Longer Duration Of Anesthesia Research Articles

Preoperative fractional exhaled nitric oxide is a risk and predictive factor of postoperative cough for early-stage non-small cell lung cancer patients: a longitudinal study

BackgroundTo determine whether preoperative fractional exhaled nitric oxide (FENO) level is a risk and predictive factor of postoperative cough by using the Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC).Methods292 early-stage non-small cell lung cancer (NSCLC) patients without preoperative cough were enrolled. 138 patients (47.2%) developed postoperative cough, univariate and multivariate logistic regression analysis were performed to identify the independent risk factors of postoperative cough. For an exploratory analysis, patients with cough were divided into low and high- FENO [≥ 31 parts per billion (ppb)] groups. The LCQ-CM was used to evaluate changes and recovery trajectory of postoperative cough over time between the two groups for 12 months after surgery.ResultsThe independent factors of postoperative cough included preoperative FENO level [odds ratio (OR) 1.106, 95% confidence interval (CI): 1.076–1.137, p < 0.001] and duration of anesthesia (OR 1.008, 95% CI: 1.002–1.013, p = 0.004). The low-FENO group reported significantly higher LCQ-MC scores at 1 month after surgery and returned to preoperative physical (28 vs. 91 days), psychological (28 vs. 60 days), social (28 vs. 80 days) and total (28 vs. 91 days) scores faster than the high-FENO group (all p < 0.05).ConclusionHigher preoperative FENO level and longer duration of anesthesia were independent risk factors related to postoperative cough. Additionally, patients with high preoperative FENO level had worse cough-related quality of life and slower recovery from postoperative cough.Trial RegistrationThis study was approved by the Chinese Clinical Trial Registry (Clinicaltrials.gov number: ChiCTR1900023419) on 26 May 2019 and the first patient was enrolled after pre-registration.

Buffered 4% Articaine Reduces Pain and Enhances Anesthesia in Maxillary Third Molar Extractions: A Randomized, Double-Blind Split-Mouth Study

Background/Objectives: Buffered local anesthetics are suggested to enhance patient comfort and anesthetic efficacy during dental procedures. However, their advantages over non-buffered solutions in maxillary third molar extractions remain under-investigated. This prospective, randomized, double-blind, split-mouth study aimed to compare the efficacy of buffered versus non-buffered 4% articaine in terms of pain, anesthetic onset, and the duration of anesthesia during maxillary third molar extractions. Methods: Each participant randomly received two buccal infiltrations on two single appointments to extract maxillary third molars: one with 4% articaine buffered with sodium bicarbonate and the other with non-buffered 4% articaine. Pain during injection, post-extraction pain, onset time, and the duration of anesthesia were assessed using a visual analog scale (VAS; 0–10). Results: Fifty adult participants (23 males and 27 females) with a mean age of 21.6 years were included in the study. Buffered 4% articaine significantly reduced injection pain (mean VAS: 3.12 ± 1.36 vs. 4.2 ± 0.3, p = 0.0001) and post-extraction pain (mean VAS: 4.4 ± 1.75 vs. 5.76 ± 1.78, p = 0.0002) compared to non-buffered articaine. Additionally, buffered articaine demonstrated a faster onset of anesthesia (mean time (seconds): 85.92 ± 27.37 vs. 126.86 ± 33.15, p &lt; 0.0001) and a longer duration of anesthesia (mean duration (minutes): 70.4 ± 13.64 vs. 51.4 ± 7.2, p &lt; 0.0001). Regarding gender’s factor, the comparisons revealed no statistically significant differences (p &lt; 0.05) in pain perception between males and females for either injection pain or post-extraction pain. Conclusions: Buffered 4% articaine provides superior anesthetic efficacy compared to non-buffered 4% articaine, enhancing patient comfort by reducing pain, accelerating onset, and prolonging the duration of anesthesia during maxillary third molar extractions.

