Intraoperative virtual reality for older patients undergoing total knee arthroplasty: study protocol for a randomized clinical trial.

Background: In an aging surgical patient population, preventing complications such as oversedation has taken increasing priority in perioperative care. Intraoperative use of virtual reality (VR) may decrease sedative requirements. We hypothesize that the use of immersive VR during total knee arthroplasty (TKA) will lead to decreased propofol requirements, improved patient-reported satisfaction, and reduced postoperative opioid requirements compared to active and usual care controls.

Volatile anesthetics for lung- and diaphragm-protective sedation.

This review explores the complex interactions between sedation and invasive ventilation and examines the potential of volatile anesthetics for lung- and diaphragm-protective sedation. In the early stages of invasive ventilation, many critically ill patients experience insufficient respiratory drive and effort, leading to compromised diaphragm function. Compared with common intravenous agents, inhaled sedation with volatile anesthetics better preserves respiratory drive, potentially helping to maintain diaphragm function during prolonged periods of invasive ventilation.

Early and late effects of volatile sedation with sevoflurane on respiratory mechanics of critically ill COPD patients.

Background: The objective was to compare sevoflurane, a volatile sedation agent with potential bronchodilatory properties, with propofol on respiratory mechanics in critically ill patients with COPD exacerbation.

Methods: Prospective study in an ICU enrolling critically ill intubated patients with severe COPD exacerbation and comparing propofol and sevoflurane after 1:1 randomisation. Respiratory system mechanics (airway resistance, PEEPi, trapped volume, ventilatory ratio and respiratory system compliance), gas exchange, vitals, safety and outcome were measured at inclusion and then until H48.

Postoperative virtual reality for recovery after bariatric surgery: study protocol for a randomised clinical trial.

Background: Enhanced Recovery After Surgery (ERAS) protocols for bariatric surgery improve clinical outcomes. However, the impact of ERAS protocols on patient satisfaction is unknown. Virtual reality has been implemented as an effective adjunct to standard analgesic regimens.

New onset postoperative depression after major surgery: an analysis from a national claims database.

Background: Postoperative depression is not well characterised. We investigated the incidence of postoperative depression with the hypothesis that after controlling for confounders, new onset depression would vary significantly by surgical type.

Methods: We conducted a retrospective cohort study using the Optum Clinformatics Datamart.

Early-Onset Invasive Pulmonary Aspergillosis in a Liver Transplant Patient: A Case Report.

Invasive pulmonary aspergillosis (IPA) in liver transplant patients remains rare but exceedingly fatal. The diagnostic challenges associated with this condition are compounded by its infrequent onset within the first two weeks following transplantation. Moreover, therapeutic management is complex due to the intricate drug interactions between triazole antifungals and calcineurin inhibitor immunosuppressants.

Increasing the reflection efficiency of the Sedaconda ACD-S by heating and cooling the anaesthetic reflector: a bench study using a test lung.

Background: As volatile anaesthetic gases contribute to global warming, improving the efficiency of their delivery can reduce their environmental impact. This can be achieved by rebreathing from a circle system, but also by anaesthetic reflection with an open intensive care ventilator. We investigated whether the efficiency of such a reflection system could be increased by warming the reflector during inspiration and cooling it during expiration (thermocycling).

Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study.

Background And Objectives: The coronavirus disease 2019 (COVID-19) pandemic and the shortage of intravenous sedatives has led to renewed interest in inhaled sedation for patients with acute respiratory distress syndrome (ARDS). We hypothesized that inhaled sedation would be associated with improved clinical outcomes in COVID-19 ARDS patients.

Methods: Retrospective international study including mechanically ventilated patients with COVID-19 ARDS who required sedation and were admitted to 10 European and US intensive care units.

Virtual reality immersion compared to monitored anesthesia care for hand surgery: A randomized controlled trial.

Introduction: Common anesthesia practice for hand surgery combines a preoperative regional anesthetic and intraoperative monitored anesthesia care (MAC). Despite adequate regional anesthesia, patients may receive doses of intraoperative sedatives which can result in oversedation and potentially avoidable complications. VR could prove to be a valuable tool for patients and providers by distracting the mind from processing noxious stimuli resulting in minimized sedative use and reduced risk of oversedation without negatively impacting patient satisfaction.

Anesthetic Preferences for Cardiac Anesthesia: A Survey of the Society of Cardiovascular Anesthesiologists.

Background: Volatile anesthetics have been historically preferred for cardiac anesthesia, but the evidence for their superiority to intravenous agents is mixed. We conducted a survey to better understand the current state of practice and the rationale behind provider preferences for anesthesia for cardiac surgery with cardiopulmonary bypass. We hypothesized that anesthetic preference would vary considerably among surveyed providers without a clear majority, as would the rationale behind those preferences.

Anesthetics to Prevent Lung Injury in Cardiac Surgery: A Randomized Controlled Trial.

Objectives: To investigate if sevoflurane based anesthesia is superior to propofol in preventing lung inflammation and preventing postoperative pulmonary complications.

Design: Randomized controlled trial.

Setting: Single tertiary care university hospital.

Intraoperative Oxygen Practices in Cardiac Surgery: A National Survey.

Objective: To describe the current nationwide perspectives and practice regarding intraoperative oxygen titration in cardiac surgery.

Design: Prospective, observational survey.

Setting: Hospitals across the United States.

Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis.

Purpose: This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO).

Methods: We queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs.

Sleep, Pain, and Cognition: Modifiable Targets for Optimal Perioperative Brain Health.

The prevention of perioperative neurocognitive disorders is a priority for patients, families, clinicians, and researchers. Given the multiple risk factors present throughout the perioperative period, a multicomponent preventative approach may be most effective. The objectives of this narrative review are to highlight the importance of sleep, pain, and cognition on the risk of perioperative neurocognitive disorders and to discuss the evidence behind interventions targeting these modifiable risk factors.

Rapid weight gain following weight cutting in male professional boxers.

Objectives: Weight classifications are used in boxing and other combat sports to match opponents of similar size. Professional boxers commonly engage in a potentially harmful practice known as rapid weight loss or 'weight cutting' to make weight the day prior to competition before rehydrating and refueling. This investigation describes the prevalence and magnitude of rapid weight gain in boxers following weigh-in as well as differences in practice with respect to weight class and promotion.

Racial and Socioeconomic Disparities in Spinal Cord Stimulation Among the Medicare Population.

Introduction: Spinal cord stimulation (SCS) is used in the treatment of many chronic pain conditions. This study investigates racial and socioeconomic disparities in SCS among Medicare patients with chronic pain.

Materials And Methods: Patients over the age of 18 with a primary diagnosis of postlaminectomy syndrome (ICD-10 M96.

Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19.

Purpose: Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19).

Methods: We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO/FiO < 100).

Prevalence of Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea.

While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from (formerly ) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.