Red Blood Cell Transfusion Requirements Before and After Implementation of a Perioperative Patient Blood Management Program in Adult Patients Undergoing Cardiac Surgery. A Before and After Observational Study.

OBJECTIVES: Anemia and transfusion are common in cardiac surgery patients, and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion, but are rarely combined altogether. The aim of this study was to compare the incidence of red blood cell (RBC) transfusion in adult patients undergoing cardiac surgery before and after the implementation of a perioperative patient blood management (PBM) program. DESIGN: Before-and-after observational study. SETTING: Single-center French university teaching hospital. PARTICIPANTS: Adult patients scheduled for cardiac surgery. INTERVENTIONS: Perioperative patient blood management program including pre-, intra-, and postoperative interventions aimed at identifying and correcting anemia, minimizing blood loss during surgery, and optimizing coagulation. MEASUREMENTS AND MAIN RESULTS: Four hundred thirty-four patients were included in the study from January 2021 to July 2022. The incidence of perioperative RBC transfusion (intraoperatively and during the first 2 postoperative days) was significantly reduced from 43% (90/213) in the pre-PBM period to 27% (60/221) in the post-PBM period (p < 0.001). The application of a PBM program was associated with a reduction in perioperative RBC transfusion by multivariate analysis (odds ratio 0.55, 95% CI 0.36-0.85, p = 0.007), and was associated with a reduction in the median number of RBC units transfused within transfused patients (p = 0.025). These effects persisted at day 30 after surgery (p = 0.029). CONCLUSION: A perioperative PBM program in adult patients undergoing cardiac surgery was associated with a significant reduction in perioperative RBC transfusion, which persisted at day 30.

Iodide Removal by Resorcinol-Formaldehyde Carbon Aerogels.

The adsorption technique is widely used in water purification, and its efficiency can be significantly improved by target-specific adsorbent design. Research on iodine and its ion removal from water has attracted a great deal of interest due to increased concentrations in the environment and acute toxic effects, e.g., in human thyroid cells. In this work, the iodide removal performance of two high-surface-area resorcinol-formaldehyde-based carbon aerogels was studied under acidic conditions. The BET surface area was 790 m2/g (RF_ac) and 375 m2/g (RMF-GO), with a corresponding micropore ratio of 36 and 26%, respectively. Both aerogels showed outstanding adsorption capacity, exceeding the reported performance of other carbons and Ag-doped materials. Owing to its basic nature, the RMF-GO carbon aerogel showed higher I- capacity, up to 97 mg/g, than the acidic RF_ac, which reached a capacity of 82 mg/g. The surface chemistry of the aerogels also played a distinct role in the removal. In terms of kinetics, RF_ac removed 60% of the iodide ions and RMF-GO 30% within 8 h. The removal kinetics was of the first order, with a half-life of 1.94 and 1.70 h, respectively.

Biomass Related Highly Porous Metal Free Carbon for Gas Storage and Electrocatalytic Applications.

In this paper we report the synthesis of a N, S co-doped metal free carbon cryogel obtained from a marine biomass derived precursor using urea as nitrogen source. Natural carrageenan intrinsically contains S and inorganic salt. The latter also serves as an activating agent during the pyrolytic step. The overall 11.6 atomic % surface heteroatom concentration comprises 5% O, 4.6% N and 1% S. The purified and annealed final carbon (CA) has a hierarchical pore structure of micro-, meso- and macropores with an apparent surface area of 1070 m2/g. No further treatment was applied. The gas adsorption potential of the samples was probed with H2, CO2 and CH4, while the electrocatalytic properties were tested in an oxygen reduction reaction. The atmospheric CO2 and CH4 storage capacity at 0 °C in the low pressure range is very similar to that of HKUST-1, with the CO2/CH4 selectivity below 20 bar, even exceeding that of the MOF, indicating the potential of CA in biogas separation. The electrocatalytic behavior was assessed in an aqueous KOH medium. The observed specific gravimetric capacitance 377 F/g was exceeded only in B, N dual doped and/or graphene doped carbons from among metal free electrode materials. The CA electrode displays almost the same performance as a commercial 20 wt% Pt/C electrode. The oxygen reduction reaction (ORR) exhibits the 4-electron mechanism. The 500-cycle preliminary stability test showed only a slight increase of the surface charge.

Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia.