Exploring anesthesia-related complications in pediatric neurosurgery: a comparative analysis of the sitting and park-bench positions.

The purpose of this study is to analyze the sitting position and the park-bench position for intra-anesthesia complications in pediatric patients undergoing neurosurgery for posterior fossa lesions. Our goal is to highlight the risks associated with each of these positions under general anesthesia to aid in clinical decision making for optimal patient outcomes with regard to postoperative complications. We retrospectively reviewed 41 pediatric patients (1 to 18 years old) undergoing posterior fossae surgery in the sitting (32) and park-bench (9) positions between January 2015 and December 2021. The majority of patients (15) who underwent surgery in the sitting position had fourth ventricular tumors (28.12%) and cerebellopontine tumors (18.76%) that required the sitting position. Of 32 patients operated on in the sitting position, 23 (71.78%) developed anesthetic complications, compared to 8 patients in the park-bench group (88.89%). Venous air embolism occurred in only 6.25% of patients in the sitting group. Compared to the sitting position, no cases of gas embolism were documented in the park-bench position. However, transient episodes of gas embolism cannot be excluded due to the higher incidence of hemodynamic instability (44.44%), need for additional fluid therapy (44.44%) and vasopressor support (11.11%), decreased CO2 (22.22%) and oxygen desaturation (22.22%). Patients who underwent surgery in the sitting position had a longer duration of surgery [247.5 min IQR (172.75 - 325.25)] and a longer duration of anesthesia [331 min IQR (237.5 - 423.25)]. Pneumocephalus (4, 12.5%) and postoperative hematoma (3, 9.38%) were the most common postoperative complications in patients who underwent surgery in the sitting position. In the park-bench group, three patients had postoperative complications, including postoperative hematoma (2, 25%) and hydrocephalus (1, 12.5%). The incidence of anesthetic complications is lower in the sitting position compared to the park-bench position. Although there was no documented gas embolism in the park-bench position, the lower rate of venous air embolism in the sitting position may suggest a better control or a lower risk in this position. However, the sitting position has a less frequent occurrence of hemodynamic instability than the park-bench position.

Permanent unilateral visual loss and orbital compartment syndrome following unilateral frontal craniotomy: illustrative case.

Vision loss following supine craniotomy is an unexpected and devastating complication for the patient and the operating team. Postoperative vision loss (POVL) is commonly associated with cardiac, spinal, neck, and prone head surgeries, as they share common risk factors, such as a prone position, intraoperative hypotension, a longer anesthesia duration, and the use of vasopressors. Herein, the authors report a case of irreversible vision loss following a frontal craniotomy in the supine position together with a review of the literature. All published cases in the literature since the first reported case in 1970 are summarized. Possible etiologies and proposed preventive measures are discussed. Different pathologies, such as vascular, intra-axial, and extra-axial lesions, are associated with POVL and have similar clinical courses and nonrecovery rates, which raises the question of whether POVL begins during the exposure part of these surgeries. Preventive measures could include avoiding direct ocular pressure during flap reflection, the use of elastic bands or fishhooks to avoid stretching the orbital contents and impairing venous outflow, and a careful review of the venous drainage of frontal tumors, which could help avoid unnecessary large venous thrombi or waxing. The role of intraoperative visual neurophysiological monitoring in predicting POVL requires further exploration. https://thejns.org/doi/10.3171/CASE2434.

