(Reg Anesth Pain Med. 2018;43:502–508) As the use of neuraxial anesthesia is potentially broadening, an increased understanding and prevention of postdural puncture headache (PDPH) is needed. While numerous studies have examined either needle gauge or design, there has not been a comprehensive study analyzing individual technical and patient-related factors. This meta-analysis aimed to examine the association between spinal needle characteristics and PDPH.

A significant relationship between needle gauge and subsequent rate of PDPH was noted in cutting needles, but not pencil-point needles.

OBJECTIVE: To compare disease-free survival between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer. METHODS: We conducted a multicentric, propensity-matched study of patients with high-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 1999 and June 2016 at two centers. High-risk endometrial cancer included grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma with any myometrial invasion. Patients were categorized a priori into two groups based on surgical approach, propensity scores were calculated based on potential confounders and groups were matched 1:1 using nearest neighbor technique. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival. RESULTS: Of 626 eligible patients, 263 (42%) underwent minimally invasive surgery and 363 (58%) underwent open surgery. In the matched cohort, there were no differences in disease-free survival rates at 5 years between open (53.4% [95% CI 45.6–60.5%]) and minimally invasive surgery (54.6% [95% CI 46.6–61.8]; P=.82). Minimally invasive surgery was not associated with worse disease-free survival (hazard ratio [HR] 0.85, 95% CI 0.63–1.16; P=.30), overall survival (HR 1.04, 95% CI 0.73–1.48, P=.81), or recurrence rate (HR 0.99; 95% CI 0.69–1.44; P=.99) compared with open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65–1.58, P=.96), overall survival (HR 1.18, 95% CI 0.71–1.96, P=.53), or recurrence rate (HR 1.12, 95% CI 0.67–1.87; P=.66). CONCLUSION: There was no difference in oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.

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Ultrasonography is part of the multimodal monitoring of the neurocritical patient. Through transcranial color Doppler ultrasound, carotid-color Doppler ultrasound, and ocular ultrasound it is possible to diagnose and monitor a multitude of pathological conditions, such as cerebrovascular events, vasospasm, Terson syndrome, carotid atheromatosis, and brain death. Furthermore, these techniques enable the monitoring of the intracranial pressure, the cerebral perfusion pressure, and the midline deviation, which allows us to understand the patient’s neurocritical pathology at their bedside, in a noninvasive way. Although none of these tools have yet been shown to improve patient prognosis, the dissemination of knowledge and management of neurovascular ultrasonography could significantly improve the comprehensive management of neurocritical patients.

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Background: Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established.Methods: Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl À1 for females and < 13 g dl À1 for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications.Secondary outcomes included the number of patients with 30-day moderate-tosevere complications, red blood cell transfusion, mortality, and length of hospital stay.Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred.Results: A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl À1 was associated with fewer postoperative complications. Conclusion:Preoperative haemoglobin ≥14 g dl À1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.