Perioperative Medicine最新文献

Background: Patients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.

Methods: Sixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.

Results: At 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61-65 μg) compared to the TAPB group (66, 63-70 μg) (p < 0.001). Hospital stay median was 7 (6-9) days for the ESPB group and 8 (7-10) days for the TAPB group (p = 0.037).

Conclusions: Patients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.

Trial registration: https://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.

Background: Racial and ethnic disparities in the treatment of perioperative pain have not been well-studied, despite being observed in a variety of other medical settings. The goal of this investigation was to evaluate the relationship between race and ethnicity and intra- and postoperative opioid administration for patients undergoing open liver resection surgery.

Methods: In this single-center retrospective cohort study, adult patients undergoing open liver resection from January 2012 to May 2019 were identified. Demographic, intraoperative, and postoperative data were extracted from the institutional perioperative data warehouse. The primary outcome was weight-based intraoperative morphine milligram equivalents (MME/kg). Secondary outcome variables included use of neuraxial analgesia and length of stay (LOS). Multivariable regression models were used, which controlled for pertinent factors such as age and duration of surgery.

Results: There were 1294 adult open liver resections included in this study: 532 (41%) patients self-reported as White, 401 (31%) as Asian, 159 (12%) as Black, 97 (7%) as Hispanic, and 105 (8%) as Other. The risk adjusted mean intraoperative MME/kg was not different among racial groups (White: 3.25 [95% CL 3.02-3.49] mg/kg vs. Asian: 3.38 [95% CL 3.10-3.69] mg/kg, p = 0.87; Black: 2.95 [95% CL 2.70-3.23] mg/kg, p = 0.19; Hispanic: 3.36 [95% CL 3.00-3.77] mg/kg, p = 0.97). In the multivariable models for secondary outcomes, length of stay was significantly higher for Black (estimate: 1.17, CL: 1.00 to 1.35, p = 0.047) and Hispanic (1.30, CL: 1.05 to 1.65, p = 0.018) patients relative to White patients. No racial/ethnic groups were significantly associated with higher or lower odds of receiving regional anesthesia.

Conclusions: For patients undergoing liver resection surgery, no racial and ethnic disparities were observed for weight-based intraoperative MME.

Background: Postoperative atrial fibrillation (POAF) is an ordinary complication of surgery, particularly cardiac surgery. It significantly increases in-hospital mortality and costs. This study aimed to establish a nomogram prediction model for POAF in patients undergoing laparotomy. The model is expected to identify individuals at a high risk of POAF before surgery in clinical practice.

Methods: A retrospective observational case-control study involving 230 adult patients (60 patients with POAF, 120 patients in the control group, and 50 patients in the validation group) who underwent laparotomy was retrieved from two hospitals. Independent risk variables for POAF were investigated using logistic regression and the least absolute shrinkage and selection operator (LASSO) regression analysis. Subsequently, a nomogram model for POAF was constructed by multivariate logistic regression equations. The prediction model was internally validated by bootstrap method and externally validated with the validation group data. To assess the discriminative ability of the nomogram model, a receiver operating characteristic (ROC) curve was generated and a calibration curve was employed to assess the concentricity between the model's probability curve and the ideal curve. Subsequently, decision curve analysis (DCA) was performed to assess the clinical effectiveness of the model.

Results: C-reactive protein (CRP), lymphocyte-to-monocyte ratio(LMR), blood urea nitrogen (BUN), and Macruz index were independent risk variables for POAF in patients who underwent laparotomy. A user-friendly and efficient prediction nomogram was visualized using R software. This nomogram exhibited strong discrimination, as evidenced by an area under the ROC curve (AUC) of 0.90 (95% CI 0.8509-0.9488) for the training set, 0.86 (95% CI 0.7142-1) for the test set, and 0.9792 (95% CI 0.9293-1) for the validation group data. The C-index of the bootstrap nomogram model was 0.8998. Furthermore, DCA revealed that this model displayed excellent fit and calibration, as well as positive net benefits.

Conclusions: A nomogram prediction model was constructed for POAF in patients who underwent abdominal surgery. The nomogram prediction model is expected to identify individuals at high risk of POAF in clinical practice for prophylactic therapeutic intervention prior to surgery.

Background: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are associated with major morbidity and mortality after surgery. This systematic review and meta-analysis determined whether preoperative cognitive training could reduce POD and POCD in patients undergoing elective surgery.

Methods: Eligible randomized controlled trials were identified from CENTRAL, MEDLINE, EMBASE, Scopus, Web of Science, and CINAHL databases from inception to April 30, 2024. Two independent reviewers extracted data on trial characteristics and risk of bias for each trial. We rated the quality of reporting of cognitive training interventions using the template for intervention description and replication (TIDieR) and evaluated the overall certainty (quality) of evidence using The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Random-effects models were used to summarize the treatment effect of cognitive training. Post hoc trial sequential analyses (TSA) were performed for POD and POCD to differentiate between "no evidence of effect" and "evidence of no effect."

