Pub Date : 2024-07-12DOI: 10.1016/j.jclinane.2024.111547
Engin İhsan Turan , Abdurrahman Engin Baydemir , Ayça Sultan Şahin , Funda Gümüş Özcan
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Pub Date : 2024-07-09DOI: 10.1016/j.jclinane.2024.111530
Paolo Formenti , Francesca Ruzza , Giulia Pederzolli Giovanazzi , Giovanni Sabbatini , Andrea Galimberti , Miriam Gotti , Angelo Pezzi , Michele Umbrello
The ultrasound study of diaphragm function represents a valid method that has been extensively studied in recent decades in various fields, especially in intensive care, emergency, and pulmonology settings. Diaphragmatic function is pivotal in these contexts due to its crucial role in respiratory mechanics, ventilation support strategies, and overall patient respiratory outcomes. Dysfunction or weakness of the diaphragm can lead to respiratory failure, ventilatory insufficiency, and prolonged mechanical ventilation, making its assessment essential for patient management and prognosis in critical care and emergency medicine. While several studies have focused on diaphragmatic functionality in the context of intensive care, there has been limited attention within the field of anesthesia. The ultrasound aids in assessing diaphragmatic dysfunction (DD) by measuring muscle mass and contractility and their potential variations over time. Recent advancements in ultrasound imaging allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily. In the context of anesthesia, early studies have shed light on the patho-physiological mechanisms of diaphragm function during general anesthesia. In contrast, more recent research has centered on evaluating diaphragmatic functionality at various phases of general anesthesia and by comparing diverse types of procedures or anatomical position during surgery. The objectives of this current review are to highlight the use of diaphragm ultrasound for the evaluation of diaphragmatic function during perioperative anesthesia and surgery. Specifically, we aim to examine the effects of anesthetic agents, surgical techniques, and anatomical positioning on diaphragmatic function. We explore how ultrasound aids in assessing DD by measuring muscle mass and contractility, as well as their potential variations over time. Additionally, we will discuss recent advancements in ultrasound imaging that allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily.
{"title":"Exploring ultrasonographic diaphragmatic function in perioperative anesthesia setting: A comprehensive narrative review","authors":"Paolo Formenti , Francesca Ruzza , Giulia Pederzolli Giovanazzi , Giovanni Sabbatini , Andrea Galimberti , Miriam Gotti , Angelo Pezzi , Michele Umbrello","doi":"10.1016/j.jclinane.2024.111530","DOIUrl":"10.1016/j.jclinane.2024.111530","url":null,"abstract":"<div><p>The ultrasound study of diaphragm function represents a valid method that has been extensively studied in recent decades in various fields, especially in intensive care, emergency, and pulmonology settings. Diaphragmatic function is pivotal in these contexts due to its crucial role in respiratory mechanics, ventilation support strategies, and overall patient respiratory outcomes. Dysfunction or weakness of the diaphragm can lead to respiratory failure, ventilatory insufficiency, and prolonged mechanical ventilation, making its assessment essential for patient management and prognosis in critical care and emergency medicine. While several studies have focused on diaphragmatic functionality in the context of intensive care, there has been limited attention within the field of anesthesia. The ultrasound aids in assessing diaphragmatic dysfunction (DD) by measuring muscle mass and contractility and their potential variations over time. Recent advancements in ultrasound imaging allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily. In the context of anesthesia, early studies have shed light on the patho-physiological mechanisms of diaphragm function during general anesthesia. In contrast, more recent research has centered on evaluating diaphragmatic functionality at various phases of general anesthesia and by comparing diverse types of procedures or anatomical position during surgery. The objectives of this current review are to highlight the use of diaphragm ultrasound for the evaluation of diaphragmatic function during perioperative anesthesia and surgery. Specifically, we aim to examine the effects of anesthetic agents, surgical techniques, and anatomical positioning on diaphragmatic function. We explore how ultrasound aids in assessing DD by measuring muscle mass and contractility, as well as their potential variations over time. Additionally, we will discuss recent advancements in ultrasound imaging that allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-06DOI: 10.1016/j.jclinane.2024.111506
Basak Ceyda Meco MD , Karina Jakobsen MCN , Edoardo De Robertis PhD , Wolfgang Buhre PhD , Neslihan Alkış MD , Peter Roy Kirkegaard MD , Daniel Hägi-Pedersen PhD , Florian Bubser PhD , Susanne Koch MD , Lisbeth A. Evered PhD , Sita J. Saunders PhD , Marco Caterino PhD , Francesca Paolini PhD , Joana Berger-Estilita PhD , Finn M. Radtke med. Habil, PhD
Background
Postoperative delirium (POD) following surgery is a prevalent and distressing condition associated with adverse patient outcomes and an increased healthcare burden.
