Background The goal of this study was to detect the predictors of chronic pain at 6 months after thoracic surgery from a comprehensive evaluation of demographic, psychosocial, and surgical factors. Methods Thoracic surgery patients were enrolled 1 week before surgery and followed up 6 months postsurgery in this prospective, observational study. Comprehensive psychosocial measurements were assessed before surgery. The presence and severity of pain were assessed at 3 and 6 months after surgery. One hundred seven patients were assessed during the first 3 days after surgery, and 99 (30 thoracotomy and 69 video-assisted thoracoscopic surgery, thoracoscopy) patients completed the 6-month follow-up. Patients with versus without chronic pain related to thoracic surgery at 6 months were compared. Results Both incidence (P = 0.37) and severity (P = 0.97) of surgery-related chronic pain at 6 months were similar after thoracotomy (33%; 95% CI, 17 to 53%; 3.3 ± 2.1) and thoracoscopy (25%; 95% CI, 15 to 36%; 3.3 ± 1.7). Both frequentist and Bayesian multivariate models revealed that the severity of acute pain (numerical rating scale, 0 to 10) is the measure associated with chronic pain related to thoracic surgery. Psychosocial factors and quantitative sensory testing were not predictive. Conclusions There was no difference in the incidence and severity of chronic pain at 6 months in patients undergoing thoracotomy versus thoracoscopy. Unlike other postsurgical pain conditions, none of the preoperative psychosocial measurements were associated with chronic pain after thoracic surgery.

Desflurane reduces the average extubation time and the variability of extubation time by 20%-25% relative to sevoflurane. The principal economic value of these end points is their reductions of direct (labor) costs of OR time. However, reductions in intangible costs of prolonged extubation are real, being associated with subsequent delays. Reductions in the average and variance of times to extubation can be interpreted and monitored in terms of corresponding expected 75% reductions in the incidences of prolonged extubation times by using desflurane relative to sevoflurane.

No abstract

Background: Although studies in neonatal animals show that anesthetics have neurotoxic effects, relevant human evidence is limited. We examined whether children who had surgery during infancy showed deficits in academic achievement. Methods: We attempted to contact parents of 577 children who, during infancy, had one of three operations typically performed in otherwise healthy children. We compared scores on academic achievement tests with population norms. Results: Composite scores were available for 287 patients. The mean normal curve equivalent score was 43.0 Ϯ 22.4 (mean Ϯ SD), lower than the expected normative value of 50, P Ͻ 0.0001 by one-sample Student t test; and 35 (12%) had scores below the 5th percentile, more than expected, P Ͻ 0.00001 by binomial test. Of 133 patients who consented to participate so that their scores could be examined in relation to their medical records, the mean score was 45.9 Ϯ 22.9, P ϭ 0.0411; and 15 (11%) scored below the 5th percentile, P ϭ 0.0039. Of 58 patients whose medical records showed no central nervous system problems/potential risk factors during infancy, 8 (14%) scored below the 5th percentile, P ϭ 0.008; however, the mean score, 47.6 Ϯ 23.4, was not significantly lower than expected, P ϭ 0.441. Duration of anesthesia and surgery correlated negatively with scores (r ϭ Ϫ0.34, N ϭ 58, P ϭ 0.0101).