Intraoperative Fluid Infusion Research Articles

Can the lung ultrasound score predict pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma: A single-center observational study

Study objectivePatients with blunt thoracic trauma have a high risk of developing postoperative pulmonary complications (PPCs). In this study, we aimed to identify the risk factors for PPCs after non-thoracic surgery in patients with blunt thoracic trauma and investigate the efficacy of perioperative lung ultrasound scores in predicting PPC occurrence. DesignProspective observational study. SettingA Chinese tertiary orthopedic hospital. ParticipantsThis observational study included 369 patients with blunt thoracic trauma who underwent surgery for pelvic and upper or lower extremity fractures. InterventionsLung ultrasonography was performed pre- and postoperatively. MeasurementsPatients were followed up for 1 week to assess PPCs and assigned to the PPC or non-PPC groups. We identified risk factors for PPCs using univariate and multivariate logistic regression analyses. The predictive value of these risk factors was evaluated using receiver operating characteristic (ROC) curves. Main resultsPPCs incidence was 36.58 %. The two groups differed significantly in Injury Severity Scores, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease, hydrothorax, preoperative hypoxemia, lung ultrasound score, preoperative hemoglobin level, intraoperative infusion volume, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) scores (P < 0.05). Independent risk factors for PPCs included ASA classification III, higher postoperative lung ultrasound scores, preoperative anemia, higher intraoperative infusion volume, and higher ARISCAT scores. ROC curve analysis revealed that postoperative lung ultrasound score (area under the curve [AUC]: 0.810, cutoff: 10), preoperative hemoglobin level (AUC: 0.627, cutoff: 97), intraoperative infusion volume (AUC: 0.701, cutoff: 886.51 mL/h) and ARISCAT score (AUC: 0.718, cutoff: 33) predicted postoperative outcomes effectively. ConclusionsPostoperative lung ultrasound scores reliably predicted pulmonary complications after non-thoracic surgery in patients with blunt thoracic trauma. ASA classification III, preoperative anemia, excessive intraoperative fluid infusion, higher ARISCAT, and postoperative lung ultrasound scores were significant risk factors associated with PPCs.Trial registration: Clinical Trial Number: 1900023408. Registered on May 26, 2019.

Evaluation of Factors Influencing Postoperative Cognitive Dysfunction in Patients After Cranial Tumor Surgery.

The authors retrospectively analyzed the perioperative data of 81 patients who underwent cranial tumor surgery to explore the factors influencing POCD in patients after the surgery. The authors evaluated preoperative cognitive dysfunction using the Mini-Mental State Examination (MMSE) score measured. For patients whose cognitive function was normal, the authors retrieved the MMSE score on the seventh day after surgery and compared it to determine whether the patients had POCD. The authors used a univariate logistic regression analysis to analyze the perioperative factors in patients, namely, age, gender, history of underlying diseases, tumor size, peritumoral edema, duration of surgery, blood loss, intraoperative fluid infusion, and type of anesthetic drugs. The authors then performed a multivariate logistic regression analysis for the statistically significant factors. The authors found that 23 of 81 patients (28.4%) developed POCD. Univariate logistic analysis showed that a history of diabetes mellitus, peritumoral edema, intraoperative blood loss, and anesthetic drugs were the risk factors for patients developing POCD after cranial tumor surgery. Multivariate logistic regression analysis showed that a history of diabetes mellitus, peritumoral edema, and use of ciprofol as the anesthetic drug were independent risk factors for POCD after cranial tumor surgery. A history of diabetes mellitus, the degree of brain tumor edema, and the choice of anesthetic drugs significantly influence the occurrence of POCD in patients after cranial tumor surgery.

