Search

Background: Extensive surgical procedures play a key role in treatment of various lung diseases. Nevertheless, these complex procedures are associated with a high risk of early postoperative complications.Objective: To evaluate outcomes of the early postoperative period in patients with various lung diseases and determine risk factors for postoperative complications.Material and methods: We analyzed postoperative complications in 377 patients who underwent extensive lung surgery. The mean age was 45.7 ± 5.2 years. The majority of patients (56.0%) had malignant or benign lung tumors. Lobectomy was the most common type of surgery. Pneumonectomy accounted for 26.5%.Results: The overall rate of cardiovascular complications was 8.2%. The highest number of complications was observed after right-sided pneumonectomy (21.7%). Respiratory complications after right-sided pneumonectomy accounted for 34.8%. Lobectomy and bilobectomy had lower rates of complications (4.4% and 6.3%, respectively). The highest number of systemic complications was also recorded after right-sided pneumonectomy (23.9%), whereas lobectomy had a lower risk (4.4%). Patients with primary lung tumors had significantly more complications (32.2%) compared with patients without cancer (10.8%). The main risk factors were male gender (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = .032), age ≥60 years (OR, 1.9; 95% CI, 1.5-2.6; P = .001), smoking (OR, 1.7; 95% CI, 1.2-2.5; P = .019), C-reactive protein level >3 mg/dL (OR, 1.8; 95% CI, 1.1-2.7; P = .015) and forced expiratory volume in the first second of expiration (FEV1)

Objective. To determine the influence of the urgency of performing surgical decompression of the spinal cord (SC) on the course of acute and early periods of complicated injury of the lower cervical spine. Material and Methods. The results of treatment of 75 patients with acute complicated injury of the lower cervical spine with ASIA A and ASIA B severity of spinal cord injuries were retrospectively analyzed. Two groups were formed, depending on the timing of surgical decompression of the spinal cord after injury. Group I included 33 patients in whom the SC decompression was performed within the first eight hours after the injury, and Group II included 42 patients in whom the SC decompression was performed in more than eight hours after the injury. Results. The mean age of patients in Group I was 29 [25; 39] years, in Group II – 35 [30; 42] years (p = 0.129). There were 31 (94.0 %) male patients in Group I and 38 (90.5 %; p > 0.999) in Group II. The time from the moment of injury to decompression of the spinal cord was 6.1 [5.0; 7.5] hours in Group I and 16.9 [11.8; 39.6] hours in Group II (p < 0.001). Pneumonia developed in 55 % [38 %; 70 %] of patients in Group I and in 86 % [72 %; 93 %] of patients in Group II (p = 0.004). The duration of pneumonia in Group I was 18 [8; 20] days, and in Group II – 28 [20; 39] days (p < 0.001). It was shown that the risk ratio for developing pneumonia in patients with delayed decompression of the spinal cord was 2.08 [1.17; 3.67] times higher (p = 0.01). The duration of mechanical ventilation in Group I was 12 [7; 17] days versus 19 [11; 26] days in Group II (p = 0.001). Maintaining the target blood pressure levels ≥ 85 mm Hg was required in 73 (97.3 %) patients with a duration of hemodynamic support of 6 [3; 10] days in Group I versus 10 [5; 15] days in Group II (p = 0.019). It was shown that SC decompression within the first eight hours after injury reduced the proportion of patients with a SOFA score of 4 points or more by 20 % in the acute period and by 42 % by the fifth day of the early period of injury. Positive dynamic in neurological status was recorded in 30.0 % [17.0 %; 47.0 %] of patients in Group I and only in 2.0 % [0.0 %; 12.0 %] of patients in Group II (p < 0.001). The duration of treatment in the ICU was 20 [16; 25] days in Group I and 29 [23.5; 41.75] days in Group II (p = 0.001). The total length of hospital stay was 38 [27; 46] days in Group I versus 57 [45.75; 67.50] days in Group II (p < 0.001). Mortality was recorded only in Group II and amounted to 5.3 %. Conclusion. Decompression and stabilization surgery within the first eight hours after the injury, together with a complex of intensive care measures for acute complicated injury of the lower cervical spine have a significant positive effect on the course of the acute and early periods of traumatic SC disease.

Background and Purpose: Tonsillectomy procedures are commonly performed worldwide. At our academic tertiary care facility, we perform approximately 1000 tonsillectomy procedures annually. We have found inconsistent pain management strategies in pediatric tonsillectomy patients have contributed to variability in postoperative complications and the number and types of postoperative pain medications required in the Post Anesthesia Care Unit (PACU). This project aimed to assess the impact of implementing a standardized perioperative pain management protocol on reducing postoperative complications in pediatric patients who underwent a tonsillectomy procedure. Methods: A pre‐post‐intervention design was utilized, comparing characteristics and outcomes of pediatric patients for whom a standardized perioperative pain management protocol was implemented over a 12‐week period compared to those who did not. The standardized perioperative pain management protocol was utilized intraoperatively by the anesthesiologists, nurse anesthetists, and residents. A Qualtrics survey was used by the Post Anesthesia Care Unit (PACU) nurses to gather data as they cared for patients who underwent tonsillectomy. Four outcomes were measured: (1) postoperative pain medication administration, (2) rate of postoperative respiratory complications, (3) rate of adherence, and (4) usability of a standardized pain management protocol. Data were compared between pre and post‐implementation groups. Results: During the quality improvement project, 180 children underwent tonsillectomy, with 81 in the control group and 99 in the intervention group. The median age did not differ between groups. The control group had higher postoperative opioid medication usage (93.8% vs. 54.5%) and a higher number of opioids administered in the recovery room. Postoperative IV fentanyl was reduced in the intervention group (49.4% vs. 28.3% in the intervention, p =.004). Respiratory interventions were more frequent in the control group (24.7% vs. 7.1%), with increased respiratory team activation. Respiratory team activation in the Post Anesthesia Care Unit (PACU) includes a 511 page for anesthesia provider assistance. Respiratory interventions included bag‐mask ventilation, lidocaine, propofol or succinylcholine administration, and reintubation. The intervention group had 100% adherence to the pain management protocol, and providers found it easy to use. Conclusion: The quality improvement project highlighted notable improvements in the intervention group for whom a standardized perioperative pain management protocol was used, including reduced opioid medication administration, lower incidence of respiratory interventions, and high adherence to the pain management protocol. These findings underscore the effectiveness and feasibility of standardized protocols in enhancing patient outcomes. [ABSTRACT FROM AUTHOR]

Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers. [ABSTRACT FROM AUTHOR]

IntroductionData examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.MethodsThis retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications.ResultsOf 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications.ConclusionsPostoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients.Level of evidenceIii, Respiratory complications.

