Infectious complications remain a major clinical problem in colorectal surgery. Presepsin has been reported to be a useful marker to diagnose sepsis, similar or superior to procalcitonin (PCT) and C-reactive protein (CRP). The aim of this study was to assess the diagnostic value of presepsin in the early detection of infectious complications after elective colorectal surgery, compared with CRP and PCT. This study was a prospective observational study. Patients of age > 18 who underwent elective colon resections were enrolled. Blood samples were collected just before surgery and on postoperative day (POD) 1, 2, 3, 4, and 6 to measure plasma levels of biomarkers. We evaluated the association between circulating biomarkers and infections. A total of 114 patients were examined, and 27 patients (23.7%) developed infectious complications. CRP and PCT markedly increased from POD 1 to POD 3 and then gradually decreased toward POD 6 in both groups, but the trends of the decrease in the infected group were blunt, compared with those in the non-infected group. On the other hand, presepsin did not show major changes just after surgery, but it increased on POD 4 and POD 6, when the complications occurred. Monitoring the presepsin trends after colorectal surgeries could be helpful to detect postoperative infectious complications.Trial registration: UMIN000025313. Registered on 17 December 2016.

The findings suggest that blunting the increase in PI by maintaining arterial pressure during induction of anesthesia improves the agreement between SpHb and tHb values.

BackgroundHyperventilation syndrome (HVS) sometimes occurs in patients under stressful conditions and may provoke severe complications such as myocardial infarction and death. The authors report a case of HVS following general anesthesia, where a continuous intravenous infusion of dexmedetomidine was effective for HVS.Case presentationA 23-year-old male patient with recurrent tongue cancer was scheduled to undergo partial glossectomy and neck dissection. Emergence from general anesthesia was prompt. Twenty-two minutes after extubation, the patient complained of unbearable distress caused by the urinary catheter. He began to cry, with an increased respiratory rate of over 40 breaths per minute. Intravenous infusion of flurbiprofen, droperidol, and morphine was not effective. Electrocardiography and laryngofiberscopy indicated the absence of acute coronary syndrome and airway obstruction, respectively. An arterial blood gas determination showed pH 7.63, PaCO2 18.2 mmHg, PaO2 143 mmHg on O2 mask 4 L/min, Ca2+ 4.29 mmol/L, and lactate 3.4 mmol/L. The patient was diagnosed with HVS. Dexmedetomidine infusion 2.0 μg/kg/h for 10 min followed by 0.7 μg/kg/h reduced respiratory rate, suppressed arousal, and disappeared the complaint of bladder distension. One hour after extubation, an arterial blood gas determination showed pH 7.33, PaCO2 51.3 mmHg, PaO2 196 mmHg on O2 mask 4 L/min, Ca2+ 4.70 mmol/L, and lactate 1.5 mmol/L. After admission to the intensive care unit, dexmedetomidine infusion was maintained at the rate of 0.2 to 0.7 μg/kg/h until the following morning, and he did not complain of distress caused by the urinary catheter.ConclusionsHVS can occur after emergence from general anesthesia, and dexmedetomidine infusion was effective for HVS.

Background: Infectious complications remain a major clinical problem in colorectal surgery, contributing to prolonged hospital stays, additional costs and significant postoperative mortality. Presepsin has been reported to be a useful marker to diagnose sepsis, similar or superior to procalcitonin (PCT) and C-reactive protein (CRP), and plasma presepsin concentrations are associated with the severity of sepsis and its outcome. The aim of this study was to assess the diagnostic value of presepsin in the early detection of infectious complications after elective colorectal surgery, compared with CRP and PCT.Methods: This study was a prospective observational study. Patients of age >18 who underwent elective colon resections were enrolled and patients with end-stage kidney disease were excluded. Blood samples were collected just before surgery and on postoperative day (POD) 1, 2, 3, 4, and 6. Infectious complications were diagnosed by surgeons. Results: A total of 114 patients were examined, and 27 patients (23.7%) developed infectious complications: 11 anastomotic leaks, 13 intra-abdominal infections, and 3 wound infections. CRP and PCT markedly increased from POD1 to POD3 and then gradually decreased toward POD6 in both groups, but the trends of the decrease in the infected group were blunt, compared with those in the non-infected group. On the other hand, presepsin did not show major changes just after surgery, but it increased on POD4 and POD6, when the complications occurred. ROC analysis to predict infectious complications revealed that the best accuracy was obtained on POD 6 for all biomarkers. CRP showed excellent predictability and presepsin showed good predictability. However, the cut-off values of all biomarkers were relatively lower than expected. Conclusions: The trends of change in presepsin following colorectal surgeries were distinct from those of CRP and PCT. Monitoring the presepsin trends after colorectal surgeries could be helpful to detect postoperative infectious complications.Trial registration: UMIN000025313. Registered on 17 December 2016.

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