Perioperative stress response to carotid endarterectomy - the impact of anesthetic modality. Own experience

Background. Carotid endarterectomy (CE) belongs to the group of exceptional operations with the possibility of intra and perioperative complications that can account for the life or well being of the patient. For this reason it requires the application of anaesthetic techniques that assure optimal conditions for blood flow and proper perfusion of the brain and enable immediate detection of brain ischemia. These conditions are fulfilled by regional anaesthesia. In accessible literature we were not able to find any comparison of exacerbation of perioperative stress depending on anaesthetic modality during CE. The aim of the study was to evaluate our patients towards exacerbation of perioperative stress depending on anaesthetic modality during CE. Material and methods. 19 patients underwent carotid artery endarterectomy. They were divided into 2 groups. Group A consisted of 10 patients operated on under epidural anaesthesia (EA). Group B - 9 patients operated on under cervical plexus blockade (CPB). The levels of cortisone (C), adrenocorticotropic hormone (ACTH) and prolactin (PR) during 6 different phases of intra- and perioperative periods were measured. Results. Levels of C during the whole study remained normal or somewhat elevated in both groups. Levels of ACTH and PR demonstrated a similar pattern of changes. Before the operation they were within normal range or slightly elevated. During CE the levels of both hormones rose in both groups especially after carotid artery cross-clamping, but they were much higher in group B. After 2 hours ACTH and PR returned to normal and remained that way until the end of observation. Because the groups were small in number, no statistically significant changes were observed. Conclusions. Exacerbation of perioperative stress measured by hypercortisolaemia is well correlated with brain hypoperfusion during CE. 2 hours after the operation the influence of anaesthetic modality on perioperative stress terminates. In our study the perioperative stress relating to CE performed under epidural anaesthesia and under cervical plexus blockade was not significantly different.Wstęp. Endarterektomia tętnic szyjnych (CE) należy do wyjątkowych zabiegów ze względu na możliwość wystąpienia groźnych powikłań śród- i pooperacyjnych, które stanowią o życiu i zdrowiu pacjenta. Z tego powodu wymaga zastosowania technik anestezjologicznych, zapewniających optymalne warunki przepływu i ukrwienia mózgowia oraz umożliwiających natychmiastowe wykrycie zagrożeń. Warunki te spełniają znieczulenia regionalne. W dostępnym piśmiennictwie nie odnotowano próby porównania wpływu CE na niedokrwienie ośrodkowego układu nerwowego (OUN) w zależności od rodzaju zastosowanego znieczulenia regionalnego. Celem pracy jest analiza własnego materiału uwzględniająca nasilenie urazu okołooperacyjnego związanego z zabiegiem CE, w zależności od rodzaju zastosowanego znieczulenia. Materiał i metody. Badaniu poddano 19 osób, u których wykonano CE. Grupę A stanowiło 10 osób operowanych w znieczuleniu zewnątrzoponowym; grupę B - 9 osób operowanych w znieczuleniu splotu szyjnego. Badano stężenie kortyzolu (C), hormonu adrenokortykotropowego (ACTH) i prolaktyny (PR) w 6 różnych momentach okresu śród- i okołooperacyjnego. Wyniki. Stężenie C w trakcie całego badania pozostawało w obu grupach w normie lub nieznacznie ją przekraczało. Stężenia ACTH i PR wykazywały podobne do siebie zależności - przed operacją w obu grupach pozostawały w normie lub nieznacznie ją przekraczały. W trakcie operacji stężenia PR i ACTH zwiększały się w obu grupach, zwłaszcza po klemowaniu, lecz w grupie B odnotowano dużo wyższe wartości. Dwie godziny po operacji stężenia ACTH i PR w obu grupach wracały do normy i takie utrzymywały się do końca badań. Ze względu na małą liczebność grup nie wykazano statystycznie istotnych różnic. Wnioski. Nasilenie urazu śródoperacyjnego wyrażone hiperkortyzolemią dobrze koreluje z kliniczną hipoperfuzją ośrodkowego układu nerwowego podczas endarterektomii tętnic szyjnych. Po upływie 2 godzin znika wpływ rodzaju znieczulenia na poziom urazu chirurgicznego. W analizowanym materiale nasilenie urazu okołooperacyjnego podczas udrażniania tętnic szyjnych w znieczuleniu zewnątrzoponowym nie różni się istotnie od nasilenia w przypadku operacji w znieczuleniu splotu szyjnego

