Intraoperative Infusion Research Articles

Association Between Intraoperative Noradrenaline Infusion and Outcomes in Older Adult Patients Undergoing Major Non-Cardiac Surgeries: A Retrospective Propensity Score-Matched Cohort Study.

Noradrenaline (NA) is commonly used intraoperatively to prevent fluid overload and maintain hemodynamic stability. Clinical studies provided inconsistent results concerning the effect of NA on postoperative outcomes. As aging is accompanied with various diseases and has the high possibility of the risk for postoperative complications, we hypothesized that intraoperative NA infusion in older adult patients undergoing major non-cardiac surgeries might potentially exert adverse outcomes. In this retrospective propensity score-matched cohort study, older adult patients undergoing major non-cardiac surgeries were selected, 1837 receiving NA infusion during surgery, and 1072 not receiving NA. The propensity score matching was conducted with a 1:1 ratio and 1072 patients were included in each group. The primary outcomes were postoperative in-hospital mortality and complications. Intraoperative NA administration reduced postoperative urinary tract infection (OR:0.124, 95% CI:0.016-0.995), and had no effect on other postoperative complications and mortality, it reduced intraoperative crystalloid infusion (OR:0.999, 95% CI:0.999-0.999), blood loss (OR: 0.998, 95% CI: 0.998-0.999), transfusion (OR:0.327, 95% CI: 0.218-0.490), but increased intraoperative lactate production (OR:1.354, 95% CI:1.051-1.744), and hospital stay (OR:1.019, 95% CI:1.008-1.029). Intraoperative noradrenaline administration reduces postoperative urinary tract infection, and does not increase other postoperative complications and mortality, and can be safely used in older adult patients undergoing major non-cardiac surgeries.

Impact of intraoperative fluid management on postoperative complications in patients undergoing minimally invasive esophagectomy for esophageal cancer: a retrospective single-center study

BackgroundEsophagectomy is a high-risk procedure that can involve serious postoperative complications. There has been an increase in the number of minimally invasive esophagectomies (MIEs) being performed. However, the relationship between intraoperative management and postoperative complications in MIE remains unclear.MethodsAfter the institutional review board approval, we enrolled 300 patients who underwent MIE at Tohoku University Hospital between April 2016 and March 2021. The relationships among patient characteristics, intraoperative and perioperative factors, and postoperative complications were retrospectively analyzed. The primary outcome was the relationship between intraoperative fluid volume and anastomotic leakage, and the secondary outcomes included the associations between other perioperative factors and postoperative complications.ResultsAmong 300 patients, 28 were excluded because of missing data; accordingly, 272 patients were included in the final analysis. The median [interquartile range] operative duration was 599 [545–682] minutes; total intraoperative infusion volume was 3,747 [3,038–4,399] mL; total infusion volume per body weight per hour was 5.48 [4.42–6.73] mL/kg/h; and fluid balance was + 2,648 [2,015–3,263] mL. The postoperative complications included anastomotic leakage in 68 (25%) patients, recurrent nerve palsy in 91 (33%) patients, pneumonia in 62 (23%) patients, cardiac arrhythmia in 13 (5%) patients, acute kidney injury in 5 (2%) patients, and heart failure in 5 (2%) patients. The Cochrane-Armitage trend test indicated significantly increased anastomotic leakage among patients with a relatively high total infusion volume (P = 0.0085). Moreover, anastomotic leakage was associated with male sex but not with peak serum lactate levels. Patients with a longer anesthesia duration or recurrent nerve palsy had a significantly higher incidence of postoperative pneumonia than those without. Further, the incidence of postoperative pneumonia was not associated with the operative duration, total infusion volume, or fluid balance. The operative duration and blood loss were related to the total infusion volume. Acute kidney injury was not associated with the total infusion volume or serum lactate levels.ConclusionsAmong patients who underwent MIE, the total infusion volume was positively correlated with the incidence of anastomotic leakage. Further, postoperative pneumonia was associated with recurrent nerve palsy but not total infusion volume or fluid balance.

