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Background: With machine learning (ML) carving a niche in diverse medical disciplines, its role in sepsis prediction, a condition where the 'golden hour' is critical, is of paramount interest. This study assesses the factors influencing the efficacy of ML models in sepsis prediction, aiming to optimize their use in clinical practice., Methods: We searched Medline, PubMed, Google Scholar, and CENTRAL for studies published from inception to October 2023. We focused on studies predicting sepsis in real-time settings in adult patients in any hospital settings without language limits. The primary outcome was area under the curve (AUC) of the receiver operating characteristic. This meta-analysis was conducted according to PRISMA-NMA guidelines and Cochrane Handbook recommendations. A Network Meta-Analysis using the CINeMA approach compared ML models against traditional scoring systems, with meta-regression identifying factors affecting model quality., Results: From 3,953 studies, 73 articles encompassing 457,932 septic patients and 256 models were analyzed. The pooled AUC for ML models was 0.825 and it significantly outperformed traditional scoring systems. Neural Network and Decision Tree models demonstrated the highest AUC metrics. Significant factors influencing AUC included ML model type, dataset type, and prediction window., Conclusion: This study establishes the superiority of ML models, especially Neural Network and Decision Tree types, in sepsis prediction. It highlights the importance of model type and dataset characteristics for prediction accuracy, emphasizing the necessity for standardized reporting and validation in ML healthcare applications. These findings call for broader clinical implementation to evaluate the effectiveness of these models in diverse patient groups., Systematic Review Registration: https://inplasy.com/inplasy-2023-12-0062/, identifier, INPLASY2023120062., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Yadgarov, Landoni, Berikashvili, Polyakov, Kadantseva, Smirnova, Kuznetsov, Shemetova, Yakovlev and Likhvantsev.)

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., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Inc.)

Unlabelled: Despite a steady decline in the incidence in recent decades, gastric cancer remains one of the most frequent causes of death from cancer in the world. By the time of diagnosis the tumor process is locally advanced or generalized in nearly 70% of patients that reduces the possibility of radical surgical treatment. Peritoneal carcinomatosis is a one of the main causes of treatment failure. There patients need complex treatment with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (IHIC) to improve the quality and duration of life. Today in Russia, surgeries with IHIC are performed in a very limited number of oncology hospitals, thus there is no unified approach to the perioperative management of these patients., Design: Since November 2010 in our institution we started a prospective clinical study of the use of intraoperative hyperthermic intraperitoneal chemotherapy in patients with locally advanced or metastatic gastric cancer., Materials and Methods: The study included 30 patients (18 men and 12 women) who underwent transabdominal gastrectomy with extended lymphadenectomy D2, supplemented principled cholecystectomy and oophorectomy (in women). Mean age was 48.5 ± 5.3 years. Technique involved the use of regional anesthesia com- ponent and inhalation anesthetic sevoflurane. Preoperative preparation included enteral nutrition (based on 25-30 kcal/ kg/day), liver protection (intravenous remaxol infusion of 500 ml/day for 3 days prior to surgery), antisecretory and antifermental therapy (omeprazole 40 mg/day, 100 mg octreotide for 2 h before surgey, aprotinin sulfate 30000 after induction of anesthesia), antioxidant and immunomodulatory therapy (galavit, cytoflavin, ceruloplasmin vitamin C), anticoagulant prophylaxis (enoxaparin sodium 40 mg on the evening before surgery)., Results: Analysis of the world and our own clinical experience with intraoperative hyperthermic intraperitoneal chemotherapy in a comprehensive plan of treatment of patients with gastric cancer showed that the this aggressive, but highly effective technique can be requires not only careful patient selection according to the criteria, but also the use of special methods to protective therapy at all stages of the surgical treatment. Application of pathogenetic ways of protection from thermal injury, timely control and correction of homeostasis caused by the toxic effects of chemotherapy and burn peritoneum, early enteral nutrition and the use of organ-therapy reduce the risk of complications and achieve better results of treatment in cancer patients.