Abstract Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer and liver resection with complete tumor removal is the best treatment option for these patients. This study examines the predictive ability of three-dimensional lung volumetry (3DLV) based on preoperative computerized tomography (CT), to predict postoperative pulmonary complications in patients undergoing major liver resection for CRLM. Patients undergoing major curative liver resection for CRLM between 2010 and 2021 with a preoperative CT scan of the thorax within 6 weeks of surgery, were included. Total lung volume (TLV) was calculated using volumetry software 3D-Slicer version 4.11.20210226 including Chest Imaging Platform extension ( http://www.slicer.org ). The area under the curve (AUC) of a receiver-operating characteristic analysis was used to define a cut-off value of TLV, for predicting the occurrence of postoperative respiratory complications. Differences between patients with TLV below and above the cut-off were examined with Chi-square or Fisher’s exact test and Mann–Whitney U tests and logistic regression was used to determine independent risk factors for the development of respiratory complications. A total of 123 patients were included, of which 35 (29%) developed respiratory complications. A predictive ability of TLV regarding respiratory complications was shown (AUC 0.62, p = 0.036) and a cut-off value of 4500 cm3 was defined. Patients with TLV

Objectives: This study aims to raise awareness toward early diagnosis, effective treatment, and prevention of respiratory complications in patients with neurological diseases. The goal is to improve patients' overall condition and reduce mortality rates. Materials and Methods: This study is a prospective observational study conducted at Damascus Hospital, Damascus, Syria, from October 2022 to March 2023. It includes (100) patients diagnosed with neurological diseases who developed respiratory complications. Their ages ranged from 18 to 89 years, with an equal gender distribution. Data analysis was performed using SPSS statistics version 19. Results: This study revealed that cerebrovascular accidents cause aspiration pneumonia. The most frequent chest X-ray and thoracic computed tomography findings showed pulmonary densities and infiltrates. Subsequently, arterial blood gas results showed type 2 respiratory failure. Many patients experienced regression of respiratory complications, and the mortality rate was low, indicating the efficacy of treatments. Conclusion: Respiratory complications significantly contribute to mortality in patients with neurological diseases. The study emphasizes the importance of early diagnosis and preventive measures such as elevating the patient's bed and periodic suctioning of secretions. Placing patients in specialized neurological intensive care units for tailored treatment is advised. [ABSTRACT FROM AUTHOR]

Pulmonary complications are one the main causes of morbidity and mortality in patients with common variable immunodeficiency (CVID). Although CVID pathogenesis is not completely understood, several genes have been identified to mainly regulate the process of terminal B-cell differentiation, antibody isotype maturation and long-life memory/plasma cell generation. The link between underlying genetic defects and the prognosis of developing different clinical complications like different pulmonary manifestations is still elusive. We provide an overview of recent advancements in the monogenic form of CVID which lead to dysregulation of B-cells at different levels of cytokine stimulations, intracellular signaling, transcriptionfactor activation, gene transcription and epigenetic controls and predispose patients to different pulmonary complications. The susceptibility to Coronavirus disease 2019 pulmonary complications was discussed in these patients. Monogenic forms of CVID have a distinct pattern in different infectious and non-infectious pulmonary manifestations including autoimmunity, atopy, lymphoproliferation, and cancer. [ABSTRACT FROM AUTHOR]

Background: Cystectomy with urinary diversion (CUD) is a highly morbid surgery. Despite implementing an enhanced recovery after surgery (ERAS®) protocol, postoperative respiratory complications (PRC) within 30 days after surgery remain frequent. This study aims to identify patients at higher risk of developing PRC after CUD. Methods: We conducted a retrospective analysis of 242 patients who underwent CUD at Lausanne University Hospital from 2012 to 2022, adhering to ERAS® guidelines. Data on postoperative complications, including pneumonia, respiratory failure, pulmonary embolism, lobar atelectasis, and pleural effusion, were analyzed. Chi-square and Mann–Whitney U tests compared patients with and without PRC. A multivariable Cox model identified independent prognostic factors. Results: PRC occurred in 41 patients (17%). Those with PRC experienced longer hospital stays and higher 30-day mortality rates. Poor ERAS® compliance was a significant risk factor. Multivariable analysis showed pneumonia was associated with postoperative ileus, while pulmonary embolism correlated with infectious and cardiovascular complications. Conclusions: PRC result in extended hospitalization and decreased survival. Rigorous adherence to ERAS® protocols, including early mobilization, respiratory physiotherapy, and avoiding nasogastric tubes, is essential for preventing PRC. [ABSTRACT FROM AUTHOR]

Objective The objective of this paper was to describe peri-procedural events and complications of infants requiring laser photocoagulation for retinopathy of prematurity (ROP) in a level IV neonatal intensive care unit. Study Design A retrospective chart review was performed of neonates requiring ROP exams from January 2017 to August 2020. Baseline maternal and neonatal characteristics, ROP exam findings, and associated treatment were analyzed. Group characteristics were compared based on the need for laser photocoagulation. Subgroup analysis of the laser group including respiratory outcomes, cardiorespiratory index (CRI) scores, and pain scores was also performed. Results Neonatal and maternal characteristics in the laser (n = 27) and non-laser (n = 172) groups were assessed. Of the 81.5% (22/27) that required re-intubation for laser, 36% (8/22) had >1 intubation and 18% (4/22) had >1 extubation attempt. The average duration of intubation following laser was 2.46 ± 7.13 days, with 40% (9/22) needing peri-extubation steroids and 18% (4/22) racemic epinephrine to facilitate extubation. Mean total respiratory support time post-laser was 8.65 ± 15.23 days. Mean neonatal pain, agitation, and sedation scores after laser were zero immediately after the procedure, 0.09 ± 0.33 at 12 hours, 0.11 ± 0.47 at 24 hours, and 0.11 ± 0.51 at 48 hours. The mean CRI scores were 1 ± 0 immediately after the procedure, 1.17 ± 0.4 at 12 hours, 1.41 ± 0.20 at 24 hours, and 1 ± 0 at 48 hours. Conclusion Nearly all infants undergoing laser photocoagulation for ROP in our cohort required intubation and continued respiratory support. Despite stability during the procedure, complications from intubation were common. Key Points Routine intubation for laser is associated with complications. Need for post-procedural respiratory support is common. Avoiding intubation may mitigate these neonatal complications. [ABSTRACT FROM AUTHOR]

The persistent and diverse manifestations of post-COVID syndrome present a significant challenge for global healthcare. Beyond the acute phase of infection, individuals continue to grapple with lingering symptoms affecting various organ systems, including the respiratory, cardiovascular, neurological, and endocrine systems. In the respiratory realm, symptoms such as cough, dyspnea, and fatigue endure, particularly in those with a history of severe COVID-19. The cardiovascular impact manifests as chest pain, arrhythmias, and heightened risks of thromboembolic events, emphasizing the intricate connection between COVID-19 and cardiovascular complications. Neurological complications, ranging from headaches to more severe disorders, further contribute to the complex sequelae of post-COVID syndrome. Additionally, disruptions in the endocrine system, including new-onset diabetes and thyroid abnormalities, pose long-term challenges for affected individuals. The review discusses the clinical management challenges posed by the multifaceted nature of post-COVID complications and the necessity for tailored multidisciplinary approaches. A holistic and compassionate response to the long-term effects of COVID-19 requires collaboration across healthcare professionals, researchers and the broader community. By navigating these challenges collectively, we can pave the way for a more comprehensive and effective approach to post-COVID care.

Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction The COVID-19 pandemic has had an unprecedented effect on hospital systems. Policy changes lead to decreased hospital visits as well as surgical case volume. The literature on pediatric surgical case volume during the pandemic is sparse. Throughout the country, hospitals sought various policies to preserve personal protective equipment and other hospital resources, and to minimize avoidable peri- and postoperative sequelae due to COVID-19 infection. Our hospital first placed a hold on all elective surgeries. Later, all elective cases required a preoperative negative COVID test prior to proceeding. We sought to review the sequelae of our hospital's policy in response to COVID-19. We identified trends in surgical case volume and cancellations due to a positive COVID-19 test. We also reviewed postoperative outcomes of cases with a positive test. Material and Methods This study was approved by the institutional IRB. Data was retrospectively collected on all surgical cases at our children's hospital between March 2019 and March 2021. We marked the start of the COVID-19 pandemic as March 2020, when elective cases were suspended. A required preoperative negative COVID-19 test was implemented in May 2020. We identified pre-operative COVID-19 test results, the posted urgency of each case and 30-day outcomes from medical records. Results From March 2019 to March 2021, we identified 25,496 completed surgeries and 3,503 cancellations. 12,024 cases proceeded during the first year of the pandemic, which appeared lower, compared to pre-pandemic case numbers. Of those, 2,785 (23%) cases were considered urgent or emergent. The average number of completed monthly cases fell from a pre-pandemic number of 1,123 to a pandemic number of 925. When comparing to a prepandemic month, average monthly case volume declined by 19%, with the largest decline noted to be 66%. There was a monthly average of 189 total cancellations between March 2020 and March 2021. 34 (18%) of those were for a positive preoperative COVID test. A total of 139 surgeries commenced despite concomitant COVID-19 infection. 25 (18 %) had identifiable respiratory symptoms documented preoperatively. 13 (9 %) were deemed to have a respiratory complication afterward. Of those, three patients (2%) had a prolonged, and one (1%) had an unexpected reintubation. The remaining nine (6%) patients had a prolonged oxygen requirement. Conclusion The COVID pandemic left operating rooms struggling to determine how to safely provide care to patients. This study demonstrated how the policies of one hospital affected the operating room case volume and how concomitant COVID infection affected outcomes in those that proceeded with surgery. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the association between in-hospital length of stay (LOS) and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). Methods: All patients who underwent either anatomic or reverse TSA between 2015 and 2019 were queried from the American College of Surgeons National Surgical Quality Improvement database. The study population was stratified into three cohorts as follows: LOS 0 (same-day discharge), LOS 1 (next-day discharge), and LOS 2–3 (LOS of 2-3 days). Patient demographics and comorbidities were compared between cohorts using bivariate analysis. Multivariate logistic regression analysis was conducted to investigate the relationship between LOS and postoperative complications. Results: In comparison to the LOS 0 day cohort, LOS 2–3 day cohort had a greater likelihood of developing overall complication (OR, 2.598; P

Léa El Haddad,1 Mainur Khan,1 Rania Soufny,1 David Mummy,2 Bastiaan Driehuys,2 Wissam Mansour,3 Priya S Kishnani,4 Mai K ElMallah1 1Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA; 2Department of Radiology, Duke University Medical Center, Durham, NC, USA; 3Division of Pulmonary and Sleep Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; 4Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USACorrespondence: Mai K ElMallah, Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Box 2644, Durham, NC, 27710, USA, Tel +1-919-684-3577, Email mai.elmallah@duke.eduAbstract: Pompe disease (PD) is a neuromuscular disorder caused by a deficiency of acid alpha-glucosidase (GAA) – a lysosomal enzyme responsible for hydrolyzing glycogen. GAA deficiency leads to accumulation of glycogen in lysosomes, causing cellular disruption. The severity of PD is directly related to the extent of GAA deficiency – if no or minimal GAA is produced, symptoms are severe and manifest in infancy, known as infantile onset PD (IOPD). If left untreated, infants with IOPD experience muscle hypotonia and cardio-respiratory failure leading to significant morbidity and mortality in the first year of life. In contrast, late-onset PD (LOPD) patients have more GAA activity and present later in life, but also have significant respiratory function decline. Despite FDA-approved enzyme replacement therapy, respiratory insufficiency remains a major cause of morbidity and mortality, emphasizing the importance of early detection and management of respiratory complications. These complications include impaired cough and airway clearance, respiratory muscle weakness, sleep-related breathing issues, and pulmonary infections. This review aims to provide an overview of the respiratory pathology, monitoring, and management of PD patients. In addition, we discuss the impact of novel approaches and therapies on respiratory function in PD.Keywords: Pompe disease, respiratory complications, respiratory monitoring, respiratory therapy

Background and Objectives: In patients with multiple sclerosis (MS), a decrease in muscle strength can lead to limitations in pulmonary functions, potentially causing respiratory complications. To address these challenges, the lung volume recruitment (LVR) maneuver has emerged as a potential intervention. This study sought to evaluate the impact of a four-week LVR protocol on respiratory function in secondary progressive MS patients. Materials and Methods: In a quasi-randomized pre/post-controlled trial, 24 patients with secondary progressive MS were recruited. Participants aged 20–70 years with an EDSS score of 2 to 9 were alternately allocated to intervention (n = 12) or control groups (n = 12). The intervention group underwent a 4-week respiratory rehabilitation training focused on LVR, using a standardized cough machine treatment protocol twice daily. The control group received no respiratory intervention. Outcomes measured included forced vital capacity (FVC), maximal insufflation capacity (MIC), and peak cough flow (PCF), using turbine spirometry and other associated equipment. All measurements were taken at baseline (T0) and after 4 weeks (T1) by a blinded assessor. Results: For the intervention group, the mean difference pre/post-treatment in MIC (mL) was 0.45 (SD 1.13) (p = 0.02), and in MIC (%), it was 0.13 (SD 0.24) (p = 0.03). Compared to the control group (n = 10), the between-group mean difference for MIC (mL) was 0.54 (p = 0.02), and for MIC (%), it was 0.15 (p = 0.02). Conclusions: The short-term daily LVR protocol notably improved passive lung capacity, despite minimal changes in active lung capacity or cough force. The LVR maneuver offers promise for enhancing respiratory function, especially passive lung capacity, in secondary progressive MS patients. Further research should explore optimal treatment durations and frequencies for more extensive respiratory gains. [ABSTRACT FROM AUTHOR]

Background: The proportion of early extubation after esophagectomy varies among hospitals; however, the impact on clinical outcomes is unclear. The aim of this retrospective study was to evaluate associations between the proportion of early extubation in hospitals and short-term outcomes after esophagectomy. Because there is no consensus regarding the optimal timing for extubation, the authors considered that hospitals' early extubation proportion reflects the hospital-level extubation strategy. Materials and methods: Data of patients who underwent oncologic esophagectomy (July 2010-March 2019) were extracted from a Japanese nationwide inpatient database. The proportion of patients who underwent early extubation (extubation on the day of surgery) at each hospital was assessed and grouped by quartiles: very low- (<11%), low- (11-37%), medium- (38-83%), and high-proportion (≥84%) hospitals. The primary outcome was respiratory complications; secondary outcomes included reintubation, anastomotic leakage, other major complications, and hospitalization costs. Multivariable regression analyses were performed, adjusting for patient demographics, cancer treatments, and hospital characteristics. A restricted cubic spline analysis was also performed for the primary outcome. Results: Among 37 983 eligible patients across 545 hospitals, early extubation was performed in 17 931 (47%) patients. Early extubation proportions ranged from 0-100% across hospitals. Respiratory complications occurred in 10 270 patients (27%). Multivariable regression analyses showed that high- and medium-proportion hospitals were significantly associated with decreased respiratory complications [odds ratio, 0.46 (95% CI, 0.36-0.58) and 0.43 (0.31-0.60), respectively], reintubation, and hospitalization costs when compared with very low-proportion hospitals. The risk of anastomotic leakage and other major complications did not differ among groups. The restricted cubic spline analysis demonstrated a significant inverse dose-dependent association between the early extubation proportion and the risk of respiratory complications. Conclusion: A higher proportion of early extubation in a hospital was associated with a lower occurrence of respiratory complications, highlighting a potential benefit of early extubation after esophagectomy. [ABSTRACT FROM AUTHOR]