Application value of machine learning models in predicting intraoperative hypothermia in laparoscopic surgery for polytrauma patients

BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications. Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia. AIM To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma. METHODS This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023. Of these, 154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio. In the training set, 53 cases experienced intraoperative hypothermia and 101 did not. Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery. The area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS Comparison of the hypothermia and non-hypothermia groups found significant differences in sex, age, baseline temperature, intraoperative temperature, duration of anesthesia, duration of surgery, intraoperative fluid infusion, crystalloid infusion, colloid infusion, and pneumoperitoneum volume (P &lt; 0.05). Differences between other characteristics were not significant (P &gt; 0.05). The results of the logistic regression analysis showed that age, baseline temperature, intraoperative temperature, duration of anesthesia, and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery (P &lt; 0.05). Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence (P &gt; 0.05). The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets, respectively. CONCLUSION Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery, which improved surgical safety and patient recovery.

Clinical Observation of Wound Fluid Extravasation after Shoulder Arthroscopy

Fluid leakage to the outside of the wound after shoulder arthroscopy can present a risk of complications such as wound infection and delayed wound healing. Most relevant studies dealt with fluid leakage to the internal environment and did not focus on fluid leakage outside the body and its effect on the wound. We, therefore, focused on and investigated the significance of wound fluid leakage to the body surface after shoulder arthroscopy. Methods: Observational and analyzed patient data from 15 cases of shoulder arthroscopy were used to calculate the amount of fluid exudation by recording the operation time, the amount of intraoperative fluid perfusion, the surgical incisions, and weighing the surgical dressings on the first day of the postoperative period. The statistical method of Pearson's correlation coefficient was used to evaluate the correlation between the patients' postoperative fluid exudate volume and the operation time, intraoperative fluid infusion volume, and surgical incision. Results: All patients had no incision infections or other postoperative complications. The duration of surgery and the amount of postoperative wound exudate were correlated in 15 patients (R=.547, p&lt;.05), the amount of perfusion and the amount of postoperative wound exudate were statistically significant (R=.569, p&lt;.05), and the incisions and the amount of postoperative wound exudate were statistically significant (R=.702, p&lt;.05). Conclusion: There is a correlation between postoperative fluid exudation after shoulder arthroscopy and operative time, intraoperative perfusion, and surgical incisions. When the operator performs shoulder arthroscopy, he or she should try to shorten the operative time and reduce intraoperative fluid perfusion and surgical incisions.

Anesthetic predictors for postoperative pneumonia in patients with non-small cell lung cancer.

Postoperative pneumonia (POP) is a preventable complication associated with adverse outcomes. The aim of this study is to explore the anesthetic predictor for POP in patients with non-small cell lung cancer (NSCLC) after surgery. A total of 306 patients with NSCLC were selected. Multivariable logistic regression analysis model was used to screen the independent predictors for POP. The primary outcome was POP and the secondary outcomes were intensive care unit (ICU) admission rate, reintubation rate and postoperative hospital stay (PHS). POP occurred in 102 (33.3%) of 306 patients. Multivariable logistic regression analysis showed that perioperative propofol administration >4.42 mg/kg [odds ratio (OR) =0.543, 95% confidence interval (CI): 0.330-0.895, P=0.02] lowered the risk of POP, while duration of surgery >3 h (OR =1.951, 95% CI: 1.189-3.199, P=0.008) and total intraoperative fluid infusion >1,450 mL (OR =2.428, 95% CI: 1.307-4.509, P=0.005) were associated with the increasing risk of POP. There was a higher ICU admission and reintubation rate in the POP group (P<0.05). Perioperative propofol administration >4.42 mg/kg may diminish the incidence of POP, while duration of surgery >3 h and intraoperative fluid infusion >1,450 mL increase the development of POP.

Perioperative outcomes of utilizing infrahepatic inferior vena cava clamping and Pringle maneuver duringhepatectomy: a meta-analysis.

