Articles: operative.
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Posterior cervical spine surgery can result in significant discomfort in the post-operative period. Post-operative pain management presents a challenge, particularly in the elderly population which is more sensitive to adverse effects from analgesia. We aimed to compare outcomes after peri-operative posterior cervical muscle plane blocks versus patients who received general anesthesia only. ⋯ These meta-analyses suggest that peri-operative posterior cervical muscle plane blocks are safe and result in improved post-operative analgesic efficacy when compared to controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of peri-operative posterior cervical blocks for elective posterior cervical spine surgery.
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Delirium is an acute state of confusion associated with adverse postoperative outcomes. Delirium is diagnosed clinically using screening tools; most cases go undetected. Identifying a delirium biomarker would allow for accurate diagnosis, application of therapies, and insight into causal pathways. To agnostically discover novel biomarkers of delirium, we conducted a case-control sub-study using the VISION-Cardiac Surgery biobank. Our objective was to identify candidate biomarkers to investigate in future studies. ⋯ We identified 26 biomarkers significantly associated with delirium; all are novel except for IL-8. We did not identify an association between delirium and recognized neuro-inflammatory proteins and markers of brain injury, which supports using biomarkers to differentiate between delirium and other neurological conditions. While exploratory, our findings support using biomarkers to diagnose postoperative delirium and validate using agnostic screens to identify potential delirium biomarkers.
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Postoperative pain, nausea and vomiting adversely affect postoperative rehabilitation after total knee arthroplasty (TKA). We aimed to identify factors associated with postoperative pain trajectory and postoperative nausea and vomiting (PONV) and evaluated the effects of different analgesic modalities. ⋯ General anesthesia and PCA had no effect on the PONV incidence following TKA. Greater BMI correlated with higher pain scores but a lower likelihood of PONV. Epidural PCA provided superior acute postoperative analgesia without increasing the incidence of PONV.
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Accurate prognostication in comatose survivors of cardiac arrest is a challenging and high-stakes endeavor. We sought to determine whether internal EEG subparameters extracted by the Bispectral Index (BIS) monitor, a device commonly used to estimate depth-of-anesthesia intraoperatively, could be repurposed to predict recovery of consciousness after cardiac arrest. ⋯ In patients comatose after cardiac arrest, four EEG features calculated internally by the BIS Engine were repurposed by a compact neural network to achieve a prognostic accuracy superior to the current clinical qualitative gold-standard, with high sensitivity for recovery. These features hold promise for assessing patients after cardiac arrest.