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[Video-assisted Thoracoscopic Surgery in Local Anaesthesia and Analgosedation - a Survey of the Members of the German Society of Thoracic Surgeons].

[局部麻醉和麻醉中的电视胸腔镜手术-德国胸外科医师学会成员的调查]。

  • 影响因子:0
  • DOI:10.1055/a-0988-0085
  • 作者列表:"Galetin T","Lopez-Pastorini A","Kosse N","Koryllos A","Stoelben E
  • 发表时间:2020-06-01
Abstract

INTRODUCTION:There is increasing international interest in the use of video-assisted thoracoscopic procedures (VATS) with spontaneous respiration in the treatment of elderly and multimorbid patients. Data on the application and acceptance in Germany are not yet available. METHOD:Germany-wide, online-based survey among the departments of thoracic surgery registered at the German Society of Thoracic Surgeons (DGT) on the application of VATS in local anaesthesia (LA). RESULTS:101 of 157 hospitals responded (64%). 42% of the respondents perform non-intubated VATS (NIVATS), 31% VATS in LA. Reasons not to perform VATS in LA are lack of experience (51%), doubts about feasibility (29%) and missing indications (24%). Among the performing clinics, the most frequent procedures are pleural catheterisation (94%), pleural biopsy (87%) and pleurodesis (87%). 42% of the clinics perform wedge resections and 10% also anatomical resections in LA. Main target groups are multimorbid patients (77%), elderly patients (65%), patients with anxiety about general anaesthesia (55%) and patients with pre-existing lung diseases (52%). In 97% of the departments, sedation is performed by anaesthesiologists. The main technical difficulties mentioned are impaired view of the surgical field (39%), hypercapnia (29%) and panic attacks (23%). Pain is of minor importance (3%). DISCUSSION:About one third of the participating departments already perform VATS in LA; others have plans to introduce the method. The majority of respondents regard multimorbid, elderly and lung patients as the main target groups, as fewer inflammatory, respiratory and neurological complications are expected. EINLEITUNG:Videothorakoskopische Eingriffe (VATS) bei erhaltener Spontanatmung erfahren vor dem Hintergrund älterer und multimorbider Patienten international eine zunehmende Verbreitung. Daten zur Anwendung und Akzeptanz in Deutschland liegen bisher nicht vor. METHODE:Deutschlandweite, onlinebasierte Umfrage an den bei der Deutschen Gesellschaft für Thoraxchirurgie (DGT) registrierten thoraxchirurgischen Abteilungen zur Anwendung der VATS in Lokalanästhesie (LA). ERGEBNISSE:101 von 157 angeschriebenen Kliniken haben geantwortet (64%). 42% der Befragten führen Non-intubated VATS (NIVATS) durch, 31% VATS in LA. Gründe, VATS in LA nicht durchzuführen, sind mangelnde Erfahrung (51%), Zweifel an der Durchführbarkeit (29%) und fehlende Indikationen (24%). Unter den durchführenden Kliniken sind die häufigsten Prozeduren Anlage von Pleuraverweilkathetern (94%), Pleuraprobeexzisionen (87%) und Pleurodesen (87%). 42% der Kliniken führen Keilresektionen und 10% auch anatomische Resektionen in LA durch. Hauptzielgruppen sind multimorbide Patienten (77%), ältere Patienten (65%), Patienten mit Angst vor einer Allgemeinanästhesie (55%) und mit vorbestehenden Lungenerkrankungen (52%). In 97% der Kliniken führt die Anästhesie die Sedierung durch. Als technische Schwierigkeiten werden vor allem mangelnde Übersicht (39%), Hyperkapnie (29%) und Panikattacken (23%) genannt. Schmerzen spielen eine untergeordnete Rolle (3%). DISKUSSION:Rund ⅓ der befragen Kliniken führt bereits VATS in LA durch, weitere haben Pläne zur Einführung der Methode. Die Mehrheit der Befragten sieht als Hauptzielgruppen multimorbide, ältere und lungenerkrankte Patienten, weil sie weniger inflammatorische, respiratorische und neurologische Komplikationen erwartet.

