Anesthesiology
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Numerous, sometimes conflicting, changes in brain functional connectivity have been associated with the transition from wakefulness to unresponsiveness at induction of general anesthesia. However, relatively few studies have looked at: the detailed time evolution of the transition; for different EEG frequency bands; and in the clinical scenario of surgical patients undergoing general anesthesia. ⋯ Propofol-induced loss of consciousness in surgical patients is associated with a global breakdown in low-frequency directed functional connectivity, coupled with a high-frequency increase between closely located brain regions. At loss of consciousness, Granger causality shows more pronounced changes than coherence.
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The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. We therefore tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies. ⋯ Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies.
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The Gompertz-Makeham law describes a characteristic pattern of mortality in human populations where death rate is near constant between age 18 and 30 years (Makeham's Law) and rises exponentially thereafter (Gompertz Law). This pattern has not been described in surgical populations, but if true, would have important implications for understanding surgical risk and design and interpretation of surgical risk models. The aim of this study was to determine if the Gompertz-Makeham law applies to perioperative mortality risk and the conditions under which it may apply. ⋯ The Gompertz-Makeham law seems to apply in a national cohort of surgical patients. The inflection point for increased 1-month risk is apparent at age 30 years. A strict exponential rise in mortality risk occurs thereafter. This finding improves our understanding of surgical risk and suggests a concept-driven approach to improve modelling of age and important interactions in future surgical risk models.
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The efficacy of serratus anterior plane block (SAPB) for treatment of pain after minimally invasive thoracic surgery remains unclear. This trial assesses the impact of SAPB on postoperative opioid consumption and on measures of early recovery after thoracoscopic lung resection. ⋯ The protocol-specified intention-to-treat analysis demonstrated that SAPB did not result in a significant reduction in opioid consumption when added to a multimodal analgesic regimen after thoracoscopic anatomic lung resection. The sensitivity as-treated analysis showed a significant and modest clinical reduction in the primary outcome that warrants further investigation.