Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery

Background: The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications. Methods: From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH.Results: Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support. Conclusions: Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors. Registration: Clinicaltrials.gov identifier: NCT05671783

Can Partial Oxygen Pressure of Urine be an Indicator for Tissue Perfusion?

Objective: None of the advanced monitorisation procedures, which are focusing only on the haemodynamic and blood gas parameters, are sufficient to estimate tissue perfusion adequately. The search for new parameters that are non-invasive and reliable to provide information about tissue hypoperfusion is significant. The purpose of the present study was to evaluate the relationship between urine partial pressure of oxygen (PuO2) and routine systemic tissue perfusion parameters in patients with sepsis-like syndrome and impaired cardiac pressure-volume relationship after an open cardiac surgery

The Influence of Class III Obesity on Subarachnoid Depth of Turkish Parturient: A Prospective Observational Study

Introduction: This observational study aimed to investigate the effects of morbid obesity on the subarachnoid depth and spinal anaesthesia technique

The Influence of Class III Obesity on Subarachnoid Depth of Turkish Parturient: A Prospective Observational Study

Seyhan, Tulay Ozkan/0000-0002-7070-8827WOS: 000535666500001Introduction: This observational study aimed to investigate the effects of morbid obesity on the subarachnoid depth and spinal anaesthesia technique. Methods: Sixty American Society of Anesthesiologists Classification II women with term pregnancy who were candidates for elective caesarean section under spinal anaesthesia were enrolled in this prospective, observational study. Only patients with a Body Mass index (BMI) of = 40 kg/m(2) (obesity group) were included in the study. Spinal anaesthesia was performed in the sitting position via a midline approach at either L3-4 or L4-5 level by using a 25G 90-mm Quincke spinal needle with an introducer. Demographic data of the parturient, visual characteristics of the lumbosacral region, palpation of landmarks, depth of the spine, technical characteristics of the block, time of block performance and satisfaction of patients were recorded. Results: the spinal depth of the control and obesity groups were 51.7 +/- 4.4 and 69 +/- 10.4 mm, respectively (p<0.001). Although needle change was not necessary for any of the patients in the control group, a 120-mm long needle change was required in six patients in the obesity group (p<0.024). We found that the incidence of patients with landmarks that were difficult to palpate was higher in the obesity group, and significantly increased attempt number, skin puncture and needle pass were also required in this group. Conclusion: Anaesthesiologists should be prepared for a longer attempt in patients with obesity but should not be discouraged as the increase in the number of attempts or prolonged initiation time of spinal anaesthesia was not associated with patient dissatisfaction or discomfort

Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery

Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery

A comparison between the measurements of arterial lactate and mixed venous oxygen saturation for the evaluation of tissue perfusion after coronary artery bypass grafting

Background: This study aims to analyze the possible correlation between the blood lactate levels and mixed venous oxygen saturation after coronary artery bypass grafting

Evaluation of microcirculation with tissue oxygen saturation monitoring in open heart surgery

Background: In this study, we aimed to identify the potential period which microcirculation tends to mostly deteriorate and other hemodynamic and arterial blood gas parameters associated with microcirculation in patients undergoing elective open heart surgery with extracorporeal circulation

Effects of short-term hyperoxic ventilation on lung, kidney, heart, and liver in a rat model: A biochemical evaluation

BACKGROUND: Despite studies on the adverse effects of hyperoxia, its use is still recommended by the World Health Organization. The aim of this study was to test the possible harmful effects of hyperoxia on the lung, kidney, heart, and liver in a rat mechanical ventilation model

dilutional anemia induces renal dysfunction in diabetic patients undergoing coronary artery bypass grafting: a consequence of microcirculatory alterations?

Background In this study we aimed to evaluate the effects of dilutional anemia resulting from cardiopulmonary bypass (CPB) and its correction with red blood cell (RBC) transfusion on tissue oxygenation and renal function in diabetic patients undergoing coronary artery bypass grafting (CABG)

Are surgical and non-operating room intervention safe in the COVID-19 pandemic?: a retrospective study.

Little is known about the impact of COVID-19 on the outcomes of patients undergoing surgery and intervention. This study was conducted between 20 March and 20 May 2020 in six hospitals in Istanbul, and aimed to investigate the effects of surgery and intervention on COVID-19 disease progression, intensive care (ICU) need, mortality and virus transmission to patients and healthcare workers. Patients were examined in three groups: group I underwent emergency surgery, group II had an emergency non-operating room intervention, and group III received inpatient COVID-19 treatment but did not have surgery or undergo intervention. Mortality rates, mechanical ventilation needs and rates of admission to the ICU were compared between the three groups. During this period, patient and healthcare worker transmissions were recorded. In total, 1273 surgical, 476 non-operating room intervention patients and 1884 COVID-19 inpatients were examined. The rate of ICU requirement among patients who had surgery was nearly twice that for inpatients and intervention patients, but there was no difference in mortality between the groups. The overall mortality rates were 2.3% in surgical patients, 3.3% in intervention patients and 3% in inpatients. COVID-19 polymerase chain reaction positivity among hospital workers was 2.4%. Only 3.3% of infected frontline healthcare workers were anaesthesiologists. No deaths occurred among infected healthcare workers. We conclude that emergency surgery and non-operating room interventions during the pandemic period do not increase postoperative mortality and can be performed with low transmission rates