Perioperative Stage Research Articles

Radial artery haemostasis after coronary angiography: A scoping review.

Nursing care in interventional cardiology is vital during perioperative stages, especially with coronary angiography. Radial artery access is now preferred, requiring proper haemostasis to prevent complications. Standardised protocols are needed for effective and economical haemostasis methods. This review aims to map the literature on haemostasis of the radial artery after coronary angiography, an area not previously reviewed. Following the Joanna Briggs Institute methodology for scoping reviews, two reviewers independently selected studies based on eligibility criteria. Data were extracted using a specially developed tool, with disagreements resolved through discussion or a third reviewer. Data synthesis is presented in tabular form and narrative summary. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews guidelines were followed. Searches were conducted in PubMed, CINAHL Complete, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, Opengrey, DART-Europe e-theses portal and six key interventional cardiology reference sites. From 43 manuscripts, four haemostasis methods for the radial artery after coronary angiography were identified: manual compression (n = 5), compression bandages (n = 16), compression devices (n = 30) and haemostatic patches (n = 7). Nearly 70% (n = 30) of references focused on compression devices. Nine techniques were used to evaluate haemostasis methods, with visual inspection (34 references) and Doppler ultrasound (17 references) being the most common. Only nine haemostasis methods lacked an associated protocol. This scoping review identifies four primary haemostasis methods post coronary angiography: manual compression, compression bandages, compression devices and haemostatic patches, with compression devices being the most frequently discussed. The variability in evaluation techniques, predominantly visual inspection and ultrasound, underscores the need for standardised guidelines. The absence of protocols for some methods further highlights the necessity for uniform standards to improve consistency and reliability in clinical practice. Standardising these methods and protocols is essential to enhance patient outcomes and advance the field.

Computer Aided Intracranial Aneurysm Treatment Based on 2D/3D Mapping, Virtual Deployment and Online Distal Marker Detection.

To introduce a computational tool for peri-interventional intracranial aneurysm treatment guidance that maps preoperative planning information from simulation onto real-time X-Ray imaging. Preoperatively, multiple flow diverter (FD) devices are simulated based on the 3D mesh of the vessel to treat, to choose the optimal size and location. In the peri-operative stage, this 3D information is aligned and mapped to the continuous 2D-X-Ray scan feed from the operating room. The current flow diverter position in the 3D model is estimated by automatically detecting the distal FD marker locations and mapping them to the treated vessel. This allows to visually assess the possible outcome of releasing the device at the current position, and compare it with the one chosen pre-operatively. The full pipeline was validated using retrospectively collected biplane images from four different patients (5 3D-DSA datasets in total). The distal FD marker detector obtained an average F1-score of 0.67 ( ) in 412 2D-X-Ray scans. After aligning 3D-DSA + 2D-X-Ray datasets, the average difference between simulated and deployed positions was 0.832 mm ( mm). Finally, we qualitatively show that the proposed approach is able to display the current location of the FD compared to their pre-operatively planned position. The proposed method allows to support the FD deployment procedure by merging and presenting preoperative simulation information to the interventionists, aiding them to make more accurate and less risky decisions.

Advancements in health informatics for monitoring perioperative patient data

Advancements in health informatics are revolutionizing perioperative care by enhancing patient monitoring, improving clinical decision-making, and promoting patient safety. The integration of electronic health records (EHR) facilitates seamless information flow across all perioperative stages, ensuring up-to-date patient data is accessible to the entire healthcare team. This accessibility reduces errors, improves coordination, and enhances overall patient outcomes. EHR systems also support standardized documentation, reducing variability in record-keeping and ensuring comprehensive patient information is consistently captured. Real-time data analytics and predictive modeling are powerful tools in perioperative settings, enabling clinicians to anticipate and manage potential complications proactively. By analyzing vast datasets, predictive models identify patterns and risk factors associated with adverse outcomes, allowing for targeted interventions and personalized care plans. Real-time analytics provide continuous monitoring of patient status during surgery, offering immediate feedback and enabling prompt adjustments to ensure patient stability. Wearable devices and remote monitoring systems further augment real-time data analytics by continuously tracking physiological parameters throughout the surgical process and into the postoperative period. This continuous data stream allows for ongoing assessment of patient status and early detection of complications, enhancing patient safety and outcomes. Health informatics solutions, including automated alerts and decision support tools, minimize human error and ensure adherence to clinical guidelines. Automated reminders for critical actions, such as timely antibiotic administration, significantly reduce the incidence of surgical site infections. Decision support tools provide real-time, evidence-based recommendations at the point of care, supporting clinicians in making informed decisions and improving patient outcomes. Additionally, health informatics facilitates continuous quality improvement by enabling the collection and analysis of performance data, informing targeted interventions and process improvements. Overall, advancements in health informatics are transforming perioperative care, offering numerous benefits in terms of efficiency, accuracy, and patient safety, ultimately leading to better patient outcomes and higher quality of care. Continued innovation in this field will be essential for maintaining and improving the standards of perioperative care.

Rate control with Landiolol in atrial tachyarrhythmias and comorbid left ventricular dysfunction: a systematic review and meta-analysis

Abstract Backround Atrial tachyarrhythmias (ATs) are frequently inter-related with heart failure (HF). ATs exacerbate HF, while the existence of chronic HF precipitates the occurrence of ATs. Landiolol, a highly selective and exceptionally-short acting beta-1 blocker has been used in patients with ATs and HF, where evidence on the available treatment options is limited. Purpose In this meta-analysis we intended to assess the clinical effects of rate control with landiolol in patients with ATs and comorbid left ventricular dysfunction, who are not septic or in peri-operative stage. Materials and Methods We systematically searched PubMed, Scopus and WebofScience up to 14 July 2023. Two independent reviewers screened and selected randomized control trials as well as observational studies according to predetermined eligibility criteria. Risk of bias and quality of evidence were assessed according to Cochrane guidelines. Results 2278 articles were initially screened and 11 studies were finally included in this systematic review. In 7 of the eligible studies landiolol was compared with placebo, while in the remaining 4 studies landiolol was investigated in comparison with other antiarrhythmic drugs and specifically digoxin and diltiazem. The total sample size included 1876 patients, 75% of whom were classified into III/IV NYHA class. Landiolol treatment reduced patients’ heart rate by a mean of 42 beats per minute (95% CI: 37-47 bpm) while 3 out of 4 treated patients accomplished targeted heart rate, described as an at least 20% reduction from baseline heart rate and final heart rate less than 110bpm. Compared to patients receiving other antiarrhythmic therapy, patients treated with landiolol had increased odds of achieving target heart rate (OR: 5.32, 95% CI: 2.87-10.05). Referring to landiolol safety, 15% of the treated patients encountered an adverse event, more frequently dose-dependent hypotension. Landiolol was discontinued only in a 6% of the treated patients. No difference in adverse events was identified between landiolol and other antiarrhythmic drugs. Conclusion In this meta-analysis landiolol has achieved satisfactory levels of efficacy and safety regarding rate control in patients with ATs and left ventricular dysfunction.Prisma FlowchartLandiolol efficacy in single-arm studies

Perioperative Management in Neuromuscular Diseases: A Narrative Review.

Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome.

Anaesthetic and perioperative considerations for extrapleural pneumonectomy and extended pleurectomy/decortication: a scoping review protocol

IntroductionExtrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (ePD) are surgical cytoreductive techniques aimed at achieving macroscopic resection in malignant pleural tumours such as pleural mesothelioma, non-mesothelioma pleural malignancies such as thymoma...

Advancing cell-based therapy in sepsis: An anesthesia outlook.

Sepsis poses a health challenge globally owing to markedly high rates of morbidity and mortality. Despite employing bundle therapy over two decades, approaches including transient organ supportive therapy and clinical trials focusing on signaling pathways have failed in effectively reversing multiple organ failure in patients with sepsis. Prompt and appropriate perioperative management for surgical patients with concurrent sepsis is urgent. Consequently, innovative therapies focusing on remedying organ injuries are necessitated. Cell therapy has emerged as a promising therapeutic avenue for repairing local damage to vital organs and restoring homeostasis during perioperative treatment for sepsis. Given the pivotal role of immune cell responses in the pathogenesis of sepsis, stem cell-based interventions that primarily modulate immune responses by interacting with multiple immune cells have progressed into clinical trials. The strides made in single-cell sequencing and gene-editing technologies have advanced the understanding of disease-specific immune responses in sepsis. Chimeric antigen receptor (CAR)-immune cell therapy offers an intriguing option for the treatment of sepsis. This review provides a concise overview of immune cell therapy, its current status, and the strides made in the context of sepsis research, discussing potential strategies for the management of patients with sepsis during perioperative stages.

Extracorporeal membrane oxygenation (ECMO) assisted huge mediastinal tumor resection combined with superior vena cava replacement: A case report and literature review.

As to huge solid mediastinal tumor which direct compression or invasion of the superior/inferior vena cava (SVC/IVC), surgical resection remains the main lifesaving treatment. However, it would present formidable anesthetic challenges due to the extremely high risks of cardiorespiratory compromise, drastic hemodynamic fluctuations and death at all perioperative stages. Here, we report a case of huge anterior mediastinal tumor resection combined with SVC replacement under the assistance of venoarterial extracorporeal membrane oxygenation (VA ECMO), and stable hemodynamics were maintained as well as high internal jugular vein pressure being avoided during the operation procedure. He was weaned off ECMO successfully just after surgery and eventually discharged. No signs of postoperatively neurological complications occurred. Therefore, the use of ECMO assistance in huge mediastinal tumor resection combined with SVC replacement is feasible and safe, which may provide the possibility of surgical treatment for such patients and improve outcomes.

Analysis of the differential expression of serum miR-21-5p, miR-135-5p, and miR-155-5p by Bifidobacterium triplex viable capsules during the perioperative stage of colorectal cancer.

In this study, we investigated the impact of perioperative administration of Bifidobacterium triplex viable capsules on the serum levels of circulating miR-21-5p, miR-135-5p, and miR-155-5p in patients with colorectal cancer (CRC). The purpose of this study is to provide a foundation for future research on the use of Bifidobacterium triplex viable capsules to enhance postoperative recovery in patients with CRC. A total of 60 patients with primary CRC admitted to the Department of General Surgery at Shanxi Bethune Hospital between June 2020 and December 2020 were selected and randomly divided into two groups: 20 cases in the control group and 40 cases in the experimental group. The experimental group was administered oral Bifidobacterium triplex viable capsules during the perioperative period, while the control group was administered oral placebo. Before and after the perioperative period, the expression levels of miR-21-5p, miR-135-5p, and miR-155-5p were compared in the serum of both groups of patients. Furthermore, we established the prognostic value of these three miRNAs in CRC patients. After surgery, the expression levels of miR-21-5p, miR-135-5p, and miR-155-5p decreased in both groups of patients (P < 0.05). Significantly greater differences were observed between miR-21-5p and miR-135-5p (P < 0.001). Expression levels of serum miR-21-5p (P = 0.020) and miR-135-5p (P = 0.023) decreased significantly more in the experimental group than in the control group. The levels of the above three miRNAs after surgery did not correlate with 3-year OS (HR = 4.21; 95% CI 0.37-47.48; log-rank P = 0.20) or 3-year DFS (HR = 1.57; 95% CI 0.32-7.66; log-rank P = 0.55) in two groups. Radical surgery reduces the levels of serum miR-21-5p, miR-135-5p, and miR-155-5p expression in patients with CRC. The use of Bifidobacterium triplex viable capsules assists in achieving quicker perioperative recovery from radical surgery in CRC patients, and this underlying mechanism may be associated with the regulation of serum miR-21-5p, miR-135-5p, and miR-155-5p expression levels.

