Postoperative Tachycardia: Clinically Meaningful or Benign Consequence of Orthopedic Surgery?

Objective

To determine the clinical significance of tachycardia in the postoperative period.

The relationship between preoperative nutritional state and adverse outcome following abdominal and thoracic surgery in children: Results from the NSQIP database

Introduction

Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <?2) and obesity (BMI Z-scores > + 2) with 30-day postoperative outcomes.

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease

Background

Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.

CatWalk gait analysis in assessment of functional recovery after sciatic nerve injury

Following peripheral nerve injury repair, improved behavioural outcome may be the most important evidence of functionality of axon regeneration after any repair strategy. A range of behavioural testing paradigms have been developed for peripheral nerve injury research. Complete injury of the adult rat sciatic nerve is frequently used in combination with walking track analysis. Despite its wide-spread use, these walking track analyses are unsuitable for the simultaneous assessment of both dynamic and static gait parameters. Conversely, a novel automated gait analysis system, i.e. CatWalk can simultaneously measure dynamic as well as static gait parameters and, importantly, it's easy to control for the speed of locomotion which can strongly affect gait parameters. In a previous study, CatWalk was already successfully used to examine deficits in both dynamic and static gait parameters using the sciatic nerve lesion model with a 1cm gap characterized by absence of recovery [Deumens R, Jaken RJ, Marcus MA, Joosten EA. The CatWalk gait analysis in assessment of both dynamic and static gait changes after adult rat sciatic nerve resection. J Neurosci Methods 2007;164:120-30]. Using the sciatic nerve crush injury model (validated with the static sciatic index) and a follow-up period of 12 weeks, we now show that CatWalk can also measure behavioural recovery. In particular dynamic gait parameters, coordination measures, and the intensity of paw prints are of interest in detecting recovery as far as these parameters completely return to pre-operative values after crush injury. We conclude that CatWalk can be used as a complementary approach to other behavioural testing paradigms to assess clinically relevant behavioural benefits, with a main advantage that CatWalk demonstrates both static and dynamic gait parameters at the same time.     

Surgical stress index as a measure of nociception/antinociception balance during general anesthesia

Background: No validated monitoring method is available for evaluating the nociception/antinociception balance. We assessed the surgical stress index (SSI), computed from finger photoplethysmographic waveform amplitudes and pulse-to-pulse intervals, in patients undergoing shoulder surgery under general anesthesia (GA) and interscalene plexus block and in patients with GA only.
Methods: In this prospective, randomized study in 26 patients, increased blood pressure (BP) or heart rate, movement, and coughing were considered to be signs of intraoperative nociception and were treated with alfentanil. GA was maintained with desflurane aiming at a State Entropy level of 50. Photoplethysmographic waveforms were collected from the contra-lateral arm to the surgery and SSI values from 0 (no surgical stress) to 100 (maximal surgical stress) were calculated off-line.
Results: Two minutes after skin incision, SSI had not increased in the plexus group and was lower in the plexus group (38 ± 13) compared with the controls (58 ± 13, P <0.005). Among the controls, 1 min before alfentanil administration, the SSI value was higher than during periods of adequate antinociception, 59 ± 11 vs. 39 ± 12 ( P <0.01). The total cumulative need for alfentanil was higher in controls (2.7 ± 1.2 mg) compared with the plexus group (1.6 ± 0.5 mg; P =0.008). Tetanic stimulation to the ulnar region of the hand increased SSI significantly only among the patients with plexus block not covering the site of the stimulation.
Conclusion: SSI values were lower in patients with plexus block covering the sites of nociceptive stimuli. In detecting nociceptive stimuli, SSI had better performance than heart rate, BP, or response entropy.     

Back to Basics: Preventing Surgical Site Infections

A surgical site infection (SSI) is an unintended and oftentimes preventable consequence of surgery. There is a significant amount of literature related to preventing SSIs, and it is up to practitioners in each care setting to review the evidence and work together to implement SSI prevention measures, such as nasal decolonization, antibiotic prophylaxis, preoperative showers, preoperative oxygen supplementation, and antimicrobial sutures. In addition, practitioners can follow several recommendations to reduce the risk of SSIs, including following proper hand hygiene practices; wearing clean, facility-laundered scrub attire; following a surgical safety checklist; and speaking up when a break in sterile technique is witnessed. The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives.