Articles: postoperative.
-
Postoperative hemodynamic deterioration among cardiac surgical patients can indicate or lead to adverse outcomes. Whereas prediction models for such events using electronic health records or physiologic waveform data are previously described, their combined value remains incompletely defined. The authors hypothesized that models incorporating electronic health record and processed waveform signal data (electrocardiogram lead II, pulse plethysmography, arterial catheter tracing) would yield improved performance versus either modality alone. ⋯ Clinical deterioration prediction models combining electronic health record data and waveform data were superior to either modality alone, and performance of combined models was primarily driven by waveform data. Decreased performance of prediction models during temporal validation may be explained by data set shift, a core challenge of healthcare prediction modeling.
-
Randomized Controlled Trial
Immunosuppressive Effect of Intrathecal Morphine, Dexmedetomidine, or Both in Combination with Bupivacaine on Patients Undergoing Major Abdominal Cancer Surgery.
An impaired immune system in the perioperative period has important clinical implications in patients with cancer. Despite the immunosuppressive properties of opioid therapy, it is still commonly utilized in the intrathecal or epidural space for the treatment of postoperative pain. Also, intrathecal dexmedetomidine has extended analgesic efficacy in postoperative pain; it can significantly affect immune function in perioperative patients. ⋯ Intrathecal dexmedetomidine has the least immunosuppressive effect than morphine and morphine-dexmedetomidine, in combination with bupivacaine.
-
Anesthesia and analgesia · Nov 2022
Association of Sugammadex or Neostigmine With Major Postoperative Pulmonary Complications in Children.
Recent data in adult patients indicate that the use of sugammadex compared to neostigmine for reversal of neuromuscular block (NMB) was associated with a significant reduction in the risk of composite postoperative pulmonary complications. Despite the clinical significance of pulmonary complications in children, studies exploring the role of NMB reversal in the risk of these complications are currently unavailable. ⋯ Choice of NMB reversal agent does not appear to impact the incidence of major postoperative pulmonary complications. Further research is needed to determine whether our results carry forth across subpopulations defined by surgical specialty, the presence of complex chronic conditions, and anesthesia technique.
-
There are 2 cardinal approaches for drug-resistant trigeminal neuralgia (TN), including microvascular decompression (MVD) and gamma knife surgery (GKS). This study aimed to compare the results of MVD versus GKS in the treatment of drug-resistant TN. ⋯ MVD and GKS both reduce pain in patients with drug-resistant TN, but MVD was superior to GKS in pain relief. Furthermore, recurrence rate was lower. Post-operative complications except facial numbness were higher in MVD.
-
Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country. ⋯ In preparation for quality improvement projects, we comprehensively evaluated pain-related patient-reported outcomes (PROs) and treatment practices of 10,415 adult patients spanning 10 countries. PROs were generally poor. Demographics, country and surgical discipline explained a small proportion of variation for the PROs, about 88% remained unexplained. Treatment practices varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively. Future studies will aim to identify treatments which are associated with improved outcomes.