Articles: surgery.
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Meta Analysis Comparative Study
Remimazolam vs. propofol for general anaesthesia in elderly patients: a meta-analysis with trial sequential analysis.
Elderly patients comprise an increasing proportion of patients undergoing surgery, and they require special attention due to age-related physiological changes. Propofol is the traditional agent for anaesthesia, and recently, remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as an alternative to propofol in general anaesthesia. ⋯ Remimazolam significantly reduced the risk of hypotension, bradycardia and injection pain, despite an increase in the time to loss of consciousness. Remimazolam appears to be an effective and well tolerated alternative to propofol in elderly patients undergoing general anaesthesia.
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The escalating opioid crisis has intensified the need to explore alternative pain management strategies for patients undergoing spine surgery. This review is timely and relevant as it synthesizes recent research on opioid alternatives for perioperative management, assessing their efficacy, side effects, and postoperative outcomes. ⋯ The use of multimodal analgesia aligns with current pain management guidelines and addresses public health concerns related to opioid misuse. While effective, these alternatives are not without side effects, and the ultimate outcome depends on balancing benefits and risks. Future research should focus on the long-term outcomes of opioid alternatives, their effectiveness across diverse populations, and further validation and optimization of these strategies.
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Curr Opin Anaesthesiol · Oct 2024
ReviewFascial plane blocks: from microanatomy to clinical applications.
In the last 20 years, advancements in the understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) have gained popularity due to their validated safety profile and relative ease. They are used in various clinical settings for surgical and nonsurgical indications. Growing evidence suggests a link between the microscopic anatomy of fasciae and their mechanism of action. As a result, knowledge of these aspects is urgently needed to better optimise pain management. The purpose of this review is to summarise the different microscopic aspects of deep/muscular fascia to expand our understanding in the performance of FPBs. ⋯ Physicians must be aware of the role of fascial microscopic anatomy and better understand their properties to perform FPBs in a conscious manner and enhance pain management.
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The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset. ⋯ Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent.
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J. Thorac. Cardiovasc. Surg. · Oct 2024
Prognostic Utility of a Risk Prediction Model for Pre-Discharge Major Residual Lesions or Unplanned Reinterventions Following Congenital Mitral Valve Repair.
We sought to develop a risk prediction model for predischarge major mitral valve (MV) residual lesions or unplanned MV reinterventions following congenital MV repair. ⋯ Our risk prediction model may guide prognostication of patients following congenital MV repair.