Application of Controlled Hypotension During Surgery for Spinal Metastasis

Effects of a 'Rebuilding Myself' intervention on enhancing the adaptability of cancer patients to return to work: a randomized controlled trial

OBJECTIVES

To explore the effects of a 'Rebuilding Myself' intervention on enhancing the adaptability of cancer patients to return to work.

METHODS

A single-center, single-blind, randomized controlled trial design was used. Eligible patients who were receiving routine hospital treatment were recruited from the university-affiliated hospital in our city. Patients in the control group only received usual care, while patients in the intervention group received additional 'Rebuilding Myself' intervention. Adaptability to return to work, self-efficacy of returning to work, mental resilience, quality of life and work ability were measured at baseline, the 6th and 12th of the intervention. The general estimation equations were used to compare the overall changes of each outcome index between the two groups at different time points. Considering that there may be patient shedding and rejection, Per-Protocol and Intention-to-Treat analysis were used to analyze the data in this study.

RESULTS

There were statistically significant differences between the two groups of patients in the cancer patients' adaptability to return to work, self-efficacy to return to work, mental resilience, work abilities, the physical, emotional, cognitive function, fatigue, insomnia and overall health status dimensions of quality of life (P < 0.05). And no significant difference was found in other dimensions (P > 0.05). The group effect, time effect, and interaction effect of patients' return to work adaptability and return to work self-efficacy were statistically significant in both groups (P < 0.05). Mental resilience, working ability, and quality of life had obvious time effect and interaction effect (P < 0.05).

CONCLUSION

This intervention could improve cancer patients' adaptability to return to work, self-efficacy to return to work, mental resilience, work abilities and quality of life. And it can be further expanded to improve the adaptability of patients to return to work, then to help patients achieve comprehensive rehabilitation.

IMPLICATIONS FOR CANCER SURVIVORS

The application of 'Rebuilding Myself' interventions can effectively improve the adaptability of cancer patients returning to work.

TRIAL REGISTRATION

This study was registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2200057943) on 23 March, 2022.

Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study

OBJECTIVES

The study aimed to analyze the application of controlled hypotension and tourniquets in total knee arthroplasty (TKA) to evaluate their early postoperative period effects in TKA.

PATIENTS AND METHODS

A total of 183 patients (43 males, 140 females; mean age: 67.8±6.4 years; range, 50 to 84 years) with knee osteoarthritis who needed TKA were recruited for this prospective, randomized controlled clinical study between August 2022 and May 2023. The study included a tourniquet group (group T, 94 patients) and a controlled hypotension group (group H, 89 patients). In group T, an inflatable tourniquet was used throughout the operation, with the pressure of the tourniquet set at 300 mmHg. In group H, controlled hypotension was used, with the mean arterial pressure controlled at 55-65 mmHg. The outcome measures of this study included blood loss, coagulation function, inflammatory mediators, knee joint function, permeation thickness of bone cement around the tibial prosthesis, and cognitive function.

RESULTS

The baseline demographics and clinical characteristics of the two groups of patients were comparable (p>0.05). Intraoperative blood loss in group H was higher than that in group T (p<0.05), whereas hemoglobin decrease, postoperative drainage flow, hidden blood loss, and total blood loss in group T were higher than in group H (p<0.05). Fibrinogen, D-dimer, C-reactive protein, and interleukin-6 levels were higher in group T than in group H on the first and third postoperative days (p<0.05). The knee joint function of group H was significantly better than that of group T on the fifth day and one month after the operation (p<0.05). There was no significant difference in the penetration thickness of bone cement around the tibial prosthesis between the two groups (p>0.05). There was no significant difference in Mini-Mental State Examination scores between the two groups on the same day (p>0.05).

CONCLUSION

Controlled hypotension technology in TKA can reduce total blood loss by reducing hidden blood loss and can help to alleviate the postoperative hypercoagulable state, relieve inflammatory reactions, and facilitate early recovery of knee joint function after surgery.

Comparison of intraoperative blood loss and perioperative complications between preoperative embolization and nonembolization combined with spinal tumor surgeries: a systematic review and meta-analysis

PURPOSE

The present study aimed to comparatively evaluate intraoperative blood loss (IBL) and perioperative complications between preoperative embolization (PE) and nonembolization (NE) combined with spinal tumor surgeries as well as to determine the subgroup of spinal tumor surgeries suitable for PE.

METHODS

A systematic search in PubMed and EMBASE and an additional search by reference lists of the retrieved studies were undertaken by two reviewers. The mean IBL and perioperative complication rate were employed as the effect size in the general quantitative synthesis through direct calculation. Meta-analysis was performed using standardized mean difference (SMD) and weighted mean difference (WMD) of IBL and the odds ratio (OR) of complications. Heterogeneity was assessed using the I2 statistic.

RESULTS

The reviewers selected 17 published studies for the general quantitative synthesis and meta-analyses. The mean IBL of spinal tumor surgeries was 1786.3 mL in the NE group and 1716.4 mL in the PE group. The mean IBL between the two groups was similar. The pooled WMD and SMD of IBL in spinal tumor surgeries was 324.15 mL (95% CI 89.50-1640.9, p = 0.007) and 0.398 (95% CI 0.114-0.682, p = 0.006), respectively. The reduction of the PE group compared with the NE group for the rates of major complications and major hemorrhagic complications were 7.80% and 5.71%, respectively. The risk of PE-related complications in the PE group was only 1.53% more than in the PE group. The pooled OR of major complications in spinal tumor surgeries was 1.426 (95% CI 0.760-2.674; p = 0.269).

CONCLUSIONS

PE may be suitable for spinal tumor surgeries and some subgroups. From the perspective of complications, PE may also be a feasible option for spinal tumor surgeries.

Management of Incidental Uncontrolled Elevation of Intraoperative Blood Pressure: A Comparative Study on Nitroglycerine Versus Dexmedetomidine Infusion

Background

Uncontrolled elevation of intraoperative blood pressure can result in deleterious effects with increased risk of morbidity and mortality.

Objectives

We aimed to compare nitroglycerine infusion with dexmedetomidine infusion in controlling accidental intraoperative uncontrolled hypertension.

Methods

This comparative study was conducted on 73 hypertensive patients undergoing cancer surgeries who experienced uncontrolled intraoperative hypertension. The data of 38 patients were retrieved from the medical records for the nitroglycerine group and 35 patients were prospectively enrolled for the dexmedetomidine group. Group N received nitroglycerine infusion (0.3 - 1 µg/kg/min), while group D received dexmedetomidine infusion (0.2 - 0.7 µg/kg/h).

Results

Both groups were comparable regarding their demographic data and clinical characteristics. Systolic, diastolic, and mean arterial pressure (MAP) values were significantly lower in group N compared to group D during the period between 60 and 120 minutes intraoperatively (P < 0.001). Heart rate values were significantly lower in group D than in group N (P < 0.001). Postoperative sedation scores were better for group D with lower analgesic requirements (P < 0.001).

Conclusions

Dexmedetomidine infusion can be used to manage the uncontrolled intraoperative elevation of blood pressure in selected patient population.