Incidence Of Respiratory Complications Research Articles

External validation of the CARDOT score for predicting respiratory complications after thoracic surgery

BackgroundThe CARDOT scores have been developed for prediction of respiratory complications after thoracic surgery. This study aimed to externally validate the CARDOT score and assess the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for postoperative respiratory complication.MethodsA retrospective cohort study of consecutive thoracic surgical patients at a single tertiary hospital in northern Thailand was conducted. The development and validation datasets were collected between 2006 and 2012 and from 2015 to 2021, respectively. Six prespecified predictive factors were identified, and formed a predictive score, the CARDOT score (chronic obstructive pulmonary disease, American Society of Anesthesiologists physical status, right-sided operation, duration of surgery, preoperative oxygen saturation on room air, thoracotomy), was calculated. The performance of the CARDOT score was evaluated in terms of discrimination by using the area under the receiver operating characteristic (AuROC) curve and calibration.ResultsThere were 1086 and 1645 patients included in the development and validation datasets. The incidence of respiratory complications was 15.7% (171 of 1086) and 22.5% (370 of 1645) in the development and validation datasets, respectively. The CARDOT score had good discriminative ability for both the development and validation datasets (AuROC 0.789 (95% CI 0.753–0.827) and 0.758 (95% CI 0.730–0.787), respectively). The CARDOT score showed good calibration in both datasets. A high NLR (≥ 4.5) significantly increased the risk of respiratory complications after thoracic surgery (P < 0.001). The AuROC curve of the validation cohort increased to 0.775 (95% CI 0.750–0.800) when the score was combined with a high NLR. The AuROC of the CARDOT score with the NLR showed significantly greater discrimination power than that of the CARDOT score alone (P = 0.008).ConclusionsThe CARDOT score showed a good discriminative performance in the external validation dataset. An addition of a high NLR significantly increases the predictive performance of CARDOT score. The utility of this score is valuable in settings with limited access to preoperative pulmonary function testing.

Complications of chest wall around malignant tumors: differences based on reconstruction strategy

BackgroundMalignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy.MethodsForty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated.ResultsTotal local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05–111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693–0.957; p = 0.0126).ConclusionsSurgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.

Comprehensive nutritional index predicts clinical outcomes for esophageal squamous cell carcinoma receiving neoadjuvant immunotherapy combined with chemotherapy.

No study has reported the clinical outcomes of comprehensive nutritional index (CNI) in esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant immunotherapy combined with chemotherapy (nICT). This retrospective study involved 233 ESCC patients who underwent nICT. Principal component analysis was performed to establish the CNI based on 5 indexes including body mass index, usual body weight percentage, total lymphocyte count, albumin and hemoglobin. The relationships between the CNI and therapeutic response, postoperative complications and prognosis were analyzed. One hundred and forty-nine and 84 patients were assigned to the high and low CNI group, respectively. The incidences of respiratory complications (33.3% vs. 18.8%, P=0.013) and vocal cord paralysis (17.9% vs. 8.1%, P=0.025) in low CNI were significantly higher than those in high group, respectively. Seventy (30.0%) patients achieved pathological complete response (pCR). High CNI patients achieved a better pCR rate than those with low CNI (41.6% vs. 9.5%, P<0.001). The CNI served as an independent pCR predictor [odds ratio (OR)=0.167, 95% confidence interval (CI)=0.074-0.377, P<0.001)]. High CNI patients had better 3-year disease-free survival (DFS) (85.4% vs. 52.6%, P<0.001) and overall survival (OS) (85.5% vs. 64.5%, P<0.001) than those with low CNI, respectively. The CNI served as an independent prognostic score regarding DFS [hazard ratio (HR)=3.878, 95% CI=2.214-6.792, P<0.001)] and OS (HR=4.386, 95% CI=2.006-9.590, P<0.001). Based on nutrition-related indicators, the pretreatment CNI serves as a sensitive and effective predictor of therapeutic response, postoperative complications and prognosis in ESCC receiving nICT.

