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Liu L, Miao L, Chen Y, Fu Y, Liang X, Han Z, Cao M, Liu Z. Modified intraoperative temperature management prevents prolonged length of stay after head and neck surgery with free flap reconstruction. J Craniomaxillofac Surg 2023; 51:732-739. [PMID: 37758600 DOI: 10.1016/j.jcms.2023.08.012] [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: 10/15/2022] [Accepted: 08/14/2023] [Indexed: 09/29/2023] Open
Abstract
The present study aimed to investigate the association between intraoperative body temperature and prolonged length of stay (PLOS) after free flap reconstruction. A total of 753 patients who underwent head and neck surgery with free flap reconstruction were collected and randomly assigned into primary and validation cohorts. In the primary cohort, univariable and multivariable analyses were conducted to evaluate associations between intraoperative time-weighted (TW) temperature (TW average [TWA] temperature, TW hypothermia and TW hyperthermia) and PLOS. Nomograms were developed with and without intraoperative TW temperature, and validated in the validation cohort. Severe intraoperative TW hypothermia (OR = 1.004; 95% CI: 1.000, 1.007; p = 0.032) was identified as an independent risk factor for PLOS. Intraoperative TWA temperature and TW hypothermia showed linear related predictive effect for PLOS. The nomogram incorporating intraoperative TW temperature showed higher C-index (0.652, 95% CI: 0.591, 0.713) and improved net reclassification improvement for non-event (0.277, 95% CI: 0.118, 0.435; p < 0.001). Lower TWA temperature with mild TW hypothermia had a preventive effect on PLOS with a linear association, which may provide a modified range for intraoperative temperature management. The proposed nomogram incorporating intraoperative TW temperature could be used to develop personalized preventive strategies for PLOS after free flap reconstruction. IRB NUMBER: SYSEC-KY-KS-2022-037. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable.
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Affiliation(s)
- Ling Liu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China
| | - Liping Miao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China
| | - Yingzhen Chen
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China
| | - Yanni Fu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China
| | - Xia Liang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China
| | - Zhixiao Han
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China.
| | - Zhongqi Liu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, PR China.
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Guo HY, Zhou HY. Intravenous anesthesia with different doses of propofol combined with etomidate for painless colonoscopy in elderly obese patients: Effectiveness and impact on neurocognitive disorders. Shijie Huaren Xiaohua Zazhi 2022; 30:756-761. [DOI: 10.11569/wcjd.v30.i17.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Painless colonoscopy in elderly obese patients is an invasive examination and requires good anesthesia and analgesia. Intravenous anesthesia with propofol combined with etomidate has good analgesic and sedative effects. However, there is no uniform standard for propofol dosage.
AIM To investigate the effectiveness of intravenous anesthesia with different doses of propofol compounded with etomidate for painless colonoscopy in elderly obese patients and the effect on neurocognitive disorders.
METHODS One hundred and twelve elderly obese patients who underwent painless colonoscopy at our hospital from January 2021 to March 2022 were selected and divided into either a control group or a study group (56 patients each) according to the odd-even nature of admission serial number. The control group (odd serial number) underwent intravenous anesthesia with a regular dose of propofol and etomidate for intravenous anesthesia, and the study group (even serial number) was given a small dose of propofol with etomidate for intravenous anesthesia. The anesthetic effect, time of colonoscopy, heart rate (HR) at different time points in the perioperative period, mean arterial pressure (MAP), incidence of adverse effects, use of anesthetic drugs, and cognitive function (Mini-mental State Examination [MMSE] score) before and after surgery were compared between the two groups.
RESULTS There was no statistically significant difference in the onset of anesthesia, anesthesiologist's satisfaction with anesthesia, or colonoscopy time between the two groups, and the time to awakening and post-awakening observation room stay were significantly shorter in the study group than in the control group (P < 0.05). HR and MAP at T1 and T2 were lower than those at T0 in both groups (P < 0.05), and HR and MAP at all time points did not differ significantly between the two groups (P > 0.05). The dosage of propofol in the study group was significantly less than that of the control group (P < 0.05), though the dosage of etomidate and the number of propofol additions were not significantly different between the two groups. The incidence of adverse reactions in the study group (8.93%) was significantly lower than that in the control group (23.21%; P < 0.05). The postoperative 1-h MMSE score was lower than the preoperative score in both groups, but it was significantly higher in the study group than in the control group (P < 0.05).
CONCLUSION The use of intravenous anesthesia with low-dose propofol with etomidate in painless colonoscopy in elderly obese patients can ensure the effectiveness of anesthesia, improve the quality of postoperative awakening, reduce adverse effects, and mitigate the impact on cognitive function.
