Articles: operative.
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Randomized Controlled Trial
Co-administration of dexmedetomidine with total intravenous anaesthesia in carotid endarterectomy reduces requirements for propofol and improves haemodynamic stability: A single-centre, prospective, randomised controlled trial.
Total intravenous anaesthesia guided by electroencephalography and neurophysiological monitoring may be used for carotid endarterectomy. Reduction of brain metabolic demand during cross-clamping of the internal carotid artery with propofol titrated to burst suppression requires effect-site concentrations that may delay emergence and interfere with intraoperative neurophysiological monitoring. ⋯ Co-administration of dexmedetomidine to total intravenous anaesthesia for carotid endarterectomy decreased the effect-site concentrations of propofol required for burst suppression by 33%. The propofol-sparing effect and peripheral alpha-agonism of dexmedetomidine may explain the reduced requirement for vasopressors.
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Persistent postsurgical pain (PPSP) following thoracic surgery affects 40%-60% of patients undergoing lung resection due to malignancies. Postoperative pain-related symptoms are common, leading to limitations in activities of daily living (ADL) and deterioration in physical function, which significantly impacts quality of life. Pain-related limitations are of interest, as postsurgical pain may present as a target for intervention to improve postoperative rehabilitation. This study aimed to evaluate the association between PPSP and ADL limitations during the first 12 postoperative months after surgery for lung cancer. ⋯ Surgery remains a cornerstone in the treatment of early-stage lung cancer. Despite advances in minimally invasive techniques and rehabilitation, persisting postsurgical pain and pain-related limitations in daily activities may endure. This study investigated specifically the pain-related limitations in activities of daily living and described recovery trajectories during the first 12 postoperative months. Patients with persistent postsurgical pain experienced multiple limitations compared to pain-free patients. Although partial recovery was observed, impairments remained significant for up to 12 months after surgery.
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With estimated global postoperative mortality rates at 1% to 4% leading to approximately 3 million to 12 million deaths per year, an urgent need exists for reliable measures of perioperative risk. Existing approaches suffer from poor performance, place a high burden on clinicians to gather data, or do not incorporate intraoperative data. Previous work demonstrated that intraoperative anesthetics induce prefrontal electroencephalogram (EEG) oscillations in the alpha band (8 to 12 Hz) that correlate with postoperative cognitive outcomes. ⋯ Intraoperative EEG alpha power is independently associated with postoperative mortality and adverse outcomes, suggesting it could represent a broad measure of postoperative physical resilience and provide clinicians with a low-burden, personalized measure of postoperative risk.