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The formula-based estimation of the right internal jugular venous (IJV) catheterization depth can be inaccurate when using ultrasound guidance. External landmark-based and radiological landmark-based methods have been proposed as alternatives to estimate the insertion depth. This study aimed to evaluate these methods using transesophageal echocardiography (TEE)-guided insertion depth as the reference. Ninety-seven adult cardiac surgery patients underwent real-time ultrasound-guided right IJV catheterization, with placement at the superior vena cava-right atrium (SVC-RA) junction under TEE guidance. The primary outcome compared the accuracy of external-landmark and radiological-landmark methods in estimating optimal catheter position (2 cm above to 1 cm below the SVC-RA junction), while secondary outcomes assessed their reliability and agreement with TEE. The external-landmark method proved more accurate than the radiological-landmark method (91.8% vs. 68%, p < 0.001) and had a higher correlation with TEE (r = 0.83 vs. 0.67). Bland–Altman analysis showed a mean difference of 0.08 cm between external-landmark and TEE methods (limits of agreement: -1.75 to 1.90 cm) and 0.43 cm for radiological-landmark (limits of agreement: -2.63 to 3.49 cm). Overall, the external-landmark method is a reliable and simple technique for estimating right IJV catheter depth and is more useful in cardiac surgery compared to the radiological-landmark method. Trial registration Thai Clinical Trials Registry (TCTR20200410012). Date registered April 9, 2020. [ABSTRACT FROM AUTHOR] more...

Background: The CARDOT scores have been developed for prediction of respiratory complications after thoracic surgery. This study aimed to externally validate the CARDOT score and assess the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for postoperative respiratory complication. Methods: A retrospective cohort study of consecutive thoracic surgical patients at a single tertiary hospital in northern Thailand was conducted. The development and validation datasets were collected between 2006 and 2012 and from 2015 to 2021, respectively. Six prespecified predictive factors were identified, and formed a predictive score, the CARDOT score (chronic obstructive pulmonary disease, American Society of Anesthesiologists physical status, right-sided operation, duration of surgery, preoperative oxygen saturation on room air, thoracotomy), was calculated. The performance of the CARDOT score was evaluated in terms of discrimination by using the area under the receiver operating characteristic (AuROC) curve and calibration. Results: There were 1086 and 1645 patients included in the development and validation datasets. The incidence of respiratory complications was 15.7% (171 of 1086) and 22.5% (370 of 1645) in the development and validation datasets, respectively. The CARDOT score had good discriminative ability for both the development and validation datasets (AuROC 0.789 (95% CI 0.753–0.827) and 0.758 (95% CI 0.730–0.787), respectively). The CARDOT score showed good calibration in both datasets. A high NLR (≥ 4.5) significantly increased the risk of respiratory complications after thoracic surgery (P < 0.001). The AuROC curve of the validation cohort increased to 0.775 (95% CI 0.750–0.800) when the score was combined with a high NLR. The AuROC of the CARDOT score with the NLR showed significantly greater discrimination power than that of the CARDOT score alone (P = 0.008). Conclusions: The CARDOT score showed a good discriminative performance in the external validation dataset. An addition of a high NLR significantly increases the predictive performance of CARDOT score. The utility of this score is valuable in settings with limited access to preoperative pulmonary function testing. [ABSTRACT FROM AUTHOR] more...

Aim: To compare incidences of abnormal heart rate (HR) between the phenylephrine/ephedrine protocol (P/E protocol) against the ephedrine‐only (C) protocol, conventionally used for treating predelivery hypotension following spinal anesthesia for cesarean section. Methods: Two hundred and sixty‐eight parturients with pre‐delivery hypotension after spinal anesthesia were equally randomized to (1) Group P/E (n = 134), phenylephrine 100 mcg in 10 mL intravenously if HR ≥ 60 beats/min (bpm), or ephedrine 6 mg intravenously if HR < 60 bpm, and 2) Group C (n = 134). The primary outcome was the incidence of the parturients with abnormal HR after vasopressor administration. The secondary outcome was the mean differences of HR and hypotensive periods during the pre‐delivery period. Results: There was no significant difference of between‐group incidences of bradycardia (12.0% in Group P/E vs 6.7% in Group C, p = 0.136) and tachycardia (26.9% vs 35.8%, p = 0.114). Mean HR was 81.9 bpm (95% confidence interval [CI] 79.9, 84.3) in Group P/E, and 88.8 bpm (86.8, 90.6) in Group C (p < 0.001). The duration of hypotension in relation to the time interval from spinal anesthesia to delivery was 20.9% (95% CI 18.4–23.2) in Group P/E, and 26.5% (23.9–29.3) in Group C (p < 0.01). The calculated area under the curve (AUC) of abnormal HR in relation to time was significantly reduced only in Group P/E (p < 0.010). Conclusions: The incidences of out‐of‐range HR were comparable, but the P/E protocol resulted in a lower mean HR and better control of systolic blood pressure than the ephedrine‐only protocol. [ABSTRACT FROM AUTHOR] more...

