Preoperative Anesthesia Assessment Research Articles

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey.

Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves. A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey. A single surgical centre in the UK. Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded. Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic. The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire. There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery. Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.

Pre-operative immune cell numbers and ratios are associated with peri-operative adverse outcomes in transfused patients

Background and objectivesTransfusion-related immune modulation (TRIM) and associated adverse outcomes during major surgery are increasingly important to patients and health services internationally. A panel of pre-operative blood tests is an essential part of the pre-operative anaesthetic assessment. This panel of blood tests commonly considers numbers of immune cells (i.e., lymphocytes, monocytes, and neutrophils and cell ratios) that may be used as biomarkers to evaluate and potentially predict post-operative adverse outcomes.DesignThis retrospective data collection from eight hospital databases, within the Royal Brisbane and Women's Hospital, considered only patients who received blood transfusion during surgery (2016–2018) (n = 2,121). The association between pre-operative immune cell numbers and ratios and adverse outcomes were assessed. Adverse outcomes were coded using the International Classification of Diseases-10 (ICD-10) coding which specifically considered transfusion-related immune modulation. Results were adjusted for confounding factors.ResultsAfter adjustment, decreased pre-operative lymphocyte numbers and increased neutrophil/lymphocyte ratio (NLR) were associated with increased odds of developing infection; decreased NLR with decreased odds of developing adverse renal outcomes; and decreased lymphocyte numbers with decreased odds of developing adverse cardiovascular outcomes. Monocyte numbers, neutrophil numbers, and the lymphocyte/monocyte ratio (LMR) were not associated with increased adverse outcomes after adjustment.ConclusionPre-operative lymphocyte numbers and NLR are associated with adverse outcomes during peri-operative transfusion. Future assessment of peri-operative immune modulation should include the assessment of immune cell function and numbers.

Preoperative anaesthesia assessment and patient preparation for surgery: update and a review

Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. The “Helsinki Declaration on Patient Safety in Anaesthesiology” establishes that the safety and quality of the perioperative care received by patients is the responsibility of anaesthesiologists. This declaration has been accepted by all the European Societies of Anaesthesiology and stipulates that all institutions providing perioperative anaesthesia care to patients should design protocols to guide perioperative patient management. The present article aims to provide an evidenced-based review of preoperative assessment and preparation and to propose a protocol that can be adapted to the needs of each hospital and be incorporated into their routine practice. Emphasis is placed on the importance of correct preoperative evaluation in reducing morbidity and mortality in the surgical patient. This task can be aided by the use of preoperative questionnaires and the rational use of preoperative tests, which will also reduce unnecessary costs. Finally, the most widely accepted recommendations on preoperative fasting is discussed. The anaesthesiologist’s legal responsibility, and patients’ views in the preoperative process are also considered. A thorough clinical preoperative evaluation of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care.

Perioperative geriatrics: A bibliometric analysis of the top 100 cited articles in an emerging specialty.

The success of modern medicine has led to surgery being performed on an increasingly older, frailer and more comorbid population. As a result, perioperative geriatrics has emerged as an important specialty, relevant to both medical and surgical disciplines. Only a small number of papers have been published on the topic. A bibliometric analysis is used to identify themes and trends in current research and practice. To identify and describe research topics relating to perioperative geriatrics; to find themes and gaps in the current literature. Thompson Reuters Web of Science indexing database was searched for all manuscripts relating to perioperative geriatrics. Of these, the top 100 were subcategorised into manuscript type, age, theme, specialty, journal and citation rate. The highest cited article was by Bhandari et al with 294 citations. The highest citation rate was achieved by Partridge et al, with 23.75 citations/year. Across the series, the mean number of citations was 50.41 (range 294-12). The highest number of manuscripts were published between 2010 and 2019 (n = 55), with 70% of manuscripts published in journals with impact factor <5. The specialty with the highest number of publications was orthopaedics (n = 36). Most articles focussed on surgical management of geriatrics patients, followed by anaesthetic management. This is the first bibliometric analysis of the top 100 most cited papers in perioperative geriatrics. Only 395 papers were returned, indicating that this needs to be further researched as a topic. Key themes identified were surgical management of hip fractures and anaesthetic preoperative assessment. Emerging themes from this study highlight the need for perioperative publications in the fields of geriatric vascular, general, plastic and gynaecology.

A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment.

Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m2, who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status.

Anaesthetic challenges in the management of renal transplant recipients - An institutional review.

