Effect of volatile versus propofol anaesthesia on major complications and mortality after cardiac surgery: a multicentre randomised trial.

BACKGROUND: The comparative effectiveness of volatile anaesthesia and total intravenous anaesthesia (TIVA) in terms of patient outcomes after cardiac surgery remains a topic of debate. METHODS: Multicentre randomised trial in 16 tertiary hospitals in China. Adult patients undergoing elective cardiac surgery were randomised in a 1:1 ratio to receive volatile anaesthesia (sevoflurane or desflurane) or propofol-based TIVA. The primary outcome was a composite of predefined major complications during hospitalisation and mortality 30 days after surgery. RESULTS: Of the 3123 randomised patients, 3083 (98.7%; mean age 55 yr; 1419 [46.0%] women) were included in the modified intention-to-treat analysis. The composite primary outcome was met by a similar number of patients in both groups (volatile group: 517 of 1531 (33.8%) patients vs TIVA group: 515 of 1552 (33.2%) patients; relative risk 1.02 [0.92-1.12]; P=0.76; adjusted odds ratio 1.05 [0.90-1.22]; P=0.57). Secondary outcomes including 6-month and 1-yr mortality, duration of mechanical ventilation, length of ICU and hospital stay, and healthcare costs, were also similar for the two groups. CONCLUSIONS: Among adults undergoing cardiac surgery, we found no difference in the clinical effectiveness of volatile anaesthesia and propofol-based TIVA. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-IOR-17013578).

Survival analysis of intraoperative blood salvage for patients with malignancy disease: A PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: Intraoperative blood salvage as a blood-saving strategy has been widely used in surgery. Considering its theoretic risk of malignant tumor cells being reinfused and the corresponding blood metastases, the safety of intraoperative blood salvage in cancer surgery remains controversial. METHODS: Following the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA), we searched the Cochrane Library, MEDLINE and EMBASE to November 2017. We included only studies comparing intraoperative blood salvage with allogeneic blood transfusion. RESULTS: This meta-analysis included 9 studies with 4354 patients with 1346 patients in the intraoperative blood salvage group and 3008 patients in the allogeneic blood transfusion group. There were no significant differences in the 5-year overall survival outcome (odds ratio [OR] 1.12; 95% confidence interval [CI], 0.80-1.58), 5-year disease-free survival outcome (OR 1.08; 95% CI 0.86-1.35), or 5-year recurrence rate (OR 0.86; 95% CI 0.71-1.05) between the 2 study groups. Subgroup analysis also showed no significant differences in the 5-year overall survival outcome (OR 0.97; 95% CI 0.57-1.67) of hepatocellular carcinoma patients in liver transplantation. CONCLUSIONS: For patients with malignant disease, intraoperative blood salvage did not increase the tumor recurrence rate and had comparable survival outcomes with allogeneic blood transfusion.

Risk factors of the postoperative 30-day readmission of gastric cancer surgery after discharge: A PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: Readmission is a common postoperative adverse event. This study aimed to analyze potential risk factors for the incidence of postoperative 30-day readmission after discharge for gastric cancer patients with surgical treatment. METHODS: Those studies that reported the risk factors of gastric cancer patients who have a postoperative 30-day readmission were identified systematically from the PubMed, Cochrane, and Embase databases through July 2018. A systematic review and meta-analysis was performed to estimate the risk factors of postoperative 30-day readmission after gastric cancer surgery. RESULTS: Ultimately, 6 studies with 12,586 gastric cancer patients were included in the present study. There were 1473 (11.7%) patients who had postoperative 30-day readmission and 12,586 (88.3%) patients without 30-day postoperative readmission. A greater proportion of the readmission group had cardiovascular comorbidity (P < .001), pulmonary comorbidity (P < .001), and diabetes mellitus (P = .020) than the nonreadmission group. Furthermore, more patients in the readmission group had total gastrectomy (P < .001), combined organ resection (P < .001) and postoperative complications (P < .001) than did patients in the nonreadmission group. Nonhome discharge (odds ratio [OR] 1.580, P = .002), diabetes mellitus (OR 1.181, P = .044), postoperative complications (OR 2.656, P = .006), total gastrectomy (OR 2.242, P < .001), and combined organ resection (OR 1.534, P < .001) were independent risk factors for postoperative readmission. CONCLUSION: Postoperative readmission is influenced by the synthetic action of preparative, intraoperative, and postoperative factors, such as diabetes mellitus, total gastrectomy, combined organ resection, nonhome discharge, and postoperative complications. Extra attention should be paid to those patients with high risk factors during the postoperative follow-up and recovery periods.

Ex vivo nicotine stimulation augments the efficacy of human peripheral blood mononuclear cell-derived dendritic cell vaccination via activating Akt-S6 pathway.

Our previous studies showed that α7 nicotinic acetylcholine receptor (nAchR) agonist nicotine has stimulatory effects on murine bone marrow-derived semimature DCs, but the effect of nicotine on peripheral blood mononuclear cell- (PBMC-) derived human semimature dendritic cells (hu-imDCs) is still to be clarified. In the present study, hu-imDCs (cultured 4 days) were conferred with ex vivo lower dose nicotine stimulation and the effect of nicotine on surface molecules expression, the ability of cross-presentation, DCs-mediated PBMC priming, and activated signaling pathways were determined. We could demonstrate that the treatment with nicotine resulted in increased surface molecules expression, enhanced hu-imDCs-mediated PBMC proliferation, upregulated release of IL-12 in the supernatant of cocultured DCs-PBMC, and augmented phosphorylation of Akt and ribosomal protein S6. Nicotine associated with traces of LPS efficiently enhanced endosomal translocation of internalized ovalbumin (OVA) and increased TAP-OVA colocalization. Importantly, the upregulation of nicotine-increased surface molecules upregulation was significantly abrogated by the inhibition of Akt kinase. These findings demonstrate that ex vivo nicotine stimulation augments hu-imDCs surface molecules expression via Akt-S6 pathway, combined with increased Ag-presentation result in augmented efficacy of DCs-mediated PBMC proliferation and Th1 polarization.

[Clinical comparison of propofol and remifentanil anaesthesia with sevoflurane and remifentanil anaesthesia for children with cleft lip and palate repair surgery].

OBJECTIVE: To compare the clinical effects and safety of propofol and remifentanil anaesthesia with sevoflurane and remifentanil anaesthesia for cleft lip and palate repair surgery in children. METHODS: Forty children undergoing elective cleft lip and palate repair surgery were randomly divided into two groups, 20 in each group. Group PR: Propofol and remifentanil anaesthesia; and group S: Sevoflurane and remifentanil anaesthesia. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO2), and end tidal carbon dioxide (ETCO2) were observed, and recorded at the time before the induction (T0), after 15 min of induction (T1), after 30 min of induction (T2), and after 1 min of extubation (T3). The time to extubation, incidence of restlessness, postoperative nausea and vomiting, and the complication of the airway were recorded. RESULTS: There were no significantly differences between the two groups with respect to sex, age, weight, category of operation, and the time of operation. In group PR, after the period of induction, two children used atropine for bradycardia. One was 3-years-old, and the other was 8-years-old. The HR of former was lower than 100 beats per minute, and the latter was lower than 70 beats per minute. The average of HR in group PR was increased after 1 min of extubation compared with that before induction (P<0.05). In group S, the average of HR was increased in 30 min after induction and 1 min after extubation (P<0.05), and HR kept in faster range compared with that in group PR (P<0.05) at the 15 min and 30 min after induction. During the operation, SPO2 and ETCO2 of both groups consistently maintained in normal range. The time to extubation was comparable in two groups. The incidence of agitation after surgery was significantly higher in group S (8 cases) than that in group PR (2 cases). There were no records of nausea, vomiting, asphyxia, and laryngospasm. CONCLUSION: Propofol and remifentanil anaesthesia was more significantly inhibited the HR of children. The emergence agitation has higher incidence in sevoflurane anaesthesia. Both methods can attain extubation requirement quickly.