Intraoperative low-dose ketamine infusion for postoperative pain relief in laparoscopic surgeries – A randomised, double blind controlled clinical trial

Abstract Background: Patients undergoing laparoscopic surgery often experience moderate-to-severe postoperative pain. The use of opioids for postoperative pain relief often results in respiratory depression and other adverse effects. Hence, we studied the effect of ketamine infusion administered at a low dose intraoperatively on postoperative pain relief. Materials and Methods: Fifty-two patients belonging to American Society of Anesthesia (ASA) I/ASA II, scheduled for laparoscopic surgery were randomized into two groups (n = 26). Group A received 0.2 mg/kg bolus of ketamine before the skin incision followed by an infusion of 0.1 mg/kg/h throughout the period of surgery. Group B received an equal volume of saline bolus and infusion. Postoperative pain was assessed (Numerical Rating Scale [NRS] scale) every 30 min till 6 h. The time taken for first rescue analgesia, the total amount of opioid used, and degree of sedation postoperatively were also compared. Pain scores between the groups were compared using the Chi-square test. Results: Pain scores (NRS scores) over various time intervals postoperatively were significantly reduced in the ketamine group (P < 0.001). The overall cumulative opioid consumption was significantly lower in the ketamine group compared to the placebo (69.29 ± 23.35 mg vs. 107.88 ± 35.21 mg, respectively, P = 0.008). There was also a significant difference in time to first rescue analgesia between the ketamine and placebo groups (2.60 ± 1.87 h vs. 0.43 ± 0.85 h, respectively, P = 0.001). Conclusion: Intraoperative low-dose ketamine infusion as an adjuvant significantly decreased postoperative pain with a reduced total dose of opioid consumption and a delayed time to first rescue analgesic.

Efficacy of intensive therapy for massive intraoperative blood loss in children: experience of the Morozov Hospital

To evaluate the effectiveness of intensive therapy for massive intraoperative blood loss in children. A retrospective analysis of primary medical records of 39 children with massive intraoperative blood loss was performed. Patients were divided into two groups (younger 1 year (n=18) and older 1 year (n=21)). Each group was divided into two subgroups (blood loss <10% and >100% of total blood volume). We analyzed total intraoperative infusion, qualitative composition of transfusions, reinfusion of washed autologous erythrocytes and vasopressor support. In postoperative period, we assessed hemoglobin, platelets, albumin, fibrinogen, lactate, prothrombin index, duration of mechanical ventilation, severity of organ dysfunction (pSOFA score) after 1 and 3 days, ICU stay and incidence of repeated blood transfusions. With regard to transfusion volume, we found a general pattern (3 parts of crystalloids, 2 parts of erythrocyte-containing components and 1 part of fresh frozen plasma in all groups with the exception of children older 1 year with blood loss >100% of total blood volume. The last ones had ratio 3:5:1 due to large volume of reinfusion of washed autologous erythrocytes. In all groups, target levels of hemoglobin, platelets, albumin and prothrombin index were achieved. Serum fibrinogen was slightly lower in the group with blood loss >100% of total blood volume. There was a direct relationship between blood loss and ICU stay (Spearman's test rs=0.421, p<0.05), as well as duration of mechanical ventilation (Spearman's test rs=0.509, p<0.05). Mean pSOFA score upon admission to intensive care unit was 3-4 points in both groups with blood loss <100% of total blood volume. In patients with blood loss >100% of total blood volume, this indicator averaged 9 points and regressed to 3-4 points over the next 72 hours. Intraoperative intensive therapy contribute to minimal severity of postoperative organ dysfunction in children with blood loss < 100% of total blood volume and rapid regression of multiple organ failure in patients with blood loss exceeding this indicator.

