High Arterial Lactate Levels after Hepatic Resection Are Associated with Low Oxygen Delivery and Predict Severe Postoperative Complications.

High End-Surgery Arterial Lactate Concentration (ES-ALC) predicts poor outcome after hepatectomy. The aim of this study was to identify intraoperative hemodynamic parameters predicting high ES-ALC during elective liver resection. Patients who underwent liver resection between 2017 and 2018, under FloTrac/EV1000TM hemodynamic monitoring, were included. The ES-ALC cutoff best predicting severe postoperative complications was identified. Association between high ES-ALC and preoperative and intraoperative variables was assessed. 108 patients were included; 90-day mortality was 0.9% and severe morbidity 14.8%. ES-ALC cutoff best discriminating severe complications was 5.05 mmol/L. Patients with ES-ALC > 5.0 mmol/L had a relative risk of severe complications of 2.8% (p = 0.004). High ES-ALC patients had longer surgery and ischemia duration, larger blood losses and higher requirements of fluids and blood transfusions. During surgery, hemoglobin concentration and oxygen delivery (DO2) decreased more significantly in patients with high ES-ALC, although they had similar values of stroke volume and cardiac output to those of other patients. At multivariate analysis, surgery duration and lowest recorded DO2 value were the strongest predictors of high ES-ALC. ES-ALC > 5.0 mmol/L in elective liver resection predicts postoperative morbidity and is essentially driven by the impaired DO2. Timely correction of blood losses might prevent the ES-ALC increase.

Evaluation of satisfaction level by parents and children following pediatric anesthesia.

BACKGROUND: Research in the field of patient satisfaction first took place in the 1980s in the USA, and later in Europe, aimed at meeting competitive requirements in the field of health care. Very few studies of this type exist in regard to pediatric anesthesia. Our aim was to develop a rapidly interpretable questionnaire to measure the level of parental satisfaction when their children undergo surgery and provide information on those factors triggering anxiety in these children. METHODS: Over a period of 18 months 179 parents of children in pediatric surgery responded to 214 questionnaires designed to investigate principally the emotional/behavioral spheres as well as the comfort provided. RESULTS AND CONCLUSIONS: We found that parents generally expressed a high degree of satisfaction which was good and correlated significantly with environmental comfort and postoperative observations performed by anesthetists and nursing staff. In the children, lack of fear at the moment of being anesthetized, and lack of anxiety on the day preceding surgery, were attributed to the serenity transmitted by the anesthetist and nurses. Significant anxiety resulted from the fear of an unpleasant impact with the operating room.

Use of intravenous ketorolac in the neonate and premature babies.

BACKGROUND: Ketorolac is a powerful nonsteroidal anti-inflammatory drug widely used for pain control in children and adults. The aim of this study was to evaluate its safety and analgesic efficacy in the neonate. METHODS: Ketorolac was used in a group of 18 spontaneously breathing neonates presenting with chronic lung disease, for the control of postsurgical pain and pain from invasive procedures. Pain scores (Neonatal Infant Pain Scale) were assessed before and after i.v. administration of 1 mg.kg(-1) of ketorolac. RESULTS: Total pain control was achieved in 94.4% of the neonates. None of the neonates had haematological, renal or hepatic changes prior to treatment, and these complications did not occur after treatment. No neonate had systemic haemorrhage or bleeding from injection and blood withdrawal sites. CONCLUSIONS: Ketorolac could represent an efficacious analgesic alternative to opioids, particularly in neonates. It would avoid the side-effects associated with opioid analgesics, especially respiratory depression.