Elective Gynaecological Surgery Research Articles

ELECTIVE GYNECOLOGICAL SURGERY DURING COVID-19 PANDEMIC: A SINGLE CENTER EXPERIENCE

OBJECTIVE: This study aims to assess the experience of a tertiary health center about the elective gynecological operations between the two peaks of COVID-19 pandemic. MATERIAL AND METHODS: This is a retrospective review of 609 patients who underwent elective gynecological surgery at Afyonkarahisar Health Sciences University Hospital from 15 March 2020 to 30 April 2021. RESULTS: All patients tested negative for COVID-19 preoperatively and 17 patients (2.8%) contracted COVID-19 during the 8-week-long period after the hospital discharge. The averagetime to test positivity was calculated as 4.0±1.3 weeks (range:2-7 weeks). The most common indications for elective gynecological surgeries were abnormal bleeding (30.9%), adnexal mass (19.2%) and uterine leiomyoma (16.9%). Operative hysteroscopy was the most performed gynecological operation (26%),followed by abdominal hysterectomy (17.6%) and laparoscopic hysterectomy (16.2%). The concurrence of hypertension and diabetes mellitus, incompetent cervix and cervical cerclage wassignificantly more prevalent in the patients who tested positive for COVID-19 after surgery (p=0.001 for all). The patients whotested positive for COVID-19 following hospital discharge andthose who did not contract COVID-19 were statistically similarwith respect to postoperative complications and duration ofhospitalization. Four patients (0.65%) who underwent electivegynecological surgery died within 8 weeks following the hospital discharge. None of the deaths were related to COVID-19infection. CONCLUSIONS: Performing elective gynecological surgery appears as a safe approach during COVID-19 pandemic. Concurrent existence of hypertension and diabetes mellitus and cervical cerclage might be associated with postoperative contagion of COVID-19.

Implementation of Surgical Site Infection Prevention Bundle in Gynaecological Surgeries: A Quality Control Initiative

Background: Surgical site infection (SSI) is the most common post operative morbidity after gynaecological surgeries. There can be multiple risk associated that may or may not be modifiable. Therefore, perioperative bundled approach are designed to reduce surgical site infections. Aim/Objective: To determine whether surgical site infection (SSI) prevention bundle reduces the risk of SSI by 30 days postoperatively compared with the standard hospital protocol. Methods: A randomized control trial was conducted on women who underwent elective gynaecologic surgery from January 2019 to May 2020. The subjects were divided into intervention and control group. The primary outcome was the rate of SSI by 30 days postoperatively. Results: Total 192 women were randomized. the intervention group included 94 and 98 were assigned to the control group. The SSI rate at 30 days after surgery was 8 /85 (9.5%) in intervention group and 22/85 (25.8%) in control group (p value=0.005; RR=0.36;95% confidence interval [CI], 0.17-0.77). The relative risk reduction of SSI was 64% (p value=0.005) after the bundle was implemented. In subgroup analysis, the primary outcomes were affected by the subgroups like age, co morbidities and operative characteristics. Conclusion: SSI prevention bundle intervention led to significant decrease in overall SSI rate in electively planned gynecological surgeries.

Pyridoxine Prevents Postoperative Nausea and Vomiting in Gynecological Laparoscopic Surgery: A Double-blind Randomized Controlled Trial.

Postoperative nausea and vomiting (PONV) are common complications after gynecological laparoscopic surgery. Pyridoxine has been recommended as a first-line drug to prevent and treat nausea and vomiting during pregnancy; however, its efficacy in preventing PONV remains unclear. Patients of 18 to 65 years old, who received elective gynecological laparoscopic surgery under general anesthesia, were randomized into either the pyridoxine or control group. The pyridoxine group received 0.2g vitamin B6 before anesthesia induction, and the control group received normal saline intravenously. Both groups received a similar regimen of combined intravenous and inhalation general anesthesia. All patients received dexamethasone(intravenous) after anesthesia induction and ondansetron(intravenous) before surgery completion. PONV occurrence was recorded according to the patients' self-reported data. Other clinical data were collected from hospital system, and concentrations of blood interleukin-6 and substance P were measured by ELISA. A total of 442 patients were screened and 240 patients were equally randomized to the pyridoxine or control group. The incidence of PONV was statistically significant lower in the pyridoxine group than in the control group (16.7% [20/120] vs. 35.8% [43/120]; relative risk (RR) = 0.47 [95% CI: 0.29, 0.74]; absolute risk reduction (ARR) = 0.20 [95% CI: 0.08, 0.30]; P = 0.001), and pyridoxine decreased the incidence of postoperative nausea (12.5% [15/120] vs. 35% [42/120]; RR = 0.36 [95% CI: 0.21, 0.61]; ARR = 0.23 [95% CI: 0.12, 0.33]; P < 0.001). There were no statistical differences in postoperative vomiting, time to the first PONV occurrence, pain, serum interleukin-6 and substance P, and white blood cell and neutrophil counts. In this single center randomized trial, pyridoxine plus dexamethasone and ondansetron reduced the incidence of PONV in patients undergoing elective gynecological laparoscopic surgery under general anesthesia. These findings need to be validated in multicenter studies in diverse populations to ensure generalizability.

