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Aragón-Benedí C, Oliver-Forniés P, Pascual-Bellosta A, Ortega-Lucea S, Ramírez-Rodriguez JM, Martínez-Ubieto J. Model for predicting early and late-onset postoperative pulmonary complications in perioperative patients receiving neuromuscular blockade: a secondary analysis. Sci Rep 2023; 13:5234. [PMID: 37002265 PMCID: PMC10066373 DOI: 10.1038/s41598-023-32017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Pulmonary complications continue to be the most common adverse event after surgery. The main objective was to carry out two independent predictive models, both for early pulmonary complications in the Post-Anesthesia Care Unit and late-onset pulmonary complications after 30 postoperative days. The secondary objective was to determine whether presenting early complications subsequently causes patients to have other late-onset events. This is a secondary analysis of a cohort study. 714 patients were divided into four groups depending on the neuromuscular blocking agent, and spontaneous or pharmacological reversal. Incidence of late-onset complications if we have not previously had any early complications was 4.96%. If the patient has previously had early complications the incidence of late-onset complications was 22.02%. If airway obstruction occurs, the risk of atelectasis increased from 6.88 to 22.58% (p = 0.002). If hypoxemia occurs, the incidence increased from 5.82 to 21.79% (p < 0.001). Based on our predictive models, we conclude that diabetes mellitus and preoperative anemia are two risk factors for early and late-onset postoperative pulmonary complications, respectively. Hypoxemia and airway obstruction in Post-Anesthesia Care Unit increased four times the risk of the development of pneumonia and atelectasis at 30 postoperative days.
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Affiliation(s)
- Cristian Aragón-Benedí
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain.
| | - Pablo Oliver-Forniés
- Department of Anaesthesia, Resuscitation and Pain Therapy, Mostoles General University Hospital, Mostoles, Madrid, Spain
| | - Ana Pascual-Bellosta
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain
| | - Sonia Ortega-Lucea
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain
| | | | - Javier Martínez-Ubieto
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain
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Aragón-Benedí C, Pascual-Bellosta A, Ortega-Lucea S, Visiedo-Sánchez S, Martínez-Ubieto J. Predictive study of pharmacological reversal for residual neuromuscular blockade and postoperative pulmonary complications: a prospective, observational, cohort study. Sci Rep 2022; 12:14955. [PMID: 36056061 PMCID: PMC9440015 DOI: 10.1038/s41598-022-18917-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
In recent years, some studies have generated controversy since they conclude that intraoperatively pharmacological reversal of neuromuscular blockade does not contribute to the reduction of postoperative residual neuromuscular blockade or pulmonary complications. Therefore, the main objective of this study was to assess the incidence of residual neuromuscular blockade and postoperative pulmonary complications according to spontaneous or pharmacological neuromuscular reversal. The secondary aim was to present a prognostic model to predict the probability of having postoperative residual neuromuscular blockade depending on a patient's comorbidities and intraoperative neuromuscular blocking agents management. A single-center, prospective, observational cohort study including patients undergoing surgical procedures with general anesthesia was designed. A total of 714 patients were analyzed. Patients were divided into four groups: cisatracurium with spontaneous reversal, cisatracurium with neostigmine antagonism, rocuronium with spontaneous reversal, and rocuronium with sugammadex antagonism. According to our binomial generalized linear model, none of the studied comorbidities was a predisposing factor for an increase in the residual neuromuscular blockade. However, in our study, pharmacological reversal of rocuronium with sugammadex and, particularly, neuromuscular monitoring during surgery were the factors that most effectively reduced the risk of residual neuromuscular blockade as well as early and late postoperative pulmonary complications.
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Affiliation(s)
- Cristian Aragón-Benedí
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain.
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.
| | - Ana Pascual-Bellosta
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Sonia Ortega-Lucea
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Sara Visiedo-Sánchez
- Department of Anaesthesia, Resuscitation and Pain Therapy, University Clinical Hospital Lozano Blesa, Zaragoza, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Javier Martínez-Ubieto
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, 50009, Zaragoza, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
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Ripollés-Melchor J, Sánchez-Santos R, Abad-Motos A, Gimeno-Moro AM, Díez-Remesal Y, Jove-Alborés P, Aragó-Chofre P, Ortiz-Sebastian S, Sánchez-Martín R, Ramírez-Rodríguez JM, Trullenque-Juan R, Valentí-Azcárate V, Ramiro-Ruiz Á, Correa-Chacón OC, Batalla A, Gimeno-Grauwinkel C, Sanahuja-Blasco JM, González-Valverde FM, Galán-Menéndez P, Díez-Zapirain MJ, Vilallonga R, Zorrilla-Vaca A, Pascual-Bellosta AM, Martínez-Ubieto J, Carrascosa-Mirón T, Ruiz-Escobar A, Martín-García-Almenta E, Suárez-de-la-Rica A, Bausili M, Palacios-Cordoba Á, Olvera-García MM, Meza-Vega JA, Sánchez-Pernaute A, Abad-Gurumeta A, Ferrando-Ortola C, Martín-Vaquerizo B, Torres-Alfonso JR, Aguado-Sánchez S, Sánchez-Cabezudo-Noguera F, García-Erce JA, Aldecoa C. Higher Adherence to ERAS Society® Recommendations is Associated with Shorter Hospital Stay Without an Increase in Postoperative Complications or Readmissions in Bariatric Surgery: the Association Between Use of Enhanced Recovery After Surgery Protocols and Postoperative Complications after Bariatric Surgery (POWER 3) Multicenter Observational Study. Obes Surg 2022; 32:1289-1299. [PMID: 35143011 DOI: 10.1007/s11695-022-05949-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery. MATERIALS AND METHODS Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03864861.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
| | - Raquel Sánchez-Santos
- Department of General Surgery, University Hospital of Vigo, Galicia Sur Research Institute (IISGS), Vigo, Spain.,Spanish Society of Obesity Surgery (SECO), San Juan de Alicante, Spain
| | - Ane Abad-Motos
- Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain. .,Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.
| | - Ana M Gimeno-Moro
- Department of Anesthesia and Perioperative Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Yolanda Díez-Remesal
- Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.,Department of Anesthesia and Perioperative Medicine, Ramón y Cajal University Hospital, Madrid, Spain
| | - Patricia Jove-Alborés
- Department of General Surgery, University Hospital of Vigo, Galicia Sur Research Institute (IISGS), Vigo, Spain
| | - Pablo Aragó-Chofre
- Department of General Surgery, Hospital Universitario de Manises, Manises, Spain
| | | | - Rubén Sánchez-Martín
- Department of Anesthesia and Perioperative Medicine, Clínico San Carlos University Hospital, Madrid, Spain
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.,Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain.,Universidad de Zaragoza, Zaragoza, Spain
| | | | - Víctor Valentí-Azcárate
- Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
| | - Álvaro Ramiro-Ruiz
- Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.,Department of Anesthesia and Perioperative Medicine, 12 de Octubre University Hospital, Madrid, Spain
| | - Olga C Correa-Chacón
- Department of Anesthesia and Perioperative Medicine, Santa Lucía Hospital, Cartagena, Spain
| | - Astrid Batalla
- Department of Anesthesiology and Perioperative Medicine, Sant Pau University Hospital, Barcelona, Spain
| | | | | | | | - Patricia Galán-Menéndez
- Department of Anesthesia and Perioperative Medicine, Vall d´Hebrón University Hospital, Barcelona, Spain
| | - Miren J Díez-Zapirain
- Department of Anesthesia and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Ramón Vilallonga
- Department of General Surgery, Bariatric surgery Department, Vall d´Hebrón University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana M Pascual-Bellosta
- Department of Anesthesiology and Perioperative Medicine, Miquel Servet University Hospital, Zaragoza, Spain
| | - Javier Martínez-Ubieto
- Department of Anesthesiology and Perioperative Medicine, Miquel Servet University Hospital, Zaragoza, Spain
| | | | - Alicia Ruiz-Escobar
- Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
| | | | - Alejandro Suárez-de-la-Rica
- Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.,Department of Anesthesia and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Marc Bausili
- Department of Anesthesia and Perioperative Medicine, Clínica Diagonal, Esplugues de Llobregat, Spain
| | - Ángela Palacios-Cordoba
- Department of Anesthesia and Perioperative Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - María M Olvera-García
- Department of Anesthesia and Perioperative Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Julio A Meza-Vega
- Department of Anesthesia and Perioperative Medicine, Hospital de Barcelona, Barcelona, Spain
| | - Andrés Sánchez-Pernaute
- Spanish Society of Obesity Surgery (SECO), San Juan de Alicante, Spain.,Department of General Surgery, Clínico San Carlos University Hospital, Madrid, Spain
| | - Alfredo Abad-Gurumeta
- Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
| | - Carlos Ferrando-Ortola
- Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.,Department of Anesthesia and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Martín-Vaquerizo
