Contraindications to use of neuraxial anesthesia for lower limb revascularization surgery in adults: a cross-sectional study.

PURPOSE: Nonrandomized and some randomized data suggest neuraxial anesthesia may improve outcomes after lower limb revascularization surgery. Nevertheless, the prevalence of contraindications to neuraxial anesthesia in vascular surgery patients is unknown. We aimed to identify the prevalence of patients with contraindications to neuraxial anesthesia, and to derive and validate a case ascertainment algorithm identifying individuals likely to have contraindications. METHODS: We conducted a historical cross-sectional study of open lower limb revascularization surgeries performed between 2019 and 2021 at The Ottawa Hospital. Medical records were reviewed for demographic data, admission, procedural characteristics, and presence of contraindications to neuraxial anesthesia. Case ascertainment algorithms to predict the presence of absolute contraindications to neuraxial anesthesia were derived and internally validated. RESULTS: We identified 340 cases. General anesthesia was used in 219 (64.4%) cases, isolated neuraxial (spinal and/or epidural) in 106 (31.2%) cases, and general plus neuraxial in 15 (4.4%) cases. Seventy-eight (22.9%; 95% confidence interval [CI], 18.8 to 27.7) patients had absolute contraindications to neuraxial anesthesia, primarily because of anticoagulation or antiplatelet medication (89.4%); 21 (6.2%; 95% CI, 4.1 to 9.3) had relative contraindications, primarily long anticipated duration of surgery (16/21, 76.2%). We derived and validated three nested case-ascertainment algorithms. Using admission and procedure variables, discrimination was moderate with moderately explained variance, and calibration was inadequate for reliable use. Patient comorbidity and laboratory data did not improve algorithm performance. CONCLUSION: Most patients undergoing lower limb revascularization surgery did not have absolute contraindications to neuraxial anesthesia. When present, contraindications typically related to anticoagulation. Admission, procedure, comorbidity, and laboratory data did not provide adequate accuracy to ascertain contraindication status.

RéSUMé: OBJECTIF: Les données non randomisées et certaines données randomisées suggèrent que l'anesthésie neuraxiale pourrait améliorer les devenirs après une chirurgie de revascularisation des membres inférieurs. Néanmoins, la prévalence de contre-indications à l'anesthésie neuraxiale chez la patientèle de chirurgie vasculaire est inconnue. Notre objectif était d'identifier la prévalence de la patientèle présentant des contre-indications à l'anesthésie neuraxiale, et de dériver et valider un algorithme de détermination des cas identifiant les personnes susceptibles de présenter des contre-indications. MéTHODE: Nous avons mené une étude transversale historique sur les chirurgies ouvertes de revascularisation des membres inférieurs réalisées entre 2019 et 2021 à l'Hôpital d'Ottawa. Les dossiers médicaux ont été passés en revue pour en tirer les données démographiques, les détails d'admission, les caractéristiques procédurales et la présence de contre-indications à l'anesthésie neuraxiale. Des algorithmes de détermination des cas pour prédire la présence de contre-indications absolues à l'anesthésie neuraxiale ont été dérivés et validés en interne. RéSULTATS: Nous avons identifié 340 cas. L'anesthésie générale a été utilisée dans 219 cas (64,4 %), une anesthésie neuraxiale isolée (rachidienne et/ou péridurale) dans 106 cas (31,2 %) et une anesthésie générale plus neuraxiale dans 15 cas (4,4 %). Soixante-dix-huit (22,9 %; intervalle de confiance [IC] à 95 %, 18,8 à 27,7) patient·es présentaient des contre-indications absolues à l'anesthésie neuraxiale, principalement en raison d'une anticoagulation ou de médicaments antiplaquettaires (89,4 %); 21 (6,2 %; IC 95 %, 4,1 à 9,3) présentaient des contre-indications relatives, principalement une longue durée anticipée de chirurgie (16/21, 76,2 %). Nous avons dérivé et validé trois algorithmes imbriqués de détermination des cas. En utilisant les variables d'admission et de procédure, la discrimination était modérée, avec une variance modérément expliquée, et l'étalonnage était inadéquat pour une utilisation fiable. Les données portant sur les comorbidités des patient·es et de laboratoire n'ont pas amélioré les performances de l'algorithme. CONCLUSION: La plupart des patient·es bénéficiant d'une chirurgie de revascularisation des membres inférieurs n'avaient pas de contre-indications absolues à l'anesthésie neuraxiale. Les contre-indications, lorsque présentes, étaient généralement liées à l'anticoagulation. Les données d'admission, d'intervention, de comorbidité et de laboratoire n'ont pas fourni de précisions suffisantes pour confirmer un statut de contre-indication.

Hospital-, Anesthesiologist-, Surgeon-, and Patient-Level Variations in Neuraxial Anesthesia Use for Lower Limb Revascularization Surgery: A Population-Based Cross-Sectional Study.