Can the FUT 2 Gene Variant Have an Effect on the Body Weight of Patients Undergoing Bariatric Surgery? - Preliminary, Exploratory Study

Background: The FUT2 gene (Se gene) encoding the enzyme α-1,2-L-fucosyltransferase 2 seems to have a significant effect on the number and type of bacteria colonizing the intestines. Methods: In a group of 19 patients after bariatric surgery, the polymorphism (rs601338) of FUT2 gene was analyzed in combination with body mass reduction, intestinal microbiome (16S RNA sequencing), and short chain fatty acids (SCFA) measurements in stools. Results: Among the secretors (Se/Se polymorphism of the FUT2 gene rs601338, carriers of GG variant), correlations between waist-hip ratio (WHR) and propionate content and an increase in Prevotella, Escherichia, Shigella, and Bacteroides were observed. On the other hand—in non-secretors (carriers of GA and AA variants)—higher abundance of Enterobacteriaceae, Ruminococcaceae, Enterobacteriaceae, Clostridiales was recorded. Conclusions: The increased concentrations of propionate observed among the GG variants of FUT 2 may be used as an additional source of energy for the patient and may have a higher risk of increasing the WHR than carriers of the other variants (GA and AA)

Gastrointestinal Tract Obstruction Due to Jejunal Adenocarcinoma – Case Report

The study presented a rare case of jejunal adenocarcinoma in a 60-year-old patient with symptoms of high subileus. No risk factors or coexisting diseases, which predispose towards intestinal cancer were detected. The study contained a description of the performed surgical procedure. The presented case illustrated the diagnostic and therapeutic difficulties in patients with small intestinal cancer. The low prevalence of small intestinal cancer makes no clear standards of mid- and postoperative treatment, including the qualification for adjuvant chemotherapy. The aim of this study was to broaden the knowledge concerning the presented symptoms and diagnostic test abnormalities, which, in case of rare diseases, is based on single patient reports. Furthermore, according to reference analyses, postoperative recommendations were presented, including diagnostics towards coexisting predisposing disease

Analysis of the Efficacy of Diet and Short-Term Probiotic Intervention on Depressive Symptoms in Patients after Bariatric Surgery: A Randomized Double-Blind Placebo Controlled Pilot Study

(1) Background: studies have shown that some patients experience mental deterioration after bariatric surgery. (2) Methods: We examined whether the use of probiotics and improved eating habits can improve the mental health of people who suffered from mood disorders after bariatric surgery. We also analyzed patients’ mental states, eating habits and microbiota. (3) Results: Depressive symptoms were observed in 45% of 200 bariatric patients. After 5 weeks, we noted an improvement in patients’ mental functioning (reduction in BDI and HRSD), but it was not related to the probiotic used. The consumption of vegetables and whole grain cereals increased (DQI-I adequacy), the consumption of simple sugars and SFA decreased (moderation DQI-I), and the consumption of monounsaturated fatty acids increased it. In the feces of patients after RYGB, there was a significantly higher abundance of two members of the Muribaculaceae family, namely Veillonella and Roseburia, while those after SG had more Christensenellaceae R-7 group, Subdoligranulum, Oscillibacter, and UCG-005. (4) Conclusions: the noted differences in the composition of the gut microbiota (RYGB vs. SG) may be one of the determinants of the proper functioning of the gut–brain microbiota axis, although there is currently a need for further research into this topic using a larger group of patients and different probiotic doses

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age >= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients >= 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those >= 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI < 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI > 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 & PLUSMN; 24.4 Kgs and 43.03 & PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = < 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection