Intraoperative Pressure Research Articles

Analysis of factors associated with postoperative acute kidney injury in patients with colorectal cancer and the development of a risk prediction model: a retrospective study.

To investigate the factors associated with acute kidney injury (AKI) in postoperative colorectal cancer (CRC) patients and develop a risk prediction model. The clinical data of 389 CRC patients were retrospectively analyzed. The patients were divided into AKI (n = 30) and non-AKI groups (n = 359) according to KDIGO diagnostic criteria. Demographic data, the presence of underlying diseases, perioperative conditions and related examination results were compared between the two groups. Binary logistic regression was used to analyze the independent risk factors for postoperative AKI, and a risk prediction model was established. And a verification group (94 patients) was used to verify the model. 30 patients (7.71%) with CRC had postoperative AKI. Binary logistic regression analysis showed that preoperative combined hypertension, preoperative anemia, inadequate intraoperative crystalloid infusion, low intraoperative minimum mean arterial pressure (MAP) and moderate to severe postoperative decline in hemoglobin (Hb) levels were independent risk factors. The risk prediction model developed was expressed as Logit P = -0.853 + 1.228 * preoperative combined hypertension + 1.275 *preoperative anemia -0.002 * intraoperative crystalloid infusion (ml) -0.091 * intraoperative minimum MAP (mmHg) + 1.482 * moderate to severe postoperative decline in Hb levels. In Hosmer-Lemeshow test, χ2 = 8.157, P = 0.718 showed that the fitting effect was good. The area under ROC curve was 0.776 (95% CI 0.682-0.871, P < 0.001), with a prediction threshold of 1.570, a sensitivity of 63.3% and a specificity of 88.9%. The sensitivity and specificity of the verification group were 65.8% and 86.1%. Preoperative combined hypertension, preoperative anemia, inadequate intraoperative crystalloid infusion, low intraoperative minimum MAP, and moderate to severe postoperative decline in Hb levels were independent risk factors for AKI development in CRC patients. The prediction model can effectively predict the occurrence of postoperative AKI in patients with CRC.

Status of transjugular intrahepatic portosystemic shunt for portal hypertension in China: A national survey analysis

AbstractAimThe transjugular intrahepatic portosystemic shunt (TIPS) procedure has been performed in China for 30 years, but our understanding of the status and difficulties associated with the use of TIPS for portal hypertension is incomplete. This study aims to investigate the current situation of the use of TIPS for portal hypertension, which should aid the development of TIPS in China.MethodsThis study involved a questionnaire survey, initiated by the China Portal Hypertension Alliance (CHESS) to investigate the use of TIPS for portal hypertension in China. Questionnaires were released on the Internet between August 16, 2022 and September 16, 2022. Detailed information was collected from 545 hospitals contracted by the CHESS in China, which performed TIPS surgery in 2021.ResultsThe 545 hospitals covers the majority of hospitals in China that conduct TIPS intervention. In the survey, a total of 13,527 TIPS interventions were carried out with 94.1% (498/545) of them had a system of routine follow‐up after TIPS. The majority (42.6% [232/545]) believed that the main indication of TIPS was the control of acute bleeding. Overall, 48.1% (262/545) carried out early or pre‐emptive TIPS, 53.0% (289/545) carried out TIPS for cavernous transformation of the portal vein, and 81.0% (441/545) chose routine embolization of collateral circulation during operation. Most used coils (97.0% [475/490]) and biological glue (72.0% [353/490]) as embolic materials, and 78.5% (428/545) routinely performed intraoperative portal pressure gradient measurements. When selecting TIPS stents, 57.1% (311/545) chose viator‐specific stents, and 57.2% (312/545) chose conventional anticoagulation after TIPS. Conventional anticoagulation after TIPS is over a time interval of 3–6 months (55.4% [173/312]). The limitation of TIPS surgery is mainly its cost (72.3% [394/545]) and insufficient understanding of the procedure by doctors in other related departments (77.4% [422/545]). Most of the hospital teams accept the use of domestic instruments in TIPS surgery (92.7% [505/545]).ConclusionsThis survey shows that TIPS is an essential part of the treatment of portal hypertension in China. TIPS is widely used in Chinese patients with portal hypertension, and this survey presents a more comprehensive picture of the options and difficulties encountered in the implementation of TIPS. In the future, it is necessary to promote TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Optimal positive end-expiratory pressure obtained with titration of a fraction of inspiratory oxygen: a randomized controlled clinical trial.

Optimal intraoperative positive end-expiratory pressure (PEEP) improves patient outcomes. Pulse oximetry has been used to determine the lung opening and closing pressures. Therefore, we hypothesized that intraoperative optimal PEEP obtained by titrating inspiratory oxygen fraction (FiO2) guided with pulse oximetry could improve perioperative oxygenation. Forty-six males undergoing elective robotic-assisted laparoscopic prostatectomy were randomly assigned to either the optimal PEEP group (group O; n=23) or the fixed PEEP of 5 cmH2O group (group C; n=23). Optimal PEEP, defined as the PEEP with the lowest FiO2 or 0.21 to maintain SpO2 greater than or equal to 95%, was obtained in both groups after placing the patients in the Trendelenburg position and conducting intraperitoneal insufflation. Optimal PEEP was maintained for patients in group O. A PEEP of 5 cmH2O intraoperatively was maintained for patients in group C. Both groups were extubated in a semisitting position once the extubation criteria were met. The primary outcome was the arterial oxygen partial pressure (PaO2) divided by the inspiratory oxygen fraction (FiO2) prior to extubation. The secondary outcome was the incidence of postoperative hypoxemia (SpO2 less than 92% on room air after extubation) in the postanesthesia care unit (PACU). The median optimal PEEP was 16 cmH2O (IQR 12-18). The PaO2/FiO2 prior to extubation was significantly higher in group O than in group C (77.0±4.9 kPa vs. 60.6±5.9 kPa; P=0.04). PaO2/FiO2 was also significantly higher in group O 30 minutes after extubation (57.6±1.9 vs. 46.6±1.8 kPa; P=0.01). The incidence of hypoxemia on room air in the PACU was significantly lower in group O than in group C (4.3% vs. 30.4%; P=0.02). Intraoperative optimal PEEP can be achieved by a titration of FiO2 guided with SpO2. Maintaining intraoperative optimal PEEP improves intraoperative oxygenation and reduces the incidence of postoperative hypoxemia. The study was prospectively registered on September 10, 2021, in the Chinese Clinical Trial Registry (identifier: ChiCTR2100051010).

Risk Factors and Prediction of Postoperative Delirium in Aortic Arch Replacement: A Retrospective Cohort Study

ABSTRACT Objective: This study aimed to explore the risk factors and prediction of postoperative delirium (POD) in aortic arch replacement. Methods: The preoperative, intraoperative, and postoperative clinical data of patients undergoing aortic arch replacement in our hospital from January 1, 2018, to March 31, 2019, were retrospectively analyzed. According to whether POD occurred, cases were divided into delirium group and control group. The clinical data of the patients were firstly screened by univariate analysis, and then the meaningful variables were analyzed by multivariate logistic regression analysis. The receiver operating characteristic curve was used to analyze the meaningful factors in predicting the occurrence of POD after aortic arch replacement. Results: A total of 162 patients were included in the study. The prevalence of POD was 46.9% (n = 76). The results of univariate and multivariate analyses showed that the intraoperative minimum mean arterial pressure (MAP) (odds ratio [OR] = 0.635, 95% confidence interval [CI] = 0.5510.731, P &lt; 0.001), postoperative C-reactive protein (OR = 1.010, 95% CI = 1.0031.018, P = 0.005), and postoperative infection (OR = 3.148, 95% CI = 1.1188.867, P = 0.030) were the independent risk factors for POD in aortic arch replacement. Among them, the intraoperative minimum MAP has the best prediction effect. When its cutoff value reaches ≤ 49 mmHg, the specificity for predicting POD is 84.88% and the sensitivity is 81.58%. Conclusions: A lower intraoperative minimum MAP is an independent risk factor and has the predictive value for POD in aortic arch replacement.

