Perioperative Medicine最新文献

Background: Penicillin allergy labels frequently lead to second-line antibiotics for surgical prophylaxis, due to concerns for cross-reactivity. This has led to increased patient morbidity, prolonged hospitalization, and increased healthcare costs. The most common perioperative cephalosporin, cefazolin, has unique R groups, the main antigenic portion of penicillin, which makes it safe to use in type 1 hypersensitivity penicillin allergy. We evaluated the effect of education on the incidence of the following: cefazolin usage in penicillin allergy labelled patients, allergic reactions, and surgical site infections.

Methods: As a prospective study with historical controls, perioperative clinicians were educated on the natural history of penicillin allergy, cross-reactivity with cephalosporins, and allergic reaction management. A questionnaire-based algorithm was provided as a guide for cefazolin use in penicillin allergy labelled patients. Chart reviews were conducted before and after educational interventions to assess cefazolin utilization and associated outcomes. 574 patients were included in the study (236 and 338 in the retrospective and prospective cohorts respectively). Participants were non-pregnant adults (≥ 18 years) with penicillin allergy labels undergoing surgery. Data analysis employed the Wilcoxon rank-sum and chi-square tests accordingly to compare the following variables: cefazolin use, administration of epinephrine for the treatment of allergy, and surgical site infections within 30 days of surgery. The primary outcome was to assess cefazolin utilization, with a secondary outcome comparing surgical site infections in first line versus second-line antibiotic administration.

Results: Patients with penicillin allergy labels having surgery where cefazolin was indicated for antibiotic prophylaxis were included. Concurrent antibiotic therapy or requiring alternative prophylaxis meant exclusion. Cefazolin administration significantly increased from 38% to 58% during the study period (89/236 vs. 196/338, p < 0.001). There was no evidence of allergic reactions to cefazolin amongst the patients. Documented use of epinephrine was accounted for by non-allergic indications. There was no significant difference in surgical site infection between the control and intervention group respectively (3.2% vs. 5.9%, p = 0.23).

Conclusions: Antibiotic stewardship based on consensus guidelines led to a significant increase in cefazolin usage in patients with penicillin allergy labels. Employing this strategy has the potential to enhance patient safety, reduce surgical site infections, and mitigate healthcare costs.

Purpose: Perioperative respiratory adverse events (PRAEs) are frequently encountered complications in pediatric anesthesia. The purpose of this experiment is to explore the significant role of miR-18a-5p in PRAEs, thereby providing a novel biomarker for PRAE clinical management.

Methods: Clinical data from 174 children undergoing general anesthesia were analyzed. MiR-18a-5p expression in serum and cells was analyzed via real-time quantitative PCR (qRT-PCR). Its diagnostic value for PRAEs was evaluated through receiver operating characteristic (ROC) curves, while logistic regression was selected to assess independent risk factors for PRAEs. In vitro experiments were conducted to determine miR-18a-5p effects on AEC-II cells proliferation, apoptosis, and lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) secretion.

Results: PRAEs subjects exhibited significantly elevated miR-18a-5p levels with diagnostic relevance. Expression correlated positively with TNF-α/IL-6 concentrations and was associated with age, obesity, American Society of Anesthesiologists (ASA) grade, and anesthesia duration. These parameters jointly constituted the PRAEs predictors. Furthermore, miR-18a-5p silencing enhanced AEC-II cells' viability while suppressing apoptosis and LPS-triggered TNF-α and IL-6 release.

Conclusion: The miR-18a-5p served as a predictive factor and held diagnostic significance for PRAEs following general anesthesia in children. Additionally, miR-18a-5p may offer potential therapeutic implications for PRAEs.

Objective: This study aimed to compare the effects of transversus abdominis plane block and hydromorphone on recovery quality in elderly critically ill patients after major abdominal surgery in the Surgical Intensive Care Unit, focusing on postoperative activity, analgesic efficacy, opioid-related side effects, hemodynamic stability, and hospital stay.

Design: A prospective, single-blind randomized controlled trial (RCT) was conducted following CONSORT guidelines.

Setting: The study took place at Jiaxing First Hospital from July 2024 to December 2025.

Patients: Enrolled, with 122 completing the study. Out of these 61 patients belonged to the TAP (transversus abdominis plane block) group & 61 to the control (intravenous hydromorphone) group.

Interventions: The postoperative VAS scores were assessed in patients, VAS score ≥ 4 was taken as indicative of the presence of postoperative pain. Our interventions were implemented as soon as the VAS rose to 4. Patients in the TAP group were administered ultrasound-guided transversus abdominis plane block, while those in the control group received intravenous hydromorphone.

Measurements: The primary outcome was the Quality of Recovery-40 score at 24 h postoperatively. Secondary outcomes included QoR-40 scores at 48 h, 72 h, and 7d, VAS scores, opioid consumption, complications, and hospital stay.

Main results: The TAP group had significantly higher QoR-40 scores at 24 h (median [IQR]: 170 [167, 172] vs. 157 [153, 158], P < 0.001) and 48 h (median [IQR]162(159,165) vs 171(169,174), P < 0.001) postoperatively, along with lower VAS scores and reduced opioid consumption compared to the control group.

Conclusion: TAP block significantly improves recovery quality and provides better analgesia than hydromorphone in elderly critically ill patients after major abdominal surgery, reducing opioid use and enhancing postoperative outcomes. It is a safe and effective alternative for pain management in the SICU.

