scholarly journals Changes in the Plasma Apurinic/Apyrimidinic Endonuclease 1/Redox Factor-1(APE1/Ref-1) Level during Cancer Surgery: An Observational Study

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1280
Author(s):  
Yumin Jo ◽  
Yeojung Kim ◽  
Eunhye Park ◽  
Yuran Lee ◽  
Jiyeon Kim ◽  
...  
Keyword(s):  
Cancer Type ◽  
Intravenous Anesthesia ◽  
Cancer Resection ◽  
Patients With Cancer ◽  
Target Plasma ◽  
Significant Difference ◽  
American Society ◽  
After Cancer ◽  
American Society Of Anesthesiologists ◽  
Radial Artery Catheter

Background and Objectives: Propofol-based total intravenous anesthesia (TIVA) is presumed to have more favorable effects on the prognosis of patients with cancer compared with volatile inhaled anesthesia (VIA). We hypothesized that these anesthetics target plasma apurinic apyrimidinic endonuclease/redox effector factor-1 (APE1/Ref-1) as a possible mechanism of action. Materials and Methods: The plasma APE1/Ref-1 level was evaluated three times during surgery for cancer, i.e., before anesthesia, immediately after cancer resection, and finally, in the recovery room. Blood (3 cc) was drawn from the radial artery catheter, and plasma APE1/Ref-1 levels were compared according to measurement time and between the two groups. Spearman’s Rho correlation analysis was performed to determine relationships among body mass index, American Society of Anesthesiologists classification, age, sex, cancer type, and tumor-node-metastasis (TNM) stage. A total of 166 patients (VIA: 129; TIVA: 37) were enrolled. Results: Plasma APE1/Ref-1 level increased significantly (p = 0.028) after cancer resection compared with before surgery, but no significant difference was observed between anesthetics (p = 0.134). The post-resection plasma APE1/Ref-1 level showed a positive correlation with the NM stages, but not the T stage. Conclusions: The plasma APE1/Ref-1 level increased during surgery with more severe lymph node invasion, but there were no significant differences according to the anesthetics used.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

Electroacupuncture at St36 Accelerates the Recovery of Gastrointestinal Motility after Colorectal Surgery: A Randomised Controlled Trial

2014 ◽  
Vol 32 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Zhaodi Zhang ◽  
Changsong Wang ◽  
Quanyi Li ◽  
Mingyue Zhang ◽  
Haifang Zhao ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Gastrointestinal Motility ◽  
Controlled Trial ◽  
Bowel Function ◽  
Group 13 ◽  
Group Data ◽  
Significant Difference ◽  
American Society ◽  
Randomised Controlled ◽  
American Society Of Anesthesiologists

Objectives To evaluate whether electroacupuncture (EA) at ST36 can accelerate the recovery of gastrointestinal motility after colorectal surgery. Methods Forty patients of American Society of Anesthesiologists physical status II and III undergoing elective open resection of malignant colorectal tumours were included in this study. Using a sealed envelope method, the patients were randomly divided into two groups either receiving EA (EA group) or sham EA (SEA group). Data regarding the recovery of bowel function (times to the first bowel sounds, passage of flatus and defaecation) were collected and analysed. Results In the EA group, the time intervals from surgery to the first bowel movement and passage of flatus were shorter than in the SEA group (13±10 h vs 19±13 h, p<0.05 and 23±14 h vs 32±18 h, p<0.05, respectively). There was no significant difference between the groups regarding the time to first defaecation (68±45 h vs 72±53 h, p>0.05). Conclusions EA at ST36 accelerates the recovery of gastrointestinal motility after colorectal surgery. Trial Registration JJ22011-15.

scholarly journals A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries

2020 ◽  
Author(s):  
Pushpal Gandhi ◽  
Mahendra Agrawal ◽  
Bhavika Agrawal ◽  
Simarn Behl
Keyword(s):  
Epidural Analgesia ◽  
Comparative Evaluation ◽  
Hemodynamic Parameters ◽  
Regional Technique ◽  
Significant Difference ◽  
Group 2 ◽  
Reversible Loss ◽  
American Society ◽  
The One ◽  
American Society Of Anesthesiologists

