Perioperative Medicine最新文献

Background: The ultrasound-guided thoracic paravertebral nerve block (TPVB) is widely used in video-assisted thoracoscopic surgery (VATS). However, the impact of ultrasound-guided TPVB on the postoperative quality of recovery (QoR) remains unclear in patients undergoing VATS. The objective of this systematic review and meta-analysis was to explore the impact of ultrasound-guided TPVB on postoperative QoR score after VATS in comparison to the control group without receiving either TPVB or other blocks.

Methods: The Cochrane Library, Embase, PubMed, Web of Science, CNKI, WanFang, and CBM databases were searched for randomized controlled trials (RCTs) that evaluated the impact of ultrasound-guided TPVB versus no TPVB or other blocks on postoperative QoR after VATS from inception to January 2025. Two independent researchers carried out the screening of records, the inclusion of full-text studies, and the extraction of data. The outcomes were evaluated using random-effects or fixed-effects meta-analyses.

Results: Seven articles involving 890 participants published from 2016 to 2022 were identified. Our results indicated that ultrasound-guided TPVB could enhance postoperative QoR score (MD = 10.48, 95% CI [5.33 to 15.64]), decrease VAS score (MD =  - 1.57, 95% CI [- 2.30 to - 0.85]), diminish the incidence of PONV (OR = 0.20, 95% CI [0.08 to 0.51]), shorten the time to extubation (MD =  - 8.71, 95% CI [- 15.47 to - 1.94]), and the duration of hospitalization (MD =  - 0.92, 95% CI [- 1.72 to - 0.11]) after VATS.

Conclusions: This meta-analysis revealed that ultrasound-guided TPVB might improve the quality of recovery after VATS. Our results also showed that ultrasound-guided TPVB could reduce postoperative pain, incidence of PONV, extubation time, and the length of hospital stay.

Background: Abdominal massage is a nonpharmacological and safe independent nursing intervention used to manage gastrointestinal symptoms after surgical intervention. This study was conducted to determine the effects of abdominal massage on gastrointestinal symptoms and comfort levels in patients who underwent abdominal massage after surgical intervention.

Methods: The sample of the randomized controlled experimental study consisted of 68 patients: 34 experimental patients and 34 control patients, who underwent inpatient surgery at the orthopedics and traumatology clinic of a university hospital between September 2022 and September 2023, and did not defecate in the first 3 days after surgery. Data were collected via the Patient Information Form, Functional Independence Measure (FIM), Bristol Stool Scale, Gastrointestinal Symptom Rating Scale (GSRS), and General Comfort Scale (GCS). Patients in the experimental group received abdominal massage for 15 min twice daily, in the morning and evening, on the 5th and 6th days, starting from the morning of the 4th day. Patients in the control group received only routine pharmacologic treatment according to the physician's order on the 5th and 6th days, starting from the morning of the 4th day. The data were analyzed using the Mann-Whitney U-test, Kruskal-Wallis H-test, Spearman correlation, and Bonferroni post hoc test.

Results: The mean age of the patients was 60.29 ± 13.86 years, and 7.9% were female. The groups were not significantly different regarding individual or disease characteristics, gastrointestinal symptoms, or habits (p > 0.05). The severity of gastrointestinal symptoms decreased, and the general comfort level increased in the experimental and control groups. The mean score of the General Comfort Scale for Coping with Problems subscale was significantly greater in the experimental group than in the control group (p < 0.05).

Conclusions: This study highlights the novel and practical contribution of a nonpharmacological method, such as abdominal massage, in postoperative care. Abdominal massage can replace pharmacologic methods, achieve similar effects, and increase patient comfort and independence. In this context, healthcare team members may recommend abdominal massage for gastrointestinal symptom management and increasing comfort after surgical intervention.

Trial registration: Clinical trials: NCT05750186, registered on 01.03.2023.

