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BackgroundAcute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.MethodsPubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.ResultsTwenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% vs. 13.2%; risk ratio = 0.57, 95% CI = 0.40 to 0.83, P =  0.003, I2 = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.ConclusionDexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.RegistrationInternational Prospective Register of Systematic Reviews; Registration number: CRD42022299252.

Assessing the risk of postoperative cardiovascular events before performing non-cardiac surgery is clinically important. The current risk score systems for preoperative evaluation may not adequately represent a small subset of high-risk populations. Accordingly, this study aimed at applying iterative random forest to analyze combinations of factors that could potentially be clinically valuable in identifying these high-risk populations. To this end, we used the Japan Medical Data Center database, which includes claims data from Japan between January 2005 and April 2021, and employed iterative random forests to extract factor combinations that influence outcomes. The analysis demonstrated that a combination of a prior history of stroke and extremely low LDL-C levels was associated with a high non-cardiac postoperative risk. The incidence of major adverse cardiovascular events in the population characterized by the incidence of previous stroke and extremely low LDL-C levels was 15.43 events per 100 person-30 days [95% confidence interval, 6.66–30.41] in the test data. At this stage, the results only show correlation rather than causation; however, these findings may offer valuable insights for preoperative risk assessment in non-cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Perioperative hypotension is common and associated with adverse patient outcomes. Vasoactive agents are often used to manage hypotension, but the ideal drug, dose and duration of treatment has not been established. With this scoping review, we aim to provide an overview of the current body of evidence regarding the vasoactive agents used to treat perioperative hypotension in non‐cardiac surgery. Methods: We included all studies describing the use of vasoactive agents for the treatment of perioperative hypotension in non‐cardiac surgery. We excluded literature reviews, case studies, and studies on animals and healthy subjects. We posed the following research questions: (1) in which surgical populations have vasoactive agents been studied? (2) which agents have been studied? (3) what doses have been assessed? (4) what is the duration of treatment? and (5) which desirable and undesirable outcomes have been assessed? Results: We included 124 studies representing 10 surgical specialties. Eighteen different agents were evaluated, predominantly phenylephrine, ephedrine, and noradrenaline. The agents were administered through six different routes, and numerous comparisons between agents, dosages and routes were included. Then, 88 distinct outcome measures were assessed, of which 54 were judged to be non‐patient‐centred. Conclusions: We found that studies concerning vasoactive agents for the treatment of perioperative hypotension varied considerably in all aspects. Populations were heterogeneous, interventions and exposures included multiple agents compared against themselves, each other, fluids or placebo, and studies reported primarily non‐patient‐centred outcomes. [ABSTRACT FROM AUTHOR]

Background: In terms of predicting surgery mortality, it is controversial whether red blood cell width works independently. In non-cardiac surgery patients older than 18 years, we intend to examine the relationship between red blood cell width and postoperative 30-day mortality. Methods: In this retrospective cohort study, 90,785 Singapore General Hospital patients were matched by propensity score between January 1, 2012 and October 31, 2016. It was determined that red blood cell width at baseline and mortality within 30 days after surgery were the independent and dependent variables. We used a non-parametric multivariate logistic regression to balance the confounders among 7807 patients with high RDW and 7807 patients with non-high RDW in the propensity score matching. We investigated the association between RDW and 30-day mortality after surgery using the doubly robust estimation method. Results: Cohorts matched according to propensity score, the risk of 30-day mortality after surgery increased by 114.6.0% among the high RDW group (OR = 2.146, 95% CI 1.645–2.799, P < 0.00001). In the crude model, there was a significant association between RDW and 30-day mortality after surgery (OR = 1.877, 95% CI 1.476–2.388, P < 0.00001). In the propensity-score adjusted model, the risk of 30-day mortality after surgery in the high RDW group compared to the control group was not as high as in the non-adjusted model (OR = 1.867, 95% CI 1.467–2.376, P < 0.00001). Compared to non-high RDW group, the risk of 30-day mortality after surgery increased by 117.0% and 127.7% among high RDW group in the original cohort (OR 2.170, 95% CI 1.754–2.683, P < 0.00001) and the weighted cohort (OR 2.272, 95% CI 2.009–2.580, P < 0.00001), respectively. Conclusions: According to the results of this observational, propensity score-matched cohort study, uncontrolled high RDW before surgery is associated with an increased risk of death within 30 days after surgery, that is to say, patients over the age of 18 with high preoperative RDW who undergo non-cardiac surgery have a worse postoperative prognosis than those with normal RDW. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to investigate the role of myocardial perfusion imaging (MPI) stress tests using stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in non-cardiac surgery (NCS) pre-operatory management. Materials and methods: This monocentric retrospective study enrolled patients with coronary artery disease or a minimum of two cardiovascular risk factors undergoing intermediate-to-high-risk non-cardiac surgeries. The primary composite endpoint comprised cardiac death, cardiogenic shock, acute coronary syndromes (ACS), and cardiogenic pulmonary edema occurring within 30 days after surgery, while the secondary endpoint was ACS. Results: A total of 1590 patients were enrolled; among them, 669 underwent a MPI stress test strategy (sCMR: 287, SPECT-MPI: 382). The incidence of 30-day cardiac events was lower in the stress-tested group compared to the non-stress-tested group (1.2% vs. 3.4%; p 0.006). Adopting a stress test strategy showed a significant reduction in the risk of the composite endpoint (OR: 0.33, 95% CI: 0.15–0.76, p 0.009) and ACS (OR: 0.41, 95% CI: 0.17–0.98, p 0.046) at multivariable analysis, with similar cardiac events rate between stress CMR and SPECT (1.1% vs. 1.3%, p 0.756). Stress CMR showed a greater accuracy to predict coronary artery revascularizations (sCMR c-statistic: 0.95, ischemic cut-point: 5.5%; SPECT c-statistic: 0.85, ischemic cut-point: 7.5%). Conclusion: Stress test strategy is related to a lower occurrence of cardiac events in high-risk patients scheduled for intermediate-to-high-risk non-cardiac surgeries. Both sCMR and SPECT-MPI comparably reduce the likelihood of cardiac complications, albeit sCMR offers greater accuracy in predicting coronary artery revascularization. [ABSTRACT FROM AUTHOR]

Background: The use of durable left ventricular assist devices (LVADs) for advanced heart failure is increasing and a growing number of patients will require anesthesia for non-cardiac procedures (NCPs). The goal of this study was to describe our experience with NCPs for LVAD patients. Methods: All anesthetic procedures performed in LVAD patients at a single center were reviewed from 2014 to 2023. Perioperative management data and complications were assessed. Results: In total, 16 patients had an LVAD implanted and 9 (56.3%) patients underwent anesthesia for a total of 22 NCPs. Most of the procedures took place outside of the operating room, mainly in the endoscopy unit, as gastrointestinal endoscopy was the most common procedure (13, 59.2%). Sedation was provided in 17 procedures (77.3%). Standard monitoring was used in all cases, and invasive monitoring was applied just in cases of major surgeries. There were no intraoperative complications reported. Postoperative complications were recorded after eight (36.4%) of the procedures, consisting mainly of lower gastrointestinal bleeding after lower endoscopy, which increased the length of hospital stay. All procedures were performed by non-cardiac anesthesiologists. Conclusions: Our data suggest that, in most cases, adherence to standard anesthesia practices can be suitable for NCPs in LVAD patients. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests an association between non-steroidal anti-inflammatory drugs (NSAIDs) and atrial fibrillation in the general population. A systematic review was conducted to characterize the association of perioperative NSAIDs with atrial fibrillation after non-cardiac surgery (POAF). PubMed and Scopus were searched for relevant studies. We excluded review articles, case studies, articles not published in English, and animal studies. The primary objective was to investigate the relationship between the perioperative use of NSAIDs and POAF during the first 30 postoperative days (from the day of surgery), at hospital discharge, and at 30 and 90 days after hospital discharge. Four studies were identified, a pooled analysis of two randomized double-blind clinical trials and three observational studies. A post-hoc sensitivity analysis for acetylsalicylic acid (aspirin) vs. other NSAIDs revealed that the former seems to decrease the incidence of POAF although non-significantly (Relative Risk (RR) (95% Confidence Interval (CI)): 0.92 (0.81, 1.04); p = 0.165). After excluding acetylsalicylic acid from the analysis, NSAIDs were associated with an increased risk of POAF development (RR (95% CI): 1.15 (1.07, 1.23); p < 0.001). In conclusion, perioperative administration of non-aspirin NSAIDs may be associated with an increased risk of POAF development. Further studies investigating the role of NSAIDs and the potential protective role of aspirin in POAF are justified. [ABSTRACT FROM AUTHOR]

