Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in amb...Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.展开更多
BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment...BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.展开更多
BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various fac...BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.展开更多
BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus ...BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.展开更多
Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is sca...Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.展开更多
BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This s...BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.展开更多
Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Met...Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Methods:Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023,dividing them into Group A(continuous pump injection of 6 mg hydromorphone+50mg flurbiprofen ester as background injection for 2 ml/h,additional single injection of 3 ml/10min,15 minutes before surgery)and Group B(intravenous injection of 50 mg flurbiprofen ester during the operation,additional injection of tramadol 100 mg intramuscular injection if necessary).Groups were compared and analyzed at different time points in surgery and post-operation time from pain level(NRS),side effects,inflammatory indexes(PCT,IL-6),satisfaction rate.Result:NRS scores at 5 time points,during operation,immediately post-surgery,12,24 hours post-operation,Group A were significantly lower than Group B(Group A during operation 3.0,immediate postoperation 3.0 to 24h 1.0;Group 4.0 to 24h 1.0,all P>0.05).The rate of adverse reactions were comparable between the two groups(all P>0.05).The amount of PCT(0.23 ng/ml vs 1.15 ng/ml)and IL-6(54.49 pg/ml vs 233.49 pg/ml)decreased post-surgery in Group A compared to Group B,but were not statistically significant difference(P=0.424/P=0.502),and more patients in Group A were relieved to grade score of pain relief 4 or above(86.7%vs.60%,P=0.001).Conclusions:Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE,has good safety,and is worth of further promotion and verifying.展开更多
The significance of glial cells in the nervous system,particularly in the modulation of pain,has increasingly gained prominence,thereby shifting the traditional neurobiological research paradigm that predominantly foc...The significance of glial cells in the nervous system,particularly in the modulation of pain,has increasingly gained prominence,thereby shifting the traditional neurobiological research paradigm that predominantly focused on neurons.Acupuncture treatment have been shown to influence the functionality of glial cells,enabling them to serve as modulators that significantly contribute to the inhibition of neurogenic inflammation,the restoration of synaptic homeostasis,and the enhancement of the pain modulation system.Furthermore,various molecules and their associated signaling pathways facilitate the biological effects of glial cells in the context of acupuncture-induced analgesia.Notably,P2X receptors(P2X3,P2X4,and P2X7),the MAPK pathway(including p38MAPK and ERK),and the JAK/STAT pathway within glial cells are implicated in the modulation of neuroinflammation and pain regulation through acupuncture.These elucidated mechanisms underscore the potential of acupuncture to modulate neuroimmune signaling for pain alleviation and suggest the prospect of developing more targeted and effective treatments for chronic pain in the future.展开更多
BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues.Multimodal analgesia may address these problems.We hypothesized that multimodal analgesia can reduce opioid ...BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues.Multimodal analgesia may address these problems.We hypothesized that multimodal analgesia can reduce opioid use and improve cognitive recovery.AIM To investigate the effects of multimodal analgesia on postoperative opioid consumption and cognitive recovery in patients who underwent cardiac surgery.METHODS A prospective,randomized controlled trial at General Hospital from January 2020 to April 2023 recruited a total of 150 adult patients who underwent elective cardiac surgery.The patients were randomly divided into two groups.Group A had patient-controlled intravenous analgesia with sufentanil and flurbiprofen axil.Group B had flurbiprofen axil and paravertebral nerve block.Data were analyzed with appropriate statistical methods.RESULTS Group B had lower postoperative patient-controlled intravenous analgesia drug consumption(2.21 mL/hour vs 4.26 mL/hour,P<0.001),shorter extubation time(2.32 hours vs 3.81 hours,P<0.001),and intensive care unit stay(15.32 h vs 28.63 h,P<0.001).Visual Analogue Scale pain scores were lower in group B(P<0.001).Group B had fewer postoperative complications(no respiratory depression vs 37.9%in group A,P<0.05),a lower postoperative cognitive dysfunction incidence(16.0%vs 28.0%,P<0.05),and higher Barthel Index scores(P<0.05).CONCLUSION Multimodal analgesia with paravertebral nerve block and flurbiprofen axil reduces opioid use and improves cognitive outcomes in patients who underwent cardiac surgery.展开更多
Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bot...Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bothμ-andκ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pureμ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis assessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic regression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postoperative pain management in patients at cardiovascular risk.展开更多
BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated ...BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.展开更多
Objective Post-operative cognitive dysfunction(POCD)and post-operative delirium(POD)are two common post-operative cerebral complications.The current meta-analysis was to systematically review the effects of penehyclid...Objective Post-operative cognitive dysfunction(POCD)and post-operative delirium(POD)are two common post-operative cerebral complications.The current meta-analysis was to systematically review the effects of penehyclidine hydrochloride(PHC)on POCD and POD in surgical patients.Methods Electronic databases were searched to identify all randomized controlled trials comparing PHC with atropine/scopolamine/placebo on POCD and POD in surgical patients.Primary outcomes of interest included the incidences of POCD and POD;the secondary outcomes of interest included peri-operative minimental state examination(MMSE)scores.Two authors independently extracted peri-operative data,including patients'baseline characteristics,surgical variables,and outcome data.For dichotomous data(POCD and POD occurrence),treatment effects were calculated as odds ratio(OR)and 95%confidential interval(Cl).Each outcome was tested for heterogeneity,and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity.For continuous variables(MMSE scores),treatment effects were calculated as weighted mean difference(WMD)and 95%CI.Statistical significance was defined as P<0.05.Results Our search yielded 33 studies including 4017 patients.Meta-analysis showed that,the incidence of POCD in PHC group was comparable to that in saline group(OR=0.97;95%Ck 0.S8-1.64;P=0.92),scopolamine group(OR=0.78;95%CI:0.48-1.27;P=0.32)and atropine group(0R=1.20;95%Ch 0.86-1.67;P=0.29).The incidence of POD in PHC group was comparable to that in saline group(OR=1.53;95%CI:0.81-2.90;P=0.19)and scopolamine group(OR=0.53;95%CI:0.06-4.56;P=0.56),but higher than that in atropine group(OR=4.49;95%CI:1.34-15.01;P=0.01).Conclusions PHC premedication was not associated with increased incidences of POCD or POD as compared to either scopolamine or placebo.展开更多
Objective： To investigate the relationship between post-operative cognitive dysfunction（POCD） and regional cerebral oxygen saturation（rSO2） and β-amyloid protein（Aβ） in patients undergoing laparoscopic pancre...Objective： To investigate the relationship between post-operative cognitive dysfunction（POCD） and regional cerebral oxygen saturation（rSO2） and β-amyloid protein（Aβ） in patients undergoing laparoscopic pancreaticoduodenectomy. Methods： Fifty patients undergoing elective laparoscopic pancreaticoduodenectomy received five groups of neuropsychological tests 1 d pre-operatively and 7 d post-operatively, with continuous monitoring of rSO2 intra-operatively. Before anesthesia induction（t0）, at the beginning of laparoscopy（t1）, and at the time of pneumoperitoneum 120 min（t2）, pneumoperitoneum 240 min（t3）, pneumoperitoneum 480 min（t4）, the end of pneumoperitoneum（t5）, and 24 h after surgery, jugular venous blood was drawn respectively for the measurement of Aβ by enzyme-linked immunosorbent assay（ELISA）. Results： Twenty-one cases of the fifty patients suffered from POCD after operation. We found that the maximum percentage drop in rSO2（rSO2, %max） was significantly higher in the POCD group than in the non-POCD group. The rSO2, %max value of over 10.2% might be a potential predictor of neurocognitive injury for those patients. In the POCD group, the plasma Aβ levels after 24 h were significantly higher than those of pre-operative values（P〈0.01）. After 24 h, levels of plasma Aβ in the POCD group were significantly higher than those in the non-POCD group（P〈0.01）. Conclusions： The development of POCD in patients undergoing laparoscopic pancreaticoduodenectomy is associated with alterations of rSO2 and Aβ. Monitoring of rSO2 might be useful in the prediction of POCD, and Aβ might be used as a sensitive biochemical marker to predict the occurrence of POCD.展开更多
Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high ...Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality.A series of post-operative complications further affects the prognosis.Post-operative pneumonia(POP)also leads to great morbidity and mortality.This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure.Methods The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei province,China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients.Logistic regression analyses were used to identify the risk factors for POP.Results In the study,31.5%of patients developed POP.Patients with POP had higher proportions of severe oxygenation damage,pneumothorax,reintubation,tracheotomy,renal replacement therapy,arrhythmia,gastrointestinal bleeding,and longer duration of mechanical ventilation,fever,ICU stay,and length of stay(all with P<0.05).The in-hospital mortality was 2.3%.Smoking,preoperative white blood cells,and intraoperative transfusion were the independent risk factors for POP in TAAAD.Conclusion Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP.Furthermore,patients with risk factors should be treated with caution.展开更多
BACKGROUND Colorectal cancer(CRC)resection is currently being undertaken in an increasing number of obese patients.Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes f...BACKGROUND Colorectal cancer(CRC)resection is currently being undertaken in an increasing number of obese patients.Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.AIM To evaluate the post-operative outcomes of obese patients following CRC resection,as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.METHODS Six-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index(BMI):Obese[BMI≥30,n=182(29.6%)]and non-obese[BMI<30,n=433(70.4%)].Demographics,comorbidities,surgical features,and post-operative outcomes were compared between both groups.Postoperative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery[n=472:BMI≥30,n=136(28.8%);BMI<30,n=336(71.2%)].RESULTS Obese patients had a higher burden of cardiac(73.1%vs 56.8%;P<0.001)and respiratory comorbidities(37.4%vs 26.8%;P=0.01).Obese patients were also more likely to undergo conversion to an open procedure(12.8%vs 5.1%;P=0.002),but did not experience more postoperative complications(51.6%vs 44.1%;P=0.06)or high-grade complications(19.2%vs 14.1%;P=0.11).In the laparoscopic subgroup,however,obesity was associated with a higher prevalence of post-operative complications(47.8%vs 39.3%;P=0.05)but not high-grade complications(17.6%vs 11.0%;P=0.07).CONCLUSION Surgical resection of CRC in obese individuals is safe.A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.展开更多
Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection...Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months展开更多
The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inad...The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.展开更多
The incidence and prevalence of cardiovascular disease(CVD)are increasing rapidly in developing countries.Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery.This highly stre...The incidence and prevalence of cardiovascular disease(CVD)are increasing rapidly in developing countries.Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery.This highly stressful experience results in increased levels of anxiety for patients.The objective of this review was to evaluate the efficacy of massage therapy on postoperative outcomes among patients undergoing cardiac surgery.A comprehensive literature search was made on PubMed-Medline,CINAHL,Science Direct,Scopus,Web of Science and the Cochrane library databases for original research articles published between 2000 and 2015.Original articles that reported the efficacy of massage therapy in patients undergoing cardiac surgery were included.The Cochrane data extraction form was used to extract data.A total of 297 studies were identified in the literature search.However,only seven studies were eligible for analysis.Of the seven studies,six studies demonstrated the effects of massage therapy on improving postoperative outcomes of patients,while one study found no evidence of improvement.Although the methods varied considerably,most of the studies included in this review reported positive results.Therefore,there is some evidence that massage therapy can lead to positive postoperative outcomes.Evidence of the effectiveness of massage therapy in patients undergoing cardiac surgery remains inconclusive.Additional research is needed to provide a strong evidence base for the use of massage therapy to improve post-operative outcomes and recovery among cardiac surgery patients.展开更多
Unrestrained anti-microbial resistance (AMR) among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. This study assessed the current AMR patterns of bacterial isol...Unrestrained anti-microbial resistance (AMR) among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. This study assessed the current AMR patterns of bacterial isolates in post-operative wound infections in a tertiary care hospital in Kathmandu,Nepal. Pus swabs collected from post-operative wound infections and submitted for culture and sensitivity were included in this study. Isolation and identification of the organism was done by standard microbiological methods. Antibiotic susceptibility test was performed by Kirby Bauer disc diffusion method and result was interpreted as per National Committee for Clinical Laboratory Standards (NCCLS) guide lines. Of the 120 pus swabs processed for culture, 96 showed bacterial growth. Staphylococcus aureus 36 (37.5%) was the predominant gram positive isolate and Escherichia coli 24 (25%) was the major gram negative isolate .The infection was most prevalent in the age group 20-40 years. All S. aureus isolates were sensitive to aminoglycosides and vancomycin. Out of 36 S. aureus, 15 (41.66%) isolates were methicillin resistant S. aureus (MRSA). Staphylococcus epidermidis showed high resistance (50%-100%) to all antibiotics but were sensitive to vancomycin. All gram negative isolates showed high resistance against cephalexin (75%-100%) and ceftriaxone (25%-100%). Overall multi-drug resistant isolates were 66.7%. A high level of AMR was observed in gram negative bacterial isolates. Rational use of antibiotics and a regular monitoring of AMR patterns in post-operative wound infections are essential and mandatory to avert further emergence and spread of anti-microbial resistance among bacterial pathogens.展开更多
OBJECTIVE To examine the ultrastructure of gastric cancer ceils by the electron microscope, in order to assess the relationship between neuroendocrine differentiation and post-operative survival time. METHODS NSE, Syn...OBJECTIVE To examine the ultrastructure of gastric cancer ceils by the electron microscope, in order to assess the relationship between neuroendocrine differentiation and post-operative survival time. METHODS NSE, Syn and CgA immunohistochemical labeling was conducted in 168 cases with a common-type of gastric cancer. Electron microscopy was performed in 80 cases with positive immunohistochemical labeling. These cases were followed-up for over 5 years and the post-operative survival data analyzed. RESULTS Neuroendocrine granules were found by electron microscopy in 39 cases. The rate of neuroendocrine differentiation found was 23% （39/168）, using routine diagnostic criteria and electron microscopy （REM）. The post-operative survival time of gastric cancer patients with neuroendocdne differentiation was significantly shorter （P=-0.0032） compared to those without neuroendocrine differentiation. CONCLUSION It is of significant clinical importance to determine if the neuroendocrine cells are differentiated in gastdc cancers. The gastric cancer patients with neuroendocrine differentiation have a shorter post-operative survival time and a poorer prognosis. Electron microscopy is a reliable method of providing a diagnosis.展开更多
文摘Introduction: The caudal anesthesia is used by many authors for postoperative analgesia. The purpose of this study was to report our experience in the practice of caudal block as post operative analgesia method in ambulatory surgery in a context of limited technical equipment. Patients and Method: Over a period of 5 months, a prospective study was conducted on 39 children aged 3 to 5 years weighing on average 15.12 kg. Children classified ASA I and II were selected. After premedication with midazolam (0.3 mg/kg) by intra rectal route, the inhalation induction was made with sevoflurane 8%, conveyed by fresh gas (50% O2 and 50% air). The caudal block was obtained with the levobupivacaine 0.25% at a dose of 1 ml/kg. The hemodynamic parameters (systolic and diastolic blood pressure, heart rates) and respiratory parameters (respiratory frequency) pre-, per- and post-operative were measured. Post-operative pain was assessed with the Objective Pain Scale (OPS). The date of first use of analgesia was noted. The adverse effects of caudal block (meningitis, respiratory disorders, acute urinary retention, cardiac disorders) have been assessed. Results: The average duration of the procedure was 55.2 minutes. The use of analgesia was made 4 hours after skin closure, when the OPS Broadmann score was greater than 3. An agitation was observed in 6 children. Haemodynamic parameters have not significantly varied from the pre- to the post-operative. No infectious complications or intolerance to local anesthetics were observed. Allthe children were able to drink 4 hours after the end of the intervention and issued their first urine later than 3 hours after surgery. Conclusion: This type of anesthesia has been found very suitable for ambulatory surgery of the child, and is always helpful. It assured a post operative analgesia of good quality, and a reduction in consumption of morphine intraoperatively.
文摘BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.
文摘BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.
文摘BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.
文摘Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.
文摘BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.