Background: Acute kidney injury (AKI) displays a common complication after cardiac surgery and must be diagnosed as early as possible. Soluble delta-like protein 1 (sDLL1) was originally evaluated as a sepsis biomarker but might also indicate other adverse outcomes. This study aims to investigate sDLL1 levels, examining its potential relationship with AKI and postoperative delirium (POD) after cardiac surgery and its predictive value.

Methods: This secondary analysis of a prospective observational trial included elective cardiac surgery patients. ELISA was used for the quantification of sDLL1. Statistical analysis involved repeated measures ANOVA and Pearson's correlation to assess associations between sDLL1 levels, renal, and inflammatory parameters. Receiver operating curves were used for prediction analysis.

Results: Ninety patients were included in the study. Compared to patients without AKI, those with AKI (6.1%) showed significantly elevated plasma levels of sDLL1 postoperatively (no AKI 6308.49 [5121.27-7955.28], AKI 7,714.77 [7151.06-10,514.73] ng/mL; p = 0.01). Postoperative sDLL1 levels showed only a low predictive value for AKI (AUCROC 0.63, sensitivity 0.91, specificity 0.53). Postoperative sDLL1 measurements were also significantly elevated in patients with POD (23.3%). Further, postoperative sDLL1 plasma levels showed a moderate prediction for the identification of POD (AUCROC 0.72, sensitivity 0.64 specificity 0.73).

Conclusion: This study demonstrates that sDLL1 provides moderate predictive value for AKI and POD after cardiac surgery and may provide valuable insights into postoperative complications. sDLL1 levels increase independently of CPB type, suggesting a role in the inflammatory response to the cardiopulmonary bypass and surgical stress rather than specific renal injury.

Trial registration: DRKS00010959.

Background: Prehabilitation programs are increasingly used to optimize patients before pancreatic surgery. A prehabilitation program should include screening, assessment, intervention, and reassessment of multiple patient-related modifiable risk factors. Consensus on the content of a prehabilitation program and which patients should receive prehabilitation is missing. This study aims to assess current preoperative screening practices, surgeons' opinions, and knowledge of prehabilitation and identify existing prehabilitation programs for pancreatic surgery in the Netherlands.

Methods: A nationwide descriptive cross-sectional study was conducted. All 15 hospitals providing pancreatic surgery in the Netherlands were included, and an online survey was sent to only one pancreatic surgeon per hospital. The survey was developed by the authors of this paper and based on a previously published survey for prehabilitation in colorectal surgery. Logical ordering and adaptive questioning were used.

Results: All 15 surgeons responded, and they were all familiar with the term prehabilitation. Twelve hospitals (80%) offered prehabilitation, and in the majority of hospitals (7/12), prehabilitation was offered to all patients. Prehabilitation programs included multiple domains, whereby physical fitness and nutrition were most often included and mental resilience was the least often included domain. Each hospital implemented a different prehabilitation program in terms of included domains, screening methods, and interventions. For the majority of the domains, two or more different forms of screening and three or more different interventions were used across hospitals. A total of 53.3% of surgeons were willing to postpone the surgery of pancreatic malignancies up to a maximum of 4 weeks, 20% up to a maximum of 6 weeks, and 26.7% as long as necessary to optimize the patients' preoperative overall fitness.

Conclusions: Pancreatic surgeons in the Netherlands have knowledge of prehabilitation, but high variability exists in current practice regarding prehabilitation programs. There is a need for a uniform standardized prehabilitation program to be able to implement prehabilitation in the standard preoperative care pathway and enable comparison of results across hospitals.

Background: Guidelines recommend avoiding preoperative anxiolytic medication with midazolam. However, the risk-benefit ratio of preoperative midazolam prescriptions remains unclear. This study aimed to investigate the association between preoperative midazolam prescription and perioperative in-house mortality as well as preoperative cardiovascular stress.

