Articles: operative.
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Anesthesia and analgesia · Mar 2024
Randomized Controlled TrialInfluence of Neostigmine on Early Postoperative Cognitive Dysfunction in Older Adult Patients Undergoing Noncardiac Surgery: A Double-Blind, Placebo-Controlled, Randomized Controlled Trial.
The goal of this study was to investigate the efficacy of neostigmine on postoperative cognitive dysfunction (POCD) and determine its effect on systematic markers of oxidative stress in older patients. ⋯ Neostigmine reduced POCD on the first day after noncardiac surgery in older patients. Neostigmine treatment inhibited oxidative stress and increased serum BDNF levels. There was no significant influence of neostigmine on POCD on the third or seventh day after surgery. The clinical influence of neostigmine on POCD should be further investigated.
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There is general agreement that acute pain management is an important component of perioperative medicine. However, there is no consensus on the best model of care for perioperative pain management, mainly because evidence is missing in many aspects. Comparing the similarities and differences between countries might reveal some insights into different organisational models and how they work. ⋯ Outcome assessment beyond pain intensity (such as pain-related physical function, which is important for early rehabilitation and recovery) is currently not well implemented. Developing common quality indicators, a European guideline for perioperative pain management (e.g. for patients at high risk for experiencing severe pain and other outcome parameters) and common criteria for acute pain services might pave the way forward for improving acute pain management in Europe. Finally, the education of general and specialist staff should be aligned in Europe, for example, by using the curricula of the European Pain Federation (EFIC).
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Minerva anestesiologica · Mar 2024
Meta AnalysisEfficacy and safety of pericapsular nerve group block in total hip arthroplasty: a meta-analysis and systematic review.
Ensuring effective perioperative pain control is a crucial aspect of rehabilitation programs following total hip arthroplasty. This study presents a comprehensive meta-analysis and systematic review to assess the efficacy and safety of pericapsular nerve group block (PENG) in the context of total hip arthroplasty. ⋯ Based on the latest findings, PENG has been shown to effectively decrease pain scores within six and 24 hours following total hip arthroplasty. However, its effectiveness in pain control diminishes after 48 hours. Additionally, PENG has demonstrated the ability to reduce opioid consumption without an accompanying increase in adverse drug events.
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Minerva anestesiologica · Mar 2024
Randomized Controlled TrialSupplemental low-dose esketamine to propofol versus propofol alone on perioperative characteristics in children undergoing surgery: a prospective randomized controlled trial.
Limited data exist regarding the use of the esketamine-propofol combination (esketofol) in pediatric surgery. This study aimed to investigate the effect of esketofol versus propofol alone on the perioperative characteristics of children undergoing minor surgery. ⋯ Esketofol reduces postoperative pain and the need for rescue opioids, but it extends recovery time in the PACU and increases BIS without affecting other outcomes.
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Anesthesia and analgesia · Mar 2024
Multicenter StudyPlatelet Transfusion in Cardiac Surgery: An Entropy-Balanced, Weighted, Multicenter Analysis.
Platelet transfusion is common in cardiac surgery, but some studies have suggested an association with harm. Accordingly, we investigated the association of perioperative platelet transfusion with morbidity and mortality. ⋯ In cardiac surgery patients, perioperative platelet transfusion was associated with reduced operative and 90-day mortality. Until randomized controlled trials either confirm or refute these findings, platelet transfusion should not be deliberately avoided when considering odds of death.