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A letter to the editor of the journal Perioperative Medicine discusses a randomized controlled trial comparing the analgesic efficacy of two regional blocks after modified radical mastectomy. The study found that the transverses thoracic muscle plane-pectoral nerve block (TTP-PECS) provided improved postoperative analgesia compared to the thoracic paravertebral nerve block (TPVB), with decreased opioid consumption and increased quality of recovery. However, the letter raises concerns about the study's design and results, including the lack of standardized factors that could influence the primary outcome assessment, small differences in pain scores between the two groups, the use of an opioid-based analgesia regimen, and the limited assessment of other outcome variables. The authors argue that the clinical significance of the findings is debatable and that the study does not answer whether the improved pain control and recovery can translate into postoperative benefits for patients. [Extracted from the article]

A letter to the editor of the journal "Pain & Therapy" discusses a recent article by Zhu et al. that examined the benefits of ultrasound-guided multipoint fascial plane block in elderly patients undergoing combined thoracoscopic-laparoscopic esophagectomy. The authors of the letter raise concerns about certain aspects of the study, including the lack of clear description regarding trocar site infiltration of local anesthetic, the use of parecoxib as a rescue analgesic, the definition of chronic pain, and the absence of important outcomes related to fast functional recovery and adequate pain control. The authors conclude that further clarification is needed to determine if the addition of multipoint fascial plane block improves the targets of current enhanced recovery after surgery (ERAS) protocols. [Extracted from the article]

Effect of transcutaneous electrical acupoint stimulation combined with transversus abdominis plane block on postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery: a randomized controlled trial. Controlled Trial" References 1 Xing R, Yang Y, Zhang M. Effect of transcutaneous electrical acupoint stimulation combined with transversus abdominis plane block on postoperative recovery in elderly patients undergoing laparoscopic gastric cancer surgery: a randomized controlled trial. [Extracted from the article]

A recent article in the BJOG journal compared the effectiveness of continuous wound infiltration (CWI) and continuous intravenous fentanyl (IVF) for pain control after gynecological surgery. The study found that the postoperative analgesic efficacy of CWI was not inferior to IVF. However, there were some limitations to the study, including the lack of patient status during pain evaluations and the high doses of opioids used in both groups. The study did not meet the requirements of current enhanced recovery after surgery (ERAS) protocols, which recommend the use of non-opioid analgesics. Additionally, patient satisfaction with pain control was not assessed. Therefore, the authors do not agree that CWI is non-inferior to IVF for postoperative pain control in gynecological surgery. [Extracted from the article]

A recent article in the Journal of Clinical Medicine by Matsumoto et al. compared the effectiveness of remimazolam and propofol in preventing postoperative nausea and vomiting (PONV) in patients who underwent laparoscopic gynecological surgery. The study found that remimazolam was as effective as propofol in preventing PONV. However, there are some concerns with the study. The authors used data from previous studies comparing inhalational anesthesia and propofol-based anesthesia to determine the sample size, which may have underestimated the sample size needed. The study also did not provide information on preoperative fasting time or the occurrence of intraoperative hypotension, which are factors that can affect the risk of PONV. Additionally, the study did not use a standardized opioid-sparing multimodal analgesia strategy, which may have implications for the results. Overall, while the study provides valuable insights, there are some limitations that should be considered. [Extracted from the article]

A letter to the editor of the World Journal of Surgery discusses a randomized controlled trial that examined the effects of preoperative carbohydrate drinks and postoperative chewing gum on postoperative nausea and vomiting (PONV) in patients undergoing day care laparoscopic cholecystectomy. The study found that these interventions significantly reduced the severity of PONV and the need for antiemetics. However, the letter raises concerns about the methodology and results of the study, including the lack of information on preoperative risk factors, intraoperative fluid volumes, and the use of analgesics and antiemetics. The authors argue that addressing these issues would improve the interpretation of the study's results. [Extracted from the article]

A recent study compared the performance of the McGrath™ videolaryngoscope with direct laryngoscopy for rapid sequence intubation in the operating theatre. The study found that 19% of patients in the direct laryngoscopy group had a difficult laryngoscopy. However, it is unclear why there was an increase in the incidence of difficult laryngoscopy compared to a previous study. Additionally, the study's sample size evaluation used a higher first-pass success rate for direct laryngoscopy than what was reported in previous research. The study also did not include an interim analysis, which may have affected the trial's results. [Extracted from the article]

