Journal of Clinical Anesthesia最新文献

Objective: To evaluate the association between sugammadex use and postoperative complications in patients with severe chronic kidney disease (CKD) having elective gastrointestinal surgery.

Design: Retrospective cohort study using propensity score matching.

Setting: The TriNetX Research Network, a multi-institutional database primarily comprising U.S. healthcare organizations, with data from 2016 to 2024, reflecting the post-FDA-approved use of sugammadex.

Interventions: Patients received either sugammadex or neostigmine for reversal of rocuronium-based neuromuscular block.

Patients: Adult patients with severe CKD who had gastrointestinal surgery. Of the 13,693 patients receiving sugammadex and 5714 receiving neostigmine, one-to-one propensity score matching yielded 5690 patients in each group for analysis.

Measurements: The primary outcome was composite pulmonary complications (CPCs) within 30 days, whereas secondary outcomes included acute respiratory failure (ARF), intensive care unit (ICU) admission, all-cause mortality, and major adverse cardiovascular events (MACEs). All outcomes were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes and assessed at the 7-, 30-, and 90-day follow-up intervals.

Results: At the 30-day follow-up, no significant differences were observed between the groups for CPCs (2.1% vs. 2.1%; hazard ratio [HR]: 1.00, 95% confidence interval [CI]: 0.78-1.29, p = 0.983), ARF (1.8% vs. 1.8%; HR:1.00, 95% CI 0.76-1.32, p = 0.984), or MACEs (3.1% vs. 3.1%; HR:0.98, 95%CI 0.80-1.21, p = 0.849). ICU admission was numerically higher in the sugammadex group (4.9% vs. 4.0%; HR 1.23, 95% CI 1.04-1.47, p = 0.019), but did not reach statistical significance after Bonferroni correction (adjusted significance threshold of p < 0.01). At the 7-day and 90-day follow-ups, no outcome reached statistical significance after Bonferroni correction at either time point.

Conclusions: Sugammadex was not associated with a significantly increased risk of pulmonary, cardiovascular, or mortality outcomes compared with neostigmine in patients with severe CKD having elective gastrointestinal surgery. Given the potential residual confounding by unmeasured factors such as surgical complexity, randomized controlled trials are needed to confirm these findings.

Background: Enhanced Recovery After Cardiac Surgery (ERACS) has become the standard of care for selected patients. This study evaluated the evolution of the Leipzig concept in a specialized postanaesthesia care unit (PACU) over 15 years, with a focus on temporal trends and clinical outcomes.

Methods: A retrospective cohort study was conducted on patients admitted to PACU after cardiac surgery at the Heart Center Leipzig between November 2005 and December 2020. Postoperative outcomes, including postprocedural complications, hospital length of stay, delirium, and mortality, were recorded. The outcomes were analyzed via multivariable models, and the adjusted results are reported.

Results: Among 56,371 cardiac surgery patients, 42% (n = 23,724) were admitted to the PACU and managed according to the ERACS protocol. After excluding incomplete datasets, 20,773 patients were analyzed. Utilization increased from 19% in 2006 to 60% in 2020. Despite a rising proportion of moderate- and high-complexity surgeries, in-hospital mortality has remained stable. Improved adherence to the ERACS components, including the integration of a delirium prevention bundle, was associated with significant reductions in postoperative delirium (p = 0.02) and in-hospital mortality (p = 0.007). Patients treated with sufentanil exhibited significantly lower in-hospital mortality than did those receiving remifentanil (p = 0.005). Subgroup analyses revealed higher in-hospital mortality in patients with EuroSCORE II ≥6%, complex procedures, and age ≥ 75 years (p < 0.001, p = 0.04, and p < 0.001, respectively).

Conclusions: This study presents the largest collection of consecutive ERACS patients ever collected and demonstrates the safety and efficacy of ERACS management with a specialized PACU, highlighting the benefits of continuous protocol optimization.