Inappropriate perioperative fluid load can lead to postoperative complications and death. This retrospective study was designed to investigate the association between intraoperative fluid load and outcomes in neonates undergoing non-cardiac surgery. From April 2020 to September 2022, 940 neonates who underwent non-cardiac surgery were retrospectively enrolled and their perioperative data were harvested for further analysis. According to recorded intraoperative fluid volumes defined as ml.kg−1 h−1, patients were mandatorily divided into quintile with fluid load as restrictive (quintile 1, Q1), moderately restrictive (Q2), moderate (Q3), moderately liberal (Q4), and liberal (Q5). The primary outcomes were defined as prolonged length of hospital stay (LOS) (postoperative LOS ≥ 14 days), complications beyond prolonged LOS, and 30-day mortality. Secondary outcomes included postoperative complications within 14 days of hospital stay. The intraoperative fluid load was in Q1 of 6.5 (5.3–7.3) (median and IQR); Q2: 9.2 (8.7–9.9); Q3: 12.2 (11.4–13.2); Q4: 16.5 (15.4–18.0); and Q5: 26.5 (22.3–32.2) ml.kg−1 h−1. The odd of prolonged LOS was positively correlated with an increase fluid volume (Q5 quintile: OR 2.602 [95% CI 1.444–4.690], P = 0.001), as well as complications beyond prolonged LOS (Q5: OR 3.322 [95% CI 1.656–6.275], P = 0.001). The overall 30-day mortality rate was increased with high intraoperative fluid load but did not reach to a statistical significance after adjusted with confounders. Furthermore, the highest quintile of fluid load (26.5 ml.kg−1 h−1, IQR [22.3–32.2]) (Q5 quintile) was significantly associated with longer postoperative mechanical ventilation time compared with Q1 (Q5: OR 2.212 [95% CI 1.101–4.445], P = 0.026). Conclusion: Restrictive intraoperative fluid load had overall better outcomes, whilst high fluid load was significantly associated with prolonged LOS and complications after non-cardiac surgery in neonates. Trial registration: Chictr.org.cn Identifier: ChiCTR2200066823 (December 19, 2022). What is Known: • Inappropriate perioperative fluid load can lead to postoperative complications and even death. What is New: • High perioperative fluid load was significantly associated with an increased length of stay after non-cardiac surgery in neonates, whilst low fluid load was consistently related to better postoperative outcomes. [ABSTRACT FROM AUTHOR]

Abstract Assessing the risk of postoperative cardiovascular events before performing non-cardiac surgery is clinically important. The current risk score systems for preoperative evaluation may not adequately represent a small subset of high-risk populations. Accordingly, this study aimed at applying iterative random forest to analyze combinations of factors that could potentially be clinically valuable in identifying these high-risk populations. To this end, we used the Japan Medical Data Center database, which includes claims data from Japan between January 2005 and April 2021, and employed iterative random forests to extract factor combinations that influence outcomes. The analysis demonstrated that a combination of a prior history of stroke and extremely low LDL-C levels was associated with a high non-cardiac postoperative risk. The incidence of major adverse cardiovascular events in the population characterized by the incidence of previous stroke and extremely low LDL-C levels was 15.43 events per 100 person-30 days [95% confidence interval, 6.66–30.41] in the test data. At this stage, the results only show correlation rather than causation; however, these findings may offer valuable insights for preoperative risk assessment in non-cardiac surgery.

Abstract Acute kidney injury (AKI) is related to adverse clinical outcomes. Therefore, identifying patients at increased risk of postoperative AKI and proactively providing appropriate care is crucial. However, only a limited number of modifiable risk factors have been recognized to mitigate AKI risk. We retrospectively analyzed adult patients who underwent endotracheal intubation and mechanical ventilation of more than 2 h during non-cardiac surgery at Seoul National University Hospital from January 2011 to November 2022. Patients were grouped into low- or high-tidal volume groups based on their intraoperative tidal volume relative to their predicted body weight (PBW) of 8 ml/kg. The association between intraoperative tidal volume and postoperative AKI was evaluated using inverse probability of treatment weighting (IPTW), adjusting for various preoperative confounders. Among the 37,726 patients included, the incidence of postoperative AKI was 4.1%. The odds of postoperative AKI risk were significantly higher in the high-tidal volume group than in the low-tidal volume group before and after IPTW (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08–1.32, P = 0.001 and OR: 1.10, 95% CI 1.02–1.19, P = 0.010, respectively). In the multivariable logistic regression analysis after IPTW, a high tidal volume was independently associated with an increased risk of postoperative AKI (OR: 1.21, 95% CI 1.12–1.30, P

The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection signs in patients treated with phosphocreatine infusion in intraoperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. Administration of phosphocreatine to patients with high cardiac risk during vascular surgery does not affect perioperative cTnI and NT-proBNP blood levels.

Acute kidney injury (AKI) is related to adverse clinical outcomes. Therefore, identifying patients at increased risk of postoperative AKI and proactively providing appropriate care is crucial. However, only a limited number of modifiable risk factors have been recognized to mitigate AKI risk. We retrospectively analyzed adult patients who underwent endotracheal intubation and mechanical ventilation of more than 2 h during non-cardiac surgery at Seoul National University Hospital from January 2011 to November 2022. Patients were grouped into low- or high-tidal volume groups based on their intraoperative tidal volume relative to their predicted body weight (PBW) of 8 ml/kg. The association between intraoperative tidal volume and postoperative AKI was evaluated using inverse probability of treatment weighting (IPTW), adjusting for various preoperative confounders. Among the 37,726 patients included, the incidence of postoperative AKI was 4.1%. The odds of postoperative AKI risk were significantly higher in the high-tidal volume group than in the low-tidal volume group before and after IPTW (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08–1.32, P = 0.001 and OR: 1.10, 95% CI 1.02–1.19, P = 0.010, respectively). In the multivariable logistic regression analysis after IPTW, a high tidal volume was independently associated with an increased risk of postoperative AKI (OR: 1.21, 95% CI 1.12–1.30, P < 0.001). In this propensity score-weighted analysis, an intraoperative high tidal volume of more than 8 ml/kg PBW was significantly associated with an increased risk of postoperative AKI after IPTW in non-cardiac surgical patients. Intraoperative tidal volume showed potential as a modifiable risk factor for preventing postoperative AKI. [ABSTRACT FROM AUTHOR]

A diagnosis of congenital heart disease increases perioperative risk for children having surgical procedures. Some will require anaesthesia at a specialist cardiac centre, while for others it is safe and appropriate to have their procedure in a local district general hospital. Children with complex congenital heart disease and poor physiological status carry the highest risk of cardiac arrest and mortality. Clinical features of cardiomyopathy, cyanosis, pulmonary hypertension, arrhythmia and cardiac failure are most likely to require specialist input and tertiary referral, whereas those with a preoperative stay of less than 10 days undergoing elective, minor surgery, who are older than 2 years of age and physiologically well may be safely anaesthetized in a district general hospital. In order to maximize safety, the anaesthetist must carry out a thorough preoperative assessment, have an understanding of the patient's individual physiology and be prepared for the potential effects of general anaesthesia. Systemic vascular resistance is reduced by most induction agents and volatile anaesthetics; pulmonary vascular resistance is affected by changes in ventilation and gas exchange. The anaesthetist should also be alert to particular potential complications, such as arrhythmias, hypoxia, bleeding and cardiac arrest. [ABSTRACT FROM AUTHOR]

Ventilator-associated pneumonia (VAP) is a critical hospital-acquired infection following non-cardiac surgeries, leading to poor outcomes. This study identifies VAP risk factors in non-cardiac surgical patients and determines the causative pathogens. A retrospective analysis with 1:4 propensity-score matching was conducted on patients in a surgical intensive care unit (ICU) from 2010 to 2020 at a private tertiary medical center. Among 99 VAP patients, the mortality rate was 64.7%. VAP risk factors included prolonged mechanical ventilation (odds ratio [OR] 6.435; p < 0.001), repeat intubation (OR 6.438; p < 0.001), lower oxygenation levels upon ICU admission (OR 0.950; p < 0.001), and undergoing gastrointestinal surgery (OR 2.257; p = 0.021). The 30-day mortality risk factors in the VAP group were late-onset VAP (OR 3.450; p = 0.022), inappropriate antibiotic treatment (OR 4.083; p = 0.041), and undergoing gastrointestinal surgeries (OR 4.776; p = 0.019). Nearly half of the Gram-negative infections were resistant strains, and a third were polymicrobial infections. Non-cardiac surgical patients with VAP face adverse hospital outcomes. Identifying high-risk patients and understanding VAP's resistant and microbial nature are crucial for appropriate treatment and improved health outcomes. [ABSTRACT FROM AUTHOR]

Postoperative cardiovascular complications (either in a hospital or within 30 days after the operation) are among the most common problems with non-cardiac surgeries (NCSs). Pre-existing cardiac comorbidities add significant risk to the development of such complications. Valvular heart disease (VHD), a rather frequent cardiac comorbidity (especially in the elderly population), can pose serious life-threatening peri-/postoperative complications. Being familiar with the recommended perioperative management of patients with VHD or an implanted prosthetic heart valve who are scheduled for NCS is of great importance in daily clinical practice. Although recently published guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology and American Heart Association (ACC/AHA) for the management of VHD and perioperative management of patients undergoing NCS addresses the mentioned problem, a comprehensive review of the guidelines that provides an easy-to-use summary of the recommendations and their similarities and differences is missing in the published literature. In this review article, we summarize all of the relevant important information based on the latest data published in both guidelines needed for practical decision-making in the perioperative management of patients with VHD or after valvular repair (with prosthetic heart valve) who are scheduled for NCS. [ABSTRACT FROM AUTHOR]

This study developed and validated a machine learning model to accurately predict acute kidney injury (AKI) after non-cardiac surgery, aiming to improve patient outcomes by assessing its clinical feasibility and generalizability. We conducted a retrospective cohort study using data from 76,032 adults who underwent non-cardiac surgery at a single tertiary medical center between March 2019 and February 2021, and used data from 5512 patients from the VitalDB open dataset for external model validation. The predictive variables for model training consisted of demographic, preoperative laboratory, and intraoperative data, including calculated statistical values such as the minimum, maximum, and mean intraoperative blood pressure. When predicting postoperative AKI, our gradient boosting machine model incorporating all the variables achieved the best results, with AUROC values of 0.868 and 0.757 for the internal and external validations using the VitalDB dataset, respectively. The model using intraoperative data performed best in internal validation, while the model with preoperative data excelled in external validation. In this study, we developed a predictive model for postoperative AKI in adult patients undergoing non-cardiac surgery using preoperative and intraoperative data, and external validation demonstrated the efficacy of open datasets for generalization in medical artificial modeling research. [ABSTRACT FROM AUTHOR]

Intraoperative nociception is affected by preoperative factors, surgical invasiveness, and anesthesia. Although age-related changes in nociception in conscious humans have been well examined, those in intraoperative nociception in unconscious patients under general anesthesia are unknown. To clarify associations between age and intraoperative nociception under general anesthesia, we performed a retrospective cohort study in consecutive patients of all ages undergoing non-cardiac surgery under general anesthesia from January 2019 to July 2023. The intraoperative nociception value in each surgery was assessed by the averaged value of nociceptive response (mean NR) index during surgery. Patient characteristics, including age, sex, body mass index (BMI), emergent surgery, preoperative serum C-reactive protein (CRP) level, and comorbidities were also collected. After excluding patients with missing data of CRP and mean NR index, 22,061 patients were enrolled, and were divided into low, intermediate, and high surgical risk groups. Multivariable regression analysis showed a significant association between age and mean NR index in all three surgical procedure risk groups. The preoperative variables of CRP levels, BMI, emergent surgery, atrial fibrillation, renal failure, and long-term steroid use also showed significant associations with mean NR index in all three groups. Sensitivity analysis showed that intraoperative mean NR index was higher in younger children than that in both older children and younger adults, and it gradually increased again in older adults to the same level as in younger children. In conclusion, there is likely an association between age and intraoperative mean NR index in patients under general anesthesia. [ABSTRACT FROM AUTHOR]

Abstract Although sevoflurane is generally considered safe, reports suggest that sevoflurane may cause postoperative liver injury more frequently than previously believed. Therefore, we aimed to compare the incidence of clinically significant postoperative liver injury following non-cardiac surgery between patients who underwent sevoflurane anesthesia and propofol-based total intravenous anesthesia. We retrospectively reviewed adult surgical patients from January 2010 to September 2022 who underwent general anesthesia in our center using sevoflurane or propofol over 3 h. After 1:1 propensity score matching, the incidence of postoperative liver injury was compared between the two groups. Out of 58,300 patients reviewed, 44,345 patients were included in the analysis. After propensity score matching, 7767 patients were included in each group. The incidence of postoperative liver injury was 1.4% in the sevoflurane group, which was similar to that in the propofol group (1.6%; p = 0.432). Comparison of the severity of postoperative alanine aminotransferase elevation showed that the incidence of borderline and mild elevation was higher in the sevoflurane group, but there was no difference in the incidence of moderate and severe elevation. In conclusion, sevoflurane anesthesia over 3 h was not associated with a higher incidence of clinically significant postoperative liver injury compared to propofol anesthesia.

The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with dexmedetomidine infusion in perioperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received perioperative infusion of dexmedetomidine at a dose 0.40 [0.34–0.47] mg/kg/h during 7.0 [6.0–8.0]) hours. Group II was a control group. In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. The start of dexmedetomidine infusion in 2.7% of cases is accompanied by severe bradycardia, requiring discontinuation of the infusion.

Abstract Background Diversity in hemodynamics of adult congenital heart disease necessitates a case-by-case selection of appropriate surgical and anesthetic options. However, previous case reports regarding the management of laparoscopic surgery in adult patients with congenital heart disease are limited. Case presentation A 72-year-old man who underwent a laparoscopic right colectomy for colon cancer had a residual ventricular septal defect and right ventricular outflow tract obstruction despite post-repair of tetralogy of Fallot. Pulmonary hypertension or right ventricular dysfunction was not observed. The preoperative pulmonary to systemic blood flow ratio (Qp/Qs) was 2.3. After positive pressure ventilation and insufflation, the amount of left-to-right ventricular shunting decreased, and the Qp/Qs approached 1.0, as calculated from pulmonary arterial and systemic arterial blood gas analysis. Conclusions Laparoscopic surgery might be tolerable in patients with tetralogy of Fallot who have preserved the right ventricular function, left-to-right ventricular shunting, and no high pulmonary vascular resistance.

About 300 million non-cardiac operations are performed annually worldwide. In developed countries, an increasing number of such operations are performed in older patients with comorbid cardiac pathology. The leading cause of perioperative mortality is cardiovascular complications. The national and international guidelines published in the last year on cardiovascular assessment and correction of the risk of cardiac complications during non-cardiac operations contain several contradictory provisions. First of all, this refers to the methods of preoperative risk assessment: which is better — to base on scales, functional status assessment or biomarkers (BNP/ NT-pro-BNP) determination? Questions remain about the most appropriate algorithm for preoperative evaluation of patients with suspected cardiac pathology (the need for preoperative non-invasive tests or limited to biomarkers evaluation), some of these algorithms have been validated in recent studies. Several publications address the problem of drug therapy in non-cardiac surgery, both previously studied drugs (statins, beta-blockers) and new ones (colchicine, nicorandil). Perioperative myocardial injury syndrome and its possible drug prevention continue to be studied. This review considers recent publications on this topic, which have not yet been reflected in the guidelines and may influence their correction in the future. The article also discusses the problems of implementing existing guidelines in clinical practice. The publications of the last year presented in the review help researchers and practitioners to form their views on existing controversial issues. Ultimately, this will promote the use of an individualized approach in the management of this category of patients.