基金The National Natural Science Foundation of China(Project No.:82172036)Undergraduate teaching quality and teaching reform cultivation project of the First Affiliated Hospital of Sun Yat-sen University in 2023(Project No.P12220011-230106)。
文摘Objective:To evaluate the analgesic effect and safety of hydromorphone hydrochloride in PCIA combined with flurbiprofen axetil and pre-emptive analgesia in patients with TACE treatment for hepatocellular carcinoma.Methods:Backward observation was made on 90 patients with advanced liver carcinoma who performed TACE treatment in the First Affiliated Hospital of Sun Yat-sen University from January 2022 to October 2023,dividing them into Group A(continuous pump injection of 6 mg hydromorphone+50mg flurbiprofen ester as background injection for 2 ml/h,additional single injection of 3 ml/10min,15 minutes before surgery)and Group B(intravenous injection of 50 mg flurbiprofen ester during the operation,additional injection of tramadol 100 mg intramuscular injection if necessary).Groups were compared and analyzed at different time points in surgery and post-operation time from pain level(NRS),side effects,inflammatory indexes(PCT,IL-6),satisfaction rate.Result:NRS scores at 5 time points,during operation,immediately post-surgery,12,24 hours post-operation,Group A were significantly lower than Group B(Group A during operation 3.0,immediate postoperation 3.0 to 24h 1.0;Group 4.0 to 24h 1.0,all P>0.05).The rate of adverse reactions were comparable between the two groups(all P>0.05).The amount of PCT(0.23 ng/ml vs 1.15 ng/ml)and IL-6(54.49 pg/ml vs 233.49 pg/ml)decreased post-surgery in Group A compared to Group B,but were not statistically significant difference(P=0.424/P=0.502),and more patients in Group A were relieved to grade score of pain relief 4 or above(86.7%vs.60%,P=0.001).Conclusions:Pre-emptive analgesia treatment using PCIA of hydromorphone hydrochloride combined with flurbiprofen axetil has better analgesic effect than routine analgesic therapy in postoperative care of mid to advanced hepatocellular carcinoma TACE,has good safety,and is worth of further promotion and verifying.
基金funded by Beijing National Science Foundation(No.7222289)the CACMS Innovation Fund(No.CI2021A03404)the Fundamental Research Funds for the Central Public Welfare Research Institutes(No.ZZ2023002).
文摘The significance of glial cells in the nervous system,particularly in the modulation of pain,has increasingly gained prominence,thereby shifting the traditional neurobiological research paradigm that predominantly focused on neurons.Acupuncture treatment have been shown to influence the functionality of glial cells,enabling them to serve as modulators that significantly contribute to the inhibition of neurogenic inflammation,the restoration of synaptic homeostasis,and the enhancement of the pain modulation system.Furthermore,various molecules and their associated signaling pathways facilitate the biological effects of glial cells in the context of acupuncture-induced analgesia.Notably,P2X receptors(P2X3,P2X4,and P2X7),the MAPK pathway(including p38MAPK and ERK),and the JAK/STAT pathway within glial cells are implicated in the modulation of neuroinflammation and pain regulation through acupuncture.These elucidated mechanisms underscore the potential of acupuncture to modulate neuroimmune signaling for pain alleviation and suggest the prospect of developing more targeted and effective treatments for chronic pain in the future.
文摘BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues.Multimodal analgesia may address these problems.We hypothesized that multimodal analgesia can reduce opioid use and improve cognitive recovery.AIM To investigate the effects of multimodal analgesia on postoperative opioid consumption and cognitive recovery in patients who underwent cardiac surgery.METHODS A prospective,randomized controlled trial at General Hospital from January 2020 to April 2023 recruited a total of 150 adult patients who underwent elective cardiac surgery.The patients were randomly divided into two groups.Group A had patient-controlled intravenous analgesia with sufentanil and flurbiprofen axil.Group B had flurbiprofen axil and paravertebral nerve block.Data were analyzed with appropriate statistical methods.RESULTS Group B had lower postoperative patient-controlled intravenous analgesia drug consumption(2.21 mL/hour vs 4.26 mL/hour,P<0.001),shorter extubation time(2.32 hours vs 3.81 hours,P<0.001),and intensive care unit stay(15.32 h vs 28.63 h,P<0.001).Visual Analogue Scale pain scores were lower in group B(P<0.001).Group B had fewer postoperative complications(no respiratory depression vs 37.9%in group A,P<0.05),a lower postoperative cognitive dysfunction incidence(16.0%vs 28.0%,P<0.05),and higher Barthel Index scores(P<0.05).CONCLUSION Multimodal analgesia with paravertebral nerve block and flurbiprofen axil reduces opioid use and improves cognitive outcomes in patients who underwent cardiac surgery.
基金supported by the Health and Health Development Promotion Project-Anesthesia and Critical Care Research Project(No.KM-20240219-01)。
文摘Background Postoperative pain,if not effectively controlled,can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications.Oxycodone,a semisynthetic opioid acting on bothμ-andκ-receptors,may provide stable analgesia with less hemodynamic fluctuation compared with the pureμ-agonist sufentanil.This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufent anil-based intravenous patient-controlled analgesia(IV-PCA)after laparoscopic abdominal surgery.Methods This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025.According to their postoperative PCA regimen,patients were divided into an oxycodone group and a sufentanil group.The primary endpoint was the incidence of cardiovascular adverse events(CVAE)within 48 h after surgery,including hypotension,bradycardia,and arrhythmia.Logistic regression was used to identify independent predictors of CVAE,and receiver operating characteristic(ROC)analysis assessed discriminative performance.Results A total of 356 patients were analyzed(oxycodone n=197;sufentanil n=159).The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group(5.2%vs.12.1%,P=0.021).Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts(36±15 vs.52±17,P<0.001)and higher patient satisfaction scores(4.3±0.5 vs.4.1±0.5,P=0.002).Multivariate logistic regression identified sufentanil use(OR:2.53,95%CI:1.16-5.84,P=0.018)as independent predictors of CVAE.Conclusions Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA.The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability,making it a safer alternative for postoperative pain management in patients at cardiovascular risk.
文摘BACKGROUND Chest physiotherapy and incentive spirometry,essential for pulmonary care,can exacerbate acute post-thoracotomy pain.Pain relief is,therefore,essential to facilitate early mobilization.This study evaluated the analgesic efficacy of unilateral continuous erector spinae block(ESB)compared to thoracic epidural analgesia(TEA)in terms of quality of pain relief and perioperative hemodynamic changes.AIM To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.METHODS This prospective,observational study was conducted at a tertiary care hospital of central India.Sixty-eight adult patients of either gender,posted for elective thoracic surgeries requiring one lung ventilation,were allocated to either TEA(n=34)or ESB(n=34)group,based on the attending anesthesiologist’s expertise.Continuous data were analyzed by independent t-tests,and categorical data byχ2 tests.RESULTS The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group.Resting numerical rating scale scores(0 hour,6 hours,and 72 hours post-extubation)were significantly higher in the ESB group compared to the TEA group[1.70±1.03 vs 1.05±0.77(P=0.004);1.64±0.98 vs 1.2±0.88(P=0.05);3.2±1.07 vs 2.61±0.92(P=0.013)].Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group.Additionally,block performance time was significantly longer in the ESB group(16.58±3.66 vs 13.84±2.88,P=0.001).CONCLUSION The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy,though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.
文摘Objective Post-operative cognitive dysfunction(POCD)and post-operative delirium(POD)are two common post-operative cerebral complications.The current meta-analysis was to systematically review the effects of penehyclidine hydrochloride(PHC)on POCD and POD in surgical patients.Methods Electronic databases were searched to identify all randomized controlled trials comparing PHC with atropine/scopolamine/placebo on POCD and POD in surgical patients.Primary outcomes of interest included the incidences of POCD and POD;the secondary outcomes of interest included peri-operative minimental state examination(MMSE)scores.Two authors independently extracted peri-operative data,including patients'baseline characteristics,surgical variables,and outcome data.For dichotomous data(POCD and POD occurrence),treatment effects were calculated as odds ratio(OR)and 95%confidential interval(Cl).Each outcome was tested for heterogeneity,and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity.For continuous variables(MMSE scores),treatment effects were calculated as weighted mean difference(WMD)and 95%CI.Statistical significance was defined as P<0.05.Results Our search yielded 33 studies including 4017 patients.Meta-analysis showed that,the incidence of POCD in PHC group was comparable to that in saline group(OR=0.97;95%Ck 0.S8-1.64;P=0.92),scopolamine group(OR=0.78;95%CI:0.48-1.27;P=0.32)and atropine group(0R=1.20;95%Ch 0.86-1.67;P=0.29).The incidence of POD in PHC group was comparable to that in saline group(OR=1.53;95%CI:0.81-2.90;P=0.19)and scopolamine group(OR=0.53;95%CI:0.06-4.56;P=0.56),but higher than that in atropine group(OR=4.49;95%CI:1.34-15.01;P=0.01).Conclusions PHC premedication was not associated with increased incidences of POCD or POD as compared to either scopolamine or placebo.
