To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hyp...To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hypotension and perioperative organ injury,[1]the results of prospective randomized trials with regard to tight blood pressure management and clinical outcomes were inconsistent.[2–4]Organ injury could be also provoked by surgery-induced stress.Dexmedetomidine has been validated to attenuate the over-expression of stress mediators;however,whether perioperative dexmedetomidine can improve clinical outcomes remains uncertain.[5,6]Therefore,this 2×2 factorial randomized trial was designed to investigate whether targeted blood pressure management with/without dexmedetomidine administration could minimize the occurrence of a composite of major organ injuries and complications within 30 days in moderateto-high risk patients after major non-cardiac surgery.展开更多
Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The p...Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).展开更多
基金supported by grants from the National Key Research&Development Program of China(Nos.2023YFC2506900 and 2018YFC2001800)the National High Level Hospital Clinical Research Funding(Nos.2022CR74 and 2022CR78 of Peking University First Hos pital)Braun Anesthesia Scientific Research Fund(No.BBDF-2019-004).
文摘To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hypotension and perioperative organ injury,[1]the results of prospective randomized trials with regard to tight blood pressure management and clinical outcomes were inconsistent.[2–4]Organ injury could be also provoked by surgery-induced stress.Dexmedetomidine has been validated to attenuate the over-expression of stress mediators;however,whether perioperative dexmedetomidine can improve clinical outcomes remains uncertain.[5,6]Therefore,this 2×2 factorial randomized trial was designed to investigate whether targeted blood pressure management with/without dexmedetomidine administration could minimize the occurrence of a composite of major organ injuries and complications within 30 days in moderateto-high risk patients after major non-cardiac surgery.
基金supported by a grant from the National Key Research and Development Program of China(No.2018YFC2001800)
文摘Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).
