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Summary: Background: Intra‐operative cardiac arrest is a rare but life‐threatening event. Over the past two decades, various initiatives have improved the care of patients undergoing surgery at our quaternary teaching hospital in Brazil. We aimed to evaluate the epidemiology of intra‐operative cardiac arrest and associated 30‐day mortality over an 18‐year period. A secondary aim was to identify associated risk factors. Methods: We conducted a retrospective observational study using data collected from 1 January 2005 to 31 December 2022. Factors associated with cardiac arrest and mortality were identified using multivariable logistic regression analysis. Results: Among the 154,178 cases, the overall rates of intra‐operative cardiac arrest (n = 297) and associated 30‐day mortality (n = 248) were 19.3 (95%CI (16.6–21.9)) and 16.1 (95% CI 13.9–18.3) per 10,000 anaesthetics, respectively. These decreased over time (2005–2010 vs. 2017–2022) from 26.3 (95%CI 21.0–31.6) to 15.4 (95%CI 12.0–18.7) per 10,000 anaesthetics, and from 23.4 (95%CI 18.8–28.1) to 13.7 (95%CI 10.8–16.7) per 10,000 anaesthetics, respectively. Factors associated with intra‐operative cardiac arrest included children aged < 1 year (adjusted OR (95%CI) 3.51 (1.87–6.57)); ASA physical status 3–5 (adjusted OR (95%CI) 13.85 (8.86–21.65)); emergency surgery (adjusted OR (95%CI) 10.06 (7.85–12.89)); general anaesthesia (adjusted OR (95%CI) 8.79 (4.60–19.64)); surgical procedure involving multiple specialities (adjusted OR (95%CI) 9.13 (4.24–19.64)); cardiac surgery (adjusted OR (95%CI) 7.69 (5.05–11.71)); vascular surgery (adjusted OR (95%CI) 6.21 (4.05–9.51)); and gastrointestinal surgery (adjusted OR (95%CI) 2.98 (1.91–4.65)). Discussion: We have shown an important reduction in intra‐operative cardiac arrest and associated 30‐day mortality over an 18‐year period. Identification of relative risk factors associated with intra‐operative cardiac arrest can be used to improve the safety and quality of patient care, especially in a resource‐limited setting. [ABSTRACT FROM AUTHOR]

This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri‐operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P =.001) and higher body mass index (P <.001) posed a greater risk of stage 2 PIs or higher. Among the surgery‐related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended. [ABSTRACT FROM AUTHOR]

Summary: Scapulectomy is performed as a limb‐sparing procedure in the management of tumours of the proximal humerus and shoulder girdle. Analgesic outcomes following this procedure are poorly documented in the literature. In our case, satisfactory analgesia following extended scapulectomy and free‐flap reconstruction was achieved with a combination of multi‐site continuous nerve block catheters and patient‐controlled analgesia, for a patient with chronic pain who had a high pre‐operative opioid requirement. Multiple continuous nerve block catheters were used, including interscalene and paravertebral catheters to provide analgesia for the shoulder resection, with a fascia iliaca compartment catheter providing analgesia to free‐flap donor site on the the anterolateral thigh. These continuous nerve block catheters contributed to effective postoperative analgesia and low postoperative intravenous opioid requirements in this case. [ABSTRACT FROM AUTHOR]

Summary: Contemporary guidance takes a patient‐centred approach and recommends discussing and planning treatments that should be considered, not just those that should be withheld. Although some organisations and communities still use specific DNACPR (do not attempt cardiopulmonary resuscitation) forms to recommend that cardiopulmonary resuscitation is not attempted, this approach has been shown to have disadvantages and is no longer regarded as best practice. The following guidelines have been produced in response to this change. They are designed to help anaesthetists, as part of the wider healthcare team, to implement and respond to advance care planning documents before and during procedures. The guidelines apply to all procedures, however minor and low risk they are considered to be, and the same ethical and legal principles apply to procedures carried out under local or regional anaesthesia and/or conscious sedation, as well as to those under general anaesthesia. [ABSTRACT FROM AUTHOR]

The article describes the main tendencies in anesthesiology, which have undergone the greatest changes in the last decade, according to the author. The article speculates on the choice of tactics and the qualitative components of peri-operative infusion therapy. The author gives an assessment of the current stage of studying the phenomenon of anesthetic preconditioning and acute heart failure management. And, finally, the challenges and achievements of the evidence-based medicine in anesthesiology are analyzed.

The object of research in the field of anesthesiology and intensive care is the functional systems of the host; this research includes original tasks, elaboration and making certain decisions especially for critically ill patients where as a rule the outcome of anesthesia and intensive care depends not only on the special professional skills but moral and ethic features of the doctor. The main feature of biomedical systems is that the human body is the system which is complex, open and stochastic, and if the man is ill it is especially complex. And the major part of information about the patient is non-verbal; so the classification is an important component providing an impact on the treatment outcome. If the principles of information classification are properly used, the doctor is fully armed for analyzing, comprehending, adopting, assessing and solving the task. It also facilitates the dissemination of acquired knowledge and experience among other specialists.

Hepatcctomy is a major radical treatment for liver cancer. Although the hepatectomy is of great difficulty for the complicated anatomical structure and rich blood supply of liver, the operative mortality is less than 5% in most treatment centers currently along with the upgrading surgical instruments and developing surgical technology Never, it is urgent clinical topic to foriherly reduce the incidence of complication in the wake of hepatectomy, which reaches up to 15%· - 50%·. To standardize the peri-operative management of hepatectomy, on the basis of the standardization for diagnosis and treatment of prinuffy hepatic carcinoma ( 2019 ), the Cancer Prevention and Treatment Expess Committee revise and update to produce the experts consensus on the peri-operative management of hepatectomy for liver cancer ( 2021 ) according to the opinions of experts in different areas. This consensus takes account of the Chinese charcteristics of diagnosis and treatment of liver cancer and follows the concept of enhanced recovery after surgery ( EHAS), which will provide reforence for the peri-operative management. [ABSTRACT FROM AUTHOR]

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

Pre-surgery infusion with levosimendan with the rate of 0.05–0.1 mkg*kg-1 min-1 to the elder patients (60–75 years old) with lower ejection fraction of the left ventricle (less than 50%) results in its increase by 16.7% (p < 0.01), cardiac index – by 10.3% (p< 0.01) and reduction of NT-proBNP level in blood by 24.1% (p < 0.1) in 24 hours after the medication infusion start. The changes persist for at least 24 hours after the surgery.

Goal: to familiarize Russian anesthesiologists with the most recent data of the evidence-based medicine about peri-operative infusion therapy. The right choice of the infusion therapy strategy and tactics is a mandatory component of the successful management of the peri-operative period. The most significant changes have recently occurred specifically in this field. First the concept of restrictive tactics of infusion therapy emerged and won its popularity very fast. Then some reasonable doubts appeared about feasibility and safety of using HES solutions. Both affect basic principles of infusion therapy and the recent changes are to be considered from the position of the evidence-based medicine. British and German experts attended these issues and published the relevant guidelines in 2011 and 2016. Comparison and analysis of the implementation opportunities in Russia and recommendations make the subject of this publication. Conclusion: It is necessary to implement the international recommendations for peri-operative infusion therapy with adjustment to relevant Russian regulations in the anesthesiology and intensive care departments.

There is a need to conduct big randomized clinical trials of efficiency of medical interventions in the peri-operative period in order to identify the end points with the use of universal classification of potential complications and unfavorable outcomes. In order to achieve that under umbrella of European Society of Anaesthesiology (ESA) and European Society of Intensive Care Medicine (ESICM) Standards of defining and using of criteria of the severity degree for investigation of clinical efficiency in the peri-operation period have been developed. These standards allow more accurate comparative analysis of data, provide researchers and clinical specialists with standard definitions and promote integration of the Russian institutes into international research activities.

Background: Despite the indisputable need to prevent peri-operative hypothermia, some evidence in the literature questions the possible role of forced air warming systems as a risk factor for the occurrence of surgical site infection. The objective of the study is to evaluate the micro-biologic safety of a forced air warming systems (FAW) in relation to the risk of emission of micro-organisms in the surgical environment.Methods: A quantitative, descriptive-exploratory laboratory study performed in a large hospital. An evaluation of possible internal contamination was performed by collecting air from the hose onto plates containing Trypticase Soy Agar. The experiment was performed in triplicate two months after replacing the filter and again after six months using a random sample of 50% of the FAW in use, which corresponded to 13 FAW and a total of 75 samples.Results: Among the 39 samples analyzed in the first stage, only nine (23.1%) plates presented microbial growth of one or two colonies, while only six (16.7%) plates of the 36 evaluated samples in the second phase had growth of one or two colonies.Conclusions: This study showed small microbial growth of culture after 48 hours after filter replacement. New investigations that correlate the findings of micro-biology analysis and the occurrence of surgical site infection should be conducted. [ABSTRACT FROM AUTHOR]

