Postoperative pulmonary complications in older patients undergoing elective surgery with a supraglottic airway device or tracheal intubation

Comparative analysis of cis-cutting and retro-cutting techniques in gastric tube fabrication for preventing postoperative anastomotic leakage after esophagectomy

OBJECTIVE

The construction of a gastric-tube-substitute esophagus is a common method for digestive tract reconstruction after esophagectomy. However, the incidence of postoperative anastomotic leakage remains high. This study aims to compare the effectiveness of 2 gastric tube fabrication methods-cis-cutting and retro-cutting-in reducing postoperative anastomotic leakage.

METHODS

We retrospectively analyzed 253 patients who underwent McKeown radical esophagectomy for esophageal cancer at the Second Affiliated Hospital of Fujian Medical University from February 2021 to February 2024. Patients were divided into cis-cut (n = 126) and retro-cut (n = 127) groups on the basis of the surgical technique used. The incidence of anastomotic leakage was compared, and logistic regression was used to identify risk factors.

RESULTS

Anastomotic leakage (16.7%, 21/126 vs 3.9%, 5/127; P < .001) and stricture (28.6%, 36/126 vs 15%, 19/127; P = .009) rates were lower in the retro-cut group than the cis-cut group. Multivariable analysis identified the gastric tube fabrication method in the cis-cut group as an independent risk factor (odds ratio, 3.390; 95% confidence interval, 1.147-10.018; P = .027) for postoperative anastomotic leakage.

CONCLUSION

Retro-cut gastric tube fabrication significantly reduces the incidence of anastomotic leakage and anastomotic stricture, suggesting its suitability as a standard technique for esophageal reconstruction.

Association between SII and postoperative pulmonary infection in elderly patients undergoing laparoscopic abdominal surgery

Objectives

This study aimed to identify the contributing factors, including systemic immune-inflammation index (SII), for pulmonary infections in elderly patients undergoing laparoscopic abdominal surgery with tracheal intubation under general anesthesia.

Methods

A total of 356 eligible elderly patients were monitored post-surgery for pneumonia. Pathogens were identified from sputum samples, and factors like age, smoking, chronic obstructive pulmonary disease (COPD), intubation, anesthesia duration, and SII were analyzed for their influence on infection risk.

Results

The pathogens were predominantly Gram-negative bacteria, with Klebsiella pneumoniae being the most common (26%). Significant risk factors for developing pneumonia included advanced age, smoking, COPD, prolonged intubation, and extended anesthesia. A higher preoperative SII was associated with an increased risk of pneumonia and correlated with infection severity and elevated levels of inflammatory markers. Multivariate analysis identified age over 70 (OR = 1.273, p = 0.021), age over 80 (OR = 2.085, p < 0.001), COPD (OR = 1.528, p = 0.009), prolonged intubation >2 h (OR = 2.187, p < 0.001), general anesthesia >4 h (OR = 1.846, p = 0.006), operative time > 2 h (OR = 1.415, p = 0.016), and preoperative SII >489.3 (OR = 1.403, p = 0.012) as independent risk factors for postoperative pulmonary infection.

Conclusion

Our study highlighted critical risk factors for postoperative pulmonary infections in elderly patients undergoing laparoscopic abdominal surgery. Preoperative SII could be a novel predictor, offering potential for improved pre-surgical risk assessment.

Second-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Second-generation supraglottic airway (SGA) devices are widely used, but thought to have inferior safety performance to endotracheal tubes (ETTs), but might be equally efficacious while improving patient-centered outcomes. We compared second-generation SGAs with ETTs for perioperative safety, efficacy, and quality of recovery in adults undergoing abdominopelvic surgery under general anesthesia. Our primary objective was to assess safety in the form of major airway complications. Secondary objectives were other safety, efficacy, and quality of recovery outcomes.

METHODS

We searched 4 databases for randomized controlled trials of adult patients having abdominopelvic surgery comparing second-generation SGAs and ETTs. After 2-person screening and data extraction, pairwise meta-analysis was conducted and the grading of recommendations, assessment, development, and evaluation (GRADE) approach was applied to assess the certainty of evidence.

RESULTS

A total of 51 studies, randomizing 5110 patients, were included. Second-generation SGAs significantly reduced the risk of major perioperative airway complications (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.23-0.71; P = .007; low certainty), with no clear clinically relevant difference in regurgitation or pulmonary aspiration (low certainty). SGAs significantly increased the risk of inadequate ventilation (RR, 3.36; 95% CI, 1.43-7.89; P = .011; very low certainty); however, postoperative sore throat (RR, 0.52; 95% CI, 0.38-0.70; P < .001; moderate certainty), hoarseness (RR, 0.32; 95% CI, 0.231-0.48; P < .001; low certainty), coughing at the emergence of anesthesia (RR, 0.17; 95% CI, 0.08-0.36; P < .001; low certainty), and postoperative nausea and vomiting (RR, 0.64; 95% CI, 0.42-0.98; P = .042; very low certainty) were all less frequent with SGAs. No other clinically relevant differences were observed for other remaining outcomes.

CONCLUSIONS

Second-generation SGAs reduce the risk of major airway complications compared with ETTs in adults undergoing abdominopelvic procedures under general anesthesia, with no reported clinically relevant differences in the risk of regurgitation or pulmonary aspiration. Additionally, they improve the quality of postoperative recovery with lower risk of sore throat, hoarseness, and postoperative nausea and vomiting. These data provide an opportunity for clinicians to reassess the implications of conservative airway management, and potentially expand the role of second-generation SGAs in routine clinical practice.

The median effective dose of ciprofol combined with sufentanil in suppressing the laryngeal mask airway insertion response in both young and older adult patients

BACKGROUND

Ciprofol, a novel intravenous anesthetic, exhibits similar sedation mechanisms and pharmacokinetic properties to propofol. However, ciprofol demonstrates greater potency and is associated with reduced injection pain compared to propofol. Given the varying sensitivities to anesthetic agents across different age groups, this study aims to determine the median effective dose (ED50) of ciprofol required to suppress the laryngeal mask airway (LMA) insertion response in both young and older adult patients, as well as to assess its potential adverse reactions.

METHODS

In this study, 46 patients scheduled for surgery under general anesthesia with LMA insertion were recruited. Upon entering the operating room, patients were intravenously administered ciprofol (0.4 mg·kg- 1) and sufentanil (0.3 µg·kg- 1), followed by LMA insertion after three minutes. To derive robust confidence intervals for both ED50 and ED95, we performed an analysis using a logistic regression model combined with bootstrap resampling.

RESULTS

In the young adult group, the ED50 and ED95 of ciprofol for suppressing the LMA insertion response were 0.38 mg·kg- 1 (95% CI, 0.35-0.41) and 0.46 mg·kg- 1 (95%CI, 0.40-0.56), respectively. In the older adult group, the respective ED50 and ED95 were 0.29 mg·kg- 1 (95% CI, 0.26-0.32) and 0.37 mg·kg- 1 (95% CI, 0.30-0.78). Regarding adverse reactions, although there were differences in the incidence of injection pain, hypotension, and bradycardia between the young and older groups, no statistically significant differences were observed between the two groups.

CONCLUSION

In this study, significant differences were observed in the ED50 of ciprofol for suppressing the LMA insertion response between young and older adult patients. The ED50 of ciprofol for young adult patients was 0.38 mg·kg- 1 (95% CI, 0.35-0.41), while for older adult patients it was0.29 mg·kg- 1 (95% CI, 0.26-0.32).

TRIAL REGISTRATION

This study was registered on February 17, 2024, with the China Clinical Trial Registration Center ( www.chictr.org.cn ; Registration Number: ChiCTR2400080891).

The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial

STUDY OBJECTIVE

This study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management.

