Geo–economic variations in epidemiology, ventilation management and outcome of patients receiving intraoperative ventilation during general anesthesia– posthoc analysis of an observational study in 29 countries

Abstract Background The aim of this analysis is to determine geo–economic variations in epidemiology, ventilator settings and outcome in patients receiving general anesthesia for surgery. Methods Posthoc analysis of a worldwide study in 29 countries. Lower and upper middle–income countries (LMIC and UMIC), and high–income countries (HIC) were compared. The coprimary endpoint was the risk for and incidence of postoperative pulmonary complications (PPC); secondary endpoints were intraoperative ventilator settings, intraoperative complications, hospital stay and mortality. Results Of 9864 patients, 4% originated from LMIC, 11% from UMIC and 85% from HIC. The ARISCAT score was 17.5 [15.0–26.0] in LMIC, 16.0 [3.0–27.0] in UMIC and 15.0 [3.0–26.0] in HIC (P = .003). The incidence of PPC was 9.0% in LMIC, 3.2% in UMIC and 2.5% in HIC (P < .001). Median tidal volume in ml kg− 1 predicted bodyweight (PBW) was 8.6 [7.7–9.7] in LMIC, 8.4 [7.6–9.5] in UMIC and 8.1 [7.2–9.1] in HIC (P < .001). Median positive end–expiratory pressure in cmH2O was 3.3 [2.0–5.0]) in LMIC, 4.0 [3.0–5.0] in UMIC and 5.0 [3.0–5.0] in HIC (P < .001). Median driving pressure in cmH2O was 14.0 [11.5–18.0] in LMIC, 13.5 [11.0–16.0] in UMIC and 12.0 [10.0–15.0] in HIC (P < .001). Median fraction of inspired oxygen in % was 75 [50–80] in LMIC, 50 [50–63] in UMIC and 53 [45–70] in HIC (P < .001). Intraoperative complications occurred in 25.9% in LMIC, in 18.7% in UMIC and in 37.1% in HIC (P < .001). Hospital mortality was 0.0% in LMIC, 1.3% in UMIC and 0.6% in HIC (P = .009). Conclusion The risk for and incidence of PPC is higher in LMIC than in UMIC and HIC. Ventilation management could be improved in LMIC and UMIC. Trial registration Clinicaltrials.gov, identifier: NCT01601223.

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A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽

10.1177/2732501620979323 ◽

2021 ◽

pp. 273250162097932

Author(s):

Naikhoba C. O. Munabi ◽

Eric S. Nagengast ◽

Gary Parker ◽

Shaillendra A. Magdum ◽

Mirjam Hamer ◽

...

Keyword(s):

Surgical Technique ◽

Intraoperative Complications ◽

Complication Rates ◽

The Novel ◽

Middle Income ◽

Middle Income Countries ◽

Lumbar Drain ◽

Cerebral Herniation ◽

Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

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