摘要

引言: 国际上对使用电视辅助胸腔镜手术 (VATS) 和自主呼吸治疗老年患者和多岁患者的兴趣日益增加。关于德国的申请和接受的数据尚未获得。 方法: 在德国胸外科医师协会 (DGT) 注册的胸外科部门中,对局部麻醉中VATS的应用进行了全德国范围的在线调查。 结果: 101家医院中有157家做出了回应 (64%)。42% 的受访者执行非插管VATS (NIVATS),31% VATS在洛杉矶。不在洛杉矶进行VATS的原因是缺乏经验 (51%) 、对可行性的怀疑 (29%) 和缺少适应症 (24%)。在执行诊所中,最常见的手术是胸膜导管插入术 (94%) 、胸膜活检术 (87%) 和胸膜固定术 (87%)。在洛杉矶,42% 的诊所进行楔形切除,10% 的诊所也进行解剖切除。主要目标人群是多发病患者 (77%),老年患者 (65%),对全身麻醉焦虑的患者 (55%) 和患有肺部疾病的患者 (52%)。在97% 的科室中,由麻醉师进行镇静。提到的主要技术困难是手术区域的视野受损 (39%) 、高碳酸血症 (29%) 和惊恐发作 (23%)。疼痛是次要的 (3%)。 讨论: 大约3分之1的参与部门已经在洛杉矶执行VATS; 其他人计划引入该方法。大多数受访者将多发病、老年人和肺部患者视为主要目标人群,因为预计炎症、呼吸系统和神经系统并发症会减少。 EINLEITUNG:Videothorakoskopische Eingriffe (VATS) bei erhaltener naturatmung erfahren vor dem hellgrund ä lterer und multimobider Patienten international eine zunehmende Verbreitung.德国的达登 · 祖尔 · 安文登和阿克泽普塔兹。 METHODE:Deutschlandweite,onlinebasierte umage an den bei der Deutschen Gesellschaft f ü rthoraxchirurgie (DGT) registrierten thoraxchirurgischen Abteilungen zur Anwendung der VATS in lokalan ä sthesie (LA)。 ERGEBNISSE:101 von 157 angeschriebenen Kliniken haben geantwortet (64%)。42% der Befragten f ü hren非插管VATS (NIVATS) durch,31% VATS in LA。Gr ü nde,VATS in LA nicht durchzuf ü hren,sind mangelnde Erfahrung (51%),Zweifel an der durchf ü hrbarkeit (29%) und fehlende Indikationen (24%)。Unter den durchf ü hrenden Kliniken sind die h ä ufigsten Prozeduren Anlage von threaverweilkathetern (94%),threaprobeexzisionen (87%) 和Pleurodesen (87%)。42% de Kliniken f ü hren Keilresektionen和10% auch anatomische Resektionen in LA durch。Hauptzielgruppen sind multimanbide Patienten (77%),ä ltere Patienten (65%),Patienten mit Angst vor einer allgemeinan ä sthesie (55%) und mit vorbestehenden Lungenerkrankungen (52%)。97%,克林肯·福尔特 · 迪安 · 斯泰西 · 迪奥塞隆 · 杜尔奇去世。Als technische Schwierigkeiten werden vor allem mangelnde ü bersicht (39%),Hyperkapnie (29%) und Panikattacken (23%) genannt.Schmerzen spielen eine untergeordnete Rolle (3%)。 DISKUSSION:Rund 1/3 der befragen Kliniken f ü hrt bereits VATS in LA durch,weitere habenpl ä nezureinf ü hrndermethode。Dee Mehrheit der Befragten sieht als Hauptzielgruppen multimanbide,ä ltere und lungenerkrankte Patienten,weil sie weniger insiomatorische,respiratorische und neurologische Komplikationen erwartet。

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影响因子:2.27
发表时间:2020-02-01
DOI:10.1213/ANE.0000000000003945
作者列表:["Winterberg AV","Ding L","Hill LM","Stubbeman BL","Varughese AM"]