Duration of Hypothermia is Associated with Postoperative Complications in Patients Undergoing Gynecological Surgery: A Prospective Cohort Study.

To investigate the relationship between hypothermia duration and postoperative complications in patients undergoing gynecological surgery. Patients who underwent elective gynecological surgery at our hospital were consecutively enrolled between October 2020 and January 2022. Core temperature was continuously monitored intraoperatively, and early postoperative complications were collected. By adjusting the logistic regression model for potential confounding factors, the association of postoperative complications with the duration of hypothermia, the lowest body temperature below 36°‍C, and the hypothermia upon admission to postanesthesia care unit (PACU) or intensive care unit (ICU) were analyzed. Additionally, the potential inflection point in the relationship between the duration of hypothermia and the risk of postoperative complications was explored by using cumulative probability scatter plots and moving average sequences. The study included 370 patients, with 193 (52.2%) experiencing hypothermia and 177 (47.8%) not. Among them, 92 (24.9%) developed complications. The duration of hypothermia (adjusted odds ratio [OR] for each one-minute increase: 1.003; 95% confidence interval [CI]: 1.000-1.006, P=0.047) and hypothermia upon admission to PACU or ICU (adjusted OR: 1.980; 95% CI: 1.135-3.454, P=0.016) were associated with early postoperative complications. Notably, the cumulative incidence of postoperative complications tended to rise as the duration of hypothermia increased, with a potential inflection point observed at 120 minutes. In gynecological surgery, the duration of hypothermia as well as hypothermia upon admission to PACU or ICU are associated with postoperative complications. Minimizing the duration of hypothermia may be clinically beneficial.

Practicability of Serum Kallistatin Levels as a Biomarker in the Diagnosis of Tubo-Ovarian Abscess.

Objective: This study investigates the practicability of serum kallistatin as a biomarker in the diagnosis of tubo-ovarian abscess (TOA) because C-reactive protein (CRP) is insufficiently specific for diagnosis. Methods: Thirty patients (control group) who presented for elective gynecological surgeries and 30 who were hospitalized due to TOA (study group) at the Antalya Training and Research Hospital Gynecology Clinic, Türkiye, between January 1 and December 31, 2022, were included in the study. Blood samples were collected for the calculation of complete blood count, biochemistry, CRP, and serum kallistatin values, and the results were recorded in a database. Results: Although no significant differences were observed between the control and study groups in terms of age or body mass index, significant differences were observed in terms of marital status, number of pregnancies, parity number, intrauterine device history, and previous surgical history (p > 0.05). Serum hemoglobin levels (12.61 ± 1.30 vs. 11.47 ± 1.77; p = 0.008), white blood cell (7.9 [6.15 ± 9.7] vs. 17.0 [11.6-19.6]; p < 0.001), neutrophil (4.6 [3.6-6.12] vs. 13.6 [9.25-16.1]; p < 0.001), lymphocyte (2.51 ± 0.71 vs. 2.33 ± 0.69; p = 0.307), and platelet counts (285.63 ± 78.0 vs. 407.03 ± 131.96; p < 0.001), neutrophil-lymphocyte ratio (2.11 ± 0.93 vs. 6.18 ± 2.20; p < 0.001), neutrophil-lymphocyte ratio (123.16 ± 52.63 vs. 184.39 ± 63.90; p < 0.001), hs-CRP (1.20 [5.55-1.92] vs. 240 [138.25-291.0]; p < 0.001), kallistatin (7.18 ± 3.15 vs. 3.83 ± 3.69; p = 0.006), and urine leukocyte values (1 [0.75-3] vs. 3 [1-6.5]; p = 0.038) also differed significantly between the control and study groups. Conclusion: The study findings show that serum kallistatin levels can be used as a biomarker in the diagnosis of TOA. Further studies involving more participants are now needed to test the accuracy of our results.

