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Introduction: The Skin-to-Epidural Space Distance (SESD) is likely to be different at two different parts of the spine in the same individual and also in the same part of the spine in two different individuals. The knowledge of the expected depth of the epidural space can be very useful in placing the epidural needle appropriately and avoiding unwanted dural puncture. Although many studies have been conducted to study the relation of lumbar SESD with various physical and anthropometric parameters, the literature on thoracic SESD is scant. Aim: To determine the correlation between SESD and Abdominal Girth (AG) in the mid-thoracic, lower thoracic, and lumbar regions of the spine in adult patients scheduled for elective surgical procedures. Materials and Methods: After obtaining Ethics Committee clearance (EC/NIMS/2671/2020, 51st ESGS No: 1082/2020), this prospective observational study was carried out at Nizam's Institute of Medical Sciences, Hyderabad, India, from October 2021 to February 2022. The study recruited 202 patients, and data from 194 patients was analysed. During the preoperative visit, all physical parameters, including AG, were noted. Using an 18G Tuohy needle, the epidural space was identified, and SESD was measured. Its correlation with AG, age, height, weight, and body mass index was studied. The data was analysed using the Statistical Pacakge for Social Sciences Software (SPSS) (2011, IBM, Armonk, NY, United States of America) version 20.0. Results: The mean SESD was 4.7±1.09 cm in the mid-thoracic region, 4.71±0.98 cm in the lower thoracic region, and 4.8±0.82 cm in the lumbar region. The correlation coefficient of SESD with AG was 0.42, 0.44, and 0.78 in the mid-thoracic, lower thoracic, and lumbar regions, respectively, and the significance level was <0.001 in all three regions. Body weight had a good correlation (r-values of 0.56, 0.66, 0.53 in mid-thoracic, lower thoracic, and lumbar areas, respectively, and p-value of <0.001 in all three anatomical regions of the spine) with SESD. All other physical parameters were correlated weakly with SESD. Conclusion: AG has a strong correlation with SESD in the lumbar area but a moderate correlation in the thoracic spine. SESD in the lumbar, mid, and lower thoracic regions have a good correlation with weight. [ABSTRACT FROM AUTHOR]

Introducton: Little is known about the prognostic utility of preoperative estimated GFR (eGFR) on perioperative Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) in apparently lower risk patients undergoing moderate risk surgeries like thoracotomy. Aim: The current study sought to identify a clinically relevant cut off value of eGFR for identifying thoracotomy patients at higher risk for MACCE. Materials and Methods: Between July 2012 and July 2016, 436 consecutive patients were retrospectively studied after elective thoracotomy in a single institution. Patients were classified into six groups according to the calculated Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI) eGFR (ml min -11.73 m -2): Stage 1, eGFR >90; Stage 2, eGFR=60-89.9; Stage 3a, eGFR=45-59.9; Stage 3b, eGFR=30-44.9; Stage 4, eGFR=15-29.9; Stage 5, eGFR <15. All the eGFR groups were analysed for perioperative MACCE, length of hospital stay, and mortality. Results: The incidence of perioperative MACCE in our study was 4.24%. The mean eGFR in our study as calculated by the CKD-EPI equation was 83 ml min-11.73 m-2. With the exception of nonfatal cardiac arrest which was not seen in any patient, the incidence of all MACCE increased with progressively worsening preoperative eGFR. It was seen by logistic regression analysis that the occurrence of any perioperative MACCE increased significantly with worsening eGFR (p<0.001).The increase in MACCE was particularly marked from Stage 3b onwards to the later stages (OR 1.9 in 3a vs. 3.6 in 3b). The two mortalities observed in the study were in Stages 4 and 5 with no deaths seen in the better eGFR subgroups. There was also an increased length of hospital stay with declining eGFR. Conclusion: Preoperative eGFR is a predictor of perioperative MACCE in homogenous moderate risk elective surgical population like thoracic surgeries. There is an inverse relationship between eGFR and MACCE, particularly manifested at eGFR values <45 ml/min/1.73. Routine use of preoperative eGFR for cardiovascular and cerebrovascular risk assessment in patients undergoing moderate risk surgeries like thoracotomy would be beneficial. [ABSTRACT FROM AUTHOR]