Effect of Rectus Plication during Abdominoplasty on the Mechanical Power and Airway Pressures: Comparison of Two Ventilatory Strategies

Background: Abdominoplasty is a commonly requested procedure for aesthetic improvement of the affected soft tissue layers of skin, fat, and muscle through the slightest incision feasible. The degree of plicature generates an increase in intraabdominal pressure that causes an increase in intrathoracic pressure. Pressure, volume, flow, and respiratory rate are components of a unique physical variable, the mechanical power (MP), and is an integrated variable linked to most factors related to postoperative pulmonary complications. Purpose: To assess the effect of rectus plication (RP) during abdominoplasty on lung pressures and the contribution to increasing the MP. Method: A open-label study was conducted at TJ Plast Advanced Center for Plastic Surgery in Tijuana, México, from September 2021 to May 2022. The study included forty-six female patients subjected to abdominoplasty or liposuction with abdominoplasty. After the induction of general anesthesia and neuromuscular blockade, they were allocated into two groups: Group 1 pressure control ventilation-volume guaranteed (PCV-VG) and Group 2 volume control ventilation (VCV). Respiratory pressures and MP were assessed before and after RP. Results: During VCV, patients had a greater increase in peak pressure (PIP) (P 0.000). Plateau pressure (Pplat) increased 1.78 ± 0.35 cmH2O in group 2 after RP (P = 0.001). MP had a greater increase in group 2 after RP (P 0.01). Conclusion: This prospective study showed that RP is related to an increase in PIP and Pplat and an increase in the MP better controlled with PCV-VG ventilation.

Patient Frailty Can Increase the Risk of Acute Kidney Injury after Cardiac Surgery: Pilot Study

Background: Acute kidney injury (AKI) is a severe common postoperative complication of cardiac surgery (CS). It increases the risk of mortality by up to 80%. Therefore, it is essential to have preoperative risk evaluation tools. Frailty is a marker of deterioration of physiologic systems and may be associated with AKI. Purpose: The study aimed to determine the utility of frailty as a predictor of AKI after CS. Method: We enrolled 91 patients undergoing CS with cardiopulmonary bypass to determine if they had frailty before surgery and were associated with postoperative AKI. The diagnosis of postoperative AKI was based on the serum creatinine criteria of the Acute Kidney Injury Network classification up to 7 days following CS. Results: The incidence of postoperative AKI was 62% in the frail group and 21% in the non-frail group. Frailty was associated with a higher risk of AKI (relative risk [RR] = 3.00, 95% CI 1.56 - 5.77, p = 0.00). In regression models, there were associations between frailty and postoperative AKI. Conclusion: This study demonstrated that frailty could be a predictor for post-CS AKI. Therefore, frailty assessment should become an essential part of the preoperative evaluation to help the anesthesiologist to estimate the surgical risk and develop preoperative and transoperative strategies to preserve the renal function and improve the cardiac surgery outcome.