Objectives
To assess the effectiveness of the Safe Brain Initiative care bundle (SBI-CB) in reducing POD in the postanesthesia care unit (PACU).
Design
A multicenter, quality-improvement initiative with retrospective analysis of collected data.
Setting
The study was conducted in the operating rooms and postanesthesia care units (PACUs) of four hospitals across Denmark and Turkey.
Patients
The convenience sample of patients were aged ≥18 years, scheduled for surgery, and could communicate verbally. Age, sex, preoperative delirium, and the American Society for Anesthesiology physical status classification were used in statistical methods to control for potential confounding influences.
Intervention
The SBI-CB, 18 delirium-reducing recommendations aligned with international guidelines. The intervention included patient education, staff training, coordination meetings across centers, and a dashboard for the monitoring of outcomes in the PACU.
Main outcome measures
The primary outcome was the POD trend in the PACU during implementation months, assessed through Nu-DESC screening at up to three time points in the PACU. We also examined the length of hospital stay.
Results
Data were collected from 18,697 adult patients across four hospitals. Initial POD incidence in the PACU after the first three months was 16.36% across all sites (n = 1021). POD in the PACU was observed across all age groups, with peak incidence in younger (18–35 years) and older (>75 years) patients. General anesthesia and longer surgical duration (>1 h) were identified as significant risk factors for POD in the PACU. Matched patients who experienced POD in the PACU had longer stays in hospital, with a mean increase from 35 to 69 h (p < 0.001). Implementation of the SBI-CB was associated with a decreased risk of POD in the PACU for each month of SBI-CB implementation (adjusted odds ratio 0.96, 95% confidence interval: [0.94, 0.97], p < 0.001).
Conclusions
The presented pragmatic implementation of a multidisciplinary care bundle, encompassing pre-, intra-, and postoperative measures alongside outcome monitoring, has the potential to significantly reduce the incidence of POD in the PACU. Improved patient outcomes may be achieved for general surgical departments with patient cohorts not typically considered at risk for developing POD.
背景:手术后谵妄(POD)是一种普遍存在的令人痛苦的症状,与患者的不良预后和医疗负担的增加有关:评估安全用脑倡议护理包(SBI-CB)在减少麻醉后护理病房(PACU)POD方面的效果:设计:一项多中心质量改进计划,对收集的数据进行回顾性分析:研究在丹麦和土耳其四家医院的手术室和麻醉后护理病房(PACU)进行:方便抽样的患者年龄≥18 岁,计划接受手术,能够进行语言交流。统计方法中使用了年龄、性别、术前谵妄和美国麻醉学会身体状况分类,以控制潜在的混杂影响因素:干预措施:SBI-CB、18 项与国际指南一致的减少谵妄建议。干预措施包括患者教育、员工培训、跨中心协调会议以及用于监测 PACU 结果的仪表板:主要结果是在实施的几个月中PACU的POD趋势,通过PACU中最多三个时间点的Nu-DESC筛查进行评估。我们还检查了住院时间:我们收集了四家医院 18,697 名成年患者的数据。前三个月后,所有医院 PACU 的初始 POD 发生率为 16.36%(n = 1021)。所有年龄组的患者均在 PACU 中出现 POD,年轻(18-35 岁)和年长(75 岁以上)患者的发病率最高。全身麻醉和较长的手术时间(>1 小时)被认为是 PACU 中出现 POD 的重要风险因素。在 PACU 中出现 POD 的配对患者的住院时间更长,平均从 35 小时增加到 69 小时(P 结论:PACU 中出现 POD 的患者住院时间更长,平均从 35 小时增加到 69 小时:所介绍的多学科护理包的务实实施,包括术前、术中和术后措施以及结果监测,有可能显著降低 PACU 中 POD 的发生率。对于那些通常不被认为有患 POD 风险的患者群体,普通外科部门可能会改善患者的治疗效果:试验注册:Clinicaltrials.gov,标识符 NCT05765162。
{"title":"A first assessment of the safe brain initiative care bundle for addressing postoperative delirium in the postanesthesia care unit","authors":"Basak Ceyda Meco MD , Karina Jakobsen MCN , Edoardo De Robertis PhD , Wolfgang Buhre PhD , Neslihan Alkış MD , Peter Roy Kirkegaard MD , Daniel Hägi-Pedersen PhD , Florian Bubser PhD , Susanne Koch MD , Lisbeth A. Evered PhD , Sita J. Saunders PhD , Marco Caterino PhD , Francesca Paolini PhD , Joana Berger-Estilita PhD , Finn M. Radtke med. Habil, PhD","doi":"10.1016/j.jclinane.2024.111506","DOIUrl":"10.1016/j.jclinane.2024.111506","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative delirium (POD) following surgery is a prevalent and distressing condition associated with adverse patient outcomes and an increased healthcare burden.