Effect of Intravenous Aminophylline on Hemodynamics and Recovery of Patients Undergoing Functional Endoscopic Sinus Surgery Under Dexmedetomidine Hypotensive Anesthesia: A Randomized Controlled Study.

The sympatholytic property of dexmedetomidine (DEX) makes it suitable as a hypotensive drug during functional endoscopic sinus surgery (FESS); however, delayed emergence from anesthesia and high postoperative sedation have been reported. Delayed emergence from anesthesia and high postoperative sedation are associated with a prolonged length of stay in the operating room and the postanesthesia care unit (PACU), which increases health care costs. This study aimed to overcome the negative impact of DEX on recovery by using aminophylline. This randomized, double-blind, placebo-controlled study was conducted on 52 patients planned for elective FESS under general anesthesia with DEX infusion for controlled hypotension during surgery. Patients were equally divided into 2 groups. The aminophylline group received 4 mg/kg aminophylline diluted in 50 mL saline 0.9% over 30 minutes after positioning in a 20-degree reverse Trendelenburg position. The control group received 50 mL saline 0.9% with a similar volume and period as the aminophylline group. The extubation time was significantly shorter in the aminophylline group (6.5 (5.25 - 7.75) minutes) than in the control group (9 (7.25 - 10) minutes) (P-value < 0.001). The PACU discharge time was significantly shorter in the aminophylline group (15 (10 - 20) minutes) compared to the control group (20 (15 - 28.75) minutes) (P-value = 0.036). Intraoperative heart rate and mean arterial pressure were nonsignificantly different between the 2 groups. Ramsay sedation score measurements at 15 min, 30 min, and 60 min after extubation were significantly lower in the aminophylline than in the control group (P-value < 0.05). Complications were nonsignificantly different between the 2 groups. Intraoperative aminophylline infusion enhances the recovery of patients undergoing FESS under DEX hypotensive anesthesia without intraoperative hemodynamic alterations and decreases their postoperative sedation without significant postoperative side effects.

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.

Effectiveness of saline solutions in surgical interventions in newborns

BACKGROUND: In recent years, neonatal surgery has been developing and improving, among other things, because of a deeper study of anesthesiological approaches and the introduction of acquired knowledge into the daily practice of an anesthesiologist-resuscitator. One of the basic factors that influence treatment outcomes in the future is a thorough study of infusion therapy methods in newborns, considering the anatomical and physiological characteristics of the neonatal period.&#x0D; AIM: This study aimed to examine the electrolyte balance, acid–base state, and hemodynamic parameters in newborns, depending on the choice of basic infusion medium during surgery.&#x0D; MATERIALS AND METHODS: A prospective study was conducted in 99 newborns. All children were given an infusion of saline solutions of 10 mL/kg/h during surgery. Groups I, II, and III were administered intraoperatively with isotonic Sterofundin, saline solution, and Ringer’s solution, respectively. A hypotonic sodium chloride solution of 0.45% was administered to 11 children. The indicators of the acid–base state and electrolyte composition of the venous blood, hemodynamic parameters, and need for perioperative inotropic support were evaluated.&#x0D; RESULTS: A tendency to hyponatremia was detected in children who were infused with 0.45% sodium chloride hypotonic solution, which resulted in the abandonment of further recruitment of children in the group and the implementation of this study option. After surgery, the pH-compensated state was maintained in all three groups. Moreover, metabolic disorders in the form of a decrease in bicarbonates and ВE were recorded in all groups. Electrolyte disturbances were detected in all groups, whereas electrolyte balance was most often registered in group I. In groups II and III, common ionogram findings included a decrease in potassium and an increase in sodium, chlorine, and calcium levels. In the analysis of the hemodynamic parameters, no significant statistical difference was recorded during surgery when comparing the groups infused with different saline media.&#x0D; CONCLUSIONS: In this study, no significant differences were found in the indicators of acid–base state and hemodynamic parameters when using different saline solutions as basic intraoperative infusion therapy in newborns. Regarding the electrolyte balance, the most common complications were hypokalemia, hypernatremia, and hyperchloremia in the 0% saline group.

