Articles: operative.
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Meta Analysis Comparative Study
High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery - a Bayesian individual patient data meta-analysis of three randomized clinical trials.
The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. The objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. ⋯ High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of postoperative pulmonary complication occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy.
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The prevalence of postoperative pain is notably high among the elderly population, which poses significant challenges for their postoperative recovery. In this study, we aimed to identify preoperative predictors for acute and chronic postoperative pain in patients undergoing lumbar spinal surgery through a longitudinal investigation. ⋯ The heightened occurrence of postoperative pain among the elderly presents formidable obstacles to their recuperation. This study delves into identifying preoperative factors influencing acute and chronic postoperative pain. Our findings indicate that preoperative pain and peak alpha frequency are crucial predictors of acute postoperative pain. However, the predictive performance for chronic postoperative pain is limited, although age was a significant predictor of chronic postoperative pain. These insights contribute to the identification of patients at elevated risk for severe acute and chronic postoperative pain, offering valuable guidance for pre-surgical risk assessment.
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Anesthesia and analgesia · Jan 2025
Occurrence of Low Cardiac Index During Normotensive Periods in Cardiac Surgery: A Prospective Cohort Study Using Continuous Noninvasive Cardiac Output Monitoring.
Continuous cardiac output monitoring is not standard practice during cardiac surgery, even though patients are at substantial risk for systemic hypoperfusion. Thus, the frequency of low cardiac output during cardiac surgery is unknown. ⋯ In a prospective cohort of patients undergoing CAB surgery, low CI was common even when blood pressure was normal. CI and MAP were correlated modestly. Correlation was higher before than after CPB with substantial heterogeneity among individuals. Future studies are needed to examine the independent relation of low CI to postoperative kidney injury and other adverse outcomes related to hypoperfusion.