Comparison of postoperative recovery from desflurane and sevoflurane anaesthesia using laryngeal mask airway: a prospective randomized comparative study

Background: Ambulatory surgeries necessitate safe anaesthesia and faster recovery. Sevoflurane and desflurane are proved as such effective inhalational anaesthetic agents. The aim of this study was to compare early postoperative recovery profile in patient undergoing elective ambulatory surgical operations and receiving anaesthesia with sevoflurane or desflurane using supreme LMA.Methods: This prospective study was conducted at Jaslok Hospital and Research Centre, Dr. G. Deshmukh Marg, Mumbai, from August 2014 to April 2015. Patients were randomized into two groups receiving desflurane (Group D- n=40) and sevoflurane (Group S- n=40) for maintenance of anaesthesia. Patients were monitored for recovery by using fast track criteria (FTC) score at different time intervals.Results: The demographic characteristics, hemodynamic parameters were comparable in both the groups and no statistical significance was seen among them (p>0.05). The mean time taken for postoperative recovery characteristics were significantly lower in in Group D than Group S (p=0.00). The FTC score was significantly higher in group D as compared to group S at all times (p<0.05) for thirty minutes. The prevalence of consuming additional analgesic was 12.5% in group D and 15% in group S (p=1.000). The additional antiemetic requirement was seen in 10% patients in both the groups (p=1.000).The incidence of coughing was seen in among 5% of Group D patients and in none among Group S (p=0.152).Conclusion: The study concludes that desflurane is superior to sevoflurane with respect to time of eye opening, response to verbal commands, orientation, ability to sit, early recovery profile and duration of stay in recovery room

Comparison of postoperative recovery from desflurane and sevoflurane anaesthesia using laryngeal mask airway: a prospective randomized comparative study

Background: Ambulatory surgeries necessitate safe anaesthesia and faster recovery. Sevoflurane and desflurane are proved as such effective inhalational anaesthetic agents. The aim of this study was to compare early postoperative recovery profile in patient undergoing elective ambulatory surgical operations and receiving anaesthesia with sevoflurane or desflurane using supreme LMA.Methods: This prospective study was conducted at Jaslok Hospital and Research Centre, Dr. G. Deshmukh Marg, Mumbai, from August 2014 to April 2015. Patients were randomized into two groups receiving desflurane (Group D- n=40) and sevoflurane (Group S- n=40) for maintenance of anaesthesia. Patients were monitored for recovery by using fast track criteria (FTC) score at different time intervals.Results: The demographic characteristics, hemodynamic parameters were comparable in both the groups and no statistical significance was seen among them (p&gt;0.05). The mean time taken for postoperative recovery characteristics were significantly lower in in Group D than Group S (p=0.00). The FTC score was significantly higher in group D as compared to group S at all times (p&lt;0.05) for thirty minutes. The prevalence of consuming additional analgesic was 12.5% in group D and 15% in group S (p=1.000). The additional antiemetic requirement was seen in 10% patients in both the groups (p=1.000).The incidence of coughing was seen in among 5% of Group D patients and in none among Group S (p=0.152).Conclusion: The study concludes that desflurane is superior to sevoflurane with respect to time of eye opening, response to verbal commands, orientation, ability to sit, early recovery profile and duration of stay in recovery room

Extreme Haemodilution to Haemoglobin of 1.2 gm.dl-1 due to Severe Blood Loss in Liver Transplantation

We report a case of a 50-year-old man, a known case of hepatitis C virus cirrhosis, who was presented for cadaveric orthotopic liver transplantation. There was severe intraoperative haemorrhage requiring massive transfusion of blood and blood products. During anhepatic phase the supply of our blood bank got exhausted. So we had to replace the ongoing blood loss with volume-expanders for approximately one hour. Patient tolerated haemodilution intraoperatively to the extent of haemoglobin 1.2 g.dl. -

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research