This review is devoted to analysis of the world experience of perioperative care in patients with high risk of development and aggravation of heart rhythm and conduction disturbances. There was given the definition of the arrhythmia, their modern classification, described the mechanisms of formation and causes of long duration. Special attention is paid to the problem of perioperative arrhythmias in oncosurgery, which is characterized by the extent and traumatic interventions in reflexogenic zones in patients with nutritive deficiency, hypovolaemia, anemia, electrolyte imbalance. The problem of interaction of antiarrhythmic drugs with anaesthetics, possible complications and ways of correction of hemodynamically significant bradycardia with the help of drugs (atropine, sympathomimetics) and drug-free (transesophageal (TEECS) and invasive cardiac stimulation) methods. Describes approaches to the diagnosis and prediction of the risk of the arrhythmia development with the help of the analysis of Holter ECG results with e of heart rhythm variability (HRV) assessment.

The study was based on 478 oncology patients (72.1 +/- 3.6 years old) with cardiovascular comorbidities operated from 1991 to 2008 in regards of abdominal and pelvic mainly 3rd stage tumors with multimodal general anesthesia (4.2 +/- 1.6 hours). In prospective group (n = 302) all patients received cardiovascular treatment, while in retrospective group (n = 176) only 48.9% received it. The evaluation of the cardiovascular therapy effect was based on the peri-operative and postoperative HR and BP dynamics. The occurrance of noticeable bradycardia and drop of BP lower than 90/60 mm Hg was considered as a deviation. It is revealed that the cardiovascular therapy with beta adrenoblockers and calcium antagonists leads to an intraoperative bradycardia in 59.8% and 73.7% of cases, while in patients without the aforementioned therapy in 26.6% and 46.4% of cases respectively (p < 0.05). Antiarrhythmics don't have a noticeable impact on the development of bradycardia (p = 0.204). Intraoperative hypotension on the basis of ATP inhibitor treatment developed in 92.2% of patients statistically significant (p < 0.01). Monotherapy with calcium antagonists or nitrates leads to the development of hypotension in 55.2% and 41.4% of cases respectively, though in patients without the given therapy a lot more often (p < 0.05). In the case of combined calcium antagonist/nitrate therapy hypotension develops in 55.5% of cases, and in 72.3% without the therapy (p < 0.05). For the means of prevention of cardiovascular complications during the surgical treatment it is appropriate to keep the therapy with nitrates, though vasodilatives should be canceled 12 hours before the surgery.

Cardiovascular events (CVE) developing at the stages of surgical treatment in 449 geriatric (aged 72 +/- 5.8 years) cancer patients with concomitant cardiovascular diseases (CVD) were quantitatively and qualitatively analyzed. Statistical analysis was used to compare and establish a discrepancy between the results of a predictable risk by the standard scale of the international perioperative CV risk index (ICVRI) and the actually developed complications. The logistic regression method was employed to analyze the risk factors included into the ICVRI scale. The risk factors that were best in predicting the development of CVE were determined. A mathematical formula was derived to estimate the adjusted prognosis of an individual cardiovascular risk. Based on their perioperative CV risk classification, the authors constructed an algorithm of a diagnostic search and surgical preparation tactics in seriously ill cancer patients with concomitant CVD. The algorithm has been put into the routine practice of the P. A. Herzen Moscow Research Institute of Oncology, which makes it possible to improve the results of surgical treatment in geriatric patients and to expand its indications. Examples of clinically applying the algorithm are given.

Investigations were made at surgical treatment stages in 102 cancer patients (mean age 72 +/- 5.8 years) at high cardiovascular risk, who received continuous therapy that reduced heart rate and blood pressure, in order to compensate for the course of coronary heart disease and arterial hypertension. The time course of changes in the major circulatory and metabolic parameters was analyzed in patients during operations on the abdomen and small pelvis while using three different multimodal anesthetic techniques (general intravenous anesthesia-based diazepam, propofol, fentanyl, ketamine; sevofluorane-based inhalational; combined epidural and intravenous one). The advantages and limitations of the above methods were shown in patients on cardio- and vasotropic therapies. Correcting modes (transesophageal atrial pacing, morning-dose drug withdrawal) for its possible related bradycardiac and hypotensive disorders, which reduce a risk of perioperative cardiovascular complications, are set forth.