Nonintubated thoracic surgery (NITS) has a good safety record in experienced hands, but has pitfalls for beginners. The main aim of NITS is to keep the patient under spontaneous respiration, avoiding adverse effects, such as hypoxemia, hypercapnia, panic attacks, and finally conversion to general anesthesia. In this paper, the safety aspects of anesthesia for NITS is discussed based on data from the literature and personnel clinical experiences.

Long-term clinical and experimental/surface analytical studies of carbon/carbon maxillofacial implants.

BACKGROUND: Over the past 30-40 years, various carbon implant materials have become more interesting, because they are well accepted by the biological environment. The traditional carbon-based polymers give rise to many complications. The polymer complication may be eliminated through carbon fibres bound by pyrocarbon (carbon/carbon). The aim of this study is to present the long-term clinical results of carbon/carbon implants, and the results of the scanning electron microscope and energy dispersive spectrometer investigation of an implant retrieved from the human body after 8 years. METHODS: Mandibular reconstruction (8-10 years ago) was performed with pure (99.99 %) carbon implants in 16 patients (10 malignant tumours, 4 large cystic lesions and 2 augmentative processes). The long-term effect of the human body on the carbon/carbon implant was investigated by comparing the structure, the surface morphology and the composition of an implant retrieved after 8 years to a sterilized, but not implanted one. RESULTS: Of the 16 patients, the implants had to be removed earlier in 5 patients because of the defect that arose on the oral mucosa above the carbon plates. During the long-term follow-up, plate fracture, loosening of the screws, infection or inflammations around the carbon/carbon implants were not observed. The thickness of the carbon fibres constituting the implants did not change during the 8-year period, the surface of the implant retrieved was covered with a thin surface layer not present on the unimplanted implant. The composition of this layer is identical to the composition of the underlying carbon fibres. Residual soft tissue penetrating the bulk material between the carbon fibre bunches was found on the retrieved implant indicating the importance of the surface morphology in tissue growth and adhering implants. CONCLUSIONS: The surface morphology and the structure were not changed after 8 years. The two main components of the implant retrieved from the human body are still carbon and oxygen, but the amount of oxygen is 3-4 times higher than on the surface of the reference implant, which can be attributed to the oxidative effect of the human body, consequently in the integration and biocompatibility of the implant. The clinical conclusion is that if the soft part cover is appropriate, the carbon implants are cosmetically and functionally more suitable than titanium plates.

Non-intubated anesthesia in thoracic surgery-technical issues.

Performing awake thoracic surgery (ATS) is technically more challenging than thoracic surgery under general anesthesia (GA), but it can result in a greater benefit for the patient. Local wound infiltration and lidocaine administration in the pleural space can be considered for ATS. More invasive techniques are local wound infiltration with wound catheter insertion, thoracic wall blocks, selective intercostal nerve blockade, thoracic paravertebral blockade and thoracic epidural analgesia, offering the advantage of a catheter placement which can also be continued for postoperative analgesia.

Nonintubated anesthesia in thoracic surgery: general issues.

Anesthetic management for awake thoracic surgery (ATS) is more difficult than under general anesthesia (GA), being technically extremely challenging for the anesthesiologist. Therefore, thorough preparation and vigilance are paramount for successful patient management. In this review, important considerations of nonintubated anesthesia for thoracic surgery are discussed in view of careful patient selection, anesthetic preparation, potential perioperative difficulties and the management of its complications.

Thoracic epidural anaesthesia for awake thoracic surgery in severely dyspnoeic patients excluded from general anaesthesia.

OBJECTIVES: General anaesthesia (GA) carries high risks of ventilator dependency with increased morbidity and mortality in patients with severe respiratory disease. It also presents an ethical dilemma if surgery remains the only treatment option for patients with advanced terminal chronic respiratory disease. Thoracic epidural anaesthesia for awake thoracic surgery (TEATS) in high-risk patients with dyspnoea at rest could avoid ventilator dependency and speed up recovery even in patients with severe dyspnoea. This retrospective observational study analysed indications, management and outcome of patients contraindicated to GA undergoing awake thoracic surgery with thoracic epidural anaesthesia. METHODS: From 716 patients requiring thoracic surgery, nine were contraindicated to GA. Eight patients [American Society of Anesthesiologists (ASA) 4] had a maximum grade four of the modified Medical Research Council dyspnea scale (MMRC). Two patients (ASA 3, grade 1 MMRC and ASA 4, grade 4 MMRC) refused GA. RESULTS: Patients (female : male ratio 1.25 : 1, age 19-76 years) had the following chronic respiratory diseases: pulmonary fibrosis (n = 2), pulmonary metastases (n = 3), chronic obstructive pulmonary disease (n = 1), alveolitis (n = 1) and myopathy (n = 2). Surgical indications were: thoracotomy (n = 6) for pleurectomy to treat recurring pneumothorax (n = 3), pleurostomy (n = 1), emphysema surgery (n = 1), lung biopsy (n = 1) and thoracoscopy (n = 3) for pleural/lung biopsy (n = 2), pneumothorax (n = 1). Lidocaine 20 mg/ml or ropivacaine 7.5 mg/ml was titrated to achieve an anaesthesia level T2-T12. No patient required GA [time of surgery: 46-128 min, mean = 76 min, standard deviation (SD) = 23 min]. Seven patients had light sedation with TCI propofol, remifentanyl or both and remained responsive. Fifty percent of patients received phenylephrine or ephedrine to maintain arterial pressure. Two patients went into hypercapnia, which was reversed with assisted mask ventilation. One patient suffered acute respiratory distress 7 days postoperatively and died of intestinal bleeding on Day 25. There were no postoperative complications in other patients. Excluding Patient 9 always remaining in a medical intensive care unit (ICU), the mean postoperative ICU stay in thoracic surgery was 4.4 days (SD 5.2). Hospital discharge was between 5 and 40 days after surgery. CONCLUSIONS: TEATS with/without sedation was an alternative to GA for thoracotomy/thoracoscopy in severely dyspnoeic patients (MMRC grade 4, ASA 4) without postoperative sequelae.

Surface analytical studies of maxillofacial implants: influence of the preoperational treatment and the human body on the surface properties of retrieved implants.

In the present work, surface analytical investigation of unimplanted as well as retrieved pyrolytic carbon-covered carbon/carbon composite implants and Ti osteosynthesis plates is reported. The Ti plates were covered by a 200-nm-thick, anodically and thermally formed TiO2 layer. Our results suggest that although the oxide layer on the Ti miniplates remained stable during the time spent in the human body, there is still material transport between the implant and the human body. In case of the carbon/carbon composite implants, damage of the carbon fibers constituting the material was found on one side of the sterile implant and attributed to the manufacturing process. The NaCl crystals originally present on the surface of the sterile material disappeared during the time spent in the human body. As a result of the interaction with the human body, a new surface layer (mainly constituted of carbon) appeared on the implant. The results indicate that both the time spent in the human organism and the preparation of the implants before operation can have detectable effects on the investigated surface properties. Surface analytical investigations could therefore provide information not only about the biocompatibility of these materials but also about the effect of their treatment before operation.

[Carbon/carbon implants in oral and maxillofacial surgery--Part 2]. / Karbon/karbon implantátumok az arc- és állcsontsebészetben--2. rész.

In their previous report, the authors presented observations regarding the long-term application of carbon/carbon implants. After evaluating the good functional and aesthetic results, the effect of the human body on the structure and morphology of the implants was investigated with state of the art methods. An implant retrieved from the body after eight years was compared to implants which were sterilized but not implanted (reference). Carbon and oxygen were the main components of both implants, however, as a result of the interaction with the human body the amount of oxygen increased 3-4 times and phosphorus, sulphur, calcium and iron were detectable as trace elements on the surface. The width of the carbon fibres (5-7 µm) building up the implants was not changed during the interaction with the human body. The surface of the implant retrieved from the human body was covered with a 15-17 µm thick layer, not present on the reference implant, having a similar composition to that of the carbon fibres (high amount of calcium that is typical to bone tissue was not detected). According to these results, the structure and the morphology of the implants were not altered notably by the human body.

Effect of human organism on the oxide layer formed on titanium osteosynthesis plates: a surface analytical study.

The question of whether or not to remove the titanium osteosynthesis plates used in maxillofacial surgery is not yet answered. These plates can be left a long time in the organism if there is no harmful interaction between the plates and the organism. The authors examined the properties of the surface oxide layers formed on osteosynthesis titanium plates by subsequent thermal and anodic oxidation, together with the properties of plates removed from patients after three years. Surface analytical method Secondary Ion Mass Spectroscopy (SIMS) was chosen. It was found that inside of the about 200-mum thick oxide on the original plates the concentration of impurities is much lower than near the oxide/titanium interface. On the surface of plates removed from the human body, a C (carbon), Ca (calcium) and P (phosphorus) enrichment was detected, suggesting a biological interaction between the organism and the plate. The passivating layer formed with thermal and anodic oxidation has not changed significantly in three years; it resisted to the corrosive effect of the human organism.