Background: Ilioinguinal/iliohypogastric nerve block is commonly performed to control postherniotomy pain. The posterior quadratus lumborum block has been recently described as an effective analgesic technique for pediatric low abdominal surgery. No data were found regarding the use of posterior quadratus lumborum block in comparison with the traditional ilioinguinal/iliohypogastric nerve block in pediatric inguinal surgery. Aim: This randomized assessor‐blinded study compared postoperative analgesic effects between ultrasound‐guided posterior quadratus lumborum block and ilioinguinal/iliohypogastric nerve block in pediatric inguinal herniotomy. Methods: One‐ to seven‐year‐old children scheduled for unilateral open herniotomy were randomly assigned to receive either ultrasound‐guided posterior quadratus lumborum block with 0.25% bupivacaine 0.5 mL/kg or ultrasound‐guided ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2 mL/kg after induction of general anesthesia. The primary outcome was the proportion of patients who received postoperative oral acetaminophen. The required fentanyl in the recovery room, 24‐hour acetaminophen consumption, success rate of regional blocks, block performance data, block‐related complications, postoperative pain intensity, and parental satisfaction were assessed. Results: This study included 40 patients after excluding four cases who were ineligible. The number of patients who required postoperative oral acetaminophen was significantly lower in the posterior quadratus lumborum block group (15.8% vs 52.6%; OR: 5.9; 95% CI: 1.3, 27.3; P =.022). The pain scores at 30 minutes, 1, 2, 6, 12, and 24 hours were similar between groups. There was no evidence of between‐group differences in block performance time, the number of needle passes, block‐related complications, and parental satisfaction. Conclusion: The posterior quadratus lumborum block with 0.25% bupivacaine 0.5 mL/kg provided better pain control than the ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2 mL/kg after open herniotomy in children. The ultrasound guidance technique for the posterior quadratus lumborum block is safe and as simple as the ultrasound‐guided ilioinguinal/iliohypogastric nerve block for pediatric patients. [ABSTRACT FROM AUTHOR] more...

Background: The external anatomical landmark and the radiological landmark have been introduced to provide estimation of the depth of right internal jugular venous catheter during insertion. Aims: This study aimed to compare the accuracy, agreement, and reliability of the external anatomical landmark and the radiological landmark, confirmation being by transesophageal echocardiography. Methods: This prospective observational study was conducted in children ages 1‐15 years. The catheter was placed at the superior vena cava and the right atrium junction guided by transesophageal echocardiography. The catheter depth derived from the transesophageal echocardiography, the external anatomical landmark, and the radiological landmark was recorded. The optimal zone of the catheter tip was 5 mm below and 10 mm above the superior vena cava and the right atrium junction. Accuracy was assessed by the difference between the transesophageal echocardiography and the external anatomical landmark or the radiological landmark. Agreement with Bland‐Altman plots and correlation were tested. Results: Eighty participants, median age of 3 years, were enrolled. The median (IQR) differences between the depth of the transesophageal echocardiography and the external anatomical landmark or the radiological landmark were 0.30 (0, 0.70) and 0.10 (−0.20, 0.90) cm, respectively. Bland‐Altman plots demonstrated good agreement between the depths. The catheter tips were located in the optimal zone more frequently with the external anatomical landmark than the radiological landmark (94.7% vs 64.5%). The external anatomical landmark showed a stronger correlation to transesophageal echocardiography than the radiological landmark (r =.95 vs.83). Conclusion: Both the external anatomical landmark and the radiological landmark enabled accurate estimation of the central venous catheter depth close to the superior vena cava and the right atrium junction. The external anatomical landmark is of more potential use than the radiological landmark in clinical practice. [ABSTRACT FROM AUTHOR] more...