Among adults undergoing major surgery, complete handover of intraoperative anesthesia care compared with no handover was associated with a higher risk of adverse postoperative outcomes. These findings may support limiting complete anesthesia handovers.

In patients with pre-existing PHT undergoing mitral valve surgery, inhaled iloprost is superior to intravenous nitrogylycerine by acting as a selective pulmonary vasodilator, reducing RV afterload and moderately improving RV-pump performance.

Previously, we have shown that small arterial trauma is accompanied by a decreased capability of both toll-like receptors (TLRs) 2 and 4 to respond to stimulation with their respective ligands Pam3Cys and LPS. In this study, we assessed whether surgical arterial trauma induces a decrease in the TLR response and investigated the time course of the altered responsiveness. In addition, TLR responsiveness was related to baseline patient characteristics. Patients undergoing arterial surgery were included in the study. Patients undergoing pacemaker replacement served as control. Blood samples were drawn before, during, and immediately after vascular surgery and 24 h postoperatively. In all samples, we measured TLR-2 and TLR-4 expression using flow cytometry. Whole-blood samples were incubated with 5, 50, and 500 ng/mL Pam3Cys and with 1, 10, and 100 ng/mL LPS. Toll-like receptor response was assessed by measuring TNF-alpha in the supernatant with an enzyme-linked immune fluorescent assay. We observed a dose-dependent response in TNF-alpha production after stimulation with both LPS and Pam3Cys (P < 0.001). The TLR response decreased significantly after arterial trauma (P = 0.022). This effect on TLR response persisted in the 24-h postoperative period, whereas no such effect was observed in the control group. Toll-like receptor 2 expression decreased significantly immediately after surgery (P = 0.005) but increased 24 h after surgery (P < 0.001). Furthermore, an inverse relation between the TLR response and smoking was observed (P = 0.026). Toll-like receptor 2 and 4 response declines rapidly after arterial trauma in patients undergoing vascular surgery. These results point to a significant role for TLRs in the induction of postoperative immune tolerance. Furthermore, smoking is negatively related to baseline TLR response.

Soluble ST2 increases significantly following cardiovascular interventions. The notion of a recent cardiovascular intervention is a strong determinant of sST2 levels and therefore needs to be taken into account when exploring sST2 as predictor of future cardiovascular events.

Clinicaltrials.gov identifier: NCT00356746.