Potential New Treatments for Knee OA: A Prospective Review of Registered Trials

We aimed to evaluate potential new treatments for knee osteoarthritis (OA). The National Institute of Health ClinicalTrials.gov database was searched for “Osteoarthritis, Knee”. We found 565 ongoing interventional studies with a total planned enrollment of 111,276 subjects. Ongoing studies for knee OA represent a very small fraction of the registered clinical trials, but they are over a quarter of all knee trials and over two thirds of all OA studies. The most researched topic was arthroplasty, with aspects such as implant design changes, cementless fixation, robotic guidance, pain management, and fast track recovery. Intraarticular injections focused on cell therapies with mesenchymal stem cells sourced from adipose tissue, bone marrow, or umbilical cord. We could see the introduction of the first disease modifying drugs with an impact on knee OA, as well as new procedures such as geniculate artery embolization and geniculate nerve ablation.

Fast-track recovery program after cardiac surgery in a teaching hospital: a quality improvement initiative

Objective Fast-track cardiac anesthesia (FTCA) is a technique that may improve patient access to surgery and maximize workforce utilization. However, feasibility and factors impacting FTCA implementation remain poorly explored both locally and internationally. We describe the specific intraoperative and postoperative protocols for our FTCA program, assess protocol compliance and identify reasons for FTCA failure. Results We tested the program in 16 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. There was 100% compliance with the FTCA protocols. Four (25%) patients successfully completed the FTCA protocol (extubated < 4 h postoperatively and discharged from the intensive care unit on the same operative day).

Fast-Track Recovery

Fast-track cardiac care (FTCC) encompasses the entire spectrum of perioperative care for the cardiothoracic surgical patient. From the preoperative assessment to postoperative care, the main goal is to expedite recovery while minimizing the inherent risks associated with cardiac surgery. The practice of prolonged mechanical ventilation due to high-dose narcotic anesthesia has evolved to early protocolized extubation pathways facilitated by multimodal anesthesia. The goal of the postoperative care phase is focused on reducing or completely bypassing the intensive care unit and ultimately decreasing hospital length of stay. Yet, here is where FTCC seems unable to achieve its goals due to multifactorial barriers. An integral part of successful FTCC is constant reevaluation of the patient through each of the perioperative phases (pre-, intra-, and postoperatively).

Comparative Evaluation of Modern Inhalation Anesthetics in Carotid Endarterectomy

The purpose of the study was to compare the possibility of rapid activation of elderly patients after carotid endarterectomy performed under sevoflurane- or desflurane-based anesthesia. Materials and methods. 67 patients aged 75 to 89 years divided into two groups were examined. To maintain anesthesia, desflurane was used in the 1st group and sevoflurane was employed in the 2nd group. Results. Patients from the group receiving desflurane, experienced decreased ability to take a sip of water and to hold oneself in a sitting position, and were characterized by decreased time before the tracheal extubation. Conclusion. Desflurane-based anesthesia provided faster awakening and activation of elderly patients after carotid endarterectomy than the anesthesia with sevoflurane, which allowed to implement the fast-track recovery protocol. In addition, the desflurane-based anesthesia provided excellent manageability and less negative impact on the hemodynamics (within the drug concentration range of up to 1.3 MAC).