Background Burst suppression (BS) is a specific electroencephalogram (EEG) pattern that may contribute to postoperative delirium and negative outcomes. Few prediction models of BS are available and some factors such as frailty and intraoperative hypotension (IOH) which have been reported to promote the occurrence of BS were not included. Therefore, we look forward to creating a straightforward, precise, and clinically useful prediction model by incorporating new factors, such as frailty and IOH.Materials and methods We retrospectively collected 540 patients and analyzed the data from 418 patients. Univariate analysis and backward stepwise logistic regression were used to select risk factors to develop a dynamic nomogram model, and then we developed a web calculator to visualize the process of prediction. The performance of the nomogram was evaluated in terms of discrimination, calibration, and clinical utility.Results According to the receiver operating characteristic (ROC) analysis, the nomogram showed good discriminative ability (AUC = 0.933) and the Hosmer–Lemeshow goodness-of-fit test demonstrated the nomogram had good calibration (p = 0.0718). Age, Clinical Frailty Scale (CFS) score, midazolam dose, propofol induction dose, total area under the hypotensive threshold of mean arterial pressure (MAP_AUT), and cerebrovascular diseases were the independent risk predictors of BS and used to construct nomogram. The web-based dynamic nomogram calculator was accessible by clicking on the URL: https://eegbsnomogram.shinyapps.io/dynnomapp/ or scanning a converted Quick Response (QR) code.Conclusions Incorporating two distinctive new risk factors, frailty and IOH, we firstly developed a visualized nomogram for accurately predicting BS in non-cardiac surgery patients. The model is expected to guide clinical decision-making and optimize anesthesia management.

Patients admitted for acute medical conditions and major noncardiac surgery are at risk of myocardial injury. This is frequently asymptomatic, especially in the context of concomitant pain and analgesics, and detection thus relies on cardiac biomarkers. Continuous single‐lead ST‐segment monitoring from wireless electrocardiogram (ECG) may enable more timely intervention, but criteria for alerts need to be defined to reduce false alerts. This study aimed to determine optimal ST‐deviation thresholds from wireless single‐lead ECG for detection of myocardial injury following major abdominal cancer surgery and during acute exacerbation of chronic obstructive pulmonary disease. Patients were monitored with a wireless single‐lead ECG patch for up to 4 days and had daily troponin measurements. Single‐lead ST‐segment deviations of <0.255 mV and/or >0.245 mV (based on previous study comparison with 0.1 mV 12‐lead ECG and variation in single‐lead ECG) were analyzed for relation to myocardial injury defined as hsTnT elevation of 20–64 ng/L with an absolute change of ≥5 ng/L, or a hsTnT level ≥ 65 ng/L. In total, 528 patients were included for analysis, of which 15.5% had myocardial injury. For corrected ST‐thresholds lasting ≥10 and ≥ 20 min, we found specificities of 91% and 94% and sensitivities of 17% and 13% with odds ratios of 2.0 (95% CI: 1.1; 3.9) and 2.4 (95% CI: 1.1; 5.1) for myocardial injury. In conclusion, wireless single‐lead ECG monitoring with corrected ST thresholds detected patients developing myocardial injury with specificities >90% and sensitivities <20%, suggesting increased focus on sensitivity improvement. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Malvidin is a natural, biologically active polyphenol found in several fruits. It exhibits several therapeutic benefits; however, limited studies are available on its effects on neurodegenerative clinical conditions, including Parkinson's disease. The study aimed to investigate the therapeutic properties of malvidin on rotenone-triggered Parkinson's disease in an animal model. MATERIALS AND METHODS: To determine the effects of malvidin, rotenone (1.5 mg/kg) was injected subcutaneously into Wistar rats for 21 days, followed by a dose of malvidin (200 and 100 mg/kg). Behavioral tests were performed on the experimental animals before sacrifice. On the 22nd day of the experiment, biochemical tests were performed, including superoxide dismutase (SOD), glutathione (GSH), malondialdehyde (MDA), and catalase (CAT). The activity of neurotransmitters and their metabolites, including acetylcholine (ACh), acetylcholinesterase (AChE), dopamine (DA), norepinephrine (NE), serotonin (5-HT), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA) along with neuroinflammatory markers including interleukin-6 (IL-6), interleukin-1ß (IL-1ß), tumor necrosis factor-a (TNF-a), and nuclear factor erythroid 2-related factor 2 (Nrf-2) were estimated. Moreover, the level of the apoptotic marker, caspase-3, was also estimated. In addition, molecular docking was performed. RESULTS: The administration of rotenone resulted in oxidative stress, cholinergic imbalances, dopaminergic alternations, and increased expression of inflammatory compounds. The docking analysis revealed that malvidin displayed a favorable binding affinity for AChE, showcasing a binding energy of -9.329 Kcal/mol. CONCLUSIONS: The investigation concludes that malvidin exhibits neuroprotective effects due to its curative effects against inflammation and oxidative stress. These findings suggest that malvidin possesses therapeutic potential against rotenone-triggered behavioral, oxidative, and inflammatory abnormalities in rodents. [ABSTRACT FROM AUTHOR]

Background: Diversity in hemodynamics of adult congenital heart disease necessitates a case-by-case selection of appropriate surgical and anesthetic options. However, previous case reports regarding the management of laparoscopic surgery in adult patients with congenital heart disease are limited. Case presentation: A 72-year-old man who underwent a laparoscopic right colectomy for colon cancer had a residual ventricular septal defect and right ventricular outflow tract obstruction despite post-repair of tetralogy of Fallot. Pulmonary hypertension or right ventricular dysfunction was not observed. The preoperative pulmonary to systemic blood flow ratio (Qp/Qs) was 2.3. After positive pressure ventilation and insufflation, the amount of left-to-right ventricular shunting decreased, and the Qp/Qs approached 1.0, as calculated from pulmonary arterial and systemic arterial blood gas analysis. Conclusions: Laparoscopic surgery might be tolerable in patients with tetralogy of Fallot who have preserved the right ventricular function, left-to-right ventricular shunting, and no high pulmonary vascular resistance. [ABSTRACT FROM AUTHOR]

Background: In patients having non-cardiac surgery, perioperative cardiovascular problems constitute the primary contributor to both morbidity and death. Objective: Uncovering hidden cardiac problems among asymptomatic patients that may cause complications during and after low to intermediate risk non-cardiac surgery. Subjects and Methods: The study was conducted on 300 cases; and all of them were subjected to full preoperative cardiac assessment including full history taking, clinical examination, laboratory investigations, 12-lead surface ECG and transthoracic echocardiography to exclude any case with significant heart disease. All patients were followed up during hospital stay for assessment of perioperative complications. Results: Regarding incidence of complications and types of cardiac complications distribution among study groups, 275 patients (91.7%) had no complications and 25 patients (8.3%) had complications in the form of: sinus tachycardia (5 patients "1.7%"), hypotension (4 patients "1.3%"), Supra ventricular tachycardia (4 patients "1.3%"), arrested (3 patients "1.0%"), venous thrombosis (3 patients "1.0%"), Atrial fibrillation (2 patients "0.7%"), pulmonary embolism (2 patients "0.7%"), acute pulmonary edema (one patient "0.3%") and suspected pulmonary embolism (one patient "0.3%"). Conclusion: There was a statistically significant increase in postoperative complications among cardiac patients who did not exhibit any symptoms. The clinical and predictive use of routine preoperative electrocardiography (ECG) and echocardiography (ECHO) in persons having low- to intermediate-risk surgery for major cardiac adverse events is limited. [ABSTRACT FROM AUTHOR]

Cardiovascular comorbidities are amongst the most important modifiable risk factors in patients undergoing non-cardiac surgery. Likewise, cardiac complications are a leading cause of all perioperative morbidity and mortality. Major adverse events include acute myocardial ischaemia, infarction, congestive cardiac failure, arrhythmias, and cardiac arrest. Preoperative assessment and planning aims to minimize these risks. Although testing is important, it must be rationalized lest resources are misused and undue delays ensue. Current thinking in preoperative therapy, intraoperative management and postoperative care is discussed. Although most patients with cardiac disease have ischaemic heart disease, other specific cardiac conditions and principles of their management are briefly considered. [ABSTRACT FROM AUTHOR]