Describe the impact of the implementation of an evidence-based pediatric preoperative risk assessment (PPRA) checklist on the frequency of postanesthesia care unit (PACU) nursing assessments and interventions in children at risk for respiratory complications during emergence from anesthesia. Prospective pre-/postdesign. Pediatric perianesthesia nurses assessed 100 children preintervention according to current standard. After nurses received pediatric preoperative risk factor (PPRF) education, another 100 children were assessed postintervention using the PPRA checklist. Pre-/postpatients were unmatched for statistical purposes due to two different groups. Frequency of PACU nursing respiratory assessments/interventions was evaluated. Demographic variables, risk factors, frequency of nursing assessments/interventions were summarized in pre-/postinterventions. Significant differences (P <.001) were noted between pre-/postintervention groups with increased frequency of postnursing assessments/interventions that correlated with increased risk factors and weighted risk factors. By identifying total PPRFs, PACU nurses used their plan of care to frequently assess and pre-emptively intervene with children who had increased risk factors to prevent or mitigate respiratory complications on emergence from anesthesia. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pneumothorax and bronchopleural fistula (BPF) are potentially fatal complications that can occur in patients with COVID‐19 pneumonia. Early detection, appropriate treatment, and consideration of surgical intervention are necessary for optimum outcomes. Introduction: Healthcare professionals face complex challenges as a result of the rare emergence of pneumothorax among the variety of COVID‐19 complications, including severe viral pneumonia. Case History: A 57‐year‐old male with multiple comorbidities diagnosed with COVID‐19 pneumonia was admitted to our center and exhibited bilateral crepitations. During hospitalization, the patient developed right‐sided pneumothorax that persisted despite chest tube insertion was linked to the presence of BPF. Discussion: The occurrence of pneumothorax in COVID‐19 patients is relatively rare risk factors for which are not yet fully understood, although smoking history may play a role. Conservative management is recommended for asymptomatic cases, while intercostal drainage is necessary for symptomatic patients. Surgical intervention may be required to manage the BPF in some instances. Conclusion: Pneumothorax and BPF are rare but potentially life‐threatening complications in patients recovering from COVID‐19 pneumonia. Early recognition, appropriate treatment, and consideration of surgical intervention are crucial for optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

Key Clinical Message Pneumothorax and bronchopleural fistula (BPF) are potentially fatal complications that can occur in patients with COVID‐19 pneumonia. Early detection, appropriate treatment, and consideration of surgical intervention are necessary for optimum outcomes. Abstract Introduction Healthcare professionals face complex challenges as a result of the rare emergence of pneumothorax among the variety of COVID‐19 complications, including severe viral pneumonia. Case History A 57‐year‐old male with multiple comorbidities diagnosed with COVID‐19 pneumonia was admitted to our center and exhibited bilateral crepitations. During hospitalization, the patient developed right‐sided pneumothorax that persisted despite chest tube insertion was linked to the presence of BPF. Discussion The occurrence of pneumothorax in COVID‐19 patients is relatively rare risk factors for which are not yet fully understood, although smoking history may play a role. Conservative management is recommended for asymptomatic cases, while intercostal drainage is necessary for symptomatic patients. Surgical intervention may be required to manage the BPF in some instances. Conclusion Pneumothorax and BPF are rare but potentially life‐threatening complications in patients recovering from COVID‐19 pneumonia. Early recognition, appropriate treatment, and consideration of surgical intervention are crucial for optimizing patient outcomes.

Abstract Background The aim of this study was to examine risk factors of respiratory complications at the diagnosis and establish an algorithm of clinical management in children and adolescents with mediastinal tumors. Methods We retrospectively collected clinical information of all children and adolescents who presented with mediastinal tumors at Saitama Children's Medical Center from 1999 to 2019, including age, sex, pathological diagnosis, eight major clinical symptoms (cough, dyspnea, hypoxia, orthopnea, chest pain, wheeze, superior vena cava syndrome, and stridor), chest computed tomography (CT) findings (tumor location, mediastinal mass ratio, pleural fluid, pericardial effusion, and compression of trachea and bronchi), types of diagnostic procedure and anesthesia, respiratory complications (severe hypoxia, difficult ventilation, respiratory failure, and cardiopulmonary arrest), and clinical outcome. Subsequently, we calculated the risk score for predicting respiratory complications by combining clinical and radiological findings. Results Of the 57 patients, 7 (12%) developed respiratory complications. Cough, dyspnea, hypoxia, and orthopnea were significantly more common in patients with complications (p = 0.02, p = 0.02, p

Abstract Background Endotracheal extubation under deep anesthesia (deep extubation) has been proved to present stable hemodynamics and steady intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. This study aims to examine, in comparison with deep extubation, if a laryngeal mask airway (LMA) could provide a safer and smoother emergence from anesthesia in patients undergoing craniotomy. Methods This prospective randomized controlled study was conducted on patients undergoing elective craniotomy for brain tumors. After the complement of the surgical procedure, the patients had anesthesia maintained with end-tidal sevoflurane concentration 2.5% and also fully regained muscle power (Time Zero), they were randomly assigned to ETT Group (n = 29) for deep extubation or to LMA Group (n = 29), where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions and hemodynamic changes through emergence from anesthesia till 30 min following Time Zero. The secondary outcomes were re-operation incidence in 24 h, stay time in the intensive care unit and postoperative hospital days. Results At 5 min before Time Zero either oxygen partial pressures (PaO2) or carbon dioxide partial pressures (PaCO2) between the two groups were comparable. No significant PaCO2 change was noted in both groups in 5 min after Time Zero, yet there was a remarkably lower PaO2 in ETT Group at that time point, 188.9 (± 71.1) in ETT Group vs 264.4 (± 85.4) in LMA Group. In ETT Group, coughs and snores were considerably more frequent, and thus more interventions were needed to maintain adequate respiration. From Time Zero on, blood pressures (systolic, diastolic and mean) and heart rates in ETT Group were generally higher than those in LMA Group, but the differences were insignificant at all time points except heart rate at 10 min after Time Zero. The secondary outcomes between the two groups were similar. Conclusions Compared with deep extubation, a LMA, as a temporary airway replacement, facilitates a safer and smoother emergence from anesthesia for patients undergoing craniotomy, in terms of better oxygen saturation, fewer respiratory complications and fewer airway interventions. Trial registration The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou Branch, Taiwan (registration number 202102115A3; January 27, 2022), and the clinicaltrials.gov (NCT05253404) on 23 February 2022.