Variants for dosing of rocuronium taken into obesity during general anesthesia in gynecological laparoscopic surgery

The objective was to identify the optimal method of dosing the muscle relaxant rocuronium during gynecological laparoscopic surgery in obese patients.Materials and methods. The study included 36 women with obesity II–III degree, which performed elective gynecological laparoscopic surgery. They were divided into 3 groups. In group 1, rocuronium were dosed at the rate of 0.6 mg/kg of ideal body weight calculated by the Lorentz formula. In group 2, rocuronium were dosed at the rate of 0.6 mg/kg of actual body weight. In group 3, rocuronium were dosed at the rate of 22.5 mg/m2 of body surface area. The comparison group (group 0) included 20 patients with body mass index equal to 18.5–25 kg/m2.Results. The shortest time for the onset of deep neuromuscular block was noted in groups 2 and 3, and the longest, comparable to the indicator in group 0, was in group 1 (p &lt; 0.05). The time from rocuronium administration to the onset of restoration of neuromuscular conduction was the shortest in group 1: 22 [20; 25] minutes, and the longest in group 2: 40 [35; 45] min. There was no statistically significant difference in the dosing of rocuronium in obese patients at body surface area in group 3 compared with dosing for actual weight in group 0: 27 [22; 29] and 27 [25; 33] min, respectively. The recovery time of neuromuscular conduction from TOF = 1 to TOF = 25% was the shortest in group 1 (23 [18; 24] min) and was significantly different from the value in groups 2 and 3, as well as in patients of group 0. In groups 0, 2, 3, values of this indicator were identical. The recovery index did not differ significantly in all four groups.Conclusion. Dosing rocuronium in obese patients based on body surface area has an advantage for comparison over dosing based on both actual and ideal body weight, resulting in greater predictability of neuromuscular block dynamics.

Addition of nitrous oxide and oxygen to carbon dioxide pneumoperitoneum during laparoscopic surgery for pain reduction: A double-blinded randomized controlled trial.

To examine if peritoneal conditioning with an altered insufflation gas mixture is associated with reduced postoperative pain intensity compared to the standard insufflation gas (i.e., 100% CO2). A prospective, single-centre, randomized, double-blind, superiority trial was performed. This study was conducted between 4 April 2019 and 10 February 2022 at the Jessa Hospital, Hasselt, Belgium. Patients scheduled for elective gynaecologic laparoscopic surgery. Seventy-four patients scheduled for elective gynaecologic laparoscopic surgery were randomised to receive either the standard insufflation gas with 100 CO2 (n = 37; control group) or the altered gas mixture of 86% CO2, 10% N2O and 4% O2 (n = 37; experimental group). Postoperative pain was assessed at 4, 8 and 24 hours after surgery and on postoperative day (POD) 7 by an 11-point Numeric Rating Scale, with 0 indicating no pain and 10 indicating worst imaginable pain. No significant differences were found between the control and experimental groups regarding postoperative pain at 4, 8 and 24 h after surgery, as well as on POD7. In addition, the median (25% and 75%) total amount of IV piritramide consumption during the first 24 h after surgery was not significantly different between groups (control group: 18.0 [10.0, 27.0] mg vs. experimental group: 17.0 [10.0, 34.0] mg, p = 0.62). The alternative insufflation gas mixture comprising 86% CO2, 10% N2O and 4% O2 used for the pneumoperitoneum during gynaecologic laparoscopic surgery does not appear to reduce postoperative pain compared to the standard insufflation gas of 100% CO2.

The effect of low-dose ketamine on electroencephalographic spectrum during gynecology surgery under desflurane anesthesia.

The perioperative administration of low-dose ketamine has shown potential in postoperative pain management, opioid sparing, and enhancing pain control. This study aimed to investigate the impact of low-dose ketamine on processed electroencephalography (EEG) signals during anesthesia. Forty patients with American Society of Anesthesiologists physical status I-II undergoing elective gynecological surgery were enrolled. EEG monitoring was initiated upon induction of anesthesia. Anesthesia was maintained with desflurane and alfentanil immediately after induction. Fifteen minutes after induction, the ketamine group received a 0.3 mg/kg bolus followed by 0.05 mg/kg/h infusion until completion of surgery. The control group received equivalent saline. Postoperative assessments included pain score (visual analog scale), morphine usage, and quality of recovery. The ketamine group had significantly higher Patient State Index (PSi) values at 10, 20, and 30 minutes after ketamine administration compared to the controls. Ketamine administration led to significant alterations in EEG patterns, including reduced relative power in delta and theta frequency bands, and increased relative power in beta and gamma frequency bands at 10 minutes post-administration. Relative power in the alpha frequency band significantly decreased at 10, 20, and 30 minutes post-administration. However, there were no differences in intraoperative alfentanil consumption, postoperative morphine usage, and pain scores between the two groups. Low-dose ketamine administration during desflurane anesthesia led to notable changes in EEG patterns and PSi values. These findings provide valuable insights into the impact of ketamine on brain activity, and offer essential information for clinical anesthesiologists.

