Perioperative Medicine最新文献

Purpose: To investigate the effect of intraoperative low-dose esketamine administered at anesthesia induction on postoperative quality of recovery in total laparoscopic hysterectomy.

Patients and methods: One-hundred six female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into saline group (group P) and esketamine group (group S). Group P received induction with normal saline, propofol, sufentanil, midazolam, and rocuronium, while group S received induction with low-dose esketamine (0.25 mg/kg), propofol, sufentanil, midazolam, and rocuronium. Both groups were maintained with intravenous infusions of propofol and remifentanil. The quality of recovery (QoR-40), Numerical Rating Scale (NRS), and Pittsburgh Sleep Index (PSQI) scores were assessed at 8, 24, 48, and 72 h, 7 days, and 30-day post-surgery. Hamilton Depression Scale (HAMD) scores were evaluated at 72 h, 7 days, and 30-day post-surgery. Intraoperative hemodynamics, remifentanil consumption, inflammatory reactions, and adverse reactions were also documented.

Results: Both groups had similar QoR-40 scores at each time point (P > 0.05). Patients in group S had less intraoperative remifentanil use (P < 0.001), less consumption of phenylephrine (P = 0.005), fewer episodes of hypotension (P < 0.001), and shorter extubation time and stay in postanesthesia care unit (PACU) (P < 0.001). The NRS scores after extubation (P = 0.007), 8 h (P = 0.027) and 48 h (P = 0.016) after surgery, and the postoperative NLR (P = 0.003) and postoperative 24-h PSQI score (P = 0.024) were significantly lower in group S. The mean blood pressure (MBP) was higher at 10 min after incubation (T3) (P < 0.001). The heart rate (HR) was faster at 3 min (T1) (P = 0.005), 10 min (T3) (P = 0.023), and 30 min (T4) (P = 0.014) after incubation and complete end of surgery (T5) (P = 0.010) in group S. Multiple linear regression analyses demonstrated that higher education was associated with better recovery (P < 0.05).

Conclusion: In patients undergoing total laparoscopic hysterectomy, one injection of low-dose esketamine at anesthesia induction did not affect QoR-40 scores. However, esketamine stabilized intraoperative hemodynamics, decreased intraoperative opioid requirements, and shortened postoperative extubation time and PACU stay. It also alleviated postoperative inflammatory response and pain without causing adverse effects.

Perioperative neurocognitive dysfunction (PND) is a significant complication in elderly surgical patients, characterized by cognitive decline and often linked to neuroinflammation. This study conducted a bibliometric analysis of 744 publications on PND-related neuroinflammation from 1999 to 2023, using the Web of Science Core Collection (WoSCC) database. Tools such as VOSviewer, CiteSpace, and Microsoft Excel were employed to analyze publication trends, geographical distribution, and key research areas. Results showed a steady increase in publications, with China leading in output and the USA exerting significant influence. Key research areas included aging, cardiac surgery, microglial activation, and therapeutic targets. Recent studies focused on the NLRP3 inflammasome and microglial activation as central mechanisms. The analysis also identified emerging trends, such as the investigation of biomarkers and the potential of dexmedetomidine and sevoflurane in modulating neuroinflammation. This study provides a comprehensive overview of the evolving research landscape, highlighting the need for interdisciplinary collaboration and the development of novel therapeutic strategies to address PND. Future research should focus on elucidating the complex interactions between neuroinflammation and cognitive decline and exploring personalized interventions to improve patient outcomes.

Background: Despite advances in treatment, hemorrhage remains one of the leading causes of early death in trauma. Rapid, personalized treatment of coagulopathy in this population should therefore be a priority. The introduction of viscoelastic hemostatic assays may improve transfusion strategies.

Methods: This prospective observational study aimed to compare the efficacy of a ROTEM-guided hemostatic treatment protocol for trauma patients with a historical control group who had received conventional coagulation testing. The study included adults with multiple trauma requiring transfusion (≥ 1 unit of RBC within 12 h). The aim was to compare transfusion requirements in the operating room, on the 1st and 2nd ICU days, the rate of massive transfusion, and the overall outcome. The data obtained were stored in a database and analyzed using Statistica™ 13.3 (Stat Soft Polska). A p-value < 0.05 was considered significant. Study was registered retrospectively at researchregistry.com (RR10995).

Results: A total of 78 patients were compared. The number of RBC units transfused in the OR and on the 1st ICU day decreased significantly after implementation of the ROTEM treatment protocol (p = 0.01, p = 0.04). Fewer patients in the study group required RBC transfusion on the 1st and 2nd ICU days (p = 0.01, p = 0.003), as well as the number of patients requiring FFP transfusion in all examined periods of time (p = 0.02, p = 0.006, p = 0.01). While FFP use per patient in the OR and on the 1st ICU day was lower, it was not statistically significant. Fibrinogen substitution in the OR remained similar, but more patients from the study group received it on the 1st ICU day (13 vs. 5, p = 0.04). The need for other blood products and coagulation factors remained unchanged. MT incidence decreased significantly in the first 24 h (p = 0.02), while 30-day mortality remained unchanged.

Conclusions: The introduction of the ROTEM- guided hemostatic treatment protocol in trauma resulted in a changes in transfusion requirements and a reduction in the incidence of MT. ROTEM can be a useful clinical tool in the rapid and targeted management of bleeding trauma patients.

Trial registration: Researchregistry.com (RR10995).

Background: Imrecoxib is a novel non-steroidal anti-inflammatory drug. As a moderately selective COX-2 inhibitor, it has achieved certain therapeutic effects in postoperative analgesia such as spinal, arthroscopic, and total hip arthroplasty. However, the efficacy of imrecoxib in postoperative analgesia after total knee arthroplasty (TKA) is still unknown. Therefore, this study aims to explore the clinical efficacy and safety of imrecoxib in postoperative analgesia after TKA.

Methods: The 120 patients were randomly assigned to two groups. The experimental group was given one tablet of imrecoxib 4 h after surgery in addition to conventional treatment. Starting from the second day, the dose of imrecoxib was 0.1 g/time, twice a day. The control group only received conventional treatment. The observation indicators included visual analogue scale (VAS) score, joint range of motion (ROM), opioid consumption, erythrocyte sedimentation rate (ESR), C-reactive protein (PCR), interleukin-6 (IL-6), and incidence of adverse reactions.

Results: At rest, the VAS pain scores of the experimental group at 24 and 48 h after surgery (3.033 ± 1.154, 2.700 ± 0.988) were lower than those of the control group (2.017 ± 0.128, 1.950 ± 0.589), with statistical differences (P = 0.000 < 0.05, P = 0.000 < 0.05). At movement state, the VAS scores of the experimental group at four postoperative time points (4.050 ± 0.805, 4.633 ± 1.048, 4.517 ± 1.057, 4.233 ± 0.844) were lower than those of the control group (4.433 ± 0.782, 5.067 ± 0.910, 5.800 ± 0.945, 5.167 ± 1.003), with statistical differences (P = 0.013 < 0.05, P = 0.027 < 0.05, P = 0.000, P = 0.000).The joint ROM of the experimental group at 24 h (84.783 ± 7.902) and 48 h (86.403 ± 10.367) was higher than that of the control group (76.725 ± 9.499, 79.802 ± 8.400), with statistical differences (P = 0.000 < 0.05, P = 0.000 < 0.05).The postoperative opioid consumption of the experimental group (0.567 ± 0.692) was significantly lower than that of the control group (2.783 ± 1.156), with a statistical difference (P = 0.000 < 0.05).

Conclusion: Our prospective randomized controlled trial demonstrates that imrecoxib can effectively alleviate postoperative pain after TKA, reduce opioid dosage, and does not cause additional adverse reactions, providing a new option for analgesic treatment after TKA.

Trial registration: The study was registered with the China Clinical Trial Registry (registration number: ChiCTR2300072839). Registered date: 20,230,616.

Objective: The incidence of respiratory dysfunction associated with postoperative residual curarization (PORC) after thoracic surgery is high, even affecting the prognosis. There is no consensus on whether sugammadex is beneficial. This study aimed to elucidate the effect of sugammadex in the management of PORC-related respiratory dysfunction following thoracic surgery.

Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched from database inception to January 2025 for studies on respiratory outcomes after thoracic surgery when sugammadex was used as an antagonist. The pooled risk ratio or weighted mean difference was used to evaluate the outcomes.

Results: Among 1398 studies searched, 11 studies were finally included, involving 1445 subjects. The results showed that sugammadex could reduce the incidence of postoperative respiratory complications (RR = 0.77, 95% CI: 0.66-0.90), particularly atelectasis (RR = 0.61, 95% CI: 0.47-0.79) and pneumonia (RR = 0.64, 95% CI: 0.46-0.91). In addition, according to the subgroup analysis by age, surgery type, anesthesia duration, and body mass index, sugammadex was associated with a shortened extubation period (P ≤ 0.005).

