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Erkan C, Inal HA, Uysal A. Intra- and post-operative outcomes of the Enhanced Recovery after Surgery (ERAS) Program in laparoscopic hysterectomy. Arch Gynecol Obstet 2024; 309:2751-2759. [PMID: 38584246 DOI: 10.1007/s00404-024-07469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To investigate the effect of the Enhanced Recovery After Surgery (ERAS) protocol on perioperative and post-operative outcomes in laparoscopic hysterectomies (LHs) performed for benign gynecological diseases. METHODS This prospective study was conducted with randomized 100 participants who underwent LH between 1 January and 31 December, 2022. A standard care protocol was applied to 50 participants (Group 1, control) and the ERAS protocol to the other 50 (Group 2, study). Length of hospitalization was compared between the groups as the primary outcome, and the duration of the operation, the amount of bleeding, post-operative nausea-vomiting, gas discharge time, visual analog scale (VAS) pain scores, and complications as the secondary outcomes. RESULTS No statistically significant difference was seen between the groups in terms of sociodemographic characteristics, medical history, operation indications, surgical procedures applied in addition to hysterectomy, operative time, pre-operative and post-operative hemoglobin levels, amount of bleeding, or drain use (p > 0.05). However, a statistically significant difference was observed in terms of nausea (60% vs. 26%, p = 0.001), vomiting (28% vs. 10%, p = 0.040), duration of gassing (17.74 ± 6.77 vs. 14.20 ± 7.05 h, p = 0.012), length of hospitalization (41.78 ± 12.17 vs. 34.12 ± 10.90 h, p = 0.001), analgesic requirements (4.62 ± 1.36 vs. 3.34 ± 1.27 h, p < 0.001), or VAS scores at the 1st (5.86 ± 1.21 vs. 4.58 ± 1.31, p < 0.001), 6th (5.16 ± 1.12 vs. 4.04 ± 1.08, p < 0.001), 12th (4.72 ± 1.12 vs. 3.48 ± 1.12, p < 0.001), 18th (4.48 ± 1.21 vs. 3.24 ± 1.34, p < 0.001), and 24th (4.08 ± 1.29 vs. 3.01 ± 1.30, p < 0.001) hours. CONCLUSION The findings of this study show that the ERAS protocol has a positive effect on peri- and post-operative outcomes in LH. Further prospective studies are now needed to confirm the validity of the results.
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Affiliation(s)
- Caglar Erkan
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mh. Kazım Karabekir Cd., 07100, Antalya, Turkey
| | - Hasan Ali Inal
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mh. Kazım Karabekir Cd., 07100, Antalya, Turkey.
| | - Aysel Uysal
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mh. Kazım Karabekir Cd., 07100, Antalya, Turkey
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Inal HA, Inal ZO. Comparison of Perinatal Outcomes Between Syrian Refugees and Turkish Women in the Middle Anatolia Region of Turkey. Matern Child Health J 2023; 27:2139-2146. [PMID: 37393424 DOI: 10.1007/s10995-023-03748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. METHODS The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. RESULTS Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32 g vs. 3109.76 ± 540.89 g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. CONCLUSIONS This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data.
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Affiliation(s)
- Hasan Ali Inal
- Departmant of Obstetric and Gynecology, Konya Training and Research Hospital, Konya, Turkey.
| | - Zeynep Ozturk Inal
- Departmant of Obstetric and Gynecology, Konya Training and Research Hospital, Konya, Turkey
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Baagil H, Baagil H, Gerbershagen MU. Preoperative Anxiety Impact on Anesthetic and Analgesic Use. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2069. [PMID: 38138172 PMCID: PMC10744982 DOI: 10.3390/medicina59122069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual's pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences.
