Daily Anesthesiology Research Analysis

AIM: To assess the effect of oxygen reserve index (ORi)-guided titration of fraction of inspired oxygen (FiO2) on the incidence of postoperative delirium (POD) and the frequency of hyperoxemia episodes, assuming a potential link between hyperoxemia and POD. METHODS: This randomized controlled trial included 114 patients aged 65 years and older, scheduled for elective surgeries lasting over two hours at Health Sciences University Tepecik Training and Research Hospital between October 1, 2023, and July 7, 2024. Patients were randomized into the control group (n=57) or the ORi+pulse oximetry (SpO2) group (n=57). In the ORi+SpO2 group, we dynamically adjusted FiO2 based on the real-time ORi and SpO2 values, targeting 95%<SpO2≤98% and ORi 0.00. In the control group, FiO2 adjustments were guided solely by SpO2 readings, with ORi values recorded but not used for decision-making. POD was assessed with the Confusion Assessment Method (CAM) and CAM-ICU at multiple time points over 48 hours. RESULTS: The incidence of POD was significantly higher in the control group than in the ORi+SpO2 group (42.1% vs 12.3%, P<0.001). The average FiO2 levels in the ORi+SpO2 group were significantly lower throughout surgery (P<0.001). The ORi+SpO2 group also exhibited a lower frequency of hyperoxemia episodes. CONCLUSION: The ORi-guided oxygenation strategy significantly reduced the incidence of POD in elderly patients by effectively minimizing intraoperative hyperoxemia. Optimizing intraoperative oxygenation through non-invasive monitoring may enhance perioperative outcomes.

BACKGROUND: Individuals with neurodegenerative disorders are often provided the same perioperative care as unaffected peers, even though unidentified diminished preoperative "brain health" worsens surgical outcomes. We summarize the implementation and standardized data from a phased preoperative cognitive assessment consisting of screening tests administered by clinic staff and, on a failed screening, an immediate neuropsychological assessment from licensed neuropsychologists. METHODS: The present observational study used deidentified patient data provided via an honest broker over 2 years. The data included patients aged 65 or older at the time of treatment who were triaged for an in-person preoperative clinic visit, excluding those patients who were scheduled for orthopedic surgery. The cognitive screening assessed education, frailty, clock-drawing-test to command and copy conditions, and 3-word registration and recall. The neuropsychological evaluation involved 90-minute assessments with interviews, cognitive testing, interpretation, and recommendations to the perioperative care team. Standardized data from general cognition, attention, and memory metrics are shown for this current report. RESULTS: Of the 14,795 patients eligible for cognitive screening, 83.1% underwent screening, identifying 22.7% with atypical cognitive performance. Patients successfully screened were more often white (87.8% vs 78.4%; P < .0001), married (61.2% vs 57.9%; P < .0001), and less frail (nonfrail: 45.6% vs 20.5%; P < .0001). Of the 2790 patients referred for the comprehensive assessment, 48.9% completed the neuropsychological evaluation. Referred patients were older (74.6 ± 6.5 vs 72.9 ± 5.7 yrs; P < .0001), less educated (13.2 ± 2.9 vs 14.1 ± 2.9 yrs; P < .0001), less likely married (58.1% vs 62.8%; P < .0002), more frail (frail: 24.6% vs 16.5%; P < .0001), more likely to live in socioeconomically-deprived geographic regions (52.0% vs 47.7%; P < .0001), and had a 50% greater 1-year mortality than nonreferred patients (P < .0001). Patients who showed no impairment or had only memory impairment on the neuropsychological examination were less frail (nonfrail: 45.5% vs 30.6%; P < .0001) and only half as likely to have a canceled surgery than those who exhibited attention or combined attention and memory impairment (P = .0002). CONCLUSIONS: Findings highlight how preoperative anesthesiology and neuropsychology teams can provide cognitive screening with referrals to brain health exams, and underscore the severity of unmet cognitive health care needs in older patients electing surgery.

BACKGROUND AND AIMS: The optimal analgesia for percutaneous nephrolithotomy (PCNL) remains uncertain. This study aims to conduct a systematic review and network meta-analysis to compare the efficacy of various analgesic strategies for PCNL. METHODS: We searched PubMed, ScienceDirect, ClinicalTrials.gov, MEDLINE, Web of Science, Ovid and EMBASE to identify all relevant randomised controlled trials published up to January 2024. Our review was prospectively registered with PROSPERO (ID: CRD42024504578). The identified methods included erector spinae plane block (ESPB), paravertebral block (PVB), intercostal nerve block (ICNB), quadratus lumborum block (QLB) and local infiltration. Our primary outcomes consisted of 24-h cumulative opioid consumption and the time to first use of opioid medication postoperatively. Secondary outcomes encompassed pain scores at 2, 6, 12 and 24 h postoperatively, as well as occurrences of postoperative nausea and vomiting. RESULTS: Overall, 27 trials met our inclusion criteria. QLB, PVB and ESPB demonstrated significant advantages in reducing 24-h postoperative opioid consumption and providing effective analgesia at all measured postoperative time points within 24 h, compared to the placebo group. However, there was no statistical difference between the three interventions. Similarly, there were no statistical differences in all outcomes between the ICNB and infiltration groups compared to the placebo group. CONCLUSIONS: ESPB, PVB and QLB offer significant analgesic benefits for PCNL compared to placebo, with no significant differences in efficacy among them. Due to limited evidence, ICNB and local infiltration were found not to be more effective than placebo.