Systematic Review and Meta-Analysis of Perioperative Administration of Acetazolamide for Management of Postoperative Pain after Laparoscopy.

Background and Objective: To perform a systematic review and meta-analysis to evaluate the efficacy of perioperative acetazolamide (ACTZ) administration with laparoscopy for reducing postoperative referred pain. Methods: The following databases were searched from inception to March 1, 2020: Cochrane, PubMed, PubMed Central, Ovid, and Embase. Electronic search used: Acetazolamide AND (laparoscopy OR laparoscopic OR Celioscopy OR Celioscopies OR Peritoneoscopy OR Peritoneoscopies). No limits or filters were used. We included only studies of patients who underwent abdominal laparoscopy (LSC), had a pain assessment at approximately 24 hours postoperatively, and included a treatment with ACTZ group and a no-treatment or minimal-treatment comparison group. Results: Five studies met inclusion criteria, with a combined total of 253 participants, 116 in the ACTZ group and 137 in the control group. A Bayesian hierarchical model was assumed for the study specific treatment effects. Posterior sampling was conducted via Markov Chain Monte Carlo methods, and posterior inference carried out on the hierarchical treatment effect. ACTZ significantly decreased average pain scores compared to control group by -0.726 points (95% confidence interval -1.175-0.264). The posterior probability that ACTZ decreases mean pain scores by ≥ 0.5 was 0.846. Conclusion: Current available evidence demonstrates that perioperative ACTZ may provide a modest improvement in postoperative referred pain following LSC.

Surgical site infection risk in cesarean delivery patients with obesity after negative pressure wound therapy: A retrospective cohort study.

BACKGROUND: There are conflicting reports of postoperative efficacy of negative pressure wound therapy in patients with obesity after cesarean delivery. METHODS: Retrospective cohort study for patients with obesity and negative pressure wound therapy or abdominal dressing after cesarean delivery between April 1, 2014 and January 31, 2018. Postoperative surgical site infection was defined from medical record charting or positive wound culture and confirmed by the hospital's Infection Prevention team. Multivariable logistic regression model for surgical site infection was conducted including additional potential confounding variables. Mantel-Haenszel tests were conducted to stratify by body mass index class and operative time, and we performed quasi-Poisson regression to determine which factors were associated with an increased operative time. RESULTS: We included 4,391 Black or White patients with obesity, 696 (15.9%) underwent negative pressure wound therapy and 3,695 (84.1%) abdominal dressing after cesarean delivery. Incidence of surgical site infection after negative pressure wound therapy and abdominal dressing were 6.1% and 3.4%, respectively (2-sample test of proportions P < .001). The multivariable logistic regression (covariates: race, diabetes, body mass index category, insurance, scheduled/emergency, artificial rupture, previous c-section, operative time, age, closure type) found negative pressure wound therapy dressing was associated with an increased risk of surgical site infection (adjusted odds ratio 1.54; 95% confidence interval, 1.01-2.34), as did a Mantel-Haenszel test which was stratified by body mass index (odds ratio 1.62; 95% confidence interval, 1.08-2.43) and a Mantel-Haenszel test stratified by operative time (odds ratio 1.85; 95% confidence interval, 1.28-2.65). Negative pressure wound therapy dressing also led to an increase in operative time in the Quasi-Poisson regression, which was the primary predictor of infection. CONCLUSION: Negative pressure wound therapy was associated with an increased the risk of postoperative surgical site infection after cesarean delivery in our obstetric patients with obesity. Future prospective studies are needed to determine a dressing type and other intervention to decrease postoperative cesarean surgical site infection in women with obesity.

Plasma fatty acyl-carnitines during 8 weeks of overfeeding: relation to diet energy expenditure and body composition: the PROOF study.

OBJECTIVE: Overfeeding is a strategy for evaluating the effects of excess energy intake. In this secondary analysis we tested the possibility that different levels of dietary protein might differentially modify the response of fatty acyl-carnitines to overfeeding. METHODS: Twenty-three healthy adult men and women were overfed by 40% for 8 weeks while in-patients with diets containing 5% (LPD), 15% (NPD) or 25% (HPD) protein. Plasma fatty acyl-carnitines were measured by gas chromatography/mass spectrometry (GC/MS) at baseline and after 8 weeks of overfeeding. Measurements included: body composition by DXA, energy expenditure by ventilated hood and doubly-labeled water, fat cell size from subcutaneous fat biopsies, and fat distribution by CT scan. RESULTS: Analysis was done on 5 groups of fatty acyl-carnitines identified by principal components analysis and 6 individual short-chain fatty acyl carnitines. Higher protein intake was associated with significantly lower 8 week levels of medium chain fatty acids and C2, C4-OH and C 6:1, but higher values of C3 and C5:1 acyl-carnitines derived from essential amino acids. In contrast energy and fat intake were only weakly related to changes in fatty acyl-carnitines. A decease or smaller rise in 8 week medium chain acyl-carnitines was associated with an increase in sleeping energy expenditure (P = 0.0004), and fat free mass (P < 0.0001) and a decrease in free fatty acid concentrations (FFA) (P = 0.0067). In contrast changes in short-chain fatty acyl-carnitines were related to changes in resting energy expenditure (P = 0.0026), and fat free mass (P = 0.0007), and C4-OH was positively related to FFA (P = 0006). CONCLUSION: Protein intake was the major factor influencing changes in fatty acyl carnitines during overfeeding with higher values of most acyl-fatty acids on the low protein diet. The association of dietary protein and fat intake may explain the changes in energy expenditure and metabolic variables resulting in the observed patterns of fatty acyl carnitines.

Assessing Energy Requirements in Women With Polycystic Ovary Syndrome: A Comparison Against Doubly Labeled Water.

Context: Weight loss is prescribed to offset the deleterious consequences of polycystic ovary syndrome (PCOS), but a successful intervention requires an accurate assessment of energy requirements. Objective: Describe energy requirements in women with PCOS and evaluate common prediction equations compared with doubly labeled water (DLW). Design: Cross-sectional study. Setting: Academic research center. Participants: Twenty-eight weight-stable women with PCOS completed a 14-day DLW study along with measures of body composition and resting metabolic rate and assessment of physical activity by accelerometry. Main Outcome: Total daily energy expenditure (TDEE) determined by DLW. Results: TDEE was 2661 ± 373 kcal/d. TDEE estimated from four commonly used equations was within 4% to 6% of the TDEE measured by DLW. Hyperinsulinemia (fasting insulin and homeostatic model assessment of insulin resistance) was associated with TDEE estimates from all prediction equations (both r = 0.45; P = 0.02) but was not a significant covariate in a model that predicts TDEE. Similarly, hyperandrogenemia (total testosterone, free androgen index, and dehydroepiandrosterone sulfate) was not associated with TDEE. In weight-stable women with PCOS, the following equation derived from DLW can be used to determine energy requirements: TDEE (kcal/d) = 438 - [1.6 * Fat Mass (kg)] + [35.1 * Fat-Free Mass (kg)] + [16.2 * Age (y)]; R2 = 0.41; P = 0.005. Conclusions: Established equations using weight, height, and age performed well for predicting energy requirements in weight-stable women with PCOS, but more precise estimates require an accurate assessment of physical activity. Our equation derived from DLW data, which incorporates habitual physical activity, can also be used in women with PCOS; however, additional studies are needed for model validation.