Methods: We performed a retrospective single-center propensity score-matched study in a university hospital in Germany before and after de-implementation of routine oral preoperative midazolam prescription in December 2018. We included adult patients who underwent general anesthesia between December 1, 2017, and November 31, 2019. Patients who received midazolam premedication before de-implementation were compared to those who did not receive midazolam after de-implementation. After propensity score matching, we estimated the treatment effects using regression modeling. The primary endpoint was inhospital mortality after general surgery. Secondary endpoints included pre-induction vital signs, duration of stay in the postanesthesia care unit, and medications administered.

Results: After propensity score matching, we analyzed 7421 patients in each group. In this adjusted analysis, premedication with midazolam was not associated with mortality (OR 0.91, 95% CI 0.60 to 1.38, p = 0.662). Midazolam premedication was associated with significantly lower pre-induction blood pressures, with an estimated average treatment effect for systolic blood pressure of - 5.33 mmHg (SE 0.41, 95% CI - 6.13 to - 4.52 mmHg).

Conclusions: Midazolam prescription was not associated with increased mortality in a large cohort of surgical patients but with a lower pre-induction blood pressure and heart rate, suggesting a potential reduction in cardiovascular stress.

Purpose: Monitoring anesthetic depth may reduce the incidence of postoperative delirium in patients undergoing general anesthesia. This study investigated the impact of varying readings of Cerebral State Index (CSI) on postoperative delirium in elderly pre-frail patients undergoing abdominal surgery.

Methods: A total of 150 elderly pre-frail patients aged over 65 years scheduled for selective abdominal surgery under general anesthesia were enrolled. Pre-frailty was defined as a 5-Item Modified Frailty Index (mFI-5) score of 1-2. Patients in the light anesthesia (LA) group were maintained at a CSI value between 50 and 59, while patients in the deep anesthesia (DA) group were maintained at a CSI value between 40 and 49. The incidence of delirium within 3 days postoperatively, as well as visual analog scale (VAS) scores, postoperative nausea, vomiting, and the 15-item quality of recovery (QoR-15) scale scores on the first postoperative day were recorded and compared.

Results: The incidence of postoperative delirium was approximately 14% lower in the light anesthesia group compared to the deep anesthesia group (P < 0.05). The QoR-15 scale scores on the first postoperative day were significantly higher in the light anesthesia group than in the deep anesthesia group (P < 0.05). In contrast, the VAS scores over the 2 days following surgery were significantly higher in the deep anesthesia group than in the light anesthesia group (P < 0.05).

Conclusion: The elderly pre-frail patients under light anesthesia (with high CSI score) may have lower incidence of postoperative delirium and better outcome.

Trial registration: ChiCTR2400083016, Date of registration: 15/04/2025.

Post-acute sequelae of COVID (PASC), commonly known as long COVID, presents with a broad spectrum of medical conditions and symptoms persisting beyond 3 months post-SARS-CoV-2 infection, affecting over 18 million Americans and 65 million people worldwide. Despite its prevalence, to date, there are no specific clinical guidelines for the perioperative management of PASC patients. PASC is a complex, multisystemic condition leading to neurological, respiratory, and endocrine sequelae, potentially resulting from persistent viral presence, immune dysregulation, and/or end-organ damage. This manuscript discusses the implications of these sequelae on anesthesia practice, emphasizing the need for vigilance in pre-operative assessments to identify PASC and associated conditions through detailed patient history, understanding of off-label medication use, and familiarity with medical terminologies like POTS, MCAS, and brain fog. Key perioperative considerations include cautious use of anesthetics, especially in patients with neurological and cardiovascular complications. Pulmonary management strategies for PASC patients, such as lung-protective ventilation and non-invasive post-operative support, could mitigate any perioperative respiratory complications. Finally, we underscore the importance of a multidisciplinary approach to manage PASC patients effectively during surgery, advocating for personalized anesthetic plans and calling for more evidence-driven guidelines for this emerging patient group as research progresses.

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.