2022年 · 第102卷第32期

The handover of intraoperative anesthesia management is common. Shift handover can reduce the fatigue of anesthesiologists and improve the quality of anesthesia management, but at the same time, it may bring the risk of loss of critical information of patients. Several large observational studies have reported the relationship between intraoperative anesthesia management handover and postoperative complications, but the findings are inconsistent. Researchers from the University of Münster School of Medicine in Germany designed a multicenter randomized trial to clarify the impact of intraoperative anesthesiologist shift handover on postoperative mortality, readmission, and complications in adult patients. The study included American Society of Anesthesiologists (ASA) Grade 3 or 4 adult patients who underwent major elective surgery at 12 medical centers in Germany between June 2019 and June 2021 with an expected surgery time of more than 2 hours and were randomly assigned to either the complete or no-handover anesthesia management group. None of the participating institutions used standardized handover procedures, and the handover content was carried out according to the custom of our hospital. Primary outcome measures: combined outcomes of all-cause mortality, readmission, or severe postoperative complications within 30 days of surgery. Secondary endpoint: A total of 19 secondary endpoint measures, including all-cause mortality within 30 days after surgery, single outcome of readmission or severe postoperative complications, time of admission to intensive care unit (ICU) and length of hospital stay, etc. A total of 1 817 patients were enrolled in the study, of which 1 772 patients completed the trial. Patients were (66 ± 12) years old, 997 patients were male (56%), and 1 717 patients had ASA grade 3 (97%). The median total anesthesia time in the complete handover anesthesia management group was 267 min (IQR: 206 to 351 min), and the median time from start of anesthesia to shift handover was 144 min (IQR: 105-213 min). In the complete anesthesia management group (891 patients), 268 patients (30%) experienced a primary outcome event compared to 284 patients (33%) in the non-anesthesia management group (881 patients) (absolute risk difference: -2.5%, 95%CI：-6.8%~1.9%；OR=0.89，95%CI：0.72~1.10，P=0.27）； All-cause mortality within 30 days after surgery was 2.1% and 3.4% in both groups (absolute risk difference: -1.3%, 95%CI：-2.8%~0.2%；OR=0.61，95%CI：0.34~1.10，P=0.11）； The readmission rates were 13% and 16% in both groups (absolute risk difference: -2.7%, 95%CI：-5.9%~0.6%；OR=0.80，95%CI：0.61~1.05，P=0.12）； The incidence of severe postoperative complications was 21.9% and 21.6% (absolute risk difference: 0.3%, 95%CI：-3.6%~4.1%；OR：1.02，95%CI：0.81~1.28，P=0.91）。 There were no significant differences in the 19 secondary endpoints between the two groups. This study suggests that there is no significant difference in the combined outcome of mortality, readmission, or severe postoperative complications within 30 days after surgery for adult patients undergoing routine surgery.

Studies have confirmed alterations in the composition and function of the gut microbiota in women with fibromyalgia, including changes in the relative abundance of certain bile acid metabolizing bacteria. Bile acids can affect a variety of physiological processes, including visceral pain, but there are no studies exploring their relationship with the gut microbiota in patients with fibromyalgia. Researchers from McGill University Health Center in Canada used 16S rRNA sequencing and targeted metabolomics to study the characteristics of gut microbiota and circulating bile acids in 42 female patients with fibromyalgia and 42 healthy controls. It was found that the relative abundance of several bacteria known to metabolize bile acids was altered in female patients with fibromyalgia, accompanied by changes in serum concentrations of secondary bile acids, including a significant depletion of alpha-murine cholic acid. Statistical learning algorithms based on these serum bile acid concentrations can accurately identify patients with fibromyalgia. At the same time, serum alpha-murine cholic acid was highly correlated with symptom severity, including pain intensity and fatigue. The above findings suggest that alterations in serum bile acids are associated with nociceptive plastic pain, and the changes in gut microbiota composition and circulating secondary bile acid concentrations observed in the study appear to be consistent with the phenotype of increased nociception and strongly correlated with symptom severity. This study is the first to prove that changes in circulating bile acids in patients with fibromyalgia may be secondary to changes in the upstream intestinal microbiota. If it can be confirmed in other independent studies, the results of this study may help to develop molecular diagnostic aids for fibromyalgia and elucidate the pathogenesis of fibromyalgia syndrome.