Coagulopathy is a common perioperative complication in aortic surgery, increasing the risk of bleeding and transfusion requirements. This study aimed to evaluate the impact of autologous plateletpheresis on reducing perioperative red blood cell (RBC) transfusion rates in adult aortic surgery patients.
This prospective, single-center, single-blind randomized controlled trial enrolled 134 participants undergoing aortic surgery with cardiopulmonary bypass, randomized in a 1:1 ratio. The primary outcome was the perioperative RBC transfusion rate and covariates included patient preoperative characteristics and intraoperative factors. Multivariable logistic regression models of the relative risk were evaluated.
The intervention group demonstrated several clinical advantages, including significantly reduced perioperative blood transfusion requirements, lower Factor VII usage, and shorter surgical duration (all p < 0.05). Storage of autologous platelet in citrate-containing bags resulted in increased calcium administration (median 3.00g vs 2.00g; p < 0.05) and prolonged time between central venous catheter placement and heparinization in aortic root surgery (52.14 ± 7.75 vs 42.15 ± 6.13 min; p < 0.001).
The autologous plateletpheresis technique reduces transfusion requirements, shortens surgical duration, enhances clinical outcomes, and accelerates recovery. However, careful calcium ion monitoring and coordination of pre-CPB preparation times are essential to maintain surgical workflow.
Registered at the Chinese Clinical Trial Registry on November 16, 2022 (ID ChiCTR2200065834, https://www.chictr.org.cn/showproj.html?proj=185761).
Intraoperative supplemental oxygen may induce postoperative organ complications by aggravating oxidative stress and vasoconstriction. This meta-analysis was to determine whether the higher fraction of inspired oxygen (FiO2) would increase the risk of organ complications among patients under general anesthesia.
We performed a systematic literature review for randomized controlled studies among surgical patients receiving ≥ 60% FiO2 compared with ≤ 40% FiO2 and meta-analysis of risk ratios (RR) comparing higher FiO2 against lower for pulmonary, cardiac, neurological, and kidney complications. We systematically explored MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to December 2024.
We included 20 qualifying randomized controlled trials with a total of 5,793 patients. Low FiO2 was associated with less atelectasis (RR, 0.78; 95% CI, 0.63–0.97), lower percentage of atelectasis (mean difference, –1.80; 95% CI, –3.30 to –0.57), and more acute kidney injury (RR, 1.64; 95% CI, 1.15–2.34). No evidence of association with low FiO2 was found for other complications in this meta-analysis: cardiac complications (RR, 1.15; 95% CI, 0.96–1.53) and delirium (RR, 1.13; 95% CI, 0.87–1.46).
The current study indicated that lower intraoperative oxygen reduced postoperative incidence and severity of atelectasis but result in more acute kidney injury. More high-quality trials are warranted regarding the optimal fraction of intraoperative inspired oxygen.
Prospectively registered at the International Prospective Registry of Systemic Reviews (CRD42023479131).
Intensive care units (ICUs) widely utilize dexmedetomidine (DEX), which is a sedative agent, for its ability to maintain hemodynamic stability and provide neuroprotection. While preclinical studies have suggested that DEX improves sedation and mitigates brain injury in experimental models of intracerebral hemorrhage, its clinical effects on patients with hemorrhagic stroke (HS) remain inconclusive. This research seeks to investigate the correlation between DEX administration within the first 48 h of ICU admission and in-hospital mortality among HS patients by utilizing a large-scale database, aiming to offer evidence supporting its clinical use.
We conducted a retrospective cohort study based on the MIMIC-IV database. Adult patients diagnosed with hemorrhagic stroke were included and classified into a DEX group (n = 320) defined as receiving DEX within 48 h of ICU admission and a non-DEX group (n = 2432). The primary outcome was in-hospital all-cause mortality. Secondary outcomes included the incidence of hypotension, bradycardia, and ICU length of stay. Propensity score matching (PSM) was performed to minimize baseline confounding, followed by Cox proportional hazards regression and Kaplan–Meier survival analyses to assess the association between DEX administration within the first 48 h of ICU admission and in-hospital mortality.