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Affiliation(s)
- Hong-Ye Guo
- Department of Pharmacy, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing 312000, Zhejiang Province, China
| | - Hai-Yan Zhou
- Department of Pharmacy, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing 312000, Zhejiang Province, China
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de Caxias FP, Sa Teles KL, Dos Santos DM, de Moraes Melo Neto CL, da Silva EVF, Goiato MC, de Magalhães Bertoz AP, Januzzi MS, Helga Turcio K. Effect of Rehabilitation with a New Ocular Prosthesis on Electromyography of the Occipitofrontalis, Temporal, Masseter, and Sternocleidomastoid. Eur J Dent 2021; 16:346-350. [PMID: 34808688 PMCID: PMC9339945 DOI: 10.1055/s-0041-1735795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives
The aim of this study was to verify during facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) if: (1) there would be difference in the electromyography (EMG) of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles on the normal side (NS) compared with the affected side (AS) (without the use of an ocular prosthesis) in individuals with unilateral absence of the eyeball, and (2) the rehabilitation with a new ocular prosthesis would affect the EMG of the muscles studied on the AS in these individuals.
Materials and Methods
Thirteen individuals, without temporomandibular disorder, with good health, with unilateral absence of the eyeball (the eye must have been removed by evisceration or enucleation), and users or nonusers of an ocular prosthesis were included. EMG of the occipitofrontalis, temporal, masseter, and sternocleidomastoid muscles was performed during rest and facial expressions (“happy,” “sad,” “fearful,” “angry,” “surprised,” and “disgusted”) before (T0) and 90 days after (T1) rehabilitation with a new ocular prosthesis. The analyses were performed in T0 on NS and AS (without the use of an ocular prosthesis), and in T1 on AS with the new ocular prosthesis.
Statistical Analysis
All data were submitted to the Student's
t
-test with
p
< 0.05.
Results
There was no statistically significant difference comparing the AS with the NS in T0 for all muscles studied, during all facial expressions evaluated (
p
> 0.05). There was no statistically significant difference comparing the AS in T0 with itself in T1 for all muscles studied, during all facial expressions evaluated (
p
> 0.05).
Conclusion
Eye loss did not affect the EMG of studied muscles when comparing NS with AS (without the use of an ocular prosthesis). The rehabilitation with ocular prosthesis was not capable of changing the EMG on AS.
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Affiliation(s)
- Fernanda Pereira de Caxias
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Karen Letícia Sa Teles
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Daniela Micheline Dos Santos
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil.,Oral Oncology Center, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | | | - Emily Vivianne Freitas da Silva
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Marcelo Coelho Goiato
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil.,Oral Oncology Center, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - André Pinheiro de Magalhães Bertoz
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil.,Department of Pediatric and Social Dentistry, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Marcella Santos Januzzi
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
| | - Karina Helga Turcio
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University, Araçatuba, São Paulo, Brazil
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Pai K, Baaklini C, Cabrera CI, Tamaki A, Fowler N, Maronian N. The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review. Laryngoscope 2021; 132:1388-1402. [PMID: 34661923 DOI: 10.1002/lary.29905] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI). METHODS We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, and Embase) and manual search of bibliographies identified manuscripts addressing how CI scores related to HNS outcomes. RESULTS A total of 116 studies associated CI scores with HNS outcomes. CIs were represented in the literature as follows: ASA-PS (70/116), CCI (39/116), ACE-27 (24/116), KFI (7/116), NCI-CI (3/116), ECI (2/116), and WUHNCI (1/116). The most frequently cited justification for calculating each CI (if provided) was: CCI for its validation in other studies, ACE-27 for its utility in cancer patients, and ECI for its comprehensive design. In general, the CCI and ACE-27 were predictive of mortality in HNS. The ECI was most consistent in predicting >1-year mortality. The ACE-27 and KFI were most consistent in predicting medical complications. CONCLUSION Despite inconsistencies in the literature, CIs provide insights into the impact of comorbidities on outcomes in HNS. These scores should be employed as an adjunct in the preoperative assessment of HNS patients. Comparative studies are needed to identify indices that are most reliable in predicting HNS outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Kavya Pai
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A
| | - Carla Baaklini
- Northeast Ohio Medical University, Rootstown, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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Mortality Within 30 Days After Head and Neck Free Flap Reconstruction: A Systematic Review. J Craniofac Surg 2021; 32:1738-1741. [PMID: 34081420 DOI: 10.1097/scs.0000000000007548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this systematic review is to analyze the 30-day postoperative mortality in patients undergoing free flap reconstruction for head and neck cancer published in literature and to identify associated factors. METHODS The authors performed a literature search between January 1950 and February 2020 in PubMed, EMBASE, and Scopus, using a combination of Medical Subject Headings headings and text keywords related to head and neck cancer; microsurgery or free flap reconstruction; and 30-day mortality. Inclusion criteria were: original studies in English reporting on 30-day mortality after head and neck free flap reconstruction in adult population. RESULTS Thirty-one publications reported on a total of 13,447 patients who underwent head and neck free flap reconstruction. The published 30-day postoperative mortality ranged from 0% to 6.3%, with an average of 1.21%. A number of studies examined the association between mortality and body mass index, American Society of Anesthesiologists, and comorbidity score and age. One study found that underweight patients had significantly higher mortality. Two studies found no association between the American Society of Anesthesiologists score and 30-day postoperative mortality; however, 1 study reported significantly higher mortality with increased comorbidity score. Regarding association with age, 3 studies found significant higher mortality in older patients, while 5 studies found no difference. CONCLUSIONS The average 30-day postoperative mortality in patients undergoing head and neck free flap reconstruction is 1.21% and is; therefore, not negligible. Careful patient selection and preoperative optimization are essential in order to reduce mortality in head neck free flap reconstruction.
