Postoperative cognitive disorders are an emerging public health problem because of its related socio-economic impact.: Postoperative cognitive disorders are an emerging public health problem because of its related socio-economic impact.

To determine the incidence and risk factors of cognitive disorders after endoscopic resection in urology.

This is an observational, descriptive and analytical study carried out in the urology department of Sahloul University Hospital during a 3 month period, and enrolling patients scheduled for endoscopic resections. Collected data included socio-demographic characteristics and parameters related to the operative management. Cognitive disorders were assessed by the MOCA Test one day before the intervention, then, during the first postoperative day. Patients developing TURP syndrome were excluded.

During the study period, 104 patients were enrolled with a mean age of 67.76 years. The sex ratio was 33.6. Main interventions were transurethral resection of bladder tumor and transurethral resection of the prostate.The incidence of cognitive disorders was 45.2% after endoscopic resection. Main Risk factors in multivariate analysis were age (p <10-3), low educational level (p <0.001), sedentary (p <0.001), smoking (p = 0.029), an age gap with spouse> 10 years (p <0.001), high blood pressure (p <0.001), myocardial infarction (p = 0.005); chronic bronchitis (p = 0.002), sleep disorders (p <0.001), preoperative concentration disturbances (p = 0.005), poor quality of patient information (p <0.05), and the type of anesthesia (p = 0.012).

The incidence of cognitive disorders after urologic endoscopic surgery is considerable. Patients with risk factors require preventive measures, regular screening and optimal management.

No significant relationships.

Rhino-orbital mucormycosis was seen in epidemic proportions during the second wave of the coronavirus disease 2019 pandemic. Many of these post-coronavirus rhino-orbital mucormycosis patients underwent maxillectomy for disease clearance. Rehabilitating such a large number of patients with surgical obturators as an emergency in a low-income setting was challenging.

High-density polyurethane foam was used to make a temporary obturator for patients who underwent maxillectomy. These obturators helped alleviate functional problems like dysphagia and nasal regurgitation, improving nutritional outcomes and shortening the hospital stay.

The coronavirus disease 2019 pandemic gave physicians time-sensitive challenges, for which immediate alternatives to established care were required. A maxillary obturator made of high-density polyurethane foam is an innovative solution to rehabilitate maxillectomy patients in the immediate post-operative period.

This study evaluated the post-operative indications for sinonasal topical steroid treatment using a corticosteroid (steroid)-eluting, sinus-bioabsorbable device and its effects in patients with eosinophilic chronic rhinosinusitis.

Post-operative courses were investigated in two groups: group A with patients who underwent sinonasal topical steroid treatment, and group B with control patients who did not.

Group A was significantly younger than group B (p < 0.01), and the pre-operative computed tomography score was significantly higher in group A than in group B (p < 0.05). In the post-operative stage, the nasal symptoms questionnaire component of olfactory loss and the post-operative endoscopic appearance score were significantly worse in group A than in group B (p < 0.01).

These data suggest that younger age, more severe rhinosinusitis and post-operative olfactory loss led to the need for sinonasal topical steroid treatment to prevent relapsing inflammation after functional endoscopic sinus surgery in patients with eosinophilic chronic rhinosinusitis.

In the literature, there are conflicting data regarding the recovery of mental disorders, in particular, pathologies of the emotional, personality, behavioral and cognitive spheres, in patients after surgical treatment of tumors of the diencephalic region.

To evaluate the dynamics of psychopathological disorders after removal of a craniopharyngioma.

45 patients (18–68 y.o.), operated through transcranial access. The follow-up period ranged from 3 months to 9 years (on average 2.8 + 0.4). The main method is psychopathological, supplemented by rating scales and questionnaires.

In the late postoperative period, mental disorders were detected in 75% of patients (Table 1). Table 1. Dynamics of the main psychopathological symptom complexes (n = 45).

The table shows that emotional-volitional disorders have a clear positive dynamics by 18 months after surgery compared with the preoperative level. Korsakov’s syndrome and personality disorders are less favorable. 23 patients (52%) returned to their previous profession; 22 (48%) stopped working due to a severe degree of disability, of which 7 (15%) need constant supervision.