基金Project supported by the Shandong Science and Technology Development Project(No.2011YD18070),China
文摘Objective： To investigate the relationship between post-operative cognitive dysfunction（POCD） and regional cerebral oxygen saturation（rSO2） and β-amyloid protein（Aβ） in patients undergoing laparoscopic pancreaticoduodenectomy. Methods： Fifty patients undergoing elective laparoscopic pancreaticoduodenectomy received five groups of neuropsychological tests 1 d pre-operatively and 7 d post-operatively, with continuous monitoring of rSO2 intra-operatively. Before anesthesia induction（t0）, at the beginning of laparoscopy（t1）, and at the time of pneumoperitoneum 120 min（t2）, pneumoperitoneum 240 min（t3）, pneumoperitoneum 480 min（t4）, the end of pneumoperitoneum（t5）, and 24 h after surgery, jugular venous blood was drawn respectively for the measurement of Aβ by enzyme-linked immunosorbent assay（ELISA）. Results： Twenty-one cases of the fifty patients suffered from POCD after operation. We found that the maximum percentage drop in rSO2（rSO2, %max） was significantly higher in the POCD group than in the non-POCD group. The rSO2, %max value of over 10.2% might be a potential predictor of neurocognitive injury for those patients. In the POCD group, the plasma Aβ levels after 24 h were significantly higher than those of pre-operative values（P〈0.01）. After 24 h, levels of plasma Aβ in the POCD group were significantly higher than those in the non-POCD group（P〈0.01）. Conclusions： The development of POCD in patients undergoing laparoscopic pancreaticoduodenectomy is associated with alterations of rSO2 and Aβ. Monitoring of rSO2 might be useful in the prediction of POCD, and Aβ might be used as a sensitive biochemical marker to predict the occurrence of POCD.
基金supported by the National Natural Science Foundation of China(No.81370134).
文摘Objective Type A acute aortic dissection(TAAAD)is a dangerous and complicated condition with a high death rate before hospital treatment.Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality.A series of post-operative complications further affects the prognosis.Post-operative pneumonia(POP)also leads to great morbidity and mortality.This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure.Methods The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei province,China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients.Logistic regression analyses were used to identify the risk factors for POP.Results In the study,31.5%of patients developed POP.Patients with POP had higher proportions of severe oxygenation damage,pneumothorax,reintubation,tracheotomy,renal replacement therapy,arrhythmia,gastrointestinal bleeding,and longer duration of mechanical ventilation,fever,ICU stay,and length of stay(all with P<0.05).The in-hospital mortality was 2.3%.Smoking,preoperative white blood cells,and intraoperative transfusion were the independent risk factors for POP in TAAAD.Conclusion Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP.Furthermore,patients with risk factors should be treated with caution.
文摘BACKGROUND Colorectal cancer(CRC)resection is currently being undertaken in an increasing number of obese patients.Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.AIM To evaluate the post-operative outcomes of obese patients following CRC resection,as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.METHODS Six-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index(BMI):Obese[BMI≥30,n=182(29.6%)]and non-obese[BMI<30,n=433(70.4%)].Demographics,comorbidities,surgical features,and post-operative outcomes were compared between both groups.Postoperative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery[n=472:BMI≥30,n=136(28.8%);BMI<30,n=336(71.2%)].RESULTS Obese patients had a higher burden of cardiac(73.1%vs 56.8%;P<0.001)and respiratory comorbidities(37.4%vs 26.8%;P=0.01).Obese patients were also more likely to undergo conversion to an open procedure(12.8%vs 5.1%;P=0.002),but did not experience more postoperative complications(51.6%vs 44.1%;P=0.06)or high-grade complications(19.2%vs 14.1%;P=0.11).In the laparoscopic subgroup,however,obesity was associated with a higher prevalence of post-operative complications(47.8%vs 39.3%;P=0.05)but not high-grade complications(17.6%vs 11.0%;P=0.07).CONCLUSION Surgical resection of CRC in obese individuals is safe.A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.
