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Povzetek: Study objective: Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study’ (LAS VEGAS) to evaluate differences between females and males with respect to PPCs. Design, setting and patients Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs. Main results: The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81–1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89–1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts. Conclusions: In this conveniently–sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes.
Ključne besede: general anaesthesia, intraoperative ventilation, operating room, outcomes
Objavljeno v DiRROS: 26.02.2026; Ogledov: 313; Prenosov: 200
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Povzetek: Background: This randomised, single-centre study and original research manuscript aimed to evaluate whether perioperative hypnosis and acupuncture can reduce postoperative nausea and vomiting (PONV), opioid use, and other complications in spinal surgery compared to standard pharmacological management. Methods: In total, 60 patients undergoing spinal surgery were divided into three groups regarding antiemetic prevention: Hypnosis and acupuncture (HG), hypnosis, acupuncture, and antiemetic (HAG), and standard control with antiemetic (CG). Hypnosis was performed one day before surgery, or patients received premedication with midazolam on the day of surgery. Anaesthesia was induced and maintained with propofol and remifentanil. Acupuncture was performed bilaterally at points LI4 and PC6 after induction of anaesthesia. Postoperatively, the consumption of opioids and antiemetics, satisfaction and well-being, length of stay and complications were recorded. Results: In all groups, additional opioids were administered in the first hour after surgery (p = 0.4). In the ICU, only one patient in the HAG and two patients in the CG and HG required additional analgesics (p = 0.8). Overall satisfaction (9/9/0 vs. 10/6/4 vs. 9/7/3; p = 0.4) and well-being scores (10/8/0 vs. 13/5/2 vs. 13/5/1; p = 0.5) were high across all groups, with no significant differences. Two patients in CG experienced mild complications. The length of hospitalisation was similar (3 days in CG vs. 4 days in HAG and HG (p = 0.7). Only one patient in the HG required antiemetics; none were needed in CG or HAG (p = 0.4). Conclusions: Within the constraints of this exploratory single-centre trial, hypnosis appeared to provide anxiolytic benefits comparable to benzodiazepines, and intraoperative acupuncture did not increase PONV despite reduced pharmacological prophylaxis. No significant differences were detected in opioid and antiemetic consumption. Larger, adequately powered studies are needed to confirm these findings and optimise the timing and modality of non-pharmacological interventions.
Ključne besede: spinal surgery, anaesthesia, antiemetic, acupuncture, hypnosis
Objavljeno v DiRROS: 05.01.2026; Ogledov: 554; Prenosov: 217
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Povzetek: Background. Awake craniotomy is a neurosurgical technique that allows neurophysiological testing with patient cooperation during the resection of brain tumour in regional anaesthesia. This allows identification of vital functional (i.e. eloquent) brain areas during surgery and avoidance of their injury. The aim of the study was to present clinical experience with awake craniotomy for the treatment of gliomas at the University Medical Centre Ljubljana from 2015 to 2019.Patients and methods. Awake craniotomy was considered in patients with a gliomas near or within the language brain areas, in all cases of insular lesions and selected patients with lesions near or within primary motor brain cortex. Each patient was assessed before and after surgery.Results. During the 5-year period, 24 awake craniotomies were performed (18 male and 6 female patients; average age 41). The patient’s cooperation, discomfort and perceived pain assessed during the awake craniotomy were in majority of the cases excellent, slight, and moderate, respectively. After surgery, mild neurological worsening was observed in 13% (3/24) of patients. Gross total resection, in cases of malignant gliomas, was feasible in 60% (6/10) and in cases of low-grade gliomas in 29% (4/14). The surgery did not have important negative impact on functional status or quality of life as assessed by Karnofsky score and Short-Form 36 health survey, respectively (p > 0.05). Conclusions. The results suggest that awake craniotomy for treatment of gliomas is feasible and safe neurosurgical technique. The proper selection of patients, preoperative preparation with planning, and cooperation of medical team members are necessary for best treatment outcome.
Ključne besede: awake craniotomy, surgery of gliomas, intraoperative neurophysiological testing, primary brain tumours, clinical experiences
Objavljeno v DiRROS: 25.07.2024; Ogledov: 1083; Prenosov: 888
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Povzetek: Background. We investigated the differences in urokinase plasminogen activator(uPA) and its inhibitors type-1 and 2 (PAI-1/2) concentrations in clinically suspected nevi, primary cutaneous melanoma and normal skin and correlations with histopathological prognostic factors of primary melanoma. Patients and methods. Fifty-one patients were enrolled. The tissue concentrations of uPA, PAI 1 and PAI2 were quantified by enzyme-linked immunosorbent assay (ELISA). Results. Mean uPA and PAI-1 concentrations in melanomas were higher than in normal surrounding skin (uPA: 1.08; vs. 0.48 ng/mgp; PAI-1: 14.07 vs. 2.07 ng/mgp; p < 0.001), uPA and PAI-1 concentrationswere higher in melanomas than in nevi, and higher in nevi than in normal surrounding skin (uPA: p > 0.05; PAI-1: p = 0.02). PAI-2 concentration was higher in normal surrounding skin than in nevi and melanomas(p > 0.05). Melanoma uPA, PAI-1 and PAI-2 concentrations correlated significantly with normal skin (r= 0.73, 0.54, 0.38 respectively). PAI 1 was significantly lower in melanomas of Breslow thickness < 0.75 mm, Clark invasion of O+I, without microscopic ulceration, without vascular invasion (p < 0.01) than in melanomas of Breslow thickness > 0.75 mm, Clark invasion > II,with ulceration and vascular invasion. Conclusions. Determination of uPA and PAI-1 can provide significant additional prognostic information for melanoma patients.
Objavljeno v DiRROS: 06.02.2024; Ogledov: 1373; Prenosov: 357
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