MELODY IN MEDICINE: CAN MUSIC ELEVATE EACH STAGE OF SURGERY?

Listening to music during surgery is a widespread phe-nomenon in healthcare institutions globally. Music can have both positive and negative impacts on the stressful and challenging surgical process. Scientific studies by Kahloul et al. (2017), Zybartaite and Gedrime (2021), and Ahmad (2017) confirm that music is an effective and eco-nomical tool to reduce stress. According to Boghadady and Kvist (2020), playing classical music at a moderate volume can enhance the speed and accuracy of surgical tasks. However, it’s important to acknowledge that music may hinder communication and concentration (Naraya-nan &amp; Gray 2018; Weldon et al. 2015; Shambo, Umad-hay &amp; Pedoto 2015), and contribute to time inefficiencies arising from the selection of music types (Sarla 2022). This qualitative study, conducted through semi-structu­red interviews, aimed to analyze how music influences te-amwork during the perioperative stages. The study an­tici-pates contributing to patient safety, work efficiency, team satisfaction, and cost reduction in the healthcare system Results and conclusions: All participants had a positive view of listening to music during surgery, with prefe-rences varying across perioperative stages. Anest­hesio-logists and operating room nurses often choose the type of music, while sometimes no specific team member is assigned to this role. Steady rhythm genres don’t dis-rupt communication and can alleviate emotional tension. High-rhythm genres may increase tension and fatigue, disrupting concentration. Fast-paced genres can improve mood, and different genres don’t necessarily affect surgi-cal duration. Slow-tempo genres may reduce emotional fatigue. High music volume can impair communication and concentration. An ideal music source in operating theaters should be compact, easily disinfected, and sim-ple to control.

Surgical Site Infection Prevention Strategies in Cardiac Surgery: A Systematic Review

Background: Cardiac surgery becomes one of surgical procedure that has potential for develop several complications including surgical site infection (SSI). Despite the case is still very common, SSI can be regarded as the most preventable, especially when the treatment approach used, because there are many risk factors associated with the target. This systematic review aims to assess the effectiveness of interventions strategies used to reduce the incident of SSI in cardiac surgery. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines provide a standardized framework for conducting and reporting systematic reviews. A comprehensive search was conducted across major electronic databases, The following database were PubMed, Scopus and ProQuest. The inclusion criteria were clinical and a randomized control trial published between 2018 to 2023. The primary outcome measure was SSI rates. Results: The studies encompassed diverse perioperative intervention strategies, such as pre operative nasal ointment, pre operative showering and shaving, chlorhexidine mouthwash, and negative pressure therapy. In total, 436.762 articles regarding SSI prevention strategies in cardiac surgery were found in this study. However, around 7 articles that were met with the criteria of this study. Conclusion: Actions to reduce the incidence of SSI are carried out at all perioperative stages. The action taken was modifying the intervention and also using additional therapy carried out by health workers.

Comparative analysis of anti-osteoporosis medications in preventing vertebral body fractures after balloon kyphoplasty.

To determine optimal anti-osteoporosis medications, we compared romosozumab and teriparatide to alendronate as a control from perioperative BKP to the 1st postoperative year for treatment and secondary fracture prevention in osteoporosis. A total of 603 patients who underwent initial BKP for osteoporotic vertebral fractures were evaluated and categorized into five groups based on drug administration: romosozumab (group R, 155 patients), twice-weekly teriparatide (group TW, 48), weekly teriparatide (group W, 151), daily teriparatide (group D, 138), and alendronate (control) (group C, 111). The 1-year incidence of SVBFs, BMD change rate, and probability of requiring BKP were compared among the groups. SVBF incidence was 3.9%, 6.5%, 8.3%, 6.0%, and 14.4% in groups R, D, TW, W, and C, respectively, with all other groups exhibiting significantly lower rates than group C. The groups that administered the anabolic agents had a notably lower incidence of distant fractures than group C. Compared with group C, group R showed significantly higher BMD change rates in lumbar vertebral bodies at 4, 8, and 12months and group D at 12months. Anabolic agent groups exhibited significantly higher improvement rates than group C after conservative treatment alone. The anabolic agents were found to be more effective at reducing the incidence of SVBF (especially distant vertebral fractures) than alendronate. These agents decreased the rate of repeat BKP even after the occurrence of a fracture. Overall, the use of an anabolic agent for the treatment of osteoporosis after BKP is better than the use of alendronate, even when treatment is initiated in the perioperative stage.

Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery.

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.

Perioperative estimations of oxygen consumption from LiDCO™plus-derived cardiac output and Ca-cvO2 difference: Relationship with measurements by indirect calorimetry in elderly patients undergoing major abdominal surgery.

Feasible estimations of perioperative changes in oxygen consumption (VO2) could enable larger studies of its role in postoperative outcomes. Current methods, either by reverse Fick calculations using pulmonary artery catheterisation or metabolic by breathing gas analysis, are often deemed too invasive or technically requiring. In addition, reverse Fick calculations report generally lower values of oxygen consumption. We investigated the relationship between perioperative estimations of VO2 (EVO2), from LiDCO™plus-derived (LiDCO Ltd, Cambridge, UK) cardiac output and arterial-central venous oxygen content difference (Ca-cvO2), with indirect calorimetry (GVO2) by QuarkRMR (COSMED srl. Italy), using data collected 2017-2018 during a prospective observational study on perioperative oxygen transport in 20 patients >65 years during epidural and general anaesthesia for open pancreatic or liver resection surgery. Eighty-five simultaneous intra- and postoperative measurements at different perioperative stages were analysed for prediction, parallelity and by traditional agreement assessment. Unadjusted bias between GVO2 and EVO2 indexed for body surface area was 26 (95% CI 20 to 32) with limits of agreement (1.96SD) of -32 to 85 ml min-1m-2. Correlation adjusted for the bias was moderate, intraclass coefficient(A,1) 0.51(95% CI 0.34 to 0.65) [F (84,84) = 3.07, P<0.001]. There was an overall association between GVO2 and EVO2, in a random coefficient model [GVO2 = 73(95% CI 62 to 83) + 0.45(95% CI 0.29 to 0.61) EVO2 ml min-1m-2, P<0.0001]. GVO2 and EVO2 changed in parallel intra- and postoperatively when normalised to their respective overall means. Based on this data, estimations from LiDCO™plus-derived cardiac output and Ca-cvO2 are not reliable as a surrogate for perioperative VO2. Results were in line with previous studies comparing Fick-based and metabolic measurements but limited by variability of data and possible underpowering. The parallelity at different perioperative stages and the prediction model can provide useful guidance and methodological tools for future studies on similar methods in larger samples.

Les traitements périopératoires des cancers bronchiques non à petites cellules (CBNPC) : standards actuels et perspectives – de la chimiothérapie aux inhibiteurs des checkpoints immunitaires: Perioperative treatments for non-small cell lung cancer (NSCLC): Current standards and perspectives – from chemotherapy to immune checkpoint inhibitors

Surgery is the standard treatment for stage I to IIIA NSCLC. Several randomized phase III trials of adjuvant or neoadjuvant chemotherapy with platinum-based chemotherapy have been carried out, demonstrating a significant survival gain estimated at 5 % at 5 years in stages II and IIIA. This benefit has been confirmed by two meta-analyses based on individual data. In stage I, however, the benefit of chemotherapy has only been suggested for stages IB > 4 cm. The Lung-ART/IFCT-0503 trial recently showed that adjuvant radiotherapy has no place in N2 resected tumors. Immunotherapy is taking its place in the perioperative stages. Two Phase 3 trials have shown adjuvant benefit, but have not been approved in Europe on the basis of current data. Four phase III trials Checkmate-81, Neotorch, AEGEAN and KEYNOTE-671 have shown significant benefit from combining an immune checkpoint inhibitor with chemotherapy in the neoadjuvant setting, with European approval based on the results of Checkmate-816 in patients with PD-L1 ≥ 1 %.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Integrated strategy for preventing delayed renal graft function