Effect of Ultrasound-guided Erector Spinae Plane Block on Recovery After Laparoscopic Sleeve Gastrectomy in Patients With Obesity: A Randomized Controlled Trial

Previous research has not evaluated the potential effect of erector spinae plane block (ESPB) on quality of recovery (QoR) after laparoscopic sleeve gastrectomy. Therefore, we investigated the effect of an ultrasound-guided ESPB performed on patients with obesity who have undergone laparoscopic sleeve gastrectomy, measured using the 15-item QoR (QoR-15) scale. A total of 172 patients were enrolled in the study who were aged 18 to 65 years, had a body mass index ≥30 kg/m², were classified as having American Society of Anaesthesiologists physical status Ⅱ to Ⅲ, and had undergone laparoscopic sleeve gastrectomy. The patients were randomly divided into an ESPB group and a sham group (treated with normal saline). The primary outcome was the QoR-15 score, measured using the questionnaire 24 and 48 hours after surgery. The secondary outcomes were postoperative pain score, postoperative cumulative analgesic drug consumption, number of patient-controlled analgesia (PCA) requests, rate of rescue analgesia required at 48 hours, incidence of respiratory complications, and nerve block-related complications. The time of discharge from the postanesthesia care unit, postoperative activity, and length of stay at the hospital were also recorded. There was no significant difference in the global QoR-15 scores 24 and 48 hours after the operation. However, the groups' subdimension scores for the emotional state in QoR-15 at 24 and 48 hours after surgery were statistically different (P < 0.05). Meanwhile, patients in the ESPB group who indicated they were "feeling rested" at 24 and 48 hours after surgery and "having a feeling of general well-being" at 24 hours after surgery were significantly better than those in the sham group (P < 0.05). Compared with the sham group, participants in the ESPB group had lower resting pain scores at 6 and 12 hours after surgery and lower movement pain scores at 6, 12, 24, and 36 hours after surgery (P < 0.05). There was no statistical difference between the groups in postoperative cumulative analgesic drug consumption, number of PCA requests, incidence of respiratory complications, time of discharge from the postanesthesia care unit, or postoperative activity. Our results indicate that a single ESPB does not improve the global QoR-15 scores after laparoscopic sleeve gastrectomy. However, the visual analog scale score for postoperative pain is reduced.

Early Supervised Incremental Resistance Training (ESpIRiT) following cardiac surgery via a median sternotomy: a study protocol of a multicentre randomised controlled trial

IntroductionThere is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is...

General versus loco-regional anesthesia for endovascular aortic aneurysm repair.

Aortic aneurysms occur when the aorta, the body's largest artery, grows in size, and can occur in the thoracic or abdominal aorta. The approaches to repair aortic aneurysms include directly exposing the aorta and replacing the diseased segment via open repair, or endovascular repair. Endovascular repair uses fluoroscopic-guidance to access the aorta and deliver a device to exclude the aneurysmal aortic segment without requiring a large surgical incision. Endovascular repair can be performed under a general anesthetic, during which the unconscious patient is paralyzed and reliant on an anesthetic machine to maintain the airway and provide oxygen to the lungs, or a loco-regional anesethetic, for which medications are administered to provide the person with sufficient sedation and pain control without requiring a general anesthetic. While people undergoing general anesthesia are more likely to remain still during surgery and have a well-controlled airway in the event of unanticipated complications, loco-regional anesthesia is associated with fewer postoperative complications in some studies. It remains unclear which anesthetic technique is associated with better outcomes following the endovascular repair of aortic aneurysms. To evaluate the benefits and harms of general anesthesia compared to loco-regional anesthesia for endovascular aortic aneurysm repair. We used standard, extensive Cochrane search methods. The latest search was 11 March 2022. We searched for all randomized controlled trials that assessed the effects of general anesthesia compared to loco-regional anesthesia for endovascular aortic aneurysm repairs. We used standard Cochrane methods. Our primary outcomes were: all-cause mortality, length of hospital stay, length of intensive care unit stay. Our secondary outcomes were: incidence of endoleaks, requirement for re-intervention, incidence of myocardial infarction, quality of life, incidence of respiratory complications, incidence of pulmonary embolism, incidence of deep vein thrombosis, and length of procedure. We planned to use GRADE methodology to assess the certainty of evidence for each outcome. We found no studies, published or ongoing, that met our inclusion criteria. We did not identify any randomized controlled trials that compared general versus loco-regional anesthesia for endovascular aortic aneurysm repair. There is currently insufficient high-quality evidence to determine the benefits or harms of either anesthetic approach during endovascular aortic aneurysm repair. Well-designed prospective randomized trials with relevant clinical outcomes are needed to adequately address this.

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study.

Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.

Clinical advantage of transmediastinal esophagectomy in terms of postoperative respiratory complications.

Although the transmediastinal approach as a radical esophagectomy for esophageal carcinoma patients has attracted attention, its advantages over the transthoracic approach remain unclear. This study aimed to evaluate the efficacy of transmediastinal esophagectomy (TME) in terms of postoperative respiratory complications compared to that of open transthoracic esophagectomy (TTE). We reviewed patients with thoracic and abdominal esophageal carcinoma who underwent TME or TTE between February 2014 and November 2021. We compared postoperative respiratory complications as the primary outcome. The secondary outcomes included perioperative operation time, blood loss, postoperative complications, and the number of harvested mediastinal lymph nodes. Overall, 60 and 54 patients underwent TME and TTE, respectively. The baseline characteristics were similar between the two groups, except for age and histological type. There were no intraoperative lethal complications in either group. The incidence of respiratory complications was significantly lower in the TME group than in the TTE group (6.7 vs. 22.2%, p = 0.03). The TME group had a shorter operation time (403 vs. 451min, p < 0.01), less blood loss (107 vs. 253mL, p < 0.01), and slightly higher anastomotic leakage (11.7 vs. 5.6%, p = 0.33). The number of harvested lymph nodes was similar in both groups (24 vs. 26, p = 0.10). Multivariate analysis revealed that TME is an independent factor in reducing respiratory complications (odds ratio = 0.27, p = 0.04). TME for esophageal carcinoma was performed safely. TME was superior to TTE in terms of postoperative respiratory complications; however, the relatively higher frequency of anastomotic leakage should be considered and requires further evaluation.

Safety of High-Frequency Jet Ventilation During Image-Guided Thermal Ablation Procedures.

Percutaneous thermal ablative technique is a common radiological procedure for malignant lesions treatment. Controlled assisted ventilation during general anesthesia is the usual mode of ventilation, but high-frequency jet ventilation (HFJV) can be a helpful alternative for the operator. The objective was to evaluate the safety of HFJV during thermal ablation procedures. This monocentric prospective analysis included adult patients undergoing percutaneous thermal ablation procedures for abdominal tumor performed under HFJV. Procedures with a transpulmonary path were excluded. The primary outcome was the incidence of respiratory complications. Secondary outcomes included gas exchange modifications (hypercapnia, hypoxemia, pulmonary atelectasis) and the incidence of barotrauma. Sixty patients were included during the study period. The mean duration time was 88min. All procedures went according to the protocol and there was no respiratory complication. There was no barotrauma event. Three patients had an exhaled capnia above 45mmHg at the end of the procedure which normalized within 10min of conventional ventilation. HFJV during thermal ablation procedures is safe regarding gas exchange and barotrauma. This technique could be an interesting alternative to conventional ventilation during image-guided thermal ablation procedures. Clinical Trials database This study was registered in Clinical Trials database (NCT04209608).

Enteral nutrition in postoperative rehabilitation after reconstructive esophageal and gastric surgery

To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries. The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group (n=121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints. Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, p<0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, p<0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group (p=0.034). Overall postoperative morbidity and mortality were similar. Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.

Maternal and fetal outcome of administration of corticosteroids in late preterm period

The role of antenatal corticosteroids before 34 weeks has been extensively studied and proven to be effective. However of the 15 million preterm births annually worldwide an important segment, late preterm births that is birth between 34 weeks to 36.6 weeks remains unaddressed. While it is true that the incidence of respiratory complications is less in these babies the morbidity is still higher than term infants. The role of antenatal corticosteroids here is controversial as there needs to be a balance between respiratory complications and long term morbidity associated with antenatal corticosteroids. Background: Late preterm birth comprise 72% of preterm births yet adequate studies regarding this period are still lacking. We conducted this study at MGM medical College and Hospital, A tertiary care centre.Objectives: To determine effectiveness of antenatal corticosteroids in late preterm period. Methods: A total of 50 patients with gestational age between 34.1to 36.6 weeks were included in this study, they were divided into cases and controls of 25 patients each. Case group received antenatal corticosteroids and control group did not receive corticosteroids. Maternal and neonatal outcomes were then studied. Results: There was a significant reduction in neonatal respiratory morbidity in the case group over a short term period. Conclusion: Antenatal corticosteroids are effective in late preterm period in reducing short term respiratory morbidity however the possibility of long term effects should be weighed against the benefits. Decision to administer steroids should be made on a case by case basis.

Effect of early mobilization in patients with stroke and severe disturbance of consciousness: Retrospective study

ObjectivesThis study aimed to investigate the effectiveness and safety of early mobilization with a physiatrist and registered therapist Operating rehabilitation (PROr) for patients with stroke and severe disturbance of consciousness (DoC). Materials and methodsWe retrospectively screened records from patients with stroke admitted to our hospital from January 2015 to June 2021. Eligible patients with severe DoC were classified into two groups: patients who received standard rehabilitation (control group) and patients who received PROr (PROr group). We studied longitudinal change in the level of consciousness using the Japan Coma Scale (JCS) during hospital stay and compared in-hospital mortality, the incidence of respiratory complication, and modified Rankin Scale of discharge between the two groups. ResultsAmong the 2191 patients screened for inclusion, 16 patients were included in the PROr group, and 12 patients were included in the control group. Early mobilization was more promoted in the PROr group compared to the control group, but there were no significant differences in in-hospital mortality, the incidence of respiratory complication, or modified Rankin Scale at discharge between the two groups. In patients who survived during their hospital stay, JCS scores 2 weeks after the onset of stroke and JCS scores at discharge significantly improved from the start of rehabilitation in the PROr group, but not in the control group. ConclusionsEarly mobilization provided with the PROr program appears to be a safe treatment and may contribute to the improvement of consciousness level for patients with acute stroke and severe DoC.

Postoperative respiratory depression in patients on sublingual buprenorphine: a retrospective cohort study for comparison between postoperative continuation and discontinuation of buprenorphine

BackgroundWe tested the hypothesis that patients who continued buprenorphine postoperatively experience postoperative respiratory depression less frequently than those who discontinued buprenorphine.MethodsThis is a retrospective cohort study of patients who were on buprenorphine preoperatively. The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/minute, oxygen saturation (SpO2) < 90%, or requirement of naloxone for 48 h postoperatively. The secondary outcome was the composite of postoperative respiratory complications. The associations between postoperative buprenorphine continuation and respiratory depression and respiratory complications were estimated using separate multivariable logistic regression models, including demographic, intraoperative characteristics, and preoperative buprenorphine dose as covariates.ResultsPostoperative buprenorphine continuation was not associated with postoperative respiratory depression (adjusted odds ratio (OR), 1.11, 95% confidence interval (CI), 0.61 to 1.99, P=0.72). In subanalysis stratified by the preoperative buprenorphine dose, buprenorphine continuation was not associated with postoperative respiratory depression either when preoperative buprenorphine dose was high (≥16 mg daily) or low (<16 mg daily). Postoperative buprenorphine continuation was associated with lower incidence of postoperative respiratory complications (adjusted OR, 0.43, 95% CI, 0.21 to 0.86, P=0.02).ConclusionsContinuing buprenorphine was not associated with respiratory depression, but it was associated with a lower incidence of respiratory complications.

