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Background: In the Netherlands, a significant proportion of moderate-to-deep sedation is performed by sedation practitioners under the indirect supervision of an anaesthesiologist but there are limited safety data available.Objective: To estimate the rate of sedation-related adverse events and patient relevant outcomes (PRO).Design: This was a prospective national observational study. Data were collected with a modified adverse event reporting tool from the International Sedation Task Force of the World Society of Intravenous Anaesthesia.Setting: A total of 24 hospitals in the Netherlands where moderate-to-deep sedation was performed by sedation practitioners from the 1 February 2015 to 1 March 2016.Patients: Consecutive adults undergoing moderate-to-deep sedation for gastrointestinal, pulmonary and cardiac procedures.Intervention: Observation: Analysis included descriptive statistics and a multivariate logistic regression model for an association between adverse events and PRO.Main Outcome Measures: The primary outcome was the rate of unfavourable PRO (admission to ICU, permanent neurological deficit, pulmonary aspiration or death). Secondary outcome was the rate of moderate-to-good PRO (unplanned hospital admission or escalation of care). Composite outcome was the sum of all primary and secondary outcomes.Results: A total of 11 869 patients with a median age of 64 years [interquartile range 51 to 72] were included. ASA physical score distribution was: first, 19.1%; second, 57.6%; third, 21.6%; fourth, 1.2%. Minimal adverse events occurred in 1517 (12.8%), minor adverse events in 113 (1.0%) and major adverse events in 80 instances (0.7%).Primary Outcome: Five (0.04%) unfavourable PRO were observed; four patients needing admission to the intensive care unit; and one died. Secondary outcome: 12 (0.1%) moderate-to-good PRO were observed. Moderate and major adverse events were associated with the composite outcome [3.7 (95% confidence interval 1.1 to 11.9) and 40.6 (95% confidence interval 11.0 to 150.4)], but not minimal or minor adverse events.Conclusion: Moderate-to-deep sedation performed by trained sedation practitioners has a very low rate of unfavourable outcome. [ABSTRACT FROM AUTHOR]

A β-lactam allergy is the most common suspected in-hospital drug allergy. This article aims to provide a practical approach to a patient with presumed β-lactam allergy in the perioperative setting. Supplemental Digital Content is available in the text. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the relation between hypoglycemia and intensive care unit mortality. The study included 5,961 patients who were admitted at the intensive care unit of Onze Lieve Vrouwe Gasthuis Hospital in Amsterdam, the Netherlands. It found that the incidence of death rate in patients with hypoglycemia was 40 per 1,000 intensive care unit days. Study authors concluded that hypoglycemia is related to intensive care unit mortality.

The article presents a study which examines the association of glucose variability (GV) with mortality rates in intensive care unit (ICU) and in-hospital care. It examines the relationship of GV and mean glucose values with mortality rate in large strict glucose control-treated ICU patients of a teaching hospital in Amsterdam, The Netherlands. Results demonstrate the relationship of high GV with the ICU and in-hospital death wherein high GV and glucose value show high ICU mortality.

Objective: To compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE)., Summary Background Data: Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery., Methods: This randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality., Results: From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay., Conclusions: This randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice., Competing Interests: Declaration of interests Prof. dr. Ruurda reported serving an advisory or consulting role for Intuitive Surgical and Medtronic. Prof. dr. Luyer reported receiving research grants from Medtronic outside the submitted work. Dr. Nieuwenhuijzen reported serving a consulting or advisory role for Medtronic. Dr. Buise reported serving a consulting or advisory role for Medtronic. Dr. van Det reported serving a consulting or advisory role for Intuitive Surgical. Dr. Kouwenhoven reported serving a consulting or advisory role for Intuitive Surgical. Prof. dr. Hollmann reported serving roles as Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anesthesiology with J Clin Med, Editor with Front Physiol, and research support and honorarium for consultancy by PAION, Medical Developments & IDD Pharma. Prof. dr. van Berge Henegouwen reported serving a consulting or advisory roles for Viatris, Johnson & Johnson, BBraun, Stryker and Medtronic, all fees paid to the institution. Prof. dr. van Hillegersberg reported serving a consulting or advisory role for Intuitive Surgical, Medtronic and Olympus. The other authors have no conflicts of interest to declare., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To investigate the relation between perioperative hyperglycemia and complications after pancreatoduodenectomy., Background: Perioperative hyperglycemia is associated with complications after various types of surgery. This relation was never investigated for pancreatoduodenectomy., Methods: In a consecutive series of 330 patients undergoing pancreatoduodenectomy, glucose values were collected from the hospital information system during 3 periods: pre-, intra-, and early postoperative. The average glucose value per period was calculated for each patient and divided in duals according to the median group value. Odds ratios for complications were calculated for the upper versus lower dual, adjusted for age, sex, American Society of Anesthesiologists Classification, body mass index, diabetes mellitus, intraoperative blood transfusion, duration of surgery, intraoperative insulin administration, and octreotide use. The same procedures were carried out to assess the consequences of increased glucose variability, expressed by the standard deviation., Results: Average glucose values were 135 (preoperative), 133 (intraoperative) and 142 mg/dL (early postoperative). Pre- and intraoperative glucose values were not associated with postoperative complications. Early postoperative hyperglycemia (≥140 mg/dL) was significantly associated with complications [odds ratio (OR) 2.9, 95% confidence interval (CI), 1.7-4.9]. Overall, high glucose variability was not significantly associated with postoperative complications, but early postoperative patients who had both high glucose values and high variability had an OR for complications of 3.6 (95% CI, 1.9-6.8) compared to the lower glucose dual., Conclusions: Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. High glucose variability may enhance this risk. Future research must demonstrate whether strict glucose control in the early postoperative period prevents complications after pancreatoduodenectomy.