DESIGN

A single-center, double-blind, randomized controlled trial was conducted.

SETTING

The study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward.

PATIENTS

Enrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries.

INTERVENTIONS

Patients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group.

MEASUREMENTS

LUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment.

MAIN RESULTS

Intention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups.

CONCLUSIONS

Compared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.

Assessing different brain oxygenation components in elderly patients under propofol or sevoflurane anesthesia: A randomized controlled study

STUDY OBJECTIVE

Elderly patients undergoing pathophysiological changes necessitate clinical tools for cerebral monitoring. This prospective randomized controlled study aimed to explore how cerebral monitoring using Δo2Hbi, ΔHHbi, and ΔcHbi manifests in elderly patients under either propofol or sevoflurane anesthesia.

DESIGN

Single-center, prospective, randomization.

SETTING

A single tertiary hospital (Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea).

PATIENTS

Enrolled 100 patients scheduled for urologic surgery under general anesthesia. Inclusion criteria were (a) age 70-80 years, (b) American Society of Anesthesiologists (ASA) physical status I-II.

INTERVENTION

Patients were double-blind randomized to receive propofol-based or sevoflurane anesthesia. Cerebral oximetry-related parameters were measured at 5, 10, 15, 20, and 30 min in a setting devoid of surgery-related factors.

MEASUREMENTS

The primary outcome focused on the Δo2Hbi pattern in the left and right sides within the propofol and sevoflurane groups.

MAIN RESULTS

We analyzed 100 patients, 50 patients in each group. In the propofol group, the left Δo2Hbi decreased from 1.4 (3.7) at 5 min to -0.1 (1.8) at 30 min (P < 0.0001), and the right Δo2Hbi decreased from 2.9 (4.2) at 5 min to -0.06 (2.3) at 30 min (P < 0.0001). In the sevoflurane group, the left Δo2Hbi decreased from 1.1 (3.4) at 5 min to -1.4 (4.4) at 30 min (P < 0.0001), and the right Δo2Hbi decreased from 2.0 (3.2) at 5 min to -1.2 (3.9) at 30 min (P < 0.0001). There were no significant differences between the two groups. ΔHHbi did not exhibit significant changes after an initial decrease at 5 min and showed no significant differences between the two groups.

CONCLUSIONS

In cerebral oximetry, Δo2Hbi and ΔHHbi could emerge as a valuable approach for discerning changes in the underlying baseline status of the brain in elderly patients during anesthesia.

Effect of lung isolation with different airway devices on postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery: a propensity score-matched study

BACKGROUND

Postoperative pneumonia is one of the common complications after video-assisted thoracoscopic surgery. There is no related study on the effect of lung isolation with different airway devices on postoperative pneumonia. Therefore, in this study, the propensity score matching method was used to retrospectively explore the effects of different lung isolation methods on postoperative pneumonia in patients undergoing video-assisted thoracoscopic surgery.

METHODS

This is A single-center, retrospective, propensity score-matched study. The information of patients who underwent VATS in Weifang People 's Hospital from January 2020 to January 2021 was retrospectively included. The patients were divided into three groups according to the airway device used in thoracoscopic surgery: laryngeal mask combined with bronchial blocker group (LM + BB group), tracheal tube combined with bronchial blocker group (TT + BB group) and double-lumen endobronchial tube group (DLT group). The main outcome was the incidence of pneumonia within 7 days after surgery; the secondary outcome were hospitalization time and hospitalization expenses. Patients in the three groups were matched using propensity score matching (PSM) analysis.

RESULTS

After propensity score matching analysis, there was no significant difference in the incidence of postoperative pneumonia and hospitalization time among the three groups (P > 0.05), but there was significant difference in hospitalization expenses among the three groups (P < 0.05).

CONCLUSIONS

There was no significant difference in the effect of different intubation lung isolation methods on postoperative pneumonia in patients undergoing thoracoscopic surgery.