Predictive value of preoperative ultrasonographic measurement of gastric morphology for the occurrence of postoperative nausea and vomiting among patients undergoing gynecological laparoscopic surgery.

Pre-operative prediction of postoperative nausea and vomiting (PONV) is primarily based on the patient's medical history. The predictive value of gastric morphological parameters observed on ultrasonography has not been comprehensively assessed. A prospective observational study was conducted to evaluate the pre-operative ultrasonographic measurement of gastric morphology for predicting PONV. The gastric antrum of the participants was assessed using ultrasound before anesthesia, and the occurrence of PONV in the first 6 hours and during the 6-24 hours after surgery was reported. The main indicators included the thickness of the muscularis propria (TMP) and the cross-sectional area of the inner side of the muscularis propria (CSA-ISMP). These were recorded and analyzed. Logistic regression analysis was applied to identify factors for PONV. A total of 72 patients scheduled for elective gynecological laparoscopic surgery were investigated in the study. The pre-operative CSA-ISMP of patients with PONV in the first 6 hours was significantly greater than that of those without PONV (2.765 ± 0.865 cm² vs 2.349 ± 0.881 cm², P=0.0308), with an area under the curve of 0.648 (95% CI, 0.518 to 0.778, P=0.031). Conversely, the pre-operative TMP of patients with PONV during the 6-24 hours was significantly smaller than that of those without PONV (1.530 ± 0.473mm vs 2.038 ± 0.707mm, P=0.0021), with an area under the curve of 0.722 (95% CI, 0.602 to 0.842, P=0.003). Logistic regression analysis confirmed that CSA-ISMP was an independent risk factor for PONV in the first 6 hours (OR=2.986, P=0.038), and TMP was an independent protective factor for PONV during the 6-24 hours after surgery (OR=0.115, P=0.006). Patients with a larger pre-operative CSA-ISMP or a thinner TMP are prone to develop PONV in the first 6 hours or during the 6-24 hours after surgery, respectively. http://www.chictr.org.cn (ChiCTR2100055068).

Perioperative liberal drinking management promotes postoperative gastrointestinal function recovery after gynecological laparoscopic surgery: A randomized controlled trial

