Preoperative Administration Research Articles

COMPARATIVE STUDY OF THE USAGE OF RECTAL TRAMADOL SUPPOSITORY VERSUS WITHOUT SUPPOSITORY FOR POST-OPERATIVE PAIN MANAGEMENT IN CASES OPERATED UNDER SPINALANESTHESIA

Introduction: Various techniques and medications are employed to lessen postoperative discomfort. Present study aimed to assess the efcacy of pre-operative tramadol suppository administration for the management of post-operative pain in patients undergoing surgery under spinal anaesthesia, requirement of analgesia and duration of hospital stay. Material & Method: The present comparative study with patients presenting to the department of General Surgery, AVMCH who were posted for elective surgeries & with no evidence/signs of inammation/infection consenting were included in the study. Patients were grouped based on utility of tramadol suppository, cases were with administration of rectal suppository and control group was with no pre-operative administration of rectal suppository. The patients were assessed for the post-operative pain at different point of time, mean duration of hospital stay and any side effects like nausea, vomiting between the groups. Results: Total 152 patients included in the study, with mean age of 47.57yrs. The pain score was signicantly lower among the cases compared to control at 1st hr, 6th hr, 12th hr and 24th hr post-operative period. (p<0.05) There was signicant shorter duration of hospital stay among the cases (2.3days) compared to controls (3.2days).(p<0.05) Conclusion: A signicant pain management in post-operative period with the utility of tramadol suppository administration compared to the patients without suppository

Influence of discontinuation of prophylactic antimicrobial agent for trabeculectomy

BackgroundThere is no unified view of the necessity of prophylactic antimicrobial agents in trabeculectomy. Preoperative prophylactic antimicrobial agent injection and cefazolin sodium (CEZ) for trabeculectomy were discontinued at the Hiroshima University Hospital. In this study, we evaluated whether discontinuation of preoperative administration of CEZ in ophthalmology affects the incidence of postoperative infections.MethodsWe retrospectively investigated patient background, concomitant medications, subconjunctival dexamethasone sodium phosphate (DEX) injection at the end of the surgery, and the incidence of infective endophthalmitis within 6 weeks after surgery in the CEZ and non-CEZ groups. We also performed propensity score matching for background matching. Statistical analysis was performed using the Mann-Whitney U-test and Fisher’s exact test.ResultsThe incidence of postoperative endophthalmitis was not significantly different between 629 and 751 patients in the CEZ and no-CEZ groups, respectively (0 in the CEZ group and 2 in the no-CEZ group, P = 0.504). More patients in the CEZ group were taking diabetes drugs preoperatively (P = 0.028) and fewer patients were receiving subconjunctival DEX at the end of surgery (P < 0.001) than those in the non-CEZ group. Propensity scores were calculated using the risk factors for postoperative infection as covariates, and matching (580 patients in the CEZ group and 580 patients in the non-CEZ group) showed no significant difference in the incidence of postoperative endophthalmitis (P = 0.500).ConclusionsThere was no significant difference in the incidence of endophthalmitis after trabeculectomy between the CEZ and non-CEZ groups, suggesting a decreased need for CEZ injections before trabeculectomy.

The Efficacy of Bisphosphonate in the Treatment of Giant Cell Tumour of the Bone: A Systematic Review and Meta-Analysis.

