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Background:The Sequential Organ Failure Assessment (SOFA) score has been developed to score the severity of organ dysfunction in critically ill sepsis patients and has been proven to have a high predictive value for intensive care unit (ICU) mortality in severely ill patients. Our goal was to evaluate the prognostic value of the SOFA score as well as trends in SOFA score for ICU mortality in COVID-19 patients. Methods: All consecutive patients with confirmed COVID-19 pneumonia admitted to the ICU between March 13th, 2020, and October 17th, 2020 were included in this retrospective cohort study. The worst SOFA score was evaluated daily. Multiple logistic regression models were used to evaluate the predictive value of SOFA in ICU mortality. Results: 103 patients were included in this study. 30 patients (29%) died during their ICU stay and 73 (71%) patients were discharged alive. The ICU admission SOFA score was 5.2 +/- 3.3 in ICU non-survivors vs. 4.3 +/- 2.9 in ICU survivors (P = 0.15). The maximum SOFA score in ICU non-survivors was 11.7 +/- 4.7 vs. 7.4 +/- 4.3 in ICU survivors. SOFA scores increased the first week in both survivors and non-survivors, but the increase was less pronounced in survivors. In the multiple logistic regression models, neither admission SOFA score nor combination with delta SOFA in the first 48 hours was statistically significantly related to ICU mortality. Only the maximum SOFA score remained significant (OR = 1.23, 95% CI: 1.11-1.37, P < 0.001) in the multiple logistic models with an AUC of 0.91. Conclusions: Evaluation of SOFA scores in the first 48 hours after ICU admission is not a good prognostic indicator in COVID-19 patients. Only the maximum SOFA score was predictive for ICU mortality. 1. Assistance with the article: This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. 2. Financial support and sponsorship: none. 3. Conflict of interest: none.

BACKGROUND: Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. OBJECTIVES: The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. METHODS: The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. RESULTS: Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. CONCLUSIONS: Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up. ispartof: Anesth Pain Med vol:10 issue:3 pages:e101669- ispartof: location:Netherlands status: Published online

OBJECTIVES: In 2009, Gramke et al have described predictive factors to pre-operatively detect those at risk for moderate to severe acute postoperative pain (APSP) after day surgery. The aim of the present study is to externally validate this initial model and to improve and internally validate a modified version of this model.METHODS: Elective patients scheduled for day surgery were prospectively enrolled from November 2008 to April 2010. Model discrimination was quantified using the area under the receiver operating characteristic curve (AUC). Model calibration was assessed by visual inspection of the calibration plot. Subsequently, we modified (different assignment of type of surgery, different cut-off for moderate to severe APSP, continuous of dichotomized variables and testing of additional variables) and internally validated this model by standard bootstrapping techniques.RESULTS: A total of 1118 patients were included. The AUC for the original model was 0.81 in the derivation dataset and 0.72 in our validation dataset. The model showed poorly calibrated risk predictions. The AUC of the modified model was 0.82 (optimism-corrected AUC=0.78). This modified model showed good calibration.CONCLUSION: The original prediction model of Gramke et al performed insufficient on our cohort of outpatients with respect to discrimination and calibration. Internal validation of a modified model shows promising results. In this model, preoperative pain, patient derived expected pain and different types of surgery are the strongest predictors of moderate to severe APSP after day surgery.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.

Introduction To ensure patient safety during Totally Endoscopic Cardiac Surgeries (TECS), patients are peripherally cannulated for coupling to the Cardiopulmonary Bypass (CPB) (1). Despite its necessity, the cannulated leg might experience clinically relevant ischemia (CRI), defined as a minimum of 15% Tissue Oxygenation Index (TOI) drop, lasting at least 4 minutes, possibly leading to poor peri- and postoperative clinical outcomes (2). TOI-values were assessed using non-invasive, Near-Infrared Spectroscopy (NIRS; 200NX-NIRO, Hamamatsu®, Japan) measurements of the skin covering the ipsilateral calf muscles. NIRS enables the quantification of the TOI, based on the difference in light absorption between oxygenated en deoxygenated haemoglobin molecules. The 200NX-NIRO has shown great sensitivity and specificity in the clinical setting (3-5). The objective was to evaluate the prevalence of poor distal leg perfusion related to short-term, peri-operative, CPB-time, since these data remain largerly unknown. Methods All consecutive patients 18 years or older, and scheduled for a TECS-based valve surgery (YIL AVR and/or MVATS), coronary surgery (ENDO ACAB or ENDO CABG), or a combination were included. Perioperative TOI-values were assessed at: baseline (B) = 5 minutes before insertion of the femoral arterial cannula (FAC); Event 1 (E1) = insertion of the FAC; Event 2 (E2) = onset of CPB; Event 3 (E3) = offset of CPB; Event 4 (E4) = removal of the FAC. Results 116 patients were included for statistical analysis. Differences between TOI-values were analysed using Wilcoxon signed rank tests. CRI in the cannulated leg was demonstrated in 18,80% (n = 22) of all cases, and showed significantly lower TOI-values for all events (E1, E2, E3 and E4) compared to the baseline TOI-value (Figure 1): p Discussion Although not all patients showed CRI in the cannulated leg, some degree of hypoperfusion was demonstrated over all cannulated legs. However, these are interim results and thus, further research regarding postoperative follow-up is necessary and might offer insights on how to prevent or prematurely treat ischemia and/or ischemia-related complications in the subclinical stage.

