Association between perioperative non-steroidal anti-inflammatory drug use and cardiovascular complications after non-cardiac surgery in older adult patients.

Background: We investigated in older adult non-cardiac surgical patients whether receipt of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased incidence of postoperative cardiovascular complications.

Methods: We retrospectively extracted the information for patients with age ≥  65 years who had inpatient non-cardiac surgery with a duration of ≥  1 h from the American College of Surgeons-National Surgical Quality Improvement Program registry data acquired at the University of Washington Medical Center. We compared patients who received NSAIDs perioperatively to those who did not receive NSAIDs, on the two composite outcomes: (1) the incidence of postoperative cardiovascular complications within 30 days of the surgery, and (2) the incidence of combined postoperative gastrointestinal and renal complications, and length of postoperative hospital stay.

Association Between Postoperative Methocarbamol and Postoperative Pain Opioid Dose Requirements: A Retrospective Cohort Study.

Objectives: We tested the hypothesis that patients who received methocarbamol postoperatively experience less severe pain and require smaller doses of opioids than those who did not receive methocarbamol.

Materials And Methods: This is a retrospective cohort study of patients undergoing surgery involving the musculoskeletal system. Of 9089 patients, 704 received methocarbamol during 48 hours postoperatively, while 8385 did not receive methocarbamol.

Patient Blood Management programs for post-partum hemorrhage.

Patient blood management (PBM) strategies aim to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Because postpartum hemorrhage (PPH) is a leading cause of maternal mortality and blood product utilization, PBM principles can be applied in its therapeutic approach. First, pre-operative identification of risk factors for PPH and identification of peri-delivery anemia should be conducted.

Prediction of postoperative respiratory depression and respiratory complications in patients on preoperative methadone.

Purpose: We developed prediction models for postoperative respiratory depression and respiratory complications for 958 patients who were on methadone preoperatively.

Methods: The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/min, oxygen saturation (SpO) < 90%, or requirement of naloxone for 48 h postoperatively. Secondary outcome was the composite of postoperative respiratory complications.

Opioid Agonist to Buprenorphine Cross-titration During Pregnancy: A Case Report.

Background: We present a case report of a first-trimester pregnant individual with chronic pain on chronic opioid therapy who successfully cross-titrated from full-μ agonist opioid to buprenorphine without causing significant withdrawal symptoms.

Case Presentation: A 37-year-old gravida 1, para 0 woman with chronic pain on opioid therapy successfully completed a 6-week cross-titration from 120 morphine equivalent dose to buprenorphine in her first trimester without affecting pain scores, functional capacity, withdrawal symptoms except for mild nausea and insomnia, or adverse perinatal outcomes. After increasing her buprenorphine in the second trimester, at 38 weeks, she bore a healthy neonate without eliciting signs of neonatal abstinence syndrome while on a stable buprenorphine dose.

Postoperative respiratory depression in patients on sublingual buprenorphine: a retrospective cohort study for comparison between postoperative continuation and discontinuation of buprenorphine.

Background: We tested the hypothesis that patients who continued buprenorphine postoperatively experience postoperative respiratory depression less frequently than those who discontinued buprenorphine.

Methods: This is a retrospective cohort study of patients who were on buprenorphine preoperatively. The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/minute, oxygen saturation (SpO) < 90%, or requirement of naloxone for 48 h postoperatively.

Spinal anesthesia for cesarean section in a woman with an intrathecal baclofen pump.

Background: Intrathecal baclofen pumps are commonly used for the management of lower extremity spasticity in the setting of spinal cord injury. There have been no reports of the performance of spinal anesthesia in patients with a pre-existing intrathecal baclofen pump.

Case Presentation: A 29-year-old parturient presented for cesarean section.

Comparison Between Preoperative Methadone and Buprenorphine Use on Postoperative Opioid Requirement: A Retrospective Cohort Study.

Objectives: Buprenorphine is a partial agonist at mu-opioid receptors and competes for these receptors with other opioids in vitro. Whether patients on buprenorphine maintenance require high doses of opioid analgesics to attain adequate postoperative pain control has not been determined. We evaluated differences in acute postoperative opioid consumption and pain burden between patients taking buprenorphine and those taking methadone preoperatively.

In-Hospital Opioid Consumption After the Previous Cesarean Delivery Weakly Predicts Opioid Consumption After Index Delivery: A Retrospective Cohort Study.

Background: To predict opioid consumption and pain intensity after the index cesarean delivery, we tested a hypothesis that opioid consumption after the previous cesarean delivery of the same patient can predict the opioid consumption after the index cesarean delivery. We further tested a secondary hypothesis that the pain scores after the previous cesarean delivery can predict the pain scores after the index cesarean delivery.

Methods: This is a retrospective cohort study of 470 women who underwent both previous and index cesarean deliveries at a single institution from January 2011 to June 2019.

Case Report: Radiographic Identification of Intrapleural Misplacement of Epidural Catheter in an Intubated Post-Lung Transplant Patient.

Intrapleural misplacement of epidural catheter is a rare complication of thoracic epidural placement, which can be difficult to detect in intubated patients with unreliable pain reports and hemodynamic response to the test dose. We describe a case of intrapleural misplacement of thoracic epidural in a 50-year-old man status-post bilateral lung transplant and highlight the use of radiographic techniques to identify the misplacement.

Postoperative Pain and Opioid Dose Requirements in Patients on Sublingual Buprenorphine: A Retrospective Cohort Study for Comparison Between Postoperative Continuation and Discontinuation of Buprenorphine.

Objective: To test the hypothesis that patients who continued buprenorphine postoperatively experience less severe pain and require a smaller dose of opioids than those who discontinued buprenorphine.

Materials And Methods: This is a retrospective cohort study of surgical patients who were on buprenorphine preoperatively. Using our previous study's data as pilot data, we selected the covariates to be included in 2 regression models with postoperative time-weighted average pain score and opioid dose requirements in morphine milligram equivalents during 48 hours after surgery as the outcomes.

Chronic Use of Angiotensin Converting Enzyme Inhibitors and/or Angiotensin Receptor Blockers is Not Associated With Stroke After Noncardiac Surgery: A Retrospective Cohort Analysis.

Background: Inhibition of the renin-angiotensin-aldosterone pathways reduces blood pressure and proliferation of vascular smooth muscles and may therefore reduce the risk of stroke. We tested the hypothesis that patients taking angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for at least 6 months have fewer postoperative strokes after non-neurological, noncarotid, and noncardiac surgeries than those who do not.

Methods: We considered adults who had noncardiac surgery at the Cleveland Clinic between January 2005 and December 2017.

Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine.

Introduction: Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. However, each specific chronic pain condition has unique pathophysiology, and it is possible that the effect of each condition on postoperative pain is different.

Methods: This is a retrospective cohort study of pregnant women with preexisting chronic pain conditions (i.

Intraoperative panic attack in patients undergoing awake craniotomy: a retrospective analysis of risk factors.

Purpose: Intraoperative anxiety is the most common psychological response of the patient during awake craniotomy. Psychological stress can trigger patient decline, resulting in failed awake craniotomy and significantly poor outcomes. This study aimed to identify the risk factors for panic attack (PA) during awake craniotomies.

Association Between Preoperative Statin Use and Respiratory Complications After Noncardiac Surgery: A Retrospective Cohort Analysis.

Background: Statins possess pleiotropic effects, which potentially benefit noncardiovascular conditions. Previous work suggests that statins reduce inflammation and prevent acute respiratory distress syndrome and infections. However, there is a paucity of data regarding potential benefits of statins on respiratory and infectious complications, particularly after noncardiac surgery.

Factors associated with persistent pain after childbirth: a narrative review.

A systematic literature search was performed to identify studies that reported risk factors for persistent pain after childbirth. Many studies have sought to identify risk factors for post-delivery pain in different populations, using different methodologies and different outcome variables. Studies of several different but interrelated post-partum pain syndromes have been conducted.

Biochemically diagnosed hypothyroidism and postoperative complications after cardiac surgery: a retrospective cohort analysis.

Purpose: To determine whether hypothyroidism is associated with cardiovascular complications and surgical wound infections after cardiac surgery.

Methods: Patients were categorized as: (1) hypothyroid [patients with increased TSH concentrations (≧ 5.5 mIU/L) within 6 months prior to surgery]; (2) corrected hypothyroid [diagnosis of hypothyroidism any time before surgery or on preoperative thyroid supplementation and normal TSH concentration (0.

Recovery after Nulliparous Birth: A Detailed Analysis of Pain Analgesia and Recovery of Function.

Background: The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients.

Feasibility of the head-mounted display for ultrasound-guided nerve blocks: a pilot simulator study.

The head-mounted display (HMD) has the potential to improve the quality of ultrasound-guided procedures. The aim of this non-clinical crossover designed study is to evaluate the feasibility of the HMD for ultrasound-guided nerve block. Eight experienced anesthesiologists performed ultrasound-guided peripheral nerve blocks on a training simulator with a standard approach and with an upside-down approach.

Lack of Association between Preoperative Statin Use and Respiratory and Neurologic Complications after Cardiac Surgery.

Background: Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery.

Methods: The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not.

Etomidate and the Risk of Complications After Cardiac Surgery: A Retrospective Cohort Analysis.

Objective: To compare incidence of atrial arrhythmia, duration of care, and major complications after cardiac surgery between patients who received etomidate and those who received other induction agents.

Design: Retrospective cohort study utilizing propensity score matching.

Setting: A single academic, tertiary care hospital.

The Effect of Hypothyroidism on a Composite of Mortality, Cardiovascular and Wound Complications After Noncardiac Surgery: A Retrospective Cohort Analysis.

Background: We tested the hypothesis that hypothyroidism, as defined by thyroid-stimulating hormone (TSH) concentration, is associated with a severity-weighted composite of mortality and major cardiovascular and infectious complications after noncardiac surgery.

Methods: In this retrospective cohort study, we evaluated adults at the Cleveland Clinic Main Campus between 2005 and 2012, who had had available TSH concentrations within the 6 months before noncardiac surgery. Patients were categorized as (1) hypothyroid (patients who had diagnosis of hypothyroidism any time prior to surgery and increased TSH value (> 5.

Blood Type O is not associated with increased blood loss in extensive spine surgery.

Study Objective: To investigate whether Type O blood group status is associated with increased intraoperative blood loss and requirement of blood transfusion in extensive spine surgery.

Design: Retrospective comparative study.

Setting: University-affiliated, non-profit teaching hospital.

The association of serum vitamin D concentration with serious complications after noncardiac surgery.

Background: Vitamin D deficiency is a global health problem. Epidemiological studies demonstrate that vitamin D is both cardioprotective and neuroprotective. Vitamin D also plays a substantial role in innate and acquired immunity.