Trial registration: The study was registered with the China Clinical Trial Registry (registration number: ChiCTR2400086600). Registered date: 20,240,708.

Background: Cataract surgery is one of the most common elective surgeries and has been shown to be safe with low adverse event rates. Most cataract patients in the US receive one-to-one intraoperative monitoring and sedation administered by an anesthesiologist or nurse anesthetist, termed "monitored anesthesia care" (MAC). Recent studies have suggested that non-anesthesia-led sedation approaches may safely be used in older adults undergoing cataract surgery. However, it is unknown how individual ophthalmologists perceive the risks of cataract surgery with respect to the need for MAC. We sought to characterize physician beliefs and opinions about the risks of performing cataract surgery when considering potential non-anesthesia-led approaches to cataract surgery sedation.

Methods: Using a semi-structured interview guide developed with the Consolidated Framework for Implementation Research (CFIR) framework, between December 2022 and May 2023, we conducted virtual interviews with ophthalmologists who routinely performed cataract surgeries in the United States with or without anesthesia care in outpatient clinical settings across the continental US. Data were analyzed from June 2023 through January 2024 using an inductive thematic analysis approach.

Results: Interviews of 19 ophthalmologists revealed 2 major themes that formed the foundational understanding of how ophthalmologists perceive cataract surgery risk in the context of non-anesthesia-led models of sedation: (1) overall safety of cataract surgery and (2) concerns about assuming sedation responsibilities. Despite conceding that cataract surgery is a low-risk procedure for the vast majority of patients, participants were hesitant to change their current practice and desired an anesthesia "safety net" at all times in case of an unexpected intraoperative event or emergency. Many ophthalmologists' responses underscored their aversion to any potential loss of routine anesthesia support without an acceptable alternative present.

Conclusions: Despite acknowledging its low-risk profile, ophthalmologists are wary of making changes to current sedation approaches for routine cataract surgery.

Objective: This study aimed to investigate the effects of a continuous comprehensive nursing (CCN) system compared to routine care on postoperative hemoglobin (Hb) levels and quality of life (QoL) in patients undergoing coronary artery bypass grafting (CABG).

Methods: This randomized controlled trial (RCT) enrolled 120 patients undergoing CABG. Patients were allocated using computer-generated random numbers (1:1) to either the intervention group (n = 60), receiving a CCN plan, or the control group (n = 60), receiving standard postoperative care. The CCN intervention provided a patient-centered approach encompassing preoperative education, psychological support, continuous postoperative monitoring, personalized care plans, rehabilitation guidance, and structured follow-up extending for three months beyond discharge.

Results: Although baseline differences in BMI and Hb were noted, both groups were otherwise comparable. While Hb levels initially declined in both groups, by day 7 post-surgery, the CCN group demonstrated significantly higher Hb levels compared to the control group (12.28 ± 0.47 g/L vs. 9.16 ± 0.41 g/L; P < 0.001). The intervention group also showed significantly improved red blood cell morphology (lower MCV, P < 0.001; lower RDW, P < 0.001; higher HCT, P < 0.001), changes in IL-2 and IL-6 levels suggesting an immune response difference (higher IL-2, P < 0.001; lower IL-6, P < 0.001), superior QoL scores across all WHOQOL domains (psychological, social, environmental, physical; all P < 0.001), reduced depressive (CES-D, P < 0.001) and anxiety symptoms (SAS, P < 0.001), and significantly higher patient satisfaction (P < 0.001).

Conclusion: Implementing a continuous comprehensive nursing system after CABG significantly benefits postoperative recovery, leading to improved hemoglobin levels, favorable red blood cell indices, measurable changes in immune markers, enhanced quality of life, improved mental health outcomes, and greater patient satisfaction compared to routine care. These findings suggest CCN is a promising strategy to optimize post-CABG patient outcomes.

Background: Elderly patients commonly pose a significant challenge, mainly in emergency settings where the time to optimize the high-risk patient with other associated co-morbidities is inadequate, which predisposes these patients to a number of complications postoperatively. There is paucity of data on predictors of morbidity and mortality among elderly surgical patients in Uganda. This study assessed the predictors of morbidity and mortality among elderly patients undergoing emergency exploratory laparotomy at Jinja, Lira, Hoima, and Fort Portal Regional Referral Hospitals.

Methods: This was a prospective observational cohort in which elderly patients (≥ 65 years) that underwent emergency exploratory laparotomy from 15th November 2024 to 14th February 2025 were enrolled and followed up until 30 days post-operatively to assess for the occurrence morbidity and mortality. The complications assessed included hemorrhage, surgical site infection, deep venous thrombosis, respiratory complications. SPSS version 26 was used for analysis, with Poisson regression done to determine the significant predictors. P < 0.05 was considered significant.

Results: Of the 86 participants, 29.1% were above 80 years of age. Majority were male (74.4%). Complications were seen in 25.6% of the participants. The commonest complication was surgical site infection. Mortality occurred in 10.5%. In the multivariable analysis, being older than 80 years, having DM or hypertension and having a perforation were associated with complications; delayed presentation to hospital and blood transfusion associated with mortality (P < 0.05 for all).

Conclusion: The rates of morbidity were high. More attention is required among the elderly undergoing surgery in order to reduce the rate at which they get morbidity and mortality with emphasis on wound care. Health education and sensitization in communities should be strengthened, advocating for timely seeking of medical attention by the elderly group.