Daily Anesthesiology Research Analysis

PURPOSE: Dexmedetomidine, an alpha-2 adrenergic agonist, has shown potential benefits in various surgical settings, but its impact on microcirculation and renal function in cardiac surgery patients remains unclear. PATIENTS AND METHODS: This randomized, controlled, double-blind clinical trial was conducted at a single university hospital. Seventy patients undergoing non-emergency cardiac and aortic surgery requiring cardiopulmonary bypass were enrolled, and 68 patients were included in the final analysis. Patients were randomized to receive either dexmedetomidine (0.5 mcg/kg loading dose, followed by 0.5 mcg/kg/h) or saline. The infusion of dexmedetomidine or saline began at anesthesia induction and continued until the end of surgery. Key microcirculatory variables-total vessel density, proportion of perfused vessels, perfused vessel density, De Backer's score, microvascular flow index, and heterogeneity index-were measured at five time points: baseline, 1 hour after cardiopulmonary bypass, 1 hour after arrival in the intensive care unit, 24 hours after surgery, and 48 hours after surgery. Data were analyzed using a mixed-effects model with Tukey's Honestly Significant Difference correction. Intraoperative urine output, the incidence of postoperative acute kidney injury, and other postoperative complications were also compared. RESULTS: Patients in the dexmedetomidine group maintained higher postoperative proportion of perfused vessels and perfused vessel density compared to the saline group, with a significant interaction effect for perfused vessel density. Baseline perfused vessel density was comparable between the two study groups (17.5 [15.9-18.6] vs 18.0 [16.1-19.8] mm/mm², p = 0.540). At 48 hours postoperatively, patients in the dexmedetomidine group had significantly higher PVD values than those in the saline group (17.0 [15.0-19.0] vs 15.6 [13.7-16.9] mm/mm²; P = 0.041). The dexmedetomidine group also had significantly higher intraoperative urine output (950 vs 605 mL, p = 0.002). Additionally, the incidence of postoperative acute kidney injury was significantly lower in the dexmedetomidine group (11.8% vs 50%, p = 0.001). CONCLUSION: Intraoperative dexmedetomidine infusion during cardiac surgery is associated with higher postoperative microcirculatory state and a reduced incidence of acute kidney injury. This study examined whether a drug called dexmedetomidine can help improve small blood flow (microcirculation) and protect kidney function during heart surgery. Heart surgeries that use a heart-lung machine can disturb blood flow to tiny vessels and may lead to complications like acute kidney injury (AKI). Dexmedetomidine is a commonly used sedative with anti-inflammatory and organ-protective effects. In this single center study, 68 patients undergoing cardiac or aortic surgery were randomly assigned to receive either dexmedetomidine or a saline during surgery. The researchers measured blood flow in the small vessels under the tongue at several time points and tracked urine output and kidney function after surgery. Patients who received dexmedetomidine showed better blood flow in their small vessels and had more urine output during surgery. Most importantly, they had a significantly lower chance of developing AKI compared to those who received saline (11.8% vs 50%). These results suggest that using dexmedetomidine during heart surgery may improve microcirculation and help protect the kidneys. This could lead to better recovery and fewer complications after surgery. The findings provide valuable insight for doctors seeking safer anesthesia options and ways to reduce organ damage in heart surgery patients.