BACKGROUND: Although neuraxial anesthesia may promote improved outcomes for patients undergoing lower limb revascularization surgery, its use is decreasing over time. Our objective was to estimate variation in neuraxial (versus general) anesthesia use for lower limb revascularization at the hospital, anesthesiologist, surgeon, and patient levels, which could inform strategies to increase uptake. METHODS: Following protocol registration, we conducted a historical cross-sectional analysis of population-based linked health administrative data in Ontario, Canada. All adults undergoing lower limb revascularization surgery between 2009 and 2018 were identified. Generalized linear models with binomial response distributions, logit links and random intercepts for hospitals, anesthesiologists, and surgeons were used to estimate the variation in neuraxial anesthesia use at the hospital, anesthesiologist, surgeon, and patient levels using variance partition coefficients and median odds ratios. Patient- and hospital-level predictors of neuraxial anesthesia use were identified. RESULTS: We identified 11,849 patients; 3489 (29.4%) received neuraxial anesthesia. The largest proportion of variation was attributable to the hospital level (50.3%), followed by the patient level (35.7%); anesthesiologists and surgeons had small attributable variation (11.3% and 2.8%, respectively). Mean odds ratio estimates suggested that 2 similar patients would experience a 5.7-fold difference in their odds of receiving a neuraxial anesthetic were they randomly sent to 2 different hospitals. Results were consistent in sensitivity analyses, including limiting analysis to patients with diagnosed peripheral artery disease and separately to those aged >66 years with complete prescription anticoagulant and antiplatelet usage data. CONCLUSIONS: Neuraxial anesthesia use primarily varies at the hospital level. Efforts to promote use of neuraxial anesthesia for lower limb revascularization should likely focus on the hospital context.

Global food security post COVID-19: Dearth or dwell in the developing world?

Today, global food systems are highly susceptible to food safety risks, economic shocks, price volatility, and natural disasters and pandemics, such as the novel coronavirus (COVID-19). This paper draws from research on food and nutritional security, food fraud and associated economic ecosystem, and the disruptions due to COVID-19 for socio-economic inequality globally. It is concluded that the safety risks have pushed enforcement of measures to reduce food supplies, adversely impacting food availability. Also, COVID-19 is likely to raise fleeting food security and nutritional concerns across the globe, resulting in rises in poverty and food fraud, limiting food supply and access. Accelerated investments intended to develop more inclusive, sustainable, and resilient food systems will help shrink the effect of the pandemic and, hence, offer a way to control the foreseen food security crisis and economic growth.

Advances in application of ultrasound in food processing: A review.

Food processing plays a crucial role in coping up with the challenges against food security by reducing wastage and preventing spoilage. The ultrasound technology has revolutionized the food processing industry with its wide application in various processes, serving as a sustainable and low-cost alternative. This non-destructive technology offers several advantages such as rapid processes, enhanced process efficiency, elimination of process steps, better quality product and retention of product characteristics (texture, nutrition value, organoleptic properties), improved shelf life. This review paper summarizes the various applications of ultrasound in different unit operations (filtration, freezing, thawing, brining, sterilization/pasteurization, cutting, etc.) and specific food divisions (meat, fruits and vegetables, cereals, dairy, etc.) along with, the advantages and drawbacks of the technology. The further scope of industrial implementation of ultrasound has also been discussed.

Ganglioside Detection from Formalin-Fixed Human Brain Tissue Utilizing MALDI Imaging Mass Spectrometry.

Matrix assisted laser desorption ionization (MALDI) imaging mass spectrometry (IMS) is used to perform mass spectrometric analysis directly on biological samples providing visual and anatomical spatial information on molecules within tissues. A current obscuration of MALDI-IMS is that it is largely performed on fresh frozen tissue, whereas clinical tissue samples stored long-term are fixed in formalin, and the fixation process is thought to cause signal suppression for lipid molecules. Studies have shown that fresh frozen tissue sections applied with an ammonium formate (AF) wash prior to matrix application in the MALDI-IMS procedure display an increase in observed signal intensity and sensitivity for lipid molecules detected within the brain while maintaining the spatial distribution of molecules throughout the tissue. In this work, we investigate the viability of formalin-fixed tissue imaging in a clinical setting by comparing MALDI data of fresh frozen and postfixed rat brain samples, along with postfixed human brain samples washed with AF to assess the capabilities of ganglioside analysis in MALDI imaging of formalin-fixed tissue. Results herein demonstrate that MALDI-IMS spectra for gangliosides, including GM1, were significantly enhanced in fresh frozen rat brain, formalin-fixed rat brain, and formalin-fixed human brain samples through the use of an AF wash. Improvements in MALDI-IMS image quality were demonstrated, and the spatial distribution of molecules was retained. Results indicate that this method will allow for the analysis of gangliosides from formalin-fixed clinical samples, which can open additional avenues for neurodegenerative disease research.