Perioperative Medicine最新文献

{"title":"PACU discharge: equally safe and more cost-effective than floor admission for uncomplicated laparoscopic appendectomy.","authors":"Christopher Hendrix, Sarah Swint, Rachel Krawczyk, Tyler Soderling, Jana Alford, John Shellenberger","doi":"10.1186/s13741-025-00511-1","DOIUrl":"10.1186/s13741-025-00511-1","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic appendectomy is a common emergency surgical procedure worldwide, known for its benefits of reduced pain, shorter hospital stays, and quicker recovery times. Although postoperative care typically involves observation on the surgical floor, advances in surgical techniques and perioperative care have introduced the potential for discharging patients directly from the post-anesthesia care unit (PACU). This study aims to evaluate the safety and cost-effectiveness of direct PACU discharge compared to traditional floor admission for patients undergoing uncomplicated laparoscopic appendectomy.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed adult patients diagnosed with uncomplicated appendicitis between January 2021 and December 2023. Patients were divided into two cohorts: those discharged directly from PACU and those admitted to the floor before discharge. Primary outcomes included 30-day readmission rates, reoperation rates, and postoperative complications. Secondary outcomes assessed costs, surgery times, and demographic variables. Statistical analysis involved Pearson's chi-square tests, t-tests, and multivariate logistic regression.</p><p><strong>Results: </strong>A total of 203 patients were included, with 103 in the PACU cohort and 100 in the floor cohort. PACU patients were younger and had fewer comorbidities than floor patients. No significant differences were found in 30-day readmission, reoperation rates, or complications between the groups. PACU discharge was associated with significantly shorter hospital stays (8 h vs. 26 h, p < 0.001) and lower costs, with average charges of $27,739 for PACU discharges versus $31,593 for floor discharges, primarily due to reduced labor costs.</p><p><strong>Conclusion: </strong>Direct discharge from the PACU following uncomplicated laparoscopic appendectomy is both safe and cost-effective compared to floor admission. These findings suggest that PACU discharge is a viable option for well-selected patients, with the potential for significant healthcare savings. Future research should focus on refining patient selection criteria and validating these findings in diverse healthcare settings.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"25"},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567794","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":"Sublingual sufentanil after orthopaedic and abdominal surgery: long-term outcome and safety.","authors":"Michael Borck, Jan D Wandrey, Claudia Spies, Sascha Tafelski","doi":"10.1186/s13741-025-00506-y","DOIUrl":"10.1186/s13741-025-00506-y","url":null,"abstract":"<p><strong>Background: </strong>Acute postoperative pain management often requires opioid treatment with patient-controlled analgesia (PCA). Non-invasive PCA with a sublingual sufentanil tablet system (SSTS) may reduce acute pain sufficiently, but opioids are associated with central nerve system side effects and risk of long-term opioid use postoperatively. The objective of this study was to observe the SSTS to assess the incidence of postoperative chronic pain (PCP) and postoperative delirium (POD).</p><p><strong>Methods: </strong>This was a longitudinal cohort study based at a university hospital between November 2017 and November 2021. Adults undergoing elective orthopaedic knee or abdominal surgery planned for PCA as postoperative pain management were included. They received the SSTS in addition to a standardised pain medication protocol depending on the surgery they underwent. Exclusion criteria were pregnancy, emergency surgery, concurrent participation in another clinical trial and chronic opioid use before surgery. Patients were followed after surgery in hospital and over 3 and 12 months for pain, cognitive function and side effects.</p><p><strong>Results: </strong>Altogether N = 80 patients were included with SSTS postoperatively. Daily pain experience decreased from pre-operatively 89.2% of patients to 45.7% and 22.5% at 3 and 12 months. None of our patients developed postoperative delirium after surgery. Patients reported high overall satisfaction with SSTS (median 8.0/10 points, IQR 3). However, 51% of patients had difficulties with handling the SSTS and required acute replacement of the authentication tag.</p><p><strong>Conclusions: </strong>SSTS sufficiently treated acute postoperative pain without incidence of POD and demonstrated good tolerability and overall ease. Postoperative pain improved significantly over time but 22% still reported chronic pain related to surgery. Technical issues with the identification thumb tag limited the feasibility of SSTS.