</p></div><div><h3>Objectives</h3><p>To assess the effectiveness of the Safe Brain Initiative care bundle (SBI-CB) in reducing POD in the postanesthesia care unit (PACU).</p></div><div><h3>Design</h3><p>A multicenter, quality-improvement initiative with retrospective analysis of collected data.</p></div><div><h3>Setting</h3><p>The study was conducted in the operating rooms and postanesthesia care units (PACUs) of four hospitals across Denmark and Turkey.</p></div><div><h3>Patients</h3><p>The convenience sample of patients were aged ≥18 years, scheduled for surgery, and could communicate verbally. Age, sex, preoperative delirium, and the American Society for Anesthesiology physical status classification were used in statistical methods to control for potential confounding influences.</p></div><div><h3>Intervention</h3><p>The SBI-CB, 18 delirium-reducing recommendations aligned with international guidelines. The intervention included patient education, staff training, coordination meetings across centers, and a dashboard for the monitoring of outcomes in the PACU.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome was the POD trend in the PACU during implementation months, assessed through Nu-DESC screening at up to three time points in the PACU. We also examined the length of hospital stay.</p></div><div><h3>Results</h3><p>Data were collected from 18,697 adult patients across four hospitals. Initial POD incidence in the PACU after the first three months was 16.36% across all sites (<em>n</em> = 1021). POD in the PACU was observed across all age groups, with peak incidence in younger (18–35 years) and older (>75 years) patients. General anesthesia and longer surgical duration (>1 h) were identified as significant risk factors for POD in the PACU. Matched patients who experienced POD in the PACU had longer stays in hospital, with a mean increase from 35 to 69 h (<em>p</em> < 0.001). Implementation of the SBI-CB was associated with a decreased risk of POD in the PACU for each month of SBI-CB implementation (adjusted odds ratio 0.96, 95% confidence interval: [0.94, 0.97], p < 0.001).</p></div><div><h3>Conclusions</h3><p>The presented pragmatic implementation of a multidisciplinary care bundle, encompassing pre-, intra-, and postoperative measures alongside outcome monitoring, has the potential to significantly reduce the incidence of POD in the PACU. Improved patient outcomes may be achieved for general surgical departments with patient cohorts not typically considered at risk for developing POD.</p><p><strong>Trial Registration</strong>: <span>Clinicaltrials.gov</span><svg><path></path></svg>, identifier <span>NCT05765162</span><svg><path></path></svg>.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024001351/pdfft?md5=679e42e3ae95979756bd71efda8e8618&pid=1-s2.0-S0952818024001351-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1016/j.jclinane.2024.111545
Lu Li MD , Li Du MD , Guo Chen MD, PhD , Weiyi Zhang MD , Bin Du MD , Lu Zhang MD, PhD , Jianqiao Zheng MD, PhD
Study objective
The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSVLRM) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis.
Methods
A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve.
Results
A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77–0.90) and 0.79 (95% CI, 0.70–0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62–64.34) and 0.90 (95% CI, 0.87–0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50–8.18) and 0.19 (95% CI, 0.11–0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively.
Conclusions
Based on the currently available evidence, ΔSVLRM has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSVLRM in predicting fluid responsiveness.
{"title":"Stroke volume variation induced by lung recruitment maneuver to predict fluid responsiveness in patients receiving mechanical ventilation: A systematic review and meta-analysis","authors":"Lu Li MD , Li Du MD , Guo Chen MD, PhD , Weiyi Zhang MD , Bin Du MD , Lu Zhang MD, PhD , Jianqiao Zheng MD, PhD","doi":"10.1016/j.jclinane.2024.111545","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111545","url":null,"abstract":"<div><h3>Study objective</h3><p>The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSV<sub>LRM</sub>) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis.</p></div><div><h3>Methods</h3><p>A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve.</p></div><div><h3>Results</h3><p>A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77–0.90) and 0.79 (95% CI, 0.70–0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62–64.34) and 0.90 (95% CI, 0.87–0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50–8.18) and 0.19 (95% CI, 0.11–0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively.</p></div><div><h3>Conclusions</h3><p>Based on the currently available evidence, ΔSV<sub>LRM</sub> has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSV<sub>LRM</sub> in predicting fluid responsiveness.</p><p>PROSPERO registration number: CRD42023490598.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-04DOI: 10.1016/j.jclinane.2024.111527
{"title":"In search of evidence-based intraoperative red blood cell transfusion","authors":"","doi":"10.1016/j.jclinane.2024.111527","DOIUrl":"10.1016/j.jclinane.2024.111527","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1016/j.jclinane.2024.111540
Geethan Baskaran , Rachel H. Heo MD , Michael K. Wang MD , Pascal B. Meyre MD, PhD , Louis Park , Steffen Blum MD, PhD , P.J. Devereaux MD, PhD , David Conen MD, MPH
Background
Noncardiac surgery is associated with an inflammatory response. Whether increased inflammation in the perioperative period is associated with subsequent morbidity and mortality is unknown.
Methods
MEDLINE, EMBASE, and CENTRAL were systematically searched from date of inception until May 2023. Longitudinal studies were included if they reported multivariable adjusted associations of biomarkers measured preoperatively and/or within 10 days after surgery with at least one prespecified adverse outcome in noncardiac surgery patients. Data were extracted independently and in duplicate. Risk estimates were pooled using DerSimonian-Laird random-effects models and reported as summary odds ratios (ORs) with 95% CIs. The outcomes were all-cause mortality and major adverse cardiovascular events.
Results
Fifty-two studies with a total of 121,849 patients were included. The median follow-up was 56 [IQR, 28–63] months and the average age was 57 (±3) years. Elevated preoperative C-reactive protein (CRP) levels were associated with a higher risk of mortality (OR 1.57, 95% CI 1.29–1.90, I2 = 93%, 28 studies). This association was stronger in non-cancer surgery populations (OR 2.10, 95% CI 1.92–2.31, I2 = 0%, 4 studies) when compared to cancer surgery populations (OR 1.51, 95% CI 1.26–1.81, I2 = 83%, 24 studies) (p for subgroup difference = 0.001). Similarly, higher postoperative CRP levels were associated with all-cause mortality (OR 1.61, 95% CI 1.17–2.20, I2 = 90%, 7 studies). Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51–2.94, I2 = 0%, 2 studies). Other preoperatively measured biomarkers associated with all-cause mortality were fibrinogen (OR 1.48, 95% CI 1.05–2.09, I2 = 52%, 5 studies), interleukin-6 (OR 1.17, 95% CI 1.07–1.28, I2 = 27%, 3 studies), and tumour necrosis factor-alpha (OR 1.37, 95% CI 1.16–1.61, I2 = 0%, 2 studies).
Conclusion and relevance
Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.
