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2. Comparison of differences in cohort (forwards) and case control (backwards) methodological approaches for validation of the Hypotension Prediction Index.

Author

Davies, Simon J, Sessler, Daniel I, Jian, Zhongping, Fleming, Neal W, Mythen, Monty, Maheshwari, Kamal, Veelo, Denise P, Vlaar, Alexander Pj, Settels, Jos, Scheeren, Thomas, van der Ster, Bjp, Sander, Michael, Cannesson, Maxime, and Hatib, Feras

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Anesthesiology, Clinical sciences
Abstract

BackgroundThe Hypotension Prediction Index (the index) software is a machine learning algorithm that detects physiological changes that may lead to hypotension. The original validation used a case control (backwards) analysis that has been suggested to be biased. We therefore conducted a cohort (forwards) analysis and compared this to the original validation technique.MethodsWe conducted a retrospective analysis of data from previously reported studies. All data were analysed identically with 2 different methodologies and receiver operating characteristic curves (ROC) constructed. Both backwards and forwards analyses were performed to examine differences in area under the ROC for HPI and other haemodynamic variables to predict a MAP < 65mmHg for at least 1 minute 5, 10 and 15 minutes in advance.ResultsTwo thousand and twenty-two patients were included in the analysis, yielding 4,152,124 measurements taken at 20 second intervals. The area-under-the-curve for the index predicting hypotension analysed by backward and forward methodologies respectively was 0.957 (95% CI, 0.947-0.964) vs 0.923 (95% CI, 0.912-0.933) 5 minutes in advance, 0.933 (95% CI, 0.924-0.942) vs 0.923 (95% CI, 0.911-0.933) 10 minutes in advance , and 0.929 (95% CI, 0.918-0.938) vs. 0.926 (95% CI, 0.914-0.937) 15 minutes in advance. No other variable had an area-under-the-curve > 0.7 except for MAP. Area-under-the-curve using forward analysis for MAP predicting hypotension 5, 10, and 15 minutes in advance was 0.932 (95% CI, 0.920-0.940), 0.929 (95% CI, 0.918-0.938), and 0.932 (95% CI, 0.921-0.940). The R 2 for the variation in the index due to MAP was 0.77.ConclusionUsing an updated methodology, we found the utility of the HPI index to predict future hypotensive events is high, with an area under the receiver-operating-characteristics curve similar to that of the original validation method.

Published
2024

4. Smallest Clinically Meaningful Improvement in Amputation-Related Pain and Brief Pain Inventory Scores as Defined by Patient Reports of Global Improvement After Cryoneurolysis: a Retrospective Analysis of a Randomized, Controlled Clinical Trial

Author

Ilfeld, Brian M., Smith, Cameron R., Turan, Alparslan, Mariano, Edward R., Miller, Matthew E., Fisher, Rick L., Trescot, Andrea M., Cohen, Steven P., Eisenach, James C., Sessler, Daniel I., Prologo, J. David, Mascha, Edward J., Liu, Liu, Gabriel, Rodney A., Hayek, Salim M., Wadhwa, Anupama N., Beck, Gerald J., Abdullah, Baharin, Ali Sakr Esa, Wael, Altinpulluk, Ece Yamak, Bakal, Omer, Bravo, Mauro, Jiang, Qiliang, Khan, Zafeer, Maheshwari, Kamal, Mounir-Soliman, Loran, Salih, Ahmed, Hackworth, Robert J., Sigmon, Carter, Padwal, Jennifer, Gunnett, Amy M., Thaper, Akshay, and Hunt, Morgan

Published
2024
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6. Continuous vital sign monitoring on surgical wards: The COSMOS pilot

Author

Rodriguez, Fabio, Mueller-Wirtz, Lukas, Mueller, Carolin Martina, Slife, Maeve, Mosqueda, Michael, Gatt, Richard, Nikoo, Maedeh Zokaei, Cekmecelioglu, Busra Tok, Kopac, Orkun, Singh, Sumi, Corrales Martinez, Maria J., Karki, Deeven, Medellin, Sara, Erazo, Valentina Lara, Brooker, Jack, Rössler, Julian, Mukhia, Rupashi, Pu, Xuan, Anusic, Nikola, Gulluoglu, Alper, Ekrami, Elyad, Mascha, Edward J., Li, Shuyi, Coffeng, René, Turan, Alparslan, Clemens, Amber, Perez, Christine, Beard, John W., and Sessler, Daniel I.

Published
2024
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7. Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative

Author

Auzinger, Georg, Chappell, Desirée, Gan, Tong J., Edwards, Mark, Fletcher, Nick, Forni, Lui G., Grocott, Michael P.W., Kunst, Gudrun, Miller, Timothy E., Morton-Bailey, Vicki, Myles, Paul S., Ostermann, Marlies, Raphael, Jacob, Saugel, Bernd, Sessler, Daniel I., Shaw, Andrew D., Zarbock, Alexander, Grocott, Michael, and Morton-Bailey, Victoria

Published
2024
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8. Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery

Author

Wang, Michael Ke, Devereaux, P.J., Marcucci, Maura, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Ofori, Sandra N., Paniagua, Pilar, Douketis, James D., Sigamani, Alben, Parlow, Joel L., Wang, Chew Y., Villar, Juan Carlos, Srinathan, Sadeesh K., Szczeklik, Wojciech, Martínez-Zapata, María José, Malaga, German, Sivakumaran, Soori, McIntyre, William F., Rodríguez Funes, María-Virginia, Cruz, Patricia, Alvarez-Garcia, Jesús, Greiss, Isabelle, Popova, Ekaterine, Hemels, Martin E., Brandes, Axel, Chow, Clara K., Barnawal, Satish Prasad, Healey, Jeff S., and Conen, David

Published
2024
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14. The relative merits of using a high-sensitivity cardiac Troponin T assay compared to a nonhigh-sensitivity troponin T assay after noncardiac surgery

Author

Borges, Flavia K., Sessler, Daniel I., Tiboni, Maria, Patel, Ameen, LeManach, Yannick, Heels-Ansdell, Diane, Srinathan, Sadeesh, Wang, Chew Yin, Chow, Clara, Duceppe, Emmanuelle, Kavsak, Peter, Ofori, Sandra N., Pettit, Shirley, Berwanger, Otavio, Kurz, Andrea, Turan, Alparslan, Tonelli, Ana Claudia, and Devereaux, PJ

Published
2024
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19. Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery: the multicentre randomised iPEGASUS trial

Author

Funcke, Sandra, Schmidt, Götz, Bergholz, Alina, Argente Navarro, Pilar, Azparren Cabezón, Gonzalo, Barbero-Espinosa, Silvia, Diaz-Cambronero, Oscar, Edinger, Fabian, García-Gregorio, Nuria, Habicher, Marit, Klinkmann, Gerd, Koch, Christian, Kröker, Alina, Mencke, Thomas, Moral García, Victoria, Zitzmann, Amelie, Lezius, Susanne, Pepić, Amra, Sessler, Daniel I., Sander, Michael, Haas, Sebastian A., Reuter, Daniel A., and Saugel, Bernd

Published
2024
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22. Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study

Author

McGillion, Michael H., Borges, Flavia K., Conen, David, Sessler, Daniel I., Coleman, Brenda L., Marcucci, Maura, Ouellette, Carley, Bird, Marissa, Whitmore, Carly, Henry, Shaunattonie, Ofori, Sandra, Pettit, Shirley M., Bedini, Deborah M., Gauthier, Leslie P., Lounsbury, Jennifer, Carter, Nancy M., Tandon, Vikas, Patel, Ameen, Cafaro, Teresa, Simunovic, Marko R., Harlock, John A., Heels-Ansdell, Diane, Elias, Fadi, Rapanos, Theodore, Forbes, Shawn, Peter, Elizabeth, Watt-Watson, Judy, Metcalfe, Kelly, Carroll, Sandra L., and Devereaux, Philip J.

Published
2024
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29. Long-term Outcomes with Spinal versus General Anesthesia for Hip Fracture Surgery: A Randomized Trial

