Perioperative Medicine最新文献

{"title":"Use of colloids and crystalloids for perioperative clinical infusion management in cardiac surgery patients and postoperative outcomes: a meta-analysis.","authors":"Shan-Dong Chen, Yu-Tong Ma, Hui-Xia Wei, Xin-Rong Ou, Jia-Yi Liu, Ya-Lan Tian, Chao Zhang, Yun-Jin Xu, Yao Kong","doi":"10.1186/s13741-024-00445-0","DOIUrl":"10.1186/s13741-024-00445-0","url":null,"abstract":"<p><strong>Background: </strong>The optimal fluid management strategy for patients undergoing cardiac surgery was controversial regarding fluid volume and intraoperative fluid types. This study aimed to assess the correlation between colloids and crystalloids used for perioperative fluid therapy in cardiac surgery patients and postoperative prognosis.</p><p><strong>Methods: </strong>The Ovid MEDLINE(R) ALL, Embase, and Cochrane Central Register of Controlled Trials databases were searched for eligible studies on fluid management strategies using colloids and crystalloids for cardiac surgery patients published before August 25th, 2023.</p><p><strong>Results: </strong>Ten randomized controlled trials met the eligibility criteria. Compared to the use of crystalloids, the use of colloids, including hydroxyethyl starch (HES), albumin, and gelatine, did not show any differences in mortality, transfusion, acute kidney injury, and atrial fibrillation rates, postoperative blood loss, the length of hospital stay, or the length of intensive care unit (ICU) stay. The results of this meta-analysis showed that the crystalloid group had significantly reduced postoperative chest tube output compared to the colloid group. In the subgroup analysis, the amount of fresh frozen plasma (FFP) infused was significantly lower when using fluid management in the ICU and when using isotonic crystalloids compared to the colloids. In addition, when using fluid management in the ICU, patients in the colloid group had a significant increase in urine volume 24 h after surgery. However, other related factors, including the type of crystalloid solution, type of colloidal solution, and timing of liquid management, did not affect most outcomes.</p><p><strong>Conclusion: </strong>Both colloids and crystalloids could be used as alternatives for perioperative fluid management after cardiac surgery. The use of crystalloids significantly reduced the postoperative chest tube output, and the need for FFP infusion decreased significantly with the use of isotonic crystalloids or fluid management during the ICU stay. ICU patients in the colloid group had higher urine output 24 h after surgery. In addition, although the infusion method was not related to most outcomes, the rates of red blood cell and FFP transfusion and postoperative blood loss in the crystalloid group seemed to be lower, which needed to be further studied in high-quality and large-sample RCTs.</p><p><strong>Trial registration: </strong>PROSPERO, CRD42023415234.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"83"},"PeriodicalIF":2.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11267693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence-free survival after curative resection of non-small cell lung cancer between inhalational gas anesthesia and propofol-based total intravenous anesthesia: a multicenter, randomized, clinical trial (GAS TIVA trial): protocol description.","authors":"Jeayoun Kim, Susie Yoon, In-Kyung Song, Kyuho Lee, Wonjung Hwang, Heezoo Kim, Dong Kyu Lee, Hyun Kyoung Lim, Seong-Hyop Kim, Jong Wha Lee, Boohwi Hong, Randal S Blank, Alessia Pedoto, Wanda Popescu, Glezinis Theresa, Archer Kilbourne Martin, Mathew Patteril, Atipong Pathanasethpong, Yada Thongsuk, Tanatporn Pisitpitayasaree, Aijie Huang, Hui Yu, Poonam Malhotra Kapoor, Kyunga Kim, Sang Ah Chi, Hyun Joo Ahn","doi":"10.1186/s13741-024-00436-1","DOIUrl":"10.1186/s13741-024-00436-1","url":null,"abstract":"<p><strong>Background: </strong>Surgery is the primary treatment for non-small cell lung cancer (NSCLC), but microscopic residual disease may be unavoidable. Preclinical studies have shown that volatile anesthetics might suppress host immunity and promote a pro-malignant environment that supports cancer cell proliferation, migration, and angiogenesis, whereas propofol may preserve cell-mediated immunity and inhibit tumor angiogenesis. However, clinical evidence that propofol-based total intravenous anesthesia (TIVA) can reduce tumor recurrence after curative resection remains inconsistent due to the retrospective observational nature of previous studies. Therefore, we will test the hypothesis that the recurrence-free survival (RFS) after curative resection of NSCLC is higher in patients who received TIVA than volatile anesthetics (GAS) in this multicenter randomized trial.</p><p><strong>Methods: </strong>This double-blind, randomized trial will enroll patients at 22 international sites, subject to study registration, institutional review board approval, and patient written informed consent. Eligible patients are adult patients undergoing lung resection surgery with curative intent for NSCLC. Exclusion criteria will be contraindications to study drugs, American Society of Anesthesiologists physical status IV or higher, or preexisting distant metastasis or malignant tumor in other organs. At each study site, enrolled subjects will be randomly allocated into the TIVA and GAS groups with a 1:1 ratio. This pragmatic trial does not standardize any aspect of patient care. However, potential confounders will be balanced between the study arms. The primary outcome will be RFS. Secondary outcomes will be overall survival and complications within postoperative 7 days. Enrollment of 5384 patients will provide 80% power to detect a 3% treatment effect (hazard ratio of 0.83) at alpha 0.05 for RFS at 3 years.</p><p><strong>Discussion: </strong>Confirmation of the study hypothesis would demonstrate that a relatively minor and low-cost alteration in anesthetic management has the potential to reduce cancer recurrence risk in NSCLC, an ultimately fatal complication. Rejection of the hypothesis would end the ongoing debate about the relationship between cancer recurrence and anesthetic management.</p><p><strong>Trial registration: </strong>The study protocol was prospectively registered at the Clinical trials ( https://clinicaltrials.gov , NCT06330038, principal investigator: Hyun Joo Ahn; date of first public release: March 25, 2024) before the recruitment of the first participant.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"79"},"PeriodicalIF":2.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of thoracic epidural analgesia versus other analgesic techniques in patients post-oesophagectomy.","authors":"Duncan Macrosson, Adam Beebeejaun, Peter M Odor","doi":"10.1186/s13741-024-00437-0","DOIUrl":"10.1186/s13741-024-00437-0","url":null,"abstract":"<p><strong>Background: </strong>Oesophageal cancer surgery represents a high perioperative risk of complications to patients, such as postoperative pulmonary complications (PPCs). Postoperative analgesia may influence these risks, but the most favourable analgesic technique is debated. This review aims to provide an updated evaluation of whether thoracic epidural analgesia (TEA) has benefits compared to other analgesic techniques in patients undergoing oesophagectomy surgery. Our hypothesis is that TEA reduces pain scores and PPCs compared to intravenous opioid analgesia in patients post-oesophagectomy.</p><p><strong>Methods: </strong>Electronic databases PubMed, Excerpta Medica Database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomised trials of analgesic interventions in patients undergoing oesophagectomy surgery. Only trials including thoracic epidural analgesia compared with other analgesic techniques were included. The primary outcome was a composite of respiratory infection, atelectasis and respiratory failure (PPCs), with pain scores at rest and on movement as secondary outcomes. Data was pooled using random effect models and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Data from a total of 741 patients in 10 randomised controlled trials (RCTs) from 1993 to 2023 were included. Nine trials were open surgery, and one trial was laparoscopic. Relative to intravenous opioids, TEA significantly reduced a composite of PPCs (risk ratio (RR) 3.88; 95% confidence interval (CI) 1.98-7.61; n = 222; 3 RCTs) and pain scores (0-100-mm visual analogue scale or VAS) at rest at 24 h (MD 9.02; 95% CI 5.88-12.17; n = 685; 10 RCTs) and 48 h (MD 8.64; 95% CI 5.91-11.37; n = 685; 10 RCTs) and pain scores on movement at 24 h (MD 14.96; 95% CI 5.46-24.46; n = 275; 4 RCTs) and 48 h (MD 16.60; 95% CI 8.72-24.47; n = 275; 4 RCTs).</p><p><strong>Conclusions: </strong>Recent trials of analgesic technique in oesophagectomy surgery are restricted by small sample size and variation of outcome measurement. Despite these limitations, current evidence indicates that thoracic epidural analgesia reduces the risk of PPCs and severe pain, compared to intravenous opioids in patients following oesophageal cancer surgery. Future research should include minimally invasive surgery, non-epidural regional techniques and record morbidity, using core outcome measures with standardised endpoints.</p><p><strong>Trial registration: </strong>Prospectively registered on PROSPERO (CRD42023484720).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"80"},"PeriodicalIF":2.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11267804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous non-invasive vs. invasive arterial blood pressure monitoring during neuroradiological procedure: a comparative, prospective, monocentric, observational study.","authors":"Xavier Chapalain, Thomas Morvan, Jean-Christophe Gentric, Aurélie Subileau, Christophe Jacob, Anna Cadic, Anaïs Caillard, Olivier Huet","doi":"10.1186/s13741-024-00442-3","DOIUrl":"10.1186/s13741-024-00442-3","url":null,"abstract":"<p><strong>Background: </strong>In the perioperative setting, the most accurate way to continuously measure arterial blood pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developed to allow non-invasive measurements and are increasingly used, but need further evaluation. The aim of this study is to evaluate the accuracy and clinical concordance between two devices for the measurement of ABP during neuroradiological procedure.</p><p><strong>Methods: </strong>This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuroradiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with two different technologies: radial artery catheter and Nexfin. Bland-Altman and error grid analyses were performed to evaluate the accuracy and clinical concordance between devices.</p><p><strong>Results: </strong>From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin were located in the risk zone A or B. However, 65.7% of hypertension events and 41% of hypotensive events were respectively not detected by Nexfin. Compared to the artery catheter, a significant relationship was found for SAP (r² = 0.78) and MAP (r² = 0.80) with the Nexfin (p < 0.001). Bias and limits of agreement (LOA) were respectively 9.6 mmHg (- 15.6 to 34.8 mmHg) and - 0.8 mmHg (- 17.2 to 15.6 mmHg), for SAP and MAP.</p><p><strong>Conclusions: </strong>Nexfin is not strictly interchangeable with artery catheter for ABP measuring. Further studies are needed to define its clinical use during neuroradiological procedure.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, registration number: NCT05283824.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"77"},"PeriodicalIF":2.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11265173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis","authors":"Tatiana S. do Nascimento, Rodrigo O. L. Pereira, Eduardo Maia, Tetsu Ohnuma, Mariana G. da Costa, Eric Slawka, Carlos Galhardo, Vijay Krishnamoorthy","doi":"10.1186/s13741-024-00439-y","DOIUrl":"https://doi.org/10.1186/s13741-024-00439-y","url":null,"abstract":"Glucagon-like peptide-1 agonist receptors (GLP-1RAs), medications used for glycemic control and weight loss, are increasing worldwide. In the perioperative period, the major concern related to GLP-1RA is gastric emptying delay and risk of aspiration. This meta-analysis and systematic review compared the risks and benefits of using GLP-1 agonist receptors and control in surgical and nonsurgical procedures under anesthesia or sedation. We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials and observational studies involving patients &gt; 18 years undergoing elective surgeries or procedures. Outcomes of interest were pre-procedural gastrointestinal (GI) symptoms, residual gastric content assessed by endoscopy, pulmonary aspiration during anesthesia/sedation, perioperative glycemic control, postoperative inotropic support, nausea/vomiting (PONV), atrial fibrillation, and 30-day mortality rate. We used a random