Postoperative Mechanical Ventilation Research Articles

Relative Factor Analysis of Postoperative Complications in Infants Below 1 Year Undergoing Repair of Ventricular Septal Defect Combined with Other Procedures through a Right Axillary Incision

Background: Compared to the traditional surgical repair of isolated ventricular septal defects, the proportion of complex congenital heart diseases has been increasing due to advancements in diagnostic capabilities and surgical techniques. Concomitant surgeries to correct multiple congenital heart diseases have become the preferred choice. Therefore, the evaluation of the safety of the combined correction of ventricular septal defects with other cardiac anomalies in young children through a right axillary incision and the analysis of related factors of perioperative complications needs to be investigated. Methods: A retrospective study was conducted on a single-center patient sample from January 2018 to December 2022 to compare outcomes between infants undergoing isolated ventricular septal defect (VSD) repair via a right axillary thoracotomy (control group) and those undergoing VSD repair combined with other cardiac procedures (experimental group). Results: A total of 397 eligible infants were included. After baseline data were matched using propensity score matching, the experimental group (n = 181) and the control group (n = 107) showed no significant differences in intraoperative blood loss, postoperative total drainage, length of hospital stay, duration of ICU monitoring, Vasoactive-Inotropic Score (VIS), pre-discharge left ventricular ejection fraction, fractional shortening (FS), postoperative severe pulmonary infection, reoperation, mortality, postoperative atrioventricular block, chylothorax, cardiac arrest, pericardial effusion, pneumothorax, pulmonary atelectasis, tricuspid regurgitation, myocardial injury, abdominal effusion, and metabolic acidosis. However, the control group had shorter surgical time [28.00 (90.00, 196.00) vs. 140.00 (95.00, 658.00) min, p < 0.05], shorter cardiopulmonary bypass time [58.00 (24.00, 114.00) vs. 66.00 (33.00, 422.00) min, p < 0.05], shorter aortic cross-clamp time [32.00 (17.00, 62.00) vs. 37.00 (15.00, 142.00) min, p < 0.05], and shorter postoperative mechanical ventilation time [22.00 (0, 99.00) vs. 23.00 (3.00, 193.00) h, p < 0.05]. The rate of abdominal effusion was lower in the experimental group than in the control group (p = 0.044). In the analysis of postoperative complication-related factors, the preoperative grade of tricuspid regurgitation, postoperative mechanical ventilation time, and VIS were positively correlated with abdominal effusion and satisfied the variable (p < 0.05) in each of three established models. In the single-factor analysis, both VIS and preoperative lymphocyte count were (p < 0.1) related to pericardial effusion; however, in the multi-factor analysis, only VIS met the threshold (p < 0.05). Gender, height, and VIS were each associated with pleural effusion (p < 0.05). Conclusion: The combination of ventricular septal defect repair with other cardiac procedures via a right axillary thoracotomy did not significantly differ from isolated VSD repair in terms of postoperative complications, monitoring, and length of hospital stay. However, increased surgical complexity was associated with longer surgical and mechanical ventilation times. Factors such as tricuspid regurgitation severity, duration of postoperative mechanical ventilation, and VIS were identified as relative factors for postoperative effusion. Additionally, the risk of postoperative pericardial effusion increased with higher VIS, while gender, height, and VIS were identified as relative factors for postoperative chylothorax.

Efficacy and safety of remimazolam tosylate for patients undergoing off-pump coronary artery bypass grafting: a study protocol for a non-inferiority randomised controlled trial in China

IntroductionMaintaining haemodynamic stability is crucial but challenging during the induction and maintenance of general anaesthesia (GA) in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Remimazolam tosylate is a novel...