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Affiliation(s)
- Hanaa Baagil
- Department of Anaesthesiology, Hospital Cologne Holweide, Teaching Hospital of the University Cologne, Neufelder Str. 32, 51067 Cologne, Germany
| | - Hamzah Baagil
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany;
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich, RWTH Aachen University, 52074 Aachen, Germany
| | - Mark Ulrich Gerbershagen
- Department of Anaesthesiology, Hospital Cologne Holweide, Teaching Hospital of the University Cologne, Neufelder Str. 32, 51067 Cologne, Germany
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Liu Q, Li L, Wei J, Xie Y. Correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery. BMC Anesthesiol 2023; 23:78. [PMID: 36915054 PMCID: PMC10009960 DOI: 10.1186/s12871-023-02036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery were explored with the Beck Anxiety Inventory (BAI) scale, 10-point Visual Analogue Scale (VAS), and Confusion Assessment Method Chinese Reversion (CAM-CR) scale. METHODS A total of 120 patients aged 65 years old who receiving gastrointestinal cancer surgery were enrolled in the study. Perioperative anxiety, pain, and delirium were assessed by the BAI scale, VAS scale, and CAM-CR scale, respectively. The correlation and influencing factors of preoperative high anxiety, postoperative high pain, and postoperative delirium were analyzed. RESULTS Preoperative high anxiety had a moderate positive correlation with postoperative high pain (P < 0.001, r = 0.410), and had a weak positive correlation with postoperative delirium (P = 0.005, r = 0.281). postoperative high pain had a weak positive correlation with postoperative delirium (P = 0.017, r = 0.236). Type of cancer and surgical approach were considered to be independent risk factors of preoperative high anxiety (P = 0.006 and P = 0.021). Preoperative high anxiety was considered to be an independent risk factor of postoperative high pain (P< 0.001). Age and preoperative high anxiety were considered to be independent risk factors of postoperative delirium (P< 0.001 and P = 0.010). CONCLUSIONS Elderly patients undergoing gastrointestinal cancer surgery had a higher incidence of preoperative anxiety, as well as first-day postoperative pain and first-day postoperative delirium. Factors such as type of cancer, surgical approach and preoperative anxiety had been identified as influencing preoperative anxiety levels; preoperative anxiety had been linked to postoperative pain; and age and preoperative anxiety have been identified as influencing factors of postoperative delirium. TRIAL REGISTRATION hiCTR2000032008, 17/04/2020, Title: "Effects of different analgesic methods on postoperative recovery of elderly patients with digestive tract tumor". Website: https://www.chictr.ogr.cn .
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Affiliation(s)
- Qing Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Liheng Li
- Department of Anesthesiology, The Guilin Municipal Hospital of Traditional Chinese Medicine, Guangxi, China
| | - Jingwen Wei
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
- Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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Mavrogiorgou P, Zogas H, Zogas G, Juckel G, Heuer JF. [Perioperative anxiety and fear of death]. DIE ANAESTHESIOLOGIE 2023; 72:266-272. [PMID: 36897352 PMCID: PMC10076359 DOI: 10.1007/s00101-023-01267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/11/2023]
Abstract
An important field of anesthesiology but also of psychiatry and psychotherapy, is perioperative anxiety and especially the fear of death. In this review article the most important types of anxiety in the individual phases before, during and after surgery are presented and diagnostic aspects as well as risk factors are discussed. Benzodiazepines can classically be used therapeutically here, but in recent years the preoperative anxiety-reducing effects of e.g., supporting talks, acupuncture, aroma therapy, and relaxation methods have come more into focus, because benzodiazepines promote postoperative delirium, which significantly increases morbidity and mortality. Perioperative fear of death should, however, be given greater clinical and scientific attention in order not only to have a better understanding and preoperative care of patients, but also to reduce adverse consequences during surgery and afterwards.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr Universität Bochum, Alexandrinenstr. 1, 44791, Bochum, Deutschland
| | - Hannah Zogas
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr Universität Bochum, Alexandrinenstr. 1, 44791, Bochum, Deutschland.,Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie (AINS), Augusta-Kliniken Bochum, Bergstr. 26, 44791, Bochum, Deutschland
| | - Georgios Zogas
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie (AINS), Augusta-Kliniken Bochum, Bergstr. 26, 44791, Bochum, Deutschland
| | - Georg Juckel
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr Universität Bochum, Alexandrinenstr. 1, 44791, Bochum, Deutschland.
