Pub Date : 2022-03-08DOI: 10.1101/2022.03.06.22271982
Susana Vacas, Tristan Grogan, Drew Cheng, Ira Hofer
Background Postoperative Delirium (POD) is a disturbing reality for patients and their families. Absence of easy-to-use and accurate risk scores prompted us to retrospectively extract data from the electronic health records (EHR) to identify clinical factors associated with POD. We seek to create a multivariate nomogram to predict the risk of POD based upon the most significant clinical factors.
{"title":"Risk Factor Stratification for Postoperative Delirium: A Retrospective Database Study","authors":"Susana Vacas, Tristan Grogan, Drew Cheng, Ira Hofer","doi":"10.1101/2022.03.06.22271982","DOIUrl":"https://doi.org/10.1101/2022.03.06.22271982","url":null,"abstract":"<strong>Background</strong> Postoperative Delirium (POD) is a disturbing reality for patients and their families. Absence of easy-to-use and accurate risk scores prompted us to retrospectively extract data from the electronic health records (EHR) to identify clinical factors associated with POD. We seek to create a multivariate nomogram to predict the risk of POD based upon the most significant clinical factors.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Precision medicine is a phrase used to describe personalized medical care tailored to specific patients based on their clinical presentation and genetic makeup. However, despite the fact that several single nucleotide polymorphisms (SNPs) have been reported to be associated with increased susceptibility to particular anesthetic agents and the occurrence of perioperative complications, genomic profiling and thus precision medicine has not been widely applied in perioperative management.
{"title":"Rapid detection of single nucleotide polymorphisms using the MinION nanopore sequencer: a feasibility study for perioperative precision medicine","authors":"Yoshiteru Tabata, Yoshiyuki Matsuo, Yosuke Fujii, Atsufumi Ohta, Kiichi Hirota","doi":"10.1101/2022.01.13.22269267","DOIUrl":"https://doi.org/10.1101/2022.01.13.22269267","url":null,"abstract":"<strong>Introduction</strong> Precision medicine is a phrase used to describe personalized medical care tailored to specific patients based on their clinical presentation and genetic makeup. However, despite the fact that several single nucleotide polymorphisms (SNPs) have been reported to be associated with increased susceptibility to particular anesthetic agents and the occurrence of perioperative complications, genomic profiling and thus precision medicine has not been widely applied in perioperative management.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-03DOI: 10.1101/2022.01.02.22268642
Martin Girard, Marie-Hélène Roy Cardinal, Michaël Chassé, Sébastien Garneau, Yiorgos Alexandros Cavayas, Guy Cloutier, André Y. Denault
Background Mechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography.
{"title":"Regional pleural strain measurements during mechanical ventilation using ultrasound elastography: A randomised, crossover, proof of concept physiologic study","authors":"Martin Girard, Marie-Hélène Roy Cardinal, Michaël Chassé, Sébastien Garneau, Yiorgos Alexandros Cavayas, Guy Cloutier, André Y. Denault","doi":"10.1101/2022.01.02.22268642","DOIUrl":"https://doi.org/10.1101/2022.01.02.22268642","url":null,"abstract":"<strong>Background</strong> Mechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-14DOI: 10.1101/2021.12.12.21267658
AJ Shrimpton, JM Brown, TM Cook, CM Penfold, JP Reid, AEP Pickering
Background Open respiratory suctioning is considered to be an aerosol generating procedure (AGP) and laryngopharyngeal suction, used to clear secretions during anaesthesia, is widely managed as an AGP. It is uncertain whether such upper airway suctioning should be designated an aerosol generating procedure (AGP) because of a lack of both aerosol and epidemiological evidence of risk.
{"title":"A quantitative evaluation of aerosol generation from upper airway suctioning during tracheal intubation and extubation sequences","authors":"AJ Shrimpton, JM Brown, TM Cook, CM Penfold, JP Reid, AEP Pickering","doi":"10.1101/2021.12.12.21267658","DOIUrl":"https://doi.org/10.1101/2021.12.12.21267658","url":null,"abstract":"<strong>Background</strong> Open respiratory suctioning is considered to be an aerosol generating procedure (AGP) and laryngopharyngeal suction, used to clear secretions during anaesthesia, is widely managed as an AGP. It is uncertain whether such upper airway suctioning should be designated an aerosol generating procedure (AGP) because of a lack of both aerosol and epidemiological evidence of risk.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-24DOI: 10.1101/2021.10.18.21263855
Brent Ershoff
Background A growing body of literature suggests that intraoperative opioid administration can lead to both increased post-operative pain and opioid requirements. However, there has been minimal data regarding the effects of the intraoperative administration of intermediate duration opioids such as hydromorphone on post-operative outcomes. Causal inference using observational studies is often hampered by unmeasured confounding, where classical adjustment techniques, such as multivariable regression, are insufficient. Instrumental variable analysis is able to generate unbiased causal effect estimates in the presence of unmeasured confounding, assuming a valid instrumental variable can be found. We previously demonstrated, using a natural experiment, how hydromorphone presentation dose, i.e. the unit dose provided to the clinician, affects intraoperative administration dose, with the switch from a 2-mg to a 1-mg vial associated with decreased administration. As the change in hydromorphone presentation dose was unrelated to any external factors, presentation dose could serve as an instrumental variable to estimate the effect of intraoperative hydromorphone administration dose on post-operative outcomes.
{"title":"Intraoperative Hydromorphone Decreases Post-Operative Pain Who Would Have Thought? An Instrumental Variable Analysis","authors":"Brent Ershoff","doi":"10.1101/2021.10.18.21263855","DOIUrl":"https://doi.org/10.1101/2021.10.18.21263855","url":null,"abstract":"<strong>Background</strong> A growing body of literature suggests that intraoperative opioid administration can lead to both increased post-operative pain and opioid requirements. However, there has been minimal data regarding the effects of the intraoperative administration of intermediate duration opioids such as hydromorphone on post-operative outcomes. Causal inference using observational studies is often hampered by unmeasured confounding, where classical adjustment techniques, such as multivariable regression, are insufficient. Instrumental variable analysis is able to generate unbiased causal effect estimates in the presence of unmeasured confounding, assuming a valid instrumental variable can be found. We previously demonstrated, using a natural experiment, how hydromorphone presentation dose, i.e. the unit dose provided to the clinician, affects intraoperative administration dose, with the switch from a 2-mg to a 1-mg vial associated with decreased administration. As the change in hydromorphone presentation dose was unrelated to any external factors, presentation dose could serve as an instrumental variable to estimate the effect of intraoperative hydromorphone administration dose on post-operative outcomes.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-19DOI: 10.1101/2021.10.18.21265155
Alexandre Lacombe, Kristi Downey, Xiang Y. Ye, Jose C.A. Carvalho
Introduction Epidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment.
{"title":"Long-term Complications of Unintentional Dural Puncture During Labor Epidural Analgesia: A Case-Control Study","authors":"Alexandre Lacombe, Kristi Downey, Xiang Y. Ye, Jose C.A. Carvalho","doi":"10.1101/2021.10.18.21265155","DOIUrl":"https://doi.org/10.1101/2021.10.18.21265155","url":null,"abstract":"<strong>Introduction</strong> Epidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment.","PeriodicalId":501303,"journal":{"name":"medRxiv - Anesthesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138542890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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