Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery

Background and aim General anesthesia (GA) is the most commonly used anesthetic technique for spinal surgery. This study aimed to compare spinal anesthesia (SA) and GA in patients undergoing spinal surgery, in terms of perioperative outcome and cost effectiveness. Materials and methods The study included 80 patients with ASA (American Society of Anesthesiologists) physical status I–II. The patients were randomized to receive SA (n=40) or GA (n=40). Heart rate (HR), mean arterial blood pressure (MABP), blood loss, duration of surgery, duration of anesthesia, surgeon satisfaction, and duration in the post-anesthesia care unit (PACU) were recorded. Postoperative analgesic requirement, nausea and vomiting (PONV), perioperative hemodynamic variables, and anesthetic costs were determined. Results HR and MABP were significantly higher in the GA group than in the SA group at the end of surgery and at PACU admission. Duration of anesthesia, surgeon satisfaction, postoperative analgesic requirement, and anesthetic costs were significantly higher in the GA group. Mean blood loss was lower in the SA group than in the GA group, but the difference was not significant. Duration of surgery, duration in the PACU, perioperative hemodynamic variables, and complications were similar in both groups. Conclusions SA could be considered a reliable alternative to GA in patients undergoing lumber spine surgery, as it is clinically as effective as GA, but more cost effective

The effect of long-term antithrombotic therapies on perioperative morbidity and mortality in elderly patients undergoing hip fracture surgery

ABSTRACT Objective: Ischemic complications or massive bleeding are important perioperative complications in elderly patients using antithrombotic drugs. The need for blood product replacement, transfusion-related complications, prolonged stay in hospital and intensive care unit, and high mortality in the perioperative period can be seen. The aim of this study was to investigate the effects of long-term different antithrombotic therapies on morbidity and mortality in elderly patients undergoing surgery for hip fracture. Materials and Methods: This retrospective cohort study included patients aged 65 years and older who underwent surgery for hip fracture between 2015 and 2018. Patients with no antithrombotic treatment (Group NonAT), warfarin (Group Warfarin), novel oral anticoagulants (Group NOACs), or dual antiplatelet therapy (Group DAPT) were compared in terms of major bleeding, deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) complications, length of hospital stay (LOS), ICU admission, and 30-day mortality. Results: The study included 668 patients; demographic data in Group NonAT (n=442), Group Warfarin (n=59), Group NOACs (n=30) and Group DAPT(n=137) were similar. Major bleeding and red blood cell transfusion did not differ statistically between all groups. (p>0.05) The preoperative and postoperative Hb values of the patients were not statistically different between the groups (p>0.05). Mortality, only there was statistically significantly higher in the dual antiplatelet group than the non user group. (p0.05) However survival was statistically significant different (

Effects of ketamine, propofol, and ketofol on proinflammatory cytokines and markers of oxidative stress in a rat model of endotoxemia-induced acute lung injury

Intravenous lipopolysaccharide (LPS) leads to acute lung injury (ALI) in rats. The purpose of this study was to examine the anti-inflammatory and antioxidant efficacy of ketamine, propofol, and ketofol in a rat model of ALI. We induced ALI in rats via intravenous injection of LPS (15 mg kg(-1)). The animals were randomly separated into five groups: control, LPS only, LPS + ketamine (10 mg.kg(-1).h(-1)), LPS + propofol (10 mg.kg(-1).h(-1)), LPS + ketofol (5 mg.kg(-1).h(-1) ketamine + 5 mg.kg(-1).h(-1) propofol). LPS resulted in an increase in the release of pro-inflammatory cytokines, mRNA expression related with inflammation, production of nitric oxide, and lipid peroxidation. Ketamine prevented the increase in markers of oxidative stress and inflammation mediators, both in plasma and lung tissue. Propofol decreased the levels of cytokines in plasma and lung tissue, whereas it had no effect on the IL-1-beta level in lung tissue. Ketamine downregulated mediators of lung tissue inflammation and reduced the level of circulating cytokines and protected lung tissue against lipid peroxidation. Ketofol decreased the level of INF-alpha and IL-1 beta in plasma, as well as expression of cyclooxygenase-2 mRNA and the nitrate/nitrite level in lung tissue. The results of this investigation support the hypothesis that ketamine may be effective in preventing ALI

FACTORS AFFECTING THE DURATION OF ADMISSION AND DISCHARGE IN A PALLIATIVE CARE CENTER FOR GERIATRIC PATIENTS

WOS: 000391285300003Introduction: The factors that have an impact on the stay and discharge of geriatric patients who were admitted to palliative care center (PCC) were investigated. Materials and Method: 111 were included in the study. Age, gender, marital status, primary diagnoses, nutritional status, decubitus ulcer, pain issues, palliative performance scale ( PPS) scores, duration of PCC and "wanting to be discharged" status of patients were recorded. Results: Distribution of patients were as follows: neurological disease 47 (42.3%), cancer 26 (23.4%), chronic systemic conditions 46 (41.4%), infections 12 (10.8%), nutritional problems 58 (52.2%), decubitus ulcers 45 (40.5%) and pain 14 (12.6%). The median duration of PC was 24 days. Duration of hospitalization in patients with nutrition and decubitus ulcers were detected longer (p<0.05). "Wanting to be discharged" rate was lower in patients with neurological disease, poor PPS scores, decubitus ulcer and nutritional problems whereas higher in patients with cancer. According to the binary logit model, a diagnosis of cancer and PPS score were increased whereas nutritional problems and decubitus ulcers were decreased the probability of wanting to be discharged. Conclusions: A coordinated effort between palliative care and home health care may shorten the duration of in-patient palliative care and hasten the process of discharge

Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n=30) and low-flow sevoflurane anesthesia group (Group L, n=30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy

Concordance and generalization of an AI algorithm with real-world clinical data in the pre-omicron and omicron era

All viruses, including SARS-CoV-2, the virus responsible for COVID-19, continue to evolve, which can lead to new variants. The objective of this study is to assess the agreement between real-world clinical data and an algorithm that utilizes laboratory markers and age to predict the progression of disease severity in COVID-19 patients during the pre-Omicron and Omicron variant periods. The study evaluated the performance of a deep learning (DL) algorithm in predicting disease severity scores for COVID-19 patients using data from the USA, Spain, and Turkey (Ankara City Hospital (ACH) data set). The algorithm was developed and validated using pre-Omicron era data and was tested on both pre-Omicron and Omicron-era data. The predictions were compared to the actual clinical outcomes using a multidisciplinary approach. The concordance index values for all datasets ranged from 0.71 to 0.81. In the ACH cohort, a negative predictive value (NPV) of 0.78 or higher was observed for severe patients in both the pre-Omicron and Omicron eras, which is consistent with the algorithm's performance in the development cohort