Results: Seven trials (four high risk and three unclear risk of bias) involving 864 participants (mean or median age between 66 and 73 years old) were considered eligible and subject to meta-analysis. The quality of reporting cognitive training interventions was fair to moderate. Most cognitive prehabilitation programs were home-based, unsupervised, computerized interventions requiring 2.3-10 h over 1-4 weeks before surgery. Cognitive prehabilitation did not reduce POD (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.57-1.18; I² = 30%; low certainty of evidence in five trials) or early POCD after surgery (RR 0.93, 95% CI 0.58-1.49; I² = 67%; very low certainty of evidence in four trials) compared to usual care. Nonetheless, TSA suggested that the sample sizes were insufficient to exclude the effectiveness of preoperative cognitive training in reducing POD or POCD. The participants' compliance rate was either not reported or mostly below 70%.

Conclusions: Current evidence is insufficient to determine the beneficial effect of preoperative cognitive training on POD or POCD. Given the well-established benefits of long-term cognitive training on cognition in the elderly, the design of future cognitive prehabilitation trials should be adequately powered and incorporated with strategies to improve patient compliance.

Background: Stroke is a critical complication of cardiac surgery that results in increased mortality and morbidity. Limited treatment options are available for patients with severe neurological deficits, such as impaired consciousness. Acupuncture is a well-known integrative management method for stroke patients. However, there are no extensive reports discussing the benefit of acupuncture in stroke patients after cardiac surgery. The aim of this study was to demonstrate the role of acupuncture in the neurological recovery of these patients and to identify the factors that provide greater benefit.

Methods: This self-controlled case series utilized inpatient data from stroke patients after cardiac surgery who received acupuncture in a single center from 2013 to 2019. The primary outcomes included the Glasgow Coma Scale, muscle strength grading scale, and Barthel Index. Wilcoxon signed-rank test was used to compare the neurological differences between pre-acupuncture and post-acupuncture.

Results: Fifty-one patients who met the criteria showed significant improvement of the severity of neurological impairment, including the Glasgow Coma Scale, muscle strength grading scale, and Barthel Index (p < 0.05). The group that underwent aortic dissection repair and the group that started acupuncture within 7 days after stroke showed greater improvement (p < 0.01). No adverse events were reported. Three patients with profound neurological impairment who received acupuncture intervention were described.

Conclusions: Acupuncture has a potential benefit in improving neurological impairment and reducing mortality in stroke patients after cardiac surgery, especially within 7 days of the event. Further larger prospective studies with control groups are needed to provide convincing evidence.

Background: Day surgery has developed rapidly in China in recent years, although it still faces a shortage of anesthesiologists to handle pre-anesthesia routine before surgery. We hypothesized that ChatGPT may assist anesthesia practitioners in preoperative assessment and answer questions on the concerns of patients. The aims of this study were to examine the ability of ChatGPT to assess preoperative risk and determine its accuracy in answering questions regarding knowledge and management of day surgery anesthesia.

Methods: One-hundred fifty patient profiles were generated to simulate day surgery patient presentations that involved complications of varying acuity and severity. The ChatGPT group and the expert group were both required to evaluate the profiles of 150 simulated patients to determine their ASA-PS classification and whether day surgery was recommended. ChatGPT was then asked to answer 131 questions about day surgery anesthesia that represented the most common issues encountered in clinical practice. The performance of ChatGPT was assessed and graded independently by two experienced anesthesiologists.

Results: A total of 150 patient profiles were included in the study (75 males [50.0%] and 75 females [50.0%]). There was no difference between the ChatGPT group and the expert group for the ASA-PS classification and assessment of anesthesia risk in the patient profiles (P > 0.05). Regarding recommendation for day surgery in patients with certain comorbidities (ASA ≥ II), the expert group was inclined to require further examination or treatment. In addition, the proportion of conclusions made by ChatGPT was smaller than that of the experts (i.e., ChatGPT n (%) vs. expert n (%): day surgery can be performed, 67 (47.9) vs. 31 (25.4); needs further treatment and evaluation, 56 (37.3) vs. 66 (44.0); and day surgery is not recommended, 18 (12.9) vs. 29 (9.3), P < 0.05). We showed that ChatGPT had extensive knowledge related to day surgery anesthesia (94.0% correct), with most of the points (70%) considered comprehensive. The performance of ChatGPT was also better in the domains of peri-anesthesia concerns, lifestyle, and emotional support.