Author

Vail, Emily A., Feng, Rui, Sieber, Frederick, Carson, Jeffrey L., Ellenberg, Susan S., Magaziner, Jay, Dillane, Derek, Marcantonio, Edward R., Sessler, Daniel I., Ayad, Sabry, Stone, Trevor, Papp, Steven, Donegan, Derek, Mehta, Samir, Schwenk, Eric S., Marshall, Mitchell, Jaffe, J. Douglas, Luke, Charles, Sharma, Balram, Azim, Syed, Hymes, Robert, Chin, Ki-Jinn, Sheppard, Richard, Perlman, Barry, Sappenfield, Joshua, Hauck, Ellen, Tierney, Ann, Horan, Annamarie D., Neuman, Mark D., Looke, Thomas, Bent, Sandra, Franco-Mora, Ariana, Hedrick, Pamela, Newbern, Matthew, Tadros, Rafik, Pealer, Karen, Vlassakov, Kamen, Buckley, Carolyn, Gavin, Lauren, Gorbatov, Svetlana, Gosnell, James, Steen, Talora, Vafai, Avery, Zeballos, Jose, Hruslinski, Jennifer, Cardenas, Louis, Berry, Ashley, Getchell, John, Quercetti, Nicholas, Hassan, Manal, Bajracharya, Gauasan, Billow, Damien, Bloomfield, Michael, Cuko, Evis, Elyaderani, Mehrun K., Hampton, Robert, Honar, Hooman, Khoshknabi, Dilara, Kim, Daniel, Krahe, David, Lew, Michael M., Maheshwer, Conjeevram B., Niazi, Azfar, Saha, Partha, Salih, Ahmed, de Swart, Robert J., Volio, Andrew, Bolkus, Kelly, DeAngelis, Matthew, Dodson, Gregory, Gerritsen, Jeffrey, McEniry, Brian, Mitrev, Ludmil, Kwofie, M. Kwesi, Belliveau, Anne, Bonazza, Flynn, Lloyd, Vera, Panek, Izabela, Dabiri, Jared, Chavez, Chris, Craig, Jason, Davidson, Todd, Dietrichs, Chad, Fleetwood, Cheryl, Foley, Mike, Getto, Chris, Hailes, Susie, Hermes, Sarah, Hooper, Andy, Koener, Greg, Kohls, Kate, Law, Leslie, Lipp, Adam, Losey, Allison, Nelson, William, Nieto, Mario, Rogers, Pam, Rutman, Steve, Scales, Garrett, Sebastian, Barbara, Stanciu, Tom, Lobel, Gregg, Giampiccolo, Michelle, Herman, Dara, Kaufman, Margit, Murphy, Bryan, Pau, Clara, Puzio, Thomas, Veselsky, Marlene, Apostle, Kelly, Boyer, Dory, Chen Fan, Brenda, Lee, Susan, Lemke, Mike, Merchant, Richard, Moola, Farhad, Payne, Kyrsten, Perey, Bertrand, Viskontas, Darius, Poler, Mark, D’Antonio, Patricia, O’Neill, Greg, Abdullah, Amer, Fish-Fuhrmann, Jamie, Giska, Mark, Fidkowski, Christina, Guthrie, Stuart Trent, Hakeos, William, Hayes, Lillian, Hoegler, Joseph, Nowak, Katherine, Beck, Jeffery, Cuff, Jaslynn, Gaski, Greg, Haaser, Sharon, Holzman, Michael, Malekzadeh, A. Stephen, Ramsey, Lolita, Schulman, Jeff, Schwartzbach, Cary, Azefor, Tangwan, Davani, Arman, Jaberi, Mahmood, Masear, Courtney, Haider, Syed Basit, Chungu, Carolyn, Ebrahimi, Ali, Fikry, Karim, Marcantonio, Andrew, Shelvan, Anitha, Sanders, David, Clarke, Collin, Lawendy, Abdel, Schwartz, Gary, Garg, Mohit, Kim, Joseph, Caruci, Juan, Commeh, Ekow, Cuevas, Randy, Cuff, Germaine, Franco, Lola, Furgiuele, David, Giuca, Matthew, Allman, Melissa, Barzideh, Omid, Cossaro, James, D’Arduini, Armando, Farhi, Anita, Gould, Jason, Kafel, John, Patel, Anuj, Peller, Abraham, Reshef, Hadas, Safur, Mohammed, Toscano, Fiore, Tedore, Tiffany, Akerman, Michael, Brumberger, Eric, Clark, Sunday, Friedlander, Rachel, Jegarl, Anita, Lane, Joseph, Lyden, John P., Mehta, Nili, Murrell, Matthew T., Painter, Nathan, Ricci, William, Sbrollini, Kaitlyn, Sharma, Rahul, Steel, Peter A.D., Steinkamp, Michele, Weinberg, Roniel, Stephenson Wellman, David, Nader, Antoun, Fitzgerald, Paul, Ritz, Michaela, Bryson, Greg, Craig, Alexandra, Farhat, Cassandra, Gammon, Braden, Gofton, Wade, Harris, Nicole, Lalonde, Karl, Liew, Allan, Meulenkamp, Bradley, Sonnenburg, Kendra, Wai, Eugene, Wilkin, Geoffrey, Troxell, Karen, Alderfer, Mary Ellen, Brannen, Jason, Cupitt, Christopher, Gerhart, Stacy, McLin, Renee, Sheidy, Julie, Yurick, Katherine, Chen, Fei, Dragert, Karen, Kiss, Geza, Malveaux, Halina, McCloskey, Deborah, Mellender, Scott, Mungekar, Sagar S., Noveck, Helaine, Sagebien, Carlos, Biby, Luat, McKelvy, Gail, Richards, Anna, Abola, Ramon, Ayala, Brittney, Halper, Darcy, Mavarez, Ana, Rizwan, Sabeen, Choi, Stephen, Awad, Imad, Flynn, Brendan, Henry, Patrick, Jenkinson, Richard, Kaustov, Lilia, Lappin, Elizabeth, McHardy, Paul, Singh, Amara, Donnelly, Joanne, Gonzalez, Meera, Haydel, Christopher, Livelsberger, Jon, Pazionis, Theresa, Slattery, Bridget, Vazquez-Trejo, Maritza, Baratta, Jaime, Cirullo, Michael, Deiling, Brittany, Deschamps, Laura, Glick, Michael, Katz, Daniel, Krieg, James, Lessin, Jennifer, Mojica, Jeffrey, Torjman, Marc, Jin, Rongyu, Salpeter, Mary Jane, Powell, Mark, Simmons, Jeffrey, Lawson, Prentiss, Kukreja, Promil, Graves, Shanna, Sturdivant, Adam, Bryant, Ayesha, Crump, Sandra Joyce, Verrier, Michelle, Green, James, Menon, Matthew, Applegate, Richard, Arias, Ana, Pineiro, Natasha, Uppington, Jeffrey, Wolinsky, Phillip, Gunnett, Amy, Hagen, Jennifer, Harris, Sara, Hollen, Kevin, Holloway, Brian, Horodyski, Mary Beth, Pogue, Trevor, Ramani, Ramachandran, Smith, Cameron, Woods, Anna, Warrick, Matthew, Flynn, Kelly, Mongan, Paul, Ranganath, Yatish, Fernholz, Sean, Ingersoll-Weng, Esperanza, Marian, Anil, Seering, Melinda, Sibenaller, Zita, Stout, Lori, Wagner, Allison, Walter, Alicia, Wong, Cynthia, Orwig, Denise, Goud, Maithri, Helker, Chris, Mezenghie, Lydia, Montgomery, Brittany, Preston, Peter, Schwartz, J. Sanford, Weber, Ramona, Fleisher, Lee A., Mehta, Samir, Stephens-Shields, Alisa J., Dinh, Cassandra, Schwartz, Aron, Chelly, Jacques E., Goel, Shiv, Goncz, Wende, Kawabe, Touichi, Khetarpal, Sharad, Monroe, Amy, Shick, Vladislav, Breidenstein, Max, Dominick, Timothy, Friend, Alexander, Mathews, Donald, Lennertz, Richard, Sanders, Robert, Akere, Helen, Balweg, Tyler, Bo, Amber, Doro, Christopher, Goodspeed, David, Lang, Gerald, Parker, Maggie, Rettammel, Amy, Roth, Mary, White, Marissa, Whiting, Paul, Allen, Brian F.S., Baker, Tracie, Craven, Debra, McEvoy, Matt, Turnbo, Teresa, Kates, Stephen, Morgan, Melanie, Willoughby, Teresa, Weigel, Wade, Auyong, David, Fox, Ellie, Welsh, Tina, Cusson, Bruce, Dobson, Sean, Edwards, Christopher, Harris, Lynette, Henshaw, Daryl, Johnson, Kathleen, McKinney, Glen, Miller, Scott, Reynolds, Jon, Segal, B. Scott, Turner, Jimmy, VanEenenaam, David, Weller, Robert, Lei, Jineli, Treggiari, Miriam, Akhtar, Shamsuddin, Blessing, Marcelle, Johnson, Chanel, Kampp, Michael, Kunze, Kimberly, OʼConnor, Mary, Gaskins, Lakisha J., Looke, Thomas, Tadros, Rafik, Vlassakov, Kamen, Cardenas, Louis, Hassan, Manal, Bolkus, Kelly, Mitrev, Ludmil, Kwofie, M. Kwesi, Dabiri, Jared, Lobel, Gregg, Poler, Mark, Giska, Mark, Sanders, David, Schwartz, Gary, Giuca, Matthew, Tedore, Tiffany, Nader, Antoun, Papp, Stephen, Bryson, Greg, Troxell, Karen, Kiss, Geza, Choi, Stephen, Powell, Mark, Applegate, Richard, Warrick, Matthew, Ranganath, Yatish, Elkassabany, Nabil, Chelly, Jacques E., Hoeft, Mark A., Lennertz, Richard, Sanders, Robert, Allen, Brian F.S., Kates, Stephen, Weigel, Wade, Li, Jinlei, Wijeysundera, Duminda N., Kheterpal, Sachin, Moore, Reneé H., Smith, Alexander K., Tosi, Laura L., Elkassabany, Nabil, Looke, Thomas, Menio, Diane, Mehta, Samir, Fleisher, Lee, Menio, Diane, Hruslinski, Jennifer, Ramsey, Lolita, Gaskins, Lakisha J., Langlois, Christine, Gaskins, Lakisha J., Mezenghie, Lydia, Montgomery, Brittany, Oduwole, Samuel, and Rose, Thomas

