Resolution of inflammation is an active and dynamic process after surgery. Maresin 1 (MaR1) is one of a growing number of specialised pro-resolving lipids biosynthesised by macrophages that regulates ...acute inflammation. We investigated the effects of MaR1 on postoperative neuroinflammation, macrophage activity, and cognitive function in mice.
Adult male C57BL/6 (n=111) and Ccr2RFP/+Cx3cr1GFP/+ (n=54) mice were treated with MaR1 before undergoing anaesthesia and orthopaedic surgery. Systemic inflammatory changes, bone healing, neuroinflammation, and cognition were assessed at different time points. MaR1 protective effects were also evaluated using bone marrow derived macrophage cultures.
MaR1 exerted potent systemic anti-inflammatory effects without impairing fracture healing. Prophylaxis with MaR1 prevented surgery-induced glial activation and opening of the blood–brain barrier. In Ccr2RFP/+Cx3cr1GFP/+ mice, fewer infiltrating macrophages were detected in the hippocampus after surgery with MaR1 prophylaxis, which resulted in improved memory function. MaR1 treatment also reduced expression of pro-inflammatory cell surface markers and cytokines by in vitro cultured macrophages. MaR1 was detectable in the cerebrospinal fluid of older adults before and after surgery.
MaR1 exerts distinct anti-inflammatory and pro-resolving effects through regulation of macrophage infiltration, NF-κB signalling, and cytokine release after surgery. Future studies on the use of pro-resolving lipid mediators may inform novel approaches to treat neuroinflammation and postoperative neurocognitive disorders.
•There is no risk score for postoperative nausea and/or vomiting (PONV) in parturients.•We assessed potential parturient and peri-operative risk factors for PONV.•Non-smoking, history of PONV after ...cesarean and/or morning sickness increase risk.•All factors were included in an obstetric-specific risk score (Duke score)•Both Duke and Apfel risk scores performed poorly in prediction of PONV.
Postoperative nausea and/or vomiting affects up to 80% of parturients undergoing cesarean delivery, but there is a lack of obstetric-specific risk-prediction models. We performed this study to identify postoperative nausea/vomiting risk factors in parturients undergoing cesarean delivery, formulate an obstetric-specific prediction model (Duke score), and compare its performance against the Apfel score.
A post-hoc analysis of data from two randomized controlled trials studying nausea/vomiting in women undergoing cesarean delivery with intrathecal morphine. Potential risk factors for postoperative nausea/vomiting within 24 h of surgery with univariate associations with P ≤0.20 were considered for inclusion in the multivariable analysis. After identifying the final multivariable model, we derived our Duke score by assigning points to the selected factors. We then tested the association of the Duke and Apfel scores with postoperative nausea and vomiting, and compared the area-under-the-receiver operating characteristic curve.
Analysis included 260 parturients, of whom 146 (56.2%) experienced postoperative nausea/vomiting. Non-smoking during pregnancy (OR 2.29 95% CI 1.12 to 4.67, P=0.023), and history of postoperative nausea/vomiting after cesarean delivery and/or morning sickness (2.09 1.12 to 3.91, P=0.021) were independent predictors of postoperative nausea/vomiting and included in the Duke score. Both Duke and Apfel scores trended linearly with postoperative nausea/vomiting risk (Duke P=0.001; Apfel P=0.049) and had comparable areas-under-the-receiver operating characteristic curve (Duke 0.63 0.57 to 0.70; Apfel 0.59 0.52 to 0.65, P=0.155).
Both Duke and Apfel scores exhibited similar but poor predictive performance. Until better tools are developed, routine prophylactic anti-emetics appears to be a reasonable approach in this patient population.
(Am J Obstet Gynecol. 2018;219:613.e1.1–10)Obstructive sleep apnea (OSA), in addition to its multiple comorbidities, is associated with a significantly increased risk of preeclampsia and gestational ...diabetes mellitus in obese, pregnant women. However, current OSA diagnostic tools are costly and time-consuming to implement on a wide scale, and although portable at-home, unattended sleep apnea testing is emerging, such tools may be impractical in this particular patient population. This study evaluated the validity of existing OSA screening tools in a cohort of extremely obese pregnant women body mass index (BMI) ≥40 kg/m and determined what screening factors were most strongly associated with OSA in this cohort.
Abstract Background There are limited data about spinal dosing for cesarean delivery in preterm parturients. We investigated the hypothesis that preterm gestation is associated with an increased ...incidence of inadequate spinal anesthesia for cesarean delivery compared with term gestation. Methods We searched our perioperative database for women who underwent cesarean delivery under spinal or combined spinal-epidural anesthesia with hyperbaric bupivacaine ⩾10.5 mg. The primary outcome was the incidence of inadequate surgical anesthesia needing conversion to general anesthesia or repetition or supplementation of the block. We divided patients into four categories: <28, 28 to <32, 32 to <37 and ⩾37 weeks of gestation. The chi-square test was used to compare failure rates and a multivariable regression analysis was performed to investigate potential confounders of the relationship between gestational age and failure. Results A total of 5015 patients (3387 term and 1628 preterm) were included. There were 278 failures (5.5%). The incidence of failure was higher in preterm versus term patients (6.4% vs. 5.1%, P =0.02). Failure rates were 10.8%, 7.7 %, 5.3 % and 5 % for <28, 28 to <32, 32 to <37 and ⩾37 weeks of gestation, respectively. In the multivariable model, low birth weight ( P <0.0001), gestational age ( P =0.03), ethnicity ( P =0.02) and use of combined spinal-epidural anesthesia ( P <0.0001) were significantly associated with failure. Conclusions At standard spinal doses of hyperbaric bupivacaine used in our practice (⩾10.5 mg), there were higher odds of inadequate surgical anesthesia in preterm parturients. When adjusting for potential confounders, low birth weight was the main factor associated with failure.
(IJOA. 2016;26:8–14)The spread of spinal anesthesia may be increased during pregnancy, and hence pregnant women are considered to need a smaller dose of local anesthetic than nonpregnant women to ...achieve the same spinal block level. Data on spinal dosing for preterm (<37 wk of gestation) versus term (≥37 wk of gestation) parturients is limited. One earlier study found that standard doses of hyperbaric bupivacaine used for cesarean delivery failed to provide as high of a spinal block in women with preterm gestations compared to women at term. The aim of this study was to investigate the hypothesis that preterm gestation was associated with an increased risk of failed spinal anesthesia for cesarean delivery when compared with term gestation.
The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst ...suppression (BSup) - electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed "pre-burst suppression" (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3-35 Hz power (dB) during the 1-s preceding BSup relative to the average 3-35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman's ρ 95% CI: 0.52 0.34, 0.66,
< 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β 95% CI: -0.10 -0.19, -0.01,
= 0.024; -0.04 -0.06, -0.01,
= 0.009; -0.04 -0.06, -0.01,
= 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio 95% CI: 1.34 1.01, 1.78,
= 0.043), though this association did not hold for preBSup (odds ratio 95% CI: 1.04 0.95, 1.14,
= 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk.
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