Anti-osteoclastic mechanism of Bisphosphonate (BP) is crucial to treat Giant Cell Tumour of the Bone (GCTB), however no established guidelines of its use have been published. This systematic review and meta-analysis is the first to summarise recent clinical studies on the subject. A systematic search was performed based on PRISMA guidelines for clinical trials of BP administration in GCTB. Baseline data including BP regimen, dose and timing was summarised. The primary outcomes assessed were recurrence rate, metastases, survival rate, functional outcome, clinical outcome, radiological outcome, and adverse effect. We identified 8 articles from 2008-2020. Most studies administer 4mg of Zoledronic acid post-operatively, with five studies mentioning pre-operative administration and six studies describing post-operative administration. There was a total of 181 GCTB cases analysed in this study. The BP group presented lower recurrence rate than control group (three studies; Odds Ratio [OR] 0.15; 95% Confidence Interval [CI], 0.05 - 0.43; p<0.05; heterogeneity, I2=0%). As for survival rate, BP group is comparable to control group (two studies; OR 1.67; 95% CI, 0.06 - 48.46; p=0.77; heterogeneity, I2=65%). Bisphosphonate therapy offers satisfactory recurrence rate, functional outcome, clinical outcome, radiological outcome, survival rate and metastases rate in patients with GCTB, with minimal adverse effects. Pre- and post-operative administration of bisphosphonates in combination might be the most beneficial in minimalising the recurrence rate.

The Impact of Peri-operative Enteral Immunonutrition on Post-operative Complications in Gastrointestinal Cancer Surgery: A Meta-Analysis.

Immunonutrition (IMN) in gastrointestinal (GI) cancer surgery remains under-utilised and contentious. Despite previous meta-analysis reporting benefit, most recent randomised control trials (RCTs) have failed to demonstrate this and have recommended against its routine use. A contemporary meta-analysis may contribute to the recommendations for immunonutrition use and help select which patients may benefit. The objective of this study was to review IMN and its impact on post-operative outcomes in GI cancer surgery, exploring its role in both malnourished and non-malnourished populations, the optimal dose to use, cancer type of patients using IMN and the timing of IMN relative to the peri-operative period. The EMBASE and Medline databases were searched from 2000 to 2022 for RCTs evaluating IMN in adults undergoing GI cancer surgery. Thirty-seven studies were included (22 pre-operative IMN studies, 11 peri-operative IMN trials and 9 post-operative IMN trials; 4 trials had multiple IMN protocols) that reported on 3793 patients. The main outcome of post-operative infectious complications was reduced with IMN [odds ratio (OR) 0.58, 95% confidence interval (CI) 0.47-0.72]. This association was significant in subgroup analysis only with pre-operative and peri-operative administration and in trials including upper GI cancers, colorectal cancer and 'mixed GI' cancer populations, and significance was independent of nutritional status. IMN in pooled analysis reduced surgical site infection (SSI) (OR 0.65, 95% CI 0.52-0.81), anastomotic leak (OR 0.67, 95% CI 0.47-0.93) and length of stay (LOS) by 1.94 days (95% CI -3 to -0.87). Immunonutrition was associated with reduced post-operative complications. Peri-operative administration may be the preferred strategy in reducing infectious complications, anastomotic leak, SSI and LOS.

Effects of preoperative intravenous glutamine administration on cardiac and renal functions in patients undergoing mitral valve replacement surgeries: A randomized double-blind controlled trial

ABSTRACT Background Preoperative poor nutrition greatly raises the risk of complications and increases length of stay (LOS). Glutamine deficiency may impair immune functions, reduce myocardial adenosine triphosphate–adenosine diphosphate (ATP-ADP) substrate and decrease myocardial glutathione level. We evaluated the effects of preoperative glutamine administration in patients undergoing mitral valve replacement surgery upon cardiac and renal outcomes or hospital/ICU LOS. Methods This prospective randomized double-blinded study included 60 patients above 18 up to 60 years undergoing mitral valve replacement. For 3 days preoperatively, Group N patients received glutamine intravenously 0.4 g/kg/day while Group C patients received intravenous normal saline as placebo. The primary outcome was to assess the effects of glutamine on cardiac function as reflected on proBNP (brain natriuretic peptide) during 4 postoperative days. Secondary outcomes included renal function, vasoactive inotropic score, duration of mechanical ventilation, and hospital/ICU stays. Results Postoperative proBNP was significantly lower in Group N during the entire period. It was significantly decreased on the first postoperative day in both groups in comparison to the preoperative values. No significant changes were recorded regarding renal functions, and duration of mechanical ventilation between groups. Also, there was signifiacant difference between the two studied groups regarding the vasoactive inotropic score at the 12th, 18th, 24th and 48th hours with lower scores in Group N. ICU and hospital stays were significantly lower in Group N than Group C. Conclusion Short term of preoperative intravenous glutamine 0.4 g/kg/day decreased the postoperative proBNP level and hospital/ICU stays in mitral valve replacement surgery. No significant implication was reported upon postoperative human NGAL level or kidney functions.

Effect of Preoperative Administration of Intravenous Ferric Carboxymaltose in Patients with Iron Deficiency Anemia after Off-Pump Coronary Artery Bypass Grafting: A Randomized Controlled Trial.

Patients scheduled for cardiac surgery often have anemia and iron deficiency. We investigated the effect of the preoperative administration of intravenous ferric carboxymaltose (IVFC) in patients with iron deficiency anemia (IDA) who were due to undergo off-pump coronary artery bypass grafting (OPCAB). Patients who were due to undergo elective OPCAB between February 2019 and March 2022 who had IDA (n = 86) were included in this single center, randomized, parallel-group controlled study. The participants were randomly assigned (1:1) to receive either IVFC or placebo treatment. Postoperative hematologic parameters [hemoglobin (Hb), hematocrit, serum iron concentration, total iron-binding capacity, transferrin saturation, transferrin concentration, and ferritin concentration] and the changes in these parameters during the follow-up period were the primary and secondary outcomes, respectively. The tertiary endpoints were early clinical outcomes, such as the volume of mediastinal drainage and the need for blood transfusions. IVFC treatment significantly reduced the need for red blood cell (RBC) and platelet transfusions. Despite receiving fewer RBC transfusions, patients in the treatment group had higher levels of Hb, hematocrit, and serum iron and ferritin concentrations during weeks 1 and 12 after surgery. No serious adverse events occurred during the study period. Preoperative IVFC treatment in patients with IDA undergoing OPCAB improved the values of the hematologic parameters and iron bioavailability. Therefore, is a useful strategy for stabilizing patients prior to OPCAB.

Study on the Effect of Topical Pre-operative Nonsteroidal Anti-inflammatory Drugs in Maintaining Mydriasis during Small Incision Cataract Surgery

A prospective, randomized, double masked, single centered comparative study done in the Bangladesh Naval Ship Patenga, Chattogram, Bangladesh, from July 2021 to June 2022, to assess the clinical benefits and effectiveness of prophylactic pre-operative topical administration of NSAIDs in maintaining mydriasis during small incision cataract surgery. Thirty patients underwent small incision cataract surgery with intra ocular lens implantation were randomized to compare the efficacy of topical NSAIDs drops (Group-A) and placebo drops (Group-B) in maintaining peroperative mydriasis. Balanced salt solution containing non preservative adrenaline was used in all patients. Pupil size was measured prior to the corneal incision and after the completion of the operation. The two groups were analyzed with respect to the changes in pupillary diameter at the beginning and at the end of the operation. The change in pupil size was significantly different among the two groups at the end of the surgery. The mean vertical and horizontal diameter of the two groups were near about similar at the beginning of the surgery. Significant differences were seen after IOL implantation with the NSAIDs group having the larger mean diameter in both vertical (P=0.003) and horizontal (P=0.008) pupillary measurements at the conclusion of surgery. Topical NSAIDs has been shown to be a more effective inhibitor of meiosis during per operative uncomplicated small incision cataract surgery and provides a more stable mydriatic effect during surgery compared to the placebo group.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 22-26

