Risk factors for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia: a retrospective study.

BACKGROUND: The objective of this study is to identify and evaluate the risk factors associated with the development of postoperative pulmonary complications (PPCs) in elderly patients undergoing video-assisted thoracoscopic surgery lobectomy under general anesthesia. METHODS: The retrospective study consecutively included elderly patients (≥ 70 years old) who underwent thoracoscopic lobectomy at Xuanwu Hospital of Capital Medical University from January 1, 2018 to August 31, 2023. The demographic characteristics, the preoperative, intraoperative and postoperative parameters were collected and analyzed using multivariate logistic regression to identify the prediction of risk factors for PPCs. RESULTS: 322 patients were included for analysis, and 115 patients (35.7%) developed PPCs. Multifactorial regression analysis showed that ASA ≥ III (P = 0.006, 95% CI: 1.230 ∼ 3.532), duration of one-lung ventilation (P = 0.033, 95% CI: 1.069 ∼ 4.867), smoking (P = 0.027, 95% CI: 1.072 ∼ 3.194) and COPD (P = 0.015, 95% CI: 1.332 ∼ 13.716) are independent risk factors for PPCs after thoracoscopic lobectomy in elderly patients. CONCLUSION: Risk factors for PPCs are ASA ≥ III, duration of one-lung ventilation, smoking and COPD in elderly patients over 70 years old undergoing thoracoscopic lobectomy. It is necessary to pay special attention to these patients to help optimize the allocation of resources and enhance preventive efforts.

Application of quantitative electroencephalography in predicting early cerebral ischemia in patients undergoing carotid endarterectomy.

Background: Quantitative electroencephalography (QEEG) has emerged as a promising monitoring method in cerebral ischemia, but the feasibility of QEEG in intraoperative cerebral perfusion-related ischemia monitoring is still uncertain. The purpose of this study was to investigate the value of QEEG monitoring in Carotid Endarterectomy (CEA) and the thresholds for intraoperative cerebral perfusion-related ischemia monitoring. Methods: Sixty-three patients who underwent carotid endarterectomy with continuous Transcranial Doppler ultrasound (TCD) monitoring and QEEG monitoring at Xuanwu Hospital Capital Medical University from January 2021 to August 2021 were enrolled in this study. Each patient received total intravenous anesthesia. Middle cerebral artery blood flow velocity (V-MCA) was obtained by TCD. Relative alpha percentage (RA) and alpha-delta ratio (ADR) were obtained by QEEG monitoring. Patients were divided into ischemic and non-ischemic groups using a decline of more than 50% in the V-MCA monitored by TCD as the gold standard. Results: Of the 63 patients, twenty patients were divided into the ischemic group, and forty-three patients into the non-ischemic group. Ipsilateral post-clamp RA and ADR values of QEEG were decreased for all patients in the ischemic group. The optimal threshold for RA and ADR to predict cerebral ischemia was a 14% decrease from baseline (sensitivity 90.0%, specificity 90.7%, Kappa value 0.786), a 21% decrease from baseline (sensitivity 85.0%, specificity 81.4%, Kappa value 0.622), respectively, indicated by TCD monitoring. Conclusions: Our study demonstrated that QEEG is a promising monitoring method undergoing CEA under general anesthesia and has good consistency with TCD.