Over View of Oliceridine Newer Opioid Analgesic

Pain relief requires a balance between adequate analgesia and risk of adverse effects. Opioids remain the cornerstone for managing moderate to severe pain, but are associated with opioid-induced respiratory depression (OIRD) and gastrointestinal complications. Opioids exert their analgesic effects predominantly via G-protein signaling, however, adverse effects including OIRD are mediated by the β-arrestin pathway. Oliceridine is the first of a new class of biased opioid agonists that preferentially activate G-protein signaling over β-arrestin, which would theoretically improve analgesia and reduce the risk of adverse effects. Oliceridine is approved by the Food and Drug Administration (FDA) for the treatment of moderate to severe acute pain. The efficacy of Oliceridine was mainly established in two randomized controlled Phase III clinical trials of patients experiencing moderate to severe pain after bunionectomy (APOLLO-1) and abdominoplasty (APOLLO-2). The results of the APOLLO studies demonstrate that Oliceridine, when administered via patient-controlled analgesia (PCA) demand boluses of 0.35mg and 0.5mg, provides superior analgesia compared to placebo, and is equianalgesic to PCA morphine 1mg demand boluses, without significant difference in the incidence of respiratory complications. However, these studies were designed to evaluate analgesic efficacy, and it is still uncertain if Oliceridine has a better safety profile than conventional opioids. Although several post hoc analyses of pooled data from the trials reported that Oliceridine was associated with lower OIRD and gastrointestinal complications compared to morphine, prospective studies are needed to elucidate if biased agonists such as Oliceridine reduce the risk of adverse effects compared to conventional opioids

Mechanical insufflation-exsufflation for the prevention and treatment of respiratory complications in acute cervical spinal cord injury: A retrospective service evaluation

Background A cervical spinal cord injury (CSCI) is a life-changing event resulting in neurological weakness. Acutely, respiratory complications are the leading cause of mortality. Mechanical insufflation-exsufflation (MI-E) is used to augment cough and promote airway clearance in the prevention and treatment of respiratory complications in this population. The incidence of respiratory complications in subjects with CSCI who receive MI-E is not widely reported. Objectives To report on the incidence of respiratory complications and to evaluate the clinical application of MI-E in subjects with acute traumatic CSCI. Methods This was a retrospective case note review. Data was collected for subjects with a traumatic CSCI admitted to a U.K. major trauma centre between January 2017 and September 2018. The incidence of respiratory complications on admission and 3 weeks post-admission were collected. Where used, detail relating to MI-E clinical application was recorded. Results 33 subjects were eligible for inclusion. The overall incidence of respiratory complications was 21% (7/33). There was no significant difference in occurrence of respiratory complications between those who received MI-E and those who did not. There was a significant difference in the clinical application of therapeutic MI-E compared to prophylactic MI-E. The ‘number of cycles’ and ‘exhale pressure’ settings were found to be significantly greater in those receiving therapeutic treatment (p = &lt;0.001; p = 0.002 respectively). Reporting of other MI-E parameters and treatment detail was poor. Conclusion Whilst the findings of this review may suggest that MI-E provides no additional benefit in the prevention of respiratory complications following acute traumatic CSCI, firm conclusions cannot be drawn due the small sample and poor treatment detail reporting. Further incidence reporting in a multi-site study, including those with thoracic injuries is warranted.

Evaluation of the association between nasopharyngeal depth and respiratory complications after cleft palate surgery in children between 9 and 18 months old

Background: Considering the incidence of respiratory complications after cleft lip and palate surgery and its significance in the survival of children undergoing the mentioned surgery, the present study was performed to evaluate the association between the nasopharyngeal depth and the incidence of respiratory complications after cleft palate surgery.Materials and Methods: The present cross-sectional study was performed on 222 children who aged 9–18 months and were the candidates for cleft palate surgery. After performing general anesthesia and implanting mouth gag and before surgery, the nasopharyngeal depth and the cleft palate width were measured with a calibrated ruler and an ophthalmic caliper, respectively. At the end of the surgery and after extubation, the incidence of respiratory complications such as respiratory distress, laryngospasm, bronchospasm, and need for intubation was recorded.Results: The nasopharyngeal depth in children with respiratory complications with a mean of 7.57 ± 3.12 mm was significantly less than that of children without respiratory complications with a mean of 10.82 ± 2.14 mm (P < 0.001). The nasopharyngeal depth of ≤8 mm with a sensitivity of 80% and a specificity of 89.60% had a significant predictive value in the incidence of respiratory complications (P < 0.001).Conclusion: According to the results of the present study, it seems that the nasopharyngeal depth of ≤8 mm can make the incidence of respiratory complications more likely. Therefore, considering the simplicity and convenience of measuring the nasopharyngeal depth and the cleft palate width, it is suggested to perform further studies to evaluate the anatomy of palate before this surgery using the employed method and address its association with respiratory complications.