Background and Aims Haemodynamic instability is associated with peri-operative myocardial injury, particularly in patients receiving renin–angiotensin system (RAS) inhibitors (angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers). Whether stopping RAS inhibitors to minimise hypotension, or continuing RAS inhibitors to avoid hypertension, reduces peri-operative myocardial injury remains unclear. Methods From 31 July 2017 to 1 October 2021, patients aged ≥60 years undergoing elective non-cardiac surgery were randomly assigned to either discontinue or continue RAS inhibitors prescribed for existing medical conditions in six UK centres. Renin–angiotensin system inhibitors were withheld for different durations (2–3 days) before surgery, according to their pharmacokinetic profile. The primary outcome, masked to investigators, clinicians, and patients, was myocardial injury [plasma high-sensitivity troponin-T (hs-TnT) ≥ 15 ng/L within 48 h after surgery, or ≥5 ng/L increase when pre-operative hs-TnT ≥15 ng/L]. Pre-specified adverse haemodynamic events occurring within 48 h of surgery included acute hypertension (>180 mmHg) and hypotension requiring vasoactive therapy. Results Two hundred and sixty-two participants were randomized to continue (n = 132) or stop (n = 130) RAS inhibitors. Myocardial injury occurred in 58 (48.3%) patients randomized to discontinue, compared with 50 (41.3%) patients who continued, RAS inhibitors [odds ratio (for continuing): 0.77; 95% confidence interval (CI) 0.45–1.31]. Hypertensive adverse events were more frequent when RAS inhibitors were stopped [16 (12.4%)], compared with 7 (5.3%) who continued RAS inhibitors [odds ratio (for continuing): 0.4; 95% CI 0.16–1.00]. Hypotension rates were similar when RAS inhibitors were stopped [12 (9.3%)] or continued [11 (8.4%)]. Conclusions Discontinuing RAS inhibitors before non-cardiac surgery did not reduce myocardial injury, and could increase the risk of clinically significant acute hypertension. These findings require confirmation in future studies. [ABSTRACT FROM AUTHOR]

Hypertension is a prevalent condition that poses significant challenges in the perioperative management of patients undergoing major non‐cardiac surgery, particularly concerning wound healing and scar formation. This meta‐analysis assesses the impact of long‐term antihypertensive treatment on postoperative wound healing, examining data from seven studies involving patients who received such treatments compared to untreated controls. Our findings reveal that long‐term antihypertensive therapy is associated with significantly improved wound healing outcomes, as indicated by lower REEDA scores (I2 = 96%, SMD = −25.71, 95% CI: [−33.71, −17.70], p < 0.01) 1 week post‐surgery and reduced scar formation, demonstrated by lower Manchester Scar Scale scores (I2 = 93%, SMD = −37.29, 95% CI: [−44.93, −29.64], p < 0.01) 2 months post‐surgery. These results underscore the potential benefits of antihypertensive treatment in enhancing surgical recovery and offer insights into optimising perioperative care for hypertensive patients. [ABSTRACT FROM AUTHOR]

Every year, not less than 300 million non-cardiac surgery interventions are performed in the world. Perioperative mortality after non-cardiac surgery is estimated at 2% in patients over 45 years of age. Cardiovascular events account for half of these deaths, and most are due to perioperative myocardial infarction (MINS). The diagnosis of postoperative myocardial infarction, before the introduction of cardiac biomarkers, was based on symptoms and electrocardiographic changes and its incidence was largely underestimated. The incidence of MINS when a standard troponin assay is used ranges between 8 and 19% but increases to 20–30% with high-sensitivity troponin assays. Higher troponin values suggesting myocardial injury, both with or without a definite diagnosis of myocardial infarction, are associated with an increase in 30-day and 1-year mortality. Diagnostic and therapeutic strategies are reported. [ABSTRACT FROM AUTHOR]

Aim. To assess the prognostic value of current scales and indices for risk stratification of any surgical and cardiovascular complications (CVC) in patients undergoing non-cardiac surgical interventions.Material and methods. This single-center cohort retrospective study was conducted in patients who underwent non-cardiac surgery in 2018 and 2020. Surgical postoperative complications (POCs) were assessed according to the Clavien-Dindo classification. CVCs included any cardio-vascular events (CVEs), major adverse cardiac events (MACE), ST-T abnormalities on the electrocardiogram (ECG), decompensated heart failure (HF), arrhythmias, episodes of hypotension or hypertension, delirium, bleeding, thromboembolic events (TEEs). Risk stratification of POCs was carried out using recommended prognostic scales and indices. Their prognostic significance was assessed using ROC analysis with assessment of the area under the curve (AUC).Results. POC risk stratification was performed in 2937 patients. There was following prognostic value of scales and indices: Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score — AUC of 0,990, 0,808, 0,825, 0,841, 0,808, 0,793, 0,701, 0,776, 0,744 in predicting Clavien-Dindo grade 5, 4, HF, delirium, TEEs, MACE, ST-T abnormalities, arrhythmias, bleeding, respectively; Surgical Outcome Risk Tool (SORT) — AUC of 0,973, 0,740, 0,890, 0,763, 0,721, 0,716, 0,700 in predicting Clavien-Dindo grade 5, 4, delirium, MACE, HF, arrhythmia, TEEs, respectively; American Society of Anesthesiologists (ASA) — AUC of 0,648, 0,600, 0,658 for HF, ST-T abnormalities, arrhythmias, respectively; Charlson comorbidity index — AUC of 0,819, 0,950, 0,789, 0,788, 0,706, 0,771, 0,898 in predicting Clavien-Dindo grade 5, 4, MACE, HF, ST-T abnormalities, arrhythmias, delirium; surgical risk score associated with the risk of cardiac events — AUC of 0,989, 0,887, 0,728 for Clavien-Dindo grade 3, 5, MACE, respectively; reconstructed Revised Cardiac Risk Index (rRCRI) — AUC of 0,916 and 0,979, 0,762, 0,741, 0,737 in predicting Clavien-Dindo grade 3, 5, HF, arrhythmia, delirium, respectively; National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) — AUC of 0,705, 0,757, 0,718 for arrhythmia, delirium, TEEs, respectively; total cardiovascular risk according to 2022 European Society of Cardiology (ESC) guidelines — AUC of 0,942, 0,726, 0,701, 0,748, 0,785 for Clavien-Dindo grade 5, MACE, ST-T abnormalities, arrhythmias, delirium, respectively; Caprini score — AUC of 0,718 and Venous ThromboEmbolism and Bleeding (VTE-Bleed) — AUC of 0,722 in predicting TEEs; simplified Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS) index — AUC of 0,729 for stratification of bleeding. In assessment of total risk of Clavien-Dindo surgical complications and any CVEs, none of the scales showed a predictive value of >0,7.Conclusion. Any CVE stratification requires improvement of current tools and development of novel prognostic tools.

Background: Postoperative agitation is common after non-cardiac surgery. It is associated with postoperative delirium and cognitive dysfunction, leading to prolonged hospital stay and delayed social readjustment. Prevention and treatment strategies are lacking. We assessed the efficacy of a novel approach, the Wash In/Wash Out procedure, in reducing post-anesthetic agitation. Methods: This multicenter, parallel-group, double-blind randomized controlled trial is enrolling 200 patients undergoing open abdominal surgery. Participants are randomly assigned to either a control group receiving standard recovery methods or an investigational group undergoing the Wash In/Wash Out procedure. In the Wash In/Wash Out procedure group, sevoflurane is stopped and then promptly restarted when the patient shows the first signs of awakening to achieve an end-tidal concentration of 1 minimum alveolar concentration (MAC) for 5 min. This stop-and-restart cycle is performed three times. The trial's primary outcome is the rate of postoperative agitation. Secondary outcomes include rate of postoperative delirium and cognitive dysfunction, postoperative nausea and vomiting, and length of intensive care and hospital stay. Discussion: The OPERA trial investigates the effect of the Wash In/Wash Out procedure to reduce post-anesthetic agitation in non-cardiac surgery. This study could offer a significant contribution to improving patient outcomes and optimizing recovery protocols in surgical settings.

The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with an infusion of a succinate-containing drug during the intraoperative period of vascular surgery.Materials and methods. The study involved 120 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1 %) who underwent elective vascular surgery. Patients were randomly divided into two groups. Patients of group 1 received intraoperative infusion of succinate-containing drug at a dose of succinate 0.35 [0.26–0.40] mg/kg/min– 1. Group II was a control group. In the perioperative period, the occurrence of perioperative CVC, the blood level of the N-terminal segment of natriuretic B-type prohormone (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed.Results. Perioperative CVC was registered in 11 (18.3 %) patients of group I and in 11 (18.3 %) patients of group II (p = 1.0). The level of NT-proBNP in patients of group I and group II was 207 [160–300] pg/ml and 229 [150.6–298.9] pg/ml (p = 0.817) before surgery, 234.2 [155.9–356] and 277 [177.7–404] pg/ml ( p = 0.207) after surgery and 240.5[149.3–306] and 235.5 [133–495.1] pg/ml ( p = 0.979) before discharge from the hospital. An increased level of cTnI after surgery was recorded in 4 (6.7 %) patients of group I and in 1 (1.7 %) patient ( p = 0.364) of group II.Conclusion. Intraoperative infusion of succinate-containing drug does not affect the occurrence of CVC in patients with high cardiac risk during vascular surgery. The succinate-containing drug does not affect the preoperative level of NT-proBNP and cTnI.

Ya-Jun Yang,1,&ast; Yu-Mei Feng,1,&ast; Tong-Xuan Wang,1 Jing-Yun Wang,2 Qian-Yun Pang,1 Hong-Liang Liu1 1Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China; 2School of Medicine, Chongqing University, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hong-Liang Liu; Qian-Yun Pang, Department of Anesthesiology, Chongqing University Cancer Hospital, No. 181, Hanyu Road, Shapingba District, Chongqing, 400030, People’s Republic of China, Tel +86 13883686721, Email liuhl75@163.comBackground: Noradrenaline (NA) is commonly used intraoperatively to prevent fluid overload and maintain hemodynamic stability. Clinical studies provided inconsistent results concerning the effect of NA on postoperative outcomes. As aging is accompanied with various diseases and has the high possibility of the risk for postoperative complications, we hypothesized that intraoperative NA infusion in older adult patients undergoing major non-cardiac surgeries might potentially exert adverse outcomes.Methods: In this retrospective propensity score-matched cohort study, older adult patients undergoing major non-cardiac surgeries were selected, 1837 receiving NA infusion during surgery, and 1072 not receiving NA. The propensity score matching was conducted with a 1:1 ratio and 1072 patients were included in each group. The primary outcomes were postoperative in-hospital mortality and complications.Results: Intraoperative NA administration reduced postoperative urinary tract infection (OR:0.124, 95% CI:0.016– 0.995), and had no effect on other postoperative complications and mortality, it reduced intraoperative crystalloid infusion (OR:0.999, 95% CI:0.999– 0.999), blood loss (OR: 0.998, 95% CI: 0.998– 0.999), transfusion (OR:0.327, 95% CI: 0.218– 0.490), but increased intraoperative lactate production (OR:1.354, 95% CI:1.051– 1.744), and hospital stay (OR:1.019, 95% CI:1.008– 1.029).Conclusion: Intraoperative noradrenaline administration reduces postoperative urinary tract infection, and does not increase other postoperative complications and mortality, and can be safely used in older adult patients undergoing major non-cardiac surgeries.Keywords: noradrenaline, outcome, older adult, non-cardiac surgery

Guangyou Duan,1,&ast; Haibo Deng,2,&ast; Hong Fu,3 Lingzhi Wang,4 Hanyu Yang5 1Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing City, 400000, People’s Republic of China; 2Department of Anesthesiology, Huizhou Third People’s Hospital, Guangzhou Medical University, Guangzhou, 516002, People’s Republic of China; 3Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, People’s Republic of China; 4Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 051026, People’s Republic of China; 5Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangyou Duan, Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74, Linjiang Road, Chongqing City, 400000, People’s Republic of China, Email duangy@hospital.cqmu.edu.cnPurpose: This study aimed to compare the electrolyte balance efficacies of two Gelatin-Balanced Crystalloid in clinical applications.Methods: A multi-center, prospective, randomized, single-blind, parallel controlled study was conducted among non-cardiac surgery patients, with clinical registration number ChiCTR2200062999. They were randomized into Succinylated Gelatin, Multiple Electrolytes and Sodium Acetate Injection (SG-MESAI) group (experimental group) and Succinylated Gelatin Injection (SGI) infusion group (control group). The same anesthetic induction technique, anesthetic method, and calculation method for the volume of colloid infusion were used in the two groups. Between-group differences in the changes in base excess (BE), Chloride ion (Cl−), bicarbonate radical (HCO3⁻) and other parameters were recorded at 15 min, 30 min after the infusion relative to the baseline. Hemodynamic indicators were determined at 30 min after colloid infusion. Safety follow-up was conducted by administering the following tests within 48 h± 12 h after surgery.Results: A total of 225 subjects (full analysis set) were finally enrolled, with 110 subjects in the experimental group and 115 subjects in the control group. The baseline data were comparable between the two groups. At 15 min after infusion, the mean changes in BE, Cl− and HCO3⁻ concentration in the experimental group were smaller than those of the control group (P< 0.001). At 30 min after surgery, the mean changes in BE, Cl−, HCO3⁻concentration and pH value were smaller in the experimental group than in the control group (P< 0.05). The incidences of adverse events and adverse reactions in the experimental group was less than the control group, but the difference was not statistically significant (P≥ 0.05). Besides, no serious adverse events or adverse reactions were reported in any subjects.Conclusion: Succinylated Gelatin, Multiple Electrolytes and Sodium Acetate Injection maintained the balance of BE, Cl−, HCO3⁻ and pH value in a better way than Succinylated Gelatin Injection in non-cardiac surgery patients under general anesthesia.Keywords: anesthesia, non-cardiac surgery, fluid therapy, drug clinical trial, succinylated gelatin, multiple electrolytes and sodium acetate injection

Zheng Wang,1,2 Xin Du,1 Jianzeng Dong1 1Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing, 100029, People’s Republic of China; 2Department of Intensive Care Unit, Peking University International Hospital, Beijing, 102206, People’s Republic of ChinaCorrespondence: Jianzeng Dong; Xin Du, Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, No. 2 of Anzhen Road, Chaoyang District, Beijing, 100029, People’s Republic of China, Tel +86 13911828375 ; +86 13370103558, Fax +86 1084005363, Email jz_dong@126.com; duxinheart@sina.comObjective: To describe the effects of various fluid strategies on mechanical ventilation time and other outcomes in patients with diastolic dysfunction undergoing non-cardiac surgery.Methods: After evaluation, 192 Intensive Care patients met the inclusion criteria. Based on infusion volume and fluid balance, we categorized patients into quartiles using two grouping methodologies. The first quartiles for total infusion volume on day one of ICU admission after surgery were as follows: Q1 ≤ 2.02 mL/kg/h; Q2 > 2.02 to 2.69 mL/kg/h; Q3 > 2.69 to 3.86 mL/kg/h; Q4 > 3.86 mL/kg/h. The second quartiles for fluid balance divided by actual body weight multiplied by the corresponding number of hours were as follows: G1 ≤ − 0.07 mL/kg/h; G2 > − 0.07 to 0.56 mL/kg/h; G3 > 0.56 to 1.54 mL/kg/h; G4> 1.54 mL/kg/h. The primary outcome was mechanical ventilation time. The research utilized both univariate and multivariate negative binomial regression models.Results: The fourth group (Q4 and G4) had a significant impact on mechanical ventilation time(P< 0.05).There were also significant differences between Q4 or G4 and some other groups in terms of ICU time, ICU cost, total hospital time, and total hospital cost (P < 0.05).After negative binomial regression analysis,Q2 and Q4 were approximately 2.406 times (95% CI 1.153– 5.017, P = 0.019) and 3.532 times (95% CI 1.812– 6.883, P < 0.01) longer than Q1 respectively, when grouped by infusion volume, but there was no significant difference between G groups. And Q4 or G4 also differed significantly from other parameters of clinical outcomes (P < 0.05).Conclusion: For patients admitted to the ICU following non-cardiac surgery with left ventricular diastolic dysfunction, the greater the fluid infusion or fluid balance, the greater the mechanical ventilation time, ICU or hospital time, and cost.Keywords: fluid strategies, left ventricular diastolic dysfunction, non-cardiac surgery, mechanical ventilation time, perioperative period

This study aimed to investigate the association between glucose dysregulation and delirium after non-cardiac surgery. Among a total of 203,787 patients who underwent non-cardiac surgery between January 2011 and June 2019 at our institution, we selected 61,805 with available preoperative blood glucose levels within 24 h before surgery. Patients experiencing glucose dysregulation were divided into three groups: hyperglycemia, hypoglycemia, and both. We compared the incidence of postoperative delirium within 30 days after surgery between exposed and unexposed patients according to the type of glucose dysregulation. The overall incidence of hyperglycemia, hypoglycemia, and both was 5851 (9.5%), 1452 (2.3%), and 145 (0.2%), respectively. The rate of delirium per 100 person-months of the exposed group was higher than that of the unexposed group in all types of glucose dysregulation. After adjustment, the hazard ratios of glucose dysregulation in the development of delirium were 1.35 (95% CI, 1.18–1.56) in hyperglycemia, 1.36 (95% CI, 1.06–1.75) in hypoglycemia, and 3.14 (95% CI, 1.27–7.77) in both. The subgroup analysis showed that exposure to hypoglycemia or both to hypo- and hyperglycemia was not associated with delirium in diabetic patients, but hyperglycemia was consistently associated with postoperative delirium regardless of the presence of diabetes. Preoperative glucose dysregulation was associated with increased risk of delirium after non-cardiac surgery. Our findings may be helpful for preventing postoperative delirium, and further investigations are required to verify the association and mechanisms for the effect we observed. [ABSTRACT FROM AUTHOR]

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Background: Early identification of elderly patients undergoing non-cardiac surgery who may be at high risk for postoperative cognitive dysfunction (POCD) can increase the chances of prevention for them, as extra attention and limited resources can be allocated more to these patients. Aim: We performed this analysis with the aim of developing a simple, clinically useful machine learning (ML) model to predict the probability of POCD at 3 months in elderly patients after non-cardiac surgery. Methods: We collected information on patients who received surgical treatment at Nanjing First Hospital from May 2020 to May 2021. We used LASSO regression to select key features and built 5 ML models to assess the risk of POCD at 3 months in elderly patients after non-cardiac surgery. The Shapley Additive exPlanations (SHAP) and methods were introduced to interpret the best model. Results: A total of 415 patients with non-cardiac surgery were included. The support vector machine (SVM) was the best-performing model of the five ML models. The model showed excellent performance compared to the other four models. The SHAP results showed that VAS score, age, intraoperative hypotension, and preoperative hemoglobin were the four most important features, indicating that the SVM model had good interpretability and reliability. The website of the web-based calculator was https://modricreagan-non-3-pocd-9w2q78.streamlit.app/. Conclusion: Based on six important perioperative variables, we successfully established a series of ML models for predicting POCD occurrence at 3 months after surgery in elderly non-cardiac patients, with SVM model being the best-performing model. Our models are expected to serve as decision aids for clinicians to monitor screened high-risk patients more closely or to consider further interventions. [ABSTRACT FROM AUTHOR]

Objectives: To identify differences in practice patterns and outcomes related to the induction of general anesthesia for patients with pulmonary hypertension (PH) performed by anesthesiologists who have completed a cardiothoracic fellowship (CTA group) vs those who have not (non-CTA group). Design: Retrospective study with propensity score matching. Setting: Operating room. Participants: All adult patients with PH undergoing general anesthesia requiring intubation at a single academic center over 5 years. Interventions: Patient baseline characteristics, peri-induction management variables, post-induction mean arterial pressure (MAP), and other outcomes were compared between CTA and non-CTA groups. Methods and main results: Following propensity scoring matching, 402 patients were included in the final model, 100 in the CTA group and 302 in the non-CTA group. Also following matching, only cases of mild to moderate PH without right ventricular dysfunction remained in the analysis. Matched groups were overall statistically similar with respect to baseline characteristics; however, there was a greater incidence of higher ASA class (P =.025) and cardiology and thoracic procedures (P <.001) being managed by the CTA group. No statistical differences were identified in practice patterns or outcomes related to the induction of anesthesia between groups, except for longer hospital length of stay in the CTA group (P =.008). Conclusions: These results provide early evidence to suggest the induction of general anesthesia of patients with non-severe PH disease can be comparably managed by either anesthesiologists with or without a cardiothoracic fellowship. However, these findings should be confirmed in a prospective study. [ABSTRACT FROM AUTHOR]

BackgroundIntraoperative cardiac complications are a common cause of morbidity and mortality in non-cardiac surgery. The risk of these complications increased with the average age increasing from 65. In a resource-limited setting, including our study area, the magnitude and associated factors of intraoperative cardiac complications have not been adequately investigated. The aim of this study was to assess the magnitude and associated factors of intraoperative cardiac complications among geriatric patients undergoing non-cardiac surgery.MethodsAn institutional-based multi-center cross-sectional study was conducted on 304 geriatric patients at governmental hospitals in the southern region of Ethiopia, from 20 March 2022 to 25 August 2022. Data were collected by chart review and patient interviews. Epi Data version 4.6 and SPSS version 25 were used for analysis. The variables that had association (p 85 years (AOR = 6.01, CI = 5.12–12.21), and anesthesia time > 3 h (AOR =2.27, CI = 2.0.2–18.25) were factors significantly associated with intraoperative cardiac complications.ConclusionThe magnitude of intraoperative cardiac complications was high among geriatric patients who had undergone non-cardiac surgery. The independent risk factors of intraoperative cardiac complications for this population included age > 85, ST-segment elevation, perioperative hypertension (stage 3 with regular treatment), duration of anesthesia >3 h, intraoperative hypoxia, and intraoperative hypotension. Holistic preoperative evaluation, optimization optimal and perioperative care for preventing perioperative risk factors listed above, and knowing all possible risk factors are suggested to reduce the occurrence of complications.

The objective was to study the dynamics of NT-proBNP blood level during the perioperative period of vascular surgery and to study the association of this biomarker level at the stages of treatment with developed cardiovascular complications (CVC).Materials and Methods. The study involved 129 patients aged 66 [61–70] years who underwent elective vascular surgery. NT-proBNP blood level was determined at stages: I – before surgery, II – 24 hours after surgery, III – before discharge from the hospital. Correlation analysis, logistic regression and ROC-analysis were used for data processing.Results. Median NT-proBNP (pg/ml) at stage I was 54[42–215], stage II – 149[63–298] (p1–2 = 0.0001) and stage III – 78[48–288] (p1–3 = 0.037). NT-proBNP blood level at stage I correlated with the biomarker level at stages II (rho = 0.558, p < 0.0001) and III (rho = 0.689, p < 0.0001). The biomarker was associated with CVC at all stages: I – OR 1.0048, 95% CI 1.0021–1.0074, p < 0.0001, AUC 0.825; II – OR 1.0040, 95% CI 1.0020–1.0060, p < 0.0001, AUC 0.820; III – OR 1.0026, 95% CI 1.006–1.0046, p = 0.015, AUC 0.687. At stage I, NT-proBNP > 218 pg/ml was a CVC predictor (sensitivity 82%, specificity 85%), this biomarker level was registered in 30 (23.2%) patients; at stage II, NT-proBNP > 281 pg/ml was associated with CVR (sensitivity 81%, specificity 80%), at stage III NT-proBNP > 158 pg/ml was associated with CCC (sensitivity 79%, specificity 65%).Conclusions. After vascular surgery, the median NT-proBNP value increases significantly, remaining within the reference limits, and does not de[1]crease until the patients discharge from the hospital. The perioperative NT-proBNP dynamics may differ in patients with different initial biomarker levels. In 23.2% of vascular surgical patients, the preoperative NT-proBNP blood level increased to a level of more than 218 pg/ml, indicating CVC risk (very good quality predictor model). After surgery, the level of NT-proBNP associated with CVC (very good quality model) exceeds 281 pg/ml. Prior to discharge of patients from the hospital, the association of NT-proBNP with CVC is characterized by a moderate quality model (AUC 0.687). The prognostic significance of the biomarker at this stage of surgical treatment needs further research.

