Impact of Ketamine on Quality of Recovery after Laparoscopic Surgery: A Single-Centre Single-Blinded Trial Using the QoR-15 Questionnaire.

Background: The quality of recovery is a cluster of patient-related outcomes that emphasise not only pain but different physical and emotional dimensions. Traditionally, ketamine is used to improve postoperative analgesia and avoid opioid consumption and opioid-related side effects. Objective: The present study sought to evaluate if intraoperative ketamine administration (as a part of multimodal analgesia) influences the quality of recovery after laparoscopic surgery. Design: A prospective two-armed, single-blinded trial. Settings. Tertiary single-centre trial between July 2021 and January 2022. Patients. From the 146 patients initially admitted to the study, 127 patients were enrolled, 60 in the ketamine group (group K) and 67 in the control group (group NK). Intervention. Both groups received a rigid intraoperative anaesthesia protocol; furthermore, in group K, 0.5 mg/kg of the ideal body weight of ketamine was administered. Main Outcome Measures. The primary outcome was to evaluate the effect of ketamine administration on the postoperative quality of recovery using the Portuguese version of the Quality of Recovery-15 (QoR-15) Questionnaire 24 h after surgery. The total score and minimal clinically significant difference (MCID) of the QoR-15 were compared. Other variables were also assessed such as the presence of emergence delirium (ED), the Numeric Rating Scale (NRS) for pain, and the presence of postoperative nausea and vomiting (PONV). Results: A total of 127 patients were allocated to the study groups, 60 in group K and 67 in group NK. Regarding the primary outcome, no differences were found in individual categories (15 items) and in the total score of QoR-15 (p=0.214). Concerning improvement (MCID ≥ 8) or worsening (MCID ≤ 8) in quality of recovery, no difference was found between the groups (24 vs. 32 and 6 vs. 6; p=0.776). Finally, no difference was found in secondary postoperative outcomes including ED (p=0.55), NRS (p=0.401), and PONV (p=0.55). Conclusion: In this study, the administration of ketamine in laparoscopic surgery had no impact on the quality of recovery 24 h after surgery. This trial is registered with NCT03724019.

Musculoskeletal Injuries in Competitive Rowers.

INTRODUCTION: The objective of this study was the assessment of the injuries occurred over the competitive rowing lifetime of Portuguese senior rowers. MATERIAL AND METHODS: We sent a questionnaire to all Portuguese senior rowers medalled in the national championships during the 2013-2014 season. We analysed biometric variables, anatomic location, type and circumstances of injury occurrence, type of treatment provided and time of inactivity. For statistical analysis we used parametric and non-parametric statistics with 95% confidence levels (p < 0.05). RESULTS: The questionnaire was answered by 18 of the 18 female and 74 of the 77 male rowers. Females had significantly lower ages, heights and weights and rowed more often sculling boats (p < 0.05). The number of years of practice, as well as the number of injuries per rower was similar, for both females and males. The mean age at the first injury was significantly lower in females (p < 0.001), who also had more progressive lesions than acute ones, although not significantly. In both, the most frequent anatomical location and type of injury were the lumbar region and muscular pathology, with a higher occurrence in winter and spring, during land training. Femalessustained longer periods of inactivity, but not significantly. DISCUSSION: The results that were different from those reported by other authors may be related with differences in the studied populations or with other factors that need to be clarified. CONCLUSION: The injuries sustained by the Portuguese competitive rowers, probably associated with a lower competitive exposure of our athletes, were less severe than those generally reported in the literature.

Introdução: O objetivo deste estudo foi a avaliação das lesões ocorridas ao longo da vida desportiva de remadores de competição seniores portugueses. Material e Métodos: Enviámos um questionário a todos os remadores seniores medalhados nos campeonatos nacionais na época de 2013-2014. Analisámos variáveis biométricas, localização anatómica, tipo e circunstâncias de ocorrência de lesões, tratamentos efetuados e tempos de inatividade. Para análise estatística utilizámos métodos paramétricos e não paramétricos com níveis de confiança de 95% (p < 0,05). Resultados: Responderam 18 dos 18 remadores femininos e 74 dos 77 masculinos. Os femininos apresentaram idades, estaturas e pesos significativamente mais baixos e remaram mais parelhos (p < 0,05). O número de anos de prática e de lesões por remador foram semelhantes, entre femininos e masculinos. A idade média da primeira lesão foi significativamente mais precoce nos femininos (p < 0,001), nos quais se registaram mais lesões progressivas do que agudas, embora de forma não significativa. Tanto nos femininos como nos masculinos, a localização anatómica e o tipo de lesão mais frequentes foram a região lombar e a contratura muscular, com maior ocorrência no inverno e na primavera, em terra, durante os treinos. A inatividade por lesão foi superior nos femininos, embora de forma não significativa. Discussão: Os resultados que diferiram dos reportados por outros autores podem estar relacionados com diferenças nas populações estudadas ou com outros fatores que necessitam de ser esclarecidos. Conclusão: As lesões dos remadores de competição portugueses, associadas provavelmente a um nível competitivo menos expressivo dos nossos atletas, foram menos graves do que as geralmente referidas na literatura.