Non-invasive estimation of the parameters of a three-element windkessel model of aortic arch arteries in patients undergoing thoracic endovascular aortic repair.

Background: Image-based computational hemodynamic modeling and simulations are important for personalized diagnosis and treatment of cardiovascular diseases. However, the required patient-specific boundary conditions are often not available and need to be estimated. Methods: We propose a pipeline for estimating the parameters of the popular three-element Windkessel (WK3) models (a proximal resistor in series with a parallel combination of a distal resistor and a capacitor) of the aortic arch arteries in patients receiving thoracic endovascular aortic repair of aneurysms. Pre-operative and post-operative 1-week duplex ultrasound scans were performed to obtain blood flow rates, and intra-operative pressure measurements were also performed invasively using a pressure transducer pre- and post-stent graft deployment in arch arteries. The patient-specific WK3 model parameters were derived from the flow rate and pressure waveforms using an optimization algorithm reducing the error between simulated and measured pressure data. The resistors were normalized by total resistance, and the capacitor was normalized by total resistance and heart rate. The normalized WK3 parameters can be combined with readily available vessel diameter, brachial blood pressure, and heart rate data to estimate WK3 parameters of other patients non-invasively. Results: Ten patients were studied. The medians (interquartile range) of the normalized proximal resistor, distal resistor, and capacitor parameters are 0.10 (0.07-0.15), 0.90 (0.84-0.93), and 0.46 (0.33-0.58), respectively, for common carotid artery; 0.03 (0.02-0.04), 0.97 (0.96-0.98), and 1.91 (1.63-2.26) for subclavian artery; 0.18 (0.08-0.41), 0.82 (0.59-0.92), and 0.47 (0.32-0.85) for vertebral artery. The estimated pressure showed fairly high tolerance to patient-specific inlet flow rate waveforms using the WK3 parameters estimated from the medians of the normalized parameters. Conclusion: When patient-specific outflow boundary conditions are not available, our proposed pipeline can be used to estimate the WK3 parameters of arch arteries.

Intraoperative mean arterial pressure and acute kidney injury after robot-assisted laparoscopic prostatectomy: a retrospective study

Intraoperative hemodynamics can affect postoperative kidney function. We aimed to investigate the effect of intraoperative mean arterial pressure (MAP) as well as other risk factors on the occurrence of acute kidney injury (AKI) after robot-assisted laparoscopic prostatectomy (RALP). We retrospectively evaluated the medical records of 750 patients who underwent RALP. The average real variability (ARV)-MAP, standard deviation (SD)-MAP, time-weighted average (TWA)-MAP, area under threshold (AUT)-65 mmHg, and area above threshold (AAT)-120 mmHg were calculated using MAPs collected within a 10-s interval. Eighteen (2.4%) patients developed postoperative AKI. There were some univariable associations between TWA-MAP, AUT-65 mmHg, and AKI occurrence; however, multivariable analysis found no association. Alternatively, American Society of Anesthesiologists physical status ≥ III and the low intraoperative urine output were independently associated with AKI occurrence. Moreover, none of the five MAP parameters could predict postoperative AKI, with the area under the receiver operating characteristic curve values for ARV-MAP, SD-MAP, TWA-MAP, AUT-65 mmHg, and AAT-120 mmHg being 0.561 (95% confidence interval [CI], 0.424–0.697), 0.561 (95% CI, 0.417–0.704), 0.584 (95% CI, 0.458–0.709), 0.590 (95% CI, 0.462–0.718), and 0.626 (95% CI, 0.499–0.753), respectively. Therefore, intraoperative MAP changes may not be a determining factor for AKI after RALP.

