Lumbar epidural analgesia (LEA) is the most widely used method in reducing labor pain. Previous RCTs have shown that LEA does not increase cesarean section rates; however, the results are inconsistent and may vary depending on the different backgrounds. Therefore, we aimed to study whether LEA would affect the course of labor in our institute. Delivery records from October 2013 to April 2016 were collected. Deliveries at gestational age < 36 weeks and multiple pregnancies were excluded. All cases were divided into the non-epidural labor (NEL) group or the epidural labor (EL) group. We performed a propensity score matching analysis to balance intergroup differences. Our primary outcome was a mode of delivery (spontaneous, assisted vaginal, cesarean). Secondary outcomes were lengths of labor and outcomes of the neonates. During the study period, 2632 cases met the inclusion criteria. All analyses were performed after propensity score matching (218 pairs). The percentage of assisted vaginal delivery increased by the use of LEA (11.5% in NEL group vs 25.7% in EL group; p < 0.001), but the rate of cesarean section was similar (12.8% vs 17.0%; p = 0.23). The durations of the first and second stages of labor were prolonged by the use of LEA in both primipara and multipara women. Outcomes of the neonates were similar in both groups. Use of LEA did not increase the rate of cesarean section when analyzed by propensity score-matched analysis in our institute.

Postoperative nausea and vomiting (PONV) are major complications after general anesthesia. Although various pathways are involved in triggering PONV, hypotension plays an important role. We hypothesized that intraoperative hypotension during general anesthesia might be responsible for the incidence of PONV. We retrospectively investigated patients who underwent thyroidectomy. The initial blood pressure measured before induction of anesthesia was used as the baseline value. The systolic blood pressure measured during the operation from the start to the end of anesthesia was extracted from anesthetic records. The time integral value when the measured systolic blood pressure fell below the baseline value was calculated as area under the curve (AUC) of s100%. There were 247 eligible cases. Eighty-eight patients (35.6%) had PONV. There was no difference in patient background between the patients with or without PONV. Univariate analysis showed that the total intravenous anesthesia (TIVA) (p=0.02), smoking history (p=0.02), and AUC-s100% (p=0.006) were significantly associated with PONV. Multiple logistic regression analysis revealed that TIVA (OR: 0.54, 95% CI: 0.29...0.99), smoking history (OR: 0.60, 95% CI: 0.37...0.96), and AUC-s100% (OR: 1.006, 95% CI: 1.0...1.01) were significantly associated with PONV. Intraoperative hypotension evaluated by AUC-s100% was related to PONV in thyroidectomy.

The association of frailty with postoperative delirium has not been fully investigated in patients undergoing cardiovascular surgery. Therefore, this study aimed to investigate whether preoperative hand grip strength is associated with postoperative delirium. This retrospective study included patients aged >65 years who had undergone elective cardiovascular surgery using cardiopulmonary bypass at a Japanese university hospital between April 2020 and February 2022. We defined low hand grip strength as hand grip values of <275 n and <177 n for men and women, respectively. Postoperative delirium was assessed using the confusion assessment method during patients’ intensive care unit stay. The odds ratio of low hand grip strength for postoperative delirium was estimated using multiple logistic analysis, which was adjusted for prominent clinical factors. Ninety-five patients with a median age of 74 years were included in the final analysis, and 31.5% of them had low hand grip strength. Postoperative delirium occurred in 37% of patients, and the odds ratio of low preoperative hand grip strength for postoperative delirium was 4.58 (95% confidence interval: 1.57–13.2). Thirty-seven patients experienced postoperative delirium after cardiovascular surgery using cardiopulmonary bypass, and low preoperative hand grip strength was positively associated with its occurrence.