Objective: to determine the efficacy and safety of an integrated strategy aimed at preventing delayed renal graft function (DGF).Materials and methods. From June 2018 to December 2022, 478 deceased-donor kidney transplants were performed at Botkin Hospital, Moscow. The patients were divided into two groups: Group I consisted of 128 patients who did not use the integrated strategy; Group II included 67 patients in whom the DGF prevention strategy was used at the perioperative stage. The integrated strategy involved the use of hypothermic oxygenated machine perfusion (HOPE) using expanded criteria donors, the use of a second warm ischemia (SWI) elimination device, personalized initial calcineurin inhibitor (CI) dosing, and use of alprostadil for high vascular resistance in renal graft arteries.Results. DGF occurred in 5 of 44 patients (11.4%) that used the integrated strategy, and in 13 of 44 patients (29.5%) in the control group. The differences were statistically significant (p = 0.034), there was a medium strength relationship between the traits (V = 0.225). The use of the integrated DGF prevention approach reduced the chances of developing DGF by a factor of 0.3 (95% CI: 0.1–0.95). The risk of DGF in the integrated strategy group was 61.3% of the risk of DGF in the non-strategy group, thus the relative risk (RR) is 1.63 (95% CI: 1.1–2.4). Median duration of graft function normalization was statistically significantly lower in group II: 5 (IQR: 3–9) versus 15 (IQR: 7–19) days (p = 0.012). Mean length of hospital stay was 19.1 ± 4.2 (95% CI: 14.5–26.1) bed-days in group I and 13.9 ± 3.4 (95% CI: 9.3–17.2) bed-days in group II. Differences in this indicator were also statistically significant (p = 0.043).Conclusion. The set of DGF prevention measures, developed at Botkin Hospital, evidence-based and implemented in clinical practice, can reduce the burden of modifiable risk factors of this complication significantly, thereby improving treatment outcomes for kidney transplant recipients considerably.

Anesthetic management of omphalopagus twins with pentalogy of Fallot undergoing separation surgery

The management of conjoined twins has several special aspects, mostly linked to the parents of the twins, such as communication, ethics and trust issues. A multidisciplinary team approach plus high level of vigilance at each perioperative stage is required. Conjoined omphalopagus twins, aged one year, were planned for separation surgery. They had fused liver, fused portal and hepatic veins, and partially fused intestines. Patient B appeared with complications of pentalogy of Fallot (PoF). The patient also had polycythemia (hemoglobin 14.7 g/dL, hematocrit 50%). Radiological features showed anterior abdominal wall with images of interconnected intestinal system between the two. In thoracoabdominopagus conjoined twins, the possibility of shared circulation becomes important especially associated with injection of intravenous drugs. The goal of anesthesia in PoF is to maintain cardiac output by maintaining heart rate, contractility and preload; and preventing right to left shunting via ventricular septal defect (VSD). Induction can cause vasodilation and the resultant decrease in systemic vascular resistance (SVR) can exacerbate right-to-left shunts. Monitoring end tidal CO2 (EtCO2) is needed. We present a report of anesthesia for such a case.&#x0D; Abbreviations: ASD: Atrial Septal Defect; PoF: Pentalogy of Fallot; VSD: Ventricular Septal Defect; SVR: Systemic Vascular Resistance&#x0D; Key words: Conjoined Twins; Pentalogy of Fallot; Congenital Heart Disease; Cyanosis; Anesthesia&#x0D; Citation: Purwoko, Santosa SB, Novianto B, Ganitafuri H. Anesthetic management of omphalopagus twins with pentalogy of Fallot undergoing separation surgery. Anaesth. pain intensive care 2023;27(3):434−440.&#x0D; DOI: 10.35975/apic.v27i3.2224&#x0D; Received: May 24, 2022; Reviewed: Sep 18, 2022; Accepted: Jan 04, 2023

Breast cancer-related lymphedema and recurrence of breast cancer: Protocol for a prospective cohort study in China.

The primary aim is to determine the factors associated with breast cancer-related lymphedema and to identify new associated factors for the recurrence of breast cancer and depression. The secondary objective is to investigate the incidence of breast cancer-related events (breast cancer-related lymphedema, recurrence of breast cancer, and depression). Finally, we want to explore and validate the complex relationship among multiple factors influencing breast cancer complications and breast cancer recurrence. A cohort study of females with unilateral breast cancer will be conducted in West China Hospital between February 2023 and February 2026. Breast cancer survivors in the age range of 17-55 will be recruited before breast cancer surgery. We will recruit 1557 preoperative patients with a first invasive breast cancer diagnosis. Consenting breast cancer survivors will complete demographic information, clinicopathological factors, surgery information, baseline information, and a baseline depression questionnaire. Data will be collected at four stages: the perioperative stage, chemotherapy therapy stage, radiation therapy stage, and follow-up stage. Data including the incidence and correlation of breast cancer-related lymphedema, breast cancer recurrence, depression, and medical cost will be collected and computed through the four stages above. For every statistical analysis, the participants will be classified into two groups based on whether they develop secondary lymphedema. Incidence rates of breast cancer recurrence and depression will be calculated separately for groups. Multivariate logistic regression will be used to determine whether secondary lymphedema and other parameters can predict breast cancer recurrence. Our prospective cohort study will contribute to establishing an early detection program for breast cancer-related lymphedema and recurrence of breast cancer, which are both associated with poor quality of life and reduced life expectancy. Our study can also provide new insights into the physical, economic, treatment-related and mental burdens of breast cancer survivors.

Disparities in Women With Endometriosis Regarding Access to Care, Diagnosis, Treatment, and Management in the United States: A Scoping Review.

Endometriosis is a benign gynecological condition that elicits chronic pain in 2-10% of reproductive-age women in the United States and exists in approximately 50% of women with infertility. It creates complications such as hemorrhage and uterine rupture. Historically, the gynecologic symptoms of endometriosis have been associated with economic strain and inferior quality of life. It is suspected that endometriosis diagnosis and treatment are affected by health disparities throughout gynecological care. The goal of this review was to collate and report the current evidence on potential healthcare disparities related to endometriosis diagnosis, treatment, and care across race, ethnicity, and socioeconomic status. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the Excerpta Medica Database (EMBASE), Medline Ovid, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycInfo databases for relevant articles on the topic. Eligibility was established a priori to include articles written in English, published between 2015-2022, and reported on cohort, cross-sectional, or experimental studies conducted in the United States. Initially, 328 articleswere found, and after screening and quality assessment, four articles were retained for the final review.Results indicated that White women had higher rates of minimally invasive procedures versus open abdominal surgeries than non-White women. White women also had fewer surgical complications compared to all other races and ethnicities. Black women had higher rates of perioperative complications, higher mortality, and spent more time in the perioperative stage than any other race or ethnicity. In the management of endometriosis, the limited research available showed that all non-White women encountered an increased risk of perioperative and postoperative complications compared to White women. More research is needed to explore diagnostic and treatment disparities beyond surgical management, socioeconomic barriers, andimproved representation of racial and ethnic minority women.

Perioperative temperature monitoring for patient safety: A period prevalence study of five hospitals

BackgroundMonitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. ObjectiveTo investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. DesignAn observational period-prevalence study over seven days across five Australian hospitals. SettingsFour metropolitan, tertiary hospitals and one regional hospital. ParticipantsWe selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. MethodsPatient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. ResultsThere were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68–0.89; emergency surgery: RR 0.89, 0.80–0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93–1.10; postanaesthetic care unit warming: RR 1.02, 0.98–1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98–1.28) were associated with monitoring rate. ConclusionsOur findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. RegistrationNot a clinical trial.