Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy – a randomized controlled trial

Introduction: The need to reduce pollution emissions in the operating room and to reduce treatment costs motivatesmore frequent use of general anaesthesia with a small or minimal fresh gas flow rate. Nevertheless, the reduction ofthe delivery of fresh gases should not influence the quality and safety of the anaesthesia. Material and methods: A total of 105 elective laparoscopic cholecystectomy patients were included in the study. Therewere 72 female (68.6%) and 33 male (31.4%) patients. Patients were randomized by a ‘closed envelope’ method intotwo groups. Group I included patients with low-flow anaesthesia and group II included patients with high-flow anaesthesia.In all patients the cerebral oximetry was measured separately for each cerebral hemisphere; the bispectralindex (BIS), heart rate, blood pressure, end-tidal carbon dioxide concentration and haemoglobin oxygen saturationwere monitored. Results: Heart rate, blood pressure, end-tidal carbon dioxide concentration and saturation were similar in both groupsand the differences between them were statistically insignificant. The BIS values were similar in both groups and indicatedthat patients who underwent low-flow anaesthesia were not exposed to a higher risk of awakening during theprocedure than the high-flow anaesthesia patients. The changes in brain oximetry values were similar in both lowflowand high-flow anaesthesia. Conclusions: Use of both low-flow and high-flow rate general anaesthesia provided patients undergoing laparoscopiccholecystectomy proper oxygenation of the central nervous system, adequate sleep depth and haemodynamic stability

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology