Articles: surgery.
-
Anesthesia and analgesia · Oct 2024
Second-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis.
Second-generation supraglottic airway (SGA) devices are widely used, but thought to have inferior safety performance to endotracheal tubes (ETTs), but might be equally efficacious while improving patient-centered outcomes. We compared second-generation SGAs with ETTs for perioperative safety, efficacy, and quality of recovery in adults undergoing abdominopelvic surgery under general anesthesia. Our primary objective was to assess safety in the form of major airway complications. Secondary objectives were other safety, efficacy, and quality of recovery outcomes. ⋯ Second-generation SGAs reduce the risk of major airway complications compared with ETTs in adults undergoing abdominopelvic procedures under general anesthesia, with no reported clinically relevant differences in the risk of regurgitation or pulmonary aspiration. Additionally, they improve the quality of postoperative recovery with lower risk of sore throat, hoarseness, and postoperative nausea and vomiting. These data provide an opportunity for clinicians to reassess the implications of conservative airway management, and potentially expand the role of second-generation SGAs in routine clinical practice.
-
Multicenter Study Observational Study
Association between delta anion gap/delta bicarbonate and outcome of surgical patients admitted to intensive care unit.
Patients undergoing high-risk surgeries with acid-based disorders are associated with poor outcomes. The screening of mixed acid-based metabolic disorders by calculating delta anion gap (AG)/delta bicarbonate (Bic) has a clinically relevant role in patients with high AG metabolic acidosis (MA), however its utility in individuals facing high-risk surgical procedures remains unclear. ⋯ In the postoperative time, patients with metabolic acidosis and no mixed disorders present higher ICU-Mortality and higher cardiovascular postoperative complications when compared with patients with combined hyperchloremia or alkalosis. Delta-AG/delta-Bic can be a useful tool to evaluate major clinical outcomes in this population.
-
Anesthesia and analgesia · Oct 2024
An Updated Systematic Review and Meta-Analysis of Unimodal Prehabilitation with Exercise Intervention to Enhance Postoperative Outcomes in Cancer Surgery.
The objective of this systematic review and meta-analysis was to update the body of evidence on the efficacy of prehabilitation with exercise interventions, in reducing postoperative complications and length of hospital stay after cancer surgery. ⋯ Evidence supports the efficacy of prehabilitation with exercise in reducing postoperative complications and length of hospital stay in patients undergoing lung cancer surgery. Further research is warranted to establish the efficacy of unimodal prehabilitation with exercise in genitourinary, lower gastrointestinal, and upper gastrointestinal cancer populations having cancer surgery.
-
Anesthesia and analgesia · Oct 2024
Preoperative Smoking-Cessation Interventions to Prevent Postoperative Complications: A Quality Assessment and Overview of Systematic Review Evidence.
Multiple systematic reviews have investigated the effectiveness of preoperative interventions for smoking-cessation, although relatively few have focused on the prevention of surgical complications. This overview of systematic reviews aimed to describe the types of smoking interventions studied to prevent postoperative complications, summarize the results, and evaluate the quality of the reviews and strength of evidence to inform clinicians, health practitioners, policy developers, and government bodies. Comprehensive searches of Cochrane Library, MEDLINE, EMBASE, CINAHL, and Johanna Briggs Institute databases were conducted to identify systematic reviews of preoperative smoking-cessation interventions to prevent surgical complications (inception-May 14, 2024). ⋯ This overview provides the most up-to-date summary and quality assessment of systematic review evidence on the effectiveness of preoperative smoking-cessation interventions to prevent surgical complications. The evidence supports providing smoking-cessation interventions which include multiple behavioral support sessions and pharmacotherapy implemented at least 4 weeks before surgery to reduce postoperative complications. Consequently, anesthesiologists need to work with primary care physicians, consultants, and surgeons to optimize smoking-cessation interventions way in advance of surgery.