Effects of low-dose intraoperative fentanyl on postoperative respiratory complication rate: a pre-specified, retrospective analysis

Friedrich, Sabine; Raub, Dana; Teja, Bijan; Neves, Sara E.; Thevathasan, Tharusan; Houle, Timothy T.; Eikermann, Matthias

doi:10.1016/j.bja.2019.03.017

Cited by 32 publications

(28 citation statements)

References 29 publications

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“…Furthermore, we considered surgical complexity as quantified by the procedural severity score . Intra‐operative candidate variables were selected a priori based on recent literature, biological plausibility and clinical reasoning and included: desaturation (S p O 2 ≤ 90%) 5 min after tracheal intubation ; duration of surgery; median fraction of inspired oxygen (F I O 2 ) ; noradrenaline equivalent dose of vasopressors; dose of neuromuscular blocking agents (NMBA) (expressed as multiples of NMBA dose needed to reduce twitch height by 95%) ; fluid volume ; oral morphine equivalent dose ; total administered fentanyl dose; intra‐operative transfusion of packed red blood cells; use of volatile anaesthetic agents ; and the absence of lung‐protective ventilation (defined as driving pressure [plateau pressure – positive end‐expiratory pressure (PEEP)] > 15 mmHg) .…”

Section: Methodsmentioning

confidence: 99%

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

et al. 2019

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Postoperative pulmonary complications are associated with an increase in mortality, morbidity and healthcare utilisation. The Agency for Healthcare Research and Quality recommends risk assessment for postoperative respiratory complications in patients undergoing surgery. In this hospital registry study of adult patients undergoing non-cardiac surgery between 2005 and 2017 at two independent healthcare networks, a prediction instrument for early postoperative tracheal re-intubation was developed and externally validated. This was based on the development of the Score for Prediction Of Postoperative Respiratory Complications. For predictor selection, stepwise backward logistic regression and bootstrap resampling were applied. Development and validation cohorts were represented by 90,893 patients at Partners Healthcare and 67,046 patients at Beth Israel Deaconess Medical Center, of whom 699 (0.8%) and 587 (0.9%) patients, respectively, had their tracheas reintubated. In addition to five pre-operative predictors identified in the Score for Prediction Of Postoperative Respiratory Complications, the final model included seven additional intra-operative predictors: early posttracheal intubation desaturation; prolonged duration of surgery; high fraction of inspired oxygen; high vasopressor dose; blood transfusion; the absence of volatile anaesthetic use; and the absence of lung-protective ventilation. The area under the receiver operating characteristic curve for the new score was significantly greater than that of the original Score for Prediction Of Postoperative Respiratory Complications (0.84 [95%CI 0.82-0.85] vs. 0.76 [95%CI 0.75-0.78], respectively; p < 0.001). This may allow clinicians to develop and implement strategies to decrease the risk of early postoperative tracheal re-intubation.

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Section: Methodsmentioning

confidence: 99%

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

et al. 2019

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“…Our results showed a significant difference in intraoperative opioid consumption between the two groups, and it could be argued that the lower opioid consumption in the sevoflurane group is caused by the analgesic effect of sevoflurane, 33,34 and intraoperative opioid savings are thought to play a role in lower rates of PPCs development. 35 However, the multivariate analysis in this study showed that intraoperative opioid dosage did not affect PPCs, which may be correlated with the overall dose being a low dose, requiring further large-sample studies. 36 In addition, the amount of urine was significantly greater in the propofol group, but there is no evidence showing that the amount of urine is associated with PPCs.…”

Section: Discussionmentioning

confidence: 59%

Comparison of the effects of intravenous and inhalational anesthesia on postoperative pulmonary complications after oral and maxillofacial surgery with free flap reconstruction: a double-blind, randomized, controlled trial