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Katna R, Singh S, Bhosale B, Deshpande A, Kalyani N. Microvascular reconstruction for head and neck cancers in high risk population: clinical outcomes and complications. Ann R Coll Surg Engl 2021; 103:278-281. [PMID: 33682450 DOI: 10.1308/rcsann.2020.7078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.
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Affiliation(s)
- R Katna
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - S Singh
- Vedant Hospital, Thane, India
| | - B Bhosale
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - A Deshpande
- Jaslok Hospital and Research Centre, Mumbai, India.,Bombay Hospital and Research Centre, Mumbai, India.,Vedant Hospital, Thane, India
| | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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Modified Clavien-Dindo Classification and Outcome Prediction in Free Flap Reconstruction among Patients with Head and Neck Cancer. J Clin Med 2020; 9:jcm9113770. [PMID: 33266480 PMCID: PMC7700532 DOI: 10.3390/jcm9113770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/04/2022] Open
Abstract
Because of limitations caused by unique complications of free flap reconstruction, the Clavien–Dindo classification was modified to include grade “IIIc” for “partial or total free flap failure.” From 2013 to 2018, 116 patients who had undergone free flap reconstruction for head and neck cancer with grade III or higher postoperative complications were grouped using the “Modified” Clavien–Dindo classification. Alcoholism displayed significant predictive effects between grade IIIb and IIIc (72.7% vs. 50%, p = 0.028). Significant differences were observed between grade IIIb and IIIc in the duration of hospital stay (23.1 ± 10.1 vs. 28.6 ± 11.9 days, p = 0.015), duration of intensive care unit stay (6.0 ± 3.4 vs. 8.7 ± 4.3 days, p = 0.001), reoperation times during the current hospitalization (1.4 ± 0.8 vs. 2.0 ± 1.0 times, p < 0.001), and wound infection rate (29.9% vs. 62.5%, p = 0.002). The severity levels were significantly positively correlated with reoperation times during the current hospitalization (p < 0.001), ICU stay (p = 0.001), and hospital stay (p < 0.001). The modified Clavien–Dindo classification with grade IIIc describes the perioperative complications of head and neck free flap reconstruction to predict clinical outcomes based on severity.
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Sáez-Alcaide LM, Molinero-Mourelle P, González-Serrano J, Rubio-Alonso L, Bornstein MM, López-Quiles J. Efficacy of a topical gel containing chitosan, chlorhexidine, allantoin and dexpanthenol for pain and inflammation control after third molar surgery: A randomized and placebo-controlled clinical trial. Med Oral Patol Oral Cir Bucal 2020; 25:e644-e651. [PMID: 32683390 PMCID: PMC7473436 DOI: 10.4317/medoral.23661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate and compare the postoperative effect of a topic gel containing chlorhexidine, chitosan, allantoine and dexpanthenol versus a placebo for pain and inflammation control after third molar surgery. MATERIAL AND METHODS A gel combining 0.2% chlorhexdine, 0.5% chitosan, 5% dexpanthenol, 0.15% allantoin and 0.01% sodium saccharin was selected for this split mouth randomized controlled and double-blind trial including 36 patients with bilaterally and symmetrically impacted lower third molars. The teeth (n=72) were randomly divided into two groups before surgical removal: control group (CG; in which a placebo was given) and experimental group (EG). Swelling, trismus, postoperative pain, wound healing and complications were measured and recorded in order to evaluate differences between the placebo and experimental product. RESULTS Five patients suffered from an alveolitis in the CG (13.9%), and none in the study group (0%), but no statistically significant difference was found (p=0.063). From day 0 to day 7, trismus and swelling were significantly less pronounced in the EG, and wound healing was considered 'good' in 22.2% for the CG and 97.2% for the EG (p<0.001). Mean VAS scores during the seven postoperative days were statistically lower in the study (2.56±1,19) compared to the placebo group (3.25±1.6) (p=0.002). The mean consumption of analgesic pills during the first 92 hours was also statistically lower in the EG (0.26±0.51) in comparison to the CG (0.56±0.67) (p=0.003). CONCLUSIONS The use of an experimental gel containing chlorhexidine, chitosan, allantoine and dexpanthenol seems to significantly reduce postoperative pain, trismus and signs of inflammation. Future studies should further evaluate, if the gel is effective in dry socket preventing after third molar removal.
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