Background: Pulmonary aspiration in patients undergoing general anesthesia is a significant complication. Adequate fasting periods and an empty stomach preoperatively are crucial for preventing pulmonary aspiration. With limited evidence suggesting no significant difference in gastric emptying times between pregnant and nonpregnant populations, many anesthesiologists still consider pregnant patients to have “full stomachs”, despite the lack of clear guidelines on fasting periods for pregnant women. Methods: Forty-two term pregnant patients and 42 nonpregnant patients were included in the study. Ultrasonography was performed 15 minutes before surgery to measure gastric antrum dimensions, and the stomach contents (empty, liquid, or solid) were recorded. Using the cross-sectional area (CSA), the antrum volume was calculated based on Perlas formula (mL = 27.0 + 14.6 × CSA − 1.28 × age), and differences between the groups were analyzed. Results: Empty stomach (8/42 = 19% versus 34/42 = 81%), liquid content (16/42 = 38% versus 7/42 = 17%), and solid content (18/42 = 43% versus 1/42 = 2%) differed (p < 0.001) between the pregnant and nonpregnant patients. Antrum dimensions and antrum volumes were different as well (p < 0.001). Conclusions: The gastric emptying rate of pregnant patients differs from that of the normal population, which should be considered when evaluating patients on the operating table.

This retrospective observational study investigates the predictive value of inflammatory indices Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR) and Systemic Inflammatory Index (SII) for detecting gallstones and forecasting outcomes in patients with acute cholecystitis (AC). Conducted from 01 September 2022, to 01 September 2023, the research involved patients aged 18 and older diagnosed with AC in an emergency department, excluding those with overlapping pathologies or insufficient data. The study employed hemogram-based indices to explore their correlation with the presence of gallstones and the severity of AC, assessing outcomes such as hospitalization duration and the necessity for surgical intervention. Findings demonstrated that high NLR and SII values significantly correlated with severe outcomes and increased hospitalization rates, while SII exhibited the highest accuracy in predicting mortality. Moreover, the study uniquely identified the Systemic Inflammatory Response Index (SIRI) as a significant marker for gallstone presence. In conclusion, inflammatory indices like NLR, PLR and SII can be practical prognostic tools in managing AC, potentially guiding clinical decisions regarding immediate surgical needs and overall patient management. This suggests a broader application for these indices in emergency and surgical settings, improving diagnostic accuracy and treatment strategies.

The supine position in unconscious patients resulted in the tongue falling back because of the loss of muscle tension which obstructed the upper airway. The head reclination opened the airway, however unexperienced rescuers faced difficulties in performing bag-valve-mask ventilation as it was hard to detect the optimal head position for opening the airway. The bag-valve-mask ventilation could be optimized if it indicated an optimized head angle to the rescuer. A digital sensor was attached to the face mask for measuring the degree of head reclination. Moreover, the face mask was equipped with an airway trainer and sealed via adhesive tape. The airway trainer was connected to a test lung and ventilated through pressure-controlled standard anesthesia machine (Pmax = 10 mbar, Positive End Expiratory Pressure (PEEP) = 0 mbar, f = 12/min). The head of airway manikin was tilted to 42 degrees starting from neutral position with a gradient of 2 degrees. The primary endpoint was the correlation of preset angles and digitally measured head position angles via the mask. In addition, the tidal and minute volumes were evaluated based on the head reclination. The preset and the digitally measured head position angles depicted correlation (R2 = 0.9895855684; p < 0.001). The tidal volume was 150 mL in head position angle of <10 degrees, 200 mL at 18 degrees, 450 mL at 25 degrees, and it levelled with about 500 mL at 30 degrees. In conclusion, digital head position angle was measured to detect the correct head position. A signal in the face mask could indicate the optimized head position to the first respondents or inexperienced rescuers in emergency ventilation.

