Articles: postoperative.
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Minerva anestesiologica · May 2023
Observational StudyMortality and incidence of cardiovascular events in patients treated with aspirin and statins at one year after myocardial injury in noncardiac surgery: a prospective observational study.
Recommendations on the diagnosis and management of myocardial injury in noncardiac surgery (MINS) show remarkable variability. Mortality reports also vary. We aimed to describe mortality and major adverse cardiovascular and cerebrovascular event (MACCE) rates in patients with silent MINS treated with postoperative aspirin-statin therapy and with cardiology follow-up. ⋯ Rates of mortality and MACCE in patients with silent MINS were high despite aspirin-statin therapy and cardiology follow-up. Further prospective research is needed to assess new postoperative care protocols that might effectively improve outcomes.
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Randomized Controlled Trial
Relative contributions of anaemia and hypotension to myocardial infarction and renal injury: Post hoc analysis of the POISE-2 trial.
Hypotension and postoperative anaemia are associated with myocardial and renal injury after noncardiac surgery, but the interaction between them remains unknown. ⋯ Postoperative anaemia and hypotension were meaningfully associated with both our primary composite and AKI. However, lack of significant interaction suggests that the effects of hypotension and anaemia are additive rather than multiplicative.
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Randomized Controlled Trial
Ultrasound-Guided Techniques for Postoperative Analgesia in Patients Undergoing Laparoscopic Sleeve Gastrectomy: Erector Spinae Plane Block vs. Quadratus Lumborum Block.
Laparoscopic sleeve gastrectomy (LSG) is a common bariatric surgery. Regional anesthetic techniques decrease postoperative pain, narcotic analgesic requirements, and opioid-related adverse effects in patients scheduled for bariatric surgery. ⋯ Bilateral ultrasound-guided erector spinae plane block and bilateral ultrasound-guided quadratus lumborum block provided adequate postoperative pain control and reduced postoperative analgesic requirements for morbidly obese patients scheduled for laparoscopic sleeve gastrectomy with priority to bilateral erector spinae plane block.
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Case Reports
Long Duration of Action of Tranexamic Acid After Cardiac Surgery in a Hemodialysis Patient: A Case Report.
A 61-year-old woman with chronic renal dysfunction was scheduled to undergo aortic valve replacement. After a bolus of 1 g tranexamic acid (TXA), the TPA (tissue-plasminogen activator)-test result with the ClotPro system demonstrated extensive inhibition of fibrinolysis. ⋯ Although TXA levels dropped to 6.9 μg/dL after hemodialysis on postoperative day (PoD) 1, fibrinolytic shutdown on the TPA-test remained unchanged until PoD 2. In dialysis patients, low-dose TXA <1 g may be considered for reducing seizure and thromboembolic complications after cardiac surgery.