Feasibility of Modified Surviving Sepsis Campaign Guidelines in a Resource-Restricted Setting Based on a Cohort Study of Severe S. Aureus Sepsis

[This corrects the article on p. e29858 in vol. 7.]

Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand

Abstract Background Inadvertent perioperative hypothermia is an unintentional drop in core body temperature to less than 36 °C perioperatively and is associated with many negative outcomes such as infection, a prolonged stay in a recovery room, and decreased patient comfort. Objective To determine the incidence of postoperative hypothermia and to identify the associated factors with postoperative hypothermia in patients undergoing head, neck, breast, general, urology, and vascular surgery. The incidences of pre- and intraoperative hypothermia were examined as the intermediate outcomes. Materials and methods A retrospective chart review was conducted in adult patients undergoing surgery at a university hospital in a developing country for two months (October to November 2019). Temperatures below 36 °C were defined as hypothermia. Univariate and multivariate analyses were used to identify factors associated with postoperative hypothermia. Results A total of 742 patients were analyzed, the incidence of postoperative hypothermia was 11.9% (95% CI 9.7%-14.3%), and preoperative hypothermia was 0.4% (95% CI 0.08%-1.2%). Of the 117 patients with intraoperative core temperature monitoring, the incidence of intraoperative hypothermia was 73.5% (95% CI 58.8–90.8%), and hypothermia occurred most commonly after anesthesia induction. Associated factors of postoperative hypothermia were ASA physical status III-IV (OR = 1.78, 95%CI 1.08–2.93, p = 0.023) and preoperative hypothermia (OR = 17.99, 95%CI = 1.57-206.89, p = 0.020). Patients with postoperative hypothermia had a significantly longer stay in the PACU (100 min vs. 90 min, p = 0.047) and a lower temperature when discharged from PACU (36.2 °C vs. 36.5 °C, p < 0.001) than those without hypothermia. Conclusion This study confirms that perioperative hypothermia remains a common problem, especially in the intraoperative and postoperative periods. High ASA physical status and preoperative hypothermia were associated factors of postoperative hypothermia. In order to minimize the incidence of perioperative hypothermia and enhance patient outcomes, appropriate temperature management should be emphasized in patients at high risk. Registration Clinical Trials.gov (NCT04307095) (13/03/2020)

Postoperative recovery in patients undergoing laparoscopic colorectal surgery: effect of perioperative intravenous lidocaine

