Perioperative Dexmedetomidine Infusion Improves Perioperative Care of Bariatric-Metabolic Surgery: A Single Center Experience with Meta-Analysis

PURPOSE

This study aims to determine the effects of perioperative dexmedetomidine infusion (PDI) on Asian patients undergoing bariatric-metabolic surgery (BMS), focusing on the need for pain medications and management of postoperative nausea and vomiting (PONV), and to investigate the association with these variables, including patients' characteristics and BMS data.

MATERIALS AND METHODS

A retrospective review of prospectively collected data was conducted in an Asian weight management center from August 2016 to October 2021. A total of 147 native patients with severe obesity were enrolled. All patients were informed of the full support of perioperative pain medications for BMS. The pain numeric rating scale scores, events of PONV, needs for pain medications, and the associated patients' characteristics were analyzed. A p-value of < 0.05 was considered statistically significant. Furthermore, to verify the effects of perioperative usage of dexmedetomidine for BMS, a systematic review with meta-analysis of currently available randomized control trials was performed.

RESULTS

Among the 147 enrolled patients, 107 underwent laparoscopic sleeve gastrectomy and 40 underwent laparoscopic Roux-en-Y gastric bypass. PDI has been used as an adjunct multimodal analgesia for BMS in our institution since June 2017 (group D; n = 114). In comparison with those not administered with perioperative dexmedetomidine (group C; n = 33), lower pain numeric rating scale scores (2.52 ± 2.46 vs. 4.27 ± 2.95, p = 0.007) in the postanesthesia care unit, fewer PONV (32.46% vs. 51.52%; p = 0.046), and infrequent needs of additional pain medications (19.47% vs. 45.45%; p = 0.003) were observed in group D. Multivariable analysis demonstrated that type II diabetes mellitus was correlated with the decreased need of pain medications other than PDI (p = 0.035). Moreover, dexmedetomidine seemed to have a better analgesic effect for patients with longer surgical time based on our meta-analysis.

CONCLUSION

Based on our limited experience, PDI could be a practical solution to alleviate pain and PONV in Asian patients undergoing BMS. Moreover, it might reduce the need for rescue painkillers with better postoperative pain management for patients with type II diabetes mellitus or longer surgical time.

Video-assisted thoracoscopic surgery for postoperative recurrent primary spontaneous pneumothorax

OBJECTIVES

Postoperative recurrent primary spontaneous pneumothorax (PSP) is a troublesome complication and an important issue to be discussed. This study is to determine whether Re-video assisted thoracoscopic surgery (VATS) should be performed for postoperative recurrent PSP (PORP).

MATERIALS AND METHODS

Patients who had underwent needlescopic VATS for PSP between Jan. 2007 and Dec. 2011 were reviewed.

RESULTS

VATS was initially performed on 239 patients with PSP in total. Eleven patients were found to have PORP during a follow-up period of 36.95 months. Nine patients received Re-VATS and only two patients receiving conservative treatment had no further recurrence. No conversion to thoracotomy, blood transfusion and prolong air leak were recorded.

CONCLUSIONS

Even for smaller size cases, Re-VATS, which is technically feasible, safe and effective with better cosmetics and minor postoperative pain, should be a strong contender as priority treatment.

Detection of Rickettsia spp. and host and habitat associations of fleas (Siphonaptera) in eastern Taiwan

Rickettsia typhi and Rickettsia felis (Rickettsiales: Rickettsiaceae) are two rickettsiae principally transmitted by fleas, but the detection of either pathogen has rarely been attempted in Taiwan. Of 2048 small mammals trapped in eastern Taiwan, Apodemus agrarius Pallas (24.5%) and Mus caroli Bonhote (24.4%) (both: Rodentia: Muridae) were the most abundant, and M. caroli hosted the highest proportion of fleas (63.9% of 330 fleas). Two flea species were identified: Stivalius aporus Jordan and Rothschild (Siphonaptera: Stivaliidae), and Acropsylla episema Rothschild (Siphonaptera: Leptopsyllidae). Nested polymerase chain reaction targeting parts of the ompB and gltA genes showed six fleas to be positive for Rickettsia spp. (3.8% of 160 samples), which showed the greatest similarity to R. felis, Rickettsia japonica, Rickettsia conorii or Rickettsia sp. TwKM01. Rickettsia typhi was not detected in the fleas and Rickettsia co-infection did not occur. Both flea species were more abundant during months with lower temperatures and less rainfall, and flea abundance on M. caroli was not related to soil hardness, vegetative height, ground cover by litter or by understory layer, or the abundance of M. caroli. Our study reveals the potential circulation of R. felis and other rickettsiae in eastern Taiwan, necessitating further surveillance of rickettsial diseases in this region. This is especially important because many novel rickettsioses are emerging worldwide.

Annual variation in semen characteristics of pigeons (Columba livia)

The purpose of this study was to evaluate annual semen characteristics of pigeons (Columba livia). Ten selected male pigeons, aged 2 to 5 yr were housed under natural environmental conditions, and semen collection was conducted via a digital massage twice weekly throughout the year. The success rate of semen collection in a total of 920 attempts was 40% (371/920) over the whole year. The highest success rate was 69% (55/80) in March followed by 66% (53/80) in November, whereas the lowest rates were in August (13%,10/80) and September (13%, 8/60) (P < 0.01). Volume of the ejaculate averaged 11.0 +/- 0.9 microL (mean +/- SEM). The greatest volume was obtained in November (13.5 +/- 1.0 microL), whereas the least was obtained in August (7.0 +/- 1.0 microL). The average sperm motility was 72 +/- 2% of all ejaculates, of which the highest motility (82 +/- 2%) was observed in March, whereas the least motility (48 +/- 3%) was in August. Sperm viability and sperm motility were positively correlated (r = 0.91; P < 0.01). Maximum sperm concentration was 4.9 +/- 0.4 x 10(9) sperm/mL noted in March, whereas the minimum was 3.8 +/- 0.2 x 10(9) sperm/mL observed in October. Donors generally exhibited susceptible (54%) or dull submission (43%), whereas resistance to handling was rarely observed (3%). During collections, a red (47%) or pink (44%) cloacal membrane was often observed, whereas during only 9% of the collections, the cloacal membrane was pale. When the ambient temperature decreased below 15 C, semen could not be obtained (0/80). A high amount of semen (>10 microL) was obtained when the temperature ranged between 19 and 24 C. Optimal sperm motility (approximately 80%) and viability (>85%) was observed when the temperature was between 18 and 24 C. At temperatures greater than 28 C, sperm motility and viability decreased. Sperm concentration was not significantly influenced by temperature fluctuations. In summary, annual variation in semen characteristics exhibited two peaks per year with mean motility and viability reaching peak annual values in March and November. Both of these months had mean ambient temperatures between 19 and 24 C, a range associated with maximal ejaculatory volumes.