Intraoperative bleeding during hepatectomy is primarily controlled through anaesthesiological interventions or surgical techniques such as Pringle maneuver (PM). Infrahepatic IVC clamping (IIVCC) is an alternative surgical technique to reduce central venous pressure and prevent retrograde hepatic venous bleeding. The aim of the meta-analysis was to compare IIVCC+PM with PMalone in terms of intraoperative outcomes and perioperative complications. Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched for comparative studies till 16.04.2024, resulting in 679 articles, of which eight studies met inclusion criteria. Data on patient demographics, surgical technique, and perioperative outcomes was assessed. Cochrane Risk of Bias 2.0 (RoB 2.0) Tool and Newcastle-Ottawa Scale (NOS) were used for risk of bias assessment. Two randomized controlled trials, one prospective, and five retrospective cohort studies with 358 patients in IIVCC+PM and 397 patients in PMalone group were included. IIVCC+PM resulted in significantly greater CVP reduction, less intraoperative blood loss (MD (95% CI) = - 233.03 (- 360.48 to - 105.58), P < 0.001), and less intraoperative blood transfusion (OR (95% CI) = 0.38 (0.25 to 0.57), P < 0.001) compared to PMalone. The two groups had comparable total operative time, transection time and total intraoperative fluid infusion. Patients undergoing IIVCC+PM had significantly shorter length of stay (MD (95% CI) = - 0.63 days (- 1.21 to - 0.05 days), P = 0.03) and overall complication rates (OR (95% CI) = 0.63 (0.43-0.92), P = 0.02) compared to PMalone group. The utilization of IIVCC along with PM during liver resection may be beneficial in reducing intraoperative bleeding and blood transfusion without adversely influencing operative times or perioperative outcomes compared to PMalone.

Predictive modeling of perioperative blood transfusion in lumbar posterior interbody fusion using machine learning.

Background: Accurate estimation of perioperative blood transfusion risk in lumbar posterior interbody fusion is essential to reduce the number, cost, and complications associated with blood transfusions. Machine learning algorithms have the potential to outperform traditional prediction methods in predicting perioperative blood transfusion. This study aimed to construct a machine learning-based perioperative transfusion risk prediction model for lumbar posterior interbody fusion in order to improve the efficacy of surgical decision-making. Methods: We retrospectively collected clinical data on 1905 patients who underwent lumbar posterior interbody fusion surgery at the Second Hospital of Shanxi Medical University between January 2021 and March 2023. All the data was randomly divided into a training set and a validation set, and the "feature_importances" method provided by eXtreme Gradient Boosting (XGBoost) algorithm was applied to select statistically significant features on the training set to establish five machine learning prediction models. The optimal model was identified by utilizing the area under the curve (AUC) and the probability calibration curve on the validation set. Shapley additive explanations (SHAP) and local interpretable model-agnostic explanations (LIME) were employed for interpretable analysis of the optimal model. Results: In the postoperative outcomes of patients, the number of hospital days in the transfusion group was longer than that in the non-transfusion group. Additionally, the transfusion group experienced higher total hospital costs, 90-day readmission rates, and complication rates within 90days after surgery than the non-transfusion group. A total of 9 features were selected for the models. The XGBoost model performed best with an AUC value of 0.958. The SHAP values showed that intraoperative blood loss, intraoperative fluid infusion, and number of fused segments were the top 3 most important features affecting perioperative blood transfusion in lumbar posterior interbody fusion. The LIME algorithm was used to interpret the individualized prediction. Conclusion: Surgery, ASA class, levels fused, total intraoperative blood loss, operative time, and preoperative Hb are viable predictors of perioperative blood transfusion in lumbar posterior interbody fusion. The XGBoost model has demonstrated superior predictive efficacy compared to the traditional logistic regression model, making it a more effective decision-making tool for perioperative blood transfusion.