INTRODUCTION: Therapeutic hypnosis appears to offer psychological and physiological benefits in various medical fields, but despite increasing interest, its value for anaesthesia remains inconclusive. METHODS: We searched for studies of any design in which hypnosis was used for any intervention requiring the presence of an anaesthetist, alone or in combination with any type of anaesthesia, on children and adults. Meta-analyses using random-effects models were stratified on hypnosis timing, when three or more randomised controlled trials reported on a similar outcome. Additional analyses were performed adding data derived from non-randomised controlled studies. The primary outcome was the use of hypnotics and opioids during the intervention. Secondary outcomes included all outcomes related to pain, anxiety or adverse events. RESULTS: We identified 142 studies that included 9238 patients (8319 adults, 919 children). Pre-intervention hypnosis decreased post-intervention visual analogue scale pain score (mean difference -0.88 cm, 95%CI -1.72 to -0.05) and anxiety (standardised mean difference -0.76, 95%CI -1.14 to -0.38). Per-intervention hypnosis decreased visual analogue scale pain intensity during the intervention (mean difference -1.14 cm, 95%CI -1.86 to -0.41) without impacting on post-intervention pain; decreased post-intervention anxiety (standardised mean difference -0.44, 95%CI -0.75 to -0.13); and lowered the risk of postoperative nausea and vomiting (risk ratio 0.43, 95%CI 0.25-0.74). Adding non-randomised controlled studies did not alter these results substantially. Evidence of the impact of pre- or per-intervention hypnosis on other outcomes, or of post-intervention hypnosis on any outcome, was lacking. DISCUSSION: Hypnosis may help reduce anxiety, alleviate pain during and after a procedure and lower the incidence of postoperative nausea and vomiting. However, despite the inclusion of more than 9000 patients in studies examining the use of hypnosis for anaesthesia, its impact on most outcomes remains unknown. Hypnosis is sometimes used in medicine and may help people feel better in their mind and body. Some doctors are interested in using hypnosis during surgery, but we still don't know for sure how helpful it really is. To learn more, we looked at studies where hypnosis was used in medical procedures that needed an anaesthetist, a doctor who helps people sleep or stay calm during surgery. These studies included both adults and children. The main thing we checked was how much medicine, like sleeping drugs or painkillers, people needed. We also looked at pain, anxiety and side effects. In total, we found 142 studies with 9238 people, including 8319 adults and 919 children. When hypnosis was used before the procedure, people later had less pain and felt less worried. When hypnosis was used during the procedure, people felt less pain at that time, had less anxiety afterwards and were less likely to feel sick or vomit after surgery. Using results from less strict studies did not change these findings much. However, there wasn't enough proof about what happens if hypnosis is used after the procedure. Overall, hypnosis might help people feel calmer, reduce pain and lower the chance of feeling sick after surgery. But even though many studies have been done, we still don't know everything about how hypnosis affects patients during surgery.

BACKGROUND: Frontal EEG alpha oscillations might reflect an ideal state of general anaesthesia with adequate antinociception. Low alpha power has been associated with a vulnerable brain phenotype at greater risk of postoperative delirium. This arm of the AlphaMax randomised trial aimed to determine if alpha oscillations could be maximised by EEG-guided titration of anaesthesia, and if this might reduce delirium in the postanaesthesia care unit (PACU). METHODS: Male and female patients, aged ≥60 yr, were randomised to EEG-guided dose titration (targeting oscillatory alpha power) or routine care. Both groups received a standardised desflurane-fentanyl-based anaesthetic technique avoiding burst suppression. PACU delirium was assessed by blinded observers. RESULTS: For feasibility reasons, we reduced the sample size and were underpowered for PACU delirium. A total of 200 patients aged 73 (SD 7) yr were included. The titration group received more fentanyl (median [interquartile range] 650 [500-850] μg vs 500 [350-600] μg, P<0.0001) and less desflurane (maintenance end-tidal concentration mean [SD] 3.9 [0.7] vol% vs 4.4 [0.8%], vol% P<0.0001) than the control group. Oscillatory alpha power was greater in the titration group early after surgical incision (+0.8 dB, P=0.008), but this effect was not sustained as surgery progressed. Titration resulted in absent desflurane-alpha correlation in the intervention group (r=-0.020, 95% confidence interval -0.155 to 0.115) and a negative association in the control group (r=-0.228, 95% confidence interval -0.396 to -0.059). The incidence of PACU delirium was similar between groups (37% vs 33%, P=0.553). CONCLUSIONS: EEG-guided titration of fentanyl and desflurane anaesthesia had a limited enhancing effect on oscillatory alpha power with no appreciable difference in clinical outcomes. CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry (ID: 12617001354370).