Study objectiveThis study aims to evaluate the effect of perioperative liberal drinking management, including preoperative carbohydrate loading (PCL) given 2 h before surgery and early oral feeding (EOF) at 6 h postoperatively, in enhancing postoperative gastrointestinal function and improving outcomes in gynecologic patients. The hypotheses are that the perioperative liberal drinking management accelerates the recovery of gastrointestinal function, enhances dietary tolerance throughout hospitalization, and ultimately reduces the length of hospitalization. DesignA prospective randomized controlled trial. SettingOperating room and gynecological ward in Wuhan Union Hospital. PatientsWe enrolled 210 patients undergoing elective gynecological laparoscopic surgery, and 157 patients were included in the final analysis. InterventionsPatients were randomly allocated in a 1:1:1 ratio into three groups, including the control, PCL, and PCL-EOF groups. The anesthetists and follow-up staff were blinded to group assignment. MeasurementsThe primary outcome was the postoperative Intake, Feeling nauseated, Emesis, Examination, and Duration of symptoms (I-FEED) score (range 0 to 14, higher scores worse). Secondary outcomes included the incidence of I-FEED scores >2, and other additional indicators to monitor postoperative gastrointestinal function, including time to first flatus, time to first defecation, time to feces Bristol grade 3–4, and time to tolerate diet. Additionally, we collected other ERAS recovery indicators, including the incidence of PONV, complications, postoperative pain score, satisfaction score, and the quality of postoperative functional recovery at discharge. Main resultsThe PCL-EOF exhibited significantly enhanced gastrointestinal function recovery compared to control group and PCL group (p < 0.05), with the lower I-FEED score (PCL: 0[0,1] vs. PCL-EOF: 0[0,0] vs. control: 1[0,2]) and the reduced incidence of I-FEED >2 (PCL:8% vs. PCL-EOF: 2% vs. control:21%). Compared to the control, the intervention of PCL-EOF protected patients from the incidence of I-FEED score > 2 [HR:0.09, 95%CI (0.01–0.72), p = 0.023], and was beneficial in promoting the patient's postoperative first flatus [PCL-EOF: HR:3.33, 95%CI (2.14–5.19),p < 0.001], first defecation [PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p < 0.001], Bristol feces grade 3–4 [PCL-EOF: HR:3.65, 95%CI (2.36–5.63), p < 0.001], first fluid diet[PCL-EOF: HR:2.76, 95%CI (1.83–4.16), p < 0.001], and first normal diet[PCL-EOF: HR:6.63, 95%CI (4.18–10.50), p < 0.001]. Also, the length of postoperative hospital stay (PCL-EOF: 5d vs. PCL: 6d and control: 6d, p < 0.001), the total cost (PCL-EOF: 25052 ± 3650y vs. PCL: 27914 ± 4684y and control: 26799 ± 4775y, p = 0.005), and postoperative VAS pain score values [POD0 (PCL-EOF: 2 vs. control: 4 vs. PCL: 4, p < 0.001), POD1 (PCL-EOF: 1 vs. control: 3 vs. PCL: 2, p < 0.001), POD2 (PCL-EOF: 1 vs. control:2 vs. PCL: 1, p < 0.001), POD3 (PCL-EOF: 0 vs. control: 1 vs. PCL: 1, p < 0.001)] were significantly reduced in PCL-EOF group. ConclusionsOur primary endpoint, I-FEED score demonstrated significant reduction with perioperative liberal drinking, serving as a protective intervention against I-FEED>2. Gastrointestinal recovery metrics, such as time to first flatus and defecation, also showed substantial improvements. Furthermore, the intervention enhanced postoperative dietary tolerance and expedited early recovery.Trial registration: ChiCTR2300071047(https://www.chictr.org.cn/).

Balanced opioid-free anesthesia with lidocaine and esketamine versus balanced anesthesia with sufentanil for gynecological endoscopic surgery: a randomized controlled trial

In this randomized controlled trial, 74 patients scheduled for gynecological laparoscopic surgery (American Society of Anesthesiologists grade I/II) were enrolled and randomly divided into two study groups: (i) Group C (control), received sufentanil (0.3 μg/kg) and saline, followed by sufentanil (0.1 μg/kg∙h) and saline; and (ii) Group F (OFA), received esketamine (0.15 mg/kg) and lidocaine (2 mg/kg), followed by esketamine (0.1 mg/kg∙h) and lidocaine (1.5 mg/kg∙h). The primary outcome was the 48-h time-weighted average (TWA) of postoperative pain scores. Secondary outcomes included time to extubation, adverse effects, and postoperative sedation score, pain scores at different time points, analgesic consumption at 48 h, and gastrointestinal functional recovery. The 48-h TWAs of pain scores were 1.32 (0.78) (95% CI 1.06–1.58) and 1.09 (0.70) (95% CI 0.87–1.33) for Groups F and C, respectively. The estimated difference between Groups F and C was − 0.23 (95% CI − 0.58 − 0.12; P = 0.195). No differences were found in any of the secondary outcomes and no severe adverse effects were observed in either group. Balanced OFA with lidocaine and esketamine achieved similar effects to balanced anesthesia with sufentanil in patients undergoing elective gynecological laparoscopic surgery, without severe adverse effects.Clinical Trial Registration: ChiCTR2300067951, www.chictr.org.cn 01 February, 2023.

Preoperative Anemia Prior to Gynecologic Surgery is Associated With Increased Healthcare Costs

