Daily Anesthesiology Research Analysis

BACKGROUND: The pathophysiology of delirium remains incompletely understood. The relationship between preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau proteins and postoperative delirium (POD) needs further validation. We aimed to verify whether these markers can identify and predict the occurrence and severity of POD. METHODS: 172 Older adults undergoing laparoscopic surgery were selected from a tertiary comprehensive hospital. All patients received intravenous anesthesia. Preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau proteins were measured using enzyme-linked immunosorbent assay. The occurrence and severity of POD were respectively assessed using the 3D-CAM and DRS-R-98 scales. RESULTS: Of 172 patients (mean age: 72 ± 6 years, 34.9% female), 20 (12%) experienced POD. Patients who developed POD had higher preoperative plasma concentrations of p-tau181, p-tau231, p-tau217, and T-tau than those without. After adjusting for age, ASA, and education, preoperative concentrations of p-tau181 (OR 1.05, 95% CI: 1.03-1.08), p-tau217 (OR 1.02, 95% CI: 1.01-1.04), p-tau231 (OR 1.09, 95% CI: 1.04-1.14), and T-tau (OR 1.01, 95% CI: 1.00-1.02) were independently associated with POD (p<.001). Preoperative plasma p-tau231 showed the highest diagnostic performance with an area under the curve of 0.966, surpassing p-tau181 (0.869), p-tau217 (0.775), and T-tau (0.750). P-tau231 also demonstrated the highest sensitivity (0.900) and specificity (0.967) for predicting POD, compared to p-tau181, p-tau217, and T-tau. CONCLUSIONS: Preoperative plasma concentrations of p-tau181, p-tau231, and p-tau217 can effectively predict the occurrence and severity of POD in older adult undergoing laparoscopic surgery, with p-tau231 demonstrating higher predictive value.

INTRODUCTION: Heart failure is a frequent comorbidity in patients undergoing non-cardiac surgery and an acknowledged risk factor for postoperative mortality. The associations between stable chronic heart failure and postoperative outcomes have not been explored extensively. The aim of this study was to determine associations between stable chronic heart failure and its peri-operative management and postoperative outcomes after major non-cardiac surgery. METHODS: This is a secondary analysis of MET-REPAIR, an international prospective cohort study including patients undergoing non-cardiac surgery aged ≥ 45 y with increased cardiovascular risk. Main exposures were stable chronic heart failure and availability of a pre-operative transthoracic echocardiogram. The primary endpoint was the incidence of postoperative major adverse cardiovascular events at 30 days. Secondary endpoints included 30-day mortality and severe in-hospital complications. Multivariable logistic regression models were calculated. RESULTS: Of 15,158 included patients, 3880 (25.6%) fulfilled the diagnostic criteria for stable chronic heart failure, of whom 1397 (36%) were female. Chronic heart failure was associated with increased risk of postoperative 30-day major adverse cardiovascular events (OR 2.04, 95%CI 1.59-2.60), 30-day mortality (OR 1.50, 95%CI 1.17-1.92) and in-hospital complications (OR 1.47, 95%CI 1.30-1.66). Transthoracic echocardiography was performed in 1267 (32.7%) patients with heart failure; 146 (11.5%) patients with heart failure presented with a left ventricular ejection fraction < 40%. Reduced ejection fraction was associated with major adverse cardiovascular events (OR 2.0, 95%CI 1.01-3.81). DISCUSSION: Stable chronic heart failure is independently associated with major adverse cardiovascular events, mortality and severe postoperative complications when measured 30 days after non-cardiac surgery.

PURPOSE: Various methods have been formulated to reduce pain and relieve immunosuppression in order to improve prognosis. The current study aimed to evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) on the postoperative analgesia and perioperative cell-mediated immunity in patients underwent laparoscopic radical gastrectomy. PATIENTS AND METHODS: A total of 54 patients scheduled for laparoscopic radical gastrectomy were randomly evenly assigned into both groups. The participants in Group Q received US-guided QLB 3 bilaterally with ropivacaine (0.25%, 30 mL on each side) before surgery along with GA, and those in Group C received GA without any special treatment. Both groups were given patient-controlled intravenous analgesia postoperatively. The primary outcomes were the T-cell subsets and Natural killer (NK) cell level at 30 min before surgery (T0) and at 0, 12, 24, and 48 h postoperatively (T1, T2, T3, and T4) were measured. The secondary outcomes were as fellows: the visual analog scale (VAS) pain score (rest and movement) at T1, T2, T3, and T4. In addition, the opioid consumption, and the incidence of postoperative adverse reactions. RESULTS: The level of CD3 + , CD4 + T, and natural killer (NK) cells, besides the CD4 + /CD8 + ratio showed less reduction at T1, T2, T3, and T4 in Group Q (P < 0.05). The VAS pain scores (at rest and on movement) were significantly lower in Group Q at T1-T4 (P < 0.05). Opioid consumption and the incidence of adverse reactions were lower in Group Q (P < 0.05). CONCLUSION: For patients undergoing LRG, the ultrasound-guided QLB 3 could alleviate perioperative cell-mediated immunity suppression, improve postoperative analgesia, decrease opioid consumption, and reduce the incidence of adverse reactions. CLINICAL TRIAL REGISTRATION NUMBER: The Chinese Clinical Trial Registry (ChiCTR2000034592).