Daily Anesthesiology Research Analysis

PURPOSE: Despite advances in perioperative care, delayed oral fluid intake after extubation remains common and is often based on tradition rather than evidence. This study aimed to evaluate whether immediate oral fluid intake "sipping" after extubation reduces thirst and discomfort and is safe in an intensive care setting. METHODS: In this single-center, prospective, randomized controlled trial, 160 ICU patients who met extubation criteria were randomized 1:1 to either delayed fluid intake (2 h post-extubation) or immediate sipping (up to 3 ml/kg over 2 h). Thirst, discomfort, and adverse effects (nausea, vomiting, aspiration) were assessed at 0, 5, 30, 60, 90, and 120 min. Thirst relief was also evaluated in the experimental group. Statistical significance was set at p < 0.05. RESULTS: At 120 min, 64 of 80 patients in each group (80 %; 95 % CI: 70-88 %) reported thirst. The difference between groups was 0.0 % (95 % CI: -12 % to 12 %; p = 1.000). However, thirst relief between baseline and 120 min was observed in 11.3 % of patients in the sipping group (95 % CI: 5-20 %) vs. 1.3 % in the standard group (95 % CI: 0-7 %), with a difference of 10 % (95 % CI: 1-19 %; p = 0.0338). At 90 min, throat discomfort was present in 23.8 % of the sipping group (95 % CI: 15-35 %) vs. 42.5 % in the standard group (95 % CI: 32-54 %), with a difference of -18.7 % (95 % CI: -34 % to -3 %; p = 0.0118). Adverse effects (nausea, vomiting) were rare and comparable; no aspiration events were observed. CONCLUSION: Immediate oral fluid intake "sipping"after extubation appears to be safe, improves thirst relief, and reduces discomfort in ICU patients without increasing adverse effects. These findings challenge traditional fasting practices and support early rehydration in post-extubation care. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on January 6, 2023 (Identifier: NCT05819645).

BACKGROUND: Acute kidney injury (AKI) is a common complication of coronary artery bypass surgery (CABG) and is associated with worse outcomes. It remains unclear whether AKIs impact on prognosis can be attributed to other concurrent major complications. METHODS: This retrospective cohort study included consecutive patients undergoing isolated CABG at a single nationwide center from 2001 to 2020. Patients receiving preoperative dialysis and those with insufficient pre- and postoperative serum creatinine values were excluded. AKI and postoperative chronic kidney disease were defined by the serum creatinine component of the kidney disease: improving global outcomes criteria. Cox regression was used to estimate the impact of AKI on short- and long-term risk of mortality and major adverse cardiac and cerebrovascular events (MACCE); before and after excluding patients with other major complications. Propensity score matching was used to balance heterogeneity. RESULTS: Out of 2287 individuals, criteria for AKI were met by 459 (20.1%), distributed as 375 (16.4%), 36 (1.6%), and 48 (2.1%) for Stages 1 through 3, respectively. The incidence of any major complication was 561 (24.5%), with 203 (8.9%) individuals having both AKI and major complications. Patients with AKI were older and had a higher incidence of comorbidities. AKI was associated with higher 30-day mortality (HR: 2.02, CI: 1.10-3.70) and inferior long-term outcomes (mortality, HR: 1.46; CI: 1.14-1.86; MACCE, HR: 1.48, CI: 1.20-1.81), but also predicted a higher hazard of postoperative chronic kidney disease (HR: 1.82, CI: 2.53-2.17). However, after excluding patients with other major complications, AKI was not associated with short- or long-term mortality but predicted inferior MACCE-free survival (HR: 1.59, CI: 1.23-2.06). CONCLUSIONS: AKI following CABG was not associated with short- and long-term mortality in the absence of major complications but predicted a higher risk of MACCE and postoperative chronic kidney disease. These results highlight AKIs role in progressive renal dysfunction and long-term cardiovascular morbidity, while its association with short-term mortality may be mediated by other major complications.

BACKGROUND: Video-Assisted Thoracoscopic Surgery (VATS) is a commonly used minimally invasive technique in thoracic surgery. The continuous serratus anterior plane block (cSAPB) involves the placement of a catheter deep in the serratus anterior fascia for the slow and continuous infusion of local anesthetics. Liposomal bupivacaine is a formulation of bupivacaine encapsulated in liposomes, which prolongs the release of the drug. This study compares the impact of cSAPB with bupivacaine and single-shot SAPB with liposomal bupivacaine on postoperative recovery quality and pain control after VATS. METHODS: This study is a Randomized Controlled Trial. Patients were randomly assigned to two groups: one receiving cSAPB with conventional bupivacaine (cSAPB + CB) (n = 35) and the other receiving SAPB with liposomal bupivacaine (SAPB + LB) (n = 35). The primary outcome measure was the Quality of Recovery (QoR-15) scores at 24 and 48 h post-surgery. Secondary outcomes included: pain intensity assessed using the Visual Analog Scale (VAS) pain scale at rest and during deep breathing at 24 and 48 h postoperatively, postoperative pulmonary function, total opioid consumption during and after surgery, and adverse events. RESULTS: QoR-15 scores were significantly elevated in the SAPB + LB group at both 24 and 48 h post-surgery(24 h: p = 0.001; 48 h: p = 0.02). Comparative analysis revealed no statistically significant differences between the SAPB + CB group and the SAPB + LB group in terms of VAS scores for pain at rest at 24 and 48 h (24 h: p = 0.06; 48 h: p = 0.46), or during deep breathing (24 h: p = 0.45; 48 h: p = 0.73). Additionally, there were no significant differences in lung function tests (FEV1/FVC ratio, p = 0.95), total intraoperative opioid consumption (p = 0.76), or total postoperative opioid consumption (p = 0.69). However, the incidence of local complications such as swelling and pain was significantly reduced in the SAPB + LB group (p = 0.03). CONCLUSIONS: The use of single liposomal bupivacaine serratus anterior plane block provides superior early postoperative recovery quality and reduces the incidence of local complications. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier ChiCTR2100054089, June 28,2024.