Prospective analysis of plasma amyloid beta and postoperative delirium in the Interventions for Postoperative Delirium: Biomarker-3 study

BackgroundThe effect of postoperative delirium on the amyloid cascade of Alzheimer's dementia is poorly understood. Using early postoperative plasma biomarkers, we explored whether surgery and delirium are associated with changes in amyloid pathways. MethodsWe analysed data from 100 participants in the Interventions for Postoperative Delirium: Biomarker-3 (IPOD-B3) cohort study in the USA (NCT03124303 and NCT01980511), which recruited participants aged >65 yr undergoing non-intracranial surgery. We assessed the relationship between the change in plasma amyloid beta ratio (AβR; Aβ42:Aβ40) and delirium incidence (defined by the 3-Minute Diagnostic Confusion Assessment Method) and severity (quantified by the Delirium Rating Scale-Revised-98, the study's primary outcome). We also tested the relationship between plasma amyloid beta and intraoperative variables. ResultsAcross all participants, the plasma AβR increased from the preoperative period to postoperative Day 1 (Wilcoxon P<0.001). However, this increase was not associated with delirium incidence (Wilcoxon P=0.22) or peak severity after adjusting for confounders (log[incidence rate ratio]=0.43; P=0.14). Postoperative Day 1 change in plasma AβR was not associated with postoperative Day 1 change in plasma tau, neurofilament light, or inflammatory markers (interleukin [IL]-1β, IL-1Ra, IL-2, IL-4, IL-6, IL-8, IL-10, and IL-12), or with operative time or low intraoperative arterial pressure. ConclusionsPerioperative changes in plasma amyloid do not appear to be associated with postoperative delirium. Our findings do not support associations of dynamic changes in amyloid with postoperative delirium. Clinical trial registration.NCT03124303 and NCT01980511.

Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements

Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.

Spinal Versus General Anesthesia for Cesarean Delivery in Pregnant Women With Moyamoya Disease: A Retrospective Observational Study

(Anesth Analg. 2022;135:617–624) Moyamoya disease (MMD), a rare cerebrovascular disease causing the vascular network at the brain’s base to be fragile, requiring careful blood pressure control and proactive medical treatment to prevent life-threatening hemorrhage and/or ischemic events. The exact risks pregnancy, labor, and delivery for MMD patients is unknown. The aim of this study was to determine if the choice of spinal anesthesia versus general anesthesia would have a significant effect on the intraoperative mean arterial pressure in MMP patients undergoing cesarean section.

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study.

Delayed cerebral ischemia (DCI) is the major predictor of poor outcomes in patients with aSAH. Previous studies have attempted to assess the relationship between controlling blood pressure and DCI. However, the management of intraoperative blood pressure in reducing the occurrence of DCI still remains inconclusive. All patients with aSAH who received general anesthesia for surgical clipping between January 2015 and December 2020 were prospectively reviewed. Patients were divided in the DCI group or the non-DCI group depending on whether DCI occurred or not. Intraoperative arterial pressure was measured every minute and recorded in an electronic anesthesia recording system along with intraoperative medication and other vital signs. The initial neurological function score, aneurysm characteristics, surgical and anesthetic information, and outcomes were compared between the DCI and the non-DCI groups. Among 534 patients who were enrolled, a total of 164 (30.71%) patients experienced DCI. The baseline characteristics of patients were similar between the groups. The World Federation of Neurosurgical Societies (WFNS) Scale > 3, age ≥ 70 years, and the modified Fisher Scale > 2 were significantly higher in patients with DCI than those without. Though it was the second derivative of the regression analysis, 105 mmHg was adopted as the threshold for intraoperative hypotension and was not associated with DCI. The threshold of 105 mmHg was adopted as intraoperative hypotension even though it was the second derivative of the regression analysis and could not be proved to be associated with delayed cerebral ischemia adjusted by the baseline severity of aSAH and age.

Arthroscopic rotator cuff repair performed with intra-articular tranexamic acid: could it provide improved visual clarity and less postoperative pain? A prospective, double-blind, randomized study of 63 patients.

Tranexamic acid (TXA) has been widely used in orthopedic surgery with the aim of reducing intraoperative and postoperative bleeding, as well as bleeding-related complications. The purpose of this study was to assess whether intra-articular use of TXA during arthroscopic rotator cuff tear (RCT) repair could improve visual clarity, shorten the duration of the operation, and provide superior pain management as compared with placebo. We conducted a prospective, randomized, double-blind, placebo-controlled study. Patients aged ≥18 years with a magnetic resonance imaging-confirmed RCT and a history of failed conservative treatment for ≥6 months were included. Patients with a history of coagulopathy; a history of cardiac, renal, or hepatic disease; a history of conservative treatment for <6 months; and/or acute RCTs were excluded. Visual clarity as the primary outcome was assessed using an arthroscopic visual scale comprising 5 grades-ranging from grade 1, best visual clarity, to grade 5, worst visual clarity (requiring conversion to open surgery)-after the procedure by the operating surgeon every 10 minutes throughout the video of the operation. Secondary outcomes were operative duration and postoperative pain scores. A total of 63 patients with similar demographic data (age and sex) and intraoperative mean arterial pressure were enrolled and randomized into 2 groups: The TXA group comprised 32 patients with a mean age of 56.46 years, and the placebo group comprised 31 patients with a mean age of 57.83 years. The TXA group was reported to have significantly superior visual clarity (mean arthroscopic visual scale score, 1.5±0.5 vs. 2.86±1.7; P<.001), with a significantly higher percentage of grade 1 visual clarity (78.1% vs. 32.2%, P<.001) and a significantly lower percentage of grade 4 visual clarity (0% vs. 3.2%, P=.003). Grade 5 visual clarity was not recorded in any patient in either group. The TXA group showed a significantly shorter operative duration (55.73 minutes vs. 67.26 minutes, P=.001) and superior pain scores at 8 hours (2.3 vs. 3.6, P=.002) and 24 hours (1.6 vs. 2.4, P<.001) postoperatively. No complications were recorded in either group. This study showed that during arthroscopic rotator cuff repair procedures, intra-articular use of TXA was able to provide superior arthroscopic visual clarity while shortening the total operative duration significantly and providing significantly superior pain management in the first 8 and 24 hours postoperatively as compared with placebo. This study underlines the safety and efficacy of intra-articular TXA use in arthroscopic rotator cuff repair.

Determining the Risk of Intraoperative Pressure Injury in Patients Undergoing Elective Cranial Surgery

Purpose: Neurosurgical interventions are long and complex, and additional difficulties are encountered in positioning in the operating room.The aim of the study is to determine the risk of pressure injury development in the intraoperative period of patients undergoing elective cranial surgery. &#x0D; Methods: This descriptive cross-sectional study was conducted with 127 patients who met the inclusion criteria and underwent elective cranial surgery in a city hospital between September and October 2021. 3S Operating Room Pressure Injury Risk Diagnostic Scale were used to collect data. &#x0D; Results: It was determined that 55.1% of the patients were female, their mean age was 53.22±13.47 years, and 61.4% had at least one chronic disease. It was determined that 71.7% of the patients were operated with the diagnosis of cerebellar tumor. Stage 1 pressure ulcers were observed in 37% of the patients. It was determined that the total score obtained from the scale was 14.87±2.83 and the patients were at low risk for pressure injury. Age, body mass index and duration of the surgical procedure were found to be independent factors affecting the patients' operating room pressure ulcer risk assessment scale score. &#x0D; Conclusion:It was determined that the risk of pressure injury in patients who underwent cranial surgery was low level.

Editorial Comment.

