Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Evaluation of the cardiorespiratory effects of the alpha-2 adrenoceptor agonists xylazine, medetomidine and dexmedetomidine in combination with ketamine in dogs

In this study, we compared the effects of xylazine, medetomidine and dexmedetomidine in combination with ketamine on heart rate, respiratory rate, blood gas values, temperature and sedation scores. A total of 30 dogs were evaluated. The dogs were randomly allocated into three anaesthesia groups, each of which included ten dogs. The first group, denoted the xylazine/ketamine group, intravenously received xylazine (0.5 mg/kg) for premedication and ketamine (5 mg/kg) for induction. The second group, the medetomidine/ketamine group, intravenously received medetomidine (10 mu g/kg) followed by ketamine (5 mg/kg). The third group received the dexmedetomidine/ketamine combination. This group intravenously received dexmedetomidine (3 mu g/kg) for premedication and ketamine (5 mg/kg). Heart rate, respiratory rate, oxygen saturation, blood gas parameters and temperature were recorded for all patients immediately before sedation onset (T-0), five minutes after sedation onset (T-1) and five minutes after endotracheal incubation following ketamine injection (T-2). The end tidal carbon dioxide level was recorded at T-2. A significant decrease in heart rate occurred following premedication in all groups. However, the decrease was most marked in the medetomidine/ketamine group. An increase was observed in venous partial pressure of carbon dioxide values at T-2 in the xylazine/ketamine group compared to the medetomidine/ketamine and dexmedetomidine/ketamine groups. The end tidal carbon dioxide levels were higher in the medetomidine/ketamine group than in the other two groups, and oxygen saturation of haemoglobin levels in the same group were found to be lower than in the others. It was determined that none of alpha(2) -agonists, namely xylazine, medetomidine or dexmedetomidine, had superior properties over the others. If medetomidine is used, special care should be taken because of the rapid decrease in heart rate

Ketamine or propofol anesthesia in dogs: how do they affect cytokines, antioxidants and neutrophil functions?

The objective of the study is to investigate the effects of ketamine and propofol on cytokines, antioxidant defense system, and neutrophil functions in dogs. A total of 24 dogs were used. Dogs were divided into two groups as ketamine and propofol. The ketamine group received ketamine (5 mg/kg) intravenously while the propofol group received propofol (4 mg/kg) intravenously.Blood samples were collected before sedation and 30 minutes after induction of anesthesia.Serum antioxidant and cytokine levels were analyzed and neutrophil functions were determined. Respiration rate, serum malondialdehyde, IL-4, IL-6 levels, and phagocytic and chemotaxic activity of neutrophils were decreased (P=0.001, P=0.010, P=0.014, P=0.039, P=0.008, and P=0.037, respectively), oxygen saturation were increased (P=0.025) in the ketamine group. Serum IL-6 and IFN-gamma level were decreased (P=0.015 and P=0.032 respectively), chemotactic activity of neutrophils were increased (P=0.049) in propofol group. The administration of ketamine was found to have a positive effect both on the antioxidant system and the neutrophil. On the other hand, positive and negative effects of propofol on different parts of the immune system were observed. Therefore, the results should be taken into account when designing an anesthesia protocol for dogs to predict possible defense system reactions during the postoperative period

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey

OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey

OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey. METHODS: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey. RESULTS: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0\%, 42.8\%, 35.0\%, and 13.2\% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9\%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3\%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 +/- 2.85 and 0.92 +/- 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation. CONCLUSIONS: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination