Quality of recovery after anesthesia is an important indicator of patient postoperative outcomes. Quality of Recovery-40 (QoR-40) is a validated and widely used multidimensional 40-item questionnaire ...that measures postoperative quality of recovery. The aim of this study was to perform translation and psychometric validation of the Croatian version of QoR-40, which included validity, reliability, responsiveness, and clinical acceptability. The QoR-40 and Short Form-36 (SF-36) questionnaires were administered to patients undergoing general anesthesia for elective surgery on the day before surgery and on postoperative day 3. The quality of recovery was also assessed with visual analog scale (VAS) 0-100. Of 192 enrolled patients, 162 completed the study protocol. Convergent validity assessed by Pearson correlation (r) between the QoR-40 and VAS scores was 0.68 (p<0.001). There were moderate correlations of QoR-40 with SF-36 Physical component scale (r=0.521; p<0.001) and with SF-36 Mental component scale (r=0.580; p<0.001). Construct validity was supported by negative correlation with the length of hospital stay (r=-0.21; p=0.007) and significant difference in total postoperative QoR-40 scores between patients with and without postoperative complications (p<0.001). Internal consistency of the global QoR-40 was high (Cronbach’s α=0.93) and of the QoR-40 dimensions it was moderate to high (≥0.714). Split-half coefficient was 0.87, Cohen’s effect size was 0.81, and standardized response mean was 0.762. Our translated QoR-40 is a valid, reliable and comprehensive questionnaire for measuring quality of postoperative recovery across surgery spectrum in Croatian population with psychometric properties similar to the original version.
Aim To investigate whether IV lidocaine improves emergence, early recovery, and late recovery after general anesthesia in women who undergo breast surgery. Methods Sixty-seven women with American ...Society of Anesthesiologists physical status I-II, scheduled for breast surgery were randomized to receive an IV lidocaine 1.5 mg/kg bolus (n = 34) or saline placebo (n = 33) before tracheal extubation. Anesthesia was induced with thiopental, vecuronium, and fentanyl, and maintained with sevoflurane ~ 1 MAC and 50% nitrous-oxide in oxygen. No postoperative nausea and vomiting (PONV) prophylaxis was given. Time to extubation, bucking before extubation, and quality of emergence, as well as early and late recovery (coughing post-extubation, sore throat, PONV, and pain scores) within 24 hours postoperatively were evaluated. Diclofenac and meperidine were used for the treatment of pain and metoclopramide for PONV. Results The groups did not significantly differ in demographics, intraoperative data, or PONV risk scores. Extubation was ~ 8 minutes in both groups. Patients who received IV lidocaine had significantly smoother recovery, both statistically and clinically; they had better extubation quality scores (1.5 1-3 vs 3 1-5, P < 0.001), less bucking before extubation (38% vs 91%, P < 0.001), less coughing after extubation (at 1 min 18% vs 42%, P = 0.026; and at 24 hours 9% vs 27%, P=0.049), and less sore throat (6% vs 48%, P < 0.001). Late PONV decreased (3% vs 24%, P=0.013). There were no differences in pain scores and treatment. Conclusion In women who underwent breast surgery, IV lidocaine bolus administered just before extubation attenuated bucking, cough and sore throat, and PONV for 24 hours after general anesthesia, without prolonging the emergence.
Abstract Study objective To investigate possible effects of volatile induction and maintenance anesthesia with sevoflurane (VIMA) and total intravenous anesthesia with propofol (TIVA) on regional ...cerebral oxygen saturation (rcS o2 ) during laparoscopic cholecystectomy. Design Randomized, prospective and single-blinded study. Setting Academic hospital. Patients ASA physical status of I and II surgical patients, scheduled for elective laparoscopic cholecystectomy from March 2013 to October 2014. Measurements Changes of regional cerebral oxygen saturation were measured by near-infrared spectroscopy on the left and right sides of forehead at different time points: before anesthesia induction (Tbas), immediately after induction (Tind), after applaying a pneumoperitoneum (TC o2 ), 10 minutes after positioning the patient into reverse Trendelenburg's position (TrtC o2 ), immediately after desufflation of gas (Tpost) and 30 (Trec30) and 60 (Trec60) minutes after emergence from anesthesia. Main results Study population included 124 patients, 62 in each group. There was no significant difference between these groups according to demographic characteristics, surgery and anesthesia times as well as in the basal rcS o2 values. Statistically higher rSc o2 values were noted in the VIMA group when compared to the TIVA group in all time points Tind, TC o2 , TrtC o2 , Tpost, Trec30 and Trec60 and incidence of critical rcS o2 decreases was statistically lower in VIMA group ( P < .05). There were no serious perioperative complications. Conclusions VIMA technique provides significantly (4%-11%) higher rcSO2 values during general anesthesia for laparoscopic cholecystectomy, when compared with TIVA and also provides significantly less number of critical rcSO2 decreases.
One of the most common surgeries in elderly patients is eye surgery. An increasing number of patients undergoing ambulatory eye surgery are on antithrombotic therapy. These drugs may increase the ...risk of perioperative bleeding associated with ophthalmic needle blocks and/or eye surgery. Intraoperative bleeding and postoperative hemorrhagic complications may lead to the loss of vision or even eyes. On the other hand, stopping anticoagulants and antiplatelets before the surgery may increase the risk of thrombotic events with potentially life-threatening complications. The aim of this narrative review is to provide a systematic review of the published evidence for the perioperative antithrombotic management of patients undergoing different types of eye surgery in ambulatory settings. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from January 2015 to December 2018 was performed. The database searches included studies providing evidence relevant to ambulatory eye surgery and perioperative antiplatelet medications and anticoagulants. Updated recommendations will be given for continuation, discontinuation, and modification of antithrombotic agents in order to optimize the management of antithrombotic therapies in outpatients scheduled for eye surgery.