Laparoscopic Adjustable Gastric Band: Complications, Removal and Revision in a Portuguese Highly Differentiated Obesity Treatment Center.

INTRODUCTION: Our objective is to determine which complications lead to reoperation, and the outcomes of reoperation using laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy at Centro Hospitalar de São João. MATERIAL AND METHODS: Observational study. Patients included were aged 18 to 65 years at first gastric banding, underwent removal from March 21st 2007 to January 23rd 2014 and were subsequently converted to gastric banding, gastric bypass or sleeve gastrectomy. Women who got pregnant during the initial gastric banding follow-up and patients that performed more than one conversion were excluded. RESULTS: A total of 103 patients were included. Fifteen underwent revision to gastric banding, 71 to gastric bypass and 17 to sleeve gastrectomy. Respectively, percentage of excess weight loss at 1 month were 1.9 ± 12.2% in 6 patients, 36.9 ± 18.2% in 49 patients and 27.1% (13.3 - 68.6) in 11 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p < 0.001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.002 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.474). At 3 months there were 12.8% (5.7 - 84.8) in 6 patients, 44.8 ± 19.7% in 24 patients and 48 ± 20.1% in 8 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0.017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.039 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.691). DISCUSSION: At revision, ages and body mass indices are higher than other studies. Gastric bypass is the preferred revision surgery, because combines restriction and malabsorption, surgeons have more experience and long term outcomes are better described. CONCLUSIONS: The main indications for reoperation were inadequate weight loss (37.4%) and band slippage (30%). At short term, in our patients, gastric banding as a revision surgery was not effective, as opposed to gastric bypass and sleeve gastrectomy.

Introdução: Pretendemos determinar que complicações levaram a reoperação, e os resultados da reoperação com banda gástrica ajustável por laparoscopia, do bypass gástrico em Y de Roux por laparoscopia e da gastrectomia em sleeve por laparoscopia, no Centro Hospitalar de São João. Material e Métodos: Incluímos indivíduos dos 18 aos 65 anos na primeira banda gástrica ajustável por laparoscopia, cuja remoção ocorreu entre 21 de Maio de 2007 e 23 de Janeiro de 2014 e depois convertidos para banda gástrica, bypass gástrico ou gastrectomia em sleeve. Excluímos mulheres que engravidaram no primeiro seguimento e indivíduos submetidos a mais de uma conversão. Resultados: Incluímos 103 indivíduos. Quinze convertidos em banda gástrica, 71 em bypass gástrico e 17 em gastrectomia em sleeve. Respectivamente, no primeiro mês, as percentagens de excesso de peso perdido foram: 1,9 ± 12,2% em seis indivíduos, 36,9 ± 18,2% em 49 indivíduos e 27,1% (13,3 - 68,6) em 11 indivíduos (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p < 0,001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0,002 e laparoscopic Rouxen-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0,474). No terceiro mês, foram: 12,8% (5,7 - 84,8) em seis indivíduos, 44,8 ± 19,7% em 24 indivíduos e 48 ± 20,1% em oito indivíduos (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0,017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0,039 e laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0,691). Discussão: Na revisão, as idades e os índices de massa corporal são superiores a outros estudos. O bypass gástrico é o método de revisão preferido pela restrição e malabsorção, pela maior experiência de execução e pelos resultados a longo prazo melhor estudados. Conclusões: As principais indicações para reoperação foram perda de peso inadequado (37,9%) e deslocamento de banda (34%). A curto prazo, na nossa amostra, a revisão com banda gástrica não foi efectiva, diferente dos bypass gástrico e gastrectomia em sleeve.

Gestational age and fetal growth assessment among obstetricians.

OBJECTIVE: We aimed to characterize gestational age assessment and fetal growth evaluation among obstetricians. METHODS: Observational, cross-sectional study. We applied a questionnaire to obstetrics specialists and residents, during a national congress on obstetrics. RESULTS: Almost all 179 respondents correct gestational age in the first trimester by ultrasound, but 63% only if there is a difference of 2-9 days. Ultrasound at 11-13 weeks was considered more accurate than at 8-10 weeks by 81%, with a higher proportion of specialists choosing correctly the last answer (p = 0.05). One-third of the respondents did not correctly point the error associated with the ultrasound estimation of fetal weight (EFW). Of the 88% who use a growth table, only 32% were able to identify it by publication/author. Ninety-eight percent identify fetal growth restriction risk (FGR) with centiles (10th in 76%) and 73% of doctors diagnose FGR without other pathological findings (10th in 49%). 44% finds that a low EFW centile maintenance (4th to 3rd) is more worrisome than the crossing of two quartiles (75th to 24th). CONCLUSIONS: The role of ultrasound in gestational age assessment and use of EFW use for FGR classification was disparate among participants. EFW and respective centiles may be over relied upon.