背景非心脏手术与炎症反应有关。方法 系统地检索了从开始到 2023 年 5 月期间的 Medline、EMBASE 和 CENTRAL。如果纵向研究报告了非心脏手术患者术前和/或术后 10 天内测量的生物标志物与至少一种预设不良结局的多变量调整关联,则纳入该研究。数据均独立提取,一式两份。使用 DerSimonian-Laird 随机效应模型对风险估计值进行汇总,并以汇总的几率比 (OR) 和 95% CIs 的形式进行报告。研究结果包括全因死亡率和主要不良心血管事件。中位随访时间为 56 [IQR, 28-63] 个月,平均年龄为 57 (±3) 岁。术前 C 反应蛋白 (CRP) 水平升高与较高的死亡风险有关(OR 1.57,95% CI 1.29-1.90,I2 = 93%,28 项研究)。与癌症手术人群(OR 1.51,95% CI 1.26-1.81,I2 = 83%,24 项研究)相比,非癌症手术人群(OR 2.10,95% CI 1.92-2.31,I2 = 0%,4 项研究)的这一关联性更强(亚组差异 p = 0.001)。同样,术后较高的 CRP 水平与全因死亡率相关(OR 1.61,95% CI 1.17-2.20,I2 = 90%,7 项研究)。术前较高的 CRP 水平与重大心血管事件相关(OR 2.11,95% CI 1.51-2.94,I2 = 0%,2 项研究)。其他术前测量的与全因死亡率相关的生物标志物有纤维蛋白原(OR 1.48,95% CI 1.05-2.09,I2 = 52%,5 项研究)、白细胞介素-6(OR 1.17,95% CI 1.07-1.28,I2 = 27%,3 项研究)和肿瘤坏死因子-α(OR 1.结论和相关性围手术期的炎症生物标志物水平与非心脏手术患者的全因死亡率和不良心血管事件相关。
{"title":"Associations of inflammatory biomarkers with morbidity and mortality after noncardiac surgery: A systematic review and meta-analysis","authors":"Geethan Baskaran , Rachel H. Heo MD , Michael K. Wang MD , Pascal B. Meyre MD, PhD , Louis Park , Steffen Blum MD, PhD , P.J. Devereaux MD, PhD , David Conen MD, MPH","doi":"10.1016/j.jclinane.2024.111540","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111540","url":null,"abstract":"<div><h3>Background</h3><p>Noncardiac surgery is associated with an inflammatory response. Whether increased inflammation in the perioperative period is associated with subsequent morbidity and mortality is unknown.</p></div><div><h3>Methods</h3><p>MEDLINE, EMBASE, and CENTRAL were systematically searched from date of inception until May 2023. Longitudinal studies were included if they reported multivariable adjusted associations of biomarkers measured preoperatively and/or within 10 days after surgery with at least one prespecified adverse outcome in noncardiac surgery patients. Data were extracted independently and in duplicate. Risk estimates were pooled using DerSimonian-Laird random-effects models and reported as summary odds ratios (ORs) with 95% CIs. The outcomes were all-cause mortality and major adverse cardiovascular events.</p></div><div><h3>Results</h3><p>Fifty-two studies with a total of 121,849 patients were included. The median follow-up was 56 [IQR, 28–63] months and the average age was 57 (±3) years. Elevated preoperative C-reactive protein (CRP) levels were associated with a higher risk of mortality (OR 1.57, 95% CI 1.29–1.90, I<sup>2</sup> = 93%, 28 studies). This association was stronger in non-cancer surgery populations (OR 2.10, 95% CI 1.92–2.31, I<sup>2</sup> = 0%, 4 studies) when compared to cancer surgery populations (OR 1.51, 95% CI 1.26–1.81, I<sup>2</sup> = 83%, 24 studies) (p for subgroup difference = 0.001). Similarly, higher postoperative CRP levels were associated with all-cause mortality (OR 1.61, 95% CI 1.17–2.20, I<sup>2</sup> = 90%, 7 studies). Higher preoperative CRP levels were associated with major cardiovascular events (OR 2.11, 95% CI 1.51–2.94, I<sup>2</sup> = 0%, 2 studies). Other preoperatively measured biomarkers associated with all-cause mortality were fibrinogen (OR 1.48, 95% CI 1.05–2.09, I<sup>2</sup> = 52%, 5 studies), interleukin-6 (OR 1.17, 95% CI 1.07–1.28, I<sup>2</sup> = 27%, 3 studies), and tumour necrosis factor-alpha (OR 1.37, 95% CI 1.16–1.61, I<sup>2</sup> = 0%, 2 studies).</p></div><div><h3>Conclusion and relevance</h3><p>Inflammatory biomarker levels in the perioperative period were associated with all-cause mortality and adverse cardiovascular events in patients undergoing noncardiac surgery.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024001697/pdfft?md5=8da8110ebd65ff425fd2e58f67998412&pid=1-s2.0-S0952818024001697-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jclinane.2024.111520
Na-Ping Chen , Ya-Wei Li , Shuang-Jie Cao , Yue Zhang , Chun-Jing Li , Wei-Jie Zhou , Mo Li , Ya-Ting Du , Yu-Xiu Zhang , Mao-Wei Xing , Jia-Hui Ma , Dong-Liang Mu , Dong-Xin Wang
Study objective
To assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer.
