Advances in the Clinical Management of Perioperative Anesthesia

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 28 August 2024 | Viewed by 2985

Special Issue Editors


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Guest Editor
Unit of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: anesthesia; pain management; perioperative medicine; anesthesiology; intensive care

E-Mail Website
Guest Editor
Unit of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: anesthesia; pain management; perioperative medicine; anesthesiology; intensive care, anesthesia in robotic surgery; ERAS; ERABS

E-Mail Website
Guest Editor
Unit of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: anesthesia; pain management; perioperative medicine; cardiac anesthesia; regional anesthesia

Special Issue Information

Dear Colleagues,

Perioperative and anesthetic management undertaken for general surgery improves surgical outcomes. 

It requires close multidisciplinary collaboration between dedicated anesthetic, surgical and clinical teams and should be based on a combination of multimodal evidence-based strategies applied to the conventional perioperative techniques, such as the Enhanced Recovery After Surgery (ERAS) protocols.

Preoperative evaluation with risk factor optimization, choice of anesthesia and anesthetic drugs, multimodal analgesia and pain management, fluid management, hemodynamic monitoring, postoperative early feeding and early mobilization are key elements of a patient-centered strategy to reduce postoperative complications and achieve early recovery. 

This Special Issue in the Journal of Clinical Medicine aims to publish topical clinical research related to the perioperative care of surgical patients, involving different main areas of interest, from throughout the surgical pathway to recovery. 

We welcome the submission of original research articles, narrative and/or systematic reviews and meta-analyses focused on the clinical management of perioperative anesthesia.

Dr. Alessia Mattei
Prof. Dr. Rita Cataldo
Dr. Alessandro Strumia
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • perioperative outcomes (surgical, anesthetic, medical)
  • evidence-based care
  • perioperative guidelines and consensus statements
  • preoperative evaluation and risk scores
  • preoperative testing
  • surgical optimization and enhanced surgical recovery programs
  • intensive care unit

Published Papers (5 papers)