743 Intraoperative Outcomes Using Infrahepatic Inferior Vena Cava Clamping During Hepatectomy: A Meta-Analysis

Abstract Aim The aim of this meta-analysis is to determine the effect of infrahepatic inferior vena cava clamping (IIVCC) with Pringle maneuver (PM) compared to only PM during hepatectomy on intraoperative outcomes. Method Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched from inception till 23.11.2021 using a predefined search strategy. The initial search resulted in 615 unique articles. After screening, eight studies including 755 patients (358 in IIVCC+PM, 397 in PM group) met the inclusion criteria for this meta-analysis. Of these, two were randomized controlled trials, one prospective and five retrospective cohort studies. Data on patient demographics, surgical technique and intraoperative outcomes was collected. Summary estimates using the appropriate effect models were generated with Review Manager 5.0. Results Patients who underwent IIVCC + PM during hepatectomies experienced significantly less total intraoperative blood loss (mean difference (MD), 95% confidence interval (CI) = -233.03, -360.48 to -105.58; p = 0.0003), less blood loss during transection (MD, 95% CI = -172.91, -308.94 to -36.88; p = 0.01), and had significantly less intraoperative blood transfusion requirement (Odds ratio, 95% CI = 0.38, 0.25 to 0.57; p&amp;lt;0.0001) compared to patients who had only PM. Additionally, the total operative time was comparable between the two groups (MD, 95% CI = 8.06, 4.29 to 11.82; p&amp;lt;0.0001). There were no difference in the parenchymal transection time and total intraoperative fluid infusion between the two groups. Conclusions IIVCC + PM is beneficial in reducing intraoperative blood loss and need for transfusion without significantly affecting operative times in comparison to PM during hepatectomy.

Рекомендации протоколов анестезии для проведения плановых кастраций собак и кошек (орхифуникулэктомии, овариогистерэктомии и овариоэктомии)

This article, compiled by the team of authors of the VITAR expert committee in 2019, contains recommendations for the administration of general anesthesia for routine operations as OGE, OE, OFE in clinically healthy dogs and cats. Recommendations are given both for clinics with full or limited access to NS and PV. &#x0D; Patient preparation and premedication, induction, optimal techniques for regional anesthesia, maintenance of anesthesia and intraoperative analgesia are described separately. The recommendations also include items on intraoperative fluid infusion therapy, monitoring, and postoperative analgesia.

Retroperitoneal localized neuroblastoma in children: a comparison of enhanced recovery after surgery versus traditional care.

To investigate the clinical value of enhanced recovery after surgery (ERAS) protocols for children with neuroblastoma (NB). This retrospective review was conducted by using the electronic medical records of 48 children with retroperitoneal localized NB who underwent tumor resection (surgery for treatment, not diagnosis) between October 2016 and September 2021. The ERAS protocols for NB excision were implemented in 28 children (ERAS group), while 20 children received traditional care (TRAD group). The same group of pediatric surgeons performed all the tumor resections. Intraoperative fluid infusion, the extent of NB resection, time of early ambulation and time of first flatus, time to total enteral nutrition (TEN) after surgery, abdominal drainages, nasogastric tubes and urinary catheters used and duration, the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table on a postoperative day 1 (POD1), 3, 5, length of stay after surgery (LOS), hospitalization expense, postoperative complications, parental satisfaction rate and readmission rate of surgical wards within 30days after operation were analyzed. The median postoperative period of early mobilization, first flatus, TEN, LOS and total cost during hospitalization were 1.0days, 2.0days, 5.5days, 9.0days and 33,397.3 yuan in the ERAS group and 3.0days, 3.0days, 7.0days, 11.0days and 38,120.3 Yuan in the TRAD group, respectively (all p < 0.05). Median intraoperative fluid volume was 5.0mL/kg/h compared to 8.0mL/kg/h and the magnitude of decrease in FLACC scores from POD1 to POD5 was greater in the ERAS group (all p < 0.05). Abdominal drainages, urinary catheters and nasogastric tubes were removed earlier in the ERAS group (p < 0.05). The satisfaction of parents in the ERAS group was slightly higher, but the difference was not statistically significant (P = 0.762). There were no marked differences between the two groups in aspects of the extent of NB resection, operation-related complications and 30-day readmissions (all P = 1.000). Application of ERAS protocols in localized retroperitoneal NBs resection in children is feasible and safe. However, applying ERAS protocols in the surgical resection of solid tumors in children still requires much more research, especially randomized prospective research.