The positive dynamics of psychopathological symptoms is observed only within 1.5 years after the removal of the craniopharyngioma, in the future they remain without a tendency to improve. 22 patients (48%) stopped working. The most severe degree of disability is 15% patients.

No significant relationships.

This study aimed to report the pre- and post-operative laryngeal endoscopic findings in patients referred by non-otolaryngologists who are undergoing thyroid and/or parathyroid surgery, and to determine the number and nature of referrals before and after the release of the clinical practice guideline for improving voice outcomes after thyroid surgery.

This retrospective cohort study, conducted at a tertiary care academic hospital, comprised adult patients referred by the endocrine surgery service for laryngoscopy from 2007 to 2018 (n = 166). Data regarding patient demographics, reason for referral and endoscopic findings were recorded.

The number of referrals increased significantly after the release of the practice guideline. The most common indication for referral pre- and post-operatively was voice change. The most common finding during laryngoscopy was normal examination findings (pre-operatively) and unilateral vocal fold immobility (post-operatively).

Peri-operative thyroid and/or parathyroid patients have laryngoscopic findings other than vocal fold immobility. Laryngoscopy to detect structural and functional pathology is warranted.

Accessory nerve palsy affects a proportion of patients following neck dissection, and results in shoulder dysfunction and regional pain. This project aimed to establish the evidence supporting post-operative physiotherapy for the shoulder following neck dissection.

A systematic review was conducted of prospective trials investigating the efficacy of rehabilitation for shoulder or upper limb dysfunction and pain following any type of neck dissection.

A total of 820 papers were identified; through a staged review process, 7 trials were found that fulfilled the inclusion criteria. These included three randomised, controlled trials and four non-randomised studies. Five out of the seven trials demonstrated a statistically significant benefit of physiotherapy.

Current evidence shows a benefit from physiotherapy in patients with shoulder dysfunction following neck dissection. Some evidence suggests progressive resistance is superior to other types of physiotherapy. Long-term benefit and cost efficacy have not been studied.

This study aimed to determine the predictors of disease progression after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.

A total of 281 adult chronic rhinosinusitis patients who underwent primary bilateral functional endoscopic sinus surgery between 2007 and 2017 and had at least 12 months of follow-up endoscopic evaluation were examined. Patients were divided into eosinophilic (n = 205) and non-eosinophilic chronic rhinosinusitis groups (n = 76). In order to determine adverse factors, post-operative endoscopic appearance scores were analysed in relation to the pre- and intra-operative findings using multiple regression analyses.

The post-operative course of eosinophilic cases deteriorated over time, like the early period for non-eosinophilic cases. Frontal sinus polyps recurred early in eosinophilic chronic rhinosinusitis. Multivariate analyses indicated young adulthood, asthma, high computed tomography score and frontal sinus polyps as significant adverse predictors.

Early, appropriate estimation of sinonasal conditions appears to be crucial for successful surgical management of chronic rhinosinusitis.

This study aimed to analyse findings of functional endoscopic sinus surgery to estimate the post-operative course of patients with chronic rhinosinusitis.

From 2007 to 2015, 291 adult patients with bilateral chronic rhinosinusitis, divided into eosinophilic chronic rhinosinusitis (n = 210) and non-eosinophilic chronic rhinosinusitis (n = 81) groups, who underwent primary functional endoscopic sinus surgery were enrolled. Functional endoscopic sinus surgery findings, scored as operating score, were analysed in relation to pre-operative olfactory recognition threshold and sinonasal computed tomography imaging score, as well as post-operative endoscopic appearance.

Operating scores in eosinophilic chronic rhinosinusitis were significantly worse than those in non-eosinophilic chronic rhinosinusitis. The anterior ethmoid sinus and superior meatus were predominantly inflamed. Operating score significantly correlated with pre-operative olfaction recognition threshold, computed tomography score and pre-operative endoscopic appearance score. In eosinophilic chronic rhinosinusitis, higher operating scores were related to post-operative deterioration of endoscopic appearance score.

The operating score reflects the course following functional endoscopic sinus surgery. Patients with more severe operative findings require longer post-operative treatment.

Throat packs are employed in nasal surgery to prevent contamination of the upper aerodigestive tract. Their use is thought to reduce the risk of aspiration and post-operative nausea and vomiting. However, use of throat packs may also be accompanied by increased throat pain. In order to inform our clinical practice, the evidence base for throat pack insertion was reviewed.

A search was made of the Pubmed database from the 1950s to March 2008. Four randomised, controlled, clinical trials were reviewed.

All the trials had significant methodological weakness. In all but one, no power calculations were done. There were inconsistencies in the measurement of pain and heterogeneity of rhinological procedures. The one adequately powered trial could not demonstrate a difference in post-operative nausea and vomiting with the use of throat packs (β error = 20 per cent).

Further, adequately powered trials are required involving patients undergoing rhinological procedures with a higher risk of blood contamination (e.g. functional endoscopic sinus surgery), in order to provide definitive evidence on the morbidity of throat packs in rhinological procedures.

A single cardiac troponin I (cTnI) 24-h measurement is an independent predictor of short- and long-term adverse outcome after coronary surgery. We compared a single cTnI 24-h measurement and kinetic analysis of cTnI release in predicting in-hospital outcome in unselected cardiac surgery patients.

Consecutive patients (n = 184) undergoing cardiac surgery with cardiopulmonary bypass were included and divided into two groups according to the time course of postoperative peak serum cTnI (6 or 24 h after surgery). Serial measurements of cTnI were performed the day before surgery, at the end of surgery and 6, 24 and 120 h after surgery in all patients. The total amount of cTnI released (integrated area under the curve), postoperative major adverse cardiac events (ventricular arrhythmias, myocardial infarction and congestive heart failure) and in-hospital death were recorded. Data are expressed as median (95% CI).

In all, 152 (83%) patients had an early peak cTnI (6 h after surgery) and 32 (17%) patients had a late peak cTnI (24 h after surgery). The integrated area under the curve differed between both groups: 159 (142–178) vs. 321 (255–590), respectively, P < 0.001. Major adverse cardiac events and/or death (22 vs. 9%, P = 0.04) was greater in patients with a late peak cTnI. The integrated area under the curve and the peak value of cTnI were no more accurate than a single 24-h measurement in predicting the occurrence of major adverse cardiac events and/or death.

Kinetic analysis of cTnI release was no more accurate than a single 24-h measurement in predicting in-hospital poor outcome.

To determine the efficacy and safety of intravenous postoperative morphine titration in the elderly compared with younger patients.

In the post-anaesthesia care unit, patients complaining of pain received morphine until adequate pain relief. Intravenous morphine was titrated as 3 mg boluses in young (age ⩽65 yr) and 2 mg in elderly patients (>65 yr) every 5 min.

We studied 350 young and 68 elderly patients. There were no significant differences between the two age groups for pain intensity at the onset of titration (numerical rating scale, 7.4 ± 1.7 in young vs. 7.5 ± 1.7 in elderly patients), area under the curve of numerical rating scale vs. morphine boluses (97.7 ± 59.6 vs. 98.2 ± 62), number of boluses required to obtain pain relief (3 ± 1.3 vs. 3 ± 1.3), percentage of titration failures (10% vs. 9%) and incidence of excessive sedation (18% vs. 21%). Renal clearance was significantly reduced in elderly compared with young patients (55 ± 21 vs. 85 ± 15 mL min−1; P < 0.0001).

Using lower bolus doses, pain relief in the immediate postoperative period with morphine was as efficacious and safe in elderly patients as in younger patients. The decrease in renal clearance of morphine in the elderly justifies the reduction of intravenous morphine boluses for the treatment of postoperative pain.

The aim of this open, non-controlled, multi-centre study was to evaluate the pharmacokinetics and safety of a 24–72 h continuous epidural ropivacaine infusion in children aged 1–9 yr.

After induction of general anaesthesia, 29 ASA I–II children, scheduled for major surgery in dermatomes below T10 had lumbar epidural catheters placed. A bolus of ropivacaine, 2 mg kg−1, was given over 4 min, followed immediately by an infusion of 2 mg mL−1 ropivacaine 0.4 mg kg−1 h−1 for the next 24–72 h.

