢后幻肢痛持续时间很久，但很少有有效的治疗方法。冷冻神经消融术是应用低温可逆消融末梢神经。作者验证了单次冷冻神经消融治疗可在4个月后减轻幻肢痛的假设。

方法：作者招募了下肢截肢并已确定幻肢痛的患者。每位患者均接受利多卡因单次注射股神经和坐骨神经阻滞，随后随机分组，在相同位置接受超声引导下经皮冷冻神经消融术或假治疗。主要结果是用数值评分量表(0到10)测量基线和4个月间平均幻肢痛强度的变化，之后提供可选的交叉治疗。治疗组的分组对研究人员、参与者和临床工作人员都是未知的，只有进行冷冻神经消融术的治疗医生除外，他后续没有与参与者进行互动。

结果:两组术前幻肢痛评分相似，积极治疗组的中位数[四分位数]为5.0[4.0,6.0]，假手术组为5.0[4.0,7.0]。4个月后，接受冷冻神经消融术的患者(n = 71)疼痛强度下降0.5[-0.5,3.0]，而接受假手术治疗的患者(n = 73)疼痛强度下降0[0,3]，估计差异(95% CI)为-0.1(-1.0至0.7)，P = 0.759。根据他们的统计相关协议，作者没有对次要结局指标进行推断或得出结论。一个严重的不良事件发生在协议偏差后，一位参与者腹股沟韧带下方的股神经而不是仅影响知觉的隐神经被冷冻消融，这导致股四头肌无力，并可能导致跌倒和锁骨骨折。

结论：冷冻神经消融术治疗4个月后的慢性下肢幻肢痛没有减轻。然而，这些结果是基于作者特定的研究方案，由于最佳的冷冻水解处理参数如冷冻时间和解剖处理位置仍然未知，因此有必要进行进一步的研究。

Education: Images in Anesthesiology

麻醉影像学

Did Ancient Egyptians Discover Local Anesthetics? 

古埃及人发现局麻药了吗?

Education: Clinical Focus Review

教育:临床焦点回顾

Perioperative Anaphylaxis

围术期过敏反应

Education: Mind to Mind

教育:心灵交流

Rhapsody in Code Blue 

蓝色代码狂想曲

Anesthesiology Reflections from the Wood Library-Museum

来自木材图书馆——麻醉学博物馆的反思

No Bones about It: Leon Schlossberg’s Intubating Mannequin

实话实说:利昂·施洛斯伯格的气管插管人体模型

The Deadly Allure of Piso’s Cure 

皮索疗法的致命诱惑

Correspondence

通信

Validity and Tolerability of Awake Calibration of an Accelerometer Neuromuscular Monitor 

加速度神经肌肉监测器清醒校准的有效性和耐受性

Personalized Surgical Transfusion Risk Prediction: Comment 

个性化手术输血风险预测:评论

Personalized Surgical Transfusion Risk Prediction: Reply

个性化手术输血风险预测:回复

Quantitative Monitoring Practice Change: Comment 

定量监测实践变更:评论

Quantitative Monitoring Practice Change: Reply

定量监测实践变更:回复

Analgesia as a Component of General Anesthesia: A Problem of Terminology? 

镇痛作为全麻的一个组成部分:术语的问题?

Reviews of Educational Material

教材回顾

A Scientific Revolution: Ten Men and Women Who Reinvented American Medicine

科学革命:重塑美国医学的十位男性和女性 

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编辑：Michel.米萱

校对：MiLu.米鹭

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