ABSTRACT
INTRODUCTION: It has been hypothesized that routine use of deep neuromuscular block (dNMB) is advisable in laparoscopic bariatric surgery to optimize workspace conditions. dNMB seems to have advantages in laparoscopic procedures on non-obese patients as it improves surgical space conditions and reduces postoperative pain scores. This systematic review and meta-analysis aimed at comparing the impact of deep vs. moderate NMB (mNMB) on surgical conditions and outcomes, including duration of surgery and postoperative pain in patients undergoing laparoscopic bariatric surgery. EVIDENCE ACQUISITION: Studies were identified from Medline, Embase and Cochrane library (update: Sep 1, 2019). Randomized controlled trials (RCTs) comparing dNMB with mNMB were identified if they reported surgeon satisfaction for workspace conditions (primary outcome). The effects of dNMB on surgery duration and postoperative pain (secondary outcomes) were also investigated. EVIDENCE SYNTHESIS: Of the 45 retrieved records, four were finally included. dNMB improved the surgeon's satisfaction score about workspace (on a scale ranging from 1 to 5), with a mean difference (MD) of 0.52 (95% CI: 0.36-0.68). Surgical duration was not affected by block level (MD: -3.29 minutes; 95% CI: from -14.35 to 7.76). Only one study showed that dNMB also decreased postoperative pain. CONCLUSIONS: It was found that dNMB helps improve surgical space conditions in patients undergoing laparoscopic bariatric surgery whereas it fails to shorten procedure duration. More high-quality large-sampled RCTs are needed to confirm these results. The relationship between dNMB use and other clinical outcomes, such as complications occurrence, needs to be further investigated.
Subject(s)
Bariatric Surgery , Laparoscopy , Neuromuscular Blockade , Humans , Pain, Postoperative , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVES: Delayed graft function is a frequent complication in deceased-donor kidney transplant, with an incidence ranging from 10% to 50% among different centers; it is also associated with lower graft survival. In this study, we aimed to identify risk factors for delayed graft function, particularly those associated with perioperative management (including cold ischemia time) and nonmodifiable recipient- and donor-related factors. The effects of delayed graft function on graft and patient outcomes were also evaluated. MATERIALS AND METHODS: Our retrospective analyses included 125 adult patients who underwent deceased-donor kidney transplant. Delayed graft function was diagnosed if at least 1 dialysis treatment was required during the first week posttransplant according to Perico's definition. RESULTS: Prevalence of delayed graft function was 30.4% (n = 38). Cold ischemia time was significantly prolonged in patients with delayed graft function compared with those without it. Multivariate regression showed that cold ischemia time was the only predictor of delayed graft function. A cutoff of 9 hours and 12 minutes was found as a limit beyond which delayed graft function occurred (sensitivity = 90%; specificity = 29%; area under the curve = 0.68). Greater donor and recipient age and longer pretransplant dialysis time in recipients were associated with occurrence of delayed graft function. In patients with delayed graft function, hospital stay duration was significantly greater and 1-year graft survival was significantly lower. CONCLUSIONS: Efforts should be focused on limiting cold ischemia time and associated injury to reduce occurrence of delayed graft function and consequently improve long-term graft survival in kidney transplant recipients. Optimization of posttransplant renal function with the help of new technologies, such as pulsatile perfusion, could be crucial for minimization of cold ischemia time.