Effect of Sodium Bicarbonate Ringer's Solution on Intraoperative Blood Gas Analysis and Postoperative Recovery Time in Liver Transplantation: A Single-Center Retrospective Study.

BACKGROUND Sodium bicarbonate Ringer's solution (BRS) is the latest generation of balanced crystal solutions. BRS does not increase the liver burden, but its impact in liver transplantation is unclear. The aim of this study was to investigate the effect of BRS as a fluid therapy on intraoperative blood gas analysis and postoperative recovery time in orthotopic liver transplantation (LT) patients. MATERIAL AND METHODS The study included 101 patients who received classical in situ liver transplantation at the Second Affiliated Hospital of Guangxi Medical University from November 2019 to January 2022. The patients were divided into 2 groups according to the intraoperative fluid infusion: the BRS group and the sodium lactate Ringer's solution group (LRS group). Intraoperative blood gas analysis, including pH, base excess (BE), bicarbonate, and lactic acid levels of radial artery blood, were collected after induction (T0), 30 min before opening (T1), 30 min after no liver period (T2), 30 min after opening (T3), and at the end of the operation (T4). Postoperative ICU catheter time, ICU stay time, and total hospitalization days were also recorded and compared between the 2 groups. RESULTS Lactic acid levels were decreased significantly at T3 in the BRS group (P<0.05). ICU catheter time, ICU hospitalization days, and total hospitalization days were significantly shorter in the BRS group (P<0.05). CONCLUSIONS BRS can decrease the lactic acid level at 30 min after opening, reducing the postoperative recovery time. BRS is more effective than LRS in liver transplantation.

Haemoglobin drift in patients following Whipple's procedure.

This study aims to identify the objective findings of haemoglobin (Hb) drift in patients that had a Whipple's procedure in the last 10 years, their transfusion status intraoperatively and post-operatively, the potential factors affecting Hb drift, and the outcomes following Hb drift. A retrospective study was conducted at Northern Health, Melbourne. All adult patients who were admitted for a Whipple's procedure from 2010 to 2020 were included and information collected retrospectively for demographics, pre-operative, operative and post-operative details. A total of 103 patients were identified. The median Hb drift calculated from a Hb level at the end of operation was 27.0g/L (IQR 18.0-34.0), and 21.4% of patients received a packed red blood cell (PRBC) transfusion during the post-operative period. Patients received a large amount of intraoperative fluid with a median of 4500 mL (IQR 3400-5600). Hb drift was statistically associated with intraoperative and post-operative fluid infusion leading to concurrent issues with electrolyte imbalance and diuresis. Hb drift is a phenomenon that does happen in major operations such as a Whipple's procedure, likely secondary to fluid over-resuscitation. Considering the risk of fluid overload and blood transfusion, Hb drift in the setting of fluid over-resuscitation needs to be kept in mind prior to blood transfusion to avoid unnecessary complications and wasting of other precious resources.

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Goal-Directed Intraoperative Fluid Therapy Benefits Patients Undergoing Major Gynecologic Oncology Surgery: A Controlled Before-and-After Study.

