Daily Anesthesiology Research Analysis

Complex regional pain syndrome (CRPS) is a poorly understood chronic pain condition of the extremities presenting severe pain disproportionate to the causative injury. Owing to its heterogeneous clinical presentation and the lack of specific diagnostic tests, CRPS is often a diagnostic and therapeutic challenge. Early diagnosis and treatment of CRPS improve quality of life and delay disease progression. Identification of focal peripheral pain generators would provide an opportunity for targeted treatments with more limited side effects. A highly selective sigma-1 receptor positron emission tomography (PET) radioligand, [18F]FTC-146, has been developed and has shown promise in identifying inflammatory or nociceptive processes. Our aim was to investigate the utility of [18F]FTC-146 PET/MRI for identifying peripheral pain generators and assessing its impact on subsequent clinical management of patients with CRPS. This single-center study enrolled 15 subjects with a clinical diagnosis of CRPS to undergo [18F]FTC-146 PET/MRI. PET/MRI findings were reviewed and discussed with referring pain specialists. Pain scores and subsequent changes in pain management for each patient were prospectively noted. Potential pain generators were observed in 10 of 15 subjects. Subsequent pain treatments guided by abnormally increased foci of uptake on [18F]FTC-146 PET/MRI resulted in an average 5-point improvement in pain score in 80% (8/10) of subjects. Overall, [18F]FTC-146 PET/MRI was able to identify potential peripheral pain generators in the affected limbs of subjects with CRPS and subsequently guided targeted treatments that resulted in varying degrees of improvement in subjective pain scores.

BACKGROUND: High-flow nasal oxygenation (HFNO) is increasingly used as an alternative for preoxygenation and apneic oxygenation during tracheal intubation. However, its efficacy in infants remains underexplored. We evaluated whether HFNO improves intubation outcomes compared to those with face mask ventilation in infants. METHODS: This prospective, single-center randomized controlled trial included 132 infants undergoing elective surgery under tracheal intubation. The infants were divided into HFNO and control groups, with both groups receiving 100% oxygen. The HFNO group received HFNO for preoxygenation (0.5 L/kg/min for 3 min) as well as during the apneic period (2 L/kg/min for 1 min) and laryngoscopy (2L/kg/min). The control group received face mask preoxygenation (6 L/min for 3 min), followed by face mask ventilation during the apneic period (6 L/min for 1 min) and no oxygen delivery during laryngoscopy. The primary outcome was the desaturation incidence (peripheral oxygen saturation < 95% for ≥5 s) from preoxygenation to 1 min after intubation. Various secondary outcomes were also assessed. RESULTS: After exclusions, 125 infants were analyzed (HFNO: n=60; control: n=65). There was no statistically significant between-group difference in the incidence of oxygen saturation < 95% (control vs. HFNO: 9.2% vs. 13.3%; relative risk, 1.44; 95% confidence interval, 0.53-3.92; P=.658). With regard to secondary outcomes, the incidence of oxygen saturation < 90%, first-attempt intubation success rate, lowest oxygen saturation, post-intubation end-tidal CO2 and O2, and atelectasis scores were similar between groups. Gastric insufflation was less frequent in the HFNO group; the difference was statistically significant (36.7% vs. 70.8%; P <.001). CONCLUSIONS: In the present study involving the use of HFNO for preoxygenation and apneic oxygenation during tracheal intubation in infants, there was no significant difference in the incidence of desaturation between HFNO and face mask ventilation, although the former was associated with less frequent gastric insufflation.

INTRODUCTION: Postoperative delirium (POD) remains challenging to predict in elderly hip fracture patients. This study posited that a newly developed electroencephalogram-derived metric, termed the Delirium Index (DELi), has the potential to elucidate latent information pertaining to the preoperative predisposing factors of POD. METHODS: A prospective cohort of 144 elderly patients undergoing hip fracture surgery was enrolled. DELi scores were derived from preoperative electroencephalography (EEG) using wavelet analysis. POD was diagnosed using the Confusion Assessment Method (CAM). Predictive performance was evaluated via ROC analysis, logistic regression, and bootstrapping validation. RESULTS: DELi demonstrated strong correlation with CAM scores (r = 0.516, p < 0.0001) and good predictive accuracy for POD (AUC = 0.791, 95% CI: 0.715-0.867). A composite model integrating DELi, Montreal Cognitive Assessment (MoCA), and FRAIL scores achieved excellent discrimination (AUC = 0.922, 95% CI: 0.878-0.965), with 85.9% sensitivity and 86.3% specificity. CONCLUSIONS: The DELi index, combined with cognitive and frailty assessments, provides a practical tool for preoperative POD risk stratification in elderly hip fracture patients. TRIAL REGISTRATION: ChiCTR2200060389.