Intravenous lidocaine infusion for colorectal surgery has been shown to provide superior analgesia compared with systemic opioids and facilitate hospital discharge. While epidural analgesia has definite advantages over systemic opioids in term of return of bowel function and quality of postoperative pain control, there is no study comparing lidocaine infusion with epidural technique in the setting of enhanced recovery program (ERP) for laparoscopic colorectal surgery. In addition, functional recovery and quality of life have not been assessed and compared with other analgesic techniques. This project is designed to evaluate the impact of lidocaine on surgical and functional outcomes. In these randomized studies, patients scheduled for elective laparoscopic colorectal surgery were prospectively randomized to receive thoracic epidural analgesia (TEA group), intravenous lidocaine infusion (IL group) or patient-controlled analgesia with morphine (PCA group). All patients received similar surgical care in the context of ERP. The average time to return of bowel function and median duration of hospital stay were similar in IL and TEA groups. TEA provided better postoperative analgesia than intravenous lidocaine in patients undergoing rectal surgery; otherwise there was no difference for colon resection. IL, TEA and PCA facilitated the return of postoperative functional walking capacity to baseline, and this was independent of the analgesic techniques use. However physical functioning and fatigue levels were impaired at 3 weeks after surgery with no difference between the 3 groups. The present study demonstrated that the restoration of bowel function and diet intake were similar in both groups receiving either lidocaine infusion or epidural. Functional walking capacity at 3 weeks after surgery returned to baseline in all the groups and this was independent of the analgesic technique used. However, in all groups physical function decreased and fatigue increased and this was also independent of the type of analgesia used.Lors de chirurgie colorectale, il a été démontré que la Lidocaine intra-veineuse provoque un niveau d'analgésie comparable aux opiacés mais facilite la récupération postopératoire. L'épidurale est nettement supérieure aux opiacés systémiques en terme de fonction intestinale et d'analgésie. Il n'existe hélas pas d'étude comparant la lidocaine versus l'épidurale en termes de réhabilitation fonctionnelle et qualité de vie dans le cadre d'un programme de réhabilitation accélérée après chirurgie colorectale. L'objectif du présent protocole est d'évaluer l'utilité de la lidocaine en termes de récupération fonctionnelle et chirurgicale. Cet essai randomisé inclut des patients requérant une chirurgie colorectale par laparoscopie. Les patients sont prospectivement randomisés en 3 groupes: Epidurale (Groupe TEA), lidocaine intraveineuse (Groupe IL) ou opiacés intraveineux (Groupe PCA). Les 3 groupes de patients reçoivent des soins chirurgicaux et anesthésique identiques dans le cadre d'un programme de réhabilitation accélérée. La récupération fonctionnelle intestinale et la durée d'hospitalisation est similaire entre les groupes lidocaine et épidurale. L'épidurale apporte une meilleure analgésie que la lidocaine chez les patients ayant des chirurgies rectales mais l'analgésie est similaire chez les patients subissant une colectomie. Les trois stratégies furent similaires en termes de récupération fonctionnelle. Néanmoins, a 3 semaines postopératoire l'état fonctionnel physique et la fatigue ne sont toujours pas retournés a leurs valeurs pré-opératoires dans aucun des groupes. La présente étude montre que la récupération fonctionnelle intestinale et la prise alimentaire est comparable entre les 3 groupes. A 3 semaines postopératoires, la capacité à la marche est retournée aux valeurs pré-opératoires dans les 3 groupes, indépendamment de la technique d'analgésie. Néanmoins a 3 semaines l'évaluation fonctionnelle physique restait diminuée et le niveau de fatigue accru par rapport aux évaluations pré-opératoires, indépendamment de la technique d'analgésie

Postoperative clinical outcomes and inflammatory markers after inguinal hernia repair using local, spinal, or general anesthesia: A randomized controlled trial.

BackgroundNo consensus has yet been reached regarding the best anesthetic technique for inguinal hernia repair. This study aimed to compare postoperative clinical outcomes and inflammatory markers among patients who were anesthetized using local, spinal, or general anesthesia for inguinal hernia repair.MethodsThis randomized controlled trial included patients scheduled to undergo elective unilateral inguinal hernioplasty at Siriraj Hospital during November 2014 to September 2015 study period. Patients were randomly assigned to the local (LA), spinal (SA), or general (GA) anesthesia groups. Primary outcomes were postoperative pain at rest and on mobilization at 8 and 24 hours after surgery.ResultsFifty-four patients were included, with 18 patients randomly assigned to each group. Patient demographic and clinical characteristics were similar among groups. There were no significant differences among groups for postoperative pain at rest or on mobilization at 8 and 24 hours after surgery. No significant differences were observed for interleukin-1β, interleukin-6, and interleukin-10 at any time points in any groups. Patients with local anesthesia was associated with less time spent in anesthesia (p = 0.010) and surgery (p = 0.009), lower intraoperative cost (p = 0.003) and total cost in hospital (p = 0.036); however, patient satisfaction in the local anesthesia group (94/100) was statistically significantly lower than the spinal and general anesthesia groups (100/100) (p = 0.010).ConclusionsNo statistically significant difference was observed among groups for postoperative pain scores, duration of hospital stays, complications, or change in inflammatory markers. However, time spent in anesthesia and surgery, the intraoperative cost and total cost for hernia repair, and patient satisfaction were significantly lower in the local anesthesia group than in the other two groups