Minerva anestesiologica最新文献

Background: Patients with obesity, especially those suffering from obstructive sleep apnea (OSA), are prone to postoperative respiratory hypoxemia. The PRODIGY (prediction of opioid-induced respiratory depression in patients monitored by capnography) Score is used to predict respiratory complications that factor in sleep-disordered breathing. Data on the impact of OSA on the frequency and timing of postoperative desaturation trends after bariatric surgery are lacking.

Methods: This cohort study included 195 patients who underwent robotic-assisted bariatric surgery between June 2022 and December 2023. Patients underwent were classified by OSA status (yes/no) and PRODIGY Risk Score (high/intermediate/low). All patients received low or opioid sparing anesthesia and were continuously monitored postoperatively using the Masimo Rad-97 device (Masimo, Irvine, CA, USA). Postoperative monitoring averaged 14.5 hours, including tracking several variables and SpO2 values. We documented desaturations and opioid usage in 2-hour intervals. Patients also underwent 30-day postoperative follow up. Descriptive statistics were analyzed based on OSA status and PRODIGY scores using Student's t-test, ANOVA, and Fisher's Exact Test.

Results: Most study patients (57.4%) had OSA, were significantly older, and were predominantly female. Patients with OSA had substantially more prolonged exposure to SpO2 ranges between 80-95% and experienced more frequent desaturation events between 10 and 14 hours after Post-Anesthesia Care Unit (PACU) discharge. Patients with high PRODIGY scores (>15) had significantly more desaturation events compared to intermediate and low-score groups.

Conclusions: Postoperative desaturation rates are significantly higher among patients with OSA with high PRODIGY scores, especially in the delayed postoperative period. Continuous extended postoperative monitoring is warranted for these high-risk patients after bariatric surgery.

Introduction: The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC.

Evidence acquisition: We searched Pubmed Central, Scopus and Cochrane Central Register of Controlled Trials (from inception to until 1 July 2024). The effects of the M-TAPA were compared with those of sham block, placebo and no intervention. Randomized controlled trials, observational and retrospective studies were included. The primary outcome was postoperative opioid consumption at 24 hours, while secondary outcomes included pain scores at 12 and 24 hours, postoperative nausea and vomiting (PONV), and rescue analgesic requirements.

Evidence synthesis: This meta-analysis included six studies encompassing four randomized controlled trials, one retrospective study, and one prospective observational study, with a total of 350 patients. The analysis demonstrated a significant reduction in postoperative opioid consumption (MD -9.06; 95% CI -11.6 to -6.48, P=0.001) in the M-TAPA group. Additionally, patients receiving M-TAPA reported lower pain scores at 12 and 24 hours postoperatively. The risk of PONV was significantly reduced (OR 0.19; 95% CI 0.10 to 0.39, P=0.001), and fewer patients required rescue analgesics (OR 0.24; 95% CI 0.09 to 0.65, P=0.05).

Conclusions: M-TAPA block provides superior analgesia when compared with control group in LC.