In this study, we retrospectively performed a review of medical records of all patients who underwent scoliosis surgery between January 2018 and January 2021. A total of 165 patients were included; (64.2% were female and the mean age was 21.6 ± 16.7 years). The most frequent aetiologies of scoliosis were idiopathic, congenital, degenerative and neuromuscular. In 48 patients who required Intensive Care Unit (ICU) stay, the rate of comorbidity was 75% (n = 36); lung disease was present in 54% (n = 26) of cases and restrictive lung disease was present in 47.9% of cases (n = 23), which were significantly higher than those who did not require ICU stay (p < 0.001). The proportion of patients with neuromuscular problems was 45.8% (n = 22) (p = 0.004) while those with epilepsy was 16.7% (n = 8) (p = 0.027). The proportion of patients with neuromuscular scoliosis was 25% (n = 12), the median number of fused vertebrae (fusion level) was 15, and the proportion of American Society of Anaesthesiologists (ASA) III patients was 54.2%(n = 26) (all p < 0.001). The median surgical duration was 307.5 minutes (p = 0.006) and the proportion of patients which received blood transfusion was 91.7% (n = 44) (p = 0.002). The pre- and post-operative haemoglobin (Hb) levels, and the post-operative arteriel blood gases (ABG) potential of hydrogen (pH) and lactate levels of patients, who needed ICU were significantly different from those who did not require the ICU (p = 0.043, p = 0.039, p < 0.001 and p = 0.037). In conclusion, a presence of restrictive lung disease, epilepsy, neuromuscular scoliosis, a high fusion level, a need for blood transfusion, long surgical duration, low Hb and pH values, and high lactate levels were found as the predictors of ICU admission.

Though chest radiography is a first-line diagnostic tool in the emergency department (ED), interpretation has a high error rate. We aimed to evaluate the usability and acceptability of deep learning-based computer-aided detection for chest radiography (DeepCADCR) in an ED environment. We conducted a single-institution survey of emergency physicians (EPs) who had used DeepCADCR (Lunit INSIGHT Chest Xray (CXR), version 3.1.4.1) as part of their ED workflow for at least three months. We developed 22 questions that assessed the subscales of effectiveness, efficiency, safety, satisfaction, and reliability. A seven-point Likert agreement scale was used to rate the responses. A total of 23 EPs who completed the survey was enrolled in the study. When averaged by subscale, satisfaction scores were highest (mean 4.71, standard deviation (SD) 1.43), and safety scores were lowest (mean 4.3, SD 0.72). When scores were converted to acceptability, the total average acceptance of DeepCADCR was 86.0%, with higher scores in ED residents than ED specialists for all subscales. Use of DeepCADCR in the ED workflow was well accepted by EPs.

The traditional axillary perineural (PN) approach for brachial plexus block is frequently used, but separate musculocutaneous nerve (MCN) block is required and increases procedure time and patient discomfort. We hypothesized that a block using the proximal perivascular (PPV) method at the MCN branching from the lateral cord would obviate the need for an MCN block while ensuring a quality similar to that of the PN method. For the PN group (n = 25), a needle was placed on each nerve, and 8 mL local anesthetic was infiltrated around the radial, ulnar, and median nerves (total: 24 mL). We then injected 6 mL local anesthetic around the MCN. In the PPV group (n = 25), we moved the probe proximally until the branching junction of the the MCN in the lateral cord. The needle tips were placed in the 12-o’clock and 6-o’clock positions of the axillary artery, and 15 mL local anesthetic was injected (total: 30 mL). The procedure time, number of needle passes, procedure-related complications, sensory/motor block level, and onset time were recorded. The PPV group had a significantly shorter procedure time than the PN group (3.9 ± 1.0 vs. 7.5 ± 3.3 min, p < 0.001). Furthermore, the PPV group required fewer needle passes. The PN group showed a significantly faster onset time than the PPV group (6.4 ± 2.7 vs. 10.4 ± 2.9 min, p < 0.001). The induction time did not show significant intergroup difference. Sensory blockade in the PN group occurred significantly faster than that in the PPV group at 5 and 10 min. There were no significant differences in motor nerve paralysis. PPV axillary block under ultrasound guidance was as effective as the PN axillary block. Therefore, the PPV axillary block is a simple, safe and effective regional technique for upper limb surgery.

