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1.
Cureus ; 15(3): e36089, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37065354

RESUMEN

OBJECTIVES: Opioid-free anesthesia with erector spinae plane block (ESPB) has the potential to decrease perioperative opioid need, thereby potentially reducing related complications. This study aimed to compare opioid-free anesthesia with ESPB and standard opioid-based balanced anesthesia in patients undergoing video-assisted thoracic surgery (VATS) in terms of postoperative opioid need (through patient control analgesia) as well as postoperative pain management, recovery quality, and opioid-related side effects. METHODS: Seventy-four patients, ranging in age from 18 to 75 years, who underwent lobectomy with VATS were included in this randomized-controlled study. The opioid-free group had ESPB, and no opioid was used during anesthesia maintenance. The opioid group received standard anesthesia with opioid use. Postoperative morphine requirement, postoperative pain as measured by the visual analog scale (VAS), intraoperative vital parameters, recovery quality using the Quality of Recovery-40 (QoR-40) questionnaire, and opioid-related complications were compared between groups. RESULTS: The opioid-free group received a significantly lower total dose of morphine during the first 24 postoperative hours through patient-controlled analgesia (PCA) when compared to the opioid group (7.3±3.4 vs. 21.7±7.9 mg, p<0.001). In addition, the opioid-free group had significantly better postoperative pain scores and QoR-40 scores (184.3±7.5 versus 171.2±6.4, p<0.001), shorter times to mobilization (5.5±0.8 versus 8.1±1.1 hours, p<0.001), and oral intake (5.8±0.6 versus 6.4±0.6 hours, p<0.001), as well as less frequent opioid-related side effects. CONCLUSION: The findings of this study suggest that opioid-free anesthesia with ESPB represents a promising option for patients undergoing lobectomy with VATS. It has the potential to decrease postoperative opioid need, improve postoperative pain management, and reduce opioid-related unwanted consequences.

2.
Paediatr Anaesth ; 33(1): 52-58, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36168810

RESUMEN

INTRODUCTION: The Plethysmographic Variability Index can be measured by both finger and forehead probes. Vasoconstriction may jeopardize the reliability of finger PVI measurements in pediatric patients undergoing surgery. However, forehead vasculature exhibits more marked resistance to alterations in the vasomotor tonus. OBJECTIVE: Our aim was to compare the Plethysmographic Variability Index measured via finger or forehead probes in mechanically ventilated pediatric surgery patients in terms of their ability to predict fluid responsiveness as well as to determine the best cut-off values for these two measurements. MATERIALS AND METHODS: A total of 50 pediatric patients undergoing minor elective surgery were included after provision of parental consent and ethics committee approval. Perfusion index measured at the finger or forehead and Plethysmographic Variability Index monitoring comprised the primary assessments. Hemodynamic parameters monitored included perfusion index, Plethysmographic Variability Index, and cardiac output. A ≥ 15% increase in cardiac output following passive leg raise maneuver was considered to show fluid responsiveness. Two groups were defined based on fluid responsiveness: Group R (responsive) and Group NR (non-responsive). Student's t-test, Mann-Whitney U test, DeLong test, and ROC were used for statistical analysis. RESULTS: The area under curve for finger and forehead Plethysmographic Variability Index prior to passive leg raise maneuver were 0.699 (p = .011) and 0.847 (p < .001), respectively. The sensitivity for finger and forehead measurements at a cut-off value of ≤14% was 92.9% and 96.4%, and 45.4% and 72.7%, respectively. CONCLUSION: Although forehead and finger Plethysmographic Variability Index monitoring were similarly sensitive in predicting fluid responsiveness in pediatric surgical patients, the former method provided higher specificity. The best cut-off value for PVI measurements with forehead and finger probes was found to be 14%.


Asunto(s)
Consentimiento Paterno , Proyectos de Investigación , Niño , Humanos , Reproducibilidad de los Resultados
3.
J Coll Physicians Surg Pak ; 32(10): 1242-1248, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36205265

RESUMEN

OBJECTIVE: To assess blood transfusion decisions in blood losses using a continuous total haemoglobin (SpHb) and non-invasive haemoglobin (Hb) device. STUDY DESIGN: Double-blinded randomised controlled trial. PLACE AND DURATION OF STUDY: Marmara University Hospital, Istanbul, Turkey, from March 2018 to December 2019. METHODOLOGY: One hundred and twenty adult patients scheduled for elective major surgery and expected to experience a blood loss greater than 20% of their total blood volume were divided into two groups. These groups were compared for bleeding management with conventional blood gas sampling (Group Hb, the control group) according to Hb monitoring versus SpHb measurement (Group SpHb, the study group). RESULTS: In the postoperative measurement, there were fewer red blood cells (RBC) in the SpHb group than in the Hb group (p=0.020). There was a greater change in the amount of RBC from the perioperative to the postoperative period in the SpHb group compared to the Hb group (p<0.001). Postoperative Hb levels of patients in the intensive care unit (ICU) were higher in the SpHb group than in the Hb group (p<0.05). CONCLUSION: SpHb can provide effective patient blood management in cases of major surgery. It does not cause a delay in the decision of blood transfusion during surgery. KEY WORDS: Haemorrhage, Anaemia, Blood transfusion, General surgery.