Efficacy of intravenous magnesium sulfate infusion on postoperative pain and quality of recovery for septorhinoplasty: a randomized controlled study

Background The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient. Objectives To investigate the effect of perioperative intravenous magnesium sulfate infusion on postoperative pain and quality of recovery in patients underwent septorhinoplasty surgery. Material and methods One hundred twenty patients who underwent septorhinoplasty were randomly divided into two groups. Magnesium group received intravenous magnesium after induction of anesthesia (30 mg/kg), then infused until the end of the surgical procedure (9 mg/kg). The placebo group received the same volume of saline infusion. The VAS score was used for postoperative pain assessment, and the Quality of Recovery-40 (QoR-40) score was used for the assessment of recovery status. Results The postoperative 30 min, 1st, 2nd, 4th (p < .001) and 24th hour (p < .05) VAS scores of the patients in the magnesium infusion group were significantly lower compared to the placebo group. Also; in terms of physical comfort (p < .001), emotional state (p < .05), psychological support, pain and total score values (p < .001), patients in magnesium group had significantly higher QoR-40 scores than those in placebo group. Conclusion Intraoperative magnesium infusion, which is widely used in many surgeries to provide controlled hypotension, also contributes significantly to patient comfort with its positive effect on postoperative pain and recovery scores.

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.

The minimum effective dose (ED90) of prophylactic oxytocin infusion during cesarean delivery in patients with and without obesity: an up-down sequential allocation dose-response study

BackgroundObesity is associated with greater oxytocin requirement during labor induction or augmentation. There are scant data exploring the intra-operative requirement during cesarean delivery in patients with obesity, and none comparing it with those without obesity. We evaluated the minimum effective dose (ED90) of an oxytocin infusion to achieve adequate uterine tone during cesarean delivery in patients with and without obesity. MethodsPatients (body mass index ≥30 kg/m2 represented patients with obesity) undergoing cesarean delivery using subarachnoid block were included. This prospective dual-arm dose-finding study used a 9:1 biased sequential allocation design. Oxytocin infusion was initiated at 13 IU/h at cord clamping in the first patient of each group. Uterine tone was graded as satisfactory or unsatisfactory by the obstetrician four minutes after initiation of the infusion. The dose of oxytocin infusion for subsequent patients was determined according to the response of the previous patient in the group. Oxytocin-associated side effects were evaluated. Dose-response data for the groups was evaluated using log-logistic function and ED90 estimates derived from fitted equations using the delta method. ResultsThe ED90 of oxytocin was significantly higher for patients with obesity (n = 40) compared with those without obesity (n = 40) [25.7 IU/h, 95% CI 18.6 to 32.9) vs. 16.6 IU/h, 95% CI 14.9 to 18.3)]; relative ratio 1.55 [95% CI 1.09 to 2.01] (P = 0.019). ConclusionsPatients with obesity require a higher intra-operative oxytocin infusion dose rate to achieve a satisfactorily contracted uterus after fetal delivery when compared with patients without obesity.

Efficacy of Low Dose Intravenous Epinephrine Infusion in Improving Perioperative Outcomes in Patients Undergoing Transurethral Resection of Prostate: A Prospective Parallel Arm Double-Blind Randomized Control Trial

