Daily Anesthesiology Research Analysis

BACKGROUND: Preoperative radiotherapy and ischemia/reperfusion (I/R) injury during free tissue transfer may impair tissue oxygenation and increase flap complications. Ischemic conditioning, which involves brief cycles of ischemia and reperfusion, mitigates I/R-induced tissue damage. It has demonstrated organ-protective effects in various clinical settings. PURPOSE: This study aimed to compare postoperative flap tissue oxygenation in patients with head and neck (HN) cancer who received preoperative radiotherapy and underwent free flap transfer, with or without application of remote ischemic conditioning (RIC). STUDY DESIGN, SETTING, AND SAMPLE: A randomized clinical trial included patients with HN cancer and preoperative radiotherapy who undergoing free flap reconstruction at Seoul National University Hospital between 2018 and 2024. Subjects who had any condition preventing RIC from being performed were excluded. INDEPENDENT VARIABLES: The predictor variable was intraoperative management. Subjects were randomly assigned to RIC or sham treatment. OUTCOME VARIABLES: The primary outcome was tissue oxygen saturation of the transferred flap measured on postoperative day 1. Secondary outcome was composite flap complications, including wound dehiscence, surgical bleeding control, flap revision, and reoperation. COVARIATES: The study covariates included demographic, surgical, and anesthetic variables. ANALYSES: Statistical analyses were conducted using independent t-test, Mann-Whitney U test, Pearson χ RESULTS: Forty-four patients were randomized, and 39 were analyzed. The median (interquartile range) patient age was 65.0 (56.0 to 70.0) years. Postoperative flap tissue oxygen saturation did not differ between the groups: median (interquartile range), 86.5% (68.5 to 95.0%) in the RIC group (n = 21) versus 84.0% (74.0 to 93.0%) in the sham group (n = 19) (P = .7). The RIC group had fewer flap complications than the sham group (4 [20.0%] vs 10 [52.6%], P = .034). CONCLUSIONS AND RELEVANCE: RIC did not improve the transferred flap tissue oxygenation in HN cancer patients who underwent preoperative radiotherapy and reconstructive surgery. However, fewer flap complications were observed in the RIC group than in the sham group, suggesting that RIC may serve as a protective strategy against I/R injury in selected patients.

OBJECTIVE: To investigate the association between preoperative Coronavirus disease 2019 (COVID-19) infection and complications in patients undergoing coronary artery bypass grafting (CABG), focusing on the timing of infection. DESIGN: A retrospective cohort study using the National Covid Cohort Collaborative (N3C) database SETTING: Multi-institutional data from the National COVID Cohort Collaborative, representing diverse US healthcare settings PARTICIPANTS: Adult patients undergoing CABG during the COVID-19 pandemic, identified through CPT codes. COVID-19 infection timing was stratified into 3 groups: 0 to 2 weeks, 2 to 6 weeks, and 6 to 12 weeks before surgery. Outcomes were analyzed based on the timing of COVID-19 infection and compared to patients without a history of COVID-19. INTERVENTIONS: No direct interventions were performed. Outcomes were analyzed based on the timing of COVID-19 infection. MEASUREMENTS AND MAIN RESULTS: Postoperative complications were assessed using International Classification of Disease, Tenth Revision codes, including venous thromboembolism (VTE), sepsis, acute kidney injury, surgical site infection, acute myocardial infarction (AMI), 30-day mortality, and 1-year mortality. For COVID-19 infection occurring within 0 to 2 weeks before surgery, significantly increased odds were observed for VTE (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.36-3.59]; p = 0.001), sepsis (OR, 1.74; 95% CI, 1.01-2.81; p = 0.032), 30-day mortality (OR, 3.60; 95% CI, 2.32-5.35; p < 0.0001), and 1-year mortality (OR, 3.10; 95% CI, 2.24-4.21; p < 0.0001), with no significant associations for surgical site infection (OR, .94; 95% CI, 0.48-1.64; p = 0.849), or AMI (OR, 1.21; 95% CI, 0.84-1.69; p = 0.274) compared to COVID-19-negative patients. CONCLUSIONS: COVID-19 infection within 2 weeks before CABG is associated with a significantly increased risk of complications. Further research is needed to understand the mechanisms and optimize care for these patients.

STUDY OBJECTIVES: Complications are common during emergency tracheal intubation. Although graduate medical education in emergency medicine and critical care mandate competency in this procedure, thresholds for proficiency are poorly defined. We evaluated the relationship between the operator performing intubation and complications of emergency tracheal intubation. METHODS: We performed a secondary analysis of data from 8 multicenter randomized trials of critically ill adults undergoing emergency tracheal intubation in an emergency department or ICU in the United States. We examined the relationship between an operator's prior intubating experience and procedural outcomes, including successful intubation on the first attempt and lowest oxygen saturation. RESULTS: Among 2,839 intubations with data on prior intubating experience of the operator, 1,863 (65.6%) were by critical care medicine clinicians and 739 (26.0%) by emergency medicine clinicians. The median number of reported previous intubations by clinicians was 56.0 (interquartile range, 32 to 100). Greater intubation experience was associated with an increased odds of successful intubation on the first attempt (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.30 to 2.36; P<.001) and increased lowest oxygen saturation (OR 1.45; 95% CI, 1.21 to 1.73; P<.001). Learning curves suggested a plateau effect between 35 and 50 intubations. CONCLUSION: For tracheal intubations performed in an emergency department or ICU, intubating experience is associated with improved procedural outcomes, reaching a plateau outcome after a mean 35 to 50 previous intubations.