Background: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P¼0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P¼0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P¼0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09e1.90; P¼0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89e1.90; P¼0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events. Clinical trial registration: NCT01601223.
Introduction. One of the main unresolved problems in coronary surgery has been the search for an “ideal” graft for coronary artery bypass surgery. Surgical procedures with the use of artificial circulation can lead to high incidence of postoperative complications compared to operations on a beating heart. The aim. To study the results of total arterial myocardial revascularization on a beating heart and to evaluate the medium-term outcomes in patients with coronary heart disease. Materials and methods. Ninety eight patients with coronary heart disease were treated from 2009 to 2013. The patients underwent total arterial myocardial revascularization on a beating heart using only arterial grafts: those obtained from internal thoracic artery, radial artery, and right gastroepiploic artery. Results and discussion. No deaths were observed in the postoperative period. In 91 (92.8%) patients, the postoperative period was uneventful. After 5 years of follow-up, clinical and non-invasive methods of examination revealed no coronary circulation disorders. Conclusions. Our clinical experience showed promising short- and medium-term results. The technique of total arterial myocardial revascularization on a beating heart is a good alternative to operations performed under the condition of artificial circulation.
The aim: To estimate the protective effect of remote ischemic preconditioning (RIPC) on kidney transplants harvested from living related donors. Materials and methods: To achieve the claimed aim, there were examined 60 donor-recipient couples, where kidney transplant donors were living-related. All donors had the same anaesthetic management. The first group (n = 30) received RIPC which included four procedures of cuff inflations each lasting 5 minutes followed by 5-minute intervals of cuff deflation to measure blood pressure up to 40 mm Hg above systolic blood pressure on the shoulder. Patients of the second group (controls) did not experience RIPC (n = 30) and control group without RIPC. Results: RIPC resulted in a statistically significant (P<0.05) increase in GFR of the transplanted kidney from 66±5 mL /min to 63±4 mL /min after 3 months, from 69±3 mL /min to 61±5 mL /min after 6 months, from 63±2.5 mL /min to 57±3 mL /min after 12 months; a 3-fold reduced partial delay of graft function; a 2-fold decreased incidence of acute kidney transplant rejection times; 1.5-fold decline in the incidence of primary non-function; and 1.4-fold tCr50 acceleration (p = 0.16). The follow-up period lasted for a year after transplantation. Conclusions: RIPC during organ harvesting improved graft ischemic protection and increased functioning efficiency in the recipient.
Objective. To investigate the connection between application of solutions for infusion and parameters of the hemostasis system while the elective operations performance of coronary shunting on the working heart. Materials and methods. The results of examination and surgical treatment were analyzed in 80 patients, in whom coronary shunting on the working heart was conducted. The patients were divided into three groups: the Investigation Group I (IG I) – 20 patients, in whom colloidal solution of hydroxyethyl starch (HES) 130/0.4 was applied intraoperatively, the Investigation Group II (IG II) - 20 patients, in whom colloidal 4% solution of gelatin was used intraoperatively, and a Control Group, consisted of 40 patients, in whom only crystalloidal solutions were included in the infusion therapy program. The coagulation hemostasis indices, the blood loss volume and the need for hemotransfusion were compared. Results. In the IG I patients the volume of perioperative blood loss was more than in the IG II patients – (615 ± 191) and (438 ± 62) ml, accordingly (p=0.0003), and the coagulation hemostasis indices were trustworthily lower at the operation ending, demanding the erythrocytic mass transfusion doing in 3 (15%) patients. The IG II patients, comparing with the Control Group, suffered more volume of the blood loss - (560 ± 164) and (438 ± 62) ml, accordingly (p=0,02), and the changes in the coagulation indices, similar to changes in patients of the IG I, comparing with the Control Group patients. Any patient from the IG II needed hemotransfusion perioperatively. Conclusion. Application of colloidal solutions while doing elective operations of CSH on the working heart leads to disorder of coagulation hemostasis, the intraoperative blood loss and the need for hemotransfusion enhancement.
Мета. Покращити результати штучної вентиляції легенів у пацієнтів з морбідним ожирінням. Матеріали і методи. До даного дослідження залучено 81 хворого, якому виконали баріатричні лапаротомні операції. Під час оперативного втручання контролювали рівень внутрішньочеревного тиску (ВЧТ), парціальне напруження кисню в артеріальній крові (РаО2), середній артеріальний тиск (САТ) та розраховували абдомінальний перфузійний тиск (АПТ). Визначали залежність між АПТ та РаО2. Результати. У пацієнтів після інтубації рівень РаО2 становив у середньому (86,9 ± 24,1) мм рт. ст., після лапаротомії – (121,3 ± 25,2) мм рт. ст., після ушивання черевної порожнини - від 60,7 до 92 мм рт. ст., у середньому (69,8 ± 9,7) мм рт. ст. До розкриття черевної порожнини рівень ВЧТ становив у середньому (18,3 ± 1,8) мм рт. ст., після лапаротомії знизився в середньому до (15,1 ± 2,5) мм рт. ст., після ушивання черевної порожнини збільшився відносно вихідного рівня до (21,3 ± 2,4) мм рт. ст. Існує пряма пропорційна залежність між рівнем АПТ і РаО2 (ρ = 0,01, р < 0,05). Висновки. Рівень РаО2 прямо пропорційно залежить від рівня АПТ. ВЧТ у пацієнтів з морбідним ожирінням є одним із факторів розвитку гіпоксемії в інтраопераційному періоді.
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