BackgroundFluid management during major gynecologic oncology surgeries faces great challenges due to the distinctive characteristics of patients with gynecologic malignancies as well as features of the surgical procedure. Intraoperative goal-directed fluid therapy (GDFT) has been proven to be effective in reducing postoperative complications among major colorectal surgeries; however, the efficacy of GDFT has not been fully studied in gynecologic malignancy surgeries. This study aimed to discuss the influence of GDFT practice in patients undergoing major gynecologic oncology surgery.MethodsThis study was a controlled before-and-after study. From June 2015 to June 2018 in Peking Union Medical College Hospital, a total of 300 patients scheduled for elective laparotomy of gynecological malignancies were enrolled and chronologically allocated into two groups, with the earlier 150 patients in the control group and the latter 150 patients in the GDFT group. The GDFT protocol was applied by Vigileo/FloTrac monitoring of stroke volume and fluid responsiveness to guide intraoperative fluid infusion and the use of vasoactive agents. The primary outcome was postoperative complications within 30 days after surgery. The secondary outcome included length of stay and time of functional recovery.ResultsA total of 249 patients undergoing major gynecologic oncology surgery were analyzed in the study, with 129 in the control group and 120 patients in the GDFT group. Patients in the GDFT group had higher ASA classifications and more baseline comorbidities. GDFT patients received significantly less fluid infusion than the control group (15.8 vs. 17.9 ml/kg/h), while fluid loss was similar (6.9 vs. 7.1 ml/kg/h). GDFT was associated with decreased risk of postoperative complications (OR = 0.572, 95% CI 0.343 to 0.953, P = 0.032), especially surgical site infections (OR = 0.127, 95% CI 0.003 to 0.971, P = 0.037). The postoperative bowel function recovery and length of hospital stay were not significantly different between the two groups.ConclusionGoal-directed intraoperative fluid therapy is associated with fewer postoperative complications in patients undergoing major gynecologic oncology surgery.

Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial

BackgroundPostoperative delirium (POD) is a common phenomenon after spinal surgery. Intraoperative fluid management may affect POD. The aim of this study was to compare the effects of restrictive fluid therapy (RF) with those of goal-directed fluid therapy (GDT) on POD.MethodsA total of 195 patients aged ≥ 50 years who underwent spinal surgery were randomly divided into two groups: the RF group and the GDT group. In group RF, a bolus of lactated Ringer’s solution was administered at a dose of 5 mL·kg-1 before the induction of anesthesia, followed by a dose of 5 mL·kg-1·h-1 until the end of surgery. For patients in the GDT group, in addition to the initial administration of lactated Ringer’s solution at 5 mL·kg-1, the subsequent fluid therapy was adjusted by using a continuous noninvasive arterial pressure (CNAP) monitoring system to maintain pulse pressure variation (PPV) ≤ 14%. The primary endpoint was the incidence of POD, assessed once daily with the Confusion Assessment Method-Chinese Reversion (CAM-CR) scale at 1–3 days postoperatively. The secondary endpoints were intraoperative fluid infusion volume, urine volume, mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), regional cerebral oxygen saturation (rSO2) value, lactic acid value, and visual analog scale (VAS) pain score at 1–3 days after surgery. Moreover, postoperative complications and the length of hospital stay were recorded.ResultsThe incidence of POD was lower in the GDT group than in the RF group (12.4% vs 4.1%; P = 0.035) in the first 3 days after spine surgery. Compared to group RF, group GDT exhibited a significantly increased volume of intraoperative lactated Ringer’s solution [1500 (interquartile range: 1128 to 1775) mL vs 1000 (interquartile range: 765 to 1300) mL, P < 0.001] and urine volume [398 (interquartile range: 288 to 600) mL vs 300 (interquartile range: 200 to 530) mL, P = 0.012]. Intraoperative MAP, CI and rSO2 values were higher in the GDT group than in the RF group (P < 0.05). Moreover, the length of hospital stay [17.0 (14 to 20) days versus 14.5 (13 to 17.0) days, P = 0.001] was shorter in the GDT group than in the RF group.ConclusionsGDT reduced the incidence of POD in middle- and old-aged patients undergoing spinal surgery possibly by stabilizing perioperative hemodynamic and improving the supply and demand of oxygen.Trial registrationChiCTR2000032603; Registered on May 3, 2020.