Asunto(s)
Anemia , Monitoreo Intraoperatorio , Adulto , Método Doble Ciego , Hemoglobinas/análisis , Hemorragia , Humanos , Estudios Prospectivos
4.
Obes Surg ; 32(4): 1236-1242, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35112267

RESUMEN

PURPOSE: This study aims to examine the predictive role of obesity-type-related indexes and perioperative intraabdominal pressure measurements for early postoperative complications following bariatric surgery. MATERIALS AND METHODS: Sixty-seven female patients with obesity who underwent bariatric surgery (laparoscopic sleeve gastrectomy or gastric bypass) were included in this study. Obesity-related indexes (BMI, waist/hip ratio, and waist/height ratio) were calculated using patient data. Intraoperative hemodynamic measurements and intraabdominal pressure measurements were done at the beginning and at the end of the operation. Intraabdominal pressure measurements were done using both bladder port and trocar port. Patients were followed for early postoperative complications. RESULTS: Among 67 patients included, 22 developed early postoperative complications (32.8%), mostly pulmonary (20.9%). Trans-trocar IAP measured at the beginning of the operation emerged as the single independent predictor of postoperative complications (OR, 40.3; p = 0.002). Based on ROC analysis, AUC for predicting complications was 0.955 (p < 0.01). Optimal cutoff point (≥ 14.5 mmHg) was associated with 100% sensitivity and 82% specificity. In addition, there were weak but significant positive correlations between trans-trocar IAP-beginning and BMI (r = 0.443, p < 0.001), waist/hip ratio (r = 0.434, p < 0.001), and waist/height ratio (r = 0.539, p < 0.001). CONCLUSION: Findings of this study suggest that a high baseline intraabdominal pressure predicts a higher risk for early postoperative complications following bariatric surgery. This information would help improve patient care. Further large studies are warranted.


Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Cirugía Bariátrica/efectos adversos , Femenino , Gastrectomía/efectos adversos , Derivación Gástrica/efectos adversos , Humanos , Laparoscopía/efectos adversos , Morbilidad , Obesidad/cirugía , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos
5.
J Clin Monit Comput ; 36(5): 1341-1346, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-34705168

RESUMEN

Oxygen reserve index, available as part of Masimo Rainbow SET pulse oximetry, is a noninvasive and continuous variable intended to provide insight into a patient's oxygen status in the moderate hyperoxic range (PaO2 > 100 and ≤ 200 mm Hg), defined as a patient's oxygen "reserve". When used in conjunction with pulse oximetry, ORi extends the knowledge on a patient's oxygen status providing clinically important information helping to prevent hyperoxemia and hypoxemia. There are limited data on patients undergoing craniosynostosis surgery. Our primary goal was to evaluate the effects of different concentrations of inspiratory oxygen (FiO2) on patient oxygenation status by monitoring ORi. Thirty patients scheduled for craniosynostosis were included in this observational cohort study. Patients were randomized into two equal groups: Group 1 received a fraction of inspired oxygen of 0.8 and group 2 received a FiO2 of 0.6 during induction of anaesthesia. In addition to standard haemodynamic variables with ORi were recorded at baseline 1 min, 5 min, 60 min, and 120 min after intubation. Postoperative complications, length of stay in the intensive care unit and hospital were recorded. In total, 14 patients were evaluated in each group. Gender, age, BMI, ASA scores were similar between groups (p > 0.05). In Group 1, ORi values were significantly higher when compared to group 2 at baseline (0.86 ± 0.21 vs 0.45 ± 0.32, p = 0.001), one minute (0.61 ± 0.24 vs 0.27 ± 0.21, p = 0.001), and 5 min (0.34 ± 0.31 vs 0.10 ± 0.13, p = 0.033). High inspired oxygen concentration during induction of anesthesia in pediatric patients is associated with higher levels of ORi. Therefore, ORi may provide the means to safely reduce the inspired oxygen fraction during inhalational induction in paediatric patients.


Asunto(s)
Craneosinostosis , Oximetría , Anestesia General/efectos adversos , Craneosinostosis/complicaciones , Humanos , Hipoxia/prevención & control , Oximetría/efectos adversos , Oxígeno
6.
Ir J Med Sci ; 191(3): 1297-1303, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34822023

RESUMEN

BACKGROUND: Elderly patients are at increased risk of developing acute kidney injury (AKI) following major surgery and rapid diagnosis is essential. AIM: This study aimed to examine the potential utility of plasma neutrophil gelatinase associated lipocalin levels in early prediction of AKI in geriatric patients undergoing laparotomic oncological surgery. METHODS: This prospective single-center cohort study included 60 geriatric patients (≥ 65 years of age) that underwent major oncologic surgery with laparotomy. Perioperative measurements of plasma creatinine, blood urinary nitrogen, plasma lactate, urine output, and neutrophil gelatinase associated lipocalin (NGAL) were made. Patients were followed for AKI development, which is the primary outcome measure, and predictive role of NGAL was investigated. RESULTS: At 48 h follow-up, AKI developed in 13 patients (21.7%). Significant differences in creatinine (p < 0.001), NGAL (p < 0.001), and urine output levels (p = 0.001) were evident over time between the two groups. High NGAL measurements at 6 and 24 h after surgery seem to be highly predictive of AKI development. At 6 h, a plasma NGAL level greater than 71.8 ng/mL has a sensitivity and specificity of 85% and 81% in predicting subsequent AKI development. CONCLUSIONS: Plasma NGAL levels seem to represent an early and reliable marker for AKI in elderly patients undergoing laparotomic surgery with the potential to allow early diagnosis and prevent further renal deterioration. Further confirmatory studies are warranted. TRIAL REGISTRATION: The study was registered to ClinicalTrials.gov (number, NCT05030727). IMPLICATION STATEMENT: Elderly patients are at increased risk of postoperative acute kidney injury (AKI). This study shows that plasma neutrophil gelatinase associated lipocalin is a helpful marker to predict AKI in elderly patients undergoing laparotomic major surgery, which will allow early diagnosis and prevent further renal deterioration in this vulnerable patient group.


Asunto(s)
Lesión Renal Aguda , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Anciano , Biomarcadores , Estudios de Cohortes , Creatinina , Humanos , Lipocalina 2 , Valor Predictivo de las Pruebas , Estudios Prospectivos
7.
Obes Surg ; 31(12): 5176-5182, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34449029

RESUMEN

BACKGROUND: Bariatric surgery is often associated with moderate to severe pain. In patients with obesity, opioids have the potential to induce ventilatory impairment; thus, opioid use needs to be limited. This study aimed to compare the novel ultrasound-guided erector spinae plane block (ESPB) technique with controls in terms of intraoperative opioid consumption and postoperative pain control. METHODS: A total of 63 patients with morbid obesity who underwent laparoscopic bariatric surgery were included in this randomized study. Patients were randomly assigned to the bilateral erector spinae plane block (ESPB) group or the control group. To evaluate perioperative pain and to adjust opioid dose, analgesia nociception index (ANI) was monitored during surgery. Total opioid dose was recorded for each patient. In addition, pain was evaluated using visual analogue scale (VAS) scores for 24 h following the operation. RESULTS: Total intraoperative remifentanil dose was significantly lower in the ESPB group when compared to controls (1356.3 ± 177.8 vs. 3273.3 ± 961.9 mcg, p < 0.001). In the ESPB group, none of the patients required additional analgesia during follow-up. In contrast, all control patients required analgesia. ESPB group had significantly lower VAS scores at all postoperative time points (p < 0.001 for all). CONCLUSION: Bilateral ultrasound-guided ESPB appears to be a simple and effective technique to improve perioperative pain control and reduce intraoperative opioid need in patients with morbid obesity undergoing bariatric surgery.


Asunto(s)
Cirugía Bariátrica , Bloqueo Nervioso , Obesidad Mórbida , Analgésicos Opioides , Humanos , Bloqueo Nervioso/métodos , Obesidad Mórbida/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional
8.
Wound Manag Prev ; 66(9): 16-19, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32903200

RESUMEN

Multiple myeloma (MM) is a common hematologic malignancy. Primary systemic amyloidosis or amyloid light-chain (AL) amyloidosis is a rare disease. PURPOSE: This article presents the case of a patient with MM and AL amyloidosis who experienced a severe case of medical adhesive-related skin injury. CASE STUDY: A 64-year-old man with MM, AL amyloidosis, and diabetes presented with a necrotic wound on his left heel that required surgical debridement. The patient experienced a traumatic avulsion of the right upper eyelid skin during the removal of the corneal abrasion preventive tape as well as traumatic avulsion of the left upper eyelid skin while the patient's face was being cleansed. The avulsed right upper eyelid skin above the tarsus was repaired with a full-thickness skin graft. The partly avulsed left upper eyelid skin was repositioned, and an excisional biopsy was taken. Both upper eyelids healed uneventfully. The biopsy specimen revealed increased amyloid deposition in the dermis, subcutaneous tissue, and areas surrounding the veins and sweat glands. CONCLUSION: This case illustrates the increased risk of medical adhesive-related skin injury and other skin damage in patients with MM and AL amyloidosis. In these patients, the use of tape should be avoided to prevent intraoperative corneal abrasion.