To compare healthcare utilization costs between anemic and non-anemic patients undergoing elective hysterectomy and myomectomy for benign indications from the date of surgery to 30-days postoperatively. Retrospective population-based cohort study. Single-payer publicly funded healthcare system in Ontario, Canada between 2013-2020. Adult women (≥18 years of age) who underwent elective hysterectomy or myomectomy (laparoscopic/laparotomy) for benign indications. Our exposure of interest was pre-operative anemia, defined as the most recent hemoglobin value <12g/dL on the complete blood count measured before the date of surgery. Our primary outcome was healthcare costs (total and disaggregated) from the perspective of the single-payer publicly funded healthcare system. Of the 59,270 patients in the cohort, 11,802 (19.9%) had pre-operative anemia. After propensity matching, standardized differences in all baseline characteristics (N=10,103 per group) were <0.10. In the matched cohort, the mean total healthcare cost per anemic patient was higher compared to cost per non-anemic patient ($6,134.88 ± $2,782.38 vs. $6,009.97 ± $2,423.27, p<0.001). Anemic patients, compared to non-anemic patients, had a higher mean difference in total healthcare cost of $124.91 per patient (95%CI $53.54 - $196.29) translating to an increased cost attributable to anemia of 2.08% (95%CI 0.89% - 3.28%, p<0.001). In a subgroup analysis of patients undergoing hysterectomy (N=9041), the cost was also significantly higher for anemic patients (mean difference per patient of $117.67, 95%CI $41.58 - $193.75). For those undergoing myomectomy (N=1062) the difference in cost was not statistically significant (mean difference $186.61, 95%CI -$17.42 - $390.65). Pre-operative anemia was associated with significantly increased healthcare resource utilization and costs for patients undergoing elective gynecologic surgery. Although the cost difference per case was modest, when extrapolated to the population level, this difference could result in substantially significant cost to the healthcare system, attributable to pre-operative anemia.

Venous Thromboembolic Risk Factors and Management of Prophylaxis in Elective Gynecologic Surgery Patients

Background: The aim of this study was to assess thromboembolic risk factors and prophylaxis in patients undergoing elective gynecologic surgery. Patients and methods: This was a descriptive longitudinal approach with prospective data collection, from January to June 2021 in the intensive care and gynecology departments of the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. The studied variables were socio- demographic data, indications for surgery, risk factors related to the patient and those related to surgery (according to the modified Caprini score), and the principles of thromboprophylaxis. The collected data were entered using CS Pro 7.0 software and analyzed by Epi-info software version 3.5.4. Results: We recruited 84 patients. The mean age was 45.1±10.2 years. The risk factors found were cancer (41.5%), obesity (32.1%) and hypertension (13.2%). The high global risk was found in 40 cases (47.6%) followed by the very high global risk with 28 cases (33.3%). All patients benefited from early mobilization while 69% used compression stockings. In the overall population, enoxaparin was used alone in 84 cases (100%) and in combination with stockings in 58 cases (69.1%). In the high-risk population (n=68), enoxaparin was used in all the cases and in combination in 48 cases (70.5%). Six thromboembolic events were recorded. Conclusion: VTE prophylaxis should be administered according to recognized guidelines to avoid inadequate prophylaxis. It is well codified. It reduced VTE events.

Evaluation of a tiered opioid prescription algorithm in an ERAS pathway: exploring opportunities for further refinement

BackgroundOpioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription.ObjectiveTo evaluate the intervention by...

Dexmedetomidine nasal administration improves perioperative sleep quality and neurocognitive deficits in elderly patients undergoing general anesthesia

ObjectiveTo investigate the improvement of perioperative sleep quality and neurocognitive impairment in elderly patients under general anesthesia by nasal administration of dexmedetomidine.MethodsOne hundred and twenty patients admitted to our hospital for various laparoscopic elective gynecological surgeries lasting more than 1 h under general anesthesia from July 2021 to March 2023 were selected. All subjects were divided into 3 groups according to the random number table method. From 21:00 to 21:30 every night from one day before to 5 days after surgery, group A was given alprazolam 0.4 mg orally; group B was given dexmedetomidine 1.5ug/kg nasal drip; group C was given saline nasal drip. All subjects were observed for general information, sleep quality, postoperative cognitive function, anxiety status, sleep quality, adverse effects and complication occurrence.ResultsThe difference in general information between the three groups was not statistically significant, P > 0.05; the sleep quality scores of the three groups on admission were not statistically significant, P > 0.05. At the Preoperative 1d, postoperative 1d, 3d and 5d, the RCSQ scores of the subjects in group A and group B were higher than those in groups C, and with the postoperative RCSQ scores of subjects in group B were higher as the time increased; the assessment of anxiety status in the three groups 1d before surgery was not statistically significant, P > 0.05. The cognitive function scores of subjects in the three groups were not statistically significant in the preoperative 1d, P > 0.05. The postoperative 1d (24.63 ± 2.23), 3d (25.83 ± 2.53), and 5d (26.15 ± 2.01) scores of the subjects in group B were higher than those in groups A and C (P < 0.05), and the subjects in group B had better recovery of postoperative cognitive function with increasing time; the occurrence of postoperative delirium (POD) in group B (12.5%) were lower on postoperative 5d than those in groups A (37.5%) and C (32.5%) (P < 0.05). There was no statistical significance in the evaluation of anxiety state of the three groups on the first day before operation (P > 0.05). The scores in group B were lower than those in group C on the postoperative 1d, 3d, 5 d (P < 0.05). The overall incidence of adverse reactions and complications in subjects in group B was 17.5% significantly lower than that in groups A and C (P < 0.05).ConclusionDexmedetomidine can effectively improve the sleep disorder of elderly general anesthesia patients, reduce the damage to their neurocognitive function and the occurrence of POD, effectively reduce the anxiety of patients and the occurrence of adverse reactions and complications, and has better sedative, improve postoperative cognitive function and anti-anxiety effects, with a high drug safety, worthy of clinical application and promotion.