Design
A secondary analysis of databases from three randomized trials with long-term follow-up.
Setting
The underlying trials were conducted in 17 tertiary hospitals in China.
Patients
Patients aged 60 to 90 years who underwent major noncardiac thoracic or abdominal surgeries (≥ 2 h) in a single center were included in this analysis.
Exposures
Restricted cubic spline models were employed to determine the lowest mean arterial pressure (MAP) threshold that was potentially harmful for long-term survivals. Patients were arbitrarily divided into three groups according to the cumulative duration or area under the MAP threshold. The association between intraoperative hypotension exposure and long-term survivals were analyzed with the Cox proportional hazard regression models.
Measurements
Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals.
Main results
A total of 2664 patients (mean age 69.0 years, 34.9% female sex, 92.5% cancer surgery) were included in the final analysis. MAP < 60 mmHg was adopted as the threshold of intraoperative hypotension. Patients were divided into three groups according to duration under MAP < 60 mmHg (<1 min, 1–10 min, and > 10 min) or area under MAP <60 mmHg (< 1 mmHg⋅min, 1–30 mmHg⋅min, and > 30 mmHg⋅min). After adjusting confounders, duration under MAP < 60 mmHg for > 10 min was associated with a shortened overall survival when compared with the < 1 min patients (adjusted hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.09 to 1.57, P = 0.004); area under MAP < 60 mmHg for > 30 mmHg⋅min was associated with a shortened overall survival when compared with the < 1 mmHg⋅min patients (adjusted HR 1.40, 95% CI 1.16 to 1.68, P < 0.001). Similar associations exist between duration under MAP < 60 mmHg for > 10 min or area under MAP < 60 mmHg for > 30 mmHg⋅min and recurrence-free or event-free survivals.
Conclusions
In older patients who underwent major noncardiac surgery mainly for cancer, intraoperative hypotension was associated with worse overall, recurrence-free, and event-free survivals.
{"title":"Intraoperative hypotension is associated with decreased long-term survival in older patients after major noncardiac surgery: Secondary analysis of three randomized trials","authors":"Na-Ping Chen , Ya-Wei Li , Shuang-Jie Cao , Yue Zhang , Chun-Jing Li , Wei-Jie Zhou , Mo Li , Ya-Ting Du , Yu-Xiu Zhang , Mao-Wei Xing , Jia-Hui Ma , Dong-Liang Mu , Dong-Xin Wang","doi":"10.1016/j.jclinane.2024.111520","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111520","url":null,"abstract":"<div><h3>Study objective</h3><p>To assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer.</p></div><div><h3>Design</h3><p>A secondary analysis of databases from three randomized trials with long-term follow-up.</p></div><div><h3>Setting</h3><p>The underlying trials were conducted in 17 tertiary hospitals in China.</p></div><div><h3>Patients</h3><p>Patients aged 60 to 90 years who underwent major noncardiac thoracic or abdominal surgeries (≥ 2 h) in a single center were included in this analysis.</p></div><div><h3>Exposures</h3><p>Restricted cubic spline models were employed to determine the lowest mean arterial pressure (MAP) threshold that was potentially harmful for long-term survivals. Patients were arbitrarily divided into three groups according to the cumulative duration or area under the MAP threshold. The association between intraoperative hypotension exposure and long-term survivals were analyzed with the Cox proportional hazard regression models.</p></div><div><h3>Measurements</h3><p>Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals.</p></div><div><h3>Main results</h3><p>A total of 2664 patients (mean age 69.0 years, 34.9% female sex, 92.5% cancer surgery) were included in the final analysis. MAP < 60 mmHg was adopted as the threshold of intraoperative hypotension. Patients were divided into three groups according to duration under MAP < 60 mmHg (<1 min, 1–10 min, and > 10 min) or area under MAP <60 mmHg (< 1 mmHg⋅min, 1–30 mmHg⋅min, and > 30 mmHg⋅min). After adjusting confounders, duration under MAP < 60 mmHg for > 10 min was associated with a shortened overall survival when compared with the < 1 min patients (adjusted hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.09 to 1.57, <em>P</em> = 0.004); area under MAP < 60 mmHg for > 30 mmHg⋅min was associated with a shortened overall survival when compared with the < 1 mmHg⋅min patients (adjusted HR 1.40, 95% CI 1.16 to 1.68, <em>P</em> < 0.001). Similar associations exist between duration under MAP < 60 mmHg for > 10 min or area under MAP < 60 mmHg for > 30 mmHg⋅min and recurrence-free or event-free survivals.</p></div><div><h3>Conclusions</h3><p>In older patients who underwent major noncardiac surgery mainly for cancer, intraoperative hypotension was associated with worse overall, recurrence-free, and event-free survivals.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0952818024001491/pdfft?md5=ced77d78cfe718902bd5680a9289ba47&pid=1-s2.0-S0952818024001491-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jclinane.2024.111543
Huolin Zeng MD , Feng Yin MD , Lingling Fan MM , Chengyu Li MPH , Hongyan Lin MM , Fei Liu MD , Qian Li MD
Study objective
We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients.