Effects of Preoperative Nutritional Conditions on Postoperative Recovery in Neonates with Congenital Heart Disease

Objective: The effects of preoperative nutritional conditions on postoperative recovery in neonates with congenital heart disease (CHD) were evaluated in this study. Methods: A retrospective analysis of data from neonates with CHD who underwent surgery at our hospital from January 2020 to December 2022 was conducted. The relationships between preoperative nutritional conditions and neonatal postoperative recovery were analyzed. Results: Eighty neonates were included in this study. The average gestational age was 38.4 (37, 39.2) weeks, the average birth weight was 3.1 (2.7, 3.4) kg, the average age at surgery was 23 (21, 26) days, and the average preoperative weight was 3.5 (3.0, 3.9) kg. The postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay of preterm neonates were much longer than those of full-term neonates (p < 0.05). In addition, these values were notably greater for neonates with birth weights ≤3 kg than for neonates with birth weights >3 kg (p < 0.05). The correlation analysis suggested that gestational age, birth weight, preoperative weight-for-age z-score (WAZ) and preoperative height-for-age z-score (HAZ) were negatively correlated with postoperative mechanical ventilation duration, length of intensive care unit stay, and length of hospital stay. Conclusions: Preterm birth and low birth weight significantly prolong the duration of mechanical ventilation and postoperative intensive care unit and hospital length of stay. More attention should be given to nutritional management during the perioperative period for premature or low-birth-weight neonates with CHD. For neonates with CHD requiring surgery, the time available for nutritional support before surgery is very limited; thus, more attention and guidance are needed for prenatal nutritional strategies.

Effects of paravertebral block on postoperative analgesia in children undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary bypass: protocol for a randomised controlled trial

IntroductionThis study aims to determine whether paravertebral block (PVB) provides better postoperative analgesia, lower incidence of complications and faster recovery compared with local anaesthetic wound infiltration for school-aged children undergoing...

Postoperative mechanical ventilation after corrective Tetralogy of Fallot surgery in infants: Assessment of perioperative factors and radiographic severity scores.

Postoperative mechanical ventilation after corrective Tetralogy of Fallot surgery in infants: Assessment of perioperative factors and radiographic severity scores.

Study on the Predictive Value of a Pulmonary Edema Imaging Score for Delayed Extubation in Patients after Heart Valve Surgery on Cardiopulmonary Bypass.

Delayed extubation with mechanical ventilation after cardiac valve surgery is an important clinical challenge. Early extubation can improve the survival rate and prognosis of patients. The study aims to explore the predictive value of a chest X-ray pulmonary edema imaging score on the first day after surgery for delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass. Retrospective analysis of the clinical data of patients undergoing cardiac valve surgery under extracorporeal circulation admitted to the intensive care unit of Zhongshan Hospital Affiliated with Fudan University (Xiamen) from January 2020 to October 2023. The patients were divided into an early extubation group according to the postoperative mechanical ventilation time (time: <24 h) and a delayed extubation group (time: ≥24 h). The radiographic assessment of lung edema (RALE) score was performed on the chest X-ray of the patient on the first day after surgery to analyze the correlation between delayed extubation of mechanical ventilation and the chest radiograph RALE score on the first day after surgery and to verify its predictive performance. Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, PaCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation (p = 0.013, 0.001, 0.034, <0.001, <0.001, <0.001, <0.001, <0.001, 0.014, and <0.001, respectively). No significant differences were observed in the proportion of males and the lactate level after the first 24 h between the two groups (p = 0.792 and 0.191, respectively). The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant (p < 0.001). Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively. The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value.