Clinical Efficacy of Ambu AuraGainTM and i-gel® in Patients Undergoing Elective Gynaecological Laparoscopic Surgeries Under General Anaesthesia: A Randomised Clinical Study

Introduction: Second-generation supraglottic airway devices that provide high seal pressures are found to be suitable for patients undergoing laparoscopic surgery, as they have a separate port for gastric tube insertion, effectively separating the airway and the oesophagus. The present study compares the usage of two such second-generation supraglottic devices-AuraGain™ and i-gel® in patients undergoing gynaecological laparoscopic surgeries. Aim: To compare the Oropharyngeal Leak Pressure (OLP) and airway pressures achieved by the i-gel® and Ambu AuraGain™ after insertion in the supine position and during laparoscopic carbon dioxide peritoneum in the Trendelenburg position. Materials and Methods: This randomised clinical, singleblinded study conducted at the Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra pradesh, India involved 100 female patients undergoing elective gynaecological laparoscopic surgeries under general anaesthesia with controlled ventilation. The primary objective was to compare the clinical performance of Ambu AuraGain™ (Group-A) and i-gel® (Group-I) concerning their oropharyngeal seal pressures and airway pressures in gynaecological laparoscopic surgeries. The secondary outcomes measured included the time taken for insertion, ease of insertion of the device, effects on postinsertion haemodynamic parameters like heart rate, blood pressure, oxygen saturation, ease of gastric tube insertion, and fibreoptic bronchoscopic grading of the visualised glottic structures after device placement, as well as postoperative side effects like blood staining upon removal of the device and sore throat. Data were analysed using Student’s t-test and chi-square test. Results: The mean age in Group-A was 39.62±4.085 years, and in Group-I, it was 39.48±2.468 years. The mean peak inspiratory pressures after device insertion were 14.34 mmHg in Group-A and 16.66 mmHg in Group-I. Haemodynamic parameters postinsertion were similar in both groups {Group-A: Mean Heart Rate (HR) 87.22 bpm, Mean Arterial Pressure (MAP) 89.72 mmHg, Oxygen Saturation (SpO2 ) 99.58%; Group-I: Mean HR 87.50 bpm, MAP 89.72 mmHg, SpO2 99.72%). Fibreoptic bronchoscopic grading in Group-A was 0/0/9/41, and in Group-I, it was 0/0/11/39. Blood staining upon removal was noted in four patients (8%) in Group-A and in 3 patients (6%) in Group-I. Sore throat in the postoperative period was noted in 14% of patients in Group-A and 8% in Group-I. Conclusion: Ambu AuraGain™ was found to provide a better seal and higher OLP compared to the i-gel® in gynaecological laparoscopic surgeries and therefore provide safer and more effective ventilation for patients undergoing such surgeries. I-gel® was found to be easier and quicker to insert than the AuraGain™.

Clinical Characteristics and Outcomes of Elective Gynecologic Cases Using Modified Medically Necessary, Time Sensitive (MeNTS) Scoring System in the Prioritization of Surgery at the Philippine General Hospital during the COVID-19 Pandemic.

The use of a scoring system that integrates various factors helps in decision-making and triage for Medically Necessary, Time Sensitive (MeNTS) surgical procedures during the COVID-19 pandemic. This study aimed to determine the clinical characteristics and outcomes of cases who were screened and underwent elective gynecologic surgery at a tertiary hospital using the MeNTS tool for prioritization. A cross-sectional study was carried out using data collected through medical chart review of all gynecologic cases screened in a 6-month period, from June 18, 2020 to December 18, 2020. A total of 155 gynecologic cases were screened, with 134 (86.4%) MeNTS cases and 21 (13.5%) non-MeNTS cases. The median length of stay (5 days), the median operating room time (3 hours and 30 minutes), and median estimated blood loss (400 ml) were within the acceptable expected outcome as with the scoring system, albeit with some cases (53%) requiring blood transfusion attributed to low baseline hemoglobin levels. There were no cases with post-operative COVID-19 transmission, needing ICU care and intubation, nor mortalities reported. The MeNTS scoring system allowed efficient handling of the backlog of elective gynecologic cases with minimal morbidity and absence of mortality. The study supports the utility of this scoring system in addressing the need of the healthcare system not just to optimally utilize and fairly allocate hospital resources but also to ensure the safety of the patient with the best health service delivery during the pandemic.