Background: Postreperfusion hyperkalemia (PRHK) has garnered increasing attention in regard to deceased liver transplantation (LT), especially for LT using the expanded criteria donor grafts. However, the impact of the effluent potassium (eK+) concentration on PRHK has been largely overlooked. We evaluated whether elevated eK+ concentrations are associated with PRHK in deceased LT. Methods: In this single-institution, retrospective cohort study, we included all adults who underwent deceased LT with intraoperative eK+ concentration monitoring between November 2016 and December 2018. The eK+ concentrations were obtained from the effluent samples collected following a standard portal vein flush. PRHK was defined as any serum potassium (sK+) level of > 5.5 mmol/L following reperfusion. Logistic regression was performed to identify predictors for PRHK, and linear regression was used to examine predictors of the maximum percentage increase in the sK+ level following reperfusion. Results: Of the 86 patients who met the inclusion criteria, 54 (62.8%) developed PRHK. Independent predictors for PRHK included greater graft weight (OR 1.283 [95% CI 1.029–1.599] per 100 g, P = 0.027), an elevated eK+ concentration (OR 1.291 [95% CI 1.068–1.561] per mol/L, P = 0.008), and a higher sK+ level before reperfusion (OR 4.459 [95% CI 1.543–12.884] per mol/L, P = 0.006). An eK+ concentration of more than 6.9 mmol/L had a sensitivity of 59.26% and a specificity of 78.12% for predicting PRHK (area under the receiver operating characteristic curve, 0.694). Multiple linear regression analyses indicated that the eK+ and sK+ levels before reperfusion were significant predictors of the maximum percentage increase in the sK+ level following reperfusion. In addition, PRHK was associated with an increased risk of postreperfusion significant arrhythmias, severe postreperfusion syndrome, and postoperative early allograft dysfunction. Conclusions: This study shows that the eK+ concentration could predict the risk of PRHK in deceased LT. Further prospective studies are warranted to clarify these associations. [ABSTRACT FROM AUTHOR]

A letter to the editor of the International Journal of Gynecology & Obstetrics discusses a study that evaluated the effect of the transversus abdominis plane block (TAPB) on postoperative recovery following cesarean delivery under general anesthesia. The study found that TAPB improved the quality of early postoperative recovery compared to intravenous analgesia. However, the letter raises concerns about the study's methodology and results, including the lack of information on wound infiltration of local anesthetics and the use of non-standardized analgesic protocols. The authors also question the inadequate quality of early postoperative recovery and suggest a longer follow-up period for assessment. The letter concludes with the authors' contributions and a statement of no conflicts of interest. [Extracted from the article]

A letter to the editor of the World Journal of Surgery discusses a recent study comparing the effects of different endotracheal tubes on postoperative sore throat (POST) in patients undergoing thyroidectomy. The study found that a neural integrity monitor electromyography endotracheal tube (NIM-EMG-ETT) resulted in a higher incidence and severity of POST compared to a standard endotracheal tube. However, the letter raises questions about the methodology and results of the study, including the lubrication of the tubes, the use of nerve blocks for analgesia, and the assessment of analgesic medication for POST. The letter also highlights the need to evaluate other outcomes, such as patient recovery and satisfaction, in future studies. [Extracted from the article]

For patients undergoing gynecological oncology surgery, postoperative pain is actually more severe during movement than in a resting state.[2] We are concerned that this issue would have biased their results of pain assessment. In a randomized controlled trial including 99 patients who underwent gynecological oncology surgery in the context of the Enhanced Recovery After Surgery (ERAS) protocols, Ben-Arye and colleagues[1] assessed the effects of integrative therapies on postoperative pain and anxiety. [Extracted from the article]

The letter to the editor made several comments regarding possible methodological issues in the recent article by Lin et al. determining the association between blood glucose variability and postoperative delirium in patients undergoing acute aortic dissection surgery with cardiopulmonary bypass, which is published in Journal of Cardiothoracic Surgery. 2021; 16(1):82. Our concerns included the lack of some important perioperative factors associated with postoperative delirium, the process of establishing multivariate model and the method of using the receiver operating characteristic curve analysis to assess the predictive performance of the standard deviation of blood glucose for the development of POD. We would like to invite the authors to comment on these and believe that clarifying these issues would improve the transparency of this study and interpretation of findings. [ABSTRACT FROM AUTHOR]

References 1 Dai L, Ling X, Qian Y. Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial. Keywords: Laparoscopic cholecystectomy; Postoperative analgesia; Patient controlled intravenous analgesia; Transversus abdominis plane block EN Laparoscopic cholecystectomy Postoperative analgesia Patient controlled intravenous analgesia Transversus abdominis plane block 2626 2627 2 11/21/22 20221201 NES 221201 Re: Dai L, et al. [Extracted from the article]

