The clinical impact of the systolic volume variation guided intraoperative fluid administration regimen on surgical outcomes after pancreaticoduodenectomy: a retrospective cohort study

Abstract Background Pancreaticoduodenectomy is associated with high morbidity. Many preoperative variables are risk factors for postoperative complications, but they are primarily non-modifiable. It is not clear whether an intraoperative goal-directed fluid regimen might be associated with fewer postoperative surgical complications compared to current conservative, non-goal-directed fluid practices. We hypothesize that the use of Systolic Volume Variation (SVV)-guided intraoperative fluid administration might be beneficial. Methods Data from 223 patients who underwent pancreaticoduodenectomy in our institution between 2015 and 2019 were reviewed. Patients were classified into two groups based on the use of intraoperative use of SVV to guide the administration of fluids. The decision to use SVV or not was made by the attending anesthesiologist. Subjects were classified into SVV-guided intraoperative fluid therapy (SVV group) and non-SVV-guided intraoperative fluid therapy (non-SVV group). Uni and multivariate regression analyses were conducted to determine if SVV-guided fluid therapy was significantly associated with a lower incidence of postoperative surgical complications, such as Postoperative Pancreatic Fistula (POPF), Delayed Gastric Emptying (DGE), among others, after adjusting for confounders. Results Baseline, demographic, and intraoperative characteristics were similar between SVV and non-SVV groups. In the multivariate analysis, the use of SVV guidance was significantly associated with fewer postoperative surgical complications (OR = 0.48; 95% CI 0.25-0.91; p= 0.025), even after adjusting for significant covariates, such as perioperative use of epidural, pancreatic gland parenchyma texture, and diameter of the pancreatic duct. Conclusions VV-guided intraoperative fluid administration might be associated with fewer postoperative surgical complications after pancreaticoduodenectomy.

Restless legs syndrome: study of prevalence among medical school faculty members / Síndrome das pernas inquietas: estudo de prevalência entre professores do curso de medicina

The aim of this study was to assess the prevalence of idiopathic restless legs syndrome (RLS) and its correlations in a sample of Medical School faculty members. A transversal study was conducted at a Medical School in the south of Brazil included 78 faculty members. The subjects answered to a structured questionnaire specific to RLS diagnosis and the Epworth and the Stanford scales to measure daytime sleepiness. Severity of the disease was also evaluated. The variables were analyzed to statistical significance. RLS was diagnosed in 10.25 percent of the subjects evaluated and most were women (62.5 percent). The prevalence of daytime sleepiness was significantly greater among the subjects suffering from RLS (p=0.04). RLS subjects were significantly younger than the group without the syndrome (p=0.02). RLS had a considerable prevalence in the sample studied. Daytime sleepiness and young age showed an important correlation to this syndrome, as other potential factors were not confirmed.

O objetivo deste estudo foi analisar a prevalência da síndrome das pernas inquietas (SPI) e suas implicações clínicas em uma amostra envolvendo docentes de um curso de Medicina. Foi realizado um estudo transversal que envolveu 78 docentes do curso de Medicina de uma Universidade do Sul do Brasil. Os indivíduos avaliados responderam um questionário com perguntas epidemiológicas e de diagnóstico para SPI, assim como escalas de sonolência de Epworth e Stanford. Os portadores de SPI responderam questionário de gravidade. As variáveis foram analisadas quanto à significância estatística. Obtivemos uma prevalência de indivíduos portadores de SPI de 10,25 por cento, sendo 62,5 por cento destes do sexo feminino. A existência de sonolência diurna excessiva foi significativamente maior em pacientes portadores da síndrome (p=0,04). Os pacientes portadores de SPI possuíam idade significativamente inferior ao grupo não sindrômico (p=0,02). A SPI mostrou-se bastante prevalente em nossa amostra. A prevalência de sonolência diurna e menos idade mostrou importante relação com esta síndrome, enquanto outros fatores possivelmente relacionados não foram confirmados.