<p class="abstract"><strong>Background:</strong> Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.</p><p class="abstract"><strong>Methods:</strong> Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).</p><p class="abstract"><strong>Results:</strong> There is no significant difference in age, weight, sex, and ASA grade in all three groups.</p><p class="abstract">Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group.  Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.</p><p class="abstract"><strong>Conclusions: </strong>Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.</p>

Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

2007 ◽  
Vol 73 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Naveen Pokala ◽  
S. Sadhasivam ◽  
R.P. Kiran ◽  
V. Parithivel
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Complication Rates ◽  
Intraabdominal Abscess ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

scholarly journals Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery

2011 ◽  
Vol 114 (4) ◽  
pp. 856-861 ◽  
Author(s):  
Christophe Dadure ◽  
Magali Sauter ◽  
Sophie Bringuier ◽  
Michelle Bigorre ◽  
Olivier Raux ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Surgical Correction ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Surgical Data ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Tranexamic acid (TXA) decreases intraoperative blood loss during cardiac or orthopedic surgery in children. We hypothesized that intraoperative TXA would reduce blood transfusion relative to placebo in patients pretreated with erythropoietin. Methods Forty consecutive children, American Society of Anesthesiologists status 1 or 2, scheduled to undergo surgical correction of craniosynostosis were randomly assigned to receive either intravenous TXA or saline, 0.9%, intraoperatively. All children received preoperative erythropoietin (600 U/kg once a week for 3 weeks before surgery). Perioperative blood loss, number and volume of transfusions, percentage of children who underwent transfusion, and side effects were noted after surgery and at the end of the study. Surgeon satisfaction and cost of treatment were also recorded. Results There was no significant difference between groups in demographic or surgical data. In the TXA group, the volume of packed erythrocytes transfused was significantly reduced by 85% (from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2 ml/kg) throughout the study period (P &lt; 0.05). Compared with the placebo group, the percentage of children requiring blood transfusion was lower in the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P &lt; 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of 19; P &lt; 0.05). Preoperative and postoperative hematologic parameters were comparable in both groups. There were no adverse events. Conclusion In children undergoing surgical correction of craniosynostosis and pretreated with erythropoietin, intraoperative TXA reduces the transfusion requirement.

Propofol Reduces Perioperative Remifentanil Requirements in a Synergistic Manner

2003 ◽  
Vol 99 (2) ◽  
pp. 347-359 ◽  
Author(s):  
Martijn J. Mertens ◽  
Erik Olofsen ◽  
Frank H. M. Engbers ◽  
Anton G. L. Burm ◽  
James G. Bovill ◽  
...  
Keyword(s):  
Published Data ◽  
Intravenous Anesthesia ◽  
Arterial Blood ◽  
C 50 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive ◽  
Surgical Stimulation ◽  
Nonadditive Interaction

Background Remifentanil is often combined with propofol for induction and maintenance of total intravenous anesthesia. The authors studied the effect of propofol on remifentanil requirements for suppression of responses to clinically relevant stimuli and evaluated this in relation to previously published data on propofol and alfentanil. Methods With ethics committee approval and informed consent, 30 unpremedicated female patients with American Society of Anesthesiologists physical status class I or II, aged 18-65 yr, scheduled to undergo lower abdominal surgery, were randomly assigned to receive a target-controlled infusion of propofol with constant target concentrations of 2, 4, or 6 microg/ml. The target concentration of remifentanil was changed in response to signs of inadequate anesthesia. Arterial blood samples for the determination of remifentanil and propofol concentrations were collected after blood-effect site equilibration. The presence or absence of responses to various perioperative stimuli were related to the propofol and remifentanil concentrations by response surface modeling or logistic regression, followed by regression analysis. Both additive and nonadditive interaction models were explored. Results With blood propofol concentrations increasing from 2 to 7.3 microg/ml, the C(50) of remifentanil decreased from 3.8 ng/ml to 0 ng/ml for laryngoscopy, from 4.4 ng/ml to 1.2 ng/ml for intubation, and from 6.3 ng/ml to 0.4 ng/ml for intraabdominal surgery. With blood remifentanil concentrations increasing from 0 to 7 ng/ml, the C(50) of propofol for the return to consciousness decreased from 3.5 microg/ml to 0.6 microg/ml. Conclusions Propofol reduces remifentanil requirements for suppression of responses to laryngoscopy, intubation, and intraabdominal surgical stimulation in a synergistic manner. In addition, remifentanil decreases propofol concentrations associated with the return of consciousness in a synergistic manner.

scholarly journals The study of oropharyngeal pack soaked in lignocaine with dexamethasone in patients undergoing nasal surgeries

2020 ◽  
Vol 8 (1) ◽  
pp. 22
Author(s):  
Mahendra Agrawal ◽  
Pushpal Gandhi ◽  
Bhavika Agrawal ◽  
Simarn Behl
Keyword(s):  
Blood Pressure ◽  
Retrospective Study ◽  
Systolic Blood Pressure ◽  
Sore Throat ◽  
Pressure Pulse ◽  
Postoperative Sore Throat ◽  
Significant Difference ◽  
Group A ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: The aim of this study determines the efficacy of lignocaine lignocaine with dexamethasone used topically in form of oropharyngeal pack in reducing postoperative sore throat (POST), hoarseness and throat irritation.  Methods: This retrospective study total of 70 adult patients included in the lignocaine and dexamethasone (LD) group. LD group patients received combination of 5 ml lignocaine 2% and 2 ml (8 mg) dexamethasone in oropharyngeal packing.Results: There is no significant difference in age, gender, and American society of anesthesiologists (ASA) grade I and II. There was no significant difference the studied group in term of measured hemodynamic indices Systolic blood pressure, diastolic blood pressure, pulse rate, and respiratory rate. Post extubation incidence of mild sore throat was occurred in patients 11 (31.4%) at 30 min, 13 (37.1%) at 2 hours, 6 (17.1%) at 6 hours, and 5 (14.2%) at 5 (14.2%). Moderate sore throat and severe sore throat was not present. Hoarseness of voice was present only 4 (11.4%) at 30 min. There was significant deference in throat irritation. A decrease in incidence of hoarseness was also seen in group LD.  Conclusions: In LD group a positive benefit is seen in form of reduction of POST, hoarseness and throat irritation helping in better recovery of patients.

scholarly journals The Effect of COVID-19 Pandemic on the Hip Fractures in Advanced Age

2021 ◽  
Author(s):  
Ahmet Metin Özsezen ◽  
Ahmet Burak Bilekli ◽  
Anıl Özgür ◽  
Onur Denizhan Sivri ◽  
Çağrı Neyişçi ◽  
...  
Keyword(s):  
Primary Care ◽  
Hip Fractures ◽  
The Elderly ◽  
Mortality Rates ◽  
Demographic Characteristics ◽  
Low Energy ◽  
Primary Care Unit ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective: Hip fractures due to domestic low-energy traumas are common problems that can cause significant morbidity and mortality in the elderly population. Since the Covid-19 outbreak, although the lock-down of older people could decrease contagion,the incidence of domestic traumas did not decrease, and led to development of various comorbidities. In this study, we aimed to compare the epidemiology of hip fractures in 6 months of the pandemic in 2020, with the equivalent 6-month period in the previous year to determine the relationship between lock-down and hip fractures due to domestic falls. Method: In this retrospective study, patients over 65 years old who were hospitalized due to hip fractures between May 1st, 2020 - November 30th, 2020 were compared with the similar cohort hospitalized between May 1st, 2019 - November 30th, 2019. The patients were compared in terms of demographic characteristics, American Society of Anesthesiologists (ASA) scores, type of anesthesia, time until surgery, comorbidities, surgical treatment modality, need for postoperative primary care unit, postoperative complications, and mortality. Results: Overall, 210 patients were included in our study. There was no significant difference between the groups regarding demographic characteristics and ASA scores. In the 2020 group, there were eight patients (8.6%) who were Covid-19 PCR- positive. There was no death proven by PCR that was related to COVID-19 disease. Time to surgery, fracture type, anesthesia type did not differ between the two groups. The need for a postoperative primary care unit was higher in the 2020 group. Ninety-day mortality rates were not significantly different between the two groups. Conclusions: In conclusion, despite higher mortality rates described in the literature, there was no Covid -19 associated mortality in our study. Hip fractures in the elderly did not alter with social mobilization; hence they usually occur due to domestic low- energy traumas. Reporting of the information in this patient group by all centers will provide important data in the management of hip fractures in this special process.

scholarly journals Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer

2016 ◽  
Vol 34 (9) ◽  
pp. 980-986 ◽  
Author(s):  
Scott D. Ramsey ◽  
Aasthaa Bansal ◽  
Catherine R. Fedorenko ◽  
David K. Blough ◽  
Karen A. Overstreet ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cancer Diagnosis ◽  
Financial Distress ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Hazard Ratios ◽  
Stage Disease ◽  
After Cancer

Purpose Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among patients with cancer is not known. Methods We linked Western Washington SEER Cancer Registry records with federal bankruptcy records for the region. By using propensity score matching to account for differences in several demographic and clinical factors between patients who did and did not file for bankruptcy, we then fit Cox proportional hazards models to examine the relationship between bankruptcy filing and survival. Results Between 1995 and 2009, 231,596 persons were diagnosed with cancer. Patients who filed for bankruptcy (n = 4,728) were more likely to be younger, female, and nonwhite, to have local- or regional- (v distant-) stage disease at diagnosis, and have received treatment. After propensity score matching, 3,841 patients remained in each group (bankruptcy v no bankruptcy). In the matched sample, mean age was 53.0 years, 54% were men, mean income was $49,000, and majorities were white (86%), married (60%), and urban (91%) and had local- or regional-stage disease at diagnosis (84%). Both groups received similar initial treatments. The adjusted hazard ratio for mortality among patients with cancer who filed for bankruptcy versus those who did not was 1.79 (95% CI, 1.64 to 1.96). Hazard ratios varied by cancer type: colorectal, prostate, and thyroid cancers had the highest hazard ratios. Excluding patients with distant-stage disease from the models did not have an effect on results. Conclusion Severe financial distress requiring bankruptcy protection after cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate this risk.

The Addition of Phenylephrine Contributes to the Development of Transient Neurologic Symptoms after Spinal Anesthesia with 0.5% Tetracaine 

1997 ◽  
Vol 87 (4) ◽  
pp. 771-778 ◽  
Author(s):  
Shinicki Sakura ◽  
Mariko Sumi ◽  
Yasuko Sakaguchi ◽  
Yoji Saito ◽  
Yoshihiro Kosaka ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Elective Surgery ◽  
Single Case ◽  
Neurologic Symptoms ◽  
Single Case Report ◽  
Significant Difference ◽  
Anesthetic Solution ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background Recent reports indicate that transient neurologic symptoms commonly occur after single-injection spinal anesthesia with lidocaine. Information regarding tetracaine has been limited to a single case report. In addition, little is known about the cause of these symptoms or the cofactors that affect their occurrence. The present study sought to determine whether the presence of phenylephrine or the concentration of glucose in the anesthetic solution affects the incidence of transient neurologic symptoms after spinal anesthesia with 0.5% tetracaine. Methods One-hundred sixty patients classified as American Society of Anesthesiologists physical status I or II who were scheduled for elective surgery on a lower limb or perineum were sequentially assigned to one of four equal groups to receive intrathecal 0.5% tetracaine in 7.5% or 0.75% glucose, with or without 0.125% phenylephrine. Patients were evaluated on postoperative day one for the presence of pain, dysesthesia, or both in the legs or buttocks by an investigator unaware of the drug given. Results Symptoms were present in 10 patients (12.5%) receiving a spinal anesthetic containing phenylephrine, but in only one patient (1.3%) receiving spinal anesthesia without phenylephrine. There was no significant difference in the incidence of symptoms between groups receiving 7.5% glucose and those receiving 0.75% glucose (8.8% and 5% of patients, respectively). Conclusions These results suggest that adding phenylephrine to tetracaine for spinal anesthesia increases the potential for transient neurologic symptoms, but that the concentration of glucose does not affect their occurrence.

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