Objective: To provide an overview of our institutional experience with anaesthetic management of renal transplant data in terms of demographics, preoperative status, anaesthesia management, and postoperative care. Study Design: Descriptive study. Setting: Pakistan Kidney and Liver Institute and Research Center, Lahore. Period: January 2022 to June 2022. Material &amp; Methods: This descriptive study included 203 cases of renal transplant. We reviewed the medical records of these patients for demographics, preoperative anaesthetic assessment, intraoperative anaesthesia records, and postoperative care unit notes. Data was analyzed using SPSS Version 25. Results: The mean age of the patients was 35.75 + 10.1 years, and most of the patients had co-morbidities. The preoperative echocardiographic findings were significant in 52.7% of the patients, and 87.2% were on dialysis preoperatively. General anaesthesia was used in 99.5% of cases. Mean volume of intravenous fluid was 5.8 L, and 9.35% required ionotropic support, 9.9% received transfusion intraoperatively while 3.9% required postoperative mechanical ventilation. Conclusions: Renal transplant recipients have significant co-morbidities and require a meticulous approach for successful perioperative anaesthetic management.

Early Outcomes of Laparoscopic Transabdominal Preperitoneal (TAPP) Repair.

Background Inguinal hernia repair is one of the commonest general surgical procedures performed all over the world. The introduction of synthetic mesh and laparoscopic repair has revolutionized inguinal hernia surgery in the recent past. Laparoscopic transabdominal preperitoneal (TAPP) repair is now considered a well-established procedure with minimal complications and short hospital stay and less recurrence. The TAPP approach gives a good view of the inguinal anatomy and a better understanding of the sac contents. The learning curve associated with TAPP repair is much less as compared to total extraperitoneal (TEP) repair. The aim of this study was to assess the effectiveness of TAPP repair for inguinal hernia in terms of the duration of surgery, hospital stay, complications, and recurrence rate. Method From March 1, 2019,to February 28, 2021, a total of 60 patients with inguinal hernias between ages 25 and 70 years were included in the study. A preoperative anesthesia assessment was done, and informed written consent was taken from all patients. The TAPP procedure was performed with polypropylene mesh in all cases, and surgery was performed by a surgeon with more than five years of laparoscopic experience. Results The total number of patients included in the study was 60. All patients were male. The mean±standard deviation (SD) age of the patients was 54.6±11.4 years. Unilateral primary inguinal hernia was present in 46 (76.6%) cases, recurrent in eight (13.3%) cases, and primary bilateral in six (10%) cases. The mean±SD duration of surgery for unilateral inguinal hernia was 59.1±15.7 minutes, and for bilateral hernia, it was 83.5±12.6 minutes.The mean hospital stay was 3.6±1.5 days. Scrotal swelling was noted as a common complicationin seven (11.6%) cases, surgical site infection (SSI) in three (5%), mesh infection in two (3.3%), urinary retention in two (3.3%), and chronic pain in one (1.6%). No recurrence was noted. Conclusion Transabdominal preperitoneal repair for inguinal hernia is a very effective procedure with a short learning curve and minimal complication rate. The hospital stay is less, and recurrence is very low.

To Assess the Knowledge and Understanding of Importance of Pre-Anaesthesia Assessment in Developing Countries like Pakistan

Objective: To assess the knowledge and understanding of importance of pre-anaesthesia assessment in developing countries like Pakistan. Design: Consecutive non-probability sampling Setting: CMH, Rawalpindi Subjects: All the patients coming to preanaesthesia assessment clinics for preoperative anaesthesia assessment Statistical Analysis: All statistical analysis was done in SPSS Ver. 22.0, descriptive analyses were used in terms of frequency and percentages, and unpaired t test was used to test the significance. Interventions: A predefined questionnaire was filled either passively by the doctor or actively by the patients themselves before being evaluated for anaesthesia fitness Result: About 50.6% of the population knew that they had come to the PAC for PAA and risk assessment, whereas 30.1% and 18.5% said they had come because the surgeon had ordered them to do so or to get the date of the surgery, respectively. 62.7% were aware that anaesthesiologist does the PAA, whereas the rest were not sure. On being asked why PAA is necessary 49.1% replied that it reduces the risks associated with surgery and anaesthesia whereas 29.5% said it helps to get the date of surgery. All these responses were compared with literacy levels and to their history of prior exposure to PACs, all of them were statistically significant with a p value &lt;0.15. Practical Implications: The aim of this study was to know the importance of preanaesthesia assessment among the general population of a developing country like Pakistan coming for surgery, almost half of the patients were unaware of the purpose and were just obeying their surgeons advice to visit PACs, this attitude is what needs to be eliminated and awareness should be created among patients and also surgeons by incorporating importance of anaesthesia related risks in morbid patients and importance of preanaesthesia assessment and investigation Conclusion: Knowledge and perception regarding preanesthesia assessment is still lacking resulting in post-op complications for the patients and there is need of creating awareness regarding PAA so that complications could be avoided. Keywords: preanaesthesia assessment (PAA), preanaesthesia clinics (PACs), questionnaire, third world countries.

Hospital based prevalence of smoking among surgical patients in tertiary care hospitals of Karachi Pakistan.

To determine the prevalence of smoking and to evaluate the knowledge about preoperative smoking cessation in patients coming for elective surgery. The cross-sectional study was conducted from July 30, 2019, to March 17, 2020, in the preoperative anaesthesia assessment clinic and surgical wards of Aga Khan University Hospital, Civil Hospital Karachi, and Abbasi Shaheed Hospital, Karachi, and comprised all patients of either gender aged >12 years scheduled for elective surgery having American Society of Anaesthesiologists physical status I-IV. Data was analysed using Stata 13. Of the 811 patients, 478(59%) were male and 333(41%) were female. The overall mean age was 43.4±16.4 years and mean BMI was 25.0±5.8kg/m2. There were 164(20.2%) smokers in the sample. The overall knowledge about preoperative smoking cessation was significantly associated with the level of education and gender (p<0.05). Smoking in surgical patients was about one-fifth of the overall sample, and knowledge related to preoperative smoking abstinence was significantly associated with educational status and gender.

Development, implementation and evaluation of high-quality virtual preoperative anaesthetic assessment during COVID-19 and beyond: a quality improvement report

BackgroundPreoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions...

An Association of Predicted/Unpredicted Difficult Intubation with Fibreoptic Bronchoscopic Intubation

Aim: Inadequate preoperative airway assessment is one of the most common causes of failed airway management and intubation. Fibreoptic bronchoscopic intubation (FBI) is an effective technique for creating airway access in patients with expected and unexpected difficult airways. The aim of this study is to evaluate the incidence of predicted difficult airway (DA) in patients intubated due to DA with FBI.&#x0D; Materials and Methods: We retrospectively reviewed the medical records of one hundred and forty-three ASA I-V patients aged 0-80 years diagnosed with DA who underwent flexible FBI from January 2006 to December 2011. Age, weight, sex, concomitant syndromes, whether difficult intubation (DI) occurred after trauma, whether FBI was applied via nasal or oral ways, size of tube, whether FBI was successful or not and relationships of these parameters were analysed.&#x0D; Results: The study involved 143 patients, 38 (22.2%) in the pediatric group and 105 patients (77.8%) in the adult group. Of the patients, 64 (47.4%) were female and 71 (52.6%) were male. 42 patients underwent DI for syndromes with craniofacial abnormalities. As a result of preoperative anaesthetic assessment, DI could be predicted in 74 patients (51.7%) by history, physical examination and Mallampati scoring, while unexpected DI occurred in 69 (48.3%) of patients. The proportion of predicted DA was much higher in children compared to adults.&#x0D; Conclusion: It is not easy to check all predictors of DI in a pre-anaesthetic examination and the predictors are not accurate. Unexpected DI is not a rare occurrence in the operating room (OR). Despite a thorough pre-operative assessment, anaesthetists may not be able to predict what they will encounter during surgery and therefore should always be prepared for any challenge.&#x0D; Keywords: Preoperative assessment, predicted difficult intubation, fiberoptik bronchoscopic intubation, syndromes with craniofacial abnormalities

Developmental dysplasia of the hip in an epidermolysis bullosa patient; how to deal with surgical difficulties: A case report

Epidermolysis bullosa (EB) is defined as a separation of the dermoepidermal junctions resulting in an increased risk of infection and the formation of fibrous tissue. We are presenting a case of a 22-month-old girl with developmental dysplasia of the left hip and EB. The patient was operated on, with the left hip open reduction, acetabuloplasty and hip spica application. For a safe surgery on EB patients, pre-operative anesthesia assessment is necessary to ensure proper neck movement and examine the mouth and airway for the presence of blisters. Certain intraoperative measures should be taken, like gentle handling of the patient to reduce the events of blistering and scarring. Avoiding all adherent dressings, tapes, and stickers, using non-adhesive dressings and applying a good cotton padding for patients, are crucial steps in such cases to achieve good results. Surgery for this patient went smoothly without acute complications. In this report, we hope to provide helpful information on the surgical management of such patients.

Anatomical location of the vocal cords in relation to cervical vertebrae, a new predictor of difficult laryngoscopy: A descriptive cross sectional study

Airway management is among the challenges faced by the anaesthesiologists. There are anatomical and clinical factors, which can predict the difficult laryngoscopy. In this study, the aim was to predict the easy and difficult laryngoscopy preoperatively by assessing the anatomy of patient’s head and neck. The objective was to assess the same by using the magnetic resonance imaging films of the neck. The study included 110 adult patients with existing preoperative magnetic resonance imaging scans of neck. Preoperative anaesthetic assessment was done by using the thyromental distance, sternomental distance, body weight, mouth opening, Mallampati classification and head neck movement. The magnetic resonance imaging scans were screened for slices to visualise the vocal cords. A projection line was drawn to determinethe topography of vocal cords in relation to the cervical vertebrae. The ease of laryngoscopy by Cormack-Lehane grade was then correlated with the vertebral level of the vocal cords.The laryngoscopy was difficult in over weight patients (p&amp;#60;0.001) and with smaller thyromental distance. It was also observed that the laryngoscopy was easy (p&amp;#60;0.001), when the topographical location of vocal cords were related to C5 and hard, when they are at the level of C4 and C6 (p&amp;#60;0.001). Magnetic resonance imaging films of neck could be used to evaluate the potential difficult laryngoscopy, preoperatively. It can be used along with the existing bedside tests like determination of thyromental distance, sternomental distance and modified Mallampati classification.

Preoperative preparation and premedication of bariatric surgical patient.

ABSTRACTThe prevalence of obesity has tripled worldwide over the past four decades. The United States has the highest rates of obesity, with 88% of the population being overweight and 36% obese. The UK has the sixth highest prevalence of obesity. The problem of obesity is not isolated to the developed world and has increasingly become an issue in the developing world as well. Obesity carries an increased risk of many serious diseases and health conditions, including type 2 diabetes, heart disease, stroke, sleep apnea, and certain cancers. Our ability to take care of this population safely throughout the perioperative period begins with a thorough and in-depth preoperative assessment and meticulous preparation. The preoperative assessment begins with being able to identify patients who suffer from obesity by using diagnostic criteria and, furthermore, being able to identify patients whose obesity is causing pathologic and physiologic changes. A detailed and thorough anesthesia assessment should be performed, and the anesthesia plan individualized and tailored to the specific patient's risk factors and comorbidities. The important components of the preoperative anesthesia assessment and patient preparation in the patient suffering from obesity include history and physical examination, airway assessment, medical comorbidities evaluation, functional status determination, risk assessment, preoperative testing, current weight loss medication, and review of any prior weight loss surgeries and their implications on the upcoming anesthetic. The preoperative evaluation of this population should occur with sufficient time before the planned operation to allow for modifications of the preoperative management without needing to delay surgery as the perioperative management of patients suffering from obesity presents significant practical and organizational challenges.

Assessing the Rates and Reasons of Elective Surgical Cancellations on the Day of Surgery: A Multicentre Study from Urban Indian Hospitals

BackgroundCancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC). This study investigates the rate and causes of cancellations of elective surgeries on the DOS in various surgical departments across ten hospitals in India.MethodsA research consortium ‘IndSurg’ led by World Health Organisation Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs, India conducted this multicentre retrospective cross-sectional study to analyse the cancellations of elective/planned surgical operations on DOS across urban secondary and tertiary level hospitals. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations.ResultsWe analysed records from the participating hospitals, with an overall cancellation rate of 9.7% (508/5231) on the DOS for elective surgical operations. Of these, 74% were avoidable cancellations. A majority (30%) of these 508 cancellations were attributed to insufficient resources, 28% due to patient's refusal or failure to show-up, and 22% due to change in patient's medical status.ConclusionWe saw a preponderance of avoidable reasons for elective surgery cancellations. A multidisciplinary approach with adequate preoperative patient counselling, timely communication between the patients and caregivers, adequate preoperative anaesthetic assessment, and planning by the surgical team may help reduce the cancellation rate.

Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review

The pre-operative phase in planning a pelvic exenteration or extended resections is critical to optimising patient outcomes. This review summarises the key components of preoperative assessment and planning in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LLRC) being considered for potential curative resection. The preoperative period can be considered in 5 key phases: 1) Multidisciplinary meeting (MDT) review and recommendation for neoadjuvant therapy and surgery, 2) Anaesthetic preoperative assessment of fitness for surgery and quantification of risk, 3) Shared decision making with the patient and the process of informed consent, 4) Prehabilitation and physiological optimisation 5) Technical aspects of surgical planning. This review will focus on patients who have been recommended for surgery by the MDT and have completed neoadjuvant therapy. Other important considerations beyond the scope of this review are the various neoadjuvant strategies employed which in this patient group include Total Neo-adjuvant Therapy and reirradiation. Critical to improving perioperative outcomes is the dual aim of achieving a negative resection margin in a patient fit enough for extended surgery. Advanced, realistic communication is required pre-operatively and should be maintained throughout recovery. Optimising patient's physiological and psychological reserve with a preoperative prehabilitation programme is important, with physiotherapy, psychological and nutritional input. From a surgical perspective, image based technical preoperative planning is important to identify risk points and ensure correct surgical strategy. Careful attention to the entire patient journey through these 5 preoperative phases can optimise outcomes with the accumulation of marginal gains at multiple timepoints.

TP6.2.13 A PEG insertion pathway for Motor Neurone Disease patients improves efficiency and patient outcomes

Abstract Aims Patients with Motor Neurone Disease (MND) often require a Percutaneous Endoscopic Gastrostomy (PEG) as a palliative procedure during the later stages of their illness, due to swallowing difficulties. More recently these are being inserted earlier before the inevitable decrease in nutritional intake and subsequent fall in albumin levels. This allows patients to eat food they enjoy rather than concentrating on maintaining intake. Insertion has traditionally been done with local anaesthetic and OGD, which can be difficult and traumatic. We propose a method of insertion using TIVA (Totally Intravenous Anaesthetic) in theatre with no intubation, performed by the surgical team, with a pathway including pre-operative anaesthetic assessment. Methods Data was collected from all PEG insertions performed in theatre from 1/1/2011 to 1/9/2019. MND patients following our pathway were compared to all other indications for PEG insertions. Length of stay (LOS), 30-day re-admission rates, 30-day, 90-day and 1-year mortality were analysed. Results 98 patients were identified. Median LOS was 3 days (mean 12.2) with a 3% 30-day mortality, 12.2% 90-day mortality and 34.7% 1-year mortality. In the MND group there were 27 patients. Median LOS was 2 days (mean 8.6) with a 7.4% (2 patients) 30-day mortality, which remained 7.4% at 90 days. There were 13 re-admissions (13.3%) overall compared to 0% in the MND group (p = 0.04 (Chi-squaredtest)). Conclusions PEG insertion under TIVA for MND patients is safe. A set pathway for admission and pre/post-insertion care increases efficiency with reduced length of stay and improves patient outcomes with no re-admissions.

Accuracy of STOP-Bang Questionnaire in Predicting Difficult Mask Ventilation: An Observational Study.

IntroductionDifficulty with bag-mask ventilation after the induction of general anesthesia and muscle relaxation places the patient at risk for a prolonged period of apnea and hypoxia and thus, at an increased risk of morbidity and mortality. This study was designed to assess the accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation (DMV) in patients receiving general anesthesia for elective surgical procedures.MethodsIt was a prospective cross-sectional, observational study conducted at a university teaching hospital. A total of 530 patients undergoing surgery under general anesthesia with endotracheal intubation were enrolled. STOP-Bang questionnaire was filled at pre-operative anesthesia assessment. Ease or difficulty of mask ventilation was assessed and documented by a senior resident responsible for intraoperative anesthetic management.ResultsOut of 530 patients, 139 (26.22%) had a STOP-Bang score of ≥ 3, of whom 55 (39.5%) were found to have DMV. Out of 391 patients with a STOP-Bang score of < 3, only 29 patients (7.5%) had DMV (P ≤0.001). Snoring, high blood pressure, BMI more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender were significantly associated with DMV. The accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation was 78.68% (95% CI 74.99-81.95) with a negative predictive value of 92.58%. The sensitivity and specificity were found to be 65.48% and 81.17% respectively.ConclusionSTOP-Bang score has a high negative predictive value and can be very useful in ruling out the possibility of difficult mask ventilation.

Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis.

To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up. Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting. We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated. Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+. Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients. CRD42020190065.

Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study

BackgroundCurrent principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery.MethodsThis prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention.ResultsA total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period.ConclusionThis observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.