No AccessJournal of UrologyAdult Urology30 Jan 2023Editorial CommentThis article comments on the following:Artificial Urinary Sphincter Cuff Downsizing Improves Continence and Patient Satisfaction in Cases of Sub-cuff Atrophy Bradley A. Erickson Bradley A. EricksonBradley A. Erickson Division of Functional Urology, University of Iowa, Iowa City, Iowa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003138.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Artificial urinary sphincter cuff downsizing improves continence and patient satisfaction in cases of sub-cuff atrophy. J Urol.2023; 209(4). Google Scholar 2. . Proof of concept: exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon. Investig Clin Urol.2018; 59(4):275-279. Google Scholar 3. . Urethral atrophy after implantation of an artificial urinary sphincter: fact or fiction?BJU Int.2016; 117(4):669-676. Google Scholar 4. . Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence. J Urol.2014; 191(1):138-142. Link, Google Scholar Submitted July 27, 2022; accepted December 6, 2022; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology30 Dec 2022Artificial Urinary Sphincter Cuff Downsizing Improves Continence and Patient Satisfaction in Cases of Sub-cuff Atrophy Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bradley A. Erickson Division of Functional Urology, University of Iowa, Iowa City, Iowa More articles by this author Expand All Submitted July 27, 2022; accepted December 6, 2022; published 000. Advertisement PDF downloadLoading ...

Application of femoral nerve block combined with modified swelling anesthesia in high ligation and stripping of great saphenous vein.

To analyze and explore the clinical efficacy of ultrasound guided femoral nerve block combined with modified swelling anesthetic solution in high ligation and stripping of the great saphenous vein. 90 patients with varicose great saphenous vein of lower limbs undergoing high ligation and stripping of great saphenous vein were randomly divided into group A (femoral nerve block combined with modified swelling anesthesia), group B (simple swelling anesthesia) and group C (epidural anesthesia), with 30 patients in each group. The serum CRP level, operation duration, intraoperative blood loss, postoperative hospitalization time, total hospitalization cost, postoperative VAS score, preoperative and postoperative VCSS score, intraoperative mean arterial pressure and heart rate, postoperative related complications, and patients, satisfaction with diagnosis and treatment were compared among the three groups. There was no significant difference in operation duration, intraoperative blood loss, postoperative complications, and preoperative and postoperative VCSS scores among the three groups (P > 0.05). The postoperative hospitalization time, postoperative VAS score and total hospitalization cost of patients in group A and B were lower than those in group C, and the postoperative hospitalization time and postoperative VAS score in group A were more significant (P < 0.05). Compared with group B, the fluctuation range of intraoperative mean arterial pressure and heart rate, and postoperative serum CRP level in group A and C were lower, especially in group A (P < 0.05). The three groups of patients were followed up regularly after surgery. The results showed that the number of postoperative complications in group A was lower than that in the other two groups (P < 0.05), and the postoperative complications of the three groups were effectively relieved after symptomatic treatment (dressing change, anti-infection, taking drugs to improve circulation, etc.). The satisfaction of patients in group A was significantly higher than that in groups B and C (P < 0.05). Ultrasound guided femoral nerve block combined with modified swelling anesthetic solution applied in high ligation and stripping of the great saphenous vein can significantly improve postoperative inflammatory stress reaction of patients, effectively ensure the safety and reliability of surgical progress, help to improve analgesia effect and accelerate physical rehabilitation, and has short hospitalization time, low medical cost, and high satisfaction of patients' diagnosis and treatment, which is worthy of widespread clinical promotion and reference.

Combined acupuncture-medicine anesthesia used in thyroid surgery: A systematic review and meta-analysis.

Combined acupuncture-medicine anesthesia (CAMA) is extensively used in thyroid surgery in China. We conducted a systematic review and meta-analysis to assess the efficacy and safety of CAMA. We searched the China National Knowledge Infrastructure (CNKI), VIP database, WanFang database, PubMed, EMBASE, and the Cochrane Library for relevant literature. The term of literature was published before April 18, 2020, and there were no restrictions on publication language, region, or publication year. The inclusion criteria included a randomized controlled trial (RCT) of acupuncture combined with cervical plexus anesthesia. We used RevMan5.3 software for data analysis. If the chi-square test showed no significant heterogeneity (P > .10, I2 < 50%), we used the fixed-effect model to calculate risk ratio (RR) and mean difference. Otherwise, the random-effects model was used. Overall, 18 RCTs involving 1211 patients were included in the study. The anesthesia significant rate (ASR) in the transcutaneous electrical acupoint stimulation (TEAS) plus cervical plexus block anesthesia (CPBA) and electroacupuncture (EA) plus CPBA groups was significantly higher compared with the CPBA group (TEAS + CPBA: P < .001; EA + CPBA: P < .001). The pooled effect values of the intraoperative heart rate (HR) and mean arterial pressure (MAP) were significantly lower in both the TEAS + CPBA and EA + CPBA groups relative to the control group (HR: P = .05, P < .001; the MAP: P = .002, P < .001; respectively). Moreover, the postoperative adverse reaction was markedly lower in the experimental group than in the control group (RR = 0.30, P < .001), and there was no heterogeneity between the two groups (P = .71, I2 = 0%). Combined acupuncture-medicine anesthesia significantly increases the anesthesia significance rate, reduces the intraoperative heart rate, and blood pressure, and reduces the incidence of postoperative adverse reactions. However, more high-quality future studies should be conducted to validate the efficacy and safety of acupuncture combined anesthesia further.

Ultrasound guided erector spinae plane block versus quadratus lumborum block for post-operation analgesia in laparoscopic cholecystectomy surgeries: A randomized controlled trial

Background: An effective interfascial plane block for laparoscopic (lap) cholecystectomy and other abdominal procedures is the Quadratus Lumborum Block type II (QLB-II). The erector spinae plane block (ESPB), which is guided by ultrasound (US), is a recently described interfascial plane block that is gaining popularity. This research aims to evaluate the relative effectiveness of ultrasound ESPB and US QLB in the treatment of immediate post-operation pain following lap cholecystectomy.Methods: Sixty cases (21-65 years old, from both sexes) having elective lap cholecystectomy were enrolled in this prospective randomized double-blind research. The cases were randomly classified into three equal groups, C group: received general anesthesia (GA) only, ESPB: received GA and bilateral US ESPB and QLB: received GA and bilateral US QLB.Results: Duration of performing block was significantly less in group ESPB versus group QLB. Intraoperative heart rate and mean arterial pressure were significantly less after incising the skin, at 30 min in ESPB and QLBs versus group C. Total fentanyl dosage and morphine dosage in 1st 1 day were significantly less in group ESPB and QLB versus group C. NRS at 6, 24 hour was significantly less in ESPB and QLBs versus group C. First time to call for analgesic requirement was significantly delayed in the ESPB and QLBs versus the C group. Conclusions: The ESPB is as efficient as posterior QLB to provide effective analgesia as comparable results of lower NRS, intraoperative fentanyl and post-operation opioid dosage, delayed first time to call for analgesic requirement and is lower side effects versus control in cases undergoing elective laparoscopic cholecystectomy.

Opioid-based Anaesthesia versus Opioid Free Anaesthesia in Laparoscopic Cholecystectomies: A Randomised Clinical Study