Asunto(s)
Lesiones por Desenguantamiento/etiología , Párpados/lesiones , Biopsia/métodos , Lesiones por Desenguantamiento/fisiopatología , Párpados/cirugía , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/complicaciones , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/fisiopatología , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Mieloma Múltiple/fisiopatología , Heridas y Lesiones/complicaciones , Heridas y Lesiones/fisiopatología
9.
Obes Surg ; 30(7): 2684-2692, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32207048

RESUMEN

PURPOSE: LSG surgery is used for surgical treatment of morbid obesity. Obesity, anesthesia, and pneumoperitoneum cause reduced pulmoner functions and a tendency for atelectasis. The alveolar "recruitment" maneuver (RM) keeps airway pressure high, opening alveoli, and increasing arterial oxygenation. The aim of our study is to research the effect on respiratory mechanics and arterial blood gases of performing the RM in LSG surgery. MATERIALS AND METHODS: Sixty patients undergoing LSG surgery were divided into two groups (n = 30) Patients in group R had the RM performed 5 min after desufflation with 100% oxygen, 40 cmH2O pressure for 40 s. Group C had standard mechanical ventilation. Assessments of respiratory mechanics and arterial blood gases were made in the 10th min after induction (T1), 10th min after insufflation (T2), 5th min after desufflation (T3), and 15th min after desufflation (T4). Arterial blood gases were assessed in the 30th min (T5) in the postoperative recovery unit. RESULTS: In group R, values at T5, PaO2 were significantly high, while PaCO2 were significantly low compared with group C. Compliance in both groups reduced with pneumoperitoneum. At T4, the compliance in the recruitment group was higher. In both groups, there was an increase in PIP with pneumoperitoneum and after desufflation this was identified to reduce to levels before pneumoperitoneum. CONCLUSION: Adding the RM to PEEP administration for morbidly obese patients undergoing LSG surgery is considered to be effective in improving respiratory mechanics and arterial blood gas values and can be used safely.


Asunto(s)
Laparoscopía , Obesidad Mórbida , Gastrectomía , Humanos , Obesidad Mórbida/cirugía , Respiración Artificial , Mecánica Respiratoria
10.
Obes Surg ; 27(1): 22-29, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27581799

RESUMEN

BACKGROUND: The feasibility of a simple side-to-side jejunoileal anastomosis (SJA) in non-morbidly obese individuals to control type 2 diabetes mellitus (T2DM) was studied in six diabetic patients with BMI 28-32. This novel procedure was performed in two Academic Centers and preliminary data is presented. METHODS: SJA bypassing a significant part of the small bowel and diverting food and biliopancretic secretions to the distal ileum was performed laparoscopically in six diabetic patients with BMI 28-32 kg/m2. SJA was performed at a distance of 100 cm from the Treitz ligament and 150 cm from the ileocecal valve, thus a total bowel alimentary and biliopancreatic loop length of 2.5 m was created. RESULTS: Three of the patients (two female, one male) experienced complete remission of diabetes from the immediate postoperative period and up to 3 years after the procedure. Two other patients remained medication-free after the operation experiencing partial diabetes remission, and the third patient significantly reduced his daily insulin requirements immediately after surgery. There were no early or late postoperative complications. CONCLUSIONS: A simple SJA, diverting the food and biliopancreatic secretion to the distal small bowel, was able to control T2DM in all patients offering total or partial remission of the disease soon after the procedure. Those preliminary data and the simplicity of the operation are encouraging and promising. However, further studies are in progress in both Institutions to reveal the possible mechanism of diabetes control and investigate the effect of this operation on larger number of patients, with longer follow-up period.


Asunto(s)
Diabetes Mellitus Tipo 2/cirugía , Derivación Gástrica/métodos , Íleon/cirugía , Yeyuno/cirugía , Obesidad/cirugía , Adulto , Anastomosis Quirúrgica , Glucemia/análisis , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Inducción de Remisión , Resultado del Tratamiento
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