Articles: surgery.
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Anesthesia and analgesia · Jun 2024
Impact of Sugammadex Versus Neostigmine Reversal on Postoperative Recovery Time in Patients With Obstructive Sleep Apnea Undergoing Bariatric Surgery: A Double-Blind, Randomized Controlled Trial.
Residual neuromuscular blockade can be associated with serious postoperative complications. Sugammadex is a newer neuromuscular blocking drug (NMBD) reversal agent that rapidly and completely reverses rocuronium. Whether sugammadex has any advantages over neostigmine in morbidly obese patients with obstructive sleep apnea (OSA) is unclear. We investigated whether sugammadex would reduce discharge time from the operating room (OR) compared with neostigmine in morbidly obese patients with OSA undergoing bariatric surgery. ⋯ No difference was observed in OR discharge time in morbidly obese patients with OSA when sugammadex was administered instead of neostigmine.
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To systematically review technologies that objectively measure CWL in surgery, assessing their psychometric and methodological characteristics. ⋯ Physiological metrics provide an accessible, objective assessment of CWL, but dependence on autonomic function negates selectivity and diagnosticity. Neurophysiological measures demonstrate favorable sensitivity, directly measuring brain activation as a correlate of cognitive state. Lacking an objective gold standard at present, we recommend the concurrent use of multimodal objective sensors and subjective tools for cross-validation. A theoretical and technical framework for objective assessment of CWL is required to overcome the heterogeneity of methodological reporting, data processing, and analysis.
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To examine the association between intersectionality of race, ethnicity, and sex on retention of U.S. general surgery residents. ⋯ Increasing intersectionality is positively associated with attrition during surgery residency. The diversity of faculty appears to be associated with resident diversity.
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Anesthesia and analgesia · Jun 2024
Diagnostic Accuracy of Vascular Ultrasonography for Postanesthesia Induction Hypotension: A Systematic Review and Network Meta-Analysis.
Arterial hypotension commonly occurs after anesthesia induction and is associated with negative clinical outcomes. Point-of-care ultrasound examination has emerged as a modality to predict postinduction hypotension (PIH). We performed a systematic review and network meta-analysis of the predictive performance of point-of-care ultrasound tests for PIH in noncardiac, nonobstetrical routine adult surgery. ⋯ The predictive performance of point-of-care ultrasound for PIH is uncertain. There is a need for high-quality randomized controlled trials with appropriate blinding and void of selection bias.
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Cases of embedded unexploded ordnance are extremely rare and pose a risk to bystanders and health providers. A patient arrived at the Role 2 medical facility in the Turkish army, whose left arm was amputated due to a terrorist attack and major hemorrhages had been halted by clamping of the left subclavian artery and vein. ⋯ In these challenging cases, safety principles should be acknowledged. Highlighting the basic precautions is important for similar scenarios and increases awareness of the utmost importance.