Postoperative neurocognitive disorders in ambulatory surgery: a narrative review.

Postoperative neurocognitive disorders (PoNCDs), such as postoperative delirium and cognitive dysfunction or decline can occur after surgery, especially in older patients. This significantly affects patient morbidity and surgical outcomes. Among various risk factors, recent studies have shown that preoperative frailty is associated with developing these conditions. Although the mechanisms underlying PoNCDs remain unclear, neuroinflammation appears to play an important role in their development. For the prevention and treatment of PoNCDs, medication modification, a balanced diet, and prehabilitation and rehabilitation programs have been suggested. The risk of developing PoNCDs is thought to be lower in ambulatory patients. However, owing to technological advancements, an increasing number of older and sicker patients are undergoing more complex surgeries and are often not closely monitored after discharge. Therefore, equal attention should be paid to all patient populations. This article presents an overview of PoNCDs and highlights issues of particular interest for ambulatory surgery.

Hereditary Neuropathy with Liability to Pressure Palsy and Vocal Cord Paralysis After Pulmonary Lobectomy: A Case Report.

Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare peripheral neurological disorder that manifests with increased sensitivity to pressure. In people with this disorder, the peripheral nerves are unusually sensitive to pressure. Minor trauma or compression causing paralysis in the extremities is a hallmark of this disorder. Ensuring there is no pressure on the extremities is recommended as a preventive measure. We describe for the first time, postoperative vocal cord paralysis in a patient with HNPP due to left recurrent laryngeal nerve palsy. Anesthesiologists and surgeons should be aware of this possible complication in patients with HNPP.

Continuous lumbar erector spinae plane block for postoperative pain management in revision hip surgery: a case report / Bloqueio contínuo do plano do eretor da espinha lombar para o controle da dor pós-operatória em procedimento de revisão de cirurgia do quadril: relato de caso

Abstract The number of total hip arthroplasty cases performed each year continues to increase; accordingly, so does the number of revision total hip arthroplasty procedures. While our traditional method of analgesia for these patients has involved multimodal medications and a continuous lumbar plexus block, we report two cases of patients who received continuous lumbar erector spinae plane blocks. Both patients exhibited excellent pain control postoperatively and were able to discharge home on postoperative day one. This case report illustrates the possible utility of continuous erector spinae plane blocks for postoperative analgesia in the more frequently occurring revision total hip arthroplasty surgeries.

Resumo O número de artroplastias totais de quadril feitas a cada ano continua a aumentar; consequentemente, o mesmo acontece com o número de procedimentos de revisão de artroplastia total de quadril. Embora nosso método tradicional de analgesia para esses pacientes tenha envolvido medicações multimodais e um bloqueio contínuo do plexo lombar, relatamos dois casos de pacientes que receberam bloqueios contínuos do músculo eretor da coluna lombar. Ambos apresentaram excelente controle da dor pós-operatória e obtiveram alta hospitalar no primeiro dia de pós-operatório. Este relato de caso ilustra a possível utilidade do bloqueio contínuo do plano do eretor da espinha para analgesia pós-operatória nas cirurgias, cada vez mais frequentes, de revisão de artroplastia total do quadril.