Jiejuan Chen,1 Xiaohua Zou,2 Bailong Hu,2 Yang Yang,2 Feng Wang,2 Qian Zhou,2 Minhuan Shen2 1School of Anesthesiology, Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China; 2Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of ChinaCorrespondence: Xiaohua Zou, Email zouxiaohuazxh@163.comBackground: Remimazolam tosilate (RT) is a novel ultrashort-acting γ-aminobutyric acid subtype A (GABAA) agonist, with several advantages including rapid induction and recovery, stable haemodynamics, and mild respiratory inhibition. However, studies have not been conducted to explore the haemodynamic effects of RT in elderly hypertensive subjects undergoing non-cardiac surgery. Therefore, we sought to compare the effects of anaesthesia induction using different doses of RT and etomidate on the haemodynamics of this group of patients.Methods: Patients were recruited into this single-center, prospective, randomized, double-blind trial from October 2022 to June 2023. A total of 150 hypertensive elderly undergoing non-cardiac surgery were randomly assigned into 0.2 mg/kg RT group (Group RL), 0.3 mg/kg RT group (Group RH) and 0.3 mg/kg etomidate group (Group E). The primary outcome of the study was haemodynamic changes (mean arterial pressure fluctuation value -∆MAP and heart rate fluctuation value -∆HR) observed during anaesthesia induction. Secondary outcomes included incidence of adverse cardiovascular events and adverse drug reactions (injection pain and myoclonus), cumulative doses of vasoactive drugs and vital signs at different time points.Results: Patients in Group E and Group RL had significantly lower haemodynamic fluctuations (∆MAP), lower incidence of hypotension and cumulative dose of ephedrine than subjects in Group RH. Patients in groups RL and RH had significantly lower incidence of injection pain and myoclonus compared with patients in group E. The results showed no statistically significant differences in ∆HR, hypertension, bradycardia, tachycardia, and time to loss of eye-opening reflex and start of intubation, and vital signs at different time points among the three groups.Conclusion: Use of low-dose RT (0.2 mg/kg) for induction of non-cardiac surgical anaesthesia in elderly hypertensive patients is more effective in maintaining haemodynamic stability and has fewer adverse effects compared with etomidate.Keywords: remimazolam tosylate, etomidate, haemodynamics, elderly patients, hypertension, non-cardiac surgery

Ventilator-associated pneumonia (VAP) is a critical hospital-acquired infection following non-cardiac surgeries, leading to poor outcomes. This study identifies VAP risk factors in non-cardiac surgical patients and determines the causative pathogens. A retrospective analysis with 1:4 propensity-score matching was conducted on patients in a surgical intensive care unit (ICU) from 2010 to 2020 at a private tertiary medical center. Among 99 VAP patients, the mortality rate was 64.7%. VAP risk factors included prolonged mechanical ventilation (odds ratio [OR] 6.435; p < 0.001), repeat intubation (OR 6.438; p < 0.001), lower oxygenation levels upon ICU admission (OR 0.950; p < 0.001), and undergoing gastrointestinal surgery (OR 2.257; p = 0.021). The 30-day mortality risk factors in the VAP group were late-onset VAP (OR 3.450; p = 0.022), inappropriate antibiotic treatment (OR 4.083; p = 0.041), and undergoing gastrointestinal surgeries (OR 4.776; p = 0.019). Nearly half of the Gram-negative infections were resistant strains, and a third were polymicrobial infections. Non-cardiac surgical patients with VAP face adverse hospital outcomes. Identifying high-risk patients and understanding VAP’s resistant and microbial nature are crucial for appropriate treatment and improved health outcomes.

Objective To investigate perioperative management and prognosis in patients aged≥80 years old undergoing non-cardiac surgery. Methods Clinical data of 828 patients aged≥80 years old undergoing non-cardiac surgery were retrospectively analyzed. Intraoperative hypotension， accumulated time of hypotension， operation time， intraoperative blood loss， postoperative ICU admission， length of ICU stay， length of hospital stay， cost of care， perioperative complications need to be treated， and perioperative death were recorded and analyzed. Results The mean age of 828 patients was （84±4） years old. All cases were classified as American Society of Anesthesiologist （ASA） gradeⅡ-Ⅴ. Postoperative complications occurred in 111 patients （13.4%）， and postoperative death occurred in 24 patients （2.9%）. The incidence of postoperative complications and death in thoracic， neuro-，and vascular surgery was 29% and 17%， the highest among various types of operations （all P < 0.05）. Among patients with different ASA grades， the incidence of postoperative complications and death in patients with ASA gradeⅣand V was significantly higher than that in their counterparts with ASA gradeⅡ（both P < 0.001）. The selection of anesthesia approach did not affect the incidence of postoperative complications and death in different operations except thoracic， neuro-， and vascular surgery under general anesthesia （P > 0.05）. Compared with patients with intraoperative systolic pressure of 0.05）. Conclusions Patients aged≥80 years old have high incidence of postoperative complications and death rates， which is probably associated with high-risk operation and intraoperative hypotension， especially systolic hypotension of < 90 mmHg enduring for≥10 min.

Aim. To evaluate any cardiovascular abnormalities in the postoperative period, their prevalence and impact on the course of postoperative period in patients after non-cardiac surgery, which underwent postoperative examinations of cardiovascular system.Material and methods. The study included 2937 patients. The assessed end points were postoperative cardiovascular events (CVEs). Along with major adverse cardiovascular events (MACE), we analyzed any cardiovascular abnormalities in the postoperative period as follows: electrocardiographic ST-T abnormalities, acute or decompensated heart failure (HF), arrhythmias, episodes of hypotension or hypertension, bleeding, thromboembolic events (TEEs), cerebrovascular events, postoperative delirium. Any CVEs constituted the any cardiovascular events' (ACVEs) group. Statistical analysis was carried out using the StatTech v program. 3.1.6 (OOO Stattekh, Russia).Results. Any postoperative complications according to the Clavien-Dindo classification were 54,7%, while grade 1 — 33,9%, grade 2 — 20,3%, grade 3 — 1 case, grade 4 — 0,4%, grade 5 — 0,1%. MACEs developed in 0,2% of cases. ACVEs amounted to 13,3%, including 2,3% — ST-T abnormalities, 6,3% — significant systolic blood pressure changes, 2,6% — arrhythmias, 0,7% — HF, 2,4% — bleeding, 1,1% — TEEs, 0,3% — delirium. In addition, 67 (17,5%) patients had ≥2 CVEs. Comparison of the length of hospital stay of patients with ACVEs, in particular with MACEs, ECG ST-T abnormalities, HF, arrhythmia, episodes of hypotension or hypertension, bleeding, TEEs, cerebrovascular events, delirium, with groups of patients without such complications revealed significant differences. ACVEs accounted for 1/4 of all postoperative complications and 2/3 of complications of grades 2-5.Conclusion. We expanded the concept of CVEs, united the totality of any cardiovascular abnormalities in the postoperative period, emphasized not only their clinical significance, but also the economic feasibility of taking into account ACVEs.

BackgroundThe effect of different non-cardiac surgical methods on islet and renal function remains unclear. We conducted a preliminary investigation to determine whether different surgical methods affect islet function or cause further damage to renal function.MethodsIn this prospective cohort study, the clinical data of 63 adult patients who underwent non-cardiac surgery under general anesthesia were evaluated from February 2019 to January 2020. Patients were divided into the abdominal surgery group, the laparoscopic surgery group, and the breast cancer surgery group. The primary outcome was the difference between the effects of different surgical methods on renal function.ResultsIslet and renal function were not significantly different between the groups. The correlation analysis showed that hematocrit (HCT) and hemoglobin (HB) were negatively correlated with fasting plasma glucose (FPG) (p