ObjectiveTo determine the efficacy of intraoperative low-dose intravenous epinephrine infusion in improving intraoperative bleeding and perioperative outcomes of TURP surgery. MethodsThis was a double-blinded, randomized control trial in which all patients undergoing bipolar TURP were included. Patients with uncontrolled hypertension, cardiac disease, and on anticoagulants were excluded. The study group received intravenous epinephrine, whereas the control group received normal saline at the same rate (0.05 μg/kg/min) throughout the procedure. Intraoperative blood loss was the primary outcome. The secondary outcomes were incidence of intraoperative hypotension (due to spinal anesthesia (SA)), resection time, indwelling catheter time, and length of hospitalization (LOH). ResultsThirty-six patients were included in each group. Demographic and clinical profiles were comparable with an overall median prostate size of 41 (34-52) gram in both groups. The primary objective, mean intraoperative blood loss in the study group was lower than the control group but statistically insignificant (67.91+/-18.7 ml vs 75.14+/-17.1 ml; p=0.086). Incidence of intraoperative hypotension was significantly lower in the study group (8.3% vs 33.3%; p= 0.01). Rest of the secondary outcomes, resection time (83 (64-111.5) min vs 86 (68-94.75) min; p=0.97), mean indwelling catheter time (p=0.94), postoperative complications (p=0.73), and LOH (p=0.87) were comparable. ConclusionsIn this first-of-its-kind trial, low-dose epinephrine infusion did not reduce intraoperative blood loss in patients undergoing TURP. However, it significantly reduced intraoperative hypotension, which complicates SA particularly in elderly population.

Effects of dexmedetomidine dosage on the short-term cognitive function of elderly patients undergoing cardiac surgery

BackgroundThis study aimed to investigate the effects of perioperative dexmedetomidine (DEX) infusion rates on the postoperative short-term cognitive function.MethodsA total of 88 patients aged ≥ 60 years who underwent cardiac surgery from January 2022 to November 2022 at the First Affiliated Hospital of The University of Science and Technology of China (USTC) were included. Based on a single-center pilot analysis, patients were divided into two groups according to the rate of intraoperative DEX infusion, which started after tracheal intubation and continued until 1 h before extubation in the cardiac surgery intensive care unit. In Group L (n = 44), the infusion rate was 0.1–0.5 µg/kg/h (low-dose group), whereas in Group H (n = 44), the infusion rate was 0.5–0.9 µg/kg/h (high-dose group). Clinical outcomes were then compared between the groups. The Mini–Mental State Evaluation (abbreviated as MMSE1, MMSE2, MMSE3, and MMSE4) scale was used for the assessment of cognitive function, which was conducted on postoperative Days 2 (T1), 7 (T2), 14 (T3), and 28 (T4), with the score from postoperative Day 2 (MMSE1) considered as the primary observation.ResultsPatients in Group L had higher MMSE1 scores compared to those in Group H (26.0 [24.0, 27.0] vs. 24.5 [22.0, 26.0], p = 0.046), and there was no significant difference in the scores between the groups at all subsequent time points. Group H exhibited a higher incidence of hypotension and bradycardia compared to Group L (p = 0.044 and p = 0.047, respectively).ConclusionsCompared to a high dose (0.5–0.9 µg/kg/h) of DEX infusion, a low-dose (0.1–0.5 µg/kg/h) infusion started after induction of anesthesia and continued until 1 h before extubation improved postoperative cognitive function scores on postoperative Day 2 in patients aged 60 years and older.Trial registrationURL: www.chictr.org.cn with registration number ChiCTR2100055093, registered on 31/12/2021.

Effect of anesthesia induction with butorphanol on postoperative nausea and vomiting: A randomized controlled trial

BACKGROUND Postoperative nausea and vomiting (PONV) are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery. AIM To investigate the effect of butorphanol on PONV in this patient population. METHODS A total of 110 elderly patients (≥ 65 years old) who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol (40 μg/kg) or sufentanil (0.3 μg/kg) during anesthesia induction in a 1:1 ratio. The measured outcomes included the incidence of PONV at 48 h after surgery, intraoperative dose of propofol and remifentanil, Bruggrmann Comfort Scale score in the postanesthesia care unit (PACU), number of compressions for postoperative patient-controlled intravenous analgesia (PCIA), and time to first flatulence after surgery. RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group, when compared to the sufentanil group (T1: 23.64% vs 5.45%, T2: 43.64% vs 20.00%, P &lt; 0.05). However, no significant variations were observed between the two groups, in terms of the clinical characteristics, such as the PONV or motion sickness history, intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters, intraoperative dose of propofol and remifentanil, number of postoperative PCIA compressions, time until the first occurrence of postoperative flatulence, and incidence of PONV at 48 h post-surgery (all, P &gt; 0.05). Furthermore, patients in the butorphanol group were more comfortable, when compared to patients in the sufentanil group in the PACU. CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly, simultaneously improving patient comfort in the PACU.

Nadir Hemoglobin Concentration After Spinal Tumor Surgery: Association With Risk of Composite Adverse Events.

Retrospective case-control study. To explore the association of early postoperative nadir hemoglobin with risk of a composite outcome of anemia-related and other adverse events. We retrospectively analyzed data from spinal tumor patients who received intraoperative blood transfusion between September 1, 2013 and December 31, 2020. Uni- and multivariate logistic regression was used to explore relationships of clinicodemographic and surgical factors with risk of composite in-hospital adverse events, including death. Subgroup analysis explored the relationship between early postoperative nadir hemoglobin and composite adverse events. Among the 345 patients, 331 (95.9%) experienced early postoperative anemia and 69 (20%) experienced postoperative composite adverse events. Multivariate logistic regression analysis showed that postoperative nadir Hb (OR = .818, 95% CI: .672-.995, P = .044), ASA ≥3 (OR = 2.007, 95% CI: 1.086-3.707, P = .026), intraoperative RBC infusion volume (OR = 1.133, 95% CI: 1.009-1.272, P = .035), abnormal hypertension (OR = 2.199, 95% CI: 1.085-4.457, P = .029) were correlated with composite adverse events. The lumbar spinal tumor was associated with composite adverse events with a decreased odds compared to thoracic spinal tumors (OR = .444, 95% CI: .226-.876, P = .019). Compared to patients with postoperative nadir hemoglobin ≥11.0g/dL, those with nadir <9.0g/dL were at significantly higher risk of postoperative composite adverse events (OR = 2.709, 95% CI: 1.087-6.754, P = .032). Nadir hemoglobin <9.0g/dL after spinal tumor surgery is associated with greater risk of postoperative composite adverse events in patients who receive intraoperative blood transfusion.

Intraoperative intravenous infusion of lidocaine increases total and small vessel densities of sublingual microcirculation: a randomized prospective pilot study

Objective Multiple organ failure can occur as a result of postoperative complications. Research has indicated that the underlying mechanism of organ dysfunction is a microcirculation disorder. Because of its antioxidant and anti-inflammatory properties, lidocaine has the potential to improve microvascular blood flow. This study was performed to assess the effect of intraoperative intravenous lidocaine infusion on the microcirculation and determine the incidence of postoperative complications. Methods In this prospective randomized double-blind pilot study, 12 patients scheduled for abdominal surgery were randomly allocated to receive an intraoperative infusion of either 1% lidocaine or the same volume of 0.9% sodium chloride solution. The microcirculation was monitored using sidestream dark-field imaging and the vascular occlusion test combined with near-infrared spectroscopy. Results Lidocaine significantly increased the total vascular density and small vessel density after 2 hours of infusion, with preservation of 99% to 100% of the capillary perfusion in both groups. No patients developed organ failure. Conclusions An increase in vessel density may be beneficial in major abdominal surgeries because it is associated with better tissue perfusion and oxygen delivery. However, this finding requires further investigation in patients with increased surgical risk. Overall, this study indicates that lidocaine has potential to improve microvascular perfusion. Research Registry number: 9549 ( https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650ffd27b3f547002bd7635f/ )

Efficacy of intraoperative subanaesthetic dose of ketamine on post-operative analgesia for patients undergoing single level lumbar discectomy under general anesthesia: A placebo control randomized clinical study

Background: Sub-anesthetic ketamine is becoming increasingly popular for opioid sparing analgesic properties. Aims and Objectives: This study was done to determine the efficacy of intraoperative infusion of sub-anesthetic dose of ketamine on post-operative analgesia in single level lumbar discectomy surgeries. Materials and Methods: A prospective, randomized, and control study was carried on 60 patients of American Society of Anesthesiologists I and II aged between 18 and 65 years undergoing single level lumbar discectomy under general anesthesia. After induction of anesthesia, Group A received Ketamine 0.3 mg/kg intravenous (IV) bolus followed by infusion at 4 μg/kg/min and Group B received 0.9% saline bolus dose of similar volume and infusion was started at similar rate. Post-operative pain relief, opioid sparing effect, and side effects if any were recorded. Results: There was significant difference (P&lt;0.001) in post-operative Numeric Rating scores for initial 6 h in Group A patients compared to Group B and prolonged duration of analgesia (8.5 vs. 4.25 h) along with reduced postoperative tramadol consumption. Conclusion: In lumbar spine discectomy, intraoperative ketamine infusion at sub-anesthetic doses produces more effective post-operative analgesia along with opioid sparing effect without any side effects.

Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study

ObjectivePostoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs...

Effect of magnesium sulphate on propofol requirement in abdominal surgeries under general anesthesia

Background &amp; Objective: Magnesium sulphate (MgSO4) has the potential to be used as a part of balanced anesthesia due to its inherent pharmacological actions. Its judicial use can enhance patient safety. We evaluated the effect of MgSO4 on the total dose of propofol used under bispectral index (BIS) targeted general anesthesia for abdominal surgeries.&#x0D; Methodology: This prospective randomized controlled trial was conducted on 60 adult patients of either sex, scheduled for elective surgery under general anesthesia. Patients were allocated to two study groups of 30 patients each. In Group I, MgSO4 was administered as 30 mg/kg intravenously (IV) in 100 ml normal saline (NS) over 15 min followed by 10 mg/kg/h infusion intraoperatively. In Group II 100 ml NS was administered over 15 min followed by NS infusion intraoperatively. Anesthesia was induced with propofol, fentanyl, and atracurium in both groups. Intraoperative propofol infusion was started to keep BIS values within 45-55. Data was compared for total dose of propofol used, Ramsay sedation score, recovery characteristics and hemodynamic parameters. Data so collected was statistically analyzed.&#x0D; Results: The mean quantity of propofol required for induction was less in Group I as compared to Group II, being 1.70 ± 0.19 mg/kg and 2.39 ± 0.58 mg/kg respectively (P &lt; 0.001). Group I achieved BIS 60 (59.20 ± 7.63 seconds) faster than Group II (78.36 ± 13.03 sec) (P &lt; 0.001). The requirement of propofol for maintenance was less in Group I (4.48 ± 0.95 mg/kg/h) as compared to Group II (6.63 ± 1.65 mg/kg/h) (P &lt; 0.001). During recovery, the MgSO4 group needed more time to reach BIS 70 as compared to control group with their mean values being 8.86 ± 1.48 min and 6.88 ± 1.54 min respectively. Response to verbal commands and orientation was also significantly delayed in MgSO4 group as compared to control group (P &lt; 0.001).&#x0D; Conclusion: Magnesium sulphate co-administration with propofol decreases the dosage of propofol to maintain a constant BIS value at 45–55. Sedation and delayed recovery are the notable drawbacks of using magnesium sulphate.&#x0D; Abbreviations: NMDA - N-methyl-D-aspartate; BIS - Bi‑spectral index; HR - Heart rate; MAP - mean arterial pressure&#x0D; Preregistration: Clinical Trial Registry-India (CTRI/2020/11/029315)&#x0D; Key words: Magnesium Sulphate; Propofol; BIS Target; Balanced Anesthesia&#x0D; Citation: Kaur H, Singh A, Prasad V, Singh A, Gupta KK, Sharma P. Effect of magnesium sulphate on propofol requirement in abdominal surgeries under general anesthesia. Anaesth. pain intensive care 2023;27(5):471−477. DOI: 10.35975/apic.v27i5.2118&#x0D; Received: January 14, 2023; Reviewed: July 17, 2023; Accepted: July 20, 2023

Effects of intraoperative Magnesium sulfate infusion on emergency agitation during general anesthesia in patients undergoing radical mastectomy: a randomized controlled study

BackgroundEmergency agitation is a common postoperative complication in patients under general anesthesia, which can lead to unpredictable damages such as shedding of drainage tube and bleeding from the wound. The purpose of the study is to investigate whether intraoperative infusion of Magnesium Sulfate reduces the incidence of emergency agitation (EA) in patients undergoing radical mastectomy, and to evaluate its safety and efficacy.MethodsA total of 70 patients were randomly assigned to two groups: the Magnesium group (M group) and the control group (C group). After a routine intravenous anesthetic induction, patients in the M group received a 30 mg/kg bolus of intravenous magnesium during the first hour and then a continuous infusion of 10 mg/kg ×h until the end of the surgery, patients in the C group received 0.9% saline at the same volume and rate. The sedation-agitation scale (SAS) and the visual analogue scale were used to assess agitation and pain, respectively.ResultsCompared to the C group, the M group reduced the incidence of EA significantly (odds ratio 0.26, 95% confidence interval 0.09–0.71, P = 0.009). The postoperative pain score of the magnesium sulfate group(0(0,1)) was lower than that of the control group(2(0,3)) at T0 (P = 0.011). Additionally, the M group required a lower dosage of remifentanil during surgery compared to the C group(300.4 ± 84 versus 559.3 ± 184 µg, respectively, P<0.001).Conclusionsthe intraoperative infusion of magnesium sulfate is a safe and effective method for reducing the incidence of emergency agitation in patients undergoing radical mastectomy.Trail registrationThe study was registered in Chictr.org with the identifier: ChiCTR2300070595 on 18/04/2023.

Intraoperative Insulin Infusion Regimen versus Insulin Bolus Regimen for Glucose Management during CABG Surgery: A Randomized Clinical Trial

Background and Aim: The stress induced by surgery disrupts the delicate balance between hepatic glucose production and glucose utilization in the body. Despite the significance of intraoperative glycaemic control for diabetic patients, limited attention has been given to this aspect. Two methods for administering insulin to manage glucose levels during surgery exist. This study aimed to compare intraoperative glucose levels in diabetic patients undergoing Coronary Artery Bypass Graft (CABG) surgery using either insulin infusion or the bolus method. Method: This was a Randomized Clinical Trial (RCT). Seventy diabetic patients aged 40 or older scheduled for CABG surgery were enrolled in the trial. They were randomly assigned, using block randomization, to receive intraoperative insulin via either infusion or the bolus method. The primary outcome measure was intraoperative glucose levels. Subsequent insulin unit requirements and intraoperative potassium levels were secondary outcomes. Data was monitored throughout the CABG procedure and recorded at six different checkpoints. Results: Male patients constituted the majority in both groups, with no significant differences in the preoperative characteristics of patients, including HbA1c levels and comorbidities. The infusion regimen demonstrated a statistically significant reduction in glucose levels (-19.12 mg/dL, 95% CI: -27.68 to -10.55, P&lt;0.001, Cohen's d=1.06) compared to the bolus regimen. The total insulin units administered in the infusion group were 480 units, as opposed to 600 units in the bolus group (P=0.001, Cohen's d=0.85). Importantly, no cases of hypoglycemia or hyperkalemia were reported among the patients. Conclusion: Intraoperative glucose control using insulin was effective for CABG patients with diabetes. However, the infusion regimen exhibited statistically superior results compared to the bolus regimen. Clinical Trials Registry and Registration Number: The trial received approval from the Ethics Committee on 2/1/2019/2020 and was registered on Clinicaltrials.gov under ID: NCT04824586.