Background: Benefits and risks of liberal and restrictive transfusion regimens are under on-going controversial discussion. This systematic review aimed at assessing both regimens in terms of pre-defined outcomes with special focus on patients undergoing major orthopaedic surgery. Methods: We performed a literature search for mortality, morbidity and related outcomes following peri-operative blood transfusion in patients with major orthopaedic surgery in electronic databases. Combined outcome measure estimates were calculated within the scope of meta-analyses including randomised clinical trials comparing restrictive versus liberal blood transfusion regimens (e.g. MH risk ratio, Peto odds ratio). Results: A total of 880 publications were identified 15 of which were finally included (8 randomised clinical trials (RCTs) with 3,693 patients and 6 observational studies with 4,244,112 patients). Regarding RCTs, no significant differences were detected between the transfusion regimes for all primary outcomes (30-day mortality, thromboembolic events, stroke/transitory ischaemic attack, myocardial infarction, wound infection and pneumonia) and a secondary outcome (length of hospital stay), whereas there was a significantly reduced risk of receiving at least one red blood concentrate under a restrictive regimen. Conclusion: The results of this systematic review do not suggest an increased risk associated with either a restrictive or a liberal transfusion regimen in patients undergoing major orthopaedic surgery. [ABSTRACT FROM AUTHOR]

Historically, metformin was withheld before surgery for fear of metformin‐associated lactic acidosis. Currently, however, this risk is deemed to be low and guidelines have moved towards the continuation of metformin. We hypothesized that continuing metformin peri‐operatively would lower postoperative serum glucose level without an effect on plasma lactate levels. We performed a single‐blind multicentre randomized controlled trial in people with type 2 diabetes mellitus scheduled for non‐cardiac surgery and continued (MF+ group) or withheld (MF ‐ group) metformin before surgery. The main outcome measures were the differences in peri‐operative plasma glucose and lactate levels. We randomized 70 patients (37 MF+ group and 33 MF ‐ group) with type 2 diabetes mellitus. Postoperative glucose levels were similar in the MF+ and the MF ‐ groups (8.2 ± 1.8 vs 8.3 ± 2.3 mmol/L P = .95) Although preoperative lactate levels were slightly higher in the MF+ group compared with the MF ‐ group (1.5 vs 1.2 mmol/L; P = .02), the postoperative lactate levels were not significantly different (1.2 vs 1.0 mmol/L; P = .18). In conclusion, continuation of metformin during elective non‐cardiac surgery does not improve glucose control or raise lactate levels to a clinically relevant degree. [ABSTRACT FROM AUTHOR]

Liver metastases are a major cause of colorectal cancer death, and the perioperative period is believed to critically affect the metastatic process. Here we tested whether blocking excess release of catecholamines and prostaglandins during surgical procedures of different extent can reduce experimental liver metastasis of the syngeneic CT26 colon cancer in female and male BALB/c mice. Animals were either treated with the beta-blocker, propranolol, the COX-2 inhibitor, etodolac, both drugs, or vehicle. The role of NK cells in controlling CT26 hepatic metastasis and in mediating the effect of the drugs was assessed by in vivo depletion or stimulation of NK cells, using anti-asialo GM1 or CpG-C, respectively. Surgical extent was manipulated by adding laparotomy to small incision, extending surgical duration, and enabling hypothermia. The results indicated that combined administration of propranolol and etodolac, but neither drug alone, significantly improved host resistance to metastasis. These beneficial effects occurred in both minor and extensive surgeries, in both sexes, and in two tumor inoculation approaches. NK cell-mediated anti-CT26 activity is involved in mediating the beneficial effects of the drugs. Specifically, CpG-C treatment, known to profoundly activate mice marginating-hepatic NK cytotoxicity, reduced CT26 hepatic metastases; and NK-depletion increased metastases and prevented the beneficial effects of the drugs. Overall, given prevalent perioperative psychological and physiological stress responses in patients, and ample prostaglandin release by colorectal tumors and injured tissue, propranolol and etodolac could be tested clinically in laparoscopic and open colorectal surgeries, attempting to reduce patients’ metastatic disease. [ABSTRACT FROM AUTHOR]

T helper 17 (Th17) and Th22 cells regulate the development of tumors. However, their roles in the development of colorectal cancer (CRC) are still unclear. A total of 49 patients with CRC and 18 healthy controls (HC) were evaluated for the percentages of circulating Th17 and Th22 cells by flow cytometry. The concentrations of serum interleukin-17A (IL-17A), IL-22 and carcinoembryonic antigen (CEA) were examined. The levels of IL-17A and IL-22 in tumors were determined by real-time PCR. We found that the percentages of Th17 and Th22 cells in the CRC patients were significantly lower than that in the HC and were associated negatively with the pathological stages of CRC. The levels of IL-17A and IL-22 mRNA transcripts were lower in the tumor tissues, particularly in the advanced CRC. After the tumor resection, the percentages of circulating Th17 and Th22 cells increased. These data suggest that decreased Th17 and Th22 responses may be associated with the development of CRC. [ABSTRACT FROM AUTHOR]

Abstract: Prasugrel and ticagrelor are next-generation antiplatelet agents that provide a rapider and more potent inhibition of platelet P2Y12 receptor than clopidogrel. In combination with aspirin, these new P2Y12 inhibitors are now the first line treatments for patients with acute coronary syndrome. However, these potent antiplatelet agents introduce a new paradigm in the daily management of antithrombotic drugs, particularly when an invasive procedure is planned. The pharmacology of these antiplatelet agents, and the results of the main clinical trials, are reviewed with a special focus on good prescription practices (indications, contra-indications, drug interactions), and on peri-operative management. Strategies are proposed for safely reducing the bleeding risk in elderly patients, in patients requiring concomitant oral anticoagulant therapy, or in patients with an increased haemorrhagic risk. [Copyright &y& Elsevier]

Introduction: Women at the peri- and post-menopausal age who are qualified for surgical procedures for gynaecological reasons are exposed to specific emotional problems related with the necessity to perform the surgery. Therefore, they often expect various types of support. A characteristic feature of this support is an exchange of emotions, information, instruments for action and tangible property. Aim of the study: The objective of the study was to perform an analysis of the type of support expected during the peri-operative period by women treated for gynaecological reasons. Material and methods: The study covered 232 women at the pre- and peri-menopausal age who received surgical treatment for various gynaecological reasons. The study was carried out using an author-designed questionnaire form. The results of the study obtained were analysed statistically. The p values p < 0.05 were considered statistically significant. Results: It was found out that respondents who had university education significantly more frequently (p < 0.05) expected information and instrumental support, compared to those with elementary/elementary vocational or secondary education level. In turn, patients who were married significantly more often expected emotional and information support, compared to those who were single. The respondents who had undergone a surgical procedure with considerable tissue injury significantly more frequently (p < 0.05) expected material support than women who had undergone surgery with moderate tissue injury. Conclusions: The education level and marital status of patients determined the expectations of support during the peri-operative period, whereas patients' age and category of surgical procedure did not have any effect on the expectations of support during this time. [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze the difference of nutrition condition in patients with oral cancer before and after radical surgery, and evaluate the role of nutrition support in oral cancer patients rehabilitation. METHODS: Thirty patients with oral cancer after radical surgery were comprised of this group. The medical history, the intake condition, body weight changes and height 1 day before surgery, 1 day and 7 days after surgery were recorded and assessed. The serum hemoglobin (Hb), lymphocyte count (LC), albumin (ALB), pre-albumin (PA) of the patients were detected. SPSS11.5 software package was used for Student's t test and Chi-square test. RESULTS: (1) Dietary survey showed that protein, energy intake was significantly lower than after operation (P<0.01); (2) Hemoglobin was significantly lower 1 day, 7 days, preoperative (P<0.01); serum albumin decreased significantly after surgery (P <0.01); Serum pre-albumin decreased after surgery, the difference was not significant; (3) The value of upper arm muscle circumference decrease 1 day after surgery, but didn' t reach statistical significance. 7 days after surgery, the difference was significant (P <0.05); (4) Total lymphocyte count 1 day, 7 days after operation was significantly lower than 1 day before surgery (P <0.01). CONCLUSION: Radical surgery of oral cancer and eating disorders decreased nutritional status of patients and nutritional support is mandatory. [ABSTRACT FROM AUTHOR]

Hepatectomy is a major radical treatment for liver cancer. Although the hepatectomy is of great difficulty for the complicated anatomical structure and rich blood supply of liver, the operative mortality is less than 5% in most treatment centers currently along with the upgrading surgical instruments and developing surgical technology. Nevertheless, it is urgent clinical topic to furtherly reduce the incidence of complication in the wake of hepatectomy, which reaches up to 15%~50%. To standardize the peri-operative management of hepatectomy, on the basis of the standardization for diagnosis and treatment of primary hepatic carcinoma (2019), the Cancer Prevention and Treatment Expert Committee revise and update to produce the expert consensus on the peri-operative management of hepatectomy for liver cancer (2021) according to the opinions of experts in different areas. This consensus takes account of the Chinese characteristics of diagnosis and treatment of liver cancer and follows the concept of enhanced recovery after surgery (ERAS), which will provide reference for the peri-operative management.

Cytoreductive surgery and chemotherapy are cornerstones of ovarian cancer treatment, yet disease recurrence remains a significant clinical issue. Surgery can release cancer cells into the circulation, suppress anti-tumor immunity, and induce inflammatory responses that support the growth of residual disease. Intervention within the peri-operative window is an under-explored opportunity to mitigate these consequences of surgery and influence the course of metastatic disease to improve patient outcomes. One drug associated with improved survival in cancer patients is ketorolac. Ketorolac is a chiral molecule administered as a 1:1 racemic mixture of the S- and R-enantiomers. The S-enantiomer is considered the active component for its FDA indication in pain management with selective activity against cyclooxygenase (COX) enzymes. The R-enantiomer has a previously unrecognized activity as an inhibitor of Rac1 (Ras-related C3 botulinum toxin substrate) and Cdc42 (cell division control protein 42) GTPases. Therefore, ketorolac differs from other non-steroidal anti-inflammatory drugs (NSAIDs) by functioning as two distinct pharmacologic entities due to the independent actions of each enantiomer. In this review, we summarize evidence supporting the benefits of ketorolac administration for ovarian cancer patients. We also discuss how simultaneous inhibition of these two distinct classes of targets, COX enzymes and Rac1/Cdc42, by S-ketorolac and R-ketorolac respectively, could each contribute to anti-cancer activity. [ABSTRACT FROM AUTHOR]

Background: Hyperglycaemia during and after hip surgery is associated with coagulation activation and an increased risk of venous thromboembolism. Whether lowering of glucose levels during hip surgery diminishes coagulation activation is unknown. We investigated the efficacy of the human GLP-1 analogue liraglutide to lower glucose during and after hip surgery and studied its influence on coagulation activation., Methods: A total of 37 obese subjects who underwent hip surgery were randomized to subcutaneous liraglutide or placebo for 4 consecutive days, starting one day prior to surgery. Glucose levels and coagulation indices at three fixed time-points (pre-operative, 2 h post-operative and 3 days post-operative) were measured., Results: Liraglutide reduced glucose at day three post-surgery (median glucose (IQR) liraglutide 5.5 (5.2-5.7) vs. placebo 5.8 (5.5-6.2); difference 0.3 mmol/L, P = 0.04). Changes in 6 out of 8 coagulation indices studied did not differ between the two groups. Only D-dimer levels were significantly lower in the liraglutide group at day three post-surgery and FVIII levels were significantly higher in the liraglutide group 2 h post-surgery., Conclusion: Although the human GLP-1 analogue liraglutide moderately reduced post-operative blood glucose levels in non-diabetic and prediabetic obese patients undergoing elective hip surgery, no changes were observed with respect to coagulation activation.

Aim: To evaluate whether the application of sorafenib during the peri-operative period of liver transplantation improves prognosis in liver cancer patients., Methods: We searched PubMed, EMBASE and MEDLINE for eligible articles. A total of 4 studies were found that fulfilled the previously agreed-upon standards. We then performed a systematic review and meta-analysis on the enrolled trials that met the inclusion criteria., Results: Out of the 104 studies identified in the database, 82 were not clinical experiments, and 18 did not fit the inclusion standards. Among the remaining 4 articles, only 1 was related to the preoperative use of sorafenib, whereas the other 3 were related to its postoperative use. As the heterogeneity among the 4 studies was high, with an I(2) of 86%, a randomized effect model was applied to pool the data. The application of sorafenib before liver transplantation had a hazard ratio (HR) of 3.29 with a 95% confidence interval (CI) of 0.33-32.56. The use of sorafenib after liver transplantation had an HR of 1.44 (95%CI: 0.27-7.71). The overall pooled HR was 1.68 (95%CI: 0.41-6.91)., Conclusion: The results showed that the use of sorafenib during the peri-operative period of liver transplantation did not improve patient survival significantly. In fact, sorafenib could even lead to a worse prognosis, as its use may increase the hazard of poor survival.