effects model, with odds ratio and mean difference computed for binary and continuous outcomes, respectively. Fourteen randomized and observational studies with 2143 adult patients undergoing elective surgeries and procedures were included. GLP-1RA resulted in increased pre-procedural GI symptoms (OR 7.66; 95% CI 3.42, 17.17; p &lt; 0.00001; I2 = 0%) and elevated residual gastric content (OR 6.08; 95% CI 2.86, 12.94; p &lt; 0.00001; I2 = 0%). GLP-1RA resulted in lower glycemic levels (MD − 0.73; 95% CI − 1.13, − 0.33; p = 0.0003; I2 = 90%) and lower rate of rescue insulin administration (OR 0.39; 95% CI 0.23, 0.68 p = 0.0009; I2 = 35%). There was no significant difference in rate of perioperative hypoglycemia (OR 0.60; 95% CI 0.29, 1.24; p = 0.17; I2 = 0%), hyperglycemia (OR 0.89; 95% CI 0.59, 1.34; p = 0.58; I2 = 38%), need for postoperative inotropic support (OR 0.57; 95% CI 0.33, 1.01; p = 0.05; I2 = 0%), atrial fibrillation (OR 1.02; 95% CI 0.52, 2.01; p = 0.95; I2 = 16%), rate of PONV (OR 1.35; 95% CI 0.82, 2.21; p = 0.24; I2 = 0%), and 30-day mortality rate (OR 0.54; 95% CI 0.14, 2.05; p = 0.25; I2 = 0%). Compared to control, pre-procedural GLP-1RA increased the rate of GI symptoms and the risk of elevated residual gastric content despite adherence to fasting guidelines. GLP-1RA improved glycemic control and decreased the rate of rescue insulin administration. There was no significant difference in the rates of perioperative hypo or hyperglycemia, postoperative inotropic support, PONV, atrial fibrillation, and 30-day mortality. • Question: What are the benefits and risks of using GLP-1RAs in patients undergoing anesthesia or sedation? • Finding: This meta-analysis demonstrates that perioperative GLP-1RAs increased the rate of GI symptoms and the risk of elevated residual gastric content, improved glycemic control, and did not change the rates of hypo or hyperglycemia, postoperative inotropic support, PONV, atrial fibrillation, and 30-day mortality. • Meaning: Despite improving glycemic control, providers must be","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"38 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative fluid management for adult cardiac surgery: network meta-analysis pooling on twenty randomised controlled trials.","authors":"Yu-Tong Ma, Chen-Yang Xian-Yu, Yun-Xiang Yu, Chao Zhang","doi":"10.1186/s13741-024-00440-5","DOIUrl":"10.1186/s13741-024-00440-5","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate colloids and crystalloids used in perioperative fluid therapy for cardiac surgery patients to further investigate the optimal management strategies of different solutions.</p><p><strong>Method: </strong>RCTs about adult surgical patients allocated to receive perioperative fluid therapy for electronic databases, including Ovid MEDLINE, EMBase, and Cochrane Central Register of Controlled Trials, were searched up to February 15, 2023.</p><p><strong>Results: </strong>None of the results based on network comparisons, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay, were statistically significant. Due to the small number of included studies, the results, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, are from the direct comparison. For transfusion of RBCs, significant differences were observed in the comparisons of 3% gelatine vs. 6% HES 200/0.5, 4% albumin vs. 5% albumin, 4% gelatine vs. 5% albumin, 5% albumin vs. 6% HES 200/0.5, and 6% HES 130/0.4 vs. 6% HES 200/0.5. In transfusion of FFP, significant differences were observed in comparisons of 3% gelatine vs. 4% gelatine, 3% gelatine vs. 6% HES 200/0.5, 5% albumin vs. 6% HES 200/0.5, 4% gelatine vs. 5% albumin, 4% gelatine vs. 6% HES 200/0.4, and 6% HES 130/0.4 vs. 6% HES 200/0.5. For urinary output at 24 h after surgery, the results are deposited in the main text.</p><p><strong>Conclusion: </strong>This study showed that 3% gelatin and 5% albumin can reduce the transfuse RBC and FFP. In addition, the use of hypertonic saline solution can increase urine output, and 5% albumin and 6% HES can shorten the length of ICU stay. However, none of the perioperative fluids showed an objective advantage in various outcomes, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay. The reliable and sufficient evidences on the injury of the kidney, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, was still lacking. In general, perioperative fluids had advantages and disadvantages, and there were no evidences to support the recommendation of the optimal perioperative fluid for cardiac surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"76"},"PeriodicalIF":2.