Prediction of early C-reactive protein levels after non-cardiac surgery under general anesthesia.

BackgroundEarly detection of postoperative increase in C-reactive protein (CRP) correlates with postoperative complications. The present study examined the association between preoperative / intraoperative factors and postoperative CRP levels, with development and validation of a prediction model of early postoperative CRP level, for prophylactic management of postoperative complications in patients undergoing surgery under general anesthesia.Material and methodsMultivariate regression analysis was retrospectively performed to determine the independent factor of CRP levels on postoperative day (POD) 1 and to develop a prediction model. Validation of the prediction model was prospectively performed. Data from 316 adult patients on perioperative variables were retrospectively obtained in a training cohort in patients undergoing elective non-cardiac surgery. In a validation cohort, 88 patients undergoing mastectomy and 68 patients undergoing laparoscopic colon surgery were prospectively utilized to evaluate the value of the prediction model. Major complications after surgery were defined as the Clavien-Dindo grade IIIa or greater.ResultsDuration of surgery, mean nociceptive response (NR) during surgery as intraoperative nociception level, and preoperative CRP level were selected to set up the prediction model of CRP level on POD1 (P ConclusionIncreases in duration of surgery, intraoperative nociceptive level and preoperative CRP level were selected to predict early increases in CRP level after non-cardiac surgery under general anesthesia. Predicted CRP levels on POD1 were likely associated with severity of postoperative complications

Imaging evaluation of continuous extrapleural intercostal nerve block for minimally invasive cardiac surgery: a case report

Abstract Background Spinal nerve block is difficult with minimally invasive cardiac surgery (MICS), because of the risk of serious bleeding complications due to full heparinization. Continuous extrapleural intercostal nerve block (CEINB) is a postoperative pain treatment for intercostal thoracotomy, with fewer complications. Here, we report a case in which imaging evaluation of CEINB with contrast medium was conducted to anatomically confirm the spread of local anesthetics after MICS. Case presentation A 65-year-old woman with severe mitral regurgitation underwent mitral valve plasty under general anesthesia via right-sided mini-thoracotomy. A CEINB catheter was placed before the incision was closed, without creating a conventional extrapleural pocket. We conducted an imaging evaluation with a contrast medium via the inserted catheter and confirmed sufficient spread around the intercostal nerve area. In addition, postoperative pain was well controlled by the nerve block. Conclusions Imaging evaluation of CEINB with contrast medium could increase analgesic quality and decrease complications post-MICS

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study.

BackgroundPostoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels.Material and methodsConsecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort.ResultsWe obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) = -10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P ConclusionCRP levels predicted using duration of surgery, mean NR, and preoperative CRP levels are likely identical to measured CRP levels on POD1, being associated with major complications after gastrointestinal surgery

Intraoperative Assessment of Surgical Stress Response Using Nociception Monitor under General Anesthesia and Postoperative Complications: A Narrative Review

We present a narrative review focusing on the new role of nociception monitor in intraoperative anesthetic management. Higher invasiveness of surgery elicits a higher degree of surgical stress responses including neuroendocrine-metabolic and inflammatory-immune responses, which are associated with the occurrence of major postoperative complications. Conversely, anesthetic management mitigates these responses. Furthermore, improper attenuation of nociceptive input and related autonomic effects may induce increased stress response that may adversely influence outcome even in minimally invasive surgeries. The original role of nociception monitor, which is to assess a balance between nociception caused by surgical trauma and anti-nociception due to anesthesia, may allow an assessment of surgical stress response. The goal of this review is to inform healthcare professionals providing anesthetic management that nociception monitors may provide intraoperative data associated with surgical stress responses, and to inspire new research into the effects of nociception monitor-guided anesthesia on postoperative complications