Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications.

ABSTRACT: A history of transient ischemic attack, severity of disease, urinary output, hematocrit, hypocapnia, and hypotension during direct revascularization (superficial temporal artery to middle cerebral artery [STA-MCA]) in patients with Moyamoya disease (MMD) may lead to a poor prognosis, however, to our knowledge evidence for end-tidal carbon dioxide (ETCO2) targets is lacking. Within the ranges of standardized treatment, the article was primarily designed to study the risk factors associated with the neurologic outcomes during STA-MCA for MMD especially including ETCO2 ranges and the duration in different groups. The primary goals of this study were to investigate the risk factors for neurologic deterioration and explore the association between ETCO2 ranges and neurologic outcome during general anesthesia for STA-MCA.This retrospective observational study included 56 consecutively adult Moyamoya patients who underwent STA-MCA under general anesthesia between January 2015 and August 2019. ETCO2 was summarized per patient every 5 minutes. Clinical outcome was assessed with clinical presentation, computed tomography findings, magnetic resonance imaging findings, cerebral angiography, and the modified Rankin Scale scores at discharge as main outcome measure. The outcomes were also compared for the duration of surgery, anesthesia, and the length of stay.A total of 56 patients were studied, all patients had comprehensive ETCO2 measurements. The incidence of postoperative complications was 44.6% (25/56). There was no association between age, sex, hypertension, diabetes, smoking history, drinking history, sevoflurane use, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis and postoperative complications. Duration of surgery (P = .04), anesthesia (P = .036), hospital stay (P = .023) were significant correlates of postoperative complications. In the multiple logistic regression model, they were not the significant predictors. The ETCO2 ranges and the length of time in different groups within the current clinical setting was not associated with postoperative complications (P > .05).Within a standardized intraoperative treatment strategy, we found that postoperative complications had no significant correlation with sex, age, hypertension, diabetes, smoking history, drinking history, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis, or sevoflurane use. Further, hypocapnia and hypercapnia during STA-MCA were not found to be associated with postoperative complications in patients with MMD.

The serratus anterior plane block for analgesia after thoracic surgery: A meta-analysis of randomized controlled trails.

BACKGROUND: The serratus anterior plane (SAP) block is a newer method that can be used in patients undergoing thoracic surgeries. The postoperative analgesia efficacy of SAP blocks for thoracic surgery remains controversial. We conduct a meta-analysis to evaluate the analgesia of SAP blocks after thoracic surgery. METHODS: We searched PubMed, Embase, EBSCO, the Cochrane Library, Web of Science, and CNKI for randomized controlled trials (RCTs) regarding the postoperative pain control of a SAP block on thoracic surgery. All of the dates were screened and evaluated by two researchers and meta-analysis was performed using RevMan5.3 software. RESULTS: A total of 8 RCTs involving 542 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 h (standardized mean difference [Std.MD] = -1.26; 95% confidence interval [CI] = -1.66 to -0.86; P < .0001); 6 h (SMD = -0.50; 95%CI = -0.88 to -0.11; P = .01); 12 h (SMD = -0.63; 95%CI = -1.10 to -0.16; P = .009); 24 h (SMD = -0.99; 95%CI = -1.44 to -0.51; P < .0001); postoperative opioid consumption at 24 h (SMD = -0.83; 95%CI = -1.10 to -0.56; P < .00001); and postoperative nausea and vomiting (PONV) rates (RR = 0.39; 95% CI = 0.21-0.73; P = .003). CONCLUSION: The SAP block can play an important role in the management of pain after thoracic surgery by reducing both pain scores and 24-h postoperative opioids consumption. In addition, there is fewer incidence of PONV in the SAP block group.

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Abdominal surgery is common and is associated with severe postoperative pain. The transverse abdominal plane (TAP) block is considered an effective means for pain control in such cases. The quadratus lumborum (QL) block is another option for the management of postoperative pain. The aim of this study was to conduct a meta-analysis and thereby evaluate the efficacy and safety of QL blocks and TAP blocks for pain management after abdominal surgery. METHODS: We comprehensively searched PubMed, EMBASE, EBSCO, the Cochrane Library, Web of Science and CNKI for randomized controlled trials (RCTs) that compared QL blocks and TAP blocks for pain management in patients undergoing abdominal surgery. All of the data were screened and evaluated by two researchers. RevMan5.3 was adopted for the meta-analysis. RESULTS: A total of 8 RCTs involving 564 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 h (standardized mean difference [Std.MD] = - 1.76; 95% confidence interval [CI] = - 2.63 to - 0.89; p < .001), 4 h (Std.MD = -0.77; 95% CI = -1.36 to - 0.18; p = .01),6 h (Std.MD = -1.24; 95% CI = -2.31 to - 0.17; p = .02),12 h (Std.MD = -0.70; 95% CI = -1.27 to - 0.13; p = .02) and 24 h (Std.MD = -0.65; 95% CI = -1.29 to - 0.02; p = .04); postoperative morphine consumption at 24 h (Std.MD = -1.39; 95% CI = -1.83 to - 0.95; p < .001); and duration of postoperative analgesia (Std.MD = 2.30; 95% CI = 1.85 to 2.75; p < .001). There was no statistically significant difference between the two groups with regard to the incidence of postoperative nausea and vomiting (PONV) (RR = 0.55;95% CI = 0.27 to 1.14;p = 0.11). CONCLUSION: The QL block provides better pain management with less opioid consumption than the TAP block after abdominal surgery. In addition, there are no differences between the TAP block and QL block with respect to PONV.