scholarly journals Robot-Assisted versus Open Pancreatoduodenectomy: Identifying Perioperative Anesthetic Factors associated with Postoperative Morbidity. A retrospective cohort study.

2021 ◽  
Author(s):  
Antoon van den Enden ◽  
Maya Vereen ◽  
Bas Groot Koerkamp ◽  
Markus Klimek
Keyword(s):  
Fluid Balance ◽  
Postoperative Morbidity ◽  
Blood Gas Analysis ◽  
Primary Objective ◽  
Gas Analysis ◽  
Major Morbidity ◽  
Arterial Blood Gas ◽  
Factors Associated ◽  
Arterial Blood ◽  
Patient Morbidity

Abstract BackgroundRobot-assisted pancreatoduodenectomy (RAPD) poses several challenges concerning perioperative anesthetic guidance compared to open pancreatoduodenectomy (OPD), e.g. combined pneumoperiotoneum with reversed-Trendelenburg positioning. The primary objective of this observational study is to specify these anesthetic differences of RAPD versus OPD and secondly to identify independent anesthetic factors associated with patient morbidity following RAPD.MethodsAll consecutive patients who underwent either RAPD or OPD between 2017 and 2018 were included for analysis. Patient records were screened for intraoperative vasopressor and fluid administration as well as for results of perioperative arterial blood gas analysis. Variables were compared for the groups RAPD versus OPD, major morbidity following RAPD versus non-major morbidity following RAPD (resp. Clavien-Dindo score ≥ III vs. < III) and high versus low intraoperative blood loss during RAPD. Perioperative factors associated with major postoperative morbidity (Clavien-Dindo ≥ III ) were identified using a logistic regression model.ResultsN=64 RAPD and n=62 OPD patients were included for retrospective analysis. RAPD was associated with higher administration of intraoperative norepinephrine (9.5% of operative time vs. 0% in OPD, p=0.005) and a higher net intraoperative fluid balance (2497.6 vs. 1572.3 ml, p<0.001). During OPD, patients received more frequent and higher doses of colloid fluids compared to RAPD (79.0% vs. 51.6%, p<0.001, median 1000.0 vs. 500.0 ml, p<0.001). Colloid administration during surgery and hyperlactatemia 12 hours postoperatively were associated with major morbidity after RAPD (OR 5.06, 95% CI 1.49-17.20, p=0.009 and OR 3.18, 95% CI 1.01-9.91, p=0.047, respectively).ConclusionsRAPD is a challenging procedure for the anesthesiologist, e.g. considering a higher demand for vasopressors. Inotropic/vasopressor administration as well as the intraoperative fluid balance are associated with (major) morbidity following RAPD. However, it remains unclear whether and in which direction a causal relationship exists.Trial registration: Not applicable.

scholarly journals The Predicitive Value of Arterial Blood Gas Analysis and Radiologic Scores in ARDS

1985 ◽  
Vol 32 (2) ◽  
pp. 112-118
Author(s):  
Seong Gyu Hwang ◽  
Su Taik Uh ◽  
Byung Soo Ahn ◽  
Dong Cheul Han ◽  
Choon Sik Park ◽  
...  
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

scholarly journals Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

2017 ◽  
Vol 32 (2) ◽  
pp. 148-153
Author(s):  
Asifa Karamat ◽  
Shazia Awan ◽  
Muhammad Ghazanfar Hussain ◽  
Fahad Al Hameed ◽  
Faheem Butt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Clinical Prediction ◽  
Prediction Rules ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
D Dimer

scholarly journals Agreement between arterial and capillary pH, pCO2 and lactate in patients in the emergency department

2020 ◽  
Author(s):  
V. Collot ◽  
S. Malinverni ◽  
E. Schweitzer ◽  
J. Haltout ◽  
P. Mols ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Sensitivity And Specificity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mean Difference ◽  
Blood Gas ◽  
Limits Of Agreement ◽  
Study Objective ◽  
Arterial Blood Gas ◽  
Arterial Blood

AbstractStudy objectiveThe primary objective of the study was a quantitative analysis to assess the mean difference and 95% confidence interval of the difference between capillary and arterial blood gas analyses for pH, pCO2 and lactate. Secondary objective was to measure the sensitivity and specificity of capillary samples to detect altered pH, hypercarbia and lactic acidosis.MethodsAdults admitted to the ED for whom the treating physician deemed necessary an arterial blood gas analysis (BGA) were screened for inclusion. Simultaneous arterial and capillary samples were drawn for BGA. Agreement between the two methods for pH, pCO2 and lactate were studied with Bland-Altman bias plot analysis. Sensitivity, specificity, positive and negative predictive value as well as AUC were calculated for the ability of capillary samples to detect pH values outside normal ranges, hypercarbia and hyperlactatemia.Results197 paired analyses were included in the study. Mean difference for pH, between arterial and capillary BGA was 0.0095, 95% limits of agreement were -0.048 to 0.067. For pCO2, mean difference was -0.3 mmHg, 95% limits of agreement were -8.5 to 7.9 mmHg. Lactate mean difference was -0.93 mmol/L, 95% limits of agreement were -2.7 to 0.8 mmol/L. At a threshold of 7.34 for capillary pH had 98% sensitivity and 97% specificity to detect acidemia; at 45.9 mmHg capillary pCO2 had 89% sensitivity and 96% specificity to detect hypercarbia. Finally at a threshold of 3.5 mmol/L capillary lactate had 66% sensitivity to detect lactic acidosis.ConclusionCapillary measures of pH, pCO2 and lactate can’t replace arterial measurements although there is high concordance between the two methods for pH and pCO2 and moderate concordance for lactate. Capillary blood gas analysis had good accuracy when used as a screening tool to detect altered pH and hypercarbia but insufficient sensitivity and specificity when screening for lactic acidosis.

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