文摘Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months
文摘The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.
文摘The incidence and prevalence of cardiovascular disease(CVD)are increasing rapidly in developing countries.Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery.This highly stressful experience results in increased levels of anxiety for patients.The objective of this review was to evaluate the efficacy of massage therapy on postoperative outcomes among patients undergoing cardiac surgery.A comprehensive literature search was made on PubMed-Medline,CINAHL,Science Direct,Scopus,Web of Science and the Cochrane library databases for original research articles published between 2000 and 2015.Original articles that reported the efficacy of massage therapy in patients undergoing cardiac surgery were included.The Cochrane data extraction form was used to extract data.A total of 297 studies were identified in the literature search.However,only seven studies were eligible for analysis.Of the seven studies,six studies demonstrated the effects of massage therapy on improving postoperative outcomes of patients,while one study found no evidence of improvement.Although the methods varied considerably,most of the studies included in this review reported positive results.Therefore,there is some evidence that massage therapy can lead to positive postoperative outcomes.Evidence of the effectiveness of massage therapy in patients undergoing cardiac surgery remains inconclusive.Additional research is needed to provide a strong evidence base for the use of massage therapy to improve post-operative outcomes and recovery among cardiac surgery patients.
文摘Unrestrained anti-microbial resistance (AMR) among bacterial pathogens has made the management and treatment of post-operative wound infections difficult. This study assessed the current AMR patterns of bacterial isolates in post-operative wound infections in a tertiary care hospital in Kathmandu,Nepal. Pus swabs collected from post-operative wound infections and submitted for culture and sensitivity were included in this study. Isolation and identification of the organism was done by standard microbiological methods. Antibiotic susceptibility test was performed by Kirby Bauer disc diffusion method and result was interpreted as per National Committee for Clinical Laboratory Standards (NCCLS) guide lines. Of the 120 pus swabs processed for culture, 96 showed bacterial growth. Staphylococcus aureus 36 (37.5%) was the predominant gram positive isolate and Escherichia coli 24 (25%) was the major gram negative isolate .The infection was most prevalent in the age group 20-40 years. All S. aureus isolates were sensitive to aminoglycosides and vancomycin. Out of 36 S. aureus, 15 (41.66%) isolates were methicillin resistant S. aureus (MRSA). Staphylococcus epidermidis showed high resistance (50%-100%) to all antibiotics but were sensitive to vancomycin. All gram negative isolates showed high resistance against cephalexin (75%-100%) and ceftriaxone (25%-100%). Overall multi-drug resistant isolates were 66.7%. A high level of AMR was observed in gram negative bacterial isolates. Rational use of antibiotics and a regular monitoring of AMR patterns in post-operative wound infections are essential and mandatory to avert further emergence and spread of anti-microbial resistance among bacterial pathogens.
基金This work was supported by a grant from theSocial Development and Scientific Programof the Nantong Municipal Government,Ji-angsu Province,China(No.S30062).
文摘OBJECTIVE To examine the ultrastructure of gastric cancer ceils by the electron microscope, in order to assess the relationship between neuroendocrine differentiation and post-operative survival time. METHODS NSE, Syn and CgA immunohistochemical labeling was conducted in 168 cases with a common-type of gastric cancer. Electron microscopy was performed in 80 cases with positive immunohistochemical labeling. These cases were followed-up for over 5 years and the post-operative survival data analyzed. RESULTS Neuroendocrine granules were found by electron microscopy in 39 cases. The rate of neuroendocrine differentiation found was 23% （39/168）, using routine diagnostic criteria and electron microscopy （REM）. The post-operative survival time of gastric cancer patients with neuroendocdne differentiation was significantly shorter （P=-0.0032） compared to those without neuroendocrine differentiation. CONCLUSION It is of significant clinical importance to determine if the neuroendocrine cells are differentiated in gastdc cancers. The gastric cancer patients with neuroendocrine differentiation have a shorter post-operative survival time and a poorer prognosis. Electron microscopy is a reliable method of providing a diagnosis.