No universal definitions have been proposed for non-urgent emergency department (ED) patients. Robust evidence on safety issues and the subsequent utilisation of health care services among diverted patients is insufficient. The aim of this study was to establish the revisit rate within 7 days, as well as the 30-day mortality and outcome of patients diverted by triage. An observational single-centre retrospective study was conducted at the Tampere University Hospital ED for the full calendar year of 2019. The primary outcomes were a revisit within 7 days and 30-day mortality. A total of 92,406 ED visits were registered. Of these patients, 7.8% (7216 visits) were diverted by triage. Among the diverted patients, the hospital revisit rate within 7 days was 10.1%, and a diagnostic or therapeutic intervention was performed on 81.4% of the readmitted patients. The all-cause 30-day mortality, hospitalisation and intensive care unit admission rates of diverted patients were 0.07%, 1.7% and 0.1%, respectively. Diverting non-urgent patients reduces ED visits. The current study showed a revisit rate of 10.1% and a 30-day mortality rate of 0.07% for diverted patients. There were more unanticipated adverse outcomes than reported previously, and the strategy may thus be suitable only for some groups of patients without increasing risks. Therefore, further investigation is needed to determine the factors associated with readmissions and adverse outcomes to enhance the performance of triage in the future.

This study aims to investigate the effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy. From January 2021 to October 2022, 90 patients treated with laparoscopic hepatectomy in Huai’an First People’s Hospital were selected as subject objects and equally divided into the study group and control group in a random method. The blood loss, surgical duration, duration of hepatic portal occlusion, serum bilirubin, creatinine, urea nitrogen, hemoglobin, plasma albumin, interleukin (IL)-6 and cognitive function in the two groups were compared. Patients in the study group receiving the combination of controlled low central venous pressure and dexmedetomidine showed less blood loss and shorter time of hepatic portal occlusion as compared to the control group. The levels of serum bilirubin, creatinine and urea nitrogen were significantly increased at postoperative 3 days compared with preoperation in the study and control groups. In particular, these factors were higher in control group than that in the control group at postoperative 3 days, indicating better liver function and renal function of patients in the study group than those in the control group. The levels of hemoglobin and plasma albumin observed in study group 3 days after surgery were higher than those in the control group. At 1 day after surgery, the level of IL-6 was significantly lower in the study group than that in the control group. Patients in the study group achieved significantly higher mini-mental state examination (MMES) scores than those in the control group at postoperative 1 day, 3 days and 7 days. The controlled low central venous pressure combined with dexmedetomidine is a promising clinical practice in decreasing blood loss, improving the liver and kidney function, and protecting the cognitive function of patients during laparoscopic hepatectomy.

Epidemics of infectious diseases, such as the coronavirus disease 2019 (COVID-19) pandemic, have various psychiatric effects. These psychiatric problems are affected not only by the fear of infectious diseases, but also by economic and social changes following the epidemic. The aim of this study was to investigate the effect of COVID-19 pandemic on their suicide attempts through face-to-face interview records of suicide attempt patients who came to the emergency department (ED). This single-center, retrospective observational study was conducted with suicide attempt patients who visited ED from February 2020 to January 2021, who underwent a face-to-face interview with a psychiatrist. The patients were classified as a COVID-19 related group if they clearly mentioned a causal relationship between the COVID-19 pandemic and suicide attempts in the interview record, and a non-related group if they did not. A total of 502 patients were included, of which 90 were classified as a COVID-19 related group. As a result of comparing the demographic characteristics between the two groups, there were more patients who were employers by occupation and patients without a psychiatric history in the COVID-19 related group compared to the non-related group. There were various differences in motives for suicide attempt between the two groups, and unemployment, financial difficulty, and loneliness were statistically significantly higher in the COVID-19 related group than in the non-related group. The number of COVID-19 related groups increased toward the late period, but there was no statistically significant difference in suicide attempt motives. In conclusion, the COVID-19 pandemic has had a variety of effects on suicide attempt patients and also affects suicide attempts in patients with no psychiatric history. As motives for suicide attempts by the COVID-19 related group, unemployment, financial difficulty, and loneliness showed statistically significant results.