P163 ROLE OF THE LAPAROSCOPIC APPROACH IN EMERGENT INGUINAL HERNIA REPAIR

Abstract Aim Analyze the evolution of the laparoscopic approach in emergent inguinal hernia repair at our center. Material and Methods Retrospective review of patients with emergent inguinal hernia repair in our center from January 2011 to June 2020. Demographic, clinical and postoperative data were analyzed as well as the evolution of the laparoscopic approach. Results 385 patients with incarcerated/strangulated inguinal hernia were registered. 58.96% were men, with a median age of 71. Of those, 22 patients (5.71%) were treated by laparoscopic approach and 363 (94.29%) by open approach. The open approach had a longer median hospitalization (4.82 vs 1.66 days), higher rate of surgical wound infection (5.51% vs. 0%), higher reoperation rate (3.31% vs 0%) and higher incidence of respiratory complications (1.97% vs 0%). 1 patient (4.54%) with laparoscopic approach required intestinal resection vs 48 patients (13.22%) of the open group, with a dehiscence rate of 0% vs 4.76% respectively. Mortality rate was 0% for the laparoscopic group and 2.75% in the open group. In the last 18 months, 28.98% of urgent hernias repaired have been performed laparoscopically, while previously from 2011 to 2017 only 0.95%, due to the learning curve obtained in elective surgery where the laparoscopic approach has had a major development in the last 3 years. Conclusions Despite the evident patient selection bias because the approach choice by the surgeon in emergent inguinal hernia repair, laparoscopic approach is feasible and has lower morbidity-mortality compared to open approach in our center. In specialized centers this may be a treatment option for selected patient groups.

Analysis of multiple organ involvement in Kawasaki disease

This study aimed to explore the incidence and clinical characteristics of multiple complications in children with Kawasaki disease (KD). All patients were diagnosed in our hospital between January 2016 and December 2020. A total of 640 cases were included, 43 patients had coronary artery aneurysm, 51 patients had coronary artery dilation, and 546 patients had no coronary artery damage. The patients were divided into three subgroups based on age: < 1year old, 1-5years old, and > 5years old. The multiple complications of all the KD children and the correlation between extracardiac complications and cardiovascular complications were analyzed. Among the 640 KD children, most were 1-5years old (415/640, 64.8%). Children < 1year old (31.6%) and > 5years old (28.3%) were more likely to have cardiovascular complications. The incidence of respiratory complications was highest in 1-5year olds (57.1%). Involvement of the digestive and the hematological systems gradually decreased with age, whereas involvement of the nervous system, the urinary system, and the joints gradually increased with age. The incidence of cardiovascular injury with extracardiac complications (22.3%) was higher than that without extracardiac complications (16.3%), although the difference was not statistically significant (p > 0.05).Conclusions: KD can be complicated by multiple-organ injury but there was no significant relationship between the occurrence of extracardiac complications and cardiovascular complications. What is Known: • Cardiovascular disease is generally believed to be the most common and serious complication of Kawasaki disease (KD). • Over recent years, we have found that extracardiovascular complications of KD are more common than generally supposed and, because they have some effect on prognosis, we believe that more attention should be paid to these complications. What is New: • There was no significant relationship between the occurrence of extracardiac complications and cardiovascular complications.

Postoperative respiratory complications affect improvement of postoperative respiratory muscle strength in patients undergoing cardiac surgery

