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Objectives To determine whether high perioperative inspired oxygen fraction (FiO2) compared with low FiO2 has more deleterious postoperative clinical outcomes in patients undergoing non-thoracic surgery under general anesthesia. Design Meta-analysis of randomized controlled trials. Setting Operating room, postoperative recovery room and surgical ward. Patients Surgical patients under general anesthesia. Intervention High perioperative FiO2 (≥0.8) vs. low FiO2 (≤0.5). Measurements The primary outcome was mortality within 30 days. Secondary outcomes were pulmonary outcomes (atelectasis, pneumonia, respiratory failure, postoperative pulmonary complications [PPCs], and postoperative oxygen parameters), intensive care unit (ICU) admissions, and length of hospital stay. A subgroup analysis was performed to explore the treatment effect by body mass index (BMI). Main results Twenty-six trials with a total 4991 patients were studied. The mortality in the high FiO2 group did not differ from that in the low FiO2 group (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.42–1.97, P = 0.810). Nor were there any significant differences between the groups in such outcomes as pneumonia (RR 1.19, 95% CI 0.74–1.92, P = 0.470), respiratory failure (RR 1.29, 95% CI 0.82–2.04, P = 0.270), PPCs (RR 1.05, 95% CI 0.69–1.59, P = 0.830), ICU admission (RR 0.94, 95% CI 0.55–1.60, P = 0.810), and length of hospital stay (mean difference [MD] 0.27 d, 95% CI -0.28–0.81, P = 0.340). The high FiO2 was associated with postoperative atelectasis more often (risk ratio 1.27, 95% CI 1.00–1.62, P = 0.050), and lower postoperative arterial partial oxygen pressure (MD −5.03 mmHg, 95% CI -7.90– -2.16, P 30 kg/m2, these parameters were similarly affected between the groups. Conclusions The use of high FiO2 compared to low FiO2 did not affect the short-term mortality, although it may increase the incidence of atelectasis in adult, non-thoracic patients undergoing surgical procedures. Nor were there any significant differences in other secondary outcomes.

Objective: Pain on injection is a well known adverse effect of propofol. The purpose of this study was to compare the analgesic effect of a lidocaine (lignocaine)/remifentanil combination compared with either lidocaine alone or remifentanil alone during propofol injection for induction of anaesthesia. Methods: In a randomised, double-blind, prospective trial, 129 patients were allocated to one of three groups (each n = 43) receiving lidocaine 20mg, remifentanil 0.3 μg/kg or lidocaine 20mg plus remifentanil 0.3 μg/kg as pretreatment, followed by injection of 5mL of 1% propofol. Pain severity was evaluated on a four-point scale. Results: Two patients (4.7%) complained of pain in the lidocaine plus remifentanil group compared with 15 (35.7%) in the lidocaine alone group and 18 (42.9%) in the remifentanil alone group (p < 0.001). There was no significant difference in the incidence of injection pain between the lidocaine alone and remifentanil alone groups (p = 0.21). Conclusion: Pretreatment with a combination of lidocaine and remifentanil is more effective than either pretreatment alone in reducing pain on injection of propofol.

Effects of lipopolysaccharide on RBC alteration in mice endotoxemic model Seolju Park, Jeihak Myung, Yeonhee Kim, Sungmook Yoo, Jaekwan Lim, Choonhak Lim Korea University Anam Hospital, Republic of Korea Korea University Ansan Hospital, Republic of Korea Korea University Medicine Graduate School, Republic of Korea Korean Artificial Organ Research Center, Republic of Korea Background/Purpose: Sepsis is a complex pathophysiological process that involves both alterations in the microcirculation (vessels with a diameter b100 m) and changes in the biochemical and physiological characteristics of the blood constituents. Alterations in RBC rheology participate in the alterations of the microcirculation. Early alterations of RBC rheology are reported to be seen commonly in the septic patients. However, time course of RBC alterations is not revealed. Therefore, we evaluated the change of RBC deformability and RBC aggregation in the mice endotoxemic model using lipopolysaccharide (LPS). Methods: Six-week-old male BALB/c mice were used in this study. The LPS-induced sepsis mice received LPS (20 mg/kg) intraperitoneally. Elongation indices (EIs) and aggregation indices (AIs) were tested at shear stresses of 1, 3, 7, 10, and 20 Pa for 0.5, 1, 2, 4, 6, 9, 12, and 24 hours after LPS. Results: There were no difference in AIs on 0.5, 1, 2, 4, 6, 9, 12, and 24 hours after LPS; however, EIs significantly decreased in only 10 and 20 Pa at 24 hours after LPS (P b .05). Conclusions: Our results suggested that change of RBC deformability was revealed on 24 hours after LPS injection, and choice of an appropriate shear stress may detect alterations of RBC deformability in LPS-induced sepsis mice.