Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding Efeito da dexametasona sobre sangramento, vômito e náusea pós-amigdalectomia

It has been stated, that the administration of Dexamethasone has an impact on the morbidity following tonsillectomy. OBJECTIVE: To re-calculate the blood values for Dexamethasone when given as fixed doses and to evaluate the effect of Dexamethasone on post-operative nausea, vomiting and bleeding rates following tonsillectomy. MATERIALS AND METHODS: The charts of 272 children (2-15 years) who had undergone tonsillectomy were analyzed. The rates of post-operative nausea, vomiting and bleeding in relation to Dexamethasone were calculated-in general and different doses (0 mg/kg, 0.15 mg/kg). STUDY DESIGN: Retrospective cohort study. RESULTS: Dexamethasone was administered in 121 children (43.7%) according to the preference of the anesthesist (mean dose: 0.2 +/- 0.12 mg/kg; range: 0.04 - 0.62 mg/kg). There was no significant difference in nausea and vomiting (p=0.953) or bleeding (p=0.827) across groups receiving or not receiving Dexamethasone. Stratification into three different groups of Dexamethasone concentration also did not identify a dose-related risk of postoperative nausea or vomiting (p=0.98) or bleeding (p=0.71). CONCLUSION: At least under common non-controlled conditions in the clinic, Dexamethasone does not appear to have an effect on nausea or vomiting or bleeding following tonsillectomy.É conhecido o impacto da administração de dexametasona sobre a morbidade no pós-operatório de amigdalectomia. OBJETIVO: Recalcular os valores séricos para dexametasona quando administrada em doses fixas e avaliar seus efeitos sobre as taxas de náusea, vômito e sangramento no pós-operatório de amigdalectomia. MATERIAIS E MÉTODOS: Analisamos os prontuários de 272 crianças (idades entre 2-15 anos) submetidas a amigdalectomias. As taxas de náusea, vômitos e sangramentos foram calculadas para a dexametasona em geral e em diferentes doses (0 mg/kg; 0,15 mg/ kg). TIPO DE ESTUDO: Coorte retrospectivo. RESULTADOS: A dexametasona foi administrada em 121 crianças (43,7%), baseado na preferência do anestesista (dose média: 0,2 +/- 0,12 mg/kg; variação: 0,04 - 0,62 mg/kg). Não houve diferença significativa em termos de náuseas e vômitos (p=0,953) ou sangramento (p=0,827) entre os grupos de pacientes que receberam e não receberam dexametasona. Mesmo a estratificação em três grupos de diferentes concentrações de dexametasona não identificou risco dose-dependente de náusea ou vômito pós-operatório (p=0,98) ou sangramento (p=0,71). CONCLUSÃO: Pelo menos sob condições não-controladas normais da clínica, a dexametasona parece não ter efeito sobre a incidência de náuseas, vômito ou sangramento após amigdalectomia

Analyse von verschiedenen Trainingsfrequenzen auf den Trainingserfolg beim daVinci Skills Simulator

Einleitung: Der daVinci Skills Simulator hat sich in früheren Studien als geeignete Trainingsplattform für robotergestützte Eingriffe erwiesen. Zum heutigen Zeitpunkt existieren keine Empfehlungen bezüglich der Trainingsfrequenz oder der notwendigen Intervalle zwischen den einzelnen Trainingseinheiten. Ziel der vorliegenden Studie war es daher, den Einfluß unterschiedlicher Trainingsfrequenzen auf den Lernerfolg am daVinci Simulator zu untersuchen. Methoden: 40 da Vinci Novizen wurden von 12/2014-04/2016 in diese prospektive Studie eingeschlossen und randomisiert in zwei gleich große Gruppen eingeteilt. Die Gruppen absolvierten jeweils die gleichen Übungen (PegBoard1, Match Board 2, Ring and Rail 2), unterschieden sich jedoch in Ihrer Trainingsfrequenz sowie dem trainingsfreien Interval. Gruppe 1 trainierte jede Übung 6mal hintereinander 1x /Woche, während Gruppe 2 jede Übung 1 x an 5 Tagen der Woche absolvierte. Am letzten Übungstag wurden zwei den Gruppen unbekannte Abschlussübungen (Needle targeting, Energy Dissection 2) durchgeführt um den Effekt der verschiedenen Trainingspläne evaluieren zu können.Ergebnisse: Gruppe 2 zeigte eine signifikant bessere Performance (overall score, time to complete, economy of motion) im Vergleich zu Gruppe 1 bei den schwierigeren Übungen. Bei den leichteren Übungen zeigte sich kein Unterschied zwischen den beiden Gruppen.Fazit: Es scheint im Hinblick auf schwierigere Übungen am da Vinci Simulator von Vorteil zu sein jeden Tag für einen kurzen Zeitraum zu trainieren im Vergleich zu einem langen Training 1 mal die Woche.Der Erstautor gibt keinen Interessenkonflikt an