Perioperative Medicine最新文献

Postoperative Nausea and Vomiting (PONV) is a potential complication in all people undergoing general anesthesia (GA), causing significant discomfort and potentially leading to serious complications. Despite decades of research and the implementation of various preventive drugs and measures, complete prevention via traditional guidelines continues to pose challenges in clinical settings. This article will review mechanisms, influencing factors (including patient-related, surgery-related, and anesthesia-related factors), and strategies for prevention and treatment, both pharmacological and non-pharmacological, for PONV in adultsunder GA. This manuscript also summarizes randomized trials investigating the incidence of PONV in adults receiving opioid-sparing or opioid-free perioperative GA-based protocols. This review aims to summarize evidence-based guidance amidst traditional guidance, and other recent considerations, for optimizing anesthetic management strategies in clinical practice.

Background: To optimize prehabilitation for patients with oesophageal cancer, insight is required into the response to prehabilitation, and factors affecting this response. This study investigated (1) the response to prehabilitation in patients with oesophageal cancer following neoadjuvant treatment, (2) the association between baseline physical fitness and preoperative changes in fitness, (3) differences in physical fitness, nutritional status, and fatigue between responders and non-responders to prehabilitation.

Methods: This multicenter cohort study included patients with oesophageal cancer, following a 6-10 week personalized prehabilitation program as part of standard care. Prehabilitation, consisting of supervised exercise and nutritional counseling, started after neoadjuvant treatment. Preoperative physical fitness and nutritional status were monitored before and after neoadjuvant treatment, and after prehabilitation. Changes over time were analyzed using linear mixed models. Impact of baseline fitness on preoperative changes in exercise capacity was investigated using a linear mixed regression model. Differences between responders to prehabilitation (> 0 Watt improvement during exercise training) and non-responders were analyzed using Independent T-Tests and multivariable logistic regression.

Results: Two hundred forty patients were included (mean age 66.0 (9.3) years; 77.1% male). On average, physical fitness and nutritional status declined during neoadjuvant treatment, and significantly improved during prehabilitation. Exercise capacity increased by + 32.7 Watts (95% CI: 25.2-40.2) during prehabilitation, with similar improvements across patients with low, moderate, and high baseline capacity. Substantial heterogeneity in preoperative changes was observed, with only 49.6% of patients following a pattern of decline-improvement (corresponding to average values for exercise capacity). Sixty-five percent of patients were classified as responders. Greater decline in fitness during neoadjuvant treatment (p < .001), lower fitness after neoadjuvant treatment (p = .001), and higher fatigue (p = .01) were associated with a positive response to prehabilitation.

Conclusions: On average, patients with oesophageal cancer improved in physical fitness and nutritional status during prehabilitation, recovering from the impact of neoadjuvant treatment. Response to prehabilitation was independent of baseline fitness. A greater decline in fitness during neoadjuvant treatment, lower fitness before prehabilitation and higher fatigue were associated with a positive response. The heterogeneity in preoperative trajectories among patients underscores the importance of regular monitoring to tailor interventions to individual needs.

Background: Hypothyroidism is a highly prevalent endocrine disorder increasingly recognized as a potential modifier of perioperative risk in orthopedic surgery. Emerging evidence indicates associations between hypothyroidism and adverse perioperative outcomes, including systemic complications and delayed recovery, in orthopedic populations. However, existing analyses remain limited by small sample sizes, lack of surgical subtype stratification, and insufficient focus on lumbar spine surgery (LSS) specifically. To address this gap, we leveraged data from the Nationwide Inpatient Sample (NIS) to clarify the association between hypothyroidism and perioperative complications in patients undergoing LSS.

Methods: A retrospective analysis was performed utilizing the NIS database (2013-2022). LSS patients were identified by ICD-9/10 codes and further divided into hypothyroid and non-hypothyroid cohorts. Propensity scores were calculated and matched in 1:1 ratios for patients with hypothyroidism to patients without hypothyroidism based on patient demographics, hospital characteristics, and Charlson Comorbidity Index, Perioperative complications were analyzed by multivariable logistic regression.

Results: Among 873,110 LSS patients, 11.66% were diagnosed with hypothyroidism. Hypothyroid patients were older (median age 64 versus 59 years, P < 0.001). Before stratification, hypothyroidism was associated with significantly increased odds ratios (ORs) for the following complications in the overall lumbar spine surgery patient cohort: sepsis, postoperative shock, postoperative delirium, acute cerebrovascular disease, acute myocardial infarction, congestive heart failure, deep vein thrombosis, pneumonia, pulmonary embolism, respiratory failure, urinary tract infection, transfusion, wound infection, wound dehiscence, in-hospital mortality, and prolonged length of stay (LOS) (P < 0.001 for all). After stratification, patients who underwent lumbar fusion alone demonstrated significantly elevated Odds Ratios (ORs) for all complications. In contrast, among those who underwent lumbar decompression alone or discectomy alone, the increases in ORs for wound infection and wound dehiscence were not statistically significant. Furthermore, for the discectomy-alone subgroup, the elevated ORs for postoperative shock and acute myocardial infarction also lacked statistical significance. For all other complications, the subgroups showed elevated ORs that were statistically significant.

Conclusions: This study suggests a correlation between hypothyroidism and a higher risk of complications in patients undergoing lumbar spine surgery. This finding indicates that surgeons should exercise heightened vigilance with lumbar surgery patients who have co-existing hypothyroidism.

Objective: This study sought to determine the incidence and risk factors associated with blood transfusion among patients undergoing robot-assisted laparoscopic total hysterectomy (RA-TLH), using a nationwide database.

Methods: A retrospective data analysis was conducted using the Nationwide Inpatient Sample (NIS), which enrolled patients who underwent RA-TLH from 2010 to 2019, with complete demographic and clinical information available. Patients were categorized into two groups based on whether they had received blood transfusions. Comparisons were made regarding demographic data, length of hospital stay (LOS), total hospital charges (TOTCHG), hospital characteristics, mortality rates, comorbidities, and perioperative complications. Univariate and multivariate logistic regression analyses were then conducted to identify factors independently associated with transfusion in RA-TLH patients.

Results: From 2010 to 2019, 3.47% of patients undergoing RA-TLH received blood transfusions. Patients who received transfusions experienced extended hospital stays, increased total hospital costs, elevated mortality during hospitalization, and were more commonly managed at teaching hospitals and medical centers in the southern region, or a higher proportion were of Black ethnicity. Besides, patients relying on self-pay experienced a higher rate of transfusion (P < 0.05). Several comorbidities were associated with increased risk of transfusion: congestive heart failure(OR 1.60; 95%CI: 1.21-2.13),coagulopathy(OR 5.27;95%CI: 4.08-6.82),fluid and electrolyte disorders(OR 2.30; 95%CI: 1.91-2.76),metastatic cancer (OR 1.83; 95%CI: 1.40-2.40), pulmonary circulation disorders (OR 1.75; 95%CI: 1.16-2.63), renal failure(OR 1.85;95%CI: 1.43-2.38),weight loss(OR 2.39; 95%CI: 1.68-3.43), and anemia. Age was not identified as a risk factor for transfusion. Blood transfusion was significantly associated with elevated rates of postoperative complications, including sepsis, acute myocardial infarction, cardiac arrest, and shock (P < 0.05), in addition to deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, hemorrhage/seroma/hematoma, genitourinary disease, pulmonary embolism, and conversion to an open procedure.

Conclusions: In conclusion, this study reports a 3.47% incidence of transfusion in RA-TLH and identifies high-risk patient profiles based on race, insurance status, and specific comorbidities. Furthermore, transfusion was independently associated with significantly poorer outcomes, including longer LOS, increased inpatient charges, and higher hospital mortality. These findings provide critical data for preoperative optimization, enhancing risk stratification, patient counseling, and the development of targeted blood management strategies to prevent adverse events.

Objective: During general anesthesia with drainage laryngeal mask airway (LMA) ventilation, a gastric tube or suction catheter is inserted through the drainage LMA hole during surgery. This allows for gastrointestinal decompression by vacuum aspiration. This study aimed to observe the effect of two decompression methods on the incidence of postoperative flatulence, nausea and vomiting, and other adverse reactions in patients undergoing general anesthesia.

Methods: Sixty patients (ASA I-II, aged 18-70 years) undergoing gynecological surgery with LMA ventilation under general anesthesia were randomly categorized into the gastric tube group (group G) and the suction catheter group (group S). After induction of general anesthesia, a gastric tube or suction catheter was placed through the drainage port of the drainage LMA in both groups, and vacuum aspiration was intermittently performed during the surgery. The antral area was monitored under ultrasound at three time points: after admission, after LMA insertion, and after LMA. Also, the incidence of adverse reactions, such as flatulence, and nausea and vomiting, was followed up at 1, 6, and 24 h after the surgery.

Results: Compared with group G, the antral area in group S increased significantly after the surgery (P < 0.05). In addition, the incidence of nausea and vomiting, and flatulence, in group S significantly increased 1 and 6 h after the surgery (all P < 0.05). No significant difference was observed in the incidence of nausea and vomiting, and flatulence, between the two groups 24 h after the surgery. No significant difference was noted in the incidence of sore throat and hoarseness at three time points after the surgery between the two groups.

Conclusions: Under general anesthesia with drainage LMA ventilation, gastrointestinal decompression with a gastric tube placed through the LMA drainage port could effectively prevent flatulence and reduce the incidence of adverse reactions such as nausea and vomiting. The placement of a suction catheter could not achieve the same clinical effect.

Clinical trial registration: Chinese Clinical Trial Registry,registration number ChiCTR2300078990,22/12/2023.

Background: Postoperative pain (POP) and postoperative nausea and vomiting (PONV) are frequent and distressing complications after surgery. Smoking has been proposed as a modifiable factor influencing these outcomes, yet evidence is inconsistent and scarce from low- and middle-income countries (LMICs). We examined whether current smoking status independently predicts early POP and PONV.

Methods: We conducted a prospective, observational study in two West Bank of Palestine tertiary referral hospitals over six months. Adults (≥ 18 years) undergoing elective surgery under general anaesthesia were included. Smoking status was self-reported (current smoker vs. nonsmoker). End-points 24 h after surgery were nausea (presence and severity on VAS), vomiting (number of episodes), and pain (presence and severity on VAS) were investigated. Logistic regression was employed to estimate adjusted odds ratios (aORs) for associations of smoking status with each outcome after adjustment for age, sex, height, weight, history of previous surgeries, history of PONV, surgical approach, duration of anaesthesia, and intraoperative opioid/antiemetic use.

Results: Among 200 patients (90 smokers; 110 nonsmokers; median age 38 years), crude rates were: nausea 32.5% (nonsmokers 37.2% vs. smokers 26.6%), vomiting 23.1% (28.4% vs. 16.6%), and pain 87.9% (91.7% vs. 83.3%). After adjustment, smoking status was not significantly associated with postoperative nausea (aOR 1.57; 95% CI 0.64-3.86), vomiting (aOR 1.13; 95% CI 0.45-2.85), pain (aOR 0.98; 95% CI 0.29-3.23), or their severities (all p > 0.05).

Conclusion: For this two-centre LMIC cohort study, current smoking status was not an independent predictor of early POP or PONV. Perioperative risk stratification and prevention should not solely be based on smoking status but include validated predictors (e.g., sex, history of PONV, type of procedure, duration of anaesthesia, opioid exposure). Well-powered standardised multicentre studies quantifying smoking exposure (e.g., pack-years, duration since cessation) are required.