Outcomes of the Modified Warden Procedure for Partial Anomalous Pulmonary Venous Connection Drainage to a High Location in the Superior Vena Cava

To report the safety and effectiveness of a modified Warden procedure. Twenty-six (26) patients underwent modified Warden surgery at our centre from September 2017 to September 2021. In all patients, the superior vena cava (SVC) was reconstructed by turning the atrial wall in the main body of the right atrium upwards and applying fresh autologous pericardial patches. There were 13 male patients and 13 female patients, and the median age of the patients was 7.0 (range, 0.3-47.0) years. The median follow-up time after surgery was 47.0 (range, 32.0-80.0) months. The aortic cross-clamp time was 108.50±34.72 minutes, the cardiopulmonary bypass time was 154.81±41.65 minutes, the median postoperative mechanical ventilation time was 8.5 (range, 0.0-91.0) hours, the median intensive care unit stay was 43.5 (range, 15.0-352.0) hours, and the median length of postoperative hospital stay was 7.0 (range, 6.0-19.0) days. All patients were safely and successfully discharged from the hospital. No deaths or sinus node dysfunction occurred during the follow-up period. The mean gradient of the reconstructed SVC and/or the right pulmonary vein (PV) increased in eight patients and decreased to less than 1 mmHg in six patients. One (1) adult patient had already undergone two vascular interventions, and one child had persistent stenosis but did not undergo reoperation at the time of the study. In addition, two patients were subjected to pericardial windowing. A modified Warden technique using a right atrial flap and autologous pericardium effectively corrected the high-plane connection between the PVs and SVC. This technique effectively avoids sinus node dysfunction; however, a short-term increase in the differential pressure of the re-established SVC or PV after the procedure is acceptable, and reintervention is required only in rare cases.

Clinical outcomes of children with COVID-19 and appendicitis: a propensity score matched analysis.

Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy. A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children's hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann-Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements. Overall, 51,861 children of median age 11y (IQR: 8-14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1-4 vs. 2d, IQR: 1-5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected. Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19. Level III.

Anaesthetic and Procedural-Related Complications in Transcatheter Aortic Valve Implantation (TAVI) and Its Outcome: A Retrospective Observational Study.

Background Transcatheter aortic valve implantation (TAVI) presents significant challenges in its management, not only due to the technical complexity of the procedure but also because it is primarily performed on elderly patients who often have multiple comorbidities, making perioperative care and post-procedural recovery more intricate and demanding. The study's objective is to discover the challenges faced during the TAVI procedure and the frequency of complications that occurred during and after the procedure. Methods This is a single-centre retrospective study. Patients with symptomatic severe aortic stenosis, considered at high risk for conventional surgical aortic valve replacement, were included, their medical records were extracted, and data were collected. Endpoints at one-year follow-up comprised one-year mortality, cause of death, and valve dysfunction. Procedural-related complications were also noted as procedural-related outcomes. Results The mean age and body mass index (BMI) of the patients were 73.9 years and 28.3 kg/m2, respectively. The main comorbidities were hypertension (n = 33, 84.6%), diabetes mellites (n = 21, 53.8%), ischemic heart disease (n = 6, 15.38%), and chronic obstructive pulmonary disease (COPD) (n = 5, 12.8%). The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 5.75% with a median of 2.38%. General anaesthesia was received (n = 27), whereas the rest of the cases were performed under monitored anaesthesia care (MAC). None of the patients developed surgical site hematoma or massive blood loss. Post-operative mechanical ventilation was required in three patients (10.2%), and two (5.12%) of them expired in the intensive care unit. One patient had on-table mortality. Conclusion A low rate of anaesthesia and procedural-related complications was observed. The TAVI procedures done in our centre are promising and parallel to the finest global centres' outcomes in terms of procedural triumph and complication rate.

Effects of preoperative respiratory muscle training for improvement of postoperative health related quality of life in mitral valve replacement patients.

A patient's defective mitral valve is replaced as part of a treatment called mitral valve replacement (MVR) with a mechanical or biological (bioprosthetic) valve. To evaluate the effects of preoperative respiratory muscle training (RMT) on the improvement of postoperative Health related quality of life in MVR patients. A quasi-experimental study was conducted at Faisalabad Institute of Cardiology. A Sample of 40 adult patients aged 25-50years of both genders who underwent MVR was selected and divided into two groups Group 1 (Respiratory Muscle Training Group) was received RMT consisting of 10-15 repetitions a day for 5days; for 3weeks. Whereas Group 2 (Conventional Group) was receive breathing exercise consisting of 10-12 repetitions a day for 5days; for 3weeks. Modified Healthy Heart Questionnaire (HHQ-GP-1) was used as screening tool. In outcome measuring tools Health Related Quality of life Questionnaire (EuroQol), New York Heart Association, was used at baseline, 3rd week and postoperatively. Duration of Postoperative Mechanical Ventilation (hours) and Hospital Stay was also noted as outcome measures of this study. Results obtained indicate that level of Self-Care in EuroQol-5-D-5L has improved in group 1 3.35±1.03 to 1.35±0.48 showing significant improvement similarly in case of Hospital Length of Stay, Mechanical ventilation 4.05±0.68 to 5.05±0.51 and Pain 65.25±8.34 to 71.50±6.70 has improved. It was concluded that Respiratory Muscle Training and Conventional Muscle Training both are effective in MVR patients. But RMT is more effective in improving self-care, reducing pain, Hospital Length of Stay and Mechanical Ventilation in postoperative period as compared to Conventional Muscle Treatment.

Preoperative neurologic comorbidity and unanticipated early postoperative reintubation: a multicentre cohort study

BackgroundThe risk of respiratory complications is highest in the first 72 h post-surgery. Postoperative respiratory events can exacerbate pre-existing respiratory compromise and lead to reintubation of the trachea, particularly in patients with neurologic disorders. This study examined the association between neurologic comorbidities and unanticipated early postoperative reintubation in children. MethodsThis multicentre, 1:1 propensity score-matched study included 420 096 children who underwent inpatient, elective, noncardiac surgery at National Surgical Quality Improvement Program reporting hospitals in 2012–22. The primary outcome was unanticipated early postoperative reintubation within 72 h after surgery. The secondary outcome was prolonged postoperative mechanical ventilation, defined as ventilator use >72 h. We also evaluated 30-day mortality in patients requiring reintubation. ResultsCerebral palsy was associated with the highest risk of early reintubation (adjusted relative risk [RRadj]: 1.97, 95% confidence interval [CI]: 1.44–2.69; P<0.01), followed by seizure disorders (RRadj: 1.87, 95% CI: 1.50–2.34; P<0.01), neuromuscular disorders (RRadj: 1.76, 95% CI: 1.41–2.19; P<0.01), and structural central nervous system abnormalities (RRadj: 1.35, 95% CI: 1.13–1.61; P<0.01). Unanticipated early postoperative reintubation was associated with an eight-times increased risk of 30-day mortality (adjusted hazard ratio: 8.1, 95% CI: 6.0–11.1; P<0.01). Risk of prolonged postoperative mechanical ventilation was also increased with neurologic comorbidities, particularly seizure disorders (RRadj: 1.73, 95% CI: 1.55–1.93; P<0.01). ConclusionsChildren with neurologic comorbidities have an increased risk of unanticipated early postoperative reintubation and prolonged mechanical ventilation. Given the high mortality risk associated with these outcomes, children with neurologic comorbidities require heightened monitoring and risk assessment.

Nebulized Budesonide Prevents Airway Inflammation in Children with High Total IgE Levels After Open Heart Surgery with Cardiopulmonary Bypass: A Prospective Randomized Controlled Trial.

Cardiopulmonary bypass (CPB) is a crucial technique used to repair congenital heart defects (CHD); however, it may induce inflammatory response, leading to airway inflammation and need for prolonged mechanical ventilation. In this study, we aimed to evaluate the effect of budesonide nebulization in children with high serum total immunoglobulin E (tIgE) levels undergoing surgical repair of CHD via CPB. We conducted a randomized, single-center, controlled trial at a tertiary teaching hospital. One-hundred and one children with high tIgE were enrolled and randomized into the budesonide nebulization group (BUD group, n = 50) or the normal saline nebulization group (NS group, n = 51) between January 2020 and December 2020. Budesonide or normal saline was administered through a vibrating mesh nebulizer during mechanical ventilation every 8h. Blood and bronchoalveolar lavage fluid (BALF) samples were examined and data on airway mechanics and clinical outcomes were recorded. IL-6 and IL-8 levels in the blood and BALF samples significantly increased after CPB in both groups. Budesonide inhalation reduced IL-6 and IL-8 levels in the blood and BALF samples in children with high tIgE (P < 0.05). The mean airway pressure, PCO2, and oxygen index in the BUD group were significantly lower than those in the NS group after the first inhalation dose and persisted until almost 24h after surgery. The peak inspiratory pressure and drive pressure were lower in the BUD group than in the NS group at nearly 24h after surgery, with no significant difference at other time points. Additionally, the duration of mechanical ventilation, number of noninvasive ventilations after extubation, and number of patients using aerosol-inhaled bronchodilators after CICU in the BUD group were significantly lower than those in the NS group (P < 0.05). Children with high preoperative tIgE levels are at risk of airway inflammation after cardiopulmonary bypass. Inhaling budesonide during postoperative mechanical ventilation can reduce the intensity of inflammatory reactions, shorten the duration of mechanical ventilation, reduce airway pressure and the utilization of NIV after extubation.

The application of ERAS in the perioperative period management of patients for lung transplantation

ObjectiveTo explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation. MethodsWe retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores. ResultsComparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05). ConclusionThe ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.

Impact of Dexmedetomidine on Hemodynamics, Plasma Catecholamine Levels, and Delirium Incidence Among Intubated Patients in the ICU--A Randomized Controlled Trial.

To investigate the impact of various sedative medications on hemodynamics and plasma levels of epinephrine (E) and norepinephrine (NE) in mechanically ventilated patients postoperatively in the intensive care unit (ICU). Ninety-seven patients admitted to the ICU undergoing postoperative mechanical ventilation with tracheal intubation and continuous analgesic sedation following general anesthesia were randomly assigned to either the observation group (dexmedetomidine) (n = 49) or the control group (propofol) (n = 48) in this randomized controlled trial. Upon transfer to the ICU, vital signs (heart rate [HR], respiratory rate [RR], mean arterial pressure [MAP]) were recorded prior to the initiation of the sedation treatment (T0), at one-hour post sedation (T1) and two hours following tracheal extubation (T2), plasma levels of epinephrine (E) and norepinephrine (NE) were measured at these time points. The incidence of delirium was recorded in both groups. MAP between the two groups at both T0 and T1 At T2 plasma NE and HR were found to be lower in the observation group compared to the control group (P < 0.001). Among the patients receiving antihypertensive medication in the ICU, NE levels were significantly lower in the observation group compared to the control group (P = 0.019) Among the patients not receiving antihypertensive medication, both NE (P < 0.001) and MAP (P = 0.001) levels were lower in the observation group compared to the control group. The incidence of delirium in the observation group (dexmedetomidine) was not significantly different from that in the control group (propofol). With dexmedetomidine sedation, blood pressure fluctuated less, plasma catecholamine levels were lower, and sympathetic inhibition was stronger in patients before and after extubation. However, it did not significantly reduce the incidence of postoperative delirium.

A Clinical Study on the Treatment of Adult Atrial Septal Defect Using Thoracoscopic-Assisted Right Vertical Infra-Axillary Thoracotomy, Total Thoracoscopic, and Median Sternotomy Approaches

Background: To compare the clinical outcomes of three surgical approaches for treating adult atrial septal defects (ASD): Thoracoscopic-assisted right vertical infra-axillary thoracotomy (TARVIAT) under central cardiopulmonary bypass (CPB), totally thoracoscopic (TT), and median sternotomy (MS) approaches, and to assess the feasibility and safety of the TARIAVT approach. Methods: This study reviewed 62 cases patients of repairing atrial septal defects via a TARVIAT and central extracorporeal circulation from 2019 to 2023. The patients included 22 males, aged between 18 and 59 years, with a mean age of 33.35 ± 10.97 years. The surgical indications were adult patients with moderate to severe tricuspid regurgitation and who were unsuitable for interventional closure of atrial septal defects. Exclusion criteria included patients diagnosed with severe pulmonary hypertension or Eisenmenger syndrome. Additionally, 67 patients who underwent TT approach repair of ASD and 72 patients who underwent MS approach repair of ASD were selected as the control groups. Operative time, CPB time, aortic clamping time, postoperative Intensive care unit (ICU) stay, postoperative mechanical ventilation time, 24-hour postoperative chest drainage, incision length, postoperative hospital stay, hospital costs, and postoperative complications were compared to assess statistical differences. Results: There were no deaths or major complications observed in any of the three groups. Statistically significant differences were found among the three groups in terms of extracorporeal circulation time, aortic clamping time, surgical time, 24-hour postoperative chest drainage, postoperative mechanical ventilation time, postoperative ICU stay, incision length, and postoperative hospital stay (p &lt; 0.05). The TT group exhibited longer CPB and aortic clamping times compared to the TARVIAT and MS groups, while demonstrating lower 24-hour postoperative chest drainage volumes compared to the TARIAVT and MS groups. Both the TARVIAT and TT groups showed shorter surgical times, postoperative mechanical ventilation times, postoperative ICU stay, incision lengths, and postoperative hospital. However, there were no statistically significant differences among the three groups regarding hospital costs, postoperative left ventricular ejection fraction (LVEF) values, and the incidence of postoperative complications (p &gt; 0.05). Conclusions: TARVIAT under central CPB is feasible and safe for adult patients. This approach presents lower invasiveness, shorter operative duration, and faster recovery compared to other methods. In conclusion, the TARVIAT approach for repairing adult ASD is both safe and effective, offering a viable surgical option for this condition.

Simultaneous thoracoscopic surgery in patients with atrial fibrillation and early-stage lung cancer

ObjectivesAtrial fibrillation (AF) and early-stage lung cancer can both be treated under thoracoscopy. This study aims to evaluate the feasibility and safety of simultaneous thoracoscopic surgery for atrial fibrillation and early-stage lung cancer. MethodsThis was a single-center, retrospective study of 865 patients with paroxysmal or non-paroxysmal AF who underwent surgical ablation between October 2014 and December 2021. Patients were divided into two groups according to whether they have undergone simultaneous thoracoscopic early-stage lung cancer surgery and resulting in 24 pairs of patients. ResultsIn total, 48 patients (24 matched pairs) were analyzed. The age was 63.71 ± 8.43 years. Procedure time and postoperative mechanical ventilation time were significantly lower in the group AF than group AFLC (Atrial fibrillation and lung cancer) (140.38 ± 27.53 vs. 230.79 ± 59.06 min, P<0.001; 5 vs 6.5 h, P = 0.002). There was no significant difference between the groups in terms of operative bleeding volume (90.00 ± 29.78 vs 85.83 ± 53.56 ml, P = 0.741), total postoperative drainage volume (1020.83 ± 516.5 vs 1406.25 ± 840.33 ml, P = 0.067), ICU (intensive care unit) length of stay (LOS) (43.5 vs 44 h, P = 0.33), hospitalization LOS (9.29 ± 1.92 vs 8.58 ± 1.98 days, P = 0.214) and incidence of freedom from AF or complications. ConclusionsSimultaneous thoracoscopic surgical AF ablation and early-stage lung cancer is safe and feasible. It can be used as an alternative method for coexisting atrial fibrillation and lung cancer with acceptable operative risks.

Respiratory system compliance during anesthesia induction and postoperative mechanical ventilation needs: An observational study.

