Journal of clinical anesthesia
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Randomized Controlled Trial
The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: A double-blind randomized controlled trial.
Laparoscopic cholecystectomy (LC) causes moderate-to-severe postoperative pain. Postoperative pain is one of the leading contributors to respiratory dysfunction following surgery. This study investigated the effect of erector spinae plane (ESP) block on postoperative analgesia and respiratory function in patients undergoing LC. ⋯ Bilateral ESP blocks provides adequate analgesia, allowing for a lower opioid requirement and significant respiratory function improvement after LC; therefore, we concluded that ESP block could be added to the multimodal analgesia protocol in LC.
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While studies have reported increased post-operative pulmonary complications with SARS-CoV-2 infection, many are limited by use of historical controls or focus on less severe respiratory complications. We characterized the association between pre-operative SARS-CoV-2 infection and post-operative respiratory failure (PORF). ⋯ Detection of SARS-CoV-2 infection within 4 weeks before or 5 days after surgery is associated with increased odds of 5-day PORF and 30-day mortality. This supports delaying elective surgery, but questions remain regarding the applicability of this recommendation for asymptomatic patients needing urgent or semi-urgent procedures such as oncologic surgery.
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Case Reports
Using the iPACK block to reduce chronic pain in a patient with knee osteoarthritis: A case report.
Infiltration between the popliteal artery and capsule of the knee (iPACK) block is an emerging modality to control perioperative knee joint pain. This case report describes the successful control of chronic knee joint pain using iPACK block in a patient with knee osteoarthritis. We suggest that iPACK block could be applied in the fields of both pain medicine and perioperative analgesia. In addition, by placing the needle closely to the popliteal plexus, iPACK block could serve as an intervention for pain related to procedures such as radiofrequency ablation.
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Observational Study
The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass.
Low bispectral index (BIS) values have been associated with adverse postoperative outcomes. However, trials of optimizing BIS by titrating anesthetic administration have reported conflicting results. One potential explanation is that cerebral perfusion may also affect BIS, but the extent of this relationship is not clear. Therefore, we examined whether BIS would be associated with cerebral perfusion during cardiopulmonary bypass, when anesthetic concentration was constant. ⋯ There was an association of BIS and metrics of cerebral perfusion during a period of constant anesthetic administration, but the absolute magnitude of change in BIS as MAP decreased below the LLA was small.
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Assess for a relationship between immediate preoperative glucose concentrations and postoperative complications. ⋯ Preoperative hyperglycemia within 6 h of surgery is a marker of adverse postoperative outcomes. Among patients with diabetes in our study, a preoperative glucose level ≥ 180 mg/dL (≥10 mmol/L) independently correlates with risk of postoperative complications and readmission/reoperation. These results should encourage future work to determine whether addressing immediate preoperative hyperglycemia can improve complication rates, or simply serves as a marker of higher risk.