Background: Diabetes mellitus (DM) is one of the most frequent comorbidities in patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a higher rate of severe course of coronavirus disease (COVID-19). However, data about post-COVID-19 syndrome (PCS) in patients with DM are limited. Methods: This multicenter, propensity score-matched study compared longterm follow-up data about cardiovascular, neuropsychiatric, respiratory, gastrointestinal, and other symptoms in 8,719 patients with DM to those without DM. The 1:1 propensity score matching (PSM) according to age and sex resulted in 1,548 matched pairs. Results: Diabetics and nondiabetics had a mean age of 72.6 ± 12.7 years old. At follow-up, cardiovascular symptoms such as dyspnea and increased resting heart rate occurred less in patients with DM (13.2% vs. 16.4%; p = 0.01) than those without DM (2.8% vs. 5.6%; p = 0.05), respectively. The incidence of newly diagnosed arterial hypertension was slightly lower in DM patients as compared to non-DM patients (0.5% vs. 1.6%; p = 0.18). Abnormal spirometry was observed more in patients with DM than those without DM (18.8% vs. 13; p = 0.24). Paranoia was diagnosed more frequently in patients with DM than in non-DM patients at follow-up time (4% vs. 1.2%; p = 0.009). The incidence of newly diagnosed renal insufficiency was higher in patients suffering from DM as compared to patients without DM (4.8% vs. 2.6%; p = 0.09). The rate of readmission was comparable in patients with and without DM (19.7% vs. 18.3%; p = 0.61). The reinfection rate with COVID-19 was comparable in both groups (2.9% in diabetics vs. 2.3% in nondiabetics; p = 0.55). Long-term mortality was higher in DM patients than in non-DM patients (33.9% vs. 29.1%; p = 0.005). Conclusions: The mortality rate was higher in patients with DM type II as compared to those without DM. Readmission and reinfection rates with COVID-19 were comparable in both groups. The incidence of cardiovascular symptoms was higher in patients without DM. [ABSTRACT FROM AUTHOR]

Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings. [ABSTRACT FROM AUTHOR]

TBCK syndrome is an autosomal recessive disorder primarily characterized by global developmental delay, hypotonia, abnormal magnetic resonance imaging (MRI), and distinctive craniofacial phenotypes. High variability is observed among affected individuals and their corresponding variants, making clinical diagnosis challenging. Here, we discuss recent breakthroughs in clinical considerations, TBCK function, and therapeutic development. [ABSTRACT FROM AUTHOR]

Abstract Background We tested the hypothesis that patients who continued buprenorphine postoperatively experience postoperative respiratory depression less frequently than those who discontinued buprenorphine. Methods This is a retrospective cohort study of patients who were on buprenorphine preoperatively. The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/minute, oxygen saturation (SpO2) < 90%, or requirement of naloxone for 48 h postoperatively. The secondary outcome was the composite of postoperative respiratory complications. The associations between postoperative buprenorphine continuation and respiratory depression and respiratory complications were estimated using separate multivariable logistic regression models, including demographic, intraoperative characteristics, and preoperative buprenorphine dose as covariates. Results Postoperative buprenorphine continuation was not associated with postoperative respiratory depression (adjusted odds ratio (OR), 1.11, 95% confidence interval (CI), 0.61 to 1.99, P=0.72). In subanalysis stratified by the preoperative buprenorphine dose, buprenorphine continuation was not associated with postoperative respiratory depression either when preoperative buprenorphine dose was high (≥16 mg daily) or low (

Abstract Background Rehabilitation strategies after abdominal surgery enhance recovery and improve outcome. A cornerstone of rehabilitation is respiratory physiotherapy with inspiratory muscle training to enhance pulmonary function. Pre-habilitation is the process of enhancing functional capacity before surgery in order to compensate for the stress of surgery and postoperative recovery. There is growing interest in deploying pre-habilitation interventions prior to surgery. The aim of this study is to assess the impact of preoperative inspiratory muscle training on postoperative overall morbidity. The question is, whether inspiratory muscle training prior to elective abdominal surgery reduces the number of postoperative complications and their severity grade. Methods We describe a prospective randomized-controlled single-centre trial in a tertiary referral centre. The primary outcome is the Comprehensive Complication Index (CCI) at 90 days after surgery. The CCI expresses morbidity on a continuous numeric scale from 0 (no complication) to 100 (death) by weighing all postoperative complications according to the Clavien-Dindo classification for their respective severity. In the intervention group, patients will be instructed by physiotherapists to perform inspiratory muscle training containing of 30 breaths twice a day for at least 2 weeks before surgery using Power®Breathe KHP2. Depending on the surgical schedule, training can be extended up to 6 weeks. In the control group, no preoperative inspiratory muscle training will be performed. After the operation, both groups receive the same physiotherapeutic support. Discussion Existing data about preoperative inspiratory muscle training on postoperative complications are ambiguous and study protocols are often lacking a clear design and a clearly defined endpoint. Most studies consist of multi-stage concepts, comprehensively supervised and long-term interventions, whose implementation in clinical practice is hardly possible. There is a clear need for randomized-controlled studies with a simple protocol that can be easily transferred into clinical practice. This study examines the effortless adjustment of the common respiratory physiotherapy from currently postoperative to preoperative. The external measurement by the device eliminates the diary listing of patients’ performances and allows the exercise adherence and thus the effect to be objectively recorded. Trial registration ClinicalTrials.gov NCT04558151 . Registered on September 15, 2020.

BackgroundDiabetes mellitus (DM) is one of the most frequent comorbidities in patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a higher rate of severe course of coronavirus disease (COVID-19). However, data about post-COVID-19 syndrome (PCS) in patients with DM are limited.MethodsThis multicenter, propensity score-matched study compared long-term follow-up data about cardiovascular, neuropsychiatric, respiratory, gastrointestinal, and other symptoms in 8,719 patients with DM to those without DM. The 1:1 propensity score matching (PSM) according to age and sex resulted in 1,548 matched pairs.ResultsDiabetics and nondiabetics had a mean age of 72.6 ± 12.7 years old. At follow-up, cardiovascular symptoms such as dyspnea and increased resting heart rate occurred less in patients with DM (13.2% vs. 16.4%; p = 0.01) than those without DM (2.8% vs. 5.6%; p = 0.05), respectively. The incidence of newly diagnosed arterial hypertension was slightly lower in DM patients as compared to non-DM patients (0.5% vs. 1.6%; p = 0.18). Abnormal spirometry was observed more in patients with DM than those without DM (18.8% vs. 13; p = 0.24). Paranoia was diagnosed more frequently in patients with DM than in non-DM patients at follow-up time (4% vs. 1.2%; p = 0.009). The incidence of newly diagnosed renal insufficiency was higher in patients suffering from DM as compared to patients without DM (4.8% vs. 2.6%; p = 0.09). The rate of readmission was comparable in patients with and without DM (19.7% vs. 18.3%; p = 0.61). The reinfection rate with COVID-19 was comparable in both groups (2.9% in diabetics vs. 2.3% in nondiabetics; p = 0.55). Long-term mortality was higher in DM patients than in non-DM patients (33.9% vs. 29.1%; p = 0.005).ConclusionsThe mortality rate was higher in patients with DM type II as compared to those without DM. Readmission and reinfection rates with COVID-19 were comparable in both groups. The incidence of cardiovascular symptoms was higher in patients without DM.

Summary: Background: Preoperative COVID-19 has been associated with excess postoperative morbi-mortality. Consequently, guidelines were developed that recommended the postponement of surgery for at least 7 weeks after the infection. We hypothesised that vaccination against the SARS-CoV-2 and the large predominance of the Omicron variant attenuated the effect of a preoperative COVID-19 on the occurrence of postoperative respiratory morbidity. Methods: We conducted a prospective cohort study in 41 French centres between 15 March and 30 May 2022 (ClinicalTrials NCT05336110), aimed at comparing the postoperative respiratory morbidity between patients with and without preoperative COVID-19 within 8 weeks prior to surgery. The primary outcome was a composite outcome combining the occurrence of pneumonia, acute respiratory failure, unexpected mechanical ventilation, and pulmonary embolism within the first 30 postoperative days. Secondary outcomes were 30-day mortality, hospital length-of-stay, readmissions, and non-respiratory infections. The sample size was determined to have 90% power to identify a doubling of the primary outcome rate. Adjusted analyses were performed using propensity score modelling and inverse probability weighting. Findings: Of the 4928 patients assessed for the primary outcome, of whom 92.4% were vaccinated against the SARS-CoV-2, 705 had preoperative COVID-19. The primary outcome was reported in 140 (2.8%) patients. An 8-week preoperative COVID-19 was not associated with increased postoperative respiratory morbidity (odds ratio 1.08 [95% CI 0.48–2.13]; p = 0.83). None of the secondary outcomes differed between the two groups. Sensitivity analyses concerning the timing between COVID-19 and surgery, and the clinical presentations of preoperative COVID-19 did not show any association with the primary outcome, except for COVID-19 patients with ongoing symptoms the day of surgery (OR 4.29 [1.02–15.8]; p = 0.04). Interpretation: In our Omicron-predominant, highly immunised population undergoing general surgery, a preoperative COVID-19 was not associated with increased postoperative respiratory morbidity. Funding: The study was fully funded by the French Society of Anaesthesiology and Intensive Care Medicine (SFAR).

Purpose: We developed prediction models for postoperative respiratory depression and respiratory complications for 958 patients who were on methadone preoperatively. Methods: The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/min, oxygen saturation (SpO2) < 90%, or requirement of naloxone for 48 h postoperatively. Secondary outcome was the composite of postoperative respiratory complications. Prediction models for postoperative respiratory depression and respiratory complications were constructed using multivariate logistic regression with preoperative and intraoperative characteristics as the predictors. Results: For the multivariate logistic regression model for postoperative respiratory depression, surgery duration (P = 0.005), body mass index (BMI) (P = 0.008), surgery involving digestive system (P = 0.031), and American Society of Anesthesiologists (ASA) physical status ≥ 4 (P = 0.038) were statistically significant predictors. The area under the receiver operating characteristic curve (AUROC) of the model was 0.581 (0.558–0.601) [median (95% confidence interval (CI))] with fivefold cross-validation. For the model for postoperative respiratory complications, surgery duration (P = 0.001), history of hypertension (P = 0.028), surgery involving musculoskeletal system (P < 0.001), surgery involving integumental system (P = 0.034), surgery categorized to miscellaneous therapeutic procedures (P = 0.028), combined general and regional anesthesia (P = 0.033), ASA physical status 3 (P < 0.001), and ASA physical status ≥ 4 (P < 0.001) were statistically significant predictors, and AUROC of the model was 0.726 (0.712–0.737). Conclusions: Multivariate logistic regression models including preoperative, and intraoperative characteristics as the predictors performed poorly to predict postoperative respiratory depression, and moderately for postoperative respiratory complications. Neither model is accurate enough to be subject to clinical use. [ABSTRACT FROM AUTHOR]

Background: Endotracheal extubation under deep anesthesia (deep extubation) has been proved to present stable hemodynamics and steady intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. This study aims to examine, in comparison with deep extubation, if a laryngeal mask airway (LMA) could provide a safer and smoother emergence from anesthesia in patients undergoing craniotomy. Methods: This prospective randomized controlled study was conducted on patients undergoing elective craniotomy for brain tumors. After the complement of the surgical procedure, the patients had anesthesia maintained with end-tidal sevoflurane concentration 2.5% and also fully regained muscle power (Time Zero), they were randomly assigned to ETT Group (n = 29) for deep extubation or to LMA Group (n = 29), where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions and hemodynamic changes through emergence from anesthesia till 30 min following Time Zero. The secondary outcomes were re-operation incidence in 24 h, stay time in the intensive care unit and postoperative hospital days. Results: At 5 min before Time Zero either oxygen partial pressures (PaO2) or carbon dioxide partial pressures (PaCO2) between the two groups were comparable. No significant PaCO2 change was noted in both groups in 5 min after Time Zero, yet there was a remarkably lower PaO2 in ETT Group at that time point, 188.9 (± 71.1) in ETT Group vs 264.4 (± 85.4) in LMA Group. In ETT Group, coughs and snores were considerably more frequent, and thus more interventions were needed to maintain adequate respiration. From Time Zero on, blood pressures (systolic, diastolic and mean) and heart rates in ETT Group were generally higher than those in LMA Group, but the differences were insignificant at all time points except heart rate at 10 min after Time Zero. The secondary outcomes between the two groups were similar. Conclusions: Compared with deep extubation, a LMA, as a temporary airway replacement, facilitates a safer and smoother emergence from anesthesia for patients undergoing craniotomy, in terms of better oxygen saturation, fewer respiratory complications and fewer airway interventions. Trial registration: The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou Branch, Taiwan (registration number 202102115A3; January 27, 2022), and the clinicaltrials.gov (NCT05253404) on 23 February 2022. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine risk factors of respiratory complications at the diagnosis and establish an algorithm of clinical management in children and adolescents with mediastinal tumors. Methods: We retrospectively collected clinical information of all children and adolescents who presented with mediastinal tumors at Saitama Children's Medical Center from 1999 to 2019, including age, sex, pathological diagnosis, eight major clinical symptoms (cough, dyspnea, hypoxia, orthopnea, chest pain, wheeze, superior vena cava syndrome, and stridor), chest computed tomography (CT) findings (tumor location, mediastinal mass ratio, pleural fluid, pericardial effusion, and compression of trachea and bronchi), types of diagnostic procedure and anesthesia, respiratory complications (severe hypoxia, difficult ventilation, respiratory failure, and cardiopulmonary arrest), and clinical outcome. Subsequently, we calculated the risk score for predicting respiratory complications by combining clinical and radiological findings. Results: Of the 57 patients, 7 (12%) developed respiratory complications. Cough, dyspnea, hypoxia, and orthopnea were significantly more common in patients with complications (p = 0.02, p = 0.02, p < 0.01, p = 0.03, respectively). The reduction of percentage of tracheal cross‐sectional area (%TCA) and compression of the carina in chest CT were also significantly more common in patients with complications (p < 0.01 and <0.01, respectively). We calculated the risk score of respiratory complications by combining cough, wheeze, stridor, orthopnea, dyspnea, hypoxia, %TCA < 0.5, and compression of the carina. A risk score ≥ 7 showed high predictive accuracy for complications (sensitivity: 100%, specificity: 97.7%, positive likelihood ratio: 43.0). Conclusion: The risk score combining clinical symptoms with radiological findings is a promising predictive tool for respiratory complications in children with mediastinal tumors. [ABSTRACT FROM AUTHOR]

Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and severity of the spinal cord injury, history of underlying lung pathology, history of smoking, and poor baseline health status are potential predictors for patients that will experience respiratory complications. For patients who may require prolonged intubation, early tracheostomy has been shown to lead to improved outcomes. Prediction models to aid clinicians with the decision and timing of tracheostomy have been shown to be successful but require larger validation studies in the future. Mechanical ventilation weaning strategies also require further investigation but should focus on a combination of optimizing ventilator setting, pulmonary toilet techniques, psychosocial well-being, and an aggressive bowel regimen. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effect of low-dose propofol on the respiratory complications immediately after tracheal extubation in children undergoing tonsillectomy. In this randomized double blinded clinical trial study, 70 children (2–12) years old with ASA class I undergoing elective tonsillectomy involved. General anesthesia was performed by the same anesthesiologist and in the same way. The patients were then intubated with oxygen after 3 min of ventilation. After the surgery and muscle relaxant injection and before extubation, 0.5 mg propofol/kg was injected into the intervention group. The control group received normal saline. Finally, the presence of post-extubation laryngospasm, cough and nausea and vomiting was recorded and all data analyzed between two groups. There was no significant difference in age (p value = 0.425), gender (p value = 0.851), cough (p value = 0.239), nausea (p value = 1) and weight (p value = 0.624) between two groups. There was a significant different in incidence of laryngospasm between two groups (p value = 0.04). It can be concluded that the administration of 0.5 mg/kg of propofol before extubation could prevent laryngospasm in patients undergoing tonsillectomy, without inducing any side effects. [ABSTRACT FROM AUTHOR]

