Anaesthesia
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While evidence from preclinical and observational cohort studies have suggested potential disparities in tumour behaviour associated with the choice of intra-operative anaesthetics, clinical evidence of tumour recurrence and metastasis remains inconclusive. We aimed to compare the impact of intra-operative anaesthesia on oncologic outcomes following hepatectomy for hepatocellular carcinoma. ⋯ Intra-operative anaesthesia technique did not affect postoperative recurrence and overall survival in patients with hepatocellular carcinoma undergoing hepatectomy.
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Understanding 1-year mortality following major surgery offers valuable insights into patient outcomes and the quality of peri-operative care. Few models exist that predict 1-year mortality accurately. This study aimed to develop a predictive model for 1-year mortality in patients undergoing complex non-cardiac surgery using a novel machine-learning technique called multi-objective symbolic regression. ⋯ This study confirms the feasibility of developing a multi-objective symbolic regression-based model for predicting 1-year postoperative mortality in a mixed non-cardiac surgical population. The model's strong performance underscores the critical role of physiological data, particularly cardiorespiratory fitness, in surgical risk assessment and emphasises the importance of pre-operative optimisation to identify and manage high-risk patients. The multi-objective symbolic regression model demonstrated high sensitivity and a good F1 score, highlighting its potential as an effective tool for peri-operative risk prediction.
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Approximately 1% of the UK population is prescribed oral corticosteroids at any one time. It is not known how many of these patients present for major surgery. We aimed to establish the prevalence, characteristics and outcomes of patients taking oral corticosteroids. ⋯ Around 1 in 29 patients undergoing major surgery are taking oral corticosteroids for > 28 days in the 3 months before major surgery. Their outcomes are poor and warrant highlighting within care pathways to aid risk prediction and mitigation.
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The diagnostic accuracy of gastric ultrasound in children has not been assessed thoroughly. We aimed to determine the sensitivity and specificity in children of a qualitative ultrasound examination of the gastric antrum in the supine 45° semi-recumbent position and a clinical algorithm for detecting a gastric fluid volume > 1.25 ml.kg-1, reported to represent an 'at-risk stomach' for pulmonary aspiration. ⋯ In order to achieve high sensitivity of gastric ultrasound for the diagnosis of fluid volume > 1.25 ml.kg-1 in children, qualitative ultrasound assessment of gastric antrum contents should be combined with calculation of gastric fluid volume when fluid contents are seen in the gastric antrum.