- Department of Anesthesia and Perioperative Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | | | - Sandra Aguado-Sánchez
- Department of Anesthesia and Perioperative Medicine, Hospital del Mar, Barcelona, Spain
| | | | - José A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.,Department of Anesthesia and Perioperative Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
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Aragón-Benedí C, Visiedo-Sánchez S, Pascual-Bellosta A, Ortega-Lucea S, Fernández-Liesa R, Martínez-Ubieto J. Study of Rocuronium-Sugammadex as an Alternative to Succinylcholine-Cisatracurium in Microlaryngeal Surgery. Laryngoscope 2020; 131:E212-E218. [PMID: 32324308 DOI: 10.1002/lary.28649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
Microlaryngeal surgery (ML) is a short procedure that requires a deep neuromuscular blockade to provide optimum surgical conditions. Succinylcholine is a relaxant widely used but involves numerous complications. One valid alternative is rocuronium, with a specific antagonist, sugammadex. The primary objective was to assess the surgical conditions in ML according to the relaxant. The secondary objectives were to assess intubation conditions and intraoperative and immediate postoperative adverse events. STUDY DESIGN Prospective randomized study. METHODS This was a prospective study of patients scheduled for ML randomized into two groups according to relaxant. Neuromuscular blockade was recorded after administration and during ML surgery. Surgical conditions were assessed using the ML Rating Scale, intubation conditions, remifentanil doses, intraoperative complications, surgery time, emergence time, and complications in the postanesthesia care unit. RESULTS Two hundred five patients were included (rocuronium = 103, succinylcholine = 102). Train-of-four values were higher for rocuronium, though the otorhinolaryngology surgical conditions were significantly better in that group (rocuronium = 5.54 ± 1.39 points; succinylcholine = 9.13 ± 1.99 points). Intubation conditions were similar in both groups. Remifentanil doses were higher for succinylcholine (P < .001) (rocuronium = 0.102 ± 0.05 μg/kg/min; succinylcholine = 0.201 ± 0.05 μg/kg/min). There were no differences in the duration of surgery, but the time to awakening was significantly longer for succinylcholine (rocuronium = 3.82 ± 1.38 minutes, succinylcholine = 9.18 ± 2.04 minutes, P < .001). CONCLUSIONS Rocuronium provides better surgical conditions and allows for the use of lower doses of remifentanil as compared to succinylcholine and cisatracurium in ML. This makes it possible to decrease the time to awakening and the complications associated with high doses of remifentanil. LEVEL OF EVIDENCE 1b Laryngoscope, 131:E212-E218, 2021.
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Affiliation(s)
- Cristian Aragón-Benedí
- Department of Anesthesia, Resuscitation and Pain Therapy, Móstoles General University Hospital, Móstoles, Spain
| | - Sara Visiedo-Sánchez
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Ana Pascual-Bellosta
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sonia Ortega-Lucea
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Rafael Fernández-Liesa
- Head of Department of Otolaryngology-Head and Neck Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Javier Martínez-Ubieto
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
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Martínez-Ubieto F, Jiménez-Bernadó T, Bueno-Delgado A, Martínez-Ubieto J, Pascual-Bellosta A. Recurrent intestinal intussusception in an adult due to intestinal pseudopolyps not associated with inflammatory bowel disease: a case report. J Med Case Rep 2015; 9:260. [PMID: 26593269 PMCID: PMC4656180 DOI: 10.1186/s13256-015-0754-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/27/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Intestinal intussusception is very rare in adults and, unlike in children, it is due to an organic cause, mainly benign or malignant tumors, in 90 % of cases. Recurrent intussusception in an adult is even more exceptional, and in the case reported it was due to repeated occurrence of intestinal pseudopolyps, which is exceptional according to the literature. Preoperative diagnosis is difficult, and surgery is always indicated because a tumor is usually present. The surgical procedure may be controversial, as some would prefer desintussusception before resection, while others would advocate initial resection because of the risk of dissemination if a malignant lesion exists. CASE PRESENTATION We report the case of a 34-year-old Caucasian man who underwent emergency laparoscopic surgery for intestinal obstruction and was found to have a jejunal intussusception. Polyps or pseudopolyps, some of them large and causing the intussusception, were seen in the surgical specimen. Our patient had also undergone surgery for intussusception 10 years before, after which the pathological report also noted the presence of these formations. CONCLUSIONS Recurrent intussusception in adults due to the presence of intestinal pseudopolyps is exceptional and, to the best of our knowledge, this is the first such case reported.
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Affiliation(s)
| | | | - Alvaro Bueno-Delgado
- Digestive and Bariatric Surgery Department, Viamed MontecanalHospital, 50008, Zaragoza, Spain.
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