Journal of clinical anesthesia
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Multicenter Study Observational Study
Evaluating prevalence and trajectory of functional disability in older surgical patients: An observational cohort study.
To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability. ⋯ Patients with preoperative functional disability experienced greater postoperative improvement in functional disability than the No-disability group. Preoperative evaluation of functional disability informs perioperative care and recovery for patients and clinicians.
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Randomized Controlled Trial
Effect of low-dose norepinephrine combined with goal-directed fluid therapy on postoperative pulmonary complications in lung surgery: A prospective randomized controlled trial.
Postoperative pulmonary complications (PPCs), the predominant complications following lung surgery, are closely associated with intraoperative fluid therapy. This study investigates whether continuous low-dose norepinephrine infusion combined with goal-directed fluid therapy (GDFT) reduced the risk of PPCs after lung surgery relative to either GDFT alone or standard fluid treatment. ⋯ ChiCTR2200064081.
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Observational Study
The influence of anesthetic drug strategy on the incidence of post induction hypotension in elective, non-cardiac surgery - A prospective observational cohort study.
To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH. ⋯ This study was registered in the Dutch Medical Research in Humans (OMON) register on 18 June 2019 (ID: NL7810). The study was approved by the Medical Ethics Committee of the Amsterdam UMC, location AMC, the Netherlands in December 2018 (NL 6748.018.18; 2018).
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Observational Study
Machine learning prediction of unexpected readmission or death after discharge from intensive care: A retrospective cohort study.
Intensive care units (ICUs) harbor the sickest patients with the utmost needs of medical care. Discharge from ICU needs to consider the reason for admission and stability after ICU care. Organ dysfunction or instability after ICU discharge constitute potentially life-threatening situations for patients. ⋯ ML models were able to identify patients that will not need unplanned ICU readmission and will not die within 48 h after discharge.
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Elderly patients are prone to develop postoperative neurocognitive deficits potentially precipitated by inadequate anesthetic management. To investigate the potential of EEG-guided individualized anesthetic titration we evaluated the effect of the patient's age on the spectral composition of the EEG during slow propofol induction. Twenty-six young (<65 years) and 25 old (≥65 years) patients received propofol until loss of responsiveness (LOR). ⋯ No patient showed a burst suppression pattern. Whereas the absolute power in all frequency bands decreased significantly with the patient's age, the spectral composition did not change throughout the extended induction period. Slow anesthesia induction may be a suitable approach for geriatric patients to preserve spectral composition patterns typically found in younger brains and to individually identify anesthetic requirements reducing the risk of excessive anesthetic effects.