Articles: surgery.
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To investigate whether the cumulative operative time spent by a surgeon operating on patients on the same day prior to starting a new procedure was associated with surgical outcomes. ⋯ First patient of the day may experience worse outcomes, prompting surgeons to warm up before starting surgery. Further research is needed to replicate these findings, as many surgeons may prioritize starting with the most complex and challenging cases, which inherently carry greater risks.
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To investigate the association between glycemic control, measured by glycated hemoglobin (HbA1c) levels, and post-operative complications across various procedures, identify the prevalence of patients with undiagnosed prediabetes or diabetes undergoing surgery, and explore whether better glycemic management is associated with reduced short-term postoperative complications. ⋯ Glycemic control significantly impacts morbidity and mortality in surgical patients. A total of 23% of patients were patients with undiagnosed prediabetes or diabetes, underscoring the importance of preoperative HbA1c screening for all patients. Both very low and very high HbA1c levels should be preoperatively addressed, with moderate control (HbA1c 7-8%, 53-64 mmol/mol) identified as optimal. Overall, these findings emphasize the need for personalized diabetes management plans tailored to each patient's needs and should inform clinical guidelines.
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Enhanced recovery after surgery (ERAS) protocols incorporating multimodal analgesia (MMA) have become increasingly popular for breast cancer surgery. Our study evaluated an ERAS approach that combined nonintubated general anesthesia with thoracic paravertebral block (TPVB) as part of the MMA and compared it to traditional general anesthesia (GA). Postoperative outcomes were assessed using numerical rating scale (NRS) pain scores, total analgesic consumption, and nausea and vomiting (PONV). ⋯ Nonintubated general anesthesia with TIVA and MMA using TPVB is a viable and safe alternative for breast cancer surgery. It results in reduced pain scores and analgesic needs compared with conventional GA, with PONV outcomes comparable to those managed with standard intravenous medications.
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Anaesth Intensive Care · Feb 2025
Survey of administration of intravenous ketamine for perioperative pain management in Australia and New Zealand.
Ketamine is an N-methyl-d-aspartate receptor antagonist approved for use in anaesthesia, with analgesic properties. Despite publication of numerous trials and expert guidelines on its use for pain management, administration of ketamine as part of multimodal perioperative analgesia remains 'off-label'. We conducted an online, prospective survey of ANZCA Fellows, exploring current prescribing practices of intravenous ketamine for perioperative analgesia. ⋯ Postoperative ketamine infusion was most commonly prescribed as third-line or rescue analgesia. The majority of respondents thought it either 'likely' or 'very likely' ketamine would reduce postoperative chronic pain after thoracic surgery, but not in other surgical categories. Our findings suggest that off-label perioperative administration of ketamine at analgesic dose ranges is routine or common practice in major surgery for a majority of specialist anaesthetists in Australia and New Zealand.