Introduction: Intravenous opioids have been frequently used to provide analgesia and supplemental sedation during general anaesthesia or monitored anaesthesia care. Opioid Free Anaesthesia (OFA) is a multimodal approach which combines different drugs likes lignocaine, dexamethasone, paracetamol and dexmedetomidine with different techniquessuch as hypnosis, sedation, analgesia and sympatholysis. Thus, reducing and avoiding opioids perioperatively will lead to decrease in opioid related adverse effects with better postoperative outcomes. Aim: To compare OFA and Opioid-based Anaesthesia (OBA) in terms of haemodynamic stability, speed and quality of recovery, postoperative pain score and analgesic requirement. Material and Methods: The present study was a randomised study conducted over a period from June 2021 to September 2022, in which 90 patients of American Society of Anaesthesiologists (ASA) Grade I,II, 20-60 years of age undergoing elective Laparoscopic Cholecystectomy (LC) were divided into OBA fentanyl and OFA-lignocaine and dexmedetomidine. A standard general anaesthesia protocol of the institute was followed. OBA group received fentanyl (2 μg/kg) over 10 minutes before induction of anaesthesia and OFA group received lignocaine (2 mg/kg) and dexmedetomidine (0.5 μg/kg) both intravenously over 10 minutes before induction of anaesthesia. In OFA group analgesia was maintained by infusion of lignocaine 2 mg/kg/hr and dexmedetomidine 0.5 μg/kg/hr whereas in OBA group fentanyl 0.5 μg/kg was given whenever required till the gallbladder was resected. Postoperative intraperitoneal instillation of gallbaldder fossa was done with 20 mL 0.5% bupivacaine. Intraoperative mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were recorded. Postoperative speed and quality of recovery, pain score, analgesic requirements and incidence of Postoperative Nausea and Vomiting (PONV) were noted. Paracetamol 15 mg/kg was given intravenously whenever Numerical Rating Scale (NRS) score was ≥6. Comparison of means between the two groups was done using unpaired t-test, association between two non parametric variables was done using Pearson Chi-square (χ2 test) test. Results: The mean age, sex, weight, ASA and duration of surgery were comparable in both the groups. The mean HR and mean MAP were significantly lower in OFA group compared to the OBA group at all the time points (p-value=0.001). Although postoperative speed of recovery was slower in OFA group, the overall quality of recovery was better (p-value=0.001). The postoperative pain score, analgesic requirement and incidence of nausea and vomiting were all significantly less in OFA group as compared to OBA group with p-values of 0.02, 0.001 and 0.02, respectively. Conclusion: OFA is new anaesthetic approach that provides better perioperative haemodynamic stability, postoperative pain control with less PONV and thus can be used safely and successfully

A study to understand the current practices regarding the use of cuffed endotracheal tubes in pediatric anaesthesia amongst Indian anaesthesiologists

Purpose: To understand the current practices regarding the use of cuffed endotracheal tubes in paediatric anaesthesia amongst Indian anaesthesiologists.Methods: We formulated a questionnaire intended to assess the use of cuffed endotracheal tubes in pediatric age-group by pediatric and general anaesthetics in India. The questionnaire was also designed to evaluate practices related to the use of cuffed endotracheal tube in pediatric age group, such as the medium used for inflation of the cuff and whether or not cuff pressure monitoring was done during surgery. The self-structured questionnaire had 23 questions, and they were widely shared amongst anaesthetists practicing in India through social media, such as Facebook groups, WhatsApp groups and direct messages, over a period of three months from November 2021 to January 2022. Results and conclusion: We found that more number of cuffed ETT has been seen to be used by the practitioners who are in the age group of 25 to 40 years. More number of cuffed ETT has been used by female practitioners for paediatric anaesthesia. Strong association has been observed between years of practice of preference of practitioners for the type of ETT, with practitioners with less than 10 years post PG experience preferring cuffed ETT while those with post PG experience of > 20 years preferring uncuffed ETT. We also concluded that majority practitioners prefer uncuffed ETT in neonates and in children between 1 month to 2 years of age, while most of them prefer cuffed ETT in children above 2 years of age. We also concluded that even though use of cuffed endotracheal tubes in pediatric patients is on a rise, the percentage of anaesthesiologists who monitor intraoperative cuff pressure is very low, thus compromising the safety.

Retracted: Application of Self-Adhesive Soft Silicone Common Foam Dressing in Reducing Intraoperative Pressure Ulcers in Elderly ICU Patients.

[This retracts the article DOI: 10.1155/2021/4482201.].

Influencing factors and nursing progress of intraoperative pressure injury

Influencing factors and nursing progress of intraoperative pressure injury