Abstract The major complications of paediatric airway management are uncommon, but the outcomes are often severe. Over the last decade, additions and advancements in the devices and technology have significantly improved our ability to manage difficult paediatric airways safely. Videolaryngoscopy involves the use of video and optical technology to facilitate indirect visualisation of the larynx during intubation and has been seen as an evolutionary step in intubation technology. Over the past few years, videolaryngoscopes have been receiving plenty of attention as new airway devices for use in paediatric patients. The objective of this narrative review is to specify the existing clinical evidence regarding the efficiency and safety of videolaryngoscopy in paediatric airway management. [ABSTRACT FROM AUTHOR]

By a randomized controlled trial (RCT) of 128 geriatric patients undergoing pulmonary resection, I Heng et al i [1] showed that in comparison to conventional patient-controlled analgesia (PCA), continuous thoracic paravertebral block (CTPB) decreased the incidence of postoperative delirium (POD) and improved postoperative pain control. I Re: Heng et al i Thoracic paravertebral block ameliorates postoperative delirium in geriatric patients. [Extracted from the article]

In patients undergoing single port video-assisted thoracoscopic surgery, this is evidently unsatisfied postoperative analgesia for successful use of enhanced recovery after surgery protocols, in which multimodal analgesia regimen is recommended and analgesics should be universally titrated to achieve patient comfort and minimal pain, that is, a NRS score of 3 or less. We believe that this study would have provided more useful data comparing efficacy and clinical values of SAPB and INB for postoperative analgesia after single port video-assisted thoracoscopic surgery. [Extracted from the article]

Dear Editor, In the recent article by Zorrilla-Vaca et al. [[1]] examining the risk factors of postoperative acute kidney injury (AKI) in patients undergoing colorectal surgery with an enhanced recovery pathway, we noted that several methodological issues were not addressed well. Third, by multivariable analysis, age > 60 years, male gender, American Society of Anesthesiologists physical status classifications III-IV, chronic kidney disease and hypoalbuminemia were identified as independent risk factors of postoperative AKI. As the diagnostic criteria of chronic kidney disease were not provided in the Methods section, it was unclear whether patients with occult or mild chronic kidney disease (stages 1 and 2) were included in the study. [Extracted from the article]

The letter to the editor was written in response to "Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium (POD) among acute type a aortic dissection patients treated with open surgical repair", which is recently published by Lv et al. (J Cardiothorac Surg 16(1):146, 2021). In this article, Lv et al. conclude that plasma IL-6 is a potential biomarker for prediction of POD. However, we note several issues in this study that would have made interpretation of their results questionable. Our main concerns include the use of a short POD assessment time, no providing the data of analgesics and sedatives used in the ICU, application of incorrect statistical methods when assessing predictive ability of plasma IL-6 for the development of POD, and incorrect interpretation for the area under the receiver operating characteristic curve. We believe that addressing these issues will improve the transparency of this study and help the interpretation of findings. [ABSTRACT FROM AUTHOR]

The letter to the editor was written in response to "The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial", which was recently published by Li et al. (J Cardiothorac Surg 18(1):128, 2023). In this article, Li et al. showed that addition of a preoperative intercostal nerve block to the multimodal analgesic strategy significantly reduced the pain scores within 48 h after surgery. However, we noted several issues in this study that were not well addressed. They were no use of a standard opioid-sparing multimodal analgesic strategy recommended in the current Enhanced Recovery After Surgery protocols for thoracic surgery, the lack of clear description for reasonable selection of rescue analgesics, the interpretion of between-group differences in the postoperative pain scores based on only statistical differences rather than clinically meaningful differences, inclusion of patients who were not blinded to study intervention, not reporting cumulative opioid consumption and complications of intercostal nerve block. We believe that clarification of these issues is not only useful for improving design quality of randomized clinical trials which assess postoperative analgesic efficacy of nerve blocks, but also is helpful for the readers who want to use an opioid-sparing multimodal protocol including a nerve block in patients undergoing thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

Second, the authors did not clearly describe how they determined the two cutoff values of a decrease in postoperative cholinesterase activity of more than 50% and an early postoperative cholinesterase activity below 4,800 U/L for prediction of POD. Diagnostic Value of Cholinesterase Activity for the Development of Postoperative Delirium after Cardiac Surgery With a great interest we read the recent article by Saha et al [1] assessing the diagnostic value of cholinesterase activity for postoperative delirium (POD) after cardiac surgery, published online in the I Thoracic and Cardiovascular Surgeon i in November 2020. In fact, this study only confirmed the associations of postoperative cholinesterase activity of more than 50% and an early postoperative cholinesterase activity below 4,800 U/L with the development of POD, but did not assess the diagnostic values of two interested variables. [Extracted from the article]

Dear Editor, By a retrospective analysis, Du et al. [[1]] assessed the incidence and risk factors of early-onset acute kidney injury (AKI) during the first week after lung transplantation and its association with postoperative mortality. First, the study objects are patients with end-stage lung disease undergoing lung transplantation. [Extracted from the article]