Published
2024
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32. One-year Outcomes after Discharge from Noncardiac Surgery and Association between Predischarge Complications and Death after Discharge: Analysis of the VISION Prospective Cohort Study

Author

Roshanov, Pavel S., Chan, Matthew T. V., Borges, Flavia K., Conen, David, Wang, C. Y., Xavier, Denis, Berwanger, Otavio, Marcucci, Maura, Sessler, Daniel I., Szczeklik, Wojciech, Spence, Jessica, Alonso-Coello, Pablo, Fernández, Carmen, Pearse, Rupert M., Malaga, German, Garg, Amit X., Srinathan, Sadeesh K., Jacka, Michael J., Tandon, Vikas, McGillion, Michael, Popova, Ekaterine, Sigamani, Alben, Abraham, Valsa, Biccard, Bruce M., Villar, Juan Carlos, Chow, Clara K., Polanczyk, Carísi A., Tiboni, Maria, Whitlock, Richard, Ackland, Gareth L., Panju, Mohamed, Lamy, André, Sapsford, Robert, Williams, Colin, Wu, William Ka Kei, Cortés, Olga L., MacNeil, S. Danielle, Patel, Ameen, Belley-Côté, Emilie P., Ofori, Sandra, McIntyre, William F., Leong, Darryl P., Heels-Ansdell, Diane, Gregus, Krysten, and Devereaux, P. J.

Published
2024
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33. A Phase I Study of the Pharmacokinetics, Pharmacodynamics, and Safety of Liposomal Bupivacaine for Sciatic Nerve Block in the Popliteal Fossa for Bunionectomy.

Author

Sessler, Daniel I., Bao, Xiaodong, Leiman, David, Song, Jia, Chittenden, Jason, Voelkner, Alexander, Turan, Alparslan, and Gadsden, Jeffrey

Subjects
*BUPIVACAINE, *NERVE block, *SCIATIC nerve, *POSTOPERATIVE pain, *LIPOSOMES
Abstract

This trial assessed the pharmacokinetics, pharmacodynamics, and safety of liposomal bupivacaine given via ultrasound‐guided popliteal sciatic nerve block with or without immediate‐release bupivacaine hydrochloride in adults having bunionectomies. Forty‐five adults were enrolled into four sequential cohorts: (1) liposomal bupivacaine 266 mg with bupivacaine hydrochloride 50 mg; (2) liposomal bupivacaine 133 mg with bupivacaine hydrochloride 50 mg; (3) liposomal bupivacaine 266 mg; or (4) bupivacaine hydrochloride 100 mg. Outcomes included pharmacokinetics (e.g., bupivacaine maximum plasma concentration [Cmax]), onset and duration of motor and sensory nerve block, and safety. Liposomal bupivacaine admixed with bupivacaine hydrochloride produced biphasic bupivacaine plasma disposition profiles with two distinct peaks. Geometric mean Cmax of the early peak ranged from 235 to 421 ng/mL and the geometric mean of the late Cmax was ∼30%–50% lower than the early peak. Median time to sensory block onset was 18 to 29 min in all cohorts. Sensory blocks lasted about twice as long with liposomal bupivacaine (median, 119–167 h) than with bupivacaine hydrochloride alone (median, 67 h). There were no serious adverse events. In conclusion, liposomal bupivacaine provided prolonged sensory nerve block when given as popliteal sciatic nerve blocks with or without bupivacaine hydrochloride, and bupivacaine plasma concentrations were well below the lower bound of the toxicity threshold of 2000 ng/mL for all cohorts. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Pain after Licorice or Sugar-Water Gargling in Patients Recovering from Oropharyngeal Surgery—A Randomized, Double-Blind Trial.