Akciğer Kanserinde Sağkalım ve Evre

Aim of study: &#x0D; Lung cancer is the leading cause of cancer death worldwide. Although the 5-year survival rates of for non-small cell lung carcinoma (NSCLC) ranges from 20% to 70%. The present study investigates the rates of early recurrence in a total of 83 patients operated for NSCLC and presents the related findings in reference to the data available in the literature.&#x0D; Materials and Methods:&#x0D; Patients who underwent lung resection for malignancy between March 2019 and September 2021 were retrospectively examined. The patient data, including age, gender, presence of preoperative chemotherapy administration, operations performed, operation dates, pathology results, postoperative staging, survival, and relapses, were documented. Ethical approval for this study was obtained from the ethics committee of Ankara Bilkent City Hospital. Approval number is E1-20-817&#x0D; Results:&#x0D; A total of 83 patients who underwent lung resection for malignancy between March 2019 and September 2021 were examined. The patients had a median age of 62 years. Of the total number of patients four patients developed recurrence and 79 continued their follow-up without any recurrence. Of the patients who underwent lung resection, eight (9.6%) patients died within the first postoperative 2-year period. The mean survival period of these eight patients was 14.6 months (7–20 months).&#x0D; Conclusion:&#x0D; Although various parameters, such as age, gender, pathological type, and location of the tumor are examined and compared, according to the available data on the long-term survival of surgical patients, it is known that the only parameter that affects survival is the pathological stage of the patient.

Perioperative Tracking of Intravenous Iron in Patients Undergoing On-Pump Cardiac Surgery: A Prospective, Single-Center Pilot Trial.

Preoperative intravenous iron administration is a frequently used patient blood management procedure. If the timeframe of intravenous iron administration before surgery is short, (1) the concentration of the intravenous iron compound might still be high in patients' plasma when undergoing surgery and (2) this iron in patients' plasma is at risk to be lost due to blood loss. The aim of the current study was, therefore, to track the iron compound ferric carboxymaltose (FCM) before, during, and after cardiac surgery requiring cardiopulmonary bypass, with an emphasis on intraoperative iron losses in shed blood and potential recovery through autologous cell salvage. Concentrations of FCM were analyzed in patients' blood using a hyphenation of liquid chromatography and inductively coupled plasma-mass spectrometry to distinguish between pharmaceutical compound FCM and serum iron. In this prospective, single-center pilot trial, 13 anemic and 10 control patients were included. Anemic patients with hemoglobin levels ≤12/13 g/dL in women and men were treated with 500 milligrams (mg) intravenous FCM 12 to 96 hours before elective on-pump cardiac surgery. Patients' blood samples were collected before surgery and at days 0, 1, 3, and 7 after surgery. One sample each was taken of the cardiopulmonary bypass, the autologous red blood cell concentrate generated by cell salvage, and the cell salvage disposal bag. Patients who had received FCM <48 hours before surgery had higher FCM serum levels (median [Q1-Q3], 52.9 [13.0-91.6]) compared to ≥48 hours (2.1 [0.7-5.1] µg/mL, P = .008). Of 500-mg FCM administered <48 hours, 327.37 (257.96-402.48) mg were incorporated compared to administration ≥48 hours with 493.60 (487.78-496.70) mg. After surgery, patients' plasma FCM concentration in the FCM <48 hours group was decreased (-27.1 [-30 to -5.9] µg/mL). Little FCM was found in the cell salvage disposal bag (<48 hours, 4.2 [3.0-25.8] µg/mL, equivalent to 29.0 [19.0-40.7] mg total; equivalent to 5.8% or 1/17th of the 500 mg FCM initially administered), almost none in the autologous red blood cell concentrate (<48 hours, 0.1 [0.0-0.43] µg/mL). The data generate the hypotheses that nearly all FCM is incorporated into iron stores with administration ≥48 hours before surgery. When FCM is given <48 hours of surgery, the majority is incorporated into iron stores by the time of surgery, although a small amount may be lost during surgical bleeding with limited recovery by cell salvage.

The Role of Preoperative Chronic Statin Therapy in Heart Transplant Receipts-A Retrospective Single-Center Cohort Study.

Statin therapy has been proven to reduce the risk of cardiovascular events. The objective of our retrospective study was to investigate the relationship between preoperative chronic administration of statins to postoperative 2-month heart transplantation complications. A total number of 38 heart transplantation recipients from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș between May 2014 and January 2021 were included in our study. In logistic regression, we found a statistical significance between statin treatment and the presence of postoperative complications of any cause (OR: 0.06, 95% CI: 0.008-0.56; p = 0.0128), simultaneously presenting an elevated risk for early-postoperative acute kidney injury (AKI). From the statin group, atorvastatin therapy had a higher risk of type 2 diabetes mellitus (T2DM) development (OR: 29.73, 95% CI: 1.19-741.76; p = 0.0387) and AKI (OR: 29.73, 95% CI: 1.19-741.76; p = 0.0387). C-reactive protein (CRP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c) represented risk factors, atorvastatin administration being independently associated with lower CRP values. Chronic previous administration of statins represented a protective factor to the development of 2-month postoperative complications of any cause in heart transplant receipts.

Analgesic Effect of Preoperative Intravenous Administration of Paracetamol on Post-cesarean Pain: A Randomized Clinical Trial.

Pain control after every surgery, especially cesarean section, is very important, and physicians strive to discover pain control methods using the least amount of opioids. Paracetamol is a non-opioid analgesic with few complications. The present study aimed to investigate the analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain. This randomized, double-blind clinical trial was conducted on 240 pregnant women under spinal anesthesia who were candidates for elective cesarean section. The patients' weight, height, age, and body mass index (BMI) were recorded, and patients were randomly divided into 2 equal groups (n = 120). In the first group, 10 mg/kg paracetamol in 100 mL of normal saline (paracetamol group) and, in the second group, 100 mL normal saline (control group) were administered 15 minutes before surgery intravenously. Blood pressure, pulse rate, chills, and nausea were recorded during and 1 hour after surgery; in addition, the visual analogue scale (VAS) and the need for additional analgesics were recorded 1, 2, 4, 6, 12, and 24 hours after surgery. Mean pain scores were significantly lower in the paracetamol group (4.01 ± 2.22) than in the control group 6 hours (4.83 ± 2.35; P = 0.008) and 24 hours (2.26 ± 1.85 and 2.67 ± 1.80, respectably; P = 0.038) after surgery. Mean meperidine consumption was lower in the paracetamol group than in the control group, but it was not significant. No significant difference was found between the 2 groups in the frequency of chills and nausea (P > 0.05). Within the limitations of the current study, preoperative intravenous administration of paracetamol significantly reduced post-cesarean pain within 24 hours.

Effect of Pre-Treatment with Ketorolac Tromethamine on Post-operative Pain Following Periodontal Surgery: A Randomized Crossover Clinical Trial

Background: Periodontal surgeries are often followed by post-operative pain and discomfort which is a major concern to both the clinician and the patient. Every effort is being made to reduce the post-operative pain, one amongst them being the pre-operative medication with NSAIDS like ketorolac tromethamine. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response hence it may be advantageous in reducing post-operative pain and discomfort. Thus, the efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was evaluated. Material &amp; Methods: Two groups of 15 patients each were selected for the study. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group doesn’t received any drug. Combination of Diclofenac sodium 50 mg &amp; Paracetamol 325mg tablets was provided as “rescue analgesic. The visual analog scale modified with using numerical rating scales and Wong-Baker Faces Pain Rating Scale was used to estimate pain. Postoperative pain was assessed hourly for the first 12 h on the day of surgery, and 4 times daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results: Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to no premedication group. Incidence and amount of rescue medication consumption was small in ketorolac groups. No adverse reactions related to preoperative medication were observed. Conclusion: The results of this study showed that 20-mg ketorolac administered immediately before periodontal surgery was effective for alleviating the early postoperative painful sequelae, affected delayed pain levels and postoperative rescue analgesic consumption.

Clinical practice selectively follows acute appendicitis guidelines

IntroductionAcute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps.MethodsWe undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications.ResultsFour thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1–4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p < 0.001).ConclusionsThe observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult.

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures: A Perioperative Pain Management Protocol.

Distal radius fractures (DRFs) are common fractures requiring surgical fixation. The literature varies regarding opioid prescribing habits, opioid consumption, and postoperative pain scores. We hypothesized that the preoperative administration of a liposomal bupivacaine (LB) supraclavicular nerve block would be safe and effective in controlling postoperative pain. A standardized pain management protocol was implemented at a single institution from July 2021 to March 2022 for patients undergoing open reduction internal fixation of DRF. Protocol elements included a preoperative LB supraclavicular nerve block and a multimodal postoperative pain regimen. Primary clinical outcomes included postoperative pain scores and number of opioid tablets consumed. Twenty patients underwent a newly implemented protocol. The average age was 56 years. Mean number of oxycodone 5-mg tablets consumed was 4.1 (median, 2.5), and mean visual analog scale pain score at first postoperative appointment was 2.8. There were no incidences of missed acute carpal tunnel postoperatively. When compared with an institutional historical control (n = 189), number of opioid pills prescribed was reduced by 60% (21.4 vs 8.6 tablets, P < 0.0001), and no patients had unscheduled health care contact because of uncontrolled pain (22% vs 0%, P < 0.016). Liposomal bupivacaine supraclavicular nerve blocks are safe and effective in the treatment of postoperative pain after open reduction internal fixation of DRF. Patients consumed <5 oxycodone tablets on average, which is less than many recommend prescribed quantities (>20-30 tablets). Patients had low pain scores (2.8/10) at the first postoperative follow-up. To our knowledge, this is the first study demonstrating the utility of LB in this clinical setting.

A decrease in NR2B expression mediated by DNA hypermethylation induces perioperative neurocognitive disorder in aged mice.

This study was designed to investigate the role of NR2B and the contribution of DNA methylation to NR2B expression in the pathogenesis of PND. Eighteen-month-old C57BL/6J mice were subjected to experimental laparotomy under 1.4% isoflurane anesthesia. Hippocampus-dependent learning and memory were evaluated by using the Barnes maze and contextual fear conditioning tests. The protein and mRNA expression levels of NR2B were evaluated by western blotting and qRT-PCR respectively, and the methylation of the NR2B gene was examined by using targeted bisulfite sequencing. Long-term synaptic plasticity (LTP) was measured by electrophysiology. Mice that underwent laparotomy exhibited hippocampus-dependent cognitive deficits accompanied by decreased NR2B expressions and LTP deficiency. The overexpression of NR2B in the dorsal hippocampus could improve learning and memory in mice subjected to laparotomy. In particular, the decreased NR2B expressions induced by laparotomy was attributed to the NR2B gene hypermethylation. Preoperative administration of S-adenosylmethionine (SAM) could hypomethylate the NR2B gene, upregulate NR2B expression and improve LTP, exerting a dose-dependent therapeutic effect against PND. Moreover, inhibiting NR2B abrogated the benefits of SAM pretreatment. Laparotomy cause hippocampus-dependent cognitive decline by hypermethylating the NR2B gene, allowing us to understand the pathogenesis of PND in an epigenetic landscape.

Pre-operative administration of butorphanol mitigates emergence agitation in patients undergoing functional endoscopic sinus surgery: A randomized controlled clinical trial.

This study explored the effectiveness of pre-operative intravenous injection of butorphanol in the alleviation of emergence agitation (EA) in patients undergoing functional endoscopic sinus surgery (FESS). Patients (n = 708) were randomized into two groups. The butorphanol group (Group B, n = 358) received butorphanol infusion (20 ug/kg) before anesthesia induction, while the control group (Group C, n = 350) received an equal volume of normal saline infusion. General anesthesia was induced with sufentanil, propofol, and rocuronium, and was maintained with sevoflurane and remifentanil. Vasoactive drugs maintained the hemodynamic indices within 20% of the baseline. The incidence of EA was significantly lower in Group B than that in Group C (Group B vs. C: 24.3% vs. 31.4%, respectively; P = 0.034). The times to spontaneous breathing (26.5 min vs. 23.7 min, P = 0.011), verbal response (36.0 min vs. 33.4 min, P = 0.012), and extubation (31.0 min vs. 28.7 min, P = 0.025) were longer in Group B, and the grade of cough (0.33 vs. 0.43, P = 0.024) at extubation in Group B was lower than that in Group C (P = 0.024). The mean arterial pressure at the end of the operation (P = 0.004) and at 5 min after extubation (P = 0.008) was higher and hypotension was less prominent (0.6% vs. 2.6%, P = 0.030) in Group B. Pre-operative intravenous injection of butorphanol decreased the incidence of EA after FESS and provided smooth and hemodynamically stable emergence without extending the stay in post-anesthesia care unit. https://www.clinicaltrials.gov/, identifier NCT03398759.

Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome.

Introduction: Implantation of a dual-head hip prosthesis to treat medial femoral neck fractures is often associated with significant blood loss. In elective endoprosthetics procedures, it has already been demonstrated that administration of tranexamic acid (TXA) reduces blood loss and need for postoperative transfusions, as well as reducing the frequency of postoperative complications. The aim of this study is to show whether the administration of TXA also leads to a reduction in perioperative blood loss and haemorrhage-associated complications when applied as part of treatment of femoral neck fractures using a dual-head prosthesis. Methods: In a single-centre retrospective cohort study, 1g TXA i.v. was administered preoperatively to 93 patients who had suffered from femoral neck fractures. This group was compared to a comparison group of 65 patients who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, frequency of transfusion, and frequency of specific complications occurring. Results: The transfusion rate in the TXA group was 6% lower, whereby the volume of blood transfused was 26.7% lower than in the nonTXA group. However, neither result was significant. The calculated perioperative blood loss remained the same. Similarly, the incidence of postoperative renal failure was not significantly lower in the TXA group, at 6.5%, as compared to the nonTXA group (7.7%). A higher rate of complications or deaths as a result of TXA administration was not observed. The tranexamic acid effect seems to be related to the dose. Conclusion: Preoperative administration of TXA during implantation of a dual-head prosthesis for treatment of a femoral neck fracture does not lead to an increased complication rate. The study revealed a trend towards fewer transfusions required, but a significant reduction in blood loss could not be demonstrated. There should be further investigation of other factors influencing blood loss, in particular the dosing regimen followed for perioperative administration of TXA. Level of Evidence: Level 4: retrospective case-control study.

Unplanned intensive care unit readmission after surgical treatment in patients with newly diagnosed glioblastoma — forfeiture of surgically achieved advantages?

Postoperative intensive care unit (ICU) monitoring is an established option to ensure patient safety after resection of newly diagnosed glioblastoma. In contrast, secondary unplanned ICU readmission following complicating events during the initial postoperative course might be associated with severe morbidity and impair initially intended surgical benefit. In the present study, we assessed the prognostic impact of secondary ICU readmission and aimed to identify preoperatively ascertainable risk factors for the development of such adverse events in patients treated surgically for newly diagnosed glioblastoma. Between 2013 and 2018, 240 patients were surgically treated for newly diagnosed glioblastoma at the authors’ neuro-oncological center. Secondary ICU readmission was defined as any unplanned admission to the ICU during initial hospital stay. A multivariable logistic regression analysis was performed to identify preoperatively measurable risk factors for unplanned ICU readmission. Nineteen of 240 glioblastoma patients (8%) were readmitted to the ICU. Median overall survival of patients with unplanned ICU readmission was 9 months compared to 17 months for patients without secondary ICU readmission (p=0.008). Multivariable analysis identified “preoperative administration of dexamethasone > 7 days” (p=0.002) as a significant and independent predictor of secondary unplanned ICU admission. Secondary ICU readmission following surgery for newly diagnosed glioblastoma is significantly associated with poor survival and thus may negate surgically achieved prerequisites for further treatment. This underlines the indispensability of precise patient selection as well as the importance of further scientific debate on these highly relevant aspects for patient safety.

Effects of Preoperative Glutamine Administration on Nutritional and Immunological Improvements and Reduction of Length of Stay in Colorectal Cancer Patients with Malnutrition

Background: Penile cancer is rare but has a major impact on patients and health workers in its management. In penile cancer, tumors can grow anywhere in all parts of the penis, starting from the glans penis, foreskin, and shaft of the penis, which can spread and damage the surrounding tissue structures such as the pubic bone, scrotum, and others. No studies specifically analyze the survival of penile cancer. Aim: This study assessed the relationship between primary tumor staging, lymph node status, tumor grading, cell subtype, lymphovascular invasion (LVI), and preoperative neutrophil-lymphocyte ratio (NLR) on the survival of penile cancer patients. Material &amp; Methods: This study was a survival analysis study with a retrospective cohort design. Primary tumor staging (T), lymph node status (N), tumor grading, cell subtype, LVI status, and preoperative NLR values are independent variables included. The dependent variables are survival time and mortality. Descriptive analysis, Kaplan-Meier curve analysis, and Cox Proportional Hazard Regression test were performed. Results: Eighty (80) subjects with a mean age of 55.71 ± 12.45 years old. Forty-one percent of the subjects died with a mean survival time of 60.65 months (95% CI 51.25-70.04). Cox proportional hazard regression analysis showed that staging N3 and the condylomatous subtype at the time of diagnosis increased the risk of mortality with a hazard ratio (HR) of 3.55 (95% CI 1.03 – 12.31) and 6.77 (95% CI). 1.02 – 44.85), respectively. Conclusion: Lymph node staging N3 and condylomatous subtype were factors with poorer survival prognosis.

Evaluation of the Effect of Granulocyte Colony Stimulating Factor on Spinal Fusion in a Rat Model of Spinal Surgery.

To evaluate the effects of granulocyte colony stimulating factor (G-CSF) on spinal fusion through manual palpation, radiological examinations, and histopathological analyses in a rat model. A total of 21 rats were evaluated in this study. The rats were divided into the following three groups, each consisting of seven rats: preoperative G-CSF, postoperative G-CSF, and a control group. L4-L5 posterolateral fusion was performed in all three groups. The preoperative G-CSF group received 5 μg/kg G-CSF subcutaneously for 5 days in the preoperative period, while the postoperative G-CSF group received the same intervention in the postoperative period. No additional postoperative procedures were performed in the control group. All rats were euthanized at 6 weeks, and the fusion site was evaluated using manual palpation, radiological examinations, and histopathological analyses. According to the classification of subjects according to manual examination, preoperative and postoperative G-CSF groups had significantly higher rates of "single prominent callus formation + fusion" (p < 0.05). When direct radiography scores were evaluated, the number of subjects with "unilateral solid new bone density - contralateral nonsolid bone density" was significantly greater in the preoperative G-CSF group, while "bilateral solid new bone densities" was more prevalent in the postoperative G-CSF group (p < 0.05). In regards to histopathological scores, the number of subjects rated as "fibrocartilage tissue is more than bone tissue" was higher in the preoperative G-CSF group, the number of subjects rated as-bone tissue is more than fibrocartilage tissue" was higher in the postoperative G-CSF group, and the number of subjects rated as "fibrous tissue is more than fibrocartilage tissue" was greaterin the control group (p=0.01). Preoperative and postoperative G-CSF groups had significantly higher manual examination, radiological, and histopathological scores and greater volume of new bone formation on 3D CT compared to the control group (p < 0.05). The results of our study demonstrated that preoperative and postoperative administration of G-CSF had positive effects on spinal fusion in a rat model.