Comparison of prophylaxis strategy for postoperative nausea and vomiting and its incidence before and after the implementation of 5-hydroxytryptamine 3 in surgical setting: a single-center, retrospective study.

PURPOSE: To investigate the association between adherence to guideline-recommended risk-based postoperative nausea and vomiting (PONV) prophylaxis, the antiemetics used for PONV prophylaxis, and the incidence of PONV in patients who were underwent general anesthesia before and after 5-HT3 receptor antagonists became available. METHODS: Patients (≥ 20 years old) who were extubated after scheduled surgery and returned to general wards between January 2021 and February 2022 and between June 2022 and July 2023 were included. Risk factors included age < 50, female, motion sickness, nonsmoker, surgical factors, and postoperative opioid use. Two and three or more prophylaxis were recommended for patients with one or two and three or more risk factors, respectively. The primary outcome was the number of patients who received adequate prophylaxis, and the secondary outcomes were antiemetic agents used during anesthesia and the incidence of PONV on postoperative days 0 and 1. PONV was defined as documented PONV or rescue antiemetic administration. RESULTS: From January 2021 to February 2022 and from June 2022 to July 2023, 2342 and 2682 patients were included, respectively. Before ondansetron became available, more D2 receptor antagonists were used (p < 0.001), and after ondansetron became available, both ondansetron (p < 0.001) and propofol (p < 0.001) were given more frequently. Before and after ondansetron became available, the number of patients with adequate prophylaxis was 3.7% and 9.2%, respectively (p < 0.001), and the incidence of PONV on postoperative days 0 and 1 was 44.6% and 44.0%, respectively (p = 0.67). CONCLUSION: The availability of ondansetron increased the number of patients with adequate PONV prophylaxis, but did not decrease the incidence of PONV.

Feasibility, reliability, and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 in patients attending the pain clinic.

PURPOSE: In the cohort of patients attending pain clinic, the primary goal has been shifting from pain reduction to improving activities of daily living and functional status. The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is one of the useful tools for assessment of functional status across all psychiatric and medical diseases; however, its feasibility, reliability, and validity have not been assessed in these patients. Thus, in this study, we evaluated the feasibility, reliability, and validity of the 12-item WHODAS 2.0 in patients attending the pain clinic at our university hospital. METHODS: This is a prospective observational study including the patients aged 50 years or older who were attending the pain clinic at Nara Medical University between April 2019 and May 2019. Patient-related outcomes including functional status and activities of daily living were assessed with the 12-item WHODAS 2.0, EuroQol-5 dimension 5 levels, and the Tokyo Metropolitan Institute of Gerontology Index. RESULTS: The response rate was 99.7%. The 12-item WHODAS2.0 had a floor effect but no ceiling effect and its Cronbach's α coefficient was 0.909. The correlation coefficients between the 12-item WHODAS 2.0 score and the EuroQol-5 dimension 5 levels and the Tokyo Metropolitan Institute of Gerontology Index were -0.66 and -0.67, respectively. CONCLUSIONS: The 12-item WHODAS 2.0 is a useful measurement tool to assess disability of pain patients with high reliability and validity.

Anaesthesia management by residents does not alter the incidence of self-reported anaesthesia awareness: A teaching hospital-based propensity score analysis.

BACKGROUND: Intraoperative awareness during general anaesthesia is rare but represents one of the major anaesthesia-related complications. Intraoperative awareness may be a result of inadequate anaesthesia management. Therefore, the incidence can be related with the experience of anaesthetists. To assess whether the incidence of intraoperative awareness is related to anaesthetists' experience, we compared the incidence of self-reported intraoperative awareness between patients managed by anaesthesia residents or by experienced anaesthetists. METHODS: This is a retrospective review of an institutional registry containing 21,606 general anaesthesia cases. It was conducted with the ethics board approval. Propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anaesthetist managements), yielding 4940 matched patient pairs. The incidence of self-reported intraoperative awareness compared as primary outcomes. Additionally, a multivariate logistic analysis in the entire cohort, using the incidence of self-reported intraoperative awareness as dependent variable, was conducted to confirm the result of the primary outcome. RESULTS: In the unmatched population, contrary to our hypothesis, the incidence of self-reported intraoperative awareness was lower in resident management compared with anaesthetist management (1.1% vs. 1.5%, P=0.028). However, after propensity score matching, there was no difference in incidences of self-reported intraoperative awareness (1.5% vs. 1.3%, 0.38). The multivariate analysis confirmed the result of the primary outcome from the matched pair analysis and showed that ASA physical status (OR=1.40, 95% CI=1.08 to 1.81), emergency case (CI=2.05, 95% CI=1.40 to 3.00), and application of postoperative analgesia (OR=0.70, 95% CI=0.50 to 0.97) were independently associated with incidence of self-reported intraoperative awareness. CONCLUSION: In conclusion, when supervised by an anaesthetist, resident anaesthesia management is not more likely to result in complaints about intraoperative recall than anaesthetist management.

