Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2020
Survival after primary breast cancer surgery following propofol or sevoflurane general anesthesia - aretrospective, multicenter, database analysis of 6,305 Swedish patients.
Retrospective studies indicate that the choice of anesthetic can affect long-term cancer survival. Propofol seems to have an advantage over sevoflurane. However, this is questioned for breast cancer. We gathered a large cohort of breast cancer surgery patients from seven Swedish hospitals and hypothesized, that general anesthesia with propofol would be superior to sevoflurane anesthesia regarding long-term breast cancer survival. ⋯ It seems that propofol may have a survival advantage compared with sevoflurane among breast cancer patients, but the inherent weaknesses of retrospective analyses were made apparent.
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Acta Anaesthesiol Scand · May 2020
No evidence of cardiac stunningor decoupling immediately after cardiopulmonary bypass for elective coronarysurgery.
There is significant uncertainty regarding the timing of onset of cardiovascular stunning after cardiac surgery. Cardiovascular stunning is affecting both contractility (Ees) and arterial load. Arterial load may be represented by arterial elastance (Ea) and participates in ventriculo-arterial coupling through the Ea/Ees ratio, giving information on efficiency and performance. An alternative approach to ventriculo-arterial interaction is oscillatory power fraction (OPF). The aim of this study was to investigate the immediate beat to beat effects of on pump coronary artery bypass graft (CABG) surgery on contractility, cardiac power parameters, arterial load and ventriculo-arterial coupling as well as classical haemodynamic parameters. ⋯ There was no evidence for clinically relevant cardiac stunning or altered arterial load immediately after cardiopulmonary bypass for CABG surgery. The unchanged Ea/Ees ratio and OPF are indicating unchanged cardiac efficiency before and after cardiopulmonary bypass. This indicates that in elective CABG patients cardiovascular stunning is perhapsa phenomenon of inflammation and not immediate ischaemia-reperfusion injury or mechanical handling.
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Acta Anaesthesiol Scand · May 2020
The risk of postoperativemyocardial injury after major emergency abdominal surgery: aretrospective cohort study.
The aim was to examine the risk of postoperative myocardial injuryafter major emergency abdominal surgery and identify pre- and intra-operative risk factors of postoperative myocardial injury. Moreover, the study aimed to examine the association between postoperative myocardial injuryand clinical outcomes. ⋯ One in four patients suffered a postoperative myocardial injury within the third postoperative day. Postoperative myocardial injury was a risk factor of adverse cardiac and non-cardiac clinical outcomes. Troponin monitoring could potentially improve the postoperative risk stratification in this cohort of high-risk surgical patients.
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Acta Anaesthesiol Scand · May 2020
Preoperative transthoracic echocardiography in ambulatory surgery- a cross sectional study.
Cardiac disease and aberrations in central volume statusare risk factors for perioperative complications,and should be identified prior to surgery. This study investigatedthe benefit of transthoracic echocardiography for preoperative identification of cardiac disease andhypovolemia in ambulatory surgery. ⋯ In this ambulatory surgical cohort, a high prevalence of preoperative LV dysfunction and aberrations in volume status was observed. The results demonstrate that preoperative TTE contributed valuable hemodynamic information. The standard preoperative assessment for this cohort might need to be revised.
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Acta Anaesthesiol Scand · May 2020
Introducing the "hip call"to facilitate early surgical treatment of hip fractures: A feasibility study.
Surgical treatment of hip fractures within 24-48 hours decreases morbidity and mortality, but goals for early surgery have not been widely achieved so far. The primary aim of this study was to investigate the feasibility of implementation of a hip call, and the secondary aim was to investigate the effect of the hip call on time for preoperative preparation and surgerycompared to a historical control cohort. ⋯ The implementation of a hip call was feasible with 83% of patients being ready for surgery within 24 hours, and 88% being operated within 24 hours. Future large-scale studies should clarify potential benefits on clinical outcome.