Articles: postoperative.
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Multicenter Study
Covert perioperative strokes in older patients having non-cardiac surgery (PRECISION): a prospective cohort analysis.
Perioperative strokes may promote postoperative neurocognitive dysfunction. This study thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from noncardiac surgery. ⋯ Among patients aged 60 yr and older who had major noncardiac surgery, mainly intracranial, one in nine patients experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.
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With estimated global postoperative mortality rates at 1% to 4% leading to approximately 3 million to 12 million deaths per year, an urgent need exists for reliable measures of perioperative risk. Existing approaches suffer from poor performance, place a high burden on clinicians to gather data, or do not incorporate intraoperative data. Previous work demonstrated that intraoperative anesthetics induce prefrontal electroencephalogram (EEG) oscillations in the alpha band (8 to 12 Hz) that correlate with postoperative cognitive outcomes. ⋯ Intraoperative EEG alpha power is independently associated with postoperative mortality and adverse outcomes, suggesting it could represent a broad measure of postoperative physical resilience and provide clinicians with a low-burden, personalized measure of postoperative risk.
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Improved perioperative patient monitoring is a crucial step toward better predicting postoperative outcomes. Wearable devices capable of measuring various health-related metrics represent a novel tool that can assist healthcare providers. However, the literature surrounding wearables is wide-ranging, preventing clinicians from drawing definitive conclusions regarding their utility. This review intends to consolidate the recent literature on perioperative wearables and summarize the most salient information. ⋯ Perioperative wearables are valuable tools for tracking postoperative health metrics, predicting adverse events, and improving patient satisfaction. Future research on removing barriers such as technological illiteracy, artifact generation, and false-positive alarms would enable better integration of wearables into the hospital setting.
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Curr Opin Anaesthesiol · Feb 2025
Integrating regional blocks into Enhanced Recovery After Surgery protocols for cesarean delivery: optimizing postoperative recovery.
This review aims to synthesize the current literature on the use of regional blocks to enhance and optimize postoperative recovery after cesarean delivery, highlighting key strategies, challenges, and emerging trends. ⋯ Managing pain after cesarean delivery continues to pose a significant challenge. The overall prevalence of acute postoperative pain remains high (58%) and, even when strict adherence to established guidelines is ensured, approximately 25% of patients report inadequate pain control. Within a multimodal analgesic framework, when neuraxial morphine - still considered the gold standard - is not an option, the use of peripheral nerve and fascial plane blocks has demonstrated clear benefits. Recent literature suggests that quadratus lumborum block may serve as a promising alternative to intrathecal morphine for women who cannot tolerate opioids. Additionally, incorporating certain regional techniques alongside neuraxial morphine may further improve postoperative analgesia, especially for patients at high risk of severe postoperative pain and those who have contraindications to other analgesic modalities.