Objectives: Limited data exist on the effect of preoperative statin therapy on postoperative respiratory complications. Machine learning algorithms (MLA) can process large, heterogenous data, and have immensely improved the ability for risk prediction. In this study, we sought to examine the role of preoperative statins on respiratory complications in patients undergoing coronary artery bypass grafting (CABG) using MLA. Methods: The study population contained the data of patients who underwent CABG between the years 2015 and 2019 (n = 5638). Three hundred and thirty‐seven independent variables were recorded and the data was randomly split with stratified sampling into training and testing data with 20% of the data (1113 records) reserved for model testing. Various models including linear models, Random forest, SVM, and XGboost were trained to predict the incidence of postoperative respiratory complications. Forty‐seven important features were found to impact model prediction (p ≤.05) using the global surrogate model method. A conventional multivariable linear regression model was then used to identify predictors of respiratory complications. Results: One thousand three hundred sixty‐two (24.5%) patients developed a respiratory complication in our series. The respiratory complication was seen in 561 (29.7%) of the patients who were not on statin compared to only 801 (21.8%) who were on a statin, p <.0001. The area under the curve for receiver operating characteristic curve using statins and respiratory complications was 0.706. Statins showed positive feature importance in all the MLA models. Conclusions: MLA showed that statins impacted the prediction of respiratory complications in all the models studied. The study confirmed that preoperative statins reduced the risk of respiratory complications by 21%. [ABSTRACT FROM AUTHOR]

Background: Smoking has various deleterious effects and peri-operative complications. Pulmonary complications following abdominal surgery are frequent and associated with increased morbidity and mortality and length of hospital stay. Aims and Objectives: Hence, this study was done to observe the incidence of various respiratory and cardiovascular complications in the perioperative period in patients undergoing elective open upper abdominal surgery under general anaesthesia among smokers versus non-smokers. The various complications which are studied are as follows - Arterial desaturation, Severe coughing, Laryngospasm, Bronchospasm, Recurrent apnea, Variations in Mean Arterial Blood Pressure and Heart rates. Materials and Methods: Male patients ASA-I, II or III, aged 20–60 years undergoing elective open upper abdominal surgery under general anaesthesia were selected. They were divided into two groups (during pre-anaesthetic checkup) - smokers (>10 cigarette/day for the past 1 year and continued smoking till admission), non-smokers (who never smoked). General anaesthesia was given according to standard protocol. Results: The smokers had higher incidence of laryngospasm as well as bronchospasm but they were not statistically significant. Smokers had low baseline SpO2; greater fall in SpO2 just after extubation, before sending to PACU and on day 1 which were statistically significant. Smokers had raised MAP just after extubation, on day 1 and day 2 which were statistically significant. Conclusion: Smokers had increased incidences of respiratory and hemodynamic complications than non-smokers.

• Meta-analysis of either dexmedetomidine during monitored anaesthesia care was done. • Dexmedetomidine-based had no significant differences in surgical outcomes. • Non-dexmedetomidine group had higher intraoperative seizure odds. • Rate of conversion to general anaesthesia and anaesthetic complications were the same. For awake craniotomy, monitored anaesthesia care (MAC) had shown relatively lower failure rates. Nevertheless, the conclusion of the appropriate anaesthetic agents, and complications, has not been proposed. Therefore, the systematic review and meta-analysis was done to compare the clinical profile, surgical outcomes, and anesthesia-related complications between dexmedetomidine-based and non-dexmedetomidine regimens during monitored anesthesia care (MAC) for this procedure. Published clinical trials described MAC, including the amount of anaesthetic drugs, or the number of patients for awake craniotomy between January 1st, 2009 and March 31st, 2022 were reviewed through PubMed, Scopus, Google Scholar, and grey literature index. The standard methodological procedures were following the PRISMA statement with the PROSPERO registration. Twenty-two articles with 2,137 awake craniotomy patients identified as epilepsy surgery, deep brain stimulation procedure, and intracranial surgery closed to an eloquent area with intraoperative awakening for neuro-evaluation were included. The relative risk (RR) regarding surgical outcomes, and anaesthesia-related complications were compared. Dexmedetomidine-based versus non-dexmedetomidine anaesthetic regimen revealed no statistically significant differences in surgical outcomes (RR 1.08, 95 %CI 0.94–1.24), conversion to general anaesthesia (RR 0.45, 95 %CI 0.05–3.83), respiratory complications (RR 0.4, 95 %CI 0.12–1.27), and intraoperative nausea and vomiting (RR 0.30, 95 %CI 0.08–1.14). However, the intraoperative seizure was higher in non-dexmedetomidine group (RR 4.26, 95 %CI 1.49–12.16). MAC for awake craniotomy with dexmedetomidine seems to be effective and safe. Randomized controlled trials with standard protocol in specific group of patients and surgical interventions would further demonstrate a clear benefit of dexmedetomidine in awake craniotomy under MAC. [ABSTRACT FROM AUTHOR]

Background and Objectives: In patients with multiple sclerosis (MS), a decrease in muscle strength can lead to limitations in pulmonary functions, potentially causing respiratory complications. To address these challenges, the lung volume recruitment (LVR) maneuver has emerged as a potential intervention. This study sought to evaluate the impact of a four-week LVR protocol on respiratory function in secondary progressive MS patients. Materials and Methods: In a quasi-randomized pre/post-controlled trial, 24 patients with secondary progressive MS were recruited. Participants aged 20–70 years with an EDSS score of 2 to 9 were alternately allocated to intervention (n = 12) or control groups (n = 12). The intervention group underwent a 4-week respiratory rehabilitation training focused on LVR, using a standardized cough machine treatment protocol twice daily. The control group received no respiratory intervention. Outcomes measured included forced vital capacity (FVC), maximal insufflation capacity (MIC), and peak cough flow (PCF), using turbine spirometry and other associated equipment. All measurements were taken at baseline (T0) and after 4 weeks (T1) by a blinded assessor. Results: For the intervention group, the mean difference pre/post-treatment in MIC (mL) was 0.45 (SD 1.13) (p = 0.02), and in MIC (%), it was 0.13 (SD 0.24) (p = 0.03). Compared to the control group (n = 10), the between-group mean difference for MIC (mL) was 0.54 (p = 0.02), and for MIC (%), it was 0.15 (p = 0.02). Conclusions: The short-term daily LVR protocol notably improved passive lung capacity, despite minimal changes in active lung capacity or cough force. The LVR maneuver offers promise for enhancing respiratory function, especially passive lung capacity, in secondary progressive MS patients. Further research should explore optimal treatment durations and frequencies for more extensive respiratory gains.