A total of 2,752 patients were analyzed. Before matching, Kaplan–Meier survival curves demonstrated a significantly lower in-hospital mortality in the DEX group compared with the non-DEX group (log-rank P < 0.001). Cox regression indicated that DEX administration within 48 h of ICU admission significantly reduced the risk of in-hospital death (HR = 0.56; 95% CI: 0.45–0.79; P < 0.001), and this benefit persisted after PSM adjustment. Meanwhile, patients receiving DEX had a significantly longer ICU stay than those not receiving DEX (P < 0.05), which remained consistent after PSM adjustment. No significant differences in hypotension or bradycardia were observed between the two groups.
In this retrospective cohort study of HS patients from the MIMIC-IV database, DEX administration within the first 48 h of ICU admission was associated with lower in-hospital mortality and no increased risk of hypotension or bradycardia, though it was linked to a longer ICU stay. These findings suggest that early (≤ 48 h) DEX administration may confer survival benefits for patients with hemorrhagic stroke, warranting further prospective validation.
Colorectal cancer is the third most common malignancy worldwide and the second leading cause of cancer-related mortality. Colonoscopy, the primary screening method for this disease, typically involves sedation to enhance patient comfort and ensure a thorough examination. The choice of sedative is particularly important for older adults, as sedation can have implications on cognitive function. This study aims to evaluate the long-term cognitive effects of propofol and ketamine by examining the risk of developing dementia, disorientation, and depression following colonoscopy.
Utilizing data from the TriNetX platform, we compared two cohorts of patients who had undergone a colonoscopy and received either exclusively propofol (n = 1,938) or ketamine (n = 1,938) for sedation. Measures of association and survival were analyzed using TriNetX. Odds ratios (OR) were calculated from logistic regression to compare the cohorts. Survival analysis was conducted using the Cox proportional hazards model to find hazard ratio (HR).
One of the most notable findings was the association between ketamine use and an increased risk of disorientation, with an odds ratio of 0.489 and a hazard ratio of 0.443 for propofol compared to ketamine. Regarding dementia, the lower OR (0.603) and HR (0.561) associated with propofol suggest that it may have a comparatively safer profile concerning long-term memory and cognitive decline. The findings also demonstrated a significant difference in depression rates, with propofol showing reduced odds (0.740) and risk ratios (0.688) of postprocedural depression compared to ketamine.
These findings suggest that propofol may offer a safer cognitive profile than ketamine, particularly for older patients and those at risk of cognitive decline. Given the increasing number of older adults undergoing colonoscopy, these results highlight the importance of selecting sedative agents that balance immediate procedural needs with long-term cognitive health.
Opioids for postoperative pain control often cause side effects and affect postoperative recovery. Combined electrical stimulation of the Xi and Yuan acupoints has been reported to exhibit an analgesic effect. We evaluated the effect of transcutaneous electrical acupoint stimulation (TEAS) of the Xi and Yuan acupoints on postoperative pain after nasal surgery in a randomized controlled trial.
Sixty patients undergoing either endoscopic sinus surgery or septoplasty surgery were randomized to Sham or TEAS (Xi and Yuan acupoint stimulation) groups in a 1:1 ratio. The primary outcome was the numeric rating scale (NRS) for pain on postoperative day 1. The secondary outcomes included intraoperative propofol and remifentanil consumption, time to extubation after anesthesia, and 15-item Quality of Recovery scale (QoR15). Data were analyzed using intention-to-treat analysis.
TEAS decreased NRS on postoperative day 1 (P = 0.020, with NRS before surgery and surgery site adjusted). A mixed-model repeated-measures analysis demonstrated that TEAS decreased NRS over the first 3 days after endoscopic nasal surgery (P = 0.035). TEAS also significantly reduced intraoperative propofol (P = 0.001) and remifentanil (P = 0.009) requirements, shortened time to extubation (P = 0.003), and improved postoperative QoR15 (P < 0.05). Notably, septoplasty and preoperative pain were identified as risk factors for higher postoperative pain intensity on postoperative day 1.
These results demonstrate that electrical stimulation of both the Xi and Yuan acupoints significantly reduces pain intensity on postoperative day 1 and throughout the first 3 postoperative days following endoscopic nasal surgery.
Registered on the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=230970), No. ChiCTR2400084850, on May 27, 2024. Principal investigator: Xingrui Gong.
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