</p><p><strong>Trial registration: </strong>This prospective longitudinal cohort study was approved by the ethics committee of the Charité Universitätsmedizin Berlin (Ethics committee 2, Campus Charité Virchow Klinikum, EA2/041/17, Prof. Dr. jur. R. Seeland, 21.03.2017) and was registered in the study register ( https://clinicaltrials.gov/ct2/show/NCT03133858 ).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"23"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531743","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":"Non-fasting versus fasting before percutaneous cardiac procedures: a systematic review and meta-analysis of randomized controlled trials.","authors":"Elsayed Balbaa, Ahmed A Ibrahim, Mohammad Bazzazeh, Shehroze Tabassum, Shrouk Ramadan, Ahmed Farid Gadelmawla, Abdelrahman Elshimy, Obieda Altobaishat, Mohamed Abuelazm","doi":"10.1186/s13741-024-00485-6","DOIUrl":"10.1186/s13741-024-00485-6","url":null,"abstract":"<p><strong>Background and objective: </strong>Despite the absence of scientific evidence, fasting before percutaneous cardiac catheterization is still recommended to minimize complications. This systematic review and meta-analysis aimed to compare the outcomes of non-fasting protocols in patients undergoing percutaneous cardiac procedures.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, Scopus, WOS, Embase, and Cochrane was conducted until September 2024. Dichotomous outcomes were pooled using risk ratio (RR), while continuous outcomes were pooled using standardized mean difference (SMD).</p><p><strong>Prospero id: </strong>CRD42024586147.</p><p><strong>Results: </strong>Five RCTs with 2034 patients were included. There was no significant difference between both groups regarding patient satisfaction score [SMD - 0.65, 95% CI (- 1.39, 0.09), P = 0.08], intra/postoperative aspiration (RR 1.00, 95% CI [0.20, 4.96], P = 1.00), postprocedural pneumonia (RR 0.60, 95% CI [0.14, 2.51], P = 0.49), emergency endotracheal intubation (RR 0.99, 95% CI [0.10, 9.51], P = 1.00), nausea/vomiting (RR 0.89, 95% CI [0.46, 1.76], P = 0.75), anti-emetic use (RR 0.49, 95% CI [0.24, 1.03], P = 0.06), hypoglycemia (RR 0.74, 95% CI [0.43, 1.28], P = 0.28), and the need for inotrope/vasopressor therapy (RR 1.03, 95% CI [0.81, 1.30], P = 0.82). However, the non-fasting approach significantly decreased the sensation of tiredness/fatigue (SMD - 0.31 with 95% CI [- 0.51, - 0.11], P < 0.001).</p><p><strong>Conclusion: </strong>The non-fasting protocol demonstrated comparable efficacy, safety, and overall satisfaction to the conventional fasting approach. REVIEW REGISTRATION : PROSPERO CRD42024586147.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"24"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531740","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":"Synthetic colloids as priming fluids in cardiopulmonary bypass and postoperative acute kidney injury: a propensity score-matched study.","authors":"Jing Wang, Luyu Bian, Tianlong Wang, Han Zhang, Jieru Zhang, Qiaoni Zhang, Gang Liu, Jian Wang, Yuan Teng, Zhenzhen Li, Shujie Yan, Bingyang Ji","doi":"10.1186/s13741-025-00503-1","DOIUrl":"10.1186/s13741-025-00503-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal fluid management strategy for patients undergoing on-pump cardiac surgery was controversial regarding the fluid types. This study aimed to compare the impact of hydroxyethyl starch (HES) and succinylated gelatin on postoperative acute kidney injury (AKI).</p><p><strong>Methods: </strong>This is a single-center, retrospective study. Adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) between 2018 and 2022 were included. Patients were grouped by the priming solution used: HES (the HES group) or succinylated gelatin (the gelatin group). The primary outcome was the incidence of postoperative AKI, and secondary outcomes included continuous renal replacement therapy (CRRT), blood transfusions, myocardial infarction, lung infection, cerebrovascular events, chest drainage, duration of mechanical ventilation, intensive care unit (ICU) stay, in-hospital mortality, and associated costs. Propensity score matching (PSM) was conducted to adjust for characteristic differences between the two groups.</p><p><strong>Results: </strong>A total of 14,443 patients were included. After 1:1 propensity score matching, 1880 pairs were analyzed. Baseline characteristics were comparable between the matched groups. The incidence of AKI was significantly lower in the gelatin group (3.0% vs. 5.1%, P = 0.001). No significant differences were found in transfusion requirements after score-matching. The use of HES was independently associated with increased odds of AKI (adjusted odds ratio [aOR], 1.785; 95% CI, 1.262-2.526; P = 0.001). The effects of HES use on the occurrence of postoperative AKI were greater in elderly and female patients.