Risk factors for 30-day complications after cancer surgery in geriatric patients: a secondary analysis.

BACKGROUND: The aim was to analyse the association between severity of complications up to 30 days after surgery and pre-operative nutritional and physical performance parameters. METHODS: The participants were a subsample of the previously published PERATECS study (ClinicalTrials.gov: NCT01278537) and included 517 onco-geriatric patients aged ≥ 65 years, undergoing thoracoabdominal, gynaecological, or urological surgery. Post-operative complications were classified according to the Clavien Classification System (CCS). Independent risk factors related to the severity of complications, defined as major complications (CCS IIIa-V) and graded complications (CCS grade 0-V), were analysed using logistic and ordinal regression, respectively. RESULTS: In total, 132 patients suffered major post-operative complications. The development of major post-operative complications was independently associated with body mass index (BMI) < 20 kg/m2 , hypoalbuminaemia (< 30 g/l), longer duration of surgery, and specific tumour sites (upper gastrointestinal, gynaecological, colorectal) (all P < 0.05). Higher-grade complications were predicted by Timed Up and Go (TUG) > 20 s, hypoalbuminaemia (< 30 g/l), higher American Society of Anesthesiologists (ASA) status III-IV, longer duration of surgery (> 165 min), and specific tumour sites (upper gastrointestinal, gynaecological) (all P < 0.05). Mini Nutritional Assessment (MNA) scores and weight loss were not independent risk factors for the severity of complications. CONCLUSIONS: Nutritional and physical performance risk factors that predicted the severity of complications differed between major and higher-grade post-operative complications, but hypoalbuminaemia independently predicted both. The results support the need for pre-operative risk screening. Due to the explorative nature of the study, further research is required in larger cohorts to corroborate these findings.

[Delirium, analgesia, and sedation in intensive care medicine : Development of a protocol-based management approach]. / Delir, Analgesie und Sedierung in der Intensivmedizin : Entwicklung eines protokollbasierten Managements.

Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental. Here, a treatment target is defined and continuously re-evaluated by validated monitoring methods. Evidence clearly supports a paradigm shift towards patients that are awake, attentive, and able to participate in their therapy. Individualized analgesia and (non)sedation approaches allow a Richmond Agitation-Sedation Scale (RASS) target value of 0/-1 for the majority of patients. Should sedation indeed be necessary, there must be a focus on avoiding oversedation, especially an early deep sedation.

Electroencephalogram dynamics in children during different levels of anaesthetic depth.

OBJECTIVE: Anaesthesia-induced dynamics in EEG are dependent on age and level of anaesthesia, but distinct characterisation in children is incomplete. Here we analyse EEG dynamics in children related to age and level of anaesthesia. METHODS: Frontal EEG recordings were obtained from 93 children (0-19years) during routine clinical anaesthesia. EEG segments were selected at four different levels of anaesthesia: emergence, light anaesthesia, deep anaesthesia, and very deep anaesthesia. RESULTS: Total power differed significantly over age at deep (R2=0.314; p<0.0001) and very deep anaesthesia (R2=0.403; p<0.0001). Relative beta band power at light anaesthesia increased linearly with age (R2=0.239; p<0.0001). Level of anaesthesia caused significant differences for relative delta band power (increasing with anaesthetic depth), for relative beta band power and for spectral edge frequency (decreasing with anaesthetic depth) for all children (p<0.0001). CONCLUSIONS: EEG parameterin children were primary dependent on anaesthetic depth, where beta band power, delta band power and spectral edge frequency showed a linear relation. Age-dependency during anaesthesia procedure were only seen for single EEG parameters. SIGNIFICANCE: Different levels of anaesthesia can be identified by relative beta band power, relative delta band power and spectral edge frequency irrespective of the children's age.