Design
Randomized controlled trial.
Setting
The preoperative area, operating room, postanesthesia recovery room and bed ward.
Patients
A total of 312 adult patients (104 per group) with gastric cancer were included.
Interventions
Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).
Measurements
The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.
Main results
The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).
Conclusions
The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.
Trial registration number: ChiCTR2000037981.
研究目的我们进行了这项双盲随机对照试验,以探讨地塞米松和右美托咪定联合作为腹横肌平面(TAP)阻滞的辅助用药是否能提高胃癌患者的镇痛效果并延长镇痛时间。干预措施患者接受双侧肋下 TAP 阻滞,使用三种不同的麻醉剂(60 毫升 0.测量主要结果是活动 24 小时后中度至重度疼痛的发生率。主要结果A组术后24小时活动时中度至重度疼痛的发生率明显低于B组(45.19% vs 63.46%;RR 0.71;95% CI,0.55~0.92)和C组(45.19% vs 73.08%,RR 0.62;95% CI,0.49~0.79)。24 小时后,移动疼痛评分的中位数明显下降(3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P <0.001)。头 24 小时内阿片类药物的消耗量(27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg;P = 0.01)和首次抢救镇痛的持续时间(65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h;P = 0.04)存在明显差异。结论联合使用地塞米松和右美托咪定作为TAP阻滞的辅助药物可降低胃癌术后24小时内中度至重度疼痛的发生率以及运动和静息时的疼痛评分,并延长首次抢救性镇痛的持续时间:ChiCTR2000037981。
{"title":"Combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane block for postoperative analgesia in gastric cancer patients: A double-blinded randomized controlled trial","authors":"Huolin Zeng MD , Feng Yin MD , Lingling Fan MM , Chengyu Li MPH , Hongyan Lin MM , Fei Liu MD , Qian Li MD","doi":"10.1016/j.jclinane.2024.111543","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111543","url":null,"abstract":"<div><h3>Study objective</h3><p>We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients.</p></div><div><h3>Design</h3><p>Randomized controlled trial.</p></div><div><h3>Setting</h3><p>The preoperative area, operating room, postanesthesia recovery room and bed ward.</p></div><div><h3>Patients</h3><p>A total of 312 adult patients (104 per group) with gastric cancer were included.</p></div><div><h3>Interventions</h3><p>Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).</p></div><div><h3>Measurements</h3><p>The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.</p></div><div><h3>Main results</h3><p>The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; <em>P</em> < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; <em>P</em> = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; <em>P</em> = 0.04).</p></div><div><h3>Conclusions</h3><p>The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.</p><p><strong><em>Trial registration number:</em></strong> ChiCTR2000037981.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-29DOI: 10.1016/j.jclinane.2024.111539
Beibei Wang MD , Dong Han MD , Xinyue Hu MD , Jing Chen MD , Yuwei Liu , Jing Wu MD, PhD
Study objective
This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization.
Design
A prospective randomized controlled trial.
Setting
Operating room and gynecological ward in Wuhan Union Hospital.
Patients
We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis.
Interventions
Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment.
Measurements
The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3–4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge.
Main results
The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]) and the reduced incidence of I-FEED >2 (PCL:8% vs. PCL-EOF: 2% vs. control:21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR:0.09, 95%CI (0.01–0.72), p=0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF: HR:3.33, 95%CI (2.14–5.19),p<0.001], first defecation [PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p<0.001], Bristol feces grade 3–4 [PCL-EOF: HR:3.65, 95%CI (2.36–5.63), p<0.001], first fluid diet[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p<0.001], and first normal diet[PCL-EOF: HR:6.63, 95%CI (4.18–10.50), p<0.001]. Also, the length of postoperative hospital stay (PCL-EOF
研究目的本研究旨在评估围手术期自由饮水管理(包括术前 2 小时给予碳水化合物负荷(PCL)和术后 6 小时早期口服喂养(EOF))在增强妇科患者术后胃肠道功能和改善预后方面的效果。假设围手术期的自由饮水管理可加速胃肠功能的恢复,提高住院期间的饮食耐受性,并最终缩短住院时间:前瞻性随机对照试验:地点:武汉协和医院手术室和妇科病房:我们招募了210名接受妇科腹腔镜手术的患者,最终分析纳入了157名患者:患者按1:1:1的比例随机分为三组,包括对照组、PCL组和PCL-EOF组。麻醉师和随访人员对组别分配保持盲目:主要结果是术后摄入、恶心、呕吐、检查和症状持续时间(I-FEED)评分(范围为 0-14 分,分数越高,情况越糟)。次要结果包括 I-FEED 评分大于 2 分的发生率,以及监测术后胃肠功能的其他指标,包括首次排气时间、首次排便时间、布里斯托尔 3-4 级粪便时间和耐受饮食时间。此外,我们还收集了其他ERAS恢复指标,包括PONV发生率、并发症、术后疼痛评分、满意度评分和出院时术后功能恢复质量:主要结果:与对照组和 PCL 组相比,PCL-EOF 的胃肠功能恢复明显提高(P 2(PCL:8% vs. PCL-EOF:2% vs. 对照组:21%)。与对照组相比,PCL-EOF的干预保护了患者I-FEED评分>2的发生率[HR:0.09, 95%CI (0.01-0.72), p = 0.023],并有利于促进患者术后首次排气[PCL-EOF: HR:3.33, 95%CI (2.14-5.19), p 结论:我们的主要终点 I-FEED 评分显示,围手术期自由饮水可显著降低 I-FEED 评分,作为一种保护性干预措施,可防止 I-FEED>2 分。 胃肠道恢复指标,如首次排气和排便时间,也有显著改善。此外,干预措施还提高了术后饮食耐受性,加快了早期恢复:试验注册:ChiCTR2300071047(https://www.chictr.org.cn/)。
{"title":"Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial","authors":"Beibei Wang MD , Dong Han MD , Xinyue Hu MD , Jing Chen MD , Yuwei Liu , Jing Wu MD, PhD","doi":"10.1016/j.jclinane.2024.111539","DOIUrl":"10.1016/j.jclinane.2024.111539","url":null,"abstract":"<div><h3>Study objective</h3><p>This study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization.</p></div><div><h3>Design</h3><p>A prospective randomized controlled trial.</p></div><div><h3>Setting</h3><p>Operating room and gynecological ward in Wuhan Union Hospital.</p></div><div><h3>Patients</h3><p>We enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis.</p></div><div><h3>Interventions</h3><p>Patients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment.</p></div><div><h3>Measurements</h3><p>The primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3–4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge.</p></div><div><h3>Main results</h3><p>The PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (<em>p</em> < 0.05), with the lower I-FEED score (<em>PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]</em>) and the reduced incidence of I-FEED >2 <em>(PCL:8% vs. PCL-EOF: 2% vs. control:21%).</em> Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 <em>[HR:0.09, 95%CI (0.01–0.72), p</em> <em>=</em> <em>0.023]</em>, and was beneficial in promoting the patient's postoperative first flatus <em>[PCL-EOF: HR:3.33, 95%CI (2.14–5.19),p</em> <em><</em> <em>0.001]</em>, first defecation <em>[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p</em> <em><</em> <em>0.001]</em>, Bristol feces grade 3–4 <em>[PCL-EOF: HR:3.65, 95%CI (2.36–5.63), p</em> <em><</em> <em>0.001]</em>, first fluid diet<em>[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p</em> <em><</em> <em>0.001]</em>, and first normal diet<em>[PCL-EOF: HR:6.63, 95%CI (4.18–10.50), p</em> <em><</em> <em>0.001]</em>. Also, the length of postoperative hospital stay <em>(PCL-EOF","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":null,"pages":null},"PeriodicalIF":5.0,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}