A comparative study published in Acta Anaesthesiologica Scandinavica examined the analgesic efficacy of continuous serratus anterior plane block (SAPB) and thoracic epidural block for multiple rib fractures (MRF). The study found that both interventions significantly reduced pain levels, but the epidural block was more effective in reducing pain during movement within 2 hours after the block. However, the study raised questions about the methodology and results, including the use of a larger effect size for sample size calculation, variability in oxycodone consumption, and the limited assessment of patient satisfaction. The authors suggest that further studies are needed to confirm the effectiveness of SAPB as an alternative method for MRF analgesia when epidural block is contraindicated. No conflicts of interest or funding were reported. [Extracted from the article]

This article discusses a recent study on the efficacy of a regional block as a postoperative analgesia technique for pediatric patients undergoing certain surgical procedures. The authors of the article raise several questions and concerns about the methodology and results of the study. They question the target pain scores set for postoperative analgesia and argue that the control group may have been ineffective, potentially biasing the outcomes. They also criticize the lack of standardized analgesic prescriptions and the limited use of non-opioid analgesics in the study. Additionally, they highlight inconsistencies in the time to first analgesic need in the ward. The authors conclude by requesting a reasonable explanation for these findings. [Extracted from the article]

The present study aimed to evaluate the effects of hypercholesterolemia on cardioprotection of ischemic preconditioning and α7 nicotinic acetylcholine receptor (α7nAChR) agonist postconditioning and explore the potential mechanisms that hypercholesterolemia affected their cardioprotection. Hypercholesterolemic and normal rats were divided into the four groups that received the following treatments: i) Hypercholesterolemic control and normal control groups; ii) hypercholesterolemic ischemia/reperfusion (HI) and normal ischemia/reperfusion (NI) groups; iii) hypercholesterolemic ischemic preconditioning (HIPC) and normal ischemic preconditioning (NIPC) groups; and iv) hypercholesterolemic PNU282987 postconditioning (HPNU) and normal PNU282987 postconditioning (NPNU) groups. Serum lactate dehydrogenase (LDH), creatine kinase isoenzyme MB (CK-MB), cardiac troponin I (cTnI), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) levels after ischemia/reperfusion were assayed. Furthermore, infarct size and expression levels of Akt, phosphorylated (p)-Akt and endothelial nitric oxide synthase (eNOS) in ischemic myocardium were assessed. Compared with the NI group, serum LDH, CK-MB, cTnI, TNF-α and IL-6 levels and infarct size were significantly decreased, and myocardial p-Akt/Akt and eNOS/GAPDH ratios were significantly increased in the NIPC and NPNU groups. Compared with the HI group, serum CK-MB, cTnI, TNF-α and IL-6 levels and infarct size were significantly decreased in the HIPC group; however, myocardial p-Akt/Akt and eNOS/GAPDH ratios did not significantly change in the HIPC group. Furthermore, there were no significant difference between the HI and HPNU groups in serum LDH, CK-MB, cTnI, TNF-α and IL-6 levels, infarct size, myocardial p-Akt/Akt and eNOS/GAPDH ratios. In conclusion, hypercholesterolemia could aggravate myocardial ischemia/reperfusion injury, attenuate cardioprotection of ischemic preconditioning and eliminate cardioprotection from α7nAChR agonist postconditioning by enhancing inflammation and inhibiting PI3K/Akt/eNOS pathway. [ABSTRACT FROM AUTHOR]

As AKI was considered early when the onset was within 3 days post-burn, it was unclear that AKI was defined based on only Scr criteria of the KDIGO classification or combined Scr and urine volume criteria of the KDIGO classification. Dear Sir, In the recent article by Chen et al. [[1]] investigating the clinical characteristics and risk factors that influenced the incidence and severity of early acute kidney injury (AKI) in severely burned patients, several methodological issues that were not well addressed. Because patients were resuscitated with the large fluid volumes in the first 48 h, the influences of fluid resuscitation on urine volume measurement and AKI definition were unavoidable [[2]]. [Extracted from the article]

Sir, By a retrospective cohort study, Wu and colleagues [[1]] assessed predictive role of preoperative estimated glomerular filtration rate (eGFR) for postoperative acute kidney injury (AKI) in very elderly surgical patients and showed that eGFR could be used as an index for AKI risk stratification. It must be emphasized that duration of AKI, especially for persistent AKI, is more important factors affecting postoperative short- and long-term adverse outcomes of patients. Assessing association of preoperative estimated glomerular filtration rate with postoperative acute kidney injury in very elderly surgical patients: Re: Wu Q, et al. [Extracted from the article]