Abstract Study Objective To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective ...laparoscopic gynecological surgery. Design Prospective, observational, blinded study. Setting General hospital, Postanesthesia Care Unit, and gynecologic floor room. Patients 111 ASA physical status 1 and 2 women, aged 18 to 53 years. Interventions Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal phase (days 16 to end of cycle; n = 37). Anesthetic, postoperative pain management, and antiemetic regimens were standardized. Measurements Frequency of nausea, vomiting, or both were assessed for early (0-2 hrs). Late PONV (2-24 hrs) along with the use of rescue antiemetic, severity of nausea, and pain. Main Results In the follicular (n = 34), ovulatory (n = 40) and luteal phase (n = 37) groups, the frequencies of PONV over 24 hours were 35%, 38%, and 14% ( P = 0.04), respectively. This was due to differences in the early postoperative period where the frequencies were 21%, 25%, and 3% ( P = 0.02), respectively, as frequencies were similar in the late period (15%, 20% and 14%, P = 0.71), respectively. Nausea scores, rescue antiemetic usage, pain scores, and opioid consumption were similar in the groups. Conclusion Patients in the luteal phase of their menstrual cycle may have a decreased risk of PONV after laparoscopic gynecological surgery in the early postoperative period.
To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two ...local anesthetics.
A prospective, single-center, randomized, double-blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n=42) or 0.5% levobupivacaine with 2% lidocaine (n=43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale.
Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean time-to-block onset (14 minutes; P<0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P<0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P=0.006) and more episodes of hypotension (17.5%; P=0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P<0.001).
The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect.
Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an ...analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.
Abstract Study Objective To assess the efficacy of intraoperative inspired oxygen fractions (FIO2 ) of 0.8 and 0.5 when compared with standard FIO2 of 0.3 in the prevention of postoperative nausea ...and vomiting (PONV). Design Prospective, randomized, double-blinded, controlled study. Setting General hospital, postanesthesia care unit (PACU), and gynecology floor room. Patients 120 ASA physical status I and II women, aged 21 to 76 years, undergoing elective gynecologic laparoscopic surgery. Interventions Patients were randomized to receive a gas mixture of 30% oxygen in air (FIO2 = 0.3, Group G30), 50% oxygen in air (FIO2 = 0.5, Group G50), or 80% oxygen in air (FIO2 = 0.8, Group G80); there were 36 patients in each group. A standardized sevoflurane general anesthesia, postoperative pain management, and antiemetic regimen were used. Measurements Frequency of nausea, vomiting, and both was assessed for early (0 to two hrs) and late PONV (two to 24 hrs), along with use of rescue antiemetic, degree of nausea, and severity of pain. Main Results There was no overall difference in the frequency of PONV at the early and late assessment periods among the three groups. G80 patients had significantly less vomiting than Group G30 at two hours, 3% (1/36) vs. 22% (8/36), respectively, P = 0.028. Nausea scores, rescue antiemetic use, pain scores, and opioid consumption did not differ among the groups. Conclusion High intraoperative FIO2 of 0.8 and FIO2 of 0.5 do not prevent PONV in patients without antiemetic prophylaxis. An intraoperative FIO2 of 0.8 has a beneficial effect on early vomiting only.
The study aimed to explore clinical influence of prostatic stones on lower urinary tract symptoms (LUTS), seminal plasma cytokines, and serum biomarkers.
A total of 70 men aged ≤50 years with LUTS ...divided into 2 groups: group with stones (GSt) and group without prostatic stones (GNoSt). All subjects completed the International Prostate Symptom Score (IPSS) questionnaire and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scoring questionnaire. Pre- and post-prostate massage test and uroflowmetry were performed. The serum concentration of total prostate specific antigen (PSA), free PSA, and free/total PSA (f/t PSA) ratio, seminal concentration of cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12p70, and tumor necrosis factor-alpha were measured.
GSt subjects had significantly more severe symptoms based on IPSS answers (p = 0.0289). All domains in NIH-CPSI scores were significantly higher in the GSt group: pain (p = 0.001), urinary symptoms (p = 0.023), quality of life (p = 0.008), and with overall (p = 0.003). GSt subjects also had significantly lower maximum urinary flow (Qmax; p = 0.011), lower f/t PSA ratio (p = 0.048), and higher concentration of IL-1β (p = 0.011) and IL-8 (p = 0.001).
Prostatic stones may influence the severity of LUTS and the symptoms of chronic prostatitis. They might reduce Qmax rate and lead to reduction of the f/t PSA ratio and produce more severe inflammation causing increased seminal concentration of IL-1β and IL-8.
Multiply injured patients with severe chest trauma have different combinations of associated extra thoracic injuries making their treatment complex. Severe pain is a prominent symptom in a vast ...majority of severe chest injuries and causes deterioration of respiratory function. Epidural analgesia provides efficient pain relief but its use in this group of patients is burdened with complications, contraindications and technical difficulties. We present two cases in which epidural analgesia was successfully used in polytrauma patients with severe chest injuries and hypoxemic respiratory failure, and discuss advantages, possible pitfalls and complications.
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