| | - Jan-Florian Heuer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie (AINS), Augusta-Kliniken Bochum, Bergstr. 26, 44791, Bochum, Deutschland
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Fentie Y, Yetneberk T, Gelaw M. Preoperative anxiety and its associated factors among women undergoing elective caesarean delivery: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:648. [PMID: 35978308 PMCID: PMC9382617 DOI: 10.1186/s12884-022-04979-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Anxiety is a behavioral expression of tension and unpleasant emotion that arises from multifactorial dimensions that might increase the mortality of patients during anesthesia and surgery. This study aimed to verify the prevalence and associated factors of preoperative anxiety among women undergoing elective cesarean delivery. METHOD A cross-sectional study design was conducted on a total of 392 patients who underwent elective cesarean delivery in Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia from October 15, 2020, to September 15, 2021. Data was collected using a validated Amsterdam questionnaire, after translating to the local language (Amharic). Descriptive statistics were expressed in percentages and presented in tables. Bivariable and multivariable logistic analyses were done to identify factors associated with preoperative anxiety. The statistical significance level was set at P < 0.05 with 95% CI. RESULTS The overall prevalence of preoperative anxiety in women undergoing elective cesarean delivery was 67.9 [95% CI = (63.0-72.7)]. Participants who came from rural areas [AOR = 2.65; 95%CI: 1.27-5.53], farmers [AOR = 2.35; 95%CI: 1.02-5.40], participants with no previous surgical and anesthesia history [AOR = 2.91; 95%CI: 1.69-5.01], and primiparous women [AOR = 1.69; 95%CI: 1.01-2.83] were more significantly associated with preoperative anxiety. CONCLUSION The prevalence of preoperative anxiety among elective cesarean deliveries was found to be high. So, preoperative maternal counseling and anxiety reduction services should therefore be given top priority, particularly for those women who came from rural areas, are farmers, have no prior surgical or anesthetic experience, and are primiparous.
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Affiliation(s)
- Yewlsew Fentie
- Departement of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, P.O.Box: 272, Debre Tabor, Ethiopia.
| | - Tikuneh Yetneberk
- Departement of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, P.O.Box: 272, Debre Tabor, Ethiopia
| | - Moges Gelaw
- Departement of Anesthesia, College of Medicine and Health Sciences, Debre Tabor University, P.O.Box: 272, Debre Tabor, Ethiopia
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Chen YYK, Soens MA, Kovacheva VP. Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption. J Anesth 2022; 36:532-553. [PMID: 35779126 DOI: 10.1007/s00540-022-03081-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
Preoperative anxiety has an incidence of 11-80% in patients undergoing surgical or interventional procedures. Understanding the role of preoperative anxiety on intraoperative anesthetic requirements and postoperative analgesic consumption would allow personalized anesthesia care. Over- or under-anesthetizing patients can lead to complications such as postoperative cognitive dysfunction in elderly patients, or procedural discomfort, respectively. Our scoping review focuses on the current evidence regarding the association between preoperative anxiety and intraoperative anesthetic and/or postoperative analgesic consumption in patients undergoing elective surgical or interventional procedures. Based on 44 studies that met the inclusion criteria, we found that preoperative anxiety has a significant positive correlation effect on intraoperative propofol and postoperative opioid consumption. The analysis of the literature is limited by the heterogeneity of preoperative anxiety tools used, study designs, data analyses, and outcomes. The use of shorter, validated preoperative anxiety assessment tools may help optimize the intraoperative anesthetic and postoperative analgesic regimen. Further research to determine the most feasible and clinically relevant preoperative anxiety tool and subsequent implementation has the potential to optimize perioperative care and improve patient outcomes.
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Affiliation(s)
- Yun-Yun K Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America
| | - Mieke A Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America
| | - Vesela P Kovacheva
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, L1,, Boston, MA, 02115, United States of America.
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Bayman MG, Inal ZO, Hayiroglu F, Ozturk ENY, Gezginc K. Foetal umbilical cord brain-derived neurotrophic factor (BDNF) levels in pregnancy with gestational diabetes mellitus. J OBSTET GYNAECOL 2022; 42:1097-1102. [PMID: 34989285 DOI: 10.1080/01443615.2021.2006159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of our study was to investigate whether gestational diabetes mellitus (GDM) affects brain-derived neurotrophic factor (BDNF) levels in foetal umbilical cord blood. A total of 96 participants were divided into a GDM group (n = 43) and a non-diabetic control group (n = 53). Cord blood samples of approximately 5 cc were taken immediately after the foetal umbilical cord was clamped during delivery in order to determine BDNF levels. While the mean age, body mass index, birth weight, rate of caesarean delivery, rate of infant macrosomia, and neonatal intensive care unit admission of women with GDM were significantly higher compared to the non-diabetic control group (p < .05), pregnancy complications were comparable between the groups (p > .05). Although no significant differences were noted between the groups with respect to cord blood BDNF levels (0.79 ± 0.37 ng/ml vs. 0.69 ± 017 ng/ml, p = .122), cord blood BDNF values were higher in female infants compared to male infants (0.85 ± 0.33 ng/ml vs. 0.66 ± 0.23 ng/ml, p = .001) and in patients using insulin compared to those not using insulin in the GDM group (0.78 ± 0.14 ng/ml vs. 0.62 ± 0.09 ng/ml, p < .001). This study found that GDM has no effect on cord blood BDNF levels. More in-depth studies with larger series are needed to validate the results of the present study.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) negatively affects the foetal neurodevelopment due to inflammation and oxidative stress caused by hyperglycaemia. Brain-derived neurotrophic factor (BDNF) expression has been shown to modulate oxidative stress and inflammation, and there may be a relationship between varying BDNF concentrations and GDM.What do the results of this study add? Our study showed that no significant differences were noted between the groups with respect to cord blood BDNF levels, cord blood BDNF values were higher in female infants compared to male infants, and in patients using insulin compared to those not using insulin in the GDM group.What are the implications of these findings for clinical practice and/or further research? GDM negatively affects the foetal neurodevelopment due to inflammation and oxidative stress caused by hyperglycaemia. BDNF expression has also been shown to modulate oxidative stress and inflammation, and there may be a relationship between varying BDNF concentrations and GDM. The association between BDNF expression and GDM has not been clearly elucidated in the literature. More in-depth studies with larger series are needed to determine this relationship.