Effects of Intraoperative Fluid Management on Postoperative Outcomes After Pericardiectomy.

Background: The effects of intraoperative fluid management on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the relationship between intraoperative fluid management and postoperative outcomes in these patients.Methods: We retrospectively studied 92 patients with constrictive pericarditis undergoing pericardiectomy and assigned them to the restrictive group and the liberal group according to the intraoperative total fluid infusion rate. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the relationship between the intraoperative total fluid infusion rate and postoperative outcomes.Results: There were 46 (50.0%) cases in the restrictive group and 46 (50.0%) cases in the liberal group. Compared with the liberal group, the restrictive group had significantly lower incidences of postoperative complications and cardiac complications (P = 0.005 and P = 0.006, respectively). Binary logistics regression analysis also showed the increased risks of postoperative complications (OR, 3.551; 95% CI, 1.192–10.580; P = 0.023) and cardiac complications (OR, 6.037; 95% CI, 1.472–25.052; P = 0.013) at the liberal group. In addition, the restrictive group had shorter postoperative hospital stay (P = 0.026) in comparison to the liberal group.Conclusion: In patients with constrictive pericarditis undergoing pericardiectomy the intraoperative total fluid infusion rate was significantly associated with postoperative outcomes. Restrictive fluid management strategy was related to the positive effects on enhanced recovery after surgery and could be advised as the preferred intraoperative fluid management policy.

External validation of risk prediction platform for pancreatic fistula after pancreatoduodenectomy using artificial intelligence

Postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreatoduodenectomy (PD). We previously developed artificial intelligence (AI)-based risk prediction platform for POPF after PD. This study aims to externally validate the formerly developed platform. Between January 2007 and December 2016, a total of 1576 patients who underwent PD in Seoul National University Hospital, Ilsan Paik Hospital, and Boramae Medical Center were retrospectively reviewed for external validation. POPF was defined according to the 2016 updated International Study Group of Pancreatic Fistula. The individual risk scores for POPF were calculated using AI risk prediction platform by Samsung Medical Center. The predictive ability was evaluated with a Receiver Operating Characteristic curve and the area under the curve (AUC). In order to obtain the optimal predictive value, we performed backward elimination in accordance with the results from the AI development process. There were 270 (17.1%) patients who developed POPF in the validation cohort. After backward elimination, each AUC varied from 0.585 to 0.672. The 13 risk factors representing the maximal AUC were pancreatic duct diameter, body mass index, pre-operative serum albumin, amount of intra-operative fluid infusion, age, pre-operative platelet count, location of tumor, combined venous resection, co-existing pancreatitis, pre-operative serum lipase, neoadjuvant radiotherapy, American Society of Anesthesiologists' score, and sex. We performed external validation of previously developed AI platform for predicting POPF. This user-friendly platform could be used to discriminate individual risk of POPF. Further research is needed to investigate other potential risk factors and to improve the predictability of the platform.

ERAS pathway for gastric cancer surgery: adherence, outcomes and prognostic factors for compliance in a Western centre.

Adherence to an ERAS program guarantees an evidence-based approach for patient care, but the compliance to ERAS in patients undergoing surgery for gastric cancer in Western countries has not been clearly investigated. Our Institution has implemented an ERAS pathway (EP) for gastric surgery, composed of 24 items, since December 2016. We retrospectively analyzed the data of all consecutive patients undergoing surgery with curative intent for gastric cancer between January 2017 and December 2019 at our Institution, and were eligible for our EP. The primary endpoint was patients' compliance to the EP. Secondary endpoints were patients' adherence to each ERAS item and detection of variables associated with compliance failure. Seventy-three patients were included. Among these, 75.3% completed the EP, with a median number of items accomplished per patient of 21. Items with critical adherence were restrictive intraoperative fluid infusion (37%), avoidance of abdominal drain (14%), first clear liquid intake (67%), first solid food intake (48%). At univariate analysis age > 75 years, ASA > 2 and total gastrectomy were associated with failure to complete the EP. At multivariate analysis, ASA Score > 2 was the only preoperative factor associated with EP failure. Application of an ERAS program for malignant gastric surgery seems to be feasible with an acceptable completion rate in a tertiary referral Western centre. Preoperative factors, such as old age, advanced stage at diagnosis and neoadjuvant chemotherapy should not be considered as exclusion criteria for ERAS.

