A new hematologic predictor of major adverse events after cardiac surgery: red cell distribution width to lymphocyte ratio

Background@#The perioperative risk factors that cause severe morbidity and prolongation of postoperative hospital stay after cardiac surgery should be determined. Various scores have been used to predict morbidity and mortality. Preoperative blood counts are considered potential biomarkers of inflammation and oxidative stress. Inflammatory and immune imbalances may have a significant impact on postoperative adverse events. The present study aimed to investigate the association and potential predictive properties of red cell distribution width/ lymphocyte ratio (RLR) for major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. @*Methods@#After approval from the ethics committee, pre- and post-operative data of 700 patients were obtained from the electronic database of the hospital, intra- and post-operative anesthesia, and intensive care unit follow-up charts. We performed a stepwise multiple logistic regression analysis to investigate the association of RLR with major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. @*Results@#Among 700 patients, 47 (6.7%) had major adverse events after surgery. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03–1.12; P < 0.001), mean platelet volume (OR, 1.49; 95% CI, 1.07–2.06; P = 0.017), and RLR (OR, 1.21; 95% CI, 1.02–1.43; P = 0.026) were significantly associated with major adverse events. @*Conclusions@#RLR indicates the balance between inflammatory and immune responses. Therefore, it can be used to predict adverse events following coronary surgery.

Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure

Blood pressure fluctuations appear more significant in patients with poorly controlled hypertension and are known to be associated with adverse perioperative morbidity. In the present study, we aimed to determine the effects of antihypertensive drug treatment strategies on preanesthetic operating room blood pressure measurements. Methods: A total of 717 patients participated in our study; 383 patients who were normotensive based on baseline measurements and not under antihypertensive therapy were excluded from the analysis. The remaining 334 patients were divided into six groups according to the antihypertensive drug treatment. These six groups were examined in terms of preoperative baseline and pre-anesthesia blood pressure measurements. Results: As a result of the study, it was observed that 24% of patients had high blood pressure precluding surgery, and patients using renin-angiotensin-aldosterone system inhibitors (RAASI) had higher pre-anesthesia systolic blood pressure than patients using other antihypertensive drugs. Patients who received beta-blockers were also observed to have the lowest pre-anesthesia systolic blood pressure, diastolic blood pressure, and mean blood pressure, compared to others. Conclusions: Recently, whether RAASI should be continued preoperatively remains controversial. Our study shows that RAASI cannot provide optimal pre-anesthesia blood pressure and lead to an increase in the number of postponed surgeries, probably due to withdrawal of medication before the operation. Therefore, the preoperative discontinuation of RAASI should be reevaluated in future studies.

Do we use too much propofol for sedation in colonoscopy? an observational study with sedline monitor

Objectives: Propofol and midazolam are popular sedatives in colonoscopy. Our aim was to measure depth of sedation with propofol-fentanyl and midazolam-fentanyl in patients undergoing colonoscopy using a blinded electroencephalogram [EEG]-based SEDLine monitor

Design: Non-randomized, prospective, observational

Setting: Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey

Subjects: One hundred and eight adult volunteers with American Society of Anesthesiologist [ASA] class I-II-III, aged 18 - 80 years, and undergoing colonoscopy with propofol-fentanyl [Group P] or midazolam-fentanyl [Group M] -based sedation Interventions: Demographic variables, depth of sedation and recovery times were recorded

Main outcome measures: Depth of sedation was measured and recorded with an EEG-based SEDLine monitor. Patient State Index [PSI] values at colonoscope insertion, removal, and at return of verbal responsiveness after colonoscope withdrawal were documented

Results: Patients in group P were younger [p <0.0001] and had lower ASA scores [p = 0.02] than group M patients. Group P patients experienced signi.cantly deeper degrees of sedation at all times and longer sedation and recovery times [p <0.0001 and p = 0.01]. Group P patients were more deeply sedated and had lower PSI values at the 5th minute [p <0.0001] and lower PSI scores after recovery [p <0.0001]. Group M had more comorbidity but more stable PSI values. Their sedation levels were also closer to normal

Conclusion: Clinical signs for sedation showed that propofol was over-used. The titration of propofol using a processed-EEG monitor, such as SEDLine, can improve sedation procedures by reducing time spent in states of deep sedation/general anesthesia while maintaining the clinical advantages of propofol