Respiratory system compliance (Crs) is a simple indicator of lung flexibility. However, it remains unclear whether a low Crs during anesthesia induction (iCrs) is associated with an increased risk of postoperative mechanical ventilation. This retrospective observational study was conducted using a local database. All mechanically ventilated postoperative ICU patients were included in this study. The duration of postoperative mechanical ventilation, length of hospital stay, and in-hospital mortality were compared between the low iCrs group (<25% of distribution) and the normal iCrs group. A total of 315 patients were classified into the low iCrs (<39 mL/cmH2O) group (n = 78) or the normal iCrs group (n = 237). Low iCrs was associated with a higher chance of mechanical ventilation in 28 days (log-rank test, p < 0.001). The duration of hospital stay was similar. Multivariate analysis showed that in-hospital mortality was higher in the low iCrs group than in the normal iCrs group (adjusted odds ratio, 6.04 [1.13, 32.26]; p = 0.04). Low iCrs was associated with an increased risk of requiring postoperative mechanical ventilation. An additional result of poor survival related to low iCrs may require further study.

Impact of perioperative COVID-19 infection on postoperative complication in cesarean section using Korean National Health insurance data

The vulnerability during pregnancy has raised concerns about the potential impact of COVID-19 on obstetric anesthesia, an essential aspect of maternal care during cesarean section procedures. To evaluate the influence of COVID-19 infection on obstetric anesthesia during cesarean section, we analyzed the data from Korean National Health Insurance System (NHIS). This retrospective study utilized data from Korean NHIS. We included patients admitted with operation codes specific to cesarean section between January 1, 2020, and December 31, 2021. We classified patients into a COVID (+) group with a diagnosis code (U071) 30 days around surgery and a COVID (−) group without the code in the same period. The primary outcome was 30-day mortality that was defined as death within 30 days of admission due to any causes. Secondary outcomes were pulmonary complications (pneumonia, acute respiratory distress syndrome [ARDS], pulmonary thromboembolism [PTE], or unexpected postoperative mechanical ventilation), ICU admission, cardiac arrest, myocardial infarction [MI], other thromboembolic events, surgical site infection, sepsis, acute renal failure [ARF], and hepatic failure. Among 75,268 patients who underwent cesarean section, 107 had a COVID-19 diagnosis code, while 75,161 did not. After 1:4 propensity score matching (PSM), 535 patients were included in each group. 30-day mortality showed no significant differences between the two groups both before and after PSM. The COVID (+) group demonstrated significantly elevated rates of pneumonia, ARDS, PTE, and surgical site infection both before and after PSM. Hospital length of stay and admission costs were also significantly longer and higher, respectively, in the COVID (+) group before and after PSM. In subgroup analysis, no differences were observed in mortality and postoperative complications based on the anesthesia method after matching. COVID-19 infection is associated with increased rates of postoperative complications, including pneumonia, ARDS, PTE, surgical site infection, longer hospital stays, and increased admission costs, in patients who underwent cesarean section.

Comparative effectiveness of neuraxial versus general anesthesia in total joint replacement surgery: an updated retrospective analysis using more recent data

IntroductionOver a decade ago, our study group showed improved outcomes among total hip/knee arthroplasty (THA/TKA) patients given neuraxial versus general anesthesia. As the use of neuraxial anesthesia has increased and...

Challenges in Assessment and Management of Postoperative Agitation and Delirium in a Stroke Patient with Limited English Proficiency: Case Report.

While Title VI of the Civil Rights Act of 1964 mandates use of interpreters for patients with limited English proficiency, significant disparities persist in intensive postsurgical care. We present the case of a 60-year-old Vietnamese-speaking man with a Type A aortic dissection requiring postoperative mechanical ventilation and stroke care. Despite use of a remote video interpreter, our language-discordant nursing and physician providers faced challenges in managing agitation and delirium and assessing neurological function. This case highlights the need for adequate interpretation equipment, linguistic diversity among providers, and interventions to promote and enable consistent certified and professional medical interpreter use.