METHODS:BACKGROUND:Anxiety and distress behaviors during anesthesia induction are associated with negative postoperative outcomes for pediatric patients. Documenting behavioral responses to induction is useful to evaluate induction quality at hospitals and to optimize future anesthetics for returning patients, but we lack a simple tool for clinical documentation. The Induction Compliance Checklist is a tool for grading induction behaviors that is well validated for research purposes, but it is not practical for routine documentation in busy clinical practice settings. The Child Induction Behavioral Assessment tool was developed to provide a simple and easy to use electronic tool for clinical documentation of induction behaviors. The aim of this study was to test the Child Induction Behavioral Assessment tool's concurrent validity with the Induction Compliance Checklist and the interrater reliability. METHODS:This prospective, observational study included 384 pediatric patients undergoing anesthesia inhalation induction. Concurrent validity with the Induction Compliance Checklist and interrater reliability of the Child Induction Behavioral Assessment were evaluated. Two researchers alternated scoring the Induction Compliance Checklist. The 2 researchers independently scored the Child Induction Behavioral Assessment. The anesthesia clinician caring for the patient also independently scored the Child Induction Behavioral Assessment by completing their routine documentation in the patient's medical record. Two age groups were evaluated (ages 1-3 and 4-12 years old). RESULTS:Clinicians' and researchers' Child Induction Behavioral Assessment scores demonstrated a strong correlation with the Induction Compliance Checklist (P < .0001). There was an excellent agreement between the 2 researchers' Child Induction Behavioral Assessment scores for the younger and older age groups, respectively (Kappa [95% CI] = 0.97 (0.94-0.99); K = 0.94 (0.89-0.99)]. The agreement between the researchers and the 117 clinicians who documented Child Induction Behavioral Assessment assessments in the medical record was good overall (intraclass correlation coefficient = 0.70), with fair agreement with the 1- to 3-year-old patients (intraclass correlation coefficient = 0.56) and good agreement for the 4- to 12-year-old patients (intraclass correlation coefficient = 0.74). CONCLUSIONS:The Child Induction Behavioral Assessment scale is a simple and practical electronic tool used to document pediatric behavioral responses to anesthesia inductions. This study provides evidence of the tool's validity and reliability for inhalation inductions. Future research is needed at other hospitals to confirm validity.

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影响因子:2.27
发表时间:2020-01-01
DOI:10.1213/ANE.0000000000003975
作者列表:["Uppal V","Retter S","Casey M","Sancheti S","Matheson K","McKeen DM"]

METHODS:BACKGROUND:Fentanyl and morphine are the 2 most commonly added opioids to bupivacaine for spinal anesthesia during cesarean delivery. Numerous clinical trials have assessed efficacy and safety of different doses of fentanyl added to intrathecal bupivacaine for spinal anesthesia, yet its benefit, harm, and optimal dose remain unclear. This study aimed to systematically review the evidence of the efficacy of fentanyl when added to intrathecal bupivacaine alone and when added to bupivacaine with morphine for spinal anesthesia during cesarean delivery. METHODS:Key electronic databases (PubMed, Embase, and Cochrane Library) were searched for randomized controlled trials in the cesarean delivery population. The primary outcome was the failure rate of spinal anesthesia, as assessed by the need for either conversion to general anesthesia or intraoperative analgesic supplementation. Two reviewers independently extracted the data using a standardized electronic form. Results are expressed as relative risks or mean differences with 95% CIs. RESULTS:Seventeen randomized controlled clinical trials (most judged as low or unclear risk of bias) with 1064 participants provided data for the meta-analysis. Fentanyl added to intrathecal bupivacaine alone reduced the need for intraoperative supplemental analgesia (relative risk, 0.18; 95% CI, 0.11-0.27; number needed to treat, 4) and the incidence of nausea/vomiting (relative risk, 0.41; 95% CI, 0.24-0.70; number needed to treat, 6.5), with longer time to first postoperative analgesia request (mean difference, 91 minutes; 95% CI, 69-113). No difference was observed regarding the need for conversion to general anesthesia (relative risk, 0.67; 95% CI, 0.12-3.57), the incidence of hypotension, the onset of sensory block, or the duration of motor block. However, the addition of intrathecal fentanyl was associated with higher incidence of intraoperative pruritus (relative risk, 5.89; 95% CI, 2.07-16.79; number needed to harm, 13.5). The inclusion of fentanyl to intrathecal bupivacaine-morphine compared to intrathecal bupivacaine-morphine alone conferred a similar benefit, with a significantly reduced need for intraoperative supplemental analgesia (relative risk, 0.16; 95% CI, 0.03-0.95; number needed to treat, 9). Analysis using a funnel plot indicated a possibility of publication bias in included studies. CONCLUSIONS:Current evidence suggests a benefit of using fentanyl as both an additive to intrathecal bupivacaine alone and to intrathecal bupivacaine combined with morphine for cesarean delivery under spinal anesthesia. The possibility of publication bias, small sample size, and high risk of bias in some of the included studies warrant treating the results with caution.

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影响因子:2.27
发表时间:2020-05-01
DOI:10.1213/ANE.0000000000004012
作者列表:["Jean YK","Kam D","Gayer S","Palte HD","Stein ALS"]

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用药物或其他方法使患者整体或局部暂时失去感觉,以达到无痛的目的进行手术治疗。

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