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment and validation of a risk prediction model for delayed neurocognitive recovery associated with cerebral oxygen saturation monitoring.","authors":"Ning Luo, Xiaowei Gao, Chunyan Ye, Lu Wang, Lu Tang, Yongqiu Xie, E Wang","doi":"10.1186/s13741-024-00432-5","DOIUrl":"10.1186/s13741-024-00432-5","url":null,"abstract":"<p><strong>Background: </strong>Delayed neurocognitive recovery (DNR) is a common complication in patients undergoing laparoscopic surgery, and there are currently no effective therapies. It is vital to provide a reliable basis for clinical prediction. This study tried to analyse the risk factors for DNR in patients undergoing laparoscopic colorectal surgery and to establish a risk prediction model.</p><p><strong>Methods: </strong>A retrospective analysis of the clinical data and DNR status of patients undergoing laparoscopic colorectal surgery at Xiangya Hospital of Central South University from March 2018 to July 2020 was conducted. Logistic regression was performed to analyse the related risk factors for DNR post-operatively, and the predictive model of DNR post-operatively was constructed and validated internally. Patients who underwent laparoscopic colorectal surgery between January and July 2021 were also selected for external validation of the predictive model, to ultimately investigate the risk factors for DNR in patients undergoing laparoscopic colorectal surgery.</p><p><strong>Results: </strong>The incidence of DNR in patients undergoing laparoscopic colorectal surgery was 15.2% (31/204). The maximum variability of cerebral oxygen, age, education, and pre-existing diabetes was related to the incidence of DNR (p < 0.05). The risk prediction model of DNR after laparoscopic colorectal surgery was established. The internal and external validation showed that the discrimination was good (the AUCs were 0.751 and 0.694, respectively).</p><p><strong>Conclusions: </strong>The risk prediction model of DNR related to cerebral oxygen saturation monitoring shows good predictive performance and clinical value, providing a basis for postoperative DNR prevention.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"75"},"PeriodicalIF":2.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between surgical position and neck pain in patients undergoing thyroidectomy: a prospective observational study.","authors":"Salvatore Pagliaro, Leonardo Rossi, Michela Meligeni, Letizia Catani, Riccardo Morganti, Gabriele Materazzi, Sohail Bakkar, Antonia Montanino, Danilo Pagliaro, Monica Scateni, Nicola Pagnucci","doi":"10.1186/s13741-024-00428-1","DOIUrl":"10.1186/s13741-024-00428-1","url":null,"abstract":"<p><strong>Background: </strong>Thyroid diseases are one of the most common health problems worldwide. Although they represent a necessary step in order to perform thyroidectomy, hyperextension of the neck can potentially increase postoperative pain. The aim of this study is to determine a correlation between the degree of neck hyperextension on the operative table and the postoperative pain in patients undergoing open thyroidectomy.</p><p><strong>Methods: </strong>Patients were prospectively enrolled from the cohort of patients operated at the Endocrine Surgery Unit of the University Hospital of Pisa, between May and July 2021. Both of patients who underwent total thyroidectomy or hemi-thyroidectomy were recruited. The following data were analysed in order to find a correlation with postoperative pain at 24 h: age, gender, type of surgery, BMI, operative time, and degree of neck extension.</p><p><strong>Results: </strong>Overall, 195 patients were enrolled. A direct, statistically significant correlation emerged between the degree of neck hyperextension and the postoperative pain 24 h after surgery, regardless of the pain of the surgical wound (p < 0.001; beta 0.270).