Author

Windpassinger, Marita, Prusak, Michal, Gemeiner, Jana, Plattner, Olga, Janik, Stefan, Besser, Gerold, Gstoettner, Wolfgang, Xuan, Pu, Sessler, Daniel I., and Ruetzler, Kurt

Subjects
POSTOPERATIVE pain treatment, TERMINATION of treatment, POSTOPERATIVE pain, ELECTIVE surgery, TRADITIONAL medicine
Abstract

Background: Glycyrrhiza glabrata (licorice) is used in traditional medicine and herbal remedies and reduces sore throats consequent to intubation, but whether it is protective for more intense pain after oropharyngeal surgery remains unclear. We thus tested the joint hypothesis that gargling with licorice, which has anti-inflammatory and antioxidant properties, reduces postoperative pain and morphine consumption. Methods: We enrolled patients having elective oropharyngeal surgery. Participants were randomly allocated to gargle with either 1 g licorice or a sugar placebo before and for up to three days after surgery. A numerical rating scale (NRS) for pain along with morphine consumption was evaluated every 30 min during the post-anesthesia care unit (PACU) stay and then three times daily for three days. We pre-specified that licorice gargling would be deemed better than sugar gargling only if found non-inferior on both morphine consumption and pain score and superior on at least one of the two. Results: 65 patients were randomized to the licorice group and 61 to placebo. We found noninferiority (NI) in pain scores with an estimated mean difference of −0.09 (95.2% CI: −0.88, 0.70; p = 0.001; NI delta = 1) between licorice and placebo gargling. There were no adverse events reported in either group that required treatment discontinuation. Conclusions: Gargling with licorice did not significantly or meaningfully reduce postoperative pain or morphine consumption in patients recovering from oropharyngeal surgery. While higher doses might prove more effective, our results suggest that other topical analgesics should be considered. [ABSTRACT FROM AUTHOR]

Published
2024
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36. The relative merits of using a high-sensitivity cardiac Troponin T assay compared to a non-high-sensitivity Troponin T assay after noncardiac surgery

Author

Borges, Flavia K., primary, Sessler, Daniel I., additional, Tiboni, Maria, additional, Patel, Ameen, additional, LeManach, Yannick, additional, Heels-Ansdell, Diane, additional, Srinathan, Sadeesh, additional, Wang, Chew Yin, additional, Chow, Clara, additional, Duceppe, Emmanuelle, additional, Kavsak, Peter, additional, Ofori, Sandra N., additional, Pettit, Shirley, additional, Berwanger, Otavio, additional, Kurz, Andrea, additional, Turan, Alparslan, additional, Tonelli, Ana Claudia, additional, and Devereaux, PJ, additional

Published
2024
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40. Nitrous oxide for the treatment of complex regional pain syndrome: a randomized blinded trial.

Author

Hale, Jason, Jijun Xu, Wang, Dong, Rodriguez-Patarroyo, Fabio, Bakal, Omer, Kopac, Orkun, Altinpulluk, Ece Yamak, Onal, Ozkan, Brooker, Jack E., Cruz, Miguel, Maurtua, Marco, Agudelo-Jimenez, Ruben, Sessler, Daniel I., and Turan, Alparslan

Abstract

Introduction Complex Regional Pain Syndrome (CRPS) is a debilitating neuropathic condition often refractory to conventional treatments. N-methyl-D-aspartate (NMDA) receptor antagonists have a well-established role in the development and modulation of chronic neuropathic pain. Nitrous oxide is widely used and generally safe anesthetic gas with NMDA receptor antagonist activity. We therefore tested the hypothesis that brief periods of nitrous oxide exposure reduce pain in patients with CRPS. Methods Patients with a diagnosis of CRPS were randomized to either 2 hours of nitrous oxide exposure on three alternating days (Nitrous Oxide) versus a placebo air/oxygen mixture (Air-Oxygen). Our primary outcome was patient-reported pain scores at 1 week and 1 month. Secondary and exploratory outcomes were physical and mental health (PRMOIS-29 v2 survey), specific neuropathic pain symptoms (McGill short-form questionnaire), and opioid consumption. Results 44 patients participated in the study; 20 were randomized to Nitrous Oxide and 24 were assigned to Air-Oxygen. Pain scores did not differ significantly, with the estimated difference in means (Nitrous Oxide-Air-Oxygen) of -0.57 (95% CI: -1.42 to 0.28) points, p=0.19. There were also no differences detected in secondary outcomes, with the estimated difference in mean Z-scores for physical health (Nitrous Oxide-Air- Oxygen) of 0.13 (95% CI: -0.16 to 0.43), mental health 0.087 (95% CI: -0.31 to 0.48), and Patient Global Impression of Change score -0.7 (95% CI: -1.85 to 0.46). Conclusions Compared with air/oxygen, 2 hours of nitrous oxide/oxygen exposure for three sessions did not provide meaningful therapeutic potential for patients with chronic CRPS. Our results do not support using nitrous oxide for the treatment of CRPS. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Incidence and Risk Factors of Chronic Postoperative Pain in Same-day Surgery: A Prospective Cohort Study.