</p><p><strong>Conclusion: </strong>The use of HES as a priming solution in on-pump cardiac surgery was associated with an increased risk of postoperative AKI compared to gelatin, although it did not affect transfusion requirements. These findings highlight the importance of considering the priming solution type in fluid management during cardiac surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"22"},"PeriodicalIF":2.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476536","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":"Comparing the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants: a meta-analysis.","authors":"Yuxi Wei, Chi Chen, Zhihong Yu, Jun Guo","doi":"10.1186/s13741-025-00502-2","DOIUrl":"10.1186/s13741-025-00502-2","url":null,"abstract":"<p><strong>Background: </strong>Hip fracture in the elderly is considered a significant public health burden due to a high rate of mortality and this is globally being seen as a serious concern. However, comorbidities requiring anticoagulants are of particular concern in the post-operative setting. In this analysis, we aimed to systematically compare the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants (NOACs).</p><p><strong>Methods: </strong>Web of Science, EMBASE, Google Scholar, the Cochrane databases, MEDLINE, and http://www.</p><p><strong>Clinicaltrials: </strong>gov were searched for relevant studies from January to February 2024. The post-operative complications were considered the endpoints in this study. Risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the data following statistical analysis. Weighted mean difference (WMD) calculated with mean and standard deviation, with 95% CIs, was used to represent the result for mean length of hospital stay.</p><p><strong>Results: </strong>A total number of 15,019 participants with hip fracture were included in this analysis. Eleven thousand two hundred and fifteen (11,215) participants were on warfarin therapy prior to fracture and surgery, whereas 3804 participants were on NOACs. Results of this analysis showed that the risks of post-operative mortality (RR, 1.03; 95% CI, 0.92-1.16; P = 0.57), deep vein thrombosis (RR, 1.10; 95% CI, 0.41-2.98; P = 0.84), pulmonary embolism (RR, 1.17; 95% CI, 0.44-3.10; P = 0.75), stroke (RR, 1.25; 95% CI, 0.23-6.71; P = 0.80) and myocardial infarction (RR, 0.42; 95% CI, 0.03-6.98; P = 0.55) were not significantly different in patients who underwent surgery for hip fracture and who were on warfarin versus on NOACs. The risks of infection (RR, 0.90; 95% CI, 0.28-2.93; P = 0.87) and blood transfusion (RR, 1.08; 95% CI, 0.80-1.45; P = 0.62) were also similarly manifested. However, the length of hospital stay [WMD, - 0.93; 95% CI, - 1.83 to 0.03; P = 0.04] was significantly less in patients who were on NOACs in comparison to those who were on warfarin.</p><p><strong>Conclusions: </strong>The post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on NOACs were similar. However, those patients who were on warfarin had a significantly longer length of hospital stay.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"21"},"PeriodicalIF":2.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441785","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":"Effect of combination of remimazolam and sevoflurane on elderly patients' recovery quality from general anesthesia after laparoscopic abdominal surgery: a randomized controlled trial.","authors":"Xiawei Lai, Shuxian Liu, Di Wang, Yuqing Chi, Xiaoqun Su, Lideng Guo, Zhijing Zhang, Haihui Xie","doi":"10.1186/s13741-025-00501-3","DOIUrl":"10.1186/s13741-025-00501-3","url":null,"abstract":"<p><strong>Purpose: </strong>Remimazolam toluene sulfonic acid is a short-acting benzodiazepine primarily studied for intravenous anesthesia. To date, few studies have focused on the effects of the combination of remimazolam and inhalation anesthesia or its impact on postoperative recovery. Our study aims to investigate the influence of remimazolam combined with sevoflurane for general anesthesia maintenance on postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery.</p><p><strong>Methods: </strong>A total of 109 patients, aged 60 to 80 years old, scheduled for laparoscopic gallbladder or hernia surgery were randomly divided into two groups: remimazolam group (Group R) and remimazolam-sevoflurane combination group (Group S). Group R had remimazolam for anesthesia maintenance, while Group S received remimazolam and sevoflurane. Both groups followed the same induction protocol, with bispectral index (BIS) maintained between 40 and 60 during surgery. The primary outcome was assessed with the Quality of Recovery (QoR)-15 score. The secondary outcomes included loss of consciousness (LoC), perioperative hemodynamic variables, extubation time, and the incidence of postoperative adverse events. During the study, 7 patients were lost to follow-up, and finally, 102 patients were included in the statistical analysis. The data will be analyzed in a modified full analysis set.