Conclusions: ChatGPT can assist anesthesia practitioners and surgeons by alerting them to the ASA-PS classification and assessing perioperative risk in day surgery patients. ChatGPT can also be trusted to answer questions and concerns related to pre-anesthesia and therefore has the potential to provide important assistance in clinical work.

Background: The use of complementary and alternative medicine (CAM) has increased substantially around the world; various global studies have documented the use of CAM by surgical patients in the preoperative period, with rates of herbal medications and other nonherbal treatments ranging from 12 to 69%. This study aimed to identify the prevalence of CAM and its patterns of use among surgical patients.

Methods: From December 2020 to April 2021, a descriptive cross-sectional study was undertaken in Palestine. A face‒to-face interview questionnaire was used. The participants were asked questions regarding sociodemographics, clinical information, CAM usage, reasons for its use, and opinions on its efficacy.

Results: Among the 300 surgical patients who were interviewed in this study, 252 (84.0%) reported that they had ever used CAM, while a total of 122 (48.4%) had used CAM before their surgery, 81.7% of the respondents used herbal methods, and 64.7% of them used nonherbal methods. CAM use among our study population was not linked to specific demographics or other characteristics, except health insurance (p = 0.004). The most commonly used herbs among surgical patients are Salvia officinalis L. (Sage) (84.1%) and Pimpinella anisum L. (Anise) (75.5%). The highest percentage was found among patients with university qualifications (73.2%), who used more than three methods (p < 0.001). In addition, 59.4% of the females used more than three therapies, whereas 45.9% of the males did (p = 0.032).

Conclusions: The herbal methods used are common among surgical patients in Palestine and are consistent with the enormous increase in the use of CAM. Therefore, awareness should be raised among the public regarding the risks and benefits of CAM use.

Total knee arthroplasty (TKA) is an efficacious treatment for end-stage knee osteoarthritis, often accompanied by severe postoperative pain. In certain patients, this pain can persist for over 3 months and is referred to as chronic post-surgical pain (CPSP). Postoperative persistent pain has emerged as a significant and noteworthy issue impacting patient quality of life following TKA. The etiology of CPSP after TKA is multifaceted. Peripheral or central sensitizations resulting from inflammatory reactions, nerve injury, and neurobiological mechanisms are the primary mechanisms contributing to chronic persistent pain after TKA. Preoperative, intraoperative, and postoperative factors can induce pain sensitization. Once CPSP occurs after TKA, it significantly hampers patient recovery with challenging treatment options. Currently, among the preventive and therapeutic strategies for chronic pain after TKA, it is widely believed that early comprehensive preventive treatment to prevent acute to chronic pain transition can substantially reduce the incidence of CPSP following TKA. In recent years, studies have investigated perioperative strategies aimed at reducing the occurrence of persistent pain after TKA. This article provides an overview of advancements in understanding the pathogenesis, high-risk factors, and preventive measures for chronic pain following TKA. We hope that this review will guide future research directions on CPSP after TKA while contributing to clinical perioperative pain management.

Purpose: Maintaining normothermia during the perioperative period is crucial for preventing complications, such as surgical site infections, prolonged hospital stays, and adverse cardiovascular events. This study aimed to elucidate methods of perioperative temperature management by integrating Western and traditional Chinese medicine (TCM) approaches. By combining advanced techniques of Western medicine with holistic and preventative practices of TCM, we aimed to provide a comprehensive strategy for effective perioperative thermal regulation.

Methods: And a comprehensive literature review was conducted to analyze the causes of perioperative hypothermia and methods of perioperative temperature management from both Western and traditional Chinese medicine (TCM) perspectives. Special emphasis was placed on evaluating the underlying factors contributing to perioperative hypothermia, as well as the effectiveness, selection criteria, indications, contraindications, adverse reactions, and potential complications associated with various temperature management techniques.

Results: Effective prevention and management strategies include preoperative risk assessment, physical warming measures, environmental temperature control, pharmacological interventions, perioperative temperature monitoring, comprehensive warming protocols, and postoperative warming and monitoring. Integrating traditional Chinese medicine provides additional methods to enhance overall effectiveness and patient outcomes. By combining these approaches, healthcare providers can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and its associated complications, improving patient safety and recovery.

Conclusion: For IPH, a complex and challenging medical condition, both traditional Chinese medicine and Western medicine have established their own theoretical bases and developed corresponding prevention and treatment methods. However, it is important to note that although each of these methods has unique value and potential, they also have specific indications and unavoidable limitations. Therefore, by integrating and combining the complementary strengths and resources of traditional Chinese medicine and Western medicine, we can achieve a more comprehensive and effective prevention of IPH, ultimately improving the health and well-being of those affected.