Prediction of Postoperative Sore Throat in Patients After Day-case Surgery With General Anesthesia: A Retrospective Study

PurposePostoperative sore throat (POST) is a major complaint after day-case surgery. The objectives of this study were to investigate the risk factors for POST and develop a stratified nursing model for POST after day-case surgery. DesignThis case-control study was conducted at Department of Anesthesiology of 1st Affiliated Hospital of Wenzhou Medical University in Wenzhou, Zhejiang, China. MethodsAnesthesia records and postanesthesia care files of adult patients undergoing day-case surgery with general anesthesia were reviewed. The primary outcome was the incidence of POST at 24 hours after day-case surgery or before discharge within 24 hours. Multivariate logistics regression was used to identify risk factors for POST. A nomogram was created to predict the probability of POST after day-case surgery. FindingsA total of 9,312 records were retrieved from June 1, 2021 to April 30, 2022, including 8,499 files in the training group and 813 files in the validation group. One thousand five hundred and twenty-five cases in the training group experienced POST. The independent risk factors for POST included: thyroid surgery (odds ratios [OR] = 22.42, 95% confidence intervals [CI]: 18.45 to 27.25), shorter thyromental distance (OR = 1.18, 95% CI: 1.06 to 1.30), smaller neck circumference (OR = 1.09, 95% CI: 1.06 to 1.11), duration of anesthesia (OR = 1.13, 95% CI: 1.04 to 1.22), female (OR = 1.66, 95% CI: 1.41 to 1.96), age (OR = 0.99, 95% CI: 0.99 to 1.00) and the presence of bloody sputum (OR = 8.33, 95% CI: 6.53 to 10.63). A nomogram that involved five factors was established to predict the probability of POST after day-case surgery. The area under the receiver operating characteristic curve in the training and validation groups was 0.77 and 0.81, respectively. The calibration curve demonstrated good consistency between the actual POST and the predicted probability. ConclusionsThe following variables are independently associated with POST: thyroid surgery, age approaching to 40 years old, female, shorter thyromental distance and smaller neck circumference, longer duration of anesthesia, and the presence of bloody sputum. A novel stratified nursing model is feasible for predicting the probability of POST.

Biological and Procedural Predictors of Outcome in the Stroke Preclinical Assessment Network (SPAN) Trial.

The SPAN trial (Stroke Preclinical Assessment Network) is the largest preclinical study testing acute stroke interventions in experimental focal cerebral ischemia using endovascular filament middle cerebral artery occlusion (MCAo). Besides testing interventions against controls, the prospective design captured numerous biological and procedural variables, highlighting the enormous heterogeneity introduced by the multicenter structure that might influence stroke outcomes. Here, we leveraged the unprecedented sample size achieved by the SPAN trial and the prospective design to identify the biological and procedural variables that affect experimental stroke outcomes in transient endovascular filament MCAo. The study cohort included all mice enrolled and randomized in the SPAN trial (N=1789). Mice were subjected to 60-minute MCAo and followed for a month. Thirteen biological and procedural independent variables and 4 functional (weight loss and 4-point neuroscore on days 1 and 2, corner test on days 7 and 28, and mortality) and 3 tissue (day 2, magnetic resonance imaging infarct volumes and swelling; day 30, magnetic resonance imaging tissue loss) outcome variables were prospectively captured. Multivariable regression with stepwise elimination was used to identify the predictors and their effect sizes. Older age, active circadian stage at MCAo, and thinner and longer filament silicone tips predicted higher mortality. Older age, larger body weight, longer anesthesia duration, and longer filament tips predicted worse neuroscores, while high-fat diet and blood flow monitoring predicted milder neuroscores. Older age and a high-fat diet predicted worse corner test performance. While shorter filament tips predicted more ipsiversive turning, longer filament tips appeared to predict contraversive turning. Age, sex, and weight interacted when predicting the infarct volume. Older age was associated with smaller infarcts on day 2 magnetic resonance imaging, especially in animals with larger body weights; this association was most conspicuous in females. High-fat diet also predicted smaller infarcts. In contrast, the use of cerebral blood flow monitoring and more severe cerebral blood flow drop during MCAo, longer anesthesia, and longer filament tips all predicted larger infarcts. Bivariate analyses among the dependent variables highlighted a disconnect between tissue and functional outcomes. Our analyses identified variables affecting endovascular filament MCAo outcome, an experimental stroke model used worldwide. Multiple regression refuted some commonly reported predictors and revealed previously unrecognized associations. Given the multicenter prospective design that represents a sampling of real-world conditions, the degree of heterogeneity mimicking clinical trials, the large number of predictors adjusted for in the multivariable model, and the large sample size, we think this is the most definitive analysis of the predictors of preclinical stroke outcome to date. Future multicenter experimental stroke trials should standardize or at least ensure a balanced representation of the biological and procedural variables identified herein as potential confounders.

Perinatal outcomes among pregnant patients with peripartum coronavirus disease 2019 infection

PurposeEvaluate maternal and neonatal outcomes in peripartum coronavirus disease 2019 (COVID-19) positive women.MethodsA retrospective cohort study was conducted, comparing outcomes between women with and without peripartum COVID-19. All singleton deliveries from June 2020 to January 2022 were included. Univariate analysis was followed by multivariate analysis.ResultsOf 26,827 singleton deliveries, 563 women had peripartum COVID-19, associated with preterm deliveries both near-term and remote from term [adjusted odds ratio (aOR) 1.6 and 2.0, respectively, p = 0.007 and 0.003]. Women with peripartum COVID-19 had a significantly higher rate of disseminated intravascular coagulation (DIC) (aOR 23.0, p < 0.001). Conversely, peripartum COVID-19 peripartum COVID-19 was negatively associated with premature rupture of membranes and prolonged maternal length of stay (aOR 0.7 and 0.5, respectively, p = 0.006 and <0.001).In cesarean delivery (CDs), patients with COVID-19 had higher rate of urgent CDs (75.5 vs. 56.1%, p < 0.001), higher rate of regional anesthesia (74.5 vs. 64.9%, p = 0.049), and longer anesthesia duration (86.1 vs. 53.4 min, p < 0.001). CD rate due to non-reassuring fetal heart rate (NRFHR) was significantly higher in women with COVID-19 (29.6 vs. 17.4%, p = 0.002). Conversely, CDs rate due to history of previous single CD was significantly higher in patients without COVID-19 diagnosis (13.6 vs. 4.1%, p = 0.006).Concerning neonatal outcomes, an association has been observed between COVID-19 and low one-minute APGAR score <5, as well as neonatal COVID-19 infection (aOR 61.8 and 1.7 respectively, p < 0.001 and p = 0.037).ConclusionsPeripartum COVID-19 is associated with preterm deliveries, urgent CDs and DIC, potentially aligning with the infection’s pathophysiology and coagulation alterations.

Anaesthesia-related morbidity associated with recumbent, low-field magnetic resonance imaging of horses

ABSTRACT Case history: Medical records from 2009 to 2021 from a private equine referral hospital in Rochester, NH, USA were analysed for cases that underwent general anaesthesia for low-field MRI of the distal limb. These were used to determine peri-anaesthetic morbidity and mortality. Clinical findings and outcome: Two hundred and forty-three anaesthetic episodes were recorded in horses undergoing low-field MRI. The peri-anaesthetic complication rate prior to discharge was 6.2% (15/243). No patients experienced a fatal complication. Ninety two of the 243 patients had multiple sites imaged, 90/243 received pre-anaesthetic dantrolene, 134/243 received intra-anaesthetic dobutamine, and 15/243 were positioned in dorsal recumbency. Complications included: abdominal discomfort (“colic”; 9/243), myopathy (4/243), hyphaema (1/243) and carpal fracture (1/243). At the time of discharge, 14/15 complications had resolved. Of 135 horses for which data were available 55 became hypotensive during the procedure (lowest mean arterial pressure < 65 mmHg). Median body weight was 553 (min 363, max 771) kg. Horses were anaesthetised for a median of 150 (min 45, max 210) minutes. There was no evidence of an association between higher body weight (p = 0.051) or longer duration of anaesthesia (p = 0.421) and development of an anaesthetic complication. For categorical variables (dantrolene administration pre-anaesthesia, dobutamine administration during anaesthesia, hypotension (mean < 65 mmHg) during anaesthesia, dorsal vs. lateral recumbency, and imaging of single vs. multiple sites), the 95% CI for the OR included 1, indicating a lack of effect of the variable on the odds of complication. Clinical relevance: The cases included in this series suggest that low-field MRI under general anaesthesia is a viable option for diagnostic imaging in otherwise healthy horses. Complications occur, but most resolve before discharge.

Influence of a chronic beta-blocker therapy on perioperative opioid consumption – a post hoc secondary analysis

BackgroundBeta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.MethodsA post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.ResultsA total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.ConclusionsChronic BB therapy was not associated with a reduced perioperative opioid consumption.Trial registrationThis study was registered at ClinicalTrials.gov (NCT02265263) on the 15.10.2014 with the principal investigator being Univ.-Prof. Dr. med. Claudia Spies.

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.

Short-term outcomes of laparoscopic and robotic distal gastrectomy for gastric cancer: Real-world evidence from a large-scale inpatient database in Japan.

Robotic distal gastrectomy (RDG) has been widely performed throughout Japan since it became insured in 2018. This study aimed to evaluate the short-term outcomes of RDG and laparoscopic distal gastrectomy (LDG) for gastric cancer using real-world data. A total of 4161 patients who underwent LDG (n = 3173) or RDG (n = 988) for gastric cancer between April 2018 and October 2022 were identified through the Japanese Diagnosis Procedure Combination Database, which covers 42 national university hospitals. The primary outcome was postoperative in-hospital mortality rate. The secondary outcomes were postoperative complication rates, time to diet resumption, and postoperative length of stay (LOS). In-hospital mortality and postoperative complication rates in the RDG group were comparable with those in the LDG group (0.1% vs. 0.0%, p = 1.000, and 8.7% vs. 8.2%, p = 0.693, respectively). RDG was associated with a longer duration of anesthesia (325 vs. 262 min, p < 0.001), similar time to diet resumption (3 vs. 3 days, p < 0.001), and shorter postoperative LOS (10 vs. 11 days, p < 0.001) compared with LDG. RDG was performed safely and provided shorter postoperative LOS, since it became covered by insurance in Japan.

Retrospective comparison of articaine buccal infiltration and lidocaine intraosseous anesthesia in carious mandibular molars.

It is vital to identify more efficient anesthesia techniques for the restorative or endodontic treatment of mandibular molars. Both articaine buccal infiltration anesthesia (ABI) and lidocaine inferior alveolar nerve block anesthesia (LIANB) may not provide profound anesthesia, necessitating supplementary anesthesia. This study aimed to investigate whether lidocaine intraosseous lidocaine intraosseous anesthesia (LIO) is more suitable than ABI as primary anesthesia for caries treatment of mandibular molars. This study retrospectively analyzed patients treated for advanced caries according to the International Caries Detection and Assessment System (ICDAS) 5 and 6. The study involved 48 patients, split evenly between those receiving ABI and LIO, and examined the anesthesia success rate, pain during anesthesia, onset time, duration, and post-anesthesia lower lip numbness using Chi-square and Independent T-tests. In the ABI group, 17 patients (70.8%) did not require additional anesthesia, whereas all 24 patients (100%) in the LIO group did not require additional anesthesia (P < 0.001). ABI was associated with significantly higher pain during anesthesia, slower onset time, and longer duration of anesthesia than LIO. There was no significant difference in post-anesthesia lower lip numbness between the two methods. Intraosseous anesthesia using lidocaine is more effective for treating severe caries in the mandibular molars because of its higher success rate, decreased pain during anesthesia, faster onset, and shorter recovery time.

Association between anaesthesia-related factors and postoperative neurocognitive disorder: a post-hoc analysis

BackgroundPostoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery.MethodsWe analysed data obtained for a prospective observational study in patients aged ≥ 65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of ≥ 25% relative to baseline in ≥ 2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score.ResultsOf the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8–27.9)], p < 0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001–1.005)], p = 0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[± 3.13]).ConclusionIn this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients’ scores on cognitive tests improved postoperatively.

Significant perioperative parameters affecting postoperative complications within 30 days following craniotomy for primary malignant brain tumors

BackgroundThe occurrence of postoperative complications within 30 days (PC1M) of a craniotomy for the removal of a primary malignant brain tumor has been associated with a poor prognosis. However, it is still unclear to early predict the occurrence of PC1M. This study aimed to identify the potential perioperative predictors of PC1M from its preoperative, intraoperative, and 24-h postoperative parameters.MethodsPatients who had undergone craniotomy for primary malignant brain tumor (World Health Organization grades III and IV) from January 2011 to December 2020 were enrolled from a databank of Kaohsiung Veterans General Hospital, Taiwan. The patients were classified into PC1M and nonPC1M groups. PC1M was defined according to the classification by Landriel et al. as any deviation from an uneventful 30-day postoperative course. In both groups, data regarding the baseline characteristics and perioperative parameters of the patients, including a new marker-kinetic estimated glomerular filtration rate, were collected. Logistic regression was used to analyze the predictability of the perioperative parameters.ResultsThe PC1M group included 41 of 95 patients. An American Society of Anesthesiologists score of > 2 (aOR, 3.17; 95% confidence interval [CI], 1.19–8.45; p = 0.021), longer anesthesia duration (aOR, 1.16; 95% CI, 0.69–0.88; p < 0.001), 24-h postoperative change in hematocrit by > − 4.8% (aOR, 3.45; 95% CI, 1.22–9.73; p = 0.0019), and 24-h postoperative change in kinetic estimated glomerular filtration rate of < 0 mL/min (aOR, 3.99; 95% CI, 1.52–10.53; p = 0.005) were identified as independent risk factors for PC1M via stepwise logistic regression analysis. When stratified according to the age of ≥ 65 years (OR, 11.55; 95% CI, 1.30–102.79; p = 0.028), the reduction of kinetic estimated glomerular filtration rate was more robustly associated with a higher risk of PC1M.ConclusionsFour parameters were demonstrated to significantly influence the risk of PC1M in patients undergoing primary malignant brain tumor removal. Measuring and verifying these markers, especially kinetic estimated glomerular filtration rate, would help early recognition of PC1M risk in clinical care.

Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing.

The primary aim was to assess the pain during intraseptal anesthesia (ISA) administration, as well as during and after scaling and root planing (SRP). The secondary aims pertained to comparing the pain in different jaw regions and evaluating the factors affecting pain during ISA administration, during and after SRP. ISA was obtained with three different doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) in 360 patients. The pain levels were measured using the visual analogue scales (VAS) for pain intensity during ISA administration (VASa), during SRP (VASi), and after SRP (VASp). These findings were then correlated with periodontal parameters. Regression analysis was performed for pain during ISA, during and after SRP. Anesthesia administration was painful in 80.8% of cases. VASa negatively correlated with pocket depth (PPD). VASi showed no dose-dependency, except in mandibular premolars. VASi negatively correlated with the clinical attachment level (CAL). VASp positively correlated with PPD and CAL. Positive bleeding on probing reduced the chance of pain during ISA administration. Longer anesthesia duration and wider anesthetic field (orally) increased the prospects of painless SRP. No dose-dependent differences were found regarding patient discomfort and pain intensity of ISA delivery of 4%Ar + Ep for SRP. The pain during ISA administration was mild and well tolerated regardless of the anesthetic dose. A lower intensity of pain during SRP can be expected in patients with greater CAL. Post-treatment pain can be anticipated after SRP in the regions with greater PPD and CAL. NCT04392804 (May 9th, 2020).

Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas.

The middle fossa approach is an effective option for the treatment of small (Koos grade I and II) vestibular schwannomas (VSs) when the goal is hearing preservation. The authors evaluated the rates of hearing preservation and examined the factors associated with improved hearing outcomes after the middle fossa approach for VSs. In this retrospective, single-center cohort study evaluating the clinical outcomes after resection of small VSs using the middle fossa approach, consecutive adult patients (> 18 years) who underwent surgery between January 2000 and December 2021 were included. Clinical and imaging characteristics were analyzed, including baseline hearing status, duration of surgery, anesthetic parameters, and imaging characteristics of the surgically treated tumors. Among the 131 included patients, 102 had valid and discoverable pre- and postoperative audiology assessments. The mean follow-up was 26 months (range 1-180 months). There were 85 patients with serviceable hearing preoperatively, defined as American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B, of whom 78% retained class A or B hearing at the last follow-up. Binary logistic regression demonstrated that preoperative hearing AAO-HNS class (OR 0.19, 95% CI 0.05-0.77; p = 0.02), overlap between fundus and cochlea (OR 0.32, 95% CI 0.11-0.96; p = 0.04), and duration of anesthesia (OR 0.98, 95% CI 0.97-0.99; p = 0.03) were independent predictors of hearing outcomes. Additionally, 75% of patients with high diffusion-weighted imaging signal in the tumor (p = 0.009) and 67% of patients with the tumor originating at the modiolus of the cochlea (p = 0.004) had poor hearing outcomes. The hearing preservation rates after microsurgical resection of small VSs using the middle fossa approach are high, with 78% of patients maintaining AAO-HNS class A or B hearing. Poor hearing status at baseline, longer duration of anesthesia, and large overlap between the fundus of the internal auditory canal and the cochlea were independently associated with unfavorable hearing outcomes. Imaging characteristics can be used to stratify patients' risk of hearing loss.

Prevalence of preoperative cognitive impairment among elderly thoracic surgery patients and association with postoperative delirium: a prospective observational study.

Preoperative cognitive impairment (PCI) may increase the incidence of postoperative delirium (POD), yet screening for cognitive impairment is rarely performed. This study hypothesized that Mini-Cog for preoperative cognitive impairment screening predicts postoperative delirium. The prospective observational study recruited 153 elderly patients presenting for elective thoracic surgery. Cognitive function of these patients was screened using Mini-Cog preoperatively. We considered that patients with Mini-Cog scores ≤ 3 had cognitive impairment. Delirium was assessed using the Short CAM scale on postoperative days 1-5. Of the 153 participants, 54 (35.3%) were assigned to the PCI group, and 99 (64.7%) were assigned to the Normal group. Place of residence, education level, and history of hypertension were significantly different between the two groups (P < 0.05). 51 (33.3%) patients developed POD. Multifactorial analysis revealed that PCI (OR = 2.37, P = 0.028), older age (OR = 1.13, P = 0.009), ASA grade III (OR = 2.75, P = 0.012), and longer duration of anesthesia (OR = 1.01, P = 0.007) were associated with POD. Preoperative cognitive impairment is strongly associated with POD. Mini-Cog could be recommended for screening PCI. ClinicalTrials.gov, identifier NCT05798767.

Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta-analysis.

Postoperative delirium (POD) is a common postsurgical complication. The early identification of its risk factors is the first step toward reducing POD. The predictive factors for POD in patients after major abdominal surgery remain obscure. Therefore, this meta-analysis aimed to comprehensively summarize the risk factors of POD after major abdominal surgery. POD studies published between January, 1900 and June 2022 were obtained by searching PubMed, Cochrane Library, Web of Science, Embase, and Medline. Two authors independently reviewed the studies to extract the risk factors and assessed the quality of related articles using the Newcastle-Ottawa Scale. Data were recorded, and a meta-analysis was performed using Review Manager version 5.4.1. Ten studies including total 2900 patients undergoing major abdominal surgery, were eligible for analysis, 608 of whom developed POD, for a cumulative incidence of 21%. This pooled analysis suggested the statistically significant risk factors for POD were age, higher American Society of Anesthesiologists grade, lower preoperative Mini-Mental State Examination score, cognitive impairment, preoperative Katz-ADL score <6, preoperative and postoperative hypoalbuminemia, lower preoperative insulin-like growth factor-1 levels, and longer duration of anesthesia. POD is common in patients undergoing major abdominal surgery. This meta-analysis identified risk factors that may aid the early detection of POD and play a prominent role in preventing POD.

Modifikovana milohioidna anestezija sa 4% artikainom I adrenalinom I deksametazonom u hirurgiji mandibularnih molara - pilot studija

Introduction: Mylohyoid mandibular anesthesia is not a standard and independent primary anesthesia for performing surgery on mandibular teeth. Objective: The objective was to examine the success of achieved mylohyoid anesthesia for mandibular molar surgery, by injecting an anesthetic that could penetrate the bone in the lingual region of the mandible, using the technique for modified mylohyoid mandibular anesthesia. Materials and methods: In the pilot study, 10 patients were divided into 2 equal groups (of 5 patients each), of both sexes and aged 18-75, who required mandibular anesthesia owing to mandibular molar surgery. In group I, 3.5 ml of 4% articaine with 1:100000 adrenaline, and the addition of 0.5 ml/4 mg of dexamethasone, was injected into the sublingual region of the corner of the mandible using a modified mylohyoid approach; in group II, 4 ml of 2% lidocaine with 1:100000 adrenaline was injected into the region of the mandibular foramen using the approach for standard mandibular conduction direct anesthesia. A visual analogue scale (VAS) was used for the subjective assessment of the pain during surgery in patients, the recorded duration of the realized mandibular anesthesia, as well as the total effectiveness of the achieved anesthesia, expressed in percentages. Results: A successful intervention was achieved in all patients, with different VAS scores, but within the values indicating successful anesthesia (group I: 17.40±11.10mm; group II: 12.80±4.55mm). A longer duration of anesthesia was achieved in the first group-205.2 min (3h 25 min), compared to the second group-182 min (3h 2 min). Conclusion: Mylohyoid mandibular anesthesia with 4% articaine and with adrenaline and dexamethasone could be applied as primary anesthesia for the purpose of successfully achieving standard mandibular anesthesia.

Predictors and occurrence of postoperative cognitive dysfunction in children undergoing noncardiac surgery: A prospective cohort study.

In children after cardiac surgery, alterations in cognitive ability and behavior are increasingly common, but whether postoperative cognitive dysfunction (POCD) occurs in children undergoing noncardiac surgery is not known. The present study was performed to investigate the incidence rate and potential risk factors of early neurocognitive dysfunction in children after noncardiac surgery. Two hundredpatients aged between 4 and 14 years old underwent elective noncardiac surgery and 100 healthy age-matched controls were enrolled in this prospective observational study. Wechsler Preschool and Primary Scale of Intelligence or Wechsler Intelligence Scale for Children-Revised were conducted 1 daybefore and 3 days after surgery. POCD was calculated and diagnosed as a combined Z score. Any factors that differed between POCD and non-POCD group (p < 0.10) were tested together by multivariate logistic regression analysis against the cognitive outcome of patients, to find out the independent risk factors of POCD. The general incidence of POCD was 15.6%. The univariate analysis revealed that POCD was associated with general anesthesia, surgical and anesthesia duration, early postoperative fever (EPF), and surgical history. However, only the history of surgery (p = 0.029), anesthesia duration (p = 0.010), and EPF (p < 0.001) were demonstrated to be independent risk factors for POCD. The occurrence rate of early POCD after noncardiac surgery in children is 15.6%. Children who had surgical history, longer anesthesia duration, or EPF are more prone to develop POCD.