Articles: surgery.
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Postoperative pain outcomes may be influenced by preoperative substance use, which is often underreported due to associated stigma. This study examined the impact of urine toxicology-identified preoperative opioid and marijuana use on pain outcomes after elective spinal surgery. ⋯ Although urine toxicology-identified preoperative opioid use was associated with poor postoperative pain relief and reliance on postoperative opioids for pain management after elective spinal surgery, preoperative marijuana use was not. Preoperative marijuana use, hence, should not delay or be a contraindication to elective spinal surgery.
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Anesthesia and analgesia · Mar 2024
Randomized Controlled TrialInfluence of Neostigmine on Early Postoperative Cognitive Dysfunction in Older Adult Patients Undergoing Noncardiac Surgery: A Double-Blind, Placebo-Controlled, Randomized Controlled Trial.
The goal of this study was to investigate the efficacy of neostigmine on postoperative cognitive dysfunction (POCD) and determine its effect on systematic markers of oxidative stress in older patients. ⋯ Neostigmine reduced POCD on the first day after noncardiac surgery in older patients. Neostigmine treatment inhibited oxidative stress and increased serum BDNF levels. There was no significant influence of neostigmine on POCD on the third or seventh day after surgery. The clinical influence of neostigmine on POCD should be further investigated.
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Anesthesia and analgesia · Mar 2024
Multicenter StudyPlatelet Transfusion in Cardiac Surgery: An Entropy-Balanced, Weighted, Multicenter Analysis.
Platelet transfusion is common in cardiac surgery, but some studies have suggested an association with harm. Accordingly, we investigated the association of perioperative platelet transfusion with morbidity and mortality. ⋯ In cardiac surgery patients, perioperative platelet transfusion was associated with reduced operative and 90-day mortality. Until randomized controlled trials either confirm or refute these findings, platelet transfusion should not be deliberately avoided when considering odds of death.
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Anesthesia and analgesia · Mar 2024
Observational StudyUndergraduate Anesthesia Skills for a Global Surgery Agenda: Students' Self-Reported Competence.
Safe anesthesia is imperative for the Global Surgery agenda and Sustainable Development Goal 3. Due to a shortage of specialists in South Africa (SA), anesthetic services are often provided by nonspecialist doctors, often newly qualified and frequently without immediate supervision. The burden of disease in the developing world demands fit-for-purpose, day-one medical graduates. Although undergraduate anesthesia training is mandatory for medical students in SA, no outcomes are specified, and these are decided autonomously at each medical school. This study describes the current self-perceived anesthetic competence of medical students in SA as a needs assessment directed at achieving the goals of Global Surgery in SA and other developing countries. ⋯ Time-on-task, capacity for repetition, and student maturity might have impacted self-efficacy and should be considered in curriculum development. Students felt less prepared for emergencies. Focused training and assessment aimed at emergency management should be considered. Students did not feel competent in general medical areas, in which anesthetists are experts, including resuscitation, fluid management, and analgesia. Anesthetists should take ownership of this training at the undergraduate level. Cesarean delivery is the most performed surgical procedure in sub-Saharan Africa. The Essential Steps in Managing Obstetric Emergencies (ESMOE) program was designed for internship training but can be introduced at undergraduate level. This study suggests that curriculum reform is required. The achievement of an agreed-upon set of standardized national undergraduate anesthetic competencies may ensure fit-for-purpose practitioners. Undergraduate and internship training should align to form part of a continuum of basic anesthetics training in SA. The findings of this study might benefit curriculum development in other regions with similar contexts.
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Chinese Neurosurgical Randomized Controlled Trials: Dynamics in Trial Implementation and Completion.
The focus on evidence-based neurosurgery has led to a considerable amount of neurosurgical evidence based on randomized controlled trials (RCTs) being published. Nevertheless, there has been no systematic appraisal of China's contribution to RCTs. Information about the changes in characteristics of Chinese neurosurgical RCTs before and during the COVID-19 pandemic is limited. This study aims to perform a detailed examination and comprehensive analysis of the characteristics of Chinese neurosurgical RCTs and to examine the differences before and during the COVID-19 pandemic. ⋯ Chinese neurosurgeons have made significant progress in advancing neurosurgical RCTs despite challenges. However, shortcomings in sample size and power calculation need attention. Improving the rigor, rationality, and completeness of neurosurgical RCT design is crucial.