Plasma concentrations of total ropivacaine (mean 0.83 and 1.06 mg L−1 at 16–31 and 59–72 h, respectively) and α1-acid-glucoprotein (mean 13 and 25 μmol L−1 at baseline and 59–72 h) increased over the course of the infusion. Plasma concentrations of unbound ropivacaine were stable throughout the epidural infusion (mean 0.021 range 0.011–0.068 and mean 0.016 range 0.009–0.023 mg L−1 at 16–31 and 59–72 h, respectively) and were well below threshold levels associated with central nervous system toxicity in adults (0.35 mg L−1). Apparent unbound clearance (mean 346, range 86–555 mL min−1 kg−1) showed no age-dependency. No signs of systemic toxicity or cardiovascular effects were observed. All patients received additional analgesics with morphine.

Following a 24–72 h epidural infusion of ropivacaine 0.4 mg kg−1 h−1 in 1–9-yr-old children, the plasma concentrations of unbound ropivacaine were stable over time with no age-dependency.

Post-anaesthetic shivering is one of the most common complications, occurring in 5–65% of patients recovering from general anaesthesia and 33% of patients receiving epidural anaesthesia. Our objective was to investigate the efficacy of intraoperative dexmedetomidine infusion on postoperative shivering.

Ninety female patients, ASA I-II, 35–60 yr old, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized into two groups. After endotracheal intubation one group received normal saline infusion and the other received dexmedetomidine as a loading dose of 1 μg kg−1 for 10 min followed by a maintenance infusion of 0.4 μg kg−1 h−1. In the recovery room, pain was assessed using a 100 mm visual analogue scale and those patients who had a pain score of more than 40 mm were administered 1 mg kg−1 intramuscular diclofenac sodium. Patients with shivering grades more than 2 were administered 25 mg intravenous meperidine. Patients were protected with passive insulation covers.

Post-anaesthetic shivering was observed in 21 patients in the saline group and in seven patients in the dexmedetomidine group (P = 0.001). Shivering occurred more often in the saline group. The Ramsay Sedation Scores were higher in the dexmedetomidine group during the first postoperative hour. Pain scores were higher in the saline group for 30 min after the operation. The need for intraoperative atropine was higher in the dexmedetomidine group. Intraoperative fentanyl use was higher in the saline group. Perioperative tympanic temperatures were not different between the groups whereas postoperative measurements were lower in the dexmedetomidine group (P < 0.05).

Intraoperative dexmedetomidine infusion may be effective in the prevention of post-anaesthetic shivering.

Early recovery after anaesthesia is gaining importance in fast track management. The aim of this study was to quantify psychomotor recovery within the first 24 h after propofol/remifentanil anaesthesia using the Short Performance Test (Syndrom Kurztest (SKT)), consisting of nine subtests. The hypothesis was that psychomotor performance remains reduced 24 h after anaesthesia.

Thirty-seven patients scheduled for elective surgery took part in the study. The SKT was performed on the day before general anaesthesia (T0), 10, 30, 90 min and 24 h after extubation (T1). Parallel versions were used to minimize learning effects. Anaesthesia was introduced and maintained with remifentanil/propofol as a target controlled infusion. Propofol plasma concentration was measured 10 and 90 min after extubation. Perioperative pain management included novaminsulfon and piritramide.

Up till 90 min after surgery and anaesthesia, psychomotor performances were significantly reduced as the lower test results in all SKT subtests indicated (P ⩽ 0.007 vs. baseline T0). In the three memory subtests (ST 2, ST 8 and ST 9), psychomotor performance was still reduced on the first postoperative day (P ⩽ 0.005; T1 vs. T0). There was no correlation between propofol plasma concentration and the psychometric test results.

Propofol/remifentanil-based target controlled general anaesthesia for surgery is associated with a reduced psychomotor function up to the first postoperative day. Further studies are needed to confirm the usefulness of the SKT in the perioperative period and to clarify which components in the perioperative period are responsible for a lower performance in the SKT.