Інтраопераційне анестезіологічне забезпечення, післяопераційне знеболювання та післяопераційна профілактика нудоти і блювання в разі гострої кишкової непрохідності (клінічна лекція)

Основні зусилля анестезіолога під час знеболювання оперативного втручання з приводу гострої кишкової непрохідності повинні бути спрямованими на стабілізацію гемодинаміки пацієнта і компенсацію водно-електролітних розладів, які виникли в передопераційному періоді. Для цього слід широко використовувати сучасні засоби моніторингу гемодинаміки, температури, респіраторної механіки і функції газообміну. Ефективне моніторування вказаних функцій і раннє застосування при артеріальній гіпотензії помірних доз вазопресорів дозволяють стабілізувати гемодинаміку та обмежити обсяг інтраопераційної інфузії. Препарати для інфузії слід цілеспрямовано обирати з урахуванням виду електролітних порушень, а як базові розчини доцільно застосувати збалансовані кристалоїди. При виборі засобів, а також доз препаратів для знеболювання та анестезії перевагу слід надавати тим, що дозволяють якнайшвидше пробудити хворого після анестезії та сприяти його ранній активізації та реабілітації. Де це можливо, методи загальної анестезії слід доповнювати регіонарною анестезією та післяопераційною регіонарною аналгезією. Питання про уникнення інтраопераційної інтубації кишечника, а також раннє видалення назоєюнального та/чи назогастрального зондів у післяопераційному періоді повинно вирішуватися разом із хірургами, що часто дозволяє зменшити відчуття нудоти та пришвидшувати післяопераційну реабілітацію хворих. Для ефективного післяопераційного контролю нудоти та блювання в разі гострої кишкової непрохідності часто необхідно застосовувати комбінацію препаратів, що знижують гастроінтестинальну секрецію, з препаратами, які пригнічують регуляцію блювотного рефлексу в центральній нервовій системі, а також із прокінетиками, що покращують евакуацію шлункового вмісту.

Comparing effects of intraoperative fluid and vasopressor infusion on intestinal microcirculation

Several studies have revealed that vasopressor may be more appropriate for treating intraoperative hypotension and preventing hypervolemia. This study compared the effects of vasopressor infusion and fluid supplementation on intestinal microcirculation during treating intraoperative hypotension. Thirty-two rats were randomly divided into the following four groups: Light Anesthesia group (LA, 0.8–1% isoflurane); Deep Anesthesia group (DA, 1.5–1.8% isoflurane); Fluid DA group (1.5–1.8% isoflurane and fluid supplementation); and Norepinephrine DA group (1.5–1.8% isoflurane and norepinephrine infusion). At 240 min, perfused small vessel density (PSVD) of the mucosa did not differ significantly between the Fluid DA and Norepinephrine DA groups [26.2 (3.2) vs 28.9 (2.5) mm/mm2, P = 0.077], and tissue oxygen saturation of the mucosa was lower in the Fluid DA groups than in the Norepinephrine DA groups [ 48 (7) vs 57 (6) %, P = 0.02]. At 240 min, TSVD and PSVD of the seromuscular layer were higher in the Norepinephrine DA group than in the Fluid DA group. Fluid administration was higher in the Fluid DA group than in the Norepinephrine DA group [66 (25) vs. 9 (5) μL/g, P = 0.001]. Our results showed that norepinephrine can resuscitate intraoperative hypotension related microcirculatory alteration and avoid fluid overload.