Stroke volume variation (SVV) has been used to predict fluid responsiveness; however, it remains unclear whether goal-directed fluid therapy using SVV contributes to bowel function recovery in abdominal surgery. This prospective randomized controlled trial aimed to compare bowel movement recovery in patients undergoing colon resection surgery between groups using traditional or SVV-based methods for intravenous fluid management. We collected data between March 2015 and July 2017. Bowel function recovery was analyzed based on the gas-passing time, sips of water time, and soft diet (SD) time. Finally, we analyzed data from 60 patients. There was no significant between-group difference in the patients’ characteristics. Compared with the control group (n = 30), the SVV group (n = 30) had a significantly higher colloid volume and lower crystalloid volume. Moreover, the gas-passing time (77.8 vs. 85.3 h, p = 0.034) and SD time (67.6 vs. 85.1 h, p < 0.001) were significantly faster in the SVV group than in the control group. Compared with the control group, the SVV group showed significantly lower scores of pain on a numeric rating scale and morphine equivalent doses during post-anesthetic care, at 24 postoperative hours, and at 48 postoperative hours. Our findings suggested that, compared with the control group, the SVV group showed a faster postoperative SD time, reduced acute postoperative pain intensity, and lower rescue analgesics. Therefore, SVV-based optimal fluid management is expected to potentially contribute to postoperative bowel function recovery in patients undergoing colon resection surgery.

Simple, convenient, and reliable preoperative prognostic indicators are needed to estimate the future risk of recurrences and guide the treatment decisions associated with breast cancer. We evaluated preoperative hematological markers related to recurrence and mortality and investigated independent risk factors for recurrence and mortality in patients after breast cancer surgery. We reviewed electronic medical records of patients with invasive breast cancer diagnosed at our tertiary institution between November 2005 and December 2010 and followed them until 2015. We compared two groups of patients classified according to recurrence or death and identified risk factors for postoperative outcomes. Data from 1783 patients were analyzed ultimately. Cancer antigen (CA) 15-3 and red cell distribution width (RDW) had the highest area under the curve values among several preoperative hematological markers for disease-free survival and overall survival (0.590 and 0.637, respectively). Patients with both preoperative CA 15-3 levels over 11.4 and RDW over 13.5 had a 1.7-fold higher risk of recurrence (hazard ratio (HR): 1.655; 95% confidence interval (CI): 1.154–2.374; p = 0.007) and mortality (HR: 1.723; 95% CI: 1.098–2.704; p = 0.019). In conclusion, relatively high preoperative RDW (>13.5) and CA 15-3 levels (>11.4) had the highest predictive power for mortality and recurrence, respectively. When RDW and CA 15-3 exceeded the cut-off value, the risk of recurrence and death also increased approximately 1.7 times.

Purpose: Chronic low back pain is prevalent among older adults, who are at a higher risk for sarcopenia. The waist-to-calf circumference ratio has emerged as a health indicator, reflecting the balance between central adiposity and muscle mass. This study examined the association between waist-to-calf circumference ratio and sarcopenia, as well as factors like muscle mass, strength, and physical performance in older patients with chronic low back pain. Patients and Methods: Ambulatory patients aged 65 years and older with chronic low back pain were included. Sarcopenia was assessed using the 2019 diagnostic criteria from the Asian Working Group for Sarcopenia. We compared demographic data, pain-related factors, comorbidities, and measurements related to sarcopenia and obesity across quartiles of the waist-to-calf circumference ratio. The prevalence of sarcopenia and severe sarcopenia was investigated, and multivariable analysis was conducted to identify independent factors associated with sarcopenia. Results: Among 592 patients, 85 had sarcopenia (14.3%), and 71 had severe sarcopenia (11.9%). Patients with a high waist–calf circumference ratio had more comorbidities and longer pain duration. The prevalence of severe sarcopenia increased with higher quartile of waist–calf circumference ratio (Q1=7.9%, Q2=8.6%, Q3=14.8%, Q4=16.9%, P=0.006). When recommended cut-off values for the parameters used to diagnose sarcopenia were applied, the numbers of patients with low grip strength and low physical performance but not low muscle mass were greater among patients with a high waist–calf circumference ratio. Also, a high waist–calf circumference ratio was significantly associated with severe sarcopenia. Conclusion: In older patients with chronic low back pain, a high waist–calf circumference ratio was associated with severe sarcopenia, characterized by reduced muscle strength and impaired physical performance. The waist–calf circumference ratio might serve as a useful tool for assessing sarcopenia in this population.

Lee CE, et al. Yonsei Med J. 2024 May;65:e25. https://doi.org/10.3349/ymj.2023.0294

Background: Neuromuscular blocking agents (NMBAs) are the leading cause of perioperative anaphylaxis. In confirmed cases with limited non-cross-reactive options, safe anesthesia requires coordination and muscle relaxant-free strategies.Case: A 64-year-old woman with confirmed rocuronium-induced anaphylaxis and multiple comorbidities—including poorly controlled diabetes, coronary artery disease, chronic obstructive pulmonary disease, and obesity—underwent laparoscopic anterior resection of the sigmoid colon. General anesthesia was induced and maintained without muscle relaxants using total intravenous anesthesia and regional blocks. Airway topicalization and deep anesthesia enabled smooth intubation. Bilateral transversus abdominis plane and rectus sheath blocks provided effective somatic analgesia and abdominal relaxation. Ventilation and hemodynamic parameters remained stable throughout. The patient recovered uneventfully, without agitation or delayed arousal, and was discharged uneventfully on postoperative day 5.Conclusions: This report describes the feasibility of NMBA-free general anesthesia using intravenous agents and targeted regional blocks in high-risk patients with confirmed anaphylaxis, even in laparoscopic procedures.

Background and Objectives: Robot-assisted direct-to-implant breast reconstruction involves procedural factors that may affect intraoperative hemodynamics, including prolonged surgery, semi-sitting positioning, and subcutaneous carbon dioxide insufflation. This study compared vasopressor requirements and hemodynamic profiles between remimazolam-based total intravenous anesthesia (TIVA) and propofol–sevoflurane anesthesia. Materials and Methods: This retrospective cohort study included 46 patients who underwent robot-assisted direct-to-implant breast reconstruction. Of these, 20 received propofol–sevoflurane anesthesia, and 26 received remimazolam-based TIVA. The primary outcome was total intraoperative norepinephrine consumption. Secondary outcomes included vasopressor infusion duration, time from induction to vasopressor initiation, incidence of hypotension, hemodynamic profiles analyzed using linear mixed-effects models, postoperative pain scores, and reconstructive outcomes. Results: Total norepinephrine consumption was significantly lower in the remimazolam group than in the propofol–sevoflurane group (median, 123.2 [interquartile range, 62.4–176.4] vs. 580.0 [338.8–790.4] µg; p < 0.001). The remimazolam group also had a shorter vasopressor infusion duration (67.7 ± 40.0 vs. 176.3 ± 66.4 min; p < 0.001), a longer vasopressor-free interval from induction (median, 140 vs. 25 min; log-rank p < 0.001), and a lower incidence of hypotension, defined as mean arterial pressure (MAP) < 65 mmHg (46.2% vs. 80.0%; p = 0.032). After adjustment for age, body mass index, and anesthesia time, remimazolam-based anesthesia remained associated with lower norepinephrine consumption (B = −515.4 µg; p < 0.001). MAP and heart rate (HR) showed no significant between-group differences over time, and neither the estimated duration nor time-weighted average (TWA) below MAP 65 mmHg differed significantly. Conclusions: In this retrospective cohort, a remimazolam-based TIVA strategy was associated with lower recorded intraoperative norepinephrine use than a propofol–sevoflurane strategy. No significant between-group differences in serial MAP or HR were detected. These associations warrant confirmation in prospective trials with standardized protocols.