Abstract Introduction The number of operations in the field of cardiac surgery is increasing year by year. In Japan, the number of operations in 2016 was about 68,000, which is a significant increase from about 54,000 in 2006. In addition, since patients undergoing cardiac surgery have low cardiac function after surgery, it is a problem that they often develop respiratory complications in the period until functional improvement. It has been reported that the incidence of respiratory complications is high in Japan as well. The purpose of this study is to clarify the relationship between the effects of postoperative respiratory complications on physical function at pre and post-operation and at discharge in patients undergoing cardiac surgery. Methods Twenty-two cardiovascular surgery patients (16 males and 6 females; mean age, 69.7±10.3 years; Body Mass Index, 23.1±4.2 kg/m2) were assigned. The evaluations were performed pre and post-operation and at discharge. We evaluated maximum inspiratory muscle strength (PImax; Maximum Inspiratory Pressure), 6-minute walking distance, balance function (Berg Balance Scale), 10 m gait speed, hand grip strength, and Activities of Daily Living (Barthel Index). In addition, preoperative cognitive function (Mini-Mental State Examination) and preoperative echocardiography, preoperative respiratory function tests, respiratory complications, length of stay in ICU, ventilator wearing time, the length of hospital stay was also investigated. The statistical analysis were performed using the SPSS 27 to examine the comparison of the differences between the two groups in the presence or absence of respiratory complications. This study protocol was approved by the Ethics Committee of Yonemori Hospital (approval number: Yonerin 18002). All patients signed the informed consent. Results Postoperative respiratory complications were observed in 45.5% (10 cases). Regarding physical function, preoperative hand grip strength (24.8±9.0 vs 31.7±6.1) and vital capacity % predicted (78.2±9.9% vs 91.1±17.5%) compared to the group with respiratory complications (complication group) and the group without respiratory complications (control group). Was significantly reduced. In addition, the improvement in postoperative PImax (21.3±18.7 vs 8.8±13.6) was significantly lower in the complication group than in the control group, and the PImax at discharge (44.5±26.5 vs 26.5±20.3) was also significantly reduced. Conclusion In this study, it was suggested that postoperative respiratory complications may affect postoperative respiratory muscle strength improvement and postoperative respiratory muscle weakness. It was also suggested that decreased preoperative hand grip strength and vital capacity may be associated with the development of postoperative respiratory complications. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by JSPS KAKENHI Grant Number JP20K19326.

English

Guillain-Barre syndrome is an immune mediated acute demyelinating polyradiculopathy, linked to various infectious agent. GBS has a very low incidence during pregnancy, estimated population incidence ranged from 0.62 to 2.66 cases per 100,000 person-years across all age groups.1 It is usually preceded by a bacterial or viral infection. Infections like CMV, EB, HIV-1, Hepatitis virus and campylobacter jejuni has been implicated as etiologic agents. Most common infectious agent associated with GBS is campylobacter jejuni.2 GBS classically presents with pain, numbness, paraesthesia, or weakness of the limbs, areflexia. Ascending paralysis with weakness beginning in the feet and migrating towards the trunk is the most typical symptoms. Life threatening complications particularly occurs if there is involvement of respiratory muscles. Increased incidence of respiratory complications is mostly due to gravid uterus. However, GBS is more common in the third trimester and the first 2 weeks of postpartum. 3 GBS is known to worsen in postpartum period due to an increase in delayed type IV of hypersensitivity response. Delayed diagnosis is common in pregnancy or immediate postpartum period because the initial nonspecific symptoms may mimic changes in pregnancy. GBS in pregnancy associated with high maternal mortality. A third of pregnant women required ventilator support with a mortality rate of 13 %.4 Diagnosis is based on the clinical presentation, laboratory and electrophysical investigations. Nerve conduction studies and EMG show an evolving multifocal demyelinating polyneuropathy. Management of GBS in pregnancy is a multidisciplinary approach. IVIG injection in high dose or plasmapheresis is beneficial if given within 1 to 2 weeks of motor syndrome.3 Maternal GBS is not an indication for caesarean section and operative delivery should be reserved for obstetrics indications only. A 25 years old, primigravida patient was relatively alright 9 days back, when she started complaining of weakness in right hand it was acute in onset and progressing gradually with time. The next day patient started having difficulty in standing up. On 29 / 07 / 2019 she was unable to move all four limbs. Patient was taken to private hospital where she was investigated. Her NCV was suggestive of severe acute onset polyneuropathy. She received IVIG at private hospital where her tracheostomy was done. She was brought by relatives to Indira Gandhi Government Medical College, Nagpur on 04 / 08 / 2019. On examination her general condition was not satisfactory, afebrile, pulse rate was 120/min, BP was 110 / 80 mm Hg, RBS 186 mg %. On CNS examination she was conscious oriented with time, place and person, bilateral planters absent, DTR absent, Power in all four limbs was zero.