BACKGROUND: The main objective of this review is to perform a systematic review and meta-analysis of the existing evidence related to the analgesic efficacy with the use of conventional, upper arm intravenous regional anesthesia (IVRA) as compared to a modified, forearm IVRA in adult patients undergoing procedures on the distal upper extremity. METHODS: MEDLINE, EMBASE and CENTRAL (Cochrane) databases were searched for randomized controlled trials published in English, French, Dutch, German or Spanish language. Primary outcomes of interest including description of quality level of anesthesia and onset of sensory block were assessed for this review. Dosage of the local anesthetic, local anesthetic toxicity and need for sedation due to tourniquet pain were considered as secondary outcomes. RESULTS: Our literature search yielded 3 papers for qualitative synthesis. Four other articles were added into a parallel analysis of 7 reports that provided data on the incidence of complications and success rate after forearm IVRA. Forearm IVRA was found to be as efficient as upper arm IVRA (RR = 0.98 [0.93, 1.05], P = 0.78), but comes with the advantage of a lower need for sedation due to less tourniquet pain. CONCLUSION: Our results demonstrate that forearm IVRA is as effective in providing a surgical block as compared to a conventional upper arm IVRA, even with a reduced, non-toxic dosage of local anesthetic. No severe complications were associated with the use of a forearm IVRA. Other benefits of the modified technique include a faster onset of sensory block, better tourniquet tolerance and a dryer surgical field. REGISTRATION OF THE SYSTEMATIC REVIEW: A review protocol was published in the PROSPERO register in November 2015 with registration number CRD42015029536 . ispartof: BMC Anesthesiology vol:18 issue:1 ispartof: location:England status: published

BACKGROUND AND OBJECTIVES: This randomized trial aimed to assess if a combined suprascapular-axillary nerve block (SSB) is noninferior (margin = 1.3 on a 0- to 10-point scale) to interscalene block (ISB) in treating pain after arthroscopic shoulder surgery. Secondary end points included opioid consumption, dyspnea, discomfort associated with muscle weakness, and patient satisfaction. METHODS: One hundred patients undergoing arthroscopic shoulder surgery were randomized to receive ultrasound-guided ISB (n = 50) or SSB (n = 50). Pain intensity at rest, dyspnea, and discomfort were recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours after surgery. Piritramide consumption was recorded for the first 24 hours. Patient satisfaction was assessed on the second postoperative day. RESULTS: During the first 4 hours after surgery, the difference in mean pain score between SSB and ISB was higher than 2.5 (±0.8). The difference gradually decreased to 1.1 (±1.0) at 8 hours before resulting in noninferiority during the night and at 24 hours. Piritramide consumption was significantly higher in the SSB group in the first 8 hours. The incidence of dyspnea and discomfort was higher after ISB. Treatment satisfaction was similar in both groups. CONCLUSIONS: Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, identifier NCT02415088. ispartof: REGIONAL ANESTHESIA AND PAIN MEDICINE vol:43 issue:7 pages:738-744 ispartof: location:England status: published

[Stinkens, Rudi; Verbeke, Nikolaas; Ory, Jean-Paul; Dubois, Jasperina; Stessel, Bjorn] Jessa Hosp, Dept Anaesthesiol & Pain Med, Hasselt, Belgium. [Van de Velde, Marc] Univ Leuven, KU Leuven, Dept Cardiovasc Sci, Leuven, Belgium. [Van de Velde, Marc] Univ Hosp Leuven, Dept Anaesthesiol, Leuven, Belgium. [Baldussu, Esmee; Ruiters, Chabelie; Stessel, Bjorn] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium.

ispartof: INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA vol:34 pages:113-114 ispartof: location:Netherlands status: published

Nijs, K (reprint author), Jessa Hosp, Dept Anesthesiol & Pain Med, Hasselt, Belgium. Jessa Hosp, Dept Anesthesiol & Pain Med, Hasselt, Belgium.

Objectives: To prospectively describe the prevalence and predictive factors of chronic postsurgical pain (CPSP) and poor global recovery in a large outpatient population at a university hospital, 1 year after outpatient surgery. Materials and Methods: A prospective longitudinal cohort study was performed. During 18 months, patients presenting for preoperative assessment were invited to participate. Outcome parameters were measured by using questionnaires at 3 timepoints: 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale was considered to indicate moderate to severe pain. A score of 80% on the Global Surgical Recovery Index was defined as poor global recovery. Results: A total of 908 patients were included. The prevalence of moderate to severe preoperative pain was 37.7%, acute postsurgical pain 26.7%, and CPSP 15.3%. Risk factors for the development of CPSP were surgical specialty, preoperative pain, preoperative analgesic use, acute postoperative pain, surgical fear, lack of optimism, and poor preoperative quality of life. The prevalence of poor global recovery was 22.3%. Risk factors for poor global recovery were recurrent surgery because of the same pathology, preoperative pain, preoperative analgesic use, surgical fear, lack of optimism, poor preoperative and acute postoperative quality of life, and follow-up surgery during the first postoperative year. Discussion: Moderate to severe CPSP after outpatient surgery is common, and should not be underestimated. Patients at risk for developing CPSP can be identified during the preoperative phase.