Journal of anesthesia
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Journal of anesthesia · Feb 2019
Preoperative continuation of aspirin administration in patients undergoing major abdominal malignancy surgery.
In contrast to that in a nonoperative setting, it has been shown that perioperative administration of aspirin did not decrease the rate of death or myocardial infarction but increased major bleeding risk. Since these conflicting results might be due to concurrent use of anticoagulants and a lower thrombotic risk of patients, this cohort study was carried out for patients at a high thrombotic risk without concurrent use of anticoagulants. ⋯ Although the sample size is relatively small, our findings suggest that continuation of aspirin administration is likely to reduce the thrombotic risk but unlikely to increase the bleeding risk of patients who undergo major abdominal surgery for malignancy.
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Journal of anesthesia · Feb 2019
Randomized Controlled Trial Comparative StudyPeak airway pressure is lower during pressure-controlled than during manual facemask ventilation for induction of anesthesia in pediatric patients-a randomized, clinical crossover trial.
Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes. ⋯ Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes.
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Journal of anesthesia · Feb 2019
Observational StudyUtilization of arterial pulse waveform analysis during non-cardiac surgery in Japan: a retrospective observational study using a nationwide claims database.
Arterial pulse waveform analysis (APWA) is used for cardiac output monitoring. However, data on the frequency of and patient characteristics for specialized pressure transducer for APWA (S-APWA) use are lacking. We retrospectively identified 175,201 patients aged 18 years or older, who underwent non-cardiac surgery under general anesthesia with an arterial catheter from January 1, 2014, to December 31, 2016. ⋯ Further, the use of S-APWA was higher in patients undergoing high-risk surgery than in those undergoing low-risk surgery [high vs low: adjusted odds ratio (aOR) 1.95; 95% confidence interval (CI) 1.76-2.15, moderate vs low: aOR 1.11; 95% CI 1.01-1.22] and those with more comorbidities than in those with less comorbidities (high vs low: aOR 1.49; 95% CI 1.42-1.56, moderate vs low: aOR 1.25; 95% CI 1.20-1.31). S-APWA use was significantly associated with both surgery risk and patients' comorbidities. In conclusion, our study may provide a benchmark for future studies related to the appropriate use of S-APWA.
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Journal of anesthesia · Feb 2019
Age-dependent error in creatinine clearance estimated by Cockcroft-Gault equation for the elderly patients in a Japanese hospital: a cross-sectional study.
The aim of this study is to assess the accuracy of creatinine clearance (CCr) calculated by the Cockcroft-Gault (CG) equation for elderly patients in a Japanese hospital. This study was a retrospective chart review of patients aged ≥ 55 years with a CCr measurement by a 24-h urine collection (24-h) prior to general surgery in our hospital between April 2009 and March 2017. In total, 1028 Japanese patients were included (mean age 73.0 ± 8.9 years). ⋯ The error was reached at 21.7 ± 13.2 mL/min in patients aged ≥ 90 years (P < 0.001). The age-dependent errors almost completely disappeared when the modified CG equation was used, in which the term of age in the original CG equation was constantly regarded as 65, if the patient was 65 years or older. Anesthesiologists and intensivists should pay attention to the potential risk of underestimating kidney function when using the CG equation for Japanese elderly patients.
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Journal of anesthesia · Feb 2019
What is the predictor of the intraoperative body temperature in abdominal surgery?
Inadvertent hypothermia is a relatively common intraoperative complication. Few studies have investigated predictors of body temperature change or the effect of the blanket type used with a forced-air warming device during the intraoperative period. We investigated the predictive factors of intraoperative body temperature change in scheduled abdominal surgery. ⋯ The blanket type of the forced-air warmer, age, sex, laparoscopic surgery, and BMI are predictors of intraoperative core temperature change.