A Multi-Country Survey on the Availability of Intraoperative Use of Echocardiography for Noncardiac Surgery.

BACKGROUND: This survey aimed to explore the availability and accessibility of echocardiography during noncardiac surgery worldwide. METHODS: An internet-based 45-item survey was sent, followed by reminders from August 30, 2021, to August 20, 2022. RESULTS: 1189 responses were received from 62 countries. Nearly seventy-one percent of respondents had intraoperatively used transesophageal or transthoracic echocardiography (TEE and TTE, respectively) for monitoring or examination. The unavailability of echocardiography machines (30.3%), lack of trained personnel (30.2%), and absence of clinical indications (22.6%) were the top 3 reasons for not using intraoperative echocardiography in noncardiac surgery. About 61.5% of participants had access to at least one echocardiography machine. About 41% had access to at least 1 TEE probe, and 62.2% had access to at least 1 TTE probe. Seventy-four percent of centers had a procedure to request intraoperative echocardiography if needed for noncardiac cases. Intraoperative echocardiography service was immediately available in 58% of centers. CONCLUSIONS: Echocardiography machines and skilled echocardiographers are still unavailable at many centers worldwide. National societies should aim to train a critical mass of certified TEE/TTE anesthesiologists and provide all anesthesiologists access to perioperative TEE/TTE machines in anesthesiology departments, considering the increasing number of older and sicker surgical patients scheduled for noncardiac surgery.

Procedural sedation analgesia in the elderly patient.

Elderly patients are perceived as a high-risk group for procedural sedation. Procedural sedation analgesia (PSA) is generally safe in older adults. What is not acceptable is undertreating pain or inadequately sedating a stable patient. All the usual precautions should be taken. One should consider any comorbidities that could make the patient more at risk of adverse reactions or complications. Older patients may be at higher risk for oxygen desaturation, but they usually respond quickly to supplemental oxygen. Geriatric patients usually require lower doses of medications. They tend to be more sensitive to medications, with slower metabolism, less physiologic reserve to handle side effects, and a smaller volume of distribution. The use of drugs for sedation in elderly patients requires careful consideration of their age-related changes in physiology and pharmacokinetics. The choice of drug should be based on the patient's medical condition, comorbidities, and potential adverse effects. Moreover, the administration should be done by trained personnel with close monitoring of vital signs and level of consciousness to prevent complications such as respiratory depression.

Impact of Intraoperative Dexmedetomidine versus Remifentanil on Recovery Characteristics following Laparoscopic Sleeve Gastrectomy.

OBJECTIVE: To evaluate the impact of intraoperative dexmedetomidine versus remifentanil on postoperative pain; and enhanced recovery profile in patients scheduled for laparoscopic sleeve gastrectomy (LSG). STUDY DESIGN: Clinical observational double-blind pilot study. PLACE AND DURATION OF STUDY: King Khalid University Hospital, affiliated with King Saud University, Riyadh, Saudi Arabia, from December 2019 to March 2020. METHODOLOGY: Forty adult patients with body mass index (BMI) >35 Kg/m2 were divided into two equal groups: group dexmedetomidine (D) and group remifentanil (R). In the post-anaesthesia care unit (PACU) and for 24 hours in the ward, the patients were assessed for pain score and other recovery characteristics. RESULTS: In the PACU, the mean values of numerical rating scale (NRS) were 4.26±1.97 vs. 4.15±1.9 and morphine consumption median values were 4 vs. 1 mg in groups D and R, respectively (p >0.05). The number of patients who developed shivering were 0 vs. 6 in groups D and R, respectively (p <0.05). Sedation agitation scale (SAS) median values were 4 vs. 4 (p <0.05), postoperative nausea and vomiting (PONV) frequency was 1 vs. 6 (p >0.05) in groups D and R, respectively. The length of hospital stay (LOS) median values were 1 vs. 1 day in groups D and R, respectively (p >0.05). CONCLUSION: Better enhanced recovery profile after LSG supports the use of intraoperative infusion of dexmedetomidine as an anaesthetic adjuvant versus remifentanil. Key Words: Dexmedetomidine, Remifentanil, Enhanced recovery after surgery (ERAS); Bariatric surgery.