Zhou¹,

Zhu²,

Wang³

et al. 2019

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Background: The effects of intravenous and inhalation anesthesia on intraoperative and postoperative pulmonary inflammatory responses have been reported in many studies. The differences in clinical postoperative pulmonary complications (PPCs) have been also studied in cardiac and lung resection surgery. However, there are few relevant reports and the findings remain controversial. Clinical evidence for the effects of these two anesthetics on PPCs in other types of surgery is still missing. The main goal of the current study was to assess the impact of sevoflurane and propofol on the incidence of PPCs in patients undergoing oral and maxillofacial surgery. Methods: In this double-blind, randomized, controlled trial, we randomly assigned 220 adults at intermediate-to-high risk of pulmonary complications after oral and maxillofacial cancer surgery with radial forearm or fibular flap reconstruction to either propofol or sevoflurane as a general anesthetic. The occurrence of pulmonary complications according to the Clavien-Dindo score was defined as the primary (within 7 days after surgery) outcome. Results: The two intervention groups had similar characteristics at baseline. The PPCs incidence during 7 days after surgery was 32.4% and 18.2% in the propofol and sevoflurane groups, respectively (adjusted relative risk, 0.44; 95% confidence interval [CI], 0.22 to 0.91; P = 0.027). The corresponding incidence of PPCs in patients who underwent tracheotomy at the end of surgery in the two groups was 44.8% and 24.5% (adjusted relative risk, 0.39; 95% CI, 0.17 to 0.91; P = 0.030). In addition, the Clavien-Dindo classification showed significant differences between groups in minor complications (grade I and II) but not in major complications (grade III to V). Intergroup difference in the time to occurrence of the first PPC after surgery was significant (P = 0.021). There was no difference in postoperative hospital stay between the two groups. Conclusions: Compared with intravenous anesthesia, the administration of sevoflurane reduces the incidence of minor PPCs (grade I to II) in moderate- and high-risk patients who have undergone tracheotomy after oral and maxillofacial cancer surgery with radial forearm or fibular flap reconstruction.

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“…Our results showed a significant difference in intraoperative opioid consumption between the two groups, and it could be argued that the lower opioid consumption in the sevoflurane group is caused by the analgesic effect of sevoflurane, 28,29 and intraoperative opioid savings are thought to play a role in lower rates of PPCs development. 30 However, the multivariate analysis in this study showed that intraoperative opioid dosage did not affect PPCs, which may be correlated with the overall dose being a low dose, requiring further large-sample studies. 31 In addition, the amount of urine was This study was a single-center study, and the sample size was not large enough.…”

mentioning

confidence: 59%

Comparison of the effects of intravenous and inhalational anesthesia on postoperative pulmonary complications after oral and maxillofacial surgery with free flap reconstruction: a double-blind, randomized, controlled trial

Zhou

Zhu²,

Wang

et al. 2019

Preprint

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Background: The effects of intravenous and inhalation anesthesia on intraoperative and postoperative pulmonary inflammatory responses have been reported in many studies. However, the differences in clinical postoperative pulmonary complications (PPCs) have rarely been studied, except in cases of lung resection. The main goal of the current study was to assess the impact of sevoflurane and propofol on the incidence of PPCs in patients undergoing oral and maxillofacial surgery. Methods: In this double-blind, randomized, controlled trial, we randomly assigned 220 adults at intermediate-to-high risk of pulmonary complications after oral and maxillofacial surgery to either propofol or sevoflurane as a general anesthetic. The occurrence of pulmonary complications according to the Clavien-Dindo score was defined as the primary (within 7 days after surgery) outcome. Results: The two intervention groups had similar characteristics at baseline. The PPCs incidence during 7 days after surgery was 32.4% and 18.2% in the propofol and sevoflurane groups, respectively (adjusted relative risk, 0.44; 95% confidence interval [CI], 0.22 to 0.91; P = 0.027). The corresponding incidence of PPCs in patients who underwent tracheotomy after surgery was 44.8% and 24.5% (adjusted relative risk, 0.39; 95% CI, 0.17 to 0.91; P = 0.030). Intergroup difference in the time to occurrence of the first PPC after surgery was significant (P = 0.021). There was no difference in postoperative hospital stay between the two groups. Conclusions: Compared with intravenous anesthesia, the administration of sevoflurane reduces the frequency of PPCs in intermediate-risk and high-risk patients undergoing oral and maxillofacial surgery with microvascular reconstruction. Trial registration: Clinical Trail Registration: ChiCTR1800015347; Registered March 25, 2018.

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Effects of low-dose intraoperative fentanyl on postoperative respiratory complication rate: a pre-specified, retrospective analysis

Cited by 32 publications

References 29 publications

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

Comparison of the effects of intravenous and inhalational anesthesia on postoperative pulmonary complications after oral and maxillofacial surgery with free flap reconstruction: a double-blind, randomized, controlled trial

Comparison of the effects of intravenous and inhalational anesthesia on postoperative pulmonary complications after oral and maxillofacial surgery with free flap reconstruction: a double-blind, randomized, controlled trial

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