Author

Boko, Melodie Fanay, Khanna, Ashish K., D'Aragon, Frederick, Spence, Jessica, Conen, David, Patel, Ameen, Ayad, Sabry, Wijeysundera, Duminda N., Choinière, Manon, Sessler, Daniel I., Carrier, Francois Martin, Harlock, John, Koopman, Josèph S. H. A., Durand, Madeleine, Bhojani, Naeem, Turan, Alparslan, Pagé, Gabrielle, Devereaux, P. J., Duceppe, Emmanuelle, and Daila Carling, Roberta

Published
2024
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42. The Gathering Storm: The 2023 Rovenstine Lecture.

Author

Sessler, Daniel I.

Abstract

Anesthesiologists are currently in demand and highly compensated. What appears to be a great success from our perspective is considered problematic from every other healthcare perspective. Consequently, there are powerful healthcare forces seeking to improve anesthesia access and reduce service cost. They will try to impose solutions that may radically change operative anesthesia. The Rovenstine lecture, delivered on World Anesthesia Day 2023, identified substantial challenges our specialty faces and discusses solutions that might be forced on us. It also presented opportunities in perioperative care. Anesthesiologists are currently in demand and highly compensated, which is considered problematic from every other healthcare perspective. Consequently, powerful healthcare forces seek to impose solutions that may radically change operative anesthesia. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial.

Author

Ruetzler, Kurt, Bustamante, Sergio, Schmidt, Marc T., Almonacid-Cardenas, Federico, Duncan, Andra, Bauer, Andrew, Turan, Alparslan, Skubas, Nikolaos J., and Sessler, Daniel I.

Subjects
LARYNGOSCOPY, CLUSTER randomized controlled trials, TRACHEA intubation, OPERATING rooms, ACADEMIC medical centers, ENDOTRACHEAL tubes
Abstract

Key Points: Question: What is the effect of initial video laryngoscopy or direct laryngoscopy on number of intubation attempts in patients being intubated for cardiac, thoracic, or vascular surgical procedures? Findings: In this cluster randomized trial including 8429 surgical procedures in 7736 patients, more than 1 intubation attempt was required in 1.7% of patients randomized to receive video laryngoscopy. More than 1 intubation attempt was required in 7.6% of patients randomized to receive direct laryngoscopy. Meaning: In this study of adults having elective or emergent surgical procedures requiring single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy increased initial intubation attempt success and reduced the number of intubation attempts compared with direct laryngoscopy. Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Design, Setting, and Participants: Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Interventions: Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. Main Outcomes and Measures: The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Results: Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P <.001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P <.001) with an unadjusted absolute risk difference of −3.7% (95% CI, −4.4% to −3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). Conclusion and Relevance: In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. Trial Registration: ClinicalTrials.gov Identifier: NCT04701762 This cluster randomized clinical trial assesses the extent to which video laryngoscopy compared with direct laryngoscopy might facilitate intubation in patients undergoing surgical procedures during routine clinical practice. [ABSTRACT FROM AUTHOR]

Published
2024
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44. Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial.

Author

Shuo Wang, Chun-Mei Deng, Yuan Zeng, Xin-Zhong Chen, Ai-Yuan Li, Shan-Wu Feng, Li-Li Xu, Liang Chen, Hong-Mei Yuan, Han Hu, Tian Yang, Tao Han, Hui-Ying Zhang, Ming Jiang, Xin-Yu Sun, Hui-Ning Guo, Sessler, Daniel I., and Dong-Xin Wang

Subjects
EDINBURGH Postnatal Depression Scale, KETAMINE, DRUG side effects, RESEARCH funding, MOTHERS, STATISTICAL sampling, BLIND experiment, POSTPARTUM depression, RANDOMIZED controlled trials, TERTIARY care, DESCRIPTIVE statistics, RELATIVE medical risk, PRENATAL care, INTRAVENOUS therapy, HAMILTON Depression Inventory, DRUG efficacy, CONFIDENCE intervals, CHILDBIRTH, MENTAL depression, PREGNANCY
Published
2024
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47. Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study.

Author

Juan Wang, Fa Lin, Min Zeng, Minying Liu, Maoyao Zheng, Yue Ren, Shu Li, Xiaodong Yang, Yiqiang Chen, Xiaolin Chen, Sessler, Daniel I., and Yuming Peng