</p><p><strong>Results: </strong>Group S had higher QoR-15 and physical comfort scores on postoperative day (POD) 1 and POD3 compared to Group R (135.0[8.0] vs. 132.0[11.0], P = 0.004; 143.0[6.0] vs. 141.0[7.0], P = 0.007). Despite using less remifentanil (P = 0.021), Group S had a significantly longer extubation time (P = 0.048). There were no significant differences in induction time, perioperative hemodynamic variables, or postoperative adverse events between the groups.</p><p><strong>Conclusion: </strong>Combining remimazolam with sevoflurane improves postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery. This approach ensures optimal anesthesia depth and sedation while minimizing adverse events and complications.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry ChiCTR2200065332. Date of registration: 02/11/2022.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"20"},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414752","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":"Perioperative real-time information sharing and its impact on family members' anxiety in patients undergoing elective thoracoscopic lobectomy: a single-center randomized controlled trial.","authors":"Yun Linjun, Luo Xi, Ying Yanmei, Luo Wulajing, Fang Linjie, Kang Jingping, He Xiao","doi":"10.1186/s13741-025-00499-8","DOIUrl":"10.1186/s13741-025-00499-8","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effect of perioperative real-time information sharing on family members' anxiety in patients undergoing elective thoracoscopic lobectomy and to explore the potential role of information sharing in reducing anxiety levels among family members.</p><p><strong>Methods: </strong>This study was a prospective, single-center, well-designed randomized controlled trial (RCT), ensuring methodological rigor, which included family members of patients undergoing elective thoracoscopic lobectomy. Participants were randomly assigned to either the experimental group (real-time information-sharing group) or the control group (routine information communication group). Anxiety levels were assessed at multiple time points, including preoperative (T-1), intraoperative (T1, T2, T3, T4), and postoperative (T5, T6) stages, using widely used anxiety scales: the Self-Rating Anxiety Scale (SAS), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder 7 (GAD-7). Statistical analysis was performed using independent sample t-tests, with statistical significance set at P < 0.05 based on a predefined threshold.</p><p><strong>Results: </strong>At several key time points (T0, T1, T2, T3, T4, T5), family members in the experimental group showed significantly lower anxiety scores compared to those in the control group (P < 0.05). Notably, at T1 (when the patient entered the operating room) and T2 (30 min after the surgery began), the GAD-7 scores of the experimental group were significantly lower than those in the control group (T = 2.98, P = 0.003; T = 3.45, P = 0.001). The experimental group also had significantly lower SAS and HADS scores at time points T-1, T0, T1, T2, T3, and T4 compared to the control group.</p><p><strong>Conclusion: </strong>Perioperative real-time information sharing has been shown to significantly reduce anxiety levels in family members of patients undergoing elective thoracoscopic lobectomy, particularly during the early stages of surgery, such as when the patient enters the operating room and 30 min after the surgery begins. Real-time information sharing may serve as an effective intervention to improve the psychological well-being of family members and is worth promoting in clinical practice.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"19"},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399652","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":"Effects of remimazolam and propofol on sleep rhythm and delirium after spinal surgery in elderly patients.","authors":"Li Yaqiu, Zhou Heng, Wu Ruimin, Wang Xuri","doi":"10.1186/s13741-025-00500-4","DOIUrl":"10.1186/s13741-025-00500-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the effects of remimazolam on postoperative melatonin secretion, sleep rhythm, and postoperative delirium (POD) in elderly patients undergoing spinal surgery.</p><p><strong>Methods: </strong>We selected 120 elderly patients scheduled for elective spinal surgery (lumbar interbody fusion via a posterior approach) under general anaesthesia from November 2023 to January 2024. They were divided into 2 groups according to medication, the remimazolam group (R group) and the propofol group (P group), with 60 patients in each group. The R group received an induction dose of remimazolam 0.2 ~ 0.3 mg/kg, followed by a continuous infusion of remimazolam at 0.1-0.2 mg/kg/h for maintenance. The P group received an induction dose of propofol 1.5 ~ 2.0 mg/kg, followed by a continuous infusion of propofol at 4-6 mg/kg/h for maintenance. Melatonin and cortisol concentrations were measured at 04:00 on the day of surgery and postoperative days 1, 2, and 3. The Pittsburgh Sleep Quality Index (PSQI) and resting visual analog scale (VAS) pain scores were recorded on the day before surgery, and on postoperative days 1 and 2, as well as prior to discharge. Additionally, we documented extubation time, PACU stay duration, total and effective button presses on the analgesia pump, instances of supplemental analgesia, and occurrence of complications.