Abstract Background There are limited data to detail the perioperative anesthetic management and the incidence of postoperative respiratory complications among patients requiring an anesthetic procedure while being SARS-CoV-2 positive or suspected. Methods An observational multicenter cohort study was performed including consecutive patients who were SARS-CoV-2 confirmed or suspected and who underwent scheduled and emergency anesthesia between March 17 and May 26, 2020. Results A total of 187 patients underwent anesthesia with SARS-CoV-2 confirmed or suspected, with ultimately 135 (72.2%) patients positive and 52 (27.8%) negative. The median SOFA score was 2 [0; 5], and the median ARISCAT score was 49 [36; 67]. The major respiratory complications rate was 48.7% (n = 91) with 40.4% (n = 21) and 51.9% (n = 70) in the SARS-CoV-2–negative and –positive groups, respectively (p = 0.21). Among both positive and negative groups, patients with a high ARISCAT risk score (> 44) had a higher risk of presenting major respiratory complications (p

Background: Considering the incidence of respiratory complications after cleft lip and palate surgery and its significance in the survival of children undergoing the mentioned surgery, the present study was performed to evaluate the association between the nasopharyngeal depth and the incidence of respiratory complications after cleft palate surgery. Materials and Methods: The present cross-sectional study was performed on 222 children who aged 9–18 months and were the candidates for cleft palate surgery. After performing general anesthesia and implanting mouth gag and before surgery, the nasopharyngeal depth and the cleft palate width were measured with a calibrated ruler and an ophthalmic caliper, respectively. At the end of the surgery and after extubation, the incidence of respiratory complications such as respiratory distress, laryngospasm, bronchospasm, and need for intubation was recorded. Results: The nasopharyngeal depth in children with respiratory complications with a mean of 7.57 ± 3.12 mm was significantly less than that of children without respiratory complications with a mean of 10.82 ± 2.14 mm (P < 0.001). The nasopharyngeal depth of ≤8 mm with a sensitivity of 80% and a specificity of 89.60% had a significant predictive value in the incidence of respiratory complications (P < 0.001). Conclusion: According to the results of the present study, it seems that the nasopharyngeal depth of ≤8 mm can make the incidence of respiratory complications more likely. Therefore, considering the simplicity and convenience of measuring the nasopharyngeal depth and the cleft palate width, it is suggested to perform further studies to evaluate the anatomy of palate before this surgery using the employed method and address its association with respiratory complications.

The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of medical comorbidities that increase the risk for severe intraoperative or postoperative complications. A multidisciplinary approach is mandatory at every stage to ensure that all nonoperative measures have been applied, and that the treatment goals have been clearly defined and agreed with the family. This will involve input from multiple specialities, including allied healthcare professionals, such as physiotherapists and wheelchair services. Surgery should be considered when there is significant impact on the patients’ quality of life, which is usually due to poor sitting balance, back or costo-pelvic pain, respiratory complications, or problems with self-care and feeding. Meticulous preoperative assessment is required, along with careful consideration of the nature of the deformity and the problems that it is causing. Surgery can achieve good curve correction and results in high levels of satisfaction from the patients and their caregivers. Modern modular posterior instrumentation systems allow an effective deformity correction. However, the risks of surgery remain high, and involvement of the family at all stages of decision-making is required in order to balance the risks and anticipated gains of the procedure, and to select those patients who can mostly benefit from spinal correction.

Objective Ankylosing spondylitis (AS) is a rheumatic inflammatory disease marked by chronic inflammation of the axial skeleton. This condition, particularly when severe, can lead to increased risk of vertebral fractures attributed to decreased ability of the stiffened spinal column to sustain normal loads. However, little focus has been placed on understanding the locations of spinal fractures and associated complications and assessing the correlation between these. In this review, we aim to summarize the complications and treatment patterns in the United States in AS patients with spinal fractures, using the latest Nationwide Inpatient Sample (NIS) database (2016–2018). Methods We analyzed the NIS data of years 2016–2018 to compare the fracture patterns and complications. Results A total of 5,385 patients were included. The mean age was 71.63 years (standard deviation [SD], 13.21), with male predominance (83.8%). The most common population is Whites (77.4%), followed by Hispanics (7.9%). The most common fracture level was thoracic level (58.3%), followed by cervical level (38%). Multiple fracture levels were found in 13.3% of the patients. Spinal cord injury (SCI) was associated with 15.8% of the patients. The cervical level had a higher proportion of SCI (26.5%), followed by thoracic level (9.2%). The mean Elixhauser comorbidity score was 4.82 (SD, 2.17). A total of 2,365 patients (43.9%) underwent surgical treatment for the fractures. The overall complication rate was 40.8%. Respiratory complications, including pneumonia and respiratory insufficiency, were the predominant complications in the overall cohort. Based on the regression analysis, there was no significant difference (p=0.45) in the complication rates based on the levels. The presence of SCI increased the odds of having a complication by 2.164 times (95% confidence interval, 1.722–2.72; p≤0.001), and an increase in Elixhauser comorbidity score predicted the complication and in-hospital mortality rate (p≤0.001). Conclusion AS patients with spinal fractures have higher postoperative complications than the general population. The most common fracture location was thoracic in our study, although it differs with few studies, with SCI occurring in 1/6th of the patients.

Postoperative pulmonary complications are common. Despite advances in perioperative care for patients undergoing major surgery, they are associated with increased morbidity, mortality and healthcare costs. Strategies to reduce postoperative pulmonary complications include identification of patients at risk for respiratory complications, followed by risk stratification and perioperative optimization. This article evaluates current literature on the definition of postoperative pulmonary complications, their underlying biological mechanisms, contributing risk factors and preventative measures. Of note, the wide variability in the definition of postoperative pulmonary complications highlights the importance of identifying outcome measures and standardized end points as they affect the validity of clinical trials. Validated risk prediction models are useful tools for clinicians to stratify patients at risk, however there is still a lack of consensus over which model is the best one to use. Evidence for preventative measures including smoking cessation, correction of anaemia, perioperative respiratory physiotherapy and intraoperative management including lung-protective ventilation and goal-directed haemodynamic therapy are discussed. Most importantly, perioperative care bundles demonstrate the importance of multidisciplinary involvement during different time points when a patient undergoes surgery, and a combination of interventions are found to be more beneficial than individual interventions alone. [ABSTRACT FROM AUTHOR]

Background: Severe obstructive sleep apnoea (OSA) is associated with increased risk of respiratory compromise in the post‐operative period following adenotonsillectomy (AT). This study analyses the economic cost of polysomnography or overnight oximetry as part of pre‐operative risk stratification in paediatric AT, supplementing previously published research demonstrating the efficacy of this protocol in predicting respiratory complications. Methods: This cost‐minimisation analysis examines costs associated with pre‐operative overnight oximetry and polysomnography in triaging paediatric patients older than 2 years old, with no major comorbidities except for OSA, undergoing AT for OSA (n = 1801) to either a secondary or quaternary Australian hospital. Decision analysis modelling via probability trees were utilized to estimate pre‐ and peri‐operative costs. A third hypothetical 'no investigation' model based upon conducting all AT at a secondary hospital was performed. Costs are derived from the financial year 2020–2021, censored at discharge. Results: The total cost per patient of AT including pre‐operative investigations of oximetry and polysomnography, and associated inpatient costs, were AUD4181.34 and 5013.99 respectively. This is more expensive compared to a hypothetical no‐investigation model (AUD3958.98). Conclusion: Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre‐operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low‐risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri‐operative risk stratification for paediatric AT from a financial perspective. [ABSTRACT FROM AUTHOR]