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Research

11 pages, 624 KiB  
Article
Comparison of Nefopam-Based Patient-Controlled Analgesia with Opioid-Based Patient-Controlled Analgesia for Postoperative Pain Management in Immediate Breast Reconstruction Surgery: A Randomized Controlled Trial
by Jaewon Huh, Noori Lee, Minju Kim, Hoon Choi, Deuk Young Oh, Jangyoun Choi and Wonjung Hwang
J. Clin. Med. 2024, 13(12), 3490; https://doi.org/10.3390/jcm13123490 - 14 Jun 2024
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Abstract
Background/Objectives: Immediate breast reconstruction surgery (BRS) often leads to significant postoperative pain, necessitating effective analgesia. This study aimed to compare the analgesic efficacy of patient-controlled analgesia (PCA) containing nefopam with that of PCA containing opioids alone in patients undergoing BRS. Methods: [...] Read more.
Background/Objectives: Immediate breast reconstruction surgery (BRS) often leads to significant postoperative pain, necessitating effective analgesia. This study aimed to compare the analgesic efficacy of patient-controlled analgesia (PCA) containing nefopam with that of PCA containing opioids alone in patients undergoing BRS. Methods: A prospective, double-blind, randomized controlled trial was conducted on 120 patients undergoing immediate BRS after mastectomy. Patients were randomly allocated to receive PCA with fentanyl alone (Group F: fentanyl 10 mcg/kg), fentanyl and nefopam (Group FN: fentanyl 5 mcg/kg + nefopam 1 mg/kg), or nefopam alone (Group N: nefopam 2 mg/kg). Pain intensity (expressed in VASr and VASm), opioid consumption, and opioid-related complications were assessed. Results: PCA with nefopam, either alone or in combination with opioids, demonstrated non-inferior analgesic efficacy compared to PCA with fentanyl alone. At 24 h postoperatively, the VASr scores were 2.9 ± 1.0 in Group F, 3.1 ± 1.2 in Group FN, and 2.8 ± 0.9 in Group N (p = 0.501). At the same timepoint, the VASm scores were 4.1 ± 1.2 in Group F, 4.5 ± 1.5 in Group FN, and 3.8 ± 1.4 in Group N (p = 0.129). Significant differences among the three groups were observed at all timepoints except for PACU in terms of the total opioid consumption (p < 0.0001). However, there were no significant differences in opioid-related complications among the three groups. Conclusions: PCA with nefopam, whether alone or in combination with opioids, offers non-inferior analgesic efficacy compared to PCA with fentanyl alone in patients undergoing immediate BRS. Full article
(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)
10 pages, 6579 KiB  
Article
Histopathologic Study of the Effects of Surgically Applied Cryoanalgesia on Intercostal Nerves in a Live Porcine Model
by Julian Guitron
J. Clin. Med. 2024, 13(11), 3304; https://doi.org/10.3390/jcm13113304 - 4 Jun 2024
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Abstract
Background/Objectives: The aim of this study was to establish a histologic baseline for cryoanalgesia of 2 min duration and evaluate the effects of different freeze durations. Methods: A porcine model was used in which the application of bilateral cryoanalgesia from intercostal [...] Read more.
Background/Objectives: The aim of this study was to establish a histologic baseline for cryoanalgesia of 2 min duration and evaluate the effects of different freeze durations. Methods: A porcine model was used in which the application of bilateral cryoanalgesia from intercostal spaces T3–T7 was completed via partial median sternotomy. The animals were kept alive for 7 days and the ribcages were sent to a specialized center for histopathologic analysis of the freezing injury. Results: Forty freezing lesions were completed and analyzed histologically. Thirty-eight (95%) of the cryo-lesions presented 100% nerve fiber degeneration at or distal to the ablation site, with preservation of the perineural connective tissue, as intended. The two unaffected nerves were found to be physically located outside of the freezing area. Conclusions: The complete axonal degeneration with preservation of the perineural tissue opens the possibility to shorter freezing times than the recommended 2 min. Visualization of the nerve and positioning of the probe is important in ensuring the proper effect on the nerve. This histologic analysis confirms the process triggered by cryoanalgesia that, until now, had only been assumed. Full article
(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)
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13 pages, 673 KiB  
Article
Pulmonary Hypertension and the Risk of 30-Day Postoperative Pulmonary Complications after Gastrointestinal Surgical or Endoscopic Procedures: A Retrospective Propensity Score-Weighted Cohort Analysis
by Yoshio Tatsuoka, Zyad J. Carr, Sachidhanand Jayakumar, Hung-Mo Lin, Zili He, Adham Farroukh and Paul Heerdt
J. Clin. Med. 2024, 13(7), 1996; https://doi.org/10.3390/jcm13071996 - 29 Mar 2024
Viewed by 677
Abstract
Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPCs). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study was conducted on 164 patients with [...] Read more.
Background: Pulmonary hypertension (PH) patients are at higher risk of postoperative complications. We analyzed the association of PH with 30-day postoperative pulmonary complications (PPCs). Methods: A single-center propensity score overlap weighting (OW) retrospective cohort study was conducted on 164 patients with a mean pulmonary artery pressure (mPAP) of >20 mmHg within 24 months of undergoing elective inpatient abdominal surgery or endoscopic procedures under general anesthesia and a control cohort (N = 1981). The primary outcome was PPCs, and the secondary outcomes were PPC sub-composites, namely respiratory failure (RF), pneumonia (PNA), aspiration pneumonia/pneumonitis (ASP), pulmonary embolism (PE), length of stay (LOS), and 30-day mortality. Results: PPCs were higher in the PH cohort (29.9% vs. 11.2%, p < 0.001). When sub-composites were analyzed, higher rates of RF (19.3% vs. 6.6%, p < 0.001) and PNA (11.2% vs. 5.7%, p = 0.01) were observed. After OW, PH was still associated with greater PPCs (RR 1.66, 95% CI (1.05–2.71), p = 0.036) and increased LOS (median 8.0 days vs. 4.9 days) but not 30-day mortality. Sub-cohort analysis showed no difference in PPCs between pre- and post-capillary PH patients. Conclusions: After covariate balancing, PH was associated with a higher risk for PPCs and prolonged LOS. This elevated PPC risk should be considered during preoperative risk assessment. Full article
(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)
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11 pages, 853 KiB  
Article
Clinical Efficacy of 10 Min of Active Prewarming for Preserving Patient Body Temperature during Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Trial
by Jung-Woo Shim, Hyejin Kwon, Hyong Woo Moon and Min Suk Chae
J. Clin. Med. 2024, 13(7), 1843; https://doi.org/10.3390/jcm13071843 - 22 Mar 2024
Viewed by 611
Abstract
Background: Percutaneous nephrolithotomy (PNL) poses a risk of hypothermia. Additionally, general anesthesia lowers the thresholds for shivering and vasoconstriction, which leads to dysfunction of central thermoregulation. Perioperative hypothermia is associated with adverse outcomes after surgery. In this study, we aimed to demonstrate that [...] Read more.
Background: Percutaneous nephrolithotomy (PNL) poses a risk of hypothermia. Additionally, general anesthesia lowers the thresholds for shivering and vasoconstriction, which leads to dysfunction of central thermoregulation. Perioperative hypothermia is associated with adverse outcomes after surgery. In this study, we aimed to demonstrate that prewarming for 10 min can effectively prevent early hypothermia during PNL. Methods: A total of 68 patients scheduled for elective PNL were recruited to this study from January to June 2022, but two patients were excluded because of a change in the surgical plan. After randomization, patients in the prewarming group (n = 32) received warming using a forced-air warming device for 10 min in the preoperative area before being transferred to the operating room, while the controls (n = 34) did not. The incidence of hypothermia within the first hour after inducing general anesthesia was the primary outcome. Perioperative body temperatures and postoperative recovery findings were also evaluated. Results: Early intraoperative hypothermia decreased significantly more in the prewarming group than in the control group (9.4% vs. 41.2%, p = 0.003). Moreover, the net decrease in core body temperature during surgery was smaller in the prewarming group than in the control group (0.2 °C, vs. 0.5 °C, p = 0.003). In addition, the prewarmed patients had a lower incidence of postoperative shivering and a shorter post-anesthesia-care unit (PACU) stay (12.5% vs. 35.3%, p = 0.031; and 46 vs. 50 min, p = 0.038, respectively). Conclusions: Prewarming for 10 min decreased early hypothermia, preserved intraoperative body temperature, and improved postoperative recovery in the PACU. Full article
(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)
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14 pages, 2156 KiB  
Article
Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study
by Olga Grăjdieru, Cristina Petrișor, Constantin Bodolea, Ciprian Tomuleasa and Cătălin Constantinescu
J. Clin. Med. 2024, 13(5), 1321; https://doi.org/10.3390/jcm13051321 - 26 Feb 2024
Viewed by 881
Abstract
Background: Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. Methods: This study aimed to evaluate the [...] Read more.
Background: Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. Methods: This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. Results: Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5–2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. Conclusions: This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines. Full article
(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)
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