Daily Anesthesiology Research Analysis

BACKGROUND: Older patients undergoing noncardiac surgery are at risk of postoperative cardiovascular events. Accurate cardiovascular risk assessment is important for informed decision-making. METHODS: This prospective cohort study enrolled older patients undergoing elective major noncardiac surgery. A frailty index based on preoperative geriatric assessment (FI-PGA) was constructed using 32 health-related parameters. The primary outcome was the occurrence of any cardiovascular events within 30 days after surgery. The associations between the FI-PGA and outcomes were assessed using logistic regression models. The added predictive value was evaluated by comparing nested models using improvement in model fit, fraction of new predictive information, net reclassification improvement, and decision curve analysis. The predictive performance of the Clinical Frailty Scale was also evaluated. RESULTS: A total of 1,808 patients were included, with 316 (17.5%) patients experiencing the primary outcome. The FI-PGA was associated with increased odds of the primary outcome after adjustment for clinical predictors (odds ratio, 1.56; 95% CI, 1.33 to 1.82 per 0.1-point increment), and clinical predictors plus preoperative N-terminal pro-B-type natriuretic peptide (odds ratio, 1.37; 95% CI, 1.16 to 1.61 per 0.1-point increment). Integration of the FI-PGA in prediction models significantly improved model fit and provided new predictive information. Net reclassification improvement analysis showed that adding the FI-PGA to risk models improved risk estimation for patients who did not develop postoperative cardiovascular events, but did not improve risk estimation for those who experienced events. Decision curves showed the models containing the FI-PGA achieved higher net benefit. Improved model performance was also observed when the Clinical Frailty Scale was used for frailty assessment, although the added predictive values appeared lower. CONCLUSIONS: A frailty index derived from preoperative multidimensional geriatric assessment can improve cardiovascular risk prediction before noncardiac surgery, primarily by improving risk estimation for patients who will not develop postoperative cardiovascular events.

BACKGROUND: Opioid-sparing anesthesia(OSA) or opioid-free anesthesia(OFA) strategy can reduce postoperative pain, but the effect of different stratigies on postoperative pain for patients with high pain sensitivity remains unclear, and the effect of different stratigies on perioperative haemodynamic fluctuations remains controversial for patients undergoing laparoscopic cholecystectomy. METHODS: A total of 173 patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into three groups: opioid-free anesthesia group(Group OFA), opioid-sparing anesthesia group(Group OSA) or opioid-based anesthesia group (Group OBA). The preoperative assessment of patients' pain sensitivity was conducted using the Pain Sensitivity Questionnaire (PSQ). The visual analog scale (VAS) scores were recorded at 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h postoperatively. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR) were recorded at baseline(T0), after admission (T1), after induction(T2), 1 min after tracheal intubation (T3), 1 min after pneumoperitoneum (T4), and calculated as the variability of blood pressure (BPV), coefficient of variation (CV) and average real variability (ARV). Time to awake, acute pain, rescue analgesia, postoperative nausea and vomiting (PONV), and time to first exhaust were also recorded. RESULTS: Compared with Group OBA, VAS scores were significantly lower in Group OFA and OSA at 2 h, 6 h and 12 h postoperatively (P < 0.05). BPV CONCLUSION: OSA can effectively control patients' postoperative pain with lower perioperative haemodynamic variability. It also has lower perioperative haemodynamic variability and acute pain in patients with high pain sensitivity, making it suitable for laparoscopic cholecystectomy. TRIAL REGISTRATION: The trial is registered with the China Clinical Trials Registry Registration Number: ChiCTR2400093036. Retrospectively registered (date of registration: 27/11/2024).

BACKGROUND: Due to their chemical nature as fluorinated hydrocarbon compounds, volatile anesthetics are highly potent greenhouse gases, with desflurane having by far the largest CO 2 -equivalent (CO 2 e) footprint. In everyday clinical practice, the CO 2 e footprint can easily be reduced through the increased use of propofol or sevoflurane as well as low- and minimal-flow techniques or through the more frequent use of regional anesthesia techniques. We wanted to assess to what extent educational measures on sustainability aspects of the use of volatile anesthetics had an impact on daily practice in anesthesiology departments and to what extent this influenced the hospital's CO 2 e emissions. METHODS: We conducted an observational data analysis of the consumption of anesthetics (sevoflurane, desflurane, isoflurane, and propofol) at all 3 clinical Charité campuses in the period from 2015 to 2023. The CO 2 e emissions were calculated for sevoflurane, desflurane, and isoflurane. External and internal (top-down or bottom-up) educational measures focusing on sustainability in anesthesia took place from September 2018 on. Shifts in CO 2 e emissions related to the educational measures are shown in a run chart. The number of surgeries, surgery duration, and purchasing costs were included in the analysis. RESULTS: CO 2 e emissions of volatile anesthetics were reduced by 90.3% from the baseline epoch (years 2015-2017) before educational interventions took place to 2023: CO 2 e 1470 tons (mean 2015-2017), to 191 tons (2022) to 142 tons (2023). This change was brought about by the phasing out of desflurane and the use of propofol or sevoflurane and regional anesthesia where appropriate. The fastest and most sustainable changes were seen after internal top-down measures. The total cost of anesthetics also fell over the period under review (from €541,102/$594,238 in 2015 to €281,646/$309,303 in 2023). CONCLUSIONS: Educational measures for anesthesiologists about the climate-damaging effects of volatile anesthetics-especially desflurane-can significantly reduce CO 2 e emissions in anesthesia clinics. On the positive side, these measures have also reduced the annual costs for anesthetics.