Abstract

Background: Previous studies report that intraoperative hypotension worsens outcomes after aneurysmal subarachnoid hemorrhage (aSAH). However, the hypotensive harm threshold for major adverse cardiovascular events (MACE) remains unclear. Methods: The authors included aSAH patients who had general anesthesia for aneurysmal clipping/coiling. MACE were defined by a composite of acute myocardial injury, acute myocardial infarction, and other cardiovascular complications identified by electrocardiogram and echocardiography. The authors initially used logistic regression and change-point analysis based on the second derivative to identify mean arterial pressure (MAP) of 75 mmHg as the harm threshold. Thereafter, our major exposure was MAP below 75 mmHg characterized by area, duration, and time-weighted average. The area below 75 mmHg represents the severity and duration of exposure and was defined as the sum of all areas below a specified threshold using the trapezoid rule. Timeweighted average MAP was derived by dividing area below the threshold by the duration of anesthesia. All analyses were adjusted for baseline risk factors including age greater than 70 years, female sex, severity of intracerebral hemorrhage, history of cardiovascular disease, and preoperative elevated myocardial enzymes. Results: Among 1029 patients enrolled, 254 (25%) developed postoperative MACE. Patients who experienced MACE were slightly older (59 ± 11 vs. 54 ± 11 years), were slightly more often women (69 vs. 58%), and had a higher prevalence of cardiovascular history (65 vs. 47%). Adjusted cardiovascular risk increased nearly linearly over the entire range of observed MAP. However, there was a slight inflexion at MAP of 75 mmHg. MACE was significantly associated with area [adjusted odds ratios (aOR) 1.004 per 10 mmHg.min, 95% CI: 1.001-1.007, P=0.002), duration (aOR 1.031 per 10min, 95%CI: 1.009-1.054, P=0.006), and time-weighted average (aOR 3.516 per 10 mmHg, 95% CI: 1.818-6.801, P<0.001) of MAP less than 75 mmHg. Conclusions: Lower blood pressures were associated with cardiovascular complications over the entire observed range, but worsened when MAP was less than 75 mmHg. Pending trial data to establish causality, it may be prudent to keep MAP above 75 mmHg in patients having surgical aSAH repairs to reduce the risk of MACE. [ABSTRACT FROM AUTHOR]

Published
2024
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48. ONE-LUNG VENTILATION WITH FIXED AND VARIABLE TIDAL VOLUMES ON OXYGENATION AND PULMONARY OUTCOMES: A RANDOMIZED TRIAL.

Author

Balla, Boglárka, Szamos, Katalin, Pálóczi, Balázs, Enyedi, Attila, Sessler, Daniel I., Fülesdi, Béla, and Végh, Tamás

Abstract

Objective: Test the hypothesis that one-lung ventilation with variable tidal volume improves intraoperative oxygenation and reduces postoperative pulmonary complications after lung resection. Constant tidal volume and respiratory rate ventilation can lead to atelectasis. Animal and human ARDS studies indicate that oxygenation improves with variable tidal volumes. Since one-lung ventilation shares characteristics with ARDS, we tested the hypothesis that one-lung ventilation with variable tidal volume improves intraoperative oxygenation and reduces postoperative pulmonary complications after lung resection. Design: Randomized trial. Operating rooms and a post-anesthesia care unit. Adults having elective open or video-assisted thoracoscopic lung resection surgery with general anesthesia were randomly assigned to intraoperative ventilation with fixed (n = 70) or with variable (n = 70) tidal volumes. Patients assigned to fixed ventilation had a tidal volume of 6 mlL/kgPBW, whereas those assigned to variable ventilation had tidal volumes ranging from 6 ml/kg PBW ± 33% which varied randomly at 5-min intervals. The primary outcome was intraoperative oxygenation; secondary outcomes were postoperative pulmonary complications, mortality within 90 days of surgery, heart rate, and SpO2/FiO2 ratio. Results: Data from 128 patients were analyzed with 65 assigned to fixed-tidal volume ventilation and 63 to variable-tidal volume ventilation. The time-weighted average PaO2 during one-lung ventilation was 176 (86) mmHg in patients ventilated with fixed-tidal volume and 147 (72) mmHg in the patients ventilated with variable-tidal volume, a difference that was statistically significant (p < 0.01) but less than our pre-defined clinically meaningful threshold of 50 mmHg. At least one composite complication occurred in 11 (17%) of patients ventilated with variable-tidal volume and in 17 (26%) of patients assigned to fixed-tidal volume ventilation, with a relative risk of 0.67 (95% CI 0.34–1.31, p = 0.24). Atelectasis in the ventilated lung was less common with variable-tidal volumes (4.7%) than fixed-tidal volumes (20%) in the initial three postoperative days, with a relative risk of 0.24 (95% CI 0.01–0.8, p = 0.02), but there were no significant late postoperative differences. No other secondary outcomes were both statistically significant and clinically meaningful. One-lung ventilation with variable tidal volume does not meaningfully improve intraoperative oxygenation, and does not reduce postoperative pulmonary complications. [ABSTRACT FROM AUTHOR]

Published
2024
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