Exploring perioperative risk factors for poor recovery of postoperative gastrointestinal function following gynecological surgery: A retrospective cohort study

PurposeTo investigate perioperative risk factors that affect the recovery of postoperative gastrointestinal function in patients undergoing gynecological surgery and to establish a preoperative risk prediction scoring system. MethodsIn this retrospective cohort study, characteristics and perioperative factors of patients who underwent elective gynecological surgery at Union Hospital from January 2021 to March 2022 were extracted from electronic medical records. Patients were grouped according to the Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system to compare collected data. ResultsIn total, clinical data from 208 gynecological patients were extracted. The incidence of poor postoperative gastrointestinal recovery was 7.21 %. The number of previous abdominal surgeries (0.73 ± 0.06 vs 1.20 ± 0.24, p = 0.044), the incidence of malignant disease (20.2 % vs 53.3 %, p = 0.003), postoperative maximum WBC count (9.15 vs 12.44, p = 0.005) and postoperative minimum potassium (3.97 ± 0.36 vs 3.76 ± 0.37, p = 0.036) were not only associated with poor postoperative gastrointestinal recovery, but also malignant disease (p = 0.000), postoperative maximum WBC count (p = 0.027) and postoperative minimum potassium (p = 0.024) were significantly associated with the severity of postoperative gastrointestinal function. An increased number of previous abdominal surgeries and malignant primary disease could increase the risk of an I-FEED score >2 as independent risk factors. ConclusionPatients with poor postoperative GI function had poorer postoperative recovery outcomes. A preoperative score prediction system was established, in which patients with ≥2 points had a 19.4 % risk of poor postoperative gastrointestinal recovery. Higher-quality prospective studies should be performed to achieve more precise risk stratification and to construct a more accurate prediction system.

Surgeon reported measures of stress and anxiety prior to and after elective gynecological surgery.

Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self-reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role. Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State-Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate-severe endometriosis, or hysteroscopic myomectomy. Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1-6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0-5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001). When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self-reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance.

Effects of intraoperative sodium oxybate infusion on post-operative sleep quality in patients undergoing gynecological laparoscopic surgery: A randomized clinical trial

Study objectivePost-operative sleep quality is an important factor that influences post-operative recovery. Sodium oxybate has been used to treat sleep disturbances associated with various pathological conditions. However, whether intraoperative intravenous infusion of sodium oxybate improves post-operative sleep quality is unknown. This study aimed to examine the effects of sodium oxybate on the post-operative sleep quality of patients who underwent gynecological laparoscopic surgery. DesignA single-center, prospective, two-arm, double-blinded randomized controlled trial. SettingThe Shengjing Hospital of China Medical University in Liaoning, China. PatientsWe enrolled 180 adult patients (90 for each group) undergoing elective gynecological laparoscopic surgery, and 178 patients (89 for each group) were included in the final analysis. InterventionsPatients were randomly allocated in a 1:1 ratio to receive either sodium oxybate (30 mg kg−1) or an equivalent volume of saline after intubation. The patients, anesthetists, and follow-up staff were blinded to group assignment. MeasurementsThe primary outcome was sleep quality measured using the Richards–Campbell Sleep Questionnaire (RCSQ) on post-operative days (PODs) one and three. Secondary outcomes included post-operative pain measured using the visual analog scale, sleep quality at one and three months post-operatively measured using the Pittsburgh Sleep Quality Index, and factors associated with post-operative sleep quality. Main resultsAnalysis with generalized estimating equations showed that sodium oxybate significantly improved post-operative sleep quality, as represented by increased total RCSQ scores (mean difference (95% CI); 9 (2, 16), P = 0.010) over PODs one and three. There was no difference in post-operative pain between the two groups over PODs one and three or in post-operative sleep quality over one and three months post-operatively. Age, surgery type, start time of surgery, and use of sufentanil-based patient-controlled intravenous analgesia were significantly associated with post-operative sleep quality. ConclusionsIntraoperative sodium oxybate infusion improved post-operative sleep in patients who underwent gynecological laparoscopic surgery.Trial registration.Chinese Clinical Trial Registry, Clinical trial number: ChiCTR2200061460.