</p><p><strong>Results: </strong>Compared to the P group, the R group exhibited significantly shorter extubation time and PACU stay duration (P < 0.05). On postoperative days 1 and 2 at 04:00, melatonin concentrations were significantly higher, cortisol concentrations were significantly lower, and PSQI scores were significantly reduced in the R group (P < 0.05). The incidence of POD and postoperative sleep disturbance (POSD) was also significantly lower in the R group (P < 0.05). Furthermore, on postoperative day 1, the PSQI and resting VAS pain scores in the R group were significantly lower compared to the P group (P < 0.05). There were no statistically significant differences between the two groups in terms of surgery duration, anaesthesia duration, total and effective analgesia pump button presses, supplemental analgesia rates, intraoperative hypotension, or incidences of postoperative nausea, vomiting, dizziness, and respiratory depression (P > 0.05).</p><p><strong>Conclusion: </strong>The use of remimazolam in elderly patients undergoing spinal surgery has a minimal impact on postoperative melatonin and cortisol secretion rhythms and sleep patterns, and may reduce the incidence of POD and alleviate postoperative sleep disturbances.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"18"},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399581","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":"Perioperative mechanical circulatory support: transitioning from sequential to parallel recovery.","authors":"Jean Deschamps, Andrew D Shaw","doi":"10.1186/s13741-025-00498-9","DOIUrl":"10.1186/s13741-025-00498-9","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"17"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365453","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":"Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial.","authors":"Hanane Barakat, Linda Gholmieh, Jessy Abou Nader, Vanda Yazbeck Karam, Obey Albaini, Mohamad El Helou, Rony Al Nawwar","doi":"10.1186/s13741-024-00486-5","DOIUrl":"10.1186/s13741-024-00486-5","url":null,"abstract":"<p><strong>Background: </strong>Opioids are commonly used in general anesthesia for pain management. However, they are linked to significant side effects. Patients undergoing laparoscopic sleeve gastrectomy, particularly those with obesity, are at higher risk of experiencing adverse effects associated with opioids. Therefore, there is a need to explore alternative anesthesia options that do not rely on opioids. This study aims to investigate the efficacy of opioid-free anesthesia (OFA) compared to traditional opioid-based anesthesia (OBA) in patients undergoing laparoscopic sleeve gastrectomy.</p><p><strong>Methods: </strong>This single-center randomized controlled trial included eighty-three patients undergoing laparoscopic sleeve gastrectomy in a tertiary hospital. Patients were randomly assigned to dexmedetomidine and lidocaine infusion (OFA) or remifentanil (OBA). All patients received intra-operative propofol, sevoflurane, a neuromuscular blocking agent, and ketamine. The primary outcome included opioid consumption during the post-anesthesia care unit (PACU). Secondary measures included intraoperative hemodynamic stability, time to extubation, PACU stay duration, opioid consumption during the first 48 h, and anti-emetic requirements. Independent samples t-test or Mann-Whitney U test was used to assess for differences across the two groups.</p><p><strong>Results: </strong>PACU morphine consumption, total postoperative morphine consumption, anti-emetic requirements up to 48 h after surgery, and pain levels after surgery were not statistically significantly different between OFA and OBA groups. Other variables were not statistically different between the two groups, except for intraoperative anti-hypertensives where more patients in the OFA groups required it.</p><p><strong>Conclusions: </strong>Opioid-free anesthesia hasn't shown an opioid-sparing effect in patients with obesity undergoing laparoscopic sleeve gastrectomy. Larger multi-center studies are required to fully establish its effectiveness.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT03507634); first trial registration date: 12/04/2018; first posted date: 25/04/2018.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"16"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256015","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}