</p><p><strong>Conclusions: </strong>A direct correlation emerges between neck tilt angle and postoperative neck pain. Moreover, total thyroidectomy (TT) predisposes more to postoperative neck pain, considering the type of surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"74"},"PeriodicalIF":2.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11251317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of postoperative results after a presurgical optimisation programme.","authors":"Francisco García Sánchez, Natalia Mudarra García","doi":"10.1186/s13741-024-00430-7","DOIUrl":"10.1186/s13741-024-00430-7","url":null,"abstract":"<p><strong>Background: </strong>Presurgical optimisation programmes decrease the risk of postoperative complications, reduce hospital stays and speed up patient recovery. They usually involve a multidisciplinary team addressing physical, nutritional and psychosocial issues. The objective of this study was to assess the results of implementing a presurgical optimisation programme led by a liaison nurse in patients undergoing major surgery in a primary general hospital.</p><p><strong>Methods: </strong>An observational, retrospective, descriptive, cross-sectional, comparative study based on the revision of patients' health records undergoing major surgery between January 2019 and December 2022. Patients entering the presurgical optimisation programme (intervention group) were compared with patients receiving usual medical care (control group). The presurgical optimisation programme consisted of oral nutritional supplementation, physical exercise, strengthening of lung capacity and psychological and emotional support. Frequency (%) of surgery complications and use of healthcare resources (duration of hospitalisation, time spent in the intensive care unit (ICU), and readmission) at day 30 were recorded. Descriptive statistics were applied.</p><p><strong>Results: </strong>Two hundred eleven patients (58.5% men, mean age: 65.76 years (SD 11.5), 75.2%. non-smokers; mean body mass index (BMI): 28.32 (SD 5.38); mean Nutritional Risk Score (NRS) 3.71 (SD 1.35; oncology diagnosis: 88.6%) were included: 135 in the intervention group, and 76 in the control group. The average duration of the presurgical optimisation programme was 20 days (SD 5). Frequency of postoperative complications was 25% (n = 33) in the intervention group and 52.6% (n = 40) in the control group (p < 0.001) [odds ratio (OR) = 3.4; 95% confidence interval (CI) (1.8; 6.2)]. 14.5% (n = 19) of patients in the intervention group and 34.2% (n = 26) in the control group had remote postoperative complications [OR = 3.1; 95% CI (1.6; 6.2)]. Patients in the intervention group spent fewer days in the hospital [mean 8.34 (SD 6.70) vs 11.63 (SD 10.63)], and there were fewer readmissions at 30 days (7.6% vs 19.7%) compared with the control group.</p><p><strong>Conclusions: </strong>A presurgical optimisation programme led by a liaison nurse decreases the rate of immediate and late surgical complications and reduces hospital stays and readmissions in patients undergoing major surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"73"},"PeriodicalIF":2.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of kidney function in cardiac surgery patients with intra-abdominal hypertension: expert opinion.","authors":"Vanessa Moll, Ashish K Khanna, Andrea Kurz, Jiapeng Huang, Marije Smit, Madhav Swaminathan, Steven Minear, K Gage Parr, Amit Prabhakar, Manxu Zhao, Manu L N G Malbrain","doi":"10.1186/s13741-024-00416-5","DOIUrl":"10.1186/s13741-024-00416-5","url":null,"abstract":"<p><p>Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of cardiac surgery patients. CSA-AKI is multifactorial, with low abdominal perfusion pressure often overlooked. Abdominal perfusion pressure is calculated as mean arterial pressure minus intra-abdominal pressure (IAP). IAH decreases cardiac output and compresses the renal vasculature and renal parenchyma. Recent studies have highlighted the frequent occurrence of IAH in cardiac surgery patients and have linked the role of low perfusion pressure to the occurrence of AKI. This review and expert opinion illustrate current evidence on the pathophysiology, diagnosis, and therapy of IAH and ACS in the context of AKI.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"13 1","pages":"72"},"PeriodicalIF":2.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}