Anesthesia With Propofol Does Not Reduce Interleukin-6 Release in Response to Abdominal Surgery of Varying Severity

Background: Data on whether anesthesia with propofol promotes or attenuates interleukin-6 (IL-6) production are conflicting. The purpose of this study was to investigate the effect of different doses of propofol, but similar doses of opiates, on plasma concentrations of IL-6 in patients undergoing two distinct operations of different severity and duration.Methods: This study was a prospective, single-center, two-armed observational study. Blood samples were collected in 28 patients undergoing abdominal hysterectomy (H) or vulvectomy (V). IL-6 was measured 24 hours preoperatively, prior to induction, at the end of the operation, and at 24 and 96 hours postoperatively. We tested the effect of propofol on IL-6 levels with linear regression.Results: IL-6 concentrations at the end of surgery were significantly higher in group H than in group V (38.6 (31.3) pg/mL vs. 3.7 (2.7) pg/mL, P < 0.001). Peak levels of IL-6 were seen in group H at the end of operation, while maximum levels in group V were attained 24 hours after surgery. No relationship between administered amount of propofol and IL-6 release could be identified. However, peak levels of IL-6 were significantly correlated to surgery duration in both group H and group V (r = 0.773, P = 0.002 vs. r = 0.568, P = 0.034).Conclusions: Propofol does not diminish perioperative levels of IL-6 in patients undergoing abdominal hysterectomy or vulvectomy. The results also suggest that surgery duration is the main determinant of IL-6 response in both patient groups. Our findings indicate that there may be a clinical benefit to reduce the duration of surgery

Development and external validation of a clinical prediction model for predicting quality of recovery up to 1 week after surgery

The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and externally validate a clinical prediction model that predicts quality of recovery up to one week after surgery. The modelling procedure consisted of two models of increasing complexity (basic and full model). To assess the internal validity of the developed model, bootstrapping (1000 times) was applied. At external validation, the model performance was evaluated according to measures for overall model performance (explained variance (R 2)) and calibration (calibration plot and slope). The full model consisted of age, sex, previous surgery, BMI, ASA classification, duration of surgery, HADS and preoperative QoR-40 score. At model development, the R 2 of the full model was 0.24. At external validation the R 2 dropped as expected. The calibration analysis showed that the QoR-40 predictions provided by the developed prediction models are reliable. The presented models can be used as a starting point for future updating in prediction studies. When the predictive performance is improved it could be implemented clinically in the future.</p

Development and external validation of a clinical prediction model for predicting quality of recovery up to 1 week after surgery

The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and externally validate a clinical prediction model that predicts quality of recovery up to one week after surgery. The modelling procedure consisted of two models of increasing complexity (basic and full model). To assess the internal validity of the developed model, bootstrapping (1000 times) was applied. At external validation, the model performance was evaluated according to measures for overall model performance (explained variance (R 2)) and calibration (calibration plot and slope). The full model consisted of age, sex, previous surgery, BMI, ASA classification, duration of surgery, HADS and preoperative QoR-40 score. At model development, the R 2 of the full model was 0.24. At external validation the R 2 dropped as expected. The calibration analysis showed that the QoR-40 predictions provided by the developed prediction models are reliable. The presented models can be used as a starting point for future updating in prediction studies. When the predictive performance is improved it could be implemented clinically in the future.</p

Lumbar Percutaneous Facet Denervation

In this chapter, we summarize the pertinent anatomy and technique of the percutaneous facet denervation technique in the lumbar spine. We also review the current literature on the outcome of lumbar facet denervation.</p

Lumbar Percutaneous Facet Denervation

In this chapter, we summarize the pertinent anatomy and technique of the percutaneous facet denervation technique in the lumbar spine. We also review the current literature on the outcome of lumbar facet denervation.</p