Anesthesia management by residents does not alter the incidence of recall of tracheal extubation: a teaching hospital-based propensity score analysis / A administração de anestesia por residentes não altera a incidência de memória da extubação traqueal: uma análise de pontuação de propensão baseada no ensino hospitalar

Abstract Background and objectives: The memory of emergence from anesthesia is recognized as one type of anesthesia awareness. Apart from planed awake extubation, unintentional recall of tracheal extubation is thought to be the results of inadequate anesthesia management; therefore, the incidence can be related with the experience of anesthetists. To assess whether the incidence of recall of tracheal extubation is related to anesthetists' experience, we compared the incidence of recall of tracheal extubation between patients managed by anesthesia residents or by experienced anesthetists. Methods: This is a retrospective review of an institutional registry containing 21,606 general anesthesia cases and was conducted with the board of ethical review approval. All resident tracheal extubations were performed under anesthetists' supervision. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anesthetist managements), yielding 3,475 matched patient pairs. The incidence of recall of tracheal extubation was compared as primary outcomes. Results: In the unmatched population, there was no difference in the incidences of recall of tracheal extubation between resident management and anesthetist management (6.5% vs. 7.1%, p = 0.275). After propensity score matching, there was still no difference in incidences of recall of tracheal extubation (7.1% vs. 7.0%, p = 0.853). Conclusion: In conclusion, when supervised by an anesthetist, resident extubations are no more likely to result in recall than anesthetist extubations.

Resumo Justificativa e objetivos: A recordação da emergência da anestesia é reconhecida como um dos tipos de memória da anestesia. Excluindo a extubação planejada com o paciente acordado, acredita-se que a memória não intencional durante a extubação traqueal seja o resultado de manejo inadequado da anestesia; portanto, a incidência pode estar relacionada com a experiência dos anestesistas. Para avaliar se a incidência de memória durante a extubação traqueal está relacionada com a experiência dos anestesistas, comparamos a incidência de memória durante a extubação traqueal entre pacientes tratados por residentes de anestesia ou por anestesistas experientes. Métodos: Estudo retrospectivo de revisão de um registo institucional com 21.606 casos de anestesia geral, conduzido com a aprovação do Comitê de Ética. Todas as extubações traqueais foram feitas por residentes sob a supervisão de anestesistas. Para evitar o viés de canalização, a análise do índice de propensão foi usada para gerar um grupo de casos pareados (manejo por residentes) e de controles (manejo por anestesistas), obtiveram-se 3.475 pares combinados de pacientes. A incidência de memória durante a extubação traqueal foi comparada com os desfechos primários. Resultados: Na população não pareada, não houve diferença na incidência de memória durante a extubação traqueal entre o manejo feito por residentes e anestesistas (6,5% vs. 7,1%, p = 0,275). Mesmo após parear os escores de propensão, não observamos diferença na incidência de memória durante a extubação traqueal (7,1% vs. 7,0%, p = 0,853). Conclusão: Em conclusão, quando supervisionadas por um anestesista, as extubações feitas por residentes não são mais propensas a resultar em memória do que as extubações feitas por anestesistas.

Feasibility, reliability, and validity of the Japanese version of the 12-item World Health Organization Disability Assessment Schedule-2 in preoperative patients.

PURPOSE: The avoidance of postoperative functional disability is one of the most important concerns of patients facing surgery, but methods to evaluate disability have not been definitively established. The aim of our study was to evaluate the feasibility, reliability, and validity of the Japanese version of the 12-item World Health Organization Disability Assessment Schedule-2 (WHODAS 2.0-J) in preoperative patients. METHODS: Individuals aged ≥55 years who were scheduled to undergo surgery in a tertiary-care hospital in Japan between April 2016 and September 2016 were eligible for enrolment in the study. All patients were assessed preoperatively using the WHODAS 2.0-J, the 8-Item Short Form (SF-8) questionnaire, and the Tokyo Metropolitan Institute of Gerontology Index (TMIG Index). The feasibility, reliability, and validity of WHODAS2.0-J were evaluated using response rate, Cronbach's alpha (a measure of reliability), and the correlation between the WHODAS 2.0-J and the SF-8 questionnaire and TMIG Index, respectively. RESULTS: A total of 934 patients were enrolled in the study during the study period, of whom 930 completed the WHODAS 2.0-J (response rate 99.5%) preoperatively. Reliability and validity were assessed in the 898 patients who completed all three assessment tools (WHODAS 2.0-J, SF-8 questionnaire, and TMIG Index) and for whom all demographic data were available. Cronbach's alpha was 0.92. The total score of the WHODAS 2.0-J showed a mild or moderate correlation with the SF-8 questionnaire and TMIG Index (r = -0.63 to -0.34). CONCLUSION: The WHODAS 2.0-J is a feasible, reliable, and valid instrument for evaluating preoperative functional disability in surgical patients.

[Anesthesia management by residents does not alter the incidence of recall of tracheal extubation: a teaching hospital-based propensity score analysis]. / A administração de anestesia por residentes não altera a incidência de memória da extubação traqueal: uma análise de pontuação de propensão baseada no ensino hospitalar.

BACKGROUND AND OBJECTIVES: The memory of emergence from anesthesia is recognized as one type of anesthesia awareness. Apart from planed awake extubation, unintentional recall of tracheal extubation is thought to be the results of inadequate anesthesia management; therefore, the incidence can be related with the experience of anesthetists. To assess whether the incidence of recall of tracheal extubation is related to anesthetists' experience, we compared the incidence of recall of tracheal extubation between patients managed by anesthesia residents or by experienced anesthetists. METHODS: This is a retrospective review of an institutional registry containing 21,606 general anesthesia cases and was conducted with the board of ethical review approval. All resident tracheal extubations were performed under anesthetists' supervision. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anesthetist managements), yielding 3,475 matched patient pairs. The incidence of recall of tracheal extubation was compared as primary outcomes. RESULTS: In the unmatched population, there was no difference in the incidences of recall of tracheal extubation between resident management and anesthetist management (6.5% vs. 7.1%, p=0.275). After propensity score matching, there was still no difference in incidences of recall of tracheal extubation (7.1% vs. 7.0%, p=0.853). CONCLUSION: In conclusion, when supervised by an anesthetist, resident extubations are no more likely to result in recall than anesthetist extubations.

Is an urban legend true in the teaching hospital that "you will get hurt if you go to hospital at the beginning of the fiscal year"?

An urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year" is in circulation, because people in general suppose that inexperienced newcomers start to work at clinical practice during that time period. We tried to determine whether this urban legend was true or not by using data from our operation management system. We retrospectively conducted a study to investigate whether the number of cannulation failures, which was used as an index of patient disadvantages at clinical practice, could be affected by the volume of residents in clinical participation. The number of insertion trials per case was not prominent in the first month of the fiscal year. However, the number of insertion trials per case increased in proportion to the average number of residents per day. It seems that there was no evidence to support the urban legend that "you will get hurt if you go to hospital at the beginning of the fiscal year." However, our results suggest that rather than an urban legend, we are now confronting the fact that patients may suffer from medical disadvantages in the teaching hospitals.

Assessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair.

PURPOSE: Monitoring motor evoked potentials (MEPs) has been recognized as a highly reliable method to detect intraoperative spinal cord ischemia (SCI) in aortic repair. However, the data regarding the sensitivity and specificity of MEPs for predicting postoperative paraplegia are limited. We retrospectively assessed the value of intraoperative MEP amplitudes for predicting postoperative paraplegia. METHODS: The medical records of 44 patients were reviewed. A train-of-five stimulation was delivered to C3-C4, and MEPs were recorded from the abductor pollicis brevis and the tibialis anterior muscles. The cutoff point for detecting SCI was set at 75% decrease of the baseline MEP. Receiver operating characteristic curves were applied at various cutoff points. RESULTS: Three patients (6.8%) had postoperative paraplegia. The minimum MEP during surgery had 100% sensitivity and 64.9% specificity in predicting paraplegia, and the MEP at the end of surgery had 66.7% sensitivity and 78.0% specificity in predicting paraplegia: only 1 patient, who had borderline paraplegia (right monoparesis), showed a false-negative result. Receiver operating characteristic curves indicated that adequate cutoff points for the minimum MEP during surgery and for the MEP amplitude at the end of surgery were a 75-90% decrease and a 64-75% decrease of the baseline MEP, respectively. CONCLUSION: Monitoring MEPs had relatively high sensitivity and acceptable specificity, with the cutoff point set at 75% decrease of the baseline MEP, for predicting paraplegia and paraparesis. Because of the small sample in our study, further investigations would be necessary to investigate an adequate cutoff point that could predict postoperative paraplegia.

Long-term assessment of hind limb motor function and neuronal injury following spinal cord ischemia in rats.

Recent evidence suggests that brain injury caused by ischemia is a dynamic process characterized by ongoing neuronal loss for at least 14 days after ischemia. However, long-term outcome following spinal cord ischemia has not been extensively examined. Therefore, we investigated the changes of hind limb motor function and neuronal injury during a 14-day recovery period after spinal cord ischemia. Male Sprague-Dawley rats received spinal cord ischemia (n = 64) or sham operation (n = 21). Spinal cord ischemia was induced by inflation of a 2F Fogarty catheter placed into the thoracic aorta for 6, 8, or 10 minutes. The rats were killed 2, 7, or 14 days after reperfusion. Hind limb motor function was assessed with the 21-point Basso, Beattie, and Bresnahan (BBB) scale during the recovery period. The number of normal and necrotic neurons was counted in spinal cord sections stained with hematoxylin/eosin. Longer duration of spinal cord ischemia produced severer hind limb motor dysfunction at each time point. However, BBB scores gradually improved during the 14-day recovery period. Neurologic deterioration was not observed between 7 and 14 days after reperfusion. The number of necrotic neurons peaked 2 days after reperfusion and then decreased. A small number of necrotic neurons were still observed 7 and 14 days after reperfusion in some of the animals. These results indicate that, although hind limb motor function may gradually recover, neuronal loss can be ongoing for 14 days after spinal cord ischemia.