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Affiliation(s)
- Melike Geyik Bayman
- Departmant of Obstetrics and Gynecology, Necmettin Erbakan University Medical Faculty, Konya, Turkey
| | - Zeynep Ozturk Inal
- Departmant of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Fatih Hayiroglu
- Departmant of Biochemistry, Necmettin Erbakan University Medical Faculty, Konya, Turkey
| | | | - Kazim Gezginc
- Departmant of Obstetrics and Gynecology, Necmettin Erbakan University Medical Faculty, Konya, Turkey
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Xiong PT, Poehlmann J, Stowe Z, Antony KM. Anxiety, Depression, and Pain in the Perinatal Period: A Review for Obstetric Care Providers. Obstet Gynecol Surv 2021; 76:692-713. [PMID: 34854926 DOI: 10.1097/ogx.0000000000000958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Maternal depression and anxiety may not only increase vulnerability for the development of postpartum depression and anxiety but may increase the perception of obstetric pain. Objective This review focuses on the relationship among depression, anxiety, and pain during pregnancy and postpartum. We will first review common clinical screening tools for depression, anxiety, and pain. Then, the existing evidence describing the relationship of depression, anxiety, and pain will be covered. Evidence Acquisition Queries for publications in PubMed, Google Scholar, and the CINAHL (Cumulative Index to Nursing and Allied Health Literature) were completed. Both searches were limited to publications within the last 20 years. Literatures on subtopics obtained from the references of publications identified in the initial search were not limited by publication year. Results A total of 19 total publications were identified regarding postpartum depression and pain; 17 were identified in the initial search, and 2 related to postpartum depression, anxiety, and pain were found by reviewing references. Eleven studies were identified regarding postpartum anxiety and pain; 4 were found in the original search, and 7 were identified by reviewing the references. Conclusions and Relevance The relationship between postpartum depression and pain is well characterized in the literature. However, the relationship between postpartum anxiety and pain is less well defined, and further research is needed. The interaction between maternal mental health and pain emphasizes the importance of screening for these conditions and also counseling and educating patients about expectations regarding intrapartum and postpartum pain.
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Affiliation(s)
- Pa Ta Xiong
- Medical Student, School of Medicine and Public Health
| | - John Poehlmann
- Resident Physician, Department of Obstetrics and Gynecology, University of Wisconsin-Madison
| | - Zachary Stowe
- Professor, Department of Psychiatry, University of Wisconsin-Madison, Wisconsin Psychiatric Institute and Clinics
| | - Kathleen M Antony
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI
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Pekcan YO, Tuncalı B, Erol V. Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:85-90. [PMID: 34848318 PMCID: PMC9801190 DOI: 10.1016/j.bjane.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGRAUND This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. METHODS Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values obtained from the final model. RESULTS There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. CONCLUSION In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.
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Affiliation(s)
- Yonca Ozvardar Pekcan
- Başkent University School of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey.
| | - Bahattin Tuncalı
- Başkent University School of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Varlık Erol
- Medicana Hospital Izmir, Department of General Surgery, Izmir, Turkey
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11
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Gorkem U, Kan O, Bostanci MO, Taskiran D, Inal HA. Kisspeptin and Hematologic Parameters as Predictive Biomarkers for First-Trimester Abortions. Medeni Med J 2021; 36:98-105. [PMID: 34239761 PMCID: PMC8226412 DOI: 10.5222/mmj.2021.32549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
Objective Spontaneous abortion is the most common complication of early pregnancy, affecting up to 20% of recognized pregnancies. Kisspeptin is predominantly released by placental syncytiotrophoblasts, and regulates their placental invasion into the uterine matrices. We aimed to establish an association of serum kisspeptin levels with pregnancy outcomes during the early gestational stage of the first trimester. Method In this prospective study, 90 pregnant women in their 7 to 8 6/7 gestational weeks were classified into three groups: (i) The control group, consisting of healthy pregnant women (n=30), (ii) the threatened abortion group (n=30), and (iii) the spontaneous abortion group (n=30). The maternal serum samples were analyzed for complete blood count parameters and kisspeptin levels. Results There was no statistical difference regarding body mass index (BMI) and gestational age (p=0.370). Regarding detailed obstetric notations, including gravida, parity, abortion, and living children, socioeconomic levels, and employment rates, all study groups were comparable (p>0.05, for all). No significant association was found regarding the biochemical parameters of complete blood count, including neutrophil, lymphocyte, and platelet concentrations, as well as neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) (p>0.05, for all). The median serum kisspeptin levels of the study groups did not differ between the groups (p=0.153). Correlation analysis revealed no significant relationship between serum kisspeptin levels and other study parameters in any study groups (p>0.05, for all) Conclusion We found no statistically significant relationship between serum kisspeptin concentrations and pregnancy outcomes in the early gestational stage of the first trimester, and serum kisspeptin concentrations did not seem to be a reliable marker to distinguish abortion status from viable pregnancy.
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Affiliation(s)
- Umit Gorkem
- Hitit University, Medical Faculty, Department of Obstetric and Gynecology, Corum, Turkey
| | - Ozgur Kan
- Hitit University Medical Faculty, Departmant of Obstetric and Gynecology, Corum, Turkey
| | | | - Deniz Taskiran
- Hitit University Medical Faculty, Departmant of Obstetric and Gynecology, Corum, Turkey
| | - Hasan Ali Inal
- Konya Training and Research Hospital, Departmant of Obstetric and Gynecology, Konya, Turkey
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Felder L, Saccone G, Scuotto S, Monks DT, Carvalho JCA, Zullo F, Berghella V. Perioperative gabapentin and post cesarean pain control: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2018; 233:98-106. [PMID: 30583095 DOI: 10.1016/j.ejogrb.2018.11.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
Abstract
Cesarean delivery occurs in roughly one third of pregnancies. Effective postoperative pain control is a goal for patients and physicians. Limiting opioid use in this period is important as some percentage of opioid naïve individuals will develop persistent use. Gabapentin is a non-opioid medication that has been used perioperatively to improve postoperative pain and limit opioid requirements. The goal of this study is to determine the efficacy of perioperative gabapentin in improving post cesarean delivery pain control. The following data sources were searched from their inception through October 2018: MEDLINE, Ovid, ClinicalTrials.gov, Sciencedirect, and the Cochrane Library at the CENTRAL Register of Controlled Trials. A systematic review of the literature was performed to include all randomized trials examining the effect of perioperative gabapentin on post cesarean delivery pain control and other postoperative outcomes. The primary outcome was the analgesic effect of gabapentin on post cesarean delivery pain, measured by visual analog scale (VAS; 0-100) or Numerical Rating Scale (NRS; 0-10) on movement 24 hours (h) postoperative. These scores were directly compared by multiplying all NRS scores by a factor of 10. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) with 95% confidence interval (CI). Six placebo controlled trials (n = 645) were identified as relevant and included in the meta-analysis. All studies included only healthy pregnant women (American Society of Anesthesiologist (ASA) physical status I or II) undergoing spinal anesthesia for cesarean delivery at term. Participants were randomized to either 600 mg oral gabapentin or placebo preoperatively and in one study the medications were also continued postoperatively. Pooled data showed that women who received gabapentin prior to cesarean delivery had significantly lower VAS pain scores at 24 h on movement (MD -11.58, 95% CI -23.04 to -0.12). VAS pain scores at other time points at rest or on movement were not significantly different for those who received gabapentin and placebo although there was a general trend toward lower pain scores for women receiving gabapentin. There was no significant between-group difference in use of additional pain medications, supplemental opioids, and maternal or neonatal side effects. There was higher pain control satisfaction at 12 and 24 h in the gabapentin versus placebo groups.
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Affiliation(s)
- Laura Felder
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Sergio Scuotto
- Department of Anesthesiology, School of Medicine, University of Siena, Siena, Italy
| | - David T Monks
- Department of Anesthesia, Washington University School of Medicine, St. Louis, MO, USA
| | - Jose C A Carvalho
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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