Conclusion: Compared with traditional muscle relaxant antagonists, the use of sugammadex after thoracic surgery can help reverse the respiratory dysfunction related to residual muscle relaxants and reduce the risk of atelectasis, pneumonia, and reintubation. However, there is no difference in the risk of pleural effusion and pneumothorax. Except for post-anesthesia care unit duration, the differences in hospitalization and chest tube dwelling duration between the two groups remain to be clarified.

Purpose: This retrospective study aimed to investigate the incidence and risk factors for surgical site infection (SSI) following instrumentation for degenerative lumbar spinal diseases, and to develop a predictive nomogram model.

Method: Patients who underwent posterior instrumentation for degenerative lumbar spinal diseases between January 2020 and December 2022 with a minimum 12-month follow-up were included. Patients were classified as having an SSI or not, and differences in demographics, clinical data, and laboratory indicators were compared. Multivariate logistic regression was performed to identify independent risk factors, and a nomogram was constructed to visualize the results.

Results: The study included 1,462 patients (687 men, 775 women) with a mean age of 52.9 ± 13.7 years and 53 patients (3.5%) developed an SSI. Multivariate analysis identified several risk factors for SSI: higher ASA class (III or IV vs I or II, OR = 2.362; 95%CI, 1.312 to 4.249), surgery involving sacral vertebrae (OR = 2.319; 95%CI, 1.242 to 4.330), open surgery compared to minimally invasive surgery (OR = 3.081; 95%CI, 1.701 to 5.581), prolonged surgical time (per hour increase, OR = 1.482; 95%CI, 1.017 to 2.160), and preoperative hemoglobin < 100 g/L (OR = 4.962; 95%CI, 1.728 to 6.943). The nomogram model demonstrated good discrimination, with a C-index of 0.743 (95% CI: 0.682-0.804), which remained robust at 0.722 after 1,000 bootstrap verifications. The calibration curve indicated the predicted SSI probability aligned well with the actual probability.

Conclusions: This study found a moderate 3.5% SSI rate following instrumentation for degenerative lumbar spinal diseases and identified several risk factors. These findings can inform preoperative patient counseling, risk assessment, and the development of personalized strategies to mitigate SSI.

In randomized controlled clinical trials, composite outcomes are often used to study treatment effects. This approach is popular because it increases the number of observed events, enhancing statistical power while reducing the required patient sample size. However, composite outcomes do not provide insight into the effect of individual endpoints. This becomes particularly relevant when mortality is combined with less critical but clinically relevant endpoints or when the clinical importance of individual endpoints varies significantly. As a result, interpreting composite outcomes can be challenging.This narrative review introduces the win ratio (WR), a method for prioritizing individual endpoints within a composite outcome. The WR offers an alternative to composite outcomes by considering the clinical importance of each component and prioritizing the most critical endpoint, such as death, over less significant events.Despite the popularity of the WR among cardiovascular trialists, this approach has not been extensively used in other areas of clinical research. We contend, that perioperative and periprocedural researchers could consider the WR and related approaches when the outcomes of interest are not of similar clinical importance. To this end, understanding the benefits and limitations of the WR will be essential to exploit its benefits, while avoiding potential misuses of the technique.

The traditional model for testing new treatments, before widespread usage in clinical practice, is the parallel group randomised trial. However, these are often inefficient, time-consuming and expensive, which can be barriers to the timely improvement of clinical care. This is a particular issue for anaesthesia and perioperative medicine where funding for large clinical trials is often scarce. Platform trials are an emerging methodology for testing new interventions, which offer benefits over the traditional parallel group paradigm. Platform trials have the ability to test multiple interventions at the same time, and to add or remove interventions during the course of the programme without undermining the validity or integrity of the trial findings. They are most often structured around a master protocol, which describes the core methods and research governance processes, with each intervention described in either a sub-section or appendix to the master protocol. The principal benefit to researchers and to research funders is that, unlike the sequential parallel group trial model, platform trials can use the same research infrastructure (e.g. database, standard operating procedures etc.) to answer multiple research questions, which is much more time and cost effective. The benefits of platform trials can be further enhanced with the use of adaptive designs or by sharing control patients, for example, by using a multi-arm multi-stage design. Perioperative medicine, anaesthesia and surgery are ideally placed to benefit from platform trials.